Scott Benner 11/8/19 Scott Benner 11/8/19

#277 Ask Scott and Jenny: Chapter Six

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

Let’s talk about the importance of hydration.
Let’s talk about the biology and impact of blood glucose on mood, function and brain.
What does a seizure feel like?

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

Scott Benner 0:00
This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. The pen is America's only FDA cleared smart insulin pen and app system. In pen works like other pens, it's just a lot smarter, you can use it in pen, like any other injector pen. The difference in pen is that it tracks each dose and delivers your data to a secure app on your smartphone. So finally, there's no complicated math and no log book to update. I urge you to go to companion medical comm or click on the links in the show notes are the ones that are available at Juicebox podcast.com.

Welcome to Ask Scott and Jenny. In today's episode, I Scott and Jenny Jenny Smith from the diabetes pro tip series in defining diabetes, you know Jenny, Jenny works at integrated diabetes. She's a CDE, a registered pump trainer CGM trainer dietician, she has type one, if Jenny caught a foul ball at a baseball game, she'd give it to your kid. Today, Jenny and I are going to talk about the importance of hydration. And we're going to have an extended conversation about the impact that blood sugars have one function mood, and just living with Type One Diabetes, it becomes a really longer conversation than I expected it to. But we're not just going to talk about how low blood sugars make you feel, but maybe why they make you feel that way. As well as highs, then I'll kind of tell a story about art and seizure and actually cover something in my own health. It's comprehensive already. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. or becoming bold with insulin.

Unknown Speaker 2:10
I'm gonna ask my question.

Scott Benner 2:13
Yeah. So Arden started school up last week. And first two days were great, you know, and then there was the weekend and then Monday came. And her blood sugar went up to like 140. I couldn't get it back down. Then she ate and I couldn't get it under 180. And then it sat there and sat there and sat down is like, Huh, what's going on? And tried everything that you would think of? Until they landed on the answer. And the answer was, Arden gets up in the morning. She leaves for school gardens, not a breakfast person. Not when she goes to school. She is on the weekends, but not when she goes to school. So she'll run out the door. She goes to school, sometimes breakfast, or sometimes they she has lunch this year, two different times 1030 and 12 o'clock. So every other day it changes just to make things fun. Yeah, right. So here's what ended up being the issue. Arden was dehydrated. I stuck a bottle of water in front of Arden and I was like drink the water. She takes a little sip of it. Like a demure princess at a tea party. And I'm like no no, no slug the water back. Now like I need you to get a half a bottle of this water in right now. So she complained and bemoan This is not what it is. Leave me alone, blah, blah, blah. She didn't do it didn't do it. Blood Sugar climbs and climbs and climbs, we're bolusing nothing's happening. I finally she starts getting a little surly because her blood sugar's higher. And I get more direct and I'm like, Look, drink the water. Or, you know, I'm gonna kick you out of the house. I forget. I forget what I said. But I you know, I was just like more direct about it. So she bangs this water in. And 10 minutes later, diagonal down arrow and here comes her blood sugar down and levels out and we're good. The next day she gets up for school. She doesn't drink water, her blood sugar's difficult. As soon as I get her to push water, it's now all the sudden, the pump does what I expect it to I don't know if you know that phrase or people listening have that idea. Like I always think of it like, is the infusion site acting the way I expect. That's one of the ways I kind of inspect the infusion site, in my mind is exactly what I think it should be doing. And this was the same thing. That's why I was like, Oh, God, is it the infusion site? Is it you know, you know, people start going through? Yeah, Moon out of phase like, you know, you start to start running through these litany of things that are probably not at the core of what's going on. Anyway, that's it, it was dehydration, but I really would like you to talk about that a little bit because I think it is. I think a lot of people are not hydrated properly. And I think we spend a lot of time chasing blood sugar's around that might be fixed with a bottle of water.

Jennifer Smith, CDE 4:54
That's a great, great one to bring up and I I in fact, I just I just had a conversation with a mother of an athlete who I specifically addressed the hydration component with. Also around like CGM and to you know CGM is remembers CGM or reading interstitial glucose, not reading blood glucose from your bloodstream. It's reading your interstitial glucose, which means that hydration makes a difference for how well the CGM is giving you data. Same thing for hydration in the body and influence flow and insulin action and movement and everything. You know, if you think about, we all wake up dehydrated. Unless you are somebody who drinks water through the night, you know, every time you get up to pee or whatever. 99% of people wake up dehydrated in the morning. That's why

Scott Benner 5:51
I weigh myself in the morning.

Jennifer Smith, CDE 5:54
Yes, exactly. Call the driveway. Absolutely. driveway dehydrated with no clothes on is the best time to wait yourself. There's another little

Scott Benner 6:04
tidbit to get my arms trying to make like maybe this will get me off the ground a little bit.

Unknown Speaker 6:12
That I that is a really humorous

Scott Benner 6:15
mix of you're just imagining that I'm actually flipping.

Jennifer Smith, CDE 6:19
But yeah, hydration. In fact, it's a it's a trick that I came across myself. In starting to do like workouts in the morning. Knowing that I was dehydrated, I was drinking some water before I would head to the gym and I was like, Huh, blood sugar, even on mornings that I wasn't then going to the gym, and I was drinking my big slug glass of water, you know, like probably it was probably at least 12 ounce glass of water in the morning when I got up. I didn't have that weird, dramatic change in blood sugar, I didn't have the problems post meal that I you know, was trying to beat down with extra insulin before. And hydration is huge. If you drink the big thing of water when you wake up in the morning. Oftentimes, not only does it wake up your digestive system, without a carb component being there to cause a significant rise. But you're also adding hydration to a system that needs it. Your insulin can work better, it can flow better, you've got better circulation.

Scott Benner 7:23
Yeah, it's one of those situations where you can see yourself as diabetes, when you should still be thinking about yourself as person two. And I just gave privately advice to somebody who said they were fighting with what they you know, they were calling it the dawn phenomenon. That's what anybody calls any blood sugar between 4am and 8am that they don't like I guess the dawn phenomenon, like you've no idea, but if it is or not. Okay. And so my we talked through this guy's problem, and I said, I'll tell you what, for about a week, why don't you put a glass of water at your bedside. And when you open up your eyes, just bang it back. And it's my son gets up early in the morning to play baseball, and I tell them all the time, like hydrate yourself right away, it wakes your brain up. It you know, while it does so many things for you. And one of them are a lot of them are the things Jenny just said. And, you know, I started off by talking about how it could stop insulin from doing what you expect. But Jenny makes a great point. And Dexcom would be the first to tell you if you're not if you're not hydrated, your CGM might not work correctly. And maybe so maybe that even goes back to Melissa's question. I don't know. I don't know how well Melissa drinks water.

Jennifer Smith, CDE 8:32
It could be pieces of a lot of Yeah, absolutely. I you know, hydration, even just from that standpoint of overall health. If you think about you know being dehydrated is like having like molasses in January running through your blood running through your system, right? If you think of all the things that are supposed to be circulating in your body, in your bloodstream, all the nutrients and the wonderful things that are supposed to get to certain parts to heal and rebuild and restructure the body and keep you running healthy. If you've got like mud running in your system, think how hard it is to heal and repair your body. Yes,

Scott Benner 9:11
yep, there we go. I fixed all your problems. Have a glass of water.

Jennifer Smith, CDE 9:17
Drink your water to the finish. I agree. Yeah. That my kids don't know anything. Honestly, they're they're excited when they get to have like a glass of juice at grandma's house because they only know water. That's, that's all they drink. They're like

Unknown Speaker 9:32
this is amazing.

Jennifer Smith, CDE 9:35
Like, what is this mom? I'm like this is called juice. Yeah. No.

Unknown Speaker 9:40
But it's amazing is that you enjoy it. That's why

Scott Benner 9:42
grandma's great. And that's that. I have one here. I have one here from Rebecca. And you She asked if you could explain the biology behind blood sugar changes in relation to mood. So the actual biology of it. I mean, I think it's I think it's Something we all recognize, right? Like, the simple one to point out is, if your blood sugar gets too low, you know, I've heard stories that are, that are, are massively sad, you know, from adults, you know, a spouse of a man, especially whose blood sugar gets low and they're still as strong as they were, but now they don't know what they're doing. And they can get, you know, violent even sometimes if your blood sugar's low enough, you know, besides, you know, the ones we know you can get dizzy, lightheaded, sweaty, you know, there's these things that happen. Those are the obvious ones I don't think we talk enough about and I tried to make a point about them on the podcast, because I think a lot of parents don't. I don't think a lot of parents lend enough credence to the idea that their kids are acting like jerks, but but you know, you're also you know, their blood sugar has been 250 for a week. But can you do it? Do you know? Like, can you speak to it on a on a biological level?

Jennifer Smith, CDE 10:54
On a biological level? And I don't know if she's asking if she's asking, like, the biology behind how you feel when blood sugar is too high or too low, or the biology behind? What stress and mood due to blood sugar?

Scott Benner 11:14
Well, I think here's what I took out of it. Wow, Rebecca, we've got three different questions out of your question. Here's what I always want to know, we'll start with me because you know, it's my podcast. So let's go with what I want to know first, what is God? What happens in the brain, like, so when you're low, I realized there's less blood or less sugar in your blood, and that sugar is sort of the energy your brain works off of right? So why do you start losing functionality when it gets lower? And it's not even a diabetes? Question? Really?

Jennifer Smith, CDE 11:45
Yes, I mean, from a I mean, from just basic physiology, your brain does it. It works off of Google's or, you know, sugar, so we have to make sure that we're maintaining his base level, so that our brain can send out all the signals and perform the way that it's meant to essentially that we're thinking about the way that we're supposed to think as a normal human being. If there's not enough glucose there in the brain is deprived. And so it's almost like, almost like the effect of alcohol on the brain. Right? You sort of get this like loopy, inability to put thoughts together, sometimes not very cohesive language that comes out. And you might be talking about very weird things. And people are like, Oh, that's totally not what we're talking about. Are you okay? You know, so when the brain isn't getting that sugar energy that it needs, if it can't perform, it's doing the best that it can. And it's almost like the signals of just are not connecting quite the right way. Or, and that can lead to some mood components. There are many people who have said, especially when I used to work clinically, in patient, there are some older people with type two, who would come in am I, my husband gets belligerent when he has got these low blood sugars. And he tries to throw the jars at me from the kitchen and whatever. And I'd be like, well, don't get too angry at him. One is not thinking clearly, this is what happens with a low blood sugar. You know, these are the ways to prevent it, blah, blah, blah. But that's pretty normal. Some people do have like this brute strength, they get violent when blood sugar gets so low. And again, from a from a true physiology, I don't know all of the real reasons that that happens, other than the fact that the brain is just not getting what it needs. And it It can't think the right way, I have

Scott Benner 13:49
one thing to add. And I have a theory which is based in nothing. But my thing to add is that Arden had a seizure from too much insulin when she was two right after she was diagnosed, like I gave her too much insulin, she had a seizure. And one day, we were talking about it in the kitchen, and I had a video camera out for a completely different reason. And I just pushed record on it. And let her tell me about the the seizure. It's on YouTube, and a lot of people have watched it but a point she says that she sounded like a monster. And she's too and she said she saw colors. And so her eyes didn't work. I saw colors and then they were back or something like that she talked to so she lost her sight during it. I saw it happen because I reached out to put my hand on her and me touching her scared the crap out of her. You were there. I didn't know I was there anymore. And she says she sounded like a monster because she couldn't talk. She was growling. So in her voice, you can hear it in this video. She's like, I couldn't talk. I sounded like a monster. So she was grunting. It was really something in Iowa. wondered, is that your body? saying? Is it confused? Like you're saying like things are just going haywire and I'm about to short circuit and shut off? Or is it shutting down unnecessary systems trying to keep you alive for right? Because it can it's just trying to do your basic function stuff and keep you alive? Like I don't know the answer, but in the in that space has got to be the answer somewhere. Mm hmm. So, yeah. Now that I bummed everybody out, going, by the way, she was fine, but put glucose in her cheek and she woke right up. It was really not that much trouble. I tried Chinese food before I knew what I was doing. I'm better now. High blood sugars though. Cause so I just talked about it. I don't know if it'll make it into this episode or not. But Arden was really dehydrated, her blood sugar got high. And then she got combative. I was like, the more I asked her to drink a bottle of water. By the time our blood sugar was up in the high two hundreds. She was you know, a million with you asking her to drink that water is like I told her to get up fly across the room. And you know, and she was like, I can't do that. You can't it's right there. Just drink it. You know, she flew. Now, I'll tell you the amazing part is she drank the water, her blood sugar came down. We talked again, 45 minutes later, and her personality was right back again. Yeah, why does that even though

Jennifer Smith, CDE 16:18
I mean I, again, everybody's symptoms, and what comes out of them high or low are a little bit different person to person. But from the high standpoint, it's kind of similar highs. And kind of almost what we talked about with the hydration component. There's this like, slog of like mud and muck kind of gunking. Up there, right? There's way too much glucose, so many people complain about, like the fatigue and inability to, like really put the thoughts together and the fatigue component being different than, like, gosh, I just didn't sleep very well. Last night fatigue. The fatigue is an all encompassing mental fatigue, and it feels like your body is weighed down by bricks, and you're trying to walk through mud. That's high.

