Scott Benner 7/6/23 Scott Benner 7/6/23

#946 Best of Juicebox: Diabetes Variables: Alcohol

Originally aired on Dec 17, 2021. Diabetes Variables: Alcohol

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 - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

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

Scott Benner 0:00
Hello friends and welcome to episode 946 of the Juicebox Podcast

I thought for the Fourth of July we would run a best of episode about alcohol. Don't ask me why just seemed like you know the right thing to do. Today's episode features Jenny Smith and I in a diabetes variables episode, Episode 596 originally aired on December 17 2021. It talks about alcohol and its impact on your type one diabetes care. While you're listening, 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, or becoming bold with insulin. If you want to check out Jenny, you can hire her at integrated diabetes.com. And if you want to check out the entire bold beginning series, it's available at juicebox podcast.com. Go to the menu at the top click on bold beginnings, you'll see all the episodes there. It's available in your podcast player, any audio app you're listening. And if you're looking for another list, but you don't want to go to the website, you can go to the feature tab in the private Facebook group Juicebox Podcast type one diabetes

this episode is ad free. But please remember to use the links if you have the need. They're in the audio app you're listening in right now in the show notes. Those links are also at juicebox podcast.com. Or you can type them into any browser. I appreciate you thinking about the podcast when you're making purchases when you support the podcast by using the links if you're keeping the podcast free and plentiful. And here's a couple of quick savings for you. If you'd like to start drinking ag one in the morning like I do drink ag one.com forward slash juice box the first time you buy at one with my link you'll get five free travel packs, and a year supply of vitamin D. And if you like comfort, comfort in your sheets, your towels and your clothing. Check out cozy earth.com If you find something you like put it in your cart. And when you're checking out use the offer code juice box to save 35% off your entire order not just one item, your entire order. Alright, check out this episode and please do not blow your fingers off. Happy Fourth. Hello friends and welcome to episode 596 of the Juicebox Podcast. Oh

so this is it. This is the last episode of the diabetes variable series with me and Jenny Smith. And today's topic is alcohol to see how I've timed that to coincide with New Year's. Hmm, that's right, I'm thinking. Please remember while you're listening 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. Today I'll be speaking with Jenny Smith. Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast so come proper I really hope you've enjoyed the variable series if in the future Jenny and I think up other ones will add them but if not, they're always there for your needs and enjoyment.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. Jenny This is the last variable we're going to record. Oh, we've done it. It's very exciting.

Jennifer Smith, CDE 4:28
That is very exciting. A whole year of recordings are variable that's that's a lot of variables.

Scott Benner 4:32
I'm not kidding about it. At one point I looked at the list and I was like why did I like this is not a good idea. But it ended up being great and I really did enjoy it you obviously brought a ton to it. So last one alcohol How was alcohol a variable for for using insulin.

Jennifer Smith, CDE 4:52
but alcohol is a variable because alcohol can lower your body's ability tea to respond to the typical turnaround hormones that would raise blood sugar, you know, if you have a low, and so alcohol in and of itself, and we're talking like, several drinks, or even just one drink, depending on how your body tolerates alcohol. And many people I think are kind of confused what to do about alcohol because they feel like, well, if they're drinking, like, a hard liquor, for example, really doesn't have carbohydrates in it. Right? So you may not be bolusing for it, and you should, you know, not not necessarily unless it's mixed with like cranberry juice or orange juice or something like that, right. But other types of alcohol such as beer, have a fair amount of alcohol to them. carbs, or sorry, yeah, the alcohol carbs. Yes, thank you. I was thinking alcohol, alcohol. Yes. So there's, you know, I mean, anywhere between 12 to maybe like 22 grams, depending on the size of the bottle or the can or whatever you're drinking, really? So do you cover the carbs? And then what happens later, right? Do you take insulin to cover the bottle of beer that you're drinking? Do you not what happens most people who don't cover the carbs initially will have a higher blood sugar.

Scott Benner 6:19
So is the concern around bolusing for carbs that are an alcohol that at some point, you become a knee braided and are not the best shepherd of your blood sugar, if it gets low?

Jennifer Smith, CDE 6:29
Those are the good questions to always be thinking about. Yes. Because in terms of low from alcohol, low from alcohol is a delayed low, it will tend to happen later on. So our typical recommendation on a normal conventional pump, it's a little more a little more, I guess, difficult if you're doing injections, but on a pump, it would usually say at the end of the night, let's say you've had several drinks over the course of the evening, it's midnight you get home at that point, you want to really decrease your Basal insulin delivery, because that's when alcohol is likely to come into the picture in terms of hitting you and causing you to go low.

Scott Benner 7:17
And is that the actual alcohol that's bringing you down? Or is that your? Or is it the Bolus that you used? Or no, if even if you didn't Bolus you would get low afterwards.

Jennifer Smith, CDE 7:28
It shouldn't really be the Bolus. I mean, again, bolusing has a definite like end point of action, right? Let's call it four hours, just give or take three to five hours, four hours. So if you last Bolus at 10 o'clock, you're low at 2am. Sure, it could have something to do with some of that Bolus still being left in the system. But it could also have to do with the way that the liver turns around and deals with, let's call alcohol a toxin, right. So as the liver is dealing with turning that alcohol around and getting rid of it in the body, your liver is also not putting out the typical turnaround for drop in blood sugar, right? You don't have that counterregulatory hormone production, so that your body has some glucose drip coming out of it saved stores to help you. So in that we usually say for every alcoholic beverage consumed, we really want to take the Basal rate down by a certain percent for about two hours per beverage consumed. Okay, so if you had three beverages at the end of the night, the percent that we would take it down would be by 40% of a decrease. And then the timeframe to decrease would be about two hours per beverage.

Scott Benner 8:45
Okay, so So you're basically people might not recognize that your liver is making glucose and you know and giving it is giving it off like Luca is it glucagon or glycogen or I forget the word,

Jennifer Smith, CDE 9:00
right? I mean, your body's counterregulatory hormones essentially coming from the liver or helping your body to essentially put out in the turret in terms of a low or a drop like that. It's helping your body to put out the glucose, right? I mean, that's why we have glucagon kits, right glucagon kit is a really quick turnaround of telling your body to spit out the glycogen and to turn it around into glucose to sort of bring you up from the low

Scott Benner 9:28
but if you're if you're taxing your body with enough alcohol, the liver gets focused on that. And then as your blood sugar gets low, it doesn't go through that process. In the same

Jennifer Smith, CDE 9:39
way, it doesn't go through that big process of counterregulatory. But also remember the reason that we're taking Basal insulin is to counter the production and natural drip drip of glucose into our system to begin with. So if the liver is busy taking care of alcohol, it's no longer going to help with that normal drip drip drip of glucose. Industrial Basal is going to be too heavy for you. Okay. In layman's terms, right? I mean,

Scott Benner 10:06
listen, I'm it's not a it's not a deep dive into how the liver works. But it is something I don't think people think about for certain,

Jennifer Smith, CDE 10:13
you know, and I think it's something that often isn't even brought up like I, I try really hard with a lot of the teens and those heading off to college that I work with, I try to bring up alcohol at some point, because it will come into the picture. Yeah, I mean, unless you're unless your kid has really sworn off because they just don't have any interest in that. At some point, alcohol will be something they need to think about. And it's really important that they know better how to adjust if needed, than just say, Well, I'm never going to do it.

Scott Benner 10:48
Right. Okay. Does this. Does this need a bigger episode? Or? What do you think?

Jennifer Smith, CDE 10:56
Come on. What do you have more? More questions?

Scott Benner 10:59
No, I just I don't know if it's, I don't know. I mean, it's like, you know, if you're, if it's beer, beer has carbs. If you're drinking, you know, some harder liquor, there's no carbs in them. But you have to look and see if you're going to add fruit juice just seems like maybe I could understand that when I start. But what happens when I'm like three drinks into it? Like, where do I? You know, what do I do when the when the room starts spinning? You know what I mean?

Jennifer Smith, CDE 11:22
Right? I mean, the big things with alcohol, too, that we always recommend is definitely have something to eat with it. Right? So it's not just alcohol. I mean, you probably know that. Or maybe you don't, I don't know, whether you drink or not. But if you don't, if you drink something on a pretty empty stomach, the impact of that alcohol is faster, right? You will feel the impact. Versus if you have it with a meal or at the end of the meal. Are you drinking along with the meal? It's much of a dumbed down. Impact. Yeah, which meal so then if you were expecting the impact of alcohol may lead you to drink more, because

Scott Benner 11:59
I'm also that there might be people who are wanting to get to that spot, too. It's a really difficult thing to talk about, because you're talking about it from the perspective of how do I do this responsibly? And I don't know that everybody starts an evening of drinking with that in mind to begin with, right?

Jennifer Smith, CDE 12:18
Correct. And you also have to consider like, I much feel like if, and I've only been drunk a handful of times, I'm not a drinker. I I'm, in fact, I came, I think the last time I was drunk was probably at my brother's wedding in Aruba. And that was a long time ago. And it was a lot of fun. But feeling drunk, feels very similar to a low blood sugar. Okay, those tip sees types of and maybe that's not a symptom of yours, but I very much have a similar feeling with alcohol as well as with a low blood sugar. Yeah. So then comes into the equation, you're also already not really thinking very well, because you have alcohol on board. Is your symptom of being drunk? Also a symptom of a low that you're not paying attention to?

Scott Benner 13:15
Yeah. And how are you going to be able to handle that, um, so I'm just thinking of a person I met recently, whose son was away at college and was not a drinker, not a drinker, and then all of a sudden, one night just dove headfirst into it. And then this person had to, like, drive to a place to like, rescue the kid and take them to a hospital. Yes, you know, because then the next problem is, is that you're now around a bunch of drunk people, no one's going to be able to help you. Like, you know, you. It's not like you have a designated, what if my blood sugar gets low person here? You know, right,

Jennifer Smith, CDE 13:49
right. I mean, it's a reason in college that I 98% of the time, I offered to be the driver, when we would go out. And I might have knowing that we were going to be out for a fair number of hours, I might have like, half a beer when we got there. And then I had nothing else the rest of the night giving it a good like four hours of clearance time to be able to be like the driver hole.

Scott Benner 14:16
I can say with confidence that in my life, I haven't had the equivalent of a case of beer. Like I just don't drink for no reason that I can particularly point out to you other than it's not interesting to me. It's just not a preference. Yeah, it's not for me, I just I don't know, like I don't even know how you like consume that much. Like I have a bottle of like, flavored like peppy water here. And if I tried to drink this whole bottle, I'd be like, oh, like it can't really be too much. happens when you start putting like hops and barley into it. I'd be like, Oh, I'm so full. But yeah, but anyway, all right. I appreciate this. I know it's it's not an easy. It's not an easy conversation, because there's a lot of perspectives that that need to be taken into account. But I think in general, I mean, at least you could Try to follow what Jenny was saying about decreasing your basil. And, and, you know, I would add, you know, you gotta have I would want to have somebody there that understood my diabetes a little bit who wasn't drinking, but

Jennifer Smith, CDE 15:12
correct? Absolutely. And I mean even people ask even about wine, you know, a glass of wine, typical table wine is somewhere between three to five grams of carb, per you know, glass, should you cover that? I think a lot of it is also experience, right? What do you know about what has happened and along with what you said, make sure somebody is there who knows, you knows you have diabetes knows how to help you if you don't seem to be acting, the way that you normally would be acting. Because all of those things very much like all of the things with diabetes in general, take a little bit of experimentation. And you have to figure out what works the best for you.

Scott Benner 15:54
Let me let you I know you have to go. But let me ask you this, because I think I remember that this is true. When I'm drinking my glucagon won't work as well, right? That is right. Yeah. Okay. So if you're thinking doesn't matter, if I pass out, I'll just use my glucagon, it might not help. It will. I

Jennifer Smith, CDE 16:13
mean, will it turn things around versus nothing at all? Yeah, but it's not going to be the the same impact from what I recall. And I would I mean, it certainly would look it back up, but I'm quite certain nothing has changed about the recommendations and what we know about your glucagon kit and alcohol in the mix together.

Scott Benner 16:33
Yes. So read the label on your glucagon if you're expecting it to save you when you're, you're drunk, because it might not be as impactful as you're hoping. Okay. That somehow we made drinking sad, and I'm sure everybody oh

Jennifer Smith, CDE 16:51
well, people don't see us so they can't tell whether we're smiling or

Scott Benner 16:55
having a great time talking about I'm like, I just started thinking like we're taking the thing or people like oh, my, my Saturday night happy place. These guys are bumming me out. All right, well, thank you so much. G voc hypo pan has no visible needle, and is the first premixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. And the diabetes variable series began I guess technically at episode 231 with the pro tip called diabetes pro tip variables but then the variables proper began at 491 with trampoline followed by temperature travel exercise hydration, food quality leaky sites and tunneling video games stress masturbation school bedsides, growth hormone sleep pump site placement, a full moon diabetes tech weight change Walmart, the final episode sort of the last episode menopause and today's episode, alcohol. Check them out. They're all available in your podcast player. We're at juicebox podcast.com. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. And now I will sing the simple version of your Grand Old Flag for the Fourth of July. You're right Grand Old Flag Euro Hi Fi in flag you're forever in peace may you weigh in. You are the emblem of the lion that I love the home of the free and the brave. Every part beach true neath the red, white and blue where there's never a boast or brag. Sure Should old acquaintance be forgot. Keep your eye on the Grand Old Flag. Never had a lesson one take for those of you who don't live in America or hate us. I'm sorry about that. Actually, for those of you with ears, I'm sorry about that. Please don't unsubscribe. I'll be back very soon with another episode of The Juicebox Podcast.

#945 In the Loop

Mike has type 1 diabetes and he knows a lot about Looping.

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Scott Benner 0:00
Hello friends and welcome to episode 945 of the Juicebox Podcast.

Today I'll be speaking with Mike He is an adult living with type one diabetes who is very involved in the looping community, the DIY, do it yourself, looping community, Mike and I are going to speak about loop and Omni pod five for a little bit today. If you're interested in algorithms and insulin pumping, this one's for you. While you're listening, 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, or becoming bold with insulin. If you're interested in building a foundation for better health, check out my link for ag one and it's a new link. Drink ag one.com forward slash juice box. When you start with ag one with my link you'll get a free one year supply of vitamin D and five free ag one travel packs with your first order drink ag one.com forward slash juice box and get 35% off your entire order at cozy earth.com. When you use the offer code juice box at checkout. There are links in the show notes and links at juicebox podcast.com to 81 Cozy Earth and today's sponsor. This episode of The Juicebox Podcast is sponsored by cozy Earth. I am right now this second on my way to a movie as soon as I record this ad I'm gonna do a movie with my family. I just pulled on my cozy Earth joggers because it's the most comfortable thing I can think of to go hang out that movie theater with I'm going to have on the sweatshirt from cozy Earth. I'm going to pull on the joggers. I'm going to watch me a film. And when I get home tonight, I'm slide into my bed with my cozy Earth sheets. And I'm going to take a shower and warm and dry myself off with my cozy Earth pals. I am not making any of this up. They are really cozy, cozy earth.com use the offer code juice box at checkout. The podcast is also sponsored today. By touched by type one touched by type one DoD word. They have a big event coming up in September that I'll be speaking at. I hope to see you there touched by type one.org. Why did I get the VIP? Oh, let's Did you because I was out of days? Oh, yeah, I just I was literally. So the um, so every year, I might leave this part. And just so you know, every year, I consciously think don't don't book the show so much that you can't add somebody like I have this real like, don't do it. Scott Don't you know. And so I start every year out very carefully, I put out a link at the beginning of the year, I say, Hey, we're gonna we're gonna book like the first six months right now. But then I'm not gonna book the next six months until, I don't know, June or something like I'm gonna wait a little bit. And so many people reach out with so many great ideas and stories and from different walks of life. I just keep going. Yeah, yeah, like, sign up for that sign up for that. And in three weeks, you can't get a recording until like October. And so by the time March or April rolls around the years full already. And then people reach out that I still want to have on the show. And I'm like, alright, well, I mean, I don't record on Mondays, except for with Jenny or something special like that. So go ahead, just take this special link and go ahead and take something on Mondays. And then before I know when I give away Fridays. And then before I know that I'm recording the podcast every day, five days a week and getting to the point where I did somebody on Saturday night the other day, because I just I don't know how to say no. So I want I want that problem. Yeah, I love that. I love making the podcast. So anyway, you ended up with the VIP link because I was out of days. But also, you're a VIP, like hell. Well, thank

Mike 4:05
you. Yeah,

Scott Benner 4:06
whatever your mom told you about you being special is 100% true. You go ahead Introduce yourself whenever you're ready.

