Scott Benner 6/11/20 Scott Benner 6/11/20

#344 Defining Diabetes: Feeding Insulin

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Feeding Insulin. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.

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

Scott Benner 0:00
This episode of defining diabetes is brought to you by Dexcom Omni pod. The Contour Next One blood glucose meter and touched by type one. Please visit touched by type one.org dexcom.com forward slash juicebox. My omnipod.com forward slash juice box or Contour Next one.com. To find out more about the sponsors. In this episode of defining diabetes, Jenny Smith and I will be defining feeding insulin. Now, you know Jenny, she's in all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring system. Jenny services are for hire, check her out at integrated diabetes.com.

We're gonna get started in just a moment. But before we do, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical more. Otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.

There are people and I am not bothered by it. I'm just telling you there are people who come into the podcast as new listeners who if they hit the right episodes, once they get through an episode where you're not on it. They're like, Where's the woman go? No, no, I'm like, No, I understand. And like she's on these and these knees. And they're like, Okay, I get it. Like I got a note one time, please. Like, I don't understand where did Jenny go?

Jennifer Smith, CDE 2:01
Still here, I was like, Jenny,

Scott Benner 2:02
Jenny records podcasts like, like, she's tanning. Like, she's canning vegetables, he just makes a bunch of them, and then brings them out when she needs them.

Jennifer Smith, CDE 2:11
I feel like people think that I like live in your closet.

Scott Benner 2:15
Let me get Jenny Hold on a second.

Jennifer Smith, CDE 2:18
There she is right over here.

Scott Benner 2:19
There you go. Ask me your question.

I use this phrase. And in my mind, it paints a tapestry of idea. And I hear back from people and they'll say like, I don't understand what you mean. So. So I use this a lot. I say feeding insulin. So you know, I'm like, oh, you're feeding the insulin. And that apparently doesn't make sense to some people. So when I use that phrase with you, what does it make you think of?

Jennifer Smith, CDE 2:56
Yeah, feeding insulin means that you're having to actually, I guess on a negative side of feeding insulin, it means that you're putting in food to compensate for there being an excessive insulin that shouldn't be there. Right. So whenever you're feeding insulin, especially, and that's something it's a term I use when I'm talking to people about weight management. Because if you're constantly adding extra food, because insulin is driving your blood sugar down, then there's a problem. there's a there's a balance that's off, you're getting too much insulin from somewhere, whether it's bazel, or too much bolus or whatever, and you're constantly having to put food in to avoid drops. I'm now on the positive of feeding insulin. I mean, that's what we do. We we feed insulin with the carbs that we put in, but hopefully there's a balance there when we're feeding insulin that way. So and if you find yourself feeding insulin too much, you can you'll have weight issues. Yeah, that wrap around that too. And we talked about that a lot. The idea that because you have type one diabetes, and you're using manmade insulin, food seems like medicine. And so you stop thinking about it as calories where you know, sometimes, I mean, don't get me wrong, you know, in the moment, when you're falling, don't don't hold up Skittles and go, No, you know,

Scott Benner 4:12
a moment on the lips, a lifetime on the hips, don't think that think oh, I want to stay alive and eat the Skittles. But right, the idea is to not have to feed that insulin. So if you want to get a look into my mind for a second, there's gonna be an old reference, I guess. But if Pac Man is insulin, and the dots are glucose, you don't want Pac Man to have energy when the dots are gone, because he's gonna turn on you and bite your face. Right? Exactly. And he needs to have more dots until until he's done. And so, but there's ways to reverse engineer that idea as well. And I don't think that people would think about it this way. But I think I just created that situation with Arden just now. So by way of an example, she gets up in the morning, she still goes Going into school at home. And it's the end of the school year, she has to return her books to school. So she she leaves the house, Kelly takes her. And I don't know if she was excited or not, I don't know. But her blood sugar was sitting around 110. I was recording a podcast earlier today. And I told her, I'll make you breakfast when I'm done. So she left the house and the 110 went diagonal up and it went 115 120. You know, it kept going her auto bolus started bolusing at it from the loop and it leveled off at 140. Then she gets home and she's hungry. And so we bolused for the 40 points plus her meal. And we're going to create a fall that happens. And we're going to in essence, feed the insulin to stop the fall at a level number. And so there's, that's there's a positive way to think about it. I think when I use the term in public, or in my mind, I don't think of what I just did is feeding the instant I think of it as Pre-Bolus saying and timing the food instead of timing the insulin. Does that make sense? Okay, yeah,

Jennifer Smith, CDE 6:11
absolutely.

Scott Benner 6:13
Absolutely. But when I generally save, you know, you're feeding the insulin, my intent of that is to say, hey, it's possible, your bazel is too high. Because I you see, you find yourself feeding your insulin I when when people show me a graph, and it bounces. My first question is always, are you stopping highs with insulin on this graph a lot or stopping lows with food a lot? Right? And that moves me towards too much bazel or not enough? bazel? It's my first question. So anyway, when I say feeding insulin, or when you hear somebody saying that, I think that is a complete explanation of what I mean by that. Do you

Jennifer Smith, CDE 6:50
know, absolutely. And I think you know, when you talk about it in terms to have, like that weight management piece of it, I was just, I just worked with somebody who she said, You know, I feel like I'm eating more normally now. And I don't feel like I'm eating as much. And I'm actually feeling more. She called it real appetite. And I said, That's right, when we adjust your, your baseline levels of insulin the right way, technically, and she's not using loop. She's just normal conventional pumping, right? So um, you know, when she gets hungry for a meal now, she knows that she's really hungry. That it's not because her insulin is telling her, Hey, there's too much of me here, like your Pac Man example. Yeah, I need more food. Please put more in. So now she has more real understanding of what appetite feels like, rather than just insulin appetite.

Scott Benner 7:50
So I realize I'm just asking you, and it's your personal experience. But is hunger? Because you're low? Does it feel different than hunger? Because you're hungry? Where is it the same feeling?

Jennifer Smith, CDE 8:02
To me, there is a definite difference, like from my personal experience, and I think everybody might be different, but I can tell the difference. When I have hunger from being low. It's more, it's much more ravenous. It's, I need food now. And it's definitely like, I don't want to sit down and eat a nice salmon fillet and a salad hunger. It's, I would like to eat the whole entire, like container of glucose tablets, which we know it doesn't taste very nice. Yeah, right. So it's, I would say it's definitely more of you need something now. Whereas if I've, like skipped a meal, because I've been out in the yard gardening through like lunch hour or something. I can tell by the time I get to like the mid afternoon, even if my blood sugar has stayed normal, you know, hopefully has stayed normal through that time. I am. I'm hungry, right? Like I can tell the pit of the stomach kind of hunger difference from a low blood sugar. It's an it's a more now craving.

Scott Benner 9:06
I figured that out first. It was a time of day thing when Ottomans say she was hungry at like 930 at night. I'm like, she's not hungry. What is that? And then inevitably, in the next 20 minutes, her blood sugar would start to fall and I was like, Oh wow, she's feeling the drop before it's happening. And it registers this hunger for anyway, I think it's funny. It's the two small words but I think feeding insulin It teaches you a lot about how to use it you it is not your goal to be doing that. And and if you find yourself doing it too frequently, it is very possible that either your basal insulin is too strong or you're over bolusing it meals and creating Lowe's later you should not I know that seems obvious, but I don't think it is that people once they get caught in the in that little Have, I'm always low and I'm feeding, they get to that feeling of like, this is just what my diabetes is. But it doesn't have to be that way.

Jennifer Smith, CDE 10:06
Right? Especially with today's very smart, smart technology that we have to use, you know, years ago, when I was diagnosed, you did actually feed the insulin, because that's how the insulin works. And you know, your, your intermediate cloudy insulin, it peaked at a certain time. So you had to eat a meal and a snack at a certain time in order to coincide with when it's action kind of was there. Today's insulin, even though it's not as rapid as we want it to be.

Scott Benner 10:34
That's not as necessary.

Jennifer Smith, CDE 10:35
It's not as necessary. Yeah. So

Scott Benner 10:38
I, I hear that. Okay, thank you. Hey, here's some quick contact information for the sponsors. If you're interested, to get the dexcom g six continuous glucose monitor, you're gonna want to go to dexcom.com forward slash juice box, and hit the button that says get started with Dexcom JSX. It's just that simple. If you get there and you want to read a little bit, definitely check into it. Zero finger sticks, customizable alarms, and alerts, smart device compatibility with Android and iPhone, the ability to share data, or data, this depends on where you live in the country or the world. Although right now, some people are like it's data, or data, you're fighting with each other, but you're just fighting with the voice in your head. So don't do that. You can any anyway, no matter how you say you can share that data with up to 10. People, it's amazing, right? Your kid could be at school being tracked by their mother, father, grandmother, school nurse, or just a friendly guy, you met up the street, you're like, Hey, you want to watch my kids blood sugar. I mean, if you're, you know, if you're a hippie, you might do that, although do hippies have cell phones, I don't know, it's not for me to judge. Anyway, dexcom.com forward slash juice box, you're also going to want an omni pod tubeless insulin pump, that you're going to get my Omni pod.com forward slash juice box. And on the pod has quite a little deal where they'll send you a free, no obligation demo of the AMI pod to your home so that you can wear it and check it out. I've worn it on the pod demo before. It's astonishing how quickly you forget you're wearing something. And you'll really get a feeling for what it's gonna be like to have a tubeless insulin pump, right, just this little device that's with you, and nothing else to clip to your belt or stuff in your bra or do anything like that with and there's no obligation. So I mean, if it doesn't cost anything, and they're not holding you to it, you might as well give it a try my omnipod.com forward slash juice box. And of course, if you go to Contour Next one.com there's a button at the top of the page to see if you're eligible for an absolutely free blood glucose meter. And I have to tell you a little more context now because at the moment, I'm wearing a Dexcom Pro to get the feeling for it. You'll hear me talk about that later. But because I'm doing that I'm testing a lot. So not just with Arden, but I'm testing myself to get a feeling for you know where the CGM sitting with accuracy. And all that stuff that I've been telling you has been my experience about using the meter with my daughter goes double for me. Small, convenient, accurate. pocket size. It's great, the light works great at night. And trust me My eyes are you know what I mean? And I what they used to be Contour Next one.com and of course, touched by type one, please, please please go to touched by type one.org to check out the good work that these amazing people are doing. For children living with type one diabetes, and people with type one diabetes in general. They raise money to support a cure. They put on all these kinds of great programs to support the community. You can be part of it touched by type one.org. We're just gonna tell you one more thing before I go short episode today. So today we defined feeding insulin. But there are many other defining diabetes episodes. It starts way back in Episode 236. And some of you are going to say Look, I know what Bolus says Scott, I don't need that episode. But you'd be surprised about how many new people with type one diabetes don't. So Episode 236 is Bolus 241 honeymooning 245 time and range 247 standard deviation 249 extended Bolus 251 algorithm 253 non compliant 255 glycemic index and glycemic load 258 Pre-Bolus 260 Trust will happen to 69 low before high to 84 brittle diabetes 286 stop the arrows 288 ketones, 295 insulin resistance and overall singing Of course today Episode 344 Feeding insulin. And there are many more on the way that was all very confusing to you, you can go to Juicebox podcast.com and scroll down. All of the episodes are there. Actually the Ask Scott and Jenny episodes are there as well. And the diabetes pro tips and of course, all this is condensed way down at diabetes pro tip comm if you want to check out the pro tips, we're share them with somebody. That's diabetes pro tip.com.

The point is at the end of tip, see what i'm saying diabetes pro tip, there's no s. No s at the end of tip. It's just tip, and then the dot and then the calm. That's my tip for you today about how to spell diabetes. Perfect. Thank you very much to Jenny Smith for coming on the show as she always does to help us understand terms and ideas. bigger, more vexing Type One Diabetes issues. She really is the best Asus there is an S at the end of best assist, but not at the end of diabetes pro tip calm. I mean the English language is funny punctuation right

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Scott Benner 6/8/20 Scott Benner 6/8/20

#343 Standard Deviation and her Friends

Type 1 diabetes data geek alert!

Dexcom's John Welsh M.D. does a deep dive on Standard Deviation, Coefficient of Variation, A1c, Time in Range and more.

Check out the Diabetes Pro Tip episodes and Juicebox Docs

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello, everybody, welcome to Episode 343 of the Juicebox Podcast. This episode of the show is sponsored by Omni pod, you can get a free, no obligation demo of the Omni pod tubeless insulin pump sent directly to you, by going to my Omni pod.com, forward slash juicebox. Imagine this for a second, you're at your home, the mail comes. And in that mail is the insulin pump that you've been dreaming of the tubeless insulin pump that you've been dreaming of no wires, no tubing, just this little Omni pod. And you're going to try it on and wear it for a couple of days to see how you like it. Once you've done that, you can reach back out to on the pod and say, This is amazing. I want to keep going or you don't want to keep going with on the pod, no harm no foul, no one's gonna bother you. No Obligation, no cost to you to try that demo pod. So why don't you give it a shot, right? There's absolutely no reason not to. The show is also sponsored today, by the Contour Next One blood glucose meter. The Contour Next One meter is absolutely without a doubt, the best glucose meter My daughter has ever used. Next month, Arden will have had diabetes for 14 years. And the Contour Next One is without a doubt, the most accurate, easy to use genuinely lovely little blood sugar meter that Arden has ever had. I love the second chance test trips, which you know happen all the time you think you're gonna get enough blood with that first drop, and you don't have to go back and get more, you can do that with the Contour. Next One without placing a test trip, you know what I'm talking about, you think you've got enough blood and you don't, it's weird that it happens when this meter needs such a little bit to begin with. But you know, just once in a while you're like you see a little red, like I've got it, you put the lance down, you give a little squeeze and then nothing comes out. You're just like, ah, and it won't, it won't. But you think this is enough and you touch it and it's not enough to go right into squeeze again and look at you finally get some more that whole thing. Don't waste a test trip with a Contour. Next One. When that happens, we all know what happens. It's great not to have to waste a test trip on it does Contour Next one.com get there. Because the top of the page, there's a link to hit. And you may be eligible for an absolutely free meter. If you're not, and you still want to upgrade your meter game, ask your doctor, they'll throw you a little prescription. And you'll be on your way with a Contour. Next One. And we're also sponsored by touched by type one, checkout touch by type one.org to see what this amazing organization is doing for people living with Type One Diabetes, it'll only take you a few minutes. But once you get there, you might stay a little longer when checking out their programs, some of the things they've done in the past, look at the kids that they're helping and the ways that they're trying to support a search for a cure. This really might be up your alley, touched by type one.org. And of course, dex cop, makers of the G six continuous glucose monitor. The data that comes back from the Dexcom g six is at the core of how we help our daughter with Type One Diabetes. Honestly, it's how a lot of people listening to this podcast are getting their data. That data that is so important for making decisions about Temp Basal increases and decreases extended bonuses for foods like pizza or Chinese food helping you to cut off low blood sugars before they happen is your blood sugar always high and you think it's your basal insulin but you can't tell Dexcom will show you if that's true. Always too much basal insulin, you always finding a low again, you'll be able to see that on your Dexcom you're going to be able to see everything and it is life changing. Being able to share your blood sugars with loved ones anywhere in the world with iPhone and Android. Just imagine that your sister in Where do I want to pretend your sister lives today? Hold on when I say less than Ooh, your sister in Kissimmee, Florida, right? She's got the diabetes, but she's living alone. She wants somebody to have her back a little bit. That could be you. You're all the way up in Anchorage, Alaska. You know, Alaska sled dogs. A lot of cold a lot of dark Anyway, you live there. Your sister's in Kissimmee, for blood sugar starts heading down. She doesn't notice. You get a little BP beep on your phone. You give her your sister frankly, like Hey, what's her name gonna be? Kathy? Hey, Kathy, the blood sugar's getting low. And she's like, Oh my god, it's you. I love you. Like, yeah, we're sisters. And then her blood sugar never gets slow. She didn't notice but you did. Imagine that if your child at school or your sister in Kissimmee. That's amazing. That's dexcom share and follow Dexcom is going to give you the speed and direction that your blood sugar's moving in, in real time. Constant hear that word continuous glucose monitors because you're getting that data continuously. It's a game changer. Please trust me. Find out more@dexcom.com Word slash juice box. Actually, you can find out about all the sponsors and the links, you need to find them right there in the show notes of your podcast player. And if you can't, for some reason you're using some, like 900 year old android phone or something like that, and you can't click on them. They're right there at Juicebox podcast.com. I'm not leaving you hanging. I'll get you there. All right, let's talk about john wells for a second.

