#1795 Had Enough - Part 2
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Justin returns to talk anger, money, burnout, and why 21 million downloads matter. A raw, funny, honest look at what it really costs to live with type 1.
Key Takeaways
- Pharmacy vs. DME Savings: Navigating insurance to move supplies from Durable Medical Equipment (DME) to the pharmacy can result in massive savings. Justin saved $2,000 annually by switching to pharmacy co-pays for Omnipod and Dexcom G7.
- Retinopathy and A1c: Justin observed that his mild diabetic retinopathy improved or receded in one eye after achieving better blood sugar stability and a lower A1c.
- Hardware Reliability: While "looping" with old Medtronic pumps is a viable entry point for DIY automated insulin delivery, hardware failure is a risk; modern options like the Omnipod Dash offer current hardware with pharmacy accessibility.
- Accessibility Commitment: The Juicebox Podcast invests in transcripts and ASL translations for the "Bold Beginnings" series to ensure life-saving management information is available to those who are deaf, hard of hearing, or non-English speakers.
- The "Legacy" Purpose: Beyond building a top 1% podcast with 21 million downloads, Scott’s primary motivation remains creating a comprehensive resource for his daughter to use as an adult.
Resources Mentioned
- Eversense 365 (1-Year Wear CGM): eversincecgm.com/juicebox
- Tandem Mobi (Control IQ Plus): tandemdiabetes.com/juicebox
- Touched by Type One: touchedbytype1.org
- Juice Cruise 2026: juiceboxpodcast.com/juicecruise
- Erica Forsyth (Therapist): ericaforesight.com
- Dexcom G7 CGM: dexcom.com/juicebox
- Omnipod 5 & Dash: omnipod.com/juicebox
- Wrong Way Recording: wrongwayrecording.com
Health Complications and Retinopathy
Scott BennerFriends, we're all back together for the next episode of the Juice Box podcast. Welcome.
JustinI'm Justin. I'm a type one diabetic. I've had diabetes since I was just shy of three years old, and I'm pissed off.
Scott BennerThis is part two of a two part episode. Go look at the title. If you don't recognize it, you haven't heard part one yet. It's probably the episode right before this in your podcast player. Check out my algorithm pumping series to help you make sense of automated insulin delivery systems like Omnipod five, Loop, Medtronic seven eighty g, Twist, Tandem Control IQ, and much more.
Scott BennerEach episode will dive into the setup, features, and real world usage tips that can transform your daily type one diabetes management. We cut through the jargon, share personal experiences, and show you how these algorithms can simplify and streamline your care. If you're curious about automated insulin pumping, go find the algorithm pumping series in the Juice Box podcast. Easiest way, juiceboxpodcast.com, and go up into the menu. Click on series, and it'll be right there. Nothing you hear on the Juice Box 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.
Scott BennerI'm having an on body vibe alert. This episode of the Juice Box podcast is sponsored by Eversense three sixty five, the only one year wear CGM. That's one insertion and one CGM a year. One CGM, one year. Not every ten or fourteen days. Ever since cgm.com/juicebox. Today's episode is also sponsored by the Tandem Mobi system, which is powered by Tandem's newest algorithm, Control IQ Plus technology. Tandem Mobi has a predictive algorithm that helps prevent highs and lows and is now available for ages two and up.
Scott BennerLearn more and get started today at tandemdiabetes.com/juicebox. The podcast is also sponsored today by Touched by Type One. Please take a moment to learn more about them at touchedbytype1.org on Facebook and Instagram. Touchedbytype1.org. Check out their many programs, their annual conference, awareness campaign, their d box program, dancing for diabetes. They have a dance program for local kids, a golf night, and so much more. Touchedbytype1.org. You're looking to help or you wanna see people helping people with typeone, you want touchedbytype1.org. Do you have any complications right now?
JustinNo major ones. My eyes seem to be struggling a little bit. I had corrective eye surgery back in, I think, 2004. I had glasses for a while as a kid, and I went with corrective eye surgery to fix that. And then maybe, like, two years ago, I started needing cheaters a lot more often for reading. I can drive without glasses. Mhmm. They say I have mild diabetic retinopathy, but it's I think I had it in both eyes, and I wanna say the one eye I don't know if it's receded or gone away or whatever, but it at least in the one eye, it's improved. And the other one, the current eye that it is noticed in, she's had a harder time finding it.
Scott BennerI've interviewed people that say that they've had pretty significant issues that once they got their a one c down and they've got nice stable blood sugars that they've experienced a lot of progress and positivity in their eyes. So, yeah, that's awesome.
The Financial Burden: DME vs. Pharmacy
JustinI I would say the only other complication is financial and with hardware. Stuff costs more now. Well, it it costs more, but maybe two years ago, it was nice. I at the one endo office, I said I was looping, but I need the old pumps. My NP went into a drawer, pulled out about eight of them from patients who would surrender them to the office once their four year warranty was up, and she just gave me six of them. I thought, this is great. So I but I think in a matter of a year, two broke and one died. So I thought, oh, that doesn't make me feel very good. And then I thought back to I had been on MiniMed since the early two thousands. I was on Desatronic before that when I first went on the pump. Medtronic's all I knew, but then I said, well, that girl at the ADA tour de cure event, she had the Omnipod, and dashes are still being made. So that's new current hardware. And, oh my gosh, it comes through the pharmacy.
Scott BennerI was gonna say, you're not still looping with an old Medtronic pump. Right?
JustinI think I have two of them upstairs. But you're doing it with Omnipod right now? I am. I am. For a couple reasons. First one's financial. I don't ask me why. Okay. Back to the anger. It pisses me off that I went, oh, boy, probably five years paying the rates for DME through my insurance for the Medtronic supplies or the MiniMed supplies, which were separately reservoirs, tubings with the infusion sets, and oh, at one time, the n light sensors.
JustinBecause the CGM went through them too. So, eventually, the first thing I switched off of was the nLIGHT, and I went to DexCom because lo and behold, LOOP would let you use Freestyle DexCom or the nLIGHT sensor if you had the Medtronic. Mhmm. And I thought, well, if I'm gonna switch off, let me try the Medtronic pump with the Dexcom sensor to get on more current hardware, and Dexcom has always been, in my mind, from what I've heard, the gold standard for CGM. In that day, certainly starting off, I migrate to Dexcom. Then eventually, I think after I broke the third pump, I said, boy, I gotta get this other pump. So I I go to Omnipod. Now that had to go through the pharmacy, so that was a single co pay. I got to easily drop the co pays or move away from DME for the Medtronic supplies. And then I said, yeah. Omnipod only goes to the pharmacy. And for some stupid reason, I looked up on the formulary list for, I think, MiniMed. And sure enough, all the supplies are in the pharmacy. Yeah. And I'm saying, where are people to—
Scott BennerTell me that. Yeah. Yeah. Yeah.
JustinWho's gonna stand up and say, DME may work? Because I guess it worked. I asked my mom recently, how much did you pay for my supplies as a kid? And she goes, gosh. I really don't remember, which to me says—not that much. I doubt it was free or covered, but it couldn't have been much. So now I'm like, how much am I paying? And so I added everything up, doing the, like, four circuits of it a year for the ninety day supplies, switching all the mini med supplies. If I changed nothing—switching the mini med supplies would save me a thousand dollars a year out of pocket.
Scott BennerThat's awesome.
JustinThen switch that around and with the change to Omnipod, which is a single co pay every ninety days, plus doing g seven instead of G 6 because G 6 was two scripts, transmitter and sensor. Yep. Going to the G 7, since it's all one unit, that's one co pay and one script. And then moving from DME to pharmacy, out of pocket, I saved $2,000 a year.
Scott BennerThat's a significant amount of money. Jeez.
JustinAnd where is somebody to say, hey. Maybe you should check that out? Or think to search through the Apple podcast app and say, oh, who's got podcasts about diabetes loop? Oh, this dummy Benner has it.
Scott BennerI'm uncomfortable with you calling me dumb. Man, I'm happy the podcast is valuable for you. I really am. It's it makes me feel great.
JustinAnd it's it's not just me. I mean, clearly, what are your downloads like each day?
Podcasting Stats and the Top 1%
Scott BennerWell, I don't share that. But Okay. I could tell you that I have this is January 2026. I've just started producing my twelfth solid year. We did 320 episodes last year. We'll probably do somewhere similar, you know, maybe a fewer this year. I, woke up this morning. The podcast was number 12 in the Apple US medicine category. It was top 200 in 42 other countries. Australia, Canada, England, there were, like, in the top twenties, top 30 in those countries.
JustinAre you just buying time to try to get a number, or are you gonna answer the question?
Scott BennerI've I've done close to 21,000,000 downloads the time I've been making the podcast. The podcast is in the top 1% of all podcasts that exist. Let me be honest. Not that I'm not being, but let me be further honest. I am in the top one percent of all podcasts. Having said that, there are about four and a half million registered podcasts. Only about 800,000 of them actually produce an episode. Of those 800,000, something like 86% of them don't do enough downloads to get an ad. So you're basically talking about 14% of about 800,000 podcasts that are, like, viable, actually get more than about a 130 downloads per episode. But of those 800,000, I'm in the top 1%. If you take the top 1% and break it down into a 100 parts, I'm, like, the top 40% of the top 1%. Meaning that, you know, the big the famous people—
JustinYeah. You're you're no Joe Rogan. You're no Jason Kelce.
Scott BennerThose people are probably doing my daily downloads in an hour. If I did some rough math here correctly, I would this is my opinion. You're in the four figures, probably— A day? We do millions of downloads a year. So the rough math would suggest that you're around maybe 10,000 a day. So that's 10,000 downloads a day Mhmm. from people like me. Hopefully, not too many people like me because I'm a jerk.
Scott BennerSo angry and mean, Justin. I'm also looking out the window. It just started to snow. So I'm gonna get angrier. Where are you at? Saratoga, New York. Yeah. That would piss me off. I don't want it to snow here. I just wanna say that right now. Go ahead. I'm sorry. People like you.
JustinThere are roughly 10,000 people who are listening to you every day because they are scared. We are scared. I'm gonna let myself in. We are scared. We are let down. We are lost, and we need you, the guy from Jersey, to basically tell us and show us what we're not being told that's more valuable than the blessed safe thing. Because what happens if and when—let me run a a crazy theoretical. What happens if somebody comes out with research that says GLP ones don't work? You've been banging that drum for a while for good reason. Let me be clear. But if you were a medical professional and that blew up in your face, you would lose your license or you would have a reputation that would hurt your well-being. What happens to you if that comes out? Probably nothing. You pivot because you're just a guy—
Scott BennerSharing people's stories. That's really it. And guiding us. I mean—that's where the value is. Justin, listen. I've come to think of it more like this. I'm sure I have some skills that make this listenable. That's all well and good. But what I've done if somebody with type one diabetes wants to say thank you to me, I think that what I've done is I built this thing up to be large enough that it attracts people to come in and tell their story so that you can hear their story. I just think of this more as like a I don't know. I own the megaphone. It's kinda how it feels. I could be doing all kinds of cool stuff with my megaphone if I wanted to, but instead of going to a football game and using it and picking something that I'm could make a bunch of money off of or whatever, I just take my megaphone every day and I hold it up and I find somebody with type one diabetes or is impacted by diabetes somehow and I say, here's my megaphone. You go ahead and use it today.
Tandem Mobi and Eversense Sponsoship
Scott BennerLet's talk about the Tandem Mobi insulin pump from today's sponsor, Tandem Diabetes Care. Their newest algorithm, Control IQ plus technology and the new Tandem Mobi pump offer you unique opportunities to have better control. It's the only system with auto bolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandem Mobi gives you more discretion, freedom, and options for how to manage your diabetes. This is their best algorithm ever, and they'd like you to check it out at tandemdiabetes.com/juicebox. When you get to my link, you're going to see integrations with Dexcom sensors and a ton of other information that's gonna help you learn about Tandem's tiny pump that's big on control. Tandemdiabetes.com/juicebox. The Tandem Mobi system is available for people ages two and up who want an automated delivery system to help them sleep better, wake up in range, and address high blood sugars with Autobolus.
Scott BennerWhy would you settle for changing your CGM every few weeks when you can have three hundred and sixty five days of reliable glucose data? Today's episode is sponsored by the Eversense three sixty five. It is the only CGM with a tiny sensor that lasts a full year sitting comfortably under your skin with no more frequent sensor changes and essentially no compression lows for one year. You'll get your CGM data in real time on your phone, smartwatch, Android, or iOS, even an Apple Watch. Predictive high and low alerts let you know where your glucose is headed before it gets there, so there's no surprises, just confidence. And you can instantly share that data with your health care provider or your family. You're going to get one year of reliable data without all those sensor changes. That's the Eversense three sixty five. Gentle on your skin, strong for your life, one sensor a year that gives you one less thing to worry about. Head now to eversincecgm.com/juicebox to get started.
Education and Curriculum through Entertainment
JustinBut you balance it with Jenny and Erica and doctor Blevins, folks who are adding more curriculum, more structured. Yeah. I mean, listen. Put another way, I think I trick you into taking care of your diabetes by entertaining you. That's what I'm trying to do. Like, I make the podcast something you wanna come back to so that you'll listen to the stuff that helps you because I think if you just made a very cold podcast about diabetes, don't think anybody would listen to it. Actually, I think other people have proven that out. You provide the wants of the stories alongside the needs of the curriculum.
Scott BennerListen. I can tell you this. The ADA has a podcast. They do? Yeah. Well, listen. The ADA has a podcast that there's been blog talk radio shows before mine, but I think I had the first type one diabetes podcast, January 2015. And when I really went back and looked, I think the ADA might have had one a couple of months before me, and I just didn't realize it. But in their social media somewhere, I saw them celebrate a million downloads, but it took them, like, ten years. And and I thought I mean, because the information in the ADA podcast must be pretty rock solid, you would imagine. You know what I mean? Listen. Getting a 100,000 downloads on a podcast in a year, and I don't know what they are, but I'm kinda saying ten years, 1,000,000, kinda breaking it down that way. That's just it's insignificant as far as a podcast goes. You know, if you're just trying to reach a small group of people and you're using it for a business or something, that might be amazing. But if you're trying to cast a net that reaches the whole world and brings back in—you know, I hate to say it, but if you're doing a $100,000 a year on a podcast, you're not reaching very many people. It's about making it something that is listenable, that you leave with something actionable, and that could be your mental health feels better, you feel heard, you feel like somebody understands you, you understand how to pre bolus now, whatever that might be for you that day. And you leave with that improved so much so that you think to go tell someone else about it. And that's how it grows, and it's why I get as many downloads as I do and why the podcast continue—actually, this year is starting off great. Like, it's growing like crazy right now again. And so that's why that stuff is happening. And was that my intention when I started? Like, I don't know. Like, I I really don't know. I just didn't wanna lose my blog was popular and it helped people. And I didn't wanna lose it and people stopped reading, so I made a podcast. And this thing has clearly grown since then.
