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

#1402 Caregiver Burnout Series: Part 6

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

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

DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome 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.

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

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?

Please support the sponsors

Donate

Scott Benner 1/7/25 Scott Benner 1/7/25

#1400 Canadian Invaders

Erica shares her journey navigating type 1 diabetes with her young son while managing her husband's possible LADA diagnosis.

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.

Sarah is here today to tell her glucagon stories, and she has more than one. This is only the sixth glucagon story episode, and somehow I have a repeat name, so that's why this one's called glucagon story different. Sarah, sorry, I didn't know what else to do. The other Sarah is at Episode 1029 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. 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. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juicebox Podcast, a healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it. It gets 150 new members a day. It is completely free, and at the very least, you can watch other people talk about diabetes. And everybody is welcome, type one, type two, gestational loved ones. Everyone is welcome. This episode of The Juicebox Podcast is sponsored by touched by type one. This is my favorite diabetes organization, and I'm just asking you to check them out at touch by type one.org, on Facebook and Instagram. The episode you're listening to is sponsored by us Med, usmed.com/juice, box, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us. Med,

Sarah 2:04
Hi, my name is Sarah. I'm 31 years old, and I believe I'm here to talk about glucagon today. Sarah,

Scott Benner 2:11
the last recording I did was with a 31 year old. Any chance you were diagnosed when you were 29 because then I don't

Sarah 2:16
have to erase this. No, no chance. I am sorry. How old were you? I was 14. I'll give you a minute to do the math. I

Scott Benner 2:24
don't really need a minute because, like, 10 more is 24 and then six gets you to 30. So it's 17 years ago. Good work, Scott. See we got Do you think other people like count like an idiot? Like I do. Yeah. It makes me feel better, actually. Okay, so tell me a bit about your diagnosis.

Sarah 2:44
Oh, man, how much time do you have? I was 14 freshman year of high school and running cross country, so probably the first time in my life where I was running that many miles that consistently, and I was losing weight. And, you know, being a 14 year old girl in the early 2000 you're like, cool, losing weight. But then I got super tired. I started drinking a lot of water, peeing every half an hour. It got to the point where I was drinking probably 1632 ounce n, l gene, bottles of water every single day. Wow. So it's crazy gallons. That's gallons of water. And I didn't think anything of it. You

Scott Benner 3:31
just thought, Wow, I'm running a lot, I'm losing weight, I'm doing all the right things. This is what my body needs.

Sarah 3:36
And it was a really hot September for up here, so I was like, Well, you know, dehydrated, drink a lot of water. It's fine,

Scott Benner 3:45
okay, all right, sick, wait a minute. 32 times 16. A second, 1218, 19, to carry the 1420,

my God, you think you

were drinking five over 500 ounces of water a day.

Sarah 4:03
It was like, four gallons daily. Wow,

Scott Benner 4:08
no one said anything. Your parents weren't like, hey, nothing

Sarah 4:12
got I have six siblings. Oh, okay,

Scott Benner 4:16
you weren't committing a crime. So they were okay with whatever was happening, and I'm in the middle of them. So you think they forgot about you years ago, years before that? Well, the

Sarah 4:25
thing is, I was kind of like the perfectionist child that really didn't need a whole lot of attention, and, you know, very easy to entertain myself, take care of myself, and they didn't worry about Sarah. So

Scott Benner 4:39
I'm gonna go down a weird road with you. Does that bother you? No, no, because I've heard from people who are like, look, I was like, the one that was good at math or I was good at homeworks, but nobody ever helped me with my homework. And there were times I sat there while other people were being helped and thought I'd like some attention from my family too, but that you didn't have that. Feeling,

Sarah 5:00
no, not really, okay. And, I mean, I feel like my parents in general were a little bit inept at parenting,

Scott Benner 5:08
okay, um, they were good at the other part.

Sarah 5:11
Oh, yeah, excellent at fairing.

Scott Benner 5:15
So you're, I'm looking at you today. You're fair skin. You seem to have a reddish hair. Are you Irish? I am 100% Finn Finn. Okay, all right. And six kids, was it like their job to make kids? Is that a religious thing?

Sarah 5:32
Well, we grew up apostolic Lutheran, which I don't know that they like, straight up, don't believe in birth control, but, like, they're very family oriented. Gotcha.

Scott Benner 5:43
So, you know, so make a lot of kids, why a family of seven is small? What do you I mean, if you don't want to talk about this, we can just keep going. But why would you say your parents weren't great at

Sarah 5:54
parenting? They're not good at communicating at all. And, you know, my dad worked swings, so eight hour shifts of days and then nights, and then afternoons and days and nights and afternoons and so he was just wrecked all the time. I gotcha. So he was a little, I would say, impaired, being able to very well communicate and orientate with his family. Being exhausted. Yeah, exhausted. Okay. And honestly, it seems like a lot of bins in general just aren't good at communication. And so if you don't want to get a little bit personal or have those deep, close conversations with anybody, you're not having them with your kids either. Gotcha?

Scott Benner 6:42
Are you? Do you have any children? Not yet? No, we're hoping you're thinking, you're you're working towards that. Okay, how was your communication?

Sarah 6:51
I made intentional efforts to work on it, and so I feel that I'm a very good communicator. And you know, my husband, I always said when I was younger that I would never marry a Finn, just because of the communication issues I saw growing up. And my husband's like 75% Finn as well. And fortunately, he's a good communicator too.

Scott Benner 7:14
You guys live in a logging community somewhere in the northeast, pretty close. Yeah, my goodness, okay. 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, 888721151, 887211514, 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 in Dexcom 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/juice, box, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do. 14 years old, six siblings, dads working. Your mom's got six kids. Was she involved at all? Or was it just like, Sarah do the thing and you did it?