JOHN has type one diabetes. He's a physician. He works at Dexcom. And he's on the show today, because I reached out to Dexcom and said, I want to drill down deep, I want to understand granularly the way smart people understand what is standard deviation? And I know that might be like you'd like, Oh, my God, that's what this episode is about. But no, no, listen to me. Well, we're gonna talk about today, standard deviation, are really going to understand what it is and how they come to those numbers. We're also going to talk about coefficient of variation. Now, there's a lot of words you don't know. But by the end of this, you're going to understand, and you're going to understand why it's so important for you living with Type One Diabetes. After we get all this information into our heads, I started talking to john a little bit about how does he manage what does he call success at the end of the day, and it wasn't as much about the numbers, as you might think. But he really helped me to understand what these words that you know, maybe don't make sense to us right away, just lay people what they mean, and how they're helping. You know, it used to be all about a one C, right? You just tell me to tell people like keep your eye on see here, this is what you have to do. But then all of a sudden, you start hearing people talk about standard deviation and variability. And this is going to help you to understand that even more. I had such a good time talking to john, that it got away from me, I was supposed to talk to him for an hour and like an hour and 20 minutes into it. I was like, Oh, my God, I gotta let you go. He was like four minutes away from having to go to another meeting. And I was just like, I'm sorry, go, go go. I found this incredibly interesting. I hope you do, too. Because I really believe that the concepts that john and i spoke about today are at the core, the basis the bedrock of how you should be considering your health with Type One Diabetes, if you're looking for data to tell you how you're doing, these three things are a huge piece, you'll see. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin. I wanted to call this episode, sugar Adam. But anyway, you'll find out why. Here's my finding. And I've been at this for quite some time, being around the diabetes space, I guess. And when the powers that be whoever they be, decide that we should all be aiming for a lower a one See, there's a way to disseminate that information they pull together, you know, industry people and they and they give them the talks like here's why a one c should be here and not here. And here's what we've learned. And you know, you get that talk. And then those people find different stakeholders and influencers and they spread the word. And before you know it when it's distilled out to the public, the message is simply, you know, the a DA decided that your agency should be this now. And that's what you're now going to hear your doctors, your doctors talking about. Like it's, you know, like it's a rule handed down from my pie, though, suddenly, they have a different opinion. And if you don't pay attention, you don't realize that that's just how we get information out to people, right? There's no good way you can't call everybody in the world and say, Hey, by the way, your agency should be a little lower. Now, you do this. But often while we're spreading that information, it lacks real context. And when this happened recently, I'm going to guess in the last two years, when all of a sudden, you started hearing your endocrinologist tell you listen, it's really much more about variability, your standard deviation, and they started talking like that. There was no context with it again. And then suddenly, everyone's just, you know, it, they're walking around, like they've learned something they say, you know, a one sees not as important as standard deviation, and then all of a sudden, the message becomes a one sees not important, and then it gets it gets you don't mean like it gets ruined as people oversimplify things. And so I really want to leave this talk just backwards and forwards understanding standard deviation. And when I reached out to Dexcom, I said I need someone who can really do that and no pressure, but they said it was you so

John Welsh M.D. 9:45
I guess you know, if you looked around Dexcom you would say all right, we need somebody who can tell stories, so you can talk in a straight line more or less. And my just by way of introduction, I my job title is medical and scientific writer. So I love a good story. And I love especially those stories that have to do with numbers and stories that try to convince people that the truth is actually true. And and numbers can really buttress a story, you say, hey, look, look what happens if you don't save for retirement. here's, here's one way you could go if you spend your money in Las Vegas on that gambling table versus spending your money in an IRA or whatever. So the the idea that you can make convincing arguments with numerical data has always been attractive to me. And, and that's why I did some residency training, I went to went to medical school, went to graduate school. And after medical school, I did residency training in Laboratory Medicine. And Laboratory Medicine is all about measuring things, and saying, Oh, you've got an abnormal value on one of your lab results. And here's why it matters. And here's what you should do to mitigate the risk of, for example, having a really high potassium level. So if you have good data, then you can make persuasive arguments and you can change people's behavior, hopefully, keep them out of trouble. And the case of a higher low potassium, you could save their life, if you get the the doctors to intervene. In the case of some really abnormal lab value that might come up in the hospital context. The bigger question about about glucose values and standard deviation, we can get to that. But you made the broader point about public health recommendations. And man, we are just right in the middle of public health recommendations with with the pandemic because there's there's a lot of uncertainty, which is gosh, you know, how can I go to the concert? Can I go to the restaurant, can I go outside without wearing a mask, and that the recommendations that we've been getting from public health authorities have been a little bit discombobulated maybe internally inconsistent, and kind of frustrating at times. But I am with you, though, the idea that we can provide good evidence based recommendations with respect to goals in managing diabetes is, is a big interest of mine. I'm all about all about the numbers.

Scott Benner 12:15
Well, many, many years ago, I came to the conclusion for my daughter that if I get what I expect is what I started thinking of it as I realized I had Arden's Highline set at 200. And I always kept for under 200. So one day, I moved into 180. And I was like, Oh, I always keep her under 180. This is really interesting. So I kept pushing it down and pushing it down. And now my daughter's, you know, ranges 65 to 120. And mostly, we keep it in there. And when we don't, it doesn't go that far out. Right? It'll go to 150. That's usually, you know, like just now, I'll use this morning as an example two slices of toast, an avocado, butter, and an orange. And her blood sugar went to 148. And it's coming back now. And it's not over a longer. Yes. Beautiful. Right. And so, but her standard deviation will look bigger than someone else's. And I don't know if I'm making up things in my head, or, like, how is it possible that Arden can have a life like that, but her standard deviation could be higher than someone who's a one sees a point or two bigger than hers, and who have swings that are far higher and last longer. And so that that's the one idea that keeps me focused on I don't understand standard deviation or not. And then when I start talking about it with the people that I that listen to the show, I come to realize that everyone's sort of got that, that confusion. So can we start very over simply. and standard deviation as an idea is a mathematical issue. Is that right?

John Welsh M.D. 13:56
Oh, it is it's it's a number that is used to describe a set of numbers. So for the case of folks who were using CGM, you might expect up to 298 numbers every day. And each number represents a glucose concentration. And you can use words to describe that set of numbers or you can use numbers to describe that set of numbers. The the average is a pretty simple number that it's easy to calculate, you would add up those 288 values and then divide by 288. And then you get the mean. In this case, it's the arithmetic mean. There's other flavors, there's the geometric and the harmonic mean. But we'll we'll leave those aside for now. But the arithmetic mean, tells you it's a measure of central tendency, where you might expect the average if there is such a thing, an average value to fall. The standard deviation is is another number that's used to describe that set of numbers and it describes the width of that Distribution so that it gives you an idea of how surprised should you be when a number shows up, which is pretty far away from the main. So here's I've got a, got a wonderful document came out a couple years ago that looked at glucose concentrations in people without diabetes. And they, they came out with normal values. And the normal value here for glucose was pretty close to where is it 99. And the express this number 99 is the average and then they give you a plus and minus seven. That plus and minus seven refers to the standard deviation. And the standard deviation. If you imagine a bell curve that you might have seen in school, where the most popular value is right there in the middle is the mean value, in this case, 99. The plus or minus seven, tells you how steep is the drop off on either side of that means value. So in this case, the 99 plus or minus seven, if you were to go up to 106. In other words to the mean plus one standard deviation, you would expect to have about I'm sorry, let's go back and say 99 plus or minus 799, minus seven is 9299, plus seven is 106. So anywhere from 92 to 106, the expectation is that you would have two thirds of the values in that pretty narrow range. So if your goal is to have if your goal is to have quite a lot of stability, which in general is a good thing. You want that standard deviation to be low, and normal people without diabetes, it is in fact quite low. 99 plus or minus seven is a very tight distribution. Two thirds of the values fall between 92 and 106. Okay, so there's there's a calculation, we could walk through it if you want, please.

Scott Benner 16:57
Yeah, I was just gonna tell you that when we're done. And I can say this, because this won't go out until after I'm allowed to, but I'm wearing a Dexcom Pro. I have been for a couple of days. Ah, it's so I can see, I'll be able to look while you're talking and figure out what mine is.

John Welsh M.D. 17:15
Oh, good. So are you able to see the real time data or not yet?

Scott Benner 17:19
No, I see it. It's not blinded. I'm looking at it on my phone.

John Welsh M.D. 17:23
Oh, okay. Well, I hope you're, I hope you're within seven points as of 99. I hope you're well in the normal range.

Scott Benner 17:29
I certainly hope so too. But I am I I was really, I have to be honest. As I put it on, I thought I'm doing this so that I can see how a working pancreas attacks things brings them back what curves look like, I wanted to see all that because I thought it would make it easier for me to speak to people about about using insulin. But at the last second as I was about to do it, I thought am I about to find out I have like type two diabetes or pre diabetic or something like that. I was like maybe you know, and I just kind of was like, Alright, well, that's if that's the case, it's the case I'm gonna find out. But I think and so far, so

John Welsh M.D. 18:09
luckily, well, I hope so. And when we do onboarding, we have people come work for Dexcom. And part of the onboarding process is, hey, look at, look at our product and look at what it does. And of course, it's voluntary, but we we say, all right, if you'd like to wear one of these, just to know what the experience is, like, we can get you set up with one of these and our expectation is always your glucose failures are going to be are going to be let me check boring. And you're going to have a really smooth ride throughout the day. You know, 99 plus or minus seven. But once once in a while we have we have people that come back and they say you know john, I learned something really interesting. And I thought What's that? If I have if I have an entire pizza, I can get my sugar up to 180 and I say wow, that's that's abnormal. And so people learn something even if they don't have a known diabetes they can learn something about diet and exercise that you know I went for long bike ride yesterday and I crashed I went pretty low. And then I had the the Coca Cola or the the sugary drink. And then I saw my sugar zoom back up so you can learn a lot. And that's a general truism that you can learn a lot just by looking. But Scott, I'm pleased that you're wearing one of the CGM sensors and I hope you learned something I really am. I'll

Scott Benner 19:34
tell you already, I had two pieces, smaller pieces of homemade pizza on Sunday. And three and a half hours later, I got a push up from the protein and the fat probably holding the the crust of the pizza in my in my system longer. That was fascinating. And this morning, I had a breakfast that was just a piece of Turkey and toast. People are like oh my god so boring. But uh, but I I smoked a turkey. Yes, it was so good job. I want to have some sort of breakfast. So I took some turkey and I had a piece of toast this morning. And when I was done, I grabbed a navel orange. And when I ate the orange, it tried really hard to push my blood sugar up, you know, not immediately, but it was it was drastic, and my body attacked the drastic rise so much so that I was 74 straight down for a second before I leveled right back out at 80. It was amazing. I went from 74 straight down to 80 and stable in a fight in all my in one five sec. Five Minute thing. So I saw my body go, Oh, that's a lot of sugar from that orange. And, you know, he's already put this bread in here, I guess, you know, I don't obviously don't know exactly how my body's thinking but, but the idea was, I was and I was starting to push up a little from the bread, not greatly. But then I think when I added the the simple sugar, I just I got a really quick response. So I'm noticing that that every time I press was simple sugar, my body comes back more aggressively than it does with more complex carbs.

John Welsh M.D. 20:58
You know, Boy, that's interesting. And, and other people have described it to me where they'll, they might have some indiscretion, they'll say I'm going to have a 24 ounce Mountain Dew, and you slam the sugary beverage and you get this wonderful increase in sugar, which you can feel in life is wonderful. And then what you described with the orange happens, happens in a very dramatic way where they're, the insulin kicks in and then the sugar plummets. And then all of a sudden, you have the big crash after the sugar high comes the crash. And that I think that's a manifestation of instability. And same thing you know, I'm going to make a quick little analogy to the cruise control on your on your car. What I hope for when I engage the cruise control on my car is just a smooth ride. And and I don't want the car to be slamming on the throttle and slamming on the brake all the time. I just want to be going at 65 all the way home. So I I'm very sympathetic to your experience with with high amplitude glycemic swings. It's it's a common thing, especially in the world of Type One Diabetes where we're all taking insulin. Yeah, it's so

Scott Benner 22:12
it's very interesting. I'll tell you and I'll let you get back to it. But then the other thing that happened that I really didn't expect, but makes total sense. Is it for about the first 36 hours I wore it. Every time I looked and saw my blood sugar stable, I had a horrible feeling of guilt. It was it was really interesting, because my daughter's had type one since she was two, she's 15. Now I have interactions with 10s of thousands of people who have diabetes. And they all would just I don't they would do anything to have that, you know, and it really it really impacted me for in the beginning. I just was I felt very guilty for my pancreas working. It was a weird feeling. So but I'm sorry, I shouldn't derail you because we're talking about something that's, you know, you don't think is complicated, but trust me I do. So I shouldn't I shouldn't distract myself. But we were talking again about about people, you know, who have a functioning pancreas. And you said, you know, let's pick 99 is that is that that kind of center target. And you can go to 92 or up to 106? And then explain again, what I'm sorry, where were you headed with that?

John Welsh M.D. 23:18
Oh, sure. The value I'm looking at a big article that came out a couple years ago, they looked at 153 people without without diabetes. And they put glucose monitors on them. And they they collected a bunch of data. And so the question, I guess the first question is, why would you care? Why would anybody bother? The answer is well, we want to know what normal looks like. So we can decide if a particular glucose profile is reassuringly normal, or if there's something going sideways on it. The 99 value from earlier is the main, the standard deviation I gave you earlier is seven. And that tells you something about how wide the distribution is. So one standard deviation on either side of 99 would go from 92 on the low side up to 106. on the high side, that mean plus or minus one standard deviation is the expectation is that two thirds of the values would fall in that relatively narrow range. two standard deviations 99 plus 14 is 100, and 1400 and 13 on the high side, and then 99 minus 14, I guess is 85. As that right on the low side, so 85 to 113. The expectation is that you would cover an even higher percentage, I think 96% of the values would would fall in that range. And if you go out even further to plus or minus three standard deviations, the expectation is that almost all the values not more than 99% of the values would fall within three standard deviations of that central values that mean so that's that's it in a nutshell, the calculation. It's not difficult, it's not trivial, but it's not difficult. I'm not sure if your audience would be interested in walking through it or just looking it up.

Scott Benner 25:14
Right now, john, this is very much meant to be for people who are interested in that. So I have a group of episodes, there's about 20 of them. They're called pro tips. And they are deep dives into specific things about type one. And this is, this is one. So don't think of this as an interview, as much as Think of it as we are really trying to pick this apart so that when someone listens through, like, I'll be honest with you. In sixth grade, my guidance counselor told me I could take algebra halfway through algebra, I didn't understand algebra at all. And I thought, Oh, my gosh, I'm terrible at math, I dropped out of it. A was a bad decision, because I followed a much simpler math track the rest of my time, which probably wasn't necessary. And just now, as you were talking, I, you know, you set up this scenario, and the standard deviation was plus or minus seven, and you started talking about out one, standard deviation two, and three, and it just started to make sense to me. So you're doing a good job? Yeah, trust me, if I understood what you just said, everyone listening has a chance to understand it as well.

John Welsh M.D. 26:15
Well, you're you're very kind. And that's I'm very pleased to think that we're making progress toward the goal, then

we can,

I can introduce the topic again, and say the standard deviation is just a number that's used to describe a set of other numbers. The standard deviation, there's a calculation for it, it's a little bit involved. But it involves, first of all, calculating the mean, for a population. The example that we used was the the mean value for people without diabetes, it's 99, you have quite a lot of values, you might have thousands or 10s of thousands of values. And this is where it gets a little bit tedious. For every one of those individual values in the set that you want to describe, you have to calculate the difference from the mean. And the difference from the mean is either going to be a negative number, or it's going to be a positive number, depending on whether the the individual value is higher or lower than the mean. you square that. So squaring a negative number gives you a positive number, squaring a positive number gives you a positive number. So you're going to get another set of numbers, which is the squared difference from the mean. And if you had 10,000 values in the set, you're going to have 10,000 squared differences from the mean, you have to add them all up, you get a sum of squared differences. And then you divide it by divided by the number of observations in the set minus one. So it's, it's a pretty complicated when you try to describe it verbally. But if you were looking at it on a sheet of paper, you would say, Oh, it's, it's a series of steps. add up all the squared differences from the mean, divided by a large number one less than the number of observations in your sample, and then take the square root. And then once you've taken the square root, bingo, there's your standard deviation. So it's, it's a few steps, but it's something that kids probably learned and then probably forget just as quickly as they learned it in, in middle school or high school algebra class.

Scott Benner 28:21
So how does clarity app like to simplify that all down? What is the clarity app looking at? When it tells me you know that the standard deviation is 35? Can you like, distill it? What is it looking at to make that decision without the without the detail?

John Welsh M.D. 28:39
Oh, absolutely. So the statistics page, for the clarity app gives you some summary statistics. And just a quick little operational note, I wonder if you're able to see my page that I'm trying to share with you on the zoom meeting? Yep. Oh, good. Okay. Um, so maybe you should ask your question again. So we could rejoin the, the post editing narrative.

Scott Benner 29:06
Oh, I just know, I was, um, what I'm worried but I'm interested in is, is there's a clarity app, obviously. And it tells me Oh, your standard deviation, or your daughter's standard deviation is 35. And or some people are like, Oh, I'm struggling, and you know, mine, mine 65. And I heard from a woman the other day that told me her doctor told her that anything under 100 was okay, which she very smartly was like, I don't think that sounds right. But I want to know, like, what does it look at? to tell me? My standard deviation is 34. Like, like, What is her taking into account?