JustinI like audio better myself personally. None of us read anymore. That's pretty much over. Well, that's true. Yeah. But it also sticks to you better. And by the way then, there's people who, like, came to me years ago and they're like, well, listen. I it's nice to hear that this pro tip series is helping people, but I don't learn that way. And I'm like, oh, okay. Well, here's transcripts. Do you know there's a person I just learned this in the last year. There's a person who helps me online. Like, I have these group of people who help in the Facebook group. Lovely, lovely, wonderful people. And I learned recently, one of them doesn't even listen to the podcast and never listens to it. And I was like, wait. What? And they go, no. I read it every day. I'm like, you read the podcast every day. He's never once heard it. Wow. Ain't that fascinating? Because when people came and said I need transcripts, I was like, why? Because I would never read it. But then I realized some people did, so we added transcripts and that helped immensely for another group of people. I don't know if 50 people will ever see it, but I, out of my pocket, paid for an ASL translation of the bold beginning series.
JustinAnd I watched one of those videos. I don't know sign language, but I watched it because you had put in that effort and expense, and that lady does a terrific job. She's awesome. The way I thought of it was for the person who needs that, my gosh, that's gonna be big for them. Right? And I only knew that because I hear from so many people who are like, a woman just contacted me recently and said, would you mind if I took all your transcripts and translated them to another language? And I was like, they're on the Internet. You can do whatever the hell you want with them. Like, go ahead. But she's got a whole population of people, I don't wanna say exactly where, but, like, on a small island somewhere who need this content. And she's like, they just don't have any context for English at all. I do. I'm gonna translate it all and give it to them. And I said, you should do that. But at the same time, Justin, what I'm gonna tell you is Facebook is doing it now. They're picking, a few videos that they're running, and you can live click on the video and choose a different language, and it just translates it right there.
Technology and Accessibility (iOS 26 and AI)
JustinOh, see. I know you talked about I think it's your AI agent in Circle. It does that too. Yeah. You can go into that Circle group, and, basically, there's, like, a couple of 100 transcripts of the podcast in there. You can type a question in a different language, and it'll query everything and answer you in your own language. But the problem with that circle group is is that it's hard to build up. I think I have, like, a thousand people in there, which is lovely, but people use Facebook because Facebook's on their phone. It's in their face. And what I'm learning after a year of running that circle group is that it could just isn't drawing people in, and it costs me $400 a month. And so I'm thinking I have to shut it off, and it breaks my heart. I wish you would all just go use it and talk to each other there and get the benefits of what else it does, but I just don't think it's gonna work. People who are on Facebook are programmed to be on Facebook, and to ask them to open up a different app, it just doesn't translate. But I also don't know that that's gonna matter in another year or so because my point is is that Apple just updated their podcast app again. If you have iOS 26, your podcast app looks a little different now. And I actually think you can update it without going to iOS 26. But update your podcast app in Apple because now it breaks it down into chapters already. As you're listening, it says, like, this part's about this. This part's about that. The live translation to text is pretty seamless. I think the Apple Podcast app makes better transcripts than whatever the services I'm using online. And my expectation is if I pull back and see the big picture, if you can type into something in one language, it can query a different language, come back to you in your language. If Facebook is starting to mess with videos that you can click on and change it into German or Spanish, like, right there, like an English speaking video, then my expectation is that we are not far away from going into Apple Podcasts or Spotify, listening to an English language podcast and just pushing a button and saying, wanna hear it in this language. I think that's probably pretty close. So once that happens, most of the things I've been trying to get to are gonna happen automatically, which is good because I along the way, didn't have the resources to do half the things I wanted to do anyway. It looks like AI is gonna take care of that for us.
JustinThat's pretty wild. Yeah. For the different languages, the spoken and written languages, that's wild. I mean, I already knew about the written translations that you could do out of the AI agent, but if they're doing that—live. Yeah. It's happening live in front of you. In audio or video. That's incredible.
Scott BennerI'm listening to an episode today because I tried a different editing thing today, and I was trying to listen to the audio. So I'm listening to my own podcast this morning to hear it, but I'm in the player right here. If you click on it, it drops down, and it breaks into chapters. The $15,000 dog, a frustrating diagnosis journey, early medical trauma, compounding health crises, finding answers through listening, redefining diabetes management, advocating for better care. Broke it down into those chapters. I didn't do that. I didn't tell it that. I just uploaded my podcast, and when it comes out on the app, it's got those chapters on it now. Everything's gonna speed up really quickly.
JustinI've never noticed your episodes that have the chapters, and I've seen—
Scott BennerNo. Apple did it. It just started happening. Yeah. Like, everybody go download iOS 26 if you wanna help me. That would be a big deal. Get the new podcast app. Anyway, the Circle Group is it's $5,000 a year.
JustinWhich was great for when you had one of the sponsors. Yeah. I got a sponsor to cover it last I'm paying for it now this year. So, like, I just go in there, and it sometimes it feels like there's, like, 20 people using it. I do see the same people I see, Monica and Domino and Jen. Yeah. Which Jen, by the way, very sheepish and concerned about what she said in her interview with you. So she's not real keen on how it's gonna come out.
Scott BennerReally? She's scared. No. You scared her, Scott.
The Unscripted Nature of the Show
Scott BennerWell, listen. What I can tell you is that most people leave this thinking like they did a bad job. And what I always say is I might be getting close to 1,800 episodes, and everybody does a good job. You're not doing a good job or a bad job. You are telling your story the way you know how to tell it, and it's it helps people. I think that one of the great things about the podcast is that it's me talking to people who have never been on a podcast before mostly. Yep. It's not somebody who's out there. Like, it's podcasting is used to be that if you got together and you in you'd interview a blogger, but bloggers became rehearsed. And so it didn't matter what you asked them, they had pat answers. And so no matter how many times they did an interview, it just all looked the same. And now with people trying to be influencers, they've all made the same mistake. Like, I could get thoughtful about why I think my podcast is popular, but I try not to fall into that, like, well, I shouldn't say that or I just def you know, don't say this. Don't talk about that. Like, know, just say these things. But it all works the same way now too. So there's the same group of people that are running around doing diabetes media basically, and they all just say the same damn thing over and over again. And so there's no value in that at all. Or they're trying to get out the word about their thing. Oh, you know, I have a coaching service or I have this or, like, they tell their stories so they can get to the thing they want you to click on or whatever. I don't have any of that. Although, I would like you to come on the cruise. The cruise is awesome. If you don't come, I'm okay with it. You know what I mean?
JustinAnd you've had, you know, some people—clearly, Jenny's from IDS to get more treatment and consultation with her. You gotta go to IDS. You've had Erica who I imagine has her own practice. She does. Yeah. But those people aren't picked by me for that reason. Jenny's picked from me because Jenny just came on the podcast, like, in the first year or so of it. And I just left that conversation thinking, oh, I love the way she talks about this. And it was maybe a couple of 100 episodes later when I decided to make the pro tip series, but I thought it would sound ridiculous if it was just me talking. It would. Yeah. And so I said, like, why don't I see if Jenny will do it with me? And then she was really tickled by it because she said, for as many people as I help in my profession, I I still don't feel like I help enough people. And she likes the way I talk about it. I mean, Jenny's probably been on this podcast hundreds of times, and it added something to it. There's no doubt the pro tip series is better because Jenny is there. If there's no doubt. Right? For sure. Yeah. And then we go on and we make other stuff, but Erica—no disrespect to other people—Erica is, like, the fifth—maybe the—I mean, I tried so many different psychologists, and I never vibed with them until I got to Erica. And I was like, I like the way this feels when I'm recording with her.
Scott BennerSo now I have somebody who can come on and entertain my my silliness or my ideas about the world or mental health or whatever like that and try to keep it, you know, together. We just finished a series that's gonna start running in a week about body grief, which is an idea I didn't understand that she brought the light, which is awesome. The next series we're gonna do is the opposite of the aces. So that aces list of life traumas that lead to difficulty later, we're gonna do a list of things that parents can do that lead to successes later. That kind of stuff is with her. And, yeah, ericaforesight.com. If you need a therapist, you should go check her out. But we don't push it. Like, she comes on and does the thing, Jenny. I don't think I ever mentioned what Jenny does for a business. It's something people figure out for themselves. And I have no business relationship with the company that Jenny works for. Sure. Yeah. Jenny just yeah. By the way, I don't have a business relationship with Erica. Like, I'm not getting a piece of anybody. If I did, I would tell you, but I'm not.
JustinRight. Have your sponsors that you do your ads for in the show, but then you're happy to have on people who have value to add for all of us, like Kenny Fox—Kenny. Yeah. Who brought me to you. His original—The Fox and the Loop House. Episodes. And then there was, is his name John Fawcett with Sugarpixel. Yeah. John and I are doing a whole thing this year together. John and I are gonna be at ADA, ADCES, Friends for Life. We're gonna do a booth together at all those events this year. You're not shy about highlighting something that will help the audience in their daily lives, but you're not shilling either.
Ethics of Free Information and Ad Revenue
Scott BennerNo. I'm definitely not. There are things that I have, like, personal discomfort with. I I don't begrudge anybody a living, but I am not gonna drive you towards a coaching service that's basically just gonna tell you you can do it and here's how you're pre bolus. I don't think you should have to pay for that. Right. There are plenty of coaches that try to come on. I'm like, I'm I'm not doing that with you. Like, you're not charging somebody a few $100 to tell them how to, like, do a sit up, you know, or something like that. And there are people who need that. You're gonna hound us to pre bolus, but you're gonna do it free. Yeah. I don't think you should have to pay to understand the bare bones ideas about diabetes. Right. Which is why I set the thing up the way I did. And I tell people, anybody who buys an ad on this podcast has sat through a meeting with me when I've said to them, I am gonna take your money and use it to make that podcast so that these people don't have to pay for this stuff. I say it to everybody. And and don't get me wrong. Like, I make a reasonable living. I'm not, like, I'm not over here telling you, like, I'm barely getting by or anything like that.
JustinAnd for the people who don't like the ads, tough. Yeah. And honestly, even as the years go on, that becomes less of a complaint. People understand how the Internet works now. You know what I mean? Like, they know if they want something for free, someone's paying for it. And if it's not them, then why should you care who it is? Right. Also, maybe you'll enjoy a Medtronic pump or an Omnipod or a Dexcom or you know what? Try US Med. I really love getting art and supplies through US Med. I'm not making that up. I was using them before they came on as an advertiser, and that's awesome. I think the Kontoor Nextgen is the best blood glucose meter you could get. That even makes that easier for me because I am not out in front talking about anything that I don't feel really comfortable about. I'll tell you right now, I drink AG one, but I didn't enjoy my business relationship with them. So I told them to go away last year. You know, I was like, and it's a significant loss. You know, I pay an editor. I I have bills. You know what I mean? Like, it wasn't easy just to say, I'm not doing this with you anymore. It was a financial loss for me.
JustinOh, no doubt. Yeah. I see AG ads often. And plus—hi, Rob. Yeah. Somebody's editing your podcast. Right? Like, that person makes a living too. Like, there's trust me. The thing I'm doing on this topic, in this niche, the thing I'm delivering at the consistency and the quality that I'm delivering at, it is nothing short of a miracle that it's happening. There are plenty of other people out there trying to make it happen. I'm the only one who scaled it. So, like, I don't know why that is. I don't even care. It doesn't matter to me. Like, it just worked out. You know?
JustinAnd you were doing the right thing at the right time starting with the blogging stuff, and then it morphed. It changed. You've described that you were a first mover. So you were in the right place at the right time. That podcast became more popular. You have the dedicated app right on your phone, so you're in everyone's pocket.
Scott BennerIt just works. And there's a little mix of me and the people. And, I mean, the truth is is that I probably don't cover every topic that people want, but I listen to them when they speak up and say, you know, hey. How come we're not talking about this? I mean, the bold beginning series is because Isabelle told me the pro tips are great, but what if we had it one for people who are a little more newly diagnosed so it wouldn't seem as scary? And I was like, alright. A bold beginning series is great. Then small sips comes from people saying, like, I can't get my kids to listen to a forty five minute podcast episode. Is there something you could do? And, you know, then all the effort that goes into that, that small sip series might seem like a throwaway and easy, but it took like a year and a half to put together. That's why my content isn't here's a great cake you can bring to a fourth of July party that won't make your blood sugar spike. Like, that's why you're getting actual thoughtful stuff that it seems like it's off the cuff, but a lot of effort goes into it in the background. This is a business. It is a ton of effort to make this podcast. Like, I'm not kidding you. I didn't realize it was gonna be this much work or I might not have started. That's the first thing. And secondly, I'm even finding it hard to believe that I'm good at doing it, but I am. Nothing's written down, Justin. I don't have any plans. I have a whiteboard, and that's it. Everything you're hearing is just my interpretation of what you guys need based on what I think, what I'm watching with my daughter, and what I'm witnessing and experiencing with people online. It's pretty much it.
