Scott Benner 5/6/20 Scott Benner 5/6/20

#332 The Wright Stuff

A Whole New World

Pietro is the first type 1 diabetic pilot to hold a 1st class medical certification from the Federal Aviation Administration. This is how he got it.

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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
Nothing but blue skies and tail winds from now. Hello, everybody. Welcome to Episode 332 of the Juicebox Podcast. Today I'll be speaking with Pietro, the first type one in the country hold a first class medical license given by the FAA, the Federal Aviation Administration, pitcher can fly whatever plane he wants. Now, Type One Diabetes be damned. This episode of The Juicebox Podcast is sponsored by Dexcom and Omni pod, you can go to dexcom.com Ford slash juice box, where my omnipod.com Ford slash juice box to find out more about the sponsors. On the pod, we'll even send you a free no obligation demo right to your home. 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. We're becoming bold with insulin. You're gonna like this.

Pietro Marsala 1:15
Hi, everybody. My name is Pietro Marsala. And I am the first insulin treated diabetic pilot to be certified for a FAA first class medical

Scott Benner 1:36
pitcher. That's the that's the nice part. We'll get to that in a second. You and I know each other through Instagram, is that right?

Pietro Marsala 1:42
That's correct. Yeah, we've we followed each other for quite some time. And we've spoke a few times the direct messenger and it's been nice. It absolutely

Scott Benner 1:50
has and you shared a photo one time of you in a plane, like with your Dexcom graph, I think. Yeah, that was you. I used to use that in, um, in live events by boy.

Pietro Marsala 2:02
Oh, did you hear me? Let me know.

Scott Benner 2:04
Yeah. Like, yeah, I'm right on top of that, by the way. made me look interesting. You know, because somebody who's listening to the podcast and I'm playing my confusion is then you were you were in it felt like you were flying the plane. Were you not flying the plane, then?

Pietro Marsala 2:20
Yeah, so one of the pictures I think I sent you way back was just a picture, we were sitting at cruise on like 10,000 feet going to San Diego. And you can kind of set your your headset up depending on what kind of headset you have in aviation, some of them have the ability, or Bluetooth. And when the air traffic control speak to us, it blocks out whatever you're listening to, if you're listening to something on your on your Bluetooth, and immediately it turns the attention to what we're doing. And in that case, we were just sitting in cruise, there's not much going on, had your podcast downloaded. So I was listening to it a little bit. And there we went. And so then I sent you that I sent you that picture. I was listening to it at 10,000 feet. And it's not the same as listening to at home. So I couldn't do it long. But it was I was pretty cool about their podcasts open listen to kind of how, how you've how you go about your podcasts and how it's kind of changed my life in a way, as well as many other aspects of like Dexcom in different things and how they've, they've kind of influenced me to be bold and like you talk about and so yeah, I sent you that picture i thought was pretty cool. I really appreciate it. I

Scott Benner 3:27
thought it was amazing, honestly. And so I was right. You had control of the plane. So you had a pilot's license them, but that's different now, right? There's so let's kind of go backwards a little bit. Let me find out. How old were you when you were diagnosed?

Pietro Marsala 3:44
Um, so I was diagnosed. Let's see. I was diagnosed back in January 2012. With type two diabetes.

Scott Benner 3:53
How long did it take them to figure out you had type one.

Pietro Marsala 3:56
So it's kind of weird. So I went to had all the classic symptoms, right? The we always talk about, I'm not going to bore you with those. But most people this this podcast know what those are. So I was diagnosed in 2012 in January, and it took me about 10 or 11 months until they correctly diagnosed me with type one because I went to go see an endocrinologist after you know, the oral medication wasn't stabilizing me. And so we went to go see this endocrinologist and he looked at me and he said, You don't fit the bill of a type two patient. Have they run this test? And you know, I forgot what test it was if it was a C peptide peptide, what it was, yeah. Yeah. And so they ran that test, and then they confirmed it was Type One Diabetes at that point in November, I believe is November 2012. And in January 2012, I was diagnosed with Type two November 2012 was diagnosed with type one.

Scott Benner 4:45
Okay. So basically, around 2013 you knew you had type one diabetes, and I've taken a pen and a pencil just down I've written down 2020 to 100. I wrote 2013 and then I did some subtraction, and I figured out that was about seven years ago. That's the Right. Yeah, that's about right. How old were you then?

Pietro Marsala 5:02
I was what? 21 years old. I was 21. I was diagnosed at 21.

Scott Benner 5:07
Okay. So were you a pilot then?

Pietro Marsala 5:11
Yeah, so it was interesting. So I had, I was in the middle of my flight training, when, when I was diagnosed, I was in January 2012, was working on my commercial certificate, because my goal had always been to be an airline pilot. And in January 2012, I was diagnosed with it. And so I went to go see a doctor, like I said, and he diagnosed me with type two diabetes, and kind of long story short, it was obviously a really hard day for me. But I was just excited as a 21 year old to know that, hey, you know, it's not the worst thing in life. You know, if I've got to manage my blood sugar, I could stay fit. And I could just exercise and diet and keep me in a safe range, then I could return to to the flight deck. And, you know, I looked on the FAA website at the time, and it said that if you're a type two diabetic, and you don't require insulin, that you could still carry what's called a first class medical certificate. And for those of you out there that don't know what a first class medical certificate is, is, it allows you to fly for an airline here in the United States. So as pilots, we carry both pilot certificates and medical certificates, and I was working on my pilot's certificate to be qualified for the airline. Well, in the middle of that I got diagnosed with diabetes, and that kind of threw a wrench in it, and didn't allow me to carry a first class anymore. With type two diabetes, I worked hard. I got my first class medical back about six months after that, because the FAA requires you to stabilize on the medication. And so I worked hard at it, I dieted I exercise, I got off the insulin and maintained my blood sugar on Metformin. At the time, I was taking the medication, and the FAA was fine with that. So they gave me my first class medical back well, only to take it away again, after about three or four months after that point. When I got diagnosed officially with type one diabetes, and obviously, as many of you know that it requires insulin on type one, and so that was probably harder than the original diagnosis of type two, because at that point, I had done my homework and my research on what, you know, what it what it takes to carry a first class medical, and I knew that insulin at the time was a disqualifying drug. And so that was that was just the hardest, probably the hardest day, my life to this day.

Scott Benner 7:14
Hey, can I ask you a question in the time between the type two and type one diagnosis where you're working so hard? To get stable? You know, I guess, for the lack of a better term? Do you think you were so focused on that stability? The Is that why it took longer for you to find out you had type one, like what I'm interested in what takes the time to figure out I really don't have type two diabetes.

Pietro Marsala 7:37
Yeah, so it was just weird, because, you know, I got on the insulin, and my agency was in attendance at the time, when I first got diagnosed, obviously, not knowing that I had it. And they told me I needed to be I think it was like below 9% to carry a third class medical to fly, like for fun, and you know, to be inflamed structure and whatnot. And so I was just, I started working at that I started working out like crazy. You know, I was watching what I ate, I ate basically, like zero carb, zero, carb was impossible, but very, very low carb, very, very low carb at the time I was because I was on Metformin, I wanted to get off insulin, and I was figuring out pretty quickly that the less insulin you take, the less risk you have for hypoglycemia. And so I started with this whole low carb thing I was, you know, dieting, I was exercising a lot. And, and so, as I was doing that, you know, it's life was, I'm not gonna say easy, but it got easier. I started, you know, pricking my finger, you know, 10 times a day, times a day, whatever I was doing, and it took me took me about, you know, a good six months, it was it was a good estimate for the FAA to say, hey, you need to stabilize for six months until I figured out you know, kind of how the Metformin works. And, you know, when you know, how the, how the low fields or the high fields and kind of get the symptoms of what it feels like to be in each range. I didn't have a CGM at the time when I was when I was a type two patient or what I thought it was a type two patient, right. And so I was just managing with finger six. And, you know, it took me it took me a good six months to stabilize, I was doing everything that I possibly could to maintain that blood sugar, and I felt confident in the ability to maintain it on that form. And while every morning I'd wake up and as many type two patients do, I think before breakfast, the first thing they do is they tested blood sugar they fingerprick right. And so I was seeing a rise in blood sugar, I would see like, you know, 95 and that would be crazy. Okay, cool. I'm below 100. Sweet. And then I would see 110 and 120 and 130 as the days went on, and I'm like, What the heck is going on? And I knew nothing about what a honeymoon phase man I was so uneducated about the whole thing when I was 21. Right. Um, and so yeah, so then that's when my mom was like, I think we should go for a second opinion and see an endocrinologist and see what he tells you. And of course, at first I didn't want to do it. So I was scared of, you know, what was to come if it was possibly type one. And he comes he looks at me and like I said, he told me I didn't fit the bill and ran a test and confirmed it was type one.

Scott Benner 9:49
It's interesting. You didn't fit the bill. Did he mean visually at first or through tests? Yes. Yeah. It's weird because you could, I mean, I know what you look like and you're a fit young guy and all but you Could have type two diabetes? It's not. Yeah, and wouldn't be my question.

Pietro Marsala 10:04
Yeah, exactly. And so and he, you know, he looked at me was you don't fit the bill. And I was like, confused by that. I don't know what you mean. I mean, yeah, I played soccer my whole life. And I consider myself a fairly fit person. And so yeah, I was confused. I was like, how is this possible? You know, I didn't know that, you know, type two, or the difference between type one and type two. And I just thought that people in general that had diabetes were unfortunately people that didn't take the best care of themselves. Well, obviously didn't, didn't know better. Yeah. And so yeah, so he diagnosed me with type one, and I had to go on insulin immediately. And I kept before he ran a test, I kept telling him like, it was gonna change his mind or something. He had some magic potion. You know, when I took the lab, lab test that he would, it would change his mind. And I kept telling him, you know, my endocrinologist, and I'm still with the same endocrinologist today. He's a great guy. But he kept I kept telling him, Hey, you know, I'm a pilot, I can't, you know, I can't be on insulin. They don't let me fly with insulin. And he's like, well, let's, let's get you healthy first, before you worry about, you know, what's next. Let's let's, let's take it one step at a time. And so you diagnose me and just crush my dreams, everything I had dreamed up since I was a kid, of becoming a pilot, while I was a pilot already, but I was a private pilot. And, you know, becoming a commercial pilot. And living this dream was just, everything just was just thrown so hard for me. Yeah,

Scott Benner 11:13
trashy bow juice. Listen, I want to understand if you were, you know, at that time, if this type two thing didn't happen in 2012, and then type one in 2013? At what point do you think you would have been able to achieve becoming a commercial pilot? Like what year? Do you think that that would have started for you as a as a, you know, a way to make money? And, you know, career?

Pietro Marsala 11:36
Yeah, good. Good question. So, um, so with type, like, like I said, so you're saying if I was if I was when I got diagnosed with type one, when I got diagnosed, I never got type two? No, no,

Scott Benner 11:47
I'm wondering if it never happened at all. Like, what what post were you on?

Pietro Marsala 11:52
Okay, so yeah, so I would have finished, I started in January 2012, my commercial certificate training. And I would have been done with that probably by March. At the latest, I finished it in two months, and I went back to school, but I probably would have taken me initially two to three months to finish that off. But the thing is, is that just because you become a commercial pilot, and you're certified, that doesn't mean that anybody's gonna hire you. Because the regulations, the way they're written is that you have to build flight time. Okay, so you have to have 1500 hours of flight time experience. So it would have taken me a few years to build that time. And so I would have been diagnosed sooner rather than later, eventually, I would have got to the point where I needed insulin, and I would have stopped eventually.

Scott Benner 12:30
But in a world where diabetes didn't exist, you'd probably would have taken three years or so to build up your flight time. And then you kind of put yourself out there and start looking for jobs. And so there's a whole process in there. But But what I'm getting at is because that didn't happen. How did you shift your ideas about how you were going to, you know, feed yourself like, what, what happened to your goals? Yeah, and

Pietro Marsala 12:54
so so the way for most,

I want to say the majority of pilots that go through school, a lot of times, there's multiple ways you can build time to get to that 1500 dollars. For me, it was I chose the flight instructor route. And I was able to be a flight instructor on insulin because it only required a third class medical, there's three different certifications of medicals, there's first, second, and third, or third being the lowest and first being the highest first for commercial pilots to exercise their privileges in an airline. And third, to do small stuff, like fly for fun and become a flight instructor. So in my eyes, I was like, Okay, you know what, I'm going to take the flight instructor out, because it beats sitting in a cubicle. And so I'm like, I'm gonna, I'm gonna go, I'm going to become a flight instructor, I'm gonna build my time, because that's originally what I had planned to do anyway, to get to my my airline job. Right, right. And so what I did was I built time as a flight instructor. And I kind of just stuck in an industry I've built, built experience and moved up in the company. And I'm pretty fortunate they take good care of me. And it's been a great company to work for. And so I'm really fortunate because they played a crucial part in this whole thing, too. And as I get telling the story, it'll all make sense. But they played this part where I was able to show proof that I'm stable in flight, because again, most people on insulin that have a certificate medical certificate from the FAA, they don't fly for a living like I do. A lot of them, you know, flight instructors, they typically don't make a huge amount of money. And so they you know, most people don't choose this life in this career. If you get diagnosed in the middle of your training, a lot of people just say, okay, you know, I'll fly for fun. And I'll kind of drop it on the professional side. But I continued, because this is all I ever knew, you know, since I was a kid, I was flying flight simulators. And so I decided, no, I'm just gonna stick in aviation. This is what I love to do. Unless I'm in an airplane. It's not commercial aviation, like I want to do, but at least I'm flying trucking and teaching other people how to fly and live their dreams. Yeah.

Scott Benner 14:39
Hey, listen, in the time before, obviously, before things have shifted recently, and now you're able to have that that first class medical license, but prior to that when you were doing the flight instruction, when you get into a plane with somebody who's looking for instruction, do you have to tell them you have type one prior? Did you have to look at them go Hey, listen, I use insulin. Here are the things that are out Or was that private?

Pietro Marsala 15:02
No, no. I mean, we had a test our blood sugar and flight and tune. So most people asked like, what is that? I've used using a continuous glucose monitor as well, g six. And so it didn't require fingerstick testing. But you know, I test as well. And they would see that and I obviously they would, he would ask a few questions, I would just tell me, I'm a type one diabetic. This is kind of what I have to do to maintain myself in flight. And most people were kind of embarrassed to ask any further questions, I just kind of explained to them that this is kind of what I have to do, and they didn't really, really dig too deep. We're

Scott Benner 15:32
looking forward, we're up in the air in a tin can and pay attention to what we're doing. Because I do understand, you've heard me with other pilots on here, I don't understand the concept of wanting to leave the ground and control that thing. I get partial airliner under protest, I'm a good flier. I don't you know, I'm not on the plane constantly thinking, well, this is the end of my life. But I don't you. The other day, I thought about getting a drone, and I thought if I got a drone, I'd fly it up in there. And it would come right back down. I crashed into the ground, I have no spatial awareness. Like when things start changing, like the idea of a gimbal just fries my mind, you know? So I don't understand at all. If somebody started talking to me while I was teaching them how to fly be like, please look straight ahead.

Pietro Marsala 16:15
Please stop talking. Yeah, I'll be fine. Oh, it's funny, because we train a company at work for we train, airline cadets, so future airline pilots from all over the world. And a lot of these guys in the beginning you have and gals in the beginning, you have to tell them. Because when we talk, our mics are linked up. And so we don't have to look at each other's speak. Obviously, we can hear each other on our headset. Yeah. And so a lot of them out of respect, because they're from different parts of the world. And especially in the Asian culture. It's, it's, it's a thing where they want you they like to look at you in the face, which is respectful, obviously, but not when you're flying an airplane. And a lot of times we have to tell these guys, hey, you know, we can talk by looking straight ahead. When I ask you a question. Don't look at me keep flying. But we all know

Scott Benner 16:53
someone we drive with who says, oh, you're like your brother. Listen, please. Just look over there. You can hear me Don't Yeah, no, no, I hear that. So yeah, you know, obviously, we're kind of talking around a little bit, but you work for one of the major companies, I'm assuming.

Pietro Marsala 17:11
Yeah. And so I work for a company out of out of Phoenix. It's a local flight school here. And for those that don't know, the flight training world in Phoenix, Arizona, we do. Among the most flight training in the country, us in California, Arizona has a lot of flight training here just because the weather is so promotable to fly. Yeah, I would say we have our flying days are probably over 300 days a year that we can fly. So the weather is great here to do flight training. So people come from all over the world to that flight training here. And I work for one of the bigger companies here in Phoenix. Yeah,

Scott Benner 17:39
right. Okay. So, you know, so there's a rule in place forever. You know, if you use insulin, if you're if you're diabetic that uses insulin, you can't have this certification. There's other kinds of planes, you can fly, you can fly for your own personal fun, you know, but you can't you can't take a people mover up in the air, basically, and move them around.

Pietro Marsala 17:57
Yeah. And so it was it wasn't you know, it's interesting, Scott is the FAA, the way the rules are written is it doesn't matter how many people you have behind you, as long as they're not paying you was that was the way the rule was written. It's interesting, because I have a, you know, I have a commercial certificate, I have a private pilot's certificate. And I have these certificates that if I was rich enough to own a jet, and fly across the country, I can do so even on insulin, as long as the people behind me aren't paying me. And that's kind of a way the rule is written. And I brought that up to the FAA before. And you know, that's obviously a head scratcher for them. And the guys that I spoke to weren't the ones that created that regulation. But that's what was interesting to me, it was theirs. It was just funny that I could fly with people behind me that are not paying me but the minute somebody is paying me for that flight, now it's held to a different safety standard.

Scott Benner 18:38
Okay, so I want to go over a couple of ideas about airplanes for a second because I'm, I don't know if you realize this or not. But today, I just saw this on social media. And I don't know what they're calling it. So I can't find it very quickly, maybe you'll know there's some fighter jets that are flying some path through the Northeast today, in support of, you know, medical professionals and everything that's going on Corona, they're going to go by my house in about the next 25 minutes, which is weird that you and I are on while that's happening. So these are fighter jets. I have been on you know, I get on a plane in New York. And I want to fly let's say to Wisconsin, I sit down on a jet that has three seats on the left and three seats on the right. 30 or so rows. I don't know what kind of plane that is. Seems like a big plane to me. Sometimes I fly out of Houston to come home. And all of a sudden, I'm in a plane that genuinely feels like a mall with wings. Right? There's, there's, you know what I'm saying? There's there's two two seats on the left on the right. There's four in the middle, there's two on the left, you know, you can't see the front of the plane from the back of the plane. Can you find

Pietro Marsala 19:50
all of those planes? Are you saying now that the rules have changed now

Scott Benner 19:54
I'm saying you personally like you know, can you bro down and get those planes and make them go? I'm gonna do two ads in two minutes, hang out, see if I can do it. The only pod tubeless insulin pump is the pump My daughter has been wearing since she was four years old, she'll turn 16. This summer, she has been wearing an omni pod every day for that time. And it is spectacular. No tubing means no controller to carry around with you clipped in your bra, under your belt, wherever you have to stuff that other two pumps, you know what I mean? There's a an infusion set along tube, and then something to carry with you, not the Omni pod. Omni pod is a small self contained device, you put it on, that's it, you control the insulin from a separate device that does not need to be attached to you. It is spectacular. This may be hard for you to believe. So what you should do is go to my omnipod.com forward slash juice box and get a free no obligation demo of the Omni pod sent directly to you today. Do it right now, it's free. That means it doesn't cost you money. And there's no obligation, which means you don't have to keep it right, you'll get the demo and you can throw the trash and be done with it. Say I don't care about this, or you can keep going it's up to you. Don't let me or anyone else make a decision that you could make on your own. The Dexcom g six continuous glucose monitor is at the heart of how we make insulin decisions for my daughter. The trend arrows tell me the speed and direction that my daughter's blood sugar is moving. And with that information, we make decisions about food and insulin, they keep my daughter in a tight range, and she stays there. Most of the time. There's no big secret, we just use the right amount of insulin at the right time. And you could too, if you had a dexcom g six, head to dexcom.com Ford slash juice box to get started today, you will not be sorry that you made that trip on your keyboard.

Pietro Marsala 22:04
So our commercial certificate doesn't limit us to any specific type of airplane. So to answer your question specifically, as pilots, we need what are called type ratings. And any claim that weighs over 12,000 pounds, you need to you need to have what's called a type rating. And so what it is, is you're having a general certificate that allows you to be paid to fly. And then once you go work for the specific airline that you you choose to work for. And they assign you an aircraft and you go to school for two months. And in addition to all the schooling you've been through over the years, you go to specific school for that airplane for two months, they teach you exactly the ins and outs of that specific airplane, they type you. They give you a Type Certificate. So they basically you're a specialist in that airplane, you're certified to fly that airplane as part of your your ratings. And so these these simulators that they put us in at the airlines, their multi, multi multi million dollar simulators. In fact, most people don't know this. But the first time that if you know if you're an airline pilot, and it's your first job of flying for an airline, the first time you have passengers behind you is the first time you're flying that plane. You don't go up and just you know fly a plane around for fun, and have the company train you the old days it was like that. But now simulators being so accurate. They don't require that anymore. You can actually the first time you have the first time you fly that plane is the first time you actually have people behind you all your training is done in a simulator because it's so realistic. Wow. So yeah, to answer your question, yes. That's so cool. Hey, so

Scott Benner 23:26
we, if a person was in that simulation process, let's call him bill. And Bill wants to be a pilot. And Bill keeps crashing the simulator. How many times is Bill get away with crashing the simulator before they tell him he'd probably make a better? You know, like, I don't know, host or host on the plane instead of the pilot. Yeah. How does that, like coming? Me strikes until you're out?

Pietro Marsala 23:49
Yeah, how many strikes? Yeah, good question.

Um, well, they don't give you I mean, it's not like one time, you know, the plane crashes you're done that that's not how that works, really. So you know, obviously, it's, it's an overall picture of what you guys are doing. And there's various phases of flight that they put you in, they will run you through the simulator. I've never done this actually, because I'm not an airline pilot yet. I just got my certification. But from what I've heard from everybody that has gone that I've known people that have been there a while they put you through various phases of flight, and they put you through the hardest of the hard. And so it's very, it's very challenging, you know, there's, there's, there's a chance that people can watch out too, and they don't hold your hand, but they hold you to it. Yeah. And so they only take the best of the best and as they should obviously and so how many strikes throughout I'm not sure yeah, Tom, but I know that they they do a lot of they're pretty selective on who they allow to fly the general public around, like I said, like they should.