John Welsh M.D. 29:42
Oh, sure. Well, that's, I think I can get that one answered pretty quickly. We've got our statistics page. And if your audience wants to look at the Dexcom, clarity, web interface, there's a page all devoted to statistics. looking right now at this Had my statistics for for Monday. And this is every Monday for the past 30 days. So there's several Mondays in that sample, I've got a total of 1253 readings. And each one of those is a estimated glucose value. And then the summary statistics, the minimum 40, that was scary, the maximum 244. So those are, those are not normal, the mean value 128. that's reassuring, and then the standard deviation 34. So to get that 34, the calculation that I just walked you through, which is look at every one of those 1200 and 53 values, get the difference from the mean. So do the subtraction 128 minus

a particular value,

you square each of those differences from the mean, add them all up, and then divide the total by 1252. And once you've done that, you take the square root of it, and it's it's 34. So there's, as I said, it's a little bit of algebra. But it's, again, the usefulness of it. Hundred and 28 plus or minus 34 tells you that you would expect two thirds of those glucose readings to be within one standard deviation of the mean. So 128 minus 34 is just 90 something and then 128 plus 34 is 162. So you would you would expect most of my sugars to be in that in that range.

Scott Benner 31:36
Take first second example. I know we're gonna oversimplify but describe what mean

John Welsh M.D. 31:45
is? Oh, sure. I mean, it's also known as the average value. So if you were to look at the NBA players, you say, Wow, NBA players are really tall, you might express that in numbers by saying the average or the mean, height of an NBA player is six feet, six inches tall. So it's another word for average, it's a particular kind of average. But we don't need to talk about the other kinds of averages. mean is usually just the arithmetic mean. You calculate it by adding up all the values, and then dividing that total by the number of values.

Scott Benner 32:26
So what I have here, what I'm looking at in front of me is 1200 and 53 readings. There were 40 that were or is that under a certain number, those 40

John Welsh M.D. 32:40
Oh, yeah, we're looking at these rows in the in the statistics, the number of readings, 1253 is a bottom of the minimum was 40. The maximum 244.

And the mean value 128.

Scott Benner 32:54
Within and within those 1200 and 53 readings. There, the high was 244. The low was 40. But on average this person's blood sugar was 128.

John Welsh M.D. 33:07
that's a that's a nice way to do it. And yeah, we're looking at, we're looking at my readings from the past month or so these

Scott Benner 33:12
are you oh my gosh, um, are you do you have type one?

John Welsh M.D. 33:16
I do. I've been living with type one for most of my life for past 45 years. And so far, so good.

Scott Benner 33:23
Show me like an example page. I didn't realize we were looking at your blood sugar. Well,

John Welsh M.D. 33:28
I yeah, you can spy on me. You can you can look at my summary statistics. Here we can we can continue with the summary statistics page.

Scott Benner 33:36
Yeah. And I'm gonna have some questions about it when you're done. But please keep keep going.

John Welsh M.D. 33:42
Oh, sure. And and this is incredibly number, it's a very useful way to get a numerical description of other numbers. And so far, so good. And you know, here's, here's the guy, john Walsh, who is this clown anyway, and what is he doing talking about his glucose numbers. So John's had a, at least one time where he went all the way down to 40. But the main value 128 is reassuring. And then we get down to some other statistics that talks about the median value, the median value is the value above, above which and below which half of the values occurred. So in my case, the median is 122. And that tells you that half of my readings were above 122, and half of my readings were below 122. So that's another measure of central tendency. The end it's usually expressed alongside the interquartile range. And so you look at the value that is 75% of the way to the top, so 75% of the values are below it. 25% or above it. And in my case, the The 75th percentile is 153. The 25th percentile is 103. So you can say with, with some confidence that half of my values were between 103 and 153. And those are the 25th and 75th percentiles, and the the interquartile range here has given us 50. And that's just the difference between 153 and 103.

Scott Benner 35:27
Nice, good question here. If If Yeah, if if half of those were range between 103 and 163, I'm assuming that the other half are how we arrive at the standard deviation of 34? Like, I'm assuming you need that information to to come back to the standard deviation.

John Welsh M.D. 35:44
Oh, no, no, the standard deviation, the standard deviation relies on all values. And it doesn't, it doesn't care so much about the distribution, it just cares about how far from the mean value the values are. So there's, there's there's another point that I want to make, which is the the median value, in my case, 122, the mean value is 128. A lot of times, those are very close together. But sometimes they're very far apart. And there's some special circumstances where the mean value is much, much different than the median value. And we can talk about those if you think it's interesting, I wonder,

Scott Benner 36:28
but what I do want to know is, is how much of a sensor like so you know, I've, my daughter has been wearing a dexcom, since seven, maybe Dexcom, seven, or seven plus back then. And so, obviously, we see things at every generation, improve and improve and improve. But I could still say that for Arden in the first number of hours, you know that you put on a new sensor, it's not as I don't know, it's not as tight with its understanding of your blood sugars and maybe is on you know, day two, or like, you know, where there's a sweet spot through the middle where it's crazy or uses a Contour Next One blood glucose meter, which is incredibly accurate. And for a large part of her sensor, where the meter and the CGM are spot on with each other, they're within a couple of points. And when you're managing type one, there's a ton of like, good feeling about that, knowing that, you know, she wakes up in the morning, and it says her blood sugar is 96. Now whether or not her blood sugar is really 85. Or it's really, you know, I don't know, 104 it to me is of no real consequence. It's, it's in that space. And I'm thrilled with that. Then I put it on, and I don't have diabetes, and I wake up and it says my blood sugar is 94. And I think Oh my God, I've been fasting all night. And I'm 94 and I do a finger stick. And I'm 85 it's amazing that those seven points to a person without diabetes is is it's a different impact than it is to a person. Right? And so it is seriously like I wake up in the morning, I'm 94 I'm like, Oh, I guess that's it, I just eat lettuce till I die. Like, you know, like, like, it's just it feels like that immediately. And but I take but that same information coming from my daughter, I am completely comforted by not just comforted by it. But it leads me and my understanding of how to manage your insulin and her health and everything. My question is, is that knowing that the sensor is a little, you know, on the on the edges, it struggles a tiny bit more than it does in the middle? Is there something about my data that I can't look at to micro? Like, do I have like, How much time do I really need before? The inconsistency is in the data and the consistencies in the data balance out to where it doesn't matter that it's not all perfect? Does that make sense?

John Welsh M.D. 38:48
Oh, that's Yeah, that is a very common question. And I don't have a I don't have a good answer. I can tell you how I deal with imprecise measurements in my own life. And, and I've got I had a wonderful bike ride yesterday, here in San Diego, and I've got a fancy bike that has a built in speedometer, it's based on how many how many times the will completes a revolution. So there's a speed sensor built into the into the wheel. And based on that you can calculate your speed. And I've got another fancy thing in my phone where you can get your speed based on satellite data from your global positioning satellite system. And and I looked at it I found myself chugging along the road and and the the the speeds you want to guess if they were exactly the same. No, they weren't. I was going 20 miles an hour. If you look at the wheel sensor, I was going 21 miles an hour. If you look at the GPS coordinates, so measuring your blood sugar and seeing one number and then looking at your CGM and seeing another number And it's frustrating because there's no good way to to know how excited or how concerned to be about discrepancies. There's always going to be discrepancies. It's a rare thing when when the blood sugar tells you you're 105 and then you get that hundred five from the CGM. And and I don't want to give medical advice over the phone like this. But there is the possibility that you could calibrate your your G six and based on the your confidence in a blood glucose meeting reading, you could say, Oh, my G six is reading a little bit low. I'm going to calibrate it, and then bring it back into better alignment with the with the blood glucose meter. So I know it's frustrating. I wish I had a better I wish we had better devices for for measuring glucose with even more precision.

Scott Benner 40:54
They're amazing. You've had diabetes fabric, you know how amazing this stuff is. Just because you work there doesn't mean you can't say that. And it's actually been very interesting for me because of the pro doesn't allow you to calibrate or delete it. I just had to go with it. And it really sure it was it was it was interesting to live in the space because for my first maybe 18 hours, the glucose monitor was reading about 10 to 12 points higher than what the finger stick was pretty consistent for those few hours. And I found myself thinking if this was my daughter, and I put a brand new CGM on her that thought she was 110 when she was 91, I'd be like, Oh my god, this is the most amazing thing ever. I love this thing. It's so amazing. Except, you know, when I didn't have diabetes, I was like, is my pancreas not working? You know, like very, like it's a it was just such a very different thing. But beyond that initial feeling. It really did just cement my idea of how much I love this technology. And, and because I can remember managing my daughter's blood sugar without a glucose monitor. And to think that she'd be stable at 110 or 91 ever for hours and hours at a time is insane. But it would just never happened. But over these last few days, we've been eating the same meals. And her care is so dialed in, due to a large due in large part to the information that comes back from the Dexcom that her blood sugar's and mine are largely matching before and after meals.

John Welsh M.D. 42:30
Congratulations. And that's that's just that's wonderful news. And you know, it's a and I'm totally with you we we can talk about the battle days when when you had to make a make a guess. And a lot of times it was not a very good guess based on just a urine dipstick. And you could say, Oh, well, I'm spilling sugar into my urine and I need more insulin, and you would have to make a guess. And some of the highs and lows were pretty scary. People you know, sad, sad to say that people are still dying from insulin overdoses, insulin, let me check, it's a poison, and it can kill you. And there's, there's a lot of downside risk to insulin, even though it's a huge blessing, we're coming up on the hundred year anniversary of the commercialization of insulin. So we're all going to celebrate and be thankful for the commercialization of insulin and the fact that we're not dead. But it's, it's a tough disease. And you wouldn't, you wouldn't wish it on anybody because it's really a lifetime burden. I'm really pleased. Thank you.

Scott Benner 43:39
I just had a conversation briefly online with a woman this morning who even with all the technology gets incredibly low every day. So I was turning her on to the podcast, I was like I This doesn't need to be you're just you're not using your insulin correctly. And it's not that it's not that difficult to figure out how you know, so I turned her off. Listen, I have an idea, or can I hit you with some questions and see if you have answers to them. These are questions that came from listeners. And

Unknown Speaker 44:03
sure, and I'm

Scott Benner 44:04
not asking you now I understand you're a doctor. But I'm not asking you that way. I'm asking you based on this information, this data and how much you've seen it. Do you see? Do you see information in the data that would help people with the things that they're concerned about? So the first one simple? Do you know what a non type one standard deviation usually is? Is there a range where it usually falls?

John Welsh M.D. 44:29
For example, somebody with type two

Scott Benner 44:31
No, no, no, just someone who doesn't have diabetes at all. Do you know where like, like, Where?

Unknown Speaker 44:37
Oh, yeah.

John Welsh M.D. 44:39
Yeah, so we've got a

we've got some data from a big study of 153 people without diabetes. Their standard deviation was was seven, seven.

Scott Benner 44:51
Okay. Yeah. Okay, is there let's see how I want to say this here. So this is a time Type One question somebody is somebody asking? If there's a lot of variability within the good range, say like, like 70 to 120, this person's kind of bouncing between 70 and 120. There what they want to know, for their health? And maybe you don't know, but would they be better off sitting at 120 than they would be from going up and down between 70? And 120?

John Welsh M.D. 45:22
Oh, I think so. And there's, this kind of leads into another number that you can get with the, the summary sheet at the ambulatory glucose profile is something that Dexcom has. It's, it's not exclusive to Dexcom. But it's called the ag Tz ambulatory glucose profile.

Scott Benner 45:40
What my things, john,

Unknown Speaker 45:45
you don't know,

Scott Benner 45:47
you really got to get creative in charge of in medical in general, in charge of the stuff that goes back and touches people, a dilatory glucose for I'm sorry,

John Welsh M.D. 45:56
there's, there's a lot of syllables there. And then there's a whole industry for you know, if you come up with a new drug, you have to hire a marketing firm to come up with a name for your for your new drug. But there's a digression for you, anyways, is the numbers. The numbers that are on the top line of the ambulatory glucose profile, the averages, they're the time and ranges there. There's another number here, which is the the standard deviation, and then the coefficient of variation. And that's a number that I think has has a lot of usefulness, because it tells you how big is your standard deviation, compared to the mean value. And there's some clinical implications for that a high, high coefficient of variation is dangerous, because it puts you at very much increased risk for dangerously low events for for hypoglycemic misadventures. So the the coefficient of variation, again, looking at my own data, for the past 30 days, my coefficient of variation 31.3. And Is that good or bad or indifferent? it's higher than I'd like it. But is it dangerous, and there was a fun article of fun, I don't know, but useful. Anyways, the the useful article came out a couple years ago, and some folks in France in the UK came out with an article on diabetes care. And they they said, CV coefficient of variation of 36% is a threshold to distinguish between stable and unstable sugars. Because beyond this limit, the frequency of hypoglycemia is significantly increased. And, and if this, my own CV here 31.3%, that's reassuring, it's low, which is good. And it's less than 36%, which tells you that I'm, I could still go low. But the fact that this CV is less than 36% is reassuring, I went to see my endocrinologist and he said, Hey, john, keep up the good work. You're probably not going to die of hypoglycemia before the next time I see you. And and so Alright, thanks. Yeah.

Scott Benner 48:10
JOHN, you know, it's interesting that I see with my daughter who is, you know, a woman, a burgeoning woman, is that with our care, the same exact care we use on weeks and days where she's not impacted by hormones? Arden's standard deviation is 24 ish.

John Welsh M.D. 48:30
But oh, my gosh, that's terrific, thank

Scott Benner 48:32
you. But that's not why I'm telling you that. But I'm telling you that is because although I appreciate it, why I'm telling you is because that when she is impacted with hormones, the run up to her period, for example, her deviation jumps up to 45. And it and our knuckles aren't different, her meals don't vary. It just she needs more insulin. And it sometimes takes a couple of days for you to realize that that's happening. And then once it's happening to remember, it's happening to remember, like, you know, oh, you know, my ratios are telling me this much insulin, but it's four days before I'm going to get my period. So it needs to be more, it's difficult to recall all that, you know, constantly. But it's fantastic to see. It's interestingly fantastic to see because if Arden was a boy, I think I would have a son with a with a standard deviation pretty consistently within 24 until they hit I'm assuming puberty as well. But you as a it's just very interesting to look at your 30 day chart here, you know, we're talking about so you don't mind but your standard deviations 42 and you're saying it's not where you want it but it's also not terrible like people are trying to understand on the outside. What's the number that keeps them healthy and what's the number where they think you know, something else is going to happen? It is very simple in people's minds when they think about these numbers like what am I got to hit? How do I get to it?

John Welsh M.D. 49:58
Oh yeah. Yeah, and I think if the more useful number and I think the one that is very convenient to have as a as a goal, and is is the coefficient of variation, and that's just a ratio, it's the standard deviation divided by the mean. And aiming for something less than 36% would be, would be a reasonable it would be a terrific will. And if I were still saying patience, I would say, here's your, your coefficient of variation is 40%. Let's look more carefully at the trajectories or at the, this is called a modal de plot. And I'm sure your audiences has seen this, it, it lays out the the clock time here on the bottom axis, and then the glucose values on the vertical axis. And you can see the median value here in the Bold Line right in the middle. And then you can see the the shading here, the blue shaded area covers 50% of the values, and then the area in between the dotted lines covers 90%, or I'm sorry, 80% of the values. So what what I'm looking for what I would be looking for if I were looking at somebody else's plot is a smooth ride. And sometimes you can identify parts of the day where the ride is pretty bumpy. For example, After lunch, if you're having lunch at your desk, and you're not going for a walk, and you're having the third slice of pizza, you might see spikes after lunch or dinner. Or you might see plummeting lows after breakfast, if you gave yourself too much insulin for breakfast, and so on to go with breakfast. So I'm not the standard deviation. If you're always cruising around a relatively high number, like 170, the standard deviation is going to be bigger than if you're always cruising around at a much lower number like 110.

And so um,

the number that I think is more reasonable to target as a therapeutic goal is the coefficient of variation. Okay?

Scott Benner 52:05
Under 36.

John Welsh M.D. 52:08
Yeah, that's, that seems to be the magic number. And that's the consensus and and it's, it should be achievable if you if just pay attention to parts of the day where you might be having a bumpy ride, you can look at your behaviors, look at your response to your behaviors and say, You know what? I think I will, instead of having three slices of pizza, maybe I'll just have one. So CGM can be a wonderful motivator. It can inform people it can motivate and reward good choices. So I'm you can tell I'm a huge fan. I love evangelizing this stuff that you can learn from, you can really learn a lot from the numbers. And the numbers can tell you if you pay attention to them, to the numbers themselves, and also to the summary statistics, like the standard deviation, you can learn quite a lot from them. I'm a huge fan.