Sarah 8:55
Yes and no. So we all kind of did our own thing. We didn't have a lot of oversight from our parents, like when we tell stories to our parents about things we did as we were kids, they had no idea, right? And, you know, they tried, certainly, but trying to keep up with seven children, and, you know, pay attention closely to each of them, and if one's a little more of a troublemaker than the other ones, then they're more likely to be the focus, which for me was fine around

Scott Benner 9:27
diabetes specifically, though, did your mom like? Well, what was your care like? I guess. What do you remember having to do when you were first diagnosed? When

Sarah 9:35
I was initially diagnosed, I was hospitalized for five days, and then they put me on Atlantis and Humalog, and probably started with a sliding scale, but then they pretty quickly connected me with a traveling endocrinologist, because we don't have endocrinology where we. Live. Okay? So a guy from eight hours away would come up here every three months and check in with the kids and say, Okay, we'll change this. We'll change this, and send you on your way. Yeah, so it was human log in Lantis, MDI for a good year. And you know, that went okay, but I really didn't have very good guidance or teaching, so we didn't really know what we were doing. And my parents, you know, their extent was, what's your blood sugar? Take your insulin, right? That was it. But, yeah, not super involved. And I've actually found out in retrospect, in the recent years how freaked out they were about it, because things weren't working well for me, I'd be high, I'd be low, I'd be high, I'd be low, and like, now I know why, yeah, back then, now, but my parents, yeah, they were just freaked out. I actually work as a diabetes educator now, and I had a patient telling me who used to work with my dad. He's like, Oh, you're the daughter with diabetes. He was telling me about you, and he thought you were gonna die, really, yeah, wait,

Scott Benner 11:16
16 years ago, like in 2000 and wait, when was like 2000 8007, yeah, okay. Your dad thought you were, you were a goner. The

Sarah 11:30
reason I'm here to talk about glucagon is I have a few stories. Oh,

Scott Benner 11:33
okay, all right, but, but his idea of this was that it was unmanageable and would shorten your life.

Sarah 11:41
Well, my endocrinologist told my parents that I was a brittle diabetic, and that's just the way it's gonna be.

Scott Benner 11:47
Ah, got it? My

Sarah 11:50
mom, she got so stressed about it she saw this book for on a magazine cover or something, the diabetes detour diet, obviously aimed towards type two diabetes, but she's like, maybe it'll help. Maybe it'll help. Let's do this. And so we did the diabetes detour diet didn't help at all, I would imagine.

Scott Benner 12:11
I mean,

Sarah 12:12
she lost like 30 pounds. It was fantastic. It was

Scott Benner 12:15
for it. Hey, Sarah is still gonna die, but I'm gonna look great at the funeral, like, I feel good. Okay,

Sarah 12:22
so, yeah, I was just in rough shape. And honestly, through my teenage years, I myself, did not expect to see 30. No kidding, because they face, they

Scott Benner 12:32
mimicked it back to you, or because you were getting low so often, you just thought, I'm not. One of these is going to get me.

Sarah 12:37
Yeah, I figured, you know, with the severe highs and the severe lows and close calls, I figured I'm not gonna make it. And honestly, because of how horrible I felt, I was okay with that, because I didn't want to live past 30 feeling the way that I did, like crap

Scott Benner 12:54
all the time. Do you know, like, my rough math just now told me that, like, 1% of the finished population has type one diabetes. Like, that's a big number. Like, how would you not know more about it? You know what I mean? Also, I have to say the podcast is shockingly not listened to in that part of the world, which freaks me out, because they're English speaking, and you would think they'd be able to, like, listen and it's, I mean, of all the countries that it's listened in, some of those kind of, I guess Nordic countries that, like, are like, have high populations of type ones. They don't seem to listen to the podcast there as much. I'm fascinated by that, too. Yeah, has been for a while. Okay, all right, so your mom's not that involved. Everyone just thinks, like, Sarah's like, a ticking time bomb. You start thinking that you don't feel good to begin with. When's the first time you have a seizure?

Sarah 13:47
Probably when I was 15, maybe a year and a half after diagnosis. How

Scott Benner 13:52
many do you think you've had over the years?

Sarah 13:55
At least eight, at least eight, and probably more that I'm not aware of. Like while you

Scott Benner 14:01
were sleeping, you think, yeah, okay. And how about low blood sugars, where you needed help? But, oh, countless, countless, dozens more more. No kidding, you were bouncing constantly. Okay? So No, CGM, obviously, no. When? When did you get one eventually?

Sarah 14:23
So a year after I was diagnosed, my endocrinology office told me, Hey, you can go on a pump now. And they gave me the different pump options. They showed me what I think was probably an animus pump, the Medtronic pump, probably a mini med back then, and the Omnipod. And because I was a swimmer at the time, I'm like, Oh, I either want this pump that's, you know, big and clunky but it's waterproof, or I want that Omnipod. And in hindsight, I think my endocrinology. This must have been contracted with Medtronic, because they told me, Oh yeah. I mean, you might not like them as much, and your insurance probably won't cover it. Either of those. They'll probably cover the Medtronic, though. And for where we live, we have, I had, the best insurance you could get. So, like, I know they would have covered that omnipot, and I really wanted it, but they hardcore pushed me to a Medtronic pump. And then eventually it got, like, that really old, just terrible sensor that connected with it, yeah, and was a horrible experience, but I got on that pump. I'm

Scott Benner 15:40
just gonna say this is crazy, but you, you grew up somewhere around Minnesota, right? Yeah, close, yeah, because that's where, that's the area that Medtronic is. The major part of the company is located there. And I've you just always see that people in that part of the world, part of the country, seem to get told Medtronic, Medtronic, Medtronic, a lot in old stories. It's really interesting. I want to say it Medtronic is currently an advertiser on the podcast for their Medtronic community. It is what it is. They probably had great sales people. You know what? I mean. I'm sure they did. Yeah. So, wow. Okay, so you get put on a pump. I got put

Sarah 16:18
on this pump. Yeah, that is not waterproof, and so me, being a swimmer, I swam multiple hours every day after school, and I, of course, had to take my pump off, and I didn't have anything about having to take a little bit of insulin here and there during practice. So every day after practice, blood sugar over 400 right, every single day, correct? Brings it probably way too far down overnight. And then, you know, waking up in the middle of the night treat the low sweating like the whole thing, right? Just a constant roller coaster. So then what I suspect happened the first time I had a seizure was maybe after like, a swim meet, which is longer than typical swimming practice, and my blood sugar is probably extremely high from being disconnected from my insulin pump, also the adrenaline, the cortisol going on while you're swimming and competing, and so being extremely high after practice, And you know, or after this meet, take my insulin to correct, take my insulin for whatever food I was having, and I probably didn't need most of that correction insulin. So then, in the middle of the night, I'm sleeping, and because I have six siblings, we shared a room, and my sister probably, luckily, she had the bunk beneath me, so we had bunk beds, and she said she could hear me just kind of like, thrashing around, making kind of weird noises, and then, like, really, just flipping out. So she she's like, Sarah, Sarah, and she looks up at me, and I'm convulsing. I'm foaming blood out of my mouth. You bite your tongue, maybe, yeah, get my tongue, get my cheek. So between the foaming spit the blood, it just looks traumatizing for my poor little sister. She screeches, run on, runs out of the room to get my mom. And of course, my dad's on midnight shift this night. He's

Scott Benner 18:24
not home. Your sister's yelling about the Lutheran devil is in her room.

