Scott Benner 8/1/24 Scott Benner 8/1/24

#1268 Ask Scott And Jenny: Chapter Twenty-Five LIVE

#1268 ASK SCOTT & JENNY: CHAPTER TWENTY-FIVE (LIVE)

• Should we pre-bolus for dessert if we have insulin on board from a meal?

• I had my son before I got type 1 diabetes: Is he at a higher risk of developing type 1 or another autoimmune disease?

• How long should we wait to give insulin again after a meal?

• Tips for teenage diabetic daughter with an irregular menstrual cycle?

• Scott, which clinical trials would you want your daughter to sign up for if given the opportunity?

• What's the reason why my blood sugar goes up when I change my sites?

• What are strategies for bolusing for stress?

• Have you heard of idiopathic type 1 diabetes?

• My doctor told me that I need to reduce my insulin usage to aid losing weight but I'm unsure how to do that without letting my numbers run high?

• I'm interested in looping, I watched tutorials, listened to podcasts but I couldn't figure it out?

• If you were going to take a couple of units of glucagon to address a low, is there a general guideline for adults?

• Do you think GLP for reducing insulin needs is feasible for a slim underweight kid?

• Why is it so hard to bolus for anxiety?

• If your A1c remains 5.8 for the last year on Omnipod 5 manual, would you still consider trying the algorithm?

• Tips for adjusting Omnipod 5 and basal rates for kids with rapidly adjusting needs, illness, etc. and thoughts on what you've seen in practice with loop or tandem being better or worse?

• Can you tell us more about digestive enzymes and constipation?

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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 1268 of the Juicebox Podcast.

Guys, Jenny is back and she and I recently did a Facebook Live, this is the audio from it. So what does that mean? We got on the interwebs. And we talked to people who listened to the podcast if you like this and you're not following the public Facebook group for the Juicebox Podcast or aren't a member in the private Facebook group, well, you might want to become one. So you hear about this the next time it happens. 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. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day. It is completely free. And at the very least you can watch other people talk about diabetes, and everybody is welcome type one type two gestational loved ones, everyone is welcome. Go up into the feature tab of the private Facebook group. And there you'll see lists upon lists of all of the management series that are available to you for free in the Juicebox Podcast. Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it to so screen it like you mean it. One blood test can spot type one diabetes early tap now talk to a doctor or visit screened for type one.com For more info. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juicebox This episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed. Ever since cgm.com/juicebox. Good morning, everybody. This is it. Usually Jenny and I look at each other and then we start a recording, and then ask each other questions that you guys have sent in. So you're gonna need to send some questions, and we're gonna be in trouble pretty quickly.

Jennifer Smith, CDE 2:46
We can't just keep saying good morning.

Scott Benner 2:48
We could chat if you want. But I don't know how interesting. Yeah, I'm not sure how interesting that'll be for how long. So this is Jenny. So you know, this is on YouTube. It is on Facebook on a lie on the private group. It's in the public group, and it's on Twitch. So hopefully, I think I could put it on Instagram, but it's weird. So I didn't do it. I think you have to do just Instagram. Good morning, everybody. If you have questions, go ahead and put them up. Okay. And if you are interested in hiring Jenny, you can email her at that link up in the corner. We'll put that up out periodically. Also, lets everybody remind you that that's the disclaimer if you want to read it, but it says that nothing we say you can take as medical advice. So it also says a lot of other things. If you want to read it, feel free to read it. It's actually on juicebox podcast.com as well.

Jennifer Smith, CDE 3:42
Good morning to everybody who's saying good morning to me. Good morning.

Scott Benner 3:47
Hey, Susie, how are you? Alright, so what do we have here? Should we Pre-Bolus for dessert? If we already have insulin on board from a meal? To

Jennifer Smith, CDE 3:57
Great question. It's a question I get all the time you go ahead and go first. Oh, okay. So I think it does differ, right, it differs for the content of the meal that you already had. And it also differs from again, now we have directional from CGM information. So depending on where you're sitting, if you're already rising in the aftermath of that meal, then potentially it's a great idea to Bolus especially if it's a particularly simple carb type of dessert, you know, sitting down to cotton candy versus sitting down to, I don't know, something else that's higher fat creams, cheesecake for example, right. So I think it definitely depends. And then in terms of the the piece here of should we Pre-Bolus for dessert? Not necessarily again, depending on where your blood sugar is sitting. It may depend on whether you need a Pre-Bolus or whether you want Just a little bit of the meal kind of Bolus that's already there play out, and then Bolus right before you start to eat the actual dessert.

Scott Benner 5:08
Right? So can I give like that was a very detailed answer, I'm gonna give a little piece of it that I think of, which is, obviously there are different scenarios. Jenny's just outlined a number of them. But overall, what you eat, generally speaking, needs insulin. So if you've made a terrific Bolus for your dinner, and your blood sugar's at five and super stable, well, great job on the Bolus from the dinner, now you're not eat something else. Again, it's time to probably Pre-Bolus that as well with a little bit and then keep that train rolling nice and flat like that, unless of course you've overestimated dinner. And now you know, the dessert could be part of it or underestimated it. And maybe the dessert plus a correction is needed. Right.

Jennifer Smith, CDE 5:51
And that's, that's again, where I think the benefit of having a continuous monitor really comes into play. Because you have a little bit more, I think it's wiggle room to determine do I need Pre-Bolus? Can I Bolus because it's a really slow kind of dessert. And it'll be okay. Do I employ the use of one of the smarter features like an extended Bolus or something that like that along with, you know, the meal Bolus that's already there. I also had a really great conversation yesterday with somebody about the number on your CGM and the directional arrow. Okay, versus really just looking at the trend line. Right, because I feel like the number on the CGM and the arrow, they go hand in hand, they're almost like a marriage. Right?

Scott Benner 6:41
How do you mean? Meaning?

Jennifer Smith, CDE 6:43
If you go solely based on the trend arrow, and then number, you may make a different decision in this questions example, compared to what the trendline looks like. Okay, the trendline. You can think of it almost absent of a number. Yeah. Because the trendline even if that in a lot of people complain, Oh, my CGM is off the number is off from a finger stick when it's trending this way, or it's going that way or the arrow is off or whatever. But the trend line itself isn't lying. Right? There's a decline happening. There's stability happening, there's a rise already happening. And so in this case, from do I Pre-Bolus, or do I Bolus at the meal or do I Bolus after the desert is eaten or whatever? The trendline can really help you there versus just looking at a number. This

Scott Benner 7:34
episode of The Juicebox Podcast is sponsored by the only CGM you can take off to get into the shower. The ever since CGM ever since cgm.com/juice. Box. Well, I mean, sure, you could take the other ones off, but then you'd waste the sensor and have to start over again, but not with ever since ever since is a six month were implantable CGM. So if you want to take a shower without anything hanging on, you pop off the transmitter jump in the shower, when you get back out, put it back on, and you're right back to where you started. Come to think of it. You could do that whenever you wanted to. Maybe it was your prom night or your wedding day. Maybe you just don't want the thing on for a little while. But you don't want to go all through the hassle of taking it off and having to restart it and you know, starting back over with like wonky numbers and having you know all that that goes with it when you take off the CGM and put it back on Oh, but you don't have to do that with the Eversense CGM. Because ever since is the only long term CGM with six months of real time glucose readings. This gives you more confidence, more convenience and flexibility. The Eversense CGM is there for you when you want discretion, a break, or maybe just a little adult time. Ever since cgm.com/juice box, pop that transmitter off, pop it back on, you're right back where you started without any wasted devices, or time. Getting older means a world of change, but some things still stay the same, like being at risk for type one diabetes. Because type one can happen at any age. So screen it like you mean it. If just one person in your family has type one, you're up to 15 times more likely to get it too. And 50% of type one diagnosis is happen after the age of 18. So screen it like you mean it. type one diabetes starts long before you need insulin and one blood test could help you spot it early and lower the risk of serious complications like diabetic ketoacidosis, known as DKA. So don't get caught by surprise. Screen it like you mean it because getting answers now can help you get prepared. The more you know, the more you can do. So don't wait. Talk to a doctor about how to get screened. Tap now or visit screen for type one.com to learn more. Again, that's screen for Word type one.com and screen it like you mean it. There have been times with the g7 that I know people got upset, because they used to smooth the number out like with software a little bit. So it kind of made you happier when you looked at it. But now I'm noticing that the direction of the line seems more accurate with what's actually happening. Okay, have you so I don't know if you've seen that or not like, there'll be times where like, you'll see I don't know, like a down arrow. So like, sometimes the arrow is indicating down. And at the same time, the number makes it feel like I'm moving in the other direction. And so I do tend to do exactly what you just said, which is put them both together. Yeah. And say that the arrows telling me one thing, the lines telling me another thing? Right, you know, but the this direction seems to be spot on, right, like the direction seems to be spot on for me. Sure.

Jennifer Smith, CDE 10:59
And from that smoothing angle with G seven, I think what I've seen is really that, because they don't smooth as you mentioned, right, G six, the data was smooth. So it was almost a from my understanding, it was, look, the system's algorithm looked at the data points preceding the current. And there was some averaging, which provided that was going on to provide a smoothing into the next numbers you saw, where as g7 took the smoothing out. And so each data point isn't, it's supposed to be an accurate one and an actual data point. Yeah.

Scott Benner 11:38
Emily says here Good morning, I had my son before I got type one diabetes, is he still at higher risk of developing type one or another autoimmune

Unknown Speaker 11:47
disease? I had my son before I got type one. Oh,

Scott Benner 11:50
I see what she's saying. Yeah, Emily, I don't think it changes auto immune probably runs in your family. You know, like, I think what's going to happen was going to happen whether you got type one before or after the pregnancy. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has been at school, they're everywhere that she is contour next one.com/juicebox test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter, you can find out about that and much more at my link contour next one.com/juice box contour makes a number of fantastic inaccurate meters. And their second chance test trips are absolutely my favorite part. What does that mean? If you go to get some blood and maybe you touch it and I don't know, stumble with your hand and like slip off and go back, it doesn't impact the quality or accuracy of the test so you can hit the blood not good enough, come back get the rest without impacting the accuracy of the test. That's right, you can touch the blood come back and get the rest and you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times, that's not a good reason to have to waste a test trip and with a contour next gen you won't have to contour next one.com forward slash juicebox you're gonna get a great reading without having to be perfect correct

Jennifer Smith, CDE 13:27
and really with the testing that we have now depending on how old your son is whether testing is an option yet or not for his age, that really is the best tracking that you can do for the potential now there are other anything we talked about this we talked about the thyroid episodes and that kind of stuff, there are antibody testing that can be doing done for a number of other autoimmune conditions thyroid in included there. So if you are concerned at all that is one of the best ways that you can just keep up with checking Yeah, and

Scott Benner 13:59
actually you'll hear in the last half of the year on the podcast ads for something called screened for type one.com which you could go to now even though I don't have the ads up yet it's literally screened for type a digit one.com And you can look into that they're about screening if you're worried Brenda says but you know what give me you have one more second on that like yeah, I don't know that because you have type one diabetes means there's going to be more autoimmune or not like it's very likely no and possibly yes but you know it at least gives you things to look out for you start seeing tired behavior you know, dry skin hair falling out you think thyroid right you know like crazy weight gain loss all the sudden lack of energy etc like ooh, they drink a lot maybe I should be looking for type one least you know to look now,

Jennifer Smith, CDE 14:46
right and even you know in in kids from a standpoint of celiac being another one that kind of is within that realm of autoimmune and kind of links in with type one kiddos who haven't been been tested, they may be underweight, they may not gain, they may complain of tummy, like my tummy bothers me. Or, you know, kids are not very descriptive in terms of their body stuff. They just tell you something hurts and it doesn't really mean very much unless they keep complaining about it. So those are things when there is autoimmune in the family that you know, oh, and or you have type one, because celiac often pairs with that. It could be something you look at.

Scott Benner 15:27
So Brenda said, how often? Should we wait to give insulin after my daughter? Right? I'm thinking she means how long? But are you saying Brenda? You have to? Are you saying that you gave insulin and now there's another meal or a higher blood sugar? And how long do you wait? Are you trying to ask about stalking? You might have to clear that up for us. I'm gonna go to the next one. While she figures that out. Okay. Oh, she said long. I got her. Okay, how long? Okay,

Jennifer Smith, CDE 15:54
so how long should you wait really, to give insulin after your child eats or anybody really, regardless of age, quite honestly, here. I mean, we have to remember the action time of our current day, rapid insulin, the more rapid like fiasco or loom JEV have a faster onset for most people and a half a faster finish. But in general, rapid insulin still has a timeline of action, as you have talked heavily about even discussed heavily. Right. So how often should you give it? Or when should you start to give extra? It really does, you know, look like evaluating? Did you count pretty precisely? Is it a pretty well known meal? Should the rise that you're seeing not really be happening? And if it is, the question would be, well, goodness, you could probably give a little extra insulin. But again, that now Bolus of extra still has its timeline to get moving. Right. So yeah, you know, I think in this it's like I give and I give in now. Okay, I've given how long do I wait to see if this is going to turn around? And that's the waiting is the hardest thing I think insulin use,

Scott Benner 17:07
I always think that the the part that you can never know, right is did I do it? Right? The first time. If I did, and it's going up, then I need insulin. And if I didn't, then the timings off and this insulin is going to catch back up all the sudden, I don't want to put more in there. I would say Brenda more than anything is as unsatisfying as an answer is this may be is that with? With experience comes knowledge. And eventually you'll just do it. You'll just be like, well, I know what to do. Right. So good luck. And

Jennifer Smith, CDE 17:34
that's why I brought in the idea of Is it a pretty typical meal? Yeah. Is this usually what you would see happen? And if it's not, my mind, personally always starts to say, Well, is it like close to the last day of my pump sight?

Scott Benner 17:50
Right like is this is the is the pump old is you know, that kind of see Brenda's newly diagnosed. Brenda, listen, I'm gonna tell you something else to listen to the bowl beginning series if you haven't. And if you have move on to the Pro Tip series, and I'll put code I'll actually right now I can give you in the top corner. There's the bold beginnings link if you haven't listened to it. Michelle 14 year old diabetic daughter irregular menstrual cycle using loop and g7, sudden insulin sensitivity and then resistance through the month. For example, we'll have a great day then dinner Bolus tanks, her and that's the start of two to seven days of needing to half dose food. Oh, yeah. I would also listen to the Pro Tip series there. And we have a lovely episode on on on hormonal stuff. But we do I mean, listen, Jenny, it feels inappropriate for me to go first. But my daughter has what I think of as three different implications throughout a month. She has an amount of insulin she needs about the five days before her period begins the amount during the beginning of the period and then at the tail end of it and afterwards, they all are different now loop will do a pretty good job with it. And I'm getting a little lazy now because I EPS is making adjustments for me as I go with the dynamic settings. But how do you talk to people about this in practice? Yeah, in

Jennifer Smith, CDE 19:15
practice, I guess I give the general idea of what a typical cycle should be. And I also clear up the fact that your cycle is not just the bleed period, it's not just the men's right? Women have females have a, let's call it a 30 day cycle of hormones. And so what you're describing here is the very normal thing that should be happening in a female body. Essentially, we call day one the first day of bleeding, right the first day of the cycle period. And that oftentimes will be your most sensitive from about day. One or two. Maybe it starts 24 hours into the period starting this in crease insensitivity, and that can often last for usually about 10 to 14 ish days, where a next cycle or a next cycle of hormones comes into the picture around ovulation. Ovulation happens when we're not on any type of birth control, you know, not menopause or anything like that. So we've got ovulation around ovulation, it could be another cycle of resistance, it could be heavier than as you describe Scott, the days before your daughter has her period, that's a time of some intense resistance as the body's hormone levels rise to either support the growing uterine lining If pregnancy is occurring, or a plumping up, and then the period starts, and it sort of discards all of that, and then the hormone levels fall down. So that's why you have this rise, fall in resistance versus sensitivity. So you're not you're not crazy in what you're seeing with your daughter, this is supposed to be happening. And it's really important that you also discuss that with her, this is normal, we're going to adjust this way. So you might have with loop and I don't know what version of loop you have, some of the versions allow you to have multiple profiles set to choose from, and then for loop to interact with. And some of the versions of loop do not where if you just have that one main profile, you may have to make adjustments to it by 1020 30% more insulin. So that loop then can work to its advantage for you by adjusting off of high the higher needs or the lower needs. No loop also has those overrides that you can use a percent adjustment up and a percent adjustment down. But what you're seeing is normal.

Scott Benner 21:41
That's all I did was the overrides with loop. Yeah, we just go percentage higher, and then you know, it was uncomfortable, because you have to save your donor like let me know as soon as your period starts, because we got to like knock this off. And then it can really tell away at the end. And then yeah, it's even strange to call it normal because I think the whole thing is normal. Obviously. It's just, it's just sucks. But like, then the normal like couple of weeks comes at the end. I'll say again, try the Pro Tip series. There's some great conversations in there about menstruation. Actually, I just put information up in the corner because a lot of people are asking about screening. So there's a link up in the corner here about how to get screened for type one for the rest of your family. So that's the answer to this question here. Kobe. Oh, Kobe wants to say something nice, Colby. Thank you very much. I appreciate Oh, yeah. Yeah.

Jennifer Smith, CDE 22:28
Thank you very much.

Scott Benner 22:29
We feel good about that. Don't worry. Let's say hi to you, Jennifer. And thanks. She's 10 months old. He'll do the antibody testing when he's old enough. Okay, that's Emily from a little while ago. Here's a question from the private group. Good morning. Which of the clinical trials would you want your daughter to sign up for? If given the opportunity? Oh, that's for me. That's just like Jenny doesn't have a daughter?

Jennifer Smith, CDE 22:50
No girls.

Scott Benner 22:52
Well, I'll tell you what. More recently I'd signed her up for that GLP study in Austin, Texas that Dr. Blevins talked about? On the podcast. That would be one. You know, if she was really, really early diagnosed, maybe I would look at two Ms. apoB. Right. I know I'm not pronouncing that correctly. That's one that I would I would think about tz old is that what it's called? Now it's easier. If you're really newly diagnosed, I'd look at tz old. But especially for a doctor. The impacts that I've seen a GLP medication have on Arden's insulin needs are significant. And if you're listening to the podcast, I think you can tell that I'm pretty high on the idea of it's going to help people. I would probably do that when Austin Texas, Dr. Blevins, there's a link in the private Facebook group somewhere for it. That's one I haven't looked at, but I think it'd be in Austin. Other than that, which ones are you excited by Johnny?

Jennifer Smith, CDE 23:44
You know, I mean, there are so many all over the place. Again, depending on where you are in diagnosis. That's really how you would search out studies that may be appropriate both age and where you lie in diagnosis or post diagnosis. Many of the studies that are being done are in the newly diagnosed, I find the studies easiest to find for those who've been diagnosed in the past like six months, okay. There are a lot of studies for siblings of children who have type one as well, especially if they are antibody positive, but yet to you know, reach that stage three, sort of of symptomatic type one really being there. I would usually look also at Jazlyn does a fair amount of studies that Barbara Davis Center out of Denver, Colorado does a lot of different types of studies, both in children as well as in adults. There's the diabetes Center, which is in Rochester, Minnesota, they have a lot of studies that come out of there, like the beta cells sort of testing. I know there's a study there are several studies that are I can't remember exactly where in Florida they do it, but they've got a number of the studies coming out from like transplants. Another

Scott Benner 24:56
way to keep up with that for everybody listening is if you go to my Link T one D exchange.org/jukebox. and complete the survey, you will get emails from them when they have stuff coming up. And that's a nice way to hear about things. The next question is, how high is it? What's the reason why my sugar goes up? Right? When I change my sites? Oh, that's an easy one, and still goes up within like 20 minutes, I will see it come down. But before then give myself and some tea Simon exon I think we

Jennifer Smith, CDE 25:24
talked about it in this in one of the episodes. Yeah.

Scott Benner 25:27
But Nellie, I think I recognize her thing, I think she's, she might be a little new to diabetes. So a couple of reasons that could be first of all, there's kind of a little trauma that happens when you know, when you put the the site in takes a little while for it to get going. Sometimes it has to soak in right, you have to get some insulin in there to get it going. You also could be nervous while it's happening and not realize it and be getting a bump in your blood sugar from adrenaline. What else Jenny?

