Scott Benner 1/10/25 Scott Benner 1/10/25

#1403 Grain Elevator

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Katie's daughter has type 1 and uses Omnipod 5

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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
We are all together again friends for the next episode of The Juicebox Podcast.

Katie is a returning guest. She was initially in the episode called Meet the Flintstones. She's the mother of a child with type one diabetes. Today, we're going to talk a lot about Omnipod five, gonna talk about community and where she's been and what she's done. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d, exchange.org/juicebox, and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa, this is the way t 1d exchange.org/juicebox it should not take you more than about 10 minutes. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com Today's episode of The Juicebox Podcast is sponsored by the Eversense 365 you can experience the ever since 365 CGM system for as low as $199 for a full year. Visit Eversense cgm.com/juicebox for more details and eligibility. Today's episode is sponsored by Medtronic diabetes, a company that's dressing hyperglycemia head on a topic that often gets overshadowed by the focus on hypoglycemia. Learn more at Medtronic diabetes.com/hyper

Katie 2:08
Hi. I am Katie. I have a daughter with type one diabetes, and I also have an older daughter. I was interviewed by you Scott, about two years ago, and during that interview, you had asked if I would come back and be interviewed about two years down the road, and here we are. Katie,

Scott Benner 2:26
this is fantastic. I'll tell you why in a minute. Not right now, first, I want to say you have an older daughter who doesn't have type one. How old is she? 1313? The t1 is 1111, when was she diagnosed? 2021? Oh, gosh, so for three years she was eight, yeah, around Correct. Okay, you've been married a long time.

Katie 2:51
Oh, we're to the point where we start doing the math, and we're at a wedding this last weekend. So I think we're at like, 17 years. Oh,

Scott Benner 2:58
you're the mid level aged people at the wedding now. Oh yeah, yep, yeah. You're not the old people, but you're not the young people anymore. Yeah,

Katie 3:06
we're definitely in that middle group, the older people, the baby boomers, all have their phones recording like the first dance. And we're like, we're not in that group, and then we had the young people and that we're all enjoying themselves, and we're not part of that group either. But yes, definitely in the middle

Scott Benner 3:21
group. You're like, I don't need to watch your dance again ever on my phone. So no to that. And I don't care how many tequila flutes I can get down. So no to that. And I don't want to be real old. It's a it's a depressing time, isn't it? At least when you're really old, you're just like, I made it, you know? I

Katie 3:38
don't know. I didn't mind just sitting there and observing. I'm totally okay with that.

Scott Benner 3:41
Yeah, that's nice. Actually, you just were happy to get away from your kids for

Katie 3:45
a day. Well, yeah, we did leave them back. So that was

Scott Benner 3:47
kind of nice. Will you do closet with a bowl of water? Or how do you handle that?

Katie 3:52
Pretty much a cell phone and food. How

Scott Benner 3:55
does your 11 year old do with the diabetes on their own? She's

Katie 3:58
good. She one of the things that has changed is, and since she was diagnosed, is she does her own, all her own Bolus thing and lunches and everything like that. During the school year, she takes on that full management. She does all for breakfast on her own. She does her lunches on her own. And that was something before our interview, I did a little bit of reflecting, and it's gotten she's gotten so good at it. Like, one day at school, somebody had bought donuts for a birthday that they had in the morning, and at like, two o'clock in the afternoon, I was helping a friend move, and I saw her numbers climb and like, oh my gosh, do we have a bad pump site? Did it she get bumped? And Jim, what's going on here? And finally, when I got to talk to her, she's like, well, I did eat a donut this morning. I'm like, Oh, it's a fat rise, you know. And so she has stopped texting me when treats are coming in the classroom, and she just kind of has taken control of bolusing for food, all of it when she's away from me. And she does a really good job at it too.

Scott Benner 4:57
She knew it was from the donut, but she. Doesn't understand the whole mechanism of it, right? Yeah,

Katie 5:02
she does. Oh, really cool. Well, she doesn't correct, like, she Noah's like, the fat she'll be like, Oh, we're gonna go eat Mexican tonight. Who is it? Your dad that's not sleeping tonight? So she understands that this comes, but she isn't the one dealing with it at this point, but I think at 11 years old, I don't think she needs to be dealing with it. She has plenty of years to take on that responsibility.

Scott Benner 5:27
No, I agree. Okay, so I said, this is really interesting. I'll tell you in a second, and now we're gonna go through this. So Katie, I'm gonna tell you and everybody listening that I record the podcast at least five times a week. And as a matter of fact, when someone hears this conversation, it will be at least six months old. It doesn't end up mattering, because we're not talking about like, you know, an election, or something topical, or something like that. So it really doesn't matter. Katie tells me her story, if it goes up on Thursday or it goes up a month from now or two months from now, it kind of doesn't matter. As a matter of fact, what matters most is that the interviews go up in the order that I make them in, because you can hear me grow and change through the podcast, right? You don't want to, like, you know, I try very hard not to get too out of order, so that you don't hear me say something that wildly is, you know, disconnected from what I said a week ago in your ears, you know, because of the fact that that's the way I work. I don't fundamentally, and I mean, in any way that is tangible, remember you. And I think that's going to be great. I know that most people will be like, Oh my God. He asked her to come back on. She went through all this whole thing, and now he's like, who are you? But I like that because I don't have any preconceived notions about the conversation we're about to have. So why do you think I asked you to come back? Because I really, really, sincerely do not ask a lot of people to come back

Katie 6:53
on. I think part of it was we were I talked to you when we were about nine months into our diagnosis. The interview started off with, like, if it wasn't water aspirin, I'm totally clueless to helping my kids with medical things, and I think you were probably more curious to see who you turned into,

Scott Benner 7:12
yeah, okay, well, that's excellent. So back then, in a couple of sentences, like, yeah, I wasn't comfortable beyond water and aspirin. That's fine. But around diabetes, where were you?

Katie 7:22
I think we were, and you take a swing stage and you might miss or you might hit it out of the park, just in that point of management where you have to just say, this takes time. And I think that was frustrating for me, because I like to be able to do things and do things well right away, you have to live life in all these different variables for so long before you it just becomes part of your life and not like now we're doing life with diabetes versus it's just life now at this point.

Scott Benner 7:55
So you are a perfectionist,

Katie 8:00
but yeah, in some things, but not all the things

Scott Benner 8:03
it bothered you around the diabetes,

Katie 8:06
yes, well, just because I listened, I did the equivalent of like a Netflix binge on your podcast within the first three months of being diagnosed. And I think you had, like, maybe 800 or 900 episodes up at the time, and I listened to you at double speed so I could get through it quicker. Okay,

Scott Benner 8:24
I hear people say that that freaks me out, because I already think I speak pretty quickly, but I understand the reasoning, and now we're going to hear from Medtronic champion Terry. How long have you had diabetes? June 2025

Terry 8:38
it'll be 50 years. I'm very much involved in the diabetic community in a lot of areas, and I helped start the walk here in Lincoln, Nebraska,

Scott Benner 8:47
when you were first diagnosed, what was management like? I started out

Terry 8:51
on beef, pork insulin, and I tell people jokingly that I used to smell like a bacon cheeseburger. Tell me about the impact of Medtronic technology. Finger stick is only a point in time, and that first 20 years for me was extremely difficult because I had high blood sugars all over the place. The CGM, to me, was the life saver.

Scott Benner 9:16
Prolonged hyperglycemia can lead to serious health problems and long term complications. Early and consistent management of hyperglycemia is critical. Learn more at Medtronic diabetes.com/hyper

Katie 9:29
every once in a while, when you get somebody from over in Europe, I do have to slow it down some, because it's their accent that catches me up a little bit. But okay, that was the first interview. Was a little bit weird for me, because I was like, Oh my gosh, it really was hard for me to do because you were talking so slow, because I was so used to you being like, double fast.

Scott Benner 9:49
So when we spoke, you're like, Why won't this guy speed up a little bit?

Katie 9:53
Yeah, like, everything just seemed like, this is going awful. It's so slow, but then I'm have different expectations. Conversations this go around, so it's good,

Scott Benner 10:01
excellent. So you have a diagnosis, you find the podcast briefly. How do you find it?

Katie 10:07
France suggested it within, I'd say, two weeks of diagnosis, and I was so tired, and I'm like, I don't do podcasts. And then one night, this is we were still finger pricking at two o'clock in the morning, and I wasn't sleeping, and like the light bulb went off, like somebody with diabetes suggested this. Why am I not utilizing that resource? And that's when I started listening, okay? And so it was just a local person that had suggested it to me. You're

Scott Benner 10:33
describing how my wife agreed to go out with me one day. She's like, Fine, okay, I guess so, nothing else is happening. So you find the podcast you did? You really binge eight, 900 episodes?

Katie 10:46
Yeah, I did. Thank you. And then I had my a friend that just would walk with me every day before school pickup, and she's like, talk to me anything if you want to talk nothing, diabetes, all diabetes, whatever. So sometimes she got a rehash of what I was listening to. And also my husband and I would just go for walks too, and that's where I'm like, This is what I learned today. And then I tell him these things, and he'd be like, well, I thought it was just about the carbs and the insulin, like our diabetes educator told us. And then I tell him these things, he'd see him happen. And he's like, Oh no, this is such good information. And so he got doesn't quite have the same time listen, and so he did select one side pass on to him. And otherwise I'd be like, This is what I learned about today. And just he has done an excellent job learning how to manage her to and so we are equally competent, but I'm the one making the changes, and but he's great at knowing, like, if something isn't going right, we usually list like it could be this, this, or that we don't have enough more insulin is kind of our management mindset.

Scott Benner 11:51
Well, can I tell you? I'll share with you that I missed the IDE now, because I put so much effort into this, to hear that it worked that well for you, and sort of in the way that I imagined it could, you know, is very gratifying, is really the only word. Like, I feel really happy for you. I feel more happy for your daughter, and I feel gratified personally, like, just from you sharing that. But that's not why I had you back on to tell you that, like, I didn't have you back on so you could say, like, nice stuff, I had a feeling about you back then, is what I'm gonna guess. And I'm gonna tell you right now. I didn't know, but as I'm listening to you now, I think you're a very clear storyteller. You're not wordy, you don't bounce around, you get your point across very clearly. And I must have thought at the time she's gonna do well, and she'll be a good reporter of how this worked out. So that's the vibe I'm getting right now from you. Tell me what episode you were in originally. Do you know? I

Katie 12:51
guess I don't know the episode number, but I think you labeled it meet the flint stones. Oh, is

Scott Benner 12:56
that what I called it? I love that title. It's fantastic. I don't even care. Why do you know? Why did it make any sense to you that that's what I called it? Yes.

Katie 13:05
Originally reached out to you was because we live in a rural state, and just we drive 90 miles for nearest care, and at that time, we had one PD after endocrinologist in our entire state. And so I was just, that's my initial reason why I reached out to you. Was just like, it's just a different dynamic of being so rural, but your podcast eliminates that barrier of getting good help, even though we're not in, like, a big city or next to great hospitals and

Scott Benner 13:36
stuff like that. It's not because you use a brontosaurus at work as a crane. That's not why. Exactly remember when Fred used to slide down the Brontosaurus neck at the end of the day, all happy to go home? Yes. Do you really remember that?

Katie 13:50
I do. I'm older. My kids watched. They called it the bam, bam show. So I did get the reference.

Scott Benner 13:57
I love the Flintstones. It basically was the honeymooners in a cartoon, right? I don't remember the honeymooners. Nobody remembers the honeymooners. Now that's alive still, but like that, that's people are like, I'm not gonna go watch the honeymooners. Scott. Never mind. Okay, so you get the diagnosis. Catch me up very quickly. At diagnosis, they give you what. They give you a pump. They give you what do you get right out the door. They

Katie 14:20
would have given us a CGM right away, but I was absolutely clueless as to what was going on, and I would have taken one if I would have known what it meant. But we went about one week with using glucose meter, had another appointment, got the CGM about a week in, and then we got the Omnipod about a month into our diagnosis,

Scott Benner 14:43
okay, all right, and a one sees in the first year about where at

Katie 14:49
diagnosis, we were 12.3 and her blood glucose was at 705 when I received the phone call, and then at my next three months. Appointment, we were at 5.4 and we're 5.1 and 5.2 and then we then transitioned into the Omnipod five, and our agencies have gone up a little from that. We've been anywhere from 5.5 to 5.8 once we switch to the OP

Scott Benner 15:20
five. Wow. What is your level of interaction now modern time, like you know today, how often are you interacting with diabetes?

Katie 15:29
Her insulin needs are so little. When we first went on Omnipod five, we were kind of at that minimum requirement needed, and I think that made it harder for the algorithm to cover the changes with the less insulin for it to work with. That makes sense. And so we started labeling our pods as the good, the weak and the strong. So if we had pump where we just ate out or did more things, our next one would be more strong, because we had such an increase of insulin to cover food, and we were honeymooning. And then other times, if she just had a few days where she didn't eat, and always on one pump, or kind of like, the next pump is weak. And so we started labeling the pot so when the pods were good, or just everything was kind of average, very minimal interaction. We still did corrections at night. Hormone rises that happened at night were like clockwork for her. When we were on the dash, we would have two hour time period at the evening where we would just have a set amount of units spread out over that time frame, and it just kept her smooth and level. And that is just something that we haven't been able to achieve with the Omnipod five, if we leave it in automated mode, but then at that time, at night, we just know what to put a pile of insulin on her and call it good. When

Scott Benner 16:48
you think of a CGM and all the good that it brings in your life, it's the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame. Sometimes it gets ripped off. I love that the adhesive kind of gets mushy. Sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox Podcast is sponsored by the Eversense 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems. The Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, you can manage your diabetes instead of your CGM with the Eversense 365 learn more and get started today at Eversense cgm.com/juicebox, one year, one CGM, you figured out how the pod works, and then you reapplied what you knew about diabetes to what you knew you were going to get from the

Katie 17:57
pod. Yes, because we had about nine months of being on the dash, and that was very in like our lines were smooth. It was great. But it also meant that at school, I would text her before a snack, like only bowls half your carbs, or if you're not going to eat your snack, cut back your basal or increase your basal. And so I bet I was texting her anywhere to three to four times a day when we were on the old dash pods in in manual mode all the time, and when we switched to Omnipod five and then she went to school, there'd be days where I wouldn't have to text her at school at all. She would just take her insulin for her snacks and her meals. And I mean, every once in a while we'd have a really strong pump where we'd be like, get some juice in you, and every once while, we'd have some weak pumps after every meal or snack. Could be like, You need to go and do a correction here. But for the most part, I hardly had the text her at school. And so that was a really big plus. It really freed up me to at the same time, not having to know that the pump will start taking away that basal when, when she starts coming down, really opened up my time for sure. Yeah,

Scott Benner 19:11
and if I'm overstating this, you'll stop me, please. But are you saying that the stuff that you learned from the podcast on a manual pump had as much, if not better, stability than automation does.

Katie 19:23
Yes, and it really, I really learned how to use insulin well by being forced into manual pumping for nine months, which I know people did way longer than we had to. Yeah, but I really understood the insulin super well. So when things weren't going so ideal, on the Omnipod five, I started doing my own things to make up the differences. For example, like she is growing when we started on the Omnipod five would be like point three an hour, and she was honeymooning. And obviously we're going to go out of the honeymoon phase. Is. And so I started doing something I called Morning math, because with the algorithm, I really don't know what her basal rate is, sure, because if you do a correction during the day, I'm like, part of that correction should have been in the basal. So you can't just look at a 24 hour period in my mind. But what I had started doing is we had typical food the night before. Like we didn't go up to eat every morning, I'd wake up not every morning, but I would wake up in the morning and do the math for midnight, till whenever I'm looking at this, seven o'clock in the morning, I take what it gave for basal and divided by the number of hours, and it just gave me an idea. And I could see like, you know what? Now, instead of point three an hour basal at night, it looks like we're averaging about point five. So then I would go into her manual settings and readjust her manual basal rate and her car ratios and stuff as and that was the only way on this automated system that I keep kind of keep up, because occasionally we do go in manual mode, and it's nice to have good settings and manual mode, even though we're in auto mode like most of the time, and that's kind of how I've managed that transition out of out of honeymoon and just increasing needs. And I mean, she's growing, her needs are always going to be changing. And that's kind of my way of, kind of keeping up with the algorithm and having just a clue of what it thinks she needs. That's awesome.

Scott Benner 21:19
You know, it feels like I drew something and then you built it, because the things that you're doing right now, the way that you decided, or the way your brain thinks about diabetes, is not the same as mine. It feels like you took an idea and you expanded on it, like in a way that I could not have. And it's just super interesting to listen to you talk about it.

Katie 21:40
Really another thing with the Omnipod five is it's, I call it the red light add on. And so we've we discovered pretty quickly that we'd wake up on a nice, consistent, like, about 110 ish mark, but with her insular needs that often bent, like you'd wake up and you click on that graph and see this huge red line. And part of the way we compensated for that was making her breakfast carb ratio stronger. But it just seemed like I was tired of getting the rise. I didn't like going into, like, the 100 and 60s after breakfast. So what I started doing was I would use the stronger car ratio for breakfast, and then I click on that graph, and if I if she's steady, and now I don't even click on the graph. She's been study hours before she gets up, we add in her basal rate into that Bolus too. So it's like, right now she's about a point eight per hour. If she's been steady, I'm just at a point eight to that breakfast Bolus, and it's we back fill our missing basal in my mind, and that way we have way more smooth breakfast experience, and we don't go as high, and we don't stay up there as long. So I felt like the red line add on. So anytime she studied before food, we always look like, how long has this been going? Okay? We'll add in half an hour worth of basal, or an hour basal into our Bolus with that food.

Scott Benner 22:58
I want to go over that again to make sure I understand if you think that the algorithm has been cutting basal away prior to a meal, you add half of it back in during the Bolus for the meal,

Katie 23:07
or all of it. If it's been, like, an hour, hour and a half, two hours, I'm like, for sure, I'm going to need a whole unit, because it we would just rock it after food. And it's like, because we have this full of basal insulin, it's just lacking and hasn't consistently been there. And when we're in manual mode, we always had a con. I always knew what basal was there to back it up.

Scott Benner 23:27
And did you get that idea out of me in the Pro Tip series, saying, if your basal should really be a unit an hour, but it's a half unit an hour, then every hour you're awake, you're deficient point five basal, so you're up for five hours in the morning. Then you decide to eat. You make a Bolus. That's three units for food. But the truth is, you're already maybe two and a half units deficient in basal, because your settings aren't right. Is that that conversation took you to that idea? Is that right? Yes.

Katie 23:58
And you experience it twice, and you're like, yep, there it is. Like, let's make a correction for that. What do you do for a living? Well, I work at a grain elevator part time. I manage a commercial property in our small town. I teach a cooking class at our small school that my kids go to, and I just, I do a variety of things.

Scott Benner 24:25
Do you go to college? Yes, for what Business Administration

Katie 24:28
with an emphasis in management, which is ridiculous, because I the thought of, like, managing people makes me want to, like, puke, and I'm a really good paper pusher, is what I like to

Scott Benner 24:40
say, Wait, do you have a really high IQ?

