#1217 iLet from Beta Bionics

Steven Russell, MD is here to talk about the iLet pump from Beta Bionics.

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

+ Click for EPISODE TRANSCRIPT

---

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 1217 of the Juicebox Podcast.

Today I'm going to be talking about the islet insulin pump with the Chief Medical Officer of beta bionics, Dr. Steven Russell. Dr. Russell and I will go over questions from the audience as well as his feelings about the eyelet pump. 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 supply of vitamin D. Drink ag one.com/juice box. If you are a loved one has type one diabetes and you are a US resident. I'm asking you to take 10 minutes to fill out the survey AT T one D exchange.org/juice. Box completing that survey helps significantly with type one diabetes research. T one D exchange.org/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. And as a matter of fact, we have quite a few users using the islet pump so if you have questions, join the group is absolutely free. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com forward slash juicebox. 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. Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now and a little later, he'll tell you about his life with type one. To hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juice box or search the hashtag Medtronic champion on your favorite social media platform.

Steven Russell, M.D. 2:39
Hi, this is Steven Russell. I am the Chief Medical Officer of beta bionics. I am also a associate professor of medicine at Harvard Medical School and I see patients at the Massachusetts General diabetes Center part time but most of my time now is spent working at beta bionics. I have been working on the bionic pancreas project for about 16 years now been working with that Damiano. And for us Alkhateeb from the early days of the bionic pancreas project and, and directed most of the clinical studies that were done three pivotal and pivotal and joined the company in the end of 2022 to help to get the product approved by the FDA and prepare for launch.

Scott Benner 3:28
Okay, so you have a good, healthy, long relationship with it. So you're gonna have all the answers, right? Some of them well, I'll do my best. What's your educational background?

Steven Russell, M.D. 3:38
So I have an MD and a PhD in biological chemistry. And I trained at UT Southwestern for my MD and graduate degree. And then I came to Massachusetts General Hospital for my internal medicine residency, and stayed at Mass General Hospital for an adult endocrinology fellowship. Okay, so

Scott Benner 4:00
did you do most of your work in endocrinology, or is it internal? So

Steven Russell, M.D. 4:04
endocrinology is a subspecialty of Internal Medicine. So you have to do internal medicine residency first, okay. And then you can sub specialize and I chose to sub specialize in endocrinology.

Scott Benner 4:16
I always like to know what made you choose it? Well, I

Steven Russell, M.D. 4:18
think it's partly the kind of work it's you know, diagnostic work, solving puzzles, but also long term management, you know, trying to figure out how to help people live their best life with diabetes is appeal to me. And from the research standpoint, I've always liked intellectually curious, I like the fact that in endocrinology, there's control loops, that are sort of intellectually satisfying. And so that was appealing. For that reason, I think, and I knew I wanted to do some research, and there's just this great history of research that comes out of endocrine I think something about hormones, they were accessible to work on, early on. If you identified a hormone, not only did you have the hormone but you that you had a drug, you know all almost all of those hormones were also immediately usable as drugs didn't have to go find a small molecule. So when insulin was discovered as the key element to control glucose, all you had to do was purify the insulin, not a trivial matter, but you had to purify it, figure out how to use it, you didn't have to then go and find some other small molecule drug that could act on the insulin receptor. It's a, perhaps a shorter path from figuring out how the mechanism works, to being able to do something with that information to help a patient. Okay,

Scott Benner 5:45
so then is it fair to say that those things that light you up are maybe one of the reasons why somebody came and found you for for this 16 years

Steven Russell, M.D. 5:54
ago? Well, we sort of found each other. So Edie had started to work on the bionic pancreas algorithms, because, as his well known now, he had a son who developed diabetes at 11 months of age. He was an applied mathematician doing fluid mechanics, but thought maybe he could use his applied mathematical skills to to improve management of diabetes. And he was to the point of doing studies in pigs that he made diabetic with bras and they were doing these studies with an earlier version of the algorithm. And he came to the Joslin diabetes Center to report on that work. And I was there doing a postdoc trying to understand how insulin signaling effects longevity and aging. But I also had a side project looking at accuracy of CGM and in people in the hospital and critically ill. So we reported these data using both insulin and glucagon. And I really liked that approach. It was kind of contrarian at that point, because people said you couldn't use glucagon as part of a control strategy. And sometimes when people say something can't be done, it's true. But in many times, they they just haven't opened their mind and really investigated it. So I was intrigued by that possibility. So I approached him and said, hey, you know, you're doing these animal studies? Could we work together to do studies in humans, and he was enthusiastic about that prospect. And from that point onwards, we started writing grants and planning studies, and, and we've been working together ever since it's

Scott Benner 7:37
interesting. It's interesting how you can ask a question, and somebody will say, No, absolutely not. Or maybe, and, you know, like that the No, absolutely not people like, are they so tied to what they know that they can't see the rest of it? Is it just comfortable for them? It must make all of these things difficult in an academic setting, right? Because so many people tie their ideas to who they are. You know what I mean?

Steven Russell, M.D. 8:04
Absolutely. I mean, if somebody has been working on insulin, only automated insulin delivery or insulin only automated glucose control for a long time, and then you come in and per proposing using a second hormone. I think that that can be kind of threatening. Yeah. And can feel like, oh, wait a second. You know, you're you're encroaching in my territory. This, we're going to do this this way. Right. At one point, I had somebody not to be named come up to me and say that nobody should be working on by hormonal glucose control until there was an insulin only system on the market. And I thought that doesn't make a lot of sense to me. I

Scott Benner 8:49
know someone told me one time that I couldn't make a podcast and talk about how we manage my daughter's blood sugars. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Tchibo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called Have an insulinoma visit je voc glucagon.com/risk For safety information. And now 17 million downloads later, it helps people in 48 different countries. So if I were to listen to that person, none of this would have happened. So here's the people who don't listen. That's great. So now we've got a fast forward all this way you go through this entire process, you get a device, it gets its way through the FDA, it's it's available on the market now. I always, when I'm thinking about it, let I want to know if I am. If I'm clearly understanding what it is. And I'll just tell you that from my perspective, it seems like a fantastic device. If someone has an elevated a one C, and struggles and can't figure things out about how to dose or count carbs or anything like to me this seems genius. I mean, if you're a person walking around with a 1011 1213, a one see, are you telling me I can put the eyelet pump on and announced meals? Like I mean, what are the announcements? It's snack? How was the

Steven Russell, M.D. 11:03
Wreckfest? Lunch or dinner and usual for me more or less? Okay,

Scott Benner 11:07
so I make those two announcements. And I get an A one see where? Well,

Steven Russell, M.D. 11:13
on average seven, about half of the people in our pivotal trial wound up with agencies below seven and about half above seven, and most of those were below seven and a half. Okay,

Scott Benner 11:25
that's astonishing. So that did. So that's my point. For every person who listens to this podcast and firmly understands Pre-Bolus eating their meals and adding insulin for fat and protein and all the other things that you need to understand to keep stability. I mean, I don't know the number, but there's got to be 100 people who don't understand it are never going to even intersect the information that if they did, they might not get it. So am I thinking about that right? Or am I undercutting islet? By thinking about it that way?

Steven Russell, M.D. 11:49
I think you are under cutting a little bit, I think you're right. It's definitely great for people like that. And we wanted it to work for people like that there's a lot of people out there who aren't being served by the current or previously available diabetes technologies before islet. And we know that that's the case, because only 20% of people in the US with type one diabetes at expert centers have an A one c less than 7%. So that's a pretty sobering statistic. The average a one sea of people with type one in the US is about 8.2%. So that tells you that the current methods are not sufficient. And that hasn't changed. By the way very much as we've gotten CGM and AI D. I think a lot of new technologies that we've gotten have allowed people who are already had pretty good glucose control to get even better glucose control. But what they haven't really done is allowed people who weren't getting good glucose control to get good glucose control. And I think that's where the islet is, is really different. One of the ways that the sense that I think you may be underselling it is even people who have good glucose control, are often spending more time managing their diabetes than they would ideally like to do. There's an enormous mental overhead associated with managing diabetes just takes a tremendous amount of thought and effort and time and consideration to achieve those kinds of results for even for the people who are achieving good results. And I think that there's a real opportunity for those people to continue to get good results. But with less effort on their part, what we found in the pivotal trial is that for people who already had an agency less than 7%, at baseline and the trial, their average a once he did not change on the eyelid. So if they had an agency below 7%, on average, they still had an agency below 7% was about six and a half percent for people on the island for people who already had an agency below seven. Okay. And they did that with a lot less effort. And you don't really capture that in the in the numbers. But we did do patient reported outcomes where we asked people using these standard sorts of questionnaires, essentially, how are you feeling? And what we found is that they had less diabetes related distress, less fear of hyperglycemia, better quality of life. And those are things that don't show up in those agencies or those average glucose numbers but are real and matter. And

Scott Benner 14:40
so are you saying that people who had a better understanding to begin with, generally speaking didn't see a rise in a one see when they moved to Island?

Steven Russell, M.D. 14:48
That's true. Yeah. What we did see is that as I said, on average there anyone see didn't change on the eyelid if they started off already meeting goals for therapy if they already had anyone see less than 7% And if you break it down further and look at that group, some of them had no change in their agency from baseline, some actually saw further decreases in their agency on the eyelet. Some actually saw increases in their agency, although by and large, they still stayed below seven. But what was interesting about those people who saw rises in their agency, they generally had significant reductions in their time less than 54. So they were seeing an increase in their agency, because they were having a lot fewer lows,

Scott Benner 15:31
people who were coming to their agency, sort of, not honestly, right, like they it was being offset, their standard deviation was being offset by low blood sugars.

Steven Russell, M.D. 15:39
That's right, okay. And on average, the eyelet didn't change the amount of time less than 70 or less than 54, there was no difference in the control group and the islet group, and time less than 54. Median was point 3% of the time less than 54. And that was true in both groups. But that does conceal a little bit that conceals interesting things. So for people who had very high levels of hyperglycemia, at baseline, the eyelet, decreased them quite a bit. For people who had none at baseline, it tended to increase it a little bit from say zero to point 2% of the time. And that might be the cost of you know, somebody having an agency of 10 or 11, or 12, with zero hyperglycemia, you bring them down to an agency of seven or seven and a half, they're going to have a little bit but still acceptable amounts. And then people who had hypoglycemia below 1%, at baseline, typically no change.

Scott Benner 16:38
Okay, so I have a ton of questions here. And if you don't mind, I don't I don't mean rapid fire, like we're going to be exhausted and sweating when it's over. But I'd like to maybe lose the conversational nature of this a little bit and go to more of a question answer if you don't mind. Of course. Okay, that's excellent. Thank you. Let's start with kind of the basic stuff. Let's just start with dosing. Like you just said, breakfast, lunch, or dinner. So you you pull up your pump and say, hey, it's breakfast, and I am having an average meal for myself, do I Pre-Bolus that,

Steven Russell, M.D. 17:09
we suggest that you announce the meal at the time you're starting to eat

Scott Benner 17:14
it. So that's a no then to the Pre-Bolus. Right? If

Steven Russell, M.D. 17:17
you are some people really like to do that and find that, you know, they might get some people say that they get better glycemic control less of a postprandial excursion. If you're going to do that, though, you need to do it consistently, because it will affect how the islet learns how much insulin you need for that meal.

Scott Benner 17:34
Okay, let me jump to that word, then learn what is learned mean, in regards to eyelet? How does it learn? What is it do with that information? How does it change the future?

Steven Russell, M.D. 17:44
Sure, it depends on which part of the insulin dosing you mean. So there's basil, there's a basil algorithm that learns, there's a correction algorithm that learns. And then there is the meal dosing algorithm that learns, and they, it is unique in that all of those do truly adapt and learn the individual's insulin needs. Most of the other AI D systems don't actually adapt or learn anything. The one exception I would say would be Omni pod five, because it it does actually determine the basil dose, it updates it every time you change a pod based on the average basil for the previous pod. But all of the other systems and all the other aspects of Omni pod five, are just reacting to the circumstance at hand, right? It's not changing how it doses in the future. But with the island, it truly is learning and adapting. So you ask about the meal doses, what we do is for each of those meal types breakfast, lunch and dinner, which are which adapt independently of each other. The island initially the first time you announced a meal, it gives just a very small weight base dose, which is point o five units per kilo. So if you're an 80 kilo person, it would be roughly four units, which for most people isn't enough, then what it does is the corrections algorithm automatically provides additional insulin to correct the blood glucose back down to the target. And it keeps track of how much insulin it needs to do that over the next four hours. Then the next time they announced another say usual for me breakfast, it looks back at that previous meal and say Oh, I gave for at the beginning but then I had to give another for correction. So it looks like a usual for me breakfast needs eight units, and then the eyelet gives 75% of that. So six units. Again, that's because we want usual for me to be most of the meals we want it to be a range so that people aren't counting carbs or just qualitatively estimating. And then the next meal keeps track of additional correction insulin maybe this time it uses a total of nine units. So the next time You announced the usual for me breakfast, it averages those two previous meals. And it keeps doing this up to seven meals. And so it's constantly looking at the average of the insulin dose it thinks you needed for the last seven meals once a day, once a day to as eight days old, it's forgotten, and you've brought a new day in. So we're always looking at the average amount of insulin needed for a meal announced that way over the last seven days. Okay, we give 75% of that.

Scott Benner 20:28
What happens if in the middle of that week, I throw a breakfast sausages or bacon in with my meal that I haven't had before. And suddenly my digestion slows down. It'll address that as a higher blood sugar when you get the fat rise. This episode is sponsored by Medtronic diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen.

Speaker 1 20:51
I was going straight into high school. So it was a summer heading into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went, I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was. My hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 21:25
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 21:30
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it.

Scott Benner 21:45
Did you eventually find people in real life that you could confide in. I

Speaker 1 21:49
never really got the experience until after getting to college. And then once I graduated college, it's all I see. You know, you can easily search Medtronic champions, you see people that pop up and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more. You know how I'm able to type one diabetes, Medtronic

Scott Benner 22:10
diabetes.com/juice box to hear more stories from the Medtronic champion community. I used to hate ordering my daughter's diabetes supplies, and never had a good experience. And it was frustrating. But it hasn't been that way for a while, actually for about three years now. Because that's how long we've been using us med us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7. They accept Medicare nationwide, and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or just call them at 888-721-1514 get started right now. And you'll be getting your supplies the same way we do?

Steven Russell, M.D. 23:42
Well, there's going to be really two effects of that right. One is that it may slow down the absorption of the carbs. But it may also make you have to get more insulin ultimately, because the fat is interfering with the action of insulin. That's part of the reason that we only give that 75% Because we don't want to overdose right up front. If somebody eats on the lower side or for instance, eats something that's going to slow down their absorption. So we tell them not to consider the amount of protein not to consider the amount of fat. That's part of why we're conservative with that initial dosing knowing that our corrections algorithm can come in and fill in any gaps. So there's an element of adaptation. It's learning how much it thinks you need, but then we're only giving three quarters of that. And then there's an element of being reactive to how this meal might be different from previous meals. Because the correction algorithm it doesn't, you know, give 75% and then give the other 25% it gives 75% And then just sees whether more is needed. Maybe none will be needed, or maybe it'll be needed later in that four hour period than earlier because they had more protein. If

Scott Benner 24:54
I flip that on its head then and I eat that fattier meal to three days in a row and then the fourth day I just I have the same amount of carbs, but just nothing that's going to slow down digestion am I going to see a low blood sugar there?

Steven Russell, M.D. 25:04
Well, if you have nothing that's going to slow down the absorption, the glucose may be absorbed faster, you may get a sharper spike, actually. And so the correction algorithm may jump in sooner to give more correction insulin, but then, because there's no fat or protein slowing it down, it may not need to give any more after that initial dosing. But

Scott Benner 25:26
in that situation, if the carbs are the same five days in a row, the first four are fat laden. And so it's it's correcting, correcting correcting on the fifth day, does it not think breakfast is going to need more? And then suddenly, it doesn't is that's where I'm asking. Like, almost like with Right, right? Yeah,

Steven Russell, M.D. 25:42
but that, but that's part of why we only give 75% That's what helps that? Yeah, exactly. Okay. Yep.

Scott Benner 25:48
It's interesting. Now what happens? I mean, do you see I guess the question should be, do you see in testing or with real life use high blood sugars that it just can't affect? Like, what happens when a person who's used to taking care of their blood sugar's looking and saying, God, I have been to 50 for three hours, I want to Bolus here like what are they supposed to do then?

Steven Russell, M.D. 26:09
Right, I think that does sometimes happen early on before the meal doses have had a chance to adapt. So it's almost by design, that you probably if you're somebody who needs more insulin than that sort of low initial estimate, almost by design, you're going to see hyperglycemia after that first meal. And the island needs to see that hyperglycemia to give correction insulin to know that you're going to need more insulin next time. Okay. And so if you are patient and wait, and assuming your infusion set is working, and it hasn't failed or anything, the the eyelet will bring your blood glucose back down into range. And then the next time you announced the usual for me breakfast, it will increase the amount of insulin that it gives you for that meal. So you do have to be a little patient over that first day, or two or three or four days in some cases, or the islet to learn how much insulin you need and to adapt up and if you short circuit that process by say, I can't stand this my blood glucose 250, I'm gonna have to do something. Let's say you give insulin that the island doesn't know about, you give an injection and the island doesn't know that you gave that injection. Now the island doesn't think you need more insulin. So the next time you announce a meal in the same way, it's not going to give more insulin, because as far as it's concerned, you didn't need more insulin, you came down on your own. Or if you announce a fake meal, you know, one, do another meal announcement, even though you're not eating more. Well, we have certain rules about our adaptation, if you announce another meal in that period, that will cancel the adaptation because we can't tell which insulin we're going to give as ascribe to that first announcement or the second announcement. And so we just decide, okay, we're not going to learn from that announcement. You know, we're conservative about which meals we use for learning. And that's fine. As you're using the device over a long period of time, you don't have to adapt on every single meal. But if you consistently are using extra insulin, either by telling, you know giving insulin, the eyelet doesn't know about or doing additional announcements, you will completely block its ability to learn that it needs more insulin the next time,

Scott Benner 28:26
how long do I need to be on the device before I don't expect it to struggle?

Steven Russell, M.D. 28:31
Well, it varies a little bit from person to person, it depends on how high your total daily insulin dose is. But I would say that if you follow the recommendations for allowing the island to learn you, most people have have gotten to a pretty good place in terms of their meal announcements within five to seven days. Okay. Now, what we found in the pivotal trial was that on average, people got to their new time and range within 48 hours. But that doesn't mean that the meal doses it adapted that fast. What was happening is that the islet was relying more on correction, insulin, the correction algorithm. And they they were getting under pretty good glucose control, on average within that 48 hour period. But over time, there was a shift as more insulin was coming in from the meal algorithm and less insulin was being delivered by the corrections algorithm. Okay.

Scott Benner 29:28
So here's my next question. Then. Exercise. I have a message here a question. So this person says or a camp director to T one camp. He says we have many families that are on I let the they're debating on sending their kids to camp due to concerns that there's no way to reduce basil for demands of camp. These people are citing to him that they are having issues around activity with no way of announcing activity or reducing Basal. So what do you think about that?

Steven Russell, M.D. 29:56
My recommendation to kids go into camp is to think about how much their activity is actually going to change a camp. Because some kids are much more active at Camp than they are at home, and others are not. So if they're not going to be more active, it's, it's probably not going to be a different issue than whatever they've been addressing at home. If they are dramatically increasing their activity, then one of the things they could potentially do is raise the glucose target. That's a lever that to that we've haven't really talked about to date, or at this point in the in the discussion, but there is the possibility of changing the glucose target. I would say that, you know, exercise is a whole conversation. Yeah, and right now, we don't have an exercise mode for the eyelet. What we recommend is that people, for the most part, keep the eyelet on. And most kinds of exercise actually don't cause the blood glucose to drop, you know, weightlifting, high intensity, interval training, and so forth typically don't cause a drop in blood glucose. And so it makes sense to leave the eyelet on and running. For exercises that do cause the blood glucose consistently to drop, the recommendation is to do one of two things, either leave it on, you'll, it'll see your blood glucose drop, and it'll suspend insulin. And you may still need to take some carbs to cover that period, until the insulin levels of the insulin on board decreases. And that takes some time because it takes, you know, on average, five or six hours for insulin to really clear. And so you should definitely have some carbs available. And then take whatever amount of carbs is needed to keep you from going low, although try not to over treat below, so that you're not provoking the islet to give more insulin, or you can just disconnect from the eyelid. And that way, the insulin levels will obviously be much less, much lower. And if you disconnect from the eyelet, then you have the option to take some carbs to raise your blood glucose. Okay, going into the exercise, just like any other AI D system, it's really important not to re carb load for exercise without disconnecting from the island. Because then what you'll do is you'll cause your blood glucose to go up the Island will see that and respond to it with additional insulin dosing. And so then you're going into exercise with even more insulin on board. We are aware that there is I think, a need for an exercise mode for the island. And we have designed one, and we're working on the strategy for for getting it out there, we have to talk to the FDA about you know what, what the appropriate way is to get that update out. And once we have clearance for that it will come out just like any of our other over the air updates. Okay, is that,

Scott Benner 32:51
uh, you hope for this year or you can't even say inside of a calendar year?

Steven Russell, M.D. 32:58
I think that I better not have any chances of getting it out in a particular timeframe. I certainly hope for it this year.

Scott Benner 33:06
Okay. You're working on it. Now. You hoped for it this year. Okay. Well, that maybe doesn't answer that question. Hey, you talked about targets. What do you mean that you haven't been telling people that there's targets? What does that? Well, we hadn't talked about it in conversation, one of the targets that I can set with eyelid.

Steven Russell, M.D. 33:20
So there are three levels of target, there's the usual target, the lower and the higher target. We intentionally don't talk about the what glucose level those are right up front, because we're trying to simplify it and to allow people to manage their diabetes without thinking about numbers. But everyone wants to know what they are. And they are on 120 is the target for usual 110 is lower, and 130 is higher, I just want to make the point that they aren't directly comparable to targets with other systems, because the algorithms work differently. So Ed likes to joke that if somebody asks what the target says, he's like, Well, what is the gear ratio in your car, what matters is not actually what the target is, but what kind of average glucose you can achieve with it. And what we found in the pivotal trial was that about 60% of the time was spent with the usual target 20% with the lower 20% with the higher. And with that mix of targets, we had an average glucose of about 155 and adults. So you know, right at an average a one C of 7%. But of course, the target for a particular person is what's appropriate for that person, right. And I should also point out that there you can have two different targets a day so you can have one target during the daytime and one target at night. And you can choose the timing of the start of that daytime target and shifting back to the nighttime target they can be at any time. So that's something that we think people shouldn't just do on their own, they should talk to their healthcare provider about but it's not uncommon to have two different targets one during the day and one at night, can they be automated? Yeah, they are. So once you set the pattern, it's just a recurring pattern happens. Okay. So, you know, probably the most common target is just to be at the usual target the whole time. But probably the most common after that is to have a target, that's one step lower during the daytime when people are eating, and a step higher than that at nighttime when they're not. And that means the eyelid can be a little bit more aggressive at dosing, any postprandial any after eating rise in the blood glucose, okay. And it just tends to make it more efficient at managing any hyperglycemia during the day for some people.

Scott Benner 35:51
My next question is from a woman who says that her husband has a co worker, a friend who's using ILF, that the guy's a snacker. And the pump doesn't seem to be handling that well. So what should I do, if I'm the kind of person who walks through the room and grabs seven carbs of something and throws it in my mouth, what we

Steven Russell, M.D. 36:07
recommend is that people announce carbs that they're eating, snacks that they're eating, if they have as many carbs as a meal. So the usual for me meal is one, a half a less meal is half of that. And a more is one and a half times that. So those are sort of the levels of what we call a usual for me a more and less meal. So if a snack has as many carbs as a less meal, so it has as many carbs as half of your normal breakfast or half of your normal lunch, or anywhere down to a quarter. So that that range is like a quarter to three quarters, that's a last meal. If it's anywhere in that range, they should go ahead and announce it. We say if it's less than a quarter of a usual meal, they shouldn't announce it. And they should just let the correction algorithm manage it. But if it's in this case, if if they're finding that they're having hyperglycemia, after not announcing those snacks, my guest is that they have significant carbs in them. And they probably should be announcing them as meals. So

Scott Benner 37:15
you're thinking already about the activity addition? Do you think about like a grazing mode? Or like you don't? I mean, there's, I mean, it'd be Listen, you've been an endo for a long time, right? So Thanksgiving comes, I tell people all the time, like put your basil up 20% Like you don't you mean, like you're gonna be eating throughout the day? Like, let's lay a heavier, you know, blanket of insulin over the situation? Like, is there thoughts about like, I guess my, my real question should be, as you're seeing it in people's hands. Are you thinking like, oh, this would be good to add? Like, are you having those thoughts, we

Steven Russell, M.D. 37:50
actually have designed a snack announcement that will be even less insulin than a less meal. There'll be a kind of a different category. I would say that for most snacks. If they're gonna if they're causing a significant rise in blood glucose, it's a meal, they probably should have been announced as immediate. Right, right.

