Scott Benner 5/1/23 Scott Benner 5/1/23

#901 Out and About and Full of Doubt

Amanda’s son has type 1 diabetes and she has rheumatic health issues and some other stuff going on.

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Scott Benner 0:00
Hello friends and welcome to episode 901 of the Juicebox Podcast

Welcome back, everybody today on the podcast I'll be speaking with Amanda. She is the mother of a child with type one diabetes. And I love the title of this episode. While you're listening to our conversation today, please remember 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 healthcare plan or becoming bold with insulin. If you have type one diabetes and are a US resident, or are the caregiver of someone with type one, completing the survey AT T one D exchange.org. Forward slash juicebox is incredibly valuable. T one D exchange.org. Forward slash juicebox. Maybe take your 10 minutes to complete the survey. You're going to help diabetes Research type one diabetes research to move forward. Simple questions, simple answers, HIPAA compliant, absolutely anonymous. It will only take you 10 minutes. I think you're basically just sitting on your sofa right now anyway, touched by type one.org. Do me a favor, please complete the survey.

This episode of The Juicebox Podcast is sponsored by cozy Earth, you can get the most comfortable and delightful sheets, towels, joggers, and more at cozy earth.com. And when you use the offer code juicebox at checkout, you will in fact save 35% on your entire order. Cozy earth.com juicebox at checkout, you're all done. The podcast is also sponsored today by Dexcom Dexcom, makers of the Dexcom G seven and G six continuous glucose monitoring systems. My daughter just got her first delivery of the g7. And just about to embark on her new journey with her smaller, lighter, very accurate, continuous glucose monitor from Dexcom. You can to dexcom.com forward slash juice box.

Amanda 2:25
So I'm Amanda and I live in the east coast of Canada. And I have a son Boyd who was diagnosed July 9 last year.

Scott Benner 2:36
Okay, so let me make sure I understand Boyd is how old nine.

Amanda 2:41
Yes. So he he was just about to turn eight when he was diagnosed.

Scott Benner 2:46
Okay, urine a month ago, 13 months ago, you already said a bit. So that's great. You don't know you did it. But I appreciate your about that was very Canadian. And we're well on our way. Okay. So you have a lot to talk about. I think

Amanda 3:03
I have a very lengthy story. Do you

Scott Benner 3:07
want to? Do you want to start with your story? Or do you want to talk for a little bit and get to your story?

Amanda 3:12
Whichever, wherever you want me to start? Interesting. Okay. Well,

Scott Benner 3:15
let me make sure I understand the backing of the story. So any other kids?

Amanda 3:22
Yeah, I have a daughter, Nora, and she just turned 14. Okay, married, not married. Married my husband Ryan. Okay.

Scott Benner 3:32
Daughter's 14. Any other autoimmune stuff? Oh, yeah, we

Unknown Speaker 3:38
have a lot.

Scott Benner 3:40
At ease with the kids.

Amanda 3:43
I know. This is the first with the kids, but I've battled with different things since I was probably 15 years old. Okay, how old are you know? I am 42.

Scott Benner 3:55
All right. What was your first thing? Well, when

Amanda 3:58
I was about 15, I started with joint pain. And it just got worse and worse. And they diagnosed me with juvenile arthritis. Okay. And I was medicated for that. And it was pretty bad. I had to stop school for a semester. And we did get into remission and I didn't really have a lot of problems until I had Nora on my daughter. And then it was about a year after I had her that I had started having symptoms and stuff again.

Scott Benner 4:40
So the joint pain came back after you gave birth. Yeah.

Amanda 4:43
And they say that that can happen with rheumatoid arthritis. That it causes like a flare up after you have children's so I did go back to my doctor that because I wasn't on any medication or anything for years. And it did take them a while to get me in. And eventually, I did get into a rheumatologist again, and they started me on Plaquenil is what I was taking. Are you Yeah, after

Scott Benner 5:14
her birth? Can I? Yeah, back when you were a kid, what did they give you?

Amanda 5:19
It was the same thing. Plaquenil and then just

Unknown Speaker 5:23
pay like,

Amanda 5:26
went away. And then I stopped taking the medication. I was good through my 20s and stuff.

Scott Benner 5:32
Okay, so you took that? I'm sorry, I think you might have like, flipped out for a second. So you took the plaque when I was a kid for how long?

Amanda 5:42
It was probably about maybe a year or so.

Scott Benner 5:46
And then you stopped taking it because the pain disappeared?

Amanda 5:49
Yeah, I just I thought I first tried to go off it and, and it did come back. And so I stayed on it for I can't even remember how much longer and then went off it again. Months later, maybe? And then it didn't bother me again, like, in my 20s at all, really?

Scott Benner 6:12
And is that your diagnosis of Ra.

Amanda 6:15
Um, they did. When I went back to the doctor, they did more testing, I didn't have a lot of, they've always told me I don't have a lot of inflammation markers. But I did test positive for anti CCP, which is a big marker for rheumatoid arthritis. So that's basically what they diagnosed me with. And then it did go on to like chronic fatigue. And I also got a diagnosis of fibromyalgia as well.

Scott Benner 6:50
Are those is that the, the full host of your issues? Or is there more?

Amanda 6:56
Well, ADHD and anxiety, a little bit of that as well.

Scott Benner 7:00
Okay, so and then I did make a list now. ADHD, I'm going to get out of my anxiety, ra, Fibro. And you said something else, fatigue,

Amanda 7:15
chronic fatigue. Now, when after I had, I did get in pretty good health before I had my son, so there's five years between the two of them. And I was off all medication had my son and then it started up within a few months, I started having joint pain again. And until he was probably I think it was three, like I had a lot of pain issues and back and headaches and stuff. And I ended up for I had my son, I started with a lot of pain and stuff again, within a couple of months. And it just got worse and worse until he was about three and I had a lot of back pain and headaches and like pain down my legs and joint pain. And I my mom was talking to somebody, a relative who had Lyme disease. And she thought, Wow, this sounds a lot like Amanda. So she had told me about it. And then I got in touch with like our local support group. And they put me in touch with a doctor in Maine and he had blood work done on me and I did have some markers that showed that I had exposure to Lyme bacteria. But it's very, like things are very different in Canada. They don't do a lot of testing for it. And a lot of doctors are skeptical about Lyme disease. But I did end up going to him in Maine so I traveled down every three months or so and see him and he gave well he he's probably the only doctor that really actually helped me because at the point when I went to visit him I couldn't even sit in the car like it was it was like four hour drive and I would have so much pain by the time I got there like just my back and the back of my head and stuff and I was in pretty rough shape.

Scott Benner 9:34
So he What do you do for you?

Amanda 9:37
Well, he he treated me for a lot of different things the symptoms like he said so he he's the only doctor that really actually helped me like I remember spending at least four or five hours in the office with him just talking about like the different symptoms and he tested for so many different things that they wouldn't test here in my city. So he thought that I probably had exposure to the Lyme bacteria when I was a teenager. And that's what cause the flare that I had so and then it just kind of goes into remission. But then when your body gets exhausted and tired or stressed, it can flare up and trigger other things to happen. So, I mean, he treated me with some of the same medications and some let me think like any depressants like that for pain as well. And I did do some rounds of antibiotics. And, and that was like injectable antibiotics. And it seems I don't know if it's just a fluke or

Speaker 3 10:59
what, but after that, I did start to get better.

Amanda 11:04
And I was probably at the best I had ever been, just before my son got diagnosed,

Scott Benner 11:11
did his diabetes, the stress of his diagnosis, put you back into an issue, are you okay? Now? You're pretty tired. I might just be diabetes, but I hear what you're saying. So. So diabetes is no secret, not easy to deal with. But Dexcom makes it much, much easier. Being able to see your blood sugar or a loved one's blood sugar in real time is a gift that I don't know that I can quantify. But right now I can see my daughter's blood sugar, and she is 700 miles away from me. I can see the number. I can see the direction it's moving if it's moving, and I can see how fast it's moving. Arden just had a meal. Her blood sugar's elevated right now around 150. And I'm watching it come down. It's happening the way I expected to happen. This is just the greatest comfort to us. And a huge help for her while she's away at college, and managing her own blood sugar. This can be the same for you as an adult, or as the caregiver of someone my daughter's age, or even younger. The speed direction and number at your fingertips right on your iPhone or your Android phone. It's just me, you should just get it dexcom.com forward slash juicebox. It's hard to sell something that, in my opinion is so obvious, right? It doesn't need a sale. I think you just need the PE dexcom.com forward slash juice box, go get it if you can. It's amazing. Seriously, seriously. I don't know. It doesn't require selling, it requires education. Just understanding what it can do for you like seeing in real time right in front of your face in a way that's understandable and easy to digest. I ate something or my kid ate something and I'm watching the blood sugar. I see what happens. I see what happens when I put the insulin in here versus when I put it in over here. I see it and then I can make decisions about it. I can fix it or do it better. dexcom.com forward slash juicebox please take my advice and check it out. While you're out buying things, get yourself some super comfy cozy sheets or towels or sweatpants or scrunchies or so much socks cozy Earth has it all cozy earth.com Premium stuff. I'm not kidding you. Super soft, super like washable and resilient. You're going to love it. I have the sheets in the viscose bamboo. I have some joggers, a sweatshirt and the viscose bamboo. I've got some towels coming. You can't go wrong with quality. And you can't go wrong with comfort. I mean, especially coming out of the shower, like all your bits are available. Should be nice to them. You don't I mean, and when you're sleeping. Oh my goodness, what are you gonna be hot and sweaty while you're sleeping? No, no one wants that cozy earth.com Now here's the thing. You go there, you get whatever you want. You put it in the cart. And then when you check out juice box is the offer code that saves you 35% On your order. I'm telling you 35% That's a lot. That leaves you only paying for 65% of it. Which is that right? 65 Dammit. I might have got that wrong. Give me a second 6535 and I take the five and the five and make it a zero then I put a one over here. So I get a zero, a six three and a one six plus three is nine was 110 Yep, that's right. Cozy earth.com use the offer code checkout to save 35% off your entire order. My math is rock solid

Amanda 15:24
Oh, I'm pretty tired.

Scott Benner 15:26
It's hard. I might just be diabetes, but I hear what you're saying. So yeah, so So for all your stuff. Basically, they gave you kind of high impact antibiotics. They gave you an SSRI for the pain.

Amanda 15:44
Yeah, and I was on neuropathy medication as well, because I had a lot of like, just weird sensations and tingling and pains in my legs and arms. But the doctors Hiro is just stuck with like, it's the rheumatoid arthritis, but they never did. Like I love my doctors here. And they're great, but they just never seem like they really listened. And I always felt like I almost like they thought I was making things up, which happens

Scott Benner 16:15
a lot. Did they tell you just to go have a Molson and take a brisk walk? And you'd be okay. Pretty much. Yeah. Amanda, if you can just get through this a little longer. Yeah, I appreciate you're about still they're really coming fast and furiously. I'm enjoying them very much. It's a good time. Okay, so you, that all happen to you. That's terrible. So in your heart, do you think you have autoimmune stuff? Or do you think you have autoimmune stuff that was kind of kicked into gear by a tick bite? Or do you not even know how to think about it?

Amanda 16:51
I don't even really know. I'm not sure if I have rheumatoid arthritis. I've said that to my doctor. And she's like, No, you're you were positive for the anti CCP. And that's America. And but I don't know if maybe lupus or because that's in my family as well.

Scott Benner 17:13
You have people in your family line that have lupus.

Amanda 17:16
Yeah, yeah, I do. And I do have an aunt on my dad's side who she experienced joint pain and like when she was younger as well, kind of kind of the same thing as me. But I have like on my mom's side, there's a couple of them that had lupus as well. And my sister my niece, they have different joint issues and problems too. But I also have thyroid issues in the family as well.

Scott Benner 17:47
Does any do any of your issues impact your digestion?

Amanda 17:53
My stomach bothers me some I did. That's one of the things that the doctor in Maine helped me with I get on like a gluten free. So I do I eat gluten some just more like if we're out somewheres but and I don't eat dairy. And I eat lower sugar. Unless I'm having treats.

Scott Benner 18:19
Okay. All right. So before we move on, just can you say Out and About for me? Out and About. Thank you. That's so amazing. Thank you so much. Because you don't know what you sound like when you say it. But it's delightful to me. Oh, great. You'd like out and about that fantastic. Thank you made my whole day. Okay, so your son's diagnosed with type one. Is there any other type one in your family line?

Amanda 18:50
Yes, my dad actually was type.

Scott Benner 18:55
Campbell believe you broke up again. Damn it.

Amanda 18:59
And also two adult children. They're adults now. But they would be my cousin's kids. So they're in the same generation line as my son were diagnosed when they were about the same age nine. I think

Scott Benner 19:15
I'm gonna stop you for a second because you started telling me that your dad had type one. I lost you again. So here's what I'm gonna do.

Hey, hi. Hi. Good. All right. Let's cross our fingers that that did something.

Amanda 19:33
Okay, you're way louder now because I got my husband's headset.

Scott Benner 19:37
Oh, you sound much better too, by the way. Yeah.

Amanda 19:40
It's playstation one so.

Scott Benner 19:43
Well, okay, so we're back. We did a little bit of updating to some software. And I asked you if there was any type one in your family and you said yes, my dad and then I

Amanda 19:53
lost you. Okay. Do you want to know but my dad,

Scott Benner 19:57
I want to know about everything you were saying when I couldn't hear you. Okay, yes. So

Amanda 20:01
my dad was diagnosed as an adult, probably in his 30s, I think. And he also are my cousins. on his side of the families. There's two children in the same generation line as my son Boyd. And they were also diagnosed when they were about the same age.

Scott Benner 20:24
Okay. So your father and two other relatives on your dad's side who are your son's age? Yeah. Okay. So that's for now. All right, and you said there's thyroid in the family, too? Who's got that?

Amanda 20:41
Um, I believe that I probably do. I did. That's one thing that I was tested for when I was in the States, and they haven't done any testing here, but I did take like a low dose dose of the Synthroid. For some time. I have my bloodwork stuff out, in case you ask,

Scott Benner 21:04
Are you not taking it now?

Amanda 21:06
No, I'm not.

Scott Benner 21:08
I didn't Well, you're tired.

Amanda 21:10
I'm not sure. I wanted them to test me again here. Before I tried it again. But I did. I don't know if it was too much. Because I was like, sweaty a lot. And just like, I felt like it was too much.

Scott Benner 21:27
Or taking too much. Probably. Yeah, yeah. So you how much do you remember how much you were taking?

Amanda 21:34
It was only 25. Okay, milligrams. Yeah.

Scott Benner 21:38
Were you losing weight?

Amanda 21:40
Uh, no, I was quite heavy at that time. Just because I was also taking something else that was making me gain weight.

Scott Benner 21:49
I wasn't sure if you were hyper maybe like, if you had hyper, if you had taken so much Synthroid that you were too low. Your TSH was too low. That's what I was trying to figure out.

Amanda 21:58
Something like that might, uh, went on, I was looking at my blood work. And the last one that was 2021. My TSH was low. And my T four was

Scott Benner 22:13
up. What was your TSH?

Amanda 22:17
Do they measure it different between Canada? And

Scott Benner 22:20
I don't know you're about to find out. It should be like about like a one to 10 scale.

Amanda 22:24
Yeah. Now secure. You're gonna hear my papers probably.

So point

Scott Benner 22:40
two, six. Yeah. So little high.

Amanda 22:44
And then at that time, because that was in April 21. Oh,

Scott Benner 22:48
wait, two? Not two. Point. 6.26. Yeah, that's what it says. Alright, so

Amanda 22:55
then my T four was 15.9.

Scott Benner 23:03
So your idea now is to go get more blood work done. But are you having trouble getting someone to do it for you?

Amanda 23:09
No, I could probably my family doctor would probably do it. I procrastinate a lot, because I'm so busy with everybody else's issues.

Scott Benner 23:20
Well, take a day and do that for yourself.

Amanda 23:22
Yeah, my grandmother. She has like my mom's mom. She's always had thyroid issues.

Scott Benner 23:29
Okay. So do they medicate for it? Yeah, she takes them through it as well. Your mom's mom's alive, though. Yeah, she's

Amanda 23:37

Jesus.

Scott Benner 23:40
That's really old. Yeah, she's

Amanda 23:43
a happy little one now.

Scott Benner 23:46
Probably the cold keeps her going. Yeah, probably. Yeah. Okay. Well, what was Pope was the What led you to believing that your son needed to go to the doctor before his diagnosis?

Amanda 24:04
Well, I always like it's funny, because I always had like this thought like, Oh, what if one of my kids have diabetes, like my dad did. And so I always had it in the back of my mind, and I always watched for it, but I never realized how much I didn't know about it and like, not know what to look for. Now, Boyd has always been a very fussy little guy ever since he was a baby. And I always felt like something was off with him. Like, even when he was an infant, like he had like, sores in his mouth. And I took him to the doctor. I took them to like our dentist, they sent him to an oral surgeon to have a look in his mouth at these sores, canker sores, and they never ever could give me any answer. And I kept saying like They come and they go, and they come and they go. And then eventually, when he was probably over one, we didn't really see many of them. But he was always tired, and just irritable and could never keep up with the other kids. And, and I, one thing why I wanted to be on the show is because I, when I first found the podcast, I listened to some ladies, I tried to find the episode that it was and it was about someone who had a lot of regret and stuff about not seeing the signs and stuff like that. So that's one reason why I wanted to come on because I, I really didn't see what was right in front of me. And I could have took him to the doctor. And I had, I had a hard time with the doctors because I was wrong with me or the kids. So I put it off. And at the end of his, I guess 2021 school year, he was drinking a lot of water. And we just thought that maybe it was hot out and stuff like that. And he was very irritable for a couple of weeks, and I reached out to his old kindergarten teacher. Because I had, I had urine analysis test strips that I had for myself, and I just got him to pee in a cup one day and the glucose on it was like at the highest it could be on the test strip, and the ketones were on the highest as well. So I reached out to her because I knew her son was diabetic. And I just had this weird feeling that something was going on with him and and when I did the urinalysis test strips,

did you get that part? Yeah. That they were at the highest

marker on them, right. So I went and got a meter at the drugstore. And did a test on him without him knowing because he's pretty high anxiety. So he would never let me prick his finger anything. And it said 33 over 33 Actually it said. So she encouraged me like to take them to the hospital. And I was still questioning like, should I take them up there? It's like, during the middle of COVID. Maybe it's not really this and I guess I just it was hard to believe that it could possibly be diabetes, like my dad,

Scott Benner 27:47
even though that's something you worried about? Yeah. Which is funny.

Amanda 27:50
So. So we ended up taking him and it was it was late at night he had fallen asleep. And we took him and he I mean again he couldn't they couldn't even read his blood glucose. It was so high. It just said high on the meter. And they admitted him like right away and started on IVs. And they had to give him Ativan to calm him down because he was so hysterical. And yeah, so he was in DKA. His a one C at that time was I think it was 12.7. So he was a sick little

Scott Benner 28:36
boy. Yeah. Well, I'm glad to talk him, obviously.

Amanda 28:39
Me too. And I thank her like, every day I send her updates all the time. Because she basically, she saved him because I would I think I would have kept doubting that. I don't know why. Because I'm usually very, like, notice everything that's going on. But maybe I was in denial that it could actually be something serious.

Scott Benner 29:06
No, I understand. And so now you're kind of torturing yourself over that still a year later.

Unknown Speaker 29:12
Yeah, I still do. I

Amanda 29:15
I think about it a lot. But I can I remind myself that, like I didn't really know. And he's okay, so yeah, it's still hard. No, I

Scott Benner 29:27
understand. But there was really no way to know. I also think I might name this episode out and about full of doubt.

Amanda 29:35
That's awesome. I'm definitely full of doubt all the time.

Scott Benner 29:42
Well, I mean, you're you're past that now, though. I mean, I don't know what you do to let go of it. All I can tell you is that most of the people I've spoken to in your situation, feel it in the beginning and it lessens over time.

Amanda 29:55
Yeah, and I know I remember. I don't even know how I stumbled upon the podcast, I just seen something and then went to it and started listening. And I just remember standing like crying, because I couldn't believe that there were other parents that felt the same way. Like I thought I was the only one that felt like that.

Scott Benner 30:16
Do you have a real like, conscious thought? Like I'm alone in this? Or is it just a feeling like when somebody says, I found community, I realized other people felt like me, I thought I was the only one who felt like this. Did you? Did you really think that? Did you really have like a conscious thought? Like, I'm by myself? No one else knows how I feel? Or is it just a? Is it just a feeling? Or an Express?

Amanda 30:43
No, I really did. I did. I guess I I didn't know that. So many people would feel the guilt that I felt for not seeing and letting it go on for so long. Kind of thing.

Scott Benner 31:00
Sort of this expectation that everybody's better at something than you are? Yeah, I probably think like that a lot. Yeah, that's probably not true, by the way.

Amanda 31:10
But I I know, I'm good at this. It's taken a while but like, I've surprised myself in like his management. I know I can be really good at it. And I'm learning a lot and I've put everything into it. But I probably wouldn't be where I was if it wasn't for you in the podcast and the whole

Unknown Speaker 31:35
Facebook group.

Scott Benner 31:37
Yeah. You got into that very quickly after diagnosis into the Facebook group. Yeah,

Amanda 31:40
it was September. So and I asked a lot of questions. I was like, Oh, my word people are gonna be so annoyed with me. But there were so many people like strangers that were willing to help out and give advice. Like, I probably sometimes put on three questions a day just to get this support and see what other people were thinking and, and know that I was kind of like on the right track.

Scott Benner 32:09
I'm scrolling through your posts right now.

Amanda 32:13
Oh, no.

Scott Benner 32:14
I'm just like scrolling. They're, they're limitless. I feel like I feel like my fingers gonna get a cramp. If I keep scrolling. You probably will. I don't know if I should be happy. I mean, Amanda. Yes. Sorry. You disappeared again. But sorry, I have no idea what's going on. It's like the last couple of days this is happening. It's not my setup, but might be the internet. Maybe everybody's home from school using the internet and they should stop and go back to what they're supposed to be doing. So I can make my podcast plus your what do you do probably like on like, the tip of an iceberg or something like that. Wherever you live, right? Sorta, yeah. Are you really know? Maybe like, right in the middle of Toronto or so?