Mike 4:14
Hi, Mike. I've been type one diabetic since 2003 How old are you? I am 32 You're 30 No 31

Scott Benner 4:29
You're 31 When will you be 33 that that confused you?

Mike 4:33
Oh no, I am 32

Scott Benner 4:35
Nevermind 32 Okay, my whiteboard is already a mess.

Mike 4:42
Like my birthday is in 90 So like the last digit matches like my your age, but only before after the birthday. So I got to think like right is it before after my birthday?

Scott Benner 4:54
You were born the year after I graduated from high school. Well, that doesn't make sense. So if I had 19 add to this. Oh, baby, let's make sense. 1011 Carry that it's the one I wasn't carrying the 1345. Yeah, that makes sense. That makes sense, meaning that simple math holds up yet again, like, I want to see the proof. Well, if I took a picture of it, then everyone would know how bad my my penmanship was. And I don't want that, either. So, when you were diagnosed, was there like, Oh, I'm definitely gonna get this because all my brothers and sisters have her or have seven uncles that have diabetes, or was it a surprise?

Mike 5:34
No complete surprise. There's, like at the time, I don't think there was any real autoimmune known in my family. Now, my grandmother passed. About a year ago, she had Alzheimer's. And then also type two, which I guess isn't connected. And then my cousin on that side also has lupus. And my keep going, my grandfather on my dad's side has rheumatoid arthritis or head. He's also past the past year. All

Scott Benner 6:15
right. Okay, well, yeah, you were one of you was gonna get something lucky, you might.

Mike 6:24
But I think all that happened after I got diabetes. So we didn't, didn't have the warning. So

Scott Benner 6:29
all of that happen in meaning that you realized it, or she developed Alzheimer's late. Lupus happened since you had type one. I mean, your grandfather's had arthritis his whole life, but they diagnosed it as RA or what do you what do you mean by that?

Mike 6:49
I just made like I was, I had diabetes. First before anyone else was diagnosed with anything.

Scott Benner 6:56
Okay. Well, then you will. I mean, I also

Mike 6:59
I didn't know that the autoimmune connections until listening to your podcast.

Scott Benner 7:03
Oh, okay. I see. So there would be even you might even know, my grandfather's got, like, arthritis really bad might be how people think of it.

Mike 7:14
Yeah, and I don't know if he actually had a diagnosis or not. I just know, that's what my parents had said is that he had Ra. And my brother might have it, he might not. He's got some joint issues that he's trying to work through right now and figure out but the doctors keep running in circles. Yeah,

Scott Benner 7:31
that's what happens. I think that everybody, honestly, it's a shame. Have you heard Jenny talked about how she manages it with her diet?

Mike 7:41
I think I remember like, she doesn't eat, like dairy. Eggs or RA or something

Scott Benner 7:47
is some nightshade things and it's in her she's an episode about how she eats and she talks about it in there. But I wish her brother luck. It's not. It's not fun, that's for sure. Okay, but you just type one. And when you're diagnosed, how I mean, I could figure it out, but just telling me how old you were when you were diagnosed?

Mike 8:07
1212 That's like, sixth grade. Yeah.

Scott Benner 8:13
Was it a situation where the management of it was given to you or did your parents handle it?

Mike 8:21
It was like, they they helped me in the beginning figure stuff out my mom's a dietician. So like she helped lift helped me with carb counts and figuring all that early on. Of course, I didn't know until listening to your podcast about fat and protein and other things that can affect it. So it's just counting the carbs but you think it was pretty much but yeah, me for Well, I guess. I think in the beginning, it was more so like someone else would figure out the dose or like my mom for the first six months while I was still on injections. But then as soon as it moved over to the pump that was just putting the carbs press Bolus, eat your food

Scott Benner 9:03
in the cars and so there's no Pre-Bolus thing there was no adjust no adjusting after meals if blood sugars got higher or did you even test afterwards to see where they were?

Mike 9:13
I occasionally test after and like if I was high I would like I'd put the number in the pump and if the pump said correct I'd correct

Scott Benner 9:22
okay, well that's something did you hate it as a child? Did you not mind it? Do you remember?

Mike 9:29
Um, I I'm pretty good at ignoring things. I feel like I did an okay job. Like Maitland sees I was looking back through and it saw like consistently in the sevens. I think the highest was like 8.2 the lowest was like 7.1 so it just kind of like shifted around in there. I feel like it would have been a lot lower had had been told the Pre-Bolus But yeah,

Scott Benner 9:57
how did you feel growing up like physically Did you feel healthy?

Mike 10:02
Yeah, I didn't, I didn't notice any problems. I wasn't like a super athletic kid. I was, you know, I'd play sports and stuff, but not very athletic, up until like high school where I could get out of Pe by joining band.

Scott Benner 10:20
Like, I just want to dig into that for half a second. What does it mean that you played sports? But you weren't athletic? Were you the, were you the guy that we all looked at? And we're like, I mean, we like

Mike 10:29
yeah, I was I was the one dancing in the outfield. They're like spinning around in circles and the ball get hit and be like, oh, there's a ball, I should go catch that.

Scott Benner 10:37
We like bikes, and we're going to tolerate this, but he's not going to be here long term. That was the feeling.

Mike 10:42
It's neighborhood organized sports, you can't kick a kid out.

Scott Benner 10:46
You'd be surprised, Mike, but I hear what you're saying.

Mike 10:50
Maybe for being a nuisance, but not just for not being good. Can't

Scott Benner 10:53
you just make it very uncomfortable for them until they leave?

Mike 10:59
I'm also kind of like a pleaser. So it's like, you know, my parents like sports or so they think baseball is important. And I did not. I'm kind of like, I can go with the flow with things a lot. Like even if I don't really enjoy something like, I didn't hate going. Can I Can I ask if I had the opportunity to leave?

Scott Benner 11:19
Yeah, let me if I had the opportunity to leave, I'm just getting the hell out of there. If I might, I know this is not really why you're here. But you and I talked before you came on, we might not actually have a reason for you to be here. So I can talk about whatever I want. Can you tell me a little more about that? You understood? How that baseball as example was important to your parents? They told you or they were just big fans of it? Or how did you know?

Mike 11:46
I don't know it like my dad's just always thinking, watching sports. Like, you know, you'd be excited for me to go play baseball, or I don't think it was also like they would encourage just because, you know, it's better to have your kids go around play sports get energy out, rather than sitting on the couch,

Scott Benner 12:07
or cooking math or something. So as 12 year olds tend to do. So she they wanted you to be active. Do you think they picked baseball? Or do you think you did?

Mike 12:21
I don't really remember it was more like that started in like T ball. So a failure. It was probably just like, hey, there's a team. Go join that.

Scott Benner 12:31
scale of one to 10. Mike, how good were you?

Mike 12:35
Oh, probably. We'll give it a two. Okay. Okay. All right. I could catch a ball and throw it but you know,

Scott Benner 12:41
do you ever remember a coach looking at you with disdain?

Mike 12:45
I don't remember. But I'm sure even if they did, I just went right over my head, you just wouldn't

Scott Benner 12:50
have cared. I'm really like now, I'm not trying to be amusing. I'm trying to like trying to gauge whether it's like as a young child, if you were taking yourself to this place and thinking, Well, my dad likes it. And I don't hate it. And I you know, I'll do it like, and if you ever looked up and thought, oh, this person doesn't want me here. So you didn't have any of that feeling like you weren't great at it? And didn't. It wasn't something you were excited to do. But But so then my question is, what's your remembrance of it? Like, how would you characterize playing baseball? I don't know. Is it a good? Like?

Mike 13:31
A neutral?

Scott Benner 13:35
Okay, I'm asking like, I'm asking you an uncomfortable question, because I want everyone who is about to force their child to play a sport that the kid doesn't want to play to hear that in hindsight, this was what you call it wasted time. Because there was there it was there something you could have done at that age that would have been better for you.

Mike 13:52
No, I mean, in hindsight, I think it was good. Like I said, it kept me kept me active kept me moving.

Scott Benner 13:59
All right, well, then they heard it from you, Mike forced your children to play sports even if they don't want to. That's what you said, right? Yeah. Keep them moving. I'm encouraged by that because I've met I know you you know what I mean? I don't know you I know kids like you. And I sometimes wonder about that. I think oh, there's two seasons where this kid just I mean, obviously, I think everybody but their father could not have cared less about this thing did not want to do this and got brought there every day. And it makes me happy to think that somewhere that kid has grown up and and not devastated by the experience hopefully using you as an example. But then you said you joined the band but what did you play an instrument?

Mike 14:45
Yeah, drums. So like marching band counted as Pe

Scott Benner 14:52
How was that for hookups marching band?

Mike 14:57
Uh, I mean, I was just a freshman year of highschool, and then I moved overseas, my dad's in the Air Force. So we moved around a lot. And every high school I went to three different high schools, and each one got smaller and smaller, and the bands got worse and worse.

Scott Benner 15:12
Did you stop going?

Mike 15:15
I kept playing. I really didn't like the last my senior year, because it was like super small schools like 200 300 kids maybe. And the band teachers spent most of the time talking about like Broadway or something nobody cared about. And I was the only percussionist so there'd be like, here's seven different instruments that are supposed to be played. And I'd be like, How many can I play at the same time?

Scott Benner 15:40
You kids don't know this, but I was the dog in a production of my fair lady in high school. By the way, is there a dog in My Fair Lady?

Mike 15:48
I don't even I don't think I've seen that.

Scott Benner 15:50
I don't know either. I just made that up. I feel let's just roll with it. Pretend there is now there. Damn. Right. As everybody's listening. It's like it's fine with me. There was a chihuahua running around the whole time. Well, that's interesting. I mean, it's interesting that that it's an it sucks a little bit that you found the thing that you liked, and then because of moving around, and dwindled on you, so you're not a drummer anymore?

Mike 16:12
No, I still drum. Oh, nice. But like, drum set, like in bands and stuff. Oh, it's

Scott Benner 16:18
excellent. You do play you play in bands? Yep. How does that

Mike 16:22
not at the moment, at the moment, I'm in between bands, but COVID kinda ended things like make things a little more difficult for a while and that band ended but yeah, I'm in for a new one.

Scott Benner 16:33
Nice. You off to college then after that?

Mike 16:37
Yeah, yeah. Went to college straight out of high school. And they were still in Germany. So and then I went in Florida to college.

Scott Benner 16:45
Did you feel any pull towards the air force or pressure?

Mike 16:51
Well, I was diabetes, so you got out of it. So in the Air Force anyway.

Scott Benner 16:55
How about your brother? Is he in?

Mike 16:59
No, he considered it for a bit but ended up not?

Scott Benner 17:02
Do you think your dad was more disappointed that you guys didn't go in the Air Force or that you couldn't play baseball?

Mike 17:08
I think he's pretty happy with this no matter what.

Scott Benner 17:11
It's a very healthy answer. Mike Good for you. I would have chosen if you gave me if somebody threw a bullshit which is what I just did choice that me I would have chosen I would have been like, I would have thought about it for a second and pick one is very healthy

Mike 17:25
weight, which was a see all the above is very healthy

Scott Benner 17:29
choice was excellent. I'm so thrilled that that's how you answered. Okay, great once you go to college for

Mike 17:37
I started electrical engineering and then the first semester I changed to computer science.

Scott Benner 17:44
And are you able to employ that education in the in the adult world.

Mike 17:49
Um, I worked at a place developing or like taking other iPhone apps and like keep updating them or for about a year, two years, maybe after college, and then I switch to another job where I print and scan stuff for lawyers. You enjoy that there's a lot of it pays the bills and it's it's something different every day. Like, I've been there like six, seven years, and there's always something like new that'll come in and be like, alright, I don't know how to do this. Let me figure out a way to do it easier quality or

Scott Benner 18:26
problems not it's not it's not just repetitive it's, it's something you can actually employ your brain with. Yeah, it's

Mike 18:33
like a mix between repetitive and not because some days you'll go in and you're literally just feeding paper into a scanner for like the entire day. Oh my god. But then the next day, it'll be something completely different. So

Scott Benner 18:45
here's my next, my next false choice for you the job or we're having to play baseball again on the schedule of a child which would you prefer right now?

Mike 18:56
What's much rather be at this job than play baseball.

Scott Benner 18:59
That's what I was getting. Okay. Alright, so you manage your diabetes? Sounds like pretty much on your own. Were you doing that MDI with a pump?

Mike 19:11
mph for the first six months and then as soon as we could get to a pump, we got a pump.

Scott Benner 19:16
Okay. Do you have a CGM now present day?

Mike 19:21
Yeah, I do now. I think I started maybe senior year of high school, maybe freshman year of college. I can't remember when I first got to CGM, but um, I was Medtronic up until a year and a half ago. So it was basically I treated it more like a don't die alarm. Like if it beeps look at it. If it's super high, then start adding corrections because I think you know, my it probably didn't beep until 200.

Scott Benner 19:48
How would you describe your your management in that time? Your management style like were you on top of it? You know, were you a person who was like I'm not, you know, 200 is my number, you can't go over 200 when it got to 200. Were you worried? Or did you feel like an intensity about how to handle it? Or just was it just part of the day and you just did what you did and didn't think about it?

Mike 20:14
Yeah, it's kind of just like in the background. I tried not to focus on it too much. But like, you know, if I thought something was wrong, if it beeps at me and says, I'm Hi, then I'm going to Bolus but then I probably won't look at it for another couple hours or until it beeps again. I see. And I'm pretty good about changing settings and stuff. Like if I'm, I noticed that I'm consistently going high after dinner, I changed my ratio, change basals and stuff. So a lot of times, that wouldn't be until like, you know, every three months, you'd have your endo appointment, and then I'd look all over the stuff like right before the appointment and wait that three months. And then I change it all and then go in and they'd be like, oh, yeah, that sounds good. You can change it to that. Or you could move this a little bit.

Scott Benner 20:59
Not incredibly helpful. At the end of this office.

Mike 21:07
Yeah, no, I mean, like a little bit, but I never really found too much use out of and two appointments. Yeah, like now I go. About once a year, a little more frequently, like nine months.

