Scott Benner 8/12/19 Scott Benner 8/12/19

# 252 A Loopy Few Months

Could this be the future of type 1 diabetes management???

Scott and Jenny Smith, CDE break down Arden's experience using DIY loop for 14 weeks.

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

+ Click for EPISODE TRANSCRIPT

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
Jenny, Normally we'd be recording pro tip episode here. Yeah, but I have never gotten such incredible feedback from people wanting more information as I did. When I told people I'm gonna try looping with Arden,

Unknown Speaker 0:15
I'm sure cuz you've got such

Jennifer Smith, CDE 0:18
a following that people are like, oh, let's do it Scott's way, you know, Scott's way it really works. And then they're like, God looping.

Scott Benner 0:26
What happened? I'm not sure. But what I am sure is that I want to talk about it. But I want you here to correct me or two. Help me, because this is the first thing that I've noticed about looping, okay. And I'm probably gonna jump around a little bit. But the first thing that I noticed is that for most people, most people living with type one and using insulin. Over three months ago, Katy de Simone came on the podcast and explained to me what DIY looping was. If you haven't heard that episode, go back. Now just stop this right now go back to Episode 227. It's called diabetes concierge, you're going to want to listen to that first, if you haven't. But if you've already listened to diabetes concierge, this is what you've been waiting for. This next hour with Jenny Smith isn't just my first reactions about looping. It's my first, second, third, fourth, fifth and 30 100 and 23rd reaction, this is a summation of the last three and a half months using the DIY loop. It's gonna be the good, the bad, the ugly things, I figured out things that I don't yet understand where I think I want to go from here, for us, and what I think looping, perhaps I should say, algorithm based insulin pumping, whether you consider that to be a closed loop or a hybrid loop, whatever it is the idea of an algorithm making decisions based on your blood sugar. Anyway, whatever you want to call it. I'm also going to tell you my ideas about what this means for the future for all of us. And I received your beautiful email, and this episode is dedicated to you and your family. It has never been more important for me to say 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 health care plan. This is Episode 252 of the Juicebox Podcast. Let's call it a loopy few months. And I want to be absolutely sure that you understand that what we're about to talk about has not been approved by the Federal Drug Administration, the FDA has not approved this, this is completely do it yourself. Long, silent pause. So that can sink in. This is the first thing that I've noticed about looping, the first thing that I noticed is that most people living with type one and using insulin who aren't listening to this podcast, I think looping is going to be just an amazing thing for them. And and now looping, looping. Yeah, closed loop. I'm talking about any pump company that comes its algorithms write an algorithm that speaks to your CGM and your pump and makes bolusing and bazel decisions based on this algorithm,

Jennifer Smith, CDE 3:20
right, and makes it more intuitive. Right, right.

Scott Benner 3:23
Yeah. So what I'm saying is, it's not just the what I've tried, which was the you know, the Do It Yourself looping off of, you know, that not just that untied pool is, from what I understand taking that very algorithm through the FDA. So it's not going to be much different between what tide pool comes up with, from what I understand. Yeah, you have to assume that you have to assume that on the pod is going to come up with their own algorithm. And they're also one day going to allow the Omni pod to talk to the tide pool algorithm. So those options exist to I'm sure Medtronic will make one mess it up. And I don't know, you

Jennifer Smith, CDE 4:02
know, Medtronic does have a, they have kind of a, an agreement along with tide pool now as well, just like Omni pod does. So, I mean, we'll kind of have to see, you know, I mean, Medtronic system works for some people, not the majority, but it does work. And for those, that's awesome. I've worked with people that Medtronic current system works really nice and clean for but as far as like the targets, I think that's the other piece within like a looping type of system or this kind of algorithm. People want to be able to set their own targets. They want to be the decision maker for themselves. They don't want a system saying you have to target a blood sugar of 120 Well, I want to target a blood sugar 90 instead. Right?

Scott Benner 4:49
Right. I think rightfully I'm sorry. My camera's not I think rightfully so. I think rightfully so as well. Like, you know, you should be Yeah, you should be I didn't realize I was on you should be able to you should be able to make decision for yourself. Now, here's, here's my high level kind of look down on this from my. So I guess I have to say this first, I imagined that the podcast feels very like freewheeling and fun and like that, and that, you know, I'm just saying whatever I'm thinking, which is true to a large extent, except that when it comes to management ideas, I don't say anything on this podcast that is not battle tested, dude. Like, like, we haven't like, I don't come up with an idea on Tuesday, and then record it on Thursday, I come up with an idea on Tuesday in February, I use it for six months, make sure it works. 100%, right, that I can explain and talk about it. Yes, it only after I know what I'm seeing back over and over again. And I can explain it to you in a way that's simple to understand. But I'm not with you. And if you misunderstand it, I don't want that to happen. So having Kate, you know, having Katie Come on from and talk about looping a few months ago, and then me at the end saying, All right, we'll give it a try. That was real time. And then two weeks later, you guys all started emailing and going like, what do you think of looping and I was like, I don't know anything about it. I've never responded to so many emails with the words, I have no idea. I'm the wrong person, the wrong person to ask. I don't know anything about this. And so let me I'll explain to people,

Jennifer Smith, CDE 6:21
I feel like I've dipped my toe. But I'm not fully like immersed in the pool yet. So please don't ask me questions, right?

Scott Benner 6:28
That's even way too polite. I was confused. Right? So it turns out that

Jennifer Smith, CDE 6:34
amongst your many text messages, I wasn't doing

Scott Benner 6:38
any I don't understand what this is doing. Why is this like this? Why in God's name, would the number go down? if the power goes up? That doesn't make any sense. Anyway, we'll get to all that. But so so in the first three days, no lie. Without my ability to text Jenny, I would have stopped. Swear to God, I would have tried it and went well. I would have stopped in the second three days. Arden came to me and said these words word for word. Why are we doing this? We are so much better at this than this is? And I was like, okay, and she was and I hate carrying this thing around with me. And I was like, Yeah, and I said what thing and she goes the Reilly link, and she was and I don't even like the name of it. I was like, Okay, so now we call it the thing. And it's been renamed in the app the thing. So that's funny, all due respect to I'm assuming somebody's child named Riley that they named this after I pop. Right?

Jennifer Smith, CDE 7:30
Back me correct. Yeah, yeah. So

Scott Benner 7:32
Uh, huh. Apologies. We call it the thing. So, you know, that was the first six days Jenny kept helping me, but everything. So there are settings in this in the loop system, right. And I wanted to bring them up. And I had them in front of me. And then I I got rid of it for some reason, because I wasn't thinking so let me pull this back up. And here it is. So there are settings inside of the the algorithm app, right, the loop app correction range, suspend threshold, basal rates, delivery limits, insulin model carb ratio, insulin sensitivities. And if those aren't right, you might as well just fall on the floor and die. Like because this thing just doesn't it does nothing if these settings aren't right. So okay, so that's fair, right? The settings need to be right. And

Jennifer Smith, CDE 8:30
the reason is because of the algorithm the way that it's written, right? The algorithm is basing all those five minute loop decisions and adjustments on your settings. So if you have these way off settings that you were on your conventional pump, you are managing, but you are hyper managing, right? You are consistently adjusting and Temp Basal and negative doing something and whatever. Well, the algorithm doesn't know you are doing this.

Scott Benner 8:59
I made a note here, right. I started to say that the algorithm is smart, but dumb, and then I realized, Oh, no, it's the difference between booksmart and streetsmart. Right? The when the settings are right, the algorithm is brilliant, but and uniform, right. But anytime something changes, it's dumb, it doesn't know it changed, right? Like You don't? Do you know what I mean? Like so all of us here with the podcasts, right? If you had a stressful moment, or ank, you know, adrenaline in a sport, you'd say, Oh, I know this is about to happen and your Temp Basal up, right? The algorithm doesn't know you're about to get upset or excited or you know, whatever.

Jennifer Smith, CDE 9:38
And it doesn't adjust until it sees a change. And

Scott Benner 9:41
the problem ends up being is that by the time it sees the change it takes for what the people listening to this podcast are going to think of as forever to fix it right because we crush high blood sugars, because we're good at it and we smack them back down again without getting low. This thing takes, sometimes it could take six hours to get a 170 blood sugar back down again. And, and if you're listening to the podcast and having this success, you're thinking I'm not doing that that's not right. So I thought the same thing I thought I can't, like, I don't want to do this. How do I, you know, can I fool this thing? And then you start going down that path God that path, which will. So we'll get to Anyway, back to the beginning. You've got to get the corrections, right. The first thing that Jenny just alluded to, I had a problem with was I had Arden's bazel setting, you know, in a in a conventional pump system, set at one point for an hour during the day. And I think overnight, it was something like point nine. Well, we do Jenny's words to me, where you do a lot of Temp Basal thing. Did you ever wonder how much you do? And I thought, No, I have no idea. So it turns out my 1.4 in the conventional pump set up. That was just where I started from. And that worked fine. That number was great when there was no food present and everything. But as soon as something came in, I'd OPT down and I was being reactive to it a fluid. Well, on loop Arden's daytime basal rate is 2.35. And I just moved it up last night to like 2.4 or five an hour, overnight, it's only like 1.2. Okay, but there was a significant difference. So now I'm starting with the idea, my basal rate is 1.4. And I put it into the loop like that Arden's blood sugar goes up to 300 and sits there all day. And I'm like, this doesn't make any sense. So Jenny helped me with a simple old school diabetes math equation to help me figure out the base rate, tell us what that is, please,

Jennifer Smith, CDE 11:51
to figure out the basal rate, how did we

Scott Benner 11:53
do that that day, do you remember you were like, I'm gonna whip out like an old timey math equation and help you like, like,

Jennifer Smith, CDE 11:59
guess the basal rate. But you can essentially take your total daily dose that you're using, and multiply it by about point four.

Scott Benner 12:12
And that comes up with your hourly basal rate,

Jennifer Smith, CDE 12:14
it gives you your units per day, it gives you your bazeley units per day, essentially. So if you take, you know, four times, you know, 30, or essentially, let's see, 30.4 gives you so if you had 30 units a day times point four, it gives you that you would need about 12 units of bazel a day, and then you can kind of break that up. And as we know, physiologically, you need adjustments through the course of the day, you need two units through the course of this part of the day, or you know, you need point nine through this portion of the day. And that takes bazel testing. I mean, true, true bazel assessment is based on looking at what's happening in a bezel only time period, right. And in order to really do that, in looping, a lot of people try to bazel test in closed loop, you really can't do that, because you're getting this, you're getting an offset of what loop is doing with its algorithm to keep you stable, right. So in order to really bazel test in loop, you have to open the loop, and you have to do it well in advance of looking at a bazel segment time. Because otherwise, you may have positive temp insulin or negative temp insulin that's still impacting where you think now I'm only in bazel, because I opened the loop. That's not true. It's several hours before the impact of any temping up or down is cleared. And you're really just on your standard bazel at a circulating level.

Scott Benner 13:53
So if you use if you try this, there are documents that have been lovingly and painstakingly put together online by wonderful people. And it's going to tell you right up front that you have to start with the loop open right with it. Yeah, not doing all that it does, so that you can get this right. If you don't listen to that, you might as well again, just drop on the floor and die, because it's just not going to work. Just give up if you're not going to follow the instructions. Here's the thing that had that happened to me with the instructions. And I'm concerned that may happen to many of you listening, is that I think that one of the reasons this podcast works for people is because it's broken down distilled down into very easy concepts, right? Because some people's minds don't work the same. So I'm going to tell you, I marked myself as a fairly bright person. But there are things I can't do. I've told you guys before, I can't do simple algebra. I could you can explain to me nine different ways I don't understand it, you start putting a letter next to a number and my brain goes, I don't care. And then that's the end of it, right? So I read these loop docs, which are again, beautiful, they're brilliant. And I read through them and I get to the end and it's as if I do didn't read anything. It's like, I felt like I was in eighth grade and someone was trying to teach me pre algebra again. I was like, yeah, it all made sense. I don't know. And so I kept reading and kept reading and I thought, Okay, I'm going to have to figure this out for myself, or I'm not going to be able to explain it to everybody else. Right. So we hammered through this for you guys. Okay, like we stuck with this because we wanted to stop a number of times. But here's the thing about it. Once we got the, you know, suspend threshold, right, and then Jenny helped me get the bezels. Right. And we got the delivery limits, right. And you know, pick the right insulin model, which was very helpful through the docks. carb ratios was interesting, because I didn't know Arden's insulin to carb ratio. So we just had to keep going. No idea, right? So we just kept getting

Jennifer Smith, CDE 15:49
No, I just give her 10 units for her pancake meal with strawberries. I don't know what that ratio is. And I was like, okay, go back, count the car, divided into how much you gave, get a basic carb ratio, play with it, see if it's working and adjusted up or down.

