#900 Best of Juicebox: Omnipod 5 Pro Tip: Overview
Omnipod 5 Pro Tips: Overview was first published on Aug 15 2022
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Scott Benner 0:00
Hello friends, and welcome to episode 895 of the Juicebox Podcast
welcome back to another episode of the Best, the Juicebox Podcast. Today we're revisiting Episode 431, which originally aired on January 22 2001. This episode includes community feedback on the topic of switching from MDI to pumping. It's very informative. So if you're thinking of switching, check it out. 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 healthcare plan or becoming bold with insulin. Are you a US resident who has type one are the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box join the registry complete the Scott Benner 0:00
Hello friends, welcome to episode 900 of the Juicebox Podcast
Welcome back to the best of the Juicebox Podcast. Today's episode was originally today's episode originally aired on August 15 2022. It's episode 736. It's called Omni pod five pro tip overview. It is the first of my three part series about how to begin on the Omni pod five. 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 healthcare plan or becoming bold with insulin. As I said, this is the first part of a three part series. They're available to you at juicebox podcast.com forward slash Omni pod five or, of course, right in your podcast player. If you're a US citizen who has type one or is the caregiver of someone with type one, please take the time to complete the survey AT T one D exchange.org. Forward slash juicebox you really will be helping type one research when you complete that survey T one D exchange.org forward slash juicebox.
This episode of The Juicebox Podcast is sponsored by ag one from athletic greens. I start every day with ag one and you can as well athletic greens.com forward slash juice box if you head over there now and get started. You get five free travel packs plus a year supply of vitamin D along with your first order athletic greens.com forward slash juice box best green drink I've ever had. The podcast is also sponsored today. By the contour next gen blood glucose meter. You can learn more or grab one at contour next one.com forward slash juice box you owe it to yourself to get an accurate meter and the contour next gen is just what you're looking for. Hello friends and welcome to part one of my Omni pod five series with Carrie Birgit.
Before we get started today with part one of this three part series, I'd like to tell you that insolate has paid the host of this podcast that's me Scott Benner and my guest Carrie Bergerac a fee to create this content. Kerry is an omni pod ambassador with an ongoing commercial relationship with insolate. This podcast provides general information discussions about health and related subjects. This information the other content provided in this podcast or in any length materials are not intended and should not be construed as medical advice. Nor is the information a substitute for professional medical expertise or treatment. Never disregard professional medical advice or delay seeking it because of something that you've heard in this podcast or read in any length materials. The opinions and views expressed on this podcast and website have no relation to those of any academic hospital, health practice or other institution. Please speak with your health care team if you or any person has a medical concern. And before making any changes to your diabetes management, you can always consult the Omni pod five automated insulin delivery system User Guide for more information. In short, nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. You are about to listen to on the pod five pro tip overview. The second episode is on the pod five pro tip settings. And the third episode is on the pod five pro tip connectivity. Please listen to them in order as I think that is how they'll best serve you. If you're listening in an audio app, these three episodes went up at the same time so there'll be right next to each other or you can find them at juicebox podcast.com forward slash Omni pod five.
Cari Berget, MPH, RN, CDE 4:22
My name is Carrie forget I am a nurse and specialty nurse and diabetes care. I work at the Barbara Davis Center which is in a diabetes Center in Aurora, Colorado. It's part of the University of Colorado Anschutz Medical Campus. And I love my job I love working with families who have kids with type one diabetes, because I get to help them figure out how to make the most of their lives and still have a great life even though they're having to deal with type one diabetes, which can be really challenging.
Scott Benner 4:54
Don't have type one, is that correct? That is true. I do not have type one. How did you make it to this kind? of work.
Cari Berget, MPH, RN, CDE 5:00
My background as a nurse actually did not bring, like prepare me at all for type one diabetes care. But when I first I've been a nurse for 17 years, and when I first started nursing, I worked in the hospital and I didn't love it because it was, I didn't get to know people enough I was it was too much just put a bandaid on things and not really get to know or help or be a part of anybody's life. And so then I started working as a public health nurse where it would do the home visiting program for young mothers. And so I would go into their homes and support them throughout their pregnancy with health education, and I got to work with them until their child was two years old. So I did that for about seven years. And while I really loved that, too, I was kind of like, well, I think I want something that's a little bit more clinical, but not back in the hospital. And I had a friend from nursing school who had type one diabetes. And I learned a lot about it from her and was just amazed at how, how smart she was and how hard she had to work to manage her diabetes, but also how much self care and commitment it took. And so then when I was looking for another career, the Barbara Davis Center came up and, and I was like, you know, I think I think this is, this is the place for me because, you know, I don't want a job where I'm the, quote, nurse who's, you know, in charge, and I just tell people what to do know, like, I want I want, I wanted a place where I could connect with people and come alongside them and support them and be a team to help
Scott Benner 6:39
him because he you get to make a real tangible difference in someone's life, right? It's not, it's not like emergent care where you just kind of run in and do what you got to do with leave. But you get to know people and see where their struggles and their strengths are. And then and then and lift them up a little bit, which I think is what we're going to be able to do here with these episodes. So I appreciate you very much taking the time to let us know about yourself. We basically have our topics broken down into a couple of headlines. Right. So the first one we have here is what do we need to know before we get started with the Omnipod? Five? And I want to ask you first, how many families have you been involved with so far with Omnipod? Five?
Cari Berget, MPH, RN, CDE 7:19
Well, I've been working with Omnipod, five for over two years now, because I got to work on the clinical trial, which was the study that you do before the device is commercially approved. So I had about 30 families that were in the child from our center, and I was the primary nurse for that study. So I got to train them on the device and teach them how to use it. And then we got to work together to figure out how to use it best. So that's been for the last two years. And then now that the device is commercially available, we're rolling it out in our clinical practice as well. And we've had over 250 new prescriptions for it. And just these last couple months, and then over 80 have started the system. So there's been a lot of a lot of kids and families that I've worked with on the system. That's perfect.
Scott Benner 8:07
So you've got to we've got a couple of years worth of knowledge that we can pull from here, it's going to be terrific. We're going to start simply getting things laid out right. And person wants to start with Omni pod five. What do they need? They need on the pod five? That's pretty obvious. But they're also going to need a Dexcom G six CGM. Is that correct?
Cari Berget, MPH, RN, CDE 8:27
That is true. Yep, the Omni pod five works with the Dexcom G six, and you do need that Dexcom G six in order to use the system. In the automated mode.
Scott Benner 8:37
It's important to remember that these are separate items. You don't get a Omni pod five prescription that ends up bringing you a Dexcom. So if you have the G six, all you need is the Omni pod five. If you have neither, then you're going to need to talk to your healthcare provider about getting a prescription for each.
Cari Berget, MPH, RN, CDE 8:54
Yes, very important point. Okay. The other important point about that is that the Dexcom G six is it really is a separate device in the fact that you need to use it on your own cell phone with the G six mobile app, there is no way to download the G six mobile app on the Omnipod five controller. So that's also an important piece to to understand and that you can't use the Dexcom receiver either if you're using Omnipod five,
Scott Benner 9:22
right. So if you're already a Dexcom G six user, and you're using Dex comms receiver, you're going to need to move your Dexcom on to an app on your phone before you can use on the pod five with it.
Cari Berget, MPH, RN, CDE 9:34
Yes, that's correct. The G six mobile app to be specific. Yeah,
Scott Benner 9:37
thank you. Now you could use on the pod five, right without the G six but you would just be using it as a just a regular insulin pump. It wouldn't be an automated system. That is correct. Yes. Having said that, Carrie. I think if you're gonna do this, like get all the stuff because, you know, right?
Cari Berget, MPH, RN, CDE 9:58
Yes, absolutely not. If you're going to get Omnipod, five, use it in automated mode, that will definitely be the best way to go.
Scott Benner 10:05
Yeah. Okay. So does that mean that you can't use Omnipod? Five if you don't have a smartphone? Well?
Cari Berget, MPH, RN, CDE 10:12
Well, the short answer is yes. But let me give you the more complicated trail have that. So you do need to have the Dexcom G six mobile app in order to operate the Dexcom G SIX sensor. And as I mentioned before, you cannot use automated mode without the sensor. But if you had the G six mobile app on one smartphone, and the sensor was all up and running, and you had already connected it to your controller, the active sensor session, if you already have the Dexcom transmitter in the Omnipod, five, app, either on the controller or your own phone, then once that's up and going, you don't need the G six mobile app within range in order for the pod five to operate in automated mode,
Scott Benner 11:01
right? Well, yeah, we're gonna go over that probably a number of times. So one of the one of the great things about the system is that it's it's self contained within the things that are on your body. So the GS six will talk to the Omni pod five, without the controller for the, for the, for the on the pod five there or without your cell phone, those things could be nowhere near you. And the algorithm can run because the algorithm actually lives, like right on the circuit board inside of the on the pod five.
Cari Berget, MPH, RN, CDE 11:29
Right, the algorithm is directly inside the pod. So the pod itself that is on your body, each one of those pods has the automated insulin delivery algorithm on it. So the Dexcom actually sends the glucose data directly to the pod. And then that pod uses that CGM information from the Dexcom directly to calculate how much insulin to give. So yes, you do not have to have the controller, the Omnipod five controller nearby, in order for the automated insulin delivery to occur,
Scott Benner 12:02
okay, so we have our stuff we got, we got our gadgets and gizmos on our websites, and we know what we're doing. And we got to get started, right. So some people are going to train in person with a CDE or a nurse practitioner, whatever they have available to them. Even I guess, I'm guessing through people that on the pod provides. Is that true?
Cari Berget, MPH, RN, CDE 12:21
Yeah, there. I mean, it depends on your clinic, there's a variety of ways that clinics might go about training their patients on insulin pumps in general, a lot of clinics do use the industry trainers, so they'll have a trainer from Omni pod that covers their clinic, and that would be the trainer that they would Gotcha. They would work with Yeah.
Scott Benner 12:40
Now there's also like an elearning situation, right? Where you can go online and take no walkthrough. Isn't that great, I don't have a job, carry, I don't have a job. So I don't get to do things the way other people do. But I hear a lot of people train online and stuff. But that, but I did take the online training from the pod five, and I'm assuming that's available to other people as well.
Cari Berget, MPH, RN, CDE 13:01
Yeah, it's available to everyone who's a current Omni Potter. The way it's designed actually, is that if you are current on new Potter, and your specific healthcare provider has like, given the stamp of approval that they're good with their patients self starting, then when you get your intro kit from the pharmacy, inside that kit includes a QR code. And it's just not very complicated, just Omni pod.com backslash setup, you go there, and it'll walk you through the steps of setting up the controller. And then from there, you can access the elearning modules, which will walk you through how the system works, how to program it. And, you know, walk you through the steps of starting it up. Right.
Scott Benner 13:43
So let's talk about that a little bit. The, I think, a couple of the key words, you and I are going to hit over and over again. One of them's going to be settings, whether this means your Basal profile, your insulin to carb ratio for your meals, your correction ratio, insulin sensitivity, all these things that I mean, if we're being honest, I guess a number of people don't even understand they go with whatever set up for them. And then whatever happens happens. But on this automated system, I think the easiest way to consider this is that if your settings aren't good, it's going to be like sending, I don't know, five basketball players out to play a baseball game, right? Like, you know, you've kind of got the tools there. You got some athletic people, but they've never held a bat before. They don't know how to throw a ball overhand. And and she you've got these things, it's close to what you need. It's not exactly what you need. So having your settings correct, is I think, in my opinion, by far the most important step of getting going. Now, how does how do you do that? When you might be in a situation? I guess what I'm what I'm thinking about is what happens if someone sees automated system while an automated insulin delivery system? I'm out of this, but it's not just going to magically work. You're gonna have to give it a good starting point.
Cari Berget, MPH, RN, CDE 15:02
Yeah, that's all true. So programming the settings, the initial settings that you have, it's, I wouldn't recommend just just blindly programming whatever you have in your current insulin pump, when you go to start on the pod five, it's important that, you know, to get off to the best start, you really should have your Basal program representing about 40 to 50% of your total daily insulin needs. And the reason for this is because the algorithm is it's using this assumption that that's typically what people require. And so you'll, it'll estimate your total daily insulin best, when you first start the system. If you have about 40 to 50% of your total daily insulin coming from that Basal program, or at least that's what you have programmed in the system. So that's what it what it assumes. And that's, that's pretty physiologically accurate. I mean, that is what you would expect, you know, we have these two types of insulin delivery, when you think about it, for intensive therapy, you've got Basal insulin, you know, which is like your background, it's what's supposed to help stabilize your glucose levels and manage, you know, the livers role and storing and dumping glucose into the bloodstream. And then you've got the Bolus insulin, which is larger doses all at once that, you know, are For if the blood sugar gets high, or if you're eating. And this is basically how the, the body works with insulin delivery. So this is trying to simulate those same type of, of structure, right, so look at what your current settings are, and then see how close or far that is. So you can always start from, what is the total amount of insulin that I receive in a day. And then how much of that is coming from Basal quote from the pump, and how much of that is coming from boluses. And you know, people with diabetes, they're really smart, and they figure out how to make things work best for them. And on a manual pump, you might be getting some of what might be considered Basal through giving extra boluses and things. So that's where if if those splits are way off of that, I think that's a time to go to your health care provider, and try and reevaluate what they really should be to get off to the best start and then start from there.
Scott Benner 17:20
Yeah, Carrie, and I've kind of put that into layman's terms for people. And this is something I've learned baking the podcast over the years, there are times that people using insulin arrive at the right destination, but they don't quite get there the correct way. And just a general understanding of what that might mean is, let's say you should be using, I don't know, 24 units of basil a day, I'm obviously doing that. So it's easy for us to remember one unit an hour. But for some reason, your Basal program is set at point five, and you end up making up that other insulin through manual corrections. Or maybe you've figured out a way where your your meal ratio is really heavy, but it works because the basil is light, or vice versa. Maybe your basil is too heavy and you are eating on a schedule and feeding the the insulin like there are a lot of different ways that unbalanced settings can still look okay at the end. But this system is going to learn more quickly. If those settings are as close to write as possible, it can still learn if you if you begin with bad settings, but it will add to the amount of time is that right?
Cari Berget, MPH, RN, CDE 18:25
Yes, I'm sitting here like nodding my head, but you can't see that. So yes, that's absolutely right. And it's going back to your analogy of the, you know, baseball players trying to play basketball, or maybe it was vice versa. If you, if you teach those baseball players how to play basketball, they'll probably learn it eventually. So it's a similar concept that if it's not perfect at the beginning, or at least not optimal, it will eventually get there, it just is going to take a little bit longer to figure that out. And I think the other point I would make is that this system really operates off of total daily insulin, that is what it uses to base a lot of its automation decisions on not all of them because it's also taking your current glucose level. It's making these you know, decisions about how much to give every five minutes, but kind of the big picture factor that plays a huge role in that is your total daily insulin.
Scott Benner 19:21
Okay, and would that be the same for somebody coming from MDI?
Cari Berget, MPH, RN, CDE 19:27
Yeah, I mean, it would be the same as somebody coming from MDI, generally with MDI, you would look at, you know, what's your, what's your total long acting insulin dose, and that would typically, you know, be what you would use to figure out Basal settings and a pump. So you just would take that total Basal dose if it represents about 50% of your total daily insulin, and then you would divide that by 24 to get a starting rate. Okay, so Carrie, I'm
Scott Benner 19:57
gonna give you a little more anecdotal from my end, which is I see people frequently going from MDI, to any kind of pumping. And having a similar issue, where settings don't look the same, you know, and they, they'll, they run into it in all kinds of different ways. But, but kind of think of it like that. So you know, sometimes people from MDI go to pumping, and it takes them a while to get their setting straight, and find your you're on your way to doing that. But that pumps not trying to learn anything from what the settings are that you've told them. So have your settings really, really close before you start. And in the next part, we're going to talk about that a little bit more, but I just wanted to, to make sure to be clear about that. So So let's, let's imagine, here we are, we've done our learning, we've talked to our doctor, we have our settings straight, and we're sitting together, it's our on the pod five, we have our on the pod five controller, our Dexcom or Dexcom is on our phone, we're ready to go. Now you need to have the controller with you right to start up, you have to get it going. And earlier we talked about that the system works without being near anything. But there are of course, some things you need the controller for, for instance, you need it to give yourself a tell it how many carbs you're going to eat, right? You need it to hear alarms and alerts. There are things that if you walk completely away from it, you won't get alarms and alerts are a big part of it. The ability to control the, the system, as far as entering carbs is another one. If you happen to be in manual mode, you know, you have access to a few more settings, then you do an automated. So those things need to be nearby when you're making changes, or when you need to hear alarms and alerts. And the truth is right, you need to hear your alarms and work.
Cari Berget, MPH, RN, CDE 21:41
Yeah, the other thing is, if you want to see anything, you need to have the controller nearby. So you know, if you're gonna go swimming, just leave it on the on the chair. And you don't need to worry that it's not going to be able to deliver insulin. But generally speaking, you're going to want the controller nearby the unless you just want to be completely blind and not know what's happening. But a couple other just clarifying things there. They're calling it a controller now. So very fancy, no more PDM. But controller, that might be the lingo you hear when you like get your intro kit box and stuff. And then also, as far as alarms and alerts, I did want to clarify. Another reason for having the Dexcom G six app near you is that you cannot program any of the Dexcom CGM alerts on the Omnipod five controller. So that's another thing to keep in mind. If you want to be getting those Dexcom alerts, you have to have the G six app within range and get it through that app. There's a couple exceptions. There's a one LOW Alert on the Omnipod five, four if it predicts your glucose dropping below 55. And then there's some like pump related alarms and alerts. But I did want to make sure it was clear because this is a common question that I get that there are no CGM related alerts other than that 55 In the Omnipod five app,
Scott Benner 23:00
right so there so you have two devices that are speaking to each other but they're giving you their information on their their own separate platforms.
Cari Berget, MPH, RN, CDE 23:08
Exactly.
Scott Benner 23:15
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So let's I guess dig in a little bit into this algorithm and what we can expect it to do and what it's going to do. I feel like I want to ask you, and because I can, we've used the Omnipod five and I know a great deal about it. But I think you have a lot more than me, as far as knowledge goes. So there's a predictive control algorithm, right. And it's called Smart adjust technology. And we know how it's going to communicate back and forth with the G six that happens every five minutes to predict where your glucose is going to go. 60 minutes from now, it increases or decreases or pauses insulin, trying to get you to that level that you actually get the program right. So unlike other automated insulin delivery systems, I guess on the pod five has a 110 target, but it also has other targets.
Cari Berget, MPH, RN, CDE 27:05
Yeah, you can program the target anywhere from 110 to 150. In 10, and 10 milligram per deciliter increments. So 110 121 3141 50. And yeah, that is the only automated insulin delivery system where you can customize the target to what you want it to be. And then additionally, you can also set that target, you can have a different target for different times of day. So if you wanted to run 110 of the rent 110 target, you know, all day, but you wanted the 130 target overnight, you
Scott Benner 27:40
can do that as well. It does not go lower than 110. No, it does
Cari Berget, MPH, RN, CDE 27:45
not you cannot program a target lower than 110. Okay, that doesn't mean your blood sugar will never go lower than 110. But the the target that you program can't be lower than 110. Yeah. So
Scott Benner 27:56
that's as good a place as I need to talk about that. So your blood sugar could get lower, and then it's going to take away insulin trying to get back to the one time.
Cari Berget, MPH, RN, CDE 28:06
Yeah, that is correct. But I think
Scott Benner 28:09
that's important for people to hear that it doesn't happen instantaneously. If you were to, I guess there's a lot of different things right, you could you could make a Bolus for a meal that's too large for what you ate. And then you might get lower than that. And then this, the algorithm is going to just try as hard as they can to take away insulin, take insulin to create a new balance, but you could be lower while it's doing that. So there are times where you might have to step in and fix a lower blood sugar. There's it that seems accurate to you.
Cari Berget, MPH, RN, CDE 28:37
Oh, yeah, absolutely. I mean, you know, what we see with these systems is they, they do a really good job at helping prevent hypoglycemia, but they don't eliminate it altogether, usually. So you may still have a few, you know, situations that the example you gave is, is a really good one. Because if you do over Bolus for a meal, for example, once that Bolus insulin goes in the body, you can't take it out, you know it's there. So if you can't remove it, all the algorithm can do is just stop the automated delivery in the background. Yeah, so it should help. It should help kind of like cushion the fall if it's too much Bolus, but it may not always be able to 100% prevent the the low blood sugar entirely. Yeah,
Scott Benner 29:23
it comes from a personal experience I had with it because when we first got it, I was like, I bet you I could get this to keep a lower number. And I did it. And Arden's blood sugar was like 85 for like two and a half hours. I was like see, I trick the outcome. And then it didn't it tricked me because because it took away so much of her basil that her you know, once that act of insulin I used in the meal was gone. Then she just started going up and up because I had basically, you know, I had I had put the algorithm in a situation where it took away the basil for so long that the only thing that was going to happen later was arised. Like that's the only thing that could happen eventually I basically trade Did my meal insulin for basil? And it said, Well, we're going to, we're going to get you back up to 110. And then that rise happened. So I just, you know, I, it's not this stuff's all really very new to people, you know, and everybody's kind of had a way they've done things and there's going to be a different, you know, a slightly different way to do things. And these are the things that are gonna get you there. So, alright, so Carrie, we thrown on this, we got our first pot on, right? What happened? Yes, five minutes. 10 minutes later, my blood sugar's perfect.
