#1127 Bare Necessities

Deborah's son has type 1 diabetes. He uses the Ypsomed pump with Cam APS.

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

Scott Benner 0:00
Hello friends and welcome to episode 1127 of the Juicebox Podcast.

My guest today Deborah has two young boys her youngest Jack was diagnosed with type one diabetes when he was three years old are some Hashimotos in the family looks like Jack is using Dexcom with the IPS omad pump and little DIY algorithm stuff going on here. Ooh, there's a lot going on here. You'll enjoy this one. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com. If you're looking for the diabetes Pro Tip series that runs between Episode 1001 1025 In your podcast players, Apple subscribers get those episodes ad free this episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met.

Debrah 1:57
I'm Debra and I'm the mom of Jack who is five and has type one diabetes. And I have another son Harry who is turning eight on Sunday. Jack

Scott Benner 2:08
and Harry Jack has diabetes. Yep. Okay, Harry is eight. How old was the Achlys? diagnosed? Three. And how old? Is he now? Five? Yeah. Do you have any autoimmune issues? Say

Debrah 2:25
my brother in law has Hashimotos. And my nephew has congenital hypothyroidism

Scott Benner 2:33
so we can blame your husband. That's good for your mental health.

Debrah 2:37
Well, the nephew is on my side to blame.

Scott Benner 2:43
Does it surprise you to hear that you look like you? There's no way you have two children? Yes, thank you really? I don't get to see people very often. But if you told me you were in, I don't know. High School, your second year of university? I'd be like that makes complete sense. Why do you look so young?

Debrah 3:04
I have no idea. Because you'll know I've not slept in the last few years.

Scott Benner 3:09
Are you telling me you looked better? 24 months ago?

Debrah 3:11
I really did.

Scott Benner 3:12
Oh my gosh, that's amazing. Do people in your family look young?

Debrah 3:17
Well, that they would like to think so. Yeah. I would

Scott Benner 3:19
like to think sit to someone told me on my birthday. My birthday was the other day. And that was not me trying to get you to say happy birthday to my birthday was the other day. And I was getting a lot of texts, which is lovely. And notes online. And somebody said to me, how old are you? You're much younger than me, right? And that person was like 47. And I thought like the we've known each other a while, you know, I'm like no, no, that's ridiculous. I'm like I'm older than you. I'm 52. And she's like, No, that's not right. Like, I wasn't even sure if you were in your 40s as like all this is wonderful. But inevitably it's it's really wasted because I'm married. And I'm assuming Kelly just looks at me. And she's like, Oh, it's that guy that won't leave my house. So anyway. Alright, let's figure out a little bit about Jack's diagnosis. You were How did you figure it out? Say

Debrah 4:16
Jack was at nursery at the time. And in the days leading up to his diagnosis, we noticed he was going to the toilet more often. And I actually put a timer on my watch and notice that it was every half an hour. In the busyness of life. I didn't really think about it again. And then a couple of days later the nursery called to say that Jack was quite lethargic. And again, didn't think much of it. It was only I think it was a Wednesday morning he woke up and said he had an earache. It was pulling his ear and so we thought okay, we'll take him to the GP and get him some antibiotics. And it was actually my mum who took him because I was working and still work full time. And I said mum when you're there, can you ask them to take a urine sample? Because I'd noticed he's been getting into the toilet more often. And the GP said when they took the urine sample that there was sugar in his in his urine, not to worry, but to go to a&e to find out what's, what's going on. When we got there. My husband went to meet my mom, and they took a finger prick. I think his bloods were 26 which is by your standards for seven, five.

Scott Benner 5:40
Okay. How long did you think this was going on?

Debrah 5:43
Oh, not long. It can't have been long weeks because he wasn't ill he didn't go into DKA he was he was fine. And why days went by between the first and, and some regression and bedwetting that we just thought for a three year old. This isn't unusual.

Scott Benner 6:03
I don't mean to cut off your story, but A and E.

Debrah 6:08
Accident and Emergency er.

Scott Benner 6:11
Emergency Room accident and emergency. Okay, that makes sense. It's not a great TV show, though. a&e, or wait a minute on British television. Is there a show called a&e that's at a hospital because hospital shows are very, very popular.

Debrah 6:31
We have a show called casualty. Oh,

Scott Benner 6:34
how horrifying. Exactly. Do they were the funny environment hats. You wouldn't think they were funny. You would think they were firemen. You mean the scrubs? No, no, when the firemen Come in? Did they have like, do you know that the hats that firemen were in England are different than the hats that they were in America did not know that. They are I don't know why it's a design choice. I'm assuming? Yeah, we know all kinds of stupid stuff that I'll be saying. As we're talking today. That mostly I know from the internet and television. Okay, so I'm gonna guess you're not in the hospital very long. But it was also during COVID.

Debrah 7:13
Yes. Oh, tape at 21.

Scott Benner 7:17
How did that go that and what did they do?

Debrah 7:19
So we were behind masks, as everybody was. And the masks stayed on all throughout the time we were in hospital. But I would say other than that, we were coming towards the end of COVID. So there wasn't really anything other than testing him for COVID, of which he was negative. It was I mean, we were too consumed in understanding what type one was all about to really notice. COVID?

Scott Benner 7:47
Do they move you into the hospital? I assume? Yeah.

Debrah 7:51
So you go into the triage room to get assessed. And then they move you up to the ward when you're when you've been diagnosed or where they know what's going on. And that's where we were for five days,

Scott Benner 8:05
five days. Okay. Now, do they educate you there? Or is this about stabilization.

Debrah 8:12
So they do educate, where they educated us there because Jack was stable, he hadn't gone into DKA. So what happens is, the days that pass, you're met with an ESA consultant, a psychologist who try and give you a whistlestop tour into what your life is going to be like?

Scott Benner 8:38
How did you find that experience?

Debrah 8:40
extremely overwhelming. I am a note taker. And I remember the nurses saying everything that you're writing down is in the blue folder that I've handed you. And I had to keep explaining to them that actually I need to take my own notes. So I remember whilst also dealing with Jack's condition, having to justify how I remember information. I

Scott Benner 9:04
thought you were gonna say explain mine. That's, and your husband's taking in the information differently.

Debrah 9:12
So my husband was actually at home at the time. I mean, yes, he doesn't pay information differently. But he wasn't there for the meetings. He was at home looking after picking after Harry. And so he came and went as he could

Scott Benner 9:30
to say it felt to you like this was on you. You're gonna have to understand it, and you're gonna have to pass it on to somebody else. Yeah, did that help you? Yeah,

Debrah 9:40
I think so. I think as as most people who listen to this podcast will know you find your kind of type one community, don't you? And actually the people who I speak to we talk about the fact that in those of us in a relationship, one of you takes complete control of everything and teaches the other One in most cases, it's very rare that both go in, kind of roll up their sleeves from day one. Because it I mean, again, it depends on the dynamic of the relationship. They worked well for us and worked well for me to be armed with as much as I could.

Scott Benner 10:17
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. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email, it's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility. Instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link, I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three, and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is call 888-721-1514. Or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox Podcast. Yeah, I think about it, like I mean, if you're, I guess lucky enough in this situation to be to very like minded people, then maybe you can learn at the same pace in the same direction. But like Kelly, and I don't think alike at all. And if you made me learn something, the way she learns it, I'd be confused and disoriented personally, and I and when I talk, I think she doesn't understand me at all. Like, I know this is odd to say because I communicate for a living. But the person who really doesn't understand me the most is the person I met. So like the way my brain works, it's just not. It's just not how hers works. So it's just it's it. I think it makes sense. Like, for me, it makes sense that one person absorbs it comes to a, you know, an understanding and then starts to parse it out. I think sometimes the problem you can run into is if you choose a person to take that task on, and then they don't get it. Now you're really lost. You know? That it's fascinating. I have to ask you, because I'm just going to wonder the whole time I need to get it out of my head. How old are you? Like I swear to you, you're not 26?

Debrah 12:54
Plus 10 Oh, wow,

Scott Benner 12:56
good for you.

Debrah 12:57
It's lovely, actually plus 11. Oh, 12.

Scott Benner 13:00
Excellent. You are doing great. I swear to you. I'm like she had these kids. When she was a teenager. This is what I'm going to find out. I'm not kidding. I'm sitting here thinking how do you own a home? Like Like, I'm not even old enough to like, have a mortgage Are you? And And my other question is, do you pick Harry because of Prince Harry? Or is that just the name you like?

Debrah 13:24
And then we like, okay,

Scott Benner 13:27
because now you say it and when you're talking? It sounds like I'm watching? Like, bad tabloid TV in America. By the way, I think that girl is gonna leave him. Not that's neither here nor there. But don't imagine that that can last. I'm with

Debrah 13:44
you. I'm right, right. Yeah.

Scott Benner 13:47
Okay. I knew it. I knew what I saw. Okay, that's all the health care system is different. So how different? Are you concerned? You sit there thinking, Oh, no, our insurance isn't going to cover this? Or like, what's the process around? Getting situated?

Debrah 14:07
Yeah, so thankfully, in the UK, we have the National Health Service. So all medications or free. All visits to the hospital are free. So we don't have to take on that additional financial burden. Thankfully, that being said, I don't know how much of the UK press is reaching you. But our NHS system generally isn't isn't great. So things take a long time. We are in talks about pay for our nurses and doctors, which is causing strikes in the country. So it's not, it's not great. But all of that being said the team who look after Jack are amazing, and have made the process as easy as possible for us. That's

Scott Benner 14:50
wonderful. So as with anything else, the people are the core of it. And then when you get into 100% of bureaucracy. Now isn't it funny? We can't make anything work. Like, seriously, like you have a job, I'm not even going to ask you what it is. Right now picture three people you work with that you wish got fired? Yep, they're in your head already. Like, oh, yeah, that one, that one and that one. I could fire a couple of people around here. But there's, it's just it's amazing that everyone agrees what the goal is. And then somehow, we can't get it accomplished. I do think it's got something to do with what we talked about just a couple of moments ago, with the idea of like one parent figuring it out, while the other one kind of lays back. Like there's just too many competing ideas and nobody sees it the way other people see it. You almost need, isn't it funny, you almost need a centralized brain. But then as soon as that happens, one of those people becomes a maniacal like overlord. And then you're like, well, we great. We put this one in charge, and he sold everything. He lives on an island now we have nothing. You can't win people. That's all I'm saying. All right. So you get insulin, but is it in a syringe? Is it in a pre loaded needle? Like how are you doing it?

Debrah 16:07
We're in the UK. We're not in a third world country? No,

Scott Benner 16:10
do they give you a stick and you have to break a hole open and dump it in? How does it work there. So

Debrah 16:16
Jack started on MDI. He started on Neva rapid and never met. And we started an application for a pump that he got a year ago. So he's on the app. So Med, web cam EPS.

Scott Benner 16:29
Okay. And if Samad is is that a tubeless? Pump? No, no, which 1am I thinking of? I'm gonna pull up some so I can say it. Did they suggest the pump for you? Or did you ask them about it? I

Debrah 16:48
would have left the hospital with a pump, if I could. MDI wasn't great for us. Whilst we had pens that would give us half units. They were too big for Jack. So we were just on a roller coaster from day one. So I couldn't have got the pumps, you know, what they did? What they were able to get for us is a Dexcom G six straight away. So we left the hospital with a Dexcom. Okay. Thank God for that. Yeah,

Scott Benner 17:16
I have to say, the people if summit way to not put a picture of any of your products on the main page of your website. Way to really think it through. Okay. Oh, this is the patch pump that like, it's almost works like G six, right, like a bed goes down and then the pump clicks into it? Yes, that's I haven't. Right. Okay. And that's just available there. And you can't get that in America for sure. Is that your only option? Or was that just the one you went with? We

Debrah 17:47
were given a Medtronic option. But I don't think at that stage, it was available on closed loop.

Scott Benner 17:57
Okay. Okay. And you are Wait, if Summit is is a loop system, calm.

Debrah 18:04
APS is the app, which speaks to IP Summit and the G six.

Scott Benner 18:09
Is that a DIY thing? No. Oh, wow. That's cool.

Debrah 18:14
So you'll remember all the press that came out about the artificial pancreas which annoyed most pet parents and carers of kids with type one, and those were type one as well. So it's clearly not an artificial pancreas. But it was what seemed to cause all the press at the time.

Scott Benner 18:33
Yeah, it is interesting, isn't it that terminology? Can you talk about that? Like Did it bother you hearing the words artifact? Tell me why.

Debrah 18:42
I think a third was the launch of the cam APS slash artificial pancreas was it was just before we got the pump. So here we were struggling with MDI, dealing with the roller coaster of highs and lows thinking we're gonna get this pump and it's going to solve everything. And whilst Jack's a once he has improved immeasurably, and actually the pump is great. It's clearly not the same thing as a pancreas. Yeah.

Scott Benner 19:14
I hate this. I hate to say it like this, because words matter. Just makes me feel like I'm, I don't know. I'm on a social media campaign on Instagram. But But I think words do matter. Sometimes. It's that it don't offer me relief. And then have me find out it's partial relief. Just say it's an insulin pump and an algorithm runs it and it'll make some decisions, but you might get high and low. I know. It's marketing, though. Right? Like they need a word. They need a word for it. So but yeah, I take I take your point about that. Also, you're newer into this, like two years is a very short amount of time. Like you're still I assume it's a raw nerve for you. At this point. Yeah. Yeah. Like at that So you understand, in this house, if you turned on three different televisions and three different late night hosts, we're making like horrible jokes about diabetes. And Arden was walking through the room, she wouldn't even notice. She, she's in a different place where I imagine some people get to and some people don't. But I can remember in the beginning, like the thing that made me the angriest was what I call cure season. It's when all the researchers are looking for more money, and they publish their articles about how they cured a mouse of some diabetes that they gave it three days before or something like that. And then anyone who hasn't been around it for a while, it's like, oh, I mean, I had, I swear to you, I sat at a desk, read a thing, got very emotional, ran into my bedroom, told my wife, I said, I can't believe how lucky we got that. Artem was diagnosed with type one diabetes, right before they cured it. Like, look, because these people just cured a mouse. And I really had that feeling. And I was overwhelmed with how like lucky it was, and my wife who actually paid attention in college, like, you know, read the article, and she goes, Oh, Scott, this happens all the time. Like these guys are looking for money to keep their lab going. And so they have this article. And I thought, Oh, how many people see that every day, and thing, and it's so concentrated in like this kind of two month period, where they all push this information out on the internet and like, oh, look what we're doing. What we're doing, it's happening. I interviewed somebody 15 years ago. And as I'm talking to her, she is simultaneously saying the thing she's doing isn't really working. And we're right on the cusp of it. And I was like, Okay. And now today, her thing is in the exact same spot, it was when I talked to her I don't know, seriously, like 10, I don't know, 10 years ago, something like that. She just trying to keep her lab open. And I don't know that she doesn't really believe what she's doing. But you're throwing darts into the universe, you're not like, it's not it's not it's not this such a specific thing the way you want to believe it when you're reading it. So like, oh, they found the thing, they're going to fix it like that kind of idea. And then I stop and think I don't even as humans, what have we even cured. I mean, almost nothing. We like have inoculated people for things and eradicated stuff. But I mean, nobody's taken a pill and been like, Oh, my God, my cancer is gone. Like, it's just, it's amazing, like in the movies. And I think that's what people are hoping for. Anyway, sorry about that. I don't know where that came from. I was explaining to somebody yesterday that if you want to make a podcast, you have to have the ability to shut off a portion of your brain and continue to talk. What portion is that as like? It's the portion who has an expectation that the person you're speaking with will get a chance. Okay, so how does jack handle it? I mean, he's three, is it? Is it like resilience resolved? Does he fight against it?

Debrah 23:18
So at the time of diagnosis, I don't think he really had a sense of what was going on. He was and still is glued to his iPad. So when we were in the hospital, he was just sat with his headphones on all the photos I have of him at that time is just him in his pajamas, watching his iPad smiling. I remember the first injection, he cried. And then the second one, he was fine. I do think when they're diagnosed young that there is the relief that they will have no memory of the diagnosis. The thing that worries me is how many more years he's living his life as a type one.