Scott Benner 16:05
I was almost embarrassed. I was like, How can I be so good at something. And now when I'm up, I'm like, and I'm like, you know, I don't know. I was embarrassed by it. I was like, I don't know where insulin to carb ratio almost found myself apologizing at one point. The truth is, I didn't need to know it the way we were doing it. You know, the way you guys all do it listening. I needed the note for this. So Jenny's like just, you know, we kind of reverse engineer it, like she said, counted the carbs, you know, how much would we use for this? How much, you know, base would go on and I kept adjusting, I eventually found it. It was much lower than I thought it was going to be, again, to our earlier point about bazel. I think it's set at like six and a half. So you know, her ratio, yeah, one car per six, or one? Yeah, one unit for six and a half cars. I never would have guessed that. But it just goes to show how much, you know, Temp Basal when we were doing anyway. So we got that set. And then the first success came. And I'll tell you, when the first success with looping comes with any of these algorithms come, you're going to be so happy that you're not going to care about the problems, because you're going to go to sleep at 11 o'clock, and wake up at six o'clock. And to a graph that looks really nice overnight. Because once these settings are right, loop, adds and takes away bazel and just keeps you steady without variables without food variables. It's just amazing. Okay, so make sure you hear what I think.

Jennifer Smith, CDE 17:31
Did me that overnight.

I think you texted it to me and you're like,

Scott Benner 17:37
let her wake up. This is genius. I'll tell you, I'll tell you anything. It's you know, Arden's asleep right now. Amazing, right when, like, you know, obviously her settings change for when she's awake, and that we have them set as like 7am for the school year. But all I do in the morning is I get up in the morning, I walk in, I push an override button, and I set everything 30% back and I call it sleep in I've named it sleep and she sleeps in perfectly with that as soon as she wakes up, you shut the override off. But here's the thing. The override are part of a branch. Now listen, if you don't know this, forget, forget, I can't explain it to you. But forget loop if you if you can't follow this long, but there are different branches. So imagine there's a build of the of the out of the app. And then there's like additions you can make to it. One of them's called JoJo, I believe it's named after Katie's dog. Again, I don't know why you people don't just pick more simple names for things. But I understand it must be like a programming thing. I'm okay with it. Right. So this Jojo addition, or branch allows you to basically turn up or down the power of the loop settings, it is the best way I've come to understand it, right Think of it as volume,

Jennifer Smith, CDE 18:45
it's kind of sense. It's kind of volume or sensitivity, you're telling loop to be more sensitive or be or that you're less sensitive within a time period, essentially, I think of it is

Scott Benner 18:57
bolder, not as more

Unknown Speaker 18:59
or less.

Scott Benner 19:01
Boom, right? So I've set up I've set this thing up where I push it basically it takes 30% of the boldness of the of the algorithm away, and rd can sleep in in the morning. It's amazing, right? That's been incredibly helpful. If it was not for the Jojo branch, I would have quit. And I'm now going to tell you super seriously, if you don't let me make adjustments to what this algorithm thinks. I don't want it. I want to sleep. But I don't want what comes next, which is the problem around meals. So once again, for most people living with diabetes, and keep in mind what that means, right? If there's 20,000 of you listening to this podcast right now, right? There's still a million and a half more people living in the world who have type one or more at this point. All those people are going to be helped by this by this algorithm or any of the algorithms or algorithms I believe that the pump comes He's going to come up with it's going to be an amazing improvement to their life. Mm hmm. But if you're a person who sees a 140 blood sugar, and looks at it and thinks I have completely this up, I'll bleep that out later. Okay, if you're one of those people, right, you're going to hate the way this thing takes care of meals. Now you can Pre-Bolus still,

Jennifer Smith, CDE 20:18
but sometimes you can't a couple of ways. There are a couple of ways to Pre-Bolus with Lou. But yes, we sell them. Do you know what they are?

Oh, yeah, well, I mean, one way and, and again, many of these, I've not only learned, but also, you know, people have been like, Hey, I'm doing this. I'm like, Oh, that's interesting, you're kind of doing it a different way. But the two main ways. One is the premium button. That second little icon next to the Bolus icon on the bottom of your screen, looks like a little timer on a plate. Essentially, when you hit that, it allows loop to aim for a lower glucose in a timeframe prior to eating. So if you're using Pre-Bolus, thing, 30 minutes before you start to actually eat your food, the pre meal technically takes care of it in what I personally and professionally feel like is a little bit more precise manner. Because it's only look where your glucose goes. Now, where do you want me to aim for it to get to which is lower than what your overall daily correction or target ranges, right. So if your target during the day is 100, you might have your pre meal set to 75 or 80, let's say, and lupus say okay, I see now you want to get to 75, you hit the premium button, it's aiming for that it starts to give you additional insulin in the timeframe before you actually now choose to bolus and eat. So 30 minutes from now you've gotten a little bit extra insulin added in to get you moving down. Thus, almost like a Pre-Bolus. But a little bit more intuitive because it's just basing it on blood sugar. And it's getting you to a value that you want to start with by a trend down. The other nice thing about the algorithm is it takes into consideration that extra it's added when you do choose to Bolus. So you're never going to have kind of a too much there. Because it's considering now what's the trajectory of the glucose? How much has actually been added in to kind of get you here? How much are you eating? You know, all of these factors are considered in this algorithm that, thankfully, uh, well, thankfully, you're not painfully our human brain is just not meant to think like that conscious. And you

Scott Benner 22:31
are going to find that. And that's the biggest problem. Jenny's gonna fall for chair. She's laughing so hard. That's the biggest problem when you try to imagine how to outsmart the algorithm. Yeah, because it's thinking about things you're You don't even know exist, let alone can't bring yourself to think about because we're just people. And so. And that ends up being one of the issues. The pre the pre meal button works pretty well, for us. But the biggest problem is, is that we had gotten so good being bowled that Yeah, I didn't even have to Pre-Bolus sometimes, like, I just could look at a meal like we don't I've spoken about it here. But I don't talk about it too much. Because it's double extra ninja level, right. But like, I can, you know, five minutes before a meal, go this meals, eight units. But if I just use 11 and a half and double or bazel, I don't even have to Pre-Bolus like I can, I can send so many. I can send so many soldiers in that when you start fighting back. You just can't win like right. And so I know how to do that for her. So but so we're now seeing spikes at meals that we didn't see before by sure there's so much stability the rest of the time. That ardency one c didn't change. It's right. I think it was five for this time, right? So on looping new is five, four to five I think was five three not looping last time. Lows still happen with loop, I'm not going to tell you like I still see lower, not like crazy lows, but she'll go down to 50 sometimes it it'll try to stop her and it can't. So what I think is that in those moments when you need the algorithm to be aggressive, and it's set up aggressively, and then all of a sudden, there's a significant variable in your life that causes a time of day when you usually need a lot to not need a lot. It can you can start you know a quick low comes out of nowhere. I'm not blaming the algorithm, it's you know, it's just like us.

Jennifer Smith, CDE 24:24
And I kind of explained that in terms of loop can only negative temps so much to prevent, right. So if there is a load coming into a drop loop, we'll do it fast. It sees you know, okay, you've got the suspend threshold set here. You've got this much insulin on board it can negative temp and or zero temp as much as it possibly can. But it may not be able to shave off enough in a timeframe to stop a true drop. It does its best, right? I mean, I have to say that my looping almost two years now, I can say that my lows overnight are less than the five fingers on my hand.

Scott Benner 25:09
Oh, yeah, I believe that. And I

Jennifer Smith, CDE 25:10
think I mean, the lows overnight are definitely the huge fan of daytime lows, I would definitely say, are more my user fault, then loops fault. It's more my I've forgotten to set my workout target or my override, I've forgotten to do this in enough time I've forgotten to account for something, you still have to mentally think about things in order to tell loop to do the right thing. Or so that it can do the right thing. But overall, the nighttime is like,

Scott Benner 25:40
Yeah, it's great, incredible. So it's funny because I Jenny just led me to tell you, like, I wanted to let you know like that this is not a magic bullet, like, and I am so concerned that people think oh my god, one day, my Dexcom is going to talk to my pump that's going to talk to an app on my phone. And I'm never gonna think about diabetes again. Right? I am here to be the wet blanket on that party. And tell you that that is not going to be the case. It's not Yeah. But I am. Let me say this again, after being with this for months. This is the future. I'm 100%. certain of it so much. So that I'm already I'm telling you, if you want it, I believe this is

Jennifer Smith, CDE 26:21
how you buy stock in tide pool about that.

Scott Benner 26:25
I'll tell you why. I don't know I'm not about that. Exactly. But here's the problem that this is going to happen. This is where my concern comes in. And why I will keep talking about this periodically, right is that doctors already can't help you very frequently with your settings, right. And the settings they're trying to help you with now with your pump are childish compared to the settings in the loop. And so if doctors can't do what they can do, now, I can't see how in the hell they're going to do it with loop, right? And then my fear is, is that someone's going to put this thing in your hand that if it's set up correctly, and you give it enough time is going to end up being a major addition to your life and your health. And you're going to have the thought I had in the first three, six and 10 days, which is this is impossible. And it doesn't work. Because if the if the settings are wrong, it will appear not to work because it isn't it isn't working.

Jennifer Smith, CDE 27:22
And unfortunately, taking that then to your doctor and saying I I can see the benefit to this, but it's not working what is wrong. And because most clinicians, it's unfortunate the system that we have in our health care, right? And what's driven by insurance and coverage and what they can, what they can, you know, tell you yes, do this, I support you in doing this. And I know all about it, and I can help you learn how to use it, unfortunately, because it is as of yet FDA approved. Unfortunately, many doctors are like, I'll support you in your decision to use it. But I can't teach you anything about it. I don't understand it myself. And I think well as a physician, then if you're willing to say, Okay, I'll continue to write your scripts for you. And we'll continue to look at the data together. I think it's honestly in their best judgment to learn about it. Even if they can't outright say, Hey, here's the pump for you. You need to be looping even if they can't legally tell you to do it. If you've chosen to do it. I think that educators and NGOs really need to get on board with learning. What are these systems doing? Why are people choosing to use them outside of the current FDA conventional pumps? And who could it be beneficial for I can definitely say I mean, there are there are some people that probably don't have enough kind of together to understand and use lube. In fact, there are some people that I think pumping is also in general too much. And it gets a good clinician to be able to help talk that out with a person. But I also think that our clinicians need to learn more about it. In fact, that's my presentation with Gary in Houston to add, this weekend is about loop and how clinicians can learn and be comfortable and where the resources are and how to talk to patients about it. And be informed.

Scott Benner 29:30
So you guys listen to this on Tuesday. And just last weekend, Jenny gave this talk that she just spoke of to the American Association of diabetes educator she's telling them that I made a panic phone call to somebody I know at tide pool and I was like, if your documents aren't right, this thing is going to crash and burn you got to make sure you're explaining it to people correctly. I gave them and it's so much so and I hope this Gosh, I hope this doesn't sound egotistical. Like I there are enough people listening to this podcast now that I feel a responsibility to understand it too. Because I'm telling you, it's the way it's the future. I'm like, imagine yourself before you found the podcast before you sent me your email. It's like, Oh my God, my eight, one C is six, it used to be eight and a half before that, if I could have given you something that would have not let your blood sugar go much over about 170, most of the time would have brought it back down without getting low. And you could have slept through the night, I you would have said to me, please give me that. And so, you know, you have that perspective, when you're thinking about loop loop is astonishing. It's amazing. It's fantastic. My concern is that if you are have been listening to those podcasts for too long, your expectations are going to be higher than what it can do at the moment. And and that's because and here's why you say, Well, that doesn't make sense, Scott, I'll just tell it to turn up the volume. You can. So it's like, it's like it? I don't know how to put it exactly. It's there to stop you from hurting yourself kind of a situation, right? So if so, here's what happens. I give Arden or insulin. And you know, we miss on the carb count or something and I start seeing her blood sugar go up and I tell our Oh God, we're gonna have to add more insulin. You put in, you think yourself I know, right? Oh, I know, for certain three more units is going to stop this and bring us back level. You put those three units in through loop and loop takes away your bazel. Right, and you're like, you, I'm gonna do a lot of bleeping this thing, because here's me in the kitchen. I'm like you. I need the bazel and I need the bowls. What are you doing? Then you start thinking maybe I can make enough of a bolus that it couldn't possibly take it all away. And I've been trying that lately to like her basals, you know, 2.5, you know, around two and a half, right? Three more units. What if I put in five and a half units is a bolus and even if it took the bazel away, the bullets would still overwhelm it, that still doesn't work. So every time you try to like outsmart it, because of what the settings are telling the algorithm it outsmarts you,

Jennifer Smith, CDE 32:01
outsmart you? That's right.

Scott Benner 32:03
A little over a year ago, so many people approached me about bolt with insulin t shirts that I made them, but I found a local printer made them and let you guys ordered them through the website. And I mailed them out myself, which took up a lot more time than you might expect. So I stopped doing it. But then the emails came again, I want to share it Where are the shirts and it's like, oh, okay, so I researched for a very long time. Found a company that has quality materials with great printing, that also does printing and shipping so that I'm not the middleman. Anyway, shirts are back. And now you have more options for what you want the shirt to say. Go to Juicebox podcast.com. Scroll down a little bit, click on March. Check it out. You're gonna find Be bold, bold with insulin, stop the arrows, new bump and nudge shirts are coming. There's t shirts in different sizes, colors, men, women, children, stickers for your laptops, coffee mugs, these really cool drawstring bags, and even flip flops. And if you're looking for something that's not there, send me an email. I mean, if you want a T shirt that says trust that what you know is going to happen is going to happen or one of the other, you know, Wavy Gravy kind of things that we talked about here on the podcast, let me know, these items only exist because you asked for them. So I want to make sure that I'm giving you what you want. Just send an email if you have an idea. Last thing, Jenny Smith is here again helping out if you want to learn more about Jenny, go to integrated diabetes comm if you want to hire Jenny, that's the same place to do it. Integrated diabetes.com there's also a link in your show notes.