Amanda 32:59
No, no, definitely not. Oh, yeah. Those people who? Um, braid on the river,

Scott Benner 33:04
so nice. Well, anyway, so you posted a ton. And as you're thinking, like, Oh, I hope people aren't bothered by this. What I privately think is, this is terrific. Because your questions, got conversations moving.

Amanda 33:25
Yeah. And I did notice that like, and some, they would lead to different conversations between other people in the threads. And then I was able to learn more just from them changing the topic to something a little bit different.

Scott Benner 33:43
Yeah, I had a person one time put a post up. It only happened once. They said, this group is full of information, you should do a search and stop asking questions over and over again. I message that person I was like, Hey, stop it. Like was like you fundamentally misunderstand what this group is. It's not a encyclopedia. Like like people who think that Facebook groups are already have all the answers. So just go find them. That's a quick way to kill a Facebook group.

Amanda 34:13
Yeah, it's, I mean, every day there's a different topic and different people's lives, like what they're going through. And it's you pick something from it. Yeah. And I was really embarrassed at first to share because I'm not like, like, my Facebook page is just like silent. There's nothing on there. But like to open up and share and ask the questions was like, like, I was really nervous about that. But at one point, I was like, You know what, it's for my son. I'm gonna do this and, and it's helped like so much. So I always post whenever there's people like new people always say like, listen to the all the episodes and ask questions.

Scott Benner 35:00
Yeah, it's very, very helpful. It's not just helpful for them. It's helpful for the, for the group to, like, I can't if if I made it my life's work to just manage that Facebook group. Just me. I'd never do anything else. No, probably not. Yeah, average of, I think it's right now 80 to 110 posts a day. That's crazy.

Amanda 35:22
Yeah. And 75 of them are probably mine.

Scott Benner 35:28
And I don't, I'm not even aware that groups at the point now if people tag me, it's even a crapshoot of I'll see it.

Amanda 35:38
But you're there, you're involved. And it's like, really something to see. Like, you comment to things like, because you're taking your time to do that. And you don't see that and a lot of groups and stuff. I'll tell

Scott Benner 35:51
you, there are moments. Like last night, I was sitting here, headphones on editing a show. So listening to a show with with a mouse and a keyboard to my left in case I needed to do something to that. On my right. I was building a web page for content that's gonna go up in a couple of days. And I was talking to people on Facebook saying,

Amanda 36:17
Oh, my goodness, I was like,

Scott Benner 36:20
and then if you go downstairs and ask my wife, oh, don't talk to him while he's doing something. He can't do two things at once. And I'm always like, Yeah, okay. But anyway, it's important, like the group is important. What it does for people is important, and the way it works. Is, is is valuable. If you come on, you don't know, you ask a question. Somebody hopefully steps in and says, Well, let me ask you another question. See if we can get to your problem, or some people will come in with advice. And every once in a while, they're still, you know, there's something happened the other day where I just felt like, there was a moment where I was like, there's like, 20 crazy people in here. If I could just make them leave, this would be better. But yeah, but at the same time, I'm like, It's okay. Like, they were in their own thread. Being crazy. And I was like, yeah, good for them. Like get any like somebody, like, you know, people can report posts. Yes, someone reported it. And it caused me to go read through it. And I thought, Oh, this doesn't matter. Like, let them let them be get an amen. Like they're, they're having their own conversation about something like do I think they're right? I don't do I think they have conspiracy theory issues and should speak to somebody? I do. But it didn't bleed out into the rest of the group. And that just means that there's 109 other posts that day that somebody else can do. And I know it can sound overwhelming, like, wow, there's that many. But it doesn't work that way, the algorithm does a surprisingly good job of pushing down posts that don't find engagement. Oh, really? Yeah. And it's not that people don't get their questions answered. They just don't end up in posts that are like 30 Answers long. If somebody comes in says, you know, asks a question. Next person's like, oh, yeah, this this, this, the other person says, Thank you, and it kind of dies. You know what I mean? But that person still got their, their question answered. So I don't see a better way to do it at this point in time, but the way technology is set up right now, I can't believe I'm saying it. But Facebook groups are perfect for this. So yeah, it's great.

Amanda 38:37
It's, it's my go to for everything. If I have any questions, I'm like, Ah, I'm gonna ask my group. And then they all laugh at me and then gets funny.

Scott Benner 38:47
Well, do you get your answers? Yes, I do. Perfect. Yeah, absolutely. Perfect. And look how you threw yourself into all this for your son. And you really did. So tell people a little bit about like, what the journey has been like, for the first year understanding diabetes?

Amanda 39:02
Um, well, when they told me that he had type one. Like, I was like, Oh my gosh, what? Like, what am I gonna do? He's a picky eater. Like, he doesn't he only has like, 10 things he likes to eat. And just I had even though my dad was type one, I had no idea what it was actually. Like. And we just, I don't even know I just came home and and his blood sugar's were I mean, crazy. In the beginning, I have a book that I looked back and that first little while was just like, above 10 all the time. And, and you can see when I pull up my clarity and stuff, when I started listening to you, and learning more, and there was at some point that I just like I wasn't getting anything for In our local clinic, the group and the podcast was where it was going to learn everything I needed to know. Now Boyd does have a lot of anxiety over pretty much everything. So that was really hard for him. He liked the injections. It was just like crying. Every time he would avoid treats like, because he didn't want to have any more injections than he needed to have. And through the group, I did find one lady had mentioned to me about the Medtronic. They i Poor report. Yeah. Have you ever seen one of those little things? See the picture of it? Yeah. Yeah. So I was like, I'm gonna order that and try it out. So I put them on. Oh, he everything he has on him all his devices we do when he's sleeping. Because he wants nothing to do with it when he's awake. So the decks calm. Whenever we have our Dexcom change night we do it once he falls asleep. He never wakes up sleeps through the whole thing. We do. We did the eye ports that way as well. And he he had said that we made this video one time, I think I sent it to you. I don't know if you've seen it. But we were just sitting at the table. And he was he was like, Can I have a chocolate bar from his Halloween treats. And I was like, Sure, we could just give you the extra insulin for and he had his eye port. So as we were sitting there, he said, you know, my eye port almost makes my life like normal again. Because he didn't have to experience the pain of having the injections. So anything that I could do to make it easier for him. I'm gonna do it. And I'm gonna find a way if there's a way he doesn't like things or bothers him, I'm gonna find a better way to make it more comfortable for him and the eye ports. I highly recommend those. Anyway, great.

Scott Benner 42:04
Is he still using MBR? Now?

Amanda 42:08
No, we're on Omni pod now. Oh, okay. He's been on that since early May.

Scott Benner 42:16
And he's okay with insertion. But it has to happen when he's asleep.

Amanda 42:20
Well, see, I he started with the Omni pod asleep. And we told him you know, it does fail sometimes. So you'll have to do it in the day. The first ones in the clinic, he did do it. And he said it wasn't too bad. But he preferred it when he was sleeping. But the last probably two months, we've had to do Dexcom in the day. And he's doing it awake. He prefers that, like when he's sleeping. But he does do it. And the Omni pod if we need to do that earlier, something he'll do that when he's awake too. So I feel like that I just gave him his own time to get used to, you know, this big

Scott Benner 43:04
life change. And he's making progress now. Yeah, he is he's doing

Amanda 43:08
it all on his own. And

Scott Benner 43:12
that's excellent. Good for him. That's really great. Plus, I mean, how you can't keep that going forever with the sleeping thing. Also, I'm impressed that he can sleep through.

Amanda 43:22
He doesn't but jumped on you if there was some nights we would have to do like Dexcom and Omni pod it would fall on the same night. And we do both of them and he'd stay sound asleep. The whole time.

Scott Benner 43:35
I was making myself laugh while you're talking. I was thinking like what happens if at four in the afternoon, you need to change something? Does he run over on the sofa? Lay down and go to sleep real quick. So

Amanda 43:43
no.

Scott Benner 43:46
But that's really great. I mean, that's terrific. It's in his time you took care of it? Do you really think it was the people say anxiety a lot, especially lately? But do you think it will it's real, like clinical anxiety? Just think it was a nine year old kid was like I really prefer if you didn't stick that needle in me?

Amanda 44:03
No, I think I mean, he's had a history of it with before diabetes, he's just always been anxious and afraid of things and, and scared of new things. And just it's just like that form but it's all once we've get over this hump of like this big life change because you know, he now he used to say like he hated his life and diabetes ruined his life and and you might as well die. He would say he has to have diabetes, and I can't even remember the last time he said that. Like, like he's happy now and he he'll joke about it some and I love insulin. I don't take it all die also. But like he's happy because I think it's because I let him adjust to the new lifestyle on his own. Yeah,

Scott Benner 45:02
no, it sounds like he did a really good job, honestly. And you're understanding the diabetes on top of that, like, what's his agency now?

Amanda 45:10
Well, we haven't had an official lab, a one C done. Because of COVID. It was

Scott Benner 45:17
an iceberg. Just stick with the Joe command. Right. And it's too hard to you know, get the dogs together and go all the way to Maine to get your blood test. So okay, now that my sledding dog right, of course, so and what are you going to feed them? They're hungry, and if you they run, they need more food and exactly busy. So but But what are you getting off of clarity?

Amanda 45:42
Yeah, and I did have one done, you can do the meter when like at the drugstores so at his six months, he was five, nine. Wow. And we're actually next week, he's gonna have the lab a one C DME, but still on Claire.

Scott Benner 46:02
We were doing so good. And say it again on clarity he was.

Amanda 46:09
He's still five nine on clarity. Wow. But it was it was up to. But did you ever notice that in? When you look at the summary unclarity of the A one C and then you look in the AGP. Part of it, it's different.

Scott Benner 46:26
Can I be honest? That's what this is. Right? I don't look at those apps very much anymore. Artists, a one C is about where I expect it to be. If we're doing great, it's 56789. If we're doing terrible, it's 6123. Like in there? Well, not three, usually six to eight. And I just don't I just trust that it's going to work out the way I expect it to because it just does.

Amanda 46:57
Yeah. And I honestly, I'm kind of like that as well. They won't see doesn't really, like it means something to me. But it doesn't because I see what happens every day for him. And I see like, I like looking at the standard deviation. If I can keep that tighter that he's not bouncing up and down all over the place. I'm more happy with that. Yeah. Now with the clarity, like, I kind of lost control after we started on the Omni pods. So maybe a little bit before that. And it did say 6.5. But I've noticed, like, in the last months, like I'm getting more control. And I've also find when like there's, I mean, there's your way of management. And then there's the doctors way of management, right. So every time I go, it's like, I get a lot of fear. They put a lot of fear in me of lows, and and I feel like I'm doing something wrong by trying to keep him in such tight control. But when he is in better control, when at better numbers, I can see that he feels better, right? Yeah, I'm not gonna, I just can't do that. I feel like it's my job as mother, right? So I'm not just gonna let him bounce all around. So I kind of get afraid of the insulin for a little while. And I feel like I'm back on track now. And I'm being more aggressive and things are, like doing a lot better. Just in the last month. When you

Scott Benner 48:43
move from MDI, you had you had a way of doing things. You move to a pump, you had to adjust. And now you're figuring that out. Right?

Amanda 48:50
Yeah. And I'm in a good place. And I'm actually I've built the loop app. Okay. So I'm dabbling in that now. But again, it's something new, so it makes me nervous. But I really want to do it. And I've built the app, and I am just waiting for my orange link because I got an emo link and it was It wasn't really working. Right. So I've had to send that back to Robert. And he's gonna look at it for me.

Scott Benner 49:26
I just bought I just bought another orange like the other day.

Amanda 49:29
Yeah. And I was like, I need to anyway, so I'm gonna get the orange link and try that and it should arrive tomorrow or the next day. But it was amazing. Like the little bit I did try it to see what it could do for him. So right now I've been kind of acting like the algorithm myself just from seeing it for only a few days.

Scott Benner 49:51
Isn't it watching watching the algorithm works. You're like, Okay, I see. Like I see or you see I see where more is needed and where less is needed and How much yeah, it is to make decisions when you've, when you've seen it happen when you've seen that algorithm do stuff. You're like, oh, I never would have thought to put insulin here. That's a great Yeah,

Amanda 50:08
yeah. And take it away. I've been doing like Temp Basal Slyke off and stuff. And I've stopped lows. Like, when I knew it was gonna keep going down. Oh, for sure. And it's worked really good. But my my problem is, well, the basil, I'm always questioning the basil, I can't seem to figure that out. And I know I heard you say once that Arden has more basil in the daytime. So I'm wondering if Boyd needs that because I can, like he's only at point two right now. For basil like his, his insulin needs are very low. Like, it's usually be at between 10 and I think 14 units a day. But that's just because we've been having summer treats and extra food. Yeah. So I can leave him if he's gaming, and sometimes till 11 In the morning, but I'll just leave him alone. And he can stay up point to that whole morning and not need anything and be like in the low fives. And then yeah, and but then as soon as he has breakfast. And then Breakfast has been really good lately. Like I think I he only went up to he didn't even really have he went to 6.9 at breakfast, and then stayed up there for a bit and I had to give him a little more. But then lunchtime. And then after lunchtime till bedtime is like the big problem. He just he stays up.

Scott Benner 52:03
Lunchtime. And what happens if you get more aggressive with it? Well, oh, later.

Amanda 52:08
Yeah. But I can't figure it's really hard. What I find to figure out is all the variables that you have to deal with with a child, especially with the activity, because if I don't give them enough insulin, which I've increased or decreased, I guess his his carb ratio, and it will work. But as soon as he starts playing and stuff, he drops right down.

Scott Benner 52:34
Right? So so that is strong enough. If he's, if he's sitting around, it's perfect. And once he becomes active, there's too much insulin there.

Amanda 52:43
Yeah. So which way do I go? Like, I just, I find it very confusing to figure out that like, but in the last week or so I have been, I've been trying the stronger like insulin at lunch. And it's almost like he is taking double the amount if he just sits around, he needs double the amount of insulin. And he, like he'll stay pretty good, like the breakfast there. And I'll keep it at the strongest or stronger insulin. And then if he's gonna do activity or play with a friend, I will judge it on that and take it away. Is that what people usually do? Do you know what I mean? Yeah,

Scott Benner 53:32
yeah, sure. You do like a Temp Basal decrease over, you know, before the activity and maybe during the first two thirds of it or something like that.

Amanda 53:40
So what because I asked a question in the group there just the other day about, like, when is your carb ratio supposed to work? Is it supposed to work? If they're just sitting still? Is that?

Scott Benner 53:58
The answer is that if they're just sitting still, then maybe there's one ratio. And if they're moving around, there's another? And you just have to maybe be aware of that or shoot the middle? Yeah. And, you know, make up for it on either side. Deal with a with more or less, depending on?

Amanda 54:16
Yeah, and I think that's kind of just clicked recently that maybe I should be more aggressive. And work back like that if I need to.

Scott Benner 54:25
Well, 13 months in Amanda. You're doing great. So thank you. Yeah, I wouldn't I wouldn't beat yourself up about it. Just I mean, it's a what do they say? It's a marathon, not a sprint. Right. So,

Amanda 54:38
oh, it's so much more like I'd never realized what my dad went through or anyone that has type one or a child with type one and a lot of people they, they just they don't understand that it just never stops. Like it's every minute every time Everything he does if he games if he gets upset if he walks the dog, like, every little thing affects his blood sugar.

Scott Benner 55:08
Yeah, it's funny. It's you know what it is, it's um, everything in life is that way, except there are things you can ignore. And or put off till later, right? And diabetes ends up not being one of those things that you can just say like, ah, you know what, I won't pay, like, you know, you get into a fight with like your neighbor, and you walk back in the house you go, I'm not gonna think about that anymore. I mean, they still hate you. And, but it doesn't really impact you in the moment, because you're back in your house. But, you know, when you're doing diabetes, you know, ignoring it, it's funny, right? Because the The goal is not to be paying attention to it constantly. Yeah, the goal is to find stability that exists on its own doesn't need your input a ton. But if you do ignore it, people ignore it on the high side, because they don't want to get low. And then before you know it, you've been in your house for six months, you haven't talked to your neighbor, and you're a one sees eight and a half or nine. And, you know, you've you've done a real disservice to your health at that point. So

Amanda 56:12
yeah, and I'm probably I fear that a lot because my dad isn't with us anymore. He, my dad was great. He was a great dad fun. But he did live, like quite a hard life. He was a truck driver, and he drank and smoked. And and that doesn't really work. Well, type one. So he did have a heart attack and asleep when he was humbled was a 51. Wow, that Moore's around there. But now, the more I have learned, like, I know that it wasn't just the heart attack. I know it was the complications from poor management,

Scott Benner 57:04
and diabetes probably caused the heart attack.

Amanda 57:07
It did. And nobody knew that. And I didn't realize that till I learned so much more like about it, because I know, there was lots of times that we thought that he was just like, on the couch sleeping, but he was probably near diabetic coma or something like he just was all over the place. Yeah. No, it was in their 80s and 90s. So I mean, you didn't? He didn't know in a small town and

Scott Benner 57:39
plus Canada. You know, I'm saying, yeah, no, you have to go all the way to Maine to find out if you have Lyme. Come on Canada do better. Terrible, really bad. You know, I don't want to share somebody's details. But I know a Canadian who's having trouble getting some simple health care right now. It makes me angry. So now

Amanda 57:58
it's different. Yes.

Scott Benner 57:59
Yeah. Well, there's a triage system. Yes, yeah. You call your doctor, you're like, hey, I cut my finger off. Oh, come right in. That's fine. You call your doctor and you say, my finger really hurts. I think it's gonna fall off again. It's fine. You come in about four months? Yeah. So it's and I don't think that the person with a cut off fingers shouldn't get quick treatment. I don't understand why everybody else keeps getting, like why does the system not account for the fact that there are some people in emergency situations, and some people were trying to improve their lives? And we could see them all at the same time? I don't. But I'm right about that. Right. Like, that's how it goes. You kind of get pushed off if your stuffs not as serious. Yeah. You don't want to speak bad about the motherland. I hear what you're doing right now. But it's okay. I'll do it for you. You don't have to say look, there's plenty of problems with the American healthcare system. So but if you have insurance, or cash getting seen isn't one of the problems.

Amanda 59:02
Yeah, exactly. Yeah. No, it isn't.

Scott Benner 59:05
So I gotcha. All right. Let's see. I was gonna make a big point that I lost it when I got annoyed at Canada. Shoot, shoot. owe you I think you mentioned in your note that you weren't really aware of what can happen when diabetes isn't well managed. That the podcast helped you understand that and I appreciate you telling me that because that was a big moment for me. When I decided like let's just be honest about the whole thing. And not just like the parts that are easier to deal with. Like it's unfair. I just I'm not okay with the idea. What do I want to say here Amanda? I'm aware that there are things happening in my life right now. Physically, emotionally, my my. My communication share with other people. Like, I know there are things that are happening that I'm not aware of. Right. But I think you want to be aware of, of as much of it as possible so that you can make conscious decisions for yourself. Like, I can't imagine your poor father 51 years old, the heart attack took him at 51. Is that right? Yes, 51 years old, and he's dying in his, you know, in his bed for something that didn't have to kill him. Not as though you know, and he doesn't get the opportunity to think like pause his heart attack and go, Oh, gosh, I wish I would have known more about how to manage my blood sugar. But it's, you can't just ignore things like this. You can't ignore anything, it's eventually going to blow up on you. But there's a difference between losing a friend, you know, in a relationship to bad communication and losing your life. Because you don't understand that you need insulin and how it works. It's not okay to me. Yeah, you know. So anyway, so you say it out loud. And then some people are like, well, you make people upset when you say that I was like, you know, when they're going to be more upset, when they're 51 Grabbing their chest, in their bed, that you know, then they're going to be more upset, like, tell them now give them the opportunity to help themselves. So I think of it,

Amanda 1:01:19
it really doesn't like it just It boggles my mind. Like I just can't believe the lack of education for diabetes. Like it's like, I really don't know where we would be without, you know,

Scott Benner 1:01:38
you don't have to say thank you so great.

Amanda 1:01:39
Like, I talked about you all the time. Like, everybody makes fun of me, my family.

Scott Benner 1:01:44
Oh, tell them to shut up.

Amanda 1:01:47
But you know what, now my husband, I got him on the group now. So I'd be like, do you Did you see this and he'll like, finish my sentence, because now he's into looking through it, and seeing all the stories and he'll ask me, Did you see this? And so it's really great. I got

Scott Benner 1:02:04
freaked out. When we get in bed. My wife says, Did you see a post in your group that I'm like, You're in my group. Stay out of there. I was like, What are you doing? She's American banks around. But no, I think that's terrific that your husband's looking at that really fantastic.

Amanda 1:02:17
Yeah, yeah. He listens to like all tell him the episodes to listen to. And it really got him on board with what I wanted to do with Boyd and how I wanted to, you know, keep things tighter for him. Yeah. And, like, we work so good together. Like, we're like a plus team. I think

Scott Benner 1:02:41
for you. That's excellent. Well, alright, so is there anything we haven't talked about that you want to I don't want to miss anything.

Amanda 1:02:48
I didn't want to I wanted to know, like, with Arden and stuff, like a lot of people push, like, oh, they have to be independent and do this on their own. And I get a lot of that from my son's doctors and the teachers at the school. And like, I believe in that. But to me when I look at how you like you push hard and to be independent, but I feel like, am I wrong that you take on most of it? Like just so she can still be a kid? Like when she was younger and stuff. I wanted to talk about

Scott Benner 1:03:32
I was talking to somebody in my private life about this yesterday. Yeah, because there are moments even at 18 years old, where I'll say something to Arden and she puts it off or she's like, Yeah, I will. I will. I will. And there's part of you that wants to say like, come on, like you're 18 Just do it. You don't I mean, and there's part of me that says, Oh, she's only 18. And people, generally speaking, don't have to live with problems like this, you know what I mean? Unless they have an issue, like diabetes and other things. So there's a balance in there in my mind. And the goal is to protect their psyche and their experience. And at the same time, be doing things in the open so they can see them and learn from them. And then the next. It's not a problem, but the next step is to transfer it to them. And I see that transfer is a slow process.