Scott Benner 24:43
What's the um, stress like, flying or even in a simulator? Does it affect your blood sugar? Do you need more insulin when you're flying?

Pietro Marsala 24:52
On a simulator, you're on the ground. I mean, it's just like an airplane right? I treated just like an airplane. Not so much. I mean, when I'm flying my plane triggers are probably the most stable a because I'm fasting and B because it's part of my scan uses CGM. I use a G's, a G six Dexcom. And so obviously, as you know, as most of you know that listen to this, that use the G six, it makes your life so much easier. And so while I'm scanning the instruments, and I'm flying myself or I'm instructing or whatever I'm doing, I use the Dexcom g six as part of my scan. And, you know, just a quick glance at my CGM to see where my levels are at and then just keep myself really stable in flight.

Scott Benner 25:27
Oh, wow. So your your glucose monitor becomes part of your, your checking of gauges?

Pietro Marsala 25:34
That's correct. Yeah. So the scan that we have, yeah, we check every instrument, what we call a racetrack pattern is where we go around, and we check in each individual instrument to make sure that it's working correctly, and that we're seeing what we should be seeing. And, you know, a quick glance of my my index come every, I'm kind of OCD about it. But I check it every five to 10 minutes, just to make sure it's still there, even though I'm stable. My bazel set right.

Scott Benner 25:58
On my skin, what part of the scan, do you look for the text from potential dates? Is that?

Pietro Marsala 26:04
No, you know, it's funny because you don't really get service and a lot of areas we're at and so cell service isn't isn't part of or dating isn't part of the scan.

Scott Benner 26:13
Right? I'm gonna ask you one unrelated question that I'm dying to know the answer to. And then I'm going to move on to things that are actually pertinent to what we're talking about. Yeah. All right. Why does my cell phone or yours or anyone else's work at certain elevations and not others?

Pietro Marsala 26:29
What is what is your cell phone work, as you know,

Scott Benner 26:33
we're moving to satellite conversations now, which has nothing to do with flight. So I understand that the signal is being beamed to the, to the surface, right. And they're being pointed at landmasses, too, which is why you don't get cell service out to see for instance, but but how you know, when you take off, everyone's been, listen, I think everyone's had something going on Netflix when the plane goes up. And you're pretty amazed that 25 minutes into the flight, you're still watching, right? So yeah, and then all of a sudden, it cuts off. Why does that happen?

Pietro Marsala 27:02
Well, let's people should be downloading before they they get airborne, so I don't have that issue of it cutting out.

Unknown Speaker 27:07
But

Pietro Marsala 27:09
But anyway, it's uh, you know, it's interesting, somebody, somebody asked, somebody reached out on social media to me the other day and said, Why can't we use our cell phones in flight? And truthfully, I don't have the best answer for you. Because before it was a myth that it, it could have been with the technology that they use before, with the radio signals that that we used to use in order to track what we call Airways, they're basically highways in the sky, we needed these specific navigation sources to operate correctly, and the cell phones could have distorted that signal. And so that's why the crew recommended for you not to be or not recommend or require you to not be on your cell phone to this day, why they still do it. I'm not sure because a lot of the stuff that we do is, is GPS based and has nothing to do with the with those

Scott Benner 27:48
with those cell signals. Hey, it's just a man trying to hold me down Pietro, but that's okay. Yeah. So, do you know the genesis of you know, I've had a couple people come on and talk about it. But I think it's interesting because of where we are now. You know, john came on years ago to talk about wanting to get these first class medical license back for people with you know, type one diabetes, even back then he was saying, you know, man, because there's, there's glucose monitors. Now, it's a different world, you know, you're not just hoping your blood sugar doesn't fall. There's different ways to manage. But what's the genesis of how this happened? Like, why is it okay, now with the FAA, how were you able to get this license, but what's the behind the scenes about how we got to it?

Pietro Marsala 28:29
Yeah, definitely. Um, so

CGM has become

a huge part of this game. And to give you kind of a quick backstory, I was able to go to the FAA, I was fortunate enough, I was just touring DC with a girlfriend at the time. And I was walking around dc in shorts and a T shirt. And I'm like, Hey, I gotta stop you. Did you say you can't get text so that you can ignore your girlfriend while you're flying? Is that what's going on here? Is this an elaborate?

Unknown Speaker 28:55
Right, right?

Scott Benner 28:57
I understand phones don't work in plane. Sorry. All right. You're in DC. Good.

Pietro Marsala 29:02
Yeah, so I'm in DC, and I'm toying around with an ex girlfriend at the time. And, you know, we come across, we're looking at the museums and one on the monuments. And we come across the FAA is building it's the Department of Transportation. I'm not sure if you've been there or not, but not that you would have any reason to be but

Scott Benner 29:16
how do you name it? Like, I'm just kidding.

Pietro Marsala 29:19
We came across the building and I'm in shorts and a T shirt just kind of in the summer just turned around. And I've been outside all day. And she goes, Hey, why don't you go inside and, you know, speak to the FA and this is back in 2016 in the summer of 2016. And she goes Why don't you go inside and speak to the FAA. I was like are you kidding? Look, come on dress me. I mean I'm not I'm not presentable. I don't even know what I want to say yet. I have what an idea, but she was we'll just go in there. Give it a shot. I'm just like, I find so you know, I walk in and there's this. There's a security like, it looks like a TSA kind of checkpoint. And there's this huge building I walk in. There's always people looking at me like what is this dude doing here? You don't look like you're you're supposed to be here. And so I asked the security guard I said hi is a is a doctor. Deval here. He's the deputy air surgeon for the for the FA. And he's like who? And I'm like, he's the deputy here. So I thought by me given him that title, he would know immediately who I'm talking about. Because this is a big building, man. He's like, there's a lot of people here he goes, but anyway, if you want to go upstairs, you need an appointment. I'm like, okay, so yeah.

So I just walked out.

And I walked out of there, and my girlfriend at the time was like, you know, what did he say? And I said, Well, we need an appointment to go upstairs. And so he's not gonna allow us and she goes, Okay. Alright, so I was like, You know what, I have his email. So I'm gonna shoot him an email, and see if he responds, I doubt it. But I'll give him a shot. I'll give it a shot anyway. So I did, I shot him an email, and I'm at dinner that night in DC, and my phone goes off. And it's it's it's him. It's Dr. Hall, I couldn't believe it. I was shocked. It was the first time I've ever reached out to him. And I told him, basically, hey, I'm here from Phoenix. And you know, I'd love to chat with you and share my story. If you have the time. It would be awesome to meet you. And he responded with great, I would love to meet you How about tomorrow at 12. I'm like, holy cow done. And so I put some things together and try to look presentable. And I went up there. And we had a meeting. And first we sat down, he was like, Hey, you know, I don't have a lot of time for you. And so I sat down next thing, you know, we're there for an hour and a half. And so he loved my story, I was kind of in a unique position as a flight instructor to kind of share my data with him every day and show him that, hey, I use a continuous glucose monitor. And they knew, and I think, if he didn't know nearly as much as they did today about CGM, because it was more the old school fingerstick as what they knew of, and, and so he said, you know, you know, we're, we're close, but we're not quite there is what he told me as far as getting a first class medical to fly for an airline. And he goes, this is interesting, you have a very interesting story. And I appreciate you coming up here and speaking with me. He goes, let's keep in touch, and I have his direct and I had his direct line. And so over the years, I would call him every month and a half, two months, or you know, you know, being pleasantly aggressive as I like to say, and so I'd check in with him. And every now and then, and, you know, we would he would kind of update me of what's going on and the latest and I would kind of fill him in with the latest that I've gotten, I just start sending him things randomly. And when I say things, I mean, like, I would send him CGM data, not that it was required. But I just wanted to show him prove to him that he that this is possible, if you maintain your blood sugar, if you can be stable in flight as a flight instructor, what is the difference between being stable in flight as a flight instructor and flying for an airline three, four times a day if I can manage it in flight, and I'm not having highs and I'm not having Lowe's? You know, why isn't this you know, a possibility. And so he understood and he agree with me, and he said, again, we're closer than we've ever been in this technology is definitely a game changer. And so it does help us get a good picture. Because as you know, Scott, you prick your finger. If you're only using finger sticks, you're only getting that picture, like you've talked about millions of times on your podcast, you're only getting the picture of where you're at doesn't tell you where you're going. But it tells you where you're at at that specific time of day. And you have no idea what's going going on for the rest of the day. And that's where CGM comes in and fills in those gaps and allows you to have a full picture of exactly what's going on. And of course, the FAA I love that idea. And so I kind of just left it at that we kept in touch and then I find I went a step further. And I got back to Phoenix and I start flying shopping. And then I myself along with the American Diabetes Association that I was in contact with. But I am still in contact with I decided I'm going to make a Microsoft Excel spreadsheet. And with the spreadsheet I included in there, it was basically a spreadsheet showing where my blood sugar was prior to take off where it was an hour into flight where it was two hours in a flight and what it was prior to landing. And then in the note section of this Excel spreadsheet, I was able obviously using the CGM data I was able to see go back and check exactly what time's you know these were and what my blood sugar was at those times. And in the notes section I would put in if I gave myself any insulin to maintain my my my glucose levels and also if I or if I gave myself any snacks to maintain my blood sugar in flight. And so they had a very, very, very detailed picture of what was going on in my day. Because as you know as CGM just tells you what's going on 24 seven doesn't tell you exactly what's going on. For me in flight at those specific time, so I showed him I went a step further and backed it up not only with the CGM data, but with a Microsoft Excel spreadsheet to show here's me in flight, and I would do three, four flights a day. And I logged that three, four flights a day, an hour and a flight two hours in flight before landing prior to take off all of that stuff. And so he would see exactly that I am safe and I I am maintaining my blood glucose levels in Flint.

Scott Benner 34:21
So it's just that it's, it's possible was probably a big deal for him. Because, you know, they set a rule like that God knows how long ago and then it gets in people's heads like oh, people will tell you know, people use insulin can fly a commercial plane, boom. That's it. It's a rule. So it must be there must be a really great reason why this exists. And then somebody like you comes along and says, Well, you know what, things have changed. And let me show you how this could work. However, real quick question. Do you still talk to Dr. Duvall?

Pietro Marsala 34:47
Absolutely. Yeah. And in fact, when I conclude the story, I'll kind of tell you how it kind of all came together but up to this day, we still keep in touch and he he and I I don't want to say become friends but we've definitely he you know He answers every one of my calls. If he doesn't answer he'll call me right back. I have his direct line to his desk and Monday This is the deputy or surgeon for the FAA. This is this guy's top dog. Yeah. And so we've established a good working relationship over these last couple of years. And I've and I've told him, you know, you can be my guinea pig, if you I'll fly you out to Arizona on my own dime, to show you that I can maintain my blood, my sugar levels in flight. And, and he was like, Oh, no, no need to do that. And he goes, you're done enough. You've done so much. By sending us the data, we appreciate your generosity, and I've gone and again, this was all at my own risk. There were pilots out there in the past that didn't want to share this data with the FAA, even if they had it, because they were afraid of the FAA denying them. And my, to me, it was like, Well, I have nothing to hide. I'm not perfect, but I know I'm controlled. And to give you an idea in it, obviously, anyone see doesn't tell the full picture, but anyone sees her six 6.2. I hang around that range consistently. And my you know, my Dexcom backs everything else up to show that I'm at a low risk for hypoglycemia. And you know, I consider myself a, I do a pretty good job. Like I said, I'm not perfect, but I do a fairly good job of managing my diabetes. And they see that and they appreciate that. And so, again, I sent in all this data to back up what I was saying, because anybody could say their control. Anybody could say they're stable, but it's another thing to prove it with the CGM. And on top of that, a Microsoft Excel spreadsheet. So yeah, yeah, we've kept in touch over the years. And they kind of use me and my data and it's interesting they, I found out later, a couple weeks ago, somebody from American Diabetes Association called me and said, they spoke to Dr. Duvall and I kind of unofficially knew this. But I then found out that he said that it was your data that convinced the federal air surgeon and the deputy air surgeon that this is something that is obtainable. It's not as this is safe, and it can be done safely. And granted, not every applicant that applies for this that has diabetes on insulin is gonna qualify. They're very selective. It's a very

Scott Benner 36:51
are they detailed process? I was gonna say, are they asking other people for CGM data? Does everyone get asked yes or no.

Pietro Marsala 36:58
So before all this happened, they changed the rule back in November 2019. On November 7 2019, the FAA changed their stance on first claros first class medicals with insulin treated diabetes, and that regardless if that's type two or type one, if you if you need an insulin, they treated it the same, and so now they require a CGM. Before CGM was never required to obtain a third class medical. But now, since the rules have changed, they now make it they now make it to where you need a CGM. And there's certain sea gems that qualify. And so yeah, so now, the rules have changed. And since they've changed these rules, now they're looking at each individual case, and there's only been a few of us certified now. But they use that CGM data to basically paint the picture of somebody who's safe or not, and they assess your level of risk and in their doctors up there at aerospace medicine, but they're not diabetes specialist, so to speak. And so they brought in a team of experts, like endocrinologist, some of the leading endocrinologist in the country, some consultants and some people to help them make these decisions to assess people's level of risk. So it is a hard process to go through and, and you know, only the safest are going to qualify as they should if they're flying the general public around. And so they're very either, you know, they're picky on who they're selecting. And, you know, is there a, you know, people have asked me these last couple days, like, what did you do? What exactly do I need to do? And it's each individual case is different. They send you to a cardiologist, they send you to an endocrinologist, they send you or you have to go yourself, and that's just paperwork, obviously. But yeah, it's it's a pretty detailed test that you have to go through.

Scott Benner 38:32
That's an astonishing story. And you know, what I took of it most is that you have a longer relationship with Dr. devolve than you did with that girlfriend who was with you. And

Unknown Speaker 38:41
really what I took from this occasion that

Unknown Speaker 38:44
that is true. I always kept in touch. He's a good guy. He really is. Well, he doesn't nag you.

Unknown Speaker 38:49
Right. So.

Pietro Marsala 38:51
Exactly, exactly. Just on the picture. And he will always be

Scott Benner 38:54
you call every six weeks. He's not like Why don't you call him or I have a question about your your blood sugar targets? Are they the same when you're flying as when you're not flying? Or do you have different ideas for range in different situations?

Pietro Marsala 39:09
Okay, so good question.

Scott Benner 39:12
When you tell me it's a good question, it makes me feel better. I don't know what that says about my psyche. But thank you.

Pietro Marsala 39:18
Yeah, so no, it is because I keep myself you know, if I'm in the 80s, and I'm hovering in the 80s, or the low 90s. When I'm at home, I'm good with that. Because I know that if my base will set right, as you've talked about with Jenny and multiple people on this podcast, that if your base will set right you can hover in those areas, and you don't need a tree, you can go a couple hours without even eating anything and hanging the 80s and 90s. And you'll float right there if your basal set right, right and mind you, I'm on MDI still, I'm not on a pump, but I'm on a G six. And so I kind of just hang out and you know, if I'm at home, yeah, do I treat it a little bit differently? Sure. I'll hang out in the 80s I'm fine with that. If I'm at 8283 i can i can be comfortable with that as long as it's staying in that room. But if I'm flying 80s, that much closer to 6060 is that much closer to 5050 is that much closer to 40. And so I don't take these risks. I don't I don't do that. And so what I do is I keep myself slightly more elevated in flight, I like to keep myself in the low one hundreds is my target between, I would say, between 100. And, and 141 30 is a good range for me to be in. And that's kind of the target range I have while I fly because I know I'm nowhere near hypoglycemia. And granted, if I was in the 80s, in flight, I know that I'm not going to pass out either you and I both know that, you know, at an 8590 of blood sugar on your CGM, you're doing just fine. But again, it's just that much closer to the range of hyperglycemia. And so I out of respect for you know, everybody else and whatnot, I keep myself slightly more elevated.

Scott Benner 40:42
Do you only fly planes where there's a copilot? What's the standard for that?

Pietro Marsala 40:47
No, it's interesting. Scott, right now I'm a flight instructor and I fly with people that don't know how to fly. Yeah. And so I will be flying. Eventually, once, you know, COVID passes in the airlines pickup hiring again, it's kind of an ironic time. But eventually, my goal is to get to an airline and I will be flying with somebody who knows how to fly, thankfully, and it's just gonna be a different world. And so it's going to be in my opinion, in many people's, many people, many people's opinion, it's going to be much easier once I go to airline because now I don't have to worry about so much of the other guy not knowing how to fly. Now I've got my blood sugar, and I've got my own job, right instead of my blood sugar, my own job. And now his job was for her job.

Scott Benner 41:25
I was just thinking you spent eight years getting to a to a place and you got there and now nobody airplanes are flying anywhere. And it's probably Is it a little bit of a bummer that I mean, not that, you know, not to specifically target Coronavirus in your life. But I mean, did it feel like that a little bit like, wow, I got here and then all of a sudden this happened.

Pietro Marsala 41:46
It is such an ironic time. It's, it's been a wild ride. But you know what, when you're working on something for eight years, and you just cleared the biggest obstacle of your life. And you recognize that, you know, you just did this. It's only a matter of time, I'm 29 years old. And I've got 35 plus years of a career ahead of me, right. And so I know that eventually this will pass I'm optimistic that this will go away one day. And whether that takes a year, two years, three years for the airlines to return to where we were, we will get there. And I'm confident that the general public will be flying around again. And there will be a need because there was a shortage for pilots only about a month ago and went from you know, this huge need for pilots to nobody needs pilots right now, obviously put what's going on nobody traveling. Well, you have so

Scott Benner 42:27
you have unique perspective and patience, obviously around this because you could have given up on it at any time and just thought it's not going to happen. It's pretty neat. Listen, I'm interested, like you said, when you got on, you're the first person to get this distinction. Is that is that true? Or you're like, How do you know? Yeah, yes, I have a number one on it or something or

Pietro Marsala 42:48
what has first class, but that doesn't mean I'm the first I'll tell you how I know I'm the first and this was a special conversation I had with Dr. Laval he I was driving with my current girlfriend and my smartwatch goes off. Does she know you?

Scott Benner 43:02
Dr. Deval better than her? Has she not figured that out yet?

Pietro Marsala 43:05
Oh, yeah, she knows. She knows I've known him for four years now. He's okay with it. She shared the love

Scott Benner 43:09
you just real quick that you were on a boat. It's thinking it only hold two people you Dr. Deval and your current girlfriend on it, what happens? And we need you to find the point home so I'm just

Pietro Marsala 43:19
gonna answer this. Eventually she's gonna listen to this. Boy,

Unknown Speaker 43:23
so

Pietro Marsala 43:24
So yeah, so I'm driving. And you know, Dr. Boyle told me weeks ago, we were close. And obviously this protocol came out in November, and I've kind of been pleasantly aggressive just checking in with him here and there. And just kind of asking him What's going on? What's the latest? When are we getting, you know, certifications? And I was thinking by Christmas, because it came out in November, I was like, Oh, this will be an awesome Christmas present. You know, I'll go to an airline come January 1, and that'll be awesome. I'll be able to live my dream and this is gonna be great. Yeah. Well, it took a little bit longer, obviously. And as things do in government, as we know, they take a little bit of time. And so I was patient, and I kind of just checked in with him. And he kind of hinted to me here and there that, you know, we have looked at your paperwork, we have looked at your data, and it's checking out in favor, everything is looking good. And about three or four or about a month ago now I called him up and I said, Well, what's, you know, what's going on? What's the latest? Do you have any updates for me? And he said, I can confirm that you're, you know, you you are in Dr. Barry's inbox ready to send out and whatnot. And it's, it's getting close. And so, so I was like, Okay, great, you know, but again, it's government talk, right? These things take a little bit of time. And so I wasn't I wouldn't want to get my hopes too high. But then eventually he said he calls he sent me that email and he told me it was going to come in an email format. And it did and so my smartwatch went off and I was like holy cow and I was freaking out my girlfriend's okay you know, pull over because you're too excited to drive right now like just pull over. So I did I pulled over to a safe spot before I open email. And I wasn't even sure what it said yet, but it was like this this secret not a secret email, but it was a security email. And so I put

Scott Benner 44:55
my name and email if we could because I think it makes it more exciting. You got a secret email from the government. It said you're a pilot now. Yeah, but right now, yeah. So it's one of those you have to put in a code to get to it and all that.

Pietro Marsala 45:07
Yeah, exactly. Put in a password. And then I scroll to the bottom of this email. And I just saw my name was on it said first class, medical. And I start obviously, just crying emotionally. It was just really, it was really important time in my life, probably the biggest, biggest day of my life to this day, there's something that you work so hard at, finally come to reality. And just knowing that your boyhood dream of doing what you wanted to do your whole life, and people telling you that, you know, maybe this career choice wasn't for you. Maybe this isn't for you, when I was first diagnosed, maybe you know, there's different God has a different place for you in life. And that was really hard pill to swallow. And so, like I said, I decided to do something about it. I went to the FDA, and I'm glad that they took me seriously. And so I called the doctor, not even a minute later, I'm on the phone with a doctor in DC. I call him up and I said, Yeah, obviously it was I was still emotional. I didn't even I wasn't even done crying yet.

Scott Benner 45:54
And that was my question. By the way, I was going to jump in right there and say, did you pull yourself together before you call? No,

Pietro Marsala 45:58
no. And looking back, I probably should have

Scott Benner 46:01
been thinking probably Yeah, but God.