Jennifer Smith, CDE 33:51
The way that the algorithm route algorithm is set up and it knows what your settings are, right. So if in the setting of the rise that you're seeing happen, you're like I need more insulin at that point is the right thing to really do would be to hit the Bolus button. You know that middle I call it the carrot. That's like a Double Down Arrow orange. When you hit that, if loop is seeing, hey, yeah, there's more insulin needed here. It will suggest a bolus. If the Bolus suggestion is still zero based on the active insulin. In parentheses above, you'll see pending insulin. And you can always also take the pending insulin because that is a calculation that loop has already figured in to need. So if it's pending insulin is 1.2. But it's recommending nothing as a bolus right now you can input the 1.2 and take that as a bolus. Because at least you're working within loops, algorithmic fingerings you're working within it looked and saw that you're going to need this much more. It's going to dose it out over a time period. It's not recommending it as a bullet point. You could take it. And if you haven't screwed loops back.

Scott Benner 35:04
And I'm glad to know that because I didn't know that. And I'll definitely try that. Because otherwise you can't. It's like playing chess against a computer. You're like, Ooh, this will work and the things like, Oh my god, I'm so much smarter than you. No, it won't. And like, so you can't, you can't fool it. Now I have found ways you can use the Jojo brands and jack up the intensity override, right? And then what other people will tell you is you can lie about carbs. So yeah, right. So you can pretend you can say to yourself, I think I need three units. Here. I'm six and a half, I am a unit for six and a half carbs. So if I tell this thing, I need 20 more carbs, it'll give me about three more units. That does work sometimes. But the problem

Jennifer Smith, CDE 35:46
and another like aside to that just for evaluation, let's say you didn't give the three extra units. Let's say you watched to see what loop is doing. And at the end of the day, when you click the lock the bottom graph the active carbs, when you tap on that, you'll see all the carbs that you've entered for the day, you'll see what you entered as an absorption time. And down below each you'll see what did loop see as carbs that were absorbed? And how long did it take loop to see the absorption over? Right? So when you look at that, let's say you put in 60 grams of carb and loop actually saw 80 grams of carb. But you know, it was 60. You know, it was definitely 60. Well, in that setting, then Lupe was seeing the need for more insulin. So it offset it with a lot more insulin, just in a slower manner. As you said before, the manner is going to be slower than you think. No, I want that three units right now because I know that I need it, right?

Scott Benner 36:46
That really is the sticking point around food is that if you're being bold, it stops you from being bold in any moment, like but to Jenny's point. If your settings are right, and you kind of the contract, it will bring your blood sugar back down at some point. And so it's just not as quickly as I want it to be. And now what will happen is, is you might go out into the world and you'll talk to people who are looping and they're like, Hey, what's the big deal? Like it comes back down? Well, those are people who didn't find the podcast who were just like, this is amazing. My blood sugar wasn't 400. So I get their excitement. And I stand by it. But I also stand by everybody else who's listening who's like look, I am not okay with that. And I can tell you this. I am slowly understanding that it might be okay if Arden's blood sugar goes to 140 for a little while and comes back. I don't want it to happen. But I'm, I'm not having a panic attack about it. Right. I'll give

Jennifer Smith, CDE 37:38
you all I'll give you a little okay with that is even in pregnancy, which is the tightest like blood sugar control that we aim to manage in, even in pregnancy, going up to 141 our post meal is okay. So, now we want to be at two hours post meal 120 or less, but even going up to 140 in pregnancy in that sticky like control it like a crazy person. That's okay. So just to let you know, that's okay. Don't worry, I'm okay.

Scott Benner 38:10
I'm feeling okay. I'm not. And I'm not giving up on the idea that I don't want those spikes. But I also saw those spikes with what we were doing before like I was never perfect with it like there are people. Listen, you can go online and find parents who are managing I think pre pubescent kids with flat lines that are amazing. I've never like shot for that to be perfectly honest, like but I'm not okay with an elevated blood sugar lasting for multiple hours. Right, Jenny brought up absorption time. That's still one of the things I'm trying to understand better because we started shortening our absorption time to two hours, which made it more aggressive up front. Yeah, but then sometimes what will happen is that then, you know, outside of two hours, when the food still exists, it thinks it's gone. And it doesn't. So something I've been doing a lot of different things trying to break up absorption times, like put in a bolus for two hours and then put in one for three or four hours. Like just trying to make that work that way, I will figure this out. At one point, I swear to you, there'll be a moment where I will talk about this algorithm with the ease that I talked about everything. But for you people who are so impatient, it's not going to happen this quickly. Like I'm going to need a year, you know what I mean? Like, really being immersed in it. I understand it much better now than I did a couple of months ago. But you know, when I say something to you, like, I don't know, like what are the things we say on the foot, like if when I say stop the arrows and then explain it in a sentence and a half in a way that paints a picture in your head so that you know how to do it. I don't have those ideas yet around loop. So I'm sorry, but apologies but it's gonna take more time. Here's what I can tell you. If you can get the settings right. It's worthwhile. If you can handle a couple of meal spikes while you're figuring out to sleep overnight. It's pretty great to sleep. I'd forgotten how great it was to sleep. It's pretty great when I was young I used to work in a pet shop and the man who owned it would eat pizza once in a while. And I'd look over at him he was incredibly happy and he would say, better than sex. And sleep is better than sex.

Jennifer Smith, CDE 40:15
The only thing that I that I would compare to that, or have you ever had the dark chocolate, Justin's brand Peanut Butter Cup, I haven't. Oh my god. They're wonderful.

Scott Benner 40:24
Jenny's husband just realized how easily he could be replaced. So it's after not sleep. Like I always say this about sleep. less sleep is better than broken. Sleep. Broken, sleep is terrible. Go to sleep, wake up two hours later, stay awake for 15 minutes, go back to sleep wake up in an hour. And my life wasn't even like that. At this point. Like I there were nights I slept to the no problem. But I'm talking about sleeping through the night, every night for a week, then two weeks than three, then a month. It's magical. Right? Right. Yeah. So I'm not taller from it, but I do feel a lot better. So it's great. And not only that, but it gives me the confidence to know that Arden is gonna go away to college, like I expected on you know, I'm assuming I'm gonna send her on her the horizon system from on the pod. I'm hoping to love that when it comes out. And and that she's going to forget being able to sleep but not be in danger overnight. Right, right. And so this is worth me understanding, I am going to keep doing this. It doesn't stop me from being able to talk about the other stuff. So all of you who I've been speaking to you privately or all the episodes you've heard before, I have not forgotten how to be bold with insulin. I know all the steps I could, I could tell them to you in my sleep. Okay, so that's no problem. Right before Jenny and I started recording.

Jennifer Smith, CDE 41:44
I think actually, Scott, that's a really good point to bring up is not forgetting how to pump conventionally, right? Because you will, at some point perhaps loop might fail, you might have to rebuild it, it might for something your computer might crash and you can't rebuild it for a week, you're going to have to go back to conventional pumping, pumping, you're going to have to remember how to pump using your brain using the algorithm that is in your brain, right. And so not forgetting those steps is really, really important. And I think that's a piece that and I hesitate saying this, but I bring it up as just a point to consider for people who are new to pumping. To begin with. I think New pumpers should try to consider some time of learning how to pump with their normal pump, they should learn those factors, they should learn what attempt B is a look like why to use it, how to use an extended bolus, what their typical food does their exercise, how to conventionally pump and use their brain to pump before they switch on to loop pumping. Because there's a lot that comes with using pump be using loop intuitively and understanding it that comes from having used a pump previously, the way that you do you know, like you being bold with insulin, learning all of those factors, learning how to adjust while it changes with loop. Conventional pumping teaches you a lot to be able to loop better.

Scott Benner 43:22
If you were diagnosed today, someone slapped a loop on you put the made the corrections perfectly say there's a way to know them perfectly. And then the zombies come six months from now you're gonna be dead Three days later. You're not gonna know what the hell to do with your insulin. And so it's it's, it sounds like an old timey idea, because I've had that thought before. People say you have to use needles before you can pump that I don't believe I think you can start with pumping. Right? But but I get the idea behind it, where it came from. And I don't think it's an old timey thought to say right now you need to understand how insulin works before you just try to jump right looping system like that's 100% I agree with that. Because there there are settings here that you can't imagine what they do. I'll tell you right now, I understand the mathematical part of it. I understand the bright people who are better at math than me but ISF right instance x insulin sensitivity setting in the in the loop, right, the lower you make the number the stronger it is. And I get that negative. I understand math and everything but who sets something up for a layman and doesn't think more is more, I'll make less more I'll make a lower number greater power I get again, if you're a math person, don't come at me I understand. But for most people, they see 70 as stronger than 60. Not 50 is stronger than 60. So wherever did that because it not because you can't figure it out when someone explains it to you like I understood it when it was explained to me. But when you're intuitively trying to run through everything that's happening in your brain, you're like make that higher. That's brain says it to you right it doesn't say turn it to 50 or something 60 instead of setting? I know,

Jennifer Smith, CDE 45:04
I know, it's a hard it's a hard point, I would say you're not alone, whether you're a math person or not, I think the figuring of what that means for insulin effect is it's counterintuitive in the human brain. It just is.

Scott Benner 45:21
Yeah. So So however the algorithm thinks about it, I don't care. But they should put a goof like me in charge of making the upfront thing that you look at like, right? Like where I would just be like, turn it towards boulder? Not not know. So I think that it's, I want to say this at some point in this episode. And here's the part. The people who did this, I'm sure are too many to count at this point. And I'm sure someone knows everybody who's had a hand in this. I don't know any of them. But I think they're all just saints.

Jennifer Smith, CDE 45:53
Like, it's phenomenal. Yeah,

Scott Benner 45:55
right. It's awesome. This is astounding. This was put together by people in the world living with diabetes, right? And amazing. And then made available to other people, which, again, amazing and then supported by other people. And I've seen them on Facebook supporting other people. And I know how tiring it can be to have somebody come to you at eight o'clock in the morning. And they're like, I don't understand any of this. And you and they want you to talk them through it. And then by the time you get them to talk through it for other people ask you, because that happens to me. Except I don't have to do it in like this very incredibly, like, technical way. I'm just like, Hey, you know, all carbs aren't created equal? Stop the address, you know, right. And here's what that means. I can literally teach you how to do what we do in like, an hour over the phone. And so, but you can't learn loop in an hour over the phone, like, yeah, isn't gonna work that way.

Jennifer Smith, CDE 46:47
Now, I will reiterate what Katie and Kate and everybody else who's you know, helped build it. Read the loop docs. And like you said, you have to read them and digest them. If you're somebody who grabs it by reading it, and you're like, get it. Totally, that's awesome for you. I have had to read and read and go back and reread and make sure that I've got it because you know, in what I do, there are a lot of people that come to us who want help understanding. So I have to be able to spit it back out in like we talk about, you know, on the podcast, in layman's terms in an understandable one or two sentences. This is what this means. This is how to make it work for you

Scott Benner 47:27
an incredible skill to do like I at some point realized I was not giving myself enough credit for how I can talk about diabetes, it is hard to take something so complicated and make it simple. And I'm not Yeah, I'm not at that place yet with loop. Katie said to me, she's like, read the documents. How's it Katie? I did check. Read him again. I'm like, I only read them once. I was like I said, they're making me feel stupid. You know, like, and, and I was and he said to me, that's when I said, I'm like, that's why the podcast is so popular. Because it takes these complicated things and makes them easily digestible. I mean, I knew that, but I don't think I appreciated that completely until I tried to read those loop docs, like seriously. Yeah, I relate it very much to my son who's astonishingly good at math. And if he explained something to you, really difficult to understand the math and you don't grasp it immediately, he looks at you like you're an idiot.

Jennifer Smith, CDE 48:17
Like you don't like what I just told you. His

Scott Benner 48:19
brain understands it right away. And so there are times I think that some of the people who understand the loop dogs really well are like, No, no, it says it right there. And I'm like, Yeah, I see that, like, I understand all the words. You know, I just don't, I don't understand what it means. Okay, let me make sure I have everything here for my stuff.

Jennifer Smith, CDE 48:38
I'm kind of like that I'm more of a shomi person. I'm I mean, I can read it and learn. I mean, obviously, I made it through college and, you know, internship and did all of the stuff that you have to do by just reading and learning. But if somebody like sits down, and shows me how to change the tire on the car, I've got it, I got it, you showed me where to put this, whatever, it would probably take me an hour worth of reading, like where to put the jack how to put the how to get the lug nuts off, it would take me an hour to read through it and then be like, what did that say to do again, and I'd have to go back to the pictures and relook, but if you show me 1015 minutes, I've got it.

