#1883 Take Your Hands Off It: The Settings
Jenny on why diabetes overwhelm means doing less, not more: basal first, stop fiddling, fix timing, and trust good settings enough to take your hands off. Part 1 of 2
Take Your Hands Off It: The Settings
Cold Open & Sponsors 0:00
Hello, friends, and welcome back to another episode of the Juice Box podcast. 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, or you can listen to it at juiceboxpodcast.com by going up into the menu.
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. 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. The show you're about to listen to is sponsored 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. Ever since cgm.com/juicebox.
Today's episode is also sponsored by the Tandem Mobi system, which is powered by Tandem's newest algorithm, Control IQ Plus technology. Tandem Mobi has a predictive algorithm that helps prevent highs and lows and is now available for ages two and up. Learn more and get started today at tandemdiabetes.com/juicebox. The podcast is also sponsored today by US Med. Usmed.com/juicebox or call (888) 721-1514.
US Med is where my daughter gets her diabetes supplies from, and you could too. Use the link or number to get your free benefits check and get started today with US Med. Jennifer. Yes. Welcome back.
Hello. How are you?
Oh, you know how I am. I'm doing great.
You're good.
Welcome. You. That's what's important.
I'm doing fine. It's oh, it's summer has started. It's the last day of school.
Okay. Alright. Is this really the last day of school for your kids?
Yeah. They're done at half day today, and then they're done. It's the end.
Congratulations to them. Another year? I imagine they passed?
They they passed. Excellent.
I never knew. At the end of the year, I was like, not sure how this is gonna go.
Yes. They have passed. They have moved on. They have been we've been told that they are absolutely ready for the next journey forward next fall.
Well, I trust the teacher that said that, so I think you're gonna be fine. I do too. Do they have good teachers? Do you like them?
They do. We've yeah. They have exceptional teachers that are really fantastic.
Well, that's a
great age.
Great time great time in life. A lot I of am gonna just ask you a few questions.
Yay.
And then later, while recording with Erica, I'm gonna ask her similar supporting questions to the question that I asked you, and this will all make sense in a second.
So Fantastic.
Overwhelmed: Where Do You Start? 3:39
When it comes to diabetes care, when you see somebody who's overwhelmed, just overwhelmed, and we're talking about settings, what do you think that they should be looking at? And I know this is a very broad question. I really just want you to start talking. I'm not looking for you to say anything specific. So we've got overwhelmed people, and you look at their graphs, and they seem wonky, and it's hard to see what's going on.
What do you look at first? Just go ahead.
Sure. So first, I look to see if there is too much interaction, honestly. Right? Is it their interaction? Many times, those who are overwhelmed often are interacting too frequently and not trusting as we've talked millions of times already about.
They're not trusting the settings that are there either because they are poorly set by another practitioner or, you know, by them after not having great help from another clinician to get things set the right way. So they've turned knobs and adjusted settings, and then it becomes a daily kind of thing. So when I when I look at data along with somebody who's pretty overwhelmed, it's usually do things look like they could be easier by just dialing back? Not specifically dialing back insulin, but dialing back their interactions. Okay.
Right? The touch The manipulation is too much. So not only am I not getting a clear picture of what actually their system is doing, especially if they're using one of, you know, the automated insulin delivery systems we have now, but I can't also tell what the setting should be.
Okay. Do you think this would go for people who are MDI or just on a manual pump as well? Touching it too much usually one of the the keys?
Yes. Okay. Definitely. I think MDI is a little harder to evaluate mainly because unlike a pump where it captures all of the little ups and downs with insulin delivery. Mhmm.
MDI, you have to really rely on the person's account of what they've put in and where they've put in and how much it actually is. But the interesting thing about CGM data today is if you don't have a pretty nice looking flow over the course of a day, and it is really variable, like big roller coasters up and down, even with MDI, you can also get a sense that there's a lot more manipulation there than needs to be. And I don't mean manipulation like bad, bad, bad, like slap the hand, but it's more manipulation because they don't know what else to do. Okay. And they don't know how to smooth it out, which you can have smooth data with injections as well as a pump.
Okay. But it starts with knowing that your settings are in a good place. And to do that, sometimes you have to be willing. I think the willingness is the hard part to step back and see what the settings you have are doing Mhmm. To then step in and make a slight adjustment at a time.
Start With Basal 6:47
And, you know, we've all where do you start there? We've always talked before about where do you start? It's with basil.
Yeah.
Let's look at just the basil to begin with, and what does it look like it's doing?
Mhmm. So people can get into a situation where maybe they were set up incorrectly Mhmm. And then things bounce around, and then they go back and touch settings or add or subtract insulin in places. You get variability up, down, up, down, up, You start chasing. You get low.
You're eating food. You're going up. You're not bolusing again. This whole thing starts. At some point, you have to just stop, take your hands off it, see what it's doing, and then make an adjustment.
First adjustment, basil.
Correct. Okay. Absolutely. Because basil basil really does lead to enough background smoothing. And if it is not set well enough for you, absolutely all the other pieces can be thrown off.
Mhmm. Right? If you are planning to exercise first thing in the morning, for example, and there is no bolus in the picture, there's no food in the picture, you're just waking up and going out for a walk fasted, but your basal hasn't been tested, then you won't have any idea what to do with what ends up happening to the glucose shift Mhmm. During the walk or the run or the bike or the yoga or whatever, the soccer game, whatever it is. If you don't know the base, then how are you going to adjust the variables that you're adding in?
Right. When you finally see somebody get their basal right, do they stop worrying the touchers or do they just shift to something else?
Like, the touchers.
The touchers. That's not the right word.
It's a funny word, though.
I don't know. You should hear the thing in my head that I came up with next. I saw it's worse than that. So
The manipulator?
They're fiddling with it too much.
The fiddler. That's there you go. The fiddler. That's better. Yeah.
Fiddler is not the second thing I thought of. Seriously, like, when when you've got your hands in it too much and you finally meet somebody like you or you go to your physician, your physician says, This is all out of whack. Let's they're gonna tell you, like, let's basal test first. Right?
Mhmm.
And get basal nice and stable again. Do those people generally in your experience step back or do they just I'm trying to figure out if they're just fiddlers by nature. Do you know what I mean? Like or can they wait then to see the next thing? What do you what what's the experience you have with people?
I think it can go many ways, definitely. We all have a different perspective on where we want things to be. Mhmm. Right? And how we think about getting it there.
And there are people who are much more willing to say, okay. I can step back for a bit because I've been given direction now. Before, I had no idea. I had nothing to start with. You've given me some direction to get started and have that base, that foundation Right.
Hold me. And I think one of the places that basal adjustment helps things get a little bit easier, so to speak, is usually the overnight time.
Okay.
And that being a big complaint and a big reason most people love their CGM, if we can get that overnight well set, it then leads into where you start your day. Mhmm. And even if those basils in the day yet aren't quite right, if you've had a stable overnight, that leads you into starting the morning in a place that's not too high, it's not too low, extra insulin, that then you're you're gonna be less likely to manipulate or fiddle
Yep.
With extras right away in the morning. Okay. Extra carb, extra insulin. What do I do? Where do I, you know, titrate this?
Whatever. And as you can see then that flows through the rest of the day.
The Tennis Ball in Space 10:32
I also think that's where the overwhelm comes from too. Yes. Because you start adding all of these different, like, small decisions and they all knock you. I I I would think of it a little bit as like a you know, if you think about traveling through space, if I if, you know, if we could go out into space right now and just take a a tennis ball and just just let it go.
In a drift?
It's going to go in a direction forever and ever until something intersects it and knocks it off. And the more things that touch that tennis ball, the further off course you get. It's sort of how it seems to me. Like, go, well, I've learned I've gotta get up in the morning and bolus. Okay.
Fair enough. That works. But what happens if you're getting up in the morning having a couple of carbs, then you're putting in insulin, then you're changing the setting, and then you just keep touching that tennis ball, and we don't know where it ends up all of a
sudden. Correct.
Yeah.
Absolutely. And I I think there is a inherent desire to even if you weren't the controlling type of personality before diabetes was in the picture Mhmm. You usually learn to be controlling, and you can be controlling to a degree that's not healthy. And then and you can be controlling to a degree of just knowing healthy healthy habits.
Yeah.
And the control of those habits keeps things on that steady path. I love the idea of a tennis ball in space that's just floating around and never gets hit by an asteroid. Right? Like Straight line. Lovely.
All the way to forever. Forever.
Wherever it's going. But it our day is also in life not like that. There will always be some type of variable potentially thrown in even if you have the plan for the day set in front of you.
But you don't need to be one of them. But yeah. Yeah. Right. Right.
Yeah.
You shouldn't be the asteroid Mhmm. All the time or the the asteroid belt kind of always, like, ducking and dodging something. Because if you are, then that's where so much of your brain power goes.
Yeah.
And it can become really not only defeating, but it can be a huge energy sock.
I also think it just starts piling confusion on top of confusion because you don't see where it's coming from anymore. Yes. Honestly, it just feels like you're being shot at from all sides. You're getting hit, but you can't you can't hear the bullet, and you don't know which way it's coming from. And why is it, you know, it's it's on my left, it's on my right, it's above me.
And then then boom, you're overwhelmed, you shut down, and now you've shut down with bad settings. And, you know, and they're so wacky your doctor can't figure them out. You can't figure them out. What I'm telling you is that I see people because of these conversations I've been able to have, this feels like it could just be like a momentary problem. But if you get caught in that wrong trajectory, you could stay there forever.
Like, because I've seen it happen to people. Like, they just
Mhmm.
They become complacent in such that they feel like, well, this is just what this is. There's no getting out of it. There's no answer. I don't have an answer. The doctor doesn't have an answer.
This must be what diabetes is. Then the brain fog comes in and all the other stuff. And before you know it, you're just you're adrift. You know?
Right. It's constantly being on the defensive.
Yeah.
Really. Right. It's constantly waiting for the next, like, the next thing to hit, and then assuming you have the right trick in the bucket to pull out to hit it with so that you don't get sidetracked by that next thing, but that's not what ends up happening. So, I mean, settings in general base Basil to start with. Yes.
Right.
And then you really do have to take some time out to say, you know what? There are always going to be birthday parties. There are always going to be vacations. They're always going but not, for the most part, not day after day after day.
Yeah.
So make the effort to find something that has a structure in a couple of days.
“We Have to Start Over” 14:14
Yeah. When things would get out of hand with Arden when she was younger, before I even knew what I was talking about, I would say to my wife, we have to start over.
Yes.
I'm like, we have to stop and start over because there's too much happening right now. We'll never make sense of any of this. Mhmm. And that's where the ideas that I talked about in the podcast, you know, for all this time came from. Like, I realized I was like, okay.
Well, if the basil's right, a lot gets better all of a sudden. Right? Mhmm. Carb ratios work better. Sensitivity, you know, factor works better when when basil's right.
So let's get the basil right. And, you know, again, without a CGM, I don't know that I ever would have figured that out to perfectly honest.
Right.
So then, you know, we talked about what gets better when the basal's right. What gets better when your carb ratio is more accurate? Diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US Med has done that for us.
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Ratios That Work (Until Vacation) 17:24
You have confidence with the majority of the things that are your day to day norm. Mhmm. Right? And as adults, there's not a heck of a lot of growth that ends up happening unlike kids. Kids settings will shift and change, not that adults won't, but less frequently, so to speak.
And if you do test within a time period to see that your carb ratios are in a certain place, then you can count on those ratios working for days, weeks, months at a time. They should really work. Where it gets thrown out is you test for two days on the apple first thing in the morning. You measured it. You weighed it.
You've got your ratio figured out for that. But now you go on vacation for the next week to wherever, and the apple is no longer your breakfast. And there are a whole host of other things in the picture. Well, this is where it doesn't mean that the ratio is wrong.
Right. It just doesn't work for this meal. It worked for the apple.
It worked for the apple and or it worked for your typical foods at lunchtime, your typical foods at dinnertime. And those ratios, there's a little wiggle room to them. Right? They're not hard set started set in stone. You're a one to 10.
I mean, right, there's a little bit of wiggle there. But in general, I think it's the other pieces that often end up had you been on a good trajectory of habit, you get thrown off by the variables of vacation, illness, digestion looks different, whatever. And then you come out on the other side of that thinking, well, now I have maybe bad habits coming out of that. I'm adjusting this way. I'm throwing in more insulin here because that clearly didn't seem enough or it was way too much.
And then on the back end when you're adding your apple back for breakfast, you don't trust it.
Yeah. It's an it is super interesting that because I've I've lived through it and I've talked to a bunch of people that have. It really should be just as easy as, I'm going to a restaurant now. This food is just gonna hit differently.
Yes.
I'm a very sedentary person, and I'm running around on the beach for the last five days. It's not a thing I usually do. Why am I getting low all the time? You should be able to just see it, turn it on, turn it off, but, boy, that's not how it works in people's minds. You know?
It's not.
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And, you know, outside of just the settings, there are settings once they are in a good place. There are adjustment strategies as well Okay. That you will typically also find advantageous. Right? And it takes experimentation.
This is not a one and done. Gosh. I tried this. It worked, and I'm gonna go forward and just use this all the time for exercise. Exercise of one thing versus another is going to require a different type of strategy.
But once the base is set, now you've got again that foundation. It's like very solid to build your strategy off of. Right. And then you don't end up making little nudges here and adjustments there and plugging in and adjusting that and taking more away, which again is just it's not purposeful and it makes it worse.
The Hardest Part: Pre-Bolusing 21:30
Guess the next thing to talk about, I think is maybe the most difficult part, again, based on conversations, but also based on watching my daughter, is pre bolusing a meal. It's incredibly difficult for people to remember to do. It's incredibly difficult to want to do. I saw Arden the other day. She just finished a college semester.
Yay.
Yeah. So she's she's so close right now. And so she slept in. And I was recording with somebody and somehow the conversation got around to, like, touching it too much, like, touching the CGM and looking too much and everything. I stopped and I said, I honestly don't know the last time I saw Arden's blood sugar.
It was, like, 02:00 in the afternoon at that point, and Arden's still asleep. And so I opened up my phone, and for the last I think it was five and a half hours, I apparently did look around 8AM, and I put in, like, point two or point three of insulin or something while she was sleeping. I mean, to adjust, a one ten blood sugar. You you know what I mean? And I just felt it I could see it was heading in the wrong direction.
I put a tiny little bolus in, and I didn't look at it again. And the person asked me, how did you manage to not look at it again? I said, well, my alarms haven't gone off. So it's in between 70 and for me, it's between 70 and one twenty. And I was like, so there's no reason to look.
The thing I expect is happening is happening, you know.
Right.
