Scott Benner 5/9/22 Scott Benner 5/9/22

#678 After Dark: Nolan's Story

Jen has type 1 diabetes and is here to tell Nolan's Story of addiction, mental illness and overdosing.

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

Scott Benner 0:00
Hello friends, and welcome to episode 678 of the Juicebox Podcast.

On today's episode of The Juicebox Podcast we have another in the after dark series. I'll be speaking today with Jen who has type one diabetes, and is the mother of three children. Her son Nolan had type one diabetes, and he also struggled with addiction. Jen does a very brave thing today sharing Nolan's story with all of us. And I'd like to thank her right now, for what must have been a very difficult hour. She was honest and open, as she discussed Nolan's life and his struggles. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you are a US resident who has type one diabetes, or is the caregiver of someone with type one, spending a few minutes today at T one D exchange.org. Forward slash juicebox. Taking their survey will help people with type one diabetes, T one D exchange.org. Forward slash juicebox. Take the survey

this episode of The Juicebox Podcast is sponsored by touched by type one, a wonderful organization doing amazing things for people with type one diabetes, learn more about them on their Instagram page, their Facebook page, or at touched by type one.org. The podcast is also sponsored by the Contour Next One blood glucose meter. Learn more Get started today. Or just buy the thing at contour next one.com forward slash juice box. My daughter's meter is a great meter. And I think you're gonna like it to contour next one.com forward slash juice box.

Jen 2:11
Hello, my name is Jen. I am a type one diabetic and the mother of a recently deceased type one diabetic.

Scott Benner 2:18
Okay, Jen, I know you from the private Facebook group. Yes. How long have you been in that space?

Jen 2:28
In the private Facebook group? Gosh, probably less probably about a year. Okay. We not that. Yeah.

Scott Benner 2:35
Yeah, not not all that long. The group might not even be like two and a half years old. So you could have been there for a very long time. And it not been that long. On the calendar. I guess that my I'd like to ask you a little bit about yourself first, I guess. How old are you now? And how old are you? Where are you when you were diagnosed?

Jen 2:57
So I was I'm 48 years old now. And I was diagnosed around age 40. I have what they call led a diabetes. I had a very slow onset, they thought that I was a type two until I almost died. Well, one doctor knew that I was the type one. He tested me for the autoimmune antibody. And I had that. And so he diagnosed me as type one. And I was proud 4041 When that happened

Scott Benner 3:34
prior to that, were you struggling with diabetes and nobody had tested you.

Jen 3:39
You know, I had I had gestational diabetes. And no, I hadn't had it really tested other than the gestational. My sugar stayed high. After I had my baby. We don't really know how long I had I sugars. But I was having trouble with getting infections. I got pinkeye maybe 20 times. And I wouldn't I just kept getting pinkeye. And so they checked me and started me on Metformin, which did not do anything and I just continued to get sicker and sicker. Put me on a couple of other type two medications. And then I went into the UK and had to have I got cholecystitis, which means my gallbladder had gall stones. And I had to have my gallbladder out. And they found out that I was a type one. So they did they finally did a fasting C peptide and checking in those type one

Scott Benner 4:41
from this. Oh, I'm sorry. I didn't mean to cut you off. Nope, that's okay. Go ahead. I was gonna say from the time that you began to not feel well. From I guess the question is, from the time you were gestational till the time you realize something was wrong was how long? About five years? You're okay. And then from that time until somebody told you you had Lada How long was that?

Jen 5:08
I'm sorry. So it was about it was not feeling well continued after I had my child, my youngest. And it was about five years until they said that I have IDs.

Scott Benner 5:19
I see. Okay. All right, Jen. I hate to say this because we went through so much trouble before we started, but I don't know if I like the headphones. I might. I might try without I might just ask you to go through the phone. Yeah.

Jen 5:34
Okay, one moment, okay. Is not a problem now. Thank you. I gotta turn them off. Hold on a second. Okay, how's that?

Scott Benner 5:49
Yeah, it's probably going to be better than the headphones straight in your longer sentences. They strain. I don't know how to put that other than when you speak more than a few words. Your, your, your ladder words in those sentences start to kind of drift away. So okay, yeah,

Jen 6:05
just just a moment. Now, is it better now like this? Yeah, you're

Scott Benner 6:09
fine like that. Okay. So I'll keep it off speaker

Jen 6:12
and on the phone. Okay, thanks. Yeah,

Scott Benner 6:16
it just sucks because you've got to be cognizant of your hair, not touching the phone and like all kinds of little things that make noises, like whatever that is, and like, you know, that kind of stuff. So just do your best to find a spot where you're comfortable. Okay, okay. So you this all happen after your youngest. So how many children have you had?

Jen 6:35
I have three children? Three. I had Nolan, Patrick and lemon is my youngest. What are their ages? So lemon is 13. Patrick is 21. And Nolan passed at age 24. Just a couple of weeks after his 24th birthday.

Scott Benner 6:52
Oh, one right after his 24th Okay. And you were about 24 When you had Nolan.

Jen 6:58
Yep. I was 23. Okay.

Scott Benner 7:02
So you have type one diabetes. Am had no one been diagnosed at this point yet?

Jen 7:10
Yeah, he was he was diagnosed before I was he was diagnosed at age seven. Okay. And yeah, I think if he hadn't been diagnosed, I likely would not have even gone to the doctor for what was going on with me. I would have just chalked it up to being old.

Scott Benner 7:26
being old. I don't know. I don't know how old you are. 3030 some years old. But I hear what you're saying. Well,

Jen 7:31
but with the first time you're 30, you don't know what it's like to be 30.

Scott Benner 7:35
Yeah. So no, I understand. I just would have seen like, oh, I guess this is the path of my health. And right, that's right. I understand. So let's talk a little bit about when Owen was diagnosed, how did you figure that out?

Jen 7:51
Well, that was interesting. He was he was getting infections that wouldn't go away. And I'd taken them to the pediatrician. Oh, gosh, it seems like every other week, I was in nursing school. And I remember, I just took him to the pediatrician so much because he had sinus infections. And then he had this big, swollen parotid gland. So that's right on your jawbone. And he just had his face was uneven. And so I took him in. And they said, well, hmm, I don't know. I don't know what this is. And we did some blood work. He did like a complete blood count. He didn't do a sugar. He didn't do a metabolic panel, otherwise, we would have known. And then I took him and he sent me over to an en te to look at the parotid while the en eyes went to two different un and T's because one was just kind of a mean guy, and I didn't like him. And the other wanted to operate on him right away. And by that time, I was in nursing school, and we were learning a little bit about diabetes. And by that time, Nolan had started to wet the bed. So that was a big flash for me, though. Well, he's wetting the bed. So I took him. They wanted to schedule surgery, and I said, Well, shouldn't we just find out there? He's not diabetic first, because he's wetting the bed. And he said, No, he's wetting the bed because of his adenoids. And I said, That's it. And I said, Give me his medical records. So I took him over to my doctor, who on December 20 2000 tour said, Sure, we can do a blood sugar check. And we did a blood sugar check. And he was up in the seven hundreds hadn't eaten, because he had been vomiting that day. I mean, he was diabetic. And so he referred us

Scott Benner 9:45
to imagine right? He was he was in decay as well.

Jen 9:49
You Oh, yeah. Oh, yeah. He had fruity breath, all the things that you look for. And they actually he referred us to a pediatrician who was an internist. Just at their office. So he came in and scroll down. One U, H for our Q 15. One for you l QD, meaning one unit for every 15 carbs of human login meal time, and then four units of Lantis daily and send us home. You didn't go to the hospital? Yeah, my dad came in and said, you know, arguably a lot of people would say you should go to the hospital. Do you want to do that? And at the time, I was an idiot. And I was like, Well, no, the hospital means he's sicker. Okay, so we went home with no blood sugar meter with a script for insulin, and a kid that we could very easily kill that day. Yeah. So yeah, that's what it was. That's how that happened.

Scott Benner 10:49
What was at that time, if I'm, if I'm doing the math right here, Patrick's around four years old. Maybe you have two small kids. Yeah, yeah. And are you a nurse now? Did you finish nursing school?

Jen 11:02
I did finish nursing school. Yes. And yes, I'm an RN, now, okay.

Scott Benner 11:06
Yeah. What was life, like, growing up with a kid who had type one, you know, what was? What was the pathway for you and for him,

Jen 11:18
you know, I, I submerged myself into the diabetes world, spent every moment on on websites and research and looking for why this happened. I was still in school. And in school, it was funny, because I was learning the opposite of what I was learning in real life about diabetes. So I had to really kind of temper myself for school and make sure I passed the tests by giving the wrong answers. Just because nursing care for diabetes is not very succinct. It's not very, it's not what people with diabetes do. I started to volunteer at diabetes camp, we started sending Nolan to camp and I just really immersed myself in the world of diabetes to the point that, you know, I think my family missed me. I think I missed him a little bit, I think that I, I put so much into this tragedy that happened to my son and trying to make it better and trying to find the best care for him and do the best that I could for him that I think in some ways, I kind of lost him. I forgot that he was a whole person.

Scott Benner 12:31
You just, you just saw the diabetes.

Jen 12:35
I saw him too, but I felt so I've just really wanted to make it as good as possible. You know, and just really make sure that he was getting the best care possible. And that and that, you know, we we fought it.

Scott Benner 12:50
Was it were things not good? Or was that just your perception that they you're trying to get them back to perfect?

Jen 12:59
I think it's my perception. I think he was doing well. I mean, his his a onesies were all great. He was doing well. He he took it in stride. like you wouldn't believe there were some battles when he got older, but he just really took it well. I think that just the regular things about a child kind of fell by the wayside. And I don't think anyone minded or thought any different of it, but in retrospect, I see that now that you know, he was a musician. We did We did music stuff with him. We took him to the conservatory and he did his drumming there and stuff and, and you know, but I feel like it was always me falling behind going, Oh, your sugar, sugar, you know, and you do you have to you have to make sure they're okay and not landing in the hospital. So really, it's a fine line, taking care of a kid with diabetes.

Scott Benner 13:58
So, okay, I guess knowing the rest of the story is tainting how I'm asking my questions, but Sure, but I guess there's no way around that honestly. Sure. Is there any chance that Hindsight is making you think this like when did you start coming to this conclusion I guess

Jen 14:19
I think I started coming to the conclusion I think I came to it right away. I think I came to it right away realizing this is this is I'm making a choice and this is the most important thing making sure that he stays alive and and that he is in good control and that he doesn't have complications later. So I think hindsight does taint it. I don't regret anything I did and I wouldn't do it differently because you can't you do what you do when when it's going on and and I would do so much of it just like I did. Because you do have to you have to advocate for your child. And I did A lot of that. You know, you have to go to bat for them, you have to argue with the school you have to you have to the school nurse is either your ally or your enemy. And that can get that can get really touchy, too. I don't think I would do a whole lot different though. I think there's days when I think that I would. But what I would have done differently would have led to him leaving us sooner. So like if I just allowed him to do everything the way he wanted to do it, he would have been gone sooner.

Scott Benner 15:35
Okay. The technology back then. So Nolan's diagnosed in 2004. Is that right? Yes, that's two years before Arden was diagnosed. So our technology path is going to be very similar because there was no, there was no great leap from 2004 to 2000. No, it wasn't so you were get you probably had. I mean, maybe a pen if you were lucky. But needles and a small meter. That was all you're here.

Jen 15:59
Yeah. Right. Yeah. And started pumping though. Yeah, pretty soon.

Scott Benner 16:04
Okay. So your your, your focus is on trying to keep his blood sugar's stable, trying for him not to be too high or too low. Aiming for that a once every three months, it's pretty much feels like your only ability to understand how well you're doing. And that was right. The extent of it. Is that right?

Jen 16:24
Yeah, yeah, pretty much. Yeah.

Scott Benner 16:28
Was he having a lot of lows or highs? Do you recall?

Jen 16:32
He had a few lows. He didn't have a whole heck of a lot of lows. And his highs were like under 200. So he wasn't really he was really in good control. I think his first A once he was five something. And then he just slowly made a climb. Like I think the highest he had before he was 18 was in the sevens. Yeah. Okay. Um, you know, he was usually around six, okay, you know, six and a half, seven. And so he did really well, until he got older.

Scott Benner 17:04
And so through regular elementary school, middle school, he was doing fine. Did he start to ignore his diabetes at any point, as he got older,

Jen 17:17
middle school, he started he wanted to take it, take it into his own hands more. And I was told at the very beginning. As soon as he was diagnosed as you need to let him as his diabetes, you need to let him do his stuff. Okay, so I tried my hardest and that was excruciating. Because he would, you know, middle school, he, he just kind of got tired of it. I would say, Do you have your kit? Yes, I have my kit. Can I see it? No, I have my kids in my bag, or you put my bag mom. Okay, so I take him to school. And I get to work on the other side of town. And I get a phone call from the nurse that said no one forgot his kit. And there wasn't my card had fallen out of the bag. But this happens so often, like almost daily. And he would start to lie about his blood sugar's and, you know, 107 it's 109, you know, and finally realized that if he was gonna lie, he should give me a believable number. It's 210. You know, I mean, he, he just became really resistant to having diabetes. And he was tired of it. He didn't like it. But he also that's when mental illness starts showing up as well. And that's when he started showing a lot more signs of mental illness as well as middle school. And so he had we just behaviors and stuff like that, and he would get in trouble at school. And I mean, it just became a whole lot to deal with.

Scott Benner 18:46
Right? Were those mental illnesses ever diagnosed?

Jen 18:49
Yes, he was diagnosed with bipolar disorder when he was oh, I want to say 18 He was diagnosed with ADHD at a young age, which we know now that a lot of ADHD in children shows up later as bipolar disorder. They're on the same spectrum. I didn't know that until recently, but so a lot of kids are misdiagnosed and medicated. And that's what happened to Nolan. I don't want to say he was misdiagnosed you can have a DD and bipolar disorder.

Scott Benner 19:21
Right. So he was being medicated for ADHD when he was younger. Yes. Yes. How does what can you remember the first time you thought something's really wrong? Like how does bipolar show itself the first time in your situation?

Jen 19:37
I think the first time I realized something was really wrong

Scott Benner 19:50
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Jen 23:05
you know, I guess when he got kicked out of middle school, he got kicked out of middle school because he bought a marijuana joint from a kid in the bathroom. Now the kid has sold it to him get to stay in school. I'm not sure how that worked out. But being diabetic and being one of the only diabetic kids that is Middle School. And on top of that the only diabetic kid with with a 504. Is it a 504? I can't even remember now with a care plan. Yeah. And a mom that was involved. They were really happy to get rid of them. And I thought that but I thought no, Jen, you're just being paranoid. That's not why. But yeah, they're happy to get rid of the diabetic kid who they have to answer to the parents of. And that was a theme that kind of went went around like him and another kid would get in trouble and he was always the one that got in more trouble. What so he bought what he bought was a fake marijuana joint in the bathroom, oh, and middle school, but that's what happened and he got kicked out. So he went to alternative school and now alternative school they had, you know, trouble getting him to listen and the teachers really sat and talked to me and said, Look, you know, I'll ask him to do this sweep the floor. And I come back in an hour and he still hasn't done it like he's this is a problem. And that's when I really started realizing that there was some some issues with him. He seemed absolutely normal. But his functioning level was not he just compensated so well.

Scott Benner 24:36
So there was you didn't see the big swings it wasn't manic and then depressed. It didn't go back and forth like that.

Jen 24:43
Unfortunately you know, with high blood sugars, we get moody. And so I did see mood swings, but we didn't know Is it is it at first we thought it's diabetes stuff. It's diabetes stuff. and it is. And then we thought, well, it's bipolar stuff. And it also is. And there's just no way of knowing which one it's related to. Keeping him on the bipolar medications was, was hell, he didn't want to take them, they make you feel crappy. I would find them hidden. You know, they, they'd been in his mouth, they were hidden. I check his mouth, say, show me that you swallow. Like it was like jail. Right? And he just didn't like them and wasn't going to take then most people with bipolar disorder don't like the medications, because there aren't really very good medications for

Scott Benner 25:35
Yeah. And so this just persists on I mean, he wasn't really going to middle school anymore. Like alternative school doesn't sound like it's not it's not a public situation, right?