Speaker 4 1:04:35
Yeah, that's what I feel too, right. And it's not

Scott Benner 1:04:39
like you're gonna like you can pull your son aside when he's 12 and go alright, guess what, Boyd you're 12 years old. Now. Here's how you Bolus for fat and protein you better not forget because you eat french fries. You know what I mean? And your blood jolly eats Yeah, and your blood sugar is gonna go to 250 If you don't know how to do this, and it's gonna stay there for three hours or a once he's gonna go to seven and blah blah, blah. My dad had a heart attack, like you don't mean like, you're gonna like you're gonna, it's too much. So it's little bits, little bits, little bits, and then you kind of have to step back and do an assessment once in a while, like, are they coming along the way I expect? I think they are. And then once in a while, you have to realize that they're kids, and they're gonna use that as protection. Like, I don't want to do that, you know? Or it's sometimes it's little stuff like, I got a text from Arne last night. Can you bring me my blah, blah, blah? And I'm like, okay, sure must be a problem, right? So I leave where I'm at, I go to where she is. And I give it to her. And I'm like, you couldn't have got this she was I just didn't feel like getting up. And I'm like, Alright, like, let her have that a little longer. She's leaving for college and four weeks, no one's gonna ever do this for again, you know what I mean? And so art is a one see right now, it's probably around six to actually I looked on the app earlier, it is around six, though. And it's because she's been doing more of the stuff recently. And she's learning Yeah. And she's, she's having her own experiences and learning things. And I'm doing that purposely now, before she leaves for school hoping that when she gets to school, it'll empower you to make good decisions, not just not just try something and go, Oh, hell, that didn't work. You know, we found out yesterday that her her first semester classes are pretty much as far away from her living situation as possible. Oh, really? Yeah. And now there's a bus that runs through the, so the campus is kind of spread out through a town. So there's a busing system that she's going to have to use. But still, it's like a 26, block walk to one of her classes. Oh, wow. So she's obviously not going to walk it. Right. And then your first thought is, oh, I guess we got to find the money and buy her a car. You know, because she doesn't have her own car. She uses Kelly's car, which drives around here. And then I'm like, I'll just let her take the damn bus. Like, she'll be alright. You don't I mean, like, it's only a couple months, the first time she's going to be away. I'm like, let her take the bus. And and figure that out. Because it's another learning experience. Exactly. Yeah. And so I get when people say it, they need to understand it for themselves. And I get when older type ones say it, because I think what they're saying is I didn't understand my care. And then look what happened to me. I think they mean that a little bit. And at the same time, I don't understand why you'd have to give it all to them on day one, or because I've also spoken to people who've had that happen to them. And it has not gone well either. Like, yeah, you're you're talking about extremes. You know, and and I don't know why everybody, I don't understand, like, you ask the question. And you get, you know, a group of people feels like they're holding the flag yelling, it's their disease, they have to understand it, give it to them, blah, blah, blah, like you don't help them. And then the other side, it's like, well, they're just kids. Like, like, where's the middle? Like, how did we lose the middle? Amanda? You don't need me? When did the? I think it happened for me? You're Canadian. So I don't know about your politics are different. But when I was growing up, politicians tried to make the middle seem like you didn't have an opinion. And I don't see the middle is not having an opinion. I see the middle is a blend of both sides. Yes. So that's how I think about this. Like, I mean, and just you just can't let it get away from you. You can't let them take advantage of you, too. Yeah. That's hilarious. Amanda. And, hello. Hey,

Amanda 1:08:52
and not think about the diabetes for just, you know, my knees playing?

Scott Benner 1:08:56
Yeah, I mean, I have to stop you. I spoke for six solid minutes. Then you opened your mouth and we lost your thing. So just start over what you just said. I'll fix it later.

Amanda 1:09:07
Now, I can't remember.

Scott Benner 1:09:10
I said you can't manage. Have you? Oh, and

Amanda 1:09:13
I said that. I don't remember. You're gonna cut that out. Right? Please.

Scott Benner 1:09:24
Oh, maybe who knows. But anyway, I'm sorry. I went online like that and answered your question. Oh,

Amanda 1:09:33
I love listening to you.

Scott Benner 1:09:34
Do you really? I'm so sorry. Yes. Hello. Have I tricked you into liking this podcast? What happened?

Amanda 1:09:40
I don't think so. Okay, just great.

Scott Benner 1:09:42
Oh, stop it. I'm gonna go downstairs and live with people who don't think I'm great in a couple of minutes. And then what am I going to do there like I to me, I love listening

Amanda 1:09:52
to about your bantering back and forth. With your family. It sounds like mine. We're always picking out each gather in teasing and going on?

Scott Benner 1:10:02
Well, I don't know, I think when you're around people all the time, no matter what the situation, you know, you don't. You don't see the whole thing I started, I started to share something with Arden and Kelly yesterday. You know, everyone's talking about this thing. This subject right there talking about God, what were we talking about? We were talking about just oh, how our brains work. Right. So about, like, some people have inner monologues and some people don't? Yes. And so we're talking about it. And I don't have an inner monologue. Like, I don't have a disembodied voice that isn't my voice that, you know, that's, that's directing me. I'm saying this wrong. But Arden does, like artists had when she reads the voice in her head, says the words to her. It's, it's how she describes reading, right? Yes. And she's like, What happens when you read? And I'm like, I don't know, I just know the words. She's like, you're not hearing them in your head? And I was like, No, I don't think so. Like, or maybe who knows, like, maybe her description or my descriptions are exactly the same. And because I'm looking like here, I'm looking at a different computer screen right now. Somebody's talking about blood sugars. And it says here, the algorithm has specific things it learns from, it won't learn from what But now, if I go back and look at it again and read it in my head. I don't hear the words in my head. Right. But Arlen does. And yeah, and so we're talking about that. And then we started talking about how we understand things. And she said that she has trouble watching television with closed captioning on because she hears the actor's voice. And then the voice in her head says the words when she reads them. And I was like, Oh, I could see how that would be confusing. And, and then I joked with her, and I was like, hey, what else do the voices in your head saying? She goes, they're not voices in my head. It's how I hear things when I read, like, like, okay,

Amanda 1:12:06
that's too funny. Yeah.

Scott Benner 1:12:08
And then I and then she started talking about how she didn't enjoy taking the SATs, because her brain doesn't work that way. And I would not be good at standardized testing, either. But my son, my son, and my wife would be anyway, this is a long way of saying, then I said, Hey, I'm doing this thing. So I can't tell you what this is exactly. But I'm doing a business thing, right. And I'm working, and I'm working with some people. And it turned out really well. But I'm kind of the one that that told them how to do it. Like, they had pages of notes and ideas. And I got on I got on a call with them with nothing written in front of me. I was like, no, no, do it like this, do this. And this, and this, put this here, this is what's going to work. And they're like, that's great. And I just thought like, I don't know why my brain does that. Like, why did I not need to write it down or go over it or think about it before it happened? And and so people's brains just work differently. Anyway, as I'm telling them that my wife and my daughter start mocking me. Oh, I'm so good at this. I'm like, That is not what I'm saying. They're just they love to tease me. It's unpleasant. Amanda. I don't deserve to funny was literally literally trying to like, expand a conversation we were having at the middle. I talked about my own perspective for a second. They're like, Oh, look who's here. It's the guy with the podcast. I'm like, oh my god, you guys are assholes. So they stopped. And they laughed at me and I stopped talking to him. I was like, Well, now you've enjoyed our conversation. Congratulations.

Amanda 1:13:42
I'm excited. Like, I don't want my kids to grow up. But I'm excited for them to be teenagers like that.

Scott Benner 1:13:48
Yeah. I would like, Tell me more. Why?

Amanda 1:13:54
No, I was just gonna say I like to keep them young and save them.

Scott Benner 1:13:58
I know you feel I've been thinking lately about what it's going to be like to drop bharden off at school. And then take a long ride home. I figure I'll just like devolve into a pool of tears and you probably will swim in. Yeah. Right. Because like, I kept thinking like, how am I gonna leave her there? Like, my son was two and a half hours alive by car. And I could like, I could get up in the morning and think and on a Saturday and say like, I'm gonna go see his baseball game today. I could just I could do it. You know what I mean? get my work done during the week and go do it. I could do that. But Arden is going to be at Best Buy car 13 hours away. Oh, she is Yeah. So that means I'm gonna have to leave her there. And I'm pretty sure I can't do that. So I don't know how to explain to her that when I leave I'm gonna suffer back in the car. Back Oh,

Amanda 1:14:54
yeah, I'd be the same way. Yeah,

Scott Benner 1:14:57
but at the same time I take your point, right. Like I want them to get on older, and I want, it's not like we're going to stop it right. And I want them to have experiences and be happy and sad and do all the things that happen. The thing that bothers me the most Amanda about them getting older. It's the medical stuff. Yeah, I was. I was looking at Arden last night before bed. And I thought I let her down. Like I really did, like, I thought I failed. Like I didn't. I didn't figure out everything that that else or before she left. And then I realized I'm like, Oh, God, is that how I've seen like the last 18 years of her life? That's just trying to get her to a place before she left. You know what I mean? Like to a level or something like that. But I know I didn't do it. Like I tried. And like you said earlier like I everything I tried everything I could think of and we got her pretty far in a lot of places her diabetes is definitely not a not a big concern. Or thyroid stuff is not a big concern. But there's other things that we just didn't come up with answers about. And I hate to say that listening to you earlier about like, stuff like joint pain, even your like it just kind of went away after a while, like I reached

Amanda 1:16:18
a certain certain have joint pain, though. Did you say that one time?

Scott Benner 1:16:21
She does sometimes. Yeah, she gets like her kneel hurt or hip. It seems to fluctuate around her hormones, but you can't really tell, you know, stiff necks, which cracks her neck a lot. She'll get headaches once in a while. You know, just like, I'll see her rubbing her hands, like things like that. And we've had her tested for just everything, you know, to the point to the point where I feel bad even taking her to a doctor sometimes to get out, like, you know, like, because they're gonna want a blood test. And then she's like, this isn't gonna do anything. And she ends up being right most of the time.

Amanda 1:17:00
Yeah. You know, that's, that's, that's just like how I am. Yeah. Well, I say to my husband sometimes. Does your feet hurt like this? Or does your back hurt like this all the time? Like, is this just what it is to be normal? But I don't feel like it is. And that's one of the reasons why I don't think, like, I don't feel like I have RA but apparently that's what they say I do. But it just bounces around and just things a Yeah,

Scott Benner 1:17:30
I wish I know. I don't know how to fit like my back. My lower back is hurt for ever. Like, I like it's just my whole mindset. And, and recently, I had to take a steroid pack for something. And I took it in for 10 days on this steroid pack my back loose as a goose. It was amazing. Yeah. And little things like my digestion works off and on. Well, and for 10 days, perfect. My back didn't hurt. I was eating and using the bathroom the way I imagined a person, you know, exists. I was it going on long enough that I was like, oh my god, this is amazing. It's a real turn. And I stopped taking that steroid pack. And immediately my back started hurting again. You know, and I was like, okay, my back's gonna hurt. I guess that's just what happens to me. Do I have some inflammation? And that, you know, maybe, like, that makes sense. You know? Like, I You have no idea. I do not. Oh, are you talking about it? And yeah, and I've had a stomach since I was like, I don't know. 13. But it doesn't make any sense. Yeah. Luckily, it doesn't make any sense at all. So I have no idea. I assume I'll just fall over one day, and somebody else will take my place on the planet and hopefully their back won't hurt. We'll keep going.

Amanda 1:19:05
I think you'll be around for a while.

Scott Benner 1:19:07
Yes. I don't know. You know what I did the other day, so bummed me out. I contacted homeless. My mom is trying to call me. Give me a second. Mom. Let me call you back in a few minutes. Okay. All right. Her doctor is not doing a good job of managing her blood pressure.

Amanda 1:19:30
Well, is she doing better?

Scott Benner 1:19:32
She is my mom had her cancer removed. Yes. When all through chemotherapy, she got remission. Good designation, and now we are getting ready to move her to where she wants to go live. So Oh, that's good. Yeah, unless her heart explodes because her blood pressure is really high. Trying to try to get people to stop that from happening. Oh my gosh. What was I gonna say? Oh, shoot. Right before she called What was I gonna say?

Unknown Speaker 1:20:05
I forget. Amanda, you are

Scott Benner 1:20:07
no help with us.

Amanda 1:20:09
Ever No, I

Scott Benner 1:20:10
I forget a lot. Forget what you said to Oh my gosh.

Amanda 1:20:16
Oh, what you were gonna do? You were doing something, weren't you?

Scott Benner 1:20:20
I was gonna do four. Oh, yes. Thank you Good job well done. Yeah, I contacted the company that hosts this podcast the other day. And I said, I have a slightly morbid question. I'm sorry. And there's no reason I'm asking this. So please don't worry. It's not like a health thing. I've just found myself wondering. I said, I have a podcast that helps people with their health. And what happens if I die? How do I keep it online? Right, so I'm gonna put this, so I'm gonna put this in here, Amanda. So everyone knows. Okay, you contact the company that hosts my podcast for me. It's called Libsyn. And you tell them, hey, the host of my podcast that I love dropped dead. And he said, you would continue to host it for free after his passing. So somebody has to remember to do that when I die.

Amanda 1:21:15
Okay, but I don't like talking about this kind of stuff.

Scott Benner 1:21:19
Amanda talking about dying doesn't make people die. Don't worry about you're fine. If the way people spoke about things made it so you'd be living on an iceberg. And your son would be riding a beaver to school? Because that's where that's what happens to you. So yeah, no. Anyway, I thought that was really nice. Yeah. Like, we'll just host it. The it will host it for as long as we're in business for free. Wow, the guys like don't die. I was like, alright, well, thank

Amanda 1:21:47
you. Yes, don't die. So.

Scott Benner 1:21:49
But anyway, I thought that was good. And I don't know when this like, when this thing stops being helpful to people, like I'm sure at some point in the future technology or insulin will shift. And a lot of what we talked about here won't be as I don't know it valuable, probably. But for now. No,

Amanda 1:22:07
Scott, I think it always will be. Because it's the truth you like you've lived it's nobody gets taught this way of how to really live with diabetes.

Scott Benner 1:22:22
I hope so. I mean, we've put a lot of time into it by now. Hopefully, it's not just, it's not throw away, you know?

Amanda 1:22:29
Oh, it's good. I started. I was trying to find the episodes that I one of the first ones I listened to this morning, but I went and I was listening to the fear of insulin. One like, that was one of the early ones. But then it reminded me how much I really liked that episode. And just and how much it like reminded me too, yeah, don't be afraid to use insulin. So now I'm going to go back through because I listened to a lot of the same ones over and over. But I'm gonna go back to those early ones. And that one, and what was the other one? Great after I just started?

Scott Benner 1:23:11
Oh, there's the ones on the Quickstart list. Maybe the roller coaster?

Amanda 1:23:15
Yeah, stop the roller coasters, something like that. And just, whenever I think I made a comment one time about, like listening to them. It feels like you're like speaking to me. Like I'm always saying like, how did he know that? How did he know to post that episode?

Scott Benner 1:23:34
You know, I have to tell you, that although I think you just I have to tell you that. Um, I get that comments so much from people. Do you? Yeah. How did they like how did he put up an episode today that was so specific to what I'm going through? And I think really, it's just an indication that you're all going through similar things. Yeah. You know, but I know how it feels like it does feel like like, because it happens to me every day. You always hear me say somebody asks a question. I go, Oh, we were just talking about this the other day, you know, and it's not like, it's not like, I'm not making it up. But it's just, it's the world you live in. You know, I can't wait to for Arden to go away to college and to find out. What I'm going to learn next because of our situation changing because we're clearly going to you know, we're clearly not going to stop talking. Oh, yeah. And she's going to have to get through a situation. You know, where she can say to me like, look, I'm good, and I don't think she feels that way yet. Yeah, I listened. Can I be honest, I don't feel that way. I'm pretty good at diabetes. And there's still days where I'm like, What is like, why is this happening?

Amanda 1:24:48
She, she needs you and I actually somebody said to me like, oh, it won't always be like this. You won't be stressed out like he's gonna be looking after it. Like he'll know what to do some day. And I was thinking like, so all this stress and everything, I'm just going to hand over to him. And now this is going to be like his problem to deal with. Like, it's always going to be the ups and downs and downs and dealing with. Yeah, The Rise and Falls, like, I'm not happy about handing that over, I'm always gonna be there to help him. And I'll always educate myself, as long as he wants me to.

Scott Benner 1:25:28
I feel the same way. I don't, I don't want to feel like that. I'm shouldering all this in one day, I'm just gonna look at it and go, hey, guess what happened? You turned 25 years old. Here's all the crap I've been worried about for the last 25 years. Good luck. You know, like, yeah, although I do think there will be an age that I hit, where, like, I watched my mom. And she just doesn't have the bandwidth to like, touch talk about all like, you know, when you're 40 and 30. And you know, your cousin does something weird. And you talk to your sister about it. You know about your sister's problem with her husband, and you know about your brother's problem, boss, like it's all in your head like that. You do get to an age where you just like, I can't, I can't worry about all this. And I don't think it's a conscious decision. I think it just happens because there are things that my mom used to be interested in and concerned with that she just does not talk about anymore. Oh, no. Yeah, so maybe, maybe. So that's the good news. Amanda. Maybe at the end, when you have to lean on something with wheels to get to the bathroom. You won't have to worry about diabetes anymore.

Amanda 1:26:35
That might be soon with me, though.

Scott Benner 1:26:39
Well, I hope that I made I really appreciate you doing this with me. Thank you so much.

Amanda 1:26:44
It's awesome. I'm so it's so exciting. Good.

Scott Benner 1:26:48
You had a good time.

Unknown Speaker 1:26:48
Yes, absolutely. Can

Amanda 1:26:50
we talk once a week now?

Scott Benner 1:26:52
No, we can't. I mean, I'm very busy. Do you know I have to answer an email right now from a person who wants me to call their friend on their birthday and wish them happy birthday. That's funny. Yeah, I can't do that. Amanda. That's a thing. Like I actually at one point, she's like, can you record a video message for my friend? And I was like, no, no, I can't do that. Well, that I get more than you think. But you guys can see. The world of cameo must give. Give people that idea. I'm like, I don't have like I'm working and I have a life and everything. I can't stop and make videos for people. And I said, I really can't do that. I said, I said, Look, why don't you just tell me figure out a way I can talk to her for two minutes on the phone her birthday. And I'll say and then she sends me the date and it's literally in the middle of Arden's moving to college. So I obviously can't Can you imagine if I walked out of Arden's dorm room or like hey, I'll be right back. I have to say hello to somebody for their birthday. My but they wouldn't even let me back in the room. If not, yeah. So now I have to send this email and say I'm very sorry, I can't do this. So I feel bad. But it is not the only it is not the only call. I got like that. Anyway, all right. Well, it was great to talk to you. Thank you so much. Yeah, hold on one second. Sure.

Well, I'm embarrassed to say I did end up making that phone call and saying happy birthday to somebody, I just felt so bad. I couldn't not do it. Anyway, let's thank Amanda for coming on the show and sharing such a terrific and open story with us. And of course, we're going to thank Dexcom makers of the Dexcom G six and G seven continuous glucose monitors. dexcom.com forward slash juicebox. Get over there. Get started. Let's do it. Speaking of doing it, you can get really comfortable luxury sheets for your bed at cozy earth.com. And then do whatever you want to do them. use the offer code juice box at checkout to save 35% on those sheets, the joggers and so much more cozy Earth. Thank you so much for listening. Thank you so much for supporting the sponsors. I couldn't do this without you. I'll be back very soon with another episode of The Juicebox Podcast. Keep listening, sharing. And of course please subscribe and your favorite audio app. If you're not subscribed, but you're listening, subscribe. Just hit follow like in the Apple podcast app or, I don't know, Spotify, wherever you get audio

#900 Best of Juicebox: Omnipod 5 Pro Tip: Overview

Omnipod 5 Pro Tips: Overview was first published on Aug 15 2022

This episode is available at JuiceboxPodcast.com/omnipod5

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 895 of the Juicebox Podcast

welcome back to another episode of the Best, the Juicebox Podcast. Today we're revisiting Episode 431, which originally aired on January 22 2001. This episode includes community feedback on the topic of switching from MDI to pumping. It's very informative. So if you're thinking of switching, check it out. While you're listening today, please remember 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 healthcare plan or becoming bold with insulin. Are you a US resident who has type one are the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box join the registry complete the Scott Benner 0:00
Hello friends, welcome to episode 900 of the Juicebox Podcast

Welcome back to the best of the Juicebox Podcast. Today's episode was originally today's episode originally aired on August 15 2022. It's episode 736. It's called Omni pod five pro tip overview. It is the first of my three part series about how to begin on the Omni pod five. While you're listening today, please remember 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 healthcare plan or becoming bold with insulin. As I said, this is the first part of a three part series. They're available to you at juicebox podcast.com forward slash Omni pod five or, of course, right in your podcast player. If you're a US citizen who has type one or is the caregiver of someone with type one, please take the time to complete the survey AT T one D exchange.org. Forward slash juicebox you really will be helping type one research when you complete that survey T one D exchange.org forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by ag one from athletic greens. I start every day with ag one and you can as well athletic greens.com forward slash juice box if you head over there now and get started. You get five free travel packs plus a year supply of vitamin D along with your first order athletic greens.com forward slash juice box best green drink I've ever had. The podcast is also sponsored today. By the contour next gen blood glucose meter. You can learn more or grab one at contour next one.com forward slash juice box you owe it to yourself to get an accurate meter and the contour next gen is just what you're looking for. Hello friends and welcome to part one of my Omni pod five series with Carrie Birgit.