The person was, like, stunned. They're like, you're between seventy one twenty for, like, five and a half hours. Like, well, she's on automated system. Her settings are great. She's not eating.
She's sleeping. Like, you know?
Right. There's nothing happening.
I'm at the point now I with automation and good settings, I don't know how long you couldn't fast for, but
Mhmm.
I've seen it go for twenty four hours without a problem when somebody's sick or something like that. But nevertheless, she gets up and then 21 years old does not pre bolus enough for her food.
Right.
And I watch her blood sugar just go whoop. It's heading up. The algorithm's pushing back, pushing back, pushing back. She gets to two twenty. It comes back down again.
And I'm gonna tell you that I wish she would pre bolus, but that's still gonna be like a 6.4 a one c, you know, over over the long time. And to be able to just walk away from that and say that is a big step for me even because when I was in control of it, I would have thought, like, we cannot I don't want this to happen. And by the way, I don't want it to happen. I don't think it should happen. And if she would have pre bolus 10
It wouldn't have.
It would not have happened. Mhmm. But I also think she'll get there one day. Yes. And so and I've had conversations with people, Erica being one of them, about this topic.
And I asked her, like, I said it to her one day, like, why would I'm trying to wrap my head around, like, why would people with type one not just pre bolus once they know to do it? And she said, Scott, I have trouble doing that. And she's like, I've had diabetes for, like you and Erica are in a race. You both have had diabetes for, like, over thirty five years. Right?
And she was like, I've had diabetes for, you know, almost four decades, and I struggle with that every day. She's like, it's not a thing your brain wants to do or mine at least. So, anyway, when you talk to people about pre bolusing, I'm sure you explained that to them, but is there a way you can get them to it? Is have you figured anything out?
Some of the way is especially with those who are fiddling
Mhmm.
As much. Some of it's actually bringing up data and looking at it together in a framework of what are they eating, you know, if it's about the same like, I usually look at the same time of the day. Right? Focus in one place before moving on. And for people that are more visual, it's interesting to see how they react once you show them their own data and the timeline of the bolus and the carb entry both went in here, and your blood sugar is going up within five minutes or ten minutes of that entry.
I can tell without asking you. I can tell that there was no pre bolus there.
Mhmm.
The c I mean, the CGM data may not be accurate number wise all the time, but that trend line should be a really good friend.
Yeah.
It is telling you the direction your glucose is going. Mhmm. And that for many people, it's an eye opener of, well, gosh, how do I stop that? And for the fiddlers, it's I just add more insulin.
Mhmm.
I get add more. I add more. I'm like, this is not a more insulin because if we look at the data on a day where you were willing to hold your hands off
Yeah.
Did the blood sugar actually respond eventually and come back down? Then it's not a more insulin issue. Timing. Instead, this is timing. Yeah.
It’s Timing, Not More Insulin 26:10
This is you ate within five minutes of taking that bolus, and that was definitely noticeably not enough time. Mhmm. So let's let's do an experiment. Right? And, again, I would say most people are very willing to at least experiment with prebolising.
Try. Yeah.
And try to. Right? And once you start seeing progress and you start seeing that positive result, it builds positive reinforcement. Certainly goes a long way. Right?
It builds that. And for many people will then become enough of a habit that they keep doing it because they see the results that they want. And as we started out with, like, the overwhelm Mhmm. Drops down because they aren't having to follow-up outside of alarms Yeah. Wherever those are set.
And I would say that some people even then step in and say, well, maybe I'll adjust my alarms to be a little bit tighter so that I can take that overwhelming look at the data, look at the data, look at the data, do something about it. I can take it out of the picture because I've got my alarm set, if it goes off, then I need to pay attention to it. But, otherwise, my settings are doing what they should be doing. My ability to pre bolus or time this well, it seems to be working out. Mhmm.
Most of the time, it decreases that load of interaction.
Yeah. I don't know that we I because some people are great multitaskers. I don't know if you if you I've been looking into this lately, and I'll probably bring it up when I talk to Erica. The human mind can actually only focus on one thing at a time. Even when you think you're multitasking, you are swapping one thing out of the spotlight for another thing.
There's a a bubble around the focus of things that you can hold in your head, and it's only, like, three or four things. Like, so when you start thinking about actual life and then you add diabetes on top of it, that's already too much. You can't then go adding more stuff on top of diabetes. Like like, diabetes is enough already. Don't give yourself 50 extra things to think about.
Right.
Why People Won’t Pre-Bolus 28:17
I'm gonna try to figure my way through that. But back to the idea of pre bolus thing, I think it's interesting that I'm trying to understand the psychological aspect of the person who tells me, I know I could wait, but I don't want to. Like, I it's one thing if you're eating because you're getting low. I that's different. But if you tell me, I'd love to have a handful of pretzels tonight while I'm watching television.
Well, then grab a handful of pretzels, put the insulin in, and wait. Right?
Like Right.
That doesn't seem insane to me. I was like, but people's answer back, and this is the thing I'm gonna have to dig in with Erica a little bit, but I am gonna I wanna ask you from your perspective too. What is that, like, that feeling? Maybe you don't experience it of, like, I don't wanna be told what to do by diabetes because I think that's what it is after talking to people. Like, I don't want diabetes to dictate how I eat my damn pretzels, but I don't know if I'm right about that.
It's just me talking to people.
It's a situation of where are you socially in that moment.
Okay. Yeah.
I can definitely tell you that it is while I'm over the I don't care if I'm sitting here and everybody else is eating, like, that's well beyond me any anymore at this point. But I can understand the perspective of you grab the bag of popcorn or whatever from the cupboard, and you're gonna watch the movie, and it's starting right now. And you wanna dig into the popcorn. Yeah. Right?
I get that, and and I think it's harder to wait when you see everybody else is digging into that popcorn right now. And there is no there's no need for them to wait. There's no need for them to take anything else into consideration when you're the one sitting back and
Does it hurt?
And waiting.
Do you know what I mean?
It's an emotional feeling of just, I guess, you feel irritated that they can't wait for you. So I think there's a piece there. Like, why don't they just get, like, I'm not eating yet. Can't they just wait like that? Can we all do this?
And some families do. Mhmm. I will say that's that's the way that some families work it or they work the parents work the pre bolus in so that by the time they're all sitting down, the pre bolus has already been working, and then the child can start to eat with the rest of the family and whatever. Right? But I think there there is twofold.
And then there's the personal attack on yourself, like, and now I have to sit here and I'd really like a piece of popcorn. Right.
Also, and Erica Erica talks about that body grief too. Yeah. That sadness that your body doesn't do what it's what it's supposed to do or what you would expect it to. I should say too, for me, I could sit and wait, but I don't have any of those outside pressures. I'm not looking.
I don't have that feeling of, oh, I can't believe I can't just start. Like, I'm deciding instead of being told. Maybe that really is the answer. Hopefully, we'll come to a way to figure out their way around that. Yeah.
I have a couple more for you. Do you have time?
Okay. Yes. I've got some time.
What Automation Handles (and What It Doesn’t) 31:14
So if auto modes are supposed to carry, like, a little bit of a load, what's the algorithm actually handling, but what is it not handling? Where should our effort be put in, and where should it not be? Big question maybe.
So it is it's a really it's a big question because I I know that algorithm in general doesn't speak to the algorithms that are available. Each of them has their own set of rules that it follows
Yeah.
In terms of how it's going to step in and help to handle things with and for you. Right? I think a good example in this conversation does go along with what you said about what you watched with Arden the other day. Right? It's okay.
She didn't pre bolus when she got up. She wanted to eat right away. That's what she did. She's young. Her brain isn't fully formed yet in the track of I can do this because this is important.
Right? So she ate. Her blood sugar went up, and you watched. You you sat on your hands despite Scott in younger ages with a younger daughter, you would have stepped in and also done something. But you also have a couple of things in hand here.
One is an algorithm. That's an aggressive algorithm. Your algorithm, you trust the settings Mhmm. Because you know what she needs. And you could watch and you could wait knowing that despite not liking the 200 blood sugar that it was going to address it, and you wouldn't have to step in and help.
And it was also not going to cause her to go low.
Right.
So I think there are a couple of things to define within an algorithm. It's what kind of algorithm is it? How heavy handed can or can it be or how heavy handed could you set it up to be? Mhmm. Some of them are adjustable, others are not so much.
And then when we're talking about food, none of the algorithms will really hold your blood sugar without announcing food.
Yeah.
Across the board, DIY, the open source, as well as the FDA approved systems. What people adjust is their expectation of target range.
Mhmm.
That is what I have truly seen is parents who are stepping back from navigating with their teenagers and letting them take over and letting them figure it out with some of the set guidelines that they've done. They have to widen their their target range. They have to widen it and say, you know what? My kid isn't gonna pre bolus for thirty minutes. They're sitting down at lunch, and they only have fifteen minutes to eat.
School doesn't do anything because they don't step in and help anymore. My kid boluses as they walk to the to the, you know, cafeteria. But my settings are really good, and I'm okay allowing them to get to one sixty, one eighty because I know that the algorithm will carry it out as long as they at least announce the food.
Yeah. It's difficult to expect a a child or an adult, honestly
It is.
To do that. It is interesting when you're doing it for somebody else. Like, you brought up popcorn at the theater earlier. We'd be driving to the theater, I'd ask Gardner, are you thinking of getting one of those slushie drinks? And if she said yes, I just threw in 10 carbs in the car.
And then, like, as we were walking through the door, I bolus for, like, more, and then hit her, like, a third time when we sat down, and she wasn't gonna do that. You know what I mean? And I don't know that I wanted her to, to be perfectly honest. So No. Then there is a separation later when you have to say, well, they're their own person.
They're getting older, etcetera. When people are still doing things manually and they shouldn't have to be, like, what do you think that's them trying to protect themselves? Like, what do you see from people? Like, when you're going, god, stop touching it. Like, we got it set up.
Like, it should be working. What's the feeling you get back from people?
I get a sense from looking at so much data
Mhmm.
That what people are doing manually that steps outside of what they should be doing is much relative to expectation. And, again, kinda goes back to which a lot of this does is what is their target? What are they aiming for? What range are they aiming to stick in? And what are they willing to wait to see happen before they step in?
Right? They're doing a lot manually of a little bit a little bit a little bit. I see it across the board in a lot of the systems and even, you know, the open source systems that you can step in as a caregiver remotely and add a bolus or nudge it or enable something or disable something. Well, some of that's necessary depending on the situation you know is coming, but a lot of the manual manipulation, you're stepping in before you're even allowed the system to do something to help you. Mhmm.
You're not using the technology to your advantage.
Yeah.
And then you have to start thinking, well, do I have to go back to the basics? Am I doing this more and more and more recently because I don't trust my settings? Then, gosh, step back and reanalyze your settings. Yeah. Get back to just normal, you know, meals without going vacation meal and see is it the fact that I've been eating vacation meals more.
That's the problem. And my settings when I eat normal chicken and broccoli Right. Goodness. They look just fine.
I hope it's comforting to people to know that there's still times when I look and I think this needs, like, an extra unit and a half here. Mhmm. I think. But I gotta wait a minute to find out for sure. It's too soon for me to decide.
And the difference between now and ten minutes from now is not gonna be that big of a deal. There are just times I look and I go, oh god. Like, we got arrows up. This is all wrong. More insulin.
Blah blah blah. But there's also times I go, I feel like more insulin, but let's wait a minute and see. Or if I put in an amount here, is it an amount the algorithm can take away on the back end? Because then I'm not as scared.
Right.
Am I pushing it to a point where the insulin on board is gonna be too great for the algorithm's ability to take away basal later to balance it if necessary? That's happens pretty fast in my head, but it still pauses me sometimes. So I'm like, I'm not sure. You know?
And what you have and what all people should get to the point of understanding, and we've talked about many, many times, is just understanding your insulin action.
Yeah. Yeah.
Right? Because you have that in what you've just described, you can take the scenario happening right now. You can look at what's happening. You can say, give like a whole extra unit, but it's subconscious, honestly. It is.
The way that your brain thinks through
it Yeah.
Yeah. You can see what's already been happening. You know the algorithm that that Arden is using, and you can say, I can hold off because I'm either expecting in the next fifteen minutes of waiting that the system's got it and I'm good. Or if I am thinking in the direction that maybe we undercounted or maybe we misjudged or whatever that I could throw in an extra unit. And yes, based on her insulin needs, the system can subtract enough or suspend enough or whatever.
So it will catch it and I won't even need to step in there either.
Right.
But you have to understand insulin and how it works Mhmm. How to time it, and you have to understand your algorithm and what it's going to do and not do for you.
What “Done” Looks Like 38:41
Okay. My last question for you is MDI manual pump algorithm based system, doesn't matter to me. When you see somebody who has it set up and it's working right, their CGM is working right, you know the data you're getting back, everything looks solid, like, when you see that, what does that look like day to day life? Like, what does a well set up running system look like as far as people's interactions and their outcomes?
Right.
How do I know I'm in the promised land? I guess. You know what I mean?
Yes. How do you know that, like, there's not much work to hear to do here. Please be on your way
and come back. Yeah. How do I know I'm done? Yeah.
Yeah. Yeah.
Yeah. That that's my question. What's what's done look like?
And done being, like, short term. Yeah. Right for now. Right? You're done.
Right.
Right. Right.
It looks like, I guess, defined by the person's target range. Are they nicely rolling through that target range? Can you see where the meal entry was? Can you see where the bolus was? Does it look like there's a nice swing up that should happen if you are eating carbohydrates?
There is a bell curve that happens in the aftermath of a meal. You can see in the data where the insulin really took hold
Mhmm.
And the action of the system if they're using an automated system or even with multiple daily injections, can almost see the peak and the clearance of that and where the basal, which is well figured out in either scenario, where it caught that and then things just sat nice and stable for them.
Okay.
Right? So it is a lot more, I say, gentle rolling hills.
Mhmm.
And when I look at automated systems and the data, I can typically tell when somebody is stepping in mainly because when I look at their total daily insulin use, automated systems, especially the the open source systems, have little tiny extras in assistive that it pops in along the way. It's always giving and taking. All of the algorithms are Mhmm. Of any system. But you can see it's got tiny little nudges to things on their typical day to day, and it's smooth transition of data.
Okay.
Whereas larger boluses in between, and the frequency of those boluses that are not coming from a system generally tends to create a lot more jagged looking Up and down. The up and down. The true roller coaster, I say the Rocky Mountains, it's up, down, up, down, up, down kind of look. And those boluses are often much larger than what the system would auto populate in.
Yep. Okay.
