Scott Benner 12/9/22 Scott Benner 12/9/22

#806 Dexcom G7 Approved By FDA (with Dexcom COO Jake Leach)

Dexcom COO Jake Leach is here to talk about the FDA approval of the Dexcom G7.

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Scott Benner 0:00
Hello friends, and welcome to episode 806 of the Juicebox Podcast.

What we have here is a bit of a Christmas miracle it seems. On December 8 2022, just yesterday, the FDA announced approval for the Dexcom G seven. And so of course, I have Jake leach here today to tell you all about it. Jake is the Chief Operating Officer at Dexcom. But more importantly, he's worked there for nearly 20 years, and his understanding of all things Dexcom is fascinating. I mentioned at the end of the episode when Jake and I finished talking, but I'm throwing questions at him from like, accuracy. You know, when's it gonna be available? How did you make this? What do you plan on doing about that? And Jake, just man, he just has the answers. Absolutely fantastic. It's a great conversation is only 30 minutes long. But it's a ton of questions that came right from you, the listeners a few of my own, and all of Jake's answers. So settle in, and enjoy. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan.

If you're new to the podcast and you don't know anything about it, you should hit subscribe in your favorite audio app, Spotify, Apple podcasts, Amazon music, wherever you get your shows, follow or subscribe. The Juicebox Podcast puts up new content four times a week, Monday through Thursday, you'll hear interviews with an adult living with type one, or a parent of a child who has type one. And we talked about all kinds of stuff. For instance, there's an entire series of after dark episodes where we talk about topics that most people don't talk about. There's ask Scott and Jenny where I and Jenny Smith CDE, who has had type one diabetes for 34 years answer your questions. We have entire episodes about algorithm pumping on the pod five control, IQ and looping. There's the bold beginning series for people who are just starting out with type one diabetes. And all of the questions and topics were suggested by listeners of the show when they were asked, What do you wish you would have known in the beginning, there's the defining diabetes series, which is just every conceivable phrase and term that you'll use with type one explained in short, fun, understandable episodes, we define thyroid issues in the defining thyroid series. Talk about the different variables that impact your blood sugar's than life. In the diabetes variable series. There's an entire mental wellness series and heard about it. I wouldn't be surprised that diabetes Pro Tip series from the Juicebox Podcast, I could explain to you what it is. But instead, I'll read you this. And then we'll get to Jake, and the Dexcom g7 excitement. This is from a listener. My son was diagnosed type one about five months ago, I have learned so much from just the pro tip shows, and I will be listening to all of the episodes. This podcast is amazing, both for the information and for the shared experiences from Scott and his guests. They make you feel less like you just got hit in the face with the shovel. And more like you can find a way to keep your loved ones happy and healthy. Check out the diabetes Pro Tip series at juicebox podcast.com. Go to the top in the menu where all the series I mentioned and much more are listed. Or you can go right into your audio app and search Juicebox Podcast pro tip. And they should all pop up right in front of you the first Pro Tip series. Is it episode 210. It's called newly diagnosed or starting over. Yesterday, I woke up to an email about g7 being approved by the FDA. It's a number of months. If I'm being fair. It's a lot of months since it was approved in Europe. That surprised me. Did it surprise you?

Jake Leach 4:21
Yeah, it did. Yeah, we anticipated those two review cycles to be similar in time. And so our goal was to launch the product globally around the same time but the approval in Europe came as expected and the FDA approval took a little longer than we anticipated. So it did yeah, it very happy to have it now very excited to get the product in users hands now but it it did take a little longer than expected.

Scott Benner 4:49
Okay. Can you tell me why? Like what the

Jake Leach 4:53
primary reason was we had to, we had a feature in there called silence All that we had to remove it's it's in the product, it's outside the US, but remove it from the US product. It's basically a feature that allows users to silence the alerts for up to six hours. You know, so that if they're in a situation where they understand this, basically, I got it, I don't need to be alerted by my CGM. At this point in time, I'm gonna, my glue is gonna be high for a while I know that it's low. Really just silence those audio alerts, the FDA wants to see a little bit more information before they get comfortable with that. So we basically had to take that out of the product. For the US for now, we intend to put it back in very quickly here, working with the FDA. But that was the reason why the review took a little longer, because we had to actually make that change and then respond to the FDA with the changes.

Scott Benner 5:47
Well, it's interesting that it's making a change responding with all that all the backroom stuff takes that many months to get accomplished. It's, it's really crazy. Alright, so why do you like that feature? Why did you want to add it.

Jake Leach 6:02
So it's a highly requested feature by users, because they while they love their alerts and alarms for glucose, and the other aspects of the product, they, they, when they understand their glucose is out of range, they don't always need to be reminded every 30 minutes. And so with some of the particularly the low alerts, it'll continually remind you even if you acknowledge it, pick, you can only acknowledge, acknowledge it, and it'll come back in 30 minutes. So that is the primary reason it's really strong user request. And so we are getting very good feedback about the feature outside the US. And like I said, we intend to bring it in as soon as we can.

Scott Benner 6:39
Okay. I'm gonna ask you to be paired to you. If there's anything you want to say before I hit you with a delusion of questions that people gave me to ask you. Do you have any app happy

Jake Leach 6:49
to answer all the questions, but just wanted to share in the excitement of the community, and you know, everyone who we now have, you know, g7 approved, we're working very quickly to get it out. Early 2023. And my say early means quite early. And we be on the heels of Medicare, the CMS recommendation for coverage for folks, Basal insulin, so not just intensive insulin anymore. So really a lot of expanded coverage for use of CGM. On top of that you see the g7 approval. So could be more exciting time. For Dexcom. And for the community in general,

Scott Benner 7:30
is the Medicare distinction, a first step to private insurance accepting those ideas?

Jake Leach 7:36
Yeah, absolutely. Usually Medicare leads. And then private insurance generally follows quite quickly after that. And so its expansion of CGM to many people who could benefit from it who weren't previously covered.

Scott Benner 7:49
It. Is that an early step towards getting type twos covered?

Jake Leach 7:53
Yeah, so that that Basal coverage is type two. You know, most folks on Basal insulin are type two as well as anybody would take to it there has hyperglycemia challenges. That's also part of the recommended recommendation from CMS to Medicare. So yeah, and then there's, there's still, as you mentioned, there's still a group of type two individuals who would not be covered by Medicare. But that's our next focus, we want to focus on how do we get coverage because we know CGM has clinical benefit in that population. And so do it basically generating the evidence that's required to show that to payers,

Scott Benner 8:30
in my mind, getting it on to type twos without forcing them to get into a situation where they have to use insulin makes a lot of like, health sense to me.

Jake Leach 8:39
Absolutely. And I think we're a years from that. Um, you know, nothing ever goes as fast as I want it to go. So, you know, I think there there's, you know, a lot of folks are you know, CGM, it's continuing to expand and there's a lot of folks are working through, you know, glucose programs, the level two program at United is an example of, you know, an insurer, basically taking CGM and using it strategically in their type two population, to generate better outcomes. And so there's, there's gonna be a lot more to come over the coming years here.

Scott Benner 9:12
It's exciting. I've been interviewing a lot of type twos lately, and all of their successes seem to come from when they start to think about their type two diabetes, like type one diabetes, and they start using insulin in targeted ways, and they have all these great improvements afterwards. So anyway, that's way off the track for for a conversation where I only have here for 30 minutes, but well ask the big questions that I imagine you know, everybody wants to know, right? When early 2023 That's great. Will you have will it be like a wide rollout or is it going to be one of those things where you know, like, three guys at Tesla drive in the car and nobody else has one?

Jake Leach 9:51
It is a great question because, you know, we, we often do limited launches to make sure we got every word comfortable with everything the support of the product, the product itself. But we had the opportunity to do that overseas in Europe. So we did a limited launch there. And then we moved into full launch. And so our US launch will be full launch. We don't intend to constrain it. We feel comfortable with the amount of product we have as as well as the timing. So it's basically going to or early 2023, it's going to be generally available.

Scott Benner 10:25
Do you think it will create more initial customer service needs? Or do you think that the ease of use might actually take back your your need for CSR coverage?

Jake Leach 10:36
What we're seeing with a g7 o u s, is that it definitely has resolved a number of the things that we experienced with the G six launch that needed support. Any new product generally requires some level of new education. And so we were ready for you know, we have the support, we've done this is the seventh time we've done a product launch each one's bigger, but we learn every time we do it. And so we learned quite a bit from our G six launch about the expectation and customers and the support needed. And so we'll be ready for for it. We've been handling the European launch quite well. And so we're we'll be ready for us.

Scott Benner 11:17
Alright, well G six transmitters can continue to be made. And do you have Is there a timeline for that not to happen are

Jake Leach 11:25
we basically will continue to supply we are planning capacity for G six will continue to supply that product until everyone has transitioned over to G seven, the the folks that are kind of some of the end customers that were waiting for compatibility with G seven, those folks will definitely we've always loved sensors and G six transmitters as needed for that tire group until everybody shifts over we do intend to roll out G seven faster than we did G six globally in terms of, you know, kind of upgrading everyone up to the g7 product and so, but we'll we'll continue to make GSX as long as we need.

Scott Benner 12:09
Sometimes I noticed when I asked people hey, if you have questions for Jake put them here, sometimes I noticed you see their fears in the questions. And some of the questions. I think, if they weren't afraid they wouldn't ask, but this is one that I think I'd like to cover anyway, I know the answer. And I have no idea what the answer is. But a person asks, every time I changed my my G six transmitter right now, I kind of have to go into my pump and tell it I've put on a new transmitter. And now they're hearing that the g7 every device they put on, it basically does its own transmission, and they're worried they're gonna have to go into the pump, but that's going to be automated, I imagine.

Jake Leach 12:45
So there's a couple of things there. So we'll start with the, with the pump. So one of the things, advancements with G seven is there's a four digit pairing code. And it's just numeric. It's not alphanumeric, so there's only four numbers that identify the transmitter you're trying to pair with. And so there's some sophisticated analytics under the hood there that make allow us to do that. Because clearly the identification number for the transmitter is quite a bit more than just four digits. But the pairing code is four digits. So with a pump, you have to you do have to enter in the four digits. But because that's a more frequent process, it'll be more easily accessible on the mobile phones, the actual applicator has a QR on it, that you can just quickly take a picture and it loads all that information into the into the display device

Scott Benner 13:39
processes is sort of it happens quickly during it. But it's not some great thing where I'm scrolling through screens and that kind of No,

Jake Leach 13:46
it's designed, it's something that you have to do it. But it's very simple. And that's why we put made the pairing code we reduced it so that it would be even simpler for users. Cool.

Scott Benner 13:58
Well, people still be able to calibrate a g7 if they want to.

Jake Leach 14:01
Of course, yeah, absolutely. Yeah. Is it that feature is still there, if you want to use it

Scott Benner 14:06
is the adhesive on g7 the same as the adhesive on G six.

Jake Leach 14:09
Now it's different. If you look at the patch, it may look very similar from the surface, but it's actually a new, new adhesive. That is we've seen in our early clinical studies as well as early performance outside the US that there's less irritation with with the sensor patch. For those, you know, the very, you know, it's a small group of folks that there are folks that do have, you know, patch rotation issues. And so we've seen a reduction in the number of that. And the occurrence rate.