Sarah 18:30
And so she goes to get my mom. My mom comes running in. She flips out. She doesn't handle stress well in general, and it's just chaos. And you know, another sister shows up, probably some of my brothers too. I think it's my older sister who figured out how to give me my glucagon, okay, and then, you know, call EMS, and they hauled me off to the emergency room to get me stabilized. And that was that you're about 15, I went to school

Scott Benner 19:00
the next day. Yeah? And that glucagon would have been the red box, right? Yes, yeah, you have the red Lily kit. Yeah. So, okay, so they somebody, did your sister give you the shot? Because the big, it was a big needle on that glucagon thing. It is gnarly, yeah? So your mom not helpful. You're dead. If it's just you and your mom in that situation, she calls 911, if you make it to the ambulance, that God bless but she ain't gonna be able to

Sarah 19:25
help you. Wow, there was another time. Okay, go ahead. There's been a few times. So that happened at least twice while I was in high school, probably from the swimming situation. Okay? Years later, years later, I had gone to school for engineering, I moved out to Washington, and I kind of wandered around for a while, and then eventually I'm like, You know what? I kind of want to go home, repair my relationship with my parents, spend time with them. And so I was living at home, and I think two of my brothers were also living at home, two. Two. I was in this phase where I would work out at night and similar sort of thing. The stress, the cortisol, doing heavy weight lifting, adrenaline, blood sugar gets super high. And I was trying to figure, I was trying to figure out diabetes at this point in time, yeah, thinking, you know, I think I'm going to make it to 30. I might as well. As well figure it out. So

Scott Benner 20:23
how about how old are you at that point?

Sarah 20:27
Oh, gosh, let's see this would have been. I'm gonna go home and talk to my 17, 2017,

Scott Benner 20:34
Oh, Jesus, not long ago, really. No, not that long ago. Okay, so you're like, in your mid 20s, mid 20s, and you've now had diabetes for a decade or more, and you're starting to think maybe I should figure out how this works. Yeah, okay, all right, I got it,

Sarah 20:51
yeah. So late night workout. Do my thing. Blood sugar's high. No surprise. Take some correction insulin. Have a shower, go to bed, didn't think anything of it. My bedroom and my brother's bedroom were right next to each other, and our beds were against the shared wall, right? He said that he was laying in bed, and two o'clock in the morning he's just getting super frustrated because he cannot sleep, and then he hears this death moan from my bedroom. Just well, what it is is when you start a seizure, your diaphragm contracts and all the air from your lungs is pushed out, and you let out this, yeah, so he hears that, and it freaked him out enough that he came running into my room, except I sleep naked until I had my door locked. And so he's trying to get into the room. He finds the key to unlock it, and he walks in, and he sees me just completely naked, seizing all over the bed, freaking out, but he's a little bit more level minded, and so he his first thought is, turn her on her side. Okay, so he comes to turn me on my side, and I start fighting him, right? And my eyes are open, and he said, the look in my eyes was just terror, and he couldn't tell, like, if I was with it, or if I was, like, trying to tell him something, but couldn't speak. But I'm just fighting him. He runs and gets my mom, and again, my dad is working midnight. Yeah, sure, of course, not there to help. Why not? So he runs and get my gets my mom, and they didn't know where my glucagon kit was, and honestly, it was probably expired. Anyways, still would work, but

Scott Benner 22:38
yeah, so

Sarah 22:40
what they decided to do was they got corn syrup and poured it in my mouth. Oh, and then called EMS, and they're like, we'll let them do the glucagon if they have it. So I kind of come out of that the

Scott Benner 22:59
corn syrup got you What's that? The corn syrup brought you out of it. I don't

Sarah 23:04
know if EMS showed up and gave me glucam automatically, or if they let the corn syrup

Scott Benner 23:10
because we don't want you choking to death before the seizure can kill you, right? But, but I get their I get their thought, like, what are we gonna do? Right? Like, we need to do something. Okay, all right, go ahead. I'm sorry.

Sarah 23:22
So I kind of come to and first thing I notice is there's a towel over my shoulder. I'm sitting in my bed naked with a wet towel on my shoulder, and I am sticky. Yeah, I'm like, What the heck? And I see strangers in my room, my older brother, my little brother, my mom, standing around, what? And I tried to speak, and I could not speak. And my first thought was, oh, my gosh, I had a seizure, and now I have brain damage.

Scott Benner 23:56
Oh, you had that thought. I was

Sarah 23:59
terrified, and it's, yeah, that post ictal phase, you're cloudy, yeah. I immediately thought, I must have brain damage. I can't speak. But then I realized my tongue, my cheeks, were just ground meat by that point, right? Wow, they're telling me what's what happened, and I like motion for a sticky note and a pen, and I write down my blood sugar was over 400 before bed, and that was the last thing I had remembered. And they're like, Well, yeah, that makes sense. And they gave me the option of going to the ER or not. I'm like, why? At this point, this

Scott Benner 24:42
is old hat. Now I'm good. Why don't I just take a shower instead? Since, yeah, two weeks

Sarah 24:47
afterwards, though, I that post Ital phase lasted and I was just cloudy. Couldn't concentrate. I genuinely thought I had brain damage for a good two weeks after. Words, okay, did

Scott Benner 25:00
you tell anybody? Oh, yeah, yeah. You're like, I definitely have brain damage. So when you look back at it now, are these all avoidable? Like, if you knew how to use insulin better, yeah, yeah, absolutely, they just probably don't happen, right?

Sarah 25:17
Yeah? Like, looking back at all of the episodes that I've had, I can understand why they've all happened, except for one, okay, there's one time where I'm just like, don't know where that came from, don't know why. Seems

Scott Benner 25:33
crazy that that one happened. Yeah, okay. You carry glucagon now. Oh, yeah, yeah. You do Which one do you carry? The nasal or the Chivo.

Sarah 25:41
My insurance company covers Dexcom. Me the nasal, so you have

Scott Benner 25:45
the nasal, the powder, okay, yeah, everyone knows how to use it. In your life. You're married, right? I am married. Does the boy know how to use it? Oh, he knows how to use it, yeah, okay. Has he ever had to Oh, yeah. Okay. So how long have you been married? We've been married five years. Okay, you've had a seizure in the last five years. When's the last one you had? Though,

Sarah 26:06
I've had a seizure in the last two weeks have you really? Yeah,

Scott Benner 26:10
tell me how the one that happened two weeks ago happened. So

Sarah 26:14
this was actually Easter Sunday, okay? And I use, well, I was using IPS at that point, and my build had just expired, so I had to build the new one, and I messed up the build, so it actually ended up being the one that we're not supposed to be using the 3.4 point zero instead of the 2.33 right? So I don't know if you, if you're aware of what's going on with the Iaps. I know

Scott Benner 26:44
a little bit, yeah, I know a little bit with drama going

Sarah 26:47
on there. Yeah. So I built the 3.4 point, oh, which is buggy, and crashes a lot. And so it was that day, I believe it was that I started using it and like, Well, we'll see how it goes for this pod, and I'll probably switch over to loop until I'm able to build the 2.33 but instead,

Scott Benner 27:12
but so this one was at least not you Right? Like, well,

Sarah 27:16
it wasn't, it wasn't. If I paid a little bit more closer attention, I would have realized that going to bed, you know how when you're having a blood sugar rise with IPS, it's aggressive, and then it backs off. So I've had some really noisy dexcoms lately, and so it'll be like 80 190

Scott Benner 27:40
110 100 so you got a bad reading. It Bolus, and then the reading went back again.