And all of the systems also give I should not say all of them, but some of the, you know, other systems like Tandem, for example, the the Control algorithm. The nice thing about looking at the data is actually that it tells you when the bolus was overadjusted or underadjusted by the user. So Control IQ has automated give that it will pop in as needed as well as positive temporary basal changes. But anytime a bolus is requested based on a blood sugar, if the system was gonna give a bolus, it has information about whether that bolus was overridden or underwritten by the user.
Oh, nice. Yeah.
Which is quite nice.
Yeah.
So
Okay. We have all this as good as it can be. What are the things we can't fix? Like, what are things that are gonna happen even with great settings and even with great timing? Like, what are the just the, like, okay.
I have to just give myself over to like, what do you think of when I ask you that question?
What You Can’t Fix: Illness & Growth 42:28
Yeah. I think it makes me think of the times that you do have to do some fiddling. You do have to do some stepping in. Honestly, that's not incorrect. Illness, growth times where because you know that more is needed or less is needed.
Let's say illness, for example. More is needed, but the base settings weren't adjusted to accommodate for illness. Mhmm. So you may have to step in, and you may have to do things more frequently. And in that, I usually tell people to also get an idea of about how much did you nudge in or about how much did you pull back because going forward, at some point, you're going to get sick again.
Yeah. Something's gonna happen.
Right? And something's gonna happen, but now you have a base to use rather than just fiddling every fifteen minutes with more more more or adjusting with temporary rates or adjustments or whatever they are. Right. You can use that to have something to start with the next time. Gosh.
Last time I had a cold, I needed 10% more insulin. I use this much more in a temporary basal really helped. Great. That should mean you're not fiddling as much then.
Yeah. I can't thank you enough for doing this. I I like this is a different kind of conversation around stuff that we talk about all the time. Hopefully, it helps people think about a different way. I would urge people if any of this made sense to you and you wanna dig deeper into any of it, the pro tip series that Jenny and I made will probably help you walk it through, more granularly.
Yeah.
Wrapping Up & What’s Next with Erika 43:55
Yeah. So Awesome. Thank you very much. And then the next part that people hear either I've worked it out so that in editing, you've gone back and forth with Erica, or the next part right now is gonna be Erica kind of addressing the mental health side of, you know, some of these things. Questions like, you know, okay.
I've, you know, I've I've reduced the load on myself here, but I still feel overwhelmed. What can I do to help with that?
So No. I'm super excited that you're gonna add that piece in with this because I think that overwhelm is a real it is a real thing. And even with settings adjusted well, we have to also know, as we just talked about, how to address a variable and then getting off of that roller of adjustment again and finding some ability to step back and feel okay just settling.
And yeah. Yeah. I would like people to know and if you're comfortable sharing how you feel as we go out here, even though you're, I think, very good at this, obviously, and you've got a ton of practice and time and professionally and personally, you still feel that overwhelm too, I would imagine.
At times, I do. I think that my overwhelm is more relative to a busier life in general.
Mhmm.
Right? I compare my navigation before children to navigation now with kids that are really busy. Right? And being the taxi driver and the parent that does things at school as well as working full time and, you know, all of the things I think that that's where the piece of navigating almost like a third child. Right?
Could my consideration of diabetes is kind of like a kid that doesn't really grow up. You do have to still always step in and take care. There's more there to consider because as you mentioned, we can only have one or two things on our mind
Yeah.
To navigate in the clear moment. Right. And mom, I need this, and I didn't get that for the project and, like, whatever. And I'm like, I just really need the bowls for dinner. Yeah.
Like,
that's all. Jenny, what I hear you telling me is that diabetes is like a it's a child you have that never stopped in its pants. Is that what you're telling me?
There you go. You always have to you always have to change its diaper at some point. Yes.
Anyway, you'll know if you have a baby. I'll see you later. Jenny, thank you very much. I appreciate The conversation you just enjoyed was brought to you by US Med. Usmed.com/juicebox or call (888) 721-1514.
Get started today and get your supplies from US Med. 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.
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I think you're gonna find exactly what you're looking for at that link, including a way to sign up and get started with the Tandem Mobi system. 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 subscribed in your podcast app, go to YouTube and follow me or Instagram, TikTok. Oh, gosh.
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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.
If you'd like to hear about diabetes management in easy to take in bits, check out the Small Sips. That's the series on the Juice Box podcast that listeners are talking about like it's a cheat code. These are perfect little bursts of clarity, one person said. I finally understood things I've heard a 100 times. Short, simple, and somehow exactly what I needed.
People say small sips feels like someone pulling up a chair, sliding a cup across the table, and giving you one clean idea at a time. Nothing overwhelming, no fire hose of information, just steady helpful nudges that actually stick. People listen in their car, on walks, or rather actually bolus ing anytime that they need a quick shot of perspective. And the reviews, they all say the same thing. Small sips makes diabetes make sense.
Search for the Juice Box podcast, small sips, wherever you get audio. 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 wrong way recording dot com.
- When management feels overwhelming, the first move is often to do less, not more. “Fiddling” — touching settings and stacking insulin all day — usually adds variability instead of removing it. Taking your hands off and watching what your settings actually do is a real skill.
- Basal first. A well-set basal is the foundation that makes carb ratios and correction factors work — if it’s off, everything downstream gets thrown off, and a stable overnight tends to set up a calmer day. Always test and adjust settings with your care team.
- The CGM trend line is your friend — it shows the direction glucose is heading. A rise right after eating usually points to a timing problem (pre-bolus), not a “more insulin” problem. Confirm any changes with your provider.
- Automated systems still need you to announce food, and changing manual settings in auto mode may do little. Knowing how insulin acts and what your specific algorithm does (and doesn’t do) is what lets you wait instead of over-correcting. Discuss your settings and targets with your care team.
- Some things can’t be “fixed,” only managed — illness and growth will need extra stepping-in. When that happens, note roughly how much you adjusted so you have a starting point next time instead of fiddling from scratch. Work those adjustments out with your care team.
- Eversense 365 CGM — The one-year implantable CGM — an episode sponsor.
- Tandem Mobi — Tandem’s smallest pump, powered by Control-IQ+ technology — an episode sponsor.
- US Med — Where Arden gets her diabetes supplies — an episode sponsor. Or call (888) 721-1514.
- Diabetes Pro Tip Series — The Scott & Jenny fundamentals series — episodes 1000–1025.
- Small Sips — Short, single-idea episodes that make diabetes make sense.
- Juicebox Facebook Group — The private community — “Juice Box Podcast Type One Diabetes,” 74,000+ members.
- Wrong Way Recording — Rob — Scott’s audio editor, and the reason he sounds 20% smarter.
#1882 Eric Benjamin, Omnipod's COO, Live from ADA
Eric Benjamin, Omnipod's COO, Live from ADA
Live from ADA, Scott talks with Insulet COO Eric Benjamin about Omnipod 5's new 100 mg/dL target, Omnipod 6, an updatable pod, and a closed-loop system for type 2.
Jump to a moment
- Omnipod 5’s lowest glucose target is now 100 mg/dL. Eric Benjamin said roughly half of users aren’t set to the lowest target — if tighter control is your goal, which targets are available is worth reviewing with your care team.
- An Omnipod 5 algorithm update (rolling out by app, started June 3) is designed to keep the system in automated mode longer and ask for fewer manual interventions during prolonged highs. It requires compatible pods.
- Insulet says Omnipod 5 also added compatibility with the Freestyle Libre 3+ sensor this week.
- Omnipod 6, described as due to launch in 2027, was framed around a new algorithm, hardware changes for more wear locations (less ‘line of sight’ dependence), and an updatable pod that can update during priming.
- Insulet is developing a fully closed-loop system with no required inputs, aimed first at people with type 2 diabetes in primary care; for type 1, Eric described continuing with ‘bolus-optional’ systems so users can choose how engaged to be.
- Omnipod — Eric Benjamin is COO of Insulet, maker of Omnipod
- SugarPixel (CustomType1) — John's device; Scott sat at the SugarPixel booth at ADA
- Diabetes Pro Tip Series — Foundational management series (verify URL)
- Bold Beginnings Series — For the newly diagnosed, with Jenny Smith (verify URL)
- Juicebox Podcast Facebook Group — ~85,000 members (verify URL)
- Juicebox Podcast — All series and free resources
Every word of the conversation
A First: Recording Live at ADA0:00
Welcome back, friends. This is the juice box podcast. Well, this is new for me. I have never, in twelve years and over 1,800 episodes of making this podcast, recorded anywhere but here at this desk on this microphone. But recently at the ADA conference, the scientific sessions, I had the, the pleasure of interviewing Eric Benjamin, is the executive vice president and chief operating officer at Omnipod.
Eric and I talked about enhancements to Omnipod five and some things that they're thinking about for Omnipod six and a few other little items. I think you'll find an interesting conversation. It was a new thing for me, not just not recording here, but as I sat down at Omnipod's booth, they have a beautiful setup where they make other podcasts and audio content and video content for themselves. I sat down and realized that I had never had a camera pointed at me when I made a podcast once in my life. I've never done it in front of other people, and I have never actually sat across from the person live who I've interviewed except for a couple of conversations that I've had with my daughter, which I don't think counts.
I'll tell you a little more in just a second. Nothing you hear on the juice box podcast should be considered medical oh, I haven't done this in a while. Live? Hold on. Nothing you hear on the juice box podcast should be considered advice, medical or otherwise.
Always consult your physician before making any changes to your health care plan. I can't believe I forgot that. I'm gonna get you to Eric right away. I just wanna let you know that being at ADA was really a terrific experience. I met a lot of people, many of whom are gonna become future guests on the podcast.
I really think it's gonna enrich the the show and its content. Met some people from the DIY community who are gonna come on. I actually just got an email from one of them today. I'm gonna get that set up. I met a lady who's writing a book, and she wanted to interview me for it because of how much the podcast has helped her.
So she's gonna come on and interview me here where you can hear it. Hope that's interesting. Had a great had a great time, like I said, and I and I I sat most of my time at ADA at the SugarPixel booth with John, the owner, and his family. Just wonderful. If you don't know what SugarPixel is, check out customtype1.com/juicebox.
Just a great little device, and and John's doing a lot of fun things for people with diabetes. He and I will actually be at ADCES and Friends for Life together. So if you're gonna beat any of those events, please come out and say hi. We'd love to meet you. And now without any, further ado, which I hate when people say on podcasts, but here I am saying it, this is Eric Benjamin.
Meet Eric Benjamin of Insulet2:40
Welcome to the Juice Box podcast. Could you please introduce yourself and let everybody know, who you are and why we're here today? Hey, Scott. I'm thrilled to be here on
the Juice Pucks podcast. I think I mentioned when we were standing aside that, you know, you're a celebrity in diabetes circles, so it's my privilege to be here with you on the show floor at here at ADA at the Omnipod booth. My name is Eric Benjamin, chief operating officer for Insular Corporation, and excited to talk to you about what's going on.
Oh, that's awesome. Can I learn a little bit about you before we jump into everything? Would love it. How do you end up with this this job?
I came to Insulet about eleven years ago, and I had worked with some people once upon a time at a company called Guidant making coronary stents and catheters. And some of them had found their way to insulin in 2014, and they knew me. And they said, hey, Eric. You should come join us. And I came, and I fell in love.
I fell in love with our mission to improve the lives of people with diabetes around the world, the culture and incredible people who are driven to build a remarkable business while we improve the lives of millions of people. And those two things are still true, and we have a huge job to deliver the innovation and impact that inspires all of us.
Back then before you came, what do you think your core skill was that was gonna be valuable here? Did it end up being that, and what have you figured out since then?
I'm not sure I have a core skill. Okay. I'm my my I I've always found myself, you know, as the person that challenges are handed to, Scott. And I spent my first ten years orbiting manufacturing quality and r and d. And I came to Insulet actually to sell licensing deals for our technology to pharma companies.
We have some partnerships with pharma companies to supply custom versions of our device to deliver other medications. Sure. And I came to do that and ended up finding my way applying some of my learned skills, you know, leading the team to develop our products, bring them to market around the world. And it's been an amazing eleven years. That's interesting.
I'll tell
you that my mom had a battle with cancer. And one of the moments that I think she actually enjoyed doing that was telling my daughter, like, look. I have your pump on. And because she was having she was getting medication delivered through a pod.
Through new the Neulasta Onpro device.
Yeah. That's exactly right. It it was like honestly, I don't know that my mom ever really understood my daughter's diabetes completely, but they had a moment together where she's like she got on the phone. She's like, hey. Wait.
Can I can I video chat with Arden? I wanna show her something. So, anyway, it's it's
an amazing moment. And it's amazing what people connect with about fully appreciating life with diabetes. Sure.
No. It it it really is. So you get here. You're the how do you end up in the job you're in now, though? Did you put up an you put out enough fires?
They were like, hey. This guy really knows what he's doing, what happens?
Yeah. It's not so much fires, Scott. It's just, you know, we're we're a company that in order to grow 20% a year for the last ten years, we're on our way to doing it for Yeah. Year 11. There's just a lot of new challenges in the organization.
And so in some of my early years with Insulet, when I was done selling licensing deals to pharma companies, I stood up our external supply chain and, you know, helped build the reliability and quality that we now rely on in order to get high quality components into all of our factories around the world. And then took responsibility for our R and D team starting in 2018 and have grown from there.
Oh, that's an interesting job, isn't it? So you know what's so when at the end of this, I can ask you what's coming with Omnipod six, and you actually know.
I do know. At this point, I think most a lot of people know, Scott, but I I have the the pleasure of working with the people who do the remarkable work that makes products like Omnipod six a reality.
I'm gonna ask you questions later, and maybe maybe we can get some details for people. So what what do you see as the goal of being at ADA for Omnipod this year? What what's your messaging? Scott, the thing
Omnipod's Message at ADA6:31
that is so amazing about being at ADA this year is the amount of data, clinical data, coming out to support so much innovation. Earlier this week, we launched some algorithm updates for Omnipod five. Mhmm. And over the weekend, we're gonna be showing the first clinical data of how those algorithm updates are helping people achieve better outcomes and stay in time and range more Interesting. Tomorrow at the show.
We released data on Omnipod six, the which is anchored by a new algorithm designed to give people even better glycemic control with less effort to get good outcomes. And we also released some data on the feasibility studies that we're working as we push towards a truly disruptive, fully closed loop product for type two diabetes. And we released that data earlier today too. Awesome. So it's been, you know, just a a show of inspiring clinical evidence paving the way to meaningful innovation for people's diabetes.
Can we pick third a little bit? Please. Okay. So Omnipod five, now I know that there's now a target of 100 because I was lucky enough to be involved in an ad where we all stood around on a set all day yelling 100. So I know that's one.