Scott Benner 17:19
Do you know at all if you stay high, we all know if you stay high long enough, your body tries to get a client listen to it. Does that go away eventually? That like? Or is it is it just a level of effort that you're used to living with?

Jennifer Smith, CDE 17:34
I would say the ladder it's a level of feeling that you get used to living which with which is why many times if people have been living high, and they bring blood sugars down or bring them down too quickly. They can actually have low blood sugars, simple, low blood sugar symptoms at a more normal value until their body again gets accustomed to that more normal value. And they realize then, well, gosh, I feel better. I'm performing better my test results. If I'm a kid, I'm performing better in school, I'm learning better. It doesn't take me three hours to study two math problems I can get through it like this. So there is you know, a deaf a definite difference there. But from from the mood standpoint, you you would be very cranky to if you had this sort of like sluggish. I just why are you bugging me go away, stop bugging me kind of

Scott Benner 18:37
hard to react it.

Unknown Speaker 18:38
Yeah.

Scott Benner 18:40
I've said this a couple of times in the podcast. And I don't know how comfortable people are when I get really emotional and talk very seriously. But I think that one of the reasons I love making this podcast is because I think everyone deserves to be who they authentically would be if they're not being impacted by low or high blood sugars, or variable swings, or any of the things Jenny just explained. So you know, I mean, think about it like that, when you're struggling to figure out how to make a bolus or how to you know where to do Temp Basal. The end result for you is going to be like this person like who they would have gotten to be if they didn't have diabetes and their blood sugar's bouncing all over the place like you owe that to yourself and, and to the people you love is and try your as hard as you can to get to that spot. It's just it's it's unfair to think like a, you know, I talk to people sometimes who are adults, and there's a one that always pops into my head. It's this woman in her late 30s. And she's a single mother of a lot of children. She told me her eight one sees her over 12 years. And I helped her and she got her blood sugar's down in range and very quickly and as happy as she was to see it happen. You could see how devastating it was to her that it was that easy, and that she had lived all that time and you could hear When she was talking to me, that she was beginning to wonder, like, what did I miss in my life that I don't even know, I missed, you know? And so I don't

Jennifer Smith, CDE 20:08
and are some of the mood component if she's got many children that she's managing on her own? What did she Miss in being able, like different communication method or different way of working with and through problems with her kids and addressing things, and even helping them learn and all of those things, you know, along the way, and I mean, now she can thankfully go forward and do what she wants to do and feel good about it and feel good doing it, you know, but

Scott Benner 20:37
I don't talk about my own health on here very often, but I, for some reason, don't retain iron. So a couple of times in my life, I have my irons gotten very low. The last time it happened was in 2019. So you know, you go to a doctor, and you try a new doctor, you think, well, the last time this happened, like I was just like, gave me a bunch of supplements, I never really felt like I bounced back, you know? So I try, I'll try a different doctor. So of course, anyone who knows anything about low iron, the first thing he thinks when he sees my low iron is so you have cancer, because obviously, you're bleeding internally somewhere and we can't see it. So the guy's face changes. And I'm looking at like, in the logs. I'm like, man, I don't have cancer man. Like, I know, I know what you're thinking and all but this happens to me. Can we just get past it? Well, he goes through all the steps. And those steps take months, he wants to do a capsule study of my esophagus, I have to get scoped from both sides, right. That was fun hormones, and drugs. Oh. So I got scope from both sides. I had to swallow a camera. I had to stop eating corn.

Unknown Speaker 21:45
And gluten.

Scott Benner 21:48
None of those things had any impact on my iron, by the way, actually, there's not even the corn and gluten actually made my iron go down. So now they ruled everything out. And I said the whole time. I'm just I'm like, Look, can you just like get a bag of iron and hang it on an IV and jam it in me? Like, that'd be great, you know? Oh, yeah, we'll do that at the end. If none of this other stuff calls, I could never figure out why they wouldn't do it then. So I over this six month period of getting all these tests done, I'm declining, like really looking bad, starting to gain weight for no reasons. And it turns out after I got two bags of iron Finally, and I'm back to my own peppy, happy self. I was and I'm gonna have to bleep this out. I apparently was quite an at around my house. And so I had no ability to like, handle anything. Like Like, if something got annoyed, I was at 100 if I was mad, I was mad if like, you know, if you were irritated me, I was completely irritated. I had no ability that who would even know this, right? And so I was I was terrible. I'm telling you, they put that iron in. And it was back to you back to myself right now. Now, here's the problem. And the reason I bring this up, even though my family knows that, intellectually, it didn't stop them from having to live through it. Of me just being unpleasant. And I think that that's something to keep in mind too in extended families, like with diabetes to have blood drawn, always lower, always high. Even though you know cognitively Oh, it's because of their blood sugar. It doesn't mean that you don't feel it the same. Like you

Unknown Speaker 23:24
know, like it could handle it.

Scott Benner 23:27
Yeah, it could mess with it with your relationship. So yeah, all the time. I tell you, it's far easier to stay in range and all the good things that come with it. I think this is another good thing that comes with it. I think you get to be yourself and get to have the relationships you are going to have then you can just hate each other for the right reasons.

Jennifer Smith, CDE 23:45
Right? Absolutely. You can be angry because of spilled milk because it really is spilled milk. Yeah,

Unknown Speaker 23:51
but at least you'll be

Scott Benner 23:53
released. You'll hate them for the right reason. Damn it, there'll be clarity. Right? That's all right, exactly. That's fun, Jenny.

Jennifer Smith, CDE 24:02
Iron you. Do you get enough vitamin C?

Scott Benner 24:05
I believe I do. Although By the way, now that I stopped they made me stop eating gluten and corn. I was just like, huh that's cool. Now I have a hard time eating food anymore. Like I'm almost a vegan. I'll tell you what stopped me from being a vegan. I don't like vegetables. But I seriously like now my body doesn't even like i don't know i don't i don't do that well with like meats and proteins anymore. Like I'm just an easier when I'm not eating. I did a baked potato fast one time. I've never been happier.

Unknown Speaker 24:38
Just eat bacon.

Scott Benner 24:40
I was thin as I'd ever been nice. I felt great. some wonderful. It has all the vitamins and nutrients I needed anyway. I don't know what happened.

Jennifer Smith, CDE 24:47
Well, I've never heard of. I'll tell you about it privately. Never heard of the big potato fast. Yeah, that's okay.

Scott Benner 24:54
huge thank you to in Penn for sponsoring this episode of Ask Scott and Jenny Check them out at companion medical comm if you're an MDI user looking for a smarter insulin pen, or you're just a person who you know, doesn't want to pump, this is the way to go in pen. Rox companion medical.com. If you'd like to see the in pen in action, you can see it and Fiona Wilds hands a lot. At her Instagram page, it's Fiona fo na underscore wild w YLD. Go check her out. At the end of this, I'm going to put in the audio from that YouTube video I told you about about art and describing her t shirt. It's a little noisy. So you can try it. If you don't like it, skip out on it. And then you can maybe find it on YouTube. But uh, I just thought I'd put it here in case you're interested. But it's old audio from like an old video camera. So, you know, let's not expect the clarity that you're getting right now in my voice.

Are you talking about when your blood sugar gets low? Like you weren't able to talk? Right? And then what happened? Did your voice make a different sound? Do you remember that?

Unknown Speaker 26:27
It means like

Unknown Speaker 26:31
evil.

Scott Benner 26:32
How did your eyes work when you're having your seizure?

Unknown Speaker 26:37
Free by doing so.

Scott Benner 26:44
It was real dark and it was scary. You feel like you turned into a monster? Yeah, you didn't turn into a monster sweetie. You couldn't see. And you couldn't talk? Yeah. You didn't know you were doing it. No, we don't think you knew you were doing it. It happened because your blood sugar got low.

Unknown Speaker 27:08
My eyes got

Scott Benner 27:11
trick I created I changed colors again. Yeah. Oh, what? Oh, you just saw that the camera was pointing at you. Yeah. Yeah. You don't want your picture Dagon? No, I just thought people would think it was interesting to hear what it sounded like when you're having your seizure.

About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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Scott Benner 11/4/19 Scott Benner 11/4/19

#276 Because Carbs Man

Kelsie takes the cake.…

Kelsie is a cake decorator and flower artist who has type 1 diabetes. Kelsie is feeling better about having a baby since finding the Juicebox Podcast..

KelsieCakes.com < check out her work!

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Scott Benner 0:00
Hello everyone and welcome to Episode 276 of the Juicebox Podcast. Today's show is sponsored by Dexcom Omni pod and dancing for diabetes, you can find out more@dexcom.com forward slash juice box, my Omni pod.com forward slash juice box or dancing the number for diabetes.com. There are also links in the show notes of your podcast player and at Juicebox podcast.com. This week on the podcast we'll be talking with Kelsey. Kelsey has type one diabetes. She is a cake decorator, and she sent me a really wonderful email. Now Kelsey starts off a little nervous, but give her time because she warms right up. We almost call this episode because carbs man but instead I'm going to call this one

Unknown Speaker 0:58
I want to be like

Scott Benner 1:01
cake Daya. Boss Daya Cake Boss Daya. But I like because carbs man. Maybe I will call it because carbs man. Alright, I'll figure it out. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Quick note, for those of you in the Pennsylvania area, more specifically Valley Forge, or even more specifically track PA, I'm going to be doing a pop up podcast there. It's going to be a live event. We're not recording it just getting together and talking about being bold with insulin. I think there's about 40 tickets out so far the place holds 100. It's happening this Sunday, November 10 2019. And you can reserve your spot absolutely for free. on my Facebook page, find us bold with insulin, then look for the events.

Kelsey 1:59
My name is Kelsey and I've been diabetic since I was 10. On and ready to

Scott Benner 2:06
look after the Oh, there we go. So you he was like so just you know, introduce myself. That's easy. And there was a pause. I'm like, well, maybe it's not that easy.

Unknown Speaker 2:16
Maybe you know,

Scott Benner 2:19
first of all, there's nothing to be nervous about. I appreciate that. Some people are well, we'll get to a point where you won't be I promise. I'll start right. Okay. Take it up for you. You were diagnosed when you were 10 years old. But how old are you now?

Unknown Speaker 2:34
I am 27 Okay, so you were diagnosed?

Scott Benner 2:37
17 years ago?

Kelsey 2:39
Yeah. Can you do?

Scott Benner 2:40
Math makes people comfortable? 10 years old. 17 years ago, it's 2019. Now you were diagnosed in 2002. Am I right? So yeah. Oh my god, right. 10 years old. What were you middle school like sixth grades?

Kelsey 2:57
Yeah, it was right before Middle School is the summer between fifth and sixth grade. People are probably pretty impressed now with my ability to manipulate time and distance and

Scott Benner 3:08
weird little time, right? Like you're pretty young siblings, siblings, any brothers or sisters?

Kelsey 3:14
Yes. I am the oldest of five. So I have two brothers and two sisters.

Scott Benner 3:18
Parents together. Yeah. Okay. They have to be they're busy making babies all the time. Right? How would they?

Kelsey 3:24
Yeah, that big crazy family.

Scott Benner 3:26
Kidding. So there's so there's five of you. You're the oldest your mom and dad have a lot of younger children. Yep, their oldest one who they're probably starting to think oh, that that Kelsey kids she could probably start cooking for us soon. You take some of the burden away. Right? And and then you're screwing around in the summertime watching cartoons running around outside What happened?

Kelsey 3:48
It was actually a, like a normal doctor's appointment before you change schools like make sure my vaccinations are all in order and all this fun stuff. Um,

Scott Benner 3:59
so that's when I was diagnosed. showing any signs or did they just do a finger stick?

Kelsey 4:05
Ah, yeah, so I'd been like really tired all the time. I'd lost a bunch of weight and going to the bathroom all the time. All the classic science. Um, I think my parents kind of suspected but it was like, Oh, I don't know, maybe it could be diabetes, but it wasn't like something they were really thinking about. Until they went to the doctor.

Scott Benner 4:26
A lot of strange things going on with you and they bring it up. Do you remember the doctor? They say hey, Kelsey is like weird. Like, can you look at her? Or was it? Like you don't mean like they were they worried enough to say something? Or do you not know?

Kelsey 4:41
I honestly don't remember how that went.

