#1987 Bolus 4 - Alcohol
Bolus 4: Alcohol
Beer, wine, liquor, cocktails and the canned stuff, with carb counts for each. Then the part that actually matters: why alcohol drops you hours later.
Jump to a moment
- The mechanism is the whole episode. Alcohol is a toxin, and the liver gives clearing it priority over its normal background glucose release — the quiet drip your basal insulin is dosed against. Take the drip away and leave the basal unchanged, and the math tilts low. So the risk is not while you are drinking. It is hours later. One drink is roughly one to two hours of processing; a heavier night can run six to twelve.
- Carb counts Jenny signed off on. White Claw is about 2 carbs a can — less than a single glucose tab, nothing to bolus for, in the same category as whiskey, gin, tequila or rum and Diet Coke. A BuzzBall is a different animal: roughly 200 ml of juice and sugar, call it 25 grams, and Jenny's shortcut is 25 per ball. Dry wine 3–4, Guinness 10, IPAs closer to 20, Long Island iced tea 20–30, frozen daiquiri or margarita 35–45, Mike's or Smirnoff Ice 32, twisted tea 26.
- Jenny's protective list, in order: don't drink on an empty stomach — eat carbs plus protein or fat before and during; tighten your CGM low alert so you get told sooner, because you will be paying less attention; keep fast-acting glucose or dextrose on you; set a lower temp basal or a higher target across the window where you have worked out the low will land; and have somebody with you who knows you have diabetes and knows where the glucagon is.
- Glucagon under alcohol works less well, but it is not useless, and the distinction is worth knowing. It has two mechanisms: breaking down stored liver glycogen, which still works with alcohol present, and promoting gluconeogenesis, which is the part alcohol blocks. Jenny's instruction is not to wait until someone is unconscious — if vomiting means nothing is going in and you know the alcohol effect is still coming, give it. And if you give it and nothing happens, call emergency rather than wait, because they can run IV glucose.
- On MDI the best single move is at bedtime: eat something with both carbohydrate and protein. The carbs lift you now, and the protein lands later, roughly when the alcohol curve is pulling you down. Some people also reduce their evening basal injection — safer overnight, but it is a 24-hour decision, so expect to run higher the next day and to need more rapid-acting to stay on top of it.
- Bolus 4 Series — Every Bolus 4 episode in one place, with a follow-along page for each
- Episode 789: Gvoke HypoPen — The glucagon episode Jenny points to — how it actually works, and when to use it
- Juicebox Podcast Pro Tip Series — Management fundamentals with Jenny Smith, episodes 1000–1025
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Every word of the conversation
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Somebody Asked This Morning1:58
But alcohol, I... Oddly enough, people won't believe this, but last night, I... Actually, before I went to bed, I I said, what are what are Jenny and I gonna bolus for tomorrow? And I thought I thought alcohol is gonna be a good one. And I put a little list together of different drinks and everything, I was prepared for today.
And then this morning, someone on the Facebook group said, I don't know how to bolus for this alcohol. And someone else said, well, maybe they'll make a bolus for episode about it. And I responded and said, doing that in, like, two hours. So here we are, Jennifer. I Awesome.
I have created a list of beer, wine, liquor, and shots, cocktails that all come with carbs. I don't know how you're supposed to know this stuff, but here we are.
Why Alcohol Scrambles the Math2:52
But I... It's a great topic, I think, especially... I don't know when this will be heard by all of your wonderful listeners, but we are in the time where many who are almost or of the age where they can be drinking alcohol legally. Mhmm. I will just put that in there.
Yeah. I know it happens otherwise, but, you know, many people are going off to college is the gist of it. Right? And so I think it comes at a very timely point, because alcohol is something that when you consider, especially type one diabetes, and alcohol, they they interact kind of in a way that messes up your thinking about what could happen to your blood sugar Okay. And what you should pay attention to.
So bolusing for is just a plan of what to do, but I think I think more so is important to understand some of the science behind why it's really valuable to understand what to do, how to bolus for alcohol if and when it might be needed. I I think they're all really important pieces.
Yeah. Because there's gonna... I mean, there's a spike, a dip, and a tail to it, I would imagine. But...
Depending on what you drink.
But it's... But that's what was gonna say. It's it's a... It's very dependent on the drink. Also, I'm sorry.
What Is a BuzzBall4:17
I'm not distracted. I'm over here trying to figure out what a buzz ball is. So I... Now I know. I figured it out.
It's, it's the thing that I once saw at the Buc ee's, I think, or some other gas station when I was in the South. Remember The South? I remember thinking, why are there pre chilled handheld alcohol drinks available like to pick and go at a gas station? And because around here, you could not do that. Right.
Yeah. Right. Like... And so I was like, well, that's interesting because it... It's also like, it's...
They're not big. Like, by volume, there's... By volume. Listen to me. It already sounds like I work for Anheuser Busch.
I've been talking about this by volume, Jenny. There's...
What are these called again?
Buzzball. Oh, I'm glad you don't know either. Buzzball?
I have... We don't drink. So...
Yeah. Yeah. So a Buzzball apparently has between twenty five and thirty grams of carbs in it, but it's this little disposable thing that only looks like it's about the size of a baseball. So Oh. A concentrated juice, there's a cream version.
They're, like, in, like, desert. So I went to buzzballs.com. Can't believe I'm saying buzz balls so much. I went to buzzballs.com, not a sponsor. Tropic Tang, Lime Rita, Berry Cherry, Limeade, Pink Lemonade.
Wow. Grapes gone wild. Is this hard to get drunk? It's like super...
I think it's a great one to consider. I would think of it like a mixed drink or a more sugary alcohol containing beverage, and I think we should go through... I think we should really look through each of the different types of alcohol you might consume. And are they bolus worthy
Okay.
Is a good way to think about it. But I think, you know, as I said earlier, the core issue with alcohol is knowing what does your body do with something that technically is a toxin. Mhmm. I mean, if you... If if we're just gonna be honest about it, that's what alcohol is.
Your Liver Picks the Toxin First6:19
It's it's a toxin in the body. And what's one of the organs you have that helps to navigate toxins?
Liver?
A liver.
Look at me.
So... Yay. Look at you. So what... I mean, do you know what
It's a filter.
Alcohol does?
Right. So...
You know?
Isn't it giving the liver something to do so the liver doesn't have time to do his other stuff? Like
Right. Pretty soon glucose done? Normally, the... Yes. Absolutely.
Normally, the give and take is in a functional body with functioning pancreatic beta cells. Right? There's a give and take. Right? The liver releases stored glucose to kind of buffer the insulin.
It's like a drip drip drip drip, and they balance each other if you will. But when you put alcohol in your body, your liver essentially gives priority to getting rid of that alcohol over its ability to drip drip, that that glucose. Right? So the buffering system kind of gets stalled as long as that alcohol is in your system. And if you consider, you know, one alcoholic beverage versus six alcoholic beverages, it could be one or two hours of processing.
It could be as long as six to twelve hours of processing with a heavier drinking evening or day.
Yeah. I...
So as you said, it could be a rise. It could be a fall. It could be what ends up happening. We usually... The biggest worry is the hypoglycemia.
Mhmm.
That could come because of what the liver is trying to do for you while it stalled and doing something else for you.
I I wanna just take a half a second here to give the marketing team at BuzzBalls a shout out. These are some twisted people who are really thoughtful. They have something called... There's a chocolate Buzzball, Jenny, in case you're wondering, but it's but it's called Choc Teas, c h o c teas. You see what you see what they're going here.
And you can get a larger one. So you can get a bigger ball... You can get bigger balls or smaller balls. The one thing you can't get on this website is any nutritional information about this stuff. So I'm like, I've been pressing through this site while you're talking because I thought, like, what is the creamy one?
I guess the chalk... I'm not gonna say chalk ball. I'm not... Anyway, I'm not saying chalk teas again. But what I'm gonna tell you is that, like, that one has cream in it and there's different versions of the cream in it too.
Like, you can go... Like, there's more, there's less. But as I go through all of these, what I don't see, PR team, is any ability to understand what's in this. So as far as, you know, carbs and and other stuff is going, I don't see nutritional information here. And if it's here, it's hidden away pretty good.
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Twenty-Five Grams Per Ball11:21
I mean, my... You said it's about the size of a baseball.
They say the suggested serving size of the cocktail version is 200 milliliters.
Which is about... So one cup is 240 ml or milliliters, which is eight ounces or a one cup portion, which is why I said the baseball is... Mhmm. It was a good estimate on your part. And if that's juice, which it sounds like there's a fair portion of either juice or some type of juicy sugary in it, I'm just thinking about orange juice as an example, eight ounces of orange juice depending on the brand and, you know, how it is, somewhere between 30 to 36 grams for a one cup serving or about 240 mls.
Okay.
So that makes me think that a drink like this would be comparable. My estimate would probably be to be on the safe side because we're also considering something that has alcohol in it. I'd say aim for 25 grams per ball. Did I say that?
You did. So if you... So, Jenny, are you telling me that if you had both of the balls in your hand, it would be about 50 carbs?
There you go.
Okay.
Two balls is worth $50.
I... Listen. I don't wanna be punitive in these podcasts ever, but you Pretty funny. You can DoorDash one of these things. And And please, if you have ever found yourself DoorDashing a buzz ball, call a friend and tell them you're in trouble.
Okay? I mean... Yeah. Oh my gosh. Okay.
Let's move on to something else.
Okay.
But but I'm gonna stay in the canned variety right now. So Okay. White claw is definitely words I've heard before. So what's that, like, seltzer based? I have here, like, two to four grams for a can.
Does that sound right to you?
Again, I know what White Claw is.
Alright. Hold on.
My estimate only knowing the basics about it is that it's carb... It's fairly carb free if I remember correctly.
Mhmm.
So maybe four grams at the most, but I think... I actually think it's less than that.
Yeah. I have two to four on here.... Four? Oh, okay. I...
On their website, they tell you there's two grams of sugar in a White Claw black cherry. Oh, and they have nutritional information. Good for you, White Claw.
Well, good for them. Yay.
Carbs. Two two carbs, two sugars. There's a little bit of sodium, and that's pretty much it. Purified carbonated water, alcohol, natural flavor, citric acid, cane sugar, natural blackberry juice concentrates, sodium citrate. I
would compare that then to more of a consideration as we're talking about bolusing for something. Right? This would be more like whiskey, gin, tequila
Okay.
There Is No Bolus For This14:19
Or something like, a Ramen Diet Coke, so to speak. Right? That kind of thing where you're not bolusing for this.
Okay.
There there is no bolus for this. The risk being later on, it is alcohol, and there have to be some considerations for the later effect, which is low blood sugar.
Yeah. So talk about that a little more when... Explain to me why the later effect is low blood sugar. Is it all about taking the liver out of the process? That's it?
It is.
That's all? Okay.
Don't Drink on an Empty Stomach14:53
Mhmm. And, you know, something that honestly helps to buffer some of this and some, things to keep in mind overall, I generally teach people try not to drink on an empty stomach. Right? Eat some carbs, protein, or honestly protein and fat before you start drinking, as well as if possible during. So if you are a bar person and you're out drinking with friends or whatever it is, and you've got the bar chips and salsa or whatever, absolutely have it, please, with your drink.
Okay. Because you...
Which brings in the potential that you're bolusing for that. But if you have something like the White Claw that you're drinking with it, you're not bolusing for alcohol.
Are you... Like, do people generally... Like, if they drink, I don't know, the the thing before, or let's go with the White Claw. Say that...... Ball?
That had too many carbs. Don't... Well well, yeah, let's let's go back to the balls for a second. So if you're drinking the the buzz ball and you've got a bolus for it because there's carbs in it and then your liver function shifts, are you telling me, like, it's is it a coin flip you're getting low later or is it a probability you're getting low later?
It's a higher probability that your blood sugar is going to go low later. Yes.
Alright. Well, I have here that also these websites are, I guess, should not, surprise anybody, but they're not real big on putting their nutritional information.
No. Many alcoholic beverages don't have nutrition facts available. You can do some digging to find it.
Yeah.
But in general, again, as most people have a... Have an issue looking up information even just for food when they're out. Right?
Yeah. That's exactly right. Yeah. Yeah.
You... Who's gonna look up their drink in a bar setting or on a vacation when you're drinking on the beach or whatever it is? You are less likely to look it up. So then it becomes a true estimate or you just don't even consider it, and then there are issues.
Beer, Wine, Liquor, Cocktails17:00
So what I did before we started recording is I had my my close personal friend Claude put a list together. Mhmm. And he gave me, she. I don't think they identify. I gave you?
It it it told me... I guess, we shouldn't say he or she. The the machine, the box, it's the I felt like my grandmother for a second. So I got a list of beers. Right?
Michelob Ultra 2.6 carbs. Corona 13 to 14. Blue Moon Wheat 13 to 14. Belgian Triple Quads 15 to 25. Double IPA, 18 to 22.
Sours, 12 to 20. Malt liquor, 15 to 20. Nonalcoholic beer, there's something you don't think about, 10 to 20. Guinness drought, 10. And then it did wines.
If if I'm saying anything that you're like, that doesn't seem right to me. Just stop me. Dry, red...
No. These all sound these all sound appropriate
Okay.
In terms of what your little friend has looked up for you. In fact, if I was going to have alcohol, which is pretty rare Mhmm. My preference in beer is Guinness. Okay. And I also really liked it.
We went to Ireland years ago and had really good Guinness.
And and 10 sounds right.
And 10 is actually pretty good because I was super excited to hear that it wasn't like the IPAs, which are closer to almost 20 grams for a whole, like, bottle, so to speak.
Yep.
That my Guinness was pretty low in carb considering.
Mhmm.
It's like, Guinness.
Hey. Guinness. That's a t shirt. Dry red or white wines, three to four carbs. Mhmm.
Moscato, sweet riesling, riesling, six to 14. A port or desert wine or just... Excuse me. Dessert wine, 10 to 14. Mimosas, eight to 12.
Mold wine, 12 to 18. Sangria, 15 to 25. Mead, 10 to 20. I guess if you're one of those things where you're pretending to be from the sixteen hundreds. Sake, which I don't even know what that is.
Seven to nine. Sake. Sake. Is that what it... Thank you.
My god. What is wrong with me today? And then pure... What is s o j u? I don't know.
Zero to three. Soshu?
Yeah. Yeah. I don't know what that one is. That one I've not heard of.
Liquor and shots, fireball, eleven. Bailey's, eight to nine. Kalua, fifteen. Jagermeister, eleven. Amaretta, schnapps, eleven to fifteen.
Triple sec, eight to 11, a flavored vodka, zero to two. Mhmm. A cocktails, old fashioned, four to eight, a martini, zero to three, regular... What is this? Gin and tonic, 15 to 16, A Moscow Mule, 20 to 25.
A Mojito, 20 to 25. Whiskey Sour, 12 to 20. Cosmo, 10 to 13. Let's see. Frozen Daiquiri, 35 to 45.
Like a hurricane or a zombie, they're saying here, 25 to 40. Long Island, iced tea, twenty to 30. Bloody Mary, five to eight. Espresso Martini, 15 to 20. Hot Toddy, which I haven't heard since I watched television in the seventies, 15 to 20.
Spiked eggnog, 20. And then the canned stuff, white claw, we said two to four. Some of the Truly lemonade styles, to 13. Canned cocktails, 25 to 35. Twisted tea, 26.
Mike's, it's like a Smirnoff Ice or a Mike's, 32. The buzz balls aforementioned 25 to 30. Hard kombucha five to 12. Jell O shots four to six. So I looked at all that, and I was like, that's a lot of stuff.
I don't know how I'm supposed to remember all that. You you know what I mean? Correct. So... You know,
Look Up Your Two Drinks Once21:05
you could as I've done with some of the college students I've I've worked with who are definitely wanting of trying even if it's not a lot or often. I usually ask them if you were going to drink or you have had a drink before, what are your preferences? So then you can really have an idea going forward. Even if you look it up once, most often your brain can recall, oh, I looked up beer and in general, it sounds like it's like 15 grams for a bottle. Great.
15 is better than nothing as a bolus.
Right.
Right? So if you can get a general amount for the types of things you have preference for, that can be easier to remember than to say, okay, I have to remember 30 different things.
So now here's the next thing is there's no world where I'm gonna have one white claw. Right? Like, this is a thing where I really don't... Like, I don't have context for this. I...
If I go to a picnic, I'm not having three sodas. Like, it's... I'm like, ugh, so much liquid. So... Right.
A Prompt You Can Reuse22:09
Yeah. But that's not gonna be the case. So I I... Listen. I don't know how this is gonna work because I have not tried it yet, but I asked Claude to make a prompt to prompt itself to help people with type one diabetes to drink, and it gave back a fairly, like, significant prompt.
So it leaves a space for you to put in your drink. So I'm gonna put in White Claw, but I'm gonna say that I'm having... I'm gonna say I'm having four of them over three hours, four hours. I don't know. Like, three to four hours.
Okay? I'm gonna tell it that. And then it asks optionally for time of day if it... If it's with food, if you have an empty stomach. So let's say...
I'm gonna say starting at noon with a burger in my belly. Okay. I actually typed that just so you know. And it asks if you're on a pump AID system or MDI. I'm gonna say MDI.
And then I'm gonna hit go and see what happens. So the the prompt is really exceedingly. Like, you guys should look at stuff like this. I said, make a prompt, make an AI prompt, build a perfect LLM prompt that a person could use to get this info for a drink if they have type one diabetes. And it gave me back the prompt.
It told me to fill in that stuff, and I'm gonna... It's just a little entailed, but it's basically broken... It's taken the fun out of drinking is what it's... It's gonna stop you from drinking. You're gonna go like, if this is it, I don't wanna I don't wanna be involved.
But here's what it said. One white claw, 12 ounces, 5% alcohol by volume, two grams of carbs, zero fat, 100 calories, about one standard drink worth of alcohol, 14 grams of ethanol. You are four... Over three or four hours should be eight carbs, blah blah blah. No real uncertainty here.
It's a labeled consistent product. The only variable worth flagging is if any of the four is a surf surge or a lemonade refresher variant, then the math would change. Essentially, there won't be a spike. Two grams of carbs per can is less than a single glucose tab. It goes on to explain that.
The dip moderate trending towards the serious end of moderate. Four standard drinks is a real alcohol load while your liver processes it. It downshifts in its normal background glucose release, the steady drip your baseline insulin is calibrated against. With the drip reduced and your basal unchanged, the math tilts low. At roughly one drink metabolized per hour, four drinks finishing at 4PM, keeps your liver occupied into early evening, and the suppression effect can linger six to twelve hours after your last sip.
So roughly into the 8PM to 2AM window, starting at noon is generally your best structural advantage here. It says it it doesn't expect there to be a tail because there's no fat in the drink. Noon to 2PM, your curve is the burger curve, your meal spike possibly... Plus possibly a fat driven drift upwards. The claws are invisible two to 5PM.
Five to 9PM, this is your watch window. The burger's done. The alcohol suppression is still active. Nine to two... 9PM to 2AM.
Lingering suppression means a lighter than usual glucose floor overnight. If dinner was bolus normally and the drift already started, this is where a surprise low was going to land. Next morning, most people are back to baseline. Does that make... That all sounds right too.
It makes sense.
Yeah.
Yeah. Again, you know, what it's really using is the clearance of a particular alcohol drink. Right?
Mhmm.
With... I expect since you gave the type of you gave the type of alcohol to the system to acknowledge, it also knows the alcohol content
Mhmm.
Of that particular kind. And that can make a difference in kind of what you're seeing in the curve of effect. Right? You gave it what? How many?
Three or four
of the clients? I'm gonna drink I'm gonna drink four over the next three to four hours. Mhmm.
I asked... So it takes a long time for that alcohol to clear. Absolutely.
I said put it into a simple paragraph to hand to my college aged child. Four White Claws over an afternoon won't spike your blood sugar. That's barely any sugar, so there's nothing the bolus for. Yeah. The thing the thing to worry about is what's gonna come later.
Alcohol makes your liver pause the background glucose. It's always quietly releasing, and your basal insulin is dosed assuming that glucose is there. So the risk isn't high while you're drinking. It's just like... And it just broke it down and it made it simpler.
So... Yeah.
And I think it makes it harder. I mean, this was a fairly easy one to evaluate for when to expect something to happen. When you when you combine alcohol with a drink that has carbs, such as if you go to a daiquiri or you go to a blended margarita or, you know, any of those, even like the Long Island iced tea.
Mhmm.
Does that look terribly carby? No. But 30 to... I think you said, like, 32 grams for the Long Island iced tea.
Mhmm.
That's a lot of carbohydrate. And if you are sipping that over the course of an hour or two, that's not that's not as much of a big deal. But if you're drinking that pretty quickly, you definitely have to have a bolus for that. And then it's a decision about are you eating with it, what kind of bolus. You still have the potential for that later hit.
Yeah.
But again, you may not be drinking four of them.
Three Long Islands27:54
Yeah. I I saw... I just asked it again. Was like, now start at 8PM, three Long Island iced teas between then and midnight. What do I need to bolus for and watch for?
Keep it simple. You're bolusing for each Long Island iced tea that roughly has 20 to 30 grams of carbs in it from the cola and the sour mix. So call this somewhere between 65 and 85 across the three. Don't cover it all. Each one carries about two to three standard drinks of alcohol.
So three of them is, like, seven to nine drinks of liver suppression stacking up behind the sugar. Yep. Well, that really does make it interesting, doesn't it?
It's a huge hit effect. And I... It's a really important piece to understand because as you... You may start out drinking beer. Right?
Or you may start out drinking like the White Claw or something like that. But if you are someone who enjoys drinking or as you get into a career and that becomes something that's social in the evening with colleagues or work events or something like that, your alcohol desire
Yeah.
Changes in most people. You get a little bit more, I guess, adventurous with
what kind of drinks you eat.
You try different things, and you have to have these pieces as a base understanding. Mhmm. I I have something that I wanna ask, but it may be later in the conversation. So Okay. What else do you want to explore with alcohol?
What do you mean what else do I wanna explore with alcohol? You're right.
We're we're bolusing for different kinds
of alcohol.
Right? So are there other drinks that you wanted to look at?
I mean... Or... Yeah. Like, yeah, let's pick through a a couple of extras here. Like, so we'll go to...
What about a...
Go ahead.
Oh, go ahead. No. You... No. No.
I was gonna say, what about a daiquiri?
Oh, let's do a daiquiri. Go ahead.
Or kind of at the end of, like, a summer vacation going off someplace, although some people do that over the winter too to get away from the cold, so they might be going to a desert island someplace.
Frozen dac... I... I'd love to be on an island. Frozen daiquiri margarita, 35 to 45. Mhmm.
It's interesting. It says the blended ice will slow your sipping, but it's still 40 grams of syrup and juice. So maybe you're gonna see, like, a long slow... Like, a steady spike while you're drinking it. Does that seem right?
Yeah. Yeah.
That seems about right. Whereas a drink that's just more liquidy, again, Long Island iced tea, you're gonna drink it faster because it's not so cold on your...
Yeah. Yeah. Yeah. I thought you were gonna say, aren't these people gonna have sex after they're drinking? That's what I thought you were getting at.
I was like, don't you think these people are gonna get, like, you know, lubricated and then, you know...
Well, then we have to discuss the activity factor that might be factored in there and what you might plan to do.
What If You Throw Up30:47
Well, yeah. What about what about if you, I mean, what if you throw up too? Right? Correct. So now you've got stuff in your stomach you're hoping to hold your blood sugar up.
You vomit once or twice. That's gone now. And now that... That's probably a free fall at that point then because now the liver's impacted. There's nothing in your stomach.
Oh, interesting.
Now what do we do?
Don't know. I just I just found myself thinking, I don't know. Yeah. Yeah. Because what if you can't eat.
Right?
And What if you can't eat?
And your glucagon isn't gonna have the same impact on you. We didn't even go over that yet. Go ahead.
Me. Was the piece that I was... That I thought was gonna be more of like, well, what are some things we should pay attention to, right, in terms of protective considerations, keeping in mind. We already said... Or I said, try not to drink on an empty stomach.
Right? Pay attention to your glucose meter or set your alarms on your CGM for higher low alerts. You get notified sooner. Right? Especially in a state where maybe mentally you're not paying as close of attention.
You could, obviously, and hopefully, have your fast acting carbs on hand from, you know, glucose or dextrose specifically.
Mhmm.
And then insulin wise, if you know enough ahead, this goes into setting an adjusted temporary basal or an adjusted target for the hours in which you defined really nicely, where is the potential for the low going to hit?
Yeah.
So... Right? Setting a different target. All those things are important along with... I always say, have a friend who knows what they're doing with you, at least knows that you have diabetes, that this is here and that brings in, goodness, glucagon.
Glucagon Still Works, Just Less32:41
How many people walk out of their house with glucagon in their pocket or their purse or whatever? Somebody should know where it's there or where it is. Yeah. Because while glucagon will work less effectively, it doesn't not work at all.
Okay. Still some impact from it. It's worth it's worth trying.
It is still worth giving absolutely if it is needed and you can. And this is where I always say, you do not have to wait until you are passed out if you you brought up vomiting or anything like that. This is the case where if that's what has happened and you can't physically get anything else in and you know the effect of alcohol is coming, give yourself the glucagon. Do not wait.
Yeah. Yeah.
And, it's gonna have a little bit of a delay. I mean, it's it's got kinda two ways that it works, which I... We've gone over in one of the episodes. Was a pro tip or a...
We did a glucagon episode about this.
We did. Yeah. Yeah. Yeah. I was gonna say go to that episode, listen to how its mechanism action kind of is working.
Right? So one, the glucagon essentially helps to break down the liver stored glycogen. It helps to break it down. Right? It's still working even with the alcohol present.
It also promotes something called gluconeogenesis, the glucagon does, and that's a piece that can sometimes get more blocked Mhmm. Overall, in what ends up happening. But if you've been drinking for a while, obviously, the more alcohol that's there, as we've already talked about,
the more
potential for a bigger hit in something that you're using as a rescue that may not work as well as you think it should.
Doesn't matter if it's nasal or the injected, it's gonna have the same... Nope. Yeah. The episode you and I made was seven eighty nine important things to know about Gvoke HypoPen. Seven eighty nine.
I put up nineteen thirty five the other day.
Wow. That was a... I... Yeah. That is a really long time ago.
Yeah. I make a lot of content, but also we're old. And so, also, if you if you you go to the website, juiceboxpodcast.com, and go to search and click... Just type in the word glucagon, you'll get that. But you'll also get
Pop up.
What I think is pretty interesting. It's a small series of people who came on just to tell a story of when they used glucagon. So Okay. Yeah. They're like...
There's, like, these glucagon stories. One of
the that I remember that I did listen to was a woman who... I think she gave it to herself, and then she walked over to the neighbors with a really low blood sugar, and then was... Like, she was traversing outside after having, I think, given the glucagon to herself, or maybe she went to her neighbors and then came back and then gave it to herself. I don't... It was one that I do remember listening to.