Scott Benner 21:19
Get your scripts. Yeah, basically do anything. When do you find the podcast?

Mike 21:28
Well, I just looked in the in the app. Not too long ago, we needed that Spotify end of the year thing? Yeah. Because I was on Apple podcasts. And it said, I listened to the first one in January 18 of this year.

Scott Benner 21:41
Oh, so you've just the year for the podcast for you. Yeah, interesting.

Mike 21:46
I swear, I heard the fatten protein episode in December, like a couple of like a month before that. But maybe I listened to it like on the website instead of podcast. Right?

Scott Benner 22:01
So you see, I mean, 2003 2022. So for a long time you live the way you live? And get did finding the podcast change? I mean, if it changed anything for you, what were the things that you adjusted?

Mike 22:21
Well, I found thinking like a pancreas first. And then, so like I learned like Pre-Bolus and a lot of good stuff from there. And then listening to the podcast just reinforces that a lot. As well as add a lot more stuff like the crush it and catch it. While I've you know, kind of done that before. I didn't really think about it as much. You know, it's just like more of the rage Bolus, and then you go low, so then you feed sugar. Whereas now it's like, okay, I know I can just give a massive dose and then like, so loop now. So I can look like right now I need to put in the carbs now. And then it'll even out before I get low. And let

Scott Benner 23:02
the loop jump in. How long have you been looping?

Mike 23:05
Since almost two years now, years, which is when everything, Eric actually I guess the first big switch was getting a Dexcom. Like I was, I remember watching seeing commercials for it on TV commercials kept coming up. And then it kept telling me like, you don't need a finger prick. And I'd be like, bullcrap, I know you need a finger prick, because I have to ferment Medtronic, like he still got to do it once a day. Like it's better than having to do it as much but. And I just kept ignoring the commercial, because I kept thinking that like, they're quite right. When I finally looked into it, working from home and COVID. So, a lot more time on my hands. I looked it up and I was like, Oh, you actually don't need to calibrate this thing. So then I got that. And then I was I also hesitant to get it because I wanted. I like like I've always been trying to get the next best thing, but it's always a Medtronic. Up until recently.

Scott Benner 24:05
Is that just what your doctor's office gave? You? know, it's

Mike 24:09
I mean, that's what it's, well, no, it started out. I remember I think my mom picked the like, she went to a thing and they had the Animus ping or the whatever the Animus one was and a Tronic. And like she thought the the only perk of the Animus that she saw was like it said pizza in it. And then the Medtronic said square wave for dual wave, right? And she was like, well, he can figure it out either way, and the reps seem to like Medtronic better. Yeah, I got with that stuck with that a while. And actually the last Medtronic I got the dreaded six seven D. My endo tried to convince me not to get it. But I was like, No, this is this is the new best thing. This is going to be auto mode. This is going to figure everything out. It's going to be easy sailing. And I was very wrong.

Scott Benner 25:01
All right, we're gonna dig into a couple of things. Here I have notes. My first thing is I want to, I want to say, I know a lot of people because of what I do that, you know, work behind the scenes that companies like, you know, Dexcom. And in places like that, and a lot of those people who make those television ads and whose job it is to try to reach people and and send the message to them that they might want to check more of it out. And I think any of them that heard what you said a second ago are still banging their head against the desk. They're working so hard. They're like, Hey, listen, just come check this thing out. Here's what it does. And you're at home gone. No, it doesn't. wires. Exactly. What I said, is people crankies people, Mike are killing themselves, trying to make people just learn about a thing. So they can decide if they want to do it. And I guarantee your answer just that it ruin their whole day. They're just like, I Why am I trying? Why do I give up? I actually, you might have seen this online. But I just put out an episode the other day with Jake Leach. And this is going to be six months later after people when people hear this but Dexcom G seven got FDA approval. And I hustled my little butt around getting Jake on to talk about G seven and go over all the questions that I had, you know, people gave me through the Facebook page, I had a couple questions on my own. I put together this really tight 30 minutes with just rapid fire great questions. His answers are super clear and valuable. We'll help you make decisions about what you want to do or what you don't want to do. And then the next part is I put it online, and then I have to support it through social media. My job is repetitive too. So I you know, put a post on Facebook, I put a post on Instagram, put a post here and then I and then I involve myself in conversations with people and try to answer questions and point them in the direction of the things they want. It's a bit of a, it takes a lot of time. And in the end, what I want is for people to listen, I made a thing. I think it's helpful for you. If you think it's helpful, I'd like you to listen to it. The other side of it the business side of it is I need people to listen to the podcasts that they hear the ads so that maybe they click on a link so that somebody will buy another ad again the following year so that I can continue to make the podcast It's the circle of life kind of thing. If people don't click on the ads, I lose the advertisers. If I lose the advertisers, I have to go get a different job, you understand. And so, so every time this happens, and I never say like I never speak out loud about it goes on for years, you put up a link. And inevitably, or three or four people come into some sort of a commenting thread and say, I don't have time to listen to this. Just tell me does it do this? And when I see you know, where does it do that. And I see that it crushes my soul. So like you don't know the way the SparkNotes Yeah, I don't want to listen to your little podcast thing just now. I don't want to just give me the answer. But put it here so everyone can see it. So no one has to listen to the podcast. And and what you don't realize about that is that I spent my entire day on Friday getting that out to you in a timely fashion. I did not eat dinner with my family because of that.

Mike 28:17
We posted those questions and it was up like the next day.

Scott Benner 28:20
I hustle Mike, you understand? I grew up a sheetmetal shop. I take that attitude. I applied to podcasting. So I'm a hard working like person. And then it just I don't I put up this what I thought was a funny post about like, are you people I put it up as a poll. Are you people trying to kill me? Oh, I

Mike 28:37
am not trying to kill you. I think you might accidentally voted for yes. Because I wanted to see who voted for yes. And I was like, Oh, wait, no.

Scott Benner 28:44
Well, overwhelmingly, I think there's like 500 votes that people were not trying to kill me. But not the point. I'll

Mike 28:51
take this one. Yes, though. Once successful, yes, we'll do it.

Scott Benner 28:56
You mean to get me dead or just to make me feel badly about it? I don't, because I don't feel badly about it that you should know. i It's to me, it's like, Oh, you shouldn't it's all in fun. You know, and, um, but I did. It is an exam, it is an opportunity to, to let people understand kind of the back end of this thing, which is, you know, if you like the podcast, I'm happy like, and I want you to like it. I am trying to help people. If you heard me speak privately, you know, this is the time of year where I mean, this is the time of the year where I'm renegotiating with all the advertisers. And inevitably, in every meeting, I say every year, I can't believe how lucky I am I do this thing that I really enjoy and love. It actually helps people and it pays my bill. I have bills that get paid because of that I can like send my kids to, you know, the grocery store. And I feel very lucky about that. And then somebody comes along a person who, you know, has been around for a really long time. And it was like This is all about money to you. And I was like, what? In the hell are you talking about? Like, if this was all about money to me, I would have put this ad, I would have put this this episode together slowly over days and given it to you sometime next week, which, by the way, is what everyone else will do. They don't they're not in a rush and released it on Patreon or something. Yeah, right, or, you know, put it here and there. And we're charged you to do it or do it some shows do which is give you like, 10% of the information and then push you towards a coaching service or something. And I was like, That's so not me. I'm so transparent. And anyway, I just don't know, it's, it's not easy to do. The marketing of your content. It's not as easy as it might look from the consumer side. We're like, oh, I you know, I, this guy on YouTube, I really love he talks about cars that I drive and puts up an episode every week, and it's well produced, and you just kind of take it for granted. But that person is probably spending. I mean, I spend 70 hours a week making this podcast. And then you know, and then we're like, stop pushing your links. And I was like, Look, if you don't click on these fucking links Mike Marino podcast, like, like, I don't do not understand how the world works. Like, I can't just, I got a family. You know what I mean? So anyway, I don't know, like, I was trying to,

Mike 31:23
I think I think Dexcom should start putting you in their commercials be like, This is our product. But if you want to know how to really use it, check out that Juicebox Podcast? Well, I'll tell you on the positive, you can get a put out to whoever watches TV. Well, on

Scott Benner 31:37
the pod made the three on the pod five episodes with me this year. That was yeah, those are good. Yeah, it was a lovely, like partnership there between those. I think, if I'm being honest, I stay on the periphery of that space. Like, you know, companies don't put my face on things. But it makes sense to me, because I don't I don't have diabetes. Like you can't you imagine the backlash they would get if they were like, Hey, this guy follow him? You don't I mean, like, Does that bother you at all that I don't have type one?

Mike 32:12
No, not at all. Because of all the content that I get out of it. Like, I don't really care who's telling me as long as it's good information.

Scott Benner 32:20
I mean, that's makes that makes sense to me. But I don't know where people's sensitivities lie, you know, and they overall, it hasn't been a problem for me. I just imagine. It's my imagination that people sit in the room in a meeting and they go, who do we want to put on this? And somebody goes, that podcast is very popular. And then someone else says he does not have diabetes? And I bet you that puts a stop to it every time. You don't I mean, I feel like

Mike 32:43
it's it's almost even better that it's that you're the caregiver rather than the diabetic, because I feel like a lot of the times are, it seems like some parents are like, super into taking care of their children like you. So it's like, focus on every detail, make sure everything's right, figure this out. Because you're hearing about another person, whereas like, for, like, in my case for myself. Up until like two years ago, it was just kind of like, well just try something if it works, it doesn't just try something else.

Scott Benner 33:15
In that vein, like it's not as fine tuned. Yeah, in that vein of thinking, what is what was, I guess, like, go back a couple of years. When you think about managing your health, around diabetes, specifically, what's the goal? Is it a daily goal, a yearly goal, a lifetime goal.

Mike 33:40
I mean, like, ultimately, the goal is just to live without complications as long as you can, or to minimize the complications. And then, but then there's, there's so many different data points now, especially now that I have all these different naps and Dexcom. And so like, now I like every day, there's a goal to hit for like your time and range or, and then you can shift that into different ranges be like, your 70 to 140 range should be some number and your 70 to 180 number should be a different percentage. And then there's a one C there's standard deviation. There's a lot of goals now.

Scott Benner 34:24
Yeah, well, there is do you think of your diabetes as a in the moment thing? Is it a big picture thing? Is that a blend?

Mike 34:37
Me I think it's got to be a blend, because your sugar affects you now, but it also affects you later?

Scott Benner 34:43
Well, yeah, it definitely has to be but how do you think of it? Like, like, overwhelmingly what is most of your time spent doing? Like don't get low right now? Don't get high right now. I want the week to be good. I want the day to be, you know, in range or like, you know, I'm trying to figure out out, help, it's probably

Mike 35:01
more immediate, like what's going on right now? Or like, what's go? What's about to happen? Or what just happened? Like, the next hour in the past hour? And now? Because you can't really change stuff for next week. I mean, I guess you could, like bagels and stuff like overall, but

Scott Benner 35:22
yeah, I you don't even know like so is that you brought up that, um, you know, the parent of someone with type one and my my role changes drastically as she gets older, right. But my vision of it, my perspective on the issue is completely different than hers. Because I hold all the perspectives at the same time. I want her blood sugar to be stable and steady and low now. And I'm worried about her future. Both in the short term and long term, I'm worried about how she'll deal with this while she's in college, will she keep focusing on it? Will she not? Will she give it away at times to do other things, which I expect? Will that translate into her her young adult life as I got away with it in college, so I'm not going to put too much effort to it now does that go into her late 20s That she started having problems when she's 30? Like, when I when I think about Arden's health. I think of it the same way I think of my son going to college and meeting people and maybe having a relationship and looking for a job like I see the whole like, Mike, you don't do you have kids? Yeah, no, you worry about the entirety of everything when you have children. I don't think of it as worry. For me, I think of it is concerned, it's considering I'm always considering the whole thing. But I don't think that as an adult living with type one. That that's the same for everybody. I mean, I've spoken to a lot of people. And I think overwhelmingly, that's not how people think of it. I think it would be too much to think of it that way. I could see why you wouldn't. But I also think that a certain amount of that is what leads to these outcomes that you want. So it's just interesting for me to hear from an adult about how they like conceive day to day of diabetes. That makes sense. Yeah. Yeah. Okay.

Mike 37:24
And, like I said, for the, like, the consideration also changed a lot once once I got Dexcom, because then it's on the phone, because like, even when it's on the pump, like I'm not looking at the pump a lot. Like I said, Whenever it would be, I'd look at it. But now that it's on my phone, it's on my watch. Like, I can see it a lot more often. So it's a lot more. There's a lot more management or like things to do. Yeah, but I'm trying to say,

Scott Benner 37:53
but that stuff helps. And that's what I want to know, like, being able to see it more readily on your watch, for example, not having to dig into even an app or do a blood sugar test or pull out a meter or something like that. Having it there helps. Having goals helps having an app that says hey, you're in, you know, we're our time and ranges, you know, 60%, and it's 40% here, and we're low 5% of the time, or whatever the numbers are, like it gives you something that you can kind of quickly focus on. But then do you adjust after that? Like when you see it, if the numbers not where you want, do you consciously think oh, I've been high too much this week? That's probably because I ate out a number of times, I didn't have a lot of success boasting for my meals or like, do you give it that much thought? Or do you just think, Oh, I've been high a lot, I don't want to be high as much.

Mike 38:43
Yet. Now I do. So now like about once a week, I'll look back at in Nightscout. Like, I'll look at like the daily reports and kind of see what the trends have been. Like, if I'm more consistently higher or lower in a certain timeframe, then I'll adjust either basil or carb ratios or ISF

Scott Benner 39:05
I'm excited for. But then I'm

Mike 39:09
also like tweaking those in the moment too.

Scott Benner 39:13
Yeah, like when something just goes the way you don't expect it to you you're in the moment helping it and then big picture, you're looking at it as well.

Mike 39:20
And I'm I'm a pretty competitive person too. So like having, like having all these stats to like, when I zoom out, I look at my management now. And I'm like, Oh, I'm doing pretty good. I'm like, you know, 91% between 70 and 180 75% between one and 130 or 70 and 130. But then when I zoom in and like the day to day I feel like I'm always like, Oh, am I again? I'm messing up fix it. I'm low again messing up fix it. But like when I zoom out then I'm like okay, overall it's it's going well

Scott Benner 39:59
yeah, it's I think of it the way I do because you're 100%, right? If you look at any 24 hour graph, most of the time, you're gonna be like, Well, what happened there? You know, and then you look back over a month ago, the month was good. So if that day existed within that month, you think, Alright, well, the month was good. But there's things happening during the day that I'd like to have a better handle on. And which one, I think the problem is that the people can just then go, well, the 30 Day was good, I won't worry about a spike to 240 that lasted five hours. And so that's why I think like thinking about it super simply, it works best for me. I'm not, you know, I'm still in the middle of trying to get Arden to think the same way I think about it. Or if I can't, I'm going to have to find a way to take the way she thinks and apply it to diabetes and adjust that, or she's going to have to find that maybe more specifically, right? Because for me, give me you've heard me talk about a million times, like just, you know, one of the big people are like, what are the rules of diabetes as far as you're concerned, and it's Pre-Bolus, don't let a spike happen. Understand the impacts of your food. But then right after that, when I say like, stay flexible. I think what I mean by that sometimes is like, you know, kind of go with it just okay, this happened. Let me keep working. But it half of that is Don't stare at high blood sugars. Like that's the biggest thing. Like, I watched art and try to do something yesterday. And she's home from school for the holidays. And I kept she's like, I have this, like, let me do it. And I'm like, that's fine. So I let her do it. But four hours into it. I'm like, I could have fixed this two hours ago. You know what I mean? Like, and I see what she's doing, but it's, as she's doing it, am I good? I ain't gonna work. And so I kind of find a time to walk into a room and I was like, Hey, listen, you know, I've seen what you've been trying to do. And I understand why he did it that way. I'm like, that's not going to work, you're gonna have to do this. And she loops and I said, You got to open the loop. You got to make an aggressive Bolus. And then we got to close the loop again to stop the low, right. So she does that she actually Bolus more insulin than I would have done. She created a fall inside of 30 minutes. And I kept an eye on it was later at night. And she was up and I sent her a text. And I said, instead of saying, like, close the loop, I said, What do you think? Does it look like it's time? And let her decide. And then she closed the loop off the loop, the algorithm kicked back and shut off the basil caught the blood sugar. And she was like, I mean, I can look. But she was super stable overnight. Yeah, so the drop happened. It fixed itself around 230. And she's been like 90 for the last 10 At least eight hours. Anyway, it's everybody's got to find their motivation, and their style. And you know, and then just, I think then the hardest. It's all that sounds hard. But then the hardest part is after you figure all that out, it's applying it over and over again, without getting just burned out by the whole thing. Oddly, it's like your job really is right? You just keep feeding those papers and that scanner, like, alright, I don't want to do this today. But this is the job and then you do it. And then you look for ways to be engaged by it. Is that right?