Scott Benner 4:44
Listen, as I'm asking you I have to be perfectly honest. I remember nothing from what I'm 10 nothing at all. And 17 years ago, I was 30. And I don't remember anything from that either. As a matter of fact, I don't remember much from last week. So I just wanted to know if it was a good like a kind of like a landmark in your life. Can you really remember? Not so not so much like so the diagnosis is what it is. You're off. I'm assuming you started with needles or pens. But how did you start? I

Kelsey 5:09
started with the syringes.

Scott Benner 5:11
And just a meter, right? There was nothing else to it. Yep. Okay. Now, were you like, how do you remember management back then? Was it about food restriction? Was it about counting carbs? Did you not really pay close attention to it? Like, what was the vibe around your house?

Kelsey 5:29
Yeah. So when I first started, we were doing exchanges. So it was like, I had to count my carbs and you have 15. Okay, like for breakfast, I would have 45 grams of carbs. And for dinner, it would be 60. And for snack, it would be 15. So it was like, very, like, regimented at first,

Scott Benner 5:49
and that is that associated itself with how much insulin they were giving you. So were you on regular an MPH? I think it was human login, mph. humalog. An mph. Okay. And so I don't know how many people nowadays realize that. But it's very interesting that not that long ago, the idea was you had to count up a certain amount of carbs. And those were your meals. Did you feel a lot of pressure to finish your food?

Kelsey 6:13
Oh, I guess I did. I haven't really thought about this in a while. But well, yeah. Like, if you don't finish this, then there's apple juice.

Scott Benner 6:23
Because I mean, what I'm learning right away is that you didn't grow up in a lot of with a lot of pressure.

Kelsey 6:29
No, not really.

Scott Benner 6:30
No. Did that management lead to outcomes that you were hopeful for? Like as you got older? became like a teenager? Where Yeah, what was your a one see like, Hey, hurry, onesies? Fine. This is all going great. Are you a person who was in the doctor's office? struggling? or How did it go as you got older?

Kelsey 6:48
Um, I want to use usually seven something. So everybody was like, that's good enough. So that's kind of how things went. It wasn't super drugs or regimented. It was like, you're doing all right. See

Scott Benner 7:01
any big problems, seizures passing out? Like, nothing like that?

Kelsey 7:06
After the original diagnosis? I hadn't been to the hospital sense. Knock on wood. So everything just was kind of tripping along

Scott Benner 7:16
sort of the way they described, it was going to like, Look, you'll count this up, you'll shoot this in and everything will be fine. We need your agency to be somewhere below this. And it always was everything just sort of worked for you.

Kelsey 7:26
Yeah, it was like he said, it wasn't like amazing. Nine, it was just kind of like, this is good enough. Well, that's kind of how I always looked at it.

Scott Benner 7:35
And now today as an adult, do you live on your own? Yes. Okay, and what technology you're using now? Are you still using pens and a meter?

Kelsey 7:44
I have a Omnipod index. com now.

Scott Benner 7:46
So you've, you've upgraded. Now, when did that happen? And what came first?

Kelsey 7:51
Omnipod came first. I got that in 2011. I had a mini med before that. And then the Dexcom I got it. Three years ago, I think.

Scott Benner 8:01
Okay, so let's go back to when you went to, you know, when you first had your insulin pump, or the mini Mater, whenever? Did that change your management? Or did that just sort of eliminate? Like, injections? How did you think of it?

Kelsey 8:15
Um, it definitely changed how I ate because I wasn't like restricted to that.

15 gram type mm regimen.

Scott Benner 8:26
Hey, when's the last time you checked out dancing for diabetes.com. If you haven't in a while, I'm telling you, now's the time. They're just about to put on their yearly extravaganza, a huge dance event, you're not going to want to miss it. There may still be time to get tickets, I'm not sure. But if there isn't, you're at least going to be able to see plenty of photos and video from an amazing day. Dancing the number four diabetes.com getting a pump back then the idea was, Oh, this is great. Now you can count your carbs and push on this button on this pump and then eat and you can you can stop doing this this exchange program for carbs for insulin.

Kelsey 9:06
Right? Yeah, it was like you can eat whenever you want now. So

Scott Benner 9:11
was that exciting? It was pretty awesome. Right? Like and so but so that was the unit hold. Were you when that was I'm sorry? around?

Kelsey 9:18
Oh, it was 11 when I got the pump. So I had been diagnosed for a year.

Scott Benner 9:22
Okay, she did the exchange for a year then you went to a pump pump for a while. When do you add a glucose monitor?

Kelsey 9:28
That one was three years or the continuous glucose monitor was three years ago.

Scott Benner 9:32
So more recently?

Kelsey 9:34
Yes, very recently. Did that change things for you and changed everything? Yeah.

Scott Benner 9:39
How so?

Kelsey 9:41
Well, before I would like, you know, test when I ate and then if I remember to i'd test after, you know, two hours later, but I never really paid attention to my blood sugars in between mealtimes unless I felt bad. So I got the CGM and I'm like, Oh my gosh, look at all this information. I didn't even know So I actually started paying more attention.

Scott Benner 10:03
Okay, and so that having more information made you think like, wow, there's more here for me to understand. I'll dig down into this a little further, did that right immediately exchange or exchange that immediately? Create a lower frequency or less spikes? Or like, what was the first thing you saw? When you saw? I guess my question should be, what's the first thing you saw when you had a glucose monitor? Was that Wow, my blood sugar goes way high or goes way lower. What struck you?

Kelsey 10:29
Oh, yeah, I think it was just I didn't realize all the ups and downs that were happening in the background.

Scott Benner 10:37
Have you mainly been able to get rid of those?

Kelsey 10:40
For the most part, I still have my off days, but it's a lot better.

Scott Benner 10:45
Okay. Oh, that's interesting. So now, I would tell you that with Arden, we see a spike once or twice a day, but we get them back quickly. But yeah, but we don't have days where like, everything just goes to like hell. And then we get back. But I do know some people say that, like, it's just like, you know, I'm going along great. And then something doesn't match up my I hit the roller coaster, and then I'm just on it. And right, is that what happens?

Kelsey 11:13
That definitely still happened?

Scott Benner 11:15
I would understand that I would imagine to it's wrapped around your day, right? Like you're at work, right? Like what kind of, you know, tell me where you work. But what kind of work do you do?

Kelsey 11:23
I am a cake decorator?

Scott Benner 11:25
No kidding. Oh, that's so cool. I can't believe you just said that. All right here. Alright. It only took us 10 minutes. Now we're going in a different direction. I can't believe you just said that. Because yesterday, driving home, my wife, my wife was like, look at this video of people decorating cakes online. So I'm driving Yes, holding a phone up in front of me. And and she's like, it's amazing. And they she starts talking about how they put the icing on. And she's like, I wish I could do that. I think I could do that. And I was like, you think you could do what and she's like, you know, they take that metal spatula, they make it really smooth. She's like, I feel like I could do that. So, but you don't know about me, Kelsey, is that going from middle school to high school, I was not maybe a very dedicated student. That'd be I think that's a nice way to say it. I didn't love school a whole lot. And there was this assembly one day, this person comes over and says I'm the principal, the technical school. Oh, and I was like, there's a tech what I don't even understand what he was saying, you know. So it turned out that back then, in like the 80s, you could go two weeks a month to regular high school, and then two weeks a month to learn a trade. I thought, well, I don't really want to learn a trade. But I definitely don't want to go to high school for three solid years. So let me look into this. So So I go on the tour. And it's like small engine repair. And like all these things that I'm just like, I don't care about that. I don't want to learn how to weld. I don't care about this. And I was like what's in here, and I walked through this door. And Kelsey, I'm not gonna lie to you. It was the room that I had been in that day with the most pretty girls. So like, I was like, What is this place? This is the place Scott's going to come in high school. And it was the bakery. So hey, I learned to bake. I can make bread, you know, 150 pounds at a time, not a low for the time. And like I can run an oven the size of two of your cars and things like that. But the one thing I couldn't do, Kelsey. Yeah, I couldn't decorate anything. I have the I'm like so heavy handed. And I could just never make it right. I would try and try. So I want to like how long have you been doing that? Like, how did you get started with that?

Kelsey 13:30
So I started in high school, I taught myself and then all the jobs I had like in college and everything were in bakeries. And after I graduated college, I just stuck with the bakeries

been doing this for

10 years.

Scott Benner 13:50
And so you just and so you and it's not like the overnight thing cuz I tried to get a job in a bakery after school. I was incredibly qualified, but they wanted you to start working at like 130 in the morning.

Kelsey 14:00
Yeah, so I definitely did that for a while. did not love

Scott Benner 14:04
that part. Yeah, that's not good. So you just come in at like a regular time and you and you sit and you look at the orders and you and you decorate cakes. Yeah, that's very cool. How do you keep from eating the icing? I know the trick is that after you're around it for a while, you really don't want it anymore, but

Kelsey 14:19
exactly the same as it is to it.

Scott Benner 14:23
So here's the thing I learned in the bakery that is that seems to skeeve people the most when you're making cinnamon buns. Take the dough before it's cooked. and dip it in the melted butter and then in the cinnamon sugar and eat it raw. It's so good. So good. It's amazing. Anyway, I that's what I know about bakeries. But okay, so you're sort of working independently most of the day, right? You're not probably around a bunch of people. Are you probably in charge of your time and everything like

Kelsey 14:54
yeah, I work in a pretty small shop. So there's only three of us and they're

Scott Benner 14:58
cool. That's right. I'm gonna have to get you to decorate a cake for me. Where are you at what? country?

Kelsey 15:03
I am in Tampa, Florida.

Scott Benner 15:06
I was just in Tampa. Oh, no way. A week ago, I was down there to watch my son play baseball. Oh, that's cool. Oh my gosh, that airport is nice. I have to tell you. Yeah, I fly out of Newark and not a nice airport. Yeah, yours is much nice Pampas is it's a nice place. Like it was a little, little on the cloudy side when I was there, but I had a good time. Okay, so. So you and I are talking right now, because we tell a little bit of a story. My daughter's diagnosed a very long time ago, probably around the time you were you were 2002. She was like 2006. And when our son was diagnosed, she was two years old, literally just had had her second birthday. We're in the hospital for a couple of days. And I think on the second or third day, they make us go to a carb counting class, which is ironic because I don't count carbs anymore. in there and freaking out, you know, with like seven other families who'd all been diagnosed around this couple of days. We come out of that class. And it had been enough time had passed since Arden's diagnosis that things started sinking in, he started having different thoughts. So we're walking out of that class pretty dazed. And I'm pretty sure I was dazed because I was like, I'm not gonna I don't want to count her carbs for the rest of her life. That sounds horrible, you know? And, and I looked at my wife, and I said, Do you think we're going to end up getting divorced because of this? Because that's how it was starting to strike me that this was difficult, and, you know, anxiety ridden? And that, Oh, my gosh, I wonder if this will impact our marriage. And my wife says, I don't think that's gonna be a problem. But I could tell by looking her face, she was thinking about something else. I'm like, Well, what do you think the problem is gonna be? And my wife who does not get emotional, because of her Irish and Catholic background, does not allow her to access her feelings. She looks at me and kind of swells up and starts crying and she goes, do you think Arden's going to be able to have a baby? And I was like, I don't know. I never thought of that. I'm like, Why are you bringing up other stuff? You know, like, like, stop saying horrible things. I just said a horrible thing. Let's talk about my heart for a second. But that was my wife's concern in the moment, right? Yeah. And so, Kelsey, I don't know that it may come to a surprise to people. But I receive a lot of correspondence from you guys, which is always fantastic. I get it a number of different ways, emails, social media, all this stuff. But you sent me a note in like October of 2018. That hit me in so many, like, places in my chest, heart and mind that I stood in my house and started to cry a little bit. And so I read your note, and I got all like, kind of filled up. And I was like, This is so nice. And I felt good about myself. And I was like this podcast is really helping people. And like, it was very overwhelming. And sometimes I'll like, just get a note and it makes me smile. I sometimes I'll get a note. And I'll be like, Oh, I never thought of that. Like, they all take me in a different way. Yours took me in all the directions at the same time. And I read it on the podcast at some point, but I'm gonna read it again here. And then we're gonna start talking about the core of it. Right? All right, so you said, Hey, Scott, I just want to say thank you for the podcast and making diabetes management actually seemed manageable. I found your podcast that summer when I was looking for details about the future on the pod products. And your interview with them was the only information I could find. Then I dove into the older episodes. And of course, listen to the classic Episode 11, which is bold with insulin. I honestly never looked at diabetes management that way before. But I changed my mindset completely, as corny as that sounds and tweaked my basal rates and my ratios and changed my dexcom alarms and started treating highs aggressively. And here I am three months later, with my agency down for 7.1 to 5.5. You're like holy crap. I don't know. If it's been that low in 16 years that I've had diabetes. Now. That's all really well and good. And had you stopped writing there? We wouldn't. I would have just been like, Oh, this is nice. Kelsey is having success. The podcast is doing what I want. I would have went on with my date. But then, Kelsey, you kept writing. Again, this is right. This is what you made me cry. I'm getting married this December and thinking about having kids. And before I found your podcast, I don't know how I would have ever felt comfortable enough to try to get pregnant with an A one see around seven all the time. But going to the doctor's today and seeing the 5.5 was so exciting. It was just a relief. I can do this. So thank you for showing me what is possible and giving me the confidence to do something about it and thank you for keeping me bla bla bla bla bla and now I'm standing in my kitchen thinking Kelsey, Kelsey is gonna get to have a baby and I kind of jello it up a little bit. I was like shaky and everything for a half a second. I was like this is amazing. And I think this is just your note is a big idea, right? It's all the things that we don't really talk about around diabetes, that, that you had a seven, seven was good. But you didn't imagine that there was better, you couldn't have imagined it, no one was telling you how to get to it. And that quietly and privately in your head, you were thinking, I probably can't have children. And I want to talk first about that, like with you and your fiance. Do we say his name? What's his name? Is Ryan Ryan. So you and Ryan, have been dating for how long?

