#936 888-ASK-SCOTT
Stephanie has type 1 diabetes and so many stories that should have gone the other way.
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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 936 of the Juicebox Podcast in a second, I'm gonna try something a little different
normally about now I jump in and say, Hey, on this episode of The Juicebox Podcast, I'll be speaking with Stephanie Scott type one and I give you the whole kind of rundown of it. Instead of doing that today, I'm going to play for you the recording I made after Stephanie and I got finished. It's there to remind me about what the podcast episodes about. I know that's weird, but I don't edit them in whole months after they're recorded. So sometimes I need a reminder. Stephanie is an adult with type one diabetes. She had a tough upbringing didn't pay much attention to her blood sugar's ended up losing her vision. In one eye, she lost a breast to a pierced nipple that got infected. And she's just a ton of fun tells great stories. We're going to call the episode. Ask Scott or 888 ask Scott or something like that. Anyway, that's what today's episode is about, I might start doing that more frequently. Well, I gotta tell you real quick 35% off your entire order at cozy earth.com use the offer code juice box at checkout. Free five travel packs and a year's supply of vitamin D with your first order of 81 from Athletic Greens athletic greens.com forward slash juice box, and I'm gonna run out of time but better health.com forward slash juice box save 10% off your first month of therapy. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. It's a blood glucose meter kids. What do you need from it? You need to work well have a bright light and be super accurate. That's what you want. Right? Easy to hold easy to handle easy to use. Condor man concert next.com forward slash juicebox. No, no reason to keep looking. I found it for you. You know what this episode is also sponsored by touched by type one touched by type one.org. Go there, find out all about what they've got going on, including the big event coming up with me in September. Check them out. Touched by type one.org. If you ever wanted to listen to a guy, talk in person who you listen to talk in your ears. This is a great opportunity. We are recording. And you go ahead. Go ahead. Well, you're saying Stephanie was like cutting you off like you were getting ready to go. You're excited to start? Oh, okay. Okay, go ahead.
Stephanie 2:36
I'm Stephanie. I've had diabetes for 27 years. And I found your podcast about a year ago. And I'm pretty obsessed with the information and content that I've listened to so far.
Scott Benner 2:50
That's what we like to hear. Stephanie. Okay. Not the part about you having diabetes. Can you imagine?
Stephanie 2:56
I know. Right. I love hearing you have diabetes.
Scott Benner 2:59
Yeah, that part. I didn't enjoy it all. But that the fact that the podcast is helping you is cool. 27 years ago is this is gonna be easy. So it's 2022. So we just take 22 right off your 27. We're left with five then we subtract. We take 2000 and subtract five. And then you were diagnosed in 1995. Yeah. And at that time, you were how old? I was six, six. That makes you 31. And you're gone. Now I'm here. Oh, did you not answer me? Were you screw with me?
Stephanie 3:33
No, I was. I was sick. And I've had diabetes for 27 years. So I'm actually 34
Scott Benner 3:44
Oh, I said 25 and was 27. Alright, so my listening skills suck. But my math was very good. Yes, yeah. All right. Well, I'm going with that. See how I high side of it right away. I was like, Maybe I can't listen. But my mouth My mouth was still correct. If you go with the
Stephanie 4:03
like, Wait, I don't think I'm 21 I don't think I'm 31.
Scott Benner 4:07
So the long pause I thought was your bit I thought was a bad internet connection. Because in the beginning, you had one before we started and but what was really happening is you were like, am I 31? I'm 31 I don't think I should say, Did you did you? Were you thinking like, Should I say something or do I just let it go?
Stephanie 4:28
It's like, you know if he wants to make me 31 I'll be 31
Scott Benner 4:32
can't cheat life just because I'm bad. But listening. So alright, so you're you're trying to tell me you're 33
Stephanie 4:37
I'm 34 Yeah. 34 Okay, so
Scott Benner 4:39
you're 34 years old diabetes for quite some time. And are you married? Do you have children anything like that?
Stephanie 4:47
I am married and I have one son, he's seven.
Scott Benner 4:51
Okay. And he's seven. And I've had him tested through trial net. He doesn't have any Barker's. Well, that's exciting, because when you signed up to come on you were you hadn't done it yet. Right?
Stephanie 5:07
Right. I had the kit, and he didn't want me to do it. And he finally let me do it. And it was very dramatic and dramatic. And I should have taken him to a lab.
Scott Benner 5:18
Wait a minute. Dramatic and dramatic. How was it dramatic?
Stephanie 5:22
So, did have you ever done it at home?
Scott Benner 5:27
TrialNet Yeah. Oh, no. But I've done I've done a test to see what your blood type is. And that, that looked like a murder scene. By the time we were all Yes,
Stephanie 5:40
yes. So do that on a six year old because he just turned seven in July. So I had to fill like that full two with blood from his finger. I owed him ice cream, like every night for a week.
Scott Benner 5:54
Was he panicking? Or was he okay?
Stephanie 5:56
No, he was just like, why are you taking so much of my blood?
Scott Benner 6:01
Do you think? Do you think you were gonna leave him with enough maybe?
Stephanie 6:06
Because I've tested his blood sugar up until that point a bazillion times? Because you know, because I was like six when I was diagnosed. And so it was just like that little itty bitty bit of blood. And so that's what he thought he was getting. And then I'm like pumping blood from his finger. He's like, this is not okay.
Scott Benner 6:25
I've been lied to I've This is it? Well, good news. He doesn't have he doesn't have any of the markers for type one law.
Stephanie 6:32
Nope. He didn't have any. Oh, that's great.
Scott Benner 6:36
But you did when you were diagnosed at six, were there any other autoimmune issues in your family?
Stephanie 6:43
Not that I knew of. I have a very limited knowledge of my family's history. So I know my mom, and my siblings, and an aunt and a grandma. And that's about it. Though,
Scott Benner 7:01
okay. You just don't know. You don't know a lot of people in your life or you don't in your family.
Stephanie 7:06
So I never met my dad. He died of ALS about three years ago, apparently. So I don't know anybody from that side. And then my mom's dad died when she was seven. So I don't really know anybody from her dad's side. And she's got one sister that way that I know of on her from her mom's side. And then she has lupus but she was diagnosed after I was diagnosed with diabetes.
Scott Benner 7:36
I see. Your mom was diagnosed with lupus at a later age. Yes. Interesting. Okay, do you have any other autoimmune stuff?
Stephanie 7:45
I have celiac?
Scott Benner 7:47
Celiac? Right. I assume when you were first diagnosed, it was needles and
Stephanie 7:56
little NPH. And regular. Yeah.
Scott Benner 7:58
Did you even have a meter?
Stephanie 7:59
I did. It did have a meter. It was the big drop. Like, basically murder scene again, you know, to get the blood. It changed pretty quickly, though.
Scott Benner 8:13
You're right on the cusp. Around that time? Yeah.
Stephanie 8:16
Yeah, it changed from the like the paper almost like strips to the ones that like suck the blood up off your finger pretty quickly, if I remember correctly.
Scott Benner 8:27
Gotcha. Okay. How do you remember growing up a diabetes?
Stephanie 8:34
I did really well starting out. You know, food scales. The handy color coded book that they send you home with this many of each food group for each meal. You have to eat it.
Scott Benner 8:47
Are you doing the exchange diet? Yeah. Okay. Yep. So by by you were good at it. You were following the rules? Yeah. What was your mom helping you with that? I imagine we're six right? Yeah,
Stephanie 9:00
yeah. So they would help me with my food. And sometimes they would even have to like leave before I would leave for school and they dropped my insulin and everything for me before I leave.
Scott Benner 9:10
And like send you with a syringe that was already ready to go.
Stephanie 9:14
Like sit on the set on the table until I got up and gave myself my shot and ate what they had already made for me got on the bus. Oh,
Scott Benner 9:22
but they weren't home anymore. Like they would leave for
Stephanie 9:24
work just before I'd get on the bus sometimes and have to do that. I see. I see. Yeah, that's interesting. It didn't last for very long though.
Scott Benner 9:34
them getting up and making you breakfast didn't last very long. Yeah, like
Stephanie 9:37
carb counting came in and like, I got old enough to where they thought I could have control I guess.
Scott Benner 9:43
Oh, I see. Okay, I thought you were like they got bored of helping me and they're like, forget this.
Stephanie 9:48
Like now you've got this. Yeah, you're fine. It wasn't so much. I'm bored of doing this. Like I think you've got this. I know you're 10
Scott Benner 9:57
But you were and you were carb counting at 10 years old.
Stephanie 10:00
Yeah, I feel like it was it was pretty early on, they switched over to the carb counting. And then I went to chemo log from regular and NPH and they finally started letting me carb count. The pump came out early on, but it was a fight to get it. One endo would say, you know you have good enough control you don't need the pump and then another then you know my blood sugar's would go crazy because I'm like I'm getting that pump and then the next minute it would be like your blood sugar is out of control. You can't have the pump. And my mom moved. My mom and I moved a lot when I was younger as are like, all over the country. And my mom finally took a job working in a doctor's office. And she convinced her doctor to write me a prescription even though he was not my doctor for the pump and got me the pump.
Scott Benner 10:56
Wait, hold on a second. Why are you moving around the country so much?
Stephanie 11:01
Oh my gosh, I hope my mom doesn't listen to
Scott Benner 11:04
I listen. She's not gonna listen if you don't tell her how would she know how old your mom?
Stephanie 11:10
My mom, and I should know that.
Scott Benner 11:15
Oh, you were so sure about how old you are. But now look.
Stephanie 11:18
She was born in 69 I can tell you that. Oh
Scott Benner 11:21
7980 992 1009 2019 2021 to do your mom is weighed 53 Yes. Oh, wait a minute. It's definitely is your mom have you when she was 12?
Stephanie 11:37
No, she was 19. I'm 19 years older than her. Okay,
Scott Benner 11:40
by the way, anything under 25 is 12 That's all okay. Yeah, young I bet. Yes, very young. We
Stephanie 11:46
grew up together.
Scott Benner 11:47
Okay, so Okay, so your mom was 19 when she had you? And you were moving around because she was
Stephanie 11:54
she's a gypsy? No, not really. That's what I tell everybody and that's why she gets mad.
Scott Benner 11:58
Oh, well. Wait,
Stephanie 12:00
hold on. She just likes to move.
Scott Benner 12:01
Okay, but she's not she's not I don't or gypsies like uh, are they even
Stephanie 12:07
know she says like gypsies don't take baths so she doesn't like to me to tell people that she was a gypsy
Scott Benner 12:11
I don't know that that's true. First of all, I don't know if that's true either malign people for at first like like at first let's make sure we're right before we move on, I'm just what I was gonna say. No, I
Stephanie 12:21
don't know. But I always tell people that she's a gypsy because the Gypsy has moved around the country a lot and have really free lives and I think it's cool and she doesn't
Scott Benner 12:29
Alright, so first I'm gonna Google is gypsy a bad word?
Stephanie 12:33
All right. Let's see. We're gonna have to see if you have to edit this whole section.
Scott Benner 12:36
I know so far. You're the only one that said it. Honestly, I'm completely in the clear. Gypsy is commonly used to describe the Romania people are Oh MA and I but the term carries many negative connotations and as derivative carries even more like oh getting gypped is one meaning like the fraud or why being chipped hurts the Roma more than it hurts you. That's not what I meant. No, no, no, I know. We might have to take this out for your protection. I mean, if they're willing to relocate they're willing to come after you I would imagine. So I've I know it's a word I grew up with then I didn't think of it as like a slur but we either Yeah, well, you're from like you live in the middle of nowhere you don't know better one way or the other.
Stephanie 13:35
I guess it doesn't matter that I'm well cultured and lived in like 13 states in my life.
Scott Benner 13:39
Now you're dodging meth heads right now right?
Stephanie 13:43
Oh my gosh. Listen, I live in my I live in my shell. My husband is homeschool that i i only associate with the people that I choose do there are probably lots of methods that I choose not to met to associate with.
Scott Benner 14:01
Really interesting. Okay, well, listen, it's definitely look I'm not the end all be all of decision making. But I say spend a couple of minutes googling gypsy make sure you're comfortable with it. And for your next time your story. I just figured your mom was like an assassin or a stripper, but I wasn't sure which. No comment. Oh my god, your mom was a stripper. No, I'm not saying anything. Wait. Your mom used to kill people? Stephanie. Oh,
Stephanie 14:29
I'm almost never killed anyone. Oh,
Scott Benner 14:31
she's a stripper. I got it. Okay. There's nothing wrong with that, by the way. No, no. How do I get that? Are you at all impressed? Stephanie.
Stephanie 14:40
I'm actually very impressed. Yeah, I'm super good. Listen, she didn't move around the country because of that. She's actually very, very, very high up in like the professional world. Now. She just was like, yeah, she just like took about and decided to have some fun and then yeah,
Scott Benner 14:58
your mom's got better stories than You probably how many times do you left home alone overnight? Did this ever happen?
Stephanie 15:05
Listen, I'm the oldest of five. So I was the one left in charge.
Scott Benner 15:10
Oh, your mom had five kids? Yeah. Oh, oh, no kidding. And you're the oldest? Yep. Oh, so you like mom went to work? And then you stayed with the kids.
Stephanie 15:20
I help mom with the kids a lot. Yeah,
Scott Benner 15:23
no kidding. Oh, that's, that's an interesting way to do you find that they think of you as a parent.
Stephanie 15:29
Some of them yes.
Scott Benner 15:32
I've traveled with that with my brother sometimes. So
Stephanie 15:35
for for, you know, for the early years. They're like they're not mom kept telling me what to do. But now like later on, they're like still calling you for the same things that you would think you would call a mom for. But they call both of us. So it's like instead of calling mom and dad they call mom and sister
Scott Benner 15:52
right? Hey, what was your mom specially up top or down bottom? You know, I don't know. Like think of her did she was she big and round in one of those places.
Stephanie 16:04
My mom is well rounded.
Scott Benner 16:07
I'm gonna take that as up top and down bottom. All right, so very blessed. I think we should spend the rest of this hour me just trying to figure out things about your life because of what you've already told me in the first 12 minutes to see how much of it I still don't even get it all. Yeah. All right. Well tell me all right. Okay. So why did you want to come on the podcast?
Stephanie 16:34
Um, well, when I first started listening, I emailed you right away. I was like, oh, I need to be on this podcast, because these stories are great, but I have better ones. And then I kept listening. I was like, I don't know. Maybe not. Maybe I just want to get on and just talk because, God, it seems cool. And I have some cool stories.
Scott Benner 16:52
Well, listen, we don't have to judge your stories against the other ones. But if you're gonna dump me up, when I asked if your mom's a stripper, then the stories are not gonna be good. But that's a phrase, where do I where's that from? Dummy up? That's from all in the family. Is that from How old are you? There's no way you know, that reference? 34. I'm pretty sure. So all in the family was a television show. Yes. And I think I'm, I know, here it is. I'm right. That's insane. How do I remember that? So I think so. Carroll O'Connor was like the, he was he was the father of his family. Right. And he was very hard on his wife. Like, really like she was ditzy. And he called her DOM and stuff like that. Like, trust me. There's no way this TV show would would make it today. But I remember the phrase dummy up and it's from that. Wow, that's weird. Anyway, no one cares about that. But me but I was stunted that came out of my mouth just now. Anyway, okay, so you have stories. We're not going to judge your stories against other people's stories. You have to tell me the story. She can't get in the middle and leave out the fun parts. Like your mom. Like you don't I mean, like your mom was like chesty and had a big ass. Like don't like, tell us that part. That's the part we want to know. So okay, well, sorry, these diabetes stories.
Stephanie 18:21
Medical stories in general. Yeah.
Scott Benner 18:23
Give them to me. Let's do it. Well, Stephanie, are you nervous?
Stephanie 18:34
I don't know what you I don't even know where to start.
Scott Benner 18:37
Are you nervous, though? Let's get to that. No, you're not nervous. Okay. All right. So you're diagnosed with type one you are overseeing? Well, not at that point, unless your brothers and sisters are 6543216. So you've got any siblings that your diagnosis?
Stephanie 18:54
Oh, yeah. Okay, I have. I have a brother that's a year and a half younger than me, a brother that is four years younger than me. And then my sister was born the year that I was diagnosed. Wow.
Scott Benner 19:09
Okay, so there was already four of you around this time. So your mom has to figure out this diabetes thing. She harangue a doctor into giving her a prescription for a pump at some point, which is Yeah, fascinating. And no, right. Also, we're all wondering how your mom got the doctor to do it now. Yeah, she's definitely now you're thinking it too.
Stephanie 19:32
You know what, that was not okay.
Scott Benner 19:35
Put that thought in your head before we got going. I mean, if I was in a bad situation, Stephanie and I had to throw it to do so. Because, you know, if I, if I had to throw a handle to a guy to get a real pump, I probably would, you know, I'm just saying alright, so you got this
Stephanie 19:58
out that my mom wouldn't do for me, so I'm not I I'm not going to even put anything pastor.
Scott Benner 20:02
Listen, if I'm sure what she did was she asked, and the guy was like, Yeah, sure. And just no more. Like,
Stephanie 20:11
twice and she does not I can't even believe she worked in a doctor's office. So I was like already, like a sacrifice she made. As soon as she got that pump prescription. Like she quit.
Scott Benner 20:23
Oh, your mom's free spirit for sure. Yeah, even if 53 Is she still?
Stephanie 20:32
She just moved back finally from Texas for three years. Like she's still moving all over?
Scott Benner 20:39
Yeah. Does she ever on tick tock account? This is how we'll judge her. No, no, no. Tick tock. Are you afraid she's going to try it? No, she uses
Stephanie 20:47
indeed like social media.
Scott Benner 20:49
Oh, she's made a big shift. She's a completely different person now. No,
Stephanie 20:56
but she's still always been super professional. Even when she when she went and had her find out the strip club. She was still had like a full time day job. Professional.
Scott Benner 21:06
Okay. Okay. Yeah. Alright, so a professional. So how was it going? Because it's a different life growing up where you're kind of overseeing your brothers and sisters, because I had to do it. And I know it's not, it's not a great way to grow up for you. And it's a bit of a shame for them. But in some families, it's just, it's what you have to do. So. So you're growing up with that? Are you struggling for yourself? Or are you just doing mph and regular, like for so many years, that you're not paying very close attention, you're just doing the shots, the way you're supposed to eat the food the way you're supposed to.
Stephanie 21:38
I did that for a few years. And then I went to the sliding scales with the human log. I went to diabetes camp a couple of times. So I kind of stayed up for a little bit. Like with the newer stuff. I definitely disconnected from from anybody else with diabetes from a very long time. Basically, I was getting just my information from my endo when I went every three months. But I've always made my own adjustments and stuff. But, you know, for a long time, probably up until the last five years, I just thought, oh, seven. That's what I need for my agency. That's my goal.
Scott Benner 22:36
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Stephanie 25:41
Yeah, just keep it around a seven. And I was doing good. Because that's what we were told early on. And I didn't stay up to date with anything and doctors never say anything. If you're at a seven they don't say that's bad. You know?
Scott Benner 25:57
Yeah. Okay, so how long do you think that went on for? Give me a frame of time where you were just living like that? Seven ACA once. He was good. Nobody was questioning anything, etc. Like a number of years near life. Money 20 years. Okay.
Stephanie 26:20
But I mean, I didn't, there was there was a definite time in there where I didn't even care what my currency was. I I was out of control, probably from about 15 to 24.
Scott Benner 26:37
How so? I didn't
Stephanie 26:41
I didn't know what my blood sugar was. I just wouldn't ask for not like, oh, I will I'll go whole day without testing. Like, I'll go a whole year without testing. There was times I couldn't even tell you where a meter was.
Scott Benner 26:54
Were you using insulin?
Stephanie 26:56
Yeah, I wore my pump.
Scott Benner 27:01
So what did you do? You just the ran your to the pump ran your Basal rate. And then you just like swagged meals? Yeah. And you don't so you never knew where you were, but you still went and got a onesies done?
Stephanie 27:18
Well, endos won't write prescriptions unless you've been in their office and the last. Some of them are six months or 12 months.
Scott Benner 27:27
Okay, so you would go because you wanted to keep going. So you wanted the script. But you didn't want it enough to put more effort into it than the amount you're putting in? Or was this something were you? Were you consciously trying to avoid diabetes? Were you giving up like, what, what's the mindset there?
Stephanie 27:47
I don't know. I think it started really like, even before I got the pump, like I could figure out tricks to make my meter say what I wanted it to say. Like there were certain meters back then that if you lick the back of the test strip before you tested, you'd end up with a perfect number.
Scott Benner 28:08
Lick the back of the test strip, or you tested?
Stephanie 28:10
How do you ask me how I figured that out?
Scott Benner 28:13
Was it diabetes camp? Because that's where sometimes people say they learned, yeah, most of their bad stuff, because there were so many kids around and they could share that stuff with each other. Right? Interesting.
Stephanie 28:25
No diabetes camp, I probably had the best control while I was at diabetes camp every year or for like three years in a row that I went.
Scott Benner 28:32
So you had a sort of an opposite experience there. Was it good.
Stephanie 28:36
I feel like when my my parents gave me the control is when I lost the control. When that's when I lost the control of my diabetes was that when they put it in my hands,
Scott Benner 28:47
what was that? Tell me Tell me though, how that transition happened? Was it just like, Hey, Stephanie, we're gonna let you do this now. And then we never talked about it again. Was it like a thoughtful transfer? Or how did that happen? No, it
Stephanie 29:01
was like, I don't remember exactly when it happened. I just remember, it was on me. And then they were like threads like, Oh, if you don't start testing your blood sugar, we're gonna start giving your shots again, and I left the hospital like giving my own shots. So then it'd be like two weeks of me doing what I needed to do so that they didn't give me my shots. And then
Scott Benner 29:28
everybody forgot about it. And then it just Yeah, yeah. Okay. You know, I know. You mean people. Yeah, people are right. Yeah, exactly. Make sure yeah. Okay, that's it. I'm gonna
Stephanie 29:42
do this while you're thinking about it. And then as soon as you stop thinking about it, I'll go back to what I was doing before
Scott Benner 29:46
and they didn't check back in on you.
Stephanie 29:48
Right. It'd be like leading up to and then coming out of endo appointments basically would when they would come down on me.
Scott Benner 29:57
So when they were gonna get pressure, they pressured you
Stephanie 30:00
Exactly. Walking out of the endo with a 12, a one C and the doctors around them, so they're going to be on me.
Scott Benner 30:07
And then that's it, then we go our separate ways on the idea. Right? Okay. So you don't take care of yourself for years, like right at all? And do you look back now I see damage from that or what you're taking i have
Stephanie 30:22
i damage what? I'm completely blind in one eye. And then during pregnancy with my son, they were able to save one of my eyes. The retinas started to detach, but they were able to say but, and I have fairly good vision in that eye. But my peripherals are pretty crappy.
Scott Benner 30:43
Stephanie, during your pregnancy, you almost lost the vision, your second eye.
Stephanie 30:48
I didn't know that I was losing either vision. I didn't know I was losing vision at all. Okay, I went for my pregnancy, they make you go when you're pregnant to test your eyes, even when you don't have diabetes. So I went for that because I did everything right leading up to and during my pregnancy. And when I went the doctor comes in came in the room and he's like, I am referring you to a eye surgeon? He goes, if you don't go and have this done, you won't see your your son born.
Scott Benner 31:23
Wow. Well, that's serious. Yeah.
Stephanie 31:28
But to have eye surgery during while I was pregnant.
Scott Benner 31:32
was when that when you go into that surgery, is there a possibility? You're gonna come out of it? And it's not going to work?
Stephanie 31:40
They didn't make it sound like it. They sounded like one of my eyes. They sounded like there was nothing they could do for but the other one, they were fairly certain they could help me.
Scott Benner 31:50
Or is this is your vision, your only issue at the moment? Yeah. Okay. So secondly, so you Yeah, really? So 20 years? Do you think you went like that for 20? Solid years?
Stephanie 32:06
No. Believing that seven was a good agency for 20 years, I I was in good control. Until I was probably about 15. I even when they handed it to me, I tried until I was about 15. And then I kind of just didn't, from 15 to about 24. So about nine years probably.
Scott Benner 32:29
Can you tell me what pushes you away from trying? Is it? Is it just the demanding nature of it? Is it that you weren't having success is that you just didn't want to? Do you have any feelings for why?
Stephanie 32:43
Ah, I'm like thinking and looking back. I don't think like in the moment, I thought this but I feel like it was a one thing that was mine that I could like go home, I guess because I had to help with my siblings. I had to help put the house in the food. I had to get myself to school, I had to do all those things. And stupidly, I was like, Well, I don't have to do this. And I'm kind of sick of it anyways.