Scott Benner 38:10
But I'm talking about like, the real like, you know, like, I don't know, a candy bowl and you grab seven gummy bears, and it's, you know, it's eight carbs or nine carbs, something like that. And like, you have no ability to maybe the biggest, like sticking point right now. And I am I'm certainly not leaning into it. I am not a person who says I don't want to change, right. So I don't get upset when Facebook changes the way it looks. You know, if a car company puts out a card, it's not quite done yet. I'm like, Oh, this is what they need to do to get to it. Like I'm okay with it, like, so I'm flexible about that stuff, and about diabetes as well. So my question, I guess is, how do people who are just so accustomed to doing something one way? Do you think if they just tried it? Eventually they they'd be like, Alright, I'm good with this? Or do you think that there's going to be a happy medium in there? So you're looking for a snack button, you're thinking about exercise? I mean, I love the idea of eyelet. Like, it's it's a romantic idea about taking good care of yourself with less input. But what does that mean? I guess, like, I'm going on a little bit, but if you told me my daughter's blood sugar was going to be 155. I'd say oh, God, what did we mess up? Right? So like, I'd be looking at like, is the basil wrong? Do we have the insulin to carb ratio wrong? Like there's part of me that feels like we're having this initial conversation with beta bionics, who is now looking at how to go to a by hormonal pump. And I'm thinking like, I'm going to look back on this one day and just see this as the infancy of the pump is is that maybe how I should be thinking about that?

Steven Russell, M.D. 39:46
Well, let me say that I think we we really see tremendous value in by her model. And the reason is, I like to think about it in terms of a population health reason with the island we can get About 50% of people to have an agency less than 7%, most of the remainder to have anyone see less than seven and a half with the buyer hormonal, we expect to be able to get 90% of people to have an agency less than seven, and 100% to have an agency less than seven and a half. That's what our pre pivotal data says. So it's it's lowering the average glucose, if you will, by about another 15 MCs per deciliter or about another half percent of a one C, you know, why do I keep talking about seven and seven and a half, obviously, seven is the recommended a one C target that ADA has come out with, and that's based on the diabetes control and complication trial, it's worth pointing out that the diabetes control and complication trial started with people who had an average valency of nine. And what they found is that if they got their control group that had and I want to point this out, on average, a one C of 7%, not everyone got lower than that, the intensive control group had an average a one C of 7%, they found that that was sufficient to cut the the progression of complications or the development of new complications to the background level. So if you look at that hockey shaped curve of complications versus a one C, below seven, there is no signal for further progression of complications. Since that time, there has been some data like registry studies from the Scandinavian countries that, you know, look at people who have been in there, who everyone who gets diabetes is immediately tracked. It's like a registry studies the whole country. When they go back and look at that, they find that people who had an A one C below seven and a half from shortly after the time they were diagnosed throughout their entire lives never get complications of diabetes. And one more piece of information is people who have what's called Glucokinase Modi, it's a particular single gene mutation. That means that people have a average glucose from birth in the 160 to 170 range. They're born, their their pancreas works, it just works for a higher setpoint. So there's several 1000 of these people in the world. They've been carefully studied, followed throughout their lifespans, they don't get any complications of diabetes. So I think that probably if we were able to get everyone below and a once you have seven and a half, diabetes, complications wouldn't be a thing.

Scott Benner 42:29
You bring up something that I never know how I've been doing this a long time. And one of the questions that people asked me that I just don't know how to answer is what is the benefit of being lower? And I don't know, I have, I always say I have no idea. Like, I don't know, when it always comes down to if you can, without it being too much trouble. I'd err on the side of doing it. I can't tell you. And I mean, those are interesting studies for certain. I think the problem ends up being and this is obviously more philosophical than anything else is that if it happens for a person, they live their whole life with a seven, for example, and then they have a problem. You can't go backwards and try again. Like, right, so there's the that's the rub. And I also feel like if we were alone in a bar, and I asked you, if you were working on the algorithm having a lower target, you would be like, oh, yeah, of course, Scott, we're on that, don't worry. I'm just super interested in where this is all going. I love the form factor. I love how it wants to work. And I appreciate you sharing that information, because that's the closest I've ever come to an answer to that question like, what's the what's the benefit of lower?

Steven Russell, M.D. 43:36
I would argue that there isn't, there isn't evidence that there's a benefit for lower. So what do I tell people? I tell people that if you can achieve a lower ANC without hyperglycemia, then great, and you want to then great, then fine. But if there's a significant trade off in terms of increasing hypoglycemia, it's not worth it. No, I don't I hate to either. And I would never target below, say 6.5. I mean, there's, you know, you just can't make an argument and evidence based argument for for shooting for an A one C lower than that in my mind. Well,

Scott Benner 44:09
you're also not trying to sell a pump to somebody who's walking around with a five, five a one C to begin with, by the way, none of these algorithms without some real like, intervention, tinkering, like deeper understanding. Like you're not you're not getting there unless you unless you really know that hey, yeah, that makes me wonder, how does the algorithm work for people who are very low carb works

Steven Russell, M.D. 44:30
great. I mean, that's, that's an easy case. Okay. Those people tend to do well, no matter what they do. So the algorithm works really well in that context. Okay. I kind of want to go back to that issue of, you know, what's the advantage of going lower? And, you know, as I said, I think that there isn't much evidence that there is an advantage in going lower and if we go to the sitting in a bar scenario, the reason that I give for wanting to use The by hormonal system is that we can just get more people, in this case, everyone to have that a one C that I think will pretty much eliminate complications, it's not about taking somebody who already has an A once fee of 6.5 and bringing them down to six, I do you think that for individual people, because we can be a little bit more aggressive with the algorithm, it probably will give them the capability of lowering their agency by another half percent, whether they should is a separate issue. I would at that point, if if somebody you know, has an agency of six and a half, the way I would use glucagon is not to further lower their agency, but to further lower their hyperglycemia. Okay, that's where the, that's where the benefit comes from my perspective perspective. And also, it has the additional advantage of meaning that you don't have to take oral carbohydrates, with all these insulin only systems, they're all pretty good at suspending insulin, if it looks like the person is going to go low. But they all occasionally fail in that, that you still need to take carbs to treat a low. And, you know, it's frustrating to people to be, you know, doing exercise because they're trying to, you know, trim down or something, and then they wind up having to take a bunch of carbs, to treat a low that happens when they exercise. So the glucagon has an advantage from that standpoint, and it also just the spontaneity standpoint, you know, not having to take carbs, just seeing your blood glucose going low, and then just going right back up without you doing anything, that certainly increases peace of mind. And, you know, whereas with the insulin only system, we found that we were able to lower that agency by half a percent, on average, more for people who are higher, obviously, we didn't lower it for people who already had agencies below seven, and we didn't increase hyperglycemia. With the bio hormonal system, we're able to lower it even further. And actually also reduce hyperglycemia.

Scott Benner 46:58
You're, you're testing it now.

Steven Russell, M.D. 47:01
We are not testing it again. Yet. We just recently announced an agreement with Cirrus pharmaceuticals, to test a new formulation of stable glucagon. And we're moving forward with that with all haste, because we really do think that that by hormonal system is going to provide terrific advantages.

Scott Benner 47:24
People are listening right now if you go back a week in the podcast, you'll see an episode with zeros and eyelet talking about that agreement that they that that Dr. Russell, just, yeah, I've done an interview about that yet that's gonna go up right before your stuff. I'm excited by it. Like, I have to tell you, I believe my daughter's 20. Right. For the most part, my daughter is away at college right now using IEP s. And a she's got an A one C like six one, I think and that's at college like and not just the college like you're thinking of it, my daughter is not like a crazy party person, she's working incredibly hard, like seven days a week doesn't take off long quarters that go into six months, times when she's at school, and that she's managing that is insane. It's absolutely fantastic. But we also do a really good job of her not having lows. Having said that, I've seen really emergent lows. And I've I've watched her have a seizure when she was two years old, she had one when she was a high school senior, it was both times variables that were not common everyday stuff. I just think in my heart if her pump would have noticed that and given her some glucagon, it might have been maybe the greatest thing that I've ever seen in my life. Like, seriously, I don't know how people who are using insulin are not Ultra aware of this constantly. To take that brain worm out of the back of my head would be amazing. You know what I mean? So I'm with you, I that. This is probably an unfair question. But if you ever talked about would you license this to other pump companies if they were interested? Or are you guys gonna keep glucagon, your your, your algorithm and everything? Like it's some point? I keep thinking at some point one of these systems is going to show and everyone's gonna say, Well, yeah, that's how we should be doing it. And then what are we doing? Then we're in what a retail game. Like, that's ridiculous, right? Like, at what point? Do we just say, because listen, I have my questions here for you 50 people, this is nice. We'll never be tubeless. So like, you know what I mean, there are people who they don't care if it comes with a free pack of bubble gum. You don't I mean, in a bus pass, if it's not tubeless they don't want to hear about it. Like that was my wonderment like, you know what I mean? Like, I wonder if it'll ever it will really get into that interoperability that we all kind of got teased about with tide pool. It doesn't seem like it's ever gonna happen, I guess is what? Yeah,

Steven Russell, M.D. 49:52
we're certainly aware that people are interested in the tubeless form factor. All I'm gonna say about that right now, but okay. where you're we're certainly aware of that. And we realize that that's really important for some folks. So all right,

Scott Benner 50:07
I take your point, don't worry, I can read between the lines. I'm good.

Steven Russell, M.D. 50:12
As far as as far as licensing the algorithm, I mean, you know, Ed, would, it would be a better person to talk to you about this. But we definitely, were interested in making the algorithm available to other pump companies. And there were no takers. That's why beta bionics got started, you know, the, the idea of having a system that's this automated was something that I think was scary to other pump manufacturers, and they preferred a system that still left more of the responsibility in the hands of the user, I say, so that if something went wrong, they could say, well, you know, we were not responsible on

Scott Benner 50:52
the pods gotten away from that they're basically telling you now, we don't even want you to understand how it's working. You know what I mean? Like, it's, you know, it's going to do what it's going to do and let it do it. And I mean, you're saying that to you are saying, like, let the thing work, right, like don't? Well,

Steven Russell, M.D. 51:05
I think that's that it's different, I would argue, because we're very clear, we have a lot of information about how our algorithm works. And I think that's a little different than than Omni pod. But Omni pod also still requires the user to do a lot. What I've learned clinically with the Omni pod is that if you want to get good glucose control with that system, you need to make sure that you fully dose your your meal, your your meal, carbs, sure, because it's a fairly conservative algorithm in terms of giving corrections and adjusting basil, and so forth. So you can get good glucose control with that, but you need to be pretty aggressive about giving the full amount of insulin for carbs, and also giving manual correction bonuses to get the best glycemic control. So it's still quite dependent on the expertise of the user in being able to count carbs accurately, and to choose the appropriate times to give corrections and you know, to to give the corrections that are needed and not give the rage boluses. So it still is quite dependent on the user, whereas the eyelet is not with the island, it's really more about not doing certain things that can confuse the island. And and, you know, sort of teach it the wrong things, right. It's often about doing less with the island, not more than and in that sense. It's really unique. Every other diabetes control system, the more you interact with it, the more you pitch in, the better glycemic control you're gonna get. And the island is unique. And that's not the case. What's

Scott Benner 52:37
our average excursion, I expect with an eyelet? Like, what number am I going to see a spike go to, for example?

Steven Russell, M.D. 52:47
Well, if you have a meal and you and you do announce that meal and your meal doses have adapted, it might be quite small, might be 150. But it might also get to 200 are transiently above 200. It just depends on where you are in that in that range of what your usual for me meal is for instance, how much of the insulin actually came up front and how much is coming as correction Bolus. I see. I

Scott Benner 53:14
mean, it's all like relative like I when I tell people my daughters they want to see I think they imagine like an ad three blood sugar that goes on for weeks and months, but she has spikes at meals just like everybody else.

Steven Russell, M.D. 53:25
And soda. Why, by the way? Yeah, I don't have diabetes. Yeah, but I wear CGM. And my blood glucose goes above 200. Sometimes no kidding. Absolutely. And yeah, I mean, that's not uncommon for people without diabetes. And I think we're only now appreciating it because you can wear CGM and you can see that which you normally wouldn't have seen right. Now mine automatically comes back down and I don't have to do anything about it. But it's not uncommon for it to go above 200

Scott Benner 53:53
Can I ask how old you're 5066 Okay, I'm 52 I have to wearing a CGM. I have to eat intentionally to get my blood sugar to go over like 160 But I'm talking about like pizza on top of fast acting sugar that's like it's I had to like gorge myself to make it happen. So it's interesting. Look at give me I'm showing off. Steve varies

Steven Russell, M.D. 54:15
varies from person to person to person to person. And I think you know, breakfast is the meal if I eat a high carb breakfast, I'm definitely going high. Okay, because it's you know, and it changed the way I ate you know, I would in the morning would have you know, some waffles and some peanut butter and maple syrup. And when I saw what that did to my blood glucose, all of a sudden I started eating more eggs.

Scott Benner 54:39
Everyone who's ever come on here, as Kevin Sayer was on here one time he's like, I wear my own product and just like four things I just stopped eating. Yep. So listen, we talked about like, okay, but even a person without diabetes is going to see an excursion up but there's also truth is there not that a person without diabetes also might see a blood sugar into the 60s throughout the day. So I mean it So it begs the question like, why were you guys not a little more aggressive with it?

Steven Russell, M.D. 55:04
Well, I think it's the idea is to try and tune the system so that we're improving or lowering the average glucose, we're lowering the a one C without increasing hyperglycemia. That was, effectively the way it was tuned over those pre pivotal studies that we did. And that's what we found in our pivotal study, we lowered aid, what CD didn't change the amount of time less than 70 and less than 50 for sort of a pragmatic choice to tune it that way. And of course, that means that, you know, in some people are going to have more hypoglycemia, and some people are going to have less, right. And we're just trying to kind of pick a middle path where we get the best glucose control we can without putting people at risk.

Scott Benner 55:52
Yeah, in fairness to every company. And every algorithm, there's the nebulous part of the conversation that we don't talk about, which is some people just eat differently. And so you're trying to make a thing that you can just handle the world without knowing each person individually. So there has to be buffer, I guess, on either side of it. I guess my more maybe, maybe my, my bigger question is, if the mind if the if the brain trust that is beta bionics now existed on day one. Do you think the algorithm would be more aggressive today? Like, have you learned more now? Or you're still very comfortable with how it's done?

Steven Russell, M.D. 56:25
I don't think it would be different. Okay. I think we might, you know, we're seeing that, we would like to add a, a, an exercise button on the island. And that wasn't built into it from the very beginning. And so now we want to add it. And I think one of the reasons that wasn't built into it from the beginning, is because the island kind of started as a by hormonal system. And we didn't really need it for the bio hormonal system. And then we got to insulin only. And we found that we were still getting very good, sort of surprisingly good results with the insulin only system. And it was quite differentiated, it was getting results similar to what other ad systems were getting, but with a lot less work. And we thought, you know, that is, that is a differentiated thing that we should get out there, even though, it's going to take us a little bit longer to get the buy hormonal product out because of the complexity of doing a drug trial as well. So that's why we chose to move forward with the insulin only system, because it it is a big difference. It I think it does bring a tremendous amount of value. But that's also why we're not stopping on the by hormonal system, because we think there's additional value that we can bring by bringing in that that by hormonal piece. So back

Scott Benner 57:45
in the day, the glucagon wouldn't hold up in the pump, right? That was the biggest.

Steven Russell, M.D. 57:49
That's absolutely right. So we did all of our pre pivotal studies, or most of our pre pivotal studies using the red kit from Lilly, and we would just reconstitute that glucagon. And we had to change it out every day. Because it wouldn't, it wouldn't last longer than that. And shout out to Lily for providing us enormous amounts of that red kit glucagon for free, they were fantastic about that, we would literally get boxes that were three feet on a side full of nothing but those red kits to be able to do our pre pivotal studies. But that wasn't going to be practical in the long run. Yeah. And so that's why we needed a stable glucagon. And fortunately, two came along. And we're, you know, moving forward with with one of those a new formulation of the zeros that the actual zero Asal glucagon that's available right now for rescue treatment. That one won't work in a pump, because it actually damages the plastic. But a different version of it a slightly modified version, it looks like it's going to work just fine and a pump. And so that's what we're going to be moving forward with.

Scott Benner 59:00
Paul was explaining that to me in that recording, because I said, Oh, you're just gonna put g voc into the pump. He's like, no, no, we have to do a formulation that changed. And I was like, Oh, that's really interesting. Like, and you know, pretty cool. Honestly, Steven, that an idea? That is how old now? I mean, when when did that study happen with those red kits?

Steven Russell, M.D. 59:20
For you guys? Well, the very first one happened in 2008.

Scott Benner 59:24
Okay, so a lot of years later, like 17, that sounds like to me, you know, you're still on it, which is pretty great. I also want to say this too. I recently just floated out into the world, like if anybody wants to come, I think I said online, if you have a device or a product that helps people with diabetes, and you want to come on the podcast and talk about it, come on, and you and I are having a pretty honest conversation I'd say about, you know, about eyelet. And I appreciate that because not everybody stepped forward and was interested. So thank you. I really do appreciate talking about it like this, because it's fair to say all these algorithms and They can all be better, obviously, right? It doesn't it's not a denigration of what they are now. And if we don't talk about it like this, then where's the onus to do the work? You know what I mean? Like I all these companies should be in a room right now looking at their data thinking, how can I make this better? And if they're not I, I hope, and I hope they'll consider doing it. And it sounds like that's what you guys are doing. So I appreciate it. I

Steven Russell, M.D. 1:00:23
totally agree. I mean, look, AI D is so impactful, it makes a huge difference. CGM was huge. And AI D is huge. And I think that probably everybody with type one should be on an AI D system. I think that beta bionics with the eyelet is trying to be available and reach a group of people that may have a harder time working with some of these other systems that require more sophistication on the part of the user ability to carb count, choosing the right times to do corrections, and so forth. Yeah. And so I think that I talked about democratizing good glucose control, it shouldn't be just for the elites, it shouldn't just be for the small percentage of people who are very numerous and, you know, have the best executive function so they can be on it all the time, and paying attention and, you know, not working two jobs, because, you know, you really with diabetes, it's like a second job. So if you already have two jobs, then you know that your ability to spend the amount of time it takes to get that excellent glucose control is limited. So I think one of the things that we bring is bringing the possibility of good glucose control to people who might not be able to do it with the other devices. And for people who already are able to achieve good glucose control with other devices, it's another option that can reduce the amount of time they have to spend with it. Yeah, not everybody wants that. You know, I think it's important to note, it's not for everybody, that kind of people who are want to be on loop or one of these other systems and are the people who are have control IQ, but they've turned it off. And they've just got it on, you know, sleep mode at all times. Because they, they they feel like they can do a better job. Those are probably not the people for the eyelet. Right. Frankly,

Scott Benner 1:02:14
the button the button pushers in the dial. Turner's might not be your your bread and butter. But there's a listen, I say it all the time. Well, let me go back earlier, when you were describing how the algorithm works, I thought, Oh, my God, that's how I managed manually, right? Like, I think back to like the Pro Tip series in this podcast, which is just me telling you how I got my daughter's a one C down and stable, and how I think about insulin and diabetes. It's all timing and amount. And, you know, understanding the variables like that, that is literally what the algorithm is doing. I didn't realize that till the first time, I saw my daughter on loop, and I could watch through Nightscout. I watched it work. And I thought, Oh, I would have Temp Basal here. Or I would have done this, like you don't even I was like, This is so interesting. It's doing everything for me. And I'm getting asleep. This is insane. You know how happy is about it. But it's never lost on me that even though I watched the podcast help, like, seriously, I'm not trying to, like blow my own horn here. But But this podcast charts in 48 countries around the world, right? Like I wake up to a dozen notes every day from people are like, Oh my God, look at my one say, it's amazing how many people it touches. And yet, if I stopped myself in a quiet moment, I remind myself, I'm probably not touching 5% of people with type one diabetes. Like it just I'm not reaching nearly everyone. This is for the people who have the time to listen to it, that have the acuity to understand it, and have the patience to put it into practice that have the patience to watch it go over and over again until it finally makes sense to them. And then they can kind of do it blindly without even thinking about it. That is not something that's going to work out for everybody. I just know it isn't. And everyone should be thinking about that like, because if not, if not, then what we're doing is we have a bunch of different pump companies who are saying to themselves, there's a block of people with type one diabetes, this percentage of them can figure out how to use this pump will market to them. And then the rest of them just they get left behind. That to me is like I have thought from day one about this algorithm like this is for the people who got left behind. And if you can turn it into something as for everybody, not just for them, then in my opinion, you know, you just jumped ahead. So, you know, everyone else should try to keep up. But you know, I would love to see this on more people and see how it works out. Speaking of it being on more people and seeing things, have you seen it on somebody who's using a GLP yet? I would imagine that's like a low carb vibe. Right?

Steven Russell, M.D. 1:04:46
Right. We have I don't have statistics for you. Sure. And I would say also in our we do post market surveillance all the time. You know, we we can look at the whole population of people on the island and Look at what average glucose they're getting and how much hyperglycemia all that stuff we look at. Unfortunately, we often don't get any information about other medications that they're on. That's not part of the information that we get. But I am aware of people on GLP one agonists with the islet. And as far as the eyelids concerned, that just means that the person is using less insulin. And their glucose excursions are less acute, less sharp, or eased, and they're easier to manage. So and you know, on the island, of course, is continually adapting to the need for insulin. So if somebody starts on a GLP, one, and their insulin needs go down, the islet just adapts to that online. And if they are absorbing food a little bit slower, the meal dose adapts to that. So I don't think there's any reason why you think that it wouldn't play nicely with a GLP one agonist and in the cases I'm aware of, it seems to play just fine with GLP, one agonist,

Scott Benner 1:06:00
I'll say here that my daughter is using Manjaro. At the moment, I I've said it over and over again, but so that, you know, I estimate show you 16,000 fewer units of insulin this year because of it. And it's, it's, and we were doing fine before like, you know, we in fairness, and we're very good at using insulin like so it doesn't matter how high or low carb she has we know how to manage. But this is just like her stability is even more stable. The it gives the algorithm that makes the algorithm look like it's better what it's doing. You don't I mean, like, Yeah, I used to say to people, you know, if you if you came to my house that I have to give one of these things back, I probably fight for the CGM over the pump. But then once they got integrated now I kind of see them as one in the same thing. But I'd have a long, hard think, before you ask me, What can I have back the algorithm or the GLP. I'm doing a small series right now with a guy you might know Tom Blevins. He's an endo in Austin. And Tom and I are recording a small series about GLP I am literally hoping to be one of the voices that pushes JDRF and other big institutions into pushing for coverage and testing, you know, for people with type one diabetes, just based on what I've seen, and what I'm hearing from other people, which has nothing to do with our conversation. But anyway, sure,

Steven Russell, M.D. 1:07:21
I will say that, you know, this is entirely separate from my role of antibiotics, but I'm still a practicing endocrinologist. And I personally use GLP one agonists in people with type one diabetes, who also have the physiology of type two diabetes, and there's plenty of those people, right? There's nothing about having an autoimmune attack on your pancreas, or B or beta cells that modifies those genetic risk factors for Type two diabetes. So as far as I'm concerned, you can have both types of physiology. And for those people, absolutely GLP. One agonists makes sense, I think, perhaps more controversial is the idea of using even people with type one diabetes who are lean, not insulin resistant. And I think that's where, you know, the companies just chose not to pursue an indication for it. But clearly, it does reduce the amount of insulin use and it and it does tend to appetite. Yeah, and appetite and it smooths out the glucose excursions. So it does make a lot of sense that, that it just makes diabetes easier to manage,

Scott Benner 1:08:33
I have to thank you, because you just put that I've been trying to make that point. I keep fumbling with it. Every time I tried to make it. The idea like they used to hear people say like, my doctor says, I have type one and type two diabetes, then people would say that and you'd like you can't have both and it would kind of like, you know, people get upset. But my daughter, for example, like very clearly has PCOS symptoms, which is just the thing you really can't even get diagnosed, you know, weight gain, acne, high need for insulin no matter what she's eating or not. And she didn't, you know, she wasn't overly you shouldn't gained a ton of weight. But she was also 20. Still, whereas I know a person who doesn't have type one diabetes is a young girl in her mid 20s, who has PCOS. And is a clean eater who exercises daily who gains weight every week, just can't stop, right? And goes on a on weego V, and boom, it all just ends and the weight starts coming off and everything goes back to normal. It's absolutely amazing. But the what you're starting to see right now and you probably know this because it sounds like you're doing it is you're you're having to diagnose your patients as having insulin resistance and type one diabetes to get around the quagmire that is the insurance at the moment on this. But I just I really, Dr. Blevins believes that if you don't go out there and do the studies that it's going to be very difficult to push through insurance and it it's going to take a big voice to push the studies along. So Oh, I'm trying to magnify that if I can, just like I'm trying to do with you and anybody else like I listen, there's part of me, Steven. Yeah. I don't want everybody fighting. And I take ads from a pump company. Like, I have no trouble saying that. But I don't want anybody get uncomfortable. Like, I make a podcast and you know, people pay me for ads, but I got a kid with diabetes. I need you guys all out there hustling? You know what I mean? You know, for anybody, you might be listening, thinking, God, I can't believe Scott had this these people on when you know, Omni pod buys ads from him. I want Omnipod to work hard. And I want you all to work hard. You know what I mean? So I mean, absolutely.