Scott Benner 24:03
Yeah. Tough. Have you heard me say that? I asked in the hospital. I was like, you know, what are the long term implications of this? And the person said, Don't worry, like you don't see, like bad side effects from diabetes for like 30 years. And I thought, but she's, she's little like, What do you mean, like 30 years from now? She'll be 34. Like, is what are you saying? You know, and then it's not long. I mean, Arden's had diabetes, what she was like, isn't that weird? I don't really know the dates. So she was diagnosed in 2006. Yeah, just got her age wrong. She was diagnosed in 2006. She was born in 2004. So Arden was diagnosed when she was two. And back then, and I still hear people getting this advice. Now. They would tell us with no trouble they didn't blink. High blood sugars are not a problem, because they're young. And I was like, what They're like, yeah, for like long term problems. They're young, it won't matter. I was like, the other lady said in 30 years, you guys are gonna pop out of her ears and her legs are gonna fall off like, like, Wait, which, which one? Is it? You know, she's young. And then I started thinking, like, the body can just regenerate from like, massive. Like, no, that's not right. Like, you know, but, but a person said it to you like a lady in a room and she has a clipboard, and somebody hired her, and she works at hospital and, and she's telling me, Don't worry about it. And the next person is telling me, you really should worry about it. But there's nothing we can do. So just go for it. Like, I'm like what is happening. And you would just think that's old timey. But I still literally hear people say it now. Like they told me don't worry about the high blood sugars because they're young. Like, I don't know what, I don't know what that

Debrah 25:50
means. And if I remember back to those days, those hazy days in the hospital, when Jack went to sleep, I went and found the podcast. And in those early days, when you're dealing with all sorts of blood, sugar's highs and lows, and you're there telling me that it's possible to get numbers in range, I must have killed you in my head many, many times. But I cannot tell you how thankful I am for retaining that message. Because I just had you not told me it was possible. I don't think I would have worked as hard as I did to keep Jack's numbers in range, because I just like you say, the education you get at the beginning, is extremely basic, just to kind of keep the child alive. So when Jack was on MCI, the nurses would say, you know, don't correct until he's to 60. So he'd have to get to 14 plus to be corrected. And you're there thinking, Okay, this is normal. He'll have high blood sugars, they're better than low blood sugars. And thank goodness, I found the podcast and was able to kind of see through all of that. And when when he went on to a pub that changed everything for us.

Scott Benner 27:13
You're not supposed to say nice stuff, when I'm looking at you. When there's no camera on, I can just like play it off and say something. But now you see me I'm looking at you. I'm so sorry. It hit me as crazy as it is. Because I hear you with your accent. And the last three reviews that have come in for the podcast this week are from Ireland, Great Britain and Bahrain. Those are the last three reviews that the podcast has gotten. None of them have said You're horrible person that I've killed you in my mind. So that's excellent. I don't know. Like, it's crazy to think like you're looking at me now. I'm in a room in my house. You know, it's not like I'm not at some podcast studio or something like that. And to know that it reached you, like my brains, like, how did you even find it? Like because I'm old? Like, I really am like, it's like, wow, you have an accent, you found my podcast. That's amazing how that happened. And then people point out how the internet works. And I'm usually more understanding, but like to know that the message is not just reaching far, but that it's needed in all those places. Like, I mean, really? There's a review here from Bahrain, like, what the hell? You mean? Like, that's insane? I'm in New Jersey? And how is it possible that this information isn't just freely handed out by people, like in hospitals, where you would expect it to be? Like, why are you like to 60 my god, like, I get what they're saying, they don't want you to make him while he's little, they're afraid you're not going to be able to react quickly enough. But at the very least, save it for now, until you understand how you're doing it better or until we're worried about a honeymoon ending or whatever. Like, their real concern was like, Why not tell you that this is going to shift as time goes on, instead of this idea of like, this is like, am I the only one that knows how to communicate with people? That's not possible, right? Like other people must know how to do it, too. You don't understand that in a pressure situation. When you say something. It's now law. Like, that's it people's minds like me, the example I always use is that I swear to you, I thought Novo LOGG was insulin. For years, I didn't know there were other insulins. I was like, No, this is insulin because the lady handed it to me and said, This is the insulin and I went Yes. Okay, I wasn't making notes on a piece of paper, but I was writing them in my head. And by the way, when you drink out of a mug that you bought off my website that freaks me out, okay? But that really is just, it's such a simple thing. It's why I'll share with you because nobody will hear this for a little while. And I don't like to give away my secrets. Because I know they're listening never and they're copying. Jet, this really will be to be, honestly will be between you, me and Jenny. So Jenny and I are going to make a grand rounds series, like aimed at doctors to tell them these types of things. So we're hoping that that helps somebody because it just it's not right. I know, it almost seems to like trite to be concerned with. But what you needed to hear was, for now, we're not going to correct until this number, because of these reasons. And as you get better at this, and as he grows, and as this progresses, we are going to change those, those numbers. And here and here's why. Like for now, we're not going to worry, because it's only going to be for a couple of weeks or a couple of months. But he's not going to feel good at that blood sugar, it's going to alter his thinking, it's going to cause health issues. Like, I just think that if I'm going to die, and you know, I'm gonna die if I don't do a thing, but it's very unlikely that I can do that thing. I still deserve to know. That's all I deserve to know still. And I've just I've spoken to too many people who have been diagnosed in their 30s like your son, like my daughter. And then 20 years later, I'm talking to them on a podcast, and they are blown away by the things they're learning. And it's, it's life altering. Like, it's just, you know, you've been living with a ticking time bomb, and you and somebody has been telling you what's a teddy bear? And then one day you find out it's not and it's hard to deal with. And

Debrah 31:46
you know that you can't necessarily tell the family all of this. In that first meeting, it comes it comes in waves, and it was actually where you talk about, okay, say your range is four to 10. Sorry, I don't know the the universal numbers. If they say you're starting from 70 to 180. And slowly you chip away at that number and suddenly your high number becomes your the number you'll accept is 170. And then it's 160. And that's really what we adopted as a family is we didn't try to get the numbers to be perfect from day one. We just chipped away, week after week. Yeah.

Scott Benner 32:31
Isn't that just common sense. Like I know your football is around in mind is oblong. But when a when a quarterback comes into the league, you don't start with them throwing the ball 80 yards down the field to go look, throw one, five yards, see how that goes. If you can do that, we'll add some 10 and 15 yard passes. And then we're going to keep growing as you grow and, and tell them that that's what's happening. Like I'm not saying on day one be like, listen, the sugar is scrubbing you from the inside, you're going to have a stroke when you're 50. Like I'm not saying do that I'm saying they should know what the implications are. And they should understand that it's not emergent like it's not, it's not today that they have to understand it. But over the next six months, we are going to take you from here to here. And then once your understanding rises to that we're going to adjust the parameters, and we're going to go again. But that would take here I'm going to be cynical, that would take planning and a level of professionalism that just doesn't seem to exist in the world, you know, because there's no, because aftercare is terrible, because no matter I mean, I don't know how it is there. But I just spoke to a person the other day, had pre diabetes type two, their doctor gave them ozempic. And it was working. And then it was time for the prescription to come back up again. And the insurance company said oh, you can't have it. We gave it to you by mistake. This person had a five, six a one C, but you need to have a 5.7 a one C to be considered pre diabetic. So the medication that was going to lower her a one C probably help her lose weight, be more healthy, maybe get out of this pre diabetes situation altogether. They said you can't have that until you're more diabetic. So once your number goes up and you get sicker, we'll give you the medication to bring it backwards, but we won't do it preemptively. Even though you're literally at the door knocking and I don't know that just seems like that's how everything. That's how we think about everything. It feels like around health care. And I know that's not up. It's not something that people don't know. But it impacts things like what we're talking about because know the person sitting with you in the emergency room is not the person you're going to see next time. And so now this person has given you emergent care, which is great, but nobody tells you. This is just emergent care. I don't Yeah, it's very upsetting because it doesn't seem difficult to fix to me. That's it to you.

Debrah 35:06
I mean, we have, you have 10 times more knowledge than I do. But I do think living and breathing it every day, it's very easy to look back and say, it should have been like this. And it's why actually, I've, I've taken on a role as a parent rep for the hospital, to join quarterly meetings to share my my thoughts, because the consultants, the diabetic nurses, they've got heaps of knowledge, but until you've lived it, you might as well know nothing. 100%.

Scott Benner 35:39
That's amazing. How did they approach you? Or is that something you found out about?

Debrah 35:45
So it was a mixture, really. So we took part in monthly therapy sessions that was arranged through the hospital when we when Jack was first diagnosed. And I think as I came to the end of that journey, and reached the place of acceptance, you know, I really felt like I wanted to give back to the families who would be at the beginning of that journey. So we had we had a meeting, I think it was about a week ago. And I can't remember what the topic was, we were talking about finger pricking. And again, they brought something that in theory made sense, but in practice was completely different. And it was only when I described our own experiences, they realized, actually, there's something to be said there. Yeah.

Scott Benner 36:28
Well, so I think that one of the things that needs to happen, and I've done it with the podcast, and it's not easy to do, is you have to say, the people I'm trying to help, don't know what they need. And so you need a person who understands what you need to just lead with conviction, that that really is it sometimes, you know, like, I'm not saying I'm perfect. I'm not saying that if you I'm not saying that the people who listen to exactly what I do, I don't think they do. I think I say everything out loud, and people cherry pick from it, they like, well, this will work in my life, I can make this work, and they do that thing. But you have to be willing to stand up and say, this is the thing we should be doing right now. It's leadership by great, you have to be able to say that because the people who are looking for leadership, if they knew what it was, they would need you. So you're in this bizarre situation, where the the physicians, like you said, have all all the knowledge, and none of the idea of where to take it. Application. Yeah, it's it's a beautiful blend. But but in the end, if I'm going to be honest, when you're in those meetings, you got to at some point, stop talking, and just do it. Like because though, you'll philosophize away a decade of oh, well, some people say this. And some people say that, and this makes people upset and we don't like, at some point, you just have to say this is the direction, hopefully, we'll bring as long along as many people as possible. So everyone's not going to make it. But by us standing here in action, nobody makes it. And it's just it's I don't know, it's how I think about it. But it's not how it's harder here. Because that's not how business works. But you you're probably not as controlled by that, as we probably are. A example I would use is that, if you like I get a different look at the diabetes space, because I know the other side of it, like some of the faces that people think of as like, oh, that person has been around it forever. Bah, bah, bah, like, I remember back when that person was sitting in a car with me going, I just got to get a job with one of these diabetes companies, I need money. And I'm like, okay, like trying to turn a blog into a thing, you know, into a living or something like that. Not to say that that person I'm thinking of is not a good person. They're not doing good work somewhere. I'm not just the lovely person who's sitting in this room waiting to help you like I have to pay for the things that you see around me like this is a business too. I'm just lucky enough that my wife made a good enough living that I wasn't in a fever dream, trying to like, make it work. And I And trust me, a lot of the people. I only know America, well, I know a couple from England. So it's not the point. A lot of the people who were in that position, were in a panic to make a living. And yes, they wanted to make it helping people with diabetes, and they're very well meant meant people. Like I've never met somebody who I've thought, honestly, I don't know any, like bad actors. Do you know what I mean? But it's still their focus is I need a job. And the companies that you deal with, sometimes their focus is like we need clicks. We need people to buy these things like I understand that, but they also have like a real philanthropic side. If when you really get to know them. You need to marry those things together. And that's difficult, because like stuff we talked, I don't know how our conversation took this turn. I don't know how I wake up in different moods ever. but you're like, I thought I was gonna have a fun conversation with the guy from the podcast. And he's like, we can fix the world if we tried hard enough. Anyway, that's lovely that you're doing that. How long have you been doing that?

Debrah 40:10
Oh, not long. A couple of months.

Scott Benner 40:12
Okay. All right. So do you have a plan? Or do you just go in there and, like, dump out your thoughts when they ask.

Debrah 40:19
So I don't have a plan. But we had Jack's quarterly hospital clinic appointment this week. And the nurse who was in the meeting was there and said, you know, next time, make sure you're bringing some of these topics to the meeting. So we've got an issue at the moment where we want to switch Jack's G six to a Libra three. So you'll remember with Aden, the Dexcom is massive PAJAK. And he wears on his arm, and he ends up just knocking it off, whereas the Libra three is a teeny, tiny coin shape. And there's an issue at the moment where the NHS haven't secured funding for the Libra. So we have to wait and lots of waiting around. And so part of what I can bring to the meeting is a human face to that and the impact of having a sensor that's not fit for purpose

Scott Benner 41:17
is the g7 not coming to England anytime soon.

Debrah 41:20
The g7 has come out. And we've also just seen that you can get the Omnipod five and g7 combined. However, Jack's ipso med cam APS setup only responds to the G six and the Libra three.

Scott Benner 41:38
Gotcha. Okay. Yeah, I you've heard about Omnipod. Five G seven already. Yeah. Really? I didn't know about

Debrah 41:46
families who are starting on it this week at our hospital

Scott Benner 41:51
not loop not like Do It Yourself loop on the pod dash with G seven. Because? Because G seven and Omnipod. Five aren't even announced here yet. And I don't expect it. I don't want to come off like I know something because I don't. But I don't expect it for maybe till towards the end of this year. Because he slim and g7 is closer. I think tandem has said they expect quarter three, maybe. But on the pod has not made a public statement about it yet. As of this is quite there. Yeah, as of this recording in July, so. But there is a way to use, like Do It Yourself loop with G seven and Ami pod dash, which is what our nine. That's what Arden is doing right now. So

Debrah 42:43
have you ever done closely with Arden?

Scott Benner 42:46
Yeah, she's using it.

Debrah 42:47
I thought she's on DIY?

Scott Benner 42:49
Well, it is I mean, it's a closed loop system.

Debrah 42:53
Right. So she doesn't she doesn't use one. That's because I don't know much about DIY, because it was never an option for us. But we went straight to an app that kind of did it all for us. We didn't have to build it ourselves. Yeah.

Scott Benner 43:06
So what do you mean, when you say closed loop? What is it you're like? What are you saying? Like?

Debrah 43:11
So is what DIY system is ordered on?

Scott Benner 43:15
She's using the loop three.

Debrah 43:16
Okay, yeah, I don't think those options are available here

Scott Benner 43:21
where you can download it, you just would need an omni pod dash that G says. So it's completely do it yourself. Like it's the codes on the internet. Like it's not from a company. So to say that it works with Omni pod dash is 100% true, but it's not like Omni pod, made it work with AMI like people online did it? So Right. Yeah. So. But yeah, she's been using loop three for like, six months, maybe longer. And prior to that she was using loop Dev, they're just different versions of the algorithm that lovely people online make. But yeah, it's keeping her loop three boluses. When you try to go high, takes away basil adds basil. You know, like that whole thing. Pretty great, honestly. So

Debrah 44:11
the difference then between what she has versus what Jack has is, Jack has closed loop, but it's all built into an app already. We don't have to build anything from the

Scott Benner 44:22
company. Yeah. Like if Samad is providing that for you. Exactly. Exactly. Now on the pod five is an algorithm based system that is provided by Omni pod. So they made it I don't know if I'm gonna hold something up for you. I don't know if the cameras gonna grab it or not. Yeah, that's our 24 hour line. So the bottom is 70 and the top is 120. So she's been over 120. Twice, maybe in the last 24 hours. But she's been super stable. Geez Jack now. Can you say that again? Yeah. Oh, no,

Debrah 45:00
he's just eaten. That's there's 9.1. Nice.

Scott Benner 45:04
Look at that. Isn't it amazing? The technology is just is moved this to a completely different level. I, you know, I did an interview yesterday with Jake from Omnipod are from Dexcom excuse me, and we're talking about Dexcom g7. And at the end of the interview, I just said, Hey, can I ask a question? They said, Sure. I said, at what point? Do you think you can scale this large enough that the price can come down for everybody? Like, I think I actually said like, this is great, this conversation is lovely. But there's going to be a lot of middle class moms and dads and adults listening to this, who can afford it and have insurance and etc. And I'm like, how many of these do you need to sell so that you can go to the business model? Because there's two business models, right? Like you see it all the time, sell a very expensive thing to a few people, or sell a very affordable thing to a lot of people. And I'm like, when can we get to that, like so that it's not just I wanted so badly to say white ladies. But instead I said, you know, middle class people, like when are we going to get it to everybody? And he actually gave a thoughtful answer about how that happens. And how they're trying to get into type two space and how that, you know, ramping that up will help support the rest of anyway, it's interesting to hear his answer. But it really is the truth is that, you know, and then once you make it accessible, it's on phones. So I have, I'm telling you all kinds of stuff. Nobody knows that, but I'm giving I'm giving a talk on World diabetes Day in November at a for a big Children's Hospital on the East Coast. Right. And they offered me an honorarium. They were like, you know, we can give you, I'll just say, we'll give you $500 To talk at our thing. And it's just on Zoom. Like, I don't even have to go anywhere. And I said, I don't want your $500 Like, let's, what can we do with it, that would be valuable. And the doctor said, Well, I could use it to buy a phone for a kid who has a CGM, but can't afford a phone. I was like, can't do that. Like, please don't give it to me, like do that instead. But that was the first thing he thought of, like, top of his head right away. We could buy a cell phone for a kid who needs a CGM, because the not having a cell phone is stopping the kid from using a CGM. I was like, right on do that, you know, please. But anyway, like that. So it's skipped. The scalability is an issue. Meanwhile, while I'm looking at my questions for Jake, and I'm talking to him three different countries, when is it going to come to hear when is it going to come here? When is it going to come here? And like you can see it on his face? Like we're trying? Like, it's not like a thing where they're like, yeah, we'll get to it. It's they're working on it. It's just, it's not easy for some reason. So anyway, God, alright, so you are advocating on your own. You are trying to help move the system along. That's terrific. You have good ear for your son. He's doing well. Your husband came on board. He understood. Yeah. Good. Excellent. And your husband is Paddington Bear in my head. You know that right? I don't know why. I'm so sorry. Those were not bad movies, by the way.