Scott Benner 33:11
Yeah, it feels like the one thing you can give away. Right? Right. It's bandwidth, then it's just right. You had too many responsibilities for your age your situation. Yeah. Okay. That's what I think it was. It's not gonna kill you right away. So it doesn't seem
Stephanie 33:29
Oh, yeah. Yeah. And my mom tried every, like, nursing homes, making me go to talk to the diabetics that lost therapy or lost their vision or, and their 80 or 90 and unlike Yeah, that's not going to help me.
Scott Benner 33:45
So, let me ask you a question. If I could have come and found 15 or 16 year old Stephanie. And I was like, Hey, Stephanie, I'm from the future. And, and somehow you can blame me because I had a ray gun with me and a spaceship. And you're like, alright, this guy might really be from the future. And I said, you are going to be blind in one of your eyes. If you don't stop this right now. Do you think that would have moved you?
Stephanie 34:10
Maybe, no, I don't know.
Scott Benner 34:12
Yeah. There's no way to know I guess. There's not you know, there are times Stephanie, that when I make this podcast, I think it's really about being a human being masked and what it's like to have diabetes,
Stephanie 34:25
right. Unfortunately, we just have very real and in your face consequences like I don't know, I guess everything in life is a real and in your face consequence.
Scott Benner 34:39
Yeah, but you can't something's you can't trace back. You don't I mean, like you can, it's easy for you to say, here's the problem I have with my vision. That's because of you know, what happened with my blood sugar when I was younger, boom, like I you know, right. You can see the line through it. But yeah, you know, when you I don't know when you're when you're 60 years old, and you're in the emergency Room? Because I don't know, you don't I mean, like if diverticulitis you don't think oh, well this is because how my parents taught me to eat when I was 10. You don't I mean, right, but it might be. And yeah, we just don't we're not able to see the lines between all the other stuff sometimes.
Stephanie 35:18
I'll say I'm a lot healthier than almost anybody else because of my diabetes, though.
Scott Benner 35:23
Because you find my time. When did when did the switch flip for you? Like, when did you go, I can't keep doing this.
Stephanie 35:35
24 I was 24. And I had just gotten out of a bad relationship and move back with my mom. And realize that, you know, our, yeah, 24 hours, almost a quarter of a century old and I couldn't even take care of myself. And some people have, you know, like my mom had, I was five at that point in my mom's life. me she had my brother and my third, my second brother. I couldn't even take care of myself. It seemed like,
Scott Benner 36:09
what? So what does that mean? When you're, when you're 24? You have to figure your budget. Are you okay? All right. Okay, well, you're 24 years old, and you you look up one day, and you go, Oh, my God, I have no agency over my life whatsoever. I'm not making decisions, things aren't happening. I'm not moving in a meaningful direction. My health is poor. Like all that stuff. How do you? What do you say,
Stephanie 36:32
you know, it's crazy. That was like, I knew how to do it. Like, it's not like I had to, like, go back through diabetes training, or, like, do a ton of research or try to figure it out. Like, I was like, Oh, I'm gonna start taking care of myself and went to the gym, a, you know, healthier foods, and adjusted my own pump, and got my own self under control. Because like, that was like the crappiest part about it. Like I knew what I was supposed to be doing the whole time. Like, I stayed up to date with the knowledge and everything that I needed to do. And just wasn't doing it.
Scott Benner 37:15
Yeah. Yeah, I guess then the, the reality hits, and then the frustration comes, right. The idea of like, oh, yeah, why didn't I just do this before?
Stephanie 37:27
Yeah. It's actually so much easier. Yeah,
Scott Benner 37:31
I know. I keep saying that. But I don't think people listen, it's okay. I'm doing my, I mean, even in real life, it's, you know, how I don't know how often you can say to somebody, look, a couple of minutes worth of effort here saves hours of pain later. And they're just like, Yeah, okay, and then they don't do it. So it's everybody. It's not just me or
Stephanie 37:54
No, I have a really good friend, and she has a 21 year old son, that's diabetic. He was diagnosed when he was like, 14. And she wouldn't get him a pump early on. And now he's over the age of 18. And I'm like, I wish you would have got a pump. I wish you would have federal pump when he was 14, because now he's struggling with like, he's doing the same things. I was doing it 19 But with no pump.
Scott Benner 38:23
Yeah. Does it make you feel like this is gonna happen to him, too.
Stephanie 38:27
I'm like, can't convince them. And she finally convinced them to get like a CGM.
Scott Benner 38:33
Good. That's good. Yeah. So 10 years ago, you go home, you realize that your mom was raising 16 kids when she was your age. You're like, Mom, I can't remember the Bolus for my meal. And she's like, shut up. But so you pull it together at that point, you go you work out, you pull it together, and is it just a different trajectory? Right from there.
Stephanie 39:01
Then so then I was still under the impression that you know, seven was a good one, see? So I got it down easily to the 6.9. That had been raised range. And I had met my now husband, and a funny story. He didn't want to get married because his life skills class in college told him that a typical wedding costs like, I don't know, like 15,000 or $20,000. I can't remember how much he told me. I just remember laughing and saying, Okay. I'm like, okay, that's fine. But having a kid was okay. Was the funny part. And I was like, oh, because this kid is definitely not going to cost us that much in the first year.
Scott Benner 39:57
Once you become an adult, you have to be understand Think of the idea that if you're going to live in a modern society, money is going to come in one window and go right out. The next one
Stephanie 40:07
is gonna get spent on something. Yeah, yeah, it's,
Scott Benner 40:11
that's the only thing that's gonna happen. That's the only thing I can tell you for sure is I'm going to make money. And I'm going to, I'm going to spend it. And that's it. Like, sometimes I'll, I'll get a check for something. And my kids will be like, Oh, what are you going to do that? I'm like, I'm gonna put in the bank and then send it to somebody, like, What are you talking about? What am I gonna do with it? What do you think? What do you what do you think happens? Oh, money? Wow. Because that was because of the way my job works. I get, I only get paid like twice a year. So I get money for ads. And like, every six months, basically. Yeah, so the checks are larger than you're used to seeing, but they're also for six months. Right? And the kids are just like, what are you gonna do with that? I was like, I'm gonna pay for your college. I'm gonna keep I'm gonna keep the lights on in the house. Like, what do you think is happening right now, I like that your husband was like, if we can just say although I have to admit. My sister in law, when she got married. She was like the youngest of my wife side. And my I remember my father in law saying, If you skip this wedding, I'll give you this amount of money you can put into a house. And she was like, That's ridiculous. I want a wedding, blah, blah. And I remember years later her saying I should have took that money. And skip the big wedding. So everyone's had a point. But I don't know. Money's hard to pile up. You know what I mean? Right. Yeah. So Alright, so now you're, you're married? Did you actually get married? Just do it on the cheap or did you?
Stephanie 41:38
Oh, we. We got pregnant. So I've
Scott Benner 41:43
been pregnant. Do I get pregnant? Yeah, it was fine.
Stephanie 41:48
No. We I am missing a fallopian tube. I had a grapefruit sized tumor removed within it. It took a Flowbee into with it. And so I thought, Oh, we're probably going to take a while to get pregnant. Who knows? There might be fertility issues, all this. And so we start saving. We're gonna move. We lived in Memphis, Tennessee at the time, it was like, we're gonna move to the coast. We'll start we'll start trying to have a kid. And
Scott Benner 42:24
we got pregnant right away two seconds.
Stephanie 42:27
But yeah, yeah, like we just thought about it. And then they're like, Oh, you want a baby. Okay.
Scott Benner 42:33
You did that wrong. You're supposed to make that last that part's supposed to last a little. But wait a minute. You just You just skipped over. I had a tumor. So what are what are you whatever you're banging stop. That's definitely make me. As soon as you started talking about cancer, you started banging something. Oh, did you know that?
Stephanie 42:57
It wasn't cancerous. Thank goodness, oh, it was a tumor that wasn't cancer. So when I was 21. We went out on the lake. And like, I got super dehydrated, I stuck my pump. And the glovebox on the boat when I was like tubing, and then put it back on and then went home and went to bed. And that insulin likely was dead. So I woke up with like really high blood sugars. And I was vomiting and I tried to get it down and couldn't get it down, which is unusual. I normally could get it down myself. So I went to the hospital. I was DKA hooked up to pump to all the IVs and everything to get that taken care of. But when the doctor came in to check on me, they like pressed on my stomach when we're like doing exam, and I like came out of the bed. And the doctor sent me for ultrasound and oh my gosh, 21 is crazy. Does that mean for an ultrasound and they're like, Oh, you have a tumor on what they thought it was on my ovary or near my ovary? You're gonna have to have surgery to have that removed. I said I have a flight that's leaving in four days. Can we schedule that for after? And the doctors like I I'd like to do it. But I guess like, I mean, I don't really it's your choice. It's like, yeah, we'll schedule that for after
Scott Benner 44:43
Where were you going?
Stephanie 44:46
Myrtle Beach
Scott Benner 44:47
for vacation? Yeah. Stephanie.
Stephanie 44:51
For the fourth of July. Definitely
Scott Benner 44:52
you make decisions like a girl that raised herself. What do you think of that?
Stephanie 45:00
So I went on my vacation and came back and they thought it was like the size of an egg. And they like, bring me all this paperwork before surgery, they're like, I just need you to sign that. If we're in there, and we need to take everything that we can. I was like, No, I'm sorry, I'm not gonna sign that.
Scott Benner 45:20
Would they want to take?
Stephanie 45:21
Like, if they needed to, like, take my ovaries or my uterus or anything, they wanted me to sign that they could thing that they could. So you said no. Like, no, you can wake me up and let me know what's happening. So I have time to process. Okay, like, that would be two surgeries. It was like, I don't care. I'm 21. You can't just take all my woman parts.
Scott Benner 45:40
Yeah, pick all my lady bits and everything. My mom's
Stephanie 45:43
like, what, like, what are you going to do? And I was like, I don't know. We'll figure it out. Because I had like, in my blood, I had like, some tumor markers. Like that would show an indicate that maybe it was cancerous. Okay. Hello, like, well, I want time to process. Like your wild.
Scott Benner 46:09
Like, listen, you go shake your ass. I'll do this. All right, just calm down. So, so they get in there. And thankfully, they didn't need to take a lot,
Stephanie 46:18
right? Yeah, they took they did take my fallopian two. It was completely embedded like that it was growing. There would have been no saving it. So it's like a grapefruit size. And it was it encompasses my entire Philippian tube. So to say the amount of times that I've woken up at a hospital or whatever and heard that like I'm one in a million I, at this point, I'm just like, Yeah, I know. I get it.
Scott Benner 46:53
Well, DKA, right. I mean, weirdly, the dka shows the tumor. Yeah. And then the tumor takes
Stephanie 47:01
away probably couldn't get it down myself. They said
Scott Benner 47:05
probably couldn't get what down yourself. Like my blood sugars and stuff. Really? Well, what would that have to do? Because the tumor didn't grow that day? You'd had it for a while. Right?
Stephanie 47:14
Well, they said I went from egg to grapefruit size in a matter of two weeks. Whoa. So whatever it was, was pretty quick.
Scott Benner 47:23
Stephanie. G jeez. Okay. All right. Well, then that makes sense. You know, it's funny, my mom who had a bunch of cancer removed last year, hers her fasting blood sugars. They were treating her like a type two. And her fasting blood sugars have been better since they removed her cancer. Oh, that's good. I've always wondered about that. I remember, you think like, you're gonna ask a doctor, but I don't know. I don't want to say anything.
Stephanie 47:54
I know. The doctor said when I came back and they did remove and I came doing everything. They're like, you're really lucky that that tumor didn't twist, like flip at all. And like, because it was the fallopian tube. So it could have like twisted it could have caused like, a lot of problems and pain.
Scott Benner 48:12
No, I'm glad. Okay, so you get to you go on vacation. And then you come back and you take care of that. Okay. All right. And what happens after that? Like, where does life go after this? You're gonna have a baby now.
Stephanie 48:32
Yeah, so we got pregnant really quickly. I didn't think we would. And we didn't make it to the coast. So I'm still in the Midwest. We moved back to Indiana. Were my family well my brother was and my A onesies are not as low as what they should have been. But I didn't know that then. Even my endo didn't even tell me. I was like low sixes. She's like your your diabetes shouldn't be an issue for your pregnancy. Your a onesies are low enough that you should have no complications. Just like every time I went in, just giving me a pat on the back and telling me how wonderful I'm doing. And then I went for the anatomy scan for my son. And he had a congenital heart condition they found in utero.
Scott Benner 49:38
Well, how pregnant were you when you learned that?
Stephanie 49:42
24 weeks.
Scott Benner 49:45
That's That's six months. Yep. Yeah, I just did that on my fingers. You don't have to be mean. So at six months,
Stephanie 49:58
I live with a guy that does Adam is sleep. He has a Bachelors of Science in mathematics. So I always feel dumb with math, so don't feel bad.
Scott Benner 50:06
Oh, listen, he thought that 15 grand was gonna save everything. So, you know? I don't know what he knows. But smart. book smarts. Yeah. Well, you've got the other side of it. Right? You could? Yeah, we'll give you the street side. Let him take care of the book side. But so what do you do in a situation like that? When you find that out? I don't know what happens then. With a heart defect when you learn about it.
Stephanie 50:34
What what did I do? Or what what I mean,
Scott Benner 50:37
what you did was, I'm assuming cry. But what did they do medically? What were what did you?
Stephanie 50:42
So I, they found out that his he had transposition of the greater bowels, which basically meant that when he was born, that the unvaccinated oxygenated blood would be pumping through his body instead of the oxygenated blood. Really? So? Yeah. So about a week old, they had to do open heart surgery on him to switch it.
Scott Benner 51:10
Oh, my gosh. So they just kind of like, like, I'm not a doctor, obviously. But they just like, pulled the hoses off and flipped them and stuck them back on again, like that kind of thing.
Stephanie 51:19
Yeah, basically. So at a week, he had to be put, like on the bypass machine, so that they could pull his heart out and literally switch all the arteries and veins on the right side of his heart to the left and vice versa.
Scott Benner 51:35
Oh, my gosh, so scary. Yeah. Yeah. How old? Was he a week? A week? Did you think he was gonna die?
Stephanie 51:47
When they first told me everything, yeah. But then they like, sat me down and told me the statistics and the odds and it made you feel? Yeah, they made you feel more comfortable. Yeah.
Scott Benner 52:02
And then is there any, like lasting effects from that and his life now?
Stephanie 52:08
No, no medications. He goes, he was going to the cardiologist every year, but they just gave him the past last year to go three. Because everything looks good.
Scott Benner 52:21
And it's just, it's just a birth defect, right? They don't give you any reason why they think it happens.
Stephanie 52:28
One, it's like a 0.001% chance for it to happen. But if you do enough research, you will find that it is more common and diabetic mothers. So the six point threes and the six point fours. Though the doctor said they were good, and they're not necessarily terrible. Now, after doing more research, and listening to your podcast, and like the pregnancy episodes and stuff, obviously, that's not the control. Yeah, that you would really need for no. complication.
Scott Benner 53:14
Right. I thought you were gonna say that it was more common in people who had been around glitter. So, but this makes more sense. Yeah, I don't know how to. There's a common argument that happens online, where people say, Hey, I read research that says that an A one C of whatever they the number is, is okay. And there's no benefit in having it lower than that. And they they come to me, even though I say it's definitely at the beginning of every episode. I very clearly say, not a doctor, not advice. Don't know what I'm talking about. Don't come to me for anything, right. But they still come to me. What are the benefits of keeping it lower than like, I don't know. I said, it just makes sense to me. I don't know if I'm right. But you know, if a person who doesn't have diabetes, they wouldn't see us in the high fours. And yours is that seven? That seems like more to me. And more seems like sugar content and sugar content seems like possible problems. And I don't know, I don't I mean, this is my common sense. And nothing else not based. And they're like, well, we want to see studies and well, you go for the study. I'm just guessing. Yeah, I'm gonna keep my daughter's blood sugar as low and stable as I can while you go look for your, whatever it is, which I'm assuming they just want to make them feel better. Like, like, it's not like they're gonna go Oh, I found something and said it should be five and a half. I guess I'll do it right now. Like I don't know what the arguments about it's not even an argument like the discussion. I don't know what it's about like, like, Are you saying you don't want to be lower because it's, you can't do it. It's hard. It's difficult or you don't know how like I understand that. Are you saying it's because you just don't want to put the effort into it? I even kind of after interviewing enough people definitely I understand that people feel Know that way too. But then why do you why are you looking into it? And the only thing I can think is that they just want that they feel guilty or they're worried and they just want it to go away. Or I mean, maybe some of them just want to make a change, because oh, if you just tell me for sure this has to happen, but I don't know who you're looking to for that information. You don't I mean, like, yeah, I don't even know like, how long what is the ADA recommendation right now? That thing moves like every 6.5 Is that where they're at now? Yeah. I'm gonna look I know how to Google I'm gonna figure the whole thing out for us right now blood glucose recommendations. Didn't did it in I found a link I've clicked on a one see they're calling a normal a one C 5.7 or lower pre diabetes they're calling 5.7 to six for diabetes are gone six, five and higher. Is this just diabetes in general? Right. Like they're not saying types. fasting glucose is oral tolerance tests. What is pre diabetes? Yeah, this is this is type two. All right, my googling. Let me type type one next to it. This gets us in a little better situation for what we want to know.
A peak, postprandial capillary plasma glucose of under 180 is appropriate for most people with diabetes. Although an ideal target for non is 140. You see, this is pretty much what I figured out on my own. I didn't need somebody to write Yeah, I didn't need somebody to tell me this. Hello. I wore a CGM. And I looked and I had to eat my face off to make my blood sugar go to 140. Right. And then yeah, and it came back in a little while. I once got it to 160. But I ate like a half a pizza. And then I put sugar on top of it. I was like, let me see what this looks like, you know, and I did not I was not having a good time. By the way. I was like, Alright, let me see what this does. But I was trying to figure it out for Arten. Like, like, what is it I should be shooting for? Exactly. Yeah. And that's why I think of like, you know, 140. Okay, but it should come back and get level without getting low. We're, you know, probably doing something wrong. I think of 180 is high. That's how I think of it. But yeah, if you're telling people you know, I can't believe I can't just find this, by the way, like this should be pretty easy to shouldn't be easy. Right? Hold on a second. Let's start over again. Stephanie Dennett, type one diabetes recommended. Well, a lot of stuff comes up and yet they recommend it doesn't it? recommended a one. How is it possible that I've now less than 7%? A one and I don't have to see it.
Stephanie 58:07
The goal for most adults with diabetes isn't a Wednesday that is less than 7%.
Scott Benner 58:12
Alright, it's definitely no reason to show off. It just popped up for me too. Okay. The American diet you're looking at what I'm looking at the American diabetes Association generally recommends the A once the bill levels below 7% or an average glucose level of 150 fours. All right. Yeah. But that number used to be higher. And in a couple of years, when the technology gets more widespread, I bet you they push it down again. Right? Because they don't want to go telling the whole world Hey, you gotta be keeping a number that you have no knowledge or technology to help to keep? You know, I'm saying so I understand why they move it down slowly. I don't understand why people looking at it. I don't know how you can look at that. And say seven. But what's the a one C of a person who doesn't have diabetes? Like why is Why are my goals different now because I have diabetes, I can maybe I won't reach my goals. Maybe there'll be difficult to reach or any number of problems getting to them. But I don't understand why that changes the target. You see what I'm saying? And you do see what I'm saying because you even though you're a nice person, and you're you're not real combative, like you don't get upset while we're talking. But you're pissed right? And how long somebody told you seven was okay. Yeah, yeah.
Stephanie 59:29
It's even more upsetting that like I still see the same endo and i She does have a very flexible mind and she does support me manipulating my palm for getting my A once the below six like she's never yelled at me for too long over a Wednesday. It would have really been helpful to hear that. You know, a 6.3 isn't great. her pregnancy.
Scott Benner 1:00:01
Yeah, there's no reason to lie to people. Like I think it's okay to say to yourself I don't think this person can do this. Or but they should still know what the goal is like. Do you really mean like, why would a doctor get to decide that you don't get the you don't get to have the right information? Yeah, what are they saving you from? Exactly like being nervous about it or sad or like okay, but you're nervous or sad now? Like, I mean, you haven't set it out? Right? I
Stephanie 1:00:32
I didn't even I didn't have a CGM when I was pregnant.
Scott Benner 1:00:37
Yeah, so you don't even know what your
Stephanie 1:00:39
maybe late pregnancy? Or right after I had my son I got the key for and but I was pregnant, my blood shirt or my finger and test my blood sugar 1215 times a day during pregnancy?
Scott Benner 1:01:00
Yeah, I don't know. I don't know another way to do it without a CGM.
Stephanie 1:01:03
Yeah, so and I was getting to that low six range. I don't know if I if I heard that low. Sixes weren't good enough. And I was already testing myself 15 times a day, I could have brought it down. You still
Scott Benner 1:01:19
think you could have done better? You know, like,
Stephanie 1:01:23
I was in the low hundreds, you know, and in the 90s, low hundreds. And in the low sixes and I, but I was being told I was doing fine. But if I was testing that much, it would have just taken a little bit more insulin to bring it lower. You know, I
Scott Benner 1:01:40
mean, no, I do. Yeah. Are you okay? By the way, I heard your alarm.
Stephanie 1:01:43
Yeah, I'm good. My I wear the tandem right now. And it doesn't let me it doesn't let me shut the alarms off for 70 Oh, that's not like me being 70
Scott Benner 1:01:57
Is that what's your blood sugar's right now?
Stephanie 1:01:59
Yeah, I'm at like, 68. So like, all my phone, my alarms are at 65. That's why my phone's not like yelling.
Scott Benner 1:02:06
Do you want to do something? Are you okay? No, I'm good. All right. No one's ever passed out on the podcast. I would like to keep that going. Please. I don't want you to be in the first one. Because I have to tell you if it happened, I would definitely run the podcast as you should. As long as you were alive when it was my
Stephanie 1:02:24
husband's gonna walk in the door any minute. And he that's another story. But he'll, he will debug me. So it's your life. But then he hit me with a heartbroken the other day. Wait, you've used the Jeeva hypopyon. One. I've had diabetes for 27 years. I have been glucagon one time and it was in the past week. And I can't believe like it. Like leading up to my recording. That's what I was thinking when he told me like when I came to and like actually had time to think about it and everything. I'm like, oh, man, if this makes, if this makes my podcast episode, that'd be funny.
Scott Benner 1:03:01
Hold on a second. So first of all, let me just say that my regulatory training, you guys don't know how many meetings I have to sit through to make ads for you. Like where I hear like, you can't say this. Don't say it that way. Don't say this. You can't make claims about this. You can't use this word. You can't use that word, your package insert. Oh, one of the things I'm not allowed to say I just said but it's not the ad. So it's not bad. But I am not allowed to call it the Jeeva hypo pen. Oh, I have to call it g voc hypo pin. Oh, I don't know why. Interesting, but I know I'm not allowed in an ad. I cannot put the word thought before the words G vocab open.
Stephanie 1:03:40
So how many times have you had to read? Oh, no, I'm
Scott Benner 1:03:43
good at it now. Like I I can say it in your sleep at this point. I've been brainwashed. Now. I know how to. Never say it. But I was in a meeting with them the other day, because we're gonna do this cool episode, where Jenny and I talked about how to use the hypo Ben, right. And so during the meeting, I sent it on purpose. And I was just like, you're watching everybody's face. They all were like, hey, and I was like, oh, whoa, I shouldn't have said sorry. And they're like, yeah, like, Don't worry, I know. It's okay. And I was trying to liven up the meeting. I just tried to make this boring part of my life better. And so I at the end of the meeting, I said I will take any of you out to dinner who will sit down and explain to me why I can't use the word VA before G vocab open. And this one guy goes I'll take the dinner and he goes but the explanation is not fulfilling and I was like alright, nevermind then. I don't want to find that. I don't want to know I just won't say it. But I want to know about this. So you got how low did you get?
Stephanie 1:04:44
Um I was showing low on my my Dexcom my husband did not test my blood sugar because He was probably freaking out too much.
Scott Benner 1:05:02
Were you conscious?