Scott Benner 14:39
Is there any chance that this is the time you're going to tell me that it's going to work directly to an Apple Watch.

Jake Leach 14:47
Not not right out the gate, Scott, but it's not far off. We built it into the hardware, we finally have the capability to have that directly in the g7 hardware. And so it's going to be an app release that unlocks that feature

Scott Benner 15:01
makes me remember, you know, you might have context for this when I was young, Kevin Smith, the film director was like blowing up. And he used to have these little private film festivals. And every year, I'd go to one that he would hold. And there was a, you know, you'd say, Hello. When you get there, you start to know them after year after year, people recognize each other. And the last time I ever went to one, I shook his hand, and I said, Will you tell me when I'm too old to come to these? And he said, if you tell me when I'm too old to make these movies, and I just had that feeling in my head, like, you and I are like, you're on the edge of retirement. I've been making a podcast for 20 years. And I'm like, is it gonna work with the Apple Watch? I don't know why that popped into my head, or why wasted time with it. But it just delighted me just now what I was thinking about. Alright, so it's built into the architecture at this point? Yes, absolutely. Yeah. Bluetooth architecture has been updated to include it. Do you expect that to happen with the g7? Yeah, absolutely. Okay. Yeah. All right. What's happening to the apps? Right, now we're gonna get a new, like, will a g7 users gonna get a new app? But will the followers like what all is going to happen there?

Jake Leach 16:08
Yeah, so the g7 plugs seamlessly into the end of the architecture. So when a new when, for example, when the user basically upgrades from G six to G seven, they actually use their same G six username and password. They enter that into the g7. And all their data is still in there clarity, still links in so now G seven is just updating their data, it also moves over their settings. So similar to when you enter your past user name and password into a new G six app, it remembers your previous settings, G seven, does the same thing. So it makes it easier, easy for customers to transition over. And then the followers, clarity app, all of that just they work. You don't have to get a new one. It works with g7, will you be updating the follow up? We will we've So over the past couple of years, we've been kind of laser focused on rolling out G seven, basically getting it ready for global launch as well as our Dexcom. One product. So both of those are on this completely new software platform. So we've been spending a lot of time our teams have been focused on that. But as we were rolling, we've been rolling out Dexcom one g7 has now got our US launch coming in a few more rollouts globally, through the 2023. In early 2024. The team is going to be we're going to be able to focus a bunch of the resources on continued innovation in the both the follow space clarity, as well as the g7 and Dexcom. One app, so bringing more features to those. So you'll be seeing a more rapid cadence, we've built a lot of software capacities, you know, basically the capacity to develop software to be able to do both Dexcom one ng seven at the same time. And across the globe. So we get a lot of capacity we can unleash on new features.

Scott Benner 17:56
Give those people something new to do. So at launch, no delta, no rate of change.

Jake Leach 18:02
No rate of change at launch. Not yet. Not yet. But it's on the list

Scott Benner 18:06
on the list for the new app. Okay. Android as well, right? Android? Oh, yeah. Yeah, okay. Yeah. How? Where do you, it's just kind of gets away from G. Seven for a second. But it doesn't really open access for things like looping sugar, pixel glucose, stuff like that, is that you guys? Stay in the course on how you think about that?

Jake Leach 18:33
Yeah, I mean, we've always thought about it in terms of, we want to have as much accessibility as we can. And so that's the reason why we have our API's. It's the way we do our partnerships. So I think it's, you know, we, we've always kind of embraced the community, the innovation in the community, and all of the great stuff that's being done there. And so, you know, we walk a fine line between, you know, regulated devices, and in making sure that users get access to their data. So our philosophy there hasn't changed. So while new systems do, you know, things change with new systems, for in all kinds of different aspects, and so there'll be no work to do for compatibility for anything, but we definitely understand how important some of those systems are to people.

Scott Benner 19:22
I think every time you make some sort of an announcement about something, excuse me, it brings up anxiety for people who loop or, or something like that, like they think like, is this going to be the time I wake up and it just doesn't work anymore? So it's nice to hear. Accuracy stuff first. 24 hours? Same better different than G six.

Jake Leach 19:42
Yeah, it's, it's, it's a little better. You know, it's still the lat the first day is, while good, the days after that are even better, in particular with the seven with the 8.2% Ameri D in the ice CGM. US study that's, you know, most most accurate I CGM data ever produced so we are very excited about that and so G seven is you know it's it's based it's based in the technology that we've been working with with G six and other generations but we've made quite a few enhancements both to the sensor probe and as well as the glucose algorithm

Scott Benner 20:22
that mark number is that just for arm where is that anywhere that it's okay to where

Jake Leach 20:27
it's arm, its arm where so it's 8.2% and adults 8.1% arm were in in peds. And then with peds, we also have the upper buttock location indicated.

Scott Benner 20:41
Okay, how about somebody is asking me about accuracy at higher numbers when people are fighting with high blood sugars. Do you see any improvement there? I guess I should just ask you how you see this as an improvement over GSX? Really?

Jake Leach 20:55
Yeah, it's what it really is, is it's all about even more consistent sensors, right? When you look at a population of sensors, in a clinical study, you know, it's not like every single one has an MA or d of eight, you get some with, you know, Emiratis have four and some of the you know, in a particular individual or particular sensor, you want to get to be, you know, a little bit higher than that. So, what we're seeing with G seven is there's less outliers, it's more it's a tighter distribution of performance. And so that's one of the things that really helps drive down overall system performance. Because the M or D number you see is it's a average across a an entire clinical study.

Scott Benner 21:33
So if I said to you just do a clinical study of day three today, eight, you'd see a better number than me making you put in my entire 10 day where yeah, of course, yeah, that's how

Jake Leach 21:45
people game CGM systems, right you do. You do a clinical study and don't do any data on day one, or you don't do any hypoglycemia data. I mean, there's there's all kinds of ways to game clinical studies, the ice CGM criteria that the FDA said basically specifies exactly how you're supposed to run your clinical study, which is why it's a rigorous standard.

Scott Benner 22:05
My buddy's a good guy, if you don't think about the fact that he takes our wallets when we're together. Have a look at the whole picture. All right. Out of pocket costs, is it going to be similar to G six. So this episode doesn't have any ads on it, because it came up rather quickly. You know, the Dexcom G seven announcement was yesterday came out of nowhere. I wanted to get this episode with Jacob for you right now. And I've already I've already done all the ads I need to do this week. So I don't have any left. But I do want to just take a second to acknowledge that I'm able to make this podcast and on a Friday afternoon, surprise recorded episode with Jake leach from Dex calm and get it right online for you. Because this podcast is my job. And it can be my job because of the sponsors. They keep they keep the whole thing going, they keep the lights on they helped me pay my bills. And I want to give them a second because it's the end of the year. And we've had we have a lot of great sponsors. And I want to take a moment to thank them for their sponsorship in 2022. And to thank the ones who were staying with me for 2023 and they are on the pod makers of the Omni pod tubeless insulin pump and that Omni pod five automated system, you can learn more about it at Omni pod.com forward slash juice box. Of course Dexcom is a sponsor dexcom.com forward slash juice box. Another sponsor of the show is the Contour Next One blood glucose meter. My daughter has been carrying this meter forever. It's absolutely terrific, incredibly accurate, and you can learn more about it at contour next one.com forward slash juice box. If you want to use the glucagon that my daughter carries, you can get ge vogue at GE Vogue glucagon.com forward slash juice box check out that GE Vogue hypo pen. US med is where we get our diabetes supplies us med.com forward slash juice box or call 888-721-1514 They carry all the latest supplies, but check them out. And last but not least touched by type one is a beautiful organization supporting the dreams of people with type one diabetes at touched by type one.org. I'd also like to take a moment to thank in pen from Medtronic diabetes for their support in 2022. They won't be back in 2023. But that's okay. They were a great great supporter of the show in 2022. And one of the reasons why you were able to get the show so plentifully and for free, and while I'm thanking people, I have a new sponsor in 2023 athletic greens. If you're looking for that AG one from athletic greens, a green drink that actually tastes good, athletic greens.com forward slash juice box, there are links in the show notes of the podcast players you're listening in right now, and links at juicebox podcast.com, to all of the sponsors, and they're not a sponsor. But if you go to the T, one D exchange AT T, one D exchange.org, forward slash juice box, join their registry and fill out their survey, you'll be supporting people with type one diabetes, and helping to move diabetes research forward, you also end up supporting the show by completing the survey. So they're not quite a sponsor, but you are supporting the show when you complete the survey. I want to say again, that this podcast is it's a full time job, it is a ton of work. And without ad support, this would not be my job. And today, you would not be hearing this information. And I'm very grateful for the people who support the show. And for the people who support the sponsors, if you have the need. And I have the advertiser, I hope you use my link, because it's actually a huge help. Let's get back to Jake.

Out of pocket costs, is it going to be similar to G six?

Jake Leach 26:22
Yeah. So yeah, basically out of pocket cost coverage? So that's a really good question, Scott. So we anticipate a GS six ng seven will be very similar. In the beginning, though, when you launch a new product coverage is, you know, some there will be some coverage. And then it continues to build over time. And so we've the second we've got approval, we can now start kind of finalizing all of those agreements with payers, Medicare appeals. And so what we we do intend, though, even at time of launch to have some very accessible cash pay options for people whose coverage hasn't quite kicked in there, they can stand at six for, you know, until they have their g7 coverage, or they can switch right over and we'll have some, like I said, very accessible cash paid pricing for them.

Scott Benner 27:07
Can people still soak their sensors with g7? Define soak, they want to put them on and wear them for a few hours before they start them?

Jake Leach 27:17
Yeah, yeah. Now you could do well actually on to be real precise their ID, you can insert a g7 sensor. What happens is though, the second you insert it, it starts the sensor session. So all of that information is being recorded on the display device, or I mean, on the g7 itself. And so you know, it has the 30 minute warmup time, as soon as 30 minutes goes by, after insertion, it's going to start calculating and saving data. When you pair it to it. It'll be up and running.

Scott Benner 27:46
But if some so if I'm wearing one now, and I and I say this one, I don't know it's done in six hours. I want to put this one on now and let it soak. But as soon as I do that, do I lose the first one I'm wearing? Or I can just decide to just watch the first one while they are just losing the life of the second one during that. Yeah, exactly.

Jake Leach 28:07
That's it. Yeah, use the none of the devices, whether it's an insulin pump, or zebra or phone, they don't talk to to CGM to, you know, she says the same time you said you have to you have to switch over. When you're ready to the other one, it's just it's more around the unique feature ng seven as the auto start the second you deploy, it starts session, which is great, because I've talked to customers who would insert sensors and then forget to start their session and then realize, Oh, now I started, I have to wait two hours before I have data. So the g7 is much faster.

Scott Benner 28:38
I've not pushed that button once or twice. Will is this gonna be a pharmacy a DME? Both just one? Oh, yeah, we

Jake Leach 28:46
have customers that get product through different channels, you know, vast majority of get product through the pharmacy. And so we'll continue to push that. But we also support DME for for Medicare and for men and for others.

