#1658 Dr. Michael Haller Returns

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Dr. Michael Haller returns to discuss early T1D screening and how identifying risk markers can open doors to preventive steps that delay or slow diabetes onset.

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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
Welcome back, friends. You are listening to the Juicebox podcast.

Dr, Mile Haller 0:13
Good morning. Thanks for having me. This is Michael Haller. I'm Chief and professor of pediatric endocrinology at the University of

Scott Benner 0:20
Florida. My grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. What do these three things have in common? They're all available at Juicebox podcast.com, up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for you at Juicebox podcast.com while you're listening, please remember that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The episode you're listening to is sponsored by us Med, US med.com/juicebox, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us med. A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox I'm having an on body vibe alert. This episode of The Juicebox podcast is sponsored by ever since 365 the only one year where CGM that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days ever since cgm.com/juicebox

Dr, Mile Haller 2:20
Good morning. Thanks for having me. This is Michael Haller. I'm Chief and professor of pediatric endocrinology at the University of Florida.

Scott Benner 2:27
Michael, welcome back. I appreciate you for having me. No, I had such a good time talking to you the first time I thought we would come back and do something else. Let's see, do you remember what we talked about last time?

Dr, Mile Haller 2:38
We talked about lots of things that we started with the intent of talking about inhaled insulin and novel insulin therapeutics. I think we wandered a little bit into immunotherapies for delaying disease and protecting remaining beta cells for patients.

Scott Benner 2:54
And maybe we'll talk a little bit more about what early testing right now and things that maybe can be hopefully done for type one before the on the complete onset. Yeah, that's what I'd hope to talk with you about today. Awesome. I'm trying to look here while you're speaking. I have you trying to see what we called your episode, because it's not up yet, but by the time people hear this, they will have heard it, feel like I have it here somewhere, like it's a grand rounds episode. I think that's what I did. I did. I think, I think I called it grand, grand rounds, inhaled insulin. I think I called it because you were so thoughtful. People can go find if they enjoyed you today, after they heard this, they can go find more of you there. Perfect, excellent. You know, before we started recording, I asked you if you saw this, this news story about something I saw recently about CRISPR genes and somebody having beta cells replaced. And I want to get back to that, but I don't think I want to start there. I want to say at this point I didn't have a podcast, so it was over 11 years ago, maybe more, I had this scientist on that the JDRF set me up with, and he went on and on and waxed poetic about this pouch they were going to make, and the pouch was going to have cells inside of it, and they were going to open your body up, put the cells inside, give you this, you know, immune suppression, and this little wallet full of cells was going to act like your pancreas and on and on and on. And all I really remember beyond that from that conversation is that I asked him, All right, let's pretend for a second. You got it all figured out. It works. How long until I go to Target and get this for my daughter, you know? And he goes, Oh, 15 years. And I was like, wait, what? And he goes, Yeah. Like, if we had it worked out today, there'd have to be manufacturing. We'd have to get the cells. Like he was go on and on, what would have to happen, right? And he's like, so if we knew how to do it today, it would be about 15 years before we could have like, a mass roll out of it. Does that timeline still work? If something was found today? Do you still think it would take that long to get in the hands of an average person?

Dr, Mile Haller 4:54
It's hard to always predict what the regulatory pathway and timeline is going to look like, so I don't think. They were that far off. Sadly, I wish we could compress it a bit. I think it's likely that the timeline will continue to get compressed as more of these options for Cell Therapy come to be and they're potentially even more effective, and it might get a breakthrough status from the FDA, but it's not a trivial thing, to build up the machinery to manufacture these kinds of biomaterials and develop cells that are effective, and then do the studies that are going to result in getting approved. But of course, it's a noble effort, because for the 99% of patients with type one diabetes who are living past stage one or stage two, where they don't need insulin, or past stage three, where the early onset but still have a lot of beta cells left. We're going to need beta cell replacements to provide meaningful, curative therapies for patients. So undoubtedly, people will continue to do the work in that space to try to bring better things to the field as fast as we can. But, but, yeah, it's a slow process. When

Scott Benner 6:06
you hear people you know in your circles talking about all of this, is there ever any you want to get involved in something like, Forget medicine for a second? Like you want to get a car that does this thing? Or you, you know, you want a new television and you think, Well, I'm not going to buy it this year because I heard the one that's coming next year is going, does that happen in medicine too? Because it just occurred to me, like, if they figured it out, like today, and they were like, Hey, we can do it. And, you know, like you said, we're starting to build up infrastructure, and all the other things that have to happen is it not in the back of somebody else's mind, we're probably going to figure out something better than this before we can get this working. And does that feeling slow people down from like, rushing forward, like, Don't you have to be all in on what you're doing and see a pathway, not just to getting it to people, but to, I'm assuming, make money with it, so that somebody will actually get behind it. You know what? I mean? Yeah,

Dr, Mile Haller 6:57
I think that's a good place to compare the difference between scientists and academics and and the commercial aspects of these things. But obviously they have to work in tandem to ultimately get something to patients. You know, scientists are iterative people. They just like to keep doing things to learn and figure out how to do it better, and the notion of we're going to do it better at some point beyond, you know, the thing that I've developed tends not to bother the scientific community, because I know that's the means to progress. It's a bit more challenging on the commercial side. To your point, because, of course, you know, people there have to be able to generate a return on their investment by way of profit of selling a device or a product or a drug, and so they are very much in tunes to, is somebody going to have a, you know, a better widget? The day after I spent 10 years of development to build mine?

Scott Benner 7:52
Yeah, I write you a $3 billion check, and next week I find out I could have had something that was faster, better, cheaper, to production, etc, so on. Like, how do I know when to jump in?

Dr, Mile Haller 8:03
Yeah, so I think that has been a challenge in the type one space, certainly on the immune therapy side, because there hasn't been a large number of therapies that have gotten a label. At this point. We have typlizumab as the only FDA labeled immunotherapy for type one. And there is, you know, Zema cells are the first cell therapy for type one to get a label, mostly around the manufacturing process of that cell approach to islet transplant. But I think the technology space is probably a good example of where that can still be effective and provide patients fast access to new, meaningful therapeutics or machinery to take care of their disease, because there's a number of people in the space, and all of them are trying to innovate to make a better system faster, and there's room for everybody to both make profit and truly develop better better pumps and better CGM so my hope is that we get to a space in the immunotherapeutics or cell therapy world where that can happen too. I think we're just at the fair, you know, we're sort of at the infancy of of that with toplasymab, you know, getting getting across that first finish line, so to speak. But, you know, being nowhere close to the end of the race that we all want to achieve, which is, you know, having a handful or larger number of drugs therapies that we can offer to people who might be at any stage of the disease. You know, that may offer something that you or somebody else's family would call a viable cure. And of course, that may mean different things to different people. You know, there are folks who would be happy with a pump and CGM style cure to their disease if it really meant they didn't have to think or worry about their their diabetes, and they were comfortable and confident that it was going to take care of it. And there are others who, I think very reasonably, say nothing is a cure until I literally have nothing on my body and my body works like it's supposed to, and I don't need. Insulin exogenously there too. I think that the two things are going to continue to be developed in in parallel and hopefully complement each other. And I don't think there's a problem with that.

Scott Benner 10:09
I think you said two really interesting things are the first idea that, you know, using the like a pump or a CGM manufacturer as an example, like they're in the game already, so they need to keep iterating, because I think we've seen how society works with like, a phone, for example. Like, nobody's happy until the new one comes out, and you haven't gotten to I still have to touch all this a number of times. Like, I just, I told you before we got I was two minutes late jumping on because my daughter's rushing around. She's a little late for school, and she's like, can you please bring me a pod? Because I got to change my pod and like, until those, like, those touches go down, you know, right? You're still there. But maybe that's why we should be happy that it's Sanofi, right? They bought Tim as a pop from prevention. So, like, we should be happy that somebody threw their hat in with their wallet, because now they're going to keep pushing. They're pot committed now

Dr, Mile Haller 10:59
100% Yeah, use that exact phrase all the time when I'm talking to patients and families. They are pot committed. Companies don't commit that number of dollars unless they do see a way forward that can generate return on their investment. It all but forces their hands to continue to innovate and develop new therapies. So to their credit. Sanofi has a number of promising immune therapies in the pipeline that are in clinical trials as we speak, that hopefully will complement to plasmab maybe be better than diplomacy map may work better for certain patients. And so again, that may get us to that space where it feels like it feels with with pumps and CGM now, and you have some choice, and you can advocate for yourself and decide which one of those things makes more sense for you or your

Scott Benner 11:46
patients. There's a framework that can be built on, hopefully that somebody's, you know, they're in already, they're not going to stop now. You don't lay out 3 billion and then go, hey, you know what? Forget it exactly. Yeah, you'd push good money after bad before you just gave up. So hopefully that that keeps the process going, and maybe you'll find out that maybe that drug will lead to something for people who don't have diabetes, like, who knows what's I certainly don't understand the the mechanism of the molecule so, but I'm hoping they do, or they wouldn't have bought it. That's my hope there. The reason I bring this up, I'm going to kind of fold together with this next thought, and then we can move forward. I see a lot of conversations online around stuff like this, right? And people either they kind of lean one of two ways that, and the one way they'll Lean is, like, it's coming. They fixed it. I saw there's a lady in China. She doesn't have diabetes anymore. Like, you know, I saw this here. They did it. It's coming. Like, they're either way too enthusiastic or the opposite of it. And I think we've gone over the first part, I want to ask you about the latter, just your personal opinion. What would you say to somebody at a cocktail party, for example, who said, yeah, yeah, no one's ever curing this. There's no money in it. They want to keep me sick. It's more viable for them financially that way. And then they tell you the story about the light bulb that doesn't burn out. And they got the guy in the room and took his patent and his light bulbs and burned all the stuff. And like, you hear all those kind of those stories after that, like, I would tell you that if you asked me to just you gave me money, you said, Scott, you got to bet this one way or the other. I bet that if something comes up, it'll make it'll it'll see the light of day, and people will say it, they'll at least know it exists. I don't know if that means money will get behind it or not, but how do you feel? This episode is brought to you by Omnipod. Would you ever buy a car without test driving it first? That's a big risk to take on a pretty large investment. You wouldn't do that, right? So why would you do it? When it comes to choosing an insulin pump, most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period. Plus, you can get started with a free 30 day trial to be sure it's the right choice for you or your family, my daughter has been wearing an Omnipod every day for 17 years. Are you ready to give Omnipod five a try? Request your free Starter Kit today at my link, omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox find my link in the show notes of this podcast player, or at Juicebox podcast.com I used to hate ordering my daughter's diabetes supplies. I 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/juicebox, or call 888-721-1514, US med is the number one distributor for free. FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7 they accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with a better business bureau at us med.com/juicebox, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do.

Dr, Mile Haller 15:56
Yeah, no, it's a common question, and parents and families ask it all the time. I'm of the opinion, I think like you, that if you really had a therapy, a biologic approach, that was curative, you as a company could name your price. And the example I'll give that is gene therapies. Right now, there are gene therapies on the market that cure awful diseases. They cost three, four or $5 million a patient. Why? Because the return on that investment is well worth it, and insurance companies are paying it, because if they don't, that patient is going to cost them significantly more. When you look at the lifetime cost of living with diabetes, and I mean all costs, both for buying all the equipment and medical complications down the down the line, and you know, the quality of life, years added, there's no doubt that a therapy that really was a cure could be a profitable therapy for somebody. Now, will that put other people out of business? Yes, but that, you know, that's true of lots of things in the history of innovation and medicine is a reason why people should continue to strive for that, and why I don't buy into the notion that somebody is hiding a cure somewhere. That just isn't the way scientists work, certainly, and even though there might be companies in pharma that would benefit from things being slower to get getting to patients than others. Eventually, things at work are going to find their way forward.