Jen 25:45
No, it's for kids that are kicked out of middle school for behavior stuff. So, you know, he got put in behavior classes when he was in high school, he went to regular high school. And the behavior classes were such that they were in the basement. When the regular kids walked by for lunch, the behavior kids were made to turn around and face the wall. It was it was not good. I'm not sure. He really didn't, he never thought he never had sold drugs in school. He, he just was a he was kind of a jerk. You know, he would giggle and not do what he was supposed to do. And he had fun when he was in school with other kids. So I think that he is, I always said he glowed in the dark, because of the diabetes, because of the involved parent. I remember going into the school and it was the first day of school, I had to go have my meeting with the nurse. And three or four different types of kids type one kids at the high school walked in and the nurse said, Okay, what is this your insulin? What do you How much do you take? And they're like, I don't know, how often do you check your blood sugar, like in the morning and at lunch? And she's like, okay, and you take how much she's like, they're like five units. And she's like, okay, and that was their plan. And I thought, that's crazy. You know, these parents aren't involved at all.

Scott Benner 27:14
Well, you have, obviously, intersecting issues that we're all coming together to share, I give you up. And then the bipolar comes, and even was ADHD early on. And then I imagine at some point, drug use ramps up.

Jen 27:29
Yeah. Then he started with drug use. And he started smoking marijuana, and taking pills from kids. And he did that for a few months and was just ridiculously tired of it. And I remember getting a text message him from him at my job. And it said, Mom, we need to get me help. real help. I can't keep doing this. I don't want to keep doing this. And I just cried. So I started trying to find him help. How old was he would have been about 16. I want to say 15. I'm sorry, he was about 15. And I was working at the hospital in a clinic. And I would spend every break time calling and calling P MCs which they're called P MCs. They're for kids with medical and substance abuse issues or behavior issues. And they they're all medical, the m&p MC is for MediCal. None of them would take him he had Iowa Medicaid. And I could not find a single place in Iowa to take him because of the diabetes. They said they were not equipped to deal with somebody with type. They weren't comfortable. They weren't equipped. They didn't have a nurse. Yeah,

Scott Benner 28:50
I've heard this a lot on the podcast when people are trying to get extra help for their kids that have you know, extenuating issues. And yeah, and then places are always like, well, we don't take kids with type one happens a lot.

Jen 29:03
And it's ridiculous. So I called the American diabetes Association. And I got an advocate who sent a letter and they got in touch with a social worker who was wanted to advocate for him. And we forced a couple of places to take him. And they would kick them out. They would find a reason to kick them out. One of them said, there was a bunch of kids that ran away. And no one opened the door to let them back in when they came back. And he mumbled something about why I want to run away or something and they sit up that's it. You're done. You're type one, if you run away, you'll die. It's a liability. And that's and they kicked him out. They made me come pick him up on Easter. And it was over in Fort Dodge. They I asked for his medical records because I was going to deal with the advocate on it. And they you know, told me my kid was not an angel and I said well, I didn't think you're safe. But thank you But I do think you should keep them in treatment facilities. You know, just it seems wrong and people have really a lot of trouble believing Oh, they won't say no. Because the diabetes? Yes, they absolutely 100%. Well, and that is a tragedy.

Scott Benner 30:19
Yeah. Well, where does that where does this all lead to? I mean, that that's a rehab. It's not. I mean, he's not getting you know what he needs from there. Obviously, they're, they're kicking him out of there. And now he's back on you. Are you married during this?

Jen 30:33
I, he's his dad and I divorced in 2009. So his dad is an alcoholic. And as that plays into a lot of his problems, his dad's an alcoholic with major mental illness. In fact, his father right now is missing. We don't know where he is. He was eluding the police about three days before Nolan passed away, and is jumped in and faked his own death. figures on suicide and now is hiding from the police. Wow, that's so that's that's it? Yeah. It's really an interesting twist. Drama,

Scott Benner 31:07
I'm not looking to go down his path. What kind of what kind of mental illness for him?

Jen 31:12
Well, I would say schizophrenia, but he's not diagnosed, but definitely bipolar. But he has a lot of paranoia. You know, he's just a really smart guy, very talented musician. Just really clocked out of his kids lives and was an abusive person. So Gotcha. Yeah. mentally abusive,

Scott Benner 31:35
right? Like that. So does Nolan's drug use like it? Because I'm thinking back to when he says to you, I can't do this. I don't want to do this. But but he was, I'm assuming self medicating, at that point. Trying to get around, eventually go back to it.

Jen 31:52
Yeah. Oh, yeah. He didn't ever stay sober for too long. You know, self esteem and all that kind of plays into into your choices. He really had trouble staying sober. And he got into, you know, he drinks sometimes it was never his drug of choice. But he did start using methamphetamines. Probably when he was about 17. We would take him to the hospital, I would find him. You know, I find him downstairs in DKA. We take him to the hospital. And after we'd have him in the hospital, in the ER, ICU, then we'd go to psych. And psych would be able to send him somewhere. Because what we wanted to do was find a place that would get long term treatment and maybe get him out of Sioux City. halfway house, that kind of stuff. But did so he would go to Cherokee, which was the mental institution and that's the one place that would always accept him. But it would happen the same way every time er, we'd start making the calls. We'd go to the ICU, we'd spend another couple of days making the calls. And eventually, Cherokee would always be the place that would take him. And so they take him up in the ambulance up there. Sometimes he would pull out his own IVs and try to walk out of the hospital and have to be stopped by the by the security there. But they always would take him and he turned 18 up there and Cherokee. We went all the family went up for his birthday party. We always kept in really good contact with him. His grandparents on both sides were very supportive. His brother and sister and I would always go up and visit and his dad tried to visit a few times. It's sometimes he wouldn't see his dad. So it just back and forth with Cherokee and finding different placements and and just in and out of treatments for the last seven years.

Scott Benner 34:04
Yeah, Jim, I try my hardest to just sort of stay dispassionate while I'm having these conversations. But Nolan had his 18th birthday party in a facility that almost made me cry for some reason. I mean, we've been talking for half an hour, nothing you've said has been like, you know, right. Not happy. Yeah. Yeah. And yet that got me. Yeah, really. He

Jen 34:27
went, he went from the pediatric unit to the adult unit on his 18th birthday. And we took pictures we they let us use a party room there. So we all drove up to Cherokee me grandma, grandpa, Indian grandma, grandpa for cello and and just all the family went up and his brother and sister and we were able to have this birthday party and it was just very bittersweet.

Scott Benner 34:54
Let me ask you a few questions about this from your perspective. So now, at this time, it's been a few years When he's 18, are you hopeful that this is going to get turned around? Or is this the thing you live in every day? That you're just like waiting for the other shoe to drop? Like, what's the what's the feeling in the back of your head? Oh, okay.

Jen 35:15
Yeah. Oh, like I think at that point, I had hope. But every time something else would happen, it was a shoe dropping, and there was always a shoe dropping so many shoes. And I think we, I always held out hope. But I always knew in my heart somehow, that no one was like, a gift that was on loan, if that makes sense. Ever since he was a little baby, I kind of knew that. And, you know, he started overdosing, he would be fine for a little while, and then there'd be an overdose. Or there'd be, you know, finding him comatose, calling the paramedics to come get him, he's having behaviors, big time, just breaking everything in the house. He just, and I had hope. But I saw him suffering so much. And that was the hardest part. It was to see somebody you love so much that you brought here, you know, that didn't ask for an invitation. And to see them suffer like that, to see him suffer with the diabetes ruined me. When he was diagnosed, I just, it was the worst thing that could have happened. And and I don't know why. Because it is not the worst thing that can happen. But it's pretty bad news. It's really hard for parents to go through that. Yeah, I took it really hard.

Scott Benner 36:45
Yeah. I can tell you that. I can tell no. Yeah. Talking about throwing yourself into it. How Oh, anything? It was.

Jen 36:54
It was it was everything. I just wanted it to go away. Because I think I think because, you know, we saw a little problems with him before when he was a kid. I think I thought just why him? Why not someone who can handle it better? Why not me? And I said, God, give it to me instead. And then God misheard me, he's had I said, as well. Why any hearing aid? I know. Anybody know,

Scott Benner 37:21
I just need to ask you just for context here. Do you have any mental health issues?

Jen 37:25
Um, I have ADD, and I have some depression. Um, so yeah, I those are mental health issues. Yeah. I think my doctor asked me if I was bipolar. A problem, I guess, mildly. I've always been really functional. But when I was a little kid in school that add was that wasn't a thing then. I mean, I'm 48 years old. We didn't have medicine for that. Really?

Scott Benner 37:52
There were just kids that didn't listen. Yeah,

Jen 37:55
there are lazy they like calling me lazy. I hate that word. Hate it.

Scott Benner 37:59
How about your other, you know, your other two kids? How are they?

Jen 38:03
So Patrick is I would say the perfect child or what they call the family hero. He has very few problems. He does struggle with depression. But he does seek help for it when he needs to. He's really ideal in the sense that he's been very self sufficient. He's very caring and kind, very funny. Just very healthy and forward moving now. He no one was his best friend. He lost his best friend. But he's really pushing to do some things now in life that he might have had on hold. So he's I you know, I don't think anyone in my family is 100% healthy, but Patrick's pretty good. Lemon. My 13 year old. She's wonderful. I think she's just an amazing kid. Two, she's learning to play guitar. She working on a feminist fanzine that she's doing. She's just really a cool kid. She does struggle with all the trauma that she's seen in her life with her brother. And the dynamic between her brother and I, I think it's got to be so hard for both of them to go through because with the drug addiction, there was just a lot of anger and and unhappiness and so many tears and so much trauma. And with the diabetes, and both of us being diabetic and moody, just you know, Nolan and I were a lot of like, in some ways. I always say he got the worst of me and his dad and then it was amplified. But he's really, you know, I think they I think both of my other kids are are very fortunate to be very bright and very aware of their own situations

Scott Benner 39:57
or their other autoimmune 's with any buddies, celiac thyroid anything.

Jen 40:03
So I would say that Patrick, who will not go to a doctor about it has possibly got like, IBS, celiac or something. He does have some stomach problems. But no, nobody's been diagnosed yet.

Scott Benner 40:17
Okay. How about your exes side of the family? Do you have any knowledge of them?

Jen 40:22
They don't have any and I'm close with the family. They don't really have any autoimmune. You know, they've got cancer in their family, but no and heart problems, but no autoimmune.

Scott Benner 40:31
Okay. So I'm gonna kind of fast forward a little bit now, because I'm assuming that from 1819 2021, it's just probably story after story of hard times, and craziness and stuff like that. Yeah. Are you? Absolutely. How did you take care of yourself during that time?

Jen 40:51
Well, that's a really good question. In all honesty, I don't think I did. I stressed a lot, I worried constantly, I wasn't sleeping. One night, I had thought, well, I can't sleep. This is so stressful when we have a glass of wine. And so I started drinking wine to go to sleep. And it didn't take very long until I was a full blown alcoholic, I could not stop. I checked myself into the hospital, in a what I like to call a bold career move, because I live in a very small town. And I went to treatment, so that I could stop drinking, and I haven't drank since that was three, almost three years. Good for you that I'll go. Yeah. But I if I didn't believe that addiction is an illness, I would be ashamed. But I wish I hadn't taken that first drink. You know, I didn't drink at all before that for many years. But it just it got me. Yeah.

Scott Benner 41:58
You were. I mean, was there a moment when you like, Did you see the juxtaposition? Did you say, Well, I'm medicating myself, the way that no one is?

Jen 42:08
Yeah, yeah. I said, I saw it right away. I saw it right away. But I couldn't stop. I went to meetings, AAA meetings and got my 24 hour chip, probably 24 times. You know, I wasn't able to physically stop I was having withdrawals and all of that and it was, life had become so stressful. that I had, just I guess I kind of threw myself into drinking. And I kind of had given up.

Scott Benner 42:45
Okay, yeah, I was gonna say at what point during all this to just go Alright, Everybody get in the garage. Let's start the car and go to sleep. Like gig. Yeah, seriously? Yeah.

Jen 42:55
Yeah, I felt like it not with the other two kids. But honestly, I had ideas of, you know, I felt so no one. He doesn't fit anywhere in this world. There's no help for him. I can't help him. Nobody seems to care. He doesn't, you know, he just can't get the help that he needs. He doesn't belong on this planet. And I'm just gonna take him with me. I had thoughts like that. And that's terrible. It's terrible. But I didn't want him to go alone.

Scott Benner 43:21
I can understand. I mean, what your Yeah, it's not what Listen, my kids got type one diabetes, and you know, thyroid. And you know, last night, for example, her toes got numb, which seems to be happening out of nowhere. And you know, like, there are things like that, that you think, well, these things suck. But we're gonna get through life, like, reasonably well, pretty great. But at what point what point does someone just pile one too many pebbles on the pile? It's on your head. And you just think I can't I just can't like it. Yeah. Not only that, you can't shoulder it. But that, that none of the things about life that make life pleasurable, exist anymore, because you have diabetes, you're depressed, you're drinking, he's doing drugs. He's got diabetes, he's bipolar. There's no second in the day that I can imagine for you where you were just like, you know, Leave It to Beaver. Like none of that existed. Oh, no. Yeah. Right.

Jen 44:15
I mean, I still make dinners for him. I still did like a lot of mom's stuff. But I clocked out, and for about about 18 months, I clocked out and then, you know, a clock back in and I knew that things wouldn't be perfect when I clock back in. You know, there were times when, when I would be so drunk that Nolan would pick me up and carry me to bed up the stairs. And I just thought that was so funny at the time. All isn't it funny? And it wasn't funny. I mean, it's really sad. But we also had that mutual love for each other that we cared for each other so much that, you know, he wanted to take care of me too. And when I wasn't drinking, he couldn't take care of me. And that caused some sadness for him. But it got to a point. I said spent so much of no one's life, so afraid of him dying, just petrified that he's dying. And then one day, I realized that now more than being afraid of him dying, I was afraid of doing this when I'm 80

Scott Benner 45:18
I see this, and that was a big deal. It's never gonna stop.

Jen 45:22
And I became more afraid of of that than him dying. Because I knew he was unhappy. I knew that I was unhappy, I knew that my other two kids were suffering. And it was becoming a burden on everybody around us. Because with drug addiction comes so much manipulation, and so much pain for the people. Like my mother could never say no to him for anything. You know, and, and because she loved him. And he would manipulate and cause harm. You know, he would take things from people sell them for drug money. What drug addicts do?

Scott Benner 46:02
Yeah. Are you saying I'm gonna, this might be ham fisted for a second, I gotta get through this thought. But are you saying that at some point? It it mimics I don't know, like someone being born with so many birth defects or so many medical issues that you think to yourself like, this is not this person's not equipped to live life even. And if you start thinking about that idea of like, maybe this is just a failed experiment, and it's not fair to them to be in this situation.

Jen 46:35
I think after I picked him up out of comas, so many times and Ted go to the hospital and psych Yeah, absolutely. And he had said to me himself, you know, I, I had complained a lot about it, like no one, this is hurting me so much to see you in the state that I see you in almost dead, like the time before he died that he went to the hospital, his body temperature was 87. That's dead, but he lived through it. And the doctor told me he's gonna have really bad brain damage and damage if it wasn't fine. Like he was fine, except for. He wasn't fine. But he probably lost some impulse control. But he didn't, you know, they said he was going to be a vegetable. And I'd said, Well, we're not going to keep him around as a vegetable. That's not what he wants or what anyone wants. But yeah, you're you're right. It was like it felt like that. Yeah. You know, now that you say that it felt it felt a lot like that. This is that I was doing more harm by keeping him around. And he even told me, Mom, stop saving me. Maybe it's my time to be an angel. And I thought

Scott Benner 47:41
he could that he could think that is one thing, but for you to hear it and to think, well, he might be right. That's another that's another thing like, like his, his existence felt cruel to him.

