#1827 From ACEs to PACEs: The Science of Rewiring the Developing Brain
A four part series on the powerful impact of early stress on brain development and long-term life outcomes. Hear science-based strategies for leveraging positive, protective, and compensatory experiences (PACEs) to foster healing and build enduring resilience within the diabetes community.
Companies that Support Juicebox
Key Takeaways
- Brain Development and Stress: Early toxic stress can alter neurological systems, making the amygdala (brain alarm system) oversensitive and weakening the prefrontal cortex, which manages regulation and focus[cite: 2412, 2442, 2444].
- ACE Study Results: High Adverse Childhood Experience (ACE) scores are statistically linked to higher risks of chronic diseases like heart disease, cancer, and depression, as well as reduced life expectancy[cite: 2462, 2463].
- The Power of Resilience: A high ACE score is not a destiny; researchers found that many individuals with traumatic backgrounds thrive as adults thanks to positive experiences that "buffer" stress and rewire brain circuitry[cite: 2398, 2399, 2561].
- Predictable Connections: Simple, consistent actions like being present when a child returns from school, maintaining focused eye contact, or offering physical touch build lasting trust and security[cite: 2501, 2505, 2530, 2531].
- Diabetes and Adversity: Families living with type 1 diabetes can intentionally build "PACEs" (Protective and Compensatory Experiences)—such as safe neighborhoods and stable routines—to offset the emotional and physical burden of a chronic condition[cite: 2371, 2621, 2693].
Resources Mentioned
- US Med: usmed.com/juicebox or call (888) 721-1514 [cite: 2379, 2483]
- Tandem Mobi & Control IQ: tandemdiabetes.com/juicebox [cite: 2383, 2474]
- Cozy Earth: cozyearth.com (Offer code: juice box) [cite: 2465]
- Juicebox Podcast Facebook Group: facebook.com/groups/juiceboxpodcast [cite: 2372, 2375]
- Wrong Way Recording: wrongwayrecording.com [cite: 2726]
Introduction to the PACES Series
Scott Benner Hello, friends, and welcome back to another episode of the Juice Box podcast. Friends, welcome to the first episode of my Paces series with Erica Forsyth. This series is about something very powerful, the experiences that shape our brains and our lives. Research from the Landmark ACE study showed that early stress can affect how the brain develops and how our bodies respond to the world. But newer research adds something equally important.
Scott Benner Positive experiences can build resilience and help heal those effects. In this series, Eric and I will explore what science says about adversity, support, and connection, and how families living with type one diabetes can intentionally build the kinds of experiences that help kids and adults grow stronger over time. If 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.
Scott Benner 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. Always consult a physician before making any changes to your health care plan.
Scott Benner US Med is sponsoring this episode of the juice box podcast, and we've been getting our diabetes supplies from US Med for years. You can as well. Usmed.com/juicebox or call (888) 721-1514. Use the link or the number, get your free benefits check, and get started today with US Med. 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. Learn more and get started today at tandemdiabetes.com/juicebox.
Scott Benner Erica, the other day, I sent you a note, and I said, we talk about the ACEs sometimes. Is there something opposite of the aces? And I went to, the Internet to try to figure it out, and then I just threw it in your lap. And you've come I said, you know what? You get this. You don't want my brain picking through it. But but it occurred to me if there are things that, you know, studies say if you grow up around these things, you may be you know, you may have certain outcomes that are not positive. Are there things that people grow up around that give them positive outcomes more often than not? And I just found myself interested in that, and I wanna know what you unearthed when you were looking through all this.
Reviewing the ACE Study
Erika Forsyth Yes. Great. So well, lo and behold, even in your, you know, inquiry and thought, those things these lists, these studies do exist. And so we are gonna talk about the kind of the the opposite of the ACEs. I think it might be helpful to start with reviewing the ACEs study. And I know we we did do a resilience series, and we talked about the ACEs study pretty extensively, but thought we could start with that and then end today with talking about what the opposite of the ACEs are, which are, you know, adverse childhood experiences. So the opposite are positive childhood experiences. How does that sound?
Scott Benner I think that's terrific. And and you can please tease here a little bit that it maybe isn't as black and white as these things happen to you. So you're going to have positive outcomes or these things happen to you and you're gonna have negative outcomes. There's also maybe a more of a gray area?
Erika Forsyth Yes. So the results of the ACE study, which, yeah, we can we'll get into in a minute, but I think what the biggest kind of outcome that researchers kind of unearthed was that even if you have a high ACE score, a high adverse childhood experience score, if you were to take the the test or the survey, They realized that, wow, still a lot of people grew up and and this is for, you know, adverse childhood experiences between birth and 18 years of age. They found that as as adults, despite having high ACE scores, they showed up in life with healthy outcomes across the board, mental health outcomes, in relationships, in profession. So it there wasn't this you know, it wasn't, an equal it wasn't proportionate to the amount of know, if you had an ice high ACE score, that meant that you were gonna have a really challenging adult life. And so that led the researchers to wonder, well, what what was it that kind of aided people in having healthier outcomes later in life?
Scott Benner We'll talk about that. That's awesome. Okay. So, yes, please, let's review what ACEs is just, you know, for anybody who's uninitiated.
Erika Forsyth Okay. So the ACE study was conducted by the CDC and Kaiser Permanente of Southern California and by two doctors, doctor Vincent Felletti at Kaiser and doctor Robert Anda at the CDC. And so they conducted studies surveys with over 17,000 members from Kaiser here in my hometown in Southern California. And from the years of 1995 to 1997, there were two waves of these surveys that went out. And so the the kind of the landmark study and this article came out in 1998 as a result of these surveys. It was titled relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. So that's a pretty, you know Intense title.
Scott Benner What a title.
Erika Forsyth Yeah. Okay. So they kind of continue to dissect and analyze the data and the research, and this continued into the February. But, basically, the summary of of the findings said that that the child's brain, you know, grows in a very sensitive way step by step. And during childhood, the brain is building, as we know, all of the systems that control your emotions, your learning, your memory, your stress response. And so because the brain is still developing when the child between newborn to 18, they have early experiences of stress or trauma, they will have a big outcome, right, and a big impact for better or for worse. Okay. So shall I keep going?
Defining the 10 ACEs
Scott Benner Can I just list them for people very quickly? So the ACEs are depending on how you read the list, I I I see them as being broken up into a couple of sections. Abuse, neglect, household dysfunction, I think are kinda like the three, you know, big ones. Inside of abuse, it's physical abuse that a parent or other adult in the household often or very often push, grab, slap, throw something at you or ever hit you so hard that you had a mark or you were injured. That's physical abuse. Emotional abuse that a parent or another adult in the household often or very often swear at you, insult you, put you down, humiliate you, or act in a way that made you afraid that you might be physically hurt.
Scott Benner Then sexual abuse did an adult or person at least five years older than you ever touch or fondle you or have you touched their body in a sexual way or attempt or actually have oral, anal, or vaginal intercourse with you? So that's the abuse section. Neglect is physical neglect. Did you often or very often feel that you didn't have enough to eat, had to wear dirty clothing, or had no one to protect you, or your parents were too drunk or too high to take care of you or take care of or take you to a doctor if you needed it. Under neglect also, emotional neglect, do you did you often or very often feel that no one in your family loved you or thought you were important or special, or your family didn't look out for each other, feel close to each other, or support each other?
Scott Benner And then under household dysfunction, which gosh. I guess they all could have, like, fallen under this one, but divorce or separation, were your parents ever separated or divorced? Domestic violence. Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes often or very often kicked, bitten, hit with a fist, or hit with something hard, or ever repeatedly hit over the at least a few minutes or threatened with a gun or a knife. Jesus. Is the last time. Number eight, substance abuse. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Number nine, mental illness. Was a household member depressed or mentally ill, or did a household member attempt suicide? And 10, incarceration. Did a household member go to prison or jail? And depending on how you answer those questions, you're, you're given a score. Is that that's how that works?
Erika Forsyth Yes. It is a heavy list. Yeah. I believe we went into the results in the resilience series, but a high percentage of people from these 17,000 participants a high, high percentage had one or two. But I don't unfortunately, I actually don't have the numbers in front of me at the moment, but I I believe we went into it, and you can probably find those pretty easily if you were to if you were curious.
Scott Benner Kicking around. Yeah. Yeah. So, anyway, that so, anyway, it's such a weird transition. Yeah. That's the ACEs list. And, you know, if you've had these things happen to you, what did the study say? It does what for to you?
Neurological and Biological Impacts of Stress
Erika Forsyth Okay. Yeah. So, yep, what happens when if you are exposed to any of these adverse experiences? So the research, even amongst not only humans, but also animals, have shown and indicated that too much stress, and particularly stress that is scary and unpredictable and repeated or repeated, can change how the brain works. It alters, the systems. And so if we can go into that, like, what does that actually mean? So the brain's alarm system, which is the amygdala, becomes extra sensitive. Right? The child may react more strongly to stress, fear, or conflict if they are exposed to these things that are scary, unpredictable, or repeated. The prefrontal cortex, which is your your thinking and kind of calming regulating system, can weaken, and this can make it harder to manage the big feelings. It could make it harder to stay focused, remain calm. The body's stress response system, which is the hypothalamic pituitary adrenocorticole, otherwise known as the HBA axis, is thrown off balance. So this the HBA axis is is designed to help you to respond to challenges. But if you get if you're exposed to early stress, it can lead you to feeling, overreactive. And maybe that's why sometimes people are are described or feel like they're being too sensitive, but that's really often a response to something like this or under reactive, and your body's just trying to shut down. Again, these are all systems and things that as a newborn or a child up to 18 develops to just try and stay alive. Right? Like, it's they're just trying to keep going, and so this is how your system responds.
Scott Benner Can I jump in for a sec? Is this a good place to pause you? Give me a half so I have the scoring here. A score of zero. None of these 10 things happened to me, reported by roughly thirty six percent of the population. One to three reported by roughly fifty one percent of the population, and those people also saw a moderate increase in health risks. A score of four plus reportedly by reported by roughly twelve percent of the population. This is often considered a critical kind of tipping point where the risk for serious health and behavioral consequences rise dramatically. It's also asking me to remind you that a high score does not guarantee a bad outcome just like a low score doesn't guarantee a healthy one. But once you get four and over, compared to a person with an a score of zero, individuals with an a score of four or higher are statistically more likely or much more likely to experience the following. Two times the risk of ischemic heart disease, two times the risk of cancer, two and a half times the risk of a stroke, three times the risk of chronic lung disease, four point five times the risk of depression, significantly reduced life expectancy. Some studies suggest that up to twenty years difference could be between the scores of zero and six and over. And then behavioral health risks, seven times risk of alcoholism, 10 times risk of using injectable drugs, and twelve times risk of attempting suicide. So that's that's some pretty impactful data.
Sponsorships and Resources
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Healing and Rewiring the Brain
Erika Forsyth Yes. No. I think that's that's it is helpful. Yeah. So kind of going through what why that happens, we're kind of going through the kind of biological, neurological systems that are impacted by the stress that lead to some of those outcomes. The last two, the hippocampus, you know, which is where memory and learning is stored, the stress hormones can slow down the growth of those new brains brain cells, which impacts, consequently, your learning and memory. But also on a positive, a nurturing and enriched environment can help repair some of those damaged brain cells. And we're we are we're gonna get to the positive stuff soon. It's coming. So, basically, the yeah. Your brain chemicals involved in in mood and relationships are are shifting, you know, in in these develop years. And so it can make it harder to regulate emotions, forming secure relationships, and feeling really safe and secure internally, which makes sense that some of that a lot of the outcomes that you listed occur because of this shift in brain development.
Erika Forsyth So we can why why are we kind of reviewing this? Why we wanna kind of just remember the impact of of the ACE study was so significant and holding that you know, stress obviously impacts your child and not and they're not just being dramatic, but it is it is a chemical experience, right, as their brains are being wired. And positive, predictable, caring relationships are incredibly powerful. So and there can be healing. There it's not like if you're listening and you're thinking, well, either I, as the if you're an adult grown up now listening to this and that you experienced a lot of those ACEs, things can be rewired. Things can be healed. Things can be also prevented. So we're gonna kind of switch and talk about studies that came out as after the ACE study. I'll pause there.
Scott Benner Okay. Well, I mean, I don't know how other people parent, but it's my core belief that that part that you just said about being predictable, I think that's just super important. You know, just that your kids know they're getting what they get from you, and it's there if they need it, and that's it. That you're I used to think I know this isn't something everybody could do, but I always thought it was really valuable that my kids knew when they got home from school, I would be there. Like, just a very simple thing. I'm gonna open the door, and that guy is gonna be there. Right? Like, that's a thing I can count on. It happens every day. It builds trust. It builds it builds a lot inside of them. Right? Confidence. And then I have something that they I need to talk to you about. You stop and talk to them. You spend time with them. Listen. My my son's 26 at this point almost, and he he still lives here. He's, you know, trying to save some money up to, you know, move out. At the same time, he's been teaching himself to play guitar recently. And last night, I was busy. And I mean busy when he rolled into the kitchen and he was like, hey. Check this out. I taught myself this riff on the guitar. And I didn't even think twice. I just stopped what I was doing, leaned on the wall, I was like, show me. And he showed me once. He showed me twice. He showed me how he taught it to himself. And it's not easy because there is a voice in your head going, you're supposed to be doing something else right now. Right? And I just I fought the voice off, and I was like, it doesn't matter. Like, nothing matters except hanging out here with him for the next couple of minutes and let him share this with me. And then once I gave that away, I was enjoying it too. Not that I wouldn't have, but I was literally being pulled from one moment into another one. You know? I see that as the the successful end to him believing that when he has something to say, I'll stop and listen to him. And therefore, he came to show me because otherwise, if he didn't think I was interested, he would not have sought me out to show it to me to begin with. And I think all of that just builds together very nicely. Anyway, I that's what struck me of everything you just said, consistency and I don't I forget the words you used, but, like, the the belief that you're gonna be there or do or do a thing. It I mean, it's just as powerful as it is. The opposite is destructive. Right? If if if that same kid believes that when they come to me, I'm gonna dismiss them or that I don't care or I'm not interested or that, you know, if something gets said, they're gonna get hit, smacked, yelled at, screamed out, whatever. Like, you can see how that would would create a completely opposite situation. Anyway, sorry. That's, that's what you made me that's what you made me think of.
Erika Forsyth No. Absolutely. I'm sure I feel like we maybe have mentioned this on another episode, but the studies show that upon reconnecting with your child, it could be after school, it could be when you're getting home from work, that it's quality over quantity. So if you were to connect with eye contact, it could be for one minute. It might be a little bit more, but it's it's just brief. Drop everything. Eye contact. Connect. Have some physical touch of comfort, hug, kiss, whatever you do is way more impactful than feeling like you need to go like, kind of not having that moment and then feeling like you need to go do something that maybe is not enjoyable for you as much for hours and and kind of half being there. Kinda maybe you're on your phone, but you're also kind of throwing the ball.
Scott Benner I think the physical touch thing's really important too. I try to just lay my hands on them at some point, whether it's, like, on your shoulder as I'm walking by or, like, you know, tap you on the side as you walk by somebody. Just let them know, like, you're aware of them, I guess, is is is the way to put it. You know, with Arden, I think it's as as they've gotten older, like, I'll kiss her, like, on the head maybe or give her a hug when she walks by. But there's a thing. You can see it on people. Like, there's a moment in everyone's day. If you stop them and give them a hug, they're gonna melt. They're gonna be like, oh, thank god. I am tired of holding myself up. You know? And it just I don't know. Anyway, so hopefully maybe that stuff's gonna pop up on that that list in a little bit.
Defining PCE, PACE, and PEACE
Erika Forsyth It it probably will. Yes. Okay. So I thought it was important for us to kind of clearly define and explain the difference between these two different acronyms as a result of the ACE study. So one is the PCE, and I guess we'll just say can we say PEACE or maybe we just say PCE? Positive childhood experiences. And then the other acronym that came out is after the ACE study was Protective and Compensatory Experiences. So we're gonna get into that a little bit today.
Scott Benner That sounds like just a smart person trying to play off the aces, and then they got wordy.
Erika Forsyth Yeah. Yes. Well and then it also that also exists is now in within the kind of ACE community world they now refer to it as your PACE score. So you can also take a positive a PACE survey. Right? So then they'll say, what is your positive and adverse childhood experience score?
Scott Benner There's ACE, PACE, and PEACE? Is that really it?
Erika Forsyth Yes. Yes. Yes. Alright. Basically, I wanna make sure I understand. Okay.