Before we get started today with part one of this three part series, I'd like to tell you that insolate has paid the host of this podcast that's me Scott Benner and my guest Carrie Bergerac a fee to create this content. Kerry is an omni pod ambassador with an ongoing commercial relationship with insolate. This podcast provides general information discussions about health and related subjects. This information the other content provided in this podcast or in any length materials are not intended and should not be construed as medical advice. Nor is the information a substitute for professional medical expertise or treatment. Never disregard professional medical advice or delay seeking it because of something that you've heard in this podcast or read in any length materials. The opinions and views expressed on this podcast and website have no relation to those of any academic hospital, health practice or other institution. Please speak with your health care team if you or any person has a medical concern. And before making any changes to your diabetes management, you can always consult the Omni pod five automated insulin delivery system User Guide for more information. In short, nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. You are about to listen to on the pod five pro tip overview. The second episode is on the pod five pro tip settings. And the third episode is on the pod five pro tip connectivity. Please listen to them in order as I think that is how they'll best serve you. If you're listening in an audio app, these three episodes went up at the same time so there'll be right next to each other or you can find them at juicebox podcast.com forward slash Omni pod five.

Cari Berget, MPH, RN, CDE 4:22
My name is Carrie forget I am a nurse and specialty nurse and diabetes care. I work at the Barbara Davis Center which is in a diabetes Center in Aurora, Colorado. It's part of the University of Colorado Anschutz Medical Campus. And I love my job I love working with families who have kids with type one diabetes, because I get to help them figure out how to make the most of their lives and still have a great life even though they're having to deal with type one diabetes, which can be really challenging.

Scott Benner 4:54
Don't have type one, is that correct? That is true. I do not have type one. How did you make it to this kind? of work.

Cari Berget, MPH, RN, CDE 5:00
My background as a nurse actually did not bring, like prepare me at all for type one diabetes care. But when I first I've been a nurse for 17 years, and when I first started nursing, I worked in the hospital and I didn't love it because it was, I didn't get to know people enough I was it was too much just put a bandaid on things and not really get to know or help or be a part of anybody's life. And so then I started working as a public health nurse where it would do the home visiting program for young mothers. And so I would go into their homes and support them throughout their pregnancy with health education, and I got to work with them until their child was two years old. So I did that for about seven years. And while I really loved that, too, I was kind of like, well, I think I want something that's a little bit more clinical, but not back in the hospital. And I had a friend from nursing school who had type one diabetes. And I learned a lot about it from her and was just amazed at how, how smart she was and how hard she had to work to manage her diabetes, but also how much self care and commitment it took. And so then when I was looking for another career, the Barbara Davis Center came up and, and I was like, you know, I think I think this is, this is the place for me because, you know, I don't want a job where I'm the, quote, nurse who's, you know, in charge, and I just tell people what to do know, like, I want I want, I wanted a place where I could connect with people and come alongside them and support them and be a team to help

Scott Benner 6:39
him because he you get to make a real tangible difference in someone's life, right? It's not, it's not like emergent care where you just kind of run in and do what you got to do with leave. But you get to know people and see where their struggles and their strengths are. And then and then and lift them up a little bit, which I think is what we're going to be able to do here with these episodes. So I appreciate you very much taking the time to let us know about yourself. We basically have our topics broken down into a couple of headlines. Right. So the first one we have here is what do we need to know before we get started with the Omnipod? Five? And I want to ask you first, how many families have you been involved with so far with Omnipod? Five?

Cari Berget, MPH, RN, CDE 7:19
Well, I've been working with Omnipod, five for over two years now, because I got to work on the clinical trial, which was the study that you do before the device is commercially approved. So I had about 30 families that were in the child from our center, and I was the primary nurse for that study. So I got to train them on the device and teach them how to use it. And then we got to work together to figure out how to use it best. So that's been for the last two years. And then now that the device is commercially available, we're rolling it out in our clinical practice as well. And we've had over 250 new prescriptions for it. And just these last couple months, and then over 80 have started the system. So there's been a lot of a lot of kids and families that I've worked with on the system. That's perfect.

Scott Benner 8:07
So you've got to we've got a couple of years worth of knowledge that we can pull from here, it's going to be terrific. We're going to start simply getting things laid out right. And person wants to start with Omni pod five. What do they need? They need on the pod five? That's pretty obvious. But they're also going to need a Dexcom G six CGM. Is that correct?

Cari Berget, MPH, RN, CDE 8:27
That is true. Yep, the Omni pod five works with the Dexcom G six, and you do need that Dexcom G six in order to use the system. In the automated mode.

Scott Benner 8:37
It's important to remember that these are separate items. You don't get a Omni pod five prescription that ends up bringing you a Dexcom. So if you have the G six, all you need is the Omni pod five. If you have neither, then you're going to need to talk to your healthcare provider about getting a prescription for each.

Cari Berget, MPH, RN, CDE 8:54
Yes, very important point. Okay. The other important point about that is that the Dexcom G six is it really is a separate device in the fact that you need to use it on your own cell phone with the G six mobile app, there is no way to download the G six mobile app on the Omnipod five controller. So that's also an important piece to to understand and that you can't use the Dexcom receiver either if you're using Omnipod five,

Scott Benner 9:22
right. So if you're already a Dexcom G six user, and you're using Dex comms receiver, you're going to need to move your Dexcom on to an app on your phone before you can use on the pod five with it.

Cari Berget, MPH, RN, CDE 9:34
Yes, that's correct. The G six mobile app to be specific. Yeah,

Scott Benner 9:37
thank you. Now you could use on the pod five, right without the G six but you would just be using it as a just a regular insulin pump. It wouldn't be an automated system. That is correct. Yes. Having said that, Carrie. I think if you're gonna do this, like get all the stuff because, you know, right?

Cari Berget, MPH, RN, CDE 9:58
Yes, absolutely not. If you're going to get Omnipod, five, use it in automated mode, that will definitely be the best way to go.

Scott Benner 10:05
Yeah. Okay. So does that mean that you can't use Omnipod? Five if you don't have a smartphone? Well?

Cari Berget, MPH, RN, CDE 10:12
Well, the short answer is yes. But let me give you the more complicated trail have that. So you do need to have the Dexcom G six mobile app in order to operate the Dexcom G SIX sensor. And as I mentioned before, you cannot use automated mode without the sensor. But if you had the G six mobile app on one smartphone, and the sensor was all up and running, and you had already connected it to your controller, the active sensor session, if you already have the Dexcom transmitter in the Omnipod, five, app, either on the controller or your own phone, then once that's up and going, you don't need the G six mobile app within range in order for the pod five to operate in automated mode,

Scott Benner 11:01
right? Well, yeah, we're gonna go over that probably a number of times. So one of the one of the great things about the system is that it's it's self contained within the things that are on your body. So the GS six will talk to the Omni pod five, without the controller for the, for the, for the on the pod five there or without your cell phone, those things could be nowhere near you. And the algorithm can run because the algorithm actually lives, like right on the circuit board inside of the on the pod five.

Cari Berget, MPH, RN, CDE 11:29
Right, the algorithm is directly inside the pod. So the pod itself that is on your body, each one of those pods has the automated insulin delivery algorithm on it. So the Dexcom actually sends the glucose data directly to the pod. And then that pod uses that CGM information from the Dexcom directly to calculate how much insulin to give. So yes, you do not have to have the controller, the Omnipod five controller nearby, in order for the automated insulin delivery to occur,

Scott Benner 12:02
okay, so we have our stuff we got, we got our gadgets and gizmos on our websites, and we know what we're doing. And we got to get started, right. So some people are going to train in person with a CDE or a nurse practitioner, whatever they have available to them. Even I guess, I'm guessing through people that on the pod provides. Is that true?

Cari Berget, MPH, RN, CDE 12:21
Yeah, there. I mean, it depends on your clinic, there's a variety of ways that clinics might go about training their patients on insulin pumps in general, a lot of clinics do use the industry trainers, so they'll have a trainer from Omni pod that covers their clinic, and that would be the trainer that they would Gotcha. They would work with Yeah.

Scott Benner 12:40
Now there's also like an elearning situation, right? Where you can go online and take no walkthrough. Isn't that great, I don't have a job, carry, I don't have a job. So I don't get to do things the way other people do. But I hear a lot of people train online and stuff. But that, but I did take the online training from the pod five, and I'm assuming that's available to other people as well.

Cari Berget, MPH, RN, CDE 13:01
Yeah, it's available to everyone who's a current Omni Potter. The way it's designed actually, is that if you are current on new Potter, and your specific healthcare provider has like, given the stamp of approval that they're good with their patients self starting, then when you get your intro kit from the pharmacy, inside that kit includes a QR code. And it's just not very complicated, just Omni pod.com backslash setup, you go there, and it'll walk you through the steps of setting up the controller. And then from there, you can access the elearning modules, which will walk you through how the system works, how to program it. And, you know, walk you through the steps of starting it up. Right.

Scott Benner 13:43
So let's talk about that a little bit. The, I think, a couple of the key words, you and I are going to hit over and over again. One of them's going to be settings, whether this means your Basal profile, your insulin to carb ratio for your meals, your correction ratio, insulin sensitivity, all these things that I mean, if we're being honest, I guess a number of people don't even understand they go with whatever set up for them. And then whatever happens happens. But on this automated system, I think the easiest way to consider this is that if your settings aren't good, it's going to be like sending, I don't know, five basketball players out to play a baseball game, right? Like, you know, you've kind of got the tools there. You got some athletic people, but they've never held a bat before. They don't know how to throw a ball overhand. And and she you've got these things, it's close to what you need. It's not exactly what you need. So having your settings correct, is I think, in my opinion, by far the most important step of getting going. Now, how does how do you do that? When you might be in a situation? I guess what I'm what I'm thinking about is what happens if someone sees automated system while an automated insulin delivery system? I'm out of this, but it's not just going to magically work. You're gonna have to give it a good starting point.

Cari Berget, MPH, RN, CDE 15:02
Yeah, that's all true. So programming the settings, the initial settings that you have, it's, I wouldn't recommend just just blindly programming whatever you have in your current insulin pump, when you go to start on the pod five, it's important that, you know, to get off to the best start, you really should have your Basal program representing about 40 to 50% of your total daily insulin needs. And the reason for this is because the algorithm is it's using this assumption that that's typically what people require. And so you'll, it'll estimate your total daily insulin best, when you first start the system. If you have about 40 to 50% of your total daily insulin coming from that Basal program, or at least that's what you have programmed in the system. So that's what it what it assumes. And that's, that's pretty physiologically accurate. I mean, that is what you would expect, you know, we have these two types of insulin delivery, when you think about it, for intensive therapy, you've got Basal insulin, you know, which is like your background, it's what's supposed to help stabilize your glucose levels and manage, you know, the livers role and storing and dumping glucose into the bloodstream. And then you've got the Bolus insulin, which is larger doses all at once that, you know, are For if the blood sugar gets high, or if you're eating. And this is basically how the, the body works with insulin delivery. So this is trying to simulate those same type of, of structure, right, so look at what your current settings are, and then see how close or far that is. So you can always start from, what is the total amount of insulin that I receive in a day. And then how much of that is coming from Basal quote from the pump, and how much of that is coming from boluses. And you know, people with diabetes, they're really smart, and they figure out how to make things work best for them. And on a manual pump, you might be getting some of what might be considered Basal through giving extra boluses and things. So that's where if if those splits are way off of that, I think that's a time to go to your health care provider, and try and reevaluate what they really should be to get off to the best start and then start from there.

Scott Benner 17:20
Yeah, Carrie, and I've kind of put that into layman's terms for people. And this is something I've learned baking the podcast over the years, there are times that people using insulin arrive at the right destination, but they don't quite get there the correct way. And just a general understanding of what that might mean is, let's say you should be using, I don't know, 24 units of basil a day, I'm obviously doing that. So it's easy for us to remember one unit an hour. But for some reason, your Basal program is set at point five, and you end up making up that other insulin through manual corrections. Or maybe you've figured out a way where your your meal ratio is really heavy, but it works because the basil is light, or vice versa. Maybe your basil is too heavy and you are eating on a schedule and feeding the the insulin like there are a lot of different ways that unbalanced settings can still look okay at the end. But this system is going to learn more quickly. If those settings are as close to write as possible, it can still learn if you if you begin with bad settings, but it will add to the amount of time is that right?

Cari Berget, MPH, RN, CDE 18:25
Yes, I'm sitting here like nodding my head, but you can't see that. So yes, that's absolutely right. And it's going back to your analogy of the, you know, baseball players trying to play basketball, or maybe it was vice versa. If you, if you teach those baseball players how to play basketball, they'll probably learn it eventually. So it's a similar concept that if it's not perfect at the beginning, or at least not optimal, it will eventually get there, it just is going to take a little bit longer to figure that out. And I think the other point I would make is that this system really operates off of total daily insulin, that is what it uses to base a lot of its automation decisions on not all of them because it's also taking your current glucose level. It's making these you know, decisions about how much to give every five minutes, but kind of the big picture factor that plays a huge role in that is your total daily insulin.

Scott Benner 19:21
Okay, and would that be the same for somebody coming from MDI?

Cari Berget, MPH, RN, CDE 19:27
Yeah, I mean, it would be the same as somebody coming from MDI, generally with MDI, you would look at, you know, what's your, what's your total long acting insulin dose, and that would typically, you know, be what you would use to figure out Basal settings and a pump. So you just would take that total Basal dose if it represents about 50% of your total daily insulin, and then you would divide that by 24 to get a starting rate. Okay, so Carrie, I'm

Scott Benner 19:57
gonna give you a little more anecdotal from my end, which is I see people frequently going from MDI, to any kind of pumping. And having a similar issue, where settings don't look the same, you know, and they, they'll, they run into it in all kinds of different ways. But, but kind of think of it like that. So you know, sometimes people from MDI go to pumping, and it takes them a while to get their setting straight, and find your you're on your way to doing that. But that pumps not trying to learn anything from what the settings are that you've told them. So have your settings really, really close before you start. And in the next part, we're going to talk about that a little bit more, but I just wanted to, to make sure to be clear about that. So So let's, let's imagine, here we are, we've done our learning, we've talked to our doctor, we have our settings straight, and we're sitting together, it's our on the pod five, we have our on the pod five controller, our Dexcom or Dexcom is on our phone, we're ready to go. Now you need to have the controller with you right to start up, you have to get it going. And earlier we talked about that the system works without being near anything. But there are of course, some things you need the controller for, for instance, you need it to give yourself a tell it how many carbs you're going to eat, right? You need it to hear alarms and alerts. There are things that if you walk completely away from it, you won't get alarms and alerts are a big part of it. The ability to control the, the system, as far as entering carbs is another one. If you happen to be in manual mode, you know, you have access to a few more settings, then you do an automated. So those things need to be nearby when you're making changes, or when you need to hear alarms and alerts. And the truth is right, you need to hear your alarms and work.

Cari Berget, MPH, RN, CDE 21:41
Yeah, the other thing is, if you want to see anything, you need to have the controller nearby. So you know, if you're gonna go swimming, just leave it on the on the chair. And you don't need to worry that it's not going to be able to deliver insulin. But generally speaking, you're going to want the controller nearby the unless you just want to be completely blind and not know what's happening. But a couple other just clarifying things there. They're calling it a controller now. So very fancy, no more PDM. But controller, that might be the lingo you hear when you like get your intro kit box and stuff. And then also, as far as alarms and alerts, I did want to clarify. Another reason for having the Dexcom G six app near you is that you cannot program any of the Dexcom CGM alerts on the Omnipod five controller. So that's another thing to keep in mind. If you want to be getting those Dexcom alerts, you have to have the G six app within range and get it through that app. There's a couple exceptions. There's a one LOW Alert on the Omnipod five, four if it predicts your glucose dropping below 55. And then there's some like pump related alarms and alerts. But I did want to make sure it was clear because this is a common question that I get that there are no CGM related alerts other than that 55 In the Omnipod five app,

Scott Benner 23:00
right so there so you have two devices that are speaking to each other but they're giving you their information on their their own separate platforms.

Cari Berget, MPH, RN, CDE 23:08
Exactly.

Scott Benner 23:15
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So let's I guess dig in a little bit into this algorithm and what we can expect it to do and what it's going to do. I feel like I want to ask you, and because I can, we've used the Omnipod five and I know a great deal about it. But I think you have a lot more than me, as far as knowledge goes. So there's a predictive control algorithm, right. And it's called Smart adjust technology. And we know how it's going to communicate back and forth with the G six that happens every five minutes to predict where your glucose is going to go. 60 minutes from now, it increases or decreases or pauses insulin, trying to get you to that level that you actually get the program right. So unlike other automated insulin delivery systems, I guess on the pod five has a 110 target, but it also has other targets.

Cari Berget, MPH, RN, CDE 27:05
Yeah, you can program the target anywhere from 110 to 150. In 10, and 10 milligram per deciliter increments. So 110 121 3141 50. And yeah, that is the only automated insulin delivery system where you can customize the target to what you want it to be. And then additionally, you can also set that target, you can have a different target for different times of day. So if you wanted to run 110 of the rent 110 target, you know, all day, but you wanted the 130 target overnight, you

Scott Benner 27:40
can do that as well. It does not go lower than 110. No, it does

Cari Berget, MPH, RN, CDE 27:45
not you cannot program a target lower than 110. Okay, that doesn't mean your blood sugar will never go lower than 110. But the the target that you program can't be lower than 110. Yeah. So

Scott Benner 27:56
that's as good a place as I need to talk about that. So your blood sugar could get lower, and then it's going to take away insulin trying to get back to the one time.

Cari Berget, MPH, RN, CDE 28:06
Yeah, that is correct. But I think

Scott Benner 28:09
that's important for people to hear that it doesn't happen instantaneously. If you were to, I guess there's a lot of different things right, you could you could make a Bolus for a meal that's too large for what you ate. And then you might get lower than that. And then this, the algorithm is going to just try as hard as they can to take away insulin, take insulin to create a new balance, but you could be lower while it's doing that. So there are times where you might have to step in and fix a lower blood sugar. There's it that seems accurate to you.

Cari Berget, MPH, RN, CDE 28:37
Oh, yeah, absolutely. I mean, you know, what we see with these systems is they, they do a really good job at helping prevent hypoglycemia, but they don't eliminate it altogether, usually. So you may still have a few, you know, situations that the example you gave is, is a really good one. Because if you do over Bolus for a meal, for example, once that Bolus insulin goes in the body, you can't take it out, you know it's there. So if you can't remove it, all the algorithm can do is just stop the automated delivery in the background. Yeah, so it should help. It should help kind of like cushion the fall if it's too much Bolus, but it may not always be able to 100% prevent the the low blood sugar entirely. Yeah,

Scott Benner 29:23
it comes from a personal experience I had with it because when we first got it, I was like, I bet you I could get this to keep a lower number. And I did it. And Arden's blood sugar was like 85 for like two and a half hours. I was like see, I trick the outcome. And then it didn't it tricked me because because it took away so much of her basil that her you know, once that act of insulin I used in the meal was gone. Then she just started going up and up because I had basically, you know, I had I had put the algorithm in a situation where it took away the basil for so long that the only thing that was going to happen later was arised. Like that's the only thing that could happen eventually I basically trade Did my meal insulin for basil? And it said, Well, we're going to, we're going to get you back up to 110. And then that rise happened. So I just, you know, I, it's not this stuff's all really very new to people, you know, and everybody's kind of had a way they've done things and there's going to be a different, you know, a slightly different way to do things. And these are the things that are gonna get you there. So, alright, so Carrie, we thrown on this, we got our first pot on, right? What happened? Yes, five minutes. 10 minutes later, my blood sugar's perfect.

Cari Berget, MPH, RN, CDE 30:30
So I wish Sunday. But so you put your first pot on, right, what'll happen is the with your very first pod, the system, you can go right into automated mode. So that's another cool thing about this is, even though the system operates off of total daily insulin, you can still go in automated mode with the very first pod, even though there is no insulin history. If you think about it, you might be wondering, wait, you just told me this algorithm operates off total daily insulin. But this is my very first pod. So how would the system even know you don't program your total daily insulin anywhere in the pot, it's based on the insulin you actually receive. So that goes back to what I was saying before that it estimates your total daily insulin. And it uses that to determine what they call an adaptive Basal rate. And so I would think of that as like a baseline, it's your baseline Basal rate that this system thinks you have. And then in then it adjusts up and down from that rate, based on the current glucose trend, recent insulin history, delivery history, all with the goal of trying to reach that 110 target. So the 110 is the brain's that's the number it's using when it's making these calculations every five minutes. And then, so you go along, and you give your meal boluses. Because that's really important. On a system like this. For one, if you want the best blood sugar control around meals, you should Bolus, you know 10 To 15 minutes before you eat, to get the best control around meals, but also to make sure that the total daily insulin that you need is actually accurate. Because if you miss the boluses, two things will happen. Your your meal control won't be as good, you're gonna go high, the system will increase to try and help you so still be better than missing a Bolus if you are on a standard pump. But the total daily insulin will start to be underestimated, then because you're not giving the Bolus and the automation can only do so much for you.

Scott Benner 32:26
So so if I, if and again, this is a great example of it's not, you know, it's not just like set it and forget it and walk away, you do still have to do the things you need to do Pre-Bolus In a meal is have you know, I think it's a basic concept. And and so what you just said makes sure I understand if I don't Pre-Bolus a meal, then we're going to see a big shoot up 2030 minutes after I've eaten my blood sugar is gone from wherever it was, you know, 100 and now it's it's 180 and on my CGM is telling me I got two hours up. And then all of a sudden, I remember to tell the, the Omnipod five, hey, by the way, I ate 45 carbs. So you're by doing that by not letting it know that food is happening when it's happening. It just thought you shot up out of nowhere, and it tries to stop it. And now you're putting the food in and telling it Oh, no, there was food here. But you're telling it that there's food at seven o'clock at night when really the food existed at 630. And then that kind of throws things off is that I understand that correctly?