Debrah 48:27
When he comes down the stairs in the bar,

Scott Benner 48:29
yeah. It wasn't bad. Like for for a movie about a teddy bear was talking. It had gravitas. All right. What else? Do you worry about? Harry? Have you had them tested?

Debrah 48:45
We actually asked a clinic about the Elsa study. Here's what's interesting. They said to us, first of all, was you know, I think this the siblings, there's a 2% chance the sibling might be diagnosed with type one, that they said that younger siblings are even more likely than older siblings.

Scott Benner 49:09
Why is that? No idea. Just time.

Debrah 49:14
I couldn't even tell you why that might be even with an educated guess. And so what we said my husband and I was we might have a conversation with Harry and bring him on that journey if it's something he wants to do. Because I think the benefits of the study or if there's anything that being picked up, it's picked up early, but I think as parents with kids with type one, the moment the sibling is drinking more is going to the toilet more wets the bed. You are there with a finger picker, understanding what's going on.

Scott Benner 49:50
I think that's the biggest consideration. Yes, right like that. That you won't see it. It'll turn a dk but I'll also say A that I've had. I had prevention bio on the on the on the podcast a couple of times over the last two years. And they were making at that time a drug that well it was in testing was called to Ms. aplomb. But as it went to market, it's called tz old now. So tz old is a drug that aims to slow down the actual onset. And it was bought by a big pharmaceutical company a few months ago. So Sanofi owns it now. So they sent off he just bought prevention bio, they paid a and I'm going to look it up, because I kind of think what they paid for it is a little bit of an indication to me about how much they believe in it. This just happened in April 2023. I'm not going to find it. And I don't want to just guess it out loud. But I think it was like $3 billion. So hold on a second. I'm going to check now that I said out loud, I have to find it. Yeah, I was right. Snuffy agreed to acquire prevention bio at a cost of $25 per share in a deal valued at $2.9 billion. So they must have really wanted it. My thought, I don't know, obviously, I don't know a lot about anything. But I think that you're going to hear a lot from them in the future, about the need for early detection, testing being ahead of it, because these kinds of things may be could be really valuable. I mean, at the moment, they're not going to say that it'll hold off type one forever, because that's not what they put through the FDA. But I've had two different conversations with them. Where you, you can hear I feel that that's the the hope and desire moving forward is that maybe you could get ahead of it and put a stop to it. Not that's what it's doing right now.

Debrah 52:04
We have friends whose son is on the trial here.

Scott Benner 52:07
Really? Is it is a he has I think he has

Debrah 52:11
levemir and occasional corrections, but it's otherwise without insulin.

Scott Benner 52:20
It's a big deal. Really. It is he mean once you have diabetes, it's hard to like say like, Oh, it doesn't matter how much insulin like I'm just doing the thing but I do think it's a big deal to slow it down to just need a basil. It's the kind of almost a turn the management into more of like, it almost feels like type two management, right? Yeah, like a little background insulin and not as and so it takes away what meal insulin corrections, low blood sugars that come from overcorrecting, like that kind of stuff. That's, I think that's pretty amazing. So I don't know where it's gonna go. And I'm getting pretty old, so I might not see the end of it, but I'll let you know. Yeah. Will you come find me in the afterlife? Won't you be in British afterlife? Yeah, so you won't be able to find me.

Debrah 53:06
We have family in New Jersey Bay. Do you really? Yeah, Englewood.

Scott Benner 53:11
Oh, did they move from there to here? Yeah. Okay, I

Debrah 53:15
hid from here today.

Scott Benner 53:16
Did they hate it? Do they not like it? I love it. I love New Jersey, New Jersey gets a bad rap. And it shouldn't. By the way, it's a lovely place.

Debrah 53:24
Very happy, though.

Scott Benner 53:25
Good. I'm glad. What have we not talked about that you wanted to talk about? You have a list, don't you?

Debrah 53:34
I have no. I think one of the reasons I reached out to you was because I mean, my mum always says there's a book in me to write about my first the first year of Jack's type one. And so I wrote to you and said wouldn't it be great to talk about all the things I wish I'd known. You know, during those, those first, those first few months, and I think you know, one of the things that I would love all families to know if they had the the ability to do so would be when you're first hit with this bombshell, just take a month off work, close the doors, bury down the hatchet and just get your head around it. I think whilst the doctors and consultants will tell you that there's a lot to get your head around and it's going to change your life. You don't really take that on board because you're thinking yeah, I've heard about type one. I've seen the kid at school that had a Mars bar. They had a few injections, and it's going to be fine. I think if I could go back to that time, I wish someone would have told me just take the time you need to get your head around it.

Scott Benner 54:47
Yeah. What do you think you lost by not doing that?

Debrah 54:50
It took me longer to accept what was happening.

Scott Benner 54:54
Because in the moment you're just busy dealing with it. Yeah, yeah,

Debrah 54:59
we made some Many mistakes as I'm sure you would anyway, if you were juggling all the things, but I think I just needed and wish I'd had that time.

Scott Benner 55:09
Yeah, I tried to remember to say that. For years, I was very, very bad at taking care of diabetes. I think it's important for you to know, like, as you're listening to this, like, because I could do it in my sleep now. Like, just no lie, like I swear to, you could send five kids over here with diabetes and three adults. I think we could talk for an hour, I could get everybody set up and they'd all just go living their their lives. But back then, I was terrible at it. I was terrible at it. I was panicked about it. I was nervous about it. I was 100% Sure, I was killing Arden. Every time I did something, every time I did something, I was like, this is gonna kill her. Like, I know, I'm I know, I'm messing this up. I saw her a one sees I was powerless to move them. It was just terrible, like, really bad. And I'm telling you this, because then I'm going to tell you the rest of it as I was a stay at home dad while I was doing that. So it didn't help me at all. But I do think that just not rushing and taking away. The other things that have to happen in life all the time, like so that you can kind of focus and end so that you can stop focusing at points too. I do see the value in that. 1,000,000% Are you in a better place now?

Debrah 56:31
So much better?

Scott Benner 56:32
Do you think that place continues to get better as time passes?

Debrah 56:36
Yeah, yeah. And as you say, it doesn't get easier. You just get better at it. And yeah, I think even the other weekend, we were with family and Jack had been on the bouncy castle and ripped his CGM off and there we were in the corner, just changing it as if it was just any old thing. I think that had happened a year ago, I would have gone into a spin. I wouldn't have I wouldn't have coped with the two hour warm up all of those things. Whereas now, whilst I I still I think there's still a way to go, I'm definitely much more accepting and much more confident with managing it.

Scott Benner 57:20
How about your personality? Like, are you nervous to begin with? Are you calm to begin with? Like, is there a state of like, what's your stasis? Like? I guess?

Debrah 57:31
I am a control freak. So diabetes and control weakness don't go very well together. So yeah, I think that's again, why learning the things is right is really important to me. Well,

Scott Benner 57:48
listen, the bookshelf behind you looks perfect. So it's doing that for you at the very least. Well, yeah, but you know, isn't that sort of like anxiety? Like, right? Like, people are like, Oh, I experienced anxiety, but anxiety really helps you like too much if it's debilitating, but the right amount of it is pretty necessary. And you will see a lot of successful people have a little bit of that like perfectionism, anxiousness to get something correct stuff like that. If you don't drown in it, then that nature is probably valuable. Right? Are you not? Is it drowning you though? Managing Jack? Yeah, like the end the nature of it, like feeling like it has to be perfect in that you're in control of the whole thing, etc.

Debrah 58:35
Less so now. Okay, let's say Now also, because we have better control. His time ranges, you know, in the 80s, whereas in the early days, it was in the 40s, or 50s. So the fact that if there's a blip, knowing that that's the exception rather than the rule, I can, you know, I can accept that I can deal with that knowing that you know, okay, he's going high, I put something in, I'll deal with a low later I can, that narrative. When you've told yourself that time and time again, you can cope with it better. Yeah,

Scott Benner 59:06
it really is. It's, it's the experience. I might sound like a broken record, but you have to just keep having those experiences over and over. Just a really simple thing was, we all went out the other day, and we were going to be gone for a couple of hours. We weren't going to go too far from the house. But Arden was not going to bring supplies with her. And I just did. Like I grabbed a little bag. I threw two Omni pods in it, and some insulin, and I put the insulin on some ice and because it's hot out, because I don't know what's happening to the planet, but it's very hot here. Probably that global warming thing. But I brought along and we got home. We never needed it. And I disassembled it I opened the bag. It's like the pods back in the drawer and I put the insulin back in the refrigerator. I think the whole process took 45 seconds on either side of it. But I will tell you that I never thought about it. I just did it. But years ago, if we were going out years ago, I would have known I have to bring this stuff with me. And it would have felt like I don't want to say a burden, it would have felt unfair. It's that, like, I can't believe that, that she has to do this, like not that I have to do it for it. But this is her situation, and that it seems so wrong. And it's upsetting and almost makes you sad, and ruins the day before it even begins and blah, blah. And now, I didn't have one of those thoughts. And the truth is, is that back then, that wasn't true. It's just how I felt. It really does. It's like everything else, like repetition gets better use, you know, I know, I'm the one that said, you know, it doesn't get easier, you get better at it. But I mean, that doesn't just go for diabetes, here marriage, it doesn't get easier, you just get better at it. painting a house, it doesn't get easier, you just get better at it. Like like everything is that, you know, it's not just diabetes, it's living, like you get better at being alive along, you're alive. As long as you don't spend too much time beating yourself up about it and staying mired down in, in things that you could get past if you just allowed yourself to keep moving forward. I don't

Debrah 1:01:19
know. And you realize also that diabetes is our world. It's, it's it consumes us at times, but there's things that are consuming all families and all people, this is just our thing.

Scott Benner 1:01:33
Gotta be something. No one is out there living some pristine situation that you know, just gold toilet bowls, and nothing smells weird. And there's never hair on the floor. Just everybody's everybody's living the same life, you don't just see some people's and honestly, health. I mean, when your thing is health, I don't know, I could probably make the same argument about money. Right? If you were, if you were in a dire situation about money, I'm sure you could make the same exact comparisons that you can make about having diabetes. And then to me then, and then I try to imagine the people who don't have the money and have the diabetes, you know, and their situation is obviously worse. The minus and, and all the things that come from also, health is, is the most important thing. Like it sounds obvious when you say it out loud. But when you're living day to day, you don't think of it that way. It's obvious that we don't think about it that way. Because of the things that people eat, that they know make them feel sick, but they eat it anyway. Or the things that people do that they know aren't good for them like, like, just because something's obvious doesn't mean you can make it happen. But at its core, it's very center, a oh, just probably say something that's been set for, you know, millions of years, I would imagine it's one way or another. Like if you don't have your health, your you know of anything. So when you're hit with this diabetes thing, it's imperative to figure it out. It just, it just is. And if you have to take time to do it, or listen to a podcast to do it, or call your doctor 8000 times so they answer your question correctly. There's nothing more important until you get it moving in the right direction. I think. I think that's what I mean. Anyway. All right. What's on your list is on that list. Deborah? Well,

Debrah 1:03:27
I had a question for you about about Aden. Which is or maybe maybe some advice you can give families like us who want to make sure that Jack's always got a good relationship with his diabetes. We're going through a phase at the moment where he's saying I don't want diabetes anymore. Why did the doctor give me diabetes? And we're, you know, we're saying to him as as we've been advised him that it's okay to hate diabetes. You know, this is this isn't trying to fudge something that's not true. It's true that diabetes sucks.

Scott Benner 1:04:05
How old were you when he said the doctor gave it to him and not you? Was that lady I swear to you? Yeah. I actually one time, in a doctor's office, I joked around with Arden. But the nurse came at her for something. And I was like, I can't believe she's doing this. I looked at the lady I was like, I'm just gonna put this on you if you don't mind. By the way, I learned very early on that the pediatrician when something has to happen to a kid that's unpleasant. The nurse does it instead of the pediatrician so that the kid doesn't associate the pediatrician with a bad moment. Which I was like, that's interesting. But anyway, that's not what you're talking about. Sorry. I went on a flight of fancy there for a second. I just remember that. My friend Adam, going like, I'll be back. The nurses gonna do this. And I was like, Where are you gonna go? As I don't want to get to see me while this is happening, I was like, Alright, I don't know that it's a question that you answer with a sentence. I think that it's a mindset and resilience to stick to the mindset. It's the ability to not martyr yourself, not to martyr your kid the situation, you have to not to have to want to not be upset by it. Meaning you can give yourself over into that kind of drama. And start woe is me and yourself. And before you know it, you're Scarlett O'Hara and you know, you're getting the vapors and stuff like that. It's messaging. It's repetition. Right? So I think we've always told RT and what diabetes is, we've explained it to her as an autoimmune issue. As a 19 year old, if she has other issues that seem like they're auto immune related. You know, she'll say things like, you know, she's like, Oh, my bad luck that I have this, or blah, blah, blah, but I've never heard her blame herself. I've never heard her blame another person. She's not thrilled about it. You know what I mean? But she also doesn't bemoan it. And I don't know that that's the thing. I taught her as much in words as I did, with example, I guess, I guess it really is like a lead by example situation. And that's tough, because you have to keep up your enthusiasm. You have to quell your anger and your despair. And I am just generally speaking, one of those people who wakes up every morning, hopeful, like, I swear to you, like if a volcano erupted in New Jersey, and I woke up the next day, I'd be like, Oh, my God, I lifted the volcano thing. This is great. We'll start over again. And I have a little bit of Groundhog Day in me, I guess, you know. But I also grew up in a situation where my dad was, you know, angry, and there's a lot of yelling, and things like that. And you can't just let it pile up on top of you. So I kind of think I see diabetes is the same thing. Like if you let diabetes pile up on top of you, it certainly will. You know, so you got to wake up every day, like it's not there. And I've had some moments, man, where I've been up all night, some nights, and then my alarm has still gone off in the morning. Like it didn't know what happened overnight. Like, like, it's no one on my side. I went to bed. I have gotten out of bed going, Oh, I'm okay. Everything's fine. I've been asleep for three hours. You know, like, like searing pain through your brain and you can't make sense of anything. And you're like, I'll probably die. Just stay alive for eight hours at Morehouse. What Siri? What the hell? I didn't say Siri. I said searing pain, Jesus. You're like, you're out of bed. You're like, I just have to stay awake for 18 hours. And then I can go to sleep. And but what if a butcher gets low again tonight? I feel like that can't happen. I'll die. And then you don't die. And you're like, ah, it. But every morning like it's I never. I never went into a room and said, You know, I'm tired because your blood sugar kept me up all night. I never said it's, I've never once said, Oh, okay, well, hold on, we have to change our pump before we leave. So everybody hold like, it's never like that. It's always just matter of fact, it's like, this is the job, we do the job. That's it. And we don't do it. Like when we do that job. Like we're being paid very well for it. And that we're excited to do the job like this is. And I think that's because I don't see. T It's funny. You said it's okay to hate diabetes. And I don't know that I'm okay with that. Exactly. Like, because while Arden isn't diabetes, she does have it. She doesn't have any way to get rid of it. It does seem linked to her. Whether you want to think psychologically, it's not linked to her, but it is linked to her. Right. And so I don't know. I mean, I don't know if I think you could wish you don't have diabetes. I think that you can hope that this gets easier. But I mean, I don't know. Like I just think of The Walking Dead and like you're on a planet now with zombies. So act accordingly. You know, they mean, no more strolls in the park. Tell you that much. Like so. So just this is your new situation. Make this like I don't want to say normal. I mean, I'm sure that's how some people think of it. But this is this is this is where we are. Like, I've been in so many different situations in my life. You know what I mean? Like I've been broke. I've had two parents. I've had one parent. I've had times where I didn't feel like I had apparent there were times where I felt like I was someone's parent before I was. There were times we had no money, little bit of money. You know, I think you can be happy in all those situations. I don't know that this is any different than that. Was any of that helpful? Very Oh, okay. I can't tell because like I told you earlier, I partially go away in my head when I started talking. Yeah, I just I don't know, I don't think. I don't think that it feels like, people try to take their round peg and fit it in the square hole. Like, I want diabetes to be the way I expected my life to be before diabetes. And I don't think that's reasonable. You know what I mean, but I don't think that it means that it's bad. It's just different than you expected. And why did you expect what you expected anyway? Was that a Disney movie that made you think that's what was gonna happen? Right? Was it Harry and his little brother, and those the Kings, the Queens they made you think like, it was all going to be exciting? Or, you know, like, I don't know, like, the same thing pops into my head over and over again, it's a country music song that I think my dad used to listen to when the 70s than the lyric was something like, I beg your pardon. I never promised you a rose garden. I don't know what that is. But like that, that is? I think about that a lot when stuff goes wrong. Like why did I expect that this was going to be this way? And why do I have the right to be disappointed that it's not? Like just this is this is what it is, I can't get out of this. Let's be happy here.