Scott Benner 17:25
I would also be inclined to be a little more cynical but hopeful at the same time by saying that the person looking for the quote, unquote cure is not the person selling you insulin or pumps or whatever else you're buying, where people think like, oh, they want us to keep buying this stuff? That's another person like, there's an ice cream shop on the left side of the street, and I'm going to open up one on the right side of the street. My ice cream is better than your ice cream. I'm going to put you out of business. That's kind of my point is that if someone came up with a cure, they would get financial backing from a group of people who are not involved in diabetes, and those people would look at that as a way to get wealthy off of curing your diabetes, like, I don't know why, yeah, yeah, it seems simple,

Dr, Mile Haller 18:09
yeah. And, I mean, there's the real world examples of that even now. So look at the one you just gave was Sanofi, and they they make in Atlantis, you know, arguably the highest selling in terms of dollars. I think insulin in the world still, and yet they're in the space of trying to prevent or delay the disease. The world's market for type two diabetes and insulin is still huge. And so they can continue selling insulin for a long, long time in that market, even if there are biological therapies for type one. And similarly, Lily, you know, other major producer of insulin, is now in the immunotherapeutic space as well, because they have a therapy, paracetamol that that looked really good in a trial done in Australia called bandit, and they're moving forward to do a stage two and stage three study for potential labeling in the US, internationally. So I think there's places for company to companies, even, even single companies, to be in both spaces and essentially be diversified so that they can have opportunities down the road. Again, I'm not a business guy, so that's not the way I think, but I think that that's that's a reasonable way for for people to see the space and try to avoid the sort of conspiracy theory mindset that somebody is going to keep something that's going to help people and patients locked away.

Scott Benner 19:30
Yeah, okay, I appreciate you going over that room for everybody out there is worried about it. Go find Bigfoot or something. Put turn that, turn that energy on something important as to whether or not there's really UFOs. Need pictures of messy too. Yes, listen, I run a very small business compared to the business that someone's going to run one day if they come up with a cure for diabetes. But if you handed me the cure for diabetes right now, I know how I would market it. You know what I mean? And I not a business mind. I'm assuming that smarter people than me can figure it out. By the way. I want to say I don't think they just see. Dollar signs. I also think that people really motivated people like that. I think they would enjoy having their name attached to something that changed the world that way, right? Great. Michael, like, wouldn't you want your name on that? You know what I mean? Like, if you had that kind of thing, I'd want people to know I did that. I'd want people to I'd want people to know that somebody figured it out that science figured it out, that maybe you guys should get out there and work on something else. Because look what we figured out. You know, we absolutely, yeah, it's only been, what it said, 100 years or so since they came up with insulin. That's the other thing that cracks me up. Like it's been forever, like it's been 100 years. That's not long. This episode of The Juicebox podcast is sponsored by ever since 365 and just as the name says, it lasts for a full year, imagine, for a second a CGM with just one sensor placement and one warm up period every year. Imagine a sensor that has exceptional accuracy over that year and is actually the most accurate CGM in the low range that you can get. What if I told you that this sensor had no risk of falling off or being knocked off? That may seem too good to be true, but I'm not even done telling you about it. Yet, the Eversense 365 has essentially no compression lows. It features incredibly gentle adhesive for its transmitter. You can take the transmitter off when you don't want to wear your CGM and put it right back on without having to waste a sensor or go through another warm up period. The app works with iOS and Android, even Apple Watch you can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox one year, one CGM.

Dr, Mile Haller 21:43
It really isn't. It is sort of amazing when you step back and think about where we've come in 100 years, from an insulin at all to, you know, all these analog insulins and pumps and CGM that were, you know, purely science fiction are now reality, and they're only gonna get better. So yeah, I think the pace of discovery is accelerating, and I think there's lots of reasons to be hopeful rather than pessimistic, but at the same time, you have to be a realist and know that unfortunately, the cure is not tomorrow or even next year. Yes, it's still a ways away.

Scott Benner 22:19
So then I'll share with you, and I'll ask your what you tell people, but I'll share with you the when someone asks me directly, Scott, what do you think about there being a cure for type one? I will tell them the same thing over and over again. I live hopefully, but we're pragmatic, so day to day, we act like it's never gonna happen like that. Arden's health long term is focused on us doing a great job day to day, hour to hour, sometimes, right? Like it's never going to happen, so we need to keep her as healthy as we can for as long as we can. But I'm also not, not hopeful, and I do think all this stuff is incredibly interesting. Like, am I going to see it in my lifetime, I'd bet against that. I'm in my mid 50s. I'd bet against that, right? If it happened, I'd be thrilled. What I hear is that if somebody came up with it today, I'd be 69 by the time maybe they could get it to market. I'm also listening to stories about how AI is changing every three months. So in my mind, medical research is going to probably get more and more, I don't know, hopefully faster, with the help of, you know, baby like, instead of bench doctors and people sitting down, taking notes and keeping spreadsheets and hoping to find, you know, a connection between this and that maybe AI will get better and better. They'll all dump their data into it, and the thing will go, Hey, I can't believe you haven't noticed this. You know what I mean, like, and maybe that will speed things up.

Dr, Mile Haller 23:49
Yeah, I agree, yeah. And I think that's a appropriate and reasonable way to think about progress. I also am a big believer in having hope. Am optimist. But the thing that drives me nuts is false hope. And there are a lot of people out there who, unfortunately are pedal it contour salesman. They're pedaling in misinformation. And all that does is serve to, you know, upset people further. It's like the whole notion of, you know, the decade of a cure and just just, it's right around the corner. I think that's that's not being fair and transparent, right and realistic for people, that just sets the field back. So I will never give people a timeline either, because I just don't think that's right. I don't think we really know. So why I suggest that you do, but I do think we're every day making progress towards it, and I

Scott Benner 24:37
appreciate that people need to fund their labs, but every time you save a mouse from something, maybe you don't make a press release, because there's every time you do that, it finds somebody whose kid was just diagnosed 10 minutes ago, and they think, Oh, listen, it happened to me 2007 my daughter had diabetes for less than a year, and I woke up one morning, was reading the news, and there it was somebody. Ordered a mouse from type one diabetes, and I actually said to my wife, I can't believe how lucky we are. Arden was diagnosed with type one diabetes right before they cured it, and that was 19 years ago, and I was like, really heartbroken when I realized, when my poor wife had to pull me aside, she's like, listen, dummy, and she explained it to me, but it's how emotional I was at the time, yeah, it's

Dr, Mile Haller 25:21
hard. You can't ignore those things. And fortunately, there are great discoveries made in the lab on a regular basis, but, but I agree with you, I hate that the press and sometimes even the investigators over promise, yeah, and then ultimately, under deliver, when people finally realize, oh, well, that was the 500th experiment, the nod mouse that was curative. Obviously, none of those have translated yet to humans in a very meaningful way.

Scott Benner 25:50
So if you look at those, Michael, the conclusion you come to is that we'd be better off trying to turn people with diabetes into mice, because apparently we know

Dr, Mile Haller 25:58
really good at curing mice. Fantastic at that. You know, I don't care much about about the mice. I care about kids and people in with type one, and so, yeah, that's patients and families all the time. It's just to start a model. It's proof of concept. And to your point about AI like we are now building and have used these in silico models where we we dump in all the data from all the clinical trials of type one in people, and try to model, you know, what might happen with different therapies. So, so you're right. I think we will get faster and better and smarter and hopefully have more personalized approaches as we, you know, understand that that type one diabetes is really 1000 different diseases with different flavors, and some patients are going to need, you know, a certain therapy, and others a different one. And so hopefully, as we continue to get better and better at that, we can, we can really provide meaningful therapy

Scott Benner 26:49
to more people. I genuinely don't remember where I heard this the other day, but some guy running a lab somewhere, I don't even know what they were researching, and he says, Because of AI, he was able to, I guess, fire a lot of his staff because the AI is doing the work that the staff was doing. And I thought, Oh, great, he'll cure the disease, so that people have more time to sit around and not do anything. They won't have a job, you know, at least we'll all be alive. So anyway, all right. So right now, September 2025 what's the best thing we have going? Where should people be focusing? And is there something they could be doing for themselves or for loved ones? What is real and tangible?

Dr, Mile Haller 27:25
Yeah, I think the lowest hanging fruit silver lining kind of stuff is around screening people for risk, for type one, and identifying the ones who are unfortunately going to develop the disease early. Now we know that the community rate for diabetic ketoacidosis at diagnosis is between 30 and almost 50% in some some communities, and unfortunately, we do a far better job of treating DKA. Analysis that the fatality rate is low, but it's not zero, and it's devastating when we lose a kid because of, you know, a previously undiagnosed case, and DKA, on the other hand, if we're screening effectively and identifying people early and getting them enrolled in follow up and early stage clinics, that DKA rate goes down to less than 1% and we convert, you know, a traumatic diagnosis story with an ICU admission and parents not knowing if their kids gonna survive to still a terrible diagnosis, but one that is far more gentle and safe and allows people to transition to the know the idea of now I gotta live this life with type one diabetes, and even there, we're doing a pretty poor job of screening everybody who is at high risk. You know, one in 300 people in the US, at least kids get get type one diabetes. So it's not a particularly rare disease. And that number is one in 20 when you start talking about first degree relatives of people with type one. And last time I checked, you know, everybody had a mother and a father and and most people have siblings in this country, and so there are tons of people living with type one whose first degree relatives are not being screened. And it's really a shame that we're not doing that, because that that's not a research question anymore. You know, it was when we first started doing the diabetes prevention trial and trying to figure out, could we pick up who are the people who are going to eventually be the type one patients of the future? That question of equipoise is a research question is answered, and it's now something that should be standard of care. And every pediatrician and family practice, Doc and internal medicine doc who has patients with type one diabetes, they'd be reminding them, and if they see their siblings or their parents or their young nieces, nephews, cousins, should be reminding them, telling them that they should be getting screened for type one antibodies. And the hope there is if we identify all these folks, so we develop better therapies that will come. Convert type one diabetes from an insulin managed disease to the immune mediated disease that it is, and pick up these folks and treat them to delay their disease, and hopefully one day be able to prevent it

Scott Benner 30:12
entirely. So first of all, like, I think that's awesome, but I have, you know, a kid with diabetes, and there's autoimmune stuff in my family, and I look up at my extended family and I see autoimmune in them that they don't want to hear about you. Try to tell them, and they ignore it. Nobody wants to hear so let's say I actually do get them to go to the doctor. How do I get them to a doctor that doesn't just go, you don't need to scream for that? You're fine, because you're gonna like, it seems like there's so much, I'm gonna use the word ignorance. There's so many, so much ignorance on this path. Like, right? Like, we're counting on me, or somebody like me to say to somebody else, hey, you know, I think you ought to look into this. If you're lucky enough to talk them into it, they're going to go to a doctor who's very likely going to tell them, Nah, you're fine. Don't worry about

Dr, Mile Haller 30:54
it. No, you're absolutely right. I was, I was just at a diabetes camp weekend, Family Weekend, this weekend, a lot of new onset families. And I asked them, like, how many of you had your endocrinologist in this your endocrinologist, not even just the their, you know, their general pediatrician mentioned that your family members should be screened for antibodies, and the response rate was abysmally low. I think it's just a failure of education, of our ability to, frankly, do a marketing job of telling people there's so much out there to know in terms of medical knowledge and practice. So you can't know everything, but this is something that's pretty darn simple, requires just ordering before biochemical antibodies that are in everybody's electronic medical record system to order now and getting folks to do it. So there's a system we call therapeutic inertia that exists until it becomes standard of care meaningfully, even though it's written in the guidelines. Now, it's just not yet something that everybody is practically doing. And changing people's behavior is hard, so we got to start by educating, educating, educating, and get people to be aware, and then they start to do it. And once it becomes habit, then then it will spread. So that's what we really need to be working on.