Scott Benner 28:59
If I'm in a household where multiple people have type one diabetes, can I follow a G seven and a G six on the follow up at the same time? Yes, you can. Excellent. See how easy this is tick. I can't believe people are so kind like just yesterday, I was like give me questions. I have enough questions here. We could make a training manual for everyone. So can alarms be silent for certain durations of times? That's going to be a no right now. Right?

Jake Leach 29:24
Right. It's basically the ability to sounds Alerts is just like GS six, but we are we do want to bring that feature. It's on the short list of things to put into the US product. We're working closely with FDA to get them comfortable with it and then we'll get it out very quickly.

Scott Benner 29:40
Your new readings every five minutes. Do you ever consider doing it? With I mean every minute or why is it every five minutes I guess.

Jake Leach 29:51
It's basically it's kind of a it's a balance of a lot of things like like almost any kind of engineering design project. There's a you're balancing multiple things So the system measures glucose continuously all the time, it's not like every five minutes, it takes a measurement, it's measuring the entire time you're wearing the sensor, it's just every five minutes is when the glucose reading is communicated between the wearable and the display devices. And so that's kind of a balance of, you know, battery power. As well as you know, the frequency of glucose change all of those things around five minutes, you know, we've we've contemplated doing it more frequently, but we haven't found a specific use case, where it's, it makes sense to do that, and change the way the whole system works. But it is something that we've, you know, we've talked about in the past, but five minutes, we feel pretty comfortable with it, you know, and with the extremely minimal lag time of the sensors. Now, it's it's much less of an issue than it was, you know, years ago when it took quite a while to see the glucose change in your CGM after you made a treatment.

Scott Benner 30:56
Right. So as time goes on that kind of adage of like, the next column is showing you something that happened in the past. It's becoming less and less of the past really. Yeah, yeah. A piggy back to that question. On the follow up, it'll tell you basically, it's been three minutes since the since the number changed. And I know for parents, like sometimes you lay in bed going Okay, one more minute. Let me just refresh this app one more time. Will you ever put that countdown on the user's app?

Jake Leach 31:26
Ah, that's a good. That's an interesting idea. Well, I don't know if our team has contemplated that. But basically add, so the user knows when that things come on. Yeah, it's a Yeah. Because when you I guess, when you're sitting there, you've made a treatment. And you're basically trying to see the glucose change. I understand. Yeah, exploring a

Scott Benner 31:45
low blood sugar when you're sort of like, yeah, tests do I drink? Do I eat like that kind of thing? What's the Bluetooth range from the g7? To the phone? Is that the phone?

Jake Leach 31:56
Yeah, it's the same as G six. Yeah, it? You know, it depends a lot on the, you know, the environment that you're in and how the distance, right? It's really good when it's just like, line of sight, you can get, you know, well north of 10 feet. But, you know, in crowded environments, it's less that, but it's the same as G six.

Scott Benner 32:14
Since it's been out already in Europe. Are you already working on things that you've seen? Like, have you? Are you making adjustments on what you're learning already? Yeah.

Jake Leach 32:26
Yeah, we've, we've got quite a few. I mean, many of the, you know, with any product, you do an initial launch, and you're always improving it, you're learning things about, you know, the way it's manufactured, you learn ways, but the way it performs. We haven't seen any surprises in the US launch in terms of product performance. And we have we have a number of updates, that will be cutting it over time that will basically be invisible to users. But you know, continuing to improve reliability. And, you know, just meeting all the needs of users. So yeah, I'd say the most exciting thing we've learned from our LRS launches that more than half of the customers are brand new to Dexcom. So they haven't, they're not just upgrading from G six G seven, they're actually new users coming in to Dexcom family. So it really helps us. You know, reiterate the fact that G seven is a really good platform for expanding the use of CGM.

Scott Benner 33:20
Is there been any change on compression lows? Do you see fewer with the new design?

Jake Leach 33:27
Um, you know, we haven't done a study that compares that exactly. But what one of the things that I've talked to folks about that of Warren G seven, as well as kind of experience myself as the size of g7 allows you to move it around a little bit more in terms of the locations where you can wear it. And that seems to be the best way to avoid compression laws is to find a place that you aren't compressing as often. Yeah, we're gonna for myself, it's I went up on the top of my upper arm that tends to help me

Scott Benner 33:57
okay. Okay, so Canada, Australia, this year, not not 2022. But do you see them in 2023? Having g7?

Jake Leach 34:07
Yep, very, very likely. They're both of those are their, you know, their approval processes, right? Regulatory submissions. g7 is already in New Zealand, and so open to bring it Australia soon. So yeah, I mean, we're, the vast majority of the countries will switch over to g7 in 2023. And then there's a few of the longer regulatory cycles that will take us into early 24.

Scott Benner 34:31
So somebody asked this question, what, it's the internet. So I don't know. I hadn't heard this. But are you seeing any lost connection data on g7 in Europe, to the point where you think of it as a problem?

Jake Leach 34:44
No, no, I think it's similar to G six, it can happen. And we actually do have technologies in our pipeline that we've been working on, that we implemented on G six some of it and we're also looking to do it on G seven to even further enhance the Bluetooth range and capabilities. But I think one of the things with a new product anytime you experienced something, it's like, oh, is it the new product that's causing that? So? It's no, it's definitely not a problem. But we do something that we are striving to improve it always.

Scott Benner 35:15
Yeah, I never know the difference between like, something someone heard, and now they're asking, and you know, I'm pretty clued into this space. And I was like, I hadn't heard that. So I think it's obvious I saved the big questions for the end. And so here they are. I know this isn't your company, and but you're gonna have as much insight to it right now is anybody that I have access to talk to on this day? So how soon until people who have just decided I want to use on the pod five or people who using control like whew, like when they're they're all at home, like looking at their sensors, trying to decide like Toyota or G six one more time? Like, how soon do you expect those companies? I mean, you guys must have conversations about it. Right? Like, when is February to work with that stuff? Yeah, we work

Jake Leach 36:02
super close with those partners, to ensure that the g7 is the integration goes smoothly. So they've both both tandem and solid. And our other partners have been working on the g7 integration for quite a while because the technology has been around. And so they, you know, when it comes to actually launching those upgrades for users, it's really, they're in control of the timing there. Now that we have the FDA approval for use with AI D. It's really around them doing their upgrades. I think their public comments, a tandem, I think is talked about middle of 23. So that's not too long after we launch, and then I think insulates a little they're a little bit farther behind that. So but they they've made and they continually update their public comments around when they'll have that compatibility. But the trust me they're working very diligently on getting those those systems upgraded.

Scott Benner 36:53
I wouldn't imagine that they're taking their time. Jake, I have to tell you, I know we're going your institutional knowledge of Dexcom is it's incredible. Like I just out of order. We I didn't send you these questions. I'm rattling things off. I'm jumping from topic to topic. And you're like that, yeah, this this that? Yeah, like, it's very impressive. So please, please work there for as at least as long as I have this podcast. Because this was very easy and just full of information. And I'm gonna pat myself on the back for getting through that many questions in 30 minutes, because I feel like my head is spinning down like, look, I'm watching this list window in front of me. And I'm like, No, don't ask that as this one. That's that one. So anyway, I congratulations for me. And for everybody listening, everybody said thank you. It's a big deal. We were all really excited yesterday. And you know what I'm, you know what, you know, what people are gonna want you to do next go make Dexcom GA right now, Jake, you can maybe take a couple of days off, but then we would like we're working on it. We'd like to see it as big as the head of a pin. And I'd like to be able to wear it on my watch. If you don't mind. Go ahead, get going.

Jake Leach 37:56
lots lots innovation still to come. We're not nearly done. So yeah, appreciate the time, Scott. It's been great. And I look forward to bringing g7 to us here very soon.

Scott Benner 38:07
You guys push this space forward in a way that just wasn't happening before. Dexcom. And I'm there. I've been around this a long time. I'm never gonna forget, you know, when a new meter every three years seemed like a big deal. So thank you. Thank you very much. I hope you have a great night. Appreciate it. Thanks,

Jake Leach 38:23
Guy Garth. Yeah.

Scott Benner 38:30
Well, I'd like to thank Jake for coming on the show so soon after the announcement. And of course, thank all the people who listen to the podcast for the great questions. How did I get them? You might be wondering, well, I got them. In my private Facebook group Juicebox Podcast, type one diabetes. on Facebook. It's a private group with over 32,000 people in it. People who live with type one diabetes, type two their parents of people with type one, they have type one themselves. The gamut is run in there. You don't even you don't even have to say anything to learn in that group. It's amazing. Juicebox Podcast type one diabetes. Thank you all for the great questions. I hope you enjoyed this episode. I hope you check out some others. Tell a friend share this episode with people. There's a Share button in your podcast app or you can if you're listening online, send somebody the link. When you share the show, you're helping it to grow. And the truth is that's that's the crazy best part of this whole thing is you guys and how supportive you are. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#805 Bold Beginnings: Illness Ketone Management

Scott Benner 12/7/22 Scott Benner 12/7/22

#804 Bad Breakup

Kristina has a child with type 1 diabetes and their endo ghosted them.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 804 of the Juicebox Podcast.

On today's show we'll be speaking with Christina, she's the parent of a child with type one diabetes. And she's here today to tell a story that I found delightful. It's in the title, but I don't want to give it away in the description. So there's going to be a breakup in this episode. You might find it interesting. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who either has type one diabetes, or is the caregiver of someone with type one, please consider filling out the survey AT T one D exchange.org. Forward slash juicebox. When you do this, you'll be helping people living with type one diabetes, you may be helping yourself and you're definitely going to be moving type one research forward. This will take you fewer than 10 minutes, T one D exchange.org forward slash juicebox the easiest thing you'll do on your sofa today, that will actually make a difference. You know, I mean unless you're gonna like beta

today's episode of The Juicebox Podcast is sponsored by touched by type one touched by type one is an organization helping helping helping helping people with type one diabetes, and they'd like for you to learn more about them by following them on Facebook, Instagram, or checking them out at touched by type one.org. The podcast is also sponsored today by Ian pen from Medtronic diabetes. If you want an insulin pen that has a ton of features that you find it insulin pumps, you should check out the in pen at in pen today.com. And finally, today's episode is sponsored by us med. If you'd like to get your diabetes supplies the way Arden does head over to us med you can get your free benefits check by calling 888-721-1514 or by visiting this special site just for Juicebox. Podcast listeners. Us med.com forward slash juicebox

Kristina 2:30
My name is Christina, I am the mother of a type one diabetic. My son Clayton has been diabetic for six and a half years.

Scott Benner 2:39
The first email I have from you goes back to 2017. Do you know that?

Kristina 2:44
Yes, I do. I recall.