Yeah.
Everyone's stories are crazy. So don't don't miss the stories. I... There was a... The the number of people who have told me that I've got...
I've gone out for a walk and had to have somebody drive to me sitting on a curb, I've lost count of that. Like, just... You know, I went for a walk. I got low. I realized I didn't have everything with me, and then I had to call somebody, and I sat down, tried to stay still, and waited for somebody to come get me.
It's... That... That's that's that's a common tale for people. So these glucagon stories, you know, when I I... When I tried to get people to come on to talk about it, a fair amount of people reached out.
Actually, it was really... It's very kind of them because it's not a... They're never fun stories to retell. No. Yeah.
Yeah. You know?
They're they're not. They're scary, and they bring up a lot of, you know, sort of even forgotten, like, feelings about things.
Mhmm.
One... The the last thing that I would say about glucagon is if you've used it and it seems like it's not really working, again, it could have a delayed, but it is also a time to absolutely call emergency.
Okay.
It is not a time to wait if you've used it and you're waiting and you feel no effect or whoever's with you sees nothing happening, absolutely get emergency help.
Somebody needs to get a line into you so they can...
They can always get IV glucose.
Right. Yep. So Jenny, last thing on this one. Besides, maybe I'll make a blog post out of this list of alcohols and just let people, like, go imagine how they could go find out more for themselves somewhere. But I I I took it on the Internet this morning because apparently the last time you and I talked about alcohol, you said it's...
You know, here's what you do on an a I... On an AID system or here's what you would do on a pump, like, you know, maybe do a temp basal decrease, do this, do that. And then we never got back to talking about MDI. So people... Yeah.
Drinking on MDI37:27
So people on MDI who wanna go drinking, are there... I don't know. Are there tips, tricks, stuff that might help them out?
Yeah. Typically, you know, we would usually say in the evening... If you've consumed alcohol in the evening to start out with, to definitely have before you go to sleep or if somebody can help you before you go to sleep, have something that's got some good protein to it. Have something that also has carbohydrate in it because despite that actually boosting your blood sugar up, the goal being that the carbs are gonna get in boosting you up. The protein is going to help to continue to keep things a little bit more stable or higher.
By the time the protein gets in, it's about the point at which the alcohol is probably possibly causing that curve down or the low blood sugar.
Mhmm.
It's one of the best things that you can do with MDI. Some some people toy with adjusting if you take your basal injected insulin in the evening, not not taking it away, but reducing the amount of it. Mhmm. Yes. The whole next day is going to also be impacted by that.
But at least for the overnight time, there will be less basal insulin there.
So it's a safe decision to be made there for overnight, but you are gonna be higher the next day when you wake up.
And you may need more rapid acting with your meals or correctives between, Yeah.
Okay. And because that's also tough for people who shoot it at night because now you didn't take it. You didn't you didn't take enough at night, and you're waiting to get back to that next twenty four hour period to take it again. So you did... That next day might be more fast acting to kinda get on top of that problem.
Okay. Mhmm. And there's... Know, it's funny. I...
A New Pro Tip Series in 202739:21
Actually, that conversation made me think online that maybe it's time, like, when we made the pro tips, for example, like, AID systems really didn't exist. And I thought, like, it might
You're right.
It might really be time to either, like, rethink some of those and update them or to, I was gonna say amend them. But I honestly, I'm starting to think that maybe in 2027, you and I are gonna like make a new pro tip series that...
It's kind of funny because I actually have a note on my desk to meant to talk to you. About that?
Oh, okay. Well, then we're in the same spot.
Okay. It actually... My notes my notes says, go through pro tips episodes. Pick out those that need updating based on AID.
That's what
my notes says.
That's what... Well, listen. I'll put that on my to do list.
I'm curious if it was... I'm curious if the only ones that were out, if they even were at that point, Medtronic had suspend on low. So I wonder if that one was there. And then Tandem had Basal IQ.
Yeah. Yeah.
Right? Which had a predictive kind of nature to just suspending based on what it was kind of seeing or when blood sugar was low. But, yeah, I haven't listened to the pro tips in a
long time. It's... I haven't either, but it's gonna be, it's gonna be interesting because that's... It's a tall order because that series works so well for people. Like, we're gonna have to update it without losing its.
So whatever it is about it that helps people, like, we can't lose that in the retelling of the stuff, and we can't, like No. Retell... We'll figure it out. I mean... Yeah.
We'll figure... Well, my idea truly for considering a big portion of it may be AID specific, we could do it by doing an overview of AIDs.
Mhmm.
And then the next steps or the next episodes, in my opinion, would be each particular AID system and the pro tips within each system.
Okay. To do one for each one?
To do one for each one, I think would hold value because they are different enough and each of them holds value enough to really cover in a more in-depth rather than kind of glossing over it just as a general, this is an AID and this is what it could do.
You know? But talk about the algorithm specifically.
Yeah.
Alright. I'm in. Alright. Let's do that. We'll do that next year.
Yay.
Yeah. Alright. Well, thank you for talking about it. Two people who don't drink talking about drinking. Must be really must be really frustrating for people.
Sorry, guys. Alright. Hold on. Thanks. Yep.
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#1986 Trio Version 1.0: Open-Source AID
Trio Version 1.0: Open-Source AID
Dan leads development on Trio. It now runs Omnipod 5, and he explains how an unpaid team scattered across the world keeps beating the industry to it.
Jump to a moment
- Trio 1.0 reverse-engineered the Omnipod 5 pod communication protocol, so the pods now run in open source AID the way Dash pods always did. The point is not the pod — it is that you are no longer locked to whichever CGMs Insulet has partnered with. Pumps supported now include Omnipod Eros, Dash and 5, several MiniMed models, Dana i and RS, and the Medtrum Nano, with the Tandem Mobi in closed beta. Sensors include every Dexcom, Libre 2 and 2 Plus, Libre 3 and 3 Plus, Eversense E3 and 365, and the Accu-Chek SmartGuide.
- The release itself was a year of work by more than twenty people — 112 new features and fixes across more than 1,500 commits. The algorithm was also ported into Swift so it now runs in the iPhone's own language instead of the one it was written in a decade ago, and that port is becoming a peer-reviewed paper with people at Stanford and UC Davis on how to safely update an automated insulin delivery algorithm. Dan's framing: "We're not rogue cowboys."
- The clearest picture of how this community works came from a community Zoom call. A user said he had a visual impairment and asked whether the lock-screen display could be bigger and colored. Dan went to bed in Germany at 1AM. By the time he woke up, a developer in the US had the feature built and opened for testing.
- Dan's answer on AI is worth the whole segment, because he builds with it and still draws a hard line. It helps with interface work, log analysis, writing tests, reviewing features — and never with the algorithm or with dosing. He and Tim Street sent the same dozen food photos to the models roughly 27,000 times, about 500 to 600 runs per image. Dan's paella in Barcelona, which he bolused for 60 carbs, came back from GPT at 423. The failure he keeps pointing at is that you cannot see the variance: you get one confident answer, with no way to know whether it landed in the middle or at the far edge.
- His structural complaint is data ownership: "we are the currency." A Clarity report of your last ninety days is not access to your raw data, and almost no manufacturer gives you the latter. His analogy — imagine Gmail would only ever hand you a generated PDF of an email, never the email. It also has a practical consequence: the only reason users were able to donate data toward Loop's FDA submission and the European OPEN project is that running open source gave them access to it in the first place.
- Trio on GitHub — The code, the onboarding guide, and the browser build Scott uses for Arden
- Nightscout Foundation — The nonprofit that funds the hackathon, developer devices and travel — donate to the annual hackathon here
- Why the Cheese Sandwich Is the Downfall of AI Carb Counting — Tim Street's write-up of the toast no model and no paid app has ever gotten right
- Episode 1243: DIY Insulin Algorithm AIAPS — Dan's first time on the podcast, if you want the longer version of his own story
- MiniMed Flex — MiniMed's smallest pump yet, the size of two stacked vials, controlled from an app
- Contour Next Gen — The meter Arden carries — second-chance sampling and a downloadable coupon at the link
Every word of the conversation
Welcome and Sponsors0:03
Friends, we're all back together for another episode of the juice box podcast. Hey. Nothing you hear on the juice box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan. The holidays are upon us.
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Meet Dan1:49
Hi. My name is Dan. I'm a 33 year old type one diabetic from Germany. I'm in... Engaged in the open source AID community.
I've had type one diabetes for the better extent of almost three years now. And, Scott and I happen to know each other because I am the lead developer of the app Trio, and that's why I'm here today.
And I am excited to talk about Trio and find out what you guys have been doing with it and where you think it's going. So we have to give some context for people who are just like, I don't know what you're saying. So I usually dumb it way down and you can fill in the the rest. But Go ahead. Shoot.
Here's how I think of it. I think of it if there's a community that's connected through, you know, being online together who has, in the past, created a do it yourself algorithm that helps people with their insulin. And over the years, those apps have been modified, changed, improved. Sometimes they branched off into other apps, and there's... I don't know how many tens of thousands of people in the world probably using the loop or Android APS or Trio.
How how... Do you do you have an idea for how many it might be?
The dark number is pretty high actually, about, like, a hundred and hundred and fifty thousand people. The people that, like, we have numbers for is probably half of that. Mhmm. But it's it's a pretty large number, actually.
That's great. And and it's it's fantastic, honestly. I I would always wanna say that Arden Arden used Loop the first time when she was in high school because a listener of the podcast came on one day and said, I just... I really wish you would do this and learn more about it so you could talk about it. And I thought, oh, okay.
Well, I'll see if Arden's interested in that. And, you know, besides the stint with Omnipod five, Arden's been using either Loop or now Trio for years. And Trio... It's funny. Like, I'm...
I think if people have heard enough of these conversations, they know that technically, don't I don't... I'm not the right person to ask about these things. I don't really understand or know know how they work. I just know how well they work and what a good experience we've had with them. And when Mike came along and told me about Trio...
Because I think at that point, we were using Loop and he was like, hey. You should try this thing we're working on called Trio. And I said, cool. And then I just switched because people I knew and liked and trusted said to, and here I am. So...
Yeah.
Yeah. How much of that do you think people don't understand now? Like, is that pretty clear?
What Open Source AID Actually Is4:21
I hope it's pretty clear. I mean, I can I can I can try to maybe say it in a couple different So you basically already, like, summarized? So open source automated delivery insulin... Sorry. Automated insulin delivery apps.
There are a couple out there. They're totally free. They're community built. They're mostly built by diabetics and for people with diabetes. And they essentially allow you to connect your insulin pump and a compatible CGM to your phone.
And then they basically talk to each other via the phone. And on the phone, there's an algorithm running that is adjusting insulin based on your blood sugar and on various things that the algorithm will, you know, calculate and compute. And because it's open source, anyone can basically build it and they can run it themselves instead of having to go to any company and buy an expensive pump system other than, you know, having to have the hardware, but you don't have to pay them for access to an algorithm. And, yeah, it's it's been great. It's been a journey that's been going on for the better part of a decade, actually.
So the the first system that, you know, was an open source AID came out in the in the early twenty tens. And now we're in 2026, and people are still using this, and people are still innovating, and we're still pushing the boundaries. And I hope we're also still pushing industry Yeah. To to do a little better for us.
Well, I've recently said on the podcast, and I'm happy to say it again here where maybe more people will hear it in context, I genuinely believe that the work that all of you do has a lot to do with how the industry does get pushed and what motivates them to keep moving. Because, you know, it would be easy to be a big company and make a pump that works and just go there. It works. You know? We'll go do something else now or let's just start making profit off of that.
But I think there's pressure that comes when you can download something that works as well as Trio does. So Yep. Yeah. I I appreciate all the effort, actually. I greatly...
I I wish was... I actually found myself telling somebody recently, I should probably not say this out loud, Dennis, because somebody's just gonna steal my idea. But I... I've... I really...
I've had the idea recently that I would like to I'd like to get together some, like, OG people and some people and and some people from along the way through this whole process and do... I I don't wanna call it, like, maybe a series of conversations with people who have been involved with it over the years just so, you know, not not different than a documentary, really. Like, just hear people's stories about, like, over the years, how it started, you know, people that jumped in and helped along the way fell out, new people that came on. I just think it's fascinating.
It it is a it is a super fascinating story. I mean, it's it's... The the thing is it's like it's like this ever growing tree. Right? And so, like, you know, some leaves fall off and then other leaves grow again, and this tree is still standing and it's growing and it's, you know, getting taller and taller.
And it's it's it's a bit of a of a, you know, romanticized image I'm kind of trying to to paint here, But it's a bit like that, honestly. And it... It's it's so interesting to meet people from across the world and, you know, when when some people pop up. Just recently, for example, there... There's this young guy out of The Netherlands.
He kind of just popped up on Discord, which which, you know, for people that don't know what Discord is, it's it's a it's a chat thing a lot of gamers use. And part of the open source community is organized in Discord. And he just popped up, he was like, hey, guys. You know, I'm using this. This is super cool.
And I heard, you know, you might be looking for help, and I I have I have cool skills, and I could maybe help here. And he's essentially, like, working on a couple CGM integrations now with the whole team, and he joined the community just a couple months ago, and now he's doing that. And it's... That's the beauty of the open source AID community. That's fantastic.
Just we just do... Sorry. No. I don't wanna swear here, but, like, you know, it's it's... We we just we just see see things that we wanna do, we see things that people need and we just we just move and we just we just not waiting for for industry to to, like, do stuff and bring stuff forward that we need.
Yeah. We just basically do it ourselves. Yeah.
It's funny. I... It it reaches the people you don't know. It... It's...
You would never... I mean, I spent a lot of my summer going from event to event with, John from SugarPixel. And at one at one point, I opened my phone. It was, you know, really early in the morning. I knew Arden was still asleep.
I heard her blood sugar was a little high. I didn't see any correction that I wanted to see, and I gave her, a little bolus. And I kinda watched John watch me for a second, and then it hit me out of nowhere. I'm like, I'm using an app he made. Like like...
Right. And and he's just one per... Like, he's one, like, random person. And then there's... And then I...
You know, you guys come over at at ADA, and I was like, oh, there's three people standing in front of me that are pushing this whole thing forward. I actually said to somebody at ADA, you three walked away. And I said, those three guys are propelling this entire industry. And and they're gonna walk right through this room, the average person wouldn't know who they were. Contournext.com/juicebox.
That's the link you'll use to find out more about the Contour NextGen blood glucose meter. Once you get to that page, just head up to the top and you can click right on blood glucose monitoring. I can even do it with you right now. You just go to meters, click on any of the meters at all. I'm gonna click on the Nextgen, and you're going to get more information.
It's easy to use and highly accurate. SmartLight provides a simple understanding of your blood glucose levels. And of course, with second chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the Kontoor Next Gen also has a compatible app for an easy way to share and see your blood glucose results. Contournext.com/juicebox.
When you get to my link, just scroll down and you're going to see things like a buy now button. You could register your meter after you purchase it or even... Oh, what's this? Download a coupon. Oh, and receive a contour next.
Oh, there might be a free meter on this page. You have to go check it out. Contournext.com/juicebox. That's contournext.com/juicebox. Head over there now and get the same accurate and reliable meter that we use.
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By using those links, you are supporting the production of the podcast and helping to keep it free for everyone. It's really fair. I just... I mean it. It's it's fantastic and and all the other people that have been involved over the years.
Yeah. So so anyway, tell me, I guess, like, just for a tiny bit of context. Yes. Loop was... It was a...
Ivan, and the Branch That Became Trio11:48
You know, Loop was going for a while. And then it it branched off. I'm gonna use terminology. I don't use it my whole life. It branched off, which means what?
You guys took the code and then...
Oh, okay.
So Yeah.
So in in in... I mean, defense is the wrong word here. No. But in all honesty, LUB is still kicking and LUB is still alive and LUB is still doing well. Mhmm.
So Loob is still there. There was a there was a developer, a Russian guy called Ivan Valkov. And in 2021, he started introducing a couple features to Loob, and they just didn't really get into the the Loop code base, so they just weren't added to Loop. And, you know, being being an open source guy that he was, he was just like, hey. You know what?
I can just do my own thing here. And, that branched off, and he he made up an app, and that app used to... Like, got to be, what then was called FreeAPSX. And, what he did, he was taking the algorithm, the OpenAPS algorithm or the ORF algorithm. So that is an algorithm that was developed in the twenty tens.
And some people here might know that it's also the algorithm that is running in Android APS, so an Android based AID system. And he built up this app. And then over the years, you know, a couple people came on, a couple people went off. And in in late twenty twenty two or mid twenty twenty three, a large group of people branched off from from a project that was... That is also still existing, and we came up with Trio.
And then ever since then, we've been developing Trio, and we work very tightly together actually with the folks that are doing loop. We are well connected with the... With our friends over at Tidepool because, you know, the people at Tidepool, part of what they can do is also, you know, push the open source envelope as well. And the Trio team is about, you know, a a dozen core developers. The wider team is about three dozen people, and we have a community of a couple thousand people that are using Trio every day.
And, yeah, that's that's... I guess, that's that's the Trio story here in in thirty seconds.
I have to ask, is Ivan still involved?
No. Unfortunately, Ivan had to kind of, like... Well, I guess, he he could no longer really participate when the when the Ukrainian Russian war broke out, when Russia invaded some parts of Ukraine, and all the sanctions were started to, you know, politically and economically stop that Yeah. Or, like, stop Russia from doing that, he could no longer, like, participate in in development, basically, with the West, I guess. And so he had...
He kind of pulled back. And to my knowledge, he's still actually developing some sort of AID up in Russia for Russian people with diabetes.
Good friend.
But he's... He he... Like, there's a big telegram group going wherein they have a community going, but he's no longer involved in in Trio or in in anything that is, like, loop Trio, Tiepool So the West. The Europe.
Yeah. The reason I asked is because I I... Listen. Again, there's a ton of people involved. I couldn't possibly know everyone's names.
But I once heard Ivan from somebody. There's, a guy in Russia. His name's... And so whenever I I reach for a generic person involved in, you know, AID DIY, I always say, there's a guy in Russia named Ivan. He's doing the...
You know, he's doing it. And then one day, somebody's like, I think he's the, like, part of the trio. I was like, oh, how random is it that that's the name I chose? And it was just the one that stuck in my head. I hope he knows how grateful I am and how many times I say his name even though I have no idea who he is.
Yeah. But
it... It's just I think that's a fascinating look at how it gets... Like, said leaves fall off, leaves come on, but almost how it's, like, passed, like, a baton, you you know,
from It's it's kinda like passing a baton. I mean, so so in in in, like, in in all respect, Ivan was never involved in, like, what became Trio. Okay. Like... So we are basically...
You know, we're always building on the... Like, we're always standing on the shoulders of giants. Right? So, basically, Ivan was one of the giants that we're standing on now. We are the...
If if you wanna call that, we are, like, the third generation of a project that Ivan started in 2020, 2021. And, it's also, I guess, to some extent, the reason why we're called Trio. I mean, the the origin story of the name is a bit, you know, you need you need glucose, you need insulin, and you have the app that controls it. That's a Trio. You know?
You have a CGM. You have a pump. You have the phone. That's a Trio. But but also, we're the third generation of, the iOS running...
Oh, sorry. The algorithm that is running on iOS and... Because we evolved out of that project. And so... Yeah.
I'm... I've I've never met Ivan. I've never talked to Ivan. A couple of people that are still, you know, some of the OG Trio folks, they actually knew him. My...
Myself, I I didn't. I I read a a ton of his code. I've worked through a ton of his code. I've I've read a bunch of the things that he's done and and and he's still doing. But...
Yeah. And that's Fantastic.
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So what got changed, and why why would would people be excited? I have a note in front of me here that says, I'll be updating Arden's Trio soon. So that's from the person who handles handles it for me. So...
Trio 1.0 Runs Omnipod 518:09
So so I I I guess one of the one of the, like, most impressive and really cool things that we were able to do with Trio is that Trio one dot o, so the the grand release, is supporting Omnipod five. Oh. So what what does that mean? Because you're like, wait. What?
Isn't that like a commercial system and wait. What? So we were able to basically reverse engineer the the Omnipod five pods, so the communication protocols. And we're now able to talk to the Omnicod five pods just as if they were dashboards, for example. And so you now can use them with Trio and our algorithm.
And I don't I don't wanna downtalk or trash talk in Slip by any means, but a lot of people are not really happy with the o p five algorithm. And so Trio one .o... And also for that matter, in all fairness, also the the most recent loop version, you can use the o p five pods in open source AD. And so the really, really, really cool thing about this, and I I really wanna emphasize on that, is it unlocks you from only being able to use the CGMs that, you know, Insulet has partnered with. So for example, if you're in The US and if you're running an Eversense e three sixty five CGM, you can now use it with an o p five pod and you can use it in Trio.
Or if you're living in, you know, in Slovakia and you're using some some older Libre sensor that isn't even sold in in The US, for example, a Libre two plus, you can use it with Trio. Or if you, you know, if you wanna use some kind of CGM that is maybe only sold in Europe. And for example, Roche, the the the company here in Europe, they have a new CGM. It's called the Aquachex SmartGuide. And we've also added support for the Aquachex SmartGuide with the recent release.
And so we basically unlocked that thing for all of our users, and we are offering true interoperability for for people that wanna use Trio. And before I forget it here, we also added direct support for the Abbott Freestyle Libre three and three plus. So you now not only have o p five, you also have, you know, all the Dexcom sensors, and you also have the latest Abbott sensor. So, essentially, you can loop with almost all the pumps in The US and all the CGMs in The US.
Yeah. It's funny how you say loop because it's it's it's a ubiquitous word at this point, isn't it? Like...
Yeah. I mean, to be fair, I mean, DIY looping is is is basically the the generic term for what we're doing here. And even the commercial systems, they are looping systems. Mhmm. And I guess the the guys that, you know, at Tidepool, they just came off this really good name.
Well... And so, like... I mean, right now, there's what? There's tide pool loop in the twist pump. Yes.
MiniMed is got their new flex pump out. Tandem's got the Mobi. They have the the control plus. They're they're gonna... They're, I mean, they're getting ready to introduce a tubeless pump, aren't they?
And isn't isn't mini med too? Like, there's a lot of pumps coming.
Yeah. Yeah. There there... There's a tubeless pump by mini med also coming. They they...
I think they've talked about it in in or around ADA, and I've also seen them on on on some podcasts talking about it. Beta Bionics is bringing out the the Islet Mint. Right? So the... They have also have a patch pump coming now.
And then, yeah, as we're saying, MiniMed has the flex, and Tandem is also going to release the the patch Mobi version. Mhmm. Not just, you know, the adhesive with the... Where you can slide the Mobi in, but an actual patch pump version of it. And speaking of Moby, actually, I mean, you were at ADA, and we talked about this basically right when it happened.
But at ADA, we we not only announced that, you know, by the end of the summer, o p five would be loopable with Trio and Loop. We're also working on the Tandem Mobi. The Tandem Mobi is, unfortunately, I wanna say, unfortunately in quotes, still in close beta testing, but we're still working on it. And, you know, fingers crossed that it'll land this year for, you know, public use. And then also the 10 demo, we will become loopable with a future version of Trio and Loop.
Yeah. Do you ever... Do you have any feeling for how... I mean, maybe it's not even something you can share. I'm not sure.
But I... I'm trying to put myself in the I'm trying to put myself in the position of somebody listening who's hearing. So I download some code from the Internet, and then it attaches itself somehow to my phone. And then it's talking to my insulin pump, and it's not using the algorithm that the people that made the insulin pump want me to use. It all probably sounds fairly, like, odd or it could sound scary to people who don't know what they're they're doing.
But my question is is do you know what the companies think about it?
What the Pump Companies Actually Think22:57
I mean, it it... I guess it depends it depends on the company, and it it depends on who in the company you would ask. Right? I mean, some some people, they are really not happy. Obviously, when they're working in, you know, regulatory or compliance, they might be scared that something can...
Could come up. What I can say is that that, open source AID is perfectly perfectly safe. It's it's not just like, you know, some shady guy sitting in in some garage somewhere and, you know, doing some weird... This is this is built, like, by actual software engineers, and there goes a ton of testing into this. And we...
Like, this this is very, very safe. And talking about the the commercial companies, you would actually be amazed, like, walking through ADA, for example, if you walk through the convention and, you know, how many people that work for some of the commercial companies are also, like, using Trio and Loop. You would be amazed. I mean, I I cannot name names, and I cannot name company names. But you walk up to, like, a couple of the booths, and and, you know, you also know a couple of faces when you go to these conferences.
And they go like, oh, hey. The Trio crew is here, and then you just start start chatting away. And then it's it's pretty interesting when you're standing basically at that booth, big logo behind them, and not... They're not even using that system. And so it just it just speaks to to the safety and to the to the outcomes that you can get with the systems.
Porting the Algorithm, and a Paper Coming24:19
Yeah. Speaking of safety, actually, so one of the one of the main things that also happened in the in the Trio one that I released was that we... Essentially, we ported the algorithm that is running in Trio, and we ported it into another language. So for for lack of a better description, so the the algorithm in Trio basically speaks the native language language of your iPhone now. It it was speaking a different language, and now it speaks the language of your iPhone.
It was speaking this different language because it's it's the algorithm that that was built in the in the mid twenty tens. And we not only ported that algorithm. We actually, like... We were a bigger team, and we we were working together with folks out of Stanford and folks out of UC Davis, and we actually are going to publish a paper on this. So there's a scientific research paper coming out of the algorithm port showing how to safely update automated insulin delivery algorithms.
And, you know, we were doing that together with a couple people at UC Davis. A very young gentleman is the is the head author of that paper. He's also type one himself. And, you know, it's it's not like a couple people sitting somewhere doing some weird stuff. It's...
We are actually approaching this from, like, a very, very professional and safety minded angle. Yeah. And... Yeah. It's
Well, I mean, for example
I I could talk about this for hours.
No. I'm I'm happy to talk about it for hours. So I... But I'm, like, you as an example. Like, you have a job somewhere.
Right? And Yes. And I'm imagining you're a data engineer. I don't know what you call yourself or something to that effect. Right?
You're coding or
I'm I'm I'm a software engineer.
Software engineer.
I'm a software engineer and a and a product manager. Yes.
And and so it's a thing you do professionally. You're surrounded by other people who have the same story. I've... I've... Listen.
I've heard people who work at those companies who have also been involved in stuff like that off and on, or the company is sometimes hiring people who have been involved in, you know, vice versa. So there's... It's a passing of... There's a lot of talent out there, I guess, is what I'm saying. And, and a lot of you are putting it in...
Into good use for this. I have a question of, like, is it all always remote, or do you ever get together? And as a group, how do you... Like, isn't it more productive to be together, or does that not really matter?