Pietro Marsala 46:04
So yeah, I call him up. And I was like, Hey, you

know, and he obviously knew cuz he just sent the email is coming from him. And I said, Dr. Ball, I just want you to know that you've forever changed my life. And, you know, this is the biggest day of my life. And I can't thank you enough. I'm forever grateful for everything that you did. And thank you for believing in me all along, and trusting me and allowing me to share my data with you and my story with you. And he said, he's a pitcher, he goes, I want you to know that you were the first one I sent out. So you're firstly the first the first treated diabetic diabetic pilot to be certified for an FA first class medical. And of course, that made me feel great, not that I was racing to be the first but I just wanted this change. And I'll get to what I'm getting at in a second. But he knew how much that meant to me because of our conversations over the years. And he shared with me, he said, you know, if I didn't shed a tear, when I sent out that medical he goes, I'd be lying to you. And so this that was just, it just told me a lot about you

Scott Benner 46:58
guys are dating.

Pietro Marsala 47:01
Yeah, it was a little bit of a bromance there. I'm not gonna lie. I'm gonna

Scott Benner 47:03
get him on the podcast and see if he cares about you as much as you

Unknown Speaker 47:09
change my life, I didn't change it. So I don't know about that sounds

Scott Benner 47:12
like it sounds like the the process of taking somebody like you and I'm, I'm thinking the countless other people like you who have type one diabetes or using insulin, wanna fly this kind of an aircraft? and can't, I would think he'd feel some sort of a real emotional charge behind changing people's lives. It's a it's undeniable. On it's definitely, yeah.

Pietro Marsala 47:33
And Scott, I told him from the beginning, when I first met him in 2016. I said, Look, that would be awesome. If I get certified, if I become certified. But I said, I don't want this just for me, I want this to be a change in a protocol, a change in regulation, I want it to be instead of a blanket, no, for people that have diabetes, I would like to see more people like myself that are qualified, that are controlled to be certified. And I said, I, I can't imagine being a kid at 10 years old, having the stream and then being crushed minutes later, when you're told not only are you living with a chronic illness, and it's hard enough, especially for these kids, that can't go to birthday parties and eat cake and ice cream like everybody else. But, you know, to be told that, hey, I'm sorry, you're you know, you have diabetes, and this is one of the things you can't do. And so that really, you know, meant a lot to me for for this to become a change in regulation. And so I shared with them, how I want this to be something that you know, isn't obtainable goal, and I think that kids, you know, when they're 10 years old, these parents, you know, could almost bribe these kids and tell them, you know, and use it as a as an incentive to, Hey, take care of your health. And this is definitely an attainable goal. Look, these people did it, these people change the rules for you guys. And so growing up, you know, I think that's a crucial time in their life when they're, you know, 1011 years old to learn that your dream is not crushed. In fact, you can dream big, because this is definitely obtainable goal, look at these people have done it, take care of yourself, take good care of your health. And when it comes time to go to flight school, if you have good blood sugars, and if you maintain yourself in a good range, and you use the CGM and to prove your data, that this is something that can be done. And so I was so thankful for that. And to know that it's not just me, it's other people as well, to me means an incredible amount.

Scott Benner 49:08
Well, sure. It's that moment, right? When you realized I have type one, I don't have type two, your back in the doctor, like, are you sure like let's not do this? This is Yeah, you said that's probably the worst moment of your life hearing that you couldn't fly these planes. And, I mean, let's face it, it's already an uncommon thing for someone to feel so strongly about something they want to do for the rest of their life. To take that thing from someone is specific especially because they're, you know, not a million people run around who want to fly airplanes around. It's, it takes a special person I know you don't know that about yourself in some small way. Being a pilot is a lot like being like a professional athlete in that you just do this thing that feels normal, and you don't realize that most of the rest of us, you know, can't throw 103 mile an hour fastball like like it's just like if honestly if you put me in a plane and said you can do Scott, I'd be like, No, I can't, and then I would get out of the plane and I'd yell at you, because I'd want you to Yeah,

Pietro Marsala 50:05
I mean, it does take somebody, you got to want it. And, you know, I see this all the time in flight training, and there's people that, you know, become pilots for various reasons. But, you know, most people that do this, they love what they do. And this is something just like you said, professional athletes and, and whatnot, this is something that we dream of, you know, as kids, most of the time, it's something that you just have in you, and it's something that you just desperately want. And, and it just shows that, you know, there's pets are a certain type of people, you know, they're very, let's just, I'm just gonna put it out there, a lot of them are narcissistic. And they like the attention and they like the but overall, they, they are people who have a lot of pride now, and they take very seriously what they do. And so it's just one of those things that you know, as a kid, if you're that kid that has that, and in you and you want to fly

to diabetes, that shouldn't be something holding you back,

Scott Benner 50:50
take it from Listen, I cost me $300 a year to have a company come to my house three times a year, and clean the leaves out of my gutters because I'm not climbing up on a ladder. I do not want that as my that's not how I'm going to understand what I'm saying.

Unknown Speaker 51:03
Yeah, I do not,

Scott Benner 51:04
I am not going to open my eyes back up, have St Peter standing in front of me, which is oddly not something I even believe in, and then have to tell him that I was trying to clean my gutters out and now I'm dead. I can't write I can't do that. I don't like leaving the ground. It's it's a bad.

Pietro Marsala 51:18
You know, you're not gonna believe this. If I tell you this, I have a fear of heights. Get the hell out of here.

Scott Benner 51:23
Why would you say that? To me.

Pietro Marsala 51:24
I don't like being on balconies. I don't like being on ladders. I don't like being on the roof. I just get weird when I'm at edge. However, in an airplane, I've never had this fear. I don't, I don't feel like I'm not secured. It's just a completely different feeling. Being in an airplane, I feel like I have control. I feel like you know, the wings are not going to fall off this thing. And so we're flying. But being on a balcony being on being on the edge of a building, I just I get kind of uneasy I don't like being and it's funny, because a lot of pilots will tell you that too. They don't like they don't like being up high where they don't feel like they have control.

Scott Benner 51:54
Well listen, you're younger. So you probably don't know about these, these old documents that you could, you could watch they were the colors were a little strange. Anyway, it was about this, um, a rabbit, and he could talk. And sometimes he would get on a plane. And then a gremlin would come and like bang with a hammer and knock the wing off the plane. So you're saying they can't fall off. But I've seen documentaries about it. And I'm fairly certain it can happen. So

Unknown Speaker 52:17
maybe in those days, so I'm just telling you,

Scott Benner 52:18
60s and the rabbit cursed. It was amazing. You guys suck now.

Pietro Marsala 52:23
I didn't know that would come out now, would it?

Scott Benner 52:26
No, I don't believe so. But anyway, they used to smoke cigars, and everything was fantastic. Honestly. Nevertheless, the world Bugs Bunny aside. I think this is really one of the more interesting conversations that I've had. And it wasn't so much of a conversation, I kind of loved it because you have been so immersed in this over the years. You You didn't need me here. Like I could have, I could have gotten on and said, Hey, real quick, tell me about that whole thing with the flying, I'm gonna go make a sandwich. And I think I would have come back and you'd still be telling your story, which I mean is a it's amazing, because, but but it's a testament to how much you were involved in it to make it happen is what I'm saying.

Pietro Marsala 53:09
Yeah, it was, it was quite, it was quite a road. And I'm so thankful I've got to the end of the, you know, on this road. And it was it was hard. I'm not gonna sit here and tell you it was easy and blue skies until wins the whole

Unknown Speaker 53:19
way.

Pietro Marsala 53:20
Because it was a it was a challenging road. You know, there were times where I was like, This is never gonna happen. And there were so many people in my life, my family's close to me, and there's so many people that picked me up and made me believe and truly to never give up on the stream and that I could be in I knew I was healthy. And it was only a matter of time. But there were times where, you know, I would sit up at night and think to myself like why why me with diabetes number one, like like a lot of people do, I'm sure. Yeah. And why out of it's interesting because I'm the only person in my family and I have a big family. My family is Italian and the majority of still live in Italy. And out of all my cousins that have all my aunts, uncles, nobody has diabetes, except me. And I was just like, how is this possible with every Not that I would wish this on anybody? Don't get me wrong, but it's interesting. nobody in my family has diabetes. But yet the only person that can't have it, or at the time couldn't have it for his career was me. And this is the career choice that I took. And I'm the one with diabetes. It's so weird to me. It was hard to hard pill to swallow.

Scott Benner 54:17
Do you want me to tell you how I knew you were Italian? How's that? All right, on your on your pilot's license that you were really cool put up on your Instagram, which by the way, if people want to see it where what's your Instagram handle?

Pietro Marsala 54:29
Yeah, it's a it's Marsala like my last name. It's an AR s a la nine zero. Okay, is

Scott Benner 54:36
my Instagram handle so everybody should check it out. It's very cool. But it's because you're five, eight on the license and every Italian. Every Italian guy I know grew like they were like five eight when they were nine years old and they never got

Pietro Marsala 54:51
to exactly tell us kid in sixth grade and then hundred percent loosens? Yeah.

Scott Benner 54:54
I mean, listen, I don't know a lot about you know, about lineage and things like that, but I've seen that enough times. I can make that generalization with a lot of coffee. Definitely. Yeah. No, that's,

Pietro Marsala 55:03
that's, that's a good point. I'm about as tall as my dad. Yeah.

Scott Benner 55:06
All right. So I'm gonna I want to thank you, this is terrific. And I can't let you go before I find out and not on the recording because this isn't anybody's business. But I want to know if you broke up with the girlfriend from Washington or if she broke up with you because I have a theory that when you failed, she lost like faith in you. And she was like, No, that's it. This kid couldn't get it done. And I'm on my way. Exactly. That's what happened. No,

Pietro Marsala 55:28
no, it's interesting. Just kind of short story. She she's an airline pilot herself now. And we met in the industry and so

Scott Benner 55:36
don't wait, wait, hold on. The planes are going by. Keep Oh, really? Don't you? There's no way you can hear them. Hold on.

Pietro Marsala 55:44
A fighter jets.

Scott Benner 55:45
Yeah. Oh, nice. Yeah, there's, um, I think it's a two squad flyover for they're celebrating people who are working in hospitals during the Coronavirus, COVID-19 thing. And on this weird path up and down that I can't believe I just my house just crumbled. And I was like,

Pietro Marsala 56:01
I suppose you're flying pretty low. Are you far from New York?

Scott Benner 56:06
No, I'm not far from New York. But I think they came out of Fort Dix. And I'm pretty close to there. Okay, so I think I'm catching them on the return to to the base. Anyway. Well, I'm sorry, you were about to share personal details about how your relationship broke up. And I don't want to stop you.

Pietro Marsala 56:22
Yeah, so anyway, so

yeah, so she's, she's an airline pilot herself. And, you know, kind of life just took us in different directions that she started traveling. And, you know, I was here in Phoenix. And so we kind of just grew apart from each other at that point. But no, I wish her nothing but the best. She's a good person. But yeah, it just wasn't for us. You know,

Scott Benner 56:37
it's amazing that you said something real and not stupid like I was getting at. And because that was the one question I have here on my notes that I've been making while you've been talking. Just because you talk quickly. And I didn't want to Yeah, I didn't want to run you over. I'm not saying you shouldn't have I'm saying I don't usually make notes. Usually I just run people over and just say something. But I made notes because I didn't want to stop your your vibe he had going. And that was my one question about one day being an airline pilot. Is that idea of like how transient you are all the time? Is that something you're prepared for? And how have you prepared for it? If If so,

Pietro Marsala 57:11
you mean like for me personally? Or for like my relationship? Or what guess?

Scott Benner 57:15
Yes, like all of it, right? You're constantly going to be in a thing yapping back and forth. And you don't end up at home at the end of the day all the time.

Pietro Marsala 57:22
Yeah. And so I know a lot of pilots now that I've been in the industry 10 years, and I can tell you that it is not easy. There's a reason why there's a lot of pilots out there that are divorced. And so I think it is hard on a lot of families to be gone. I mean, you're missing, you know, you're close to your kids, I've heard you talk about your son's baseball and whatnot, you've been very active in his life with that. And so you do miss these things, you miss birthdays you miss, especially in the beginning, you know, if you start your career in your 20s, your early 20s, and you're, you know, an airline pilot in your early 20s, I think it becomes a little bit easier because seniority in this world of aviation, at least in the commercial aviation part of it is everything. And so if you start in your early 20s, by the time you're in your 30s, you have pretty good seniority built at your company, typically. And so you're able to, you know, get these days off, you bid your schedule a month in advance. And so if you have your son's baseball game that's coming up, and you see his schedule, you know, you can, you know, request these days off, you can get these days off in advance if you're senior enough, but if you're a guy like myself, who's just starting out, now, you're gonna be at the bottom of the seniority list. And unfortunately, you're gonna miss things like birthdays, you're gonna miss things like, you know, baseball games, and special events and weddings and whatnot. Not to say you don't get time off, but it's a lot harder when you're at the bottom of the seniority list. And so yes, it is it is a challenge, not just for relationships, but just all the above it, it does become really hard. But again, going back to pilots, and there's nothing else I'd rather do than then stare outside. And that be my office when I'm looking out, you know, at 30,000 feet, 35,000 feet. That's what I dream of doing. And I know it sounds kind of selfish to some people. But you know, at this point in my life, I'm just focused on my career. And in one day, you know, if I meet the right person who wants kids, and at that time, if it's the right time that kids and whatnot that don't, then I'll cross that bridge when I do but, yeah, it's gonna be a lot of sacrificing and it's not for everybody. There's not a life. Anybody that travels in general for a living can tell you that it's it's not easy on any family.

Scott Benner 59:11
Yeah, I have to say I mean, it being sincere. I'm jealous of the idea that you know how to fly a plane. I think it sounds incredibly peaceful. I wish I had the type of mind that was interested in that. But mostly, I guess what I've learned there at the end is that until you gain seniority, yours and Dr. devolves relationship is probably going to be the best one you have.

Pietro Marsala 59:33
Exactly, exactly. I think he's got like five or six years left till you retire. So yeah, whoa.

Scott Benner 59:40
Nice. You guys have plenty of time once he doesn't have anything to do.

Pietro Marsala 59:43
Yeah, there you go. Exactly. I'll go visit and we can hang out and talk about the good times when I didn't have a medical and how

Scott Benner 59:48
we got there. All right, man. Listen, I genuinely appreciate you coming on and doing this. It was It was great. You were terrific. And I wish you nothing but success. I mean, hopefully, obviously everything you know comes together. It's all about, you know, being able to move around more freely, and you're able to get out there and find the job you've been for for so long. I'm, I'm incredibly happy for you.

Pietro Marsala 1:00:08
Thank you. I really appreciate that. Scott, it was nice to speak with you on the phone, not just hear your podcast and actually kind of meet, officially. So thanks for making me laugh, as well as a good conversation. Yeah, I've done a lot of these interviews. I did one with CNN and I did one with the local Fox station here in Phoenix, and mine was the best Is that what you're trying to say? Yeah, I'm getting that that I was the most. I'm a little bit more experienced now with podcast even though I still speak quickly. And I've listened back on these podcasts that I've done. I'm like, Guys, I don't even want the guy talk. Hopefully, it wasn't like that with you. And I, I let you speak a little bit because I get going. And like you said, I don't

Scott Benner 1:00:42
even know that I'm still talking. Well, that's how I go. And I don't know anything about how the FAA made it possible for people with type one diabetes to get this first class medical license. So I figured I'd be better off letting you talk now and listen to your passionate it comes through, and it's much preferable, you can ask anybody who does an interview, it's much preferable that you have too much to say, then I'm sitting here pulling thoughts out of you for an hour. So I thought it was terrific. But I do like the ranting on I was better than CNN. Is that what you were getting ready to say?

Pietro Marsala 1:01:10
Yeah, I'm getting there. I'm getting there. No, it was fun. It was it was uh, it was it was very relaxed the podcasts on I enjoyed it. I appreciate that. We'll keep in touch. And obviously I follow you on Instagram, you follow me? So you'll be able to see my career progression. Hopefully in the not too distant future. We could get back at it after the salt passes. I'm excited for one day, there'll be the technology where you and I can record one of these while you're flying a plane. That would be amazing. I don't know if the FAA would like that. You know, the guy that would work it out. I know the guy. Exactly.

Scott Benner 1:01:37
All right. Have a great day. Thanks so much.

Unknown Speaker 1:01:38
Hey, YouTube.

Scott Benner 1:01:41
Huge thanks to Dexcom g six continuous glucose monitor. And to the Omni pod tubeless insulin pump for sponsoring today's show. There are links to all of the sponsors at Juicebox podcast.com. Or right there in the links of the show notes in your podcast app. Don't forget, g six is just a decision away. Just do it. dexcom.com forward slash juice box. And at the very least get yourself a free no obligation demo viavi pod. That's just fun to get stuff in the mail.

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Scott Benner 5/4/20 Scott Benner 5/4/20

#331 Shirley’s Birthday Wish

A Grandmother's Love

A long time type advocate, Shirley has two grandchildren living with type 1 diabetes and she has a birthday wish!

To make a donation to Shirley’s JDRF click here

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:05
Hello, everybody, welcome to Episode 331 of the Juicebox Podcast. Today's show is as unique as I can make them. Today I'm going to be speaking with a grandmother of two children who have type one diabetes. Now you might think that doesn't sound that unique, Scott. Well, it's because you don't know all the details, surely is the grandmother and I spoke with her, only a few days removed from her 100th birthday. That's right. The grandchildren that she's been trying to help. Those grandchildren are adults with children of their own, but surely is still out there banging the drum for type one diabetes. Awareness. Surely we'll share with you why she's so passionate about type one diabetes. What she thinks of this lockdown for the Coronavirus. She'll actually talk about a lot of different things. Want to find out how refrigerators worked before electricity, or what it was like to hear a radio for the first time surely knows when we chatted about it. When this is all over if you're so inclined, please take a look at the fundraiser Shirley is doing for her 100th birthday celebration. It benefits the jdrf

this episode of The Juicebox Podcast is sponsored by Omni pod Dexcom. The Contour Next One blood glucose meter and touched by type one to get a free no obligation demo of the Omni pod sent directly to your home. Your home was weird. directly to your home, please go to my Omni pod.com forward slash Juicebox Podcast To find out more about the Dexcom g six continuous glucose monitor dexcom.com Ford slash juice box. By the way, you may be eligible for an absolutely free Contour Next One blood glucose meter you'll find out if you are at Contour Next one.com. And of course my favorite diabetes organization touched by type one, check them out at touched by type one.org. You'll find links to all the sponsors as well as Shirley's fundraiser in the show notes of your podcast player and at Juicebox podcast.com.

Shirley 2:25
My name is Shirley Bornstein, but I actually that's my third lesson. That's your third last name. My first name when I was born is surely blondes thing. Then it was surely Murtha's when I married Stanley Murphy. And then after he died, I married Herman Bornstein. So like my first name, and my present name are just a few letters apart. And I understand from Sarah, that you are in New Jersey.

Unknown Speaker 3:14
I am Yes.

Shirley 3:16
It just, it just so happened. I was born in New Jersey, we're about in de Valle de Leon. And then I when I was three years old, we moved down south. My wife's

Scott Benner 3:30
first professional boss. Oh is the her favorite person she's ever worked for. His name was john and he is from Bayonne still lives there. Now he absolutely loves it there. So when you say you were born in Bayonne, you mean in 1928. Wow. And so in 1923 your family left New Jersey and went to the south. Right? Wow, no kidding. Okay, I'm gonna ask you a lot of questions. I hope you don't mind. You are Have you already celebrated your birthday? Or is it coming up?

Shirley 4:05
No, it was April 25. Last Saturday.

Scott Benner 4:08
Congratulations. It's lovely. tell people how old you are.

Shirley 4:12
And 100 Okay,

Scott Benner 4:14
now does everyone you meet ask you the secret to living to be 100 years old?

Shirley 4:20
Not necessarily. No, surely I'm

Scott Benner 4:22
going to okay. So do you feel like you lived in a way that created longevity or do you not think anything special about your life like that?

Shirley 4:32
No, like, is a friend of mine but pastor The only different thing I did is I didn't

Unknown Speaker 4:44
keep doing it. You're doing great.

Unknown Speaker 4:47
You're you had another friend who lived past 100

Shirley 4:51
No, my family all.

They really didn't live very long. My father died. 65 my mother's 72 my two sisters were in their 70s. And I don't know why I'm living so long. But I may I think it's because I so desperately want to see a cure for type one diabetes. How? How are you connected

Scott Benner 5:23
to type one?

Shirley 5:25
I have two grandchildren.

Scott Benner 5:28
And they both have diabetes.

Shirley 5:30
Type One type one. I have a lot of grandchildren. great grandchildren. I have 24 great grandchildren. But these two have type one. Diabetes, right?

Scott Benner 5:48
Are they both on this? Because you've had, I'm assuming, let me ask you had two husbands. Were you married to both of them for a long enough time to have a family with each of them?

Shirley 5:58
No, no. My first family was with Stanley mirvis. And we got married in 1945. During the war, and he died in 1979. And I had three children. The fam

Scott Benner 6:19
you guys, you guys were married? They're almost 35 years. Yeah, yeah.

Shirley 6:26
And then

when I remarried to Herman Bornstein, have three stepchildren Okay. Wow. Well, I really have six children all together.

Scott Benner 6:39
And so the the grandchildren with a type one diabetes are from your first marriage?

Shirley 6:45
Yes. And from his older I in my oldest son.

Scott Benner 6:53
Okay. And and So tell me a little bit about your grandkids. How, how old are they? Do we? Will we say their names on here? Do you keep that private? No. What do you want to know? Let's start with how old they are.

Shirley 7:05
Oh, Bruce, my oldest

child is 72. And he's a pediatrician. And in the front line on this virus right now, and he's married to a nurse who goes into the hospital every day. And they're the two I worry about the most course. They had three children have three children. Kirsten Sarah, who has the Type One Diabetes. And then the youngest, his name is Stanley after his grandfather. And he is really a hero. I have to mention him. Because when Gus needed a kidney, and his failed due to diabetes, got a family stepped up to the plate and gave him a kidney. That's amazing.

Scott Benner 8:07
That is a very selfless thing. Have you ever thought about that? I have, like, could you give an organ to someone if they asked for it? It's a big decision.

Shirley 8:16
He made the decision. Yeah. Well, they were looking for a donor. He stepped up and said test me. And he was a good match. That's amazing.

Scott Benner 8:27
How old is Gus and Sarah and Stanley.

Shirley 8:31
He's about 42 or 43. In his 40s Okay. Yeah. And danly was born in 81.