Cari Berget, MPH, RN, CDE 30:30
So I wish Sunday. But so you put your first pot on, right, what'll happen is the with your very first pod, the system, you can go right into automated mode. So that's another cool thing about this is, even though the system operates off of total daily insulin, you can still go in automated mode with the very first pod, even though there is no insulin history. If you think about it, you might be wondering, wait, you just told me this algorithm operates off total daily insulin. But this is my very first pod. So how would the system even know you don't program your total daily insulin anywhere in the pot, it's based on the insulin you actually receive. So that goes back to what I was saying before that it estimates your total daily insulin. And it uses that to determine what they call an adaptive Basal rate. And so I would think of that as like a baseline, it's your baseline Basal rate that this system thinks you have. And then in then it adjusts up and down from that rate, based on the current glucose trend, recent insulin history, delivery history, all with the goal of trying to reach that 110 target. So the 110 is the brain's that's the number it's using when it's making these calculations every five minutes. And then, so you go along, and you give your meal boluses. Because that's really important. On a system like this. For one, if you want the best blood sugar control around meals, you should Bolus, you know 10 To 15 minutes before you eat, to get the best control around meals, but also to make sure that the total daily insulin that you need is actually accurate. Because if you miss the boluses, two things will happen. Your your meal control won't be as good, you're gonna go high, the system will increase to try and help you so still be better than missing a Bolus if you are on a standard pump. But the total daily insulin will start to be underestimated, then because you're not giving the Bolus and the automation can only do so much for you.
Scott Benner 32:26
So so if I, if and again, this is a great example of it's not, you know, it's not just like set it and forget it and walk away, you do still have to do the things you need to do Pre-Bolus In a meal is have you know, I think it's a basic concept. And and so what you just said makes sure I understand if I don't Pre-Bolus a meal, then we're going to see a big shoot up 2030 minutes after I've eaten my blood sugar is gone from wherever it was, you know, 100 and now it's it's 180 and on my CGM is telling me I got two hours up. And then all of a sudden, I remember to tell the, the Omnipod five, hey, by the way, I ate 45 carbs. So you're by doing that by not letting it know that food is happening when it's happening. It just thought you shot up out of nowhere, and it tries to stop it. And now you're putting the food in and telling it Oh, no, there was food here. But you're telling it that there's food at seven o'clock at night when really the food existed at 630. And then that kind of throws things off is that I understand that correctly?
Cari Berget, MPH, RN, CDE 33:24
Yeah, yeah. Yeah, the only thing I would add to that is, it's just that the time it's the time doesn't really matter. So like the algorithm doesn't really care when you like to eat breakfast, lunch or dinner, like it's not going to learn that it's not going to learn, oh, Scott always eats lunch it at seven, or dinner at seven, you know, yeah. But if you, like you said though, if you don't eat him, if you don't Bolus for a meal, your blood sugar will rise. And the algorithm will respond, you know, it will respond and try and increase the insulin delivery, the automated delivery, right? But the other but what happens if you put the 45 grams in an hour later, you've got a bunch of insulin on board now from this automated delivery, then you put in the 45 grams, it's just going to calculate, you know, based on your carb ratio, which is going to be too much because now you already had this other insulin in there. So it does create this yo yo effect because if you come in with the meal Bolus after, it's going to likely be too much. And then you're going to you're going to crash down and then you're going to treat that low and then you're going to rise up. So that's where it goes back again to the pre meal Bolus is is really important. Yeah, because but what I what I was saying before, it was actually more than if you just miss the Bolus altogether, the total daily insulin calculation will start to be be off to okay, it doesn't you don't give those boluses it's not going to know that you require the amount of insulin that you require.
Scott Benner 34:55
See, that's a bigger picture idea that's important. It needs to understand like I guess in this same breath. If you were a really high carb person for three days, and then decided to eat very low carb for three days, the system isn't going to magically know that you stopped eating 150 carbs a day versus now you're having 50 or something like that. Right?
Cari Berget, MPH, RN, CDE 35:15
Right? No, it won't. But it will update your total daily insulin every time you change your pod. So this is a very important point, because, you know, especially with kids, which is what you know, I work in pediatrics. And so kids grow and their insulin needs change all the time, constantly. And that's expected. And so a lot of people will ask, well, how, if it's based on total daily insulin, like how does it adjust as my kid grows, or, you know, needs more insulin, and it does that by updating the total daily insulin with each and every pot. So every pod, it's going to change the adaptive Basal rate based on the more recent total daily insulin, so it will adapt over time to changing insulin needs.
Scott Benner 35:59
Okay, so this first pod is on and it's collecting data, it doesn't know anything except the settings that we've given it. And it's just living with you. And it's seeing what you're doing. And it's seeing what's happening. After that first pod is done, you move to the next one. And that's where you really start seeing the system working a little more, right, that very, very first pod is a is a collection day, or days Excuse me.
Cari Berget, MPH, RN, CDE 36:24
Yeah, and it's, it's operating more conservatively, conservatively with the first pod, because it's only estimating your tea, it's guessing your total daily insulin. And then in so because of that, it's just more conservative, it's a little more constrained on how, how high the adaptive Basal can go how much it can increase the insulin. But then when you change, and you go to the second pod, it starts using your actual total daily insulin, and then those constraints aren't, aren't there anymore. So I see.
Scott Benner 36:55
Carry, I've been told something by my my little birds. And I want to know, if you see any value to it at all, they say, that first pod instead of going the full 72 hours, they say change it after 48, because it's learned everything it's going to learn and you want the next pot to get moving to have you heard that at all?
Cari Berget, MPH, RN, CDE 37:14
I haven't directly heard that. But my guess is that comes from the fact that you know, what's required for the system to start using your actual TDI instead of the estimated TDI after the first pod is at least 48 hours of insulin delivery and A pod change. Okay, so that might be where that comes from. But in my opinion, I don't, I don't know that I would worry too much about that. You certainly could change it after 48 hours and like, make it start using your actual TDI. But there's also concerns of like, do you, you know, do you really want to change your pod earlier than you need to you only get a certain amount of supplies. So I don't think it's essential, or will make a huge difference. But certainly could.
Scott Benner 37:55
I just wanted to get that in there because the internet always thinks it knows. And so I wanted to see what you thought. Thank you very much. All right, I have some questions here. Actually, I want to thank existing podcast listeners, they sent out a ton of questions for this. This person says, I've read that the first pot operates at a reduced Basal rate. Is that that true?
Cari Berget, MPH, RN, CDE 38:17
I mean, reduce from what I don't, and I'm not sure that that's actually true. I mean, what I would say is the first pod operates off of more conservatively than it will in subsequent pods. And I would say that the maximum delivery is more constrained. But I wouldn't say that it is operating off of a reduced Basal rate, because the adaptive Basal rate it determines is based on the total daily insulin it estimates. So a lot of that is based on what you have initially programmed for your Basal program,
Scott Benner 38:50
in a perfect situation, you're gonna put this first pot on, and you're gonna let it do its thing, you're gonna live your life and let it learn. Is that correct? Yes, yeah. What if you get into a situation where your settings were way off when you got started? So you're seeing a high blood sugar that you're just not okay with? Do you come in and correct it?
Cari Berget, MPH, RN, CDE 39:08
Yes. And I would encourage, especially in the first couple of weeks, as it's getting, you know, adapting and adjusting to your total insulin needs. If your glucose is high, give, give a correction Bolus, it all it can do is help because it does two things, one should help bring your blood sugar down. But then too, it's it's adding more insulin in to the total daily insulin. And so you know, that's going to increase the total daily insulin and then with the next pod, you're going to have a higher baseline adaptive rate, and it's all just going to balance out from there. So the principle of giving correction boluses really, really helps. But can I add one more thing about correction bonuses at this point? You're
Scott Benner 39:50
the only one here really, I'm just okay, if you don't, we're pretty dumb. You know what I mean? Yeah.
Cari Berget, MPH, RN, CDE 39:56
So, okay. And this gets to what you were saying before, a little bit. In that, you know, people who live with diabetes really figured out how to make their insulin delivery work for them. And there's a lot of different ways to get there. As you mentioned, when you're using a manual pump therapy, and the difference with an automated system is that you now have insulin delivery going on that you aren't in charge of anymore. And so my best advice for giving correction boluses is to follow the Bolus calculator recommendation. And I know that's really hard for for many people, because you know how much you need. But with an automated system, you can have a lot of insulin on board from the adaptive Basal increasing that you just may not be acutely aware of. Yeah, so what what's great about the system is if you're using the Bolus calculator, any insulin delivery that is above the baseline, so this baseline I told you, the system calculates for you, it will factor that into the insulin onboard. Point being you can see how much insulin onboard is active. And that includes the automated Basal, which is also different from standard pumps where typically Basal insulin is not incorporated into the insulin onboard calculation. And it is now if it's, you know, being given to deal with hyperglycemia. So, you can follow the recommendation and just be advised that the the correction dose may seem smaller, you know, a lot of people will say to me, oh, my gosh, this thing thought said, I needed point five and I, on my other pump, I would have given two units for this. And I have to tell them well, on your other pump, your basil was stupid, it wasn't helping you like it was stupidly delivering point five units an hour, no matter what your CGM was doing. So just keep that in mind and try to work with with the system and not against it. And that will really help with frustration, but also with getting better outcomes to
Scott Benner 42:00
carry Listen, may I make a mean, let me just be honest here for a second, I fought it. In the beginning, I was like, that's not what I would do. Or that's not what I need to have happen. Or and it really did just eventually occurred to me, I was like, this thing is gonna do stuff. I'm not going to understand it all. And if it works great, why do I even you know, you know, why am I fighting. And I was just applying what I knew prior to what was happening now. And it really did take me longer than it should have to say to myself, This is not an apples to apples situation here. I am not doing manual pumping the way I used to. That's not what this is. This isn't even another automated insulin delivery system, right? Think because they all work differently. I mean, there's a number of them that are available, and not one of them is accomplishing what they're accomplishing in the same way. And so I did find myself having to put away some of my old tools that I thought worked really well. And and look at on the pod five more and try to find the tools that I thought worked better with it. Yeah, you
Cari Berget, MPH, RN, CDE 43:03
may need to find some new tools, you know, and you will, but I think that that's, that's really, that's really the key, I think. And in admit it, I mean, that's hard to do. I mean, you know, when you've been spending years and years and years, taking care of diabetes, and then sometimes you'll you'll have to let those things go. But that can be in that can be hard to let those things go. So I usually tell people, you know, the system needs time to adapt to total daily insulin as far as thinking about expectations of like, you know, how long is this going to take to get used to this? Most people are asking, like, how long is it gonna take for the algorithm to figure out how much insulin I need? And while that's true, there's another piece, it's how long do I give myself to get used to a new type of insulin delivery. So that's another piece of it is it's you know, you as the user, you have to figure out where you need to let go and let the system do its thing. And then where you need to give insulin and do your part in how to find this, like, beautiful harmony, where the two of you work together the system and you you know, to get the best out of it. Yeah,
Scott Benner 44:11
I think we'll jump into that. We'll do a settings episode where we'll talk more about how to make those adjustments and even how to talk to your healthcare provider about making those adjustments. I'm just, I'm glad you brought it up. Because I feel like what I need to know like if I'm going to recap here is that I'm going to come in with as good a settings as possible. And could that even mean that I start on the pod five in manual mode for a couple of days, say I'm not coming from on the pod dash, maybe I'm coming from MDI or something else, right. If I start in manual mode for a little bit, I'm looking for that stability, right? It's my basil at a good place where I'm held. I mean, the way I talked about on the podcast is Bezos job is to hold you at a number, right and that number is, you know, it can be whatever you you think it is, but if your basil is set correctly, it will hold you away from food and active insulin. Add a number at 90 at 100, you could use a little more basil and have it lower, you could use less basil and have it higher. But stability is the important part. If you don't have stability, then your basil is not close to being correct away from food and away from an act of Bolus, you know, your blood sugar shouldn't be dropping very harshly, you're jumping up and down your basil. I mean, Basil is everything. I think it's the it's the bedrock of diabetes. And it's the way to, it's the way to have success is no matter what you're using. So maybe I even start on the pod five, in in manual mode for a little bit, it's still seeing if my basil is working, it's still seeing my bonuses and my corrections. And it seemed my total daily insulin, that would work as well. Right?
Cari Berget, MPH, RN, CDE 45:42
Yeah, I mean, you could do absolutely necessary, right, right, it's not necessary. And the only other caution I would give you is that, you know, the system isn't using the Basal rates themselves. So testing it, that'll give you a really great Bayes Basal profile for if you're using it in manual mode, right. But what's more important for getting the best start in automated mode is really just the total insulin. And so, you know, if your settings are just have gotten off over the years, like, let's say, you know, per your programmed settings, you only get 25% of your insulin from the Basal rate, I wouldn't recommend starting Omnipod five, with it like that, you could go into manual mode, tweak it all up, you know, test it out, if you want it to, but you could also just talk, look at what your actual total insulin is. Because if you have, you know, relatively, you know, good control that you're happy with overall, you have a total amount of insulin that you're receiving. And that seems to be working as far as the amount. So you could just re estimate what that basil really should be based on the total insulin, can I
Scott Benner 46:56
pick your brain a little more here on that? Yeah, so if my total daily insulin is whatever it is, but my average blood sugar is 180, then my total daily insulin might not be enough.
Cari Berget, MPH, RN, CDE 47:10
Right? Right. And that is a excellent point. Because, and especially I mean, I see this all the time, it's, I think this is very, very common in youth, even, especially, most kids are not getting enough overall insulin. And so I will sometimes when, because what I do at my clinic right now in prep for everybody starting up the system is I review, I try anyway, to review everybody's current pump settings, and suggest different settings for them, and work with them to you know, what they should programming Omnipod five, and if I see that somebody's, you know, got an average blood sugar of 200. And their last time in range was, you know, 45%, then I'll look at what their their Basal is. And if it's, if they're over Bayes alized on paper, as in like, Oh, they're getting 60 70%. But really, that represents more of an expected TDI, total daily insulin, then I probably just keep it. So that is an excellent point that just because on paper, the split might look off, it's all relative to whether the total daily insulin that you're getting is actually the amount that you need. Yeah, it
Scott Benner 48:25
just occurred to me that you might be, you know, doing great, you know, and thinking I'm doing fantastic. You know, my blood, my a one sees a seven and a half, and this is my average, you know, insulin intake, and then all of a sudden you put on this, you know, the Omnipod, five, and you put on target of 110. But you give it settings that led to a 170 or 180, those two things are in Congress at best. So, yeah, so that makes, there's going to be an adjustment period is what I keep thinking to say.
Cari Berget, MPH, RN, CDE 48:55
Right? Yeah. And it all starts with, I think, if you just remember that it really all starts with what's your total daily insulin? either? What is it that you're getting? Or? Or how much is it? Would you really expect that you would need? Because, yes, it is different for everybody. But it's not a complete mystery. Like there are ways to estimate how much you really should be expected to be getting based on just simply based on weight. So like, if you're really not sure that the amount you get, whether it's really close to optimal or not, you know, talk with your with your doctor. And it'd be like, what, how much should I probably actually begin, you know, and go from there.
Scott Benner 49:36
So, a minute ago, I talked about being in manual mode. And I just wanted to point out that even if you're in manual mode, the algorithm is paying attention to your total daily insulin there. But in manual mode, there's no algorithm to stop you from getting low. It's just you're using an insulin pump just like a regular old insulin pump then, and I didn't I didn't I didn't say that clearly enough. So I wanted to we ever A couple of things here, a person who started on the pod five, and they had, you know, they were like, well, I wanted to be more aggressive. And so they get to their fourth pod, and they start making all these changes to their settings, thinking, this is going to make it more aggressive, I'm going to increase my Basal the carb ratio, the insulin sensitivity factor, etc, on and on, right. Except that's not how this works. Like after that first pod, you put that first pod on the algorithm is learning. And it's adjusting those things. So if you made a change to one of those settings, that change would only be concrete if you were in manual. That's correct, right?
Cari Berget, MPH, RN, CDE 50:41
Partially, I mean, if so when you're in automated mode, I cannot stress enough that it does not care what Basal rates you have programmed. Even if it's the first pot, it doesn't care about the actual Basal rates, the profile itself, it's concerned about the total only to help it estimate your total daily insulin. So I just want to make sure that's really clear that even with the first pod, the actual rates themselves and the different ones you put at different times of day, it does not use those in any way. So no changing, no changing Basal rates at all, when you're using automated mode. Those would only be used if you were in manual mode. Okay. But for boluses, if you change your insulin to carb ratio, if you change your correction factor, that will change the amount of insulin that's recommended for your Bolus doses. And that can actually make a really big difference in your overall glycemic control. Really fine tuning those Bolus doses, because that's what you have the control over, it's your job to give those boluses for meals. And so focusing on those actually, I would highly recommend because it can make a huge difference in your overall blood sugar control.
Scott Benner 52:02
Okay. All right, thank you. I just, I'm trying to put myself in the position of somebody who just comes at it new and doesn't, doesn't quite understand what's going on. You want to do one more question? Or do you want to move on? Let's see.
Cari Berget, MPH, RN, CDE 52:17
Do you have questions? It's good for ya. It's like sending a man you know, then they want them answered. I think it's, that's good.
Scott Benner 52:23
I love you. You're very nice. I'm having a good time. It's our first time recording together. And I feel like we're doing well. What do you think give some credit for Yeah,
Cari Berget, MPH, RN, CDE 52:32
we're feeling great. I'm feeling more and more normal. And the more we go,
Scott Benner 52:36
you're not as nervous any longer. Cool.
Cari Berget, MPH, RN, CDE 52:39
Okay. Settling in.
Scott Benner 52:42
I'm oddly calm, just so you know,
Cari Berget, MPH, RN, CDE 52:46
you do seem very calm. I'm like waiting for the I don't know, waiting for you to yell at me about something.
Scott Benner 52:55
Okay, so carry, like, let's just kind of dig in. Before we move forward, let's add a little more clarity to total daily insulin in manual mode. So, okay, do you? Do you feel like we've covered it all? Or do you think there's more there? Like, I don't know, what to add to what you've said. So maybe you did.
Cari Berget, MPH, RN, CDE 53:16
I mean, I think the point you made of just making it clear that Omni pod five, it the pod tracks total daily insulin, whether you're using manual mode or automated mode, it's always tracking that. So if you went out of automated mode into manual mode, for whatever reason, for you know, a week, two weeks, a month, a year, it's still tracking it. So then if you switch back to automated mode, it's it's just going to pick up with that total daily insulin, maybe is the point there.
Scott Benner 53:49
Carrie, I believe that was a perfect explanation. Thank you very much. All right. So let's roll through a couple of questions that I have pretty simple answers. person asked, Will it be possible to decrease to decrease the target blood glucose level from the current built in minimum values? Now I know the answer to this one. So no,
Cari Berget, MPH, RN, CDE 54:07
no. No, the target is 110.
Scott Benner 54:13
Yes, yeah. And you can go higher if you so desire, up to 150. I think we've said already, all the way up to 150. If you want to target a 90 it, it's not going to do that.
Cari Berget, MPH, RN, CDE 54:25
It will not okay. All right. But can I just have one thing about that, please? Because I have stuff to say to go. Yeah, the target thing is fascinating. For me, because I work with a lot of automated systems, not just Omnipod five, and this is something that comes up with every single one. I would just realize that this target is the brains, it's the brains of the algorithm. It is not i It's not saying that your blood sugar is going to be at 110 all the time, and that it's never going to be under 110 or that you couldn't possibly ever be under 110 it's just every time The algorithm makes a dosing decision, it's doing it trying to reach 110. That doesn't mean you're always reach 110 Or never go below it. Does that make sense? So I would focus, when I think about adjusting the target, since this is the first system where you can do that, look at it more from the bigger picture. Like, if you're running high overnight, and your target set at 130, drop it, because then the insulin is gonna give more in the algorithms gonna give more insulin. So think of it more as like, if you want to try and make the algorithm more aggressive, because you're running high, overnight, drop the target, if you're running lower than you want to be, I don't even wherever that might be, like, I just worked with someone the other day who was running at five overnight, which some people would love, he, they did not love that. And so we bumped up the target, you know, so in it, it helped bring them up a little higher. So, think of it more pragmatically like that, like, it's a way for you to influence what it does and less focus on what the actual specific number, it's
Scott Benner 56:07
sorry, listen, I think if people listen to this podcast, they'll understand this. And if they're new to it, and they're finding it because of the only pod five episodes, and this might be a little lost on them for a moment. But there are so many variables that go into how insulin works for you. So if you're a person who does a set amount of exercise every day, your insulin will probably be more effective. If you're hydrated, well, it will probably be more effective than if you're not hydrated. Well, if you're experiencing a fluctuation of hormones, say, at one point, but you aren't at another point, the insulin is going to have different impacts. And so it's a lot about your behavior, as far as what you know about that, and what you and what you ask of the system. My point being, if you go along, eating, you know, a house salad for three days, and then on the fourth day, decide, I'm going to have a half a pizza, well go for it, except, just understand that if you are a person who has been eating how salads for a year, your your insulin to carb ratio, for example, is probably more tied into that style of eating. So if you're gonna slide into a completely different style of eating, all of a sudden, that insulin to carb ratio might not be the same for pizza, as it is for something else. And I'm getting a little outside of you know, I'm not a health care provider and etc. But you do need to understand how insulin works, I guess, is what I'm saying. And if you don't, you're gonna run into problems. And you could turn to, you know, and think it's, you know, you could, I don't know, you could chase ghosts around, you could think you see what's happening, but you might not be.
Cari Berget, MPH, RN, CDE 57:46
Yeah, and then I would just end that statement with I mean, I think that people give more concern to the target than I think is necessary. That it's not as big of a deal that sometimes it can be beat out to be. And so I try to encourage people not to worry too much about that back to what you were saying, just focus on doing what you can to get get the best control that you can, and the target is not really the most important factor here.
Scott Benner 58:16
Well, yeah, my only point was, is that if you're if you're targeting 110, and you know, your blood sugar's rising, and the system says, Oh, it's coming, you know, that's happening, I'll do what I did yesterday. And that'll work except that you've made some, yeah, here's, here's a better way to think of it maybe, if you are getting low overnight, for example, and the algorithm is stopping that low by taking away basil, you may have had less basil than your body really needs, you know, four or five o'clock, six o'clock in the morning, because of, I don't know, a bed Bolus, she made it about three o'clock, who knows. But when you wake up in the morning, the algorithm doesn't know to you know, that your toast is going to hit you extra hard now, because you really haven't had your full Basal for the last three hours. Like you kind of have to know that. And yeah, you know what I mean?