Sarah 27:46
Well, I got a bad reading of 131 with a straight arrow up as I'm going to bed. And so I just clicked on the little Bolus button to see what it was recommending. And it was recommending 3.5 units, which for me is a ton. I'm like, I'm not gonna do that. I'll do like, 1.7 not realizing that, while I'm deciding about this, it initiated its own micro Bolus of point eight, and

Scott Benner 28:10
then you gave it 1.7 and

Sarah 28:12
then I gave 1.7 and not even an hour later, I had a seizure. Unfortunately, my husband was home, which he's not always, because He works nights. Okay, like we knew right away that my blood sugar was starting to drop. I'm like, Ah, cute. It over Bolus. So I drank a juice box, ate a roll of Smarties, and I'm like, that should cover it. And I just laid down and went to sleep, and then all of a sudden, my next awareness is, I'm holding my phone and like trying to do something on it, but I can't figure out what I'm trying to do, and it's not working whatever I'm trying to do. So I just lay my phone down and my husband's looking at me like, What are you doing now? And I'm like, I'm fidgeting with something, and I feel like I might do something that I'm not supposed to because I'm not completely aware right now, so I'm just not going to do anything. He goes, okay, yeah, well, you had a seizure.

Scott Benner 29:21
He's like, I know you're just getting back in the game, but here's what's been going on here while you were gone, right? Oh, wow. He took a video

Sarah 29:27
for me this time at least, so I could see, like, what was going on, right? And he said, as he was giving me another juice box, I had the seizure. And he's like, Well, let's see what the juice box does, maybe that'll be it. And you know, I'm starting to come back up again, and then half an hour later, I start crashing again, and it's another juice box. And now you start coming back up, and then I'm crashing again. And at this point, you know, my iob, according to Iaps, was. Was negative. And he's like, Why do you keep crashing? You shouldn't be continuing to crash if you don't have any insulin on board. We can't figure out why, but I was so nauseous and just sick feeling. I'm like, I cannot drink any more juice. And he's like, you have to you keep dropping. And I'm like, why don't you just give me some Dexcom me.

Scott Benner 30:21
And then we went for that, and that helped. Yeah, we

Sarah 30:25
had a conversation about, he's like, Are you sure you really want this? I'm like, I'm pretty sure if I drink more juice, I'm gonna throw up, and then we're gonna I ended up throwing up anyways, yeah? So I'm like, yeah, just give me the back semi and juice

Scott Benner 30:38
sick is a real thing that overly sweet, like stomach that it could give you, it's not good, yeah. How come you didn't just eat something at some point?

Sarah 30:47
I don't think I was aware enough to think of that. How about him?

Scott Benner 30:50
Where was he with? Here's a piece of bread like nothing. We don't even keep bread in the house. Would you like a cracker? Look like nothing, like that. So you've just been at this for so long, you did the things you thought were gonna work, and they just didn't work that time, like with the first the juice box of Smarties, that kind of a thing like, that'll be okay, and it just wasn't. But is it reasonable for two units of insulin to make you that low when

Sarah 31:16
I was on ozempic? Yes, okay. I have since stopped ozempic. And honestly, just like the month and a half has been a struggle out of kind of nowhere. I think we were all sick. We probably had the flu, we probably had COVID, so I wasn't as active as I normally am. So in general, I'm pretty doggone in sensitive to insulin. But just this last month and a half, it's been a struggle to have a consistent insulin sensitivity. I guess.

Scott Benner 31:47
What did someone give you ozempic for? Because you sound like you're not in you sound insulin sensitive already. I

Sarah 31:54
am okay, and I'm very fit. I'm healthy, yeah, PC, OS, no, no. I approached my provider and said, Look, I am starving constantly. I can't stop thinking about eating. I eat a full meal, and half an hour later I'm looking for something else, yeah, and this is maddening. And I told her, Look, it's because I don't make Amylin. So, yeah, I could take an Amylin replacement. I could take sim line, but that's a three times a day injection at least. Or I could take a once a week injection of ozempic and have the exact same effect. How much were you injecting? I was at one milligram when I stopped. Did you need

Scott Benner 32:37
it? Could you have not gotten away with less? I probably

Sarah 32:39
could have, but I liked how I felt at one milligram. Okay, so

Scott Benner 32:43
you had found, but So why'd you stop taking it then? Because we want to have babies soon. Oh, they're doing, listen, I am certainly not a researcher. I want to say that up front, but they're starting to do studies on pregnant women on glps, and I think they're going well. So

Sarah 33:00
yeah, I really want to see the research on of course, I really miss the ozempic. But you know, reading the insert is specifically says, If you're planning on getting pregnant, yeah, stop this medication at least once in advance. I

Scott Benner 33:13
think what the insert says is, we haven't tested on pregnant people yet, so, yeah, yeah, which is a shame, but yeah, but hopefully they'll get to it. They are. I don't know who they is, but I've seen some GLP studies with pregnancy happening and they they're going positively. I feel the best I've ever felt my life. And I'm using zepbound. I just got my blood work back today. My blood work is fantastic. You guys know, if you listen like I'm always have forever having to get, like, iron infusions a couple times a year, because my ferritin crashes. My Fert is 180 I haven't had an iron infusion over a year, yeah, just from, like, my digestion, working, like properly, actually absorbing the nutrients that I'm taking in, right? What about the GLP made you feel good? Do you think because you're not taking it for weight. You're insulin sensitive already. This was just about hunger for you. So,

Sarah 34:04
yeah, it was maddening to just constant hunger, constant food noise in my mind. When can I eat? What am I going to eat? And so taking that away gave me so much more mental space. Honestly,

Scott Benner 34:18
did it happen for you? The way my wife describes it. She says she would open her eyes in the morning, and the first thing she would think is, I wonder what I'm gonna have for breakfast. And then she would think about it, and she's like and by the time I finished breakfast, I started wondering about what I was gonna have for lunch, and she's like, that all went away on a GLP, I guess

Sarah 34:36
I wouldn't say that I was instantly thinking about food right when I would wake up. But when I was a kid, my dad called me a bottomless pit. I could eat and eat and eat and I would eat just about anybody, and always have room for more. This

Scott Benner 34:54
is since, since your diagnosis, not prior to it, right? Yeah, I know that people don't. I. Understand that a lot of type ones have that insatiable feeling, and I know people just think it's, I don't even think they think twice about it, that it could possibly be connected to diabetes. But turns out it is. Well, knock this baby out, and then we'll get back on ozone book. How come your insurance is covering that?