A Hackathon in Vancouver26:35
It it it does matter, actually, and it's so funny that you mentioned it. I I was thinking of how can how can I bring this up, and you brought it up? It's perfect. Thank you thank you for that. So we we do meet at at scientific conferences.
We we try and meet up at these at these conferences. But three years ago, we... The the NICE the NYSCAA Foundation, I should say. So the nonprofit that is funding a lot of this work is... Has been doing a a hackathon.
So hackathon is basically a multi day event where you where you meet, where you work on problems, you know, where you come up with cool solutions, and a lot of it is is around code. And, we're actually gonna, have another hackathon, coming up in Vancouver, this year. And there was also one in Vancouver last year, and the one before that was in San Diego in 2024. And, yes, we are meeting there. I mean, there's, like, 70, 80 people going to be there this year, hopefully.
And
I don't know if
I if I can actually plug this. Scott, please, like, you know, interrupt me if I can't. But this is this is completely, like, donation based. Right? So, you know, this is a nonprofit, and there is, like, no for profit idea behind this.
And then we're still, like, raising funds, actually. And we're still about, like, 30 away from our, like, funding goal for this year's hackathon. So, you know, if if anyone wants to donate, it's it's pretty easy. It's donate.hackdiabetes.io. You can just go there.
And as much as you know, a Starbucks coffee, like, $5 can make a difference. And yes, we're gonna meet there. It's gonna be 80 people from across the world, out of New Zealand, out of Australia, from from Europe... From many countries in Europe, actually, from The US, from Canada, and we're gonna meet there for a whole weekend, and we're gonna sit there and collaborate. But to kind of answer your question as well, a lot of it is actually remotely.
And that's kind of the beauty about this community because whenever someone, like a a regular user... Like, whenever Arden would have a problem, she can come up on, a Facebook group, and there will always be someone up that can help her
Yeah.
And, you know, twenty four seven, basically.
I I struggle with this sometimes because the people who help manage my Facebook group, I'll do it as a... You know, they're just donating their time. And I I always wish I could help them sometimes because they are so valuable and move people to the right information and and help them to get clarity when they need it. I'm on this webpage now. So it's donate.hackdiabetesdot...
Say it again? Io.io. Okay. So then...
And and it'll it'll forward you it'll forward you to to the NICE COURT Foundation website, and then there you can donate.
Oh, yeah. Look at that. So there's different levels. You could donate... Asks for another amount of $15, 5,000.
Scott Donates On Air29:25
You can put in whatever you want. Yeah. What do I do? I'm gonna put money into this. How do I do...
And you guys should... If you... Anyway, I can't tell you what to do with your money, but I would do it if I was you. Well, here, there's a there's a $250 level here. I'm gonna do two of those.
That is that is super cool.
Thank you very much. No. Are you kidding me? You guys... I I I couldn't...
If I could send you a million dollars, I don't know that it would be enough. You know what I mean? So... Alright. Here we go.
I can do this. This is simple. I'll put my name here.
I'm doing it right now. It puts in my address. There there is also there is also, like, a little store there. You can buy cool T shirts. And then, also, if you, you know, if you're open to supporting our community on on a regular basis, there's something called a subscription, basically.
So you could donate donate, like, $10 a month. And I I really I really wanna say this. Like, you don't have to donate, like, a thousand bucks. The typical donation that we that we got from the community for the hackathon this year was around a $100. But, you know, if you can't do that for whatever reason, because we all know life is getting expensive and more and more expensive, you know, $5 or $15 already help a long way because, you know, we're a grassroots movement and and, you know, many, many small donations also make really, really big events and really, really big help.
Okay. Well, listen.
And
I'm doing it right now. I expect everybody listening to do it. That's all I'm saying. It doesn't have to be what I put it. But but, I mean, if you...
If you're using this technology, it's been for free for a long time. And I I guess if you don't understand that... I mean, you're you're... Listen. You're a real person.
You know what I mean? Like, you have... You already have a job. You're doing this thing. I'm gonna get...
I'm gonna ask you in a second why you're doing it, but you're doing this thing in your own time and so are a lot of other people. And if you all getting together once in a while and and having the opportunity to do this moves things forward. I mean, what... Do do it again. How many CGMs will it work with now?
So it used to be you had to have Omnipod dash to run loop or to run trio, but now you can use Omnipod five.
And... You can use... Let me let me quickly try try to get all these together. So you can use Omnipod Eros, which is the the old school classic Omnipod, but you need a linking device for that. You can use Omnipod dash.
You can use Omnipod five. You can use various mini med models. You can use the Dana pump, the the Dana I and the Dana RS. You can use the Metrom pump, the Metrom Nano Patch pump, which isn't in The US, unfortunately, because it's a wonderful pump. It's it's a small patch pump.
It's smaller than the Omnipod, and it has a steel cannula. It's awesome. Mhmm. You can you can soon use the Tandem Mobi. You can use all of the Dexcom CGMs.
That means g six one, g seven one plus and Stilo. You can use the Freestyle Libre two and two plus. You can use the Freestyle Libre three and three plus. You can use the Eversense e three, the Eversense e three sixty five, the EchoCheck smart guide, and I'm probably butchering something and missing a sensor here. But, yeah, it's...
You you you can use a lot of pumps, and we are going to add... Like, right now, we're working on on directly integrating the Dex Com g seven family into Trio. So you could, like, pair and use the CGM from within Trio, and you don't have to, like, take care and maintain two apps running side by side anymore. Yeah. And we're also working on...
I was actually, when we were meeting in in New Orleans, Scott, I was wearing four CGMs at that time because we're working on, like, integrating CGMs into the app, and I was, like, testing them on myself because I'm the guinea pig here. But, like, we are... We're gonna add a bunch of new devices. And to be completely honest with you, I think since we've started Trio, we must have added, I think, six devices to the to the... Formerly, it was only Dexcom and Omnipod basically and some mini med pumps.
Yeah. My point's gonna be that you just listed a lot of different devices and each one of those took a number of people's time and attention and, like, for those of us that don't understand coding, you know, like, we're never really gonna understand what what it is you're doing. Mean, the closest I come is that my son does this kind of work and sometimes he, like, comes out in the morning, looks at me, and he's like, I have to try to connect this API to this thing and it's gonna pull from these couple of... And he can see him, but he just disappears into his room and comes out ten hours later. I'm like, how are you doing?
He goes, I I I made it work. It's good. And I'm like, oh, okay. You you know, like... And I don't know what the hell he did.
There's there's a lot of screens, a lot of keyboards, and he seems to be very tired when it's over. So, I mean, I can't imagine how many people or how much time it took to get through all those different devices and and to make them,
you know It... Like, you you would think it takes a village, but, you know, the the village is quite small. And and people peep... People, like, invest a a ton of time. Like, some of us, like, you know, almost almost have, like, a second full time job doing this, basically, but it's unpaid.
So Yeah. It's it's very altruistic.
Listen. So now I gotta tell you now that we're involved in this. I tried to make my donation, and it errored at the end. So now I gotta do it Oh, it errored. Now I gotta do it again.
But don't give up if it errors. Hold on a second. I tried to use Apple Pay. I should have known Apple Pay is notoriously terrible.
So Sometimes sometimes Apple Pay can do that to you. Yes. That is very true.
I'm gonna try one more time. I'll try a different way just to... Because now I feel like somebody's gonna listen to this and be like, did he really do it? I'm doing it. Relax.
I gotta put my email address here.
I can leave a little note for everybody. I'm definitely gonna say thank you in my note. Yeah. Hey. Well well well, while you're doing that, I can I can, you know, I can talk a bit about more about the Trio the Trio release?
QuickPick, and the Apple Watch35:03
So, actually... So many people have been using, like, the Apple Watch with with Trio, and you, you know, you can you can... We have... There's a companion app on the Apple Watch. We also have Garmin complications now.
So, you know, if you're, like, into into running or just, like, lock... Like to wear a Garmin watch, a smartwatch, you can have, like, complications on your Garmin now. It's very handy. We, actually, Mike is preparing for a marathon, and he, you know, he set up a really cool complication for it where he can see his pace and his his, like, heart rate, but also his glucose and his IOB, which is pretty handy when you're, you know, when you're running. And then another, like, really, really cool feature, and personally, I really love that feature.
I have to I have to say here. My good friend Magnus out of Norway, he implemented this feature. So the way I use Trio is I basically don't really do a lot. I I might maybe, you know, announce a meal, and I might maybe give, like, a one two unit bolus to, like, get stuff going. Mhmm.
But I don't really I don't really do that. And I... And you've met me. Right? I mean, I'm I'm I'm a gym guy.
I I work out a lot. I go running. So, like, you know, I I eat a pretty, you know, balanced diet, I would say. And so most most times, I actually, like, eat the same kind of, you know, carb amounts. And I I kinda got tired, and I guess Magnus as well, and we kinda got tired, you know, to, like, always tap the plus button and, know, tap in, like, 50 grams of carbs and then do the whole thing.
And so what he came up with is he... We call it the quick pick treatment. It'll come up in Trio if you long press the plus button in the in the home navigation. And what it'll do is it'll basically kind of learn what... How you're using Trio.
So it'll go into your data of, like, the last ninety days. And then for that time of day and that day of the week, it'll give you up to three picks. So that's why it's called QuickPick. And it'll give you up to three carp amount picks and three bolus picks, and you can just go tap, tap, tap, and you just added a 100 grams of carbs and five unit bolus, and that's it. And it's basically a three tap meal entry and a three tap pre bolus if you want to do a pre bolus because you don't really have to if you don't want to with Trio.
And it's based on your data. So if you want to if you wanna say it, Trio kind of learns like how you use the app.
Okay. That's amazing. Jeez. And and do you guys like... Do do you find yourself sitting around often and saying like, hey.
You know what would be nice? Or are you... And you work on new ideas, or are you mostly working?
All all all all the time.
Okay. Okay.
All the time. Honestly, we were we were... Like, just this week, we were on a Zoom call with, like, the community because when we do these we do these scheduled Zoom calls a couple times a month where they are never recorded, and you can just come up and and ask questions because, you know, there are no stupid questions. And people are just much more comfortable when they can, you know, just blurt out a question. And it's not recorded, and, you know, someone could make a stupid comment about it.
And so we've been doing these calls, and, obviously, we were doing a a call for, hey. This is the Trio one that I'll release, and this is the new lube release. Come up if you have any questions. Mhmm. And a guy was coming on there, and, I mean, I I don't wanna name names.
I don't wanna make anyone uncomfortable, but he mentioned that he has a visual impairment. And he was asking, like, hey. Could you maybe, you know, make the text on the the live activity, the live activity? So this is, like, the the really cool thing you have in... On your lock screen that updates live.
You might know that. Like, when you when you order, like, an Uber or a Lyft or, know, Uber Eats, you get this little thing on your lock screen, and it it kind of, you know, shows you how far out the the guy, the delivery driver is with your food. You know what I mean? The thing on the lock screen. Yeah.
We we have that for Trio. Right? And you you can you can customize it to a bit. You can have, like, a chart on there, and you can have it, you know, show you your your ILB, your glucose, the last time the algorithm ran and stuff like that. And he was like, you know, can you maybe make this a little bigger, and can we maybe make it a bit colored or something?
He Went to Bed, Woke Up to a Fix38:51
And we got off this call, and, you know, the team was still chatting a bit. And I went to bed because it was, like, 1AM in Germany. And by the time the next morning, I woke up, like, one of our US folks had done a pull request, which is, basically, he he kind of put up a new feature and was like, hey, guys. Look at this. I made fire.
And was like, hey. I I... So I coded this thing where you can now customize the font size, it's, like, super big, and, you know, it's colored. And I'm testing it right now, so it's it's not yet merged. By the time this episode comes out, it might actually be in the development branch of Trio, so it's not, like, in the main release.
But I just wanna, like, give an example. Like... So, you know, we were on a call just a couple days ago, and someone mentioned a bit of an issue for them because, you know, they live with diabetes and they unfortunately have a visual impairment. And one of the devs was on the call, and he just went, man, I'll just... Can solve this now, like, right away.
And I went to bed, and he went to work. And by the time the next morning I got up, we had a solution for this. That's something. And, I mean... And now it's in testing, but a lot of the things that you will find in these apps are basically built like this because this is patient led innovation basically.
Yeah. Well... And and you guys are having like in the moment concerns that you can... So you're you're you're almost in the same situation that I am, which is like, I just do this by myself. If I have an idea, I say to myself, I
have
an idea. I'm gonna try this and I do it. And if it works, it works. I'm like, great. If people don't like it or it doesn't strike people the way I was thinking was, it's like, that's no big deal.
I didn't hurt anybody's feelings. I only wasted my own time. But then a lot of things that I make or put out, like, actually end up helping somebody. I don't have to go to a meeting. I don't have to discuss it with people.
I don't have to, you know, oh, is Karen already working on something like this? I don't wanna step on anybody's toes. Like, none of that stuff comes up. And it's... You're just able to just pivot and and be flexible.
And and you're also in the space where you see the problems first hand so you can you can react very quickly. I imagine that's what happens when you all get together too.
Yes. Yes. Very much so. And and to to be fair, I mean, we we work super collaboratively. Like, it's it's it's a team.
Like, you know, it's it's not just, you know, I don't know. You met James. Right? You met James at 88. It's not just, like, you know, Mike, James, and Dan doing stuff and, you know, they don't talk to people.
Actually, like, we we we listen a bunch and, you know, we read along in the groups and we have we have friends in many, many other groups. And, you know, we we read along. We read more than you might think. Mhmm. And then, you know, we come up with ideas, and then we discuss them in the teams.
And and that's how, basically, feature requests come forward. And the thing with open source is, basically, anyone who has an idea can come forward and be like, hey. I have this idea. I don't know if it's great, but I just had this idea. And, you know, what do you guys think?
And then we had a bunch of things that that came came to be like this, and and and and that's that's how it goes, basically. Yeah. One one of those would be probably... So there... There's a companion app.
I don't I don't know if you're actually using it. It's called LoopFollow. You you might be using it because because John Fawcett was the guy who who, like, created it back
in the
day, and it's now being taken over because, you know, John pulled a bit out of the open source community Right. Because he's concentrating on Sugarpixel. But LoopFollow is getting major releases. Like, it's it's now in version seven dot one, actually, you know, and and, you know, John was doing one dot o just to, you know, show you how much it's evolved. Right?
Yeah. And and there are a bunch of, like, things in that app where parents, for example, just were like, hey. I I really would like to have this kind of feature to get, a certain alarm, for example, or to be able to, you know, better better interact with my child, for example. And the team just gets together and has an idea, and they solve the issue, and then we release it after a a shit ton of testing. That's the important part here.
It's not just, you know, a couple of people getting together and, you know, coding something up, and then two days later, it's released. It goes through, like, a ton of testing, a ton of automated testing, a ton of structured testing by humans. And when it's good, it's good, and then we ship it. Mhmm. Yeah.
I I use LoopFollow every day. So...
Oh, you do? I'm sorry.
Yeah. Yeah. Cool. 100 a 100%. I I...
It's the story I was telling you earlier. So I was I was sending a bolus through that.
Oh, yeah. Yeah. Yeah. See. See.
Yeah. And and so so one of one of the one of the main things, for example, that that started with the Trio team and the LoopFollow team collaborating is the way you can now do remote carve entries and remote boluses in LoopFollow with Trio and Loop and how you will now get a little push notification back whether it worked or it didn't. Like, that whole system was completely redone from the ground up because we were like, yeah. Like, you as a caregiver or as a parent, you just need to know if if stuff actually works and, you know, the the team came up with this idea. Someone in The US actually had a really cool idea and did it like a prototype, and then the prototype wasn't it wasn't scalable.
What I what I mean by that, it wasn't it wasn't so that you could just, like, build it and use it. It was, like, very complex to set up. Then, you know, the team got together, and we we we innovated, and we we tried around, and we fiddled around, and then that's what's been in for a long, long time now, for example.
That's awesome.
Also, in in the new LouFollow app, for example, because we collaborate with the team across across the teams. Basically, we're we're one big family, so we we all work on the same things. You can now, you know, pinch the chart and you can pinch Zoom the chart and you can you can tap in the chart and you get stuff in the chart. That originated in, like, work that we did for Trio one dot o. And, you know, I was talking to one of the main guys that is doing Lufolio.
He's called Jonas. His son is a type one diabetic, and, you know, that's why he's involved in the community. And we were just talking, and I I still hadn't, you know, finished my own work. And I was just... You know, we were just chatting away.
And and I I sent him a link to, like, my code, and I was like, hey. Can you take a look at this? What do you think? You're like, maybe you can use it. And, you know, and now it's in both apps, and we we we we pushed innovation, and we we made things better.
I mean, improved the, you know, the user experience when using the charts in Trio and and in loop follow. And that's just how we roll. It's it's really, really cool, and it's it's one of the main reasons that I guess I'm also involved because you can, like, you can really push the boundaries, and you can really make lives of people better. And and it's it's it's a pretty giving giving thing, honestly. Yeah.
For for all the, like, sleepless nights and all the stress and all the, you know, hardships that it's that it's kind of creating, in in one's own life, to an extent, it's it's very, very much worth it, if you, you know, get to see how you can, affect people's lives for the better.
Right. Hey. Listen. I either have donated $500 or you have my entire four zero one k. I'm not sure what exactly just happened, but good luck with whatever I sent you.
God Hey.
I mean, for for the Knightskot Foundation's sake, I kind of hope it's your 401 k. Seriously? For your retirement, I don't.
I either just donated once or twice. I have no idea. Enjoy the money. I'd I'd... You know, I hope it it flies a couple.
Thank you
very much. Yeah. Yeah. You're welcome.
Appreciate it. I'll I'll I'll I'll tell the team that you did this.
I think I'm gonna stop spending money while I'm
talking to people. I don't think I'm good at that. Hey. I mean, I can give you my address if you if you wanna go and have them, like, you know, order something. Send you over some paper towels and toilet paper or something.
Yeah. Please. Yeah. Do it.
Well, I... Listen. I mean, you've had diabetes three decades. Right?
Coming up three decades. Yes. 2027 will be my thirtieth. I mean,
if it doesn't mean a lot to you, who's it gonna mean a lot to? Right? And and I would say too, you you probably used other systems before you did this. And you you know what I mean? Like, you know the impact it has on...
Listen. I know the impact. Look. I'm... I don't think this is awkward.
I Take an Ad From Every Pump Company46:36
I think I take an ad from pretty much every pump company that exists. And I am I am more than happy to, like, tell people what's out there for them, and I hope they find something that fits them well. I also think that, generally speaking, most people are not gonna be comfortable building their own app, or being... Or or doing this. I think for the people who are gonna find it, interesting, they're gonna they're gonna go and work on it and think like, oh, this is really awesome.
And there are gonna be plenty of people who are like, yeah. It sounds nice, but not for me. When that's your world, maybe it's the mini med flex, maybe it's Control IQ, you know, and their offerings, maybe it's Omnipod, maybe it's Beta Bionics. I don't know what you're gonna like, but I want you to know about them and have your choice. I also think that every one of those algorithms works really well.
I think I I... You've been around diabetes for thirty years. My daughter's had diabetes since 2006, which is twenty years that I've been aware of diabetes. It is absolutely... Every one of these pumps is far and away, and it's sincerely better option than what my daughter had when she was diagnosed.
And people are having fantastic outcomes. I think other people also have levels of effort they wanna put into these things, and I think that each one of these offerings offers you an ability to put in the kind of effort that you wanna put in. And you Absolutely. Yeah. You should go check under every one of them and figure out which one's for you.
You know? Yep. So...
Mister Potato Head for Diabetes48:01
And and and to kinda double that on that, and and that's the beauty here. It's like, we... We're not even saying, you know, any of the commercial systems doesn't have a place. You know, every every every commercial system is is crappy. Like, don't use it.
No. Not at all. We... Like, people came up with the algorithm that we're using, and for many, many people, it's it's creating, like, much better outcomes and results, but it does also mean you have to, you know, tune the system, understand how the system works. And many people are just, you know, they aren't really comfortable maybe with using a system that isn't quote, unquote, you know, officially regulated.
Yeah. But at the end of the day, and that's... I I was talking about this earlier, what we really wanna do is we wanna we wanna be the mister potato head, basically, basically, for diabetes. We wanna be, you know, the system where you can just go, hey. This is a pump that I really like.
This is a pump I can afford. This is a pump that is, you know, available to me under my insurance scheme in my country or whatever. This is the CGM that I can use and that I really like and that also, you know, gives me good results. And, you know, I'll just use that pump and I'll just use that CGM, and I can I can fortunately pair it with the system and run it with their algorithm, and that algorithm is also really good? But that doesn't mean, like, at all that, say, you know, using...
I don't know. Using the o p five over Dexcom g seven is a bad thing or or using the the Beta Bionics eyelid because you're just someone who, like, at all, like, doesn't wanna think about diabetes, and you just wanna, like, pop something on and, you know, maybe push a button that you're eating a meal right now, which is what the outlet does. Right? Very valid. And there is no right or no wrong here.
Like, what works for you works for you.
Right.
Like, I I really I really wanna, like, double down on this because at the end of the day, diabetes is a very, very, like, personal and individual condition. And, you know, however you wanna live your life, you live your life, dude. And and I I wouldn't wanna be dictating to anyone what they have to use. The thing here is I just wanna give them give them choice, and I wanna give them options. And I wanna have them...
You know, if they use my option, I want that option to be the best option that they can use. But at the end of the day, it's just giving them true interoperability and giving them the best algorithm that we can develop.
Well, listen. In a world where I heard people throwing the word interoperability around for years and years and years, I didn't see it come. You you know? So, like, it was talked about. Yeah.
We're gonna do it, and it's gonna happen. And it's still it's still business when it, you know, when you... When it all boils down to it. And, you know Yep. I think you're...
You've come the closest so far to to offering that to people. It's all... It's fantastic. You know what I mean? Like, it really is fantastic.
I I... It's not gonna happen the other way. It just isn't. Like, you're not gonna get companies to agree on everything they need to agree on. And, you know, I hear people say sometimes, like, well, why doesn't this pump work with that CGM?
This pump company's gotta get it together. And I'll think, are you sure it's the pump company? You you know, like, maybe it's the CGM company. Or why doesn't the CGM... Maybe it's the pump company doesn't wanna work with...
You don't know what's... I don't either, by the way. But, like... But you don't know what's happening. And to think that somebody's gonna sit down and hammer through that, they're not going to.
You you know what I mean? Like, it's it's never coming. So...
It's it's it's it's also... I mean, it's it's... At at the end of the day, these these companies have to go through, like, a ton of hoops and and, you know, bringing a product to market is is a really expensive thing, and it's also just, like, you have to jump through a bunch of hoops. You have to do, like, various clinical trials. You have to go through regulatory.
And, again, I wanna... I don't wanna say that the things that we develop in the open source space isn't isn't safe by any means because at the end of the day, we are using, like, you know, fully tested, fully regulated, you know, commercially available products. We just make them available to you through, you know, going through the communication protocol, But it doesn't make them any less safe. That's that's that's the beauty of it here. But, you know, we don't have to do that is what I'm kinda trying to say here.
Like, we don't have to spend, you know, $2,000,000 on some kind of randomized clinical trial to, you know, test out the pump that we're gonna bring to market. So it it just comes with different challenges, and it it just goes to show, I think, that, like, how complex this space is. And a really good friend of mine, he said the... He said at a panel we were at... He was he was a panelist, and he was saying it's it's the fastest, slowest industry.
How so?
Fastest, Slowest Industry52:26
And... Well, because because we do move and, you know, you've you've probably also heard the whole thing of, like, you know, the cure is five years away. And, you know, I was diagnosed in 1997, and back then, it was, like, five years away. And and, I guess, in, like, in '28, it's also still gonna be five years away, the cure. But you have, like, these these major players in the market, and they're, you know, trying to fight for their share.
And no one really wants to, you know, have other people sit with them at the table and share the food. And that collectively... And I don't wanna, like, nitpick, like, single company here and be like, yeah. This is a bad company. But, collectively, that is slowing down innovation.
And then again, if you look at, like, what has happened in the last, you know, ten, fifteen years in our space, there's been, like, so much progress and so much innovation even in the commercial space. Like, if I if I look at what I had available when I went to high school and what, you know, high school does now have available, for example Oh, yeah. Just, like, you know, twenty years later, It's it's it's insane. I mean, you you were saying it yourself, like, couple minutes ago. Like, it is insane where we've gotten to.
But then again, it's, you know, it's the it's the slowest, fastest industry.
Yeah. There's a push and pull. Right? Because a a company a company is a company, and the people that work there are trying to make money and get paid and and probably make, you know, investor, you know, value and everything else. And and if it wasn't for them wanting to do that, the thing wouldn't even exist.
So you can be mad at them for wanting to make money at it, but you could also say, like, pretty reasonably speaking, if they couldn't make money at it, I bet they'd take their Legos, go home, and build something different with them. Like, they're not people who are either going to make a CGM or make a pump or not. They're gonna make a thing that they can sell or make a different thing that they can sell. These are people trying to make money by producing something. I take the perspective of, I'm super happy they're making CGMs and and insulin pumps.
Like, I'm I'm thrilled they're out there doing that. I think that you're not gonna... They're not gonna be an altruistic... You know, they're not just... They're not a...
They're not an org. You know what I mean? They are a company. They're doing their part. You're doing your part.
And I think everything helps and pushes and and assists each other. Like, there's not one pump or CGM manufacturer, or for that matter, the FDA, who is not aware of what you're doing. Like, do know what I mean? And so Yep. Yep.
It... And the whole world hasn't burned down. Know You what I mean? So it feels to me like it's an unspoken everybody's kind of okay with what's going on situation. I don't know I don't know anything for sure.
I'm telling you from the outside perspective. It's how it feels to me. So Yeah. You know, it... And and a lot of the world works like this.
It... It's it's... I know people wanna put things in, like, neat little boxes and say, oh, that's this and this is that, and it's all sanctioned or... Most of the world doesn't work that way. So I like it.
I like what everyone's doing. Everybody just keep doing what you're doing. Scott says it's good. Keep working. You you know?
Like, you guys... I mean, honestly, man, you guys made an algorithm. That thing's insane. I love it. I couldn't possibly love it more.
I talked to a person yesterday. Loved their Omnipod five. Two days ago, somebody who's... I talked to loved the twist pump. I talked to somebody who loves the new...
There's a guy on my... There's a guy in my group. If he loved the mini med flex anymore, I think his head would explode. Like, do know I mean? Like, it's...
He's so happy with it. And Yeah. Yeah.
And it's good and it's good that he's happy with. And Yeah. You know, we, like, so so, like, our... Again, we're standing on the shoulders of giants here. Like like, our team owes it to to Scott and Dana.
So Dana Lewis and Scott Librand who who came over the algorithm that we are now using in in Trio, and it is also being used in Android APS. We're standing on their shoulders. Right? We... We're also standing on on on shoulders of other people that did other cool things in our community, and it's it's the same thing of, like, you know, we...