Jennifer Smith, CDE 25:55
Well, the resistance that comes with creating the trauma under the skin, I think the best, the best way for people to see like the light bulb often goes on. If you were a G six user, and you had that two hour startup window, the real reason that that's there is because the sensor needed to get wet, or a lot of people call it marinating right, they even do it longer insertion time, but it really decreases then the inflammation at that trauma site, which allows both insulin to start getting absorbed the way that we would expect it to. The another reason though, often and this is regardless of the type of insulin pump that you use, or the type of infusion set, it really has to do with when you start up a new site, most people remove the old site, because that's what you're taught to do. And what often happens, especially if you're one to change it right after a meal. Often what happens is you pull that old site and it's wet. What that is, is leakage from the old site, the insulin that was under that area has not yet completely absorbed. And so not only are you starting a new site that's now a little bit inflamed and not quite absorbing the way you hope it will. But now you're losing insulin from the other site. And so you're creating a deficit

Scott Benner 27:11
all those possible implications. So I think about simple ways to fix it is you can kind of flood the new site with a Bolus, when you first put it on, you can give a Bolus for the rise, you know is going to happen from the old pump before you take it off. If that site still working well leave the old site on for a while after you've Bolus to make sure all the absorption happens. But I don't think people would realize about the just like you saying, like, you know, you're you're causing a small wound, the body floods the area with like white blood cells and inflammation, everything and it's just not a great host for the insulin right away. Right.

Jennifer Smith, CDE 27:45
Yeah. I mean, I usually go about it. I mean, again, years ago, myself, even before using the pump that I use my old tube pump, I found that pretty quickly after I started pumping that the old site had to be left in, I just disconnected from it, left it hanging out there. And then I to kind of start saturating that new site with insulin, I gave a little Bolus with the new site to really encourage that site to start doing something. Yeah,

Scott Benner 28:15
you guys are interested in hiring Jenny, you can click on that link in the top corner there and send her an email. Thank you. Of course. Thank you. What are you kidding? Strategies? Dakota says for bolusing for stress, is there even a way sometimes my blood sugar rockets when I get to work? Not always just sometimes? Well,

Jennifer Smith, CDE 28:32
that's what I would. This is not only for adults, but also for kiddos. There's a very big difference seen between heading to school, or I call it like foot in the door at school. So this might be foot in the door at work kind of thing. It may also be depending on the type of job, Dakota, it looks like, has it really is it a job where some days, you have a lot of meetings to get to you have to host something, you've got a project that's due that you've got to present versus other days, you just move into the office and you get rolling with the things that you need to do. But there's not really an adrenaline type of interaction. So you may want to look at what your work schedule looks like. Pay attention to what your blood sugar does. And you can make some associations in the moment. You can address it. Yeah, but if you want some historical to it to be able to say when and if you will need extra insulin. That's the best way to do it.

Scott Benner 29:27
I can just tell you that like used to drive art into high school. And I'd look at her graph on the way out the door and if it was going up, we'd get in the car and I'd say just Bolus and she'd like throw a unit in just to go to school. And then she had very aggressive Basal rates throughout the day at school that we had to kill. I could never stop them long enough. They were so aggressive during the day to keep her stable like there was not a big there was not an early enough time to stop them. So I knew that when she left from school, there was a snack that had to happen in like 20 minutes because as soon as She left school and all that adrenaline or nervousness or whatever left her blood sugar started to come down really quickly. Right? Yeah, it was really interesting, actually.

Jennifer Smith, CDE 30:06
Yeah, there are a lot of kiddos that I get a chance to work with who the afternoon after having things ramped up during the day are much more aggressive, like Bolus strategy, usually with the school day ending around three or 330. By about 130. We've started pouring things down because otherwise there was such a considerable drop that many kids could have an uncovered snack in the afternoon, because of just that joy of I'm done with school. Yeah, it's

Scott Benner 30:34
really crazy. I often used to eat for free in the afternoon for sure. Yes. Hey, Jonathan, how are you? Due to love Dr. Blevins saying diabeetus Yes, he is. He is a Texan for sure. There'll be a new episode with Dr. Bill Evans in two weeks, but next week, you're going to get Jim who is 58 got type one when he was 50. Antibodies whole thing he's got type one full blown. You know, using insulin, everything started Manjaro. No, Jenny, and is off insulin completely right now. has been for like a year and a half. Crazy story. We don't miss that one next week with Jim. He won't say diabeetus though. I'm sorry.

Jennifer Smith, CDE 31:08
I know. That was I actually I listened to that episode. And as soon as he said it, I was like, Oh my god.

Scott Benner 31:15
How knowledgeable is he though? He can tell he's off the top of his head just talking about those GRPs. Man.

Jennifer Smith, CDE 31:20
That was why I didn't stop listening after he said diabeetus. Yeah.

Scott Benner 31:27
It's like a cringe. I found him on YouTube. Doing a talking head on YouTube about GLP. And I was like, This guy knows what he's talking about. Yeah, that's awesome. Jonathan said question for Jenny. Have you heard of type one idiopathic type one? Type one B idiopathic type one. Do you know it?

Jennifer Smith, CDE 31:42
Yeah, I not. I mean, off the top. I do I know it by name. I do know it by name. There are so many of these different classifications of type one that isn't specifically what we call just type one. Right? It is a remember correctly. It's a Modi. It's one of the Bodie types of type one. But again, there are type one C, I think there's type one D, I think that it skips a bunch of letters. And there are a whole bunch.

Scott Benner 32:11
We did an episode once where we went through all them. It was mind numbing. It did

Jennifer Smith, CDE 32:16
I can't remember which episode it was. But I do remember doing it. And I think there were a couple that you brought up that I hadn't even

Scott Benner 32:23
well here. I went to our chat GPT Overlord, it said, idiopathic type one diabetes, also known as type one. diabetes is a form of type one diabetes, where the cause of insulin deficiency is not related to auto immune response. Unlike more common, here's some key points about it. insulin deficiency, non auto immune heterogeneous group, this group can include various other causes of insulin deficiency, including genetic factors and other pancreatic issues. It's far less common than type one a. That's what Chad GPT and Jenny knows about it. Jonathan? Hey, tell me why you ask that, Jonathan? Yeah,

Jennifer Smith, CDE 32:55
that would be interesting. I mean, again, I would expect it's something to do with knowing you have this, which means that you had a really good doctor to actually catch that there was a difference. Yeah. Right. And or the question being, well, are there new therapies? Are there there ways to navigate this? And I wonder also, if maybe Jonathan was misdiagnosed initially as a type two, given that there wasn't an autoimmune, notable component. And with further testing, maybe, you know, I

Scott Benner 33:27
get lots of questions here. Karen says my daughter tried recibo, she needed more Bolus s as expected, while she changed the longer transceiver profile. However, by day three, she was in the hospital of high ketones and told the change back to her old long lasting insulin and the only thing I can think of is there just wasn't enough, or you talk because that shouldn't that doesn't make any sense to see the use correctly shouldn't end up with like ketones, it

Jennifer Smith, CDE 33:53
should definitely not. And I'm wondering, again, lots of questions for things that come up like this is it that they adjusted the Basal dose back from what the original base Basal was, and thus, we just needed to go to the real amount of Basal insulin that you had been using? Or, I mean, again, in really rare cases, there are some people who just react very differently to one brand or type of insulin versus another. So again, it could certainly be that your

Scott Benner 34:24
initial concern though, is where my brain left to like Did they get really conservative on or when they switched and maybe maybe her daughter like I'm guessing her maybe her daughter started at one level you know, has increased over time and then maybe they were took it back to be safe and then didn't give her enough? I mean, I don't see why Tracy but would cause that and it is a really good Basal insulin. Yeah, is

Jennifer Smith, CDE 34:48
very good. In fact, the majority of the older school people with type one who use Lantis usually I highly recommend that they switch to the

Scott Benner 34:58
same amount as love them. err. Oh, that sounds like she used more

Jennifer Smith, CDE 35:04
Bolus to that is really interesting. See,

Scott Benner 35:07
though, like, Do you really think that you would expect to need more Bolus if you went one to one change from level miniature? Siba? No, that just I feel like it means she needed more basil with a Joseba.

Jennifer Smith, CDE 35:19
Yeah, yeah. And again, it depends. I mean, all questions, right, that you ask is this daughter going through a menstrual cycle at the time of the change is there but she's,

Scott Benner 35:34
I'm sorry, she's not day three, day three, just a time where I want to say nothing you hear on that Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Don't listen to us. Okay. Let's move on to Stephen by doctors saying I need to reduce my insulin usage to aid losing weight. But I'm not sure how to do that without letting my numbers run high. And by the way, Jenny, before you say anything, I think Stephen has tried to GLP and it hasn't dropped well with him if I'm not mistaken. Oh,

Jennifer Smith, CDE 36:03
okay. Yeah, that would have been my potential option would be a GLP. One. Again, not knowing any lifestyle things here, it could also be that in order to reduce insulin abroad, look at lifestyle inclusive of intake of food, are you meeting your need, it sounds like you know, you're wanting to lose weight. So oftentimes, if weight is higher than what the body should normally support, then you are going to be a little bit resistant, potentially. So adding in again, some activity and doesn't mean going to the gym or buying a member just take a walk every day. I mean, if you if you again, aren't doing any of these things, and then as I said, already taking a hard look at overall intake comparative to your output of movement and whatnot during the daytime, because they think, and I've said this so many times before that we become really carb centric with diabetes, especially type one diabetes. Yeah. In terms of insulin use, that we ended up covering, covering, but the other parts proteins and fats, they play a really big role in caloric intake. And if they're not being contained, either.

Scott Benner 37:20
Yeah, I find sometimes and I don't know that this is the even situation. But I find sometimes with people with type one, they get so focused on like, can I Bolus for this and they figured out how to do it. They stopped thinking about the food like calories, and it's just like a thing they conquered. They were like I eat a thing. And I didn't I didn't have a bolt like a blip. And I don't think that that's his situation. But I mean, I also might say if you can't handle the GLP, Metformin might help to some degree now. Yeah,

Jennifer Smith, CDE 37:47
it looks like he actually he said his doctors suggesting a medical procedure. He doesn't want to do that. Try GLP. One works out almost every single day of the week and eats less than 30 grams of carbs a day. So that's crazy. Again, Metformin, it could be an option. Absolutely. The Extended release is usually the best tolerated. starting dose is probably not going to show much. But once you get to the upper levels, usually around 2000 milligrams of Day of metformin is more the therapeutic amount.

Scott Benner 38:17
Also, Steven, I wonder if you couldn't find a doctor who would be willing to like dabble in micro dosing GLP is with you. Because right now they're stuck with that dosing strategy. Right? They put you on ozempic They move you move you move, you put you to two and leave you there like, I mean, right? could point to five just make a difference for him. You know what I mean?

Jennifer Smith, CDE 38:36
I don't know if he wondered GLP. One, there are many GLP ones. I don't know which one you've tried. The older generation provided a little bit in terms of weight loss, but really nothing compared to the new generation GLP ones?

Scott Benner 38:50
I don't know if he tried Manjaro know, or just I'm not sure but I do remember seeing online and talking about that it was not jiving well for him.

Jennifer Smith, CDE 38:57
Yeah, I mean, the other you know, in terms of again, the disclaimer of don't take any of this as medical advice but as could be very beneficial. I mean, there are some supplementals such as Berberine that are very beneficial in terms of insulin sensitivity that could help you especially more at mealtimes, which is when it's recommended to take allow cottage at least in Bolus doses of insulin depending on what your you know, sensitivity or body acceptance is to to using that and that could be an option. Also

Scott Benner 39:30
I've seen people use digestive enzymes, magnesium oxide stuff to help things move so that they don't feel backed up on the GLP this one here I'm interested in looping but I couldn't figure it out of watch tutorials and podcast but could not loop T one D PAL is a company that will set it up for you. Yep, Jenner you guys don't deal with all right.

Jennifer Smith, CDE 39:52
We do not we do not we absolutely 100% support all loopers in fact any of the do it yourself types of automated delivery systems we 100% support, we will not build it for you. If there are one of our educators, Catherine, she's very helpful in terms of there are during your build some questions and issues and whatnot that come up. Um, she's very helpful in terms of helping direct you to the right adjustment or to clear an error in the app. No, yeah, but we will not make the app, I do know that there is I can't remember the doctor's name out in California, you have to be part of his practice, obviously, but you will build it. And then does does it usually through something called testflight, which just download the app right onto your phone for you. So that is an option, I will tell you that to one pal. They do a wonderful job. But it is a monthly cost. So just be aware that this is don't want in one and done they build it and then you're on your merry way. It's a monthly upkeep. So when there are upgrades to loop, they do that for you behind the scenes, you don't have to really keep up with any of that I

Scott Benner 40:58
might say my moreover just go to the loop and learn Facebook group and ask if somebody will help you build it I'm sure somebody would and there's Mike is in our group, he would probably help you there's there's definitely people who would help you get it built. And then you know, there's nothing really to maintain after that after

Jennifer Smith, CDE 41:13
in the loop group. I've seen people who have done weekend we're gonna get together at the library together to do the build all together. So you may want to outreach to your community to

Scott Benner 41:25
Sarah saying if you guys if you were going to take a couple of units of glucagon to address a low is there a general guideline for adults, I think I've seen one unit for a year for kids.

Jennifer Smith, CDE 41:35
Actually, that's it's great. You already know the guideline for kiddos. If you can treat a low yourself with the old school glucagon kit, the red kit. The other kit that can be micro dosed is what you're really talking about here micro dosing of glucagon is G voc makes, not their usual one shot done. But they also make the hypo kit. The hypo kit comes with a pick a room temperature stable pre mixed vial of glucagon. And it comes with a syringe that's empty. In general, you would usually use that syringe to draw it up and dose in an emergent situation. If you're micro dosing that though, you would use an insulin syringe, and you would draw up out of that vial. And in order to do it, for adults, it's usually one unit per year of age under the age of 15. And then it's 15 units, or, you know, 30, if you read dosing it that 15 would be the usual sort of micro dose of glucagon to see if you and treat a low that you can address yourself before getting lower. And then you evaluate to make sure blood sugar comes up, stabilizes up and then technically you shouldn't have to read DOS,

Scott Benner 42:51
I believe I've signed a contract that says I can't talk about that. So I'm moving on to the next one. Okay.

Jennifer Smith, CDE 42:58
Well, I talked about it. I

Scott Benner 43:00
have nothing to do with you know, he loves the group we love, you know, a thank you very much. Any news about g7 and Omnipod? Five, there's an LMR. And I saw something on their Facebook recently where they were looking for more people. But that's all I know about. And that's just, I don't know, nobody tells me anything. Just in case you're wondering. I told me

Jennifer Smith, CDE 43:20
last night I have you know more about that than I sometimes

Scott Benner 43:23
I know stuff for a couple of days before they happen, but not, not for weeks or months. And also, I think if they knew they would tell us for certain so I'm not sure why it's taken the time it is to be perfectly honest. Susie says do you think GLP is used reduce insulin needs are feasible for a slim underweight kid. So I think if the person has a real need, like a real like insulin resistance, like you have, like, you know, your carb ratios one to two or something like that, there probably is a place where in the future, they'll find smaller doses to help people but there's no doubt in my mind, you will not be as hungry, it will be more difficult to eat. And if you're underweight or low weight, it could end up being an issue for sure. Right? Yeah, because it

Jennifer Smith, CDE 44:06
really does impact appetite. That's one of the biggest things that I hear from people one to a positive when they're noticing the definite difference in appetite, sometimes to the detriment right, where a person really just has to remind themselves to eat and that's not the goal of this medication at all.

Scott Benner 44:26
It listen, I'm on the GLP I have to remind myself eat somedays like there's no doubt I could go forever without eating and never notice it. But moreover, like, you know, as we were getting hard on it, there were times where we just had to take what we could get. And at one point, she lost, I think more weight than we meant, like she lost a healthy amount of weight. But then she probably lost I would say another seven or eight pounds more than she should have. We thought we adjusted her dose and she's putting that weight back on now. Yeah,

Jennifer Smith, CDE 44:55
I think this is a really interesting question too, because it's the The effect of thinking that with a child that doesn't have a weight issue, it sounds like in fact is more slim to being a little bit slimmer than desired. And the want to reduce insulin

Scott Benner 45:14
Yeah, I wouldn't take a GLP just to use less insulin, need to have like a real insulin resistance issue PCOS symptoms, weight gain, that's just doesn't make sense based on your situation, and

Jennifer Smith, CDE 45:26
are really heavy users of insulin that suggest we have to change the pump site every single day because the reservoir is empty. Absolutely, then, but that often doesn't, most often, in fact, doesn't go along with a kid or an adult who is already fighting to gain or maintain weight. Yeah,

Scott Benner 45:44
yeah, I agree. I don't I don't think that GLP is just going to be a thing that every type one gets one day, I think it's going to be very specific uses. Let's see. Next question. Michelle said so hard to Bolus for anxiety? Are Ms. 10. As she gets there calms down? And then she drops? Yeah, that's trust me. There's conversations all over the podcast about when Arden would sometimes shoot up for sports events, and not always, and we'd end up bolusing for it. And then if she didn't get anxious, we gave her juice to cover it. But yeah, it isn't easy, that's for sure.

Jennifer Smith, CDE 46:18
No, it's certainly not. And sometimes, again, depending on what your targets are, what your goals are, and also paying attention to how your child or your teen or yourself how you feel, honestly, with that, sometimes those sporting events are also really long, right? So you may get that spike on the way there. And if you don't Bolus for it, as soon as the movement gets going. A good majority of kiddos it comes down on its own

Scott Benner 46:44
to drop on its own. Yeah. So hey, this isn't really a question. But I just wanted to say good morning to Yolanda. And you know, I hope she has a good day. And we all trust us. All of us hate this. So no one no one's excited about it. Super excited to have diabetes.

Jennifer Smith, CDE 47:00
No. 30, after 36 years, I could I could easily if somebody knocked on my door and said this is it. Yeah, here's what you get. I'd be like, great.

Scott Benner 47:09
Yeah, Jonathan said it took a long time for him to figure out he was type two, he has an episode, if you want to hear it, it's a type two story. Okay, I asked Jenny to see how common that type why this is an old reply to another question. Okay. Let's see, the

Jennifer Smith, CDE 47:23
type one beat. Yeah, it is not as a response. It is not a common but I also think in terms of proper diagnosis, you really have to have the right clinician to be able to say, this is not the typical, you have these sort of, you know, visible things going on, you don't look like a classic type one, you don't look like a classic type two, it takes further testing. And I think that's also why, as I mentioned earlier with that Modi is, I've heard a lot more about it in the past five years. But Modi is also one of those things that it's really poorly tested for general, in general.

Scott Benner 48:05
So what about this hear that Cassandra is saying that receiver needs three days to get going for full coverage? Yes, so

Jennifer Smith, CDE 48:13
this is so for fully effective, meaning there's almost a ramp up to it, getting going at the full effect. You know, this, I would say is about a 5050 in those that I've seen using trustee, but specifically have a couple of little kids who definitely if we are going to adjust their trustee bar, we have to give it about two to three D days to actually see that it's truly making the difference that we would expect before adjusting again, and other people can go like I went from Lantis to tercio. Myself, and I was curious. So I went off my pump for a number of days just to test receba comparative to what I knew about my Lantis years ago, and I had no issues with it whatsoever.

Scott Benner 49:01
About the same so I'm putting this up because if Isabel or Nico or somebody who's looking can give Jennifer a list of the GLP episodes, that would be great. Somebody else says BC diabetes can build loop for you.

Jennifer Smith, CDE 49:14
Correct? That's Canada, though. Yeah. Just FYI.

Scott Benner 49:18
He's got across the border to get it done. Then, if anyone sees remain five, eight for the last year on Omnipod, five manual, would you still consider looping or? I mean, there's trade offs. Maybe. But, you know, it sounds like you're doing a great job manually. If you're not if you're sleeping, and you're, you know, not having a bunch of lows then. I don't know. It seems like you're doing a great job.

Jennifer Smith, CDE 49:39
And it sounds like the question here is really if I've got this and lows are not a big piece in the picture, and I'm navigating this with good stability, then I think it's really could I do better. Could I get better?

Scott Benner 49:55
She says she's not sleeping. I turned it on. Absolutely. All right, because Susie if you're all dead, but you've got a great day once. And I'm sure you can find a way to get Omnipod five and get your a one C there, you're just going to need to Bolus not an incredibly aggressive algorithm. But you know, and

Jennifer Smith, CDE 50:15
considering that Omnipod five has been being used in manual thus far, it does have some historic insulin data already.