Katie 24:43
I don't think so. Don't you just

Scott Benner 24:45
really understand this? Well, I think it's

Katie 24:48
like a I love problem solving, and I think it's more of like a problem solving than a high IQ. If I have to say, I like problems,

Scott Benner 24:55
you have good focus. Though. Are you good at being focused on something you.

Katie 24:59
Yes, and and I go through phases of what I'm focused on. Like, it was photography for a while. Obviously it was diabetes management once we were diagnosed. And through, like, a bread phase, like, I learned how to make all sorts of different types of bread and how yeast works. And I love learning, I guess is the other part of

Scott Benner 25:17
it too. Yeah, because my brain doesn't work the way yours does. So, like, everything that I understand about diabetes is, like, it's stuff I learned by watching it. But I know people think I know that you could possibly listen to the podcast and think, Oh, he's so good at kind of, like, colloquially, like, simply, like, bare bones, saying what he's doing. But I want you all to know it's the only way I know how to talk to talk about it. I'm not dumbing it down for anybody. Like this is how it occurs to me, and I couldn't be as specific about it as you are. If you paid, yeah, like, like, I wouldn't know how to talk about it the way you talk about it. My brain won't work that way. It's super interesting. Interesting. Yeah, it is really cool. You're

Katie 26:00
the only source of information that I've had. So we had three hours of diabetes training the day after she was diagnosed, the next appointment we went to, I think we got like a half an hour of sick day training. And that is all the diabetes education that I have received from our health care system here. Otherwise, everything I've learned is from you. I think I read a book or two, but that's it's just boring reading.

Scott Benner 26:23
They say fundamental, but I find it boring, so

Katie 26:29
I will listen to audiobooks all day long. I love it, but yes, reading is not my ideal way of doing that. But even like you and Jenny, had an episode of determining your carb ratio that rule of 500 and that is the other tool that I really picked up from your podcast and helping make adjustments to what her insulin needs are as she does change otherwise. How do you begin to know where to start to change those settings in your pump? And so when we started on the Omnipod five I think we are like a one to 40 carb ratio. And I just did your little carb ratio math that you should shared with us, and now she's about one to 10 for carb ratios at this point.

Scott Benner 27:09
That's even Awesome. Can I? Can I make an admission right now? I would have to go look at that episode to understand that, like Jenny knows it off the top of her head, and I knew it was important to tell you guys, but if you pressed me right now for the 500 rule, I'd be like, I gotta go look at my podcast. I'm not sure

Katie 27:28
well, and I'm that way too. I just know it's there, okay? And then when I need it, I go back and find it. And so, like, every time I've done it, I've had to look it up, and so just to make sure I was doing it right. But that's where you take to get a ballpark of what carb ratio you want, you just take 500 divided by your total daily insulin. And so we just went on vacation, and I'm like, her part, she's been going high after every time we're eating. Let's make a change. And all I did for the week was go back and take her total daily insulin, write it out for seven days divided by seven. I'm like, here's my new average carb ratio, if we're going with this. And I changed it the day before we left on vacation, you know, and I didn't feel bad about it. And

Scott Benner 28:07
that makes me really happy, because I think the reason I worry about those three episodes the math behind because I did it, and still I don't know it by heart. But to hear that, you don't need to know it by heart, that you just refer back to it, that really is that's good for me to know, because I've actually already built calculators, online calculators to do that stuff. And I'm super, super nervous to put it online, because it's not exact, you know what I mean? Like, it gives you a these things give you a starting place. And I'm so worried about putting it online, I think I could probably, like, you know, put a bunch of language on top that says, like, look, this might not be right. It's for, you know, called entertainment purposes only, or something like that. I think you can kind of cover yourself that way, but you should see how well they work. Anybody

Katie 28:57
that's done diabetes management for more than a month will know, like, none of this is exact. If you think there should be a this, then here's the outcome. You're delusional. Like, it just be able to be like, this is a ballpark. Much too little. Let's move forward, change some things. And I don't want

Scott Benner 29:14
to be responsible for delusional people, though, so, but I but I swear to you, I look at I have the web pages. They're built, they're done. The calculators work, and I don't have the nerve to put them online. But maybe I'll get there one day, I don't know, because I think it's a really big deal. What you just described how you were able to just go back and look at total daily insulin and make bigger decisions just like that. You know, in a week, because people don't think about that, they don't think about, hey, I have an 11 year old. They're going to be 12, and when they're 12, they're going to weigh four more pounds than when they were 11. Or they're, you know, it's winter time now, so they don't move around as much, or it's summertime now, so they're running around more. No one thinks about that stuff. And I know that because that's what happened to me when my kid was growing up. Like I try to tell that story where. Or I've always ballparked insulin like I don't really count carbs. I look at food and think about insulin. And for anybody who doesn't understand that, I think you had to go back and listen somewhere. But I don't count carbs, and I never have so because I didn't Arden's insulin to carb ratio before automation was unimportant to me. And one day, we were in the the endos office, what is this? And she's going through Arden's PDM on her, on her Omnipod, and she goes, her insulin to carb ratio is one unit moves her. It covers 300 carbs. And I was like, Oh, that's not right. And she goes, but that's what the pump says. I was like, Oh, that was from, like, when she was like, four, and she goes, Well, how are you bolusing? I was like, Oh, you just look at the plate. You go, 123, half, that's five units. And she goes, that's how you do it. And I'm like, yeah, 100% I was like, that not how you do it. And she goes, No, I count the carbs. And I let the thing decide. I was like, well, not me. But the takeaway from that for me was that people settings can get away from them as things

Katie 31:08
change. Oh, definitely. And especially the summer, like, we would just start, we call it padding. We just be like, well, that's what it says. It just hasn't been enough. I'll add a unit to it, you know, like, and that's I have to take the time to pause and be like, I need to update these settings so that when my daughter does do the things, it's closer because she doesn't see all the things going on in my head. And so that's kind of how I know when it's time to make changes. And like, I've been adjusting all the things it says for me to do. I'm like, not enough, not enough, and not and I'm like, Well, it's time for me to actually make some changes inside the pump itself. We're going

Scott Benner 31:41
to pause on diabetes for half a second, because I need to understand what managing a grain silo means

Katie 31:47
a grain elevator. Elevator, excuse me, I don't manage it, but I go down the grain elevator that I work at is smaller. It's still farmer owned, and they are not located on a real line, and so their ability is, is they're going to remain small. And so the software system they have, I used to work at another local elevator that had three different locations, and we had amazing software, so you're counting and your green inventory were all handled within one software system. But that is not the cost of that is not feasible for the smaller one that I work at. So I reconcile their systems and say, like we have a discrepancy here. Let's make these two systems match. And so I help write contracts when grain is contracted, and I just kind of keep the guys in line. And then I go away for two weeks and I come back and say, what happened here? And I just make sure what happened is actually recorded, and I pay them on I do their payroll for them too, and that's kind of my role down there.

Scott Benner 32:48
We're going to do a very strange juxtaposition between your actual description of what you do and me letting everyone tell you that chat. GPT 4.0 says a grain elevator is a facility designed for the storage and handling of bulk grain. Grain elevators store large quantities of grain, such as wheat, corn, soybeans and other crops. The grains are kept in large bins or silos. The term elevator comes from the mechanism that lifts the grain from the ground level to the top of the storage bins or the silo. This is typically done using a vertical conveyor belt with buckets attached grain elevators receive grain from farmers and then store it until it can be shipped to markets. They can load and unload grain from trucks, trains and ships. That's all right, correct? Yep, no kidding. And those grains go out to like, as as other I mean, I guess it gets shipped to people use them as ingredients and other things, right? Yes.

Katie 33:43
And so for us, we ship to more local elevators that have contracts with bigger companies, like 80 MBQ, they loaded on trains, and those trains go to ports on east and west coast and get you know, some of it stays within United States, but otherwise it gets shipped off seeds

Scott Benner 34:00
so you work for a smaller farmer who doesn't have the ability to put that grain onto an a train, for example, and get it somewhere else. So they sell it to a another farmer who has that. Oh, wow. They're a subcontractor for a larger farmer with a better distribution situation. Yeah,

Katie 34:16
I don't work for a farmer. It's a cooperative, so it's a group of farmers that have the business. Oh, okay, and then there's a manager and there and workers and stuff. But yes, so we're kind of like the first go between, between, go betweens. That's

Scott Benner 34:32
kind of awesome. Do me a favor when we're done recording, because this is no one's business. I'm going to ask you, like, a completely personal question that has you have no reason to answer, but I'm literally going to ask you how much you make to do that. And if you don't want to tell me, you don't have to. But don't let me forget to ask you when the recording is over, because I'm fascinated by all this, so I want to, I want to understand, like the whole process. Tell me, please, if you would, about the process of binging a podcast with so many episodes so you. You said that you'd listen to an episode, there'd be takeaways, and then you'd share them, either on your your buddy, walk with your friend, or with your husband, if you thought he needed to know. But the way I make the podcast is purposeful, meaning. I don't think anybody just blurts out the thing you need to know. Like, you know what I mean? Like it, it's not tick tock. You don't get 30 seconds. And there's the idea, like, you have to have conversations. I think they have to be interesting. But am I right? Because you did it? Did you actually listen? Because you were like, all right, I'm getting good information out of this, but I'm bored by this person's story. Or were you entertained by it at the same time? Do you hate listen? Do you hate me, but you like the information? Like, can you tell me your experience?

Katie 35:44
I would say it's a mitt. As far as if it was, I hate to admit this, but if it was something more technical, I would jot it down on a piece of paper or more of like, the meat and potatoes of your like, half an hour podcast. They were shorter in the beginning. And I would just like, This is the main idea. And so just even rewriting for me the main idea. And then sometimes I'd be like, what's what's keep going. I need more information. But I think part of the reason why I could remember it because it wasn't the meat and potatoes, like the good information constantly, but built into other things that gives your mind more space to be able to tuck that information away, because it is an overload, okay? And then I the interviews. Of course, I started out with, like the pro tips and just gaining and defining, getting the right words for what was going on. I left listen to those, but then I saw the value very quickly. And just listening to people, even if you interviewed them, and only 10 minutes of the hour was actually about diabetes, it just helped you realize, like, this isn't my entire life, which it kind of felt like that when you're binge listening to something Sure, sure, but the nuggets of information that people share, and I think it's just Arden sharing when she had that low, when you guys were away, and like, You guys are great at managing diabetes, and it's just a really good reality, a check of like, even if we think we're doing well, just know that things can go wrong. And just to keep that in the back of your mind, and not like, in a doom and gloom way, but just in a reality way. And there was somebody else that was, it was a mother and daughter that you had interviewed, which was really interesting to me. And the daughter had a severe though too, and it was just because her mom was involved in it sounded like she had good management. And it's just good to hear all these different scenarios of people continuing on, but yet knowing like, don't completely disregard the things that can go wrong. I don't know if that makes sense. No,

Scott Benner 37:45
it does. And actually really valuable for you to say I can't believe of all the things you picked out, because generally speaking, I'm a public person, but a limited public person. Do you know what I mean? Like, the way I could explain it to you is that if we went to a diabetes conference right now, I'd be George Clooney, and if I walked outside, no one would know who I was. And so I'm I'm limitedly public, and there are people who don't like me, which I don't think would you know, come to any surprise to anybody, and the thing that they've more recently been attacking me on, I mean, they tell it as a lie, but they say you shouldn't listen to that podcast, because his daughter has seizures all the time, which is which is not true. Yep, she's had one as a baby, and she's had one as a as a high schooler, Arden's had three seizures since she's had diabetes. She's also had diabetes since she was two, and she's 20 now, so in 18 years, the first one was in the first couple months, we didn't know what we were doing. She, you know, we gave her the insulin that the doctor told us to give her. She took a nap. She was two years old, and she had a seizure while she was sleeping. You know, we stopped it with glucose gel, and that was that she had another one. When we went to we took the kids to Disney. I've told this story already, but it's the end of the night a long day out in the heat, walking around, we intersected a popsicle salesman on the way back to the hotel. The kids wanted a popsicle, and I know now that that thing was like simple sugar and, you know, like she'd walked around all day, she probably needed five of those popsicles, but I gave her the insulin for the popsicle, and we went home later down we heard, you know, we knew what it sounded like at that point. It happened. We got her out of it in like two seconds with some glucose gel. The next one, of course, is, you know, some 15 years later, almost. And you know, this happens to her after her her prom, and she comes on and shares it, and in my heart, when she shares it, I think that's good, because people should know that this they should know exactly what you just said, like your takeaway from her telling that story is exactly what I was hoping someone would take from it. By us sharing it, it's not a fun thing to tell people. Yeah, and it's not, you know what I mean, like, it's not super exciting to get on a podcast and tell a story about how something went wrong for you, but it's where people learn. And you sharing that with me just now really helped me feel better about it, because I was so sure that was the right thing to share. And then, you know, you jump online and there's five or six keyboard heroes out there, you know, making up big lies about, like, literally, like, literally using the words his daughter has seizures all of the time. You shouldn't listen to that podcast, and that's just them trying to keep members or listeners in their thing. I think they realize that if somebody makes it to this podcast, they're not getting back to their thing. You know what I mean, does that make sense? Yeah, yeah. It's nice you to share, because I it's one of the things that I I'm not sure about. Actually, you bringing up a lot of things today that I struggle with, like, privately that I'm like, oh, Katie says that was a good thing to do, and she's doing really well, so I probably should stop worrying about

Katie 40:56
that well. And I find people's lives fascinating, like the experiences that some people are just so hard for me to fathom. Some of them are so sad that they lack, like a stable home. But I just, I do find it all very interesting. Me

Scott Benner 41:12
too. Yeah, that's really cool. I appreciate that because so I have a bigger idea around the podcast. And I know I've been, you know, people will hear and like Scott's like, you know, letting chat, GPT answer questions and stuff like that. But I believe in how good these large language some of these large language models, are at absorbing information and then regurgitating it in more succinct ways. And so it's kind of my long term goal to feed every ounce of the podcast into an AI model and keep asking it the questions like, you know, today is a conversation, you know, if you know, I don't know, it's say it's an after dark and it's the one where the girls talking about, like being diagnosed while she was on a heroin Benner. So if you tell the large language model, if you tell chat, GPT read this transcript, at first glance, it's gonna sound like a story about a parent addict, but I need you to go through it and pick out any key takeaways about diabetes management. It will actually be able to do that the way you did it while you were walking and listening and so kind of my The last thing I'd like to do before I get out of this space, which I'm not saying I'm doing that now, but before I do that, I would like very much to put all of those things together, like bind them all together. I think

Katie 42:32
that's really valuable. I've told other people about the podcast. We have a couple different scenarios that have come up from my daughter's diagnosis. My husband's area leader was diabetic, and we knew he was diabetic before my daughter's diagnosis, and when he found out that she was type one, he called us and he was just finger pricking and using insulin pens, and told us it made him a better person for all these different reasons. We got the technology, and we told him, like, why don't you have Dexcom or an Omnipod? He's like, I don't want things attached to me. And just through re one Cs that we've been able to achieve. It was like, nine months later, he was like, What are you guys doing? And he got Dexcom because of us, and then once he had seen what the Dexcom did, the first time, he had to wait two hours, he's like, I can't believe that I used to fingerprint. Like it's driving me nuts not to have information for two hours. And so that was, like, a big change for him. But like we told him at the beginning, like we don't understand, but at that point, we don't push it any farther, and then we're under the same insurance too, because the same employer, and we had wrote an insurance letter, and we're self funded insurance, and so he also wrote a letter to get Omnipod five covered under our insurance before the formulary was due. And he was like, Why you after this pump? And then when I explained it, then he decided to try that. And so, like, it's neat to see, not that I'd want other people to have diabetes, but because of your podcast, what we've listened to, what choices we have, like, it's starting to like, flow out to other people too. And he texted us, I'd say, within the last year, and said he had his best a 1c ever in his whole life, because of changing to this different technology that is out there. You became

Scott Benner 44:22
like a thought leader for him, like he looked at you and he was like, wow, they know something I don't know. Like,

Katie 44:29
he texts us, like, what's going he sends us graphs, what's going on with this. And my husband's like, Katie, like he reaches out to us and like, ideally, I would love for him to start listening to your podcast, but I don't know that he has the same amount of time that I do, but it gets fed out that way. And then I also had an acquaintance in our town, like reach out to me, and it was through a voicemail, and she had said, just wondering, how do you calculate carbs and recipes? Because I make a lot of food from scratch, and you. Then she kind of left this long voice mail, and at the very end of it, she told me that her son was diagnosed with type one in the last two days. For her, they have like six different kids, and I'm like, we're just a family of four, and it was overwhelming to us. And so I just called her back and gave her the information that she was looking for, and I said, don't ever hesitate to ask me any questions. But I purposely waited for about two or three weeks after the diagnosis to even bring up your podcast, because I think one of the reasons why first didn't listen to you was just because I was so overwhelmed by everything else. Sure, she has started listening to but at the same time, when you have that many kids you don't have as many times to have your earbuds in to be able to listen to you. I

Scott Benner 45:46
thought you were gonna say she's having sex, because there's a lot of kids

Katie 45:50
that too. It's a whole village, but just her reaching out to me, and then she'd call me, and we're very similar personalities and proud. Husband actually said, I don't know if you two should like talk to each other, because you might make her obsessive about the diabetes management, and

Scott Benner 46:07
if it leads to good, stable blood sugars, then that's okay to put some effort into it, you know, yes,

Katie 46:12
and but just to be able to come along them and not dump it on her all the time. And she would call me like, this is going on? Why? And I would say, well, sometimes if they're doing a physical activity, it'll like sports. And I kind of like, this is what I've heard in for our Emma, this is what happens. But know that other people have a different reaction than just us. And so I think, like, the value of your podcast is, not only am I able to share this is what works for our experience, but I've also heard all these other people say these things. So keep an eye open. It might be a B or C, and use that information going forward.

Scott Benner 46:49
Excellent. I have to tell you, it's, it's just gratifying to hear you talk about it because, you know, I kind of alluded to it earlier, but it, you know, if you're listening, you don't realize, right? Like, though this pops up once a day, and there's, like, some content there, and sometimes I listen and sometimes I don't. Some people dig right into pro tip stuff and never come back. Some people become fans, like the whole thing. But the bigger point is that I am so busy making the podcast, I don't know what it is, and I know that's a weird disconnect for people, but like, it does everything Katie's explaining for her. And maybe it wouldn't work for you. Maybe it does, like, you know, maybe people get to it at the wrong time in their life, or they come back to it, or you don't jive with me, or whatever. Like, there's a million different ways you might intersect the the content, right? But I'm so busy making it and thinking about out in the future and building on what happened yesterday. That I'm not lying to you, it is Thursday I have had. You're the fourth conversation I've had this week. I've had three really wonderful conversations this week. And if you offered me money right now, I couldn't tell you what they were about. Oh, it's all moving too quickly. And like when I put this down. When you and I get done recording, I'm gonna do some back room stuff to make sure that it's saved, and it gets off to the editor and everything. And then I'm gonna go have an egg and come right back up here and work for the next seven hours, like, doing websites, and I have to re record new ads, and, you know, I'm trying to set up a speaking engagement. And like, you know, like, there's so much stuff happening, like, right? I found myself while I was talking to you, thinking if someone just gave me $50,000 a year, I'd go hire somebody to do that thing that I just said about the podcast. I would literally tell I would get someone, and I'd say, look, it's your job to feed this podcast into this AI model, get back key takeaways, write them, you know, in ways that are very like bullet pointy and understandable for people, and turn this into a book, and we'll sell it online, digitally and like, we don't need to bound it or anything like that. And then I would like that information back again, and then I'd like to read it back into the podcast right. To give you, like, what would end up being is, like, the Ultimate Pro Tip series from the Juicebox Podcast. Like, here are all the key takeaways from 1000s of episodes. They just sit down and hear them. You can decide to listen in 15 minute chunks or 30 minute chunks, or maybe we could break it up into like, you know, tick tock type stuff like that. All would be really helpful, except I'm just me and I don't have a budget, but I know that would all help. And anyway, I'm busy doing all of that. I can sometimes lose sight of what I'm doing. I don't do it poorly because of that, because I'm I don't know how to explain this. I know exactly what the podcast is, and I am willfully and meaningfully building on it. I guess I can't know how it's intersecting with other people until I get feedback like yours. And so I just, I put it out there with this intention and hopefulness, but then I don't get feedback. So I don't know my the only feedback I get are numbers. Did people listen today? Did they listen through the episode? Like you know, did we grow? Are people coming into the Facebook group? Because if those things are happening, then the podcast must be working. Does that make sense?