I don't know. I mean, I don't wanna get, like, too philosophical here, but, like, if if if it hadn't been for banting, you know, and and, you know, basically making insulin patent free, we would still be dying like flies. Right? And so it's it's it's clear where we've what we've, you know, where we've gotten to. And I I I just hope that everyone just, like, you know, gets access to the things that they feel like they can use and make their, you know, their life suck a little less because they have diabetes.
Like, know, make make diabetes suck a little less.
In the sixty third and sixty fourth episode of this podcast, keeping in mind that your episode will probably be, like, episode 2,020 or something like that.
Okay? Mhmm.
I talked to Dana and then Scott back to back. And I haven't heard them in ten years, those conversations. But I bet you it's just me going, I don't understand. What'd you do? Yeah.
Right. Right. Yeah. And then it's in a Tic Tac box. What's in a Tic Tac box?
Your Raspberry Pi's in a Tic Tac box. I don't know what the hell you're saying. And, like... And that and that was literally, like... I mean, honestly, it's, twelve years ago.
And, you know, and and to think that we're sitting here now, I I mean, I couldn't be happier with how Arden... Arden uses Omnipod with Trio and Dexcom g seven fifteen day. It's fantastic. And I'll... And let me add this to it.
We're not talking about it. Little GLP really writes the whole ship. Okay. So... Yeah.
Yeah. An algorithm, a CGM, a pump that can break up that insulin, insulin, and and a a GLP, you could you could sleepwalk through a six a one c. And and Yeah. That's the that's the
For many people listening.
For many... Is it every... It's not everybody. I'm not saying... I'm saying, like, you know, for a mass of people.
This is this is fantastic. I still... I just interviewed a woman three hours ago who was just diagnosed as an adult, but started talking about how her sister was diagnosed some twenty, thirty years ago as a baby. Her sister is still struggling because she came up with die... In diabetes in a time where somebody told her this is a sliding scale.
Here's how you do it, and she just never progressed. Like, so Mhmm. Where you put people is sometimes where they stay. And imagine that today where we're putting them is in all of these algorithms that exist on all these different pumps with all these different CGMs. And and that...
Are you telling me that's gonna be that person's baseline twenty, thirty years from now? A six, a six and a half a one c eating how they like, living their life fairly unencumbered compared to the past. You talked about what you had going to school. My daughter was diagnosed, given a a... Literally a bag.
We just had a box with bags inside of it. The bags had 10 needles in them. They gave us Yep. They gave us basal and and bolus insulin and a meter that that literally felt like it fell out of a bubble gum machine. And and that was the entirety of how we manage Arden's diabetes.
And if Hey. And, I mean I
Twenty Years of MDI and Finger Pricks59:13
mean I mean, it's it's it's... I was the same, basically. Right? And so we we... So, I mean, this is the second episode.
I've I've been on your podcast before. We kind of... We we kind we kind of touched on that in that other episode. But just to quickly quickly touch on that again maybe, I was doing MDI and and finger pricks for twenty years. And so if you if you think about this, like, I was still not wearing a CGM in 2017 because, you know, my endo was this old guy.
He's a type one himself, and, you know, it was kind of like, you know, don't don't turn the running... Like, don't don't turn the ship. It's it's going it's going great. Like, you know? Yeah.
Set the sail and go ahead. And I was having good a one c's, but holy holy freak I was doing so much work. I mean, if you wanna if you wanna get to, like, a, like, a five nine a one c and eat a normal diet, do you know how much you have to, like, micromanage on MDI and finger pricks? Oh. Holy.
Oh, I know how much because I did it, like, for a bit...
For a
kid, and it was killing. Right? Like, literally killing me. So Yeah. Yeah.
Yeah. Yeah.
And and and so and so I was... I I I got onto a pump because of of some other medical condition. I was, you know, I'm... We we made the... We made the switch to a pump.
And at that time, I was I was also already working as a software engineer, and I had been, you know, following along the open source AID community, but I didn't have the devices. So I was just kind of, you know, sitting sitting back in awe. And, dude, I went I went to my Endos clinic, and this nice lady from Insulet came up, and she was like, so this is a PDM, and this is how you use this. And, you know, she gave me the pod, and I filled up the pod, I put the pod on my arm. And then I I, you know, I was I was nodding and smiling.
I was nodding and smiling, and then I signed the piece of paper that she really taught me how to use it. And then I went home. I pulled off the pod. I filled up a fresh pod, and then at that point, I was running loop because back then, there was only loop, basically. Right?
And, you know, fast forward a couple months later, I started... I joined this team and started developing, like, our own app. And, again, fast forward fast forward a couple of years, I'm doing what I'm doing now, and I'm sitting on a podcast with this guy who's doing podcasts that's, like, millions of people listen to because I'm doing this app. Right? So...
And not only that, but I'm making the podcast the same way you're helping with Loop. Like, I just one day was like, oh, I live in this. I think that I have a talent or a skill that might help with it. Let me see what I can do to help. That's really all I was thinking to doing, and you're doing the same thing.
It's... And and there's a lot of people doing stuff like that. A lot of people who nobody knows, and that... That's always my point. So, you know, people know me and they know this podcast, and that's wonderful, but there's a lot of people doing a lot of stuff you have no idea about.
Also, you know, I also know a ton of people at every one of these companies. They're also working really hard and lovely people. And many times, a lot of them have diabetes. And there's just people in corners of this world, nooks and crannies trying to help you with your type one and trying to get us as fast as possible from here's a bag of needles, good luck, to where we are now. Also, I I guess it kinda takes me into the next part of my conversation.
Let me just tell people before I jump here that you were initially on episode 1,243. It's called DIY insulin algorithm a I a p s. So if you wanna hear more conversation, go check there. But it it... Taken that we got...
We've gotten as far as we've gotten since my daughter was diagnosed in 2006 to where we are now. Just from your perspective, as somebody who's working on something specific, where do you think this is leading to? Like, I mean, how much is new technology going to help you? I mean, is there a ceiling on these algorithms? Or or...
You know what I mean? Like, are we gonna get to the point where it's just like when we buy an iPhone, we're like, the camera's better? Like, or are... Is it gonna is it is it gonna hit a ceiling, or is it going to... Do you think it can continue to prove?
Is There a Ceiling1:03:04
So speaking of what is available commercially, there's... There is a lot of ceiling left to to... Until we, like, hit the ceiling. There's a lot of air. Speaking of what we're working on, there's also still a lot of air.
I think right now, if if we take, like, three steps back here. Right? So there's a bunch of research going on. You know, there's, like, antibody medications now going on that, you know, can postpone the the the breakout of, you know, the Sure. Beta cells being killed and stuff like that.
And I guess that is that is, I guess, the actual cure to an extent. I hope... I still hope that at some point, we will get to that actual cure. But what I personally like to call these systems is a functional cure. Right?
So right now, this is, I guess, the best thing that we can get, and we we are still trying to improve them to to having to do, you know, less less inputs. So, you know, just eat, and you don't have to worry about boluses, and you don't have to worry about putting in insulin. You don't... Ideally, you don't even have to worry about, like, you know, what you're eating exactly. So that is, I guess, what we're working on.
And then if you wanna get a bit more detailed, you know, right now, we are working a lot on stuff like there is something that, you know, auto adjust settings, and there is something that, you know, kind of maybe like a questionnaire, and you you you answer, like, five questions, and it sets up the system, and it it sets up the settings for you. Because one of the main pain points for many people that use an insulin pump is setting up the system and finding the right settings on that system for them. Right? I I think the the the ceiling that we'll hit at some point right now, other than, you know, improving the algorithm and making it better and better, is a, that there is currently nothing like a smart insulin. So, like, insulin dose is insulin dose.
You can't really take insulin out at this point. And the other limitation is honestly just the accuracy and the quality of the of the, like, the input that we need, and that is glucose readings. So how good are CGMs working? How fast are they working? It's it's still, you know, based on interstitial fluid.
So it's not actual blood glucose. It's it's, you know, it's a chemical reaction based on the fluids in your cells, basically. And because of the chemical reaction, they can they can calculate what glucose you will have, but it is still delayed. Right? So I guess those are the the limits right now.
But on on on... Like, we... There's still so much to be done and so much to be improved, and I I don't think we're we're we're there yet, honestly. And also, taking another step back here, you and I, we are very fortunate enough that we were born in, you know, the Western world in in, you know, in very educated and rich countries. Right?
Like, you were born in The US. You live in The US. Your kid was born in The US. I'm I'm I'm here in Germany, Central Europe. We have, you know, very, very good medical care.
We have access to all these systems. But there are, like, low and middle income countries in the world. Right? And I think one of the one of the things that also the open source community is working towards is really making these systems available to as many people as possible for... You know, to to to just also have some kid that is living, you know, in in rural India somewhere or, like, I don't know, in in somewhere in in in the in The Middle East be able to use this kind of stuff.
Yeah. So, you know, I don't wanna I don't wanna go into politics at all, but, you know, it's it's it's a crazy world we live in, and I think there's a lot of things to be done for, like, people with diabetes in the world Yeah. Generally.
Yeah.
Right? And and then when it comes to these systems that we're using, I think there is still a lot to be done. And I don't wanna, like, sour the mood here at all, but it's like we we are still very, fortunate that we can we can use these systems. And, like, for me and for Arden, it's something like, you know what? I'll just have lunch.
I'll... I don't give a And for someone else, it's, oh my god. I don't even have insulin for the next week. Oh, yeah. And I think I think this is like the...
It's it's it's like a really double edged edged sword. I'm sorry. But I think we'll we'll improve as much as we can, and we'll also very much push to try and make this available to as many people as we can. But I think the... I guess this...
I guess the ceiling to an extent is trying to make life with diabetes better for everyone that has diabetes on this planet and not just, you know, the people that are fortunate enough to have access to these systems. Yeah. Is there... Sorry. I don't...
I didn't wanna sour the mood here.
You know what? You know what? Don't you sour the mood. It's it's absolutely true. I...
Listen. I've interviewed a ton of people from The Middle East who have, like, financially the, you know, the the ability, but don't have any access at all. A lot of families, Saudi Arabia, places like that, they get on a plane and fly here and buy their their devices for their kids and then fly home again. Like... And, listen.
It's amazing they can do that, but the point is is that they live in a place where they have money and they still can't get to it. Imagine places that... Where you don't have money and you can't get to it or you don't have money and you you could get to it if you had money. I mean, most people are not enjoying this kind of this kind of technology or outcomes, even access to information about something as simple as like, hey. The fat in your food makes your blood sugar go up in a couple hours.
Like, that's... Yeah. That's just not a thing people talk about. It's... I hardly find people in America who were taught this stuff.
The podcast is, generally speaking, popular because I talk about prebolising and covering, like, macronutrients that impact your blood sugar. Most people don't talk about that. And then they have, like, wildly better outcomes because they found out about that, and then they think I'm, like, special. I'm like, I just... I told you some pretty basic stuff.
You know? But you have to you have to have somebody who's gotta be willing to have that conversation and tell you about it and go over and over again until you're like like, oh, I'll try it. Like, leave me alone. You know what I mean? Like, until you get kinda, like, pushed into giving it a shot one day.
And if you're... I don't know if you're digging in a mine for coal bought, though, there's definitely nobody talking to you through a podcast about the fat in your meal if you're lucky enough to have a meal. Alright. I'm with you, man. You know?
Yeah. Yeah. I I... But but what you do specifically, if those people can't get to the technology, the thing you're not... The thing you're doing is not going to be able to impact them.
Is that That
is correct.
Is that hard for you? Like, I mean, do you feel like you're helping and you could be helping so many more people, but there's things in your way that are out of your control?
I mean, obviously, there are things out of my control. Right? Or, like, out of our control. But, it's it's it's a growing thing. So, like, even in in low and middle income countries, more and more people are using open source AID because it's it's...
Again, it comes it comes to the whole interoperability bit. Right? If if they can get their hands on some kind of pump and some kind of compatible sensor and then they have a phone, it it... They have a system that works for them. Right?
And so this is this is, like, really, really awesome to that regard. I think the the limitations that that we kind of struggle with is just, to a point, getting the word out there about these systems. Because I think at the end of the day, if you have access to all of the, you know, all the little components that you need for them, they can they can, like, just massively improve your life. And and then just also, like, just advocating and educating about these systems. Right?
So open source AID has been part of the ADA standards of care for, like, a couple years now. A trio is being mentioned by name for the last three editions. Right? The the... There was, like, a massive consensus statement published in The Lancet, which is, like, a really, really, you know, known and famous publication in in the medical space where, you know, dozens of endocrinologists and leading researchers actually came out and were like, hey.
Open source AID is really something you guys should support and clinicians and, you know, practitioners should help and support their patients if they wanna use this. And so a lot of the things that we feel limitations right now is honestly just, you know, doctor Jane Doe and doctor John Doe in in the middle of wherever that don't really keep up and, you know, then their patient comes along and tells them about the system. And they'll just, like, write off, tell them, nope. You can't use this. Like, I won't support you.
And that that is the, like, kind of limitations that really frustrate me because, you know, they could very much use these systems because their doctor just has to write a prescription and be a little supportive about it and maybe learn a thing or two. And those are the kind of things that frustrate me. And I I don't really can change them. Right? I can't really change the world in in in in a...
In the, you know, blink of an eye here. But those things are frustrating, and that's why we do advocacy. That's why I travel to conferences, and that's why I'm, like, involved in research and and, yeah, general advocacy for diabetes as well. But I really hope to be, you know, improving that aspect. And then another aspect, I I shouldn't forget this actually.
Female Bodies Are a Research Gap1:12:20
I'm I'm kind of embarrassed that I'm just thinking of this now. It kind of shows that I'm a man. A big portion of of, you know, diabetes research and medical research in general, but, like, especially diabetes research is also... That is overlooked is is, you know, is just the whole, you know, female side of things. Right?
The female body is just this super duper complex thing, and we don't really understand a lot of things of it. And especially when it comes to diabetes, you know, how does how does the female cycle influence insulin sensitivity and how algorithms work? You know? How do various things in in the female body and when it comes to pregnancy and stuff like that? How do they how do they influence diabetes?
How do algorithms need to adjust for them? Do the systems themselves need to adjust for them? Just, you know, how, you know, people use them. And so I would... I I really, like, love that we're doing work in this in this realm now.
There are a couple researchers that are putting down work. Actually, there's the team out of Charity Berlin and the Hauser Platte Institute here in Germany who's working on this. There... There's a team at Typool also who's working on this, and they're collecting a bunch of data and doing research on this. But I'm I'm going from, like, one to the other here, but it's it's...
There are, I think, some systemic issues that we just can't change or or, like, systemic limitations, I guess, that we just can't change in an instant and that we're, like, advocating for. And then there's just, like, knowledge gaps, and I really, really hope that we can close these knowledge gaps and do a lot of work and research to close these knowledge gaps. And one of those big big gaps is, as I was saying, is the whole the whole female body and
its Yeah.
Its connection in relation to, like, what diabetes does to it and how insulin works and how algorithms need to work for it and stuff like that.
Yeah. I happen to love to adult women, my daughter and my wife, and to watch them try to get through their life, especially with autoimmune stuff. And it's fascinating and really disturbing how frequently a woman will get to an answer to doctor's office and the answer is we don't know. And Yeah. You know, and good luck.
So... Or you... Maybe you're depressed. And, you know, somebody... I've heard people say, yeah.
Well, I mean, if you were in pain every day for three years, you might be depressed too. And and just like how quickly they there's no answers and then no studies. I... I've been watching recently the endometriosis, like, world. And apparently, now suddenly there's a lot of study about endometriosis and everyone will joke, well, yeah, they found it in a guy.
So now we're now we're working on it. And even that, like... So we don't know for sure, but we're not... We're we're getting sure and sure that Arden might have endometriosis. Right?
And it's a a painful issue. And so I've been digging into a kind of behind the scenes and you find this person, you know, is working on this this peptide that they think is, you know, they kind of basically talks the cell into just killing itself and... Great thing. And six months ago, they make this announcement. You can't find, like, another thing about it all of a sudden.
Like, it's just... I I mean, I've reached out to the company. I haven't heard back. I've reached out to the doctor. I haven't heard back.
I'm like, hey. Is this a study? Is it happening? I'm interested to interview you about it. If so, I can't find anything online about it.
Now maybe they're just not talking right now, but there's not a lot of people moving and that's just on one thing. You know? And and some of these... Some of the pumps are like, hey. You know, we got...
You know, I I think Tandem's got an FDA approval for pregnancy now. That's the only pump that has, a pregnancy approval, right, at this point?
The Ipsa pump and the the chem APS FX algorithm that is unfortunately not available in the
Yeah.
Roman Roman Kavoka and his team actually, like, went out, and and one of the main things was, like, he was saying, I wanna I wanna develop an algorithm and a system that works for, like, women that wanna be mothers and, you know, have children and then also ideally for children because that will essentially cover everyone and not just, you know Yeah. White men.
That's people. Right? It... But, I mean, my point is is that... And I don't know for sure, but Tandem had to make a decision at some point.
Like, we're gonna spend money to do a trial to try to get this distinction. And because that's how this... I mean, you made the point earlier. Right? Like, it's expensive to get something through the FDA.
And and why do it if a doctor's just gonna give you a pump and let you use
it off label? Like, you know what
I mean? Like, so this stuff just never gets dug into. And I... It... You know, it's because it's...
Life's Not a Pony Farm1:16:48
I I guess either the juice isn't worth the squeeze or, you know, something to that effect, but it's gotta be something similar. Can I tell you something funny? I took the Go ahead. I took the the transcript from your first episode because the way I make my my episode pages now is different. And I I thought, oh, let me refresh his in case people find their way back to it.
But part of the... I I... This will be boring maybe. Actually, probably not to you, but to most people. I take the transcript of a podcast now, and I give it to my friend Claude.
And through long conversations that Claude and I have had, he turns it into a web page for me. Not only does it embed an audio player, but it gives you, like, moments where you can jump to where it jumps to the audio. It gives you the the transcript if you wanna read through it. It gives you links back to players. It actually...
You know, the the advertisers get put in there. There's takeaways. It's like a really, like, lovely little thing. Right? One of the things that that that prompt does for me is it helps me look through the transcript for possible titles for the episode.
Okay. Yeah. And so the title it came back with from yours, from episode twelve forty three, which initially, I think came out, like, the end of June or early July twenty twenty four. And it's funny because I have no context for this, but it wants to call it life's not a pony farm. Yeah.
Now I'm dying to know how that happened.
We we we... So we we were talking about, like, idioms, and and, like, I... That is the literal translation of of a German idiom.
Oh, okay.
And it would like... The literal translation for it is like life's not a pony farm. Yeah. That's what it came up with. Anyway, I just...
I... It popped up in front
of me because I did it a while ago. I have... Like, I just dropped the transcript in while we were talking. Thought, oh, I wanna remember to do this when I get off the recording. And and then it's just...
I'm looking at I'm like, what does that mean?
So Yeah. Yeah. Yeah. Yeah. I...
I'm I'm trying to think of the English version of the idiom. I I think it would be something like, you know, life's not a walk in the park or something like that.
Yeah. And I
think that's the... That's the translate. Like, that's
Right. That's interesting. Yeah. But... So...
But I I I was... I guess I never really I never really asked my question before you got melancholy a couple of minutes ago. But, will will will you... But this brings it back up again. Will you get any help from these large language models?
Will this make your work easier, or is it... I mean, in any way valuable to you, or is this this something you need to sit down and hand code and and that's just how it has to be?
No. No. It's it's... So so you... We...
So we have to make a very, very important, like, distinguish... Like, we would have to distinguish here, like... Because there's... Okay. How how do I put this?
So if if if you, as Scott, would just ask, you know, Claude, hey. Implement an automated insulin delivery algorithm for me. And then, you know, it it gives you a a bunch of code, and it tells you it's so great because it did this and that. You know? And then you just go ahead and use it.
And at the end of the day, you might really hurt yourself. Right? That is not how we can, you know, use an LM. But, yes, we very... Because, like, you know, you have to have contextual knowledge.
You have to have knowledge of the systems. You need to be very much the human in the loop and and verify everything that it gets back to you, especially when it comes to, you know, a drug with such a narrow, you know, therapeutic indication because, you know, insulin, a couple units more or less, and you can literally die. Right? So you can't just throw something at a clot and be like, hey. Do this for me.
But I will say, yes. It has helped tremendously, of course. Right? Anything that doesn't touch the algorithm and anything that doesn't touch instant dosing. So for example, something like, you know, stuff in the user interface, we can ask Claude or or another LLM for some help on that.
It's it's incredibly helpful for stuff like analyzing logs when someone, you know, sends an issue report. And the the logs that our systems create, you know, it's it's a ton of text, you know, because all the different components under the hood are basically, you know, sending messages that are get... That gets stored. And so analyzing those logs and those issue reports, it can help with that, for example. Yes.
We're also using it to some extent to to review new features and to test new features and also to some extent, you know, to, like, write tests. And then, of course, it can also help in certain people that really know what they're doing in trying to reverse engineer certain components. But just, you know, cluelessly going ahead, opening a call chat window, and just asking them, you know, to create the next best insulin dosing algorithm or whatever.
Probably not the way to go. Yeah. Do you think that's how most people think of of it that you just ask the magic box a question and it just gives you the answer back?
We have... Like, it... It's actually... I mean, good that you're touching on it. It's it's actually a bit of an issue.
Like, we have people, posting, like, pull requests or, like, offering up features, that are so clearly vibe coded where they cannot explain themselves what is actually happening and, like, you know, what is happening in the code. And a lot of them will do stuff that does touch on instant dosing, for example.
Oh, jeez.
And then they, you know, they they put out these features and then... Or they... Also, another thing, a lot of a lot of people are asking, you know, Claude to make adjustments to their insulin settings, for example. And it's it's really not a good thing because an LLM cannot cannot do this kind of work safely unless you, you know, you have a bunch of God Rates in them. And even then, an LLM is not really the the good thing to to use.
I'm actually involved with good fellow friend out of London. His name is Tim Street. He also has a blog, Diabetech. You can you can give it to Google. He does a lot of work in in the AI realm, and him and I have have also collaborated on some of this.
A Paella GPT Called 423 Carbs1:22:55
And we did a fun little experiment where... Or he did a fun little experiment, I should say, where he sent the same, like, 12 or 13 food photos. Right? So they're just, like, snaps of, you know, a plate of something or, like, a pan of paella and stuff like that. And we send it to the various LLL models, and he send it to the LMs 27,000 times.
So every image was sent to the LMs about 500 to 600 times, and then we compared... Like, he compared the results. And we had crazy stuff come out. I mean, I can I can send you the photo of the paella, Scott, after we're done here because I actually? Like, that was my paella in Barcelona at ATDD.
Mhmm. And I think I bowled this for 60 grams of carbs. And GPT was was of the opinion that it... I should have bowled this for 423 grams of carbs. That be done that Yeah.
We wouldn't be having this conversation right now.
Oh my god. No. And,
yeah, I was gonna
say there's no way it's doing that. Yeah.
But Yeah. And and and and and and the... I I don't wanna downtalk LMs by by by all means, but it's it's really bit of an issue because the thing is an LLM will make it sounds, like, super confident. It it is built to regurgitate text in a way to you that makes you trust in that answer and in that response. Mhmm.
And what you cannot see is, for example, is intermodal variance. So if you sent the same kind of food photo 500 times to an algorithm... Sorry, to a... To an LLM, it it is not deterministic in its in its... In how it interprets it.
So you will get essentially 500 different responses. And what you cannot see is is the response pretty much spot on, or is it, like, really, really, like, on the lower scale, or is this really, really on the bigger... Like, on the higher end of it? And then and then it can happen, like, it telling me, like, that a paella would be 400 grams of carbs. And and...
But you don't see that, and you just get a response where it tells you, yeah, dude. Like, oh, this is this is a really, really nice looking paella, man. And you even got gumbos on there. Wow. Cool.
Like, oh, you must be in Spain right now. Really cool. Enjoy that. And by the way, bolus, this and that. Right?
It's it's it's the typical message that you've that you've read from, like, Claude or GPT Right. Or Gemini. And then and then the thing is, right, I mean, I I... I've I've had this stuff for for long enough, and I've bolus for for, you know, enough meals that I kinda know this isn't 400 grams of carbs. But if you are someone that is, like, newly diagnosed
How would you know?
You... And, you know, suddenly you get this, and then and then what do you do with it? And so, like, my recommendation to this is be the human in the loop and, you know, get a second opinion. So is is this, like, super comfortable? No.
But, like, would you maybe, like, submit it again, or would you use another LLM and compare it with? And, you know, these are some of the things that you could do. But just like blindly trusting an LLM for, like... In our context, for for anything on the AID system and just code isn't gonna help you out as much. And on the other hand, even in diabetes, just like blindly trusting the system is is a bit of an issue, I guess.
Yeah. I wouldn't have imagined you would have. I just... I wanted to ask the question so you could answer it like that. I I find it...
Look. I have no technical skill, but I... There's places I've used it where I'm like, this is really valuable for this. And... But you also have to be able to look and go, but there's no way I'd let it do this.
You you know, like, it's... I mean, I don't know. Like, figuring out, like, a carb ratio is a simple math problem. If somebody built themselves a little tool that, like, they put in their carb ratio and a couple things and it gave them back an answer, I'd be like, alright. As long as the tool's right and the math is right, then it'll probably work over and over again.
That's not the same as asking it an obtuse question about a a picture or, you know, I'm having Yep. You know, I'm having a grilled cheese sandwich today with a handful of french fries. What do you think? Like, that's not... Yep.
Do... Like, don't do that for God's sakes.
Funny that funny that you mentioned a grilled cheese sandwich. So so one of the things that that Tim always does is is it it sends... He sends, like, an image of a of a of a of a cheese toast, basically. It's it's a cheese sandwich how you would have it in The UK because he's from The UK, And not a single has been able to crack it. And he's also testing a bunch of, like, paid fork apps and, you know, and and also free, like, carb estimation apps that all use AI and, you know, are are, like, advertised to be this great thing.
And not a single app was able in all his tests and all his publications that he's done on the topic to correctly guess the 40 something grams of carbs on his, like, cheese sandwich. No. It... And and so he's he's been calling it the end of AI.
Yeah. And also it... Jokingly. Jokingly. Yeah.
It doesn't see the way you think of seeing. It doesn't... Exactly. It it also can't hear. Like, there was this...
I... There's this moment where I was like, this is interesting. And I, like, I put an m p three, and I was like, what does this sound like to you? And it was like, I can't, like, I can't hear it. And it was it was like, I can interpret the data from the m p three and give you...
And it it was interesting. It gave me, like, a a pretty interesting idea of what kind of music it was, but it can't hear it. It also can't see pictures. It's not the way it it interprets stuff, and it and it... And for some things, I mean, like, here, I'll give you a simple example.