Scott Benner 49:15
There's nothing more valuable than a good teacher. But seriously, you know, like, it's just, it's 100%. So here's something interesting. I was interviewing somebody, I forget her name, and I apologize a couple of weeks ago, and I was at the point again, where I was like, I am gonna quit this loop thing. Like I got to that spot again. And she said something to me. That made instant sense. So there's correction ranges, right, like so. So when my brain with that, I thought, Oh, I want my daughter's blood sugar to stay between 70 and 100. I'll set the production range between 70 and 100. And it never worked. Like it was never she was never in that spot. There came a time when I thought maybe I'll just lie and say I like it's keeping her at 120 What if I just told her I wanted it to keep it Add with that keep it at 100. Like I started thinking about how to trick it. And she said to me, don't think of it as the target range. Think of it as when the bazel turns off and turns on. And I don't know why. But I was like, Oh, that's brilliant. And I made slight adjustments to it, and adjustments to how I thought about things based on that one sentence. And I thought that is, and it made a difference for me. And I don't know why it was just, I thought about it differently. I used to think I used to think, okay, I'll set it from 70 to 100. And that's where the loop will keep things, but it never really did that. And then when I started thinking of it, as this is the Basal shuts off at 72, Basal turns on 100. It's like, Oh, so if I drop the high number down more than when I get to 90 diagonal up, it'll come on and bring me back, but I'm waiting till 100 or 120. And that's how I'm getting to 160. Right, because Basal doesn't work that quickly. Now, the one thing we have not spoken about yet. That I want to tell you is amazing. So I'm using the night scout out night scout app. Now, to watch Arden's loop. I want to I want to say, visually, I hate it. I just I like it. Okay, but I'm getting used to it. And it's not just a new thing. I don't know what it is. There's a lot going on, but part of it I love is this, it shows you your basal insulin, visually. So you can see on on this app, as it gets stronger. It's basically, you know, like a stalagmite like it's, you know, pushing Is that the one that goes down, whichever one goes down from the root,

Jennifer Smith, CDE 51:32
slide type, I think, yeah, I think like type comes up. I don't know. I'm not a rock person. But

Scott Benner 51:38
yeah, one or the other. I swear to you, I'd call this episode. I'm not a rock person. It's like an icicle, right. So coming down. So when the thing that's not his, you set these Max bazel rates, right. So I think we have Arden's set at like seven an hour. And there are times that when her blood sugar tries to jump up, this thing's like boom, no way, seven units an hour, it might only stay on for 10 minutes like that, right? Right. And then then maybe it comes back to five, and then it goes to three, and then maybe her blood sugar keeps rising and it pushes it back again. And then all of a sudden it thinks No, I have it, it reads the data from the Dexcom and says, Oh, no, I've got it. Boom, right back to normal. And the same thing with like, you start getting low and it starts taking it away a little bit at a time, then all of a sudden it might take it all away. Yep. fascinating to watch. You will learn more about manipulating insulin watching the that bazel on nightscout, then Yep, I don't it's it's it's a learning tool in and of itself. It's really spectacular.

Jennifer Smith, CDE 52:39
And if you wanted a little bit more I know, Nathan is wonderful. Report wise, I think there are good reports in two places. nightscout is one of them. But tide pool also from my, from my learning perspective, as well as from teaching people, you know, a clinical perspective, I like tide pools Daily Report For for loop, because on the daily report on the bottom, you can still see the bazel right, you can see that what I call it looks like a cityscape, you know, the UP DOWN nature of what loop has been doing. But because tide pool online is interactive, you can hover your mouse over the actual bazel rate. And you can see what the temping was that happened. You can also see what pro What was your program bazel you know, if it was program 4.9, but it was temping you at 3.3 for how long was attempting you add that anything from a learning perspective? If you're looking for a trend that might be happening, you know, overnight, or during the daytime, always after breakfast, it seems like you're getting these tremendous High temps to get things contained in kind of learn from that and say, Do I need to setting adjustment loop looks like it's working really, really, really hard for me consistently at this time of day. Maybe something's off my bazel might be off, my ratios might be off something might need evaluations. But I think only from actually visually being able to hover over and see what was the bazel. That loop was kind of instituting nightscout isn't as interactive like that you can't once a report is generated. It's sort of like a flat report. You can't hover over anything and see extra data.

Scott Benner 54:23
Yeah, so if that's an amazing point, and I want to add to it that if so if you're a person who's Temp Basal, like we talked about on the podcast, and the first way you got to do it was I said, Dude, don't worry, Temp Basal is a great idea here because you can always bail on it, you can always shut it off. Like I always say, like, you know, if you think this is gonna be a carb heavy meal, and it's six units, but you think it might be eight, then double the bazel you know, or something like that for an hour because you can always shut it off. Having a gremlin inside of a phone every five minutes, turning it up, turning it down, shutting just like exactly what she could see right now. It's my God, I'm never gonna forget it had that. It is. It's undescribable. Like, it's just it's everything, this thing's ability to Basal up Basal down double bazel, triple bazel, zero bazel. It's

Jennifer Smith, CDE 55:20
I've never really considered it a gremlin. That's kind of a, that's a really humorous way to think about it. I've actually thought of loop as more of like, a broom. I feel like it's sweep, I feel like it sweeps up the things in the background that I can't consciously pay attention to all day long. I mean, if I was going to loop as a conscious human human brain all day, which is what I thought I was doing conventional pumping, I was doing a lot of micromanagement all day long. And I just I got used to it. It was my day to day, right, as you did with artists find it easy.

Scott Benner 55:53
But

Jennifer Smith, CDE 55:54
yeah, but with loop, it's kind of like there's this little like cleanup crew in the background being like sweep, sweep, sweep, sweep, sweep. Oh, we got to sweep up a whole load more here. You know, whatever. It's, I feel like it's like the cleanup crew.

Scott Benner 56:07
Okay, listen, we'll have a vote later of cleanup crew. But, but no, seriously, it's just changed. You have to go? No, I'm good right now. Okay, because we're just a couple more minutes. And I'll let you go. So it, it's, I want to kind of go over everything again, just wrap up. The part we haven't talked about is that you if you want to do this DIY, you have to download their stuff to do you have to have a Mac computer, you have to understand a little bit of how to use Xcode. You know, you have to get this code offline, you're taking full responsibility for this, right? Like you're This is not FDA approved, no one's going to help you with it, you're on your own. But if that scares you, I think you should realize that whenever tide pool gets this thing through the FDA, when on the pod gets horizon on the market, when you know t slim when all these companies do this. This is in my opinion. Amazing. It's absolutely, and I don't think everyone's going to do it, I would understand why you wouldn't. But it's it's it is the future like is what you could still do what you do fine with needles, you can still do but pump I'm not telling you to change. I'm telling you, this is a leap. And that's what you're looking for in technology, you're looking for a real substantial leap forward. So correct, even if you don't want to do it now. Take a look at it again, when it gets to the FDA.

Jennifer Smith, CDE 57:33
Well, and I think that's where these companies are going, right? I mean, even with horizon with the control IQ with tandem with Medtronic 670 current, you know, 670 G and whatever they come out with going forward. Being FDA approved, they're essentially they're seeing the light, they're seeing that people need more help, because it takes up a lot of our life. It does it mean diabetes is no turn off, there is no unplugged from it, go lie on the beach and drink a Mai Tai, that doesn't happen. And so we need a system that is going to be the cleanup crew, we need a system that's looking at things is consistently adjusting and correcting based on all those variables from that podcast that we did. I don't know two months ago now right on variable.

Scott Benner 58:25
Love that episode, by the way. That was Jenny's idea. Thank you, Jen.

Jennifer Smith, CDE 58:29
Awesome. Yay, yeah, it's it's like that we need the we need to clean up or the Gremlin or whatever in the background being like, I gotta fix this. This is happening. Take care of this, you know, um, so yeah,

Scott Benner 58:41
and I would I would guard against like, you know, getting out a crystal ball and trying to see the future a little bit, which is a little bit of what I think my job is with this podcast is that you also have to think you can't just slap a coupon and then never think about it ever again. Because Because you'll because the same things we talked about at the beginning of this podcast all those years ago will happen to you again, all of a sudden 150 will be okay, then when 80 will be okay, then 200 you'll think it's not that bad. And then eventually, you'll be automating your death instead of manually, like, like, you know, managing it. So you just have to, you're always going to need unless something happens that stunning in our lifetime, technologically. You're always going to need to be involved to some degree but lupa is like Jenny saying going to give you long gaps of not having to be that concerned. And if those gaps start at night, that's a pretty great place to start.

Jennifer Smith, CDE 59:34
So because as we said before, that's a third of your management. Yes,

overnight is a third of your a one fee. Wait, right? Yeah,

Scott Benner 59:42
yeah, it's just it's it's there. I mean, if you're looking for the, you know, I can't recommend or not recommend anything. I'm certainly not going to recommend you use something that's not you know, FDA approved. But and nothing you hear on this podcast is certainly advice but I can tell you, for I'm going to keep doing it. So, I, I can't, I'm going to keep doing it for Arden and I'm going to keep doing it for for you guys so I can try to figure it out because I want to be able when this thing comes through the FBI, I want to be able to, I want Jenny and I to be able next year to sit down and do a pro tip series on looping. And that will make looping as easy for you as we've made being bolt. So that's my goal. I'll be awesome. Thank you, right? It's almost Jenny doesn't get sick of me. Okay, so did we miss anything that you can think of? I

Jennifer Smith, CDE 1:00:34
don't want any that's the beat. Those are the good.

Right? Like I just want an overview.

Yeah, follow up

Scott Benner 1:00:40
to what it's like to start loop. I didn't miss it. Correct?

Jennifer Smith, CDE 1:00:42
Yeah, I don't think so.

Scott Benner 1:00:44
All right, you guys have a great week. I'm gonna say bye to Jenny privately. I'm gonna shut this recording off. Now.

Don't forget, if you're looking for Juicebox Podcast merchandise, go to Juicebox Podcast comm scroll down to the merge button, banner, whatever it is, you'll see the big word merchant click on it. Thanks so much, Jenny for coming on and helping me begin to sort through my thoughts about looping. I expect this episode to be the first of many as I tried to kind of make my way through this new management idea. As 2019 progresses and even into 2020. I'm going to have on some other people who've been looping longer than I have, maybe to help me answer questions or clarify things. The podcast is not going to change, don't worry about that. It hasn't had a big, you know, tectonic shift. All you guys who are bold, are still going to be talking about that stuff all of the time. doesn't go away, please don't panic. This is just me trying to understand what I do believe might be the next step. In Type One Diabetes Care, to be perfectly honest, when on the pod releases horizon, I have every intention of having art and try it. I want to end with sincerely thanking and making sure that everyone who's listening understands the incredible undertaking that is this, do it yourself loop system. There are countless people out in the world, putting countless hours of effort into this, not just the design of the algorithm. But you know how you are able to download it implemented to help you understand the more, you know, complex parts of just getting the algorithm onto your phone. It's not intuitive for most of us, and there are amazing people out in the world helping others. Their efforts are a shining example of what the diabetes community can be at its best. So I don't love loop. I don't think looping is perfect. There are things about it that I downright despise. And there are things about it. They're absolutely amazing. But I don't want anyone who's been involved in this to take any of my opinions good or bad as either a slight or critique. It's certainly not this thing is spectacular. The people who worked on it are angels. And it's just not 100% for me, but I absolutely do find it valuable and worth pursuing farther. So for the time being, I am going to try to continue to figure this thing out. And I will report back to you as my thoughts become clear. For those of you who I think may have been hoping for me to say yes, definitely do this or No, don't do it. That's not up to me. I tried really hard here to give you this information in this hour that I think is enough for you to make a clear decision for yourself, which as we always say on the podcast you should be doing anyway right you should be making these decisions on your own. All I've done here is report my experience and the rest is up to you.

Support the podcast, buy some swag!