Jen 47:54
It did. Yeah, it did. Okay. I mean, the the existence with diabetes is cruel. The existence with diabetes and bipolar disorder with schizoid, fast, effective traits. That's mean. No, that's not. That's terrible.

Scott Benner 48:11
And then in that situation, the drugs are inevitable, actually, I mean, I've spoken Absolutely. I've spoken to enough people have have Bipolar to know that the drugs are are inevitable after that. So yeah. And you describe something that I don't want to skip over. And I also don't want to make you dig through it too deeply. Because it sounds painful. But the one thing I think maybe we're not talking about is that being lost on drugs doesn't exactly set you up for taking care of your blood sugar as well. So no, right. So not only is he kind of obliterated on what was the drug of choice by the end, methamphetamines. Okay. Not only is that happening, but on top of that wildly out of control blood sugars.

Jen 48:53
Oh, yeah. He became septic, probably five times and had to go to the hospital in the last year of his life. He tested positive, you know, he tested his blood sugar was in the 1500s. When they had him in the ICU, one of the times it took him three days to get it down. Below 700 I feel like it was ridiculous. He had sepsis, which is deadly. He had tested positive for tuberculosis. Like the kid made it through so much. It was done his body just the havoc that that wreaked on his body. You know, it was poor body and he I just looked at him and I think what a beautiful kid he was, and all the things that were going on inside of it the brain and and his body.

Scott Benner 49:50
If I give you a magic wand, you can lift away one of his troubles. I'm guessing it's the mental illness stuff, right?

Jen 49:58
And it's funny you say that because when he was cared, it was always the diabetes I'd take care of, it's always the diabetes, that I would take away. But once the drug addiction started, it was definitely the mental illness I would take away because that would help that would have that would have made it easy to recover from drugs easier to recover from drug addiction.

Scott Benner 50:18
This is uh, maybe, uh, maybe this questions, not clear, but or maybe it is, but if you take the bipolar away, do you think he was still an addict? Or do you think the drugs were a function of the bipolar?

Jen 50:31
I think the drugs were a function of the bipolar, okay, for sure. I don't think you would have tried the drugs at all, he was so impulsive as a kid. You know, if someone said This feels good, he would have tried it. And he was always that way. very impulsive.

Scott Benner 50:47
Gotcha. Okay, so anyway, geez, Jeff, give me a second. I don't know how you're living through it. Because it's, it's on top of me now. Oh, no, no, I'm okay. I don't want you to worry about me. It's just, I'm just listening very intently to what you're saying. And I'm thinking ahead and trying to imagine things. And it's a lot all at once. Yeah. So when do I know? When do I see you? Like, pop up in the Facebook page? Like, what? What got you there? Like, what made you find? Did you find the podcast first or the Facebook page? First,

Jen 51:26
I saw on the Facebook page first. And I think out of all the Facebook pages that I belong to for the for diabetes, this was the one that was that was good that had that was more real to me. And I posted something about Has anyone else ever struggled with Max meth addiction? I was reaching out this was the last time that he was in the hospital, Biddle. Um, was it maybe it was when he was in treatment, and he went to the hospital in Champaign, when he lived in Champaign, Illinois, and he was in treatment there. I had just said, you know, my son's in the hospital, he's has anybody else ever struggled with the meth addiction? What do you do? You know, what is this, you know, just reaching out. And the response that I got from people was one, so supportive, and to so much response, and I was just, I was shocked. Because most people kind of ignore that kind of thing. Most, especially parents with diabetes, they don't want to, they don't want to hear it. And they don't want to see that that could happen. They just, it's, it's too much to think about for sure. And that's something I thought about, I don't want to worry, parents of new diabetics by any means.

Scott Benner 52:40
That's my for you, I listen, I often have this thought, while I'm making the podcast and seeing all these people's lives virtually, that, you know, people, you know, babies are born every second, there's just countless numbers of them. And they're all going to go in slightly similar in slightly different directions. And some kids are gonna end up being alcoholics, and some kids are going to end up not and some kids are going to end up on drugs. And some kids aren't some kids are going to be incredibly kind. And some people are going to be mean and like blah, blah, blah, blah, right? And right. And we knew you have this idea when you're when your kids are younger, and they get diabetes, like oh, this is the thing they're going to be except those people still end up being alcoholics, drug addicts, nice people, etc. You don't you don't think of that when they're eight. And I'm, you know, I can hear when you're talking about Nolan even. I feel like you picture him sometimes. Like he's six, seven years old, when he's just nothing but possibilities.

Jen 53:38
Yeah, yeah. And I saw that throughout his life, I still till the till the day he died. Well, maybe a couple of weeks before I stopped, kind of, but he was doing so poorly. But I still had fleeting moments till the day he died of feeling. Hope for him. Yeah. And you know what a smart guy he is and what he could do, you know, he, he was very smart. And he was such a talented drummer and an artist, and just all of these things. And I thought, you know, he had just gotten a tattoo gun for his birthday. His grandma said, that's what he wants. Should I get it for him? And I said, Who cares? At this point in his life, getting whatever makes him happy.

Scott Benner 54:24
All right, in this rocket right into the ground. Great. Yeah, let's go for it. Right.

Jen 54:27
Yeah, basically, yeah. And he wanted to tattoo me and I was actually going to let him after he, you know, showed that he could do a tattoo on himself. And so he did a tattoo on himself, which he had done when he was younger anyway, with the kid made a tattoo gun out of a remote control car motor, like he was 10 or 11. When he did that he just was smart, but the deviant and because who wants to kid detect?

Scott Benner 54:54
What a weird, weird parenting moment my child has fashioned another device out of a device except pig likes to draw a picture of Scooby Doo on himself. So now I'm not sure, exactly.

Jen 55:04
Well, you know, he tried to he tried to tattoo the word love on his arm. But I confiscated his gun. So he only had the first two letters. So it said l o. So I called it his British tattoo, I'd say hello. He got so mad.

Scott Benner 55:20
So, so back to where you're at in that Facebook group, like you come in, you asked that question, what I saw, and I can't see the whole group, like, it's too big for me to, like, stay on top of but what I saw was a lot of just support for you. I don't think people had a lot of practical advice, but they were there was a ton of kindness

Jen 55:41
to absolute so much kindness. Yeah. Was how much time was

Scott Benner 55:45
that actually helpful for you are?

Jen 55:47
Absolutely, absolutely. And a lot of people saying yes, my sister's a drug addict, or this and that and just talking about people who had addiction in their family, it just opens up the conversation for people. And it's so liberating. Because you don't go around, you know, everyone's got that bumper sticker that says, you know, my son's an honor roll student, you don't say, hey, my son got into a really good treatment facility. I would, I would, but but they don't make that bumper sticker. But shouldn't they? Yeah,

Scott Benner 56:18
my son handles math fine. Just yeah, no way to do that. So so he gets put into treatment around the time you're on the Facebook group, and then gets out. And then it happens again, am I remembering that right?

Jen 56:32
Yeah, he came back to Sioux City. And he relapsed pretty quickly. And then he had, I want to say two or three more stents in the hospital.

Scott Benner 56:44
And he made these related stuff.

Jen 56:46
It was always for diabetes. But it was always because so what would happen when he would do the math and he would be up on meth for several days, and then he would go to sleep and people on meth sleep for several days at a time? Well, unfortunately, Nolan doesn't have several days to sleep because he needs to take insulin. So many times, I would kind of try to follow his pattern, I would go to where he was, I would give him insulin, I would find his insulin and give it to him. And, and that was another thing is insulin was never kept in a good way. You never knew if it was expired or what you know what you were, you'd give him whatever, right. And sometimes he would fight you and if he was going to punch me, I wouldn't do it. You know, I would say okay, we're gonna go I, I love you goodbye. But I would try pretty hard to get his insulin. And it's a miracle that he lived through that as many times as he did. So he would wake up and take insulin and you know, his sugar would come down and he'd be fine for a week or two. And then you'd start up again. So this pattern is hard to follow the pattern because it changed.

Scott Benner 57:57
Testing. Give me a testing.

Jen 57:59
Yep. Testing.

Scott Benner 58:00
Okay, sorry. So you were trying to chart you were trying to find a pattern you and you couldn't. So when you went and visited? Yeah. You were visiting him like in like, where he was held up using it, wasn't it? Was he even living on his own? Or was he bouncing around or

Jen 58:14
he was homeless for a while. And then he on his birthday? September 16, my mom let him move back in. He was already kind of staying. He would go there to shower during the day and stay for a really long time. And she would make him leave at night. There was our you know, we were trying to do the tough love, like you can't do drugs and stay here. But she just couldn't. And I'm glad because he died at home and not on a street corner at my mom's house. And yeah, so and I had been I was in Des Moines, so I was two and a half hours away. And then on the way home. I got a call from Patrick. And Patrick said, Nolan is cold. And he's not I don't think he's breathing. And I said, Okay, call 911. And I had just left the morning and had two and a half hours to travel. And I called Dennis who was driving in front of me my fiancee and told him what happened. I said, I think no one's gone. And this is something we just were, it was a matter of time, because he had just been in the hospital weeks before that we just knew. And you know, I hung up the phone and then I panicked and lost it and started crying. My youngest was with me and she started crying. And we were just kind of panicking all the way home. And then we got home and he was gone. The paramedics come and pronounced him dead. My mom lost her mind and you know, it just it was it was a big family and then we just kind of sat around and told stories about him and It felt peaceful.

Scott Benner 1:00:02
Can I? You You said you knew this was gonna happen. I remember you being on line once and saying that he was in a rehab, but they kicked him out or something and you were like he's going to die like you were you were positive like a week before this happened that it was going to

Jen 1:00:18
yes, this was this. This was not in rehab this that was in the coffee psych facility in the hospital, and he was supposed to go to inpatient treatment. And they had had him signed up to go to inpatient treatment, all the doctors, and I'm looking through the doctor's notes and everything, everything says inpatient treatment. Well, the very last day, the nurse practitioner who has done this before, several times, let him go. And I called, I heard that they were gonna let him go. Because he called and said, Can you pick me up? And I'm like, hang on, let me make some calls. So I called and I talked to Sarah, the social worker, and I say, Tara, she can't let him go. He's gonna die. He almost died. The last time he did she know, he almost died. And she said, Yeah. And I said, Does she know that he's going to die if she lets him go? And she was quiet for a second? And then she said, Yes. And I just lost it. I couldn't, you know, and then we picked him up. And I picked him up and took him to my mom's we talked to her, they decided he couldn't stay there if he was going to use and he said, he's, you know, he wouldn't stay there. And he was homeless for a couple of weeks. And that's, and then he came back to my mom's he was at my mom's for another. He was I suppose he was homeless for a week. And he came back to my mom for two weeks, and then that's when he died.

Scott Benner 1:01:49
Well, I'm very sorry that any of this happened.

Jen 1:01:52
Thank you. Me too. Of course.

Scott Benner 1:01:54
Can I ask you? Was there any sense of like, relief? That's might be the wrong piece?

Jen 1:02:01
Or no, yeah. It's not a wrong word. Yeah, there was lots of sense of relief with it. I mean, because he wasn't suffering anymore. You know, we had our first holidays. And not only, I mean, I missed him so much. And it was hard, and it was sad. But when you have a drug addict, the holidays are not good times. Because you're constantly worrying about what is what are they going to do? What are they going to show up and have a problem with? How are they going to, you know, he would become very, his sugar would get really high, and he would be extremely moody and mean, and yell and verbally abusive, and just these things that would just very upset me so much, even though I knew that it wasn't coming from his heart. It's just upsetting. And so there's been relief. But then there's been the extreme sadness, and then the the sadness for what his life should have been. Yeah. Came right. You know, I hate to say should because that's presumptuous. But I what, what it could have been or what, you know, why did he have such a hard time? Yeah. You know, and all these other kids get to have nothing physically wrong with them. You know, all kids with diabetes have such a hard time.

Scott Benner 1:03:19
Yeah. But then once it starts to, when all this other stuff on top of it, though. Oh, yeah,

Jen 1:03:25
absolutely. Absolutely. Is that fair? And I don't think life is supposed to be fair. I'm not. I'm not one of those people. But I mean, nice was a little more fair.

Scott Benner 1:03:38
A little more fair would be okay. Yeah. How long has he been gone now?

Jen 1:03:43
So he died on October 3 2021. So it'll be six months coming up soon here. It seems like longer. And so also, it seems like yesterday, too, sometimes.

Scott Benner 1:03:54
So has this. I've so I still barely don't want to ask you these questions. But you can. It's pretty open, has his passing made your other kids lives easier in some ways, and harder in some ways.

Jen 1:04:09
It's hard for them because they lost their brother and their friend. But it opened doors for sure. One, I've gotten to know them a little more now. So they kind of get their mom back, which is nice. We're learning to know each other a little bit now. Patrick is going to go to college now. He's never gone left town or anything like that, because he's wanted to stay home in case something happened with his brother. That was never asked of him. But it's just what you do for family. So yeah, some doors are opened and I think that Nolan would have been very, very happy to open those doors.

Scott Benner 1:04:52
Was he aware of the impediment that he was on other people's lives?

Jen 1:04:58
I think so. And he was definitely aware of how much he impacted my life. And he would say, don't do those things for me. He wanted independence, he wanted that. But we knew what would happen if he had it. And it did, you know, the more I pulled back, the more sick he got, and I but, but pushing more and taking more control would have made his quality of life so poor. Because what 24 year old wants to be taken care of by their mother,

Scott Benner 1:05:37
I think you're in a completely Listen, my understanding of all this is is, you know, obviously not yours. But I've now interviewed two people who have who are bipolar. And now have this conversation with you about your son. There's an after dark episode, I think it's back in the three hundreds, it's just called after dark bipolar. And it's okay. It's with a young man who has type one and bipolar. And I'm telling you that if his experience was even anything like your sons, I don't understand how you're supposed to. I don't understand how you're supposed to win. You know, so I couldn't see a path through it. When I spoke to him. I don't see a path to it. While I'm speaking to you. I think that you're either. I mean, I'm trying to figure out why you seem so okay. Right now. Or, I mean, how is

Jen 1:06:29
it? I think, I think that I'm okay. I guess, I guess it's who I am deep down. Like I said to the lady doing my eye exam, she had known me and known about my son and said she was sorry. And I said, you know, I got it late. Think of it this way, I have two amazing children living and I got 24 years was an amazing, brilliant human who taught me a lot. And I have to think of it that way. Because there's no any other way is very negative. And really, and don't get me wrong, there are times when all I am is a bundle of tears, and I just hate everybody around me. And I have to curl up in a ball and go cry by myself and write sad stories and just feel incredibly sorry for myself and miss my son. I have to do that sometimes. But then there's other days where I wake up, and I feel that way. And I I let myself do it for half an hour. And then I have to move on with the day. I do some yoga, I'll do some, you know, make some coffee and just read or meditate and then just go to work. Whatever. I I guess I speak about it, frankly, because it is Frank. It's It's It's facts. And missing tremendously most of the time, but I still feel him here. If that makes sense. It does.

Scott Benner 1:07:58
When you close your eyes and you think of him. Is he at a certain age?

Jen 1:08:03
Yeah, I think them at about 2021. Okay. Yeah, I think of him about 21. I mean, I miss him as a little boy, but I think of him is perpetually about 21 With just a little bit of scruffy facial hair, messy hair, making some dumb joke driving around with the dog in his car. You know, his best friend was that dog Tommy and he I'd be driving home from work and I'd see him pass me on the road, the dog sitting in the passenger seat like a girlfriend. It was just the cutest thing in the world. So

Scott Benner 1:08:40
was he able to have any personal relationships.