Scott Benner 8:43
Anyone? 2001 so he's about 30. Yes. 30. Did your son Bruce have an oops baby. And was it Stanley?

Unknown Speaker 8:53
No, no, no, not an extra one. At the end. I got just Well,

Shirley 8:56
listen, I've been married for

a number of years. Sarah was the old.

Scott Benner 9:03
Okay. Sarah is older. So Sarah is older than Gus.

Shirley 9:07
Oh, yes.

Scott Benner 9:08
Did they all live nearby with you? In the south?

Shirley 9:10
No. They live in Columbus, Ohio. And I live in Atlanta, Georgia.

Scott Benner 9:16
How long have you been working to help raise awareness for type one diabetes?

Shirley 9:24
Since 1985, my goodness. That's when I retired. I was working for Emory University Medical School with a very prominent cardiologist. And then at one go, and then I retired in 1985 when I was 65. And went to work. Oh, almost immediately. jdrf

Scott Benner 9:56
No kidding. What surely What did you do for 35 years.

Shirley 10:00
25 years I've worked. I did research. I was a research coordinator on cardiac research. Wow.

Scott Benner 10:09
That's amazing. Do you ever feel like you've had four lives?

Shirley 10:16
Well, I've done a lot of different

Unknown Speaker 10:19
have. I mean, you?

Shirley 10:23
I graduated from Temple University with a degree in medical technology.

Scott Benner 10:29
Okay. I grew up just outside of Philadelphia. You came up here from Atlanta to go to school? Yeah. Wow. That's amazing. That's so yeah, because they offered a great, huh? Okay, now he was that something? Was that uncommon for women? Or no? Were you like leading the way being a woman in that industry?

Shirley 10:52
No, no, there were other women. I have really wanted to be a doctor. But in the 1930s, it wasn't considered proper for a woman to be a doctor, including my father, who was very opposed to it. So I found another Korea.

Scott Benner 11:18
I'm sorry, do you think you would have made a good doctor?

Shirley 11:25
I don't have a crystal ball. But I probably would have gone into research.

Scott Benner 11:31
Yeah. That's amazing. You know, it. You said that happened? Yeah, I guess at the end of the 1930s, when my wife went into college, and told her parents, she wanted to be a doctor. They said, Well, what about a nurse? You know, I don't think that ever hasn't gone away too much. For some reason for some people, the idea that women shouldn't do that, but obviously they can and should. So you had to, you know, married two different men love two men, raised a family, worked a full career, retired at a good age, and then went on to spend 35 years, right To this day, still trying to, you know, hold up the jdrf, which is really amazing. Do you have any idea how much money you've raised over the years for them?

Shirley 12:14
Oh, no idea. But never stop.

Scott Benner 12:19
Just keep going. How do you do that? How do you? How do you talk to people about diabetes?

Shirley 12:25
I tell them, it's a terrible disease. And the biggest robber of childhood, I can imagine, because I know, most of the children that I raised, and that I know, had very carefree childhoods, who thought about shots, and cash and blood sugars? Yeah. But then they came my grandchildren who had to cope with this.

Scott Benner 12:56
Yeah, and it goes since he was three years old. And Gus needed a kidney. And you're saying that was from diabetes? How old? Was he about when that happened? Do you remember?

Shirley 13:09
He might have been in his 20s.

Unknown Speaker 13:12
Do you

Scott Benner 13:13
know much about how your grandchildren manage their diabetes? And how's it changed over the years for them?

Shirley 13:19
Oh, what changed completely? I think in the beginning, you did urine test to figure out how much with insulin you needed. And since then, there have been tremendous advances.

Scott Benner 13:37
Yeah, there really are. My daughter's wearing an insulin pump right now. And glucose monitor right. We'll do. Oh, Sarah and Gus. Well, enough now to

Unknown Speaker 13:51
Oh, yeah. Yeah,

Scott Benner 13:52
that's excellent.

Shirley 13:53
And glasses. biggest problem from the diabetes is his eyesight. He's legally blind. I'm sorry. And he has we have gotten him a diabetic dog who lets him know when his blood sugar's are up or down. And that's a tremendous help. Cuz it's hard for him to read a small sensor.

Scott Benner 14:22
Yeah, yeah. I think about that, you know, when I think about it, I'm I'm I'm only 48 I By the way, thank you. You make me feel young today. I don't get that feeling too often. But when I'm now feeling like I've only lived like two of my four lives, so I'm doing okay. But at night when I go into help my daughter in the last five or so years, I need glasses now to look at the meter. And it made me right away. Think of all the people who need glasses who were by themselves and wake up in the middle of night need to look at these things and can't see them is Gus I'm married or is he alone? What's his situation?

Shirley 14:59
Oh, he's mad. Lily has a little girl who's fun.

Scott Benner 15:04
Good. That's amazing. Do you think they worry about his daughter perhaps getting diabetes one day? Do you ever talk about that? Well, of course.

Shirley 15:11
And Sarah has two little girls. So I have three great grandchildren that I keep hoping will avoid. Type One Diabetes. Yeah.

Scott Benner 15:27
How is your health in general? I know that you're I know your age. But do you? Have you been through things in your life that you've battled past?

Shirley 15:35
Oh, sure. Hasn't everybody?

Scott Benner 15:38
Oh, yeah. my list is starting to build up. No, but but you know, it's just interesting. Like, I kind of imagined that if somebody sees you, at 100, they might think you were just, you know, you were so lucky. You just didn't get sick. nothing ever happened. But you've had surgeries and gone through hard times.

Shirley 15:55
I've had I

think I can't go back to the doctor right now with this being isolated. Yeah. But I have battled breast cancer. And I'm taking a pill letrozole. That last examination is shrunk. And I'm just hoping it continues to shrink. Yeah.

Scott Benner 16:25
No, that's. So if you've not had breast cancer for long, when were you diagnosed with that?

Unknown Speaker 16:31
Oh,

Shirley 16:34
just two or three years ago, okay.

Scott Benner 16:37
And you're using medication to treat it right now.

Shirley 16:40
I take pills left herself. Yeah. And I've also had surgery on for a hernia, um, that the colon came through and was very painful. And I guess I had all the childhood things.

Scott Benner 17:03
Right. How much can I ask you how much activity you get in the course of a day? What do you do to stay? I don't mobile like my, my mom who I tease all the time about being older. 76. And now I feel like I owe her an apology. But she you know, she I know what she does to stay. You know, active. What do you do?

Shirley 17:23
Well, for years, I did Thai tea. And then I had a very bad fall. And I have to use a walker. Okay. Um, I'm not as steady as I used to be. And I try to keep active. Yeah. But it's limited right now. I use this Walker Walker slows down. Hey,

Scott Benner 17:54
I can't imagine you like it now. But I guess it helps you. So in the end.

Shirley 18:00
I had a very bad fall. Last year, I was 19 when I had this bad fall. And I haven't been as mobile since.

Scott Benner 18:12
Yeah. I'm sorry to hear that. I

Shirley 18:14
I stay at

work on the computer. I read a lot. And I try to stay active.

Scott Benner 18:27
Do you watch Netflix? Do you have a favorite show?

Shirley 18:31
Just the news in the evening news.

Scott Benner 18:33
Yeah.

Shirley 18:34
And then find that depressing? Well, no, I can't listen. I hear you. Can

Scott Benner 18:40
I ask you how? Because you have a lot of, you know, historical knowledge. You've I mean, you've saw, I guess you saw a couple of pandemics throughout the years how

Shirley 18:52
I was born.

After the end of the last pandemic, no kidding on the Spanish flu. Okay, which I guess 1917 1819 it was. But then I was born in 19 2020.

Scott Benner 19:12
trying to think what? When was legionnaires in Philly?

Shirley 19:16
Oh, it was a few years back. Yeah, I bet you started on a cruise ship. And they contributed it to air conditioning

Scott Benner 19:27
in a hotel in Philadelphia, right?

Unknown Speaker 19:31
Yes,

Scott Benner 19:31
yeah. I yeah. I wonder when that was. I'm gonna find out Hold on one second. 1976

Unknown Speaker 19:41
Okay. Wow.

Scott Benner 19:42
8696 2016 Wow, that was a long time ago. Okay, and so and so how are you finding this idea of? I mean, what's the most limiting aspect for you being an older person? Is it not being able to go to the doctor is it the idea Have you know you can't really be in contact with people? How does it affect

Shirley 20:04
in contact with people all the time? Oh, we've done this through email through telephone. No. And, and on my birthday, we had a zoom of about 100 people. That's

Scott Benner 20:21
amazing. And I know you We won't meet her but you have a health health worker who lives with you she there 24 seven with you.

Shirley 20:28
Yes, that's nice. He doesn't wait. She was here when we began to hear how bad it was. And she's been here ever since. A takes care of their high school daughter. They're isolated. And he comes over and brings things in, they wave through the window. What they do not see each other. Oh, my goodness. And she's doing I mean, they see each other they do not have any personal contact.

Scott Benner 20:58
Right. And is that to keep you safe? Yeah, that's wonderful. It's very lovely of them to do.

Shirley 21:04
Oh, she is wonderful person. I don't know why she walked out.

Scott Benner 21:09
Oh, yeah. We tried to get her to stay on the camera. The beginning. She said this isn't for me. Well, that's really amazing that How long has she been with you?

Shirley 21:20
Since the beginning of March.

Scott Benner 21:22
No kidding. That's really wonderful ever. That's lovely. And so you're not able to go to your doctor's right now. What do you think about? I have to ask you, because you're in Atlanta and Georgia's talking about opening up restrictions.

Shirley 21:35
Oh, they all they'll opening up all kinds of things. I think our governor Bruce completely stoked.

Scott Benner 21:43
Surely, I was wondering what you're gonna say, but I appreciate you being honest.

Shirley 21:47
Very young. Yeah. Yeah. I think he's an idiot. And I think we're gonna have an upswing of this stupid virus.

Scott Benner 21:57
Yeah. I don't see how opening up

Shirley 22:01
nail salons.

Scott Benner 22:01
tattoo portals. Can you think that anything worse? No, no, I I'm trying to understand why. Those are the first things that we're we're getting to I guess I know.

Shirley 22:14
You don't I mean, I think he

probably owns a strip mall.

I think he's thinking your money is more important than health.

Scott Benner 22:26
might be. I think you're I think you're right. I think you know, it's a short lesson, we obviously have to get the the economy going at some point, you know, eventually will cause such a problem financially will kill people in a different way. But in the moment, it is really difficult not to feel like that. Like it's a it's a you're putting, you know, money in front of health. I just pulled up your, your type one diabetes fundraiser that you have set up for your birthday for your birthday. And my goodness, you're, you're up to $29,000.

Shirley 22:58
Okay, and let's give them

Unknown Speaker 23:02
the link the link Well,

Scott Benner 23:03
the links a little it's long, right? So what I'll do to You don't think so? Hold on What? I can

Shirley 23:10
tell it to you in those few seconds. Don't maybe

Scott Benner 23:13
I'm looking at the wrong one. Go ahead.

Shirley 23:15
www to jdrf.org slash go to slash cheryle be 100

Scott Benner 23:29
surely be 100. So www.jdrf.org slash go to slash surely be 100. Why I did it. Okay, so I'm going to put that show. You don't need to know about this. But when I post your video and your audio, I'll put that link right where people can click on it. And I hope that people from the podcast Shirley's trying to get the $35,000 and she's a little over 29,000. So if anybody can kick in, that would be really, really nice.

Shirley 24:01
Okay, and I think they do the s in surely capital. Okay.

Capital B's rest in lowercase.

Scott Benner 24:11
Don't worry, I'll get I'll make sure I have it right when I share it. And people can click on it. Alright, listen, I get to talk to you a little more about the virus. So is it when you first You said you're listening to the news. So a number of weeks ago when it's all becoming kind of obvious What's happening? How do you prepare just to protect yourself or immediately

Shirley 24:33
to stay home? Just stay isolated? Yeah.

Scott Benner 24:38
Just is there's nothing more to it right. Just keep yourself for a little while and let people pass let let medicines

Shirley 24:45
not have any contract. And God bless Valencia. She was here listening to the news with me, because I had a group of caretakers that took turns Because my son's all thought I should never be left alone, right? After that bad fall, I had worse. And I said, I think we should be isolated. And she said, I think so too. And we agreed we'd stayed together. She talked to her husband. And they agreed to he'd stay isolated with their daughter. And she'd stay isolated with me.

Scott Benner 25:32
It just it makes sense. My family has been, you know, we've been all together in this house for my gosh, it's coming up on. It's gonna be two months in a couple of weeks. So we're over six weeks already. And

Shirley 25:45
tell me what your family consists of?

Scott Benner 25:48
Well, I've been married to my wife, Kelly since 1996. And we have two children. My son is 20 years old. His name is Cole. He's a college student. But you know, they they sent him home, obviously. So he's finishing up his sophomore year, this week, online. And my daughter is also a sophomore, but in high school, so she's 15. And she's the one who has type one diabetes. She was diagnosed when she was two years old.

Shirley 26:15
Anyone else in your family have tried?

Scott Benner 26:19
So surely, I'm adopted? So I don't have any history beyond me on my bloodline. But on my wife's side of the family, there is a fair amount of other autoimmune issues, but not type one diabetes. Do you see that in your family? Do you see other autoimmune stuff like hypothyroidism or celiac?

Shirley 26:42
Yes. And strangely enough, it's one of my grandson's on my step. family that has silly acts. So our immune diseases, so Alright,

Scott Benner 26:59
yeah. Now they're more prevalent, it seems to me over the last couple of decades and they have been prior or maybe there were just things that we didn't know about? I'm not sure.

Shirley 27:07
Well, I think there's two reasons for that. One is climate change, and a lot of pollutants in the air. And also better testing and diagnosing right

Scott Benner 27:25
now. Yeah, I think so too. I it's hard to argue with. I mean, you're seeing it over the last couple of weeks, right? We're all in our homes. So we're not driving our cars and factories aren't running. And even my son who doesn't pay attention to stuff like this at all said to me the other day, have you noticed that the air feels fresher? It's it's just he's like, it's almost neutral. Like there's no odor to it whatsoever. And you're getting those reports from all over the country that smog and pollution are lifting. And all these things are, look how quickly they changed. You know, in a few weeks

Shirley 27:58
that we learned stop factors,

Scott Benner 28:01
there's got to be a way to do things that we have to do that are better, there is a more safe way for everyone. Because, you know, it's not gonna matter how cheaply we can make a cell phone if we're all hiding in our house for the rest of our lives, right. The Dexcom g six continuous glucose monitor will give you invaluable data. How would you like to know the speed and direction that your blood sugar is moving? Is it climbing at one point per minute, two points? How fast is it falling? How would you like to know if you're going to be under 5520 minutes from now, the dexcom g six can tell you that Dexcom also offers a share and follow feature, meaning that a loved one with type one diabetes can be anywhere. And their information will go up into the cloud and down to a follower. It almost is magical. But honestly, it's just the cloud. I guess that's not that magical. It is however available for iPhone and Android. For instance, right now, I'll pick up my phone, I will unlock my phone and tell you that my daughter's blood sugar is 148. Actually, I'd like her to do a little bit of a bolus. So I'm just gonna send her a text and say one unit. My daughter happens to be downstairs right now. But that's exactly the way we handle our blood sugar when she's at school, or at a friend's house or at a sporting event. And you could to find out more@dexcom.com Ford slash juice box. You can also use the same insulin pump that RJ has been wearing since she was four years old. It's not hard to do. You go to my omnipod.com forward slash juice box and ask on the pod to send you a free, no obligation demo, which they will do. It'll arrive at your home and you or your child or loved one can wear the army pod to see how fields to see how it looks to see how it would integrate into your life, then you're going to get a real feeling for what it means when I say a tubeless insult, I'm not connected to anything, nothing to clip to your belt, really small, you can kind of hide it if you want to, or were proud. Doesn't matter. Whatever makes you feel right. My omnipod.com forward slash juice box dexcom.com forward slash juice box links in the show notes at Juicebox podcast.com. Five second dance party and then back to Shirley.

Tommy over the years, what have you done for the jdrf?

Shirley 30:49
Well, I used to work in the office too. We got paid staff. And I also started, I figured that education was the most important thing. And children should know and understand what's happening to them. So I started a children's educational project program. And we called it sugar show where kids learn. We did all kinds of things that asking about type one diabetes, so children could understand. And now I think everyone understands how important education is. And we have the type one nations summit. That's education for everybody. For the children, for parents, for caregivers, for teachers, everyone needs to understand this.

Scott Benner 31:56
Do you? Do you know that I just gave a talk in Atlanta at your type one diabetes nation summit. That's what I understand. I come to the summit's. I done about eight or nine of them in the last year. So and I come and I explain how we use insulin, I'd seems overly simple, but we talk about how we use insulin to stop spikes and to stop low blood sugars so that you can have more stability and spend less time thinking about your blood sugar. And I I love those events, those type one nation events are wonderful. They bring in

Shirley 32:27
all kinds of great, I'm sorry, I didn't know about you out have been in Utah and to listen to you.

Scott Benner 32:35
Were you there that day?

Shirley 32:38
Probably. I know this many things.

Scott Benner 32:41
I was excellent. You really missed it. Man. Hopefully I can come back. When all of this you know goes get becomes less common and do it again. I would love to meet you in person. That would be wonderful. So you worked right. So you were a volunteer until they got an office staff. You help build programs. I guess you make phone calls for donations and all that stuff. Have you ever Oh, yes.

Shirley 33:05
And I also started with grandparents.

grandparents.

Scott Benner 33:12
That's lovely. You know, I have a lot of so I don't know how much you understand about what I do. But usually I don't record video, I just record audio. And it's available for people to listen to, through a podcast. And it's it's incredibly popular. And now what is your podcast? It's called the Juicebox Podcast. So I interview people who have type one diabetes, or the parents of type ones. A lot of CEOs of companies that do things around diabetes, and we just talk either conversationally like this hearing people's stories. Sometimes we talk about real management stuff, the way to use insulin. We talk about technology and where it's going. It's been on the podcast is it's six years old. There's 330 episodes of this. So

Shirley 34:02
what's the name of the juice?

Scott Benner 34:05
Yeah, it's called the Juicebox Podcast, because you know, people use juice boxes to bring their blood sugars up. So yeah, so yeah, that's, that's what it's called. And I've had it for a long time, I started to write about diabetes in 2007. And then in 2014, I started thinking about making this into an audio show. It took me about six months to figure out all the technical stuff and then I started the show in January of 2015.

Shirley 34:34
No, if I wanted to listen to it. What do I do? Well,

Scott Benner 34:39
you could do you have an iPhone? Do you have a phone? Yeah, there's a if you have an iPhone, there's an app on the iPhone where you can listen. You can

Shirley 34:49
juice box,

Scott Benner 34:50
it's called it's called Juicebox Podcast. I will send you a link so you can see you can Valencia can help you get on it. Good. Okay, so you'll at least be able to listen to yourself. No, no, every you know, everyone thinks they're not going to be good. And then everyone ends up doing a wonderful job. It's very interesting. No one thinks they have anything interesting to say. But they always do. I have to ask you a little bit about the cost of diabetes now versus before. And I guess just the cost of things in general and how you've seen them change over your life. Do you remember things like what you paid for your house, your first home and things like that?

Shirley 35:32
Oh, I certainly do. I'd love them. gone up. Amazingly.

Unknown Speaker 35:38
Low bed, right.

Scott Benner 35:40
Yeah. What did you pay for your first home?

Shirley 35:44
My First Home or this home?

Scott Benner 35:46
Well, do you remember your very first home and when you got married? What you pay?

Shirley 35:52
Well, we weren't. We win. And then I'm talking right. But then the first house we bought was $23,000.

Scott Benner 36:00
No kidding. Isn't that something? And now, real estate in Atlanta is incredibly expensive. I do I wonder what that house is worth now?

Shirley 36:11
Oh, I probably cook way up. And the house I live in now. And I'm still in my own house. I bought in 1964. Okay, so I have been here quite a while.

Scott Benner 36:27
What did you pay for that?

Shirley 36:30
Can you hear me? I can't

Scott Benner 36:31
I'm sorry. I was wondering what you paid for the this house that you're in now?

Shirley 36:35
$50,000 50,000?

Scott Benner 36:39
Is it paid off? Oh, it's all yours, I guess.

Shirley 36:42
Oh, sure.

Scott Benner 36:44
That's thunder.

Shirley 36:45
pay that off ages ago. And I have been offered amazing amounts of money for it. But I have no intention of selling it moving. I would hate to live in one of those retirement places and be with old people. I have neighbors. I have children that have moved in. And I enjoy children. Yeah,

Scott Benner 37:16
no, I don't think there's any reason for you to go. Especially if you're able and you have good help. I listen, I think for people who have to go to a home if they have to. They have to but your situation is it's too poor.

Shirley 37:28
I love my house. Yeah. And I have very good hell.

Scott Benner 37:33
Yeah. Good for you. That's why me you've lived in that house over 50 years. Is that right?

Shirley 37:37
Oh, fifth day? Um, well, we now in 20. So 56 years. Okay. That's amazing.

Scott Benner 37:48
You bought that house? Eight years before I was born. And I've owned and I've owned this house for 20 years. So that's pretty great. It really is an exception to ever think about how kind of exceptional it is for you to be very independent at your age and doing all that it really is uncommon, isn't it?

Shirley 38:15
Well, I don't know anyone my age. All my friend's dad.

Scott Benner 38:21
What is that? Like? Is it is it hard to see people go over and over? Do you?

Shirley 38:27
Yeah, it would be nice to see your dear friend.

Scott Benner 38:32
Oh, right. No, I just wondered if it got easier over the years if you came to expect it. But I don't imagine it's

Shirley 38:39
never easy.

Scott Benner 38:41
Do you have an idea of how old you think you're going to be like, Do you ever wonder about that?