Erika Forsyth Okay. The positive child experiences. So the study comes out. You know, the article comes out in the late nineteen nineties. People are dissecting the research. They're trying to determine why are people showing why are adults now showing up with such resilience even with high ACE scores? So doctor Christina Bethel released the results of a study in in 2019, and the study kit was conducted of 6,188 adults at John Hopkins. And she was seeking to identify what what are these qualities, these positive childhood experiences that could buffer against the health effects of the traumatic ones, the what that basically, all those things that you just listed.
Scott Benner Yeah. Right? So because what we just explained, people are are showing up with kind of healthy, normal development, good adult emotional health, wanting to understand the why behind it.
Scott Benner So somebody looked at somebody with a high ACE score and was like, I don't understand why is this person not suffering some of the same consequences we expect from people on this the the score high on this list. Exactly. And that leads to this. Okay. And that that leads to the study. Basically, it identified seven experiences that are statistically linked to good, positive, emotional, and mental health in adults. Okay? So this is kind of leading to, like, you know, how we went into this again a little bit in the resilience series of, like, how does one become resilient? How does one have up with resilience later in life? And these seem to be the, the outcomes. So here should I go ahead and list them?
The 7 Positive Childhood Experiences (PCEs)
Scott Benner Yeah. Do it. Yeah.
Erika Forsyth Okay. Okay. So the seven positive childhood experiences are:
- The ability to talk with family about your feelings and feeling safe to do so.
- The sense that family is supportive during difficult times.
- The enjoyment of participation in community traditions.
- Feeling a sense of belonging in high school.
- Feeling supported by friends.
- Having at least two nonparent adults who genuinely cared, like, maybe coaches, people in your your faith community.
- Feeling safe and protected by an adult in the home.
Scott Benner Wow. That seems like pretty basic stuff. I guess not. I'm sorry. You're saying something positive and I got negative. You're like, there's some great things that happen to people, Scott. I'm like, why don't they happen to everybody? And but some of these didn't happen to me when I was growing up. But, just hearing them back, it I don't know. It just doesn't seem like a big lift to, I I mean, support somebody during a difficult time, for example.
Erika Forsyth Right. Right. And and, yeah, I think that there you could look at it from two different, you know, perspectives of, like, wow. It's remarkable that people, even with high ACE scores, still were exposed to these situations that buffered the stress that kind of helped heal, maybe rewire some of the the negative experiences that they had as a child.
Scott Benner Right. I'm gonna choose to think of it that way. Thank you. Yeah. Yeah. Seriously. Because if you're in a household that also has the those ACEs thing going on, if you're experiencing any of that, that means that somebody is probably fighting through their worst demons trying to bring this to you as well. Right? That's the situation where you find yourself talking about your parents later, and you go, well, they did the best they could, which meant they were they were limited, and they still pushed through in some areas. And okay. Alright. I'm sorry. I shouldn't have come negative. Okay.
Erika Forsyth No. No. It's okay. But I I think it yes. We one could also look at this list and think about it as, yeah, it seems like common sense. Seems like, you know, it would be nice to feel like a sense of belonging in high school. It would be nice to feel supported by friends, but also when you're thinking about those adverse childhood experiences, it also makes sense why some of these things would be highly difficult to be exposed to. But with that so the this list is, I think, just important to note that, like, it is something that has occurred for these these later in life, these adults who also experience these positive experiences that help them, you know, succeed in life or at least health be healthy and thrive.
Scott Benner So I I'm looking at, like, an offsetting. Right? Like like, I don't know. The aces put three on, and we took one off, and it got a little like, that kind of thing. Okay. Yes. Alright. Yes. Okay. So that's that's the positive childhood experiences. So kind of moving forward and saying, okay. Well, what if like, must have been nice. Right? If if you're you're listening to this and you're thinking, well, gosh. I didn't I didn't have any of those things as a child, and I do have a high ACE score. Or perhaps your family system is experiencing a lot of these, stressors currently. I think where our hope is in that, you know, today and perhaps in the next, you know, one or two episodes is that we can provide some hope and some tools that things that if you have not experienced yet can be helpful to even heal now wherever you are in your age and stage of life to heal some of that pain and trauma.
Updates to ACE Scoring
Scott Benner Before you move on, I wanna add something about the the ACEs scoring because it struck me as odd, so I've been looking into it while we were talking. I thought, why does it not affect me poorly if I see a woman batter a man in my household? And it turns out that's a fairly common flaw, understood flaw in the system, and more modern clinicians have added it to say, do did you witness a parent or household member being hit and sold or threatened, etcetera? So but the the the the description's interesting that it said in the nineties, they they what they were trying to say was, have you seen your primary source of safety be assaulted? And that assumption back then that the children saw the mother as the primary source of safety. And that's why so the the question was designed on purpose like that, but it's been it's been changed, over the years. So, anyway, it just just as we were talking, like, I was like, that seems so strange. Why does it matter what sex is beaten on what sex? Like, that doesn't make any sense to me, and so there's your answer. Sorry about that.
The PACEs Science Initiative
Erika Forsyth That is interesting. Okay. So, as a result, the there was a a kind of a community initiative called the PACES Science Initiative. And this acronym stands for Protective and Compensatory Experiences. So and, again, this was developed after the ACES framework. And so we'll we'll go over the list, and then we can the hope is that we'll be able to go into more detail and even perhaps apply it to some, you know, diabetes Specific work as well in the next two, in the next few episodes. So these these are 10 specific protective experiences that that not only like like the positive childhood experience that can buffer or counteract, but also repair the harm from the ACEs.
Erika Forsyth So they these the PACEs fall into two different categories. One is relationships that heal, and this might these sound similar to the the PCE. So:
- Having parents/caregivers who provide affection.
- Having a best friend.
- Having adults who stand by you during difficult times.
- Being a part of a group, whether it's school or church or or other sports or activities.
- Having at least one caregiver with a steady job.
- Participating in hobbies or community activities.
- Living in a home with predictable routines.
- Attending school that feels safe.
- Having neighborhoods where people look out for one another.
- Having access to healthy food.
Erika Forsyth So these these are more kind of actionable, right, things that that a family or a community or a school can can focus on and intentionally build and apply. So with that and we I think we kind of already discussed kind of identified the difference between the the PCE and the PACEs. And, ultimately, the PCEs are what helps the kids thrive and be stronger later in life, and the PACEs are are things that have been identified, again, through research that helps kids heal and thrive.
Breaking Generational Patterns
Scott Benner Oh, yeah. I think this is really awesome because when I when I had the thought, it really was just a fleeting thought. I was sitting here working and doing something else at night. I thought there's so many times that I refer to this in the in the podcast. I'm like, did this happen to you? Have you heard about the ACEs? That thing I thought, is there not? Like, some like, didn't somebody do a study to, like, figure out the other side of all this? And, like, I I'm happy to know I I wasn't the first person to think of it, obviously. I actually feel a little silly now, but that's not the point. I like getting this back, like, especially because the resources here are they're just not heavy lifts, you know, like so what I'm reading is if if you're not living a life full of aces and you are, you know, doing some of these these, you know, piece or paces, then you're looking at a a a hopeful outcome. And even if you are struggling with things and you you could maybe facilitate some things that would offset and and really leave your kids in a better place. I mean, it's it's just a matter of you understanding that that's what's happening, and that's why we're doing it so that people can hear it and maybe hear because I I would also say that I wonder how many people are hearing this and thinking, oh, that's that's a horrible thing that happens to other people. But that's not me. I'm from a good family and blah blah blah. But I'm telling you now, I've interviewed enough people. We all have some of those aces. Like, I I don't know that I've ever met anyone who's heard those 10 things and gone, nope. Not me. Haven't heard about it. So, you know, if you have some of that stuff happen to you, and you're effectuating other people's lives based on the building blocks that you came up with, you might not even know you're doing it half the time.
Scott Benner I mean, there have been examples throughout the podcast that were, you know, not nearly this dire that, you know, I I I think of this one this one lovely woman who came on one time, and she was talking all about how her mom hid her health stuff from from them. They never she was never honest about her health stuff. But as she was telling her story as an adult, I was like, you hide things from people all the time. And I said it to her. Like, I'm not you know, she's allowed it to be on, I'm happy to talk about it. But I was like, do you not notice that about yourself? And she really didn't. I was like, you talked about being covert here, here, not sharing this, not sharing that, and then easily flipped into talking about how your mom you couldn't believe your mom didn't share these things with you. I was like, that's I'm like, that's great. She's like, what should I do? I'm like, definitely go see a therapist. But but at the same time, like, this is what it makes me feel like. Like, you know, as you sit here and, like, wonder about, like, a magic wand fix for all this that doesn't exist, but as you try to imagine it, I mean, I quickly recognize there's no stopping this. This isn't gonna, like this isn't a light switch problem. Like, this is generational slow building. Maybe fifty years from now, we won't be experiencing all this if you're lucky kind of movement.
Scott Benner But for those people who are interested in it right now, I mean, again, I don't living at home with a predictable routine, you you must be able to, like, accomplish that. Like, that's not tough. And I'll tell you too, I get uneasy when my household gets off of routine too far. You know? Like, it just it feels like everything's mixed up all of a sudden, and I don't know why that is. It because my dad yelled at me? Apparently, maybe. You you you're like, like, I don't know exactly, but that adds a ton of a ton of grounding. Even just watching my son, like, teach himself to play the guitar because we spoke about it one time. He seems more content. He's you know, in his free time, he's doing something valuable. He feels like he's getting somewhere. Even though it's not going incredibly quickly, he seems very proud of himself. He can come show with us. We are proud of him. We're happy to share that with him. You know what I mean? Like, in build, build, build. Guys could all do this is, I guess, my point in bringing all this up.
Increasing Positive Experiences
Erika Forsyth Yes. And I think what what is encouraging and hopeful, you know, that after the ACE studies came out, a lot of the discussion and emphasis was on, you know, how do we decrease these adverse childhood experiences which is still a movement and still an emphasis. But I think as a result of a lot of this research and identifying, you know, resilience and wanting to learn and understand it more, the the research and a lot of you know, even the clinical interventions have been focused on how do we increase these positive childhood experiences. And my hope is that as we kind of go through, it does seem like a very, maybe, basic list. It also might be a really complex and challenging list as you're thinking through. Well, how do I do this? I can't afford it, or I don't have time, or I don't have a community around me that feels safe. Our our hope is that we can kind of go through these two different categories, the relationships that heal and the resources that build skills and resilience, and talk about some practical ways that might seem maybe very obvious for some, maybe not as obvious for others and and go into more detail through these two different categories.
Scott Benner No. I take your point. I look forward to having the conversation and having you point out to me that that's not so easy for everybody. Like, seriously, because just because it seems obvious to me doesn't mean it'll seem obvious to someone else. And, also, I might be thinking I'm doing it and not really accomplishing it too. You should go ask my kids. But, actually, don't ask them. But, like, you should yeah. It might be like, I don't know what that guy's talking about. None of that happens here. But I don't know. I I again, I look forward to looking through it and trying to make sense of it so that the people listening can identify things that maybe they've seen in their past that maybe are impacting their future and can wonder out loud about how to stop it. Because it's all like, I hate to sound like an Oprah, like, episode from '86. But you were just trying to break patterns, really. Just trying to stop the circle from from perpetuating onto itself. Because you do it to them, they're just gonna do it to somebody else. And, you know, it's never gonna stop until somebody figures it out. And luckily for me, I have a lot of episodes to make, so I have plenty of time to talk about stuff like this. And I find this to be incredibly interesting.
Fascination with Human Behavior
Scott Benner I I think you know, Eric. I imagine people listening though, and this is not some unique thing about me, but I am you know, there are plenty of people who feel this way, but I am just endlessly fascinated by people's decisions and what they do and why they do them. I'm probably just trying to figure out why somebody treated me a certain way, but that's fine as long as we all get to talk about it and it helps somebody. I think that's part of, what building a a a complete community looks like. And Yes. But and like you said, after you get this part hammered out, it's not too hard to adjust it and point it at diabetes a little bit. Like, there's easily gonna be ways to look at this and think about how do I be more supportive of people with their diabetes. And, you know, it it's just as easy as easily as you could sit here and say, if these things happen, then down the line, I might end up being an alcoholic. Right? It's easy it's easy to say if these things happen, then down the line, I might not be taking care of my diabetes the way I should be. So what could we do to offset some of that to give people a chance at at long term health and and happiness at the same time? So if we can help people a little bit with that, I'm gonna call this a big success. Appreciate you doing it.
Erika Forsyth I'm excited about it. Thank you. I know you are. Actually, she was shot out of a cannon. Those were her words when we started recording. She's like, I'm so excited about this. And then they put a lot of pressure on me because I'm like, oh, god. I'm gonna screw this up. I know for sure. And I was like, she's got it all worked out in her head. I'm gonna say something dumb, and then she's gonna be like, no, idiot. And then we're gonna, like, go off on a oh, you know what I mean. And then we're gonna go off on a tangent. You're such a therapist. She's like, no. I don't think you're an idiot. I know you don't think I'm an idiot. Stop. I got a lot of good feedback about you recently. I just wanted to share that with you. People really, really, really love these these conversations with you. So I yeah. Thank you very much for adding them to the show. Alright. Well, next time we get back together, we'll keep this going.
Erika Forsyth That's right. Awesome. Thanks. See you soon. Bye.
Conclusion and Sponsorship Credits
Scott Benner Today's episode of the Juice Box podcast was sponsored by the new Tandem Mobi system and Control IQ Plus technology. Learn more and get started today at tandemdiabetes.com/juicebox. Check it out. Arden has been getting her diabetes supplies from US Med for three years. You can as well. Usmed.com/juicebox or call (888) 721-1514. My thanks to US Med for sponsoring this episode and for being longtime sponsors of the juice box podcast. There are links in the show notes and links at juiceboxpodcast.com to US Med and all of the sponsors. 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.
Scott Benner My 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, where you can listen to it at juiceboxpodcast.com by going up into the menu. 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.
#1826 Re-thinking Control IQ Plus Technology
Optimization of Control IQ technology , emphasizing correction factors as primary levers and the importance of fresh setting calculations when switching between insulin pumps.
Companies that Support Juicebox
Key Takeaways
- The Power of the Correction Factor: In Tandem's Control IQ system, the correction factor is the most critical setting to optimize. Strengthening this factor makes every five-minute automated delivery and the hourly auto-boluses more aggressive, leading to better time-in-range.
- Avoid Legacy Settings: When switching between different pump systems (e.g., Medtronic to Tandem or Omnipod), do not simply transfer your old settings. Recalculate fresh settings based on current total daily insulin needs to give the new algorithm the best chance of success.
- Settings Drive Success: Research indicates that stronger, more "tight" settings generally lead to improved outcomes. Users should prioritize accurate correction factors over minor tweaks to basal rates or carb ratios.
- Autonomy Predicts Success: Success with type 1 diabetes is strongly linked to a user's genuine interest in their health and their willingness/autonomy to adjust their own pump settings as their needs evolve over time.
- Simplification is Art: Effective diabetes management doesn't require complex 13-page papers; it often boils down to simple strategies like accurate pre-bolusing, understanding food impacts, and using features like "Sleep Activity" mode to target tighter ranges.
Resources Mentioned
- Tandem Mobi & Control IQ: tandemdiabetes.com/juicebox
- Dexcom G7: dexcom.com/juicebox
- Cozy Earth (Code: JUICEBOX): cozyearth.com
- Juicebox Podcast Website: juiceboxpodcast.com
- Wrong Way Recording: wrongwayrecording.com
Introduction and Dr. Laurel Messer's Background
Scott Benner Friends, we're all back together for the next episode of the Juice Box podcast. Welcome.
Laurel Messer Hi, everyone. I am doctor Laurel Messer. I'm vice president of medical affairs at Tandem Diabetes. But even more importantly, I am a fierce advocate for people living with diabetes. I have worked in diabetes technology for over twenty years, and I'm so thrilled to be on this podcast today with Scott.
Scott Benner If this is your first time listening to the Juice Box podcast and you'd like to hear more, download Apple Podcasts or Spotify, really any audio app at all. Look for the Juice Box podcast and follow or subscribe. We put out new content every day that you'll enjoy. Wanna learn more about your diabetes management? Go to juiceboxpodcast.com up in the menu and look for bold beginnings, the diabetes pro tip series, and much more.