The Case for the 100 Target7:40
What are you seeing by lowering that target? What do you think is the value for people wearing the pod? The 100 target
is a is a big impact for folks. We actually we showed data at a d excuse me, ATTD a couple of months ago that first, only about half of customers use the lowest target. So we're actually out educating people that there are lower targets available in Omnipod five that are options to get tighter glycemic control. I can see you're surprised.
Well, no. You stunned me because I and I I sometimes I think I'm in a bubble. I think the people listening to this podcast are incredibly motivated to do well for themselves. I I don't know that I know one person not using the lowest target on Omnipod five. So but tell me the
number again. How many people don't? It's about half are not using the lowest target. And I would bet that even among your very engaged listening community, specifically, I bet there are parents of kids who are not using the lowest target. Okay.
So there you know, what we see is that parents of children choose to use higher targets for a variety of reasons, often fear of hypoglycemia. Mhmm. And then, you know, adults who are in care settings where they may be getting a little less attention on how to adjust Omnipod five to get the best clinical outcomes, a lot of them are still using higher targets too, and they could they could get a pretty significant benefit. We started down this road because you asked what's the benefit from a 100. Yeah.
And, you know, we showed at ATDD, it can be as much as five points of time in range of moving from one twenty to down to a 100. So it's a it's a big change for folks that can be available.
I have to tell you two things. First of all, I my brain works in such a funny way. When you just said, well, we started with your question. I thought, oh, did I ask that? And now I realize that was forty five seconds ago, which is, I guess, how my conversations end up going the way they do usually.
Reaching Patients Through Clinicians9:27
But tell me how you're gonna educate people to to to use that lower target. Like and how I mean, does it go through the clinicians? Right? Because you don't have a lot of contact with the the patients directly. So how or do you not do it?
You just hope that the the the community
Oh, no. We definitely do it. Okay. We have we have a we have a few levers. Before we started, you and I were having a chat about, you know, what's the value of companies like us being here at ADA.
And, actually, this is one of the vehicles that we rely on in order to get attention of clinicians and help them connect with the fact that, hey. But you may have a lot of patients who are not at the lowest setting. And if you want tighter glycemic control, have a look at, you know, the settings that they're using when they come into your office. So moments like this are part one. The second thing is, you know, our field teams that are out supporting clinicians in the market all the time are gonna be having conversations with providers to make sure that they know that the 100 target is available and that they have an option now to give people even tighter glycemic control.
And so that's a big part of what they'll be doing over the next few weeks and months as we pull through the launch. Additionally, there's two other levers. You know, we we do have direct contact with our customers, and so we have the option to make them aware of the fact that this lower target is now available, and we'll pull that lever. And we've actually we're just announcing and launching the full market release of Omnipod Discover, our data platform, which, actually has weekly insights in it for people with diabetes. And that also gives them some nudges and some ideas that maybe maybe they wanna explore Yeah.
A lower target to get titerglycemic
control. Website's coming soon?
Yeah. It's rolling out clinician team by clinician team. So as as an office sort of ops in, then our team gets them set up, and then people with diabetes who are cared for by the office can then get access to the part of it that faces people with diabetes, and that provides weekly insights directly to them on their care with support when they've done well, celebration when they've done well, and some ideas for how they might take better care of themselves.
So based on your experience, what do you think stops a clinician from either getting the information themselves or sharing it? Like, you you put yourself in because I really have trouble with it. I don't I I can't wrap my head around when, for example, someone says to me, oh, I tried to get x pump, but my doctor said they don't know how to use it. And my follow-up question is, could you not take an hour and figure it out and then help them? But, like, I talk to doctors and bring it up, they'll say, we don't I don't have time for that.
And so is there is there a lever in there to be thrown that would be valuable for everyone? Or, I mean, what do you see from your perspective?
I we see the reality that you're describing, which is, you know, we have huge empathy, respect, and gratitude for the work that HCPs who care for people with diabetes, you know, for the care that they put in. Right. They are incredibly busy people. And and I actually I have high empathy for the fact that they don't hear our messages the first time. You know, I'm I'm out in the field a lot with our team.
Okay. And, you know, it's a common theme actually that, you know, Rip will say to me. I I Eric, I I swear I've told them that five times, but they heard it for some reason in this conversation. And, you know, part of it is just about creating a moment where somebody can slow down enough to absorb new information. And if you're a health care provider charged with caring and delivering clinical care for the patients that you're responsible for, I think it's natural that they wanna understand the technology well.
What that means for us, Scott, is two things. The first is we dramatically simplify the technology. And so we work very hard during design so that there are as few inputs for health care providers to put into the system and to manage sort of as they're caring for patients. And second, you know, our teams out in the field are working hard to make sure that health care providers have the support that they need so that when somebody does want Omnipod, if that's the if that's the answer back, our team's there to say, hey. We'd love to have a conversation with you to help get this patient who really wants Omnipod.
We can help you through that and help you support that patient in having a great experience.
Outcomes, Simplicity, Fewer Barriers13:33
Yeah. So my perspective here on that is I feel like what it is you're doing. So making the the target lower at 100, but there's also other enhancements to the algorithm right now that I wanna know about. But you're doing that because it's your overall feeling that the less somebody has to touch it or understand it, the better off they'll be because maybe they weren't going to to begin with or maybe the doctor wouldn't. Like, are you trying to just take the I mean, I'm sure you have a tagline around this that I'm supposed to know.
But, like, like, you're trying to take the the the work out of it so they can have an outcome that's great. But then there are people who are lever pullers and knob turners who are probably irritated that they can't make more adjustments to it. So then if I'm putting myself in your position, my expectation is is you're trying to get to the point where the knob turners are happy and the people who would never learn are gonna be healthier. Is that the goal?
Yeah. You got it. Yeah. When when we if we just take a big step back, there's less than half of people who live with type one diabetes benefit from automated insulin delivery in The United States. So despite the fact that it's been a technology renaissance for ten years, you know, we are we're touching less than half of people who live with type one, and we're touching approximately five percent of those who use multiple daily injections live with type two diabetes.
The unmet need is huge. And, you know, what that means for us is we're focused on three things, basically, and all of the product development efforts that we think about and all the commercial go to market. It's first, how do we deliver better clinical outcomes? So why do we do something like a 100? Because we want people to get better clinical outcomes.
And we saw that we could offer tighter glycemic control with no additional increased risk of hypoglycemia. That's that's exactly the kind of bull's eye innovation that we go after every time we can. Okay. The second thing is we wanna simplify the technology, and we wanna do that because we know that diabetes is an incredibly burdensome disease. And giving people an option to use a 100 may, you know, at the margins, mean the system does more for them.
There may be a couple of moments in their day when they don't have to think about their diabetes because they know the automation's working harder for them in those moments. Similarly, you mentioned some other changes. We also adjusted how the automation keeps people in automated mode more and requires fewer manual interactions, especially during moments of prolonged hyperglycemia. And that's, you know, again, sort of pointed straight at this notion of simplification. Yeah.
We wanna make it as easy as possible for people to stay in automated mode because we know that's how they get the best experience.
What did you have to change to make that a reality?
So we adjusted how some of the safety controls that we'd built into the first generation of the algorithm, we adjusted how they operated. And in that first generation, there were moments where when the algorithm worked as hard as it could for a long period of time, it would ask for manual intervention. Because, you know, if you wind back the clock five or six years, we weren't sure how well CGM was gonna work, and we weren't sure, like or or pods gonna be not delivering insulin. And, you know, do people need to check something in moments where the algorithm had worked as hard as it could for a few hours? Mhmm.
What we actually saw in real life is we didn't need that safety constraint. We were asking people to put work into the system that they don't need to. And so we said, great. Let's design that out. Now people don't have to do that.
And so Omnipod five works harder for people in exactly the moments that they need it. Okay. And the final thing that we're always innovating for is to break down barriers. And, you know, that's part of why we think so hard about simplification for providers is part of the reason that penetration is low is that it's still challenging for providers to prescribe AID. We were just talking about that burden of all that they have to know.
And so if we have an opportunity to take away something that a physician might need to know to confidently prescribe, we're gonna do that because that'll make them more likely to offer AID to their people in their care.
You know, it occurs to me that instead of trying to change the way humanity works or the way people think or how things have gone for so long that we can't break free of them, just take them out of the loop. Right?
Yeah. You got it.
Getting the Omnipod 5 Update17:31
That's awesome. Okay. So Omnipod five is where it is now. How do people get it? Is it available now?
Are they gonna need new pods? They need a download? They need a what do they need?
They need an app update that's rolling out now. Mhmm. I sat next to a gentleman on the flight here who already had the latest iOS update. I happened to see his Omnipod five app as he was flipping between a couple of other things that he was doing, so we had a conversation. And, you know, I bump into Potters all the time, Scott.
And I I always tell him, look. I'm not a clinic clinician. I don't have opinions about your care. But if you want me to tell you a little bit about the technology, I'm happy to help. And so yeah.
No. He was all in. He wanted to know about a 100. He had just gotten a new iPhone, so he that had been how he'd gotten the app. But the app's just rolling through our customer base.
Started on June 3 and will be done in the next couple of days. A lot of people have it already, and you do need compatible pods. There's a little indicator on whether they're compatible. We've been shipping those for a while. So a lot of people do have compatible pods Okay.
To use the 100 target.
And those who don't, the next time they get a shipment, they will. Yep. That's awesome. And what does that leave? I hate saying that.
I always feel I always feel ungrateful. Like, people are like, here's more. And I'm like, but is there more? So is there more for Omnipod five, or is this gonna be what it is until we see Omnipod six?
So we also launched compatibility with Freestyle Libre three plus this week. So we had we made the algorithm changes, the lower target glucose and compatibility with Freestyle Libre three plus. At this point, that's what we've disclosed about Omnipod five because we are looking ahead with enthusiasm to Omnipod six Mhmm. Which data we're presenting this weekend, the STRiVE data, and then it's due to launch in 2027. So Omnipod six is coming quickly, Scott.
It is. Yes.
Okay. So I should imagine a bunch of people behind the scenes toiling away working for Omnipod six. Omnipod five is about where it's gonna be.
Again, we know that it's important that we keep delivering what customers need. And, you know, we have experience sustaining multiple platforms in the market today. And so, you know, we're not gonna leave customers behind, but we do also need to turn our innovation focus to make sure that we can put full force behind Omnipod six, which is gonna be a pretty remarkable product.
A Closed Loop for Type 219:48
You're good at this part of the job, but not the podcasting part. You save the Omnipod six stuff for the end. What are you doing? Everybody's gonna tune out if you tell them about the Omnipod six. Alright.
Don't you wanted to know about the closed loop system for type twos?
Absolutely. Let's
talk about that now. Alright. Alright. Well, we'll do it we'll
do it in the year order, Scott.
Why tell me how this is gonna help type twos, what this system does for them, and then get ready for the question when I ask you how come type ones don't have a closed loop system like that. So please. So
as you described, we've we're working on updates to Omnipod five, Omnipod six, and a fully closed loop system for type two. The the reason we started with type two is two things, Scott. The first is back to that, how do we break down barriers to access for technology? About seventy percent of the people who take multiple daily injections and live with type two are cared for in primary care. Mhmm.
And despite all of the work that we have done simplifying Omnipod five, despite our efforts, it's still too complicated for broad adoption by primary care. Mhmm. The amazing thing about the flake closed loop system for type two is that it's designed so that physicians can write it. It's as easy for them to write as CGM. Customers pick it up from a local pharmacy, bring it home, and they can start it without any required inputs.
There is an option to adjust the glucose target in so folks can do a little personalization. Okay. But there's no required inputs in order to get it started. And, you know, what that means and then folks can self start in their own home. Mhmm.
And what that means is it breaks down these critical barriers to prescribing where the GPs who are doing the writing don't have to be educated on things like basal rates and insulin to carb ratios and all the things that today are obstacles for primary care physicians writing AID. And similarly, customers don't have to be educated on BolaSign or, you know, what what it what's required in order to safely dose insulin. So it's a dramatic simplification designed to help bring AID to the millions of people cared for by primary care who use multiple daily injections of insulin.
Will those users have access to those settings through something you give them, or will it be through a phone, or is there are multiple ways to get to it?
You know, we imagine a pretty simple experience where just like in today's Omnipod products, there's an easy to understand target that offers just a tiny bit of personalization, but there's nothing clinically required Okay. In order to use the system.
But when somebody does put something, input something, they do it through a phone app?
Do it through a phone or a controller. Through a controller. Yep.
Where GLP-1s Fit In22:20
When you're testing that, do you have to take GLPs into consideration now because they're so widely used? Is that I assume. Right? Is that a thing you're gonna be thinking about about for type ones too? Because I fully expect GLPs to be I mean, you're seeing a lot of people use them off label now.
Right? So do you have any background on that for me? I'm just super interested in this.
So Yeah. Maybe to hit type two first and go to type one. Please. So yes is the short answer. GLP ones have been used in the treatment of diabetes for almost twenty years at this point.
I'm sure you know this well, Scott, but maybe for your listeners, you know, they began as diabetes medications and have been, you know, in use as part of the treatment paradigm, usually ahead of insulin and often with insulin as complementary therapies in the treatment of type two for a long time. Right. And what we see is that actually people who live with type two diabetes get the best clinical outcomes when they are using a GLP one and on AID. Mhmm. Because once they're at the point that they need insulin, they need insulin.
And then the question is, how do you make that insulin delivery as effective as possible? And guidelines now recommend automated insulin delivery, and what we see in our clinical data is that the people who are on AID and the GLP one do even a little bit better. And so we don't so we do take them into account, but actually we we celebrate that innovation for the fact that it works really well with AID.
No Settings, Self-Start at Home23:40
Before you move forward with the type two, it's like, I'm it's just hitting me what you said now. So I'm gonna get this device. It's gonna I'm gonna bring it home, and I'll put it on myself. There's no settings? How does it how do it know?
I
I love this moment, Scott.
Because we we we had a
few of these over the
last few months. Wait. Did you just say that I don't have to do anything when I get it? How how is it gonna figure me out and do the thing?
The short answer and actually, so Trang's gonna present data on this at during product theater tomorrow, but actually, we're gonna show how we started in evolution three, the the data presented this weekend. We started everybody. They put on the pod, and the system adapted to the individualized insulin needs, adapted to the individual individualized insulin needs of each participant in the trial and, you know, delivered overall time and range. It was really compelling and you know, significant improvements in time and range. And so, yeah, the intelligence in the system is there in order to start safely and then adapt to the insulin needs of people with type two diabetes.
That's awesome. Because you're reaching a population that just from my personal experience, it's just a a a close friend of mine who, you know, came to me three years ago and said, Scott, I have neuropathy, they tell me. And I said, well, you have type two diabetes or prediabetes? No. I don't think so.