Stephanie 1:05:04
I was. He said, I was conscious. I'm very chatty. There's nothing I won't talk about. And he was asking me a question. And I would just stare at him. So, he knew there was obviously something wrong, right? So he grabbed my phone and he was like, I'm gonna, I had already asked for juice. Okay. I'm just gonna tell you, I don't know how this happened. And maybe possibly a pump malfunction, because nothing else makes sense. I went to bed without changing my cartridge when I knew I should have and I forgot. Okay. And so my pump started yelling at me at like, four 20 something in the morning, my husband gets up at 430. And I was like, okay. I'll have him. Set me up a cartridge and hand me a set. I'll do this right in bed. I'm not getting out of bed at 430 in the morning. Okay, so his alarm went off. And I was like, Hey, take my pump. No, yeah, I was like, I went to go into my pump to set up my cartridge. And it was dead. It was yelling at me because it was dying. Not because it was almost out of insulin. I was like, Okay, it's all right. I'm still not getting out of bed here. Take my pump. plug this in for me. When you bring it back before you leave for work. I need a set. And he's like, okay. Like, you know, that's what I want to do at 430 in the morning to me.
Scott Benner 1:06:41
Yeah, this sounds great. Thank you. So he takes for the you're using control IQ, right? Yeah. So it has to be charged. Right? Okay. So he took it somewhere to charge it.
Stephanie 1:06:53
It takes my pump to charge it. And he said about 20 minutes later, I called them back there again, and asked him for juice. So he brought me juice and I drank the juice. And he went to go check on me again, and I was unresponsive to him. Like I was
Scott Benner 1:07:16
but you weren't wearing the pump for a while at that point.
Stephanie 1:07:19
Right? So you think I would be going up? And I was sleeping. Okay. And there weren't there's no Bolus history. Anyways,
Scott Benner 1:07:30
well, what am I? Well, if you
Stephanie 1:07:33
can't stand up, I think it was a
Scott Benner 1:07:36
reason wearing it though. I
Stephanie 1:07:40
but I was low. I was low when I gave him my pump.
Scott Benner 1:07:45
So it did so the so the pump died. So when it dies, it can't give you basil even Right? Right? It can't do anything. So it's dead. You're not getting anything. And then you will see here's what I'm gonna say Stephanie. First of all, I'm not there. And I have no idea. But my expectation is, is that if you count on that thing to not give you insulin because it's it can say hey, she's getting low let me take insulin away. And now suddenly it's not working. Is there a way for the insulin in the tubing to still reach you?
Stephanie 1:08:22
I don't know. I don't know. All I know is I didn't it said I did not have very much insulin left. I had like nine units before I went to bed which would have been fine to get me through it about probably about
Scott Benner 1:08:41
like Arden here if I go to bed now and I get up at this time then I'll have enough insulin I can check.
Stephanie 1:08:47
I didn't intentionally do that I was going to change it but I just I took a bath and then did it and I just there is no good reason
Scott Benner 1:08:57
for the night before you you were going to change it you didn't
Stephanie 1:09:00
Yeah, I just didn't so and so when it woke me up like beeping at me I was like dang I didn't change that bed to change it my husband can help me so you thought anyways I ended up low and there's no rhyme or reason why
Scott Benner 1:09:15
right? But so so he let me make sure I understand. He took the pump to get it charged. He comes back you ask him for a juice he gives you the juice you slept the juice down the next time he comes back to bring you the pump back you our guns will not not respond. Yeah. Okay. And then he gets G vo Capo pen and jams on you. Yes, he stabbed me in my way. Well, let's not make him sound bad because they are a sponsor, but I haven't I haven't tried my husband's fault clearly. I have a trainer pen right here. Pop the cap off. Fine scan push down. Yeah, and you're done like that. Yeah. Did it bring you back?
Stephanie 1:09:56
Yeah, I didn't even know he did it.
Scott Benner 1:09:59
How long how long after he popped you with it until you came back.
Stephanie 1:10:03
He said like 10 minutes later I, I will I had gotten up and I like came out to the kitchen. I'm like, why are you not gone for work? And he's like, Ah, I text my boss. And I told him I might be a little bit late because I was gonna stay here and make sure you're okay. And I'm like, I'm fine. Go to work. Like you should go to work and he's like, I glucagon do. And I'm like, why?
Scott Benner 1:10:33
An adverb when the way you just use it. Yeah, yeah. Okay.
Stephanie 1:10:38
I had to glucagon you and I'm like, why? He's like, You were unresponsive. Like, Well, the fact that I don't remember you stabbing me with a needle probably means I probably needed it, but I'm fine. Now. You could probably go.
Scott Benner 1:10:52
Did he test your blood sugar after you did that?
Stephanie 1:10:55
No. I grabbed my phone. And I was like, Thanks for Thanks for like, shoving glucagon in me. I have never been glucagon before. But I'm gonna guess I'm gonna end up at like 300 At some point, right? Okay. He's like, do you need me to stay home? Oh, like, No, I've got this.
Scott Benner 1:11:17
So, alright. It's definitely listen. I usually try not to judge people on the show. But if he thought you needed glucagon, but then didn't check your blood sugar afterwards? What was he doing in that time? Oh, no, he has. He has the follow up. So what did he see? Oh, he was watching your blood sugar come back up from Dexcom. Yeah. Oh, but he didn't call 911.
Stephanie 1:11:39
I know. I told him I was like, I told him when he got home. After work. I was like, just so you know. You won't get me to call 911 or telling me that you need to take me to the ER. But like, if you ever have to glucagon me, I think you're supposed to.
Scott Benner 1:11:59
It's definitely you're making me feel very good about something. Let me tell you what it is right now. But I don't think I'm supposed to be talking about business outside of business. But I'm just gonna say this. G Volker and I are doing this one episode together, right? But it started off as an idea about three episodes or four episodes. Because I said to them, I don't think people understand. Glucagon. I don't, I don't think they understand when they need it. Why they need it, how to use it after they use it. What they should do blah, blah, blah. Like that was my pitch to them. Like I think we should do these episodes together. And I think we're going to but we're starting with this one. Your your description of what just happened? Absolutely. cements my thought. Like,
Stephanie 1:12:43
I know that I'm supposed to go to the ER still. Yeah, but I did not want to go to the ER, yeah. But he didn't know. He told me he said the package said to call 911. And I was like, Okay. He's like, I didn't want you to have to wake up in the hospital or anything. If you were fine. Your blood sugar came up and you were completely coherent. And I was like, Alright, there's a reason. I told him I was like, Do you want to know why it tells you to, like, take me and he's like, sure. I was like, You didn't inject glucose into me. You injected something into my body that triggered my body to release all the glucose stores in it.
Scott Benner 1:13:27
And he doesn't know what I'm saying. Alright, Jeeva Are you listening? I told first of all, I told you I was right. And be yelling. Unbelievable. You are so Stephanie. You were so lucky to be alive. But not for any of the reasons that any of those doctors ever told you.
Stephanie 1:13:49
Is it for this one right now?
Scott Benner 1:13:52
I mean, between your No offense, but between your mom and and, and your husband, and you wake up and go vacation, leave that tumor in there a little longer. Unbelievable. I'm
Stephanie 1:14:07
gonna die or get like a cancer diagnosis. I'm gonna take my beach vacation for Stephanie.
Scott Benner 1:14:12
I have to tell you, I'm gonna I'm gonna shutter the podcast right now. I'm not doing this anymore. Here's what I'm gonna do. I'm gonna set up an 800 number. Okay. And it's gonna be 888 Ask, Scott. That's what I'm doing. I just decided it right now. I'm wasting my life with this podcast. Right? Let me see. Does that work? 888 I'm literally looking this up. 888 ask Scott. All right, it doesn't exist yet. I'm getting it. I'm gonna find out what it takes to get an 800 number. Yeah, and I am and my life is just going to be I'm gonna whip my phone up to my ear. I'll be like, hello. And you'll be like, Hey, Scott. It's definitely my Hey, Stephanie. What's up, and then you'll go I have type one diabetes. If they found a tumor around my fallopian tube, but I want to go on my beach vacation first I go, Stephanie, no, you're gonna go take that right to the hospital and take care of that. Okay? And you go, Okay, I'm sorry. You're right. And then you go and you pay me like $20, something like that. Okay, so that's it. That's what I do like here. And if this existed for years, the phone's gonna go off. I don't care. I get a call. This is this is 30 years ago. Hey, Scott. I was thinking of leaving my kids at home and going and stripping. Well, no, I don't think you should do that. And then I would like I would talk them through that. I ain't gonna make money here. There's a way for me to help people and and make money.
Stephanie 1:15:37
I don't care. By the time she did that. I was like, 16 I was good.
Scott Benner 1:15:40
Yeah, that's fine. Everything was great. You were 16 Completely ignoring your blood sugar and not taking care of yourself at all. Right? Yeah. Okay. No, 888 ask Scott. That's what this episode two
Stephanie 1:15:54
questions shouldn't be. Should I wait, my kids district should be should I still be in control of my child's diabetes? Yeah, well, I would probably talk the whole thing through whether I've told so many parents on on the page. I'm like, and I'm just envious that you're even still like, taking control your kids diabetes.
Scott Benner 1:16:13
I hear that from a lot of adults. They're like, I'm so jealous that you help art and like and so that's interesting. It really is. Alright, you're not gonna die right? Because I'm not gonna let you down like everybody else has. How's your blood sugar now? I am 66 what are what are you going to do? Let's do something.
Stephanie 1:16:34
I'm gonna let my control like you not give me insulin until it comes back up.
Scott Benner 1:16:38
You don't want to just need to gummy bears or something right now to gummy bears. What do you got? You got gummy bears the house
of Skittles. Alright, eat three scales for
me. right angles. My God. And I'm charging you for this one even though you didn't call the number
Stephanie I'm not kidding. I think I've just had a brilliant business idea. I gotta go find out. I gotta go to GoDaddy right now hold on a second while she's getting her Skittles and find out of common sense that calm has taken
somebody owns that. Let's find out what's there?
Stephanie 1:17:30
Are you talking crap? Long gone?
Scott Benner 1:17:32
No, I'm looking up to find out of common sense that calm is available. I think I'm gonna be rich. Common sense is a leading nonprofit organization dedicated to helping all kids thrive in the world of media and technology. Why that ain't helping anybody that's just kids away from movies and our boobs and it which by the way, they don't even make any more way to ruin movies. Woke people. Good job. Okay, seriously. Every movie I saw growing up Stephanie. Yeah, for reasons that I couldn't even tell you. A bare breasted woman ran through one scene. It was just it always happened. And now nothing we're all right, so I can't have common sense.com Let's think of other things to call it
Stephanie 1:18:26
spot.com
Scott Benner 1:18:27
I want to help you think is oh somebody's got help you think.com He's sons of bitches All right, hold on a second. Now I have to find out what help you think that comments tell me when your skills are in help you think that calm is parked? This is what happens when people
Stephanie 1:18:53
I mean didn't do anything with it yeah
Scott Benner 1:18:57
that's what they do they sit on it
Stephanie 1:19:01
and then they try to make buy it from them.
Scott Benner 1:19:03
Yeah, not that this has anything to do with my idea but dummy up.com is also not available.
Unknown Speaker 1:19:09
Oh my God.
Scott Benner 1:19:10
Now if I click on dummy up.com And I don't see a picture of Archie Bunker I'm going to be past one of these is going to be porn by the lake Stephanie.
Stephanie 1:19:21
So it's five clicks away
Scott Benner 1:19:22
dummy up.com also part it's for sale they people just they um they park these sites and then they sell them scumbags. Seriously, trying to make a couple $1,000 Selling dummy up.com Here. Here's here's a here's a little clue for you. No one's gonna do that. Okay, I wanted to make diabetes pro tips.com It didn't. It wasn't available. So I just took the s off and I was like here I'll just call it this since that nobody's gonna send you money because you parked your stupid. Anyway. Alright, I'm going to figure this out. Let's say
Stephanie 1:19:56
one year listeners. One of your listeners bought that
Scott Benner 1:20:00
If you think they're sitting on it, yeah, I want it back thought you'd
Stephanie 1:20:03
buy it from them. That's not happening.
Scott Benner 1:20:05
I want to ask Scott DICOM not available.
Stephanie 1:20:09
When you took the s off and decided to go with diabetes pro tip they probably stopped listening to
Scott Benner 1:20:16
good reading. By the way, Scott Nicholson is a professor of game design and development at Wilfrid Laurier University in Brantford, Ontario. I mean, not for nothing Scott Nicholson, but you're not doing anything with this website. Give it to me, okay. It's Oh, look at that. It's a forward. It's not you son of a bitch Scott. He's got Scott nicholson.com But he's just parked on ask Scott. Give me that. I want that. Scott Nicholson when you eventually find out that I want to ask scott.com Please contact me. I would want this. Seriously, we have to do something. I've listened to your story. I love you. First of all seven. You're delightful. I love you. All right. But you have battled through so much. You've battled through so many thumbs while you're alive? Me neither. It'd be the honestly it's it's it's ponderous. Is everyone living like this?
Stephanie 1:21:21
I doubt it. No, I
Scott Benner 1:21:22
think I think they are. I think so. i There are times you want to hear something that's gonna sound pompous. Let's at least I know it's gonna sound pompous before I say it. So while you're listening, keep that in mind. Okay. There are times I think the podcast is only popular. Because I have a I have a firm grasp of common sense. And people don't sometimes. Is that say I've lived?
Stephanie 1:21:47
I've lived. And I have a ton of comments on.
Scott Benner 1:21:51
Now you do now you know what you're doing? Yeah. What though?
Stephanie 1:21:54
Even back then like, I knew that was dumb. But I just didn't care.
Scott Benner 1:22:00
You didn't stop yourself? Yeah, no. So it's not just common sense. Because I stopped myself. When I think of something. And I'm like a doofus don't do that. You know what I mean? Like, that's not a good idea. We're not going to do that one. Yeah, okay. All right. So it's not just common sense. What else is it then?
Stephanie 1:22:20
I don't know, either impulse control.
Scott Benner 1:22:22
Is it not a? Well, impulse control is possible. I was thinking like, a desire to protect yourself. There's a phrase for that, that I can't think of at the moment, but a sense of self preservation is what I was like. Yes. Yes. Is that not does that not pop into your head? Like, I can't go to Myrtle Beach. Stephanie. You weren't even going anywhere? Good. You know, they mean? So like, so like, not like you're on your way to Cancun or Barbados or something like that. I can I got I got four days in Myrtle Beach. I got my, my deposits in already. So but like, there was no thought like he pressed on that it really hurt. I should take care of that.
Stephanie 1:23:07
Denial. already spent too much time in the hospital. You know what I mean? My knee hurts not even like my largest, like, hospitals day lonely my largest medical story. Yeah. I was 18 and spent 30 days in the hospital and went through like six surgeries.
Scott Benner 1:23:28
So bring that up an hour and 20 minutes into this. What do you mean? How did that happen?
Stephanie 1:23:37
Ah. So when I was 18, I went out with my cousin and we got nipple piercings. Go ahead. And I got necrotizing fasciitis and one of my breasts Stephanie, did
Scott Benner 1:23:54
you lose a? Yep. To a nipple piercing? Yep. Oh my God. Are you serious?
Stephanie 1:24:01
Yeah. 18
Scott Benner 1:24:04
I don't want to chastise you because this is a sad story. But please, if anyone's listening. Bring those up first. We were doing the podcast start with I lost my boob
to a nipple piercing. Don't start with I grew up in Indiana. What are you doing to me, Stephanie? Hi. All right. Hold on a second. First of all, are you okay? Yes. Okay. That's horrible. I'm sorry. How does that happen? Like a dirty needle?
Stephanie 1:24:30
Yeah, not a very clean shop.
Scott Benner 1:24:33
Oh my god. Oh, it's horrible. I'm so sorry. So so how long after you get the piercing did your friend have a problem to
Stephanie 1:24:43
actually she had already had her spear she my cousin was in the military and she already had gotten her spirits and she took me to get mine pierced when she came back to visit for my birthday.
Scott Benner 1:24:53
She feel horrible to this day. We don't even talk that's not okay either. You Yeah, if I'm the one that takes you to the nipple piercing and you lose your breast over it, we have a lifelong commitment to each other now, do you not believe that? I do believe that by the way? I would? I would think so. But I would send you a great gift every year on your birthday. If you know 100% I'd be like, all you're thinking about what do I get? Stephanie? So, so Oh, my gosh, so you go into a hospital? How long after Oh, let me understand it. How long after the piercing? Do you know you have a problem? Two months, two months. And then you go to the doctor, I hope vacation Did you know,
Stephanie 1:25:41
I was at work. And I had called the shop to be clear, I had called the shop and explain what was going on. And they told me that I would be fine to wash it with antibacterial soap and water. So like, I ate tea, and I thought I was doing the right thing. Okay. And it just kept getting more and more sore. So I left work when I was working nights. And I went to the hospital. And they admitted me. And they didn't the first hospital that I went to did not know what was going on. And when they admitted me the next day, I decided I would go ahead and call my mom and I was in the hospital. And so she came up and I don't know is I wasn't I was in the beginning of septic shock. So I don't really remember a whole lot of like what was said, but I know I ended up transferred to a big learning Hospital in Indiana. And the doctor came in and told me, you know, they were gonna have to remove the breast and all the skin and everything. And my mom asked for a second opinion. And the doctor literally looked at us and said that we did not have time for a second opinion.
Scott Benner 1:27:09
Oh my gosh. That's terrible. And so they, they, they, they have to remove enough that they, they're short, it's not going to keep happening to go right down to your chest. Take the whole so do you lose? You lose the gland? Like the whole thing, right? Like, notes everything like a mastectomy. Yes. Okay. And then did you opt to do something with it afterwards? Like do you have an implant?
Stephanie 1:27:37
They move. They made me gain weight and then moved like fat from other parts of my body to my breast.
Scott Benner 1:27:48
Okay. Have you ever had anything done with it? Like, has it been? I don't know what you would do. I'm not sure of the process but like I've seen people have like nipples tattooed on and things like that if you've done anything like I had
Stephanie 1:27:59
the option to do that. But I had been through five surgeries and a year and I'm like, I don't even care.
Scott Benner 1:28:09
Five surgeries just on this one thing. Yeah.
Stephanie 1:28:13
Because I had to have it removed I had to have a skin graft I had to have the surgery to move the fat and tissue and they had I had like drainage tubes and everything and so like by the end of it all when everything was healed they said you can come back in and have a nipple tattooed and I'm like I
Scott Benner 1:28:35
I'm good yeah
Stephanie 1:28:38
I just want I don't care
Scott Benner 1:28:39
what what so I mean Did anybody bring up the your unregulated blood sugar's might have led to poor healing and maybe that's also what happened dirty needle poor healing out of range blood sugars, do you think all that had something to do with it?
Stephanie 1:28:52
I think now looking back that I mean, infection is going to be worse than uncontrolled diabetes but they didn't say anything about it.
Scott Benner 1:29:03
But you did you that was your situation though with your diabetes at that time?
Stephanie 1:29:07
Yeah, at that time I wasn't in very good control. So
Scott Benner 1:29:11
Wow. How did you find the podcast
Why did you find it What were you looking for?
Stephanie 1:29:25
I haven't had any like I up until the past year and a half ish I hadn't been in any like diabetes groups or anything I'm gonna mention something else this is how I found it okay, if I remember now, I somehow Facebook ad came across a mastering diabetes.
Scott Benner 1:29:50
The vegetable people Yeah, the vegans Right, right.
Stephanie 1:29:53
Um, so I listened to that book and their podcast and then like that led to other good Oops. And then it doesn't matter what diabetes group you're in, you'll will see your group tagged. And so I found your group and joined that group and started looking through the posts. And I was like, Oh, this seems like some I'm an information junkie. So like, I constantly have information coming in book podcast, something reading. So like, I'll check this podcast out. And then like, a couple 100 episodes later.
Scott Benner 1:30:37
You stuck with me?
Stephanie 1:30:38
Yeah. If this is the diabetes podcast, I'll stick on mastering diabetes is very fun to listen to.
Scott Benner 1:30:49
Well, yeah, cuz they're not gonna say things like I've said, for the past hour. 25. I have to tell you, there was a moment when I thought, gosh, maybe we should cut out that part about gypsies. That sounds like I don't that's kind of like racy. And now I don't think any of the rest of the episode, if people make it this far, they're not even gonna remember that. It's gonna just be like, I mean, honestly, when I said what I said, after you told me about the piercing, I actually, I thought I was being facetious. I didn't realize you actually lost your breasts. So that was a anyway. Yeah, we'll see. Other people are probably paying attention to what they're saying and trying to be acceptable, which is why it's no fun. I have to tell you, I'm when people come into the podcast group on Facebook, the private one, it asks them, like, where did you hear about it? And the amount of people who are just like, everywhere? Yeah, it's really something. I'm very grateful for that, that people speak about it so well, in so many different places. Me too. Yeah. Well, Stephanie, we're going to just stop right now. Because I'm afraid we're about to find out that you've murdered somebody. You're from another client. I
Stephanie 1:31:59
told you. I told you, I didn't know where to start. That's why I see But you
Speaker 1 1:32:03
couldn't do it. I tried so hard to get these stories out of you. You didn't say and you wouldn't give them up and then you're just like, hey, my, like if I said to you right now, tell me one more story. That's crazier than you lost your bras to a nipple piercing does something pop into your head?
Stephanie 1:32:18
No, that's the craziest one.
Scott Benner 1:32:19
Okay. All right. Jesus. All right. I don't know what I'm calling this one anymore. I was so gonna call it 888. Ask Scott. But now I'm not sure what to do. That's all alright. That's it. I'm done. I'm done with you, Stephanie. I don't know what else to say. Although I do I do want to know if your mom's still hot. But I'm not gonna ask you. And I'm not gonna look, I don't want to find out. But it's just a it's a background question in my head that hasn't gone away since like, an hour ago. That's all Don't Don't tell me.
Stephanie 1:32:54
You're gonna go to my you're gonna go my profile, and you're going to try to find her and good luck.
Scott Benner 1:32:59
I don't have that kind of time. Stephanie. All right. I got to figure out how to get started Scott Nicholson off ask scott.com He's
Stephanie 1:33:08
email him.
Speaker 1 1:33:09
Hey, that's a great idea. Everyone go to ask scott.com And ask this guy to give me his web address is his website. Tom, I need to ask scott.com It belongs to him. Yeah, it's my it should be mine. I mean, not that he's, he seems like a decent guy at all. Like, I'm not saying that.
Scott Benner 1:33:26
I'm just saying.
Stephanie 1:33:27
Yeah, I know. He seems kind and generous, which is why he should give you your website. It's got enough.
Scott Benner 1:33:31
I need my idea. Oh, my goodness. I just went to his YouTube page. Yeah, no, nobody's watching this stuff. I deserve somebody get me. Yes. All right. Make it happen, guys. All right, or 888. Ask Scott. Actually, I didn't look into it. Let's just do that real quick stuff. Me. Let me just go back to godaddy for a second. Can you get one with numbers in it? 888. Ask Scott. Who wasn't available? It is. There you go. All right. I have a lot to think about. Your blood sugar. Okay. I
Stephanie 1:34:13
can't. Yeah, you can't stop the podcast. Oh, well, I
Scott Benner 1:34:17
don't know how I'm gonna have time. You have to do both. Well, then I'm just gonna have to make the podcast while I'm answering calls. There you go. Like in the middle. I'd be like, Hey, can you hold on a second? My phone rang and I'll be like, Hello. Yes. No. Well, then don't eat the nuts. Okay. $20 Goodbye. That's it. Hey, help me with something real quick. Stephanie. I'm supposed to make an eat video for Medtronic diabetes. And I have this balloon here. I'm supposed to bounce while I'm doing something else because balancing diabetes is hard. I'm gonna make the video while we're talking. Okay. Okay. All right. So alright, I've started the video. I am recording the podcast with Stephanie. Stephanie on don't think they can hear you. That's okay. This is the this is the blue balloon challenge. And then I'm supposed to bounce the balloon while I'm doing a day to day chore to show how hard it is to balance diabetes while I'm making a podcast. Honestly, I am now bouncing the balloon. Holy crap. It's not that easy. Okay, hold on a second. All right, I dropped it. Alright. blue balloon challenge. It's a hashtag hashtag blue balloon challenge. guys go check it out and tag bitrock diabetes. Thank you, Stephanie.
Stephanie 1:35:31
Thank you. Yes. You'll
Scott Benner 1:35:32
hear that on my social media later today. This was a I want to say I'm being sincere. I don't know what we talked about. But I had a really good time. Me too. Thank you. Yeah. And I think that's what matters. Also. Take care of your diabetes. And the people listen, oh, you're doing great. You listen to the podcast. Now. I assume you're a one sees terrific.
Stephanie 1:36:00
Yeah. 5.7. Yeah. Or a year now.