Right? Jenny and I, Jenny Smith, we do these episodes. We do, these bolus four episodes where we pick up a a food and, basically, Jenny, like, off the top of her head just kinda, like, guesses at the carbs and how she would bolus for it and stuff. While she's doing that, I'm using, like, an estimator that I built that I'm, like, I'm trying to get the same thing from. Right?
And we kinda compare back and forth to see how close it gets. It's a nice conversation. People like it. I I... They're incredibly popular.
And so very recently... And for people who don't track this stuff, it'd be boring for you. But when when Claude went to... Every time Claude goes up a model, I go back and I I have it relook at any code that I've made for my website. Website because I just think, like, clean it up, make it faster, look for mistakes, that kind of thing.
And it usually does find stuff. But every once in a while, you'll notice it gets better at something out of nowhere, and you're like, oh. So I I took a a a transcript from one of those conversations, and I said, can we turn this into, a visual... Like, a web page that you could listen to the conversation, but it would kinda jump around from visual stuff and maybe... And then as I was doing it, I was like, oh my god.
Remember in the chef TV show? This is gonna be, like, very random for you. But, like, the the movie director John Favreau made a movie called chef.
I I know the movie chef.
Oh, and then
It's the grill... It's it's it's the grilled Cubano of heaven.
Exactly. So so... And then and then later he makes a Netflix show. It's a cooking show. And they they used to do this thing where, like, the the food truck would...
Like, was an animated food truck. It would bounce down the road. When it hit a big bump, it would explode, and the food item would come out and it would explode into all of its ingredients. And that popped into my head. I was like, oh, we should, like, have an image of the food we're talking about and then let it pop apart into its ingredients if we talked about it.
Only if the conversation lends to the image should there be an image for it. And, you know, I messed around with it for a while, and now I have a whole web page of them. And not only not only you click on it and you can you can ask it to follow the conversation, it'll just move throughout the web page, show you different pictures, images, pull quotes from the conversation so that it's a little more interactive where you can bop around it. And, like, I think in one of them, we must have gone through, like, five or six different donuts. You could just click on the donut.
It'll jump right to that part of the conversation. You'll hear it and it's over. It's really kind of amazing. And had I tried to do it five months ago, it wouldn't have worked. And and I...
And I'm wondering what happens in five more months or six months. I'm I'm wondering, like, when do we get to the part where you say, hey. This is my trio. You know, this is how this part does this. Do you see something that it could be doing better?
Or do you think that's... I mean, when you say there's more error, do you think that's how we get to the error? Do we just get it through trial and error and human beings using it?
Machine Learning Isn't a Chatbot1:31:03
Well, so if if if you're if you're talking about just, like, algorithmic improvement, I don't think that's just technically an LLM is the right tool here. And and and that's... I guess that's that's a bit of a... I I don't wanna get too technical, but we we have AI. Right?
And AI is actually, like, a bit of a spectrum. So, like, you have machine learning, and then you have GenAI, which, like, an LLM would be. And then you have various various classification models that that, you know, also fall into that spectrum. So I very much think that we will be using more and more AI, but the the AI that we will be using is is, like, machine learning stuff. So, you know, getting a ton of data and then trying to, I guess, predict patterns out, like...
Or find patterns in that data and then use these patterns to adjust how the system functions. Right? That is not something like Cloud or like an LLM or or chatbot for that matter. You can... What what you can use an LLM for, and I think that's...
That we will probably be seeing that more and more in in commercialized apps and also maybe in Tria at some point. I don't know. Would be something like having a little chatbot be part... Sorry. Having a little chat be part of, like, the the user interface, and then you can ask it a question.
It it explains to you a complex concept. Like you were saying. Right? So, like, it it... Right now, they can listen to they can listen to something, and then it kind of, like, moves them around and how did...
You know? And then maybe you have a little chat window, and you could even, like, ask a little question, and it, you know, still moves to, like, another image and shows you another, like, set of information. Yeah. I can see something like that maybe happen... Like, happening in Trio where, you know, there are certain buttons and then, you know, a a little view opens, it's it's called the loop status view.
You might have seen it, like, when you when you tap on the the green loop circle, and then you see everything that is going on under the hood. Right? And a bunch of numbers and a bunch of weird metrics and a bunch of weird abbreviations. And something that I can see, for example, in LM being used for is we make all of that gibberish that doesn't really mean something to you into, like, a single human readable sentence. And then it'll just tell you, Scott, you're really high right now, but you also have a lot of, like, like, really high insulin.
Maybe your pump cannula is bent. Have you checked it? Mhmm. Right? Something like that.
And it doesn't mean that we wouldn't be maybe using, like, the bed... There isn't already work happening actually where, like, machine learning is being being utilized in in making algorithms better. Same guy I was mentioning earlier, Tim Street, he has been involved in the open source community for a decade plus. He he builds a little branch or, like, a fork of Android APS called Boost, and he's experimenting with a ton of things in Boost right now having to do, you know, with with identifying sleep patterns, identifying movement patterns, identifying, you know, heart rate stuff, and how he can utilize that for adjusted dosing. And there's a bunch of things happening already, right, where we use machine learning, for example, and try try trial and error around with it in in a safe space.
So with, you know, simulation in vitro, not necessarily on the human body to try and find a better algorithm. I'm pretty sure we will we will be doing that more and more and more. Yeah. But I think just the whole concept of of having, like... Everyone thinks, like, Claude is the next best thing since sliced bread.
But, yes, it it can help you a ton, but there are just, like, limitations to those systems. And we should just be, like, applying the systems in where where you can probably apply them.
No. I appreciate you talking about it. I just... I really think that most people hear it and think that you just say to it, like, make a better insulin pump for me, And and that just magically happens. But I I I I wanna drill down for a second on your idea about the machine learning because, I mean, I'll open up and tell...
I've said this before, but when... As an example, like, have Dexcom on fairly... Probably once a year. Right? And they're like, oh, it's getting better.
It's doing this. And I used to think in my heart, like, oh, they must have fixed the wire or made the chemical they put that powder. Like... And and I realized one day, I think it was Jake Lee just said to me, he's like, no. We we just have a lot of data.
And then we're looking... And he's like, when we tell you it's getting better, he's like, we're turning knobs. Like, we're, like, making... It's the it's the algorithm that's getting better. It's not the it's not the the physical stuff.
And I was like, oh, and it just hit me out of nowhere. I was like, oh, that's where the ceiling is left. Like, they've done all they can do with... I mean, I'm sure there's improvements to make with the physical device.
Yeah. I mean, they they can make the thing smaller. They can make the transmitter better so it stops losing connection to the pump and stuff like that. They can do that. Right.
But... You know? But the wick that's in there measure... You're you're soaking up your interstitial fluid so that it can be measured, like, that's pretty much works pretty well already. And when he's talking about making an improvement, he's making an improvement to the...
You know, to his... For people, like, listening, like, for the software they use and how it interprets the data and comes back with, you know, what what the... And turns that data into something in the physical world. Right? And and I think you're saying the same thing is that, if you have enough data of women who are going through their periods or sleep cycles or that kind of stuff, like, you can use you can use a machine model to, like, look at that over and over again and try to just harmonistically figure out what it means and how you can...
How it can repeat in ways that that you can trust so that you can try to impact it. Is that really Yep. That's right. Yep. Okay.
To to a point, I mean... And and and to to to, I guess, put on my my citizen researcher hat here, in the first step, collect all of that data and, you know, find how this influences, say, insulin dosing and how insulin works in the body, for example, how it affects the concept that we have coined insulin sensitivity because, you know, that's also just a thinking model, right, that we kind of made up so that we can... We we have a way of describing and working with something that is extremely complex and happens, you know, in an instant in the human body. Right? Because your your body and your pancreas doesn't think an insulin sensitivity, you know, rates and and what you just ate, it just starts secreting a hormone.
Right? But we made up this this model of, insulin sensitivity, for example, and we're working with it. And so we have this and, I guess, you know, every woman you talk to, they will tell you, like, going through their cycle depending on which phase they're in in their cycle, they will have different insulin needs. And, you know, that is, I guess, somewhat, you know, part of the of the published published knowledge out there. But how exactly does that happen?
Can you can you predict it? Can you find it in patterns? Can you can you, based off of a glucose pattern, find out which actual phase they're in in their cycle? Can you use that to, you know, adjust the dosing? Can you use that to
Mhmm.
To to adjust other things in in in the algorithm? That is the stuff where, like, research is more and more steering towards, and that is... Mean, like, the second step, I guess, that is where the algorithms will will steer towards, and and they will utilize that stuff, and then they'll get better and better and better. And and then again, to, you know, kind of reiterate on the whole concept of we are pushing the envelope here, we will be we will be at the forefront of that, and we will be pushing that that that envelope because we can do it much quicker and, you know, from from, like, a patient leading perspective and approach versus what all the commercial companies and the commercial entities are doing. Yep.
And the great thing is that we've... We were now working, like, more and more with researchers and being kind of seen as as a serious, you know, entity to be... Like, sorry, as an entity to be taken seriously and to, like, work with versus, you know... I think it must have been actually a former CEO of Taxcom who calls the the people that created Nightscout the rogue cowboys. Right?
We're not rogue cowboys. We're actually, like, pretty pretty serious people, and we're pretty serious about the things that we do here. And we we we wanna innovate, and we wanna push the... Push stuff. And there are researchers and clinicians out there and also people in in other areas out there that start realizing that, and so that's what we'll do.
Did they ever come and try to hire you guys, like, different companies? Did did they
Well, not me personally. I'm... Might have gotten a couple approaches, but it's it's not like we don't talk to the companies. Let's just say it like that. Like, we we know people at companies and they talk to us.
And as I was saying earlier, a lot of people at these companies also use our systems. So, you know
They're not in the way.
If if if if you meet Mitch by the Starbucks next to your office and Mitch talks about the cool thing that he's running, you know, you'll know about it. And it it takes a couple Mitches until certain people in certain levels that the companies know about it.
Yeah. They're like, I'll I'll give it a whirl too. No. I... Listen.
I I don't wanna say differently. I know people who work in different companies that are not using their products. So I don't think that's... I don't think that makes the product bad, to be perfectly honest with you. I think it just Exactly.
Yeah. They they they did the thing we all say we want is to, you know, for people to have a choice and and do what they think is gonna work for them Exactly. In their life. Yep. Yeah.
And I... Also, we have no idea. Like, I... Listen. I...
What I know about, you know, how how much I understand, you know, the world today and technology probably fits in a thimble. But I also would not be... I wouldn't be shocked if we woke five years from now and it was easy as, like, picking up your phone and going, make me a better insulin pump. And it... Like, maybe...
Like, I don't know what's gonna happen when recursive comes and when it starts teaching itself, and I have no idea. You don't either. Like, none of us know. So Nope. Yeah.
But, I mean, the... Just the idea that you could build a sandbox somewhere and just tell it, like, look. Here's my code. Just work on it. I'll I'll come back in in three months.
Like, tell me tell me what you come up with. Like, and maybe it'll... Maybe it would say, I don't know. It's pretty good. I don't see anything here.
And maybe it wouldn't. Like, maybe it'd be like, have you ever thought of this? You'd go, oh, holy hell. I didn't. But I don't think that's how it's gonna happen.
I think it's gonna be... If it doesn't have data, to your point, if it doesn't have people's graphs and how it intersects with how much insulin they got and where they were in their period when it happened, if it doesn't have that stuff, it's only so much it's gonna be able to do. Right? Like, it's it's it's math guessing up to a point.
We Are the Currency1:41:29
And That's actually that's actually really, really your point that the data that you were touching on, and and may may... Maybe on a note here. That's that's... Because we were talking about the ceiling, right, and limitations earlier. One of the one of the big issues actually for for us in the diabetes space is that, essentially, we are the currency.
Right? So, like, we are wearing all these devices, and these devices are collecting essentially our data. And for the most part, we don't have access to our own data. And to be fair, because we... You were talking about, you know, making making it available to to implement new stuff and to do research on new stuff and to, you know, to to innovate, we need we need access to this data.
So, you know, the right to my own patient data and the right to my own diabetes data is actually a pretty high commodity, I would say. And that is that is a real... It's funny that that we've, like, gone into this for so long now and only now touch on this, but, actually, it's one of them. Like, it's a really big issue, actually. I'm getting access to my own data because...
Again, not to, like, single out any any specific company, but it's just a good example. To to be to be able to go on Dexcom and to get a clarity report of, like, my last ninety days of, like, glucose readings is not the same thing as getting access to my raw data. I I hope that makes sense.
No. No. Of course it does. Yeah.
Yeah. And and so... And and there are many companies, almost all companies are actually not giving you this kind of direct data access. And as... At the end of the day, again, like, this is your data.
Like, you should own it. It was collected off of your body, and and you should you should be the the the the the person that can, you know, access it and can can do with it whatever for for for better or worse. And and, you know, use it for for research, use it use it to do your own analysis, or or not use it at all. Right? But it's one of the main things where these big companies are kind of, you know, putting putting stones in in the path here, and then we have to try and jump over those hoops.
And it's also... I... To to a certain point, how the the open source AID community and what we are doing with making these devices accessible, we're also kind of, like, freeing up access to people's own data by doing that.
Yeah. I mean, I... I'm... I find myself back in the same conversation from before because the the data is, I think, the most valuable thing they have. You you know?
Like, that's how they're going to try to make make money or value for their company moving forward. I mean, my transcripts are my data. Do you know what I mean? Like, everybody has some everybody has something. And I I...
Listen. I'm not taking a side on this. What I'm telling you is I don't know how you're gonna get it from them. I don't see why they'd wanna give it to you from their perspective. Do you know what I mean?
And from your perspective, yeah. Right on. You know what I mean? Like, I I completely agree with you. So I I don't know if it's gonna be one of those impassable things where we have to say there's...
I don't... I can't see a way around this. I mean, I mean, if you tell them, look. You can't have my data. They're gonna say, well, then you can't use my device.
And Well, see, and there's a compromise to be made, to be honest.
What is it? Like...
Well, the compromise could... I mean, just just a really easy one would be, hey. I'm... A, I am paying you money to use your device, so, you know, you've got money. B, I'm...
Like, you you you can still have the data, but I will also just like to have access to the data. Right? I mean... Because because, like, one of the compromises, and this is, I mean, not... Maybe not the best one, but one of the compromises could could be, for example, I am happy for you to also have my data, but I want to have access to my data.
Mhmm.
Yeah.
Right?
If you put yourself in their position, why would they say no to that, do you think?
Well, because we are the commodity. We're the commodity, and they don't wanna they don't wanna give it out. And then, you know... Yeah. Yeah.
I I mean, what would what would make you say... Be be...
Right right now, what's right now, what's happening, I mean, it it... It's a it's a crude example. But, like, right now, what's happening is, essentially, you're you're using Google Mail, and you just can't access your emails. You can only access a generated PDF of an email you've gotten through Google Mail.
Mhmm.
And then you go to Google and you go like, hey. No. I I would really like to access my own email, please. And they go like, yeah. No.
You you you get to use you get to use Gmail. You get to send emails. You get to read the created email read report, but you're not going to get your email. And that just doesn't make sense. Yeah.
And we should we should really fight hard for that and advocate for diabetes data rights and access to this kind of thing.
There was a big push around this a couple of years ago, wasn't there? But I don't know. Like, people... Because everybody was trying to... Or was it Tidepool trying to get everybody to...
It was for... Maybe it was for... Maybe I'm thinking of when Tidepool was trying to go to the FDA, they needed everybody to give them their, their loop data, right, or something like that.
Well well... Yeah. The... That... That's the the the big data donation project, and it was...
Parts of it were used, together with the data from the JAIP Center to, you know, put the loop algorithm through FDA approval. But, and that is still ongoing, actually. And then there's also, like, a second really big dataset where users of the OpenAPS algorithm donated their data. It got used in a four year research project here in Europe called the Open Project, and that data collection still exists. It's called the Open Data Commons.
But, yes, there are research projects where you can donate your diabetes data to a nonprofit organization, they will be doing research with it, which is which is one good thing. But, again, like, you can only do that, and you can only donate your data for research, for example, if you have access to your data.
Yeah.
It's kinda like, you know, you you donating your own your own body after you pass to research. Well, you can only do that if you have if you have bodily autonomy in
giving We say so. Yeah. Yeah. Well Yeah. I mean, to your point, I mean, I...
If I'm understanding this right, and that is the thing that was hitting me in my head that I couldn't remember what you just mentioned. But the only reason those people were able to donate that data is because they were using Loop and they had access to it. Correct. Yeah. Right.
So they were... Yeah. Yeah. Had they been using a regular system and said, oh, I would like to give... You know, I would like to donate the information about how this is...
There's no way that was gonna happen. Yeah. Okay. Alright. I get it.
Okay. Well, how do people get Trio? I know I... Listen. I'm just gonna come out and tell you.
Someone else helps me with Trio. I I don't know how to do it. But I... Maybe... Why don't we let you hear?
Instead of saying how to... So other people to teach me how to do it. Like, if I was gonna set it up today, how would I do it?
How You Actually Install It1:48:12
Well, so there... There's basically two two two building ways, I would say. So the the code is published on GitHub. It's it's a it's a platform where we where we host our code. It's it's freely available.
You have to register account on there, but it's it's free. You you can just get on there, and then there's the code, basically. And then because you're on iOS, you need an Apple developer license. So, essentially, you you register with Apple. You say, hey.
I am a developer. Unfortunately, you have to pay $99 a year, and then you have an Apple developer license. And that's more or less all... Everything that you need, and then you download you download the code, and then you can do two things. You can either use what we call the browser build.
So you go on GitHub and you use something that we as a as a community build out on GitHub where you enter six little text snippets, and then it'll automatically build for you once a week. It'll check if there's updates, and then it'll set... It'll send, basically, the built app to your phone in a little app called TestFlight. It's kinda like an unofficial app store, basically, on your phone, and you can go into TestFlight, and then you install Trio. Or you go the the more hardcore way.
I don't know. That's not real. It's it's not a hardcore way. I'm I'm trying to be to be jerky here. You can go on your MacBook.
You can download Xcode, which is which is an integrated development environment for iOS apps. And you can go on Xcode, and you can download the code from there. And then you can compile it on your MacBook, and then you can load it onto your iPhone. Those are, I guess, the two the two options that you have there. There's a bunch of things that the community has built around this.
So for example, if you don't really know how to use Xcode very well, you can paste a little... Like, you can copy a little text snippet, and you can paste it in the terminal window, and you press enter once. And then the terminal window will essentially do, like, a little guided conversation with you. It goes like, hey. What do you wanna build today?
And then you go one one is trio, and then you press, you know, next step, next step, next step. It it asks you a couple of questions. And at the end of it, it'll it'll basically tell you, if you press enter now, Xcode will open, wait until it has fully loaded, and then press the play button in, like, the top center of the window. And that's what you have to do. And then, you know, it has helped you through the...
What did I call before? The more Harker way? Yeah. It has helped you through the more Harker way, and it's also made that pretty easy for you. Most people that build nowadays are using what we call the browser build, so the one that is using these GitHub actions because of the big perk that I was kind of mentioning earlier is where it does an auto build every week, and it checks once a week, basically, whether there was an update.
And if there was an update, then it it skips that built. But once a month, it builds for you, so you... Your app never, like, expires, basically.
Yeah. Because I I can... I... Listen. I've lived through that a couple of times where my garden's like, my thing doesn't work anymore.
And I'm like, I I think that it it expired, I think. I'll text somebody. Hold on a sec. Happened once while I was traveling, by the way. And Oh, wow.
I had to text a person who had to contact... It was it was a
it was... It was a horror show. Actually, you set if you set up this... That browser built, like, you you could actually go on your iPhone and you can you can just press a couple buttons on your iPhone even and would be doing the build, and it takes maybe, like, fifteen, twenty minutes. And at that...
And then Arden has a new build on her phone.
I just texted the person who handles it for me. I said, we're using the browser build. Right? And they were like, yes. They also told me to tell you, oh, hold on a second.
Catherine said... She said, oh, here's a funny story that maybe Dan will laugh at. I once introduced him to somebody at Yale, and I called him Dan Moody thinking a 100% that was actually his name. And so I don't know if you if you clocked that,
but she apparently remembers it. No. No. No. No.
It it it was... So so, like, my my Facebook name is an alter ego. It's not my actual last name. And and she only had interacted with me on Discord where it's like... My my GitHub name is my disc...
My my Discord name. It's... Right? And then... And she interacted with me on Facebook Messenger.
And we had met in real life, and and everyone calls me Dan because I call myself Dan. It's my it's my... It's been my nickname for twenty five years, basically, since kindergarten. People called me Dan. And she knew me as Dan, and so she...
Like, she she introduced me to to this researcher out of Yale, and she went, so, yeah, this is this is Dan so and so. And then we were, like, texting back and forth, and at at some point, I I messaged her privately. I was like, you do realize that I am not I am not mister Moody. Right? That's not my name.
And and and she was like she was like, shut off. You you gotta be kidding. Yeah. She mortified in this text. Yeah.
So
Yeah. That's funny. No. I, listen. I...
So many great p... Again, so many great people. I even... It's not lost on me that I think there are there are people that are involved in this that we'll never know. I I...
I'll never know. Like, you know, I shared with you earlier, I think it would be awesome to just gather as many of them as you could together and let them tell their story about the part. Even if it's ten minute conversation or five minute conversation, put together a Yeah. You know, a... You know, an absolute, like, kind of...
I... I'd be so afraid to miss somebody. That really would be my concern doing that. Like, I would... I'd be so afraid to miss somebody.
Oh, I mean, we... So I mean, I... We we can, you know... Once we get off the air, we can probably set something up and and get you connected to a couple people. And I can I can only say the people that contribute to these to these projects, they live all over the world?
The developers live all over the world, and it's it's awesome that we do this, and it's awesome that we get together, you know, remotely and asynchronously. But in a in a cool way, there's nothing like getting together at, like, conferences and also at a thing like the hackathon that we'll be doing in Vancouver in November to, you know, get this really fucking super special energy in the room for, like, two, three people... Two, three people. Sorry. Two, three days.
You know, work on stuff together and just, you know, be in a room together with the people that you spend, like, dozens and hundreds of hours online with working together with. And Yeah. Yeah. And we can we can probably get you get you hooked up with a couple people if you wanna do this series.
Yeah. What would be interesting then is that, you know, as you talk to people, you would probably get the names of more people. It's a thing you could Oh, yeah. You could do ongoing. Like, I'm not...
Listen. I don't have the infrastructure to turn it into, like, you know, a documentary, but, like, it would be interesting to, like, let people share their remembrances of of how they were involved in it, you know, just to show the path. Where would you start? Do you start with do you start with lane, or is that not going back far enough?
You would you would probably start with, yeah, you would probably start with with with with Nightscout, I guess. Yeah. We will discuss... We will start with the Nightscout project, and, well, Lane was involved in there and a bunch of other people. I don't I don't wanna I don't wanna
alter the
names because I will forget names, so I'll I'll not name names. But Lane was one of them. And, actually, if you talk to Layne and if you ask him about, like, the origin story of, like, what he contributed to Nightscout and how that came to be is one of the most badass OG fun stories.
Yeah. Maybe that's maybe that's what I should do is start with him and then let him... Like, let the, like, the flower grow from there, and then I'll just keep working off.
And and then, yeah, there there are so many... There there are so many people in in a way, but but then again, at the same time, you would actually be amazed how Few people. How small the group of people is that builds this for tens of thousands of people and runs it and maintains it and keeps it alive. Yeah.
Yeah. I've I've I've... I'm sure I've shared this with you in the past. Like, I feel... Like, I've...
I have felt badly in the past because, first of all, it's not a world I know. Right? Like, it's, like, coding and, like, it's just not it's just not something I'm involved in. And, and then somebody comes along one day and is like, you should try Loop. And I try Loop, and I start talking about it from, like, my entry point into it.
And I I only know what I know when I start. And I've heard stories of, like, people have been insulted. You didn't say their name when this happened, or there's people that are involved. I'm like, I'm not trying to hurt anybody's feelings. Like, I think I try really hard to say there's a lot of people, to your point, maybe not as many as I'm imagining.
But, like, a lot of people put a ton of, like like, you know, sweat equity into this. They're never gonna make a dollar off of it. They're... They never... It wasn't even their intention.
Right? And they're... And they... A lot of their effort has gone into, like, a lot of the success that my daughter's had and a lot of other people have had. And I...
It's just hard that when you're talking, you can't stop to do your land acknowledgment every five minutes while you're trying to talk about something. You know what I mean? Like, at some point, you just kinda gotta let the conversation roll a little bit. But, you know, I've heard from people that they've been pissed in the past, and I'm I'm genuinely sorry about that. Like, I wish I knew who more of you are.
And this is gonna be... This is my attempt to, like, to do my best to put it on the record somewhere because maybe I have more of an ability to do that than other people do. So I... I'm hoping that'll... You know?
I don't know. I just... I hope people understand how all this is happening. It's... I think it's fantastic.
I've... I had the guy on one time who invented the Omnipod. I mean, it's just... That that thing is, you ever crack that thing open? Of course, have.
It's an insane machine. You you know what I mean? Like, that somebody, like, designed that one time is crazy. And then there it is. You know?
Like, and you talk to that guy and you realize, like, he doesn't work there anymore. He hasn't worked there in forever. It's just an interesting... Or I talked to the guy that put the assembly line together for the Omnipod five. Like, that's...
I think those are interesting conversations. You know? So I'm always trying to dig those people up wherever I can. Anyway, dude, we've been talking for two hours.
Yeah. We've been we've been on a long time.
You are?
Yeah. You were rushing home trying to get through traffic to do this
and now, like, you gotta be hungry by now.
I was I was stuck in traffic. Yeah.
Yeah. Well, just make sure make sure... I wanna make sure you feel like we talked about everything that you were hoping to talk about today.
I I think so. Yeah. Yeah. I think so. So, like, while we were on, I was actually messaging the the Knight Scott Foundation folks, and I was asking if there's if there's any...
Anything I should also mention. And they were they were kind enough to to to remind me that there there is, like, the recurring donation link. We were talking about the subscription thing earlier. Mhmm. And and and it would be ninescoutfoundation.org/donate.
Okay. And so if people wanna wanna give that, it's it's a really cool thing. You know? We we kinda need to support year round. The Ninescout Foundation funds, you know...
If if developers need devices to to work on these systems, they help fund that. And they help fund travel. They help fund these very cool events. And it's it's a nonprofit, and so we kinda we kinda need support year round or, like, they need support year round. I shouldn't say we because I'm I'm not involved in the foundation.
I I luckily benefit of the great work that they do. And, yeah, I think we've we've talked about the 03/2001 o release. It was... Actually, you know what? What I didn't mention back back when we were talking about this, and I kinda I kinda should probably...
Let me quickly, like, look up my notes. Go ahead.