Katie 50:07
And I'm astonished by the number of people in your Facebook group that don't listen. But

Scott Benner 50:11
let's not call it Astonish, because if you were me, you'd be something different. You'd be irritated, because that's what I am. Okay?

Katie 50:17
I can, I can be irritated with you too. Thank you. They're missing out on a valuable resource, and they're just choosing not to utilize something that's there. That would be the irritating part to

Scott Benner 50:27
me. Well, so for me, the irritating part is, Listen, this is the thing that used to happen to people, and you're immediately, you go back into the 80s, you know, or go back farther than that, you get diabetes. Your doctor is half looking at you like, oh, sorry buddy, tough call. You know what I mean? Like, it's not going to be, not going to be what you thought this life. And if you drop dead when you were 50 of a heart attack, then they'd be like, yeah, diabetes, you know, if they would tell you things like, you know, you still hear in the ether like, Oh, if it goes up to 300 but it comes back down, that's okay. No, it's not, you know, like, can people live their lives like that? And, I mean, you done all these series to try to pick through why? Like, the Grand Rounds having doctors come on and talk about how they talk to people, the cold wind stuff, so you get back room understandings of how people happen, so that you can hear like, how does it get to this point? Like, how come healthcare works this way? And I think we've laid it out pretty well that it's, it's a limitation of human beings, right? And time and money and all these different things. But in the end, what it means is you're going to get the like, well, here's the pump and here's the CGM, and if you figure it out, good on you. But we're not going to tell you a whole lot about this. What is the B is going to be like? It's faded complete. I got diabetes, and it's just not going to go as well for me as it goes for other people. And in that inside of that system, inside of that world, when all that happened was that cell phones got unlimited cell service. That's why you are all doing better with your diabetes, by the way, because I had a message, and I finally found a way to deliver it to people. And I know that sounds crazy, but cell phones used to be limited. You couldn't listen to a podcast on a cell phone. It would have made you poor Yes, and now you can. You can download and stream, and it doesn't cost you any more money than it already cost you to hold your phone. This cell phone is why people can get my podcast, and it's why they can do better with their diabetes, and why I was able to find a distribution channel for it, right? And so you make it all through that, the history of diabetes, the fact that I don't have diabetes, you know, that's a pretty big thing I had to overcome, like I had a message, and I know how to deliver it, and it works. But some people hear me and go, Why am I listening to a guy who doesn't have diabetes? Tell me about how to take care of my diabetes. And you know what fair, fair statement, it seems like, you know, on its face. So you get past that and you say, okay, they wanted a Facebook group. So you put a Facebook group together. It's not just a Facebook group. It's 51,000 active members, and it adds 150 new members, like every three days, it's an astonishing monument to helping people. And you get them there, and then they go, what's this podcast people are talking about? And you're like, Oh my God. Like, what do I gotta come to your house and whisper it into your ear, because it's like, kind of how it feels sometimes, you know, and and you say, like, please just listen to this. Just it's not all of it. You don't have to listen to 1200 I mean, if you do, thank you. I broke them up into into series. Here's a series just listen to. It's 20 goddamn episodes. You can't find 20 hours to save your life. That doesn't make sense to me. And then you start realizing, well, what I've started to realize is, is that I can't believe I'm gonna go all the way back to probably like 1850 but you can lead a horse to water, but you can't make a drink. And so, like, that's the end of my job. The end of my job is to go here. Here it is. I hope you try it, and then I'm done. I can't really do anything else, and that is frustrating, because you're right there. If I could just stick if I could just stick your face in the water, damn it. Katie, go drink it. Drink it. I think your a 1c would be in the high fives or low sixes. Yeah, you know.

Katie 54:07
So I was, I don't like reading, but I listen to a lot of books, and there is one book that I found super interesting, and I think it kind of covers what you were just talking about, too. It's called Four tendencies, and it lumps people into some very broad categories of upholders, questioners, obligers or rebels. And that book was so interesting to me, and when I read it, I'm like, This is why everybody has a different ability to cons, like grasp the concept of how the best manage your diabetes. I think it's just who you are as a person is just a big part of it too. Because I'm a person that I just make the best choices for myself, and I don't care what other people think. It's kind of my personality where other people will only do things if other people expected of them, where i i. It's super interesting. But it, I think it does boil down to, like, are you going to be a person that somebody has to dunk your head in the water? Are you going to go drink that water yourself?

Scott Benner 55:07
I'm not actually frustrated by it. Like, if you get to the if I get you to the information, and you're just like, you start listening like, I don't like his voice, or I don't like the way it speaks, or I don't want to listen to a whole story to get to one idea. Like, that's completely legitimate. You know what I mean? Like, I'm not telling you, although I have, like, some of my favorite reviews are like, I hate that guy, but that podcast really teaches me a lot. Like, I swear to God, that makes me feel happier than anything else. I'm like, oh my god, they hate me, and they're making it through it. That's how valuable the podcast is. Like, that actually seems like a triumph to me. I don't know if my brain's weird, but, like, that's one of the things I'm most proud of, but, but most proud of it, because not everybody can like everybody, not everybody's for everybody else. Even you don't have to dislike me. I just, it might, just might not be your cup of tea, but I know the information is there. I know how to diabetes. You know? I mean, like, I swear to you, I could come to someone's house today, watch them for two hours and fix their blood sugar like I just know I could. And I wish that people knew that that was possible, because I think that so many people think that, like, this is my lot in life, or I have the sugars, there's nothing I can do about it. Or, you know, oh well, you were diagnosed with this, you're not going to live as long as everybody else, or you won't get to be as healthy or as happy because you dumb, lucked into diabetes. And I just don't feel like that's actually true. So

Katie 56:32
do you feel like that is less now with the technology and devices that are becoming more prevalent for more people that are managing. Oh, of course. Oh,

Scott Benner 56:41
yeah, yeah. The more technology that comes, the easier it is for more people. But if you look back to 1970 and talk to some of these people who've had diabetes for 50 years, who are, like, super, super, like healthy and don't have any you know issues at all, if you listen to their stories, they were people who just back then when they didn't know what they were doing, they were heavy handed with their insulin. That was pretty much it is that they were not high all the time. That's the end of it. Their blood sugars weren't high all of them, they didn't know what they were doing. They were shooting once in the morning and maybe once at dinner, you know. And that's it. But they were aggressive about it, and now they don't have complications 50 years later. And not because being aggressive keeps complications away, but because using the right amount of insulin keeps your complications away. That's my takeaway from talking to the older heads about diabetes, is that they were just the ones that ended up doing well, were just kind of aggressive about it. So it would just be so lovely if everybody could have your experience with with what I made. Because I think everybody would be doing terrific if they, if their brain picked it up the way yours does. I want to thank you for listening and and doing the thing it makes me a lady had a baby the other day. Did she name it? Scott, no, she didn't, which I was very disappointed about, and took the time to explain to her, but she put up a post in the Facebook group, and she's like, look, this is my second kid. I'm paraphrasing, basically, she said, I, look, I took what I learned in that podcast, and I held an A, 1c, in the fours and the low fives during my pregnancy. And here's my incredibly healthy baby, you know. And I saw that it was so a baby was adorable. I was very happy for her. She made a family and everything. And then I took five seconds and very quietly in my own head, said to myself, like I did that, like I made, I helped make that baby healthy, you know, like that really is. That's very cool. Like to think about your daughter rolling around, you know, understanding her stuff already at 11 years old, having good outcomes. She has a real opportunity to live a long, healthy life and and if, if you I'm not taking, I genuinely don't want to sound pompous, because I don't feel that way about it, but it's just undeniable, like, like, I did that, and we could keep doing it, and we could do it for more people. That's the way I think about it, not like, Oh, I get the credit, and I get to run around going, Look what I did. Like, I don't do that. And I don't feel that way. What I feel like is, there's another healthy kid, there's another happy family. There's two parents that might not get divorced, you know what I mean, because they're arguing about diabetes all the time. There's a little girl who might go to college and not give up on herself for four years and just hope she doesn't drop dead, you know what I mean, and hopefully she'll pick it back up when she's 28 and start taking care of herself again, like there's another person who recognizes their hypothyroid symptoms and doesn't back down when the doctor says, Oh, you're able. Your TSH is only five. We're not going to medicate that. Like, like, that kind of stuff. Like, all the people who have come to me and said that by sharing my low iron stories, they've got their iron back up, and their lives have changed. That stuff is all gratifying, is a nice word, and it. Keeps me working, like it helps me get up every day and do the thing. And you know, on the days when it can feel long, or when there's some assho online saying about my kid, that's not true, like it helps you get through all that. But my my driving force is like, I want to find another person who makes another healthy baby, or another kid, or another adult who's had diabetes for 40 I just got a lovely note from a woman in her 60s who's like, I've had diabetes my whole life. I've been listening to this podcast for six months. I have the best day one season I've ever had in my life. That's my goal every day. And anyway, listening to you makes me feel very comfortable that I'm moving in a good direction, if that makes sense well, and

Katie 1:00:41
it's not just the ability to understand the insulin and make changes and run the numbers, but also, like the emotional side of that is also fed. And the community aspect of that too, I think is really important just to I mean, in our community now, I think I know two other people type one diabetes, but it is just nice not to feel like you're on your loan Island as you're navigating changes and everything like that and having resources available. There's a couple people that I had listened to on podcast that I like personally seek doubt afterwards, and one of them was like, somebody really seemed to understand the Omnipod five. And some like tell me he seemed like he knew how the algorithm worked. And so I picked his brain and learned of another resource there that was excellent. And then there was another interview that you did of a guy out in Montana, and his main thing was, you might remember this episode. It was about the house that it's never, I'm going to say it wrong.

Scott Benner 1:01:45
It's never, it's never. Sarcoidosis,

Katie 1:01:47
yes. Okay. And his episode, he had said like he had started a nonprofit, like it was such a small part of his interview, which was just such an interesting interview there, but he said he had a nonprofit in Montana, and my daughter and I got in the one with type one got invited to go backpacking out in Montana. And I'm like, yeah, we can do this, but it he was just such an amazing resource. I ended up contacting his nonprofit, and you helped me, like, tell me about your mountain experiences, and what do we do we do with our low snacks at night? Because it is bear country, and would you trust any sugar in your tent? What would you do? And like this, that community of going out and doing another adventure, and I'm sure I could come up with everything that he suggested, if I spent enough time thinking through it, but it was just nice to like I reach out to a resource. He knows what he's doing. I don't have to put any more mind space towards that and just go with what he tells me, Wow,

Scott Benner 1:02:45
that direction. You got that from the podcast too. That's crazy.

Katie 1:02:48
Yeah, yes, yeah. And it was amazing. She backpacked, and I went with a friend who lived in the same town as us and moved away about six months after her diagnosis, and she invited us to go along with her and her son. And I don't think she realized what it meant to ask along my diabetic child and tell us, like, Okay, so we're going to hang the bear bag, but you're the one at night if we go low, because we had all this extra activity hiking up the mountain. Like I'm not sure how this is going to play out. So just know if I come to your tent in the middle of the night, we need to go get this. And everything was great. She had wonderful numbers, and we were able to set up a plan that it was so enjoyable. It was an amazing experience. But she at one point like, well, we don't have to backpack up into the mountains. We can just stay at a campground, if you think that would be better, and then there's less variables. I'm like, No, we're going to backpack. This is something we're completely capable of. I just need to plan more, carry more, and it'll be fine. And it was lovely. Fewer

Scott Benner 1:03:47
variables, let's say because, I mean, I don't want to get low, but I also don't want a bear to eat me. That'll probably be worse. Yeah, you know, it's funny. I don't, I don't not feel the community side of it, but it was the part of, you know, when you make something and then you learn a thing by mistake. Like, I knew it was important. I knew the connection part was important. I didn't realize how important. And I'll say all the time that it's the people who listen to the podcast who are like, Hey, you should make a private Facebook group where we could talk about the podcast. And I've said before, I'll be happy to reiterate, when that was suggested to me, I was like, Oh God, I don't want to do that. Like, I don't, I don't, I don't want to be in charge of a Facebook group that sounds bad to me. And in the end, it's become, like, it's become one of the most enriching parts of my life like to watch all these people continue to come together and watch it grow and grow and grow it just it non stop, grows. And then these people go in there, like you and others who've listened to the podcast and understand things, and they answer each other's questions. I know it seems obvious people like, Yes, I understand what a Facebook group is. It's the way it. Happens, and how little drama there is, and how overall kind people are. All I see when I see them talking to each other and helping each other is, oh, they found people I wasn't going to be able to get to. I don't have I can't my group does 125 new posts every day. Like, I can't keep up with that, you know. So like, now you guys are all out there, sort of like emissaries, like taking care of it for me and helping each other, which brings in more people. And it builds and builds and builds, really, it's the whole thing's lovely. It really is. So okay, all right. Well, Katie, if there's nothing else, I'm gonna let you go, because you mentioned earlier that some of my podcasts have gotten longer, and it's been in my head now to get out of this early because of that, you screwed yourself out of a longer interview, is what I'm saying. Yeah, me too. This is really wonderful. I swear to God, you should come back on five years from now, but not not a year like, not five years like, when you're like your kids, like heading off to college time. Keep me in mind around that. Okay, okay, all right, if I'm still interesting, if I'm still you're like, Oh God, I don't want to go to college. Not yet. I'm not ready for that. Yeah, I'll try. I'll do my best to keep it going for like, five or six more years. And you get that kid off to college and then come back and and tell me what else you figured out you're really good at this. I know you. I don't feel like you know that, but you really are. So thank you. Oh, thank you. Do you know? Know what that you're good at, what you're doing, like explaining it and being really thoughtful about it? I

Katie 1:06:28
hope that I can. Katie,

Scott Benner 1:06:31
do you know? I

Katie 1:06:32
want to help other people, you know, and if you can't understand it well enough to explain it to other people, I hope so. I hope it's helpful and not confusing or

Scott Benner 1:06:42
overwhelming. I guess I'm not gonna get you to say anything nice about yourself. Okay, all right, hold on one second for me. Thank you so much.

Can you name the only CGM that has only one sensor placement and one warm up period every year. Think about it. It doesn't matter if you can I can ever sense 365 is sponsoring this episode of The Juicebox Podcast ever since cgm.com/juice box a year is a long time. The episode you just enjoyed was sponsored by Medtronic diabetes. Learn more about hyperglycemia and what you can do about it at Medtronic diabetes.com/hyper Hey, you listened all the way to the end. You might want to know more about the Juicebox Podcast. If you do, go to Juicebox podcast.com, scroll down to the bottom and subscribe to the Juicebox Podcast newsletter. If you're living with type one diabetes, the after dark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about, from drugs to depression, self harm, trauma, addiction and so much more. Go to Juicebox podcast.com up in the menu and click on after dark there you'll see a full list of all of the after dark episodes. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. Hey, what's up, everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording doing his magic to these files. So if you want him to do his magic to you, wrong way. Recording.com, you got a podcast. You want somebody to edit it. You want rob you.

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Scott Benner 1/9/25 Scott Benner 1/9/25

#1402 Caregiver Burnout: Isolation and Stigma

Isolation and stigma: Discovering new forms of support through online platforms

Raising a type 1 child while questioning her husband's diagnosis.
How quick action saved her son from severe diabetic complications.
The fight for clear answers when doctors won’t listen.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome back to another episode of The Juicebox Podcast.

Erica forsle is back with me again today for the sixth part of her caregiver burnout series. This is the last part for now, but we're gonna probably be adding to it again in the future. If you'd like to hire Erica, she's available at Erica. Forsyth.com, please don't forget 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink, ag one.com/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast, private, Facebook group. Juice box podcast, type one diabetes. But everybody is welcome. Type one, type two, gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. This episode of The Juicebox Podcast is sponsored by Omnipod five, and you can learn more right now at my special link, omnipod.com/juicebox dot com, slash, Juicebox, Erica, we are going to finish up the caregiver burnout series today. I appreciate you doing this with me. That's right. Thank you. Of course, Episode Six, look at us making time we're doing well.

Erika Forsyth, MFT, LMFT 1:56
What's this one about? So this six burden focuses on the isolation and stigma that caregivers or even people with diabetes might experience. Navigating this might feel similar to how we discussed the previous episode as you navigate social experiences post diagnosis, but this one really the lens through which we're talking about this isolation and stigma can occur even in, you know, a phone call with the family member and very small, nuanced interactions with other people. Through the research that we've we've also seen in our own lives that because of the intensity of the stigma and the isolation that people experience, one of the benefits has been the online, the social, you know, online platforms that have certainly been growing in the last 510, years, significantly. So do you want to lead? We get, do you want to lead with the quote, the parent quote,

Scott Benner 2:54
I get to read the parent quote. This one's very talky, meaning, this is a direct quote, but it's obviously like conversational. So stick with me. I'm gonna do my best to put my to put their emotion into it a little bit. I don't think people truly understand how hard it is on us, on a physical, daily, everyday thing, people don't get it. And I think because we are coping and we're fine, people just think, Oh, it must be fine, but it's really hard, and they don't get that, whereas, if your child had cancer, people, they drop off meals, and people would be running around after you, thinking, Oh you poor thing. It's terrible. But they're like, Oh no, it's fine. I hear that from a lot of yes, you hear that, yeah, from a lot of it's the comparison that gets made a lot, which is, I think what they're really saying is people know cancer is bad, right? So they have that overly empathetic What can I do a response? But when people hear diabetes, they think, like, oh, you take a pill, or you just don't eat a cookie or something, and then it just, you know, like, Oh, it doesn't sound so bad. And then you don't get the same response, and then you get that's, that's isolation, right? Yes, yeah, okay,

Erika Forsyth, MFT, LMFT 4:07
isolation and not being understood, right? They say, you know, they don't understand that the physical, daily, everyday thing of managing your child's diabetes. Oftentimes, I even saw this, you know, a lot of comments yesterday online during our, you know, World Diabetes Day of, oh, at least you know you have a diagnosis like, now you know what's going on, which, yes, there is that kind of relief. Okay, my child's been sick for so long. Now we know there is that kind of immediate relief, but then, as we know, also immediately comes the shock of what it actually means. And that's where people who don't know diabetes misunderstand what it is that you are doing for your child on a moment to moment basis. Yeah, like,

Scott Benner 4:58
it's not like, great. You're right, at least. I know now, because you hear people come on the show all the time and talk about that, like, oh, it was horrible not knowing. And you're like, well, at least now I know, yeah, that gets rid of the part where it's horrible not knowing. It doesn't fix anything else. It just, you know, that part's over. You know,

Erika Forsyth, MFT, LMFT 5:14
yes. So this kind of, this constant, either the stigma around what the other person perceives diabetes to be. You might experience that right, like, you know, all the myths that you and Jenny have talked about, you know, the myths of diabetes. Did you give your kid too much sugar, etc, etc, you can feel stigmatized based on the other person's perception of what diabetes is and why your child has it, and then consequently misunderstood around what it means to keep your child alive or keep yourself alive. And I also hear, not only from, you know, family members who are maybe trying to do their best to support but don't quite understand it, are also, you know, when you're at pickup and you're trying to connect with another parent. They I know

Scott Benner 6:04
what you're gonna say is making me laugh. Okay, go Google. Say it. Say like, when they it's like when they complain about some banal thing in their life, like, it's the worst thing that ever happened. And you're like, I haven't slept in six months. Like, yes, I look at my kid and I constantly think, is it about the die? Is that the same as having to rush to soccer practice and make dinner doesn't feel like it, because we also play soccer and eat dinner like, Yeah, I know, trust me, I know, yeah, yes.