Scott Benner 1:36:03
That's Do you want to say anything nice to me about that, or no? Yeah. Thank you. Oh, you're welcome. Really, what's the secret? Pre-Bolus. Pay attention. Don't let your blood sugar stay high. That's pretty much
Stephanie 1:36:17
your threshold lower. Say, Okay. Pre-Bolus and set your threshold lower.
Scott Benner 1:36:23
Right? You want to know if your blood sugar is going up? And then you want to do something about it? Yes. And then you get to keep your vision and your boobs and everything. Oh, that's definitely like a cyborg. You know that. We should make one of those movies again. Arnold Schwarzenegger hasn't worked in enough time. He's he's still alive. He's got to be alive, right? Yeah, for sure. Remember when he had sex with his maid?
Stephanie 1:36:49
Remember when he went into politics?
Scott Benner 1:36:51
He was the governor of California. He didn't go into politics. He was the governor of California. Exactly. But yeah, but he like he thanked us made and made a baby. Did you know that? No. Yeah. He probably got that super sperm. Like your husband works right away. Oh my god. He's 75 Holy crap. I'm old. I am so old. This is the end. If he's 75 I've gotta be honest. 52. And his son thing is, is it Christopher? I think so. He's got a couple. I don't maybe it's Joseph. It'd be Christopher and Patrick are with the with the Kennedy. Mushy Kennedy. You're no help in this conversation. No idea. No, Maria Shriver. Isn't she a Kennedy somehow? Oh, yeah, her grandparents. Rose Kennedy. Joseph, you don't know anything about this. That's the closest we had to royalty in America and you don't even remember them. All right. Well, let's just stop this Stephanie. Because I feel like you and I together are a problem. All right, hold on a second.
I don't know that I can say this vociferous ly enough. Way to go Stephanie. Way to bring the stories. Thank you so much for coming on the show today and sharing. Also let's thank touched by type one and remind you about the big event coming up in September touched by type one.org Or you can find them on Facebook and Instagram. And of course that contour next meet or get them to contour next gen is waiting for you at contour next one.com forward slash juice box. You can buy it right there online if you like or go tell your doctor if you want it or whatever. Anyway, it's pretty long episodes. I'm gonna jump out of here. Don't forget to use the links if you're going to visit the sponsors. It really does help. Don't forget to find their private private Facebook group. That place is amazing. I'll be back very soon with another episode of The Juicebox Podcast.
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#935 Weight Loss Diary: Three
Scott is taking Wegovy for weight loss. This is diary number three.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
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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 935 of the Juicebox Podcast
if you've been following my week Ovi diary This is entry number three entry one was just like this entry is going to be every week that I injected I came on and talked a little bit about the previous week did the injection moved on? We go read diary number two was actually me talking to Erica Forsythe about the metaphorical empty feeling I had while on we go V and today we're back to the injection conversations. So while you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. If you're looking to save some money, here three quick ways betterhelp.com forward slash juice box saves you 10% On your first month of therapy, athletic greens.com forward slash juice box get you five free travel packs and a year's supply of vitamin D with your first purchase of ag one from athletic greens. That's a green drink that was so many people talk about. I drink it every day. And the offer code juice box at checkout will save you 35% At cosy earth.com This episode of The Juicebox Podcast is sponsored by me, Scott. I'm just here to remind you that if you're listening to this podcast, and you're not using an audio app or a podcast app like Apple podcasts, Spotify, Amazon music, so on and so forth. Please consider getting one on your phone, downloading the podcast, subscribing and following. It's absolutely free. And it's the best way to listen. I want to remind you too, that there is a Facebook group for the podcast 40,000 active users, and it's just amazing. Juicebox Podcast type one diabetes, even though that's the name I don't care what kind of diabetes you have. We welcome you doesn't matter how you eat, how you live, how you think how you feel. You got diabetes, you love someone with diabetes, you're welcome in the group Juicebox Podcast type one diabetes
Hey, everybody, good morning. It is May 9 Tuesday, time for my 123 my seventh injection of we go V still on the point five milligrams. dose the last week. Last week, I had not a lot of weight loss. And then a little bit over the weekend to 220 pounds 220 pounds where I'm at now. And I basically stayed at that weight all week to 20 in the morning to 20.2 next day to 20 next day to 20.4 this morning to 20. So how was my eating this week? Not bad. I increase the amount of food I took in. I added I had some bread this week, which I didn't do the week before. And I added more red meat and I didn't lose any weight. It didn't gain any weight. I mean, I lost a couple pounds but I mean there was no like big weight loss. But my weight is incredibly stable. I feel great. I don't have any problems. Little bit of reflux if I eat the wrong thing. Who What did that mean? Okay, two things. I was at an event where I spoke and I had a little cheese cake. I think I might have brought that up and the other one that didn't sit well. But this week, what I really had to focus on was not eating late at night and late at night man after 658 after six I'd have kind of like a reflux feeling. So that's it. All right, this is a let's see. Number seven. Alright, so here comes injection number seven. Sticking with the belly working well so far
all right, I'll see you next week. Hello everybody. I am back to do my eighth injection of weego V. This is the last point five milligram injection I move up to the one milligram next week. I lost Three pounds this week I'm to 17.2 this morning, and BMI continues to drop slowly. Body fat dropped pretty significantly over this week down to 31.4 from like 3332 My body water keeps increasing, which is good. And let's see what else is here. I am going to tell you what scale this is because I'm liking this skill. Fat free body weight is dropping down to 140 9.2 subcutaneous fat dropped from 28.7 to 27.1 this week, visceral fat down another point from 16 to 15. Let's see what else I got here. I don't know how it says protein but that's going up metal and my metabolic age went down to 57 I'm almost to my actual age Amy What is this thing called it is the
bread fo r e n p H O is the scale. My wife said it was like 40 bucks or something like that on the on the Amazon. Alright, so I'm going to do another injection in my stomach. And what was this week like? Still eating late at night will lead to like reflux. So I mean I'm down to like I try not to eat after like 6pm at this point. If I do certain things are okay, like I eat a I'm a small gram cracker the other day and it was like Kodiak. So it was all like protein thicker. First of all, it didn't taste great. But secondly, it just sat really heavy on my stomach. But I had like a rice cracker the next night, and that didn't bother me. So I think the density of the food later at night has something to do with it. My hunger is exactly the same. I don't really think about food. I have to remind myself to eat I eat on a schedule. Or you know, where I just won't think to eat. I'm not hydrating enough. I wish I was drinking more. I'm going to try to push myself to drink more all my supplements I have no trouble with vitamin D, zinc, digestive enzyme, things like that all are going in no trouble. Sit on my stomach very well. I injected like you heard in the previous recording, I was a little like steady my weight was kind of steady last week. But I injected the week over on Tuesday I woke up the next day like 1.2 pounds lighter. i Right now weigh this is the lowest I've weighed since 2018. So in five years, I would not say that my lifestyle. I mean, I guess if you want to make eating food, like part of your life, like meaning, like it's super important to you, like obviously, I haven't had pizza or anything like that in the last couple of months. But I would say my lifestyle hasn't changed at all, I've just adapted a little bit. I feel so much better. Having lost this wait. I'm super excited to see how I'm gonna feel, you know, 15 more pounds from now hopefully. So let's get this done. And then I'll let you get back to your lives. Here we go. I'm gonna just move the microphone towards my injection spot. Take off the cap. And here we go V
it's in baby. I'll be back next week with the one unit injection or the one milligram injection. I keep saying units because the diabetes you know that right? Say, Hey, it is May 23. And I am back to talk about my first one milligram injection of we go up before I do. Let me just open up the app that came with the scale, which is working very well I think and tell you that I have Yep. Took my weight the first time on 328 Bytes march right March 28. Today is May 23. And I have lost exactly I mean Exactly. To the ounce. 20 pounds. Crazy. So last week, like as you heard just a second ago. Not a lot happened. This week. I just you know stayed the course actually went to a graduation party had like a reasonable amount of food continued to lose weight this week added some exercise this week for the first time in the form of household chores. So I had a big project that I wanted to do outside was going to be many hours, probably by the time I got done 2025 hours of moving over three days, outside physical labor. I did that. And I just kept losing weight. So very cool. I also recorded an episode that is up already about the kind of hollow feeling I have, as I'm eating less and less and hollow meaning like, like a loss like I'm not like I don't have as much to do because I'm not cooking as much and shopping as much and all that stuff. If you want to hear that it's actually with Erica Forsythe. And it's episode 919 It's actually we go V diary two, this will be I think we go the diary three. Anyway, things are going great. I'm taking my supplements every day vitamin D, magnesium oxide, I take a probiotic, I take zinc, that all is just going along very well. Some mornings, I have a yogurt. Some mornings, many mornings, I have an egg with maybe like a piece of shrimp or two or piece of chicken a couple of ounces of chicken in a wrap. It's probably because of the wrap of 40 carbs. Middle of the day. Some days I've been having like a small sandwich salads you know, just it's not a lot of food. I don't know another way to put it. Again, I'm still not hungry at all. Don't think about food, although I did have the experience. After working outside all day, like I got up I had an egg wrap. I went outside, I worked all day I had grabbed a banana in the middle of the day because I felt a little like hungry, like not hungry. I felt tired. Like I was hungry. But I didn't have hunger. So I had a banana. And I got done in the evening. And I was wasted. And I was like I had that, um, it felt like like just released from prison hunger, you know, where I sat down, stared down and just ate. But I had like a can of like chicken soup with a few saltines in it. And I couldn't finish it. I was like, not I was ravenous, like head hungry. Not belly hungry, which I think I've explained well enough already. Like I knew I needed sustenance. Because I was just like, you know, zoning from all the work. But I ate ravenously like an animal, but then couldn't get it all in. Last night actually had a slice of thin crust pizza went in very well. And no heartburn. That's another thing I should bring up as times passing. I'm not having like I was having heartburn a couple of weeks ago. Remember after the cheesecake, that's not happening nearly as often or at all maybe this week. I'm gonna have to keep better track of that. I don't remember it being an issue this week. I think that's about it. I'm going to do the injection. We go v one milligram. All right. Here we go. You're ready. You're like yeah, I'm not injecting and I don't care stuff. Here we go.
All right. Well, I can't tell you I'm excited. This is the ninth injection I've done. Four point twos, four point fives now a one milligram and I so far could not be happier with this. The weight is still coming out of my midsection, my chest, my back. love handles belly. My arms and legs all look fairly similar. My face still hasn't thinned out much. Which is funny because everybody talks about like ozempic face and I don't I don't have that yet. Actually, I would like a little bit of it a little chubby and my face still hopefully some of that comes out. I have no idea where this is gonna go but 20 pounds in two months is a triumph. In my opinion. It has been easy, and it really has changed. Like my day. Like you know, I'm not as involved with food even though I wasn't before. And somebody asked me the other day about I said oh you could pick that up at Wawa. It's a convenience store around here. And I said I can't think of one thing in that store I could eat or want to eat and that's just not like you know we used to get sandwiches there like at baseball games and stuff like that and grab like chips and drinks and and now I think about that store. I couldn't there's nothing in there I want not a thing. It's amazing. Anyway, Novo Nordisk makes this stuff thank you Novo Nordisk, you should buy ads because I'm a fan. This next check in comes from the patio of a hotel that I was staying at. It's little noisy and will sound a little different, but at least I remember to do it. Alright everybody it is Tuesday, May 30. I'm about to take my one milligram we go V can you see that? Anyway, I'm in Georgia, we're getting ready to pick up art and after her freshman year of college has ended which will just be happening in a day or so. But it's time to take my we go v. And I thought I would tell you about it. Just like I have been so cap off. But it looks like if I can do this with one hand, probably can pick up my shirt
Okay, anyway, I don't know how much weight I've lost this week, because we left on this trip. Let's see, what did we leave for this trip? Thursday, Wednesday or Thursday, last week, it's Tuesday already really nice day here. We spent a few days with our son. And now we're here picking up Arden. And Canvas, might we go V, I can tell you that my hunger is exactly the same, which is to say none. eating at restaurants you just have to kind of be careful pick through the menu a little bit. I've ordered some things that I haven't been able to finish, obviously a big deal. Kelly and I have been splitting food instead of ordering our own. What else I appear to be losing weight, I feel terrific. That's about it. I guess. I'm gonna put this audio in with the diary that you'll be hearing on the podcast, probably in about a week or so. Hey, everybody, I'm back. It's June 6. I'm about to do my third injection of one milligram but I'm going to tell you some kind of exciting stuff first. So as you heard a minute ago, I left my house on a Wednesday and didn't return till the following Friday. So all day Wednesday in a car. Thursday we went to professional baseball game with my son saw the Braves in the Phillies play. I avoided ballpark food but I had some grapes. More importantly, Wednesday was travel time and a restaurant, Thursday, Friday, Saturday, Sunday, Monday, Tuesday, Wednesday, all restaurant days. Now I was careful not to eat fried foods or anything fatty or weird or anything like that. I felt great the whole time. But I didn't really know what was happening with my weight. Because obviously I wasn't weighing myself was getting a little more exercise. But overall I felt good the entire time. I didn't have any trouble eating in restaurant had to be careful. Get a turkey sandwich here have half of it. little bowl of soup, stuff like that. Anyway, I got home and weighed myself on Saturday morning. And I was only up like a half a pound. I'm telling you that if I would have gone away like this without we go V I would have come back five pounds heavier. But instead, no real weight change. Now today's really my first day getting back into it kind of slowly drift back into life, went and saw a movie that spider verse movie is terrific, by the way, did some other things like that? Getting the house settled down getting Arden booth back in. But now I'm back on it now back on my regular schedule back on my regular eating habits. So we're gonna see what happens. But I did weigh myself this morning. And I weighed 213 Let's say yeah, 213.8 pounds. So that is officially only point four pounds heavier than my lowest weight so far. Back on 523, that's may 23. I was to 13.4. Since then I've got a couple of weigh ins to 14.6 to 14.8 to 14.2. And today to 13.8. Sorry, taking a drink. It's early here. That's a major success in my opinion. So I can't wait to see where this goes after this. But for now I've got to do my injection. one milligram of weego V still putting it in my belly. Still have a belly to put it in. But I'm actually I'll tell you this in a second. Let me inject this first. Here we go.
Okay, what do I want to tell you? I saw some graffiti while I was away. And it reminded me Hold on, I'm taking off the injection thing. There we go. I held it longer, I always hold it longer than I'm supposed to just to make sure. I saw some graffiti that reminded me of live from a recent afterdark episode, live with me. And I took a photo to send to her. But I jumped into the picture. And my wife took the picture. And I'm 100% being honest with you. It's the first photograph in maybe 15 years that I've seen myself in where I was comfortable with it. That was pretty much all I wanted to say about that was, it was a leading to look at the picture and think I would show this to people. And then after that I had the realization that I have at times not gotten in photos with my children and my family because of how they would look. And that was pretty heartbreaking. Anyway, okay, what happens now is I emailed the doctor to tell her that I've taken my third injection of one milligram, she starts the process of writing a new prescription for the step up, I don't actually remember what the step up from one is, but you'll find out soon, I have one more injection of one to go one milligram to go. And so you'll hear me again in just a second, a week from now, I hope you guys are having a great day, and you're enjoying the diaries. On the next installment, I'll go over all of the different measurements that the scale makes. So like, you know, water weight, etc. This role fat, blah, blah, blah, blah, blah. Anyway, I mean, you're gonna hear it right now. So I probably didn't have to say, Hey, everybody, I'm back. It is June 13. And I am about to inject my last dose of one milligram of weego V. But first, let's see about the measurements. This was an interesting week, my doctor put me on an oral iron replacement, so that we're trying to keep my iron from falling again. But it was too much too significant was too severe. But it was too much constipated me just gonna come out and tell you that. So that kind of threw the whole week off here with B, go v a little bit wasn't losing weight, I realized the iron was having the impact. I stopped it add a little extra magnesium oxide to get things moving again. And then all of a sudden, I was like, I'm losing weight again, I'm gonna lose a couple pounds this week. But then I had a sandwich now. I think this illuminates food choices really. I had this feeling all day I got up in the morning I had a yogurt and an egg. And like a little rap. That's like I'm gonna go to the store today and get a turkey breast and I'm gonna bake it and then slice it up and make a small sandwich. But they got away from me and I was never able to do that. But I was still thinking about the sandwich. At the end of the day. I was hungry. It was time for dinner. And I went to a sub shop instead and bought a six inch turkey roast beef with a piece of cheese on a roll. And I woke up the next day, like almost a pound heavier. And I thought I mean, alright, it's a little bit of bread, but I've had bread on this diet before I've never put weight on. I think it's the salt in the deli meat. Actually think I'm retaining water from the salt, the deli meat. Anyway, the measurements. So we started this whole thing and by way, I guess I mean me and then me telling you about it. Let's see, march 28. I hate doing this on March 28. I weighed 233.4 pounds. Today, June 13. April, May June, not three months yet. Just about maybe another week. 213.2 pounds, so that's 20.2 pounds, but two days ago I was 211.6 So two 12.64. So I put like a pound and a half on with the sandwich and you know, I don't know whatever else not going to the bathroom regularly. That's just a little look into that. My BMI right now is 31.6 Wow, it started at 34.6 body fat 30.1 started at 35 This is interesting. My hydration continues to go up today. It was 50.4 I started 47% I still don't completely understand the connection between losing fat and hydration but maybe I'll figure Read up on skeletal muscle from 42 to 45.1. BMR 1856. It began at it's 1822. Now, my fat free body weight is 140 8.2. But it started at 150 1.8. Does that mean that without fat I'd weigh 142 pounds is what that means. subcutaneous fat began at 30 is 26. Now, visceral fat began at 17 is 14. Now, muscle mass is dropped a little, which you expect with dieting. with weight loss, excuse me started at 144 and is 140. So, bone mass 7.6 to 7.4. That's nominal. My protein is going up. I don't know how I don't know how the scale knows this. But 14.8 at the beginning 16 now and my metabolic age has dropped still just one year from 58 to 57. Which of course is concerning because next month, I'll be 52. But maybe that will keep going down. Alright, so those are the numbers. I'm gonna tell you a little something about hunger in a second. But first, let's, let's shoot this week. Ovie? Shall we, I just keep putting in my belly. And that seems to be fine, right? Yeah, what the hell that's working. I haven't said this in a while. Here we go V. Y is that point they make ads, you can have that for free. Here we go. He's genius. Here we go.
Okay, well, that was pretty easy. Just holding it in for an extra second or two. Because you know, I'm used to doing that with insulin and needles like to get it all out. And we're done. So I'm saving all the pens. I don't know why. There's a little box here at my desk. A hunger. Yesterday, had been obviously six days since I had my last shot if we go up. And I have to admit, I was able to eat a sandwich that I would not be able to eat earlier in the week. What else I want to talk about about food. Oh, when you get constipated, the slowdown throughout your entire system makes you feel made me feel a little more. I guess some people might call it nauseous. But just like your food's not going all the way down like it's got nowhere to go. So what I've noticed is, if you have that feeling, going to the bathroom can eliminate the feeling number two now number one. And you do have to be very careful about not eating too late in the day because I'll get acid reflux if my foods not digested before I go to sleep. So at this point now, in honesty, five or six o'clock in the afternoon is the last time I tried to have solid food or something that's going to sit in my stomach for a while because obviously the medication makes it stay there longer, slows digestion. Last thing I want to tell you is that I went to the doctor on Saturday, a little follow up for my week OB and she was just like, wow, you're great. She said I looked younger. That was nice. I was two people have told me this week for the first time that I look like I've lost weight. One person said did you change your hair? And I don't think they were being polite. And one person just looked at me from across the parking lot and yelled go skinny, what's going on? That was better. I enjoyed that. Thank you for that person. I am not skinny, by the way. But what I have figured out is that I don't think consciously, but I've lost 20 pounds now. And if you would have asked me before I started doing this, how much weight do you need to lose? I would have said 20 pounds. And now I see myself and I think oh boy that was either generous or a lie. Not sure which but I do think that you can slowly start to just accept things, even visually or how you feel. Maybe you make excuses for them along the way. But I definitely need to lose more than 20 pounds for my own health like forget how I look. I will tell you that I feel better My back feels better. My feet feel better, my knees feel better. Generally speaking, I have good energy. I think a lot of this has to do with the decrease in mass that I'm just carrying around all the time. Anyway, I hope you guys are enjoying this. I think I'm gonna button this one up and start a new one with the first injection of the next step up. So I'm gonna go now, but I'll put this up for you soon. Maybe this week even? Yeah, maybe I could do it on Thursday or Friday, at the very least on Monday. You don't care about this part. This is just me thinking about my schedule now. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. This week, we'll be WorkKeys they should call workI they should call it work Covey, or I don't know what they should call it. But it really is amazing. I'm telling you, like i Two days ago, well, I'm sorry. I know. I said I was done. Two days ago, I got up. I had a yogurt in the morning. I'm drink drinking. I mean eating coconut milk yogurt, which is really good. I did not expect that to be good. But it was it is. And then it was like, three in the afternoon. And I thought, oh my god, I haven't eaten today. But I had no indication of it physically. Now, on Saturday, we decided to go visit some family. So we jumped in the car, and we're going out the door and I was like, I gotta take a banana with me because I'm gonna get hungry while we're there. And I grabbed a banana went there. And it turned out my banana was too ripe. So when I started feeling like well, I should eat something and I was like, Oh, this thing's nasty. And I put it down and I just did what I normally would have done. I'm like all eat later. But like 20 minutes a half an hour later. I said to my brother in law, I'm like, I'm woozy. Like do you have a banana in your house? Interesting. Like I started getting like dizzy. Banana fix it obviously ate a little something else. I had like a handful of something. I forget what it was a hard pretzel or crack or something with a banana because I mean, I was at someone else's house. I was just grabbing out of their closet. Anyway, you got to remember to eat on this, which I I feel like I should keep bringing it up. All right now I'm really going see
well, there's no one to thank because I was the only one on the podcast. So anyway, thank me for coming on the podcast being so open and honest about my week. Ovie thing. Yeah, that's probably too much. Now it's too late to go back. Thank you so much for listening. Please remember about the private Facebook group. Please remember that you can save 35% off your entire order cozy earth.com with the offer code juice box at checkout that you can get 10% off your first month of therapy@betterhelp.com forward slash juicebox and of course you'll get five free travel packs in a year supply of vitamin D all for free with your first order of 81 from Athletic Greens when you use my link athletic greens.com forward slash juice box. I'll give you a little bonus for staying till the end. I am putting this all together recording these bumpers for you two days after I just recorded the last entry and I am back to my lowest weight ever. Tomorrow morning. With any luck. I'll see a new lower number one
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#934 iLet Bionic Pancreas with Ed Damiano
Ed Damiano is the Founder of Beta Bionics and he's here today to talk about the iLet Bionic Pancreas.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
+ Click for EPISODE TRANSCRIPT
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 934 of the Juicebox Podcast.
On today's episode of The Juicebox Podcast Ed Damiano from beta bionics is here to talk about the iLet bionic pancreas. Edie and I had an almost two hour long conversation about islet. I got in a ton of listener questions. Edie told me all about the company, how things started, where it is now when he expects people to be holding an eyelet and so much more. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. Here are three quick ways you can save money. Your first month of online therapy betterhelp.com forward slash juice box Use the link to save 10% off that first month. The offer code juice box at checkout at cozy earth.com will save you 35% off your entire order. And if you want to try ag one, go to athletic greens.com forward slash juice box when you do you'll get five free travel packs and a free year's supply of vitamin D with your first order
this episode of The Juicebox Podcast is sponsored by us med us med is the place where my daughter gets her diabetes supplies from and you can to go to us med.com forward slash juice box or call 888-721-1514 To get your free benefits check us med always provides 90 days worth of supplies. And they have fast and free shipping. They carry everything from insulin pumps to CGM diabetes testing supplies you want the libre to the libre three, the Dexcom G six or Dexcom G seven US med has it. You want Omnipod five you want Omnipod dash us med has that too. They have tandem T slim x two. Oh my goodness, they have it if you're looking for it, US med.com forward slash juicebox. Before it comes on, let me tell you two things. There are some ads that are in this episode. But I'm not going to put them in the conversation there at the end. So if you want to hear them, please hang out. And listen, I appreciate that very much. I want to remind you to go to the private Facebook group Juicebox Podcast type one diabetes head in there. There's 40,000 active members. It is the most lively and lovely diabetes Facebook group known to man. That's my opinion. If you're looking for the bold beginnings, diabetes, Pro Tip series, type two diabetes Pro Tip series defining thyroid, all of the things that people who listen to the podcast love. If you can't find them in your podcast app, go to juicebox podcast.com. There's a menu at the top, you'll be able to find everything there. Or if you're in the private Facebook group hit the feature tab at the top of the group. If you have a question about diabetes, or autoimmune issues in general, we've covered it on the Juicebox Podcast. Welcome back, even though you don't remember ever being on the show. I barely remember talking to you, but you were definitely on this podcast in the first year of it. I cannot find in the list anywhere like what would you have been calling it eyelet back then?