Kelsey 20:34
We dated for four years.

Scott Benner 20:39
And at some point in those four years, you're like, I'm gonna let this Ryan guy marry me at some point. You didn't tell it? You didn't tell him but you know, I'm assuming. Right.

Unknown Speaker 20:47
Right.

Scott Benner 20:48
And, and you gotta keep him working. He can he can, of course. So you're thinking about that. And you think I Brian probably wants to have a family. I want to have a family, but I don't think I can. Can you talk about the anxiety and the kind of stress that comes with having private thoughts like that?

Kelsey 21:05
Yeah, it's very stressful. Because it's a conversation we had talked about, um, it was like, we were kids. We gotta get this diabetes thing locked down. Um, but, you know, even when he was so supportive about it, it's still like, this is on me. I don't know. It's gonna be really hard. I'm just gonna have to eat like, eggs and cheese for nine months. Because barbs man,

Scott Benner 21:37
I have to tell you, strong chance this episode's gonna be called because carbs, man. And so that's my, that's what I was getting at, like. So the first things first is you guys are in this together, but it feels like it's on you. Right? Well, absolutely. And if you can't accomplish this thing, if you can't figure out how to just eat, you know, eggs for free. I can't believe that was your that was your fallback plan.

Kelsey 22:05
That was it. That was like eggs don't affect my blood sugar. I can eat.

Scott Benner 22:11
Hold on a second. I'm laughing. It's

cold. So if I start laughing, I'm gonna cough. So when when that was your plan, that didn't seem like a really, like, something you were really excited to do? I would imagine the same time you probably weren't sure if you could do it. Like, but did it ever occur to you? Like, what if I get three months into my egg plan? And this baby grown inside of me? And suddenly I'm like, Oh my god, I can't eat eggs anymore. Right? And then it feels like what? Like you're letting the baby down? Or what?

Kelsey 22:42
Exactly, yeah, that's a lot of pressure. Yes, right. Oh, yeah.

Scott Benner 22:46
what's already hard enough to be a person. I think it's harder to be a woman. You guys have the deck stacked against you in a lot of different ways. Mostly it's imposed by men. And and so all this is going so you have this feeling like oh my gosh, this is on me. Right? I have to do this for the health of the baby. Not just the health of the baby. But for the idea of building a family for you and Ryan. So you could you could let yourself down with the baby down. Let Ryan down. Let the egg market down in Tampa, which is probably relying on you for some some heavy funds coming in. And so there's a lot there. Did it make you feel like maybe I shouldn't try to have a baby.

Kelsey 23:29
I don't think I ever thought I'm not gonna do this. But it was kind of like a, I'll just keep putting this off. And feeling.

Scott Benner 23:38
Oh, no kidding. Oh, that's interesting. So if if so, are you married now?

Kelsey 23:43
Yes, we got married in December. Congratulations.

Scott Benner 23:46
Well, how are you finding it so far? Has Ryan become annoying? And you realize now you don't have a baby with him?

Kelsey 23:52
No, we're still in the honeymoon phase. So

Scott Benner 23:56
your your marriage pancreas is still working? Is that right? Exactly?

Kelsey 23:59
Yeah.

Scott Benner 24:02
I always tell people that honeymoon phase and diabetes is called the honeymoon phase for a reason. And it was named by people who have been married for longer than a year and a half. So that's great. So congratulations. You guys are on your own and you're you know you're you're doing your thing. Is that noise? Can you tell me what that noise is? Because I'm just gonna wander.

Kelsey 24:23
Somebody is blowing leaves

Scott Benner 24:26
outside the window, or something like that. That's fantastic. Why are their leaves in Tampa?

Kelsey 24:31
I don't know. I mean, we got

Scott Benner 24:33
we got trees of trees. It's not like a paradise down there. Just cactuses and palm trees and everything right?

Kelsey 24:40
I mean, at the beach, but not

Scott Benner 24:41
downtown. Are you like right in the city?

Kelsey 24:45
I am like right outside the city. Gotcha. Gotcha.

Scott Benner 24:49
Okay, so now, by the way, first of all, I shouldn't tell you what to do. But please don't have a baby too soon. It's not good for you. There's A lot of great things to do, and all that stuff. But now at a 5581 C, can you tell me like, what would? What changes do you think got you from seven to five, five? You're gonna want to check out the Dexcom g six continuous glucose monitor, and you're gonna want to do it. As soon as I'm done talking, or you know what, at the end of the episode, go to the links in the show notes or Juicebox podcast.com. Get yourself to dexcom.com forward slash juicebox. And here's why you want to do that. today. It is right now I'm recording this noon on a school day. Arden left for school this morning. Her blood sugar was on the lower side. Low 7071 72 and it's kind of laying there. But she wasn't hungry. So what would you do in that situation? You probably give him food. What we did was nada. We watched Arden's blood sugar, and we got four hours, excuse me, four and a half hours of a 72 to 75 blood sugar. Now how are we confidence thing there? Dexcom right, because the G six is sending back constant updates about what Arden's blood sugar is doing. Is it going up? Is it going down? Is this thing steady? And it seemed that today it was staying steady. Even without food, too. We wrote it out. And she got four and a half beautiful hours. We were able to then Pre-Bolus for lunch. And right now, an hour after her lunch. Arden's blood sugar's 121. And super stable. Partly because Dexcom showed me that we missed a little bit on Arden's meal bowls, we were able to add a little more insulin after she began to eat. That's how you bump and nudge. That's how you use the Dexcom to your advantage. Let's I mean, we didn't even talk about the share and follow features. I mean, obviously, I'm seeing Arden's blood sugar, and she's not with me, where the fact that there's zero finger sticks required none of that. I mean, there's just so much to say, two minutes isn't long enough dexcom.com forward slash juice box. So links in your show notes or Juicebox podcast.com. What changes do you think got you from seven to five, five?

Kelsey 27:05
First thing I did was changed my basal rates. Um, because I don't think they were high enough. Okay. And then the other thing I did was I started Pre-Bolus thing. And then I also was more aggressive about correcting highs, whereas before, I'd be like, Oh, I don't want a second slim. So I'm just gonna wait and see what happens. But now like, I'm getting this thing down. Nice. That's excellent. So you've, you've outed the fact that the podcast is really just a few very simple ideas put together in my mind.

Scott Benner 27:41
And and look how well it worked out for you. I mean, honestly, 71255 is an incredible like, like, change. So my question is, you're pretty expected. So but so that's interesting, right? So when I, when I talk to a lot of people privately, they'll they'll say, like, you know, I don't know where to start, and they show me their graph. And look at the graph. And the first thing I think, is you your Basil's wrong, because because, you know, because if your blood sugar is not sitting at 85, constantly when you're not eating, then your bazel is not as high as it could be, right? Like talking about getting low and everything like that. But I'm just saying if you're sitting at 150, you're, you know, 150 because you don't have enough insulin at the right time, and that that, you know, counts for bazel as well as boluses. So, it's an adjustment for bazel. I think always kind of the first step. Yeah. Right. And you have to make sure your basal insulins, right, if your basal insulins wrong, nothing else is really going to work. At the very least you're not going to be able to kind of like diagnose what's going on. Like you can't figure out what's wrong with a bolus, if you're Basil's that far off. So okay, so then you move your alarms on your Dexcom. I want to right, yeah.

Kelsey 28:55
So I didn't have the high alarm on my Dexcom at all, like I turned it off, because it beeped all the time. And it annoyed me, which I know is not like kind of not the point. But I set it to 130 I'm actually you know, keep it under there now.

Scott Benner 29:14
Nice. And just you just bump it a notch and you're just hitting that 130 and bumping it back. Exactly. People listen, listen to what Kelsey is telling you the podcasts where you have to you can't just listen and think that guy's full of crap. I don't want my thing to be all the time. I mean, does it really beep that often? No. It doesn't now No. Yeah. How long did it take you to get from? I don't think I can keep this under 132. Wow, I can't believe how long this stays under 130 during the day.

Kelsey 29:42
I think it was like within the first week that I was like, Oh my gosh, this was working. Remember going out to dinner with Ryan and being like, Oh my gosh, look at this graph. Can you believe this?

Scott Benner 29:55
Did that immediately make him think he was gonna get that sex cuz he was like, oh my god. She's ready to have it. Baby like I would have been like, this does not mean you can give me a baby. So

Kelsey 30:06
I'm just gonna quite make that leap.

Scott Benner 30:08
Yeah. That's what I'm glad that Ryan's got his head on straight and he's not like apparently I am. That that's really cool. So I don't October, November, December, January, February, March, April, we're like you're six months into this idea. And it's going along pretty well. Have you had a second a one? See since then.

Kelsey 30:29
I actually haven't I had a doctor's appointment scheduled. And then I was going to be out of town and they couldn't fit me in April. So I have it

Scott Benner 30:38
set up. Okay. So I'm going to ask you to do something for me. It's March now. We can get that doctor's appointment. Would you send me your next day Wednesday, because when I added this, I'll put it in. Okay. So true to her word, Kelsey sent me that email that says this, Drumroll, please. Because I just got my latest a one C and it was a five, five again. I know it's just a number. And then she put some parentheses. And I did have an after breakfast bike of 210 today. So thank you diabetes, for keeping me humble. But I'm really proud of myself. We looked at all my past agencies, and they were all in the sixes and sevens, and an eight even. So I felt like I could let this big breath out that I've been holding in for years. Plus, I just feel better without the constant up and down rollercoaster. You're a shining example of what we talked podcast like seriously, study your, your website again. A case study case. Yes. A case study in cake decorating and bow and bolusing at the same time. Do you agree with me? Just to go off for a second? That icing shouldn't be too sweet? Oh, yes. Right. Yeah. And it can't it can't be greasy.

It needs to be right.

Kelsey 31:48
Yeah, I don't know. My favorite, I think is called Italian marine. And it's very, like creamy and smooth and buttery, but not too sweet. That's

Unknown Speaker 31:57
the best icing sounds amazing.

Scott Benner 32:00
I just think that some people make icing too greasy. Okay, it's not good. And then some people use way too much sugar. I don't like that either. So see, everything's about balances. Your boluses That's right. Everything really is. Okay. So I like this. So you're you're moving along the idea. You figured out the the alarms on the Dexcom. You figured out bumping and nudging you figured out your basal rates? Do you eat a fairly regular what we would consider regular diet?

Kelsey 32:32
Oh, I think for the most part,

Scott Benner 32:33
yeah. So you're not like very low carb or something like that?

Unknown Speaker 32:37
Yeah. Okay.

Scott Benner 32:40
Kelsey, I'm so proud of you. I really don't even know each other. And I'm so incredibly proud of you. I'm over being mad at you for making me cry. And I'm up to being proud. It's astonishing. So tell me a little more about like your debt.

Unknown Speaker 32:54
You work every day?

Scott Benner 32:56
Um, yes, pretty much you get up in the morning Do you eat before you go to work? Or how do you handle your life?

Kelsey 33:01
Yeah, get up, have a cup of coffee, eat breakfast, and then head out the door.

Scott Benner 33:05
Would you eat today?

Kelsey 33:07
Today I had a slice of toast. That was it. I was gonna eat a banana. But then right at the last one.

Scott Benner 33:16
Ryan, you can't eat the last banana man. Like, do you need me to talk to Ryan? You can't empty the trash and I put another bag back in it. Yeah, eat the last day food. You can't insinuate that anything that Kelsey said is in any way crazy. Never use the word crazy. You never want to say that. I could tell the kid what to do. If you haven't called me but. But he'll figure it out along the way. The The trick is Kelsey, will he figure it out? Before you want to throw him off of an overpass? That's really the whole trick. I'm sure he will. So you had a piece of toast to do Pre-Bolus for the toaster. How did you handle that? Was your blood sugar? Yes.

Unknown Speaker 33:53
Nice. Hello.

Kelsey 33:54
115 before breakfast?