Jen 1:08:44
He had girlfriends. And he had a lot of long term friends a lot more friends than I knew about because his funeral is packed full of kids. He did have friendships and he had some girlfriends, but towards the end, I think the addiction and he even said Who wants to go out with a drug addict? You know? And I said, Well, yeah, I always hoped you'd find a girlfriend that would be like a nurse and want to take care of him. But I didn't I wouldn't want to do that to her either. Right? Because it's too hard.

Scott Benner 1:09:17
Do you think? How, how prevalent Do you think that the drug problem is in your area? In general? Oh, it's

Jen 1:09:26
huge. It's huge. There's a lot of it here. So cities, especially with methamphetamines, it's really big. And alcoholism is huge here too. It's kind of you know, it's a conservative conservative area of Iowa where there's a lot of very poor people. And then there's your middle class and then there's a lot of very wealthy people. The poor and the wealthy are make up a huge portion of the population. And it's anytime you have those economic issues you have people that are doing? I mean, some people use methamphetamine so they can work three jobs. And they do it for years.

Scott Benner 1:10:07
Wow. Yeah. And not to make a ton of money just to keep going.

Jen 1:10:11
Oh, yeah, just pay the bills. Right.

Scott Benner 1:10:12
It's sad. No kidding. It's sad. Jen, is there anything that I haven't asked you about that you wish we would have talked about?

Jen 1:10:21
I don't think so. I think you did a really good job asking good questions.

Scott Benner 1:10:25
Thank you. I've been looking forward in an odd way to talking to you for a while. Me too. Yeah, I just know that. As the as the day gets closer and closer, and I see your name coming closer to me on the on the calendar. I just I don't want to do a bad job is how I started thinking as it gets closer. Oh,

Jen 1:10:45
you do? Wonderful. You did great. I made me feel good. And no judgment. And I really liked that. And the stuff you said to me before, too, about this is real. This is real stuff. And you don't want to sugarcoat things like that. No pun intended.

Scott Benner 1:10:59
Yeah, I just think that, um, I mean, listen, I whoever would hear Nolan's story, and judge him. I mean, has no, no, no idea about health or, you know, like, it's just, there's only so many things that can get attached to you in the course of a lifetime, then they're gonna drag you down. Point. Like, I mean, yeah, they're not like, you know what I mean? Like, it's, yeah, mental illness is still completely misunderstood by some people. This this poor kid was, he was just taking the past that were available to him. And yeah, none of them are good. No, you know, it's not that there was a good path available, and he just decided not to take it. I just don't think his options were in any way going to lead them to where anybody would hope for him to go. Yeah,

Jen 1:11:47
I agree. Yeah.

Scott Benner 1:11:48
I'm glad you said that. No, it's sucks. But I mean, it does.

Jen 1:11:53
Get 24 good years,

Scott Benner 1:11:55
ya know, and I'm really impressed with your excuse me. I'm really impressed with your ability to, to focus on the good stuff. Thank you. Yeah, no, it's really wonderful. I want to wish you a ton of success. And are you taking care of yourself now? How's your time? I am. Yeah,

Jen 1:12:14
I am. Yes. I just passed my written out but the tests with no retinopathy so I'm, I'm happy with that. Because I'm old. And yeah, yeah, I'm doing I'm doing good. I finally got myself to You know, I'm on the league right now. And and I'm taking a lot better care of myself now, too. So, in honor Nolan, we always say that everything goofy that we do. We say it's an honor and all and and everything, you know, but there's a lot of things I do in honor of him too. So

Scott Benner 1:12:41
listen, I we didn't talk about him at all. But the bravest person that story is the guy that's dating you.

Jen 1:12:47
Yeah, I know. Tell me about it. He's He's a lucky guy. Dennis is a really good person. You know, he has a good you know, his dad was a type one. So he has a lot of understanding of that to

Scott Benner 1:12:59
really well, I'm glad you found. I'm really happy. Like it made me happy to think that you that you have somebody. Yeah,

Jen 1:13:05
you're the second person to say that today. So yeah, you're right. It makes me happy too.

Scott Benner 1:13:10
Yeah. I mean, you've been through a lot too. You deserve it. And sort of your children, I hope I hope Patrick goes off and, and builds a big life for himself. And I think lemon sounds like she has enough time to kind of process all this and, and find her own way. So

Jen 1:13:27
he's doing good.

Scott Benner 1:13:28
I'm glad for you.

Unknown Speaker 1:13:29
I thank you so much, of course.

Scott Benner 1:13:40
Once again, a big thanks to Jen for coming on the show and sharing Nolan's story. I also like to thank touched by type one.org. And remind you to head over there and check them out. And the Contour Next One blood glucose meter, which you can learn more about it contour next one.com forward slash juicebox. There's also links in the show notes of your podcast player, and links at juicebox podcast.com. To these and all the sponsors, head over to t one D exchange.org. Forward slash juice box and take that survey. And if you're interested in more after dark episodes, I can tell you about them. Let me wait The music's just wait one second.

There are so many more episodes in the afterdark series. Couple of ways. You can find them either at juicebox podcast.com, scroll down, you'll see them there. Or you can go to the private Facebook group Juicebox Podcast, type one diabetes, go to the top of the page, the page or the top of the page, click on the featured tab. There's some featured posts there. One of them says Juicebox Podcast series. And there's a whole bunch of lists a whole bunch of lists. There's lists of lists. No seriously, there's these really great little graphics that break down different series. For example, there's some special episodes. There's the Pro Tip series, the quickstart guide how we eat diabetes variables. Scott and Jenny episodes, how to Bolus for fat and protein. And right now, there's so many great lists here. Oh, there's a whole series about pregnancy, thyroid, and then after dark, this is a episode. What do we say at the beginning? 677? No 678 of the podcast, but it might be like, oh, gosh, let me I can read them to you. First afterdark was it episode 274 is about drinking to 83 was about weed 305 trauma and addiction. 319 was sex with type one from a female perspective. 336 was depression and self harm. 365 was sex with type one from a male's perspective 372 divorced and co parenting 380 For bipolar 393 bulimia and depression 399 heroin addiction for 22 is called afterdark Ami. 450 psychedelics for 62 Sexual Assault PTSD for 72 living with bipolar five await adult child of divorce 531 diabetes Complications 545 Eating Disorder 558 life struggles 577 50 years 585 ADHD cocaine and abandonment. These are the titles 606 childhood trauma 618 sex worker 627 Male disordered eating 651 recovery and today of course 678 Nolan story. Check them out. I think they're some of the more brave episodes of the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#676 Dexcom G7 is Getting Close

Jake Leach Executive Vice President and Chief Technology Officer at Dexcom is back to talk G7.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 676 of the Juicebox Podcast.

Today on the Juicebox Podcast, I don't know why I'm talking like this. Let me start over again. On this episode of The Juicebox Podcast, I'll be speaking with Jake leech. Jake is, you know from Dexcom. He's been on the show a bunch of times. And he's here today to talk about g7. It's a short episode, but it's full of good information. If you're looking forward to the Dexcom g7, you're going to like what comes next. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you are a US resident who has type one diabetes, or is the caregiver of someone with type one, your answers to simple questions are valuable. Go take the survey AT T one D exchange.org. Forward slash juice box in fewer than 10 minutes, you will help people living with type one diabetes while you're supporting the Juicebox Podcast.

This episode of The Juicebox Podcast is sponsored by us Med, get your diabetes supplies from us med find out more and get your free benefits check by going to us med.com forward slash juicebox. Or you can call I love reading the phone number. It brings me back to my childhood when I watched television, I was who my parents were the television. And then the ad was nevertheless ready. 888-721-1514 That's 88721514 Call now. That is how every ad when I was a kid ended? Was that the phone number that they said call now. Anyway, if you call that number, or you go to the link, you can get a free benefits check and get started with us, man. I'll tell you more about them later. I actually just switched over Arden's on the pods to us med.

Jake Leach 2:25
We're working on getting g7 approved, sorry about being late. It's not a stupid excuse. That's literally what I was on the phone talking about. That it's approved, don't take that as long as the record is more of like three questions. All

Scott Benner 2:42
right, hold on a second, I can't get my light to come on. So I'm going to be in the dark. But I'll still be see if I can throw a secondary light on. No worries. Let's see. Hey, how are you? Good, man. How you doing? I'm on okay. So is that really what you were doing? You weren't just like in the bathroom? And you couldn't get here on time? What was that? No,

Jake Leach 3:08
no, literally, I was I was on the phone with our team, we're, you know, back and forth with the FDA, they ask a question and you answer it, then they want some more clarification you answered. And I mean, it really comes down to there's just so much in these filings that they you know, they can't possibly read all 38,000 pages. So they just kind of pick areas that they want to spend some time with. So we ended up helping point them to the right places. And so it's very, it's really interactive. It's great. And very thorough, but it takes a little time.

Scott Benner 3:36
Yeah. Does the integration with algorithms change your submission? Or is that on the pump person side?

Jake Leach 3:42
That's on the pump side. Yes, the pump side, they basically once we get G seven approved as an IC GM, then they quickly do their submission. They've a little bit of validation work they have to do on their side to show that they have compatibility with the new G seven system. But it's all of this is based on the work that FDA has done to do the I CGM and the AI Controller it really facilitates quicker approvals. If if they wouldn't have done that, it almost likely wouldn't, you'd have to run a new study with every generation of technology instead of trying to make them more compatible. So it's pretty it was good forward thinking on the FDA has purposely set it up. So yeah, each of those pump companies will have a submission right after we achieve seven approved that they'll have to go through to get the g7 approved for use with their automated insulin delivery systems.

Scott Benner 4:31
Do you think that I'm going to ask you to speculate Do you think that's something they have ready to go and they're just waiting for you to get your Okay, so they can submit theirs? Or is it a process that like starts at day one when you

Jake Leach 4:40
know No, there are both both of them in tandem and insulet are already working on g7 integration. I've already seen prototypes working of their systems so they you know, they're not ready to like file it right away. They might be by the time we get to seven approval we'll see you know, because you know, probably a little More review time on D seven. So we'll see. Hopefully, I mean, they're moving as fast as they can. We're supporting them in every way to help them move as fast as possible. But there will be some time where people will stay on G six, if they're on those systems before they can move to G seven. What was I'm going to jump around a little bit here. Do you mind? No, I'm no problem, man.

Scott Benner 5:19
Good to see you got approval overseas already? Yeah,

Jake Leach 5:24
we got to see Mark last last month. And you know, we'd like to move fast. So we already moved into a limited launch. So g7 is in the hands of customers in the UK right now. That the recent attd show that just is wrapping up in Europe, they, we had a number of clinicians that have used the product as well as some of their customers. And they shared a little bit feedback, feedbacks been great. No surprises. Everyone loves the smaller size, easy use new app, the grace period, the 30 minutes start up, the more configurable alerts. For convenience, there's just there's a whole lot in g7. So pretty, everyone's pretty happy with it. We're happy with how it's going. We do these limited launches just to test, you know about the product, but also just our systems technical support, make sure we know how to support this, the last thing you'd want to do is go big and then have an issue that while it's fit, correctable it's kind of hard to correct when you're hurt. Yeah. At the scale we're at. So you want to get it going a little bit slower at first,

Scott Benner 6:23
was that the first time that that's happened that you've gotten something moving overseas before in the US on a new products?

Jake Leach 6:30
No, it's you know, there's been lots of different reasons over time where this has happened. I'll give you one example is g4 actually was approved first in Europe, with the Animus pump of all things right. So that was actually a previously approved version. So that was, you know, then we ended up redesigning some of the GE for for a product, he made it g4 Platinum, and then launched it. This one was just the case here is that the clinical trial that we had to run for the FDA is a little bit larger and takes longer than we the one that is required for the regulatory agencies in Europe. So we purposefully ran two separate trials, we wanted to get the product out as fast as we could. So we ran a trial for Europe. And we ran a separate trial for the US. And we submitted the European submission while we were still running the US trial.

Scott Benner 7:21
Okay. Can I flow through some questions real quick? I think they're going to be kind of kind of quick ones? No, of course. Excellent. I have these are from people who listened to the podcast who want to know what they want to know. I'll, I'll start with, they're wondering if the new form factor of G seven cuts down on compression lows. I've asked you guys this question in the past? And the answer has been We hope so. But I was wondering if you have any more data? Yeah, we don't, I don't have anything valid validated to say, you know, if

Jake Leach 7:51
you place the sensors in the exact same spot, and you lay on it in a, you know, statistical format, does it reduce compression, those, I don't have that, but what we have seen is that with the size of g7, it can be worn, you know, in slightly different locations on the particular the arm, where you can kind of move it around that because the sensor probes shorter, it's also more comfortable in the arm. So people have found like they can wear a little bit lower and there are a little bit higher. So we have seen people that they experienced professional have figured out how to move it around a bit so that they don't don't have it, but they still can happen on g7. But from a statistically significant perspective, I don't have an exact answer. Is it less, but it's certainly more comfortable to wear? Because it's so much thinner.

Scott Benner 8:36
Yeah. Hey, you just mentioned the sensor probe, does it go on in on a different angle than the G six?

Jake Leach 8:42
It does? Yeah, it goes straight in. It's a 90 degree angle versus the 45 degree angle. And what we were able to develop sensor technology within our electrodes that allow us to have a shorter sensor probe. So the depth is actually slightly shallower than G seven or G six. So G seven shallower than G six. And it's also less sensor probe under the skin because it's straight in versus that 45 degree angle.

Scott Benner 9:04
Oh, no kidding. So the G six is it? Am I ready? Test my memories at 13 millimeters? Yes, yes, exactly. I can't believe this is how long I've been doing this chicken. Bird right off the top of my head. What about the g7? Is it? Do you know the measurements? six millimeters? six millimeters? Oh, that's amazing. Oh, cool. Is the change in size going to impact the cost at all? I think what people are asking. Moreover, as do you see yourself as a competitor with libre or a different? Are you in a different space than they are?

Jake Leach 9:38
Well, actually, Scott, that is a very good question. So we're definitely looking at a portfolio of products. So in Europe, we've launched a new product called Dexcom one which is going to be in same the same markets as our G seven product as well. Usually six but we'll be replacing G six with G seven. The ideas There's certain in certain countries, people have access to GS six, but they may not. There's some people that don't have access to G six. So for example, right now, it's some countries categorize if you're at higher risk, meaning maybe a pediatric whose parents are taking care of their diabetes management or someone who's hypoglycemic and aware, they absolutely have to have alerts and alarms. Those folks have access to G six, there's a large population of people that don't have access to G six, they have access to other technologies. And so what we did was with Dexcom, one, we brought in the product, it's doesn't have all the same functionality as G six. It's a simpler product, but it still has alerts and alarms, it's still all based on the same accuracy, same hardware platform with a new mobile application, the whole purpose of that product is to help grow our business internationally and give more people access to Dexcom CGM. And so that product, you know, just over the past year, we've we've opened up over a million new people who have access to Dexcom that have never had it before around the globe. So that and then we're kind of just starting with that we've launched in a few countries with Dexcom. One, and we plan to launch in quite a few more. But, you know, getting back to that question around cost, you know, g7 is not intended to be more expensive, or at a higher out of pocket for people, it's, you know, part of people's cost of the product is have their insurance coverage. But you know, there's 30% of our customers don't pay anything. And you know, the other 30% pay quite a low copay, I think it's less than 30 $60 per month. So it's, you know, g7, one of the things about launching it is there's some coverage that we have to get for the product to ensure people can transition from G six to G seven, or get coverage for D seven. So there's some steps we take once we get FDA approval.

Scott Benner 11:51
So for people who are out of pocket, though, will there be an increase from cheese?