Ed Damiano 3:34
No, no. So if you think it was 2015, we definitely had give my wife was the one who named it the eyelet. I called it the bionic pancreas before we had the name islet and she came up with the name pilot. And I think that happened in 2013 is my guess. But we weren't you know, we were using both terms sort of interchange, there was no company in 2013 or even 2014.
Scott Benner 3:58
Wow. Well, so then how did I? Well, how did this all start? I'm assuming you or your child has diabetes, right?
Ed Damiano 4:05
Yeah. So that is how I got involved with this. So my, my background is an applied mathematics. And specifically I do what I would describe as mathematical biology. That's what I used to study. And what does that mean, I would you know, I was looking at mathematical models of how the inner ear works and fluid structure interactions that happen when you move your head through space, the vestibular system and your sense of balance and equilibrium. Understanding the underlying mechanics of that was very much a mathematics problem. And I spent some time working on that, I got very interested in blood flow in the very smallest micro vessels in the microcirculation blood flow through capillaries and understanding various important physiological phenomena that are connected to blood flow in micro vessels. And that became a big part of my research effort. And that's kind of what I did it was extremely theoretical, not not, not the least bit Practical, you know, I would write published papers in the Journal of fluid mechanics and, you know, PNAS and things like that. And, you know, there were three people who read the papers, and I was two of them. You know, that's what I used to say. So it was very, very arcane stuff and, and I enjoyed it very much. And certainly I could make a bit make build a career around it. But when my son developed type one in infancy, he was 11 months old, it became pretty clear that, you know, I had some basic skill sets that I could lead to the problem of building a device that could control blood sugar levels. And I had a student at the time, Feroz Alkhateeb, who was he was a PA, he was a master student in my lab, and he just come over to the US and he was doing some work in my area of blood flow, I had him working on a problem that he wasn't much interested in, frankly. And he'd finished finished his master's thesis, and he's sort of looking around for something else. And just five months after Ross arrived, David develop type one he was, as I said, 11 months old, my wife's a pediatrician. And she actually made the diagnosis. And I turned to fear also a year or so later saying, Listen, I've been thinking about a device that could deliver insulin and glucagon to automatically regulate glucose and people with type one. And at the heart of that is software is smart, intelligent software that determines how much insulin and glucagon to deliver, to get good glucose control based on a continuous stream of data from something like a continuous glucose monitor that didn't really exist in 2000, or 2001. Or two, there was a gluco watch, you may recall the sickness gluco watch. That was in 2000. And that didn't work particularly well, but it did get FDA approved. And so I envisioned that we would build the software that makes those those dosing decisions. And he got really interested in that as such, offered that up as a potential PhD project, and that became the summon substance of his PhD. And that was around 2002. So a little over 20 years, we started thinking about what that centerpiece, you know, technology would do, how it might work. And he started working on developing the mathematical algorithms. Initially, it was a single algorithm now we have three separate algorithms that run in parallel on the island. And that was at that time, he and I were at the University of Illinois, I was a professor of mechanical engineering, and this is in Urbana Champaign, and he was my PhD student. He finishes his PhD under under, in my lab at at ui UC Illinois and then I went to Boston University in 2004, took a faculty position in in Biomedical Engineering, Feroz, came over to Boston and did a postdoc in my lab. It's this fear still works with us today at beta bionics. So he's our VP of research innovation. And, and so he stuck with this project from the very beginning, we came to BU and started animal studies looking at glucose control with the algorithms that he'd been developing for his PhD in pigs that we could induce diabetes like pathology in and we could test the system in, you know, basically pigs with diabetes. We did that for about three or four years. And then I met Stephen Russell, my clinical collaborator of many years now 17 years, I think, in 2006 at MGH at Joslin diabetes Center, he was doing the fellowship he was doing as a postdoc fellow there. And so we started collaborating on bringing that system to human trials. And by 2008, we'd started clinical trials at the Massachusetts General Hospital Clinical Research Center in the inpatient setting.
Scott Benner 8:33
While you've been talking, it occurred to me, I don't think you've been on the podcast.
Ed Damiano 8:38
I mean, I totally believe you if you said it either way. I
Scott Benner 8:42
like something about when you said Boston, it hit it hit me and I researched. I researched not research, but read dash search my my blog just now. Yeah. And in 2016, January, a woman named Kelly was on to talk about being in your trial. That's what this is. Yeah, that's
Ed Damiano 9:03
much later and
Scott Benner 9:04
your name like, rings my bell because of that. And obviously, I know who you are, like, you know, we've never met before. I know your face. You and I have never met before. And if somebody asked me to describe you, I could do it. Right. I'm not aware of who you are. But yeah, I think that's what I was thinking of. Wow, that was Yeah, no kidding. Okay.
Ed Damiano 9:23
I mean, I've done a lot of interviews, as you might imagine. And so I could easily be convinced that I given an interview to just about anybody
Scott Benner 9:29
I want to be, I want to be completely honest, there are lovely people who helped me with the Facebook group. And if someone asks a question, I'll say, I don't know Have I ever said that and somebody else will have to come in and tell me if I said it, or I'm beyond being upset or or embarrassed by that. So that's how you get this whole thing going. That's fascinating, but my daughter was two and she was diagnosed like right after her second birthday. I do not meet a lot of people whose kids were younger than that. Usually.
Ed Damiano 9:56
No, it's extremely rare. I mean, I think it's, you know, probably Just a handful of people who are diagnosed under the age of one with actually with type one, you have some kids who get this congenital, this congenital, this neonatal diabetes. That is something it's exceedingly rare but it happens and it's often misdiagnosed as type one. We actually thought David might have that but neonatal usually see that around six months of age and he was around 11 months, so he was actually old for neonatal. We did some testing and it was pretty clear that he doesn't have neonatal as type one. But he's been on an insulin pump since 13 months of age. Wow. Which
Scott Benner 10:33
one? Did he have them? Mini med fiber? Wait.
Ed Damiano 10:37
We used his old mini med pump in the big studies. So once he graduated to the Animus we took his mini med pump and put it into big studies. Yeah, about that. Do you have other children? Yeah, my, my daughter is two years older than David. So she's 26. Now David's 24 And she's about she just finished grad school and she's gonna go into another grad program in the fall.
Scott Benner 10:58
Wow. Any other autoimmune your family? Yeah,
Ed Damiano 11:01
Emily herself. She has celiac disease. Okay. So that was diagnosed. Toby was doing a workup on her just for short stature. And she thought maybe she should be able to taller. And she, she ended up having celiac that's sort of in the, in the, in the panel when you look at look at that kind of thing. So she, she was around 12 or so when we figured
Scott Benner 11:23
that out. My daughter was the smallest person in her school. And we figured out she had hypothyroidism and she's 18 now and she's 570
Ed Damiano 11:31
Good for you. So she did just fine. My wife's five, seven.
Scott Benner 11:34
We went to good height. Yeah, but we got it. I mean, I'll never know what would happen if it wouldn't have got caught but it was hard not to catch. She was like basically passing out like asleep. She had no like energy and no energy at all. Yeah. But it was just really something like, she was the tiniest little person. And then now she's just isn't it's really something else what the right, the right thing can do to help you. Alright, so that's got to be enough. Everybody's like, just ask the question, Scott.
Ed Damiano 12:07
Well, we certainly have a kinship there with a very young person and you know, to watch it through infancy, diabetes progress through infancy and toddlerhood and, and, you know, preschool age, and then the school aged kid and the teenager and now the young adult, to see that whole arc pass before me over the past 20 years is quite amazing thing.
Scott Benner 12:26
It gives you a perspective that a lot of people don't have either you can kind of really step back sometimes and see all of the different impacts that I think get lost on people from time to time. Yeah, yeah. It's, it really is held been a hell of a journey. Okay. So, modern day a few weeks ago, I was speaking at an event, I met Stephen Russell, right. He works at UC did. And he was like, you know, spilling the beans that you guys were about to get an FDA approval. So tell me about that process a little bit. So once you say we've got a thing, it works. This is the thing we want the FDA to say yes to? Like, when was that? How long? Have you been at that part?
Ed Damiano 13:07
Great question. So I think it'll surprise you. In order to be really ready to submit an application to get market approval or market clearances, it's called by the FDA for this device, you have to have a clinical data set that is collected in a pivotal trial. And what that means is that you you conduct a study that you design with the FDA, you work with the FDA to design what that trial looks like. And it has to you have to capture data in such a way that you're you've got a good quality system wrapped around it and you're pulling the data. Together, we use the Job Center for Health Research as the contract research organization to help us put that package together. And then you build a clinical clinical study report at the end of the trial. And the Job Center puts this together you know, we have input into that that document, but ultimately, once the clinical study reports are written that has all the data that was captured from that pivotal trial, and all the other testing for the device is done, which is enormous amount of work as you're building the system from scratch the eyelet is in fact device it's built at beta bionics not by contract manufacturing, we build in our own facility in Irvine, California. And building a device is a non trivial task, a durable medical a piece of durable medical equipment. And so it has its own quality system wrapped around it. We have a manufacturing process at debated bionics to build the system, and then in undergoes an enormous amount of testing all kinds of tests that were done for insulin pumps also had to be done for a bionic pancreas, along with this clinical data set that was captured to this very large pivotal trial, you pull all that together in a document that is 10s of 1000s of pages long, literally. And we submit that to the FDA. So the clinical trial, the data needed for that trial was collected was was basically in hand in December of 2021. Okay, all right, so the trial mode the trial the substitute trial happened to January in October of 2021 and the jibs And it worked really quickly to lock the database after the last participant last visit in October of 21. And within really, essentially, within two months, they had the readout of the of the primary outcome analysis that we were, we were waiting for. We were very pleased with the results. And then went the process of building the clinical study report into the early spring, early part of 2022. Okay, and so by 2022, we were 20, March of 22, we submit the application, and we got clearance in May of 23. So 14 months later,
Scott Benner 15:31
I'm gonna forget the I don't know the terminology. But were you able to claim that your device was similar to another device? Or did you have to start from scratch?
Ed Damiano 15:38
No. So we used I hope you're not getting this guy doing some yard work here. I'm hoping not getting that. Hopefully you're editing concat do something magical.
Scott Benner 15:49
Is it seems okay. Yeah, I think all right, microphone I made them send you is very close to your face. So
Ed Damiano 15:55
yeah, I think it's working well. And I've got the headset, everything I can hear up as long as you can't. That's great. So yes, the the hybrid closed loop systems on the market today, we could use one of those as the predicate device to as they call it to our application. And so the FDA suggested that we use that as the predicate device. And we went forward with that, that submission with that in mind.
Scott Benner 16:17
So are you able to get the device okayed, and the processor created at this, then the algorithm at the same time? Or did you have to make the pump, prove the pump work, and then step forward and do the next piece?
Ed Damiano 16:30
No, in fact, we had no intention of ever building an insulin pump. And I really want to make it clear that the bionic pancreas isn't an insulin pump. And really, and that's not just that's not just semantics, it's really not, there is no way to program Basal rates, carbs, and some ratios or correction factors on the island. There's no setting of parameters like that. So you can't operate the island in any configuration other than closed loop. So it's every 100% of every dose is determined autonomously by the device. And even if the CGM goes offline, you enter fingerstick measurements to keep it going. And it will use the fingerstick BG to determine the dose at the time if necessary, and dose automatically at that time. The more finger sticks you enter when the CGM is offline, the more glucose better glucose control you can get, because it can have has more opportunity to check in. But it gives Basal insulin when the CGM is offline because it figured out the Basal rate. So there's no insulin pump under the hood like there is with hybrid systems. There's no manual mode to go through this thing. There's no manual mode. And why that's important, is because there's a number of reasons why it's important in the context of your question. Every other hybrid closed loop, oh, the hybrid closed loop systems. And I would say the iLet isn't, isn't that. But the hybrid closed loop systems started as insulin pumps. And they all started in a world where you didn't need clinical data. Insulin pumps don't require clinical data, they require what's called human factor studies where people come into a conference room, they won't hook up to the device, but they'll go to the user interface and show that they can do the basic functions. And then if that human factors report goes into their market application, so the tandem system, the TCM pump, for example, the Omni pod five, the Medtronic system, the Omnipod, not five, but the early Omni pod system, and the Medtronic insulin pumps all went through human factors testing, but they didn't require any clinical trial data, we did not make a user interface where the islet could be a standalone met and manual insulin pump, in which case, if we had done that, we could have put that through the FDA a few years earlier, had a manual insulin pump and would have needed a clinical trial for that product. But to add the algorithms needs the clinical trial, we did it all simultaneously. So not to
Scott Benner 18:29
be too obtuse, but basically, the islet is like a self driving car with no steering wheel and no pedals. And the algorithm you get it drives you where you go. That's not
Ed Damiano 18:38
obtuse at all. Those are that is the that is exactly the analogy I make all the time. Okay, great, right. So it's like sitting in the in the passenger seat of a self driving car, you can't adjust the insulin dose, you can't, you can't override an insulin dose, you can't give a Bolus, right, so you can watch the thing, control your blood sugar, right, you can watch the self driving car go. And you can watch it, turn it steering wheel and so forth. But it really is determining 100% of every dose. Now you can interface one way to interface with the device is to let it know that you're having a meal and we have something called a meal announcement, which we can talk about. But even that when you issue a meal announcement, you're not determining the size of the insulin dose that is delivered in response to that. It figures that out by itself. And then it comes to know what that appropriate dose should be when you give a meal announcement for breakfast, lunch and dinner. And then it cleans up the rest downstream of that we can talk a bit more detail about how that works. I think it'd be a worthwhile thing to talk about. I
Scott Benner 19:37
know for certain I have one more question about that. Then we can definitely move on. Am I wrong? Just say that in the very, very beginning. You imagine this happening with a tandem pump?
Ed Damiano 19:46
No, no. Yeah. So no, no, not No at all. Actually, in the very beginning. I imagined it happening with something called The Aviator pump resume. You've never heard of that. So Dean came in had built a pump that was So 510 K cleared in a traditional insulin pump, and he licensed that to Abbott diabetes care. Abbott had a possession of this Abbott navigator which my son used from 2008 to 2012. It was in the US at that time. And it was a continuous glucose monitor. Phenomenal one, really. And the notion was we were working with the guys at Abbott, to put our algorithms in between the aviator insulin pump and the navigator CGM. And we would be the smarts in the middle. And what happened was Abbott had a change of heart. And they they did not proceed with the aviator pump. They never marketed even though it's 510 K cleared and they the navigator itself. They abandon that product in favor of what is now believed right in Flash glucose monitoring. So I found myself without a partner. I never intended to start a company never intended to build a hardware platform. My intention was to take the software that Feroz and I were working on and collaborate with Steven to test it and human trials and then license it off or be you Boston University with license that off to an abbot or a Medtronic or a tandem. So we did start talking with tandem. He's one of the reasons tandem is called tandem, as I understood it from 2011 is because they were always contemplating multiple fluids pushing multiple fluids, not just one. Okay. And so there was great interest in in a dual chamber T slim pump and I was working with a guy named Sean St. Who is now our current CEO at beta. Sean 2000 companion. Am I right about that? Well, he was not when I met him. When I met him. He was a young whippersnapper, engine engineer at tandem diabetes in 2011. And he approached me at an ADA conference. And he said we're about to get we think we're about to get 510 K clearance for the T slim pump, which he was right few months later he did. And I started working directly with Shawn in 2012 to build our first mobile device that ran on an iphone four s and commanded insulin and glucagon doses out of two independent tandem T slim pumps. And the woman Kelly you interviewed would have used that system. So you put two TCM pumps in your pocket one delivered insulin one was repurposed to deliver glucagon and this giant brick that an iPhone for us on one side and a G for Dexcom. Receiver all bundled together. Right. And that was our iPhone, bionic pancreas for about eight years. We use that thing.
Scott Benner 22:20
Wow. Wow, that's something look how far it's come and how long it takes us? Yes, a little humbling. Actually.
Ed Damiano 22:27
It For Me in particular. I mean, I never expected this first one never expected to build the whole thing or build this build the team that built the whole thing. But I never would have expected it would take as long as it did and cost as much money as it did. Yeah. It just it's just a huge undertaking of infrastructure to do something.
Scott Benner 22:45
It's funny, because when you talk about the first idea, like it occurs to me couldn't, couldn't any pump company just accept a bunch of algorithms from a bunch of different places and say, Look, just choose the one you want to use. And we could adapt, but I guess nothing. Everybody wants to be proprietary at some point, right. But it's
Ed Damiano 23:02
not just that you're right, that has historically been the case. But until recently, the FDA didn't make that easy. And they and the FDA sort of wanted to get out of its own way. It didn't like the fact that there are all these different companies making algorithms, mostly academic groups back then. Right? Not so much companies, but mostly academic groups, and companies were licensing algorithms from academia. But then you had a few companies making pumps, and you had a few companies making sensors. And so initially, the idea was at the FDA is that we want these sensors, these continuous glucose monitors of which there were like three on the market and now they're there a few more to be able to talk to any one of these pumps. Yeah, and integrate with any one of them. And then they evolve their thinking to say Okay, now let's allow these pumps you know, the a certain type of pump to not only talk to any one of these CGM, which they call they dubbed I CGM, you know, inter operable continuous glucose monitor. But then they wanted to, they made this thing called ACE pump, which was a device that that could talk to anyone these icy GMs and could host algorithms. And you could just plug and play this ace pump can work with this IC GM, that one or the other one. And this icy gem can work with these three A's pumps, and that they wanted that interoperability. And then they said to sort of flesh it out. The third technology in this piece right in the system is the are the algorithms and then they came up with something called AI AGC inter interoperable automated glucose controller, which was one of these plug and play algorithm 510 case or market applications. So now, you could have an AI AGC tested in one ace pump with once I CGM and once you do the clinical data, collect the clinical data for that ace pump IGC you could put it in different ace pumps without having to do another clinical trial. And you can make a talk to other ICBMs without having to do another clinical trial. So they're trying to be able to really promote this interoperability and all this different cross communication in this in this ecosystem of C GMs pumps and algorithms. And so they gave birth to all of these these three different regulatory pathways. And now we have an interoperable space that for the first time, now that as of just recently, in addition to the G six Dexcom, which is a, you know, II CGM, there is now the G seven Dexcom on the market, which is an IC CGM. And there is the libre three, which is an IC GM, it's the first time we've had more than one. I CGM out there.
Scott Benner 25:26
Right? Did you ever consider licensing it to pump companies? Or was that that's
Ed Damiano 25:31
what I wanted to do is what you that was my initial intent. And that's why I was working so closely with Abbott. And the problem with this was that when you start working with the med tech industry, the it can be it can be they can become quite capricious. And the reason is, especially big med tech, you have these divisions, diabetes divisions in these big med tech companies. So they do a bunch of things, right. But one thing they do is diabetes, and they have a diabetes division, and they have a precedent of that division. The president of that division, if they are very successful, very often gets promoted into some other space like cardiovascular within that company, leaving in that person's wake the need for his or her replacement. So another president comes in with totally different objectives. And they might say, you know, I want to pivot away from type one, type two, and this technology that my predecessor has been been investing in, I'm going to divest all of our interests in that and move into a new product, then they carve out their own little legacy for themselves. And so I couldn't rely on the med tech industry, I saw no way to do that. When there's that kind of capriciousness happening in the system. It's built right in right to the way these companies evolve.
Scott Benner 26:35
You don't want to spend six years turning yourself into the right quarterback, and then your coach leaves and he says, I want to run the ball more. And now. Now you're exactly I got it. Okay. Wow. I don't think I have any more questions around that part of it. I have.
Ed Damiano 26:51
I mean, there's a lot of history, right. And we can talk for an entire podcast on the history of this. Yeah, for sure. But the long and the short of it is we ultimately evolved our thinking through experience that we had to build this thing ourselves from the ground up and soup to nuts.
Scott Benner 27:04
And so I let because it's not an insulin pump, it needed a different name. So I that word just doesn't exist in your day.
Ed Damiano 27:13
Yeah, yeah. So it's funny because if you think about the evolution of the of my terminology, I go from the nerdiest of terms that you could imagine like a geeky engineer. And if you look at my slide decks from 2008 910 11, my, my terminology gets worse and worse. And I hit an all time low in 2011. So initially, I called it a closed loop blood glucose control system, which just rolls right off your tongue, right? And then I realized that that's just not, you know, it's a very academic, you know, thing engineer in particular would say things like that. And then I tried to come up with better terms. And I never liked artificial pancreas, because artificial practice tells you what it isn't. It isn't a real pancreas. And we know it's not a real pancreas. Can we have something that's more descriptive? So my ward, my lowest moment was when I called it a prosthetic pancreas. And I may as well just shown a picture of a little pump with crutches on either side of it, right. But in fact, it wasn't a I mean, it is a prosthesis, if you will, and in a way, but it's just not the right terminology. The next year, I said, What is it let's be positively descriptive, and not negatively descriptive, what it isn't. And then I looked, I thought about bionic pancreas. And then I looked in the dictionary, and it's you know, it's it's a technology that imitates you know, biological processes through through electronic electromechanical systems and electronic means it's exactly what we do. And so I coined that term in I think, 2012. And I've used it ever since. And that's kind of a category. It's a bionic pancreas, who my wife came along a couple years later and said, I know what the, you know what the device should be, should be called, it should be called an eyelet binding pack, because obviously an homage to the islets of Langerhans. Yeah,
Scott Benner 28:46
that's a great idea. Also, I don't want to get off topic before we get on topic. But how come you're an engineer and so personable?
Ed Damiano 28:54
I don't know. I mean, I think that AI engineers get a bad rap. You know, I think many of them can be quite personable. Excellent. I'm
Scott Benner 29:03
just like, well, you're like a good storyteller. And
Ed Damiano 29:07
you know, when you tell the story enough times it becomes
Scott Benner 29:09
rote? Yeah, I There are a couple things in my head that if I say I can shut off while I'm sending them off course. Alright. So you've got, you've got your clearance now, is it? I mean, I am assuming you're a smaller company. So what's it like? There's got to be a ramp up plan, right? Like you're gonna launch and then like, how do you foresee that going?
Ed Damiano 29:32
Yeah. So I'll give you a little bit insight into into, you know, our vision for how that should work. Remember, we did, as I said earlier, a pivotal trial. So we took the iLet. By the end of 2020. We had basically locked this thing into this little device that looks just like this thing I was just showing you. And we could then with funding from the National Institutes of Health, we had a large grant from the NIH to help pay for this study. It was what's called an investigator initiated trial. So beta bionics didn't spawn To the study, it was, it was basically sponsored by that jape Center for Health Research. The grant came in through my lab at Boston University, and went and dispensed out to 16 clinical sites. And so we had subcontracts sites at the university, North Carolina, Chapel Hill at Stanford University and masters, General Hospital, and so on and so forth. We had 16 sites. And we chose these sites carefully. Stephen Russell, myself, and Roy Beck sort of went through across the country and said, we really want to pick sites that can bring a lot of ethnic diversity into the trial. So we don't have you know, a study that's consistent, almost entirely of white, very wealthy, and very educated people, but rather a study that has a much better cross section and a better mirror of the population of the population at large. So we chose sites in northern Florida, in southern Texas, in Detroit, in Atlanta, Southern California, where we could get in a lot of ethnic diversity into our cohort and bring a bring a broader demographic into the study. So we designed that study with those 16 sites as the targeted places where they each bring in anywhere between 20 and 35 participants over the course of that 2021 calendar year. And that was really always my my thinking about how we should bring this thing out. We should start by using those sites as the places to launch the device. And when Sean St. came on board as CEO over the summer, you know, I think that jives well with him, he's like, Okay, well, I'll have we'll build a sales team. And they'll break up the country into sort of eight. It's a targeted launch, we break the region of the country up to eight territories, within each of those territories resides one or two of our pivotal trial sites from that study. And so those are the people who are in my mind, the de facto experts of using the island are the only ones have ever used it. In a close to real world setting our trial was designed to be a very good approximation of real world usage, people were on the device for 13 weeks. So they understood the device in a way nobody else could, until you use it, you can really understand and appreciate it. So we thought that was the best place to start. Now, in each of those regions, most territories, there are several other sites that are also going to participate in our launch. But we are moving very quickly. And because we're a small company, as you mentioned, we have, there's a kind of agility that we have, that allows us to go from getting 510 K clearance of a in a company that's never launched a product to launching the product within the space of about a month. So you know, we have certainly launched the iLet. It is, you know, the we have we're using a distributor distributor Durable Medical Equipment approach to distributing the device like like, like a traditional insulin pump would follow. And so we you know, we've shipped our product out to distributors, and they can in turn, ship those two people with type one diabetes and traducida, typically in those regions, and those regions covered a big section of the US, right? And so we just want to get our feet wet in the first few months and just get experience with the pivotal trial sites, and then expand and add territories in the fall. And then more sites as well.