Scott Benner 33:59
How long before?

Kelsey 34:02
How long? Um, 15 minutes before?

Scott Benner 34:06
It's your Do you remember what your blood sugar was before you? Pre-Bolus?

Kelsey 34:09
I think it was like 112 115.

Scott Benner 34:11
Nice for you nice and steady overnight. I think I was excellent. Now tell me about this. If you don't mind, we've already talked about other things that are private to you. How can you find managing your period?

Kelsey 34:24
Um, it? Well, very interesting. Um, I have had an IUD for the past year. So I haven't really gotten a period. So as far as this new style of management, I don't know. But before it was kind of all over the place. Okay. Um,

Scott Benner 34:42
I was just wondering because I that's a question. I get a lot from people. I go, yeah, okay, this is all well and good. But what do I do when I get my period and I always give them the same advice or I don't give anybody advice. Kelsey, actually nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise and always consult a physician before making any changes to your medical plan or because But with insulin, but when people bring that up about their periods, I say, look, in my world, when this happens to my daughter, we just you know, all I look at it as is the diabetes as being more aggressive, it's it has bigger insulin needs and you have to be aggressive back with the insulin you use. fluctuates a little more, but in the end, it's you know, it's hitting harder, you need to hit harder back. You have an IUD, which I'm assuming Ryan takes personally, he's like, I knew she didn't really want to baby this whole. anyone see thing was a smokescreen. And now she's got a one seat down says you have to do something else. I'm joking. We're Ryan taking shots in this for no reason whatsoever. Again, it's fine. He'll deal with it.

Unknown Speaker 35:45
It's a good point.

Scott Benner 35:46
That's excellent. Good for you. That's really cool. What does he work? You guys work together? What does he do?

Kelsey 35:52
He was an engineer. So he's like the opposite of a cake decorator.

Scott Benner 35:55
Not really your engineering a cake cakes are symmetrical. It's the same thing.

Kelsey 36:00
That's true. You got to stack them and make sure they don't fall over. And yeah, there's a little bit of engineering.

Scott Benner 36:04
So what are you what what do you put in on your, on your LinkedIn? Now? You should say that you're a confection engineer.

Kelsey 36:13
There you go. I like that. I

Scott Benner 36:14
got write that down. Yeah, that's it. Kelsey, your infection engineer. That's exactly what you are. You can't tilt it can't be. It's got to be symmetrical. It can't fall over needs to support its own weight. You have to be able to add other things to it without changing its its integrity. Are you kidding me? You're an engineer. I bet you I bet you Ryan can't decorate a cake.

Kelsey 36:34
He's done before. He's uh, he's alright.

Scott Benner 36:38
He's alright. I was so bad. Maybe some birthday cakes. I have. I have decorated cakes in ways that made me not want to eat them when they were over even knowing that they would still taste Okay, you look at them. Or something wrong with it. Now. It's not easy is what I'm getting at. It's a little practice. You use a spinner like when you're like, initially like do you like spin a like you put a cake on something? flop? Somebody? turntable? Yeah. Why would I advise I never able to do that. Do you think?

Kelsey 37:12
Like it's just practice, but

Scott Benner 37:15
I have no patience. If I had patience and accounting, yeah. If I had patient scelzi, this podcast wouldn't exist. And I would have no idea how to get my daughter's a one seat on anything. Because if I was patient, I would have listened to the doctor stayed patient and continued to try to know what he was telling me to do. Instead, I was just like, Oh, this is stupid. I'll figure this out myself. Like a better approach. So far. So good, right? Yeah. Okay. All right. Um, what are you excited about moving forward? Are you thinking about new technology? Or are you pretty happy with where you are. Usually, I like there to be a little more space in between the ads, but this is a good spot for this one. And then we can roll right through and talk to Kelsey the rest of the way better diabetes, as the story unfolds, and she gets a little more comfortable. Okay, that took 20 seconds, sorry, on the pod, go to my omnipod.com forward slash juicebox. Do it today because when you do, you're going to be able to get a free absolutely no obligation trial of the Omnipod. That's right, they will send you a demo directly to your home. They call it the pod experience kit. It's a pack like a kiss from Omnipod that comes through the mail. Absolutely for Free. That does not oblige you to do anything after that. I'll tell you why this is amazing because then you can try the on the pod on for yourself. You can find a spot that you like you can put it on you can see what it's like to put on a shirt or pants, some undergarments, get in the shower, go for a run all with the on the pot on how well you don't have to make an educated guess when you're choosing an insulin pump. When you wear it, you're going to notice there's no tubing involved. You're not going to be tethered to anything and I think you're going to see that as a real bonus. On top of that, like I just said you can shower with it. It is the only insulin pump that you can get into the shower with so that makes it the only insulin pump that you can get into the ocean with we're swimming pool. I know a lot of people who disconnect their pumps to play sports or workout with the only pod you don't have to you stay in control of your boluses and your basal insulin the entire time. Check it out at my Omni pod.com forward slash juicebox are the links in your show notes or at Juicebox podcast.com get that free pod experience get today the pod doesn't have any tubing to get caught on your clothes. It'll never wrapped around the doorknob worried like that thing in your countertop drawer that you know Yanks all your stuff off.

Unknown Speaker 39:37
ami fine.

Kelsey 39:40
Yeah, I think he like the horizon and all the like artificial Pinker's type systems are super exciting. I've been like reading about that for years. I'm like Hurry up. Why 90?

Scott Benner 39:55
Like right like just just to take any I guess any extra stuff. out of your day would, would be great, right? So you, even though you're rocking a five, five on your own, you'd be willing to hand it off to something else if it if it meant you're not thinking about it as often. Oh, for sure. Cool. I agree with you. By the way, I'm, uh, I'm looking to get out of this. Although I got a lovely note from someone the other day who said, Please stop saying that it makes me nervous when you say the podcast doesn't have to go on forever, don't worry. podcast is gonna go on. Plenty long. But But I still, I'm interested to get into the next part about diabetes like to find out, like what happens next, you know, and because there's going to be management ideas around all that there was actually there was actually an article that came out the other day, that over the third, please make sure you listen closely to everybody. Everybody listening. over a third of people who started on the Medtronic artificial pancreas, left it because it, it didn't work very well, is what they said. So I, I look at that. And I think you know what, it was exciting to be first. But wouldn't you rather be right than first? You know what I mean? Like, we have an artificial pancreas. It only makes over one in every three people we give it to run away from it's screaming. Maybe it's not ready to put on the market that in that situation, right. And so while I do hear people complain, and I have those thoughts, too, sometimes, like about Omnipod, I'm like, Oh, they were a little late to the game. And they didn't quite figure it like, but it ends up being in my opinion, it's a good thing, because you get to see, you get to take your time now. Like there's no expectation to be first so be right, that that's how I say it. So I'm very hopeful I would knock on some wood. I'm very hopeful that horizon is going to be something that people don't, you know, treat the way they treated the Medtronic one like I hope I hope it does what they say it's gonna do and and that's worth waiting for. It. Just you know what it is? So it really is are you from the Tampa area originally?

Unknown Speaker 42:04
I'm from Atlanta.

Scott Benner 42:07
How'd you make Tampa that's where Ryan was?

Kelsey 42:10
Well, no, I went to school down here. Um, so I met him after I moved.

Scott Benner 42:14
Okay, and just ended up staying. Yep. So what school What What school did you go to? You went you said college you went to?

Kelsey 42:20
Yeah, I went to St. Louis University. It's a pretty small school down here but

Scott Benner 42:26
major businessman events? Are you going to try to buy the bakery at some point?

Kelsey 42:32
No, I'm my original plan was to open my own bakery. Um, but when I started this job, I'm like, I want to stick around this place is good. Um, but actually own a side business. So I can still get my management in over there.

Scott Benner 42:45
Nice. Is that something you want to share what your side businesses are? You

Kelsey 42:50
know, if I sell sugar flowers on line, the decorations for the wedding cake for other bakeries and stuff.

Scott Benner 42:58
That's brilliant. So you make the flowers and then other people use them during their decorating?

Unknown Speaker 43:03
Yes.

Scott Benner 43:04
Hmm. That's really cool. Is that something I can look out while we're talking? Sure. How do I do that?

Kelsey 43:11
All right. My website is a Kelsey cakes calm.

Scott Benner 43:15
I'll see you next.

Unknown Speaker 43:19
Time look the other beautiful.

Unknown Speaker 43:22
Oh, my God, Kelsey, you're really talented. Thank you. No kidding.

Scott Benner 43:27
I you guys have to look at this. I don't know if anybody listening would need these. Some of them look real.

Kelsey 43:34
Can I? Technically, tactics don't taste very good. They're very crunchy.

Scott Benner 43:40
Technically, it won't kill you, Scott. If that's what you're asking. That's really seriously, I'm gonna put a link in the show notes to this. I have no idea if anybody would. But it is really astonishing. Like you're an artist. Oh, absolutely. That's really cool. Is this taken off for you? is this doing the thing

Kelsey 44:01
you said is a

Unknown Speaker 44:02
nice Oh, Oh, nice. Oh, listen, you stay busy enough. You won't need that IUD anymore.

Scott Benner 44:13
You're so young. It's inappropriate for you to make that joke. Get married that long and you're like, oh, he doesn't know what he's talking. like three months later, like 10 years from now. You'll be like, Oh, I get what that podcast guy was. There's one here there's a featured item it says blush and burgundy sugar flower arrangement cake topper, including dahlias. Roses, Fern leaves. It really is it's astonishing. It really I hope everybody takes a look at I don't know what the heck they would do with

Unknown Speaker 44:44
them from you but they're not again.

Unknown Speaker 44:48
A cake I guess there really is a limited use for them right.

Unknown Speaker 44:54
What else would

Kelsey 44:55
put them in phases so

Scott Benner 44:56
that she wrote what she's very proud of you? I imagine.

Kelsey 44:58
Yeah. Awesome. template my first flowers from like high school and I'm like, Why do you still have these there's,

Unknown Speaker 45:05
um, your mom loves you. That's so nice.

Scott Benner 45:10
Later you have that baby and you love that baby like that. You end up saying stupid things to it. Like, my son FaceTime the other day from school. And my wife just turns into like, she's just like, Hi, buddy. Like, she gets real life. And then my daughter stands behind our mock sir. I'm like, stop making fun of Mom, where she can't see you. Because I'm laughing and now she doesn't know why I'm laughing. I was like, you should at least have to make fun of her to her face. But she turns into mom pretty quick when she sees my kids. So sounds like your mom does, too. That's really cool. Okay. Give me a message for people who were where you are, who thought seven was good. And they were doing okay. And like, what what would you tell somebody like, like, if I came up to you and said, bumped into you in the street, and I was like, Hey, I heard you on this podcast. Kelsey, and can you tell me like what what to do?

Kelsey 46:04
Or that's a tall order.

Scott Benner 46:06
It is right. But what would you say if I if I came up to you? And I said that?

Unknown Speaker 46:10
Oh,

Kelsey 46:12
yes, I would say, you know, take a deeper look at it.

You know, don't don't take it as being good enough.

Unknown Speaker 46:22
Yeah, um,

Scott Benner 46:24
yeah. Did your doctor tell you? It's possible your doctor looked at that seven was always like, Hey, this is great. You're doing great.

Kelsey 46:31
Yeah, she was like, you know, you're doing all right. She didn't think great. But, you know, not like, we got to change everything or

Scott Benner 46:42
right, and not that seven. Let me say this. I don't think seven is a bad one. See? And if you have one, I'm not coming down on you. I'm saying that when we set an expectation that sevens good.

Kelsey 46:52
Exactly.

Scott Benner 46:54
Just that right? Yeah. It's all about expectations. The Dexcom alarm is expectation. Yeah, it really is. If you set it, so it never goes off, then your expectation is your blood sugar's gonna get high, that's what happens. And you're okay with it. If you set it at 130, then 130 is your expectation, you try to meet that expectation? Eventually, you start building on tools that keep you under 130. And you don't even find 130 that often. And then when you do, you have an expectation that you're going to fix it, you don't just look at it and go, Oh, that's what this whole thing is about that. And so, you know, it's, you try to teach this to kids when you're when they're growing up, right, which is that you should expect something from yourself every day, like, you don't just get up going, whatever happens happens. You know, I'll go with what that guy says, you know, let me see it, you should look at yourself and say, here's my hope for myself today and take steps towards that. You know, like, I mean, those flowers, you just, I just looked at, like, how long have you been working to? To perfect that?

Kelsey 48:05
gear? I don't even know. Um,

yeah, I mean, I mean, my first ones in high school, but I've been doing this continuously for like, four years. So I mean, they definitely didn't look like that when I started.

Scott Benner 48:18
But you expected that they would? Yeah, right. With enough practice and enough desire, you thought you could get to it?

Kelsey 48:25
Right? Like, gotta build towards it.