Scott Benner 32:07
Yeah, the pathway to it seems, I mean, full disclosure, I did ads last year for screen, for type one, and even I was as I was making the ads, and I was like, God, this seems like this isn't going to work. There's a lot there. And then I've seen how they've kind of gone this year with the I'm gonna get, I'm gonna guess the Chrissy Teigen People magazine article has something to do with it, right? Like, and that kind of stuff. But that's not, I don't know. It just feels to me like you just maybe got to go to the doctors and say, like, look, just take a family history and just you need to be the one to say to them, like, hey, why don't we screen for type one diabetes while we're here? Because, I mean, because that's cutting out a number of steps. And, I mean, it would seem to, if you're gonna, like, I don't know, it just seems, it seems like a lot to me, to for me to have to talk a family member into believing and the family member into being lucky enough to find a doctor that's in on this whole thing, and then, even if they are for that doctor to then know what to do. You know, afterwards is the LEAP again. I think the education doesn't lie with the public. I think the education lies with the physician that could order the test that's just

Dr, Mile Haller 33:12
completely agree with you. I think the, you know, the screen for type one program, which is supported by, you know, Sanofi, is really focused on general population screening and guidance, because ultimately, 90% of new onset patients don't have a family member. So you know, just screening family members is going to not give you the biggest overall yield of future type one patients. But my counter to that as always, well, we're not even doing that low hanging fruit of screening all the family members of people who do have type one. So we should kind of, you know, crawl before we walk and run. And you're absolutely right. I think the focus needs to be on educating the providers. They're the ones who have to click the boxes to order the labs, and if they don't even know the names of the labs. They're certainly not going to do that. So we have to, you know, educate them, make it easy for them to do, make sure they get, you know, appropriate reimbursement for when they're spending time talking about counseling and screening for autoimmune disease and Type one. And so those are things that we're actively doing. You know, in Florida, for example, we had some funding from the state this year to expand screening programs for type one, and so we're doing exactly that. We're doing educational sessions, providing continuing medical education for providers going to providers clinics, to literally show them how to order antibodies and what their options are for doing it with either point of care collection kits or sending patients to commercial labs or doing it through a research assay. So I think you know all those modalities have to be used and have to be optimized before we're going to see, you know, the real large number of folks being screened in. For the 60 something 1000 new onsets a year in the US. You know, it's only a tiny, tiny fraction of those that knew that they were going to progress and had antibodies measured before the disease. And that's a shame. I mean, many of those folks we could have picked up if people were screening family members.

Scott Benner 35:17
You know, can I thank you for a second, because I sat in a number of meetings saying this, and people looked at me like, Oh, look. Podcaster boy thinks he knows what he's talking about. Thank you for agreeing. That's all I wanted to say, because I feel, I feel vindicated, because I felt Listen, Michael, and between you me and everybody listening, I took their money and I made the ads, but I first tried to tell them like, I don't think this is where you should be putting the effort. Like, I've been in this space a long time, like I think you want to go this way. I was, I think I did an interview once, and I've said it to them privately, to beta bionics with eyelet. I was like, I don't know what you're doing for marketing, but skip it and just go write the PCPs, because those are the doctors that are helping people with type one who don't go to endos, who very likely do not have good outcomes. Start slapping your eyelid. Pump on those people that's going to help them. Like, you're going to take people with 1011, 12, A, one, CDE, put their a, 1c, and seven. Like, come on. Like, that's a no brainer, but those are the people you're trying to find. You're talking to me, you're on a podcast. I'm talking to people who are on the razor's edge of their diabetes care. These are people who are forward thinking, out in front, putting a tunnel like effort into trying to figure out how to get a six, five AC to a 1c down to five nine. They're trying to get their time and range from like 80% to 85% they're not they're not trying to turn a 12, a 1c into a seven, like you're looking in the wrong places. The

Dr, Mile Haller 36:37
marketing for the one percenters is different than the folks who are,

Scott Benner 36:42
Michael, no one listens. I sit here and get frustrated sometimes with this screening thing again. Like, you know, I guess I'm never gonna get an ad again, but you guys are going about this all wrong. The lady on the peloton that's not going to do it for you, okay? Like, come on, who's watching peloton videos. Michael, you know what I mean.

Dr, Mile Haller 37:05
I can't disagree with you. I know all screening is good in that we identify more people the Yeah, it does seem like they kind of jumped steps one, two and three and went straight to sort of step four, when they when they could have gone with with a lower hanging fruit

Scott Benner 37:22
ESPN, whose wife or daughter or somebody has type one. I'm like, Oh my God. Like, you got to get your head out of New York and the marketing scene there. And, like, see what it is you're trying to really accomplish here. You know, are you trying to put together a marketing campaign that looks awesome? Are you trying to actually reach these people? Anyway, I said that in a meeting, so I'm not afraid to say it here. They never called me back, so I don't think they agreed with me. But you know,

Dr, Mile Haller 37:48
I've done some advisory boards for for companies too, and I'm not shy about sharing my opinion, but sometimes that means

Scott Benner 37:57
they're not calling me again, but they, you know, the funny thing is, is that they should. They really should. I mean, you other people like me, like, I've been around this for so long, like, I know how it goes. You can't just hire a marketing team who no one has diabetes on the team. They don't know anything about it. They spend the first 30 minutes of the phone call asking you to explain the drug to them, like, you know what I mean, and then, and then suddenly I see all this money goes out the window, and there's tag lines and colors and websites. And I was like, this isn't going to get seven people screened. I would actually like to see people get screened, because I've interviewed people who have used that drug and their kids are not developing diabetes. I've interviewed the people who, you know, actually put that pouch into them. You know, for science, maybe this getting screen thing will or won't lead to you having some benefit, but it's definitely going to lead to somebody having a benefit 510, 15 years from now. Like, if we all don't like do a bit, this ain't going anywhere. Like, everybody's got to do their part to make this move forward. You're not just sitting back waiting for the people or the guy or the lady with the thing to do the thing. It's not like that, like everybody's got to get involved. You know, it ain't gonna go anywhere.

Dr, Mile Haller 39:11
Yeah, and I think that's where maybe the pharma folks are hoping that they're seeing, you know, 10 years down the line where we really are doing general population screening and its standard of care, and every single kid who comes through the pediatrician gets antibodies screened and and they're not wrong in that that's what it will ultimately take to identify every single one of those 60,000 kids who's going to progress before they progress. But you know, some of our group's counter argument has always been that's nice, but, but there's all these folks over here that are much higher yield on the per patient ratio that we're not doing a very good job of yet, either or yet, and we should probably focus on those folks first.

Scott Benner 39:51
Yeah. Well, listen again. I want to thank you because, like, sometimes I feel insane in those conversations and and it's not lost on me. Listen for people listening. It's not. Lost to me. I'm a guy that makes a podcast. I have no degree, I have no background, like Michael, you went to more school the first day of college, and I've gone to my entire life. Okay? I mean, this is obvious, and somehow it's not obvious to the people who are making the decisions half the time. And that's that's upsetting to me, because I really do think the screening would be beneficial. But anyway, good luck everybody. All right, so let's pretend they actually get somebody to get screened. They find a doctor who's willing to screen them. What's the process like? What do they expect to have happen next?

Dr, Mile Haller 40:29
Yeah, so I think we're just trying to give people choice providers, namely choice and how they do this, and make it easy for them. You know, there's the point of care, collection kits, enable Biosciences. There's point of care collection kits from the Ask study run out of the Barbara Davis Center, Colorado. There's even home kits that we provide capillary collection through through trial net. And then there's sending people to get a Venus draw at Quest or lab core. And you know, I think proponents of screening in high risk populations, we just need to make it as easy as we can, so that there's no no other inertia, creating barriers for folks to get it done, because there's always a reason, an excuse, to not do something when it's not an emergency in the person's eyes. So that's, that's what we've been trying to do, and certainly awareness campaigns and education campaigns for for the doctors helps and and then the next step, of course, is when they get somebody who's positive, we have to make it as easy as possible for them to do the right next thing, which is first confirm the antibody status. I'm I'm somewhat surprised by the number of folks who get, you know, a single antibody test and then label themselves as having early stage diabetes without a confirmatory antibody, which the you know that that should be done for sure. But then when somebody you know is identified with with multiple antibodies and confirmed with antibodies, they need to be followed up in, you know, an early stage clinic. All the data that I spoke of before that shows reduced eka rates. You know, that wasn't in the vacuum of somebody just being told your antibody positive and walking away your antibody positive. And we're going to follow you, you know, with metabolic testing, and remind you of your risk for type one, you know, every three to six months in a study setting, and that's where we saw the decay rate go so low. So we want to make all those things easy for providers. So we Florida, our team here has set up an early stage clinic where most of what we do is guidance and education, and because of that, we're able to serve people throughout the entire state because we do it through a telemedicine clinic. So if you're a doc in Key West, or your doc out in the Panhandle and anywhere in between, you can call us and we can set up a telemedicine visit with a family to talk through what it means to have antibodies and what their child's risk really is and what we should be doing to monitor them, and then that allows us to talk through all their choices and options. Do you want to be in trial net and have follow up that way and be offered studies? Or do you want to just have clinical follow up and be a candidate for typlizumab? And I think, you know, the most difficult thing is talking to families after the fact, when they're diagnosed, and they say, Oh, I wish I had known about all these opportunities. And they just, you know, they just didn't get that opportunity. Because in their world, their circle there, there weren't people who who knew about the the notion of screening and follow up.

Scott Benner 43:38
Yeah, yeah. Well, Michael, the the amount of I wish I would have in the world, or are great, right? I wish I would have wore my seat belt. I wish I would have stopped smoking. I wish they are endless. Yes, that's usually when it's too late, is when you're flying through the air, thinking maybe I shouldn't have brought a motorcycle. I feel like we're talking to, I don't know if you're aware of this, not Michael, but a lot of physicians and clinicians listen to the podcast. So I I really feel like, like we're making a bigger picture argument to people out there to get screened, but at the same time, I hope who we're really talking to are the people who could actually maybe make a difference on this. So for those of you listening, here's an example. I interviewed a woman not so long ago, and her kid was, you know, misdiagnosed a couple of days at a time, and then there was a person who was supposed to call and tell her to go into an ER, but, you know, went home from the doctor's office without making all their calls that day. And you know, some days later, her daughter's in the hospital throwing up what they described initially as black tar, and eventually, and I forget what it is, it's not common, okay, but it happened to this kid or esophagus and like that. Trust me, the details are lost on me. Go find the podcast episode, but it was like, from the DK, like it was rotting inside, like she was throwing up her flesh. And that is not a thing that's going to reverse for her, and now the rest of her life is impacted by. This. And literally, somebody just had to say, like, why don't we do a finger stick? Why don't you go to the hospital? And so many people drop the ball along the way. And I'm not saying this happens to everybody, but it happens to more people than you think, and some of those,

Dr, Mile Haller 45:15
no, it's a common experience. And just at this family weekend, I asked people to tell their their diagnosis stories. And invariably, you know, there's one out of 15 or 20 that was seen by a handful of providers in the weeks prior to their diagnosis with symptoms and signs that should have been plainly obvious. And like you said, all they needed to do was a finger stick or even a urine dipstick, and the diagnosis would have been made prior to the kid or adult getting particularly

Scott Benner 45:47
sick. And that's it's good that you bring up those numbers, because I do think that, generally speaking, most physicians, clinicians, etc, like, do a great job for people like, I'm certainly not,

Dr, Mile Haller 45:58
you know, it's not the majority of people, but it's still too many. You know, one's too many. So it happens, absolutely, when

Scott Benner 46:03
it happens, it happens that you have no idea how many people come on this podcast, they start talking about their health. And I'm, I want to be 100% clear. Michael, I think the number was 56 days. That's how many days of my senior year I didn't go to school. Of high school, okay, because I was poor and I went to my job at a my uncle's sheet metal shop to make $4.50 an hour. Okay? And so I would go to work instead. I was not a good student, and I still graduated, and I went along the way and blah, blah, blah. And now here I am making this podcast. And I realize you all probably wish it was somebody else whose diabetes podcast got really popular, but you're stuck with me. It was mine. Here I am interviewing somebody, and they're talking about their life 10 minutes. I'm like, Hey, you're anemic. And they go, what? I'm like, you're anemic. You have hypothyroidism. No, I don't. No, you do. You just described it to me. My point is, I know when people describe it to me, how the hell does a doctor not know? Like, this woman's describing her kid who went through this DK, and the whole time she's talking, I'm thinking like the kids got type one diabetes, like no one notices this when it happens to somebody again. I don't think it's a lot. I don't think it's everybody. There's a ton of you out there doing a great job. No one's talking to you. But every once in a while, we're going to hit a clunker, and some people hit a couple clunkers in a row. They go to an urgent care, they don't get a good answer. They go to a doctor, they don't get, Oh, you got the flu. Blah, blah, blah, next thing you know, you're throwing up your esophagus like that kid's got a real lifelong problem now that a week earlier didn't exist in them, if somebody would have just said, Hey, it sounds to me like you might have type one diabetes. And my point is, is if a guy that skipped his senior year of high school to cut sheet metal could figure it out, I guarantee you that a doctor could figure it out too, like it just something's wrong along the way. I don't think we're going to fix that bit, I guess is my other point. You know what I