Scott Benner This podcast is full of collections and series of information that will help you to live better with insulin. While you're listening, please remember that 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 Benner This episode is sponsored by Cozy Earth. You can use my offer code juice box at checkout to save 20% off of your entire order at cozyearth.com. Everything from the joggers that I'm actually wearing right now to the sheets I sleep on, the towels I use to dry myself with, and whatever else is available at cozyearth.com. Just use the offer code juice box at checkout.
Scott Benner 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. Learn more and get started today at tandemdiabetes.com/juicebox.
Scott Benner The podcast is also sponsored today by the Dexcom g seven, the same CGM that my daughter wears. Check it out now at dexcom.com/juicebox.
Laurel Messer Hi, everyone. I am doctor Laurel Messer. I'm vice president of medical affairs at Tandem Diabetes. But even more importantly, I am a fierce advocate for people living with diabetes. I have worked in diabetes technology for over twenty years, and I'm so thrilled to be on this podcast today with Scott.
Scott Benner Thank you so much. I have to tell you, you know, I shared this with you before we started, but I just saw something you posted on LinkedIn. I found it interesting, and I reached out to somebody I know at Tandem. And I was like, can I get Laurel on the podcast? And they were like, let's find out. So here you are.
Laurel Messer Absolutely. And that answer is always yes, by the way. Because if I get a chance to talk about my work and why I'm doing it and talking to the people that I do it for, it is always a red letter day. So this be assured, this is the highlight of my day today.
Scott Benner Oh, well, thank you. I will say the same in return. Although, I did feed my chameleon today and it was exhilarating watching him shoot his tongue across and pick up that bug. This is definitely beating that. So tell me, how did you get into this work? Like, what did you I actually, I'll ask a a slightly farther back question. Coming out of high school, going into college, what did you think you were gonna do? What direction had you taken then? And where did how did you get to this point?
The Journey from Broadway Aspirations to Nursing
Laurel Messer Sure. So number one career aspiration was to be on Broadway. I wanted to be in the musical Cats. But it turns out you need to be able to sing, and you need to be able to dance and act, and I can't do any of those. So restricting. My my, like, first high school dream was crushed.
Scott Benner Okay.
Laurel Messer And so I ended up going into, research. I wanted to do, like, genetic counseling or something like that. And I ended up in a lab where I was working with mice and then with cell cultures and then eventually with humans. Yeah. And I looked around and I realized that nurses were doing the majority of the work with people living with chronic conditions. I realized that nursing like, nurses are who meet you where you're at when you're in active crisis. So I went back to school. I have, like, four degrees, but I went back to school for nursing. And the first job I got out of nursing school as my second degree was with a famous pediatric endocrinologist named doctor Peter Chase who hired me over the phone. I have no idea why he was so bold to do that. And he said, I need you to come and run my diabetes technology trials. And I'm like, well, I mean, I know about diabetes, but I don't know what you mean by technology. And so I show up on day one, and we're talking about CGMs that were blinded and had cords attached to them and had plastic shower bags. And I just immersed myself in this to this diabetes technology world. And I'm thinking, it's not Broadway, but it's deeply meaningful. And I I like, on day one, I see how technology can change the lives of people living with diabetes. So I have no regrets, but if Broadway ever called, we would have some competition.
Scott Benner Is Kat's even running? It's not running anymore.
Laurel Messer I don't know, Scott, but it's really important that it stays in our collective, consciousness forever.
Scott Benner I think it's important right now for you to commit to, at the end of this episode, just singing a a stanza from your favorite cat song for us.
Laurel Messer Yes. I will 100% not do that, but thank you.
Scott Benner Well, if you tell the people you're going to it, they might listen till the end.
Laurel Messer Okay. Well, I mean, I'll yeah. I'm a little caught off guard. I'll have to see where we go with this.
Scott Benner My god. Well, okay. So you get this job, and you get brought into the world. Yeah. And I guess what captures you about it? Like, is it is it the helping? Is it the new frontier kind of feeling? Like, what what got your imagination going?
The Human Element of Diabetes Technology
Laurel Messer Yeah. You know what it is? I think it's so diabetes is so front and center all the time. It's not something you take a pill for once a day. It becomes such an intimate part of lived experience. And so, you know, I had these families. So I work primarily in pediatrics. And I have these families who are drawing me into, like, the daily intimate details of their life managing diabetes from onset, from a year in, from five years in, watching children develop through adolescence and and having to figure out how to navigate this on top of all the other social pressures. So it was very quickly addicting human to human. Like, I feel so honored to be brought into someone's intimate journey of their life living with diabetes. And so if we wanna spend our day, you know, feeling like you make a difference, it's journeying with someone who's doing hard things. And people with diabetes do hard things all day every day. So, I mean, it was so quickly part of I want to help people on that journey even though I don't live with it myself.
Scott Benner Are you a caregiver at heart, do you find?
Laurel Messer No. No. No. I think about when my children were small. I'm like, oh, can you please just grow up?
Scott Benner Why do you like strangers better than your own children, Lara?
Laurel Messer Oh my goodness. It's a complicated question. I love my children. But just the like I said, it's just this human privilege to to come along on a journey. I can't always fix. I can't always caretake, but I can be witness, and I can listen, and I can learn something about people's experience beyond my own.
Scott Benner I wish you were just a regular interview because I would dig into your childhood and figure this out, but I don't have the kind of time to...
Laurel Messer And I have a therapist. It's it's really fine.
Scott Benner Have they explained it to you?
Laurel Messer I'm an empath. I mean, yes. I'm an empath. Okay. Hands down.
Scott Benner Well, I'm glad you are. It's a put you you know, life puts you in a good position. So you moved through that. And I guess, like, give me, like, kind of the quick step to how you get to your current, like, job and and and what led to what you wrote.
Laurel Messer Yeah. So, you know, I was a nurse by training at this point. I had an advanced master's in public health, but I wasn't the doctor. I wasn't the study investigator. And as we go, you know, progress through decades of research on CGM, and now there's smart pumps. And now the two are talking to each other, and now we're automating insulin delivery. I realized we were asking all the great clinical physiological questions, but we weren't asking the questions I was interested in, which was like, how does this impact the person with diabetes? What do they feel like when this system when they're wearing this system? How how is their lived experience impacted? So I I gravitated heavily toward more of these, like, quality of life questions. Finally, one of my career mentors just said, look. If you wanna ask those questions, you need to go get your PhD so that you are the scientist asking the questions. So I did. I went and got my PhD in nursing, and my entire dissertation work was spent researching the lived experience of adolescents using CGM. What makes them use it? What makes them not use it? What are some of the characteristics of what makes someone successful using it? And it's so funny because I probably paid $50,000 for that degree, and I'll tell you the secret of my dissertation. Turns out, if people find a technology to be useful, they will use it. If they find it to not be useful or too hard to use, they won't use it. There is my doctoral...
Research and Real-World Value
Scott Benner You're making me laugh because I know by now people who really listen are probably sick of me saying this, but there's a a really well considered person in this space and a person who I have a lot of respect for who, you know, made an announcement a couple years ago that they've been researching I think they said they've been researching something for ten years. They have big news about CGMs. And then they and they you know, it's like, you know, drum roll, please. And turns out if you set your high alarm at a number, you, stay under that number. And I said, yeah. I figured that out, like, six months into using a CGM. I was like, you you had to do a study afterwards just to get the rest of that together, did you? And I appreciate that part of life, but it just you what you just said is, like, you know, that makes everyone you know, we all are, like, online sometimes and see something, and it's like science says, and we're all like, yeah. Yeah. Yeah. We we all knew that. Thanks.
Laurel Messer We've been telling you that for years.
Scott Benner Smiling makes people around you comfortable. Oh, thank god. Yeah. Yep. So But So they use CGMs because they find them valuable. Yes. But why do they let's cut you a break. I'm sure you learn more than that. What is it they find value valuable about them?
Laurel Messer Yeah. I think they it's the peace of mind piece. It's the feeling like something is has their back. Mhmm. I think I I I wrote an analysis once that was called, like, best friend or spy, you know, like deep perspectives on CGM. Because it can also be used very much in adolescence as a tool, not for punishment, but for for adolescents feeling spied on by their parents. But the the places where it really impacts users are when they feel like, you know, they don't have to think about their diabetes all the time because something else is helping them. Yeah. And, really, that that helping piece of automated insulin delivery or CGM or insulin pumps, all of these technologies, they're useful when it works for the person. When they have to spend all their time troubleshooting it and, you know, it it not meeting standards, that's really when you run into this this diabetes burden, this burnout piece of things.
Scott Benner So the phrase, the juice needs to be worth the squeeze is basically what we're talking about here.
Laurel Messer Well, I think that's exactly right on the Juice Box podcast.
Scott Benner I was actually Absolutely. know, it's funny you would think that's why I said it, but it's actually because of this, guy that whose son used to play baseball, with with my son. And sometimes he would just in this very, like, Brooklyn accent go, help. The juice ain't doing very which just ain't worth the squeeze here. And I was like, no. I know. I've never heard that before until you said it to me. But no kidding. You know, I listen. I talk to a lot of people with diabetes, and and I, you know, I just said to somebody from a from a pump company today, no one wants a thing stuck to them. Yeah. Like, right? So you have to give them compelling reasons why they'd put up with that.
Laurel Messer Yeah. And I had, Scott, can I just tell you? Had a 14 year old say to me. I said, this is but this was back when I was in practice. I'm like, this is one of the best things that have ever come, you know, available to people with diabetes. He said, I don't care if it's the best if it sucks.
Scott Benner Yeah.
Laurel Messer And I'm like, well, that's that's very apropos. If you hate it, it doesn't matter how good it is.
Scott Benner It needs to work the way you tell me it's gonna work. Yeah. But, I mean, that really is it. Like, you set an expectation. Yeah. That's right. You just need to meet that. And, really, life's pretty much like this. You just you set an expectation you need to meet it. And once in a while, we can all be accepting of things once in a while not working out. The damnedest thing around, like, this kind of technology is that you're taking an inert object and sticking it into a real life person whose physiology is different from the next person. I think it's amazing how well they work on mass. And yet, if you're one of the people it doesn't work well for, it shuts off on the sixth day or it gives and you that that could literally be just as frustrating and maybe even more so than the unknown that you were experiencing before you put it on.
Moving to Tandem and Product Design
Laurel Messer Yeah. I appreciate that. And kind of getting to your other question of how did I end up where I am, I left academia because I had an opportunity at Tandem. One of the things that compelled me was what you just said. Like, I spend part of I I do a lot of different jobs within Tandem. But one of the things I do is I spend time in our product pipeline, and I say, okay. If you make that product decision, here is how it is going to impact the person on the other end. This is how the lived experience with a person with diabetes is going to change because of that decision you made. And usually, it's for really, really good decisions, but other times, it's like they didn't quite have that perspective of how for many people, certain product decisions are not going to be ideal. And so I think bringing that perspective, again, that people with diabetes have taught me, if I can bring those into early product development, that's how we get to products that really are life changing and we can set appropriate expectations for and then deliver on them.
Scott Benner It's valuable too not to believe, like, from a marketing or a business perspective that you're gonna make something that everyone's gonna like. Yeah. You know what I mean? Like, I I'll tell you. I think the Moby's a great example, and I'm happy to be candid. Like, I have met people who have told me the Moby is the greatest pump they've ever used. They're incredibly happy with it. They couldn't possibly be more happy. And I've met people who said, oh, I saw it. It looked a little big to me, so I skipped it. How are you supposed to take those two people and then make them a thing that they both, like, are gonna go like, oh, that's perfect. Yeah. The way technology sits right now today, I don't think you can make things small enough for everybody to like because I think that has something to do with it. There's form factor, the way you have to carry it. You know, there's a lot to it. I guess my question would be using continuing to use Moby as an example. Like, how does it end up looking like it looks? Like, how does anything end up being what it is at the end? Like, it's you start with an idea. Right? Like Yeah. Is it about just, like, well, we gotta put liquid into it. It's gotta have, like, electron is that is that kinda how it goes? And and how do you how do you help with that?
Sponsorships: Tandem, Dexcom, Cozy Earth
Scott Benner This episode is sponsored by Tandem Diabetes Care. And today, I'm gonna tell you about Tandem's newest pumping algorithm. The Tandem Mobi system with Control IQ Plus technology features auto bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandemdiabetes.com/juicebox. This is going to help you to get started with Tandem's smallest pump yet that's powered by its best algorithm ever. Control IQ Plus technology helps to keep blood sugars in range by predicting glucose levels thirty minutes ahead, and it adjusts insulin accordingly. You can wear the Tandem Mobi in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately, clip it discreetly to your clothing, or slip it into your pocket. Head now to my link, tandemdiabetes.com/juicebox, to check out your benefits and get started today.
Scott Benner The Dexcom g seven is sponsoring this episode of the juice box podcast, and it features a lightning fast thirty minute warm up time. That's right. From the time you put on the Dexcom g seven till the time you're getting readings, thirty minutes. That's pretty great. It also has a twelve hour grace period, so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable, and light. These things, in my opinion, make the Dexcom g seven a no brainer. The Dexcom g seven comes with way more than just this. Up to 10 people can follow you. You can use it with type one, type two, or gestational diabetes. It's covered by all sorts of insurances. And, this might be the best part. It might be the best part. Alerts and alarms that are customizable so that you can be alerted at the levels that make sense to you. Dexcom.com/juicebox. Links in the show notes. Links at juiceboxpodcast.com to Dexcom and all of the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful.
Mobi Design and Customer Input
Laurel Messer Yeah. Well, you know, that's an interesting one. The form factor piece of things, this all happened before I came to Tandem. So I've been at Tandem three years. The Tandem Mobi had already been in development for a long period of time. But, you know, it's one of those things with every product both at Tandem and outside of Tandem. I'm like, oh, well, I have an opinion on that. Sure. There's there's always a lot of good reason things look the way they do, they design the way they are. And, you know, for Tandem Moby, that's been in development a really long time. One thing I asked about when I got to Tandem, I said, why do you have to see the the vial? It makes it look like a medical device. And what they said was when they were, talking to people with diabetes, they said it was really important to them to want to see the cartridge itself. So they intentionally you know, if you look at a tandem Mobi, you can see the, the insulin cartridge, and that was because people with diabetes had spoken into the design saying, we do want to see that. You know? And you can cover it up. You can bedazzle it. People do incredible things to their Moby. I do think, you know, asking people with diabetes is one of the most, like, important sources of information for when you're making product design decisions.
Scott Benner I agree. I'm glad to know people are doing that too. I I have the same feeling when I do ever jump on a website and start using it and think, did the guy who designed this ever try to use it? Yeah. Yeah. Like Yeah. Like, I know it works, but Yeah. Geez, this could have been done 10 better ways, I feel like. You you know? Well, that's really that's interesting. So okay. Yeah. So now I'm gonna just fast forward a little bit. I feel like I know who you are, and I feel like I know what kinda got you here, which is great. But I wanna leave the rest of the time, you know, for the for the paper that I saw. Rethinking Control IQ plus technology, simple strategies for easy optimization. Like, what what gets you to think about that? I mean, you didn't do it yourself. There's a lot of people's names on this paper.
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Rethinking Control IQ Optimization
Laurel Messer Yeah. I have, like, world class HCPs on this paper from all over the world, but this was probably a brainchild of mine from the last few years. So remember, back when I was at Barbara Davis Center working in pediatric diabetes, I founded a program called the Panther program. And the majority of our time was spent helping HCPs and people living with diabetes understand the differences between devices. So I was very much in the weeds of how every single device works. I still am in the weeds of that, honestly. But trying to simplify this so that people understand the technology they're working with. And then when I came to Tandem, I realized being on the inside, even I had some misconceptions for how Tandem worked even though, honestly, I'd been using it for years before it was even publicly available. I was using it in clinical trials. Mhmm. And I realized that after a product has been out for, you know, five plus years now for Control IQ, there's still a lot of misconceptions about what it is, how to use it, and, much of that was because we've learned it in the last five years. And so I wanted to take an opportunity. It's I'll be honest. It's a long paper, and there's a lot of sections, but I think of it as, like, a primer. So if you just need to know the basics, read the basics part. If you are a person with type two diabetes or a doctor who works with specialty, like, new onset pediatric patients, there's a section for you too. This is not a paper I expect people to read front to back. I want them to take the section that is most meaningful to them and then use it in their practice. Okay. But if I had to give, like, a one liner about what this paper is about is that Control IQ can be used much more simply than I think it's it's typically talked about out in the world.
Scott Benner Well, how do you think people are using it that's more difficult, and what could they change?