Scott Benner 33:00
Do you see it as a years long project? To get up? Like when when Will everybody be able to walk into their doctor's office and say eyelid? Yeah, good question.
Ed Damiano 33:10
So right now at launch, we were we weren't able to get for example, Medicare and Medicaid Services to cover the device. You know, this is a device that you would, you would use private insurance and government insurance to pay for the device, you'd have a copay, just like a traditional insulin pump and similar similar with the supply with the supplies, but you can't we weren't allowed to negotiate with CMS Center for Medicare Medicaid Services. Prior to 510 K clearance, which we only obtained, you know, just less about four weeks, little less than four weeks ago, once we got 510 K clearance, we can start entering into a contract with CMS. And that takes anywhere between, you know, two and three months. So anybody on Medicare Medicaid Services, needs to know that we can't get it out to them right away just because there was no way we could have teed that up
Scott Benner 33:56
if I didn't have the conversation before the clearance.
Ed Damiano 33:59
Exactly. But with with with with commercial insurance, we were able to through the distributor Network Distributors across the country that sell insulin pump supplies, we were able to set up contracts with them. So the minute we got clearance, they could place an order. So we literally took orders right away upon FDA clearance that allows us to get out to a lot of people in the country in the you know, in the back half of this year, who have private pay. And we're hoping by say the fourth quarter maybe or maybe even sooner than that third or fourth quarter, we'll get government insurance on board once that contract sells and that allow us again to then penetrate further out and reach more people who do
Scott Benner 34:36
you see as your target user group?
Ed Damiano 34:41
The vast majority people type one but specifically, we see this technology is playing really well in the hands of people who are on MDI therapy in the hands of people who are willing to and I think this is most people will let go Have their diabetes management as much as possible. And what I would say is who it's not for, is who we call the knob Turner's and I would have to admit that I am probably one such person. Right? And yeah, I bet you are as well. Yeah. Right now, probably. So what do we do? Well, we have this little tiny child in front of us who has type one diabetes, and we are going to pour all of our energies into making sure this kids glucose is tightly controlled as possible without destroying their lives, right, we don't want to interfere with their lives so much that they're just, they're just a little experiment. So you have to do it in a way that, you know, they can coexist with this, but you want to give them as good of care as you can. So we were all over this little guy. And we grew him up that way. And he organically began taking more and more responsibility of his diabetes management. But I have to say that in taking over that responsibility over the course of a decade, to the point where he goes off to college with a animus pump, and a G six Dexcom, or G five Dexcom, back then he's doing a really good job managing his diabetes, and he is a tinkerer, he's going to adjust to fine tuning of insulin dosing, he's all over it, and multiple times a day. Now, many people who do that and do well with that are going to be able to use the eyelet successfully and comfortably, there may be an adjustment that they need to make and get used to handing the steering wheel off to some autonomous system. But they can sometimes make the adjustment. There are others who won't be able to, it'll provoke too much anxiety, and they just won't get through it. And the reality is, you don't know what sort of person you are until you try it. So living with the eyelid is the only way to find out if you can let go the wheel as he likes to say Yeah, and so we will offer a 90 day return policy with the island. So we want to make sure we really want to make sure that the right people find this device. But we also want to make sure that those who just find that the device is not right for them. Find a way to a device that is a loop system or more of a manual system where you get in, you know, you can take more responsibility for insulin dosing.
Scott Benner 37:01
Yeah, that's interesting. I mean, so what's the straight from the listener questions? What's the target a one see gonna be like, what do you expect the eyelet to pull for people?
Ed Damiano 37:12
Well, so our pivotal trial was, by the way, the largest pivotal trial ever conducted for a automated instant delivery system. It was a huge trial, and we enrolled children and adults simultaneously. So we went all the way down to age six, and all the way up to age 83. So we had a very broad range of ages. And if you typically the way you think about, you know, where the agency comes in, as you typically look at adults separately from pediatrics, it's very commonly done. In statistics you hear usually parse it out that way. So we found that the average a one see that the device achieved was about 7.1% In adults, and about 7.5%. In the kids. It's pretty amazing, actually, it's a really good one say, and we did not increase hyperglycemia, relative to the standard of care. And I think it's important to emphasize that the way we designed our trial was to have a standard of care study arm. So not everybody who went into the trial, use the eyelet right away. So what happened was there was a randomization, who you would use your screen to do the trial. And when you were enrolled, you would randomize the either the eyelet, which is called the intervention arm, or the standard of care arm. And by standard of care, we mean whatever your insulin therapy was, when you came into the trial, do that, but do it with a G six Dexcom. Now, if you were, for instance, using a CGM already, then we don't need to bother introducing a G six Dexcom. If you use the Medtronic, then that's your standard of care. You've got CGM, and we give you a blinded G six Dexcom. Because want to capture all the data ng six. If you're using a Eversense, or Liebreich continue doing that, but will give you a blinded G six. And if you didn't use any CGM, we taught you how to use the CGM, if you went into the control arm into the standard of care arm, and they became a CGM user, at least for that 13 week period. So the study cohort divided across these two groups. And because we had a standard of care arm, we could keep track of how well people did in the trial on their own care. And people tend to do better in clinical trials than they do on their own because they're being watched. They're being you interact with them more. It's called the study effect, the Hawthorne effect. And so we want to keep track of that. And whatever the eyelet does, it's really the difference between how much the you subtract out the improvement the standard of care arm saw from the improvement the eyelet saw relative to baseline. And that difference is the difference in the improvement of the eyelet. You can quantify the improvement and what we found was that it was statistically significant reduction in HBA one C of half a percent relative to standard of care. So we saw a point 5% improvement in Me included in a one C relative standard care on the island. And that was a statistically significant difference, which means that the likelihood that happened to chance is exceedingly small.
Scott Benner 39:55
How about if you take I mean, I heard you I heard the pride in your voice from us. said how you chose the people to go through these testings. And I feel like I understand the underpinning of that, which is that some companies pick ringers, like people who they know are gonna do a good job, right? How many times like how much data do you have about people coming in with just wildly out of control? A onesies? elevens twelves? Did they bring them to a seven?
Ed Damiano 40:23
Yeah, so it's an excellent question. So we were very careful not to have an upper limit on HBO and see, and that's unprecedented. There's never been an AI D study, where where there wasn't a limit on upper limit on HBO and see a pivotal trial. So we, you know, for for a market application for a device. And so we were really clear about this, we wanted to make sure that no more than a fifth, we asked the sites to limit those, those people that you randomize such that the limit limit or fill certain buckets, so make sure that at least a third of them have a one C above 8%. And no more than a fifth have an A one C below seven. And that's because these large epidemiological studies out there like the T Wendy exchange, and other studies have shown that on typically in the US, all these studies tend to corroborate that only about one in five people meet the American diabetes Association goal for therapy. Anyone see below seven. Yeah, that just is it just continues to ring true at least adults kids are even worse, unfortunately, having worse outcomes. But adults 18 and older, it's about one in five are achieving goal and 80% aren't. So we wanted to make sure our cohort as much as possible reflected that. So we asked the sites to try to limit the enrollment of Pupil tendency below seven. And to make sure you had at least a third they went above eight, we also wanted to make sure that at least a third of the cohort was on MDI at baseline. Right. So we didn't take pump users, you know, as as as exclusive requirement. We allowed people who on pumps and people who are on hybrid closeup systems to participate in the trial. So it was an FDA cleared device or an FDA approved device, it was admissible into the study. Yeah, I
Scott Benner 41:55
feel that when you mentioned earlier, it struck a chord with me because, you know, I had somebody asked me recently about, like, how do you stay so made motivated about making the podcast and I was like, for all the people I reach it's a very small percentage of people have diabetes. And you know, those other people are not running around with a onesies in the sixes, you know, and they they're overwhelmed. They don't understand what they're doing. They've long past given up and they're just they're on a they're on arrived with their eyes closed, wondering when it's gonna like come to a stop. And
Ed Damiano 42:28
I think the eyelid is for those people, the eyelid is for most of those people, it's not for everybody. And that on one end of the spectrum, right, as I was trying to emphasize the knob Turner's who are going to have anxiety by giving up control and can't get past that is not for them. And there are therapies. Fortunately, we have so many good alternatives. Now, there are therapies for that. But on the other end of the spectrum, you have to at least, you know, you have to attend to what Stephen Russell calls the care and feeding of the device, you have to make sure there's insulin in the cartridge, you have to make sure the CGM is streaming data, you have to make sure the infusion set is intact and working. Right. And you have to make sure the battery's charged. So that is a care and feeding level of responsibility that's essential for the aisle to help you. And they're going to be some people who won't do that either. And
Scott Benner 43:11
and also couldn't for reasons that you can't be pregnant use and I would imagine, because this is
Ed Damiano 43:16
not indicated for pregnancy, we did not test it in pregnancy. So that would have to be done separately is another try. Are there reasons
Scott Benner 43:21
that a doctor couldn't write it off label at some point for somebody under six? Are you going to have to do that testing before that gets okay?
Ed Damiano 43:29
Oh, physicians can write do anything they want with off label usage. They can use these devices, not just hours, but any of these devices off label, we just can't train to that. And we just need to be very clear. What is on label. Yeah. And what is on label is people with type one diabetes who are six and above, okay, who aren't and not pregnancy? So that's certainly not something we have an indication for.
Scott Benner 43:50
So So for clarity like, I can't use islet and achieve a five five a one C with there's no way for me to manipulate it or do that kind of stuff without Lowe's.
Ed Damiano 44:01
Ah, good question. So I noticed one of your one of your, some of your users had some of your listeners had a question similar to that. So what we found is about 46% of our adults had a mean glucose after 13 weeks on the island of about 100, about about 46% had a mean glucose under 154. And an agency of 7% corresponds to mean glucose about 154. So 46% of the cohort had a mean glucose below. Below 154. About 27% of the cohort on the island had an A one C below seven. So almost a third. So what does that mean? What was the lowest day when seeing the island? It was in the fives by the way. So we did have somebody who were those 13 weeks on the island, they ended with an A one C sort of in the mid fives, but it's unusual. The island tries to bring people's mean glucose and anyone see up a little higher if you're sitting down at what I mean glucose at 110 or 120. Right? You're likely going to see it increased toward 130 or 140 or 150. So it is that increase that some of the As folks who enjoy being down there, maybe they pay a price of hypoglycemia, but they want to be down there. Skimming the trees, so to speak, will be frustrated by that rise. But the reality is, all the clinical data suggests that there's no advantage to an agency of five and a half over an agency of six and a half. There's almost no signal for microvascular damage polonium exceeds seven, which is why these, you know, these societies like the Endocrine Society and American diverse decision, have these goals for therapies, goals for therapy.
Scott Benner 45:28
So, nuts and bolts. I want to go over just how it works for a second. So yeah, I'm going to eat a meal. Am I right? Like, I probably should just ask you, but my understanding of it is, and I'm assuming if this is my loose understanding, it's ever about a lot of other people's. I announced the meal by saying This is breakfast, lunch or dinner. And then I say whether this is similar, smaller or larger than I'm accustomed to eating, is that it?
Ed Damiano 45:53
That's it. Okay, so even rolling the tapes back Further still, to start the island on your own day zero, right, you get on the island, you enter your body weight. And that is it, right. So there's no programming of Basal rates, there's no programming of insulin correction factors. There's no programming carbs and some ratios. And there's no carb counting specifically, right, we do ask that you be carb aware. And I'll make a mention of that in a moment. But so to start the system, you enter your body weight, you have to learn how to hook up the infusion set and pair it with the CGM and so forth. But then you enter your body weight, and then you go bionic. And then you swipe to go down again, the system starts dosing every five minutes of every day and adjusts insulin therapy according to your needs to your ever changing insulin needs. But the meal announcement works as you describe almost exactly, to give you a little bit of color under the hood, as to what's actually happening when you do that. So with the meal announcement, you just simply swipe to unlock the device, and you just press on the little knife and fork. There's a little knife and fork here. And you press on that and it asks you, you know, is this you know, what meal type is it and you get to bucket breakfast, lunch or dinner. So given the time of day, I'm going to choose, let's just say, Well, it depends on where you are. Let's just say I choose dinner. And then it asks you is this usual carbs? For me more or less? So three buckets? And no numbers? No, mind you, right? This is diabetes without numbers. As a primary care physician that we've been working with, for years, who was really the one who coined that, and then you just simply, once you say, you know, usual for me, for instance, let's choose usual for me, then you just swipe, and it then determines the dose at that moment, and it begins to deliver. So what happens is it gives a dose of insulin at that moment. So if you have the food delivered, you don't pre meal Bolus, we discourage that, we ask people to wait until the food is in front of you not to worry about fat and protein, right, just focus on the carbohydrates on your plate. And by that I mean is this is this bowl is this is this lump of rice, the usual amount of carbohydrate I'd have for my lunch, say, or my breakfast or my dinner. And it will then on the very first offering of a meal announcement say for your first lunch meal announcement that you issue. It'll give a Bolus at that moment. Once you once you say usual for me lunch, for example. It'll give a Bolus based on your body weight initially, and it'll be quite conservative on that first attempt. And then it will watch every five minutes of the rest of the day, how much you know what your glucose does, and it will add insulin as needed, or suspend insulin as needed. And we have two other controllers that are running separate from the meal announcement controller, the one that gives that Bolus up front one we call the Basal controller or the Basal algorithm. And the other algorithm we call the corrections algorithm. And they're working in concert every five minutes and they adapt on multiple timescales to your changing needs. But the correction algorithm will add insulin above and beyond what the Basal algorithm thinks you need for your Basal requirement. And if it sees the blood sugar starts to rise, even in the in the face of that meal announcement Bolus that was just delivered, the correction algo will add some additional insulin. And at and tomorrow, when you issue another meal announcement for say lunch or usual for me, it will look to see yesterday when you did this, the meal announcement gave three units of insulin and then we added another three units of insulin of correction insulin in the four hours afterwards. And that was not the right balance. It wants the meal announcement to be a majority of your mealtime insulin over the four hours after the meal announcement. And if it was short of that, it'll make it a little bigger. The next day you do it a little bit smaller if it was too much if it was all of the insulin, and then they'll start adapting that and the body weight thing becomes less important. You initialize that with body weight but it's allowed to depart from that very quickly and start adjusting the size of that lunch meal announcement to be to account for most of your for our insulin but not all of it. And it separately adapts the meal announcement for breakfast, separate from lunch separate from dinner it buckets those three and if you have a snack, you know if you have an evening snack you might want to bucket that with dinner if you have a morning snack, you know a little left o'clock ish like Winnie the Pooh, you might call that a breakfast snack.
Scott Benner 50:03
Okay, right? Why doesn't it need a Pre-Bolus? Is it? Because, I mean, I've used a number of different algorithms with my daughter, but most specifically Luke and Omnipod. Five. And they they seem to have in common that once you put in insulin, they take away basil and then work backwards is kind of how I think about it. Does that make sense? To you stay understanding, is the eyelid staying aggressive when the Bolus goes in? Because you my daughter can't eat food without Pre-Bolus? Like whether I did it like so what is it doing? Is it is it matching the power of the rise with insulin and then getting the hell out of there before it causes a low?
Ed Damiano 50:45
Well, yeah, so what it does is it the Basal controller is a controller that adapts on multiple timescales. So let's just focus on that one. First, the basil algorithm, we call it, and it has, you know, it's adjusting sort of an average Basal rate that it figures out by itself over time. And there's an there's a, an ability of the basil algorithm to shut Basal insulin off completely, if you're starting to go low. If you are low, or you're tending low, it can turn the Basal Basal insulin dosing off completely. But it's adjusting this on a very short timescale, looking at your glucose levels, every five minutes, it's it's got to be very responsive, I'm going to turn off Basal insulin if you're dropping too fast, or if you're low, or it can just run along. And it also can see daily patterns. So it also adapts on a diurnal nocturnal timescale of 24 hours. And so we can see that, you know, suppose your child who has growth growth hormone secretion upon the onset of sleep at around 11 o'clock or 12 o'clock at night, and they tend to need more insulin because of that, because the growth hormone causes, you know, release of glucose by the liver. And so the Basal control will start to see that and it'll start to adapt upwards and it might see this pattern that typically around this hour of the day, I need more Basal insulin, it'll just sort of it'll, it'll see that pattern and it'll reinforce it. But if you change as you grow into a young, a young child, and then a teenager, and you start having a cortisol secretion, or just before waking in the dawn hours, you no longer have the growth moment at night. Now that shifts toward your needing more Basal insulin, say it five in the morning, it'll figure that out automatically. And similarly with intercurrent illness. So if you have an upper respiratory virus, and you see a sudden need for more Basal insulin or more correction, insulin for two or three days, it'll see that automatically and we realize that I've got to get more insulin to keep the glucose down at this average that I've been trying to achieve. So I will adapt upwards for that two, or three or four days or a week when you're more insulin resistant. And if you have a vomiting illness, you're very insulin sensitive, it'll do the opposite, it'll back off and become less aggressive. So it's doing the Basal controllers doing that the Basal algorithm and the corrections albums also figuring out your insulin sensitivity, automatically, not so much in terms of the number, what is your insulin sensitivity factor, but rather recognizing that this person over the over the days and weeks, months and years, their insulin resistance might change, they might need more insulin, when your blood sugar hits 250 than it used to when you were six years old, then then you need now when you're 14, and it'll suddenly start adjusting that upwards as well. And you'll get more correction and then on top of it, and it adapts on multiple timescales, not just five minutes in daily timescales, but intermediate timescales as well. And that adapting on multiple timescales allows these two algorithms to learn. It's really a self learning system, and allows that system to engage in what is essentially called lifelong learning. So it does see patterns on a daily basis and is able to adapt to your ever changing insulin needs. Meal announcements adapt according to how you provide input on what is tip usual meal for you breakfast, lunch and dinner. And you're
Scott Benner 53:46
comfortable calling it learning. It's not just going off of what it seen recently, but it's it's remembering stuff from the past.
Ed Damiano 53:54
Yes, it is. And so it is storing information from this past week on where your insulin needs were higher and lower. So it is a kind of an autonomous learning system. I wouldn't call it artificial intelligence. Right? It does. It does do some pattern recognition, though, in the sense that if it sees if it sees, you know that the basil algorithm is giving more insulin at this, you know, early morning hours over and over again, it will see that and it will, it will it will it will tend to be higher in that in that period, unless for some reason in that particular morning, you don't secrete the cortisol and you're more insulin sensitive, it can very quickly turn off the Basal insulin. So it is a learning system in that regard. Yeah, so
Scott Benner 54:32
that brings up a question that a lot of people ask them that. I was wondering just while you're talking us an idea like somebody's getting their period, like so one day like I'll use my daughter because I'm sure one day she'll love to listen back to this podcast and hear her period as much but in the days approaching, Arden can be need more insulin, and then when the event happens, she can fairly suddenly need less, and it changed his dress. So how Otherwise, how does like can I just like whisper in the eyelids here? Like, you know, I got my period or like, like, how does that like you because you can't tell it stuff like that,
Ed Damiano 55:07
you know, you can't tell and stuff like that. And it doesn't have it doesn't have memory over a monthly cycle, right? It's really looking more over the seeing patterns in the past week or so. But just to be clear, the eyelet learns and adapts very, very quickly. So what we found was in the pivotal trial, remember, we start the system with your body weight. So imagine you have a teenager, a raging hormone adolescent who weighs 70 kilos, and uses 90 units of insulin a day, and an adult who weigh 70 kilos, he uses 45, the islet will figure out that difference in about 24 to 48 hours that difference, that's fast, right? That's fast enough to handle the increased insulin demand around periods around intercurrent illness, the physiological changes in insulin demand happen over the space of a day or so it will see that and if you suddenly become very insulin sensitive, like you just described, it can shut Basal insulin off and it won't dose correction and insulin if it doesn't need it. If you're not hypoglycemic. So if it sees you sort of staying low, it'll back off completely on Basal insulin or or shut it down dramatically. So that if you won't go low as easily as you can go high. So it definitely is biased and trying to prevent hypoglycemia. That's like the first order of business is to limit hyperglycemia.
Scott Benner 56:24
How does that work with exercise?
Ed Damiano 56:27
So with exercise, I would like to introduce you to the idea of a by hormonal system. That is, indeed, unequivocally the best way to deal with exercise is that you know, is to be as biomimetic as possible. That is how the pancreas handles exercise. It reduces insulin secretion simultaneously with increasing glucagon secretion. And we really do need a by hormonal system to handle exercise elegantly in type one. All single hormone systems are vulnerable to exercise, even insulin pen therapy, all of it. Yeah. So you have carbohydrates to help and other other tricks to deal with that using carbs, you know, many carbs to treat, or being fasted going into exercise are different ways to deal with people different ideas about that. And many of those tools are going to be used with the single hormone island, but specifically, disconnecting from the device is what we recommend, if you're going to engage in exercise, just this is going to add the infusion set, if you're going to engage in exercise, that where you find yourself going low in on your other therapies, try disconnecting from the eyelet. There's no setting of temporary basals. But if you do have to go beyond that, and say it's not enough just to suspend insulin, I also need to usually take some carbs ahead of exercise, if you're going to carb load like that, to prevent hypose. during workouts, what we ask you to do is to disconnect from the eyelet first and then take the carbohydrates not the other way around. Because if you do the carb loading and forget to disconnect in your workout, it'll see the rise and we'll start dosing just when you don't want it working out. So the order is actually important there. And that's something a little different from traditional pump therapy.
Scott Benner 58:05
Okay. Would you say that the system if it's trying to address a higher blood sugar, for example, does it address it with Basal insulin or with a Bolus?
Ed Damiano 58:14
Yeah, so it has the correct the correction algorithm is responsible for giving insulin above and beyond what the Basal is, sees its responsibility to be the Basal insulin. The Basal insulin algorithm is sort of swimming in its own swim lane. And then you've got the correction algorithm that swims and it's swim lane. And when you start to have hyperglycemia excursions for whatever reason, stress hormones, stress, hormones, stress, you know, whatever is or an illness, or carbohydrates, right if you forget to meal announce or if you meal even if you do meal announcing you tend to see a still arise after that. The Corrections algorithms responsibilities to come in and give that additional insulin above and beyond Basal that handles hyperglycaemic excursions. And if you forgot to meal announced it will provide all of the additional meal insulin, if you will, it doesn't know its meal. Instead, it's just correction insulin needed to bring you back into range. But if you do forget to meal announce, it will step up and do that. What we tell people is that what we've seen is that typically, if you forget to meal announced and you eat a meal and it has the sufficient amount of carbs to cause a glucose excursion, you'll typically you'll likely go higher than you would if you did a meal announcement you'll be higher for longer and there is an increased chance of late postprandial hyperglycemia if you don't do the meal announced because the meal announcement gets the insulin up front, it's always best to get the insulin up front than to wait until you see the rise but it is designed to handle glucose excursions when you know nothing of any sort even those occasions when you forget to meal announce Okay,
Scott Benner 59:40
so here's another idea. What if I'm a very low carb person and I weigh 150 pounds I put on island a family 150 pounds and I'm eating breakfast and it's normal for me. Like but normal is three eggs and two slices of bacon and a half a piece right? What happens then?
Ed Damiano 59:59
Great question. So as I said, with a meal announcement, all we're asking you to do is be what we call carb aware, meaning, you know, know what the difference is between the three macronutrients know what a fat a protein and carbohydrate are, right? You should that's every every, every person should know that whether you have diabetes or not everybody should have that level of nutritional education. So with the eyelet, we expect that level of nutrition education, and we provide educational materials in our training documents to help understand some of the macro nutrition, some basic nutritional guidelines, but essentially, understanding that, you know, if you're eating eating eggs and bacon for your, for your breakfast, and you're having no carbohydrate, there's no meal announcement to be had, it doesn't matter if there's 80 calories on that plate, right, or, you know, whatever your hundreds of calories on that plate, you know, 150 300 500 calories, if there's no carbohydrate, and there's no need for a meal announcement, suppose you're a grazer, and you never have more than, you know what we typically say, for adults, if you're having fewer carbs than just a single slice of bread, then there's no need to meal it out. So that's just a rule of thumb. Again, you'd like to stay with numbers. But for an adult, you might think of, you know, a piece of bread, or anything less than that, you can probably just skip the meal announcement and let the corrections algorithm do the rest. So for small snacks or meals, where you have very low carbohydrate, you wouldn't meal an ounce. Where would
Scott Benner 1:01:17
I expect my blood sugar to go in a scenario like that?