Dr, Mile Haller 47:47
mean? Well, despite your despite your lack of formal schooling, clearly you are gifted in the art of observation and talking to people. This is why your podcast has been so so successful. And good physicians do exactly that. And unfortunately, the current American healthcare system has disadvantaged providers in practicing the art of medicine, and they don't always take the time to sit back and recognize what is fairly obvious to others, hindsight always being 2020, so it's easy to Monday morning quarterback it but to your point, like those, those kinds of misses are still far too often and easily could have been avoided if we did a better job of educating those providers you know about early signs and symptoms of type one, and at least made sure it was somewhere in the back of their mind, so that when the next kid comes in, you know, vomiting and losing weight in the middle of flu season, they don't just write it off as being as being flu or gastro enteritis and send them

Scott Benner 48:51
home. I'm sure this makes some people upset, and you know, who are scared of AI and me, you could probably mark me as somebody who's scared about what might be able to what might happen too, but I do have this like I am 100% certain I've settled on here so many times. I hope somebody just steals the idea, because I don't certainly have the capital to get it started, but I think that it would be incredibly valuable if people had an app on their phone that they spoke to and just told it how they felt, that would iteratively keep all of their conversations and complaints and continue to look at them, because that's, to me, is the way that you're going to diagnose things in the future. Because even if you get a good doctor, you're counting on, I mean, Michael, you know this, right? You're counting on the person to come in and actually say all the things and not to mislead you with their theories about what's going on. And then you have to You're also arguing with your wife and you got a kid who's like, you know, I mean, like, everybody's got a life. There's a lot going on in people's heads. If you had a simple, personal AI that you said, like, Hey, I woke up this morning and my knee hurt, like, anteriorly, just right here. Like, I don't know it's only happening when I'm driving. And, you know, this happened to me, and my bowel movement was kind of runny today, and, blah, blah. Lot, eventually you'd say enough to it that it would go, Hey, you should look into this, because that's really what you're asking of a doctor, but you're asking them to do it 10 minutes at a time, three times a year. And I really,

Dr, Mile Haller 50:12
I'm bought into the use of AI to take care of patients already. I mean, I have many times put symptom complexes or patient complaints in to see if it broadens my differential or makes reminds me of something I didn't know before. And right? My philosophy in teaching has always been, you know, don't memorize stuff, understand it, and it just makes that so much easier. Now you don't, you don't have to memorize every single pathway or every single name of a drug, but if you at least can give, you know, a large language model like chat, G, P, T, the right information to go find it. It will make it far more efficient for you. So you can get back to that, that art of medicine, of really observing and talking to patients and families and and that's what I think the future is like. I don't think AI will replace doctors, but I don't think there'll be any doctors, successful ones who don't use AI, right? That's just, that's just the way it's going to be. So you can either choose to adopt the technology and let it help you take better care of people, or, you know, you can become a dinosaur,

Scott Benner 51:12
yeah, and it'll stop people from having to send a bunch of people into DKA to learn their lesson as a physician, because that is really what happens, right? Like, it's trial and error, like everything else, like you everything else, like, you keep having experiences, Till one day your brain just goes, Oh, that's this. Like, I've now seen that enough times that it just pops into my head. It's not lost on me. You can't teach somebody everything they need to know to be a doctor in medical school. Like, I get that, yeah, you know, and that there are some people out there who want to be great doctors. There's some people out there. They're like, hey, my mom told me to be a doctor. I'm a doctor. And, you know, yeah, right. Like, so there's a, there's a, you know, a mix of of situations you're going to run into. But going back to the person, the person who's sick, they don't know who they're going to go talk to. They don't know if you're about to walk in with a doctor who's been at this for three days or 30 years. Like, you know what I mean? Are you the one they're going to send into DKA to learn their lesson? Like, that's that doesn't need to be like that anymore. I think at this point, when I go to a physician now, or if I send my kids, I know with reasonable certainty what's going on before I get there, but everyone's been directed. Don't say it out loud. Keep it in your Keep it inside. Let them do their job. And if they don't get to what you're thinking about, that's the time to lay your bread crumbs out and say, Well, I also saw this and this and this. I was wondering if maybe it could be that, and let them think about it. Because I find that if you go in and say your thing, then they don't do their process. And you don't want to take them out of the loop. You'd like to hear what they think and what they what their you know, thought is here. But you also don't want to walk in and walk out when you're 99% sure this is the problem. So I don't know, like I hope everybody I know people say, advocate for yourself. It's I hate that honestly. I hate that word. I hate the idea that you need to do that. I hate the idea that there's possibility that I'm going to run into a physician who you know, if I don't advocate for myself, isn't going to help me. Like you have to arm yourself with as much knowledge as you can, let the physician do their job and then fill in where you don't hear back from them. But you got to do it in a way that doesn't rub people's egos wrong or come off like you're telling people, it's, it's a it's a dance, it really is. You know, it's hard to go to the doctor, is what I'm saying. You know, there's too many people walking around might go with a TSH of four being told they're fine. They've got six different things. They're struggling with it. All point to hypothyroidism. Like that just happens all day long to people. How does that happen? By the way, yeah, well,

Dr, Mile Haller 53:39
that's a that's a good example of one that the data don't really support. There being much that should be treated with the TSH that's in that range, but lots of people come in with the symptoms, and it is hard for physicians to differentiate the ones that may really have symptomatic hypothyroidism that needs to be treated with a high normal reference frames, TSH from, from those who have very valid complaints, but they're coming from other things. So it's not all black and white in medicine for

Scott Benner 54:10
sure. Yeah. So you need people who have been through it enough times to say, like, look, I see the symptoms. I'm going to get you some medication. We'll, we'll see what this does here. And, yeah, I mean, that's just that. One's a is a thorn in my side because it, it, it really, like, derailed a large portion of my wife's younger life, you know, like walking around, fortunately, yeah, it's just, it's, it's upsetting and so, and now, since then, I've had tons of doctors on who talk about it differently. There's a great thyroid series on the podcast, if you really want to understand it like Dr Benito comes on and talks about she'll medicate you 2.1 or higher with symptoms you're you're going to get a thyroid replacement from her. Interesting, yeah, and she helps people at an incredible she's one of those doctors you can't go see anymore because too busy. You know. Do you think that it all. Ends up going that way one day, are the ones that really know what they're doing just going to open their own practice and be cash pay?

Dr, Mile Haller 55:07
Oh, I hope not, just because I think that will result in only a small portion of people having access to to the best of care. I mean, it's tempting for physicians to do that because it's, you know, because it gets rid of all the middlemen and logistics and allows people to spend a lot more time with their patients and provide care that way, we here at our at our institution, at least in our clinic, it's we're about 60% Medicaid, so we would immediately be leaving almost all those patients without access to endocrinologist if we did that. So I think we just need to do better jobs of of improving the system so everybody can have access to good

Scott Benner 55:43
docs. Yeah, is there anything that we didn't talk about that you wanted to that was lovely conversations got I appreciate it. Thank you. I'm gonna keep bugging you to come on like you're great to talk to. Thank you. I appreciate your time. Hold on one second for me. Okay, thanks. You.

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#1657 Bain’s Mom Marlee (TikTok) - Part 2

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

Scott talks with Marley, mom to one-year-old Bane, diagnosed after DKA and a life flight. From ICU to CGM and Mobi, she shares hard-won reality, faith, and growing TikTok advocacy.

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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 back to another episode of The Juicebox podcast.

Marley 0:14
Hey, my name is Marley. I have a type one diabetic, one year old son named Bane. And you may have seen us on Tiktok or Instagram and now even Facebook, but we just post our life as a family handling type one diabetes and our toddler son, and just go with the flow and do whatever.

Scott Benner 0:39
This is part two of a two part episode. Go look at the title. If you don't recognize it. You haven't heard part one yet. It's probably the episode right before this in your podcast player. If this is your first time listening to the Juicebox podcast and you'd like to hear more, download Apple podcasts or Spotify, really, any audio app at all, look for the Juicebox podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management. Go to Juicebox podcast.com up in the menu and look for bold beginnings, the diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin while you're listening, please remember that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Today's podcast is sponsored by skin grip. Your devices, they can fall off, but with skin grip, they stay secure for the full life of the device. Juicebox podcast listeners will save 20% on their first order at my link, skin grip, Comm, slash, Juicebox, if you want a durable skin safe adhesive that lasts you want skin grip. This episode is sponsored by the tandem Moby system, which is powered by tandems, newest algorithm control iq plus technology. Tandem Moby has a predictive algorithm that helps prevent highs and lows, and is now available for ages two and up. Learn more and get started today at tandem diabetes.com/juicebox the episode you're about to enjoy was brought to you by Dexcom, the Dexcom g7 the same CGM that my daughter wears. You can learn more and get started today at my link. Dexcom.com/juicebox dexcom.com/juicebox, I mean, obviously he's very little right now, and the world's a different place, and kids are more accustomed to this. This is like, a thing. But have you given thought to like, how long would this go for? And at what point does he get an opportunity to say, like, I don't want people seeing this, or like, I mean, it's got to go on through your head, right,

Marley 3:02
for sure. And I get those comments. I used to get them a lot more, but I never did this for followers or for anything that Tiktok has brought Like, I literally posted a video of me put on his Dexcom, really, to just show my friends like, this is the life that I have to live. This is why I don't work anymore. This is why I can't go hang out with you right now, because I'm busy watching my 15 month old with diabetes. So when I post videos now, I'll never force him to sit on the couch and be like, film this video like that's just not how I am sure if we're outside and he's doing something crazy, I'm always having my phone out anyway, taking videos of him way before Tiktok, just because that's the kind of stuff I want to remember when he's acting like that. So when he gets older, if he ever tells me, like, I hate this, I hate that you did this, I will, you know, apologize to him. I will take anything down that he wants. But also, I feel like his story is reaching so many more people that aren't diabetic and don't have any family with diabetes and don't understand type one diabetes, and I feel like he has a purpose and a testimony that should be publicized. I don't tell every single thing about him. I don't tell, you know, I don't tell his numbers or any I don't do that type of stuff, because there is stuff that should be private. Like, yeah, there's stuff that should be private. He's my baby, but I do want people to understand I feel like people need to understand diabetes and toddlers so that he's safe in the real world. He can't even go to daycare. You know what? I mean, I

Scott Benner 4:39
spent a while of my life sitting in a car outside of a daycare so Arden could go to daycare.

Marley 4:44
Yeah, like, I can't even send my one year old to a daycare so I can go work. No, it's tough because he's not safe. And the reason he's not safe is because look at all these trolls on the barbie launch Facebook group, from Facebook page, commenting all those horrible. Things about diabetes, like, that's the reason he's not safe, because people think just don't give him the brownie, he'll be fine,

Scott Benner 5:06
yeah, right? Or that you've willfully done something wrong, and therefore you don't, I don't know what deserve, like, good health or something like that.

Marley 5:14
You know, you don't know who you'll be dealing with. Like, he's just not safe at this point, and he can't commute, yeah, he's starting to communicate, and he's starting to learn what feelings are in his body, and when he goes low, how he feels, or if he's high, he's starting to kind of feel that stuff, but he needs somebody to advocate and talk for him and teach him. And you know, people that don't understand this, ain't we

Scott Benner 5:38
get along. Because I feel like what you're telling me is you can't tell one head from somebody who's not a shit.

Marley 5:42
So exactly, you don't know if that daycare teacher was on that Barbie launch talking

Scott Benner 5:46
crap. Yeah, no, no, no, I hear I felt like that's what you were saying. And then as you were talking, that is definitely what she's saying. She's like, I can't tell the good ones from the bad ones. Just looking at

Marley 5:56
them and those comments were horrible. Did you see them? Horrible? I had to stop.

Scott Benner 6:00
I've been at this a long time. When the Barbie doll came out, I already knew exactly what was going to happen.

Marley 6:05
Like, I had to stop. I was like, it was horrible. I was feeling, yeah,

Scott Benner 6:09
you know, we do this thing in my Facebook group, like, when something like that happens, I wait about 12 hours, and then I'll put up a post, and I'll be like, hey, has anybody heard about this Barbie doll thing? Because, like, there's already been 1000 posts about it. And then I'm like, anyway, I'm joking. Can we stop posting about the Barbie doll please? Like, the whole page is, like, consumed with it. We all get it. And then what I don't say out loud, but I'm thinking, is, like, 54321, the crappy comments are gonna start.