And I went, you probably do. And I said, here's a meter. You you know what I mean? And I gave him a meter, and I said, you know, here's what I want you to was like, test yourself here, here, here. Make a little graph.
I'll come back next week. We'll look at it again. Right? I came back next week, and he said, I couldn't figure out how to get the strip in. And the and I I said, okay.
And I showed it to him again. Then I came back a week later, and I said, how are doing? He goes, I forgot. I didn't do this. Now between you and I, like, he's definitely prediabetic.
And if somebody could step up to him and just say, like, look. There's nothing to learn. There's nothing to do. I'm I'm imagining him in my heart right now. Like, he would be helped immensely by this.
How how are you gonna get from this amazing innovation through? Because you gotta go through GPs. Like, what's the new process to to get them out there? Is it you send the staff out and and tell them to tell the story, I guess?
Yeah. And it's moments like this where we show the clinical data and the potential impact of the technology. Clinical data and then physicians creating the opportunities for clinicians to learn from other clinicians is really impactful. And then the last piece, yes, is that we will we will staff and support our team in going and taking that message to primary care providers when we've got that technology ready to go broadly.
Yeah.
The the good news, actually, we're we're learning a bit about that now as we as we pull through the launches of Omnipod five this year. We're actually gonna be calling on a few GPs that actually care for about a hundred and fifty thousand more people with diabetes in the second half of this year. But it's good because it helps us start to appreciate the practice differences in GPs compared to endo. And so it exactly as you said, like, it's a different world, and we're getting ready for that so that we can do it with impact when the technology is ready.
When you look up at those GPs, are they anxious for this? Do you find them saying, oh, I'm glad there's something here finally to help these people. We haven't had a lot of success, or do you find that it's difficult to do they get scared of the idea of insulin, I guess, or or about pumps?
The the kinds of folks that we are building relationships with are people who are already prescribing insulin and already prescribing CGM. And when they see the pod and they see what it can do, they're incredibly interested. And then, you know, they they in some cases, you know, the ones who are at the leading edge, we're teaching them to prescribe Omnipod five today. You know, as the market leader, we spend a lot of our energy broadening the prescriber base because that's the key barrier to access for a lot of people's diabetes. Yeah.
But then we bump into a lot of them who are like, look. This technology is amazing. I don't have fourteen minutes to do that in an office visit. So, you know, they need the product that I was just describing, which is the one they just send it to the pharmacy. The patient picks it up.
They self start at home, and away they go.
When you hear stuff like that personally, does it frustrate you or make you sad? Like, what's your response when you because I'm a person who I deliver information to people that I know helps people.
Yep.
And when you put so much into putting it together and finding the right way to package it and deliver it, and there it is, and you feel like you're like, here it is, and they go, I don't have time. I I get frustrated sometimes. So I'm wondering how it feels for you.
It actually doesn't trigger frustration. It triggers motivation for me, Scott. And I think, like, that's the inspiration for the product we were just talking about that, you know, has nothing in it in order to start was we looked at we looked at the real unmet need. The real unmet need is caring, well meaning physicians do not have the time in order to prescribe today's AID systems to give the people in their care the benefits of technology. That's a super clear problem statement that we have been working on in order to deliver the technology to the world that's gonna help address that problem.
Okay. And and so, you know, look, challenges are just motivation. And, you know, there's there's probably fourteen million people insulin requiring diabetes thereabouts in the markets that we serve today. Mhmm. And only about ten percent of them benefit from automated insulin delivery.
And it's problems like this, barriers to access, barriers to prescribing that motivates us keep innovating and keep broadening who can benefit from technology.
Why Type 1 Isn't Fully Closed Yet28:55
So the question is, this type two system, is it informed by what you learned from Omnipod five, or is it about to inform what we're gonna see with Omnipod six?
Both is the answer to that. We have been we have been thinking about, you know, how do we simplify physician interactions? How do we simplify the wear experience for people with diabetes since the launch of Omnipod five, and I've been learning quickly. And so that, you know, Omnipod five is sort of the precursor for both. And but the spirit of simplicity, going back to our three pillars, you know, simplifying the experience to the greatest extent that we can, How do we eliminate, you know, bolus burden for people and reduce the amount that they have to manually bolus?
How do we increase clinical outcomes? Those two goals underpin both Omnipod six and the type two fully closed loop product, and we've taken technology learnings to both of those from Omnipod five. Okay.
So people are listening or hearing fully closed loop for type twos. Like, why is that not a thing that type ones can have?
Folks who live with type one, I think, will get there in an iterative fashion. I think what we see is that a lot of what is talked about as fully closed loop today are really bolus optional systems. And, you know, a few minutes ago, were talking about what about tinkerers and people who are highly engaged. And I think what we see is that within the type one population, in fact, even a little more broadly, within the population cared for by specialists, which are the folks who've been prescribing technology for, you know, ten to thirty years, the the the people with diabetes cared for in that call point want options. They wanna choose how engaged do they wanna be in the technology.
And and so and so for us, that says, okay. We need a a bullish optional system. We need to keep pushing the envelope of how good can the automation get so that the hybrid closed loop systems invite people to engage as much or as little as they want to. So I guess that's our vision, is that the people with type one diabetes, yes, we are innovating towards how can they choose to interact not at all with the system. But I think what we see is that a lot of them are going to choose to interact with it a little bit because of the realities of how quickly insulin works.
Right. And, you know, they may choose to bolus once a day or every other day or a couple times a day. But that notion of choice is, I think, what we see that's the right product for people cared for in what have been the traditional settings for AID systems.
From what you've seen so far, is there a tuning that one day gets us to a hands off, or is it about the insulin at some point? Like, do you think it do you think you get there eventually where you just you slap it on somebody and you're like, go ahead and that's that, or do you not see that in the near future?
I think it depends what clinical outcomes folk folks are targeting, Scott, and how carb heavy a diet is. So, like, today's technologies could deliver that experience for folks who are eating very few carbs. I think for the for the average normal diet person living with type one diabetes, for for them to feel like they're getting acceptable time and range, which I'll say is somewhere in the seventies probably for a motivated type one who's eating a normal diet, We're gonna need some help from faster insulins in order to deliver a truly hands off product. But I I think what's inspiring to us is that the journey to getting there is better and better automation where people may choose, yeah. Okay.
You know what? Maybe I'm only gonna bolus once a day
or maybe
I'm only gonna bolus on certain days, I'm gonna skip it entirely. And offering people that freedom to choose is super empowering as I know you know from your own work.
I try to remind myself, and I try to remind the audience too that, you know, even in my daughter my daughter's 22. She was diagnosed when she was two. There was a time when we were excited if they put out a new meter. It wasn't any more accurate. It didn't do anything that the old meter did.
It just looked different. We were like, oh, this is awesome. A new meter. And now we're sitting around going like, oh, so you made the the advancement of Omnipod five. When are you gonna make more to it?
When's Omnipod six coming? Have you thought about Omnipod seven, eight? Not you know? And and I know the world works that way now, but it's it's valuable to remember that there are people alive with type one diabetes right now who boiled needles in a in a pot of water to sterilize them. And I I get really excited about how quickly things are moving nowadays.
Inside Omnipod 633:14
With that in mind, if we're back here next year, what are we talking about? Are we talking about Omnipod six? And can you give me give people a little detail about it for those who haven't heard your announcements?
Yeah. When we're here next year, we're gonna be talking a lot about Omnipod six, and we'll be talking even more about the fully closed loop product for type two. Omnipod six is super exciting, Scott. Omnipod six is our next flagship Omnipod product. It's starts with a new algorithm back to better clinical outcomes, simplifying for people.
It's a big step on both of those from an AID perspective. Is it
a completely new stack? It's not Omnipod five zooshed up a little more? It's it is it a completely different like, is it a built a bottom up build, or is it in a is it iterating on top of Omnipod five? Or are you not allowed to say that out loud?
It's not so much about what I'm allowed to say. I'm actually just thinking about the question. I think one of things I've learned is we're all always standing on the shoulders of giants. And so even when one thinks you're doing something bottom up, one never is. Certainly, it builds on Omnipod five.
So we learned a lot from Omnipod five, and we saw some really powerful ways that we can improve outcomes for people when we pulled those levers in Omnipod six. In addition to the automation improvements, we're also improving wearability. So as, sensors have gotten smaller, the wear locations that people are wearing automated and delivery systems to keep connectivity high have become a little bit restricted. And, you know, we recognize that what people want from a wearable experience is they wanna wear it anywhere they can take an injection of insulin and still have great connectivity to a CGM. Yeah.
And so we're making pretty significant hardware changes in order to enable that for Omnipod six.
So next year, I won't have to say the words line of sight anymore. Is that what you're telling me?
That is our aspiration. Awesome. That yeah. I the gentleman I sat next to on the plane, on on the one hand, I was happy that when he reached to show me his body, he reached for the wrong arm, and I thought, oh, that's good. He forgot where it was.
And then he put it he reached for the other arm. Then he told me I had the two side by side. And and look. We as we aspire exactly as you just said to break the need for line of sight and let people have the freedom to enjoy the wearable experience where they want it. That's really awesome.
There is one more piece of Omnipod six, if I may.
Well, yeah. Tease me. Tell me what's happening. Let's go.
The the last piece of Omnipod six is it's it's an updatable pod. So in with Omnipod five, when we launch new innovation, we actually have to start it in our factories. Oh. And so and it's often a new physical skew that people have to pick up in the pharmacy, which takes six to nine months. We were making pods that were compatible with Freestyle Libre three plus in our factories at the end of twenty twenty five, and we're just announcing that launch this week because we have to make enough supply, get it into the wholesale channel, and get it in the hands of customers.
So, again, back to our principles with Omnipod six, we've got a fully updatable pod, which means it's easier for prescribers to prescribe because they've just one SKU to write. And it means we can accelerate innovation to customers because when we have an update, we can actually push updated pod software to the pod hardware through app updates, which is really cool.
Wait. Is what you're telling me is that some of it's gonna live on the pod, but some of it'll live on your phone? Or no. You're telling me that when I put the pod on, it's gonna update?
Yes. Get out
of here.
It's it's
very cool. Did that person get a raise? I don't I don't know the answer to that,
but I I think they probably did.
Yeah. That's a May so if I have a you make a pod and it's version a, and you guys have updated to version b. I put a on. And during the priming process, it updates that pod, and it's ready to go with the new the new brain.
You got it. You're good at this.
No. No. Stop. And and so we do you have to go back to the FDA as much then, or does that does that that doesn't stop that?
Yeah. It doesn't really change the regulatory requirements. There will be some things that, for various reasons, it takes us a couple generation to be able to update absolutely everything on the on the pod, but we'll be able to update a lot of the technology on the pod during priming exactly as you described.
That's exciting. And it brings people stuff quicker, probably eliminates waste, and a lot of other things. Right?
You got
it. Really appreciate you doing this with me. Thank you very much. Likewise. This was fun.
So I'm glad you think so. I thought so too. Yeah. It was. Thank you again.
Wrapping Up37:20
If this is your first time listening to the Juice Box podcast, I'd love it if you'd subscribe and follow in your favorite app, Apple Podcasts, Spotify, or wherever you get your audio. There's also a ton of free offerings on my website, juiceboxpodcast.com. And if you're looking for community, we have maybe the most active and lovely Facebook group wrapped around type one diabetes. It is called Juice Box Podcast type one diabetes. And as of this recording, I believe it has 85,000 active members in it.
It is really maybe the most lovely place you'll ever find online. You should check it out. Even if you just wanna lurk around, It's a great place to feel, you know, like somebody's got your back.
If you're looking for
are you looking for if you're looking for diabetes management content, check out the pro tip series, the bold beginning series, or any of the other, I think, like, 26 different series that are available on the podcast. You can find all of those again on the website juiceboxpodcast.com. That's pretty much it, really. I hope you enjoyed this. I enjoyed bringing it to you.
Again, really did enjoy being at ADA, meeting Eric and actually a ton of other people who are gonna be on the podcast because I was able to meet them in person and and have nice conversations. And we thought, oh, this is this is good. I wish somebody else was listening to this. We're gonna be talking about DIY algorithms with people I met there, a lady who's writing a book about diabetes that I found very interesting. Gosh.
The the person who makes glow gummies. And I think we're gonna be doing some stuff with other companies, and it's gonna be great. It was a it was a really good time, and it was definitely something that's gonna help the podcast to grow. So you guys are gonna get, gonna get more because of it. If your loved one is newly diagnosed with type one diabetes and you're seeking a clear practical perspective,
check out the
bold beginnings series on the juice box podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over thirty five years of personal insight into type one. Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one. You can start your journey informed and empowered with the Juice Box podcast.
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© 2007–2026 Juicebox Podcast. All rights reserved.
Recorded live at the ADA Scientific Sessions, Scott Benner talks with Insulet COO Eric Benjamin about what's new for Omnipod 5: a 100 mg/dL glucose target, an algorithm update that keeps the system in automated mode longer, and Freestyle Libre 3+ support. They look ahead to Omnipod 6 (new algorithm, wearability, updatable pod) and a fully closed-loop system aimed first at type 2 diabetes.
#1881 Subsistence Diabetes
Emily spent months farming in Tennessee, attributing her extreme thirst to an electrolyte imbalance. Today, she shares her grounded, "roll with it" approach to managing Type 1 diabetes.
Key Takeaways
- A Stoic Approach to Diabetes: Emily manages her Type 1 diabetes and Hashimoto's with a practical, "roll with it" attitude learned from her mother and her life as a farmer. She doesn't let the diagnosis overwhelm her, choosing instead to handle it as just another variable in her day.
- The Trap of Self-Diagnosis: Before being officially diagnosed, Emily attributed her severe symptoms (sweating, weight loss, extreme thirst) to working on a humid farm in Tennessee, convinced she just needed electrolytes. It's a reminder of how easy it is to rationalize serious medical symptoms.
- The Importance of Community: Emily highlights how simply hearing other people's passing thoughts and relatable experiences on the podcast provided her with a profound sense of comfort and connection that she was missing in her day-to-day life.
- Farming and Insulin Management: Working intensely active, 10-hour days on an organic goat and vegetable farm requires constant adaptation. Emily uses the activity mode on her Omnipod 5 to prevent lows during strenuous tasks.
- The Psychology of Settings: Scott and Emily discuss the complex psychology behind avoiding certain diabetes tasks (like taking a GLP medication or adjusting pump settings) and how doing so can sometimes feel like "admitting defeat."
Resources Mentioned
- ABLE Now: ablenow.com
- Dexcom G7: dexcom.com/juicebox
- Omnipod 5: omnipod.com/juicebox
- Juice Box Podcast Pro Tip Series & Tools: juiceboxpodcast.com
- Wrong Way Recording: wrongwayrecording.com
Introduction & Sponsors
Scott BennerHere we are back together again, friends, for another episode of the Juice Box podcast.