Cari Berget, MPH, RN, CDE 33:24
Yeah, yeah. Yeah, the only thing I would add to that is, it's just that the time it's the time doesn't really matter. So like the algorithm doesn't really care when you like to eat breakfast, lunch or dinner, like it's not going to learn that it's not going to learn, oh, Scott always eats lunch it at seven, or dinner at seven, you know, yeah. But if you, like you said though, if you don't eat him, if you don't Bolus for a meal, your blood sugar will rise. And the algorithm will respond, you know, it will respond and try and increase the insulin delivery, the automated delivery, right? But the other but what happens if you put the 45 grams in an hour later, you've got a bunch of insulin on board now from this automated delivery, then you put in the 45 grams, it's just going to calculate, you know, based on your carb ratio, which is going to be too much because now you already had this other insulin in there. So it does create this yo yo effect because if you come in with the meal Bolus after, it's going to likely be too much. And then you're going to you're going to crash down and then you're going to treat that low and then you're going to rise up. So that's where it goes back again to the pre meal Bolus is is really important. Yeah, because but what I what I was saying before, it was actually more than if you just miss the Bolus altogether, the total daily insulin calculation will start to be be off to okay, it doesn't you don't give those boluses it's not going to know that you require the amount of insulin that you require.

Scott Benner 34:55
See, that's a bigger picture idea that's important. It needs to understand like I guess in this same breath. If you were a really high carb person for three days, and then decided to eat very low carb for three days, the system isn't going to magically know that you stopped eating 150 carbs a day versus now you're having 50 or something like that. Right?

Cari Berget, MPH, RN, CDE 35:15
Right? No, it won't. But it will update your total daily insulin every time you change your pod. So this is a very important point, because, you know, especially with kids, which is what you know, I work in pediatrics. And so kids grow and their insulin needs change all the time, constantly. And that's expected. And so a lot of people will ask, well, how, if it's based on total daily insulin, like how does it adjust as my kid grows, or, you know, needs more insulin, and it does that by updating the total daily insulin with each and every pot. So every pod, it's going to change the adaptive Basal rate based on the more recent total daily insulin, so it will adapt over time to changing insulin needs.

Scott Benner 35:59
Okay, so this first pod is on and it's collecting data, it doesn't know anything except the settings that we've given it. And it's just living with you. And it's seeing what you're doing. And it's seeing what's happening. After that first pod is done, you move to the next one. And that's where you really start seeing the system working a little more, right, that very, very first pod is a is a collection day, or days Excuse me.

Cari Berget, MPH, RN, CDE 36:24
Yeah, and it's, it's operating more conservatively, conservatively with the first pod, because it's only estimating your tea, it's guessing your total daily insulin. And then in so because of that, it's just more conservative, it's a little more constrained on how, how high the adaptive Basal can go how much it can increase the insulin. But then when you change, and you go to the second pod, it starts using your actual total daily insulin, and then those constraints aren't, aren't there anymore. So I see.

Scott Benner 36:55
Carry, I've been told something by my my little birds. And I want to know, if you see any value to it at all, they say, that first pod instead of going the full 72 hours, they say change it after 48, because it's learned everything it's going to learn and you want the next pot to get moving to have you heard that at all?

Cari Berget, MPH, RN, CDE 37:14
I haven't directly heard that. But my guess is that comes from the fact that you know, what's required for the system to start using your actual TDI instead of the estimated TDI after the first pod is at least 48 hours of insulin delivery and A pod change. Okay, so that might be where that comes from. But in my opinion, I don't, I don't know that I would worry too much about that. You certainly could change it after 48 hours and like, make it start using your actual TDI. But there's also concerns of like, do you, you know, do you really want to change your pod earlier than you need to you only get a certain amount of supplies. So I don't think it's essential, or will make a huge difference. But certainly could.

Scott Benner 37:55
I just wanted to get that in there because the internet always thinks it knows. And so I wanted to see what you thought. Thank you very much. All right, I have some questions here. Actually, I want to thank existing podcast listeners, they sent out a ton of questions for this. This person says, I've read that the first pot operates at a reduced Basal rate. Is that that true?

Cari Berget, MPH, RN, CDE 38:17
I mean, reduce from what I don't, and I'm not sure that that's actually true. I mean, what I would say is the first pod operates off of more conservatively than it will in subsequent pods. And I would say that the maximum delivery is more constrained. But I wouldn't say that it is operating off of a reduced Basal rate, because the adaptive Basal rate it determines is based on the total daily insulin it estimates. So a lot of that is based on what you have initially programmed for your Basal program,

Scott Benner 38:50
in a perfect situation, you're gonna put this first pot on, and you're gonna let it do its thing, you're gonna live your life and let it learn. Is that correct? Yes, yeah. What if you get into a situation where your settings were way off when you got started? So you're seeing a high blood sugar that you're just not okay with? Do you come in and correct it?

Cari Berget, MPH, RN, CDE 39:08
Yes. And I would encourage, especially in the first couple of weeks, as it's getting, you know, adapting and adjusting to your total insulin needs. If your glucose is high, give, give a correction Bolus, it all it can do is help because it does two things, one should help bring your blood sugar down. But then too, it's it's adding more insulin in to the total daily insulin. And so you know, that's going to increase the total daily insulin and then with the next pod, you're going to have a higher baseline adaptive rate, and it's all just going to balance out from there. So the principle of giving correction boluses really, really helps. But can I add one more thing about correction bonuses at this point? You're

Scott Benner 39:50
the only one here really, I'm just okay, if you don't, we're pretty dumb. You know what I mean? Yeah.

Cari Berget, MPH, RN, CDE 39:56
So, okay. And this gets to what you were saying before, a little bit. In that, you know, people who live with diabetes really figured out how to make their insulin delivery work for them. And there's a lot of different ways to get there. As you mentioned, when you're using a manual pump therapy, and the difference with an automated system is that you now have insulin delivery going on that you aren't in charge of anymore. And so my best advice for giving correction boluses is to follow the Bolus calculator recommendation. And I know that's really hard for for many people, because you know how much you need. But with an automated system, you can have a lot of insulin on board from the adaptive Basal increasing that you just may not be acutely aware of. Yeah, so what what's great about the system is if you're using the Bolus calculator, any insulin delivery that is above the baseline, so this baseline I told you, the system calculates for you, it will factor that into the insulin onboard. Point being you can see how much insulin onboard is active. And that includes the automated Basal, which is also different from standard pumps where typically Basal insulin is not incorporated into the insulin onboard calculation. And it is now if it's, you know, being given to deal with hyperglycemia. So, you can follow the recommendation and just be advised that the the correction dose may seem smaller, you know, a lot of people will say to me, oh, my gosh, this thing thought said, I needed point five and I, on my other pump, I would have given two units for this. And I have to tell them well, on your other pump, your basil was stupid, it wasn't helping you like it was stupidly delivering point five units an hour, no matter what your CGM was doing. So just keep that in mind and try to work with with the system and not against it. And that will really help with frustration, but also with getting better outcomes to

Scott Benner 42:00
carry Listen, may I make a mean, let me just be honest here for a second, I fought it. In the beginning, I was like, that's not what I would do. Or that's not what I need to have happen. Or and it really did just eventually occurred to me, I was like, this thing is gonna do stuff. I'm not going to understand it all. And if it works great, why do I even you know, you know, why am I fighting. And I was just applying what I knew prior to what was happening now. And it really did take me longer than it should have to say to myself, This is not an apples to apples situation here. I am not doing manual pumping the way I used to. That's not what this is. This isn't even another automated insulin delivery system, right? Think because they all work differently. I mean, there's a number of them that are available, and not one of them is accomplishing what they're accomplishing in the same way. And so I did find myself having to put away some of my old tools that I thought worked really well. And and look at on the pod five more and try to find the tools that I thought worked better with it. Yeah, you

Cari Berget, MPH, RN, CDE 43:03
may need to find some new tools, you know, and you will, but I think that that's, that's really, that's really the key, I think. And in admit it, I mean, that's hard to do. I mean, you know, when you've been spending years and years and years, taking care of diabetes, and then sometimes you'll you'll have to let those things go. But that can be in that can be hard to let those things go. So I usually tell people, you know, the system needs time to adapt to total daily insulin as far as thinking about expectations of like, you know, how long is this going to take to get used to this? Most people are asking, like, how long is it gonna take for the algorithm to figure out how much insulin I need? And while that's true, there's another piece, it's how long do I give myself to get used to a new type of insulin delivery. So that's another piece of it is it's you know, you as the user, you have to figure out where you need to let go and let the system do its thing. And then where you need to give insulin and do your part in how to find this, like, beautiful harmony, where the two of you work together the system and you you know, to get the best out of it. Yeah,

Scott Benner 44:11
I think we'll jump into that. We'll do a settings episode where we'll talk more about how to make those adjustments and even how to talk to your healthcare provider about making those adjustments. I'm just, I'm glad you brought it up. Because I feel like what I need to know like if I'm going to recap here is that I'm going to come in with as good a settings as possible. And could that even mean that I start on the pod five in manual mode for a couple of days, say I'm not coming from on the pod dash, maybe I'm coming from MDI or something else, right. If I start in manual mode for a little bit, I'm looking for that stability, right? It's my basil at a good place where I'm held. I mean, the way I talked about on the podcast is Bezos job is to hold you at a number, right and that number is, you know, it can be whatever you you think it is, but if your basil is set correctly, it will hold you away from food and active insulin. Add a number at 90 at 100, you could use a little more basil and have it lower, you could use less basil and have it higher. But stability is the important part. If you don't have stability, then your basil is not close to being correct away from food and away from an act of Bolus, you know, your blood sugar shouldn't be dropping very harshly, you're jumping up and down your basil. I mean, Basil is everything. I think it's the it's the bedrock of diabetes. And it's the way to, it's the way to have success is no matter what you're using. So maybe I even start on the pod five, in in manual mode for a little bit, it's still seeing if my basil is working, it's still seeing my bonuses and my corrections. And it seemed my total daily insulin, that would work as well. Right?

Cari Berget, MPH, RN, CDE 45:42
Yeah, I mean, you could do absolutely necessary, right, right, it's not necessary. And the only other caution I would give you is that, you know, the system isn't using the Basal rates themselves. So testing it, that'll give you a really great Bayes Basal profile for if you're using it in manual mode, right. But what's more important for getting the best start in automated mode is really just the total insulin. And so, you know, if your settings are just have gotten off over the years, like, let's say, you know, per your programmed settings, you only get 25% of your insulin from the Basal rate, I wouldn't recommend starting Omnipod five, with it like that, you could go into manual mode, tweak it all up, you know, test it out, if you want it to, but you could also just talk, look at what your actual total insulin is. Because if you have, you know, relatively, you know, good control that you're happy with overall, you have a total amount of insulin that you're receiving. And that seems to be working as far as the amount. So you could just re estimate what that basil really should be based on the total insulin, can I

Scott Benner 46:56
pick your brain a little more here on that? Yeah, so if my total daily insulin is whatever it is, but my average blood sugar is 180, then my total daily insulin might not be enough.

Cari Berget, MPH, RN, CDE 47:10
Right? Right. And that is a excellent point. Because, and especially I mean, I see this all the time, it's, I think this is very, very common in youth, even, especially, most kids are not getting enough overall insulin. And so I will sometimes when, because what I do at my clinic right now in prep for everybody starting up the system is I review, I try anyway, to review everybody's current pump settings, and suggest different settings for them, and work with them to you know, what they should programming Omnipod five, and if I see that somebody's, you know, got an average blood sugar of 200. And their last time in range was, you know, 45%, then I'll look at what their their Basal is. And if it's, if they're over Bayes alized on paper, as in like, Oh, they're getting 60 70%. But really, that represents more of an expected TDI, total daily insulin, then I probably just keep it. So that is an excellent point that just because on paper, the split might look off, it's all relative to whether the total daily insulin that you're getting is actually the amount that you need. Yeah, it

Scott Benner 48:25
just occurred to me that you might be, you know, doing great, you know, and thinking I'm doing fantastic. You know, my blood, my a one sees a seven and a half, and this is my average, you know, insulin intake, and then all of a sudden you put on this, you know, the Omnipod, five, and you put on target of 110. But you give it settings that led to a 170 or 180, those two things are in Congress at best. So, yeah, so that makes, there's going to be an adjustment period is what I keep thinking to say.

Cari Berget, MPH, RN, CDE 48:55
Right? Yeah. And it all starts with, I think, if you just remember that it really all starts with what's your total daily insulin? either? What is it that you're getting? Or? Or how much is it? Would you really expect that you would need? Because, yes, it is different for everybody. But it's not a complete mystery. Like there are ways to estimate how much you really should be expected to be getting based on just simply based on weight. So like, if you're really not sure that the amount you get, whether it's really close to optimal or not, you know, talk with your with your doctor. And it'd be like, what, how much should I probably actually begin, you know, and go from there.

Scott Benner 49:36
So, a minute ago, I talked about being in manual mode. And I just wanted to point out that even if you're in manual mode, the algorithm is paying attention to your total daily insulin there. But in manual mode, there's no algorithm to stop you from getting low. It's just you're using an insulin pump just like a regular old insulin pump then, and I didn't I didn't I didn't say that clearly enough. So I wanted to we ever A couple of things here, a person who started on the pod five, and they had, you know, they were like, well, I wanted to be more aggressive. And so they get to their fourth pod, and they start making all these changes to their settings, thinking, this is going to make it more aggressive, I'm going to increase my Basal the carb ratio, the insulin sensitivity factor, etc, on and on, right. Except that's not how this works. Like after that first pod, you put that first pod on the algorithm is learning. And it's adjusting those things. So if you made a change to one of those settings, that change would only be concrete if you were in manual. That's correct, right?

Cari Berget, MPH, RN, CDE 50:41
Partially, I mean, if so when you're in automated mode, I cannot stress enough that it does not care what Basal rates you have programmed. Even if it's the first pot, it doesn't care about the actual Basal rates, the profile itself, it's concerned about the total only to help it estimate your total daily insulin. So I just want to make sure that's really clear that even with the first pod, the actual rates themselves and the different ones you put at different times of day, it does not use those in any way. So no changing, no changing Basal rates at all, when you're using automated mode. Those would only be used if you were in manual mode. Okay. But for boluses, if you change your insulin to carb ratio, if you change your correction factor, that will change the amount of insulin that's recommended for your Bolus doses. And that can actually make a really big difference in your overall glycemic control. Really fine tuning those Bolus doses, because that's what you have the control over, it's your job to give those boluses for meals. And so focusing on those actually, I would highly recommend because it can make a huge difference in your overall blood sugar control.

Scott Benner 52:02
Okay. All right, thank you. I just, I'm trying to put myself in the position of somebody who just comes at it new and doesn't, doesn't quite understand what's going on. You want to do one more question? Or do you want to move on? Let's see.

Cari Berget, MPH, RN, CDE 52:17
Do you have questions? It's good for ya. It's like sending a man you know, then they want them answered. I think it's, that's good.

Scott Benner 52:23
I love you. You're very nice. I'm having a good time. It's our first time recording together. And I feel like we're doing well. What do you think give some credit for Yeah,

Cari Berget, MPH, RN, CDE 52:32
we're feeling great. I'm feeling more and more normal. And the more we go,

Scott Benner 52:36
you're not as nervous any longer. Cool.

Cari Berget, MPH, RN, CDE 52:39
Okay. Settling in.

Scott Benner 52:42
I'm oddly calm, just so you know,

Cari Berget, MPH, RN, CDE 52:46
you do seem very calm. I'm like waiting for the I don't know, waiting for you to yell at me about something.

Scott Benner 52:55
Okay, so carry, like, let's just kind of dig in. Before we move forward, let's add a little more clarity to total daily insulin in manual mode. So, okay, do you? Do you feel like we've covered it all? Or do you think there's more there? Like, I don't know, what to add to what you've said. So maybe you did.

Cari Berget, MPH, RN, CDE 53:16
I mean, I think the point you made of just making it clear that Omni pod five, it the pod tracks total daily insulin, whether you're using manual mode or automated mode, it's always tracking that. So if you went out of automated mode into manual mode, for whatever reason, for you know, a week, two weeks, a month, a year, it's still tracking it. So then if you switch back to automated mode, it's it's just going to pick up with that total daily insulin, maybe is the point there.

Scott Benner 53:49
Carrie, I believe that was a perfect explanation. Thank you very much. All right. So let's roll through a couple of questions that I have pretty simple answers. person asked, Will it be possible to decrease to decrease the target blood glucose level from the current built in minimum values? Now I know the answer to this one. So no,

Cari Berget, MPH, RN, CDE 54:07
no. No, the target is 110.

Scott Benner 54:13
Yes, yeah. And you can go higher if you so desire, up to 150. I think we've said already, all the way up to 150. If you want to target a 90 it, it's not going to do that.

Cari Berget, MPH, RN, CDE 54:25
It will not okay. All right. But can I just have one thing about that, please? Because I have stuff to say to go. Yeah, the target thing is fascinating. For me, because I work with a lot of automated systems, not just Omnipod five, and this is something that comes up with every single one. I would just realize that this target is the brains, it's the brains of the algorithm. It is not i It's not saying that your blood sugar is going to be at 110 all the time, and that it's never going to be under 110 or that you couldn't possibly ever be under 110 it's just every time The algorithm makes a dosing decision, it's doing it trying to reach 110. That doesn't mean you're always reach 110 Or never go below it. Does that make sense? So I would focus, when I think about adjusting the target, since this is the first system where you can do that, look at it more from the bigger picture. Like, if you're running high overnight, and your target set at 130, drop it, because then the insulin is gonna give more in the algorithms gonna give more insulin. So think of it more as like, if you want to try and make the algorithm more aggressive, because you're running high, overnight, drop the target, if you're running lower than you want to be, I don't even wherever that might be, like, I just worked with someone the other day who was running at five overnight, which some people would love, he, they did not love that. And so we bumped up the target, you know, so in it, it helped bring them up a little higher. So, think of it more pragmatically like that, like, it's a way for you to influence what it does and less focus on what the actual specific number, it's

Scott Benner 56:07
sorry, listen, I think if people listen to this podcast, they'll understand this. And if they're new to it, and they're finding it because of the only pod five episodes, and this might be a little lost on them for a moment. But there are so many variables that go into how insulin works for you. So if you're a person who does a set amount of exercise every day, your insulin will probably be more effective. If you're hydrated, well, it will probably be more effective than if you're not hydrated. Well, if you're experiencing a fluctuation of hormones, say, at one point, but you aren't at another point, the insulin is going to have different impacts. And so it's a lot about your behavior, as far as what you know about that, and what you and what you ask of the system. My point being, if you go along, eating, you know, a house salad for three days, and then on the fourth day, decide, I'm going to have a half a pizza, well go for it, except, just understand that if you are a person who has been eating how salads for a year, your your insulin to carb ratio, for example, is probably more tied into that style of eating. So if you're gonna slide into a completely different style of eating, all of a sudden, that insulin to carb ratio might not be the same for pizza, as it is for something else. And I'm getting a little outside of you know, I'm not a health care provider and etc. But you do need to understand how insulin works, I guess, is what I'm saying. And if you don't, you're gonna run into problems. And you could turn to, you know, and think it's, you know, you could, I don't know, you could chase ghosts around, you could think you see what's happening, but you might not be.

Cari Berget, MPH, RN, CDE 57:46
Yeah, and then I would just end that statement with I mean, I think that people give more concern to the target than I think is necessary. That it's not as big of a deal that sometimes it can be beat out to be. And so I try to encourage people not to worry too much about that back to what you were saying, just focus on doing what you can to get get the best control that you can, and the target is not really the most important factor here.

Scott Benner 58:16
Well, yeah, my only point was, is that if you're if you're targeting 110, and you know, your blood sugar's rising, and the system says, Oh, it's coming, you know, that's happening, I'll do what I did yesterday. And that'll work except that you've made some, yeah, here's, here's a better way to think of it maybe, if you are getting low overnight, for example, and the algorithm is stopping that low by taking away basil, you may have had less basil than your body really needs, you know, four or five o'clock, six o'clock in the morning, because of, I don't know, a bed Bolus, she made it about three o'clock, who knows. But when you wake up in the morning, the algorithm doesn't know to you know, that your toast is going to hit you extra hard now, because you really haven't had your full Basal for the last three hours. Like you kind of have to know that. And yeah, you know what I mean?

Cari Berget, MPH, RN, CDE 59:08
Right? That's a really good example, because it does show the interaction between, you know, things that the algorithm doesn't, and that's a perfect example of, of that kind of perspective. And that, oh, what's the word like, kind of the vision the that you see that that insight of, oh, look, I'm about to eat breakfast, I see that the system has suspended my basil for the last hour. And if I when I eat this toast, it's going to have a huge impact because I've got very little if any insulin currently working in the system. So in those cases, you know, Pre-Bolus saying as far ahead as possible, makes a really big difference because, you know, you get you make sure you have some insulin starting to work before you, you know, eat get those carbs in the system

Scott Benner 59:59
x One. I feel like care. Tell me something. I feel like we've done a good job here. Do you not agree?

Cari Berget, MPH, RN, CDE 1:00:07
I do.

Scott Benner 1:00:10
You're looking at the same notes I'm looking at. And I feel like we covered so much of it. Without getting to it in the notes, does that makes sense to you? Sure.

Cari Berget, MPH, RN, CDE 1:00:18
I, I haven't even looked at the notes. So I mean, I'm glad that you think we're covering it

Scott Benner 1:00:23
carry on me.

Cari Berget, MPH, RN, CDE 1:00:27
I mean, I've looked at the notes, but I didn't want to make a bunch of noise there right here. But I, yeah, I've seen them before. Yes, we're doing we're we're doing great.

Scott Benner 1:00:35
Okay. So I just wanted to sit down for a second and go through a couple of ideas about just making sure people understand what the adaptive Basal rate is. But I feel like we've done that. No, I'm just gonna run through them. And you tell me if you think we've done it, adaptive Basal rate is a baseline for automated insulin delivery. It is the insulin delivery calculated in units per hour than the smart adjust technology continues to change over time as only part five is used. And this is all of course, based on your total daily insulin. Yes, okay. Adaptive Basal rate is based on the total amount of Basal and Bolus insulin delivered in a 24 hour day or the total daily insulin again, updates with each pod change based on the previous insulin history to best match the user's needs.

Cari Berget, MPH, RN, CDE 1:01:21
That is true. I'd like to add one thing, this is a very common question. Can you what how do you know what your adaptive Basal rate is? The short answer is you don't? And there's no way to know you can't find it out. So we should probably get that out of the way.