Marley 6:35
Oh yeah. And they and they always are there, no matter where you go. Like, there's gonna be crappy comments. Well, you know, you just block them and keep on rolling.

Scott Benner 6:44
But then some people are gonna get insulted by it. Then some people are gonna get, like, zealous about it, like, we have to fix this. And I'm like, Are you ain't gonna fix this? Like, just

Marley 6:52
some lady told me, she said I had glasses and buck teeth when I was little, and they didn't make a Barbie for me. I said, Well, I wish my child had glasses and buck teeth over diabetes.

Scott Benner 7:03
That's a pretty interesting statement to make. Yeah. What a comparison. Oh, your child, that's what I said.

Marley 7:09
What a comparison, like buck teeth and glasses and there is Barbies with diabetes. I mean, with glasses.

Scott Benner 7:17
Like, what do you mean? You know, don't you feel like sometimes people think they're being deep and they don't realize they're just dumb.

Marley 7:25
I'm like autoimmune disorder that can kill you if you don't have insulin over glasses and buck teeth.

Scott Benner 7:30
Okay, those comments eventually become every level of people's political ideation. Like, right? Like, why don't we just keep making Barbie dolls? And you know, they don't need to be for anybody special. Like, did somebody say, like, what's gonna happen next? Is Barbie gonna be in a wheelchair or something

Marley 7:46
like that? Yeah, there was like, what's gonna be next crackhead Barbie? I'm like, What do you

Scott Benner 7:51
mean? Can I say two things that's not a child friendly doll? So I don't think that's going to be,

Marley 7:56
yeah, exactly. Barbies are for kids, right? But what people would say, or, Why are we Norman normalizing needles? I'm like, we can't help that. You have to inject insulin. Like, my toddler can't take that breathable insulin.

Scott Benner 8:13
Also, just don't buy the Barbie doll if you don't want it, like, exactly, I'll say you weren't buying one to begin

Marley 8:18
with, exactly. You're just here to troll like, that's why you're here. You're a 45 year

Scott Benner 8:22
old guy and who seems to have a little bit of free time to talk about a Barbie doll in the middle of the day, so I'm worried about you as well.

Marley 8:30
I posted some of the comments on my Instagram story, and somebody DM me back, and she was like, I hate old grumpy women.

Scott Benner 8:40
Listen, I've been at this a really long time, like I've seen every, every iteration of person, you know, from I don't know, just plain old crazy, to just plain old, mean, plain old drunk. I've seen plain old high. I've seen thinks they're smarter than the rest of the world, everywhere, just anything you can paint a picture of there's somebody out there, you know, who's like, oh, I have a thought. I definitely have to share, yeah, especially on Facebook. Listen, my Facebook group is awesome, but we also, oh yeah, and yeah, people don't troll in your Facebook group. Well, I mean, listen, some people do, and then they get pruned out. Because that's not it's there to support people. It's not there for you to complain. We're there to learn and teach. I think it would be interesting sometimes to have conversations with the people who have been, you know, asked to leave, or, you know, we're just, we're taken out of it. And you know for sure that because we have these, like, it's not done lightly, like nobody's just, like, kicked out of the group, yeah, group of people who look in, in say, like, here's what I'm seeing, here's what I'm seeing, here's what I'm seeing, here's what I'm saying. What do you think? Like, you know, like this. And in the end, it just becomes about, like it's proselytizing at the end, like somebody just thinks that there's a thing they believe that is so important that it supersedes everything else. It needs to be spoken about all the time. And if you don't agree with them, somehow you're a monster. Yeah, and that's the thing with the Barbie doll. Like, it's like, look, it's not like, what's next? A crackhead Barbie? It's, I don't like the way the world's going. People are soft. Like, that's what they really mean. Like, just get a regular Barbie doll.

Marley 10:14
Somebody said it's this new generation. Everybody's got to be included. And I get that thought also, but it is a big deal when my one year old's at the park and a kid runs up to him, why has he got that on his leg? Why is he wearing that on his leg? And you're having to explain to a five year old that your kid has a disease that could kill him, yeah, and he has to wear this.

Scott Benner 10:35
I also, by the way, I mean, I could sit here and make the argument the other way, if you wanted me to, like, maybe there's something to their argument of, like, just a Barbie doll's a Barbie doll. It doesn't need to have other i I'm sure that if you want to go sit with a bunch of your friends at dinner or something and have a an academic conversation about whether or not Barbie should have an insulin pump or not, like, go ahead and do it. But that's not the same as just getting online and just attacking somebody for it. Or, like, yeah, exactly, like, it's just not the time and place. Yeah, it's weird. Like, you know, like you're grown and these are kids. That's what, in the end, that's what I end up thinking. Like, no matter what level of like, whatever you want to call it, I see I sit there, and I'm almost jealous. I'm like, how do they have the time for

Speaker 1 11:19
this? Yeah, exactly like you are grown. I would love to have the

Scott Benner 11:23
kind of free time that it must take for you to jump online to complain about my diabetes podcast that you don't have to listen

Marley 11:30
to. Instead, I'm trying to catch up on sleep, because I was up with my son with his low blood sugar

Scott Benner 11:35
all night. Yeah, like I, how about I got a job? Yeah, exactly. There are things in this life I detest. I have never spent a second making sure that the person knew about it. Like, you know, like, if I go to a movie and I don't like it, I we walk out in the lobby and I go, Yeah, I didn't love it. That movie sucked. Yeah, exactly, I don't then try to figure out how to contact Warner Brothers. Yeah, exactly, exactly that part. Like, I don't think I'm ever going to completely understand that part of it.

Marley 12:05
I think it just, it literally just shows that type one diabetes isn't is so unknown to basically all humans on Earth, unless you deal with it or have somebody that you're close with that deals with it.

Scott Benner 12:20
Yeah, yeah, no. I mean, usually you do have to be involved.

Marley 12:24
You have to, you have to be involved with type one somehow, because to grasp it completely, yeah, truly, you don't understand what goes into it until you see it

Scott Benner 12:33
firsthand. And Marley, and I'll tell you this too, and then you're still not going to grasp it completely, like, I have it from my perspective. I'm going to just tell you right now, like, I don't want to burst your bubble. Live with this. Yeah, I'm gonna, I don't want to burst your bubble. But my daughter just had type one since she was two, and in a few days, she's going to be 21 wow, she goes through more stuff than I'm ever going to understand, for sure. Yeah, and some of it I'm not even aware of, like, some of it I know about and can't contextualize, and some of it I'm never going to be aware of. And in fairness to everyone else out there who has a kid with type one diabetes, I've spent the last 11 years talking to people trying to figure out how they feel, so that hopefully I might understand how my daughter feels a little better. And guess what, it doesn't really help that much you can manage diabetes confidently with the powerfully simple Dexcom g7 dexcom.com/juicebox the Dexcom g7 is the CGM that my daughter is wearing. The g7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smart watch. The g7 is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes. The Dexcom g7 can help you spend more time in range, which is proven to lower a 1c The more time you spend in range, the better and healthier you feel. And with the Dexcom clarity app, you can track your glucose trends, and the app will also provide you with a projected a 1c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom, dexcom.com/juicebox when you use my link, you're supporting the podcast, dexcom.com/juicebox head over there. Now this episode is sponsored by tandem Diabetes Care, and today I'm going to tell you about tandems, newest pumping algorithm, the tandem mobi system with control iq plus technology features auto Bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandem diabetes.com/juicebox, this is going to help you to get started with tandems, smallest pump yet that's powered by its best algorithm ever go. Control iq plus technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead, and it adjusts insulin accordingly. You can wear the tandem mobi in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately, clip it discreetly to your clothing or slip it into your pocket head. Now to my link, tandem diabetes.com/juicebox, to check out your benefits and get started today.

It's still her thing, very personally and even like, like, look, I don't think you're ticked. Like, I don't if somebody wants to make a Tiktok, I'm certainly not against that at all. But like, trust me, we could have a 15 minute conversation where I could tell you five things that would make you shut it off right now, you'd be like, Oh, I didn't realize how that could go. Doesn't mean it's gonna go that way. And it's, it's for you to figure out, and it's for him to figure out. And it's the same way with the podcast. Like, I'm sure I said something last year I wouldn't say this year. Yeah, exactly. You're always learning, yeah, I'm sure I said something 10 years ago that if I listened to it now, I'd be like, Oh my God. Like, that was ridiculous. I'm sure I said something three weeks ago that I'll wish I didn't have said but, but that's not how we figure things out like, like you being willing to like, point that camera at something, or me being willing to like, open up this microphone, not plan ahead, say whatever comes into my mind, knowing I might be right. I might be wrong. I might be like, my tone my I may be tone deaf on something like, all the possibilities, but like you can't look at it in the moment, like, you don't judge that five seconds, or this day, you have to step back when it's over and say, like, this was a journey that this guy, Scott, went on making a podcast. And is it a net positive? It is then great. Like, that's it. Was everything right? No, was everything perfect. No, do 20, 3040, people a day send notes that say, my life's better today than it was before I found the podcast. Yes, yeah, time for us, if I have to say something and be wrong, or Thumper through something trying to figure something out, or misspeak, or whatever the hell happened, I don't know what happens. Like, you know, like you're just talking like and in the end, it's getting people to a better place and in mass. And so I say, good for you, and you're, I guarantee you're doing the same thing.

Marley 17:29
Yeah. I mean, I feel like we get comments daily, if not that, say, like, my daughter just got diagnosed. Like, give me tips. What works for you? What over patches do you like to wear? Like, what kind of food do you like to give him? And you know, if I can help him any bit, I do not know everything. I do not know a lot. I feel like, but I'll help them, or lead them into that, diapers and diabetes Facebook group and heartbeat.

Scott Benner 17:54
Yeah, no, it's a wonderful thing. Like, you have to look back before the internet and say, all those people who had diabetes had all these same thoughts, and it began and ended with them, and unless they were lucky enough to meet a great doctor who oftentimes has to have type one if you're going to get the kind of down deep that you need, yeah, or they were maybe lucky enough to go to diabetes camp and have a good experience, because, by the way, I can point you to 10 episodes of people who went to Diabetes camp had a bad experience, so, like, everything had to go really super right for them just to meet another person or 10 more people that have type one diabetes, to not feel quite so alone. Yeah, and you're telling me now that they can pick up their phone and no matter how their brain takes something in, like, whether it's an hour long conversation between you and I, or it's a 22nd long video that somebody puts up on Tiktok like there's something out there for you to help you feel better about this and give you some information or even a direction to look into, right? There's you can't tell me that's a bad thing.

Marley 18:53
I think that's how Tiktok has saved me, because I don't know anybody that deals with being a mom of a type one diabetic toddler like no one in remotely close to me that I've ever seen this happen to so when I got on social media and I met these moms that have dealt with their child like I have a friend, her son's name is Miles, and she posts his life. And they have a diabetic alert dog. He got diagnosed at 10 months old, and anytime I need a question answered, she is there to help me. And he's now five years old, and she's dealt with it for this long now, and it just helps you feel seen, and helps you learn things from parents that have dealt with this that doctors and diabetic educators just don't understand.

Scott Benner 19:38
Yeah, there's a lot of good that's going to come out of it. And, you know, like, I said, like, even if you said something that was completely batch crazy. Like, people are smart enough to go, well, I'll ignore that part. The world's become like, a place where information is available and it's available the way you the way your brain works, even, which is even better. Like, sometimes people say to me, like, Hey, listen, I'd like. Have to listen, but I don't, I'm not good with audio, yeah? And I'll say, Well, we, you know, we have transcripts, if you think that would help. And a lot of, like, way more people, Marley, like, when Listen, when somebody told me, I need a transcript from the podcast. I was like, read it, yeah? I was like, What the hell? Like, you know, because that's not a way I would want to do it, yeah, but I heard them, and I was like, Here you go. Like, here's what I can offer you. They're AI generated transcripts. They're not perfect, but they're way better than nothing, and a lot of people read the podcast. So like, I'll tell you something that even I learned this week. I have about think I have 11 group experts who are just people in the Facebook group who help, you know, people answer questions. They'll say, like, Hey, here's an episode you might want to try, or here's a link that might help you, like, you know, trying to help people with with their questions. And this one person who is dear to me told me the other day, I don't listen to the podcast, and I'm like, what? I said, No. And she goes, No, I read it. And I was like, what? Like, I've known you for years, like, you don't listen to podcasts. She says, I don't think I've heard three episodes of it. That's so funny. Yeah? And to me, like, that's a thing that I would have never met things differently, yeah, yeah. So it's awesome. Like, and by the way, I'm not good at short form content. The way I do it. This is how I do it. Yeah, I can make a Tiktok. Nobody's gonna care about it.