Cari Berget, MPH, RN, CDE 59:08
Right? That's a really good example, because it does show the interaction between, you know, things that the algorithm doesn't, and that's a perfect example of, of that kind of perspective. And that, oh, what's the word like, kind of the vision the that you see that that insight of, oh, look, I'm about to eat breakfast, I see that the system has suspended my basil for the last hour. And if I when I eat this toast, it's going to have a huge impact because I've got very little if any insulin currently working in the system. So in those cases, you know, Pre-Bolus saying as far ahead as possible, makes a really big difference because, you know, you get you make sure you have some insulin starting to work before you, you know, eat get those carbs in the system
Scott Benner 59:59
x One. I feel like care. Tell me something. I feel like we've done a good job here. Do you not agree?
Cari Berget, MPH, RN, CDE 1:00:07
I do.
Scott Benner 1:00:10
You're looking at the same notes I'm looking at. And I feel like we covered so much of it. Without getting to it in the notes, does that makes sense to you? Sure.
Cari Berget, MPH, RN, CDE 1:00:18
I, I haven't even looked at the notes. So I mean, I'm glad that you think we're covering it
Scott Benner 1:00:23
carry on me.
Cari Berget, MPH, RN, CDE 1:00:27
I mean, I've looked at the notes, but I didn't want to make a bunch of noise there right here. But I, yeah, I've seen them before. Yes, we're doing we're we're doing great.
Scott Benner 1:00:35
Okay. So I just wanted to sit down for a second and go through a couple of ideas about just making sure people understand what the adaptive Basal rate is. But I feel like we've done that. No, I'm just gonna run through them. And you tell me if you think we've done it, adaptive Basal rate is a baseline for automated insulin delivery. It is the insulin delivery calculated in units per hour than the smart adjust technology continues to change over time as only part five is used. And this is all of course, based on your total daily insulin. Yes, okay. Adaptive Basal rate is based on the total amount of Basal and Bolus insulin delivered in a 24 hour day or the total daily insulin again, updates with each pod change based on the previous insulin history to best match the user's needs.
Cari Berget, MPH, RN, CDE 1:01:21
That is true. I'd like to add one thing, this is a very common question. Can you what how do you know what your adaptive Basal rate is? The short answer is you don't? And there's no way to know you can't find it out. So we should probably get that out of the way.
Scott Benner 1:01:37
Yeah. Okay. And if for some reason, and I know, it's not a not fun to think of, but if for some reason your controller explodes, like you drop it in the pool, or you throw it across the street for some, I don't know what you might do to make it break apart. But if that happens, you are starting over again, when that next pod goes on. Yes, yes. Yeah. So I want to point out, always know, what you're like, know, your settings as best you can, right? Right. Like whatever you put to that thing, the first time write them down somewhere, don't just, you know, don't just go I don't know, know what your total daily insulin is like that, I think is incredibly important, right? Because then at the very least, even if you're just like, I don't know, any of these settings anymore, you can at least look at the total daily insulin, you could say to yourself, Okay, let me just take 50% of this and make it or break it up over 24 hours and make that the Basal. And I'll take the rest of this, and I'll look at some of my carbs, and I'll figure out my insulin to carb ratio. And these would be good restarting settings. That's a very basic way to think about it. But but at least you'd be getting that total daily insulin set in there. Does that make sense to you?
Cari Berget, MPH, RN, CDE 1:02:43
Yeah, no, it does end. But the only thing I would add to that is, you know, your insulin needs can change over time. So depending on how long it's been, since you started, before you broke your controller, I mean, if it's been a year, and your manual mode, Basal rates haven't been changed at all, they might be slightly off, if your total daily insulin has actually gone up any
Scott Benner 1:03:08
number of 1000s, changed your activity, a few pounds, lost a few pounds, etc, etc.
Cari Berget, MPH, RN, CDE 1:03:13
So the best way to really keep track of that information is to have your Omnipod five linked to gluco. Because this is one of my favorite things as a healthcare professional, because if you link your Omnipod, five to gluco, which is a data management system that you can summarize, you can get reports that summarize your insulin delivery and glucose control, then you can just log if you break your controller, you can log into gluco. And you can see what the settings were, and how much and you can see how much what your average total daily insulin has been okay, and so, and that it'll walk you through doing that when you go to the setup screens. So I highly recommend doing that and not skipping that part. Because it's, it's really cool. And then once you're set up, it will automatically upload the pump to gluco via the cloud without you having to do anything, you don't have to manually upload it. And then when you show up to see your your doctor, the data is already there, and everyone is so happy.
Scott Benner 1:04:15
I like not having to do anything that makes sense. So so keep track on your own use paper. If you still have a pencil on your house or use your computer or your phone. Most people just use their phones, right Carrie I sound very old now when I send someone to use their phones. Yeah. So keep track of all your settings and and utilize glucose. Glucose is free, right?
Cari Berget, MPH, RN, CDE 1:04:36
Yeah. And when you go through the setup, it will it'll walk you through pairing it and if you don't have a Google account, it will walk you through like creating one and everything.
Scott Benner 1:04:44
Okay. What can I see? So you've had a lot of experience with with the system and with the controller. So what can I see as a user day to day like what do I have access to?
Cari Berget, MPH, RN, CDE 1:04:57
On the controller? Yeah, like Can the app itself?
Scott Benner 1:05:01
Yeah, like, like, do I just see oh, it made a Bolus or do I see, you know how much it used?
Cari Berget, MPH, RN, CDE 1:05:07
Yeah, so what you can see on the main screen is you can see this current CGM glucose value and trend arrow. Because you've, you've paired the transmitter into your Omni pod five, so it can, the pod will send that duck that information to the PDM. So you can see the CGM data on the Omni pod five app. So you can see the CGM value and current trend arrow, you can see how much insulin on board you have. And you can see your last Bolus, it's very similar appearance to the dash interface very, very similar. So you can see the last bullet you gave and how much that was. And then there is a way that you can expand the CGM graph, you can, you can see the last three hours of the CGM values and on that graph, you can also see the insulin on board and the current CGM value as well. And then you can get a visual representation of the automated delivery. So at the bottom of the CGM graph, you can see if you're in automated delivery, or manual delivery, and then you can also see visually if the algorithm is at maximum delivery, or suspension. So you can see things categorically, but it won't show you the exact amounts. Okay. However, you could go to the history, if you want to see each five minute, you know, micro delivery that, you know, or adaptive Basal delivery, if you are so inclined. I mean,
Scott Benner 1:06:41
I think it's, it's pretty obvious, right, that the system is set up to try to take away your burden, and so that you're not constantly worried and looking and, you know, overwhelmed. I mean, I think, you know, I'm going to put my, my personal opinion in here, I think Omnipod five, for most people is going to be an incredible improvement for them. You know, like just an incredible improvement and, and getting it set up and getting it rolling is the crux of the whole thing, right? It's just why we're talking about it, because what's beyond this should very well be some fairly smooth sailing, where the algorithms learning and keeping up with you and making adjustments where it's necessary. And even you're learning as you go along. How to how to Bolus for your meals better, or how to think about things as far as the way the system works. And, and hopefully you're, you know, you're you're, you're feeling a weight lifted at some point.
Cari Berget, MPH, RN, CDE 1:07:31
Yeah, I think so. I mean, I think there's a lot of potential here for a lot of people to get much better blood sugar control than what they've been able to, you know, to get on a manual pump, as well as more stability. Because the other thing I think we often don't talk about is glycemic variability, just the ups and the downs. So sometimes the average looks fine. But when you really go and look at it, you know, yeah, you're spending 50% of your time high and 50% your time low. So this helps you kind of find the balance and be more stable with less big fluctuations. Yeah. And sleep. That's the thing,
Scott Benner 1:08:08
you still might think, oh, go ahead. Go ahead.
Cari Berget, MPH, RN, CDE 1:08:11
I was gonna say that's, that's the thing, especially for for parents. And you know, I worked in pediatrics, I always want to give that disclaimer, I don't really know much about adults. But for parents getting to sleep at night is the constant theme that that I hear, because not only is the blood sugar improved overnight, it's the stability that you just get to sleep the whole night. And that's just not something many parents and kids really experience so
Scott Benner 1:08:40
I have never slept so well, as I have, since some automated insulin delivery has become a reality. So and it sounds
Cari Berget, MPH, RN, CDE 1:08:49
overnight, it's really very exciting. If you think about it, it's half of your day. So I mean, it's, it's also super encouraging that, you know, the nighttime tends to be relatively, like, really reliable, like you can really rely that for almost everybody, like it's just it is gonna help overnight
Scott Benner 1:09:07
for sure. I think also, he had kids that go on sleepovers, or, you know, adult who's got a real heavy sleeper or no, you know, next to them or nobody next to them, they're on the road. I always think that being an adult with type one and living by yourself has got to add an extra amount of anxiety to your life. You got kids going away to college, all these things. It's just, it's, listen, I'm a huge fan of the stuff I have been saying on this podcast for years, that you do not want to get stuck in how it's done. Because, you know, people are gonna make advancements and you don't want to be back with like, Oh, I'm still peeing on this test strip. Is that not the way we're doing it anymore? You know? And so this is, it's a big deal. It really is. I can't I don't think I can quite say enough. What a big deal. Yeah,
Cari Berget, MPH, RN, CDE 1:09:53
it's a really exciting time, you know, and it's only gonna get more and more exciting as we go. I think I think we're just at the beginning. Okay,
Scott Benner 1:09:59
we're gonna hammer through couple of questions here. And then we're gonna we're gonna button this up, try to keep it around an hour, right? Okay. Realistically, how long should I expect it to take for the system to adapt, optimize the insulin delivery, do its thing, what did you see during the, during your time with it,
Cari Berget, MPH, RN, CDE 1:10:17
I think a couple of weeks is a is a good expectation to set for yourself that you've got to give it a couple of weeks, you know, three or four pods for it to really get some time to adapt. And then the other thing is that it's not even just the adaptive basil and figuring out the total, you know, giving the algorithm time to figure out the total daily insulin. That's obviously a huge part of it. But it is very, very common. And this has been true with every automated insulin delivery system I've worked with, you almost always need stronger carb ratios on an automated system compared to a manual system. And again, like, work with your doctor and look at this stuff, and talk about what your carb ratio should be. But if you're running high after meals, don't hesitate to reach out because there is something that can be done. Oftentimes, you just need to strengthen the carb ratios. And it's not a bad thing, it doesn't mean the system's not working. It's expected it's it's a dynamic Basal delivery, that's totally different than a manual pump, where it's just statically delivering. So because it's dynamic, you're going to have periods where it's turning off and then turning back on. And oftentimes leading up to a meal, you have less insulin on board, because there's been suspensions, because you're getting back to that target. And so, because of that, naturally, you're going to need a stronger carb ratio than maybe you used before. So keep that in the back of your mind. Because after those couple of weeks, if you're still running high, or higher than you'd like or high after meals, specifically, reach out to your doctor and in fine tune those carb ratios because it can make a huge difference.
Scott Benner 1:11:58
Well, it really does depend, I guess, on the person or its individual, how long it's going to take days, weeks, plus all the other stuff that we just spoke about.
Cari Berget, MPH, RN, CDE 1:12:06
Yeah, I would agree with that. I mean, everything's individualized. But I would say, you know, give it a couple of weeks. And if you're not where you want to be, you know, reach out to your health care provider to help you because there's probably, you know, some Bolus settings that can be adjusted to really help you get where you want to go.
Scott Benner 1:12:23
Let me ask you a question. Because you've seen so many people on it attached to this idea. Is there something I can be looking for that shows that we're moving in the right direction? Like, when's the when's the part where I go? Ooh, maybe I will call my doctor here. I think we're, we're at a point where maybe we've plateaued?
Cari Berget, MPH, RN, CDE 1:12:41
Yeah, that's a great question. Ooh, that's a hard question. Um, I mean, I'm a big, big picture person. I think time and range is the most important thing. And so if your timing range is not getting to where, you know, you want it to be, and you should be able to get it, you know, above 70%, and meet those targets. You know, reach out and, and help have your doctor help you get there.
Scott Benner 1:13:07
Okay, I guess in in the end, you can paint that picture to your doctor as well. And let them help you make the decision. If you can't decide if you're seeing Yeah, man or not. Carrie, I find that thinking about insulin is like a time travel movie, right? Like insulin I use now is for later. But really insulin that's happening now was from before, and it always helps to have another person to talk about that with. So you don't get a little lost. You know what I mean? Like, it's great to talk to your healthcare provider, your nurse practitioner, whoever it is that you're making those decisions with, because it's nice to just have another person to bounce it off of sometimes because, you know, like, at some point, you're sitting in the theater, and you're like, I don't understand how to slow those down. Like, you know, like, you need somebody else to chat with about it and, and make good sense of it. You sound like you would be a good person to do it. With.
Cari Berget, MPH, RN, CDE 1:13:56
Oh, well, thank you. I really enjoy it. And I do it a lot. So love working with people to get those carb ratios. Right,
Scott Benner 1:14:03
right. So if I even if I start the pod, and I'm like, Oh, God, I used all the wrong settings. I just might have to wait a little longer for it to figure it out.
Cari Berget, MPH, RN, CDE 1:14:11
Yeah, exactly. Yeah, you might just have to wait a little longer, but it will get there. It will all be okay.
Scott Benner 1:14:17
Okay, so time settings. bolusing. You know, the way you need to Bolus whether that means amount or timing, timing and amount, such a big deal. And then just let Omnipod five do its thing.
Cari Berget, MPH, RN, CDE 1:14:32
Yeah. And can I make one more comment about that? So the other thing is, like I already told you like, I highly recommend following the Bolus calculator for correction doses so that you can work with the system and not against it. But if you find that it's always recommending zero, and you're still running high, again, you don't have to just sit there it could be that your correction factor is two Hi, it needs to be stronger. I find that correction factor is like the forgotten about setting often. In pump therapy, you know, we're all in manual therapy, we're always tweaking the basals. And we often change the carb ratios, and we hardly ever do anything with the correction factor. And so I see this, you know, 15 year old and they have the same correction factor from when they were six
Scott Benner 1:15:22
was 350 points. Yeah, it's like, I don't think
Cari Berget, MPH, RN, CDE 1:15:25
that one unit is going to drop the 300 points anymore, you know, so the correction factor, yeah, it needs some attention to sometimes, you know, yeah.
Scott Benner 1:15:34
And I know it's, you know, it's, it sounds super simple. But the idea of, you know, if your correction factor is one unit moves you 50 points, but you haven't looked at it since you were five years old back when it was one unit moved to 350. Now you're trying to adjust the high blood sugar, and you have no hope of that working. And on top of that, you've told the algorithm this should work. And you've given a bad information.
Cari Berget, MPH, RN, CDE 1:15:59
Yeah, isn't the Bolus calculator is just going to use whatever is programmed in there to as part of his calculation, so Right, yeah, it makes a big difference.
Scott Benner 1:16:06
Okay. Well, I think this is a great time to break and say that we hope we see you in part two, where we're going to do a deeper dive on settings.
I'd like to thank Carrie Birgit for being on the show today and sharing her knowledge about the Omni pod five with us. And a huge thanks to the listeners of the podcasts who shared questions and comments that led to the building of these three episodes. If you're interested in getting started with the Omni pod five, we're learning more about it, go to Omni pod.com forward slash juicebox. And don't forget that these episodes will be available in your audio app forever. But you can also find them at juicebox podcast.com forward slash Omni pod five. This episode was just part one of a three part series, you still have Omni pod five pro tip settings and Omni pod five pro tip connectivity to listen to. If you found this episode helpful, and you're new to the podcast, be sure to subscribe or follow in your audio app for more diabetes and on the pod five content. Thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. A huge thanks to athletic greens and contour for sponsoring this episode of the Best of the Juicebox Podcast. Get started today with that green drink ag one from athletic greens, athletic greens.com forward slash juice box you and I could be doing the same thing every morning together except not really together. But I mean, we you know what I mean? And of course, you want you need you deserve an accurate blood glucose meter contour, next gen at contour next.com forward slash juicebox. When you click on the links, you're supporting the podcast and I appreciate it very much. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
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#899 Diabetes Pro Tip: Transitioning
Diabetes Pro Tip: Transitioning
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends, and welcome to episode 899 of the Juicebox Podcast.
My diabetes Pro Tip series for type one diabetes began in February of 2019. Today I'm adding another episode. Jenny Smith and I are going to be talking about transitioning. We're going to do an overview of transitioning from your blood glucose meter to a CGM, from MDI, to pumping from pumping to algorithm pumping. And at the end of the episode, I'm going to add feedback from Juicebox Podcast listeners about all of these topics. 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 are becoming bold with insulin. If you'd like to help type one diabetes research, all you have to do is complete the survey AT T one D exchange.org. Forward slash juicebox. The T one D exchange is looking for US residents who have type one diabetes, or are the caregiver of someone with type one to complete a very short and simple survey. The answers that you give will help move type one research forward T one D exchange.org. Forward slash juicebox.
The diabetes Pro Tip series from the Juicebox Podcast began on February 25 2019, with an episode called newly diagnosed restarting over after that episode 211 was all about MDI episode 212 all about insulin, Episode 217 Pre-Bolus Singh, Episode 218 Temp Basal 219 Insulin pumping to 24 mastering a CGM to 25 Bump and nudge to 26 the perfect Bolus to 31 variables 237 setting Basal insulin 256 Exercise 263 fat and protein 287 illness injury and surgery episode 301 was glucagon and low blood sugars episode 307 Emergency Room protocols episode 311 long term health 350 Bumping nudge to 360 for pregnancy 371 explaining type one episode 391 was glycemic index and load 449 postpartum 470 weight loss 608 Honeymoon 612 female hormones and today episode 899 transitioning, you can find these episodes in your audio app Spotify, Apple podcasts or anywhere you get audio. You can also find them at juicebox podcast.com. And at diabetes pro tip.com. As always, these episodes and the entire podcast are absolutely free for you to listen to the information inside of this podcast. And more specifically inside of this Pro Tip series. This information is at the core of how my daughter has kept her a one C between five two and six two for over eight years without diet restrictions. Myself and Jenny Smith Jenny of course is a CDE who works at integrated diabetes.com Jenny and I we go over the topics go over the ideas in easy to listen to and digestible ways you can apply this information to your life whether you're an adult with type one who's been living with it forever, or a parent whose child was just diagnosed, I implore you to check out the entire series. It really will help. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy Earth sells sheets and towels and joggers and comfortable things really that's what I should have said cozy Earth has comfortable things whether it's sheets or towels or clothing. It is soft, it is warm. Unless you don't want it to be warmed I don't even know how to describe the sheets or they keep you cool or they keep you warm. Depends on what you want. I don't even like I don't know if there's a word for it but your body is temperate in it is temporary the word. I looked it up it is a word it. How do I put this? I wear my cozy Earth gear on an airplane the other day. I wasn't too hot. I wasn't too cold. When I got home. I got my bed with my cozy Earth sheets. I wasn't too hot. I wasn't too cold. Everything is soft. It feels terrific. Check it out at cozy earth.com where the offer code juice box will save you 35% at checkout The podcast has a number of long term sponsors, Omni pod Dexcom contour G voc, US med touched by type one, athletic greens. Of course, you heard about the T one D exchange earlier cozy earth. All of these sponsors are prominently displayed at juicebox podcast.com. Or in the show notes of the podcast player you're listening in right now, when you support those sponsors by clicking on my links or typing in those web addresses, you are supporting the production of this podcast. So please, if you have the need, use my link. What I would like to talk about today is transition. Just a an overview concept for this one, but transition from just finger sticks to CGM transition from MDI, two pumping, transition from pumping to algorithm. Sure, can we do that? Yeah. All right. I thought we could all thank Isabel here for having her finger on the pulse of the people in the Facebook group and knowing exactly what people ask about, and what they seem most confused about. Why don't we start with MDI, because everybody starts there, right? After you're, you're doing it for a while, like, let's put ourselves in that place. We've been doing MDI for a while it's working pretty well, or at least at a baseline. We're shooting a Basal insulin once a day, and we are shooting a meal insulin to correct blood sugars and to cover our carbs. That's the basics of MDI. Okay, correct. So then we're in a doctor's office, but I'm gonna make up some numbers. Let's, let's say our basil. It's like, I don't know, let's say our basil is 10 a day. And let's say were, I don't know, one to 10 for carb ratio. Okay. All right. Let's say our correction is one to 100. Let's keep it all very like, like that, so that it's easier to talk about. Okay, round 10 numbers and numbers, we're gonna do that. So the math makes sense when people are listening. So we're in the doctor's office, and the doctor says, you know, you might like a pump?
Jennifer Smith, CDE 7:24
Is he gonna say it just like that?
Scott Benner 7:25
I mean, if it's a lady, she might be like, You made like a bump? I don't know, like, people are anywhere in between. There's some women have more masculine voices, Jenny, this isn't the point of what we're talking about. Yeah. So they see, you might like a pump. You are. I'm guessing, gonna have a couple of different reactions. I see a lot of people scared. Oh, no, don't change something. I see a lot of people are like, yes, please, because this isn't working. And maybe this will they don't know why they think that just right, they're hoping for a change. So the first thing that's going to happen is the doctor is going to translate your Basal insulin to this pump. So Jenny, you do that math for me? I correct I get 10 units a day injection, what are they going to do on the pump for me
Jennifer Smith, CDE 8:13
most often on a pump, because it's expected that your Basal insulin which and this is kind of outside of it, but within your Basal insulin will now be given by the pump as rapid acting insulin. So that's the first thing to understand is that you're injected Basal insulin, which is a specific long acting kind of insulin will now sit in your refrigerator as a backup in case of pump failure, right? So you don't put Basal insulin into a pump. The only insulin that goes in the pump is your rapid acting insulin of any of the brands, right. Depending on the pump, company, they all have a little bit of different kind of recommendations for type of rapid insulin, but it's a rapid insulin and to translate your Basal dose of what we said 10 units into a pumped Basal delivery, you would essentially take 10 units into a 24 hour day. Right? And that translates into a a dripped amount, right? Because insulin pumps drip drip, drip drip consistently to deliver that total amount of basil that you want.