Scott Benner 52:59
I don't understand that obviously, nearly as well as you do, but I know what it tells me. So for instance, after Arden's my, my poor daughter, one day is going to listen back to this and be like, how much did they talk about my period on that podcast, but after so the lead up to her period, there's like three or four days prior to it, she gets, you know, all of a sudden, she needs way more insulin. And then in the first day or two of it. It happens still, but then there's a moment where it levels like whatever happens is done. She still the periods still happening, but the hormonal impact seems to be going out of her body. So let me give you an example. Because it just happened yesterday for the last 24 hours. Arden's estimated a one C is five and her standard deviation is 24 per average blood sugar's 98. But if I just go back seven days through her you know through this lead up to this period, estimated a one c 5.8 standard deviation 43 average blood sugar 119 it's an it's just the hormones it's the lead up to her period. And so it's fascinating and not that you don't know but and then there's another time of the month where it happens again to her for four or five days. But just those just that week and then that other chunk so basically what I think is about 789 probably 12 or 13 days of the month takes what would normally be I think an SD and like I said in the mid 20s and in a one seat closer to five than six and it moves hurry once the more towards like hurry once he pretty much sticks at like 5.6 it doesn't move very much. Okay, it's just very I don't know like I don't know what I would do before this information like no lie prior to it. I wasn't a different person and we were not good at this at all. You just diabetes in general her hurry onesies were The eights and then I finally got them into the sevens just by having, you know, better tools and insulin pump glucose monitor, but I still didn't understand that enough to turn it into real, like success, you know, like, like the idea of knowing when to bolus and that sort of thing. But I know all that from this data now. And it's a sure incredibly beneficial.

John Welsh M.D. 55:22
Absolutely. Well, I'm, I'm with you 100% on that. And I think for my own my own experience was in the battle days before CGM, I was poking my finger and making a lot of guesses. And it really got me interested in how the body works. And it was a great, great motivator all through college. And that was part of my story. When I was applying to medical school. And I'm not alone, there's a lot of a lot of physicians who specialize in in Endocrinology and Metabolism, who also have type one diabetes. So my own story is, is hey, this is really interesting. I want to learn about it. And I want to go to medical school and and what do you know, the medical school here in town said, All right. All right, come to medical school, and you can learn, you can learn quite a lot in medical school about, about the disease itself, and about how you measure and you measure sugar and measure all the other important things that we care about in metabolism. So it's, for me anyway, it was a not just a life changing event when I got that diagnosis, but it also sort of defined my career path toward a toward becoming a physician and also to working here at Dexcom. Yeah,

Scott Benner 56:35
hey, so that's fascinating. And I'm afraid I'm going to start talking to you and then lose track of what we're supposed to be doing. Because I have questions I almost answered, ask them. And I was like, Oh, don't do that. What kind when you, when you when this data is pulled together? Given that there are, you know, blood sugar lags and meters aren't perfect, and nothing's perfect. What? What's built in to deal with the error? Like, how does it come to the number and and take the, the imprecise pneus out of it? Is it like, like, looking at yours? For example, your standard deviations? 42? What if if, if a dexcom was absolutely perfect? If there was a you know, if it wasn't technology, but it was it was your, you know, I don't know, something organic, they could know, 100%? For sure. What all these measurements are in your glucose all the time? How far off? Do you think that number would be? If you had perfection? Does that make sense?

John Welsh M.D. 57:36
Oh, yeah. Yeah. You're You're hypothesizing that there is some there's a

Unknown Speaker 57:41
real answer. So

John Welsh M.D. 57:42
yeah, there's there does exist some true number, and we're always trying to become more more accurate and getting closer to that true number. We are, we're never going to get there. You have to stipulate that we're always going to have some, some wiggle and some imprecision. And that's, I think true because nothing on this planet is perfect. And we have to, if we get to heaven, then then everything is perfect in heaven. If we ever make it there.

Scott Benner 58:12
I'll and that'll be my first question. When I get there. I'll be like, what was my kids? Really?

John Welsh M.D. 58:19
Yeah. So that that's a whole nother line of inquiry. But we're probably certainly within 10%, I think I'm confident that we're within 10%, I'm less confident that we're within 5%, I would be surprised if we were within 3%. And I would be really astonished, if you told me it was within 1%, I would be astonished. So I've got some confidence, the for the 10% precision. And I've got some optimism that we can usually get within 5% of the true value. Those are just speculative numbers. Because there's no such thing as a perfect value, even if even if you use the gold standard. We could quibble about any reference instrument. And this is one of the things they drilled into us during my residency training in Laboratory Medicine, which is is there such a thing as a perfect measurement? No, not until we all die and go to heaven. While we're living on this earth you have to deal with in precision and uncertainty. But I think we're pretty good. And just for purposes that we care about managing managing diabetes and living a long happy life. I think we're we're well within the realm of good enough. And outcomes

Scott Benner 59:35
are good based on what we know just does that mean, from what you just said is at a 42 standard deviation. Is it possible that your standard deviation is somewhere like 36? Or possibly like, I don't know 48 or 47? Or is it more likely it's lower or more likely, it's higher if it's desert a likelihood that it's more one way than the other?

John Welsh M.D. 1:00:00
Oh, yeah, the standard deviation just tells you how, how spread out the distribution is. And the the true standard deviation could be higher or lower, because all the the numbers that the standard deviation depends on could actually be incorrect. So

I think,

yeah, that's a tough one. Let me let me think about that. Yeah, I'm looking now at this. I'm looking now at the standard deviation and this the famous bell curve, the you know, what the, if I'm understanding your, your question correctly, could the standard deviation be something different? You use me

Scott Benner 1:00:47
as an example, in my situation, right. Now, if I put on CGM, every 10 days, I wear three sensors a month, nine sensors over a three month period. If I look back at my 90 days, my standard deviation, if my if my sensors reading just 10 points higher for the first, I don't know, just say 36 hours of every one of those things. Am I more likely to look higher than I am? or lower than I am? Because of that? Higher, right?

John Welsh M.D. 1:01:14
Oh, yeah, I think I think you would have a high. It's called a high bias. Okay. Yeah, but your earlier question, could the standard deviation be something other than the calculated result? I, I think the answer is no. If you give me the numbers from one to five, could the total be something other than 15? And I would say no, that the total of the integers from one to five is 15. And if you give me a set of numbers, I can calculate the mean and the standard deviation. So I think the calculation that we've done here, resulting in this standard deviation of 42. If we did the math correctly, then the standard deviation is 42. Is the the

Scott Benner 1:02:02
I'm sorry, does the algorithm that's making this decision? Does it scrub anything like, you know, like a compression load? Does it see that and go, we're not going to take this into account doesn't do any of that kind of stuff?

John Welsh M.D. 1:02:13
Oh, yeah. And that's, I think that's true. That's got to be true for Medtronic, it's got to be true for Abbott, it's got to be true for Sensi onyx. And also for Dexcom. We've got, we've got algorithms, the signal that we are measuring is actually a voltage. It's a, it's I'm sorry, its current. So the current is very low. Current, usually measured in amperes. And we're dealing with billions of an ampere, I think, nano ampere, or Pico amperes. so incredibly small currents. And the challenge for the engineers is to take that very small electrical current, and translate that into a number that makes sense and number of milligrams per DL. So that requires some, some engineering talent. And it requires an algorithm. And I think that's part of the secret sauce that we have here at Dexcom. Medtronic, I'm sure they have a algorithm, which is similar, but slightly different. And the same for Abbott. And the same for sensing onyx. And that's true. Whenever you're measuring something and saying what you're measuring, you know, for the example of your oven, if you're cooking, you're making your cookies, you're measuring temperature, what you're really measuring is the height of the mercury in the thermometer. And the trust is that that's a good representation of your temperature. And then going back to the bicycle speedometer example, what it's really measuring is how fast the wheel is turning in, you're translating that revolutions per minute into a speed. So it's, it's a challenge to take a very small electrical current and turn it into a glucose value. And that's, that's what we do. And I think that's what all the manufacturers have to do.

Scott Benner 1:04:02
It's amazing. And listen, we're one rabbit hole away from wondering if we live in a simulation. So let me ask a more concrete question. Ready, john? JOHN, in 30 more minutes, we're gonna be like, we're probably in the matrix. So just a real quick when Canadians or people who are using other scales, did they multiply their standard deviation by 18 to get their answer? Like this person gave me an example said their last standard deviation in Canada was 1.6. Do they multiply that by 18 to get the number that the way we're talking about it right now?

John Welsh M.D. 1:04:41
They sure would. Yeah, so the the units for standard deviation. The standard deviation here in the US is milligrams per deal. outside the US, the standard deviation is millimoles per liter, and the conversion factor is is 18. So the standard deviations would be Less by a factor of 18. In places where they use millimoles per liter, the and and that's a good point, thank you for bringing it up. And the point is that what would not change is the coefficient of variation. So if you were to take all my numbers are, if I were lucky enough to be a Canadian, and measuring my sugars and millimoles per liter, I would still have this coefficient of variation of 31.3%. That would not change, I say, because you're dividing milligrams per deal in the numerator, milligrams per dl and its nominator. And those units would would cancel them out coefficient of variation. There's no units for that. It's just a percentage. I'm glad

Scott Benner 1:05:45
you said that are some persons this gacha tune was going to take their coefficient and multiply it by 18. And that and panic. Now, that's great to know. And thank you for knowing it. By the way, when I asked the question, I appreciate that.

John Welsh M.D. 1:05:59
Oh, that's a good one. You know, if you got a if you were to travel to Japan, you would trade your dollars for yen and you would find yourself 100 times more wealthy. Because you can buy you can buy about 100 yen with $1. But wait, everything's 100 times more expensive, so

Scott Benner 1:06:16
well, so let me make sure I'm understanding exactly. So coefficient of variance variation we're talking about under 36 really lessens your possibility of low blood sugars. Standard Deviation shows us how much stability we have, right like by keeping our variability lower. What is it you don't see measuring?

John Welsh M.D. 1:06:40
Oh, in terms of our

Oh, yeah, a one see there's, I love a one See, I want to strangle it and drown it in a bathtub I Awan see has been with me for a long time it's a biomarker, its hemoglobin obviously, is the protein that fills up your red cells, it's got the red color, because it's got iron in the middle of it, it's got an iron atom. And it's the same color as rust. The hemoglobin a one C, the a part of it refers to the a chain. There's an A chain and a B chain. The hemoglobin a one refers to the first amino acid in the a chain of hemoglobin. And the C refers to the isoform. If you want to know it refers to the isoform of altered hemoglobin that travels on chromatography. Anyway, that's that's the long answer. The short answer is that hemoglobin a one C is a abnormal form of hemoglobin that has a sugar atom stuck onto it. And having that sugar, sorry, sugar atom, it's a sugar molecule stuck onto it. And it's it's a nice indicator of how your ambient glucose concentrations have been going over the past two or three months. The downside of having a high a one C is that hemoglobin eight one c molecules behave a little bit differently. And they're also markers that things are going haywire in other parts of your body, other proteins in your vasculature in your kidneys, and your liver might be getting decorated with sugar molecules when they really shouldn't be. So having having a very high hemoglobin a one c number tells you that quite a lot of your hemoglobin molecules are traveling around with this kind of gooey sticky sugar molecule stuck onto them. As I mentioned earlier, I it's it's not my favorite biomarker. What's your favorite biomarker john, there's there's ways that you can fool the hemoglobin a one c test, and we can talk about those. There's some some people have problems with red cell production or red cell destruction that would throw it off. So you can really be misled by an 81 c number, it can be too low. And you can say, Ah, you're doing just fine. Your a one C is in the normal range, when it should be much higher. And then on the flip side, you can see anyone see some people have a one c values that are unexpectedly high compared to what their average glucose values are. So it can it can mislead you in a couple of different ways. I'm a much, much more enthusiastic about just using the average glucose value that you get from a CGM system to assess the adequacy of your classima control.

Scott Benner 1:09:45
Is that okay? You know, it's interesting you made me think of last year I suffered. I had my ferritin was very low. And it's it. You know, at first everyone, doctors thought I had cancer and we did all these things. And it turns out I just had low ferritin And so I got an infusion of of what do they call it? It's, I can't think of it now. It's an iron and it's a it's a mix, it looks like a rusty bag of water. And, and it popped back up. But during that time, what I was told was, we can't trust your Awan see right now, because of your low ferritin. And I was like, Huh, I didn't dig too deeply into it. But something you just said now made me think of it again. And then it made me think about how, you know, measurements, right? And we you always get, um, you could use anything as an example. My daughter has hypothyroidism. But when we first figured it out by her symptoms, the doctor's office looked and said, Well, she's low, but she's in range. We don't want to do anything. And we made them give her, you know, the hormone, then because we had an experience with my wife who was low in in range, and they would never help her. And it really hurt her over time. And so it made me wonder, especially for, you know, women in the menstruation age, is it possible that they have an A one see, that looks better than it is, if they have lower ferritin. Just

John Welsh M.D. 1:11:09
like, there you go. There you go. There's, that's another of all the ways that a one c could be misleading. That's, that's, that's one of them. And I'm thinking, my own experience, I used to be a really avid blood donor. And and I thought, Oh, you know, what, if I, if I were to donate two units of blood, and then wait around for a couple of weeks, and then get my a one c measured, that would falsely lower the anyone see, because as soon as I donate two units of blood, my, my bone marrow is going to wake up and say, Oh, my gosh, john, you did something either stupid or crazy or really altruistic. By donating those two units of blood, we have to ramp up production. And we're going to flood your system with brand new red cells. So after two weeks after donating the blood, I would have a population of red cells, which were relatively young and had not had a chance to get glommed on to buy the sugar molecules. And my one c would be falsely low. And I say, Yep, I can sure game the system that way. And this the same for people who undergo acute blood loss, see, the one c would be falsely decreased within a couple of weeks, once the red cell production line kicks into gear. And then people who have shortened red cell lifespans, there's there's some conditions, a lot of syllables, but hemoglobinopathies, if your hemoglobin if your red cells are, are not up to the task, and if they're prematurely destroyed, you would have a very low a one C, and it would be misleading if you were trying to manage diabetes based on that.

Scott Benner 1:12:50
Okay, so Okay, so use a person who's had type one for a long time, and is a physician and I think if we didn't really dig into it, but it sounds like you used to help people with type one as well, when you were practicing is all right.

John Welsh M.D. 1:13:04
Oh, you know, indirectly I specialized in Laboratory Medicine and also anatomic pathology. So I would, I would look at disease and I would measure disease and then I and then I went to anyway, so I never directly took care of people who were who needed insulin management.

Scott Benner 1:13:22
But for yourself, this isn't let me just ask yourself that I guess it makes more sense it with your background, and how much time you spend digging around in this data? How do you measure your success? Like which one of these? I know there's gonna be a grouping of them here. But But can you tell me what you look at every time you look at your data, just when you want to look and go, Oh, I need to do a little more a little less. Like, what what is it your where do you focus? And is there any way to put them in descending order?

John Welsh M.D. 1:13:52
Oh, well, I am getting old every if you wait long enough, everybody's going to get old. I used to worry quite a lot about my one C and now i i really don't care I what I focus on mostly is the average glucose and the the example that we're looking at now is 133, which which is wonderful. And beyond that, I try not to rank myself I try not to compare myself to my peers. Here at Dexcom. We've got some some very talented folks with type one who are even more dialed in than I am. If it if it seems like I know what I'm doing, there's people down the hall who are even better. And then there's people in the community who who are need some advice, and that's the mandate. I say you know what, I'm doing fine. But let's, let's see if there's problems that I can address. So I look at my average sugar. I look at the time high and low time and range and the example that we're looking at 85.9% is pretty good. And then I also look at The the amount of trouble and strife that it causes me and I try to minimize that I try to settle in on a good routine, that doesn't cause me too much trouble and strife. And finally, after 45 years, I think I've found a good routine for managing my own diabetes. It's amazing.

Scott Benner 1:15:19
That's, I think what people need to hear too. It's funny, as you were saying, all that I was looking at, at my daughter's nine, like I went to 90 days on her information, because you said average blood sugar. And, you know, her average blood sugar has been 115 over the last 90 days, with an an estimated a one c 5.6. But her standard deviation over that time is, like I said, it's it's 45. And is that? Should I be more concerned about that?

John Welsh M.D. 1:15:50
Well, here's, here's an important question. And it relates to the time that she spends really low. And I wonder if there's numbers for either time, less than 70, or time less than 54. Because Because those are, those are things that can cause trouble in a hurry. Yeah, being being less than 54 is kind of dangerous.

Scott Benner 1:16:09
I have I have her range set as 65 to 120, she's 9%, low 54% in range and 37% high, but she does not get for the most point, we don't go over about 180 ever. And under 55 I don't think happens twice a month, maybe. And not for long periods of time, not like under 55 and falling where people are running around the house, you know, looking for the will and stuff like that just you know, like a dip down that you caught a little too late. And, and it'll go to 55 and hang come back up. But you know, we don't let her sit under that number. But I look at her standard deviation all the time. And I I'm always just like, Ah, that's where I need to do better. But like I said, you know, for half of the month, that standard deviation is 24. And then during her, you know, her hormonal times throws throws that number off, like, is that number less scary? Because she's a girl than it would be if she was a boy. I know. That's a weird question.