Mike 43:32
Yeah, yeah, I think so.

Scott Benner 43:35
All right. Well, if we could pay everybody for diabetes will probably make them more engaged. Do you think just get it? There you go. I get behind that get a nice hourly salary for taking care of yourself.

Mike 43:46
24/7 365 jobs. So

Scott Benner 43:49
like, do you think that would work?

Mike 43:53
Think about probably not, well, no. I mean, even when I was a kid, like I remember my mom giving me like a list of like, it was like a packet of meals that I had to go through and like calculate the carb counts of everything. And I think it was like, I don't know if it actually was, but I think she told me it was like something for her work. And she was like, Oh, I'll pay you to do it. And I feel like the real mastermind plan behind it was like if I could just, you know, pay him to learn more about carb counting. But the money wasn't worth it. Or not not worth it. But

Scott Benner 44:28
Mike was the juice not worth the squeeze?

Mike 44:31
Yeah, there's the idiom. I love that one. That's one

Scott Benner 44:34
of my favorite ones. Why do I love that one because it was taught to me by Charles, this big, very Italian man that that whose son played baseball with my son when they were in high school, not for their high school, but for their travel team. And we spent a number of years together. Standing in the outfield watching our kids play baseball, and he would say stuff like that all the time. He's from from, from the city from one of the boroughs and he'd be like, pow, let me tell you, the juice ain't worth the squeeze. And I it's not what he sounds like, but I'm just approximating it for you. And it's just delightful. It's so wonderful guy. I'm going to tell some story here. That is because you're on and because of what you said earlier. I've never been mean to a child on purpose Mike.

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I've never been mean to a child on purpose Mike. Except for once to get started. And and I want to be clear, this was never to the kid's face. And the kid never knew about this. Never. But my son played baseball with a kid. And again, I've never met a kid that I like it's hard to dislike a child. Do you know what I mean? Like it's just it just it is and and um probably started knowing this kid at the end of middle school, so I don't know how old they are, they're like, ninth grade eighth, ninth grade right there, and all through high school right into going into college and actually, still was tangentially aware of them in college. And the and the, the kindest thing I can say about this person was that he was a dick. He just someone told this kid, I assume, hourly, how wonderful he was, and how everyone else around him was subpar compared to him, either that or he had a significant mental issue, I don't know. But this person believed in themselves in a way that was unwarranted, and, and cruel, to the point where my son said one day that he could hit a ball and got thrown out trying to stretch a single into a double, which he would frequently do get thrown out trying to make a double into his triple A single to double the gauges, just always cocky. And anyway, the kid gets thrown out doing this comes into the dugout, everyone's pretty quiet. Because I mean, it was an obvious situation where this was just a single, like, you would never go to second on this. And he comes in, and he takes off his gloves and his puts him in his helmet, slams his helmet down, turns the everyone in the dugout, and goes, I'm better than all of you. And then just walks away. And that is but one small example of the dickish pneus of this person. This happened constantly, I once saw him hit a legitimate double. He's running the third even though the third base coach, he just has his hands up going stop, go back, like this is not a triple you and boom gets, you know, gets thrown out at third, I swear to you after the fourth time that happened this summer, the kids slides into third gets tugged out. He stands up and the coach goes, What are you doing? And the kid goes, you like like this was the kid, right? So one year, the kid decides that he's so good, he's gonna go to this out of state camp where he's obviously gonna get drafted from because this is how he feels, which by the way was never gonna happen. But he goes to this thing, it's one of these things you pay money to go to, it's not a special thing. It's if your mommy and daddy have money, then you can do it. And he went and did it. And he came back with batting gloves that had the American flag on it. And that is when myself and the other parents started referring to him as Captain America. And then Superman. And then one night, on a Friday night when we got stuck with the last game of the day. And it's 11 o'clock, and the kids are still playing. And we have to be back again at like seven o'clock in the morning. He comes to the plate. And one of the guys pulls out their cell phone and plays the orchestral music from the first Superman movie, Dan, Dan intentar. And like no one knows, but us it's just we're literally we're out in right field. There's no one within 100 yards of us. We're just hiding watching this game. And we just start snickering like little girls. And then it became a habit where we would find big important music to play as this kid walked to the plate and then like children, we would laugh. And I believe that the the the Olympic music, the thrill of victory and the agony of defeat was the funniest one for some reason. They're dead and dead and just have to imagine his kids just you have to you don't know him and I can't but he would stand up so straight, like two straight. And he walked with his chest out. Like like that he just anyway, he was just a deck. He was he was a child that was a deck and I always thought like, Oh, I hope this like not I hope he goes to college and, you know, maybe finds himself or relaxes a little bit. But no lie in my son's senior year of college. They ended up playing him. Same attitude. Same person just kept going. And I was like, wow, that's who he is. It's fascinating. He's a deck. So I don't know I just at some point that had to be put on the record somewhere. So here it is. I just put one kid in the I've never met another kid I didn't like and it's not even that you don't like him. You just you can't root for him. I don't know if that makes sense or not. But um, he's like his worst his own worst enemy or something. Anyways, the opposite of you. You seem delightful. Alright, so hey, I

Mike 54:41
got a delightful.

Scott Benner 54:43
You are delightful. I want to dig a little bit into the Medtronic thing. So you said you got 670 G right, the automated version you're using their thing. It didn't go the way you expected. Why is that?

Mike 54:58
I'm not a very cool sistent person. So having it like an automated black box, change all your settings and do everything. Like if I'm active one week, go into the gym bike ride. And then the next week I'm sitting on the couch like the algorithm doesn't know how to handle that, or like, one day I'll have 300 carbs the next day I'll have 30 carbs. So like if your Basal is more like, not where it actually should be, but because like you can't actually set the Basal on that one, like it takes care of itself. So if you're eating more fatty foods, and not putting the fat in to the cart Bolus, then it's thinking that you're going to need more basil. And then the next week when you're not eating as fatty foods, then you have too much basil. Okay. And the sensor also just, I don't know if it was, it might have been a problem with me not calibrating it correctly, like not calibrating it at a flatline. But also, it's hard to have a flatline a lot of the times, so like it's always going up and down. But with that, when you have to calibrate it, then it's not like you can wait until you get a certain line, it yells at you at three in the morning. And unless you just turn it off.

Scott Benner 56:16
I have to say that anything that is set up to wake me up at three o'clock in the morning, do something doesn't seem well thought out?

Mike 56:22
Well, it may just because like it has an error or something. Or, you know, it's got to be like every nine hours and like if I don't time it right, or I think it was like every 12 hours, it claimed it was every 12 or 24 hours, but it was always way more than that. Like it would say you have 12 hours until your next calibration and then like six hours later, it'd be like, You need to calibrate.

Scott Benner 56:45
Do you do you find the experience with Dexcom to be better or different, or

Mike 56:53
what insanely better, okay, but it's also like, because I started with like Dexcom. As soon as I got that I was like, because I was a little hesitant getting it because it didn't work with my pump. And even before the six, seven D they had the, I forget what they call it, but like it stopped to your Basal if you go if it thinks you're gonna go low. And I like typing that safety feature in it. Of course, when the six seven D, like does calibration errors or overnight or like, it'll just turn that you'll it'll kick you out to auto mode, and it won't turn on that safeguard. To stop your Basal.

Scott Benner 57:26
Yeah. So you think you have to say that you have to safeguard your mind. Like I'm sleeping, at least it'll like sort of like control IQ had Basal IQ first, where are they? Yeah, it was just Its goal was really just not to let you get too low. And then but um, but the problem is the Medtronic would kick you out of automation, if it didn't like where it was. And then this protection you thought you had didn't exist.

Mike 57:48
Yeah, but so as you know, it has a tint going over your Dexcom because like I wanted it to talk to my pump to prevent me from getting low. And I realized, you know, Dexcom can't do that. But then I started looking at I was like, alright, well, how do I at least see the graphs of everything like side by side. So that's when I found tide pool. And then from tide pool, I found loop. And loop it's like, you know, what you tell it to do? It

Scott Benner 58:15
does it shows you everything that it's thinking it's, it shows you like this is what this is how we think your blood sugar is gonna go in the next six hours. Yeah, you don't like the way you're talking? You can fine tune everything. You the way you're talking makes me think to say something I've never said before, which is loop feels like automation, that you're a partner? And if Yeah, if you want to be I mean, you can set it and leave it if you want. But if you want to be a partner in it, you absolutely can be.

Mike 58:45
And you can also go back and like look to see kind of why it made a decision, it made a decision. It's not just this little black box, like you can't even I don't think you can even see like what the basil is we're

Scott Benner 58:58
okay, yeah. And on the pod five, it's a similar idea where they want it to be very automated, and kind of happening in the background. I think it works for who it works for. You don't I mean, and

Mike 59:09
I think if you're a consistent person that it probably works great. But if you're not,

Scott Benner 59:14
I also have to hope. I don't know. I mean, I'm not a computer engineer for certain, or software engineer, but I have to imagine that these are really the first generations of these things. And it does make me wonder what it'll look like in five more years. You know, like, will it be able to, excuse me? Like, will it be able to sense something and just ask you on the screen, like, are you inactive today? Yes or no? Like something simple like that. You know, I'm noticing like, you would think the algorithm could see that you need more or less.

Mike 59:53
And I like how like, I haven't used Android APS but on there like it'll tell you like if you're You're more sensitive or less sensitive than you are previously, so then you can look at it and be like, Okay, I need to increase things or decrease things. And it'll do some of that automatically, I think.

Scott Benner 1:00:10
Yeah, I mean, that's, that's the stuff I'm talking about, like, I mean, they have to let

Mike 1:00:15
you know, the FDA gets involved in and then pushes, like anything they wanted to do, like, you know, tide pools coming out with their, their version for I'm assuming it's still gonna go on me pod if that ever happens, but like, I think the I think the app that they're trying to push through the FDA is like what Luke looked like four years ago. Like they can't put like, I'm using LWC dev now. And like, they can't put remote control in or a bunch of other stuff. Yeah, God Oh, Bolus and like, they got to taper it down enough to get it through the FDA. And then it just, you know, the whole hashtag, we're not waiting movement

Scott Benner 1:00:55
started to wait when it got to the FDA. We're not waiting tide pools, like we're gonna take this and we're gonna go through even when they settled, I was like, how's that gonna work? Okay. I thought, good, go do it, you know, but now, like you said, it's been years. Right? And it, it's not here yet. And I'm Arden's not using the same version of lupus, she was back when they made that. So they have to take some version of the app and say, This is what we're going to send to the FDA for them to judge. You can't keep adjusting what the algorithm does. While you're in that process. Once you're in that process. That's that. What version of

Mike 1:01:34
30 have oh, sorry, go ahead. No, I just didn't like because like, you know, Dexcom g7. Like it's going to be from your episode. I think he said, like, mid 2023, like mid next year for tandem. And like a little later for Omni pod, whereas it already works with loop.

Scott Benner 1:01:51
Doesn't really seven, I didn't even know. Yeah.

Mike 1:01:56
Well, you like it's got to be looped up at like one of the more recent ones. And I think you have to go in and do a little more tweaking, but but you can get it to work.

Scott Benner 1:02:05
Yeah. And and more quickly than you imagined, it will just one day, they'll put out a version. And they'll just they'll be like, here you are using the GSX or the g7. You just tell it and that's it, and then it works. Well, that's the idea of I mean, that's what happens when you put software engineers on to something. And they have to make sure it works. But they don't have to send it out to somebody else to say yeah, you're right, that works. So what what version are you using right now of loop?

Mike 1:02:32
I'm using loop Dev, but the one in the build the fixed. Fix Dev, build script, Nick, it's called?

Scott Benner 1:02:40
Is it? So like? Good?

Mike 1:02:43
So Luke three. And then I'm also using John facets patches.

Scott Benner 1:02:50
Why did you choose those,

Mike 1:02:52
just because I like a lot of the features they have in them, like it'll switch between, like, depending on what blood sugar you're bait, or what your blood sugar is, like, if you're if you set that to 110, you can have it anything under 110. It'll just do auto boat or auto Basal, anything over 110 it'll switch to auto Bolus mode. That way, it'll kind of be a little less aggressive when you're at a lower and you don't have as much time to catch like too much insulin. Oh, I

Scott Benner 1:03:18
love that.

Mike 1:03:20
There's also a Basal lock feature so you can have it so like if you hit whatever you set. So if you set it to like 220 that means it won't cut your Basal off. If it's above that number. It'll just keep it on and like once you're under that number, then it'll cut it off.

Scott Benner 1:03:34
You know, I feel like I just got an email from him the other day his kids using Omni pod five now.

Mike 1:03:39
Yeah, doing really well on it here. Yeah,

Scott Benner 1:03:42
it's funny. This is the that I'm aware of I'm sure it's happened more than this. But then I'm aware of like a handful of times where somebody has been very involved in the looping community and really helping with it, you know, and then control IQ comes out one of the people's like, Hey, listen, I'm putting my kid on control IQ. And then that and then that's it. That person like kind of disappears out of the community. And then I mean, I just set John up to be on the show, I think. So to come on and talk about it. But But But what you just said is amazing, like switching between Otto Bolus and like basil instead, depending on the the blood sugar is kind of genius. Because like one of the problems we have. What in the hell excuse me, Mike, this is unconscionable. Why would that happen? Thing Nevitt I've owned this phone a long time and I don't know how to use it. One of the problems Arden's had you know it happens a handful of times a year as you can get into this situation where you're fighting a low and you got it and then it starts to come up but it's been one of those days where you've just been low, you know what I mean? Like you just don't need as much as usually need. You finally get the blood sugar to like kind of stabilize and it rises up a little bit and hits, I think Arden's thresholds are like 90 or 95 on loop. And then you get to 95. And it sees a rise, and that Bolus is in auto Bolus. And you're like, No, like, don't do that. Not now, not today, you like

Mike 1:05:16
it with with the patch two, there's another feature that helps out with that a lot called negative IO B factor. And you can go into the settings and tell it to only count like, whatever percentage of negative iob that you want. So like if you stop your basil, if your basil leaves two units an hour, and you stop it for a half hour, your iob is a little less than negative one, like at the end of that Temp Basal. Okay. But if you set the negative IB factor to 50%, your negative iob will only be negative point five. So then it won't try to give you as much insulin.