Marley 21:26
I'm sure they would, honestly, because you have some stands I have,

Scott Benner 21:30
well, yeah, but I'm, I don't think I'm good at it. Is what I'm saying. Yeah, I know what you mean. Like, even if you listen to me talk about anything, like even Barbie I mean, let's be fair. I need 300 words to say what I'm gonna

Marley 21:41
say? Yeah, I feel you. I feel you totally, like, a little bit more time.

Scott Benner 21:44
Yeah, people are not, like, up for that on that platform? No, they want it quick and fast. No kidding, right? And even on YouTube, like, I don't want to, like, I mean, you should see me right now. I'm sitting here sideways. My foot's on my desk. This would not be interesting for you to watch, like, while we were talking, right? I'm good at, I'm good at the audio thing. I don't know. I just, I think there's so many different ways to reach people, and I'm grateful for anybody who's out there trying to do it. Now, for some people, it ends up becoming like a business, I know for me, like I have ads on my podcast. Like, it's certainly a thing that I do every day and spend, I mean, the better part of 1516, hours a day on sometimes, I'm wondering about you if, and you don't have to tell me, but I'm interested. Like, I think everybody thinks on Tiktok that you're all getting rich. But like, can you explain to people getting rich? Can you explain to people how it works? Because I actually think I know the truth, but I'd love it if you told somebody

Marley 22:36
so on Tiktok, I think you have to have 10,000 followers to get in the Creator rewards program, but you only get paid off new views, okay? And your videos have to be over a certain amount of time, okay, so if

Scott Benner 22:51
you somehow got to like, 3 million of your 4 million,

Marley 22:55
those viral, like those videos that go viral, yeah, you might see a few $100 you don't get, right? So you're not getting paid 1000. Like, it's just not, like, not what people think. No, yeah, and I'm not posting him to do that. Like, no, no, I don't money that we've made off tick tock. We're actually taking a huge family vacation next year for Bain. Like, we're doing this stuff for Bain. Oh, that's nice. So you're telling me that money back for Bain, yeah?

Scott Benner 23:22
So you're telling me that the money you've made from Tiktok is going to take your family on a nice vacation, yeah,

Marley 23:27
we're going on, like, this really nice vacation, a once in a lifetime opportunity for him, and it's something that he'll cherish and remember. I mean, he might not remember it because he's not even too but I'll remember it, and he'll have pictures and, you know, it's just that type of money's for him. If he gets brand deals, it's for him,

Scott Benner 23:44
right? And does that happen? Do people reach out and want to, like, do like a brand deal with you?

Marley 23:49
Yeah, he's an ambassador for a lots of different companies. Like, I don't know if you want me to say I'm on here. Honestly, he's an ambassador for, like, Spy belt. He does like some bars that, like, Wait, he loves Dino bars. He loves that zip bars. Like, they'll send him, they'll send him little snacks and spoil him. But no, we're not, like, rolling like, I still work. Yeah, no, I have a job.

Scott Benner 24:15
Yeah. I just think that people think that you're just like, oh my

Marley 24:18
god, Beatties is expensive. Like, you got to have jobs,

Scott Benner 24:22
and even if a company were to come along and offer you something for a video, like, I don't want an actual number, but we're talking about a few $100 like, right? Like, it's not going to be crazy, right, right? It's they're not. Like, hello, here is a pile of money. Here's $100,000

Marley 24:39
scam your your followers and tell them that this is awesome, like, and I'm not that type of person

Scott Benner 24:44
anyway. Yeah, no, it doesn't work that way. Is what?

Marley 24:47
Unless I love something, and that's something we use every day. No, like, I'm not gonna post that

Scott Benner 24:54
I even like one time some I said to somebody that I worked with, I was like, What are you paying those Tiktok. Years, and when they told me, I was like, Oh, I'm like, oh, okay, never mind. Yeah, I didn't understand exactly what was happening there either. I thought, like, bigger ideas and not the case.

Marley 25:09
So my goal for Bain is not necessarily to be Tiktok famous, or whatever you want to call it. It's more like, I just want, like, How People magazine put us in their magazine, and they put out an article about us, like, I just want people to realize that this is something that can happen to your toddler, and this is how we have dealt with it as a family, and this is how my son has dealt with it up until this point. And this is how, yeah, you know, my view of it is.

Scott Benner 25:37
It's exactly why I started that blog. I was like, I wonder if I could just raise more awareness around

Marley 25:41
this. Yeah, it has nothing to do with money. They could take the money away and I still would post tomorrow.

Scott Benner 25:46
Like, I have to tell you that this morning, I got a text and someone said, Could you do a one hour zoom at a diabetes camp? Like, could you zoom in for an hour and talk to people? And I always said, I said, Absolutely. I said, yes right away. Then it turns out the date overlapped with something else that I'm doing, albeit touched by type one that exact same day. And I said, Oh, I'm so sorry. I'm speaking that day already. I'm like, I don't see how I could carve out an hour from that day to do this, but I actually sat and thought about it. I thought like in the middle of one of the most busy days of my life, could I find an hour and do another thing for somebody? And I couldn't. So I said, is there another date I could do it? Yeah. She said, Well, maybe you could do it the next day. And then I thought, like, maybe I could jump on a plane and fly to that thing that night and then be there the next day for it. And by the way, that would have killed me. I'm old sleep, and I'm trying to think about how I could do it. And I could do it? And I said, Well, I could definitely zoom in the next day. And then she's like, well, we have another one in a few months. And I said, I'll definitely do that one for you. Doesn't interrupt anything. She goes, That's awesome. Thank you. Then she said, how much will we have to pay you? And I was like, for what? And she goes, like, well, is there's a speaking fee. And I was like, I mean, like, you just want me to jump on a zoom for an hour? And she goes, yeah. I'm like, I mean, I'm an adult, like, I'd just be happy to do that for you. Yeah? And it was like, really? I was like, don't get me wrong. I said, if you want to, like, dump a pile of money on me, I'll be happy to take it. I'm like, I'm not gonna tell you, No, yeah, but I'm not gonna shake $400 out of here for this. That's ridiculous. I was like, just tell me when it is and I'll make time. And I'll do it. I don't think people would think that, you know,

Marley 27:23
they wouldn't think that they wouldn't, especially the type of people that don't have your best interests or don't believe in you as a person, or what you're doing, that's the first thing, like, you're using your child's disability for money. No, I'm not, like, I never did this for money.

Scott Benner 27:39
I can't imagine that anybody could start this and think that they were going to like that. It was going to

Marley 27:44
work out again, rich off diabetes, because it ain't me. It's like Eli Lilly, you know what I mean?

Scott Benner 27:49
Well, listen, I also, I don't, I'm not crying poor. Like, I have a pretty big podcast, and I have a lot of sponsors, and I do make a living from it. Like, there's no doubt about that. Yeah, there'd be an argument to be made that if I, you know, assigned a reasonable dollar value to all the people that have been helped by it, that I'm probably not making very much as much as you should. Yeah, exactly. I don't assign a value to it. It is what it is. And by the way, it's not going to last forever, and

Marley 28:15
it's your it's a greater purpose, like, that's your testimony. That's how you're helping people.

Scott Benner 28:19
The word legacy has been used to me a couple of times in the last couple of weeks. I never really never really thought about that way, but I feel like, for sure, you have a legacy. Feel good about that. You know, also, it's social media, it's gonna just stop one day. Like, it's not a job that, like, I make a nice living, right? Like it's it's comfortable for me, and it's a thing. By comfortable, I mean, it's an amount of money that pays my bills, that allows me to save a little bit that, like, you know, makes me feel like that my time is being compensated in a way that I'm comfortable with. Like, I could go get a job and make more money, yeah, for sure, I kind of feel the same way, right, so, but I'm doing this, like this, but also, like, try to be like, a little like, understanding this could just stop, yeah? Like, what am I gonna do? You know what I mean, what am I gonna send out a resume that says, hey, I made a really popular podcast. Yeah, people are gonna go, we don't care about that. Yeah? Like, I need somebody that knows how to build this wall or knock this thing over do this thing. Like, I can't just go get another job, and, by the way, just starting another podcast that's over too. Like, even that was, like, it's a moment in time. Like, right now, you don't start a new podcast and get to where I am unless you're, like, famous already, like, yeah, like, you've built this from the ground up, and I happen to have been in a window when that was possible. Yeah, that possibility doesn't, I don't want to break people's hearts, but that possibility doesn't exist. Possibility doesn't

Marley 29:43
exist anymore. Yeah, it's hard even I feel like, not that we're tick tock famous or, you know, we're not like the OGS, but there I'll see new kids popping up on tick tock. I feel like, every day, I'm like, I don't know if they're just doing this, you know, to spread awareness or. They doing it because they see other kids on here, I don't know, like, I feel like every day there's new ones. And I'm always commenting like, Hey, welcome to Tiktok. I'm glad you're

Scott Benner 30:08
here. Yeah, now you got to just invite everybody in. And it shakes out in the end, like, there are some people who are just think there's money there, like they see, yeah,

Marley 30:16
that's the kind of thing I'm trying I'm trying to figure out not that I even care. I'm like, are you doing this because you think your child will bring in money? Because I promise you, like, I'm not rolling $10,000 a month. Like, it's just not like that.

Scott Benner 30:27
I mean, if you want a couple of free bars, remember, listen, I want to be fair. Let me be honest. Here I am looking at an absolutely free freaks of nature stick for my face, sunscreen. I got it absolutely free. AG, one sent it to me. There's almost an ounce of it in here, and I did not have to pay for it. There you go. I I'm rolling. Oh, and you know what? Hold on a second. I do think I have here. I'll open this right now. I've had this for two weeks. I haven't opened it. Omnipod sent me this. Let me see what's in here. I'm seriously opening

it right now. It is. I have five copies of the DIA Sonic, sound of strength, Marvel, comic book from Omnipod. They doing like a collab with Marvel. They did, yeah, all right, I'll give these away. You know, I was gonna sell them and buy a house, but I'll give them away. I'll give them away instead. Also, running your own business is not a lot of fun.

Marley 31:28
So I feel like that's that's more of a perk on being social media than not. Like companies like to, like, send you little thing stuff, yeah. Like, they'll send Bane like, cookies or like, I don't know clothes like they I love to dress him. It's probably not. I live in Mississippi. I don't know if you can hear my

Scott Benner 31:48
accent, but you're a delightful Marley. It's the only thing I hear. But go ahead, we put

Marley 31:53
smart like, not all parents, but I dress Bane like, in smocked outfits and cute, very expensive outfits. Like, that's just what we do in the south. And all these cute boutiques are like, I'll send Bane some clothes. I'm like, Yeah, send them some clothes. I don't want to pay $50 an outfit. Like, send it. I'd be happy to take that from you. Yeah? Like, I'll post that on tick tock. I don't care.

Scott Benner 32:16
I was at friends for life last week. I got a tandem t shirt, a Dexcom t shirt. I took one of those Lenny the lions from the Medtronic table. That was, by the way, they're kind of awesome. I think I took a teddy bear from Abbott.

Marley 32:30
You got to get everything, yeah? I also

Scott Benner 32:33
gave away two Apple Watches while I was there. So I think I'm in the net.

Marley 32:36
I'll try to go next year. Oh, it was really great.

Scott Benner 32:39
It was my first time, it was really awesome. Yeah, so, but yeah. I mean, look again, I'm not I have no trouble saying, like, there's ads on this episode I got paid for Yeah. Like, yeah, exactly. But hopefully you got something out of it that makes it feel like you know

Marley 32:56
for sure. And I'm telling you, like, whenever bang got diagnosed, anytime you ask a question, like, how am I going to do this? Or, I think the first thing I said on diabetes and diabetes was like, I still breastfeed my child. He just got diagnosed with diabetes. How do I do this? Like, the doctors don't know how I'm supposed to dose for this. What am I supposed to do? And everybody on that group was telling me what to do, and then they'd be like, you need to buy a sugar pixel. You need a you need to join the Juicebox podcast. You need to listen to these episodes. Like people like you are the go to I feel like, for most people like you need to, you need to listen to this. You need to get in this pot, this group.