Jake Leach 11:55
I don't believe so. Yeah, I'm not. I mean, I'm not deep into the pricing discussions, but I don't expect it we don't have any expectation that we're increasing price for QBO. Customers,

Scott Benner 12:06
okay, great. When, eventually, one day when on the pod five and control, like you are compatible with G seven, and they're through FDA and everything, this is a big, I know this isn't really a question for you. But I got asked so many times, today, I'm going to bring it up anyway. If someone set up with GE six on one of those systems, and they move to G seven is it going to just be as simple as going into a setting and telling it I'm using the G seven now not the G six

Jake Leach 12:33
there, you know, each each, the architecture, these systems are a little bit unique, right? Each one is, you know, the Omni pod has the algorithm on on top of the disposable, you can look at control IQ, it's built in to the pump. And so you take control IQ for an example, when you want to upgrade to G seven, there'll be a firmware update that's required on the pump. Similar to my expectations be similar going from Basal IQ to control IQ, and they did the you could do the update is going to be something similar to that is what I would expect. And, you know, with Omnipod, it's likely a new firmware version on the pod, right that can communicate with G seven. So I think it's gonna be you know, the whole point is it's very easy for customers to do it. It's not like you have to get a whole new system. It just you know, it's about making these systems upgradeable. That's the whole point of trying to be able to keep up with the innovation that's going on in you know, sensors AI D they're all on slightly different timelines, but you want them to come together. So Right. That's why the FDA is approach with a CGM was such a good approach

Scott Benner 13:37
of let's see, oh, people want to know about overlaying session time. So we'll with g7, will there be a possibility of putting on a new one while you're still wearing an old one?

Jake Leach 13:47
There? There is completely you can do that if you want. With the 30 Minute startup time, though, it's it's not quite the same challenge that you're trying to solve for. Because right now, you know, I get feedback from customers that the two hours that they don't have the CGM data while it's doing its warm up at the initial beginning session is a terrible time because you know that the ID systems are not working or they're not getting that data, they're flying blind. So you do have a 30 minute startup with G seven, G seven starts the sensor session immediately upon insertion automatically you don't have to do anything so it just starts Okay. And you get into 30 minutes later I get data. Literally you get data Yeah, accurate, reliable data.

Scott Benner 14:35
US med is a place where you can get your diabetes supplies, they offer you white glove treatment. US med is a number of things. I'm gonna rattle them off for you right now ready, the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer status faction surveys. How about that? They have served over 1 million people with diabetes since 1996. They always provide 90 days worth of supplies and they have fast and free shipping. That's right us med carries everything from insulin pumps and diabetes testing supplies to the latest and CGM, like FreeStyle Libre two, and the Dexcom G six. Here's a little personal information for you that you really have no business knowing, but I will tell you anyway, I just had Arden's prescription for Omni pod five, sent to us Med, they accept Medicare nationwide, and over 800 private insurers, you should check out us Med and find out why they have an A plus rating with the Better Business Bureau. How do you do this? Well, you can do it with a link us med.com forward slash juice box or by calling this special number just for Juicebox Podcast listeners. That number is 888721151 for us med wants you to get your diabetes supplies, they want you to have a better experience than the one you might be having now with whatever company is sending you your supplies, switch to us Smith. But also remind you to go to T one D exchange.org. Forward slash juice box and fill out the survey. And lastly, that the links to us med T one D exchange and all the sponsors are available in the podcast player that you're listening in right now. Like go in there. There's like shownotes, they're right in there, or they're available at juicebox podcast.com. Super important. When you click on the links, you're supporting the podcast if you love the podcast, if you love how much content there is, and that it's free for you. Supporting the sponsors and sharing the show with others are the two quickest way is to keeping it going.

Is there is there any kind of wonkiness in the first 24 hours like some people see what G six

Jake Leach 17:03
the all, you know, my experience with CGM technology over you know, last 20 years is that always the first day, and there's more a little more variability in that day at times some people experience it more than others, some people, you know, experience once in a while. And it really just comes from the form of kind of wound response from inserting a sensory of a brand new sensory insertion site. There's a whole lot that's actually going on from a physiology perspective. And so that does create variability in the first day. And so the performance is still really good. But yeah, you can have some of that, you know, signals that generally they run a little lower sometimes, you know, that give you a bit of a dip in the sensor signal. But still still accurate and reliable, but not, you know, not perfect. It's clearly the meds on the later days are better than the initial days.

Scott Benner 17:58
Things I think we know already were times 10 days.

Jake Leach 18:00
It's actually 10 and a half days. Okay, there's a there's a new feature called grace period. And

Scott Benner 18:07
we talked about that before. I have not spoken anything about it yet. No. So yes,

Jake Leach 18:11
we have this new new feature on G seven that was basically designed based on feedback from customers saying, you know, when the sensor stops showing data exactly 10 days after I insert it, it's not always the most convenient time to change my sensor. So sometimes I have to stop my sensor session earlier to replace the sensor, because you want to do what's convenient. So the the 10 and a half day we're on g7. The grace period, which is 12 hours is basically once you get to your 10 days from sensor insertion time, so let's say you did at four o'clock in the afternoon 10 days later at four o'clock in the afternoon and it's saying hey, we're going to time your sensor off we actually want you seven extend it we notify you saying hey, your sensors expired, but you have another 12 hours to find a time that's convenient for you to replace your sensor.

Scott Benner 18:56
Wow. Do you have anything that will make my daughter actually pay attention to that message when it pops up and says a little arm that'll come out of it and like knock around their house or something like that? I say change your sensor art and what happened? I don't know. It told me something earlier but I didn't read it. That was great. Thank you

Jake Leach 19:17
every time you go every Yeah, we're trying.

Scott Benner 19:21
I know you guys have been doing I know that you've been doing testing on adhesives because listeners of the podcast through T one D exchange have gotten opportunities to be in trials for but have you got any? Any results from that yet? Or people are asking a lot about adhesives. We have

Jake Leach 19:38
Yes. So a couple couple things on adhesive. So G seven has a new adhesive. It's different than G six. It looks similar, but it doesn't have some of the compounds that we've identified that can be irritants for some people. So the within the adhesive of G six we've through those tests that we were really happy that people were supporting those trials and participating in them, and wearing all the different types of patches, because it really did help us learn about some of the compounds that can cause irritation. They're not identified as irritants, but they ultimately can become them for certain people. So g7 doesn't have those in it. And actually, with G six, we've been working on a version of the patch that doesn't have those same compounds in it, a little bit of its proprietary between us and our patch supplier. But we basically are very focused on ensuring that we have as little irritation as possible, while still sensitive, having sensors last you know, that he here to the body, it's kind of like this little bit of a balancing act at work. But we've learned quite a bit over the last year and a half with those studies. So appreciate everyone participating in those that can and people will see it in the products, which is seven in particular, did it become more easy? Because the product is smaller? Does the adhesive not need to be as strong because it's not holding on as much weight? Or did that not? No, it was just it's just basically using some different types of adhesives and not including the same ingredients. And also some of the manufacturing processes we use are different with G seven that also helped enable using some different adhesives, they literally if you look at it, you can't tell the difference. But the g7 adhesive is, is strong. It's not less strong than G six. You're right, though it's quite a bit smaller, which is nice. Yeah. And then also with every g7, we supply the over patch for use if folks want to it's automatically placed in the box. And so you'd have to call for that separate

Scott Benner 21:39
burners, DME, durable medical, pharmacy, Medicare, how is that all going to be covered?

Jake Leach 21:48
So generally, for GCC, so you're basically asking me when we transition to g7? Yeah, well, there's a basic Yeah, the it's a bit of a, it's a bit of a process, the DME and Medicare usually moves a little faster than all of the pharmacy contracting. So you would expect that DME coverage would come quite quickly upon FDA approval, and then the pharmacy contracts will work their way over time. But we are working on programs to ensure that customers can get G seven as fast as they can. So more to come there. But it does, it does take a little bit of time to get the G seven into everybody's systems in the pharmacy and available for every all the patients that have G six today.

Scott Benner 22:29
Okay, well, G seven, show any improvement over sensor errors and not lasting 10 days for people.

Jake Leach 22:36
Yeah, it's, it's similar. It's similar in terms of g six. But what we have seen is that, and I know a lot of customers do wear G six in their arms. But we are seeing with G seven quite good sensor longevity when worn in the arm. And so if you look at the clinical trial results that we've published, we get better performance in the arm that we do the abdomen, the abdomen, still very good performance, but the arm is better. And so we we've we've kind of known that, or we thought that that was the case for quite a while, but we'd never run enough large clinical validation study work to really prove it. But with the g7 studies that we ran for approvals, they were quite large, you know, hundreds and hundreds of customers or patients subjects in the study, and both pediatrics and adults. And that we saw in both cases the arm performance was it was more accurate and lasted longer in the arm.

Scott Benner 23:30
Interesting. Are you expanding the approved places? Or is it still the same as before?

Jake Leach 23:34
No are no g7 Our intent is to get an arm indication to get definitely it'll be indicated for use in the arm.

Scott Benner 23:40
I often only wear scars on her hips. So I'll be interested, I wonder if the size change would maybe get her to move it to her arm. That'd be great.

Jake Leach 23:50
It's it's it is quite convenient. With the size and it's one of the things like it's kind of obvious, but when you actually experience a product, you You do understand how much smaller it is and basically forget you're wearing it is really quite different than my LG six experience. Okay, excellent.

Scott Benner 24:07
Smartphones at launch, are you adding any, are there going to be the same ones that people get for G six.

Jake Leach 24:12
So we so we're basically the way we approach smartphones is we're always working on whatever the latest available phones are. And so with Apple, you know, always takes us a little bit a little bit of time to get all of the validations and testing approved and you know, through the system. So you often get a little warning that says we're still in the middle of testing this GPU kit. Okay, and you can continue to use it. But we are still in the formal validation phase. So won't be any different with G seven Apple will we're working on the latest phones and iOS is there. Same with Android, right? The Samsung models are are the ones that we support the most number of phones, but we you know we are internally working on programs where we do want to support more handsets. We think about it as we go global right? We're During this global business in the US and outside the US and you know, there's a lot of different handsets out there. And so we're working on ways to be able to support more. And for us, it's really just about can we enhance our efficiency in the testing that we do to validate, we have to validate every single phone to ensure that the Bluetooth performance meets the requirements, because the alerts and alarms of our products are so important. And if the Bluetooth isn't reliable on that particular handset, which is not uncommon, then we really don't want customers using them. So that's why they end up not being supported. Yeah. A lot. A lot of people say, Well, we get support, tubular support anything, but it's actually interesting. And within each cell phone, there's some different hard functionality, in particular on the Bluetooth chips. And they're not all as reliable as we would want.

Scott Benner 25:46
Yeah, I guess Speaking of things that integrates with Apple Watch g7 to Apple Watch.

Jake Leach 25:53
So geez, yeah, so at launch, you'll have the same functionality as G six in the US launch with, with a secondary display of your information on on your watch, you can clear your alerts. So you basically you get the alert, you can acknowledge it on the watch. But the director, watch, we did build it into the hardware of G seven. So the wearable has the capability to do that functionality. And we're looking forward to some an upcoming release of a new watch OS that has a bunch of support in it that we need to help us make that feature actually happened.

Scott Benner 26:31
How about Garmin,

Jake Leach 26:32
Garmin will be the same as it is today, which is the functionality where if you have the Garmin Connect app, then you can, you know, basically put G seven data on your garmin watch, you just it's it'll be the exact same process. The beautiful thing about those cloud API's that we've launched with partners like Garmin is that which is G 60, G seven, it's a very simple update on our side. And then you may have to log back in, log out and log back into your account with that g7 credential. But really simple

Scott Benner 27:03
check, you have to go where do I have more time? Now you have a few more time? Yeah, I

Jake Leach 27:07
was late. You have more time.

Scott Benner 27:08
Excellent. Thank you. I was like, I'm not sure if I'm getting if we have to go or not. So I didn't want to I don't want to drag you along. So let's talk about that for half a second. Somebody asked me a question that I wasn't going to ask you. But based on what you were just talking about with Apple Watch, I'd like to understand this piece a little better. The question was, could you get me functionality with the apps where it calls me for a low at like sugar made has was which was the statement? And what made? What made me think I wouldn't ask the question is, in my mind, if you can't say that it's going to do it? Definitely, then you can't get it through the FDA. And so that's where functionality like that becomes less easy to try to put into place. Am I right about that?

Jake Leach 27:51
You are you are Scott, you know, the one of the most critical things our product does is the alerting in the FDA and our Dexcom as well view that is it's a really important aspect of the product. And so when it comes to safety, it is the thing that saves lives, when you get those low alerts. And so it, it is something that validation of those things takes, you really have to go through a lot of different use cases, edge cases, all kinds of stuff to make sure you have absolutely everything covered. And that's really been what you know, as we've worked on the director watch with on the Apple Watch platform, ensuring that every user gets reliable alerts, when that thing becomes your main receiver, your phone's not around, your receivers are on your pumps not around. So you're not getting an alert, unless it comes from that watch. And so being able to do that reliably has been something that Apple and Dexcom have worked together on to ensure that that can happen. And from my perspective, on the technology side, we're really close to being being able to introduce that functionality. But as you mentioned, the call feature, it's very similar in that it just has to happen. We do know our partner, sugar mate has that functionality. And trigger mate quickly connected up to our real time API once it's been available now and so there, they do have that. So it's not on our roadmap to add that. But you're right though about it gets pretty difficult to do some of those things what

Scott Benner 29:21
it scared you if I if you say hey, if this thing reaches a certain number, we're gonna send you a phone call. And I don't know it has to do with a cell network and the cell network was down. Then suddenly the alert you told me I was gonna get didn't come and there's nothing you can do about it. So you can't put yourself in that position to begin with.

Jake Leach 29:38
Yeah, yeah. And you probably will call us and it'll be a complaint that hey, it didn't work and we're gonna have to investigate it. And so yeah, it definitely is one of the things that when we when we're doing you know, we listen to customer feedback. A lot of the features in G seven are based on the great feedback that we've gotten from customers around g six, right. And so we we We're very thoughtful about which features we introduced and how we prioritize them. And you're bringing up one of the things that's can actually can add some complexity for sure. G seven is going to be approved for what ages? It's same as G. 602. And up to that's the intent.

Scott Benner 30:17
And let me just ask you about the apps little bit because I feel like we've been talking about these revamped apps for I'm gonna say forever. Maybe, so little things, you wouldn't you wouldn't tell me last time we talked, but are we gonna see rate of change on the new apps?

Jake Leach 30:33
So not not immediately. But it is definitely in the roadmap, because we've gotten a lot of feedback on that. And actually, after our last call, I dug in to see where in the feature priority list it was. So it's not in the initial release. But one of the things that we're doing different with G seven is we have a cadence, we call it our release trains. But we have a whole cadence of things planned for the next couple of years to bring significant value to customers through new versions of the app we've been in the past, you know, which is six, we didn't bring, you know, we did a number of enhancements to it. But they weren't as frequent as I want, as we want. And so what we're working on is, how do we bring more value faster, and it's really doing a lot of what, you know, the tech industry does, in our software team looks much, much different today than it did even a couple of years ago in terms of size, capability and breadth. So what I'm really excited about what we're going to be doing with our apps, as we continue to go forward,

Scott Benner 31:32
do you anticipate more frequent app updates than have been normal in the past?

Jake Leach 31:37
That's, that's the intent. That's what that's the expectation we've set for ourselves is that we're going to be developing features at a much faster cadence than we had in the past.

Scott Benner 31:47
Okay, so I'll hit you with these little things that seem like messages more than questions since the last one, like it might have helped in the past. One of them was overwhelmingly more Android phones, please, which we already talked about. People feel very passionate about the packaging being lesser every time and the ability to recycle things. A lot of people give feedback about that. And then there's a message for you here, which I'll save to the end. But this is the last question, which I think is hilarious as you're trying to get g7 through the FDA. What is GA going to be like?