Scott Benner 1:05:51
Yeah. Well, I What I've learned to do in that scenario is just say like, like turn off micro boluses. Without carbs, until you find some stability, then we'll put it back on. And that

Mike 1:06:02
free APS has that setting. Yeah, which isn't in,

Scott Benner 1:06:05
right. Yeah, right and aren't using free abs. But the truth is, at this point, there's so many different versions, I don't even know what to do anymore. Like, wait, maybe there's a better version I could be using, I don't even know how to know that at this point. So you're using it on the pod or using it with what kind of pump.

Mike 1:06:24
I will I started out with a Medtronic because I had one in my drawer that I worked with. The nice thing about having met tronics for 20 years. But then I switched to Omnipod. More. So just because I was worried about the warranty situation. Like if this pump breaks, I don't have a replacement for it, I can't get it repaired really. So then I started using arrows, and I didn't really think I'd care much about the tubeless feature. But then like six months later, Thanksgiving came up. And it was like I kept hearing people talk about the tunneling, like for too big a boluses. And like, Alright, I'm gonna put my Medtronic back on. And those were the most annoying three days of like, my pump going everywhere and having to take it off, put it back on. Getting caught on things. Yeah. And like, I guess, like, well, when it happens for 18 years, you just kind of deal with it, you don't really notice it. But then having six months without that, and then going back to it, it was like, Oh, this actually is a huge improvement. I've tried dash and I like like, I would like to move to dash, but it's billed as pharmacy instead of DME. And my insurance, the way it works like it's way better for DME for me.

Scott Benner 1:07:34
I'm at the point now where I'd like to move out into loop with Dash. And

Mike 1:07:40
you can keep using free APS with dash right now. It's a different version of it. But it's still free P for APS, it should look almost exactly like what you're using now.

Scott Benner 1:07:52
Is it a stable bill? Yes. Yeah, I might have,

Mike 1:07:56
it's the exact same thing, just with Dash added. I think there's a couple other bugs that are fixed or something. But

Scott Benner 1:08:03
I don't want to send her back to school with a prop with something that she wouldn't know how to deal with. But at the same time, this is

Mike 1:08:12
I posted a Dr. We tutorial thing a while ago. Yeah. So like you can remotely install it on her phone to I've actually got even when she's in Georgia, like you can just remotely update it or

Scott Benner 1:08:25
Yeah, Mike, we're supposed to say Chicago, she goes to school in Chicago. That's what,

Mike 1:08:30
that's what I said. Right? Yeah.

Scott Benner 1:08:32
And interestingly enough, Kenny just sent me that same thing. And he any and he's like, you know, you can just do it remotely now. And I was like, really? Like, that's crazy. Yeah, that sounds good. So that's what I want to do. I just need to find the time to sit down. And I mean, I am assuming all I really do is just rebuild the app and then restart a pod with dashboards. And that's it. Yep, yeah, it does. What do you know about? So here's the thing. I put up a post the other day on Facebook. There's two things I want to talk to you about before I let you go. I put up this thing on Facebook. And I was like, tell me something you don't know. This is like the most popular thing I think I've ever posted online. It's just been seen by Oh, your Heroku thing? What? Yeah, yeah, because I don't understand it. I know I have a Heroku app or page. I know I pay for it. For the life of me. I don't know you do. Really? Yeah, they made me start paying for it. For the life of me. I don't really know what it does. I know it's, if I if I didn't have it, I wouldn't have Nightscout. I do like Nightscout. And so like, I don't know, like I don't understand. I've never done a thing I don't understand before as much as this.

Mike 1:09:50
So like Heroku is basically it's the website that hosts your Nightscout app. And then do you have another Yeah, MongoDB like on another website holds all the database. So Heroku or the Salesforce that people who own them, they decided they can't keep the free tier anymore. So then they had to, like now it cost $5 A month is the minimum you can do. So the easiest way is to just pay that $5 a month, and then you don't have to do anything different. Heroku just keeps working with your NetScout. or Now there's also as soon as like the Heroku started, like announced that they were going to start charging $5 A lot of people started to look at other websites that could host it instead of Heroku. So like I've moved mine over to Google Cloud now. So that'll that'll just be free. And then I also with Google clouds, nice because you don't have to go back and clean up the database. Because like, with Heroku, or with the Mongo DB, you're limited to half a gig, I think. So once you have like, you know, every six months or so you gotta go back in and clear the data. ON CLOUD one, I don't even know you really not do that.

Scott Benner 1:11:12
Yeah, I'm fascinated that you're saying that. I was like, Oh, is that a thing? I'm supposed to be doing that I'm not doing too. Even I don't

Mike 1:11:18
if underpinning if it's working, then I guess it doesn't? Doesn't matter. Yeah. But under penalty

Scott Benner 1:11:23
of death. I've seen the word like the word MongoDB. before. And I even feel like I know that if I tried to log into it. I have a way to save your password somewhere. Yeah, but I don't know what it is. And I, but but I don't know, I just listened to somebody. They told me like, do this. I did it. And it works. And it works amazingly. But I mean, that's the part of it. Like all of that is where this gets like sketchy. Like for people coming in trying to like, Oh, I'll try it. But then you're like what you just said, I know makes sense to you. But as you're talking my brains, like, I don't know, it sounds like there's an app. That's Nightscout. It has to be put somewhere. It has to exist somewhere. And then I think well, how come I can't just build it in the Apple Store, like in Xcode like I do with the app for the blue. Like, why is that not okay? And then

Mike 1:12:18
it's got to be, it can't run on your phone, it's got to run like somewhere in the cloud. And like it, if it's an app, it's got to someone, like, if someone put it in the app store, they'd have to pay for their own big giant server for everyone that runs Nightscout. Okay, so this way, like you're just building it yourself. That way someone doesn't have to hold everybody's like, there are some websites that, like, there's a couple. What did you call them like monitored? That's not the word. It's got it set to like, are just for web or just for Nightscout. Like, so you can set it up, and they take care of all the database work stuff behind it.

Scott Benner 1:13:00
I mean, you think, Well, if you switch to this, because people have come on people like go to rail, is it railway?

Mike 1:13:05
Yeah, railway is nice. It's probably the easiest one to switch to.

Scott Benner 1:13:10
And then I'm like, I don't know, like, what what if that company goes out of business? Or what is it like, you know, you like?

Mike 1:13:16
And then you got to switch to a different one or Yeah, that's also why I didn't go with real quick, because I'm not really sure what the future of it is where Google's not gonna go away. Like, I suppose they could get rid of the free tier. But if that happens, I'll figure something else out.

Scott Benner 1:13:29
Yeah. See? That's because you understand it gives you Well,

Mike 1:13:33
I know where to go online to find other people that understand,

Scott Benner 1:13:37
oh, well, that's probably better than understanding yourself. I, I just feel bad. When I ask people questions. I'm like, I don't know what to do. Can you help me? Like I feel badly about it? But I think you know, in the end, I do talk about it on here. So it does, it does get the word out. So I guess it's a fair trade. But I just I keep thinking about in the future. Like, you know, I mean, this aren't going to have a Mongo DB when she's 30. I bet she won't. So anyway, I like the way that it's progressing. So So you're telling me right now there's a version of free APS for dash that stable?

Mike 1:14:17
Yes. The problem is that free APS like it won't keep getting updated. Like it'll, right now it's at a point where, like, they'll keep like, when a new version of iOS or Xcode comes out. Maryann will go in and do like, she'll try to keep it updated so that it continues to work and stuff, but there won't be other features that like it won't improve at all from here on out. And if something happens with the new version of iOS that breaks it, like not going to spend a lot of time to fix it. I see. So really, I mean, it really I think most people including you should just just move over to the well, like like, by the time this comes out, loop three will should be out on Last year, hopefully,

Scott Benner 1:15:01
you think that's the way to go. Loop three.

Mike 1:15:05
Yeah, which is what loop Dev is.

Scott Benner 1:15:09
But right now, if you if you like, go to the if you go to any if you'd like Google loop three right now, don't do it later because like I said, this will be six months later. But it the way it reads on the, on the on the GitHub document, it's like it says right now, like this is being tested by experienced loopers right now. Yeah. So it's still in the in a beta phase.

Mike 1:15:33
Yeah, but I mean, I've been using it since March, I think, okay. And I haven't had an issue with it. But I also like, I keep tabs, like, I'm always in the loop group, and I'm part of the loop and learn group. And then I'll check the zulip Every once in a while, where it's like more than the actual developers hanging out there. So but then also like, like, it probably won't really matter, because it'll be six months in the future. But there is a version in loop docs called fixed Dev, I think, where it's where Marian like, froze loop dev at a certain point. So she's like this, look at this version right now, like is fairly stable. Like working well. So then, that's the version that you'll download just from that. It's like a build script works the same way that the master build script does. And you're so then you're like, Oh, I'm sorry, you won't keep getting the new update stuff like so when they keep putting new stuff in. And they're like, because if you just take the very newest version of loop dev every time, you don't know how much that's been tested, you don't really know if there's something that might break the app that gets added to it. But if you use the fixed Dev, then there's nothing added to it anymore. Like that's just where it stops for some time. They're unstable. Yeah. So and if something comes in, and like a bug comes out, and they're like, oh, this actually does affect the, that version too well, then they'll both go in and look at the options and update that script to download a version that that bug would have been fixed. And

Scott Benner 1:17:09
but even if that happens now with this new like, I forget what you call it earlier, what Kenny was telling me about but But if, yeah, if so if something happened to the app, and it just crashed, or it had a problem, it's now as easy as putting a link on like a cloud server, sending it to art and having her downloaded to her phone, click on it. And it just rebuilds the app right on our phone. Yep, that's insane. How come we haven't been doing that the whole time. Like, that seems amazing.

Mike 1:17:39
And the one caveat is like it has to be a phone that you've already plugged into Xcode and built loop to

Scott Benner 1:17:44
write you can't just install it fresh with that

Mike 1:17:47
with like, if if she threw her phone off the bridge, and like needed to get your new phone, you like there are ways to get around it to add that phone to your Apple account without actually plugging it into your computer. But it's a lot more clicking around online. And like kind of a roundabout way to find like the specific number of the phone to enter. So it is possible, but more difficult. It's

Scott Benner 1:18:12
interesting. So I'm gonna put you in charge for a second. Should should Artem be using loop Dev. The loop three.

Mike 1:18:22
Yeah, I think as long as I mean, as long as you're active in the diabetes, like online community for loop blooped. And like so if there there is a bug or something catastrophic that comes up like you would see it. Other than that, like I for you, I would say yeah, like, you know, look well enough, like, better than anyone else really. So like, if something's not working right on it, I feel like you would see it and realize, but like I said, since March, I haven't noticed anything really.

Scott Benner 1:18:54
So you haven't rebuilt the app in nine months?

Mike 1:18:58
Oh, no, I rebuild that a lot. But, um, the well, the version I'm using now, I think is from like, two months ago. Okay, that's when it stopped getting updated. For the fixed one.

Scott Benner 1:19:09
Yeah. And so you do you think it's getting close for them to say this is a like a stable version?

Mike 1:19:16
I hope so. But I'm sure it'll probably go to like a release candidate where like, they're like, this is the version we think passes all the tests, and then that'll sit there for a little bit. And then though, as long as they don't have any problems with it, then we'll move that to master.

Scott Benner 1:19:30
Yeah. Hey, can I can I move her to a version that supports dash and then four months from now remotely move her to loop three?

Mike 1:19:47
Yes, Inchon Yeah, you can do that. It'll be a little more difficult to move her back to free APS from three. But I think it's just basically you have to make sure everything's uninstalled on the phone.

Scott Benner 1:20:02
Just like to take the app off it completely.

Mike 1:20:05
Yeah, there might be another step or two that you have to go through. But that'll be in like loop docs, he could find that or message me and I'll figure it out.

Scott Benner 1:20:15
Interesting. So if so if I went through a version right now that was dash compatible, but wasn't loop three, which version would I be looking at?

Mike 1:20:27
If you don't want loop three, you still use the fix dev build script. But that script has free APS dev in it. Okay. And that's step B, which basically what you're using now free APS, except with Dash support added in,

Scott Benner 1:20:42
got it. And that one's pretty people seem pretty happy with that right now. As near as I can tell, from people talking online.

Mike 1:20:51
So yeah, well, I think like I said, we're like the people running loop docks and like, trying to push people more toward like, if you want to use dash, especially if you're an experienced user, or Looper to move towards the loop Dev, just because it's, it's what everyone will move to, to and hopefully, once it's released as master, it's interesting. Three, APS will eventually die out.

Scott Benner 1:21:18
I think that very few people listening to this understand what we're talking about.

Mike 1:21:25
That's a good chance. Because I also tried to, I tried free APS X. And like, February this year, and it's so like, it runs off the same as like the open APS or Android APS, like off that same base algorithm. But developed by Ivan, the same guy who created free aps that you're using. But it was still pretty early on in the development. So it was neat and interesting. But then as soon as the Russia stuff happening, he can't really update it since then. Right. So it's just been kind of sitting there stagnant. So like, once that, like, once the rest of the situation kind of figures itself out, or like once he can start pushing updates to it. I might try that one again.

Scott Benner 1:22:14
I feel like we should smuggle him out of the country and get them here. Seriously, every time I talk to somebody, I'm like, I don't know who Ivan is because someone hire him, please. What are we doing? Go get them all from a job for God's sakes. All right. Okay. Is there anything we haven't talked about that you want to because I have one last thing for you?

Mike 1:22:39
Oh, maybe I mentioned a new bus. Have you heard of that? A new bus, a new bus. So it's made by it's made by people in Australia. And it's a Dexcom transmitter that they've like, drilled into and modified the firmware on. So that sensors don't end. So like you can just keep it running. You don't have to restart it, really. And then it also puts the warmup time down to 15 minutes. And it comes with a battery that lasts. I think I got mine in like sometime early this year, and the battery is still going like I think the battery is supposed to last six months instead of three months. But then you can take the battery out put a new one in

Scott Benner 1:23:24
that I've seen people do I've seen them like dig into it, pull the battery out put another like put like hot glue over top of it to hold it in something like that. Is that the kind of thing you're talking about? Yeah, basically. Amazing.

Mike 1:23:38
Then you can just have one transmitter, and that'll just keep working. And then the restart thing is what's really helpful then, like I had a sensor on that lasted 30 days, and was still like within 10 points.

Scott Benner 1:23:50
It was just what I use. Sometimes it was just one

Mike 1:23:53
drawing like normally I get like 14 days and then it starts getting noisy. So then I pull it. I really wish g7 just lasted 14 days. Like I can't wait until they get to that point.

Scott Benner 1:24:04
I thought it was going to I thought that early on. That was the chair and

Mike 1:24:08
then I think there is something with like the adhesive like they had problems getting it staying on everybody for 14 days without making the adhesive too crazy. Yeah, but libre has been doing it for a while. So I don't know why.