Scott Benner 50:24
Yeah, your starting setting should be rock solid, that's for sure. And then you're just because I know she has a young son, but he's still going to keep growing. So when you see those, like, if he makes a leap and weight or needs or something, you might have to go back and do a reset to keep up with it once in

Jennifer Smith, CDE 50:40
a while and or the insulin to carbon sensitivity get adjusted. Or if you've got a higher target set, lower the target, or you know, lots of

Scott Benner 50:48
little things. Yeah, Sarah's saying thank you, I don't want to breach my contract, which evoke that's for sure. We're going to start looping after Omnipod. Five, we will need to get our settings dialed in. I'm a bit worried since we were never able to fine tune it in Omnipod. Five. Yeah. Well, were you in on the pod five manual and you were trying to fine tune it? Are you waiting for the algorithm to figure it out? Because those are probably two different things. Crystal, I have to tell you that I have recently taken the three episodes, Jenny and I did the math behind Basal insulin sensitivity and sunder carb ratio. And I've actually turned the math into code and put it on my website. But I haven't had the nerve to put it public yet. It's disclaimer it out the ass so that I'm not really worried about but like you can literally plug in numbers about yourself and get a starting place. But that math is available in those episodes for you to figure out for yourself. You know what I mean? You know what I mean? Jenny, like, I can just put them up online. And people can just say like, literally like, this is how much I weigh. I'm an adult, I'm meter active, etc. It just spits out the information. Yeah, I had Isabel do it. And it like it pegged her settings. Wow. So I wanted to do a smaller test group before I made it public. That's

Jennifer Smith, CDE 52:03
a great idea. I'm quite sure that many people would donate their information.

Scott Benner 52:07
Yes, did to find out. But for the moment, there's the three episodes the math behind and you can definitely figure it out. Oh, Crystal. Okay, send me an email and I'll get medical advice. Oh, no, I I'm an idiot. You should definitely not listen to me. Have we heard anything about the twin health program? What does that help? I don't know what that I don't

Jennifer Smith, CDE 52:27
know what that is either. I'd have to look that up myself.

Scott Benner 52:31
Let's look at this.

Jennifer Smith, CDE 52:32
Whether it is a confined by a state or is it a national?

Scott Benner 52:41
Also, I'm going to be at the touch by type one event in Orlando. There's a link to it right there. It's Free to get tickets. I don't know if somebody else is going to be there or not. I haven't talked to her.

Speaker 1 52:50
Me. Yeah, we'll be there. Oh, oh. I already have topics.

Scott Benner 52:55
Oh, well. You can come see Jenny and I in Orlando. When is that? Do you know? Oh,

Jennifer Smith, CDE 53:01
it's September. Something touched by? Yeah, that link

Scott Benner 53:05
will take you to touch by type one.org. You can go to the programs tab hit annual conference. I'll get the date for you. September 14. Oh, September 14. Okay. Yeah. Are we gonna go out to dinner afterwards? Sure. I you can you're gonna have your family with

Jennifer Smith, CDE 53:20
dinner with my family.

Scott Benner 53:22
Oh, oh, good. I have something to do in the evening. All right. Anyway, touched by type one.org. If you guys want to see it's completely free. It's actually Jenny, I'm not gonna ask you to out anybody. But it's a well put together event No. 100%

Jennifer Smith, CDE 53:35
No. Touch by type one is lovely. I think this is the third thing. Is it third year that I've that I'll be there. But it is a wonderful event. Can

Scott Benner 53:47
you look at the screen?

We're working on that. We'll say let's see so far. We're not sure. working it out. We'd love to see a beta two. All right. So awesome. Can you test it to Cassandra? Sure. Like everybody just email me and I'll let you say it. Yay. Are we out of questions? They can

Jennifer Smith, CDE 54:10
pull it off to me too. I'll test it. You. Brilliant. That's super awesome. Okay, well, yeah, the twin health I, you know, twin health is interesting. They have a the one that's connected to diabetes is it looks like an advanced like, like digital, like whole body evaluation. So but know that I mean, I've heard of other things that evaluate you know, taking like poop samples, and that kind of stuff, right to evaluate, evaluate, what kind of metabolism do you have and what should you eat and what shouldn't you eat? And some even go as far as suggesting the impact on glycemic, you know, excursions and shifts and changes? I don't know if this this looks a little bit more comprehensive. But yeah, there are lots of Different things like this out there.

Scott Benner 55:01
Okay? I don't know, I can tell you that I'm working on my gut health designer poop. And I watched

Jennifer Smith, CDE 55:08
that's actually one of my favorite words is poop. Isn't that appeared? I don't know why.

Scott Benner 55:12
That's a little strange thing. It's

Unknown Speaker 55:14
kind of fun.

Scott Benner 55:15
Did you watch the Netflix documentary about gut health?

Jennifer Smith, CDE 55:18
I don't think so. Is it newer? Okay.

Scott Benner 55:21
It's newer. Yeah. Let me see if I can find it real quick. I found it really interesting. But one of the things they talked about was people. It's called watch. It's called Hack your health, the secrets of your gut. I enjoyed it. Okay. And so, but there's a woman in there, this was the craziest thing you have a second. There is a woman in there who decided she couldn't afford to have like a company give her like a fecal implant basically. So she went to her brother. Let's not get into the details of this and because I don't know exactly how she did it, but she got her brother's poop and put it in capsules, like she took it. Now, her gut health improved, but you gotta go watch this to hear the story. In case I'm getting the wrong

Jennifer Smith, CDE 56:05
science plant is what you're talking? Yes. Okay. She she

Scott Benner 56:08
got hormonal acne that she'd never had before. But her brother struggles with it. So she stopped taking his poop. Her acne went away. And she thought okay, but I want the good gut health. She went to her boyfriend got his puppies, but started to pick up his depression. Oh, is that not crazy? Wow. Like, I don't know if that's right or not. But I was like mesmerized while I was listening. I was like, Is this true? But anyway, I thought it was really crazy. That

Jennifer Smith, CDE 56:36
is very interesting. I will have to I will have to look that up on Netflix.

Scott Benner 56:41
Yeah, Crystal. I'm making an episode about this. And it's not done until I'm done. But I've been working with a gut health guy named Josh deck and we record as we do stuff for ourselves. So it'll come out eventually come out. Like my poop honeypot five adjustment and Basal rates for kids with rapidly adjusting needs illness, etc. The lag with on the pot five is rough. Do you have any thoughts on what you've seen in practice with the looper tandem being better or worse? Etc?

Jennifer Smith, CDE 57:08
Yes, it's a great question. My personal as well as professional in practice, what I have seen is that loop is, for lack of a better word, it's easier, because there are adjustments that can be made more or less aggressive, depending on what you're seeing in terms of sensitivities. The next of the ones mentioned here, tandem does a lovely job as well, tandem is the only company for their T slim or their mobi, that actually allows multiple profiles to be set and enabled for their control IQ to work off of. So for kiddos who have a high growth period, and then it goes back to you know, more stability or lower needs, you can have almost like a high, moderate or low need sort of profile. And you could enable those then for again, the algorithm to work with. And that can be a huge advantage. You're You're right. And I think it's unfortunate because I think Omnipod five is a really lovely product. And it does do a really great job, but it is by far the leg if it accommodated, respond

Scott Benner 58:23
to Quick, Quick Change, it really doesn't. It's just not going to listen to artists using IEPs, which is like dynamically changing almost all of our settings and it still doesn't move that quickly. Like it's and it's moving fast. You don't I mean, like it's not unless you're gonna go in there and have settings set up which Omnipod five doesn't, doesn't have like, you know, different profiles, then, you know, that's the quickest way to change is with different profiles.

Jennifer Smith, CDE 58:49
And IPS is definitely you know, above and beyond in terms of its decisions that it makes in its adaptive nature with with the unannounced meal and the small micro Bolus and depending on what it sees in the rise and the rate of change and all it knows it makes a decision on which of those kind of navigates between it's a fantastic

Scott Benner 59:11
Arden kappa six three at college she was a college by herself for six months, she kept a six three a one C and I don't think she was Pre-Bolus thing that much and I don't know what she was eating half the time she was pulling all nighters not eating, eating going all over the place like it really held up. I thought

Jennifer Smith, CDE 59:30
I have to say hi to him. He says hi to both of us.

Scott Benner 59:35
He's in a great episode of the podcast. It's got to be years old by now but it's nice to say yes. And

Jennifer Smith, CDE 59:40
he just agreed. You're just a great guy. Nice that you said hi.

Scott Benner 59:44
Could you Donny get in like love back? Chinese give them flowers as they say if we were famous. That's what we would say we say Jenny gave Donnie his flowers but we're not famous and we just say hello.

Jennifer Smith, CDE 59:54
I know.

Scott Benner 59:55
It's very nice to say started vitamins recommended with the Hashimotos Episode. I've seen improvements in several ways. Oh, that's great crystal are fantastic. It is great. I'm doing a protocol right now of methylated, vitamin B, and A C, Milk Thistle and something else. And I've noticed I'm losing bloating in my, in my upper stomach. So I'm working on that right now. We'll talk about in the podcast one day.

Unknown Speaker 1:00:20
That's great. So

Scott Benner 1:00:21
let's see profiles tomorrow. Yeah, I mean profile. That's what you just what you need sometimes is more or less. I think we only have Jenny for a couple more minutes. For let's celebrate with Jennifer diagnosing at nine at 11 years old. 35 years going only on a sensor for the last five years. Ray once he is six. She's self taught old school diabetes. Good for you. That's fantastic. Really very cool.

Jennifer Smith, CDE 1:00:49
I'd be curious what kind of glucometer she was started with? Because

Scott Benner 1:00:52
that's right around five years ago.

Jennifer Smith, CDE 1:00:54
Yeah, that's right around the time that

Scott Benner 1:00:55
probably had that guillotine like poker that you had to?

Jennifer Smith, CDE 1:00:59
Yes, it was like the being down. Like, I'd hold the platform slightly above my fingers that it didn't quite kill my finger reached.

Scott Benner 1:01:09
Yeah, Amy, you can feel free to send that email to Omnipod. And tell them what you think. Can you tell us more about the enzymes, I tend to get constipated digestive enzymes. I like pure encapsulations. They make one. But you can find them probably at most health food stores. If you have type one, which I know many people here do. You might see a slowing and your digestion they could help to supplement it your meals. And do you have anybody say

Jennifer Smith, CDE 1:01:37
No, I was just gonna say for that one. Also hydration. It's really, really important does hydration and oftentimes even hydration. You think about that being just water. And you can over hydrate with just water. And that can create enough issues too. So hydration with some baseline electrolytes can be very beneficial.

Scott Benner 1:01:57
Yeah. Also, as your I'll tell you what, four or 800 milligrams of magnesium oxide a day and you will take it.

Jennifer Smith, CDE 1:02:03
Go Yeah, and use it at bedtime. Work on your gut all night. Yeah,

Scott Benner 1:02:07
God, do you want to poop do that? Start with 400. But after like two or three days, if you're not going go to 808 will happen. Do you have any clients Jenny with gastroparesis? That's using a GLP?

Jennifer Smith, CDE 1:02:18
I do not personally know. I mean, I could check with the other clinicians in our office and see if they do but I have not in all the years that GLP ones have been out. I've not had anybody use it.

Scott Benner 1:02:31
I'm interested to see how it goes. Because Are there going to be a whole generation of type ones that this is not available for because they actually have clinical gastroparesis. They have nerve damage that slows their digestion, or are we going to start learning more about people just having gut health issues with type one? Right? And you know, they don't have actual nerve damage. They just digest their food slowly. Right? Exactly. Interesting. Jenny, you have to go. I imagine. I have three minutes, three minutes. Okay. You guys have three minutes to ask any question. There's a link up here now to the diabetes Pro Tip series. But you can get all this at juicebox podcast.com. Of course, nothing we said here today was advice, medical or otherwise. And you can email Jenny at work if you'd like to work with her with that link that's right up there. This is the first time we've done this. But we held we got up to 70 people at one point we held 50 people real consistently. So I thought this was a great success. Fabulous. Yeah, super exciting to talk to people like this, especially on a Friday and launch into the weekend. Knows Jenny if this is going to be a thing we do every day as well. Yep. Okay, everybody will take care. I'm going to hang out for a couple minutes. But Jenny's gonna go back to work. Are you literally going to jump into a call and help somebody? I'm jumping into a call. Yes. What kind of plant is in your window?

Jennifer Smith, CDE 1:03:49
It is a Christmas cactus.

Scott Benner 1:03:52
Oh, does it flower often? Well,

Jennifer Smith, CDE 1:03:54
that's the interesting thing. So it flowered around Christmas time, which was lovely because it doesn't always and then in April, it got all these blooms again. And it is in the blooms on a Christmas cactus last for quite a while. And it just started losing. You can see some of the dead ones on it. But it just started losing those blooms like recently. So yeah, Christmas cactus. It's a lovely plant. I

Scott Benner 1:04:19
have a giant one. I can never make flowers come out of it. When the flowers come out. I don't know what I did to make it happen. So you have to sometimes

Jennifer Smith, CDE 1:04:25
you have to kind of shock it. It's almost like bulbs that you take out of the ground. And then you put them in a dark place. And then when it starts getting warm and the ground on freezes, you plant them and that sort of kind of sparks them. So Christmas cactus. I did not do this. So it just was random. But my basement is also which is where my office is it's also colder than the rest of the house. So I think when I brought it down here I moved office spaces. I think the cold kind of shocked it.

Scott Benner 1:04:56
Okay, so anyway, there you go. Wow, the thank yous Jenny, hear from everybody.

Jennifer Smith, CDE 1:05:01
This is really wonderful. I like the live option to do this.

Scott Benner 1:05:05
Michelle stayed up in Australia to talk to us. It's 1am there. Oh, that lovely. And I think Isabel makes a good point. There are maybe 30 episodes of Ask Scott and Jenny where you can hear us pontificating ad nauseam about your questions. So, alright, Jenny, thanks so much. I'll talk to you. Yeah.

Jennifer Smith, CDE 1:05:24
Thank you. Bye, bye.

Scott Benner 1:05:24
All right, guys. That was it. Should we do this again? I literally threw this on Jenny. Like yesterday afternoon. I was like, would you do something tomorrow at 10 o'clock with me? And she was like, Yeah, sure. We maybe we'll do this again. I mean, there's a lot of people here it was great to see everyone want to thank you all, for your support, remind you seriously, you subscribe to the podcast. If you don't, it helps the show immensely. And Apple podcasts or Spotify or wherever you get your audio etc. Please, if you're in the private Facebook group, follow the public page. Because this thing you see here with the chat, it really only works through the public page, this software, it's not the software's fault. Facebook blocked the software from getting into the private groups. So if you want to be part of that, this is a great place to do that. If you love the podcasts, leave a five star review wherever you listen, five stars and a great review that will help somebody else be interested in the show. Please, if you're an apple podcast, don't forget to turn on your automatic downloads and your settings so you don't miss an episode. And so that I get downloads, because downloads is what the advertisers care about. And if you want Jenny and I popping up like this, the middle of our day, Scotty gotta make money somewhere. So keep pumping out those episodes, please. Very, very helpful Spotify as well. If you care. People are saying goodbye. I'd like to say goodbye. And we thought it was awesome. That was great. Appreciate that. I think we'll do it again. Hopefully I saw a number of you clicked on Jenny's link. So Jenny will not that she did this for business. But you know a couple of you check her out. I'm sure she'll definitely come back. Great weekend. Oh, thank you. Oh, my God, please. I'm not camera ready. We will definitely try to do it again. Calvin has gotten a chance for an annual subscribers to have all the episodes uncensored, Calvin, I am working on it slowly. It is very expensive. Every time I uncensor an episode, it costs a significant amount of money through the bank. So I'm trying at least going forward. We're we're trying to do it. But it's another problem. Like even producing two different two different files increases my costs by like twice as much. So I'm trying to build up enough money where I can use that money to pay for that. Okay, all right, you guys are still chatting with each other. Thank you everybody for coming. I'll see you later. I'm going to try to make this when I end the stream. I'm going to try to save it and make it available but it should be floating around in Facebook for you for quite some time. Take care have a great weekend.

type one diabetes can happen at any age. Are you at risk, screen it like you mean it because if just one person in your family has type one, you're up to 15 times more likely to get it to screen it like you mean it. One blood test can help you spot it early. And the more you know, the more you can do. So don't wait. Talk to your doctor about screening. Tap now, or visit screen for type one.com To get more info and screen it like you mean it. Arden started using a contour meter because of its accuracy. But she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter. There's already so many decisions. Let me take this one off your plate. Contour next one.com/juicebox I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever sent cgm.com/juicebox to learn more about this terrific device. You can head over now and just absorb everything that the website has to offer. And that way you'll know if ever sense feels right for you. Ever since cgm.com/juice box, you have questions Scott and Jenny have answers. There are now 19 ask Scott and Jenny episodes. That's where Jenny Smith and I answer questions from the audience. If you'd like to see a list of them, go to juicebox podcast.com up into the menu and click on Ask Scott and Jenny. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording runway recording.com

#1267 I Only Cry on Mondays

Ally is 33 and the mother of a small child with T1D. She has an incredibly handsome husband.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:11
Today I've got ally for you. She is the mother of a small child with type one. She also has another child, and she was pregnant with her third when we recorded this, her son was diagnosed right before his second birthday. Ali felt like she gets so much out of the Facebook group in the podcast that she wanted to add her voice, so someone else might be helped. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one, and you're a US resident, please go to T one D exchange.org/juicebox. complete the survey. That's it. You'll be helping people with type one diabetes, you'll be helping yourself and you'll be helping me t one D exchange.org/juicebox. Go complete the survey takes about 10 minutes. My cozy Earth offer code goes back to 40% off in August. Go to cozy earth.com use the offer code juice box at checkout after August 1 to save 40% off of your entire order. Let's keep it 40% cozier What do you say? Today's episode of The Juicebox Podcast is sponsored by Omni pod and the Omni pod five. Learn more and get started today at Omni pod.com/juice box. This episode of The Juicebox Podcast is sponsored by Dexcom dexcom.com/juice. Box get the brand new Dexcom G seven with my link and get started today. This episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed. Ever since cgm.com/juice box.

Ally 2:10
My name is Ali and I am the mom of two kids. One of them is a three and a half year old with type one diabetes. And I'm actually pregnant with my third or so are very busy and yeah,

Scott Benner 2:25
Bolus is three and a half. Yes. You're like one of those people that gets a kitten and then keeps buying more kittens. What's the next one?

Ally 2:33
Funny story that was like kind of part of our diagnosis story. But she is eight months old now. Eight months and so yeah, this third one is definitely a surprise.

Scott Benner 2:43
Are you how pregnant are you?

Ally 2:46
I am eight weeks right? Or no? Nine weeks. Oh, really? Yeah.

Scott Benner 2:52
Those are called Irish twins. Are they not?

Ally 2:54
Yeah, they are.

Scott Benner 2:56
Are you Catholic?

Ally 2:57
I grew up Catholic actually. But no, not anymore.

Scott Benner 3:00
You know why they call them Irish twins, right? Yeah. I want to hear you say it but it's okay. Don't worry about it. My

Ally 3:07
husband and I was like we are having Irish twins did not ever think this was gonna be part of our plan. But here we are.

Scott Benner 3:14
Congratulations, or I'm sorry. I don't know where you fall on this. Thank you. Can you afford three children? Yeah, we're

Ally 3:22
gonna have to.

Scott Benner 3:23
That's not an answer to that question. Wow,

Ally 3:28
definitely a big shock.

Scott Benner 3:30
How old are you?

Ally 3:31
I am 33.

Scott Benner 3:32
Okay. Oh, I see what's so you're you're trying to get them in? Where was it your intention to make three babies?

Ally 3:38
We never were like, I guess we were kind of like maybe you know, one day if we have a third grade but we weren't like yes or no either way.

Scott Benner 3:48
Seven months from now, right? Yeah, definitely not.

Ally 3:51
This close together.

Scott Benner 3:52
How old your husband 34 C stable. He isn't leaving you or anything like that. yearns okay. Oh, is that oh yeah. Hard worker comes home late a little bit because he's working because he's at a bar stuff like that. We're all good.

Ally 4:09
We're all good there.

Scott Benner 4:11
Because I mean, I don't I'm doing the rough math here. This is I don't know unless there's major laws enacted I'm looking at $1.3 million to send three kids. So I know Yeah, and feeding them. I mean, what is the cheese gonna be at five gonna be two grand a week for two grand a month for food?

Ally 4:30
Oh my god. Yeah, consider juicer expensive. Yeah, it's all the fruit. It's all the wide. The fruit. Fruit is so much fruit and it's like, it just Yeah, it's expensive. All of its expensive. Especially like, you know, we do like some special foods for my son and then some, you know, just regular foods and yeah, it adds up.

Scott Benner 4:49
What's your favorite fruit?

Ally 4:51
Right now? Like any kind of fruit but I tell you what, my son eats all the fruit. He's the type one he eats fruit and like Got you every meal. When he was diagnosed? It was two weeks, three weeks before his second birthday.

Scott Benner 5:05
Okay for my money around Christmas or New Year's a mandarin, you can't go wrong. Oh, yeah, perfect timing. A few weeks before his second birthday. Yes, I see Arden was a few weeks after her second birthday. This is not a race. I'm just bringing it up. Wow. Any autoimmune in the family at all.