Ed Damiano 1:01:21
Oh, well, I mean, it of course, it varies. But I mean, if you had a very low carbohydrate meal, you know, you could see an excursion, you could see a small excursion to you know, 100 to 200. Meg's per deciliter, and the direction album could kick in, and then bring you back down. If you had a very high carb meal, like suppose you had, you know, 120 grams of carbs, right. If you're a teenager having a big bowl of cereal cereal in the morning, it's not an unreasonable to see her glucose, go to 250 or 300, even with a meal announcement, because it takes time because we do encourage people to do it at the side of the meal, but not before. And by the way, if you forget the meal announcement, and it's been more than 30 minutes, since you started the meal, we asked you not to do a meal announcement, then just let it go, let the corrections do it. But it isn't unreasonable for your glucose to go to 250 or 300. If you have a very large carbohydrate load, even with a meal announcement, but then the correction will kick in and take care of that.
Scott Benner 1:02:17
And I couldn't say have a breakfast that I called normal and then realize like, oh, hell, it was larger than Can I go back and tell it like, hey, you know what that was a large breakfast, or do I
Ed Damiano 1:02:29
know what you would do is the way you would try and deal with that is suppose you have a breakfast, and then you want to have or dinner and a dessert, right or a meal, let's just get it out of the category breakfast is, in general, if you have a meal, and you look at what's in front of you now estimate is this usual, more or less than usual for me. And so in what's in front of you, now, I'm going to clean my plate, I estimate I estimate, I'll clean my plate, let's do usual for me and swipe. And then it'll give that that meal dose and it'll start watching your blood sugar rise. Now let's say 45 minutes later, you're gonna have a dessert and dessert comes and it's got more carbs than the meal. Then you could add right at that moment, you could say more than usual as another because it's like another meal and you can just stack it right on, attach it to that it's not stacking, because you really do need that insulin. So you're attaching an one meal announcement to another and they're separated by say 30 or 45 minutes, whatever it is between the time you get your primary meal, and you get your dessert. So desserts can very often be more than usual. Because they very often are carb rich. So you shouldn't resist you'd still call it so let's say you're having a dinner and you have a usual for me dinner, typical amount of carbs and then the dessert comes in. It's it's you know 50% or 75% more than your carbs and you'd have in there in the in the dinner you just you just swiped for you then swipe for a more than usual dinner as your as your dessert.
Scott Benner 1:03:49
Okay. I'm going to look through a couple of these. These. These questions here? Sure. Do you have an idea of what it would cost out of pocket? Once it's available?
Ed Damiano 1:04:01
Out of Pocket? Are you do you mean with insurance?
Scott Benner 1:04:04
Now if I didn't have insurance, I want to pay cash? Oh, yeah. Do you have? Yeah, I
Ed Damiano 1:04:07
do think yes, you can. You can buy you can buy. We have one of our distributors that allows you to buy direct if you were to do a cash pay. Okay. So yeah, I think it's very, very similar to the price you might pay for an insolent a durable insulin pump. So, you know, several $1,000 is what you'd expect to pay for out of pocket cash pay. And you would purchase that not directly from beta, but one of our, like eight or 10 distributors that we're working with. There'll be one distributor you'd go to to do a cash pay, and there's a special price for that. And you can if you'd like if you're in a warranty and you want to get out, you can do a cash pay. Again, it's important now we do have the 90 day return policy and that's important for people to find out if they can live well with the eyelid or if it's not the right device for them, and it's
Scott Benner 1:04:54
covered by a wide range of of insurances. It is how What kind of uh, hell is that setting up on the business side, people that go out and knock on an insurance company doors and I mean,
Ed Damiano 1:05:05
it's dedicated team, right? First of all, we have a dedicated team and market access team at beta for helping people with reimbursement. But the way we started this is through the what's called the DME channel, the Durable Medical Equipment channel, right. And through the DME channels, you have distributors across the country, and each distributor has set up contracts with all the commercial payers, so they had that there, like a buffer for us. So they'd had all those conversations. And similarly, CMS can go through those distributors as well, once we have our contract our contract with CMS setup. So we will sell through distributors at launch, we do also, we're very interested in getting into the pharmacy channels as well, which we think is in our future. And we have several reasons why we think that makes a lot of sense. And it's best for people with diabetes as well as as providers. But for now, and at launch. It's all through the DMA channel,
Scott Benner 1:05:54
okay. Infusion sets, just what are their options,
Ed Damiano 1:05:59
we have one steel set at launch and one Teflon set, they're both 90 degree six millimeter, and they're made by unit medical. So we are using the unit medical family of infusion sets. So if you're familiar with the terminology, we have the inset one, which is six millimeter 23 inch tubing to the eyelet cartridge, and we have the contact detach, let's put this Teflon set and the contact details for the steel set, which is a 90 degree. You know, I think it's a six millimeter 29 gauge steel set.
Scott Benner 1:06:31
So you said something earlier that it's not leaving my head. So I'm after asked about it. If I sit down at a burger joint, and I have a cheeseburger and french fries. And I go okay, the rolls 30. And I'll even throw in five more for the burger just in case and the fries are 80 carbs. So it's 120 carbs. But I know for certain that 90 minutes from now when my digestion slows down and that fat slows everything down. I'm gonna see a rise up to 220. If I don't Bolus for the fat, how does it deal with that?
Ed Damiano 1:07:04
Right? So you're you're you're invoking this idea of a square wave Bolus or something where it's been a very complicated way, with a traditional pump, you think about saying, well, let's release some of the insulin now. And then later, I want more insulin to come in a second wave. gastric emptying happens over a long period of time, right? Because of the fat and the protein slowing that? Well remember what I said at the beginning, we have two other algorithms besides the meal announcement algorithm that are running every five minutes of every day. It's like a perpetual squarewave Bolus ready to be let loose, if needed, but only if needed. Okay, so it's watching you every five minutes. And suppose what happens is the meal announcement comes in, and some of the carbs are released quickly. And you see this rise in the meal announcement insolence catches up to it, and you start coming down and you dropped to say 170. And now you're at like two hours out, and you're down to 120. And suddenly you start to rise. The Basal control is just chugging away. The Corrections Adams watching it, it's like a hawk every five minutes now suddenly start drifting up to 151 6170. It starts adding insulin saying basil, you're not you This is out of your league. I'm coming in to take over and so the correction element comes in and starts adding insulin without you having to pay attention any of that because it's not your it shouldn't be your job to do that. Is that is that
Scott Benner 1:08:19
stream thinking?
Ed Damiano 1:08:21
They just ate three hours ago. This is probably a reoccurrence or does it not care. It has no opinions. It just it sees no judgments and no opinions. A number and it goes no, no, no. Yeah. All it cares about is your glucose at the moment. And it uses gets past insulin insulin history with you it's learnings from that history and your current glucose level and the amount of insulin that it is that is pending. It's keeping track of all the insulin that's pending every five minutes and updating that itself.
Scott Benner 1:08:48
So if Bolus is the number it sees not a predictive trend, it's not.
Ed Damiano 1:08:54
Yeah, I mean, it's certainly we have we use something called Model Predictive Control. So it does look, it does make an estimate of what the glucose is going to be in five minutes from now the next step, and then it will update its estimate of that at the next step once it sees the real value and compares it to the model. But that's it, it's just a, it's a five minute prediction on what your glucose is going to be. But importantly, it keeps track of the very long horizon into the future of your insulin tail. Because every dose it gives, it keeps track of how long that dose takes to rise and picking your blood which is usually about an hour and six more hours before that insulin I'm giving right now is really got mostly gone. And then five minutes later gives another dose and it's superimposes that insulin rise and fall profile and it has that insulin to look forward to it's what we call pending insulin action. It's accounting for that and predicting what your glucose is going to be in the next five minutes
Scott Benner 1:09:45
when I talked to people in in person when I do in person talks I explained to them about there's different levels of or different lines of insulin happening all the time you put in some here the Basal is hitting peaking and tailing. And then the basil from five minutes later is hit, you can't keep it all straight in your head, right, but so is every Bolus. And if you if you really think about it like that there's, there's these constant pushes. It's right fantastic that an algorithm can like, make quick sense of that.
Ed Damiano 1:10:15
And that's what it's, that's all it does, like, you know, it's really good at this very narrow task, it's much better than we are the vast majority of we write it is much better than that, because it's got one very narrow job, we do many things very, very well. But the vast majority of us can't do what the eyelet can do, because it's its only job, and it's doing it every five minutes, it doesn't have anything to distract it. That's all it really cares about. And so it keeps track of every one of those doses and literally superimposes those doses, one on top of the other to account for how much insulin is trailing off and how much is rising.
Scott Benner 1:10:48
It's got a cartridge, right? And for how much does it hold?
Ed Damiano 1:10:52
It's 180 unit cartridge. And after you prime the tubing, you'll have about 160 units. So we found it lasted about three days in the average adult,
Scott Benner 1:11:02
okay, but if I pop I just get somebody to write me a script for more and so it's I've never right, I'm gonna I'm gonna sound odd for a second. I've never, I've never used the tube pump. So my daughter Okay, and using exclusively Omni pod since she was four. But you just pop out that cartridge, put a new one in prime it and keep going.
Ed Damiano 1:11:19
Correct. So let me tell you two things about that cartridge. One is we have we have two different types of cartridge. One is a patient fillable cartridge. So it's a glass cartridge, 1.8 ML, and you can put human law or Nova log in it through the septum, you just draw it out of a vial like you would with your Omnipod into a syringe and then introduce the syringe needle into the septum of the cartridge which looks just like the septum on your insulin vial. Yeah, and then you introduce the insulin and remove the bubbles and then you load the filled cartridge into the eyelid chamber, quarter turn to have the eyelid connector and tubing to the eyelet. And then it'll prime some of the tubing and then you prime the rest of it and hook it up to your set. The other thing I want to tell you about is that in the pivotal trial, we used human logon Nova log in the adults in the in the randomized control trial. But we also had a cohort of adults use fiasco in a prefilled cartridge that no one artist makes which is identical in shape and size to our patient filled cartridge, or ready to fill cartridge and it's filled in a blister pack, it comes in a blister pack of five cartridges and it's prefilled with the Aspen so that dispenses with the need to transfer insulin from a vial and pull up the air bubble. And that process takes about five minutes or so we eliminate that. So with the prefilled cartridge in the trial, you just pop it out of the blister package, slide it into the chamber quarter turn and you prime the tubing, you can change a cartridge soup to nuts a prefilled cartridge vs cartridge in less than 60 seconds with the out because it's got a very fast motor drive train like the atom is pumped it for those of your listeners who are familiar with that. So we had it we emulate that very fast movement of the rewind and then advancing and priming you can do less than a 62nd change if it's a prefilled cartridge,
Scott Benner 1:13:02
did you notice any better outcomes with fiasco or other insolence?
Ed Damiano 1:13:08
Not much for one thing I'll say is that in almost every every analysis we did it was very similar to human login or login the adults 18 and older. And what we found was that in every way, you know, it had very low levels of hyperglycemia. Like similar to standard of care, like we saw with hemoglobin Novolog. It's mean glucose was very similar. The ANC was similar time and range was similar 71% With vs versus 69% in the adults for hemoglobin Novolog. But we did see a statistically significant improvement in time and range. It improved by 14% relative standard of care relative to human lung Novolog, islet users which saw an 11% improvement in time and range. So that was statistically similar, but it's not sure I'm not sure that's clinically relevant. But it was a little better. And one thing I add to that we didn't tell the islet it was fiasco. Right so we have hard coded in the islet knowledge about insulin kinetics. Now we know that the aspirin the aggregate absorbed more quickly, in most adults, or you know, in the aggregate of a cohort of adults, then he will log on over log and it clears a little faster. So it's a slightly faster drug. And if that information had been provided to the eyelet, we have some pre pivotal studies that showed you might see better glucose control and lower mean glucose higher time and range with the aspirin human log, no log. But we for this study, we talked to the FDA about it. We didn't have enough data to do go into a pivotal trial and adjust the the built in parameters in the device to let it know that fiasco was faster. So it was under the assumption it worked operate under the assumption that it was just like chemo Novolog. And so it didn't get to leverage the faster kinetics. It was in the mathematics that's built into the device in the future. We will visit that possibility. But we didn't see big differences and probably just because we couldn't tell it it was faster Okay.
Scott Benner 1:15:00
If should people hear that those are the only insulins they can use and think that that's the case? Or can they use the I mean, you can't tell them to use it off label, but it's something horrible gonna happen if they put a pager in it or something like that as
Ed Damiano 1:15:14
well, we didn't test it with Piedra, we did test it in adults with jemalloc. No bloggin. fiasco. And one thing I didn't mention is that is that the when people who randomized to the standard of care arm in the pivotal trial for 13 weeks, they kind of drew the short straw. I mean, they want it to be in the trial to test the island, but they ended up randomizing to their own care. So what we did was, those people had the option who randomized Sustainer, care to spend 13 weeks on the island after the study ended. So they could cross over the island. And the vast majority of them did just that. And when the kids crossed over, they all use the Aspen the prefilled cartridge. And we saw very similar results to what we saw with the adults with the ASP. So what we have right now in front of the FDA is an application to get the prefilled vs cartridge approved for use with the eyelet. And that's going through the process right now. So we're hopeful, hopeful that that will that will come through soon. But right and at launch, it's cleared for use of human lot with hemoglobin Oplog in our patient field cartridge,
Scott Benner 1:16:10
right? A couple of ideas around you being a smaller company. So people ask questions, like, you know, there's the diehard on the pod people that are like, Look, if it's got tubing, I don't want it, can they make one without tubing? Can they get it for kids under six? Can they can they can they do you have the bandwidth? Can they can they can they or where are
Ed Damiano 1:16:29
you at? Yeah, I mean, we do have limited bandwidth. But we're very creative about some of the things we can do. Like for instance, because we came from an academic realm, myself and Stephen Russell in, you know, in the early days of the project, we do try and think creatively about ways to bring resources, financial resources into the company to help us do trials that might give us indications for use for other kinds of conditions, right, other kinds of diabetes, you know, and so forth. And different age groups and things like that. So what we have done is we've worked with other investigators who are in academia, like ourselves, and they can put in grant proposals to the Helmsley Charitable Trust the JDRF, the National Institutes of Health, to get funding for studies now dilates, FDA cleared to test it in other indications. And so our hope is that we can work collaboratively with academic institutions and clinical investigators like ourselves to do those studies, instead of it being Stephen and Ed's teams doing those trials, we're now going to work with other investigators like ourselves, to do that in the academic realm. So we can leverage all that financial resource that comes from private foundations and government funding, it doesn't come money that's coming to beta, but then beta doesn't have to spend the money to do those trials. So that's how we hope to get expanded indications. And at this time, at least, and then, you know, as the company gets more resource, then maybe we could do some, some sponsored studies as well. But we're limited in what we can do. Outside of you know, we really want to get the buyer model pivotal trial started, because we're very committed to bringing the buyer model eyelet. Yeah. To people with title,
Scott Benner 1:18:00
I want to get to that. I just, I have a couple more questions first, of course. So I don't know anything about what you did, like, I don't have technical knowledge, did you decide we're gonna shoot for a seven a one C? Or is that what the algorithm is capable of? Like? Were there four dials? You could have turned and you'd be on here telling me oh, it keeps people around to 681. C, and you spike to about 180? Not to like you don't I mean, like, or is that not the case?
Ed Damiano 1:18:26
Yeah. So the way we did this is we started by studying the by hormonal system. And we we chose a glucose target, and aggressiveness factors and things like that initially. And then and we did these studies, first in the inpatient Center at MGH, just with the by hormonal system, once we started human trials, and after a while, we, you know, it became clear to us that with the biochemical system, occasionally the glucagon channel might be might not be available. And so what happens if the glucagon runs out while you're out and about, well, what happens if you have an occlusion or your Google infusion set fails, then if that happens, you know, it needs to sort of fall back safely into an insulin, a single hormone insulin only configuration, and we hadn't really tested what that looks like we weren't back then thinking about making a single hormone islet is a product, right? We were thinking about this being a fallback. And so we started doing studies testing the by hormonal, bionic pancreas against the single hormone bionic pancreas against standard of care. And what we found was the single hormone Bender packers was a very differentiated technology in its own right. It couldn't it but it had had had all of its glucose targets had to go up higher, to be able to get really good glucose control and not have hyperglycemia. And so we started studying different glucose set points for the insulin only system and for the by hormonal system. And with single hormone, we found that you can safely have these targets up here and not have much hypoglycemia. And with the by hormonal ones, we could have safely have these targets down here and still not have hyperglycemia. Because glucagon is helping that. So we could basically have effectively something that could give a little bit more Just went up front a little bit more aggressively, just because the targets are lower that it operates under with the buyer model. And so that's how we came to figuring out what these targets were. So the agency that it gets, or the media glucose that it achieves was really It fell out of the mix, we weren't shooting for a particular target of is it going to be to get 154? We said, What is this system do configured this way with this target? What is the average or cohort will get on the system. And we found out with the single hormone, it was about 155 In adults, and the bimodal and in adults was more like 140. So it's about 15 meg per deciliter improvement by adding the second hormone and being able to use these lower targets with single hormone. As you lower the target every time you lower the target, you see a lowering in the mean glucose but a concomitant increase in time below 54. With the buying hormonal system, we saw as you lowered the target, you saw a progressive improvement or lowering of mean glucose without an increase in hyperglycemia. But with an increase in glucagon usage, okay. So we exchanged hypoglycemia for slightly increased and glucagon infusion. And so we can keep these lower targets safely.
Scott Benner 1:21:11
So when you get to a dual chamber at some point, and you're doing glucagon and insulin, what do you think you'll be back on here telling people about their outcomes?
Ed Damiano 1:21:20
Oh, so what we've seen in the as I mentioned, what we've seen in all of our pre pivotal studies that we published across over the years is a mean glucose. This is about about 15. Meg's per deciliter lower than what we saw with the eyelet pivotal trial, which would correspond to about a half a percent lower a one C one. And as as you may recall, I said about about almost half the people had a mean glucose below and 54. On the single hormone island of the adults, what we see is that about 90% of people on the buy hormonal system have a main glucose below and 50 for adults. So it's a big difference in terms of bringing more people under,
Scott Benner 1:21:58
and it's going to become increasingly unlikely that you experience a low and what are we calling a low, by the way, you said it arranged a couple times is that 71 8070 to 180? is what we're calling in range. Okay. And so that's timing, right? The lowest 69?
Ed Damiano 1:22:13
Oh, no, no. So yes, certainly. That's, that's out of range. So that's below range, right? So we measure two different we keep track of two metrics. In our pivotal trial studies, we had an outcome that looked at how much what percentage of time do you spend 70? And what percentage of time you spent below 54. And the way we powered the study was we said that, you know, we powered the study for statistically for superiority, we expected to see a superior outcome in HBA win see in reduction of HBO and see so we saw a superior we thought we'd have superiority in a one zero standard care, and non inferiority in time below 54. relative standard care. And that's exactly what we found in the trial. Yeah, I feel
Scott Benner 1:22:52
like I haven't, like just expressed enough how pretty amazing it is just the meal announcement portion of it. Like I can't imagine what a what a relief that must be to people. Did you talk to them about that in like exit surveys and
Ed Damiano 1:23:09
things we did? Excellent question. So we had we had focus groups at the end of the trial. So we worked with Joe Weisberg, ventral she's up in Chicago, and she works at the Lurie Children's Hospital. And so she's an expert in psychosocial and behavioral outcomes when it comes to studying diabetes technologies. So she developed, validated, behavioral psychosocial tests questionnaires that we gave throughout the study. And also ran the focus groups at the end for people as they came off the device. So that was qualitative. So we have these quantitative questionnaires. And then we have these qualitative focus groups at the end. So we did get to find out, you know, how people felt about things like diabetes, distress, fear of hyperglycemia, but also just sort of qualitative measures of how how people feel about the eyelet. And I do think you're right about this giving up of carbohydrate counting this diabetes without numbers is really important to people because we're trying to say that we really hope this device is agnostic to levels of literacy and numeracy to levels of to technical acumen to socioeconomic status, race, ethnicity, and so we did a lot of work. In the trial doing subgroup analysis, we published something in the European Journal of Medicine after the main study was published, in a letter to the editor looking at the subgroup analyses to show that the people who needed the most improvement in glucose got it from the eyelet, more so than people who were very close to range. And so it didn't seem to discriminate against people if you're an MDI therapy and never use the pump versus people aren't hybrid closed loop didn't discriminate against people who had never used the CGM versus those who had. What you do see is the people of the highest baseline agencies at at baseline before the study started. So the greatest improvement and you'd mentioned, you know, I imagine you're seeing people with higher agencies than other studies, our highest day when he was 14.9 at baseline, so we brought people in across the mix with you know, hi, when season the double digits
Scott Benner 1:25:04
did that 14 leave at a seven
Ed Damiano 1:25:07
6.80. Wow. So the 14.9 went to 6.8. That is not. That's anecdotal though. That's one data. We had. We had other people at agencies, you know, maybe have nine that dropped eight and a quarter and a half or something like that. So it's not everybody sees that remarkable reduction. But it is noteworthy that some do. Yeah. And again, it's a device with you know, that you initialize with bodyweight and you use meal announcements without counting carbohydrates.
Scott Benner 1:25:33
It's a very small barrier to entry. That's for sure. And I mean, obviously, you're talking about, like data that's at the end, this is the average, but not everybody achieved a seven. But that's still just worth bringing up that there's a 14 that came down that Fars is insane. Yeah. Do you think you'll get in other countries in any time soon? Or is the US? Yeah,
Ed Damiano 1:25:54
I think that it's quite surprising how things have changed through the pandemic. So it used to be that med tech companies would first target Europe, as you probably know, in diabetes, med tech was no no exception to that, where they would start in Europe, they'd get what's called a CE mark, and they'd start distributing in Europe. And then they would work their way into the US with a big pivotal trial, and then they get FDA clearance. We're doing it the other way around. So we got FDA clearance first launched in the US first, the next step for us to come to Europe or other countries owe us will be a CE Mark, what's happened through the pandemic is the CE CE mark process has really changed, it's much longer process it's taking, it's taking a very long time to get regulatory clearance outside of the US now it used to be quite the opposite. So it's certainly something we're going to pursue our goal at beta bionics is to bring this technology to as many people as possible, because it is a device that's made for as many people as possible is literally designed for that, that that kind of uptake in that kind of broad demographic adoption. So we certainly want to get this out to Oh, you owe us to Europe, Middle East, in other countries, other regions. And that will require first to CE mark. So unfortunately, that will take a long time just from a regulatory process. It's certainly more than a year's worth of regulatory review, right? But it's certainly something we're going to be doing.
Scott Benner 1:27:14
I have a fair amount of Canadian listeners that will be mad if I don't just say Canada like out loud. Of
Ed Damiano 1:27:19
course in front, you have to say Canada. Yeah, I mean, they are literally our next door neighbor. So we've got to Canada and Mexico, we've got to get out there right and you mighty mark is the way to start. He
Scott Benner 1:27:27
shouldn't have let all that smoke come down and choke me out or I would have been a little more. A little more feeling about it. Okay, so like I told you before we started recording when I first heard about this, I thought, oh my gosh, this is amazing, right? Like they're gonna have glucagon in the same pump. And you know, it's going to stop you from getting low. I have a couple of quotes. And I'm assuming the the major hold up was liquid stable glucagon, it had to had to exist in the pump for the amount of time at least you were wearing it. So now that exists. And you have access to that great. Does this my first like Boohoo? Like I don't know. Like question is, is glucagon doesn't work if you're drunk. Is that right?