Steven Russell, M.D. 1:10:35
I think it's incumbent on all of us to continue innovating. And I'm, I'm thankful that we have multiple different AI D Systems, because I think they're not all perfect for everybody. And I think everyone should be on an AI D system. And it should be one that fits their lifestyle and their predilections and their interests and, and it works for them. And so I think there's no way that any one system is going to be all things to all people. So I think it's great that there are choices. I agree.

Scott Benner 1:11:06
I also think that when you're being diagnosed, the next thing you thought you should have is, what's that you're putting on my arm? Is that a CGM? What is that, but you shouldn't leave the hospital without a CGM. If you had a heart issue, they would put a monitor on you. They would not let you out of the hospital without it. But

Steven Russell, M.D. 1:11:22
yeah, 100% agree. Yeah. And I, you know, one of the things I do is I still work in the hospital. On the weekends, we have this inpatient diabetes service. And it's getting pretty big. Now it takes three doctors to cover it every weekend, we see all these patients in the hospital. And, you know, we're seeing the patients who are already on our service with consults to us. But we also get new onset people in, you know, people get new onset type one diabetes all the time as adults. So I see these folks. And I really try and take it upon myself to try and get them on CGM as soon as possible, you know, send the script down to our pharmacy, and get them on a Dexcom or an Abbott sensor before they leave the hospital. And put in a statement of medical necessity for an AI D system if they're willing to consider it. Yep, as soon as possible. I'm really grateful that there, there are more than one systems out there that are automating glucose control. I really like to get people on CGM as soon as possible after they're diagnosed. And, you know, there's adults getting diagnosed all the time. And, and I really want everybody to think about an AI D system. On the day they're diagnosed when I see them in the hospital. Yeah,

Scott Benner 1:12:42
I completely agree. And I like again, not only is it good for people to have choice, but from a different perspective, it is very good if the space is not controlled by one company, we've seen in the past that company gets comfortable, and then nobody gets served. So that's

Steven Russell, M.D. 1:13:01
absolutely true. And I and I think it's really, it's really important for us to continue innovating. You know, once you have something that's approved in a very highly regulated industry like this, there is the tendency to feel like well, we, you know, it would be too costly, too time consuming. To continue to innovate, let's just keep pushing the product that we already have. But I don't think any of us should be satisfied with that. We should always be looking to how we can make it better.

Scott Benner 1:13:28
Yeah, listen, I have a two year outboard for podcast, they should be doing the same thing. As soon as everybody I always say you get your thing through the FDA, everybody gets a vacation, then we come back. And we started thinking about how do we push this farther. And if you're not doing that, then I think shame on you a little bit. So seriously, like, it's just, I mean, you saw it in the past, one company had control of everything. And they were just like, whoo, and now look at them rushing around trying to get back in the game, you know what I mean? So it

Steven Russell, M.D. 1:13:55
can, it can be that kind of behavior winds up coming back to burn you in the end, but it tends to be years later in their case. I think now that there's more people in the game, it's doesn't take as long right? For that kind of behavior to loop back and burn. It's

Scott Benner 1:14:14
not just cyclical now because it's cyclically happening, like four or five different in four or five different buildings. And that really is valuable for us because listen, if you're gonna talk about the business of it, we got the big thing through now we're going to make the money I'll cut costs right now I'll be a big hero bringing a nice bonus for myself, I'll retire and then the problem will be on somebody else when we're not innovating anymore. That's the backside business problem. So I guess what I'm saying is if you're in a business where that's happening, you better speak up or 10 years from now your job is going to be worth much anyway there. I just want to make sure everybody's working Steven, that's all I got. I got a I got a daughter I got to worry about you know, well you know,

Steven Russell, M.D. 1:14:49
we are we are working very hard on it and and as you as you know, you know, we launched the product with G six and shortly after We put out an update that made us compatible with g7. And, you know, we've been very clear that we want to be compatible with any CGM that is able to meet the ice CGM stand there. It's because we think people should have choices. And we're going to continue to innovate in other ways as well. Cool.

Scott Benner 1:15:19
It sounds like maybe you've reached out to the people ever since then, perhaps they just got their IEP s. Distinction, didn't they? They did. Or I used the wrong terminology. I CGM. Excuse me, but yeah, CGM.

Steven Russell, M.D. 1:15:34
Yeah, yeah. And I actually a fan of that technology. I, one of the things I do in clinic is to replace and replace those Eversense sensors. And I think it's a it's a good system.

Scott Benner 1:15:46
That's excellent. Good. Well, hopefully, I mean, I, they buy ads from me too, like, just so I'm being clear. But I always say to them, like, you know, like how the transmitter vibrates as like, Wouldn't it be cool if the pill vibrated? And they're like, Wouldn't it be? And I was like, it would be wouldn't it be? Like somebody work on that? That's a great, I mean, can you imagine that an implantable CGM that gave you a little shake if you were low or too little shakes? If you're getting high? That's insane. I mean, I think it'd be fantastic. Anyway. Is there anything I didn't ask you that I should have something we left out?

Steven Russell, M.D. 1:16:18
Hmm, let me think I know there was some because I had some things on our because I have here.

Scott Benner 1:16:25
Can you tell me about the you

Steven Russell, M.D. 1:16:27
know what, there was one that was on there? What are the best practices in the first two weeks? I'd love to address that, please. All right. Well, one of the questions that comes up is what to do when you first start on the island, what are the best practices to get the most out of it. And those best practices really are derived from the way the algorithm works, what you want to do is give the algorithm the best chance to learn you as quickly as possible. And because the way the meal algorithm works is it looks at the the four hours after the meal, we do ask people to space out their meals by four hours, initially to allow the islet the chance to learn how much insulin they need for the meal, because we have these rules that if you get another meal announced within that four hours, it will cancel the adaptation, okay, now there is an exception to that, which is if you announced multiple meals in the first hour, it will actually combine those meals and adapt on the sum of those meals. And that's quite useful for announcing meals by courses. So you go out to eat for dinner, and you have an appetizer. And that appetizer has sent you out to eat maybe as many carbs as your usual meal. So you announced the appetizer, and now your main course comes out. And that may have more carbs than your usual meal. So you announced that and maybe you then have dessert, you want to announce that it will combine all those announcements and adapt on the some of them. And that may be better than trying to anticipate at the very beginning of the meal, how much total carbs, you're going to have for the entire period, for two reasons. One, because it may be hard to do you not sure whether you're going to have that dessert or not at that point. But to because if you took all of the insulin, if you told the islet, you're going to have all those carbs right at the beginning, it might give too much insulin too early. In other words, you know, an hour later, when you actually have the dessert, you want to have that insulin, then not at the very beginning, it might be too much too soon. But after that first hour period, if you announce another meal in that two to four hour period, it'll cancel that adaptation. So if you never space out the meals by four hours, it's never going to have a chance to learn after that initial learning, then you can be much less regimented about it. You know, if you decide to have a snack a couple hours after the meal, have at it, go ahead and announce it. That'll cancel the adaptation for that meal. But so let you know there you have lots of opportunities to sort of update the meal announcements, and most people tend to eat about the same amount, you know, same stuff anyway, right. And so you probably don't need to update it. But in that first week or so, spacing them out is good. Also, eating meals that really are typical for you or usual for you is good so that it has a chance to learn that there is always this temptation that you've got a new system, like a new fancy car and like let's try this thing out, see how it goes. And we definitely see some of that. Yeah, I remember in one of our first outpatient study, a long time ago now, we this was early on when Twitter was new and shiny. And one of our users had a Twitter account and he was tweeting all of his meals that he was having. And you know one of them was a plate with a burger fries, a couple beers and then stack of of little dessert dishes hmm And, and he's like, you know, I just had this meal. And, you know, seven bowls of ice cream hashtag bionic pancreas?

Scott Benner 1:20:09
Can I tell you how old I am? I know that photo. Yeah, I can't believe. I just thought have I been doing this that long? I know exactly what you're talking about. That's crazy. Yeah, yeah. So what's the downside isn't doing that?

Steven Russell, M.D. 1:20:25
Well, the downside, of course, is that the chances of being able to adapt on that meal are not very good. And certainly it's not a usual meal. least not for most mortals. Yeah. So really, if you want the eyelet, to learn you, you've got to, you've got to give it the right information. And this is when we see problems. These are the kinds of problems we see somebody, like, let's say they, they, they have habits that they've developed over the course of a long time with diabetes. That totally makes sense with some other systems, but don't make sense with the eyelet. But they find it hard to readjust. So I'll give you an example. Somebody has that first meal with the eyelet. And their blood glucose goes high. And that's a common occurrence, because it's starting off with this very low dose, they see that go high. And they think, Oh, this thing isn't going to give me enough insulin. And so the next time they announced a meal, they announced it as a more meal instead of a usual meal, even though they're eating a usual meal, right. If they just announced it as a usual meal, it would have given them more insulin, because it learned from the last time, okay, but now it doesn't have a time, it doesn't have a chance to show them that. And they will get a little bit more insulin that one time because, of course, they announced it as a more than usual. But that will actually make it think that they need less insulin for a usual meal. So it has the exact opposite effect over time that they intend. So it works wants to get more insulin, but in the long run, they'll actually get less. Yeah. So the islet, because it's adaptive, it has this unique characteristic that you can, you can't trick it, but you can confuse it. And if you tell it things that aren't true, it will learn the wrong thing, right. And another example that is totally understandable, given you know, how people have been managing their diabetes is they're about to eat a usual meal, but they're like, but my blood glucose is dropping. So I'm going to announce it as a lesson meal instead of a usual meal, so I'll get less insulin. The problem with that is that the islet is already taking into account that dropping glucose in terms of its Basal dosing, it's correction. It's like, if you're in a self driving car, and it's turning around the corner, but you grab the wheel and turn it to, and now you at the curb, you're both trying to take care of the same thing. And you're overdoing it, I've

Scott Benner 1:22:46
come to believe that we've reached the level in some technology, you can outsmart it, you can't even understand what it's thinking about. And you know, your little thoughts are gonna get in the way I learned that with loop when my daughter started using a loop. Like if this isn't working, our settings are wrong. Our timing is wrong. Me trying to fix a problem is just going to make it more confused. And it wasn't like a learning stitch. Yeah, I'm going to try to hack through. Plus, why am I putting myself in that situation where I'm constantly having to do more, when it should be automated as much as it possibly can be? Yeah, no, I mean, it's, it's it's AI, right? Like, it's it's a it's a learning model. It's considering just more things than, you know, exists, let alone that you could consider and and it's on different timelines, which is That's right. Yeah, yeah, all

Steven Russell, M.D. 1:23:37
that adaptation is going on. And if you try to outsmart it to hack it, it'll just screw up the adaptation, things will get worse, not better. But that is a really hard thing, especially for the knob, Turner's button pushers, folks, it's just so hard to sit on their hands and and wait for the system to learn. And so we, you know, some of those people do want to try the eyelet. And we're encouraging of that, if they want to, as long as they're, you know, willing to at least try re considering how they manage things. And some of them find that they can push through, they can sit on their hands for long enough for it to learn and do well. And then they think, Oh, great, I, I'm fine with not doing all that extra work as long as the results are good. Yeah. Interestingly, we've also seen some folks who got undeniably great results on the eyelet in some cases better than the results that they were getting with all of their work. And they just still find it an uncomfortable thing. They want to be able to go in and give that insulin, even if they're not going to achieve a better result. That's just who they see themselves as being Yeah, and that's fine. That's fine.

Scott Benner 1:24:52
It's interesting. It is it's the psychological. We I've had these existential conversations with type ones before about Like, what would you do you know if diabetes disappeared, and the number of people who say that they wouldn't even want that to happen, because they don't know who they are without diabetes is fascinating. Like, you know what I mean? Like, it really is interesting how much it becomes a part of, of who you are and what you do every day. Anyway, and there's

Steven Russell, M.D. 1:25:17
just sort of a pride of being able to manage it, like you're really good at this, this is something that I have got down. And so taking it away feels like a loss almost. Yeah,

Scott Benner 1:25:27
I did all this work to understand this thing. I let it go. I have to tell you, it's even between you and I, I don't want to sound pompous. But I can manage insulin within an inch of its life. I'm really good at it. I kept my daughter's a one C like 5355. No problem through like middle school, high school, no big deal. And then I was like, oh, god, she's going to go to college. And you know, like, she's not going to do the stuff I do. But luckily, prior to that, we started to use a loop before Omnipod five was even available. And I got to sleep. And once I got to sleep, I thought, Oh, I was gonna die. I didn't even know it. You know, like, like, I was my my No kidding, that by the time I got my daughter off to college, like I had to go to a doctor and say, Okay, now we gotta save me. Like, you know what I mean? Like my health had gotten poor. Just it's not sustainable. It just really Yeah. So

Steven Russell, M.D. 1:26:20
that's right. I mean, that's very impressive. And I'm always impressed by people who can do that. And there are plenty of people out there who can do it, but there is a cost to it, there is a real cost to it. It just takes years off your life. You know, I

Scott Benner 1:26:33
was not going to make it the whole way. Like I just if I had to do that for another 10 years, I have had times in my life where I've sat in bed in the middle of the night, and my brain is vibrating because I hadn't slept. And I've actually had the conscious thought, I'm going to have a heart attack. Like I'm gonna die like I have to go to sleep. And then you look at that blood sugar and you go I can't right now because we made a correction and like Boba, like that whole thing. All that is gone. Like I just, and I'm telling you, if you add glucagon to that, I might, I might, man, I might sleep with a noise machine. Like I might be like, I really don't want to hear a damn thing. Well, this is let me sleep. Anyway. Good luck to you. Godspeed. Seriously, I hope it goes exactly the way you guys are envisioning.

Steven Russell, M.D. 1:27:18
All right. Thanks a real pleasure talking to you. Oh, sincerely thank you for thank you for taking the time to have me on now. It's a pleasure.

Scott Benner 1:27:24
Hold on one second for me.

A huge thank you to one of today's sponsors, G voc glucagon. Find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGL You see ag o n.com. Forward slash juicebox. 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 Jalen is an incredible example of what's so many experience living with diabetes. You show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong and together we're even stronger. To hear more stories from the Medtronic champion community where to share your own story visit Medtronic diabetes.com/juicebox And look out online for the hashtag Medtronic champion. 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. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#1216 April Fools

Sofia from episode 487,  From Russia With Sarcasm is back. Warning: Mention of suicide.

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

+ Click for EPISODE TRANSCRIPT

---

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 1216 of the Juicebox Podcast. I have a returning guest today

First things first, if you haven't heard episode 487 called From Russia with sarcasm, you are missing out. That was 14 year old Sophia talking to me about how she found the podcast, got her parents to get her devices that she needed and figured out her own world with diabetes fantastic episode 47 From Russia with sarcasm but today, it's three years later and Sophia is back to check in and a lot has happened in her life. 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. 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

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 med this episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with it's easy on Easy Off smart transmitter and allows you to take a break when needed. Ever since cgm.com/juicebox. How old were you? The first time we did this? I was 14. So that's how I remembered it too. But then how old are you now?

Sophia 2:28
17.

Scott Benner 2:29
That part? I don't understand. It's been three years since we recorded.

Sophia 2:33
It has been three years. Yes.

Scott Benner 2:35
Oh, wow. That's crazy. I had no idea. Honestly.

Sophia 2:39
It was around this time, wasn't it? Or March?

Scott Benner 2:43
I'm not certain. I honestly, Sofia I've recorded like what episode number were you? Do you remember?

Sophia 2:50
I could find out? Yes. 400 something and you've recorded 600 More episodes since we talked?

Scott Benner 2:57
Yeah, that's the thing. I was gonna say you were 487. And I put up 1082 today. So yeah, my my like feeling for time is a little screwy. But not for you. I remember so fondly having that conversation with you. So let's recap for people just briefly in case they didn't hear 47 when you reached out the first time, it was one of those emails that I get where I'm like, There's a child emailing me to be on my podcast. And that's and now that you're 17 Do you even see that? That's weird.

Sophia 3:28
I don't think it's weird. I think I think every single teenager feels that way. But I never felt 14.

Scott Benner 3:36
I understand. So to you. You just had an idea. And you were going to try it. Yes. Okay. So we go on to have this really lovely conversation where I feel like can I give you what my remembrance is of like, if you told me like, give me the Cliff Notes of Sofia's first episode, I would say you're 14. You were living in Russia. That's where you were from. You got type one, and did not like the care you were receiving. So went online to figure out how to take better care of yourself. Found the podcast went back to your parents kind of like strong arm them into getting you technology that you needed, and then figured out the whole thing by yourself using the podcast and had like really great results. Is that pretty accurate?

Sophia 4:24
That's I'd say that's fairly accurate. Yeah.

Scott Benner 4:26
Okay. I tell you I really enjoyed the episode. What ends up happening is that the episodes called From Russia with sarcasm because you and I appear to get into like the most sarcastic conversation I've had in a really long time that goes on for almost the entire time we're doing it. Is that your remembrance? That

Sophia 4:44
is Yeah, and it's funny because recently at my college, we re listen to the episode which is how I emailed you again because I suddenly remembered that I promised you and I didn't. But we listened to Do it and everybody was like you did not change a bit. Time.

Scott Benner 5:04
Wait, who did you listen to it with?

Sophia 5:06
I just have a, like a study group. The college I go to, and we were reminiscing about the stuff we did when we were younger and for the Cure podcast came up.

Scott Benner 5:20
You were just like I was on a podcast one time. Yeah,

Sophia 5:24
that was those things what was said? Yeah, and we listened to the whole thing on two times speed.

Scott Benner 5:31
Why can't kids sit back and just enjoy an hour? How come it has to be on two times speed?

Sophia 5:34
Okay, it's final season.

Scott Benner 5:37
Okay. you're low on time. I understand. But you're in America now?

Unknown Speaker 5:42
I am. Yes,

Scott Benner 5:44
I don't You don't need to tell me exactly where you are. I'm not asking that. But how did you end up here?

Unknown Speaker 5:48
I don't know.

Sophia 5:53
It's been a few years, surely accident accidental. So we were hoping to get a visa before. Because we lived in the US briefly when I was very young. But like, the hopes were very low, because that's how the immigration process here is. And then we just suddenly get an email from the agency that was like, Hey, you can come live here if you want now, as a few years ago, that was in 2021.

Scott Benner 6:25
So maybe not be about a year after you and I actually spoke.

Sophia 6:30
Yeah, I think it was about like a year and a half. Okay,

Scott Benner 6:33
so you've been living here for a couple of years before college? In my mind. I thought maybe you came here to go to school?

Sophia 6:39
No, yeah. I graduated high school here, actually. Oh,

Scott Benner 6:43
wow. Okay. So you and your parents are all here

Sophia 6:47
is just me and my mom. It was me and my brother, but there's a situation. It's just me and my mom.

Scott Benner 6:53
It was you and your brother and your mom now? Okay, and now it's just you and your mom? Okay. Yeah, the situation isn't like horrible. I hope. You don't have to

Sophia 7:04
tell me but committed suicide a month ago.

Scott Benner 7:06
Oh, my God, Sophia. How are we? Oh, my God. I'm so sorry. That's the it's still

Sophia 7:14
in the denial phase. So

Scott Benner 7:17
you'll be dealing with it that way.

Sophia 7:19
I'll be dealing with it after finals.

Scott Benner 7:23
I gotcha. Oh, I'm so sorry. I didn't realize I wouldn't have pushed. I thought he went back home to be a mobster. I wish, you know, maybe that's just the story. You can tell people

Sophia 7:33
that would have been a funnier story to tell, but maybe not right now in this like, climate? For

Scott Benner 7:38
sure. Oh, you know what? Yeah, forget that. I didn't say any of that. You went home to be a peacekeeper. Let's say that. Well, I'm so sorry. Was this? Can I ask you one question about it. completely unexpected, or not? Unexpected?

Sophia 7:53
completely unexpected. He was just like, we talked to a week prior to that. And like he was still attending all of his classes. And he was still because he lived in California away from us. And like, one day, we he missed our family call that we scheduled for every week. And like the next day, we get a suicide now. Through like an email. Send a text message or

Scott Benner 8:23
text message. Oh, my gosh. And by the time you receive that it was I imagined too late.

Sophia 8:28
Yeah, he was a computer science major. So what he did was he set out automated text messages to everybody that came at one same exact time. That was already too late.

Scott Benner 8:40
Oh my gosh. Well, that's, that's terrible. I'm sorry for you and your family and everybody who knew him and loved him. And that's really terrible. Yeah, okay. Well, was this before you and I set this up? Or after? It was

Sophia 8:55
I? Oh, my perception of time is very messed up right now. And I'm not sure actually it was on Halloween. Oh, it might have been a plot from my friends to distract me. If I'm being honest. Now

Scott Benner 9:10
we have the whole story. Okay. Now we understand. Do you think you can do this? Is it okay? Yeah.

Sophia 9:14
Again, complete denial stage, which I'm completely aware of. I'll deal with it after finals. Okay,

Scott Benner 9:20
what year of school you're in right now.

Sophia 9:22
I'm a freshman in college.

Scott Benner 9:24
Oh, wow. It's your first year. Oh my god. Yeah. Did you decide on what you're going to study? Are you still figure Oh, what is it?

Sophia 9:31
I'm going for a bachelor's in biomedical engineering. And then I want to transfer straight to an MD PhD.

Scott Benner 9:41
Yeah. What do you hope to do when you're all finished?

Sophia 9:45
I can't decide between endocrinology and urology because because endocrinology is very close to home and that's not great in the scientific world. And neurology is just fascinating. Gotcha.

Scott Benner 10:01
So the thing you really are drawn to, and the thing that you would like to really help with. Yeah,

Sophia 10:08
is endocrinology, to be honest. Yeah. I

Scott Benner 10:11
mean, we talked about it all the time, obviously on the podcast, they'll but there's a real need for people who understand diabetes in endocrinology, but then you'd have to do other things to be doing. You know, some of them don't by the way, some of them just say like, I do this, I don't do that. And they stay out of the stuff they don't want to be involved in. Do you think you would focus on diabetes? Or do you think you would do a few different things? 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 origin. This is your friendly reorder email from us med. You open up the email to 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 ducks comm G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juice box. Using that number or my link helps to support the production of the Juicebox Podcast. This episode of The Juicebox Podcast is sponsored by the only six month were implantable CGM on the market. And it's very unique. So you go into an office, it's I've actually seen an insertion done online like a live one like, well, they recorded the entire video is less than eight minutes long. And they're talking most of the time the insertion took no time at all right? So you go into the office, they insert the sensor, now it's in there and working for six months, you go back six months later, they pop out that one put in another one, so two office visits a year to get really accurate and consistent CGM data that's neither here nor there for what I'm trying to say. So this thing's under your skin, right. And you then wear a transmitter over top of it, transmitters got this nice, gentle silicone adhesive that you change daily, so very little chance of having skin irritations. That's a plus. So you put the transmitter on it talks to your phone app tells you your blood sugar, your your alert, show arms, etc. But if you want to be discreet, for some reason, you take the transmitter off, just slip comes right off no, like, you know, not like peeling at or having to rub off it. He's just kind of pops right off the silicon stuff really cool. You'll say it. And now you're ready for your big day. Whatever that day is, it could be a prom, or a wedding or just a moment when you don't want something hanging on your arm. The ever sent CGM allows you to do that without wasting a sensor because you just take the transmitter off. And then when you're ready to use it again, you pop it back on, maybe you just want to take a shower without rocking a sensor with a bar of soap. Just remove the transmitter and put it back on when you're ready. Ever since cgm.com/juicebox, you really should check it out.