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

Scott Benner 8/9/19 Scott Benner 8/9/19

# 251 Defining Diabetes: Algorithm

Defining Diabetes: Algorithm

Scott and Jenny Smith, CDE define the terms at the center of your type 1 diabetes care

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
No Jenny in this episode of defining diabetes, but that's okay, I can handle it. In today's episode, I'll define the algorithm. Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, the Always consult a physician before becoming bold with insulin, or making any changes to your medical plan. The word algorithm isn't really thought of as diabetes specific, but in the coming months and years, it's going to be the general definition for algorithm is a process are set of rules to be followed in calculations or other problem solving operations, especially by a computer. In Webster's definition, it expands this a little bit, a procedure for solving a mathematical problem in a finite number of steps that frequently involves repetition of an operation, more broadly, a step by step procedure for solving a problem or accomplishing some end. Now, why am I choosing in the middle of all these diabetes definitions to tell you about algorithm? Well, that's simple. In closed loop systems, algorithms are the brain, for example, on the pod is working on their horizon system that they expect to have out in the year 2020. It's a hybrid closed loop system that uses an omni pod, a Dexcom, G six, and an algorithm. This algorithm is designed specifically to take the information from your Dexcom G six be information about your blood sugar, what it is how fast it's moving, what direction it's going, this algorithm takes that information, goes through a bunch of settings, and decides this is how much more or less insulin you need to maintain a steady, stable time and range to avoid a low blood sugar to stop a pending Hi, this algorithm is going to make all of those decisions. So I think it's incredibly important that you know what an algorithm is, because you're gonna be hearing the word a lot. Now be clear about what an algorithm isn't. It's not a fortune teller, it can't see the future. It doesn't know something's going to happen before it does. It can only make decisions based on the settings that you tell it. What do I mean by that, if you're setting say that your insulin to carb ratio is, you know, one unit covers six carbs. And your Basal rate is definitely two and a half an hour. And you count your carbs up and you say, Okay, this is 50 carbs, algorithm. Here it comes but your way wrong, it's 100 carbs. But the algorithm believes you that it's 50 carbs, and it believes that it knows what your insulin to carb ratio is what your Basal rates supposed to be. And so it is possible that it won't be able to stop that high blood sugar, not right away, but eventually it will see that it's happening. And we'll get on it. But it's not a mind reader. It's not a catch all. It's not going to fix everything. These algorithms, however, are in their infancy right now within the diabetes community. And from what I've seen already from a number of them, they're spectacular. So I think it's worth you understanding what an algorithm is, as I believe they're going to have a large part in the way you live your life with type one diabetes in the future, the not so distant future

the T shirts that you've all been asking for and the other swag is now available at juicebox podcast.com. Scroll down, click on merch there you will find T shirts, flip flops, Kid shirts, coffee mugs, stickers. Really nice quality tote bags are always going to be adding more. Right now you can get a shirt that says bold with insulin, stop the arrows be bold, and the brand new Juicebox Podcast logo designed by one of you. Coming soon bumping nudge more insulin and the other phrases from the podcast that you use in your everyday life. So support the podcast. Remind yourself to be bold, grab a t shirt, all you have to do is go to juicebox podcast.com. As always a sincere thank you for listening for supporting the show for telling others about it. And I'll tell you what, I'm not even going to ask you to leave a beautiful review on Apple podcasts or wherever you listen because I've already asked you to buy a t shirt and it would be too much to ask these two things of you. That's what a good person I am. Hey, last thing, this algorithm episode of the finding diabetes it's not you know timing by mistake or anything like that sort of on purpose because going to be talking about something you guys have all been bugging me about for months. Next Tuesday So enjoy your weekend and get ready. The podcast episode you asked for is on its way

Defining Diabetes Series

#964 Defining Diabetes: Carb Ratio

#830 Defining Diabetes: MDI

#826 Defining Diabetes: Meet the Need

#818 Defining Diabetes: DKA

#814 Defining Diabetes: CDE and CDCES

#810 Defining Diabetes: Untethered

#795 Defining Diabetes: Kussmaul Respirations

#681 Defining Diabetes: Types of Diabetes

#677 Defining Diabetes: Hypo and Hyper

#672 Defining Diabetes: Antibody

#668 Defining Diabetes: Carb Absorption and Digestion

#664 Defining Diabetes: Dictate the Pace

#660 Defining Diabetes: Black Holes

#656 Defining Diabetes: Barriers

#652 Defining Diabetes: Pump Break

#648 Defining Diabetes: Insulin On Board

#466 Defining Diabetes: C-Peptide and Beta Cell

#463 Defining Diabetes: Crush It and Catch It

#460 Defining Diabetes: MODY Diabetes

#455 Defining Diabetes: LADA Diabetes

Please support the sponsors

Donate

Scott Benner 8/6/19 Scott Benner 8/6/19

#250 Everything Doesn't Have To Be Perfect

1 + 1 = Turtle…

Karly has type 1 diabetes and she is on the show to hare her perspective on parenting a child with type 1, eating disorders and hypoglycemia.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello everyone and welcome to Episode 250 of the Juicebox Podcast. Today's episode is sponsored by Omni pod dancing for diabetes and Dexcom. 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.

Welcome back everyone today on the program, Carly, Carly has had Type One Diabetes since she was a child. She's on the program today to talk about a number of different things an eating disorder, how it develops, and how she got past it. The role her parents played in her diabetes care. Some of the organizations that she reached out to as an adult hypoglycemia study she's involved in, I came super close to calling this episode one plus one equals turtle. But instead, I present to you everything doesn't have to be perfect. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before becoming bold with insulin or making any changes to your health care plan. One last thing, I listened to the emails and the messages and there are t shirts available again, just go to Juicebox podcast.com. scroll down, you'll see a big image that says merge on the front. When you get to that link. You'll see the new podcast logo with Be bold on the back. A t shirt that says stop the arrows, one that says bold with insulin. mugs, flip flops, bags, stickers, there's so much to choose from.

Carly 1:47
Hi, my name is Carly. And I'm from Minnesota and I'm a 23 year old guy but it goes 15 years.

Scott Benner 1:56
Okay, so 23 you're still in college?

Carly 1:59
Um, no, I actually graduated in May just got done.

Scott Benner 2:03
Okay. And for 15 years, so since you were How old?

Unknown Speaker 2:07
Um, the math on that seven? Seven, I think

Scott Benner 2:12
I was trying to get out of doing the math, I thought you would just know. So you're diagnosed at seven years old? And is this something that your parents were involved in most of the time?

Carly 2:23
Um, initially, yes. When I was seven, they did most of the taking care. And then I would say probably once I started giving myself my own shots when I was like 12, it kind of just got handed mostly off to me.

Scott Benner 2:40
So from seven to 12 and beyond, tell me a little bit about what the idea of managing a day looked like to you. Like, were you trying to keep your blood sugar at 85? Were you trying to keep it anywhere? Was it all over the place? Did you not track it that tightly? What kind of technology were using? Give me a big overview of of what your day was like?

Carly 3:01
Yeah, so when I was on when I was first diagnosed, it was kind of like yesterday, it was within 80 to 180. And first of all, I was terrified of influence shots, and I would not do them myself when I was first diagnosed. So I would I didn't want insulin at all at all. So I would do the long acting in the morning. And then as obviously fast acting in the morning, too. And I'm not really exactly sure how it works to be honest, because I didn't get insulin shots at school at all, but I was still able to eat lunch. So I think and I would take my blood sugar and be you know, within 80 to 180. And if I wasn't my mom would come give me a correction.

Scott Benner 3:44
Dancing for diabetes, calm dancing, the number for diabetes.com

Carly 3:53
when I got home at the end of the day was still no blood sugar. So to be honest, I don't really know exactly what insulin I was on that allowed me to do that. As far

Scott Benner 4:00
as you were saying that does it start sounding screwy to you? Because, yeah. And it's funny how at the time you were just like this is what we're doing. So you didn't want to give yourself an injection at that age and there was no one at school to do it or you didn't even want anybody at school to do it.

Carly 4:16
I would only let my mom do it. So I didn't want anyone at school doing it. And I think I was also still honeymooning and i i know i honeymooned for quite a while because I did not have a whole lot of insulin for the first probably two years of diagnosis.

Unknown Speaker 4:30
Okay,

Carly 4:31
so maybe that was after that couldn't watch my home under school though. I didn't get shots that fulfil, yeah, I must have just been on my probably high after lunch and just I got home and I was fine.

Scott Benner 4:42
And if you got over 180 your mom would make the trip to the school and she would inject for you.

Carly 4:47
Yeah, usually. Yeah.

Scott Benner 4:48
Did that happen frequently in your memory?

Unknown Speaker 4:51
No, not really.

Scott Benner 4:53
Alright, so I don't think we're ever gonna really know how it is you got through your days. Excellent. Yeah, I know. That's interesting. Right,

Carly 5:00
I should really ask, I should really ask. I don't know how I just know that that's how it was. And I, until middle school, I never even gave myself shots at schools. Oh, yeah.

Scott Benner 5:09
No kidding. And so and now when you turn 12 Did you just magically one day, say to yourself, I can do this now.

Carly 5:18
Kind of it was more, I wanted to go to sleep overs and not have to have my mom come and give myself insulin. I remember the first few times I had sleepovers, I would, he would come and give me you know, come super early in the morning, and then come super late at night and give me and give me insulin for whatever snacks I was having and stuff.

But after, you know, after a couple times that I was like, I want to kind of figure this out. So then I, then I did and that's, that's when that started. So necessity was the mother of your invention, you were just like, Look,

Scott Benner 5:49
I don't need my mom showing up at these like social events anymore. So I'm gonna, I'm gonna figure out this needle thing. Yes, that's,

Carly 5:57
that's what I that's what I did. And, um, I was terrified of this stabbing myself in the arm was just, like, normal injection needle. So we had this thing called a shot ease. It was like, you put the needle into the bodies, and then you just click it, and then it releases the needle without you having to stab yourself.

Scott Benner 6:14
So I've heard of that a little bit, but I've never seen one and you but you had. So there was there's a huge phobia going on for you then. Yes. And do you feel that way now?

Carly 6:27
Actually, because I have, obviously my insulin pump. But um, so Medtronic, but I, the other day at work, my insulin pump came disconnected. And I had nothing with me, because I just wasn't thinking when I left the house, so I had nothing with me. And I luckily work at a hospital. And so one of the nurses was like, we'll use the use the little vial and your insulin pump and then use one of these needles and drop some insulin and just give yourself some insulin and just kind of keep doing that until you can go home because I was halfway through my shift. Not a good idea. Except for I hate needles. So I was like, Can you give me the shot? And she was like, yeah, that's fine. But that's weird that you can't give it to yourself. I was like, Yeah, I haven't done this in like 10 years, probably.

Scott Benner 7:07
So I have a couple of thoughts around that. But first, I have to ask you, what sort of work do you do at the hospital?

Carly 7:12
I am a nursing aide. I graduated with a degree in biology and I want to go to physician assistant school.

Unknown Speaker 7:17
Okay.

Carly 7:19
So yes, so right now I'm just trying to get direct patient care hours, and I'm working as a nursing aide, are you

Scott Benner 7:23
able to give other people injections?

Carly 7:27
No, we are able to do a lot of blood sugar checks, but I'm not able to give them and

Scott Benner 7:32
so the rules don't allow you to if the rules allowed you to do you feel like you could do it?

Carly 7:37
Yeah, definitely. I have. I mean, I have gone to diabetes camp and had to give kids shots and I can do to other people. It's just myself. I just I don't know,

Scott Benner 7:46
no, no, don't don't be I first of all, don't apologize or be embarrassed because, um, trust me, I'm getting to this for a reason. So and so when so when the nurse or somebody who helped you at work that day, did it? It didn't hurt, right?

Unknown Speaker 8:00
No, not at all.

Scott Benner 8:00
And so and you know, cognitively that if you did it, it would have heard either, yes, but there's just something between that thought and the action of doing it. You really are like, like stopped by it's so interesting. How are you with putting your pump on?

Carly 8:16
That I'm perfectly fine with too, because it's like, I just press a button. And I still, I think it's the sight of seeing the needle go into. I don't know why it freaks me out.

Scott Benner 8:26
But it does. Have you tried turning your head and not looking? I have not done that. Close your eyes just like like swing in the direction. If you're fine. See what happens. I think I could do it. I think there's a game to be made of figuring out how you're able to do this on your own because it sounds to me. Right? It sounds to me that you are able to do it. There's just whatever the sticking thing is for you. Maybe it's visual, like you're saying.

Unknown Speaker 8:52
Yes, that could be I guess

Scott Benner 8:55
this is great. I so Arden doesn't I don't think Arden's ever given herself an injection. Okay, I honestly don't. And I you know, to say that we haven't used them in a really long time is you know, since she was four, probably with any consistency. But I don't think like when she was four, maybe she did it a few times. But I don't think if I handed her a needle right now, and I was like, hey, do this. I don't think she'd be like, yeah, right on no problem. You know, yeah, definitely. She can manage your pump, fine. Take your pump on and off. And you know, and do all that there's, there's no problem with that at all.

Carly 9:30
I think it's kind of a mind game. like doing it to yourself, at least like doing it to other people. It's easier, but to yourself. It's just a mind game.

Scott Benner 9:38
What do you think about like, like, so your mom was like, Look, I'll come to the school and do this for you. Do you think that if she was just like, Listen, I'm not coming to the school. You're gonna go into a nurse's office and do this. Do you think you think you would have done that? Have you thought Do you feel like you would have been like, Oh, honey, you're not winning this game. I'm out there. Just send me home. Or you roared head on I guess is my Question.

Carly 10:02
I was stubborn when it came to diabetes stuff. So I would probably have just cry, then she would have been like, okay, I'll come do it.

Scott Benner 10:08
See is I hear you? Yeah, I don't know, when my kids cry, just like, look at them. And I'm like, oh, you're gonna stop, right? Like, this is SCADA, this has got to end. I don't want to be a part of this. Okay, so I just wanted to go through that a little bit, because I'm sure there's a lot of people who feel that way. And I'm sure there are people who have given, you know, injections for people and, you know, asking for people to do it. They don't want to or feel like they can't, I don't think there's any shame in it. Obviously, you're managing, you know, just as well. No, no, in your note to me, you said that around 12 years old, your parents sort of passed off the care like you, you learned how to inject like you've just gone over, but then that sort of took them out of the loop. So you were now making insulin decisions when you were 12?

Carly 10:53
Yes, basically, um, I would say, maybe not right, when I was 12, was I making the decisions in terms of, like, how much to give myself I would still probably ask, and I wasn't the best at counting carbs, quote, unquote, but um, I. So I think, initially, I was just kind of they would, you know, my mom would dose them for me, and then I would get them to myself on but probably probably, like, as soon as for sure High School is when I did make all my insulin decisions, especially because around 13, I got an insulin pump. So that's when I started really making all my decisions.