Ally 5:26
The only thing we have discovered is my mother in law has Hashimotos. But other than that, we haven't no type one. And then that's the only autoimmune that we've come across. We've you know, after talking to everyone in our families and stuff, just the Hashimotos Oh, well

Scott Benner 5:42
blame her then that's fine. Celiac. Nobody runs to the potty after they eat got a bipolar uncle somewhere?

Ally 5:50
Not that we know of.

Scott Benner 5:52
Okay. What else? How about psoriasis?

Ally 5:57
I think actually, my brother in law has psoriasis. I want to say

Scott Benner 6:04
that's all on me. Yeah,

Ally 6:05
I do think he does. I guess I'd have to double check that for sure. Thank

Scott Benner 6:08
you pick through this for a couple more minutes. Ali. I'll find six people on your husband's side of the family who have something going on. I guarantee one of them's got a bit a Lago but it's little you can't see it. And I know I'm just I'm like, You ever see that show house? No, I don't think you're young and you're really busy having sex. So you might not have seen it. But the he's just like a diagnosis. Way to diagnose Are you not a die agnostic doctor, but what's the how do you say that diagnose?

Ally 6:42
Yes, I know what you're talking about. Yes. I've seen like commercials for I've never watched it though.

Scott Benner 6:46
Okay, well, you should. I know. I mean, now I'm not telling you what to do. But you should. And I feel like that sometimes listening to the podcast, like because I'm making it I'm like, Oh, I wonder if this is happening like I get very it actually helps me my own life. Do you know I diagnose my brother while he was in the emergency room the other day was something that the hospital couldn't figure out. Oh my gosh, what was it over text messages? Hold on one second. I just need to text my wife something. Because the dog is barking. I'm just gonna say kill. There we go. So my brother goes into the hospital. And he has pain. Right side. You know could be gallbladder space like that spot there. Whatever. He's got type two diabetes say once. He's pretty good. He's on we go V. He goes in first day in a massive amount of pain. I should mention my brothers had gall stones, kidney stones. He knows pain he once had. Oh, I don't think he'd want me to tell people this. Oh, well. He once had a fissure. And he said if you want to know pain, you know, have a hole pop open near your butt. So he's been through pain. He knows real pain. He said this was terrible. This episode of The Juicebox Podcast is sponsored by the only six month were implantable CGM on the market. And it's very unique. So you go into an office, it's I've actually seen an insertion done online like a live one like, well, they recorded the entire videos less than eight minutes long. And they're talking most of the time the insertion took no time at all right? So you go into the office, they insert the sensor, now it's in there and working for six months, you go back six months later, they pop out that one put in another one, so two office visits a year to get really accurate and consistent CGM data that's neither here nor there for what I'm trying to say. So this thing's under your skin, right? And you then wear a transmitter overtop of it. Transmitters got this nice, gentle silicone adhesive that you change daily, so very little chance of having skin irritations. That's a plus. So you put the transmitter on it talks to your phone app tells you your blood sugar, your your alert, show arms, etc. But if you want to be discreet, for some reason, you take the transmitter off, just slip comes right off. No, like, you know, not like peeling at or having to rub off it. He's just kind of pops right off the silicone stuff really cool. You'll say it. And now you're ready for your big day. Whatever that day is. It could be a prom, or a wedding or just a moment when you don't want something hanging on your arm. The Eversense CGM allows you to do that without wasting a sensor because you just take the transmitter off and then when you're ready to use it again, you pop it back on. Maybe you just want to take a shower without rocking a sensor with a bar of soap. Just remove the transmitter and put it back on when you're ready. Ever since cgm.com/juice box, you really should check it out. Today's episode of The Juicebox Podcast is sponsored by Omni pod. And before I tell you about Omni pod, the device I'd like to tell you about Omni pod, the company I approached Omni pod in 2015 and ask them to buy an ad on a podcast that I hadn't even begun to make it because the podcast didn't have any listeners, all I could promise them was that I was going to try to help people living with type one diabetes. And that was enough for Omni pod. They bought their first ad. And I use that money to support myself while I was growing the Juicebox Podcast. You might even say that Omni pod is the firm foundation of the Juicebox Podcast. And it's actually the firm foundation of how my daughter manages her type one diabetes every day. Omni pod.com/juicebox whether you want the Omni pod five, or the Omni pod dash, using my link, lets Omni pod know what a good decision they made in 2015 and continue to make to this day. Omni pod is easy to use, easy to fill, easy to wear. And I know that because my daughter has been wearing one every day since she was four years old. And she will be 20 this year. There is not enough time in an ad for me to tell you everything that I know about Omni pod. But please take a look. Omni pod.com/juice box. I think Omni pod could be a good friend to you. Just like it has been to my daughter and my family. They medicate him for the pain, which you know, is nice. And then they go about doing their scans and they're this is the NATs and then tell him of course there's nothing wrong with you. We can't figure anything out. And they sent him home. Yeah. And the next day, he's back in that emergency room with even worsening pain. So now I'm texting with him. Hold on, I'm going back and forth. I'm asking my questions. It feels like he's on the podcast, but we're texting because I'm like, how about this? What about that, like, you know, that kind of stuff. And I figured out he had a slightly elevated white count the day before that they ignored. So I told him had them rerun the white count. Now the funny thing is, is he's sitting there and they're not doing anything for him. But if he says hey, run my bloodwork, again, to see if my white blood cells went back up, they go, Okay, it's like you're running. It's ridiculous. If he doesn't say anything, they'll medicate him again and treat him. But, you know, he says, you know, do this, please. white blood cell counts up again. Well, but we don't see anything wrong. So I said, I text him back and I said, here's what you do. Grab the nurse, say to the nurse, Hey, would it hurt anything if I got like an IV antibiotic just to address this high white blood cell count? And I said you'll put that in her head. And then she'll go back and mentioned it to the doctor, then he'll think it's his idea and give you the a&e biotics. That is exactly what happened. So now my brother is on the way to something and we start picking through it a little more. I go through some family history and I say to myself, I think he's got diverticulitis. So I say close that you think this could be diverticulitis because your mom's had it and ended up in the hospital in the similar pain floated to the nurse. The nurse goes back disappears for a while. An hour later, the doctor comes in as if on a white horse. And he says, I really think you have diverticulitis and I thought you motherfuckers don't know what you're doing. Medical School stole this man's money. Okay. So should nevertheless they get them all set up. You know, we think you have died. We think you have diverticulitis? No, I think he has diverticulitis. I told him to say it off handedly to the nurse so she could go back and tell him so him and his ego and his she diagnostics diagnosing him what's that word? skills come in and try to save the day. So it's three days later, my brother feels much better now.

Ally 13:30
Well, that's good. Yeah, like send me the bill for that diagnosis,

Scott Benner 13:33
put them on a nice diet for the diverticulitis and by the way while he was there on day one. This pissed me off more than anything. I almost said these motherfuckers and that I said it anyway, so I should have said it. These motherfuckers ally tell him to go off as soon as Empik The only thing keeping is a one c out of the sevens and in the fives. Yeah, cuz we heard it might give you pancreatitis. We heard what would you hear that on Joe Rogan? Could ya can you do your job? You know what I mean? Oh, Ali, look how upset I am. Let's get past that. Okay, so you're a little sweet child is is diagnosed before two years old. Can you walk me through that a bit?

Ally 14:13
Yeah, so it was like three weeks before his second birthday and we had it my husband took a trip to Vegas and I was like well that is part of the story. So I was like when we get back I think I'm going to try to start potty training him he just seemed ready it was a little bit early from just like you know other mom friends that I know and stuff and but I was like he just seems really ready for it. So I started potty training him and as I'm potty training, he is paying like I would started setting a timer and it was every 15 minutes like on the dot like sometimes even before the timer went off he would be had like a little potty setup for him and he would go pee and it was Like, it was a lot every single time and I was like, Wow, I'm never gonna be able to leave the house. This is, this is a lot like how are we ever gonna I can't even be live for more than 15 minutes from anything. So we're not even gonna be able to get out of that the neighborhood.

Scott Benner 15:13
Like where your mind Wait, you're like that will never leave the house again.

Ally 15:18
So I'm like, Okay, well maybe he just doesn't know how to hold it. We live in Texas. It was summer that was June. And we were outside like, I mean, he's a boy. So a lot of his potty training was outside. Like, we're just outside. He has no pants on just pee whenever

Scott Benner 15:33
I tell you something. The enormous amount of men who own their own property and maybe some who don't. I think if you polled them privately would tell you they pee in the backyard of their house. Oh, yeah. I would never do that alley. Except, you know, if I was in my backyard, I had to bake. Yeah.

Ally 15:53
And he still does it. So I was like, well, he's drinking a ton of water. It's Texas. It's June. It's 115 degrees out all the time. So he's probably thirsty and just paying a lot. So I gave it like, almost two weeks. I was texting my aunt, which I don't talk to her often. But she was I had posted something on Instagram. And she had responded and she was like, Oh, you're potty training him. And I texted her. And I was like, when you were potty training my cousin. He's a boy. Did he pee like every 15 minutes. And she immediately called me. And she was like, No, he didn't do that. Are you taking them to the pediatrician? And I was like, I actually had his like, checkups, even actually, it was ironically, like in a couple of days. And she was like, well, you should ask her about diabetes. And I was like, What do you mean, diabetes? He doesn't have diabetes? Like I had. I had no, like, I didn't know anything about diabetes.

Scott Benner 16:47
Where does Dr. House get all this information?

Ally 16:50
She works at a hospital. And yeah, so I think she just just No, no, I,

Scott Benner 16:56
I'm thankful for that. But by the way, does she work in medicine? Or does she work in the cafeteria?

Ally 17:00
I think she works at the front. She's not like she's not a nurse or a doctor or anything. I was gonna

Scott Benner 17:06
say if she was she wouldn't have been able to figure it out. Yeah. I

Ally 17:10
think it was just she thought it was weird that he was paying so much. And I did too. I was like, well, we have an appointment in a couple of days. I'll just ask her, the our pediatrician about it when we get there. And I thought I literally like texted my mom, I'm like, hey, we'll be home around this time. We're gonna like garden. I'm like, you meet me at the house when we're done with a pediatrician. So we get to the pediatricians office. And I told her that he you know, you're seeing a lot of drinking a lot of water. And luckily, our pediatrician at the time was she actually worked in the diabetes like community. She did like several camps. And so she knew a lot about type one diabetes. That was the first thing she did when we got there. She had him pee in a cup. And yeah, I could, as soon as she came back in the room, I could tell something was wrong. She was like, yeah, he has type one diabetes, you guys are going to need to go to the hospital right now. And I was like, like, right now. Like, can I go home and get my, like, get stuff first. Like, we don't have anything. I thought we I thought we were gonna go to the hospital and like, they were just gonna like check his vitals and tell us what to do and send us home. Like I still was very naive. I did not know that we would be be

Scott Benner 18:15
there. Did you think he had diabetes? And that's what they were gonna tell you. Oh, no, no, no, no, I

Ally 18:21
thought I thought her pediatrician. He's such a goofy kid too. And like how he was drinking water was so funny. He would like go bait, like, really loudly and just funny. He was just he just goofy and I was like, I thought she was just gonna say like, He's just funny drinking water, like making funny noises. He's it's summertime like you guys are? Yeah, you guys are good. He had lost two pounds. And that's when she was like, yeah, he lost two pounds, you know, let's have him take. She didn't even say anything about diabetes at all until she came back in and told me so it was not even like other than my aunt mentioning it. It was not even like a thought in my head. I thought I didn't think like my kid would have diabetes. There's I didn't have any history of it. Like I knew one girl in high school that had it. But other than that, I had no like, no idea what diabetes really was about. Yeah, yeah. So we drive to the hospital. And my husband was at work. And luckily he works like he works at downtown Austin. And so he was really close to the hospital and was able to meet us there. And I like on the way there there's this like children's museum that we go to a lot and I was like, Oh, cool. Like it's right next to this hospital. We'll stop there when we're done here. Like I just thought it was gonna be this like, rolling

Scott Benner 19:35
thing. Yeah. Turns out the lady at the front desk is the only one who knows what's going on. Yeah. Which by the way, makes sense. If you think about it, she's like the podcast or at the hospital. She has all these conversations with all these people. And you know, seems to remember them. Hey, hold on one second. Do this with me. I'm turning up the volume on my other computer. Hold on second. Okay. Today's episode of the podcast is sponsored by Dexcom. And I'd like to take this opportunity to tell you a little bit about the continuous glucose monitor that my daughter wears the Dexcom G seven, the Dexcom G seven is small, it is accurate and it is easy to use and where Arden has been wearing a Dexcom g7 Since almost day one of when they came out and she's having a fantastic experience with it. We love the G six but man is the G seven small the profile so much closer to your body, the weight, you can't really feel it and that's coming from me and I've worn one I've worn a G six I've worn a G seven I found both of the experiences to be lovely. But my gosh is that g7 Tiny and the accuracy has been fantastic Arden's Awan C's are right where we expect them to be. And we actually use the Dexcom clarity app to keep track of those things. That app is built right in to Arden's Dexcom G seven app on her iPhone. Oh, did you not know about that? You can use an iPhone or an Android device to see your Dexcom data. If you have a compatible phone, your Dexcom goes right to the Dexcom app. You don't have to carry the receiver but if you don't want to use the phone, that's fine. Use the Dexcom receiver. It's up to you. Choice is yours with Dexcom dexcom.com/juicebox. Podcast agnostic diagnostician have a little voice wants to say it again. Hola diagnostician. So I was saying it right? It's just a stupid word. Okay. Sorry, the little voice continued. Just Did you know you can YouTube basically the pronunciation of any word? Yes.

Ally 21:38
Very helpful.

Scott Benner 21:40
If you've ever heard my G voc ads, and you've heard me say, so finally, you'll Rio, which I don't know if I just said correctly just now. But I want you to imagine me sitting here listening over and over and over again to something going so final urea. So final urea. So final urea, and then I hit record and I went, if you have diabetes, or So finally, you're like I blurted it out as fast as like,

Ally 22:04
I'm always gonna imagine that now. You're

Scott Benner 22:05
gonna have to I sat here for 45 minutes trying to say that right. Then I sent it off to GE voc who sent it back to me and said, You're not pronouncing it correctly. And I was like, you've got to be kidding me. So I did it again. Anyway. Okay, so not funny drinking. Funny. He said, Goofy. You should have said, Yeah, you should see what his dad thinks it's funny. You're now in the hospital, you have this diagnosis. Does the weight of what it is hit you then? Or how long does it take for you to really, like, come to grips with what they're telling you?

Ally 22:38
They hit us like when we got in our room, like we when we got there. It was crazy. Because they like, met us at the door. They had like a stretcher and everything like that, because his blood sugar was like nine. It was like 900 something. And I mean, he was in DKA. Like for sure. But he never acted like it. Like he definitely was tired sometimes. But I mean, he's he was a toddler too. So I just thought he was tired. But he was never like, so lethargic, that I was like, Oh my gosh, something's wrong with him, you know? Yeah, they like medicine at the door with a stretcher and he just like comes bolting running in the door and they're like, oh, okay, I guess we don't need this. Like, he's like running

Scott Benner 23:17
all they saw that number I thought that kid can't walk probably Yeah, they thought he was like

Ally 23:21
in a coma almost. But no, he's running down the halls like I think when it really hit us is when we got to our room. And they started like going over everything with us and you know, telling us he was gonna wear a device forever and you know, all those just everything that came with it and we had some great nurses and doctors but we kind of had like a rocky we definitely had a rocky start with his diagnosis, just like from the support that we had. I think when it like really hit us was when we had one just she was not a great nurse. And I was panicking because His birthday was in three weeks. And I was like well do I need to like contact our cake baker and see if they can make like a sugar free cake. I had no idea you know, like what to do at this point. And the nurse was like, oh definitely he'll never be able to eat sugar or sucker or cake ever again. And that's when I like I just like lost it at that point. And I was like emailing the cake baker and like can you make a cake and sugar free like it was just like devastating because I was like I had you know, in my head I was like he's never going to be able to do these things again like and obviously she was just not very educated and he eats cake and he does all that stuff now but at the time that's when for me I was like wow, this is really life changing like he's things are really going to change and then of course like putting on we we actually left the hospital like with a CGM and we got to where that I think that's when it really stuck. Sunken. We're there for three days just because we were like, I'm not ready to leave. Like I wasn't confident in everything.

Scott Benner 24:54
We stay another couple of months maybe Yeah, I know. I felt like that. I was like we're going where home Yeah, yeah, I don't know that I know what I'm doing. Can I ask? What was more impactful to you that his diet you thought was going to change? Or that he was gonna have to wear a device? Well, both

Ally 25:12
for sure. But I think I think more his diet, I guess, that's what I heard while you were talking. Yeah. It's funny story because like, two days before he was diagnosed, my husband was watching him and sent me a picture of them at Target. And he had an apple juice in one hand and a cake pop in the other. And I text all I sent back was, why is he drinking an apple juice? I had never given him juice. Like he never really had sugar other than like, you know, his birthday cake or, you know, special occasions. Yeah. And I was like, why is he drinking an apple juice? That was like, two days before he was diagnosed. That was his first time ever drinking apple juice. And I was so mad at him. I was like, There's no, like, why is he drinking that? And then ironically, we get to the hospital. And they're like, yeah, and the best way to treat his Lowe's is with apple juice.

Scott Benner 26:00
We know where to get that, actually. And I can get a decent cake pop, too. Yeah. I want to say something before we move forward. I want to I want to, like take up for you here. I realized that you were in my Facebook group. And I just went and looked and I want to say and I mean this with a lot of respect. I am very straight. And your husband is so handsome. Like really? Seriously. Like what did you like? Oh, my God. He's an attractive guy. No kidding. Look at his eyes. Yeah, I mean, if he sauntered up to me, I'd be like, handsome. Okay, all right. That's that. I'm just saying you've got a really good defense. No. This is not to denigrate your looks. I am just saying the man is really attractive. What? You know this about him? I imagined. Well, yeah, yeah. Geez. Talking about a facial structure. Oh, look how pretty your kid is. What the heck?

Ally 26:58
You people are making? I'm never gonna hear the end of this one up.

Scott Benner 27:01
Is he gonna take credit for it? You're attractive. I just don't want to tell you I did people say I sound creepy. No, but seriously, you have a really attractive family. Oh, I think you seriously look at your son's eyes. They're so almondy but still pretty. Like your husband's who does not? Does not have almondy eyes. But really?

Ally 27:21
Thank you.

Scott Benner 27:22
Holy Christ. What did you people do? Did you meet him at a magazine shoot or something like that?

Ally 27:28
No, we actually met at like a restaurant and bar at this place in Austin. And yeah, that was I mean, I was attracted to him. Obviously.

Scott Benner 27:39
I would have slept with this guy to date. So I'm just saying was a lady. I'd be like the first ones. For me. The second one is for me to get an Amen. All right, it's enough for this. Your kids got diabetes. We shouldn't be mesmerized. I wish I was handsome like that. That's amazing. Okay, I'm warm. Do you think that's because I've admitted to something. All right. Oh, my gosh. You get home, wearing a CGM shooting with a pen or needles?

Ally 28:08
Yeah, we were MDI. Yeah, like whenever I was leaving the hospital, like the last night we were there. They were like, Okay, you guys can leave if you want it, like, we're able to discharge you. Do you want to stay one more night? And I was like, No, I want to say one more night for sure. Just to like, get the hang of everything. And the minute we left the hospital, I call my mom. And I'm just like, bawling. And I'm like, we have to find a nurse. I can't do this by myself. Like he's gonna die. He's gonna die tonight. Like, I have no idea what I'm doing. We need to have a nurse that just like, is with us for at least a few hours a day or something. Like, let's see if insurance covers that. We're like, trying to like, look into having a nurse and we didn't end up doing that. But I was just like, so freaked out. We got home and we were MDI for we got on a pump in October of that year. So about four months. Yeah, we had, it was we have a new doctor now which he is amazing. He's like, we are so lucky that we have him but at first we had it was just a rough start, like our team was just he was assigned to us at the hospital and that's just who we like kept seeing after he was diagnosed. And they were very what was that?

Scott Benner 29:16
They socked is what you're trying to say. Seems like you're trying to be nice, but they were.

Ally 29:21
They're terrible. They were like, so confused. And I'm very like Type A I had, I would like write down exactly what he ate at what his blood sugar was before we started how long we waited to Bolus him when he was at an hour after what he was at two hours after like I wrote down everything on like an Excel sheet and I would like bring it into them. And they're like, Ah, I don't know. I don't know. I just don't know they were always like, I don't know confused Yeah, they could never figure out what to do. At one point the doctor was like, well you know he's gonna be getting on it. This was in like June or July still there like he's gonna be getting on a pump here in like October we had our appointment set up for the train And she's like, it's okay, if he just runs high until then. And I was like, what that's like three months away, I'm not gonna just let him run high for three months, like, and at that point, I had been listening to the podcast. So I was basically like, I was like, being a pump. For him, like, I would go in and give him like, point two, five, with a needle. Like, we were giving him like 15 to 16 shots a day sometimes just to like, yeah, slowly get him to come down. But and we got his we got his agency down from 9.9 to six, just being in MDI, and like, constantly was giving him shots.