Laurel Messer So when we when we teach people about Control IQ, we're like, oh, you can change basal rates. You can change carb ratios. You can change correction factor. And that's fine, but it doesn't give a person very much guidance about how to do that well. And so one of the, first things I did when I came to Tandem three years ago was did an analysis to say, look. What settings are associated with better outcomes? Scott, I really like on your website, you have this, like, setting simulator where people can kinda play around with what doses should I be using because I kinda did the same thing with Control IQ users. And what I found was this is, again, like, doctoral level research that's boiled down to a very simple fact. Stronger settings lead to more time and range. Uh-huh. But what was unique about Control IQ, and this is a big message in the paper and what I wanna get out to everyone out there, is because it works a little bit differently than other systems, you're gonna have to remember correction factor as the most important lever to pull. And I can confidently say that's not true of any other system, which is why I want to make sure that people know that. When they give when they set themselves a really strong correction factor, what they're doing is they're changing every aspect of Control IQ plus automation. So that every five minute insulin delivery is impacted to be more dynamic. The auto boluses that the system gives on top of that once an hour, they are made more aggressive. And then if the user is bolusing and they give a correction dose, that is made more aggressive as well. So one of the key points of simplification is don't worry about all the settings, and don't worry about tweaking it every hour or two hours. Just make sure your correction factor is super tight, and you're gonna see an improvement in time and range. And the data indicate it does not seem to be a large trigger of hypoglycemia in the same way that some other settings could cause hypoglycemia.
Simplifying Diabetes for Mass Impact
Scott Benner I don't know how well you know the podcast, but this is my twelfth year making it. I am up to I'm over 1,800 episodes. I'm telling you all that so that you know that prior to that, I wrote a blog about diabetes too. So February, I started writing the blog. February, I started making the podcast. And I can tell you right now that by the time I got 200 episodes into the podcast, it's when I made the pro tip series because I said to myself, there are things, and I know if I do them, my daughter's a one c stays in the low sixes, the high fives. Right? And they're not incredibly difficult things. And Yeah. You keep talking about, like, there's this this you know, there's a paper. Here it is boiled down. I kept thinking the same thing. Like, I could hand somebody your paper. I don't know what's gonna like, they're gonna go, okay. And I felt the same way about, like, you know, like, about what I was doing. And I and I kept thinking, like, I need to somehow, like, distill diabetes down into t shirt slogans. Yeah. And then teach people, like, you know, here's the slogans. Here's when you might notice them being important. I I have to tell you, like, I I hope this doesn't come off as pompous. I certainly don't mean it that way. I believe I've impact tens of thousands, if not hundreds of thousands of people's lives with diabetes by telling them that if your blood sugar's too high, you probably need more insulin. And if your blood sugar's too low, you might have used too much insulin.
Laurel Messer Do you have a doctorate? That sounds like doctoral level research.
Scott Benner Well, yeah. Yeah. Again, like, you might think I took ten years and $50,000 in a in a in a room full of people to figure this out. And then in the end, what I learned was it's all timing and amount. Yeah. Like, everything about diabetes is using the right amount of insulin at the right time. It doesn't I don't care if you're MDI. I don't care if you're on a static pump, and I don't care if you're on an algorithm. Like, if your settings are wrong going in, you're gonna get junk back out again. And you have to understand the impacts of your food so that you can meet it with insulin, and that's really the whole thing. Yeah. How do you get that thought into someone's head? I used the podcast. Like, right. I I have to tell you, like, we've only been talking for twenty one minutes. I've already tasked my Gemini to take your paper and turn it into a tool to an interactive tool to help people.
Laurel Messer Amazing.
Scott Benner I'm not gonna do that because that's your thing, but you should do that. You see what I'm saying? Like, you Absolutely. Like, because I'm looking at your paper. You're 14 keystrokes away from somebody logging onto a web page and talking to your paper. Yeah. And I just think that's that's what you need. Like, you need you need this stuff to be available for people and meet them. I hate saying meet them where they are because it really feels like you're being pejorative to people. But, like, people have impacts of life, of health, of time, of finance, of all these different things, and they do not I used to think it was because they didn't care enough to do the work for themselves, but now I after doing this for so long, what I believe is is that just life is hard. And and somebody just needs to tell me my blood sugar's high here, like, why? Mhmm. And that's it. Like, you know, it's because you don't know about the fat impact from the cheeseburger and fries you just had. Yeah. Here's a way to cover that. And and there. Now go go, you know, go forth and do your best. So do you have any plans for this information? Like, what are you gonna do with it? Because now you did it. It's here.
Bridging the Gap Between HCPs and Patients
Laurel Messer Yeah. I know. Now that I got the the paper published, we're kind of thinking about ways to make this practical, digestible, available for people. Your, you know, your pro tips idea is excellent. It reminds me reminds me of Van Gogh. He says great the great artist is the simplifier. And we don't need a 13 page paper to talk about simple Control IQ use. We need the top three tips, which are going to help people, you know, both in the moment, but also as they're making settings adjustments. So I'm thinking of how to distill this down and boil it into something tangible and useful, both for HCPs who honestly have a really hard time differentiating between systems, but also for people with diabetes and people using Control IQ Plus.
Scott Benner And you know why that's so necessary? Do have any idea how many people tell me that they go to a doctor's office and they say, hey. I wanna get an Omnipod. And the doctor goes, we don't support Omnipod here. We support Tandem. Or, hey. I wanna get a Tandem. They go, oh, we don't support Tandem here. We support Medtronic or vice versa all over the place. Yeah. And I used to think, like, how long would it take? You know, then you you push the doctor. What do you mean? Well, I don't have any experience with the Medtronic pump, so I don't know how to talk to you about it. Mhmm. Do you have a Saturday afternoon in the Internet? Couldn't you go teach yourself that? Like, is that and then I learned that that might be too big of an ask. You know?
Laurel Messer Yeah. I mean, the the time and capacity of HCPs is limited, But we we also know that's a problem, though, because, you know, historically, people have, you know, seen HCPs as gatekeepers. They say, oh, you're not a good candidate for blank, for an insulin pump, a CGM, an AID system. And what's cool is that from all across the industry, every major manufacturer, more and more data come out that show, like, most people can use these technologies safely and effectively. And I think many of our, you know, I'll be honest. Early in practice, I would I would say, oh, I'm concerned. I don't know if we should put that patient on a pump. They might go into DKA. And I think when we got AI when we got automated insulin delivery, that note probably should have been revised. But even in my own narratives, I'm thinking there's no longer this thought of who's a candidate. It's everyone is a candidate. It's finding the piece that's going to to work the best for them. Yeah. But, yes, it is it is a hard, hard challenge to solve all the things HCPs need to know. So if we can give them, you know, the bullet points, it's gonna equip them to do their job better.
Scott Benner So scary to think that we used to work on a model where if you said something to a doctor, that's what people got told for twenty years afterwards.
Laurel Messer Yeah. I mean, yeah, that's true. Do you know how hard it was to, like, to break people of, like, I don't know, 15 carbs, fifteen minutes as an example? Many still don't know that that's not great advice. Yeah. So if anyone listening still is giving 15 carbs and retesting at 15, go ahead and reduce that number, especially if you're on an automated insulin delivery.
Educating on Pre-Bolusing and Expectations
Scott Benner Listen to my podcast. I'll explain it to you in eight seconds. Also, you know, as much as people like this podcast, in the end, I think that I've won over most of them by telling them how to pre bolus their meals, which should not be a thing. No one should leave their endocrinologist's office thinking that pushing the button and starting to chew happen at the same time. That's insane. How do you either educate physicians so that they go out into the world and spread better information? Or how do you find people who are already out in the world or past that that sticking point and are out there fighting with this this all these technologies. Like, I know you work for Tandem, but, like, listen. Between you and me, they all work pretty well. It ends up being settings and timing and your understanding of food, and there really isn't much more to it than that. Yeah. And so, like, do some of them work better for some people? Yes. Or some of them are more aggressive or some of them are, you know, less input. Like, I mean, can't tell you how many people came up to me recently to show me their eyelet pump at this event I did. And, like, know, like, has and by the way, that was an interesting thing there. Like, I met a few people who were like, I don't really wanna be involved in this. Yeah. Like and you you're not gonna talk them into being more involved in it. They've decided that this is their level of, you know, of of touch points they wanna have, and they're comfortable with it. Like so, I mean, I'm looking I I know this is it probably sounds insane, but I already have a pretty nice model for your your embeddable tool online. It's got a it's got a type one and type two side. It's got a physician side and a patient side. It's got a nice little thing here where you can change your daily dose to see how to set up the the this is what you need. Perfect. I'm seriously I'll tell you what. The world changed about three months ago. Like, I I I'm talking to you and coding this at the same time. If I showed you what I just did when we got done, I'm gonna tell you right now, you could do it yourself. And then let Tandem put some money behind it. Yeah. Let them get off their butts and do something. I'm calling them out right now.
Laurel Messer Yeah. Now I want everybody to do stuff like this. Yeah. No. I think anyway so I love the idea of coding a tool, Scott. I love the idea of making this more tangibly available. And I think the timing piece is really important. Some people need this information upfront. Some people need it when they realize their settings aren't working anymore. Mhmm. Some people need some guidance even in the moment. You know, it's interesting. You're talking about bolus timing. I'm talking about food for insulin. One of the really cool things I'm always thinking about the user who does struggle to maintain adherence to ideal bolusing habits, etcetera. We had such great data in our type two study with Control IQ plus where people were you know, they were doing some simplistic variances of bolus thing, like small, medium, large meals, thirty, sixty, 90 carbs, where they're not, you know, precisely calculating and weighing, etcetera. And they did just as well as the people who were precise carb counting. Who did just as well as the people who were just putting in some fixed units. And I think when I see these things, I get excited about opportunities to reduce some of the cognitive burden. It doesn't go away entirely, but there are strategies to help. You know, like the term meeting people where they're at? I kinda love it because if we can't get them if they're not able to change what they're currently doing, we can give them strategies that will work for them. And that really excites me as an educator.
The Future of Closed-Loop Algorithms
Scott Benner Yeah. First of all, thank you for looking around my website. I appreciate that very much. Yeah. I I I keep I keep saying, like, this far are we off from this kind of stuff being right in the pump? Like Oh, sure. Like, we we gotta be closer to that. Right? Like, we're like, isn't the pump gonna be able to think a little more, or can you just plug it into something that thinks for it and then downloads, like, adjustments to it? I mean, it's Yeah. At this point now and, Laurel, I don't wanna mix the message here. Okay? Because but I've seen people online drop their Dexcom graph into a chatbot and say, hey. With no other like, not not this is my sensitivity. This is my nothing. Just like, do you see what's going wrong here? And it's oddly right about what they did wrong. Yeah. And you know what I mean? And then suddenly, you give them you give it access to, your insulin sensitivity, your carb ratio, stuff like that, and it it's all I keep trying to I'm sorry. I feel like I'm all over the place, but I've been trying to tell people forever. These pumps, they're magical, but they're working off of a few really basic mathematical principles. They're not that complicated on the inside. And, you know what I mean? Like, I just feel like I'm not saying you have to make them more complicated, but I hate that people go out into the world. They get it set up by somebody. I think what's happening is I'm not speaking for you. Is that the doctor that was told 15 carbs fifteen minutes is now in charge of putting you on a pump. Mhmm. And they've been over baseling people for fifteen years because people don't bolus correctly for their food. And then they get worried that that like, you just said earlier, like, the machine will make you low. Like, we're afraid. Like, people have to be super smart to use these things. I also don't find that to be true. Yeah. They set you up with bad settings, set you on your way. You have a slightly better outcome than you had before. They call it a win, and they never talk about it again.
Laurel Messer Yeah. Yeah. I mean, you're you're describing classic therapeutic inertia. You know? It's like, it's good enough. It's not perfect, but, you know, we we did something here. And I do think you're right that there's ways to automate that. But, Scott, I think you actually I think we all wanna think even bigger than that. We should be getting to the place where you have a system that does not require you to be tweaking basal rates and carb ratios and targets. Well, yeah. You Go ahead. do that. Yeah. I mean so and that's really that's, you know, the future of fully closed loop. This is something you know, JDRF back in the day and Aaron Kowalski set this vision for having this eventually a fully closed loop with one or two hormones. I don't know. But I think we are closer than we've ever been. So I'm kind of the way I see this in my brain is I think Control IQ plus is one of the best algorithms out there. I can give you tips about how to make it better. But in five years, I don't wanna give you a single tip on our system. I want an algorithm that is continually adapting to do it itself. Yeah. And so this is a paper I don't wanna write again in five years.
Comparing Automation to "Vibe" Management
Scott Benner No. This is the Yeah. We want we want someone to open up a a app on their phone, and the app has one button. Says, let's go on it. And that's it. Yeah. If what algorithms are doing now is working so well, and I really think it is. I think it's working incredibly incredibly well. Like, going back to you know, going back all those years ago when somebody came on the podcast and said, Scott, why don't you put your daughter on loop? And I was like, what? What is that? And and I tried it, and then I was like, oh, that thing is doing all the stuff I've been doing. Like, you know, temp Basil here, reduce this, up that, put some in, take some out. Like, I was doing that forever. Like, I also wasn't sleeping, and I was going out of my mind. But that's Anyone can be a pancreas if they have a you know, don't have a full time job or anything sleep. Yeah. I yeah. It's really not that hard. Sleep. Not that complicated. I I tell people all the time that through the Night Scout app, I get to watch the loop work. Yeah. And then it it almost reinforced me. I thought, oh, I was right. Like, I actually felt like that. Was like, oh, god. It's doing what I was doing. Yeah. And then, you know, obviously, you know, everybody's got an algorithm working for him at this point. And my gosh. Like, it's still not doing anything all that complicated. All I keep thinking is is what if you just had a little bot in that app that was just constantly assessing and turning those same knobs again, like, on a, like, on a micro level of what it's doing now? And I I mean, there's gotta be a point where if you collect enough data, then you can make parameters that will work for most people and that and that's gotta be it. Right? Isn't that the I I don't know anything. By the way, I barely got through high school, but isn't this I'm right. Right?
Laurel Messer Yeah. Absolutely. Okay. I think that so this is what I you know, I'm learning on the inside being at a company. You can invest dollars and time and development into that type of, you know, engine that helps recommend settings, or you can work on the next algorithm that's going to automate it entirely. Mhmm. And so I I think sort of the way we're thinking about it at Tandem is we are putting all our resources into future algorithmic development that's going to be fully closed loop. And as a second effort, I'm gonna tell you in five bullet points, you probably need a stronger, correction factor. That's something you have to remember as a correct, Control IQ user. I'm telling you that if you're bolus ing regularly, turn on sleep activity all the time, and you're gonna see a tightening of that target. So, like, I think there's ways to give people some practical information and put your development resources into the future of automation, which is gonna be fully closed loop.
Utilizing AI to Decode Experience
Scott Benner Do you know how I made that bolus estimator? No. I took all the episodes of the podcast that deal with management. And I just fed it to an AI, and I said I need you to pull out all the important things about this because that this is what I wanna do with it afterwards.
Laurel Messer That's amazing.
Scott Benner And that was it. I don't know the first thing about coding. I don't know. I'm not a doctor. I see you're certain no one listening should listen to me. Nothing here in the Juice Box podcast should be considered advice medical or otherwise. I'm an idiot. Like, be be clear about that. Okay? I had these ideas in my head. When I did them for my daughter, her a one c stayed in the high fives to low sixes. I recorded my thoughts. I did it with a CDE who gave me, like, her perspective while we were talking back and forth. And over a decade, I hear back from genuinely countless people who have been able to listen to something we said out loud without any techno without any it's not written down anywhere. There's no charts. There's no graphs. It was a vibe. Right? Like, here's the vibe of how I do it. Here's the vibe of how I think about it. Like, oh, you know, are you having trouble bolusing for something because you're afraid you're gonna get low? You should trust that what you know is gonna happen is gonna happen. Like, literally, with that kind of, like I teach. First of all, I don't teach anybody anything. I share how I do my thing. But the way I talk about it is just the way my brain works around it. And then I kept thinking, it's all there. It's in the podcast. But it can't be pulled out because it's not numbers and graphs and letters. Right? Like, it's it's vibe. And I thought, well, I guess it's stuck there forever, it will only ever help the people who are listening to it, who jive with it, who can pull out the meaning and apply it for themselves. Right up until AA got so good about a year ago. And then I thought, oh, no. I can pull it all out of there. And so then I pulled it out. I did, I just did a deep research dive on my own content. I taught the LL about the content itself. Then I had to go out to the Internet and fact check and QC it till the cows came home. And then I brought it back, and I said, these are the rules about how to take good care of yourself with diabetes. What if we if I built an estimator to teach it to other people, what would they need to know? And it's like, well, it needs to know this and this and this and this and and this, and then you put these numbers in here, and we have to take the Warsaw method into account, blah blah blah. And here's the answer. And six weeks ago, I sat down I'm now doing these episodes called bolus four, where we just sit down and walk through how to bolus for an item.