Scott Benner 9:32
Okay, so let's clean it up for people who get lost very easily. You may be injecting trusty Abba love Amira, Lantis what are the other ones,
Jennifer Smith, CDE 9:43
Basil Glar or these are all based in jail.
Scott Benner 9:46
These are basil insulins. These are now gone. You don't use those anymore, because as Jenny points out, you're going to take your mealtime or your fast acting correction insulin, put it in the pump, and it's going to split it up. Those 10 units are going to get split up Over, not just over hours, that's how the settings the pump work, right? You're gonna come up with what is it going to be like point four, maybe an hour if you're 10 a day about like that, right?
Jennifer Smith, CDE 10:10
Right, depending on your pump, all of the pumps differ in their precision of a single drip of insulin. Some pumps can drip as little as point one, one, some can drip as little as point oh, two, five or point oh, five. So it just depends. But if you broke this down 10 units a day into 24 hours a day would be a rate of about point four, two, if you do rounding, right? Yes, some pumps, you may have to round that 2.4, because they can't deliver the point oh two.
Scott Benner 10:42
And you're, you're gonna hear that if you're MBI. and think, oh, at the top of every hour, it's gonna give me point 14 incidents on but it's not doing that it's going to break the rack to wait for Twos Up over the entire hour
Jennifer Smith, CDE 10:53
over the course of the time. Exactly. Now, the other step to this calculation is that we expect that your Basal insulin you've been injecting I'm trying to think how to say it. So people don't think their insulin is not working. But when you inject Basal insulin as its type it, it will not be absorbed as efficiently I guess is the better way to say it as it would from a pump where it gets infused in those little tiny drips over a very precise amount of time, a very precise dose. So your rapid insulin in your pump gets infused out of sight. And so we usually take your base Basal dose down by about 10%. Some, some physicians even go down by 20%. But the general idea is taking your base dose down by 10%. So 10 units a day taken down by 10% is one unit less, so nine units instead of 10 units. So if you do the math there, nine into 24 gets your rate down instead of point, let's call it point for an hour, down 2.37 an hour, which again, we'd probably round down to point three, five.
Scott Benner 12:05
And you're going to want to keep an eye on that because I've seen it go either way. I've seen that be right. And it's amazing. I've seen that be now not enough insulin, and people are getting high blood sugars. And they immediately like you hear them say like the pump doesn't work like well, you gave yourself less insulin and turns out you need right. So pay close attention to that.
Jennifer Smith, CDE 12:27
It also translates into the next step. Once you've been making some notes on this 24 hour dose of let's call it point three, five units an hour. And you can say Well, it seems okay here. But then at this time of the day, I'm always high no matter what I can skip eating and I'm high I can eat and I go even higher. Well, that's when the next step is Basal testing. Right, we need to really look at it and say, where is that point? Three, five, sufficient and where is it not? And where might it be too much.
Scott Benner 13:01
And you might notice, and this, this might sound a little heavy if you're thinking of switching but you could put your pump on your belly and have a different reaction to the insulin that is if it's on your hip or your thigh, you know, there's reasons like Arden's thigh doesn't work as well as her stomach does,
Jennifer Smith, CDE 13:19
you know, neither does mine, I don't use my thighs anymore. Yeah, back of your arm might
Scott Benner 13:23
be better than your, the back of your butt. Or who knows, like right and with
Jennifer Smith, CDE 13:27
with this being new from coming from MDI, to going to using a pump, I would suggest initially utilizing and testing out within an area of the body, you know, we talk a lot about rotation, not only should you be rotating, if you're doing MDI, your injection should be going multiple different places, not just the same site over and over. The same goes along with pumping, those sites need to be rotated. If you're new to pumping, however, you really want to get an idea if your settings are fairly good. Stick with rotating around your abdomen, right? Get an idea. And then once you have that fairly well set, you can then move to upper body or the back of the arm or maybe your thigh or you know your lower back and see if you notice any difference some people do and some people don't at all.
Scott Benner 14:19
No, right? No. I mean, there's it's your body composition, hydration, how you know where it's actually going inside of you. Is it subcutaneous Is it very close to a muscle? We don't overwhelm people, but the muscle can kind of I don't know what the term is like what a large muscle group can. It kind of lessens the impact of the insulin but for the life of me, I can't think of why right now. Do you know what I mean?
Jennifer Smith, CDE 14:44
lessons? I know I don't know what you mean.
Scott Benner 14:46
I always thought that's why the thigh wasn't a good spot because it was a large muscle.
Jennifer Smith, CDE 14:51
Well, it might have more to do with how well the insulin at that site is getting absorbed. Like that's a big reason that I don't use My thighs is because whenever I tried using it, either I got a clusion alarms because the cannula was bumping into muscle or potentially that I had nicked, like a small vessel under and it had been clouded kind of near that site were was trying to infuse. And so that backs up into the pump and the pump tells you hey, the delivery of insulin has stopped. It gives you nice alarms. Right? So I think in some cases that may be part of the issue is the proximity to muscle, yes. But also I it was either painful or I got occlusions like it just never worked on my thighs.
Scott Benner 15:41
Okay, I'll say, Look, I'm learning from the podcast. Finally. Finally, I learned about this every day, you learn a lot. Okay, so now we've, I think here's a good place to insert that it is possible that there are some people on MDI who are achieving reasonable lower blood sugar's some how do I say this? Sometimes your doctors over baseline you because they don't think you're covering your food correctly. And
Jennifer Smith, CDE 16:12
or they may not have looked at your records enough to know why they've you know what I mean? Like, it might just be easier to backup with enough Basil with what they're seeing in your data. Yeah. And it may as you're saying, it might be wrong,
Scott Benner 16:26
right, right. So like, imagine if you're a person who has been getting more basil than they really technically need, but you kind of forget meals, sometimes you don't cover all your food. But now all of a sudden, you have this pump, you're like, Oh, it's so easy. Now, I just push the buttons for my foods, and now you're covering your meals well, and you're like, why am I low all the time? Right? It might be because you're using more insulin than you have been in the past. So those are things to look for that I see people struggle with the beginning with a pump. And I do want to say I think there's a, I think there's a period of transition there. It's not going to be like if you're nervous. It's not unfounded, you know, like you are starting a whole new way of doing something. But it really is just another way of delivering insulin to you. It's not that complicated.
Jennifer Smith, CDE 17:16
And I can say personally, when I switched from MDI, having done MDI, a long time before I started using a pump. By the time I started using a pump I was already doing. I was already doing somewhat of a Pre-Bolus. But it wasn't the same once I switched to a pump, there was a definite time difference between my Pre-Bolus with injections, and there still is, yeah, I can take an injection and my Pre-Bolus Time is not as long as it is on a pump. Right? Again, and of one. But that's what I noticed. And so those are some things to pay attention to between MDI and what you're doing along with what you said about maybe the doses you were taking on MDI, were covering a certain way for your rapid insulin for meals and corrections. And now that you're on a pump, your meals, the food hasn't changed, your strategy has stayed the same. And things are looking
Scott Benner 18:14
weird, right, right there, you do have to step back a lot and try to see what's happening. One reasonable reason for that could be reasonable reason why it wasn't right. But anyway, you use an omni pod and delivers insulin a little slowly. Like it doesn't just like you take a needle and you go Yeah, the pump is pumping over time. And I don't imagine you use very large bonuses, but larger bonuses take longer. I've seen I've sat at a restaurant with Arden and, you know, you forget you've done it and you kind of still here like that, like think like click clicking. It's still giving her insolence feels like it's been five minutes, you know, and yeah, so that's, that could be part of it. Anyway, these are things you're going to learn along the way. They're new lessons, but they're not a reason not just try, because you're going to gain what you're gonna gain so much, right? Like if, to me a pump is at its core, I've always thought of pumping as a way to be able to manipulate basil. Whereas on MDI, I shoot it in, it's in there, nothing left to do. If it's too much, if it's too little, it's what it is, you know, with MD with a with a pump, you know, you can go back and listen to the Pro Tip series. I think about like, wow, if we sit down to a meal, that's all of a sudden much carb heavier than what I usually eat, I could do a Temp Basal increase, they try to help me with this. You know, I was thinking a minute ago when we were talking about breaking the 10 units down into point 4.35 That if you think about putting a sprinkler out on a dry, dry lawn, right, and you need to give your lawn 10 Guys gallons of water, you could come along and dump it on all at once, it'll just be there, that'll be it right, or it could break it up into a little point three, five gallons every hour and go back and forth. And just a light covering, covering, covering, covering, you're never gonna soak it down, you're and it's just I think of basil like sort of like that. Sometimes you're just,
Jennifer Smith, CDE 20:20
and that's a good way to think about it too. Because if you consider that slow Basal drip that you are getting from a pump, when you inject your Basal insulin all in one clump, right? You can, depending on the kind of activity you like to do, you may have found that you have to pay attention to Gosh, I'm doing like a really heavy arm workout, I'm probably not going to inject my Basal insulin into my arm today, I might inject it someplace else, right? Because there's this whopping dose sitting underneath your skin. And any kind of insulin, whether it's rapid, or Basal can get enhanced in action, the more active you are, and especially if you're using that site. So, you know, those are the kinds of things that having those tinier doses that you can manipulate and adjust, especially with the variables that you know, are coming in the day.
Scott Benner 21:21
If somebody's listening and thinking like, well, they have spent the first 15 minutes talking about Basal insulin, it's because it's really important, and nobody tells you it's important setting. So if you listen to this podcast, like while I do MDI, they're always talking about, like, their settings on their pump or anything. This is still settings, you know, if it's MDI, it's your settings, it's, you know, these Basal carb ratio, correction factor, they're all settings. So it's just very important to have them. If they're not accurate to your needs, then everything else is just going to be a mess. And especially Basil, basil is wrong. The whole day is confused. So okay, so we've translated our basil, our insulin to carb ratio, does the doctor keep it the same? Do they usually like what is common?
Jennifer Smith, CDE 22:06
They may keep it the same, especially if your records prove to show that it seems to be for the most part working fairly. Okay. Right? Could there be improvement somewhere, possibly, or whatever, maybe that's also part of the reason that they feel like a pump might actually be better. Maybe you're the kind of person that just eats really slow digesting food. And so you've had problems with taking your insulin and having these big drops in your blood sugar too fast, and then it ends up catching up with you. And then you end up high later, and you've treated low blood sugars, right? And there's not a timing thing that you can really get quite right with MDI. And maybe the doctor says, Well, why don't we try a pump, because hey, you're eating these types of foods more frequently, we could actually use some of the smart features on our conventional pumps that allow you to take some insulin for food, we're calling these extended boluses. And you can just kind of like basil. It's almost like a secondary use of basil. But for a Bolus, where you drip drip, drip drip drip a Bolus in over a certain amount of designated time, you
Scott Benner 23:13
know, there's just, there's so much you're gonna get out of having a pump there, there's also going to be some things you need to know, sites can, like they're going to tell you whatever pump you have, they're gonna say this pump you can wear for X amount of days, or X amount of hours. But sometimes sites go bad. You know, sometimes new sites don't work as well in the beginning. Those are little things that you'll learn along the way. There's, if depending on Arden's blood sugar, she might put on a new pod, and we might just Bolus a little bit to get the site working. This morning. I woke up in the morning, I saw that artists blood sugar was trending up overnight. And listen, for those of you just switching like Arden is looping, but I can see how much insulin is left on a pod remotely, which most of you aren't gonna be able to see. But I can see she was down to like 30 units. So this is the end of her sight, right. And I just spent the weekend with her. And doesn't matter. But we were in a lot of restaurants this weekend. So Arden got a lot of insulin this weekend. And in my heart, her blood sugar is drifting up because this site is kind of done. So because you have experience, yes, I can just tell and you will be able to one day as well. So I sent her a text and I said I wouldn't go to class with this pump one. Because if she does, she's going to spend her whole day with blood sugar around 150 And she's going to be fighting with them constantly. And bolusing and they're not going to work and and by the way, if that happens, and then all of a sudden she gets crazy active out of nowhere. She might experience a low blood sugar from all this insulin kind of sitting in this right over us. Yeah, getting this pole right. And so like that's Here's the thing you'll learn along the way, you'll learn, you know what people worry about so much like, well, you know, do you travel with pumps? If we go too far from our house, we do. If it's a 15 minute turnaround, we don't like, you know, what, I'm gonna have to have insulin with me now, like, I don't know, we don't travel with insulin that frequently, as long as we're in your home base, you know. But if we go far, you know, half hour, 45 minutes, and it's not something we want to turn back from, we'll take insulin with us, you know, you just you, my point is, is that it becomes all second nature at some point. Just like everything else about diabetes, you're gonna have experiences they're going to teach you, you'll learn from them and move on. Speaking of moving on, you'll think I'm gonna go from MDI to pumping, to pumping to algorithm pumping, but I want to do CGM is first. So you have a meter. And that's how you check your blood sugar. And that's all you have. When you're in the doctor's office. The doctor is like, you know what you want to do?
Jennifer Smith, CDE 25:59
It must be the same doctor.
Scott Benner 26:01
I got one of the drawer here. Take this a sample you try. You'll love it. They're gonna try to give you they're gonna say to you, hey, you might want to leave Ray, you might want to Dexcom if you're on a Medtronic pump, they might ask you to do whatever the Medtronic CGM is called. And you're gonna say I don't need that or you're going to be newer. You're gonna Yes, please.
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Wherever you fall on that you do want it. Your insurance covers it you want it? That's for sure. Right? Tell me why.
Jennifer Smith, CDE 28:49
And I think it applies in all realms of diabetes as well. Right? Not just in type one diabetes, but also type two diabetes and even worthwhile and gestational diabetes. I know there are some rules in terms of when it can be prescribed whatnot. But I think it's beneficial all around what you miss with finger sticks are all of the little dots in between. So where things are trending, right, so if it is something that your doctor does bring up? Absolutely say yes. Right. You may not know how to look at the information or what you're getting from it initially. But it's so worthwhile.
Scott Benner 29:30
You want to know what you don't know. And with finger sticks, especially if you're newer to diabetes, or if you just been doing them your whole life and this is how you tend to think of it. You do the well i i test before I eat or I test before I go to bed or I test before I drive. And right. And I know you've asked yourself what's happening when I'm not looking right like and if you haven't asked yourself that. I wonder how do I go from two 50 to 50 in an hour, like how does that happen? And you'll learn you'll start seeing the impacts of activity and the lack of hydration, and different foods that you eat. The age of your, your insulin pumps cite all these different things that have a huge impact on the way your blood sugar moves. And now suddenly, it's there. A CGM is going to show you minute by minute. I think it's every five minutes. Right.
Jennifer Smith, CDE 30:32
And I think there are there are some people who have been using it long enough that can say, there can be some frustration around the amount of data that you get. And I wouldn't disagree with that I but I do think it's how you interact with the data, right? It's how you actually take a look at things and what you do with it and what you learn from it. And you'd have to, you have to expect that in the first month. Let's call it of using a CGM, you're gonna see a lot of stuff. And so rather than being so very emotionally reactive, again, taking a step back and kind of looking at the data to be able to make better decisions about what you felt like was probably happening, and now you can actually see it
Scott Benner 31:21
right. Well imagine you have your sprinkler out on the yard, and you have to keep the dirt moist because you've planted grass seeds, except every time you look out, it's kind of dry. That's the CGM. You look at the CGM ago Oh, from 3am till 6am. My blood sugar's 140. It's pretty stable, but it's 140. I wish it was lower or moister. I can turn up the sprinkler a little and put on a little more insulin and make it where I want it to be like push that number download
Jennifer Smith, CDE 31:48
and the CGM can show you that if you're really looking at it. That way the CGM can show you where did it start to lose? Right effect? Where do I start to need to add more insulin? It's not once you get stuck higher or once you get stuck lower than you want. It's before that so any drifts up or drifts down. You can see that very clearly on a CGM I, you have a really good example I think from when Arden first started using her CGM, it was like that overnight thing that you were constantly missing was at Lowe's when you had finger sticks, and I would put all you could see them.
Scott Benner 32:27
I thought I was a genius. I've said it before I would put Arden to bed at 180. And she'd wake up at 90. And I was like, Look how good I am at this. And what would happen. We put a CGM on her. She was 180, she'd go down to the 50s sit there for hours, I'm assuming her liver would be like, hey here, try not to die. Here's some, you know, here's some, here's some glucagon, I'll give you a little bit. And then she drift up to 90 overnight. It was happening constantly. So the reasons for that are mind numbing is not for this conversation. But we were bad at bolusing for dinner. We were her basil wasn't like there were so many things that weren't right.
Jennifer Smith, CDE 33:03
But you didn't know it because you couldn't see what was happening unless you really did a finger stick even an hourly finger stick, it would have caught a drift. But it still would right? But it would have still been confusing unless you've sat down and you connected all those dots. And you could say, well look, look at this. And you probably I mean not necessarily wanting to see your child sit at 50 for three hours before your body actually reacts and gets you the glucose that is needed to bring it up. But you'd have on a first finger stick probably under 70, you would have ended up treating so you also wouldn't have had the information to show. Well, how much do we need to take away? And what do we need to do differently?
Scott Benner 33:45
I can't I can't say how valuable it is to be able to see a graph and to enter look at it every three hours or you know what's it look like over six hours, like Jenny's point is great as the you you don't know why? What happened happened? It's um, if you're married here, it's nine o'clock at night. And you're now in an argument. Right? And you think I don't know what just happened. But mostly this is guys like they're like what? They searched the last five minutes their brain and I've not done anything wrong in the last five minutes. But if you could step back and see a whole graph of your day, you'd realize that at 630 at dinner, you said something really stupid, and now it's hit me at nine o'clock. So I think that that can be similar. You could have cheeseburger with french fries at dinner at eight o'clock at a restaurant and hit it with a great Bolus. And you're like, oh, wow, my blood sugar's still where I want it to be it's 140 After dinner, that's not bad. And two hours later, it starts to jump up. And that doesn't make any sense to you because you haven't listened to the Pro Tip series. You don't know about the fat and the French fries and the slow digestion and how your blood sugar is gonna go up afterwards. But at least if you see it on a graph, and then you go have those French fries and that burger again. You see it happen again. You can go Oh, I could get get ahead of this, right? Yeah, I could not say that stupid thing at dinner. And now we'd be watching television and she wouldn't be yelling at me.
Jennifer Smith, CDE 35:06
Right. And if you have a pump, you can also address it a different way than waiting for it to finally start rising and getting too high, you can offset it ahead of time knowing what is coming, because you've had the experience that, oh, it always hits around two hours. So I'm going to start doing something about an hour and a half before that. So that it actually doesn't happen. Right. So I mean, yeah, it's million
Scott Benner 35:32
ways to handle that if you're Yes, right. For for art in an hour after she has french fries, we have to Bolus for the fat. And there's a calculation you can do. And there's that heads off that secondary rise and doesn't cause a low later. That's the other great thing is the everyone. When you don't have enough data, you think, Oh, if I just keep throwing more insulin here and there, it's gonna be it's not true. Like you can match the need up with the impact of the insulin and never cause a low, right. And that's something you're going to learn looking at a CGM that, that uh, that a stable line on a CGM is really your insulin, your insulins pulling down and your food and your other impacts are pushing up. And neither of them are winning, like so if you can kind of imagine that line going off into affinity nice and stable. There's invisible lines. cables attached to it. One's trying to pull it up. One's trying to pull the line down, and neither can win because you have a great balance between your insulin and your knee. Yeah, so that in the CGM, like, seriously, like, I don't care, like there's Dex comms and advertiser, it's not like I'm saying that like, get a CGM. It's of any,
Jennifer Smith, CDE 36:43
right? Absolutely. I mean, I've said before, many times if somebody was going to take my technology, I would fight for my CGM. Before I'd fight for my palm. Yeah, no 100% would keep my CGM.
Scott Benner 36:58
I'll throw this here too. Even though it's about like, leaving quote unquote, finger sticks, you're never going to leave finger sticks by the way, you're going to need them. You're gonna test when you're not sure about your CGM. You're gonna test when you're making big decisions. I listen to my daughter's blood sugar looks high on her CGM, and we're gonna make a big Bolus. I said, Look, you gotta test we got to know this numbers, right? We can't just start throwing insulin in here. And you're actually 40 points lower than this, or whatever.
Jennifer Smith, CDE 37:23
And I think it's also really important to acknowledge what you know about how you feel around certain blood sugars. Because again, technology. It's wonderful. And it's so much better than it was years ago. But it may still not be accurate at certain points. So always those finger sticks are important to continue to use. Because if your symptoms or how you're feeling doesn't go with what your CGM is reading, I guarantee a finger stick isn't gonna lie to you not unless you still have like, apple juice on your fingers.