Scott Benner 30:36
Oh, you know, I here lately, the last six months, the feedback I get sometimes is, you know, the pro tips are great. But you know, there's more algorithms now. And you should update the algorithm information. I think what people might not realize is that I was acting as an algorithm before they existed. And I didn't know that, but I was right. And, you know, if you learn it that way, then you know it, you just know it then and making the small adjustments bumping and nudging blood sugars, taking away insulin, giving extra that kind of stuff, like learning how to meet the need, that all those things I talked about in that Pro Tip series. And in the podcast, I think are just, they're very foundational. Yeah, for

Ally 31:20
sure. Yeah. That's what I was doing. I was like, basically, just I listen, I remember that episode. And that's when I was like, Alright, I'm just gonna stop. They actually told me one time I was calling, like, every day, and they were like, You can't call every day. Like, that's not what we're here for. And I was like, he was just diagnosed, like, I have no idea what I'm doing. And this was like, even with a low or high blood sugar, we don't have like the staff to support every day. And this was like a very well known, like, Children's Hospital here in Austin. And they're just like, Nope, you can't call every day. I'm like, What do you mean, I can't call every day?

Scott Benner 31:50
Well, you saw it, though, because you charted everything so well. Yeah. And they couldn't help you. Yeah, they were so confused. What they mean, when they say you can't call every day as we don't know how to help you stop reminding us how bad we are at this place.

Ally 32:02
Yeah, just let it run high. And when you get on the pump, the pump will do our job for you. Basically,

Scott Benner 32:07
can we just let the kid be sick for three months? And then we'll put the magic box on him and this will all be over? Yeah,

Ally 32:14
yeah. And at that point, I was like, alright, well, I'm going to find a new doctor because this is crazy. I was like, I will fly to like, I just want the best doctor and we found he wrote a book actually the sugar surfing Doctor ponder, ponder.

Scott Benner 32:26
Yeah, on the very first meter of the podcast, I think,

Ally 32:30
really, he's like, incredible. So we we drive to him now. But yeah, I didn't mean it was like night and day difference. Like it was it was great moving to him. I

Scott Benner 32:40
can't imagine otherwise, honestly, like, I don't. I mean, it's been 10 years since I talked to him. But I remember I didn't know who he was like listener. The show was like, Hey, you have to have my doctor on. He's really good. He wrote this book. And I was like, whatever. So he comes on now. First of all, I don't read so I didn't read the book. And and I'm talking to him. I don't read I just said, it's so proudly, like your husband is like I get pregnant every time. That's what people don't know. Well, you've only had sex three times in the last five. It's just very accurate. But But I had Dr. Ponder on. And I remember, I think I said it out loud. During the episode. I remember saying or thinking, Oh, you do what I do. But you call it something. Like that's what I remember feeling when he was on the show. I'm like, Oh, you do what I do. And he was just like, ahead of the curve on understanding where to put insulin. Yeah. and where not to put it. Yeah, that's

Ally 33:31
what I noticed, too, when I read some of his book, but I was like, this is this reminds me of the podcast. And yeah, I was like, this definitely aligns more with what we're looking for. For sure.

Scott Benner 33:40
Yeah. Oh, no. Wonderful. And I want to be clear, like, I don't imagine that Dr. Potter ever heard this podcast, and I'd never read his book. If you really think about diabetes. Like if you step back and see the whole picture, it's the only understanding you can come to is that insulin needs to be where it needs to be. And you know, and that that's going to change. It's not static. It's not just like, oh, I use seven units of Basal insulin every day. And that's always going to work. That's a ridiculous idea. My Basal rate at 2am is always point five. That's ridiculous. Why would it always be point five? You know, so, once you can see the, like, I used to say in the podcasts all the time, it's like, it's like the movie, The Matrix, when Keanu Reeves slows the bullets down and it just wanders in between them. Like at one point, that's how I felt with diabetes. I'm like, Oh, my God, I see everything now. Like, I know, I know where to step. And, and he very much has the same vibe. So very cool. Yeah. And you're lucky to be in Texas where you can get to him. Yeah, okay, so what about you? Like I what I hear you made me is so funny. I said a lot of stupid stuff. And then I got really warm. I think I was like, Oh, I probably shouldn't have said that about her husband, but whatever. And then I got like, I got like, warm and then you said I wanted to have a nurse the day we came home. I thought he was gonna die. And then I got this horrible chill that all sent my warmth in a really weird way. I got humid for a second, which is not something you want to know. But that's how fast my body changed. Because I remember leaving the hospital thinking, Oh God, I'm gonna kill her. Yeah, that's, yeah,

Ally 35:13
that's very much how we felt I was like, There's no way I can do this. Without them. It was more like, it was like a lot of the math behind it. Like, I've never been great at math and just like all the numbers that they gave us, and it just took me a while to like, wrap my head around all of that. And I'm like, I don't know if I'm doing it right. Like, what if I gave them too much, and he was definitely still honeymooning. So sometimes we would give them insulin. And here we get low. And yeah, I mean, it was just, we're definitely in a much better place now. But

Scott Benner 35:42
I have to tell you, if you promise not to have any more kids, I'm going to call this episode one plus one equals five.

Ally 35:49
No, we're, we're done. Okay.

Scott Benner 35:51
Totally the title then. Because you're like, I'm not good at math, but you're pretty good at some adding. So I'm gonna that's what I'm calling. It has nothing to do with what we're talking about. I really don't care. somebody the other day said, Hey, we just listened to this episode. And it's called this this this? What does that have to do with anything? And I was like, I don't know. It's like, there's 1100 episodes. There's an episode coming up in a couple days. It's called reheated Happy Meal. You would think I'd know why that is. But I'm staring at it. I have no idea whatsoever. I'm gonna have to listen to wow. Yeah, it's just it's this. The math got me at first too, which was funny, because it's not complicated math. It's like, it was like fractions. You know, math. I knew. And yet I left I thought, Oh, I'm gonna do the math wrong. And I'll pick an amount of insulin. That's wrong. And then I'll kill her. That's what's gonna happen. Yeah, yeah. Yeah. No juice. Well, anyway, I feel for you. I've been there. But that didn't happen. And as a matter of fact, the irony is, is that that feeling you had that day? Like, I can't leave these people. I have to bring one of them home with me. These are the people who no, it took you very, not very long at all to find out are not the people I should be talking to at all

Ally 37:03
about rice. Yeah, I was like, No, we're definitely moving on here.

Scott Benner 37:06
How quickly do you think you became the master in that situation? How long did it take you to get it? Like, put it all together?

Ally 37:14
It was when they said you can't call every day and just let him run? Hi. And that was probably I don't even think I was listening to the podcast at that point. Because I was like, I just knew that was not right. I was like, that's insane. Why are you telling me that? I would say that was probably one to two months in. And that's when I started looking for another doctor. And Dr. Ponder was booked until it was October that he was booked out till and I literally called they probably got me in because they were like, she's never gonna stop calling if we just don't get her an appointment that called every single day. And I was like, Hi, have you guys had any cancellations? And eventually, they were like,

Scott Benner 37:51
Jesus, let me come at lunchtime on Thursday. For God's sake, let's get this done.

Ally 37:55
Eventually, they were like, Yes, we had a cancellation. And so we switched over right away, but

Scott Benner 38:01
they probably kicked them out of the practice that they could take, you

Ally 38:05
know, I was like, the person who answers the phone. She was like, Oh, hi,

Scott Benner 38:09
Ali. I know you're embarrassed. You don't want to say but you emailed the lady on the phone a picture of your husband and said, I'll bring him if you let me in. Right? Yeah, that was it. You're like, Oh, God, he's really gonna think he's handsome. By the way. He aged? Well, you don't mind me saying that. Right? No, you know, they mean, like, he got better looking as he got older.

Ally 38:29
No, it's just funny because I know my husband and he is never ever gonna let this go.

Scott Benner 38:34
Oh, if this was me, I'd have a T shirt said that. There's a podcast somewhere that says I'm handsome. One man said he'd be gay for me and he striped. That's what my T shirt would go on the back. There'd be a whole explanation about it. I'd be in public explaining it the people. Good for him. I wish I would have met him when I was in Austin. I might be married to him now. And you wouldn't. Yeah,

Ally 38:53
we met you. We went we went to the he was there. We were at the Capitol.

Scott Benner 38:57
Oh, okay. Well, then I don't know what happened that day must not have been his best day or you wouldn't be pregnant a third time and I'd have a new man. So it's lovely. But what a nice event by the way, huh? Yeah, no, it was great. Yeah. Yeah. Gave me a lot of thoughts about how to do things in the future. Actually, that's neither here nor there. What What kind of pump does your son use now?

Ally 39:17
He's Lundy Omni pod five.

Scott Benner 39:19
Okay. How do you find this to be? How's it going?

Ally 39:21
It's good. We, I mean, we definitely have our ups and downs with it. But I think that's just his settings needing to be changed. Yeah, like recently we were we were having a really hard time with His blood sugars. And I just reach out to our doctor and they're really good about like, looking at his history from like, the last two weeks to a month and they'll just send me over what they think I need to change and we made some changes to it. And he's, it's been great now. We definitely really liked it a lot.

Scott Benner 39:48
Oh, that's excellent. Why did you want to be on the show? Well,

Ally 39:50
when I first started listening to the podcast, I was well I guess part of my story too was so I yeah, I guess it didn't mention this one. When my son was diagnosed, I thought I was pregnant too, because we had been trying for a while to get pregnant with my now my daughter at the hospital, I was like, I think I'm pregnant. Wait until I got home and I ended up not being pregnant. And we took a little bit of a break. Our plan was, we wanted them kind of close together, like two to three years apart. Sorry. When we got home, I was like, I don't think I ever want to have another baby. Like, I'm glad I'm not pregnant because I I cannot imagine having another kid. I thought that we were just done. Like, I was like, I don't want another kid. i This is too much to handle. And then we started trying again, because I was like, That's ridiculous. Like, you know, one day if he's like, how come I never had a sibling? Are we just gonna say well, because you got diabetes? Like

Scott Benner 40:44
he was thinking of jumping out a window, so we didn't do it. Yeah.

Ally 40:47
We're like, That's ridiculous. So we ended up getting pregnant. And I struggled with that for a while because it was I was grieving, obviously, like, the diagnosis of my son. And then I was also kind of grieving, like, maybe never having another baby. That's something that I really wanted. And I was just like, really going through a hard time. And I listened to the podcast, and I think I didn't like post it on there, if anyone had, like a toddler, and then also had another baby, like, right after just to see if anyone else, like went through something similar. So and you know, now here I am, we're having a third and like, you know, I just a really helped me a lot like listening to other people and their experiences, like other people's stories, I guess. And yeah, I just wanted to be an inspiration to someone, like if someone listens to this, and they're going through something similar to what we went through, and they're in that phase where they're like, I'm just stuck here. Like, I don't want to grow my family or, you know, gonna kill my child. Like, I just want it to be an inspiration that Not gonna happen.

Scott Benner 41:50
That's wonderful. When you reached out to other people. Did you find other people with super handsome husbands? That said, No, I felt like that at one point. But I got over it or like, what was the response back that you got from when you asked that question?

Ally 42:02
A lot of people said that they had other kids. I remember like showing my husband, I was like, Okay, other people have kids that begin with type one or like, have a baby, like, you know, a second baby after. So my daughter ended up there. It was a year after he was diagnosed almost of the day, her birthday was is June 17. And his diagnosis date was June 23. So almost exactly a year later, we had another baby, so and I do feel like that year was like, I mean, a whole year, we learned so much about his diabetes, like his a one CEU is like, I think at the time, it was like 5.4. So I mean, we were we're in a good place. And like, for sure, I felt I was like, I'm so glad we decided to have another kid because that would just be ridiculous to let this stop us from anything. But definitely from growing a family.

Scott Benner 42:52
I'm reminded all the time of I don't know if anybody remembers this. But Sam fold who is now like the general manager of the Philadelphia Phillies was a professional baseball player. I had him on the show years ago. And I asked him if like something about, you know, did you ever think of having your kids tested to see if they might get type one at some point? And his answer was somewhere around? Well, no, because that doesn't matter. And when I dug into it a little bit, he his answer was I have diabetes, and I'm okay. And I thought, oh, it's like such a simple little moment. But it really is stuck with me all these years. Like, yeah, like, why would he be scared of a thing he is that he's, it's not causing him any trouble? You know, and I was like, Oh, that's really something like, I think it's so much about understanding it. Understanding the insulin, understanding how to make your life run, not normally. smoothly, you know, and there are going to be issues, you know, like, you are gonna get low, sometimes you're gonna have problems, like, you're always gonna have concerns that other people don't have. But if day to day, you get what you expect. And you start doing things kind of like almost unconsciously, because you just know the right things to do, then why would you think that? Like? It seemed like such a normal question to ask. But I would never ask my daughter present day. Hey, do you ever think about not having children because you think they'll have diabetes? Now? She might have that thought, but I would never ask it over anymore. Yeah, yeah. So anyway, he gave me that great answer years ago. And it stuck with me this whole time.

Ally 44:20
Yeah, we've definitely talked about that. Like, if we want to do the testing for either of our kids. And part of me is like, I mean, yeah, it'd be nice to know if they carry the gene. But like, then on the other hand, I'm like, Are we just going to if they do, are we going to sit there every day wondering like us today? The day? Like, I almost don't want to live like that.

Scott Benner 44:40
It's a hard question. Yeah, it really is, especially now that these drugs are coming out like tz old and things that can, you know, keep you from getting diagnosed, you know, for longer and stuff like that. You think, Well, maybe if I could do something to keep it away for a year or two. I would, you know, yeah. But no, no, it's just I think it's a bigger point. I think it's a philosophical point. and not so much a question about management and, and medicine. But anyway, so you found the podcast podcast was helpful. I don't want you to like, say that again. Like, I hear you. I'm terrific, whatever. And, and but but isn't it odd that I can vacillate between stupid and really thoughtful about diabetes the same 35 minutes? It's a skill of I mean, I don't know what other people think. Definitely. Yeah. So one kids got it. One kid is eight months old. You're nine weeks pregnant? What are your plans for your family? Like, you're 33 years old? You have a very young family. You're a young person, like, how do you see your life going? Do you ever think about that?

Ally 45:39
Yeah, definitely. Yeah, I mean, I guess like diabetes related. I remember, like, at the very first appointment with our art doc, Dr. Ponder that we have now he made a comment that was like, I was still like, not in a great place when we went to see him like I cried at our first appointment, because I was just, I was very emotional about it for a long time. And one of the first things he said was the way that you perceive this disease and the way you handle it, and like, how you carry this is how he's going to perceive it. And that really stuck with me, because I feel like I was letting it consume me. And like we had, for example, we had a Disney trip planned, like before he was diagnosed. And I was like, we have to cancel it. And then after we had that appointment, I was like, why? We can't cancel it. What is that teaching him like, he has to cancel things because of diabetes. Like, we have to just live our lives the way that we normally would and just continue on the same way that we do in it. It's fine. Like everything went well, like we went to Disney, and it was great. And that's one thing with diabetes that I'm like, I really tried hard to just not let us let it stop us from anything.

Scott Benner 46:49
I'm gonna write down perception is reality, and do an episode about that. That's really good idea.

Ally 46:57
Yeah, it just the way that we like, handle it, I guess we just don't ever want him to feel like he can't do anything. Or we can't take a trip or he can't We can't have a sibling and because of diabetes, like in every time we've been scared to do something, we we go, you know, we do it. We went to Disney when he was still on shots, like we were MDI and we look back and I'm like, Oh, my gosh, I can't believe we did that. That was intense. Doing that at Disney. But we did it. And yeah, and you can went fine. I

Scott Benner 47:27
think they are I think he is right. First of all, if management was difficult for you, if you didn't know what you were doing, and you were having wild blood sugars all over the place, they were up and down, up and down. I don't know how much your perception of it would be changed for him. If you were just always like, super happy or like, everything's fine. Because you'd be like, Yeah, everything's not fine. Yeah. But you know, if you're doing well, and you don't let it burden you psychologically, then I see that. I mean, by the way, there'd be value the other way to at least, you know, things are going badly. But we have a good attitude, I think would be a good way to live. Yeah. But better yet, you know, we've got a handle on this. We know what we're doing. And we don't

Ally 48:05
act like we're burdened by it. Yeah, like it's not ruining our lives. You know, some

Scott Benner 48:09
people would say, I wasn't acting burdened, I was burdened, but you were burdened, but then stopped being so so how do you make that transition? That makes sense?

Ally 48:18
Well, it's definitely a really, it was hard at first for sure. Like, I definitely, it took me a while to, like, get out of that. That like hole that I was in, like, I was constantly just mad, and like, I was grieving. I mean, I grieved I feel like for a pretty long time, like I, I mean, I work. I'm a hairstylist, so I work one day a week. Luckily, I'm at home all the other days with the kids. And every single Monday I would go in to work and I would just start crying. Like as soon as I got there, and I'm close with my co workers and even with some of my clients, like I would go out and as soon as I received them, I would just like start bawling. They're

Scott Benner 48:53
like how are you ally? And

Ally 48:57
it was just like, like, Okay, I have to pull it together. But I started thinking to myself, I'm like, why? Every Monday, like, that's the only time I cry, like I get to work and I just like let it all out. I was like, I'm holding it in all the other days when I'm at home with them. And like, I mean, it's okay to like, let them let him see me upset about it too. Because that's not realistic. I don't want him to just live his life like holding in his feelings about diabetes either like it's okay to cry about it and it's okay to be mad and upset about it, but just don't let it consume your life. And I started seeing a therapist actually and she is the one who was like it's okay to let him see you cry. Like it's okay. And that really like stuck with me and I was like, Okay, I don't always have to cry on Mondays that work. It's okay to like for him to see it.

Scott Benner 49:44
Well, now you might have called the podcast like I cry on Mondays. That's such a nice title. I'm writing that down too. I think that's well first of all, I think it's good advice. Think if you're gonna cry, it's okay for people to see you be emotional. I also think that if you're crying constantly should pull yourself together because you know, it is going to hurt your kids at some point to see you, you know a disaster. But there's that's not what she said good

Ally 50:06
balance. Yeah, no definitely like, don't want him to feel like he has to hold it in and just act like everything's fine because that's not healthy either. But

Scott Benner 50:14
especially when people can tell you're upset, but you don't let it out. Like, then that becomes exactly right. You learn to hold in your emotions. That's not good. Yeah. So you found this balance. So you you worked your way through it. My question was, how do you go from genuinely being upset to not being? And the end? The answer is slowly?

Ally 50:31
Yeah, I think I mean, it definitely took some time. Yeah, I mean, it took it took a while for sure. For me to like, stop grieving over it, I guess. And I think just like living my life the same way that we would have, yeah, as much as we could without, you know, before we before he got diagnosed. And yeah, I mean, seeing started, I started seeing a therapist that I guess it was about six months after he was diagnosed, because I was just like, just still just not in a great place. I feel like I was just grieving it for so long. And that helped a lot. Like, I think, and she actually has type one diabetes. So finding a therapist that has type one diabetes, and understands like what I go through is very helpful.

Scott Benner 51:11
Thank you. Yeah, I genuinely believe that. Doctors with type one helping people with type one, there's a pretty big value add there. Yeah, it's not to say that a doctor who doesn't couldn't manage well, or a therapist couldn't manage well, but it sort of gives them a head start. Yeah, definitely understanding what's going on. Do you go more than 15 minutes from your house? Now? I just want to make sure you're getting

Ally 51:38
yes, we definitely do. We're able to get out.

Scott Benner 51:43
I like the way your brain works. You were like we can we can never drive more than 15 minutes away from the house now. Which by the way, you can actually put the potty in the car. It's only seven and a half minutes because you have to be able to get back. So I also did not occur to you there are toilets, other places. Yeah,

Ally 51:59
well, we have like a little port like his potty can like go in my car. So I guess I'll just bring that and we'll just have to pull over like, let him use his little potty all the time.

Scott Benner 52:09
I'm married to my wife for a few years when she says out loud, but you think they should install toilets and seats and cars and I went wow. I actually thought I wish you would have said that sooner. I may not have married you. So funny. I remember being able to travel with like a potty. What you were doing potty training for kids. Yeah, that's a low point your life as an adult. What do you got back there? It's a bowl of pee.