Influences and Interviewing Style
JustinPlus you have the pedigree or wisdom from listening to radio hosts for the better part of, I think, your childhood and young adulthood. So it comes naturally. You see how they conduct their interviews, their shows, and you apply it to this. Yeah. Some of you might not like it, but if you like this podcast, you've got Howard Stern to thank. And if you like that it's a podcast, you also have Kevin Smith to thank. He's a movie director who was making a podcast long before podcasts were a thing. Silent Bob. Yeah. I loved his podcast. So, actually, his mom just passed away and it made me feel sad. I've met Kevin a few times. But yeah. I mean, I just based on listening to Howard Stern since I was in high school, I know to keep things moving. If I get bored, I move on. I don't let people drive the conversation. I believe that I know what people wanna hear, and I do my best to, like, keep things moving in that direction. I must be right. It's working out pretty well. Because it would be easy to let somebody come on and prattle on and just go, well, it's their story. Let them talk. And I'm like—but you can hear in my mind—this is probably a quote from Howard Stern—but I can hear the radios turning off if people get boring. And not only that, but, like, even this thing here you and I are doing right now, we don't know each other. We've been talking for an hour and a half. I've just, like, articulated some fairly deep ideas off the top of my head a 100 miles an hour. If you go back and listen to it, it makes sense. I am good at talking. I know people who aren't good at talking. They know their story, but to get it out of their mouth is a struggle. And plenty of those people come on here as guests and I help them get their story out. And but I'm proud of that. Like, I'm proud of helping somebody who can't just sit down and talk a 100 miles an hour like I can to sit down and feel like when they're done, I was able to express myself. I think this podcast is awesome. I'm trying to keep it going for a decade.
JustinYou should be proud of what you've built. Thank you. You clearly reach 10,000 people a day, roughly. You you just gotta scroll through, like, three screens worth of your Facebook group to see the people that you've helped and touched and made cry, and that means something. Yeah. Yeah. Yeah. Whether they cried because they are so scared because their four year old was just diagnosed in DKA, which I don't even think I was in DKA when I was diagnosed. My parents, even back then, saw that I was being irritable with my grandparents, and that probably mixed with frequent urination and thirst were the big signs. I didn't have some catastrophic event. Yeah. But you beating that drum of here's the signs and symptoms. Here's the tools and techniques to get through your day, to do the best for your blood sugar and for your life, your family members, loved ones' life. That means a lot, and you should be proud of what you've built. Yes. I said I'm angry with you, but I truly am incredibly thankful for what you've built, what you give to all of us, for having these intimate conversations. Yeah. I was reading through the Circle group, and it's I think Jen was saying that Monica said that she hasn't even listened to her episode. It's too bad because—good episode—you should listen—Yeah.—to them all. But Jen was worried about what she had said in her episode with you, and I I replied and said that it's the embarrassing, the sensitive, the vulnerable stuff that you pull out of us and that you add. You know, you add very intimate stuff about you, your health situation, your, you know, Arden's, Cole's, Kelly's situation that, you know, at a dinner party, you probably wouldn't tell to somebody else.
Scott BennerJustin, you don't know me, but I probably would. Most of us would. Most of us. Most of you wouldn't. Yeah. I would. Listen. I just interviewed a doctor that I had something done with the other day and his episode will be up. I don't know when. But I talked about something in detail where I was like, oh god. Like, why am I even doing this? But the real reason is because I don't know how to expect you guys to come on here and open up if I'm not willing to do it as well. And, you know, if we want this thing to be valuable for people, then it has to be it has to be like this. It can't just be pleasant or, you know, it can't be two people going like, does your blood sugar get low when you work out? Yeah. Diabetes. So, like, I I can't stand all that. It's just such a waste of your time. Yeah. I just cringed. Yeah. Yeah. Yeah. But you know what I'm talking about. There's a ton of it out there. It just doesn't help anybody. I mean, it's nice and all, but it doesn't get to the core of the issue. I get done interviewing somebody and sometimes the the recording stops and they'll be like, my god. I feel so much better. You know, where people will joke that they're gonna send me their copay and not go to therapy this week. Or, you know, they leave and send me an email five minutes later and they're like, oh, I you know, I'm gonna try that thing. I just called my endo, like, that kind of stuff. Like, that's what we need. We need people being really clear and honest about what's happening to them so that you can say, oh, wow. That happened to me too. What did you say worked for you? Then actually have that a leveling up of your life, whether it's how you feel or where your health is or maybe a lessening of the burden, whatever it ends up being. This is how I think it has to happen. It has to happen in long form conversations where people are being really honest. And I know there are people who tell me, I can't listen that long. I feel bad for you. I don't know how else to do this.
Sharing Personal Stories Honestly
JustinWell, I was just looking it up. The Harry Potter audiobooks are, like, like, on average, near twenty hours a piece, and people go crazy for Harry Potter. Well, listen. I that's why I said it must have felt magical to you. See? I'm trying to get the Harry Potter group. Man, Justin, I don't know. Like, it's not for everybody. Also, if people hate my guts, you should check out some of the reviews. Oh, it's true. Yeah. Yeah. Oh, yeah. Yeah. But it just is what it is. If it works for you, that's awesome. And if it doesn't, let me try to leave you with this. When I hear other people who make podcasts, like, really popular podcasts, and they talk about how I can't worry about what other people think of me, and then you hear about how, like, some of the people dislike them, you realize it's all bull—from me to somebody who's got five people listening to them, to somebody who has 5,000,000 people a day listening to them, there are some people out there being performative and saying what they think you want them to say. I get that. But for the ones who are just talking, the bottom of their heart or the back of their head like I am, not prepared for this at all every day when I make this. For people who are just talking, I don't have a deeper—you know what I mean? Like, if this was a political podcast, this would just be me talking. It wouldn't be me trying to affect politics. If this was a, like, a lifestyle podcast, this would be how I feel about things, not me trying to get you to eat a certain way or do a certain thing. Like, I am just sharing how this occurs to me. I am not trying to make you do something. I'm not trying to make something happen. And I think that the average listener to content always is looking for, like, what's this person's ulterior motive? Like, why did this guy just say this about the senator in my state? Why did he just say that about the food pyramid? Why did he, or whatever it is that people think, I have no ulterior motive. At this point, I make this podcast because I know it helps people and I enjoy doing it, and then it pays my bills. Those are the three reasons I make it. And I have never once gotten on here and thought, well, let me say this because it will make x happen. I do deliver content that I think you guys need, but it's not some Machiavellian thing. Like, I say it out loud. I say I'm trying to trick you into listening to podcast content about diabetes because I think it's boring and you wouldn't listen otherwise. It is just really me being myself. And if you're out there listening to somebody else's podcast or watching someone's YouTube channel and they're just talking the way I am, you should stop wondering what it is that they're doing because they're probably just doing what it appears to be, like, on face value because at face value, I am just doing what it appears that I'm doing. I don't have another and I know that bothers me when I see people break apart. Like, I'm not on the level of some of these people that take it all day long in the media and everything like that. People are like, oh, this is what he meant. This is what he's trying to say. And I'm like, you don't know that. You don't know that person. You know? I go anyway. And sometimes I don't know what the hell I'm saying too, but that's part of making this thing. It is what it is, man. It works the way it works. You know?
JustinIt does work the way it work. I mean, you wanna see people have their a one c's down. So you you bang your drum of pre bolusing, and you get stories all the time that the a one c's are good for people. Yeah. It's nice. It's nice to see. Like, on my day, I just told somebody three days ago. They were asking me what I did for a living, I said the the part about this that I could have never expected is that it just it fills me up every day. I feel like I sound like a douchebag saying that. Right? But, like, it really does like, seeing you all out there doing well makes me feel lighter. I say this all the time and I'm happy to say it here too. If you guys are enjoying the podcast or it's helping you, I'm glad for you, but I'm making this thing for my daughter. Like, that's it. Like, I am trying to put together a spot where she can go as an adult when I'm gone and get answers that she might need. I started writing the blog for her. Yes. It starts to help people, and it does become about that at some part because I I've had times in my life I have felt like I'm not helping enough people. I've been able to give that away, but there's there are years where I felt bad about the number of people I was reaching. And now I just this is what it is. It works the way it works. And every day, I'm having a conversation that maybe one day when I'm dead, my daughter will listen to. And maybe she's listening right now fifteen years from now and saying to herself, like, yeah. I gotta get back to pre bolusing. Know what I mean? Like, who knows? That's it. I'm trying to make money. I'm trying to help you, and I like this. That's it. That's my triangle of why I make the podcast.
Managing the Community: Behind the Scenes
JustinYou're trying to make money to sustain the production of the podcast. You're not trying to make money so that you retire in Cabo or on the shore. You know? Hey. Listen. If that happens, I'm not gonna say no. But, no. Like, it you're right. I'm I'm trying to make a living. I'm trying to get through my life. And for all of you that think like, oh, it's you know, whatever you might think about how this is, there's an editor and people help me with Facebook. But other than that, this is me. I get up in the morning. I come into this room. I sit my ass down here. And last night, I stopped working at 09:30 at night. So, god, I easily put sixty hours just into the podcast, and there's other countless hours about Facebook that, like, happened fifteen minutes, thirty minutes at a time. Like, I was in the middle of working yesterday, and I had to stop and go online and stop a problem, you know, because one person was saying something insane and another person was chiding them. And I'm like, I wish I could just have both of them in front of me right now and just say, like, look. I'm happy for you to, like, share your experiences, but we're gonna have to put a caveat on this here because what you're saying is a little weird. And the other person, leave her alone. Just stop because I'm trying to make the podcast, and now I've stopped to do this. But that happens all the time. It's forty five minutes just shot in the middle of the day to manage something like that. But it's also really important because, yes, that happened, but at the same time, that Facebook group is overwhelmingly positive and runs overwhelmingly smooth for what is just about to be 80,000 members. And so it's very important to keep it moving smoothly like that. I'm not like, oh, I gotta stop to do this. I'm just saying it takes up my only fear is that I'm gonna get done doing all this and look back and think, oh, wow. I spent twenty years talking into a microphone and keeping people on track, and a lot of my life is gone now because I really don't have a lot downtime. And I've been trying to fix that over the last couple of years, so I'm starting to get there. But, anyway, as I said that, I'm getting a text right now about something that needs to be managed online. So I'm gonna go do that now.
JustinYour twenty year investment is gonna lead to thousands of years collectively for us listeners to have our lives extended and then be better health. So—that's lovely. Thank you. On behalf of everybody, I will thank you for that. Thank you. A few of you come to my funeral, please. Just a couple. Hold some signs up in the back. Anything. That that man brought my a one c down. Anything like that just so my family will see because I don't think they think I'm doing anything in here.
JustinAnnoy me, but lower my a one c. By the way, I still I'm always gonna say my favorite reviews are the ones that are like, I don't like that guy, but you should see my a one C. That makes me so happy. I have no idea how to explain it to you. That says something. Yeah. No kidding. Alright, Justin. Thank you so much, man. I appreciate you spending the time with me. Thanks, Scott. Yep. Hold on one second. Okay? Holding.
Outro and Series Resources
Scott BennerThis episode was sponsored by Touched by Type one. I want you to go find them on Facebook, Instagram, and give them a follow, and then head to touchedbytype1.org where you're gonna learn all about their programs and resources for people with type one diabetes. Today's episode is also sponsored by Tandem Diabetes Care. Learn more about Tandem's newest automated insulin delivery system, Tandem Mobi with Control IQ plus technology at tandemdiabetes.com/juicebox. There are links in the show notes and links at juiceboxpodcast.com. Are you tired of getting a rash from your CGM adhesive? Give the Eversense three sixty five a try. Eversense c g m dot com slash juice box. Beautiful silicone that they use. It changes every day. Keeps it fresh. Not only that, you only have to change the sensor once a year. So, I mean, that's better. Okay. Well, here we are at the end of the episode. You're still with me? Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribe in your podcast app, go to YouTube and follow me, or Instagram, TikTok. Oh, gosh. Here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't wanna miss please, do you not know about the private group? You have to join the private group. As of this recording, it has 74,000 members. They're active talking about diabetes. Whatever you need to know, there's a conversation happening in there right now. And I'm there all the time. Tag me. I'll say hi.
Scott BennerHow would you like to share a type one diabetes getaway like no other? Join me on Juice Cruise 2026. You may be asking, what is Juice Cruise? It's a week long cruise designed specifically for people and families living with type one diabetes. It's not just a vacation. It's a chance to relax, connect, and feel understood in a way that is hard to find elsewhere. We're gonna sail out of Miami, and the cruise includes stops in CocoCay, San Juan, Saint Kitts, and Nevis aboard the stunning Celebrity Beyond. This ship is chosen for its comfort, accessibility, and exceptional amenities. You're gonna enjoy a welcoming environment surrounded by others who get life with type one diabetes. I'm gonna host diabetes focused conversations and meetups on the days at sea. There's thoughtfully designed spaces, incredible dining, and modern amenities all throughout the celebrity beyond. Your kids can be supervised and there's teen programs so everyone gets time to recharge. Not just the the kids going on vacation, but maybe you get the kickback a little bit too. There's gonna be zero judgment, real connections, and a whole lot of sun and fun on Juice Cruise 2026. Please come with me. You're going to have a terrific time. You can learn more or set up your deposit at juiceboxpodcast.com/juicecruise. Get ahold of Suzanne at cruise planners. She will take care of everything. Link's in the show notes. Link's at juiceboxpodcast.com.
Scott BennerMy grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. What do these three things have in common? They're all available at juiceboxpodcast.com, up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for you at juiceboxpodcast.com. Have a podcast? Want it to sound fantastic? Wrongwayrecording.com.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#1794 Had Enough - Part 1
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Justin, diagnosed at age 3 in 1987 , explores how DIY looping lowered his A1C from 10.0 to 5.1 , CGM necessity , and how stability improves relationships.
Key Takeaways
- The Criticality of CGMs: Justin emphasizes that while pumps are helpful, the Continuous Glucose Monitor (CGM) is the most valuable tool for safety and long-term health, as it provides the data necessary to stop highs and lows in real-time.
- Advocating for Pre-Bolusing: Justin expresses frustration that modern medical guidance often neglects the importance of pre-bolusing. Using rapid-acting insulin requires a lead time to match the peak of the insulin with the rise of the food.
- The Power of Community & Word of Mouth: Justin's life changed after a chance meeting with a "looper" at a diabetes event. This peer-to-peer connection provided information about Automated Insulin Delivery (AID) that he hadn't received from clinical settings.
- Overcoming "Old School" Habits: After decades of minimal testing (2-3 times a day) and higher A1cs, transitioning to an AID system helped Justin bring his A1c from the high 7s to the low 5s, significantly improving his quality of life and physical symptoms like cold extremities.