Scott Benner 2:48
I just saw that today. And I thought, well, that's crazy. Not

Kristina 2:54
good. It's funny to think back like I mean, I think just because we've been in it for so long. You know, like when you're first diagnosed you like think about time, like I think about, you know, the two and a half years before he was diabetic. And when you're like when you become diagnosed, you think of like, wow, he's been, you know, not diabetic longer than he is diabetic. And then you kind of hit that halfway point of like, okay, now he's been diabetic the same amount of time, you know, if he was before he was, you know, diabetic, and then you kind of hit the tipping point. It's like, well, now it's been longer. And then you kind of just stopped counting, because it's just life. Yeah, like, I don't really remember a time before. I don't mourn that. Like, I don't think about when he was two and not diabetic. I don't really think about it. It just is Yeah, I

Scott Benner 3:43
think I find that to be a feeling that, um, that wanes over time. And it is very interesting to see how we measure time. It's always it's interesting how people do it. You know, it's, it's been twice as long, it's been the same amount of time. It's 50% off, like, who cares? You know? It's just a way to keep track, I guess. And and I think your point is, at some point, there's nothing to keep track of, but this is just what it is. I have that feeling a lot. That what's the feeling I have a lot I was just thinking about last night was on a long drive last night. And I was thinking about how all of this feels like such a big deal at some point. And then you realize it's not and how I wish you could take that feeling and give it to people who are more newly involved. You know, but I don't know. I don't know if you can.

Kristina 4:33
Yeah, we might get there because I'll this will lead to why I came on but we have a new doctor now. And he actually kind of said to me, like, you know how old Clayton he's nine. Okay, he's like, Well, you know, you don't really have much more time with him like doing it. And I like that like shocked and I'm thinking like, this is my life like this is all I do kind of you know, like, What do you mean? Like what I'm doing is such a small fragment than what he's going to be doing is all of It's kind of like not doing what I'm doing is not important. But you know, like, I view it is so much bigger. I guess in reality what it will be?

Scott Benner 5:10
Well, first of all, it was the kid going to college when he's 12. What are we talking about? It seems like not to not to just make fun of what we just talked about. But it seems like he's been alive for nine years, and you have 100% of that time left before he becomes a teenager. So your entire experience has to happen again. And then that part will happen. But I'll share with you that very recently, were doing something privately, that led someone who I don't really know, you know, who's just helping with, I don't know, like a personal thing. And they said, Well, how do you envision your retirement? And I said, I don't know how to answer the question. Like, it took me completely by surprise. And so I think the guy just felt that I didn't have an answer and let it go. And then we spoke a couple of weeks later. And he says the same thing again, you know, I guess we're gonna have to figure out how you envision the end of, you know, your working life. And I really thought about and I told him, I said, I have to be honest with you. That question has now made me sad twice. And he said, I don't mean to make you sad. And I said, No, no, no, not sad like that. sad, because I don't know the answer. Because when I think about myself, I just think of myself, this is gonna sound sad. No, it is, I guess. I think of myself as a tool that makes money and comfort for the people I care about. And I don't know what I would do if I didn't have to do those things anymore. Yeah, I can't even imagine like, I can't like when you say to me, like, what would you do? Scott, if you had a week off? I don't even know how to consider that. And there's something I mean, wrong with that. But at the same time, you know what he's told me. That's what everybody says. So yeah, yeah, didn't feel too special. Luckily, hopefully, we'll figure it out along the way. And I won't just sit around like watching television going, I used to have a podcast.

Kristina 7:11
Well, sometimes people's heart you know, hobbies become their work. And then they, you know, do that work for their whole life. And then they don't really have a hobby after work, right? We actually joke about this with my dad, like, he formed his own company. It's older than I am, like, we kind of joke. It's like, what would he do? Like he goes to his work on the weekends? Like he just, I don't think he knows what to do. What is free time, you know, kind of a thing. So yeah, kind of just think helpless to work.

Scott Benner 7:38
I think I've said this on here before, but the day, the evening, we dropped coal off at college when he was a freshman. When we got home, the girls went to sleep. It was a long day. And I did the laundry, the coal left behind? Because I just didn't like, I didn't know what to do. You know. So I would like to know what I like. But at the moment, I think the truth is, I like making this podcast, I like helping people. And I'm very, like, fulfilled and happy doing this. So I maybe it just is an indication that I'm so happy. I I don't want to imagine something else at the moment. But I would like to sit on a beach for a couple of days. But that's not a whole life, right? Or is it? Can I just sit on a beach forever? Probably not.

Kristina 8:25
If you move somewhere where warm and sunny?

Scott Benner 8:28
Do you think I could just look at me, I'm putting you in charge of my life. Now. We know each other tangentially Christina, go ahead and you decide. Do you think I could just keep making this podcast but probably not put it out as frequently as I do. Now, as I get older and older, I could probably do that.

Kristina 8:45
You probably could. And I'm gonna be honest with you, Scott, like, I kind of don't listen anymore. To no fault of the amazing podcast, but I think you've said this before is like, Yeah, this isn't what people in Facebook groups, you know, you come when you're newer, and you have a question and you're kind of more active and then you kind of just let it be in the background. And it's just kind of, you know, there you see things go by maybe you put some input in here or there for the podcast anyway, for me. I live in California, so I used to have a pretty bad commute into the city. And so that is where I spent a lot of my time listening. And then over time, you know, other interests come into play or whatnot. And actually now working from home I just don't really have time to like podcasts. I don't really listen much anymore.

Scott Benner 9:30
No, no, I completely I completely understand it would be absolutely maniacal and insane to think that everybody is listening to every episode forever and ever. That would be crazy.

Kristina 9:42
I was very much in order. So I had you know, gone one to whatever, you know, say 200 And then it's I felt like I got so far behind like but I know I want to go back. I don't want to just pick up at number 400 on whatever.

Scott Benner 9:53
Can you maybe, maybe just start with a couple of months and start with the new ones. I'm actually much better at it. No, I think I don't know. Who knows, we might get to the end of this. And you'd be like, you're actually not better at this at all. Who knows what? Well, you've been on the show in the past. Am I right to say that?

Kristina 10:12
Yeah, I think it was back like 120 something. Yeah. Do you remember? We were like two years in two years in at that point.

Scott Benner 10:20
Do you remember the title of the episode by any chance?

Kristina 10:23
The normal floor?

Scott Benner 10:25
Oh, I remember saying that. Oh, yeah, Episode 127 2017. i Isn't that interesting? I listen, that's episode 127. I'm about to put out episode like 670 something. Okay. That's amazing, please. So my point is, is that I don't have complete recollection of everything. But I feel like I remember that you were in an institution somewhere, and you got moved to a floor. And it was kind of I Am I about right. And that was the That's right.

Kristina 10:55
Yeah, I will, because I think we're gonna pick you. And then we got moved from the PICU to like, the normal, I don't know, the normal floor. And then I don't know what it's called. You know, that's where that was, you know, during diagnosis anyway.

Scott Benner 11:05
So you refer to it as the normal floor. And that amused me. And that's how it ended up being the episode title. Yes. I have a system. That's amazing. Okay, so what made you want to come back on?

Kristina 11:19
So I had, you know, posted, you know, in a moment of frustration and irritation to the group that our doctor was essentially firing us. And that, you know, I just wanted to express irritation in that. And then it was like, Oh, this would be a good episode. Because I think, you know, I don't think that happens very often. Maybe more. So we would fire our endo and not really the opposite way. But that is what happened to us.

Scott Benner 11:48
I wish people understood how my brain works. I'm all lit up inside. Now. I'm like, Oh, this is an episode. I love it. Okay, so why don't we do a little bit of backstory, and then we'll move you up into it? So let's just get people like, like, in line, your son, right? Type one. Yeah. And how old was he when he was diagnosed?

Kristina 12:07
So Clayton was diagnosed when he was two and a half? And

Scott Benner 12:10
I will say, No, he is 992 and a half. I know you're like, Scott, we just did this whole thing with the math and 918. My nine is doing more, Christina cut me a break. He's nine now. Any technology?

Kristina 12:25
So yes, he's on Dexcom. And on the pod and we use an algorithm based system that rhymes with hoop?

Scott Benner 12:33
Or is it a is it a problem? This? I don't know?

Kristina 12:37
I wasn't sure loop. Yes, we're loopers we have been for the last couple of years.

Scott Benner 12:41
Okay, DIY loop? And how are things generally going?

Kristina 12:49
are good. I mean, I still feel like I'm like, kind of learning never really 100% getting it, you know, things are amazing for like, three days where I think, wow, these are the settings they should be and then not so much. So, you know, schools, tools, challenging, I feel like, you know, I feel like they're active more than they sit in a desk. And you know, in theory, that's wonderful for kids, I want kids to be active. But for a diabetic mother, it's or for a mom, that's taking care of the diabetes and makes it very challenging. When you have like, you know, recess, pe recess and like all in a row. Anyway, so it makes it kind of complicated. Of

Scott Benner 13:27
course it does. But so it's funny, I think I think of the podcast as, as a pathway to diabetes, success, and comfort and ease. And so when you say to me, I don't listen anymore, in my mind, that puts your a one C at five, five, and you never think about diabetes. But that's obviously not true. That's just the thing that I put on what you said. So first of all, are you comfortable sharing a onesies and things like that?

Kristina 13:54
Yeah, of course. So since about, I actually had to look this up, because we've been actually in the sixes for so long that I don't even remember really, when that was that that started, but it was about mid 2017, we kind of like broke into the sixes. And we're kind of saying to like mid to high sixes and I was just really wanting to break lower than that. And I feel like lupus kind of what helped us kind of get there that was about that time. So we kind of went from the mid to high sixes to the you know, mid to low sixes in around 2019 and have been there ever since.

Scott Benner 14:29
You ride between six and six and a half ish in that space.

Kristina 14:33
Yeah, and we even had some low some high fives so we kind of broke into that. But this goes into where our doctor was not really in line with what I was doing. So

Scott Benner 14:42
Christina, don't give it all away at once for only 15 minutes. All right, we'd like people to listen and enjoy the conversation allowed to build on our end so that maybe we can find other topics and ideas. conversational. Don't just throw it all out at once. You don't. You don't come into the room like can just be like I'm here. Let's do it. Write a bit of a dance first, let's do the dance. Well, so obviously, that's successful no matter how you cut it, honestly, going all the way back to 2017, you're you're doing really well. I understand the frustration of being in the high six isn't thinking I just want a little more out of this. What about an algorithm got you mid to high six to low to mid sex?

Kristina 15:24
I think where you gain a lot is there, the overnight the sleep time, we don't know when no one's eating. It's wonderful. Right? So I think that that's kind of what helped it helps with the sleep and just you know, all that an algorithm based system can kind of provide and I feel like that's where we noticed that the most. It seems as though because he's still small, he kind of seems between a Basal rate, you know, so I don't know, sometimes he's got that negative Basal when he wakes up, sometimes not so much just like, well, was that food related? Where why he's waking up with positive basil? Is it like no pod? And then or why is it negative? Is it just the settings are too aggressive? And it can't take it away fast enough? You know, you kind of go back and forth. What's the way? 60 pounds?

Scott Benner 16:12
What's his Basal rate? Do you have to have a lot of them? Or do you just have one?

Kristina 16:17
No, I had one. I think we're at point three right now.

Scott Benner 16:22
Okay, that seems low for his weight.

Kristina 16:25
Yeah, I've heard I actually I saw I have listened to a recent podcast where you were talking about oh, X amount of

Scott Benner 16:31
fire. So is his insulin sensitivity? More aggressive?

Kristina 16:41
It's higher, I would say. All right, we have like a higher number like 180, something like that higher

Scott Benner 16:47
numbers are less aggressive.