Scott Benner 37:58
I was gonna say and I didn't get to it just an accurate meter, just a blood glucose meter. Yes, they're not all the same. They don't all work as well. Don't just take the one that doctor handed you from the drawer, do a tiny bit of research use the one that I that advertises here because that's the one we use and it's amazing and, you know, like or do what you can do your own research and find out I will throw out a little story here. Because I did spend the weekend with my college age daughter, which I haven't done in a while as a visitor at school. Second night she was with me. We replaced her CGM. Okay. So at five o'clock at night, I said, Hey, your Dexcom is going to expire one in the morning. You should switch it now. It's before we're going to eat dinner. We'll get it back online. It will have it we can do some finger sticks through dinner. And then it'll be rolling and working well by the time we go to sleep, because it does take a little while for some people where to look right. You know, she does. I don't want to do that right now. So then when do we change her CGM? 10 o'clock 11 o'clock, you know, like, oh, so then it's done. So then it's wonky for the first couple hours. And for Arden, if her Dexcom is wonky, it's wonky low when she first puts it on minus two. Okay. So like, I mean, it'll be like you're 42. And she's 10. Like that kind of thing. Yep. So there's a lot of consternation in what you should do. I'm a fan of letting it be on for a little while and calibrating it to help it get along a little more. But now we're asleep. And it's like BP people. All I could think was I told I know I said this. Nobody listens to me. But that's fine. And I'm like, and I know she's not that low like and but it's worrying. So now she's, she's asleep. And I get up and I'm checking her blood sugar and she wakes up. She's like, What are you doing? I'm like, your CGM is going off. She goes, I'm fine. It's like okay, so I tested her and she was 130. And I was like, okay, so she's right. And I did a calibration and it came together. Other pretty quickly. And that was it. Having said that, we could have done that at five o'clock. There. So there is a way to time, your technology. Now the new g7 is going to have a shorter warmup period, which will help overlapping you'll be able to soak your sensor, which I'm not going to bother explaining here. But yeah, but as the technology gets better, so should those things. But that is not to say it's not, like hands down. The most valuable thing that's happened to people who have any kind of diabetes. Since I've since I've been aware of diabetes, so absolutely. Okay. All right, Jenny. Now we got our CGM. We're using a pump. We're looking online. And we're like, see, this isn't that the doctor is not gonna go you know, you got to do. That's not gonna happen now because this stuff's also new. Maybe Maybe you're really in tune doctor might say, why don't you get an algorithm? But for the most part, I don't think I think that's the thing you're gonna figure out on your own a little bit. So all this stuff we're talking about about, you know, the Bayes will be incorrect. And you might need a Temp Basal here. You might need an extended Bolus for fat you might need all this. There are pumps that make those decisions autonomously. Yeah, you have to be wearing at this time, you have to be wearing index calm, because it works with that correct. But
Jennifer Smith, CDE 41:19
or med tronics. Um, CGM? Yeah. Because they're their system also works with their pump.
Scott Benner 41:25
Yes. So there's a Medtronic version of this. There's a tandem version of this. There's an Omnipod version of this. All their algorithms are proprietary, they work slightly differently, but long, and the short of it is they're going to give you insulin when you need insulin, and they're going to take insulin away when you don't need it. They're going to endeavor to stop you from getting low, and endeavor to stop you from getting too high. You
Jennifer Smith, CDE 41:48
still know how they do that it was with targets. Yes. Right, right, specific targets in each of the different pump systems. Medtronic newest one was just approved, which is really nice. But they all have specific targets. So how that algorithm works is based on when and how to give you more or less based on a target and based on what the system is projecting off of your current CGM trend. So it's a very interesting, like the algorithms don't just willy nilly deliver or take.
Scott Benner 42:24
Like, I think maybe now more,
Jennifer Smith, CDE 42:26
right? Yeah, exactly. There's a map to the algorithm right
Scott Benner 42:29
Gremlin inside of your pub flipping a coin going, Oh, my God heads. Let's do it. So but it's it's it's stunning. Now there's another version. There's a number of other versions there are Do It Yourself versions. There's Android APs. There's loop. I think, Jenny, you loop. Right. I do. I think you would
Jennifer Smith, CDE 42:48
have been looping for five and a half years.
Scott Benner 42:52
And Arden has been doing it. I think since 2019. Maybe? So yeah. And you're Arden's using loop three, as am I and you just switched to it as well. So like, they're all just different versions of an algorithm making decisions about insulin based on your CGM trend. That's Yep. They're astonishing. They work incredibly well. They are not magic. I know in all settings, all knowing how to Bolus for certain foods, understanding the impacts of things, your digestion, your hydration, like all the things that are important about MDI are the same things that are important about pumping are the same things that are important about using an algorithm.
Jennifer Smith, CDE 43:38
And you made I know, people can't see you, but you were very in a line going from MDI, to pumping to algorithm. And I think that's, it's a really important piece. For those who are listening to understand if you're kind of listening to this, because these are not pieces in your life already. Right, and you want to get an idea. There is 100%, I'd say 1,000% value in learning on MDI. And then moving to a conventional pump, that does not do anything for you, meaning it does not use an algorithm. There's absolute value in that, you know, we talked about testing, and evaluating settings, and learning about all the variables, food and activity and everything and how to adjust your pump or your insulin doses to accommodate for those variables. I think as you mentioned, when you said you owe your pumps, like, hey, let's start on algorithms. I can't go as deep as you. So it's a totally different doctor, right? But in that sense, there are I think more doctors today who are thinking algorithm, but in my personal and professional In all opinion, I think some of them are thinking that too fast. Okay? They are they are moving somebody to, hey, you're MDI, let's move to this algorithm driven system, whatever the system is, whether it's Omnipod, five, or tandem or Medtronic. There is, there's a missing piece in the middle there, that if for some reason, and we talked about CGM is potentially not being always accurate or technology failing. If your pump fails in its algorithmic dosing, and you have nothing to step back to, you're at a loss. And it's important to understand that, you know, so I can't emphasize.
Scott Benner 45:42
It's incredibly important. Jenny's been talking to me about this privately for years. Honestly, she's like, people can't just be put on the machine, the machine does the whole thing. And they don't understand why it's happening. Because, you know, the general argument is, what if the machine stops working? I don't even think that's the need for that. No, I think the need is, is that this is a thing you have to understand. Like it, no matter what none of this machine stuff is at the point where you don't need to know how to how it works. It's not AI, it's not even a computer like you know, used to have to know how to fix your computer, because it would break all the time. Nowadays, you buy a Mac, it'll just do the thing you want it to do, you'll never have to touch it, and it'll die. At the end, you're like, Oh, my Mac doesn't work anymore, you get another one. And you don't need to understand how a computer works. To use a computer. You need to understand how diabetes works. To have diabetes, I don't care what version of care you're using, I don't care what the next one is. Now, if someone magically comes up with something one day, where it just works, no matter what, like a, like a laptop from Apple, okay, then then okay, then God bless. If you want to skip it, then skip it. But I'm still gonna say, that isn't happening anytime soon. Because of not just the things we've mentioned today. You know, your insulin pump site might not work on time, like your CGM might not be right right away, like all the other things, it just not happening anytime soon. So you don't want. The worst thing I can imagine is that you put an algorithm on a nine year old who it works for. And then five years later, the kid hits like puberty hard or something and you have no idea, like the algorithms doesn't know you just became a completely different person, you're gonna have to change your settings to make that work, right. And that takes experience. And if you I think if you ever find yourself listening to Jenny and I talking and thinking, How come whenever something comes up, they just fill the next space with something valuable. It's because Jenny's been living with diabetes for over 30 years. And I've been staring at my daughter for 15 years watching her have diabetes. And I have a never ending supply of experiences and answers in my head because I learned through them. Yes, that's why and that's why you? Yeah, like you didn't go to like diabetes University where they told you something secret that they don't tell everybody else, right?
Jennifer Smith, CDE 48:14
No, no, no, not at all. I mean, I have valuable behind the scenes, like information about disease states and those types of things from a medical knowledge base. Absolutely. And understanding them helps me to understand some of the navigation of that with diabetes, but the lived experience and the work that I get to do with so many people, that's the valley that you can't teach that. In a university, you you can't teach, there's no degree and diet.
Scott Benner 48:47
And for your situation, you've been helping people for so long it professionally. I tell people all the time, like, it's, it's gonna sound self serving, but it's not like it's that I was able to get advertisers for the show. So I get to turn the show into a job so that I could put this much effort into it. Because I learned every day I talked to people, like you'll hear me say like, Oh, I was talking to a guy the other day, he said something about this. That's me. hearing something I'd never heard before and right and retaining it and being able to apply it to a situation go, oh, you know where that'll help here. And then you get to keep expanding those conversations. I'm going to get to something here and you get to keep expanding those conversations till they help other things. We did fibroid episodes. Now we hear from people are like, Oh my God, my life is different. Because I got my thyroid managed well, I'm getting a lot of my I didn't realize about my iron and my ferritin like a lot of women especially are getting back to me like they're feeling so much better, because it's something they heard on the podcast. They heard it on the podcast, because I was able to focus on this because this is what I think about And now and now it's coming to digestion. And that because we had to figure out a problem with my daughter's digestion. And then we shared Get on the podcast now I've seen that help other people. That goes for little things about diabetes too. Yes, that's how this stuff spreads. This is a repository of information, but you're gonna build that in your own mind. Correct. But not if somebody slaps an algorithm on you and tells you don't worry about the thing. I'll take care of it.
Jennifer Smith, CDE 50:18
Right? Because it one that's such a, that's such a big thing that I hear well, shouldn't it be helping me with this shouldn't be doing this shouldn't? The one word I hate is learned, shouldn't have learned that I don't need this much insulin at two o'clock in the morning. Nope, your system isn't learning. I promise you it's not learning. doesn't keep track of two o'clock in the morning, gosh, I gotta give less insulin for this person. It's not that's it's not smart.
Scott Benner 50:44
Now. And Jenny, do you know oddly enough, as we make this episode, I put up an episode today called Rise of the Machines, where a guy comes on to talk about his Android APS system and how it he does believe it's going to learn in the future. Correct is so exciting, but not now. Like, what's one of his examples? He said, location services. So if you say I'm having pizza, and it realizes you're at Domino's, okay, and you have an experience with insulin, at some day, it will remember that experience. Yeah, if you go to a different pizza place and have a different experience. It'll remember that if you go to a pizza place, it'll remember that if you head back to Domino's, it's gonna go Oh, we're back at Domino's. This. That's not happening right now.
Jennifer Smith, CDE 51:33
No, in fact, there is there are some. There are some apps that actually you can track that way. Like you can take a photo of something and tap the location indicator. And the next time you come back to that location, you'll be able to see what your dosing looked like what your CGM trend looked like. So you can learn from Bob's pizzas, Friday night, last week to this Friday night, maybe I should change my strategy, it looked like this. And I want to improve this right or do it differently. But those they need to be married right into the pump so that not only do you have Okay, now I'm at Bob's pizza, this is what I had. And hey, let's the pump then can acknowledge and I'm going to do something different for Jenny.
Scott Benner 52:17
But for that happening just automatically, that's not here yet. 2023 on the pod five doesn't do that. Tandem T slim doesn't do that the control IQ doesn't do that. The mechanic doesn't do that. Now, it may have happened one day. Sure. But the other I think the other thing is, I know you want your days to be easy, and they can be they can be much easier than they are now they can be more your intuition can come into play as you grow. But this is a lifelong thing. And what you want is you want to get to the point where I saw Arden get into this weekend, where we sat down to this meal, there were 16 different things. And she just looked at it and picked up her phone and went and pushed the button. Yeah. And I was like, how much did she give? She was I don't know, I told it was like 85 carbs. And it was and she and I was like, okay, and then she was okay. And it was okay, just looked at a table at a restaurant. And she's like, I think about this much. And and that's boy, forget this podcast and everything else. It's that's where you want to get to where just where you wake up at two in the morning, you see a high blood sugar and you go, Oh, I know what this is. And that does come it really does come. So anyway. But you're gonna transition along, by the way, I think algorithms are amazing. And
Jennifer Smith, CDE 53:42
yes, they are. Absolutely I I love my algorithm. Absolutely. But I've also learned to work with it. And I've learned what it can do and what I still need to tell it to do. I think that's the big thing about algorithms is knowing that you still have a fair amount of action to put in to it so that the algorithm can work with you.
Scott Benner 54:04
Yeah, yeah, I wouldn't want anybody to think like, oh, you're using a do it yourself loop. It's magical over the other comp there. It all is about the same. Like they all need your help. They all need your intuition. They all need your knowledge. There's nothing if you think you're going to just put a loop on or on the pod five, and it's just going to be perfect. Like you don't have to do anything. Like that's not going to be the case. No. Yeah. So but don't be afraid. No, like I I'll say something here on the hall, save myself Saturday, make a beat and make myself sad. Yesterday was my friend Mike's would have been my friend Mike's birthday. And I don't want to bring all this down. But Mike had diabetes. Type one when we were teenagers. He's not with us any longer. I believe that one of the reasons Mike's not with us any longer is because Jenny alluded earlier that I was stepping along with my hands while I was talking about things like Mike Never came along. He just somebody gave him regular and mph. And he used it long, long after he should have been, you know, didn't have updated meters and didn't you know, he didn't do the little things that you do to come along. I mean, I guess what I'm saying is you don't want to be managing your diabetes like it was 10 years ago. Right? I don't think so.
Jennifer Smith, CDE 55:25
I think you're also bringing something in here. That's really important to consider, because you've, you've talked about, you know, practitioners bringing up hey, why don't you try a CGM? Hey, why don't you try a pump? If, if you're the one always going to your doctor asking for what's new. I don't know. I you know, and your doctor is very willing and can talk about it then with you. Maybe they didn't bring it up. But they're very, they're knowledgeable about it. Once you do get on it fine. But if this is someone who's never really brought it up, and kind of like, shrugs their shoulder and like, sure you could try it, whatever you may need kind of like your friend maybe didn't have a doctor who was keeping up with what could have been better for him.
Scott Benner 56:10
Yeah, yeah. Yeah, you don't you have to take this as a, I don't know, if you want to call it a disease or like, some people don't like that word. But this is a way of living, that it begs you to be involved in it? Yes. Like, it just, it just really does. You have to be aware, you have to take some time to learn what is happening with technology, what's happening with insolence, you know, and you need to move along with it. Because if you look back 50 years, I still interview people who are like in their 70s and have had diabetes forever. And they don't even understand why they're alive. Like, like, you don't want your life to be a coin flip. You don't I mean, like there are things you can do to to, to give yourself better health outcomes. And those health outcomes are not just health outcomes, their quality of life, they're your they're your psychological state of being like there's so much good that comes from just understanding. I know that sounds silly, but how to set your basil right? And make sure your correction factors, right. And you know how to cover the foods you eat?
Jennifer Smith, CDE 57:16
Absolutely, I think and on a bigger scale. We're also we're all supposed to be a participant in our life, right? health in general, you may have been given good health to begin with, but you're the keeper of that health. Right? It's just like, you're the keeper of the car. If you continue to let the salt buildup on you never wash it off, you're gonna have a rusty car. Well, you're your body's the same way, right? You're the keeper of your health, you got to do things to maintain your health, diabetes, it stepped up a level it is
Scott Benner 57:50
absolutely. And so prepare to transition by getting as much good information as you can, but then at some point, just have to do it. You have to just dive in and do it and then learn a new thing. And then once then you'll be surprised at what else comes from that. And anyway, listen, it's also not to say that you couldn't get an algorithm pump right now and teach yourself backwards. I actually think you can. Sure. I think some people have a harder time with that than others. And I don't want you to be in a position where you're lost and something's happening. And you don't understand why because it won't be any different than a person that gets over Basal on MDI and thinks they're doing okay, but it's not really covering their meals well, right, you know, and then doesn't get hungry one day, and then it's up low all afternoon doesn't understand what happened. Like diabetes. There's no reason that if, if you have an if you have enough information and understanding diabetes doesn't have to happen to you. And I think that's maybe the most important part like I would if it feels like it's happening to you, instead of you are doing something and then something's happening. I think you have to have to look and get a deeper understanding, because it shouldn't just be happening to you. That's all. Okay. Awesome. Thank you Jerry.
Huge thanks to Jenny for helping me once again on the Juicebox Podcast, you can learn more about what she does for a living at integrated diabetes.com Jenny might be able to help you. Thank you very much cozy Earth for sponsoring this episode of The Juicebox Podcast get 35% off your entire order at cozy earth.com By using the offer code juice box at checkout. And don't miss the rest of the diabetes Pro Tip series and the other series within the podcast. If you give me a little gifts, give me two more minutes of your time after the music and I'm gonna tell you a little more about this series and the others But first tips from other listeners. I want to thank everyone who left their tips for this episode on the private Facebook group Juicebox Podcast type one diabetes and the people who left their tips on the public group bold with insulin. This first one is for going from pumping the algorithm test your basil and your ratios before you move to an algorithm. The first few weeks may be frustrating, don't give up. Reach out to people online for advice. They probably have been doing it longer than you. This person leaves a little bit of advice from going from MDI to pump says the first night they kept getting low and didn't remember that they could turn their basil down. We talked about this in the episode having access to your Basal insulin. Next one says Oh, I love this one. Listen to the diabetes Pro Tip series from the Juicebox Podcast Take notes. Here's another one from this person. Some sites have dramatically different absorption rates. We talked about that in the podcast. Here's one for Dexcom. Learn to look at the dots instead of just the number in the arrows. This person says when you're going from just having a meter to a CGM. Remember the CGM is just one of the tools in your arsenal, it's not a full replacement for a blood glucose meter. Use both tools effectively. Don't get overwhelmed. They are just numbers and data. It's not a grade for you. It's good advice to this person says no matter what you're doing, whether you're changing from MDI, to pumping pumping to algorithms, your ratios are likely going to change. And that takes time to figure out. This person says not all algorithms are the same. So make sure you understand which one you have and how it works. Their example here is if you're having trouble with a T slim product, don't use someone's advice from the pod five, it won't be the same. Don't assume that your CGM is always correct calibrated if symptoms aren't matching the number, use finger sticks to make sure other person preaching patience, and says not to make perfection your goal, just shoot for shorter peaks, and more shallow valleys in the beginning and over time, your skills will get better. And those peaks and valleys will flatten out. This person says be prepared when your technology doesn't work. And please don't expect perfection. Another person basil testing, there's a great episode about Basal testing in the Pro Tip series. Here's one that just says don't give up. I like that one. I like this one here. Don't use too many new or different foods when you're trying to figure something out. So stick to meals that you are good at bolusing for that way you remove variables, right, like you know, on MDI knew how to cover this food. So I'm doing the same thing on pumping, what's not working, then you can look at your settings and see what's different. I'd say that's a great one. I like that a lot. Educate yourself on how your pump works. Don't just trust that your rep set it up correctly. It's a lot of settings in there. It's a good one. We were used to coasting high no matter what this is an MDI, person to pumping. And we rounded up way too much on our carbs. When we switch to a pump, it took a few weeks of lows to get out of that habit and trust that the pump knew what it was doing. Interesting. So if the settings are good on the pump, I see what they're saying their settings on MDI weren't great. So they were always just, you know, doing more. But when the pump was set up, well, they didn't need to do that anymore. It's interesting. That's a good one. Here's a great one. Don't just put in settings into your palm, write them down somewhere. If something happens to the pump, you need to have them to put back into a new one. And keep a pen or needles handy in case you need to do manual injections. Even on a pump, you might have to do that sometime. That's very good to your settings in a manual pump may not work in your algorithm. This person talking about a CGM says when you start a sensor start at a time of day when you haven't eaten for a couple of hours. And you're not going to eat for a couple more hours if you can. Evening is good, especially for kids in school so the sensor doesn't run out at school. Oh, that's a good one. So he like you don't want to like put it on. I think what they're saying is you don't want to put it on at nine o'clock in the morning on Saturday. Because then at nine o'clock in the morning, you know, on a weekday it might run out. That's a good one. Don't feel bad about removing a sensor if something's wrong, whether it's causing pain or discomfort because you can always call the company and they'll respond with a replacement. You may have heard leaders or readers, that's not always the case. This person says if you haven't heard that phrase, you will eventually take pictures of your CGM sensor codes and transmitters put the expiration date into your calendar with a reminder and that way it won't sneak up on you. Here's one for going from MDI to pumping make sure the correct factor is calculated using the number, the pump shoots for not the one you were shooting for on MDI. Interesting. So what she's saying I think is if the pump gets set up in the target is 100. But when you are MDI the target was, then your correction factor won't be correct. Interesting. This is funny, I can't read you the whole thing, but it says, eventually, something's gonna go wrong. And your tech savvy husband is somehow going to push the wrong button and deactivate everything. I don't think that's as much advice as somebody who wanted to tell a funny story. Going from a blood glucose meter to a CGM. Don't look at the thing every five minutes for me that led to me overreacting to blood sugars, that may not have warranted a reaction at all. Set your alarms at a useful level. This one's terrific the person who sent this one and use that to guide your decisions rather than checking constantly on CGM. I'm a big believer in this by the way, if it doesn't beep, I don't look, there's a person here echoing this sentiment that blood sugars can be fluid, and that it's possible you can overreact and be the reason it's jumping up and down. I think that's worth repeating actually. When you're going from MDI to pumping, you don't need to wait to do a correction Bolus, make use of the insulin onboard information that the pump has great one, that's a great little tip. There's a comment here with a ton of information for the Omni pod five, I'll tell you there's actually an omni pod five Pro Tip series. Definitely listen to that before you go to Omni pod five. But I do want to add a little bit here from this post. Fluid insulin delivery, like an algorithm has to do suspending and increases and decreases and that demands a different approach than a static Basal. So in a regular manual pump, where you might just say, um, one util an hour all day long. You're making a lot of adjustments throughout the day that you don't realize, because there are times you don't need that insulin at a unit an hour might need it more may need it less. That's why the initial settings on these are so important and you kind of stepping back and watching it work for a while to see where your settings may need to be adjusted. Or maybe the way you use your insulin needs to be adjusted Pre-Bolus etc. This person says that a pump was not a cure all for their problems. And they found it very deflating when they went from MDI dual pump and it just didn't make everything better. That's important, Jenny and I definitely went over that in this episode. But keep in mind, this person says here that your doctor's office might say we don't give a pump till one year or you can have a pump till after you've been on MDI for six months or something. That'll sound like a rule to you when they say it. But that's not really a rule. You can, you can push. This is a reiteration of something we heard before. But when you're going from just a blood glucose meter to a CGM, you might want to take some time to just absorb everything. You don't want to just jump in and start tinkering right away before you know what it is you're doing. You know why you turning this dial on that dial really kind of lived through it for days, maybe weeks, even before you just say, alright, I see a trend here. I know what's happening. This is an interesting one. This is for somebody going from MDI to pumping. They don't want you to forget the tricks, you know, brain like if you see a blood sugar, and it's kind of stuck and it won't move and back on MDI, you want to inject it in a unit, there's no reason why you can't give a unit with the pump. Just because the pump says, Hey, there's still insulin onboard, it doesn't mean that that insulin was calculated correctly, and is really about to make an impact. I think they're saying trust your gut. This one's a little long, but the person says everyone's experience is going to be different. So roll up your sleeves, go into it with an open mind and be ready to dig in and do some problem solving. And don't forget to listen to the podcast, they go on to say when going from MDI to a pump, you really have no idea what to expect, you can only kind of hope that you start out with great settings. But that may not be the case. So many people end up having a poor experience when they switch and then they share that online. And then this person was like scared. That's what was gonna happen to them. But then that wasn't what happened at all.