- The Impact of Blood Sugar on Relationships: Justin and Scott discuss how high blood sugars can lead to irritability and conflict in marriages ("being a prick"), and how stabilizing those numbers can lead to a more harmonious home life.
Resources Mentioned
- Juice Cruise 2026: juiceboxpodcast.com/juicecruise
- Medtronic Diabetes (MiniMed 780G): medtronicdiabetes.com/juicebox
- Contour Next Gen Meter: contournext.com/juicebox
- Tidepool Loop: tidepool.org/loop
- LoopDocs (Katie DiSimone): loopkit.github.io/loopdocs/
- Wrong Way Recording (Rob): wrongwayrecording.com
Welcome back, friends. You are listening to the Juice Box podcast.
JustinI'm Justin. I'm a type one diabetic. I've had diabetes since I was just shy of three years old, and I'm pissed off.
Scott BennerHow would you like to share a type one diabetes getaway like no other? Join me on Juice Cruise 2026. You may be asking, what is Juice Cruise? It's a week long cruise designed specifically for people and families living with type one diabetes. It's not just a vacation. It's a chance to relax, connect, and feel understood in a way that is hard to find elsewhere. We're gonna sail out of Miami, and the cruise includes stops in CocoCay, San Juan, Saint Kitts, Nevis aboard the stunning Celebrity Beyond. This ship is chosen for its comfort, accessibility, and exceptional amenities. You're gonna enjoy a welcoming environment surrounded by others who get life with type one diabetes. I'm gonna host diabetes focused conversations and meetups on the days at sea. There's thoughtfully designed spaces, incredible dining, and modern amenities all throughout the celebrity beyond. Your kids can be supervised, there's teen programs so everyone gets time to recharge. Not just the the kids going on vacation, but maybe you get the kickback a little bit too. There's gonna be zero judgment, real connections, and a whole lot of sun and fun on Juice Cruise twenty twenty six. Please come with me. You're going to have a terrific time. You can learn more or set up your deposit at juiceboxpodcast.com/juicecruise. Get ahold of Suzanne at cruise planners. She will take care of everything. Link's in the show notes. Link's at juicepodcast.com.
Scott BennerIf you're looking for community around type one diabetes, check out the juice box podcast private Facebook group. Juice box podcast, type one diabetes. But everybody is welcome. Type one, type two, gestational, loved ones, it doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort, or community, check out Juice Box Podcast, type one diabetes on Facebook. 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. Today's podcast episode is sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed seven eighty g system and their new sensor options, which include the Instinct sensor made by Abbott. Would you like to unleash the full potential of the MiniMed seven eighty g system? You can do that at my link, medtronicdiabetes.com/juicebox. Today's episode is also sponsored by the Kontoor Next Gen Blood Glucose Meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at kontoornext.com/juicebox.
The "Pissed Off" Diabetic
JustinI'm Justin. I'm a type one diabetic. I've had diabetes since I was just shy of three years old, and I'm pissed off.
Scott BennerYou're mad. How old are you now?
JustinI'm 41.
Scott BennerYou're just mad because you're 41, or what are you mad about?
JustinWell, there's that. I was more mad when I turned 30. We can get to that later, but I'm just pissed off at how let down we are as as people with diabetes that it's so hard, and we don't I don't think we get good guidance from the people that we ought to.
Scott BennerYou're not just mad for yourself. You're mad for the collective community that you're aware of.
JustinMostly, yes. Naturally, there are pieces that I think are more attributable to me. But on the whole, it's more for all of us. Yeah.
Scott BennerYou know, time my wife leaves to go to a how are we starting? This is crazy. Every time my wife leaves to go to a gyno appointment, I say when it's all over, just look her dead in the eye and say, so on the whole, is everything okay? And she won't do it.
JustinShe should.
Scott BennerI well, yeah. Right? Come on, Kel.
Scott BennerQuite obviously is what should happen, nevertheless. Well, let's go back to the beginning. How old were you when you were diagnosed?
JustinJust shy of my third birthday. That was a month shy.
Scott BennerOkay. So when's the first time that you, I guess, have recollection of diabetes being in your life?
JustinThe oldest memory that I have is one morning. I was three years old. It must have been shortly after diagnosis, and I must have been whining to my dad whose name is Kelly. So I've always thought of Kelly as a man's name, but I know that he's kind of a unicorn being a man named Kelly.
Scott BennerI went to high school with a guy named Kelly.
JustinIs that right?
Scott BennerYeah. What's up, Kelly? You're listening. Yeah. No. No. And by the way, everybody, every time you're on the phone for something for Arden, they say he. They just assume Arden's a man. Really? Yeah. Anyway, sorry. Your dad's Kelly.
JustinI was complaining to him that I had to be awake so early. I was still sleepy. Blah blah blah. He says to me, well, you had an infection in your belly. That's why you have diabetes, and you have to be up at a certain schedule to eat, and that's why we have to do this. You know, it's not fun. We don't want to do it, but it's what we have to do. Because at three years old, if you've done the math already, that's 1987. So I was on a schedule of NPH and regular.
Scott BennerYeah.
JustinOkay. Unlike today, it's much more time dependent on a daily schedule and using the NPH, which has the intermediate action. It's much more difficult.
Growing Up in the NPH Era
Scott BennerHave you and your father, since then, as you've gotten older, talked about it again and again, or is your understanding of your diabetes come from when you were very young and you guys didn't really discuss it, I guess, more moving forward?
JustinBoth my parents and I were quite involved. Naturally, being so young, they drove the bus heavily probably from diagnosis at three until 96 when I went on the pump. So they definitely were heavily involved. My dad's been a firefighter since he was 18, and my mom served in and out of the fire department and then on the ambulance squad, I think, before I was born and then through parts of my childhood too. So they very much embraced the responsibilities that were laid out in front of us. And to the best that we could, they went to all the appointments. They you know, we managed it a lot with just my pediatrician up until maybe a year or two years before I went on the pump. So a lot of it was only what we learned at the hospital at diagnosis and then through the pediatrician who was very his guidance and treatment were pretty good.
Scott BennerWere you doing two shots a day until the pump?
JustinI think when I was younger, three, four, five, I did two shots a day mixing regular and NPH. Then as I got older, maybe eight, nine, 10, it was three shots. There was regular NPH in the morning to cover breakfast and lunch, then regular at dinner, and then I think NPH at bedtime.
Scott BennerSo they were they were starting to make a little adjustments. Did you ever go to more modern fast acting basal setup, or did you go right into a pump? Do you remember?
JustinRight into the pump. Yeah. It went from regular NPH. I think then it went to Humalog and NPH. Humalog came out a year or two before the pump.
Scott BennerOkay. Did that for a little bit then right into but they just put the Humalog into the pump, and you were on your way? Right. Okay. And is that the point where it sort of becomes your football? They give it to you?
JustinFor daily treatment decisions? Yes.
Scott BennerYeah. So you're you're bolusing on your I mean, you're counting carbs and bolusing on your own and stuff like that.
JustinThe carb counting came somewhat from, my parents probably more than me, at least in the beginning. And then certainly testing because it's this is before CGM, so testing was still my responsibility. It was a lot of shared responsibility.
Scott BennerStill. Okay. They didn't abandon you. They didn't go, oh, finally. Here, kid. Get out of here. No. You guys kept it together. So you had a lot of support growing up with your diabetes?
JustinGood amount. Yes. Okay. So you weren't angry then? No. No. Okay. So are you one of those people who you know, when people say all the time, like, I don't know if it's better to be diagnosed old or young. And the argument for young is, of course, you'll never know any better. Do you feel like you don't remember any kind of life without insulin?
JustinI do not remember life without insulin, and I would argue that it was better being diagnosed young because I don't know any better. Certainly, this far removed, I definitely don't know any better.
Scott BennerAnd you don't have a feeling of loss. Is that it? Or do you still?
JustinFeeling of loss? I don't know. I have it's not regret, but I have disdain. I have disdain for not having the technology we have today back then.
Scott BennerAlright. You're pissed that that you got into the game so early that they didn't have stuff like they have now.
JustinI'm disappointed by that. We haven't even gotten to the stuff that makes me angry.
Scott BennerNo. No. Don't worry. We're getting to it. Take your time, Justin. We want you to yell and scream. I'm good. Listen. I have been for, like, years hoping people would come on and talk like this, so I'm I'm up for this.
Why It Took a "Dope from Jersey"
JustinWell, it's your fault.
Scott BennerWait. Wait. It's it's my fault you're mad?
JustinWell, I'm I'm mad at you. Justin, I didn't marry you and dedicate my life to you and tell you I love you every day. How how do you have the nerve to be mad at me?
JustinBecause why is it that people have been treated with insulin for a hundred years? I've had diabetes for almost forty. Why the hell is it that it takes you, some dope from Jersey, who barely graduated high school to give me the best therapeutic decisions and strategies and counseling such a a goofy word to because you're no counselor.
Scott BennerI offer my counsel. Let's say it like that maybe.
JustinOh, fine.
Scott BennerHow come more people don't come on with this awesome, like, vibe that Justin has? I feel like you and I are improving together. This is awesome. I'm having such a good time.
JustinWell, I have what? My dad's got six cousins from Jersey. So I get you.
Scott BennerYou're accustomed to these conversations.
JustinI I'm accustomed to wacky people telling you wacky. You'd think back on it, you know, in the shower a couple weeks later and you go, oh my gosh. That's brilliant.
Scott BennerThat guy had a thought and it was I thought at the time he was an idiot, but my goodness, it's making sense. That's awesome.
JustinI mean, he's still an idiot, but, you know, it makes sense in in this one thing.
Scott BennerJustin, I'll accept idiot. I won't accept wacky. What do you think of that?
JustinWhatever helps you sleep at night.
Scott BennerAwesome. So you're telling me that even with that pump as a teenager and growing up, you don't feel like this all came together for you till you found this podcast? How long ago was that?
JustinLet's see. I, on a whim, was looking for help with Loop because I went on Loop well, so let's back up a couple minutes.
Scott BennerPlease.
JustinBack in, I don't know, 2016, my wife's a physical therapist. She was working in a hospital system, but in one of their outpatient offices. She had a patient come in who he broke both shoulders on a motorcycle spill. And turns out after he you know, she talks to him for a while, turns out his wife is a nurse in the hospital. So they strike up a conversation. Sometime, it comes out in conversation that she has type one. From what I recall, she had gestational with her first pregnancy, and it never went away Mhmm or evolved after that. So we talk about that. We become friendly and social after that time, see each other more casually. So they wrote me one gosh. I think it was a Friday night. And they said, we're both going to this ADA tour de cure event up at the center of town, up at the fairgrounds. You wanna join us? And my wife was leaving earlier that morning on a plane. So I said, well, I guess I got nothing better to do, and I'll be up anyway. So, yeah, I'll go up for the tour de cure thing. They had she was in the five k run, and I think he went on the 10 k ride.
Scott BennerOkay. Wait. You and your wife I I just want the the younger people to hear this. When you say you can't meet people, you and your wife now have friends that they met because a man had a motorcycle accident, came into the ER where your wife was. During chatting, realized that his wife works with her. They're actually colleagues, and then you guys strike up a friendship together.
JustinIt's true. it this wasn't at the ER, but it was it was in the outpatient PT stuff.
Scott BennerBut, otherwise, that's a true story. That since see, you can meet people. That's really nice. I actually find that to be a a lovely story. Think it's because I'm older. But I'm so sorry. You're the tour de cure. What happened then?
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Meeting the Looper
JustinAfter all the events wrap up, they have a lunch, and I hadn't signed up for the event at all. So I figured I was gonna go without lunch because, you know, I didn't have the tickets for any of that or whatever. One of my friends gave me their ticket because they went through the line and, you know, being somebody who had a bib on and was sweaty and gross, they're like, oh, yeah. You were at the event. Go ahead. Go get your lunch. So they gave me their ticket, and I went through, and I got lunch. I sat down at the table, and there's this older fellow who he's on his phone, tinkering on his phone. And I'm saying, you're at this great event. You're sitting next to, like, two other people who have all got their phones out, which this is back in 2019 or 2018. So everybody being on their phones all the time wasn't so prevalent. But I'm like, why are you guys tinkering on your phone so much? You know, why don't you just enjoy the music that's being played?
Scott BennerYes. Talk to the people. What are you doing? Head down with this generation. That whole thing.
JustinExactly.
Scott BennerSo I didn't have the nerve to ask the guy any questions. My buddy comes over after he grabs his lunch, and he says to this other guy, what are you doing? Or maybe he asked him what pump he had. Mhmm. And he goes, oh, I've got Medtronic, but I've got an old one. And then he brings out his phone, and he's got loop on his iPhone. And we're like, what the hell is that?
Scott BennerMagic sorcery.
JustinIt was magic. You know, he shows us, you know, he's gotta take, you know, half a unit for this, I don't know, Apple that I'm gonna have with my lunch. Types it in on the phone. We heard the the Medtronic beep, you know, the pump beep. I'm like, what the hell is that?
Scott BennerYeah. That fries your mind. Yeah. The first time you see that, he's on his cell phone and then his pump gives him insulin and without context and and a life lived the way you live. That really must have really seemed awesome to you.
JustinIt was nuts. And I thought, where the hell has this been? He he gets into the whole, you know, AID pitch. And first, I'm thinking, is he selling this stuff? Like, is he trying to line his own pockets by it? But he goes he pointed to his daughter or niece or something. She had loop on her phone using the Omnipod. And I'm like, what is that? You can do either one? What?
Scott BennerIt works with yours. It works with the one without the tubes. Like, what? What? Yeah. Yeah. Yeah.
JustinRight. I always thought everything was so closed course, closed circuit that how on earth using your damn iPhone, how does that work? What do you mean? So we get the whole pitch. We get the whole description from this guy. I got his name thereafter, and I said, well, shoot. I've got a endo appointment in a week or a month or something. It was pretty close. So I mentioned it to my endo NP, and she said, well, I don't recommend it. I can't recommend it to you, but I have one other patient. Yeah. I think she said at the time she had a couple patients on t slim which was maybe just getting into the Basal IQ thing. And she said, I cannot—
Scott BennerJustin, did they do this? I felt like somebody had this written down somewhere in those years. I can't support you while you're using it, but I'll keep writing you your prescriptions, which was code for leave us out of it, but I don't care if you do it.