Debrah 1:11:35
You have a choice that you have whether to let what to manage diabetes, or let diabetes manage you? Yes,

Scott Benner 1:11:42
unless you have a mental illness, you have a choice. And I'm being I'm being 100% serious about that. Like, unless there's something in your brain that is stopping you from having what I would consider to be reasonable human reactions to things. If that's your situation, that's a different conversation. But for the rest of us, you decide, it's up to you. I use this phrase all the time, when I'm talking about other people in our lives, and my wife and I are talking about them privately. And don't judge me, you all do it. And I don't think my wife understood it until recently, I explained it to her like a different way, I realized she wasn't taking me at my intention. But I think some people want to be upset, right? I don't think that they consciously want to be upset. I think that it's there in their nature, to be at odds with something. And I've used a number of different ways to explain it throughout time. But like, I'll tell you this, if you're married, and you don't know that this is true, you're not paying attention. But when you have a common enemy, you get along better. Right? When you're mad, when you're mad at the school, when you and your husband are like, yeah, they're screwing the kid, you have never been in more harmony than when you have a common enemy. Right? I try to always have a common enemy with my wife. So I'll even like, you know, like, if someone's like, she gets off a call, I'm like, That lady was nasty. What do I care if she was nasty? Doesn't matter to me. It's not my job. It doesn't matter. But I'm like, I can't believe she spoke to you that way. And then my wife's like, yeah, she was and I'm like, right? Not me, though. I'm on your side, honey. Life is hard. I mean, it's hard. And it's repetitious. And it doesn't really pay you back. Except in the moment. I think what I've learned, I don't want to bum you out. But my mom died a couple of weeks ago. I got to watch her in our last two years fight with cancer and a number of different health issues. And when it was down to the last couple of days, and my brothers and I were together, and we were trying to make sense of it. And you're still like in that, like fix it mindset. Like if we do this, then maybe this will get better. And maybe she'll get to hear like that kind of stuff. I said to my brother, I was like, we're out of carrots and sticks. And he was like, what? And I said, I think life is carrots and sticks. I said I think it's goals, and you get into the goals. And I'm like mom's our goals. Like that's it like she's done. She it's over her body gave up. There's nothing we can put in front of her that will entice her. And even if we could, she's still going to have cancer when she gets there and it's going to kill her. So mom's out of carrots and sticks. And that's it like we need this is good, like not good. But this is right. You know what I mean? And then I kind of took that thought and I've been thinking about life that way. And I don't mean that life is empty and you're just chasing something. I mean that life is today. Like your life is not what happened yesterday and it is not what might happen tomorrow. It is literally today and to tomorrow, it'll be today again. And it won't be today. You know, it won't be yesterday and it won't be tomorrow like this is it? Like, there's a million ways to say it, I might get hit by a bus tomorrow. I don't know what the future brings, etc. But this is it like today, you will have talked to a guy on a podcast, you will have helped your children, you have made food, I'm assuming you'll straighten those books up one more time. So your brains happy. Things like that. And this is it. If you died tomorrow, This Was Your Life. And so I don't know, like in that rambling is how I talked to art in about diabetes, like somewhere in there is that answer, which I don't know how to put into a sentence. And if I could, I wouldn't have a podcast, I'd have a T shirt. So you have that too. But I do have t shirts too. But that's when it's not going to break down to like be bold, or you know, Pre-Bolus or something like that. But anyway, I don't even find that sad, to be perfectly honest with you. That's been one of the real oddities of the last couple of weeks. Like I can make myself myself sad about my mom. Like I stopped deleting or voicemails when she got cancer two years ago, and I still have some I haven't listened to yet. I could go listen to one right now if you want to see me cry, but but I am not. I am not sad about my mom's life or how it went or how it ended. I think partially it's not because she had some like amazing life. It kind of sucked if you step back and look at it realistically, but she never acted like it sucked. So I never thought of her as like having that situation. I don't know. I think you can live with anything. If you if you have the right attitude. That's all. Geez, wait a bomb everybody out there a great job. Do you have any other sad questions? Or was that? No, no more question. were sad questions. Okay, I did not make a list. I apologize. Do you think it would stun people to know that I sat down thinking this lady's last name makes me think of bears necessities. And she wants to talk about how to be aligned with people in management and how to be in like an advocate and help. Like that's all I thought when I sat down. And I knew you were weren't from America because of your timezone. That was literally it. That was my preparation. I apologize. You live on the edge. Is that the I Am? Is that a scary idea to you? Yeah. Is it really? Oh, I interviewed like I said Jake last night from Dexcom. And it was like 45 minutes before it was going to start. And I was like I could probably cut the front yard before this happens. I got the mower out. I was like, I'll cut the yard, then I'll go talk to Jake. And then I'll cut the back yard. And then I'll come in and edit the podcast. And I sat down with him. And I did have that feeling later. I was like I wonder if this would make people nervous. And why more importantly, am I not nervous by it? That's a mental illness probably right? Like why am I not nervous to talk to somebody and have it recorded? And then go let a ton of people listen to it? Well, you don't

Debrah 1:18:12
have you. Have you recorded your 1,000th episode yet?

Scott Benner 1:18:15
I mean, yes and no. So I have enough recorded that one of them could be the 1,000th episode, but I'm going to make a 1,000th episode. So no, I guess is the actual answer.

Debrah 1:18:29
Yes. And no. Yeah, I think when you've been doing it as long as you have be pretty confident. I

Scott Benner 1:18:35
wasn't upset the first time I did it. I'm telling you, there's something wrong with me. I sat down the first time I did. So the first time I did this in 2015. Maybe January 2015. Might have been a little sooner than that. But like I've said on the podcast before, my intention was to like read my blog posts into a microphone, which obviously wasn't a good idea. And I figured that out pretty quickly. But while I was figuring that out, this guy Adam Lasher was all of a sudden on American Idol. And he had type one diabetes. And his uncle was Carlos Santana. And I reached out to and I was like, you want to be on my diabetes podcast. I left out the part where there wasn't really a diabetes podcast yet. It was just the thing I was thinking about. And he said yes. And so I sat down one night and interviewed him and I've never gone back to listen to it. Because it probably is awful. I don't know how good I was at it. But I wasn't nervous. And that I worries me. Anyway, all right. Is there anything else we should talk about?

Debrah 1:19:42
I did have one very quick one was probably not quick but how do how does the US respond to type one in educational settings so they inclusive like we have so many issues here with certain provisions not taking Jack because I think they just Think managing his type one is seems like too hard work. Is that the same over there?

Scott Benner 1:20:05
Yes, it is. My is my experience. And yes is what I've heard from most people. There are some people who will say, we've had like an amazing time and the school has been terrific. I also don't know what that means. Also, I think it was a dig at me when you said this might be isn't a fast thing. I feel like you were like, Scott's gonna talk a lot. But But seriously, I think the problem isn't the educational system. I think it is exactly what you said, it's a new scary thing that people don't want to be involved in. They do not want to kill your kid, like no one wants to be the one who makes a bad decision. And so they throw it back on you. And they say you find a way for that not to happen. And we'll do as much as we can, as much as the law makes us. And then there are some people who go over and above. And I think that the over and above people are when you hear somebody say, Oh, I have a great experience. I have a terrific nurse, my schools great, blah, blah, blah. Having said that, I still don't know what great means. It feels a little bit to me, like when people come on and say, Oh, I'm doing terrific. My onesies. Fantastic. I go, what is it? And then they go oh, well, you know, it's it's it's 7.8. But it's down from nine, which is fantastic. You've moved it from nine to 7.8. But you've said it's fantastic when it's not fantastic. Right. Right. Right. And so I think that people, when they're happy with something, I think they say it's fantastic. It's all subjective. Yes, yeah. 100%. And what I would tell you is that you're not going to find a school person, a teacher, you know, a school nurse, an administrator, who's going to understand that the way you are. And that's, that's going to be at so what you're measuring is there. I think you're measuring their ability to say, please explain to me what you need, and we will do our best. And then for them to actually follow through. Now, if you're actually hitting pushback, that to me is fear. That's either it's legal fear, or it's actual physical fear, where they're like, We don't want to be involved in this. I've seen I've seen both. I've seen. I'm not making that decision. And I've seen I'm not doing anything that you can sue me about later. Like, like, I've seen it both ways. And I don't I don't know that I I don't know that if you put me in that situation. I wouldn't say the same thing. If I wasn't me, and I didn't know about diabetes. You know what I mean? But so what are you experiencing?

Debrah 1:22:41
We've got a situation where one provider childcare provider aren't prepared to take him on. Because it just well, they'll they'll throw me all sorts of excuses, but it feels like, it just seems like too much hard work. Yeah,

Scott Benner 1:22:56
I would imagine that's true. We went to Arden go to nursery school preschool, and I had to sit in the parking lot while she was in there. So in order to give Arden a preschool experience, three hours a morning, I sat in my car for three hours a morning, and then came in and checked on her once in a while because they would not be involved in it. And if I wouldn't have done that I wouldn't have been able to find a preschool for when I got her into elementary school. So kindergarten her first year. I tried so hard to get them to understand the nuts and bolts of diabetes and where things could go wrong in and that's all I was trying to do. Like I wasn't trying to keep our agency at five or something like that. I was just trying to keep something bad from happening. You explained it, laid it out, wrote it down. They ignored it. They were like it'll be fun. It was that like it'll be fine. Like it was like watching someone smoke a cigarette going like is not gonna happen to me. Like it really felt like that if it wasn't for the fact. Like one of the luckiest things that happened to Arden is that when she was in kindergarten, a little boy with a heart condition had an episode when they were supposed to test Arden's blood sugar before she went out on the playground. And so they got focused on the little boy. I can't believe I'm saying this was lucky but they got focused on the little boy forgot Arden. No one checked her blood sugar before she went outside. Luckily, I I was on a timer with them. I made them call me and tell me her blood sugar before recess every day. And then I would tell them what to do before she went out. So I didn't get the call. I laid back for a couple of minutes trying to be like a human being like not on the phone. 30 seconds later going, you know you didn't call me but a few minutes into it. I called the office I got forwarded to the nurse's office. She answered the phone. She was frazzled because she was helping the kid with the heart thing. I said where's Arden and she goes Oh, Arden and then she hung up the phone. And I was like, my didn't seem good. So I just sat there thinking, okay, like I put myself in her position, she forgot Arden like she's guiding. Well, they found Arden like on like monkey bars with a blood sugar of like 50. And that was enough of a situation where I could go into an administrator's office and say, Look, I've been trying to explain to you what this is, you've ignored me. I was like, now today, we came within a couple of minutes of Arden getting dizzy falling off of, you know, a monkey bar, maybe having a seizure for blood sugar gets so low. And I was like, and then when that happens, I said, I will spend the rest of my natural life punishing you in any way that I can think of mostly legal. And I was like, or we could just do these couple of things. I actually said that to a person in their office sitting across their desk from them, I was like I will spend the rest of my natural life suing you is what I said. I said, nothing else will matter to me. I said, my name will be on the school, we will dedicate it to Arden, all of the money you make will come to me. I was like, I will do this forever and ever. Because you will have ruined my life. And I was thinking I will have no other outlet for the hate that I have. He's looking at me and I'm like, trying to make my point. And I was pissed, by the way to it. It was all real time it happened to her. I made sure she was okay to write to the administrators building stood outside of his office. Totally unfortunate to see me. And so then they did the things. And then she was okay. So something bad almost had to happen so that they could get scared enough to do the things they were supposed to do. And that's not gonna happen.

Debrah 1:26:39
I feel like we were we're suffering the opposite, which is they're too scared to take him.

Scott Benner 1:26:47
Not even they're like, you can't get them in the building. And that's his age too, right? Yeah. Is it? Is this not?

Debrah 1:26:55
Illegal? Yeah.

Scott Benner 1:27:00
So what do you do? Who do you say, Oh,

Debrah 1:27:01
well, that's I mean, there are there are steps we can take. It's whether we're going to take them to be honest.

Scott Benner 1:27:07
I think they know that too. Like you don't you don't want to get involved in that. I didn't either, by the way, like the last thing I would ever want to be involved in. Is some like legal wrangling. It's not it's not something I have any interest in at all. So I think they know that too. It's almost like when an insurance company denies you for something, they're like, they'll probably give up. You know, that's, my wife does that. And it's

Debrah 1:27:33
interesting. You say his age because I I have every faith and hope that the older he gets and the more he can manage himself, the less we will be faced with this issue. Yeah.

Scott Benner 1:27:44
Oh, one of the most popular episodes of the podcast is the third episode, where I just talked about how Arne and I manage things over text. Like because you will you remove the other people from the scenario. Now they're just emergency personnel if you need them, and they're not caregivers, that's really, to me that's one of the things that kept Barton's kept me able to keep working on art and say once a while she was in school, was that really we weren't involving other people were like these false limits on when she could be tested her when she could get insulin, stuff like that, like we just did it on the fly. I don't know, it worked out well.

Debrah 1:28:25
But congratulations on getting a child to respond to your text messages. That sounds like naming fee either.

Scott Benner 1:28:31
She and I have the same personality. So we get along pretty well. So that's pretty good. I have sent the live I don't know if they even have it anymore used to be able to send something called a Find My iPhone sound to a phone you owned. And it's a horrifying noise. And it's embarrassing to children when they're in school. So maybe once or twice, I sent that noise and I got back the like, you can't do that I'm at school. And I said all you have to do is answer and this will never happen again. So little bit of that. And mostly, mostly she is desirous of, of managing it and doing well. And I do think there's for some people, that's not as important to them. Kids, adults. You know, I got lucky I could easily be on here talking about like the struggles we have because she pushes back against everything. It's just this is how this worked out. And and I do think there's a way to get to it within reason. But I mean, if you're in a situation with your kids, where they're just flat out ignoring you, like if you think that's a diabetes problem, I think you're wrong. You know if there's something else going on, and it's showing up in this situation, so I don't know. Good luck with that. Nobody should have kids. It's ridiculous. I do. The very expensive and annoying. The love thing that keeps you You go and but you know, the rest of it's horrible.

Debrah 1:30:06
Amen. Yeah, no kidding.

Scott Benner 1:30:07
All right. Well, thank you so much for doing this with me. I really do appreciate it. Thanks, Scott. Yeah, thanks for having a good microphone too. I don't have to edit this. Hold on one second.

A huge thanks to us Matt for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box. This is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. If you're not already subscribed, or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#1126 Grand Rounds: Technology Part II

Scott and Jenny discuss diabetes technology. Part two of two. Part one is episode 1125

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android  -  Radio Public, Amazon Alexa or wherever they get audio.

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

Scott Benner 0:00
Hello friends, welcome to episode 1126. This is part two of the Grand Rounds episode on technology. For part one, go to Episode 1125.

Today Jenny Smith and I are continuing on with the Grand Rounds series, we're going to discuss technology in this two part episode and the first half general overview of CGM and pumps and in the second half different pumps technology and understanding the differences between them. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com. If you're looking for the diabetes Pro Tip series, it runs between Episode 1001 1025. For subscribers to the podcast, those episodes are ad free. For everyone else. There's just a couple of ads episodes 1002 1025 diabetes Pro Tip series from the Juicebox Podcast. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. If you're interested in checking out the diabetes Pro Tip series, the bold beginning series or any of the series within the Juicebox Podcast, there's two quick ways to find them. First, go to juicebox podcast.com. Go up into the menu. And you'll see links for each of the different series, pro tips algorithm pumping, after dark etc. Click on them, there's a player in there to check them out. Or you can use that player to see which episodes correspond and go find them in your podcasts that the other quick way is to go to the private Facebook group, click on the feature tab. And there there are lists upon lists of all the series. Jenny has been a week and we're back. Yay. Last time we kind of stopped in the middle. Not really in the middle of the episode we'd already recorded quite a nice episode already. But we'd run out of time your schedule didn't allow. And you and I have just listened to the voice note that we that I left for us. So we're going to pick up by talking to doctors about why insulin pumps are so important for people. I think we should just start maybe at the misnomer that still exists that a pump is just a way to avoid injecting and nothing else.