It was incredibly easy, she said, and his numbers got much better very quickly. So I think the I think the message here is, sometimes people just share bad news online, doesn't mean everything's bad news. Here's a little tip. A pump company puts their pump through the FDA for approval, and they choose a couple of insolence to use in the pump. Those insulins are then approved in the pump. It doesn't always mean that the ones that aren't improved in the pump won't work in the pump. It just means they didn't put it through FDA testing. I want to thank everybody who share those tips and remind you that those people exist in the private Facebook group for the Juicebox Podcast. There are so many other management based series within the podcast. You're listening, of course right now to the diabetes Pro Tip series diabetes Pro, tip.com, juicebox, podcast.com, and in your audio app, but there's also the defining diabetes series, diabetes variables defining thyroid, bold beginnings, ask Scott and Jenny. And we have collections of episodes about algorithm pumping, which we talked about a little bit today, you can find out way more in the algorithm pumping episodes. There's the after dark series where we talk about all the things that people don't usually talk about about diabetes, how we eat mental wellness, there's so much to choose from. And if you happen to know somebody with type two, there's a brand new type two diabetes series for people with type two or pre diabetes. Check them out at juicebox podcast.com. Here's a little feedback from other Juicebox Podcast listeners. After devouring the Pro Tip series, I got my daily average down by 30 points. And I'm excited to continue learning from this all in one resource. If you're struggling with insulin, this is the place to figure it all out. I am so thankful that a friend recommended the Juicebox Podcast to me, and I wish that I would have found it at the beginning of my journey. I have been binge listening since I found this podcast. My son and husband both have type one man, I wish I had this when my son was still living at home. I'm learning and sharing how we're going to get our agencies lower. I've had type one diabetes for 20 years, and it was never well controlled until I started listening to the Juicebox Podcast. I've become bold with insulin. And this podcast is unlocked the solutions to so many issues I've struggled with for years. I can read you these reviews all day. But I would prefer to stop because it seems it's tricky to do this right? I just want you to go listen to the Pro Tip series, find the defining diabetes. If you're new, go check out bold beginnings. All of the information that you could possibly want and need about managing your insulin is in the Juicebox Podcast. Subscribe now in a podcast player like Apple podcasts or Spotify, Amazon music or wherever you get your audio. And don't forget to check out the private Facebook group, which is also free Juicebox Podcast type one diabetes 37,000 members and it grows by hundreds of people every week. What a resource. Please don't miss out on this community.
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#898 Breaker Breaker
Jacqueline's daughter has type 1 diabetes. We talk about school and expectations.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends, and welcome to episode 898 of the Juicebox Podcast
I make little notes for myself after I edit the podcasts. And usually my notes are meant to help me record the open to the podcast but I gotta tell you, I didn't understand my own notes. So this is Jacqueline and she's got a kid with type one diabetes. Think they had a problem at school, we end up talking about people's responsibilities at their job a lot. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Also try to ignore the fact while you're listening to me rant about people not doing their jobs that I did not do my job by leaving myself an audio note that was clear enough for me to make the beginning of this episode just let that irony go past you. Actually if you need to be distracted, go to T one D exchange.org. Forward slash juice box to cleanse your palate. Get there and take the survey finishing the survey helps type one diabetes research it supports the show. It helps people with type one T one D exchange.org forward slash juicebox your mental sorbet before beginning the podcast
this episode of The Juicebox Podcast is sponsored by Omni pod. Of course Omni pod makes the Omni pod five which is an automated tubeless insulin pump. And they make the Omni pod dash, which is not automated but still a tubeless insulin pump. You'll figure it all out at Omni pod.com forward slash juice box My daughter has been wearing an omni pod every day. for over 14 years. It's been a friend in this journey. I think you'll enjoy it. Omni pod.com forward slash juice box will you support the sponsors by clicking on my links or typing them in a browser you were helping to keep this podcast plentiful and free. You're also helping to support the private Facebook group Juicebox Podcast type one diabetes. I mean, technically you're paying my bills and then I do all this stuff and then you get it for free. You understand how commerce works I imagined juicebox podcast.com. All the links to all the sponsors. If you need g Vogue hypo pen, you need a contour next gen blood glucose meter a Dexcom and Omni pod. What else you want to check out touched by type one, you want to get yourself some ag one from athletic greens, or you want some quality bedding from cozy Earth. These are things you'll find at juicebox podcast.com. There are also links in the show notes of the audio app you're listening in right now what I forget what I forget what you're like just start the podcast scout. What are you doing? I'm doing business Omni pod Dexcom contour G Vogue, ag one, the T one D exchange us med that's what I forgot us meds where my daughter gets her diabetes supplies from touched by type one cozy Earth. I think we've got I can't say that one yet. But I think we got a new and common T one the exchange. So I say that I said it. That's it. Oh, better help better. help.com forward slash juicebox save 10% of your first month of therapy therapy. I think we all need therapy betterhelp.com forward slash juicebox. Alright guys, that's it. I appreciate you listening to this stuff. I mean, being completely honest and serious. The podcast doesn't exist without the sponsors. And the sponsors don't come back without you. It's a circle of life kind of thing. If you need one of these things, please click on my links. I'm not saying go buy something you don't want. I'm not saying to go buy something you don't need. I'm not saying to go buy something you can afford. I'm saying if you're getting therapy, if you need to hype open if you want to Dexcom etc and so on. Click the legs.
Jacqueline 3:59
Hi, my name is Jacqueline and I have a daughter living with type one diabetes.
Scott Benner 4:07
Jacqueline. Why do I hear people talking behind your back on what's going on?
Jacqueline 4:11
My daughter actually is an online learning right now she's doing digital school. Oh, I could close the door. I don't know if that would make the echo worse. Let's
Scott Benner 4:19
find out. We definitely can't have a disembodied voice behind us
Jacqueline 4:28
she must have just made it louder because it wasn't couldn't hear before and now I can
Scott Benner 4:33
No it's okay. You You were like hey, I'm Jacqueline. I have a daughter living with type one diabetes. And then I felt like I was picking up half of a CB channel behind me so Okay, so my house sounds like CB radio.
Jacqueline 4:47
Yeah.
Scott Benner 4:49
Do you think people even know what that is?
Jacqueline 4:51
I had a nightmare about a CB radio two nights ago actually go on well being one. Oh god. It's so disturbing. It's so I was so upset. I, I had a dream that I was with. I have a friend who has a daughter, that's my daughter's age that hang out and I dropped me and my friend were like, on this road trip, we're going somewhere. And we were letting a little girls like, go for walks out on their own. And we were like watching them from a distance. And then like, we check in on them, and then we're just letting them walk around in the woods like idiots. And then like, it gets dark, and I realized I don't know where they are. And I have this giant TV radio. And I'm like, calling out on the radio, like, has anybody seen these little girls and, and then this crazy, like, the creepiest, deepest voice you've ever heard comes back on the radio, and indicate that like, he has them. I'm thinking but it was like cracked up like you couldn't tell what he was saying. And then I was like, begging him to get them back to us. And he's like, they're fine. They've already had their milk and cookies. And then I woke up and I was like, so sick, like and upset. And I. That's because, because it's ice cream from the night before it was called Milk and cookies. I think Wait,
Scott Benner 6:09
you had ice cream in the evening before called Milk and cookies? Yeah. I listened. Oh, my God. So had I not like arbitrarily said CB radio, which is a very bizarre thing to say. Then we would not have heard about your dream.
Jacqueline 6:26
Maybe not. No, I don't really it really like messed me up. It was really a
Scott Benner 6:31
wake up sort of like, shock.
Jacqueline 6:34
Yeah, well, it was kind of one of those things were this was like I woke up at like, it wasn't even midnight yet. Like I had just, I hadn't even been asleep that long. And you're kind of in that headspace where you don't even really realize what's real and what's not. And if you're sleeping. So you know, you wake up and you're like, Oh, my God is my kid. Like, abducted and like my child was abducted like this in the in the pit of my stomach. And it was not good. Then I woke up and I'm like, oh, it's it's just type one diabetes.
Scott Benner 7:07
Is that what woke you up?
Jacqueline 7:10
A bit dream woke me up. Yeah, I think because I was just physically so Ill over it. That's crazy. Well, yeah,
Scott Benner 7:17
we were just, we were just talking about dreams. Last night, my son comes up to me and he goes, in your dreams. Do people can you hear people when they're talking? And I was like, why? And he goes, and so at first I thought, well, yeah, I can hear people's conversations in my dreams, right? I don't really recall them. But I hear them. I know that I'm aware of them when I'm dreaming. And then he goes, No, no, he goes, do you actually hear them? Or do you just know that? What they're saying to each other? And I was like, Oh, wow, this is like a matrix question. Like, like, are you hearing sounds in your head? No. You say yes. But I don't think so.
Jacqueline 7:58
Because that voice was so distinctive. Like, I heard that voice that that creepy voice over the CB radio, like I can tell you exactly what it sounds like. Right.
Scott Benner 8:08
But I think what my son is saying is does your brain just create that? That impulse that makes you feel like you heard it, because if you if you and I stopped right now, if we all stop right now, you know, here, we'll do it all together. Everybody's listening. If we get very quiet, and try to picture someone who we knows voice, you can hear it in your head. But that doesn't mean you're hearing sound.
Jacqueline 8:33
Not physical sound. Right?
Scott Benner 8:34
Right. So he's talking to me like this. And I'm like, I'm feeling like, I'm having a conversation. And we're all high. Because he's like, he's like, he's like, can you really hear it? And I'm like, No, and he goes, and plus dreams move very quickly. He goes, maybe you just infer that you know what's happening. Like, you're seeing the images, quote, unquote, but not, but he's like, how would you hear it? It's moving so fast. And and so I was just like, Oh my God, you're flipping me.
Jacqueline 9:01
How old is your son sounds like my son. He's 22.
Scott Benner 9:06
Somebody said it downstairs and it caught his attention. I was upstairs working and I think he had a half an hour conversation with my wife about it before he walked up and asked me so anyway, the at some point during this podcast if it gets weird required for just one second, I'm gonna lean into the microphone and go, Jacqueline, I have the girls.
Unknown Speaker 9:29
It's pretty close.
Scott Benner 9:32
Don't worry, they've had their milk and cookies.
Jacqueline 9:35
Oh my God, that's really creepy.
Scott Benner 9:38
Oh my gosh, anyway, okay. So how many kids do you have in total?
Jacqueline 9:44
Um, I have two biological children. And then I have two bonus stepsons that are older now. So my stepsons are 18 and 20. And then I'm My daughter is 10 and my son is 12.
Scott Benner 10:05
Okay. Alright, so a couple of interesting questions here. Do your stepsons have any autoimmune issues?
Jacqueline 10:12
No. Okay. They're not related. So we're just kind of like the Brady Bunch.
Scott Benner 10:17
Are they not related to the man you're married to?
Jacqueline 10:21
Yeah, they are. But my two children are from a previous marriage.
Scott Benner 10:25
Oh, hold on a second. All right. So there's like when you woke up from your dream last night, there was a guy laying next to you. Those boys are his. Your, your kids are not his so that your kids are his stepchildren?
Jacqueline 10:39
Yes, yes. Okay. Yes. I got it. I got I got like the Brady Bunch.
Scott Benner 10:45
With fewer people. And creepy. Yeah. Okay, so you have a 10 to 12 year old your 10 year old has type one. Yes. As a girl, I'm sorry. Yes, sorry. How about a 12 year old girl or boy?
Jacqueline 10:57
He's a boy and healthy as can be. And nobody in my family or their dad's family has any history of any autoimmune,
Scott Benner 11:06
nothing? No, nothing at all. Nothing
Jacqueline 11:09
or nothing. She did get this was a COVID thing.
Scott Benner 11:14
Yeah, so this is super interesting, because I watch these conversations evolve online constantly. And I can never tell because it's online writing, if it's just people's, like, you know, they're not being specific when they're communicating and writing or if they really feel this way. Because you'll hear people say, you know, I was diagnosed with type one diabetes after I had COVID. And you'll have and you'll hear people say COVID gave me type one diabetes. And I don't know what they mean when they say that. So how do you feel about it when you when you think about it? So
Jacqueline 11:51
what happened with my Actually, both of my kids got COVID After being at school for two weeks, last August. So they both had a fever. And then Bell had like a super light cough for a couple of weeks. Lincoln, nothing. I mean, they really had like, hardly any symptoms at all. And just for to preface this, my kids have never had an ear infection. They used to get perfect attendance. Like my kids are like, I'm a nutrition freak, like we they are no history of any issues whatsoever. And I thought my kids could handle it. Because every news source told me this isn't the kids can handle this, right? Yeah. And and so it was exactly two weeks. It was the day she was supposed to go back to school after she was, you know, quarantined at home. The night before she started vomiting. And I thought it was something she ate. I didn't link it to anything else. I'm like, Oh, she must have had, you know, because she was at her dad's house. So they eat a little different, which is fine. But, like just
Scott Benner 13:01
fine, in case you're wondering.
Jacqueline 13:06
away, I wouldn't do it, but I appreciate everything they do.
Scott Benner 13:09
That's why he lives by himself now. No, no, actually,
Jacqueline 13:13
he's actually remarried as well. And she's fantastic. She's been really fantastic. Anyway, so she had dinner over there. Actually, she started to get sick over there the night before she was supposed to go back to school. And when she started to get sick, I was like, I'll just come get her because I'm her mom. And she used to be with me when she's not feeling good. I'm not biased at all, by the way. So I bring her home and she just is vomiting like all through the night. And on our like four or five. I'm googling like, when do you take your kid to the ER how much? Because I'm in my overreacting is it's probably just a food poisoning or a bug or something. And then I noticed she was breathing kind of heavy. And her and then I'm like, Okay, if your breathing is off, like to me that's emergency room. Like if you can't breathe or you're like she just had very labored breathing. And so took her in. She like had trouble walking from the car to the ER. And I'm like, I'm like, Come on, let's like what's wrong with you? And I like had no idea what was going on. I thought she was just being dramatic because she has a history of of dramatics. And we got in there and oh my God, thank God for this children's hospital. They were just amazing. They pricked her finger immediately. They said they smelled it on her. And immediately they said, Oh, looks like onset. And I'm like, I have no idea what that means, like onset onset. What like what the hell are you talking about? And so, you know, the whole thing happens and this was obviously during COVID. So there was no breaks from it. I couldn't leave the room to cry or to freak out. I was in front of her like the whole time, which was interesting. But anyway, like in talking to the nurses and doctors, the nurses had said, Yeah, we're seeing a ton of these lately. And so while I was stuck in that ICU, we were in the ICU for three days, the last day was education. But I read the entire Internet. I'm a reader, and that's an I. And I found you I had I was posting on Facebook, and I had a Facebook friend that recommended the podcasts. So I was super lucky to find the Juicebox Podcast in the Facebook group. Oh my gosh, that's everything to me. But I read the whole internet. I went to the American diabetes Association, I watched the president of the diabetes Association, talk, give updates. And in one of the speeches that he was talking in, he was talking about how DKA doubled in 2020. Right. So I also have a acquaintance of mine that got pancreatitis from COVID. And I read a ton about the link and so COVID actually directly attacks the pancreas. That's scientific knowledge that that's what it does. The question is and people and I don't really know for sure, exactly. You know how this happened. If if
Scott Benner 16:31
Oh, Jacqueline, you just disappeared again. Or attack Jacqueline. Hold on. For me. That time? Yeah, that time. It definitely wasn't my fault. So what is going
Jacqueline 16:41
on? I
Unknown Speaker 16:41
know it
Jacqueline 16:42
keeps on this computer for living. I never have.
Scott Benner 16:46
Hold on one second. I'm going to try something. But we're gonna try something together. Hold on
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Alright, are you still there? I'm here. Okay. So I made an adjustment here and we're going to see if that helps. So I apologize because it's okay by surprise. And so you what you said was, I'll recap. Okay, you watched the video from the ADA. Right? He said that DK was up significantly. You had a friend you had a friend. Okay. You had a friend who had pancreas haitus after after COVID And you're saying you're saying that COVID goes, but towards the pancreas, which is not something I know about. So um, yeah, so there's a,
Jacqueline 20:11
there's a study on Harvard Medical. And there's some other studies out there that talk about how COVID attacks the pancreas. It doesn't talk about how COVID attacks beta cells, but COVID attacks the pancreas 1,000%. So, my question is, and the question that hangs out there in the universe, if COVID is attacking the pancreas, if your body is under attack, will your body make antibodies? To go towards that place? Because not only do the COVID cells attack the pancreas, but they replicate the pancreatic cells and infiltrate as well. So if that is the part of your body that's causing the problem, can your body create those type one antibodies to fight it? I don't know. Nobody knows. There's not enough research. Yeah, um,
Scott Benner 20:58
so I'm just I Googled while you were talking and came up a couple of things right. So this is from Medscape. It says SARS. cov. Two infection has also been shown to affect the exocrine pancreas manifesting as pancreatitis in 5%. of critically ill patients with COVID-19, as well as enlargement of the pancreas, and abnormal levels of lipids and amylase in seven and a half to 17% of patients now that that's data from pretty recently made 2022. Another one says, What are the most common organs affected by COVID-19 lungs are the main organ affected, however, the virus can also affect others. But then it says, such as kidneys, brain, and liver doesn't mention the pancreas. So it might, for me, knowing nothing, and everyone keeping in mind that I slept through a lot of my high school education and did not go to college. My expectation is this is that for your daughter had antibodies that made it more likely for her to get type one diabetes, and that a virus kicks that process in so my daughter had Coxsackie virus and then got type one diabetes. Right? And
Jacqueline 22:14
got Yeah, and I think, and I'm not saying I know for sure that COVID caused this. But when you look at the statistics for what's happening, either there was just a crap ton of people that were predisposed, that it's triggered like crazy. Or maybe it could be creating antibodies and some people that weren't predisposed.
Scott Benner 22:37
So that's a question. Yeah, it's a it's a valuable question to ask, obviously, my expectation is, is that the first thing you said is what happened? So think of it this way, my daughter was two and she was diagnosed, if I just don't go somewhere with her one day where she gets Coxsackie. Maybe she's not diagnosed till she's six. Right. And it's like, because at some point, you have to get you have to get a virus that has the right mixture, who cares what it is, that will kick you into your type one. But but my daughter always had those antibodies, like coxsackievirus didn't magically make antibodies for type one diabetes appear in her. So it so my point is, is that I think that the population usually doesn't all get sick at once, with a virus. And I think it kind of needs to be a virus, like, from what I've, you know, called together talking to people all this time. So I think we just laid a blanket of virus across the, across the world. And what grows from that, as people with type one diabetes should show their head. They're like, Oh, look, I'm I have type. Yeah, that's how I think of it. I could be 1,000,000% wrong, but that's how it occurs to me. Oh, yeah.
Jacqueline 23:54
And I think there's a good chance that that you're right, too. And I just, I just don't know, and I hate not knowing where you're in any place,
Scott Benner 24:03
aren't you? Because in the beginning of diagnosis, a lot of people torture themselves with this question.
Jacqueline 24:12
Oh, my gosh, I tortured myself like crazy and the guilt for even sending my kids back to school because they stayed home the year before, you know? And then, you know, me and my husband got vaccinated, and we thought the kids would be more resilient. And so yeah, I really, unlike I just should have just waited for the vaccine to come out. And maybe she would, you know, have another 10 years without it or another, however long, you know, and then on the other side of the coin, I'm like, God, I wasted her last year of being healthy sitting in the house.
Scott Benner 24:49
Okay, had any psychological issues stemming? Yeah. Oh, good. I think it's fun for us here on the podcast bad for you. Yeah, so I was talking to somebody the other day, and they were just they had this problem. And I was like, Oh, this poor person. And then the rest of me was like, This is great for this.
Jacqueline 25:09
Logically, logically, I know and people tell me and I know like, it's, it's not my fault. It's, it just feels like parenting through COVID. And now through type one diabetes, I feel like every decision I make I regret or is wrong, or I can't, there is no right decision. And even if you would have made a different decision, that I could have ended terrible, I could have entered the wrong way. You know,
Scott Benner 25:33
I'll tell you what to imagine this. Imagine you get her a vaccine. And she goes back to school and she gets COVID. And she ends up with type one diabetes, you would have been like that vaccine.
Jacqueline 25:47
Oh, and there's a lot of people out there that that that claim that the vaccine gave their kid COVID or XYZ to and you know, yeah. And I'm like, Oh, those people are crazy, but
Scott Benner 26:00
not me. Not me.