Jake Leach 32:23
Well, we wouldn't be we wouldn't be Dexcom if we weren't already working on that. So yeah, absolutely, we are working on GA, it's a another kind of step in the wearable technology, making it you know, less than even, you know, more discrete. Manufacturing scale, right, that's become a very important part of how we design our sensors is we need to be able to manufacture you know, hundreds of millions of them. And so there's a bunch of that kind of technology that's going into g8 g7 is going to be a big focus for us, though, our plan is to roll it out as fast as we can across the globe and reach millions of customers with it. And so, yeah, GA is a program, we are running it, and we're excited about what's going on there. But you're not gonna get any secrets at me today.

Scott Benner 33:11
Well, then I'm still gonna ask my last question. Do you have any idea when this might happen?

Jake Leach 33:17
You say an FDA approval and g7 lunch? Yeah, my expectation is it happens this year. We've got you know, we're in that back and forth period with the FDA. Things are going great. We're really happy with how the good the interaction. And so you know, we're thinking sometime after Ada, likely So Ada is coming up here in June. And so, you know, our last earnings call we talked a little bit about, you know, our expectation is sometime after AD will get approval, and then we'll be launching but in a meaningful way this within this this year. It's not like we're launching on December 31. That's not our intent, right? Of course, regulatory timelines are always I've always Kevin CRC, you know, everybody asks us to predict when the FDA approves the product. And so it's, you know, we basically are saying our best estimate at this point, given what we know today is that it'll be some time after ADA but will allow a full launch at but this year, Jake,

Scott Benner 34:14
Kevin's more fun around these questions. And you are, I just want you

Jake Leach 34:17
to know he can be

Scott Benner 34:20
and there's a number of messages from here from people who just wanted me to say thank you for the technology. So I won't I can't read them all to you. But a lot of heartfelt thanks came through as well.

Jake Leach 34:31
Very, very much appreciate all the folks that that use our technology every day to you know, help them manage diabetes.

Scott Benner 34:38
Yeah, no, thank you for taking the time to do this. I appreciate it. Cool. Thanks, guys. Take care Jake. Jake, you think we'll be doing this

I bet you want to know what I asked Jake when I shut off the recording and what he answered, but I guess I'm telling you thank you so much to Jake leech for coming on the show and talking today about Dexcom g7. And thank you to us med for sponsoring this episode of The Juicebox Podcast head over now to us med.com forward slash juice box or call 888-721-1514 Get your free benefits check and get started today with us med. Getting your diabetes supplies should not be difficult, and with us med it won't be

if you're new to the Juicebox Podcast, hit subscribe in your podcast app or any audio app that you're listening in, for instance, audible Spotify, Apple podcasts, etc. etc, etc. Hit subscribe or follow follow and subscribe. Get the next episode right there on your phone. If you're looking for support online, the Juicebox Podcast has a Facebook page it is a private page with nearly 25,000 people in it. They all use insulin or love someone who uses insulin. And they're having vibrant and valuable conversations all day long that you may enjoy. You could get involved in them or just kind of look around and see how people handle things. It's actually very helpful. And a great way to learn about type one diabetes management and the use of insulin in general. So I'm saying type two as well. You hear me? Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#675 How Affordable Insulin Happened

Martin Van Trieste is the President and Chief Executive Officer, Civica Rx. Civica is making affordable insulin.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 675 of the Juicebox Podcast.

On today's show, we're gonna have a conversation that I didn't think I'd ever have on this podcast. It's with the CEO of a pharmaceutical company whose goal is to make insulin and make it affordably. I know that's weird, right? Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. We're becoming bold with insulin. If you have type one diabetes, and are a US resident, or are the caregiver of someone with type one and a US resident, you are eligible to take this survey AT T one D exchange.org. Forward slash juice box. It's a quick survey. It's not hard. Your answers help people with type one diabetes. It also supports the podcast. It's completely HIPAA compliant. Absolutely anonymous, simple to do, you really can't go wrong. T one D exchange.org. Forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. Learn more about my daughter's blood glucose meter and buy it even if you want at this link. Ready, I'm going to say the link contour next one.com forward slash Juicebox. Podcast is also sponsored by us med. US med offers white glove treatment to its customers, you can get your free benefits check at us med.com forward slash juicebox. Or by calling 88087211514. Start getting your diabetes supplies from us Med and get rid of the headaches that you have now, wherever you currently get your diabetes supplies.

Martin Van Trieste 2:19
My name is Martin Van Trieste, President and CEO of civica. civica is a nonprofit Generic Pharmaceutical company whose mission is to bring quality medicines that are always available and affordable for everyone.

Scott Benner 2:33
Okay, I want to find out how you got to this. So I'm gonna go back pretty far. What did you do in college?

Martin Van Trieste 2:40
So I'm a pharmacist by training. So I got a degree in pharmacy from Temple University School of Pharmacy. And as I was graduating pharmacy school, I had a chance to do an internship at Abbott Laboratories in Chicago, and I decided to take that. And ever since then I've worked in the pharmaceutical industry.

Scott Benner 3:01
Did you go to college with the intention of dispensing pills? Or did you think you were always going to go into Pharma?

Martin Van Trieste 3:06
No, I went to college that game on Sunday with all my own little pharmacy.

Scott Benner 3:10
Really? That's great. That's really interesting. Is there something about it that moved you was just the opportunity and you enjoyed it and just kind of stuck with it?

Martin Van Trieste 3:20
Yeah, I think the first I had the opportunity to go into industry and experience what industry were like when I was an intern. I thoroughly enjoyed that. At that time, I began to become aware of the little mom and pop pharmacies were closing faster than others were opening. And I said, you know, probably don't want to work for a chain pharmacy, or hospital. And so I went into industry, I don't want to date you, but about what year was that? So I graduated pharmacy school in 1983. Okay,

Scott Benner 3:51
so yeah, it's interesting, right? You you grew up with this idea in your head, and then the landscape shifts right out from under your feet, I guess.

Martin Van Trieste 3:58
That's it within a really quick time period. So when I went into pharmacy, there was definitely an opportunity to have a viable pharmacy and when I came out that opportunity had been gone. So just five years

Scott Benner 4:10
well spent that change. It's really fantastic. How quickly could happen. Okay, so you above what did you do the for that first job? Were you in compliance where you

Martin Van Trieste 4:21
say I was in I was a research pharmacist, so I did formulation development. So I was the one who took the active ingredient and made it into something that was pharmaceutically elegant that you could actually administer to a patient. So they could consult to be effective.

Scott Benner 4:39
Yeah. Did you work on anything that you're particularly proud of?

Martin Van Trieste 4:45
Not when I was an intern.

Scott Benner 4:50
You weren't allowed back close to the I

Martin Van Trieste 4:51
guess. I guess I have to be careful about that comment. So I met my wife who was also a an intern at Abbott at that same time, so I worked on Making a family I

Scott Benner 5:01
guess. There you go. Yeah. So you're you're definitely proud of that. But I know my wife will tell me all the time. My wife's in drug safety. And very interestingly, she went to college to be a doctor. And when she got out, she had a little, a little kind of falling out with her family and she just couldn't afford to apply to med schools. So she got a Kelly Services job, they Kelly does scientific stuff, too. And she just was really good at the safety stuff and stayed with it. And she tells me all the time about her second job out of college was with a very small pharma company called forest labs. So she worked on Celexa and, and she's, she's really proud of of what she did with that when she was younger. So that's what what made me ask. Okay, so do you jump on? I mean, Pharma is one of those jump around jobs. Did you bounce around a little bit?

Martin Van Trieste 5:52
Yeah, I mean, I think you know, what I would have to say is, I worked at Abbott for 21 years. Wow. And why was it Abbott, I did numerous kinds of roles. I was a formulation pharmacist, I worked in manufacturing, and then I was in quality. And I left Abbott as the head of quality for the hospital products division. And what happened is, when I was at that point, my career, Abbott had spun off the hospital division to become Hospira. And I said, you know, what, I spent too much time building the organization that I didn't want to be part of the one that was probably going to tear it down, you know, as a standalone company. So I left there, I went to bear healthcare is their global head of quality for their biologics group, based in Berkeley, California. So from Chicago to Berkeley, and then I moved after two years at in Berkeley, I went to Amgen and 1000 Oaks, California, where I was their chief quality officer.

Scott Benner 6:56
You have a little the Chicago in your voice. I don't go Yeah. So when you were moving around inside the company like that, was it a case of you getting bored? Was it a case of you wanting to learn more, or were people poaching you because they saw your work?

Martin Van Trieste 7:14
I think it was a combination of my leadership wanted me to be a well rounded, professional. So Abbott was good at making sure people got exposure to different parts of the company. So when they became an executive, they were well rounded and understood how the company were. So it was partly that it was a little bit partly because, you know, I didn't get bored, but I always wanted to do something different.

Scott Benner 7:44
I understand at some point, you start feeling like you're doing a repetitive job. And that feels like it's time to move, right? Yeah, yeah. I when I was in eighth grade, my guidance counselor said you should be an attorney. And I said, but then I'd be an attorney every day for the rest of my life. And I just, I couldn't imagine even as a little kid, like, doing the same thing over and over again. Anyway. So what I guess the question is, is that what did you pick up along the way or see that made you want to make this leap from Amgen to what you're doing now? Well, it's

Martin Van Trieste 8:15
very interesting. So I retired from Amgen Oh, I retired from Amgen and went into retirement. And one day my phone rang. And I typically don't answer my telephone unless I know who it is. And it rang. I had no idea who it was it says a Utah area code. And for some reason, something said answer this phone call, which is like I never do that. And I answered the phone call. And it was a gentleman by the name of Dan Lilly quest. He was a chief strategy officer at Intermountain Healthcare. And he was talking to me about starting a nonprofit, pharmaceutical company, and he was telling me about his ideas. And he asked if I would come to a meeting that they were having in Utah, where he's bringing in various advisors to, you know, beat up on his idea to see how it'd be how they make it successful. And they were politicians, health system executives, pharma people, academics, so wide group of people came to this meeting in Utah. And I had known no interest in going, right. But I looked at my wife, I said, we haven't been to Utah. All right, let's go to Utah and make your day better vacation. And then one thing, you know, led to another, I kept providing advice over some time to them. And they got to the point where they're gonna announce the official name of the company and started the company. And he had called me about it and I go, Dan, do you have any employees the company yet? He goes, No, thanks. So you can announce some company, whether snow would work. So They said, Well, can you hire some people for me? So I hired the original team at the company. And then I said, Okay, Dan, what are you going to do? Now you need a CEO, someone needs to leave these people I just hired. And I gave him some names to some people. And they came back and they said, no, none of those that they want to do a bigger national search. I said, guys, you're gonna delay you know, the start of this company by a year from do a big national search. I said, You got to, you really got to look at these people are. And one thing led to another dad called me one day and says, we got the answer. I go, good, who to hire, because I got to tell the other ones why they didn't get hired. He goes, No, we want you to be the CEO. I said, you know, what, don't you understand about retirement? I'm happy. I'm retired. I'm just dabbling on the edges helping you? No, no, we want you to be the CEO. And I think I said no, on eight consecutive days, multiple times during the day, when Dan is a very persistent individual,

Scott Benner 11:06
I gather.

Martin Van Trieste 11:09
Finally, my wife tapped me on the show or said, Look, you should probably do this job. It's, you know, it's exactly what you've been preparing for your whole life. You know, your your experience in developing all the drugs that are on the list of drugs we're gonna make are on drug shortage. And I may either formulated them as a pharmacist, I manufactured Deb, where I oversaw the quality of them when I was at Abbott. So So I said, Okay, I'll do it. I told Dan, I said, I'm going to do this job, so you can find her my replacement. So I'm only giving you six months to find my replacement. Four years later, I'm still doing that.

Scott Benner 11:51
Are you Are you pleased about it?

Martin Van Trieste 11:53
Oh, yeah. No, I thoroughly, thoroughly love the work. And you know, it's more of a volunteer assignment for me, because I get no compensation from the company. Oh, no. All Pro Bono. So it's really, it's really been interesting and fun. And I have loved the team we've put together I mean, how many times in someone's career do you get the higher your entire team from scratch? Right. So it's a great team. It's been a lot of fun. And we've had great success. We've done a lot of great things. And so, so yeah, it's been it's been a real pleasure.

Scott Benner 12:29
I interviewed the gentleman that put together the production floor for Omni pod. And his story is so similar to yours. It's fascinating. He was retired from a soda company. And, you know, somebody said, Hey, come take a look at what we're doing. You have any thoughts? And then the next thing you know, he's not retired anymore. But you're not taking a salary. So you were retired and comfortable. And, and you're doing this? I mean, okay, I see why you helped in the beginning and I even see why you took the CEO position. How come you didn't bail on in six months? What kept you there?

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Martin Van Trieste 17:09
Oh, why imbalance expense? Because there was always another challenge? You know, we did we achieved our first big objective, right? And then what's the next object? Right? So there's always a big challenge ahead of us. And at some point, you know, you got to look at it and say, though, always will be a challenge. If you do your job correctly, if you're trying to change the industry and transform and disrupt the way things have been done, but front of you, there's always going to be challenges ahead to keep it interesting.

Scott Benner 17:38
Excellent. So what did you I mean, what were your first steps? Obviously, you set up the company had needed employees. But you're I mean, can you talk a little bit about the difficulties and some of the things that came up in that room when people were trying to shoot holes in this idea of like, what what are the I guess my question is, what are the big obstacles into getting into such a? I mean, into a space that makes a lot of money for the companies that are in there. When you're saying we don't? That's not our goal? How do you get into that? How do you not end up in an alley beat up by?

Martin Van Trieste 18:14
A lot of people ask, Are you afraid that someone's going to kill you? I said, you know, the pharmaceutical industry is so used to competition, right? And for people to try to do things differently, that it doesn't pose a big threat to them, right? Because they know there's always going to be someone doing that and they prepare for it. And they have something new that they're introducing in the marketplace. The other thing is remember we're working on old generic, very old generic drugs that are on shortage. And by just that definition that they're on shortages. People don't want to make them anymore. Okay. Right. So there's, there's limited competition, the drugs are on shortage. So So that's part of it. The other part is, you know, people took us for granted, they didn't think we could do it. I remember one quote from the CEO of a very large generic company, who said to one of our members, the CEO of a large health system, go you know, you guys don't know how to make drugs, you're not going to be successful. You don't bother me. And I think that was a prevailing thought process. When we introduced the company that they thought, you know, a bunch of hospital executives aren't gonna know how to make drugs. They didn't realize that the hospital executives are really smart and they hired a pharmaceutical executive. Pharmaceutical team knew how to do

Scott Benner 19:42
that. Did you go look at his back catalogue of drugs and decide which ones you could make? Just to show him

Martin Van Trieste 19:50
actually, how we select our drugs is really, really interesting. So civica is a member driven organization, right? So large health says firms are members of the company. And they decide what drugs we should make. So they look at their portfolio of where they're having trouble finding a drug. And then they look at what is the patient impact for not having that drug, okay. And they prioritize it together to say, here's what we want you to make. Now, it's a great idea on paper. But when we went to execute it, I thought this was going to be total chaos. Right? We had 60 people in a room, hospital pharmacists supply chain professionals, nursing nurses, in a room to say, we can only do 10 drugs to start in the first year, what 10 Do you want us to make, and her over two, at that time, there were like 280 drugs on the FDA drug shortage list. And over half of them were sterile injectable products were, which is what our focus was on. And I thought this was going to be total chaos. Right? It was a four hour meeting. And after the first hour, we had consensus on the first 25 drugs that we should work on. And they actually prioritize them one through 25. So I was pretty impressed, because that really showed what was important for the patient was into getting a bunch of people in a room who could agree on something that quickly says they're really focused on what that patient needs. Yeah.

Scott Benner 21:28
And it means they all they're all seeing the same thing over all right, yeah, was insulin on that initial list of 25.