Jennifer Smith, CDE 3:04
Yeah, that's a great way to start. I'd certainly not it takes the place of injections. But it is not a one for one conversion. By any means. There is a major difference between injections even the smarter injection devices that we have today. 100% difference when you change to an insulin pump, it's a really strong way to assist somebody in improving management, just because of the much more I guess in general, just the much more precise dosing that you are offered with an insulin pump. Yeah, you

Scott Benner 3:38
have fine control over Basal insulin, extending boluses creating, you know, patterns. Yeah, you can you can create a little here's the I think a great example is that, you know, if you experience a fat rise after a meal with fat in it, you push a button again to give yourself more insulin, or you tell it Hey, 90 minutes from now I'm expecting a rise, let's put some in here, you're not coming back at somebody with a with a needle again. And I know it feels like Oh, so you're just saying I'll avoid having to inject. But that's not it really, it's the psychological part of it, that people won't remember to do that. Or if it comes to, well, I have to do it to inject, they may just avoid it.

Jennifer Smith, CDE 4:21
And in one of one of two ways of avoidance there, that's a good thing to bring in. It's either they'll avoid doing it kind of resulting in sustained high blood sugars because they're just avoiding taking 10 injections a day versus the four that they were told were necessary, despite them knowing better. Or secondly, they may actually go the route of just avoiding additional food that may be necessary. I

Scott Benner 4:44
just interviewed a lady the other day that said that her newly diagnosed son changed his eating patterns and she couldn't figure out right away what was happening and then it hit her that she'd say Are you hungry and moments when she knew he was hungry and he's saying No, thank you. And then he kind of like soak away. But he was just trying to avoid injecting. Yeah,

Jennifer Smith, CDE 5:05
absolutely. And it is a not only from the standpoint of injecting more, there are people absolutely, who that's their desire is just to manage with an injection and to do it multiple times a day in there, they're fine, and they do a wonderful job. But then there are the people who could do so much better. By having the precision instead of the smallest dose really is about a half a unit unless you really eyeball on a syringe and assume you're getting a quarter of a unit, which is again, not very precise. But you know, the precision of a pump to be able to deliver for somebody who is ultra sensitive to insulin. It's not there with injections.

Scott Benner 5:49
Yeah, yeah. Where my concern comes is that if a doctor were to tell you, the contour, next gen blood glucose meter, is sponsoring this episode of The Juicebox Podcast. And it's entirely possible that it is less expensive in cash than you're paying right now, for your meter through your insurance company. That's right. If you go to my link contour next one.com/juicebox You're going to find links to Walmart, Amazon, Walgreens, CVS, Rite Aid, Kroger, and Meijer. You could be paying more right now through your insurance for your test strips and meter than you would pay through my link for the contour next gen and contour Next, test strips in cash. What am I saying my link may be cheaper out of your pocket than you're paying right now, even with your insurance. And I don't know what meter you have right now, I can't say that. But what I can say for sure is that the contour next gen meter is accurate. It is reliable. And it is the meter that we've been using for years contour next one.com/juicebox. And if you already have a contour meter, and you're buying test strips doing so through the Juicebox Podcast link will help to support the show. Even as they're handing you a pump, if they were to tell you this is great. Now you don't have to inject any more and make it feel like all we've done is take away like times you're getting poked, it takes your brain away from thinking that this thing could do other stuff for me. Like do you know what I mean by that? Yes, you neglect to mention that, if you get low every night at 2am, we could turn your Basal back at 12:30am to stop the low from happening at two, which if you're injecting Basal insulin is not a thing you could do even just correct. Think about that small idea, instead of messing with, oh, maybe we should, you know, shoot the Basal insulin an hour earlier, let's do it at night, instead of during the daytime, let's try 20 units instead of 21 units. Like instead of going through all that you just go I get low every night at 2am. I'll just take away some basil and see what that does. It's magical. But if the doctor puts in your head, oh, it's just a replacement to stop you from having to get poked so much. I think you don't wonder what else you could possibly do. Right? That's not me guessing that's me, having talked to so many people who've really told me that story. So

Jennifer Smith, CDE 8:15
Right. And I think it also goes along with the lack of explanation of the pluses, or smart features, let's call them on today's pumps, even conventional versus the newer kind of algorithm and whatever that is out there. Myself example really is. Before I switched to a pump, I was taking a Basal insulin that required me to have a snack before I went to bed. If I did not, I was low by three o'clock in the morning. I was every and if I change every night, and if I changed my mind was worse with exercise and everything. If I changed my dose of the Basal insulin, it messed other things up that were not great. And so again, it brings in because food is such a center of diabetes management, it brings in the precision of a pump means that you're not feeding insulin that shouldn't be there. Yeah, yeah, right. I didn't want to have to have a snack at night. Most people don't want to have to nibble and snack when they don't want to or have to have very kind of timely meal intake to offset the action of a Bolus of insulin or their Basal action or whatever it is, as you said, if you can navigate those pump settings to accommodate for high need times are low need times you got something that can take care of that need to feed the insulin. Yeah.

Scott Benner 9:39
I want to say to to empower somebody to make an adjustment or make adjustments to their insulin through their pump is would be huge. I can't possibly tell you how many people live months at a time waiting to get back to the office where let's be honest, if you're listening in your dock You're you're throwing darts at a wall going, I don't know, try this, you know, like, turn it this way, see what happens how you suppose. And that's no shade on the doctor how they're going to know, from a couple of graphs, what happens, you know, it's ridiculous. And then it puts the doctor in a position of trying to pretend they know what's happening, which then just makes you look bad in the long run. And it leaves the person in a in a position where they're never doing as well as they could be. And you could end up turning a knob in March, that's even worse. And they don't come back till April, May June, like you don't even talk till the spring. Correct. And these people don't feel like a thing I hear the most from people about the podcast is it gave me the courage to try something.

Jennifer Smith, CDE 10:47
Yeah, people should try something specifically with the main control factor of diabetes, which is insulin. Yeah.

Scott Benner 10:52
100%. And, and my point is, is that doctors should be encouraging that, like, you can't sit there and tell people like on one hand, wow, you're gonna know more about this than I do in six months. But don't do anything till you come see me. Right? You know, it's weird mixed messaging, and it freezes people and it leaves them with higher or lower blood sugar, either some people are eating, they're like crazy trying to keep their blood sugar up. You just made that example, like if I adjusted an injectable Basal insulin. Okay, I didn't get low anymore at 2am. But all day long, I'm 45 points higher than I want to be, you know, so it's not a fix. It's a anyway, and none of that's necessary. And if you're listening to this and thinking it is, it's not plenty of people live with lower stable blood sugars that don't create crazy lows and, and huge spikes all the time. Absolutely.

Jennifer Smith, CDE 11:42
I think that is really, it kind of goes along with the fact of teaching people about their pump in the right way, right? If you're recommending a pump, you've got a patient, you've started on a pump, you're getting them going, their education needs to go beyond the basic of filling it with insulin, putting the tubing on or slapping on, you know, the pod device or whatever, and hitting go, and it just starts delivering insulin. That's not teaching. That's just learning how to use a device. Right there, there's so much more to learning because again, of the smart features, even the simplest smart features like a temporary Basal rate, when to use it, why to use it, how long to use it for before actually making true set adjustment. When you're using an extended Bolus, write a square wave or a dual wave type of Bolus. Those are advantages in the aftermath of food, or coverage for different types of, you know, different types of intake. And you can't do that as precisely with injections, unless you're willing to be the person to give multiple multiple injections to cover that type of intake. Right.

Scott Benner 12:53
I want to say that plenty of people that I've met, manage amazingly on MDI, yes, but they understand how insulin works and when they need it. That's that, like, if you and I talked about this all the time, people would come to us and say, hey, the Pro Tip series is so like for people with pumping, can't you do more for people with MDI and I said, Oh, it's the same thing. I said, just when you hear me say, pump, think needle. And if you hear me say extended Bolus go, oh, I can't do that. I'll have to inject again. Like, that's the difference, really. But if you don't know that, Jenny, if you're the doctor, and you don't know that, and then someone comes in and says, Hey, every night at 3am, I get low, but I changed my basil, it didn't work. I'm still getting low at 3am. Now I'm getting high at, you know, 5am I don't know what's going on. The doctors gonna be like, Oh, they tried turn the basil down. That didn't work. They're gonna skip right over the idea about timing of insulin, which is why we talked about it so much in the other episode, because it's all about timing. And I don't regardless of the delivery method, no, right. It doesn't matter how you're putting it in the timing of the insulin. There's not much of a parallel about how basil works. When it's injected versus basil works through a pump. They're pretty different. They accomplish the same thing, but they're not manipulatable by the user at all. And that's it really like, and by the way, stop giving people Basal insulin that was invented 20 years ago, when there's stuff that works a lot better if they're going to be on MDI, at least give them modern basals that that have longer coverage and actually make it not just 20 more stable.

Speaker 1 14:25
Yes, just stability. You know, I don't know how much time I spent. While Arden was on Leba mir wondering what the hell was happening when the truth was this 11 year wasn't lasting 24 hours.

Scott Benner 14:39
It doesn't. I mean, a year and a half maybe of my life just staring at a wall and thinking about running my head through it trying to figure out what was going on. Then one day somebody said to me, oh, you should split that. I was like, why wouldn't somebody who said that to me sooner? I give her half now and half 12 hours now work, right? That was it, right? Yeah. So and that's timing. That's insulin time it is

Jennifer Smith, CDE 15:01
it's insulin timing. And it's also based, you know, the kind of insulin I think that's another place to, to navigate within whether you're multiple daily injection, but definitely, if you're on a pump is we're talking about Basal insulin here, the understanding from a practitioner, that you still need to really recommend and have the person understand, they need to have a Basal insulin as a backup, right? Because we're talking about technology, technology can and at times will fail. And you have to have that backup as an injectable, in case. But I think it also is really important to explain that once you're on a pump, that Basal insulin gets put in the fridge with a label that says do not use unless pump fails. I've had a number of people over the years, who couldn't understand the concept that the pump was going to do the Basal and the Bolus delivery, but with one kind of insulin in the pump,

Scott Benner 15:59
are you going to tell me they put two different insulins into the pump? They

Jennifer Smith, CDE 16:03
did not. But they thought that they still needed to tow they were shooting? Oh, along with their pump? And then you know, I mean, clearly you clear that up very quickly, etcetera. I mean, it all goes into proper information and proper education from the get go. You know, there's a checklist of things that definitely, I told them this, I took care of this, this, this and this. They're all really important pieces that I think they sort of either get missed, but I don't think from I don't think it's a miss because they mean to miss it. Okay.

Scott Benner 16:36
All right. Well, it's interesting. All right. So that would be just the conventional pump, what we would consider old school, instead of Basal rate, it gives it to you, you tell it how many carbs and you've preset your insulin to carb ratio, and it does the thing. But I mean, honestly, every company now, Omni pod has Omnipod five, tandem is control like you. Yeah, Medtronic, what is it? The mini med? was an ad G seven AG, that's the new one from them. Okay, I'm pretty new. So there now, I mean, those are the three major pump manufacturers, right? Like I'm not missing anything.

Jennifer Smith, CDE 17:12
So you're in the States, those are the major rights.

Scott Benner 17:14
So wherever you live them, there might be others that you're using. But these algorithms are prevalent. They're available. You know, they require you to wear a CGM at the same time. But correct. Let's say this. How do I put this? If I let you, Jenny, would you put an algorithm on everybody? You could? Or no, I'm interested in your feedback?

Jennifer Smith, CDE 17:35
That's a really good question. I think, I think it depends on the algorithm. Okay. I think that an algorithm can improve the vast majority of people with diabetes, whether it's type one or insulin dependent type two diabetes, and insulin pump absolutely will be an advantage, and the algorithm within that will improve things. And I think the biggest group of people with diabetes that it improves are those who, for whatever reason, in life, they're just not navigating management, to the degree of effectively bringing glucose levels down to a place that long term is going to be healthy, right? And an algorithm again, depending on which one what system you're using, an algorithm can and will improve things. So for the majority of people, yes, I think it's a fantastic idea.

Scott Benner 18:37
So let's stick with that for a minute. If you are, what do you think the cut off is in your head? If you're a one sees above, seven, seven and a half an algorithm is going to help you for almost for sure if the settings are right, and you're even reasonable about announcing carbs, is that fair? Correct? Yeah, yes. If you're rolling around with a five, five to a one C, you might not have that same outcome. If you just let the algorithm roll. As a matter of fact, they all target God, it's a What's the target for t? So obviously, it's something weird, like 100. And

Jennifer Smith, CDE 19:12
technically, we just say 110. It's one 12.5, whatever you got, right? But yeah, one 12.5 or 110, Omnipod, five, the lowest adjustable is the 110. And then Medtronic, interestingly, with their 780 G, they have the lowest in an FDA approved product, which is 100.

Scott Benner 19:32
Okay, but so those are still your targets, they're, they're a target. And if a doctor is probably listening, they're like, Oh, my God, you mean somebody could have 110 blood sugar most of the time, like, yes, like, I don't see that with anybody. But there are plenty of people who know how to use insulin in such a way and are are thoughtful about it in such a way that they're achieving lower agencies, but I remind myself constantly Jenny, I don't know if you run into this as well. Is it making the podcast your often talking to people who are either so lost, that they're just looking for information, or they're very. And maybe this is an end or so interested in doing better for themselves. It's a certain type of personality and you forget that you're, it's also a certain type of, sometimes it's a certain type of financial ability to write because these people have pumps they have you know, CGM is oftentimes, which means they have insurance. Yeah, I remind myself all the time, that that's not nearly most people, you know. And so, you say so easily, like, you know, I say so easily will put an algorithm on, it'll help them I don't even know if they have insurance, correct?

Jennifer Smith, CDE 20:40
Yeah. Right. And those are, I think, from a provider standpoint, those are the pieces that many are trying to understand and trying to navigate. Because there are so many different carriers, right, when you get into the group of people are using Medicare, and the restrictions and the things that you have pay attention to, or Medicaid, or even the general insurance plans that are national plans. Each of them has different pieces that work in a certain way in terms of coverage. And so that may dictate product to product, what you may be able to tell somebody about, I think, in general, all products should be an offering. And then when you boil it down, what's available in terms of coverage? What can you use? Great, you can have your choice of all the products, fabulous, you know, we're looking at your lifestyle next, then what does your lifestyle dictate? Do you you know, swim six times a week? Well, great, you probably may not love a tube pump, then it's going to be a lot of on off, disconnect, reconnect, etc. Do you really want an algorithm that's a little bit, you know, less your work and more at work, or a little bit less input? You know, there are certain systems that work person to person, and that's where you individualize once you know, what is available to them.

Scott Benner 22:02
Yeah, so Jenny's point is, if you don't understand how these different algorithms work, you can't just hand somebody out and say, like, here, you know, it's not like you're just handing them a lighter, and it makes a flame at the end. You're all good, right? Like it's, I guess, be more specific. Right. On the part five is a little more, we take care of it, you don't take care of it. Right, right. Yeah. Yes. And what do you think of the other ones to what is control IQ? Is it a little more?

Jennifer Smith, CDE 22:28
Yeah, I think that one is the most unique of the three that are on the market, it's most unique, because for those people who have fairly good settings coming from maybe a conventional pump that isn't giving that assistive help, right, if they've got fairly good sis settings, are there willing to test some settings, the control IQ system from tandem allows the users Basal profile, insulin to carb ratio correction factors and everything to be used by the algorithm to adapt or Anatidae app to adjust up and down. Their algorithm is really simple. It takes your baseline, it adjusts up or down based on factors that are very simple. But the great thing is that it works off of a pattern that for the most part, you know, works well. You just need some help navigating cleaning up little ups and downs that you otherwise would have to do on your own. Yeah.

Scott Benner 23:23
How about the new Medtronic, I'm starting to hear people speak really well about it?