Ed Damiano 1:28:10
No, that isn't right. So we had, we had looked into that specifically. So Stephen Russell did a clinical trial where he actually brought people into the clinical research center at MGH and got him drunk IV though. So we actually got a protocol approved and what he did was he we can infuse alcohol intravenously, and look at the efficacy of glucagon. Okay, Mike would that is microdose not big rescue doses, right? We're giving tiny, tiny doses of glucagon. Okay, I see. All right, and it's not Basal glucagon. It's not like every five minutes, you're gonna get a dose of glucagon. It uses glucagon sparingly and only as needed. But the dose you might get at any step where it sees your blood sugar might be your glucose CGM glucose might be dropping, or if you're already low, that dose could be one to 2% the size of a rescue dose that small, tiny little doses and he gave us doses that were comparable to this to the to the doses we would give in the in the bionic pancreas, the by hormonal bionic pancreas, and at different levels of blood, blood alcohol levels in the in the Clinical Research Center. And he was able to see that there it was, it was pretty much insensitive to the levels, alcohol levels you'd likely see out in the wild. So let's put it that way.
Scott Benner 1:29:20
So a rescue dose of glucagon might be different in that scenario, but the small amounts you were using were working.
Ed Damiano 1:29:26
Yeah, so he didn't test the rescue doses to see if that would be an issue. But definitely that because you know, the doses we're giving are so small, you're not depleting glycogen stores because what glucagon does is it breaks down stored glycogen in the liver, which is a stored form of glucose breaks it down and it liberates glucose into the blood and that's how it raises your blood sugar.
Scott Benner 1:29:43
I I'm asking this question way too ahead of but now we're into it already. So would do you foresee the eyelet being able to rescue if you're not drunk in a rescue situation like if it if it somehow thought this person's going to zero? Would it go for it? or would it?
Ed Damiano 1:30:01
Yeah, it wouldn't release the whole cartridge if that's what you mean, right? It wouldn't do that. And by the way, the amount of glucagon in this little tiny glucagon cartridge is much more than what you'd see in a rescue dose as well. It's a small cartridge, it's only it's only one ml. So it's like, think of a cartridge only 100 units of insulin. That's the size of this cartridge. It's really tiny. But the glucagon we're using made by Zealand Pharma is four times more concentrated and rescue glucagon, okay, it's four Meg's per ml versus one meg Parral ml. So you wouldn't want to ever unload that whole thing. It's really about a seven day supply of glucagon further, by the way, the islet uses it lasts about a week and that little cartridge, but what it would do is it wouldn't wouldn't actually give a rescue dose. But it would continue to give glucagon doses every five minutes if it doesn't see your glucose coming back up. And remember, it also turns insulin off just like the single hormone islet does. Yeah. So it's using both it's using the X gas and accelerator, I like to use that analogy of the insulin is like the gas and the and the brake is the I shouldn't say gassing sorry, should it break an accelerator. The insulin is like the accelerator and the glue guns like the brake. And so you really want to take your foot off the accelerator and hit the brake, if you want to slow down quickly. And with the single the biometric system, you have both at your disposal. Okay. So hopefully, you know, the amount of glucagon that it can give should really prevent any need for rescue glucagon, as long as it's flowing into your, under the skin.
Scott Benner 1:31:22
Is there an amount of time or a number of like, little bumps with glucagon before? Like, doesn't it eventually, like just empty your liver? And then there's just no more there anymore? Right? Yeah. And you're
Ed Damiano 1:31:33
not going to get to a point with environmental system where you get depleted unless you were very sick, right? So suppose you've been you had a vomiting illness and you haven't been getting, getting anything down for a few days, you could get into a situation where you're depleted of glycogen stores, and then there's no substrate upon which glucagon can act if there's no glycogen stores. But that's,
Scott Benner 1:31:53
it's hard to get to that stage. I was gonna say, and in that scenario, doesn't matter how you're managing, you'd probably be in the hospital one way,
Ed Damiano 1:31:58
I think you're going to be finding your way into the hospital in that situation. But what we did see in our, in our pre pivotal studies is that you're, you know, overnight, where you're getting just Basal insulin overnight, so you're not having a ton of insulin, which helps store glycogen. And you're not eating at all, and you've been fasted for a very long time. So you got no carbohydrates for seven or eight or 10 or 12 hours, right? Since you went to school, since you had your dinner went to sleep. When they got up at the morning in the morning at 7am. And they start becoming active and there, they there might start going low, you'd see these little shots of glucagon, tiny little micro doses at 6am and 7am. And it would pop them up. So that meant that even though they've been fasted for 12 hours, they hadn't eaten anything, and they've been getting very low levels of insulin, they still had plenty of glycogen upon which that glucagon could act, okay. And so we never saw any depletion of glycogen storage, any any evidence of that in any of the trials we did, and sort of routine day to day basis, but we've never studied, you know, pushing it to the limit to see how many days could you go fasting, before you'd run out of storage? I don't know.
Scott Benner 1:33:00
I just imagine that most people I try hard. But I imagine most people think that rescue glucagon is like sugar that brings up your blood sugar, and they don't recognize that it actually signals your liver, you know, etc, and so on. Like, I don't know how well that's understood.
Ed Damiano 1:33:16
I mean, if it were up to me, I would if it worked, which it wouldn't, I would rather push sugar than glucagon because it doesn't have to rely on that secondary source of sugar. Yeah, liver that could be depleted when you're sick. But there's no way to infuse tiny amounts of sugar under the skin and have it do anything, it's we really we do use the hormone just the way the pancreas does. That's how the Packers prevents hyperglycemia your first line of defense, people without type one, their first line of defense against hyperglycemia is glucagon. And it's it's, you know, we should not have the hubris to think that we can build a truly biomimetic closed loop system without adding glucagon back because people with type one diabetes lose their ability to use glucagon effectively. So when the when the autoimmune attack takes out the beta cells that secrete insulin, it disrupts the alpha cells ability to release glucagon, they still make look and they just don't release it in any coordinated and useful way anymore. So they really have a dual hormone insufficiency. And that should never be ignored. And so that's one of the things we do with beta bionics is not ignore that, right, we build an entire technology platform that will look just like this one, right? It won't be any bigger. It'll have, you know, we have we built a second chamber here to take a glucagon chamber. And this is actually the exact same platform that we'll be we'll be testing in the pivotal trial with two hormones system,
Scott Benner 1:34:30
when is that going to happen?
Ed Damiano 1:34:32
So our goal is to have that start by the end of the year. 2023. Yeah, so we want to have that trial start by the end of the year. Now that's that's that trial is is huge. So as I mentioned, the single hormone study the biochemical pivotal trial, the bionic pancreas, overdrive with a single hormone device was the largest automated insulin delivery randomized controlled trial ever done. Right. by a longshot. The by hormonal pivotal trial will be way larger, in fact, eight times larger in terms of the number of Patient years of exposure. So it won't be a three month trial, it'll be a 12 month trial, it won't involve 440 people. it'll involve over 700 people. And we're going to have phases. So if we start by the end of this year, the first phase will be a small cohort of 70 or so people. And they'll engage in a crossover trial with the final buy hormonal device, and the single hormone device that you see here. And people will use both and a crossover design. So they'll spend like four to six weeks in the in the single hormone, Iowa and four to six weeks in the biomedical crossover in random order. Once that study is done, that'll take about six months or so we read out the data. And if everything looks good, and we like the way the system is performing, we lock in and we start the big one year randomized trial. And a one year trial doesn't take one year to do. Because we have 700 people and 30 clinical sites, we have 16 sites and the other trial 30 sites or so it takes a half a year just to load everybody into the trial 700 people and then a year for the last person in to finish, that's an 18 month commitment. So it's a long road, right? It's going to be a couple of years, two and a half years just to get to the last participant last visit of the buyer model trial. And then you have to build the FDA package, submit that and they have to review not just the by hormonal island. But here's the big sort of the long pole in the tent, they also have to review the glucagon glucans never been used chronically, it's only used as a rescue. And so Zealand pharma will have to put in their own application for dasi, glucagon, as they call it, their analog of human glucagon, which is a, you know, a 12 month typically a 12 month review process with the FDA that will go in parallel with our buyer model Island.
Scott Benner 1:36:34
Did they have to wait for this first eyelid to be approved to do that? No, it's just no time? No,
Ed Damiano 1:36:40
no, it's just that we were just, you know, we couldn't do too many things at once.
Scott Benner 1:36:44
Is there anything about any patents you hold that would stop an insulin pump company from going to a duel hormone? Or?
Ed Damiano 1:36:52
You know, we have we have intellectual property portfolio that I think is pretty robust, not just in terms of the by hormonal, but also the single hormone algorithms. So yeah, I think that our on our algorithms side, we have some IP out there on bio hormonal, that's pretty robust. But ultimately, you know, we're not engaging in an exclusive relationship with sealant Pharma. So if somebody wanted to build a dual chamber system, you know, they'd have to sort of work around our IP and build their own algorithms. And they'd have to work with Zeeland pharma to figure out how they're going to use their drug. But it is true that if we do the pivotal trial with the Zealand pharma forming per ml concentration drug, that particular very specific formulation and get FDA approval of that any other pump company that builds a dual chamber system would not have to do as long a study with the Zealand pharma for a per ml formulation, right? Because it's been proven out to work in chronic use this way. So is this going to be two different infusion sets? Well, in the trial, it will be but ultimately, that's not our intent for the commercial product. So we can start the trial and do the pivotal trial with two separate sets. And all of our pre pivotal psychology studies use two separate sets. And they're both unit medical infusion sets one was an insulin and one was a glucagon and we put them right next to each other, they're about a centimeter apart. What will will ultimately want to do is build a single set that has, you know, a couple of cannula in it, you'd insert that and one go every like three days or so. But you will have two separate tubes that you could sort of tie together like speaker wire here like at the headphone jack wire. And the reason it's important that you have the two separate tubes is because the insulin cartridge might last three days on average, and the average adult say and the glucagon cartridge might last a week, they're not going to be changed on the same frequency. There's no reason to change them both out if one is still has a few days left in the cartridge. Oh, that
Scott Benner 1:38:40
makes sense. Yeah, I was just trying to like, like I always have, people always ask me for years. When is they always say they when are they going to put them on one device? And like, I don't know what you're thinking about like you want like a CGM and a pump in the same like structure, which I'm like, That can't happen like forget business. Like Like, like functionally it can happen. Right? Well,
Ed Damiano 1:39:04
the thing about it is that with Transcutaneous, CGM sensors, right, they typically are lasting 10 to 14 days, right. And we now have infusion sets out there that are FDA approved to be used for up to seven days. But they don't, on average, last seven days, that's what they can be used up to. But on average, they last shorter than that. Well, why is that? Well, mainly what fails with infusion sets very often as the adhesive fails. And you know, when you are infusing liquid you know insulin under the skin, that he's if you're and you have a tube that's connected to it as you move around that tube is putting a little bit of stress on the infusion set all day long every time you twist and turn and it's tugging on that set. And so the adhesive ultimately is overwhelmed. And after three four days, some people can run it out longer but other people can't and it depends on the to how the adhesive works with your skin and so forth. But generally Do you want someone who uses an infusion set for four or five days, we'll start to see if they go well beyond its intended use, we'll start to see the set fail. And what happens is the insulin starts flowing up around the cannula and wets the skin and doesn't go into the body. Yeah, but, but if you look at a sensor, you put a sensor in, and it's not nearly as much stress and pulling on it, there's nothing connected to it, right your shirt to touches it, but you're not pulling on it with a tube every now and again. And that adhesive can really last longer, and it's more forgiving the sensor under the skin, if it moves a little bit around relative to the tissue versus a cannula where insulin can then leak out. So they just they have very inherently different life's life scale, lifetime, you know, or characteristic time. So make and stay under the skin.
Scott Benner 1:40:42
I wish people could have seen you because I enjoyed watching the the engineer and you know, like, like the face up. Because I always think that when I always think like simple things, like, first of all, what do you like, you're gonna build us like, on the PA that has a Dexcom in it like that, how's that gonna happen? And what happens if your sensor goes bad in three days, but your pumps work or two days, but your pumps working for like, you want to rip the whole thing off? Okay, you understand the desire. But it's always I always feel like that question is asked by somebody who's never built anything before in their whole life. And, you know, yeah,
Ed Damiano 1:41:13
there's just inherently different sort of lifelines, or whatever you would say that sort of the lifetime expectancy of those two systems are so inherently different, and you don't want them to be coupled. Because you as you just said, you don't want to have to change all three, because only one fail right
Scott Benner 1:41:29
right now. Okay. All right. So I've had you for a long time longer than I promised. I have one question. And then I'm going to ask you, if there's anything we haven't talked about, a number of people asked me, islet how like, you know, 40 carbs of I don't know, a soft pretzel, and 40 carbs of cotton candy, 40 and 40. But significantly different impacts, it doesn't matter to the
Ed Damiano 1:41:54
eyelet. No, it really doesn't. Because as I mentioned before, it's because the corrections algorithm is always running in the background. So suppose you have what you're really getting at, I think is a food that's got a very high glycemic index versus one that's got a very low glycemic index and takes longer to raise your blood sugar. Or it's just more muted, right, you just don't grow up as much. It's just it's just, it's just extended out to over a longer period of time. So the island is watching every five minutes. And it has unlike, you know, most hybrid close up systems, it has the occasion, or the opportunity to dose every five minutes if it needs to, so it's always on top of it. So if you have something if you do the meal announcement for that 40 grams of cotton candy, you're gonna see a very fast rise. And the meal announcements going to kick in. And the the it's going to keep track, the islet keeps track of the insulin in that meal announcement dose that it just gave, and it watches the glucose rise, and it says, Okay, if you've got all this insulin pending, I'm keeping track of its rise and its clearance and I'm watching your glucose rise. Now if you rise very quickly, it might just stay in the background for a while there will come a point where I'll say I'm gonna add a little bit more correction insulin now because the correction algorithm has been quiet. But now I think you've risen high enough that the meal announcement insulin even insulates. Pending from that meal announcement isn't enough. So I'm going to add a little bit more, and then it's going to walk it's going to keep watching. And it's very patient because it's keeping track of the insulin it just added, in addition to the meal announcement insulin, and then it'll see it crest if it's a very high glycemic index food, it's just going to rise quickly and and stop and then start coming down. And it'll see it come down, it'll just back off your blood sugar, it could be 252 20. If it sees it slow down, it's going to back off, it doesn't care that you will hyperglycaemic It knows that insulin is coming, it's gonna be patient. And now what if instead, you didn't rise nearly as much, because it's a slow a low glycemic index food. Now you went up to 190 or 220, instead of 250 or 260. And it sees that meal announcements enough, it's really enough, I'm gonna stay back, I'm gonna stay quiet. And now an hour has gone by and you're sort of sit there and now you're, you're coming down to 170. And it's an hour and a half after the meal announcement. But you're still a little bit, you're still a little bit stubborn. And then it's gonna say, well, that meal announcements getting old now. And I'm the correction algorithm checking in every five minutes, I've decided at this step. Finally, that meal announcements not enough given that you're 170, I'm going to start adding a correction insulin now. And so it's very patient and looking at the meal announcement doses and how much your glycemic excursion has risen and how much it's coming. It's responding to that before it weighs in on adding more, but it's always there to add it if it needs to. And it's using very precise mathematics to make that very objective decision. It's it doesn't get it's not irrational, and it doesn't reach Bolus. But it does ask that you the user be patient. And what that usually means is don't keep looking at the iLet and expect magical results and say, oh my god, I'm still 170 Just let it do its thing and that is the ultimately the message that we want to convey to people who use the iOS is let it let it work. Don't Don't fuss over it too much. Just make sure you maintain the character Feeding have it. But let it do its thing and don't try and meddle with it too much. Because you know, it won't help. It doesn't it doesn't get better glucose control, just because you're watching it. And it doesn't get worse glucose control. If you don't watch it. That's another thing we learned from the pivotal trial, you don't have to look at it all the time to get the same equally good control. And you know, with other diabetes therapies, right? We know that the more you interact with a fingerstick meter, the more you interact with your CGM, or an insulin pen, or a pump or hybrid close up system. The the better your glucose control typically is if you look at a group of people interact frequently with their, you know, diabetes therapy, or diagnostic work or another group of people who interact infrequently with it. Those who interact frequently tend to do better statistically, we don't see that with the island, we see that it's pretty agnostic to how much you engage with the device as long as you're taking care of it. And that's, that's a really, I think, a really important point to remember. No, it's a bonus for sure. And the other thing, the other thing I'd like to just was sent heavy. No, go ahead. No, no, I
Scott Benner 1:46:03
was pleased. You're fine. I'm I'm trying to wrap you up. If you want to keep talking. I'm happy for you to keep talking. I just tried to help you out of this.
Ed Damiano 1:46:10
Oh, yeah, very good. I do. I do have a call coming up in a few minutes. But I would say this that what is unique here with the there's a number of things about the AI that I think that are unique, right? It's unique in several ways. But importantly, it determines 100% of every therapeutic dose of insulin. And there's that it's not a system that where you can go and override the dose, you can't add a correction insulin Bolus, you can't add a meal dose, you can't say I didn't give myself enough insulin. So I'm going to add 20 grams of carbs. And it's going to then figure out what to dose which is what a lot of people do in some of these systems. It determines 100% of every therapeutic dose, and you don't override that and your physician doesn't override that. So that is that is not a hybrid system, the hybrid system inherently means that you are playing a role in insulin dosing decision, you and your physician as well as the audit some automation. That is not what's going on here. And as a result of that, you have to really get comfortable with this new world of fully automated insulin dosing decision making, right? That's being added to a device,
Scott Benner 1:47:10
I have to say, I'm actually impressed. And I think it's smart that you're talking about it so directly. Like you're not doing any like marketing, like talking around, you're like, look, this is what it does. If that's good for you, then great. And if not, was nice talking to you. Like I think that's terrific. I don't see enough of that. I've been very impressed with that the entire time you've been going over this. So I really do appreciate, do you think there's anything we didn't talk about that we should have?
Ed Damiano 1:47:38
Not really, I mean, I guess it's more more re emphasizing this idea that the reason I think we can talk so frankly, about is first of all, we want to build technology that's in the best interest of people with type one, we've always been committed to that. And that means that you know, the eyelid, I think is that device that is very complimentary to some of the high tech out there that does serve the interests of the needs of those people who are already in good control, or who have the best had the access to the best resources, the best health care. And, you know, and so we're trying to, to address that other segment, which I think so happens to be the majority of people with type one who don't have all the resources and all the access to the best health care, you realize that you know, 75% of us counties do not have a single endocrinologist in their borders, right. This is something that the Ozeri has published a few years ago. And nightly, whereas 95% of people go counties in the US. So 75% of counties don't even have one endo 95% of counties have at least one primary care physician. Primary care physicians can't use that high tech, it's just it's anathema to them. I mean, they don't have, they don't have the resources, they don't have the staff, they don't have the training, they can't use that tech. But we think the eyelid is a device, a very high tech device that is really the first device that plays very well in primary care, because it is for that large 80% of people who aren't meeting goal. And I do think for those who are meeting goal, many of them will still prefer the island, because they're going to be unburdened of a lot of that cognitive effort and into the vet burden that goes along with constantly being all over your diabetes management all the time. And there'll be others in that same group who just you know, are just too anxious to give that control up. So it's really all about finding those people that that are going to benefit from it and who, who will be able to do that comfortably. And I think he's just a lot of people out there that that we're trying to serve.
Scott Benner 1:49:39
Will you be adding salespeople? I mean, it's because it feels like you're going to have to go to non traditional doctors to talk. Yeah, you know,
Ed Damiano 1:49:48
yeah, we have so we have a very small group at start. And so we've got about 16 people on the sales team right now who are focused in those eight territories I was telling you about and what what we've been doing these past couple of months, Stephen Russell and I I've been going to all those territories with each of the two sale the two commercial people in each of those regions, and meeting with the clinical sites that we targeted in those regions to launch the product. And spending a few hours with each of those clinic clinical teams, and with our commercial team with us, at each of those sites, so that they get introduced to these folks that we've been working with for years, frankly, are as many of them. And so that's how we're doing it at first is we're sort of introducing the commercial team, to the people we've worked with over the years in the clinical setting the clinical research setting, and ourselves being introduced to the clinical people who aren't doing clinical research, but who worked with our clinical research scientists, collaborators. So that introduction is happening. And that's where we're focusing the launch. And then as we get experience in those eight territories in the fall, then we expand more territory, more territory. So we've been doing a lot of traveling, getting on the road and seeing a lot of these sites and moving back and forth across the country, you know, 17 sites in the past nine months, nine weeks.
Scott Benner 1:50:53
It's amazing, busy pace, because you're gonna go to the trouble of I mean, listen to this story, how long it took to make this thing. And now it's the last piece right? Like, how do you how do you set it in someone's hand? And it's not apples to apples, but I'm a person who's trying to deliver something to people too. And you would never know it? If I wouldn't say it out loud. But that's the hardest part of this job. It's making the thing is great. And then giving it to somebody is it's the hard part, you know?
Ed Damiano 1:51:20
Yeah. And that's it's all about scalability. So I'll leave you with this. This notion, if you think about what the diabetes control complications trial did between 1983 and 1993, was to test the hypothesis, right? This was a landmark study, many clinical sites across the country took 1500 people and randomized about half of them into conventional therapy, they called it which was not multiple shots a day, or insulin pump therapy was just one or two shots a day. And that and or intensive therapy where they were checking their blood sugar seven times a day, but importantly, they were giving multiple shots many times a day or using a pump. And what they found was they could dramatically reduce me mean glucose and HPA when see in the intensive therapy group and sustain that for a period of you know, six and a half years on average for each person at a huge effort on the part of the patients who randomized to intensive therapy, and the physicians that supported them, the clinicians that supported them. And they were testing the hypothesis back then it wasn't known that good glycemic control was necessary to stave off long term complications of diabetes. That was that was a contested point back in the early 80s. And until we had the HBA when C test, and insulin pump therapy and fingerstick meters, we couldn't really test the hypothesis. You know, if people take a bunch of people and control their glucose, well, do they have fewer long term complications and those who you don't. And resoundingly, the DCCT, the diabetes control and complications trial showed us it by 1993, that huge, markedly reduce long term complications. And that study took about 10 years to do. And 30 years ago, this month, it was read out to the diabetes community that you got to do this. Well, you know, 10 years after that study, we started building the bionic pancreas. And in that 10 year period, and we've been doing it for 20 years, but in this period after the DCCT, what we also found is it's not scalable, you can't do what the DCCT did in a large scale everybody's anyone see is more like in the eights low eights, not seven, which is what they're able to do with the DCCT. So it wasn't for 30 years after the DCCT that there's a device now that we think and reach broadly, a much larger audience than than most diabetes tech people with type one, that is something you can put in your pocket and you type in your body weight and do these few meal announcements a day and keep it going and get glucose control that's comparable to what the DCCT achieved in the intensive group. And so we sort of answered the question, is there a scalable solution here? And I think the eyelid is that is that device now
Scott Benner 1:53:41
it sounds like it. I mean, I've really appreciated you telling me so much about it, but I'm excited for you to to get it going and get it out there. How long do you think it'll be? It's June till I see somebody online going. I use an eyelet. Online Yeah, like sighs thanks a picture on their Instagram. Like when am I going to see that? Like,
Ed Damiano 1:54:01
in a month, really less than I think in a month? Okay. I think we'll have one or two people at the ADA conference next week on the island. Okay. But on Instagram, I think, you know, on social media, I think you'll see something come up within the next
Scott Benner 1:54:11
month. Pretty amazing. Okay, Ed, thank you so much. I really appreciate Of course, Scott.
Ed Damiano 1:54:15
Thanks for having me.
Scott Benner 1:54:26
Hey, huge thanks to Ed for coming on the show today and telling us all about eyelet. I also want to thank us med for sponsoring this episode of The Juicebox Podcast. I'll remind you to go to us med.com forward slash juice box or call 888-721-1514 To get your free benefits check so you can get started with us med check out that private Facebook group Juicebox Podcast, type one diabetes on Facebook. It's absolutely free. It's for everybody. I don't care what kind of diabetes you have. I don't care how you eat. There's a beautiful community there with over are 40,000 people in it waiting for you? This podcast is sponsored every week buy great companies. I'll list them in a moment. But if you have the need or the interest, please use my links. When you're finding out more, it really does help to support the podcast. If you want to check out the Omni pod Dexcom us med that contour next gen blood glucose meter Chivo hypo pen, athletic greens, cozy Earth BetterHelp touched by type one, they're all there. Just look in the show notes of the audio app you're listening in now or go to juicebox podcast.com. When you click on those links, you're supporting the production of this podcast and keeping it free. The podcast is sponsored today by better help. Better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapists who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit for any reason at all. You can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price. I myself have just begun using BetterHelp betterhelp.com forward slash juice box that's better help h e l p.com. Forward slash juice box save 10% On your first month of therapy. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast
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