While you're doing that, I'll just say to the Knight Scout Foundation, I hope you enjoy the either 500 or or $9,000 that I sent you this afternoon. Was If that much, could you send some of it back, please? Yeah. I
I I really I really hope we... Like, you didn't send your whole retirement. I know. I I I was joking. But we want you to we want you to have a good retirement here.
No. So the the 1 dot o release was... Represents more than a year of... Like, more than two years actually, but, like, the the core of the release represents more than a year of work by 20 plus people, and it ships a whopping 112 new features and fixes over 1,500 commits. So a commit is essentially like code.
Yeah. Like a a... How do you... How do I explain the commit? Jesus.
Okay. Pep... People who know what a commit is will know what a commit is. But it it... Ton of code.
And we added, yeah, four new sensors and a new pump to this. We we modernized Trio. It... It's got liquid glass added into it. We added a new alerting engine.
We added the cool quick pick quick pick treatment feature I was talking about that kind of learns based on your data, what you're doing, and gives you... You know, suggests treatments for you. And essentially, oh, I should have also mentioned that we invested a ton of time into making the app more accessible. So if you happen to be visually impaired and you have to use, you know, accessibility tools on your phone, the app should now also work better for you there. And I guess, all in all, I can only say I'm I'm...
I've been talking to you for two hours now, and I am a part of the Trio team. And I I invest a lot of my time there, but I'm not doing this alone. This is a a very cool team, like, you know, splattered across the world. And we're all doing this because we wanna help people. We wanna we wanna make diabetes suck a little less.
Two Grown Men in a Jazz Bar2:01:20
And if if if I can tell, like, a little small anecdote here and then maybe we can kind of end on that
Please.
A really, really good friend of mine... I I won't name names, but a really good friend of mine, we met at ADA. It just happened to be that he was also in New Orleans. And he has a kid, and his kid has diabetes, and his kid is using Trio. And we were sitting in a jazz bar, and he was asking me the same question that you were asking me earlier, like, why do you do this actually, dude?
And I was I was just saying, you know what? Between all the, you know, long nights and and sometimes also some of the drama that goes on the Facebook groups and, you know, and, you know, sorting through bug reports and and sitting sitting there being sleepless because you spent the last three nights on some kind of feature and something didn't work out or whatever. You know why why I do this at the end of the day? It's it's for for people like like your kids, right, who is is empowered enough to live a confident life and kind of can just go about about their day using Trio and doesn't really have to worry about diabetes because, you know, his his kid is so confident in in in their diabetes because of Trio that they just go about their day and don't really, you know, are worried that they're diabetic. And I said that to him, and then we kind of looked at each other, and then it was like two grown men sitting in a jazz bar in New Orleans kind of crying.
And, you know, ending on this note, like, this is this is why we do this. It's it's to make the lives of people better, because we live with it. We we are in their shoes. We know what it is like, and we just, you know, wanna wanna make diabetes suck a little less.
I I mean, I can't I can't agree with you anymore. Anytime I hear from somebody and they're like, it doesn't matter what they say. It it it really is. It's like something got better for me, and it it had something to do with something you touched, and I think, well, that's that's really fantastic. I wish I wish more people could put their their energy into things like that.
I feel lucky to be able to, to be involved in something that somebody, you know, says is helpful to them. And you guys are doing it in spades, but it's also very behind the scenes. I mean, it just it just really is. Like, you know what I mean? Like, you don't...
If you made a podcast about this, like, six people who understand coding would listen to it, and it'd be really interesting to those people. And and you you... You know, how do you get out in front of it? Or, you said, you try to, like... I don't know.
It's just... It's a hard thing to put a face to, and I'm... I hope I'm doing that to some degree. So Yep. Yeah.
I would like I would like for you guys to get your flowers and, and to feel as... To feel as the gratitude that I know everyone feels. They just don't know where to send it to. You you know? Like like, if I'm just a regular person who downloaded Trio, I I mean, I imagine there's people who did it, but I don't know the rest of that story.
Oh, actually actually, there there there there are there are more and more people doing that. We've we've we've the only for five release and even before, we we we are seeing such a massive influx in in, like, new users. And the great thing about Trio is that it has, like, this very detailed onboarding guys. So usually, they they come somewhat equipped and then, you know, and then they come across the the open source community and they come across the the various Facebook groups. Because, you know, the the Trio the Trio community has a similar group to to the the Juicebox podcast group on Facebook, for example.
We're not as big because, dude, your group is fucking huge, but there's there's still a couple of thousands of people in there. And they can ask questions, they're helped. And and then they they learn the the system, and then they use it, and they love it.
It's amazing. Yeah. And I'm glad I'm glad people are reaching out and saying thank you because, I mean Yep. Obviously, you're helping them in ways that, mean, it's it's just hard to put into context how how exactly valuable it is. It's it's...
You know, there's nothing but... There's nothing more important, honestly. So... Alright. Jens, thank you so much for doing this.
I really do appreciate it. I... I'm... We're really gonna be testing our new system about how we track curse words and remove them from... Because you're a...
You you used a few today. So this
I'm very sorry.
No. Don't be sorry to me. It's a a lovely girl named Catherine who's gonna be handling it. So... And different Catherine that I spoke about earlier.
So good luck, Catherine. Go go get them. Yeah.
Sorry, Kenny. Oh, I'm very sorry.
Alright. Hold on one sec. Something new just arrived from MiniMed. It's the MiniMed Flex system. Think about everything people love about MiniMed technology, designed for great outcomes, helping keep you in range, and made to be easy to use.
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That's right. Today's episode was sponsored by the Contour Next Gen blood glucose meter. It's the meter my daughter uses. She has it on her right now, and you're one click away from having it too. And don't forget using juice box podcast links helps support the show.
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I'll tell you right now. I'd get the towels. I'd get the sheets. I'd get the joggers. Probably a t shirt, definitely the blanket for the sofa.
These are things I would do. You do what you want. And while I have your attention, nobody's asking me to say this, but I just wanna add it here. The Night Scout Foundation could use your help. Nightscoutfoundation.org.
Donate to the annual hackathon. They're up to 59,000. As of this recording, they're trying to get the $75,000 to get all of the great people to the event so they can work on the next thing the DIY community will be bringing to you for absolutely free. It's not bad. If loop or trio or something like that has benefited you in the past, throw them a couple bucks.
Friends, my diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. I am joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down the complex concepts into simple actionable tips. The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up in the menu. If this is your first time listening to the Juice Box podcast and you'd like to hear more, download Apple Podcasts or Spotify, really any audio app at all.
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#1985 Woosah
Woosah
Melissa's son drank a case of water a day. The pediatrician wouldn't poke his finger. Eighteen months later: a 5.4, and a mom learning to let go.
Jump to a moment
- The weight loss looked like puberty. The water was the tell — Melissa watched her son empty a 24-bottle case in a single day, and nothing in her family history had taught her what that meant.
- Her husband asked a pediatrician's office to prick a finger and was told no without an appointment. He drove to the ER instead, where it took seconds: type 1, in DKA, ambulanced to the PICU.
- She went hard into low carb at diagnosis and pulled back about four months in — not because it wasn't working, but because a 14-year-old walking into high school already felt different enough.
- When Bennett adjusted his own basal rate without asking, their nurse practitioner stopped Melissa mid-sentence: a person willing to change their own settings is one of the strongest predictors of long-term success. Congratulate him, don't correct him.
- Her own labs had been called normal for years. A functional medicine visit found a TSH of 4.8, low B12, low vitamin D and sex hormones out of range — and treating those, then adding a GLP, is what finally made her feel like herself.
- Halloween Candy Carb Counts — Carbs, fat and protein for 68 of the most common Halloween candies, plus the favorite-candy vote
- Tandem Mobi with Control-IQ+ — The pump Bennett switched to in December, after eleven months on MDI
- Eversense 365 — One insertion a year, with unlimited data sharing through the Eversense Now app
- Touched By Type 1 — Annual conference, D-Box, Dancing for Diabetes, golf night and local kids' dance programs
- Juicebox Podcast Pro Tip Series — The management fundamentals Melissa found in her first days after diagnosis
Every word of the conversation
Welcome, and Halloween Carb Counts0:03
Hello, friends. Welcome back to the juice box podcast. Nothing you hear on the juice box 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. Right now, there's a special homepage at juiceboxpodcast.com just for Halloween.
Look there right now, and you'll find a link that will help you understand the carb count, fat content, and protein content of the top 68 candies that you might find on Halloween. There's also voting going on for your favorite Halloween candy at that same link. As of this recording, looks like Reese's Pumpkins are in the lead with 22% of the vote. Juiceboxpodcast.com, head over there right now. Get those carb counts for your favorite Halloween treats.
Today's episode is sponsored by Tandem Diabetes Care, the Eversense three sixty five, and touched by type one. There are links in the show notes and at juiceboxpodcast.com to all the sponsors. When you use those links, you are supporting the Juice Box podcast and helping to keep it free. The Eversense three sixty five is a one year wear CGM. That's one insertion a year.
That's it. And here's a little bonus for you. How about that there's no limit on how many friends and family you can share your data with with the Eversense now app, ever since cgm.com/juicebox. Now let's talk about Tandem Mobi, the impressively small insulin pump. Tandem Mobi features Tandem's newest algorithm, Control IQ Plus technology.
It's designed for greater discretion, more freedom, and improved time and range. Learn more and get started today at tandemdiabetes.com/juicebox. Touched by Type one is my favorite diabetes organization, and they're sponsoring this episode of the Juice Box podcast. Please take a moment to learn more about them at touchedbytype1.org. Also, follow them on Facebook or Instagram.
When you get to touched by type one dot org, check out their many programs, their annual conference, the d box, dancing for diabetes. They have a golf night. Gosh. They have a dance program for local kids. Go check them out at touchedbytype1.org and see what they're up to.
Meet Melissa, Mom of Three Boys2:28
Hello, everyone. My name is Melissa. I am a mom to three boys, and my oldest son has type one diabetes.
Why at this ungodly hour do you have that much energy, Melissa? What's going on?
I'm usually awake so much earlier. So I took the morning to sleep in to seven. I'm usually up by five. So
Wait. I
think I've had my coffee and...
Okay. There's so much I don't understand. Why are you up at five? Is it to go to work?
Yeah. Yeah.
Yeah. May I suggest to all of you getting a podcast? Because this leaving the house thing is for the birds. Do you you don't... Do do you leave the house?
I mean, what do you... You get up at... Alright. Hold on. You have children.
There a is there a guy you're generously letting live with you too?
I do have an amazing husband, and he does the entire morning routine with our family. He's done that for
Oh, Melissa, say it.
Ten years? Yeah. He's just
Just say I got a sucker on the line. That's all. That's all. I I see. You drifting through the morning, shower, maybe a shave every couple of days, like, that kind of thing out into the world.
Hey, everyone. Mommy's here. And then right out the door?
I don't even see them. I'm up before them and gone before them usually.
You got it worked out, Melissa. I didn't realize. Okay. Alright. Alright.
Yeah. Solid. What time do you leave the house?
I leave no later than 06:15.
Oh, you're freaking me out. I... We started this at 9AM, and at 08:50, I was like, you gotta get out of bed, man. The last thing I said before I said goodnight to my wife last night was how in God's name did I let a recording on my schedule at 9AM?
Well, I appreciate it. I was like, I can make that work. Oh
my god. What do you do? Are you, like, are you the president or something? You must have a very important job.
Up at Five, COO by Six4:19
I am a COO for a real estate and property management company.
Oh, you guys gotta... Well, you you start taking people... It starts early in the morning getting people out to houses and stuff like that, or is there just this business happen early? Why? I'm just saying why can't this start at 10AM is all I'm asking you.
My day starts early so that I can get actual work done before everyone else is in the office and meetings start and, you know, the day just
Why do you have energy for this? How... We... So you have three kids?
I do have three boys.
Does the the... Oh my god. Do you really? Does your husband... Is he like a stay at home dad?
He isn't. He owns, three of his own businesses. But because of that, there's flexibility, of course, for him to kind of manage his own time and schedule the way that he needs to. So he's not as bound to an office and, able to When to be around much more than...
When you say three businesses, you mean, like, he's a contractor who also, like, has a yard full of wood and and a truck. And he says he's, like, the delivery guy. He's the wood guy, and he... Not... Nothing like that.
That's, by the way, a loophole in the tax system if you wanna go look into it. I don't I don't do it personally.
I probably should, honestly. Oh, don't tell anyone I said that.
Well, I mean, you're telling a lot of people you just set up the everyone. But... No. No. Seriously, how does he have three businesses?
You don't have to be super specific. Yeah.
Yeah. Like small businesses. He has a handyman company. He has an inspections inspections company, company, and and then then he he has has a landscaping company that he actually partners with a couple other people on. So it's all like field services that...
Is he a go getter, or are you very demanding? Which is it exactly?
Oh, goodness gracious. I'd say a little bit of both. Probably more so than my my being demanding, but I actually have not encouraged this. He he has done all this on his own. So...
I like I like the idea of you, like, looking at him at six in the afternoon and going, lot of idle time. We could be making money. Right?
Oh, man.
Get out there.
Poor guy. He's gonna die when he listens.
Well, listen. I know what's going on. I mean, he's probably scared. But, how old are your kids?
So my oldest, the one with type one, is 15. He's actually turning 16 in a week, so we're in the midst of all that crazy. And then my middle son is 14, and my youngest is 11.
Wow. Okay. And all boys. Is the dog a boy? All boys.
We do not have a dog. Smart. Yeah. Yeah.
That's smart.
We've tried a couple times and it just...
Can I be? Can I ask, do you have three kids? Because you kept thinking like this one will be a girl. Or...
It's a great question. For the third child, we knew it would be our last. Like I I... We didn't want more than three children. But I did have a deep seated hope that it would have been a girl.
And I remember it was the only child where we did a gender reveal because I was like, it's the last one. We should make it fun. So I had all my friends and family. We were hosting like this big party, which was probably a bad idea because it ended up being a boy and my emotions. I had to like really hold in a little bit of sadness.
Now looking back, obviously, so grateful and I love him and he's like the perfect little cherry on top of our family. But at that time, I was a little bit sad. But I'm like, well, I'm definitely not going for a fourth. Like, we're... It's not
happening first. The blue smoke goes up in the air. You bend at the waist, put your hands on your knees, and then the video just... The audio bleeps out when you're like, son of a bitch. And then you do...
Pretty much. You Pretty much.
Got in
the car, and I started crying at the end of it. I got in the car, and I was like, oh my god. I gotta let this out. I'm so sad.
Did you ever tell your husband this is clearly your fault?
I have I have alluded to it. I'm like, man, we just, like, can't produce females. What is
happening? My last question that has nothing to do with this. But were you down to, like... Like, when I was a kid, they used to say silly stuff, like, try a different position when you're... Like, did you do did you do...
I mean, I know, by the way, that can't possibly have any, like, basis in reality. But do you get to the point where you're like, hey. I got a book and it says if you... Can you hold yourself like that long enough? Like...
Or or do you not go that far?
Oh god. No. We did we did make jokes about it. Although what we actually ended up do... You know what I mean?
We would laugh and be like, what
if we did that? And then just get...
Or maybe I should drink this or eat this. Like, what is happening?
But in the end, it just happens the way god intended, drunk after a while. Is that right? Yeah. Yeah. Yeah.
Okay. Alright. So how how old is your child when they're diagnosed the oldest? This episode is sponsored by Tandem Diabetes Care. And today, I'm going to tell you about Tandem's 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.
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Yes. So my son was diagnosed. He was 14. It's been about eighteen months. It was last January Oh.
2025.
Well, this is why you still have energy. Okay. Alright.
Yeah. Yeah. Yeah. You know, pros and cons of the timing of that diagnosis, I guess.
How did you find out? Like, what is it... What was the first thing that popped up, and what was the process of getting to the end? Yeah.
He Drank a Case of Water in a Day11:25
Yeah. So I started noticing that he was thinning out. He had been a little, like, chunky as a boy, and we started noticing that he was getting thinner. And part of me was just like, cool. He's hitting puberty.
He's growing. He had been going to the gym a bunch. And I'm like, great. He's kind of like finally growing into his skin. And this was like probably before Christmas of twenty twenty four.
We started noticing that he was getting thin. And then after Christmas, my husband and I had just gone on a trip to Nashville. We left our kids with our in laws for a long weekend, got back from the trip, and pretty much the entire week after we got back, he was not well. Like, was complaining he felt sick. He was drinking so much water, like empty bottles of...
I'm telling you, like, a case of 24 waters drank by him in like a day's time. And I'm like, that is just so strange. But we don't have any type one in our family. I really had never been exposed to type one throughout my life, so I I didn't know what some of those symptoms were. And then I remember so distinctly, had had some stomach pain and we still sent him to school.
He got home from school that afternoon. It was like a, I think it was a... No. It was a Monday night. It was a Monday he got home from school and he said, I'm really just not feeling well.
I got dizzy today at school. I couldn't see this computer screen. Like, I almost blacked out in the hallway. And I'm like, okay. Something is very wrong.
Yeah.
So I guess for better or for worse, I can kind of go down a rabbit trail. And that night I could not sleep. I was just Googling every set of symptoms. And I tried to Google like different sets of symptoms and everything said type one diabetes. It just kept anything I'd put in.
It was like type one, type one. So I was like, is this just me freaking out? I woke my husband up early that next morning. It was a Tuesday morning. I said, you know, I think I'm probably overreacting.
I can tend to do that. I'm going to go to work. Can you just take him into the pediatrician? And my husband was like, sure. Son woke up, had a stomachache.
Pediatrician Said No, Dad Said Hospital13:50
My husband was like, I'm just going to try to walk into the pediatrician. And they refused to see him. They were like, we were like, can you please just poke his finger?
Wait. Your husband went, first of all, a man brought a child to a pediatrician. And, like... So first, I I have been a stay at home dad most of my life. I have never seen another man in a pediatrician's office.
And my... Like, I walk in there all the time. People just look at me like, look at this guy
Why is he here?
Just leeching off that poor woman. I mean, what... He's even at the pediatrician's office. I've... People...
Like, the doctors would high five me. Like, I don't know how you work this out, my friend. Good job. Like, you know what mean? Like, there's not a lot of guy...
Anyway. So you go in there and say, my son was dizzy, almost passed out, couldn't see the computer yesterday. Can you see him? And they're like, no. No.
Thank you. Is that true?
Like, can you just... Yeah. Can you just prick... My husband was like, can you please just prick his finger? Like, we don't have a glucose meter at home.
Can you please just prick his finger? And they were like, we're really sorry. We can't do that without an appointment. And so my husband was like, f y'all, I'm going to the hospital. So my husband took him to...
There's like a ER hospital right around the corner from our house, Took him in there and literally within seconds of being in there, he called me. I had already gotten to work. I was sitting down in a, like, company all hands on meeting we have every Tuesday morning. He called me and I'm like, okay, I know he's with Bennett. I know that he's not well.
Let me answer this. I picked it up. He's like, you gotta get here. He has type one diabetes. And I just lost it.
Like one of those, like, you shouldn't really be driving the way that that hit me because I think for me, it was like, wasn't overreacting. Like, I I was right about it, and I think that surprised me.
More more?...
Been other instances of, like, you're just overreacting. You know what I mean?
Sorry. No. No. I was gonna ask a question, but you're in the middle of going like, you don't know me, Scott, but I've overreacted in the past.
But... Yeah. Yeah. I'm just gonna be honest.
Oh my gosh. More or less more or less, upset than when you found out the third one was a girl. Much more. Oh, okay. Well, there you
the type one. Yeah.
It's much much more.... Good balance then. I... Do you... This is apropos of nothing almost, but you never go back to the pediatrician's office again.
Right? Like, you just find a new one, or do you go back and and...
Exactly. No. We found a new one.
What what do you think is wrong with everybody? Do you sit and wonder ever?
I just think it's so sad and disappointing that it's all about, like, billables instead of actual patient care. You know?
It's fascinating. And and inability to think outside of whatever somebody's been told to do and... Like, you don't go get somebody and go, hey. These people, like, yeah, like, you know, they're asking for something pretty specific here. The kid's having a lot of problems.
We don't have an appointment. How do we work this out? No one can think. It's fascinating. Hey.
I wanna just point out to everyone how proud I was a few minutes ago when you said that you were on a trip to Nashville, and I didn't blurt out, oh, I just got back from Nashville last weekend.
It's the best place ever. I... I've been listening to so many episodes, we're talking about Tennessee. And I'm like, you should definitely move there. It is just the best.
I spent... Well, I'm gonna... At the end of this, I don't know if I'll record it or not, but I have a question about real estate I'm gonna ask you when I get to the end. Alright. Thank you.
Happy to help. Happy to help. Thank you. Okay. So do do you get somebody to drive you?
Do you get yourself there? How do you handle the next step?
I drove myself. I called my mom in the car, and I was like, I just need to be on the phone with you. I was crying. She was like, you just need to, like, focus on the road, please. But I drove myself.
It's like a forty minute drive back to the hospital that he was at. So I get there. They're like, we're we're needing to ambulance you to the downtown children's hospital. We're not equipped here. He needs to be in the ICU.
He's in DKA. And I'm like, what is all of this mean? I don't know what type one diabetes means. I don't know what DKA means. Can you guys just slow down a second?
And luckily one of my good friends, she's actually a nurse at this particular hospital that we we went to first. And she called ahead and was like, please take care of my friends. So they were amazing. But we ended up ambulancing to the Downtown Children's Hospital. That is a story in of itself, Scott.
That Hallway at the Children's Hospital18:12
Oh my word. We get to the downtown hospital. They had called ahead saying we were coming and, like, get a room ready for him on the PICU Floor. And so we get there and he's in a, you know, in a bed. They're wheeling him up and I'm walking alongside him.
My husband was like, I'll drive separate. You go in the ambulance because he knew that I wanted to be with him. And we get to the floor and the nurses are all like, wait, wait, wait. You can't come in here. And I'm like, what is happening?
This was already so traumatic so far. And they turn his bed into the hallway of the PICU to wheel him to his room. And the entire hallway is lined with all of the PICU nurses, doctors. It was like a processional. And I'm like, is this a birthday celebration?
Like, are they welcoming Bennett? Like, what is happening? And then it was actually like a...
A child just passed away?
Yes. A child had just died. Oh. And their family was being, like, escorted out. I was like, this cannot be real because I think for me, I'm like, oh my god.
Kids die on this floor. That was kind of what was going through my head. And then I'm thinking, okay. My 14 year old son, he's coherent. He can see what's happening.
He can hear what's being said to me after they finally got us in our room and closed the door. And they're like, we're just gonna keep that door closed for a little while.
Yeah. Oh, jeez. It
was Well, that's terrifying.
A lot of bad luck for everybody.
That was terrifying. And they felt so bad. I mean, I just... Timing was impeccable. But...
Yeah. That was wild.
Yeah. That's not a thing I imagine you can schedule. Also, I didn't realize that they did that. I thought that was a thing that just happened on television. But, that's
Maybe dependent on the hospital. I don't know. But they definitely were, like, taking that moment of silence with the family and
so sad. Yeah. No kidding. So in hindsight now, I know you said there's no type one in the family, but does anybody have autoimmune issues? Are you...
Have thyroid problems? Is there anything like that going on with anybody?
Hunting for Autoimmune in the Family20:20
Yeah. Great question. As soon as we found out about the type one, I immediately went into like full research mode of like, how does this happen? What is this? And so we started asking our family members, is there any autoimmune?
What's going on? My mother-in-law has, Hashimoto's and that's really it. I did end up getting my thyroid checked cause I was having some symptoms really like testament to listening to the podcast. That's been such a value add even just to me personally. And so I had gone and done a bunch of lab work this earlier in this year.
I don't have like the autoimmune thyroid. I do have hypothyroidism, but it doesn't seem to be the autoimmune type. I don't know.
But impacting But
no, other than her Hashimoto's, that's all I know. If he has historically had really bad allergies and I somehow feel like that is related. I don't know if that's actually science or just me trying to make some connection.
I'll tell you that I had terrible allergies growing up. My son does and did. I I mean, listen. What is an allergy but your body overreacting to an outside stimulant? Right?
So I don't know. That sounds like your immune system to me. Also, barely got through high school, so I mean, I wouldn't write that down anywhere. But it it it feels that way to me enough that I would pay attention to it for... Oh.
Yeah. Hey, by the way, listen to the podcast. Get your kids a one c down. Bonus, balance out your thyroid. Really, it's a full service free podcast....
P. Like, I'm like, you have...
Oh, did I fix you up?
Oh my gosh. I'm like, I feel like a million bucks. That's probably the energy. It's all you, Scott.
I swear to god.
You've got...
I swear to god that I got on the phone the other day with, well... So we we drove from the Northeast to Tennessee last weekend to look at a couple of houses. And, you know, when you're driving, you talk to people on the phone. It's funny you said you called your mom because you needed to talk to somebody on the way to the hospital. It made me remember the time I dropped my son in Atlanta.
The first time he didn't live at home anymore, and then I had to drive to... From Atlanta to see Arden in Savannah. And I called my brother because I was crying so hard when I left my son at that apartment that I thought it's not really safe for me to be driving and I have to leave. So I called my brother and I was like, hey. We're gonna talk about something.
Don't really care what it is. You you know what I mean? And he stayed on the phone with me for... Anyway, we're driving home. And, you know, we had seen a few houses and we were calling people and whatnot.
And I was... I don't wanna see who I was talk... Talking to, but I was talking to someone who I helped get onto a GLP just through, like, kind of, like, you know, making them feel comfortable about it, who then subsequently's entire family got on one. And they were telling me that the four of them combined had lost over 300 pounds.
Oh my word.
And to see them in a photograph, you just genuinely would not know it's them. Yeah. And they tell me this really lovely story, and I just turned to my wife in the car, you know, we're on speakerphone, and I go, you see this? And she goes, what? I said, I'm saving people all over the place.
You really are, Scott. You really are.
They're on the phone. They're like, we're still here. I'm like, just give me a second.
That's fantastic.
Mother Teresa needs a minute. Okay? No. That's fantastic. Nobody ever throws a party for Mother Teresa.
Let's have a half a second. Also, I don't know if that's a... I'm not religious. I don't know if I've just said something that's offended any of you.
I meant to. But but and
I also don't think I'm Mother Teresa. I would not wash your feet a million percent if you showed up here. Melissa, I just want you to know that for sure. If you said wash my feet, I'd go, it's okay. So...
But but it's, I'm glad I'm glad you're doing better. Maybe we'll get to that if we can. I wanna know how your son at that age having gone through that whole process, how does it, I I guess I'd just like to know, like, like, step through the eighteen months. Initial impact, how does he absorb it? What is your feeling?
Are you even able to think of, a parent at that point? Are you just, like, trying to stay alive? And then how quickly does technology come or not come? How how do you fold into your life? How does he feel today?
Yeah. I think initially, like in the hospital, he was so calm. He was so resilient. He was saying things to me. Like, it actually...