Erika Forsyth, MFT, LMFT 6:31
And so again, those you know, those other parents are maybe they're trying to relate, you know, and trying to empathize and try to share, like, you know, we've got hard things going on? Maybe they're just having a conversation, but obviously where you are in your journey and how you're hearing other people's issues, it's okay if it's hard, right, that if you're if you're running that line in your mind, like, I'm just trying to keep my kid alive here, so that's okay. But that also can contribute to that feeling of like, oh my gosh, no one really gets how hard this is, and that sense of isolation.

Scott Benner 7:05
It's the medical thing to the seriousness of it that stops you from being able to step back and go, Oh, they are trying to connect with me. They're just, they don't have all the details. Like in any other walk of your life, you'd be like, Oh, thank you. Like, you know, you'd feel it, and you'd be like, Oh, they're they're trying to empathize with me. But instead, it just feels like, What are you talking about? I think that when you have diabetes or your child, does your perspective on the world levels up, like whatever, that low level stuff that people worry about, you don't have time for that anymore. Like that just it's gone. Now I'm worrying about bigger, more immediate problems. I can't sit around and pontificate about whether or not, you know, Scary Spice is really in love with whatever. Like, you know what I mean, like, whatever, right? What is that? What is the modern version of that? I don't care if Kim and is arguing with her sisters, yes, yeah, my kid cries when I put a pump on them. So I I'm done with that part now your perspective, you just level up your perspective and that person, and I say too, thankfully that person doesn't have that. I'm glad that they don't feel the weight of what I feel. But it is hard not to be jealous about it. Sometimes I think that's probably the wrong Yes, today's episode of The Juicebox Podcast is sponsored by Omnipod, and before I tell you about Omnipod, the device. I'd like to tell you about Omnipod, the company. I approached Omnipod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet because the podcast didn't have any listeners. All I could promise them was that I was going to try to help people living with type one diabetes, and that was enough for Omnipod. They bought their first ad, and I used that money to support myself while I was growing the Juicebox Podcast. You might even say that Omnipod is the firm foundation of the Juicebox Podcast, and it's actually the firm foundation of how my daughter manages her type one diabetes every day, omnipod.com/juicebox whether you want the Omnipod five or the Omnipod dash, using my link, let's Omnipod know what a good decision they made in 2015 and continue to make to this day. Omnipod is easy to use, easy to fill, easy to wear, and I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omnipod. But please take a look omnipod.com/juicebox I think Omnipod could be a good friend to you, just like it has been to my daughter and my family

Erika Forsyth, MFT, LMFT 9:46
to not be jealous, and then to as we talked about last episode, do you then make that decision to try and communicate how hard it is right to say, hey, it actually is really, really challenging. To do what I'm doing to keep my child alive, or keep their their sugars in range, and let them do all the things I want them to do, because then, if you don't, you feel like you're not recognized for the amount of work that you're doing. You're not doing it for like, oh, pat on the back you're doing you you want that. You just want people to know how hard it is, because it's really hard. And that's, as we've kind of talked about this issue many times before, that's kind of human nature you want to be seen and validated for the struggle, the pain that you're carrying, so that you feel supported and you don't feel as lonely in what you're carrying. Yeah. I

Scott Benner 10:34
mean, we're obviously social creatures, right? And when you don't have that feeling, you feel alienated, then, you know right away, like you're on the outside of the of the pack. I guess is the way to think about it. I need you to understand why I look tired. It's not because I'm weak. It's not because I can't do this the way you do it, like I'm a good parent too, you know, I've got more of a burden than you might also. The other thing is, you don't know what the other person's burden is either right, like, you know, they've got stuff going on as well. I don't know, the belonging, connecting, empathy, mirroring back and forth, it's all really important. But a lot of times you just lose your fuse for that conversation. And I think the explaining, some people could feel like, if I start explaining this, I'm just going to sound like I'm complaining. I also don't want to seem weak or like I'm complaining, either you think,

Erika Forsyth, MFT, LMFT 11:27
right, or a burden to other people, right? Like to and are they really going to get it? And why do I need to tell them this? You know, all those things can be running through your mind, and are they really going to get it anyway? So I might as well just not share it, right? And then you still land in a place of isolation. It

Scott Benner 11:45
kind of boils down to when someone says, How's your day, they probably don't care. So, you know, like somebody says to you, how's your day, and you start telling them they're going to be like, oh geez. Like, that's enough. I was being polite, you know. And and they really aren't wait. Diabetes is that thing you do need to live with it to understand it. I mean, in the same house, like, I think if you drug anybody into your house for a week and then let them back out, they'd go out and start complaining for you. They'd tell everybody you're not giving Erica hardly enough credit. Like she's married, she's got two kids, she's got a job, she does all this stuff. She still has diabetes. I saw her. I was in her house for a week. I saw her change her pump twice. I saw her change her CGM. I saw her get low. I saw her get dizzy. I saw her feel foggy, like she started yelling about nothing, like, you know, that's none of that was even her fault. It's crazy. I don't know how to count carbs. I couldn't figure it out I was there for a week. If you had an advocate on your side, like that, I

Erika Forsyth, MFT, LMFT 12:37
was just wow. I feel really validated. Thank you with that. Were you there last week? Eric

Scott Benner 12:41
and I have only ever been together, like, steadily, for like, an hour and a half, but I still, I know your pain well.

Erika Forsyth, MFT, LMFT 12:46
Actually, I Well, I'm debating whether I was going to share this story, but I feel like I'm just going to because, okay, when I had my high episode recently, for the first time in my I think that I can even remember, after 34 years, started vomiting due to a high due to kind of random, out of the blue, high blood sugars, everything was fine until I wasn't and I felt ill for many hours, baited. Do I go to the ER? Do I not? I ended up being able to ride it out at home. But it was probably, you know, five, six hours of really not feeling well the next day, the three people I reach out to are I email my doctor, I call Scott. Thank you very much for being there, of course, and my brother, who also has type one. And obviously my husband was there to support me. He doesn't have type one, but he watched it. I didn't need to tell him about it, and I didn't tell anybody else. I didn't tell any good friends, until days later, I told one good friend, and I went through this process of, do I need to tell people I was really ill, even not feeling well? The next day, I had to cancel some things. But it's that process if you want to reach out and feel connected with someone who understands. And I am grateful to you, Scott, for being there and helping me, you know, walk through possibly what happened. And then my brother, who understood and shared, and then he shared a story recently of having a random low that was pretty scary for him, and that was it. And then later I told a good friend of mine we were going to walk. And I found myself in this space of like, do I want to keep going and telling her why and how and how bad it was to kind of fully help her understand and for this close person, it was worth it to me to to go into depth. But I think, as we've talked about before, too, finding kind of those, those circles of people, when is it worthwhile to share the depth of how hard it is to care, give or live with it? I think

Scott Benner 14:38
I've seen in the past too, where people make that decision, like, here's a person I'm going to share this with, and then when that person's not understanding or receptive, it's heartbreaking. I've seen that happen to people a lot like, I am going to share this with a very good friend who ends up just treating it flippantly or it makes them uncomfortable to hear about your struggle, which is. Probably more we all can't go to therapy. Trust me, everyone would have to be a therapist for us all to be okay. We'd all need one. But if you open up to a close friend who you think is gonna have your back and understand this, and they, for some reason, don't, it's tough. I've seen friendships end over stuff like that, you know,

Erika Forsyth, MFT, LMFT 15:18
absolutely or even family members, right kind of pulling back and withdrawing as a result of your attempt to try and under explain what's what it's like, yeah, so we're kind of already transitioning into, you know, what can you do with this feeling of isolation, of stigma, of kind of not being totally you know, your your work is unrecognized and underestimated, and it can be it can be challenging, right? Like, based on what we've already talked about, you you don't want to be a burden to other people. Can you trust the other person? Are you naturally an extrovert? And you can confidently, and that's just kind of how you are. You're able to talk and process, and you can understand where your needs end and the other person needs begin and end. Are you introverted and feeling like, if you are sharing with other people? Does that take a lot of extra effort, energy, risk? Does it feel scary? So just wanting to to note that like, based on your past experience with being vulnerable and also your personality can contribute and exacerbate or help those feelings of isolation.

Scott Benner 16:25
What do you do if you have a personality that's not going to let you make that connection, but you still need that, right? You still need to do that for yourself. How do you find a person to do that with?

Erika Forsyth, MFT, LMFT 16:35
If going publicly or in person feels too scary, you know, I see more and more people posting anonymously right in the in the face, in the Juicebox Facebook group, which I think is fine if you feel, if it feels like, Oh, this feels too scary to share who I am or my identity, seek help. Keep it anonymous. Seek help in you know, whether, if you can't, go to therapy and other support groups, keep your screen off, right? Those are kind of more the virtual tools that I'm thinking about. If you lean more introverted, hopefully you have found, over time, those one or two safe people that you can trust when

Scott Benner 17:14
Facebook offered the anonymous posting in the private group, at first, you know, we were like, we can't let this happen, because it's going to open people up to getting scammed, right? Like, you know, if you can be anonymous, yeah, and scam somebody. And I was like, thought about it for a while, and then I came to the conclusion you did, which is, it's going to be extra work, and it's, it's, it's going to suck, like, it's, it's extra moderating work, but I think it's really important, because I kept imagining like there are some things I read and I think, why does this need to be anonymous? I can't, from my perspective, understand why this needs to be anonymous, but from their perspective, it does. So who cares that now this allows them to say it out loud. I think it's a great tool, because of that. Yes, it really if you can't walk into an in person meeting, or you can't or won't go to therapy, and you still need to say it. And the posts are, I mean, you see them too, right? Like, I just want to share this success that I had with somebody. Like, you're the only people who are going to appreciate how hard it was for us to get the standard deviation from 160 to 120 Yes, excuse me, I from, I don't know why I use that number. The the average blood sugar from 160 to 120 not standard deviation. And you can see, like they're just thrilled to tell somebody. I don't even think they care if anybody replies. They just want to be like, hey, world, look, figure this thing out, you know, or I'm struggling with this thing. Yeah, right. Just saying it helps,

Erika Forsyth, MFT, LMFT 18:37
saying it out loud, and not necessarily needing the response. And that takes courage, right to be vulnerable and knowing in the Facebook group it's already it's a safe place, because, you know, you can go do that, and that's what to be expected. It can feel really scary doing that, you know, quote, in real life. And so I wanted, I think it can feel just going back to like, you know, I feel like it's, it's a privilege, a that I could reach out to you when I was going through this DKA like experience. And my brother, who has type one, I have that, like, that's my little, you know, community. And not everybody has that.

Scott Benner 19:15
How was it helpful to you when we spoke? Because I felt like I was just listening and mirroring and, like, I brought up a couple of things, maybe. But like, it's not like you were like, Oh dear, oh my, I don't know what happened you had diabetes for like, what do you get diabetes? Like, 35 years

Erika Forsyth, MFT, LMFT 19:30
or 34 years? Yes, yeah. But this was a first time experience.

Scott Benner 19:35
You were I was listening to you process what had happened to you, and then what were you doing? You were looking for a sounding board that you could trust to see if you were thinking about things correctly. It was that what it needed to

Erika Forsyth, MFT, LMFT 19:47
be. Yes, I wanted to be, not only validated, validating that it was, it was a scary experience because I hadn't gone through it before, and I thankfully got that from you and my doctor and my brother. And then also wanted. To learn, how could I have done things differently, like have ketone strips on hand?

Scott Benner 20:06
Yeah? Erica owns a ketone meter now. Yeah,

Erika Forsyth, MFT, LMFT 20:10
yeah, to kind of learn and say, when this happened, maybe should I have gone this way or that way? So to be without having to explain to you or to my brother or my doctor what DK is like, or what you're experiencing, right? There's already that known entity. So to have that conversation with you, you have a lot of experience hearing people's stories and obviously, Arden's life journey. So to have that from an experienced there's no shame from any of the people that I connected with, also, like you should have done this. Why didn't you do this? Right? Yeah. And I think sometimes when you're scared, not really knowing what to do, and this happens a lot at the beginning of your journey with diabetes, but also 34 years in, something totally random happens, and it can feel scary,

Scott Benner 20:56
sure. And talking to me is nice, because I'm like a therapist that curses, yes, all the listening, none of the nice stuff that sometimes makes people uncomfortable.

Erika Forsyth, MFT, LMFT 21:08
Oh well, I think I mean just the validation and the support and the education. And I was really grateful for Scott for your time in that. And I think if you're listening to this and thinking, Well, I don't have a brother or a family member with type one, or I don't have Scott's direct number, or my endo isn't that supportive. I just want to validate that if you're here thinking or feeling that, and there might be somebody else out there, whether it's in the Facebook group or somebody a smaller group, but we're going to get to some of these different entities where you can maybe connect and find those two or three people to be in a text group with. Yeah,

Scott Benner 21:44
no, you just need somebody honestly there. I've seen people do it all different kinds of ways. Go over some of the things that you think are great, and I'll fill in things I've seen that maybe aren't on this list. Okay,

Erika Forsyth, MFT, LMFT 21:53
so, you know, as as we were saying, you know, to take that courageous step, to be vulnerable, like I didn't know, just go sorry. To go back to my brother. Example, I shared this moment with him, and then he was able to say, oh my gosh, me too. I just had this scary thing happen with the low and my wife, you know, when he shared his story and we talk diabetes, sometimes, not all the time. And so then I was able to listen to Him and hear him. And so there's just this beautiful moment when you are taking that courage and to be vulnerable in a space that feels safe, that often gives the other person the opportunity to be vulnerable as

Scott Benner 22:29
well, so be ready to offer what you're asking for in return. Possibly, yes, it's

Erika Forsyth, MFT, LMFT 22:35
beautiful. It's a beautiful exchange. Obviously, we know the Juicebox Facebook group. You guys know that it isn't a great resource and safe space, and as we talked about before, I think in the previous episode, I've seen people say, Hey, I live in such and such ZIP Code who wants to get together this Sunday at the park. So to kind of bring that larger group into a smaller personal perspective or group environment is really helpful, touched by type. One has monthly events. And they actually have, I don't know this is probably going to air after, but they have their dancing for diabetes show that, which is an amazing connection. And they also have monthly local events. You're just my type. They are mostly la based, but their whole mission, and I'm going to read this from her website, is to create a world where all individuals with type one diabetes feel empowered, supported and connected. She Laura is the director, creator of this group, and they have a lot of La meetups, but people from different caregivers and children and adults, most of their in person meetups are in the west coast. In LA, I think she had Seattle, she had New York, and then there's one coming up in London. I believe in January.

Scott Benner 23:56
Yep, I see it January 11. This should be out before then. Okay, yeah, I don't know the organization, but just, you're just my type.com,

Erika Forsyth, MFT, LMFT 24:06
yes, yes. Also on Instagram and probably Facebook, you're just my type, yeah.com, the next one is, let's see type one together. They have a diet buddy list, kind of similarly to what I see doing happening on the Facebook group. They're like a, they're trying to create, like a national registry list, I guess, if you will. And so you can go on, I think it's free, add your address and also learn to see who people you know, which families are near you. Those are some of the main ones that I know of. Before we go into this next point about the positive messaging. Were there other groups or things that you thought would be helpful

Scott Benner 24:49
if you or a loved one was just diagnosed with type one diabetes? And you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place. Art that series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl. Beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player. Or you can go to Juicebox podcast.com and click on bold beginnings in the menu. Well, I know people listening who have extensive WhatsApp texts set up with people with diabetes, which is awesome, right? Like hundreds and hundreds of people in a whatsapp chain, and they just talk about diabetes stuff. I think if that's the thing, you could get started with a handful of people, I think that would be a big idea. Big thing to do, too. I mean, you could do it with text messaging, obviously, if you wanted to, but just a place where you can drop in and say something that somebody might quickly get back to you about it. My private Facebook group is, it's so big as far as membership and posts go that you would think like, Oh, my post is gonna get lost. But it just usually doesn't happen. There's always somebody online, always somebody looking. And I think a text chain, if you can find the people, is another way to accomplish that. So WhatsApp text chains, beyond that, I have to tell you, I'm just so head down, doing the thing I'm doing. I don't know as much about other things that are going on as I probably should. I would

Erika Forsyth, MFT, LMFT 26:27
say, you know, even attending the local, you know, breakthrough, T, 1d summits, if you can connect with people there, or any of the conferences that you attend, finding and connecting with like a small group, right? So, and I know caregivers who have you know their diabetes caregiver text chain, just like your child might have their diabetes text chain, to have kind of that maybe more immediate result that you're you might be looking for a response, yeah? Also camps. Well,

Scott Benner 26:57
camps a great idea, if you can find a great diabetes camp that's a the people who have a good experience at diabetes camp have an awesome experience at diabetes camp. And I think there are some people who just aren't camp people. Or sometimes find a camp that's, you know, doesn't end up being great. But overwhelmingly, from what I hear from people, they they love their camp experience. I was going to say, though, if you go to a local event. Breakthrough two on the event, I would just not caution you, but remind you that you're probably going to meet a lot of newer diagnosed people. So, yeah, you're looking for a sage advice. Kind of person you're gonna you might be a lot of people standing around, going, I need help. You know, me too. What a nice way to meet people who are newly on the path you're on, because at least you're all kind of step by step, you know in sync with what's happening right now, and then you guys could grow and learn together too, which would be awesome, yes,

Erika Forsyth, MFT, LMFT 27:47
and that can often be part of your own healing journey, as you support maybe a more you know, newly diagnosed family, even if you're six months a year ahead of them. I often hear of parents saying, Wow, I didn't realize how much I already learned and knew, and we were just there. It feels like yesterday, but it was a year ago. And then you kind of have that ability to gain that perspective also, yeah.