Sophia 13:43
I think I would just do auto immune diseases in general. I've done that a bit. I've, I have an internship with a like laboratory at a university. And before that, even in my senior year of high school, I partnered on a research paper for a theoretical model for a cure of type one. And it's just it's everything is so interesting how it's connected to so many systems in the body that we don't even comprehend. It's yeah,

Scott Benner 14:16
all the autoimmune stuff. Have you been listening to the podcast? Since you've recorded or did you stop at some point?

Sophia 14:22
Yeah, I've I'm not listening as often because of the the moving and everything but I still do listen, you pick it

Scott Benner 14:30
up, okay. The reason I asked is because I've come to start asking people at the beginning of the, you know, at the beginning of their interview, like is there any other autoimmune in your family? And there's just so many times that someone says, oh, yeah, no, and then they think about it longer and they go and then I start prompting them. How about celiac? Oh, yeah, that there is that and then you start and then before you know what they're like, Oh, my dad has been a Lago and And you know, I have a But then here's the thing is a lot of people bring up up a family member who's bipolar. Yeah, right, that happens a fair amount. And, you know, I know that the research on like bipolar disorder, sometimes it'll skirt around the idea that maybe there's some auto immune impacts, but doesn't really ever come out and say it. But I mean, at this point now, over 1000 episodes, all these people who've said it over and over again, I keep thinking, well, that has to be connected somehow. And then what else was connected? You know, I mean, stress anxiety, like that kind of stuff.

Sophia 15:35
So basically, another recent like research area of of type one that I can see from my experience is that it's connected to your nervous system. Well, auto immune your endo system endocrinological system is connected to your IQ through a pathway, I think it's called the collagen, collagen, nergic, auto, anti inflammatory pathway. But don't quote me on that. It's effects like the oscillations in your cells, which prompts autoimmune attacks. Interesting.

Scott Benner 16:10
Well, you cut out for a second though it's connected to

Sophia 16:14
I don't want to say the exact name on the internet. He's I feel like I've pronounced it wrong. And I'll

Scott Benner 16:21
you'll be embarrassed or you'll do the right thing. Oh, I do. Remember you feeling like that. Where are you? Are you self conscious about accents still? And words?

Sophia 16:31
I guess slightly. I'm just worried that I'll say the wrong scientific thing gets

Scott Benner 16:35
somebody going in the wrong direction. But you Yeah, but you're wondering about the connection as well.

Sophia 16:39
Yes, yeah. Well, there's so much of research has focused on neuro immuno modulation, which is so interesting, because this is not what we expected when we first started studying type one,

Scott Benner 16:54
right? That these things could be connect well, how about this one? GLP medications are very, kind of in the in the news right now. And a lot of people are using them. And they start off as, oh, it's going to be a type two diabetes drug they think. And now a number of years later, as it gets more and more into the population. I'm seeing people talk about, you know, ears Danlos Syndrome. Like, yeah, I found it very interesting thread on Reddit, about people talking about how their GLP medication is making their joint pain go away. Which is fascinating. You know, just a lot of other things that it's accomplishing. See, Think like, you know, this one little medication, right, like the GLP, one GLP tube to what GeoIP? Right, I think those are kind of the the cocktail, it's in some of them. And women who have been, like, unable to get pregnant for ever, are suddenly on these medications for something else, and popping up pregnant all over the place. Yeah, you don't I mean, like, what else is connected? You know, it just because, you know, you hear all the time, like, Oh, she has type one diabetes, but she has PCOS. And those two things start to seem like they're going hand in hand. And, you know, or the, I hope I'm saying your standard was correctly, because it's spelled oddly for me. But you know, just your connective tissue being too, like stretchy basically. And you know, Pete, like when you can like hyperextend your elbows or like that kind of stuff. Like that's an autoimmune issue that even after they diagnosis for you, what, what you're told is, there's nothing you can do, except go to physical therapy, and strengthen the muscles around the joints and help support them. That's it. There's, we don't know anything else about it. So, yeah, I'm just I can't wait to figure out what everybody else figures out. And that's going to be like your generation of doctors and scientists.

Sophia 18:47
Like we're already connecting very strange things to autoimmune diseases. For example, even Schizophrenia has now been connected to autoimmune causes. Oh, yeah.

Scott Benner 18:56
Oh, please. I think I figured that out with a podcast. So I'm glad doctors were able to figure it out. Yeah, just really fascinating stuff. Or even just how many people like I know right now, it's, you know, a lot of people say that they're anxious. But I've been doing this for years, where people talk about, like, what else is going on with you? And they're like, Well, I have some anxiety or I'm depressed. We're, and it just seems to follow along. And so do you think there's a I mean, I know you're just a freshman in college, but I'm not trying to put the pressure of the world on you. But do you feel like there's a way to figure out what's happening?

Sophia 19:29
What's happening? Like, the whole picture in the whole world?

Scott Benner 19:33
No, no, like, in people's like, why are people's immune systems like just like a, and doing all these weird things? You know,

Sophia 19:43
I think that there's never going to be a complete understanding of the human body. Because it's, I can to study in quantum mechanics where we just cannot understand why something happens the way it does, but I think a lot of the human creations that we're not supposed to be constantly around our bodies have definitely caused an impact on them. And we're we're definitely being very self destructive.

Scott Benner 20:18
You're talking about pollution, plastics process. Yeah, stuff like that.

Sophia 20:24
Even technology and the constant like we, we microwaves that are around us.

Scott Benner 20:33
Yeah. So all these things are just they take time. Like you have to have these experiences over and over so people can see through lines and go, Oh, this is what's impacting that. And, you know, the GLP is a great example of it, right? Like, the first thing that the that the research shows is, it is telling your brain you're not hungry. It's making you feel full, because it's slowing down your digestion, which is impacting your insulin usage, you're using, not as much insulin, because that's happening. People are losing weight. They see it over and over again. They go, Okay, this is a weight loss drug, you know, but hey, how about people's a onesies are coming down to when they have diabetes? Oh, it's a diabetes drug. And then somebody with diabetes takes it who has PCOS, and they go, Oh, that lady got pregnant. It's only going to be a couple of years before they go, hmm. People who are having trouble conceiving if they have PCOS symptoms, and blah, blah, blah, this might help them with that. And for me, Sophia, the reason I know a little bit about it, is because I started taking it in March this year. Okay. And I've lost 40 pounds. Oh, my gosh, right. But I haven't changed anything else about my life? And it's very interesting. Yeah, yeah. So I would tell you that for my entire life, I have thought my body doesn't work, right. And I can't really put more of a fine point on it than that. Like, I eat food, I don't feel well. But I don't have celiac. And, you know, I retain a lot of fluid like you and I could go out and have a normal meal together. And I'll show up the next day, I'll be literally like two pounds heavier. I taught myself to like, restrict food through my life, eat very small, like portions of things, very specific stuff. Because if I didn't, I would just keep gaining weight and keep gaining weight and keep gaining weight. And no matter what I did, I couldn't get back to a reasonable weight. I started going along thinking, well, this is me, right? Like this is what's wrong with me. There's nothing we're ever going to do about it. And then one day, this doctor says you should try this. And I take this medication, and no lie. I look like a completely different person. And I feel different. And my body works now. And like, you know, I haven't like, I don't know, Sophia if you know the phrase run to the bathroom. But I haven't had to, like emergency go to the bathroom in a year. In a year. It hasn't occurred to me to like, oh my gosh, I'm in trouble. You know, like, we people, like, you know, a person you take them to a restaurant and then you know, they disappear afterwards. I mean, yeah, yeah. Yeah. That would have been me, like at one point in my life, like, if you go out to eat doesn't matter what I have. We should go home now because I'm going to need to go to the bathroom at some point. And doesn't happen anymore. That's

Sophia 23:16
very interesting. Yeah. Did you measure your blood markers, or anything before? And after?

Scott Benner 23:22
I did get? Yeah, complete, like blood panels done right before I started, and actually, I'm up to have them repeated

Sophia 23:27
soon. I would be very curious to see the difference. I'd

Scott Benner 23:31
be happy to send them to you. Don't worry, you're 17. But I'll give you my blood work door.

Sophia 23:35
Hey, I'm 17. But I already I didn't know I have no nothing to say

Scott Benner 23:41
to that. You're gonna say I've seen some? Is that what you're about to say? I was going

Sophia 23:45
to say that. But I decided to stop myself from cursing on the podcast.

Scott Benner 23:51
Okay, I'll curse for your door. Yes. So I just think that's insane. Like, they get a really obvious like that it's a through line. Like, now somebody needs to pay attention to it. And and see it through. You

Sophia 24:04
know, yeah, but the problem isn't just paying attention to it. The problem is the whole scientific method takes so much longer to actually even to, like release a research paper, it would take at least a year, at minimum, like most of the research papers, I finished with my internship a year and a half ago or two are only now getting, like, published Yeah,

Scott Benner 24:30
but here's why I think that's not going to matter with the GLP is because there are so many people who are overweight or who have diabetes, who are going to be eligible for the medication. The doctors are going to see it working for people. So they're going to prescribe it all over the place. And then you're gonna get these other I don't want to call them fixes but like you're gonna get these other results that nobody's looking for or expecting. And after enough people start reporting it back. It will Point science in those directions. And I think that's what's going to happen like with the PCOS with it, like, I mean, GLP is are not a new, they're not new. But in the hands of people like ozempic, we go V, mon Jarno, these ones that are like have been in the news for like last year and a half or so like, you know, when basically when famous people started turning up, then you're like, hey, what just happened, they're like, great, you know, like that when that started. And then people realize that then people with money started cash buying it, and then it started working. So now insurance companies are starting to cover it, and it's starting to go, it's starting to grow like that. What

Sophia 25:35
you're saying is that they're the new hair.

Scott Benner 25:39
Well, they're, they're definitely the new test group, and they don't know it. Because you're gonna take it for weight. And like me, then start going, hey, you know, it's funny, I don't like this doesn't happen to me anymore. Or, you know, or somebody's gonna go on Reddit and go, Hey, I started a GLP. And, you know, I have eerste Danlos Syndrome, and all my symptoms are gone. And then somebody else is gonna go Holy hell, that happened to me, too. And then before you know it, I'm looking at a Reddit thread with 15. People who think that their symptoms from danlos have been completely like removed by a GLP medication. Now, I don't know if that's true or not. But that's the that's the way that stuff starts are a Facebook group full of women who are losing weight. And then one of them just goes, Hey, I got pregnant, I've been trying to get pregnant for 10 years. And someone else jumps into the thread and goes, Oh, my God, that happened to me. And before you know it, there's 20 Women in there going I recently, like people who were not practicing birth control anymore, because they were like, you know, the world doesn't, isn't gonna let me have a baby. And then they go on a GLP medication, they all get pregnant. And then they realize while they're talking, you know, I used to have a lot of bad PCOS symptoms that I don't have anymore, either in that weird, and then boom, you've got a study group. And then it just has to get back to the scientists, and they have to do the actual research on it so they can figure out the dosing that will help people for specific

Unknown Speaker 26:57
things. Yeah.

Sophia 26:59
And that really is very fascinating, because that's not what usually happens with the release of new medications. But I think that's very exciting. Yeah,

Scott Benner 27:10
no, it's this one little caveat that we were all that so many of us needed to lose weight or had diabetes, that this one medication is getting spread out over the population in weird different ways. Now, I don't know. Obviously, I don't know the rest of it. I tell people all the time. Like if I end up growing a tail from using a GLP medication, you know what I'll tell you, Sophie, if that happens, I'll say nothing's as bad as skinny feels good. That's what I'm gonna say.

Sophia 27:34
Okay, that's starting to sound very much like diet culture.

Scott Benner 27:38
I'm sorry, I'm just gonna tell you, I don't have any. I'm just saying I don't think I'm gonna grow a tail. But if I did, I'd have to really think about it, I'd be like, I can just get close that a tail fits into. So I don't know what's going on. But

Sophia 27:51
having a tail would be really cool. So I wouldn't let me see. What's

Scott Benner 27:54
even the problem with it. Now, I don't know where I would stop horn out of my forehead. Maybe I say no to that, you know, but I'm just saying like, at the moment, you're gonna, it's gonna be crazy. And, and for type ones as well. So I know right now that that medication is not okay for type ones, but, but there are type ones taking it for weight, who are seeing significant decreases in their insulin needs. Yeah,

Sophia 28:19
it happened kind of that way with metformin, too, because I was prescribed Metformin in Russia, which isn't approved in the US for type one. And it like helped so much. It reduced my insulin needs by the 40%. And it makes everything so much easier. But when we came to the US, the doctor didn't like that, and wouldn't give it they removed it. They wouldn't Yeah. And like, my, I had to readjust everything by a factor of one and a half probably

Scott Benner 28:56
does have other impacts on you stopping the Metformin. I

Sophia 29:00
wasn't paying that close attention. I was more focused on having to readjust all of my insulin needs.

Scott Benner 29:07
Yeah, I bet 40% Yeah,

Sophia 29:11
it was a life changer in when they first prescribed it to me. And I said, to be honest,

Scott Benner 29:18
can you find another doctor?

Sophia 29:20
So we actually we moved ones stays here and both doctors in both states are on the same page on that. That's,

Scott Benner 29:28
you know, it's funny because Arden's Endo, last year started talking and saying, you know, I think I'd like to put her on Metformin. And we were trying a couple of other things first, that just never panned out. And it was Metformin would have been Ford like to kind of reduce her insulin needs a little bit, but because she was also trying to impact like her, like, her belly pain around her periods and stuff like that, right. And that doctor was thinking, you know, in that direction with metformin, and then these GRPs became, you know, So available, and then we had, you know, I had the success I had with it. And so two weeks ago art and just started on a very low dose of ozempic. Oh, really? Yeah. Now our insurance, you know, is screwing with us and everything. So we got, the doctor gave us a, um, a sample to start with. But she's like, look, this will give us six weeks to figure out another way to handle this, but I don't think she's like, I don't think Arden is going to even be taking, like a big dose of it. So, you know, the idea would be even if you had to pay cash for it through another country, let's say that it would be a pretty small outlay of money over the entire year, because you would barely be using it. So right now we're using it to try to see what's happening for and she's hoping for, like heavy period symptoms to be impacted by it. And have

Sophia 30:49
you noticed any differences thus far, it's only

Scott Benner 30:51
been, she's done two injections. So she's like nine days into it. Okay, I think the first place we'll be able to see if something happens is the next time her period comes around. So we're waiting for that probably. Yeah. So hopefully, and then like, and she's only using point two, five micrograms, like the tiniest little bit right now, which is, is the ramp up dose to get your body accustomed to it. But on the ramp up dose of the same drug, you know, different brand name, but it's the same drug for me. I started losing weight, when I wasn't supposed to, like the doctor was like, This is not a therapeutic amount of this yet. It shouldn't be happening. And yet I lost four pounds the first week I was on it.

Sophia 31:31
Okay, so maybe that was water weight, the first definitely

Scott Benner 31:35
gonna be but that was the thing I was telling you, though, is that my body like, retains water, abnormally retained water, and I took it in and it's gone. Interesting. I'll tell you this, since we're talking about this kind of stuff. I have a number of times in my life, four or five times had to take a steroid pack for you know, something. And everybody says, Oh, I take steroids in my body, and I retain so much water. I gain weight on steroid packs. As soon as I get ramped up on a steroid pack, I can do the second day of it. I pee out all the extra water in my body. Like I'm never. Yeah, it works backwards on me. So it's very curious. I'll be a doctor and figure it out.

Sophia 32:18
Can I call you back in 12 years? Absolutely.

Scott Benner 32:20
I'll try to stay alive and you call me back in 12 years when I'm 64 years old.

Sophia 32:25
You're not gonna die by 64. Okay.

Scott Benner 32:27
Well, now that I'm thin, probably I'll be alright. But you know, I got to buy new clothes.

Sophia 32:33
That was nice. Yeah, except for the money spent. party didn't

Scott Benner 32:37
enjoy. That's right. I didn't enjoy. So listen to your friends said that your sarcasm is exactly the same. When you were 14 it is when you were 17. So what were they talking about? I

Sophia 32:48
kind of have a reputation at the college. I'm kind of the whole reason that our study group came to be in general, the one of the members, he's actually the head academic coach, like he already graduated, he just works there. And I just started making fun of you for no reason. So I'm fluent. And as a joke, and the other members from my class kind of joined in and we've been hanging around each other ever since. I just kind of think that. I haven't grown out of it very much. I'm not sure if that's a good thing or not. But yeah, I

Scott Benner 33:31
am a fan of it. I still use it as an adult it um, it's sometimes difficult, like personal relationships. Yeah, yeah. Nobody wants you to be sarcastic. They'd like you to be sincere. Yeah,

Sophia 33:43
I think the only thing that's changed is just the fact that I know when it's more appropriate to be used, and when it's not. You

Scott Benner 33:50
are good at it when you were a kid, but I think that was partially because you didn't know not to do it.

Sophia 33:55
Yes. That is very true. Yeah,

Scott Benner 33:58
your sarcasm was fantastic. Like, I honestly remember talking to you and thinking like, it's like talking to an adult. But you made those tell people that one thing I alluded to earlier, like you say you got type one, although How old were you when you're diagnosed? It goes left. Okay. And you went online to figure out your care on your own? How did that talk about that?

Sophia 34:26
I think a lot of it was just that I grew up during the time of the internet. It started out mostly with I wanted to understand what the sihvonen was. And then I was realizing that my numbers are not matching up with the numbers that like people on Reddit are saying are good or the Juicebox Podcast, I found it and you were talking about completely different levels of control than I was being told to. And that made me very curious and kind of frustrated in the fact that I might be doing My body farm through the care that my doctors are telling me to do. So I just tried to figure out a way that I could fix that. I didn't want to do any my body any harm, which was really frustrating, because I was doing what my doctors were telling me to do. And it was making things worse as it turned out. So I just went on the internet to see if there's any way that I could fix it myself. And I guess it kind of worked.

Scott Benner 35:34
Because you were, would you get more aggressive with insulin? Yeah.

Sophia 35:39
And I found ways to get the Omnipod out there, and the ducks calm. And I found new ways, like hearing other people do what you say to do for type ones made me feel better about doing it myself, because I wasn't the only one doing crazy control things.

Scott Benner 36:02
Okay, so the doctor tells you one thing, and then you realize that doesn't seem right. But even once you figure I'd like to try something different. The actual act of doing it feels wrong.

Sophia 36:14
Yes. Because I was in a country where nobody else was doing anything like that. And it felt risky, because everybody else who is doing what you say, feels so far away. Yeah. You know,

Scott Benner 36:29
so. So it was actually valuable to hear people's stories. Absolutely.

Sophia 36:33
And I think that was part of the reason why I also reached out back then, yeah, you're

Scott Benner 36:39
not the first like, under age person to be like, I'd like to come on the podcast, I in fact, just did this one with a Canadian girl. She's like eight or nine. You know, you get that email. And you're like, hi, I want to be on your podcast. I'm, I'm 14. Do your parents know? Like, please look them into this email. And then you don't know how it's going to go. And that's the other side of it is I want to have conversations with kids. But at some point, I don't think you'll find this hard to believe Sophia. Some of them are boring. And so it's like hard to talk to them. Because they ask a question. They're like, Ah, my goodness, the podcast, you get to talk quicker and that there's all that problem, but then you get on the recording. And before I know it, like I'm starting off, like trying to be like, Oh, I'm talking to a 14 year old girl from Russia, like this is weird. And then, before I know it, I'm actually really sarcastic. Yeah. And you know, you because you couldn't hold it in, you probably weren't even trying. I would imagine. I

Sophia 37:32
was not. I was not. No, I was very nervous in the beginning. But I think you have you make the conversations flow very easily, which I think is the reason why it came out. So naturally.

Scott Benner 37:46
Oh, good. I'm glad when you listened back to it. What was your takeaway afterwards? What did you think? Well,

Sophia 37:51
I was just trying not to cringe. Because I felt like, I don't know, I was such a kid. Which sounds probably funny to you, because I'm still very young. But everything I said is just so from such a lens of a child, in my opinion.

Scott Benner 38:13
Yeah. Even just three years later, it's interesting to look back at yourself. Yeah, it'll happen again. By the way, you'll listen to this when you're 25. And you're big. I bet. Yeah. I'm sure what was that Sophia do it. But you know, you only live in the, you can only live in your reality that you have and you you're making decisions and assessing things from the perspectives that you so far half. So I actually found myself thinking recently about how differently I see people in my 50s than I even did in my 40s. And so much so, you know, more differently than I did, even when I was younger, and like decision has been granted

Sophia 38:53
the experience to talk to so many people from so many different backgrounds that I would think that your perception of the world has absolutely changed.

Scott Benner 39:01
It's crazy. There's still some stuff that I'm just like, like, I wish I could tell you, I can't tell you, but there's a big diabetes organization that said something like made like a statement online yesterday. And I thought, What the hell are you doing? Like that's, that's wrong. Like don't do that. And I think I know you are, but I don't know how to.

Sophia 39:26
You can cut it out.

Scott Benner 39:27
I can cut it out. So all these people just get to like pick up a minute later, and I'm saying something different. They're like, Well, what the hell did he say? Yeah, I I don't know, a way to say it without making somebody sad or upset. I'll tell you when it's over. Okay, okay. All right. All right. Yes. Okay. Okay, I have a note for myself at the end. I'm sorry to everybody else. I don't want to make anybody sad. But my point was that you can see that the organization is being run by younger people, which is good. But they've taken In a position on something that I think hurts people's health, and they're doing it in the name of supporting people's mental health, it's an interesting decision to make. And maybe I'll be able to talk about on the podcast at some point. But moreover, what I think will happen is I think the world is gonna yell at them online, and they're gonna stop, and that's gonna be the end of it. So, you know, we'll say, your study group, we should say hi to them very quickly, how many people are in this group? four, or five? And you guys get together? And

Sophia 40:37
how do you pretty much live at the college?

Unknown Speaker 40:39
So do you like

Speaker 1 40:41
do you like literally read together and take, like, do practice tests and things like that? Or do you just bounce stuff off of each other? How does it work? Working kind of like a collective like that.

Sophia 40:51
We just sit together, all of us has mostly different classes, we usually just have one class in common. But I have again, the reputation of not really studying but doing everything but studying. I still get my work done. Just not there. They they're very good at actually focusing in blocking me out.

Scott Benner 41:10
So you're the problem. I am the problem. Yes. Sophia, I'm on your LinkedIn at the moment. Yeah, yeah. How do you get away with being so academically successful, but not paying attention?

Sophia 41:26
I don't think I'm academically successful. To be honest. You don't I did my best in high school. I kind of sped run high school to be honest. You why I graduated a 16.

Scott Benner 41:40
I know I know. You're too young for to be in. So so how can you say that you graduated when you were 16? But you didn't do well academically? I

Sophia 41:49
mean, I just I don't really like accepting achievements as a.

Scott Benner 41:53
I think that's how you end up being successful, by the

Unknown Speaker 41:56
way. Maybe? Yeah,

Scott Benner 41:58
maybe it doesn't feel does it feel boastful to you that you don't have a problem with that? Do

Sophia 42:04
I It does feel slightly. Things click in my head very easily. Math makes so much sense immediately to me. And I just, it's so fun to me. And that sounds so not humble when I say it, and I hate saying that out loud.

Scott Benner 42:26
Okay, well, I think it just sounds representative of who you are. But I appreciate how you feel. Let's see how dorky you are with math. Did you teach yourself Python for fun? And

Sophia 42:36
teach myself Python for fun, but I taught myself differential equations for fun.

Scott Benner 42:41
Yeah. Alright. So we all see where you're at. Okay? Because, you know, the entire time we're talking, I'm doing the math. And I was like, when would she have to be born to be a freshman at 17? That doesn't work out no matter how I

Sophia 42:54
know. Yeah, I graduated at 16. And I am going to a community college until I turned 18. So I don't move out until I'm 18.

Scott Benner 43:04
Could you get accepted at another school, but you're not old enough.

Sophia 43:07
So I could get accepted. And I could have gone. But the thing was, they have so many restrictions. The one school that I will transfer to Johns Hopkins. They have a lot of rules for underage students. So I just decided that it would be easier to transfer when I'm 18 and get some cheaper credits while I'm at it at a community college. Very nice.

Scott Benner 43:33
Good idea. All good ideas. And I love the way you just slipped in Hopkins like it was nothing like that's a humble brag right there. Sophia.

Unknown Speaker 43:40
I take that.