Scott Benner 1:01:37
Yeah. Okay. And if for some reason, and I know, it's not a not fun to think of, but if for some reason your controller explodes, like you drop it in the pool, or you throw it across the street for some, I don't know what you might do to make it break apart. But if that happens, you are starting over again, when that next pod goes on. Yes, yes. Yeah. So I want to point out, always know, what you're like, know, your settings as best you can, right? Right. Like whatever you put to that thing, the first time write them down somewhere, don't just, you know, don't just go I don't know, know what your total daily insulin is like that, I think is incredibly important, right? Because then at the very least, even if you're just like, I don't know, any of these settings anymore, you can at least look at the total daily insulin, you could say to yourself, Okay, let me just take 50% of this and make it or break it up over 24 hours and make that the Basal. And I'll take the rest of this, and I'll look at some of my carbs, and I'll figure out my insulin to carb ratio. And these would be good restarting settings. That's a very basic way to think about it. But but at least you'd be getting that total daily insulin set in there. Does that make sense to you?

Cari Berget, MPH, RN, CDE 1:02:43
Yeah, no, it does end. But the only thing I would add to that is, you know, your insulin needs can change over time. So depending on how long it's been, since you started, before you broke your controller, I mean, if it's been a year, and your manual mode, Basal rates haven't been changed at all, they might be slightly off, if your total daily insulin has actually gone up any

Scott Benner 1:03:08
number of 1000s, changed your activity, a few pounds, lost a few pounds, etc, etc.

Cari Berget, MPH, RN, CDE 1:03:13
So the best way to really keep track of that information is to have your Omnipod five linked to gluco. Because this is one of my favorite things as a healthcare professional, because if you link your Omnipod, five to gluco, which is a data management system that you can summarize, you can get reports that summarize your insulin delivery and glucose control, then you can just log if you break your controller, you can log into gluco. And you can see what the settings were, and how much and you can see how much what your average total daily insulin has been okay, and so, and that it'll walk you through doing that when you go to the setup screens. So I highly recommend doing that and not skipping that part. Because it's, it's really cool. And then once you're set up, it will automatically upload the pump to gluco via the cloud without you having to do anything, you don't have to manually upload it. And then when you show up to see your your doctor, the data is already there, and everyone is so happy.

Scott Benner 1:04:15
I like not having to do anything that makes sense. So so keep track on your own use paper. If you still have a pencil on your house or use your computer or your phone. Most people just use their phones, right Carrie I sound very old now when I send someone to use their phones. Yeah. So keep track of all your settings and and utilize glucose. Glucose is free, right?

Cari Berget, MPH, RN, CDE 1:04:36
Yeah. And when you go through the setup, it will it'll walk you through pairing it and if you don't have a Google account, it will walk you through like creating one and everything.

Scott Benner 1:04:44
Okay. What can I see? So you've had a lot of experience with with the system and with the controller. So what can I see as a user day to day like what do I have access to?

Cari Berget, MPH, RN, CDE 1:04:57
On the controller? Yeah, like Can the app itself?

Scott Benner 1:05:01
Yeah, like, like, do I just see oh, it made a Bolus or do I see, you know how much it used?

Cari Berget, MPH, RN, CDE 1:05:07
Yeah, so what you can see on the main screen is you can see this current CGM glucose value and trend arrow. Because you've, you've paired the transmitter into your Omni pod five, so it can, the pod will send that duck that information to the PDM. So you can see the CGM data on the Omni pod five app. So you can see the CGM value and current trend arrow, you can see how much insulin on board you have. And you can see your last Bolus, it's very similar appearance to the dash interface very, very similar. So you can see the last bullet you gave and how much that was. And then there is a way that you can expand the CGM graph, you can, you can see the last three hours of the CGM values and on that graph, you can also see the insulin on board and the current CGM value as well. And then you can get a visual representation of the automated delivery. So at the bottom of the CGM graph, you can see if you're in automated delivery, or manual delivery, and then you can also see visually if the algorithm is at maximum delivery, or suspension. So you can see things categorically, but it won't show you the exact amounts. Okay. However, you could go to the history, if you want to see each five minute, you know, micro delivery that, you know, or adaptive Basal delivery, if you are so inclined. I mean,

Scott Benner 1:06:41
I think it's, it's pretty obvious, right, that the system is set up to try to take away your burden, and so that you're not constantly worried and looking and, you know, overwhelmed. I mean, I think, you know, I'm going to put my, my personal opinion in here, I think Omnipod five, for most people is going to be an incredible improvement for them. You know, like just an incredible improvement and, and getting it set up and getting it rolling is the crux of the whole thing, right? It's just why we're talking about it, because what's beyond this should very well be some fairly smooth sailing, where the algorithms learning and keeping up with you and making adjustments where it's necessary. And even you're learning as you go along. How to how to Bolus for your meals better, or how to think about things as far as the way the system works. And, and hopefully you're, you know, you're you're, you're feeling a weight lifted at some point.

Cari Berget, MPH, RN, CDE 1:07:31
Yeah, I think so. I mean, I think there's a lot of potential here for a lot of people to get much better blood sugar control than what they've been able to, you know, to get on a manual pump, as well as more stability. Because the other thing I think we often don't talk about is glycemic variability, just the ups and the downs. So sometimes the average looks fine. But when you really go and look at it, you know, yeah, you're spending 50% of your time high and 50% your time low. So this helps you kind of find the balance and be more stable with less big fluctuations. Yeah. And sleep. That's the thing,

Scott Benner 1:08:08
you still might think, oh, go ahead. Go ahead.

Cari Berget, MPH, RN, CDE 1:08:11
I was gonna say that's, that's the thing, especially for for parents. And you know, I worked in pediatrics, I always want to give that disclaimer, I don't really know much about adults. But for parents getting to sleep at night is the constant theme that that I hear, because not only is the blood sugar improved overnight, it's the stability that you just get to sleep the whole night. And that's just not something many parents and kids really experience so

Scott Benner 1:08:40
I have never slept so well, as I have, since some automated insulin delivery has become a reality. So and it sounds

Cari Berget, MPH, RN, CDE 1:08:49
overnight, it's really very exciting. If you think about it, it's half of your day. So I mean, it's, it's also super encouraging that, you know, the nighttime tends to be relatively, like, really reliable, like you can really rely that for almost everybody, like it's just it is gonna help overnight

Scott Benner 1:09:07
for sure. I think also, he had kids that go on sleepovers, or, you know, adult who's got a real heavy sleeper or no, you know, next to them or nobody next to them, they're on the road. I always think that being an adult with type one and living by yourself has got to add an extra amount of anxiety to your life. You got kids going away to college, all these things. It's just, it's, listen, I'm a huge fan of the stuff I have been saying on this podcast for years, that you do not want to get stuck in how it's done. Because, you know, people are gonna make advancements and you don't want to be back with like, Oh, I'm still peeing on this test strip. Is that not the way we're doing it anymore? You know? And so this is, it's a big deal. It really is. I can't I don't think I can quite say enough. What a big deal. Yeah,

Cari Berget, MPH, RN, CDE 1:09:53
it's a really exciting time, you know, and it's only gonna get more and more exciting as we go. I think I think we're just at the beginning. Okay,

Scott Benner 1:09:59
we're gonna hammer through couple of questions here. And then we're gonna we're gonna button this up, try to keep it around an hour, right? Okay. Realistically, how long should I expect it to take for the system to adapt, optimize the insulin delivery, do its thing, what did you see during the, during your time with it,

Cari Berget, MPH, RN, CDE 1:10:17
I think a couple of weeks is a is a good expectation to set for yourself that you've got to give it a couple of weeks, you know, three or four pods for it to really get some time to adapt. And then the other thing is that it's not even just the adaptive basil and figuring out the total, you know, giving the algorithm time to figure out the total daily insulin. That's obviously a huge part of it. But it is very, very common. And this has been true with every automated insulin delivery system I've worked with, you almost always need stronger carb ratios on an automated system compared to a manual system. And again, like, work with your doctor and look at this stuff, and talk about what your carb ratio should be. But if you're running high after meals, don't hesitate to reach out because there is something that can be done. Oftentimes, you just need to strengthen the carb ratios. And it's not a bad thing, it doesn't mean the system's not working. It's expected it's it's a dynamic Basal delivery, that's totally different than a manual pump, where it's just statically delivering. So because it's dynamic, you're going to have periods where it's turning off and then turning back on. And oftentimes leading up to a meal, you have less insulin on board, because there's been suspensions, because you're getting back to that target. And so, because of that, naturally, you're going to need a stronger carb ratio than maybe you used before. So keep that in the back of your mind. Because after those couple of weeks, if you're still running high, or higher than you'd like or high after meals, specifically, reach out to your doctor and in fine tune those carb ratios because it can make a huge difference.

Scott Benner 1:11:58
Well, it really does depend, I guess, on the person or its individual, how long it's going to take days, weeks, plus all the other stuff that we just spoke about.

Cari Berget, MPH, RN, CDE 1:12:06
Yeah, I would agree with that. I mean, everything's individualized. But I would say, you know, give it a couple of weeks. And if you're not where you want to be, you know, reach out to your health care provider to help you because there's probably, you know, some Bolus settings that can be adjusted to really help you get where you want to go.

Scott Benner 1:12:23
Let me ask you a question. Because you've seen so many people on it attached to this idea. Is there something I can be looking for that shows that we're moving in the right direction? Like, when's the when's the part where I go? Ooh, maybe I will call my doctor here. I think we're, we're at a point where maybe we've plateaued?

Cari Berget, MPH, RN, CDE 1:12:41
Yeah, that's a great question. Ooh, that's a hard question. Um, I mean, I'm a big, big picture person. I think time and range is the most important thing. And so if your timing range is not getting to where, you know, you want it to be, and you should be able to get it, you know, above 70%, and meet those targets. You know, reach out and, and help have your doctor help you get there.

Scott Benner 1:13:07
Okay, I guess in in the end, you can paint that picture to your doctor as well. And let them help you make the decision. If you can't decide if you're seeing Yeah, man or not. Carrie, I find that thinking about insulin is like a time travel movie, right? Like insulin I use now is for later. But really insulin that's happening now was from before, and it always helps to have another person to talk about that with. So you don't get a little lost. You know what I mean? Like, it's great to talk to your healthcare provider, your nurse practitioner, whoever it is that you're making those decisions with, because it's nice to just have another person to bounce it off of sometimes because, you know, like, at some point, you're sitting in the theater, and you're like, I don't understand how to slow those down. Like, you know, like, you need somebody else to chat with about it and, and make good sense of it. You sound like you would be a good person to do it. With.

Cari Berget, MPH, RN, CDE 1:13:56
Oh, well, thank you. I really enjoy it. And I do it a lot. So love working with people to get those carb ratios. Right,

Scott Benner 1:14:03
right. So if I even if I start the pod, and I'm like, Oh, God, I used all the wrong settings. I just might have to wait a little longer for it to figure it out.

Cari Berget, MPH, RN, CDE 1:14:11
Yeah, exactly. Yeah, you might just have to wait a little longer, but it will get there. It will all be okay.

Scott Benner 1:14:17
Okay, so time settings. bolusing. You know, the way you need to Bolus whether that means amount or timing, timing and amount, such a big deal. And then just let Omnipod five do its thing.

Cari Berget, MPH, RN, CDE 1:14:32
Yeah. And can I make one more comment about that? So the other thing is, like I already told you like, I highly recommend following the Bolus calculator for correction doses so that you can work with the system and not against it. But if you find that it's always recommending zero, and you're still running high, again, you don't have to just sit there it could be that your correction factor is two Hi, it needs to be stronger. I find that correction factor is like the forgotten about setting often. In pump therapy, you know, we're all in manual therapy, we're always tweaking the basals. And we often change the carb ratios, and we hardly ever do anything with the correction factor. And so I see this, you know, 15 year old and they have the same correction factor from when they were six

Scott Benner 1:15:22
was 350 points. Yeah, it's like, I don't think

Cari Berget, MPH, RN, CDE 1:15:25
that one unit is going to drop the 300 points anymore, you know, so the correction factor, yeah, it needs some attention to sometimes, you know, yeah.

Scott Benner 1:15:34
And I know it's, you know, it's, it sounds super simple. But the idea of, you know, if your correction factor is one unit moves you 50 points, but you haven't looked at it since you were five years old back when it was one unit moved to 350. Now you're trying to adjust the high blood sugar, and you have no hope of that working. And on top of that, you've told the algorithm this should work. And you've given a bad information.

Cari Berget, MPH, RN, CDE 1:15:59
Yeah, isn't the Bolus calculator is just going to use whatever is programmed in there to as part of his calculation, so Right, yeah, it makes a big difference.

Scott Benner 1:16:06
Okay. Well, I think this is a great time to break and say that we hope we see you in part two, where we're going to do a deeper dive on settings.

I'd like to thank Carrie Birgit for being on the show today and sharing her knowledge about the Omni pod five with us. And a huge thanks to the listeners of the podcasts who shared questions and comments that led to the building of these three episodes. If you're interested in getting started with the Omni pod five, we're learning more about it, go to Omni pod.com forward slash juicebox. And don't forget that these episodes will be available in your audio app forever. But you can also find them at juicebox podcast.com forward slash Omni pod five. This episode was just part one of a three part series, you still have Omni pod five pro tip settings and Omni pod five pro tip connectivity to listen to. If you found this episode helpful, and you're new to the podcast, be sure to subscribe or follow in your audio app for more diabetes and on the pod five content. Thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. A huge thanks to athletic greens and contour for sponsoring this episode of the Best of the Juicebox Podcast. Get started today with that green drink ag one from athletic greens, athletic greens.com forward slash juice box you and I could be doing the same thing every morning together except not really together. But I mean, we you know what I mean? And of course, you want you need you deserve an accurate blood glucose meter contour, next gen at contour next.com forward slash juicebox. When you click on the links, you're supporting the podcast and I appreciate it very much. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#899 Diabetes Pro Tip: Transitioning

Diabetes Pro Tip: Transitioning

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 899 of the Juicebox Podcast.

My diabetes Pro Tip series for type one diabetes began in February of 2019. Today I'm adding another episode. Jenny Smith and I are going to be talking about transitioning. We're going to do an overview of transitioning from your blood glucose meter to a CGM, from MDI, to pumping from pumping to algorithm pumping. And at the end of the episode, I'm going to add feedback from Juicebox Podcast listeners about all of these topics. While you're listening today, please remember 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 are becoming bold with insulin. If you'd like to help type one diabetes research, all you have to do is complete the survey AT T one D exchange.org. Forward slash juicebox. The T one D exchange is looking for US residents who have type one diabetes, or are the caregiver of someone with type one to complete a very short and simple survey. The answers that you give will help move type one research forward T one D exchange.org. Forward slash juicebox.

The diabetes Pro Tip series from the Juicebox Podcast began on February 25 2019, with an episode called newly diagnosed restarting over after that episode 211 was all about MDI episode 212 all about insulin, Episode 217 Pre-Bolus Singh, Episode 218 Temp Basal 219 Insulin pumping to 24 mastering a CGM to 25 Bump and nudge to 26 the perfect Bolus to 31 variables 237 setting Basal insulin 256 Exercise 263 fat and protein 287 illness injury and surgery episode 301 was glucagon and low blood sugars episode 307 Emergency Room protocols episode 311 long term health 350 Bumping nudge to 360 for pregnancy 371 explaining type one episode 391 was glycemic index and load 449 postpartum 470 weight loss 608 Honeymoon 612 female hormones and today episode 899 transitioning, you can find these episodes in your audio app Spotify, Apple podcasts or anywhere you get audio. You can also find them at juicebox podcast.com. And at diabetes pro tip.com. As always, these episodes and the entire podcast are absolutely free for you to listen to the information inside of this podcast. And more specifically inside of this Pro Tip series. This information is at the core of how my daughter has kept her a one C between five two and six two for over eight years without diet restrictions. Myself and Jenny Smith Jenny of course is a CDE who works at integrated diabetes.com Jenny and I we go over the topics go over the ideas in easy to listen to and digestible ways you can apply this information to your life whether you're an adult with type one who's been living with it forever, or a parent whose child was just diagnosed, I implore you to check out the entire series. It really will help. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy Earth sells sheets and towels and joggers and comfortable things really that's what I should have said cozy Earth has comfortable things whether it's sheets or towels or clothing. It is soft, it is warm. Unless you don't want it to be warmed I don't even know how to describe the sheets or they keep you cool or they keep you warm. Depends on what you want. I don't even like I don't know if there's a word for it but your body is temperate in it is temporary the word. I looked it up it is a word it. How do I put this? I wear my cozy Earth gear on an airplane the other day. I wasn't too hot. I wasn't too cold. When I got home. I got my bed with my cozy Earth sheets. I wasn't too hot. I wasn't too cold. Everything is soft. It feels terrific. Check it out at cozy earth.com where the offer code juice box will save you 35% at checkout The podcast has a number of long term sponsors, Omni pod Dexcom contour G voc, US med touched by type one, athletic greens. Of course, you heard about the T one D exchange earlier cozy earth. All of these sponsors are prominently displayed at juicebox podcast.com. Or in the show notes of the podcast player you're listening in right now, when you support those sponsors by clicking on my links or typing in those web addresses, you are supporting the production of this podcast. So please, if you have the need, use my link. What I would like to talk about today is transition. Just a an overview concept for this one, but transition from just finger sticks to CGM transition from MDI, two pumping, transition from pumping to algorithm. Sure, can we do that? Yeah. All right. I thought we could all thank Isabel here for having her finger on the pulse of the people in the Facebook group and knowing exactly what people ask about, and what they seem most confused about. Why don't we start with MDI, because everybody starts there, right? After you're, you're doing it for a while, like, let's put ourselves in that place. We've been doing MDI for a while it's working pretty well, or at least at a baseline. We're shooting a Basal insulin once a day, and we are shooting a meal insulin to correct blood sugars and to cover our carbs. That's the basics of MDI. Okay, correct. So then we're in a doctor's office, but I'm gonna make up some numbers. Let's, let's say our basil. It's like, I don't know, let's say our basil is 10 a day. And let's say were, I don't know, one to 10 for carb ratio. Okay. All right. Let's say our correction is one to 100. Let's keep it all very like, like that, so that it's easier to talk about. Okay, round 10 numbers and numbers, we're gonna do that. So the math makes sense when people are listening. So we're in the doctor's office, and the doctor says, you know, you might like a pump?

Jennifer Smith, CDE 7:24
Is he gonna say it just like that?

Scott Benner 7:25
I mean, if it's a lady, she might be like, You made like a bump? I don't know, like, people are anywhere in between. There's some women have more masculine voices, Jenny, this isn't the point of what we're talking about. Yeah. So they see, you might like a pump. You are. I'm guessing, gonna have a couple of different reactions. I see a lot of people scared. Oh, no, don't change something. I see a lot of people are like, yes, please, because this isn't working. And maybe this will they don't know why they think that just right, they're hoping for a change. So the first thing that's going to happen is the doctor is going to translate your Basal insulin to this pump. So Jenny, you do that math for me? I correct I get 10 units a day injection, what are they going to do on the pump for me

Jennifer Smith, CDE 8:13
most often on a pump, because it's expected that your Basal insulin which and this is kind of outside of it, but within your Basal insulin will now be given by the pump as rapid acting insulin. So that's the first thing to understand is that you're injected Basal insulin, which is a specific long acting kind of insulin will now sit in your refrigerator as a backup in case of pump failure, right? So you don't put Basal insulin into a pump. The only insulin that goes in the pump is your rapid acting insulin of any of the brands, right. Depending on the pump, company, they all have a little bit of different kind of recommendations for type of rapid insulin, but it's a rapid insulin and to translate your Basal dose of what we said 10 units into a pumped Basal delivery, you would essentially take 10 units into a 24 hour day. Right? And that translates into a a dripped amount, right? Because insulin pumps drip drip, drip drip consistently to deliver that total amount of basil that you want.

Scott Benner 9:32
Okay, so let's clean it up for people who get lost very easily. You may be injecting trusty Abba love Amira, Lantis what are the other ones,

Jennifer Smith, CDE 9:43
Basil Glar or these are all based in jail.

Scott Benner 9:46
These are basil insulins. These are now gone. You don't use those anymore, because as Jenny points out, you're going to take your mealtime or your fast acting correction insulin, put it in the pump, and it's going to split it up. Those 10 units are going to get split up Over, not just over hours, that's how the settings the pump work, right? You're gonna come up with what is it going to be like point four, maybe an hour if you're 10 a day about like that, right?

Jennifer Smith, CDE 10:10
Right, depending on your pump, all of the pumps differ in their precision of a single drip of insulin. Some pumps can drip as little as point one, one, some can drip as little as point oh, two, five or point oh, five. So it just depends. But if you broke this down 10 units a day into 24 hours a day would be a rate of about point four, two, if you do rounding, right? Yes, some pumps, you may have to round that 2.4, because they can't deliver the point oh two.

Scott Benner 10:42
And you're, you're gonna hear that if you're MBI. and think, oh, at the top of every hour, it's gonna give me point 14 incidents on but it's not doing that it's going to break the rack to wait for Twos Up over the entire hour

Jennifer Smith, CDE 10:53
over the course of the time. Exactly. Now, the other step to this calculation is that we expect that your Basal insulin you've been injecting I'm trying to think how to say it. So people don't think their insulin is not working. But when you inject Basal insulin as its type it, it will not be absorbed as efficiently I guess is the better way to say it as it would from a pump where it gets infused in those little tiny drips over a very precise amount of time, a very precise dose. So your rapid insulin in your pump gets infused out of sight. And so we usually take your base Basal dose down by about 10%. Some, some physicians even go down by 20%. But the general idea is taking your base dose down by 10%. So 10 units a day taken down by 10% is one unit less, so nine units instead of 10 units. So if you do the math there, nine into 24 gets your rate down instead of point, let's call it point for an hour, down 2.37 an hour, which again, we'd probably round down to point three, five.

Scott Benner 12:05
And you're going to want to keep an eye on that because I've seen it go either way. I've seen that be right. And it's amazing. I've seen that be now not enough insulin, and people are getting high blood sugars. And they immediately like you hear them say like the pump doesn't work like well, you gave yourself less insulin and turns out you need right. So pay close attention to that.