Shirley 38:47
Well tell your story with my 99th birthday. One of my sons gave a party and one of my grandson Stanley, in fact,

Bruce's youngest son

called me and said he was sorry, he couldn't be there. It was too busy. He's been made the head of the history department at our zona state. And he had so much to do and curriculum and lectures and he didn't have time. But he said you probably have some time, about 10 years. So he'll promise he'll give me my heart. He'll take care of my hundred and 10th birthday party. I don't have to worry about it. So I'll be around for Stanley to do my 10th birthday party imagine

Scott Benner 39:47
you will be by the way. I really do. That's something else. I was just thinking and I and it the your story was delightful and the thought went out of my head. Oh, what? When you think back on your life, if you were to share some thing with someone a regret or something you've learned that you think is really important to know is do you have a nugget like that like something you'd want people to know about? About living?

Shirley 40:18
I have been asked, What do I think is the greatest advance I've seen in my lifetime? Number one, I'd say dryers. I hated going outside hanging up clothes to dry. And the second thing I think, is the most important, most rewarding advance of cell phones. when my kids were teenagers. I didn't have we didn't have cell phones, right. And I used to worry about too late got at home, too. I heard that door open.

Scott Benner 41:00
And especially after they started to drive, and it's so good. Now. If you have a teenager, out in the call, you can call and let us know where they are. And when they're coming home. That's not so convenient. I have to tell you show you don't know this about me. But a while ago now. I think it's been more than seven years. I wrote a book. And the the title of the book is life is short laundry is eternal. Because I've been a stay at home dad for over 20 years. And the only thing I hate about it is doing the laundry. But I've never had to hang clothes up to dry them. I guess if I had that I'd really hate it.

Shirley 41:41
Well, if you had we got a washing machine. But then I had to take the clothes outside to drive.

Unknown Speaker 41:49
Yeah, you've said

Scott Benner 41:52
you've seen refrigerators that

Unknown Speaker 41:54
you had ice though I remember

Shirley 41:56
the ice man coming with the ice.

Scott Benner 41:58
That's something my grandmother used to talk about that about a block of ice that went in the bottom of the refrigerator to keep the food cold. And the man would come every so often with a new block of ice.

Shirley 42:10
And I can remember though, wonderful, fresh vegetables. We used to have a farmer that came with his I guess it was a horse and buggy. And he brought vegetables to us every day that he picked in the morning, and a mama would go out and pick the ones we'd have for dinner. Yeah. And we had really fresh that nothing tastes as good as it used to

Scott Benner 42:45
Eve you know even stuff you're not supposed to eat like cereal in a box. It I don't know what happened. But when they stopped using sugar it doesn't it doesn't work right anymore. Like every I that's interesting. I said this is not the same thing because you said Doritos, or you said vegetables but I said to my wife the other night. Doritos don't taste the way they did when we were kids. And I don't eat them because of that. And and it is interesting how the production of food changes the flavor, but we don't know just because it happens sort of slowly. And we don't have people like you who remembered from a different time. That's interesting. That is really interesting. You know, it told

Shirley 43:23
me that butter tasted so much better. We got butter from a farmer who churned and we never got sticks. We got a clone. And then buttermilk was just the milk left after the butter formed. It didn't taste like that sour stuff they called buttermilk today, right?

Unknown Speaker 43:48
You know, delicious. Yeah, no kidding. And

Scott Benner 43:51
fresh and just organic. There was not much to it other than the than what it was, you know, I just realized I was very close with my my grandmother growing up. And she passed away when I was 16. And she was 72 then, so I just did the math while you were talking about butter. So she'd be 104 today. And I can remember so vividly that she got a microwave when microwaves came out. But she was so scared of it. She'd only ever heat water up at it. She would never do anything else with she wouldn't cook with it. And I'm wondering did that seem very foreign to you? When those came out?

Shirley 44:25
I think I have a microwave. I use. I have used it. I think it ruins food. And more more. I would much rather use a real oven. I agree. I think it ruins the taste of food. Right?

Scott Benner 44:44
What is your favorite meal? What do you enjoy eating still?

Shirley 44:48
lamb chops.

Unknown Speaker 44:50
How do you like them made?

Shirley 44:52
Oh, I love them with

Scott Benner 44:57
the little man. Now. You've been down south for a while. I guess Huh?

Shirley 45:01
Yeah. since I was three years old,

Scott Benner 45:05
except for college and then you came back right away again. Where? Yeah. Where did you meet your first husband?

Shirley 45:12
Right here in Atlanta. He was from New York. got a job in Atlanta. And

he was great. Yeah.

Scott Benner 45:25
That's interesting.

Shirley 45:26
He was a wonderful guy. And we wrote all during the war. He was overseas. We wrote every day. I have every letter he ever wrote me in Cedar chest downstairs. I yeah. And he only came home on r&r. It's near the end of the war. And we got married. And he went back overseas again. Okay,

Scott Benner 46:00
so you almost made me cry when you said you have all the letters. Just so you know, I got all. I got all emotional when you said that. That's so wonderful. Do you ever go back and look at them? I cry. Yeah, I would too. I have to tell you.

Shirley 46:15
And they make me cry. Yeah, I can't I keep saying I'm gonna go through a mall. But I just can't.

Unknown Speaker 46:24
Do your children know that they exist? Oh, yes.

Scott Benner 46:27
Oh, that's lovely. That really is something else. You must you must have just seen so many strange things. You know, I mean, honestly,

Unknown Speaker 46:39
like technology. Remember,

Shirley 46:41
I remember the first time I heard a radio, my father brought one home. And we all sat down on the couch. And he turned it on. And lo and behold, lo Thomas came.

Remember that distinctly?

Scott Benner 47:03
You know, the only story I have like that is that my father bought a VCR home one day. And then we went to a local pharmacy that rented movies in the back. And they had like 20 different movies on those videotapes. And we felt like we were wealthy because no one had them at that point. And I don't know what made my dad do that, because we grew up so poor. I don't know what what made him spend a bunch of money on something like that. But it was it was crazy that that was that and now, you know, now you watch movies on your phone or on your computer. It's just so simple. But I was gonna say Is that you? You live through so many big leaps in technology. And now the technology that we use every day, it doesn't grow as fast anymore. It's just amazing. All the things that you've that you've seen, and I mean, even just air travel, did you do a lot of flying as a as a younger person?

Shirley 47:54
Yes, I love flying.

Scott Benner 47:57
Where are some places you've been?

Shirley 48:00
lots of places. I have my children or where my butterfly? buttercups that you blow dandelions all over. So I have one son in Oregon. I have one son in from another son in

Unknown Speaker 48:23
Ohio. Oh, my.

Scott Benner 48:26
It's hard. My wife and I talk about that a lot. We we were trying to imagine like letting the kids settle somewhere and then trying to find a central place where we can be reasonably close to them. But I know I

Shirley 48:39
went around to all mine. Yeah.

Cuz then if I go to them, I can see all the children and grandchildren and great grandchildren. Whereas if they came here, just one came. But now that's what happens. Right. And I've been to a lot of countries in Europe.

I have been to Israel.

Unknown Speaker 49:07
I'm

Shirley 49:09
done on cruises in the Caribbean.

You've been around quite a few places. Yeah.

When you feel good. Come back to it. While

right

Scott Benner 49:22
now. It's a lovely place. I've been to Atlanta a number of times, not just to speak but my son used to go there a lot to play baseball. And I would go with him. But it gets super It's so hot there in the summertime. Do you can you even go outside in the heat of the summer? How do you handle that?

Unknown Speaker 49:38
I love it, do you?

Scott Benner 49:41
You would laugh at me when I'm in Atlanta then I we were in a baseball field one day. And my son played two games. So it was the second game and I had been outside all day. And I found myself I found a telephone pole and I stood next to it. And as the sun moved, I just kept shimmying around the telephone pole trying to stay in the little shadow there. It was making I thought it was gonna fry me. I really did. But you it's it you get used to

Shirley 50:06
remember before we had air conditioning? Oh my goodness, just

Scott Benner 50:12
yeah, I guess you body really does become accustomed to it right?

Unknown Speaker 50:16
Yeah,

Scott Benner 50:17
that's amazing. Good for you. Oh, I've kept you very long. I did not mean to keep you this long. I'm so sorry. Are you okay for time?

Shirley 50:25
Oh, I'm fine. No.

Scott Benner 50:28
So then I have nowhere to go. None of us do right? I don't have anywhere to go either. I do. I am God speaking of time, maybe this won't resonate with you. But let me know if it does. as I've gotten older. In the beginning, when I was younger, the days felt like they took forever.

Shirley 50:46
And then now they will.

Scott Benner 50:48
Now they feel like they go by much more quickly. And I've lost track of the idea of a day a week seemed to go by quickly. I sometimes I watch my feet go on the floor in the morning and I just think, Wow, I'm just I'm on a hamster wheel here. It just keeps happening over and over again. Does that feeling ever go away where you're cognizant of time?

Shirley 51:08
Because time goes by faster and faster. Every day?

Scott Benner 51:15
Do you ever find yourself not worrying about it? Or is it still something you think about?

Shirley 51:21
can think about I can't worry about it?

Unknown Speaker 51:26
Yeah,

Scott Benner 51:27
I don't worry. I don't worry about it. I just I'm aware of it. I guess.

Shirley 51:32
I don't know if that means and time goes faster and faster. And it used to go real slow when you were young.

Scott Benner 51:42
Yeah. Cuz you're busy you think or because you're not aware of an end. Do you know? I can't give you the race. Yeah, I don't know either. I just I think about it a lot. And I just wondered if it was something that that maybe one day I would just be alive for so long that I'd stop. I'd stop noticing it because there's other things you know, they mean that I don't notice anymore. But yeah, I don't know. It feels like that movie Groundhog Day. You ever see that one with with Bill Murray?

Unknown Speaker 52:09
Sure.

Scott Benner 52:12
Oh my gosh. What do you when you do get out when we're not like what's the first thing you're gonna go do when you're able to get out of your house again for enjoyment?

Shirley 52:23
I guess just drive around.

Scott Benner 52:28
See everything again?

Shirley 52:30
They go see? Go see money You know I love my step grandchildren. will be great to go

Scott Benner 52:38
see them feel like you're not gonna get sick for being there and everything. Have you in Valencia gone for a ride? Have you broken out and just?

Shirley 52:45
No, no most I've done is on my birthday. I went to the end of my driveway. And they had a big parade. Led by fire orange 20 car. It was while

Unknown Speaker 53:01
that's lovely. Did you

Scott Benner 53:03
guys get some

Unknown Speaker 53:04
video of it? You have a little video?

Scott Benner 53:06
Yeah, do you? Oh, that's wonderful. That's that's a very nice memory to have. Your town got together and did that.

Shirley 53:14
My stepchildren got that

Scott Benner 53:16
all set up for you. That's very nice. It's lovely.

Shirley 53:20
And they had quite big they did it in the middle of the night. A great big fans all across my front yard. That said Happy 100th birthday, grandma Shirley.

Scott Benner 53:36
Nice. Listen, I have to say I when I was looking at your your jdrf page, the people making large donations on your behalf they that you must have a lot of good friends that know how hard you've worked on this because there are 5000 2000 there are big donations here.

Shirley 53:52
Well, don't let up. Yeah, right. Like wanting to raise money for jdrf and find a cure. Yeah.

Scott Benner 54:00
Well, I hope I hope we can i and i think i want to thank you for this talk. This was really lovely. I appreciate the time that you said.

Shirley 54:06
Thank you. Very interesting, man. Thank you. What is your name again? Scott. Scott. Yep. And you do love Juicebox

Scott Benner 54:16
Podcast? That's 100% right? Yep. Okay, I'm gonna make sure you have a link to this so that you can hear it and see it if you want to. Oh, I do. And I find and it was nice to just say interesting. I would have liked if you said handsome but

Shirley 54:33
yeah.

Scott Benner 54:35
Thank you and humble to I would say

Shirley 54:40
Well, I think you're out there, pushing your foot. A cure to for type one.

Scott Benner 54:45
I'll tell you this. Surely What I love most about the jdrf is how hard they work in Washington for people with type one diabetes, their rights. You know that stuff that they do is incredibly important. I am incredibly hopeful. About a cure. But I also know that day to day advancements that have been made in pumping and glucose monitors are all they make people's lives better today for diabetes. I

Shirley 55:11
also did mention that I work with the advocacy committee,

Scott Benner 55:17
you do you do with them as well? Have you ever been up to that big thing in Washington that they do? The Children's Congress?

Shirley 55:24
No, I never went to that.

But I have been to Washington on behalf of the jdrf.

Well, I'm always on.

Scott Benner 55:35
That's nice. So you'll probably you'll tell anybody who sits still long enough about diabetes and the need for this support. Right?

Unknown Speaker 55:43
Right. Yeah.

Scott Benner 55:44
It's very, it's, it's just very kind of you to spend your time that way. I really appreciate it. And I'm sure everybody else does, too. I'm gonna say thank you. And, and, and, and go by but this has been really genuinely a nice way to spend my Friday afternoon. Thank you very much.

Shirley 56:00
Okay. And I hope I get to talk with you again.

Scott Benner 56:03
That would be nice. We'll do it. We'll definitely do it on your hundred and 10th birthday for sure. But But know that the next time you have something to share you let me know. I would love to do this again. Take care. Thank you. Yep, have a great day. You too. Thank you. Bye bye. Huge thanks to Shirley for coming on and sharing with us 100 years of perspective and her passion for Type One Diabetes awareness. Please don't forget to support Shirley's campaign to raise money for the jdrf there are links in your show notes at Juicebox podcast.com. Thank you also to Omni pod Dexcom the Contour Next One blood glucose meter and touched by type one for sponsoring the show. You can go to my omnipod.com forward slash juice box dexcom.com forward slash juice box with the links in your show notes are the ones you'll find at Juicebox podcast.com. To find out more.

Shirley 57:06
w w w www to jdrf.org slash go to slash Shirley be 100

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Scott Benner 4/30/20 Scott Benner 4/30/20

#330 T1D Exchange

David Walton (T1D 24 years) is the CEO of T1D Exchange

David (T1D 24 years) is the CEO of T1D Exchange, a population health organization focused on improving care for people living with type 1 diabetes, primarily through the creation and use of real world evidence.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello, everyone, welcome to Episode 330 of the Juicebox Podcast. Today's show is incredibly conversational, I don't want to break it up. So I'm going to put the ads right up front here. Today's guest is David Walton. He's the CEO of T1DExchange. And I expected to have a more technical conversation with my guests about what T one D exchange did. But instead, we ended up having a multifaceted conversation around Type One Diabetes that I enjoyed so much that by the time I got to an hour and a half, I realized I had to let him go. David and I are going to speak today about the research that T Wendy exchange is doing with the COVID-19 virus. And then we get into his diabetes, his life, his management style, concepts about how to help people with type one. I just really enjoy talking to David, I think you'll enjoy listening to him talking to me, and me enjoying talking to him. And I guess hopefully him enjoying talking to me. But that's an assumption on my part because I didn't ask him anyway. ads are up front. podcast in the back. Was that party? What is it? What was that thing he used to say about mullets, business up front party in the back. That doesn't apply to this. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter and touched by type one. It's also sponsored by Omni pod and Dexcom. Everyone's got a blood glucose meter. And since you have to have one, you should probably have a great one. And you will, if you go to Contour Next one.com and find out more. The Contour Next One meter is multifaceted just like this episode. And not just because it can speak to a contour app on your phone, iPhone or Android By the way, and help you make sense of the data that's coming back from your meter. But because it's easy to use, easy to handle has a terrific test strip that will allow Second Chance testing like if you touch the blood, don't get it right, you can go back in without wasting a test trip. But the accuracy of this thing is just otherworldly. Arden has been using it for well over a year now. maybe longer, and it's absolutely the best meter she's ever had. As far as accuracy goes, and portability. I just love it. Anyway, if you go to Contour Next one.com there's a button at the top where you can find out if you're eligible to get the meter for free. And if you're not, you can still have your doctor write your script for it or pick it up at a anywhere Honestly, I guess pharmacy once people are allowed to go to pharmacies again. Anyway, this meter is worth looking into Contour Next one.com. After that, please check out touched by type one.org. The people that touched by type one are dedicated to helping those living with Type One Diabetes to excel. And they have a dance program for children actually have a dance studio, you got to go check it out touched by type one.org. If you're interested in finding out more about the Dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com forward slash juice box. And to get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to your home. My Omni pod comm forward slash juice box there are links to all the advertisers in your show notes. And they're also available at Juicebox podcast.com.

Not gonna argue with you You went to Princeton? Is that a burden, but by the way we're recording? And by the way, is that a burden?

David Walton 3:52
No, it's not a burden.

Scott Benner 3:55
But does everybody say it to you at some point?

David Walton 3:58
I definitely get it once in a while. You know, interestingly, I have a I have a twin brother and he went to a good school Gettysburg College. But every time I would go visit him there. It would just be nonstop comments from his friends about you know, why didn't he go to Princeton and you know, various jokes and things like that and but I you know, once I acted stupid and silly, he they realized I was just like, everyone took care of that. Hey,

Scott Benner 4:26
you know, you might be the first person I say this to who genuinely understands what I'm saying. My son goes to Dickinson.

David Walton 4:33
Oh, really? Yeah. Yeah, I have a friend whose daughter plays basketball there.

Scott Benner 4:38
Oh, no kidding. Yeah, I am probably a 10 minute ride from Princeton University. So, you and I overlap a little bit but that's gonna be where that ends educationally. Because my son's the bright one, not me. And I think our our overlap around education will probably end right around there.

David Walton 4:56
I actually live about 25 minutes from print. In right now, I'm in Pennsylvania.

Scott Benner 5:02
Oh, no kidding. I grew up in Bucks County.

David Walton 5:05
In bucks. Yeah. Yeah, yeah, I'm in New Town.

Scott Benner 5:08
Oh, okay. Oh, so let's start over. I was born in New Town. My parents moved into lower Southampton, we lived there for quite some time. My wife got a job in Manhattan soon after we got married, put us into the Princeton area just to be near the train. And we've kind of kind of stayed since then. But not right. in Princeton. If you don't mind walking over some water, you've walked over before, how old were you when you were diagnosed?

David Walton 5:39
I was older. I was 24 years old. I had, I was in business school at Penn. And notice the symptoms that ironically, I knew about because I had, in my very first job at a college, I worked in a consulting company that did work for pharmaceutical companies and the diabetes, the dcct, the diabetes control and complications trial had just findings have just been released. And everybody was talking about, oh, we need to do tighter glycemic control. And one of these pharmaceutical companies hired us to help them come up with a program. And we essentially designed like a

kind of a

patient compliance program, it was discovered a reward system for people if they did the things that were beneficial, like testing your blood sugar, and exercise and so forth that it was for type one and type two, okay, this program, but that they would get points and we developed like a point system and worked with lifescan, who had the blood glucose monitoring, they were one of the partners, we were talking to gyms, etc. So anyway, I did market research and heard from doctors talking about both type one and type two and the symptoms for newly diagnosed. And so I learned a little bit about it. And then fast forward. Two years from then, you know, I'm in, I come back for the second semester, my first year, and I'm going to the bathroom more frequently, I can't quench my thirst, I started losing some weight. And I just started dating my now wife, like a week prior. And I'm telling her that this isn't normal. This isn't how I normally AM. And ironically, she had worked for Eli Lilly as a sales rep and a managed care rep and sold insulin. So she knew a bit about it. And she didn't come out and say it sounded like it. But I asked some doctors who are also in this Healthcare Management MBA program about the symptoms. And I said, it sounds like type one, doesn't it? They said no, you're too old for type one. And you're not really a candidate for type two. So then my vision got blurry. And I went into the student center that day, and read off the symptoms to them. And they kind of looked at me and said, well, let's just test your, your blood sugar. We sure and then I was put in the hospital for a couple days. And you know, off we go. There was no family history. Although subsequently, I have a my sister son, at three years old was diagnosed with type one that more recently that that was more recently and

fortunately, my twin brother and I are adopted.

But we met our biological family when we were 18. So we were adopted at birth. Our parents were teenagers, biological parents. They ended up getting married and then had a son and daughter that our full fledged, you know biological brother and sister. And it's my biological sister whose son got developed type one. So I think we have that that genetic predisposition runs

Scott Benner 9:03
through there. You've brought a lot of things up I have to ask you about so a and this is just gonna be odd. I'm adopted. B are your biological brothers and sisters. I don't know how to say this. Maybe you're not going to answer I did. They go to great schools to

David Walton 9:21
my twin brother biological and grew up with me, Brad. So he went to Gettysburg. My both my brother and sister went to Florida State. They grew up in Tallahassee, and my sister still lives in Tallahassee. My my younger brother, ironically moved up to Boston. And so he and his wife and his two kids, they they live now out west work again to end exchanges up in Boston. So I go up to Boston almost every week for a few days. And every once in a while I get to see him because he's out in the suburbs. But there's no other family history there had there was none private My diagnosis, right? And since my diagnosis, just my my nephew again at age three. Yeah. So I joke if you add us together our ages, you're pretty close to the median age of diagnosis for type one. But I was a little bit older and he was a little on the younger side. And I know you've you've got experience with a young young child. I really do.

Scott Benner 10:24
Let me ask you one thing real quick before we move forward if you're on an Apple Computer, right?

David Walton 10:29
Yeah, I turn notifications off on Outlook, but I guess my yahoo email, don't worry,

Scott Benner 10:34
I know what to do. You're in luck, the apple in the top left corner System Preferences, System Preferences. Okay. The speaker that says sound. And then under the sound effects, tab, alert volume play sound effects through drag the alert volume all the way to the left. But leave it open. So you remember to drag it back to the right when you're done.

David Walton 10:59
You're saying on the output volume?

Scott Benner 11:02
Sound Effects? Not output. So there's sound effects out?

David Walton 11:06
Yeah, I'm on sound.

Scott Benner 11:09
No sound effects sound effects at the top. Yep. And then alert volume. There's a slider bar you run all the way. And then that one,

David Walton 11:16
I'll just keep it off. I don't need to be alerted.

Scott Benner 11:19
Like, wow, I wish I would have known that years ago.

David Walton 11:23
I thought I saw this with turning I look off that.

But I my Yahoo emails. Okay, now that email

Scott Benner 11:28
really wants you to know that you're there. While we're taking a break, I'm gonna have my daughter bolus something she's downstairs

Unknown Speaker 11:39
for school.