John Welsh M.D. 1:17:17
But because I you know, I mean, um, well, I, I don't know if I'm, I'm gonna take issue with your premise. What you told me was, is that number scary? And I don't think so I don't think that's a scary number at all. Just based on the fact that she is so dialed in that she has almost continuous awareness of where she is. And she's got good access to, to her family and to you and good access to to Candy if she needs it. So it doesn't sound like she's in harm's way at all. The thing that you know, there's there's some things that are absolutely dangerous. One is one is going low and finding yourself waking up with a crowd of people trying to resuscitate you as a terrible misadventure. Because you, you went low and you ignore the symptoms. And guess what? You had a seizure, you lost consciousness, you bumped your head. And now the EMTs are out. That's a scary misadventure. So I think if you told me earlier, she's, she's had it for quite a long time. She's diagnosed, too, and she's gonna be 16 next month. Okay. So 14 years, 14 years into it. Hopefully all the autonomic counter regulatory hormones are are intact, and I hope they stay that way. So the hypoglycemia awareness, I hope is fully intact, and the counter regulatory hormones that that would kick in to bring her sugar back toward the normal range, I hope are intact. The, the coefficient of variation, you mentioned earlier, the standard deviation for your daughter and remind me of the coefficient of variation.

Scott Benner 1:19:06
Oh, let me get it for you. It does similarly, change with with what's happening in her I have it at 90 days as 39% in the last 39, in the last week, 36%. But if I go into just the last three days, where like I said the impact from hormones is going it's 30%.

John Welsh M.D. 1:19:30
Okay, wow. So sometimes, sometimes it gets above that arbitrary number of 36%. So there's some stretches of time where the variability is, is in excess. And it's it's

Scott Benner 1:19:43
important to note that so my daughter now for over six years has had an agency between five two and six, two, and we don't protect her diet in any way. So she'll have pancakes, you know, for breakfast on a Sunday morning. Just as easily as this morning I said she had, you know, an avocado avocado toast. And so you know she she's all over the place with what she'd still have nights where she just has a big salad for dinner. And nothing else. Last night she had some turkey and small amount of potatoes. But when dessert came out, she wasn't interested. And so she's I would call I would call her eating healthy and varied and not excessive. She's not a sweets person like she's she'll Trick or treat, but that's the hang out with her friends and she comes home and doesn't know what to do with the candy. We get it like that. That's sort of an idea. But you know, I'm trying to talk through her to everybody so that everybody can kind of get a feeling for how they should feel about this information for themselves personally.

John Welsh M.D. 1:20:47
Sure, yeah. Well, there's, there are some things and we we spend a lot of time looking at data here we've got some data science, people who built our career on looking at data, there's a couple of comments that might that might be helpful and one is to to look for opportunities to lower the standard deviation lower the coefficient of variation. One is to see if there's any evidence of overtreating highs or lows. And sometimes those really jump out, if you look at the, the hourly plot, we call it the modal day plot. Sometimes you'll see Oh, here's here's something where I know, I know where I went sideways on this, I know I had the the big snack after lunch, I shouldn't have Oh, there were free doughnuts in the conference room, I should have said no to those doughnuts. So sometimes there's opportunities for looking at your data, not the numbers. But just looking at the the image of the 24 hour stretches of daytime, you say wow, there's a big spike there. In the early morning hours, maybe I had too much snack before I went to bed. Maybe I had too much. My own case, I had a habit of taking too much fast acting insulin to cover breakfast, and I would always go low around nine o'clock in the morning. So being looking at the data, not just as numbers, but as a graph can be very helpful. And it can reveal opportunities for making adjustments. And if if the standard deviation is in, in the high range, if the coefficient of variability is in the high range, then it deserves some some careful consideration about Wow, this is a bumpy ride, are there any particular times of the day that you would like to address with your end might be in brilliant amenable to making thoughtful changes?

Scott Benner 1:22:46
Can I ask, given how the numbers are calculated? If how much is that? What's my question? Are any of the numbers based off of the the range that I've set up? So get keeping in mind that my daughter's ranges on my phone? It's 65 to 120. on her phone, I think it's 70 to 130. And so on her phone, which is the one that you know her clarity accounts connected to and everything. If my daughter's blood sugar is quite literally between 75 and 110 for two thirds of the day, but she has two big meals that Spyker to 180. But she's not more she's not at that 180 for more than an hour and comes back down without getting a low. Do those numbers look artificially inflated? If that's how it works for her sometimes?

John Welsh M.D. 1:23:42
Um, the I think your question is, what are the numbers that you see in the in the clarity report or the clarity, summary. And the time in different ranges, you can, you can set those you can customize the ranges that you want to see for and you can do that in the daytime in the nighttime. So my

Scott Benner 1:24:02
ranges they if I changed her range, this might be a stupid question. But if I pushed my daughter's high number up to 180, would her standard deviation fall?

John Welsh M.D. 1:24:13
Oh, no, it would not know the standard deviation doesn't care whether a number is in the range, the range that you said is pretty arbitrary. You can you can turn that dial up or down. The range that you set within clarity just tells you when are you going to get beeped. And what are the summary statistics for timing range kind of

Scott Benner 1:24:35
the data is based off of those ranges. Got it?

John Welsh M.D. 1:24:39
That's right, that's right, the standard deviation coefficient of variation, those numbers are those are not subject to change by just changing the the alerts or the the target ranges.

Scott Benner 1:24:52
Okay. And they're based off of what quote unquote normal would be. Is that right?

John Welsh M.D. 1:24:58
Oh, Actually not the the normal range I mentioned earlier than the normal range is no more than 120. And that's at the moment, I'm just leaning over and checking my sugar right now is it's 109. But for the most part, having having a sugar of 150, would not be concerning. I don't think for any endocrinologist, if you were to cruise around at 150, all day, every day, the endocrinology community would say you're doing a good job, your agency is likely close to 7%. And your risk of long term complications is close to baseline is close to what the non diabetic population would have. So that would be very reassuring, even if you're having a abnormally high glucose number, I got a I got a call once I did some lab tests and for a different occasion, and the nurse called me up and said, john, I've got some very concerning news. Your your glucose is 123. And I thought, well, what's concerning about that? And and she said, Well, it's it's higher than normal. And I said, Well, I have type one diabetes. And and as soon as she heard the fact that I had type one diabetes, she said, Oh, well, you're boring. Have a nice day, goodbye.

Scott Benner 1:26:19
You're making me think of my daughter had to give urine one time and I left the room or I dropped it off and didn't tell the nurse she had diabetes. And I walked halfway down the hall and ran back because I was worried for the nurse and she was running out of the room at the same time. And I looked there and I went she has type one. And she goes, Oh, okay. And then she, she goes back in the room. Let me re ask my question, because I have it in my mind. And maybe I might ask another dumb question here. Trust me, it's very boss. I'm ready. So So Arden's blood sugar does sit in the 80s for most of the time. But sure, and and like I said, sometimes she'll hit 180 on a couple of meals. What if her blood sugar always set at 120? And sometimes hit those 180s? Would that make her standard deviation lower?

John Welsh M.D. 1:27:09
I don't think I don't know. I don't think you've given me enough information. To ask that question. We could. We could do some numerical simulations, which would be interesting, but maybe a quite a digression. I don't think we can tell for sure. Just based on what you told me. So it's, it's a big question mark. Right. Now I I'd have to punt and say, I don't know.

Scott Benner 1:27:34
That's fine. I'm trying to I can't wrap my head around my own question, which is frustrating, as you may imagine, and a limitation of my intelligence. But I'm trying to, I'm trying to decide how, you know, so. So you don't, I know, you've heard a couple episodes of the show, john, but you don't listen to the show. And I actually would like to send you a short list of episodes, and let you listen to them and hear what you think of them. But most of the people who listen to this podcast, I would assume have a one seat in the fives, or I would think over six and a half for somebody who's been listening more than three months would be uncommon. And the basic tenant of the podcast is that you don't, you don't stare at a higher blood sugar, you get it back down without causing a low and there's ways to use insulin, you know, with the data that that makes that work. So we, you know, we're pretty heavily talking here about Make sure your basal insulin is right Pre-Bolus your meals, don't stare at a high blood sugar, you know, don't cause a low bumping nudge with insulin, you know, if you after a meal at a meal time, you know, 45 minutes after you eat. If you're 136 diagonal up, we bump it back down again, if you're 85, diagonal down, that turns into 80 that you think this is going to keep going. You don't wait to see a 60 you take in a few carbs and nudge that that blood sugar back up again, it's like driving between two lines, you know what I mean? Like you don't want to swerve, you just want to kind of try to stay as steady as possible. And we talked about a lot about how to use insulin, temporary basal rates, both positive and negative, and food in ways that keep those swings from being crazy. And yet, there are people who come back with amazing a onesies who don't get low very often, but have a couple of spikes with larger meals. And these numbers that everyone's telling them, they're super important, you know, standard deviation, they they can't seem to get into the space that they want. And then they start thinking about limiting food to make that happen. And I i think that i think this podcast has a lot of different goals. But one of them is for you to understand insulin enough that you can eat what you want to eat. And I'm not saying that everyone should run out and eat those doughnuts at the conference table. Like that's not my point. My point isn't. I'm not a person who says oh, you have diabetes. You know, don't ever think of you know, don't ever think about your your health. Just eat whatever you want, because insulin can take care of it. My point is that If you understand how to use insulin, then you can go off into the world. And with a diet of your choosing, keep your blood sugar's in a more normal range and extend your health. But I'm baffled a little by my daughter's standard deviation. All the other numbers make sense today, but that one number, I can't wrap my head around. But

John Welsh M.D. 1:30:23
yeah, and and you mentioned, you mentioned the hormonal changes that come by every month and, and sometimes the, the good control becomes more of a challenge obviously. And the coefficient of variability goes up. And and then unfortunately, the having a high coefficient of variation gives you a higher risk of symptomatic or potentially dangerous lows. But but so it's it's especially important to have that awareness of misadventures on the low side, especially during that time of the month where the swings are, especially high amplitude. The but the goal is, as you said, I think the goal is to spend most of your time out of harm's way. And to live a long happy life where your retinas your retinas last your whole life and your kidneys are gonna last your whole life and you're gonna die with all 10 of your toes, where they belong at the end of your feet. So it sounds like she's well on the way and especially the education that you've been giving her and the insights that she's been getting from from CGM sound like they've been tremendously helpful.

Scott Benner 1:31:35
I appreciate john, I just did something that I'm so I feel badly about that because you're sharing sharing your screen. I can't see my screen. And I just realized that I've had you on for an hour and 20 minutes. I'm so sorry. I didn't even I am really enjoying this. And I didn't I didn't recognize about the passage of time. I hope I haven't kept you from something. You're not just being polite to me.

John Welsh M.D. 1:31:56
Oh, well, let me You know, I think I had something that I did have something else on the calendar, and I hope I'm not. Let me check my little outlook here. You can see my calendar, there's something coming up at at noon, so maybe we ought to

Scott Benner 1:32:10
go is what I was gonna say Yeah. 100% I, I just looked at my phone to look at something about art in the city. And I was like, Oh my gosh, they're gonna crucify me. I've been I've had you wait too long. Listen, this was incredibly interesting. And I can't really thank you enough for doing it. Because it you know, it's not something everyone jumped up to do. And I said, Can I get somebody who really understands standard deviation to talk is, it wasn't a long line of people with their hand up, you know, so I really, I genuinely appreciate this. And I have to tell you, it's gonna go right out tomorrow. I don't usually put stuff out this quickly. But if this fits right into my schedule, so you'll be able to hear yourself and be horrified by your own voice in probably 12 hours or so.

John Welsh M.D. 1:32:52
Well, that's great. So you can I hope you cut out the obscenities and the screaming and and the lawnmowers. And the all that

Scott Benner 1:32:58
horrible stuff you did will be cut out now people will just hear you say that. I'm wonder what it is that we click on.

John Welsh M.D. 1:33:05
Scott, what a pleasure, I enjoyed speaking with you, thank you for thanks for reaching out. And I'm do boy Dexcom is great. I'm just surrounded by really smart people who love who are really bought into the mission. It's it's a good company, it's a good product, it's a good mission. And and I it's nice hearing about your own experience and your daughter as well. I hope you have a long happy life with with this thing that nobody wants. But we're doing the best we can with Type One Diabetes, you're

Scott Benner 1:33:33
very nice, john, but to think that you're not going to get drugged back on this podcast at some point is, is not reasonable. I'm gonna get you back here. We'll find out more about you and your diabetes one day. I really appreciate this. I'm gonna be incredibly humble all day long after talking to you Just so you know.

John Welsh M.D. 1:33:51
I realized you've got it.

You're the God of podcast. So you can go have some podcast swagger and brag about having a wonderful podcast. I'll have to wait

Scott Benner 1:33:59
on that since I couldn't get out of algebra in sixth grade. So thank you very much.

John Welsh M.D. 1:34:03
Okay, cheers Have a good rest. cfn. And

Scott Benner 1:34:07
I know that was a denser episode than you're accustomed to on this podcast. But I just thought that having someone like john walk through these ideas was important. I took a ton from it. I'm gonna listen back to this a couple of times, because I am I'm not as smart as I need to be sometimes about some of this stuff. But john made it understandable and complete. I was really thrilled to have him on I'm gonna have him back someday and just talk about him and his diabetes and try to learn his story. I wish you could have heard the conversation I had with my Booker when I was like, hey, I need somebody from Dexcom to talk about standard deviation like, really deep dive. Is there somebody over there that can do that? And she was like, I'll find out. And boom, john Walsh comes out of nowhere. really lovely man. I want to thank you for listening. I mean, especially if you're still here an hour and a half into this. You are a major geek about diabetes data and I love you for it. Thanks so much to Omni pod touched by type one, the Contour Next One blood glucose meter and Dexcom for sponsoring this episode of the Juicebox Podcast. Please again, go to Juicebox podcast.com for those links, or look right into the show notes of your podcast player. You can clicky clicky on them right there. One way or the other. If you use my links, you'll let the sponsors know that you came from the Juicebox Podcast and I will of course really appreciate that. Hope you're all well, especially in these times. I'm thinking of all of you and I'll see you soon

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

#342 Everything the Light Touches

Kyle Banks is a broadway performer living with type 1 diabetes

Check out what he’s doing at Kylercares.org

Check out the Diabetes Pro Tip episodes and Juicebox Docs

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello and welcome to Episode 342 of the Juicebox Podcast. Today's show is sponsored by Omni pod and Dexcom. You can find out more about the Dexcom g six continuous glucose monitor by going to dexcom.com forward slash juice box. And to find out more and even get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to you go to my Omni pod.com forward slash juice box.

Today on the show I'm gonna be speaking with Kyle banks. Kyle is a Broadway actor. And I'm sure you've probably seen him as I think we've all seen the Lion King on Broadway, right? Like everybody. Anyway, Kyle has type one diabetes. He's here today to talk about his journey, as well as what's going on currently in the world. And also tell me a little bit about his organization called Kyler cares, which you should check out at Kyler cares.org.

Don't be shocked. Kyle has an incredibly deep voice. He's going to make me sound like a five year old girl singing in the choir. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making changes to your healthcare plan. or becoming bold with insulin. Do you hear me trying to get deeper so that in a second it sounds

Kyle Banks 1:42
like I'm not.

Scott Benner 1:43
Thank you. Why do you say how's got a nice voice?

Kyle Banks 1:57
Kyle Banks here. Actor and it's diagnosed with Type One Diabetes about five years ago this coming November?

Scott Benner 2:07
How old are you now?

I am 4343. So you Wow. 38.

Kyle Banks 2:13
Yeah. diagnosed later in life.

Scott Benner 2:16
Anyone in the family that made you feel like this was a possibility? Or no, I'm the only lucky one. I assume that means you get the bigger piece of meat at Thanksgiving and things like Oh, oh, yes.

Unknown Speaker 2:30
Sure.

Scott Benner 2:32
If it's not the diabetes?

Kyle Banks 2:34
Yeah, I'll definitely I definitely use it to my advantage. No kidding.

Scott Benner 2:38
Well, that's, I mean, that's, you know, I guess to say, that I'm shocked by the age is a little bit of a fallacy because I've interviewed enough people now at every age to know what happens, but it really just isn't in what you would consider the sweet spot of getting typos. Maybe?

Kyle Banks 2:52
Yeah, most definitely. How did it present? I mean, people used to tell me this all the time, and it would kiss me off in the beginning. But now I totally get what they mean by if they would say you're lucky that you were diagnosed later in life? Like, what do you mean, this is horrible? Why would anybody want to be diagnosed with this at all, but I totally get what they mean, because they'd be diagnosed with it earlier. And just knowing that goes into it. And all that it requires of you. I do share that sentiment now.

Scott Benner 3:25
I wouldn't have to think and I'll be, you know, obviously, I don't know. But a couple of things come into my mind. First of all, the idea of complications, the earlier you start the more time diabetes has to work on Yes, but also as an adult, it's got to be a little easier to see a shift in your life and adjust to it then

Kyle Banks 3:47
most definitely things

Scott Benner 3:48
like that has happened before, right? I mean, not on this scale, but still you've had a place to live and then suddenly not had a place to live had a had a you know had a you know, I don't know you were dating somebody and then all of a sudden they were gone. Like that kind of stuff is an adjustment when you're 18 or that's that's tough. So

Kyle Banks 4:04
yeah, well yeah, I've also made decisions like for my life as far as like nutrition and just certain things that I've I've removed from like my diet and the way in which I've developed like exercise and in have incorporated that in my life. Now, definitely much better suited to deal with it now than I would have been years ago. So where were you?