Jennifer Smith, CDE 23:27
Yeah, the new Medtronic actually has a I think of, of the three systems on the market. It's, it's auto micro boluses. Or it's micro corrections along the way, are the most aggressive quite honestly. And a lot I've heard the same thing I only have a handful of people that I've been able to use it with us far because it's again newest kind of but it really it quite honestly does a lovely job. It's adjustments in between its corrections for those climbs and whatnot makes it a lot less the person's job to try to navigate. So yeah, it's a they've done a really nice job with updating that Yeah. And then

Scott Benner 24:08
there's the the newer eyelet pump, which I don't know how like readily available that is Yeah, but there's a pump that tells you you don't really need to do anything like you just tell it I'm having a what is it a normal large or extra large meal something like that and it's breakfast lunch or dinner normal? Yeah, small normal large This is breakfast lunch or dinner and it's going to dig make adjustments where you know your blood sugar's are going to maybe go up from that it's going to I don't even know what they're saying. Like, I think they're trying to promise in a onesie in the sevens. But still, for my opinion, if you're a doctor, and you've got somebody running around with an 11 a one see that you're just like, look, they're not going to take care of themselves. This is a this is a great idea. And I don't know where that pump is with Medicare. Yeah, I don't know where they're at with that. Like I know Dexcom is good with it, right, the CGM czar now Omni pod, I think has Medicare coverage. I think they all like probably do.

Jennifer Smith, CDE 25:04
Definitely, yes, I've got a couple of people I work with on Medicare who are using tandem. But

Scott Benner 25:10
then that's the next spot is that you can't just tell somebody, oh, you should get a pump. Right. Okay. Like, I don't know how to do that. Do you know how many people don't know how to? I'm not going to sit here and argue whether or not people should or shouldn't understand how to handle their lives. Okay, they should. But if they don't, that doesn't mean they don't get an insulin pump, or that they have to have an A one C and the elevens. I think it's got to be incumbent upon that the doctor to build an office staff that can help shepherd people through these things. No, absolutely

Jennifer Smith, CDE 25:39
have an office staff that's knowledgeable in technology is really important. I think, you know, it's one of the it's one of the filters, that when you are searching out clinician who can help with your diabetes management. It's certainly one of the things that you can ask when you call to make a new appointment. How does your office navigate this? What technology do you understand? What's the especially if you're type one versus type two? How much of the clientele that you see is type one, right? The all those questions are a good way to filter when you're in the search for a new endocrine providers specifically. Because there may very well be some that are very tied to one pump, despite there being multiple options available. They have known and kind of gotten used to the one and they're very inclined to recommend that one versus the other ones being very likely just as good or maybe better for your personal need. Yeah,

Scott Benner 26:40
at this point, too. There's, I mean, if you live in the Midwest, upper midwest, you're very likely are being told about a Medtronic pump, because the company's nearby there, and it's just sort of like a thing that's happened, right? I'm assuming back from Salesforce days where people were just probably working for the hub, you know, Omni pod is very sexy online. Like it has like a social media following Do you know what I mean? Like, yes, they have that. Like, you don't see people taking pictures of their tandem pump, as much as you see people taking pictures of their on the pod, which is interesting. You never see pictures of people with their Medtronic pumps. But I also assume that those are more like that slated and people who are like, well, I'll just take what the doctor tells me to get, and I'm not going to think about it again. But they're all different segments, I guess is what I mean, like in business, if that makes sense. Yeah,

Jennifer Smith, CDE 27:30
absolutely. And I think sometimes to even in, you know, working with so many people, I've had people who were one pump for such a long time. And again, my job as a diabetes educator is to be able to help somebody with individualizing, their, what they need in their life. And we can say, well, you know, what, you've been using this, you're using it really, really well. But you know that this new product, think about these things in your life, this would fit you better, you're coming up for a new pump, you know, your end of warranty is coming. Research this, let's talk about this. And those are all steps that as again, a clinician, you need to have in the forefront of your mind whenever you're working with somebody. Because if you're not getting the results that you want, and they're complaining, because they're not getting the results that they want, but you're not changing anything, then you're kind of at a standstill. Something has to change. And it might be their technology. Yeah,

Scott Benner 28:32
not very well could be also I think it's important to remember that moving from MDI, to pumping or pumping to algorithm pumping, feels like starting over to people, and they're going to be very, a certain kind of person is going to be incredibly resistant to that. And by the way, a certain kind of person is going to be like incredibly enthusiastic, maybe more so than they should be like, You know what, I mean, people, some people jumped around from devices all the time. But, you know, even if it's in your head, like, Hey, I think if you use the pump, like Jenny was just saying, we we'd see a difference here. And the person goes, No, thanks. I don't know. Like, I think he maybe should dig into that a little more. Because I know you're picking up the chart and going asked about a pump check. You know what I mean? Like, like, don't

Jennifer Smith, CDE 29:15
don't do don't do don't just check a box. But there is your that's a great point. It's No, I don't think so. I mean, it begs the why, right. And if they offer some really good reasoning, I'm doing well here. I think I you know, I needed this there. Maybe there are some pieces that you could be more informative as to how could a pump actually improve some of the things that they're bringing in as concern? Right,

Scott Benner 29:41
right. I'm also not talking about badgering people. I'm just saying that. I've just spoken to too many people who will eventually say my doctor asked me for years, and I finally broke down at Oh, I wish I would have done that sooner. Right. Absolutely. All the time. Yeah, not just about pumps, CGM EMS Paying attention to like the food I'm eating like like the Oh, I wish I would have paid attention sooner sentiment is wallpapered around diabetes, you know? And yes, what I'm saying is, is, is there not a way to say something, do something, ask a question that leads to people? You know, right, giving it harder consideration and moving. Exactly. Yeah,

Jennifer Smith, CDE 30:22
absolutely. And I think your technology is, for those who are, who have grown in the years with diabetes, I think, if that hasn't been a discussion that's revisited recently, for somebody who's been using, as we said, more of a conventional pump, right? They've been on it. And they're, you know, they're doing baseline, they're doing pretty good. And they're kind of at this place of comfort. But there are some things that you can see could be better with some of the newer systems, sometimes, those are a little bit more in depth discussion of bringing in, hey, you know, I know you've probably seen this, I know, you've probably heard about this, let's have a discussion about how this could really be a benefit beyond what you're doing. Right. And sometimes that that's hard. The growth of technology is really, really, really moved in the past couple of years.

Scott Benner 31:18
It's happening much more quickly now than it has in the past, which I think is also another reason why doctors are getting left behind and why I'm, I'm talking to people who are saying, at the end of my appointment the other day, the doctor asked me if I would stop and explain how am I pumped work to them? Which by the way, the person was not filled with, like confidence when that happened? No, there's there's a two headed argument there. At least the doctor asked, I maintain, they should have asked in a way that didn't leave the person going, Oh, my God, am I seeing the wrong physician? You know, yeah, because I can see the doctors perspective, by the way, like, you know, I don't know, I don't have diabetes. I don't know how this works. Can you show it to me? So Jenny, overall, we need the doctors to understand these devices, how they work, why they're important, how they can be helpful to help people get them, help them with their insurance, that stuff. And you know, make sure they have a choice. There's a lot of different options, those options work for other people for important reasons. Know what those reasons are, ask those probing questions, make sure you're getting them on a good device. And then I just want to add from the feedback that we got from people, Oh, yes. One person said that as an older type one, they equated a pump with being a bad diabetic, which is a term you hear a lot from people, you know what I mean? Like, and so, you know, that idea, like, cuz you know, what, from type two diabetes, oh, if you can't control it with food, then you didn't try hard enough. So now we're gonna give you a pill, oh, the pill didn't work? Well, you're gonna have to give you answered, you must have the really bad kind like that right? Progression or right

Jennifer Smith, CDE 32:47
or failure, right? That really brings into the person with diabetes, I've clearly failed. And then you're on a slippery slope of getting them back up. And acknowledging this isn't a failure. This is progression. This is many times where things navigate and let's get you using what's going to be appropriate to improve and prevent further issues down the road. It's

Scott Benner 33:11
another reason why the communication is so important. Because if you communicate failure to them, they might then start getting what they expect. And if they expect that they're failing, then they might let go of things, the amount of times that people just like throw their hands up, because they're so frustrated is true. So, you know, please let them know that getting these devices doesn't mean they're doing a poor job. This is going to help them experience something they didn't think existed, right? Not, you're doing a bad job, we need to do better. This is like, Hey, you should see what exists now, like, this is incredible, you know,

Jennifer Smith, CDE 33:43
should be put out there as a step forward, not a step back. Yeah, it should be an example of, well, this hasn't been working the way that we wanted. But you know what, if we bring this into the picture, we're going to be moving forward with your health, overall quality of life, all these things that should be given examples as why it would be positive to include this type of technology. That's where you should be explaining things and coming from a clinician standpoint, so that you don't get that negative. Oh, well, I failed anyway, I guess I have to do what the doctor says. And then you do the baseline, right? You never go forward with asking for more information, because clearly, I've failed. I just have to deal with this new thing now and not learn any more about it. I'm gonna

Scott Benner 34:32
leave this here at the end for anybody listening agenda. You can do this too, if you want to. I'm not pressuring you. I'm looking at my daughter's last 24 hours. She manages her diabetes the way I told her to she understands timing. She understands how insulin works. She understands how food impacts her. She's wearing a CGM and an algorithm. Her highest blood sugar in the last 24 hours was 154. That was a spike after a meal that lasted for no more than an hour and a half. And since Then her blood sugar has not been over 125 or under 72 For the last 24 hours. That's fabulous. That right there. That's an algorithm right there. Yay, no input, Jennifer, not like nobody's doing anything except announcing carbs and right. That's it, right. So please, if you're a doctor, and you don't know about this stuff, please learn about it. Because you could move an entire generation of people with diabetes, not forward, you can delete them. It's the difference between driving from New Jersey to Connecticut for vacation, and getting on a rocket ship and going to Mars. So,

Jennifer Smith, CDE 35:40
you know, we talked to talk to clinicians about, you know, educate yourself, one one step of navigating education for yourself is get in touch with your area reps, get in touch with the clinical for all of the companies for these technology, you know, driven devices, and learn about them. Many times, they've got demos, they can pull, bring in for button pushing and whatever. There are even online resources like Dana tech for the clinical who, you know, if you look under their Panther services, essentially, you can look up all the devices you can play with simulated devices online. Yeah, I mean, they're wonderful resources for your reference,

Scott Benner 36:19
whereas CGM, I mean, you can wear dummy, like, No, you can wear like a, like a Omni pod. That's not a real pump. That's just gonna give you the idea of what it's like to wear it. But you could actually wear a CGM and watch it work. Yes, that would be a big deal. And take a meter homes, you know, if you have to calibrate it,

Jennifer Smith, CDE 36:37
and learn how the meter works. Yeah, learn how the

Scott Benner 36:39
meter works. First, it really would be incredibly beneficial for people. Okay, gentlemen, thank you so much. Appreciate it.

Jennifer Smith, CDE 36:45
Oh, course thank you.

Scott Benner 36:52
Arden started using a contour meter because of its accuracy. But she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter, there's already so many decisions. Let me take this one off your plate. Contour next one.com/juice box. If you know a health care professional that could use this series, send it to them, or anybody else for that matter. And if you're really enjoying it, please take the time in your favorite podcast app to leave a five star rating and a thoughtful review. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Die diabetes Pro Tip series is available for you from Episode 1000 to 1025. And for subscribers in Apple podcasts. You'll get those same episodes ad free. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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#1125 Grand Rounds: Technology Part I

Scott and Jenny discuss diabetes technology. Part one of two. Part two is episode 1026

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

Scott Benner 0:00
Hello friends, welcome to episode 1125. This is part one of the Grand Rounds episode for technology part two is it episode 1126.

Today Jenny Smith and I are continuing on with the Grand Rounds series, we're going to discuss technology in this two part episode and the first half general overview of CGM and pumps and in the second half different pumps technology and understanding the differences between them. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com. If you're looking for the diabetes Pro Tip series, it runs between Episode 1001 1025. For subscribers to the podcast, those episodes are ad free. For everyone else. There's just a couple of ads episodes 1002 1025 diabetes Pro Tip series from the Juicebox Podcast. This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org. And find them on Facebook and Instagram touched by type one is an organization dedicated to helping people living with type one diabetes. And they have so many different programs that are doing just that check them out at touched by type one.org. This episode of The Juicebox Podcast is sponsored by the insulin pump that my daughter wears Omni pod, learn more and get started today with the Omni pod dash or the Omni pod five at my link Omni pod.com/juice box. Alright, Jenny, we are back doing the Grand Rounds, which I guess is gonna get called by default, because I can't think of anything else.

Jennifer Smith, CDE 2:26
I think it's a great name.

Scott Benner 2:27
I love the name until one person online. It took one person to say to me, I don't think every hospital calls it that. And I was like, Oh, I pick the wrong. And but I think it makes the point, right?

Jennifer Smith, CDE 2:37
It makes the point it does. Yes.

Scott Benner 2:41
So today we're going to talk about continuous glucose monitors and blood glucose monitors in the same short conversation here. I guess we'll just start with BGMs blood glucose monitors and go over very quickly, that they're not all the same. And I'm beginning to wonder if doctors offices know that. That makes sense. These are not incredibly expensive items. Most people's insurance, if not all people's insurance are going to be covering a blood glucose meter. Yes, in a world where they're right. That's

Jennifer Smith, CDE 3:16
some kind, it's fair. It's fair, I wouldn't say that they even good insurance companies have sort of a preferred glucose meter. Right. And you may pay more for one that you expect in reviewing is better in terms of accuracy. Insurance will typically cover up a meter. Yes,

Scott Benner 3:36
I just think that it's worth mentioning that this meter that I'm giving you may not be as accurate as other meters, perhaps you should look into it or I don't understand why doctors offices don't begin with here are the top three, right? Because I think there's about three of them that kind of fall in similar space as far as accuracy goes, right? So here's the top three. If your insurance company doesn't cover the test strips for this, then you know, here's a declining list of accuracy. I just don't think that is a conversation that's ever had, I think you Gill, whatever the office leans towards maybe or I don't know how it even works to be honest, true.

Jennifer Smith, CDE 4:11
Years ago, when I was working in office, the standard that would be is that you would get from different companies, you would get sent meters and the meters are not the expensive piece. The meters are actually more of like the freebie that kind of like we would give for newly diagnosed we would give them either Yeah, the prescription and the pay part comes with the test strips, right? So it then depends on what test strips are kind of covered at what cost they're being covered. But most of the offices like I said when I worked in the past would get a good supply from all of the brand name ones not the typical ones, that you're gonna find it like Walmart or any of the pharmacy places that might have the generic brands, but we would get all the way Any ones and we would essentially help to kind of figure out which one would work best for this person size, what other things that they might be working with, et cetera. For

Scott Benner 5:11
my money, its accuracy and being able to read it. That's what I'm concerned with, and blood drops at this point. They're all pretty smaller, like requirements.

Jennifer Smith, CDE 5:21
They are for the most part. I mean, you know, when I was first diagnosed, it had to be this hanging blood. Like this gigantic off your finger? Yeah, exactly. Yes, to get enough. But these days, pretty much they're all about the same tiny, you know, head of a pin sort of size that Yeah. And the other nice thing is that many of the good ones actually allow second drop applications so that if it didn't get enough to begin with, you have a certain number of seconds in order to reapply some additional blood to get enough of the sample.

Scott Benner 5:52
Yeah, yeah. Are mucking it up. So it's not as accurate. Correct. So that to me, that's it just like, explain to them, here's the accuracy. I don't know what your insurance company is going to cover. I mean, even be clear and say, Look, from a purely business standpoint, the game is selling the test strips, like that's where they make money, right? So the meter is your, you know, caretaker meter, and then hopefully, you'll buy our test strips, because you like the meter afterwards. I would imagine there are people listening right now that are thinking, Wait, some of these meters are more accurate than other ones. I honestly 100% believe that that's not a thing everybody understands. And why would you think that? You know, why would you consider one to be less than the other or better. So I think have that conversation. And then on top of that, even if you're giving someone a CGM, which we're going to talk more about, you still give them a blood glucose meter. It's important. And you know, you test your blood sugar, if your blood sugar's really 110. And the the meter says, it's 150. That's a lot more insulin you're about to take, you know, right. And that's just not okay. So

Jennifer Smith, CDE 6:56
all right, it's a safe place that you think that you're starting based on what you're planning to do after this test. And you may be aiming for that, when in fact, you might actually be lower. Or maybe you're actually higher than that. So yeah,

Scott Benner 7:08
it's just important and I want to say to just because you're gonna give somebody a CGM doesn't mean, they don't need an accurate blood glucose meter. So right, you take five seconds to make sure they understand how to use it. Here, I'll ask you a question. You test your finger sometimes, right? Yes,

Jennifer Smith, CDE 7:26
when's the last time more than sometimes,

Scott Benner 7:28
sometimes, when's the last time you cleaned your hands with alcohol before you tested? In 2015, I needed support to start making this podcast and Omni pod was there. They bought my first ad, in a year when the entire podcast got as many downloads as it probably got today. Um, the pod was there to support the show. And they have been every year for nine seasons. I want to thank them very much. And I want to ask you to check them out at Omni pod.com/juice box. My daughter has been wearing an omni pod every day since she was four years old. And she turns 20 This summer, it's been a friend to us along the way. And I think you would enjoy it as well. Omni pod.com/juice box links in the show notes links at juicebox podcast.com to Omni pod and all the sponsors. I don't use

Jennifer Smith, CDE 8:22
alcohol to wipe my finger. There may

Scott Benner 8:24
not be alcohol in this house, actually. So I

Jennifer Smith, CDE 8:27
do use it to clean sites. I do use it to clean the back you know those little ports. And again, we'll talk about CGM, but I do use it to clean that off. But in terms of it's really a degreaser, right? an alcohol swab is kind of a degreaser, you're better off honestly just washing your hands with warm, soapy water, sing the birthday song to make sure that you you know, get as much bacteria off as you're supposed to get off and then wipe your hands nice and dry. And then do the fingers.