Scott Benner 11:42
There. Okay, cool. Well, that's interesting, has nothing to do with what you're on. But it is really incredibly interesting. And I just picture you in, you know, in business school trying to impress a new girl and you're just running to the bathroom constantly. That must have been a that must have been a big a big rock the drag up the hill, like I'm cool. I swear I am I gotta pee again. I'll be right back.

David Walton 12:02
Yeah, yeah, no, I don't normally go 20 times a day. This I'm telling you, this is an aberration, I swear. But thankfully, again, we were in a health care program. And I'm I was, you know, as casual as you could be about, you know, it happening in the diagnosis after I mean, I didn't freak out. I kind of tried to attack it rationally. But I, I was pretty fortunate that I had a little background and I was older. And you know, I was a college wrestler. So you know, I was thinking, wow, what if this had happened earlier, like it would have totally changed probably what I did or how I did it. But ironically, in the in the Penn hospital, I received a call the first day from a woman who I dated prior to dating my now wife. And she said, Hey, I just wanted to let you know, I heard about the diabetes. And if you ever want to talk to someone about it, you know, you can always call me I know what it's like to live with it. I said, What are you talking about? I've never saw you check your blood sugar or given injection, you have type one? And she said, Yeah, I'm pretty private about it. So often would go to the bathroom. And that's where she tested and, you know, right from the get go I it kind of gave me an appreciation for the fact that there's a spectrum of how people kind of deal manage their diabetes, how they think about it. I was diagnosed in a very kind of,

Unknown Speaker 13:35
let's say,

David Walton 13:37
out front manner, people people knew, like, why is Dave in the hospital here? So and I was older, and it was just a different thing versus you know, if someone's a teenager or someone's younger, you also

Scott Benner 13:49
you also did like a group thing. thing to figure out if you had it, you were talking to people and ask

David Walton 13:54
people they could and they knew about it, and there were physicians that kind of thought but maybe not and then just in general I that's often you know, I that's often the way I you know, think through things that I don't know, it's like, let me talk to other people who may know information that will be helpful.

Scott Benner 14:10
Yeah, well, that's a smart way to figure anything out. I'm now fascinated that you dated a person who had type one and you didn't know it, how long were you together?

David Walton 14:19
Less than two months? Okay, like

Unknown Speaker 14:21
totally

David Walton 14:22
as you're as you're being interrogated in the hospital and I think I was I had every resident intern med student, you know, come through because it's an academic, you know, Medical Center teaching hospital. I got asked the same question you know, any relatives this out of the other? I had several people asked me to knowledge Have you been exposed to a virus in the past six months, and I said, I don't really have a virus meter. I don't I don't know if I if I have been or not, but there was one incident with Taco Bell where I was violent. sick with a stomach virus that happened a few months ago that I guess it's, it's possible. I was just attributing it to bad a bad burrito, but perhaps that was a stomach virus. But then I said, Well, is it possible that this this woman I dated, had a virus and I caught it, I had the same reaction she did, like, Oh, that's crazy. You can't catch diabetes, right? Like, well, I'm not necessarily saying I can catch diabetes, I'm saying, could I catch a virus and we both had a reaction to a virus that was, you know, this autoimmune thing. And they, they kind of treated me like I was the dumbest idea they'd ever heard. And granted, it could have had nothing to do with it. But there weren't a lot of other great theories they were proposing. So I just figured I'd throw that out. I want

Scott Benner 15:45
to tell them I went to Princeton. So David, you're it's only April. But if we give an award this year, for the most organic and natural segue, you're going to win. Just so you know. What? Okay, yeah. Why don't we tell people a little bit about what the T one D exchange is doing? By the way? I don't know. Did we even say that you're the CEO of T one, the exchange, it's not important. It'll be in the title. Anyway, you are? And what are you guys doing right now? based around COVID-19? Sure.

David Walton 16:18
So first of all, it is a very, very high level, we do a lot of kind of what we call real world evidence, doing research and gathering data from things like electronic medical records, for people with type one diabetes. And the goal is to help improve care to work collaboratively with hcps, and researchers on that. So we have diabetes centers across the country that participate. Yeah, through that effort, this quality improvement collaborative we have with different centers, this topic came up regarding COVID, from some of the researchers to our team, that, you know, there's just not a lot known out there, you know, people are, you know, the early information that was coming in, you know, a couple months ago, was, oh, diabetes as a risk factor people, people with diabetes are getting COVID-19. And, as, you know, some of these researchers were looking into what data was really available about type one versus just type two, or overall, just having a diabetes diagnosis, there really wasn't much known. And a couple of things came from China and Italy that we saw that suggested it type one was not a risk factor in and of itself. But that later, we, you know, it seems some indications that poor blood sugar management are probably more indicative of or have more of a causal role in getting infected or having a severe reaction to the infection. So we said, well, we are set up to gather information from different centers on, we're not going to be able to do this automatic kind of poll of data from the electronic medical records of different hospitals. What if we set up a different system to gather data on this from like a survey Type Tool and have a point person at each one of these centers? Just document the cases of COVID that have come in? and answered about we have about 30 questions in the survey, that will give us some idea about the symptoms they had about what their blood sugar control had been previously. What type were they using an insulin pump or CGM? If they were using a BGM? How often were they testing? what medications were they on? and gathering this information? We, you know, had a few goals of trying to characterize does it appear people are being diagnosed in any different rate than either people with type two diabetes or just in the general population? If they are when they are being diagnosed? What is it? How is it presenting? Is there any pattern to the symptoms? And how is it progressing our people? What type of outcomes are they having? It is our are there more instances of DK for these, these people. And so the goal was let's get as many centers as possible. We started with the ones that we work with, which was a about 15. But quickly, other centers were interested and we were started talking to people at other diabetes centers and we saw what was going through on Ada websites and newsletters and things. So we've gotten it up now to about 65 centers. Wow. And and the goal is to get up to 150 to 200 cases documented so that we'll have some ability to draw some insights and conclusions that we can disseminate out spread to the to the medical community and to the patient community, about you know, understanding it better Who knows what some of it is going to be? Interesting, what do we find, and then others we might try to, you know, confirm some of the thinking that we do have, which is that just having a type one diagnosis is not, does not put you at higher risk for getting a covid infection,

Scott Benner 20:19
have to tell you, I'm thrilled to hear that because a friend of mine, who is a physician, by the way, went to Penn, really you and I might be friends, we don't know it. And he's been on a couple of times, through the first six weeks of you know, Cronin, we talked very much at the beginning. And then about three weeks later, and he'll come back on again, as things continue to morph and change. But that really was the consensus, you know, that the best defense for a type one against you know, COVID-19 is being healthy, as healthy as you can be. And in all the ways that that means. And that, you know, he couldn't, you know, early on, figure out how someone with Type One Diabetes, just just by virtue of having Type One Diabetes would be more susceptible to it. Anyway, so since you said that it makes me feel comfortable that about what we talked about?

David Walton 21:13
Yeah, yeah, absolutely. And there are some, you know, some other I've heard Dr. Peters talk, and Dr. Mark Clements, who's at a children's hospital in Kansas City and involved with us. And they've essentially said, that's what the research at this point indicates. Right. And again, it is possible that as you get more information, maybe we will learn something about a certain segment or slice. Sure, you know, we're gathering some other information that could characterize this, but from all the, you know, what we've seen so far, and we're still early, we haven't, you know, analyzed all that, you know, we have about 60 cases documented in the system, by clinicians, but we haven't analyzed all that yet. We just started to do the first 25. And there's a manuscript being written as we speak, because, again, some of its doing the work and some of its getting it out there, yes, and helping to disseminate it and provide it so that other people that are looking for it, you know, have access to that knowledge. And a lot of I've had a lot of parents that I'm in touch with just in the community where I live, who know that I work in the arena. I've reached out to some proactively and a couple of others had, I had some inbound questions, you're wondering, you know what the situation is. And that's basically what I've, I've told them, it's like, we'll learn more. But at this point, we don't believe there's a high risk, but the best, the best thing to do is to keep your blood sugar. And it's tightly controlled as possible, because we know infections, like sugar, right? And if you keep your blood sugar controlled, and to the lower side, it likely will will help about a medical provider. So no, but

Scott Benner 22:56
I have some questions that I don't know if you can tell me from what you've learned so far, maybe you haven't. But first thing is about 60 people from about that many locations was where their hot zones are, was it fairly well spread across the 60?

David Walton 23:11
Yeah, so you know, there's a bit of when you look at the the data coming in, we still have some places with a lot of cases in New York as an example that haven't pulled there. They joined later to the effort. So they're just going through their administrative process, that they're that they're center before they submit the cases, but that should be coming within a week or two. Within two weeks, we should have 100 cases, I believe. We know that there's one one hospital in New York, you know, said that they have about 15 cases. Mount Sinai. Mm hmm. But we haven't seen that yet. That was very got that that. But but they're looking to to put that in, but someone had done someone had quickly looked to see through their systems. And so they haven't entered that in but they told us that they think they have 15 cases. Another another one? I believe NYU said they may have eight cases, or there's some

Scott Benner 24:08
hospitals that are on your list that have not reported back at type on case.

David Walton 24:14
Yes, there are some that said we went through and we had no cases. Gotcha. So yeah, so that's what we need to get more of the information. We can draw conclusions about prevalence from what the numbers that we have, but it is interesting we've seen and our centers may have 1000 type one people in that come to their center routinely. So some of them are decent size, we even have some that are bigger than that, that are 2000 or one that's 5000. So we expect to see some cases just if you think about general population and whatnot, you know, one in 200 people has type one diabetes in the us so

Scott Benner 24:55
well, you know what I find doing the podcast and maybe you know a lot of people with type one as well. I see, there's two, you know, listen, everything's not black and white, but you meet people with diabetes who are either very just micro about it, they're very on top of it, they're a onesies are in the fives. If they get into the sixes, they're, you know, they feel like they've done something extraordinarily wrong, which of course, it's a little silly, but that's what they're that's what they're thinking. They're always well within control. And then you'll see other people who, you know, just having this conversation with someone last night, who asked me, could you interview more people who don't have technology, but who are doing well? And I said, Well, that's, you know, subjective, like what is? Well, first of all, and so the person said, you know, I'm looking for somebody, you know, like you who, you know, whose daughter has a one C and the fives very consistently, I wanted to hear from someone who doesn't have a CGM, you know, doesn't have a pump and is doing that too. And I said, Well, I, you know, I can try to find someone like that. I said, but you'll never know if they're achieving that a one see through protracted lows, you know, they don't have that data. And also, when I've interviewed a lot of people who don't have, you know, any kind of technology that's moment to moment, and I asked, How are you doing, they always say, Oh, I'm doing great. But then they'll very frequently Tell me about an agency that's in the high sevens or in the low eights. And then I realized that their threshold for what great means, you know, is subjective. And for them, I don't pass out during the day and I'm not dead. My doctor says I'm okay. So I'm great. And and it's, you know, there's, there's an interesting swing between, you know, how people manage, and I'm not saying one's better than the other. I'm saying that all those people exist, and then they end up in the hospital. It's funny, because I think that people who are in tighter control lose some of their control in the hospital. And I think people who are in looser control probably gain better control in the hospital. And I'm wondering if there's, if that's being tracked, as you said, we know what were your blood sugar's like prior to being in the hospital? And gap? Do you know what I'm getting at?

David Walton 27:03
Yeah, now a couple of interesting points that you brought up that I could maybe expand on, please. Because here we are, we are collecting the most recent a one see the date and what that was prior to them coming in. So that will give us an indication of where their blood sugar has been, and what their control has been. So that that is part of what we endeavor to look at. You know, we'll get something around that if that, that that role that you mentioned, you know, in terms of the technology, it's, it's funny, I, you know, I came along this, this trajectory, like anyone else, I mean, I feel like I was in a healthcare MBA program. I was very educated.

And I had very good insurance.

I worked at j&j for 11 years. And yet, in my early part of j&j in the early 2000s, my blood sugar control was not that good. And I was only testing with a blood glucose meter, one and a half times a day. I would test every morning, and then either at lunch or dinner, and it was almost, yeah, I've never had an endo say anything different. My Awan sees would go between mid sevens to low eights. But I never broke seven. And, you know, I had moved in a new job, new house, kid, you know, you're busy with life, I was just doing injections and using a blood glucose meter. You know, I decided I'd learned a little more. And I'm like, I really should be doing a little better. My Yo, my endo might say you should test more. But they never said my ANC was a problem was a problem or that I could be doing better. Yeah. It kind of suggested if you tested more, it'll be easier to to stay in tighter control, which is absolutely true. All the data shows that but i was i was a little lackadaisical about it, then that I you know, I decided I want to go on a pump and see because I had a friend who was on a pump. And, and her ex husband worked for a pump company. So I got on the pump. And I saw a little bit of improvement. still didn't break seven on day one. See. Then I joined an insulin pump company in 2006. Right. I was at j&j, they acquired animals. So I went over, and I had to, I was leading strategic marketing, which was looking at new products and what was going on with competitors and all the emerging technology and clinical data. It was a great, very interesting job. And I I, to orient myself, I read through some presentations on advanced pumping by john Walsh on San Diego. And it was a great PowerPoint that went through all the ins and outs of using it and but through that I realized, wait a minute, they have these formulas for how you dose insulin based on your weight and your total daily dose and these rules of 1800 and 500 You divide your total daily dose into those numbers to get your correction factor and your carb, insulin to carb. And I realized mine were seemed really out of whack. I was taking one unit of insulin for 25 milligrams per deciliter to correct and I was taking one unit of insulin for 15 grams of carbs. That's what the educators put me on when I was diagnosed. Nobody ever looked at that no one ever suggested that might not be optimal. What have you, yeah, I start reading this presentation and realize that those numbers don't seem to fit with the way Big Data Analysis would ever suggest, or these formulas and clinical studies that were out there with suggest would be in a kind of a stable adult kind of ratio of those factors. So I just changed them on the fly. I looked at my total daily dose, which is like 53 units of insulin that was in my pump. And I divided it in I just instantly changed my my correction factor to one to 35, I think and my insulin, the carb to one to 10. And next day, when c 6.8. First time I cracked said, Yeah, so I didn't need necessarily the pump to deliver the insulin, but the pump tracked my total daily dose for me accurately. And all I had to do was go through the little cap the history in the pump, and I was able to calculate it. Yeah. And that little formula that had been derived from some people, I think, down in Atlanta, and but it was all over the education and diabetes sources. So for 10 years, I was on the wrong dosing. And it's easier to find issues like that if you're using technology and you're collecting data and then even have have, you know, analytics run without you having to do it, like download reporting now and tools that are out there will do this automatically. But I had a you know, I saw great endos one worked at Stanford, one worked at Novo Nordisk that they didn't. I had no hypose to speak of. So they weren't really acutely concerned about anything, and they wouldn't see a 7.6 for someone with no lows and seems to be doing okay, he's busy. That wasn't, you know, they've got other more problematic situations to deal with. But yeah, that wasn't hitting the target. And I had every other thing at my disposal, great insurance, j&j covered all of our supplies for diabetes. So I, I had no excuse. Once I got in better control. I'm like, Wow, it was positive, that positive reinforcement of, well, now I'm taking the right amount of insulin. And, you know, and I was frustrated, it wasn't brought up sooner. But I was pleased that I finally figured out one of the things that was frustrating me, yeah,

Scott Benner 32:35
no, I'm glad. I'm glad you had that feeling. And you didn't just you weren't angry about it. Because I've I've met people who are so angry after they find out that it's hard for them to get past. You know, I've lived my whole life like this, you know. And I heard, I heard a podcast and my agency went from, you know, 8.9 to 6.9. In three months, how could nobody have told me that? It's sometimes it's hard to get past? Yeah,

David Walton 32:59
no, absolutely. And I also benefited from being around a lot of people with type one, I picked up some tips that after that, so then it was like sustaining that my agencies just got a little bit better. And then we're consistently at those, you know, positive levels. And because of that, that education, and then the technology, and then certainly CGM coming out. And I think I first tried it 2007. And it didn't work very well. It was the first gen of Dexcom. But then 2008 when I tried the next one, this the seven Yep. And that that worked better still had some issues. But you know, wow, the insight of seeing how you spike after breakfast, and you know, all the all the various things that come with CGM. One last point on what you just talked about the hospital though, cuz I think that's a very interesting point that it should be pointed out from some of the data that's coming out. And there was a study done by glide tech on just anybody with diabetes, or any high blood sugar they saw in the hospital, a pure hospital study, that it's clear if you manage blood sugar, and if the healthcare team manages blood sugar, more tightly in the hospital, people do better. In a lot of scenarios, after surgery, getting out sooner, and if they're dying, they have diabetes, and and, you know, they were in for some other condition. If you keep their blood sugar and control, they have better outcomes with that other scenario. That's not what's happening right now. Because of COVID. There are healthcare teams that understandably, are trying to minimize contact with patient and blood sampling and they're busy and, you know, being tapped, you know, the bandwidth is being challenged. Yeah. And what that this One study showed is that, you know, David Kahn off was the author that that People aren't doing as well, there, there are a lot of people. And again, this was a lot of type two diabetes. But you know, we're certainly interested in the type one angle, and we are going to be looking at that potentially with with them. And this is data that comes in from all these 300 hospitals that that they work with. And it's, it's fair to say that there are people that get frustrated when they go to the hospital, if they've been managing their diabetes, well type one. And then they're told they can't use their pump, you know, they can't be doing it themselves. And I know the number of hot there are hospitals that will defer to the patient preference, if they've been self managing all this time. And if what they're in for the hospital for is such that they can be lucid and clear their decision making, then let them keep doing it because they have been doing a great job of 24. Seven outside. So why are we going to change that because we're a healthcare team that doesn't know their body as well as they do and so forth. But that's a, you know, if you can see, it's a challenging problem to know, what's that threshold for a hospital say, No, we've got protocols for our quality, and we don't want to get sued. If something happens, we have to follow certain rules. And, you know, there's it, I can understand both sides of that equation. But clearly, I know people that have gone in to the hospital and said, I'm keeping my pump, you're gonna have to rip it off me, I do a good job with this. I don't want this being mismanaged. And I your point. Some people might be a little over the top with that, but you understand where they're coming from, because you know, they're a little anxious about what's going on. And they know they can do it. But if they pass out, or if they're given, you know, medications that change their thinking that, you know, you've you've got concerns there on the other side. So

Scott Benner 36:50
yeah, we we do a, we do a series inside the podcast called diabetes pro tip. And I do it with Jenny Smith, who works at integrated diabetes. She says, Oh, yeah, she has a CD, she's had type one for over 30 years. And there's, I don't even know, at this point, there's probably like, 20 episodes of it. But we very recently went over emergency room protocols, and how to handle yourself during an illness and injury or surgery. Because it's just so it just it, it's not something that would occur to you, you get into a hospital in a position of thinking, well, these people know better than I do. And you just kind of hand yourself over to it. And it's very infrequently with diabetes, the case, you're often you know, the best arbiter of what's going on. And so I think that's, I think that's incredibly important. Also, I want you to know that when you reached for the word lucid, and I did it exactly the same time, it made me feel like I should have tried harder in school.

David Walton 37:48
One thing my mom, who I grew up with, right, as I mentioned, I was adopted, she was a voracious reader, and a stickler for grammar and vocabulary, right. And just because she read so much the words that she would use around the house, some of it I just picked up, because I didn't like to read that much. Certainly, I, like twin brother, and I played sports constantly, in a way with typical boys. And sitting down and reading was sometimes you know, like, just couldn't be done. But I read in school, certainly, and all that, but she's responsible in part for sometimes I would, you know, use use the dsat words, and then I did some sap tutoring after college, on the side, right, make much more money. And I had to learn extra vocabulary so that I could make sure I knew what I was talking about when I tutored some of these kids when vocabulary was a bigger deal on the LSAT. So yeah, it's it's purely there. The circumstances that exist sometimes explain, you know, explain things more than any other, you know, innate as my grasp of vocabulary is probably the same as anyone else.

Scott Benner 38:59
I got my vocabulary from Howard Stern. So

David Walton 39:01
I got into the radio interviewing

Scott Benner 39:06
podcast, there are times when I think I'm probably only halfway good at this, because of how much of that show I've listened to. There's just a, I have a timer in my head. And when my timer gets bored, I just, I move it along. And I think that's a helpful thing. Okay, so interesting. I want to kind of just hit one thing, and then I want to ask some more questions. But, you know, I don't know that people think about it, because you get diagnosed, and then you're sort of frozen in that time period, right? That happened to you, you were diagnosed, this was the level of care and then that just became what was and as the world moves forward around you, your care doesn't always move forward with you. And that makes sense. If you're with the same doctor for too long or you're not around other people with type one and you don't say to yourself, like how come that guy gives himself insulin before we go to the cafeteria and I'm doing it after I eat, you know, like, like those small idea. And we also all sort of sit back, traditionally, and we wait for the a DA to tell us what our agency should be. Right? That happens historically, over time. The a DA says, this is your goal. And then technology gets a little better than the a DA says, you know, we've done some research. And the problem is, is the research started 10 years ago. And now they're rolling up in 2020. And telling you, here's what you're able to see should be. But you know, I did some research to it was called, I took care of my daughter and figured out how to use insulin, it turns out, you can keep your Ebensee lower, if you have a handful of, you know, tricks in the bag that you can, that you can use for the lack of a better term. I call them tools on the podcast, usually, but they're just simple ideas around using insulin to keep your blood sugar in a more stable and lower place. And so I understand completely the need for the diligence, you know, looking at that over time to come to a conclusion and tell somebody something, don't get me wrong. I'm not, you know, I shouldn't be listened to like the a DA should be their, their their information is vetted. But that vetting process takes time where my vetting process is faster, right. It's it's Yes, anecdotal at first, but then eventually, it's experiential, and then it then it's provable. And I'm a firm believer that I think it's nice when people in the diabetes community say things like, you know, your diabetes may vary. And, you know, your, your experiences with diabetes may vary. I don't argue with that. But the way insulin works, that doesn't really vary. That's pretty scientific, you know. And so the way you use it, or what you eat, or your activity level, or all number of other variables, variables could be different. But at its core, and I say it constantly, I don't think I'll ever stop saying it. type one. diabetes management is about using the right amount of insulin at the right time.