Scott Benner Oh, wow. And people find it really valuable. It just it kind of, you know, contextualizes it and and makes it more colloquial and everything. But we did one recently where I took this concoction. Found online this this recipe. And the girl I do it with, Jenny, she's a CD, CES. She's got type one diabetes for, like, thirty seven years now, Jenny does, and she's a nutritionist. And I just said all I did was gave her the link to the recipe. And I was like, I want you to use, this carb ratio and this sensitivity factor and tell me how to bolus for this. And we did it together back and forth. And while she was doing it on paper and in her head, I was doing it with the estimator, and it came up with the exact same bolus. Wow. It was really awesome.
Recalculating Fresh and Fighting therapeutic Inertia
Laurel Messer That's incredible. Yeah. What a great use of technology.
Scott Benner Yeah. Well, listen. What am I I it seems so complicated, but it's not. Right. There are so many people running around who I mean, listen. Every one of these pump companies is getting calls all day long. The thing don't work. It don't work. You told me it was gonna work. I didn't doing the right thing. And I'm like, these poor people, it's set up wrong. They're putting their insulin at the wrong time. They misunderstand their the impacts of the glycemic index of the food, whatever. Like, it's Yeah. It's not difficult stuff.
Laurel Messer So You know what's interesting? That really brings to light one of the things we're struggling with is it's very common, especially when people are going from one system to another system, they're often just transferring their settings. So, you know, you go from a Medtronic pump to a Control IQ. Mhmm. You just pop in the same settings that you had over there or an Omnipod to Control IQ. And what you realize very quickly is that because all the systems work a little bit differently, this is setting you up not for success. What you're doing is you're you're almost you would have been better if you were coming from MDI and estimating new doses. And so one of the things I'm really pushing, I think it's in this paper as well, is, like, do not use legacy settings across systems. Go ahead and calculate based on your current amount of insulin you need. Like, create those settings new because when you do that, you're giving the system such a better chance to work than, like, taking all of these things that are, like, inappropriate in the new system that worked fine for the other system. Even people who are frustrated with their devices, this is tandem agnostic. But, like, if you're unhappy with how your pump is doing things, recalculate settings because it's gonna give it a fresh start in in kind of its automation piece.
Scott Benner I did a private event a couple weekends ago where I spent a couple of days with, like, a group of about 400 people. Most of them have type one diabetes. And I think I spent most of my time just sitting with people going, okay. Listen. Just start over. Like like, let's make sure your settings are right. Put them back in and start again. Just reset the thing. You're it's...
Laurel Messer It's so simple, and it's so impactful. Yeah. And the one last piece I'd say about Control IQ is one of the common calculations for correction factors, you take the number 1,700, and you divide it by total daily insulin. We know with Control IQ, you can go stronger than that. Do 1,500 divided by TDI, 1,600, but make sure you're recalculating fresh because you're going to just see a lot of those problems from legacy settings evaporate.
Real-Time Optimization
Scott Benner I'm gonna read something. He's gonna freak you out. Okay. I've expanded the Control IQ plus optimization assistant to fully incorporate the core clinical teachings from the paper. Physician mode now includes focus on three pillars of optimization, basal, insulin to carb ratio, and correction factor using the paper's recommended seventeen hundred total daily dose and four fifty total daily dose formulas, user mode. It it's I it already like, everything you know, it already knows about your paper. It's fat. That's amazing. There's a slider here where you move your total daily dose already. Yeah. And it's optimizing in a dashboard, changing your basal, changing your car ratio, your correction factor, and it's showing you on a graph where your graph works now and where it'll work with the the updated settings.
Laurel Messer Oh my god. We gotta talk about this offline.
Scott Benner I know. I know. I'll show it to you. People, you know, people come up and they're like, I don't know what's going on. Like, look at my graph. And I said, well, you know, sometimes I go I it just looks like you don't pre bolus your food. And then and then I I would, you know, I'd open my phone up and I would take out the little thing that I built for myself. And I'm like, how much do you weigh? And then we'd look and I'd say, well, your settings look close. Like, I wouldn't start monkeying with your settings. They look close. I'm like, I would just start pre bolus. Like, do it for a week. Like, promise yourself you're gonna pre bolus for a week, and let's see if this gets better. And as and if it doesn't, then fair enough, then look back at your settings again. Right? Because, you know, that's not the it's not the be all end all of settings, your your weight as a starting point, but it's Pretty close. Gets you there, you know? And then there were some other people where I I would like they'd say, oh, look at my graph. Look at their graph. I put in I go look to their what their settings should be, like, baseline. I'm like, my god. Your basil's way off. Like that and then you can go back to the graph and go that that's why you're high all, like, in these hours here. Like, you did pre bolus your meal. Your carb ratio did work, but not quite well enough, then you just hung forever. Yeah. And and I said, if you bolus this right now, would you come would you go down and bounce back up, or would you go down and stay down? Yeah. And they were like and one lady said, well, I would go down and I bounce back up. And I was like, that's basil. And, like, just simple, like, ideas like that. And you can just see them light up because Yeah. Oftentimes, they've had diabetes for decades. Mhmm. And they don't know what they're doing. You you you know what I mean? Like, they somebody set them on a path.
Clinical Empowerment and Takeaways
Scott Benner We did a series called Grand Rounds a few years ago where I reached out to my Facebook group. I reached out to them and I said, tell me things that you were told a diagnosis that were helpful and things you were told a diagnosis that were not helpful or even detrimental. Yeah. I got back I don't wanna lie, but I think I got back, like, 80 or 90 pages of returns from people. And all we did was synthesize them down, collect them up under categories, like, put them all together. And then I built basically, like, a rule of thumb list for doctors at diagnosis. And then we put together an eight part series about it. Right? Like, what to say and what not to say. Yeah. Like, the cure the cure is in two years. Well well, yeah. Little things like that or, like, because what I think the doctors don't understand is sometimes you say something on day one and two years later, that person still thinks that's a rule. Like, here's one for you. We're gonna put your settings in your pump that you should say the rest of that. They're going to change over time. Like, not like this is it forever. Right. But people don't people take it very especially when they're in that, like Yeah. Freshly diagnosed thing. Everything you say is is gospel. Right? Literal. Very literal. Exactly right. And so, like, you know, we put that whole thing together, and you know what it turns out? It's like, it's a lot of common sense if you're looking at it from the outside, but I could also see how doctors wouldn't know to say some of those things or not say some of those things.
Laurel Messer Yeah. And you know what's also interesting, Scott? I I think clinicians may sometimes, they come in to do a job, they're like, oh, I'm gonna change your settings, and there you go. They don't take it to the next level of, let me teach you how I'm doing that. Let's let's think about how insulin works and how we can sort of do this together, and you can do it on your own as well. You know, it's it's very often you you see a a person with diabetes come in for a clinic visit, and their settings haven't changed since the last time we saw them. But in the meantime, they gained 10 pounds and shot up two inches, and it's like, well, hold on a second. Yeah. You know, I think we could do a better job of empowering people with diabetes to say, you don't have to go to med school, but you can know with Control IQ that your correction factor can has has a lot of room to move. You're growing. Your carb ratio needs to be stronger. Mhmm. You're high. Go ahead and make your basils tighter. Like, we can empower people with diabetes with this knowledge, and we just haven't, I think, done it in a systematically advantageous way.
Scott Benner I'll I'll tell you that what I've learned doing this for all these years is that from for my money, two best predictors of success, I think, are genuine interest in your health and Uh-huh. The autonomy to make changes to your settings. Thoughtful. Yeah. That's it. And and by the way, I recently, just in the last week or so, I've been putting together like, just told you about the grand rounds. I've been putting together I have 72 comments so far working on predictors of success. Like, what do you find to be good predictors of your success with diabetes? And we'll we'll put together a series about that to talk to people about, you know, because in the end, what that means is people who do x find their outcomes come out better. And and, like, I just think that that kind of stuff is is important. But but moreover, if my point was is I don't care how long that predicts the success series ends up. I'm gonna tell you right now, understanding your settings and having the clarity and knowledge to make changes to them, that predicts success with type one diabetes. My weight my weight changed, my activity level changed, I went on a different pump. I just been doing this for a while and things aren't going the way I want. People who can change their settings and aren't waiting for a doctor are gonna do better because most of the time and by the way, I'm a listen. I think there are a million great doctors out there. I'm certainly not bashing anybody. But the the number of times I've seen somebody go to a doctor with a low blood sugar at 2AM, and the doctor turns their basal down at 01:00. And I think, why don't you go back over the last six hours and see what happened with the insulin before you start making decisions about what happened at 02:00? Then they mess up their basal at 01:00, And then that messes up something else. Then they go back again, and they mess it up again somewhere else. And then before you know it, you have 17 different settings, and none of them And they're all just addressing the last problem you made.
Laurel Messer Yeah. Yeah. Yeah. That is so apropos. That is exactly how it works. Yeah. And then you and then you're sitting there in front of the electronic medical record, and you're like, I have to put all of these in? Holy moly.
Scott Benner And then you bump into somebody who knows what they're doing, and then they're trying to they're trying to untangle this disaster.
Laurel Messer Exactly. And that's again, like, start fresh. Good grief. Yeah.
Scott Benner See how I brought it back to that. Exactly.
Laurel Messer I see how you brought it back. That was incredible.
Scott Benner It's not my first day, Laurel. I've been doing this a while.
Laurel Messer Not mine either. I appreciate it. Yeah. What am I not asking you about all this? Like, what do you want people to know? Like, thinking back on that paper, like, what should their takeaways be? More importantly, should you and I be doing a small six part series on the takeaways in this?
Laurel Messer 100% we should be doing that. The the takeaway again, I I I I love this phrase. Control IQ can meet you where you're at. It you know, if you are not able to bolus perfectly, you know, preprandially, this auto bolus really helps cover you. If you don't know how to get better control, this correction factor is your secret sauce. If you bolus all the time and want a tighter target, use sleep activity. And then if there's you know, if you're a child, if you're pregnant, if you're type two, if you're new onset, there's all these different clinical clinically relevant tips in there. And they're not from me. They are from world class physicians who've been doing this for years and years. And so it's like, you're supported, but we can give you some basic tools to do on your own. And at the end of the day, Control IQ is so adaptable. It can meet you where you're at. So that's the takeaway on the paper.
Scott Benner Okay. So I'm gonna tell you that I think if you're interested, what you should do is take all of your knowledge that you have around this, break it into categories Yeah. And that you think we could that you could explain well inside of a thirty minute conversation, and that's how many, like, little sections we should make about this.
Laurel Messer Perfect. I'm I'm game.
Scott Benner Awesome. Because it just it's going to help people. Because for listen. For every person who, you know, says, oh, just give me a tool or tell me the the math or something, I'm gonna tell you that it's my expectation that there are 50 times more people who will never intersect well with that information that way. And this conversational way really works for a lot of people. I really do think it's a it's a great idea, I'm I'm I'm happy to hear that you might be interested because the truth is is I didn't know if you would be or not. Like, I just...
Laurel Messer Oh my god. I love talking about this stuff. I get really passionate about simplifying things for people. That's why I have a Van Gogh quote on my on my wall. But, yeah, these are I want to give anybody simple information that's going to help them on their diabetes journey in an easier way. So 100%, am in.
Scott Benner What's the van Gogh quote?
Laurel Messer The van Gogh quote is the great artist is the simplifier.
Scott Benner That one. Okay. Yeah. Yeah. Yeah. I mean, that speaks deeply to why I do what I do and what I want people to know.
Scott Benner I you know, it's funny from two completely different perspectives, you and I are doing the exact same thing. A 100%. And and I think there's it's gonna take it takes many vehicles and ways to do it. Yeah. And I yeah. I I'm so appreciative of what you do. And that's one of the beautiful things about the diabetes community is there's so much crowdsourcing. There's some there's some concern with that too, but in general, I think people with diabetes learn from other people with diabetes so so well. And I think that's one of the most beautiful parts of this community that's very different than many other medical communities.
Scott Benner Yeah. When we get off, I'm gonna tell you a a quick story about somebody that I I it's already been in the podcast, so people don't need to hear it again from me, but, to to kinda solidify that point. So you feel like we've done a good job with this conversation?
Laurel Messer 100%, Scott.
Scott Benner We're gonna keep talking then. So we're gonna I'm gonna shut this off so nobody else they can't hear anymore, but we're gonna talk about how to do this moving forward. And I'm gonna tell I'm gonna tell you that story. Thank you, Laurel, for doing this. I really appreciate it.
Laurel Messer Oh, 100%. This is great. Thank you, Scott.
Scott Benner A huge thank you to Cozy Earth, a longtime sponsor. Cozyearth.com. Use the offer code juice box at checkout. You will save 20% off of your entire order when you use that code. Don't let me down kids. Head over there now. Get yourself some joggers, some towels, some sheets. Save yourself some money. Support the podcast. Make your life beautiful and comfortable all at the same time. Cozyearth.com. Use the offer code juice box at checkout. Dexcom sponsored this episode of the juice box podcast. Learn more about the Dexcom g seven at my link, dexcom.com/juicebox. Today's episode of the Juice Box podcast was sponsored by the new Tandem Mobi system and Control IQ plus technology. Learn more and get started today at tandemdiabetes.com/juicebox. Check it out. 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. My 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 juice box podcast dot com. 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.
#1825 Insurance Let Me Down - Part 2
Kelly opens up about raising two teens diagnosed with Type 1 at age six. She discusses international living , multiple miscarriages , alarm fatigue , and managing different sibling personalities.
Companies that Support Juicebox
Key Takeaways
- Self-advocacy is a critical necessity in the modern healthcare system because insurance companies operate as for-profit businesses that prioritize holding onto money over patient wellness[cite: 588, 594, 940, 942].
- Insurance terminology is often intentionally non-transparent; for example, modern technology like CGMs may be hidden under antiquated categories like "diabetic supplies" to make them harder for consumers to find or verify[cite: 501, 506, 621].
- Legislative "fixes" for diabetes coverage can be ineffective if they do not explicitly prohibit insurance companies from using high deductibles and coinsurance to maintain cost barriers for patients[cite: 577, 578, 580].
- Modern diabetes technology significantly improves glycemic stability and safety, yet "medically necessary" is often defined by insurers as the bare minimum required for survival rather than the tools required for optimal health[cite: 733, 737, 739].
- Utilizing AI and large language models can help patients decipher complex, jargon-heavy insurance plan documents to determine true out-of-pocket costs and benefits[cite: 682, 683, 684].