Scott Benner 1:24:22
I imagine it comes eventually. So I don't know. Okay, my last thing for you. You left a review for the podcast. That was the it was the most like thoughtful and lovely and then cake made me cringe and it made me laugh and I just I very much appreciate it. Thank you. I've never read something that took me aback. It's only a paragraph and I'm started reading it. Now I got to Google. I don't know who this person is, like Google. I'm like, alright, that's who that is. And then you said something that I was like, Oh, I don't like don't don't Don't compare me to that. Like that made me feel really? Yeah, I don't know. It's just so funny. But I there was

Mike 1:25:06
a lot of parts of that. I was like, oh, I should take that. No, maybe I'll leave it in, like I almost rewrote, or like, deleted that and read it a couple times. So I'm glad I left it there.

Scott Benner 1:25:15
Yeah, no, I'm glad you did too, because I feel like most people who read it, we'll just pick I don't know what this means. Exactly. But I, I was, I was just very, it was heartwarming, and, and it made me feel weird at the same time, which is how I know I liked it. But I appreciate you. I appreciate the podcast being valuable for you in a way that made you think to write that. So

Mike 1:25:36
I think I've got 105 episodes left. And then I'm all caught up.

Scott Benner 1:25:40
I'm thinking of giving out an award for people who listened to all of them. Now, it'll be it'll be a digital real award. I will not be sending a trophy to your house. You know, the trophy might that you never won playing baseball.

Mike 1:25:54
Are you the trophy?

Scott Benner 1:25:56
Am I the trophy? I am nobody's trophy that's for sure. No one would get me and go. Oh, I feel very accomplished right now. No, I just, I mean, it occurs to me, especially as the as the podcast gets into the eight hundreds as far as and nine years. Like in a couple of weeks. I started that ninth year, but I saw this podcast the other day. So funny. It's been out for like three years. And they're like, we're in the season nine. And I thought to myself, No, you're not. Like, stop it. You can't make a season 10 episodes and then tell me you're that's a year, that's a month. That's two weeks for me. Like I think that episodes in a half a month. And they're like we're in season nine. I'm like you just started in 2000. And like 20, like, What are you talking about? But, but anyway,

Mike 1:26:45
I just we're going back through the podcasts and because of how, like you started off, I think like once a week and then moved it up and up and up. And now it's like four times a week. So like going back through the podcast, it's like the last half of it is like the last two years. Yeah, may not pass. But a good chunk of it is just like since COVID. And then like, as soon as I hit the point that was like, pre COVID. It was weird. Well, COVID

Scott Benner 1:27:08
changed it for me. Because Because I saw overwhelmingly if people heard this already, they can probably you could probably shut this off now. But overwhelmingly podcasters I thought made the wrong decision at COVID. They, they they were saying, well, people aren't going to be in their cars as much. So they're not going to listen as much. So they started making like less content. And I it just struck me the complete opposite way. I was like I'm gonna make more, because I think people are gonna have a lot of time. And that for you? Well, except for me, I'm the only one that didn't get the cruise through COVID. And, and by the way, was up all night on Friday getting you the Dexcom g7. So just listen to it. But that's not the point. The point is that and I also stopped thinking my I stopped thinking of myself as a podcast. I mean, it's a podcast, obviously. But you know, once a week, or some come out twice a month or something like that. I started thinking about who who is successful in the space of delivering audio to people. Like I looked at those people, those people don't put out an episode a week, they put out three or four a week. And when you listen to it, you might not always be interested, you might like log on on Tuesday and go I don't care about this interview. But I love the one on Monday, and I might like the one on Wednesday. And I looked at that and I thought that's the model for me. I'm going to put out a lot of good content, you're not going to care about all of it maybe and it's there if you want it. And that's just where I went when COVID switched and to your point a minute ago, this year 2022. The podcast is just by a hair's breadth gonna miss 5 million downloads in 2022. So is a big number for people who are not in podcasting this show I don't think I usually say this on the show. But I'm in the 96th percentile of all podcasts that exist. As far as I know all like not even just health. All not just in health actually today in health. I actually have this in front of me because I pulled up I was pulling up your review today in health. The podcast is 134 in health and fitness which is the parent category and that is that's high they only track the top 200 shows to begin with. Like your your charting if you're in the top 200 So I have I have a parent category health and fitness which I'm 134 in today and it pretty consistently stays in the top 200 all year long. But in its in its subcategory which is health and fitness medicine. I'm number 12 Today in and there's some Pretty big podcasts ahead of me, like, like stuff that has, you know, dozens of people working for them. And they are a part of a media company. And like I read down from the top, Peter Atea, who is just a huge help body has Mark Hyman, Rhonda Patrick. Paul Saladino. Like, you know, these are the people Peter McCollum, these Matt Walker, they're the only ones really out of me. And then it's me today. And I guarantee you that they don't make that podcast by themselves. So it's pretty cool. RFK is there too, but I'm not sure of what it is he's peddling. So I didn't. I haven't looked too deeply. I've heard people on two different sides of him. So I'm staying away from that one. But, but yeah, the podcast is popularity is measured by downloads and by new subscribers. So the one great thing about charting is, if you're not constantly getting new subscribers, you don't chart no interest. Yeah. And that's the big deal about being in the I think in the medicine category. I've I've been pretty consistently the top 20 for like the last three years. So anyway, I just want I put content out and if you want it, that's great. If you don't want God, I got it. Like you don't I mean, so you'll be like the one that I

Mike 1:31:23
just don't go look for a summary of it online. Yeah. Because what the, well, the crazy thing, too, is like, your transcripts are on the website. So if they really wanted to just read it, they could just skim it there.

Scott Benner 1:31:35
I also don't think that these people are like bad people who are like, please just tell them like, I just need to know this. Yeah, they don't know my and that's why I I thought, I thought in a joking way, like and and yet, like very like, I don't know, honestly, I was just trying to say like, please understand my side of this. If we all give away what's in the podcast, and nobody has to listen to the podcast, then there won't be a podcast. Like that's it unless you want me to start charging you for the show. And, you know, the truth is, if people did that, I'd make a lot more money, like a significant amount more, and I still don't think it's right to charge you for the show. So I don't do it that way. I guess.

Mike 1:32:17
You'd be making more money, maybe, but you'd be reaching less people.

Scott Benner 1:32:21
Exactly. And I don't want that. I don't want to limit who gets to hear it. Because you can say something. I mean, think about it. The 5 million downloads. What if I charged 10 cents an episode? Just 10 cents? I don't know the math on that because I'm not smart. Okay,

Mike 1:32:38
but I spent $80 This year then, right?

Scott Benner 1:32:42
You're one person. So if I take 5 million? That's a lot of zeros. Okay, so I take 5 million. you to help me on this because I might be wrong. That's 500000. Wait, is that wrong? Six years 50823456 5 million. And I say times point one. That'd be 10 cents, right? Yep. Ah, yes. I would have made $500,000 this year. I want you didn't know I don't make $500,000. So. So just every other year well now. So now think about that. That was 10 cents. What if I just made it 20 cents a download, I would have made a million dollars this year. And instead I take ads. And I let the advertisers pay for it. And you guys don't have to pay anything for it. So it because of what Mike just said like your smart person. Like Like, even if you charge 20 cents 20 cents for something, it will eventually eliminate some people. And then what happens if that's the person who doesn't know how to Bolus fat. And then they spent their entire life with a seven and a half a one C when it could have been a five and a half a one C if they only would have known to put in some more for French fries an hour later. I don't I don't want to. I don't want to think that I'm limiting people from getting good information. Just to make money. Although now that we did that with the calculator, I really would like to charge 20 cents for each episode. I've been thinking about it for a little while. And it's gonna make me a little sad inside but I'm gonna be okay. I'll be like, I'll get past it. But anyway, I just think it's I think it's a it's a it's an endeavor that I like being part of I like trying to help people in mass. And I I'm not telling you that one day maybe the advertisers will dry up one day and you'll hear me get on here and go look, the podcasts cost 20 cents an episode now. You don't like it don't listen, there's nothing I can do about it. But for now I'm I've been able to keep it for eight solid years 800 app episodes, I've been able to keep this podcast free for people. And, and still, my house is heated, you know. So that's my goal. Although I guess maybe I should take a swing at the end. Right, Mike? What do you think? Like the last year go completely dirty, just curse through the whole thing charge like 25 cents and

Mike 1:35:20
oh, I think if you just made a separate one that was unedited, not edited, but like uncensored. Yeah. And then just charge for that one. I think people might buy that you think I could

Scott Benner 1:35:30
do that just curse like, what am I going to record? Jesus holiday time, I might have to get an editor. Let's make enough money that that can happen. Although I also need to, like, I have these people, these wonderful people who help for free with the Facebook page. And that's important too. I need I need more money all the advertisers have to pay twice as much. I gotta I have to start paying moderators online. That's it. I'll call them right now. Let them know the price is doubling. You think they'll be okay with that?

Mike 1:36:01
I think there'll be okay with whatever you tell them.

Scott Benner 1:36:02
I don't think they will. I think they told me to go to

a huge thanks to Mike. Hey, a huge thanks to Mike for being on the show today. And for all he does for people living with type one diabetes. I also want to thank cozy Earth and remind you to use the offer code juicebox at checkout to save 35% off your entire order. And of course touched by type one.org. Go check out the event. Find out the details. And while you're at it, why not find them on Instagram and Facebook and give them a follow. At the end of the music. I have a little note for you for Mike to add on to what he said here. I will read it in just a second. Thanks so much for listening. If you're enjoying the show, please share it with someone else. And give it a follow or subscribe in your favorite audio app.

If you're looking for community around diabetes, look no farther than the Juicebox Podcast on Facebook, a private group with 40,000 members. There's a conversation happening right now that you want to know about Juicebox Podcast type one diabetes on Facebook. I don't care if you have type one or type two. Lada doesn't matter to me. I don't care if you eat keto, if you eat a bunch of hotdogs or potato chips doesn't matter to me how I eat doesn't matter to me, but you do matters to me that you know how to use insulin and you feel supported Juicebox Podcast type one diabetes on Facebook. Mike sent me a note the other day that said Hey Scott, I mentioned I might switch back to free APS X when I was recording your episode. So could you please update people that I did switch back, except now it's called AI APs. Anyway, about a month ago, he switched back and he's loving it. He said I opened the app far less than I used to with loop. And now that I switched to loom Jove, which is a faster acting insulin. I'm sitting 98% of the time in my target range of 70 to 180. Prior to that, he was sitting at 90% Since he switched to Dexcom and loop to two years ago for two years. He was Dexcom and loop two. Now he's using something called I APs and see him better time and range. And Mike just wanted to let you know. Alright, everybody. This was a good day. I'm feeling good. I'm gonna go check out my movie. I am seriously gonna go put on my joggers. And I'll let you know how the movie was later. Even though I didn't tell you what movie it is. You guys can wonder what movie I went to say. Hey, go follow that Facebook Group. Subscribe and follow the podcast in an audio app. Share the show with somebody else and except my thank you for doing all of that. I'll see you very soon. When I'm back again with another episode of The Juicebox Podcast

#944 Bold Beginnings: Treating Low Blood Glucose

Bold Beginnings: Treating Low Blood Glucose Originally aired Oct 27, 2022. Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 944 of the Juicebox Podcast.

Hello, everyone, and welcome back to another episode of the Best of the Juicebox Podcast. Today's episode is from the bold beginning series. This episode features myself and Jenny Smith. It originally aired in Episode 780. That was back on October 27 2022. And it's called Bold beginnings treating low blood glucose. While you're listening, 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, or becoming bold with insulin. If you want to check out Jenny, you can hire her at integrated diabetes.com. And if you want to check out the entire bold beginning series, it's available at juicebox podcast.com. Go to the menu at the top click on bold beginnings, you'll see all the episodes there. It's available in your podcast player, any audio happy listening. And if you're looking for another list, but you don't want to go to the website, you can go to the feature tab in the private Facebook group Juicebox Podcast type one diabetes

this episode is ad free. But please remember to use the links if you have the need. They're in the audio app you're listening in right now in the show notes. Those links are also at juicebox podcast.com. Or you can type them into any browser. I appreciate you thinking about the podcast, when you're making purchases, when you support the podcast by using the links, if you're keeping the podcast free and plentiful. I'm gonna hit record gently to tell you this little preamble bit that I normally would have said ahead of time, but what we're done, you and this is the last one the not yay, I should say, oh, no, we're done. We're done with the bold beginnings, then we will move on to the long list of things that I have to do with you for next year. So but I'm gonna throw a little curveball in here. So you and I were going to talk about insurance. And then we were finished. But I'm going to bring somebody else in to talk about insurance. Cool. So because otherwise, it would just be you and I, you know, talking about our experiences with insurance, which might not answer some of the people's questions.

Jennifer Smith, CDE 2:37
No, I think that's great. Because I think there are quite a number of people that definitely no more about the navigation. And I think in terms of this topic, it's more how to really nudge yourself into insurance and get what you need, and get to be able to talk to the right person about it. Yeah. So I think that's great. Yeah.

Scott Benner 3:01
So you and I would have done, we would have had fun. And I would have told stories about yelling the F word into phones to get art and things and stuff. But I can do that with someone else who can also hit the technical sides of it for us a little awesome. So instead, you and I are going to add our very last episode to the bold beginnings series together about how to treat low blood sugars. Oh, right. Because you get diabetes. And nobody says to you, hey, you might get low. And the low might be slow. And it might be fast. And it might be harsh, and you might be dizzy. They just say if your blood sugar gets low at 15 carbs, wait 15 minutes.

Jennifer Smith, CDE 3:43
And then it might respond really fast. Or it might not resolve for a couple of hours. And you're thinking Where did the food go?

Scott Benner 3:52
So so so I want to kind of talk through a number of scenarios. And I know, I know, I'm dropping this on you out of nowhere. And of course I don't Is that is that anything new? No. But I don't have any notes whatsoever. Like we've been doing bold beginnings off of people's questions. So, you know, we might have gotten lazy because we're like, we don't have to drive this conversation. I'll just wait and see what this person said.

Jennifer Smith, CDE 4:14
Well, I'm sure there are probably lots of questions that have come in about low blood sugars.