Scott Benner 8:56
So here's the question. That health aside, I don't mean like you don't want to open up a hole into your hand while there's bacteria and germs and everything in your hand that I know No, I don't want to do. But for the accuracy of the test. Dirty hands don't matter, right? Well, it depends what they're dirty with. Right? So glucose in your hand sugar on your hands that would interfere with the test. True, but if I was muddy, and I just rubbed my hands real quick and found a clean spot, would I get an accurate test? Jenny's like I don't want to say

Jennifer Smith, CDE 9:25
that? It's a great question. It really is. I mean, I've I've never actually thought about it. Although I will have to say that so in I in college, I used to do Habitat for Humanity and we would do trips out of state for spring break. And there were many times on the worksite it's honestly that it wasn't easy to get to just like running water with soap. So I I would actually just dip it in like my water bottle. Wipe it off. I'm assuming it was clearly I never had any infections. I'm not by any means recommending this as a therapy or an option.

Scott Benner 9:59
I just want to have the conversation. Jenny's not recommending it. Listen, I saw Mark Andrews get catch a touchdown pass a few weeks ago, and I'm telling apply somebody went on the sidelines tested his blood sugar didn't see him stop and wash his hands. So, right? Correct. The reason I bring it up is because I've seen newly diagnosed people kind of crippled by it. Like, oh, I have to test but I don't have a an alcohol swab, or somebody's like, I think I'm low, but I have to go get an alcohol. I'm like, Just test your blood sugar. You're like, yeah, let's get moving here. So anyway, that's my little bit for that. Why?

Jennifer Smith, CDE 10:31
I think as far as accuracy, too, I think that that's something that, unfortunately, unless, as a, you know, we're speaking to, hopefully, practitioners here, too, right. And in terms of their understanding about accuracy, you really do have to read the fine print, this is where you might need to get your reading glasses out and read that tiny little print that comes inside each and every one of the meters that you may be recommending or handing out from your office space. Because if you haven't read that, right, all of the different blood glucose meters on the market, including continuous glucose monitors, they all have marred, right. It's an accuracy rating. And so you'll be able to tell by easily lining those papers up with the little graphs inside of them. Which ones are the better ones to be recommending to your patient? Why

Scott Benner 11:24
do you care which one lives as long as it's the better one and their insurance covers it? Correct? Look, I'm not saying if you have no other options, or you're a cash payer, and it's hard for you, whatever, then take what you can get, you know, the best you can get. But while we're handing them out, it just it seems to me, it seems to me that you probably said that, and a number of physicians probably just in their mind with these meters are different. Like why would you think that their blood glucose meters? Seriously, you know, you would expect that

Jennifer Smith, CDE 11:50
if they're on the market, they've been approved? And yes, they've met some type of accuracy rating in order to actually be on the market. Yes. But there are, as you said earlier, there are three that are pretty much the top tier and align with each other in terms of accuracy. I mean, I have two of the top three. And I will not often but probably, you know, once or twice a month, I'll actually pair them off of each other with the same drop of blood, just to see how they're still, you know, on par with each other

Scott Benner 12:24
remarkably close every time you do it. They

Jennifer Smith, CDE 12:27
are Yeah, very, I would say within about five milligrams per deciliter, honestly, they're very close to each other.

Scott Benner 12:34
I just last night. So I mean, they're sponsors of the show. But you know, our news is a contour next meter, one of the content x meters, and there's a number of them, but she was bolusing for a blood sugar. And I was looking at her CGM. And I thought, that's not right. I know that's not right. Your blood sugar is not this high. From what she ate, and how much we Bolus. It just didn't make sense to me. I knew her site was working well. So I was like, you just gotta test real quick. And she tested and no kidding like her. I think her CGM had her at 190. And she was 150. So I was like, I knew it. And before we were gonna make another big Bolus. I was like, Don't do that. Again. I'm like, we have to check first. And I have to say I trust that meter pretty implicitly. So pretty great meter. Okay, so but CGM seems good, or do you have more to say on meters? No, I

Jennifer Smith, CDE 13:25
wanted to make a point, though, about what you just brought up in terms of sensing or having a sense of where glucose should be. And as we move into talking about continuous glucose monitors, the accuracy of your blood glucose meter, where you're doing a finger stick and getting a number from, if at any point you need to calibrate that CGM, the accuracy of the blood glucose meter also makes them very big difference in terms of the CGM.

Scott Benner 13:58
I left that out. But that was the last bit of what we did. As soon as that number came up. I was like, go ahead and calibrate the CGM it. Yep. Well said, I know that marketing wise. You know, all the CGM companies like to say like, you know, you don't have to calibrate you don't have to calibrate but you can, if you you know, so why can I if I don't need to sometimes. Right. And you know, and I'm down with that. I know, some people say it'll figure it out and we'll figure it out. But I mean, this is, is four or five days into this thing, her blood sugar. You know, it's she's got her period stuck a little higher using some extra insulin like stuff like that. But I was like, that's not right. And that's, by the way, we're not talking about management right now. But I don't mean that you can figure out what your blood sugar is by wandering out the space. It's a lot of years of experience and knowing what she ate what we Bolus and I think that can't be right. Also how the line moved on the CGM. It just wasn't acting the way I expected it to whichever Which made me think that something was up. Okay, but CGM. Give one to everybody. There. That's my advice. I mean, just everybody, if you've got type one diabetes, given the CGM, I would give type two CGM. I don't know if they're covered by insurance, I think they're incredibly helpful

Jennifer Smith, CDE 15:17
depends on insulin use for type two diabetes. And other factors, obviously, but insulin use the big one. somebody with type two who is on insulin is going to have sort of priority, I guess, in terms of the ability to get one. So but I would 100% mean, if I was going to lobby for something, I would say everybody with diabetes should have a continuous glucose meter. Because that's the only way that you're actually going to see trends based on the variables in your life.

Scott Benner 15:49
Right? I put up an episode today. It's an after dark with this 27 year old girl who said that when she was younger, they told her she was brittle, because her blood sugar's would bounce up and down, up and down. By the way, she's 27. She only had diabetes for 17 years. So it's in the last 20 years. Somebody told her she was brittle. So after I explained to her that that probably isn't really what was happening to her. All I could think was that she had a CGM. Maybe it would have like, struck a chord in or maybe she would have seen it, you know what I mean, instead of just guessing and testing when she wanted to. And by the way, all that led to and this is for the doctors. I mean, obviously timing wise CGM is didn't exist for this person. But not having one being told she was brutal, lead to an eating disorder. It led to manipulating her weight with insulin. It led to this anxiety about food she barely eats now, because of it, you know, all this stuff from just not being able to, like, witness what her blood sugar was doing and make some cogent decisions based on it. Right. So CGM, I mean, listen, Dexcom is a sponsor, but I still I just want to speak honestly here like, you know, I'm not trying to skirt anything. Big difference between g7 and libre three, like, no right

Jennifer Smith, CDE 17:06
now, and that's it's a good point to bring up because I think all the sensors honestly have fair enough similarity and accuracy. What may be the difference person to person is how their body actually interacts with that sensor. Right? I mean, I've said before, I don't know anything about the new Medtronic sensor, the newest one with their seven ATG insulin pump system. I've had people have told me it's a lot better for them compared to previous models. The previous models never worked for me. But Dexcom has always worked very well for me. And prior to going off the market in 2010 ish. I think Abbott used to be called the Navigator. That one was phenomenal. It worked wonderful. I switched to Dexcom it works similar and accuracy now is quite great. The libre as well, I haven't used it in yours. But there are a lot of people that actually prefer that to Dexcom. Right. So there are I think, accuracy. They're similar. But then person to person, you may also have adhesive issues. So don't discard somebody's comments about one system. Because the other systems may work in terms of accuracy, but it may work for other things like adhesives, skin issues under the skin, you know, reactivity and all that kind of stuff.

Scott Benner 18:31
I've seen people who can't wear a certain sensor just doesn't even give them a reasonable reading. And right, who knows, you know, they, I mean, you're not you're never there, but they say I'm hydrated. They say, you know, I did the right things when I put it on and they've tried sometimes for months and eventually abandoned them go to the other company or whatnot, is the sensor from Medtronic called a guardian still did they just keep that name? through it. It's just the newer one, or I wonder if they renamed it.

Jennifer Smith, CDE 18:58
I think it's still the Guardian, I'd actually have to check. But it's it's the newest that works with their seven ATG system. So

Scott Benner 19:06
there's Dexcom libre, Medtronic, there's the Sensi onyx, the implantable one, ever since ever since. Right, right. Yeah. And is that it at the moment?

Jennifer Smith, CDE 19:18
here and I'm trying to think here in the United States. That is

Scott Benner 19:23
it. Yeah. And those are the ones that are that are accurate enough for somebody to dose insulin from them. There's a crap ton of them now that are for like exercise and stuff like that. But yeah, those are not

Jennifer Smith, CDE 19:34
right. Those are not what would be recommended to use for dosing. Oh,

Scott Benner 19:40
Jenny, that was a big word out of you recommended. Okay.

Jennifer Smith, CDE 19:46
Not usually use big words. No, no, I

Scott Benner 19:48
mean it I thought it had a lot of implication when you said it. Maybe I was reading more into it. But no, you're not saying they work but they're not recommended.

Jennifer Smith, CDE 19:55
They're not recommended mainly because they're not you know, There's no indication on them.

Scott Benner 20:02
They haven't gone through the FDA process, right? That they're not going to pair with AI D systems or, you know any of that. Right? And really, you know, for doctors who are listening who might not know, I do think we should dig into it for a second, I'm just gonna let you speak from your own experience. But what is the difference between managing type one diabetes or insulin with diabetes with a CGM or without a CGM? Oh,

Jennifer Smith, CDE 20:28
it's night and day. Really, I mean, as and I think I've said before, in other episodes about the number of times I was doing finger sticks to gather enough information in my day, to make enough decisions about things right, my doctor had written my prescription for 15 test trips a day, just so that insurance would give me enough test strips. And I wanted all of that information at my fingertips are now very happy since about 2005. That I don't have to do that. finger sticks every day. But there's a really good graphic that came out eons ago, when sensors really first sort of started to get a foot in the door. And it gave a graph a 24 hour graph of, I think it was four or six finger sticks on the graph at different times of the day. And then what brought in the visibility of the sensor, kind of what the sensor provides is an overlay behind all of that of the ups and downs from every five minutes of a sensor reading, compared to just the four to six finger sticks values. So I know you've said before, too, you thought you guys were doing really well. When Arden was little right, you'd put her to bed at a certain number. she'd wake up at this number. But then once you had to CGM, you could see that she was going hypo overnight, right? Yeah. And landing in a place that you thought was good. Without the sensor, you didn't know that was happening. I also didn't know where there were problems in the aftermath of my meals, despite doing what is a lot of finger sticks in a day. Yeah,

Scott Benner 22:03
in the time, it took you to say that I with my pen in my hand, and my whiteboard in front of me, wrote down mental health, physical impacts, accuracy, being able to adjust your blood sugar. Well, being able to deal with difficult foods with insulin better being ready to pair with an algorithm. Those are just the reasons that I could think of in two minutes to have a seat salutely. So absolutely. It's not a fancy thing. It's not an extra it's not a nice to have like it really is. In my mind. It should be the first thing like you should get one in the hospital, when you're diagnosed. All these things that you hear people talk about years of diabetes, you know, the things old timers talk about the problems they have, I think many of them are completely alleviated with a with a CGM. Absolutely.

Jennifer Smith, CDE 22:52
And I think in terms of where it should be prescribed in hospital would be great. Because if you've got it in the hospital, you would at least have an education component to what you're seeing, you know, sending somebody home with a prescription newly diagnosed and then they're supposed to slap on this device and make heads and tails out of what they're actually seeing, along with all of these other things that our new variables to pay attention to. That's an overload. It really is. Can it help if they get quick intervention of information after they get it? Yes, and it can make a big difference from the beginning. But it just goes to also demonstrate how important it is that follow up right after diagnosis with all of this stuff being valuable. It's it's just really,

Scott Benner 23:43
even for people who are not like, dialed in super motivated about their diabetes, right? People who are just getting by not paying a ton of attention to it, let them see this number is when I don't feel good. Or this you know, I didn't know I started feeling dizzy at this number, but I still had time to do something about it before I got really low. Like those. I think that showing people those, those little guardrails maybe allows them to retrain their brain over time, to the point where they don't even know they're doing it. You know, until one day someone just says, Oh, I got a beeping it and wherever they ended up setting their, you know their CGM to beat that. I know when I'm 95 Diagonal down, I need like 10 carbs, that's another thing they would know before they would test their blood sugar See 95 And they Oh my god, this is perfect. And then you know, end up low a half an hour later. And that's when the mental part comes in the the instability is like, this is unknowable, and I'm never gonna figure this out. It doesn't make any sense because without that data, it doesn't make sense plus, it helps the doctor you know, it does

Jennifer Smith, CDE 24:47
and the you know, we're talking about general medicine, primary care who may be working with more of the type two population. That also means that you now have to do a bit of homework and understanding and live Learning how to read reports, if you are going to prescribe these, being the primary person, this person with diabetes is coming back to, to relay information, you have to know what you're looking at and how to help them, you know, maybe you've talked to them before about not drinking two glasses of orange juice every single morning, hey, this isn't good for your blood, sugar, et cetera. Well, now that there's information and a view of what that actually does, that has to be brought back into the conversation, if that's the point you were trying to make. And sometimes it's just one point at a time, it's one point per visit,

Scott Benner 25:35
it also helps people see the impacts of certain like foods to that they think are like Staples, like great stuff for them, but maybe they'll like, I don't know, maybe the third time they have mashed potatoes, they'll think I you know, that's not worth my blood sugar be in 250. For the next three hours, I'm gonna have, you know, a smaller amount or not eat this anymore, do something different to it, like all kinds of small things. We're always telling people to do the right thing. And then not giving them the tools to do it with, you know, or even the direction to do it with you just say you should eat better. exercise more, what does what does all that mean? You know, like, it's nice to say, but it's not actionable. Right? My brother is a type two, he got a hold of samples of a G six, get G six samples on time, enough to keep him going for like a month. And the significance was huge, like things that a doctor had been saying to him for years that he thought he understood, it turns out, he didn't understand that at all. And he was telling me, he understood, I get what they're saying, you know, and then he wears the CGM for three, three weeks, you know, a month and boom, he understands it.

Jennifer Smith, CDE 26:39
He's like, Oh, that's what happened. That's what

Scott Benner 26:44
they meant. I didn't get it. So anyway, I mean, again, back to insurance, everyone who can get it should get it. And even people who, you know, can't, Medicare, right covers Dexcom, I know, I'm pretty sure for Dexcom, these things are only going to get more and more popular and covered as time goes on, in my opinion, you should start at, we want you to have these things. Let's see if we can get your insurance to cover it. If not, you know what wouldn't be wrong to say to somebody, if your employer is self pay, maybe you should go talk to them. Because they might say okay to this for you, but you have no idea what you can work out. And as a doctor, I think that's the minimum you should understand to say to somebody, right, that's all that's what I got, there. We missing anything with this stuff, and what you want doctors to know about them. I

Jennifer Smith, CDE 27:36
don't think I you know, I mentioned it before in terms of technology really takes some desire to learn about in order to be able to know what you're recommending to your patients. And so, you know, take some of your time, whether it's a class that you take, that you don't really think is purposeful for you that somebody is going to come in from Dexcom, or somebody is going to come in, you know, from Avid or whatever it might be. And you're like, whatever. But you know what you might grasp something from it. There are a lot of actual online tutorials. So you don't even have to go and sit in a class, though, do an online tutorial, but how does the system work? What type of information does it give, and they're all professional based tutorials. So it might take you 15 or 20 minutes, but you know what, now you can better serve your patients, you're actually more informed. And that goes across the board for the technology. Because not only do we have the continuous glucose monitors and the blood glucose meters, but we also have apps and things that sync with them. So from a clinical standpoint, the ability to get that information from somebody and be able to make sense of it and send them some thoughts back or in a visit, discuss that with them becomes even more for facilitating their well being.