Resources Mentioned
- US Med Benefits Check: usmed.com/juicebox or (888) 721-1514 [cite: 486, 726, 1023]
- Omnipod 5 Starter Kit: omnipod.com/juicebox [cite: 488, 653, 1026]
- Eversense 365 CGM: eversensecgm.com/juicebox [cite: 494, 643, 1021]
- Juicebox Podcast Facebook Group: Juice Box Podcast, Type One Diabetes [cite: 482]
- Podcast Series Lists: juiceboxpodcast.com/lists [cite: 1038]
- Wrong Way Recording: wrongwayrecording.com [cite: 1043]
Introduction and Part Two Context
Scott BennerWelcome back, friends, to another episode of the Juice Box podcast. [cite: 473]
LauraHi. My name is Laura Keller. I am 52, so I'm dead solid into Gen X. And I spent twenty five years working in diabetes, and I live with type one diabetes. I've had type one diabetes for twenty seven years. [cite: 474, 475]
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. If you're looking for community around type one diabetes, check out the Juice Box podcast private Facebook group. [cite: 476, 477, 478, 479]
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. [cite: 480, 481, 482]
Bet 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. [cite: 483, 484]
US Med is sponsoring this episode of the Juice Box podcast, and we've been getting our diabetes supplies from US Med for years. You can as well. Usmed.com/juicebox or call (888) 721-1514. Use the link or the number, get your free benefits check, and get started today with US Med. [cite: 485, 486, 487]
Today's episode is also sponsored by Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox. You may be eligible for a free starter kit, a free Omnipod five starter kit at my link. Go check it out. Omnipod.com/juicebox. Terms and conditions apply. Full terms and conditions can be found at omnipod.com/juicebox. [cite: 488, 489, 490, 491]
The podcast is also sponsored today by the Eversense three sixty five. The Eversense three sixty five has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get. Eversensecgm.com/juicebox. [cite: 492, 493, 494]
The Barrier of Language in Insurance
LauraThe only one they cover, and better covers is the Libre? [cite: 494]
Scott BennerNo. But they're covering the pump. The pump needs the CGM. [cite: 495]
LauraBut no. They they no. Mm-mm. They cover the Libre as a standalone. And here's what's really crazy. I also yelled at them for this. Is that, I like to use first person language because I was an advocacy director for a long time. I also don't think diabetes defines me. It's something I have. I have type one diabetes. I am not a diabetic. That's just my own personal thing. [cite: 496, 497, 498, 499]
Scott BennerOkay. [cite: 499]
LauraEverybody's different. Okay? So, anyway, when I searched on the PDL, like, for all the right things, I searched every word I could think of. The one word I didn't search for was diabetic. They said, well, it's under diabetic supplies. Well, first of all, under diabetic supplies, the only thing they list is the Libre. So they don't list lancets or needles or whatever. And I was like, that's not even good English, people. Like, how would I know to search for that? Because when I search for a continuous glucose monitor, which is the correct category for the Libre, that didn't even show up in your little PDF. And I was like, it's so bad how they treat people with type one diabetes. [cite: 500, 501, 502, 503, 504, 505, 506, 507]
Scott BennerAre you here to tell us that people are incompetent and large corporations are trying to keep their money? [cite: 508]
LauraYes. Is that what it. And totally. And here's the thing. [cite: 509]
Scott BennerMake money. I have a four zero one k. [cite: 509, 510]
LauraI want corporations to make money, but the system with health insurance is broken. They're making billions. The parent company, they're making billions. I looked up their reports, you know, that they give to their stockholders and all the things. [cite: 510, 511, 512]
Scott BennerLike, shareholder reports and stuff like that. [cite: 513]
LauraRight? And I get it. I looked that stuff up. Fine. Make some money. But the reality is when you have something like a a chronic disease, and they're not even gonna cover for co pay anyway for a long time. [cite: 513, 514, 515]
Scott BennerMhmm. It's all about holding the money as long as possible. [cite: 516]
LauraYeah. It's terrible. [cite: 516]
Scott BennerThe money in their account is more valuable than than giving it back And to and they will give it back to you eventually if they owe it to you. But you are, like you said, you're gonna have to fight and claw and cry and scream and... [cite: 517, 518, 519]
LauraExactly. [cite: 519]
Scott BennerAnd doesn't it feel like you're being put on the phone purposefully with people who don't understand? [cite: 520]
LauraI don't know if it's that. I feel like they're doing the best they can. These are clearly people in different call centers or working remotely. And I've talked to some nice people who really have tried to advocate or at least showed some compassion. But these are frontline people. [cite: 521, 522, 523, 524]
Scott BennerAnd Yeah. I'm not saying they're not good people or they're not trying, but I'm saying, isn't it possible that the company itself is putting them in a position where they don't know what to do so that it frustrates you? [cite: 524, 525]
LauraYes. A 100%. No. And they're told, like, when this first happened and my first prior authorization got denied, I said, well, can I speak to a supervisor? Can I speak to someone else? And they were like, no. No. You can't speak to anybody else. This is it. You can only talk to us. And I was like, you assholes. Like, that is not true. There is somebody else. And then the next time I called back, I was even more forceful. And I guess what? I got to someone else. Right? I mean, I'm surprised they don't block my calls as many times as I've called. And I told my husband, I was like, they might decide to drop me after all this, and it can't be any worse than what I'm dealing with now because I'm not paying for my type one stuff. [cite: 526, 527, 528, 529, 530, 531, 532, 533]
Antiquated Technology and Intentional Delays
LauraAnd what I think is crazy too is that I'm very healthy. My diabetes is the only thing. I have one other medication that I take, and that's an estradiol patch, which is cheap because I am 52. And, well, there's this thing called menopause that every woman hits at some point. But other than that, like, I'm not a high utilizer. I'm not usually sick. I get my flu shot. I get my vaccines. I'm very healthy. I work out a lot. I have low cholesterol. I'm not even on a statin. Why do they have to be jerks? [cite: 534, 535, 536, 537, 538, 539]
Scott BennerBut you know, though, you have your answer. Right? [cite: 540]
LauraYeah. I know. I did this for so long, and that's why I cried because I was so frustrated. Yeah. But that's why I was like, I have to tell people, do not give up and warn people that this is how Ambetter treats unless you're lucky enough to get into one of their diabetes plans. But even then, it says they cover syringes, meters, things like that. I don't know how they cover type one diabetes in those plans. I think those plans might be a little more targeted for type two diabetes based on what I can find. But they don't even sell that one in the exchange, their diabetes plans. Sometimes I feel like they just really don't like people with type one diabetes. That's what it feels like. It's, ridiculous. [cite: 541, 542, 543, 544, 545, 546, 547, 548]
Scott BennerI would tell you that no one even understands what it means. I don't think they're like, oh, we won't help people with type one diabetes. I don't think they're helping anybody with anything. I would imagine if you called with completely different circumstances, completely different disease state, you'd be running into a very similar situation. [cite: 549, 550, 551]
LauraNo. I think you're right. I think advocating for yourself in the health insurance system is the same. It to your point, it's universal. You have to keep going, and you can't wait for them to send you something in the mail. And the fact that the way doctor's offices have to send them a fax is so nineteen ninety five. Like, come on. [cite: 552, 553, 554, 555]
Scott BennerI love that. Like The fax machine thing is hilarious. It's like we don't have a fax about it. I'm like, I like it when they ask you, can you fax it to us? And I go, no, because it's 2026. Right. No. I can't fax you because I don't own a fax machine. And by the way, no one else does either. Like [cite: 555, 556, 557, 558, 559]
LauraExactly. And it's intentional. Right? They haven't and they can pretend to hide behind HIPAA, which is BS. Because you know who actually uses apps like Clara all the time? Health care services. That's like my endocrinology office in Scottsdale. It's a HIPAA protected app called Clara, And I just text them, and they text me, and it's efficient. And you've got digital records now and all this stuff that are HIPAA protected, but they hide behind the fax machine because they can say, oh, we didn't get it yet. It's this. It's that. There's a delay. There's whatever. It's so much easier for them to hide. Slow down claims by using a fax system. And by the way, how HIPAA protected could a fax machine be now? You send my information to my doctor's office, it's sitting on a fax machine somewhere that anybody could see? [cite: 560, 561, 562, 563, 564, 565, 566, 567]
Legislative Realities and Coinsurance
Scott BennerIt fell on the floor and slipped underneath Right. Desk and yeah. Yeah. Listen. You're a 100% right, but there's no answer to this. [cite: 568, 569]
LauraI know. Well, here's the answer. The answer is, especially on the state level, they need to pass legislation that prohibits health insurance companies from doing things like this. So the health insurance companies will testify against bills, they'll say, you know, a consumer has to do all the right things. The consumer needs to advocate. They need to look at their plans. They need to look at the PDLs, whatever. I did all that, and I still got screwed. Right? And I know what I'm doing. But here's an example. There in Arizona state, there's a bill right now in session that would go into the statutes where we protected people's rights with diabetes and health care saying health insurance has to cover these things. And they were going to try to codify that if you have type one diabetes, insurance plans have to cover CGMs. That sounds great on paper, but here's where the insurance companies still get away with not covering CGMs is that the last line of that bill, because I was so pissed, I looked this stuff up, said nothing prevents insurance from using deductibles and coinsurance prohibits them from using those. Right? So until you change that language, it doesn't matter. You can say you gotta cover type one diabetes, CGMs, and insulin pumps. But if they can still do deductibles and coinsurance, that's not insurance. Deductible is you have to meet it. And some people pick deductible plans that are, like, $10,000 that you gotta meet, right, before you even get there. And then you have coinsurance. And coinsurance is such BS because people get screwed. Right? Like, it's expensive for coinsurance, and a lot of people don't understand the difference between coinsurance and, like, a co pay. Right? And coinsurance makes it sound like you've got extra insurance, not, oh, you gotta pay more and you're only getting a percentage. Right? Even the language is confusing for a lot of people. [cite: 570, 571, 572, 573, 574, 575, 576, 577, 578, 579, 580, 581, 582, 583, 584, 585]
Scott BennerLook. I can't tell you for certain what's happening in the world, but I can step back and be as thoughtful about it as I think I can be. This is just clearly about people with money keeping the money as long as they can or as hopefully forever. It's just a business. Yeah. They're not a health care business. They're providing insurance. They're a casino. Right? Like, you You are giving them money, and they are hoping you don't need it back. And then they get to keep it. They invest it. They make more money off your money. They pay dividends to stockholders or, you know, wherever money ends up going after that. And then anybody who asks them for money is hurting their bottom line. So you saying, please pay for this, they're gonna put five or six low level, low paid employees between you and their money, hoping that you give up on the way. Yep. That's all it is. And listen, I talked to you for the first half an hour not about this on purpose because even in the last twenty minutes of talking about this, you sound crazy now. [cite: 586, 587, 588, 589, 590, 591, 592, 593, 594, 595, 596]
Personal Impact and AI Solutions
LauraRight? [cite: 596]
Scott BennerBecause they made you nuts. Yeah. Yeah. And I don't think you are. I think that this is incredibly frustrating. [cite: 596, 597, 598]
LauraIf was I frustrating. [cite: 598]
Scott BennerStarted talking to you about what had happened to me, I'd sound just like you by the time I got done talking about it. But how many people get to the end and forget to make the call on time or the right form doesn't come through, and the third time it's kicked back to them, they just go, you know what? Just I'll just pay the goddamn thing. Like, who cares? And, like, I can't keep doing this. And then they smile and keep your money. [cite: 599, 600, 601]
LauraOr they don't get the care that need, and they switch from an insulin pump to two shots. Right? And they take their care backwards, you know, or they don't use that CGM. I do think it's kind of ironic that the year that changed everything in terms of health care in The United States was 1973, which is when Richard Nixon and congress he signed it into law. Congress passed a bill that allowed health insurance to become private and to be, like, private companies and and make more money than nonprofits Really codified that. Not to say that before that's there there weren't some health insurance companies that were a little more private, but not to the extent that they are today and what they're allowed to do today, is the same year that I was born. Yeah. Well I think that's really funny. And I was like, they picked... [cite: 602, 603, 604, 605, 606]
Scott BennerYou think they were coming after you right then? [cite: 606]
LauraI don't think they were coming after me. At least, Anne better picked the wrong girl to piss off with type one diabetes. [cite: 607]
Scott BennerIt's also easy to say, like, if they just change the language or the law or something like that. But, you know, as soon as some public official says like, let's say you beat your head against the wall with your local representation and you got somebody to, you know, say, alright. I'll propose a change to this law that'll help. And as soon as they do that, those insurance companies are gonna send all kinds of, you know, muscle to DC to pressure people out of doing that because they're always listen. This hasn't take this out of our conversation for a minute. No one's giving away their money if they don't have to. If I walked up to you right now and I said, Laura, give me a $100. You would say no. Yeah. You would say no. And I say no, but I really need it. You go, well, I need it too. You can't have it. And that's all we're talking about here is people are trying to hold on to what they have and get more of it. Everything's money and power, and, you know, and you have less of it when you're in this situation. You've been told that, you know, buying insurance is going to do these things, but there are so many rules and the language is so incredibly confusing that you don't know really what's gonna get covered until they turn it down. [cite: 608, 609, 610, 611, 612, 613, 614, 615, 616, 617, 618, 619, 620]
LauraYeah. Because their their systems and their websites are designed not to be transparent. Right? It's it's all intentional. It's a 100% intentional. [cite: 621, 622]
Scott BennerYeah. It is not difficult to make a user friendly website. If it's not user friendly, it's not user friendly on purpose. No. If the people you're talking to on the phone are not knowledgeable, they are not knowledgeable on purpose. If they are not empowered to make a decision for you that gets you to an end, that's on purpose. They are layering layering layering layering ways to keep you from your end goal. And I know this is true because I've been married for thirty years. There is a lady putting up roadblocks between me and my happiness constantly. Okay? And and if you think this is different, you're out of your mind. She's protecting herself. She's protect Yeah. I don't wanna tell you what she's protecting herself from, but she's protecting herself from something and so are the insurance companies. [cite: 623, 624, 625, 626, 627, 628, 629, 630, 631]
LauraYeah. [cite: 632]
Scott BennerAnd you are fighting a war with a pea shooter, you know, and because your weapon is but I need this or it's right or it's for my health. And they Don't care about that. That's not their end goal. They have a different end goal than you. You have an end goal of being healthy, and they have an end goal of keeping your money. [cite: 632, 633, 634, 635]
This episode of the Juice Box podcast is sponsored by the Eversense three sixty five. Get three hundred and sixty five days of comfortable wear without having to change a sensor. When you think of a continuous glucose monitor, you think of a CGM that lasts ten or fourteen days. But the Eversense three sixty five, it lives up to its name, lasting three hundred and sixty five days. That's one year without having to change your CGM. With the Eversense three sixty five, you can count on comfort and consistency 365 a year because the Eversense silicone based adhesive is designed for your skin to be gentle and to allow you to take the transmitter on and off to enjoy your shower, a trip to the pool, or an activity where you don't want your CGM on your body. If you're looking for comfort, accuracy, and a one year wear, You are looking for Eversense three sixty five. Go to Eversense c g m dot com slash juice box to learn more. [cite: 636, 637, 638, 639, 640, 641, 642, 643]
This episode is brought to you by Omnipod. Would you ever buy a car without test driving at first? That's a big risk to take on a pretty large investment. You wouldn't do that. Right? So why would you do it when it comes to choosing an insulin pump? Most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period. Plus, you can get started with a free thirty day trial to be sure it's the right choice for you or your family. My daughter has been wearing an Omnipod every day for seventeen years. Are you ready to give Omnipod five a try? Request your free starter kit today at my link, omnipod.com/juicebox. Terms and conditions apply. Eligibility may vary. Both terms and conditions can be found at omnipod.com/juicebox. Find my link in the show notes of this podcast player or at juiceboxpodcast.com. [cite: 644, 645, 646, 647, 648, 649, 650, 651, 652, 653, 654, 655]
Socioeconomics and the Healthcare Racket
LauraYeah. You know, it's like Mark Cuban, really smart guy. And I've heard him talk, and I know that, know, he's got his prescription drug platform, and he's trying to get people, you know, cheaper medications and things like that. But I've heard him talk. He's like and even Scott Galloway, prop g, he's really cool guy. Love to listen to him. They talk about how they don't have health insurance, that health insurance is kind of a racket. And that you know? But they're, like, billionaires. Right? So Yeah. They're millionaires. You know? Several times over, they can afford to pay cash for the health insurance, which I think is why, especially in the Scottsdale area, there's more and more of these concierge doctors where you pay a monthly fee to them instead of paying for health insurance. The problem is though... [cite: 656, 657, 658, 659, 660, 661, 662]
Scott BennerThat's for people with cash, with excess cash. [cite: 662, 663]