Scott Benner 11:27
Okay. And so, you know, we're, I don't for burying the lede here or not. So you've at some point in your life developed an eating disorder around diabetes?

Carly 11:38
Yes, um, I would say High School is one that started. And I didn't really even know it was an eating disorder. When I first start when it first started, like, I just kind of, I don't, I guess, like, there's no really pinpoint to confirm that started. But, you know, I've just started putting two and two together that I wasn't giving myself a lot of insulin in my blood sugar's are always high and losing weight. And then it just kind of, yeah, I just kind of went into a downhill spiral after that, when I actually started realizing what I was doing. And then into college continued until probably my second year of college. But being a bio major, he kind of, well, it's not that I didn't realize before, but being a bio major, especially you realize how bad it is for your body and how much I wanted to make a change and to be healthy around diabetes. Okay, so let's

Scott Benner 12:29
kind of if you don't mind, like, unpack that a little bit and go through it. So in the beginning, it was just, if I left my blood sugar higher, I'd lose weight. That is that was that the the starting point?

Carly 12:44
Yes, I think, um, I think that and also, there was also a part of it, too, that I was also very active, I was on track and in the in depth team, and I didn't want to, I didn't want to go low. I didn't want to have to go low and be not a part of that. So keeping my blood sugar a little bit higher, I was able to, obviously not go low on and so initially, it wasn't, I was always 400 it was initially I was just kind of, you know, floating in the sky. 100 200 and being being okay. But it wasn't, I guess, I guess, later on, it started being you know, it would be more higher in the four hundreds and it got even worse. Okay.

Scott Benner 13:25
Did you were you not eating? Were you not eating because of this? Or were you eating? More? Like, what how did the what was that piece of it? Like?

Carly 13:37
I think at the beginning, when I again, wasn't really realizing what I was doing was making me lose weight. I was kind of not eating as much that was more the classic eating disorder symptoms of like, more anorexic, just not, not, not eating a lot at all. But then once I started realizing that Oh, I just don't take influence, but I can eat things and it started being I would eat whatever I wanted to I just have really high blood sugars. So I guess it was a little bit of both.

Scott Benner 14:05
Did you? Did you find yourself in DK ever.

Carly 14:10
I was just talking to a friend about this the other day, I do not know how I was never NDK like I probably wasn't BK but I never was. I never was sick enough that I actually went into the hospital. Okay, so I don't know how I never Yeah, never ended up being super sick.

Scott Benner 14:27
And then and then tell me to when you go to your endo appointments. I'm assuming you are going to reasonably regular endo appointments, right?

Carly 14:35
No. Okay. No, yeah, that's Yeah, as soon as my parent my parents, my parents are lovely people, but they but they were not pressuring me in terms of diabetes at all. And so I would go on what kind of I would not go regularly at all. And when I would go it would be very I'd be very defensive and my endo you know, kind of knew something was up like obviously I have you know, 13 a one see there's something up on. And at first, my first endo kind of passed it off as cheese, you know, noncompliant to the teenager, you know, she didn't need to do better controls, let's just try this whole thing a little bit for these meals or whatever, let's just try it. I don't think he was understanding that I had an eating disorder at all. But then I went to a second barrel because my insurance changed. So I had to go to switch to different, different No, basically, um, and she knew what was going on, totally figured me out and kind of told my parents and, or my dad, at least while he was there, you know about possibly that I had any disorder. And I was just totally rebellious against it. I do not. And I reached out. And then after that, I don't think I went to an endocrinologist for two or three more years. Okay, because I just didn't, I didn't want to face it. Okay, Carly,

Scott Benner 15:52
you're so you're saying a lot here. So first of all, I want to thank you, because there have been hundreds of people on the show, but only a handful of them ever have to dig into stuff like this. And these are really valuable conversations, and you're brave to have it with me. So So first of all, thank you very much.

Carly 16:11
Yes, it's definitely a very important thing to talk about.

Scott Benner 16:14
No, absolutely. It seems like there was a couple of components here, right? The first one was that your parents weren't exactly dealing with you like, hey, look, this is something we do every three months, we go to the doctor, you get some sort of a, whatever the doctor does, they make, you know, adjustments or suggestions, and we're gonna keep doing this, that that just wasn't just wasn't part of your life. And I'm sure it's not part of a lot of people's lives. To be perfectly honest. Yeah,

Unknown Speaker 16:43
right. Yeah,

Carly 16:44
I was just very, I'm very defensive about about the whole thing. In general, I think my parents just kind of like, well, because I'm not, I'm not a defensive person in any other ways. In my life. I'm very, um, I'm just not that kind of person. Um, so when I started being super defensive, and just kind of angry about the whole thing, they just kind of stepped back and were like, Whoa, like, I'm sorry. Like, we'll let you handle this. Like,

Scott Benner 17:04
yeah, so there's this. If I've mentioned this before, I apologize. But it fits so well, here. I spoke at a hospital in the recent past. And, and endocrinologist, nurse practitioners came up to me afterwards, because I had mentioned how I'm involved with gardens care. And they thanked me when it was over, saying that it was very important for the parents in the room to hear that because a lot of parents think that this is just something they don't need to be involved in. Or sometimes they don't want to be or for whatever reason, they distance themselves from the care and leave it on children who are quite honestly too young to really, you know, understand that. Yeah,

Carly 17:48
definitely. This is definitely both perspectives, like, like parents, like, I think as I go to diabetes camp, so I see the parents that are very like, on top of it, and then the other parents are kind of like, oh, it'll be okay, it'll be fine. And some of them, some of them are, whether they're responsible, but then some of them aren't. And it just like, I want to help them and be like, you know, just try to mentor them while they're there. Because I know that they when they go home, I don't want them to end up like I did not have not have as much guidance, which is unfortunate, right? Because somebody said that about you? Oh, she'll be fine. And you weren't fine. And exactly, and what you know, you're only I don't want to say only 23 but you're only 23. You know, you don't have children, you haven't been out in the in the world in the fight yet. You know, so yeah.

Scott Benner 18:32
Right. So so you're you may know this through your experience now, or, or maybe don't have the perspective yet. But there are always going to be parenting moments, when it's not easy. It's not fun, and their kids hate it. And you still have to, you still have to be there and do that thing with them. And and there's, you know, obviously there are things that kids can avoid when they're in their own time if they're at school. You know, we're talking about diabetes, but this could be anything you could be telling your kid Look, don't smoke a jewel, and the kid still sneaks away and does what they're going to do. But I think that every time you see that jewel, you still have to be the person who takes it from them and then put some sort of a consequence in order and and work through it. It's it becomes touchy and scary when it's about a health thing, you know?

Carly 19:20
Exactly. Yes. And I think I'm also parents just, I guess from my perspective, my parents just didn't want to don't want to hurt me, but they didn't realize in the long run that's not helping for anymore. They were just trading easier now for worse later. Exactly.

Scott Benner 19:37
I asked you, do you have any feeling for what you for what would have been valuable from your parents in that moment? Like What Did you need? Consider pod therapy and say goodbye to needles and pens. If you have diabetes, and your body requires insulin you need to know about beyond the pod. It can make your diabetes a smaller and more manageable part. If your day to day life, people would type one or insulin requiring type two diabetes, along with caregivers of both children and adults with diabetes are choosing the Omni pod. Because of its simple, smart and discreet design and functionality. There's a lot of claims in there, right? How are we going to know for sure? How do you make a leap like this? It's a big deal. Yeah, just give up on what you're doing right now. Just because the guy on the podcast, that's Oh, no, I wouldn't expect you to do that. Here's what you can do. You go to my link, it's my omnipod.com Ford slash juicebox. There's also links in your show notes in your podcast player, and at Juicebox podcast.com. So you can't remember, there's places to go to click on it. When you get there, you fill out the tiniest bit of information about yourself. When you do this, on the pod sends you an absolutely free, no obligation. Demo pod. They call it a pod experience kit comes with a cute little box. That kit allows you to put an on the pod on your body. I know so many of you that tried the demo pod, and are now very happy on the pod users. My Omni pod.com forward slash juice box the links in your show notes are Juicebox podcast.com. Get a free no obligation demo of the Omni pod. Try it on today. You see what you think. You like it, you keep going? You don't like it? You don't have the choice is completely yours. There's no pressure, no obligation? Absolutely no reason not to just try Miami pods.com forward slash juicebox. Do you have any feeling for what would have been valuable from your parents in that moment?

Carly 21:40
I think they kind of realized what was going on. So I think I needed someone to just come alongside me and just say hey, like I know that you know you're defensive about this. But I think that you if you don't want help from us, we need to bring you to another chronologist or we need to find another another key Wendy, that's your age that you can talk to her someone because I literally had nothing. So just to have that support would be really helpful. And I'm and I'm not blaming them at all, like for sure. Like they, they didn't know what to do. Like, I'm also their only child, but like, it's not like they've had practices before. And so yeah, so I think just taking along, going alongside a kid guidance, and just letting them know that you know you're there for them. Or they can help you find resources.

Scott Benner 22:26
But that could help them. Yeah, they didn't have a practice kid them when they could just mess up and go, Hey, that was our first one. This is not our fault. You are the practice kid. So yeah, look what they figured out from practice, no more playing. I hear him. Okay, so something, try something, try anything, do something. If that doesn't work, do something else. But don't give up. And I think the message for parents needs to be that. Just because kids push back doesn't necessarily mean they don't want you there. There might be other reasons why they're pushing back too. And for you. You know, it could have been anything, it could have been your fear of needles, it could have been that you just didn't want to have diabetes, you know?

Carly 23:08
Exactly. Yeah. And I think for me, it was it was I think it was perfectionism. You know, I want perfection and diabetes, well not perfection. So if I just ignored it, and it wasn't, it wasn't there. And I could just continue living my life and being perfect in other aspects like not going law at dance practice or not going low when I'm trying to study for a test or whatever.

Scott Benner 23:27
How do you end up working your way through something like an eating disorder? And is there are there things that parents can look for in their kids that are kind of hints that something like that's going on besides the elevated blood sugars ne one sees it seemed crazy out of whack and stuff like that?

Carly 23:45
Yeah, I think um, well, first are things that you can look for. I think I'm just not you know, I guess avoiding avoiding food or having specific, specific things that they want to eat. I guess our classic eating disorder signs, also kind of being I guess, depressed around depressed in general, I've obviously teenagers can be anxiety and depression, but I think especially around like diabetes and eating. And for me specifically how I worked through it, I took me a long time to really realize that, like I said that I even really had an eating disorder. And then after I did, it took me a long time to figure out how to solve it. I didn't I didn't go through classic like treatment going to a treatment facility. I going back I wish I would have been in college. I was just like, I'm too busy to figure this out myself. And so what really helped me was on I, first of all becoming involved with the college diabetes network. I found our chapter at our at the University of Minnesota and kind of came affiliated with them and then ended up going on a retreat. They have like a leadership retreat every year where they have leaders from chapters around the country. Me too. And for a week, you kind of get to be with all these key windy leaders and learn about, about new technology, learn about things that you can take back to your chapter. And that week kind of changed my life. I'm actually that was two years ago now, yeah, two years ago in May. And we still have an active group Snapchat that we literally every day is always blowing up with people, you know, sending each other grass with their Dexcom, or whatever you're talking about general things that we're frustrated with. And just having that connection, even though they're not obviously living in Minnesota, having that connection of people, and constantly talking to them, and seeing how they're keeping track of their diabetes really helped me. And also, aside from that I learned of an organization called we are diabetes that is focused on specifically type one diabetes and eating disorders. And the founder of that I kind of came in connection with and she came alongside me and kind of mentored me a little bit too. So I think just having in general, the seven connections to diabetes things and being around people that are keeping good track of the diabetes really helped me community, right, just hearing, having knowing someone else's, they're being able to bounce something off of somebody showing somebody something that's not perfect. And then going Oh, yeah, that

Scott Benner 26:17
happens to me too. And, and that feeling that everything doesn't have to be perfect, right?

Carly 26:23
Yes, yes.

Scott Benner 26:24
Were you like, are you were you like that? In your personality about other things? Or did that idea of perfection, just live in the diabetes space for you?

Carly 26:35
Oh, definitely about other things, too, about school about any sport I participated in. And, yeah, I'm very perfectionist, which has its good qualities, but also it's bad quality.

Scott Benner 26:48
I know, I might be married to a person like you, I understand what's going on. So a lot of a lot of this isn't quite right. Not quite good enough, like that sort of thing. Does that come? Do you think it was a learned behavior? Did somebody show you how to be like that? Or do you think that it's just sort of hardwired?

Carly 27:05
I don't really, I guess, I don't really know. Because my dad is most easygoing, like fun person in the world, like, everything's a joke to him. And then my mom's not a perfectionist, either. She's not as easygoing as my dad, but she's definitely not. not expecting us to be hardwired from past past relatives or something. Yeah.