Ally 52:39
Yeah, it's funny when like other people get in the car and like my sister, she's much younger than me. And she's like, Why do you have a potty in here? Like,

Scott Benner 52:46
because look how handsome this guy is. I don't mean to say that if a person is very handsome, you have no agency over whether or not they have sex with you and make you pregnant. But for me personally, I wouldn't have any conscious. I'd be like, sure you want to that'd be great. By the way, this is gonna backfire on him. Because if he brings this up, you're gonna go the other way on it. So I'm just telling him right now if he's listening, dude, don't do it. Because she'll she'll run in the other direction. That's so funny. All right. What have we not talked about that we should have?

Ally 53:21
I think that's pretty much everything. We

Scott Benner 53:23
did it. See ya had everything written down. So yeah. Did we really are you at suffered now? Yeah, like notes. Oh, my God. That's amazing. I should try planning this out once in a while.

Ally 53:35
Yeah, I think that was everything. Oh, that's

Scott Benner 53:37
so cool. I appreciate you doing this. I really do appreciate you coming on sharing your experiences on the show, sharing your vulnerability of being willing to be funny and loose. Like all that was really nice. This is one of these weird episodes where we're not even quite up on an hour yet. But I feel like we've been talking for two hours. Yeah. I love that link. I really did. Yeah, no, I think that's fantastic. Sometimes when I get into those like hour and 20 minutes, that's sometimes me going I feel like I didn't get it at all. Yeah. And I feel like I'm digging around. Like, I know, there's something I left here. I don't know what it is. But for you, I feel like Wow, we got the story out like really well, it's fun. It moves quickly. And it tells it made me cry. Like I really did cry. Oh, when you said like you felt like you couldn't leave the hospital. It made me it made me well up. It was like bawling. Like, like if your husband would have left me but like I just welled up a little bit. You know what I mean? And, and it was just, I just remember feeling like that so clearly. You know, so I thought it was really nice to share that. It's a lot. Well, thank

Ally 54:37
you and thanks for having me on. I appreciate having me on and just all the help that you've given us really, I mean, we would not have been able to do any of this without the podcast. I'm

Scott Benner 54:48
so it's so nice. I have to you want to know what I'm gonna do after I get off with you? What's that? Please? So sure you're gonna go not really Scott. I don't really give a fuck what you're gonna do

Ally 54:59
it Hey, you're gonna message my husband? No, no, I see

Scott Benner 55:03
where you're at. Your pause was a little too long. I was like, what I'm about to do. I was gonna go have an egg. Probably gonna have to. And I was thinking to put a little protein with it. But instead first I have to go to my private Facebook group where someone is being silly. And I have to now like go answer and silly to me. I'm sure not silly to them. And would you like me to share it with you want to talk about? Yes. Okay. Yeah, definitely. So there's a person, I'm not going to say their name, obviously, but has made a post it says GLP or T one D? Hello, Scott, I guess you're transitioning the podcast to weight loss over type one. What is your intention? I am very sympathetic about those who desire to lose weight. However, I began listening to your podcast for information about type one, and to learn from the experience of others with type one. Now a couple of things to this person. First of all, podcast is one word. It's not a big deal. And I'm not shaming you over. But it's not pod cast. Its podcast, one word. So taking it away from this. I've never understood this before. And not about me specifically. But about anything. I've been making this podcast for 10 years. Yeah. I mean, he's talking about the same exact thing every day. Yeah. Also, you get five new episodes a week, if one of them once in a while talks about GLP. The podcast is transitioning to weight loss. Yeah. I don't understand the there is a specific mind that sees things that way. I'm not saying it's a good or a bad thing. But there's a specific mind that sees things that way. Like you're the person who wears red T shirts. Why would you wear an orange t shirt? Like, well, what, like, that's weird, you will need to do the same thing over and over again. I've seen it through history with, like entertainers who have like long careers. I don't think I'm an entertainer. But you know what I mean? Like somebody who's been in like a medium for such a long time. And as they mature and grow. They change kind of what they think and how they talk about it sometimes. And then yeah, people will come in and yell at them. That's not what you do.

Ally 57:12
Yeah, just don't listen to that episode. I don't even know what she's talking about.

Scott Benner 57:16
Oh, I like that. You thought it was a woman? That's nice. Oh, yeah. I mean, I'm not saying it is you're saying it is or it isn't. But you know, if that happens to me, I'm sexist. When you don't, it's nice is a mistake. It's interesting, because my to go I'm gonna go back and explain to them, but I don't know where to start. Like part of me wants to say, currently, there are 1138 episodes of the podcast. There are countless series about different management ideas. Like go listen to those. Yeah, you want me to say the same exact thing over and over again. Day after day, the podcast will implode it'll die like it won't. Yeah, I can't get on every day and be like, hey, Alec, would you like me to explain to you how to Bolus for food?

Ally 57:58
Cuz there's something for everybody. Gift episodes you don't want to give.

Scott Benner 58:04
were more like what is your intention? My intention? There's so there's like, the monkey side of my brain wants to respond and go stop listening. You don't understand? It's bad for you. It's making you upset. Part of me wonders if I'm just reading the posting correctly. And if maybe their tone and intent isn't how I'm taking it. Right? Like it sure like No,

Ally 58:28
sometimes. Sometimes I see posts and I'm like, What are they doing? I'm just kind of person real. Middle she like I've computer just posting this. Trying

Scott Benner 58:38
to piss people off. Listen, yeah, I have a master list in front of me of just the the episode series that are about management. The defining diabetes series has 51 episodes in it, where we go over different, you know, meanings for different works here in diabetes, the diabetes Pro Tip series 26 episodes, I have heard over and over again, listen to those a once he goes into the low sixes diabetes variables, 22 episodes about variables that impact diabetes. Bold Beginnings is basically the pro tips for beginner 25 episodes defining thyroid 10 episodes, after dark now has 47 conversations with people who are talking about things that maybe aren't like polite, you know what polite conversation is? I don't believe in that. But obviously, I don't believe in that diabetes myths series 17 episodes about myths about diabetes 39 episodes about algorithm pumping 12 about how different people eat different ways. 25 about mental ill mental wellness for type one, there are 20 Almost 30 episodes of Ask Scott and Jenny where people send in questions. There's 16 About type two diabetes 17 about pregnancy with type 128 about talking to children with diabetes 12 About disordered eating 15 about celiac 42 with families that have multiple people with type one in them, how to Bolus or fat and protein seven episodes, eight episodes about the math behind your settings. eight episodes about glucagon stories, people who have had to use glucagon. And they're explaining what their situation was. There's a parenting series, a grand rounds series now for doctors, cold wind is healthcare whistleblowers talking about how doctors really are like, I don't know if you've heard it yet, but they're talking about what they see at their jobs like doctors, nurses, stuff like that. It's not uplifting. And I have nine episodes about my weight loss journey called a week over diary. Nine. So

Ally 1:00:33
it just sent her that.

Scott Benner 1:00:35
I love again, you said her? I thought

Ally 1:00:38
you said she for some reason.

Scott Benner 1:00:41
1138 episodes available right now. Nine of them are about me using weego V. Why is the podcast Let me ask it again, transitioning to weight loss. I don't know what to say about that. That person is listening right now. I don't know how to answer that question. It would be like if you said to me, why do I see your fingers transitioning to being all pinkies? And I go, there's just two pinkies there's a there's a total 10 total digits two thumbs to pinkies. They're not all pinkies. I don't understand. It's a line someone draws their head or a fear or I don't even know what like I can't figure out why this person's asking this question. But now it's my job. Drama. It's my job to go explain it instead of eating my goddamn egg, which is all I wanted.

Ally 1:01:30
I did want to say I really enjoyed the parent teen series, I forgot to tell you that. I liked the because that's kind of new. I've been listening to that. And it's not even I mean, sometimes it's not even about diabetes. It's

Scott Benner 1:01:41
not about diabetes. What am I turning this into a parent? One episode a week. Thank you. And by the way, if you listen to it, it's about parenting. But it's also about diabetes parenting, you just don't have to say the word diabetes constantly to do it. Also, not for nothing. But G LPS you want my opinion, not a doctor, no research don't only stock in a pharma companies nothing like that. GLP medications are going to be widely used with people with type one diabetes in the coming years. That's my belief. And I'm talking about it now today's episode, which is probably what prompted this person is a mother of a young child with type one diabetes. Child's fifteen's had type one for two years, who is using we go V for weight loss, but we go V is ozempic. It's the same drug, right? And this kid's insulin needs are significantly less. As a matter of fact, by the time you get to the end of the episode, you find out she's one four to seven units of basil a day and not currently bolusing for her meals. Wow, she was not not honeymooning, nothing like that. Is this going to be a common story? I don't think so. But it's incredibly interesting. Yeah, story about GLP is being used by a person with type one diabetes. And this person says to me, why is this podcast not about type one diabetes, I'm talking to the mother of a child with type one about her child who has type one diabetes, who happens to be using a GLP. And this person says to me, how come this shows not about diabetes? I don't know what to do, like

Ally 1:03:16
your podcast anyway. So you can do whatever you want

Scott Benner 1:03:20
to be that person. But also, if we're gonna go down that road for a second, I've helped 10s of 1000s of people live better with their diabetes, using my idea of how to communicate with them. I don't know why a person who hasn't helped three people in one way that I know of, maybe they have, but they definitely I mean, this person has definitely not helped as many people as I have. Why would they say to me, you know, I know how you should be doing what you're doing. And this, isn't it. Okay. I don't even know where to go with that. Like, imagine if I got on line today. And I was like, dear Steven Spielberg, you don't make movies, right? Why are we talking so much about your family? And this last one? Where is Indiana Jones that don't watch that one? Like, oh God, la now you've made me upset. Alright, mate, if you know what I'll do to calm down. I'm gonna look at a picture of your husband. Stare into his eyes till I relax.

Ally 1:04:25
I'm gonna have to go look for that post. Because now I want to know, oh, are you responding? Why don't

Scott Benner 1:04:29
you say it's gonna be a lot of fun. I'll be very polite. I'm a nothing but polite. And if this person is listening right now, it's like eight months later, resist the urge to get upset because I know you're still listening. Because I mean, podcast is fantastic to me. Did you hear this episode? I'm at the top of my game alley. There's nowhere to go but up, and I still feel like I'm bumping my head on the sky right now. There's there that's me being no way modest. Anyway, you're delightful. So am I, we're done Hold on one second

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#1266 Dr. Tom Blevins on Inhaled Insulin

Dr. Blevins is back to talk about the inhaled insulin called Afrezza.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1266 of the Juicebox Podcast.

Hey Dr. Blevins is back today to speak about Frezza the inhaled insulin. You know, I love Dr. Blevins on the GLP episode so I thought, I wonder what else this guy knows about today we're gonna find out. He actually runs a lot of studies out of his Austin practice. So if you're interested in some type one studies, you should reach out to him he tells you how towards the end. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Don't forget, if you use my link drink ag one.com/juice box you'll get a free year supply of vitamin D and five free travel packs with your first order. And if you go to cozy earth.com and use the offer code juice box at checkout, you're gonna save 30% off of your entire order. Kids don't forget he won the exchange.org/juice box if you're a type one, or the caregiver of a type one and a US resident I need one and would love if you would go over there join the registry complete the survey takes about 10 minutes you're going to be helping type one diabetes research while you're supporting yourself and me.

This episode of The Juicebox Podcast is sponsored by the only implantable sensor rated for long term wear up to six months. The ever since CGM ever since cgm.com/juicebox. This episode of The Juicebox Podcast is sponsored by us med us med.com/juice box or call 888-721-1514 Get your supplies the same way we do from us med this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Everyone Dr. Blevins is back, you might know him from some of the GLP conversations we've had recently. But today he's here to talk about a Frezza which is of course, the inhaled insulin. Dr. Blevins Welcome back,

Dr. Blevins 2:24
Scott Good to be here. I do want to point out to the audience that I participated in one of the studies with a Frezza are actually a couple of studies. And I'm actually one of their advisors. So keep that in mind. And it's great to be here. I think this is a this is a type of insulin that everyone wants or needs to know about. Why do you think? Well, I think it's because, number one, it is unique, and is quite unique. And it's kind of less known about and people need to know about it as an option. And it's, it's unique in that it gets in so quickly. First of all, it's inhale that's unique. And it gets in very quickly and out very quickly. And I'm going to talk more about that. Right.

Scott Benner 3:08
So how long has a President been in the marketplace? You

Dr. Blevins 3:13
know, I think if you ask people how long they would say, oh, it's brand new. And the answer is just not at all. It was approved by the FDA in 2014. And it started off being licensed to Sanofi. And then it returned to the company called mankind where it which is where it exists right now, the company mankind in 2016. Some people may remember that in, in the past, a very, very impressive person named Al Mann actually developed the the insulin, he saw this potential of dry powder. And he knew that if it was inhaled, it would get into blood very quickly. And he put a lot of his own money into it. And you might also remember that he was the guy that helped develop the mini med Medtronic insulin pump. No kidding.

Scott Benner 4:03
Yeah, about that. Listen, when people are passionate about things, that's how you get different and change, you know, because it's easy to get behind the thing that exists. But if you have this kind of, because it's not so much well, not that it's not difficult to make something work. But once you make it work, it's the selling it part. And I don't mean the financial part. I mean that explaining it to people and letting them know what it is and getting them to try. Like, that's where a lot of the really difficult work is because yeah, so that's what I don't want. Like, I don't want to be a barrier for people listening, because I was presented with the idea of letting art and use inhaled insulin. I mean, forever ago, and I said, I don't know enough about it. And, you know, just hearing what I'm hearing. I'm like, I don't know how thrilled I am about my daughter just inhaling something. And she was young, so we didn't really look back at it again. So I'm interested to hear what you think of it and what this study showed. Yeah,

Dr. Blevins 4:57
well, you know, many people remember this First inhaled insulin was, came in a ball really literally what we would call a ball. And I'm looking at what across my room, I kept it up in my history of diabetes shelf there. And it was a big mess, you had to put the little medicine and a little, sort of a bong, and it, modified it a little bit and aerated it a little bit. And then you took the big Bong up to your mouth. And this this, now, the Frezza comes in a very little small inhaler, very simple, and very portable, and very discreet. And I think that's one of its advantages.

Scott Benner 5:35
And so, I've had it described to you before, but what's the process of inhaling it and it's a powder, is that right?

Dr. Blevins 5:42
Here's what happens, it comes in three doses, which we'll talk about more in a minute. And of small amount of powder, if you look at the cartridge, and the cartridge is then just inserted into a simple little inhaler that measures about I wish you could see it, but it's about two and a half inches or something like that. In length, the end it's about though maybe a half to three quarters in width, and depth, and says clip it in, put the inhaler up to the mouth and aim. So it goes into the into the airway and not in palate or to the tongue. And then take an inhale inhalation, and then that's it. And and take a deep inhalation. And that is the dose. Okay, so, you know, I was gonna mention this later, too, but it's very discreet. A person could give me in a restaurant, just reach in with the cartridges in, flip it in. No, no injection, no pin needles, no pins, that kind of thing. And those are pretty discreet too, I think. But don't get me wrong. But many people run into the restroom to give their insulin injections in a restaurant, or when they're out in public. And they don't have to. But the inhalation is very, very straightforward. And I've had quite a few patients who sit in a board meeting and they're taking their their medicine, it doesn't interrupt them or anything else, no

Scott Benner 6:56
one knows. It reminds me of a whistle. When I look at it, like that kind of size, you know what I mean? Not not large. And then that's disposable when when you're done right?

Dr. Blevins 7:06
Well, the inhaler lasts for about two weeks at a time, the little cartridges measure may be three quarters by half an inch or something. And they are disposable. They can be carried in person's pocket. They can be carried in a purse or bag and they're very portable. And they are disposable after they're used.

Scott Benner 7:23
Okay, so inhaler that a cartridge goes into, I inhale that the cartridge is disposable. But I can use the inhaler for a bit. That

Dr. Blevins 7:31
is exactly right, usually two weeks at a time, as was recommended. And I'll say something to Scott, when people inhale, I've seen kind of models, there's a kind of a mock up over at the MannKind manufacturing facility, and the Frezza manufacturing facility. And when people inhale that this powder gets into the lung very quickly. And you know, the advantage here is that it gets across the alveoli very quickly. And some people ask, well, you know, what is the surface area for absorption of the lung, it's about the size of a tennis court. I mean, those lungs are there. They're absorptive machines. So getting something across that rapidly is very doable. You put it on a carrier, there's something called a technosphere micro particle that the insulin is is attached to adsorb to and then once they inhaled inhalation occurs that gets out to the alveoli, it gets across into the circulation immediately. And and you know, I can I can say something about the rate of absorption and compare it to other insolence too, so

Scott Benner 8:35
people don't get confused, I think I understand but like your lungs are just a great pathway to get the insulin to your bloodstream. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store G vo Capo pen and how to use it. They need to know how to use G vo Capo pen before an emergency situation happens. Learn more about YG vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit GE voc glucagon.com/risk For safety information. I used to hate ordering my daughter's diabetes supplies and never had a good experience And it was frustrating. But it hasn't been that way for a while, actually for about three years now, because that's how long we've been using us med. Us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash. The number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7. They accept Medicare nationwide, and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box, so just call them at 888-721-1514 get started right now. And you'll be getting your supplies the same way we do.

Dr. Blevins 11:18
It is okay our as it turns out, of course your lungs get oxygen across immediately quickly. And they they also deliver carbon dioxide back out. The lungs are sitting there they're delivering oxygen removing toxins, you might say are metabolic products in a way. And also people take like inhalers for their lungs to dilate the lungs, if they have asthma. They take inhalers for all kinds of things. But also it's a great absorption, Oregon, and things can get across into the circulation very, very promptly if they're delivered properly, and inhaled insulin gets gets that that insulin out there to the alveoli to be absorbed.

Scott Benner 11:58
Why don't we see more medications delivered this way? You know, I

Dr. Blevins 12:02
think I think there's been a big focus on medicines that treat like asthma, and and emphysema, things that are aimed at the lung itself. And a few medicines can go across the lungs, not every medicine, you have to have a small, relatively small particle. That's that gets across the alveoli. So I think you'll see more meds that are delivered that way. And and certainly inhaled insulin is here now. And you know, it's been out again, it's been out since 2014. And we look at it as something new because many times it hasn't been talked about really hasn't been used as much as it should be. And I think part of that was the initial I mentioned a while ago, the thing about the bond, the bond was a real inhibitor to use. And and then along came pins that made giving rapid and some more, more feasible and more doable. So the the excitement about inhaled insulin sort of faded. And now many times practitioners and people with diabetes, just don't think about it. I mean, I have people, unfortunately, I'm probably I'm a culprit too. When it comes to not talking to people unnecessarily about every single option, I make myself do it as much as I can. And now I talk to people about inhaled all the time, because it works so well. And we have now a very good data that shows that inhaled inhaled insulin can be very effective, versus injectable, versus injectable. And, and I could, I can say a few words about injectable. Of course, I mentioned earlier we did a study with the Frezza here at my clinic here in Austin, Texas, Texas, diabetes and Endocrinology, we do quite a bit of phase two and phase three clinical research. And so we did a study We've done studies with other insolence to and with the newer, more rapid acting injected insulins like and I'll say the name brand because people understand them. When you when you talk about namebrand T acid, which is fast acting as part, which is a fast acting Novolog. We did studies here with blue Jeff, which is fast acting LIS Pro, they're called fast acting, they're called Ultra rapid, but they really don't come close to the rapidity of absorption of of the F Frezza. And I can let me go through if it's okay. Let me just give you a few numbers. Yeah, please. Okay. So, there are three measures that are kind of interesting to look at when it comes to absorption of rapid acting insulin. One is time to first measurable effect. The other is, so the first effect it has lowering the sugar. You know, once you give a dose, it takes some time for it to have an effect. And when it comes to injected insulin, what delays the effect is the fact that it's given in the sub q, subcutaneous space and it has to break down into a single molecule of insulin before it can get absorbed. It's given typically and in in cluster of six like it's called hexamer. So when you give insulin, typical insulin sub q, the rate of absorption has everything to do with how rapid it becomes a single molecule, that single molecule can be absorbed a single molecule is called a monomer. So, you know, you want to go mono Marik as quickly as you can if you give sub q, because that's what allows it to get absorbed. That takes some time, even even the most rapid sub q insulins take time to get absorbed longer than a Frezza Frezza. Inhaled, it's into the system right away. It is mono Merrick to begin with, by the way, it doesn't have to break down, there's no subcutaneous tissue for it to break down into, it gets in right away. And that leads to another very important characteristic. And that is, it gets it also gets out quickly. It doesn't linger. And I'll tell you more about that. So time to first effect time to peak effect and time for the insolence return to baseline. The limit, let me give you some comparisons. Yeah. And if interrupt me if I'm not clear, and and you in the audience, you just make notes in your mind or on paper, if you want. And I'm going to, I'm going to go through those measures for a Frezza be asked and also loom Jeff, okay. And those are the best competitors, because those are the most fair competitors that have the most rapid li absorbed sub q insolence. So, time to first a measure of measurable effect of the middle dose of a Frezza is kind of a middle dose is 12 minutes. So it gets some pretty quick, the first measurable effect time to first a measurable effect of the ASP 17 minutes. So it's not as fast as a Frezza. But it's this relatively quick, first measurable and the same as for limb, Jeff 17 minutes. So that's that's interesting. Time to peak effect. So once it starts getting in, you wanted to get in quickly, right? Most people diabetes tell you I don't want I want my sugar to be affected right away. And I have to wait and wait. Well, time to peak effect is about 45 minutes for Frezza. At the the middle dose it was studied. So that's about 45 minutes. And you might say What do you mean 45 minutes? Well, what do you think's gonna happen with fiasco time, the first time to peak effect is 122 minutes. And loom Jeff has 138 This is right out of the product insert? I'm not. Right. This is right out of what is published, for people to see. So that's the peak effect is much faster with the present. So if you take it, you're gonna get an effect, more rapidly peak effect. What about duration? And let me let me just say, you may ask, why is duration important? Well, duration is really important because when you dose insulin, you really want it to act quickly. You don't want it to hang around because you can you can have hypoglycemia if there's a long tail on the rapid acting insulin. Does that make sense?