I look back and have done, excuse me, so much reflection over the past eighteen months on how I responded and how I have continued to respond and then looked at him and how he's responded in certain moments. And I'm just so proud of him, because I think in a moment where really he he probably should have been the one upset. He was so calm, and he was like, we're gonna get through this. I'm gonna be okay. We're gonna figure this out.
I love math. This carb counting that they're teaching us is fun. Like, he really responded so well initially. I think initially because I went into, like, full blown research mode, that can take you down so many rabbit holes Mhmm. That may or may not be the right fit for your family long term.
Low Carb, and Why She Pulled Back25:58
Right? So I think I found the low carb world very quickly and was really adamant that we tried to go that direction. And I think I I look back and maybe regret that a little bit because I think it changed some of his relationship with food. He doesn't... I wouldn't say that he has any sort of disorder, but I think I went way too far left in an extreme direction thinking that was the best way or the only way.
Yeah. And about, I don't know, probably four or five months in, I said, you know what? I think I need to scale back the pressure about this because I want him to be a teenage kid that can go get pizza with his buddies, and I want him to get an ice cream cone and like the things that I thought we couldn't do.
You realize you can't.
I really said that's that's actually not true. And so I think the podcast helped with that tremendously. The online community helped me with that. Seeing how other people have navigated well, regardless of their diet choices really helped me. And I think it helped him because at the beginning, that was probably what was hardest for him is feeling like he couldn't just be a normal person.
Everything changed instead of this one thing changing. Mhmm. Yeah. I... You know, it's funny.
I I hope... I don't know if it'll actually come out this way, when the... When it comes out in the podcast, but it happened this way for recording. I sat... I I sit down every day and record with somebody.
Right? I I I genuinely don't know who they are or what they're gonna say when I I get here. I... As you heard nine minutes before we started this, I was in bed willing myself out of bed. So I'm, I pop on with this lady, and she tells this story about similar to you, like, kid got diagnosed, like, really went whole hog, low carb, and now just thinks that, like, it was such a a huge mistake.
And they even thinks that one of her other children, you know, was on their... She's... She was very careful to say it. She doesn't think low carb dieting, like, gave her child an eating issue. But she had another child who was not type one who was probably the...
I think in her words, like, on her way to it anyway, but feels like that this pushed her into a really... Anyway, she was, like, really on to say, learn how to bolus. You don't need to be like, blah blah blah. The very next day, I pop on with a woman who's like, I've been eating low carb since I was diagnosed. It really saved my life, and she was so, like, thoughtful about it.
And it really just made me... Like, it it gave me... I think because they happened back to back, and these two people had such real, honest, I don't know, experiences that were completely opposite of each other really made me feel like it's good for some people and not for others just like everything else. And why do we get online? And, like like, when I recorded them, I'm like, oh god.
Low carb people are gonna yell at me. They're gonna think I did this. Like like, when the one woman was talking, like, she was adamant. I was like, oh, I'm gonna come off as, like, anti low carb for having her on, which I'm not. I couldn't possibly...
I genuinely could not possibly care less how you eat. But it's... But it is interesting. I do feel like I've identified the pathway to it. It's diagnosed or having big trouble trying things usually without all the tools or ideas that don't work out.
The the obvious common math is take the carbs away. You do that, things settle in, level out, whatever you wanna say, and then you think, oh, this is the answer. And then I think some people like eating that way or, you know, it fits their lifestyle and some don't. That's it. I...
Listen. You know?
People post their graphs and, you know, everyone's posting their highlight reel, not their real life. You know? And so I think that really... Initially, at the very beginning, I was looking at these low carb people's graphs and I'm like, okay, this is the way I keep my son healthy. And I, I believe every person in every family has to make the best choice for them.
And I don't think low carb is wrong by any means. I think at the moment in time where we were going down that path, I just look back and reflect and say, at the age of 14, going into high school, like navigating so much already, that was just one more thing I think he felt like was different now. Mhmm. And he could make the choice in the future to eat however he'd like to eat.
Yeah. Yeah.
But I think I I realized, like, I think this is just not the right moment in time to be trying to force this on him.
Plus there's a moment when you've just had one too many bacon wrapped cheeseburger chicken wings, and you're like, uh-oh. I I can't do this anymore. Yeah. It was for me at least. You know?
I mean, the Atkins diet was huge when I was younger.
Mhmm.
And, apparently, I was huge. So as I tried the Atkins diet, and, just... I just realized where that sentence was going as it was coming out. And it wasn't not valuable, and I didn't not feel terrific, like like, almost having no carbs every day and all this stuff. Like, I I agree with everybody who talks about, like, the value of, like, eating low carb.
I don't disagree at all, actually. But for me, it was just this one day. Was like, I can't eat another piece of chicken. I'm gonna I'm gonna die. Like, it it felt like that.
Like... And it's funny now. My... When my my wife said to me the other day, the GLP really is interesting in so many different ways. And she...
And I said, what what are you thinking right now? Like, what makes you bring it up? And she said, you really don't need as much food as you think you do. Mhmm. And I was like, yeah.
I I guess so. Like, just the mass of food, the actual amount of it. Mhmm. I'm incredibly... Like, I'm doing as well as I've ever done in my entire life.
So is she. We're very healthy and, like like you said, like, full of energy and, like, etcetera, the whole thing. And we just don't eat as much as we used to. And and back then, everything felt like... And I do wonder how much of it is just, like, I'm gonna say marketing.
You'll understand what I mean in a second. But, like, that idea of, like, big portions or I'm paying for this. I want a lot. You know what I mean? I paid for it.
I should eat it. Like, that whole... Like, they're starving kids and blah blah blah. Like, you know, I mean, I I don't know how old you are, but every day I didn't finish everything on my plate, my mom would tell me there were starving children in Africa.
My mom did not say that, but she was always like, finish your plate. Finish your plate. It was... It's that mindset of, I think, how you grew up really shapes I think a lot of the decisions you end up making as an adult.
Yeah. And, for me growing up broke, I have... I used to have that feeling of like, oh, I paid for this. Like like, I'm bad.
You'd waste it.
Oh my god. Like, you... You've never met a person, like, you know, who goes in the in the vegetable drawer and finds like, oh, how did we not see these carrots? They're smushy now. And, like, you know, they're a dollar 99 for three pounds of carrots, and I'm dropping them in the trash.
And I'm like, I I feel like I let the world down when I do that. And it's still with me. Like, you know, to this... Anyway, point being, you know, I I guess the point being is if you wanna eat low carb, there's a lot of great reasons to do it. And, I don't disagree with any of them.
If it's not for you, then it's one of those things that's really not for you. I think is the way I've come to think of it. Yeah. For sure. And I
think it... Because he's forts... Like, he was 14 at that time. And I'm thinking, this kid, he's going into he's transitioning into, like, manhood. Right?
Like, he's developing sense of self and independence, and he's trying to find his own way. And so I think it also just felt to me like this is not this isn't worth the fight and the battle that is likely to happen.
Yeah. I
saw...... Also isn't worth the impact it could potentially have on him.
Yeah. And you sniffed it out as a parent. You're like, this doesn't seem right. So Yeah. So am I right about my supposition though?
Like, you started in the beginning not really understanding how to use the insulin very well, and so everything creates these, like, rocketing ups and downs. It... Does that happen to you?
Eleven to Five Point Four34:28
Actually, no. No? I I think it was so funny. I was very proud of myself for this. In the hospital, one thing I will say about our local children's hospital, we...
From all the horror stories I've heard through the podcast, we have received exceptional, exceptional care. I am so, so grateful to the diabetes team that supported us. We were in the hospital for four days and we had two full days, eight hour days of education, one on one with an educator who came into our room and walked through things step by step. And then in all of my downtime, I was just reading, reading, reading research papers, everything I could find online. I mean, I think I found the Juice Pots podcast Facebook group the first day of diagnosis.
So I think we actually got a really good grip and handle on the general, like basics Mhmm. Pretty early on. I think we were MDI for the first eleven months. Those largely... My son wanted to be on a pump pretty quickly.
Like, he wanted to get on a pump in May. So, you know, three, four months in, he wanted to be on the Omnipod five. My insurance wouldn't cover that. So I was like, listen, here are your options. We have to wait for my new insurance plan so I can switch my plan to get the coverage, which is a year from now, or we can go on tandem or you can stay MDI, like you decide what you want to do.
And
so we deliberated over that for several months together. But when we... So we were pretty smooth sailing. Everything was good, but obviously, you know, basal rates on MDI is a little bit different and it was kind of a moving target because he was hormonal and growing and things like that. So we had to dial that in.
But I think once we got that dialed in, everything else was pretty good. I think he was also honeymooning for a lot of that time because pre bolus was not as much of a thought process that... As it is today. I'm like, did you pre bolus? I can tell you didn't pre bolus.
But... So I think we were... I mean, his a one c was 11 in the hospital. And by June of that year, it was down to five. So...
And with like a standard deviation of 20, 19 or 20. So he was pretty well controlled and still largely is, you know, there's good days and bad days, but his most recent a one c was 5.4. He got on the Tandem Moby pump in December of last year. And that... It was funny because I was really, really scared.
I'm like, god, we finally have figured this all out and now we're gonna change it again. And what if things are worse? And the first week on the pump, was like, oh my god, we should have done that sooner. This has taken so much of a load off of me mentally. So I'm so grateful for the technology.
He's on, Dexcom G seven. We got that two weeks after the hospital. They are really weird here about doing finger pokes to like learn the way in case technology fails you. So we didn't get his first Dexcom. I think it was like ten days after the hospital stay.
And that was also revolutionary and life changing in many ways. It also became something that I was hyper fixated on for a very long time and had to really learn to set some boundaries and trust alarms so that it wasn't consuming everything in my headspace all the time.
Refreshing a CGM That Updates Every Five Minutes38:20
Okay.
Because I was checking that, like, it would be, like, three minutes ago, and I'm refreshing. Like, something's gonna happen in the... You know what I mean? Like, this refreshes every five minutes, Melissa. Calm the freak down.
Can you can you contextualize what made you look and look and look?
It's inter... I think I was just so fearful, and I don't even know of what. I think I was honestly so much more fearful of highs than I was of lows, which is interesting because I feel like I listened to most people's stories, and most people, it's like the inverse.
Yeah.
But I was so afraid of the effects highs have long term. And I'm like, he can't be at 200 for two hours. Like, that is unacceptable. And I've really worked through that. I mean, I started having...
Doing some, like, personal therapy, I don't know, probably six months ago because I was like, this cannot be what consumes me.
Hey. You're doing it by yourself or with a therapist? I've never heard anybody say personal personal therapy. Are you therapizing yourself?...
Into... No. I am not. That didn't work, Scott. That would be way cheaper, but it didn't work.
You're... I tried.
You you tried to self talk your way through it?
Yes. Yes. Can I be? Can I
can I ask a serious question? You sat quietly in a room and were like, Melissa, listen. You gotta stop. And it and No. No.
No. No. No. Okay.
Tried to just draw on the the tools and resources I've gained over my life to calm myself down, and it wasn't working.
Prefer the Tobey Maguire Spider Man where William Defoe was talking to himself in that weird room. I assumed you were just in a room, like, sitting on a sofa going, Melissa, listen. I think you're being overbearing. And then getting up and walking over to the other chair and sitting down and going, I just care about his health. And then...
No. Not that... Not quite that.
I will share. I'd... And, it'll come to no surprise to the people who leave leave reviews that I just talk about myself. But I will share that, I know exactly what you're saying. I would tell you that I have softened on the inside, but not completely about the idea of, like, blood sugars that are too high and stay too long.
I am learning a lot by watching Arden. And I think there are just some things about being type one that are not understandable if you're just not. And I know that's probably obvious, but, you know, like, one of the ideas is, like, you know, I I said to her the other day, was like, hey, you're gonna get low in a minute. And she's like, yeah, probably. And, like, when she was younger, I thought it was just, like, apathy.
And now I just think it's more about like... I mean, just... I don't know how much bandwidth you have to do something. You you know what I mean? And she's like, I know I'm gonna probably go to like 70 or 65 here and I'm gonna need a little food and maybe I won't feel okay for a half a second, but I can't quantify to you why I'm not getting up and doing something about it right now.
But I just know I'm not going to, and I'm also gonna be okay. Like, that...
That is so real in my life right now.
Yeah.
It's so real.
Right. Right. And so, like, you know, I don't know how many times you... I don't know. You know, listen.
I've been alive a while now, and I've raised a couple of kids into their twenties. And I've meshed together, you know, the the personalities and wants and desires and fears of, you know, a 20 year old girl that I met and myself. And all I can tell you is you can't make people do anything. You really just can't. And so if that's how she's going to live, then it's not up to me, and I couldn't possibly change her.
And do I think she'll always do what... I mean, I'm just using one example. Do I think she'll always do it exactly the way she does? I don't think so. Like, from listening to everyone's stories, what I think is going to happen is that she will morph and change and mature as she goes along and make different decisions and and decide that different things are important.
And I'm gonna hope that those decisions move her in a healthy direction. I also don't know that that will happen or not. And you can't... There's nothing you can do about it. The high blood sugars part, that one's easy for me.
I look at that and I go, what are we doing? Like, one eighty for an hour? Like, just bolus. You you you know what I mean? Like, like, throw a half a unit on this and, like, let's make this go away.
You know?
Bagels for Dinner at Two Ten43:00
Last night, he wanted to go to bed early, and, we're... He's in marching band in high school. So it's a very intense, rigorous situation.
Mhmm.
And he was so tired. He'd gotten home, and he's like, I just... Don't I wanna do anything tonight. I'm gonna finish my homework. I wanna go to bed early.
I said, okay, no problem. I don't even know what he fed himself for dinner. It was not from me. I'm like, what did you eat for dinner? Because his blood sugar was going up.
And he's like, I had bagels. I'm like, oh, great. This is going to be awesome.
You had bagels for dinner?
Bagels. I was like, there's leftovers in there. Why didn't you eat the chicken Caesar wraps that I made? Anyway, it doesn't matter. He ate bagels.
And so then he goes to sleep and I'm like, I go in there, I wake him up. I'm like, hey, bud, your blood sugar's two ten. It's been two ten for forty five minutes. I don't think we dosed enough for our bagels. Can you do a correction?
He did a correction, went back to sleep. I kept watching it. It did... Was doing nothing. I'm like, great.
He's laying there still. He ate bagels. I think he's probably needed to change his sight and didn't. So now absorption is in my head of, like, it's probably not absorbing the way we would normally see. You need to...
He probably needs to change his sight, but he was asleep. Didn't wanna do it. I go back in there. I'm like, I'm gonna give you another correction before I go to bed. So I gave him another correction.
I go to bed. I text my husband. I'm like, listen. When you get home... Because he was at baseball with my other son.
When you get home, if it is still above 200, please wake him up and make him change his sight. My husband got home. It was like one eighty. So my husband's like, I'm just gonna let it ride. It got down to one zero seven this morning, and my husband made him change his sight this morning.
But it's like, it's those moments where I think in the very beginning, I would not have let it go at all. I would have been too scared and I would have been like a dog with a bone. You have to do what I'm saying when I'm saying it. And I'm really trying to take a different approach to some degree, although, obviously, very much still care of, like, he's 15, about to be 16, about to be driving two years from college. Like, some of this, he has to define how he wants this to look for himself.
And as long as that's within reason, I have to be okay that this is not my body and this is not my complete full choice. And that's been really hard because I would say I'm a I'm a little bit of a control freak. You could ask anybody and they'd all probably agree. So it's been hard for me to let it go and say, like, I can't... I...
This is not personal to me and it's not defiance to me. This is him figuring some things out himself. And it's been hard. It's been really hard.
Yeah. Of course. Because the unknown part... Because it's him figuring things out for himself dot dot dot hopefully.
Mhmm.
Right? I I want... Know, I have to decide how it's his body, his choice, unless he doesn't understand what he's choosing, and then it's too late when he figures it out. Like, the dot dot dot stuff is the stuff that lives in your head, which by the way is completely real. I...
I'm very grateful that no one in my life has an addiction issue. I do think that watching someone not do something for themselves that leads to poor health must be how it feels to love somebody with an addiction problem. Like, I really feel like that that might be as... I'm hoping as close as I ever get to understanding that. This morning, listen, great example.
Right? This morning, I wake up. I know I joked about not getting out of bed until, like, the last minute, but I was up a little earlier than that. And I I was just in bed. I didn't get a lot of sleep.
Actually, if you wanna know, I was working on the podcast last night till 03:30 in the morning. Okay? So, it's not... I know none of you asked me to, but I was. And so I didn't get a lot of sleep.
I woke up around eight, and I was kind of pulling myself together. And then I realized, oh, Arden texted me thirty minutes ago. And it just said, my pod just expired. Would you grab one for me? I'm with the dog.
If I get up, he's gonna have to go pee. I don't wanna go through all that. I never saw that. So I texted her and I said, hey. I'm so sorry.
I didn't see this. And she goes, it's okay. My blood sugar is great. I'm just gonna jump in the shower first. And what I thought was, oh, well, that's going to be an unmitigated disaster.
But what I texted back was, okay. Well, if I have time, I'll go grab a pod and put it in your room. So it's there when you get out because that... What I wanted to say was hot water makes your blood sugar go up. You have not had basil running for thirty minutes, and the reason your blood sugar was 88 when you woke up is because I set a temporary target last night at 03:00 in the morning.
But I didn't say any of that. I just said, okay. Well, if I have time, I'll bring up a pod and leave it in your room. Now what I wanted to say was, I'm leaving a pod in your room, put it on immediately after exiting the shower, and don't forget to bolus all the missed basil plus any high blood sugar that you have right now, but I didn't say any of that. Instead, in case you're wondering what I all...
What I did is I let Arden's blood sugar fly up over 200 so that hopefully, she'll think to herself, this isn't really what I want. I should have just done those things that I know to do that my dad must have held back and not said, and it must have killed him not to say it out loud. Like, you really do have to have teaching moments. And as a parent, I've learned and from conversations and through my own experience that all of the things that I could have said, even though I could... I would have said them very nicely and they wouldn't have been pejorative or anything like that, would have just been met by her by, you can't take care of yourself.
You need me to tell you what to do. Mhmm. And that's not how I feel and definitely not how I want her to think I feel. So you horse trade inside your own soul with a little bit of health for a little bit of long term happiness and relationship building and and the hope that one day this all settles in. And I think...
And I guess that's the other part is we always think about the the times where things don't go well. But the reality is, like, he has a 5.4 a one c. He he handles all of his own everything 99% of the time, and he does it so well. So it's like instead of just me getting so hung up on the individual sporadic moments where it didn't go the way I would have liked it to go. Like, I think I'm really challenging myself to think through how can I celebrate when he does all the right things?
And it looks beautiful. And like, I think there's just... We we all... And this is just humanity probably, like hyper fixate on everything that went wrong or everything that's not going well instead of stopping to smell the roses and think, wow. We've we've really come a long way and he's doing a great job and I'm doing a great job.
So it's just such a such a difficult...
I don't I don't know. I still don't know how to think about it because what I wanna tell you is just swap the pump real quick before you get in the shower, and then bolus whatever you missed for the basal, and your blood sugar will still be 88. Mhmm. And or... Okay.
I understand you want to take a naked shower real quick, but as soon as you get out, you have to put a giant bolus in to cover all the other stuff. This is not a big deal. Just do it. And and I think I I think both things are right. But what I think is is that for her and her personality and where she is right now and all those other things, that answer isn't gonna jive with how she feels.
Yeah. So it doesn't matter if I'm right. And that's why, you know, listen. When your when your kids are younger and they're doing what you tell them to do, you know, and what you've laid out for them, try really hard to know what you're talking about because it is what you're gonna imprint on top of them. It's not necessarily what they're going to do, but my hope is, and I think it's so far been pretty accurate, is that when they do decide, I'm gonna handle this, they do...
They use the tools you gave them when they were younger. So it's it's how they know to do it. So knowing how to do it and doing it are two different things.
What the Nurse Practitioner Told Her51:45
It was... I remember one of the very first appointments, I guess maybe six months in, and we have an awesome nurse practitioner that we see at our endocrinologist office. I actually requested that we see him instead of the actual endocrinologist because he's a man, he has teenage boys. He's so good with my son, just like he's amazing. And he talks to my son at the appointments.
Like, I sit there and I try to chime in and he's like, actually, Bennett, I'd like to hear from you. And so it's really been good.
Bennett, your Uber driver is super chatty.
Exactly. That is exactly how I feel in those moments, but I will take it. And I remember we were sitting there, we were going through pump settings and, like, reviewing his graphs. And he said, well, Bennett, you know, what happened here? And Bennett was like, oh, I changed my basal rate because I felt like I needed to make that adjustment.
I think I needed more basal. And I told the doc... I like chimed in and I'm like, yeah, you know, one of the things that I really was hoping he would have done was ask me about that before just doing it on his own. And the guy stopped me and he's like, I'm going to tell you one of the most indicative things of future success is a person willing to make changes to their own settings. So you should actually be congratulating him and telling him how proud you are of him instead of like criticizing that he didn't come to you.
And it was one of those things where he put me in my place, and I... It was, like, a positive thing. I appreciated it. I was like, dang.
There's no way you told this story to your husband. Right?
Oh, yeah.
Oh, you did? Look at you. He was probably he was probably like, maybe I'll try that one day. He's not going to, but he got all excited for a second. He's like, I'm gonna do it too.
He does. He does. He tells me what's up.
Hey. But I... Does that doctor listen to the podcast?
I haven't ever asked him. I honestly should. He gives me the impression that he really understands this stuff, because our appointments are so personalized. He spends an hour or more with us every three or four months when we go in. He's talking to Bennett about all sorts of tips that...
And tricks that he can do to, you know, whether that's, hey, how are you utilizing activity mode? Maybe you should start activity mode sooner before band. Like things that I just don't really seem to hear in other people's stories. Mhmm. Again, I'm so grateful for the care that we are currently receiving.
He is amazing.
I'm trying to decide if you just remembered that story in my words or if he spoke them. But that's... I've said that a thousand times that I I think that one of the biggest indicators of future success is people who have the autonomy to make changes to their settings.
Well, so he had said that. And then I, at that point, I probably hadn't been listening to the podcast yet. I think I was just online. And then I started listening to the podcast and I'm like, oh my gosh, Scott says that all the time. Look at that.
He's... This guy's right. Like you can... You made me believe the doctor. I was like, okay.
If Scott says it, then I'll believe the doctor. But it... Yeah.
Well, I'm glad I'm glad somebody's out there saying. I'm sure there are more than one person, but, like, it is absolutely true. And for me, it's the, you know, it's the conversations I've had with people. And you you start to say, I mean, I don't know how the rest of you guys are listening, but I've been doing this for twelve years and 2,000 episodes. So I'm trying to aggregate everything I've heard together.
And when people are successful, there's a few things that they do, and that's one of them. And everyone who struggles is the one who's... You know, they're always like, well, you know, I'm seeing a problem here. I'm gonna mention this to my doctor next time I see him. I'm like...
Three months from now when you've already been suffering. And I think that's I find that to be very interesting because at the very beginning, I felt that way. I'm like, we can't just give you more Lantus. Like that... We can't do that.
But the further I got into it, I'm like, yeah, we can. We're gonna we're gonna do whatever we need to do to manage this. This is your life forever and not theirs. So I just... I find it interesting that that some people don't feel that level of confidence and it makes me sad.
Like, I wish everyone felt like they had the ability to
Speak up for themselves.
Take matters into their own hands or do what they need to do. And obviously within careful reason, like don't go crazy, be safe. But at the same time, like, I'm not gonna wait three months for somebody else to tell me what we should and shouldn't do. So I was really... I I think now I look back at that and I'm like, yeah, I actually should be so proud of my my child.
Yeah. Now he saw he saw a problem and he was like, oh, I think I need more insulin here. Mhmm. It's awesome. Yeah.
I mean, were you scared? Like, why do...
I think when I found out he did it without talking to me about it, it was not necessary. It was probably some fear. I think it was more so just, hey, bud. Like, we need open lines of communication because I'm making decisions on other things based off of what I think to be true. So if you're making changes to those things without telling me, I might have something wrong in my own mind about how I would be approaching situation.
So that's not wrong either. So so let me ask you a question. When you said it to him in front of the doctor and the doctor responded how he did, is that how you meant it? Like like, were you saying to him you did something wrong by changing this, or were you...
No. I meant it as communication. And I... The doctor did follow-up with my son after he told me off. He said, but listen, your mom loves you.
You're the most important person in her entire world. You've got to talk to her. You've got to communicate because like, yeah, this is... And so I...
So learning experience for both of you in that moment. Yes. Yeah.
And it's teenagers already, a teenage boy who doesn't communicate already. It's just like, let's layer on diabetes and see how this goes.
Well, it's just like there's four there's four men in my house. No one's saying anything.
It's so... It's so quiet.
I'm just sharing how I feel and everyone stares through me. I... Yeah.
Yeah. It's like you're here, Scott.
Is she sad? I don't care. Like... Yeah. Yeah.
I mean, I've been a boy a long time. I I know what's going
on. How could I say this in a different way to get someone to talk to me? Someone talk to me. I can't believe
that third kid wasn't a girl.
He's my sweetheart, though.
Oh, I'm sure he's lovely. Don't worry. I know one's saying otherwise. But but you probably do feel a little alone sometime because men do, you know, generally speaking, communicate in one way and not the way a lady does. But when my...
When Arden got bigger, like, it was, like, my wife's, like, saving grace. She finally was like, oh, there's another person on my team now.
That's cool to talk to.
Yeah. Yeah. I mean, she agrees with me.
Yeah.
Yeah. I said something the other day, and Arden's like, be nice to your mom. And I was like, wait. I'm not not being nice to mom. And she looked at me like...
And I was like, oh, okay. Like, I've been being nice to your mom for three decades. I like, was that lady is my girlfriend. I'm good. Don't worry.
And Arden was like, I don't like the way that came out. And I was like, oh god. Oh my goodness. That's hilarious. Being word police by two people now.
So that is so funny.
Alright. So pivot off of this for a second. So he's doing well at the moment. You said his a one c is great. He's picking things up as he goes.
Alright. Do you have confidence that, like, heading off to college will go in a positive direction?
Yeah. I mean, I think of... My husband and I joke all the time. If any of our kids were to be the one to have type one diabetes, he's the one because he is the one that's most... He's a rule follower.
He wants to do the right thing. He... You know what I mean? He's very worried about doing good in school, in band, in life. So I do think of all of the kids, not that I'd want any of them to have it, but if any of them would, he is maybe best suited as his personality.
There are moments where I'm like, oh, boy. If I wasn't here, things would be super sideways. But for the most part, I think that I feel pretty good about it.
I've been asking for Christmas gift lately. I say, I want you guys to get me two custom t shirts. One of them should say, you'd all be dead without me. And the other one should say, you'd all be broke without me. And, please just...