Scott Benner 27:25
I was just wondering, it's interesting, because I know for my wife, it's, it's a family trait. You know, like, it's definitely something that, you know, is in the genes. And so I was just wondering, but that's, that's super interesting. Okay. So you, you get yourself on a better path. And you do that through it sounds like through community and support and everything, which is, which is fantastic. Did you have any lasting medical effects from the disorder? And is it something you still fight with today? You know, what is maintenance look like?

Carly 28:02
Yeah, I actually did not have any lot lasting well, aside from my vision, you know, I had 2020 vision before this all happened. And I have glasses now. But that could have been from that could be from not having good diabetes care, or just other things in general. So and it's not like I have terrible vision, I just have to wear glasses on but other than that, I really have no, no residue effects from it. And it's definitely still, it's still present. I'm not like anything like it was but I would say, um, in terms of like fear going low overnight, like, which I don't know, it's not necessarily an eating disorder thing anymore. It's just that I'm so used to not going low overnight that like, I freak out. When I go to bed below 120 I would say like, I'm like, I need to eat something before I go to bed because I don't want to wake up low. And I think that's just because for years and years, I've reduced to that. It's definitely become much better. And I was actually listening to your podcast as helped a lot because this summer on every time I would go out for a walk or whatever, I would listen to your podcast and listening to other people kind of had the same issue where they don't want to bump a nudge and go a little bit have their blood sugar's went a little bit lower on kind of inspired me.

Scott Benner 29:16
Good. I'm good. That's excellent. So hearing other people's stories got you kind of like revved up, but you're and how did you put that into? Like, once you had that momentum, and you were feeling like, Hey, I would like to do something more like what I'm hearing about other people saying, What's the first step to that? It's got to be the overnight stuff, right? Like that's got to be your biggest fear, I would imagine because you do live by yourself.

Carly 29:39
I don't right now I did when I was in college, but now I live back with my parents until until I find another place.

Scott Benner 29:48
No place. I would stay there as long as I could. If I wish you I would. I would. I'm all for someone paying my rent and still if someone wants to show up and do it. So don't don't rush around for that plus you sound like you have bigger plans. So just you know, as long as they think you're moving towards something, I'm sure they'll leave you alone.

Carly 30:05
Yes, I would like to, I would like to move out, but I will take advantage as long as I can

Scott Benner 30:11
for you. Plus, you're in Minnesota. I mean, most half of the year can even go outside anyway. What's the difference? It's just like, like a meat locker.

Carly 30:20
Coal kind of Yeah. Today, it's made in the 20 degree melvil? I think so it's kind of warm outside, but it's 20

Scott Benner 30:26
degrees. Listen to what she just said. It's 20 degrees. It's kind of you live in a place where you can walk on a lake, just let's stop. Okay. It's not natural. But But seriously, I escaped. Yeah, no, please. I was my brother lives in Wisconsin. told me when he moved there, because he, you know, he's from where we're from. And he's like, Guys I work with invited me to go ice fishing. And I was like, What is that? He explained it to me, and I'm like, are you gonna do it? He goes, I don't know. I don't know how I can't like we all work together. He went one time. He's like, it was insane. Yeah, he's like, he's like, they lit a fire on the top of the lake. And I was like, right, because it just burned. Nothing happened. It's like nine feet of it. It's like, come home. Boy.

Carly 31:12
I can see how that could seem really weird to someone that's never done that before. Yeah,

Scott Benner 31:15
you're done. Right? It is. But so so when you make so let me I guess let me ask you this. Prior to coming out of high school, and you're in you know, you're come to college, and you find the college diabetes network, and you find yourself some stability. Where are you at? Like a one c? You know, average blood sugar wise in college? Like, what were your goals? Like day to day goals? And how did they end up? Like kind of grading out? I guess, at the end of the three months? Although someone's gonna get really mad that I said grading out, but it's a term just Well, I'll be fine.

Carly 31:50
Yeah, so I think the first first year of college, I definitely didn't go the endo at all. So I don't know what it was, it was probably still 1213 second year of college, it started when I'm actually kind of certain, trying to figure stuff out. So um, when I went and I think the first time it was like, 9.6, or something like that. And then recently, I guess, a third year of college in the fourth year of college, I got it down into eight. And then last time I went in, it was seven, which was at the beginning, or when I got back from Vanderbilt. So that was like, I guess, the end of the summer. So I'm going in next month, so

Scott Benner 32:28
So yeah, absolutely go, that's you should be incredibly proud of yourself. I'm sure you are. But you don't need me to tell you that. But. But that's a really amazing accomplishment in a very short amount of time on your own. Coming from where you came. That's, that's spectacular. And you don't shy away from food. And you don't you don't overeat to avoid lows and all that sort of going.

Carly 32:50
Yeah, yeah, I definitely am someone that since I do kind of diaper infection, I do kind of eat only regimens that are not right to certain things, because I know how to bowls for them. But I definitely expanding my horizons in terms of figuring out how to bowl for other things for you.

Scott Benner 33:05
Well, this is very exciting. Now listen, I think it's important to say to people listening that I think Carly's story is shocking, like if you don't live this life, or if these things have never kind of, you know, crept up in your life. I would see we're hearing them might be like, wow, that's insane. But I don't think that your story. Is that uncommon? Carly? You know, yeah, I don't at all. And have you met other people who were in a similar situation? I know, I don't know if you have or not, but I'm just interested in like a diabetes camp.

Carly 33:36
Well, it's kind of interesting, because I have not like, specifically met I've like, through we are diabetes, like I've talked to like the founder who had eating disorder. And I was, I guess, that multiple people have default diabetes network that, that kind of went through disorder phase, but not like, not extreme. But it is interesting, because I do work at the hospital. And I see so many people that are around, you know, between the ages of 18 and 25. that come in with aka. And obviously, not all of them have eating disorders, but a lot of them are not. Some of them, you can kind of just tell do and I just want to like I know, as my position, I can't step up and be like, hey, like, I want to help you. But I'm interesting that I can't say anything, but I do see a lot of people at the hospital that um, that are going through that same thing. So it kind of makes me realize that Yeah, my story is not there. A lot of people are going through this

Scott Benner 34:29
right. And I think that that goes for most people like whatever it is that your story is around diabetes, it is probably not so dissimilar from other people. And it just, I think we I somebody put it to me, I'm trying to figure out a way to say something, somebody put something to me one way recently that I didn't know 100% with the makeup, but they they said I would bet that people who listen to your podcasts are either the people who are you know really quote unquote good at it, or the people who are really struggling and hoping to get good at it. I was like, Well, isn't that everybody? Like, like, they're just variations of that in between. But still. But still, I think that when I hear you talk, I can sit here and think, well, this could easily happen to my daughter, right? Like this could absolutely easily happen to her. And she, you wouldn't think that would be common, you know, for her situation. But who knows what goes on once she takes over her own, you know, care a little extra. And I think this is just, I think it's just incredibly kind of you to offer your experience so that everybody can can kind of look up and say, I wonder what what's going on in my life that maybe I should be paying more attention to? or What does my kid need that? I may be acting like, oh, they're fine. And maybe they're not, you know?

Carly 35:47
Yeah, definitely. That's why I want to, I want to share my story. And I want to let other people know that because yeah, when they when they hear that other people are going through the same thing. I wish, I wish when I was going through it, I would have had resources like this or someone, here's someone else's story and been like, well, that's me like I need to, I need to try to, you know, reach out and try to figure figure out how to handle things.

Scott Benner 36:09
So so Okay, so let's talk a little bit about like today like getting the mail right now in in now time now time, which is not a phrase commonly used. So what would that be called the present? There we go. Unbelievable, Carly.

Unknown Speaker 36:22
They're hard baby. I've

Scott Benner 36:23
done too many these podcasts. I just had now time. It's making me so you have a pump now. glucose monitor.

Unknown Speaker 36:33
Guess Yes, I

Carly 36:34
have a pump on a pump. Right now. I have the Medtronic 670 and the on the sensor. I really don't like it. I have so I'm actually on a clinical trial right now for not for our glucose monitor or anything, but I'm wearing a Dexcom for the clinical trial. And I'm in love with it that it connects to my phone and that it sets my Apple Watch. It's amazing. And so I'm gonna try to switch to Dexcom but I am currently on the truck. Oh, Medtronic, people. You must be so sick of turning on this podcast and hearing people say I like my Medtronic CGM. But you had no choice you live in Minnesota, which I believe is the headquarters for Medtronic isn't aren't they? Yes, it is. literally everyone. You go to the endo here, everyone up until like, probably a year ago, everyone had Medtronic. Now they're kind of figuring out that maybe Medtronic is not perfect. But up until up until a year ago, like literally every kid we didn't even know what like panda was or Dexcom was

Scott Benner 37:31
how hard how difficult could it be? to trick a person who thinks it's spending a day standing on a frozen lake fishing through a hole is a good idea. Right? Like it must be so it just has to be so easy. Like it just Hi. This is the only insulin popular out Oh, it is Thank you very much. And then you just take what it probably is a sticker on the box that says won't freeze during ice fishing. Which then right makes everybody there go Oh, this is this is the best insulin pump it won't for a perfect

Carly 37:58
insulin pump. Yeah,

Scott Benner 38:00
walking on water. So, but no, no, I didn't know that. I just you know, I know I bear saying every once in a while, a couple episodes. I didn't ask you what kind of pump you had when you came on. You know you offer that information up. I didn't know you were currently using Dexcom on a trial. But this is totally where I'm going to put the Dexcom ad right here. Yesterday took Arden and two of her friends to a small shopping district nearby our home, drop them off so they can have a nice day together. Arden was armed with a few things. They bought insulin pump, a juice box, her meter and test strips. But only one thing made the entire trip. Simple. It was the dexcom g six continuous glucose monitor and its ability to share Arden's blood sugars with me remotely, I just dropped them off and left kicked him right out of the car. I was like Hey, get out of here. Have fun, you crazy kids. As Arden was getting in the car, I said look, I'm not sure if walking around this heats gonna bring your blood sugar up or down. As soon as we see what's going on. We'll make a decision her blood sugar was 91 at that moment. The walking around actually Can you guess drove her blood sugar up a little bit. So she used her Omni pod put up a little temporary bazel rate continued on with the day. Then they went to a restaurant for lunch for art and had macaroni and cheese and salad. We were bolusing and when we missed on the bowls a little bit we are going to put in more insulin Why? Because the dexcom showed us the direction and speed of her blood sugar. It showed us that we missed a little bit with her meal and so we put in more now, the more almost help we got it a 150 and it leveled off and just as it leveled off at 150. What did Arden want to do? Well, her and her friends found a cupcake shop. We were able to Bolus at the 150 aggressively enough. Keep in mind these are results and yours may vary but Arden's blood sugar did not go up during the cupcake from the 150. But down settling in again in the mid 80s. All of that I'm going to talk right past the music. All of that is because of the functionality of the dexcom g six continuous glucose monitor direction, speed of your blood sugar. super important. Just as important, the ability for her blood sugar to be shared with a loved one, in this case, me. You want to make good decisions about your diabetes, start with this one, go to dexcom.com forward slash juice box and get the G six continuous glucose monitor. Tell me about the trial you're doing right now.

Carly 40:40
Yeah, so it's, um, it's really interesting, actually. So it's about people that have hypoglycemia unawareness. And, um, and recently, as I have started on getting my blood sugar's in better control, I will go out for a run and also wearing my sensor, I started realize this, I'll go out for a run and literally drop into the 40s and not even not even realize it and then get back and be like, Oh, I'm low. And so I've heard of this clinical trial that they're doing. It's measuring basically people that have hypoglycemia unawareness. It's measuring their brain activity when their glucose does go really low. And they think that type one diabetics have some sort of compensation or something going on in their, in their brain cells that are making it so their brain kind of says, you know, you go low all the time, so we're just not going to give the normal normal awareness signs, you know, the shakiness feeling sweaty and stuff, because it happens all the time. And I feel like we don't need to freak out about this. So So yeah, so they basically put you in, they put four IVs in you on one and both of your feet one both of your hands and put you in an MRI machine and drop your glucose really low, and measure your brain activity. And see if there's anything funky going on. And Carly for this you being paid $1 million a day. Is that correct? Because that's what I would charge to do that. I think it's like, I think it's compensation of like $500 a day, so it is quite a bit.

Scott Benner 42:02
Wow. Fancy and in Minnesota, that's like 1500

Unknown Speaker 42:06
right? Yes, yes.

Scott Benner 42:08
It says a lovely place anywhere cold. Really? You're gonna hear me speak poorly about I just.

Carly 42:14
It's very, it's a lovely house. Beautiful falls beautiful summers and beautiful springs. But yes, the winter is a bit a bit cold.

Scott Benner 42:21
Yes. My brother in Wisconsin says, come out and visit see the lakes. To which I respond. No. And then that's how that ends. We have beautiful lakes as I'm sure you do.

Carly 42:36
You got to come in. But you got to come in the fall. And

Scott Benner 42:39
one day, I mean, I'm just trying to get him to move home. I it's been a decade. I'm pretty sure he's not coming. But I I thought if I withheld my delightfulness he'd have to come back for it. But I don't I

Carly 42:49
don't know. He's not catching on to that.