LauraYes. Yeah. Yeah. And if you need a surgery or, like, let's say you're playing pickleball and you snap your Achilles or something like that because you haven't been played sports in forever, which I think happens a lot in the Scottsdale area. A lot of people start playing pickleball in there as they age and they have these injuries and they're at PT. They don't have cash prices for all those things. But if they do, you have to have so much. So you still kind of need some level of health insurance if you're a semi average person. Yeah. And so the concept is great, and I would love to give up health insurance and just pay cash for everything, but I don't have the kind of resources that they have. Right? You know? And I go on, Mark Cuban's website periodically, and I try to see if they've got type one diabetes things like insulin pumps and CGMs, and they never do. And I'm that one person who every time is like, you need to start helping people with type one diabetes for their pumps and their CGMs. I do every time I go on there. [cite: 663, 664, 665, 666, 667, 668, 669, 670, 671]
Scott BennerOh, well yeah. Well, also, I hate to say it like this, but what is that? 2,000,000 Americans? Like, you know how many Americans there are? 2,000,000 is not a big percentage of that. No. No. Even if you're a company I don't know everything about Mark Cuban's company. But, like, even if he's out there trying to do the right thing, they have limited resources and limited manpower, and they're not gonna start with something that only benefits 2,000,000 people. [cite: 672, 673, 674, 675]
LauraExactly. [cite: 676]
Scott BennerRight. Exactly. And to your point about people with enough wealth to pay for their health care not keeping insurance, my son actually, the irony of this conversation turned 26 today. Today is his 26th birthday. So Yeah. We jettison him from our insurance now. Can't participate in our health insurance any longer. He's been looking at it through his job, and they present him with three PDFs that are, like, four years old. [cite: 676, 677, 678, 679]
LauraMhmm. [cite: 679]
Scott BennerYou read them. They're they use a lot of lingo. They're difficult to figure out what they mean. You know, this one's $400 a month, and this one's $350 a month, and this one's $72 a month. And as you're reading through, if you don't like, seriously, like, who in who in their right mind reads, like, industry lingo and understands it? So what we did was we took the PDFs and threw them into a large language model into an AI, and we asked it to break them down for us. [cite: 680, 681, 682]
LauraNice. [cite: 683]
Scott BennerAnd then we went in and talked to it about his health, and then asked for pros and cons, and then that stuff was at least it it made sense to us. And then we could go back and then look at the lingo and then make sense of the lingo through this plainer English that we were, you know, served back with. And Yeah. It's funny because I'm an adult and I've, you know, I have a bit of a savings. I I'm having income. Like, I'm a little ahead and everything. And when I looked at the three, I thought to myself, just buy the most expensive one because, you know, there's no way you're gonna buy the $72 one. So, like, one's $350, one's $420. Just pay the extra $70 a month because that'll probably be better. Until I looked at it and then looked at him and then took out the diabetes because my son doesn't have diabetes. Right. My son has Hashimoto's and nothing else. He he needs Tyrosine and a t three all year long. Other than that, he's incredibly healthy and athletic and doesn't get sick or hurt very often and doesn't have a family. Right? And Yeah. And when we got done, I was like, oh my god. Get the one that's $72 a month and just pay cash for the medication. Yeah. And you just saved almost $4,000 if you don't get hurt. And if you do get hurt, then you'll have to pay the $4,000, okay, before it kicks in, but you were gonna pay it anyway. So you're basically... [cite: 684, 685, 686, 687, 688, 689, 690, 691, 692, 693, 694, 695, 696]
LauraRight. [cite: 696]
Scott BennerHe's basically setting a bet that he won't have a catastrophic illness this year. And if he doesn't, he saves $4,000. Well, if he does that for four years, he saves $16,000. Yeah. And that's a lot of money. Right? Like and so now he's got this and then I just told him, was like, I can't believe I'm saying this, but I guess we have the insurance we have because of Arden's diabetes. Because generally speaking, we are not particularly unhealthy people. We don't we're not buying a lot of medication. My wife's your age. She's using one of those patches too. You know what I mean? Yep. By the way, god bless them. She's way less crazy than I remember my mom in her fifties. You know? So rock and roll. Yeah. My mom used to have something we called insane Sunday. Yep. I'd be happy to tell you about it sometime. And so we, you know, we're using a patch. Now she and I both use a GLP medication. And so okay. Having an insurance policy that covers that, that benefits us. Right? Because I would tell you that I think to cover the four of us, you know, keeping my son in the picture for a second, we're probably shelling out, like, $67,000 a year in health insurance premiums. Yeah. But Arden has type one diabetes. I use a GLP. She uses a GLP. So right on. Yeah. That makes sense. If we didn't have a GLP and, you know, five years from now, we're older then. So then the value kinda stays again. And you think, okay. Well, maybe we'll stick with that one. But my son, I was like, man, unless you get married or something happens, I think I'd throw my dice and try to ride this out for a while. And I never thought I'd say that till I really dug into it last week with him and talked to him about it. Yeah. If you got type one, I mean, you just need as much coverage and help as possible. But then you're in a situation where you're getting as much coverage as you can, and then you're like, hey. I would like my 60¢ back on the dollar, and they're like, oh, you can't have that. No. Yeah. Yeah. [cite: 697, 698, 699, 700, 701, 702, 703, 704, 705, 706, 707, 708, 709, 710, 711, 712, 713, 714, 715, 716, 717, 718, 719]
"Medically Necessary" and Modern Technology
LauraYeah. When they told me it wasn't medically necessary, I went ballistic. I was like, are you kidding me? I I was talking to the person on the phone to your point. Do they really understand type one? Because I was like, so I could die. Like, just to be clear, without an insulin pump, if I didn't have access to insulin and what I need, like but I could die. [cite: 720, 721, 722]
Scott BennerWell, they're gonna be happy to give you needles and insulin. Right? I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years though because we began using US Med. You can too. Usmed.com/juicebox or call (888) 721-1514 to get your free benefits check. USmed has served over one million people living with diabetes since 1996. They carry everything you need from CGMs to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites. Libre three, Dexcom g seven, and pumps like Omnipod five, Omnipod dash, Tandem, and most recently, the Islet pump from Beta Bionics. The stuff you're looking for, they have it at US Med. (888) 721-1514, or go to usmed.com/juicebox to get started now. Use my link to support the podcast. That's usmed.com/juicebox or call (888) 721-1514. [cite: 723, 724, 725, 726, 727, 728, 729, 730, 731, 732]
LauraRight. But that's so archaic in terms of management. Like, my blood sugars are so stable. I to your point, I barely have lows. And I hike, and I do play pickleball, and I do go to Orangetheory and workout five days a week. Right? Like, that kind of stuff. Like, I used to have Lowe's way more often, but once I got on the Omnipod and the Dexcom, like, my blood sugar's gotten so much better. Like... [cite: 733, 734, 735, 736]
Scott BennerNo. You're not gonna get an argument from me. You're going to be way better off, but way better off is not medically necessary. Right. [cite: 737]
LauraWhich is such BS. [cite: 738]
Scott BennerOf course. Because they're not calling medically necessary as healthy as you can be. They're calling medically necessary you don't drop dead from having diabetes because here's some needles in your insulin. [cite: 739]
LauraYeah. [cite: 740]
Scott BennerRight. [cite: 740]
LauraYeah. Yeah. Yeah. Yeah. So And it's just so frustrating. [cite: 740]
Scott BennerAlso, it probably is part of the reason why, like, pump adoption is as slow as it is because, by the way, insulin pump adoption is much less than you think it is amongst the entirety of the type one community. [cite: 741]
LauraThat is insane to me. [cite: 742]
Scott BennerYeah. Far fewer people have insulin pumps than you think. [cite: 743]
LauraAnd I've tried them all, by the way. Like, well, not all. I've been on Medtronic. I've been on the t slim, and now the pod. And the pod is by far my favorite. Yeah. I didn't know how cool it would be to go tubeless. Mhmm. And so I do owe that to my friend Vicky. Shout out to Vicky. She's a big fan of the show. She'll get a kick out of that. But it's amazing what technology has done in comparison to where it was when I started, when I was diagnosed in 1999. [cite: 743, 744, 745, 746, 747, 748]
Scott BennerI met a maybe a dozen people this weekend using the eyelet pump, And I think they all would have described themselves as having a concern about not wanting to be that involved with diabetes. And they tried the pump for that reason, they seemed happy with it. Like, I think there's a pump out there for everybody. [cite: 749, 750]
LauraI agree. [cite: 751]
Scott BennerIf you and I wanna be, like, reasonable for a second, take out Omnipod, take out Tandem, take out Medtronic for a second. Just think of all the people probably running around with ten, eleven, 12 a one c's. And imagine if you just put an eyelet pump on them and they didn't need to do anything. They didn't need to get educated. They just said this is a small breakfast. Right? Or a average Mhmm. Or whatever those buttons tell them. Like, even if that system's not perfect, and I have to tell you, like, from my perspective, the way it sits right now, I wouldn't want my daughter to use it. Mhmm. But her a one c is also in the sixes. But for everyone else, imagine the alleviation on the health care system and on insurance if everyone could have better outcomes like this. You're not gonna get them to go with that because what they'll tell you is, well, yeah, but not enough people are gonna adopt it for us to actually to get our return back to begin with. Like, it's always gonna be about money. Like, always, always, always, always gonna be about money. [cite: 752, 753, 754, 755, 756, 757, 758, 759, 760]
The Future of Cures and Self-Advocacy
LauraThat's why I kind of crack up a little bit when people are like, there's gonna be a cure for type there will be a cure for type one diabetes someday, whether it's a mechanical cure, islet cells, whatever it is. But the reality is, if I can't get insurance in 2026 to pay for my insulin pods... [cite: 761, 762]
Scott BennerYou don't think they're gonna pay for your islet cell transplant ten years from now? [cite: 763]
LauraHell no. You know how long that's gonna take? [cite: 764]
Scott BennerFor just $800,000, you can cure me of my type one diabetes. [cite: 765]
LauraRight. Like, the only people are who are gonna get that cure are gonna be rich people who can afford to pay cash for it. Insurance is gonna not gonna pay for that. It's gonna need organizations like the ADA, Beyond Type One, Type One International. All the organizations are gonna have to come out and advocate hard, and that's gonna take years before any cure is gonna be paid for by insurance. It'll basically be a rich person's cure. [cite: 766, 767, 768]
Scott BennerYeah. I definitely don't think that's gonna work out in anybody's favor to any great number. No. Honestly, it's a limitation of so many different things. To fix them all would be two lifetimes. [cite: 769, 770, 771]
LauraYes. [cite: 772]
Scott BennerYou would either need a government plan that just said, hey. Look. We have a functional cure for type one diabetes, and everybody who wants it, it's just free. We'll pay the bill. Yeah. It's either that, which I mean, that's not gonna happen. [cite: 773, 774]
LauraBut no. [cite: 775]
Scott BennerRight? Or it's somehow through technology, the price falls so much that there's another company that comes along almost like a generic company that comes along and says, like, well, we can reproduce this and do it cheaper. So we'll do it for everybody to make that money. You know, it's like with anything else. I was talking to a CGM company the other day, I said, why don't you cut your price down and so everyone can have it? And then make the money that way. Instead of charging a dollar for it and selling it to one person, why don't you charge 25¢ for it and sell it to four people? And, you know what I mean? Like and you still make your dollar, and everybody else gets helped. I don't know. It's just that's not how it works. [cite: 776, 777, 778, 779, 780, 781]
LauraNo. It's not. Unfortunately, it's not. [cite: 782]
Scott BennerListen. I very purposefully apolitical on my podcast, but if you're waiting for government to come save you, that is not happening. If you're waiting for government to tell the private sector, hey, we don't want your money, so don't bother lobbying with us. We're just gonna go do what's good. That is not gonna happen either. If you think if you're waiting for insurance to stop lobbying because they just want you to be healthy, I'm gonna give you the same advice that I gave those 75 women when I was talking to them about advocating for themselves in a hospital setting. You are the only one that cares about you. And if you don't treat things that way, you are very likely not gonna get the outcomes you deserve. [cite: 783, 784, 785, 786, 787]
LauraIt's true. [cite: 788]
Scott BennerAnd I hate to say that, but you gotta come first and you gotta find a way to fight your way through it because no one's coming to help you. A woman looked at me sideways when I said that, and I said, we're in a rowboat. It's me and your kid and my kid. And the boat starts to sink. I'm gonna throw your kid right in the water. And I said, and I would expect if it was you and my kid and your kid and the same thing happened, you pick my kid up and toss him right in the river too. I said, would you? Would you throw yourself in and leave your kid behind? Would you throw your kid in to save mine? No. I'm not judging you. And I'm not saying there's anything wrong with that instinct. I was like, but you've gotta take that instinct and point it at your daily health with diabetes. It was a nice conversation, and Mhmm. Nobody was saying anything wrong. You deserve better care. The hospital should know better. You're right. All that should be that way. But since it isn't, what are you gonna do? You're gonna sit here and wait to die and point and go, oh, the world's letting me down. It's letting me down. Yeah. And I know that there's a barrier to that when we're talking about insurance and these kinds of things, and that barrier is cash. But up into the end of your ability to help yourself, you have to believe it's on you. If that's a realization you have and you can't afford it, I don't even know what to say about that. I'm not sure how you're supposed to keep your head up in that situation, perfectly honest. It's hard. [cite: 789, 790, 791, 792, 793, 794, 795, 796, 797, 798, 799, 800, 801, 802, 803, 804, 805]
Humanity's Ebb and Flow
LauraYeah. I think it's really hard. And I think having done advocacy for people with diabetes and passed legislation on the state level that people have told me that'll never pass or whatever, it can make a difference. The problem is laws can be changed anytime. They can be rolled back. They can be adjusted. So it's never a 100% permanent solution. And the average person can stand up, but it takes a lot. And you're pushing a boulder uphill, basically. Right? [cite: 806, 807, 808, 809]
Scott BennerAnd Yeah. That's a level of depression on this I wasn't even gonna go to. But you're saying if you somehow find a way to get the law passed and it helps somebody, as soon as you do that, just be sure those other people are gonna try to push it back the other way again. [cite: 810, 811]
LauraExactly. Because they will. [cite: 812]
Scott BennerAnd why? Because you just took their money from you took their money from them. They can't let that happen. They can't let that happen. [cite: 813, 814]
LauraMm-mm. No. There were so many times I testified, and other companies, insurance companies, and health insurance companies and things or whatever, they would say things that were blatant lies so that these bills wouldn't pass, and we'd have to counteract them as advocacy groups. And there's not one group who's doing all the work. It's a coalition of people. It's people sharing their stories. People don't share their stories enough, And it's hard because they're also afraid of retaliation. Right? They're afraid to share their stories and complain against health insurance or whatever because they're afraid they're gonna get retaliated against. [cite: 815, 816, 817]
Scott BennerYeah. Laura, this might be a good time for me to say I don't stay in hotel rooms on high floors. I'm not depressed. I don't feel suicidal. I just want everyone to know I'm a happy person who wants to be alive. I mean, listen. It I don't know what the answer is. I don't think there's an answer. The answer is Star Trek. You know what I mean? Like, until you can get society, you get to a place where everyone's working and it's all about trade and nobody's trying to be wealthy and everybody's just trying I mean, maybe that helps more people, but it just does not to me seem like that's the way humans are wired. [cite: 818, 819, 820, 821, 822]
LauraYeah. I believe in the greater good in people. I believe there's a lot of people and there's a lot of good in the world. And there's some people who are straight up evil a 100% or super greedy. I mean, I grew up Wall Street. Right? That was a pivotal movie in my life. You know? Greed is good. Right? There's a whole generation of that's very common. I I think what is hard is that, yes, make money. Yes, be profitable. People should be paid good wages. They should be able to have nice things and whatever. Right? If you work hard and the American dream, believe in that. But at some point, there's this line where that exceeds human decency. Right? Like, how much money do you need to make? Like, car insurance. They raised my car insurance this last year so much. It was insane. And so I called my insurance person, and I called and I was like, okay. Wait. Well, the Florida and this tragedy, don't live in those places. I live in Arizona. So you're telling me I have to cover their costs so you're raising my. And then they snuck in a bunch of, like, other charges for stuff that I didn't ask for, and I was like, why is this in my plan? Why is and I cut it out, and I cut it out. And she's like, well, we're not making any money. And I looked up before I talked to them. I was like, your company made $2,500,000,000 last year. And I get you're just a franchise, but you can't tell me you're not profitable. And she was like... [cite: 823, 824, 825, 826, 827, 828, 829, 830, 831, 832, 833, 834, 835, 836, 837, 838, 839, 840, 841]
Scott BennerMy State Farm office told me you should really consider turning that in because we might drop you. [cite: 842]
LauraRight. [cite: 843]