EmilyI'm Emily. I'm 30 years old, diagnosed with type one diabetes three and a half years ago at 27, and I had a Hashimoto's diagnosis right after that.
Scott BennerMy diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple, actionable tips. The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it @juiceboxpodcast.com by going up into the menu. 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. This episode is sponsored by Able Now, tax advantaged savings accounts for eligible individuals with disabilities. If you or your child lives with diabetes, you may qualify for an ABLE account because of ongoing medical needs, and many people in the diabetes community do. With ABLE Now, you can save for future expenses without affecting eligibility for certain disability benefits such as Medicaid. Learn more and check your eligibility at ablenow.com.
You spell that ablenow.com. Today's episode is also sponsored by the Dexcom g seven, the same CGM that my daughter wears. Check it out now at dexcom.com/juicebox. The podcast is also sponsored today by Omnipod five. Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections.
Learn more and get started today at omnipod.com/juicebox. At my link, you can get a free starter kit right now. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod dot com slash juice box.
Meet Emily: Double Diagnosis
EmilyI'm Emily. I'm 30 years old, diagnosed with type one diabetes three and a half years ago at 27, and I had a Hashimoto's diagnosis right after that.
Scott BennerThose are your two things happening right now?
EmilyThose are my two things happening right now. Yeah. The Hashimoto's came after a whirlwind of the diabetes, and I wouldn't know what my symptoms were in regards to that, if any. They said take a pill once a day, and I said can do. So So
Scott Benneryou think they picked it up in regular testing after you were diagnosed with type one?
EmilyThey actually, years before, found some levels that were off and even did an ultrasound and kinda went back and forth between this is a problem, this isn't, and landed on this isn't. So never started any medication. And then right after the diabetes at the doctors, they were like, you know, this side of your thyroid eye
Scott Bennerneck Neck. Yeah.
EmilyIs is really swollen. Right? And I was I had no idea. Nope. Didn't notice that.
And did more testing, and then, yeah, we've then we found out Went down. Hashimoto's.
Scott BennerLook at you. Big fun. Let me ask you a question. This is my first time asking somebody this. I've been thinking about this today, and I thought I would try it.
What do you imagine we're gonna learn in this conversation today?
EmilyYeah. I've been thinking about that as well. I think what it's the same piece that impelled me to reach out to you, which is I gained a lot of technical insight from your podcast and your resources with the Facebook group as well. But a huge component was just being able to relate even if it was one thing out of a whole podcast that somebody said. Mhmm.
Just being to relate gave me I mean, it's not like a piece, but it's a comfort. It's some it's something that is, I guess, missing in my day to day existing that I didn't realize until I felt it.
Scott BennerOkay.
EmilySo I'm not sure I have anything groundbreaking. I know I don't have anything groundbreaking to contribute, but maybe somebody feels like, oh, I can relate to that, and it just makes them feel, I don't know, comforted, a little more
Scott BennerOkay. Well, that's a great answer.
EmilyYeah.
Scott BennerYeah. Well, so you're saying that maybe the technical stuff aside or, you know, the help that, you know, when you're like, I don't know why this is happening when I'm bolusing or something. Listening to people's conversations, inevitably, someone says something that what maybe patches a little tiny leak in your your dam, and then those patches come on more and more and more and more, and all of sudden you sort of feel better?
EmilyYeah. Yeah? Yeah. For sure.
Scott BennerOkay.
EmilyFor sure. Because when I turn on your podcast, I'm just surrounded with people who may we have totally different lived experiences and maybe even interact with diabetes differently, but there's still something it's the diabetes connecting us. And, yeah, I guess just it's pretty simple. Like, somebody's stating something about their life with it or how it's impacting them.
Scott BennerEmily. Emily, do you know those do you know those moments in a movie when the scene is taking place in front of a crowd of people like a theater or on a football field or something like that? And they do that very kind of like ham fisted hooky thing where one person starts to clap slowly and then another person goes, oh, are we clapping? And then they start clapping, and then before you know it, there's, like, a thousand people clapping and 10,000 people clapping. It goes on and on, and that feeling it gives you.
Yeah. I wonder if it's that a little bit. I wonder if it's people standing up, putting themselves out, and becoming part of a tapestry of, in this case, sound, right, and feelings. And then eventually, you feel like that tapestry turns into a blanket. Maybe I'm getting rid of my damn analogy, and I'm going to this maybe.
EmilyI love a blanket. No. I think
Scott BennerHave you ever seen Rudy?
EmilyYeah. Yeah. Yeah.
Scott BennerBut you didn't love it. Some guy drug you to it and right? Or made you watch it at home or something, and then they let
EmilyI don't have a mind for movies. I if I see them, I am I immediately they don't So take up I'm not I'm this person.
Scott BennerSo that's okay. So so Rudy walks on at Notre Dame. I think this is, like, based on a, like, a true story. Right? And I believe if I'm not wrong, Rudy is one of those guys that end up being a hobbit at some point.
And, sure that's how he'd love to be remembered. And, and at the end, I think it's, like, his last possible like, they let him on the team. He's, like, a mascot though. Like, they beat him up in practice. He never plays, etcetera.
And they eventually let him on the field. This is, you know, a thing. I cried when they let Rudy play, and I didn't give a shit about Rudy. But I think it's all part of that, like, crescendo of emotion feeling. I struggle to put a name to that.
This is maybe boring to people, but I think about that feeling all the time and what that is. Like, why does it feel so good when a group of people come together like that? But nevertheless
Emilyyeah. Okay. Powerful.
Scott BennerIt really is. Yeah. So I will tell you this. You don't have to have a special thing to say in our conversation today for that to happen for somebody else.
EmilyThat's kind of You know? Yeah. That's kind of what I've gathered from from listening. I mean, a lot of people say a lot of special things, so no doubt. But Yeah.
Yeah. Just goes back to what we're saying. I mean, there's there's a lot of magic and simplicity in somebody just saying it in a way that you've had a thought about without thinking about it in-depth where it just ends up meaning more because it's as broken down as your passing thought.
Sponsor Break
Scott BennerOh, that's that's a nice way to think of it. Okay. Well, let's find out more about you then. So you're 27, and you're feeling what? Like, how did it come on?
Today's episode is brought to you by Omnipod. We talk a lot about ways to lower your a one c on this podcast. Did you know that the Omnipod five was shown to lower a one c? That's right. Omnipod five is a tube free automated insulin delivery system.
And it was shown to significantly improve a one c and time and range for people with type one diabetes when they switched from daily injections. My daughter is about to turn 21 years old, and she has been wearing an Omnipod every day since she was four. It has been a friend to our family, and I think it could be a friend to yours. If you're ready to try Omnipod five for yourself or your family, use my link now to get started. Omnipod.com/juicebox.
Get that free Omnipod five starter kit today. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. As I told you earlier, Able Now is sponsoring this episode.
Able Now, of course, tax advantaged Able accounts for eligible individuals with disabilities. If you or your child lives with diabetes, you may qualify for an Able account because of ongoing medical needs. Many people in the diabetes community do. With ABLE now, you can save for future expenses without affecting eligibility for certain disability benefits such as Medicaid. And thanks to updates to federal law, ABLE accounts are now available to more people than ever before.
That means more individuals and families can use ABLE now to save and invest. Funds in an ABLE now account can be used for a wide range of everyday needs, including education, transportation, health care, assistive technology, and more. There's no enrollment fee, and you can open an Able Now account with a small initial contribution and build from there. Learn more and check your eligibility at ablenow.com. That's ablenow.com, ablenow.com.
Farming in Tennessee: A Recipe for Misdiagnosis
EmilyOh my goodness. It came on. So I was diagnosed in October, and I was having symptoms since definitely May.
Scott BennerOkay.
EmilySo no. March, actually. It came on, and I I can only imagine all of these things, symptoms that I was having, are related to the diabetes because they were just nothing normal, and I couldn't place them to anything else. And then they basically just tumbleweeded into more and more drastic characteristics. So at first and this sounds so strange.
I don't know if it's related, but I was having severe shoulder pain. I couldn't move them at all for no reason. Every morning, I was, I mean, I was having I was nauseous. I was constipated. I was constant acid reflux.
I was having stomach pains, and, eventually, it comes on in into bigger and okay. So let me slow down, maybe. I was freshly on a farm in Tennessee where I hadn't ever previously lived. And so I and I had been for a year in kind of transient living conditions
Scott BennerOkay.
EmilyIn a state of settling in constantly or kind of just, like maybe not even settling in, but adapting. I'm placing all of these new things either really lightly because I'm fixated on the newness in front of me, or I'm attributing them to the new conditions that I never lived in. So I never lived in such a humid state, and I'm working outside six days a week, ten plus hours a day, living outside in the hottest summer on record and in such a humid climate. So when I start drinking x amount of water bottles a day and peeing five plus times throughout the night, I'm, you know, dehydrated.
Scott BennerCursing Tennessee. You're not thinking you're sick. Right?
EmilyNo. I'm thinking this
Scott BennerWhere'd you move from, by the way? Where were you prior to going there?
EmilyPrior to going there, I was living on the road with my partner for about three months.
Scott BennerMhmm.
EmilyPrior to that, we had come from a farm in Vermont that I had I'd only but he had been there for a season. I'd only gone to meet him after the wildfires in California where I was working kicked me out or I decided to escape Mhmm. From.
Scott BennerSo Let's take a second, Emily. Are you what they call a hippie? What's going on here? Or you just are you a farm worker or how do what is this? Explain that more.
EmilyThere's probably some crossover, but I wouldn't self identify as a hippie. Definitely a farm worker. Yeah. I've worked on farms, organic farms, that's probably for the last eight years. And so I had actually left Montana where I'm back to now to go out to a farm in California that my best friend was managing at the time.
Right before leaving Montana, I had met who's now my fiancee, and he was moving to Vermont, and I was moving to California. And so we had plans at the end of the season to meet up together. Things weren't going so hot in Vermont, so we were gonna go on this road trip. We were gonna, you know, see what we wanted to see, experience where we wanna experience whilst kind of trying to find the next place we wanted to farm together and, hope, settle in to a good fit somewhere, which Tennessee was not it.
Scott BennerYou you're breaking my heart, by the way. I'm leaving tomorrow to go to Tennessee.
EmilyOkay. Okay. Well, I mean
Scott BennerI'll find out more later. I'm actually going to give a talk in Atlanta, but I decided to drive and stop in Tennessee to see some some towns and stuff because I always I always talk to my wife about, like, I think we should move to Tennessee. And I don't I haven't been there since I was a kid, so I have no idea why I'm saying that. So I'm taking this opportunity to swing through.
EmilyNo. I think it's the best to just have a hunch about a place and wanna go because you wanna go and check it out.
Scott BennerThat's Okay.
EmilySuper exciting. And I think my experience of Tennessee is really tainted, and I try to separate that because the people I was working for were just not the right fit. And then, also, I'm suffering Yeah. For my entire experience without even without realizing it, but my body is just
Scott Bennerfully suffering. Yeah. I gotcha. Yeah. Between those two things, you could go back under a different circumstance and have a good time, you're saying.
You think?
EmilyOh, yeah.
Scott BennerYeah.
EmilyYeah. I think so.
Scott BennerBut how bad is the humidity? Like, what what are we talking about?
EmilyWow. So it was brutal. I mean, you're never not sweating. I you take a shower and granted you would probably live indoors, maybe with air conditioning.
Scott BennerMhmm.
EmilyWe didn't have that. That shower was outdoors, and then we had our living situation set up at the top of the hill above the farm. So as soon as you shower, you're hiking, and you're Sweating. Yeah. You're
Scott BennerI'm not gonna farm while I'm there probably, so that'll probably but what time of year were you there?
EmilyIt was there from March to September, October.
Scott BennerIn even in the fall and the spring, the humidity was existed?
EmilyIt did exist. Yeah. And so I live in Montana. It gets pretty darn cold. And I remember being there at the beginning of the season in March, and it was probably, like, 52 degrees out, something like that.
And I remember thinking it felt like 32 because of the humidity just made it.
Scott BennerMade it cool. Yeah.
EmilyCool. Old. It was yeah. And then yeah. Then there's no relief in the summertime.
It's just sticky and
Scott BennerWell, I think they're gonna put a thing on the moon. Maybe I'll go there.
EmilyYeah. Could that could hold
Scott BennerI don't know. I just I I so badly wanna be somewhere warmer, but not, like I also don't wanna be dripping the entire time. There's gotta anyway, I'll figure it out. Alright. Let's get back to you.
So you're you're down there suffering that's going terribly. Are you diagnosed by yourself, by a doctor? Like, how do you get to the medical help?
Sponsorship Break
Scott BennerThe 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.
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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.
The Electrolyte Trap & Acceptance
EmilySo I have kind of, like, always tried to approach things from a I don't know. I'll I'll research my symptoms maybe leaning towards, like, more holistic or natural solutions. And so I'm sweating buckets. I'm thinking it's my electrolytes are out of whack. That concept never left me for, like, eight months.
I was gung ho. My electrolytes are out of whack, so I'm just feeding myself with things I, obviously, weren't the solution. So that was me trying trying to self diagnose.
Scott BennerYeah. What gave you the idea about the electrolytes? Was it a thing you heard, or did were you googling, or what got you to it?
EmilyYeah. I can't exactly remember. I just kind of think by the amount that I was sweating, I thought surely I'm losing nutrients and disrupting balances quicker than I can replenish them.
Scott BennerI see. Not a crazy thought, by the way.
EmilyNot a crazy thought, but it easy to lock on to that and put your blinders on to anything else. And really think
Scott Bennerthat the sixth month of trying to, impact your electrolytes is when it was gonna come together. Yeah. Right?
EmilyPrecisely. The moment of diagnosis, I 100% knew that they just needed to hook me up to some hardcore IV electrolyte situation, and I was gonna be good. I knew that's what they were gonna tell me. Of course, that's not what they told me at all. But I don't know why, but I was just so
Scott BennerIt didn't occur to you to keep looking or thinking about something else. You felt like you figured out the problem and you were trying to address it.
EmilyYeah. I mean, I'm not sure how much I believed I figured it out. I mean, because I just had all of these crazy symptoms. Like, I was losing my vision. I couldn't remember things or hold conversations.
I you know, everything that could deteriorate was deteriorating in front of me. So it's hard to think back and think that I just believed that because I fancy myself a little more intelligent than that. But I think there's an wildly powerful thing that happens maybe in the name of self preservation where this is also happening in tandem. All of these all of these symptoms are becoming my new normal, and I start to think to myself, oh, no. That's how I always am.