Scott Benner 42:51
No, not at all. That that's he doesn't love my mom. I think that's what I'm just kidding. We tease them about it. Sometimes I'm like, Oh, you know, if you love mom, you'd come home and live here. And he's like, this is where my job isn't like, is it? But it actually is, he doesn't deserve that. He's a really nice person. Anyway, you so you're on this study, which is insane. But that's very nice. It's a nice thing you're doing for other people. Plus, you might get some answers for yourself. It's incredibly interesting that you're hearing that it's possible that people who experience a lot of low blood sugars might have a mechanism that tells them like, Look, don't feel like this, because you're more because your body spent a long time at elevated blood sugars. So it really adapted to that space. How long says something I'm interested to know after you brought your blood sugar's down to a more reasonable place. You didn't even feel it then at that moment, like in the beginning. Like like coming from like a 200 all the time down to an a you know, 100 all the time. That didn't make you feel oddly,

Carly 44:02
I think it was very gradual. I didn't like it wasn't like everyday I'd be at normal blood sugar's I was kind of you know, back and forth. So I think it didn't really hit me that hard. Um, I think maybe it maybe the actual lows did like I was not used to going low. So you know, if I was below 70 at all, like I was shaky, like not I could not function at all. But eventually Yeah, that kind of disappeared and I know sometimes can't feel my feel my lows.

Scott Benner 44:27
Wow. And and but you've never become incapacitated.

Unknown Speaker 44:29
Never know.

Scott Benner 44:31
So you're functioning. Do you look back and think Hmm, I wasn't as cognitively sharp as I thought I was in that moment or does that not even change?

Unknown Speaker 44:42
I'm like when I'm like running and I'm like say

Scott Benner 44:46
you say you go for running you're low. Do you look back like an hour later and think oh, I just as I was running, I thought one plus one equals turtle or nothing,

Carly 44:55
I guess. I guess not. Because I'm not really like I'm just more like have my music playing I listen to a podcast or something. So usually, usually I don't have to think too hard. So I guess I don't I don't really know. When I get when I get back home, I definitely can tell because I'll start fumbling around and you know, being shaky and be like, Hey, I'm probably low. Okay. But yeah, when I'm running, I can't really I can't really tell.

Scott Benner 45:17
Carly, are you excited that there's a high likelihood your episode is going to be called One plus one equals turtle?

Carly 45:24
Yes, that sounds like a great, great name.

Scott Benner 45:26
We're turtle math. Maybe we'll figure it out. Don't worry, but something's gonna happen. I said, I just said that. I wish you could all live in my head from it. I just said that. And I thought inside my brain, I thought, I've never had that thought before in my entire life. Like, how did that just come out? That's why people like the podcast who knows what I'm gonna say? I don't even know. God knows if any of this diabetes stuff is even correct.

Unknown Speaker 45:49
I'm just kidding.

Unknown Speaker 45:51
That's very true.

Scott Benner 45:52
You caught me a good day. I'm a little giddy today, Carly. So I'm so sorry. Sorry, to everyone's made it this far into the episode. Okay, so right now, you said your human agency sort of in the eight ish range that you're bringing down slowly? Which by the way, I like the I like the slow approach to like not getting crazy and just going nuts. How's your variability? Like? Are you bouncing around as much? Or are you? I guess it is 781? See? Are you like very stable around like 141 50? Most of the day? Or how does? How does? How's that?

Carly 46:28
I would say, um, again, it really depends upon the day. But I would say I'm pretty stable. I don't have a whole lot of dropping. When I first I will say when I first started working at the hospital, though, it's a lot of a lot of just the entire day. I'm on my feet running around. And so I that has gotten me kind of some, some ups and downs because you know, I'll go low correct gold high, like just kind of up and down rollercoaster. But I'm definitely figuring out my bazel bit more, a little bit more now. And actually, that is one thing that I do use the 674 is figuring out at work and figuring out how to change my basal rate, because I didn't even know and it has been kind of helpful for that.

Scott Benner 47:07
Is that is this? Is it the 670? Is that the one that does the Is it like an artificial pancreas type one?

Carly 47:13
Yeah, yeah, the auto mode. Yeah, what I first was very frustrated with and did not like, but after realizing that it could help you at work, I kind of it's kind of like a little bit more. It's interesting,

Scott Benner 47:23
but it targets your blood sugar for what, like, where does it set out? You know,

Carly 47:28
so I haven't set. I haven't set up the lowest setting, which I believe is like, I think it's like 70 to 100 or something like that. But it will sometimes be okay with me being you know, 141 50 even sometimes, which can get frustrating because then you end up eating fake carbs. Because you can't give yourself just like, Well, my girl bowl says that you have to pretend like you're eating something. Just to cut out microvolts to get you a little bit lower. You're tricking the pump. Yeah.

Scott Benner 47:56
I'm sorry. Go ahead. No, I was just gonna say I guess that's fair. It's tricking you. I told you it was gonna keep you between 70 100 and your 150. So I guess it's fair if you trick it back.

Unknown Speaker 48:05
Yeah, yeah.

Carly 48:08
You can't do that. I'm like, Well, it wasn't what am I supposed to do? Because it's really annoying that I you know, could potentially be in the lower 100 right now, and it's keeping me at 150. Like, it's annoying, right? I

Scott Benner 48:18
know, this is the official insulin pump of Minnesota, but it's not doing a good job for me and I have

Carly 48:25
a rep in Minnesota very well.

Scott Benner 48:26
No, we and and know exactly. That's not fair to Minnesota. At all. You guys made a wrestler governor, you know that right? Yes, it's winter or something like that. I'm just saying, as you know, maybe it is fair to Minnesota is what I'm saying. He's a conspiracy theorist now who lives on a beach in Mexico because he doesn't want to be in the country near what I'm assuming are the people who are coming to get them. So I think you guys did a great job. sussing that one out, and, you know, onward and upward. But um,

Carly 49:04
Oh, goodness. Yeah. Like, just ignore that part of our

Scott Benner 49:06
body visscher that that was his name. Yeah, he's a little he's, he's, I'm sure he's fine. But maybe he's just saying those things to get attention and have a television show. But I think he's one of those people who believes any crazy thing you might think he he's pretty sure it might be true. So good for him. Anyway, so So okay, so you're using that pump with the, you know, the auto mode, it automatically keeps your blood sugar at 150. And then you so I get what you're saying this, you pretend you're eating so it'll give you insulin. So it'll bring you down? Yes, but then that isn't. They're telling you you can't do that because that throws off the algorithm, which I gotcha. But what you're saying is you better hope that this tax calm doesn't hook up to a pump to make a different algorithm, buddy, because I'm getting out of here one way or the other.

Carly 49:57
Yes, exactly. What I do There is a way to like hook up the Dexcom, to the old Medtronic and like make your own artificial pancreas or something like that

Scott Benner 50:06
you just got out of my space, I'm not sure. What are some of the things you're looking forward to? I mean, with your own health as well as like, you know, with your life, like, you must feel like you're on a completely different path. And you've been on so far.

Carly 50:23
Yeah, I'm definitely looking forward to, um, I want to go to PA school, and I want to specialize in endocrinology. And the men work with people with diabetes. And I actually, um, yeah, I think my whole career path changed after kind of getting in control of my diabetes of wanting to somehow go into health care, it helps those that have diabetes, and I think realizing that teens have more time to spend with their patients and how, you know, you always go to the endo, and they're kind of you know, you get your agency and they don't have much time to sit down with you. I feel like the PA that I work with that my clinics despite you get more time to work with them, and sit down and you kind of get time for them to kind of say, Hey, what's going on here? You know, let's look at your look at your graphs and stuff. Whereas I'm more like a CD kind of role, where is on? And those don't think that's, I'm like, I'm really looking forward to be able to possibly go into that as my career.

Scott Benner 51:20
Are you getting better at that like, for yourself? Are you able to start looking at your graphs and really figure about like, Oh, I think this is that, and I'm at this point, now. I just look and I'm like, Oh, I know what this means. And I can adjust it in like two seconds. And, like, just Yeah. Are you getting to that point?

Carly 51:39
Yeah, I think, um, but also, I think I still have so much variability in my day to day activity that I still kind of, still in figuring out a little bit, but I'm definitely getting better at being able to look at it and be like, you know, you were whatever, like, made this you were now 200. You know, you can have both for this a little bit earlier, and, you know, maybe one more unit and would have been a little bit better. Um, so I definitely, in terms of like, running and stuff, because I do, I do run it quite frequently. And, um, that that's a little bit more of a challenge for me and figuring out exactly, I it seems like it varies from day to day what my blood sugar's do no matter what I do for that, so I figured that out.

Scott Benner 52:19
So I've heard, and I'm not 100% the right person to talk about this with but I've heard some people talking about if they, they tried to get the insulin completely out of themselves before activity, like before working out,

meaning that like right haven't had like an active bolt, there's no act of bolus, even the end of one. And that they can kind of work out forever without their blood sugar kind of dropping from that. Yes, that is something that I have figured out that if I have any insulin on board, I'm going to plumb it, no matter if I had, you know, 1000 carb breakfast, that was

Carly 52:53
a huge breakfast, it wouldn't matter. Like if I have any insulin on board, I'm just going to plummet no matter what. So I have to wake up. If I want to workout before work, I have to wake up super early and bolt through whatever I'm eating and you know, then and then go work out or just eat something that has more protein and not a lot of carbs and eat that and then just not have to bowl because if I have insulin, I'm just gonna plummet and not be able to not be able to finish my run.

Scott Benner 53:20
Well, this is a little unfair to you, Carly. I'm sorry, because we got a little bit of a late start because of me, but my schedule is super tight today. So I have to ask you if there's anything we did not talk about that you wanted to that I forgot?

Carly 53:33
I don't think so. I think we kind of everything.

Scott Benner 53:37
I'm pretty good at this. You are yours. I could tell like you were you were by the way. Congratulations. I know if you've ever been on a podcast before. Nice and chatty, I liked it. And well thank you know, amen. You knew what you were gonna say you got right to it, you spoke about it. Like you're obviously an incredibly bright person. And so I was like, This is great. I'm just gonna sit back and say stupid things about Minnesota on fairly. So thank you. I

Carly 54:04
was very nervous about what exactly I was gonna say. I was like, I'm gonna go for it. And just, you know, we'll do it.

Scott Benner 54:09
Are you happy that that went that way? Because you emailed me and you were like, what should I be preparing for? And I'm, of course no help. Anyone who's ever been in your position knows that I just emailed back. I'm like, it'll be fine. Don't worry about some people that doesn't really work for their personality too. Well, so. But you You really did. You went from what are we going to talk about to Don't worry about it to doing a really great job. So I genuinely appreciate you taking this time like this. Thank you. Thank you. You're very welcome. Dancing for diabetes has a new space they're working on they just completed the demolition portion of the construction process. You gotta go check it out. It's very exciting. Dancing, the number four diabetes.com were on their Instagram or Facebook pages to see those pictures. Huge. Thank you to Carly for coming on the show and baring her soul on so many important topics. Thank you all so to us. In the pod Dexcom, and of course dancing for diabetes for their support of the podcast. I do want to give you two other things here that Carly mentioned during the show. We are diabetes.org is the organization that Carly mentioned. They're not sponsors. But it seemed to be very helpful to her. So I think you should check them out. We are diabetes.org. And it comes up a lot on the show, especially with college aged students, but the college diabetes network is that college diabetes network.org. Also, don't forget the 1 million giveaway celebration is underway for the podcast. That is right in August of 2019. That Juicebox Podcast Thanks to you, we'll reach 1 million total downloads. And I wanted to celebrate with you in a way that you didn't have to do anything. It's a giveaway that you don't have to do anything to enter. So go to Juicebox podcast.com. Scroll down till you see the little thing for the 1 million celebration, click on it. You'll see all the stuff that's going to be involved in the giveaway on the pod decks comm and dancing for diabetes swag, one free item of your choice from myabetic.com. Stay put medical is going to give us a gift bag. We'll give you the winner. How about a 30 minute consultation with Jenny Smith. Oh, come on, right 30 minutes on the phone with Jenny. The winner will also get two new bold with insulin t shirts. Which if you want to see right now, just go to Juicebox podcast.com. and scroll down to merch you can buy them now if you want or try to win the giveaway. And the big prize, depending on how you think of it could be the prize you don't want, you might end up going Hey, Scott, I'll take all this stuff except for this last thing. But if you do win and you are interested in offering one week of unfettered access you and I can text call by phone, FaceTime, whatever you need any questions you have for seven days, I'm here to answer them for the winner. The contest is open to everyone. There are some limitations for overseas, you'll see when you get to Juicebox podcast.com. But everyone can play. Everyone can enter. It doesn't cost anything to enter. And you can enter once a day for nothing. You don't have to follow me on something or do anything. I'm not going to make you do anything you do those things if you want to. But I'm not going to make you do something to enter. Just go enter. There was 324 I just logged on 324 entries so far. And you can enter once a day so you can get like I don't know how many days left in August, but for every day left in August, you can get an entry give yourself a better chance to win. That's pretty cool. I just actually refresh it. There's 326 entries now You better hurry up and get over there. Thank you so much for listening to the Juicebox Podcast. I hope you guys are having a great summer. hope you really enjoyed this episode. I thought there was a lot of insight into a number of important issues here. 1 million downloads new swanky t shirts. This podcast is really classing up.

Please support the sponsors

Donate