Scott Benner 33:35
Yeah, I'm glad to know that. So, you know, I'll finish with this. I think this was interesting. You mentioned earlier, there was like, something on you guys in People Magazine, and people posted it inside the Facebook group. And I was like, Oh, that's awesome. And then you, you answered, and I was like, Oh, my God that ladies in here. Like, that's how it makes me feel, ladies, yeah, I'm like, oh look, because I don't know who you are. Like, you just you're somebody's mom at that point. Like, I'm not sure. And then people are like, actually, there's like, a fake Facebook group for her. So this so people started reporting you as, like, not being you. This hilarious. Oh my gosh, that I just sent you a note. I just sent you a note, right? I was like, Are

Marley 34:11
you did you're like, is this real? Yeah, I think you said, Is this real? Please don't

Scott Benner 34:15
mess with me. I don't have time. Like, are you the real person? So

Marley 34:18
whenever before Tiktok, went to that fake band thing in January or whatever, like it was gonna get banned and didn't or whatever. That's when people on Tiktok started transitioning to like Instagram, I feel like so I made an Instagram for Bain. I never used it, and it never got banned or whatever. So we just kept on posting on Tiktok, and then one day on Facebook. I was on my personal Facebook that I've literally had since elementary school. Video came up of me and vain, and it was like a video of our tiktoks with the caption, and the user was like, Marley Brandon or something, and I'm like, I didn't make a Facebook. I don't think like, Did I make a Facebook when I made Instagram? Did it like make a Facebook? Book. So I go look the page has like 30,000 followers, millions of views, and has basically all our videos from the past three months on there with all millions of views. Yeah, and it's not you, so they're rolling in the money, I'm sure, from Facebook views, honestly. So I reported it, yeah? So I report it for copyright, because, sure, apparently it's very hard to get in touch with Facebook, because I could not get in touch with anybody from Facebook, yeah, but I found out from Reddit how to like, basically get them for copyright, and had to support all this stuff with, like my Tiktok page or videos or whatever. And it finally got taken down. And then that's when I just made a Facebook for us, and I just pay for the blue check mark, because if you pay for the blue check mark, they'll take down anybody that's like frauding you or like scamming

Scott Benner 35:53
your name. Oh no kidding. I didn't realize that. So it's worth the $15 I pay so little attention to

Marley 36:01
all this stuff that was my real Facebook, like my facebook I've had since elementary in your group, and I joined your group, like, probably the week he got diagnosed. I'm not really active, like commenting, but I do read every single day, like, different things that pop on my Facebook, and somebody posted that article, and I was like, hey, that's me, and

Scott Benner 36:23
basal, that's so cool. No, I and I was happy that it was actually you. And then this is how this got set up. So anyway, I think it's great anybody who's willing to, you know, share how they feel or what they're experiencing. I think it just helps people immensely. You do have to have a thick skin, so I hope you're okay. I noticed this morning, because I get an email when, like, new stuff pops up for the podcast, and I clicked on the latest one. It's like, the Juicebox podcast is a fantastic resource for anyone living with type one diet. And it goes on, it's very lovely, right? And then I look at the next one, and the next one's like, I've seen several people in online groups recommend this podcast, and I've tried to listen a few times and I didn't get any useful information. The problem is, Oh, good. This person's listened at least three times, so they know it's too long. There's too many episodes, and frankly, the host seems to talk about himself a lot, and, God, annoying. I don't have time to sift through all that casual chatter to find the useful information. Now there's a person who they don't realize the bigger picture, which, by the way, it's cool if you don't like me, or if you think I'm annoying, or whatever, I would assume not everybody likes it. Yeah, like everybody likes everybody, or that everybody's everybody's cup of tea. But what that person didn't realize was is that the the information that they're being told about is, like the Pro Tip series, or the bold beginning series, or, like those series of you know stuff. We just put out a bunch of mental health stuff, again, with Erica and like that kind of stuff. Like, that's what people are talking about. But why does it still exist so somebody can click on it? Because I also make a podcast like, where you and I are talking like this, like this, yeah, these conversations beyond offering people who wanted community, which is obviously not what this person was looking for, and they were very brave not to use their real name in the review, but that's not what this person was looking for, but it was there. They just didn't figure it out that it was there, or look in like it has a lot of episodes. That's how it stays popular. Because it's popular is why people have the time to build out a 25 episode series for the Pro Tip series, or like like or how I'm able to put the time into making sure that like Erica can come on and talk about a bunch of different mental health issues and stuff like that or that. We you know how we can spend months culling together people's thoughts on what do I wish my doctor would have told me when I was diagnosed that we can put the Grand Round series, it has to be a viable thing so that it supports the effort that needs to go in to get the information that this person obviously wanted but couldn't find. And what they're mad at isn't me. They don't realize what they're mad at is the way podcast apps are set up. Like, yeah, I can't put it all together. Also, if they would have hung out a little longer, they would have realized that I just started a second podcast where only the series are going to run in order. Oh, that's awesome, yeah. And two weeks later, this person would have heard an ad for that and then known where to go to find it, yeah.

Marley 39:20
But instead they had to come to Facebook.

Scott Benner 39:23
Try to imagine that you've tried like people say, Hey, this is a nice podcast. Like, you see all these people saying something nice about it, and then it's not your experience in a brief section of time. And your first thought isn't, like, I wonder what I'm missing that all these other people are seeing. The first thought is, oh, well, this podcast sucks. And I'm like, okay, like, I don't know how people's minds work that way. Like, if somebody tells me over and over again, like, something's really valuable to them, and I go, look at and I go, it's not valuable to me. I don't think, Oh, the thing's not valuable. I think I don't intersect well with it, yeah.

Marley 39:59
Or, like. Maybe that episode wasn't for me. Maybe I should go to a different series.

Scott Benner 40:03
Maybe I just hit the wrong thing. There's like, yeah, I find that super interesting.

Marley 40:08
Like, if I went in to your podcast and looked up Omnipod stuff that doesn't pertain to us in our life, like, No, I'm not gonna take anything from that, yeah. Also, I'm not gonna come to Facebook and complain about that episode.

Scott Benner 40:21
I mean, that's what we talked about earlier, yeah, that's just, like, the I now have time to go complain about it. Like, just, it's not for you. Like, just go ahead. That's okay, yeah, it's awesome. Like, just don't like it and move on. Yep. I love that TV show. What's it called the bear? I sometimes I tell people, and they go, I don't like that at all. And I go, okay, yeah, it's awesome. You go watch what you like. I just thought that was funny because it literally, like, I opened up my email here as we were getting ready to get done, and you just see, like, these just lovely, like, lovely things. And then the next one's just like, this sucks. I'm like, okay,

Marley 40:58
like, I promise you it, there's more people that love it than hate it.

Scott Benner 41:02
Also, it's cool, if you think it sucks, and if you do, then it sucks. Like, that's fine. Like, I still don't

Marley 41:08
know, it's not a big deal. Yeah, the world still keeps rolling.

Scott Benner 41:11
Yeah. Anyway, it's very cool. I'm glad you did this. I lose you a ton of success with everything you're doing, and with Bane obviously, it's going to be a long, ever changing process raising a kid with type one, there's going to be things that come up that you never expected. My best advice to you would be to try to stay flexible and do your best to try to see Bain's side of it while you're going because there's a balance. I've been thinking a lot about this lately. There's a balance between healthy and harmonious. It's not always easy to make those decisions. So yeah, for sure, and they appreciate you for having me. Yeah, no, it was really lovely. I love that you said. I don't know if you I'm sorry

Marley 41:51
for my soup, sorry for my dog, what you're sorry for? What my super country accent? I'm sure I probably sound like a hick, but I promise you, I'm not.

Scott Benner 41:59
No, not at all. It's, it was, it's, it's delightful. I thought it was lovely. I was gonna say to you, I appreciate you saying. I don't know if you can hear my accent. That was maybe the funniest

Marley 42:08
thing. You don't realize how contour you sound until you hear yourself. You're like, oh my goodness, I sound like

Scott Benner 42:15
that. I don't know how northeast I sound until somebody points. You just

Marley 42:19
sound like a very like well spoken American, do I

Scott Benner 42:23
really, that's crazy? Yeah, to me, you do well you are country. Then if you think I'm well spoken, but I'm country, I know I am. There's nothing wrong with that. Qualms with where you live, it would be the humidity, not your accent.

Marley 42:35
Yeah, the humidity is horror. Like, I don't know what I'm gonna do with this heat and bane's blood

Scott Benner 42:40
sugars, they've been horrible. Yeah, no, I couldn't live like that. The humidity right now is 80% Oh, no, no, no, no. I would, I would, I would miss 87 degrees outside. I would have a podcast where I just complained about the humidity.

Marley 42:53
So it's horrible. And Bane went from like a normal blood sugar to 40 double arrows down.

Scott Benner 43:01
Wow, wow. Yeah. Because what happens? It gets real hot and then overheat. Yeah, just people.

Marley 43:06
People online keep telling me, when they go outside in the heat, they go up, but he tanks.

Scott Benner 43:11
It's funny how, it's funny how, like, you make me think about, some people say that about a shower, like, I get in the shower and my blood sugar goes right up. And then other people say, I get in the shower, my blood sugar tanks.

Marley 43:23
Yeah, you just never, I guess it just depends on the person. But he always tanks,

Scott Benner 43:27
yeah. You know, you could break down every little bit of this and have like, long conversations about it. Like, I've heard people say, get, you know, you heat up and like, you're, I don't even I'm, this is not gonna be technical, but like, you know, your vessels kind of, like, expand, and then maybe that helps, like, move the

Marley 43:42
insulin more. I've heard that too, like, it makes your insulin hit harder or something.

Scott Benner 43:47
I've also heard people say, like, I just get in the shower and I relax. My my anxiety goes away, my stress goes away, and I think that I have a bunch of insulin that's like fighting with the anxiety, it goes away. I've heard people say, I get in the shower and my body heats up and my blood sugar goes up. It goes down. Like, who the I mean, you know, good luck. It ain't easy.

Marley 44:03
That's part of like, What sense does diabetes ever makes? It doesn't make any sense ever.

Scott Benner 44:09
No, no kidding. Okay, all right. Well, Marley, this was awesome. I appreciate you doing this. Thank you for taking the time of people want to check you out on Tiktok. It's m, A R, L, E, E, B, R, a n, d o, n, that right, yep, yep, okay, hold on one second for me, please. Okay.

Dexcom sponsored this episode of The Juicebox podcast. Learn more about the Dexcom g7 at my link, dexcom.com/juicebox dexcom.com/juicebox, did you know that skin grip has donated over $100,000 in scholarships to help people with diabetes? The people at skin grip, they know what it's like to live with type one diabetes. They know what it's like when your devices fall off at the absolute worst. Time, and they're here to help. Skin grip.com/juicebox save 20% off your first order when you use my link. That's what you get for being a Juicebox podcast listener. The podcast you just enjoyed was sponsored by tandem diabetes care. Learn more about tandems, newest automated insulin delivery system, tandem Moby with control iq plus technology at tandem diabetes.com/juicebox. There are links in the show notes and links at Juicebox podcast.com.

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#1656 Bolus 4 - Little Bites

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

Jenny and Scott talk about bolusing for all kinds of Little Bites.

+ Click for EPISODE TRANSCRIPT

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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 back to another episode of The Juicebox podcast.

In every episode of Bolus for Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a roadmap called meal bolt. Measure the meal, evaluate yourself, add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM. Tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more. Go to Juicebox podcast.com. Forward, slash, meal, dash, bolt. But for now, we'll find out how to Bolus for today's subject,

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. Jenny, we are going to jump into our Bolus for today. Yay, with one that I will admit got me when Arden was first diagnosed, and is a food that I no longer will let my children eat. But, and I think it's diabetes that showed me that this is not a thing we should be eating. Do you know a little something called little bites, chocolate chip muffins?