JustinSort of. She wanted to say you can try it, and, you know, it's like a no lifeguard on duty, swim at your own risk. But she said, you know, I've got one other patient who is a child. The parents are both in tech and software. So they had the confidence to build it, and they've been doing it, and they've been great.
JustinWell, I'm in software, so how hard could it be? And thank god for Katie DeSimone to write up the loop docs because without that, even being in software, I do a lot of Microsoft stuff. So all this Apple app development was, like, over my head. Thank goodness she does that. So I go through, buy the Riley link. Maybe a week later, that comes in. Had to buy iPhones because I was a steadfast Android person up until then. And oh, I think when we were talking about it at the tour de cure event, the other guy said that Tidepool had just had their press release that they were gonna take Tidepool Loop. So I said, well, I'm not gonna fart around with trying to do an Android thing. If Tidepool's gonna get Loop into the App Store and I'm not gonna have to build it myself forever, I'll go with them because they're already on the fast track. They're already 10 steps ahead. Let's go with that.
Scott BennerIt took them a while, but there it is. Twist exists now.
JustinYeah. Twist exists, and a fair amount of people from the Loop community early on are are working there, which is good.
Scott BennerYeah. And they're iterating still. Like, they're updating that that app too. I think that's going quickly and and in a way that makes me feel good about what they're doing.
JustinI do too. I think that's adding more CGMs, adding more pump manufacturers, I I think is a good thing. Yep. But leads to the disappointment that in 2019 or 2018, I don't know how long Loop was out before then, but where the hell is anybody to even mention it? Their hands are tied at the doctor's office, so they can't mention it.
Scott BennerYeah. I mean, if they even know about it. Right? I don't know how many people have downloaded Loop or Trio, you know, combined at this point or, you know, Android APS or any of those really. Like, I don't know how many people said, oh, I'll give it a shot. Give me the code or you know, even now it's I mean, it goes on your phone so much easier now. It's crazy. I don't know, like, how is a how is the thing that's DIY supposed to publicize itself other than the way you found out about it, was being at an event with other people at type one and somebody mentioning it to you. And I love that you described him as like, you thought he might be selling it at first because that's how stuff like that gets spread around.
Scott BennerI felt like that in the early two thousands when I was trying to tell people about TiVo. I'm like, you don't understand. It was like, records it on a hard drive. You can pause it and fast forward. There's a button that jumps to the commercials, and people looked at you like, what do you you got stock in this or something? I'm like, no. It's just you're so overwhelmed by what a leap it is that, you know, you you come off like that when you're talking about it. That's how word-of-mouth works. My podcast is completely word-of-mouth. A pump company is not gonna tell you about it. Right?
JustinWell, now they are because Tandem invites you to friends for life or, you know, other events. Omnipod is—
Scott BennerI'm doing a nice thing with Omnipod next week. You guys will see it a little bit. So I'm saying, like, Pepsi doesn't tell you that Coke is good. You know what mean? Like, so they're not gonna do that. But at the same time, Loop's interesting because it works with those old Medtronic pumps. It works with Omnipod. Listen. I've never had a conversation like this once with anybody, but I'm just gonna go out on a limb and say, I don't think Omnipod's allowed to say loop out loud. That would be a horrible thing for them and the FDA and all that stuff. Right?
JustinIt's gotta be the same with the endos. I know the ADA standards of care just came out where they're pushing endos, HCPs, CDEs to help as much as they can. Not solely shut down the DIY stuff, but to say, we'll support you as much as we can. And and really that's what my endo NP said was that we'll tweak your settings if you could show me your basils and show me your insulin to carb ratio, insulin sensitivity factor based on what we see from your CGM data.
Scott BennerThey got more comfortable with it as time went on too.
JustinI think so. And the commercial adoption with the Medtronic six seventy system that I think was announced very shortly after that, after I'd started on loop, maybe that's boosted everyone's confidence, wisdom, experience.
Scott BennerAbout an algorithm in general?
JustinYeah. And how to make productive changes to settings, to algorithms, to basal rates, you know, depending on what they see because CGM unlocks all that possibility too.
The Pre-Bolus Frustration
Scott BennerYeah. And I also think that in a world where many endocrinologists aren't comfortable or don't know to tell you to pre bolus or aren't comfortable or don't know to tell you that, you know, fat and protein might impact your blood sugars later. It's a pretty big leap to think those same people are gonna tell you, like, hey. There's a bunch of people on the Internet writing code that, gives you insulin.
JustinThat's what pisses me off.
Scott BennerI know. Go ahead.
JustinIt's you, the dope from Jersey, who stands up on your soapbox and says, pre bolus your meals. I thought back, I don't know, maybe a couple months ago, you were talking with somebody about pre bolus thing, and maybe they said that you had to prebolise with regular because the peak or the onset was so much later than Humalog. I was told going on Humalog that I could just take it because it's onsets in fifteen minutes, peaks at an hour.
Scott BennerJenny has explained this to me what her thought about this is is that so back in the day when you first started, like, you injected that insulin. It didn't work forever. Right. They didn't even call that pre bolus, and you just had to get it in and then eat at a certain time. And then when they went to insulins that were faster but not actually fast, where that faster acting insulin name comes from, Jenny supposes, is that both the clinicians at that time, it was so much faster than what they were using that they called it fast acting insulin. Maybe they should have just said, this is faster acting insulin.
Scott BennerSo then as time goes on and those old people are, you know, gone away and the people who were doing cloudy and, you know, NPH and all that other stuff, when those memories kind of fade away, what they're left with is, oh, we have this stuff now. It's modern fast acting insulin. And for the people who were used to you injecting at 8AM and eating an hour or so later, this stuff works in, fifteen minutes. Like, we don't want people to get low. Like, you know what I mean? Like, I think it's that slow transition and having to work through people with different perspectives, and that's how the naming system gets where it is, and that's how the directions get where they are. I actually think she's right about that. I think that's the pathway to somebody not telling you to pre bolus.
JustinI suspect she's right. Yeah. Certainly, Jenny's had her ear.
Scott BennerShe lived through it too. Yeah. Yeah. She lived through that time.
JustinYeah. And, you know, both as a patient as she was a teenager, young adult, and then certainly now as a CDE. It's just one of the oddities of how things make it through society. Why do certain terms and phrases run through the world Or, you know, like, that kind of thing. Or we they somebody puts out a thousand songs every summer when we're growing. How come two of them hit and everybody knew it? And it's just I don't know how all that happens. I don't think it's it might not even be trackable by a human being, but I think that's how we get to this situation.
Scott BennerAnd then, like you said, then somebody's gotta say, I don't know. This doesn't make sense to me. And by the way, when my kid gets diagnosed, I have no context for NPH regular, cloudy, clear, blah blah blah. Like, I don't I'm just here now. And they give me this insulin, and they say, inject this insulin when she eats, and that's it. And then I'm, you know, spending years, like, pulling my hair out with a a freestyle meter, you know, and not even pens. Do you know no one ever gave me a pen? What so needles and a freestyle meter.
JustinI've never had one either. I lie. I've been given the trial Lantus pens in the event that the pump crept out on me.
Scott BennerIn the two years before we started talking about pumps when Arden was four, no one ever once said, hey. This is an insulin pen. So I don't whatever. But my point is is her blood sugar shooting up. And I mean Arden's blood sugar, which shoots so far up. And then I'd stare at it. And then, you know, learn a little more and figure things out, tiny little increments. But two years into it, I wasn't good at it still. And then you get the pump and people are like, oh, the pump's gonna fix everything. That used to be how it was talked about. Wait till you see the pump. The pump will take care it. We got her on the pump. The pump didn't fix anything. It just stopped me from having to stab her, which was nice, but her a one c didn't move much. And I was like, I thought this thing was supposed to be magic.
The CGM Revelation
Scott BennerI mean, it's not until a CGM. Right? It's not till we get that first Dexcom where I'm like, oh, I can see what's happening now. And then you can fill in all the blanks. Sort of like in Jurassic Park where they have most of the DNA, but not all of it. They filled in with a frog. And I had a lot of the idea, but not all of it. And this the CGM was what I needed to fill the slots and that I didn't understand. And then I thought I really understood it. Until Arden got on loop, and then I through NightScout, I could see the algorithm working, and then it really started to make sense to me. Anyway I mean but are you really mad, or are you happy that somebody said it? Are you or are you more mad about the lost time?
JustinI'm disappointed at the lost time. Naturally.
Scott BennerYeah. No. I would be too.
JustinCGMs really came into their own and had a they became really fruitful and available. What year was that? Like, '20, what, 2010?
Scott BennerYou know, it's funny. You'd think I'd know when we got it, but I really don't. You know, I think Arden was, like, six or seven maybe. So I don't know.
JustinSo there was speaking for me, you know, from '87 to, what, the early two thousands, there's fifteen years at least where I really didn't have a better option.
Scott BennerHow did that impact your life and your health?
JustinOh, I my wife has told me that one of her old coworkers used to write progress notes for someone who would come in with a a double knee repair or something like that and go, patient has enjoyed sixty years of poor health with, you know, high blood pressure and blah blah blah. I would have to say that I enjoyed a one c's that were from the eights into probably the tens at some points during high school and college. Now high school, college ages, there's lots of growth hormone. There's lots of other hormones. Ignoring.
Scott BennerRight? Did you ignore it in college?
JustinIgnore what?
Scott BennerDiabetes. Would did you back burner it and just do the minimum, or were you working on it?
JustinOh, minimum. For sure. My endo, I had the view every three months that I was just gonna get the finger wag that test more, bring these numbers down. Let's see that a one c drop to below seven because, you know, I just floated along there. But I can also say that unless I was doing a sport, I didn't go low all that often.
Scott BennerYeah. Well, your a one c was 10. Your blood sugar is probably over 200. Right? Yeah. For good portions of the time. Certainly.
JustinIt took seeing the guy at the tour de cure event to really impose on me that you can't have this magical system running on the phone without the sensor. So put on the sensor, you get the information, and then you can run with it. Work as anybody to say that.
Scott BennerYeah. Well, no. Listen. I've tried over the years to say that I valuable as I find Arden's insulin pump, and I do. I find it incredibly valuable. Like, if you came to my house with a gun and said, hey. You gotta give me the pump or the CGM. Like, I'd throw the pump at you. You you know? Like, I don't know how to get rid of the CGM. I believe your health is going to deteriorate without it, and I think that your effort is gonna increase 20 fold if you wanna keep your health where it is without the CGM. You're be testing all the time and trying to fill in those gaps in that understanding with guesses and supposition. So—
JustinOr you're gonna be like me, test maybe three times a day for decades. Just ignore the whole damn thing. And just make guesses. Yeah. Sure. I I might get there was a while it was just two tests a day, morning and night. And in the middle of the day, if I didn't go low, I really didn't know where it was. So having that data, even when it was just the n light sensor going to the pump in the first run that I went with loop, yes, it was annoying because there were technical difficulties with the in line sensor. But for some reason, it worked fairly well for me, and I could see the graph on the MiniMed that was saying it's giving me that data. So I could stop some lows. I could stop some highs. I didn't love the eight hour check-in for having to calibrate it every eight hours. That was a pain in the neck too.
Scott BennerMoment in time too. Like, they're getting through it. Like, hey. Does that anger inside you, does that carry over if you see someone online like, my CGM only made it eight days. This thing sucks. Are you, like, shut up? Or how does that strike you when people who are newer to diabetes don't have context for what you live through?
JustinI think the people who are let's talk about it if it's a child who's diagnosed. I think the child and the parents are scared, overwhelmed, and you're not reliant on the CGM to administer the insulin. Clearly, the insulin comes in pens and pumps and vials and syringes and all that, so you don't need it. But it is so valuable. I agree with you. If I had to give one of them up, I would give up the pump. That CGM is so valuable in just keeping your numbers in range. Even if you do have the spikes up to 5,300 after a meal or something like that, at least you know it. And you know the pump is wrong or you bolus too late or you didn't bolus.
Scott BennerYeah. You do something about your blood sugar doesn't stay two fifty for a week. Right? Right. Yeah. Right. So when they are upset about the sensors, I get it. I do get it because we're also paying dearly for them.
Scott BennerNo. Yeah. No. I under I do too. Listen. You're counting on it. You've paid for it. Someone's promised you that it does the thing. I understand all that. I do. I it's the part where I wish for them and I'm not mad at them. I was just wondering where you are. I wish for them that they knew your story. In that moment, I wish that knowledge could kind of flood into their heads and they could feel like, hey, this sucks, but I'm gonna call the company and they're gonna send me another one. And this is way better than how Justin grew up. I don't want people running around angry all the time. And I don't think that technology is perfect or is gonna be perfect anytime soon. I find that it's an opportunity to be upset at a thing that you should be grateful for, and I don't want that for people. You know? I mean, listen. I'm not in charge of how you feel, but, like, I hope you could take your anger out on something else other than this thing that you have no idea what it's doing for you if you don't know Justin's story or, you know, other people who have come before.
Algorithms as the Gold Standard
Scott BennerAlso, now, they're chocolate and peanut butter at this point. Right? Like, a pump in a CGM, a pump with an algorithm in a CGM, in my mind, I know they come from two different companies. That's it. They're one and the same. They belong together now. I know it's important not to pressure people into doing things or to tell them that what they're doing isn't the gold standard. But if you're not using an algorithm, I mean, in my mind, and I don't care. Medtronic, Twist, omnipod.com/juicebox for all of them. Exactly. Links at juiceboxpodcast.com. But, like, all of the pumps, All the pumps, all the CGMs, those are gold standards now. I wish they weren't gold standards. I wish they were commonplace, and that's just what happens. Because I think you're gonna see a lot of people live a lot longer with far fewer issues as they get older.
JustinI certainly agree about the CGM given the value that it adds. Pumps are amazing. I think there's a a point of incentive. The incentive for me when I was first going on the pump, I resisted it for quite a while, and my parents kept nudging me toward the pump. And the big incentive when I finally bit on it was that it was one, quote, unquote, injection every three days as opposed to three per day. That was the easy sell back then. Right? That was the easy sell. Yeah. The at least the most compelling to me. Mhmm. Certainly, there's also the advantage of basal rates and only using short acting, no more NPH because we had a near, I I guess, near fatal thing where there was one time I grew up we had a two family house.