Yeah.
Scott BennerMhmm.
EmilyMy gums bleed and are swollen a lot.
Scott BennerThat's It happens to people, doesn't it? So you think maybe it's a little bit of the brain fog, a little bit of the I can get through this, I can do this, and a little bit of the slow kind of drip drip drip of it if it changing and you're really being able to remember where you were before it started.
EmilyRight.
Scott BennerYeah. That kind of blend of stuff. Yeah. Yeah. What's that what's that fantasy you don't know.
You're not a movie person where they all go to that bar and then they get they realize they've been there for, like, twenty years already and it feels like five minutes. Like, I feel like that's part of it. Like, that feeling of, like, you just sort of get lost, you know. Okay. Okay.
You see, you finally what do you do? You break down does somebody help you get to medical care or do you actually make the decision?
EmilyI made the decision. So we left the farm in Tennessee. We were coming back to the farm that we previously worked on in Montana. So we're on the road. My partner's going straight to Montana.
I'm going to visit my mom in Oregon first. So I head there, and here's where I also solve all of my woes. I think to myself, well, I'm not gonna be working my ass off, and she has air conditioner. So I'm gonna sit inside. I'm just gonna I'm not gonna, you know, get into all this physical activity.
I'm gonna eat food, and I'll ride it all. All it'll all fall all the pieces will fall back in. Mhmm. Gain back those 30 pounds I lost, and, we'll be good
Scott Bennerto bada boom, we're gonna be right back to good. That's it. Yeah. Yeah. Yeah.
Yeah.
EmilyYeah. So so I got there, and I'm doing all of those things. Check. Check. Check.
I'm just getting worse, though. More and more fatigued. Turns out probably because I'm not moving. I think all the activity in farming helped maybe keep my blood sugar
Scott BennerA little
Emilya little Yeah. Yeah. Lower. It functional. So that more kind of stagnation whilst heightened symptoms was when I was really hit with this isn't right.
So I just made, like, a quick appointment for the for the next day at an urgent care or some kind of clinic right around the corner from her house. And so we went there in the morning, sat me down, took a I guess they took a finger prick. So I'm there all of five minutes before they come back in the office and say that I have type one diabetes. And I don't remember if I said it out loud or just screamed it in my head, but it has just I just remember saying, that's not me.
Scott BennerYou got the wrong chart. You're looking at the wrong piece of paper there. That's somebody else.
EmilyPercent. Yeah. 100%.
Scott BennerI just need a Gatorade. Did you not?
EmilyRight. Just hook me up. I need some of that sodium, potassium Yeah. Y'all got.
Scott BennerYou need a magic trick. But I'll be alright.
EmilyExactly. Exactly. And so they go my my mom was out in the waiting room, and they were asking, you know, do you want to tell her? Do you want us to tell her? And I was just thinking to myself, like, alright.
Well, you can lie to me, but you can't lie to that woman. Yeah. Bring her in. You tell her I have type one diabetes. And yeah.
So that was real.
Scott BennerYeah. And they they they stick your in an ambulance, or did they did they let you drive?
EmilyThey
Scott Bennerbecause you had someone with you maybe. But you went right to the hospital. Right?
EmilyNo. I didn't. What'd you do? I well, I went back to my mom's house. Think, you know, when I left there, they had said, like, we're really gonna push for you to get in with an endocrinologist as soon as possible.
And so I went back to my mom's. I think either that day or the next day, somebody from their office called and said checking in on me and said I should go to the emergency room. And my mom and I kind of looked at each other and was like, that's really expensive. You know? I think it was only maybe a few days later I got in with that appointment, maybe two days later or something like that.
I got in and, yeah, I had just kind of decided, I'm well, I'm just gonna keep breathing. I'm just not I won't die.
Scott BennerWell, that's not how that works there, Emily. But, we we so had you lost a bunch of weight?
EmilyI had lost yeah. I had lost weight that I didn't really have to lose.
Scott BennerOkay.
EmilyProbably thirty thirty plus pounds.
Scott BennerHow tall are you?
EmilyYeah. Five nine.
Scott BennerAnd when someone says type one diabetes, that sounds serious. Right? And you go back home, do you and your mom go, like, let's Google this and see what this means?
EmilyYeah. So those first few days from that appointment to the endo appointment, I can't remember the timeline, how many days were in between, what I did in between. After the endo appointment, though, that's when I came home, and I'm on Google. And I find your podcast out the gate. Wow.
And I start listening to maybe some of the defining episodes, and I'm just thinking to myself, bolus. Not once did she say the word bolus to me. I was like, they're not I've never had extreme faith in relying entirely on doctors and what they say. I take it upon myself to educate as well and consider, more than just what they're saying. So that's kind of what I was looking for and also just more information.
I kinda felt like they were treating me really timidly.
Scott BennerMhmm.
EmilyAnd I could handle a lot more. And so when I found your podcast, I just was consuming it because I felt like they weren't explaining anything of import to me probably to not overwhelm me, and that probably would work really well and would be what some people need. But
Scott BennerYou'd rather have the information.
EmilyOh, yeah.
Scott BennerI imagine if you go to a doctor and they tell you something, like, big, like, you have a thing, and then you go look online and find a bunch of contacts that no one mentioned to you, you have to think, like, why is no one saying that to me? How come the guy with the podcast or the website or wherever whatever you find? Like, how come they think all this is so important and yet the doctor didn't mention it?
EmilyRight.
Scott BennerRight? Yeah. That that's gotta be, off putting, I would imagine. Were you in DKA, by the way?
EmilyI don't know.
Scott BennerEmma, what was your blood sugar? You had to be in DKA. What what was your blood sugar?
EmilyI think that morning, it was 400 something, and my a one c was 15
Scott BennerYeah. There's you had no one ever said that did they put you on IVs, keep you in the hospital for days? How did all that go?
EmilyNo. I never even went
Scott Bennerto the hospital. To the hospital.
EmilyYeah. Alright. Listen. Emily, let
Scott Bennerme ask you again. Are you a hippie? Just say yes this time. I'm sorry.
EmilyIf you asked me that, twelve years ago, yeah. Duh. 100%.
Scott BennerYeah. There's some pictures of you in overalls with a bandana over your hair somewhere?
EmilyA couple dreads shouldn't have had for sure. Yeah.
Scott BennerI think I I think I could I could paint a picture of you in my mind. By the way, when you were like, don't really trust doctors, I was like, yeah. I heard you say you were from Oregon.
EmilyI'm not from Oregon. But is? No. She's moved around a bit.
Scott BennerWell, I was gonna say your mom's a hippie too. Like right?
EmilyI should've no. No. No. No.
Scott BennerWait. No. Your mom's moved around a little bit?
EmilyYeah. She's just she's real adaptable and Listen.
Scott BennerI think it's awesome. I'm just telling you, the people who are listening are like, I don't go outside and cut my lawn. This girl's worked on 17 different farms. That's pretty cool. I think it's really cool the way you're doing things.
But okay. So when you start digging in to figure out what's going on, how long does it take you and what helps it get through to you, the seriousness of this, and the fact that you, you know, you kinda have to bear down and you can't just treat it like, oh, I got a thing. I'll do a little insulin, and I'll go on my way.
"Rolling With It" & Finding Acceptance
EmilyYeah. I think something that I think about sometimes is just how as shocking as the diagnosis was, felt like it came out of thin air, nowhere land, I took it and, for the most part, didn't look back. That was it. That was my life. I have to figure it out, do good at it, and that's it.
I think it's almost like leading all it's kind of like the whole symptom section of life, prediagnosis that, you know, this is just my life now, and I I can live like this. It's like that, but in reverse and for the better. Over on this side now, I have diabetes, and I know that's for life. So I just wanna take care of myself. And, I mean, as soon as I got on insulin or really rather quickly thereafter, I felt like I had a lease a new lease on life.
I just felt like I had my life back, my mind back, my body was coming back. I felt good, and that's where I wanted to be. And so the decisions I was gonna make and, like, the priority I was gonna make diabetes was going to be to uphold what I just got back. You know?
Scott BennerYeah. Are you a religious person, or was it a a spiritual feeling? You just kinda just gave yourself over to it right away?
EmilyIt really goes back to how I was raised by my mom who is an excellent top tier example of rolling with the punches.
Scott BennerMhmm.
EmilySome huge comes onto your plate you weren't expecting, and she doesn't stumble or falter. She matches it and lives through it without it being this, like, ground shaking. I mean, she just keeps steady through it all. So I've witnessed that, and she's lent me that ability because of that, I would say. So it doesn't really feel like so much of a choice.
It's just what I've seen, and it's the way that I react. That's not to say I didn't have several, you know, breakdowns within the first year of frustration or it feeling too big.
Scott BennerK.
EmilyBut, largely, it's just I can't undo it. The electrolytes weren't the ticket. You know? Here's the solution, and I'm not gonna get in my own way of letting it be the solution.
Scott BennerSo this has always kind of been your mom's vibe, and it Yeah. You know, came over you. Obviously, it's what helped you move around the country and do those things. Right? Like, because new stuff doesn't feel overwhelming.
It just feels like what's next. Right? This is the thing I'm doing now, and I just do the thing.
EmilyYep. Exactly.
Scott BennerOkay. Makes sense. And how do you apply that to diabetes, though? Like, do you take that feeling, that vibe, and apply it to diabetes?
EmilyWell, I think I have to kind of yeah. It's I think maybe it's just ingrained. I have to kind of tease it out to answer that question. I mean, I think in all of how do I apply it to diabetes? You have to keep educating yourself, which I think happens through the podcast naturally.
And then also if I'm going after something more educationally based in three year series. Let's see.
Scott BennerTake it. It's just you take I know it's a it's no. No. It's an out of it's a it's a weird question. It's not a thing you've thought about before.
I'm just I'm saying you grew up in a this is what we do. We just do it. It's not bad. It's not different. It's just life.
And then suddenly, hits you, but how does it hit you? Right? Like, you have to learn about stuff you've never heard of, words you've never heard before. How do they affect you? The fear of putting in that insulin.
Right? Like, all that other stuff. And even when you have a breakdown, you think, god, this is terrible. Like, how does that like, way you grew up, how does that apply to this?
EmilyIt keeps the ball rolling. I think it doesn't keep me in any one negative place too long where the rest of the things in my life still take center focus.
Scott BennerMhmm.
EmilyAnd then diabetes is this large piece that I have to tend to and keep up with, keeps following me throughout my day, so I have to mind it. But it's kind of, like, rolling rolling
Scott BennerYou just roll with it.
EmilyThe next day. And
Scott BennerHow much does knowing how to do hard work help? How much does, like, having a job that I imagine you wake up with the sun and and, you know, work until the sun's gone and you're exhausted and everything, but you don't complain, you do it again the next day? Like, how much of that, like, training do you think applies to diabetes? Maybe it doesn't.
EmilyYeah. I don't know. I don't know if it how it does. I'm sure you know, I think the hard work is a piece of the puzzle, but the nature of the work is just ingrained in very tangible things. It's just, you know, I'm working with the elements.
I'm working with animals. I'm growing food. I'm working with all real tangible things. And I don't mean to say that if you're not working with any of those, then you're not, but it's less like I don't know. I'm just I'm working with life's elements.
Scott BennerYeah. I would assume too there's a lot of variables in those elements that are beyond your control.
EmilyOnly. Yes. For the most part. Yeah.
Scott BennerProbably all of them. And then at the same time, that that can't stop you. You can't not grow the food or pick the food or process the food because it's raining or because it got too hot or too like, you just have to continue to, what, like, reassess what's happening and then apply the skills you have to that new situation, and that could probably be hourly or daily or or or so on.
EmilyRight.
Scott BennerOkay. Yeah. Alright. Well, that makes that makes a lot of sense to me, actually. So diabetes isn't the hardest thing you do in the course of a day, or is it
EmilyIt can be.
Scott BennerIt can be. Okay. So talk about that. When when that breakdown comes, is that a flooding of emotion or just it's too much? You you don't have you don't have the bandwidth for it anymore?
Is that burnout?
EmilyI don't think it's burnout. If it is, it it just lasts for the moment until that alarm stops beeping at me. I think the hard part is just considering all of my activity and insulin because I'm constantly active or maybe then we're switching gears and doing something less active. And here it's lunchtime, and I started out low. And now after lunch, I'm gonna be racing around.
And I think, honestly, it's difficult to have a thing that I have to tend to in front of other people and have potentially even if it's very minor, have a plan or a moment shift based on my need
Scott BennerMhmm.
EmilyOf, oh, to eat sugar now. Or
Scott BennerWell well, now you surprise me, Emily. Like, it's no. Seriously. Because you've got, like, a go go with it attitude. Right?
So then what about it being in front of other people is bothersome?
EmilyI just don't like the attention on me, and I don't like and I really don't think it is on me.
Scott BennerBut it feels like it is?
EmilyBut it feels like it is, and I don't like having to express that it's I don't know. I did I I had a hard time just having diabetes as something that could slow me down or impact me, and therefore, once that bleeds out into other people affecting other people.
Scott BennerDo you feel like you're intruding on other people's time?
EmilyYeah. Intruding on their time. Maybe they're seeing a vulnerable moment for me, especially if I am low and my mind is a little out of sorts, then I feel especially vulnerable in a way that I don't feel connected to and definitely don't want other people to connect me too.
Scott BennerYou don't want people to see you as being weak or out of out of control or
EmilyRight.
Scott BennerNot as smart as you normally are, all the things.
EmilyAll the things. Yeah. Yeah. Okay.
Scott BennerWell, I mean, that'll make sense to me. I'm just by the way, I'm really enjoying listening to you think through your thoughts and your life. Thank you for doing this. Appreciate it very
EmilyI really appreciate that because
Scott BennerNo. Because I know it can feel awkward when someone asks a question and you don't have, like, a rattle off answer. And you realize that I'm not gonna go away and we're still recording and you've gotta figure out what the answer is. And, like, it's interesting to hear people process that, I think.
EmilyYeah. Yeah. Yeah. Definitely. I think I would
Scott Bennerprobably have I'm sorry. You would probably what?
EmilyYeah. I'm sure the more that I thought about these things, the more would come to light. So
Scott BennerYeah. No. And it's a good opportunity to sit and think about stuff that I I believe you don't normally ruminate over. I find the podcast very helpful for that. Myself you know, for myself too.
You know, you just you're sort of you're in the moment. You're you're kinda forced to deal with whatever it is that's being asked or said, and sometimes you don't have an answer right away. And I think it's more interesting when you don't have an answer than when you do sometimes. So okay. So I
Emilyyour Yep.