Kristina 16:49
Okay, okay. I don't like that about Oh, listen, if

Scott Benner 16:53
you kept listening to the podcast, you would have heard me go crazy about it for a number of episodes like 300 episodes ago, where I was like, Who is the genius that decided that more aggressive was a lower number? I mean, come on. And then math people are like, it's obvious if you understand math. And I'm like, Well, if I understood math, I wouldn't have this damn podcast. What I so I guess I would just do the math for the diabetes. Maybe that would work. So okay, so interesting. And he doesn't, he doesn't get low.

Kristina 17:21
No, he gets low more often. That's the problem. And this is part of, well, if he would let me talk about the doctor. Anyway.

Scott Benner 17:30
So tell me a little bit about that for a second. So he when he gets low, when what time of day, does it normally happen? And what are we calling him? Well.

Kristina 17:39
So it's a kind of a two part if you're like separating the day in two parts, you know, like daytime at school, because school is the majority of the week, you know, we kind of can have lows. Let's see. So he's eating breakfast around like 777 30. And then he might go low, about three between three and four hours later, which is like also in conjunction with like a recess time. So it's hard to say it's like, well, is that breakfast too aggressive? And it's just kidding, the tail end of that insolence still working Is it because he's running around? You know, who knows I'm not there right? Is that That's why school is a little tricky. Do

Scott Benner 18:19
you see the loop being more aggressive in the morning with this Basal taken away or how does it work?

Kristina 18:31
Not necessarily, sometimes it's the so you know, you'll just breakfast and then it might hit the you know, it might hit a spike because it's starting to rise. So it wants to give more insulin. And then sometimes that might cause the low which is I think why we put the sensitivity up higher to kind of make it not be so aggressive.

Scott Benner 18:52
Which version of the of the loop are you using? Is it auto Bolus? Or is the or it is

Kristina 18:57
yes, we are on auto Bolus. That's kind of some low that can happen in almost we can sometimes get a repeat low although I do set remote overrides from home like a higher target so that we can avoid that. Sometimes he might get a secondary one. And then I would say another low that kind of can happen if we get it overnight, it's going to be because maybe I missed the mark on dinner or that's just you know, he's active he's nine so sometimes he eats dinner and it's like I'm gonna go shoot baskets it's like well that's great because then he can make himself you know essentially go low before bed or then almost right after he goes to sleep.

Scott Benner 19:36
Yeah. So do most time do most of the lows you see revolve around activity

Well, there's no way around it. If you have diabetes, you need stuff. He the insulin pumps and continuous glucose monitors and test strips stuff. And you might just won't get your stuff from somewhere who's not going to mess around. You know what I mean? If you order your stuff from other places, you might know what I'm talking about. You may have headaches and horrible memories of phone calls and yelling at people but you don't need to do that. You could check out us med instead. Us med.com Ford slash juice box or call 888-721-1514. Why would you do this? Well, how about to get hooked up with us med who has an A plus rating with the Better Business Bureau accepts Medicare nationwide and over 800 private insurers. Plus they carry everything from your insulin pumps and diabetes testing supplies to the latest and CGM is like the FreeStyle Libre three, and the Dexcom G six, better service and better cares what you get from us med. But you also get 90 days worth of supplies. And fast and free shipping every time. Over 1 million people have trusted us med since 1996. And you could be one of them. 888-721-1514 Or go to us med.com forward slash juice box, call the number or hit the link to get your free benefits check. And to get started with that white glove treatment from us met. That was in one take. I'm so proud of myself, there's no edits in there, I'm going to try to roll into the Dexcom ad without stopping. I gotta be honest with you, I don't know if I can do it or not dexcom.com Ford slash juicebox. Now, here's the first thing I'm gonna tell you, you may be eligible for a free 10 day trial of the Dexcom GS six and you can visit my link to find out more about that. Why would you want to do that? Because the Dexcom GS six makes knowledge your superpower, being able to see the blood sugar of your child or yourself in real time. Is it rising or falling? How fast is it moving and what's the number all of that right on your receiver or your Apple phone or your Android phone? Damn Apple phones are called iPhones. Alright, I'm just gonna keep going Dexcom G six says, see your glucose readings right on your smart device. Customize your alerts and alarms, and zero finger sticks. Read more about zero finger sticks at my link dexcom.com forward slash juice box you can share your data with up to 10 followers there Siri, you can actually like ask Siri to read your glucose numbers to you. And it's indicated for children two years and above, not just children two years above people two years and above. So take the next step with Dexcom. Head to my link, fill out the form. Get started today you want to see your numbers, you want to see them in real time. And you want to be able to see how fast they're moving. And where they're at. Trust me that information is at the base. It is the absolute start of how you will make great decisions with carbohydrates and insulin dexcom.com forward slash juice box us med.com forward slash juice box links in the show notes of the podcast player you're listening now. Or links at juicebox podcast.com. To touch by type one US med Dexcom and all of the sponsors. When you click on my links, you're supporting the production of the podcast and keeping it free. So I really appreciate it when you do that. I'm not telling you to buy something you don't want but I mean if you're getting a Dexcom hit my leg you know what I mean? Thanks

it's unplanned activity it's just something that pops

Kristina 23:49
up. Yeah. But not like when the neighbor got a trampoline. That was real fun.

Scott Benner 23:54
I would have I would have made a move. I would have said Do you cannot put the trampoline here next to my house please. What are you doing? Did you tell him did you go over and be like listen,

Kristina 24:02
it's his best friend. So no, I can't Oh my god.

Scott Benner 24:05
I'd rather have a handgun range out back than that a trampoline seems seems less dangerous than me for my children to be involved in. Well, that's thanks I mean it's very it's not not uncommon obviously for for that and you can't I mean if you could plan for it then you could do like an override on loop. Of course take it back but how do you plan for it? Right it's

Kristina 24:27
you try to be as much proactive instead of reactive but I feel like sometimes with his age and then just what's going on you kind of just have to the nurse at school is really amazing and she knows him and she's been with him ever since kindergarten. So she kind of like understand how he how he runs and kind of can anticipate with me as well so you know that's that's nice.

Scott Benner 24:47
Okay, ask you away from being away from food away from activity away from active boluses Where does his blood sugar sit stable up?

Kristina 24:59
Well, Scott, he's not So he's constantly wanting to eat. When is this time you speak?

Scott Benner 25:03
Yes. I think it's 230 in the morning, where's what's his blood sugar 230 In the morning,

Kristina 25:08
I would say it's sub 100. Okay, we'll float between like 100 it can almost get down to like the low 70s. And then it might like bump back up. It will take away basil for so much. And sometimes it causes it to, you know, makes it rise, but sometimes it rises. Sounds like too much like it, then it he gets, you might get up to 120 in the mic go back down. So he kind of like floats around. It depends. I would say not every not every day is the same, which is

Scott Benner 25:37
I'm trying to figure out. I'm trying to figure out why. You're seeing a six mid six a one, see when you're putting this much kind of focus and effort on it and add stability. He's got stability in sub 100. So that that that's interesting to me, are you correcting a lot of lows with food maybe and then not really addressing it? Or something like that?

Kristina 26:00
Are you this, I would say food spikes. We do Pre-Bolus. At school, it's hard to Pre-Bolus because he has a recess right before lunch. And I just don't feel comfortable. Like if you were home, I would be sitting watching. I don't know, it's school, if they're five minutes late to the lunchroom, if we do find if his blood sugar is in a good spot, and it doesn't look like he has a lot of insulin on board. And you know, things are looking the prediction. You know, wine is looking. Okay. We will do a five minute Pre-Bolus for school lunch. Okay, and that is a lunch AIPAC.

Scott Benner 26:40
And then you see a spike with that? Yeah, we do. We could put a number on the spike for me.

Kristina 26:47
Um, he could probably get close to 200. Interesting. And then it kind of wants to stay and then sometimes it will crash because then you have another recess that happens in the afternoon. Or if it doesn't, by the time he's done with school, he walks home and then you know, it's like, almost low, and then he's got to eat give any as to eat because it's like, say coming down below 80. And then you can't Pre-Bolus That snack, right? Because then he's eating?

Scott Benner 27:17
Yeah, well, then you shouldn't get that roller coaster. You shouldn't have to Pre-Bolus that snack. You should be able to Bolus and eat on that snack. The

Kristina 27:25
spikes, it still spikes. Well, then, maybe because the quality of what he's eating,

Scott Benner 27:29
then, Christina, then why can't you Pre-Bolus it? Because he'll get low first.

Kristina 27:37
Walk Home always makes them go low.

Scott Benner 27:39
Okay, but I'm saying if he gets home at 80 stays at diagonal down. Yeah, and you know, he needs food. Yes. What? Why? Why can't you Pre-Bolus A few minutes before he eats? Because he's at work because you're not there with him.

Kristina 27:54
No, I am there with him. I guess we just get I normally just dose it and then get it ready and then eat. So I guess it is a few minutes. But you know, normally at that time he wants like, I don't know, chips and an apple or whatever he's eating. I think it just the food type is just I commit I do. Okay, so Luke, normally doesn't want to dose that. But I normally will override what is the suspend, and I'll put it at like 65 really quick so I can get their recommendation and then dose that amount. And then I'll switch it back and put it back into where what it normally is like 82,

Scott Benner 28:34
or whatever it normally is. I think we actually suspend it 65 No matter what. And if I was in that position at diagonal down about the chips or an apple, I would just tell her, like put in however many carbs it is let's just pretend it's 30. And then she'll say it doesn't want to give anything and I'll tell her Bolus anyway. Yeah, you know, so sometimes you have to think for the algorithm in that scenario, but

Kristina 29:00
I'm wondering if I should like over do what it's even recommended. Or

Scott Benner 29:04
you could do that which is you could not not Pre-Bolus at all but over Bolus. Have you heard the defining diabetes episode about over bolusing? No, because you stop listening to the podcast. Christina whatever. Okay. I mean, it feels like we're on here to talk about a bunch of things that don't need to be a problem but just you stopped commuting. Is that what's going

Kristina 29:29
you know, I really didn't like during our Nafi choice that oh, there's I might have to do it again. Yeah,

Scott Benner 29:34
get back in the car and just drive around during the day. I don't do you not vacuum or do a dish or something you could listen Christina Are you a kept woman? Okay. Is there no vacuuming? What's going on? Are you just are you just is it 1950 Are you bond bonding with your hair up and paper curlers waiting to make a make a gimlet for somebody at four o'clock? What's going on over

Kristina 29:55
there? Definitely not that is not happening.

Scott Benner 29:59
No one Everyone's bought me a drink. I just want to be clear about that. If it happened one time, I would think my mom was dead or I had cancer, and I was the only one that didn't know it. I was like, why are people being guided to me? Okay, so, so we have our answer, right? Your six and a half a one C comes from not not getting the timing right meals often enough. Yeah, exactly. So you wouldn't going

Kristina 30:25
backwards to school time. Like I said, if we get that, say one low, and then it almost does like it wants to head into a repeat low that always is in conjunction with lunch, so it won't recommend anything. But like I said, the nurses great. I just have to pick an amount. So I'll be like, Just give him a unit and a half or give him whatever. And so maybe it's just my estimate is not good enough, you know, or I'm just so conservative because he's at school that I'm like, just scared to like,

Scott Benner 30:52
I mean, that's what it sounds nice. And then I'm like, Yeah, that's what it sounds like to me as a as a, you know, a dispassionate onlooker, it seems like you're being overly careful at school trying to avoid lows. But then you're making a lot

Kristina 31:05
like the PTSD from all of this school Doctor issues. I feel like we thought

Scott Benner 31:09
so. Interesting. If I may act as your therapist for one second, then we'll move on. Okay. You're trying to avoid a low at mealtime. And instead creating a spike that later turns into a low? Yes. So are you avoiding lows?