JustinMy grandma would put me on the bus and take me off the bus as both my parents went to work. So there was one day she knew how to give the injections, and she would do so, but my parents would draw up the needles or the syringes. And back then, it's regular in NPH, so it it's clear before cloudy. I always used to think, oh, that's kind of a lame, like, silly thing to say, but there was one day where Graham took the syringe out, and it was all clear. At the time, I was probably doing one third regular, two thirds NPH. I I don't remember specifically, but this is, in kindergarten. And she took the cap off the syringe and I go, I'm not taking that. And she thought I was just being fussy and dumb kid. I said, no. That's clear. It's all clear. Yeah. Supposed to be cloudy and clear. Where's the other one? Yeah. It should look milky.
Scott BennerJustin's going down for the count. You hit me with that whole thing. Right.
JustinWe called my mom at work. She raced home. Her heart's probably pounding. Well, I I shouldn't say that. Her heart would have been pounding more had it been delivered. But she felt like mud because, I mean, she probably just had gotten to work that we called to say the insulin isn't mixed up right. So at least we dodged a bullet there.
Scott BennerAnd And you saw it. That's awesome that you saw it too. You know?
JustinIt was dumb luck. Just like dumb luck going to, you know, get the invite for my friends to go up for the tour de cure event. Dumb luck sitting next to that guy who's got between him and his party, he's got one Omnipod looper and one MiniMed looper.
Scott BennerYeah. Do you ever hear that episode where the school nurse gave that little girl, like, way too much insulin, but the school nurse insisted on putting a Band Aid over top of the injection site and the mom—what the hell is that gonna do? This is where the dumb luck comes in. Hey. Have you not heard this episode? It's fantastic. I feel like I've heard you mention it to somebody else, but not the episode itself. No.
Scott BennerShe hit that kid with, like, I think, like, a 100 units of insulin or something like that. Oh. So much that it didn't fit in the syringe. Because of that, she gave her two syringes. Because of that, she put two Band Aids on her. The mom happened to be bringing something. So the reason the kid was getting injection is I think they left the PDM in the car, and the mom was bringing the PDM in the interim time they went to MDI. The nurse does it completely wrong. The mom says, why do you have two Band Aids? And that started the conversation that led them to understand what had just happened. That's wild. That kid totally goes back to class and drops dead in that school if they don't do it. You know? Oh, for certain. Or or god forbid if they went out to recess before. Kid's gonna have a seizure. Maybe somebody gets to her. Maybe somebody doesn't. Like, it would have been really bad. And just the two Band Aids, like, made her go, how come you're wearing two Band Aids? And that was it. They just figured it out like that.
Scott BennerYeah. Yeah. I'll take some good luck once in a while is what I'm saying. So okay. Just suggesting, where are you at now, man? Like, how long have you been looping what? For six years now?
JustinI think so. Yep. Yeah. Okay. By the way, for people who wonder how my brain works, every time you say 2019, you mean 2018, I hear the start of a Doce song in my head. And when you said fussy, I thought Bob Fosse. Those are references no one's gonna know, but I just wanted to let you know what pops into my mind when people are talking.
JustinThe only, thing about Fosse I know is that they mentioned him in the bird cage.
Scott BennerI swear to you. I think that's probably where I know it from. And at the same time, like, you have to be impressed with how my brain is able to fight off that whole, like, Bob Fosse Bob Fosse thing and go back to, like, staying with you. You don't know how hard it is for me to accomplish this podcast, but it's not as easy as it should be.
JustinLike, it's hard for you to accomplish because you're playing with the chameleons all day long.
Scott BennerI'm actually right now watching something run around this cage that I'm just so tickled by. I can't believe how crazy it is that it's in here with me. It's just I'm talking to you and just watching this thing live its life. My question is, first of all, I'm thrilled for you. Know, you find Loop. You find so you found Loop, and then to understand Loop better, you found the podcast. Correct. Okay. And then I'm saying things that you're just like, no one's ever mentioned this stuff before. So does Loop get you from eight ten a one c down, or is it a combination of Loop and the podcast? And now that you're down, like, how do you found your life versus prior to that?
Life with Stable Blood Sugars
JustinThe a one c started to come down with my wife's support with taking it more seriously. Like I said, she's a a physical therapist. She has a biology degree. So things like a and p and biological systems, she's privy to. So she naturally wants to see me do better so that I'm here longer. Not to mention when we were dating and newly married, because my blood sugar would go so high from either late boluses, missed boluses, bad carb counts, we would fight a lot. Yeah. You're probably a prick. Right? Still am. Yeah. But now at least it's natural. Exactly. So she wanted to see that come down. And I think the context for her was that ADA wants to see you with an a one c. Is it below eight or below seven? I mean, now I think it's seven and a half for kids, seven for adults. I forget where they're at right now. But back then, I don't know. It could have been higher at that point. I think they were at eight not that long ago.
JustinSo back in those days, the eight was probably the benchmark we were aiming for. But she wanted to see us do better and see me do better. So from what I remember, around the time where we got together, I was probably in the low eights, high sevens. And I remember it was either my memory's a little fuzzy about whether I actually started using the nLIGHT CGMs months before loop or if I really just got on nLIGHT at the same time as loop. But I remember starting at a 7.9, and within, I think, a year, I was down to 6.9, then COVID hits. So I've got some you know, I have a a longer gap when my a one c was taken because they did telemed stuff during that point. And I've had let's see. I've got recordings going back to 2021, 06/1957. My last two were 58 and 51. 51 scared me a little bit because I said, I'm not pregnant. I don't really wanna be that low.
Scott BennerWere you getting low a lot for the 51, or you just things are dialed in. You are?
JustinI was. Yeah. It was probably in every other day. Yeah. Well, we don't want that. No. We don't. But if I was gonna float around with a 54, I would take that happily.
Scott BennerYeah. No kidding. The stability is there too. Right? You're not bouncing around anymore. And is that just like, beyond not fighting with your with people in your life because your blood sugars are fascinating all over the place or high. I mean, do you feel other value? I mean, other than knowing you're gonna live longer and, like, stuff like that. But, like, is there other value day to day that you could point to people who are of a higher a one c and say, look. If you were able to bring this down and get it stable, you might enjoy these things as well?
JustinI think from a biological perspective, I remember asking my NP if my circulation had gotten better with a lower a one c because my feet felt warmer over the winter. I always struggled with cold hands and cold feet. Not to the point where they were blue or numb, but they would always be cold, always from October through April. And she said, probably not with the circulation, but the nerve endings and your neuropathy might be getting better. I was never diagnosed with neuropathy. I never had numbness or tingling long term, but she said that your neural pathways to the feet might have improved, which is why they feel warmer to you in the winter months. Yeah. That possibly could happen.
Scott BennerSo awesome. Do you have any complications right now? This episode was too good to cut anything out of, but too long to make just one episode. So this is part one. Make sure you go find part two right now. It's gonna be the next episode in your feed. I'd like to thank the blood glucose meter that my daughter carries, the Kontoor Next Gen blood glucose meter. Learn more and get started today at kontoornext.com/juicebox. And don't forget, you may be paying more through your insurance right now for the meter you have than you would pay for the Kontoor Next Gen in cash. There are links in the show notes of the audio app you're listening in right now and links at juiceboxpodcast.com to Kontoor and all of the sponsors.
Scott BennerI'd like to remind you again about the MiniMed seven eighty g automated insulin delivery system, which of course anticipates, adjusts, and corrects every five minutes twenty four seven. It works around the clock so you can focus on what matters. The Juice Box community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, visit my link, medtronicdiabetes.com/juicebox. Hey. Thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of the juice box podcast. The juice box podcast has been in production since January 2015. And in that time, we have amassed just a fantastic catalog of information for you. The defining diabetes series. Also, bold beginnings, diabetes pro tips, small sips, fat and protein, algorithm pumping, mental wellness, ask Scott and Jenny, diabetes variables defining thyroid, after dark, the math behind Omnipod five pregnancy, how we eat grand rounds, cold win, GLP meds, the quick start guide if you wanna get going with the podcast but you don't know where to go, diabetes myths, there's even a type two diabetes pro tip series. All of this is at juiceboxpodcast.com. Go to the menu. Click on series, and they can all be found right there. If you go to juiceboxpodcast.com/lists, you'll get all these great downloadable lists of all the the different series so you can save them on your phone, keep them for later. Every episode is listed along with its episode number. So you can go into Apple Podcasts or your you know, wherever you listen to your audio, and say you wanna hear episode fourteen sixty nine, steal a one c overnight from the small sip series. Just go to the search bar, type juice box, one word, and then the episode number fourteen sixty nine. It should be the first return you get. Hey. Do you need support? I have some stuff for you. It's all free. Juiceboxpodcast.com. Click on support in the menu. Let's see what you get there. A one c and blood glucose calculator. People love that. That's actually, I think, the most popular page on the website some months. A list of great endocrinologists from listeners. That's from all over the country. There's a link to the private Facebook group, to the Circle community, and, we have a a fantastic thing there, American Sign Language. There's a great sign language interpreter who did the entire bold beginning series in ASL. So if you know anybody who would benefit from that, please send them that way. Just go to juiceboxpodcast.com and click on support. While you're there, check out the guides like the pre bolusing guide, fat and protein insulin calculator, oh gosh, thyroid, GLP, caregiver burnout. You should go to the website. Click around a little bit on those menus. It really there's a lot more there than you think. If you have a podcast and you need a fantastic editor, you want Rob from Wrong Way Recording. Listen. Truth be told, I'm, like, 20% smarter when Rob edits me. He takes out all the, like, gaps of time and when I go, and stuff like that. And it just I don't know, man. Like, I listen back and I'm like, why do I sound smarter? And then I remember because I did one smart thing. I hired Rob at wrongwayrecording.com.
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#1793 Bolus 4 - Real Food
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Scott and Jenny talk about bolusing 4 real food.
Key Takeaways
- Settings Evaluation: If bolusing for "clean" or "healthy" foods (whole ingredients like salmon, broccoli, or blueberries) is difficult, it is a primary indicator that your basal rates, carb ratios, or correction factors may need reevaluation.
- The Impact of Processing: Highly processed "Rube Goldberg" meals (like Cinnabon or McDonald's) have hidden variables like high fat and complex additives that require layered boluses; simpler foods should ideally follow a straightforward "count and pre-bolus" logic.
- Dynamic Life Changes: Significant changes in activity levels (sedentary vs. active) or body composition (weight loss/gain) necessitate proactive adjustments to insulin settings, as old settings may be masking or creating management issues.
- The Value of Visual Tools: Utilizing tools like the Juicebox Podcast Settings Calculator or Bolus Simulators can provide visual motivation and a starting point for discussions with medical providers, especially when navigating weight loss or lifestyle shifts.
- Automated System Awareness: For users of automated insulin delivery (AID) systems like Omnipod 5, it's crucial to periodically check manual settings. As the algorithm adapts to growth or lifestyle changes, manual settings often become outdated and "left behind."
Resources Mentioned
- Omnipod 5 Starter Kit: omnipod.com/juicebox
- Dexcom G7 CGM: dexcom.com/juicebox
- Juicebox Podcast Settings Calculator: juiceboxpodcast.com/settings
- Meal Bolt Roadmap: juiceboxpodcast.com/meal-bolt
- Bolus Simulators: juiceboxpodcast.com/bolusfour
- Juice Cruise 2026: juiceboxpodcast.com/juicecruise
- Juicebox Podcast Facebook Group: Search "Juicebox Podcast, Type 1 Diabetes" on Facebook
Introduction and Meal Bolt Overview
Scott BennerWelcome back, friends, to another episode of the Juice Box podcast. In every episode of bolus four, Jenny Smith and I are gonna take a few minutes to talk through how to bolus for a single item of food. Jenny and I are gonna follow a little bit of a road map called meal bolt. Measure the meal, evaluate yourself, add the base units, layer a correction, build the bolus shape, offset the timing, look at the CGM, tweak for next time. Having said that, these episodes are gonna be very conversational and not incredibly technical.
Scott BennerWe want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of Miel Bolt in every episode, we will be thinking about it while we're talking. If you wanna learn more, go to juiceboxpodcast.com/meal-bolt. But for now, we'll find out how to bowl us for today's subject.
Scott BennerIf you're looking for community around type one diabetes, check out the Juice Box podcast private Facebook group. Juice Box podcast, type one diabetes. But everybody is welcome. Type one, type two, gestational, loved ones, it doesn't matter to me. If you're impacted by diabetes and you're looking for support, comfort, or community, check out Juice Box podcast, type one diabetes on Facebook. Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise.
Scott BennerAlways consult a physician before making any changes to your health care plan. This episode of the Juice Box podcast is sponsored by the Omnipod five. And at my link, omnipod.com/juicebox, you can get yourself a free what'd I just say? A free Omnipod five starter kit. Free? Get out of here. Go click on that link. Omnipod.com/juicebox. Check it out. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. Links in the show notes. Links at juiceboxpodcast.com. Today's episode is also sponsored by Dexcom.
Scott BennerThe Dexcom g seven, the same CGM that my daughter wears. You can learn more and get started today at my link, dexcom.com/juicebox. Jenny, I I got a note from somebody the other day that said, are you and Jenny? Well, don't all yet. Are you and Jenny?
Jenny SmithAlways get lovely note. I mean, you know, some of the the notes are very inquiring. Mhmm. I think that that's great.
Defining "Healthy" and "Real" Food
Scott BennerWell, this lady said, can you do some bolus for us for healthy food? And I said, we're just doing the ones people asked about. I don't know. Like, it's funny as I started to think about it is I don't know what she meant by healthy food, but when I—
Jenny SmithOh, she didn't give any examples. It was just—
Scott BennerNo. Healthy food. Can you please well, the McDonald's one had come out. And the best I got so many, like, really interesting little notes from people about the McDonald's one. But the best one was, I don't eat at McDonald's. I just tuned in to hear Jenny try to hold her gasp inside.
Jenny SmithThat's kind of funny.