Scott Benner 4:18
There may have been but they were not. They were not called together for me for this situation. So we're just going to fly by the seat of our pants, which I think will be fine. Not like before. All right. So let's think about this. Your newly diagnosed and I guess the first thing we can consider is that you might be honeymooning, still true. All right. So if that's happening, if you're getting help from your pancreas that you don't expect, you might see protracted I saw somebody online the other day whose kids blood sugar was like low all day. And she's like this has to be a honeymoon because, like we're not doing anything different than we've done in the past. So I guess if you're MDI, and you start experiencing low blood sugars that seem like they're being, I guess, impacted by your pancreas still, you can't cut off your your Basal insulin because you've probably shot it already that day. Correct. But you could start limiting, I don't know, would you limit

Jennifer Smith, CDE 5:23
limit your Bolus insulin, right? Right, or you could look at for that day, making your insulin to carb ratio, more conservative. You know, if you're floating around at a ratio of an in honeymoon, I mean, kids, and even some teens might be a one to 30 ratio, right? You could suggest one to 45 or one to 50. Or right, if you know that you're floating, pretty stable when there's not food introduced, but the stable is low, and you're having to give it a little bit of carb to keep it from like, dipping, then it would be the Bolus is that would be the easiest to adjust in that day. And in looking forward into the next day thinking, this might be what it is, you could downplay your basil that day, whether it's morning or evening time dose, you could take it down a little bit, and see if then the next day floats just slightly higher, and leaves you without having to add so much extra carb

Scott Benner 6:31
to treat. And on the day that you get surprised by it and your basil is already in. You can kind of feed the basil a little bit for the day. Yeah, right and spread out and spread out carbs to cover the timeline. But so this is where you need to understand the difference between like a faster acting car, but a more sustainable impact, right. And so if you're being drugged down constantly over hours and hours and hours, a couple of skittles might stop it for a minute. But the minute you bounce back up again, and this extra Basil is there that you don't need, you're gonna get drugged back down again. So you need foods that are slower to digest. Right? You start you start reverse engineering your problems from diabetes and using your problems as solutions, right? Like, right, if you ate pizza, that might take that might sit in your system for hours and hours and hours impact you. So what a great opportunity to have pizza, a little bit of pizza. Or what are

Jennifer Smith, CDE 7:30
pleading some proteins with some carbs. Right, you might want to treat if you're dipping or lower already. And if you do, then knowing what you just said you want some sustaining power after that to not drop yet again, you could do something that incorporates some fat and protein in it to hold things level because again, the other consideration that if if it is a honeymoon based, like drop in blood sugar, it could be that anytime your blood sugar does nudge up from what you treated with simple sugar. It could be that your betas are also like oh, look at that. There's a rise in blood sugar. Let's give some help. And it doesn't really know that you've got basil injected, that's also there.

Scott Benner 8:15
That's see you know, isn't that interesting that you brought that up? It didn't occur to me that I've always just thought of it is like you're getting help from your pancreas, but your pancreas seeds the carbs and attacks them while the insulin you've learned the manmade insulin you've put in is also drawing your blood sugar there. Wow. So you have dumb insulin and smart insulin working at the same time.

Jennifer Smith, CDE 8:37
Correct. And common time for that. And honeymoon is overnight for a lot of people actually, where they may have corrections that work pretty well in the daytime despite them being really tiny, you know, miniscule amounts of correction. But I've got person after person that says I can't correct unless my blood sugar's 300 At night, because if I correct with just a minor half unit of insulin, I'm sitting at like a 60 blood sugar.

Scott Benner 9:06
And this is the reason we're newly diagnosed people.

Jennifer Smith, CDE 9:09
Correct. It's specifically more honeymooning. I mean, you can even see it on nights where blood sugar is going up. You don't correct the high blood sugar because you have the hindsight to know what's coming. Blood sugar could hit 202 20 and it downplays you wake up in a beautiful number. That's that's not injected Basal that did that. Your body helped you?

Scott Benner 9:33
Yeah. Okay. So that's one kind of low you could experience now another one might be activity, right? I'm trying to think of I'm trying to put myself in a newly diagnosed person's situation right, like they go back to their life like I have diabetes. diabetes isn't gonna stop me and then they go play tennis, and then their blood sugar falls really quickly. There we need fast working sugar are correct something that's going to hit you very quickly and stop this freefall. So if you're in a freefall, for whatever reason, you can't eat. That's not the time to have a slice of pizza.

Jennifer Smith, CDE 10:12
That's not the time to have peanut butter cups, the slice of pizza, the nacho meal breaks, not

Scott Benner 10:17
because that's because you're gonna keep crashing before it has an opportunity to start digesting and to stop you. You're looking for simple sugars. I mean, in emergency situations, I know, I know, people don't seem to talk about glucose tablets anymore. Like they've become persona non grata, right. Because they taste achy,

Jennifer Smith, CDE 10:37
they're not the greatest. I mean, they are they are okay. I think the greatest thing about them for me personally, is that I am never going to over treat with glucose tablets. Right? I mean, they do their job. They're doing the job that I want them to do. But they're not like a bag of I don't know, licorice, like licorice. I like black licorice. So you might be like, easy to keep eating with a low blood sugar. Well, that

Scott Benner 11:04
is one interesting thing. There's a plus for for glucose tablets, you will you won't eat them for fun, that's for sure. No. Gel. I mean, I don't even know Do people carry that still, they should, right?

Jennifer Smith, CDE 11:16
We should and or it's easy, especially if somebody needs to help you. Because you can just get it into kind of the gum line and sort of massage it in it. It does work really quickly. So if you don't love the taste of glucose tablets, that glucose gels might work really great. There's a nice liquid glucose, that I just heard about two that I really liked.

Scott Benner 11:39
Okay, so, but in but in general, juice boxes, people are gonna use Skittles gummy bears stuff like that. Right? Correct.

Jennifer Smith, CDE 11:47
Exactly. But the another good thing as you bring up glucose tablets, glucose, or dextrose is the simplest form of sugar, right? So your body doesn't have to go through this breakdown of the structure of of sugar, if you will. And so it gets absorbed really fast. So if you're looking for candy, specifically, you really want to look for candy that has glucose or dextrose as one of the first two or three ingredients. Because it's going to have the fastest impact on a low or really quick drop that you want to stop.

Scott Benner 12:21
Yeah, the timing. So super important. Because I know a story about a person, I won't say their name, but they're an adult. And diabetes for a long time, felt themselves getting low knew it, ate a bunch of carbs passed out, and then just turned back on when the carbs hit them. They were just like, hey, I'm back. And so so there's an it's an example of having the timing wrong. Like you're falling at a certain degree of speed or rate of speed. And you need that sugar to come in and to slow like a parachute almost to parachute that that number fall down and to stop it. You know what a nice level sponsor don't go too low. So things need to work the way you need. I mean, that really is the message of this episode, right? Like if you're one if you're 120, and you're wearing a CGM, and you see this gradual fall, and you look back over at 90 minutes going down, geez, like I Bolus for this meal, it clearly looks like it's too much insulin, I'm going to get low a half an hour from now. Well there, you could just add some more carbs to your meal or have a couple more bites. Correct. And you might stop that. But if that same 120 was falling quickly, you're in a different scenario, you need to use different carbs.

Jennifer Smith, CDE 13:38
You need to use quicker exactly the simple carbs on a quick drop. If you've got a gentle sort of glide down something that's a little more complex, like crack, you know, something like peanut butter crackers, I hear a lot kind of get used because there's a little bit more to the cracker with the peanut butter added to it. Right. So something like that could use it down. But if you're really really dropping then sugar,

Scott Benner 14:06
yeah. And you have to in the beginning, it'll be hard not to overeat a low but that is a skill you need to learn. Because otherwise the bounce comes and then you're like I don't know what to do. I was cheeky of that fear from you've just been low. You don't want to Bolus like you get caught in that. That bouncing rhythm. You don't want to be in that so maybe you'll learn at some point to look at your situation and say half a juice box here. Or you know, take a couple of sips just have two Skittles you know I say to people all the time just because you open the bag doesn't mean you have to eat all of them. Right? Yeah, just eat what you need.

Jennifer Smith, CDE 14:43
All right, which is also why those little tiny bags I mean this is a popular time of the year for a lot of people to end up stocking up on simple car because we have Halloween coming up. Whether you celebrate it or not. It's a great time of the year to find really little packets of somewhere between eight and maybe 15 grams of carb, simple sugar, Candy really prepackaged. So the whole bag of Skittles versus the tiny little packet helps you to contain things a little more. And if

Scott Benner 15:17
you're not lucky enough to have a CGM in the moment and you're just leaning on your, your finger sticks. How frequently do you tell people to after they think after they've identified a low or felt it and treated it? How often do you stick your finger and look, I find myself, you know what I mean? I use a lot more test strips in that moment than you do sometimes for the whole week

Jennifer Smith, CDE 15:41
you do. But you can expect that even simple sugars going to take a little bit of time for digestion, right? So you're really not going to see much shift. If you do a finger stick, confirm your low, treat the low and five minutes later, you're doing another finger stick, you're probably not going to see not much of a difference, right? So that's where old school was that 1515 rule. 15 grams, 15 minutes while you might not need or take 15 grams to treat this low that you have. Waiting about 15 minutes to retest will give you enough information to say, well, I treated it. It doesn't look like it's come up, but it hasn't also fallen. So that should give you enough to say it's not dropping. Clearly, digestion is happening. Well, let's give it another 15 minutes and test again.

Scott Benner 16:33
Yeah, you know, I have two thoughts. So one of them I'm going to make a note about and then the other one I'm going to say if you are wearing a CGM. Sometimes it will not register as quickly. So you can see like a like, Oh my God, my blood sugar's 50. You know what I mean? And you take a bunch of carbs and, and then there's this way to look at the arrow with the Dexcom. At least I don't know how it works with libre, you'll, you're stopping a low blood sugar, let's just say it's 60. And it's the arrows diagonal down, and you take some carbs in and the next reading is 55. And the arrows still down. And then all of a sudden, the arrow will like sometimes disappear. Like almost like the algorithms like I don't know what's happening right now. But the number stays the same. Or sometimes the number or the number will get lower, but the arrow changes. And do you know what I mean by that? Yeah. And so your whereas

Jennifer Smith, CDE 17:32
if you were testing in a look, then it said 55 with an angled arrow down, you've treated it. And now you can see it has a horizontal arrow, but the number is reading like 51 or 50. And you're thinking well, what that really indicates is the system has found a stability, even though the number has slightly nudged down yet, it's not dropping, what you've done is actually making some impact overall. So it's not really time to treat with yet another like whole box of juice.

Scott Benner 18:06
It's so weird. It's a weird moment because the CGM is a little behind. And what you did with the carbs is maybe more in the now, but you can't see it. And so there's like, there's like multiple things happening at once that the technology has, has difficulty showing you. But you can see that something's happening. And so that's when that's when I say to myself, Okay, now this thing looks stable. And we've gotten to, you know, readings in a row that say 50. But I want to know what's really going on, because either the CGM seems confused and I didn't do well. And we're lower than we think. Or we're higher than we think. And I don't want to treat more. That's the perfect time to do a finger stick to me. Absolutely. You have to. Right,

Jennifer Smith, CDE 18:51
absolutely. Especially for those those numbers where you're treating I say at a number less than 60. Honestly, if you're varying at all and decision about whether I should do a finger stick or not. If you're less than 60 and you've treated it and the numbers on the CGM just don't necessarily add up. Or you're mentally not quite like with it enough with a low blood sugar like that. Just do a confirmatory finger stick, because at least that's going to show you real time right now. Where is your number? Yeah,

Scott Benner 19:29
yeah. And I know we're trying not to over treat. But if you get caught and you don't know, like, this is the time you're going to hear me say I'd rather I'd rather just Hi. Yeah. Because Because what you're saving yourself from or saving another person from we don't talk about very much like in diabetes in general, even on the podcast very much like it just doesn't get talked about very much. You're talking about becoming incapacitated. You're talking about having a seizure. You're talking about death, like you're talking about out. There's a lot that happens between 40 and then I don't know how low anybody's ever been right, you know, but while they were still alive, I saw Arden's blood sugar. I saw Arden's blood sugar 22 wants on a finger stick when she was really little. And she was okay still. And I was just like, keep eating, eat, Yeah, II keep going. And then all of a sudden, it was 30. And I was like, Oh, I might have tested, I might have tested her blood sugar 10 times in seven minutes. I was like, but But I mean, it's the truth, right? Like you, you have to learn to do this. Because you use manmade insulin and your blood sugar is going to get low. I just don't care who you are, it's going to happen. So you need to know how to handle it, or how to handle it for somebody else. And you need to know how to handle it without causing a problem in the future. Whether that problem is a high blood sugar, or calling an ambulance, like right, you're it's not. I guess we don't talk. It sounds scary. It's probably why people don't talk about it, huh? Yeah, yeah. So

Jennifer Smith, CDE 21:03
it's absolutely it's it's more around how to treat. There's not even an emphasis on like the overtreatment. It's just treat it. But why, right? Why is it so important to recognize a low sooner than later or deal with it sooner than later? Or stop it from happening? sooner than later? Because there is that scary factor of? I don't know. I don't know why some people can have a blood sugar. I might the lowest I was ever was 26. I don't I was fine. My mom actually thought the number had to be bad. I mean, it was really old. I mean, this was like 1988. So clearly, the meters were not what they are today. But she's like, that's gotta be wrong. You feel good, right? We were camping. Did it again, it was like it was pretty much the same. Just like you need to eat. Here's the juice. Where's it? Where's the regular soda? You know, why could I be there? And fine, when somebody else could be passed out, have a seizure, need an ambulance need assistance? When their blood sugar is 61 and low?

Scott Benner 22:10
Right? Right. Yeah, everybody's going to be different. And so. So let me let me say a couple things here. I use a football analogy, because it's football season, right? You can't like the reason they offensive linemen are these giant blobs of people is because they're trying to stop this insane force that's coming at them. Right? Correct. You can sometimes put carbs in. And you've made such a mistake earlier in the day with insulin or, you know, there's just so much power on the side of the insulin. It's like the carbs aren't there, like you might as well not have anybody blocking because it runs right through them. Right? That's a panicky situation. The first time that happens to you, where you take in a juice box, and realize that it's, it's like you didn't drink it. If you're enjoying the Juicebox Podcast, and you would like it to remain free. Please support the sponsors. Today's sponsors are Dexcom G six dexcom.com, forward slash juicebox. And Omni pod, both the Omni pod five and the Omni pod dash are available at Omni pod.com. Forward slash juicebox. It's a hard moment, you know what I mean? Because this is what you know is going to work. And now suddenly, it's not working for some reason. And you're like, Oh, God, what do I do? You can't find yourself in those scenarios. Wondering what's in the cabinets? Or what's in my bag? Or what do we have in the car, like you have to be prepared? Correct all the time. Just all the time. You know, anywhere you are. There are fast acting carbs. I don't give a crap if you don't use them for six months. I don't care if they get stale, throw them out and replace them. If the juice, you know, when the juice box gets some spongy from being in the car in the heat, throw it away. Put another one in there. Like just don't. Don't ever find yourself in a situation where you're like, it'll be okay.

Jennifer Smith, CDE 24:06
Right? Yeah, right. I mean, It's fall now and I were just like rotating through. We don't really have summer jackets, but like into fall into the winter jackets. We're kind of rotating them into the mix, right? So I bring up my winter stuff. And absolutely in at least like one if not two of my, like fall into winter jackets. They're old, nasty, bad glucose tablets. Like they've gotten the like crystallized sugar like dots, though and like if I had to, I would still use this. So like that juice box that's like nasty and squishy. If that's all you got, you use the squishy juice that

Scott Benner 24:45
you could spread them around your life like your grandma's spreads around her reading glasses. Do you know what I mean? There's just a pair in this room and over here. You need to be listening. You can't be it's a weird scenario. You can't be scared. You can't live your life scared If you don't want to live your life with a 200 Blood shirt, because you don't want this to happen, because also, that's not any safety from not being low, right, as a matter of fact, that might put you in a situation where you're alone more frequently, but, but I like to say about diabetes, that you don't learn these things, you don't prepare for these things so that you can stop a problem. The problem is always going to sneak through somewhere, it's never going to be where you think it's, you know, because if it was where you think, then you'd get ahead of it, right. So you have to be ready for when it happens. And then the last bit of this is, if all else fails. I mean, please be carrying glucagon, you know, with you, like not, it's in the cabinet in the kitchen, but we don't take it, you know, anywhere. I left it in the car when I went pumpkin picking like it needs to be with you. Right. Yeah, exactly. So well, this is a fun conversation.