Martin Van Trieste 21:35
Insulin was not on that list of 25. But it was something that people were asking us about, because insulin is not was not on shortage, it was high price. But it wasn't on shortage, right. So we want to focus on the drugs that were on shortage. And I was in I was, I really did believe that the marketplace would fix the insulin problem. As generic insulin would come to the market, the marketplace would correct itself. And we watch that market very carefully, hoping that the marketplace would correct itself, and it hasn't. And so we had a bunch of philanthropic individuals come to us and said, Can you make insulin. And we said, we can that we did look at it, we know how much it costs to bring it to the market. And they said Walmart will raise the money to make it happen. So Dan, Lilly quest led that initiative for us. And we set a goal of $125 million in capital to be raised to bring the three different insolence to the market. And those three insolence would be the generics of Lantis, human live, and overlock, which is about 80% of the insulin used in the United States. And that's why we picked those three, and they were off patent, which is important. And we're on well on the way we've raised over two thirds of that 120 $5 million to bring those three molecules to the market. And I'm pretty sure by the end of the summer, we'll have all of that money.

Scott Benner 23:09
Wow. up when you said you thought that the market would correct on insulin, it never did. Do you have an idea about why or a guess? Yeah, I'm

Martin Van Trieste 23:19
pretty confident. I know why. And it's these perverse incentives that creeped into the market. So the higher the someone raises the price on insulin, and gives giant rebates to a pharmacy benefit managers, these are middlemen between the pharmaceutical company and the patient. And they're negotiating contracts for insurance companies in large employers, and they develop these formularies. So if you go into the pharmacy, there's a formulary. And depending on who the insurance company is, that drug that's higher on the formulary has a higher probability of being dispensed. So you have three insulins out there, they're very similar in the way they work. And so the what they want to do is to be very high on that formulary, they want to be the first choice. So what they do as they raise their price, and provide big rebates, the Pharmacy Benefits managers, who then put them higher in the formulary than anybody else. Now you have three players in the marketplace that are competing by seeing who can give the biggest rebate. And so it's estimated that probably 80% of the list price of insulin is a rebate is rebated to the PBM. So if you look at that means $100. If the if Lilly raises they've crossed $100 For VIOME Lilly insulin, that means $80 has been given to pharmacy benefit

Scott Benner 24:50
managers so they put you higher on the list. So that

Martin Van Trieste 24:53
puts you higher on the list. Now what happens is for those who have no insurance Right, they pay that list price. And insurance company negotiated a lower price through that pharmacy benefit manager. So an insurance company's paying the $20 per $100 spent, right? So the person with no insurance, or have big deductibles in their insurance plan, pay that list price until they can get something, you know, till they meet their deductible or they pay it the entire year. Okay, so what that says is, the sickest people in society pay the highest price for their medications. And that seems the that's the perverse way what insurance is supposed to do, right? Insurance is supposed to say, the healthy of us take care of the sickness. Right. But because these perverse incentives have creeped into the system is broken the insulin market and it's an it's not going to get fixed easily.

Scott Benner 25:58
How did if you know how to pharmacy benefits managers wiggle their way into this system? Was it through large employers?

Martin Van Trieste 26:06
I honestly don't know the history of how that all started. Okay.

Scott Benner 26:11
Yeah. So this, it's kind of crazy, because it's almost like it's a little like three card monte when you're talking about it. So. So the insurance company is are they paying more like who's paying for this? Because if the people who were insured, I mean, there, I pay, I don't know what I pay it, to be honest with you. 20 $40, when my daughter gets insulin, I don't think it's much I think my health care probably cost. I hate to think about it, but I have recently, I've a family of four, we might be around eight $9,000 a year, like when you know, what comes out of the check what's out of pocket, etcetera, etcetera. But I mean, after that, who's, who's paying for this.

Martin Van Trieste 26:57
So, the way the system is set up, the benefit never reaches the patient, right? So you would assume that if there's rebates being paid the pharmacy benefit managers that some of that rebate makes its way to the patient, and that doesn't happen. So pharmacy benefit managers are providing money to the insurance companies to large employers. And it's being dispersed through the system. But the vast majority of that of that rebate stays with the pharmacy benefit manager.

Scott Benner 27:29
So these people are just passing money around to each other. That's right. Okay. What percentage of patients do you think aren't covered by insurance? So who is really being hit by this numbers wise?

Martin Van Trieste 27:44
Yeah, that's a good question. It's and there's not a good statistic on that, that I've been able to find. But I hear enough horror stories about people and the cost of their insulin that says that we'll be able to have a pretty significant market impact. Great. And remember, it's not just those without insurance. It's also those who have those high deductible plans. Yeah, no, sure. Right, that unique need to meet your deductible. And we're and at the end of the day, if we can transform and disrupt this system, really helpfully premiums can be lowered for people who have insurance.

Scott Benner 28:21
Why? Why are they not fighting more about this? Where are they are they just see you described earlier, a scenario that made me think the the way the NFL works, which is offense is developed something then defensives figured out how to get through it, and then the offense changes? Are they just changing their offense right now? Are they letting you do this?

Martin Van Trieste 28:42
Yeah. So I think they're, they're not taking us for granted because we have a proven track record that we can disrupt and transform. But it's part of our society is what have you done for me this quarter? Right, I have to meet my quarterly objectives to my shareholders are rewarded. So they're not focused on something that's coming out in 2024. They're focused on what's coming out in May, August, right. So it's that short term view of the world that I think, but I do see, as we get closer to the launch of civic insulin, we will see a bunch of gnashing of teeth of those pharmacy benefit managers. But they also will shift the rebate game away from insolence some other product.

Scott Benner 29:31
Okay. Just some other vectors gonna get hit by this.

Martin Van Trieste 29:35
That's right. Yeah. So if you think about it, the first big rebate drug that comes off patent will be humera in 2023, used for arthritis and psoriasis, and so forth. That's the first big drug that pays a lot of rebates. It's going to come and get generic competition. And we'll watch what happens in 2023? Will the generic companies play the rebate game to try to get better preference on the list? Or will the generic company one generic company say I'm going to try to break the system? So we're going to watch that closely. Okay, I the actress or Milan slash NaVi actress Aviatrix, now they have generic insulin called sem sembly. Right. And when they introduced it, they tried to break the marketplace with a low price. But they then had two versions of the same product, one that played the rebate game, and one that just has a low price. Okay, we're trying to serve two different marketplaces with that,

Scott Benner 30:43
well, that work because that's always what I've wondered, I've always wondered why the big companies don't just, I mean, from my, I have a bit of a hippie attitude, you know, and I always just thought, like, well make the money the way you're making the money off the insured people and everybody else just give it to them. Like, who cares? Right? Is that not viable?

Martin Van Trieste 31:02
Well, they're not doing it. Yeah, no.

Scott Benner 31:06
Well, why don't have the viable and palatable are the same thing. But you know, I was, you don't mean, like, at some point, do you just? Well,

Martin Van Trieste 31:15
they're all these companies have patient assistant programs. Right? The really, really poor people have access to the medicine. But it's more affecting your the middle class, I would say, Okay, who don't have the insurance or in between jobs, you know, things of that nature?

Scott Benner 31:35
Yeah, yeah. How are you? So in this idea, where you just kind of keep paying attention to drugs? Like how many drugs do you manufacturing right now.

Martin Van Trieste 31:43
So we offer 60 products to our members. We don't manufacture anything right now. We acquire them through other suppliers. So remember what I was saying drugs around shortage, that means people used to have a license to make something and they stop, or they're having difficulty making it. So we try to find alternate suppliers, bringing them back into the marketplace, by providing them a better economic model than what's currently in the system?

Scott Benner 32:14
And are you able to accomplish that because of the collection of hospitals that you're feeding, so you have enough need for them to go back into manufacturing?

Martin Van Trieste 32:22
Right, so we guarantee them a certain market size, and a certain market price for a five year period. Okay, so they we've taken uncertainty out of the system for them, right, know how much you're gonna charge how much they need to make over a five year period. And the other thing we do that's different than the current system, is we go to them and we say, You know what, we want to buy this product from you. And we'll pay you the day you deliver the batch to us. Current system doesn't do that current system, you take it and put it into the wholesale network. And the whole seller pays you after they sell it. Yeah. So it could take you six 810 months a year to be paid for a batch when we pay you instantly. So we're changing the model. And we also then tell the supplier, you don't need to keep inventory, we keep all the inventory, and we'll keep six months of the inventory. So there's always resiliency in our supply chain, so we won't have a shortage. When I

Scott Benner 33:27
was growing up, my buddy worked in a bookstore is a long time ago now. Over 1300, Geez, how old am I it's over 30 years ago. And you know, paperbacks would come out. And they sell as many as they could. And when they were done and the interest was gone. If they had 10 books left, they'd return eight of them. But the way they got returned was they rip the covers off of them sent the covers back to prove that they hadn't sold them. And then the books were just destroyed. And I don't know what about what you just said made me think about that. But I think that most people who don't understand how this stuff works, would be shocked to know that you don't I mean that that, um, so that you're paying up front? Is that got to be a huge comfort to them. And are you actually using the drugs? You're not? Are you? Are you getting stuck with stuff that you are doing books with covers ripped off from laying around?

Martin Van Trieste 34:17
No, no, we've not had any product. We have 60 products we offer our members. Remember, we have guaranteed business from our hospital systems. Right? We can forecast off of that. So we don't have product that expires because we know what the health systems needs are, what their buying patterns are. And so we build our inventories to support that

Scott Benner 34:39
it's amazing. It really is.

Martin Van Trieste 34:42
Now insulin is going to be different, right? Insulin is not going to be just given to our members. Insulin is going to be provided to anybody and everybody.

Scott Benner 34:50
Mark You're good at this. Hold on. Let me just scratch off my next question from my little tip sheet in front of you that I was writing. My next question was how do you get it out? side of the system to the people go ahead, how are we doing that?

Martin Van Trieste 35:03
So, so we're gonna give it to anybody and everybody. And of course, we're gonna have the help of diabetes advocates. So you know, JD Rh, right? Beyond type one. So these organizations that have raised money to support us to bring insulin to the market, are going to be advocates for us and let their pay their membership, know where our insulin is available, how much it's going to cost, etc, etc. So they'll be advocates for us, we will provide that insulin to anybody who agrees to our pricing policy, right. And so our pricing policy is for a vial of insulin, it will not be more than $30. And we're going to communicate that through those advocacy organizations, we're actually have a little QR code on our product labeling, so that you can read that QR code, you get the package insert, but more importantly, you know, there'll be a note that says you shouldn't pay more than $30 for this. So we're trying to give that information to the people with diabetes or their families. Let them know that if you pay more than that, you know, find another pharmacy. Somebody

Scott Benner 36:17
is up charging you. Hey, just for clarity you misspoke a second ago, you meant JDRF?

Martin Van Trieste 36:24
JDRF. Yeah.

Scott Benner 36:25
You said, Ah, that was oh, I'm sorry. No, don't be sorry. I just I was like this. There's someone I don't know about. I wanted to double check to see, okay, this has to go to pharmacies, then. I mean, there's no other way to distribute it right?

Martin Van Trieste 36:39
Well, it's what your call your definition of a pharmacy, right? So clearly has to be dispensed by our pharmacy. But a pharmacy can be at Walmart, or Costco, or Amazon, or a bunch of these new pharmacies that are being developed called Digital pharmacies. Okay? Right. So has to be dispensed by a pharmacy, but there are different kinds of pharmacies today than the brick and mortar ones on the corner.

Scott Benner 37:06
So this can be on this may be online as well, then. That's right, it could be online. And so you're, you're gonna direct ship from your, from your stock.

Martin Van Trieste 37:16
We it depends on how we're doing and who we're working with. But we could direct ship from our stock, I don't think we'll be using wholesalers.

Scott Benner 37:24
Okay, this was I sat in a room once, I don't want to say with what company and I kept saying, Can't you guys just ship it directly? Like, why don't you get out of this model. And it seemed like something no one was interested in at the time. But it made sense to me in the moment, like listening to the wash of what they thought their problems were and their things to overcome. I was like, just sell directly to people like start your own. Like, I remember saying in that room, like start your own. Just do it. I was like you could pay yourself I was I was kind of genius, Nolan. Everybody's like. So is the real thing here is that the way this is getting accomplished is through desire. And that and that somebody had to step outside of the system and and want to do this because inside the game, no one person could make this change, right? Like you couldn't, if you would have stood up and had this idea at a big pharma company, everyone would have just turned their back on you and walked out of the room because like, I need this job. I don't want to talk about this. Like, that is the thing, right? It had to start over.

Martin Van Trieste 38:26
Ya know, clearly, it needed a disruptive, transformative and innovative approach to be successful. And, and, you know, it takes startup companies to do that. You know, Big Pharma is traditionally very conservative. And conservative organizations try not to be disruptive.

Scott Benner 38:53
Okay. Yeah, yeah, that's what I see, too. I just, I mean, there was, because people are always saying, like, why don't you just why don't you just and I think to myself, like, if you were there, you'd know, that's not possible. Like it's theoretically possible. But once you get into the system, you're not breaking free of that idea. I mean, you know, you know, in your regular job, good luck getting rid of the birthday cake they bring out on Friday for people like you couldn't, you couldn't get consensus on stopping that, you know, so how are you going to get involved in this? Well, this is really kind of amazing. How, how long ago? Was that meeting in Utah? Tell me again.

Martin Van Trieste 39:32
So that meeting was, I want to say January 2017.

Scott Benner 39:39
Wow. So over five years ago, yeah, yeah. And just for people to understand, like the length of time that things like this take to happen. And because that person you've met with he had that idea prior to that even so you're you're over five years of just thinking Planning and trying. And then the next step is I'm trying to imagine how you get startup money from people when you're not trying to profit. That seems like that might have been a daunting task as well or no.

Martin Van Trieste 40:14
So it wasn't that hard. Okay, but it was, but it wasn't easy. Don't get me wrong, it wasn't easy. But it wasn't that hard. There was a there, there was a giant problem impacting patients lives in hospitals. But also, it was driving any efficiencies and higher costs in hospitals. So traditionally, what most hospitals have a drug shortage team consisting of pharmacists, supply chain, nurses, and even physicians, and they meet on a regular basis. And sometimes they move even daily, to say, what can we get today to treat the patients? And how are we going to have to do something different a different procedure, or buy a different drug. So now you have these people meeting every day, they're coming up with alternative ways of treating a patient, which means you got to train people in the hospital. And then you maybe have to buy more expensive drugs than the ones that were on shortage. It is estimated by like, you know, the Government Accounting Office vizient, which is a large group purchasing organization, that that's somewhere between 600 million and a billion dollars annually, that's added costs in the health system. So you have that pain and suffering that's going through the health system, patient care, and financially. And you want to solve this problem. So you have a big problem that wants to be solved. And we asked you for some startup capital to go do it. And it's not a hard sell. Okay? Right. So we very quickly brought in about 1/3 of the hospitals in the country into our membership group. Now, when we just go and talk about insulin, that's another type of different kinds of thing. The pain and suffering that diabetics deal with every day, with die price insulin and rationing their insulin, not taking their insulin right leading time really bad consequences for them for doing that. Over the long term. There are a lot of people who are wealthy, that want to change that that paradigm, and they gave us money. You talked about the length of time. You know, we're building our own manufacturing plant in Virginia. And that plant was originally designed to make these drugs that are on drug shortage, that that process from the time you say, let's go and do it to the time you're completed is about five years. Yeah. Right.

Scott Benner 43:07
It's a it's a long haul. It really is. Do you think other? Well, I have a question before that question. When you're talking about the flange, the flange? Where did that word just come out of people who want to help you? I'm not gonna sit here and try to say, say that word that won't come out of my mouth for some reason that I clearly know. When you when you're trying to get money from those people. And it's coming in? Do you think it does it need to keep coming or once you're up and running, you'll be okay.

Martin Van Trieste 43:38
So our entire business model, both on the drug shortage side, and on the incident side, is once we're up and running with any particular product, that product has to be self sustaining. Okay, so we have to charge enough for an individual product, that it's self sustaining. So we operate on a cost plus basis, what does it cost us to make a particular product? Let's add a little bit of margin to that. So the product is self sustaining.