Kristina 31:30
While I'm trying to put our you know, I'm not alright.

Scott Benner 31:35
So instead of preparing for failure, I would plan for success. Does that make sense? Yes. All right. That's it. We're done. Let's get off. No, no, I'm just kidding. All right. So what the hell happened? You went to the doctor and you got yelled at this is my this is the whole thing. You are so serious. Your your doctor told you out and see you're done. You can't be a patient here anymore.

Kristina 31:57
No, she couldn't really say it because I don't think she was like, you know, aggressive enough. But I kind of had to be like, is this what you mean? And we kind of both looked at each other like, okay, and then no one came in to make the next appointment?

Scott Benner 32:10
So she broke up with you? Yes, pretty much by treating you poorly and hoping you would go away.

Kristina 32:18
She just didn't agree with the amount of lows we were having. Okay. And unfortunately, yeah,

Scott Benner 32:23
what are we calling Allah? What was she calling well?

Kristina 32:28
Below 70?

Scott Benner 32:30
What are you calling low?

Kristina 32:33
That's below 70. It was all about the Dexcom data, to be honest. So Dexcom you know this, that when Dexcom works, it works great. Unfortunately, when it doesn't work, especially in an algorithm based system, it's like, crap, shoot, you know what I mean? Like? I don't for Clayton.

Scott Benner 32:53
Hold on. I don't I don't know what you mean. Are you talking about like maybe compression lows or first day of a sensor?

Kristina 32:57
What is above all of the above? So for Clayton? Clayton, the first day of a sensor is super, super jumpy, like where it will think it's, you know, 110. And all of a sudden, oh, no, it's 130. And so loop will dose off of that, and then make him go low. And it just, it's it can't correct fast enough. So actually, this last sensor, I opened loop. And it was amazing. And I was like, Wow, maybe I need to do this for every sensor. So that is maybe what I'm going to be doing going forward to try something new to see if we can help that first 24 to 36 hours.

Scott Benner 33:33
So let me make sure I understand. On the first day of a sensor, you get kind of wonky jump around numbers. By the way, I might just calibrate it. And had you listen to the episode about when to calibrate a Dexcom sensor, you might know what I'm talking about. But since you didn't listen to it, you don't know what I'm talking about. But I'll put that episode number in here for you at the end. But Christina, I appreciate you telling me earlier about the listening thing because now I can teach you incessantly. So I might just calibrate it. And as some people will be like, Oh, you're not supposed to like I don't care. There's a whole episode about it. Go listen to it. It's got a ton of different opinions in there, including mine, Jenny's. And literally like dozens from people in the Facebook group. Everybody sent in their kind of best practices, we put it into one episode. Anyway, so you're saying that he jumps around? Meaning is that, you know, suddenly the algorithm might think he's 140 and give a Bolus Now meanwhile, it's only giving us 60% Bolus, right? Well, it's up how you have yours. Yeah, right. And then that makes him low. And instead of your doctor looking at that and saying, Oh, that's a limitation of the technology. They're blaming you.

Kristina 34:44
Yeah, I just don't although she was supportive of loop and fine with us doing it. I don't think she had enough knowledge. And to her credit, I don't expect every doctrine to know all of the things you know, but I think that she wasn't able to she didn't know the system enough to be able to then give any advice I used to help.

Scott Benner 35:01
Christina, how much do you need to know about something to know that it's an auto Bolus? And when it sees a number it boluses. I mean, it's not like you, you weren't getting her to like, she didn't have to learn a new language did she? Like, you know, she wasn't trying to pick up like 600 year old Yiddish or something like that, right? Like she, she's just trying to understand a slightly different way that this algorithm works. I'm saying, I think you're protecting her, this feels like a breakup where you're still protecting the person who did something wrong. This is fun. So it tells me Tell me, like, take me through that, that, that entire visit to the doctor, how did it go?

Kristina 35:43
So that particular visit, or just like our experience in general,

Scott Benner 35:46
with, yeah, let's start high level, and then we'll go into that one specifically. Good idea.

Kristina 35:52
So I can go back to the beginning.

Scott Benner 35:54
Yeah, go to the beginning, we're all good.

Kristina 35:56
So to be honest, I actually didn't pick this Docker. So when we were diagnosed, and, you know, we went to clinic with the actual doctor that was like, in the hospital with us. So I had, like, you know, good feelings towards that person. And then they moved on to Yale, because, you know, they went to go do great things. We moved to a location that was much closer to home, because the other spot was like, over an hour away. So we're now we're going to, you know, still within Stanford, and you know, just someone that's nearby. Okay, great. So I think for the beginning portion, it was very much like, you guys are doing great, you obviously know diabetes better than you know, you know, your own diabetes better than we would, which is, I think, sometimes can be a common thought with doctors, which is like, obvious, we're living with it day in and day out. And you're just seeing, you know, the numbers here and there. So, I felt like we had that support. And then when we started looping, the I think there was a, although she wasn't as familiar with it, the doctor, there was a CD that I think her daughter was living, so she was familiar with it. So they understood kind of, you know, she understood what we were kind of doing. And so there was that support that it was like it was fine. You know, like, it's not like I had a doctor that was saying, Oh, we don't support loop, like I'm not giving you a prescription, it wasn't like that. But, you know, we would come in, and they would look at our Dexcom clarity, and they wouldn't download our meter. And I'm actually really good at doing finger sticks. Because going back to the Dexcom, we actually stopped using the Dexcom. Code. And we started doing daily finger stick calibrations, because I have felt that those finger sticks help the Dexcom work better for Clayton than using the code does. So we do do finger sticks quite frequently. And going back to the Dexcom. Unfortunately, he just does get a lot of compression lows, we get a lot of like, second or third day, low night trends, where he will just be low ello W for three hours until it can kind of move itself out of its way. And the sensor really only lasts for him about six or seven days. And I have to pull him

Scott Benner 38:03
when you just test during those ello ws he's not actually low.

Kristina 38:07
Now. So this is where I go to where the doctors using data. That's not really true in you know, you're getting, say a nine or 10% low on your report. But I'm like, You're not even checking my finger six, but I'm really you know, we're not showing, you know, so

Scott Benner 38:27
I don't understand that at all. So you're clear with the person about this. Also, you're not a crazy person, right? You seem like a reasonable human being. And so they're treating you like you're lying where you're making it up or I don't understand, like, why would they not just believe you?

Kristina 38:43
Yeah, I think just not wanting to go that extra step or like, I mean, there was even times where she's like, Well, what about 2:50am? Like, what was his blood sugar? I'm thinking, Well, if you downloaded the meter that I brought gave to you, you would see So I'm sitting there going scrolling back. No, he was 78 or no he was whatever she would give me like pamphlets of like, why it's better to have your blood sugar in the sevens, it's more safe to not be hypo unaware and all these things I'm like, This is my goal is to get him in the fives like so we're not like talking the same language here,

Scott Benner 39:13
right? Is she just an ass cover? Or she just because I get listen, I get some ask covering statements made to me, you know, once in a while. And it's always around a low. Like, they'll look at a low index card or this is too low. It's dangerous. And I say and that looks like a compression load to me. I don't think that's real. I don't remember anything like that, you know, around insulin or food at that time. I think that's just an anomaly. And our RCD goes, no problem, great, but they still say it. Like Like they say it as if they have to say you don't I mean, and but mine takes my takes what I say at face value and moves on where it sounds like yours was just sort of like, here's a pamphlet, stop doing that.

Kristina 40:00
Yeah, I think she really just believed what, you know, she thought to be true, you know, cut and what I was saying was too dangerous. And you're, you know, like, a line, that's not good kind of a thing, and you're only getting your agency because he's too low. And I'm saying, but the data is not like, what you're looking at is not true. And she like what your ad wants us to close to that. So I, you know, I don't know, we kind of would just leave every time being like, okay, and this was the thing is, I wasn't against any advice. I wasn't coming there saying, Please help me, right. But I wasn't fighting against anything. And her only advice she could give was just make everything higher. And I said, well, but you might reduce the lows by making things higher, but then you're taking away all my good numbers that are in the middle, and you're making them higher, and then you're just making my highs really high. So I don't think that that's really sound advice. Like, I feel like we need to tackle these certain times that I'm struggling with or that I'm telling you, school is really hard for me, it's really hard for me to figure out his schedule, and not really,

Scott Benner 41:06
and you're saying please help me with this. You're saying please help me with this? And their answer is, we'll just put the kids a one c into the sevens and none of this will be a problem. Yeah, yeah. I tell you something, Christina. And people with seven agencies get low too. That's not it's not a full thing. Well, so it sounds like to have two different perspectives. Right? And obviously, you step back like adults, and you said, Alright, look, get your clothes that televisions yours. Right? The dressers mine, everybody get out? We're going to start over again. But no, it went right to Silent treatments and bad communication. This is the part I'm dying to know about. Tell me about the moment when she broke up with you.

Kristina 41:50
It was a while ago, so I I probably had more fire and like, I remember it better back then when I had originally.

Scott Benner 41:58
To get y'all stoked up to me like can get you excited. If you want like cheap, mistreated you and she doesn't care about your kids health, I can get you upset if you need me.

Kristina 42:07
No, I think she I think she was just more like, well, if you continue on this path, I can't really you know, help you with what you need or like your prescriptions, you know, like sort of just like it was a very roundabout way. And I kind of like, understood what she meant. And I was like, so if I'm not getting in the numbers that you are wanting, you're not gonna want to see him anymore. Is that what I'm getting at? And so it was kind of just, she wasn't really saying it. And I was trying to feed off of what she meant. But I did I did straight up tell her I said, You know what, I don't think you would be happy with a five a one c and if he had zero lows, and she said, No, I wouldn't like she so it's so then that shows me that wasn't always about just the lows. It was that she just didn't want his a one C in a five or a six.

Scott Benner 42:53
I don't want to be in who but she's foolish. That's what you're telling me? Right? Like she she had something she wanted? And she was trying to push you towards it. Yeah, yeah. And would make up excuses along the way about why you shouldn't be where you are. What she really means is, I want this kids a onesie in the sevens. And you fought back. Christina, did you guys have sex one last time? That happens? We did not know. Because sometimes during breakups that happens. You know what I mean? You're like super mad at each other. You're like, let's just do it one more time. Christina, are you laughing? Because that's happened to you? Or because?

Kristina 43:32
No, I'm not. Okay. All right.

Scott Benner 43:35
Just you're afraid somebody you know, is gonna listen to this. I hear what's going on. Okay. Okay, so was I'm

Kristina 43:42
sorry, it wasn't like this more of like a fight and whatnot. But it was, you know,

Scott Benner 43:46
some hair pulling to this. Can you imagine if the two of you were like, shaking each. Anyway, so, so seriously, though, she left the room. And then the port, the part where someone comes in to schedule you for your next one just didn't happen?