Jennifer Smith, CDE 1:47
I do. Are they? They're not a Little Debbie product? Are they

Scott Benner 1:50
made by a company called entamins? Oh, and

Jennifer Smith, CDE 1:52
Tim, oh, I Well, I know entamins Definitely. They're the, they're the package thing that looks like, even after the apocalypse, they probably wouldn't be moldy in the box at the grocery store,

Scott Benner 2:02
right? There's something to it, because a pouch of little bites chocolate chip muffins, which I think, I mean, if I'm going off of how they got used in my house, it's, you know, from mornings when you got up late and the kids would grab them and go to the bus with them, or something like that, right? Okay? And to say that the muffins are maybe, I don't know, like maybe an inch and three quarters across and maybe that high. They're not big. Sure you ran, I think you get five, usually in a bag, but once in a while you only get four. You get six. It's a crazy day. You've gotten super lucky, and there's six in there. But let's just go with the five. I'm looking at the label right here. So at calories, 190 calories for the pouch, okay, nine total grams of fat, not so bad. There's a lot of cholesterol in them. That's interesting. 20 milligrams of cholesterol, 150 milligrams of sodium. Total sugars, 17, added sugar, 17 total carbohydrates, 27

Jennifer Smith, CDE 3:03
and what? What's half of 27 it's half of 27 it's,

Scott Benner 3:09
let's see 10, like 13 and a half, or something like that.

Jennifer Smith, CDE 3:13
Do you know why I'm asking this? I have no idea. I'm asking it because 17 grams of total sugar means that more than 50% of these muffins

Scott Benner 3:23
is sugar. Oh, yeah. I don't know what a muffin is, but it's not it's not that,

Speaker 1 3:27
like these are Sugar Bombs in a

Scott Benner 3:31
package. I want to point out that if this Smart Label website that I'm on is correct, that these are manufactured by bimbo bakeries for intimacy. If that's correct, are they trolling us? Is that what's happening exactly? Yeah. So if I, if I switch over to the ingredients label, the first thing on the ingredients label is, in fact, sugar, then it is white flour. So those are your tops, sugar and white flour. Anyway, let's go to our our steps. Is there any protein? Yes, like a gram, I think it's two protein, two, two grams of protein, no vitamin D. There is some added calcium, iron and potassium. Okay, fortified isn't my new favorite word is, we're doing this. It's been fortified,

Jennifer Smith, CDE 4:23
fortified and enriched. Yes, they're both right.

Scott Benner 4:27
It makes it sound like they've lined a bunch of army people around our castle to fortify it. We're going to be safe because we fortified your mother for you. Don't you worry. Everything's going to be fine. Now here's the real interesting thing about little bites muffins, from my perspective and from the perspective of everybody who wrote in about little bites muffins I have, I didn't realize they were such a thing. They are so high on my list, and my list is set up by how many people brought them up. So wow, yes, they are only below here. This will give you some context. They are only below pancakes. Pop Tarts, French toast, Costco muffins, cinnamon rolls from Cinnabon. Oh, I haven't had a Cinnabon in a long time. Toaster, strudel oatmeal cereal. That's the only thing that's above it on the list, so, but here, somebody actually sent in a little vignette about them, and I'm gonna read it, please. She eats them almost every morning. We're MDI. We Pre-Bolus 45 minutes. If we give her a half a unit more, she crashes hard. We've played around with the Pre-Bolus too. And no matter what, she goes to 230 and comes back down. Then this person came back, commented again, 25 weeks later, because I've been pulling this information together for like, a year. Okay? So I know people are like, Oh, I didn't realize he was actually planning any of this out. So 25 weeks later, she came back and said, We figured them out. We pair it with a protein, like an egg or a breakfast meat. We Pre-Bolus 30 minutes. She eats the protein completely first, then the muffins. We also do four to six ounces of water during the Pre-Bolus to get her hydrated. She still goes to 160 or 170 but comes right back down. She used to sort of 250 or even 300 every single time we ate these muffins. And this person's like, Hey, we got this down now. And I really and thanks to the podcast. And actually they thank Omnipod five, and they're all happy. But that's a win. A win is, you know, yeah, yeah, it absolutely is. But at the same time, I mean, I'm in my mind, Jenny's going don't eat those muffins. I think that's the answer to this question. But, like, I know we don't have them in front of us, and we don't have a breakdown, but there's something about this specific food item, right? That just, it's like rocket fuel. I mean, a 45 minute pre bouls And she was still going

Jennifer Smith, CDE 6:46
to and again, kudos to this person, this family, honestly, for sticking with it and saying, Hey, I'm going to figure it out. I know there are a lot of there are a lot of kids who have choice kind of issues, sensory types of issues, that it is what it is, and you have to do the best that you honestly can. And while the parents were probably thinking, we could just change this, maybe it wasn't that easy. And despite it not being food that technically is providing quality nutrition, they have figured it out, utilizing all of the strategies that they have learned, which is 100% a win for them, they are now getting glucose levels that are much, much improved, right shorter. They're also not over bolusing to achieve the results, and probably along the lines of the A ID system, Omnipod, five. It sounds like they're using right? They've figured out by doing a lot of experimentation, how much do we have to give? What do we have to add to the picture? The proteins and the fats are huge, especially along the lines of starting with them first, so that it creates almost a slower digestion to get going, especially first thing in the morning, their body's breaking that down before you put in the sugar, which is what these are, right? I mean, you read the ingredients, you can't lie about it. They're more than 50% sugar by kind of carbohydrate count, but they've navigated smoothing that and again, on the back end, with the help of the A ID and their bolusing strategy and the way that they're putting their nutrients in, they figured it out.

Scott Benner 8:29
Yeah, no, I think it's awesome that they said to themselves, there are settings here and timing that will do will handle this. Yes, and they did it, which is awesome. So like, let's another thing to add to this, but let's go back here to our to our checklist, measure the meal we did that, evaluate yourself. You know, it's, she actually said it's the morning like, not as hydrated. She put some more water in. Yeah. You know, gonna come out and see, you know, is our blood sugar? 150 is it? 180 is it 70? You know, right? Keep that in the in the idea, when you're making your Bolus, calculate your food with this one here, using our one to 10, you know, example number that we're going to use every time in one of these episodes, just looking at like 2.7 units, right? You know, as

Jennifer Smith, CDE 9:13
long as your blood sugar is at Target or in that target, then there's no correction.

Scott Benner 9:17
And if not, we'll make a correction to that if there's more less needed. Now this is one of those where you're like, Well, how do I build the Bolus out? Is it? Is it extended? Like it's tough one because it hits so hard. I mean, obviously, look at the crazy Pre-Bolus. She needed just to sort of stay ahead of it. But if she were to make the Pre-Bolus that long and give a little too much insulin, there was a crash. So she gets that all figured out. It's a tough one for me. Like, I know it's a, it's a sugar spike, I wouldn't feel super comfortable layering, like extra basal or extended boluses over a sugar spike, because it's gonna, it's gonna crash the other way, right? And then, you know, take a look at your CGM an hour later, and, you know, make adjustments if you need to. And then a. Right? The thing she did, which is awesome, which was tweak it for next time

Jennifer Smith, CDE 10:03
well, and something that goes along with building that Bolus, especially for breakfast or the very first meal of the day that you're eating, this can definitely still be the case, even on an A ID system like Omnipod five, that you don't have control of your basal anyway. So it's not like they could really shift that, because it's right, it's an adapted give. But if they've had any mornings that this child has slept in or maybe didn't want breakfast, they probably had a good idea that without this meal, everything looked hunky dory, right? Everything was smooth in Target stable, there were no issues. So they knew that the Bolus and how they were adjusting for the components of the meal eventually, that was going to be what created the win.

Scott Benner 10:52
Let me ask you a question, because when this happened to me all those years ago, what I did was I started making chocolate chip muffins from scratch, and I just used, I didn't do something super healthy. I went to actually remembered what it was, and brought it up while we were talking King Arthur baking.com. So King Arthur makes flour, a lot of different flour, and they have some recipes on their site. So I found this, like they call it a golden chocolate chip muffin recipe. Now I'm gonna, I have the nutrition from that here to show you that it's not like some like, you know, grand experiment in good health, right? You get 12 muffins out of a batch. Now, a muffin is 95 grams, and with the little bites, the pouch was 47 grams. So, you know, it's twice as big. You don't have to eat the whole thing. But keeping that in mind, but there are 50 carbs in a 95 gram muffin made from this, you know, King Arthur recipe that I found, 17 grams of fat, way more cholesterol, you know, more sodium, 50 carbs, right? But it's butter, sugar, baking powder, salt, flour, eggs, milk, chocolate chips. That was it, right? And it did not hit Arden nearly as hard. So then I'm sure not, yeah, yeah. But, like, let's give people some understanding why. So I just read you the the ingredients of the muffins I made. That was, that's what's in them. The ingredients on the little bites are sugar, bleached wheat flour, water, soybean oil, chocolate chips. And it's easy to say, oh, good chocolate chips. Chocolate chips are sugar, chocolate liqueur, dextrose, coconut butter, soy lecithin, lecithin, vanilla extract. Now there's also in that eggs modified corn starch, dextrose, whey, fructose, glycerin, leavening agent, which would you know, like baking soda or baking powder, like that, artificial flavors, mono and big lysir rides. Do you know that one digly, CDE, glycerides, salt, sodium, sterile, lactate, sterile like lactate, potassium sorbate, which is a preservative, sorbitin, mono sorbet and mono saturate. Xyna, thin gum, poly sorbate, 60 cellulos, gum, soy lecithin, lecithin, whey protein concentrate. So somewhere in those words, is the reason, right? And it's mostly sugar, right?

Jennifer Smith, CDE 13:27
That is the major hit. It's the reason that it required initially, at least a 45 minute without even really great results with that right?

Scott Benner 13:36
Why does that hit harder and is more difficult to control than the one I made that has more sugar in it.

Jennifer Smith, CDE 13:41
It's the simplicity of the ingredients. And the question too, is your flour? And I know the King Arthur Flour brand, they have quite a number of quality types of flowers, my expectation is that you weren't getting a bleached flour.

Scott Benner 13:59
Yes, yeah, no, yeah. And I do, and I do that on purpose too, actually, now that the prices are all crazy, it doesn't matter anymore, but I did, you did spend, I think, a couple dollars more for a five pound bag back then, right? Yes, that was me trying to say, well, like, if we're gonna do this, like, at least, let's use as pure ingredients as possible, correct? Anyway, absolutely. Okay, so there you go for all you little bites fans, of which, like I said, God bless you. They're super easy to buy. They're super easy to give to the kids in the morning. And you know what? It's funny on the label, I just want to say it says, made with real chocolate. There's no artificial colors in it. And this one's like, actually surprised me because of how hard they had no high fructose corn syrup. So what happened there? Yeah, well, they used sugar instead, there instead,

Jennifer Smith, CDE 14:50
which, you know, great again. But I think the biggest hitter that this family found was that, and it's much like the glucose goddess talks about. And I. Taught years before I even know who she was. Right? It's if you start a meal with some proteins, proteins and fats, you get a much slower glycemic hit from the carbs that you do eat. Now, the nature of the carbs makes a difference as well, which we've talked about. But if it's going to be a carbohydrate like this one in particular. Definitely help yourself by adding something in that's providing a stabilizing base.

Scott Benner 15:29
Awesome. Okay, I appreciate it. This is, I mean, this is going to be a good one. People love this, these chocolate chip mops. I also want to say I thought they were good too. That's all. Bye, you.

In each episode of The Bolus four series, Jenny Smith and I are going to pick one food and talk through the Bolus thing for that food, we hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward slash, meal, dash, bolt. But here's what it is, step 1m. Measure the meal E, evaluate yourself. A, add the base units, l, layer a, correction B, build the Bolus shape, O, offset the timing. L, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load, and then we evaluate yourself. What's your current blood sugar, how much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress, hormones, illness, what's going on with you? Then a we add the base units your carbs divided by insulin to carb ratio, just a simple Bolus l layer of correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape? Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes? Are we going to have to, again, consider combo square wave boluses and meals, figure out the timing of that meal, and then l look at the CGM an hour later, was there a fast spike three hours later, was there a delayed rise five hours later? Is there any lingering effect from fat and protein tweak for next time, tea, what did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus for measure the meal, evaluate yourself, add the base units, layer a correction, build the Bolus shape, offset the timing, look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus. 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, wrong way recording.com,

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