Scott Benner 28:10
Now I say all the time, when I meet people who are really struggling in the beginning, I say, look, here's some fundamental tools that will help you. Here's some places to learn about more. And a year from now, you're going to look back and not recognize yourself from today probably sounds like bullshit when I'm saying it to them, but a year from now, you look back and you go, wow, I have learned so much. I didn't realize you don't even know what there is to learn. So you can't even imagine making such a leap, you know? But then when you do, if you are, yeah, it's funny. You put it the way you did, because I used to describe what I do. I'd say to people like, look you're looking for someone ahead of you who's already been down this dark path. Knows where all the holes are, all the sticks to trip over and can, like, just look back at you, shine a light and go, Oh, look out. Look out for that. Like, step over that. Go around this. You might want to do it this way, and you know, you'll get you get to that point two, so you could be that person, or somebody in a Facebook group, in an in person group, you could show up at an event and stand up and share your experience. I think there's an unending number of ways, once you're in the ecosystem with other people, everyone's story is really valuable at that point.

Erika Forsyth, MFT, LMFT 29:19
You know, yes, absolutely. And if you are able again, it might take some courage, some effort, some time. And I know when you're exhausted and feeling like, how could you do one more thing to then find and reach out to other people and create this group? There's so many benefits. And I just thought it would be interesting to share this recent study. They took groups of parents, and they were going to give one group of parents just positive messaging about parenting in general, and then the other group was going to get specific diabetes messaging about management. And encouragement. And so they looked at the and then when they got messages via text and Facebook Messenger, yeah, basically the parenting group that received the diabetes specific positive messaging reported higher levels of disease management, more satisfaction, and their perception of burden was also decreased that they reported. And so I just thought this was such, you know, I think it's so great to have all these the Facebook group, your Whatsapp group, your text group, your in person support group, to validate how hard it is, because that helps us decrease that isolation and stigma, right? Like, that's really important, but also to have these positive messages to send to one another randomly. Like, for example, one of them was, you know, being a parent of a child with type one diabetes. This is 24/7 365, job. Be kind to yourself. You're doing great, just randomly. You know, sharing that with your with your group, with your family, whatever is your support group, can be really effective. And you can also do this for your child. I

Scott Benner 31:10
have an example this from today, so I'm in an unfair advantage. A lot of people send me notes, so I usually have, no matter what we're talking about. I normally have an example from the last couple of days. So I will leave this person's name out of it, but let me read this and says, I've been a member of this group, and they're referring to the private Facebook group for the podcast for a little while, but I have never listened to the Juicebox Podcast. I've never been a podcast person, and usually my ADHD doesn't let me sit and listen to something for a long enough time, but I've seen so many people share about how the podcasts help them to take control of their diabetes, so I decided this week to give it a chance. This week, okay, my daughter is five, was diagnosed recently. Since then, it's been a constant roller coaster of highs and lows, and I felt like we couldn't get a grip on her blood sugar at all. And then this person includes two photos their Dexcom clarity reports. It says this first picture is an average data from the past two weeks time and range, 59% average glucose, 170, the second one is just over the last two days since I've been listening to the podcast and making changes that are suggested in the show. Time and range is now 93% and the average glucose is 116 so this person says, I don't want to do this. It's not for me. I have ADHD. I'm not good at podcasts. I don't list the pie as all the reasons in the world not to listen, right? But being in the group, and then this is my point, watching other people share what's been working for them. They finally go, all right, you know what? Let me try to overcome myself here and try this anyway, and look what happened for them. And that's why I'm always a proponent of people sharing what they're doing that's working. Because there are so many people who can't, for any number of reasons jump in. And I've heard the argument, you make people feel bad when you share how well you're doing. I make the argument you are a hope for that person when you're sharing. I think eventually somebody says, My God, they're doing that. I could do that too. I watch it pay off all the time. You don't want somebody to feel bad like you don't want somebody to look at a 116 average glucose and think, Oh, I can't get this accomplished, but at some point you got to do something. And so I say, go out there and share. Be kind about it. Be understanding about it. Don't be very Don't be like, Oh, look what I did. Like, it's not boasting. It's like, there's a way to do this. Like I did it. Like you could do it too. Anyway, I'm a big fan of that idea, and

Erika Forsyth, MFT, LMFT 33:41
she was sending, you know, a positive message to you, but also just and she chose to, I don't know if it was of those public or private, but like, what a great moment. It was private. No,

Scott Benner 33:54
no, no, this was a public post. Oh, okay, okay. I mean, in the private group of public posts, but I'm not giving anybody's details, right? But that person, like, I didn't read the end of it. The end of it is, if you have doubts about the podcast, erase them. It really does help. Like, so now this person realizes, Oh, I've been helped. I'm gonna go help somebody else. And, like, it's nice to tag me and say, Thank you, but that's not that post is, if you're like me and you think this is impossible. It's not. I just did it and I didn't know what I was doing two weeks ago. That's pretty awesome. You know what I mean? Like? So you can be that person listening right now. You can be that person for somebody else. And, you know, yes, that's all I that's how I think of it, instilling

Erika Forsyth, MFT, LMFT 34:36
hope, very important. And she, and she was being vulnerable, right? So she led with vulnerability, and that took courage, and she did something new, and then is instilling hope. And I think that the positive messaging, whether it's you know, publicly in that, in the Facebook group, or privately to your you know, your small debt. Diabetes text chain or to your child is so powerful. And again, I It's okay to validate how hard it is, that's half the work, right? But then to also acknowledge, wow, this is you guys. You're doing a great job, and we need that, you know? We need that encouragement and hope.

Scott Benner 35:17
I also think we do a very good job in the group of exactly know how to do it, because it's not like we're enforcing rules. It's just, I think I have set the tone for what the group is. And so when it was smaller, it took on that vibe of, you know how I am, which is to say, like, I want to be supportive. We're not here to like on people or tell them to do anything wrong. We're not going to tell them how to eat. We're not going to tell them how to manage their diabetes. We're just it's the supportive atmosphere the group built up around the idea of being a supportive atmosphere, and then as it got bigger, somehow it held on to that. I still don't know exactly how, but that doesn't mean that sometimes people don't come in in a bad mood, they don't come in at drunk o'clock, they don't come in when their blood sugar is real high or real low, or they don't see something that tears at their belief system so heartily that they have to they fire back a little bit, right? And people's communication skills can, you know, can vary, and so sometimes somebody's not trying to be harsh, but it feels harsh. Or someone, you know, there's a lot of different things that happen, but we try very hard to deal with those things in the light of day. We don't just, like, remove your like, it's not like, Oh, that was shitty, and just remove, like, you jump in and say, Hey, were you trying to say this? Because it feels like you're doing that. You know what I mean, like, and if you did, I think if you just take out the WoW at the beginning, like, you know, maybe you know, don't let people feel like you're judging them. This would be really valuable. And I'm going to tell you why this is important, and I say it out loud all the time, because there are more people here lurking around than are typing in this group. And those people are waiting for their moment to be that person from that note. They are waiting to jump and go like, I can do this. I'm going to do it. I'm going to do it. And I don't want them to spend six months getting to that point where they're like, Yes, I'm going to do it. And then on that day, they get on Facebook and see you waving your shit stick all over the place and decide to go back in their hidey hole for another six months because the world's a scary place, and I don't want to get involved today. That group is about helping people. That's the only goal it has. It's the only goal I have for it. It's the only goal I have. And if you're going to do something that's going to stop people from being helped, then you don't get to stay right, like so it, but you got to just be nice. I'm so scared they'll leave, and then they don't get to have the the, you know, the experience that this person just shared with you from a one? I mean, imagine a five year old kid. Can I be honest with you? This person posts this thing about that kid, and I read it and I go, Oh, that's cool. Podcast doing what I expected to do. Facebook group worked the right way. They were here long enough they saw it, they jumped in. They learned they're doing better. This is awesome. I'm not cold to it, I just see it a lot. So I was like, All right, great. It worked for them. And then I don't know what happened, I think it was sitting here editing, and it was still up in front of me, and I clicked on the person's picture, and it was a husband and a wife with like, two or three young kids, and I got so filled up, I thought, oh, that kid's gonna have a better life, you know, and they're going to have a better life, and they're going to sleep better, and they're going to be happier, and, you know? And then I just got, like my I got very So Erica. The reason I say this is my eyes filled up, and I want to ask you a question, because you're a professional. Are we at the end? Because I can ask

Erika Forsyth, MFT, LMFT 38:36
my question at the end, you have more. I always had one last point resource. Then I'm going to ask my question. Go ahead, I but we're interrupting your your beautiful, heartfelt story. I just wanted to point to which I think we've done before. Also, if it's feeling impossible to find your group or your people, you're reaching out. Obviously, therapy is a great way to do that, and the ADA mental health directory has a list of people who either have diabetes themselves, they have experience working with people with diabetes, and they also have had to take a behavioral, behavioral diabetes health class or a course to be approved to be in this directory. In the past, it has been you could only search by zip code, which has prevented you from finding people increasing the search?

Scott Benner 39:22
Yeah, close to you, but not in your zip code. Yeah, yes. Hopefully by

Erika Forsyth, MFT, LMFT 39:26
January, they will have a renewed filter just to search by state, so you hopefully will have more people to access to go through that list. Just wanted to share that my.diabetes.org/health-directory

Scott Benner 39:39
Yes, but ADA mental health directory if you're Googling Yes. Okay, so here's my question. My girls took me to that movie with the boy that used to be Spider Man and the girl from Black Widow. Again,

Erika Forsyth, MFT, LMFT 39:53
I will not be able to

Scott Benner 39:54
hold on a second. I'll figure it out for you. Hold on a second. Do you think if I typed in boy? I. Who used to be Spider Man and the Black Widow girl. Let's see if I come up with it. No, but in 2023 an eight year old boy in Bolivia was bitten by a black widow spider because he wanted to become spider man. Get out of here. Is that real? Oh, my God, Dear God, that's not okay. Look at this kid. Oh, that's so, yeah, yeah, little neck. That wasn't gonna work. Okay, hold on a second. Instead, I'm just gonna, I'm just gonna go to Rotten Tomatoes. Where is this move? I mean, they took me to this movie. It was just recently, yeah, yeah. It was like, Jesus. I don't know I I'm embarrassed. I saw this movie, like, a week and a half ago, and I don't remember the title of it, but I did. Why can't I remember the title of it? This is terrible. Also, why is it not where I want it to be? How come nothing works when I need it to work? Damn it.

Erika Forsyth, MFT, LMFT 40:49
It wasn't mo I can start listing Moana too.

Scott Benner 40:55
These are epic. This is a cancer movie, honey. You're gonna get to it just like that. Everybody had can't, like the people like cancer in the movie. What is this? What is it? What was it called? It had the word time in it. All right, I'm getting closer. My brain is coming back. I sound like I'm 1000 years old. Hold on a second. And it was Andrew Garfield.

Erika Forsyth, MFT, LMFT 41:13
I'm getting to it. Oh, we live in time. Is that what it's called? Well, I don't know. That's just a movie that has time in it.

Scott Benner 41:22
We live in time. Yes. Andrew Garfield and Florence Pugh, okay, I'm not gonna ruin the movie for you. Florence got cancer. Okay, you know you're like halfway through the movie, and it turns out Florence has the same kind of cancer that killed my mom. So it hit me pretty hard, right? But I bucked up. I held myself together. And I just want to say that I was in a theater. It was me and 350 ladies and like, five guys who were just too good of guys not to come. You know what I mean? Like so. But I just want I just

Erika Forsyth, MFT, LMFT 41:52
would have been okay. Had you cried, you would have been okay. No, no,

Scott Benner 41:55
wait. So a couple of times to the movie I get, like, filled up, where I will describe to you that my eyes were glassy, but water did not go down my face. So when the movie ended, by the way, this is what happened when I saw the person's picture their family. This is why this came up. So when the movie ended, my lovely daughter, my wife, who just are dying to make fun of me for crying, because they know I cry in movies, they turn to Me. Movie ends. You would think people would say, Hey, are you hungry? Do you want to get this to say, we have to go to the bathroom? No, right on me. Did you cry? Right like that? Okay, so I say, No, I didn't, but I got filled up a number of times, and my wife goes, Yeah, that's called crying. And I said, No, I don't think so. I think crying is when water drips down your face and you go like that a little bit. I didn't make that I didn't make that noise, and no water went down my face. So you're a professional. Was I crying? Yes, I was

Erika Forsyth, MFT, LMFT 42:49
right. Your tear ducts, your tear ducts, were releasing tears into your eyes. You just worked hard on not blinking.

Scott Benner 42:56
Erica, it's okay. Let's say it wasn't natural and normal. They said the same, oh, good, good. But I don't think I attribute crying to the noise you make when you can't breathe because you're crying. Does not everyone cry like that, like when they're real? I don't cry like that. Often. I

Erika Forsyth, MFT, LMFT 43:14
see a lot of people who silently cry, really, just, yeah, just your tear, your eyes get watery, and then they just, they slowly

Scott Benner 43:22
pour out. Okay, well, I'll apologize to them, because then I was crying. I mean, if you say and you are professional, you went to college and everything, also, we never talk about it, but you went to a really good college, so I believe in you. Oh, thanks. So anyway, when I clicked on this person's picture after they sent me this note, I got real. I got filled up. I was like, and not for the reasons why cynical people would think it's not because, like, oh, I helped them. I didn't have any of that thought. I just felt really happy for them. Because I know where this can go, and I know how much easier it is if you find other people to share the burden with, and you ask for help from people who are ahead of you on the path. And so I just was like, Oh God, good. It worked for them, because I see too many people who resist that, right? They resist this thing we've been talking about for the last 45 minutes, and then they either never find their way to it, or eventually, begrudgingly get drug to it and end up saying to themselves, I wish I would have done this sooner, you know. So I wish you would all just go out there and any of the things that Erica brought up that might help you find connection or ideas it is really, really worth your time, and I think would alleviate the burden that you feel as a caregiver. Yes, yeah, okay, well, go do nobody listens to me. So, I mean, you know, just go help yourself, damn it well.

Erika Forsyth, MFT, LMFT 44:45
And I think what that what you were just reflecting upon the story as you're seeing the picture of the of the family, the little girl you were, you felt filled up because you also had the joy of giving like you through your work. Through your podcast. I know you're not saying this to get these pads on the backs, but like that's the gift of giving that feels so joyful. And I think even in this space of when you're struggling and feeling so unrecognized, you're so exhausted, the stigma you're experiencing is so hard. It feels Hey, it's physically and emotionally difficult to reach out and say, I need help. Can you please help me? I want to, I need to be vulnerable, but that feels scary. But then, in return, you might also be able to reciprocate and give that to somebody else. And that is so powerful. So it's if that helps you move through that space of like, I don't want to, I don't want to be a burden to somebody I don't want to, you know, share all the stuff that feels so hard they're never going to get it and they might not, but also, you're giving them that gift of your vulnerability so that they might be able to respond to,

Scott Benner 45:51
yeah, you don't realize I'm in a unique position to share with you that that recharges me, right? So then when I get back up next week to do this again, like, this podcast been gone for 10 years, like, at some point you think I might just get up and go, Hey, you know what? I'm gonna go get a different job. I don't feel that way. I know this works. I have it set up in a way that it works. And there are going to be new people tomorrow who need it again. And there are going to be people who found it two years ago, who I hear from that they they lose their way again in the future, and then they find their way back through this. This place is a, you know, it's a it's a touch point. For some people, after they've been here, they can come back to it. And so you guys give me the energy and sometimes excitement that I need to make the podcast, and not that I don't like talking to people like that. The truth of it is, if you told me I had to have a conversation with a stranger every day for the rest of my life, I would just easily do that. I would love that, even if they didn't record it. Actually, if they didn't record it, be much better, because I could, you know, enough to be as appropriate and so, um, you wouldn't have to filter. I would. I could just curse way more is what I'm saying. So like, because the cursing is, then the guy's gonna edit it out, it takes time, you know, like, I pay by that minute, like, you know, I don't want to make it sound like I don't want to do it. I absolutely want to do it, but I'm still a person, and I still don't feel well some days and some days I have other stuff going on. And, by the way, I have a kid with diabetes too, and, you know, like, that doesn't become, you know, that doesn't just go away. So I get this feedback from people, and I'm like, Yeah, this is valuable and worthwhile, and it makes me feel better as a human being, like, I don't know another way to say I used to tell people that I was not a Chicken Soup for the Soul person when I was growing up. And as a matter of fact, if you've listened to this podcast and thought this is a good guy, if you would have met me when you were like, I was like, 23 you would have been like, this asshole is not going to grow up to help people with like, diabetes. Like, that's not going to happen. He seems like a prick. I did not have my head in the space at all. And yes, I got into it to help Arden, but I stayed into it because of everybody else, right? Like, she's been helped. Arden is good, and I still learn about diabetes through other people. And even that's not the whole thing, like, the whole thing is just, I somehow, I don't know how created. I don't know, like, a like, a planet of like, where the gravity pulls people in, and people who need it find it, and then they're allowed to fly away when they don't need it anymore, and that's hard to do, so even though you brought up other places that are great, that help people, but those places could work for a decade and never achieve the mass appeal that the podcast has made. So while I have this year, I want to do as much good with it as I can. But the reason I said that is because all of you can go do that thing, you know? I mean, if this podcast is the sun, then you guys could the earth. I don't know a lot about astrology, not astrology. What is it? When we talk about planets, obvious. I don't know a lot about it. But if this, oh my gosh, if this podcast is, is Earth, you guys could be moons all around it, like doing, that thing on a smaller scale for five people, 10 people, 20 people at a time, and that would be, trust me, you would feel the exact same way I feel when someone came back to you and said, This thing you shared with me really helped me. So go, go out in the world and do nice things, please. And it'll get rid of your burden too, which is what we're talking about today.

Erika Forsyth, MFT, LMFT 49:19
We're talking about planetary science. That's Is that what it is the study of planets, planetary science. Scottie

Scott Benner 49:26
slept through that one too. I just want to let you all know that you've been listening to a podcast for 10 years from a guy who barely made it through high school, I mean, and it was because I was asleep, like on my desk, face down, in case you're wondering, just slobbering on on one of those blue notebooks. They don't make any more that, like jeans, you know, what a year old? You know, yes, yes. Not as old as of course. But anyway, nearly are we going to keep doing this? Do you think there? Do you think there's more content for burnout? Or do you think this is going to be a nice, little, contained series?

Erika Forsyth, MFT, LMFT 49:57
I think this could wrap up. You know, this, the. Like the caregiver, the burden, the burnout. I'm sure there are more hot topics that we did not address, but my hope is that these themes kind of encapsulate all of what you do experience on a minute to minute basis. But certainly you can let us know, well, I'm

Scott Benner 50:17
sending you back into the world Erica then to have another great idea for the podcast. Thanks so much for doing this. I appreciate it.

Erika Forsyth, MFT, LMFT 50:23
You're welcome.