Sarah 35:19
So I've had really, really good insurances, right? And I specifically became a nurse so that I would continue to have really good insurance after I got off my dad's

Scott Benner 35:31
insurance. You thought about that a lot when you were younger. Oh yeah, for the very first time last week, Arden talked to us about it. So in one of her college classes, they're talking about, like, health health care. And she called, like, not in a panic, but she was like, Hey, I have to get a job with good health care because I'm going to get kicked off your insurance when I'm 26 and like, she's going on and on, and I'm like, first of all, we've already told this to her, like, I don't know why she wasn't paying attention the first time, she took it super seriously all of a sudden. And she's like, this stuff's expensive that I use. And I'm like, Yeah, I know I'm paying for it. Like, I know people probably think, like, I get everything for free, but that's not how that works. I don't get any of this. Like, our insurance pays for all of our supplies. And, you know, the companies actually can't give me, it's not legal for them to give me that stuff, and so it's not available. It's never been offered, like I we pay for everything. But she suddenly was, like, thinking about it. So it's interesting that you thought about it too. You became a nurse, partly so that you'd have good health care,

Sarah 36:34
I would say mostly so I would have good health care. Wow, that's interesting. When I was a teenager, I didn't really know what I wanted to do, and I am a really good massage therapist, okay, that's what I'm passionate about. I love doing it, but you don't get insurance doing that. So I went to school for biomedical engineering out of high school, okay, but I hated the whole sitting behind a computer, not interacting with humans, sort of thing. So I'm like, you know, I'm just gonna massage and milk out this time that I'm on my dad's insurance until I'm 26 and then I realized Cobra would allow me to keep it for another three years. So I paid an exorbitant amount of money for three years to keep my dad's insurance benefits and get that really good coverage. It's

Scott Benner 37:25
a lot. It's a hey, do you side hustle massage now? Do you nurse? Yeah, gonna say that's what I would do. Did people come to you or do you go to them?

Sarah 37:35
Depends on the situation. Okay, interesting. It's a

Scott Benner 37:38
cost to get a nice rub down for an hour.

Sarah 37:42
Depends on where you are, okay, and it's certainly changed in the last few years. I worked for a chiropractor for good five years, and because it was usually covered by insurance plans, they could only charge like $1 a minute, which is what the insurance Yeah, that's pretty cheap now compared to what people are wanting when I massaged, when I lived out in Seattle, it was like 90 to $100 an hour, if, depending on where you're working. I worked in a hotel spa that charged, I think, it was 165 an for a 50 minute massage, which I thought was insane. It's

Scott Benner 38:25
interesting. But prior to me losing weight, I was one of those people. I would watch a YouTube video of like, a chiropractor, and I would have like, actual, like, daydreams about going there and having that done for me, like I'd be I used to say I just wish a car could just drive over me, flat me out, and then I could come back to life like a Bugs Bunny cartoon. I think that's what I need, and I don't think about it anymore. Now that I've lost weight,

Sarah 38:50
it's interesting nation probably, well, yeah,

Scott Benner 38:53
I think so. I just I'm not creaky and achy and everything like I used to be. I don't crack my neck anymore. I do still, if I work too much, I do still lean, like, lean over a counter and stretch my back kind of that way. But it's not the way it used to be, like, I used to be all beat up. I felt all beat up all the time. I've had, like, conscious thoughts where I'm like, I'm gonna drive to South Carolina where that guy puts that thing around your neck and yanks your head up. I definitely feel like I need that. Meanwhile, I don't think that's a good idea at all, probably, but nevertheless, scariest seizure you ever had. And why was it scary? Which one pops in your head? Were they amalgam? Probably the scariest

Sarah 39:32
one I had was again, living at my parents, and at that point, I was living in the attic, okay, because more people were living at their house at that point in time, and the attic was the only place that was open. So I made myself a little room up there. And this was really like at the start of when I consciously decided i. Going to start to figure this out. And so it just involved a lot of experimenting, which very often didn't go well. But so what happened is, I think in the middle, in the early, early morning hours, my Omnipod emptied out, and I was not with it enough to address that. So I'm like, Well, okay, I'll just, uh, take a small injection of insulin until I get up and address this. Okay, that small injection of insulin, I don't think was actually that small of an injection of insulin. And so I I you know, go to sleep, and then I wake up, and I'm just delirious and soaking wet, and my body's trembling. I feel like I'm gonna throw up, and I know that I'm three floors away from everybody else, right in the attic, yeah, and so everything inside of me, I'm just willing myself get out of bed, get downstairs, get help, and I'm just very gingerly but weekly, because after you have a seizure, your muscles take a little bit of time to figure out how to function again. It's like your legs will give out from under you. So I'm like holding on to the handrails as I'm trying to go down the stairs, and I'm looking down at this very narrow stairway. It's steep, and I'm looking at my legs and my feet, and I see them, and they look mangled to me. It looks like my legs are on backwards as I'm going down the stairs, and it's just a disturbing image in my mind of my body is messed up, which obviously my legs were on straight.