David Walton 41:49
Absolutely. Like I couldn't I couldn't agree more. I the, and again, I worked at an insulin delivery company, animus I mean, what was the point of wearing this, this pump 24. Seven, it's to give the insulin in a better way. Because if you give insulin and and the optimal fashion, you will have great results. It's just very hard to do. But if you pick up all of these, all of these little tips that you're in scenarios about the you know, the first thing people discovered was CGM. I heard Dr. Bruce Buckingham mentioned this, it's Stanford a lot was

Oh, if you

once you put CGM on someone, the first thing they realize is how much that oatmeal causes them to spike. And they don't, their blood sugar's high for three hours afterwards. So people start switching the bacon and eggs, you know, like the carbs in the morning when you're insulin resistant. That that that hyperglycemia contributes, you know, a decent amount to people's kind of above target glucose throughout the day. That dosing formulas that I mentioned, I mean, those Yeah, not everybody is going to fall, right, exactly the formula, it just so happens, I do. I'm like, literally, it worked out. Right on those that it just it fits and my weight, you know, the amount of insulin I use a day is almost exactly half of my weight in kilograms, which is what one and Joe had mentioned to me that that's a good rule of thumb. And it turns out, I get pretty good control, you know, in the sixes, mid sixes to high sixes, depending. And now with control IQ that I use, it's, you know, I'm more in the mids. And I'm not having to, you know, I love that, and we can talk about that later. But, but that aspect of the of the dosing. I fall Exactly. on that. And so I know there are people that have that don't fall right on that, you know, and that average comes from, you know, distribution, a number of people, but when you're way off of that average for no good reason. Or you're doing a number of things like it certainly should give someone pause to think maybe there are some things that aren't tailored to me that maybe I do need more Now, a lot of people don't take enough bazel insulin and so they're putting a lot of insulin to correct for these excursions they have these highs that because, you know, if you're if you're not taking a bazel it's like you've already kind of lost the battle so hard to recover, to, you know, given how long it takes insulin to work. So,

Scott Benner 44:24
David, you would like this podcast?

David Walton 44:26
Yeah, I definitely agree. But one thing I do want to say about who can who's able to figure that out on their own? You know, there is this, it's no

Unknown Speaker 44:34
one

Scott Benner 44:34
it's because the life man because you're busy living here's how I was able to figure it out, right? I don't have type one. It's for my daughter. And because it's for her I feel an incredible responsibility. Right. And I was and continue to be to some degree, a stay at home dad while she was diagnosed, so I had nothing to do but stare at her and and figure it out and and and go through the the Real defeating moments and realize, like, I can't let this be her life, like, I have to figure this out. Like, it must be doable. Some people are doing it, but nobody could explain it. You know, on a side, I got a note yesterday from someone that said, hey, there's someone with an Instagram account ripping off your ideas for the podcast, but trying to put it in their own words. And it's, it's funny. And so I went and looked, and sure enough, there, it's ripped right out of the podcast, and that's fine, you know, whatever. But my point is, is that they said it in their words, and it doesn't work that way. And so there's something about my specific experience and who I am and how I communicate with people. I'm telling you, those those pro tips, it, you know, the other day, I put a website up for, because people were asking, so I made diabetes, pro tip calm, just so people wouldn't have to, you know, go through the entire podcast podcasts if they were just looking for management, because it's interesting. Some people are very interested in community. And some people are very interested in management, the community, you know, just regular interviews with people with type one, and not even like hooked in people, like, people you don't know, they don't have a podcast, they're not online. They're just people with type one, I try really hard to keep those interviews to people like that, right? Those are the most popular podcast episodes. But the people who care about management are fervent about the management. It's It's interesting how some people want the community and some people want the management. But anyway, I put up this thing just yesterday, I said, hey, I've got this diabetes, pro tip calm now. Here's the link, if you could help me in the comments below, just if the podcast has been valuable to you, could you share here, and you know, so people who are coming on new kid could you know, figure out what to expect. And I didn't even believe some of this, this, there's I'm just looking now, my four year olds, a one C is down from 97259. From the diabetes protests, my husband's is down to five, six. And it just it goes on and on. It's it's fascinating. And so I'm proud that I found a way to talk to people about it, because once I could do it, I thought, well, now how do I replicate it for everyone? You know, like, how do I make it as mass market appeal as possible, the idea of, you know, how we manage, and I just broke it down and kept breaking it down and distilling it until it's just the simplest ideas. So that while you're busy living your life, and you know, you're worried about getting COVID-19 and whether or not you can afford your groceries and how you're going to do it your job. And you know, all the other things that people worry about when they start noticing a trend up in their blood sugar that they don't have to go back to a book or go to a doctor's visit, like what what one sentence, can you kind of say to yourself, that'll bring it back for you. And I tried to do that with all the tools. And I think I have. And and, and it's interesting when I used to wonder out loud, like, why can't doctors do that. But now I realized that my whole life's been about communicating with people. That's not what a doctor's life is about. Like, they know the idea, and some of them are terrific at it, don't get me wrong, but a lot of them aren't. And, you know, like, you know, or a lot of them are just like, oh, David's fine, he doesn't pass out. Because they once he's not too high. There's bigger problems here in the practice. So

David Walton 48:26
I'll go I think on the adult side, you know, you find this more, I mean, think about, you know, an adult endocrinologist. How many people with type two is he seeing and, you know, in general, people with type two diabetes are not as engaged and don't spend as much of their mindshare on their diabetes as those with type one do right. Now, it's obvious with kids, I mean, usually people don't have another condition. If they do, it might be asthma, or it might be something else. But diabetes, and with their parents also there, the amount of collective, you know, mindshare, that's focused on that and the importance of that and so forth. Different so you can imagine these endocrinologist who are just beating their head against the wall because they've got type two diabetes patients with multiple chronic diseases, they're not taking their insulin for getting to take their insulin, they're not taking enough insulin, their numbers aren't getting any better. And then if they're worried about a low because of it, I, my endocrinologist mentioned this to me that, you know, when he's had low blood sugars, and some of his older patients, it's when he has their adult child, ensure that they take their insulin every night. And then they get a low because he's been adjusting their insulin up based on the based on that hazard way they use it the way they use it. And so that's part of their skittishness or like, because they don't want to, you know, do no harm they're afraid to, yeah, give them something where an older person who's not used to hypo, that's the thing that happens with tattoos. That they have many more cardiovascular issues. Heart attacks occur when they're not accustomed to having a low blood sugar, and they end up having it at, you know, when they're 65 to 75 years old, it can be, that can be very dangerous. So having spent some time also in the type two space and looking at smart insulin pen caps to try and track that data, so we could try to attack that problem. It's a huge problem. And it's, it's overwhelming, and certainly for primary care, that's taking care of those. Yeah. You know, it certainly can be that well, the percentages,

Scott Benner 50:32
I see them here, because there's, there is no more popular type one podcast than this one. And I know how many people listen to it, versus how many people have type one diabetes. And the percentage of people who, you know, are looking for this kind of information is still small compared to how many people have diabetes, there's, there's far more people who fall through cracks, for you know, the reasons you mentioned, and many, many more than then who are going to have the wherewithal and the and the drive to figure the rest of it out?

David Walton 51:04
Yeah. Well, you know, interestingly, throughout, you know, I've worked in health care for 25 years. And before I was in the diabetes field, you know, I was a consultant, working with health plans, and with pharmaceutical companies. And I remember looking at a segmentation, consumer segmentation, and what are the different kinds of types of behaviors and a couple of these different analyses show that there's like this 15 to 20% of the population, that are the proactive segment, they're the ones that are going to go research, they're going to go take control of things. And if you ask them, How do you approach care? Do you? Do you research it and then go ask your doctor? Or do you wait for your doctor to tell you because they're the trusted health care professional, or somewhere in between. And when you look at that, it's, you know, 20%, maybe 25, depending, are in that proactive kind of thing. And I saw it in oncology, they saw another company had done this, and the people who are the passengers and people who are the drivers, and then people that are, you know, something else. And that unfortunately, like a lot of the digital health tools, and a lot of things they get built, get built for the proactive segment. But we only address that only that kind of population takes full advantage, it's very hard to get to some of the other people, or you have to do more to, to, you know, bring them along that journey to educate them, you know, etc. And this, this is one of the the challenges in healthcare across a number of different conditions. But Type One Diabetes is certainly in that, you know, in that same in that same vein, yeah, that there, you know, you can go online and look at influencers and so forth, and you see certain profile of people, and they're, they're the ones that are have this, they want to share with what they know, because they've seen it work. And they're like, why aren't more people doing this, right. But there are a lot of other people just living their life who don't aren't connected to people, they don't know about things. So awareness is some of these things. You know, it's tough, like I've been at dinner tables at a restaurant. And I'm adjusting my pomp and telling someone where my friends about it, like they're asking what I'm doing. And the table next to me, a woman leans over and says, I'm sorry to butt in, but my boyfriend has type one, and he just doesn't want to listen to me. Could you talk, literally

Scott Benner 53:29
asking me to tell him why you should test more and all this. So I, I understand that and I, I try to massage the situation. I mean, this guy does not want to be told by a stranger what to do in a public place. That's not the way to handle it, but she cares about them. And she and she's frustrated, she can't make an impact and, but people are all over the place. And that's because I did a lot of market research at atomists and surveyed thousands and thousands of people at a time and, um, you know, it's, it gave me a real appreciation for that spectrum, just like when I was diagnosed. And I mentioned, you know, the previous ex ex girlfriend who took a different approach to her Type One Diabetes than I did once I was diagnosed. And that's perfectly fine, that people are different. And you know, the way people these different personality types and so forth. It transcends the Type One Diabetes diagnosis, it's not naturally going to change someone. So understanding that people are different and that different approaches are needed to get people into the education circle. For me, I realized that everyone's life is gonna take a different trajectory, and their level of you know, how much they want to put into their health on many different fronts is is personal. And I'm okay with people making those decisions for themselves, as long as they know what their decisions are, are going to bring, like, as long as they understand, it's okay with me. I don't know if that makes sense or not. But if you want to get your car and drive it into a wall as long as you understand the car is going to you know crushing the law and you're gonna die right on you, you've got free will, you can do whatever you want. You know, and so I just want them to know how insulin works. I think once you understand how insulin works, then the rest of the things that, you know, quote unquote, are happening to you, you can start to see causality for and then you can make your own decision, like, do I want to Pre-Bolus? You know, I think Pre-Bolus thing knocks a point off of a one say,

David Walton 55:24
yeah, it's absolutely. And again, I mentioned that Buckingham comment he made in 2007, at an at a conference, it just struck me, you know, at the time, and if, if you were to think about and we actually came up with a list of these for insulin pumping, when I was at atomists, I remember, you know, this concept of so many people say if they just could share what they know, or they wish they knew this earlier, right. So the idea is, let's get more people to understand these things. And so, the basics of Pre-Bolus, the basics of how much it should be roughly for the carbs are to correct based off your weight. And based off, you know, trial and error sometimes helps you but you have to get that right. If you're if you're you know, and I was I was, again, I was taking too little insulin for what I ate, and then I was taking too much to correct it, I had this little yo yo thing going on. But you know, given that it takes insulin a while to work. And I don't know, four hours is probably an average duration. We know some people go five or six, and some might be within three, three and a half. But that's about as fast as the rapid acting's go. Now you have ultra rap backing, I guess that can be a little faster. A frenzy, you know, inhaled insulin, that could be certainly faster to bring down high spikes, but that gets, you know, that's a that's like the Masters level, like the introductory level, you're talking about. Having just, hey, if you if you did a handful of things, like the Pre-Bolus, that right amount, to avoid Lowe's, you know, you did what's necessary, whether that's if you have a pump, you can do something if you don't, you're on injections, you do something else by eating right. But the timing of your when you take your long acting insulin, and there certainly are better ones now than there used to be. So if they're more forgiving, but they used to be that you needed to get that right, you know, you couldn't miss the time window too much. So that would be a problem. So you go through, it's not a list of 50 things. No, right? Here it

Scott Benner 57:25
is, your Basal has to be right, that's First, if your Basal is wrong, nothing else works. And the things you're seeing are ghosts, because they're not real. And you don't you don't know if that low what that's from, you know, when I do a talk in person. And I explained to people that if they're bazel should be, you know, two units an hour, but it's a unit an hour, then they're a unit deficient every hour, then all of a sudden they come along, see a meal. And I said I always say like, let's say that God himself has come down or herself has come down and told you that this is absolutely 60 carbs, and that your carb ratio is 100%. Right, you can definitely trust that you count the carbs, you put the insulin in your blood sugar shoots up. That's because most of your bolus is really just making up for the job that the bazel was supposed to be doing. When you say something like that to people the look of all on their face is is fascinating. Like, why would no one tell me that? And it's because no one knows how to tell you how to adjust your basal insulin. And so I figured, you know, I figured out a way to talk about that. I was like, look I talked about based on some like volume, I'm like, you turn it up until it's as loud as you as you can stand it. And then if that makes you a little too low, then just turn it down a little bit. If you had a pump David, and your anybody and your basal insulin was wrong, I could spend a half a day with you and fix your basal insulin. Yeah, it's not hard.

David Walton 58:48
I, I absolutely believe that. And we, again, design these download reports for clinicians to download the pumps, and then with CGM data as well. I mean, that's often You're the ones who are really good and used to doing data interpretation to help patients out. That's the first thing. The first thing they look for is, are they having a bunch of they're having lows. If they're not having the lows, then it's let's, let's go. And even if you're having lunch, it could be the bezels wrong. But usually people are under bazel. That's fine. So that's your point. It's the number one thing from a percentage of the time it's wrong. Like that's where you go first. You have to get that right. Because then, like you said, Why worry about your attempts at trying to fix your bolusing and all that the timing and the amount are futile, because you're you've got the wrong background that you can't operate. And so I I totally agree.

Scott Benner 59:41
I practice, not on purpose, but I practice for this podcast by talking to people privately. So try to imagine never meeting someone before having a phone call with them that lasts less than an hour and figuring out their issue and pointing them in the right direction. Not being able to see anything except for what they're telling you. So you have to learn how to ask the right questions. And then you have to learn how like what the path is for them, like, where do they start? And eventually, during that conversation, they'll feel a little emboldened and say, okay, so around my meal, and I always say, No, your meal is all wrong. It's not even work. I know, it's frustrating, but everything you've been staring at trying to figure out around your meal. It's all meaningless data. It's not real, because your bazel so far off, and I said, so you're gonna have to forget everything you've seen before and start over again. It's just, you know, I don't know, man, is it frustrating and not uplifting?

David Walton 1:00:36
What you just mentioned it brings up to two thoughts first, I you know, I just was talking to some people at at t Wendy exchange about this, you know, we have new people come in, I've started giving a diabetes one on one presentation that kind of updated an older one we had and put additional content in there for my experiences in industry and so forth. And

you know, it's it's interesting

Unknown Speaker 1:01:03
that

David Walton 1:01:05
Oh, God, I just lost my train of thought, because someone's banging outside my door. You don't hear the banging. I don't hear the banging. You need to

Scott Benner 1:01:11
get out of the building. First.

David Walton 1:01:13
decks getting prepared. Oh, okay.

Scott Benner 1:01:16
You said you redid the diabetes 101 that you guys had?

David Walton 1:01:20
Yeah. So so we we give that education everybody about? Yeah. So they have some some, you know, baseline understanding about, you know, what's taking place and one of the things we were talking about, and I mentioned was, you know, people counting carbs incorrectly. And Bolus Bolus calculations. So it turns out there are lots of studies that show that people consistently under dose their bolus insulin Yeah. And and the thought and Howard Wolpert when he was a Joslin did a nice study with a 30 gram apple and showed, most people guessed it was 10, or 20, or 15. And that correlated with having a higher agency, and the people that saw it 30 or 35, or 40, which were fewer, their agency was better. And so the idea was, if you're better at carb count, you're more accurate at carb counting, you're going to have a bit it correlated with a better agency, is it? Is it causal? Or is it Who knows? But certainly, it makes logical sense that if you're better at that, but the reason people are consistently under is because they have a fear of hypoglycemia. So are they really? Do they really think it's only 10? Or 20? Or are they nervous about giving too much insulin and getting a low blood sugar. And so we did some research with with a, an insulin maker, about this fear of hypo issue to try to understand some of the aspects of it, and the severity and so forth. And we were going to be doing a broader survey, and there's some things that we're going to be teasing out, but it does, you know, brings up that interesting point about you know, there are there are reasons, sometimes you can think the answer is we just got to hammer people with carb counting, let's give them apps, let's give them flashcards, let's, let's get a picture of the the food they eat and send it to a reference database and tell them what it is, you know, I've seen a couple of these apps that you can scan the photo and or scan the food plate, and it will give a reasonable estimate of the carbs. But it turns out, people may actually have some intuition about what the number is, but they're downvote out adjusting because they're nervous. And so that's the first point. Yep, the second would be the potential and promise of Finally, good closed loop systems, or hybrid closed loop systems in the market. And, and, you know, I'm, I'm a little biased, because I used the tandem with the control IQ. But, you know, this promise that we've been hearing about for at least 15 years since I've been working in the diabetes industry, it's right there talking about closing the loop. And now, some of these issues that do exist, where you can say, Is it an education? You know, can we help people understand this better and train them better on these things? Or can we use technology to handle some of the challenges that just only some people have been able to master themselves? Right? Some people just won't. And there's a spectrum there. And, you know, the power of this with the time and range that, you know, we're seeing with people, and that's the thing I'd point out is my agencies haven't improved that much since going on this, but I have no lows. So you know, I like zero will be my top my time and range will have zero sometimes you'll have 1% I used to be at seven or 8% consistently. And that's that to your point in the beginning about there are some people that keep a when C's down in the fives, but you know, but they've got some real significant blood sugar, low blood sugars at times. I used to have more I never, I've never passed out. I've never had something bad bad but I certainly had a lot more lows and I'd have to, you know, go run, get something to drink and whatnot. That just is much less and that's because of the technology. You know, nighttimes being much better. So that whole issue of what are some of those tips, there are tips that you still would need to do even with these kind of systems. But then there are things like, overnight control can be drastically improved. Because I can't think and do things at 3am when I'm asleep when the system can

Scott Benner 1:05:20
Yeah, I started off all my talks by talking about fear, first, you have to get rid of your fear of insulin First, it just, it has to be, you know, if you're going to be afraid of this, it's not going to work out. I talked about, you know, when you're asleep, it's a third of every 24 hours, basically, right? So it's free a one seat time, think of it that way, you know, and, you know, and then, you know, the Pre-Bolus thing and readdressing blood sugar's when they don't go the way you want. My daughter's not, you know, low, you know, a scary amount. I mean, everybody has a scary low once in a while, but it's not not a monthly occurrence or anything like that. Her a one seat is just cemented at five and a half. And she has no diet restrictions, and only we had Chinese food for dinner last night. And you know, and then she worked out afterwards, like, it's not like, you know, it's a regular life. And her a one C has been between five, two and six to for six years. And it's just doing the things that I talked about on the podcast, and it's being it's understanding them, and they don't get me wrong, like after you have some experience with it, it does become second nature, you know, I don't look at an elevated blood sugar for an hour and a half trying to figure out if this is the right one to put another unit on or not, you know, like, it comes to me pretty quickly. I'm still teaching it to her. But the other part of me believes that closed loop systems are going to keep her from really needing to understand all of the things I understand. And you alluded to it, I'm happy about that as a parent, like if my daughter can, my daughter is not the, you know, she's not the sounding board for the rest of the world. She's a person who's going to try to live her life. And if she can live her life without the burden of knowledge about how insulin works that I have, that would make me happy. You generally mean and and I see it too, like, you know, it's it's obviously here, no control, like who's here, horizons gonna be here. Before you know it. I'm assuming Medtronic will figure out how to make that other thing work better at you know, you know,

David Walton 1:07:24
no, absolutely. The next version of a tronic will be better. You mentioned that those are three closed loop systems. And there are four other ones that are in development, right, and will be out within a couple of years. So that's correct, you know, super excited separation of these different systems. But you I think, the point you made, like, even when you're using the systems they'll handle they'll help take over certain issues or problems or, and make certain things better. But you have to have a base understanding of how it's working, and what to do when, oh, wait a sec. I ran out of a supply or my cartridge, something malfunction, I'm getting an alarm here. And they have they have some technical support, you can call it but there are times where some things have happened where I had to improvise, and not understanding what to do, you know, understanding how insulin work when I was traveling five years ago, and I had an empty vial of insulin in my carry case, and I went to go fill up my cartridge in my pump into Oh, I don't have any insulin. Yeah, this is that you know, what midnight, and places are closed, what am I going to do, and I found a 24 hour pharmacy, and then I go and they can't get the prescriptions not on file. So they could give me regular insulin. And so I got a premix. And I just kind of guesstimate of what I should do based off of what I knew and how much I knew I took for long acting and short acting, I divided it up and turns out it worked reasonably well. But like, if I couldn't have done that, what a scary thought if you were by yourself traveling somewhere in a different city, and you don't have anything like what are you gonna do? These these things happen. I mean, I, everyone's gonna have a moment of absent mindedness or forgetfulness, or, you know, unexpected, you know, something came in and took change your plans and you weren't preparing for that. And, you know, I joke to my wife, you know, going for a walk right after I took a lot of insulin, it's just a walk. But it's amazing how that my blood sugar will go down and I just, It surprises me every time and it shouldn't. It's like I'm just walking. But it's insulin, and I play basketball on the weekends and I you know, lift and workout. I'm relatively active, walking right after insulin. It's amazing how my blood sugar drops. And certainly when I you know, I've ran a couple marathons a way back when I learned how my how to balance the insulin. I take any insulin on board relative to how long I'm running for how hot it is. I'm a big guy. So like, you know, I think it's even more drastic, so I would have to drastically cut back my insulin. Yeah. You know that that was trial error that there wasn't a simple formula I could follow. I talked to people who also ran and but I was a little different and you know, you learn these things, how to tips from other people. So I do think that other people with die with type one can be the best source of information, provided you can kind of take it in the right context. So you'll learn a tip or two from somebody But no, they're like, someone else responds differently to oatmeal or to steak than I do.