Scott Benner 50:33
Omnipod five sponsored this episode of The Juicebox Podcast. Learn more and get started today at omnipod.com/juice box. Links in the show notes, links at Juicebox podcast.com, are you starting to see patterns? But you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would, I think I see something here, but I can't be sure, once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 Hey, what's up? Everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you. Wrong way recording.com. You got a podcast. You want somebody to edit it. You want Rob. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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Scott Benner 1/8/25 Scott Benner 1/8/25

#1401 Beta Bionics (iLet) Clinical Services Director

Kelly Postiglione Cook, Director of Clinical Services for iLet (Beta Bionics) answers listener questions. Kelly holds a Master of Science in Nursing from Vanderbilt University, is a Certified Diabetes Care and Education Specialist (CDCES), and board-certified in advanced diabetes management (BC-ADM).

What makes the iLet pump different from other insulin delivery systems?
How does it handle meals, highs, and the unexpected?
We’re answering your questions about this new approach to managing type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I have a treat for you today. Kelly, who is the Director of Clinical Services at beta bionics, is here to talk about the eyelet insulin pump, and she's going to answer every one of the listener questions that you guys sent in. Thank you so much for doing 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d exchange.org/juicebox, and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa. This is the way t, 1d, exchange.org/juice, box. It should not take you more than about 10 minutes. This episode of the juice box podcast is sponsored by us Med, US med.com/juice, box, or call 888-721-1514, get your supplies the same way we do from us. Med, this episode of The Juicebox Podcast is sponsored by ag one, I start every day with a delicious drink of ag one, you could as well drink. Ag one.com/juice,

Kelly Postiglione Cook 1:57
box. My name is Kelly postiglione Cook, and I am the Director of Clinical Services with beta bionics. Wow, is that a hyphenated name so well, it's technically two last names with all the nursing licensure and whatnot, it was an easier route to go that way. I'm proud of my Italian roots. I was gonna say that in there. Did

Scott Benner 2:16
you grow up with postic Leone is your last name? I did. Wow, that's awesome. I've never heard that name before, and

Kelly Postiglione Cook 2:23
I'm a southern Italian too, so pronouncing that was a bit of a nightmare growing

Scott Benner 2:27
up. It's absolutely awesome. Not often do people say a name, and you think I've never heard that before, but that's really that's wonderful. I really appreciate you Kelly, coming on and doing this with me. So we have a ton of questions from listeners about islet before we start with people's questions, can you just tell me a little bit about your path to the company and what you do there?

Kelly Postiglione Cook 2:50
Yes, well, I guess it's kind of a long, long, long path, if you think about the nursing background and all of that. I got into nursing after being an exercise physiology several years back, when I started getting into healthcare, I thought I wanted to do physical therapy, and kind of quickly realized that I wanted to be involved in medication management, and ended up going the route of nurse practitioners. So I got my NP from Vanderbilt University in Nashville. So I started out working in an endo clinic as a registered nurse before I finished my MP, and I just loved it. There's so much detective work and endocrinology, you know, you do a lot of trying to investigate and figure out what's causing certain symptoms, and even the same thing with diabetes management, there's a lot of Q and A and trying to figure out how to help people, you know, meet their their personal goals. So spending time as an RN in an endo clinic really kind of opened up the world of of diabetes management to me, and I had a great physician that I worked with, Pascal do fan, who's outside of Nashville, who's just a really great teacher. So once I finished up my MP I stayed in the outpatient diabetes world for a few years. Then I did some inpatient diabetes management, health diabetes management, and ended up moving into industry after that and working with an insulin pump company as a clinical rep. So actually, you know, training patients on the device and going that route, did some sales and diabetes tech as well, and then got into clinical leadership a few years after that. So I've worked with tandem diabetes care, companion medical, and then came over here to beta bionics in June of 2023, so right when we were launching this product, is when I came on board. And I'm here because of Ed Damiano, Steven Russell, their mission, the time that they spent putting into this project, and really their why behind it is why I'm here,

Scott Benner 4:48
what attracted you, and I'm guessing too, the there's got to be a connection between Sean and you, right? If you were a companion, is that? Right?

Kelly Postiglione Cook 4:56
Yeah. So he was at, we were at tandem, overlapping. The same time frame, and then companion medical too. He's just brilliant. He's a brilliant guy to work with, Mike men, singer, our Chief Product Officer, the two of them together are just outstanding. They move fast and furious and really do so much for the diabetes community. It's just it's a really fun place to be and a really great mission to be behind awesome. So that's kind of my why for being here.

Scott Benner 5:22
That's excellent. Mike came through Dexcom, right? Am I remembering that right? Yeah.

Kelly Postiglione Cook 5:26
Mike was at Dexcom, and he also was a co founder for companion medical.

Scott Benner 5:30
Gotcha Okay, all right, I'm putting all the pieces. I feel like I'm solving a mystery, and there's yarn on my wall. Does anybody watch only murders in the building? Or is it just me?

Kelly Postiglione Cook 5:40
That's funny. Fun fact, my dad was a homicide Sergeant in Nashville for about 30 years. I think that's why I like the detective work of diabetes management and also endocrinology. Oh,

Scott Benner 5:53
tell your dad if he wants to start a podcast with a guy who doesn't know anything about it, I'll host it and he can tell his stories. That'd be awesome. Oh, oh, my God, He must. Is he still with us? I'm so sorry. Yeah, he

Kelly Postiglione Cook 6:03
actually did. He's done quite a few podcasts. He's the pro with this type of thing, not me. That's awesome. No, no kidding, yeah, so some of that and a show on the ID channel at one point.

Scott Benner 6:13
So cool. All right, okay, so fun fact, yeah, no, that's really wonderful. All right, we're gonna get to it here. So why don't you tell me where the device is right now, meaning how it works for people who don't know, and you know day to day how people use it. Yeah. So

Kelly Postiglione Cook 6:32
where we are currently. We have an insulin only bionic pancreas. So the device itself is fully autonomous insulin delivery, meaning that the system determines 100% of the insulin dosing for the user, and it does that through the work of three separate algorithms that work in conjunction with each other to get the user to goal. Hopefully, those three algorithms, I know you guys have talked about them on previous podcasts, but just as a reminder, you've got a basal algorithm that's going to modulate every five minutes, layered over that you have our corrections algorithm, which I think really sets us apart from other devices on the market, because it's a really it's got strengths to it. So if a user you know forgets to announce a meal or has a snack that's not covered, that sort of a thing, our corrections algorithm can really provide that, that safety net for them, and also work with those postprandial highs as well. So the corrections algorithm is truly a separate algorithm layered over that, that basal algorithm, and again, can also dose up to every five minutes as needed. In addition to that, you've got the meal announcement algorithm, so that will determine the user's meal needs based on their usual size, breakfast, lunch or dinner. Meal announcements, those three work in conjunction with each other, and the device itself doesn't ask the user to specifically carb count. It asks them to be carb aware, which means, you know, you're aware that a bowl full of spaghetti noodles, for example, is going to be higher carb than, you know, two slices of bread on a turkey sandwich. So just being aware of kind of general amounts of carbohydrate, how

Scott Benner 8:07
does it handle fat, and the impacts of like fat and protein,

Kelly Postiglione Cook 8:11
that's actually been a really interesting thing watching this system work, is you don't have to make any adjustments for that so that corrections algorithm will come in after a meal is announced and doses received for that so if a user is absorbing carbohydrate more slowly in that postprandial time frame, that corrections algorithm will come in as needed with the strength that's needed. So you don't ever have to adjust an announcement or the timing of that announcement based on the fat or protein content of a meal, which is relieving for people who've had to worry about that before. Yeah,

Scott Benner 8:47
in a situation where it doesn't work out, like, for whatever reason, and we see, like, a stuck high blood sugar, I'm right to say, there's no ability for the person to just, like, say, correct like, there's no ability for them to give themselves a Bolus, even, right? And you don't want them announcing fake carbs. So how does that get handled? I used to hate ordering my daughter's diabetes supplies. I never had a good experience, and it was frustrating. But it hasn't been that way for a while, actually, for about three years now, because that's how long we've been using us Med, us, med.com/juice, box, or call 888-721-1514, us, med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. Us. Med. Carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7 they accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with a better business bureau at US med.com/juicebox, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do. I have two resolutions for 2025 keep doing what I'm doing. So that means drink AG, one and get on a rowing machine the AG, one thing that's going to be easy, because that's every day. It's super simple, and I enjoy it. I'm hoping I get myself on that rowing machine. The way I'm trying to think about being healthy is by creating a sustainable pattern to my day. Get up in the morning, drink, AG, one exercise, shower, get ready for work. I need a routine, and it's never too late to start that routine. You can start today with ag one. And ag one is offering new subscribers a free $76 gift. When they sign up, you'll get a welcome kit, a bottle of d3, k2, and five free travel packs in your first box. So make sure to check out drink. AG, one.com/juice box to get this offer that's drink. AG, one.com/juice, box to start your new year on a healthier note.

Kelly Postiglione Cook 11:30
That's a great question. You're correct in that you should never use a meal announcement to correct for a high glucose value. So with the corrections algorithm when you're using fully autonomous delivery. That doesn't mean you're never going to have higher low glucose values. Those will still happen, and if there ever is a high that's lasting longer or higher than the user is really comfortable with, you definitely want to make sure that the infusion site is not bad. We have an alert on the device for high glucose. If you're above 300 for 90 minutes, we would ask that you check the integrity of the insulin site and make sure that or the infusion site, and make sure that that is not compromised, because it's pretty rare that you're hitting that value for that time frame using the islet, because the corrections algorithm does have strengths to it, and it will work to bring the user down. Now, if you see someone who has a high glucose value after a meal, let's say maybe the meal announcement, you know, wasn't sufficient. There was, you know, maybe it needed to be a more than usual, but it was announced as usual, something along those lines. I completely Can, can sympathize with that. It's frustrating to see a high glucose but because the the corrections algorithm has some strength behind it. You don't want to intervene because you've got insulin on board. It's already come in, and it's doing that work for you. One of the things Dr Russell says, our chief medical officer, is it's not your job anymore to correct a high glucose. So even if you see that value, just rest assured that it is going to come down, even if it took a little bit longer than than you necessarily wanted it to. And that singular event, you know, that's not going to change things long term for the user, and the system will resolve it for them, but intervening and trying to deliver either external insulin, announce a meal, that sort of a thing, can really mess with the learning of the system, but also put the user at risk for hypoglycemia, because that corrections algorithm is already working hard to bring it down, right?

Scott Benner 13:24
It's almost like you're stacking at that point exactly. And listen, I'm not trying to put you on the defensive about how, I mean, I think the device works the way it works. And, yeah, right. So you're not trying to, like, if you're a person listening, and you've got, like, a, five, one, A, 1c, and you're tinkering all the time and making adjustments and everything like, good for you, but then this probably isn't for you. Is that fair or no? Do you think a person could have a five a 1c on islet?

Kelly Postiglione Cook 13:52
We have five a one CS on the islet?

Scott Benner 13:53
Is it with eating strategies too? Or,

Kelly Postiglione Cook 13:56
honestly, we don't have published real world data yet, so I couldn't speak to that, and it wouldn't involve, like, you know, any kind of patient interview type things. But I think typically, if a user has normal hemoglobin levels and their a 1c or G m i values, I shouldn't have said a 1c G m i values, is what we can see. If they're running that low on the A 1c side, and they're not having hypoglycemia and that sort of a thing, I'd say they probably have their insulin doses pretty tailored in and there's, there's not a lot of maybe variation to carb amounts in a lot of scenarios. So in that situation, they probably were going to do fantastic on any automated system. But people who eat really low carb on our system do really well. So it's not uncommon to see really low GMI values without hypoglycemia. Got it.

Scott Benner 14:42
Got it. I understand, yeah, do you think, I mean, I know you can't tell me anything. You can't tell me, but like I have, I mean, go to one of my questions here this, this person said, Is there any chance that islets going to be able to offer lower targets? So they said, lower a, 1c, results. But I think what they. Mean is like targets. So right now, what is the target for the device? So

Kelly Postiglione Cook 15:04
you've got the option of three different CGM targets, but keep in mind the our system works so differently than others. I think the idea when people think of a numeric value associated with those targets is that, like, that's where the mean glucose is going to be. You know, if you have it set to that target, and our system just works a little bit differently from that. But we have our usual setting, which is at 120 milligrams per deciliter. Lower is at 110 and then higher is 130 milligrams per deciliter. Okay. And

Scott Benner 15:34
do you foresee a world where one day I can target 80 or 90 and that that will make it more aggressive and search for lower GM eyes. We

Kelly Postiglione Cook 15:44
have a lot of active projects going on, and I don't think that's out of the question. I couldn't speak to, you know, timelines and things like that, but I understand. I think definitely looking at changes to the algorithm is definitely not out of the question, right. Okay,

Scott Benner 15:57
all right. So here's a real like user question, how do meals adapt when the meals are less than four hours apart? So it was explained to me that if you announce a meal at 9am and then have another meal at 11am that the system can't, I don't know, like the user wasn't sure, but he felt like there was an issue, and he wanted me to ask that question. So am I making sense to you? Like, do you know what the question is? Okay, go ahead. Sorry, yeah.

Kelly Postiglione Cook 16:25
So part of the way that the system learns is from those meal announcements. So let's say you announce a breakfast meal, like you said, At 9am I've announced a usual breakfast the system is actually going to look at that four hour postprandial window, and within that window, it's going to see how much correction insulin was necessary. Do we need to adapt this dose for this user's specific needs? That dose will carry a 1/7 weight for breakfast announcement, so it uses an average there of the last seven breakfast announcements. So it needs the four hours to be able to adjust that dose or adapt. So in the beginning, when you first start the system, that four hour window is important. We want to make sure that we set the system up for success, that it learns the user's baseline needs and that it's effective. So in the first few days, we do ask the user announce your meal. Give it about four hours before you announce another meal, or have any kind of snacks with carbohydrate in them that would impact the glucose levels, because the system is still figuring out what your needs are. Now, once you've been on it for several months, you know that sort of or really after that first week, and the system knows what your needs are, there's no need to space those meals out by four hours anymore, because every dose doesn't necessarily have to be counted for adaptation. So if occasionally you know breakfast and lunch are closer together than than that four hour window, it won't adapt based on that dose. But it's not a big deal because it already knows what your needs are or write about what they are, so it doesn't have to adapt for every single meal announcement that is made so long term. It'll adapt when it's got that four hour window, and then if it doesn't, no big deal, it'll catch it on the next one.

Scott Benner 18:05
For how much time in history is it considering the user? Like, if a person's on this for 10 years, is it going to be thinking about 10 years worth of data, or, like, what's the window it thinks inside of? So

Kelly Postiglione Cook 18:16
for meal announcements, it's looking at the last seven for that particular type of announcement. So the last seven breakfast announcements, seven lunches and so on. Okay?

Scott Benner 18:25
So seven meals or 21 meals, seven, seven and seven

Kelly Postiglione Cook 18:30
No. Seven meal announcements, yeah. All right.

Scott Benner 18:34
So it's making decisions about insulin for food based on the last seven meals that you've experienced and the outcomes and what it needed to do, et cetera. Exactly gotcha. I had someone say to me that I moved to islet to get away from carb counting. They talked about the mental health stress that they were under, always carb counting, getting it wrong, feeling that pressure, et cetera. Yeah, but they did tell me that it has been replaced a little bit with the fear that they're going to pick the wrong meal size. Like, how do you ask people to judge, is this a I never get these right. It's a normal small How do you guys

Kelly Postiglione Cook 19:15
usual? Usual is, and that could be anything. So if your usual is 80 grams of carb with a meal. That's totally fine. That is your usual meal. Okay, yeah, but that's a big range. Usual can count for a large chunk of your meals, if you will, because you don't go to a more than usual unless you're eating one and a half times what you normally would. And you wouldn't go to a less than unless you're eating less than 50% of what you normally would. So it's a pretty wide range. So for most of our users, a vast majority of what they announce is gonna be usual. Gotcha,

Scott Benner 19:49
okay? And then, like less than usual, it's still too big for I'll get to another question here. A person said, Hey, can I get you to add a snack button to this thing? So I. Guess what they're saying is that less than usual is not quite the same as like, I grabbed a candy cane off the Christmas tree, or I had a handful of nuts as I walked through the kitchen. Like, I think that is that right? Or are they not seeing it correctly? So

Kelly Postiglione Cook 20:14
it depends on what usual means for that particular user. If their meals tend to be significantly higher in carbohydrate than their snacks. So for a less than meal, you wouldn't use that announcement unless you were having at least 25% of what you typically would have in a meal. So if the snack is smaller than that, you would not announce it in that scenario. But you can use the less than announcement for any particular meal, for your snacks as well, if you are having something with enough carb to be considered a less than announcement. Okay,

Scott Benner 20:44
so in a scenario where my blood sugar is 110 I haven't eaten in hours, and I quite literally walk past the Christmas tree and grab a candy cane, I can't Bolus for it, but my blood sugar rises, then what happens? So the

Kelly Postiglione Cook 20:57
corrections algorithm would come in and handle that for you, we have quite a few users who never announce snacks. You know, they may have a small granola bar that's, you know, not super high in carb content, and do totally fine without announcing that snack. Or other users may want to announce that snack and use one of the less than options, like I said, if it's appropriate based on their usual carb content.

Scott Benner 21:21
Do you think I know again, you I'm not asking you to guess for the company, but is the goal that one day it's just a button that says I'm eating. You know what I mean? Like, is that where you're trying to get to, because either people using, you know, DIY algorithms that have their settings jacked up in a way where they're not announcing meals anymore, like literally not even announcing them. They're just the eating, and they're probably a lower carb eater, but still, they're eating and seeing insane outcomes, like, so, I mean, now that's a very learned person making some pretty significant adjustments to their insulin. But like, bigger picture, I mean, if I'm in a board room at beta bionics, is that the big conversation, like, how do we get it to towards, like, as close to that as possible? Because that seems like what you guys are trying to do with this system. But I think

Kelly Postiglione Cook 22:08
if it can be done, we have the right team to do it. I can't speak to you know, exact product changes, things like that, that are coming down the way or timelines, but I can tell you, if it can be done. We have the team to do it, and like I said, they work fast and furiously. It's never out of the question. How can we improve? How can we make things even easier than they already are, right? That's definitely a part of the conversation, absolutely interesting.

Scott Benner 22:34
Okay, person here who is a user says, I need a better solution for when I don't have CGM supplies, or CGM data. What does that mean? What are they telling me? So

Kelly Postiglione Cook 22:43
with the islet, the system is not designed to be used without CGM, so it goes into what we call BG RUN mode, which means it's running off of blood glucose meter readings at that point. So it's not designed to be used like that, but it does have built in where the user can use it in that BG RUN mode for up to 72 hours. So if they lose CGM connectivity and they're out of sensors, they've got 72 hours to get back online with a sensor so that they can get back into going bionic and having that closed delivery. So they have 72 hours there. What I will say is what we've seen in a real world setting, Bg, RUN mode, just hasn't been a problem. Very low risk that users end up actually to the point where insulin delivery stops, because that's what would happen at the end of that 72 hour time frame. But we're just not seeing it happen frequently, which is fantastic. And then the other part of that is we innovate quickly. So we have the option to use either Dexcom g6 or g7 and now the FreeStyle Libre three, plus previously, when it was only one sensor connected to it, it was a little bit more difficult to get access to, you know, samples and that sort of a thing that can sometimes help to bridge a gap. If a user, you know, forgot to place an order or something like that, or there's a delay at the pharmacy, or now there's more options, and you can switch between the sensors at any point in time. So you can go from, you know, a Dexcom g7 to a FreeStyle Libre three plus, and then back to a Dexcom g7 so you can do that as needed. So that's I think it improved some options for patients if they do run into an issue where they don't have CGM supplies for whatever reason, but they do have a 72 hour time frame, and there's on the screen itself, it will let them know the timing of when the system would stop delivery. I see, okay,

Scott Benner 24:38
you've been going pretty fast and furious. Here, I'm going to give you an easy one so you an easy one so you can breathe. Will I let be coming to Canada? So we

Kelly Postiglione Cook 24:46
actually have talked about international plans. We just don't have a public timeline on it yet. So that is our plan to be available internationally. We just don't have a timeline for that yet.