Scott Benner 41:48
Oh, they weren't backwards. No, I'm just kidding, shockingly, but I was hoping that was your interpretation of it. Yeah, yeah,

Sarah 41:55
I'm hallucinating as I'm trying to get downstairs. And so I go down these stairs, I get to the second floor, and then it's a long hallway to the other end where the next set of stairs are, and I'm just hanging on to the walls as I'm working my way down the hallway. And I get to the top of the next set of stairs, and I sit down, and I just start sliding myself down those stairs. And then when I get halfway down the stairs, I'm just help, help. Just weak voice. Don't really have much in me, and I'm just trying to call out for help. And I know my I can hear that my parents are in the kitchen on the bottom floor on the other side of the house, and I'm just calling out. And eventually my dad heard me, and he comes in to see me, and he's like, what's going on? What's going on? I'm like, I need sugar. I need sugar. I need sugar. I think I had a seizure. And he basically carries me into the kitchen, and my mom starts freaking out, what do you need? And you're naked,

Scott Benner 42:55
by the way, right? Not at this Oh, look at you, because I remember how I had clothes. Okay? Because I'm like, you sleep, by the way, the worst part when you said I woke up soaking wet, I was like, Ooh, naked. Suck to the sheets. That's what I actually thought like. But so you okay? So your your mom freaks out, your dad helps you,

Sarah 43:12
and they give me some orange juice and and set me down at the table and just give me a little bit of time, and they're asking me questions. And I'm like, I don't know. I don't know. I can't have a conversation right now. I don't know what's going on. Do

Scott Benner 43:26
you ever have the feeling Arden described to me that it felt like she was jumping, and when she clarified it, what she meant was there was another person in the room. When this happened, and when she could see them, they were 20 feet away, and then the next time she was conscious, they were 10 feet away. And then the next time she was conscious, they were in front of her. And she described it as feeling like she was jumping through time. But really she was like, seeing, not seeing, seeing, not seeing. Has that happened to you? Yeah, yeah. Is that is that strikingly like frightening or,

Sarah 44:01
Oh, definitely the first few times it happens. But I'm unusually able to be objective about what's going on with my body. And like, if get your way through freaking out, I'm focused, right? So, like, emotion gets brushed aside. I just focus on what's the problem? Let's fix it. Almost

Scott Benner 44:24
feel like you're trapped in a, in a, in a body that can't move talk, but you feel like you know everything is happening around you. Do have that, that experience? Yeah, yeah. That's how Arden described it, too. Okay, so now I have to, like it's an incumbent upon me to ask you this, you're a nurse. What kind of NURSE Are you?

Sarah 44:47
I am an RN, and I did a very brief stint on the cardiac unit, and then, by a weird chain of events, I was approached by a. Diabetes educator who wanted to retire, and she said, Please take my job so I can retire.

Scott Benner 45:06
So you're a CD CES. Now

Sarah 45:08
I'm not eligible to test for my CD ces until the fall, because you have to be licensed and working hours.

Scott Benner 45:16
Okay, so you're that close to that. So I'm going to ask you a question. I don't mean this harshly. Why can't you figure this out?

Sarah 45:23
Well, Scott, I do feel like I have figured it okay. I just have a lot of crap situation.

Scott Benner 45:30
But you know that, like, I'm just the mouthpiece for the people listening. Everyone's wondering, like everyone's listening and going, I don't get it, like she said at the beginning. She's like, you know, like, because I'm worried that what they're thinking is, oh, Sarah, can't figure it out. How the hell am I supposed to figure it out? Because you're not, listen, I'm not gonna I'm not gonna make a statement. I'm gonna ask you a question. Do you think you're a brittle diabetic? No, there's

Sarah 45:52
no such thing as a brittle diabetic. It just means you don't know what the heck you're doing, right? And that

Scott Benner 45:56
was gonna be my next question. Do we even think that's a real thing? You're pretty sensitive to the insulin. What's your insulin

Sarah 46:02
sensitivity in your pump right now, it's at 105

Scott Benner 46:06
that's pretty. That's pretty. Are you stature wise? How tall are you by five? By five you and you said you're fit. So five, five would be like 135 pounds.

Sarah 46:19
I'm at 150 but I'm very muscular. Okay, all

Scott Benner 46:22
right, so then you're a muscular 551, 50. Your sensitivity is, you're right, that's 105 is crazy. So what's your insulin to carb ratio? One to 20?

Sarah 46:33
Like one to 22 and of course, it changes based on time of the month, right?

Scott Benner 46:39
And your basal is what like point four an hour.

Sarah 46:44
When I was on ozempic, it was point four to point five. Okay, and now it's more. I think I've got it up to like point 6.7 Yeah.

Scott Benner 46:53
So what is it? Do you do you pre bullish your meals? I do okay. And what's the spike for you when you eat? How much? What's the number where you're like, Oh, I spiked

Sarah 47:07
while I was on ozempic and doing my usual, usual care. A spike, I would be upset being above 140 okay? You know, waking up in the 70s and 80s, very typical for me, right? Very minimal variation. Very comfortable in the 60s. Very rarely would I be hit in two hundreds, except for this last month and a half being sick and who knows what going on. But it seems like in the last couple of days, it settled down quite a bit. So

Scott Benner 47:38
on ozempic, was your A, 1c, like, like, 5657,

Sarah 47:44
no. Typical was less than 5.5 5.5

Scott Benner 47:46
okay, all right, how long did you do ozempic for three years? How many seizures did you have in those three years?

Sarah 47:54
One, okay, hey,

Scott Benner 47:58
do you want to know why Scott do but that's great, but why?

Sarah 48:02
So it was my first day working as a brand new nurse on the cardiac unit. And, you know, 12 hour shifts, you know, going through the orientation, all the new stuff, which, sure, it's stressful. And I was looping at that point, my blood sugar is just creeping up, creeping up all day long. I'm like, it's, it's the stress, it's the cortisol, adrenaline, yeah. So I set an override, and I want to say it was probably like a 50% override, and once I set that, the remainder of the day, blood sugar, beautiful. Back down below 100 nice and steady, minimal variation. I'm like, Okay, fine. So I went home from work, and I am fried.

Scott Benner 48:49
Long day, lot happened. Long

Sarah 48:51
day we had a dead body. I'm just like, I want to go to bed because I have to work again tomorrow morning, right? I got home, my husband had made dinner for me, you know, just wants to get the pre run down. How did everything go? And then so I ate and took my insulin like had my shower, go to bed. I forgot to cancel the override. Oh, and I am far more sensitive to insulin when I sleep. Yeah,

Scott Benner 49:21
how much was the override 50% Oh, you were getting one and a half times the insulin you needed. And then you and you were exhausted and you fell asleep, yeah,

Sarah 49:29
I was just crashed, yeah, way too much insulin. And so probably

Scott Benner 49:37
was the override arm when you Bolus, yeah, oh, so not just your basal and your Yeah,

Sarah 49:43
also that Bolus. And it's all within a short amount of time that I did that and then go to sleep. Yeah. Fortunately, my husband was home. He again, works nights, and so he was going to be up for a while, and he's out in the other room, and he hears the. Death moan, right? And comes running in and finds me seizing, and straight away gives me, I don't think it was back semi then it must have been that the lily box, the lily kit, yeah, so he gives that to me, and it's taken a really long time for me to come out of it. And so he found another one and gave that to me, which that one definitely was expired, but whatever. Yeah, he calls EMS, and he actually is a registered nurse at the local emergency department, so he's got a pretty good relationship with the EMS workers. And so they come in and they're they're just watching me, seeing how things are going. And they said it was probably an hour of me sitting there in bed, and just like not with it at all, they're staring at me, trying to assess my mental faculties. What year is it? And I'm like, it's 2016 who's the President Trump,

Scott Benner 51:01
Milford Fillmore,

Sarah 51:05
they asked me, Do you know where you are? I'm like, Oh yeah, I'm at the hospital in Marquette, and obviously I'm not my husband asked me, Do you know who I am? I'm like, You're my nurse. And he goes, No, Sarah, I'm your husband. And I just go, No way.