Jennifer Smith, CDE 12:27
It also translates into the next step. Once you've been making some notes on this 24 hour dose of let's call it point three, five units an hour. And you can say Well, it seems okay here. But then at this time of the day, I'm always high no matter what I can skip eating and I'm high I can eat and I go even higher. Well, that's when the next step is Basal testing. Right, we need to really look at it and say, where is that point? Three, five, sufficient and where is it not? And where might it be too much.

Scott Benner 13:01
And you might notice, and this, this might sound a little heavy if you're thinking of switching but you could put your pump on your belly and have a different reaction to the insulin that is if it's on your hip or your thigh, you know, there's reasons like Arden's thigh doesn't work as well as her stomach does,

Jennifer Smith, CDE 13:19
you know, neither does mine, I don't use my thighs anymore. Yeah, back of your arm might

Scott Benner 13:23
be better than your, the back of your butt. Or who knows, like right and with

Jennifer Smith, CDE 13:27
with this being new from coming from MDI, to going to using a pump, I would suggest initially utilizing and testing out within an area of the body, you know, we talk a lot about rotation, not only should you be rotating, if you're doing MDI, your injection should be going multiple different places, not just the same site over and over. The same goes along with pumping, those sites need to be rotated. If you're new to pumping, however, you really want to get an idea if your settings are fairly good. Stick with rotating around your abdomen, right? Get an idea. And then once you have that fairly well set, you can then move to upper body or the back of the arm or maybe your thigh or you know your lower back and see if you notice any difference some people do and some people don't at all.

Scott Benner 14:19
No, right? No. I mean, there's it's your body composition, hydration, how you know where it's actually going inside of you. Is it subcutaneous Is it very close to a muscle? We don't overwhelm people, but the muscle can kind of I don't know what the term is like what a large muscle group can. It kind of lessens the impact of the insulin but for the life of me, I can't think of why right now. Do you know what I mean?

Jennifer Smith, CDE 14:44
lessons? I know I don't know what you mean.

Scott Benner 14:46
I always thought that's why the thigh wasn't a good spot because it was a large muscle.

Jennifer Smith, CDE 14:51
Well, it might have more to do with how well the insulin at that site is getting absorbed. Like that's a big reason that I don't use My thighs is because whenever I tried using it, either I got a clusion alarms because the cannula was bumping into muscle or potentially that I had nicked, like a small vessel under and it had been clouded kind of near that site were was trying to infuse. And so that backs up into the pump and the pump tells you hey, the delivery of insulin has stopped. It gives you nice alarms. Right? So I think in some cases that may be part of the issue is the proximity to muscle, yes. But also I it was either painful or I got occlusions like it just never worked on my thighs.

Scott Benner 15:41
Okay, I'll say, Look, I'm learning from the podcast. Finally. Finally, I learned about this every day, you learn a lot. Okay, so now we've, I think here's a good place to insert that it is possible that there are some people on MDI who are achieving reasonable lower blood sugar's some how do I say this? Sometimes your doctors over baseline you because they don't think you're covering your food correctly. And

Jennifer Smith, CDE 16:12
or they may not have looked at your records enough to know why they've you know what I mean? Like, it might just be easier to backup with enough Basil with what they're seeing in your data. Yeah. And it may as you're saying, it might be wrong,

Scott Benner 16:26
right, right. So like, imagine if you're a person who has been getting more basil than they really technically need, but you kind of forget meals, sometimes you don't cover all your food. But now all of a sudden, you have this pump, you're like, Oh, it's so easy. Now, I just push the buttons for my foods, and now you're covering your meals well, and you're like, why am I low all the time? Right? It might be because you're using more insulin than you have been in the past. So those are things to look for that I see people struggle with the beginning with a pump. And I do want to say I think there's a, I think there's a period of transition there. It's not going to be like if you're nervous. It's not unfounded, you know, like you are starting a whole new way of doing something. But it really is just another way of delivering insulin to you. It's not that complicated.

Jennifer Smith, CDE 17:16
And I can say personally, when I switched from MDI, having done MDI, a long time before I started using a pump. By the time I started using a pump I was already doing. I was already doing somewhat of a Pre-Bolus. But it wasn't the same once I switched to a pump, there was a definite time difference between my Pre-Bolus with injections, and there still is, yeah, I can take an injection and my Pre-Bolus Time is not as long as it is on a pump. Right? Again, and of one. But that's what I noticed. And so those are some things to pay attention to between MDI and what you're doing along with what you said about maybe the doses you were taking on MDI, were covering a certain way for your rapid insulin for meals and corrections. And now that you're on a pump, your meals, the food hasn't changed, your strategy has stayed the same. And things are looking

Scott Benner 18:14
weird, right, right there, you do have to step back a lot and try to see what's happening. One reasonable reason for that could be reasonable reason why it wasn't right. But anyway, you use an omni pod and delivers insulin a little slowly. Like it doesn't just like you take a needle and you go Yeah, the pump is pumping over time. And I don't imagine you use very large bonuses, but larger bonuses take longer. I've seen I've sat at a restaurant with Arden and, you know, you forget you've done it and you kind of still here like that, like think like click clicking. It's still giving her insolence feels like it's been five minutes, you know, and yeah, so that's, that could be part of it. Anyway, these are things you're going to learn along the way. They're new lessons, but they're not a reason not just try, because you're going to gain what you're gonna gain so much, right? Like if, to me a pump is at its core, I've always thought of pumping as a way to be able to manipulate basil. Whereas on MDI, I shoot it in, it's in there, nothing left to do. If it's too much, if it's too little, it's what it is, you know, with MD with a with a pump, you know, you can go back and listen to the Pro Tip series. I think about like, wow, if we sit down to a meal, that's all of a sudden much carb heavier than what I usually eat, I could do a Temp Basal increase, they try to help me with this. You know, I was thinking a minute ago when we were talking about breaking the 10 units down into point 4.35 That if you think about putting a sprinkler out on a dry, dry lawn, right, and you need to give your lawn 10 Guys gallons of water, you could come along and dump it on all at once, it'll just be there, that'll be it right, or it could break it up into a little point three, five gallons every hour and go back and forth. And just a light covering, covering, covering, covering, you're never gonna soak it down, you're and it's just I think of basil like sort of like that. Sometimes you're just,

Jennifer Smith, CDE 20:20
and that's a good way to think about it too. Because if you consider that slow Basal drip that you are getting from a pump, when you inject your Basal insulin all in one clump, right? You can, depending on the kind of activity you like to do, you may have found that you have to pay attention to Gosh, I'm doing like a really heavy arm workout, I'm probably not going to inject my Basal insulin into my arm today, I might inject it someplace else, right? Because there's this whopping dose sitting underneath your skin. And any kind of insulin, whether it's rapid, or Basal can get enhanced in action, the more active you are, and especially if you're using that site. So, you know, those are the kinds of things that having those tinier doses that you can manipulate and adjust, especially with the variables that you know, are coming in the day.

Scott Benner 21:21
If somebody's listening and thinking like, well, they have spent the first 15 minutes talking about Basal insulin, it's because it's really important, and nobody tells you it's important setting. So if you listen to this podcast, like while I do MDI, they're always talking about, like, their settings on their pump or anything. This is still settings, you know, if it's MDI, it's your settings, it's, you know, these Basal carb ratio, correction factor, they're all settings. So it's just very important to have them. If they're not accurate to your needs, then everything else is just going to be a mess. And especially Basil, basil is wrong. The whole day is confused. So okay, so we've translated our basil, our insulin to carb ratio, does the doctor keep it the same? Do they usually like what is common?

Jennifer Smith, CDE 22:06
They may keep it the same, especially if your records prove to show that it seems to be for the most part working fairly. Okay. Right? Could there be improvement somewhere, possibly, or whatever, maybe that's also part of the reason that they feel like a pump might actually be better. Maybe you're the kind of person that just eats really slow digesting food. And so you've had problems with taking your insulin and having these big drops in your blood sugar too fast, and then it ends up catching up with you. And then you end up high later, and you've treated low blood sugars, right? And there's not a timing thing that you can really get quite right with MDI. And maybe the doctor says, Well, why don't we try a pump, because hey, you're eating these types of foods more frequently, we could actually use some of the smart features on our conventional pumps that allow you to take some insulin for food, we're calling these extended boluses. And you can just kind of like basil. It's almost like a secondary use of basil. But for a Bolus, where you drip drip, drip drip drip a Bolus in over a certain amount of designated time, you

Scott Benner 23:13
know, there's just, there's so much you're gonna get out of having a pump there, there's also going to be some things you need to know, sites can, like they're going to tell you whatever pump you have, they're gonna say this pump you can wear for X amount of days, or X amount of hours. But sometimes sites go bad. You know, sometimes new sites don't work as well in the beginning. Those are little things that you'll learn along the way. There's, if depending on Arden's blood sugar, she might put on a new pod, and we might just Bolus a little bit to get the site working. This morning. I woke up in the morning, I saw that artists blood sugar was trending up overnight. And listen, for those of you just switching like Arden is looping, but I can see how much insulin is left on a pod remotely, which most of you aren't gonna be able to see. But I can see she was down to like 30 units. So this is the end of her sight, right. And I just spent the weekend with her. And doesn't matter. But we were in a lot of restaurants this weekend. So Arden got a lot of insulin this weekend. And in my heart, her blood sugar is drifting up because this site is kind of done. So because you have experience, yes, I can just tell and you will be able to one day as well. So I sent her a text and I said I wouldn't go to class with this pump one. Because if she does, she's going to spend her whole day with blood sugar around 150 And she's going to be fighting with them constantly. And bolusing and they're not going to work and and by the way, if that happens, and then all of a sudden she gets crazy active out of nowhere. She might experience a low blood sugar from all this insulin kind of sitting in this right over us. Yeah, getting this pole right. And so like that's Here's the thing you'll learn along the way, you'll learn, you know what people worry about so much like, well, you know, do you travel with pumps? If we go too far from our house, we do. If it's a 15 minute turnaround, we don't like, you know, what, I'm gonna have to have insulin with me now, like, I don't know, we don't travel with insulin that frequently, as long as we're in your home base, you know. But if we go far, you know, half hour, 45 minutes, and it's not something we want to turn back from, we'll take insulin with us, you know, you just you, my point is, is that it becomes all second nature at some point. Just like everything else about diabetes, you're gonna have experiences they're going to teach you, you'll learn from them and move on. Speaking of moving on, you'll think I'm gonna go from MDI to pumping, to pumping to algorithm pumping, but I want to do CGM is first. So you have a meter. And that's how you check your blood sugar. And that's all you have. When you're in the doctor's office. The doctor is like, you know what you want to do?

Jennifer Smith, CDE 25:59
It must be the same doctor.

Scott Benner 26:01
I got one of the drawer here. Take this a sample you try. You'll love it. They're gonna try to give you they're gonna say to you, hey, you might want to leave Ray, you might want to Dexcom if you're on a Medtronic pump, they might ask you to do whatever the Medtronic CGM is called. And you're gonna say I don't need that or you're going to be newer. You're gonna Yes, please.

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Wherever you fall on that you do want it. Your insurance covers it you want it? That's for sure. Right? Tell me why.

Jennifer Smith, CDE 28:49
And I think it applies in all realms of diabetes as well. Right? Not just in type one diabetes, but also type two diabetes and even worthwhile and gestational diabetes. I know there are some rules in terms of when it can be prescribed whatnot. But I think it's beneficial all around what you miss with finger sticks are all of the little dots in between. So where things are trending, right, so if it is something that your doctor does bring up? Absolutely say yes. Right. You may not know how to look at the information or what you're getting from it initially. But it's so worthwhile.

Scott Benner 29:30
You want to know what you don't know. And with finger sticks, especially if you're newer to diabetes, or if you just been doing them your whole life and this is how you tend to think of it. You do the well i i test before I eat or I test before I go to bed or I test before I drive. And right. And I know you've asked yourself what's happening when I'm not looking right like and if you haven't asked yourself that. I wonder how do I go from two 50 to 50 in an hour, like how does that happen? And you'll learn you'll start seeing the impacts of activity and the lack of hydration, and different foods that you eat. The age of your, your insulin pumps cite all these different things that have a huge impact on the way your blood sugar moves. And now suddenly, it's there. A CGM is going to show you minute by minute. I think it's every five minutes. Right.

Jennifer Smith, CDE 30:32
And I think there are there are some people who have been using it long enough that can say, there can be some frustration around the amount of data that you get. And I wouldn't disagree with that I but I do think it's how you interact with the data, right? It's how you actually take a look at things and what you do with it and what you learn from it. And you'd have to, you have to expect that in the first month. Let's call it of using a CGM, you're gonna see a lot of stuff. And so rather than being so very emotionally reactive, again, taking a step back and kind of looking at the data to be able to make better decisions about what you felt like was probably happening, and now you can actually see it

Scott Benner 31:21
right. Well imagine you have your sprinkler out on the yard, and you have to keep the dirt moist because you've planted grass seeds, except every time you look out, it's kind of dry. That's the CGM. You look at the CGM ago Oh, from 3am till 6am. My blood sugar's 140. It's pretty stable, but it's 140. I wish it was lower or moister. I can turn up the sprinkler a little and put on a little more insulin and make it where I want it to be like push that number download

Jennifer Smith, CDE 31:48
and the CGM can show you that if you're really looking at it. That way the CGM can show you where did it start to lose? Right effect? Where do I start to need to add more insulin? It's not once you get stuck higher or once you get stuck lower than you want. It's before that so any drifts up or drifts down. You can see that very clearly on a CGM I, you have a really good example I think from when Arden first started using her CGM, it was like that overnight thing that you were constantly missing was at Lowe's when you had finger sticks, and I would put all you could see them.

Scott Benner 32:27
I thought I was a genius. I've said it before I would put Arden to bed at 180. And she'd wake up at 90. And I was like, Look how good I am at this. And what would happen. We put a CGM on her. She was 180, she'd go down to the 50s sit there for hours, I'm assuming her liver would be like, hey here, try not to die. Here's some, you know, here's some, here's some glucagon, I'll give you a little bit. And then she drift up to 90 overnight. It was happening constantly. So the reasons for that are mind numbing is not for this conversation. But we were bad at bolusing for dinner. We were her basil wasn't like there were so many things that weren't right.

Jennifer Smith, CDE 33:03
But you didn't know it because you couldn't see what was happening unless you really did a finger stick even an hourly finger stick, it would have caught a drift. But it still would right? But it would have still been confusing unless you've sat down and you connected all those dots. And you could say, well look, look at this. And you probably I mean not necessarily wanting to see your child sit at 50 for three hours before your body actually reacts and gets you the glucose that is needed to bring it up. But you'd have on a first finger stick probably under 70, you would have ended up treating so you also wouldn't have had the information to show. Well, how much do we need to take away? And what do we need to do differently?

Scott Benner 33:45
I can't I can't say how valuable it is to be able to see a graph and to enter look at it every three hours or you know what's it look like over six hours, like Jenny's point is great as the you you don't know why? What happened happened? It's um, if you're married here, it's nine o'clock at night. And you're now in an argument. Right? And you think I don't know what just happened. But mostly this is guys like they're like what? They searched the last five minutes their brain and I've not done anything wrong in the last five minutes. But if you could step back and see a whole graph of your day, you'd realize that at 630 at dinner, you said something really stupid, and now it's hit me at nine o'clock. So I think that that can be similar. You could have cheeseburger with french fries at dinner at eight o'clock at a restaurant and hit it with a great Bolus. And you're like, oh, wow, my blood sugar's still where I want it to be it's 140 After dinner, that's not bad. And two hours later, it starts to jump up. And that doesn't make any sense to you because you haven't listened to the Pro Tip series. You don't know about the fat and the French fries and the slow digestion and how your blood sugar is gonna go up afterwards. But at least if you see it on a graph, and then you go have those French fries and that burger again. You see it happen again. You can go Oh, I could get get ahead of this, right? Yeah, I could not say that stupid thing at dinner. And now we'd be watching television and she wouldn't be yelling at me.

Jennifer Smith, CDE 35:06
Right. And if you have a pump, you can also address it a different way than waiting for it to finally start rising and getting too high, you can offset it ahead of time knowing what is coming, because you've had the experience that, oh, it always hits around two hours. So I'm going to start doing something about an hour and a half before that. So that it actually doesn't happen. Right. So I mean, yeah, it's million

Scott Benner 35:32
ways to handle that if you're Yes, right. For for art in an hour after she has french fries, we have to Bolus for the fat. And there's a calculation you can do. And there's that heads off that secondary rise and doesn't cause a low later. That's the other great thing is the everyone. When you don't have enough data, you think, Oh, if I just keep throwing more insulin here and there, it's gonna be it's not true. Like you can match the need up with the impact of the insulin and never cause a low, right. And that's something you're going to learn looking at a CGM that, that uh, that a stable line on a CGM is really your insulin, your insulins pulling down and your food and your other impacts are pushing up. And neither of them are winning, like so if you can kind of imagine that line going off into affinity nice and stable. There's invisible lines. cables attached to it. One's trying to pull it up. One's trying to pull the line down, and neither can win because you have a great balance between your insulin and your knee. Yeah, so that in the CGM, like, seriously, like, I don't care, like there's Dex comms and advertiser, it's not like I'm saying that like, get a CGM. It's of any,

Jennifer Smith, CDE 36:43
right? Absolutely. I mean, I've said before, many times if somebody was going to take my technology, I would fight for my CGM. Before I'd fight for my palm. Yeah, no 100% would keep my CGM.

Scott Benner 36:58
I'll throw this here too. Even though it's about like, leaving quote unquote, finger sticks, you're never going to leave finger sticks by the way, you're going to need them. You're gonna test when you're not sure about your CGM. You're gonna test when you're making big decisions. I listen to my daughter's blood sugar looks high on her CGM, and we're gonna make a big Bolus. I said, Look, you gotta test we got to know this numbers, right? We can't just start throwing insulin in here. And you're actually 40 points lower than this, or whatever.

Jennifer Smith, CDE 37:23
And I think it's also really important to acknowledge what you know about how you feel around certain blood sugars. Because again, technology. It's wonderful. And it's so much better than it was years ago. But it may still not be accurate at certain points. So always those finger sticks are important to continue to use. Because if your symptoms or how you're feeling doesn't go with what your CGM is reading, I guarantee a finger stick isn't gonna lie to you not unless you still have like, apple juice on your fingers.

Scott Benner 37:58
I was gonna say and I didn't get to it just an accurate meter, just a blood glucose meter. Yes, they're not all the same. They don't all work as well. Don't just take the one that doctor handed you from the drawer, do a tiny bit of research use the one that I that advertises here because that's the one we use and it's amazing and, you know, like or do what you can do your own research and find out I will throw out a little story here. Because I did spend the weekend with my college age daughter, which I haven't done in a while as a visitor at school. Second night she was with me. We replaced her CGM. Okay. So at five o'clock at night, I said, Hey, your Dexcom is going to expire one in the morning. You should switch it now. It's before we're going to eat dinner. We'll get it back online. It will have it we can do some finger sticks through dinner. And then it'll be rolling and working well by the time we go to sleep, because it does take a little while for some people where to look right. You know, she does. I don't want to do that right now. So then when do we change her CGM? 10 o'clock 11 o'clock, you know, like, oh, so then it's done. So then it's wonky for the first couple hours. And for Arden, if her Dexcom is wonky, it's wonky low when she first puts it on minus two. Okay. So like, I mean, it'll be like you're 42. And she's 10. Like that kind of thing. Yep. So there's a lot of consternation in what you should do. I'm a fan of letting it be on for a little while and calibrating it to help it get along a little more. But now we're asleep. And it's like BP people. All I could think was I told I know I said this. Nobody listens to me. But that's fine. And I'm like, and I know she's not that low like and but it's worrying. So now she's, she's asleep. And I get up and I'm checking her blood sugar and she wakes up. She's like, What are you doing? I'm like, your CGM is going off. She goes, I'm fine. It's like okay, so I tested her and she was 130. And I was like, okay, so she's right. And I did a calibration and it came together. Other pretty quickly. And that was it. Having said that, we could have done that at five o'clock. There. So there is a way to time, your technology. Now the new g7 is going to have a shorter warmup period, which will help overlapping you'll be able to soak your sensor, which I'm not going to bother explaining here. But yeah, but as the technology gets better, so should those things. But that is not to say it's not, like hands down. The most valuable thing that's happened to people who have any kind of diabetes. Since I've since I've been aware of diabetes, so absolutely. Okay. All right, Jenny. Now we got our CGM. We're using a pump. We're looking online. And we're like, see, this isn't that the doctor is not gonna go you know, you got to do. That's not gonna happen now because this stuff's also new. Maybe Maybe you're really in tune doctor might say, why don't you get an algorithm? But for the most part, I don't think I think that's the thing you're gonna figure out on your own a little bit. So all this stuff we're talking about about, you know, the Bayes will be incorrect. And you might need a Temp Basal here. You might need an extended Bolus for fat you might need all this. There are pumps that make those decisions autonomously. Yeah, you have to be wearing at this time, you have to be wearing index calm, because it works with that correct. But

Jennifer Smith, CDE 41:19
or med tronics. Um, CGM? Yeah. Because they're their system also works with their pump.

Scott Benner 41:25
Yes. So there's a Medtronic version of this. There's a tandem version of this. There's an Omnipod version of this. All their algorithms are proprietary, they work slightly differently, but long, and the short of it is they're going to give you insulin when you need insulin, and they're going to take insulin away when you don't need it. They're going to endeavor to stop you from getting low, and endeavor to stop you from getting too high. You

Jennifer Smith, CDE 41:48
still know how they do that it was with targets. Yes. Right, right, specific targets in each of the different pump systems. Medtronic newest one was just approved, which is really nice. But they all have specific targets. So how that algorithm works is based on when and how to give you more or less based on a target and based on what the system is projecting off of your current CGM trend. So it's a very interesting, like the algorithms don't just willy nilly deliver or take.

Scott Benner 42:24
Like, I think maybe now more,

Jennifer Smith, CDE 42:26
right? Yeah, exactly. There's a map to the algorithm right

Scott Benner 42:29
Gremlin inside of your pub flipping a coin going, Oh, my God heads. Let's do it. So but it's it's it's stunning. Now there's another version. There's a number of other versions there are Do It Yourself versions. There's Android APs. There's loop. I think, Jenny, you loop. Right. I do. I think you would

Jennifer Smith, CDE 42:48
have been looping for five and a half years.