Scott Benner 24:55
I see you pretty lean organization still. Is that a is that like? Head count issue sometimes, like just having the people to put on

Kelly Postiglione Cook 25:03
it. I mean, we do run lean, but I think, no, I think we just got some other projects that we need to kind of take priority for the time being, and then we'll probably have some timelines around that, hopefully in the near future. Okay,

Scott Benner 25:16
all right, I'm gonna jump back to a user question. Can I select breakfast as usual for me, if it's not breakfast time. So this person said, what happens when I do breakfast for dinner? Is it dinner or breakfast? Like, is the algorithm thinking about the kinds of impacts that normally come at that meal time? Like, do you see the question? Yeah, okay, cool. So

Kelly Postiglione Cook 25:40
you have two choices there, either you can announce based on time of day, or you can announce based on meal content. So for example, if pancakes are typically a breakfast food for you, and you want to always call pancakes breakfast, that's totally fine. You can announce that at any time of day. Or if you want to call pancakes dinner because you're having it at dinner time, that's okay, too, and just announcing based on the carb content for that particular meal. The key in those two strategies, whether you're announcing by time of day or content of meal, is just be consistent with it, because that's going to teach the system the most accurate information about you if you're consistent with the way that you announce. Okay, so

Scott Benner 26:19
it's not that the algorithm thinks breakfast foods are carbier. It's that if you have breakfast foods that are more aggressive in nature, then it will start considering breakfast to be like that. Is that? Right? Right? Yes. It's not like magically thinking like, oh, they eat steak at dinner and they eat pancakes at breakfast. It's not like that. I gotcha. Okay. I didn't think it was, but this person, again, real world situation. They said they made breakfast for dinner one day and they stood there going, I don't know what button to push.

Kelly Postiglione Cook 26:52
I think a good takeaway from that is, you know, typically, if you just don't have to overthink it again if you mess up a meal announcement. On occasion, it only carries that 1/7 weight, so it's not a big deal in the grand scheme of things. It'll all kind of come out in the wash, if you will. But I would say, try to be, you know, consistent in the way that you announce. If that's something that you do frequently, then you would want to announce the same way with with that type of a meal. I told

Scott Benner 27:19
this one person I was talking to that when they describe how they Bolus with their eyelet, I feel like I'm listening to somebody discuss how a Fresnel works because, because the Fresno users are always like, I don't know, I did a four and then an eight and then a four, and I'm like, I don't know what that means. But anyway, I'm gonna jump to a long question here from a parent. Okay, I'd like to know how to handle teenagers when basal is changing so rapidly and the pump doesn't seem like it wants to keep up. I honestly thought about giving him some long acting on top of his pump, but I didn't know how that would affect the pump algorithm, which you already said, don't do that or mess things up long term. His endocrinologist states that this is totally normal practice for kids on other pumps, but she was uncomfortable doing it with eyelet, like layering over other basal. He's literally the only one in the practice that's using eyelet, so it sounds like they're not getting a lot of help there when he doesn't dose for a meal, because that happens. How does the pump go about interpreting that? I feel it's a semi counter intuitive to the basal and pump runs because the company tells you not to Bolus if you realize you missed a meal 30 minutes out. So she's got two different questions in a very quickly shifting landscape of maybe weight gain or like, I mean, listen, honestly, Kelly, if you gained weight, if you suddenly became sedentary, if you suddenly became active, if your basal needs change for any reason. Like, how does it keep up? And when it doesn't keep up, what are you asking them to do? So

Kelly Postiglione Cook 28:44
it adapts really quickly to scenarios like this, where, you know, a growing teenager that's a tough population for, you know, trying to manage their glycemia in general, but especially with the growth. So with the islet as a user's needs change, the system can adapt really quickly to that. So it does it in about a day or so again, if someone's hitting a growth spurt and all of a sudden their insulin needs are going up, the way that that basal and corrections algorithm is looking at what's happening right now, which is always going to trump historic data, right? So if you're sky high right now, you're going to get more insulin, even if you were not that high previously. So what's happening now always Trump's historic data, but it does know your historic data too, so it has a starting place. So for example, if somebody has Dawn phenomenon, it learns diurnally. It will learn that your needs are higher in the first part of the day and lower in the next part of the day. So we'll learn that information, but it takes about a day or so to adapt to the user's new needs. I would be curious with this particular user, it's rare that we see that it can't keep up at all. So I have additional questions about that, and I would encourage the user's parent to call into our customer care. You can actually get connected with our diabetes education team. And they'll review reports with the parent and kind of talk through what they see on there as well, and can kind of coach to how to get the best outcomes using the islet. And I would also encourage the endocrinologist or the clinic in general, they could check out. We have several webinars online about managing users on the islet that they could take a look at as well. But the question about you the basal not being able to keep up. I kind of have questions about it. Not being able to keep up. I want to look at a report, but you can use a basal insulin as well. We usually see that more in those who have really high insulin needs, like if they're above 100 units a day, we may see someone add a basal dose to that. Or we may see for athletes who want to disconnect for several hours per day, they'll add a small basal dose as well. We do have a healthcare provider guide on our website that the endo can reference to see kind of dosing for that. But generally, we don't recommend exceeding 50% of the users basal dose on the islet with any kind of external basal, but it'll adapt to that user's new needs in about a day, even if you add basal insulin to it. Okay, so of course, you'd always want to be vigilant watching for hypoglycemia, because that that first day of taking the basal dose will be different than historic data. But again, what's happening now will trump historic data? So it is an option to use a dose of basal. They also can get some help from our diabetes education team at beta bionics. And then, of course, we're happy to connect with that endocrine office and help educate them as well, because it's a totally different approach to insulin delivery, and it's, it's a lot to wrap your head around. I have

Scott Benner 31:43
to say, you have a the ability for them to contact you and talk to, like a, like a practitioner of some kind diabetes

Kelly Postiglione Cook 31:49
educators, a Certified Diabetes Care and Education Specialist. We have a full team of remote educators, and they're fantastic. We cover all the time zones so they're available during business hours. Yeah, we can set up additional coaching. Because what's really great about this product we talked about, there's CGM targets in the system. But other than that, there's not settings. It's all discussions around, how is the user interacting with the system, what kind of information is it learning from, and how can we best optimize it so that the user gets the outcomes that they want from the system. So it's great. They can basically help to coach the user to get where they want to be. So

Scott Benner 32:26
there's still the second part of this question, and your answer just gave me another question, and I saw and I want to show you something, but first I have to say I have a couple of chameleons. So I keep chameleons. I've never heard anybody use the word diurnal outside of reptiles before. So that was,

Kelly Postiglione Cook 32:43
that was fun. That's, that's an ED Damiano, uh, special there. That was

Scott Benner 32:47
fun. Like, I've been making, I've been making the pies my 11th year, and I've made, like, 1400 episodes. And I was like, no one's ever said diurnal before. Anyway, the second half of her question was about, what happens if the kid just whiffs and doesn't Bolus at all. So are you saying? Is what she said, right? If, if I forget, it's fine five minutes later, but after 30 minutes, I don't do anything. Yeah.

Kelly Postiglione Cook 33:12
So if you don't announce a meal and it's forgotten, if you're more than 30 minutes out, typically, the glucose has already started to climb, and you're going to start getting a reaction from that corrections algorithm. So after 30 minutes, if a meal announcement wasn't made, then we usually recommend not making the meal announcement at that point and let the corrections algorithm cover it, so that the user is not at risk for stacking and hypoglycemia if they do announce at that point.

Scott Benner 33:39
Okay, I have to tell you that I'm happy to say that my daughter has been using an Omnipod since she was four, and she's going to be 21 this summer. It's been fantastic for us. And I've always, steadfastly, over the years, said I'm very happy with Omnipod. I have no reason to move but at the same time, the advice I give anybody, and the advice I would take myself is that you do not want to wake up one day and say, I'm doing this thing. Nobody does. Nobody do it this way anymore. Or did this thing not come along with the times? And I'm not saying that Omnipod five isn't coming along with the times. I'm saying I love you guys all fighting with each other. It's awesome.

Kelly Postiglione Cook 34:18
I think it's good for everyone. Yeah, I think we all push each other to be better. And I think for the diabetes community, the more options that are out there to meet needs, the better beta biotics, it's been such a cool place to be because we have helped people get onto product that maybe wouldn't have been considered device candidates before. I have my own very like staunch soap box around that in general. But, you know, there's people using our product that really wouldn't have been considered for other products, and they're doing fantastic, which is been really rewarding to be a part of.

Scott Benner 34:53
Well, I first of all, I think you guys should just all get into a fight, of all fights, and keep trying to innovate and make things better and better. Forever. That's awesome. And I have to say, the first time I heard about eyelet, what I thought was, wow, you're telling me, I can put a pump on somebody who might be wandering around with an 11. And by the way, this is a thing. I think people listen, oh, that doesn't happen. There are a lot of people wandering around with 1112, 13, a one, CS, much more common than you think. And you know, even if it's a nine or an eight, like you're telling me, like, you could put a thing on something, somebody could just go, it's breakfast. This is usual, and they do better and be healthier. Awesome. Like, really awesome. I think when I was talking to Ed or Steven, I said I would put sales effort into GP offices, because I bet that's where those people are getting their help with their insulin to begin with. I bet you they're not even seeing endocrinologist. Yeah,

Kelly Postiglione Cook 35:44
I think you're right. There's about half of the people that live with type one don't receive endocrine care. Yeah, that's a tough place to be, because, you know, you're in a primary care or internal medicine setting, and the time frame around that visit, it's really difficult to address everything that's happening in your health, and that that small window, let alone discuss diabetes technology, or, you know, yeah, be able to interpret reports, that sort of a thing. So, yeah, I think that there's some, some room there. In general, it

Scott Benner 36:12
just makes sense to me, like, if they seem like people who could really use it and who are not going to hear about it, because, I mean, you just got a question from somebody who listens to my podcast who is telling you that they're in their endocrinologist office and they're the only one using an eyelet there, and the endocrinologist is like, well, this is what I would normally do, but I don't know if I can do it with this. So we're not going to do anything. And you know, like, that's I'll give you more work to do. I think you guys should be doing that. I think it would be awesome. Okay, so here's my next question, how does one use the eyelet for exercise? Growth hormones, like periods, like anything like that, like that seems to be not just for islet, by the way, but most algorithms that let me say it like this, most, what I'll call retail algorithms, seem to give people problems in those situations. So what do people see? Their kids sit in school all week long, and then on Saturday morning they get up and run around like a lunatic at a soccer game, and they're like, Oh, my kids, blood sugar gets low on Saturdays because the algorithm thinks this is how much insulin they need. But then, you know, etc, or growth hormones overnight, or, you know, period. So my daughter has PCOS, like, I'm sitting here the whole time wondering, like, I don't know if this could handle Arden or not. Like, so, like, what do you like, what's the direction right now for people who are in those situations? Yeah,

Kelly Postiglione Cook 37:30
I think any kind of physiologic stressor, you know, whether that's hormonal, whether that's illness, anything that's going to cause a higher need for for insulin. It usually takes about 24 hours for the system to adapt to the new you, if you will. What we see is about that 24 hour time frame to get to the new mean glucose. You know, we've seen. They did a sub analysis of the people in our pivotal trial, for example, that use corticosteroids and and found that they reached their new time and range and main glucose within about a day or so. So you actually, you don't have to do anything with the system. You could be proactive with the CGM targets, and of course, you have to speak with your healthcare provider about that. But let's say you're at usual and you want that corrections algorithm to come in a little bit earlier in a in a glycemic excursion, and just run a little bit lower, you could drop it down to lower to be a little bit more proactive. So you have the CGM targets in there, but otherwise, you just give it a day and it'll adapt to the new you, which is really a great piece of this system. So when people have had illnesses, just anecdotally, what we're seeing in the real world, the system adapts really well to their new need pretty rapidly. Now, if someone's needs decrease significantly, keep in mind the system will what's happening now will always trump historic data. Again. That doesn't mean you're never going to have a low glucose, but the system is going to recognize the trend that you're, you know, average CGM reading, you're different today than you were yesterday, and it's going to adapt to that new need as well. So again, you kind of become a new you in those scenarios. Exercise is different, though. Exercise is a little bit different if we're talking about kind of episodic exercise,

Scott Benner 39:16
yeah. I mean, there's more than I didn't send all the the people to you that said, I really this thing, this thing really needs exercise mode. So, and by the way, I want to give you a bit of credit here, like, I had three follow up questions while you were talking, and you hit each one of them. I was just like, oh, I don't have to ask that now. And then I had another one. I was like, Oh no, she got that one too. Somebody should give you a raise or something. So you really,

Kelly Postiglione Cook 39:42
I don't know if I'm John, are you listening? No, I'm just kidding. I don't

Scott Benner 39:44
know, Kelly, if I'm in charge of that, but if I was, I'd like to see with a nice, at least 15% bump. But go ahead, tell me. How come you won't just give them an exercise button. I

Kelly Postiglione Cook 39:52
would say that we won't just give them one. It's definitely a project that we've been working on. I don't have a timeline that I'm able to share currently. Hmm, but it is something I think, that, you know, we regularly request feedback from our users, and that is something that we've heard, along with the snack option. And those are both two active projects. We just don't have a timeline for release, and need to do some testing around those. For exercise. Currently, the strategy is, you know, if you're someone who you can either wear it while you're exercising, you know, depending on the type of activity, if it's not something that typically causes you lows, you could leave it on for that. If you do choose to wear the device during exercise, like with all aid systems, it's not a great idea to pre load with carbohydrate, because you're going to kick in some correction insulin, and you could cause a low because of that. So if you're going to stay connected, don't pre load with carbs. If you do want to pre load with carbs, you can disconnect. And we added a pause feature to our device last year, where when you disconnect, you pause it. It's not learning or anything like that, during that time frame while you're disconnected. And then you know, once you complete the exercise, reconnect and UN pause. It's got a little timer on it too to remind you to UN pause your insulin as well. I have to fish a

Scott Benner 41:06
little bit here, because I feel like I heard you say something earlier that would indicate to me that you and I would get along really well. Talking about diabetes, you said you had an opinion about not putting certain people on products, which I felt like. You wanted to say that some endos don't give people pumps because they're struggling, but they should. Is that what you were going to say?

Kelly Postiglione Cook 41:23
You know, not in my capacity as a beta bionics employee, I'll start there, but as a diabetes educator, I you know, if someone understands the risk involved with going on a device, I don't think it's fair as a prescriber to not consider them for a device.

Scott Benner 41:41
This is awesome. Okay, if so. Now I asked that to ask you, would you, as a diabetes educator, tell people to take their pumps off to for activity you want them having active insulin, right? So

Kelly Postiglione Cook 41:52
it depends. I think disconnecting and taking the device off is really common. I just wouldn't leave it off for really long, extended periods of time. So like, if you have someone who's going to be doing, you know, hours of activity, that's the kind of and they want to take their device off for that, then that's the kind of person I would say, well, maybe we should consider adding a little bit of basal insulin so that you're not completely without insulin, because you don't want to be in that scenario either. So, you know, typically, if you're disconnecting for about an hour or so, and then reconnecting. You should be in good shape there. I think that's a pretty common practice. But I also think, you know, there's exercise modes available and other devices. I wish we were better at exercise in general, as people who recommend things to people who live with diabetes, exercise is just a tough one, because people respond differently with different intensities, and it's just kind of a tough one to conquer in general. But even with the exercise modes on other systems, you know, I'm sure they help, but I think there's a lot to be desired there still. So I think people do want an exercise option on our device, and we'll bring them that first

Scott Benner 43:00
of all, definitely, right? Like, exercise, it's not a, it's not a catch all. Like, I think it's just a more of a, hey, pump, I'm about to get way more active. Like, that's the mode. And then if, if the button doesn't work, the button, if the button doesn't work for you in that situation. Now, at least you know, but at least you have the option. I think that's what they're saying about the snack thing too. Like, I don't want to go up 20 points because I had eight carbs of something. Can't I just tell the thing I'm snacking now, so that it gets a little more aggressive sooner. Like, so, like, let me pivot into my other question. Like, do I not want to Pre Bolus my meals? Or do I, like, some companies are, like, Don't Pre Bolus, Pre Bolus. Like, I don't know, like, how much that has to do with the algorithm. But, like, Listen, my daughter uses trio, okay, and it's about as aggressive as a DIY algorithm as I've seen so far, that in the loop, and she has to Pre Bolus. Like, so like, what do you guys tell people to do?

Kelly Postiglione Cook 43:57
Yeah, insulin. It'd be great if we could keep getting it to be a little bit faster, right? Yeah, be nice. So the way it was done in the pivotal trial is that they told them to announce the meal when they sat down to eat. So that's the recommendation that we go with. However, if someone is a Pre Bolus er, and they come to us with that habit established, whether it's from MDI or from another device. Absolutely continue doing that. You just want to be consistent, because the meal is going to learn from your behavior around that. So if you're a Pre Bolus, or, you know, no more than 15 minutes before the meal, and be consistent about it. Otherwise, our kind of general recommendation is, you know, announced at the time of of eating. But I do think there's some people that get better postprandial control. If they're Pre Bolus. Saying a bit with that, yeah, for sure, the big thing is just don't forget to eat. A few pre, I guess I'm saying Bolus, but really, pre announced, just don't forget to eat, right?

Scott Benner 44:53
I see what you're saying. I see you're covering your ass. I see what you're

Kelly Postiglione Cook 44:55
doing. That one was for regulatory I hear you.