Scott BennerBut I said, that did happen. Many times Yeah, it did. But but at the same time, I think I made this person say, and, you know, what about healthy foods? As I started thinking about it, I was like, aren't healthy foods easy to bolus for? Like, aren't they carb counts for the most part and a little bit of pre bolus in the right place, and where am I misthinking it?
Jenny SmithThat would be my first, I guess, way to explain it as well. Yeah. In general, food that is and I wouldn't even say let's just say clean food. Right.
Scott BennerThat's how it makes me think. Something that's not processed or has a ton of stuff in it. Yeah.
Jenny SmithRight. I mean, the ingredients are all readable. They're real food ingredients. There might be, like, sodium or ascorbic acid or something. But, again, those are they're still real food.
Scott BennerYeah. Right? Why don't we do bolus for real food today? Alright. And—
Jenny SmithWhat kind of real food do you wanna eat?
Scott BennerWell, Jenny, now this is the problem. Right? Because she didn't give me any examples, and I am, I grew up a trash person. So I don't know how I'm supposed to think of what people eat.
Jenny SmithWell, when I think of real food, I think of the food on the plate didn't necessarily come from a box, let's say. And there are some packaged foods that are still quality foods that are somewhat processed. I think of bean. You can buy dry beans. There's a whole process, like, you have to soak them and then cook them and then drain them and rinse them. Like, it's it's a process, right, which most people in today's world, they just don't have the time for. So then you purchase canned bean. Okay. Great. They're processed, but they're not full of a bunch of junk.
Jenny SmithThings like dry let's do quinoa. Quinoa is dry. You buy it in a package. That doesn't mean it's not a quality nutrient dense food. It's just the way that we now have to buy it. Right? Even if you have a co op or something you go to and you buy it from their bulk, it's still technically dehydrated and you know what I'm saying?
When Simple Food Becomes Difficult
Scott BennerI know what I do. I wonder if when she said, you know, real food or or healthy food or however she put it. I just pulled up a list. I just I just went and I said, like, give me a list of real foods that humans eat most often worldwide. And I mean, and it's chicken, pork, fish, bananas, beans, you know, garlic, tomatoes Broccoli. Broccoli. Yeah. Cabbage, bananas, apples, oranges, grapes. And now I'm thinking, if she's having trouble bolusing for this stuff, is it more about settings and timing? Is it maybe back to the basics? Because this shouldn't be difficult. Right?
Jenny SmithIt shouldn't be difficult. And that is it's a good place to start. Is it that your settings aren't right? That's the first place of evaluation. If you're sitting down and you're eating let's give a meal of something like grilled vegetables, some baked salmon Mhmm and maybe blueberries. Okay? All real food. You might put a little oil on it to cook it. You might or butter. You might put some seasonings on or whatever. But in general, that's real food.
Jenny SmithYou can count on the nutrients that you look up, that you get from chat GPT, from a photo, from whatever. You can count on the carbs, proteins, and fat being real Mhmm and not impacted by a bunch of other additives Yeah or ingredients. And so a meal like this, you'd essentially say, well, what are my carbs? Right? I've got some broccoli, pretty low carb, very low glycemic, got a good amount of, you know, dietary fiber in it. Even has vegetables are by weight, actually a little higher in protein. Most people don't think they can get protein from veggies, but you can. And then you've got your blueberries, which are also a carbohydrate source. Again, pretty low glycemic. So a meal like this, once your settings are set, should be pretty easy to bolus for. There's not much on the back end that you're gonna have to worry about.
Scott BennerRight. It it just feels to me that a person who's eating that way like, I just know from talking to you really mostly. Like, you eat like this. And I've seen your graphs for years. They look like I expect them to look almost all the time. Right? And around food. And so her just as we're chatting about it now, I'm like, maybe this maybe I really maybe I really was onto something all those years ago when I was like, it's just timing and amount. Like, use the right amount of insulin at the right time. Like, I might have been onto something. You know?
Scott BennerAnd when you're talking about, you know, chicken nuggets and french fries and Cinnabon and all the other things that are on that that bolus four list, is growing because you and I have been making it for a while now, those are like like Rube Goldberg meals. Like, there's arms sticking out of places that you have to think about and you don't, like, really understand all the pieces that are there. It's so big and unwielding.
Jenny SmithLike abstract art. You have to look at it for a long time to kind of pull the parts apart and say, I don't know. I think the artist was saying this.
Scott BennerYeah. And I think I need some insulin here for that part and a little more over here for that thing that's gonna come at me. And, oh, there's the boot down here that cooks the toaster. That's gonna need insulin forty five minutes from now. And, like, okay. Now, when you that's hard to understand. You put together a plate with fish and a broccoli and a half a potato or something like that. Like, I mean, it's count the carbs pre bolus and make sure your blood sugar is moving in the right direction when you start eating, and you should be okay.
Jenny SmithRight. And something fair to bring, which I love actually, I love this question. So whoever asked it, thank you. I think it's a wonderful way to highlight the fact that all the hard things that we've addressed, they are truly hard. They're things like you said, we have to pull them apart. We have to figure out what parts are gonna hit when, and then it still is the timing of when to put the insulin in the right way. Right? But simpler foods, real just basic. Essentially, you need the information, the carbs, and then you just need to know that your settings are starting in the right place.
Jenny SmithAnd then even bolus timing isn't that difficult. And with today's technology, we have our CGMs that are pointing our glucose trend in a direction or stable or in the other direction that then goes into the consideration too, but it's a little less cumbersome than what we get from more, I guess, full and complex meals.
The Variable Problem: A Real-Life Example
Scott BennerI'm probably chief among them at some point in my life that would look at a a Cinnabon at the mall and think, oh, that's very sugary, but not think about all the fat that's in it. Or you get a a so you people don't think about how something's cooked sometimes. Right? Like, you commented during the during the McDonald's bowls where you're like, is this all fried? And I was like, Jenny, they don't even have an oven in there. What are you talking about? I do remember that. I've never yeah.
Scott BennerSo I guess I I feel like this is maybe a good spot to bring up that there's a settings calculator on the website. And maybe if you're having that much trouble bolusing for simple clean meals, maybe your settings are off or, you know, you know what I'm saying? Like, maybe that's a good place to go.
Jenny SmithI do. I also think another consideration here is maybe maybe this person was also asking because they were considering doing a bit of turnaround in what was typical for them to eat. And maybe they've got down what they were doing. And now that they want to eat a little cleaner, let's call it, the food is simplified in a way that you're right. Maybe the settings actually were catered to the type of intake they had and they had it figured out. But now that they've started eating a little bit cleaner or home cooked meals and they know what goes into their food, they may actually be seeing things that are not responding like they'd expect with the settings they've got. Yeah. And therein lies a a good question of, well, what do you do with that? Right? You have it figured out for harder stuff, but now the simple stuff comes in and it all goes wonky and it should be easier.
Scott BennerYeah. So if you were eating differently and then changing to cleaner or I mean, honestly, if you were a sedentary person and then suddenly got more active and because maybe those two things go hand in hand. I'm gonna get some more exercise and eat better. You'd you wouldn't realize after time that the settings you have now, what your carb ratio is, your bolus, you know, correction factor, your basal insulin, those settings, what those settings are are set up for a sedentary person eating not cleanly. And now you suddenly get active and, oh gosh, I I seem to mess up all my mess.
Scott BennerListen, last night last night, I'd already told Jenny about this. I feel like I'm saying something twice to somebody. But last night, my family took me to a concert for it was my Christmas present. And Arden had a class late in the afternoon. She runs in the house. She's like, I haven't eaten yet today. And she looks around, looks around, looks around, and grabs a muffin. Then runs upstairs and gets ready to go to this thing like we are. We gotta go. You know what I mean? Right. And it's like a muffin from Costco. It's not—
Jenny Smithit's yeah. Those are gigantic.
Scott BennerAnd it wasn't the big big one. It was the smaller one. They figured out not to give you six giant ones. They now give you eight slightly less giant ones. But, like, she grabbed it off the counter, bolus while she was eating it, and now we're sitting in the car for an hour driving, and I'm watching her blood sugar just two thirty. It is just sitting there. It ain't moving. Alright? And the algorithm's pushing, and it isn't moving. So we bolus, and it's not moving. But eventually, we're like, fair enough. There's enough insulin in here. Like, we have to stop.
Scott BennerParked the car at the NJ PAC Center. By the way, NJ PAC Center, thank you for building another, parking lot because it's a disaster there, but still the traffic is horrible. And you had to walk. And you get out of the car. We're late hustling through the parking garage, up a bunch get to the escalator. Escalator's out of order. Ran up the stairs. Run inside. Get our tickets. Everybody's gotta go to bathroom. Run-in the bathroom. Like, we're going to see Yo Yo Ma. Like, I'm not seeing it. Like, I wanna be on time. Like, we're hustling. Right?
Jenny SmithYou're not seeing, like, a dog jump through hoops or something.
Scott BennerThis is one of these things that listen. This doesn't belong here, but you should go sit quietly in a room. Be very still. Listen to Yo Yo Ma play once in your life. It'll change how you feel about being alive. You can manage diabetes confidently with the powerfully simple Dexcom g seven. Dexcom.com/juicebox. The Dexcom g seven is the CGM that my daughter is wearing. The g seven is a simple CGM system that delivers real time glucose numbers to your smartphone or smartwatch.
Scott BennerThe g seven is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes. The Dexcom g seven can help you spend more time in range, which is proven to lower a one c. The more time you spend in range, the better and healthier you feel. And with the Dexcom Clarity app, you can track your glucose trends, and the app will also provide you with a projected a one c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for dexcom. Dexcom.com/juicebox.
Scott BennerWhen you use my link, you're supporting the podcast. Dexcom.com/juicebox. Head over there now. Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery. And a third of Omnipod five users pay $0 per month. You heard that right. 0. That's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery.
Scott BennerMy daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21. My family relies on Omnipod, and I think you'll love it. And you can try it for free right now by requesting your free starter kit today at my link, omnipod.com/juicebox. Omnipod has been an advertiser for a decade. But even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox. Terms and conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit? Full terms and conditions can be found at omnipod.com/juicebox.
Managing the Crash: Community and Compassion
Scott BennerAnd so, like, I'm trying to get to this thing, and we sit down, and I'm not very involved in her care anymore. But I think just out of repetition, the last thing I did before we turned our phones off was look at her blood sugar. Because I know from years of experience, something's gonna go wrong. This is gonna be it right here. Right? And but I wasn't thinking about at that point, oh, we gave her a bunch of insulin. She was stuck high. We just weren't I didn't think about any of that till the next day, till today. But no kidding. I opened up my phone and I was like, hey. You're one forty five arrow straight down. Like, you're you're crashing. And I said, what do you have with you?
Scott BennerAnd she goes, I have two juice boxes and a pack of Gushers in my purse. And I said, well and I reached in my pocket and I pulled out a fistful of gummy bears. I said, I brought gummy bears. And she was like, okay. So and I don't know that I'm ever gonna be able to stop myself. Jenny, I think if you and I went somewhere, I would stick, like, snacks in my pocket for you. Like, I just think I don't, like I don't know how to not do that. You know what mean? So—
Jenny SmithYou just yeah. No. You're a good you're a good parent and a good friend. You're lovely.
Scott BennerSo she's she's having a couple of gummy bears, and I'm like, do a juice. Then And you could see on her face, goes, but I only have two juices. If I do one and we have a problem, what am I gonna do? I watched her work that out in her head, she goes, I'll just get up if it's a problem. I thought, I do not want you to have to get up and miss this. No kidding. If you have to get up, I'm gonna go with you. And I don't wanna miss this either. Yeah. And I said, drink a juice. Let's do a couple gummy bears. I think we're good. The single arrow down went to double arrows down. Arden does not see double arrows ever, ever, ever. So what was it? It was bad timing, bad amount, suddenly having more exercise.
The Juicebox Podcast Settings Tools
Scott BennerAnd so, like, in a in in that that moment, that could happen to you in your real life. And so listen, juiceboxpodcast.com/settings. You're gonna be met with a calculator. It just asks for your weight in pounds, and it's going to give you a starting point to think about your settings. I am not saying it is gonna be a it's gonna be right or anything like that, but maybe a great opportunity for you to go back to your doctor and say, hey. I looked at this calculator, and it says my basal should be more like this, but mine's way higher. Maybe that's when you're gonna find out that you're over baseling yourself to make up for the fact that you don't count carbs well or—
Jenny SmithRight. Who knows what, you know, collection of variables are being hidden by your settings. And now you take those variables away, and suddenly your settings are way off. That happens.
Jenny SmithAnd in this case, the variable being had she had, like, some scrambled eggs and, I don't know, an apple, it would have been very different. The stock high wouldn't have happened. You wouldn't have been prompted to bolus bolus to kinda get it or allow the algorithm to do what it was again, all the things and it just brings into light the true amount of variables we do have to look and consider every single day.
Scott BennerYeah. 100%. The life portion of it that's hard to write down on a list and make sense of or that I wasn't even thinking was happening while it was happening. Right? But yeah. But if your if your settings are rock solid and all all Arden would have had to have done is pre bolus, and we would have been okay. But because of the rush, that didn't happen. It threw everything off, and then you see this cascading problem. Yeah. The same thing could happen to you, you know, if you're like, hey. I used to eat like this, but now I wanna have what did the lady call it? Hell, I wanna eat healthier. Healthier. Yeah. Right. So go get your settings right.
Scott BennerI mean, I'll just for people just I'm looking at it right now. I typed in one fifty as a weight. As soon as you type in that number, it asks you if you're highly sensitive, have standard sensitivity, if you're resistant or highly resistant. When you click on one of those things, it chooses your daily dose. Right? So, like, at the standard number for a hundred and fifty, it has thirty seven and a half units. But if you go to resistant, it goes to forty four point three. If you go to highly sensitive, it goes down to thirty point seven. There's also, like, a little slider you can fine tune it to maybe, you know, if you really feel like you know better or maybe you and your doctor could do it together, whatever. As soon as and then it gives you your basal, your carb ratio, and and it's not perfect. But it's it's a good way to look at your settings now and then look at this and go, why are these so far off? You know?