Kristina 44:03
Yeah. And it will she had said to me, why don't you take some time to think about, you know, maybe to see if I can make any changes towards what she wanted.

Scott Benner 44:13
We need time apart. She told you.

Kristina 44:16
You know, what the, the sad thing is, though, is that I kind of was upset about it. And I did kind of, I did kind of concede, and I like kind of raised things higher to like, kind of see, well, is she kind of right? Like, should I be? Am I being too aggressive? Like, am I you kind of put on yourself and I spend so much of my time trying to make things right. And it's like, this is so much of my life and like what I do, I'm trying to do the best for him and like, you know, and what you that resulted in is us getting a 6.6 a one C the last time and so it's like, no, no, I'm gonna go back and do what I think I need to do and I'll try to fine tune it. Figure it out. The school year is almost over. I'm sure I'll figure it out by the last day of school and then we'll have a new schedule next year.

Scott Benner 45:00
Right. For next year, his his recess won't be at the same time or something like where he'll weigh 10 pounds more, etc, etc, etc. Right? Like, something's going to change, I'll tell you, that's my biggest takeaway from raising a kid from two to 18. So far with diabetes, is that anything you think of is this massive problem is just going to change go away or something? You know what I mean? Like, like in six months, so it's, it's not even worth being upset about it. I mean, you just sometimes there's, I don't know, it's like choppy water in a boat, you just sometimes you just have to get through it. And then it comes down again, on the other side, you can't make the world stop waves, right. But you can get through it as best you can, and then move on. And it would have been nice if she said something like, Hey, let me try to help you get through these bad recess times or whatever. I see your goals. They're healthy goals. And I'm going to try to help you with the part you need help with. You keep doing the part you're doing great with. And this, this too shall pass and we'll move on, but instead, not nice. Can I ask you? This is based on my episode I did with Arden, which you probably didn't hear

Kristina 46:08
that what I was very curious to hear. And I'm wondering when she's coming back, and I see everyone post about her like, I know she did. Like it's not her favorite thing.

Scott Benner 46:16
It's common sense. Don't worry. I'm gonna get her again. Did this doctor have high cheekbones? Was she blonde?

Kristina 46:25
No, no,

Scott Benner 46:26
these are reasons why Arden would dislike her immediately. Did you hear Arden to say that about the cheekbones? No, I don't recall that. Like I don't trust people with high cheekbones. Why? She's? Yeah, she's got like a whole reason. But you know, anyway. And if you have high cheekbones, I'm sure you are probably very trustworthy. And please don't write me an email that your cheekbones have nothing to do with your personality. But so you did step back that you did the adult thing you listened. And you thought, Okay, let me take some constructive criticism here and see if she's right. And it just wasn't right for you? No. All right. So now you see. Who do you go to for an endocrinologist? How did you find somebody who would be more amenable?

Kristina 47:15
So I had kind of, you know, reached out like, Oh, my God, what are we gonna do? We're gonna go because the other doctor that's in that same office, I had actually seen one time, and I wasn't really fond of. So I knew I didn't want to go back there. But I was also thinking, I don't want to drive really far again. So there are, you know, a few diabetics in the community who like Vin, the city I live in. And so I kind of reached out in text, like, Who do you go to what do you all the things and so someone had recommended to me a doctor that unfortunately was far away for another hour or so. But that is diabetic himself. And that loops. I'm like, Well, that just is who I'm going to see. Because that sounds like the dream. And yeah, that's what I need to do. And so he actually only does telehealth, which I mean, now in this day and age, I guess, you know, okay, that's fine. So we have only met with him one time back in January. And he pretty much didn't care about the other doctor. I said, Hey, you know, like, he saw the the decks calm. He's like, I don't even care about your loads, like so it was like such a different, like, Okay, wow. So, like you were home, find a doctor that tells you what you want to hear. But it was nice to get a different perspective. Maybe that like you? No,

Scott Benner 48:27
no, I got. I think that's terrific. Did you try juice box Doc's dot com. There's an extensive list of doctors who I have looked at

Kristina 48:35
that, you know, so don't think that I don't do anything on podcast related. And

Scott Benner 48:40
you're the one that said you were breaking up with me, I I'm still here every day trying to make you dinner and rub your feet and you're the one who's not sitting down on the sofa and put your feet up. I don't know what to tell you. So this is not my fault. This is a this is like a really bad breakup. I do think that's the episode title to bad breakup? Who knows? Did you find yourself ever? Hold on? I have two different questions. Let me ask this one before that one. Did you ever think oh my god, this is my fault. Like did you ever like slip into it and think maybe this person is right. Like, am I? Did you ever consider if you were difficult to I can't believe I'm using the word difficult. Like it's, I don't mean it like it's 1950. And you want to

Kristina 49:24
have no my husband would actually say that about me. Like you need to talk to people differently. Like you can't like just I just get really defensive. And like this is obviously something I care about. It's my son and I do spend a lot of time and she would essentially tell me like, well, it shouldn't take over this much of your life or, you know, I think she just wanted it to be cool. Maybe she didn't. But I think she presented that she wanted it to be easier for me that I shouldn't have to like, do so much. I'm like, This is my child and I want to do as much as I can for him. And I do have feelings of defeat when I can't figure things out. I think that that's natural.

Scott Benner 49:56
Maybe she was trying to protect you from those feelings. A little bit.

Kristina 50:00
I can't say that she was like, so concerned about my feelings. But I mean, I think as a general, I mean, she's not a horrible person. But I mean,

Scott Benner 50:07
and you're not coming on him. She's not like, like thinking like, Oh, I've got to help Christina, once she leaves here, no, right things are going sideways. Like she didn't have a feeling you were like sitting in the corner, rocking back and forth, like it like up against the wall or something like that.

Kristina 50:21
I think she was more concerned about, you know, like, safety and like, legal, like, I can't support this type of Governor.

Scott Benner 50:29
But I hear what you're saying. Yes, exactly. Well, now you have found somebody better. This is lovely. Yes. Excellent. And important, by the way, because far too many people are going to be treated in ways by doctors that are not in their best interest, it's going to be for reasons that you may often not even know about, you know, and you have to be able to kind of self diagnose the situation and have the nerve to walk away from it, or to stick up for yourself or whatever needs to be done. And also, by the way, you know, I could tell you, maybe Christina, there would have been a way you could have made this work, if you would have approached her differently. But I don't think yeah, I don't think that's fair to you. I don't think that every time you go to a doctor's appointment, you should have to be on your best behavior and wear something pretty, you don't mean like, like, and just go in there and charm her, like, You got to be able to roll in there and sweat pants and be like, Listen, I don't know why this is happening. Can you help me I need to get the hell out of here. Like, you shouldn't be in there charming people that shouldn't be necessary. I think

Kristina 51:33
I think it goes both ways. I mean, like, you know, maybe I didn't need her for more than, you know, just prescriptions. But like, when there was a question or a time when I was being a little bit more open with, like, letting someone come in, like, she wasn't able to really do that. And I needed to find someone that was you know, so sometimes it takes I guess those, you know, those relationships to end for them something new to come?

Scott Benner 51:55
Well, you know, what you're describing is just poor communication. Right? Like you came in, when you found yourself, allowing yourself to be vulnerable with her. She didn't hear you and take you at your word. She decided what was your problem, and then tried to fix it. He sure she wasn't a guy. Sorry, I didn't mean to throw guys under the bus there. But we do that a lot. So, you know, it's just interesting. She just didn't, she should have just taken you at face value and tried to meet you where you were, and help you with the situations you said you needed help with. And instead, she just decided I don't care what your problems are, we'll just change your problems to different problems that I'm more comfortable with. Or they can be someone else's problems, or will make them your son's problems and with no concern for the fact that you would have felt terrible, leaving his blood sugar higher. Their psychological impacts from it that he would have health impacts from it. This is all about making her comfortable. Yeah, yeah. And you're having trouble saying it's still even though it happened to you. Why do people do that? Why do we Why do we protect our our attacker sometimes? I don't know Scott Chrystia you didn't want to get this deep into this? See, I told you the podcast was different now. Am I better at it from your recollection?

Kristina 53:19
All right. You were great, then you're great now, right? That's

Scott Benner 53:21
that's the right answer. Good job. Any words of wisdom for people who are going through something similar?

Kristina 53:31
Oh, geez. I mean, I think you kind of just need to listen to yourself, right? I mean, I, I think I knew that. Like, you've been having the same conversations over and over and over again. I mean, we go three times a year. So you know, this wasn't anything new. I think there was just kind of a tipping point. And I guess I just thought I could figure it out on my own. And I wanted to prove it to her that like, look, I figured it out. Haha. And I guess that didn't happen for me. But

Scott Benner 53:59
that's not a healthy approach. Christina. Do you wonder listening to our conversation, your own mind? How many people are going to get divorced or break up after listening to this and be like, yeah, why am I putting up with that? Anyway, real relationships are more important to work on. To be clear, I don't want to give up so easily. Yeah, I don't want an email from somebody who was like, Hey, your podcast conversation about breaking up with your doctor led to the dissolving of my marriage. And now I live in an apartment above a pizza place. You know what I mean? So try harder and your personal relationships. Also, no lie. If this was a personal real, a real personal relationship, which obviously isn't She's a doctor, she feels like she holds some sort of sway over the situation. It's not a fair balanced, you know, relationship. But you could have just stepped back had a fight and said, Let's start over again. But you can't you can't do you can't have a knockdown drag out with your endocrinologist in the middle of a Wednesday. And then everybody go, okay, fair spare. You made some good points. I made some good points. Let's try again. You know, because that's all you needed was a resetting of the of your communication skills? Or maybe I'm being unfair, maybe she really was pushing you in a direction purposefully, but not being completely honest with you about it. So maybe not. Anyway, this is interesting. Did your husband blame you?

Kristina 55:23
I husband doesn't really do much with diabetes anymore. He can't really say anything.

Scott Benner 55:28
He lost his his ability to speak on the issue.

Kristina 55:33
I just don't think he he just doesn't do much anymore. So I don't feel he just he does what I say. Most things I'm like,

Scott Benner 55:41
look at you settling into a lovely married relationship. What do you married about 12 years? Yes. Did I get it exactly right. team this year? I'll tell you what, for anybody who thinks that I don't know people. You're 100%? Wrong. I did not know that before. Christina tell people right? Not at all. Yeah, I know how this stuff goes. Oh, my God, you're still having sex once in a while. Interesting. So interesting.

Kristina 56:06
I also did hear I don't know if it if it was on the Facebook group, or someone was talking about how you talked about that too much and more with the females than the males? And they were not happy about it.

Scott Benner 56:16
I know. And I don't agree. So if you were a guy, I wouldn't be talking about your relationship any differently. I think it's interesting. You brought that up? I think that I think that, in that specific situation, that person was an older woman. And I think it made her uncomfortable to hear a man and a woman talking about sex publicly. Yeah, that's what I think.