Scott Benner 48:28
And you had the tools like you had the basic tools, and you knew, like, Oh, I could, I can hone this.

Kelsey 48:34
Exactly. Right. I took classes, and I hope to and learning from others and watching YouTube videos.

Scott Benner 48:41
Okay, so now let's translate that to diabetes, right? Maybe, maybe you don't have the tools. But you checked out the podcast, you found the tools, and now you're practicing. Right, and you're getting pretty flowers.

Kelsey 48:55
Exactly.

Scott Benner 48:56
I love this down here. You want to see something interesting?

Unknown Speaker 48:59
Yeah, I

Scott Benner 49:00
just got a text message from someone who did not say that I can use their name on the podcast, so I'm not going to do that. But I've been talking to this person for a week maybe. And they started right where you and so many other people describe just blood sugars all over the place. They don't know what to do, this person is still doing shots. So they're doing like a slow acting insulin shot, long acting and we still started with basal rates, we got their basal insulin together. And you know, blood sugar's came down overall. Then talked about you know, Pre-Bolus saying and you know, getting the timing right and in just a couple of days. This is a mom of a 14 year old girl like they started like seeing better results, and and less spikes and less lows and it's all just, it's coming together for the middle week. And I'll be Get into her text when you and I are done talking, and I guarantee you what I'm going to hear is she hit a roadblock. It's gonna be something, right? It always is when they follow up, right? I'm gonna pull them up. Let me see my test myself. Let me open on my phone.

Unknown Speaker 50:14
And question for you.

Scott Benner 50:17
Yep. Okay, she's having trouble. And the trouble is I'm gonna get period related, this is the first day of the right. So it's all I'm going to do is reinforce to her is that what you've been doing? You need to do stronger, like, be just go back and be more aggressive, it's going to be more difficult because no pump, right? So you can't just go to like Temp Basal rates that are jacked up. But it's still gonna be doable, she's gonna have to Bolus a little more get it down. This is a person who's looking for a pump, and we'll be getting one soon. But it's, it's all doable. And now the questions that they're asking, and their texts are so much more thoughtful than the the questions they were asking last week. That interesting, like, do you feel like you're diagnosing things quicker when you look at them now?

Kelsey 51:12
Yeah, I think so. Um, and I'm definitely actually sitting there and thinking about instead of just going oh, well, I guess.

Scott Benner 51:22
Oh, well, that's it. And so is that what happened in the past? You just, it would go up? And you'd be like, yeah, I guess that's just part of what happens.

Kelsey 51:29
Pretty much. Yeah. I just thought that was part of the package.

Scott Benner 51:32
No kidding. And what set that expectation for you to think

Kelsey 51:36
just, oh, yeah, I just think it was all the years of not having the CGM and not knowing and not knowing how to fix it and think everyone was crazy. And then when you're told you're a one sees good, and you're like, I mean, this is good. What else can you do?

Scott Benner 51:55
Do you feel overall better now than you did six months ago?

Kelsey 51:59
I do I feel less like overwhelmed. Like, it's less of a thing that I'm constantly thinking about.

Scott Benner 52:08
That's really cool. I try to make that point to people. I don't know if they believe me or not. But like, they're like, oh, you're talking about more work? I can't do more. And I'm like, no more work upfront, less work

Kelsey 52:20
forever. Right. Exactly. It was only more work at first, but now it's like, Okay, I know how to deal with this. Because you're learning something.

Scott Benner 52:27
It's just something new. And you have to give away all the notions about diabetes that you had prior.

Unknown Speaker 52:33
Right, right.

Scott Benner 52:34
Exactly. Yeah. And isn't it? Is it? Do you find it true that what you're doing now doesn't really resemble what you were doing before? Almost at all? Right? Yeah, completely. See, Kelsey, and I really, I'm onto something here with this podcast. I have to tell you, it's really working out. Is there a podcast idea for decorating cakes? No, right? It's a visual medium, you need to do a YouTube channel. Right now, Kelsey, would you do a YouTube channel? Have you decorating cakes and making those flowers? Because I think I think time lapse footage of you, of you making those flowers would be amazing.

Kelsey 53:12
Yeah, I'm a video like kind of complicated. Get the lighting right and all that stuff. But something I've thought about but I only have one video I've ever made and that was like to help a customer figure out how to use their flower.

Scott Benner 53:27
Where's this Ryan in this? What's he busy? He can't figure the rest out of this. I'm making the flowers. You figure out how to video the flowers. Like we got to do get into the fight a little bit. Ryan Come on. And so this those flowers are like does he know they're amazing? Has he ever told you how many

Unknown Speaker 53:45
days before? I bet you he

Kelsey 53:46
helped me make a couple of them. Maybe? Yeah, cut this. This is trying to teach him more but

Scott Benner 53:52
you need to get a production line up. Exactly. Yeah, actually, you start rolling those babies out and teach them how to make those. Hey, you

Kelsey 54:00
go both an intern you imagine if you just

Unknown Speaker 54:04
like a little sweatshop of your children and making like flowers for

Scott Benner 54:09
their make the purple ones don't get up there's no ping until they're done. And But seriously, like I when I looked at them I thought the process of making them would be an incredibly interesting like, you know Instagram video or something like that. I we could get you to a spot where you had so many orders for those flowers. You couldn't keep up with them. Oh, yeah, you know what I mean? Have to quit that job.

Kelsey 54:35
Well, I'd have to get some interns or something.

Unknown Speaker 54:36
Do you sell them to the bakery?

Kelsey 54:40
Um, no, I make the flowers there for them. So it's not good.

Scott Benner 54:43
I don't like that. No, no, I don't like that because you're making a flower for an hour long rate and you're probably not making as much now as you charge for the flower.

Kelsey 54:54
Rebel I've never actually done like an apples to apples comparison. But time to shine up as I like to draw So I'm pretty happy. They're

Scott Benner 55:02
looking at me. I'm trying to get you fired. I'm

Kelsey 55:05
not gonna let them listen to this podcast.

Unknown Speaker 55:08
He's like, Listen,

Unknown Speaker 55:09
I like my job. Why are you trying to talk to me?

Kelsey 55:12
Cuz I get home I just do the flowers. But then here I get to like actually decorate the cake and do the weddings and all that stuff that I don't get to do

Scott Benner 55:20
with the flowers. You take the cakes to the, to the weddings. Yeah. And then do you put them together there or tell me about sometimes.

Kelsey 55:27
So if it's a small cake, we can just put it in the car and deliver it. But for like a really big like a two foot three foot tall cake. We got to assemble it there because it's just too heavy.

Scott Benner 55:38
So you take everything you need icing, like because I don't think do people. I don't know if anybody listening. Thanks. And I but when you assemble a larger cake, there's icing in between the cheese like mortar, like you're like you're building a brick wall. Right? Right. Right. And so you take all that to the site. How long do you think you can spend at a site like putting a cake together for a wedding?

Kelsey 55:58
Um, it depends on what the timeline is sometimes like it was an hour to set up sometimes they give us 10 minutes. So

Scott Benner 56:05
have you seen Have you seen those videos of the one My wife has shown me actually where you sort of build a cake stack? And then use a bread knife to shave it down into a shape?

Kelsey 56:19
Yes, like a bolton type thing? Yeah, like

Scott Benner 56:22
they're like you're making like a like an ice sculpture but out of out of like, Uh huh. Isn't that amazing? Yeah, that's pretty cool. You should try that too.

Kelsey 56:31
Thank you. My favorite thing to do?

Scott Benner 56:32
No, listen. That's what we'll teach. Right. Right. I'll do the shaving part. Yeah, I don't know. And do you? Here's me from the bakery. As she's cutting it down and shaving it in the video. All I can think is isn't that gonna create like a lot of crumbs when I tried to like Yeah. Well, yeah, what I mean, right? Because if the icing is too thick, it grabs the cake and pulls up like little pockmarks get crumbs, the icing, the whole thing's just a disaster. And I find that very,

Kelsey 56:58
like, do a crumb layer of icing first and then do the smooth layer on top of it.

Scott Benner 57:03
Is that what I was doing wrong? Maybe late now, I'm older.

Kelsey 57:09
That's definitely a helpful hint there.

Scott Benner 57:12
I don't even think I'm allowed to eat cake anymore. Like so hit that age where they're like, Can you just like rice cakes? Like light salt, maybe have a glass of water? And yeah, it'll eventually it sucks, honestly. But actually, I guess if you're lucky, you'll get old enough to where someone says, Hey, don't eat that anymore.

But anyway, so Okay, kills? Have we covered everything? Or is there anything we've left out or anything you want to talk about? That? I didn't know, I know, I basically forced you don't have on this podcast because of your butt.

Kelsey 57:45
Right. I was like, I have no idea what we're gonna talk about. Let's just see how this goes. And I think it's gone. Well.

Scott Benner 57:51
Yeah. See? And are you still nervous the way you were in the beginning?

Kelsey 57:55
Oh, not as much. I'm still a little nervous. But

Unknown Speaker 57:57
I can tell like i think

Scott Benner 57:59
i think we'd have to do like three hours before I think there's a whole other person side of you. I didn't meet today.

Kelsey 58:05
There might be

Scott Benner 58:06
there might be who is that person?

Kelsey 58:08
I'm a little shy at first, take some take some time getting used to

Scott Benner 58:13
it. Well, listen, it's very, it was very nice to be to do this. Because if you are a shy person to begin with, plus, you weren't like, I want to be on the podcast. I was like, Kelsey, you have to come on the podcast. Now. So here's how we're going to end up that if we if we've covered everything you were hoping to cover. I want the baby to be named after me somehow. I don't know how reasonable that is or not, but I'm making a real plea to you here. Okay, now I realize my name is kind of boring. And you're probably not gonna want to go with Scott. But maybe an initial some sort of a shout out in the in the middle name somewhere. Where do you think we can make this work?

Kelsey 58:46
Oh, no, no, I feel like names are a little bit further down the road. But

Scott Benner 58:52
Alright, so let's start thinking about it now that like, maybe we don't have an answer yet. But if it's just an initial, something to that effect, I mean, I'm not asking you to name Okay, like juicebox or something like that. Like, that's ridiculous. But, uh, if we could get an S in there somewhere, even if there's an s still there. Yeah. Can you hear me?

Unknown Speaker 59:10
Okay, yeah,

Scott Benner 59:12
no, even if there's an s in the name, and you didn't put it there, because of me. It wouldn't hurt to set a note and say you did you know what I mean? Like, like, yeah, like here. Here's an example. It took my daughter off to school this morning, and my wife was packing up her bags to leave for work. When I came back, my wife was still there. And I said, Oh, did you wait around to see me? And she said, No, my computer's just shutting down. And I said, Kelly, How hard would it have been to just say yes, like, just go Yeah, I wonder wait around, say goodbye. Like, you know what, I mean, caution, nothing kind of a situation. So I'm saying if you if you come up with a name with an S or a B, like anything, just lie to me later and tell me it's for me.

Unknown Speaker 59:53
Okay, I think I can

Scott Benner 59:54
handle that you'd be willing to lie to me. I'll see. Thank you. This is very sweet. Have you

Kelsey 1:00:01
know anything for a friend?

Scott Benner 1:00:04
I really do appreciate. I wish I would have known that. That you were in Tampa. I think I totally would have stopped by down there at one point. And do you want to say the name of the bakery?

Kelsey 1:00:14
And the bakery is called hands on sweets?

Scott Benner 1:00:17
Hands on sweets, and it's right outside of Tampa.

Kelsey 1:00:20
Yep. Right. Right in South Tampa.

Scott Benner 1:00:22
Okay, so if a lot of people with diabetes are coming in to say hi to you, I apologize for that up front. And if you guys are weird, don't go see Kelsey. But if you're nice, you can go sad or okay. And you know which one of you are weird look in the mirror. You can figure it out. Okay. Right. Like me, I would be like, I would scare you. So I would never come. But But somebody else might. Alright, Kelsey, listen, I want to wish you and Ryan Absolutely. Like, you know, happy marriage. Congratulations. It's still very new thing. So very well done. Did you did your wedding do everything? Was it what you hope? Did you have a great day?

Kelsey 1:00:56
Yeah, it was awesome. We had so much fun. That's excellent.

Unknown Speaker 1:00:59
Did you make the cake?

Kelsey 1:01:01
I made the flowers for the cake.

Scott Benner 1:01:04
That's really nice. It really is. If you have a picture of your wedding cake, and you want to share it, I will put it up on this episode.

Kelsey 1:01:11
Sure I can email you a picture.

Scott Benner 1:01:12
Seriously. I would love that. Yeah, I just was really taken when I went look at your flowers. I was like that. They're really, they're astonishing. So thank you. I see that web address one more time.

Kelsey 1:01:23
Ah, Kelsey cakes.