Scott Benner 42:52
And Arden has been doing it. I think since 2019. Maybe? So yeah. And you're Arden's using loop three, as am I and you just switched to it as well. So like, they're all just different versions of an algorithm making decisions about insulin based on your CGM trend. That's Yep. They're astonishing. They work incredibly well. They are not magic. I know in all settings, all knowing how to Bolus for certain foods, understanding the impacts of things, your digestion, your hydration, like all the things that are important about MDI are the same things that are important about pumping are the same things that are important about using an algorithm.

Jennifer Smith, CDE 43:38
And you made I know, people can't see you, but you were very in a line going from MDI, to pumping to algorithm. And I think that's, it's a really important piece. For those who are listening to understand if you're kind of listening to this, because these are not pieces in your life already. Right, and you want to get an idea. There is 100%, I'd say 1,000% value in learning on MDI. And then moving to a conventional pump, that does not do anything for you, meaning it does not use an algorithm. There's absolute value in that, you know, we talked about testing, and evaluating settings, and learning about all the variables, food and activity and everything and how to adjust your pump or your insulin doses to accommodate for those variables. I think as you mentioned, when you said you owe your pumps, like, hey, let's start on algorithms. I can't go as deep as you. So it's a totally different doctor, right? But in that sense, there are I think more doctors today who are thinking algorithm, but in my personal and professional In all opinion, I think some of them are thinking that too fast. Okay? They are they are moving somebody to, hey, you're MDI, let's move to this algorithm driven system, whatever the system is, whether it's Omnipod, five, or tandem or Medtronic. There is, there's a missing piece in the middle there, that if for some reason, and we talked about CGM is potentially not being always accurate or technology failing. If your pump fails in its algorithmic dosing, and you have nothing to step back to, you're at a loss. And it's important to understand that, you know, so I can't emphasize.

Scott Benner 45:42
It's incredibly important. Jenny's been talking to me about this privately for years. Honestly, she's like, people can't just be put on the machine, the machine does the whole thing. And they don't understand why it's happening. Because, you know, the general argument is, what if the machine stops working? I don't even think that's the need for that. No, I think the need is, is that this is a thing you have to understand. Like it, no matter what none of this machine stuff is at the point where you don't need to know how to how it works. It's not AI, it's not even a computer like you know, used to have to know how to fix your computer, because it would break all the time. Nowadays, you buy a Mac, it'll just do the thing you want it to do, you'll never have to touch it, and it'll die. At the end, you're like, Oh, my Mac doesn't work anymore, you get another one. And you don't need to understand how a computer works. To use a computer. You need to understand how diabetes works. To have diabetes, I don't care what version of care you're using, I don't care what the next one is. Now, if someone magically comes up with something one day, where it just works, no matter what, like a, like a laptop from Apple, okay, then then okay, then God bless. If you want to skip it, then skip it. But I'm still gonna say, that isn't happening anytime soon. Because of not just the things we've mentioned today. You know, your insulin pump site might not work on time, like your CGM might not be right right away, like all the other things, it just not happening anytime soon. So you don't want. The worst thing I can imagine is that you put an algorithm on a nine year old who it works for. And then five years later, the kid hits like puberty hard or something and you have no idea, like the algorithms doesn't know you just became a completely different person, you're gonna have to change your settings to make that work, right. And that takes experience. And if you I think if you ever find yourself listening to Jenny and I talking and thinking, How come whenever something comes up, they just fill the next space with something valuable. It's because Jenny's been living with diabetes for over 30 years. And I've been staring at my daughter for 15 years watching her have diabetes. And I have a never ending supply of experiences and answers in my head because I learned through them. Yes, that's why and that's why you? Yeah, like you didn't go to like diabetes University where they told you something secret that they don't tell everybody else, right?

Jennifer Smith, CDE 48:14
No, no, no, not at all. I mean, I have valuable behind the scenes, like information about disease states and those types of things from a medical knowledge base. Absolutely. And understanding them helps me to understand some of the navigation of that with diabetes, but the lived experience and the work that I get to do with so many people, that's the valley that you can't teach that. In a university, you you can't teach, there's no degree and diet.

Scott Benner 48:47
And for your situation, you've been helping people for so long it professionally. I tell people all the time, like, it's, it's gonna sound self serving, but it's not like it's that I was able to get advertisers for the show. So I get to turn the show into a job so that I could put this much effort into it. Because I learned every day I talked to people, like you'll hear me say like, Oh, I was talking to a guy the other day, he said something about this. That's me. hearing something I'd never heard before and right and retaining it and being able to apply it to a situation go, oh, you know where that'll help here. And then you get to keep expanding those conversations. I'm going to get to something here and you get to keep expanding those conversations till they help other things. We did fibroid episodes. Now we hear from people are like, Oh my God, my life is different. Because I got my thyroid managed well, I'm getting a lot of my I didn't realize about my iron and my ferritin like a lot of women especially are getting back to me like they're feeling so much better, because it's something they heard on the podcast. They heard it on the podcast, because I was able to focus on this because this is what I think about And now and now it's coming to digestion. And that because we had to figure out a problem with my daughter's digestion. And then we shared Get on the podcast now I've seen that help other people. That goes for little things about diabetes too. Yes, that's how this stuff spreads. This is a repository of information, but you're gonna build that in your own mind. Correct. But not if somebody slaps an algorithm on you and tells you don't worry about the thing. I'll take care of it.

Jennifer Smith, CDE 50:18
Right? Because it one that's such a, that's such a big thing that I hear well, shouldn't it be helping me with this shouldn't be doing this shouldn't? The one word I hate is learned, shouldn't have learned that I don't need this much insulin at two o'clock in the morning. Nope, your system isn't learning. I promise you it's not learning. doesn't keep track of two o'clock in the morning, gosh, I gotta give less insulin for this person. It's not that's it's not smart.

Scott Benner 50:44
Now. And Jenny, do you know oddly enough, as we make this episode, I put up an episode today called Rise of the Machines, where a guy comes on to talk about his Android APS system and how it he does believe it's going to learn in the future. Correct is so exciting, but not now. Like, what's one of his examples? He said, location services. So if you say I'm having pizza, and it realizes you're at Domino's, okay, and you have an experience with insulin, at some day, it will remember that experience. Yeah, if you go to a different pizza place and have a different experience. It'll remember that if you go to a pizza place, it'll remember that if you head back to Domino's, it's gonna go Oh, we're back at Domino's. This. That's not happening right now.

Jennifer Smith, CDE 51:33
No, in fact, there is there are some. There are some apps that actually you can track that way. Like you can take a photo of something and tap the location indicator. And the next time you come back to that location, you'll be able to see what your dosing looked like what your CGM trend looked like. So you can learn from Bob's pizzas, Friday night, last week to this Friday night, maybe I should change my strategy, it looked like this. And I want to improve this right or do it differently. But those they need to be married right into the pump so that not only do you have Okay, now I'm at Bob's pizza, this is what I had. And hey, let's the pump then can acknowledge and I'm going to do something different for Jenny.

Scott Benner 52:17
But for that happening just automatically, that's not here yet. 2023 on the pod five doesn't do that. Tandem T slim doesn't do that the control IQ doesn't do that. The mechanic doesn't do that. Now, it may have happened one day. Sure. But the other I think the other thing is, I know you want your days to be easy, and they can be they can be much easier than they are now they can be more your intuition can come into play as you grow. But this is a lifelong thing. And what you want is you want to get to the point where I saw Arden get into this weekend, where we sat down to this meal, there were 16 different things. And she just looked at it and picked up her phone and went and pushed the button. Yeah. And I was like, how much did she give? She was I don't know, I told it was like 85 carbs. And it was and she and I was like, okay, and then she was okay. And it was okay, just looked at a table at a restaurant. And she's like, I think about this much. And and that's boy, forget this podcast and everything else. It's that's where you want to get to where just where you wake up at two in the morning, you see a high blood sugar and you go, Oh, I know what this is. And that does come it really does come. So anyway. But you're gonna transition along, by the way, I think algorithms are amazing. And

Jennifer Smith, CDE 53:42
yes, they are. Absolutely I I love my algorithm. Absolutely. But I've also learned to work with it. And I've learned what it can do and what I still need to tell it to do. I think that's the big thing about algorithms is knowing that you still have a fair amount of action to put in to it so that the algorithm can work with you.

Scott Benner 54:04
Yeah, yeah, I wouldn't want anybody to think like, oh, you're using a do it yourself loop. It's magical over the other comp there. It all is about the same. Like they all need your help. They all need your intuition. They all need your knowledge. There's nothing if you think you're going to just put a loop on or on the pod five, and it's just going to be perfect. Like you don't have to do anything. Like that's not going to be the case. No. Yeah. So but don't be afraid. No, like I I'll say something here on the hall, save myself Saturday, make a beat and make myself sad. Yesterday was my friend Mike's would have been my friend Mike's birthday. And I don't want to bring all this down. But Mike had diabetes. Type one when we were teenagers. He's not with us any longer. I believe that one of the reasons Mike's not with us any longer is because Jenny alluded earlier that I was stepping along with my hands while I was talking about things like Mike Never came along. He just somebody gave him regular and mph. And he used it long, long after he should have been, you know, didn't have updated meters and didn't you know, he didn't do the little things that you do to come along. I mean, I guess what I'm saying is you don't want to be managing your diabetes like it was 10 years ago. Right? I don't think so.

Jennifer Smith, CDE 55:25
I think you're also bringing something in here. That's really important to consider, because you've, you've talked about, you know, practitioners bringing up hey, why don't you try a CGM? Hey, why don't you try a pump? If, if you're the one always going to your doctor asking for what's new. I don't know. I you know, and your doctor is very willing and can talk about it then with you. Maybe they didn't bring it up. But they're very, they're knowledgeable about it. Once you do get on it fine. But if this is someone who's never really brought it up, and kind of like, shrugs their shoulder and like, sure you could try it, whatever you may need kind of like your friend maybe didn't have a doctor who was keeping up with what could have been better for him.

Scott Benner 56:10
Yeah, yeah. Yeah, you don't you have to take this as a, I don't know, if you want to call it a disease or like, some people don't like that word. But this is a way of living, that it begs you to be involved in it? Yes. Like, it just, it just really does. You have to be aware, you have to take some time to learn what is happening with technology, what's happening with insolence, you know, and you need to move along with it. Because if you look back 50 years, I still interview people who are like in their 70s and have had diabetes forever. And they don't even understand why they're alive. Like, like, you don't want your life to be a coin flip. You don't I mean, like there are things you can do to to, to give yourself better health outcomes. And those health outcomes are not just health outcomes, their quality of life, they're your they're your psychological state of being like there's so much good that comes from just understanding. I know that sounds silly, but how to set your basil right? And make sure your correction factors, right. And you know how to cover the foods you eat?

Jennifer Smith, CDE 57:16
Absolutely, I think and on a bigger scale. We're also we're all supposed to be a participant in our life, right? health in general, you may have been given good health to begin with, but you're the keeper of that health. Right? It's just like, you're the keeper of the car. If you continue to let the salt buildup on you never wash it off, you're gonna have a rusty car. Well, you're your body's the same way, right? You're the keeper of your health, you got to do things to maintain your health, diabetes, it stepped up a level it is

Scott Benner 57:50
absolutely. And so prepare to transition by getting as much good information as you can, but then at some point, just have to do it. You have to just dive in and do it and then learn a new thing. And then once then you'll be surprised at what else comes from that. And anyway, listen, it's also not to say that you couldn't get an algorithm pump right now and teach yourself backwards. I actually think you can. Sure. I think some people have a harder time with that than others. And I don't want you to be in a position where you're lost and something's happening. And you don't understand why because it won't be any different than a person that gets over Basal on MDI and thinks they're doing okay, but it's not really covering their meals well, right, you know, and then doesn't get hungry one day, and then it's up low all afternoon doesn't understand what happened. Like diabetes. There's no reason that if, if you have an if you have enough information and understanding diabetes doesn't have to happen to you. And I think that's maybe the most important part like I would if it feels like it's happening to you, instead of you are doing something and then something's happening. I think you have to have to look and get a deeper understanding, because it shouldn't just be happening to you. That's all. Okay. Awesome. Thank you Jerry.

Huge thanks to Jenny for helping me once again on the Juicebox Podcast, you can learn more about what she does for a living at integrated diabetes.com Jenny might be able to help you. Thank you very much cozy Earth for sponsoring this episode of The Juicebox Podcast get 35% off your entire order at cozy earth.com By using the offer code juice box at checkout. And don't miss the rest of the diabetes Pro Tip series and the other series within the podcast. If you give me a little gifts, give me two more minutes of your time after the music and I'm gonna tell you a little more about this series and the others But first tips from other listeners. I want to thank everyone who left their tips for this episode on the private Facebook group Juicebox Podcast type one diabetes and the people who left their tips on the public group bold with insulin. This first one is for going from pumping the algorithm test your basil and your ratios before you move to an algorithm. The first few weeks may be frustrating, don't give up. Reach out to people online for advice. They probably have been doing it longer than you. This person leaves a little bit of advice from going from MDI to pump says the first night they kept getting low and didn't remember that they could turn their basil down. We talked about this in the episode having access to your Basal insulin. Next one says Oh, I love this one. Listen to the diabetes Pro Tip series from the Juicebox Podcast Take notes. Here's another one from this person. Some sites have dramatically different absorption rates. We talked about that in the podcast. Here's one for Dexcom. Learn to look at the dots instead of just the number in the arrows. This person says when you're going from just having a meter to a CGM. Remember the CGM is just one of the tools in your arsenal, it's not a full replacement for a blood glucose meter. Use both tools effectively. Don't get overwhelmed. They are just numbers and data. It's not a grade for you. It's good advice to this person says no matter what you're doing, whether you're changing from MDI, to pumping pumping to algorithms, your ratios are likely going to change. And that takes time to figure out. This person says not all algorithms are the same. So make sure you understand which one you have and how it works. Their example here is if you're having trouble with a T slim product, don't use someone's advice from the pod five, it won't be the same. Don't assume that your CGM is always correct calibrated if symptoms aren't matching the number, use finger sticks to make sure other person preaching patience, and says not to make perfection your goal, just shoot for shorter peaks, and more shallow valleys in the beginning and over time, your skills will get better. And those peaks and valleys will flatten out. This person says be prepared when your technology doesn't work. And please don't expect perfection. Another person basil testing, there's a great episode about Basal testing in the Pro Tip series. Here's one that just says don't give up. I like that one. I like this one here. Don't use too many new or different foods when you're trying to figure something out. So stick to meals that you are good at bolusing for that way you remove variables, right, like you know, on MDI knew how to cover this food. So I'm doing the same thing on pumping, what's not working, then you can look at your settings and see what's different. I'd say that's a great one. I like that a lot. Educate yourself on how your pump works. Don't just trust that your rep set it up correctly. It's a lot of settings in there. It's a good one. We were used to coasting high no matter what this is an MDI, person to pumping. And we rounded up way too much on our carbs. When we switch to a pump, it took a few weeks of lows to get out of that habit and trust that the pump knew what it was doing. Interesting. So if the settings are good on the pump, I see what they're saying their settings on MDI weren't great. So they were always just, you know, doing more. But when the pump was set up, well, they didn't need to do that anymore. It's interesting. That's a good one. Here's a great one. Don't just put in settings into your palm, write them down somewhere. If something happens to the pump, you need to have them to put back into a new one. And keep a pen or needles handy in case you need to do manual injections. Even on a pump, you might have to do that sometime. That's very good to your settings in a manual pump may not work in your algorithm. This person talking about a CGM says when you start a sensor start at a time of day when you haven't eaten for a couple of hours. And you're not going to eat for a couple more hours if you can. Evening is good, especially for kids in school so the sensor doesn't run out at school. Oh, that's a good one. So he like you don't want to like put it on. I think what they're saying is you don't want to put it on at nine o'clock in the morning on Saturday. Because then at nine o'clock in the morning, you know, on a weekday it might run out. That's a good one. Don't feel bad about removing a sensor if something's wrong, whether it's causing pain or discomfort because you can always call the company and they'll respond with a replacement. You may have heard leaders or readers, that's not always the case. This person says if you haven't heard that phrase, you will eventually take pictures of your CGM sensor codes and transmitters put the expiration date into your calendar with a reminder and that way it won't sneak up on you. Here's one for going from MDI to pumping make sure the correct factor is calculated using the number, the pump shoots for not the one you were shooting for on MDI. Interesting. So what she's saying I think is if the pump gets set up in the target is 100. But when you are MDI the target was, then your correction factor won't be correct. Interesting. This is funny, I can't read you the whole thing, but it says, eventually, something's gonna go wrong. And your tech savvy husband is somehow going to push the wrong button and deactivate everything. I don't think that's as much advice as somebody who wanted to tell a funny story. Going from a blood glucose meter to a CGM. Don't look at the thing every five minutes for me that led to me overreacting to blood sugars, that may not have warranted a reaction at all. Set your alarms at a useful level. This one's terrific the person who sent this one and use that to guide your decisions rather than checking constantly on CGM. I'm a big believer in this by the way, if it doesn't beep, I don't look, there's a person here echoing this sentiment that blood sugars can be fluid, and that it's possible you can overreact and be the reason it's jumping up and down. I think that's worth repeating actually. When you're going from MDI to pumping, you don't need to wait to do a correction Bolus, make use of the insulin onboard information that the pump has great one, that's a great little tip. There's a comment here with a ton of information for the Omni pod five, I'll tell you there's actually an omni pod five Pro Tip series. Definitely listen to that before you go to Omni pod five. But I do want to add a little bit here from this post. Fluid insulin delivery, like an algorithm has to do suspending and increases and decreases and that demands a different approach than a static Basal. So in a regular manual pump, where you might just say, um, one util an hour all day long. You're making a lot of adjustments throughout the day that you don't realize, because there are times you don't need that insulin at a unit an hour might need it more may need it less. That's why the initial settings on these are so important and you kind of stepping back and watching it work for a while to see where your settings may need to be adjusted. Or maybe the way you use your insulin needs to be adjusted Pre-Bolus etc. This person says that a pump was not a cure all for their problems. And they found it very deflating when they went from MDI dual pump and it just didn't make everything better. That's important, Jenny and I definitely went over that in this episode. But keep in mind, this person says here that your doctor's office might say we don't give a pump till one year or you can have a pump till after you've been on MDI for six months or something. That'll sound like a rule to you when they say it. But that's not really a rule. You can, you can push. This is a reiteration of something we heard before. But when you're going from just a blood glucose meter to a CGM, you might want to take some time to just absorb everything. You don't want to just jump in and start tinkering right away before you know what it is you're doing. You know why you turning this dial on that dial really kind of lived through it for days, maybe weeks, even before you just say, alright, I see a trend here. I know what's happening. This is an interesting one. This is for somebody going from MDI to pumping. They don't want you to forget the tricks, you know, brain like if you see a blood sugar, and it's kind of stuck and it won't move and back on MDI, you want to inject it in a unit, there's no reason why you can't give a unit with the pump. Just because the pump says, Hey, there's still insulin onboard, it doesn't mean that that insulin was calculated correctly, and is really about to make an impact. I think they're saying trust your gut. This one's a little long, but the person says everyone's experience is going to be different. So roll up your sleeves, go into it with an open mind and be ready to dig in and do some problem solving. And don't forget to listen to the podcast, they go on to say when going from MDI to a pump, you really have no idea what to expect, you can only kind of hope that you start out with great settings. But that may not be the case. So many people end up having a poor experience when they switch and then they share that online. And then this person was like scared. That's what was gonna happen to them. But then that wasn't what happened at all.

It was incredibly easy, she said, and his numbers got much better very quickly. So I think the I think the message here is, sometimes people just share bad news online, doesn't mean everything's bad news. Here's a little tip. A pump company puts their pump through the FDA for approval, and they choose a couple of insolence to use in the pump. Those insulins are then approved in the pump. It doesn't always mean that the ones that aren't improved in the pump won't work in the pump. It just means they didn't put it through FDA testing. I want to thank everybody who share those tips and remind you that those people exist in the private Facebook group for the Juicebox Podcast. There are so many other management based series within the podcast. You're listening, of course right now to the diabetes Pro Tip series diabetes Pro, tip.com, juicebox, podcast.com, and in your audio app, but there's also the defining diabetes series, diabetes variables defining thyroid, bold beginnings, ask Scott and Jenny. And we have collections of episodes about algorithm pumping, which we talked about a little bit today, you can find out way more in the algorithm pumping episodes. There's the after dark series where we talk about all the things that people don't usually talk about about diabetes, how we eat mental wellness, there's so much to choose from. And if you happen to know somebody with type two, there's a brand new type two diabetes series for people with type two or pre diabetes. Check them out at juicebox podcast.com. Here's a little feedback from other Juicebox Podcast listeners. After devouring the Pro Tip series, I got my daily average down by 30 points. And I'm excited to continue learning from this all in one resource. If you're struggling with insulin, this is the place to figure it all out. I am so thankful that a friend recommended the Juicebox Podcast to me, and I wish that I would have found it at the beginning of my journey. I have been binge listening since I found this podcast. My son and husband both have type one man, I wish I had this when my son was still living at home. I'm learning and sharing how we're going to get our agencies lower. I've had type one diabetes for 20 years, and it was never well controlled until I started listening to the Juicebox Podcast. I've become bold with insulin. And this podcast is unlocked the solutions to so many issues I've struggled with for years. I can read you these reviews all day. But I would prefer to stop because it seems it's tricky to do this right? I just want you to go listen to the Pro Tip series, find the defining diabetes. If you're new, go check out bold beginnings. All of the information that you could possibly want and need about managing your insulin is in the Juicebox Podcast. Subscribe now in a podcast player like Apple podcasts or Spotify, Amazon music or wherever you get your audio. And don't forget to check out the private Facebook group, which is also free Juicebox Podcast type one diabetes 37,000 members and it grows by hundreds of people every week. What a resource. Please don't miss out on this community.

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