Scott Benner 4:31
I guess professionally, what were you doing at 38?

Kyle Banks 4:35
Well, I've been performing on Broadway for since I was 25. So is on on tour at the time of my diagnosis and traveling. It just been wrapped up three months in Canada, and had just gotten to California. We were touring California for about two months. It's

Scott Benner 4:59
helped me expand Understand that and explain it to people because I live close enough to New York that when you say Broadway, there is a picture I get my mind. But people who live across the country, when when shows are incredibly popular. Eventually they they hit the road, right?

Kyle Banks 5:14
Right, the road, touring with Lion King at the time. And Lion King is based in New York, where it sits. But there's also a touring production that tours the country. So I bounce back and forth between the Broadway production and the touring show. That's interesting. So

Scott Benner 5:33
Wow, is that based on your desire to move around? I mean, I'm assuming there's some people who don't want to tour or is that not within your purview to make that decision to they just tell you, this is where you're going. Now, this is where you're

Kyle Banks 5:47
at? It's totally up to me, like, no one's putting a gun to my head, say you have to tour? No, initially, I was on Broadway for like, maybe five years. And I was asked if I would be interested in going up to the tour to fill in sometimes. And initially, I was like, No, I'm working in New York. Like, why would I go out to the tour and perform in Kennebunkport, Maine, right like that. But I had no idea that the tour actually pays more money, a lot more money.

Scott Benner 6:18
And you don't have to pay to live in New York anymore. It's probably

Kyle Banks 6:21
Oh, yes, yes. Yes. So I was like, why? After I learned that, I was like, why did you come to me sooner with this offer?

Scott Benner 6:28
When we were really young, my wife worked for a company that was in Manhattan, and she commuted in and out every day. And then one day, she didn't anymore. And she was in New Jersey, and her first paycheck came after New Jersey, and I called her on the phone. I was like, yo, they made a big mistake. Don't tell anybody. But it was just not paying the taxes in New York. Exactly. Yeah, very well. That's cool. So how long did you do the boat? I guess, how long did you perform in Manhattan? And how long were you doing the toy?

Kyle Banks 6:54
Well, I am, I'm a swing, I'm calling for this call the universal swing. So I have in and out of the show as needed. People will take a real job. So we have like vacations, people to take time off the six Luke sick leave. Because Lion King is such a high intense show with physical, physical activity. There are a lot of injuries. So I hop in as needed. So I part of the time I'm in New York, part of the time I'm on tour just just depends on where the need is.

Scott Benner 7:29
That's interesting. It's not something that would ever I mean, it makes perfect sense. But it's not something that would occur to me.

Kyle Banks 7:35
That's really that the show has to go on regardless, like what's going on with the actors. So there's always someone there to fill in.

Scott Benner 7:43
Can you do multiple roles? Mm hmm. Okay.

Kyle Banks 7:47
Yes, yes. Yes. You

Scott Benner 7:48
have like a sweet spot, like where you are where you did one more than another? Or does it not even work like that?

Kyle Banks 7:54
It doesn't work like that. It's just basically where the need is. The principal characters, they, they're really good about coming to work, and just being there and being present. But you know, sometimes no injuries happen. It said, people just need a break for family time, or personal refunds, or whatever the case may be.

Scott Benner 8:16
So you're in Canada headed to California, and how do you win? What's the first time you don't feel? Well?

Kyle Banks 8:22
Well, I began having vocal issues of cannabis. So I was traveling back and forth to the states to visit in T specialists to pay to go to visit EMT specialists to sort of help me figure out what was going on with me vocally. And once we got once we got to California, I was still having issues. So I continued to visit specialists in whatever area we were in just so that I could get through work and eat specialists prescribed for me prednisone, steroids. To help deal with some of the inflammation I was experiencing on my vocal cords. I was on prednisone for about two and a half months at a very high dose. And so maybe about two towards the end of like the two and a half months, I'll begin experiencing like these other symptoms that just started out of nowhere. Like the extreme hunger and extreme thirst and the constant urination and exhaustion, which is just awful when you're doing a show like The Lion King because what you need most is energy. And I I didn't pay much attention to it. I just noticed that I was feeling off. But what really got me to to visit a Urgent Care Physician in California was I just looked in the mirror one day and I was like, wow, I look really gone. I didn't even I hadn't even noticed that over the course of three weeks, I'd lost like 30 pounds, okay. And that's scared the hell out of me. So I ran to the urgent care doctor that day. And he tested my glucose. And he suspected that I had steroid induced type two diabetes. Interesting and suggested I go to the emergency room, I was like, well, I can't do that. I have a show in like two hours. But we'll just, he gave me prescribed Metformin for me. So I began taking the Metformin. And two weeks later, I still wasn't feeling I wasn't feeling any better. So I spoke with my mom, and she suggested that I come to New Orleans and visit her doctor and get a formal checkup. Right. And at that point, she took instruct that physician instructed me to go to the emergency room.

Scott Benner 10:52
I can't so I'm looking at you, but I'm only looking at you from like, chest up, but you look like a bigger person. 30 pounds. Where were you when you lost? 30 pounds? How much do you weigh?

Kyle Banks 11:00
I was typically like, between 175 180 Wow,

Scott Benner 11:04
you went down to like a a teenager's weight? Yeah. How tall? Are you? 620. My goodness, you must have been there for most.

Kyle Banks 11:14
I was looking like Skeletor. And out there.

It happened. It happened so fast. I noticed a drastic amount of weight. But I mean, when it when it falls off so quickly. You don't say anything? You don't see it.

Scott Benner 11:26
Yeah, I can only see Arden in a couple of photos. And then think how was it possible that we didn't notice that? Yes. Wait, you know?

Kyle Banks 11:35
Yeah, when I look back at photos of me, like you take a lot of photos, we clown a lot backstage. So I definitely looked ill did not look well, at all, at some

Scott Benner 11:46
point someone had to make the joke that you look like the week is Ellen, the line was definitely gonna get you.

Kyle Banks 11:52
The dancers can be a little sick, and that they you know, the ballerina body and everyone wants to be slim. And so they like work. You look.

Like, I look amazing, but I feel like I'm gonna pass out. Right?

Scott Benner 12:08
That's terrible, man. It really is. Especially true, because I can see a bunch of things coming here at 38. I mean, you're in amazing shape. Obviously, you're the only thing on me that is built like he was like one of my fingers. They're pretty thin. And so like, You're, you're in great shape. But But I think my bigger point is that at 38 do start thinking, am I getting older? Like, is this just time coming after me? Or, you know, yeah,

Kyle Banks 12:33
that that was definitely a thought, like, you know, maybe, maybe my metabolism is slowing down? Maybe my endurance is slowing down like I could I couldn't figure out what was going on. I just started taking more vitamins in that moment, hoping that it would help

Scott Benner 12:51
just using I realized you've been in other things, but just using Lion King, what's the what's the timeframe, you arrive when how long as the show run? How long you actually onstage,

Kyle Banks 13:03
we arrive at the show a half hour before the curtain goes up and gives us enough time like warm up, stretch, vocalize put on makeup wardrobe for the show. And the show runs for two hours and 40 minutes. Okay. So it's a long show.

Scott Benner 13:25
And I'm assuming you're walking and probably to the to the theater, and then there's just a lot of activity. And then there's

Kyle Banks 13:31
a lot of Yeah,

Scott Benner 13:32
and they are out there doing what you're doing. And everything's I said Is it is it a hype song I tried to figure this out. Because I obviously, we've been to a number of shows in my life, not just a couple, but a lot. It's interesting. If you hang around a little bit, or you're having lunch across the street afterwards or something, you'll see the performers just roll out the back door. And it's no different than if you hang out at a baseball game long enough in the parking lot. Eventually you will see 40 guys walking to their cars, you know leaving the Yes. And and I use my son as an example. Like when he's like they're so loose in the dugout when it's not their turn to do something. And then all of a sudden, it's like work time and you just something comes over them. So now I'm imagining that behind the curtain, very just a bunch of foolish people making nonsense, that all of a sudden it's time to roll out on stage and do your thing is that sort of like that.

Kyle Banks 14:22
That is the most accurate.

Scott Benner 14:29
That is very fun. Now it makes me wonder what those rockets are doing during the Christmas show.

Kyle Banks 14:33
Madness backstage. I mean, the real show happens behind the curtain. Sure.

Unknown Speaker 14:38
That sounds really interesting.

Scott Benner 14:44
There is an absolutely wicked thunderstorm going on outside of my house right now. So if I suddenly get whisked away out of respect to me and what I've given, don't forget to go to my Omni pod.com forward slash juice box to get yourself a free no problem. demo of the Omni pod tubeless insulin pump sent directly to your door. Why do you want to do that? Well, perhaps you've been thinking of changing pumps. That's one reason. Maybe you're taking injections or have a pen right now and you want a pump, but you don't know which pump to get. The Omni pod is, besides my daughter's pump for many, many, many years, the only company that will send you a demo to your home so that you can try it on and wear it to see if you like it before making a commitment. That's pretty damn good, isn't it? try before you buy, no obligation whatsoever, right to your door, my Omni pod.com forward slash juice box. Now when their package arrives, when your demo pod gets to the house, I'm saying you're going to be able to wear it wherever you want. Take a shower, sleep, frolic, whatever that means to you. Maybe do your due gyrations you're working out however you stay in the fitness and see, wow, this is what my pod would be like if I had this. And you've got a really good idea of you know what you're in for. And I think what you're in for is tubeless, wireless, insulin pumping, being able to set Temp Basal, and extended boluses from a little handheld device, bang, bang just like that. And on the pod stands behind their stuff, customer service, there is astoundingly good. And I have found that to be true for Arden's entire life with diabetes. Arden has had an omni pod since she was four years old, she's going to be 16 this summer. And I don't call if I have a customer service issue. I don't call them the pod and be like, Hi, it's me Scott from the podcast, please give me extra good service. That's not how that works. I call in like everybody else. And I get the same great service that everybody else gets. I don't think I can say enough great things about the Omni pod, tubal send some pop. And at the very least, it is worth a shot. Check out the free no obligation demo. Now, you've got yourself an omni pod, kind of project into the future, you've got yourself an omni pod. But you really want to Dexcom g six continuous glucose monitors around out the back edge, right? You want to be able to give yourself insulin in a timely way, in a discreet way. But you'd also like to know when that would be a good idea. You want to see your trends, and my 89. And rising at nine stable, the nine falling all different situations, the dexcom g six continuous glucose monitor can give you that information. That's the kind of data that comes back constantly to your iPhone or Android, or to a dexcom receiver if you don't want to use it with your cell phone. But if you have it on your phone, well that opens things up, doesn't it? Imagine your child off at school or in a playground? You know, when we're allowed to go to playgrounds again, and you're at home or out in the parking lot? Doing whatever it is you're doing. I'm thinking playing like word Words with Friends probably trying to avoid little kids at a park. But that's not the point. You're anywhere you want to be. And you can see a loved one's blood sugar's what speed what direction to amazing anywhere, a person using Dexcom can share their blood sugar's without the 10 people if they want to. It's really excellent. That's like a school nurse, a mom, a dad, a grandma, my best friend, your neighbor, whoever it's up to you dexcom.com forward slash juicebox get started with the Dexcom g six continuous glucose monitor today. Okay, I didn't get blown out the window. But the storm is raging and I was here very bravely recording this ad. So, you know, check out the advertisers. There are links at Juicebox podcast.com. Right there in your podcast player. Of course, you can just type them into your browser, my omnipod.com forward slash juice box and dexcom.com forward slash juice box. Let's get back to Kyle is amazingly deep voice and hear the rest of his story. When you're diagnosed five years ago, and the Metformin and all that goes away, you're down with your mom it actually it's interesting in Louisiana that that you found I mean not it's how am I saying this? I when I asked people for care. When I asked for recommendations for great doctors that are some parts of the country I get less recommendations from Does that make sense? Yes, it's so I'm just wondering. She obviously your mom had a real good feeling about this doctor he sees you or she sees you. You have Type One Diabetes then what's the next step? What do you do next?

Kyle Banks 19:36
As hospitalized for two days and give them instruction about like you know how to inject insulin and and released sent out to the world to that's it Yeah,

my new life with Type One Diabetes.

Scott Benner 19:54
Yeah. Did you put on any weight in the hospital.

Kyle Banks 19:57
Again, my weight came back immediately.

I probably gained back all the weight I lost in it just as fast as I dropped it. Yeah,

Scott Benner 20:07
it's really interesting.

Kyle Banks 20:08
Mm hmm. It was just starting for those nutrients. And once the insulin got in, it was able to process it. Do what it was supposed to do again didn't Yeah.

Scott Benner 20:17
Have you looked back yet? and thought, wow, I was almost dead. Did you have you had that thought?

Kyle Banks 20:25
Yes. Yeah, yes, I could remember like, after the show would be so exhausted like I would have to sit in my dressing room for in the last thing we want to do is hang out in the theater after the show. We just want to get out and just whatever we do after the show, but I would literally sit in my dresser for sometimes two hours, just gain enough strength to like put on my pants and wash my wash the makeup off my face and walk to the hotel room across the street. It was definitely the close. I know I was really close to die. Yeah.

Scott Benner 21:00
Especially when your body starts giving away like that. The weight loss waste

Kyle Banks 21:04
such a wasting away. Yeah,

Scott Benner 21:07
cuz it starts getting into your muscles. And before you know it. I don't know. It's just It's terrible. I look back at Arden sometimes. And I think how close were we? You know, the doctors put a number on it. But you know, they're guessing But still, they thought they thought she'd be in a coma in another 24 hours. Yeah. And we brought her in and I was like, how did you get to Louisiana? You didn't drive in that condition? Did you

Kyle Banks 21:26
know we flying was a thing? You know, before the pandemic. I was like on a plane? At least three, maybe four times? Yeah,

Scott Benner 21:34
yeah, I get these notes. Now. They're like, hey, you'll come speak at this thing. And I'm like,

Unknown Speaker 21:40
maybe I will. Could I do it through like zoom or something?

Kyle Banks 21:43
Right. Now I'm driving everywhere.

Unknown Speaker 21:46
Can you wrap me in plastic and put me on the

Unknown Speaker 21:48
plane? To get sick?

Scott Benner 21:52
Meanwhile, it's probably gonna be fine. But you know, I don't know. The whole world seems like it's going crazy. Right? I guess for context for time. You and I are talking towards the end of COVID-19 while people are starting to go back and in the middle of the video church flirt riots. So right.

Kyle Banks 22:09
Yeah, every that's fascinating times in which we live. Yeah,

Scott Benner 22:13
no kidding. I, I'm just encapsulated by it for the last couple of days. Just you know, trying to wrap your head around. Everyone's perspective. Yeah, it's so clear how where everyone lands. Just think like, how are these things gonna find common? You know? Yeah, it's really, it's really ridiculous.

Kyle Banks 22:35
Anyway, at least

Scott Benner 22:37
Yeah. We it is ridiculous, right? Because you see somebody, you know, you see, see protests that seem well organized and intended. And you think, okay, that's right. And then four hours later, some guys like, you know, I could probably just piggyback off this to get myself a pair of sneakers. And, and then it becomes crazy. And someone thinks to light something on fire. And you're like, What is? What are you thinking?

Kyle Banks 23:03
Yeah, you know? Yeah, really? Yeah. Yeah. They really, they really went off in New York City and hit all of the high end shops.

Scott Benner 23:13
My daughter comes running down last night she goes, you should see what they're ripping off. And in Hollywood. She's like, She's like, a lot of people are gonna have great Pam bags. And it's so sad. Like, it really is. Yeah, I was listening to a family member of Mr. fluids. And he said he would not want people doing this. And yeah, you know, you just it the whole thing's heartbreaking. I don't even know how to,

Kyle Banks 23:37
you know, it really is. But yeah, to have people, like you said, piggybacking off of this moment, off of the protest, and using it as an opportunity to cause chaos.

Unknown Speaker 23:52
Or to put is pretty

Scott Benner 23:54
good, or to put any other thing in motion that I'll tell you. And I know, this isn't why you're on but it's just so timely at the moment. I saw a person make the point last night, that the rioting is a far left conspiracy to keep small businesses closed. And I was like, What? Wow. So wait, you're telling me that somebody went to Minneapolis, found a guy willing to murder someone with his knee and said, yo, we really need to keep the small businesses closed the next time you pull over a black guy could you kill him for me? Like, like,

Kyle Banks 24:27
Who thinks that way? That's deep.

Unknown Speaker 24:32
Crazy, is what it is. And I was like, I'm like, that's that's

Scott Benner 24:37
I mean, I guess the next question is, how much of this did the Illuminati have to do with and I was I just I backed away slowly. And I was like, that's enough internet for today. It really was fascinating. What's the impact on your day to day life right now is Is there any Are you just hiding inside waiting to go back to work like everybody else?