Scott Benner 44:10
Okay, that's amazing. So the end, these donors are not expecting any return on their money at all, or they are. They're not. Okay. Wow, I didn't know if that was part of your business model where eventually the money comes even just their initial money comes back to them or not. Do you think? Do you think that this is something that you can scale to keep impacting things? Or do you imagine other companies might start up like you and do similar things in other spaces?

Martin Van Trieste 44:38
So clearly, there's there's enough things that need to be corrected in the in the marketplace that there's room for lots of competition? Yeah. And we don't view it as competition. Right, because our whole goal is not how much market share we get. That's not our goal. It's how much market impact we make. Right? We fix To America, but there are other nonprofits starting up that are trying to do similar things and other pieces of the of the area. You have other organizations that are for profit that want to break the system and do things differently, all those digital pharmacies, they're trying to break the system. You have Amazon, they're trying to break the system. Right? So you have lots of lots of people trying to do things different in this marketplace to try to change it.

Scott Benner 45:26
Do you think if the system was successfully broken down, would that drive the major players out of the insulin game or other drug companies from making drugs?

Martin Van Trieste 45:36
I don't think people would leave the market. Especially the insulin market, you know, Lilly and Nova and Sanofi right are heavily invested in insulin. And they're always working on how to make improvements. So I just read yesterday that one of Lily's drugs, that lowers blood sugar causes weight loss, and just like novice drug does, and so they're looking at taking that a product that lowers your sugar levels to drive weight loss, right? So they're always working on something in the space are always figuring out how to make improvements. And like I say they're used to generic competition. They've right since 1984, the hatch Waxman Act has encouraged generic competition. And so they're used to it and they're always trying to innovate. So if their product goes off patent have something to replace it.

Scott Benner 46:29
You didn't get any pushback politically for this.

Martin Van Trieste 46:32
Oh, no, everybody, the entire political spectrum, basically loves us. Okay. It's a bipartisan issue. Right? Patients are Republicans, Independents, and Democrats, they all hear the pain that patients have gone through. Every time I go to Washington, it's amazing. Every time I sit with a congressman or a senator or their staffers, how positive they are about us, they're encouraging us to be successful. And so no, it's it's very positive from Washington. Now, I know others are lobbying against us Sure. Every, every time I go sit with the senator or congressman, they, they basically say, when you're going to do insulin, when you're going to do insulin, that was from day one, when you're going to do insulin,

Scott Benner 47:23
do you find that what they're saying in the room is reflected in their actions in public?

Martin Van Trieste 47:29
You know, in public, they can't agree on anything. Right? Right. I mean, they wouldn't even be able to agree that Washington's Birthday should remain a holiday. Right? So to me, you know, what they do publicly is, you know, is is very, is very partisan. And this this issue, you know, at least insulin, they're talking about a $35 cap on insulin. And that actually is very complementary to what we're doing, okay? Because if you do a $35 cap, the pharma companies are still going to charge the price they charge, you're still gonna give rebates to pharmacy benefits managers, so someone has to backstop what the current price is to the $35 cap. Yeah, right. So whoever is paying that backstop, if it's the government, and we're charging $30, they benefit from what we're doing. Right? If it's an insurance company, they're benefiting from that backstop. And by the way that that $35 cap only affects someone's copay. Okay. All right. So if you're uninsured, that doesn't help you that $35 backstop.

Scott Benner 48:44
Right. Well, you know, it's it's just it's almost, it's angering it is for me, it's angering to think that this entire problem is built off of people just like basically lining pockets to stay higher on a list so they can sell their thing. And at the same time, I actually understand how they fell into it. Like once it was there, I understand why they played the game, you know, where they wouldn't be selling.

Martin Van Trieste 49:08
And I think the game started with EPI pens. Really. That's where someone was smart enough to figure out. Okay, generic competitions coming from my epi pen. I charge right now $300 For two epi pens. What I'm going to do is I'm going to and when I was charging $300 for two epi pens, I was keeping $260 and the pharmacy benefit manager was getting 40 Okay, I'm gonna raise my price, I'm gonna double my price. I'm going to double it to $600 and I'm going to give $300 to the pharmacy benefit manager to keep me at the top of the list and not put the generic guys anywhere on the list at all. And I now know I don't keep to under $60 I keep $300. And the pharmacy benefit managers, they don't get $40 they get 300. So now I want to bring a low cost epi pen to the market, I have to go to those pharmacy benefit managers. Right, I have to go through them for the get the insurance companies to pay for me. And I got generic epi pen I want to bring to epi pens for $50 to the market. And they go, but you gotta give me 300 to get on the list. Why can't give me 300 I'm only charging 50. It's

Scott Benner 50:36
like trying to get into a club in the 80s. Right, you just you grease some palms at the door to get in. I have two questions here. So my first one is, and I just want to kind of come from this from the other angle for a second. Is there how to I mean, this making a drug is not easy. You're obviously a bright person. Right? And and you have a lifetime worth of experience. And I think that as a as a layperson, I want bright people with lifetime's worth of experiences making drugs. Is there. Is there a world where you break the system so much that a kid coming out of college won't choose Pharma? And do we weaken the system that way? I know that's a real big picture idea. But I was wondering if you ever thought about

Martin Van Trieste 51:24
it? I mean, well, we think about it from a different perspective. Okay. So we say we do not want 100% of the volume for any drug. Because if we do that, eventually will become the problem that we're trying to solve. Right? Right, if we provide one or percent of any drug, and if something goes wrong in our supply chain, will no longer be able to provide that drug. And that's not good. So we try to limit the amount of a drug that we produce to no more than 50% of the market. And we work with our members to kind of worked through that those calculations and those forecasts and those commitments we talked about. So we're trying not to do that, from that perspective. Could we break the market in such a way that no one would want to go into the, into the pharmaceutical industry in the future? I think that's hard to do. I mean, one company can could hurt another company, right? I could take all the sales of insulin, for example. And, and Sanofi and Lilly and Nova would be really financially hurt by that. But that's just three companies in an industry that has 1000s of companies making pharmaceuticals. So I think it's hard for us to do to break the model so bad that people won't want to go into pharmacy

Scott Benner 52:57
and civic as an example. Are you compensating employees similarly to how they're they be compensated in a foreign?

Martin Van Trieste 53:05
Absolutely, I'm the only one that makes nothing.

Scott Benner 53:10
somebody's walking,

Martin Van Trieste 53:12
otherwise, we pay very competitive salaries, or I would not have been able to hire the team of people that I have. Yeah,

Scott Benner 53:19
I get that. It's just It's, uh, you know, in my mind, those people, they go to Expensive Colleges, and they come out and they have, you don't I mean, there's still people and they still have dreams, and they want to put kids through college, etc. But I think what we're really hearing is that some people civic are walking around with Martin's money in their pockets. It's a really, it's a really kind thing you're doing, I have a couple more questions, I'm gonna let you go. Have you ever considered open sourcing what you're doing going to other companies and sharing what's working and what's not working so it can grow?

Martin Van Trieste 53:52
We were very transparent organization, and we actively teach our model to anybody who wants to learn it. And so not only companies, but I've had foreign governments call me and say, How did you do this? What are you doing? What can we learn from it? So we're very transparent, and we do teach the model to people.

Scott Benner 54:14
It's wonderful. It really is. Okay, well, we have painted a really rosy picture of of insulin pricing in the future for people who I mean, you imagine mostly this is going to be people who don't have insurance, right? This is going to help?

Martin Van Trieste 54:28
Well, so it'll definitely help those people people with high deductibles. Right. But also, right. It'll help insurance companies, right, because insurance companies are paying a higher price and then we'll be selling it for so to help insurance companies and hopefully the insurance companies then lower their premiums based on those savings.

Scott Benner 54:53
I guess if I just want to stick it to the man I could buy your insulin if I wanted to. Right. But

Martin Van Trieste 54:57
clearly, I mean think about it, right? I go to buy some generic drugs for myself, right? I, I'm an old white guy, I have hypertension and high cholesterol and things, bad knees. And so you take take all your medicine. And so I know the cost of generic drugs and what it is, and I'll go to a pharmacy, and my insurance deductible might be $10 $15, right. And I go and pay cash and I pay $7. Or sometimes some of the generic drugs that I had take, there was one example, where I went to the pharmacy, and they wanted to charge $250 for the drugs, right, and my insurance company, that was my deductible with the insurance company to their $50. And I went on good RX. And I found out if I go next door to the pharmacy next door, it'd be $25. Right. So clearly, there's games going on, in, in the insurance space, too, that people should be aware of tools like good RX, and things like that, to get that information to have the power.

Scott Benner 56:08
So you might not I don't know if you'll be comfortable commenting on this. But I'm just asked me a question. So there are for profit, people who are still delivering drugs at more affordable and really affordable prices, their people are still being well compensated. We're talking about like obscene wealth at the top of organizations, right? Like, I don't have a Maserati, I have seven miles or Audis. And so does my wife and my girlfriend like that kind of thing. But right, it's just, it's a piling of money at some point. Am I right about that?

Martin Van Trieste 56:38
Well, CEOs in all industries are highly compensated. Yeah. But that doesn't, that has very little to do with the price. Right? Because you can deduct, you can say that person gets no money, it's not going to significantly lower the price of any of the medications, right? Because one, people are trying to maximize the, for a for profit company is designed to create shareholder value. Yeah. Right. So the way you create shareholder value is either you increase your sales, increase your price, or cut your cost, right, there's no other way to create that shareholder value. And that's, that's what people are supposed to do in a for profit space, right?

Scott Benner 57:20
I had a person come to me once and with this idea, and they said, Well, why don't they just stop marketing, if they put so much money into marketing, and I said, you're gonna fire the marketing guy, I was like, He's 50. He's got two kids, one of them just went off to school, he's got diabetes, now he can't afford his insurance like, and by the way, when they fire him, they're not going to take his $100,000 Or two, whatever the hell he makes a year and split up between all of us. And even if he did, the, you need a quarter of a penny that badly, you know, like, it's, it's a big, you really have to understand the space to impact it's so great that you were able to pull that group of people together, or those other people as invested in like, a civic, I guess, is the feeling I get from you. Is it pervasive? Or you don't I mean, like, sometimes people are just selling widgets, you know what I mean?

Martin Van Trieste 58:09
So I would say clearly, the clearly the leadership team is, is looking fast, right? I mean, it's hard to get people to change jobs, right, who are highly successful in their industry? Sure. And they change jobs, because they believed in the mission and what we were doing. And it's interesting that the rest of the organization, the number of people who come to us, say, I want to work for you, I want to make that difference. Yeah. Right. And I can't make that difference where I'm working today. I'm like the cog in the gears, right?

Scott Benner 58:49
That's very interesting. My wife talks about that all the time that she, she felt she felt more fulfilled as a as the parent of somebody with diabetes when she worked at a company who just made diabetes stuff, you know, and not that she doesn't enjoy her job now, but that she there was extra for. It's amazing.

Martin Van Trieste 59:09
And it is true, we found out after we made the announcement that we were going to do insulin, the number of people who want to come to work for us that had that diabetes connection, like you said with your wife was was overwhelming and not just coming to work for us. A bunch of people who are at the end of their careers said I'm going to retire I've come to work for you for free. Wow. Do what I did. Right? Because of that diabetes connection.

Scott Benner 59:38
That's terrific. All right. Well, all right. I'm sold Martin. When When does this happen?

Martin Van Trieste 59:43
So we'll deliver our first insulin and we'll be the biosimilar of Lantus Claridge clergy in early 24.

Scott Benner 59:52
No kidding. You think first quarter or do you not say out loud but you think I always say out loud Guess you're not publicly held, you can say whatever the heck you want. But

Martin Van Trieste 1:00:04
we're really pushing for the first quarter of 24. Okay? It's got to be a tight schedule and a green light schedule to get there. But it will happen in 2024

Scott Benner 1:00:15
is the similar human lager Novolog. Next,

Martin Van Trieste 1:00:19
so everyone will have a little bit of a lag behind it. So right, we've developed the first insulin, the our partner who's making the active ingredient does, he then makes the first one that has a turnover and makes the second one a turnover and makes the third and repeats the process. So Glargine will be first. And then the other two will follow

Scott Benner 1:00:42
shortly thereafter, in sequence, give a timeline for those are the All of those will

Martin Van Trieste 1:00:47
be in 24. It's about a quarter between each one to get the first ones to the market.

Scott Benner 1:00:53
Do you have to do you have a an amount of time you'll need to ramp and scale? Or will it happen pretty immediately?

Martin Van Trieste 1:01:01
Well, when I say we're coming out in 24, we've built that ramp and scale into Oh, that's beautiful. Now we anticipate that in our fourth year of operation, we'll have about 1/3 of the market for those products. That's based on a forecast. Yeah, you know, forecast are wildly incorrect, right? They're not they're not an accurate thing. So. So we'll say that it will all depend on how the Marketplace responds, right?

Scott Benner 1:01:31
Well, if you ever want to come back on here and let people know about it, I'd be thrilled to talk to you more. I think it's a really wonderful thing that you guys are doing. Am I not asking you anything that I should be?

Martin Van Trieste 1:01:44
No, you asked all the right questions, did I because I'm

Scott Benner 1:01:47
surprised by that. Martin, when we sat down what I knew was your name was Martin. So I just went with the conversation. Good, good.

Martin Van Trieste 1:01:56
I mean, you go through this, you, you you have association with diabetes, you know, what it's like, I have a question for you. Okay. So we hear from diabetics, that they keep large quantities of insulin, stored in the refrigerator for fear that there's going to be a shortage of insulin, or they can't afford to pay for it, change companies, whatever it is. I find that amazing that people feel the need to do that, in our very, you know, well to do society, right. Do you, does your family do that? Do you keep large stocks of insulin?

Scott Benner 1:02:41
So I have, I think because I'm gonna have to, I think because of a job change that my wife experienced, at some point, we got into a position where we had to send scripts to a new insurance through a new insurance company, and we got insulin that we kind of didn't need. And so we had some left, and then more came in. And then since then, I've been able to maintain that backlog, I guess, as a lack of a better way to put it. Prior to that, I would have felt uncomfortable. It's funny, I would have felt uncomfortable under four vials. And my daughter probably uses what she uses 200 units every three days. So it's not a I don't have that fear that you're talking about. But I have spoken to many, many people who have it. And I do generally subscribe to what you said there are literally four pharmacies within a mile of my house and I have insurance and if I needed insulin, I could go get it. I'm not pressured by it, but I understand when people are you know, I guess that's my answer.

Martin Van Trieste 1:03:51
Oh, good. It's really nice to meet you, Scott.

Scott Benner 1:03:53
You as well, Martin, this was this was absolutely terrific. Thank you, I wish you all the best with this thank you again for what you're doing. Right? You want to take a printer out of that place or a pack of paper or something you know what I mean? One time just be like this is Martin's and just leave with it. I like to see you compensated

Martin Van Trieste 1:04:15
I've been very fortunate in my life. We you know from a family we're having a great family and three great kids and you know working in great companies and you know I'm well to do and you know, this didn't it just didn't seem nice start take

Scott Benner 1:04:28
us out really lovely. And there's no diabetes in your family. Is that

Martin Van Trieste 1:04:31
right? No diabetes in my family. Okay, well, from all of us.

Scott Benner 1:04:35
Thank you very much. I really appreciate it. All right. Yep. Take care you too.

Well, let me start off by thanking Martin for coming on the program. This was an excellent conversation. I'd also like to thank the Contour Next One blood glucose meter and remind you to go to come contour next one.com forward slash fuse box to get started today. And let's not forget us med I wasn't going to forget them. I just you know, it's a way to start talking and let's not forget us med white glove service, always 90 days worth of supplies and fast free shipping. Get your free benefits check at us med.com forward slash juice box or by calling 888-721-1514

I have to go get knee surgery tomorrow. So I'm going to keep this brief. If you're enjoying the podcast, please tell a friend subscribe in a podcast app. That's pretty much it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. It's a simple knee surgery please don't worry about me. I'll be fine.