Scott BennerYeah. So how long does it take you to rebound from being sick? Do you gain the weight back? Do you set up I mean, do they give you a CGM? Like, how do they get you launched off?
Managing Farming with Omnipod 5
EmilySo launch off was the pens with long acting at first, dialing that in, and then short acting and finger pokes. So they started me off slow. I was meant to kind of keep a diary of blood sugars and carbs I was eating that went on for probably two weeks. So I was advocating for a CGM. That inspiration definitely came from the podcast.
And so I got on Freestyle Libre, and then I was doing MDI for probably six months or so until getting on the Omnipod
Scott BennerOkay.
EmilyWhich I've done ever since now with Dexcom.
Scott BennerThe Omnipod five? Are you using automation?
EmilyThe Omnipod five in automation. Yes.
Scott BennerHow is that working for you? Because you're so because you're farming still. Right?
EmilyYep.
Scott BennerYeah. So how does that work with your activity?
EmilyIt works pretty well. Over the last maybe six months or so, I've been playing around with activity mode quite a bit more. Mhmm. That's definitely helpful. Definitely helpful.
Even if I'm starting to go low and notice that, I'll switch it into that. And it more often than not catches me or catches me more than had I not. So that helps helps me a lot, I think.
Scott BennerCan I ask a question about your activity? Yeah. It's occurring to me as you're talking that some people talk about, like, oh, you know, when I work out, this happens, or if I suddenly go to Target, it happens. But your activity is significant but constant. Right?
So it's not really activity as much as it is just your your baseline.
EmilyRight.
Scott BennerYeah. So what do you do you have days off? Do you like, are your days off consistent? Are they Saturday, Sunday, or they or do you not have days off? Like, how does your schedule work?
EmilyYeah. I have Saturday and Sunday off. Otherwise, for the most part of the year, it's Monday through Friday. And, yeah, I don't know. I guess the pump has generally I don't have anything too crazy about it.
I would say if I do, it's from my end of timing insulin. Kind of I touched on come lunchtime, maybe my number's sitting just right in the little lower spot. And so I bolus as I'm eating or right after I'm eating, just thinking of the rest of the day ahead.
Scott BennerLet me ask my activity question, okay, and see what happens. I would think for most people, they get low around activity, but you probably experience a high on the weekend. Right? Because the system's not giving you much insulin Monday through Friday, and then on Saturday, Sunday, you slow down. Is it more difficult?
Do you have the bolus more, or is your activity so significant that it's a stasis for your body seven days a week? Does that make sense?
EmilyYeah. I actually never considered that. I think that might be the case based on I don't I'm not fighting the Omnipod on my weekend. I'm not fighting my blood sugar on my weekend.
Scott BennerOkay.
EmilyYeah. I would say the numbers are generally the same. I have less to consider in terms of activity, so maybe I need to look at food a bit differently come the weekend time. Mhmm. But that's also the same as when I get home and have dinner and being Stopped.
Still. More still. Yeah. So it's not like, here comes the weekend. It's a foreign entity of diabetes that gets differently throughout the rest of the week.
No. I there's lots of overlap.
Scott BennerYeah. No. It just occurs to me that because of your job, I would imagine it's very consistent. Because I even hear from people who have jobs that are aggressively, you know, needy physically. Like, there's definitely better words there than that.
More active at certain times a day, but not at others, and they'll have, like, peaks and valleys during the day. But I'm imagining that your gets out of bed, hits the ground running, and you don't stop. Right? You're moving constantly, aren't you, or on your feet or not comforted? No.
You're not comfortable somewhere. You're not in a chair at any point.
EmilyYeah. No. Not in a chair. Nope. We're raising.
Oh, I work on a goat dairy slash vegetable production farm. So, yeah, right now, we're raising 40 or so kids. That's what they're called. Good kids with a herd in in the hundreds. And so, yeah, as soon as I get there, taking care of all the kiddos, attending to birds, we've got a new wave of kitting happening.
So we got a bunch of mamas having their babies. And other than that, I mean, it's springtime, so we're getting going in the fields and the greenhouses. And yeah. I mean, the spring is like a get up and go, and then the mid season is the height of the season, so it's super get up and go. And then the fall is huge harvest and tuck everything back in before the winter and
Scott BennerAnd then do the inside stuff until right? Do you fix equipment during the winter, stuff like that?
EmilyWell, actually, in the wintertime
Scott BennerI was gonna say, do you cough and and go do something else? But I don't know why. So I was gonna put it that way, but do you go off and do something else during that time?
EmilyYeah. Yeah. Yeah. A bit between, vegetable season ending and then our main kitting season that picks up in January, February time, my partner and I will go travel. We get some time off off the farm, off work, and get to go, have fun.
And then we come back in the height of winter and help birth a bunch of babies.
Scott BennerWow. That's crazy. Well, it's a is that a passion project kind of job, or does it pay more than I imagine it does? Like, is it a career you could do your whole life and take care of yourself, or is it a thing you're doing now while you're younger because it calls to you? What's that what's that like?
EmilyYeah. It's a good question. I don't necessarily have answers to all, but it is passion. Yeah. You can't do this without passion.
It's not the pay. It's just a love for for the animals, for the land, for providing quality food to people, for tending to land in a way that's respectable and can carry on a future. It's so many deep things, really. I can feel welling up inside of me more than I can verbalize. I do wonder you know, I think when you first get into farming and everybody is wondering, like, oh, you're gonna have a farm of your own one day?
And you think, surely, well, yes, of course. And then it goes on and on, and you realize more the realities of owning an organic farm in a society that does support it. Absolutely. But there's a grander where the overarching decades long putting down of the organic farmer and the small farm. So there's a battle within that.
There's a battle financially. And I think I if I'll have my own farm one day, maybe my partner and I would would love to see something like that work out, but we also get to work on a farm that we love, have roles in it that we've grown into, and help us grow. And at the end of the day, we can take off and go to Mexico for for a few weeks. Mhmm. We can live our lives without what I'd imagine would be a tremendous amount of going out on a limb for a struggle.
The Psychology of Diabetes & Avoidance
Scott BennerYeah.
EmilyBut there's that voice there.
Scott BennerAnd and does the voice win usually, or does it They
Emilythey it's a good fight.
Scott BennerIt's okay.
EmilyI'm not sure who comes out. At at the end, the voice wins, but the outcome needs to happen first for for me to like, coming on coming on here to talk to you, I you know, within the week before, I was like, I have what am I gonna say? I have what am I gonna contribute? I just started getting worked up about it. I was like, maybe I'm gonna cancel.
Another voice in my head is like, you are not going to cancel.
Scott BennerGood. I'm glad you didn't. I really enjoyed this. Actually, you know, I watch Arden do this thing sometimes where pretty simple. Right?
She has a a fairly large aversion to needles, which I know is interesting. But, like, because of that, she'll struggle to take her GLP meds sometimes. Mhmm. And, you know, she'll do it for weeks in a row and everything's great, but then sometimes she's like, oh, I can't like, she just can't bring herself to do it, and she starts to put it off. And once you put it off, it kinda it it don't stretch into weeks. You know?
And she did it again recently. And I said, hey. You're gonna have to change settings, you know, but we're gonna have to change them again in a few days and take down insulin to carb ratio, make it weaker. You're gonna have to make basal weaker. You're gonna have to make instant sensitivity weaker, like, all this stuff.
And all day yesterday, I was like, why does she keep getting low? I mean, like, she just shot that med, like, four days ago, and I know what's going on. And trust me, if you ask me, I can explain it to you pretty well. And I forgot, like, thirty, like, six hours throughout the day, like, it didn't occur to me until finally, I, like, smacked myself in the head. And I walked into her, I was like, what's going on? She's like, I'm low.
And I'm like, yeah. I'm like, your settings are all wrong.
EmilyWow.
Scott BennerWell, in that time, all we have to do to combat that is to change her settings back. She doesn't want you to put the settings back to where they need to be without the GLP. And I am forever trying to figure out the psychology behind that. And the closest I've come to it is to think that she doesn't want to admit defeat. Like, in her mind, she's going to take the GLP.
And putting the settings back is saying, no. I'm not going to. And she doesn't want to feel like or admit that it's taking the does all that make sense?
EmilySo much sense.
Scott BennerYeah. Yeah. Yeah. And and so I've been watching this go on now for a while, and I just try to support her through it the best I can. You know?
And even there's even times where, like, it'll go, you know, three days and I'll be like, hey, Arden. Listen. You know, just move your sensitivity or do this or that. She's like, no. Like, I'm gonna you know, she's like, I'm I'm no.
She doesn't even say I'm gonna do it. She just it's just no. And then no to me sounds like, if I move those goddamn settings, I've lost. And then, you know, I'll tell you, like, honestly, like, you know, I'll just sometimes just wait until she leaves the room for a second. I pop her phone open, I put her settings where they are.
And, like, so so that she, you know, her because her a one c could go from, like, a rolling average of, 5.5 up to, like, seven
EmilyJust for
Scott Bennerfor not changing those settings because it's such a significant difference. She doesn't want me to do that. But then she realizes that I've done it, and then somehow after it happens, the pressure's off of her, and then she does the shot again.
EmilyWow.
Scott BennerAnd I might be wrong. She might listen to this in the future and be like, that is not what was happening. Like right? But, like, from my perspective, that seems like what's going on.
EmilyAnd I feel like you described what, what can go on with me sometimes, like, the not wanting to admit defeat, the pressure around that, both of those things happening in regards to some decision you have to make or choice for yourself, something. Yeah. I I don't know what what you said resonates, though. And I think I need to figure out where why that resonates, where I feel that, and why something can hold a can hold so much meaning in it when really it's the click of a button on your phone.
Scott BennerYeah. Do you know why I told you the story?
EmilyBecause I
Scott Bennerheard you say something a little while ago. It I heard you say something a little while ago that made me feel like you must feel like that.
EmilyYeah. Yeah. Yeah. Don't know why some things overwhelm simple simple stuff, but there's some, yeah, there's some layers there.
Scott BennerYeah. Keep thinking about it.
EmilyYeah. No. For sure.
Scott BennerYeah. You'll you'll get the I I have a lot of a lot of good feeling about how you're gonna turn out as a person. I know you think you're old probably because you're 30, but you're just getting started. You know?
EmilyYeah. No. I appreciate that. I do.
Scott BennerThat's cool. Also, I'm super impressed with myself sometimes, and this is one of those moments.
EmilyYeah. Well
Scott BennerYou would never say something so boastful, Emily, but I'm not above it. I really just I felt like I heard you say something that fit in that vein, and I thought I'm gonna hopefully, Ardino listen to this one day and understand when I shared something about her life that, you know, she probably doesn't tell anybody else just so that because I think it's gonna be really helpful to you and to the people listening to. So I think you gave something to the conversation twice today, and this was me giving something to it as well, I hope.
EmilyYeah. Oh, 101100%. Absolutely. Cool.
Scott BennerCool. Listen. I have the greatest job. Everybody should get a podcast. We should all stop working, and we'll all starve to death and the electro will go off, but we'll all be very, very mentally healthy as we're starving to death.
Right? If we all just get a podcast and talk about how we feel.
EmilyWe can live off of that. Yeah.
Scott BennerFor a little while, Emily, and then you will die without food. So are the goats dangerous? Are they fun? Or do they have different personalities?
EmilyThey are so fun. They're mischievous. They do have different personalities. The worst that could really happen to you is you have your head in the wrong place at the wrong time and get a little concussion.
Scott BennerThey give you a little smack?
EmilySome some strong downs. But yeah. No. They're a blast. They're That's very cool.
They're sweet. They're playful. I mean yeah. I feel
Scott BennerYou feel what? I cut you off. I apologize. You feel what?
EmilyI just love having a connection to animals that respond to you. It's fun to feel like you can communicate with a herd of livestock animals. It's a
Scott BennerYou wanna say magical?
EmilyYeah. It's magical.
Scott BennerIt's okay. You can say that. Listen. I have a tree monitor, and I associate a sound and a tapping with food time. And I went in there the other day be and she was hiding in a log.
And I did the sound and the tapping, and she came out of the log and looked at me like, oh my god. Are we gonna eat? And I was like, oh my god. I taught that thing with that sound in the I was I was like, We're having a moment. I'm not a herd of goats, but I I do think I understand what you mean.
And I also, even though I kinda keep animals that are, you know, smaller and and more, you know, contained, I think that it's I'm gonna sound I'll say something to make me sound like more of a hippie than you you have the whole time. Okay. Ready? Thank Yeah. Yeah.
I thank you. Did you say thank you? I think that because I've chose to keep the animal, it's my job and and charge almost to do things that it needs to get its you know, not just its food right, but its lighting and its heat and its surroundings. Like, I it's my job to look at it and figure out what it needs and provide it that those things.
EmilyI agree.
Scott BennerYeah. And it's sort of an extension of how I think about parenting too. So I originally got a chameleon because I was like I said to my wife, I'm like, kids don't really need me anymore, and I feel sad about it. I like, I need something to, like, take care of. Now since then, I've learned those kids, they still need you.
It doesn't really matter how old they are.
EmilyYeah. That's that's good. I feel that way
Scott BennerMhmm. That month. But anyway, how much my last question is, how many acres do you need to have a nice, like, functional small farm?
EmilyOh, you could have a quarter of an acre.
Scott BennerAnd work it out.
EmilyYeah. Yeah. You could you could have a little backyard to to provide. You can grow a lot of food in a small small space.
Scott BennerInteresting. That's really cool. Well, I appreciate what you're doing, and I appreciate that you came on here and shared it all with me. I am going to get into a car very soon and go give a talk, so I gotta run. But if you hold on one second, I'll just explain to you how the rest of this works.
Okay?
EmilyOkay. Well, thank you so much.
Scott BennerNo. You were terrific. Hold on one second.
Outro & Sponsors
Scott BennerDexcom sponsored this episode of the Juice Box podcast. Learn more about the Dexcom g seven at my link, dexcom.com/juicebox. This episode of the Juice Box podcast is sponsored by Omnipod five. Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. Learn more and get started today at omnipod.com/juicebox.
At my link, you can get a free starter kit right now. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. A huge thanks to today's sponsor, AbleNow.
AbleNow offers tax advantaged Able accounts for eligible individuals with disabilities. If you or your child lives with diabetes, you may qualify because of ongoing medical needs. With Able Now, you can save for a wide range of disability related expenses without affecting eligibility for certain disability benefits such as Medicaid. And thanks to recent federal law updates, more people are eligible than ever before. Learn more and check your eligibility at ablenow.com.
You spell that ablenow.com. There's links in the show notes and links at juiceboxpodcast.com. 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. 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.
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. 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.
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You got a podcast? You want somebody to edit it? You want Rob.