Jacqueline 26:04
Well, whatever. Yeah, you really can't, when they really can't, yeah,
Scott Benner 26:07
what it brings up is the uncertainty of being alive. And what happens when you get put in charge of another human beings life and you love them? Right? You know, so now you feel like I have to make, I mean, listen, I'm no expert, but but my kids 22. And I thought we did pretty well. And then there are times when something pops up, and you're like, he's like, this is completely botched. From my childhood. You're like, really, like, you don't I mean, like I say that. My son, my son is older. He's like, he's like, this thing happened. And you guys should have done this. He's got hindsight. And I let him have his feelings. And I yeah, they're perfectly reasonable. But but, you know, he wasn't 26 and trying to figure out what to do with a one year old or something, you know what I mean? Like, like, he lacks context. And and you don't care about context, you care about making the exact right decision, and there's no way to do that.
Jacqueline 27:10
I know that logically, my brain knows that, you know, but it's still hard to get some of those thoughts out of your head.
Scott Benner 27:19
You also don't have all the information ever, like so. Like so my wife for example, through her work has knowledge of the j&j COVID vaccine. Okay, so at the, at the very time that people were like the j&j vaccine is killed a bunch of you don't even that was all
Jacqueline 27:36
going on. Right. That's the vaccine that I got.
Scott Benner 27:39
I was I was supposed to get the j&j vaccine three days after that popped up in the news. And I was like, God, I hope they don't stop me from getting my vaccine. And then, and then they did. And then I was like, oh, then I had to wait. And then you know, as soon as they said, it was okay. Again, I went and got the j&j vaccine, because I was making decisions based off of what I knew. And, and I also had different contexts where I forget the details of this. So please, don't take this next couple of sentences for details. But there were a handful of women who died after having the vaccine. But they weren't. They were in a very specific medical situation, right or life situation. I don't remember. I'm being very honest, I don't remember. But the point is, is that I was not in that medical situation. So I so I liked the idea that j&j vaccine because it was kind of based on older technology, and I liked it. So I'm like, we're going to do this plus, my wife had spent a year sifting through safety data for like, that's, you know, while you were all hiding in your house, my wife was trying to make sure that that vaccine was okay.
Jacqueline 28:45
If you want to know something interesting about that vaccine that I was reading about is people that took it were more likely to faint afterwards. And I I hate needles so much. It's funny, you will never meet anybody that hates hate them. I am very needle phobic I've always been. And so I chose the Johnson and Johnson vaccine because there's one of them. And I also can pass out if I get freaked out or you know, yeah, or sad, or get blood drawn or something. So it's funny that that's the vaccine that people are more likely to pass out in because that's the one all the wimps take
Scott Benner 29:30
it even that's an interesting statement, like you're more likely to pass out if you do this than this. What an and we hear those things as headlines. And then oh my god, then in our minds, like, you know, there's a room a gymnasium full of people getting the j&j vaccine. They're falling over like those sleeping. Yeah, except what it probably means is that, you know, I don't know 100 people out of every million passed out with this one, but with this one, it was 120 to me Yeah.
Jacqueline 30:01
I just think this psychological aspect of it is interesting, like, the types of people that chose that one might be more predisposed to painting or freaking out, you know, the types of people that would willingly sign up to get double the needles.
Scott Benner 30:17
That's so interesting. Yeah, you're getting the shot never occurred to me as being an issue one way or the other. Yeah, I never thought of it that way. But I don't have a trouble with the needle. So it's anyway. Well, anyway, however, no, don't be sorry. Your daughter's got diabetes now. So. And how long ago was this?
Jacqueline 30:36
August 23. So for diversities coming up?
Scott Benner 30:41
Oh, one year she's coming up on. Okay. All right. So diagnosed during COVID. Did you how long did she stay in the hospital for?
Jacqueline 30:51
We were in the hospital for three days. She was when they admitted her her blood sugar was 575. And then her a one C was 8.4.
Scott Benner 31:04
Okay, so your question the day that she was diagnosed? Yeah. Was How long after she had gotten COVID?
Jacqueline 31:14
Two weeks. 14 days,
Scott Benner 31:18
14 days. And her blood sugar was five or 75?
Jacqueline 31:26
Well, 14 days from her fever. Now she could have been exposed a week before that. 14 days from her fever.
Scott Benner 31:34
Okay. I hear you. Alright, I got it. I got it. I'm trying to remember how long I thought Arden had Coxsackie furl a month or so before, even longer than she was diagnosed. Yeah. Okay. Anyway. You stay in the hospital, they let you out. What did they give you when you leave?
Jacqueline 31:59
Oh, they were so great. We had I had bags and bags. I had. Well, she got her little JD are up there. We they gave us like tons of books and material. I actually met with the dietician at the hospital, which was nice. And they did lots of training for me at the hospital. I left with insulin pens glucose meter. So we had Lantis and Humalog. And then keto ketone strips. I mean, pretty much everything we we would need.
Scott Benner 32:38
Okay. I liked how you it was like you were leaving a birthday party and people are like, here take a kazoo.
Jacqueline 32:43
Yeah, and she had this huge like blanket that gave her all these toys that they were constantly like, showering us with it was just great Children's Hospital and, and there was a social worker that came in to make sure we were okay. Like, do you need anything? She got me like a brush. And yeah, they were just amazing.
Scott Benner 33:01
So you you had done a lot of reading while you were in the hospital. So what was your expectation of what living with diabetes was going to be like versus what it ended up being?
Jacqueline 33:13
Oh, at first, it was so overwhelming. It was just, you know, like I said, we're both I hate needles. She hates needles. I mean, even now getting bloodwork it's it's horrible. I, I would I never wanted to. So, at first I'm like, How the hell am I going to do this? Like, how am I going to do this? All the time, multiple times a day. It's just such a shock. Like, it's such a, it just turns everything on its head and it seemed so daunting and so intimidating. And like I obviously like went through so much grief of just how our lifestyle was about to change, you know. Now a year later, it's not that big of a deal. As much. i It's a small, a smaller part of life.
Scott Benner 34:13
Yeah. Does she have did she have a honeymoon?
Jacqueline 34:17
I don't not a well defined one. I don't really understand the honeymoon thing. Because it's, um, I don't know. And she's had she's 10 So she's got like hormones, hormonal stuff is starting. So it's hard to tell like we need to make adjustments sometimes but she never got to a point where like she didn't need insulin or anything like that.
Scott Benner 34:43
Yeah, I was gonna say if you don't understand the the honeymoon then you didn't say it. Yeah, probably not. Right. But that's even interesting that she had a short or non existent honeymoon. So her her needs haven't changed. significantly, in any leaps?
Jacqueline 35:03
Not really interesting. Not really like how you
Scott Benner 35:07
said she has hormone stuff going on.
Jacqueline 35:11
You know, you know that thing when you think you have it all figured out, and then you're like, Oh, I got a couple of days here, we're, we're doing good. And then all of a sudden it changes, you know, she needs she needs half the insulin or twice the insulin. You're like the hell's going on
Scott Benner 35:27
right now? I know. Okay, so how did she handle it? Like, I guess just kind of psychologically and like as a person?
Jacqueline 35:37
I'm at first really, really well, at first it was. She, she started giving herself shots, actually, fairly quickly, she preferred that. She got a lot of attention in the beginning. And she really liked that. And she didn't mind the candy either. So at first it was it was good. It took a little while for things to kind of soak in. Now. She's still pretty. I don't know.
Scott Benner 36:17
I like how you said she doesn't like she wanted to do the shots yourself. And I'm thinking of course she does. Because you're probably holding the needle. Like, I don't want to do this. This is terrible.
Jacqueline 36:27
I mean, I got used to it pretty quickly. I got I really like was able to, obviously a necessity. I compartmentalize and detach myself from feeling anything at all, and just go into like robot mode. So no. But now it's it's complicated. There's a lot of layers there. There's a lot of things we were working on. I started taking her to a horse therapist, which is not a a horse talking to her. But as a therapist that uses horses. My husband says every time I say horse therapist, do you think of like her talking to her?
Scott Benner 37:09
It's funny, I thought opposite. I thought all these poor people can afford a therapist for a person. That's terrible. I knew
Jacqueline 37:20
what's funny is the reason she's going to equine therapy is because I couldn't find a normal one. I you know, I was looking everywhere. And she was asking for help. And she you know, obviously has a lot that she's dealing with and isn't great or comfortable with expressing herself. Like she keeps a lot on the inside. That's and she's always been that way. So I searched forever. I contacted the hospital, I contacted everybody and nobody had any resources that would take our insurance that would talk to somebody her age. And then finally, I was just at this leadership thing. And one of the people that I was going with, he's like, Well, I do equine therapy, and I have an opening and she takes insurance. I'm like, Oh my gosh. So it worked out.
Scott Benner 38:13
How does this? How does this work? Does she just sort of care for the horse and, and ride it. That kind of thing. She hasn't
Jacqueline 38:21
actually ridden the horse. But she will like room it so she brushes it and does like breathing. And then the horse is very in tune to feelings. And so, you know, if you put your hand on a horse and you think happy thoughts, and you put your hand on a horse and you think angry thoughts, the horse reacts differently to your mood. And so it's kind of getting in touch with your own feelings through getting in touch with the horses feelings, and the horse expresses how it feels with different body language and, you know, and the thing that the horse does, and so she's teaching my daughter, you know, see how he does this with his head or how he that means he's feeling this way? Or are we we don't want to make him feel nervous. So it's a lot with, it helps with like anxiety. Yeah, but also just kind of identifying what are your feelings and how to kind of be a little bit more in control of them and identifying them.
Scott Benner 39:19
That seems like either very worthwhile, or somebody's tricking you into paying them to brush their horse.
Jacqueline 39:25
Well, I mean, it's insurance. So
Scott Benner 39:29
I imagine the person right now they're like, This is amazing. These people give me $40 And then they brought my horse for me. And I know right, I tell them I know what it means when the horse looks down to the right.
Jacqueline 39:41
I need to start advertising like vacuum therapy services.
Scott Benner 39:44
Oh my god. I've been thinking the same thing while you're talking. People would feel better pressure washing my siding.
Jacqueline 39:53
I know that that crossed my mind to
Scott Benner 39:56
helping her kind of doesn't matter. Ya know,
Jacqueline 39:59
she really likes it. it it just sucks because it's it's hot. We're in Arizona. So over the summer. She's we can't do we can't do the worst stuff over the summer because it's triple digit temperatures. So yeah, you have to wait until late September to get back into it probably. October,
Scott Benner 40:16
you live somewhere where people aren't supposed to be. Because the temperatures,
Jacqueline 40:21
it's gorgeous. But we do need to be we do need either water or air conditioning, we need to be in the pool, or in the house.
Scott Benner 40:28
It's interesting, isn't it? Yeah. I was just talking to somebody the other day from Canada. And they were talking about how cold it gets. And I was like, move. Like why are you there? And now you're telling me triple digits on like, I don't care how nice it isn't the other times a year to get the hell out of there.
Jacqueline 40:45
Well, I don't know if you can see my Facebook profile. But you can I actually went for a walk at sunrise this morning around the lake, the park by my house and I take I like wake up at 5am and take pictures of the sunrise and it's just it's everything. It's yeah.
Scott Benner 41:03
How hard is it? It's five o'clock?
Jacqueline 41:05
Um, it was what 82 Okay, this morning at 5am. So it's not too bad right now, because it's monsoon season. So we're getting like rains. and stuff.
Scott Benner 41:17
I like when people from different places say things that they think sound normal, like it's triple digits hot and it's monsoon season. You're like, you know, because it's monsoon season. I'm like, oh, yeah, sure.
Jacqueline 41:29
That's just basically when were pelted with like these months, students are crazy. We had two trees ripped out of our front yard that were like 10 years old.
Scott Benner 41:37
You're explaining a scenario where I would run. Like, I gotta go somewhere else where there's no monsoon season, if at all possible.
Jacqueline 41:48
Well, I visited my friends in California a couple of weekends ago. And she gave me a hard time because I had to wear a jacket to the beach. Because I was like chilly. And I like I just I couldn't live anywhere else. Because I you know if it's anywhere around 70 or below, forget it like I'm freezing.
Scott Benner 42:09
I've only been to Arizona once I was in and out very quickly. But it was nice. But I was there to a reasonable time of year. Although, now that I'm thinking of it. When I landed. We had to take alternate routes to where I was going because some of the streets were flooded. Yeah, yeah. So you don't it doesn't handle rainwater well, either, right.
Jacqueline 42:30
Not too great. So historically, there is a history of flooding we had we haven't seen we haven't had anything too horrible in recent history, but Gotcha. Well, the town I live in has like walls built to just in case.
Scott Benner 42:48
You're painting a photo for people. No one's going to move to Arizona after you describe it.
Jacqueline 42:53
So hopefully we're like the fastest growing one of the fastest growing places in the country. So that's fine if people stopped moving here.
Scott Benner 43:00
Only because of the equine therapy industry. Taking Yeah, wow, fire trucks. That doesn't happen very often here. Can you hear that? No, no, my microphone is so good. It, it takes my voice and blocks everything else out. Okay, so she's struggling a little bit. Is that fair?
Jacqueline 43:24
Yes, yes.
Scott Benner 43:25
How does that how does that present itself? Like, what side of that? Do you see? Like I know, you said she holds things inside. She needs help. She's having trouble expressing herself. But what does it look like to you from the outside?
Jacqueline 43:39
I'm getting just reactions that don't match the situation. Sometimes we're being upset and not knowing why. I'm crying and not knowing why sometimes. So and not wanting to do things that she previously wanted to do, she gives up very easily. We tried doing school last year in person with diabetes, that was a nightmare. It was a it was a really hostile situation with the administration at that school. So I didn't want to deal with them again. But I left it up to my daughter, you know, I would do it for her if that's what she needed, you know, but she hated that. I mean, they pulled her out of school seven, eight times, 678 times a day sometimes to check her blood sugar and just refuse to use Dexcom to follow her at all. Like I was so excited when we got the technology and like oh, she could be in class least restrictive environment. And they're just like, which is funny because the school really touts like technology. But they're, oh no, you know, it's gonna make us liable Whatever. So instead of just looking at a screen to see her numbers, they wanted to bring her into the nurse's office, you know, before and after every meal before and after PE and recess, you know, beginning of the day end of the day and you know, and I before and after everything
Scott Benner 45:17
they were finger sticking her like nine times a day when she was wearing a CGM.
Jacqueline 45:21
No, baby, they wanted her to physically leave the classroom and go report to the nurse what her CGM said,
Scott Benner 45:27
why does that matter? I don't understand. Yeah. Instead of the nurse having access to it,
Jacqueline 45:36
yeah. And we donated $400 to the school, so they could get a tablet. And they happily took my money knowing exactly what it was for and then refused to buy one.
Scott Benner 45:46
Oh, are they playing? When
Jacqueline 45:48
I went into questions, I wanted to ask questions. And I talked to the principal for the first time and I had never talked to this person never really met the principal, except for maybe like in the beginning when we had the meeting, but I had never like had a one on one conversation with her. And I went in there to like ask for her help. Right? I I know how to deal with people. I was in customer service for ever. Like I, I'm not like some crazy person, right? And she's like, Oh, we could talk about this in my office. And I was like, Oh, great. I could to try to talk to her. I slipped I talked to her. We sit down. And she was Well, first of all, you need to calm down. And though the first thing she said to me, and I'm like, Oh, she and she. And she was like talking down to me like an angry teacher, like a bad teacher would talk to us. And she's like, every time you come in here, you have an attitude. She said that to me. And I have no I, I had
Scott Benner 46:51
never spoken to her before. I have never spoken
Jacqueline 46:53
to her before. I felt like I was being nice to everybody. I felt I was doing the best I could I I never said a negative thing to worry about anybody. And I brought in baked goods when they asked me to when I brought, you know, gifts at Christmas time. And I'm like, I thought it I know I'm not like, maybe I'm just not a likable person, like, but like she was telling me to this woman was telling me like, she doesn't like me, you know, and I'm and I'm sitting there asking for help for my kid. And she's like, we're doing everything we need to do. And we're not legally obligated to do this, this or that. And, you know, we're doing what we can do to keep your daughter safe. And she was so hostile, I started shaking, and I started crying. And I left and
Scott Benner 47:42
I would have taken I would have taken $400 worth of office supplies out of her office when I left.
Jacqueline 47:48
She followed me into the front office from her office and kept going at me. And I don't remember what she said, because my ears were ringing. And I turned around and I yelled at her. And I said, stop talking you don't know how to talk to people. I yelled at her. And I got in my car. And I was like, a mess. I couldn't drive because I was shaking and crying so hard. I was just there to ask for help. Right. And I was so viciously attacked. And, um, I tried to I went online to try to find somebody that this woman was accountable to is a public charter school. So they're not part of a district. And I couldn't find anybody. I couldn't find anybody to reach out to for help. And I almost pulled my kids out of school that day. So, but I'm like, okay, you know, get your head straight, calm down, cool off. And I did I calm down and cooled off. I sent her an email a couple of you know, the next day, saying like, you know, these are the things you said that made me feel this way. And I would recommend maybe not using this verbiage with other parents in the future. I put it all in writing. And she, you know, she came back and she emailed me back and apologized if that's how I felt. And she said, I just I have a history of going in there and questioning what they're doing. And criticizing them she said, which I didn't feel like was the case at all. So but I'm sorry for asking questions. This is all I'm just trying to help my kid to you know, so
Scott Benner 49:33
not knowing you for more than 45 minutes. I I'm thinking that she didn't like being challenged and they didn't want to expand what they do because then it opens them up to liability and it opens them up to having to provide those services for other people in the future. So
Jacqueline 49:50
yeah, and the funny thing is, is when when Bellwood and she, you know your first year, you're gonna be all over the place and maybe you're all over the place all the time, I don't know. But there were times where she was really high. And there were times where she dropped fast. And those the times that she dropped fast, were not the times the nurse had her check in. So, right, having that extra security to me, is less liability. To me, if you told me no, I'm not going to monitor your daughter, and then my daughter has a seizure, because you're not monitoring her. Right? That's when I'm going to get a lawyer. That's what I'm going to sue you for not doing what I told you needs to be done to monitor her. Yeah. So how is it more liability? Well, to to have that information,
Scott Benner 50:37
the way it's more liability, if you look at it just from their side, is that saying that you'll do it in first that you'll stop that the problem from happening in their mind, instead of just saying like, you know, we'll do our best to monitor this. If by the way, my phone is silence that I don't get a an alarm or something or I walk away from my tablet, and I don't hear that that's what they're worried about is that you then your kid has a problem. And then you say, well, we gave you the tablet, you were monitoring it, how did you let this happen? This is your fault. Like, so it's just it's liability. It's like everybody trying to
Jacqueline 51:12
say things. So common sense that, you know, I understand that there's going to be human error. There's human error when she's with me, I'm monitoring it at home as well. Right? You know, but if an extra set of eyes, I'm sure would have been nice.
Scott Benner 51:28
It's all common sense, right up until somebody can sue somebody, and then everybody hides in the corner and covers there as
Jacqueline 51:35
well. I hope that they get sued for not having it. Like they're going to show me, to me like declining, declining us. Declining, the technology that would help you to keep a child safer, is putting that child in more danger.
Scott Benner 51:49
Yeah. But that, you know, that's a coin flip at schools, whether or not somebody's going to want to follow or not.
Jacqueline 51:55
I know. Yeah. It's which is why, which is why we're learning online this year, because I can't, I can't fight I don't want to fight anymore. And I'm well, and she she chose it to she was tired of it too. I'm hoping by the time she gets to middle school, that she will be self sufficient enough to not need help at all from the NURSE
Scott Benner 52:24
Are there? Are there not other school options for you? Or will she at middle school be in a different system by then.
Jacqueline 52:36
So I could put her in another elementary school. It's funny, I was thinking about putting her in this one that was supposed to have this great nurse and then the nurse quit right beforehand. And it's just the turnover right now is through the roof. And the staffing right now is really bad. So I feel like even if I did find the perfect situation, there's no guarantees that that person would even stay.
Scott Benner 53:00
Yeah. Are you do you work full time?
Jacqueline 53:03
No, I work part time. I teach online.
Scott Benner 53:07
Okay. Is there a world where you? But you were watching though, right? While she was at school? Yeah, yeah.
Jacqueline 53:15
Yeah, I was I was managing from home and I was going in there like maybe once a week and, and it was stressful, because she has a T slim now as well. And she doesn't always respond to her alarms. And so I was having to call the school and just trying to do everything from home. It was just a lot. I was just, it was a lot.
Scott Benner 53:37
Yeah. So because what I was thinking was isn't Wouldn't it have been possible for just like, we'll take these check in times that the nurse wants, and you'll check at those times?
Jacqueline 53:49
Well, and that's why did towards the end of the school year. Because it was getting so out of hand, she was missing so much class. I got with my endo team, and we got a new health plan together that says she has never to go to the nurse unless if she's below 60. Or she doesn't feel good, or she wants to go to the nurse, right? So we essentially kind of fired the nurse. And that's when I started doing everything 100% from home, which again, it's like, it was still a lot. And she's still she's very self conscious about her pump beeping so sometimes she would turn those off. Or if she's in the middle of a project or in the middle of doing something she didn't want to deal with it. I have to call the front office, they have to go get her.
Scott Benner 54:36
How often was that happening?
Jacqueline 54:39
Maybe once or twice a week in the school doesn't
Scott Benner 54:42
have phones. You had to call the front office they had to go getter. They couldn't just call the room and say hey, send Bell Well, I would try calling
Jacqueline 54:49
her cell phone and sometimes she wouldn't answer and the worst was when she was at recess. I tried to get the teacher to hold on to the phone but she didn't understand like how to answer it or whatever like Oh gosh.