Scott Benner 43:44
I just said it to make you feel worse. Yes. So you'll be here with me. You're gonna be a couple hours for me when you get there. Oh, really? Yeah,

Sophia 43:50
I'm here in New Jersey, right? Yeah, I

Scott Benner 43:52
drive past. Well, my my kids are in the south right now. So I drive through that area a lot. But my son's coming home. So a little less. Okay. Arden is going to school in Georgia. So yeah.

Sophia 44:04
And she's getting like in design degree. Yeah, that's fashion

Scott Benner 44:09
design. Nice. We just spent a couple of days thrifting which was a planned event with Arden and my wife and myself. So we went to all these thrift shops, one of the boroughs in New York, and we spent like a day and a half, like just walking the city and going like from thrift shops to thrift shops. So she could like somehow pick clothing that no one would ever put together and make these like crazy outfits that like we she couldn't walk. I'm not over exaggerating. We couldn't walk for more than five minutes without somebody stopping her to tell her how much they loved her outfits. I was like, well, this. This certainly seems like she might be successful with this. That is awesome. Yeah, very cool. Thank you so much. So that she's like, oh, like Thank you. She's very nice about it. And she's like, I really, really appreciate it. Thank you very much. And then you kind of move on, but the things people say They are so like, you know, they're like, they're like, I feel how you look. Like one woman said, like, what?

Sophia 45:07
So what does she want to do with the degree?

Scott Benner 45:10
She just wants to design clothes? That's awesome. Yeah. So that's what she's trying to learn how to do. And I have to give her a ton of credit, because prior to College Art, it was not a particularly artistic person. Like she wasn't a person who sat around drawing or painting or modeling or anything like that. She just, she had a vision in her head. But she was actually, yes, by the time she was a junior in high school, she had sat us down and had this pretty, like serious conversation where she said, I either want to be an attorney, or a fashion designer. And we were like, Okay, those two things seem different. But she could have she had the grades and the aptitude for the attorney thing. And she just one day, she's like, I'm gonna, I'm gonna learn fashion. And then she got to, you know, college.

And, you know,

the first thing they do is they put you in, like, these big drawing classes. And, and we're like, are you okay? Like, you've never done this before. And she's acknowledged figure it out. And they in that first semester, like, like, she's not Picasso, like, don't get me wrong, but she taught herself to draw. And, and she's significantly better at it than you would imagine a person who had never really done it before ever, just picking it up and forcing themselves to learn how to do it was really,

Sophia 46:32
that takes a lot of dedication. Yeah, that's really awesome. Yeah,

Scott Benner 46:36
I thought so too. So that's pretty cool. But you, this just comes very naturally to you.

Sophia 46:40
It never did, up until I kind of started homeschooling myself in high school. I was never like the gifted kid in elementary or middle school. In fact, I had the worst grades in all of my classes. But at some point in high school, I just started actually looking into stuff myself. And I found my own purpose, and every subject, and for math just became my special interest, which it never was, I always thought I was, what origin never was the our ticket. I played. I was I'm a classically trained pianos, piano player. I play guitar, and I've always drawn and that the math never seemed like something that would become my thing. But it just made so much sense. And it just feels like such a beautiful language to me. Which I'm realizing sounds so nerdy right now. No,

Scott Benner 47:47
not at all. I don't think so. I think it's, it feels to me like you were like, Hey, I taught myself diabetes. I wonder what else I could teach myself? Yeah,

Sophia 47:54
I actually, I think that was the case. I think the conversation that we had really made me feel more confident in the fact that I have some ability to do stuff. And it gave me a lot of motivation to actually try in life to be honest.

Scott Benner 48:11
Wait, Sophia, I want to just take a second where if you don't want to be boastful, and it makes you feel weird. I'm okay with it. So are you saying that the conversation you and I had gave you confidence and that maybe one day you will like figure out something for people's health and I can help partially take credit for it? Is that what you're getting at? Yeah, I think so. Beautiful. Let me write that down. So I don't forget, take credit for Sofia success. Okay. Yeah, I'm gonna do that. Next time I get a chance in the kitchen with my wife, but she will then roll her eyes at me and walk away. Just so you know, you can call me and I can like, support your point. Oh, okay. I'd be willing to do that. I was reading this message from someone the other day, you know, I was cooking for myself. So I was like making I don't know how everyone else's life is. But my wife still works at home, which I really wish she would get a different job and leave because it's just too much. It's supposed to be my gig. So we had this thing of not everybody's you know what I mean? COVID messed it all up. This is my house. I lived here by myself and other people came in, in the afternoon alone time I welcomed them in, I cooked for them, and then I cleaned up. They don't need to be there all day. But I was sitting around, I was cooking for myself. I was waiting for something to finish warming up. And I had my phone out and I was working. And she's like, What do you do? And I'm like, I'm working. She goes, Are you on Facebook? And I was like, Well, for me. That's work. I'm answering people and, you know, commenting on threads. And I'm like, I'm doing that she knows that by the way. But she still she screws with me. You know what I mean? So I said I have this really lovely note here from this person who says that the podcasts really significantly change and I look over at her and she's, you know, the duck hand you can make when people are talking too much with you're like, Yeah, I look over at her to see if she's interested in hearing what the person said. She's like, I help the person like what they owe. I don't want to paint her as not. She's not unfeeling about it. It's it's lovely. But and she really does know that if you got her alone, and I wasn't there to hear it, I'm sure she would say some nice stuff about me, but not in front of me, you know? And so she's like, Yeah, you help people. And I was like, I do.

Sophia 50:23
I don't blame her. It was like philosophy

is probably frustrating to constantly hear how you get immediate feedback on your job. And she probably doesn't feel as appreciated.

Scott Benner 50:36
Oh, Sofia. That's a really good point. I do make a point of telling her all the time how good she is at what she does, though. But it probably doesn't count coming from me. You think? Well, yeah,

Sophia 50:44
because you constantly get reassurance from all of your listeners, right? And you talk to them everyday directly.

Scott Benner 50:50
I actually would like me to admit this something. I'll tell you a story. So last night, I've been having a not good time being a podcaster for the last couple of weeks. It's apple has changed something about their app, and it's screwing with my downloads. And so I'm having to like, bug people and be annoying and be like, Hey, can you check your app, you know, look for the setting, it may have changed, like that kind of stuff. And it sucks. Like I hate bothering people. I hate asking people for things like my idea about the podcast is I provide it. If you find it valuable. You listen to it. I know everybody doesn't listen to every episode. I know people don't listen forever. Like I understand all the intricacies of it. But to have someone show up one day, and basically like a gremlin crawl inside of everybody's app and turn a switch so that you don't get the the episodes. That's like it literally feels like I'm fighting with Tim Cook right now. Do you know what I mean? Like, I feel like Tim Cook's in an office somewhere going, Hey, Scott took nine years to build this type one diabetes podcast into this juggernaut that it is, why don't we with him? Like that's what it feels like. It's

Sophia 52:03
more simple than that, Scott is the fact that he just works with Big Pharma and they don't want you to control everybody's blood sugar.

Scott Benner 52:09
Oh, Sophia, you're making a ton of sense here. So you think let me make sure I understand that big tech and Big Pharma are in a meeting right now. And they've decided to impact the entire podcasting landscape to stop me from helping people with their diabetes. Yes, I believe that's true as well. I'm glad I'm glad you and I are on the same page. So anyway, as crazy as that sounds, that's what it feels like. So like, it feels like I against all odds, turned a thing that nobody wanted to listen to. You don't I mean, like conversations about type one diabetes, into a thing that reached a 14 year old girl in Russia, helped her with her health, put her on a path to mathematics, and one day will make her a Nobel Peace Prize winner. And then somebody said to me, Hey, you know, just when it was exploding, like over the last two years, my podcast is exploding. It's growing in leaps and bounds. And basically, they came in turn the dial and said, this was the average download a purse that a device was accomplishing every day. And we're gonna cut that number by two thirds, or two. So

Sophia 53:20
it sucks in general. So

Scott Benner 53:22
anyway, the new episodes are downloaded just the same way as they always have been. Because I didn't actually lose listeners, right. But when most people turn on their podcast app, they get a few episodes. And then they listen to them. Now what's happening is you're getting the most recent episode, and nothing behind it. And so you wouldn't think it was there because you don't know like, I interviewed a guy yesterday, who loves the podcast. He's been listening to it for years. And when I asked him how many episodes I put out a week, he doesn't know. So like, he just, he listens to what I give him. So when he opens his podcast app every day, there's an episode there. He listens to it. If I put out the two of them yesterday, for some reason, and it didn't give them to him, he wouldn't go back and look for it. Because he think I'd be getting it if it was there. And so that's what they've done. So now, now I have to train everybody on what happened to a podcast, which nobody cares about, like, can you imagine turning on your favorite podcast and somebody being like, Oh, my God. So here's what happened. Apple bought and you're like, what the like, I don't care about this. You mean, but it's it's impactful on the podcast. Anyway, I've been having a bad couple of weeks living in this reality and getting it fixed. And last night, I had to do a little bit of work before I went to bed. And I jumped on the Facebook group. And I just said, Hey, I'm writing this thing right now. I can answer some questions or you know, if anybody just wants to chat, and at some point in that thread, somebody said I want you to take this opportunity to tell you how much you've helped me. You know, since I know you're here right now, and they wrote me a note, and it saved my day. That's awesome. And yeah, but you're right. Everybody doesn't have the ability to do that.

Sophia 55:12
Most people's jobs don't. I think I

Scott Benner 55:16
could honestly go on Facebook right now and just put up a post and somebody would come by and eventually tell me, Hey, this podcast is really helped me and I can get like a, like a boost from that. And I never really thought about it like that before. But you're right. Well,

Sophia 55:28
I you will absolutely credit you in my Nobel Peace Prize. Oh,

Scott Benner 55:33
that'd be wonderful. I'll come. By the way if I would, like I'd get on a plane. If you know, for the metal presentation, if you want to get me in. I will, if that ever happens. Okay. So if you ever get a Nobel Peace Prize, I'll come to is it Switzerland? Sweden, Switzerland? Or they should know this? I do not know they're not gonna let you in if you don't know where it's at. Oh,

Sophia 55:56
no. Okay. Well, there goes our plan.

Scott Benner 56:00
Can you imagine if I ended up in Sweden, and it was Switzerland, Oslo, Norway. Really? Wait a minute. Norway. So Norway? Yeah. Neither of us are going to be there. No, Oslo City Hall. The Peace Prize ceremony takes place in Oslo City Hall at 1pm. On the 10th of December.

Sophia 56:16
I don't want I don't feel like going to Norway. It was two days ago. That's weird. Oh, isn't that crazy? I really need to get myself together. Oh, it

Scott Benner 56:26
literally was two days ago. Had we? Not? That's insane. I wonder what else we're talking about that we're making the world do?

Sophia 56:37
Well, we have here Scott, I wanted to ask you, what do you feel about the new eyelet bionic thinkers?

Scott Benner 56:43
Ah, I had them on had a really long conversation with them. About It, like couple hours actually, with the guy that started the company. And after hearing everything he had to say, I think that the islet pump will significantly help people who otherwise did not understand their diabetes, or were never going to put the effort into it. That is

Sophia 57:09
very politically correct wording to say that you should not get it if you're listening to this podcast right now.

Scott Benner 57:15
I mean, it's gonna keep an A one C in the sevens, right? Oh,

Sophia 57:19
you're making me nervous. I am switching to it. Next one.

Scott Benner 57:22
Are you really?

Sophia 57:23
Yeah, my endo a stick kind of? Well, how

Scott Benner 57:27
come? What what are you using now?

Sophia 57:29
I'm still on the Omnipod Oh, come?

Scott Benner 57:31
Were you looking for new pump.

Sophia 57:33
I was not really but she has a very big bias against the Omni pod. So she wants me to either switch to the T slim or the new bionic pancreas. And they just came to talk to her the whole off the whole like hospital like last month to them and got every single endocrinologist there on board. So now they're all really big fans of it.

Scott Benner 58:02
Sophia, you're saying that one sales call and they're gonna switch everybody off their insulin pump?

Sophia 58:06
Yeah, pretty much.

Scott Benner 58:08
What's your agency right now?

Sophia 58:09
I was at a five foot nine before the brother. I remember the 6.5. Now.

Unknown Speaker 58:15
Okay.

Scott Benner 58:17
Your agency is gonna go up. That's don't say that Scott is going to that's it'll mean, it's the goal of the pump. The pump doesn't that I let pump is not shooting for a five or a six. I mean, they were on here saying it's targeting a seven a one C or an A one C and the sevens the idea behind the eyelet? Which I think so I'll go back to my was what I said I wasn't trying to be politically politically correct. I was actually it's what I mean. So we there are so many people in the population living with high one C's don't understand how insulin works. You know, they don't have a lot of the information that we talked about in the podcast. Either they don't have it. They don't want it they you know, maybe they have like mental health reasons they can't focus on there's a ton of reasons why like I'm not, I'm certainly not coming down on anybody for their situation. But if you're running around right now, with a seven and eight, a nine a 1011 1213, a one C and you put an eyelid on it, well, my gosh, like your life's gonna get better. Because all you have to do is say to it, you have to announce the meal, right? It's breakfast, lunch or dinner. And I'm having a small, medium or large serving those the two things you tell it, I'm having breakfast, this is a, you know, an average meal for me. You know, it's going to keep your a one C in the sevens. That is a massive thing for people. And I think most people living with diabetes using insulin. I mean, I hate to say it but I think there's more people who are living in that reality than are living in the one where you have a 591 C or you're walking around with a six two or something like that while you're in college like which is you know, everything you've been through Throw in the last couple of months on top of college and you have an agency of six and a half, that's insanely good. So I don't think that's most people's situation. That's really

Sophia 1:00:10
reassuring to hear from you. Especially because I was kind of beating myself up about it.

Scott Benner 1:00:14
No, you're doing wonderful. That's amazing. Yeah, don't don't Don't be absolutely terrific. So I've never used the eyelet personally, right. But you're going from tubeless to a tube pump. And you're a person accustomed to a five, nine a one see? Who's going to end up with anyone seeing the sevens probably?

Unknown Speaker 1:00:33
Well,

Sophia 1:00:34
I'll talk to her if I can not do that. I

Scott Benner 1:00:39
have a question. Why don't you just not tell her I'm not switching my pump. I

Sophia 1:00:43
guess I just wasn't advocating for me myself as much, because I still have the notion that maybe this doctor does know better and she is advocating for it so much.

Scott Benner 1:00:55
It sounds like to me, Sofia, that for reasons that I don't understand this lady's got what they call a bug up about Omni pod. And then somebody came in and made is that is that a term that translates? You know that one from? Yeah, okay. And then. And then someone came in and gave her a big sales push. And she's like, Okay, this is on this team now. So

Sophia 1:01:21
I came in, she was really pushing for the T slim. And she really wanted me to switch to the T firm. Now, she's really wanting me to switch the island.

Scott Benner 1:01:32
Are you on an algorithm or using dash or Omnipod? Five? Omnipod five, and you have a five nine and a six? Oh, why would you switch? You're gonna go to tubes. You're gonna go to carrying a device on you like, how come?

Speaker 2 1:01:45
I am not sure.

Sophia 1:01:49
I know. Now I'm second guessing it I had like really logical reasons. But now that we've talked I don't anymore.

Scott Benner 1:01:56
Don't forget I made you love math. The last time we spoke. You

Speaker 3 1:02:00
did this one. I'm gonna do this. The catalyst you were the catalyst?

Scott Benner 1:02:04
Sophie, I thought we agreed.

Sophia 1:02:09
For everybody listening. God will make your children love math.

Scott Benner 1:02:13
Yeah. Thank you. Good job. Well, that Oh, do you think people know math is the way? Yeah,

Sophia 1:02:18
I feel like you've said a lot on this podcast that you don't like math. I know.

Scott Benner 1:02:22
But my my son got a quantitative econ degree.

Unknown Speaker 1:02:25
Really?

Sophia 1:02:27
I did not know.

Scott Benner 1:02:29
And last night, oh my god, Sophia. Last night. He shocked that crap out of me. So he went away. He got a job. He got out of college, he went got a job. He's worked it for about a year, it was a year long contract. And at the end, he said, I'm not going to stay here. i He's living in Atlanta by himself. And he's like, I miss everybody. And I'm bored and like, you know, doesn't particularly love Atlanta. And he's like, I want to honestly the only friends he has Sophia are the gods. The people are men and women he met at work that he likes small group of friends there. And the I guess I can say this now, the drug dealers that he plays basketball with in the park. I should be more clear about that. He he said to me one day, he's like, baseballs over. I gotta get moving. He's like, I can't like he's like, I can't just keep lifting. Like I'm playing baseball. He's like, That's ridiculous. I don't need to be this big. So he's, he was like six feet tall carrying like 202 pounds on his frame, right? Like, say he was jacked up to play baseball. And he's like, so I'm gonna stop working out like this. He's like, this is how I stay in shape. So I'm gonna go play basketball. And I'm like, Okay, I was like, well, where the hell are you gonna do that? He goes on. He's like, there's parks all over the place. I'm gonna go to a park near my apartment. I'm gonna bring a ball and I'm gonna play basketball. It's like, okay, so he gets there. He said, It took him a while to like gain the trust of the people there like to actually get into a game they could see can play a little and example attic. And so then they kind of liked him and everything. He's like, but you know, the longer I've been there, I realized that most of these guys are drug dealers. Like, okay, and he's like, and he goes, they're really great guys, I guess the side of what they do for a living. And I was like, right, he goes and but he's like, at the end of the games, like, you know, we like go go back to our cars and like, change our clothes and put stuff in bags and like, take our phones out of our gym bag. He was when I'm taking my phone out of my gym bag. The other guys were pulling guns out of their gym bag. And I'm like, okay, and I said, stop going there. And he goes, they're really good games. And I was, I said, okay, and he goes, I can't find another place to play. I'm going to gain weight if I don't play basketball. So anyway, my son has made friends with drug dealers to play basketball with and he's made friends at work.

Sophia 1:04:35
But it's Atlanta, Georgia. Isn't everybody a drug dealer? I

Scott Benner 1:04:39
don't think that's the thing we should say out loud. Sophie, I don't believe everybody in Atlanta is a drug dealer. No, no, I don't think that's true.

Sophia 1:04:45
Yep. Although that might be my bluntness coming out. Also

Scott Benner 1:04:49
across the hall is apartment. This just happened again the other day. He has twice had to call the police. Oh my about screams coming from the apartment across the hall. Ah, where one man is yelling at another man, you have to let me out of here. I want to leave. So that's happened twice. By the way this the second time it happened he called 911. And do you know what happened when he called 911? In Atlanta,

Sophia 1:05:15
what happened?

Scott Benner 1:05:16
You got a message that said His call was very important, but that they couldn't pick it up right now.

And that he should leave a message

Sophia 1:05:24
that is mildly concerning. Hi,

Scott Benner 1:05:26
911. I'm upside down in the car on the expressway. What's this doo doo doo? We're sorry. So anyway, if you're in Atlanta, I'd vote for somebody who would fix that. But so he's, he's coming home. That was a really long way of saying he's coming home. And we were FaceTiming last night. And he's talking about packing. And, you know, he doesn't have enough space in his car to get his stuff home. He's selling like some like furniture and stuff like that. And I'm going to drive down to help him bring us the rest of the stuff home. So we're making plans about that. And out of nowhere, he says, You know, I think I'm gonna take a master's, I'm gonna get a master's degree. And I'm like, this is a thing that he has been like, the entire time he was in college. He's like, I cannot wait to get out of college. I'm never going to college. Again. I hate going to college, like, bah, bah, bah, and a year in the real world. And he's like, you know, if I want to get the jobs I'm looking at, I got I'm gonna have to get a master's degree. I was like, getting a master's. He thinks computer science.

Unknown Speaker 1:06:26
Nice that

Sophia 1:06:28
that would be really smart. Especially right now. Yeah,

Scott Benner 1:06:32
he's been taking a lot of like, courses online this year. Python, ar, AI, Introduction to AI, stuff like that.

Sophia 1:06:41
I would recommend instead of Python, C sharp or C++, they're the leading programming languages right now.

Scott Benner 1:06:47
Is that in health?

Sophia 1:06:49
No, those programming languages?

Scott Benner 1:06:51
Yeah. But where are they being used? Mostly, most video games

Sophia 1:06:55
are either now Java based or C sharp and C++ because they are. Python is more for beginners, because the languages it uses. It's more like we talk so they're easier to comprehend. Because they are based. It's basically written like we talk. But they're not as versatile as when you use the complete vast syntax of C sharp or C++ or whatever.

Scott Benner 1:07:20
No, thank you. Yeah. So he's been doing that stuff online and getting like certifications and like growing his understanding and everything. But I think the biggest thing, is he seeing the jobs that he's looking for? They're like, you know, you need seven years of experience or a master's, or a master's he's like, so it'll take me far less time to get a master's than it'll take me to get seven years of experience working? Of course, yeah. So he's thinking about that.

Sophia 1:07:44
That's a problem. Yes, right now, because like most college students, they don't have time to get an internship or experience. But most jobs require experience right off the bat, which is why most high school students are, like, already starting to look for internships and stuff, ya

Scott Benner 1:08:00
know, it's, uh, it's certainly for anybody listening. One of the mistakes my son made in college is he was playing baseball so much that he didn't get internships. And that did screw up. Now he was able to get a good job with a subsidiary of Sony. So he got a good job this year. And he got a lot of great experience. But he's like, inside of six months of being there. He's like, I've learned everything. This job's gonna teach me. He's like, I am now just, I'm doing a task now. And I was like, okay, he goes, I have to move to get more experienced with that was this idea. Like, I'll go grab this job and build more experience here and build and build. But I think now he's thinking more like, what if I can get this master's and then kind of leap a little bit, those first couple jobs and start there?

Sophia 1:08:43
That would definitely be a really good way to go. Yeah,

Scott Benner 1:08:47
that's what he's thinking. So anyway, that shocked me because the last time we talked about college, it's when he handed me his diploma and went here. You wasted a lot of money on this. And I was like, well, thank you. He said to me, after he graduated, he said, I could have taught myself everything I learned in college was six months with the internet. Yeah,

Sophia 1:09:07
yeah. Basically, what what I'm what we're learning in our associate's degree right now, it was what I taught myself last year in like, two months. Yeah,

Scott Benner 1:09:16
that he was disappointed by that. And it's not it's not like a laissez faire attitude. He like, He's genuinely disappointed in the way the system works. And, you know,

Sophia 1:09:26
yeah, but you guys who don't understand you don't want like the Russian educational system, either. Or most European educational systems. There's the study. Thus far, we do not have a perfect system to be used.

Scott Benner 1:09:42
Oh, no, I think I don't think perfect. exists anywhere. It's nice to hear you say that. But I think that, um, honestly, I think it's your story. It's that your education or your opportunities are what you make of them, not what somebody gives you, not what somebody gives you. Yeah, yeah.

Sophia 1:09:59
The only reason I think I did well in high school was because I taught myself the material myself. I self studied for AP tests. And that's why I got fives and fours. Now because I took a really good class,

Scott Benner 1:10:13
right? Yeah. Same idea here, like you can take like prep courses for SATs and stuff like that, but they teach you how to take the test. Not really not, you know nothing about the information. As much it says, it's an imperfect system. But again, it does, it favors the people who are willing to put the work in have some aptitude, but also it favors people who can afford it, like so, you know, the one thing we're skipping over here is that if my son comes home, I have, there's a place for him to be like, he doesn't have to go work to stay alive. Like, we're like, look, you can come back here, if you want to go back to school, that's fine. And you know, he'll be able to do

Sophia 1:10:52
that support system, it's very important to have a support system. And that's amazing that you can give your kids that. It

Scott Benner 1:10:59
is really gratifying, honestly, to do that. I was looking forward to not supporting him in any way. But I guess I can just work a little longer. If Tim Cook would get his foot off my neck. It wouldn't be such a problem. Sofia understand. Yeah,

Sophia 1:11:14
I understand. The last time we talked by the way that was the day that our origin took her sad. Oh, was it really? Yeah, yeah. You said you have to leave to pick up the origin from her sad. Oh,

Scott Benner 1:11:28
no kidding. Well, that ended up just yet. I don't remember it ended up not mattering at all. Oh, really? Yeah. So here's what ended up happening. I don't think that art schools see a lot of interest from people who were very carefully academic in high school. Yeah. So yes. So she looked like she looked like a million bucks to them. And they were very happy to give her all the financial aid that was available to a person with her grades.

Sophia 1:11:57
Nice. Yeah,

Scott Benner 1:11:58
that was very nice. Really cool. Yeah, we saved a lot of money. Because imagine, yeah, because of hardens grades in high school.