Jennifer Smith, CDE 25:51
Harder, I think it's a harder conversation than you think about before. Because there's a lot of, there's a lot more on the back end of not taking care of a low well enough. That is actually scary. Yeah. And it doesn't get talked about. We always try to like smooth it out, like not to worry about it so much, and whatnot. But in order to not really worry about it. Preparation is needed. You have to have things in your purse or your car or your backpack or, you know, at your friend's your friend's house that you go to all the time, or whatever it is. I guess it's like being a girl scout or a Boy Scout be prepared

Scott Benner 26:33
how to be prepared. Yeah. You know, when Artem was younger, she spent her whole day in one classroom, right? Or she went to art or something like that. So she had a bag and she took it with her when she hit middle school and high school and she started having English in one room and math in another room. When that started happening. We put supplies in each room. Like we didn't say to ourselves like she should be humping this stuff all over the place constantly. Let's put a little here there was a couple of juice boxes in every room. You know, it's interesting. It's when you learn about your management to how come we're always restocking the English class. And never the math class. What's the time? Yeah, it's the time of day we're doing something that's making a low around this time of day, it's actually an interesting way to learn a little bit about your management is where am I grabbing my supplies from? You know, do you think that? Do you think that every low is different? Because there's there are questions here from people that are like, you know, after I stopped a low with a fast acting, should I put a protein in every time afterwards? But not necessarily, right?

Jennifer Smith, CDE 27:38
Yeah, no, I mean, the idea. Again, it's kind of an older concept. It's sort of like the 1515 rule, it's 15 grams, 15 minutes, and then you essentially may need to follow that up with a snack. But again, there's lack of enough information about why the idea really was simple carb will typically help keep your blood sugar up for about 90 minutes, give or take. Now, again, a variable in the picture is why was the low there. If it's excess insulin, you may actually need to treat with more than what you thought you would need. But the other idea is that the simple carb to keep your blood sugar up is it's meant to sustain you for that time period, before you might eat again. So if you treat a low blood sugar at, let's call it three o'clock in the afternoon, but you don't typically eat dinner until seven or eight o'clock at night. Lows can bring on another low they can. And so if you treat the low, but there's something in the picture that's keeping you lower, could be honeymoon, it could be excess insulin, it could be more movement in the day, whatever. You may actually for longer than two hours before your next meal. It may be beneficial to have a handful of nuts a spoonful of peanut butter a piece of string cheese a boiled egg, whatever it might be. The the idea there is that that's a little bit more sustaining and or a snack that might have a little bit more complex carb to it long with some protein to sustain things. So you're right every low is not the same

Scott Benner 29:20
right art in tried art in psychology right now. She tried to use a falling blood sugar as a Pre-Bolus for her lunch, but it just didn't like she didn't time it well enough. So like at 60. So listen, for anybody who's listening. Here's how I did it. Arden's in another state. She's 13 hours away. I'm able to look at her phone and see where it is. Right so I use Find My Phone to see. Okay, she's in the cafeteria, so at least I know she's right. So now where she should be near food. I text her Hey, what are we doing about this? Because she's got this like seven One day that became 65 pretty quick. And then I looked at the arrow and then I looked at the line and I thought this isn't stopping. Like this is not a low that's going to stop right like this is this is going to be negative 15 If we don't do something about it, right. What are you doing? I'm trying to like Miss like, you don't I mean, I don't want to be upper asked Jenny. And at the same time, I don't need her dropping dead. It's College. Like, I'm trying to find the middle. I'm like, Hey, what's up? And nothing. Now I know she's with the food. So I'm like, you see this? Nothing. Art and I really need to know you're okay. I'm eating now. I'm like, okay, like the food's going in your mouth. Yes. But Jenny 6060 560-560-5550 5540. I'm like, Are you eating now? Yes, I'm eating. I told you. I was What are

Jennifer Smith, CDE 30:49
you eating lettuce leaves. So

Scott Benner 30:53
what's happening? Like, you're eating like handfuls of sugar, right, like, and so, but so I texted her to test her. So then I sent a text to test her cognitive, like, where she was cognitively. Right. And I'm just like, how do you feel? And she's like, I feel fine. And I'm like, Okay, have you been eating for a while? She said, Yes. So I said, Okay, I got it. There's food in there. It's working. The CGM hasn't caught up yet. But I had to stand there. for like three go rounds. That CGM watching that 42 Just sit there knowing she's not really 42. She's in the mid 60s already. I know. I know this. But I only know this from

Jennifer Smith, CDE 31:35
you. Because you've lived with her. You've dealt with it long enough. You knew the questions to ask. You knew how to get her to respond and whether or not she was going to answer you the right way. And that it takes learning Oh, it's

Scott Benner 31:48
yours. Because otherwise I would have been like drinking juice. I don't care if you don't drink the juice. I'm bringing you home. I'm not paying for college. Like I don't you know, like, you know, because the number because we've done everything's over come home and live in this room for the rest of your life. Because the because the number was so scary, right? But I was able to pick together enough information. I swear to God, that CGM. One more time went from 42 to 66. And I was like, Okay, I was right. But I'll tell you, you're like, God, what if I'm wrong, you know what I mean? Like, I don't want to be wrong, but I might be. The next thing I think we should bring up about lows. Because we're in a we're in an algorithm world now. Right? Control like you on the pod five, that thing that Medtronic makes i What is it? Which one is that? Let me learn the number. Medtronic, don't they have an algorithm right now?

Jennifer Smith, CDE 32:39
Say, do they've I mean, they've had an algorithm for a long time I use as a their CGM, right. And I don't know that their does their algorithm have a name like Omnipod, five, six, so their new their new one and the ISC, that number is what you're looking for seven, seven DG. And I know some plays I don't know if it's here. I don't think it's here yet. Seven. ATG I know is available in some places in Europe already. But 777 80

Scott Benner 33:11
I just I feel like they buy they buy ads for in pen. So I figure I, I owe it to them to learn the name. I just can't keep saying the thing that Medtronic has they're gonna be like, How about how about if you're not the podcast that we sell the embed on anymore? Like? Alright, so the 770 GE, right. So yeah, so whether it's one of those algorithms, we all live in a new space now, where the algorithm sees a low coming, and it takes away and takes away and takes away your basil and takes it away. But it isn't, it isn't always going to get it right. And so you might end up treating a low after a prolonged amount of time of not having any insulin. And then your blood sugar shoots back up very quickly, because there's nothing to stop it. And what is the algorithm do when it sees the higher number gives you more it gives you more insulin, sometimes sometimes can happen. That's what I'm saying. It can happen that's a better way to and when that happens. Here's what I know for certain Yeah, gonna be low again later. Because because, you know, they, you know, when you're taking, you know, sugar and for a low if you take in the right amount, you've been getting on a regular you know, on a regular pump or on an MDI you've still been getting your Basal the whole time. So you're, you're correcting that low more in real time. When you do it right algorithm. The algorithm thought it was going to stop you. It does not expect these carbs. And now you jump up and it Bolus is the number or it's pushing basil at the number that the other night. I guess I should have listed lupus one of those Arden had Jenny I think it was around her period and she was tired. She's rundown and she's getting her period at the same time. We had this whole day where she was a little too low. And it persisted into overnight. And so around eight or nine o'clock we fixed the low and I said Listen, take these carbs, go into the settings and shut off micro bolusing without carbs. I was like, where this thing's gonna hit your, your correction, right? And it's gonna push it back again. And she did that we went through the night really nicely. It was a nice learning experience for her because then she brought it up the next day. She's like, should I put the micro balls back on again? And I was like, Yeah, everything looks good now. So, but anyway, you have to be aware of that. So, I mean, I don't know what you do. Me. I mean, there

Jennifer Smith, CDE 35:29
are other you know, for other systems, you can certainly also navigate something like that. If you've treated a low, you know that you've overtreated it, but the system is going to give back eventually, and you know that it's going to be too heavy, similar to your scenario there. The other systems do have, I guess, adjustable targets or different targets that would be higher. So then it would adjust less if you adjust the target up and say, Hey, I'm aiming for this now. So as my blood sugar is going up, it's okay. You don't have to give me as much because I want to be higher

Scott Benner 36:07
anyway. So like an example with Omnipod? Five, you might tell it to shoot for the higher range. And that's correct. And yes, with I'll tell you what, in that exact scenario with art, and I said, I asked her what did you take for the low? And she's like, Oh, I had gummy bears. They hit her really hard. So I was like, Oh, crap, she's gonna jump straight up. But they don't hit her and hold her. They hit her. And then they disappeared on her. So I was like, oh, no, no, don't let that thing Bolus. Yeah. Anyway, this probably all sounds much more confusing than it will be you have diabetes for a few months. It's all gonna make sense. Don't

Jennifer Smith, CDE 36:41
maybe know very well, yeah. There's still some things I throw my hands up. And I'm like, Well, clearly, like Venus is not in the right place in the orbit of something because I, I just I don't know right. Now,

Scott Benner 36:57
you're maybe just said Good. Luck is what I heard.

Jennifer Smith, CDE 37:01
That was so not the case. That's not the beginning of this is what you want to hear. Yes. Forget the maybe nine I shouldn't say maybe should be like the point 1% of the time. You know, it doesn't take much to learn, especially with CGM is in the mix. These days, it doesn't take much to learn how much is needed. And as you were sort of, you know, talking into the effect of algorithms, you'll see, well, gosh, I was used to using this much, I probably need to use a quarter to a third of what I used to use to treat when I didn't have a system that was helping me

Scott Benner 37:37
You know, I saw a woman yesterday say, I don't know the exact numbers, but the gist of it was on control IQ, I needed 14 or 15, carbs stop below and on Omnipod five, I'll need four or five carbs to stop below. Interesting that interesting, I found that incredibly interesting actually. So especially

Jennifer Smith, CDE 37:53
system to system, given the fact that they're both doing a give and take of insulin, but they are they are very different algorithms. Yeah. So that it does make sense.

Scott Benner 38:03
Alright, so check me on this. You need to know how to stop a low they're going to happen. You're not going to stop a low from never happening. You need to understand the different impacts that these different carbs are going to have on your low blood sugars. After a while teaching yourself to stop a low without creating a high is a great tool to have.

Jennifer Smith, CDE 38:22
Yes, if you it will happen. Yeah, yeah. Oh no,

Scott Benner 38:25
you're gonna rebound high until you until you learn how to do it in a real panic situation. Screw everything else save your life. Correct. And that's it right? Have glucagon with you have snacks with you. Don't go anywhere without ways to treat Lowe's, the people who love you and are around you should understand how to help you if you're unconscious or unable to help yourself.

Jennifer Smith, CDE 38:49
And I think another thing as you mentioned, caregivers or loved ones or you know, whoever. I think within that for Lowe's is recognizing the like what you mentioned about cognitive when you're doing kind of a check with Arden the people that are around you enough should be able to tell whether you're responding or or talking or whatnot, the way that you normally would. And in the case that your CGM is off, or you aren't using a CGM or technology, somebody who knows you well should be able to kind of chime in and say, Hey, are you okay? You know, and don't be angry at them for that. It's just a it's a checkpoint to be able to keep you safe. So

Scott Benner 39:38
yeah, also for I guess caregivers, low blood sugars could leave you with people who are difficult to yes help, right? They could become combative or and that's a real concern, especially as they become adults and I There's one story that sticks out in my head all the time of this woman whose husband got low and she just wasn't big enough to overwhelm him. Do what he needed, you know? And she had to call 911 because of that. But yeah, I mean, the people around you just need to know. And people should be following you. If you have CGM, like I don't know if liberi has follow like Dexcom does, but it doesn't. Okay. Arden is in a suite with girls. And the girl in the next room follows her on Dexcom Oh, wow, that's awesome. She only has a 55 alarm and nothing else. But we explained to her I'm like, if this thing's beeping, please go find Arden. And make sure she's okay. That's all. Yep. And it just, I don't know, especially for adults living by themselves or kids off at college, like somebody, you know, has your back because it also not everybody hears the alarms to like I had a low last night. It was only like 65. But I was sleeping. And in my sleep. I thought did I hear something? Like that was all I thought, right? And then I'm like, I woke up and I looked, and I was like, huh, yeah, I'm gonna watch that for a second because the being honest with you, it was a real slow drift. The loop had been taken basil away. I'm like, I think this is gonna bounce. Like, I think it's okay. I don't want to wake her if it's not going to be okay. And it waited and waited and waited. And then I was like, Oh, it is gonna be okay. It went back up again. But I talked to her this morning. And I was like, you know, you're a little last night. She has no idea. But since she had that seizure more recently, if you listen to her last episode, she'll tell you about it. If she has a she experiences any kind of a quick fall while she's sleeping now. I don't know. I don't know how that rewired her brain. But she's boom. I'm up. I drank juice. I'm good. Hey, Dad, I did this. Do you think this is enough? Like she never used to wake up. And now I don't know if she's feeling the fall while she's sleeping right now. Which has only happened twice since she's been away. But anyway. Alright, Jenny, did we do it? We did it. I think so. Yeah. Yeah. For us then.

Jennifer Smith, CDE 42:00
Okay for us. Awesome. Thank you. Oh,

Scott Benner 42:02
I guess we should say something like thank you for listening to the beginning series. And I hope you found it like, helpful.

Jennifer Smith, CDE 42:08
Absolutely. Especially in the beginning when everything is so new. So

Scott Benner 42:11
let us know if you want us to add to this series. If you go back and listen to it and find something that should have been in there that wasn't please send me a note. And Jenny and I will we'll add it if we think it needs to be added? Absolutely. What are we doing? What are we busy or something?

Jennifer Smith, CDE 42:29
Got nothing else to know. Right? But just hanging around?

Scott Benner 42:38
Well, as I mentioned at the beginning, we've already found more stuff for bold beginning. So this was not the last episode. Let me thank Omni pod and Dexcom. While I have your attention on the pod.com forward slash juice box, see if you're eligible for a free 30 day trial of the Omni pod dash. Or if you're interested in the Omni pod five. For full safety risk information and free trial terms and conditions, you can also visit omnipod.com forward slash juice box. And of course, thank you to Dexcom for being a longtime sponsor to the podcast dexcom.com forward slash juice box see blood sugar in real time, the speed direction and the number right there on your iPhone, Android, or on your Dexcom receiver. There's so much more I want to tell you, but I'm on about day seven of this illness that I have. And to be perfectly honest, editing the show together almost killed me. So I'm gonna go take nappy, and I'll see you next week with another episode of The Juicebox Podcast. Hey, everybody, it's me. I hope you enjoyed the episode. I want to remind you about the private Facebook group Juicebox Podcast type one diabetes. I don't know if past Scott said that in that episode. But future Scott, or I guess President Scott wants you to know about it. Juicebox Podcast, type one diabetes on Facebook. It's a private group that now has 40,000 members. And there are conversations going on night and day. Doesn't matter what country you live in. That group is always jumping, you have a question, somebody in there is going to answer it for you. You need a link, somebody in there will find it for you. There are group experts that will help you find episodes of the podcast that can help you. And I'm in that group every day. So please just stop by and say hello. That's pretty much all I have for you today. I hope you enjoyed this episode. I'll be back very soon, with much much more. Thank you for subscribing, following sharing, telling a friend telling a doctor whatever you do to get the word out about the podcast. I really appreciate it. Keep it up. You are helping the podcast to grow

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