Scott Benner 45:00
So I mean, listen like I heard what you were saying earlier, and I see the value in this, and I see the value in where I think all this is going. But if you told me that my daughter's blood sugar had to be 180 for an hour and a half or two hours after she ate, that's a non starter for me. Like, and I think a lot of people listening are in that boat, but love everything else that's being said. And so they're trying to figure out, like, well, how can I use this but not have that experience like and also I think it's possible that from the way you're talking and and how other people who have come on from Benny have spoken in the past, I also think it's possible that I wake up two years from now, and that's not a concern anymore for now, for the people who are like, Oh, I'd like to try this, but I think that's what this conversation is. It's trying to assuage their butts, so that they That came out wrong, like, so that they, you know, so they can say, like, is this a viable thing for me right now? So I appreciate you asking all these questions. Here's another one that's not going to be covered by any testing, but is going to become more and more prevalent as each day passes. So this person's questions a little longer. I know weight is a factor in how the pumps algorithm works, and that you just, you know, do meal size and versus carbs and etc, but what about people who are also on other medications that help them with insulin resistance? So this, I know this is a GLP question, so I know you can say like, look, glps aren't FDA approved for type ones, but, you know, Wake up and smell the coffee, if that's how you think. Because there's a lot of people who have type one who are using GLP medications. So I'm assuming you guys have tried to look at it like, does that change anything? The slower digestion, the slower spikes like, this is going to be weird, because we're not on camera, but I'm going to pop my camera on for a second for you to show you something. So this is my daughter's last 24 hours, wow, and her top line is 120 and her bottom line is 70. Okay, so you see that she hasn't been over 120 or under 70 in 24 hours, right? That's trio. It's and it's also Manjaro. So I put her on a GLP. I watch her insulin needs drop. I go in and I tell it, all right, hey, let's make the insulin sensitivity weaker. Let's make the basal weaker. Let's make the insulin to carb ratio weaker. Boom. We're back in it again. Is what you said earlier about the 24 hour window. Like, do you think it would keep up with that? That change. So

Kelly Postiglione Cook 47:21
for basal and correction, absolutely, if it impacts the way that the user's eating, and that the amount of carb for their usual is no longer the same, and it's significantly less, for example, and they need a much smaller dose of insulin for the usual amount of food that they're eating, you've got a couple of options there. You can kind of announce and and let it adapt down. Or you can do what we call as a factory reset and take it back to zero and just start over with it. You're a brand new person, and now it's learning from zero with you. If you started a medication like that and thought that the really it's you would factory reset it. If the meal doses had gotten too strong, and we were worried about a risk for severe hypoglycemia, if you were to announce for your meal. So if that's the case, you would factory reset it to bring it back to zero if you really changed how you were eating. So same thing would go if someone, you know, woke up tomorrow and decided, I'm going keto, and I've never done this before, and you know, I'm really going to need, like, significantly less insulin than I typically would. That would be a scenario where you would talk to your health care provider about starting over and kind of factory resetting the device. But that being said, if someone's using that medication, it'll adapt to how their body's absorbing food, similar to, you know, we have users who have gastroparesis, didn't specifically test it for that, or have special indications or anything like that, just kind of watching how the system works. You know, the correction insulin will come in as needed. So if their carb absorption is, you know, delayed to some degree, it will adapt to that specific need. So same thing with the GLP ones as well. So we do have users who are just anecdotally using the GLP ones as well. I didn't I wanted to circle back to something you said earlier about meal announcements and hanging out at 180 for like two hours after the meal. That shouldn't be a typical experience on the islet. I mean, if it happens occasionally, because maybe you ate on the the top end of your your usual amount of carb, or it could have gone either way, with a more than announcement or a usual Sure, you may see it happen in those scenarios. But if you're in that hyperglycemia area, I mean, you're getting correction insulin, and it's trying to bring you down, which means your meals are adapting up right? So it's going to adapt up until that's not something that's happening routinely. So if that is happening regularly, and again, you know, the user feels like they need a little bit of coaching to get that, you know, to stop happening, or have someone review reports with them, have them call into the Customer Care. Again, we've got that great education team that can work with them, right, and review that. That for them, because that really shouldn't be a an everyday or regular occurrence. I

Scott Benner 50:04
mean, also, I don't want to, like, try to say that, like, in case people are listening, like, my daughter's blood sugar does that too. Like, just because, you know, I showed you 124 hour graph, like, it doesn't mean it doesn't happen like that. Although, honestly, Kelly, you saw that graph and you thought my blood sugar might not be that good, didn't you actually,

Kelly Postiglione Cook 50:20
literally thought that I also have PCOS in my blood sugar does not look that good. Listen,

Scott Benner 50:26
I won't go down this road with you on this, but if you want, after we're done, I can tell you how the GLP has been helping her with her PCOS symptoms. So it's been really valuable. I'm gonna move on here. Let's see, is there or will there be an option to take over? So I think this person's asking you, are you ever going to give them manual control of the pump? I don't think you're going to, but I'm asking anyway,

Kelly Postiglione Cook 50:49
there is not a plan to have any kind of manual mode, if you will. So it goes into when it's in BG run when you don't have CGM capability. That's about as manual as it gets. So what happens in that status is it runs off of what we call a nominal basal. So it will learn what your needs are and look at kind of the last seven days, and average that out and figure out what your body needs at specific times of day. So that would be your nominal basal when you aren't running CGM. And it's conservative, you know, because we don't have have CGM values there for that. So it would run that nominal basal, and then when you you still would announce your meals, and it will give you that adapted dose for each meal announcement the same way it would, or similarly to how it would if you had CGM connectivity as well, but realizing there's no correction in there and all that good stuff. So that's about as manual as it gets. I don't foresee us adding anything further to it to make it manual. Let

Scott Benner 51:49
me answer that. Listener, no, okay, how about God who came on? Sean and from zeros, Paul this past year on the podcast, they were very excited about their their agreement about glucagon. So I'm going to ask, are you guys working on, can you talk a little bit about dual chamber, the ability for this pump to, maybe one day, give a tiny bit of glucagon to save a low blood sugar? Yeah.

Kelly Postiglione Cook 52:16
So that is definitely an active project that we are committed to, and obviously our, our kind of flagship reason we were were founded so super excited about that potential here down the road, I can't speak to any timelines other than it is an active project. Zerus is our partner on that, and we are again working fast and furious, as we do with all things, to make that a reality for people living with diabetes. Awesome.

Scott Benner 52:41
Zeros is a sponsor of the podcast. I just want to point out, I have to tell you, I recall back however many years ago that that picture of Ed and he was like, I'm gonna make a pump that gives you glucagon and insulin. And I mean, I don't know how long ago that was, but I do think it's interesting to think back on it. You know, it's fun to say, like, can you give me a button for this? Can you do that? Can you this stuff takes time. You know what I mean? Like, yeah, and you need people who are dedicated, don't give up, stay in the fight, that kind of stuff, to get something like this out there. So, you know, I think people's questions are great, but I would always tell people, like, just don't imagine. You're just gonna wake up tomorrow and it's just gonna be magically happening. Like, this is a thing that's gonna happen over time. And I mean, I like people being progressive about the thinking, because, yeah, when I think about all these algorithms, Kelly, when I think about them, what I think is, I hope that every one of these companies is treating their algorithm the way Tesla treats self driving like. I hope there's a whole bunch of people looking at data constantly trying to figure out, like, how do I tweak this so it works better? Like, not just like we made a thing and it works, so let's sell it now, but like, we made a thing, it works. Let it go help people. And behind the scenes, we should be continuing to figure out how to use this data to make better decisions, to help more people, a broader range of people, a broader range of people's, you know, who have different implications, you know, variables in their physiology, etc. Because I think it's there, like, I think the answer is there. You just have to dig through it and be persistent to pull it out. So anyway, that's me. You're, I mean, I think you're

Kelly Postiglione Cook 54:20
I mean, I think you're describing exactly what happens on a daily basis with our team, like there's no attitude of, oh, well, that's good enough. They will never stop innovating. Like they're some of the most creative and brilliant people I've ever been around, and it's fun to watch them work and see how quickly they come up with solutions to things. I mean, you know, we've rolled out several software updates just since we've been on the market that have been really exciting. You know, we've got the Share feature, like they built out our circle app, so you can, you know, share the glucose values with your family. Have up to 10 people in your circle. I mean, that was a tremendous lift, and done so quickly. You know, the. Know, the integration with Dexcom, g7 with libre three plus, like, That's fast. It's just been really fast. And they will, I don't think that they will ever settle, which is why I want to be here. And I think most of the people that are here, they just aren't satisfied with with the status quo, which is a cool place to be.

Scott Benner 55:18
Yeah, I hope everybody is taking big swings and not playing from a scared position. Like, that's what I want, you know, for my daughter, for my daughter, like, I don't want her to have to think about this forever. Like, I'm telling you I don't care. Listen. I want to be clear. I don't care if it's you or somebody else, right? I want somebody to, like, send me an email one day that says, hey, guess what? Our pump now has the just push this button feature. Yeah, get to it. You know what I mean? Because I think it's out there. And I think, I mean, this is me, but I think AI is going to help people parse the data faster and get to the answers more quickly. So I'm excited. Oh, I agree. Yeah. All right, let me roll through some of these other questions. How is my data uploaded at my provider's office? Like I take my Omnipod in and gluco blah, blah, blah, do you have something like that?

Kelly Postiglione Cook 56:04
Yeah. So we have an HCP portal, so users connect their islet to the islet app, and then it pushes it up to the cloud, and the HCPs can log in, and they have their patient list, and they can review reports right there. So really similar to other cloud based reporting systems.

Scott Benner 56:21
This is a user question here. Could you ask about the islet for getting the last six hours of data if we just choose Fill cannula option? Does this also happen when changing cartridges and tubing, when the user selects fill cannula, when they do a complete site change? If yes, is there a better time to do a site change? I want to be honest, I don't completely understand that question. I'm gonna

Kelly Postiglione Cook 56:44
assume you do. I do. I was actually surprised to see it in there. I was like, wow, they were really listening. That's great. So when the user fills the cannula, it will not learn from the previous six hours before that site change. So whether that site change takes place on its own, or it takes place with a full cartridge change the previous six hours. Won't be your used for learning. Can you tell me why? Just in case someone had a bad site, you don't want it to think that the user's baseline insulin needs are crazy high. Okay, so

Scott Benner 57:15
meaning, if you guys produce a patch pump at some point, this will persist through that device too, that

Kelly Postiglione Cook 57:21
I can't speak to yet for the current setup. It is in there with the six hours previous not learning from that data, but it is specifically for a bad site, and really where it's going to be most important. Because the second part of their question says, Is there a best time to do the site change, when the device is first learning you you don't want to do it within that four hour window after you've announced a meal because you want those to adapt pretty quickly. So maybe first thing in the morning would be a good idea. You're only doing it every few days, so you know, if you have something going on, like Dawn phenomenon, that kind of a thing, it's going to figure that out anyway. But first thing in the morning might be a good idea while you're still getting your meal announcements dialed in, but otherwise, you can do it whenever, like I said, it doesn't have to adapt to every single meal that's announced. You really can loosen that up once you've been on the system for a long time. You don't have to be really strict or do that four hour spacing between the meals at all I

Scott Benner 58:18
see earlier, I advocated for you to get a 15% increase in your payment. I'm payment. I'm going to 20 because, like, it my note here, after the GLP question was, ask about gastroparesis, and you just, like, you pivoted right into it. I was like, oh my god, I love Kelly. At first, I was like, Did I leave my camera on? Can she see my notes? You're a great example of somebody who came up through it and your understanding of it like you were speaking so effortlessly about this. It's not I'm trying to give you a compliment here, Kelly, like, I know you've sat with attorneys and they've taught you how to talk about regulatory stuff, but it doesn't feel like that. And it also feels like, do you have type one?

Kelly Postiglione Cook 58:57
I don't. My husband loves the type one, but I do not okay,

Scott Benner 59:01
because you talk about it like you have it too. Like, that was the other thing. Like, I could, you know what I mean? Like, you have that, like, there's a naturalness about like, where you pick up, it doesn't just feel like your job, I guess is

Kelly Postiglione Cook 59:10
what I was saying. I'm definitely passionate about what I do. Yeah, no,

Scott Benner 59:14
it's obvious, for sure. Just so, you know, I'm assuming you know already, but it, but it was obvious, because I have a couple things here. I don't know that. We haven't gotten to all of them, but they're inside of other questions. Like this person says, If my CGM goes bad and I don't have a backup on hand, does it create a profile? But we've gone over that, is that correct? Like, so we have that one tape, yeah, would

Kelly Postiglione Cook 59:32
be that BG run setup where it's running the nominal basal and your meal announcements would still be that adapted. Dose,

Scott Benner 59:39
yeah, there's another one here about teens forgetting to eat, but we've got that or forgetting to Bolus. I'm going to give you a statement here. It's not a question. I just want to hear you respond to it. I guess this person said I tried islet, unfortunately, did not like the fact that I had no control over carb counting and that it holds 160 units of insulin. So it went back to my Medtronic cell. Have an ADG pump with a guardian sensor. I might try again in the future. Right now, I'm disappointed. Like, how would you talk to a person who who had that experience?

Kelly Postiglione Cook 1:00:08
Yeah, I think I would want to ask a few questions to understand exactly which parts were difficult. I think, you know, you talked to Ed, you talked to Stephen, they talked about who's right for the eyelet, that, that sort of thing. I do think if being really methodical in, you know, entering carbohydrate values or intervening on high glucose, if it's going to be anxiety inducing to not be able to do those things, this might be a little bit of a lift for someone kind of on the psych side of it, because that is a stressful thing, especially if you've done it for years, right? Like, if that's something that you're used to doing and it, you know, having that control over that aspect of it is important to you, or or anxiety inducing, if it's not there, that's definitely something to consider. I will say, when we've had people go on product who are like, you know, I've been doing all of those things, and I'm ready to let that go like it's it is a burden in the background, if you will, of having to do this all the time. It's not like a one week thing where it's no longer anxiety inducing. It really takes some time. You know, in my talking to, you know, colleagues and friends of mine who have made that transition from doing a lot of input on their aid devices to, you know, using an eyelet and using it as it's designed, with the meal announcements. And that's it they talk about, you know, sometimes it's like a six week time frame for them to really get to the point where it's like, Oh, I get it now rewind, like it's a it's a long time frame for some people to get there to where it's no longer anxiety inducing. They've had enough time with the system to sit with it and say, Okay, I did have that high that was frustrating. It resolved. I've moved past it, you know, I didn't intervene. Yeah, then it's just a longer time frame, I think, for for some people, but for that user, you know, like I said, I'd want to understand more about what it was, how long they used it. You know, hopefully they will try it again in the future, but understand if it's not the right fit for everyone, what you

Scott Benner 1:02:08
just said reminded me of over the years, I've so many times heard the question asked, like, if you could, like, get rid of your diabetes, would you? And most people are like, yeah, obviously. But some kind of old heads will come in, like, people have had type one for a long time, and they'll talk about, like, I don't know who I'd be without it. It's an interesting perspective, and I'm wondering if a little bit of that isn't what you're talking about here. Like, how do I just decide not to be worried or thoughtful about these things that I've had to think about for so long? Like, just letting go of them seems like, for some some people might just feel free like, Yeah, I'll let it go. But some people might be like, I don't know how to let that go. That's interesting. It really

Kelly Postiglione Cook 1:02:46
is. Yeah, I completely understand that. And especially if you're really good at it, like, it sounds like, you know, you've been really good at that for a long time working with your daughter. You know, that's a hard thing to let go of, especially if, you know, sometimes you feel like you would have done something differently than the system. So I feel like, if someone is going to inter try to intervene on the system frequently, like, that's just not a good fit, because the eyelet is not going to learn any good information, and you're not going to get the outcomes that you want.

Scott Benner 1:03:14
You'd be fighting with it forever. I also want to make clear that I am not that person. I am good at it, but I would be happy to be rid of it, and I would be, yeah, you're talking to a weird person. I was just focused enough to help my daughter. But I'm not type a like, I don't love it. I know people listening who might be like, that's not true. I do not love it. Like, yeah, I'd love to wake up one day and go, hey everybody. This is the last episode of The Juicebox Podcast. Buy a thing, put the thing on, push the button. It's all done. Congratulations. I'll see you later. Like, I'd head to a beach. You know what I mean? Like, I'm good to get away from diabetes if I can. And I have to be honest, like, I don't know if it's you, like, if it's I led, if it's somebody else, but I do think we're within like, a reasonable amount of time before these systems are just, like, kind of bulletproof for most people. So like, I'm super excited about that. I'd like to see cannula technology get better, right? Like, I'd like to see, I would like to see that, like you said earlier, it'd be cool if, if insulins worked quicker. But, you know, a lot of people with those faster acting insulins, my daughter is one of them. Like, she can't tolerate whatever one of the ingredients is. So I think it's the I've looked into it a little bit, but not enough. Like, I guess they use, like, vitamin B to speed up the process, or so, I don't know exactly I'm talking out of my ass right now, but like, I think you're right. Oh, awesome. She gets very she just can't manage it, like, it stings or it burns, or it leaves her bruised or something like that, which is a real shame, because the ASP did work really well for her, but it would leave her sights sore and loom Jeff burned her so badly, like she had to take it off, like she just hated it. Now that could just be her, right? Yeah, it does work great for other people. I've also heard people who it works great for then it sort of stops working great for them, like finding a way to speed up that insulin awesome, making cannula technology better so that you don't get, you know, agro. Activated, you know, inflammation, which obviously slows down absorption and messes things up. That would be awesome. Like there are little things that along the way, with these algorithms could definitely turn diabetes into a little more of a back of a mind thing. As far as the moment to moment management comes in, I honestly think I'm gonna live to see it. So super excited. Keep working over there. Also don't take that raise. I need them to have that money to innovate. I'm sorry. I know I promised, I know I promised it to you, but you

Kelly Postiglione Cook 1:05:28
can't have it. You dangled it right out there, and I'm just pulling it back like that. I just want to keep

Scott Benner 1:05:31
you working. Kelly, that's there anything we didn't talk about that we should have let

Kelly Postiglione Cook 1:05:36
me think about that we talked about new innovations. You know, we've just, we've been out there for a year and a half, and I think we will be publishing some of our real world data hopefully in the coming months this year. It's just unbelievable what the system is doing. It's crazy. So I'm excited to get that out there for everyone to kind of look through and see how well it's working. I think for the community, if your end does aren't familiar with beta bionics, or they're not familiar with the islet and they want to learn more about it, please direct them to our website so we can get someone out there to talk with them and help to educate them, because it is a really different way to help people get their glucose to gold. And you kind of have to wrap your head around it a little, because you don't get to go in and just start pulling levers and say, All right, well, we'll see in three months. Good luck. Yeah, they have to have a totally different conversation. So I think that's an important thing, you know, the HCP education and bringing everyone up to speed on beta bionics, so that the technology is made available for for more people living with diabetes. Well, Kelly,

Scott Benner 1:06:38
I appreciate your time, and I appreciate you being so good at this, like you really were, like every time, like you're talking and I'm making notes to follow up, and I never had to go back to them. I think I could have just said, Hey everyone, this is Kelly. She's going to talk about eyelet. And I could have went and made a sandwich and come back, and about an hour later, I think, I think you would have been

Kelly Postiglione Cook 1:06:56
done. So I'm from the south, and I have the gift of dab, so listen,

Scott Benner 1:07:00
I appreciate it made my day very easy, and it's Friday, so it's awesome. Oh, great, yeah. Hold on one second for me, this was terrific. Thank you. Thank you.

This episode of The Juicebox Podcast is sponsored by us med. US med.com/juice box, or call 888-721-1514, US med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, thanks also to AG one for sponsoring. And don't forget with your and don't forget that you're and don't forget that new subscribers are gonna get a free $76 gift when they sign up. You're gonna get that welcome kit, a bottle of d3, k2, and five free travel packs in your first box when use my link drink, AG, one.com/juice box, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. Hey, what's up everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you wrong way recording.com, you got a podcast. You want somebody to edit it? You want rob you?

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