Scott Benner 51:23
I got married to a boy and he's hot. I did it. I told you, you start talking to voices. I told you we'd get a guy. My god, that's crazy. That went on for an hour,

Sarah 51:37
yeah. So after about an hour of just me not coming around, they're like, yeah, maybe you should bring her in, right? And you know, being EMS workers that my husband knows, they're like, you're probably fine to just driver, we'll save you on the ambulance bill, right? And he gets me in the car, and he keeps, he keeps telling me, you had a seizure. We're going to the ER, I gave you glucagon. You're okay. We're just going to get you checked out. I'm like, Yeah, okay. And he keeps telling me I'm your husband. I'm like, You're my husband. Okay, you're my husband. Yeah, you're my husband.

Scott Benner 52:17
You didn't know somebody was related to you and you were being told you were wouldn't you be scared or, or, you know what I mean, or I guess you don't. You're not. You don't have the wherewithal to be scared.

Sarah 52:28
I'm pretty docile. Honestly, pretty docile.

Scott Benner 52:32
You could kidnap me, easy, Scott. I just want to say, I'll go along. Oh, you're my mom's friend. Sure. Let's go. But

Sarah 52:41
if you give me problems, we're gonna fight, yeah,

Scott Benner 52:43
but I will smack the out of you if you come for me with that glucose, that's for sure. Oh, my God. Seriously

Sarah 52:49
though he got me to the ER, and they put me in a bed, and he's telling his co workers what happened and what he's wanting, yeah. And so they hook me up to dextrose, and they get a sandwich. And of course, the plan is, pump me full of dextrose, get that blood sugar up. Even though at that point, my blood sugar already was up, my brain just wasn't catching up to it. Yeah, and he tells the nurse who's assigned to me, he goes, she's not gonna like it if you start pumping that dextrose in her, she's probably going to get mad, actually,

Scott Benner 53:24
because her blood sugar doesn't look like it needs it. So yeah, and

Sarah 53:28
yeah, dextrose would be unnecessary.

Scott Benner 53:31
Sarah, have you ever seen a I don't know what the word is I'm looking for. Why can I come up with the word I want? Have you ever had your brain scan to make sure you're okay after all these seizures. No, no. Do you think about that ever?

Sarah 53:45
No, because I can still do calculus pretty comfortably. Because,

Scott Benner 53:48
you know what a quadrilogical Something triangle is like? I don't know it obviously I think

Speaker 1 53:54
critical thinking skills. I'm still very logical. I can think through problems, and, you know, I don't feel like I have any

Scott Benner 54:02
actual deficit, but the light hearted conversation aside that we're having, I you don't want to be having these seizures, obviously, so and one in three years after having so many to the algorithm. You think is, had you not, I didn't mean to say screwed up, but had you not screwed it up? Yeah, had you not screwed up the override? You wouldn't have had one except for this weird one you had recently that you can't figure out what happened, right? The more recent one, oh, no. The more recent one was when you put on the wrong DIY app.

Speaker 1 54:34
Yeah, yeah, yeah. The one that I can't figure out happened was actually a year after the year after, I don't know. You

Scott Benner 54:44
can't say you don't know right after you said, cognitively, I'm okay. There's so many. Scott, no, I know you're just trying to keep them all straight as all. What would you say to people about, like, being safe? Like, you know, like, obviously you're. A different story, and most people are not going to have nearly as many as you did. But I mean, is it? Just have glucagon on hand. Make sure people know how to use it. Try not to be alone. Like, what do you do if you're alone? You know what? I mean,

Speaker 1 55:14
I'm a lot more conservative. I guess I would say I do a lot of experimenting, honestly, yeah, sometimes it doesn't work

Scott Benner 55:22
out. Well, what are you experimenting for? Like, what is it you're trying to get to?

Speaker 1 55:27
I just like to understand how things work. And, you know, see how different things make me feel. Like, I experimented with a Fresa. Sometimes I use it here and there, yeah, you know, experimenting with the ozempic. Now I'm experimenting with SIM line, Metformin, yeah, the different insulins, the different algorithms. I just want to find what works well, and to be able to tell people, This is my experience with this medication or this algorithm or this system. Yeah, this is what you could feasibly expect. Don't mess it up.

Scott Benner 56:01
Is the sim line helping you with the hunger problem? Or no,

Speaker 1 56:06
it does, but it's very tricky. With figuring out Bolus timing, it's literally

Scott Benner 56:12
three times a day you have to shoot it. Yeah, that's tough. I have to be honest that. GLP, I haven't thought about food in forever, like I actually got busy last weekend, and I had that feeling at like, four o'clock in the afternoon. I was like, What's wrong with me? And I was like, something's wrong. And then I was like, Oh, I haven't eaten today. Like, I got up, I got involved with the dogs. Then a thing happened. Then this project I wanted to get to I started, and then before I knew it, I was like, what is wrong? And then I was like, Oh, I haven't eaten today. And I was not hungry, like, not hungry at all. It's wonderful stuff. I have to, I have to say that Arden's using a half of ozempic right now. She started at a quarter. She's at a half now, her insulin sensitivity went from one, I I've said it like 42 or 43 but in that range to like one to like 93 now, and her basal is down. Her insulin to carb ratio is weaker, like, just everything. Like, she's using a lot less insulin. It did impact her eating. And I haven't, you know, I'd have to get her on here to have her really talk about it. And she's, there's times where she's like, I can't eat, and there's times where she's like, I can eat fine. Like, you know, I just not as I don't eat as much. But her decrease in insulin isn't just because she lost a little weight, but a tiny like, on her, it probably looks like a lot, but it's probably 10 pounds, you know what I mean. But her insulin usage is not directly related to the food. It's it's something about that, the GLP and how it slows down your digestion. It's just fantastic. So I think at some point it'll be offered to every type one, if I hope so. Yeah, once insurance comes around on it, you know, I think it's more about the they got to figure out how to make enough of it first. Like, I actually think, like, 10 years from now, like the whole society might overall look differently because of it. It's really impactful. So you're shaking your head, yes, you know, because you've used it. So I probably just sound like, I'm, I'm being paid by a GLP company, which I'm not.