Scott BennerI don't think I've asked them for money in twenty years for something. We had a a small thing happen, and they were like, I wouldn't if I was you. And she said it right out to me. She didn't even hide it. She just said it to me. No. But listen. Here's the other side. May I give you the other side? For everybody who's listening right now, it's like, right on. The rich people, blah blah blah. There's they got too much. All of you out there listening, shut up. If I came to your house and I said, hey. I just wanted to give you $10,000,000 and a boat, and you'd be like, thank you, and you would take it immediately. Right. So A 100%. So don't be mad at the people who've figured out how to do it because if you could've figured out how to do it, I'm pretty sure you would have too. Yeah. Look. There's some of you hippies out there. I get it. You're like, I don't need that, man. Like, it's good. And I believe you. I believe you, hippies. And I will tell you too that I've had conversations with people. We're talking about the lottery recently. It was one of these, like, lotteries that was, like, I don't even know. Like, it felt like it was a billion dollars or something like that. Like, it was just a number that was so insane. And it sparked a conversation in our house about, like, oh my god. Like, if you woke up tomorrow and somebody's like, oh, you did it. You won a billion dollars. Like, what would you do? I have to tell you, like, I didn't have a lot of thoughts around it. I say things very similarly over and over again. I'd collect up my family and my very close friends, and I would bring them all to one location. And I'd say, hey. Listen. I've just won a whole lot of money. I wanna make sure your health is okay. I've brought doctors here to help you. Like, if you have any health issues you haven't been dealing with, like, let's talk to these people about this. And when we're done, I'd like to talk to you about clearing off your debt and giving you a little bit to get started with. But then after that, I would say, please never call me again. Yeah. I don't wanna be your mom for the rest of my life. [cite: 844, 845, 846, 847, 848, 849, 850, 851, 852, 853, 854, 855, 856, 857, 858, 859, 860, 861, 862, 863, 864, 865, 866, 867, 868]
LauraSo that's like a health care version of a George Clooney. I told my friends, if I ever win big, I'm gonna pull a George Clooney. And they're like, what? I go, if I tell you, you have to get on a plane to Scottsdale on these dates, your ass shows up because I'm gonna pay for the taxes. I'm gonna pay for the money. There's gonna be a security guard. They're gonna roll in some suitcases with some money in it. We're gonna throw a kick ass party. I know the hotel I would choose. Yeah. [cite: 869, 870, 871, 872, 873, 874]
Scott BennerAnd then go live your life and try not to piss my money away because I'm done. [cite: 875]
LauraThat's it. [cite: 876]
Scott BennerBut at the same time, like, I got done saying that, then somebody said, but what about for you? And I was like, I don't know. I think I'm okay. Like, I take your point. I also like, I also don't think you should limit people about how much money they can make. No. I take your point about, like, millionaires and billionaires, and at some point, like, they're just numbers and everybody else doesn't have any. Like, I could have that conversation forever and probably come down on your side of it. But, like, I'm not comfortable telling somebody they can't be innovative or they can't be greedy because I'm sure there's a lot of good things in the world that came from someone's greed as well. [cite: 876, 877, 878, 879, 880, 881]
LauraA 100%. A 100%. I believe in people being able to make money and make good money. Like, again, I have a four zero one k. My husband and I are invested in the stock market. I am considered well off. I am not poor. I am blessed that way. We worked hard. We've made good choices, all the things. Right? [cite: 882, 883, 884, 885, 886]
Scott BennerYeah. [cite: 887]
LauraI am not complaining about my status in life. I think we're what's frustrating is when you're paying into something called insurance, particularly health insurance... [cite: 887, 888]
Scott BennerIt should insure you. Right. Yeah. Call me crazy, but I was hoping my health insurance would pay for my health care needs. [cite: 888, 889, 890]
LauraBecause they're not losing money. Like, that's the thing. They're not losing money. If they were losing money, that'd be different because they were paying for everything. [cite: 890, 891]
Scott BennerIf I brought them on here and they were being honest, don't you think that they would tell you that if they did pay for everything for everybody, they would be losing money? [cite: 892]
LauraWell, of course, they would probably say that. Still, I don't necessarily know that that's true. Right? Because we know that if you pay for preventative stuff, people don't get the complications and the things, but that's not the way our health care system right now is designed. [cite: 893, 894]
Scott BennerI was gonna say, can I play health care devil's advocate for a second? Yeah. I talk to people all the time about their health. You know what one of the last things people are? Preventative. [cite: 895, 896, 897]
LauraI know. [cite: 898]
Scott BennerI think it's a thing we talk about, but I don't think it's a thing that even if we paid for that people would do, generally speaking, in mass. In a world where you it takes twenty years to talk somebody out of smoking or drinking soda, you really think they're gonna go to the doctor four times a year to check their vitamin b and d levels and make sure that their blah blah blahs are like, do you really think that's what's gonna happen? [cite: 898, 899]
LauraSome people. It depends. Right? Some people can and some people do, and not as many as one would hope. But some of it is have you ever been to the grocery store? And I'm like you said, I'm doing well. I'm doing okay. I'll go to the grocery store, and I'm looking at buying organic foods. And I can buy one bag of organic fruits and vegetables. And for the same price, someone could buy 12 frozen pizzas, you know, processed junk food, all of the things. So kinda depends, I think, on your socioeconomic level, what you can afford to be preventative and what you can't. You know, I think it's also crazy that as a healthy person with type one diabetes, I have to go to the doctor, what, three, four times a year to make sure I have prescriptions and stuff and things like that. Well, that's just a waste of the health care system right there. Right? Like, if I'm healthy and I don't have anything wrong, why do I have to go in and see you? Why can't you just upload my data and look at it and go, yep. Things look good. Great. Moving on. Right? Did you know that when you turn 65 and you have type one diabetes and you go on Medicare, you have to prove that you do have type one diabetes? [cite: 900, 901, 902, 903, 904, 905, 906, 907, 908, 909, 910, 911]
LauraWhat? I'm gonna live my whole life. Knock on wood. I'm gonna get turned 65. I'm gonna be healthy, and Medicare will still be there. And in order for my type one insulin CGMs, pumps, whatever it is at that point, get covered, I have to reprove. They have to give me the test again to prove that I have type one diabetes. Yeah. That is a stupid waste of money. Why? [cite: 912, 913, 914, 915, 916]
Scott BennerYou're talking about what makes sense versus how things work. [cite: 917]
LauraYes. Well, that's true. [cite: 918]
Scott BennerAnd if this just happened, if that just happened, if we only did this and if we only made sense here, like, yeah, I'm with you. But, like, that's not going to happen. Yeah. At every level of this conversation, the base of this conversation as is everything else that you talk about is people. Yeah. People have limitations. They have a limitation on how much energy they have, how much desire they have, that they also have lives and girlfriends and boyfriends and kids and bills. And they don't have twenty four hours a day, seven days a week to thinking about something. And even if they did, they're not computers. They can't come up with the right answer all the time. There are plenty of people who come up with an answer and spent their adult professional lifetime doing the wrong thing, trying to do the right thing. And so while all that's happening, this mess, you're not just cleaning up your bedroom. This is a billion intertwined things that are intertwined with billions of people. And they all have an opinion about what to do about it, and they all have pain points that are different than others. They all have different intellects and financial concerns. [cite: 918, 919, 920, 921, 922, 923, 924, 925, 926, 927]
Scott BennerYeah. You can't fix this stuff. [cite: 928]
LauraNo. [cite: 929]
Scott BennerThis is how it works. Yeah. We will find a better way just as we have over generations and millennia and all that stuff. Mhmm. But it is not gonna be because someone woke up tomorrow and said, oh, I know how to fix this. Yeah. It's just gonna bleed towards the answer. And then eventually, in ways that our minds can't grasp, so many different things are gonna change and morph over time that we'll just end up in a better place. Or Yeah. We'll end up in a worse place for fifty years, and then it'll ebb and it'll flow. Yeah. The truth is my lifetime might be the lifetime where it goes the wrong way So that eventually, when my kids are 50, it starts to go the right way. Like, we're measuring success based on our lifespans, but you need to be measuring success or change based on humanity. Sadly enough, the speed that humanity runs at is not the speed that my life is running at. [cite: 929, 930, 931, 932, 933, 934, 935, 936]
LauraNo. It's true. I really I really like that there's a lot of people in humanity who were fighting the good fights trying for the right things. And I'd like to believe I'm on the right side of that line of fighting for other people and caring about people's rights and access to health care and healthy foods and the environment, all that. But you're right. It's a slow moving thing. And in the meantime, I think to sum it up, you have to advocate for yourself. That's kinda where we started. Right? You talked about how you were talking to those women. You have to advocate for yourself. You have to advocate for yourself in your job, in your health insurance, in the hospital, whatever it is for other people because that really will make change over time. Yep. And you can have positive impacts on your life and other people's life even when it's hard. Don't give up because, like I said in my story, I am a trained professional, and I still got screwed. And I'm still advocating for myself. I'll follow-up with you if I ever even get my insulin cost covered because you just don't know. I might be paying out of pocket for the next year until I can get out of this silly plan. But... [cite: 937, 938, 939, 940, 941, 942, 943, 944, 945, 946, 947]
Closing Perspectives and Taylor Swift
Scott BennerSo much of it is perspective. Whether you're sitting there listening now and you're thinking, like, I'm broke, and there's no reason for somebody to have $5,000,000,000 in the bank. And look at all the people that could help. I guarantee if you take that person and sit them down, they have a different perspective than you. Yeah. And their perspective is gonna be trying to take care of them and theirs and what they see as the world order. So are you and so is everyone else in between, and you are not gonna get somebody to just agree that they should give you their money. Whether that's you being asked to pay 60¢ on the dollar for something or that's some maniacal, like, cartoonish character out in the world that has all the money in the world. And you say to them, like, I mean, they all figure it out in the end. Right? Because you see they get old and they give it all away. They they figure it out at the end. They go like, oh god. What am I doing? And then it's but but in the middle, you can't get people to do that. [cite: 947, 948, 949, 950, 951, 952, 953, 954, 955, 956]
LauraYeah. [cite: 957]
Scott BennerTo give away your money, imagine how hard it would be to make all that money. And then imagine in your thirties, someone said you give it to somebody, but you feel immortal still. You're like, I can't give it away. I have to stay alive. Like, what if this happens? What if that happens? You don't think a person with a billion dollars has a, like, what if I lose all this feeling? Of course, they do. Probably more so than somebody who makes $60,000 a year does. [cite: 957, 958, 959, 960, 961]
LauraYeah. [cite: 962]
Scott BennerAgain, everyone's perspective is different. Their pressure points and pain points are different. [cite: 962]
LauraYep. [cite: 963]
Scott BennerAnd by the way, even if there was a right answer, I don't trust you to come up with it. I'm talking to people listening, and you don't trust me to come up with it or somebody else. Right? So Right. When you hear people say, like, the only answer is to, like, hope the AI doesn't kill us and then ask it for an answer, that considers all of us. Like, our brains are not big enough to hold the entirety of what needs to be considered to make a decision that big. Having said that, I go very back to what you just said. I wanna say a million percent I agree with you. If everyone's out there doing their best and fighting, I think the fight moves us in the right direction. And I do think it's important to stick up and argue and push for what seems right because overall, like, I'm sure whatever it is you out there think is right is probably right. And so, you know, like, just think about civil rights or something that's a little easier to comprehend. If people don't stand up, if people aren't willing to stick their neck out, these things do not move forward. So No. You know, whatever the thing is you're worried about, like, I hope you can find a way to get out there and fight for it. [cite: 963, 964, 965, 966, 967, 968, 969, 970, 971, 972, 973]
LauraI agree. [cite: 974]
Scott BennerI'm doing that in my own life in ways that some of you might know and some ways that are more private and you're never gonna know about. So you know? No. Laura, we fixed the whole world here. It's fantastic. [cite: 974, 975]
LauraI wish because then I'd go buy a boat or a... [cite: 976]
Scott BennerYou don't need a boat. It would be free. [cite: 976, 977]
LauraYeah. Well, there you go. I don't know that we need to go a 100% free. I have a business major. So I was a business major. I believe in nice things and working hard. I just hope that everybody is able to be happy. Sometimes attitude is everything. [cite: 978, 979, 980]
Scott BennerCan I paint a picture for you? We're all millionaires. Mhmm. You couldn't even get your yacht out of the harbor. There'd be too many yachts there. It would cause a different problem. [cite: 981, 982, 983]
LauraIt would cause a different problem. [cite: 983]
Scott BennerThere's gonna be a different problem. You're gonna get murdered by one of your crazy kids who wants all your money. [cite: 984, 985]
LauraYeah. It's like that Taylor Swift song. Yeah. [cite: 985, 986]
Scott BennerWhat is it? [cite: 986]
LauraThere's a Taylor Swift song where she talks about how her daughter-in-law thinks she left money for her in the will, but she didn't. It's that thing. Yeah. [cite: 987, 988]
Scott BennerWow. I don't know anything about Taylor Swift. I just realized. [cite: 988, 989]
LauraOh, I'm a big Swifty. I'm a big Swifty. [cite: 989]
Scott BennerSo I'm happy for you. You think that she'll marry that football boy? [cite: 990]
LauraI do think she's gonna marry mister Kelsey. Yeah. Mhmm. I like it. I think they're a good match. [cite: 991, 992]
Scott BennerWill she be Taylor Kelsey when it's over? [cite: 992]
LauraI think there's a difference between what she might do privately and what she'll do publicly because she's obviously a billionaire, and her name, obviously is copyrighted and all of the things. So you never know. Especially if they decide to have kids, it's easier for your kids if your kids have the same last name than different last names, and that's even true if your parents aren't rich. I think sometimes that can be tricky. The only thing I have to say about her marrying Travis Kelce is that I'm a 49ers fan, and they beat us one too many times in big games and things like the Super Bowl. So when they lose the Super Bowl, it doesn't make me sad. But I am happy that a lot of young girls have started watching football now because of the Taylor Swift phenomenon. Because I started watching football when I was a kid with my dad Yeah. In Oregon, and that we would bet quarters on quarters and things like that so that I would get into the games. [cite: 993, 994, 995, 996, 997, 998, 999]
Scott BennerYour dad used sports betting to get you excited? [cite: 1000]
LauraHe did. Yeah. He did. We played with quarters. It was part of my allowance money. It was very fun. I learned how to swear while my dad was watching football. He was a LA Rams fan when, like, Eric Dickerson and stuff was there. [cite: 1000, 1001, 1002, 1003]
Scott BennerYeah. Well, that'll make you a curse. [cite: 1004]
LauraRight? It it can be a very good bonding for girls and their dads to watch sports together, so I commend them for that. That's that's pretty cool. [cite: 1004, 1005]
Scott BennerThat Taylor Swift, her dad noticed years ago that they were spending so much money on tour buses, And then he thought about all the acts are out on tour, they took some of Taylor's money and bought up tour buses. And now they're basically the largest owner of tour buses in the world, so they make money off of that too. [cite: 1005, 1006]
LauraThat's brilliant. [cite: 1007]
Scott BennerThere's an interesting way how money makes money because if you had a thought like that, you'd be like, oh my god. If only I had enough money to buy tour buses, but I don't. [cite: 1007, 1008]
LauraTour bus. Right? [cite: 1009]
Scott BennerAnyway, I'm just gonna say this here, and then I'm gonna stop the recording because I don't even wanna hear your reply. I don't think she has a very good voice. [cite: 1009, 1010]
LauraDisagree. Disagree. A 100% disagree. I'm in the Amazon top point 05% of listeners to Taylor Swift in my year review from 2025. She's got so many albums. She could listen for hours. [cite: 1010, 1011, 1012]
Scott BennerIt's possible you're in a cult, Laura. It's possible. [cite: 1013]
LauraBut we can agree to disagree. We can agree to disagree. It's totally fine. Everybody can, like I... [cite: 1013, 1014]
Scott Bennerdon't care if you listen to Taylor Swift or not. That's for certain. [cite: 1014]
LauraExactly. Not hurting anybody. [cite: 1015]
Scott BennerShe has a few boppy songs I like. I I'm not, against it. I'm just telling you why. I think there's a reason she started in country. There, I'll just piss everybody off, and then we'll stop right here. Thanks so much, Lara. You were terrific. [cite: 1016, 1017, 1018, 1019]
LauraIt was a pleasure. Thank you. [cite: 1019]
Scott BennerOf course. Hold on one second for me. The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense three sixty five. That thing lasts a whole year. One insertion. Every year? Come on. You probably feel like I'm messing with you, but I'm not. Eversensecgm.com/juicebox. [cite: 1020, 1021, 1022, 1023]
This episode of the Juice Box podcast was sponsored by US Med. Usmed.com/juicebox or call (888) 721-1514. Get started today with US Med. Link's in the show notes. Links at juiceboxpodcast.com. [cite: 1023, 1024, 1025]
A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox. You may be eligible for a free starter kit, a free Omnipod five starter kit at my link. Go check it out. Omnipod.com/juicebox. Terms and conditions apply. Full terms and conditions can be found at omnipod.com/juicebox. Thank you so much for listening. I'll be back very soon with another episode of the juice box podcast. If you're not already subscribed or following the podcast in your favorite audio app, like Spotify or Apple Podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes, I'll be your best friend. And if you leave a five star review, oh, I'll probably send you a Christmas card. Would you like a Christmas card? 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. [cite: 1025, 1026, 1027, 1028, 1029, 1030, 1031, 1032, 1033, 1034, 1035]
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. You 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. Have a podcast? Want it to sound fantastic? Wrongwayrecording.com. [cite: 1036, 1037, 1038, 1039, 1040, 1041, 1042, 1043]