Kyle Banks 24:58
Oh, just hiding inside. waiting to go back to work like everyone else. And I'm here in New Orleans at the moment with my mom has a lot of like underlying condition. So I couldn't make it a point to like, continue quarantining, not seeing any of my friends that lived here. And if we do, like an outside spaces where the social properly social, or social distancing properly, and it's making sure I don't bring anything home to my mom, but um, I think, of course, I'm affected by all of the protests, just watching what's happening. On the news, it's troubling to see. Yeah. But, you know, it's definitely something that the protests was definitely something that's needed. There's so much pain and suffering happening right now. And it's just like the perfect storm with with George with George Floyd and Ahmad arbury. And then there's the situation in Central Park, you know, in couple of that with like, all of the suffering from the pandemic and people losing their jobs and not having ways to like provide food for their families. I guess nervous, which is really frayed. It's a powder keg.

Scott Benner 26:22
It really is. Yeah, I think my mom was that he was the guy that was jogging, right?

Kyle Banks 26:26
Yes. jogging. And yeah, I just

Scott Benner 26:28
kept thinking is this was going on? I was like, at some point, there's a tipping point in here, and we're gonna find it, you know. And it's just horrible. It's horrible. And I have to say, I hundred percent agree with you. At some point. You have to protest. Like, you have to go out in the street. You have to yell and scream. Yeah, I mean, you shouldn't be. I mean, first of all, if you're going to steal don't steal from $1. General, because what are you risking getting locked up for? For like a squishy ball in a cup? This like holds a lot? Yeah, I try to try a little harder than that, I guess. But seriously, they're coming out. I'm like, what could you need out of there? But anyway,

Kyle Banks 27:07
they were definitely successful it with that New York and LA on Melrose Place. But yeah, it is just awful, though. You can't just keep

Scott Benner 27:15
it things like this cannot continue to happen. And we just act like Oh, yeah. This is the thing that happens every six months. Yeah, you know,

Kyle Banks 27:23
this happened. I do you think it's good that the news is hasn't really been distracted with their messaging about what the protests are about as a result of like, all the fires that have been said, in the stores that are being looted? You know, they're still that they're reporting that, you know, especially NYPD is, it's reported that, you know, they know for sure that their outside influences, you know, sort of antagonizing the situation. And, you know, but it was was George Floyd is still like the center of

Unknown Speaker 28:00
the protest. I, I heard that. I think that's

Kyle Banks 28:02
a beautiful thing. Me too.

Scott Benner 28:04
I had heard that too. I'm sorry, I stepped on you there. But. So this When this happens, when people see protesting, then other groups can say, Hey, listen, if we send some people in there to cause trouble, they're gonna blame those minorities for that. And, you know, and it really is. Some people's minds work very deviously in a way that, uh, I don't, I can't appreciate, you know, so I just, I'm one of those like, I guess I'm crazy. I think just go do what you're doing, do a good job at it. That'll work out and you don't if it doesn't, doesn't work out for everybody. Keep going. You don't even like it just seems like life to me. But anyway, it was interesting what you said before about wanting to be out a little bit, but not wanting to be bringing something back to your mom, because she's got underlying issues. But also, if you looked at a lot of the deaths, being black was not a great thing for having COVID-19 Oh, yeah. And is that something community wide that people are aware of? And is it discussed?

Kyle Banks 29:06
Oh, yes. Yeah, no, here in New Orleans. I have a family distant family members that contracted to the COVID-19 and many households that lost their lives like a mother and two siblings. My mom's first cousins so distant relatives to me, but yeah, personally we know and friends of my mom's had lost their lives. So it's definitely in the effects of it have definitely been felt.

Scott Benner 29:41
Right. There's a when when Broadway opens back up, which there's no timeline for that yet as they're shooting for December But no, it's a it's a it's a touchy situation. Would you be able to go back if it was December, like for you in your heart personally.

Kyle Banks 30:00
I want to, you know, I'm hoping that things, I mean, I definitely would not do it if, as the as the way things are now, but you know if if there's a vaccine or if the if the virus seems to take a break in the coming months, and I'll definitely consider it. I mean, I love my job. I love what I do, and to not be able to do it is a it's a bit nerve wracking, but

Scott Benner 30:29
I'm picturing a lot of like paunchy gazelles jumping behind. So people have been on the sofa long too long, those first couple shows. Mommy does that. Does that look tired to you?

Kyle Banks 30:44
He does, sweetie. At his mom's house.

Scott Benner 30:50
Oh, my gosh, what? How much effort would it take to put you back into physical shape to perform?

Kyle Banks 30:57
Oh, well, I just I recently, about a month ago, I started working out again, because sitting on the couch is definitely taking effect.

Scott Benner 31:07
Your mom's probably cooking better than they do wherever you

Kyle Banks 31:11
most definitely. So spin stretching and working out at home. And so I'm getting, I'm getting getting in pretty good shape.

Scott Benner 31:19
I was talking to my son the other day because he should be. He should have been playing baseball through the spring. And then he gets a little break. And then he goes and plays in the summer. And I said to him, I was like, you gotta and he's working out sporadically. But he's like, it's hard to just without a goal. You can do maintenance stuff, but when you know, I have tasks I perform, and I know how to work out to support those tasks. And he's like, Can I do the workout and then I don't have the the other side of it is it gets it's kind of it feels useless a little bit in its interest. It really is interesting. basketball games are gonna be much more lower scoring by the time this is

Kyle Banks 32:00
bronze, like whoa, slow down.

I mean, the wake up call for me was I tried to put on a pair of jeans a few weeks ago. And I was like,

Scott Benner 32:11
well, in the beginning, I'm sorry.

Kyle Banks 32:15
All of my clothes are like basically the same size. So shopping. I need to do something about this

Scott Benner 32:23
to be hanging out in Louisiana in your underwear. Well, I tried to when this all happened. In the beginning, I looked at myself and I was like Scott, you cannot afford to gain any weight. So I just sort of went the other way. I've lost 11 pounds since COVID-19 started, because I like nice. I'm like I'm gonna have to like willfully go backwards. Or I'm gonna, you know, I don't know what will happen because trust me, I can't dance. And I can't hit a baseball either. So I'd be in a bit of trouble. When you left the hospital was it injections a pen? They give you a glucose monitor. How did all that kind

Kyle Banks 33:01
of pin hemlock pin and

lace?

moving a hammock pin and

Scott Benner 33:13
lattice for your slow Atlantis?

Yeah. Are you on the block? Now? Where do you still inject?

Kyle Banks 33:18
I'm on him on a pump and glucose monitor.

Scott Benner 33:22
Okay, what are you use? Dexcom? What? What pump? do you have? Omni pod? Could you write for the show?

Kyle Banks 33:29
All right. twinsies

Scott Benner 33:32
You certainly. Except trust me she she can't sing. So

Unknown Speaker 33:39
you know my pump?

Unknown Speaker 33:41
I lost your car.

Scott Benner 33:44
Good. I'm going yeah, all of a sudden you were like my pump and you were just going. So

Kyle Banks 33:49
yeah, my pump actually a malfunction. About two weeks ago, the PDM

Scott Benner 33:54
or the word PDF. Okay.

Kyle Banks 33:57
So I had to go back to the pins to add so luckily, I had the pins kenalog pins and Atlantis pins on me. And I'm surprised you I have to thank you so much. Because you have just given me I feel like it might be like two years ago I was introduced podcast is just researching, just looking for like more information on how to better take care of myself. And it was a

so sorry. Oh, who is that? That is a lovely Daesil What's the name? bazel bazel

like ardens bazel. Exactly. It's lazy bait. Exactly. Uh huh. Like if I if I have to think about bolusing and bazeley at least it's gonna bring a smile to my just

Scott Benner 34:55
Bell be an adorable dog. That's 100% true. I know. But thanks happier when I see him running around, I have this word attached to something else. But I can't believe that bazel would bark in the middle of you saying something amazing about me. So let's not overlook there.

Kyle Banks 35:13
But yeah, you know, you really just gave me like, the, the push, I needed to begin making decisions for with regard to my health and insulin therapy and, and just all of it. It's been great because it was at that point when I heard you know, being bold with insulin. Does that mean? And you know, just listening to you talk about like your experience with helping Ireland? Um, yeah, it just gave me the push, I need to just make some necessary changes.

Scott Benner 35:50
I appreciate knowing that. Thank you for sharing that with me. What was what was your life like? outcomes wise, prior to that those first three years, I guess, oh, just

Kyle Banks 36:01
a constant Yo, yo, okay. Like I would go, I would go to work and make sure that my glucose was really high. Because I knew that by the end of work, I would be crashing. So it was no real control. I didn't know what I was doing. I was just trying to get through, get through the show. And the only way I knew to do that was to just let myself go high. Otherwise, I would be crashing by intermission.

Scott Benner 36:26
I say I say how high did you have to come in at to make it through?

Kyle Banks 36:30
Not to 10? Okay.

Scott Benner 36:34
And then the effort and so was that? That was with pens too, right? That was pins for the for six months into my diagnosis, and then I moved over to the pot. Okay, so you still had your settings are off far enough with the pumps, though, that you've? So what do you do now to get ready? Is it do temp back, your basal rates,

Kyle Banks 36:54
sent back my bazel rates if I'm I'm, I'm from around 100 I'll cut my pot off completely for like an hour. Because activity will usually and I'm not not eating so the activity will usually sustain me. Yeah. And I'll still need a snack by intermission to keep from crashing. Okay. Um, but yeah, I definitely have a better system in play a healthier system, because I would not have a blast doing that, Oh,

Scott Benner 37:27
just a small portion of your check. When you go back in December, you just send it to the house, I'll say, for some time, just pick it's maybe it would be more reasonable. Now. That seriously, that's, that's really amazing. Do you can you I guess was my question. Can you describe to me Why have you ever been performing and felt yourself going low? What do you do in that situation?

Kyle Banks 37:51
That's another thing like the stress of like going low and having to drop out of scenes and having stage management so that when something happens in that show, it's like it's, it's it's just starts like a whole wrecking ball of like different departments needing to, if I drop out of the scene and stage management has to be contacted may have to notify the sound department which has to notify the wardrobe department in order to get another actor ready. And just at times, I was going low a lot, I have to drop out of scenes a lot. And I just really felt like I was affecting the show in a horrible way. Although Disney was they were very, really wonderful about it all making me feel they were more concerned about my safety. But me personally, I just felt like I was destroying the integrity of the show. At

Scott Benner 38:46
some point, it's got to be in the back of your head. Like they're not gonna put up with this forever. Right? Yeah, it gets some point. They're gonna say, look, we need, we need some consistency here from you. And we're sorry about your health problems. But, you know, this specific job Well, I'm glad that that didn't end up being the case.

Kyle Banks 39:00
And I'm really grateful to do and they were I mean, it's a it took me a while to figure it out. So they dealt with this for a few, maybe a year. Wow. So they were really they were really patient and understanding about me learning how to use this new technology that I'm using now. It's lovely.

Scott Benner 39:22
You said that you made some adjustments to your diet. Can you walk me through what you did?

Kyle Banks 39:28
Well, I'm not adjustments as far as being diagnosed was concerned. A few years before I was diagnosed, I began eating plant based diet. And And so yeah, that's, that's the I consume a totally plant based diet and I do believe that that has aided me a lot with regard to being able to to gain control.

Scott Benner 39:57
Okay, but the stuff you learned on the podcast applies Just as well to plant base as it does to prime Yeah, right.

Kyle Banks 40:03
Yeah. I mean, cuz boots do I mean it affects your glucose. So it even greens. So I mean it'd be minimal but they still have effect.

Scott Benner 40:13
It's funny there are some there are some vegetables that have more carbs in them, then you would venture to guess you know? Yeah, I'm always interested when people you know, in the beginning we start talking to them, they're so bad. I'm sorry for everybody listening, but you guys are so bad at like guessing carbs for for foods. And it's always I don't understand I did the right thing is such a confirmation bias like I counted, right? So I'll stop thinking about that portion of it. It's something else is the diabetes very common to get me you know what I mean? And, and I'm like, No, it's just you, you know, did you not count all this here? Or the fat or the protein like that stuff that no one tells you to think about it really? And

Kyle Banks 40:55
isn't it beginning, maybe, maybe for that entire year, I was probably given myself. I was dosing for 15 grams, regardless what was on my plate,

Scott Benner 41:07
that was just your go to.

Kyle Banks 41:09
That was my goal to Yeah.

Scott Benner 41:10
Now I've seen people that I might go to for artists 50. Just always like, it's too much. We'll figure it out later. But we're not going to have it be too little. That's for sure. Because too little just starts to little happen today. So you know, you and I were supposed to record a little earlier. And I had a hiccup in my day, which left me out of the house when Arden had breakfast. And Kelly did a pretty good job with her helping her with, you know, the overall amount of insulin. But their Pre-Bolus wasn't good enough. And so it started shooting up, I got home I fixed you know, I worked on fixing it. But it's now I'm looking at a graph, I can see. We're like three hours into this. Now, we stopped it at 200. And now she's more like 150. And she'll be back again. So our, you know, our meal disasters aren't maybe the same as other people sometimes. But still, it was all still the same problem. It was she used the right amount of insulin at the wrong time. The food got ahead of her. And now suddenly, we're scampering to put more in that isn't too much and and then it ruins a ruins a gap of her day. It now makes you think about diabetes for three hours. Yeah, you know, instead of just getting it in at the right time and being done with it.

Kyle Banks 42:25
So Well, that was another thing that I got from you just Pre-Bolus thing. I mean, what a game changer that was. Was that it should say,

Scott Benner 42:35
yeah, just putting the putting the insulin in a position to to have a chance. I mean, really is all you're doing right. That's very cool. That's excellent. I'm

Kyle Banks 42:45
hoping a lot of people Scott, I really hope you, you get that. realized how important informative the work you're doing is That's very kind of you. Thank you.

Scott Benner 42:56
I was gonna say that Kyle met. So Kyle was introduced to me by Sam and as you will remember, I think, what is her episode called Sam is the Robin Hood of type. I don't know, there's something about I really, I know, I'm sorry about how I named the episodes. But anyway, so Sam is Sam is a is a person who's just amazing at handling, like kind of stuff you would never think about, like with insurance companies and, and hammering on them for to help people and stuff like that. So Sam reached out and said, you know, Kyle wants to be on the show. And I just thought she knew you. And that was like, I was like, great. But she does. He loves the show. And I was like that's not true. Because then I got like, I felt a little giddy. You know, I was like, you know, and and I was like that's that's really cool. I thought she was just being polite at first.

Kyle Banks 43:44
When when you texted me I told you is so weird. I'm like listening to you right now. And now you're texting.

Scott Benner 43:51
I have to admit that when you said that I felt weird to so we were both on uncomfortable. The difference. Like, I was like I I see the downloads. But you know, I had a conversation with a woman last night for five minutes, that who's thinking about coming on the show to talk about something touchy and difficult. And she wanted to talk a little first. And she started telling me about how the podcast helped there. And it's hard to know how to respond. Honestly, like, I appreciate it. And I feel it I really do. But it's don't it's strange to have so many people saying something similar to you and and you feel it every time. But if I really let myself I'd start crying. You could have made me cry if you would have went a little longer just now I would have been like, Kyle's doing better. And he gets the dance now, you know, like and Scott, you did that and you know, like I could easily fall apart. I'm a very emotional person. So I have to kind of hold it back a little bit, right. I literally I can't cry every time somebody sends a note. But it almost happens to me a lot. And my family makes fun of me when it happens. Just so you know. They're like There he is. He looks weepy and

Kyle Banks 45:00
Some pleasant for me is when I'm saying I have a positive impact on people's lives can be an emotional thing for sure. No,

Scott Benner 45:07
I appreciate that. I really don't. But in your you have a an organization that you started?

Kyle Banks 45:14
Yes, yes. It's called Kyler cares. We found it a year ago. And then our goal is to raise funds for insulin pumps and continuous glucose monitors for kids living with Type One Diabetes, especially kids coming from marginalized communities.

Scott Benner 45:35
Okay. You're so you're hoping to you have an organization you'd like to bring money in, and then turn that money back around to people to get them devices that they can afford? You know, it's incredibly odd that you say that. And if you'll, if you'll allow me one second to look here. I just had a really lovely phone call with a woman named Rebecca, the other day, and I went out on a limb there saying her name out loud before I checked the email, because you know, you listen to this podcast, and I've I really, I'm not good with names. But yes, Rebecca, I got it right, from something called the Fincher foundation. And she has a foundation that's doing the exact same thing. Wow. And it sounds like and you know, and it sounds like she's pretty successful at it. So I can I can maybe make an introduction for you. If you'd want to pick brains or anything like that ever. Let me know. Because it's, it's something that most of you don't know. And I don't really know how you would but well, prior to the podcast, when I realized that the blog was really popular, and I wanted to do something good with it, I hadn't considered the podcast yet. And I had forms in my hand to start, like a 501. c three, because I would the same ID issue, I thought, I wonder if I could help people pay for pumps and glucose monitors. And then I got overwhelmed by the process. So kudos to you for sticking to it because it about halfway through looking at those forums, I was like, Oh, boy, maybe I'm not the right person for this.