Scott Benner 1:01:24
calm. Cool. All right, Kelsey, thank you so much. You have no idea how nervous Kelsey actually was. The stuff I cut out in the beginning was hilarious. I asked her to introduce herself and it was like she did not know who she was. But she definitely knows how to make cakes and the gorgeous flowers that go on top of them. She wasn't asking for a plug when she came on. But I think it's worth five minutes of your time to look at it. KL si e cakes, calm Kelsey cakes calm. Her flowers are stunning. As always my great appreciation to on the pod decks calm and dancing for diabetes for their continued and longtime support of the podcast. Check them out dancing for diabetes.com my omnipod.com forward slash juice box dexcom.com forward slash juice box. There's always links in the show notes or at Juicebox podcast.com. If you can't remember them. Don't forget to check out my Facebook page where there's now a private group where over 1500 people are discussing their diabetes together. It's possibly the most civil place on the internet. I don't say that lightly. These conversations are wonderful. They're helpful, warm, not judgmental. A really good group of people. If you think you fit in, go check it out. I'll leave you this week with what it sounds like when a leaf blower goes past the window of the person you're interviewing. Over if you

Kelsey 1:02:55
like right there.

All right. Can you hear me now?

Scott Benner 1:03:06
I can hear you fine. Don't worry. I edit that out or leave it in for humor purposes. I can't decide

Kelsey 1:03:11
All right. I mean he was like right there. Okay, so

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Scott Benner 11/1/19 Scott Benner 11/1/19

#275 Dexcom Pro and COMISAIR

Dexcom Pro and the COMISAIR study…

Dexcom's Senior Medical Director Tomas Walker is back to explain Dexcom Pro and the COMISAIR study.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello, everyone, and welcome to Episode 275 of the Juicebox Podcast. Today, you're probably expecting an ask Scott and Jenny are defining diabetes. But instead, they're bringing something that I think is just as valuable. Every once in a while there's research done around diabetes, that when you stop and listen to it helps you do better. And this falls under that category. This is just going to be a quick 20 minutes, but it's packed with good information. Today's episode of The Juicebox Podcast is sponsored by companion medical makers of the in pen, go to companion medical.com. To find out more.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. or becoming bold within quick announcement for those of you living in Pennsylvania, particularly in the Valley Forge, or more specifically trap PA Area on November 10 2019, it's a Sunday, but don't worry, the Eagles are in Dubai. I recently shared all my speaking engagements online and somebody came to me and said privately, I wish you would come to this area. And I said I you know, I can't control who invites me to come where. And this person told me well I can find a space for you to speak. Will you come if I do that? And I was like, Yeah, sure. So this isn't sponsored by anybody. It's not for the jdrf or anything, just gonna be me showing up at a church that was nice enough to donate some space for us. We're going to talk about being bold with insulin go over the tenants of the podcast, the protests kind of stuff. And then there's going to be huge q&a, where we're just going to chat and try to figure out people's problems. So if you're in the area, and you're interested, I think there's about 20 people coming now I think the space holds about 100. Go to the Events tab on my Facebook page, and RSVP.

Tomas Walker 2:04
I'm Tomas Walker, I am the senior us medical director with Dexcom.

Scott Benner 2:09
Those of you who love data and understand how it helps people will remember Tomas from Episode 66, which is still relevant to this day, and you should listen to. So when I heard that Tomas had some data, some new data from a really incredible study from the Czech Republic that he thought was important enough to share. I booked him on the show immediately. And as a bonus, there's a little something called Dexcom Pro that he's here to tell us about as well, that may help a lot of you at your doctor's office. You're ready. Let's do this. So there's two things going on right now with Dexcom. One is the Dexcom. Is it called pro?

Tomas Walker 2:48
Yeah, the Dexcom g six Pro has just been just received FDA approval. All right.

Scott Benner 2:52
And then the other thing is like an acronym that I don't know, am I right?

Tomas Walker 2:57
The commissar study

Scott Benner 2:58
is that with this, I think of it as an acronym, because there's a lot of capital letters. But that may be

Tomas Walker 3:02
the comments or study. Yeah. So yeah, which was a study on the impact of sensor augmented insulin regimens, which essentially looked at the benefit of using CGM compared to multiple daily injections and finger sticks, insulin pumps and finger sticks and then insulin pumps and CGM and multiple daily injections and CGM. So wanted to see the benefit of adding continuous glucose monitoring to the classic regimens of diabetes therapy and compare them to each other.

Scott Benner 3:32
Okay. And that was something you would like to share. I guess it's a must. It must be interesting. If you're assuming if it wasn't interesting. You guys wouldn't be interested in sharing it. You feel like nothing happened? Just a big waste of time. Nevermind. Yeah. going on.

Tomas Walker 3:49
Everybody.

Know that. So either. It's a fun study that came out of the Czech Republic by Dr. Yan Schauble and Dr. Martin progeny. And what the study actually did was recruit 90 some patients who were coming into their diabetes clinic training sessions, and they put them all into a three four day intensive clinic training session at the end of it, they essentially pick the treatment option they want for the next four years of therapy. Okay, so the patients could choose I want to stay on MDI and finger sticks. I want to go on a pump, but I'm going to stick with finger sticks. I want to go on a pump, but I want to use a CGM, or I want to stay on MDI. But I'd like to use a CGM. So the patients were allowed to self select for which therapy option they want it. They were then enrolled in this study, which was really just more of an observational study. And they were followed out three years now, which makes this the longest study of people using diabetes technology ever completed. So that's what's really exciting to me is prior to this the longest studies we had of people using CGM were six or 12 months We have completely blown that out of the water now and pushed it out three years. And I'm very pleased to tell you that they actually have the funding to complete the fourth year of study. So you know, most of the time you get an insulin pump. It's a warranty for four or five years. So now we're going to be able to say this is the entire life cycle of someone using CGM technology out four years,

Scott Benner 5:19
and the CGM you're talking about is I'm assuming that GE six,

Tomas Walker 5:22
they've No Actually this study was based around the Dexcom, g4 this was in Europe at some of the patients did have G five, none of these patients were using Gen six.

Scott Benner 5:31
Okay. Okay. And, and varying pumps. Not though, do they give them all one, sir?

Tomas Walker 5:36
It was, my understanding was that they had a choice of two pumps in the Czech Republic, they could use the Medtronic pumps, or they could use the Animas pumps with the g4 centers. But

Scott Benner 5:46
see, you know, you start looking back a couple of years you start hearing words you don't hear anymore,

like Exactly.

That so far, that's amazing. And who put the study together again.

Tomas Walker 5:57
So this was done by Dr. Leon Schauble and Dr. Martin prizemoney, who are two endocrinologists out of the Czech Republic, and this was funded by the Czech health ministry. So people ask me, what's my favorite part of this study? My favorite part of this study is, is nobody in industry had anything to do with this. This was done entirely by this group of clinicians and the Czech government to look at the impact of these technologies on diabetes care.

Scott Benner 6:22
That's very cool. That's great that people are thinking that way stolen? Yeah. Because it's and so how did you get involved in I mean, other than I'm assuming they had to come to Dexcom. And say, we want to use the G for for the study, or

Tomas Walker 6:32
no, no, actually, we didn't get involved with it at all. There is no Dexcom sponsorship of this study. That's why we didn't actually know about this study until we saw the first poster regarding it a few years ago and saw that the protocol had been submitted to the NCT trials database. So again, this is this is a study that was done without the contributions of Dexcom, or Medtronic or anyone in industry, it was done entirely by the Czech government and the the Charles University and in the Czech Republic. So three years

Scott Benner 7:04
worth of data, Is it broken down by how you chose like, or what is it? What is it telling you?

Tomas Walker 7:11
It is broken down by how you by how by this by the approach you chose, basically, it wasn't quite equal groups, but it was almost equal between the the subjects of 25 subjects in each group in MBI, excuse me an MBI and finger sticks, pump and finger sticks. MBI and CGM are pump and CGM. And then they were tracked out every three months for four years. And at the end of this three year period, they have 88 of these 94 subjects still active in the trial. So great, a great retention, great follow through. And what they've been able to show is that the patients who went on pump and CGM or MDI and CGM have a 0.1% difference in their a one C, out three years later. And this has been consistent since six months after starting the therapies. And the interesting thing is this is mirrored almost exactly in the patients who stuck with finger sticks. So the patients who are on MDA finger sticks and pump and finger sticks also have a difference of about point 1%. And they're a one see out three years. Now they're a one C is about 1% higher than the patients who were using CGM. So that's also a strong message that the insulin delivery method doesn't matter. What matters is using CGM is what improves diabetes care, because patients are able to make those real time decisions they need to manage their disease.

Scott Benner 8:36
What do you have an idea for the range? So people pumping with CGM and people shooting with CGM? You said they're about a percentage off. But what where does the range fall? Like? Are they a seven and an eight or a six and a seven? Yeah,

Tomas Walker 8:51
you're looking at 6.9 to 7.1. That's where everybody was CGM was falling. Okay.

Scott Benner 8:57
Okay. People using finger sticks were more like 8.1.

Tomas Walker 9:02
Like in that video. They were sitting around 8%. Yeah.

Scott Benner 9:05
Wow. So if you so if you see. So I guess the other thing is that it has to show that the people who are injecting, not afraid to inject more like they

Tomas Walker 9:17
sold. So that that's one of the interesting, one of the interesting findings of the study was when they looked at the data, we assumed that the patients on the pumps would be more likely to take multiple boluses. Right, there was an old study done called the switch study, which showed that when you gave patients on pumps, CGM, they were more inclined to take an extra bonus. Like I'm so high after lunch, I'm going to take an extra unit. They were willing to take more injections, and that was part of what improved their control. Well, when you look at the commissar data, they actually they actually track the number of injections per day. And the number of injections per day was like 6.6 of fast acting insulin per day, which matched like 6.8 micro boluses per day using insulin pump two extra against that. There's no difference. This, there was no statistically significant difference between the number of bonuses the pumpers, were giving, versus the patients on multiple daily injections. I actually thought that was kind of interesting, because if I had had to make a guess and predict, I would have said that people injecting were probably going to be taking a little bit less injections in the patients on the pumps. But it wasn't what was shown what it showed was up, the patients were on multiple daily injections. And they were doing just as inclined to do an extra bolus of insulin as a patient using an insulin pump. It's something I

Scott Benner 10:27
I thought, what you would probably find you are finding, which is that when you get the data, you can start making better decisions. And those decisions then lead to not needing to make more decisions later. You know what I mean? Like, once you've seen a meal, go, you know what I did an episode Tomas, the other day there will be cursed on it. I almost said something that I shouldn't say. So let me start over again, when after you see a meal go the wrong way, a couple of times, you can make the decision. You know what I keep Bolus and four units for this. But obviously, it's five. So why don't I just do five and you can start injecting more thoughtfully after you've seen it once or twice. I listen, I can't agree more. I wanted to have you on to talk about this, because I'm a huge believer, obviously. So that is really something and and that they didn't. Now they're adults, too. I guess that's important to keep in mind, right? Are these all adults?

Tomas Walker 11:21
These are all adults, this is entirely adult population.

Scott Benner 11:23
And I would say to an adult population have probably motivated people or they wouldn't be involved to they're not a passive group, I would imagine.

Tomas Walker 11:32
You know, if they were following through on their routine care every three months, but the fact that they had 88 of the 94 that enrolled still present in three years tell you tells you that this group was really at least committed at some level to this care.

Scott Benner 11:46
Yeah, yeah, they were not cherry picked. But they were people who were interested enough to follow through. My point is, then they're interested enough to pay attention to the data and make adjustments to Sure. Yeah, that's excellent. That's really cool. Oh, my God. So now where do you go from here with that? What do you do with this data?

Tomas Walker 12:03
So where this goes from here is this goes to four years now. So they're going to finish getting the fourth year of data. And then they were discussing the group running the study how they want to take the next, the next study forward, they really raised the bar here, you know, bringing in four years of data on 100 patients with type one diabetes, like Stand back, this is groundbreaking. No one has done this sort of diabetes technology study before. I'm glad to see they've done it, they've really raised the bar. I think that they're discussing themselves the best way to go forward. Yeah, I wonder if this isn't something you can use to pressure health agencies or insurance coverage or that sort of thing? I mean, it would you would think that saying to them, putting putting this person on this should lower their a one c appoint that would be a big motivator, I would think for them. So you know, one of one of the comments I make when I talk about this study when I talk to payers is I don't want to hear any more griping about not enough longitudinal data. Okay, know what else is coming in with three and four years worth of data if you you have to look at this and recognize the uniqueness of this data set?

Scott Benner 13:10
Yeah, I appreciate that. Because I just I just heard the other day from a person an adult who was flat told him in America you're a one sees too good. We're not gonna let you have it CGM. Like I don't even know what that means. You don't even but but it's it's too so your your health isn't poor enough for us to cover this the the CGM for you is something it's fascinating.