Scott Benner 28:55
There should be some continuing education for you. You know, diabetes, insulin, that the technology I mean, come on, like you have to understand how that works. And I don't know how you ever buy a car, and then had the person show you the car, but they didn't know how it works. And all you can do is sit there and think you work here. Shouldn't you know this? Did you know this? Yeah. What do you mean, you don't know what this switch does? You work here, you only sell for cars. You don't know what the switch is? That feeling that immediately removes your ability to trust the person you're talking to? Yes. Right. And, and what Jenny's saying about educating yourself about how these systems work, so you can speak about them is it's not just about that. It's not just about helping the person feel better and not going like Oh, they'll figure it out. You know, it's about them trusting you moving forward. Yes, it really is. You shoot yourself in the foot and it's hard to get back from it. I've had that experience where a physician has said something so bad bonkers, that I was like, Oh, now I know not to listen to them anymore, which isn't fair either. You don't mean like, but it is how it makes you feel. And

Jennifer Smith, CDE 30:08
in today's world of, again, technology, technology being an online driven review system, honestly, shooting yourself in the foot is kind of a bottom of the barrel way of saying it. There's so much feedback that's given in online forums and everything in all different types of professions that you can make one little kind of misstep, and you're getting a bad review. And then it's bad review after nobody coming to you after somebody commenting. It's that it's sort of just snowball.

Scott Benner 30:44
Yeah, you're in business to might be important for people to think that you're a value to them. Yeah. Especially in a world where by the way, people now can go to walk in clinics and get prescriptions if they needed. Even some people have, through their insurance through their employers have access to physicians now. Like, Yeah, everybody's not just going to come to you because you're there. But let's go through real quickly, Jenny, what everybody said, Oh, yes, for CGM, SB gems. My doctor didn't even tell me to watch even a YouTube video. He just prescribed it and left me on my own. So that's such a crazy idea. Here. Take this it does this good luck.

Jennifer Smith, CDE 31:22
Right. Yeah, I know. I mean, when I and I don't know what you guys had when you first got the one because you only started with Dexcom. You never used anything else. Right? Correct. Yeah. So I'm assuming that you got some education given that Arden was a child? Yes.

Scott Benner 31:40
But it felt like they were building the plane as they were flying it because it was so early on. You know, it's like you were learning together in the office with somebody which I appreciated. They, they were like, look, it's new. We don't really know. Right, which I thought that was great. Because we'd also had an experience in the past, where we were told not to use an omni pod. Because I forget, what did they tell us? Or they said Your daughter's to lean for that. And oh, and I was like, I don't know what that means. But we're getting this anyway. And so we got it. I mean, I went with Omni pod originally, because of the just the generally the tubeless nature of it seemed, for a number of reasons like the way to go. It took two years for the endocrinologist to pull me aside one day and say, We want you to know that because of RT and success on Omni pod. We're now writing prescriptions for Omni pod to younger kids that we weren't before. And I said, Why did you tell me all those years ago like not to use it, and in a very quiet tone, the person said to me, it was newer, and we weren't comfortable with it. So we didn't want you using a device we didn't understand. So it had nothing to do with how lean Arden was it had to do with they didn't understand it. They didn't want to take the time to learn it. And so they weren't going to they were going to just push me towards another device. And

Jennifer Smith, CDE 32:55
or they had experience with what was already on the market. And in comparison, which wasn't a fair comparison. They were able to say she may be too lean, she may not do well with this or whatever. And again, their comfort level and I find this not as much now but years ago honestly, many offices had a comfort level weren't talking just about insulin pumps with one particular pump. Yeah, that's what they maneuvered everybody toward this pump. Because we know this pump Oh

Scott Benner 33:29
yeah, that was a whole day of somebody saying to me animus ping animus ping, which by the way doesn't exist anymore?

Unknown Speaker 33:34
No, it wasn't good pump.

Scott Benner 33:35
I was on it. Everyone I've ever spoken to says they love it. Absolutely. But Arden is also used Omnipod for she started on a pump when she was four. She's 915 artists been using Omnipod for 15 years. So I think we did okay, but that point of understanding what you're talking about, so that you can actually talk about this person says they should know that CGM 's are extremely important at diagnosis, not knowing exactly how insulin affects you. And all of the other factors that go into managing sugars are very helpful in determining all of your personal factors. Yes. And I wrote a note after that, they just said, Look, patients shouldn't even have to ask for CGM. You shouldn't make a person. They don't know anything about diabetes. You don't I mean, now you're asking them to choose what they're supposed to be. You know, using they don't have any idea this person's like, You got to tell me, you know, she goes on to talk about, about catching loads how important it was, especially for their child. And then this other person says, I'm, uh, I was diagnosed at 29 I needed this the same for the same reasons, right? And then oh, this is interesting. This person had a libre back when back when they were scan only you had to hold the device up to the libre to get that number. And the physician told them that they were scanning it too frequently. You have you ever heard somebody say don't look at it so often.

Jennifer Smith, CDE 34:51
Yes. Yeah. From a mental health standpoint. I think that there are there are some people obviously who they you Use it. Not quite to their health. But as almost an obsessive, I have to check, I have to check. I have to know where I am. Oh, it's going down. Oh, it's going up. And there's a difference in that versus I need to see where I am because I have this planned. And I need to see what my action is right now. For the coming, you know, plan? Yeah,

Scott Benner 35:21
the best way I've ever found to make people comfortable there is to tell them, Look, let's set more reasonable alarms. And then don't look. Unless the alarm sounding. That's it, but we can't make your high alarm 250. Like, you know, we can't do that,

Jennifer Smith, CDE 35:35
right? Because then you're gonna miss the mark. And that's going to make you hyper vigilant, again,

Scott Benner 35:39
not gonna be the point. And for a doctor who says, Oh, if I don't make it to 50, the thing will be beeping all the time, I would say to you, you might want to go listen to the Pro Tip series, because it doesn't need to be beeping all the time. It doesn't need to be going high all the time. There's simple ways about using insulin that will help you right, so Okay, agreed. All right. Thank you very much. Yes, of course. Let's do this. Let's move into pumping. But if it doesn't fit here, I'll split it up into two different episodes. That way I have it here. But I can maybe put in its own if it needs to be is that okay? That's fine. I have about 15 minutes where you're going to go through the people's questions. And if we have to come back later and finish up we will. So cool. I wish they would have explained the difference in detail between t slim and Omni pod. Oh, isn't this interesting? In the new device world. This person doesn't even mention Medtronic. They were extremely vague and our toddler is on Omni pod. And so you made this point already in the CGM episode, but you need to understand what these things do. This is Omni pod, this is how it works. Here's why it might be better for you or you are here's what I'm even seeing from people who are using it. This is what the T Slim is. This is what control IQ is like. Do you think that it's possible that doctors just like tube, no tube, you think they're like, it's that simple.

Jennifer Smith, CDE 36:55
Could be practice to practice, quite honestly, it could be that simple. It could also be, these are the pumps, they all deliver insulin. And I think they're trying to save people from some of the very little tidbits of information that make you different. But I also think that that's really important. From an individual need perspective, really good pediatric practices, I know often will have like pump exploration days, where they'll have you know, all of the different pump options come. And you can walk around almost like a fair, right, you can explore talk to the representative, you can feel it, pick it up push buttons, get kind of an idea of what it would look like feel like you know, you can even like clip it on and see what it would be like to kind of have it dangling on your pants or whatever. But those are all really important things when you as a clinician are recommending something, don't recommend based on your preference. That's the bottom line, you have to really consider what does the person need to know if they are a swimmer? And a competitive swimmer? Well, you might tell them a little bit more about why one may be more optimal than another. But it's still up to them to make the decision.

Scott Benner 38:16
I think they should blend information to like I mean, the person who comes out to explain the device to you is the salesperson, right? So like, you know, okay, here's these are the highlights of the pump, that's great. But also go do some research on your own, and talk to users and get their feedback. And go online and hear what people are saying there. And then blend that together. When you're talking about don't just like you're not a salesman for T slim or for Omnipod you're you know, you can't just go by what the pamphlet says the pamphlets, its marketing, right? So right. I'm not saying that one of them is hiding something or something like that. But it's not going to give you a full understanding of it by just reading the brochure. I mean, that would be like making a decision based on my ad. Like if you hear an ad for something, these are the highlights. You should now go figure out the rest of it. Like you know, don't make a decision based on this. I think that's incredibly important. And it goes back to that thing you said during the CGM. It's like you have to educate yourself on how these things work. And especially with the algorithms now. It's not just the I mean, honestly, before the algorithms pumps were, they were just basic,

Jennifer Smith, CDE 39:23
basic delivery that makes it easier than taking

Scott Benner 39:27
injections. The idea behind going from MDI to pumping is that with pumping, you gain control over your Basal insulin. You know, you could set up extended boluses squarewave Bolus, things like that. You can vary basil Yeah, right. You know, you could temporary basil your insulin completely off if you wanted to, if you were in a situation these are things you can't do with MDI. But it wasn't some like insane leap. Like it was just here's the extra things you to me. It's amazing and it's incredibly helpful. But now you're gonna go from those Is to these algorithms, they all are aiming for the same thing, but doing those things differently. And you should know the differences. It just makes sense to me. Because when I stop and think about, where are doctors going to struggle in the coming years with algorithms? I think of it's like little things like fat and protein becomes really important. Right? Like, you know, because a doctor is gonna, like, say, oh, no, the thing does it. But it doesn't. It doesn't know, the thing doesn't know that there's a bunch of fat and the carbs that you told him about at one o'clock and 90 minutes later, your blood sugar's gonna start going up. And then people are like, Well, what should I do? Should I wait for the thing to do it? The thing is gonna take, I mean, honestly, hours to make another decision. And to

Jennifer Smith, CDE 40:44
clarify, will the thing do it? It'll do it? Well, yeah. But as you just said, it'll take hours of time, because all the systems are based on with their algorithm are based on an sort of an extended time of action of our rapid acting influence, which are not rapid. It's a horrible word, whoever came up with that word for today's insulin, yes, it's faster than what I used originally, but it's not rapid, as fast

Scott Benner 41:11
as the word makes it sounds correct. If the algorithm is thinking on a, I don't know, on a six hour timeframe, then your blood sugar shoots up an hour after you eat. And five hours later, the algorithms gonna be like, Oh, we should probably be more aggressive with this, you know, that happens to you at two meals, well, then this, I don't know what good the algorithm is to you at that point, like, you know, if your blood sugar in the 200. Now, if it's holding your blood sugar at 200, and eventually gets it back down, I see the doctors argument, this is way better than these people were doing before. And it is yeah, and I understand that, but a tiny bit of a tiny bit of understanding how insulin works. And a tiny bit of understanding how the algorithm works could lead you to tell them, here's a secondary Bolus maybe we could make that would help us, which the company isn't going to tell you about, because they're not legally allowed. That's not how that works. Like the FDA doesn't allow insulin pump manufacturers to direct you about how to use insulin. That's just the thing that they're not allowed to do. What you're

Jennifer Smith, CDE 42:09
getting into is the idea that, and we've been talking about all along is that as a clinician, you have to educate yourself. Right? There are so many things that you learn as somebody with diabetes, because of the huge benefit of continuous glucose monitors. And when you fold that continuous information of what your glucose is doing, into a system that can now dose insulin, along with that, you have to know how to look at the data to help somebody best make decisions for their life. I mean, we started MDI, it is what it is you could Bolus 16 times a day and sort of mimic what you think you need to do. Sure, go ahead, but it's not going to have precision, conventional pumping. Next line, you've got some smart features, but who's the driver, the person, the person drives the the use of those precision parts of that technology. And then algorithms bring it even further. But not far enough. Our algorithms are not AI, right? They're not learning. They're not saying Oh, every Friday night pizza is coming in, you got to be ready for this. It's not there yet. So the smart driver is still the human. And the human needs the right information in order to be able to navigate blood sugars in a target range that's going to keep them healthy, long term,

Scott Benner 43:32
we made a significant adjustment last night to get Arden's blood sugar down. We didn't wait for the algorithm to do it. We were like, No, I know what to do here like to get this down and did not cause a low or anything like that afterwards. I think maybe I'm just as you were talking, I thought maybe doctors should do ride alongs with people who have type one, right? Because you always hear my endo is terrific. They have type one diabetes, like people say that all the time. Like I hate to say it, but my endo is better because they have type one my nurse practitioner knows, I mean, listen, you have type one, right, like so. I do. Wonder if that's not doable. I wonder if doctors couldn't just like, live a day with a patient every once in a while. Just I mean, honestly, that's how you if you lived here for a week, you wouldn't, you'd know everything you needed to know.

Jennifer Smith, CDE 44:17
But I wouldn't even say to go there. If you are a doctor who is prescribing these, an easier ride along really would be take the product, put it on your body and use it as if you were somebody with diabetes as if you were following the directions that you're giving people to walk out of your office with. Right? Yeah, you know, look up your carbs. Check what is happening before you go for a run, look at your data and know it's not going to reflect shifts like somebody with diabetes has, but it'll get you in the mindset of all of the considerations along with using this piece of technology that is delivering insulin, which is not a silly medication. Even

Scott Benner 45:05
like, maybe this is the right along idea. Maybe it's Can't you just follow one of your patients for a week? Like, can you get somebody like get there? They say, Look, I'm trying to learn more about all this, would you help me? I'm gonna follow your CGM. I know that sounds crazy. But for a few days, just text me, I just ate this, it was this many carbs like that, like, here's how much insulin I put it, it wouldn't take you long to like, go, okay, I get this. And now you've had this, you take this thing you take time, one time. And now you can take what you learned and give it to everybody. It's just none of you are going to do that. I know when I said let me just tell you right now, that's the best idea I've ever heard. So if you're a doctor trying to help people with type one, following a type one, knowing what they when they ate it, and how much insulin they got, then watching their CGM, you would understand in no time at all what was happening. And you'd be able to not only just help that person, but you'd be able to transfer that knowledge on to other people. So anyway, you would I'm 100%. Right about that. I'm not I'm not backing down off of that, quickly, if this person says hey, if you're having issues with like a glucose monitor, or a pump or something, it would be lovely if the doctor would help us when we need help with our insurance, oh, writing letters of medical necessity, things like that, you know, don't just give people a script and then go, Oh, it didn't work out. That's tough. There are times they need you to step up. I would also say that giving somebody an arbitrary amount of time before they're allowed to have a device, I don't think makes a ton of sense,

Jennifer Smith, CDE 46:37
is ridiculous. It needs to be individualized. Yes. Yeah, I

Scott Benner 46:40
mean, I get that my assumption is, is that they've had this experience with insurance companies. And they know that the insurance companies deny in the beginning, but that's also you can get around that, and you know it. So you know, people are begging for insulin pumps, just telling them Oh, it has to be six months, or the practice has a rule. You have to be on MDI for a year, correct. You know, I mean, a year Jesus, you can't figure it out, you know,

Jennifer Smith, CDE 47:04
yeah, I was gonna say that, that's often what it actually boils down to is a protocol that's within the practice, or within the department or whatever, that says, you have to meet all of these pieces. And typically, it takes six months. So we're gonna say, within about six months, then we can start working towards getting you a pump. Yeah, but again, that everybody is so different in their life, and has so many different variables and needs, that you really have to throw those protocols out. And you have to say, well, you know what, this person definitely needs a weight, there is a lot going on here, this person could definitely have it within the next month, because they need it and they, they get it, they're at a higher level of learning, or they've reached certain, you know, points of education that are already important. So individualize. Okay,

Scott Benner 47:58
thank you, Jenny. I'm gonna leave a voice note here for both of us. So when we come back and re record again, we're going to talk about why insulin pumps are so important. What they do for people, they're not just replacements for injections, and what value they'd get out of pumping and what value they'd get out of an algorithm. And we're gonna actually like continue this conversation next time you're back. Fantastic. Thank you so much, of course.

A huge thanks to Omni pod, not just my longest sponsor, but my first one Omni pod.com/juice box. If you love the podcast, and you love tubeless insulin pumps, this link is for you. Omni pod.com/juice box. A huge thanks to touched by type one for sponsoring this episode of The Juicebox Podcast. Check them out on their website touched by type one.org or on Facebook and Instagram. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox 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 Juicebox Podcast type one diabetes on Facebook. To continue this conversation jump now to Episode 1126. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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