I want those two. I don't think anybody's gonna really do it, Melissa. But...
I should get those for me too. Yeah.
I agree. I I hear I hear what you're saying. I hear what you're saying. There's sometimes where you're just like, how did I get this job? Like, why does everyone else get to bounce around, like, all, like, footloose and fancy free?
And I'm like, here, I picked your medication up at the pharmacy or, like, you know, oh, thanks. Yeah. You could have gotten it. You know?
Yeah. It's also this dynamic, like my husband and I, I think it's an interesting... He's very... He cares a lot about the diabetes. He's super involved.
He's a great dad. But he does not... It does not run his life and mind like it does mine. And so we've also had to find that balance of working on it as a team and also when he's with him, me deferring to their decision making that, like, he's the one that's there. He's the one that's seeing things in real time.
I need to trust and know that it's gonna be okay. I think there's still so many moments where my husband's like, he'll wake me up in the middle of the night. He stays up super late and I go to bed super early. So he's like, babe, I need your advice. What am I supposed to do with Benet's blood sugar?
I'm like, can you please just figure it out? Can you figure it out right now without me? But I think he does lean on me a lot, which I prefer that. I want that.
I was gonna say, come on. Stop it. I've been married a long time. You're like... But also...
Wanna sleeping.
I'm literally sleeping. Why are you waking me up if you're already awake?
So are you... Listen. I want every single guy to hear what just happened here. Okay? Because get yourself ready.
She wants him to defer to her and check with her, but not if she has to wake up. Then he's a person who can't do anything by himself and doesn't know how to make a decision without me. Melissa, did I get that right?
No. No. Of course not. It's not what I'm saying.
Have you... I... It's what you're saying. It's what's happening.
Like, so have you ever heard
have you ever heard the, have you ever heard the saying, I can't win for losing? Yeah. Yeah. Like... Or
Yeah. It's an impossible situation. Yeah. Yeah. It truly is an impossible situation.
I don't know what to do. If I ask her, she's gonna think I'm inept. If I wake her up, she's... Oh, no. But if I do it wrong, she'll see in the morning on the CGM.
What
did the you do?
I have to leave. I have to leave my family. I've gotta go. I have three jobs. It'll be okay.
Oh, I'm dying.
Yeah. Yeah. Yeah. No. I...
I've been married a long time. I I...
At least I can laugh at it too.
You know? Well, I mean, we're laughing at him.
And his and his... Myself. I understand how unreasonable it all sounds.
Woosah, Anxiety, and Everyone Wanting a Thing1:03:26
Are you anxious?
Yeah. I'd say so. For
fun or classically? What do you... Like,
this Not for fun. No. No. It's an an active, active effort and journey to try and woosa myself.
So... Wait. Woosah?
Yeah. Have you ever heard of that? Woosah?
No. I think you got... You're telling me something I
don't know. Look it up.
What do you mean look it up?
Know, AI. You say, yeah. Ask what woosa means.
Wait. Is it woosa? Woosah. Woosah.
Do you
wanna ask him?
No. I think it's like w o o s a h. Like, woosah.
Hold on a second. I was...
Restoring anger man... It's a slang term used as a reminder to take a deep breath and stay calm in stressful moments.
What does Woosah mean? What does it stand for?
I think you might mean Wausau, the city in Wisconsin.
I definitely don't mean that. No.
I I literally... I'm reading it. Wausau.
It's about taking a a slang term... Hold on. Let me tell my guy. A slang term used to what?
As a reminder to take a deep breath and stay calm during stressful moments.
It's a reminder to take a deep breath and be calm during stressful moments. Is this the thing you've heard of, or do you need to look on the Internet?...
Culture. The phrase was popularized by the 02/2003 comedy film Bad Boys two, where Martin Lawrence's character is told to say woosah and rub his earlobes during anger management.
It's not an acronym. It's just
a soothing sound, an anger management mantra.
Yeah. He got the same thing. I said he, but it's my phone. So I don't think it's really a person. Not yet.
In our lifetime, somebody's gonna wanna vote to give AI rights. And when that happens, I want everyone to know you're out of your minds. So I just wanna get ahead of that one. I'm gonna call you crazy if you ever say that out loud. Okay.
So you have anxiety? Like like, is it is it something you should be taking a pill for anxiety, or is it just... What... How do you think of it?
No. I... No. I don't take any medication. I don't have, like, a formalized diagnosis of anxiety.
I consider myself to be a high functioning anxious person because I think in so many ways it fuels success and it's, like, can be wielded as a strength, obviously. Then there's other things in my life where it's disruptive. Like with diabetes, it's been a harder thing for me. Do you ever get
the feeling we are all just looking too hard at ourselves sometimes?
Yes. 100%.
Yeah. Maybe psychology ran out of things to do, and now we're doing this. There are times when when I'm listening to, like, that that idea. Like, you're... Listen.
Here's what I hear. You're a motivated person. Right? Like... And you and you work hard, you want things to go well.
And when they don't go well, you have a feeling that you'd like them to go well, and you keep trying. And now we call that being anxious.
Anxiety. Yeah.
Right. Right. Maybe. Or or or, you know, like, I don't know. Like, I I have a weird speech pattern, which apparently some people find entertaining.
And then somebody comes on and goes, well, you have ADHD. And I think, mom, you don't know me. I have no trouble concentrating on anything. Like, I I I concentrate eighteen hours a day on things. I get a lot of stuff done.
I'm I'm not flighty. I don't find myself staring at walls. If I get tired, I stop working. Like, I don't have ADHD. Well, yes, you do.
Why? Well, you know, sometimes you start a sentence and you start thinking about it and you go on another. I'm like, I'm telling a story. Like, the... It's not a linear story, and sometimes you need another piece of it to get it.
And then, like, no. That's... Everything's not a diagnosis is what I'm telling you. Right? Like, if you're good at math, you're not autistic.
Stop it. Like, I don't know what you're all doing out there. Just relax. Why does everyone wanna have a thing, by the way? Have you noticed that?
I don't know. I think it's like there's a a mental health culture, and I don't think it's necessarily all bad, but I think, you know, I think about how I was parented and then, you know, fast forward and there's so much out there about like soft parenting and...
I didn't experience that. I don't...
Think somebody needs some discipline. Like, what?
I don't know what soft parenting is, but I didn't live through any of it personally....
Think some of it's that. It's like, we're very mindful of how everything we say and do is going to...
I... By the way, I also don't disagree with everything that you say and do impacts something. I know it does. Right. But, like, we're not built to track it all.
So, like, just... Hey. So Melissa's... Like, you know what I mean? She's a pain in the ass.
She's a little high. Yeah. Yeah. She's a little high.
High strung. You know? High strung, intense, tenacious, passionate.
In the '7... In the seventies, they would have called her a pain in the ass. In the nineties, they would have called her something else. Like, she's a lady who gets stuff done. Right?
Yes. Yeah. Yeah. Absolutely. And I'll tell you what.
Yeah. You set those goals for those boys so they'd all sit around picking their ass. I guarantee you he wouldn't have three jobs. He's just trying to make you happy And good. Because what would be happening otherwise?
I'm only working because my wife said we needed a house. I mean, I a 100% would still live in the same apartment she and I rented together when we were, like, 22. If, like, it wasn't for her being, like, not good enough, keep going. And I'm like, oh, okay. Yeah.
I think ladies are the only reason we move forward. Right? Yeah. I seriously do. I agree.
Yeah. Otherwise, we'd all just be forming football leagues and betting channels and stuff like that. You have no idea how base everything would get if you left us in charge too long. So funny. Alright.
Listen. What happened to your health? Tell me a... Let's take a a left turn for half a second.
Her Own Labs, and the GLP That Changed Things1:09:15
Yeah. I think... So I was a college athlete. I played softball at Florida State. Mhmm.
Bragger. I I know.
I didn't know you were blonde. How come you didn't say you were blonde when we started?
I am blonde.
I know you are.
I don't know. I don't know why I have to say that. But...
Well, I mean, you didn't have to say that. I'm just saying I'm just saying
that I guess.
I have never turned a Florida State softball game on and thought, oh, where did they get that Italian girl from? It's never happened one time when I was watching.
There are a lot of blondes. So I I think because physical, like, activity exercise intensity was such a huge part of that season of my life and like all of high school leading up to that, everything was about fitness and health. And I think after college, I was like, cool. I don't ever have to work out like that again. And when you're young, you think your body's gonna stay young forever.
And so... And then you start having children and you're like, oh, well, never mind. That's not how this works. And so then I had... Fast forward, had my third son.
I got very, very sick after he was born and was hospitalized for a little bit of time.
Oh, how come...
And after that happened, like nothing bounced back. Because after my first two children were born, I bounced back right away and everything was looking great. Everything was good. And then after his birth and like that whole traumatic story, I did not bounce back. And so for many years, I've just oscillated on like, what if this is hormones aging?
What if this is diet and exercise related? And so I've, you know, I've lost weight and then I've gained it back and then I've lost weight and then I've gained it back. And I think I... It all kind of came to, probably two years ago, I got on semaglutide and it made me very sick. And so I just got off of it.
I was like, I can't do this. I did lose some weight on it, but I was so sick that it was brutal. And I'm like, I just don't feel like this is good. So I came off of it and I gained all the weight back that I had lost, and that was super frustrating to me. And then it all came to a head, like at the end of this year, I just felt like garbage.
I was tired all the time. I was not sleeping well. I was like, I have to get my butt in the gym. I have got to move my body, but I just couldn't physically. I was like, I literally am so tired.
I have a very taxing job, so that takes a lot of my mental energy. Anyway, I said, you know what? Forget it. I'm going to find a functional medicine person because every time I had done labs in the past, they're like, oh, normal. Oh, normal.
And when you started talking about TSH and if you have symptoms and it's above two, doesn't matter if it says it's normal, you need to go tell somebody that something's wrong. Like you, I can truly... I... I've told everybody I know about you in this podcast because I'm like, this person, the stranger gave me the confidence to go demand more for myself in a way that I had not done before. And so I went and got a ton of labs done.
This wonderful functional medicine lady that I found, she's a little cuckoo, but she's awesome. She ran every lab that I asked her to run and so glad I did that because my TSH was 4.8. My estrogen, progesterone, testosterone was all out of whack. My B 12 was super low. My vitamin D was super low.
I just like finally got answers to why I had been feeling the way that I'd been feeling. So she started me out immediately on a thyroid medication. She said, Hey, you need to take these supplements. And we reran labs. So I really took the approach of, I want to get the inside right before I start worrying about the outside because I feel like I had never done that before.
It had always been, like, I was doing it to look a certain way instead of doing it to feel a certain way in
a sense. You're fighting bad internal settings too. Right? Yeah. You're...
Exactly. The way I imagine the things in our body that we, at this point, know how to manipulate, I just think of them as, like, dials that are set wrong. And 100%. Right. You just need to turn them and get them back, and maybe that'll be with a pill or maybe it'll be with an injectable or maybe...
I don't know what it'll be with. It depends on your situation. Maybe it'll be a thing you can't... We don't know how to impact yet. But it doesn't mean that it's not impactable.
It just might mean that we don't know how to do it yet. Women, especially with these new, like, estrogen patches and the hormone replacement and stuff like that, you know, you don't have to you don't have to go from, like, you know, third baseman in... At Florida State or wherever you played. You have third baseman energy. That's why I said it.
I was a pitcher.
A pitcher. Okay.
A left handed pitcher.
Okay. You don't have to go from that to, I'd like to have a baby to, oh my god. Is this what they mean when they say boxy? To, why am I so old in my fifties? Like, do you know what I mean?
Like, it it... Poor women are on, like, a trajectory. It really is like nature means for them to be disposable. I hate... I really...
It makes me upset to say out loud because I love women and my wife and my daughter and everything. But, man, it feels like after you have a baby, it gets sideways. And then, like, we just write you off. We go, that's what happens. You you know what I mean?
And then that's... But turns out you put a little patch of estrogen on it. That's not what happens anymore. Turns out you put a little GLP in, that isn't what happens anymore. Yeah.
And so I'm I'm in for this. I love this ride. Yeah. So...
My insulin resistance was really bad. And so while my a one c was great, because I was like, am I, do I have diabetes? I started wearing a Stello for a few weeks to track my blood sugar because I was just like, I feel like things in my body are wrong. So anyway, she put me on thyroid. She put me on some supplements.
We redid labs. A lot of things had started to improve, not, not wildly improved, but the TSH had certainly improved. My vitamin D had improved, B12 had improved things like that. And so I said, you know, I think that now that I feel like I'm at some sort of a baseline where at least we're addressing the issues on the inside, I want to get on a GLP again. So I got on tirzepatide that was probably June, maybe June of this year.
So a few months now.
Like four months ago? How much have you lost in four months?
I've lost 24 pounds.
Why don't they just call it magic juice? Why do they gotta give it Yeah. Such a Yeah. Go ahead. Sorry.
I know. No. You're good. No. You're good.
It's, and I feel better. I feel so much better. And obviously I'm sure that some of that is the thyroid medication because that was super out of whack.
It's everything.
But I'm like, I think it's really impacting. I feel like it's impacting my insulin resistance the most because I feel different. I'm eating, I'm eating obviously very different because of the appetite suppression and how your food is digested. But just, I just feel so much better. So it's amazing.
My husband just started it two weeks ago.
Yeah.
I was like, you need to get on this. This is amazing.
It's funny. You lose, like, 20 pounds. Go, hey, Chunky. Come over here. I wanna talk to you.
Yeah. I think
that was a motivation for him. He's like, oh my god. I can tell you're losing weight.
And I'm like, I'm sorry. He's like, he's
like not. You better hurry up. Yeah. He's like,
she gonna leave me with these three boys. I'm a go out of my mind. I gotta I gotta I gotta pull it together quick.
100%.
That's... Well, that's... Listen. Congratulations. Fantastic.
Anybody listening who thinks it's cheating, I don't understand how your brain works, but good luck. And, I think they should spray it out of airplanes on top of all your heads. What do you think that? I I just... I don't...
I've I've get... Listen. I get it if you take it and you're like, it didn't make me feel good. I I mean, right on. Like, everything's not right for everybody.
But like you say, you tried one. And for people who don't understand, like, you tried Ozempic and then you went to Zepbound. Is that about right?
Okay. Yes.
Right. And, I... It's too expensive. It's almost free now. Like, we're almost at that point.
And by the way...
Oh, that's not the case. Dear god. How do you get it free? That's a trick I'd love to hear.
Is your insurance not covering it?
No. Insurance won't cover it.
My god. You people, you gotta get a you gotta get a square job. You know? You gotta work for a company.
I do work for a company.
No. They're not big enough. Work for a bigger company....
Not be.
I'm
like, dear lord. Insurance is so expensive. Maybe it's the plan I'm on.
I I I can't tell you. I'm... First of all, I hate saying this out loud because it feels such, like, a silly thing. I am a 100% grateful that my insurance covers it. And I do know people who don't, but I also...
What I'm saying is I'm seeing the cash price come down. Like, it is it is... There's plans where you can get it cheaper. There's a ton of people who are compounding it now. There's a thousand companies who are trying to turn it into, like, a generic injectable.
I think in the next year or so, you will be able to buy it at a bodega. So... And that's...
Yeah. That is my hope for the future because, obviously, it is currently not covered by insurance, so it's pretty expensive. But I think for me, I'm like, I...
Look. Can I?
The amount of, like, time, effort, and energy that I had spent, you know, what's the price of that when you can feel great?
When I when I first started talking, I had to talk somebody into doing it cash one time. They're like, I don't have this much money. They... At the time, it was like it was like $600 a month. And I was like, that is a lot of money.
I am not saying otherwise. I said, but let me go over a couple of things with you. A, I wonder how much money you'll save on your food bill, which has ended up
I do have three teens, so that hasn't helped me.
Yeah. That hasn't helped you. You have to stab that.
But it would help someone else.
Yeah. Yeah.
It would definitely help someone else.
You stab those kids with that you stab those kids with that pen, you won't have the same problem. They'll be like, I'm not hungry. Yeah. Right. But but like I said, I think your food bill will go down a little bit.
It'll... At least it'll mitigate it a little bit. And we went over a couple of other ideas. I said, plus, it will go down. Like, the price is going to come down.
Maybe you will eventually have insurance that covers it. And and I think this is the most important part. Do you know who doesn't need $3,000 a year? A dead person. And so you're on your way to a really bad health outcome.
So if you've gotta find a way to make another $3,000 this year, don't care if you have to get another job. Hey. Melissa's husband's got three of them. Like, you know, like, I don't care if you have to get another job. Like, find a way to do this.
Find a way to mitigate the cost in different ways. Give up something else. Find a way to make this happen for yourself. And I say this all the time because she was very clear. She she called me back later, and she's like, thank you for bullying me into going on this.
And I was like, because I a 100% did. It's just a private conversation. But all the things I said happened. Her food bill came down. Right?
Her family has lost hundreds of pounds collectively. And on top of that, she just got a new job. By the way, with her new look, her new self confidence, her new, like, life, like, like, outlook, she went out, got a new job, and guess what that job has? Insurance that covers her GLP medication.
It's awesome.
Yeah. So for for $500 a month, she... For... It was only for a year. She changed her entire life, and now she's okay.
And now she doesn't have to spend the $500 a month anymore. So now aggregate that $3 out over the next forty years of her life. She paid a penny a day to to stay alive. You know what I mean?
It's incredible.
You know, think think different. That's that Steve Jobs guy. He said that. Right? Yeah.
He, by the way, then got pancreatic cancer, thought differently, and instead of doing what his doctor said, tried some hocus pocus and was dead very quickly. Not the... By the way, not that pancreatic cancer is a thing you can easily overcome. Not funny. Yeah.
Yeah. But but, anyway, I think I think you just gotta try something. Yeah. Like, it's better than sitting around going, this isn't working. Like, if your body is the way Melissa described, something isn't right.
Yeah.
It's not just bad luck or your genetics.
It's just... This isn't normal. I'm 38 years old. I should not be... Like, I just started looking at myself and thinking, there is no way on earth that this is supposed to be how a 38 year old woman feels.
There's just no way that this is right. This is not normal. And we just settle. I think we're busy. We're distracted.
We're... Whatever you have different priorities, but like we just settle to accept things in our lives that we don't have to accept. And I think you... I really do. I know that...
I don't know. It's like I'm giving you all these compliments, but I really do think it was because of how you have talked about it that gave me the confidence to say, man, he's right. This is not right. And why am I allowing myself to just kind of keep going through the motions of my own life? And so I'm really grateful for, I'm grateful for this podcast obviously related to type one diabetes and my son because it's given me so much knowledge and just like a support system that, you know, doesn't exist in my physical world.
You know what I mean? Like in my day to day life and just hearing other people's stories and listening to other moms talk about what they're going through, it's just been so refreshing. But then at the same time, it's been something where I've been able to take for myself as well and impact my own health, and I'm just really grateful for that.
Well, that is incredibly kind of you, and I appreciate your heartfelt statement. I think there's only really one way to answer that, and it is with the last two sentences that were spoken between my wife and I after we hung up on that phone call in the drive back from Tennessee where I said, look at me saving people. And she said, shut up, idiot.
I think you take the win, Scott. I agree with you.
No. Seriously, it just needs... I mean, listen. I don't wanna pontificate about my my conversation or sharing style, but I just... I...
I've said it a thousand different ways to a thousand different people. Like, sometimes I say, like, you just need a tiny bit of my narcissism, or I don't know why I'm built like this, but I wouldn't put up with that crap. Like, it's the... We all grow up differently, and we get told to be polite or don't question that person or or shut up, put your head down, and keep working or whatever. You know, whatever's stuck in your head that allows you to get to a point where you say, something's wrong, but I'm just gonna take it.
And I don't just mean about your health. I mean about everything. I don't take crap from anybody about anything. Like, I really couldn't possibly care. Like, I'm the perfect person to do something like this because when people complain about me online, it doesn't even register for me.
I'm like, whatever. Bye. Yeah. Oh, that's awesome. Random guy in Montana doesn't like me?
Oh, no. I'm okay. Yeah. Oh my god. Yeah.
It it doesn't it doesn't hit me. But when I'm in a personal situation or in a public situation... Like, I've never told a story on here that's not true. Like, whether it's just, like, you know, going back to a grocery store. Have you heard the one about the the lunch meat yet, or is that not gone out yet?
No. I don't think I've heard that yet. Oh, I And I'm pretty caught up. The only ones I haven't listened to of, like, recent are the ones with Addie Taylor, which I'm so excited to listen to those.
Oh, she was lovely.
That just came out, I think, yesterday.
It was yesterday and today. It's a two parter.
Today. Yeah. Two parter. Yeah.
Yeah. Yeah.
So I'm excited about that. I'm gonna follow her online.
Yeah. She's really awesome. She's really honest about, what it's like to make, like, content too for stuff. It's real... It was super interesting, and she's got an interesting story.
It's, yeah. You'll get a lot out of it. But I just don't... I I don't understand. I don't understand letting yourself being treated poorly.
I don't understand accepting things that are less than than what is, like, obvious or deserved. I don't get it around health care. Like, you guys probably think, like, I have some theory about living with type one diabetes. I just have a theory about living. You you know, like, when when Arden's little and we're having an eight and a half a one c, nine a one c, the doctor's going, you're doing great.
I'm like, that's wrong. And that's it. I don't think about it again. That's wrong. I'm done with that now.
Now if that person can't help me, how do I figure out how to do it? I love how you figured out your son's issues. Like, you called it, like, going down a rabbit trail. By the way, it's rabbit hole, but whatever. I didn't stop you at the time.
And, like...
I do that all the time. I miss... Say all the little sayings. People make fun of me. They're like, oh, there goes another
I've never mentioned my sister-in-law like this before. My sister-in-law uses the wrong word about three times in every conversation you have with her, and I've I've learned to find it to be delightful now. I like... She... She's like, she'll say something.
I'll think, I wonder what she meant there. And so... But but I like what you did. I would have done the same thing. My...
I got my son's diagnosis for his Hashimoto's. I I made... I did that. I was like, that's not right. I first picked up on his, like, just this temperament.
I'm like, something's not right. This is not how his personality usually goes. And then I I took him to the doctor. I said, I think he has a problem with his thyroid, and then I let the doctor tell me he was okay even though I'd watched my wife live through it. And then we came home.
I was completely frustrated. And instead of trying to tell that doctor again and again and again, no. You're wrong. Do something. I just went and got him a different doctor.
Mhmm. And I got him one of those functional medicine ladies who's a little left to center, but really awesome and really smart and willing to see the world a slightly different way, but isn't gonna rub essential oils on my forehead. Like, there's a gap in there. You just gotta find
100%.
You just gotta find the gap right in there. That's... You wanna live Absolutely. You wanna live between essential oils and know you're fine. Like, you just gotta find that, and it's always a lady.
I just wanna tell you. Like, so go find her. She's wonderful. It's somebody... Some motherly woman who understands the world a little better than the rest of us, who's not afraid to say, this isn't how we usually do it.
We... Whoever we is, but try this. And and I immediately got him okay. Now he could've lived like that forever. It could've turned into people going, oh, wow.
Cole's kind of a prick. Because he's not. He just... His thyroid was all messed up. And, you know, like, I did that.
Like, I I... And I'm happy about it. I I wouldn't apologize for going down a rabbit hole. I can't. I physically remember sitting at this desk at 03:00 in the morning before ChatGPT, like, googling and searching, all kinds of crazy stuff.
Like, I'm telling you, like, I was in NIH articles, and I finally found a a study that said that my son's one symptom that we could track physically has sometimes been tracked back to, Hashimoto's. And I copied that, sent it to the doctor, and I was like, see that? Give him the medicine. And boom. Like that.
And he was fine fine in days. Yeah. I I was out of my mind trying to figure that out. I have to tell you, for the rest of you, I don't understand not having that energy when you're being attacked. Like like, do you know what I mean?
Like, if you were coming after my family, I drop everything, and I figure out what's going on. And we You
get the bat out of the room. Oh my god. That was the best story. Yeah.
People peep... We're gonna... Is this what we gotta do then? This is what we gotta do. I I swear to you, like, I've...
When people go crazy in the street, I don't judge them too much. I think they grew up a specific way. And I've... Because I've had moments in my life where I've heard something and I thought, oh, I didn't think this is how I was gonna die. But if this is how it has to go, then I guess this is how it has to go.
And and there's other times where I would run from danger, like if my kids were with me. But if I was alone, I'd be like, oh, I'm definitely the guy that would, like, run you over if you pulled a gun out of the diner. I'd be like, oh, cool. I didn't know this was gonna happen today, but we can't just let this go on. And and by the way, I'd get there and you'd find out I was an old man.
I could barely knock the guy over. He'd probably shoot me immediately. And, but I would just think, like, there's a problem in front of us. Now no other problems exist until we fix this one.
Yeah. And Take it. Take control of it. Take action. Like, take some step forward.
Don't be so afraid. Just... And don't listen to people all the time. Don't listen to me. Listen to yourself.
Like... And if you're not smart enough, find a person that... And by the way, some of you are dumb as a wall. It's okay. Don't be embarrassed.
Go find somebody else that knows what's going on and let them help you. But don't sit back and go, I wish I could figure this out, but I can't, so I guess I'm just gonna die. That's crazy. Yeah. Alright.
Alright, Melissa. You made me all upset. I'm all warmed up. I'm good to go for the day. Guess I'll have an egg now.
You know what I mean? I'm boring. I'm gonna poach a couple eggs, throw it over a piece of rye toast to get going with my day. That's delicious. You were awesome.
I'm gonna ask you a couple of real estate questions and then let you go about your life. Nobody nobody cares about them, so I'm gonna stop the recording right now. But thank you very much for doing this. I really did enjoy the conversation.
Thank you so much.
Can I just say how? Like, before I hit stop, I never thought blind girls would like me, but this is really a nice...
This has been a nice moment. Whatever. Oh god.
This has been a nice moment for me.
I have been looking forward to this so much. My family my family's texting me, how did it go?
Oh, Melissa, I swear to god. I just assumed everyone had dark hair that was listening. Like, this is a really big moment for me. Thank you so much. Hold on one second.
Welcome. Today's show was sponsored by Tandem Diabetes Care, the Eversense three sixty five, and Touched by Type one, who you can learn more about on Facebook, Instagram, and at touchedbytype1.org. Head now to tandemdiabetes.com/juicebox and check out today's sponsor, Tandem Diabetes Care. I think you're gonna find exactly what you're looking for at that link, including a way to sign up and get started with the Tandem Mobi system. I'd like to thank the Eversense three sixty five for sponsoring this episode of the juice box podcast And remind you, if you want the only sensor that gets inserted once a year and not every fourteen days, you want the Eversense CGM.
Eversensecgm.com/juicebox. One year, one CGM. Thank you so much for listening. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple Podcasts, please do that now. Just hitting follow or subscribe really helps the show.
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