Tomas Walker 13:33
got an A anyone see is is not a perfect marker. I mean, all you have to do is look at what some of the work from right back in the djabe Center to say that, you know, a one C, it doesn't always correlate as closely to time and range as we think it might.

Scott Benner 13:45
Yeah. Did this data show anything around variability of time and range?

Tomas Walker 13:49
Yeah, they showed this the patients with CGM had significantly less glucose variability and significantly more time and range regardless of the insulin delivery method.

Scott Benner 13:58
What's the range they used, you know, off the top of your head? And I'm sorry to have to go back and look at the paper again, I don't remember that one. I'm on top of my head is pretty specific. I just took a swing there that wasn't sure if you would know I am I joke sometimes for the people listening that you can't, you can't set your your Dexcom at 65 and 400. And then get online and tell me you were in range haltech. I you know, you get to pick something reasonable.

Tomas Walker 14:23
I'm pretty sure that the range they looked at was 70 to 180 milligrams per deciliter would have been my guess I think that's pretty widely accepted

Scott Benner 14:33
range for people. I know. We keep ours incredibly tight for reaction purposes. So when when I look at some of our data is skewed because ours is 7120. And so I you have to kind of look through some of the numbers, you know what I mean, and figure out what they really mean. And then you can kind of reset that out to 150 and you Oh, okay, this is this is very reasonable. Tomas. We'll be back in a second to talk about that. compro. But first, I'd like to tell you about the in pen from companion medical. So try to imagine that your CGM, your insulin pen, and an app on your phone all connect to each other, creating a sort of triumphant of diabetes care. What is this do? You may be wondering, Scott, why do I care about this? Well, if you're an MDI user, a person using multiple daily injections, and you're just using a regular old dumb pen, this smart pen is a game changer. What it does is it gives you a lot, if not almost all, of the options that you gain with an insulin pump options like understanding insulin on board, which is incredibly important. How do we do that? Well, that's for you to find out. And for me to know, my heart knows, I'm just kidding, I'll tell you. So the intent is like any other injector pen, except it tracks each dose and delivers your data to a secure app on your smartphone. So really, it's not really like every other pen is it way better. The pen app displays your active insulin, blood glucose and the last dose of insulin that you've taken. It also can remind you when to take your insulin, it helps you calculate and recommends your next dose, and it'll warn you if your insulin is expired, or has been stored outside of the recommended temperature range. So if you'd like to eliminate the guesswork, that often comes with injecting the pen is probably for you. There are links in your show notes at Juicebox Podcast COMM But in the end, you just need to go to companion medical.com. To get started. I think that you'll be pleasantly surprised at what you learn when you get there.

Tomas Walker 16:45
The Dexcom Pro is ducks coms most recent professional CGM offering, what places us in a unique position in the market with our professional system is we are offering patients and clinicians the opportunity to have this as either a blinded data gathering system. So you come in to the clinic and you start the system up. And it begins to gather glucose data every five minutes 280 glucose readings a day for 10 days in a completely blinded data logger mode. So there's no interaction from the patient with the device or the clinician with the device, then they can return to the clinic and download it. Or we give you the option of having the patient download an app and have a real time CGM experience with this 10 day professional system also. So the benefit as speaking as a clinician is that in those patients who are maybe they may not want to engage in it, or maybe I don't want them to engage in the data, I have the option of doing that. But the same system can be turned around and use in a real time mode to benefit both the patient and myself by giving them that real time feedback. You know, as someone who lives with Type One Diabetes, you understand that this is a disease of self management, there's 1760 hours in a year, and you might see your doctor for two or three hours a year. The rest of the time you got to figure this out and giving people CGM gives them the ability to do this. And this is the approach we took was that there are there are times when a professional CGM should be real time because it will benefit both the patient and the clinician

Scott Benner 18:21
is one of the uses here. I don't have a CGM, but I can get on one for 10 days. So we can try to figure something out. Is that one of the ideas behind it?

Tomas Walker 18:29
Sure. That's one of the potential is you know, if you come in to see me in the clinic, and I don't know why you're having these high a one sees and your logbooks look good, and maybe we're missing the nocturnal hyperglycemia, maybe you're really high postprandial than we realized. And this gives us the opportunity to get a lot more data instead of bringing me six finger sticks a day, we're going to get 288 readings a day, we're going to get a much better data density.

Scott Benner 18:52
Is it also like a test drive to? I mean, is that one way to think of it or like for somebody who can get covered for it no full coverage for Dexcom. But they not sure if they want it they can try before they drive is that there? Was that not what the thought is?

Tomas Walker 19:08
It could potentially be used as a test drive platform also for patients who are maybe not sure they want to they want to engage in this technology. I'm I'm always kind of surprised that there are a lot of patients who still don't want to engage fully in these technologies. I think it's important as clinicians that we recognize that patients have individual expectations and individual needs, and giving clinicians the flexibility with the our professional systems is something that's really unique in the marketplace.

Scott Benner 19:33
So if if someone mentions Dexcom prior to me, it's likely going to be my doctor, not me, or should I walk in and mention it if it's something I'm hearing about now,

Tomas Walker 19:42
the way you know, I strongly believe in educated patients is educated patients have better outcomes. So but never hurts to poke your clinician for what you want or what you think might help you. But if this is really this will be a device that is going to be accessible through health care providers. Okay.

Scott Benner 19:58
All right. So Okay, and it, like, tried to help me for a second. There's a pile of them in an office, I did no office or I go into my endo. And I say, hey, look, we can't figure this out. You and I don't seem to be getting anywhere. I heard about the Dexcom. Pro, I want to give it a try for 10 days to see if we can get some data that'll help us, then I get a script

Tomas Walker 20:19
for that, no, this, this will be this will be access to the healthcare providers office. So you won't be you won't be filling this in the pharmacy. You'll be getting through your health care provider.

Scott Benner 20:27
Gotcha. That's what I thought I just wanted to be certainly as I have to tell you, Arden did this a long time ago, and probably with a GE, for what and it was a blinded sensor. And what had happened was, we were asking for CGM. And Arden was having like these crazy lows overnight, but you couldn't like you said, you know, with a finger stick, you don't know what's happening. Like you just you just think this is what's going on. So they put this blind went on or took it off, the insurance company looked at the data and said, okay, you can have a glucose monitor. And it turned out that what was happening was, we were putting art into bed, you know, like you hear a lot of people doing especially in the beginning, when you really don't know how to manage your insulin. Well, we're putting her to bed at like 181 90. And She'd wake up in the morning at like 85 or 90. And I just thought like, wow, we're so good at this, like we've really figured this out. And then you know, then the blind data came back. And it turned out she was going from 192 50 and sitting at 54 hours before she would drift back up to 90 in the morning. And that was happening. Like every night. Yeah, that was very scary. It was frightening. It was like, wow, not only was I not doing a good job, like I thought I was but I don't know what's happening. And she was incredibly low. And you know, so and, and her 81 C, by the way, was still like eight and a half. Like that's how bad we were at it. Like, you know, in the beginning. It's just it's good to have that information. It's

Tomas Walker 21:51
also a strong story there that a one sees only part of the story when you're looking at managing someone's diabetes. It's it gives you one piece of the puzzle, it is not telling you everything that is going on, right? I think getting people access to real time systems in a professional manner is going to help a lot of patients, it's going to really open a lot of eyes. Something I constantly heard from patients in practice when you put them on a professional CGM, and they can see the data is when they used to come back to the clinic to me, the first thing I would ask them is what did you learn? Before I tell you anything that I've discussed? What did you learn? Because people would always have something to tell you, they would say there is no way I can eat Chinese food that white rice just drives my sugar bonkers. You know,

Scott Benner 22:31
it's eye opening for what your insulin needs are for certain a guy something just went out of my head? Do you hope that the pro can maybe also take steps to showing what CGM does to the clinicians? Like there are still plenty who don't? I don't want to say believe in it. But they don't care about it. You don't hear them talking about it with their patients like is that also the hope that maybe they'll see something that they go, Well, why am I not? Why am I not prescribing this?

Tomas Walker 23:00
Yeah, and there's a strong hope that we can get more clinicians engaging more patients with CGM by offering another professional platform and a pathway towards patients, giving them the ability to have this retrospective or this real time data, combining it with our clarity system, which I actually think is pretty good, where we can give patients these great reports. And we can give these reports to clinicians also, and kind of help the clinician to recognize the patterns that patients are having, and see what we can do to help improve them.

Scott Benner 23:27
Is that is the biggest, what is the biggest stumbling block I mean, taking insurance out of it for a second. Is it it? Do you think it's people not wanting more information? Because they're scared of it? They don't know what to do with it? Or do you think it's the doctors who are maybe a little older, I don't want to say out of touch, but maybe just haven't been brought up in this space? where CGM is so prevalent now? No, I,

Tomas Walker 23:48
I don't think we can reduce it to one factor. I think that there's a lot of issues at play here. You know, one of the things that we always struggle with clinically is momentum, there's a momentum on the patient's part, there's momentum on the clinicians part. Because every time you stop and start trying to adjust therapies, it takes time, but it's the right thing to do. And we can give people tools to make that limited time visit because you have a limited time with his clinician, if we can take that visit and make it more efficient and more impactful than we've done something good for everybody.

Scott Benner 24:18
I agree. I tell people all the time, like don't wait till the next appointment. Don't do that thing of like, like, you know, it'd be easier in the summer to do this or it'd be easier. Like everyone always thinks there's gonna be a magical time we're making an adjustment easier. It's just not like you just have to do it and, and get through it. And then it's over. It usually takes a couple weeks to a month, whether you're moving from injection to a pump, or you're moving into a CGM, like you know, it takes it's about a month before you can start making sense of it. And there's not going to be any perfect time. You know, I mean, unless you're a person who could take off for a month and go sit on an island with your new CGM and figure it out. But I don't think that's most of us, you know, most of us, right, right. I just think I'm a I'm a proponent of you know, Don't think you should switch, just a switch. But when the technology is so much better than what you have, it doesn't make a lot of sense to stay in the past. I don't think, you know, this is really great. Thomas, thank you so much. I appreciate you coming on and doing this.

Tomas Walker 25:13
No, I appreciate the chance to talk to you. And it's an exciting time. And we continue to push the envelope and try and improve the lives of people living with Type One Diabetes.

Unknown Speaker 25:21
Thank you so much.

Scott Benner 25:25
Thank you, Tomas for coming on and sharing this exciting stuff. And I mean that I know that often data doesn't sound exciting to people. But what you learned about that study is important. It's impactful. It can change the way you think about your type one diabetes index compro. That's how my daughter found out about Dexcom that so that was our first look into it. Right? We were having trouble way back before people understood what CGM is we're talked about in the community like this just didn't happen. And, you know, doctors like we can put you on this CGM thing and see if we can figure out the problem and look where it's led us. All these years later, it's the core of how we handle things. You never know what's going to be a big benefit to you in the future. So it's good to know about all of it. You know, it's November and that means diabetes Awareness Month is here, right now at the Juicebox Podcast store, the merchandise place where I sell the, you know, its shirts and stuff, but good stuff, I promise. Actually, I just got this from one of you. Thank you. I love my shirt. I ordered yours and another company's November diabetes awareness shirts. Yours is great. Theirs was made horribly. Haha. I'm just kidding. I'm sorry that this person, actually, here's what I responded, hey, I'm glad to know this. Not that you bought a crappy shirt, but that it makes a difference to you. I spent a lot of time researching the company that I'm using. So I'm really happy to hear that you're happy. Anyway, I've got some pretty great merchandise, if you want to go to Juicebox podcast.com. Scroll down to merge. Right now, the know the signed sweatshirts are on sale, I took as much of the cost as I could, there's not a ton of there's not a ton of money to be made in selling quality t shirts, you can sell cheap t shirts to people and make a bunch of money. But a shirt they're gonna love that's gonna hold up, there's not so much there. So I cut a couple dollars out of the sweatshirts, you'll see the sale there. And right now in November of 2019. If you use the code JBP fa n Juicebox Podcast fan at checkout, you'll save even a little more money. So I hope you like that. Also, the Facebook group is really growing. It's like up to 1500 people and I know some people might be like, that's not a lot. But you should see. I guess if you're really interested in talking like nuts and bolts about diabetes with people, it's a great place to be. You can find that on my Facebook page at bold with insulin, you just find the juice box discussion group and you know, try to get in there. Yeah, answer a couple quick questions. So I make sure you're not like you know, a monster. You're a real person. Then you're in what else? Are there kind of stuff can we do? Seriously the thing from November 10. The talk I'm going to do if you're in that area around Valley Forge, Pennsylvania. I'd love to see you there be really great actually, I think you'll find it really beneficial. We'll talk about a lot of stuff in the podcast, q&a, bring your decks calm graphs. We'll do our best to help everybody that's there. Hmm. Is that it? Just say Have a good weekend? No, probably.

Unknown Speaker 28:16
Yeah, that's it. Have a good weekend.

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