Scott Benner 55:02
Again, you do not work for the Arizona travel council or whatever. I'm not I love
Jacqueline 55:08
Arizona but our education system is is is, is it's very, very tough. And in Arizona, even teachers at charter schools don't even need to have degrees or certificates. So. And I went to school for education, and I'm telling you a lot of the teachers with degrees even. So
Scott Benner 55:34
let me tell you something. My mom is in a place where she lives in a place where they're monitoring her care. Okay, yeah. And two days ago, I'm talking to her, and I'm like, how's everything going, mom, and she's like, My blood pressure's high. And I was like, okay, so it was high enough to be concerning a bit high for a couple of days. So what are they doing? She said, Well, they gave me more blood pressure medication. And I was like, okay, is the doctor seeing, you know, they just gave me more blood pressure medication. I said, is that working? She said, No. I was like, okay, so I call the nurse and I say, Hi, my mom's blood pressure has been very high for four days. She's 80 years old. What are we doing? Well, they gave her more medicine. I said, is that working? And she goes, No, doesn't seem to me. And I said, Okay, I said, Okay, so what are we going to do? Now? She goes, Well, we'd like to wait a little longer. I said, Well, why don't we talk to a doctor? And so I said, I think maybe we'd want to speak to her physician who's making the decisions about the medication. Can you talk to the doctor for me? She goes, Sure. And I said, When can I call back to see what the doctor said? She was called back in 24 hours. I was like, okay, that's me saying, I know you're not going to call the doctor. Right. So I call back in 24 hours, I get her back on the phone, and I say, hey, What'd the doctor say about my mom's blood pressure? Oh, you know, I usually bump into him during the day, but I just haven't seen him today. So I haven't spoken to him yet. I was like, Oh, okay. Well, it's been 24 hours. Can you go speak to him? Now? She goes, Sure. I'll call you right back. I was like, great. I'll wait for your call. So she calls back and says the doctor upped her blood pressure medication again. And I was like, Oh, my God. I said, isn't that? And she goes, Uh huh. And I was like, what kind of doctor is he? And she goes, he's a GP. I said, so he's a general practitioner. It's a great isn't. What did the cardiologist say about this? And she starts flipping through. She goes, Well, your mom's never seen a cardiologist for this. Oh, my God, and I go, don't you think that'd be a good idea? She has a pacemaker, say two years old is just went through chemotherapy or blood pressure's up. It's high. It's consistently high, don't you think? And then the woman started covering her ass. The nurse, I was listening to her cover her ass while we were talking, you should probably talk to her doctor. Because I don't know the answers to these questions. I'm like You sure you do you see, or five times a day? You take her blood pressure every time you do No. So she doesn't take her blood pressure and see a problem and go, Oh, I have to help Bev. She says, I have to document this, because that's what keeps me out of trouble. And then I told the doctor now it's his problem. And so I said, Well, we're letting the GP make decisions about this. It doesn't make sense. She was well, I don't know, I'm not aware of his complete training. I said, You think he's a GP? And he's privately a cardiologist and keeping that a secret from everybody. And she and she's like, well, I don't know. You have to call him. So I call him. I say, Hey, I hear about my mom, blah, blah, blah, what are we doing? He goes, Well, I doubled her blood pressure medication. I said, is that working? And he goes, No. And I said, well, she's on a medication for pain. I said, a tiny bit of googling tells me that could cause high blood pressure. Well, she's been taking that for a while. So that wouldn't be it. I said, Are you sure? Why don't you try cutting it back and see what happens? Because if you just take a pill from her from it for a day, and see if maybe her blood pressure goes down? Why don't we try a little bit? Well, I don't think that's it. I was like, Yeah, but why don't we try it anyway? And he goes, Okay, I'll look at that. And I'm like, All right. And I said, and what about our senior cardiologist? And he goes, Yeah, she hasn't seen a cardiologist for this. And I went, do you think she should? And he goes, here, that's a good idea. I'll set that up. Yeah, that's a good idea. I'll say at least he didn't fight you on it. It's because I'm like, were you sat in the office, you're like, she's yelling at me. I was like, and you kind of you kind of crawled up. That's when I blossom. I'm at like, you guys know me like 47% You know what I mean? Like, I love being in fights, like this is the best thing that ever happened to me.
Jacqueline 59:41
Normally, I'm creating a confrontation. I don't know what it was, I don't know if it was just the subject matter of it, you know, and the it being about this and just just how overwhelmed and taken off guard and like I I've never been treated that way by anybody that's worked anywhere and to have the principal of your child's school treat you that way. I mean, I was in just such state of shock.
Scott Benner 1:00:07
Yeah. I I'm still pissed that we don't haggle over car prices anymore. We're buying cars. So it's one of my favorite things to do like every five years. Well, that's
Jacqueline 1:00:15
what I used to do. I was a sales manager at a Ford dealership. And I worked for Ford for four years. Then it was an internet manager at Nissan for two years. And I loved negative. It's my favorite. Yeah, it's so fun to negotiate and haggle. And
Scott Benner 1:00:33
we were young, we left and my wife's like, we argued for three hours and saved $1,000. I was like, you know, it's amazing, right? She's like, did it matter? And I was like, I don't know, I had a great time. Making
Jacqueline 1:00:43
$333 an hour. I know, he made $333.
Scott Benner 1:00:48
I'm like, I'm killing it here. You know. But so so then I so but think about this. The no one has my mom's best interest at heart in this story, except for me, right? And everyone is willing to do bare bones, basic, whatever it is, one nurse said to me, I swear to you, well, your mom is older and she has heart problems. And I was I said, Yes, she goes, heart problems don't get better, they get worse. And I went, okay.
Jacqueline 1:01:19
So to get better.
Speaker 1 1:01:21
Let's just say she's right. We're done. Are we done with her now? Like, why are we going to, we should just push her in the dumpster? Is that is that this like, you're not gonna try to do something? Because like, she just spent the last year of her life, defeating cancer. And now you're gonna tell me her blood pressure got higher, and oh, well, it's over now. Like, she actually said it to me in that tone. Well, like this, you know, this isn't gonna get better. And I was like,
Jacqueline 1:01:46
I'm like, probably She's probably just so jaded. She, she,
Scott Benner 1:01:50
she's the one in charge. She's, she's my mom's frontline defender, you know? And then I get to the doctor, and he think about this. If my mom seeing a cardiologist was a good idea, why did I have to call and say it? Because it was not going to happen if I didn't call? That doesn't make any sense, right? Yeah, right. So you think that that principal is going to put her ass out in the sunshine for you? No way. Not in a million years. If your kid has to go learn in her bedroom for three years, so that she keeps her job, then that's what's going to happen. That's it. That's what happened. I'm sorry. I'm sorry. I don't see this as being cynical, by the way. And I'm certain that there are plenty of people. And
Jacqueline 1:02:35
that's not the only layer to this, either, is she's really struggled in math. And I didn't realize the extent of it until COVID hit and I actually saw how she struggled in math. Yeah. And that's one thing she would cry about a lot last year. And when I would go to her teacher, I would get nothing. And so I like she needs help in math. And you know, a lot of kids when they're bad at math, it's like, okay, just don't get a job that has math in it. But it's like, no, you have to understand how numbers work to manage your health care for the rest of your life. Like you can't just not understand how numbers work, you know,
Scott Benner 1:03:14
exactly. And also not for nothing. But bailing on a 10 year old as unhelpful around math is silly. Like, well,
Jacqueline 1:03:20
and that's not what happened. What happened is I would call and ask how she's doing. And the teacher would say, Well, I don't know, she doesn't really raise her hand. She doesn't know she's struggling, because she doesn't raise her hand and ask and tell her that she's struggling. And I'm like, Okay, well, you know, she's not able to do any homework, and she's crying, but she feels like she's stupid, a sweat in class, and everybody else gets it, and she's not getting it. And I was like, I think she has a learning disability and math. And I said that repeatedly. I think she has a learning disability. Well, we don't really have any, any inner any programs to to do anything about that. Well, it wasn't till the end of the school year where somebody told me no, you have to put in writing, I'm officially requesting that she gets tested for learning disability. Okay, I send them an email and in writing, but it was too close to the end of the school year. So like, we'll do it. But when school starts, I'm like, Oh, great. Do
Scott Benner 1:04:10
you see that if we take that little parable that you just told me and pull out the words math and put in high blood pressure and a couple of other things? It's the exact story about me talking to the doctor about Yeah, right.
Jacqueline 1:04:22
It's just it's just, it's just complacency. And I'm, I'm sorry that, you know, I'm, that's, you know, I just I have higher expectations of people. And it's,
Scott Benner 1:04:33
yeah, my point isn't that it's, it's specifically in healthcare, or specifically in education. It's specifically in people that are like, listen, there's a process here. I am following the process. You have not written down the words you just said to me, and I'm not legally obligated to tell you that if you write it down, that we can get our help, or I don't know or whatever. And so it's a checklist.
Jacqueline 1:04:56
It's well there's there's there's two kinds of people. There's people that go to work and they go with emotions and they collect their check. And then there's people that are passionate about what they do and take pride in their work, and are there to really do the right thing and be helpful. And unfortunately, in my daughter's case, she's really been experienced to that first type of person in education, and health care. She's been very lucky, right? You know, and I could be here telling you the opposite story. She could have fantastic, you know, school and horrible hospital. And there's people with that, too. But in this case, we've had the complacency on the school side, and I don't even want to roll the dice to deal with that, again, because I've done so much I started reading again. I know she has dyscalculia dyscalculia is math learning disorder. That's about as common as dyslexia. But it affects a certain part of the brain. And I've been with, I listened to every podcast, and I've read everything I could about it. And it explains why she didn't learn how to ride a bike until she was nine. It explains why she has trouble understanding how time works, and how money works. And all this other stuff, like with numbers are really difficult for her to comprehend. And so her online schools gonna be testing her for dyscalculia. But, again, after my research, I'm like, Okay, this is, I'm so relieved. I'm like, Oh, my God, I can we could actually do something about this week, there's actually like, a try. There's actually, you know, processes, we can, you know, combinations and tools to use to help people. And there's a lot of adults this that, that suffer from dyscalculia that but nobody knows about it. They just feel like they're, they're dumb, and they're not.
Scott Benner 1:06:45
You know, how money works is one of the signs that I might know a lot of.
Jacqueline 1:06:49
Yeah. I love but it's sad. I mean, because my daughter is she's very, very bright. And she reads like a fish. She reads all the time. And she writes all the time. And she's very intelligent. But when it comes to numbers, they just, her brain just doesn't process them. For everybody else. And, and with diabetes, that's scary to me, you know? So like, she needs to understand number concepts.
Scott Benner 1:07:18
I'd also like to see her have a little savings when she's older. That'd be nice, you know?
Jacqueline 1:07:23
Well, it's not necessarily about like managing money. It's more so like calculating change and understanding amounts. And really like that
Scott Benner 1:07:31
time, how does time fit into it?
Jacqueline 1:07:33
Well, basically, especially like second through fifth grade, that's when kids are learning like all these different number models. So you know, you count in base 10. But when you when you do time, you're in base 12. You know, and then when you're talking about dollars, you're in base 100. And you're learning about all these different measurements, right? And a ruler is 12 inches, and there's 30 days in a month, and there's 12 months and a year, and I'm just kind of getting to remember all these different base value systems is really tough to
Scott Benner 1:08:10
to for some people, it just happens. And then for some people, it doesn't, right, okay.
Jacqueline 1:08:15
It's a physical brain thing. We're like a certain part of their brain on one side isn't communicating, you know, so in these people, one of the podcasts they listen to, they were saying, when you give these people calculations, when they try to do calculations, the language center in their brain lights up. And so the math center, so super interesting. It's just like, it's a different, different way of thinking.
Scott Benner 1:08:41
Now, listen, everybody's not going to think exactly the same way. But you could have the basics and somebody could help you, especially when you're 10 years old. That just makes sense. So I you know, I don't I listen to your making the sound like I can't even make fun of Canada anymore. This is what Arizona is.
Jacqueline 1:08:59
Like, there's it's not it? Well, you know, it's everywhere. And there's there's there's great schools, I'm sure we're in Arizona, there's great schools in Arizona, and there's horrible schools in Arizona, and there's great schools everywhere and horrible schools everywhere, I'm sure except for maybe some places don't have poor schools because everyone there thinks education is important. But here Oh.
Scott Benner 1:09:22
All right, Jack. Well, listen, let's start talking about whether or not we got to everything you want to talk about. So I'm gonna look, you've said some things in your notes that have not come up at all. Yeah, so wait a second. You've recently got married?
Jacqueline 1:09:41
I got married in April.
Scott Benner 1:09:43
Oh, okay. All right. That is very recently.
Jacqueline 1:09:46
Yeah. Yeah, yeah.
Scott Benner 1:09:48
So there's so there's that that that must be difficult for kids to like. I mean,
Jacqueline 1:09:53
well, we were already living together for a few years before that. So it wasn't really too bad. It was just a party didn't really change our lifestyle or anything.
Scott Benner 1:10:03
Okay, I understand. Alright, that makes sense. All right, well, then let's let me ask, is there anything we haven't talked about that you wanted to talk about?
Jacqueline 1:10:12
That you have been we haven't talked about was the custody thing? And
Scott Benner 1:10:20
how well how does custody work for you?
Jacqueline 1:10:24
Ah, so, right now it's kind of 5050. With school being back in session, it's 5050 for my son, who's in middle school, and then for my daughter, it's, she's here everyday during the day, and then she's with him three to four nights a week. So I, my daughter's here a lot more.
Scott Benner 1:10:49
How does how does? How was the custody issue with the diabetes.
Jacqueline 1:10:53
So my ex is a recovering alcoholic. And he. So he's been, he's been doing great for a very, very long time. So but it's just kind of one of those things where once you have that, in you, it's like any addiction, right? There's always a chance of something happening. So when when my daughter was diagnosed, my ex was already going through a lot with his he had family members. He actually had a family member that went into the hospital the day before. belted my daughter did. And he had another family member that was having that he needed to help with because the other family members in hospital. So he had a lot going on. And then the thing happened with my daughter. So I was really worried for him that, you know, that could trigger something. And then about a month after. So it's so for me, like as a mom, like even before diabetes, there's just kind of always this like, like if something happens, like if this if his wife were to leave him or if something were to happen to his parents, like I was worried like he could start again. And what happened was,
Scott Benner 1:12:17
yeah, how does that impact like day to day stuff?
Jacqueline 1:12:22
Well, it wasn't well. So his wife, like I said, is amazing. And she handled a lot of the diabetes stuff, especially at first when he wasn't really able to process it because he was going through a lot. But about a month after she was dying. She went on vacation, like she left for the weekend, and left him home alone with the kids. And I got a phone call from the kids crying and terrified because he was very intoxicated, and they didn't feel safe. And so I had to pick them up and file a police report and do all this stuff. And my son had to give my daughter her Lantis shot, which he had never done before.
Scott Benner 1:13:11
Oh, Jacqueline, you broke up.
Jacqueline 1:13:14
It's not that she wasn't under stupid. She can. Like she could be thinking six and right a nine.
Scott Benner 1:13:20
You broke up again, your your son had to give your daughter Lantis. And
Jacqueline 1:13:25
yeah, and my you know, my daughter isn't, even though she likes to give herself the shot, I always want to double check that it's the right dose, because sometimes she can think one number and write down another number. So she can mix up numbers very easily. And my son has never done this. And I wasn't even sure he knew how much to dose her. So that was happening. So I had to go pick them up. I was actually at my parents house, we drove across town. I had to file a report and go back to court and get more testing done. And then he had to do some, some testing. So and he did and he went through everything and he and he got it back together. And she's his wife is like, I mean they're doing the best that they possibly can. And I can't and I'm grateful for that. But it's just it was just some an additional little trauma that she endured. So they've endured some she's endured some trauma. Yeah. So that's just a little it's kind of in the back of my mind if if she's not there will be take advantage of the situation and give in to those impulses.
Scott Benner 1:14:44
So it's kind of scary. That sounds scary.
Jacqueline 1:14:47
I mean, diabetes is scary. And I'm just and just as a mom, I don't know if all moms are like this but or parents are like this, but there's just a certain level of paranoia that I always have a certain level of like Worst case scenario with them that I always am, you know, is wondering. So it just kind of adds to that a little bit.
Scott Benner 1:15:12
I think I understand. Yeah, it's a rough situation. Yeah. I mean, even on your son who all of a sudden got thrust into like, I'll I guess I'm gonna give her this shot, you know, is uh, I mean, I'm it sounds like they took care of it, but the circumstances make it. It's not a triumphant feeling under those circumstances.
Jacqueline 1:15:33
Right? Yeah. That's yeah. Well,
Scott Benner 1:15:38
alright, Jacqueline, listen. I don't want to say your life to show but it's not great.
Jacqueline 1:15:44
I have a great life. Wonderful. I'm, I have a wonderful, wonderful kids, I am madly in love with my husband. I'm, I'm grateful that I have the opportunity to be here with my daughter, and I don't have to keep fighting with the school while I'm at a full time job. You know, so I have got a lot to be grateful for, though, for
Scott Benner 1:16:03
sure. No, I was teasing. There's and who wouldn't be somebody about that? I just I was like, it's just it's a heavy conversation. Get it? I mean,
Jacqueline 1:16:11
yeah, yeah, it is. It's
Scott Benner 1:16:16
because especially, I mean, listen, the alcoholism aside, if, if a couple of people in your life just wanted to do a slightly better job, or be a little more valuable to the people around them, the most of these big problems you have just wouldn't exist. And it would take such a tiny bit of effort on their part to, to remove a lot from your shoulders and from your daughter. And, and everything, you know, and it's, that's what's frustrating to me, is
Jacqueline 1:16:49
Oh, yeah, if, oh, if she was able to go to school, I would be teaching in the classroom right now. Right? Right. It's just so you're in Arizona, where we have no teachers in the classroom. You know, there's such a shortage here, everyone's desperate for teachers. I can't be there. I can't teach in a classroom right now. Because my daughter has to come first. You know, if I knew she was safe at school, and they were watching her, and I could trust them, then I could be teaching in a classroom. But I'm not.
Scott Benner 1:17:19
It just doesn't seem like it would take that much for that to happen. You would think, yeah, it's a little bit of will, that's all like the will to do it. And, and that's most of it, I think they would find that the actual effort on their part would actually would go down, not not up, like, like actual effort put out would go down, safety would move up.
Jacqueline 1:17:43
And they have they had for type one diabetics in the school. So they had four kids doing this. So you know, multiply the number of nurse visits by four. And that's how many times she had somebody coming in interrupt or when all she could have put them off for on the tablet, and looked at the screen.
Scott Benner 1:18:01
I wonder if I wonder how much of it is, is job protection of like, well, if these kids don't come down here, then what do I do? Like I wonder if that ever popped into anyone's head? Well, there are
Jacqueline 1:18:13
two there were actually two nurses and one of the nurses was really great and open to it. And then the other nurses. Oddly, oddly clinging to their odd like clinging to this more. Yeah, and it's unnecessarily. It's like, it's like government, right? Like, like, like, Why do you have to make things more complicated difficult than they have to be? Like, just just make it easy on yourself? It sounds like the one there's a technology.
Scott Benner 1:18:44
Yeah, it just sounds like the one nurse is stuck in the way they do it.
Jacqueline 1:18:48
Yeah. And she and she took it. Oh, gosh, I can't tell you this. She said it's so personal. You know, stick is so personal when I wasn't happy with with the way they were doing it. Like she's missing too much class, she I you know, I want I would much rather her be remotely monitored. So she could stay in class. She's healthy, you know, and she she took it very personal. And after that confrontation happened with the principal. The next day, she didn't let me in her office, she picked her head out to talk to me, but the door closed around her head. And then like she was really hostile with me for the rest of the year like so much so because my son used to meet me at the nurse's office. He goes why is the nurse so mad at you? Like she was openly like yeah, like junior high level like junior high level like I can't stand you I'm not going to give you eye contact or smile in your direction. I'm going to frown and look in a different direction. And I I just It's just It's so wild to me like I don't I've never seen adults behave that way in any professional, any setting. I just
Scott Benner 1:19:57
that's it's incredibly unfair. It In the end, it's just incredibly unfortunate luck. You know, just bad luck that those are the people you ran into. Yeah, so I'm sorry. All right, Jacqueline. I appreciate you doing this very much with me. I really do. I I hope you had a good time even though we talked about some bummer stuff, but but I thought it was. I thought it was good conversation.
Jacqueline 1:20:20
Yeah, it's fun. Cool.
Scott Benner 1:20:23
Hold on one second for me, okay.
Well, Jacqueline did her part, didn't she? That was wonderful. And you know who else chipped in Omni pod Omni pod.com. Forward slash juice box, get yourself the Omni pod five or the Omni pod dash. It's up to you. You get to choose. But whatever you choose, choose it through my link, Omni pod.com forward slash juice box. I got a bounce in my voice. I'm getting on a plane tomorrow to go visit my daughter for a couple days for Parents Weekend. So I'm kind of excited. Anyway, that's neither here nor there. What else? Oh, wow. I gotta thank you for listening, of course remind you to tell other people about the podcast. If you're enjoying it. I mean, if you really love it, leave a five star rating and a beautiful review. Wherever you listen. Don't forget to check out the private Facebook group Juicebox Podcast type one diabetes. Oh, you know what else to hold on? If you know some people with the type two diabetes, I just put out a great series about type two. Can you please let them know about it? We're trying to spread the word. So all I'm asking you to do if you don't know where to find this information, fair enough. That private Facebook group under the feature tab will have a whole list. And gosh, I want to say yes, here it is. You go to juicebox podcast.com. Click on the top type two diabetes. There's a whole menagerie there. And Azure, you have information for people who have pre diabetes, or type two. Thank you so much for listening. Thank you for sharing. I'll be back very soon with another episode of The Juicebox Podcast. Hey guys, just jumping in to remind you that one of our sponsors BetterHelp is offering 10% off your first month of therapy when you use my link better help.com forward slash juicebox. That's better. H e l p.com. Forward slash juicebox. Better help is the world's largest therapy service. It is 100% online boasts over 25,000 licensed and experienced therapists and you can talk to them however you want text chat phone or on video. You can actually message your therapist at any time and schedule live sessions when it's convenient for you. Better help.com forward slash juicebox save 10% On your first month.
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