Jenny SmithIt's a good starting place. I think another way to use that tool could also be let's say you feel like you are highly resistant because you know your lifestyle. And let's say it's the turn of the year and you're like, I'm gonna make some changes. Right? I'm gonna start walking three or four days a week. I'm gonna do this class. I'm gonna also clean up my pantry. I'm gonna get rid of this. I'm gonna bring this in instead. You could potentially use that tool then. You're the same weight, but now, goodness, you've cleaned things up. You've gotten a lot of the resistant generating foods out of your intake and you're adding exercise.
Jenny SmithSo maybe now you're more normal sensitivity. You could use the tool at your same weight to see, goodness, how much should my dosing change taking your current let's say you're on a pump, taking your current profile and just scaling it back to see does this now hit better? Mean, even those on MDI could do the same thing. They could say, okay. Well, it told me or I'm using this basal dose. Now that I'm more sensitive and I've cleaned things up, gosh, look at how much less I can probably start to use. And again, it's not like a big jump. It's just a scale it back and see what ends up working.
Scott BennerBut you could use that tool as a starting place instead of trying to just figure it out in your brain and pick something from the air. I'll you tell another thing you can do with it very simply is if you're looking for motivation about, like, weight loss even, like, if you put in here a 170 pounds, it tells you your total daily insulin is 42. Well, guess what? If you lost 20 pounds and you went to one fifty, it goes down to 37. You know? And especially now with GLPs, I'm getting a lot of notes from people.
Scott BennerI just got a really great one yesterday. Person thanked me. But there are people who are losing 30 pounds quickly. Right? And then they're losing another 20. Imagine you weighed two hundred pounds and you're using, you know I don't know. You're using fifty units of insulin a day. And then all of a sudden, you're down 50 pounds and it's down to 37. Like, what a great motivator. Absolutely. Listen. We'll talk to people all the time. Like, I want you to use the amount of insulin you need. I think the way I've said it before, I'm pretty comfortable with. I can't tell you how to eat, but if you're gonna make a poor health decision with food, let's not also make a poor health decision with diabetes.
Scott BennerWith your blood sugar. Yeah. Right. Let's at least have the the the blood sugar parked together. But that might be a motivator for people. I don't know what motivates people anymore. That note I got yesterday was from a guy whose kid has diabetes. It's not even him. He listens to the podcast for the child. I did that weight loss diary, and he said that motivated me. I've lost, like, 30 pounds already. That's awesome. You know, like, you how so whatever motivates people, I don't I don't know. Right? But maybe or just go mess with the calculator just to give yourself a shot.
The Bolus Simulator and Fat/Protein Impacts
Scott BennerNow once you have good numbers from it or a starting point, there is another calculator. So that one's gonna be juiceboxpodcast.com/bolusfour. By the way, these all have, like, a ton of, disclaimers. You're gonna have to click through to use them. You know, they're educational purposes only. Talk to your doctor, that kind of stuff. But once you have those numbers from the settings, then you can take those numbers and put them into the calculator. And once if I did it the way I meant to by the way, I wanna say these calculators were made by, like, vibe coding on AI just so you know, you know, how they came. So if you take that number, insulin to carb ratio for one fifty, which is I'm looking at the other one here. 13.3. Now let's just believe these insulin sensitivity, it has 48, and we're gonna make our target blood sugar on the calculator 90.
Scott BennerThere's a little thing here you can you can calculate. Like, you can put a cap on how much, you know— it can give you— kinda like yell at you if you if it goes over 25. Max bolus limit. Yeah. Very nice. Right? So then we take carbs all of sudden, and we say, hey. A 50 carb meal, no fat, no protein. I, you know, I have no insulin on board. My current blood sugar is, you know, 100. I'm trying to get the 90. I have a stable arrow. It says simulate the strategy, and it tells you 3.97 units for the 50. Yep. And and it gives you a little, like, wait ten minutes on a pre bolus thing, suggestion. But the minute— I'm sorry. No. No. Jump in.
Jenny SmithYeah. I was gonna say and to compare for, again, somebody who's considering moving to a healthier intake. Now take that carb content and add into it, especially if you're working on weight loss potentially or stabilizing your weight to keep yourself where you really want to be, Add into that 50 grams. Now the meal contains 30 grams of fat and 50 grams of protein. What is the dose difference? My goodness.
Scott BennerYeah. It doubles it, basically. It's still Right? Three point nine seven up front, but now it's asking for three point five three over the next eight hours. So the theoretical requirement is seven and a half units, and that's you know, now you're setting square wave boluses or, you know, extended boluses. A lot of you are on algorithms right now that don't accept fat as an input, so the algorithm's just gonna fight with the the rise, and it's not gonna use nearly enough. And not only that, but then now you can come back. It's it's such a great point. You come back again, and then cut the fat down to 15 and cut the protein down to 25 and then hit it again and see to yourself, oh, now it's five and a half units of insulin. And what happens if I lost 10 pounds and these settings change again? Like Yes. Whatever's gonna motivate somebody to do a bigger idea. I hope these things help you. I hope you play around with them and they they make sense for you and help you—
Jenny SmithThat's what I was gonna say. I think the beauty of technology is that tools like this can give you more insight when you're working really hard to navigate some changes that you know are going to eventually pay off. They are going to be better for you. Right? But it's hard when you I'm a very visual learner myself. And so when I can see it there, I say, oh, wow. Yeah. Look at that. It definitely makes a really big difference. Whereas, sometimes it's something that's said, but you don't really have anything to attach it to. doesn't really make sense.
Reevaluating the Big Picture
Scott BennerThis is a lot to understand, and it it's a lot easier if you don't really have to understand it. You can just see it, and it go and it makes your brain go, oh, okay. I see why that's important. And I I don't know. I've just had enough conversations with enough people to think that oddly enough around using insulin, people don't think about the food that much. Right? Like, it it it's it's the whole thing. Right? You're controlling the impact of the food with the insulin, but we don't talk about it that way. And I understand listen. I understand why bigger picture, you or your kid gets diagnosed. You don't wanna feel like your life is gonna change. And so what does the doctor say? Oh, nothing's gonna change. Just count your carbs and use insulin.
Scott BennerThey're not thinking beyond the bigger picture. They're okay if your blood sugar goes to two fifty and comes back down five hours later. That's and if you're not okay with that, then I gotta look at the rest of these variables around exercise and body composition. What am I eating? You know? And not not and I don't mean what am I eating, like, punitively. I mean, like, what's in there and what does it need so that it doesn't cause a problem for me, blood sugar wise. That's all.
Jenny SmithAnd that's why I think these these conversations that I have the opportunity to have with you are valuable from my perspective in what I see out in the world of people with diabetes. Because these are the tidbits, the pieces that don't ever make it into the on the discussion table in the room with many clinicians. I'm not saying all, but with many clinicians, it is a starting place of count your carbs. Here's your insulin to carb ratio. This is how it works. This is easy math. But it it never goes farther than that. There aren't enough of these beyond the base discussions that people need in order to feel like they have some ability to succeed.
Scott BennerWhen I realized talking to you years ago that the settings that somebody gave my daughter at her diagnosis were from simple math equations. And I was like you were like, yeah. That's what we all do. We use them. I was like, wait. So I can know the math too? And she was like, yeah. And I'm like, oh, okay. When I realized that and then I realized that Arden was diagnosed at such a small age, at such a small weight, and she was gaining weight and no one ever reevaluated her settings. Yeah. It was the oddest thing, and it took me a a long time to figure out that that wasn't happening. And I think listen. The numbers are gonna—it's been a long time ago now, but I think I realized that when her insulin sensitivity was, like, one unit moves her 350 points, I was like, what? That's not right at all.
Scott BennerAnd I sat there thinking, like, where do we get that number from? And I'm like, oh, that's from three years ago. Yeah. And I'm like and then I sat in that office. It was one of the first times I thought, oh, these people are not gonna be helpful to me. I see. Okay. I got it. I'm gonna have to pay attention. Okay. But how does that happen? Like, because there's a little kid. She's diagnosed in the hospital, seventeen pounds on death's door. I swear to God. She a day and a half on insulin, she was nineteen and a half pounds. And then on the years that's followed, she's 20, 25, 30. Like, she's gaining weight appropriately. No one ever changed her settings again. And we're over there struggling, and I don't know why. And I and they're like, no. Are you counting the carbs right? I'm like, I mean, I think so. anyway, it could spin out of control really quickly.
Closing Thoughts and Future Planning
Scott BennerThen nothing wrong with going back once in a while and say to yourself, hey. And and I, by the way, I slow rolled this out. I put it out to the community on Facebook first. I got a lot of good feedback from it. Jenny is sharing it with people privately now, which makes me feel comfortable, talking about it more. But I got I got back from somebody who's like, I thought that calculator was gonna be a joke and I put it in. She's like, it matched all my settings. And I was like, right on. And I said, do you think you have good settings? She goes, my stuff works like right. And I was like, good. Good. Like, go Yeah. try to help yourself. I don't know. Absolutely.
Jenny SmithYeah. And No. And, you know, that's one of the things that I always take a look at, especially with my younger population. I ask all of my like, what's their weight? How are they on their growth curves, especially? Are they staying on it? Are they veering off of it in one way or another? And then we look at their their intake. And then with some of the algorithm pumps too that are adaptive algorithms, something really valuable to look at is for little kids, as the system adapts to giving them insulin, kids are also growing. So over time it has to adapt to that growth and it gives more and they need more insulin, but what gets left behind are their manual settings.
Jenny SmithAnd unfortunately, if you ever did have to use manual pumping mode then, things like the base basal for only manual mode, it might be three units behind what the system has adapted to giving in the automated basal profile. So it's really important to pay attention to all of these. Kids specifically through the growing years but even adults who might be making life changes. Again, kinda going back to this woman who may be what's healthy food look like for bolusing? Right? Maybe something changed, so you should pay attention to that.
Scott Benner100%. You and, you know, you said just now, but, like, real specifically, Omnipod five, like, you start off with a setting and that thing's adjusting your insulin now into the future, into the future, into the future. All the time. You suddenly go back to manual. Those settings have nothing to do with you anymore. Right. Maybe or maybe not. I don't know, but, like, you certainly don't know. That's for sure. And I I think it's worth just looking at once in a while. You could change your eating habits could change. Your body composition could change. Your activity level could change. There's a lot of different things that are changing. You can't just keep staring and going like, oh, well, that part is done now. It is not let's just not set it and forget it.
Scott BennerI know you want it to be, but it it just in a lot of cases isn't. Especially with growing kids or people whose lives are changing, and people's lives are changing a lot now. I mean, honestly, Jenny, look at me. I don't even look like the same person I look like two years ago. No. You don't. Yeah. It's insane. And then there's the guy or the thing, lost 25 pounds already. People I got a note from a woman the other day who said, never stop making that podcast. I believe she said she's lost a 130 pounds since she lost since listening to my weight loss diary. Right? And Wow. Then you know what the next problem becomes? One person says, I'm in the ER and DKA because of my GLP.
Scott BennerAnd I'm like, no. You are not in the ER because of your GLP. You're in the ER because you're not taking enough insulin. That's a different thing. And so, like, then people see that and they get scared of it. And and, like, so there's more to nothing listen. Between this, your relationship with your mom, politics, the world, nothing's as simple as as a banner, you know, statement. The headline's never the answer, so you gotta dig into this stuff. That's what I'm gonna leave with everybody with. Like, dig into this a little bit. Try to figure it out. Awesome. Jenny, you were terrific. Jenny Helps. We should call this episode. Jenny Helps? Yeah. Oh, I like that. Yeah. It's nice, isn't yay. It'll be called bolus for healthy food or something But like you know what I mean. Alright. I'll talk to you.
Scott BennerThis episode of the Juice Box podcast is sponsored by the Omnipod five. And at my link, omnipod dot com slash juice box, you can get yourself a free what I just say? A free Omnipod five starter kit. Free? Get out of here. Go click on that link. Omnipod.com/juicebox. Check it out. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. Links in the show notes. Links at juiceboxpodcast.com. Dexcom sponsored this episode of the juice box podcast. Learn more about the Dexcom g seven at my link, dexcom.com/juicebox.
Scott BennerIf you've listened to any number of podcasts or maybe watched a YouTube video, you're very accustomed to listening to the creator of that content ask you and sometimes just outright beg you without any feeling of self respect for you to follow, subscribe, share an episode. The reason that happens in podcasting specifically is because podcast players don't have a sophisticated recommendation engine like YouTube or TikTok does. They can't watch listener behavior and then give you content that you might like. Word-of-mouth skips that line completely. It's an instantly expanding reach engine and really the only thing I've ever found that helps to keep the Juice Box podcast growing.
Scott BennerSo subscribe and follow because that the algorithm understands. Set up automatic downloads, listen to the show, but share it with somebody else. Leave a five star review. Make it a thoughtful review that the algorithm can understand. I really appreciate the time it takes you to do those things, and I hate that I have to say this to you because I feel like an idiot. But subscribe and follow, tell a friend, please and thank you. How would you like to share a type one diabetes getaway like no other? Join me on Juice Cruise 2026. You may be asking, what is Juice Cruise? It's a week long cruise designed specifically for people and families living with type one diabetes.
Scott BennerIt's not just a vacation. It's a chance to relax, connect, and feel understood in a way that is hard to find elsewhere. We're gonna sail out of Miami, and the cruise includes stops in CocoCay, San Juan, Saint Kitts, and Nevis aboard the stunning Celebrity Beyond. This ship is chosen for its comfort, accessibility, and exceptional amenities. You're gonna enjoy a welcoming environment surrounded by others who get life with type one diabetes. I'm gonna host diabetes focused conversations and meetups on the days at sea. There's thoughtfully designed spaces, incredible dining, and modern amenities all throughout the celebrity beyond.
Scott BennerYour kids can be supervised, there's teen programs so everyone gets time to recharge. Not just the the kids going on vacation, but maybe you get the kickback a little bit too. There's gonna be zero judgment, real connections, and a whole lot of sun and fun on Juice Cruise twenty twenty six. Please come with me. You're going to have a terrific time. You can learn more or set up your deposit at juiceboxpodcast.com/juicecruise. Get ahold of Suzanne at cruise planners. She will take care of everything. Link's in the show notes. Link's at juiceboxpodcast.com.
Scott BennerMy diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple, actionable tips. The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up into the menu. The episode you just heard was professionally edited by Wrong Way Recording. Wrongwayrecording.com.
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