Scott Benner 1:10:39
Oh, yeah. Hundred percent or younger people like coffee, half the balls for coffee and other people don't have to for the Exactly. I'm

David Walton 1:10:44
wanting to ask the Bolus, right. I don't drink Starbucks often. But my kids love it. And I get the sugar free. I get you know, and do it that caffeine and why? I have to take four and a half units. If I get a venti

Scott Benner 1:11:01
macchiato. Yeah, we've been we've been doing a great

David Walton 1:11:03
Diet Coke with caffeine, you know, nothing, not profitable, in fact, so it's,

Scott Benner 1:11:07
yeah, sometimes sodas make my daughter's blood sugar go up. And I

David Walton 1:11:11
yeah, and I've heard people talk about that. And like, I drink so much diet soda. And like a lot of people with a one and zero impact like I've, I've looked at this I've watched and see because people will tell me, oh, your body treats diet just like regular nice. Well, your mind doesn't?

Scott Benner 1:11:26
Yeah, you're different, right? Your stuff. We've been doing it, we probably have a half a dozen podcast episodes now about algorithm based pumping. And there's more and more coming because I have to tell you, from my perspective, it's my belief that for the great many people who will never find a podcast like this or find community or talk to somebody or live with another person who has type one diabetes and get a tip from them, you're gonna slap this algorithm on them. And with a, you know, hopefully a little bit of guidance there a one C is going to improve their lows are going to improve, it's going to make their life better. Absolutely. You know, and that that for and there and then there'll be people like me and others that will manipulate the algorithms at times and get it to do more of what we want. And that to me is that's the future. Honestly, I I would give everyone a dexcom if I had the power to do it. Yeah, yeah. Well,

David Walton 1:12:13
I certainly I've heard more and more examples now of endocrinologist putting CGM on right away. Yep. to people and after a diagnosis. And it's it's interesting, because I remember this discussion coming up years ago, and people saying, you know what, you know, pumps are put on sooner than CGM a lot of the time, just because they've been around longer. And there's more familiarity with them. But as the familiarity has increased, and they've gotten simpler and more accurate, that has shifted over the last few years now. So I think if if given a choice, and you told people, you had to have either CGM or a pump one or the other, you have to choose Yeah, I think most people are going CGM. Now,

Scott Benner 1:12:58
my daughter has been using wearing on the pod every day since she was four. And she'll be 16 this summer. And they are sponsors of the show. And I am a huge fan of Omni pod in a million different ways. I know people there and I know good people who are working behind the scenes. And same with Dexcom. And if you held a gun to my head, I'd give my daughter's pumped back if you made me you know if you put me in an either worse situation. I right. I'd rather have a seat. Yeah,

David Walton 1:13:22
no, absolutely. I think, you know, you do have studies like the diamond study that showed you can do very well CGM and injections. Similarly, as you could with a pump. I do think you know, the pump has certain advantages. And then there are certain drawbacks to wearing wine. Well listen, once you see

Scott Benner 1:13:41
the data, in my opinion, then you're gonna want a pump. You're gonna just be like, Oh, I would love to use an extended Bolus here or Temp Basal.

David Walton 1:13:47
Yeah. So like there's that. Absolutely. But you mentioned earlier about some of your listeners being interested in those that technology is funny, because so there are three people, you know, that I know from high school that we all have type one, only one did at the time, two of us got diagnosed as adults. And you know, I won't name her but you know, she has done very well. She was diagnosed in her mid 30s. Very well, just on when she was on a blood glucose meter and injections, okay. They wouldn't see in the low sixes. She's very athletic. But she did. I talked to her a couple times. And you know, I showed up told him what I did, but I'm like, hey, you're doing great man. I you know, enjoy, enjoy that like you're you've got good results. There's not necessarily need to do anything. But then you know, I think some things changed a little and she got out of the habit Libra and think, Wow, this is so much easier than I thought it would be. And I didn't realize like it's kind of cool seeing my body the way it reacts to certain foods. Like Yeah, let's that's the benefit of CGM. And now you know, she's like an advocate. But she was she, not everyone needs the technology at that point in time, but there There's no doubt that a technology like CGM can absolutely give you insights and help make things easier and more and help you do a better job of controlling. Right. You know, and and she's now a convert. So that's why we're getting up into this. I think the estimates are about 4035 to 40% of type ones might be on CGM.

Scott Benner 1:15:26
It's getting there. You know, it really

David Walton 1:15:28
worth that level. Yeah, depends. Depends on what denominator use, I use 1.6 million. But some people use different numbers. I think that's pretty close. That's what CDC came out with recently. So

Scott Benner 1:15:42
yeah, I hear you, I think it's, uh, I mean, honestly, you'd be hard pressed to see the data coming back, like the, when I make an ad for Dexcom, it makes itself data comes back, you get to see what the insulin impacted what it didn't, how you can next time, do a little sooner, a little later, a little more, a little less, you know, do things like I talked about, you know, there's, there's, some times people have meals, they're like, no matter what I do, if I put too much insulin up front, I just get low later. And so we start talking about bigger ideas like getting the insulin up front through a bolus and extended bolus, you know, even attempt bazel increased it to really force the insulin on the place you need it and then create a I call it a black hole of bazel later, just make a void of bazel later, so that when the the harsh bolus you made tails, it tails right into a black hole where there's no bazel. And then that tail just acts as the bazel instead of a catalyst to drop your blood sugar. Yes, it's Yes. It's not as hard as it sounds. Don't even say if you talk if you have a cup, if you talk it through a couple times and understand the timing that your insulin hits, and you can create those sort of, you know, those really kind of what feel like advanced ideas. And you know, I couldn't do that without a CGM. You think I figured that out before Arden had a dexcom? You're out of your mind. So

David Walton 1:17:04
yeah, yeah. Now that that whole concept of like, you know, the Super Bolus, right, that was the concept of pumping A while ago, that much better now, when you have CGM combined with it that, you know, if you're, if you're high right now, you could take even more Bolus and turn your bazel off and get that to get to, you know, try to really bring this thing down faster, right. And like I said, when it's coming down, it's some of it's replacing the bazel deficit. And so you get that softer landing. And so these different ideas, it, you know, because there's a danger element to it, it's not something you enter into lightly, because if you overdo it, you could have a, you know, a bad low. But how nice to have a warning system and alarms go off, if you are coming down fast, and you are cutting below a threshold. Yeah, I mean, that's, that was the early stage of CGM just having that alarm. Like, and yeah, I'm one of those people that doesn't wake up all the time when my alarm goes off the middle the night, which is why control IQ has has helped on the overnight. But that early experience of finally having something it's an early warning system, immensely helpful. And so if people are fear of hypo, I'd say, you know, CGM can be unbelievable in that regard. Now, you have to be okay, and realize you're gonna have some alarms. And those alarms can be annoying at times. But it's kind of a necessary evil I'd much rather have an alarm than wake up in an you know, profusely sweating you know, and, and anxious, you know, in a panic, not know what's going on. And

Scott Benner 1:18:35
I'm hoping you do the right thing that you don't fall back asleep before you figure out if you're okay, and yeah, all the

David Walton 1:18:41
trip down the stairs as you're going because you're a little a little off balance. And, you know, just all those things like, you realize the way we were acting when the technology wasn't as advanced that let's let's take advantage of technology making my life better and simpler. Oh, you only

Scott Benner 1:18:55
you only have to find one person who's had diabetes for 20 years to tell you a story about the time they woke up in the morning and it looked like a bear attack their kitchen and they don't have any record. no recollection of it whatsoever. You start thinking you're gonna call the cops, somebody's broken into your house, but that was just you looking for frosting. You know? It's it's an interesting, it's a really interesting, David, I have to tell you, I mean, this genuinely. You would love this podcast. It hearing you talk. It was interesting for me because I don't come through academia and I don't have type one diabetes, right. I I had a daughter. She got she got diabetes when she was two. I was immediately the person who was you know, with her constantly. Two years into it. I was just still a wreck and everything wasn't going right. And I really felt like I was killing her most of the time. I'd started a blog in 2007, the very beginning of 2007, which sounds cute now but there were only maybe three diabetes blogs. Then, and I wrote about diabetes for such a long time. And then, kind of Luckily, I guess, I wrote a book about something different. And during my PR tour of all people, Katie Couric told me I was good at communicating with people verbally. And I just assumed that everyone was good at that. But she stopped me and told me, no, she's like, you're really interactive. You're moving these people like, Don't you see like your, the way you're talking? They're following along with you. And it was such a nice thing she said to me, about a year later, when blogging seemed to kind of tail away. And it wasn't the thing any more people didn't like to read, I guess. I didn't want to lose the impact of that I was seeing myself have on other people's lives with type one through the blog. And so I started this podcast, which is now 240 episodes, or 340 episodes deep.

Wow. It's crazy, right. And so

when I start talking about what I was blogging about, I realized I could explain it. And then I was getting feedback from people. And they're like, hey, my agency's dropping from listening to the podcast, and it built and built. And then suddenly, I realized that I had a system that I developed an actual system for managing diabetes that I didn't even realize was a system. So I kept distilling it down into t shirt slogans, like more insulin, be bold, Pre-Bolus, like just little stuff, you know, like, just right down to the basic concepts. And what used to be an email or two a month through the blog, like, hey, this blog is really helpful to me, it's now become about a half a dozen notes through different like emails and social media a day, Hey, I just wanted to share with you, my agency came down a point, my agency is down two points, you know, my variabilities, like, I just had a guy the other day show me his, um, his standard deviation was like, 22, from the podcast, which is just crazy, right? Like, I can't get my daughter to 22. I don't know how he did it. It's amazing. And seeing that this was the way that it's repetition, even though it's not your repetition, someone comes in talks about diabetes, I interject a little bit with what I would do there, they tell a story that makes you more comfortable that diabetes is normal. You hear different ways of managing ideas, suddenly, you start seeing, you know, reflections of your own life in these conversations, you make little adjustments, and before you know it, your life suffer. And that was not my intention, I just didn't want to lose my blog. Like that was really it, and that it's turned into what it is. It fascinates me. Because the truth is, is that it's elevated my understanding of diabetes, it's this podcast is much more helpful to me than it is to the people listening to it, I guess, is my is my point. And I've gotten to the point where I've spoken about it so much and broken down so many people's lives with type one, that, you know, I have experiences where I go to, you know, jdrf events and speak and three days later, someone's sending me a 24 hour graph that's never over 120 and never under 70. And they're like there's, you know, there's ice cream in here. Can you find it? I'm like, No, I don't. You know, and, and not that everyone needs to live like that. And I don't mean to say that my daughter's blood sugar is always at five. Because it's not. We're just very reactive to spikes. And we're able to get them down without creating a low. And but but the point is, is that it's there for people and it and it works and to have you come on I mean this with with the with reverence, I really do have you come on and you don't know me, I don't prep for these things. So five minutes before you and I started talking. I had no idea about you, I jumped onto your bio real quick. I was like I went to Princeton, and Penn Oh, this will be fun. And and for you to say things that so closely mimic the stuff that we talked about on the podcast, it made me feel good. It really did. Like it made goods not the right word it It made me comfortable. You know, because there are times where you're saying like, anecdotally I saw this thing, and you're saying it out loud. And you know, when you're blogging to a couple hundred people or 1000 people, which you know, at some point, it became a million people, you know, the stakes are higher, and you realize your responsibility in this podcast has almost 2 million downloads. And so, you know, like, you start realizing like I'm saying something, I better say it right. And it better be universal, you know?

David Walton 1:24:26
Yeah. And so anyway, you know, interestingly, I mean, I'm proud of my Ivy League degrees, but they really don't help with this nothing to do with my diabetes knowledge. And I would tell people, when I got to enemas I didn't know that much. I knew basics of type one diabetes and you know, someone I'd read articles about new products coming out and whatnot. But you know, I, I had to do research to get up to speed and like, I would go to these conferences and just go to the poster sections where all the clinical research are outlined. It's like mean, ridiculous, hundreds and hundreds of yards of posters, you know, on different aspects of diabetes, and you could spend all day in there reading them. And I immersed myself to understand things because I wanted to feel like I was very knowledgeable since I was making decisions about what product we go with next, and what features should be in that product. But I learned so much from talking to people who've been dealing with it, and the the power of experience, and cause and effect, and like being able to figure out what you can use from what someone did. And you know, some people, like you said, with coffee have different, different experiences and reactions to it. And that's something just knowing that that's the case, and that you can't just jump on something because one person told you that's, that's also an important thing. But when someone has gone and talked to a bunch of people, and then curated that and given you a perspective, that's where it's valuable. So that's the role I would play. I used to get frustrated, like people would say, oh, what do people with diabetes? Think about this, Dave? What do they think? As if not asking me because I surveyed 1500 enemas users? Because you haven't been asking me because I was Dave Walton, the type one right, you know, and that type of thing. You know, happened a fair amount.

Scott Benner 1:26:19
Yeah, no, I hear I don't like I don't pretend that everyone's life is the same. I don't think that I just think there are basic tenants about how insulin works. And I think that there are a lot of similarities to people's lives. Like, for instance, one thing I tell people all the time, like, well, how am I ever going to know how to bolster all these meals because we don't count carbs. So we Bolus historically? And how do you learn how to do that? Well, some of the truth of that is you don't really eat that many different things. You don't I mean, like you maybe have 10 favorite meals or, you know, there, it's not like one day you're having, you know, truffles, and the next day, you're having chicken and the third day, you're gonna like give me like, you just eat what you eat. And so I started telling people, like, Look, you can look at that plate, and say, I don't care what the carb count says, this serving is, you know, the outcome of this meal taught me that while my pump said this was five units, it was really seven. If I come around and make this meal next week, and don't put seven units in, I'm an idiot, you know, like, like, I don't just why would I count the carbs? Gonna go five units, just like last time? Like it didn't work

David Walton 1:27:22
last time? Yeah, absolutely. My my diabetes educator in, you know, at the Pet Hospital, when I was diagnosed, said, after the carb counting lesson, eventually, you'll probably get to a point where you don't do the calculation, you just immediately gravitate to the end, you go to the end result, which is this food means, you know, this granola bar means 2.5 units, right? or what have you. It's not that you're, you're just going to jump to that know that association and not go through the math directly. And so like I see pepperoni pizza, which I don't eat that often. But when I do it's three and a half units a slice with a combo bolus, which is what you know, or extended bolus 60% up front 40% later done over about two and a half to three hours. Right. And that's how pepperoni pizza works for me if it's the right size, the right not to thicker crust, whatever. What when it deviates from that, yeah, I'll be a little bit off. But generally speaking, I go right into it. Let's pepperoni pizza. Here's what I do.

Scott Benner 1:28:22
And if it goes wrong, you're not flummoxed.

David Walton 1:28:25
know exactly how you'll spend the next six hours. Okay, right. I'll monitor and say, wait with my insulin. Do I need to give a little extra was a little under was just a little heavier in carb than I thought. Yeah, absolutely. All the time. Chinese food. You mentioned pizza and Chinese food were two of the problem. foods for a lot of people to usual suspects. And the Chinese I never eat the rice, but manage the sauces and any kind of you know, reading they put it on certain things. But I try to be mindful that I swear I still always get it wrong.

Scott Benner 1:28:57
Yeah. Oh, it gets in there with the fat man. And it just stretches out over hours and

David Walton 1:29:01
hours. Now you see that stuff in the refrigerator and the next day you realize how much fat is in the corn starch or this whatever is in there to make it taste good? Is this big jello? It just congeals in the refrigerator, you realize that's what the chicken egg carry on was?

Scott Benner 1:29:19
I have to tell you last night, my we were finished. And my wife's like here put this away. And I'm like, throw it away. And she goes, What am I gonna keep that? And I was like, Yeah, I mean, I'm not eating it again. Just so you know, like the heat was the only thing making it palatable.

Yeah. Anyway, David, I've learned I can talk to you forever. And I've kept you much longer than you. Then I told you, you're gonna be on. Here's the funny thing. Did we finish what you want to say about what's he when the exchange is doing for people with COVID-19.

David Walton 1:29:47
We know we talked about COVID. I think the last thing I'll wrap it up with is that so we are going to be presenting results along the way. So think of it as the cases come in. We analyze them so Yeah, the first 25 cases, we started to do some analysis, draw some, just just to characterize here's kind of what we're seeing. But you can't really draw too many conclusions from the first 25. But we'll be communicating this information out on a regular basis. So I think, by the end of the first week, in May, well, probably the first time we just talked about that. But we've got 60 cases, and now we'll have 102 weeks. And then there's going to be a lot more and it'll be growing. And we're working with the researchers, these clinicians, you know, Todd Alonzo, at the Barbara Davis center in Colorado. So it's a, you know, a big, one of the biggest in the in the country in terms of taking care of people with type one. And Mary Pat Gallagher at NYU, that they're kind of leading the research along with this Dr. asagi, the cozy and who's at t Wendy exchange. And he has a wife with type one. He's got a lot of great experience working in the type two diabetes and HIV arenas before he came to us as a consultant, and then as a full time doctor, clinical researcher, so those results will be coming forth. We are talking about additional studies, there's a lot of interest. And I talked about the hospital, we may do something looking at just hospitalizations because of some data that this other company has. They want to work with us potentially. But there are other aspects of the what we've done. So that's our big focus now with COVID. But in general, this collaborative we have, we're focused on improving care. And we work collaboratively with leading diabetes centers. And we're growing that and so we'll be at over 20 centers that do this regularly with us picking out topics like how do you drive CGM uptake? How do you screen for depression more consistently, right? Because these things impact care. And the are collaborative, we help do the data analysis and share it with them and work with them hand in hand on how can we get us all to a better spot. And we're all collectively focused on let's get people in better outcomes with Type One Diabetes. That's our that's our mission. That's that's their, their mission. They just happen to be providers of care at diabetes centers, and we happen to be a not for profit in Boston that works with them and does a lot of data and research as part of it. So I love working at that T Wendy exchange. And, you know, I think we have gotten more focused on near term impact and near term, how can we help other organizations and whether that's a healthcare system or another, not for profit, improve the situation for people living with type one. And, you know, I think we're we've had some, some good progresses here, and more people are interested in joining this collaborative, more centers, and we want to get that bigger, so the knowledge is shared amongst all of them. We don't have situations where like I was describing, I'm on the wrong insulin dosing ratios for 10 years. And that was such a simple fix to take off, you know, at least half a percent, if maybe pi more like point 7% off my agency, right? That those kind of things should be done more routinely. And again, we work with some great centers that do a lot of great things consistently. But part of their interest in the collaborative is they're learning from the others. And so they may have a lot of people using CGM, but they may not be screening people for depression and realizing Wow, so that's how you guys are doing it with your, with your medical record system, and how you're getting counselors and social workers connected with patients so that they can deal with these tough problems and challenges like oh, okay, and so it's a it's witnessing it is it's awesome.

Scott Benner 1:33:40
How do you take once you learn something from, you know, you gather the data, and you you sit down and you make sense of it? And you find a, you know, something that that's fallen through the cracks? How do you? How do you put it into practice? Because that's, that's, that's really, you know, great question. Yeah.

David Walton 1:33:59
And I'll tell you what, so this is I won't go deep into quality improvement methodology, because that'll cause some snoozing potentially with some listeners. But there are things called change packages that we helped create working with the Diabetes Center. So it's kind of like an implementation plan. And here's how you do this now. So like we know with CGM usage, look, there are things you can do to make it easier to start someone on CGM. There are also things you can do to make sure that the reimbursement exists. So in Texas, the Texas Children's Center that we work with, they've done a lot of great things to drive up CGM use, but Medicaid wasn't paying for reimbursing CGM for people with type one, right. And they've actually I think, been pretty successful in working with Medicaid to get one off approvals and maybe get a system wide kind of change for that reimbursement well by sharing some information and approaches used by others, centers and other states that helped their cause. But they took a kind of a leadership thing, like they recognize the importance of it, and we help support them with data. You know, we have a portal that we provide that they can do some reporting themselves and look at things. But we also do analysis and provide them with with things so. But the idea is, there are these change packages that we help roll out that's like the implementation plan to do it. And then there's measurement. And every month, you can see how things are going. So are you seeing the CGM usage going up, just like we they look at a one C, we have several years worth of a one c values for all type one patients at these centers, they can see what's happening there, they can see what's happening in their high risk group of people without a one C of nine or above. And so by tracking it, and really, it, you can't manage what you don't measure. And unfortunately, we've lived through that as a country with with COVID. Diabetes is the perfect example of that, when you do a good job of measuring it, it really helps to manage it. And that's something that we're kind of, we help drive that change with these centers working kind of hand in hand, and we're lucky to have a great starting set of centers, and we're looking to add a lot more so we can have a bigger impact. So you know, 1.6 million people, you know, we've only got about 25,000 patients so far in our, in our system, the data from from those EMR, those centers, we're hoping to, you know, drive that number up over the next couple of years. So we have a much bigger sample to work with. And it's, and we're touching more people at those centers. And then other people can learn from that we'll put publications out, a lot of the researchers that work with us at the Centers are putting abstracts out at the ADA conference, European conferences, trying to even share it learn from people, you know, in Europe and elsewhere. So there's so much that can be done on that knowledge sharing and getting it into the hands of gay I'm working with organizations like ADA, and at CES, the new diabetes educator name. And then patient organizations to like, we'd like to get the word out there. And so we've had good work with jdrf and beyond type one and TCL ID and children with diabetes. You know, a lot of great organizations there. We're all trying to figure out how to help each other kind of just complement each other not overlap too much. And that's a big part of what we're

Scott Benner 1:37:25
doing. Well, I'm really pleased that you came here to share it with me so I appreciate it. Thank you for coming on. I know I kept you long. You know to find out more about T one D exchange you can go to T one d exchange.org. Huge thanks to David for coming on and sharing I'm pretty confident he's going to be back at some point I really enjoyed speaking with him. I want to thank also the Contour Next One blood glucose meter. Of course more information about that can be found at Contour Next one.com there's links in the show notes touched by type one is that touched by type one.org please go check them out. dexcom.com forward slash juice box for more information and how to get started with the Dexcom g six continuous glucose monitor. And of course, a absolutely free no obligation demo of the Omni pod tubeless insulin pump can be sent directly to your door by going to my Omni pod.com forward slash juice box. Have a great day.