Scott Benner 18:10
Yeah, it also makes sense to me that if I needed to reduce again, I'd like to be able to feel relatively comfortable that what I did first is gone. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since cgm.com/juicebox. The ever since CGM is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. And you didn't hear me wrong. I didn't say 14 days. I said six months. So if you're tired of changing your CGM sensor every week, you're tired of it falling off or the adhesive not lasting as long as it showed or the sensor failing before the time is up. If you're tired of all that, you really owe it to yourself to try the ever since CGM. Ever since cgm.com/juicebox, I'm here to tell you that if the hassle of changing your sensors multiple times a month is just more than you want to deal with. If you're tired of things falling off and not sticking or sticking too much or having to carry around a whole bunch of extra supplies in case something does fall off. Then taking a few minutes to check out ever since cgm.com/juice box might be the right thing for you. When you use my link. You're supporting the production of the podcast and helping to keep it free and plentiful ever since cgm.com/juicebox.

Dr. Blevins 19:42
Exactly. And that what you're talking about you don't want to stack because once a once the shirt goes up and you're disturbed by it, you want to you you're tempted to reduce it, right hit it again, that might bring it down more quickly but unfortunately that insulin can hang around. And the detail of the first dose, the tail of the second dose can cause you to become hypoglycemic. And that is stalking. So the duration is a big deal that leads into what is the time for the effect to return to baseline of a Frezza. It's about anywhere from 90 to 180 minutes. And let's compare that to the other two. Remember, they're the fast ones. The fiasco time to return is five to six hours. Right? It is, yeah. And the time for limb Jeff, which is a great, it's a fine answer. And we use a lot of it, of course, but the time to return to baseline is 4.6 to 6.2 hours, we're not talking, you know, remember, a phrase is 90 to 180 minutes. So what you said is exactly right. You want the insulin in but you want it out. And if you want to reduce it, you want to be comfortable that that first, or the prior dose is not going to be hanging around to cause you to get low later on. Right?

Scott Benner 21:02
Especially if you know if you if you underdose a meal, for example, or it's fatty and you don't go after correctly, and then you do have to hit it harder. But then eventually that logjam inside breaks and the food passes through and it's no longer impacting your blood sugar. All the leftover insulin is just going to It's like a It's a lead weight than it is. I know, it's not part of what you want to talk about. But if I asked you to go over like Novolog, or or a pager, would they be significantly different than loom? Jeff and fiasco?

Dr. Blevins 21:29
Yeah, they're slower in and they're going to be slower out. Okay.

Scott Benner 21:33
They don't. Six hours still, though? Do they? know they do?

Dr. Blevins 21:36
They go six, seven hours really ration? Okay. Yeah, they do. And they peak later. Most people, if you ask someone who has diabetes, or even practitioners are right down the peak time of various of these insulin, they would they think it peaks sooner. And it doesn't the pay people with diabetes know, they take a dose and they know it takes a while for it to kick in. And they just were patient, and many times very impatient, though. And they'd like something that acts faster. And the fastest pencil on the planet is a Frezza. It gets in quick. And one of its big advantages is also and I'll just say it again. It gets in quick. It gets out quick. Yeah,

Scott Benner 22:17
no, it's a big deal. And let me stop here for a second to highlight what I think might be some people's can, like concern. Yes. What if anything about it, like is dangerous or concerning? Like it's the idea of inhale, I'm still listening to you and thinking like, Yeah, but inhaling something. And I don't know if that's based in just like, a nonsensical fear or if that's a real thing I should be worried about? Well,

Dr. Blevins 22:41
I mean, there are things that are cautions that people need to know about when they use it inhaled insulin. One is there are side effects potential cough can occur in a significant number of people, it tends to get better over time, I tell my patients when I when I start to monitor for, as I say, you may cough, and you may see some powder come out, it's okay. It doesn't mean anything. And nothing has gotten absorbed, I can tell them. That's the what, but the studies show clearly enough has gotten absorbed, if you cough, somehow, a cough can occur sometimes sore throat, which tends to be transient, I had one person who developed a very sore throat initially, and we thought we were going to have to stop the medicine, she kept taking it, it went away. And, and so there are certain people also who shouldn't simply shouldn't be taken it. And those are people who have some kind of any type of chronic lung disease like chronic recurrent pulmonary disease, that would be asthma or COPD. We don't we don't prescribe it for Frezza for people who have those conditions. And there are some people who are hypersensitive to human regular insulin too, of course, they have trouble with any insulin. And we also know that when people take a Frezza there is some reduction in a measure of lung volume called f e v one. And it can reduce a small amount, usually about 1% 30 or 40 cc's of lung volume reduction reduction when on the Frezza. Now, interestingly, when people go off the phrase, it comes right back, so it's not a permanent thing. But let me also put that into context, what 40 cc's of reduction? Well, what is the typical male female lung volume total, that's about anywhere from males have greater lung volume than female, but it ranges anywhere from 3.5 to 4.5 liters. And I would just say make it easy as four liters. And you know, that 40 cc's of 4000 CC's is it's it's tiny amount on percent. So, that is important to know people see that that the lung FEV one can reduce but it's it's really a tiny amount of what we do and it's important for everyone to know we do. Typically we do a measure of lung function at baseline, or at least when we decide to continue the Frezza that's called the FEV. One, it's a simple little test we do in the office, and there's a little machine I can hold in my hand that will allow me to get an FEV. One a person breathes into it. So we do it at baseline, after six months, and then about once a year, that's the current recommendation. And if there's a decline of over 20%, then we would discontinue the medication. So the safety is good that we know we know what kind of changes we might see. And we measure for them. Those are the primary sort of concerns there's people sometimes have, in the past have said, What about lung cancer with inhaled insulin? And let me just make a long story short and say that there were some there were some cases reported, one of them occurred very soon after person started. So it couldn't be related. And, and they're just really tiny numbers. And there's no sign or signal here that I can detect.

Scott Benner 25:56
Yeah. So stuff like this, am I right to say exists with almost every medication you take? So I mean, like, there's some people who are just not going to work well, for some people are going to have an adverse event that you have to discontinue because of, but is it any more or less so than other things? I mean, or I know, with injectable insulin, you can't just stop if you have type one diabetes, because I've interviewed people who have like significant insulin allergies. And it's very infrequent, thank God, but it's it's horrifying. And they had to just keep doing it. Actually, those people end around their problem by using a Frezza. In some situations, generally mean like, my question is, is this something that's more concerning than any other general situation? I put myself in with the medication?

Dr. Blevins 26:46
And Scott, my answer is, I think not. I think that there's been a lot of caution. Fortunately, as there should be. And careful evaluation of data as there should be. The route of administration is unique. To me, the greatest side effect or, or adverse reaction related to insulin is hypoglycemia. If I have an insulin that is associated with less hyperglycemia, then I'm going to be really happy. And I will say that not every bit some of the studies but the Frezza have have suggested lower risk of hypoglycemia, because it doesn't hang around so long. So to me, the greatest risk of insulin is hypoglycemia, be it inhaled or injected. And so finding a quick and quick out insulin for mealtime, or rapid acting, or for intervening when the glucose is high, is is an advantage. I still

Scott Benner 27:40
need a Basal insulin if I'm using a third crack, so I'm going to inject a basil. You do okay. And so this is this is for meals or affecting high blood sugars, or for somebody who's using a pump to bring out high blood sugar down. Are those the use cases that you say?

Dr. Blevins 27:55
Yeah, I'm gonna say yes to all of those. I will point out that the approval currently is adult for adults, it's not approved for children yet, there's a big study that's been conducted that that is looking at that possibility and don't have results yet. And, and I'm optimistic but I don't know yet. It's approved for adults with type one and also type two. So certainly the adults with type one have to have basil. Most of the people with type two will have to have basil too. But there's some people will talk to you that might not need it. But you're also exactly right on this is for mealtime to get in quickly and cover the meals quickly. You know, your when a person doesn't have diabetes, the pancreas doesn't wait. It doesn't pick the insulin at at an hour, it peaks it quickly. And this gets about as close to that as possible. So mealtime is is number one. Number two, yeah, if you're a person's low two hours after a meal, because of the short duration, they can reduce it. And we had people do that in the study, and people on pomps if they have a high reading, and they want rapid reduction they could use it to. And I'll point out in a bit that in the study that we conducted, we had people who went off the pump to go on the study, and they went on to a Basal plus a Frezza. And many of them afterwards decided that they would want to stay on the injected insulin with the A Frezza. And we had a couple people who are on on pumps that decided to use the pump the automated pump as a background and use it Frezzer for the mealtime because of the rapid

Scott Benner 29:29
effect. Is that a thing that insurance is covering our

Dr. Blevins 29:33
results when it comes to getting things covered recently, this has been better and better. Good.

Scott Benner 29:37
Yes. Do you see? I might feel like it's off base for a second but I've now interviewed three people who probably have Lada who started a GLP and now are almost completely off of insulin are completely off of it for that for the time being I imagined but they still see excursions that their meals and they get like some of them are afraid to use insulin When at the excursion because like you said, the the insulin lasts so long would this be a better fit for that? Do you think?

Dr. Blevins 30:05
I have to admit I haven't used it in that way. But I will tell you that your thinking is exactly right. It's quick and quick out. And when a person has beta cell failure near failure, or you know, impending failure, the first thing to go is the postprandial. And the sales just can't keep up with the need. And so yes, the present would be a reasonable option in that in that case, and so I think you have to You're doing the right thing, Scott, you're thinking through, and then that would be one, wrap it in wrap it out, that would be a good potential. For person has a high sugar at bedtime? Frezza gets in gets out doesn't hang around overnight, make different times? Yeah,

Scott Benner 30:50
everything I think about insulin is about timing and amount, like meeting need with with impact. That's just kind of how that's the the entirety of the way I think about managing diabetes. So yeah, it's interesting. Approved for type ones and type twos. Yes.

Unknown Speaker 31:06
Okay. It is.

Scott Benner 31:07
But adults, what is that 18? And over? Or what's the cutoff at the moment,

Dr. Blevins 31:11
it is adults 18. And over, all right, and we're hoping for an approval, it goes down to much, much younger, and it would seem to be a very usable treatment for the pediatric population, because it's, again, it's discrete, it's quick, and you get rapid response to hyperglycemia. And that that just really fits the PD population, but a study has to be done. And then approval has to be obtained.

Scott Benner 31:37
Are there smaller instances of low blood sugars with a Frezza versus injectable?

Dr. Blevins 31:42
You know, there have been a number of studies that have looked at that. And I could go through them by name. But you know, One study in adults with type one showed that Frezza as rapid acting insulin, reduce the frequency or kept maintained it or reduce it just as well as in that in that study, they were using actually insulin as part which is Novolog. And also shown also in people with type two, and there are a couple of the studies have shown a reduction in hypoglycemia as well, because of the shorter duration of action.

Scott Benner 32:12
Okay, what's interesting, am I missing anything before I ask you to move on to the to the study?

Dr. Blevins 32:18
Well, I can I can say that. There are a couple things I might talk about the dosing?

Scott Benner 32:23
Yeah. Oh, please. You know what? Yeah, how did that slipped my mind? That is the most confounding part of this. And even when I asked people, listen, I asked the CEO of mankind, I was like, explain the dosing. And the explanation feels a lot like art, and not a lot like science. And I get that insulin is that in general, but I guess in a world where people are used to hearing my insulin to carb ratio, is this my insulin sensitivity is that that means if I do this, then this is how much insulin I use. This seems vague, I guess. So how does it fundamentally get used in a real world situation?

Dr. Blevins 32:57
Well, let me explain some of the dosing when I go to talk about that study, because I think that study helps to find the right way to dose. And that's why okay, but let me also point out that a Frezza, comes in three doses. One is called a four unit one and I say is called, and I'll explain that in a minute. One is called a four unit, one's called an eight unit, what's called a 12. Unit, the FDA requires mankind to assign the number to the cartridge of relating to the amount of insulin in each cartridge. Okay, that makes sense. But in fact, when you inhale, insulin, some of it gets caught in the inhaler a little bit, a little bit, get caught, gets caught in the oropharynx. And a little bit get constantly gets caught in the upper airway, so it's not going to get absorbed. And so what I tell patients is their three doses, four, eight, and 12. And you can't imagine how many people tell me Oh, four is way too much for me. And I say, Well, it turns out that for as to, when it comes to the amount that gets into the absorptive area of the lung, I'm going to also tell you, that is an estimation, but it works for is to eight is 412 is six. So if you are on four units pre meal, and you're going to change over to a Frezza, do you dose the four you're going to cartridge, and you might do the carb count this, I'm just gonna say if you're on four units, most time before meal, you use the four unit cartridge. And the answer is you can but your sugars not going to do as well because there's really only two units. So we tell people to use that conversion for us too. And by the way, this seems a little confusing, but I've given this conversion to so many people now. And the next visit, you know what they do? They come back and say remember for us to hate us for that. They understand it very well. And it's very straightforward for us to eight is for 12 is six and now that may have to be adjusted. That ratio may not be true for everybody but that works. So you can get people who are very, very sensitive on a four unit cartridge, and they're really just getting about two units. And that works. And then people who have to take more than, like, if they need, like eight units, in reality, the eight units of their usual insulin, then they would have to take a 12. And then nothing would have to take a four to get up to eight, because 12 is six and four is two. And they can do that they can take one Hila inhalation, then go out, cartridge switch really quickly. And inhale again, it's very fast it works.

Scott Benner 35:33
Do you think? I mean, you've spoken to a number of people, obviously, who reuse it? So what's the response? You get back from people using a Frezza? Is it? Do they find it easier? Do they find it more difficult, but worthwhile? Like, what's the what's the user experience? Without,

Dr. Blevins 35:50
we learned that the study, quite a few people who actually had been on the pump before actually decided they wanted to stay on it forever, either with or without the pump, either with with the pump or with Basal insulin. So So Pete, some people really, really like it, not everyone, it's not for everyone, it's an option. And, and the the critical thing here is that we need to be talking to people, we practitioners, we people, other people, people who have diabetes, need to be talking to people about about this, it is an option. And people should, should be exposed to all of the options available. I know that's one of my jobs in medicine period to say, Hey, these are things we can do. And and I give people samples, I let them try it. And if they like it, we move on. Lots of people want to get the prescription after they try the sample. I tell them about it. So a lot of people really do want this type of insulin activity. Some of the responses I've gotten have been, I want to continue it. One, the response I got from a somewhat elderly gentleman, there's no age limit on the upper end. In the end, he told me which which he said no one told me that an option like this existed, and I felt very badly because I'm his doctor. And that was my thing. He was he was sort of a little bit indignant, and I realized that I'm going to change the subject here. But he's doing really well on it. And I've had a few people say, is this insulin new? Because they like it. And they're why haven't we done this before? And another person just said, simply this kind of same thing. Why didn't we start this before? This was a personal study, not a person I was taking care of, as it turns out, in my own personal practice, but when she she volunteered for the study, and she says, wow, this stuff has this effect. Why didn't this get started before? So I Yeah. And some people say, you know, it's not for me, I'm coughing, they have the side effect. It's not for everybody. And some people say, Well, I like the way it works. But I really want to get back onto my pump. And that too, so that we had quite a few people. I could give you some stats on that here in a bit. Yeah, I

Scott Benner 37:56
imagine that that's just going to be the case with everything. But I think to hear that if I begin to take it and I get the call off, and I don't like the call off or it doesn't dissipate, eventually, stopping puts me right back to where I started again. Is

Dr. Blevins 38:09
that correct? That's right. Yeah, that's That's exactly right. So nobody's

Scott Benner 38:13
going to experience permanent damage. As far as the studies have shown or your experience.

Dr. Blevins 38:19
That's exactly what the studies show, when it comes to the FEV. One, that lung volume thing, and the cough will go away. As soon as a person stops, the med sore throat tends to go away. And so that would go away to You're right. You're exactly right. Yeah.

Scott Benner 38:31
For me, personally, I can tell you that, if I didn't have a lot of good information, when I started using a GLP medication, I can see that there would have been times where I would have stopped. I would just said like maybe the juice isn't worth the squeeze here. But I do know now that sticking with it was really was important. And you know, any of the kind of earlier side effects that I had really are gone. I'm doing 12 milligrams of zap bound right now. And I don't have any nausea at all. Well, like nothing. So yeah, that's great. Yeah, it's, it's sometimes you just your body's got to get accustomed to what's happening. Am I right about that, too, to equate those two ideas? I

Dr. Blevins 39:13
think so every medicine has potential side effects, and effects. And sometimes the side effects are not tolerable, and then that that dictates what happens. But many times the side effects are known, tolerable and go away. And, and you get the effect. So it's important. Every medicine has a benefit and a risk. So it's important that you look at medicines, just the way you're talking about these outbound. Look at medicines that way.

Scott Benner 39:40
So when you presented at Ada, is that where you presented the information about the inhale study? Yes,

Dr. Blevins 39:46
I along with a number of other excellent presenters. We had about an hour and a half session at ATA a few weeks ago. Seven presenters got 10 minutes each, and amazingly stayed on time. That doesn't mean Are we presented the inhale three study? What have you

Scott Benner 40:03
not said so far? In our recording the from the study that you think people would be interested to know about Skogafoss Okay,

Dr. Blevins 40:09
let me walk through the study and a real general kind of way. Yeah, yeah. Because the study is in people that are we take care of in practice and and people who agreed to go on a study and some of them took a bit of a leap. Because automated insulin delivery on the pilot with a pump, and these people, you wouldn't expect to go on a study like this. And then the people took a leap as well, some some of them had never heard of inhaled insulin. And one or two had been ordered before and they'd gotten off so they could still participate in study because it was it was they got back on it. It really is very typical patient types in the practice. And these were people with type one diabetes. This was a study that was done around the country, by the way, 19 sites from Jocelyn I won't name everyone, but I'll just say Jocelyn northeast Mount Sinai up in the Northeast University and University of North Carolina, Atlanta, and also Texas, diabetes and Endocrinology right here at Austin, a group in San Antonio diabetes and glandular UT Southwestern Barbara Davis did it Las Vegas, endocrinology Sansom, diabetes, Loma, Linda University of Washington, all over the country, Mayo to Northwestern, and all over all over the country, 19 sites, and the the entry criteria was people had to have type one diabetes, and they had to be adults, they could be on automated insulin delivery, they could be on just a regular pump without automated, they could be on multiple daily injection, they if they had asthma. And just to emphasize this, if they had asthma, or history of lung cancer, they could not be on the study, it turned out that about 48% Were on automated insulin delivery to start the study. Now, the way the study goes is that people are going to be placed on degla Deck, which is true SIBO plus a Frezza. Or they're going to be left on their usual care. It's going to be about, you know, half and half. So that's nearly 50% of people on pumps. Now, what does that tell you? I think that tells you that though, we love pumps, and I love pumps. Not everyone who pump is just totally enamored to the point that they want to go on forever. And they wanted to explore something maybe a little different. And that's kind of interesting. And we should be open to that possibility. And sometimes I think we're not. So most of the pumpers it turns out, we're on the tandem or the Omni pod. It turned out there about 123 people that were randomized 62 that means of course, they're put into one treatment group or the other about half into again, degla deck plus Frezza. And we call it in the in the presentation technosphere insulin because we're not supposed to use brand names in front of a group like a continuing medical education group that the ADA, our usual care. Now usual care was I stayed on what they were on. And it was a 17 week study, we did try to titrate the doses and the way we calculate the dose of the Frezza was that we would multiply the usual dose by two and then we would round down to the closest dose of a Frezza. So bottom line, we were doing exactly what I mentioned earlier, we were doubling the dose of a Frezza recognizing that only about 50% in each cartridge gets absorbed. And we did a what's called a meal tolerance test at the first of the study. And the people on the Frezza took a Frezza beforehand. And the people unusual care gave the insole however they normally gave it afterwards and I'll tell you about that in a minute. The baseline anyone see when people entered the study was about 7.6 With of course some variability but that's kind of the general part. I can tell you with the the baseline meal challenge that we did, again, the reference versus the usual the glucoses were clearly lower out to about 9120 minutes for the people who got it for so I could go into a lot more detail but it's the present gets in quickly. stops

Scott Benner 44:07
a spike. Yes, that's it. Yeah, it gets ahead of a spike right by the end without having to Pre-Bolus at all.