Sophia 1:12:09
So you must be really proud of her. I'm,

Scott Benner 1:12:11
I'm very proud of her. And significant actually, I'm super proud of that. She went away to college, and managed a one C so well on her own, because the one thing so you're you're living at home, like as you said, you're doing community college till you go off to college, the one thing you're gonna need to be careful of when you get off onto a campus is that the food is garbage. Yeah, yeah, it took her a lot more insulin to manage the food at college.

So you're

not going to have that kind of control with the eyelet either, by the way, I

Sophia 1:12:42
already kind of eat in a very, like low carb way anyway, because I'm both gluten and dairy free. Okay,

Scott Benner 1:12:50
well, that will actually, I mean, that'll help, obviously. And that might help you to with the pilot as well. Like, what what's your, like? What's a standard meal have as far as carbs go for you?

Sophia 1:13:01
Like no more than 10? Actually, now that I'm thinking about it?

Scott Benner 1:13:06
I mean, listen, maybe that'll work for you, then. I don't know. You don't I mean, but I don't know. I just I feel uncomfortable that that after a sales call that a doctor pushed you to change your, your insulin pump, and what did you mean that they have? She has a problem with Omni pod? Do you know what the problem is? She

Sophia 1:13:29
doesn't particularly like the control that Omni pod does. And she sees a lot of issues on her end, which I know I shouldn't be saying on your guarantee sponsored by omniva. You can say whatever you want, that's fine. Okay, well, she's seen a lot of issues with Omni pod five, PDM. DMS, like failing for especially younger children for some reason. And I think she just doesn't like the standards, it sets and house. I remember her saying how slowly it learns. Well,

Scott Benner 1:14:02
it doesn't actually learn. So I have a wonderful series about Omnipod. Five, have you listened to it? Yep,

Unknown Speaker 1:14:09
I have. Yeah,

Sophia 1:14:10
I have a great experience. The only bad five. And it's completely my fault that I got kind of manipulated into it. It's it. Well,

Scott Benner 1:14:19
isn't it interesting that you're having I mean, a five nine, with AMI pod five. And your doctor seeing other people struggle with it. And her instead of asking you what are you doing to have this success? She said, why don't you come over here with all the people that are struggling? Yeah.

What a weird thing. Yeah,

Sophia 1:14:42
I feel like that's most probably doctors. Well,

Unknown Speaker 1:14:46
I can't people think

Sophia 1:14:47
Sophia. Lead Poisoning. Oh,

Scott Benner 1:14:50
you know what? It could be that 100% i But seriously, isn't that am I the crazy one? Maybe I'm the crazy one. Why would I look at a group of people I'm struggling, and one person not struggling. And instead of asking the person not struggling what they're doing, I say, hey, come over here and struggle with everybody else. She

Sophia 1:15:09
doesn't have enough time to really get a picture of what everybody is doing. I'd say, like our appointments last, like 10 minutes with her. Do you

Scott Benner 1:15:17
think she just thinks you're low carb? So that's why you're there? Or do you think she thinks you're having lows that you're not happy? But she can see that you're not so? Yeah,

Sophia 1:15:26
I she doesn't really look very carefully. I think, anyways,

Scott Benner 1:15:31
just makes big changes to your life. Yep.

Sophia 1:15:35
I don't really listen to the changes, usually. But again, I think I just got roped in. It was also I was not in a very good like, emotional state. When we had that appointment. It was like, a week after I say,

Scott Benner 1:15:49
I'm okay, well, I'll call Scott's back. We're not going to do that. Okay, we're not doing that. Do I have to have you on once a month to make sure things were okay. What are we doing right now? Sophia? What's your level of need for me right now? Yes. Let me know. I'll be here for you. Okay.

Sophia 1:16:04
Thank you. I appreciate it. I think I'm just surprised how much blood sugars really are affected by, like, stress levels. I wish I knew in theory, but it's really, in practice much more intense than I would have assumed.

Scott Benner 1:16:20
Yeah, it's your heart, right? Just like really

Sophia 1:16:23
does. Like I, one day, I spent completely in the three hundreds and it just wouldn't come down.

Scott Benner 1:16:30
I think that's school or something that was going on in your life.

Sophia 1:16:33
I think it was just like the whole the whole package of life at that moment.

Scott Benner 1:16:40
Did you let the algorithm deal with it? Or did you put in extra insulin?

Sophia 1:16:44
No, I did. I had to put in twice my normal daily total amount of insulin, and like the next day was completely fine. And back to my usual self, but that one day just would not react. That's

Scott Benner 1:16:57
crazy. Well, it's not. I mean, I've seen that before. So if you had the knowledge and the confidence to do something about it, or your blood sugar would have been even higher than that. It

Sophia 1:17:07
probably would have because I was doing injecting so much more than I usually would in that case. No,

Scott Benner 1:17:15
well, good for you. It's good to be able to recognize it and do something about it right away. It's something people struggle with sometimes

Sophia 1:17:21
that is 100%. All credit to you. Oh,

Scott Benner 1:17:25
thank you. You didn't have to say that. We already did that earlier. Yeah, I

Sophia 1:17:28
know. I'm being serious.

Scott Benner 1:17:30
I know your thank you. I'm muddying the waters with my own sarcasm, just so everyone's off balance, and nobody knows what's actually happened.

Sophia 1:17:39
particularly enjoy.

Scott Benner 1:17:42
Thank you. I appreciate that. So few people who appreciate my, the way my brain twists up into little like not so

Sophia 1:17:49
people wouldn't be listening if they didn't appreciate it. But what if

Scott Benner 1:17:53
I gave it all to them? I don't think they can handle all of it.

Sophia 1:17:57
You should try for just one episode and like pay attention to what your Facebook group says.

Scott Benner 1:18:01
I mean, I think if I let all of me out in an episode that I wouldn't have done the next day I'd release an episode no one, they'd all be gone. They'd be like, Wait, what did he say? That's not okay.

Sophia 1:18:11
Okay, then release it on April Fool's. Oh, that's

Scott Benner 1:18:15
a good idea. That way I've got cover if I need it. Exactly. Yeah, that wasn't me. I was joking for April Fool's Day.

Speaker 2 1:18:22
What's a really good idea? Yeah, exactly. Write that down.

Scott Benner 1:18:25
I already wrote down. The thing I have to tell you afterwards, though. Yeah,

Sophia 1:18:29
I'm very excited. I think I have an idea of what it is. Should

Scott Benner 1:18:35
I call the episode April Fool's. You could good. I don't know what to call it though. I just heard Arden go down the stairs and like a pair of boots. I'm sure I paid for. They were very heavy. I assume that anything that sounds heavy. I paid for me. Yeah, I Yeah. Heavy to me sounds like expensive.

Sophia 1:18:55
Every time her phone drops? Oh, you're

Scott Benner 1:18:57
like, oh, no, no, I dropped my phone yesterday. And as it was, as it was leaving my hand, I was like, oh, no, no, no. But case, tip. So there's Tim Cook helped me. The case is the case. Save the phone. Nice. Yeah. But he's screwing me otherwise. Also, by the way, just not me. Everybody who has a podcast that has a significant invaluable back catalogue or puts out a lot of information. Because it this is basically this is happening. Because most podcasts put up an episode a week or a month. That's how most of them do it. Right. And what they do is they're when they're trying to get advertising. They put out like, I don't know how to put this exactly. They put out like crappy content like short episodes, to bump up their download numbers. So easiest way to say it is if you had 100 followers and you put up an episode a month, you'd probably get about 100 downloads. But if you put up two episodes a month, you'd get 200 downloads. So what they end up doing as they put up their episode, then they'll do one of those like five minute like, like, hey, don't forget about this thing which you, your, your app automatically downloads they get what the hell is this and you delete it, but they get the they get the number for it like so now they have extra downloads. So the app is now limiting how you see all that content. But for me, I put up five really, like well considered thoughtful episodes a week. And now it's not delivering those episodes to people. And so the simple fix is that as you go into your settings, you go to automatic downloads, you tell it like download all the episodes, everybody who upgraded to iOS 17 their app, eliminated that setting. So even if you were set up to have that happen anyway, now that's not happening. And now you'll just

Sophia 1:20:46
never go for the iOS updates.

Unknown Speaker 1:20:49
Well, it's

Scott Benner 1:20:50
too late now, Sofia, he's, he's come with his sickle and his hammer. And he's, oh, that was not a Russia reference. That was a death reference. He's come from me, he's, he's swiping up my neck right now. Now, you know, I believe that I said, the people are going to still get the interviews, hopefully they'll hear me say this and go back and change their settings at some point. But it's just it literally is, like it might sound like it's about downloads to me. But it's I took a lot of time and care building this thing up. And I was like really starting to get it into people's hands at like mass numbers. And now, this comes along. And what Tim Cook doesn't realize I'm sure it wasn't him, by the way, but is that in this specific space, you have a real opportunity to like change your health. But it's not going to happen in one episode. And so you might need to hear a dozen people's stories. And you might need to be listening for three months before you realize, oh, there's a Pro Tip series. You know, like that kind of stuff. And so you need to you need people to like kind of live in this ecosystem for a while. Until they can get to a point where they can do these things for themselves, make these bigger decisions, go find the information, and then help themselves like after all that happens if you don't want to listen to podcasts anymore, like I understand, like, that's fine with me. But I want to reach people and give them the real opportunity to help themselves. And if they're only going to see every fifth episode of the podcast, that I don't know that that's going to happen. And then that's, that's upsetting

Speaker 2 1:22:21
to me. So, anyway, yeah.

Scott Benner 1:22:25
This is what he's done to me.

Sophia 1:22:28
It's fine. You should write a very strongly worded email.

Scott Benner 1:22:32
What if I wrote all that out on a piece of cardboard just stood in front of the Cupertino? Like, gate? I was just stood out there. I was like you're ruining people's health, because that's in the end, what's gonna happen? Or by the way, if he, the advertisers don't have the foresight to be able to see oh, no, I'm still getting what I need from Scott, then they could leave. And if I don't have advertisers, you wait till you see how quickly Scott becomes the most popular cashier at Walmart and is no longer a podcaster. This all has to kind of work in symbiosis. The business side of it and the helping side of it,

Sophia 1:23:05
of course, and Yeah, that sucks. But I'm sure every single one of your listeners will eventually stumble upon an episode where you tell the issue.

Scott Benner 1:23:16
I hope so. But I don't want to say it too much. It's boring. You know what I mean?

Sophia 1:23:20
We listen to your ad reels. So I

Scott Benner 1:23:22
do appreciate that, by the way. Meanwhile, as I should give the people credit in the pot that are listening to the podcast, because in the Facebook group, I've been kind of making this pitch for about a week. And it's driven the podcast up in charts, like pretty significantly. So you guys are obviously clicking and subscribing and stuff like that, which is great. But you know, kind of needs you to get the episodes as well. So it's not just about subscribing. Like you need to actually get the stuff and listen to it or download it. At the very least,

Sophia 1:23:52
are most people really listening on Apple podcasts? And not like Spotify, overwhelmingly

Scott Benner 1:23:56
more apple podcast listeners. That's interesting. Yeah. Well, I think it's got something to do you want to hear my thought on that? I think I think it has something to do with the thing we talked about earlier. With my son coming home and being able to go to master a master's program, its financial ability and support to actually have the time to think about your health. And I think somehow that correlates to an Apple product in

Unknown Speaker 1:24:23
your home. Does that make

Sophia 1:24:25
sense? I thought you were gonna go in a completely different direction with that. Yeah,

Scott Benner 1:24:29
I think I think that the people who listen to this podcast are more passionate. Yes. Yeah. And therefore they are more likely to have an Apple product. And I know that's weird, but I but I know my numbers, and they're incredibly skewed towards Apple devices, which I don't think is the norm for most podcasts.

Sophia 1:24:52
That does make a lot of sense. Yeah. Yeah, I think especially with the demographic group in your face. This book. Yeah, you can see that a lot. But most people, I've kind of been a salesman for your podcast on the side here. So I'm kind of also reaching the other part of the population and a lot of Spotify users should have been in should have noticed, like at least three in the last few months. Well,

Scott Benner 1:25:26
there's more than that. But thank you. And I do have a, like, Spotify is my second app, like my second most popular app. It goes, Apple, Spotify, and then some, like third party apps, overcast iHeartRadio. Amazon music, Firefox, cast box Pocket Cast, these are all like, apps that people use to listen. But overwhelmingly, the numbers are with Apple.

Sophia 1:25:55
That doesn't make a lot of sense. I thought you were gonna say just because the it's so much easier. It's already installed on your phone, or? Well, I

Scott Benner 1:26:05
think that's part of it as well, is that people know how they don't have to know that's the other thing is that I bring a lot of people to podcasting, to listening to podcasts that don't listen to podcasts. Yeah. So I bring a lot of new listeners in, and they are going to go with what's in there. What's in their hand when they when they do it. But I'll, I'm looking back at the last week give you a fairly on. Okay, out of the last 1.2 million downloads that the podcast has gotten. A million of them are on an Apple product.

Sophia 1:26:38
Oh my gosh, that's way more than I thought it would be. Yeah, it's

Scott Benner 1:26:42
overwhelming. Like, yeah, of those million 1.2 million 50. Call it 60,000 of those downloads or Spotify.

Speaker 2 1:26:53
That's insane. That difference? That is

Sophia 1:26:57
really huge difference. Yes.

Scott Benner 1:27:00
Yeah. And by the way, there's nothing saying that the person listening on Amazon music or you know, I Heart Radio isn't on an iPhone as well. So it's overwhelmingly app. So Apple is they could make or break me if they wanted to. Do

Sophia 1:27:15
you think it has something to do also with the fact that Dexcom is so much easier to get on an apple?

Scott Benner 1:27:23
I mean, that's that's not unreasonable, either. Or why so many people complain when stuff comes out? And it's not available for iOS? In diabetes?

Sophia 1:27:29
Yeah. Yeah. Because we're used to having the Dexcom app on on iPhone. Yeah,

Scott Benner 1:27:37
that's, I mean, Arden. The one thing that Arden didn't like about Omnipod five is that it didn't have an an iPhone app.

Sophia 1:27:46
Yeah. So that's why I prefer the right we'll include To be honest,

Scott Benner 1:27:51
she's using it now. With a dash pod, so you don't even need the link anymore.

Sophia 1:27:56
It's pretty cool. Oh, that's awesome. I might look into that.

Scott Benner 1:28:00
Oh, yeah. Well, because you did looping for a while. Why did you switch? When we

Sophia 1:28:05
moved to the US? The doctor kind of said, This is not FDA approved. And I can't really support this. Unless you switch to another bump. Oh,

Scott Benner 1:28:12
they told us that they couldn't support it either. And I went, Okay, thank you. Yeah.

Sophia 1:28:17
But like we didn't coming to

Scott Benner 1:28:24
that I didn't have that part going for me or that like, oh, look, these people just showed up and look what they're doing that kind of thing.

Unknown Speaker 1:28:29
Yeah.

Sophia 1:28:32
Especially because the doctrine has never seen that before.

Scott Benner 1:28:35
You were the first person to show this. Oh, yeah. Wait, would you come here and move into the woods? Oh,

Sophia 1:28:44
that state was Florida.

Scott Benner 1:28:45
Oh, I don't know what that means. I don't I a lot of people listen to Florida. I love Florida. I'm not saying that.

Sophia 1:28:50
You love Florida. I can't be friends with anyone. You

Unknown Speaker 1:28:55
didn't enjoy Florida. No.

Sophia 1:28:57
There are there are people who enjoy Florida.

Scott Benner 1:29:00
I'm sure there are Floridians that enjoy Florida. It's hot. It's humid. And Florida. Well, yeah, the Florida man thing. I just want to say like for the record, Florida is my third most downloaded state. I love you all in Florida, and I don't Oh, yeah. Yeah. I don't agree with

Sophia 1:29:21
Sofia at all. You're just being politically correct again. Well, that's

Scott Benner 1:29:25
how I gotta roll in this one. I mean, California is the biggest state obviously because it's just so many people on it. But then from there it's Texas. Actually. Florida is for Texas, New York, Florida. Illinois, Pennsylvania, Ohio, Michigan. These are my top like downloads, but allow I haven't done this in a long time. There is no state where somebody doesn't listen to the podcast with some significance. That's pretty cool. Even overseas is going like incredibly well

Sophia 1:29:59
with The podcast. How many listeners do you have in Russia? Well,

Scott Benner 1:30:03
at least one last now. Yeah, yeah, you've ruined it for me.

Unknown Speaker 1:30:07
I did. Retargeting

Scott Benner 1:30:09
very well in Great Britain, Canada, Australia, Germany, South Korea, Sweden, China, Spain, Brazil, Norway, Ireland, Denmark, Japan, the Netherlands, New Zealand, Switzerland, Saudi Arabia, South Africa, India, Belgium, Turkey, Hong Kong, Argentina, Colombia, Israel, Finland, Hungary, United Arab Emirates, Malaysia, Romania, Slovenia, Nigeria, Iceland, Egypt, Lithuania, Zimbabwe is a new one, by the way that just popped up recently. Is that Qatar? Or Qatar?

Unknown Speaker 1:30:39
Out? Have they said? No.

Scott Benner 1:30:41
Okay, there Bahrain, Nepal, nem,

Unknown Speaker 1:30:45
Namibia,

Scott Benner 1:30:46
Botswana Cayman Islands Liberia Russia not on the list right now. I'm not charting in Russia doesn't mean there's no downloads. They're just not charging there at the

Sophia 1:30:55
moment. I was honestly slightly surprised that you were still up for doing the episode.

Scott Benner 1:30:59
When you wanted to come on originally? No right now. Why?

Sophia 1:31:05
Because of like, the whole registration.

Scott Benner 1:31:08
Did you invade the Ukraine? I don't think you did. Right. It wasn't you? Was it? Wait, oh my god, Sofia, wasn't you was it? No comment. Okay. No, I mean, you. You have nothing to do with that would be like not wanting to interview somebody from Canada because something that the Prime Minister did, like, what would that have to do with anything?

Sophia 1:31:29
That's very fair. But see, that's a bit too logical for the general population.

Scott Benner 1:31:34
No, you're just very interesting. I don't care where you're from. That's meaningless to me. Yeah, that doesn't matter to me at all. Yeah, I'm a little light in Russia since you left. Just gonna say I think you killed my downloads there.

Sophia 1:31:45
Man. I should have stayed there just for you. Yeah, you

Scott Benner 1:31:49
definitely should have just stayed just for that. Yeah. We should I think Australia is the biggest non US cut actually, Canada, Canada, Australia. Do a fair amount of downloads.

Sophia 1:32:04
I would imagine. So I would imagine the primarily English speaking countries.

Scott Benner 1:32:09
Yeah, United Kingdom is pretty huge for me to actually United Kingdom often competes and beats Australia for downloads. So we'll see. Anyway, Sofia, what have we not talked about that we should have?

Sophia 1:32:22
I think we've covered pretty much everything's all done.

Scott Benner 1:32:25
Exactly. Alright. You go off into the world and be my Emissary. Okay.

Sophia 1:32:30
I will let you know when it's time for you to show up for the Nobel Peace Prize, which

Scott Benner 1:32:34
we all know happens in Norway. That's right. Not Switzerland. The city. Why is wait. Norway is its own country, right? I don't want to I'm number one. I'm number 51. In Norway right now. I should probably go like I know you guys replaced Don't worry. Don't you get mad at me. I don't need people mad at me. You had like

Sophia 1:32:54
people on the podcast from Norway?

Unknown Speaker 1:32:58
Yeah. Oh,

Scott Benner 1:32:59
don't tell them that. I don't remember. Okay.

Sophia 1:33:01
Okay. I think they will probably hear that for themselves.

Scott Benner 1:33:05
Oh, you're right. Let's stop the recording. And I'll tell you the thing that I was gonna say that I can't say. All right, yes.

A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days with the ever sent CGM? You just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juice. Box. A huge thanks to us med 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 888721151 for 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 the diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise to hydration and even trampolines. juicebox podcast.com Go up in the menu and click on diabetes variables. If you are a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC es a registered dietician and a type one for over 35 years and in the bowl beginning series Jenny and I are going to answer the questions that most people have after type one diabetes diagnosis. The series begins at episode 698 In your podcast player or you can go to juicebox podcast.com and click on boll beginnings in the menu thank you so much for listening I'll be back soon with another episode of The Juicebox Podcast the episode you just heard was professionally edited by wrong way recording wrong way recording.com

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#1215 Cold Wind: X Ray Tech

"Lindsay" is an X Ray Technologist with diabetes. 

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

+ Click for EPISODE TRANSCRIPT

---

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 1215 of the Juicebox Podcast

gonna call today's guests Lindsay. She is an x ray technician who has diabetes, and she's going to tell us a little bit about what she sees in the medical field. From her perspective, 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 go to cozy earth.com Don't forget to use my offer code juice box to save big at checkout that's juice box at checkout at cozy earth.com When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box help out with T one D research at T one D exchange.org/juice box go over there complete the survey. That's all you need to do you have to be a US resident who has type one diabetes or is the caregiver of someone with type one, you'll be helping yourself helping the show and helping everyone else living with type one T one D exchange.org/juice box go fill out that survey this episode of The Juicebox Podcast is sponsored by the Dexcom G seven made for all types of diabetes Dexcom G seven can be used to manage type one, type two, and gestational diabetes, you're going to see the speed, direction and number of your blood sugar right on your receiver or smartphone device. dexcom.com/juice box. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next one.com/juice box. This show is sponsored today by the glucagon that my daughter carries G voc hypo penne Find out more at G voc glucagon.com. Forward slash juicebox. Don't forget everybody. This is a cold wind episode. So we've changed the name and the voice of the person that I'm talking to. All right, Lindsay, what is your background? workwise? What do you do for a living?

"Lindsay" 2:31
So I am an x ray tech, technically, it's a radiologic technologist, if you want to get specific, there are many different modalities, but I just do

Scott Benner 2:41
X ray. Okay, and what kind of education do you have to have for that.

"Lindsay" 2:46
So you have to have an associate's degree, they go back and forth, if it needs to be a bachelor's, because it's actually three years you have to have a year prior to starting the program in prerequisites. And then it's two full years of clinic and classes. So but it is an associate's degree, and then you have to take a national registry and pass the boards in order to get your license. And then many states most states, I think it's like 45 states in the US require a state license. So it's just taking that national license and registering it with the state.

Scott Benner 3:21
I say, Do you have the accreditation to read the X rays or what is your exact job?

"Lindsay" 3:27
So I do the procedure, the exam, I take the x rays, in order to read the X rays, you have to be a doctor. So a radiologist reads any imaging modality and you have to go to medical school and then go through a residency and radiology and then do additional multiple years in order to read them.

Scott Benner 3:49
I know a doctor who told me that a buddy of his is a radiologist. And it is the fattest job in the world. He said he sits at home, waits for images to come reads them, writes up the notes puts them back in it's his whole life.

"Lindsay" 4:06
Yeah, so there is a few companies that do it digitally. It's becoming more and more especially with the pandemic, they let them have more licensing, openness in order to do it from different states because just like medical practice, in order to do a home health visit with somebody that's in another state, you have to be licensed in that state. I say interesting. So there are some companies that I'm not sure how they go about this and how they do it. But like because our doctors don't want to work overnight. We send it to an off site company and they're specific companies that do that and have the radiologists reading from home or wherever. But there is also procedures that radiologists do in the hospital as well. So we do have radiologists on site as well. Yeah,

Scott Benner 4:59
no, I I'm just saying there's like a job now like to work from home like you imagine being a doctor making a doctor salary and not having to leave your house or talk to patients, right?

"Lindsay" 5:09
There's always a joke about radiologists being mushrooms because and not having people skills. There's several specific doctors that were like Yep. Well, you see why there are radiologists because they sit in a dark room looking at computers all day.

Scott Benner 5:22
I can't believe I didn't get the mushroom reference right away. As soon as you said darkroom, I was like, Oh, why did I not see that? That's nice, though. Maybe they're fun guys.

"Lindsay" 5:31
They are? Absolutely. All right.

Scott Benner 5:36
Well, please, it's hard to mess. It's a ham fisted dad joke from 1973. What made you well, we'll hold on a second. Do you have type one diabetes? Are you the parent of someone with type one? Neither.

Unknown Speaker 5:47
Really?

"Lindsay" 5:49
How do you find yourself to me?

I have type three see?

Scott Benner 5:54
Oh, they snatched up your your business right out of there. How did you lose your pancreas function?