Unknown Speaker 58:23
I prescribe it all the time. Yeah, do

Scott Benner 58:25
you good? Yeah, I I am not being paid. But I want to be clear, I would accept money because I genuinely have had such an insane experience with it, like my wife and I, both our lives are like completely different artists too, just, you know, and so because we found a doctor who was willing to, like, kind of deal with things the way you were talking about, this is very nice of you and brave of you to do because you because somebody's gonna judge you over this, just so you know, like, Oh, I'm sure I get crap online once in a while, because I've shared, like, Arden came on here and talked about having a seizure after her senior prom. And you know, if you dig around in the right corners of the internet, you'll hear some horrible people like say, see his daughter eats carbs, and look what happened to her. So I've actually seen that if those people are listening, I hope you fall on a sharp stick. I don't care like and she doesn't care either. That's what happened to her. She had a very similar experience. She had a big day. She was very active. Her blood sugars were fantastic. All day long, nothing. I was watching it like, you know, remotely she was paying attention to there was nothing that you would have thought like nothing you would have thought that was strange. And then she had, like, they had some weird meal at like, three or four o'clock in the morning, and she didn't even Bolus for all of it. It's like she knew, and she still Bolus less, and still, you know, an hour and a half later, you know, she's having a seizure, and her friends are helping her out of it. And so I talk about it because I. Don't want people to be scared, but I don't think you should be ignorant of the fact that it can happen, because you do need to be ready for it, you know what? I mean? Yeah,

Speaker 1 1:00:07
so, and it's frustrating how infrequently glucagon is prescribed, yeah, even to type one diabetics, yeah, they

Scott Benner 1:00:18
should have it. Arden has one with her constantly. There's one in her bedside. There's one in the bag she carries around. I have them in my house, like they're everywhere. Do you want the injectable? Or are you happy with the like, if you had your druthers, would you pick chief oak? Or do you are you happy with the vaccine?

Speaker 1 1:00:34
I probably would pick G, VO, just because, you know, this last time that I had the vaccine he administered. I was actually conscious and aware for that, and it hurt so bad. Not

Scott Benner 1:00:47
fun. It was horrible. Yeah, squirting a powder up your nose wasn't pleasurable. Getting

Speaker 1 1:00:52
punched in the face right through your back to the end of your occipital bone felt

Scott Benner 1:00:57
like it went right through your brain. Yeah, you were just like, whoo. Here we go, like that burned, right? Yeah, yeah. So I glucagon burns in general, though, right? The injections burn too, don't they,

Speaker 1 1:01:08
yeah. I mean, that could be, is it the glucagon, or is it because it's an im injection, right? Which doesn't feel good,

Scott Benner 1:01:15
but not in your head, yeah? So I, so what I actually have, a, I have a trainer pen here, a G vo trainer pen. And what I love about it is it's like, it's, it's just like, it's cap, click, done. It's over, like, you know what? I mean, it's the self injectors are, like, they're pretty great. I had this experience with a few of the sponsors to the podcast, but GEVO is a sponsor because Arden uses it. And I was like, Hey, if you want to sponsor the show, my daughter uses this. And she uses it because it was the first glucagon form factor that actually allowed her to carry it with her, because we didn't carry the lily kits anywhere. Like, what do you no one's gonna figure that out. Yeah. What are you hoping for that a Rando is comes along and goes, Oh, I bet, like, your mom couldn't get it together. Like, did it? Yeah, you know what I mean. Like, so, yeah, it just never seemed reasonable to me, and it was very hard at a school level to talk a nurse into even training to do it. But this one, nobody has a problem with. They're like, yeah, sure, because it looks like

Speaker 1 1:02:18
it's pretty dummy proof, although I have had patients who have had loved ones screwed up, really?

Scott Benner 1:02:24
Boy, it's pretty simple. But anyway, that's, uh, sorry. Is there anything we didn't talk about that we

Speaker 1 1:02:33
should have? I mean, I could probably just tell you a lot, a lot of stories about glucagon or anything in general, but

Scott Benner 1:02:38
you might have to come back one day, and we'll talk not about glucagon. I like you. You're fun. So Thanks, Scott. You know. I appreciate it. How do you know about the podcast? Probably a

Speaker 1 1:02:47
year and a half ago, deer season, I needed something to entertain me while I was cleaning and gotten and processing my deer, and so I'm like diabetes podcast that sounds interesting, and I didn't like it at first, to be perfectly honest.

Scott Benner 1:03:03
Yes, I'm very coarse. People don't like me, generally speaking, no, not at all.

Speaker 1 1:03:06
I'm like, this guy doesn't even have diabetes. Listening and like, he might know something. Oh, he actually knows what he's talking about. I can, I can deal with this. I

Scott Benner 1:03:17
get that he doesn't have diabetes. Anger. I mean, I understand it like, I probably would be like, wait what? This is ridiculous, but I'm glad you stuck with it, and it's really cool to know that I'm with you while you're cleaning deer. Yeah, I wonder, where else? I wonder, what else people are doing while they're listening?

Speaker 1 1:03:34
Oh, you probably don't want to know, Scott, that's

Scott Benner 1:03:38
Oh, my god, yeah. Maybe I don't shooting deer. I never would have thought somebody would have said I was gutting and cleaning a deer while I listened to your podcast. People don't. Oh, now I'm gonna wonder forever what you're all doing. Seriously. All right, that's good. Leave me on that one. That's good. Let me. Let me think about that for the rest of the afternoon. Hold on one second. For

Unknown Speaker 1:04:02
me, I A huge

Scott Benner 1:04:06
thanks to touched by type one for sponsoring this episode of The Juicebox Podcast. Check them out on their website, touched by type one.org, or on Facebook and Instagram. The conversation you just enjoyed was brought to you by us. Med, us. Med.com/juice, box, or call 888-721-1514, get started today and get your supplies from us. Med, hey everybody. I know there's so many episodes you might be like, I don't know where anything is, but if you go to Juicebox Podcast com, or go to the private Facebook group and look in the feature tab, you'll see a complete list of all the series that exist within the podcast. And I'm talking about after dark ask Scott and Jenny, algorithm, pumping bold beginnings, defining diabetes, defining thyroid, diabetes, pro tip, diabetes, variables, mental wellness, type two diabetes, how we eat and if we add something. Results like, say, my weight loss diaries, which we did, you'll find them there as well. And as a matter of fact, we're about to add a new list right now about GLP medications, because we have a seriously nice grouping of episodes on that topic. This is a good way for you to keep up with what's going on on the Juicebox Podcast. And even a better way to find those series that are, you know, compendiums at this point, 1020, episodes that are all on the same topic. 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.

Please support the sponsors

Donate