Dr. Blevins 44:14
Yeah, that's right. Okay. That's right. They didn't have to they gave the insulin right when they started to eat thank you for pointing that out.

Scott Benner 44:21
And yeah, I mean it's a big deal because it takes away from that having to like remember 1520 minutes depending on what my blood sugar is etc and so on. So a lot that's right. Yeah, yeah,

Dr. Blevins 44:32
yeah, that's exactly right. One of the people who I know pretty well who was on the study would be in a various meetings and he could just kind of whip out his little inhaler and dose himself right before a snack or eating and and he didn't pre Pre-Bolus did not do that. Is

Scott Benner 44:49
the to ever too much. The two unit cartridge does it is it ever too much where people are like, Oh, I have two more than I want to because I can't go lower.

Dr. Blevins 44:58
You know it it'd be but I have to admit, I haven't seen that happen. It's the four the four unit is the two is what you're talking about. Yeah. And that's a such a small amount. I have people who are very sensitive, I saw someone early this morning is on a Basal of like point two, or like actually reduced it a little bit. So, you know, plenty of people with type one are very insulin sensitive and many are, are really almost type two ish in their in their insulin resistance. So a lot of variability.

Scott Benner 45:27
Okay. All right. Interesting. God, I'm sorry. I didn't mean to cut you off?

Dr. Blevins 45:30
No, that's a great question. And now in terms of so that's the meal test. That's one one outcome, the other was a one C. So let me let me just pose the question to you and and the people who listened to this? And do you think that inhaled insulin with Basal insulin given one time a day placebo degla deck as a background could compete when it comes to a one C with an automated insulin top?

Scott Benner 45:52
I would think that anything that stops a meal spike, and can quickly defeat a stock high blood sugar without causing a low that would cause me maybe to treat and rebound high would have a better chance. Right? Yeah, that's my expectation.

Dr. Blevins 46:11
Yeah, well, you're you're you're right on, I think there were hopes that the ANC would be lower with the president because there was reason to think it could be competing against not everyone who was on automated insulin delivery, that we are the automated insulin pump on and the control group. But many were, it turns out at the end of the day, he was he was the same in both groups, really. So it was an A Frezza was not inferior, that, that I think that's quite an achievement. And there's more to it, though, when you delve and kind of dig into the actual data. And bear with me here, I'll try to make this as clear as I can. The proportion of people in the study, who achieved a one C levels below 7% 30%, with the Frezza 17% with usual care, which of course included the automatic pump, and 21% of those on a Frezza had a go and see improvements of point 5% or greater 21% versus just 5% with usual care. Now you're thinking, Well, how did the one seed turned out to be the same that? Well, it turns out that some people actually got worse. So 26% of people had about a point 5% worsening with the Frezza compared to just 3% of usual care. And and the bottom line here is that not everyone does better with a Frezza. Or as well. And you really have to be someone who is willing to actually dose sometimes between meals when you have a high and and be ready to do that. And is that

Scott Benner 47:48
what you saw that people would just kind of stare at high blood sugars and not do anything about them?

Dr. Blevins 47:53
Yes, yeah. Sometimes, we did instruct people to study if their sugar after a meal. And after the previous dose was over 140, then they could dose again, at one or two hours after, because for two reasons. One, we're aiming for very good control. Two, we know it doesn't hang around, they're not going to stack their chances stack is much lower, put it like that. Many people did that. And we're watching their numbers, and we set their alarms and just do it. And some people just just didn't want to do that. And that's pretty typical what we see in practice in general. I mean, we do see that,

Scott Benner 48:29
Tom, that's almost an argument for automated insulin delivery, because at the very least, if you go to a 224, your algorithm is going to keep pushing when the person maybe who's either unmotivated or distracted or whatever, is not going to do something again. Yeah, yeah.

Dr. Blevins 48:46
Let me say something about that. And that makes logical sense to me, too. It turns out and I'm, you know, asked me in a minute, that quite a few people who had been on the automated pump, who were on the in the Frezza treatment group actually stayed on the Frezza afterwards, so it's like anything else? This is an option. Sure. It's really not designed to compete with the pump. But this was a this was a brave study in a way to actually allow it to compete against automated insulin delivery. Actually, quite well. Yeah. And quite a few people decided that it was in their interest to continue on it would

Scott Benner 49:24
occur to me that there's probably like three outcomes here right? Either I listened to the direction and you know, either stayed where I was, or or did better, and I don't have to wear a pump anymore. So great. Or I did the minimum I needed to do and even my you know, my one C went up a little bit but I love not wearing a pump. So I'm you know, I'm down for this if that's yeah, or I guess the other option is somebody who's super motivated and really paying attention could probably terminate one seeing the fives with this if they were if they were paying attention and then on top of it, sure, yeah. Oh,

Dr. Blevins 49:59
I think you're I think you're right. And this idea of pumps are great automate is great. I love them. We've done studies with them, we use them in clinical practice, we use every one. They're wonderful. I mean, it is so nice, yet, many people really don't want to have the apparatus on their person. Yeah. And many people would just as soon have been, I learned a new term, a pump Keishon, you know, and, and sometimes they want it to be pretty long. So if there's an alternative for them, and gives them the ability to interact, they may take it. So it's, I would never have thought a person with a pump was a candidate for a Frezza. But I know better at this point based on the study. But your point is a good one. I mean, some people really do better do just very well, overall with the automated insulin pump right

Scott Benner 50:49
now. I mean, listen, I It's my expectation. I mean, I've been making this podcast for a decade now. And it would have been easy for me in the beginning to get lost in the idea that like, Oh, everybody wears a pump, or everybody tries really hard all the time. But that just seems to be the people that the podcast attracts either people who are desirous of living that life or wanting to get to it right. But I don't know the numbers. But I wonder if you do, the percentage of type ones wearing pumps is not as high as I would think it is. Is that correct?

Dr. Blevins 51:20
It's pretty high. It depends. It depends can depend a lot on various regions, practices, things like that. But I don't know the exact percent but it's got it's at least two thirds at this point. That's fascinating. Yeah, it is fascinating. Leaves a high percentage of people that are really that aren't on you would think that the technology would kind of bowl people over. But there are reasons not to wear a pop. I mean, one is, it's something you have to wear. The other is the catheter one way or the other is in constantly, and life situations like going swimming, and some things are just come more complicated things getting pulled off falling off and things like that, like catheters and that too. And this gets back to the idea of option. We should be giving people all of the choices and letting them experience and let them decide and not just say, Hey, you are a pumper, son. Let's do it.

Scott Benner 52:16
No, I'm gonna propose that yeah, of that. Yeah, yeah. Yeah. Yeah. There's a lot of different ways to hack your health situation. And at the very least, you deserve to know what they are. That's right. Yeah. No, I agree with that. Totally. Totally. What are we missing here? Anything.

Dr. Blevins 52:33
One thing that was really interesting about the study is that it's a short acting insulin. I've said this before. And we found that when people dosed at bedtime, they did better than theirs. People are so cautious, and had been so cautioned against dosing. Couple hours later stalking, and people have have been Tolo, don't take that insulin Bolus, don't take much at bedtime, you'll get low overnight, because the current sub q insulins hang around even the fastest, as I pointed out, and I talked about the fastest while ago, they hang around. And if you dose at bedtime, you could get in trouble. This one, you really need to guide the insulin at bedtime. And it's a big deal. And this one, inhale gets in and gets out as not going to hang around. And so we did learn that that dosing a bedtime was really important when it came to improving control. Now,

Scott Benner 53:27
I mean, I preach all the time to people, first of all, you can steal a onesie overnight, it's the easiest time because there's no carbs usually. And you know, making a thoughtful Bolus at a meal definitely stops you from having to, to address it again later, which is very likely going to lead to a low if you're not really adept at it. So yeah, but in for those people who are missing, and coming up on bedtime, they're very willing to go to bed with a 200 blood sugar or greater to avoid the risk of even getting low overnight, and then they'll start their next day high. And then then it's just a perpetual circle they can't get out of which is I think, you know, a lot of the ways where we start to accept Oh, my a one C seven. Oh, it's a it's okay. You don't I mean, there's nothing I can do about it like that minds. The mindset around insulin is and, you know, lack of tools and understanding are pretty much the drivers and in poor outcomes, I think, at least Yeah, yeah. I see the value 1,000% of being able to just say look, I have a 200 blood sugar here. I can pump this in real quickly. And, you know, an hour from now 90, would you say 90 minutes, maybe maybe three hours from now at the at the at the greatest? This? This impacts go on for me now. Sure. Yeah.

Dr. Blevins 54:49
Can we get it's gone. You could reduce it in one or two hours. That's what we found that was safe and it worked. And if you've got handy to guide your sugar down, you could guide it down with the quick hit And that devastated after meals that between meals bedtime, and then people learn to be comfortable with that because they've learned to not be comfortable. Like I dare you to take another dose of sub q insulin two hours after you eat and not get low or I dare you to take it a bedtime, we always have people take a bit of time to guide their sugar was sub q2, but it's a little, it's just a little different, you have to be cautious because the insulin does hang around, you don't want to leave the glucose high. With either type of insulin.

Scott Benner 55:29
I have a specific way I talk about snacking, because I genuinely believe both things. First of all, it's not stalking if you need it, it's bolusing. But that infers great settings and a great understanding of timing on your part. And then you know, otherwise stalking is 1,000,000% going to lead to a low blood sugar later, that is probably going to take more carbs than you imagine to stop. And yeah, and so there's you have to keep until you know what you're doing. The idea of bolusing inside of the window where the previous Bolus is still active is, you know, it's an issue because you're you very likely may do it wrong. Once you know what you're doing. I just think it's bolusing. At that point, if I know I need it, then then you use it right? And that doesn't lead to a low, which people also have trouble. Like, when I talk to people, you can see them processing and they're like, Well, I ate and I ate again an hour later. I'm like, wait, we'll be sure Bolus again. And they're like, Well, I get low. And I was like, why don't you get high if you don't? And they're like, yes, that's a person who knows their settings work. You don't I mean, Sakhalin, another person who doesn't just I talking to somebody the other day that said that they're on a pump, they see people on pumps who see doctors and still have a one season double digits. And I think How is that even possible? They don't have a good lead into this, the you know, they their settings are way off, or their understanding of insulin is significantly off. Right. So do you think that a Frezza is more of a ninja level? Or do you think that everybody could use it successfully?

Dr. Blevins 57:00
I think a Frezza. But let me let me let me go. Let me back up. I like that analogy. I think a Frozen is a one of the borders the Greenbelt. Okay. That's that's a starter, I think a presidency we talked about a green belt, and it may make a person a black belt. If if the if they use it the way it can be used? I think it goes all the way up, I think is something we should be talking about from the get go. Let people have the option of it. I don't think wait till any particular time. So now you're a Frezza person, I hope I interpreted your question. Some way did somewhat closely. Okay. I think it's something we need to talk to people about right off the bat, if it makes, if it fits their personality, their life, their thinking, their approach, then they need to know about now. And and frankly, you know, they really need to try it. We try everything along the way. Anybody on a pump has been on probably every insulin basil, you can imagine every bowl as you can imagine, but mostly, most likely they haven't been on present. That is something we need to grapple with. As people who prescribe and talk about options, people should have the options and should should be allowed to try them

Scott Benner 58:15
you find the doctors if they don't understand it well, and the whole force to this is that, like might stop them from understanding it. Like, are you fearful, I guess that this won't get the foothold it deserves. And the community

Dr. Blevins 58:28
and the in all societies already has had that happen. I do think that this inhale three, study. And I'll tell you more about the kind of what we learned here. Finally, as I close out talking about it, I think it really gives us a foundation better than ever. We already have foundations. This is not like the first study, there have been a lot of studies. This is a really good one, though, that tells us about the here. And now. What about against automated insulin delivery? How do you use it? What are the proper concepts that we learned from ourselves and from our patients mainly? And you know, how do you use it? And so I think I think you're right, I think that people don't understand how to use it, therefore they shy away from it. That's one thing. Second thing I think we've made these assumptions that people on pumps want to stay on panels forever. We could keep talking about other insolence for them. Thirdly, there have been a reimbursement issues that people have sometimes knock their head against a brick wall when it comes to reimbursement that's getting a lot better in our experience. And frankly, if we think an option is good for a patient, I'll say we need to go and go to bat for it and we do we do after the what I'll call the GLP one wars when it comes to getting things reimbursed and paid for I think we're pretty good at going to bat when it comes to getting things covered. So I think that whole reimbursement things better now to to there are a few kind of little blocks that have occurred along the way. Yeah, knowledge and reimbursement that that are better now. And I think This study has taught us so much. And our next job is to get all that information out to everyone in the in the people that prescribe insulin world.

Scott Benner 1:00:08
Yeah, I agree with you. I'll tell you, I took my daughter's endocrinologist the better part of two months to talk our insurance company to covering her GLP medication. Right. Yeah. And it was it was more about being on the phone talking, like sending the sending what they asked for worked at first, but then of course, a month later, they were like, we'll do it again. And you know, Mike, I'm like, are we doing this every three and a half weeks, we're gonna have to reevaluate like, what, what's happening here? So she finally got them on the phone and walk them through it. And they said, What did they give her? They gave her a three year window for GLP. Really, yeah, they're gonna reassess or they're gonna reassess her again, in three years.

Dr. Blevins 1:00:48
That doctor is very convincing, I must say, very persistent. And I, I admire that we do the same, we tried to do the same thing here. And, and with GLP, ones for people type one, or Frezza. And it's just the world we live in. I mean, growth hormone. We're, I'm an endocrinologist. And I prescribed things outside of diabetes, of course, and, and cholesterol meds that are hard to get. We're just used to it. And unfortunately, we really have I mean, fortunately, we know how to do it. But unfortunately, we have to go to bat repeatedly. And we just we do that. She's

Scott Benner 1:01:21
interesting, because she's not she wasn't born here. So she has a more less American idea of how things should be. But she's been here long enough that she understands how things work. And so I think I think not growing up in the system allows her to fight against it easier, if that makes sense. Yeah, but anyway, it does.

Dr. Blevins 1:01:42
Yeah. That's impressive. My hat is off to her. All right, good. Finding

Scott Benner 1:01:46
her was one of the luckiest things that ever happened to my family, actually, Dr. elevens, I really do appreciate this. I needed somebody who could talk about this. And I learned from the GLP conversations with you, you are the exact right person to talk about things like this with so I hope to have you back again on other topics. Thank you.

Dr. Blevins 1:02:02
Do we have a few more minutes? Oh, my gosh, if

Scott Benner 1:02:05
you do, I was over your time I was trying to let you go.

Dr. Blevins 1:02:07
Let me let me close out with a few comments, some of which are redundant, truly. But and then I'm then yeah, it's great. This has been fun. This is a whole talking to you is a lot of fun. I tell

Scott Benner 1:02:19
you, Tom, you and I seem to get along very well, I would I expect you're going to be on this podcast for years. So thank you,

Dr. Blevins 1:02:25
I'd be happy to I may have to put off the screening one a little bit. I've just got so much going on right now. But anyway, back to inhale. You know, some things we learned in the inhale three study. And this is a little bit of redundant. But these are a big deal. And I hope to get this information out as soon as possible to people who prescribe insulin, people who are first of all very involved in their own self management, they're perfect for Frezza. And if they want to reduce hyperglycemia, this is a good way to guide the glucose down. And people who would like to try something other than a pump. This study showed this was a very, very, very good alternative. And this thing about rapid in rapid out that is just golden. I mean, we could read those people, one, two hours after a meal, and we didn't see an increase in hypoglycemia at all. And we had actually people you'd be some people roll their eyes here, but we had people set their alarm at 140 and dose over 140. And I'll tell you not everyone did that. But the ones who did did well. And and so the people are gonna have to be, I think, okay, with multiple or extra dosing. Yeah, but this is something they've wanted to do for a long time. I think

Scott Benner 1:03:33
if people you're talking to on this podcast, my daughter's high alarm is at 120. So you're not scared? You're not scared. And then with 140 Don't worry, I'm

Dr. Blevins 1:03:41
so well, thank you for saying that. Yeah, because I felt I was imposing on people on the study, I'd say set your alarm at 140 and kind of look at him. Like, are you going to throw something at me? But no, I'm glad to hear that. That's so good. Because it works. So well.

Scott Benner 1:03:53
Yeah, I'd rather use a little bit now than a lot later. That's just the way I think about it. So go ahead

Dr. Blevins 1:03:59
and the other party or is that people who completed the extension phase, there was a second 17 weeks that I don't have information on yet but afterwards we asked them Do you want to continue or Frezza and I can just tell you if they were on multiple daily injection and before the study, and they were they were we said hey, you can go back to whatever you want 60% wanted to stay on Frezza if they were on pre study automated insulin delivery the fabulous automated pumps water No, I'd love to ask people what they what percent of people they thought would want to stay on a Frezza it was 43% and and then if they were on just regular old pump without the automated features 60% wanted to stay on a Frezza now maybe they selected themselves out to try something different. Okay, maybe so but that was amazing to me. Yeah. And and so why would you use in conclusion, why would you use a Frezza patients choice is number one, and number two, we talked about it in and out. It's discreet and inconvenient. There was a day when I've said the people that are the best candidate are people who are needle phobic, and people who had lipo hypertrophy, you know that fatty buildup that occurs when people give injections in the same place. But really, those are the bottom, they're not low. There are good reasons but they're at the bottom of the list patients choices number one, and and then we talked about the conversion thing. And, you know, in the study, we allowed people to Lex the insulin, we learned that if they're going to have a big meal, that could take an extra four, if they're gonna have a small meal, they could subtract from their Frezza dose, and then they can adjust their dose just the way they do with other types of insulin. And we did have people correct 60 to 90 minutes after they, they ate. And we had them sometimes interact with their rate of fall that they're seeing when they dose rate of rise too. So maybe a little less if it's falling, when there does seem a little more if this rising. And and I'll just also comment that in our, our site here, we had, I think eight or nine people on the study here in Austin, and we had about four of those who wanted to stay on. Oh, that's right, we had we had quite a we had more than 50% Who are to say on a Frezza. At the end of the study, whether they were on MDI, the automated insulin palm, people liked it for quite a few different reasons. And so it's easy for travel exercise, quick and quick out. And you could talk about scenarios quite a bit. So you

Scott Benner 1:06:29
don't have to refrigerate it when you carry it. Is that right? Does it have to be refrigerated when I carry it? Once

Dr. Blevins 1:06:35
you take it out of the blister pack it can say room temperature for about three days. Okay, now you would want to you don't want to keep your your stores refrigerated. But the supply that you're going to use the next few days can be at room temperature. Yeah,

Scott Benner 1:06:50
yeah. And thanks to the people who do the studies, by the way. And, Tom, if people want to jump on a study, can they contact you, I know you, you seem to have some running almost all the time.

Dr. Blevins 1:06:59
You know, the present study is over. And I don't have another phrase instead of yelling away, we are doing some studies and people type one diabetes who are on, especially on multiple daily injection of medicines that are kind of like ozempic, the GLP ones, and we're trying to get a drug approved for type one, that'd be great with GLP. One. And you know, as you said, your daughter's practitioner had to, you know, really go to bat to get it approved. And hopefully that could be a thing of the past in the future if we get something approved. So we're doing studies and people with GLP ones, we're doing a study with a medicine that might help reduce hypoglycemia, and people with type one as well. So if if anyone in the Austin region is interested in talking to us about studies, we'll be happy to talk to them. They could call the Texas diabetes and Endocrinology and ask for the clinical research department.

Scott Benner 1:07:48
Nice. That's excellent. Thank you. I really did I let you get everything out. You did. Great. Would you hold one second for me? I just want to ask you something when we're not recording. Yes. Great. Great. Thank you so much for doing this again. I really appreciate you Scott. It's a pleasure what.

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