Kyle Banks 47:10
It's overwhelming. The funny thing about starting a new venture is you know, you have all these grandiose ideas until you realize the process is what it takes to actually see it through. So unluckily for me, I announced this idea at a convention with like, 3000 people there before I even like looked into what it would take to start it. So you know

Unknown Speaker 47:34
what Kyle's gonna do?

Scott Benner 47:38
Now you have to where you got to go find all 3000 of those people and be like, Listen, don't tell anybody about what else. Do you have space online that I can look at?

Kyle Banks 47:49
I do Kyler cares.org.

Scott Benner 47:55
Ky le our car yes.org? Mm, right. Okay, take a look.

Kyle Banks 48:01
Yeah, we were, um, we were having we're, we're planning on having our first fundraiser concert, here in New Orleans, in August. Mm hmm. It's tapping into Broadway community just connecting with a bunch of friends of mine that perform in shows like Book of Mormon and Kinky Boots, and Lion King, of course, Hamilton, and they're all coming down to perform in New Orleans for the concert, call it from Broadway with love, had the theater space donated as a 2800 seat theater of the Sanger theatre. It's where all the Broadway shows perform when they travel here, donated the space. And we're just all ready to go. Let's begin with Vanessa Williams about headlining, and then COVID happened. So now we're

Scott Benner 48:55
at that split on a pangolin. And now whatever happened, and now you're done.

Kyle Banks 49:01
Well, we were transitioning that to like an online concert. Okay.

Scott Benner 49:07
I hope you get to do it in person one day too, because that that sounds really lovely. What was the idea? Were you going to put on small portions of productions, or

Kyle Banks 49:17
were performing love songs from some of the most loved musicals around now?

Scott Benner 49:23
That's really nice to see. I want to see that alright, that should happen lifestyle. We're gonna get to a point I would love to see you do that live. But I'll I'll definitely share the link here for people to check it out and donate if they can. Kyler cares.org and the teddy bears really adorable. That's the first thing that caught my eyes like I like how it feels like it's hanging a little bit worse up straight. I can't decide what I feel like it's doing. But one way or the other. It's a T shirt. There should be if it's not,

Kyle Banks 49:53
it is a T

Scott Benner 49:57
is very nice. So how do you plan on on finding people who need the help?

Kyle Banks 50:03
Well, I've been

with Lion King, we do a lot of research outreach throughout the years, so I was already connected to Children's Hospital. So I just reached out to them. And that's when I really began to understand like how grave The situation is, especially among communities of color. Um, this, people with T, one D, from communities of colors, they're frequently using pumps and CG is they lack access to the technology because of finances or they're underinsured. They infrequently perform glucose testing, they, they have less contact with management staff is a difficulty relating to staff because of socio economical and cultural differences. So there's just a whole slew of problems that that antagonize a really bad situation. Did you ever by any chance hear me when I spoke to Anthony Anderson? And I asked him, if culturally, it's just one of those things like, Oh, I got it. And now whatever is going to happen is going to happen. Like this is my lot in life, I have diabetes, is that is that a function of everything you just said, if not having good information, or someone who can talk to you, you know, where you can, where you can listen? Totally. And I don't even think that it's a conscious choice that people are making just to disregard their situation. It's just the cards they've been dealt, and they don't have the resources and or the information to, you know, tackle it. Probably.

Scott Benner 51:49
Yeah, it's it's so interesting that it's no different than any other thing. And so yesterday, my son, who I have to admit, is a really good kid, and it's not getting a lot of trouble. He went to visit some friends. And park somewhere, got his car towed. And he called me, and nothing like that never happened to him. And he said, He's like, my car got towed. And I said, well, get it back. You know, like, I just figured it out, man, you're 20, you're pretty bright kid can get them car back, you know. And it was interesting to watch him work his way through it. Because there were just simple ideas or concepts, tools that he didn't have. And when he, when he reached into his mind, he just there was no, there was no function for this problem. And it's, it stopped him. And so I said, Okay, here's what you're gonna do. You know, first thing I want you to do is go back to where you parked the car, see if there's any signs there to indicate who might have towed your heart. If not, we're gonna call the police department, don't call 911 call the the non emergency line, ask them. And then I gave him tools, then he went off, did it no problem came right back and said, and as you're talking about it, I don't see any difference between that in a health thing. Someone's put you into a situation that you just don't have, you don't have a tool for and your imagination can't find it. Because it just doesn't it doesn't know from it, you know? And then that's it.

Kyle Banks 53:13
In the healthcare system is it's impossible to navigate. So yeah, that just makes that makes I mean, I, even when I have to reach out to my insurance and figure out, like, you know, who's paying for what, and you know, who do I have to contact for certain things that I need? It's, it can be really challenging, and it also consumes a lot of time. Yeah,

Scott Benner 53:40
I can see very simply people going from all those questions that they don't have answers to, to, you know, what they gave me the insulin, I've got the needle, let me just do this. And that's it. And then and then whatever is going to be is going to be and I mean, it's very unlikely. Like you think about the things that you've learned listening to the podcast, and you think about how long it took me like, what a What a weird situation I was in to even be able to do what I did. I was a stay at home parent, I got put in charge of a small child. I had time I had no resources, the resources kind of fell apart. And for people who are wondering, what we're describing happens to other people. It happened to me too, I didn't walk into some magical doctor's office who was like, here's the things you're going to do you know it and we live in a in a place with a good with a good health care system, and we were at a good institution. And still, it wasn't like they laid it all out. For me. We struggled for years. And had I not started the blog and felt some function to make the blog more than just Hey, diabetes sucks, right? You know, like, I don't know if I even would have ever helped Arden and so every we all can't have that. Those, I don't know, circumstances that allow us that kind of time together. get to something, you know, it's it's somebody needs to step in and say, Hey, listen, I want you to get your bazel. Right, then I want you to Pre-Bolus. And I want you to do this. And when this happens, do that, and then you learn as you go. I just it makes sense to me,

Kyle Banks 55:13
honestly, like you said, having the time to do it. I know I worked for a, the only time I took off from work after my diagnosis was made the three days I was hospitalized. And I worked for a year, just going through the motions, you know, just trying to survive with this new pump, and you know, insulin injections and figuring out, you know, living walking around most of the day with exorbitantly high glucose numbers, right. Um, but I, after a year that I took a year off, just because I just needed to reset, figure out what was going on with me. That's when I was introduced to podcast. And that's really when I had the time to just study and figure out, you know, how to better take care of myself.

Scott Benner 56:03
Yeah, I understand when I get notes sometimes from people, and they're like, Can you just point me to the couple of episodes I need on my head, it's not that easy. You know, I'm like, and I think just take some, you know, take 20 hours and listen to these, and that should get you going. I don't have time for that. And I think I understand, like, I understand that you don't feel like you have time. But if you listen, it's gonna create so much extra time for you like, but not everyone's even, like, I'm assuming you would you do to go home for that year?

Kyle Banks 56:32
I did. came to New Orleans.

Scott Benner 56:34
Yeah, some support somebody was there to like, to help you out? Yeah.

Kyle Banks 56:39
To your fact, at the top of the podcast, where I received care at aashna Hospital, and they actually making since COVID. In New Orleans, as hard as it has, it's actually been in the press a lot. But I was surprised as well that my caregivers here and my independent chronology team and National Hospital was was. So that's the word I'm looking for. They have been so helpful and so good. And I'm surprised that they are as forward thinking as they are with regard to treating diabetes. That's excellent.

Scott Benner 57:19
I'm always excited when I hear that there are institutions that are out on the edge and, and leaning into good ideas, because that's the only

Kyle Banks 57:27
way that you know, I also have, because I've been has been part of my time here in New Orleans. And part of my time in New York. I also have doctors in New York, that I endocrinology team in New York that I work with as well. And I find that the doctors in New Orleans, surprisingly, are a bit more knowledgeable. Yeah.

Scott Benner 57:48
But it you know, everybody likes to say, yeah, if something done like that, go to the city go to Manhattan. That's right, I get it. Right. You know, but a good doctor can live anywhere. That's the first thing but and having the having the the nerve to not be so institutional that you're more worried about not being wrong than about helping somebody is is a big deal. You know, it really is. Well, that's an interesting story, man. It really is. I'm glad I did this actually, by mentioning current events, you got your podcast moved up six months on the schedule. It's good to go out this week instead of like, you know, at Christmas. Because I don't want six months from now people going

Unknown Speaker 58:33
Wait, what's COVID-19?

Kyle Banks 58:37
That would be beautiful. If that's where we are in six. I hope so.

Scott Benner 58:41
Yeah. I don't know how to wonder what's going to happen. But I do know that I I completely beside with what you're saying about being frightened to just go get sick. And then there's the other side of me that thinks of it on a macro level. And I'm like, we got to get going, like, you know, Okay, sit around like this. You're seeing what's happening. You let people sit around, not make money for a few more months. And, you know, and see, it'll take a lot less to set, set them off, you know, and I don't know where it goes from there. It's it's, I always wonder to how it feels for people who live in more remote places to flip on the news and see something happening in Boston and Philly in New York. Like does it feel like another world to them? Or, to me it feels like it could be at my house at any second because that's how close I am. Yeah, you know,

Kyle Banks 59:30
it Yeah, imagine something you know, it's been pretty quiet here in New Orleans. So we haven't been affected by like the riots and the looting isn't some protests, but it's been all relatively peaceful and calm and not really a lot of numbers. But I guess that's how people felt when when the quarantine first began, like certain areas wasn't really being affected. So they were wondering, oh, why why should I shut down in Idaho? Right and we don't have during any deaths here, okay, we're not experiencing what New York City is in California are experiencing. So

Scott Benner 1:00:07
I had a talk set up in Wisconsin, as this was all going down in the second week of March. And they were still like, no, you're coming. And it was like the 26th of March. I'm like, No, there won't be airplanes on the 26th of March. And they did not know what I was talking about. And then all of a sudden, one day, somebody got sick in Wisconsin, and then they figured it out real quick, you know, and I was like, that's, it's really interesting how that happens. I always go back to in my mind. My brother grew up here on the East Coast with us, but he moved to Wisconsin. And I took that Wisconsin gig, partly because I could see my brother when I went. But, but so he's got an East Coast sensibility about the world. And on 911 he called me He's like, is this really a big deal? What's going on? I can't tell here. And I was like, Yeah, man, this is his terrorism. And this is a problem. Yeah, you know, and he's like, Alright, he's like, that's what I thought he was, but the way they talked about it here, you know, a plane hit a building, but like, it was very, I don't know, laissez faire in the in the first number of hours, you know, right. Obviously, they figured it out after that. But in the very beginning, New York's one of those places, like if you've never been there, I suggest coming in underground, which you'll end up doing unless you drive. Because the first time you walk up in the sun hit your face, and you look up you'll think I have never seen anything like this in my entire life. You

Kyle Banks 1:01:27
know, it's crazy. It's intense. You got to be ready. Working at a Time Square every day is is definitely a treat.

Scott Benner 1:01:36
Yeah, I we, you know, obviously I haven't been up in a little while because of all this, but it is a real, you just you've never, most people have never seen a building that tall next to a building. That's all that goes on seemingly forever. So many people moving. in unison, but separately, it's hard to put into words really generally mean but there's a flow of people it works. And I don't know I love it there. I love it out here in general on these coasts. I like I like, I like that feeling that the same guy that may flip you off or bumping into him a block later if you tripped and fell would stop and be like, yo, you are right. Yeah. It's just it's a it's a, I don't know, it's a weird thing. That's hard to put into words. Unless you've been there. Is there anything that we didn't talk about that you were hoping to?

Unknown Speaker 1:02:30
Um,

Unknown Speaker 1:02:31
no, we would cover

Kyle Banks 1:02:32
we covered a lot, you know, just basically, definitely the the organization kind of cares. We're figuring out now what our first fundraiser is going to look like later in this summer. So just be on the lookout for that. And we were also going to be producing some pieces of in collaboration with the partners that partnerships that we have with like the New Orleans Saints, the NFL, mobile snack cakes, intellect index calm, which sort of like help with like, marketing the message about centered around self care, okay? Because it's, it's a, it's, it's a really big issue. People just not having the information not realizing that the big with just minor tweaks that can really just make life with this disease a lot less stressful and just make life better.

Scott Benner 1:03:40
Yeah, I used to joke that if people figure out what I'm saying, isn't that complicated? They won't need the podcast anymore. But I don't joke like that anymore. Because then other people have been ripping me off. So I'm like, it is complicated. I'm the only one that can tell you.

Kyle Banks 1:03:54
But no, no, this is like one of the areas where, you know, copying is sort of like, it's gotta be flattering. You know, when you when you hear somebody

Scott Benner 1:04:07
do it. My wife is such a pain. She's like, she wants me to take the dogs out. And I'm like, she doesn't realize I'm still going. I listen, I'm not gonna joke with you about it. I'll be I'll be seriously. It is flattering to start doing something that people see and think, Wow, that's great. where it hurts a little bit is how much time and effort I put into the podcast. Then I see somebody else like trying to be like, oh, look what I thought to do. And I'm like, Yeah, like not that Pre-Bolus thing is patented. I'm not saying that. But there are ways that I explained things that I know for certain. I figured out and then I hear some and I hear someone used those exact words. And then there's two feelings. There's the This is great. It's getting around. But then there's the part of me who makes the podcast who wants everyone to listen to the podcast. You know, I mean, so it's a very interesting it's a it's a weird thing. It's a weird thing to have happen, because you definitely just want people to be healthy. Yeah, I suppose definitely. Yeah. But at the same time I want my downloads

Kyle Banks 1:05:14
you should get, those are

Scott Benner 1:05:15
my downloads, don't take my downloads.

Kyle Banks 1:05:18
You know, the thing I really would like to stress, especially with people of color that may be listening to your podcast is not I mean, you glucose now in how it affects you today is one thing, but the thing we really need to look out for is its effect on your life in 510 15 years from now, because I have been in communication, people who were just having the most heinous complications, and it's awful to see someone at the age of 35, you know, dealing with neuropathy and high damage in or females having pregnancy complications, or young males who who have to deal with erectile dysfunction in their early 30s. And like, it doesn't have to be that way. Yeah,

Scott Benner 1:06:01
no kidding. There's, there's just like everybody, there's always going to be somebody who no matter what happens, their body's just not going to do well with the diabetes. But for the most part, for most of you, for most everybody, there are certain easy things you can do to stop that stuff from happening. And it's like you said, it's, it's easy now to think oh, that's later it probably won't happen to me. But man, when it when it happens to you, there's no going back, you know, you it's not pretty, it isn't going to be something you want to deal with. So I appreciate that. But I'm going to put the link in for sure. And I'll mention it against the people here. That link of course is Kyler cares.org ky le r ca r s dot o RG or if you can imagine how Kyle would say it. Okay, why no, I can't do it. His voice is beautiful. Isn't it? Makes me feel like I'm feel like I'm squeaky over here. Thank you so much to dex comment on the pod for sponsoring this episode of the Juicebox Podcast. Please go to my on the pod.com forward slash juice box or dexcom.com forward slash juice box. Why did I say or it's and go to both of them? Find out more about the sponsors. A couple of housekeeping things first, and not that Disney needs to help. But if you've never seen the Lion King on Broadway, it is a beautiful spectacle. It is an absolute charm fest Did you hear that Thunder? It's coming. Whoo, geez. This could be a people, Episode 343 with a podcast and I get another one going up in a cyclone apparently. But before I do, let me ask you, if you Hi, just in case I get pulled up into a tornado, you might want to go to Apple podcasts and leave a wonderful review of the podcast. You know, so that other people who are finding it for the first time can trust what they're going to hear. They need to take a leap. And it might just be your review that lets them feel comfortable trying the podcast. So if you can do that, I would really appreciate it. What else if you're looking for, you know, some deep conversation with other listeners, check out the Facebook page for the Juicebox Podcast. There's of course the public page. It's called bold with insulin. And there's the private page, the juice box discussion group where people get together and talk about management ideas. It's a really great tight group. I'm proud of it. Honestly, there's over 3000 people in there now. I'm juice box. If you have a great physician that you'd like to suggest to somebody else, go to juice box docs.com and send me your addition and I'll add it to the list. It's JUICBOXD OCS calm and anything else. Hmm. I'm gonna be doing something cool next week, but I can't tell you about yet but I will tell you about it as soon as I can think it's gonna add to my understanding of how insulin works a lot actually. So I'm excited about that. It's embargoed for a while. I think I can tell you it a few more days. Oh, you know, dex company will be back on the show soon. I think the CEO is going to be back probably on June 16 ish around there. A lot of stuff going on at FX calm. Kevin Sayer is going to come back and fill us in on that. And I don't think oh, and I just recorded a really great afterdark today that I think you're going to enjoy. And next week I'm doing a bunch of recordings with Jenny so Jenny Lee backson. Speaking of Jenny, all of the diabetes pro tip episodes are collected at diabetes pro tip calm if you'd like to share them with a friend. There's no assets diabetes pro tip.com takes you to the collection of the episodes from the podcast. You of course can listen through your podcast player but easy way to share or to revisit anything else. Hmm No, I think that's it. I think I've covered everything.

Unknown Speaker 1:10:11
If I yeah,

Unknown Speaker 1:10:21
no, I was up say