"Lindsay" 5:59
I have neuroendocrine pancreatic cancer and they removed up 30% of my pancreas. I have six remaining tumors that were watching I get treatment every month to they've been stable for seven years. The thought is eventually I'll have the rest of my pancreas removed. But for right now it's stable. So we're keeping it as long as I can.

Scott Benner 6:21
Lindsay, can you hear the conspiracy listeners right now?

"Lindsay" 6:24
The X rays got her right. I actually got it before I started X ray. Ah, yep, X

Scott Benner 6:31
rays are let's be clear with people though, like X rays or give you cancer if you're not shielded from them. And you get them too much, right? Like it's a lot of radiation. Am I right?

"Lindsay" 6:40
So yes, and no good. Clean film X ray, like just going and get a chest X ray or an abdomen or you break your foot and you get foot X ray? is very, very low dose. Okay. Why don't you 30 years ago, when it was film, it was higher. Um, now we know more about it. And with the switch to digital, it's like a quarter of what it used to be. And you get radiation every day of your life from existing. So our bodies are actually very good at recovering from small doses. There's a thing that they called time distance and shielding. So the longer time you're exposed, the more risk, the more exposure in a small time, the higher risk. But a chest X ray, if you go on a six hour plane flight, you actually get more radiation than you do in a tube you chest X ray, interesting, I appreciate you spend a day at the beach, you get more radiation than you do in an x ray. However, when you go to the other modalities, like CT, that is actually hundreds of X rays, taking it in succession. So that CT does give you more radiation. And you do want to be careful not to get too many CTS too close together. You get like one a year your body should be able to recover from that. But if you get one a week, you're gonna get cancer from that.

Scott Benner 8:01
No kidding. My lovely moan when you said day at the beach wasn't because I was like, oh my god go to the beach. And this is how much radiation I just like, oh, maybe we should just go to the beach today. That'd be amazing. Yeah, yeah. Okay, great. not warm enough for that yet. But keep going. I'm sorry, this is fascinating. Tell me as much about this as you, as you know, and you would like to tell me, yeah,

"Lindsay" 8:19
if you go into the O bar and have certain procedures done, sometimes you get some X rays in that they use that we call fluoroscopy, which is Live X ray, it's pulses of X ray. So it's not continuous. Like in CT, it's like you can set it for like three pulses per second per second, or 10 pulses, depending on what they're looking at and how clear and crisp they need it. But usually it's within a few seconds. They do it for a few seconds at a time. So you don't really get that much from that mammography uses X rays. But that is it's more than a plain film X ray. But getting it once a year, it's pretty low compared to a CT. Nuclear Medicine uses a different type of radiation than what you use an x ray. And that can get up to higher doses. So those are things that you want to be careful about getting in succession, and your doctors really should be paying attention to that. And every single different nuclear medicine test is going to have a different dose. And the nuclear medicine technologists are really dialed in to how much dosing I know a lot more about it than I do. And then an MRI doesn't use radiation that uses magnets so you don't get any dose in that. You just get claustrophobia. Exactly. And ultrasound is not radiation, it sound waves.

Scott Benner 9:42
Okay, those are the ways those are the ways we image people right now modern medicine.

"Lindsay" 9:47
Exactly. And every single one of the modalities looks at something different. So it's not like you can say, oh, MRI doesn't use radiation. So that means I never want to get a CT I always want to get get an MRI, but an eye MRI looks at different tissues than CT does. So if your doctor is ordering one or another, it's probably because that is what is best for that specific,

Scott Benner 10:07
right? I can't get I can't get an MRI for a broken ankle.

"Lindsay" 10:13
But it's not going to be it's going to be more expensive. Your insurance, you're gonna have to fight your insurance for approval, because the CT is better and while they'll see the brake, it's not going to be I mean, it's just more involved

Scott Benner 10:28
the values with the actual x ray for that for that injury for example. Okay,

"Lindsay" 10:32
exactly there they would look more like muscle and tendons and things like that in memory.

Scott Benner 10:37
Okay, let me ask you a couple more questions about your own health then we'll move on to your job. Sure. You said there are some tumors left that they're keeping an eye on what does that mean? If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store Chivo Capo pen and how to use it. They need to know how to use G Bo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk For safety information. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has been at school, they're everywhere that she is contour next one.com/juice box test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter, you can find out about that and much more at my link contour next one.com/juice box contour makes a number of fantastic and accurate meters. And their second chance test strips are absolutely my favorite part. What does that mean? If you go to get some blood, and maybe you touch it and I don't know, stumble with your hand and like slip off and go back, it doesn't impact the quality or accuracy of the test. So you can hit the blood not good enough, come back get the rest without impacting the accuracy of the test. That's right, you can touch the blood come back and get the rest. And you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times, that's not a good reason to have to waste a test trip. And with a contour. Next Gen. You won't have to contour next.com forward slash juicebox you're gonna get a great reading without having to be perfect.

"Lindsay" 13:24
So I have, I think six tumors right now I get a monthly injection it is every 28 days, right into my butt. It's a deep subcutaneous injection, and it's a subnet of statin analog, which is a hormone that fills the receptor sites on the tumors and does some kind of magic. It is actually off label for tumor suppression. But it's actually supposed to be used for symptom control. But because it whatever it does, it keeps the tumors from growing. That's why I say I've gotten seven years without any growth. And so they'll just I get scans every year to watch the size of it. And once it either symptoms get too bad for me to control or size gets too big, then they'll take the rest of pancreas out.

Scott Benner 14:17
What are the symptoms? Oh,

"Lindsay" 14:18
it depends on what kind of tumor it is. So I have several. Right now I don't know of any hormones they're producing. But as you know, the pancreas produces insulin. If you have an insulinoma your blood sugars will go well. If you have glucagon, Noma, then your blood sugars are gonna go high because it's producing too much glucagon. You also get some rashes. You can have acid producing tumor, so you end up with heartburn. Well, of course my mind is going blank. I actually am pretty well versed in all of the different hormones but

Scott Benner 14:51
you are here I'll ask you a question while you kind of reset a little bit. Yeah, okay. So they give you the injection of the injection for the lack of a term that is technically correct. Keeps the tumor happy. And in its current state, so it doesn't grow or or act up. Is that about right? Yep. Okay. Otherwise you can see any number of those other things that you just brought up. Yep, that can make you feel all different kinds of ways. My question is, why did they take some of the pancreas but not all of it? Originally, because

"Lindsay" 15:22
I didn't go to a specialist. Prior, I just went to a local hospital. And that was the recommendation because I didn't know any better

Scott Benner 15:30
when they're done with that procedure, your type three, see, at that point,

"Lindsay" 15:34
I wasn't actually it was several years before I was the medication that I use suppresses my pancreas. So even though it's suppressing the tumors, suppressing all of the tissue, so my agency has slowly gone up slowly over the years, when it was about 6.5. I tried to get a CGM. And so I could start watching and seeing what was happening. And I was told I wasn't diabetic enough. And so to just keep fingers sticking, I would do good for a few months, and then my numbers would be pretty good. And so I would give it up until I started feeling crappy again, and I'd start finger sticking again and watching what I was eating. And then, about a year ago, I was just really fatigued, really sick. I went in for my shot by a doctor did routine bloodwork, which he did about every three months, and my fasting blood sugar was 363. And they didn't even call me I just happened to see it on the portal, when I went to send them a message. And so I started finger sticking and the next day, my fasting glucose was 430. And so I went to the walking clinic, they took my blood sugar and said, You need to go straight to the hospital right now. On the way my PCP called me back and said, Oh, no, I'm gonna save you an ER visit. Don't do that. I'll put in a prescription for you come to my office, we'll do some blood work. That was on a Friday afternoon, Monday, I still didn't have the results or any medication. Wednesday, they finally gave me a prescription for insulin. And I went and picked it up. And there was no pen needles. So it took until Thursday before I could get a prescription for pen needles. So it was almost a week after my

Scott Benner 17:31
senior doctors, like let me save you an ER visit and then didn't get back to you with the things you needed for six days. Yep. Perfect. Yeah. So today, what's the reasoning behind not just going in there and cleaning out the pancreas and getting rid of the tumors?

"Lindsay" 17:46
I just talked to a surgeon and I told him, You know, I'm insulin dependent. Now I'm on a pump. And he says that yes, well, I do have to control my blood sugar's it is pretty controllable, it's pretty easy for me to handle. If my pump gets occluded in the middle of the night, I can just take it off and go back to sleep. And I'll be okay. In the morning. If you takes my whole pancreas, I will be struggling a lot more, it'll be a lot harder to control. And I'll have to be very much on top of it. And because of all of my other medical issues, he doesn't want to make any of it more complicated and thinks that we should continue to wait.

Scott Benner 18:26
What do you think? I mean, because there's the trade off, right? Like you could basically remove your cancer or have the balance of help from the pancreas. Yeah, what do you think's the best thing for you?

"Lindsay" 18:36
I don't know, I am going back and forth. Because the reason I have this cancer is because of a genetic disease, and which my dad, my grandfather, my great grandmother all died from all from metastasis, which it right now, I am stage one. It's only in my pancreas. And if I could have it taken out and know that I will never have a metastasis, I would do it right the second year. However, they know that even people that have it taken out, it's possible that those cells have already left and implanted in the liver, and just aren't big enough to see. So it's possible it's already spread. And even if I take it out now, it won't save me.

Scott Benner 19:16
I say I'm sorry to ask you this. But how old were your family members when they passed away? They

"Lindsay" 19:21
lived a pretty full life. My dad was 72 and actually died from COVID. My grandpa was 78. My great grandmother was 32.

Scott Benner 19:31
Oh, great grandma. So a couple of generations ago. Yes. You got the magic juice. Now they're, they're popping in your butt. So yes, yeah, exactly. Okay. I appreciate you going over all that with us. So we understand your your context, and your perspective, because I think that's going to like help me pivot into this next bit. Right. So, yeah, you're on a cold wind episode. So obviously, you're here to talk about what you see working in healthcare. My first question is going to be based on the thing You're about to tell me about what you witness at a hospital. Does that impact your ability to be comfortable with your care for your tumors? Like, do you not see doctors the same way I would if I just walked in off the street and I was like, I'm here, I need help. You're the magic guy in the coat, tell me what to do. Absolutely,

"Lindsay" 20:16
I am angry on a almost daily basis about the fact that these people are supposed to be the people helping me. And they don't care. They don't care about my symptoms, they don't care about my quality of life. They just want to check their boxes to say that they saw me in there doing what they should they order my scans, they order my blood tests, I frustrated and angry on a regular basis, about how I know what I need, from being in support groups, being online, doing research, talking to other people dealing with it, who have doctors, who are on the frontlines of creating new treatments. And knowing that there are things out there that could make my quality of life better. But I'm not allowed to give it to myself, because I'm not a doctor. Only a doctor can prescribe that only a doctor can order that. And I spend multiple days a month at doctor's appointments in tears, begging people to

Scott Benner 21:26
help me. Do you think that that perspective of they don't want to help me? Is that coming directly from your experience with your doctors, for your disease in your problems? Or is it because you see them treating other people? You then kind of juxtapose that on to what your doctors must be thinking while you're talking to them? Does that make sense?

"Lindsay" 21:48
It does. I think in my my very specific situation, I have multiple rare issues that they don't see on a regular basis. I think that I demand a higher quality of life, I don't accept, just because I'm sick, this is how I have to feel. And I want the newest, most aggressive treatments there are in order to live the fullest life I can. And even when my doctors do want to help me with that, a lot of times it's outside of their comfort zone, because they haven't done it before. And it's easier to say it's not available, or I don't know enough about that to feel comfortable than it is for them to risk it and do something and get in trouble.

Scott Benner 22:46
Yeah, wonder where their sense of exploration is? You know what I mean? Like, I mean, listen, not for nothing. But Lindsey, you've got a number of people in your family who have died from this thing. You've got six tumors on your pancreas? Like, what's the like, what are we hurt and trying something? You don't? I mean, that is

"Lindsay" 23:05
exactly how I feel. Yeah, exactly how I feel. My PCP is great, and wants to help me. But she admits that a lot of this is outside of her scope. She is a general practitioner. And this is complex, and not something that she learned. Her job is to send me to the other people that do. So

Scott Benner 23:26
the one person you're able to talk into kind of like paying attention to your bigger ideas and concerns is powerless, and the people who are powerful? How do they treat you when you bring it up?

"Lindsay" 23:37
So I actually have had an appointment with a world renowned endocrinologist at one of the top teaching and research hospitals in the US that specializes in one of my issues. He seemed very kind he was very, how are you today? What's been going on? I know it's difficult to get here. You've traveled far, what can I do for you? So I was very hopeful first walking in and talking to him because he did seem very concerned and like he really wanted to help. And as soon as I brought up anything that was outside of what the book says, what The Book says was, that's not helpful. That doesn't really work. He told me that he has patients with this disease that are doing perfectly fine running multimillion dollar companies. And so he's not sure why I'm struggling so much. It must be my diet and exercise or

Scott Benner 24:35
the diet and exercise answer is for everything. They'll say it about anything.

"Lindsay" 24:43
And you're gonna laugh at this one. So I also I had cancer on my adrenals as well. So I had my adrenals removed. So I'm adrenal insufficient. It's not adolescence, because it's not autoimmune. But it's basically the same acts are similar, right? Yeah. So I was asking him if He knew anybody that would do cortisol pump. And he told me that infusion pumping is a matter of choice. And it's just what you want. It doesn't actually help even for diabetics on insulin pumps, it doesn't give you better control.

Scott Benner 25:17
Wait, he said an insulin pump doesn't help you more than MDI. Yes, speaking about diabetes. Yes. And so I mean, can you inject cortisol? You can, but not as specifically, and particularly with measurement and stuff like that. Yeah,

"Lindsay" 25:33
in order to do that, you have to have a doctor order some specific tests, because your cortisol isn't a straight level like insulin. Yeah, there's a range that you want to keep it in. But cortisol peaks at certain times of the day, and then tapers off. And so trying to find that balance, you need somebody willing to do serial tests throughout the day in order to find the correct dosing. And he's just like, well, the average is between 15 and 25. So you go ahead, and the lower you're on the better, so reduce it until you don't feel well. And then when you don't feel well stay there. Or if you don't like this, or you don't feel this, then try this. And it's like, no, it's just up to me just to figure it out. Do

Scott Benner 26:19
you feel like his answer is, I don't know. Dexcom g7 offers an easier way to manage diabetes without finger sticks. It is a simple CGM system that delivers real time glucose numbers to your smartphone, your smartwatch. And it effortlessly allows you to see your glucose levels and where they're headed. My daughter is wearing a Dexcom g7 Right now, and I can't recommend it enough. Whether you have commercial insurance, Medicare coverage, or no CGM coverage at all Dexcom can help you go to my link dexcom.com/juice box and look for that button that says Get a free benefits check. That'll get you going with Dexcom. When you're there, check out the Dexcom clarity app where the follow Did you know that people can follow your Dexcom up to 10 people can follow you. Right now I'm following my daughter, but my wife is also following her. Her roommates at school are following her. So I guess Arden is being followed right now by five people who are concerned for her health and welfare. And you can do the same thing. School Nurses, your neighbor, people in your family, everyone can have access to that information if you want them to have it. Or if you're an adult, and you don't want anyone to know, you don't have to share with anybody. It's completely up to you. dexcom.com slashed use Box links in the show notes links at juicebox podcast.com. And when you use my link to learn about Dexcom you're supporting the podcast.

"Lindsay" 27:47
I honestly I don't know I left really upset. And I am not sure where it's coming from. But the thing that pisses me off the most is his name is all over the treatment recommendations that teachers medical art teach in medical school, I say that's what doctors are taught is the correct treatment is being as on them. So

Scott Benner 28:13
everybody's being taught with this with his lens. Yes, yeah. Now, in your job. You sent me a thoughtful note here about this. You said? Can I just I'm gonna say what you said. Okay, you were to remember it was Oh, dear. Okay. Health care behind the scenes working in a hospital. Health care workers are human like everyone else. They have different personalities and different ways of going about treating people as well as different experiences that affect their ability to treat. And I was like, Oh, I wonder if this person doesn't want to come on and talk about like the other side of this conversation. And then you said, in the end, it's a business. And they are just a single entity of a larger system. So as much as they want things to be a certain way the system is against them. So okay, so they're operating inside of a system, they don't have a lot of autonomy, the larger goal is to make money and keep the company open every day unnecessary exams are ordered. Now, do I think those doctors are ordering them to increase revenue? No. But the system is set to cover your ass and support unnecessary testing. So I hear this argument all the time in these episodes, and I find it fascinating because to me, it's parsing words, right? Doctors order these tests, and they're unnecessary. But it's not them trying to make money. It's the company they work for trying to make money, but they know what they're doing. They know they're ordering tests they don't want the answer to but that the protocol tells them to answer. So I mean, complicit is it. I mean, at the very least you're complicit I understand if you can't go against your employer, but it's not like they're like Mary Poppins and the employers the Big Bad Wolf and Mary Poppins doesn't know that the wolf seat and the pigs, you know what I'm saying? Exactly. Okay. All right. There's a difficult balance to be a good provider and not dissolve into despair. Discuss Dr. Death and nurse Colin and how the system they worked in didn't disclose or remove their license. They ignored and covered in order to save their hospitals from negative press, the biggest information that I want to share is that patients must be part of their own, be advocates basically be involved, be heard, you need to feel valued, and understand their medical needs to get the care they deserve. So let's talk about all this for a bit. Okay, let's start with unnecessary tests. What do you mean? What do you say?

"Lindsay" 30:38
So if you come in with a complaint that I have a cough, alright, so I work I work in a hospital setting right now. And if somebody comes into the ER, they walk in, I said, a cough, let's go chest pain, you walk in with chest pain, the triage nurse, in order to get through and get results as fast as possible to find out to make sure you're not having heart attack is going to put in a list of things that's, you know, that they need to run some bloodwork a chest X ray, you have chest pain, you're getting a chest X ray, because I'm not a nurse, I don't know all the things that they put in, but then you get put into a room. Now, the order for chest X ray is put in an F, sometimes it gets made ready for me to go take the chest X ray before the patient's even seen a doctor, okay, in order to try and expedite things and get some answers. However, if you're having a heart attack, the chest X ray isn't going to help very much. Yes, you can see the heart shadow, you can see the size of the heart, you have congestive heart failure, you might have some fluid around it or an enlarged heart. So it is useful. But I've seen multiple times that I go do a chest X ray, take the patient back, and in the notes later find out that the patient fell and hit their ribs. And it's not actually chest pain. It's actually their rib. And so they didn't need any of that blood work. And instead of a chest X ray, they actually needed a rib X ray. They didn't tell the triage nurse all of that because they were just trying to get the basic information. Yeah, in order to get triaged into a room.

Scott Benner 32:15
Okay. So sometimes the the pace of how it works ends up putting people through testing that they don't need if somebody could have triage them better. Yep. Okay.

"Lindsay" 32:24
There's also multiple times that a doctor will put in an order and we'll go check with them. And they're like, We have low suspicion, they fell, they said that their hip hurts now, or their butt hurts. Now, we all know it's not broken, because they're walking on it. But because they're in the ER, everything has to be thoroughly checked out and need out. And in order to 100% verify that they don't have a broken hip, they have to go get a hip X ray. So

Scott Benner 32:49
is that an unnecessary test? Or is it necessary based on society, the system that somebody's going to come back and see you later if you get it wrong? Like it's a little bit of it like that kind of cya. It

"Lindsay" 33:01
is the way to make sure that you are thorough, even though it's mostly, I mean, you could say it is necessary that it's due diligence. But I think that if doctors didn't have that protocol, there's a lot of times that they would skip that. And even if you go into your PCP, if you're complaining about something, and they're not really sure what it is, and they think it's because you're overweight, and you need to eat better, and exercise in order to get you to shut up. They'll just order some tests, just so they can say that they've done something, even though it's not a test that you need. It's just something so that they can say until you well, we looked, we did blood work and everything came back. So see, it must be because you need to diet and exercise.

Scott Benner 33:43
You think that there are some times when there are tests that are run, just that they can shut you up and tell you the thing they want to tell you. Yes. Interesting. And maybe this perspective that they have is what stops them from actually doing like, kind of extraordinary or things like like you're asking your doctor for it, because maybe they just have this experience so often, where the person comes and going, I know what I need, I know what I need. And they're just like a like, you know, you're in a Facebook group. And the Facebook group said that, like it's not real. I went to medical school, even though I went to medical school 35 years ago, and I don't see the need for that. And so, because I wonder if it wasn't for insurance, and it wasn't for people's propensity to sue each other. I wonder if doctors would be more in inclined to just go what you want to try. Yeah, fine. I don't care. Let's try. Absolutely, yeah.

"Lindsay" 34:34
If it wasn't if there wasn't the fear of malpractice and ambulance chasers, I think it would be a lot better. Yeah.

Scott Benner 34:42
People who listen No, I've been taking GLP for weight loss for like over a year now. And I had a real plateau on seven and a half milligrams of zinc bound. And it wasn't even just a plateau like my my weight was creeping up and then going back and it was just I was like, starting to vacillate between like in a fight. pound range, which had not happened the entire time I was on it. I go to a good doctor. I go, I tell her that and she goes, Oh, we'll move you up to 10. That was it just up to 10. Now I'm two pounds lighter. Three days after starting 10 milligrams, most people would get told something not helpful, not accurate. This doctor is saying, Look, I've watched people use this stuff all day long. I see more weight loss at 10 and 12 milligrams will move you to 10 and see what happens. You're tolerating the medication, fine, who cares? You know, it's another couple of milligrams right a week. And I get great results right away from talking to a person who's not afraid. And who is paying close attention to the thing that they're doctoring. They have, like, an intimate understanding of it in a modern sense. But that's not most people situation, like most people are so busy. Like they're part of the mill at this point. Like you don't think of doctors that way. Right? But it's a machine and now they're just a cog in the wheel. Exactly. Yeah. Right. And so they're just trying to do the thing and keep it moving. If you

"Lindsay" 36:04
go in and say, Well, I'm in this Facebook group, or I'm in the support group, or I read this on WebMD, or Dr. Google. I mean, every time you go to WebMD, it tells you, you're gonna die, right? So you come in with all of these expectations and ideas of what it could be. And you say that to the doctor, and I understand why they're getting taken aback and step back a little bit. And it's like, oh, yeah, cuz you read it on the internet, you know, better. And I fully admit that I have been wrong in my assumptions. When I have gone in, there was one of my surgeries I had, I hadn't had a period for like five years because of a pituitary tumor. And I had my adrenal removed. And in the hospital, I started my period. And I started freaking out and called the nurse and was like, I'm bleeding. I'm bleeding. And she just rolled her eyes and was like, Yeah, you started your period. Everyone does it. And I'm like, No, but I don't, I don't, I'm telling you, something's wrong. And it was it was just my period. But you

Scott Benner 37:10
had five years of experience this. It's not, it's not unreasonable for you to not think that was happening right then and there.