Kristina 56:43
But I just wanted you to know that I'm there. And I see things and so I don't want you to think I just came up on you

Scott Benner 56:48
for showing off that you're lurking in my Facebook group. Yep. Well, it's a weird flex, but I appreciate it. No, I listen, somebody actually came in and said, you know, Scott, like, overwhelmingly records with more women than men, right? Like, you know, I said, I've never seen him treat men or women differently. It was interesting. It was an interesting conversation, because I do think that in the end, that's what it was. That for some people, first of all, just saying sex out loud, in general is uncomfortable for some people. And, and that, then it's, I mean, think about it, like you're, you're a guest on the show, I have a like a big, deep voice. You know what I mean? We're talking back and forth. I'm being flippant about stuff like that. But the truth is, around 12 1314 years of being married, you're still having sex once in a while. And for those you haven't been married for 20, or 25 or 30 years, I know you're laughing and thinking, Oh, that'll never happen to me. But you're wrong. So there will be a day where Christina just walks in the room and goes, there's the guy that makes money and brings it home. And he'll look at you and go, that's the lady that does the laundry. And you'll be like, this is fine. That'll be that. And everybody can say, oh, it shouldn't be like that. But screw you. That's how it goes. So and for any of you out there who are having some magical relationship, and you're 65 years old, having sex every 35 Good for you. I'm happy. I'm happy for you. Anyway, I don't see about I can't think of anything I would talk about with you that I wouldn't talk about if this was your husband.

Kristina 58:24
Yeah, maybe just more women are reaching out. So to record and then also, maybe more women are taking care of you know, so that's not I mean, it's the audience. So

Scott Benner 58:37
what am I gonna do? Oh, excuse me. I'm not sure what happened there. Although I am sure what happened. This is the second time I've recorded today. So I've been talking way too much. Yeah, well, I'm glad you're comfortable with like, usually I asked this after the recording. But just for context here. Are you comfortable with what we've spoken about so far? You can feel free to say no, of course not. Yes. And if you weren't, I would hope you would tell me. And I will ask you after the recording ends, if you're uncomfortable with anything that we talked about, because I don't want you to be uncomfortable. And I don't want people to hear things that you don't want to hear them to hear. So, anyway, there's a part of the podcast that none of you hear that happens after it's over, where I double down and make sure everybody's okay, and we're not recording anymore. So we're not using big voices and excite you know, they mean, like, go make your own podcast, dammit, leave me alone. I'm sorry. It's not your fault. It's those fall. And actually, I didn't mind the woman bringing it up. I thought it was an interesting conversation. I think everything's an interesting conversation. So I don't think conversations just need to happen. Yeah, I don't know. I can't think of anything we shouldn't talk about. be perfectly honest. So every once in a while, I'm gonna say something that somebody doesn't like, and there's not a lot I can do about that. But what I have learned is that limiting myself makes a bad podcast and taking a risk that not everybody's going to like it. That's what makes a good one. You know, here I am. Alright, so this kid that you made that has diabetes, anything else going on with him? You got the celiac or the thyroid? Do you have anything like that any of it in your family? Husband? Extended? A unicorn? Just just the one? Alopecia? Nope, nothing? You have a bipolar uncle? Nope. Okay. That's all. I'm done. Okay. It's just a weird anomaly. How about you have other kids?

Kristina 1:00:30
I do, he has a younger sister, she's four and a half, nothing going on there. Nothing there. But I do think from time to time, you know, I'm really glad she's not the diabetic one.

Scott Benner 1:00:41
You see difficult.

Kristina 1:00:43
I just think that other years are quite, you know, interesting. She's super strong willed. So she doesn't really care if you're an adult, or a parent, like she just wants to do what she wants to do. And she thinks that that is fine. And she doesn't look to anyone for any sort of approval, or anything. So I think that because brother sometimes needs things, you know, a juice box, or gummies, or whatever, she then feels that she should get them. And I feel that though sometimes we can seem to that because they'll be fine. Yours too. I just fear that if she ever does become then we're gonna have a major problem with regulating things

Scott Benner 1:01:25
you should have let her deal with the doctor would have been terrific. If you just plop your four year old down in front of her and said, work it out with her, I'll be back in 10 minutes. She'd be like, no, no. Oh, my gosh, well, I hear what you're saying, look, I think everybody has who has multiple kids, I think it's pretty reasonable to look at their personalities and go, ooh, this would be easier with this one than that one, etc. And I'm sure there are plenty of people who in the reverse look at multiple children and think, Gosh, as crazy as it sounds, this would be way better. If it was, you know, Billy and not Veronica, you know, it's going to have a harder impact on her etc. For whatever reason, you know, what I mean? Like some people are, I mean, there are all levels of success that people are gonna have with diabetes, and a lot of it is attached to your personality and the way you attack problems. And that's not something that anyone thinks about early on in this stuff, that you have to be a head down, move forward, I can do this person. And if you are, this all goes a little easier. Get you know, if you're constantly in a position where you feel like things are happening to you, this isn't fair. This is my lot in life, I guess this is what I get, like that kind of attitude is, it's harder to get through this with for certain, I believe.

Kristina 1:02:44
I do want to say something that's kind of off track. But I think it's like a positive thing to tell people I think, littles with type one, it's just, it's harder, it's a special, like, niche group, you know, when they're that small, I think you feel like, you're never gonna get out of it, it's always going to be that hard. And, you know, they don't have the dexterity to be able to punch in the numbers correctly. Or maybe they can't read and they can't, you know, text or use a phone properly. But like, they will get there and playing being nine, I would say the last two years of this crazy pandemic, like he got to practice diabetes a lot, his best friend lives two doors down. And normally, I would just have clicked just come home, if you want a snack, if they're gonna give you something just come home, we'll enter it really quickly. But he was able to kind of do that on his own to call me or FaceTime me or have the mom kind of overlook his shoulder and kind of make sure that he was entering something correctly. And I think it just gave him so much freedom to be able to do things on his own. And you kind of just get to that space where it's like, you can kind of like breathe, I can drop them off at baseball practice for like 45 minutes early and not have to sit and stay and watch. You know, like, I kind of think that when you're in the earlier stages, you feel like it's just you're never gonna get there. But

Scott Benner 1:04:01
you will. It's a great point. It really is. The only thing I disagreed with is I loved watching baseball practice, but

Kristina 1:04:06
Oh, well. I actually I do as well. But if I need to, I understand.

Scott Benner 1:04:11
Alright, you know this. This week, marks the final few days of Cole's undergrad college baseball career. So I've been zigzagging across the East Coast driving to colleges to watch baseball games. And it's very sad. I'm trying very hard not to think about it. But a three or four days he's gonna play his last game as an undergrad. So I don't know if he's gonna go play grad ball somewhere or not. He might. But I'm up against the fact that this might be the last time Cole plays organized baseball. It's very weird to me. He's been doing it since he was four. And he's 22.

Kristina 1:04:49
And when did Arden Stop stop stop softball.

Scott Benner 1:04:53
When her shoulder started hurting, maybe she was 13 Maybe or 14 in there. I don't know. Yeah, 13 or 14, probably. She still has like a wicked arm. She could Arden could throw a ball at you and it would frighten you. So oh, that yeah, I watched my son do something on Saturday that was just, it was otherworldly how far and accurately he threw a baseball wall like moving during a panicky, like, live game situation while people were running around, and you had to throw the ball to the right place. I, I told him afterwards, if you want to go to grad school to play, I'll support that. I said, the person who just did that is I don't think done playing baseball. So we'll see what

Kristina 1:05:36
I can get so nervous watching.

Scott Benner 1:05:38
Now I don't. I have a really weird feeling about baseball. I think that you play baseball so you can keep playing baseball. And it's always a learning experience to me. And so whether he's successful or he fails, as long as he's moving forward and thinking of something new or figuring something out, or having a personal breakthrough or physical breakthrough, I'm okay with the process like he's not, you know, he's not Bryce Harper, he didn't come out of the womb like nine feet tall and ready to play Major League Baseball League. So it's a, it's a, he's been building on top of himself for a long time. I think there's been uncountable benefits that come from him playing an organized sport like this, he'll be a much better person for having done it as an adult. I just, it's a weird thing to I don't know how to put it. Imagine if nine more years from now, like double the time your son's head diabetes. Imagine, imagine if, when he's 18, you have to take everything you've learned about diabetes, for example, and put it in a box and never use it again. It only means like my son has spent the last 18 years amassing massive skills, and he might suddenly have nowhere to apply them. Yeah, it's a really weird thing. So we're hoping he keeps playing a little longer. Yeah, I mean, he's hoping I just want him to be happy, although I am gonna probably not handle it well, when he stops playing. So I fully expect to cry in front of people on Saturday is what I'm telling you. We should be uplifting for everybody. Anyway, have we not talked about anything that you wanted to talk about? Now, I think we got it all. You're sure? Because if not, we're done. Do you want to be done?

Kristina 1:07:39
Are you finished? Next time Scott.

Scott Benner 1:07:42
Are you gonna come back on in five more years?

Kristina 1:07:45
You know, maybe you want to figure out loop we can chat or you know, if I give you the next thing a whirl. I'm not opposed. But I'm also not like trying to jump on the train to get the Omni pod. I don't even know what they're calling it now. Because they keep changing the name right?

Scott Benner 1:07:57
The pod five I just spoke with someone i by the way. This isn't going to go out until after it doesn't matter. But between you and I, I can tell you and you just have to promise not to tell anybody online that I just spoke with somebody about art and getting on the pod five the other day. So that's cool. Yeah, it's coming. I can't wait to try it. I'm super excited to try everything, honestly. So I can't wait to try that. See if that works for us. If it doesn't, I mean, I'd probably go back to looping if it didn't do what I needed it to do. But I do. I do want to know and I want to find out. You know, there are a number of episodes about looping. They're called Fox in the loop house. I think they're like three.

Kristina 1:08:34
I have heard those. Yes, love Kenny. He's great. Very helpful.

Scott Benner 1:08:36
Annie is really terrific. All right, Christina, can you hold on one second, I have to stop the recording and ask you a bunch of questions to make sure you are comfortable during this. Absolutely. Thank you Well, big thanks to Christina for coming on the show and sharing that story. Love that her doctor broke up with her. Who else we thank and Dexcom makers of the Dexcom G six continuous glucose monitor please use my link dexcom.com forward slash juice box us med.com forward slash juice box or call Oteiza put the phone number away or call 888-721-1514 To get your free benefits check. Seriously, I know it sounds like a big deal to switch your person that you're getting your supplies from but us med will help you and it will be well worth your time when it's done. And of course let's thank touched by type one to remind you to go to touch by type one.org Or follow them on Facebook and Instagram. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#806 Dexcom G7 Approved By FDA (with Dexcom COO Jake Leach)

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#805 Bold Beginnings: Illness Ketone Management

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Test your knowledge of episode 805

1. How should blood sugar levels be managed during exercise?

2. What is the role of insulin therapy in managing diabetes?

3. Why is carbohydrate counting important in diabetes management?

4. What should be done if blood sugar levels are low during exercise?

5. How does physical activity affect insulin sensitivity?

6. Why is it important to adjust insulin doses based on the type and duration of exercise?

7. What types of exercise are beneficial for people with diabetes?

8. How often should a person with diabetes exercise to see benefits?

#804 Bad Breakup

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