"Lindsay" 37:16
And being scared about complications of a surgery that was just pretty invasive. So I mean, I've made mistakes, too. And I've definitely, and so I get why they're on the defensive. I see people every day come in, because there has been hurting for three years. And today was the day they decided to come in and have it looked at instead of talking to their PCP, and things like that. And so I think that you had hit the nail on the head complacency, getting in the day and day groove gets overwhelming. Yeah,

Scott Benner 37:51
I would imagine I listen, I have a family friend who has been an ER nurse for seven years. And in the beginning, their travel nurse, they would actually go to places where there was like more crime because they were looking for like to learn more like gunshots and knife wounds and stuff like that, like really critical stuff. And now seven years later, I was talking to her the other day, and she's like, I gotta get out of nursing. I can't do it anymore. Like, that was like seven years. And she's like, cooked, you know. And so I take that, and I and I'm very respectful of it. And at the same time, it doesn't help you, or me or somebody else in the moment when I'm in the ER having a real problem. And I'm, and I'm faced with a nurses cook. And they're just like, I don't care. Like just follow the checkboxes. I gotta get out of here. You know what I mean? Like, yeah, I asked her, I was like, what happened? She goes, you don't see the people like people anymore. And I was like, she goes, you just you lose your empathy at some point. And she's not on purpose. You know what I mean? It's not like you give it up. It's just how much of it can you possibly take, so I have a ton of compassion for them. But you have such an interesting perspective. Because you work in the setting. You see the stuff happening, right? You see how the doctors are doing what they're supposed to do, or what they're told to do, and how it's not always valuable. But yet, you're on the other side as a patient, and you know what it's like to be ignored by one of those people. So it's interesting, because I don't know if you realize this, but in a half an hour, you are fairly successfully arguing both sides of the argument. I

"Lindsay" 39:24
absolutely know that and it is absolutely insane to me. How many times in a day in an eight hour shift. I judge a patient before I see them. You had started to ask me earlier how I got into this field. And it was because I was a patient. I had an MRI, and the tech was short, and I was 19. I was by myself. I was scared. I didn't know what to expect. The Tech was short and rude, and it made the whole situation worse. And then the next similar I had a couple of years later, the tech was kind took an extra three seconds to explain what was going to happen to me, told me everything is going to be okay. And it alleviated my fears. And it was so easy. And I decided, I'm going to be that person for other people. I see them on their worst day, I'm going to be the comforting word. I'm going to tell them. It's okay, we got you. And that's why I got into it. So the fact that I do still that I do it on a regular basis, will read a patient notes before I go get a patient judged the patient, like, oh, my gosh, why are they here for the seventh time in two months? You know, we have regular frequent fliers, and oh, that person again. And then I get down there and realize, oh, yeah, they are human. And they just want somebody to help. And I'm being the asshole that I hate. Yeah,

Scott Benner 40:56
that's something being a person is complicated. Right? Well, this is interesting lens, isn't it? I like this. I like this perspective. Because you're you're also by the way, and I mean, this not poorly. But you're also at a level in the hospital where I bet you're a little invisible to doctors, too. Yeah, yeah. So they'll be in front of you. And you get to say it. Yeah, I thought that, okay. So

"Lindsay" 41:21
one of the things in my know was, how difficult it is, and how you have to lose some of your humanity in order to continue to do this. And because you do see people in awful situations on a daily basis, and if you took all of that home with you, you would implode, you literally can't save everybody, you can't fix it for everyone. And so you have to compartmentalize things, you have to shut yourself off, I have been in a trauma room with somebody dying on the table. They had a LUCAS device, which is a CPR device, it's like, you know, electronic compression machine, with the patient coding. They're intubating. And the doctor and the nurses and myself are in a conversation about how the director just left and I wonder who's going to take their place it like completely, like not even thinking this is somebody's family member dying on this table right here.

Scott Benner 42:26
You're having a workplace water cooler conversation around this event. Cuz the the machines doing the compressions. You've done everyone's done everything they can do. And now we're just waiting to see what's going to happen. And you guys are basically like, did you guys see the they have turkey sandwiches today in the cafeteria? Yeah. Yeah. About that.

"Lindsay" 42:44
Yeah. So we're waiting for his start heart to start pumping by itself again, so that I can take my X ray and check the intubation tube. And the next sentence after Oh, so and so left, I wonder who's going to replace them as All right, well, we need to get the family in here and explain that he's not gonna make it through this. We can't keep bringing him back.

Scott Benner 43:03
And that person past? Yes, yeah. But your point is, and I think it's an obvious point, but worth repeating. You can absorb all that as a human being over and over and over again and not lose your mind. So you disconnect from it.

"Lindsay" 43:18
I do recognize that if somebody lost their dad and brother and husband that day. And that is sad. And I am sorry to them. But I mean, yeah, I am a little emotional about it right now. But in the moment, completely cut off on emotional. I'm not thinking about it, because I still had to go take X rays for another four hours. I still have to see other patients. Yes, they still herself.

Scott Benner 43:46
Yeah, yeah. No, you you can't go on carrying the weight of everyone's world on your shoulders. That would be That's insane. I don't think any reasonable person's asking a doctor to do that. But you can't disconnect yourself to the point where you're not doing your job anymore. You don't mean or you're not hearing people when they're saying the things. For example, you're saying in your doctor's appointment, that you're being told in response, like no, sorry? No. When I'm off having a different experience with a doctor who's listening to me, am I watching my life exponentially get better, because I have a good back and forth with it. By the way, this is not a doctor who would just blindly say yes to anything I've asked. I've asked questions before to and she'll look and go, I don't think you should do that. And I'll go okay, and then I won't do it, you know, like or like that. I can see that that might be helpful. And it wouldn't be harmful if you tried. So go ahead and try. Like everything's not going to work out. But the things that aren't going to hurt you if you want to try them, try them and you need a person there to help you understand what's the stuff that's worth a shot and what's the stuff that it's not worth the risk.

"Lindsay" 44:51
Yeah, yeah. So another example that I have so I without my adrenals I don't die once electrolytes. Well, I tried drinking electrolytes. But I was having trouble, I had a ton of fatigue. So there is a medical spa where I could pay $150 to get IV fluids. So I started doing that once a week for three months, and my life significantly changed my fatigue. I went from not being able to work 40 hours a week, to working 60 plus hours a week, not even 40 hours a week sitting at a desk to back in the hospital running around the hospital not sitting down for eight hours. And I couldn't have done that without IV fluids. It literally is sailing. Yeah, how it does that much? I don't know. But it did. I have tried to be like, Oh, it has to be a placebo effect. I'll just go a few weeks. But if I go more than two weeks, I am back on the couch. And well, I was paying out of pocket $150 a week. That's not sustainable for me. And I have insurance that I pay 1000s of dollars to get I meet my out of pocket deductible of $7,000 By February, every year.

Scott Benner 46:03
And for $600 a month. They do almost anything that the formulary covers. Yeah, like they would do all that but not the thing that you're actually finding valuable. So

"Lindsay" 46:13
well the leave uncovered that if I could just get a doctor to order it.

Scott Benner 46:16
Oh my god, seriously key? Yes. Okay, go ahead. So

"Lindsay" 46:19
I asked my PCP and she said, No, she wasn't comfortable about it. She didn't understand the benefits of it. And so she wasn't comfortable. And I said, but look, I am going to do this, whether you prescribe it or not, but by you prescribing that I will save some money. And she said No, it's my medical license. If you came in here and told me that doing cocaine made you feel better. I wouldn't give you cocaine. So you can expect me to do do whatever makes you feel better.

Scott Benner 46:49
Wait, she correlated cocaine and acetylene? Yes. Oh, what an order. A great word Smith. That one was

"Lindsay" 46:59
when I saw my oncologist. A couple months later, he went, Oh, that's gotta be expensive. And I went it is he goes, how about I order it for you? I said, Thank you. So I'm getting it covered by insurance now. But it took months.

Scott Benner 47:11
Did you ask him for cocaine too?

"Lindsay" 47:14
No, I didn't. I should next time. I know. He

Scott Benner 47:17
definitely would give it to you.

"Lindsay" 47:18
I'm not sure.

Scott Benner 47:20
I mean, based on your other doctor's

"Lindsay" 47:21
opinion, since he gave me saline, why wouldn't you give me?

Scott Benner 47:26
I swear to God, if someone said that to me, I would just I'd start banging my head on whatever hard surface I was closest to. And then I would say out loud, you're looking idiot. And then I would leave? Oh my god. So anybody can become a doctor. I think it's important to say that

"Lindsay" 47:46
these get degrees, right? These are

Scott Benner 47:48
you're gonna say these nuts. For some reason. I was like, where's this going? Did you go back and tell that doctor that you got another doctor to do it?

"Lindsay" 47:59
No, I'm sure she gets the notes. I haven't seen her again.

Scott Benner 48:03
Oh, I would I would call her on the phone and tell her. Yeah, I'd be like, Yeah, I found a compassionate person. And I'm taking the $600 a month and I'm putting it in the bank or buying food with it or whatever. Well, I mean, the way the world is right now getting a sandwich.

"Lindsay" 48:17
Yeah. Went to the grocery store once and got half a cart. Yeah, I think we

Scott Benner 48:21
live in a world where 20 $25 an hour is the new like minimum wage for what everything costs, you know? Yeah. Anyway, what are we not talking about that we should have so far? Do you have a from work story that if you told it that people listenings balls would shrink to the size of raisins and run back up inside their body? Are you more of a big picture? Yes.

"Lindsay" 48:45
So I mean, the whole reason that what I thought I was going to come on and talk about was, I mean, we've covered most of the points that this gives. But when I first got my license, I

Scott Benner 48:57
Lindsay masterfully because I'm an amazing host. And I've stepped us through this in a very entertaining way. I don't know if you've noticed or not. But oh, thank you. I'm just teasing. I just needed a second take a drink. That's all gonna be take a drink and then I want to hear this guide you you go down that road. Let me hear it.

"Lindsay" 49:16
Alright, so when I first got my license, I actually worked for a physician owned company that had different divisions and I worked for the radiology division. So I worked directly for the radiologists. It wasn't actually taking x rays. I was actually working behind the scenes doing scenes doing administrative work, making phone calls, connecting them to doctors making sure orders were correct and things like that. And this is kind of when I realized that medical is just another business. I got to know those radiologists very well. They know my medical history. I had amazing radiologists that sat outside the CT radiologist cave when you watch TV and use the hungriest Anatomy, the neurosurgeons sitting in the CT waiting for the patient images to come up. That's absolutely ridiculous. They don't walk in, they don't go in those rooms at all. It's a tech. So I actually had a radiologist know, I was getting an exam. And so she actually did Wait, not in the CT ring, but like at her desk right outside and sit down with me and go through the images, I got a very good relationship with several of these doctors. And because I knew them, so Well, I knew that they meant the best, they wanted to do the best for what they were doing, they are trying to diagnose and take care of things. However, they have a business to run and to make money. And the more money they make, the more they all get paid. And they do a lot of great things. They do a lot of charities, charities and stuff. But ultimately, that's what it boils down to. And they would run reports monthly, and wait the different exams, because you can read an x ray a whole lot faster than you can read a CT and body CT a lot faster than you can read a brain MRI. So they wait the average time it should take to read each of those studies, and then pull reports on how many each radiologist completed and tell them this is how many man hours you completed last month. And then they would take all of the people and they would average it and anybody that was below it would have pressure to work faster. Yeah, to go faster, you took more than 30 seconds to read an x ray, that's not good enough, you need to get pumped out more numbers. And there's this constant pressure on them to do more, get more complete more. Because if we're not completing all of the exams, then we're gonna have to hire another person on which is going to reduce the revenue that everybody else is making. Sure, if you want to do less work, and everybody wants to do less work than we can bring on 10 more employees 10 More radiologists split the work between them, you can work less hours, but you're also going to cut your paycheck in half, right? So there's this constant pressure and actual arguing between some of the radiologists that other person's not pulling their weight. Well, I read 359 hours worth of exams last month and you only build 250. So why are we making this thing? Right?

Scott Benner 52:19
Yeah, and keep up or they're gonna hire somebody else that is going to cut in all our money.

"Lindsay" 52:24
Yeah. So that brings it to things getting skipped things getting missed, because you're in a rush, because you've been staring at a screen for seven hours without a lunch break. Because, you know, and every those styles and personalities come into it. There's one radiologist that wants you to code down the image as small as you can to barely get the anatomy because anything extra they're now responsible for, and then other people that want you to get a full picture.

Scott Benner 52:53
And that's the difference between somebody who wants to do a good job and somebody who wants to keep their numbers up, right?

"Lindsay" 52:59
Yeah, I believe they all want to do a good job. But there's outside pressures pushing on them. And after years and years of the same, you've got to hurry up, you got to hurry up, you've got to get more the more we get done. Oh, now this hospital is bringing on another MRI, which means we're now going to have 27 More exams in a day that we have to read. So now you have to squish that in before we get another radiologists.

Scott Benner 53:28
So it's funny because I don't want to see people lose their jobs. Right. But is there not going to be a waiver, like aI kind of thing can read these images much better in the future than a person can? Or is there something about it that needs a human touch?

"Lindsay" 53:43
So there are actually some, especially with breast imaging, they do have some AI software that goes through and will like highlight areas of concern. There will always be a human person over looking at. But there is you know, there's that constant caveat of might miss it too. How long is it going to be before you start trusting that software more than your eye? Oh, because it didn't catch anything. Now you're not going to look at it with the same Yeah. attitude or it is in the works. Yeah,

Scott Benner 54:16
the thing you just described, like, I want to be clear, I don't have anything it's people making money. And doctors, you know, and they're making more than other people but I mean, God bless them. They went to college like you don't I mean, like they they're set up a business they're following the structure of how the world works. I don't have any problem with that. When you're knowingly telling people to go faster. And you know, that means do a poor job. You don't mean to do less quality work, then you have to say okay, well when we can't make as much money or we gotta hire better people are more people are that's a weird decision to make like in you know, we'll skip quality for quantity.

"Lindsay" 54:55
But you just because I played devil's advocate and like you said this whole Interview, I'm playing both sides. And they do have a quality department, they do do quality checks, they will randomly pull exams and have a second person look at them to make sure and if one person is starting to miss too many things, or if they do get a doctor to say, come back years later that something was missed, they do a quality review. And they do a root cause analysis. And so they do the things to catch the other side as well. Yeah. And so it's just they're trying to find a balance. And me as a patient, before going there, assumed that the doctor was taking as much time as they need to thoroughly go through my history and see exactly what they're looking for, and spend the hour or however long I thought it would take to look through my scan. And that's just not the case, they get a few snippets of details about while you're getting the scan, they can if there's something confusing, or if it's complicated, they can go back into your medical history and get more information. They do spend a lot of time consulting with doctors and back and forth. I'm not saying it's completely on an island. But it is not as much as I expected.

Scott Benner 56:15
Yeah, so here's where I'm going to say to you, Lindsay, that people are people, and it doesn't matter what walk of life we're judging them in, you're gonna get about a human job out of them. There's nothing wrong with that. I'm not judging anybody. But you know, there's in every possible thing that we could focus on, you're going to hear stories like this, that mean, part of the reason I started doing this, is because I wanted people to hear from doctors, from nurses from people in health care, whatever. I wanted them to hear like the truth, because people have that feeling that you started with, which is, there's like, there's special different people. And they're, it's just not true. They're not special and different. They're just people like everybody else. And they have shortcomings, and some of them are lazy, and some of them aren't. And some of them care more about money than people and some of them keep care more about people than money. And there's a mix of those people out in the world. And my point is, you don't know which one you're getting. But it's a disservice to you to always imagine that the one you're getting is the bestest one ever. And so you have to pay attention. That's where we end up saying to people, like you need to be your own best advocate. But that's also insulting. Because if I hire a plumber to change out my hot water heater, do I stare at him for six hours while he's doing it to be my own best advocate in case he doesn't sweat a pipe? Right? Like, no, right? Like, you know, watch

"Lindsay" 57:40
a YouTube video before he shows up so that you can make sure he does every step. Right.

Scott Benner 57:44
Right. Exactly. And right. But maybe that is what's happening in health. Yeah, is that people are coming in with their information. And some of its right and some of it's wrong. But ironically, some of its being ignored when it would be very valuable. by a doctor who hasn't heard about this, you know, hasn't, he's been out of school for 15 years. And now suddenly, as hard as it is to believe if you're a physician, there might be someone in a Facebook group who knows more about cortisol pumping than you do. For example, or you might be faced with a person who says, I listen, I listen to a podcast, and this guy told me I should Pre-Bolus like 15 minutes before a meal. And that might not be a thing that you would tell somebody to do. It doesn't make it wrong. And if you're not willing to dive deeper into that, to find out if the thing they're saying is actually right or not. That's where you're doing the disservice. Like I get saying what you heard on a podcast like, oh, boy, let's slow down. i Great. Like I get that if I was a doctor and someone came in and said, I heard on a podcast, I'd be like, Whoa, slow your roll. But I would just dismiss them. In less. I was so burned out that I couldn't. And are we just caught this loop. It's why I genuinely believe that you're going to see people have like personal AI assistants. And it might be for more than just health care, but for health care, and where eventually I think I think it's possible medicine turns into a thing where you go to a physician and you say, Look, I've been plugging in everything. It's been happening to me for the last two months. And my algorithm thinks this is what's going on. And then the doctor is going to be more of less of a physician. You know, a person who sits there and tries to help you figure out what's going on and more of a button pusher says okay, well what's the algorithm think we should do next? Let's try it. And then they'll they'll go over it and say, Okay, I see how it came to all this. But I think the truth is, is that you're going to be able to if you just stop on its face and think about what AI is. It's just like what's chat GPT right. It's a thing that basically has read everything that's available on the internet, and a doctor is up person who we sit in a room for eight years and try to push as much information into their head as we possibly can. Well, you can push more information into AI than you can into a person.

"Lindsay" 1:00:08
And things change, we learn about new things about the body,

Scott Benner 1:00:13
right? And doctors don't generally speaking, even those in like, in specific categories where they're like, I'm only going to pay attention to this, those people end up usually knowing more, because they're surrounded by it all the time. But once you start pulling back, like, you know, a PCP like me, what are you saying, like, they haven't been at school and 25 years, they don't know, they know what they know, they don't go home every day, and continue to read the Internet or continue to take in all the studies. Whereas you can just have this AI just continually keep training itself on new NIH articles and published data and, you know, all kinds of stuff that would actually help you make a better decision. I think you're gonna see healthcare get a lot better in the next 10 years.

"Lindsay" 1:00:56
I sure hope so. Yeah,

Scott Benner 1:00:58
but here's gonna be the problem. There are a lot of people making a great living being doctors right now. And they're not going to want to see it happen. And I understand that. I genuinely do. I bet you the my guy who picked up the garbage got really pissed when the trash truck learned how to pick up the cam by himself.

"Lindsay" 1:01:14
My argument about that all the time when people say, Oh, technology is going to take jobs is, but somebody has to do the technology. There has to be somebody behind the scenes, making the algorithms, feeding the software, teaching it new things, still doing the research to add into it. It's just trading jobs. It's not taking jobs, and

Scott Benner 1:01:35
I'll give you a Yeah, but yeah, yeah. But it's like when they told coal miners, don't worry, we'll retrain you for tech jobs, you really think you're gonna take a 55 year old coal miner and teach them how to write Python? That's true. Yeah, that's not gonna happen. You have to recognize that we're not. If we're not in forward motion, then we're here forever. Yeah. And so it's a personal thing, you have to say, Oh, I'm going to become obsolete inside of my adult like money making lifetime, that's going to be tough. That's going to be bad. But instead of worrying about it, I say, I don't know, listen, it's easy to say like, we're moving towards Star Trek, like, don't just want to get up in the morning and put on your foil suit and do whatever you want to do.

"Lindsay" 1:02:13
Have them come scan you with a wand and tell you exactly what's wrong with you

Scott Benner 1:02:17
not want a magic wand. Is that what you're against? No, no. But you know what I mean? Like, like if these things in the short term are taking jobs from people think that's obviously going to happen. Yeah. But that's where you'll start getting involved in the idea of like, both things just happen, you know, maybe people won't need jobs. And listen, we could go down another road and say, Oh, then people are going to become lazy and not do anything. And but there's going to be a lot of growing pain around this. And it's going to go on for 150 years. Yeah, that's true. But in this moment, you are not going to stop the progress that this is. No and and so I think you're watching doctors as an example, just like in a lot of other jobs, you are watching people become obsolete, for good reasons. Because people can't do as good of a job as this thing's going to be able to do at some point. And, you know, that causes a lot of concern. I understand. I would also like a beach house. I don't have one, but I can see where it would be nice. It would be nice. But the point is, is that like you're not stopping this train. There

"Lindsay" 1:03:23
are people out there that are progressiveness, and I just need to find them. Yeah.

Scott Benner 1:03:29
Well, that's that's always the tough part. Like me, even finding the doctor that helps me like it was not easy to do. And by the way, she doesn't take new patients. Of course not right, because she's a she's a cache doctor. And then I mean, we turn into our and it's, we're actually very lucky, I pay her cash, and then we get reimbursed like 90% or something like that. So it's not a problem for us financially. Just have to have a little money in the beginning to get, you know, to pay her until it comes back. But the problem is, is like I almost had to like crowbar myself into her practice. And once you get a good doctor like that, and they fill up with enough people, they're not out there in that mad scramble that you were talking about. Because this is a lady who's not trying to become wealthy. She's trying to help you just trying to help the people. She's helping. Yeah. And she's very comfortable and happy doing it. And so she does it. You know, lovely woman, like, I mean, I've seen her home, she's not living in ostentatious lifestyle. She's just helping, she's doing a really good job helping the people she helps. And so I think you're gonna see more of that you're gonna see more of these cash doctors split off. But then the problem becomes is that you're better doctors are going to do that. And then it's going to leave the system full of people who aren't capable of doing that because nobody be interested in paying them. And then, you know, then that maybe is where in the short term you see things get a little worse. Anyway, this has been horrible. Like every one of these episodes makes me feel horrible, right?

"Lindsay" 1:04:52
So I wouldn't mind growing up I had the respect your elders and you know a lot Just respect for other people, I had high expectations, I was the top of everything that I did. And I had the expectation that everybody else was like that. When you walk into the doctor's office, the doctor knows everything about your health, because they went to school for 13 years. They know. I mean, it's so much. So I had this expectation that I thought if I walked into the Home Depot, and said, I need this tool, that any person in that building would be able to walk me straight over to that tool, show me how to use it, tell me exactly everything I needed, because they worked in Home Depot, so they must know every single thing.

Scott Benner 1:05:36
You grew up, sheltered deer. Yeah, very much

"Lindsay" 1:05:41
so. And becoming an adult and realizing that that is not life was a little earth shattering. But also, for people that don't have a lot of medical issues. And they go to their PCP once a year for their annual checkup and say that, yep, you're good. That might still be the case, they might still feel like when they walk into the dark, the doctor's office, their doctor knows everything. Every four years, they get a cold, or a flu, and they go in and they get some antibiotics, and they're better and their doctor fixed everything like that still their life, they still have the expectation that their doctor knows everything. Anybody that has a rare disease, that actually has to go to doctors on a regular basis, starts to realize that they are just human, just like everybody else. And that this is just a job. They only have the knowledge of the experiences that they've experienced. And that's when you have to learn to advocate for yourself to learn to fight and learn the information on your own to take back right and

Scott Benner 1:06:39
plenty people go to the home store and just need a screwdriver. And the whoever they bumped into knows where the screwdrivers are. And they all leave saying, Oh, I had an amazing experience. I'm going to end on this. But this is the thing I've learned one of the things I've learned making the podcast, if you ask people about their health, how's your agency? Oh, it's it's seven and a half. I felt okay. Not bad. Also could come down, right? And you talk for a little while longer. They don't quite understand how their insulin works. They've got some shortcomings and their management ideas, blah, blah, blah. And then you ask them about their doctor. How's your doctor? Oh, I love it's great. Oh, she's fantastic. I just part of my family, like a URI one. C 7.9. You love your doctor. That would be like saying, I went got my tires changed and they put on I don't know, almost all the lug nuts when they put my tires back. And when I said how did you like your tire experience? And oh my god, amazing. Great guy. Why? Because he chatted you up while you were there. Because they had the magazine you liked in the in the waiting room? Like why? Why do you like a person who's not doing a good job for you? Well, they're great. I'm like, okay, they're great. The job they're doing subpar. But that's not how people see people over and over again. I see people do that. They say my doctors fantastic. And no, I drill down with them their cares, not good. Yeah. And I'm like, I don't understand why you told me your doctor was fantastic. They don't know any better. Yeah, they will. And then you know, and then like you said, then people who are not really sick or don't need like, care that that's ongoing. If you ask them how their doctors are gonna say they're fantastic. This is what happens. It's why you can't trust people's reviews of things. It's why people have different experiences when they get there. I just want to end on this because I always want to say this at the end of these episodes. No matter what you heard here today, you fall you break your arm, you have a pain in your chest, go to the goddamn emergency room, there are plenty of things that hospitals are fantastic at and you want to take advantage of those things. Don't become anti doctor, just pay attention and learn more so that you can be you can be more aware of what's happening to you. That's all I'm saying. And

"Lindsay" 1:08:42
take a family member with you. Especially if you're older. Have a second person in the room to listen because if you aren't feeling well, or you get bad news, you're you're shut off and you don't listen. Yeah, anytime you're able have a second person I

Scott Benner 1:08:57
agree. 100% All right. Well, Lindsey, if that is your name, which it isn't. Thank you very much for doing this. I really do appreciate it. And I want to wish you good luck with your with your medical issues.

"Lindsay" 1:09:08
Thank you very much. I want to thank you for everything you've you've done with this podcast. I've been going back and listening to episodes in the hundreds and every single episode I thoroughly enjoy. So thank you for all of the time that you put into this. You really are changing people's lives.

Scott Benner 1:09:26
You made my day. Thank you. That's very nice of you. Hold on one second. Okay.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juicebox 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/juicebox Today's episode of The Juicebox Podcast is sponsored by the Dexcom G seven, which now integrates with a tandem T slim x two system. Learn more and get started today at dexcom.com/juice box. If you're living with type one diabetes, the afterdark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juicebox podcast.com up in the menu and click on afterdark. There you'll see a full list of all of the after dark episodes. I just want to remind you one last time what a big deal would be if you went to T one d exchange.org/juicebox and completed the survey. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate