#1401 Beta Bionics (iLet) Clinical Services Director
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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.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.
I have a treat for you today. Kelly, who is the Director of Clinical Services at beta bionics, is here to talk about the eyelet insulin pump, and she's going to answer every one of the listener questions that you guys sent in. Thank you so much for doing that. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d exchange.org/juicebox, and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa. This is the way t, 1d, exchange.org/juice, box. It should not take you more than about 10 minutes. This episode of the juice box podcast is sponsored by us Med, US med.com/juice, box, or call 888-721-1514, get your supplies the same way we do from us. Med, this episode of The Juicebox Podcast is sponsored by ag one, I start every day with a delicious drink of ag one, you could as well drink. Ag one.com/juice,
Kelly Postiglione Cook 1:57
box. My name is Kelly postiglione Cook, and I am the Director of Clinical Services with beta bionics. Wow, is that a hyphenated name so well, it's technically two last names with all the nursing licensure and whatnot, it was an easier route to go that way. I'm proud of my Italian roots. I was gonna say that in there. Did
Scott Benner 2:16
you grow up with postic Leone is your last name? I did. Wow, that's awesome. I've never heard that name before, and
Kelly Postiglione Cook 2:23
I'm a southern Italian too, so pronouncing that was a bit of a nightmare growing
Scott Benner 2:27
up. It's absolutely awesome. Not often do people say a name, and you think I've never heard that before, but that's really that's wonderful. I really appreciate you Kelly, coming on and doing this with me. So we have a ton of questions from listeners about islet before we start with people's questions, can you just tell me a little bit about your path to the company and what you do there?
Kelly Postiglione Cook 2:50
Yes, well, I guess it's kind of a long, long, long path, if you think about the nursing background and all of that. I got into nursing after being an exercise physiology several years back, when I started getting into healthcare, I thought I wanted to do physical therapy, and kind of quickly realized that I wanted to be involved in medication management, and ended up going the route of nurse practitioners. So I got my NP from Vanderbilt University in Nashville. So I started out working in an endo clinic as a registered nurse before I finished my MP, and I just loved it. There's so much detective work and endocrinology, you know, you do a lot of trying to investigate and figure out what's causing certain symptoms, and even the same thing with diabetes management, there's a lot of Q and A and trying to figure out how to help people, you know, meet their their personal goals. So spending time as an RN in an endo clinic really kind of opened up the world of of diabetes management to me, and I had a great physician that I worked with, Pascal do fan, who's outside of Nashville, who's just a really great teacher. So once I finished up my MP I stayed in the outpatient diabetes world for a few years. Then I did some inpatient diabetes management, health diabetes management, and ended up moving into industry after that and working with an insulin pump company as a clinical rep. So actually, you know, training patients on the device and going that route, did some sales and diabetes tech as well, and then got into clinical leadership a few years after that. So I've worked with tandem diabetes care, companion medical, and then came over here to beta bionics in June of 2023, so right when we were launching this product, is when I came on board. And I'm here because of Ed Damiano, Steven Russell, their mission, the time that they spent putting into this project, and really their why behind it is why I'm here,
Scott Benner 4:48
what attracted you, and I'm guessing too, the there's got to be a connection between Sean and you, right? If you were a companion, is that? Right?
Kelly Postiglione Cook 4:56
Yeah. So he was at, we were at tandem, overlapping. The same time frame, and then companion medical too. He's just brilliant. He's a brilliant guy to work with, Mike men, singer, our Chief Product Officer, the two of them together are just outstanding. They move fast and furious and really do so much for the diabetes community. It's just it's a really fun place to be and a really great mission to be behind awesome. So that's kind of my why for being here.
Scott Benner 5:22
That's excellent. Mike came through Dexcom, right? Am I remembering that right? Yeah.
Kelly Postiglione Cook 5:26
Mike was at Dexcom, and he also was a co founder for companion medical.
Scott Benner 5:30
Gotcha Okay, all right, I'm putting all the pieces. I feel like I'm solving a mystery, and there's yarn on my wall. Does anybody watch only murders in the building? Or is it just me?
Kelly Postiglione Cook 5:40
That's funny. Fun fact, my dad was a homicide Sergeant in Nashville for about 30 years. I think that's why I like the detective work of diabetes management and also endocrinology. Oh,
Scott Benner 5:53
tell your dad if he wants to start a podcast with a guy who doesn't know anything about it, I'll host it and he can tell his stories. That'd be awesome. Oh, oh, my God, He must. Is he still with us? I'm so sorry. Yeah, he
Kelly Postiglione Cook 6:03
actually did. He's done quite a few podcasts. He's the pro with this type of thing, not me. That's awesome. No, no kidding, yeah, so some of that and a show on the ID channel at one point.
Scott Benner 6:13
So cool. All right, okay, so fun fact, yeah, no, that's really wonderful. All right, we're gonna get to it here. So why don't you tell me where the device is right now, meaning how it works for people who don't know, and you know day to day how people use it. Yeah. So
Kelly Postiglione Cook 6:32
where we are currently. We have an insulin only bionic pancreas. So the device itself is fully autonomous insulin delivery, meaning that the system determines 100% of the insulin dosing for the user, and it does that through the work of three separate algorithms that work in conjunction with each other to get the user to goal. Hopefully, those three algorithms, I know you guys have talked about them on previous podcasts, but just as a reminder, you've got a basal algorithm that's going to modulate every five minutes, layered over that you have our corrections algorithm, which I think really sets us apart from other devices on the market, because it's a really it's got strengths to it. So if a user you know forgets to announce a meal or has a snack that's not covered, that sort of a thing, our corrections algorithm can really provide that, that safety net for them, and also work with those postprandial highs as well. So the corrections algorithm is truly a separate algorithm layered over that, that basal algorithm, and again, can also dose up to every five minutes as needed. In addition to that, you've got the meal announcement algorithm, so that will determine the user's meal needs based on their usual size, breakfast, lunch or dinner. Meal announcements, those three work in conjunction with each other, and the device itself doesn't ask the user to specifically carb count. It asks them to be carb aware, which means, you know, you're aware that a bowl full of spaghetti noodles, for example, is going to be higher carb than, you know, two slices of bread on a turkey sandwich. So just being aware of kind of general amounts of carbohydrate, how
Scott Benner 8:07
does it handle fat, and the impacts of like fat and protein,
Kelly Postiglione Cook 8:11
that's actually been a really interesting thing watching this system work, is you don't have to make any adjustments for that so that corrections algorithm will come in after a meal is announced and doses received for that so if a user is absorbing carbohydrate more slowly in that postprandial time frame, that corrections algorithm will come in as needed with the strength that's needed. So you don't ever have to adjust an announcement or the timing of that announcement based on the fat or protein content of a meal, which is relieving for people who've had to worry about that before. Yeah,
Scott Benner 8:47
in a situation where it doesn't work out, like, for whatever reason, and we see, like, a stuck high blood sugar, I'm right to say, there's no ability for the person to just, like, say, correct like, there's no ability for them to give themselves a Bolus, even, right? And you don't want them announcing fake carbs. So how does that get handled? I used to hate ordering my daughter's diabetes supplies. I never had a good experience, and it was frustrating. But it hasn't been that way for a while, actually, for about three years now, because that's how long we've been using us Med, us, med.com/juice, box, or call 888-721-1514, us, med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. Us. Med. Carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7 they accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with a better business bureau at US med.com/juicebox, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do. I have two resolutions for 2025 keep doing what I'm doing. So that means drink AG, one and get on a rowing machine the AG, one thing that's going to be easy, because that's every day. It's super simple, and I enjoy it. I'm hoping I get myself on that rowing machine. The way I'm trying to think about being healthy is by creating a sustainable pattern to my day. Get up in the morning, drink, AG, one exercise, shower, get ready for work. I need a routine, and it's never too late to start that routine. You can start today with ag one. And ag one is offering new subscribers a free $76 gift. When they sign up, you'll get a welcome kit, a bottle of d3, k2, and five free travel packs in your first box. So make sure to check out drink. AG, one.com/juice box to get this offer that's drink. AG, one.com/juice, box to start your new year on a healthier note.
Kelly Postiglione Cook 11:30
That's a great question. You're correct in that you should never use a meal announcement to correct for a high glucose value. So with the corrections algorithm when you're using fully autonomous delivery. That doesn't mean you're never going to have higher low glucose values. Those will still happen, and if there ever is a high that's lasting longer or higher than the user is really comfortable with, you definitely want to make sure that the infusion site is not bad. We have an alert on the device for high glucose. If you're above 300 for 90 minutes, we would ask that you check the integrity of the insulin site and make sure that or the infusion site, and make sure that that is not compromised, because it's pretty rare that you're hitting that value for that time frame using the islet, because the corrections algorithm does have strengths to it, and it will work to bring the user down. Now, if you see someone who has a high glucose value after a meal, let's say maybe the meal announcement, you know, wasn't sufficient. There was, you know, maybe it needed to be a more than usual, but it was announced as usual, something along those lines. I completely Can, can sympathize with that. It's frustrating to see a high glucose but because the the corrections algorithm has some strength behind it. You don't want to intervene because you've got insulin on board. It's already come in, and it's doing that work for you. One of the things Dr Russell says, our chief medical officer, is it's not your job anymore to correct a high glucose. So even if you see that value, just rest assured that it is going to come down, even if it took a little bit longer than than you necessarily wanted it to. And that singular event, you know, that's not going to change things long term for the user, and the system will resolve it for them, but intervening and trying to deliver either external insulin, announce a meal, that sort of a thing, can really mess with the learning of the system, but also put the user at risk for hypoglycemia, because that corrections algorithm is already working hard to bring it down, right?
Scott Benner 13:24
It's almost like you're stacking at that point exactly. And listen, I'm not trying to put you on the defensive about how, I mean, I think the device works the way it works. And, yeah, right. So you're not trying to, like, if you're a person listening, and you've got, like, a, five, one, A, 1c, and you're tinkering all the time and making adjustments and everything like, good for you, but then this probably isn't for you. Is that fair or no? Do you think a person could have a five a 1c on islet?
Kelly Postiglione Cook 13:52
We have five a one CS on the islet?
Scott Benner 13:53
Is it with eating strategies too? Or,
Kelly Postiglione Cook 13:56
honestly, we don't have published real world data yet, so I couldn't speak to that, and it wouldn't involve, like, you know, any kind of patient interview type things. But I think typically, if a user has normal hemoglobin levels and their a 1c or G m i values, I shouldn't have said a 1c G m i values, is what we can see. If they're running that low on the A 1c side, and they're not having hypoglycemia and that sort of a thing, I'd say they probably have their insulin doses pretty tailored in and there's, there's not a lot of maybe variation to carb amounts in a lot of scenarios. So in that situation, they probably were going to do fantastic on any automated system. But people who eat really low carb on our system do really well. So it's not uncommon to see really low GMI values without hypoglycemia. Got it.
Scott Benner 14:42
Got it. I understand, yeah, do you think, I mean, I know you can't tell me anything. You can't tell me, but like I have, I mean, go to one of my questions here this, this person said, Is there any chance that islets going to be able to offer lower targets? So they said, lower a, 1c, results. But I think what they. Mean is like targets. So right now, what is the target for the device? So
Kelly Postiglione Cook 15:04
you've got the option of three different CGM targets, but keep in mind the our system works so differently than others. I think the idea when people think of a numeric value associated with those targets is that, like, that's where the mean glucose is going to be. You know, if you have it set to that target, and our system just works a little bit differently from that. But we have our usual setting, which is at 120 milligrams per deciliter. Lower is at 110 and then higher is 130 milligrams per deciliter. Okay. And
Scott Benner 15:34
do you foresee a world where one day I can target 80 or 90 and that that will make it more aggressive and search for lower GM eyes. We
Kelly Postiglione Cook 15:44
have a lot of active projects going on, and I don't think that's out of the question. I couldn't speak to, you know, timelines and things like that, but I understand. I think definitely looking at changes to the algorithm is definitely not out of the question, right. Okay,
Scott Benner 15:57
all right. So here's a real like user question, how do meals adapt when the meals are less than four hours apart? So it was explained to me that if you announce a meal at 9am and then have another meal at 11am that the system can't, I don't know, like the user wasn't sure, but he felt like there was an issue, and he wanted me to ask that question. So am I making sense to you? Like, do you know what the question is? Okay, go ahead. Sorry, yeah.
Kelly Postiglione Cook 16:25
So part of the way that the system learns is from those meal announcements. So let's say you announce a breakfast meal, like you said, At 9am I've announced a usual breakfast the system is actually going to look at that four hour postprandial window, and within that window, it's going to see how much correction insulin was necessary. Do we need to adapt this dose for this user's specific needs? That dose will carry a 1/7 weight for breakfast announcement, so it uses an average there of the last seven breakfast announcements. So it needs the four hours to be able to adjust that dose or adapt. So in the beginning, when you first start the system, that four hour window is important. We want to make sure that we set the system up for success, that it learns the user's baseline needs and that it's effective. So in the first few days, we do ask the user announce your meal. Give it about four hours before you announce another meal, or have any kind of snacks with carbohydrate in them that would impact the glucose levels, because the system is still figuring out what your needs are. Now, once you've been on it for several months, you know that sort of or really after that first week, and the system knows what your needs are, there's no need to space those meals out by four hours anymore, because every dose doesn't necessarily have to be counted for adaptation. So if occasionally you know breakfast and lunch are closer together than than that four hour window, it won't adapt based on that dose. But it's not a big deal because it already knows what your needs are or write about what they are, so it doesn't have to adapt for every single meal announcement that is made so long term. It'll adapt when it's got that four hour window, and then if it doesn't, no big deal, it'll catch it on the next one.
Scott Benner 18:05
For how much time in history is it considering the user? Like, if a person's on this for 10 years, is it going to be thinking about 10 years worth of data, or, like, what's the window it thinks inside of? So
Kelly Postiglione Cook 18:16
for meal announcements, it's looking at the last seven for that particular type of announcement. So the last seven breakfast announcements, seven lunches and so on. Okay?
Scott Benner 18:25
So seven meals or 21 meals, seven, seven and seven
Kelly Postiglione Cook 18:30
No. Seven meal announcements, yeah. All right.
Scott Benner 18:34
So it's making decisions about insulin for food based on the last seven meals that you've experienced and the outcomes and what it needed to do, et cetera. Exactly gotcha. I had someone say to me that I moved to islet to get away from carb counting. They talked about the mental health stress that they were under, always carb counting, getting it wrong, feeling that pressure, et cetera. Yeah, but they did tell me that it has been replaced a little bit with the fear that they're going to pick the wrong meal size. Like, how do you ask people to judge, is this a I never get these right. It's a normal small How do you guys
Kelly Postiglione Cook 19:15
usual? Usual is, and that could be anything. So if your usual is 80 grams of carb with a meal. That's totally fine. That is your usual meal. Okay, yeah, but that's a big range. Usual can count for a large chunk of your meals, if you will, because you don't go to a more than usual unless you're eating one and a half times what you normally would. And you wouldn't go to a less than unless you're eating less than 50% of what you normally would. So it's a pretty wide range. So for most of our users, a vast majority of what they announce is gonna be usual. Gotcha,
Scott Benner 19:49
okay? And then, like less than usual, it's still too big for I'll get to another question here. A person said, Hey, can I get you to add a snack button to this thing? So I. Guess what they're saying is that less than usual is not quite the same as like, I grabbed a candy cane off the Christmas tree, or I had a handful of nuts as I walked through the kitchen. Like, I think that is that right? Or are they not seeing it correctly? So
Kelly Postiglione Cook 20:14
it depends on what usual means for that particular user. If their meals tend to be significantly higher in carbohydrate than their snacks. So for a less than meal, you wouldn't use that announcement unless you were having at least 25% of what you typically would have in a meal. So if the snack is smaller than that, you would not announce it in that scenario. But you can use the less than announcement for any particular meal, for your snacks as well, if you are having something with enough carb to be considered a less than announcement. Okay,
Scott Benner 20:44
so in a scenario where my blood sugar is 110 I haven't eaten in hours, and I quite literally walk past the Christmas tree and grab a candy cane, I can't Bolus for it, but my blood sugar rises, then what happens? So the
Kelly Postiglione Cook 20:57
corrections algorithm would come in and handle that for you, we have quite a few users who never announce snacks. You know, they may have a small granola bar that's, you know, not super high in carb content, and do totally fine without announcing that snack. Or other users may want to announce that snack and use one of the less than options, like I said, if it's appropriate based on their usual carb content.
Scott Benner 21:21
Do you think I know again, you I'm not asking you to guess for the company, but is the goal that one day it's just a button that says I'm eating. You know what I mean? Like, is that where you're trying to get to, because either people using, you know, DIY algorithms that have their settings jacked up in a way where they're not announcing meals anymore, like literally not even announcing them. They're just the eating, and they're probably a lower carb eater, but still, they're eating and seeing insane outcomes, like, so, I mean, now that's a very learned person making some pretty significant adjustments to their insulin. But like, bigger picture, I mean, if I'm in a board room at beta bionics, is that the big conversation, like, how do we get it to towards, like, as close to that as possible? Because that seems like what you guys are trying to do with this system. But I think
Kelly Postiglione Cook 22:08
if it can be done, we have the right team to do it. I can't speak to you know, exact product changes, things like that, that are coming down the way or timelines, but I can tell you, if it can be done. We have the team to do it, and like I said, they work fast and furiously. It's never out of the question. How can we improve? How can we make things even easier than they already are, right? That's definitely a part of the conversation, absolutely interesting.
Scott Benner 22:34
Okay, person here who is a user says, I need a better solution for when I don't have CGM supplies, or CGM data. What does that mean? What are they telling me? So
Kelly Postiglione Cook 22:43
with the islet, the system is not designed to be used without CGM, so it goes into what we call BG RUN mode, which means it's running off of blood glucose meter readings at that point. So it's not designed to be used like that, but it does have built in where the user can use it in that BG RUN mode for up to 72 hours. So if they lose CGM connectivity and they're out of sensors, they've got 72 hours to get back online with a sensor so that they can get back into going bionic and having that closed delivery. So they have 72 hours there. What I will say is what we've seen in a real world setting, Bg, RUN mode, just hasn't been a problem. Very low risk that users end up actually to the point where insulin delivery stops, because that's what would happen at the end of that 72 hour time frame. But we're just not seeing it happen frequently, which is fantastic. And then the other part of that is we innovate quickly. So we have the option to use either Dexcom g6 or g7 and now the FreeStyle Libre three, plus previously, when it was only one sensor connected to it, it was a little bit more difficult to get access to, you know, samples and that sort of a thing that can sometimes help to bridge a gap. If a user, you know, forgot to place an order or something like that, or there's a delay at the pharmacy, or now there's more options, and you can switch between the sensors at any point in time. So you can go from, you know, a Dexcom g7 to a FreeStyle Libre three plus, and then back to a Dexcom g7 so you can do that as needed. So that's I think it improved some options for patients if they do run into an issue where they don't have CGM supplies for whatever reason, but they do have a 72 hour time frame, and there's on the screen itself, it will let them know the timing of when the system would stop delivery. I see, okay,
Scott Benner 24:38
you've been going pretty fast and furious. Here, I'm going to give you an easy one so you an easy one so you can breathe. Will I let be coming to Canada? So we
Kelly Postiglione Cook 24:46
actually have talked about international plans. We just don't have a public timeline on it yet. So that is our plan to be available internationally. We just don't have a timeline for that yet.
Scott Benner 24:55
I see you pretty lean organization still. Is that a is that like? Head count issue sometimes, like just having the people to put on
Kelly Postiglione Cook 25:03
it. I mean, we do run lean, but I think, no, I think we just got some other projects that we need to kind of take priority for the time being, and then we'll probably have some timelines around that, hopefully in the near future. Okay,
Scott Benner 25:16
all right, I'm gonna jump back to a user question. Can I select breakfast as usual for me, if it's not breakfast time. So this person said, what happens when I do breakfast for dinner? Is it dinner or breakfast? Like, is the algorithm thinking about the kinds of impacts that normally come at that meal time? Like, do you see the question? Yeah, okay, cool. So
Kelly Postiglione Cook 25:40
you have two choices there, either you can announce based on time of day, or you can announce based on meal content. So for example, if pancakes are typically a breakfast food for you, and you want to always call pancakes breakfast, that's totally fine. You can announce that at any time of day. Or if you want to call pancakes dinner because you're having it at dinner time, that's okay, too, and just announcing based on the carb content for that particular meal. The key in those two strategies, whether you're announcing by time of day or content of meal, is just be consistent with it, because that's going to teach the system the most accurate information about you if you're consistent with the way that you announce. Okay, so
Scott Benner 26:19
it's not that the algorithm thinks breakfast foods are carbier. It's that if you have breakfast foods that are more aggressive in nature, then it will start considering breakfast to be like that. Is that? Right? Right? Yes. It's not like magically thinking like, oh, they eat steak at dinner and they eat pancakes at breakfast. It's not like that. I gotcha. Okay. I didn't think it was, but this person, again, real world situation. They said they made breakfast for dinner one day and they stood there going, I don't know what button to push.
Kelly Postiglione Cook 26:52
I think a good takeaway from that is, you know, typically, if you just don't have to overthink it again if you mess up a meal announcement. On occasion, it only carries that 1/7 weight, so it's not a big deal in the grand scheme of things. It'll all kind of come out in the wash, if you will. But I would say, try to be, you know, consistent in the way that you announce. If that's something that you do frequently, then you would want to announce the same way with with that type of a meal. I told
Scott Benner 27:19
this one person I was talking to that when they describe how they Bolus with their eyelet, I feel like I'm listening to somebody discuss how a Fresnel works because, because the Fresno users are always like, I don't know, I did a four and then an eight and then a four, and I'm like, I don't know what that means. But anyway, I'm gonna jump to a long question here from a parent. Okay, I'd like to know how to handle teenagers when basal is changing so rapidly and the pump doesn't seem like it wants to keep up. I honestly thought about giving him some long acting on top of his pump, but I didn't know how that would affect the pump algorithm, which you already said, don't do that or mess things up long term. His endocrinologist states that this is totally normal practice for kids on other pumps, but she was uncomfortable doing it with eyelet, like layering over other basal. He's literally the only one in the practice that's using eyelet, so it sounds like they're not getting a lot of help there when he doesn't dose for a meal, because that happens. How does the pump go about interpreting that? I feel it's a semi counter intuitive to the basal and pump runs because the company tells you not to Bolus if you realize you missed a meal 30 minutes out. So she's got two different questions in a very quickly shifting landscape of maybe weight gain or like, I mean, listen, honestly, Kelly, if you gained weight, if you suddenly became sedentary, if you suddenly became active, if your basal needs change for any reason. Like, how does it keep up? And when it doesn't keep up, what are you asking them to do? So
Kelly Postiglione Cook 28:44
it adapts really quickly to scenarios like this, where, you know, a growing teenager that's a tough population for, you know, trying to manage their glycemia in general, but especially with the growth. So with the islet as a user's needs change, the system can adapt really quickly to that. So it does it in about a day or so again, if someone's hitting a growth spurt and all of a sudden their insulin needs are going up, the way that that basal and corrections algorithm is looking at what's happening right now, which is always going to trump historic data, right? So if you're sky high right now, you're going to get more insulin, even if you were not that high previously. So what's happening now always Trump's historic data, but it does know your historic data too, so it has a starting place. So for example, if somebody has Dawn phenomenon, it learns diurnally. It will learn that your needs are higher in the first part of the day and lower in the next part of the day. So we'll learn that information, but it takes about a day or so to adapt to the user's new needs. I would be curious with this particular user, it's rare that we see that it can't keep up at all. So I have additional questions about that, and I would encourage the user's parent to call into our customer care. You can actually get connected with our diabetes education team. And they'll review reports with the parent and kind of talk through what they see on there as well, and can kind of coach to how to get the best outcomes using the islet. And I would also encourage the endocrinologist or the clinic in general, they could check out. We have several webinars online about managing users on the islet that they could take a look at as well. But the question about you the basal not being able to keep up. I kind of have questions about it. Not being able to keep up. I want to look at a report, but you can use a basal insulin as well. We usually see that more in those who have really high insulin needs, like if they're above 100 units a day, we may see someone add a basal dose to that. Or we may see for athletes who want to disconnect for several hours per day, they'll add a small basal dose as well. We do have a healthcare provider guide on our website that the endo can reference to see kind of dosing for that. But generally, we don't recommend exceeding 50% of the users basal dose on the islet with any kind of external basal, but it'll adapt to that user's new needs in about a day, even if you add basal insulin to it. Okay, so of course, you'd always want to be vigilant watching for hypoglycemia, because that that first day of taking the basal dose will be different than historic data. But again, what's happening now will trump historic data? So it is an option to use a dose of basal. They also can get some help from our diabetes education team at beta bionics. And then, of course, we're happy to connect with that endocrine office and help educate them as well, because it's a totally different approach to insulin delivery, and it's, it's a lot to wrap your head around. I have
Scott Benner 31:43
to say, you have a the ability for them to contact you and talk to, like a, like a practitioner of some kind diabetes
Kelly Postiglione Cook 31:49
educators, a Certified Diabetes Care and Education Specialist. We have a full team of remote educators, and they're fantastic. We cover all the time zones so they're available during business hours. Yeah, we can set up additional coaching. Because what's really great about this product we talked about, there's CGM targets in the system. But other than that, there's not settings. It's all discussions around, how is the user interacting with the system, what kind of information is it learning from, and how can we best optimize it so that the user gets the outcomes that they want from the system. So it's great. They can basically help to coach the user to get where they want to be. So
Scott Benner 32:26
there's still the second part of this question, and your answer just gave me another question, and I saw and I want to show you something, but first I have to say I have a couple of chameleons. So I keep chameleons. I've never heard anybody use the word diurnal outside of reptiles before. So that was,
Kelly Postiglione Cook 32:43
that was fun. That's, that's an ED Damiano, uh, special there. That was
Scott Benner 32:47
fun. Like, I've been making, I've been making the pies my 11th year, and I've made, like, 1400 episodes. And I was like, no one's ever said diurnal before. Anyway, the second half of her question was about, what happens if the kid just whiffs and doesn't Bolus at all. So are you saying? Is what she said, right? If, if I forget, it's fine five minutes later, but after 30 minutes, I don't do anything. Yeah.
Kelly Postiglione Cook 33:12
So if you don't announce a meal and it's forgotten, if you're more than 30 minutes out, typically, the glucose has already started to climb, and you're going to start getting a reaction from that corrections algorithm. So after 30 minutes, if a meal announcement wasn't made, then we usually recommend not making the meal announcement at that point and let the corrections algorithm cover it, so that the user is not at risk for stacking and hypoglycemia if they do announce at that point.
Scott Benner 33:39
Okay, I have to tell you that I'm happy to say that my daughter has been using an Omnipod since she was four, and she's going to be 21 this summer. It's been fantastic for us. And I've always, steadfastly, over the years, said I'm very happy with Omnipod. I have no reason to move but at the same time, the advice I give anybody, and the advice I would take myself is that you do not want to wake up one day and say, I'm doing this thing. Nobody does. Nobody do it this way anymore. Or did this thing not come along with the times? And I'm not saying that Omnipod five isn't coming along with the times. I'm saying I love you guys all fighting with each other. It's awesome.
Kelly Postiglione Cook 34:18
I think it's good for everyone. Yeah, I think we all push each other to be better. And I think for the diabetes community, the more options that are out there to meet needs, the better beta biotics, it's been such a cool place to be because we have helped people get onto product that maybe wouldn't have been considered device candidates before. I have my own very like staunch soap box around that in general. But, you know, there's people using our product that really wouldn't have been considered for other products, and they're doing fantastic, which is been really rewarding to be a part of.
Scott Benner 34:53
Well, I first of all, I think you guys should just all get into a fight, of all fights, and keep trying to innovate and make things better and better. Forever. That's awesome. And I have to say, the first time I heard about eyelet, what I thought was, wow, you're telling me, I can put a pump on somebody who might be wandering around with an 11. And by the way, this is a thing. I think people listen, oh, that doesn't happen. There are a lot of people wandering around with 1112, 13, a one, CS, much more common than you think. And you know, even if it's a nine or an eight, like you're telling me, like, you could put a thing on something, somebody could just go, it's breakfast. This is usual, and they do better and be healthier. Awesome. Like, really awesome. I think when I was talking to Ed or Steven, I said I would put sales effort into GP offices, because I bet that's where those people are getting their help with their insulin to begin with. I bet you they're not even seeing endocrinologist. Yeah,
Kelly Postiglione Cook 35:44
I think you're right. There's about half of the people that live with type one don't receive endocrine care. Yeah, that's a tough place to be, because, you know, you're in a primary care or internal medicine setting, and the time frame around that visit, it's really difficult to address everything that's happening in your health, and that that small window, let alone discuss diabetes technology, or, you know, yeah, be able to interpret reports, that sort of a thing. So, yeah, I think that there's some, some room there. In general, it
Scott Benner 36:12
just makes sense to me, like, if they seem like people who could really use it and who are not going to hear about it, because, I mean, you just got a question from somebody who listens to my podcast who is telling you that they're in their endocrinologist office and they're the only one using an eyelet there, and the endocrinologist is like, well, this is what I would normally do, but I don't know if I can do it with this. So we're not going to do anything. And you know, like, that's I'll give you more work to do. I think you guys should be doing that. I think it would be awesome. Okay, so here's my next question, how does one use the eyelet for exercise? Growth hormones, like periods, like anything like that, like that seems to be not just for islet, by the way, but most algorithms that let me say it like this, most, what I'll call retail algorithms, seem to give people problems in those situations. So what do people see? Their kids sit in school all week long, and then on Saturday morning they get up and run around like a lunatic at a soccer game, and they're like, Oh, my kids, blood sugar gets low on Saturdays because the algorithm thinks this is how much insulin they need. But then, you know, etc, or growth hormones overnight, or, you know, period. So my daughter has PCOS, like, I'm sitting here the whole time wondering, like, I don't know if this could handle Arden or not. Like, so, like, what do you like, what's the direction right now for people who are in those situations? Yeah,
Kelly Postiglione Cook 37:30
I think any kind of physiologic stressor, you know, whether that's hormonal, whether that's illness, anything that's going to cause a higher need for for insulin. It usually takes about 24 hours for the system to adapt to the new you, if you will. What we see is about that 24 hour time frame to get to the new mean glucose. You know, we've seen. They did a sub analysis of the people in our pivotal trial, for example, that use corticosteroids and and found that they reached their new time and range and main glucose within about a day or so. So you actually, you don't have to do anything with the system. You could be proactive with the CGM targets, and of course, you have to speak with your healthcare provider about that. But let's say you're at usual and you want that corrections algorithm to come in a little bit earlier in a in a glycemic excursion, and just run a little bit lower, you could drop it down to lower to be a little bit more proactive. So you have the CGM targets in there, but otherwise, you just give it a day and it'll adapt to the new you, which is really a great piece of this system. So when people have had illnesses, just anecdotally, what we're seeing in the real world, the system adapts really well to their new need pretty rapidly. Now, if someone's needs decrease significantly, keep in mind the system will what's happening now will always trump historic data. Again. That doesn't mean you're never going to have a low glucose, but the system is going to recognize the trend that you're, you know, average CGM reading, you're different today than you were yesterday, and it's going to adapt to that new need as well. So again, you kind of become a new you in those scenarios. Exercise is different, though. Exercise is a little bit different if we're talking about kind of episodic exercise,
Scott Benner 39:16
yeah. I mean, there's more than I didn't send all the the people to you that said, I really this thing, this thing really needs exercise mode. So, and by the way, I want to give you a bit of credit here, like, I had three follow up questions while you were talking, and you hit each one of them. I was just like, oh, I don't have to ask that now. And then I had another one. I was like, Oh no, she got that one too. Somebody should give you a raise or something. So you really,
Kelly Postiglione Cook 39:42
I don't know if I'm John, are you listening? No, I'm just kidding. I don't
Scott Benner 39:44
know, Kelly, if I'm in charge of that, but if I was, I'd like to see with a nice, at least 15% bump. But go ahead, tell me. How come you won't just give them an exercise button. I
Kelly Postiglione Cook 39:52
would say that we won't just give them one. It's definitely a project that we've been working on. I don't have a timeline that I'm able to share currently. Hmm, but it is something I think, that, you know, we regularly request feedback from our users, and that is something that we've heard, along with the snack option. And those are both two active projects. We just don't have a timeline for release, and need to do some testing around those. For exercise. Currently, the strategy is, you know, if you're someone who you can either wear it while you're exercising, you know, depending on the type of activity, if it's not something that typically causes you lows, you could leave it on for that. If you do choose to wear the device during exercise, like with all aid systems, it's not a great idea to pre load with carbohydrate, because you're going to kick in some correction insulin, and you could cause a low because of that. So if you're going to stay connected, don't pre load with carbs. If you do want to pre load with carbs, you can disconnect. And we added a pause feature to our device last year, where when you disconnect, you pause it. It's not learning or anything like that, during that time frame while you're disconnected. And then you know, once you complete the exercise, reconnect and UN pause. It's got a little timer on it too to remind you to UN pause your insulin as well. I have to fish a
Scott Benner 41:06
little bit here, because I feel like I heard you say something earlier that would indicate to me that you and I would get along really well. Talking about diabetes, you said you had an opinion about not putting certain people on products, which I felt like. You wanted to say that some endos don't give people pumps because they're struggling, but they should. Is that what you were going to say?
Kelly Postiglione Cook 41:23
You know, not in my capacity as a beta bionics employee, I'll start there, but as a diabetes educator, I you know, if someone understands the risk involved with going on a device, I don't think it's fair as a prescriber to not consider them for a device.
Scott Benner 41:41
This is awesome. Okay, if so. Now I asked that to ask you, would you, as a diabetes educator, tell people to take their pumps off to for activity you want them having active insulin, right? So
Kelly Postiglione Cook 41:52
it depends. I think disconnecting and taking the device off is really common. I just wouldn't leave it off for really long, extended periods of time. So like, if you have someone who's going to be doing, you know, hours of activity, that's the kind of and they want to take their device off for that, then that's the kind of person I would say, well, maybe we should consider adding a little bit of basal insulin so that you're not completely without insulin, because you don't want to be in that scenario either. So, you know, typically, if you're disconnecting for about an hour or so, and then reconnecting. You should be in good shape there. I think that's a pretty common practice. But I also think, you know, there's exercise modes available and other devices. I wish we were better at exercise in general, as people who recommend things to people who live with diabetes, exercise is just a tough one, because people respond differently with different intensities, and it's just kind of a tough one to conquer in general. But even with the exercise modes on other systems, you know, I'm sure they help, but I think there's a lot to be desired there still. So I think people do want an exercise option on our device, and we'll bring them that first
Scott Benner 43:00
of all, definitely, right? Like, exercise, it's not a, it's not a catch all. Like, I think it's just a more of a, hey, pump, I'm about to get way more active. Like, that's the mode. And then if, if the button doesn't work, the button, if the button doesn't work for you in that situation. Now, at least you know, but at least you have the option. I think that's what they're saying about the snack thing too. Like, I don't want to go up 20 points because I had eight carbs of something. Can't I just tell the thing I'm snacking now, so that it gets a little more aggressive sooner. Like, so, like, let me pivot into my other question. Like, do I not want to Pre Bolus my meals? Or do I, like, some companies are, like, Don't Pre Bolus, Pre Bolus. Like, I don't know, like, how much that has to do with the algorithm. But, like, Listen, my daughter uses trio, okay, and it's about as aggressive as a DIY algorithm as I've seen so far, that in the loop, and she has to Pre Bolus. Like, so like, what do you guys tell people to do?
Kelly Postiglione Cook 43:57
Yeah, insulin. It'd be great if we could keep getting it to be a little bit faster, right? Yeah, be nice. So the way it was done in the pivotal trial is that they told them to announce the meal when they sat down to eat. So that's the recommendation that we go with. However, if someone is a Pre Bolus er, and they come to us with that habit established, whether it's from MDI or from another device. Absolutely continue doing that. You just want to be consistent, because the meal is going to learn from your behavior around that. So if you're a Pre Bolus, or, you know, no more than 15 minutes before the meal, and be consistent about it. Otherwise, our kind of general recommendation is, you know, announced at the time of of eating. But I do think there's some people that get better postprandial control. If they're Pre Bolus. Saying a bit with that, yeah, for sure, the big thing is just don't forget to eat. A few pre, I guess I'm saying Bolus, but really, pre announced, just don't forget to eat, right?
Scott Benner 44:53
I see what you're saying. I see you're covering your ass. I see what you're
Kelly Postiglione Cook 44:55
doing. That one was for regulatory I hear you.
Scott Benner 45:00
So I mean, listen like I heard what you were saying earlier, and I see the value in this, and I see the value in where I think all this is going. But if you told me that my daughter's blood sugar had to be 180 for an hour and a half or two hours after she ate, that's a non starter for me. Like, and I think a lot of people listening are in that boat, but love everything else that's being said. And so they're trying to figure out, like, well, how can I use this but not have that experience like and also I think it's possible that from the way you're talking and and how other people who have come on from Benny have spoken in the past, I also think it's possible that I wake up two years from now, and that's not a concern anymore for now, for the people who are like, Oh, I'd like to try this, but I think that's what this conversation is. It's trying to assuage their butts, so that they That came out wrong, like, so that they, you know, so they can say, like, is this a viable thing for me right now? So I appreciate you asking all these questions. Here's another one that's not going to be covered by any testing, but is going to become more and more prevalent as each day passes. So this person's questions a little longer. I know weight is a factor in how the pumps algorithm works, and that you just, you know, do meal size and versus carbs and etc, but what about people who are also on other medications that help them with insulin resistance? So this, I know this is a GLP question, so I know you can say like, look, glps aren't FDA approved for type ones, but, you know, Wake up and smell the coffee, if that's how you think. Because there's a lot of people who have type one who are using GLP medications. So I'm assuming you guys have tried to look at it like, does that change anything? The slower digestion, the slower spikes like, this is going to be weird, because we're not on camera, but I'm going to pop my camera on for a second for you to show you something. So this is my daughter's last 24 hours, wow, and her top line is 120 and her bottom line is 70. Okay, so you see that she hasn't been over 120 or under 70 in 24 hours, right? That's trio. It's and it's also Manjaro. So I put her on a GLP. I watch her insulin needs drop. I go in and I tell it, all right, hey, let's make the insulin sensitivity weaker. Let's make the basal weaker. Let's make the insulin to carb ratio weaker. Boom. We're back in it again. Is what you said earlier about the 24 hour window. Like, do you think it would keep up with that? That change. So
Kelly Postiglione Cook 47:21
for basal and correction, absolutely, if it impacts the way that the user's eating, and that the amount of carb for their usual is no longer the same, and it's significantly less, for example, and they need a much smaller dose of insulin for the usual amount of food that they're eating, you've got a couple of options there. You can kind of announce and and let it adapt down. Or you can do what we call as a factory reset and take it back to zero and just start over with it. You're a brand new person, and now it's learning from zero with you. If you started a medication like that and thought that the really it's you would factory reset it. If the meal doses had gotten too strong, and we were worried about a risk for severe hypoglycemia, if you were to announce for your meal. So if that's the case, you would factory reset it to bring it back to zero if you really changed how you were eating. So same thing would go if someone, you know, woke up tomorrow and decided, I'm going keto, and I've never done this before, and you know, I'm really going to need, like, significantly less insulin than I typically would. That would be a scenario where you would talk to your health care provider about starting over and kind of factory resetting the device. But that being said, if someone's using that medication, it'll adapt to how their body's absorbing food, similar to, you know, we have users who have gastroparesis, didn't specifically test it for that, or have special indications or anything like that, just kind of watching how the system works. You know, the correction insulin will come in as needed. So if their carb absorption is, you know, delayed to some degree, it will adapt to that specific need. So same thing with the GLP ones as well. So we do have users who are just anecdotally using the GLP ones as well. I didn't I wanted to circle back to something you said earlier about meal announcements and hanging out at 180 for like two hours after the meal. That shouldn't be a typical experience on the islet. I mean, if it happens occasionally, because maybe you ate on the the top end of your your usual amount of carb, or it could have gone either way, with a more than announcement or a usual Sure, you may see it happen in those scenarios. But if you're in that hyperglycemia area, I mean, you're getting correction insulin, and it's trying to bring you down, which means your meals are adapting up right? So it's going to adapt up until that's not something that's happening routinely. So if that is happening regularly, and again, you know, the user feels like they need a little bit of coaching to get that, you know, to stop happening, or have someone review reports with them, have them call into the Customer Care. Again, we've got that great education team that can work with them, right, and review that. That for them, because that really shouldn't be a an everyday or regular occurrence. I
Scott Benner 50:04
mean, also, I don't want to, like, try to say that, like, in case people are listening, like, my daughter's blood sugar does that too. Like, just because, you know, I showed you 124 hour graph, like, it doesn't mean it doesn't happen like that. Although, honestly, Kelly, you saw that graph and you thought my blood sugar might not be that good, didn't you actually,
Kelly Postiglione Cook 50:20
literally thought that I also have PCOS in my blood sugar does not look that good. Listen,
Scott Benner 50:26
I won't go down this road with you on this, but if you want, after we're done, I can tell you how the GLP has been helping her with her PCOS symptoms. So it's been really valuable. I'm gonna move on here. Let's see, is there or will there be an option to take over? So I think this person's asking you, are you ever going to give them manual control of the pump? I don't think you're going to, but I'm asking anyway,
Kelly Postiglione Cook 50:49
there is not a plan to have any kind of manual mode, if you will. So it goes into when it's in BG run when you don't have CGM capability. That's about as manual as it gets. So what happens in that status is it runs off of what we call a nominal basal. So it will learn what your needs are and look at kind of the last seven days, and average that out and figure out what your body needs at specific times of day. So that would be your nominal basal when you aren't running CGM. And it's conservative, you know, because we don't have have CGM values there for that. So it would run that nominal basal, and then when you you still would announce your meals, and it will give you that adapted dose for each meal announcement the same way it would, or similarly to how it would if you had CGM connectivity as well, but realizing there's no correction in there and all that good stuff. So that's about as manual as it gets. I don't foresee us adding anything further to it to make it manual. Let
Scott Benner 51:49
me answer that. Listener, no, okay, how about God who came on? Sean and from zeros, Paul this past year on the podcast, they were very excited about their their agreement about glucagon. So I'm going to ask, are you guys working on, can you talk a little bit about dual chamber, the ability for this pump to, maybe one day, give a tiny bit of glucagon to save a low blood sugar? Yeah.
Kelly Postiglione Cook 52:16
So that is definitely an active project that we are committed to, and obviously our, our kind of flagship reason we were were founded so super excited about that potential here down the road, I can't speak to any timelines other than it is an active project. Zerus is our partner on that, and we are again working fast and furious, as we do with all things, to make that a reality for people living with diabetes. Awesome.
Scott Benner 52:41
Zeros is a sponsor of the podcast. I just want to point out, I have to tell you, I recall back however many years ago that that picture of Ed and he was like, I'm gonna make a pump that gives you glucagon and insulin. And I mean, I don't know how long ago that was, but I do think it's interesting to think back on it. You know, it's fun to say, like, can you give me a button for this? Can you do that? Can you this stuff takes time. You know what I mean? Like, yeah, and you need people who are dedicated, don't give up, stay in the fight, that kind of stuff, to get something like this out there. So, you know, I think people's questions are great, but I would always tell people, like, just don't imagine. You're just gonna wake up tomorrow and it's just gonna be magically happening. Like, this is a thing that's gonna happen over time. And I mean, I like people being progressive about the thinking, because, yeah, when I think about all these algorithms, Kelly, when I think about them, what I think is, I hope that every one of these companies is treating their algorithm the way Tesla treats self driving like. I hope there's a whole bunch of people looking at data constantly trying to figure out, like, how do I tweak this so it works better? Like, not just like we made a thing and it works, so let's sell it now, but like, we made a thing, it works. Let it go help people. And behind the scenes, we should be continuing to figure out how to use this data to make better decisions, to help more people, a broader range of people, a broader range of people's, you know, who have different implications, you know, variables in their physiology, etc. Because I think it's there, like, I think the answer is there. You just have to dig through it and be persistent to pull it out. So anyway, that's me. You're, I mean, I think you're
Kelly Postiglione Cook 54:20
I mean, I think you're describing exactly what happens on a daily basis with our team, like there's no attitude of, oh, well, that's good enough. They will never stop innovating. Like they're some of the most creative and brilliant people I've ever been around, and it's fun to watch them work and see how quickly they come up with solutions to things. I mean, you know, we've rolled out several software updates just since we've been on the market that have been really exciting. You know, we've got the Share feature, like they built out our circle app, so you can, you know, share the glucose values with your family. Have up to 10 people in your circle. I mean, that was a tremendous lift, and done so quickly. You know, the. Know, the integration with Dexcom, g7 with libre three plus, like, That's fast. It's just been really fast. And they will, I don't think that they will ever settle, which is why I want to be here. And I think most of the people that are here, they just aren't satisfied with with the status quo, which is a cool place to be.
Scott Benner 55:18
Yeah, I hope everybody is taking big swings and not playing from a scared position. Like, that's what I want, you know, for my daughter, for my daughter, like, I don't want her to have to think about this forever. Like, I'm telling you I don't care. Listen. I want to be clear. I don't care if it's you or somebody else, right? I want somebody to, like, send me an email one day that says, hey, guess what? Our pump now has the just push this button feature. Yeah, get to it. You know what I mean? Because I think it's out there. And I think, I mean, this is me, but I think AI is going to help people parse the data faster and get to the answers more quickly. So I'm excited. Oh, I agree. Yeah. All right, let me roll through some of these other questions. How is my data uploaded at my provider's office? Like I take my Omnipod in and gluco blah, blah, blah, do you have something like that?
Kelly Postiglione Cook 56:04
Yeah. So we have an HCP portal, so users connect their islet to the islet app, and then it pushes it up to the cloud, and the HCPs can log in, and they have their patient list, and they can review reports right there. So really similar to other cloud based reporting systems.
Scott Benner 56:21
This is a user question here. Could you ask about the islet for getting the last six hours of data if we just choose Fill cannula option? Does this also happen when changing cartridges and tubing, when the user selects fill cannula, when they do a complete site change? If yes, is there a better time to do a site change? I want to be honest, I don't completely understand that question. I'm gonna
Kelly Postiglione Cook 56:44
assume you do. I do. I was actually surprised to see it in there. I was like, wow, they were really listening. That's great. So when the user fills the cannula, it will not learn from the previous six hours before that site change. So whether that site change takes place on its own, or it takes place with a full cartridge change the previous six hours. Won't be your used for learning. Can you tell me why? Just in case someone had a bad site, you don't want it to think that the user's baseline insulin needs are crazy high. Okay, so
Scott Benner 57:15
meaning, if you guys produce a patch pump at some point, this will persist through that device too, that
Kelly Postiglione Cook 57:21
I can't speak to yet for the current setup. It is in there with the six hours previous not learning from that data, but it is specifically for a bad site, and really where it's going to be most important. Because the second part of their question says, Is there a best time to do the site change, when the device is first learning you you don't want to do it within that four hour window after you've announced a meal because you want those to adapt pretty quickly. So maybe first thing in the morning would be a good idea. You're only doing it every few days, so you know, if you have something going on, like Dawn phenomenon, that kind of a thing, it's going to figure that out anyway. But first thing in the morning might be a good idea while you're still getting your meal announcements dialed in, but otherwise, you can do it whenever, like I said, it doesn't have to adapt to every single meal that's announced. You really can loosen that up once you've been on the system for a long time. You don't have to be really strict or do that four hour spacing between the meals at all I
Scott Benner 58:18
see earlier, I advocated for you to get a 15% increase in your payment. I'm payment. I'm going to 20 because, like, it my note here, after the GLP question was, ask about gastroparesis, and you just, like, you pivoted right into it. I was like, oh my god, I love Kelly. At first, I was like, Did I leave my camera on? Can she see my notes? You're a great example of somebody who came up through it and your understanding of it like you were speaking so effortlessly about this. It's not I'm trying to give you a compliment here, Kelly, like, I know you've sat with attorneys and they've taught you how to talk about regulatory stuff, but it doesn't feel like that. And it also feels like, do you have type one?
Kelly Postiglione Cook 58:57
I don't. My husband loves the type one, but I do not okay,
Scott Benner 59:01
because you talk about it like you have it too. Like, that was the other thing. Like, I could, you know what I mean? Like, you have that, like, there's a naturalness about like, where you pick up, it doesn't just feel like your job, I guess is
Kelly Postiglione Cook 59:10
what I was saying. I'm definitely passionate about what I do. Yeah, no,
Scott Benner 59:14
it's obvious, for sure. Just so, you know, I'm assuming you know already, but it, but it was obvious, because I have a couple things here. I don't know that. We haven't gotten to all of them, but they're inside of other questions. Like this person says, If my CGM goes bad and I don't have a backup on hand, does it create a profile? But we've gone over that, is that correct? Like, so we have that one tape, yeah, would
Kelly Postiglione Cook 59:32
be that BG run setup where it's running the nominal basal and your meal announcements would still be that adapted. Dose,
Scott Benner 59:39
yeah, there's another one here about teens forgetting to eat, but we've got that or forgetting to Bolus. I'm going to give you a statement here. It's not a question. I just want to hear you respond to it. I guess this person said I tried islet, unfortunately, did not like the fact that I had no control over carb counting and that it holds 160 units of insulin. So it went back to my Medtronic cell. Have an ADG pump with a guardian sensor. I might try again in the future. Right now, I'm disappointed. Like, how would you talk to a person who who had that experience?
Kelly Postiglione Cook 1:00:08
Yeah, I think I would want to ask a few questions to understand exactly which parts were difficult. I think, you know, you talked to Ed, you talked to Stephen, they talked about who's right for the eyelet, that, that sort of thing. I do think if being really methodical in, you know, entering carbohydrate values or intervening on high glucose, if it's going to be anxiety inducing to not be able to do those things, this might be a little bit of a lift for someone kind of on the psych side of it, because that is a stressful thing, especially if you've done it for years, right? Like, if that's something that you're used to doing and it, you know, having that control over that aspect of it is important to you, or or anxiety inducing, if it's not there, that's definitely something to consider. I will say, when we've had people go on product who are like, you know, I've been doing all of those things, and I'm ready to let that go like it's it is a burden in the background, if you will, of having to do this all the time. It's not like a one week thing where it's no longer anxiety inducing. It really takes some time. You know, in my talking to, you know, colleagues and friends of mine who have made that transition from doing a lot of input on their aid devices to, you know, using an eyelet and using it as it's designed, with the meal announcements. And that's it they talk about, you know, sometimes it's like a six week time frame for them to really get to the point where it's like, Oh, I get it now rewind, like it's a it's a long time frame for some people to get there to where it's no longer anxiety inducing. They've had enough time with the system to sit with it and say, Okay, I did have that high that was frustrating. It resolved. I've moved past it, you know, I didn't intervene. Yeah, then it's just a longer time frame, I think, for for some people, but for that user, you know, like I said, I'd want to understand more about what it was, how long they used it. You know, hopefully they will try it again in the future, but understand if it's not the right fit for everyone, what you
Scott Benner 1:02:08
just said reminded me of over the years, I've so many times heard the question asked, like, if you could, like, get rid of your diabetes, would you? And most people are like, yeah, obviously. But some kind of old heads will come in, like, people have had type one for a long time, and they'll talk about, like, I don't know who I'd be without it. It's an interesting perspective, and I'm wondering if a little bit of that isn't what you're talking about here. Like, how do I just decide not to be worried or thoughtful about these things that I've had to think about for so long? Like, just letting go of them seems like, for some some people might just feel free like, Yeah, I'll let it go. But some people might be like, I don't know how to let that go. That's interesting. It really
Kelly Postiglione Cook 1:02:46
is. Yeah, I completely understand that. And especially if you're really good at it, like, it sounds like, you know, you've been really good at that for a long time working with your daughter. You know, that's a hard thing to let go of, especially if, you know, sometimes you feel like you would have done something differently than the system. So I feel like, if someone is going to inter try to intervene on the system frequently, like, that's just not a good fit, because the eyelet is not going to learn any good information, and you're not going to get the outcomes that you want.
Scott Benner 1:03:14
You'd be fighting with it forever. I also want to make clear that I am not that person. I am good at it, but I would be happy to be rid of it, and I would be, yeah, you're talking to a weird person. I was just focused enough to help my daughter. But I'm not type a like, I don't love it. I know people listening who might be like, that's not true. I do not love it. Like, yeah, I'd love to wake up one day and go, hey everybody. This is the last episode of The Juicebox Podcast. Buy a thing, put the thing on, push the button. It's all done. Congratulations. I'll see you later. Like, I'd head to a beach. You know what I mean? Like, I'm good to get away from diabetes if I can. And I have to be honest, like, I don't know if it's you, like, if it's I led, if it's somebody else, but I do think we're within like, a reasonable amount of time before these systems are just, like, kind of bulletproof for most people. So like, I'm super excited about that. I'd like to see cannula technology get better, right? Like, I'd like to see, I would like to see that, like you said earlier, it'd be cool if, if insulins worked quicker. But, you know, a lot of people with those faster acting insulins, my daughter is one of them. Like, she can't tolerate whatever one of the ingredients is. So I think it's the I've looked into it a little bit, but not enough. Like, I guess they use, like, vitamin B to speed up the process, or so, I don't know exactly I'm talking out of my ass right now, but like, I think you're right. Oh, awesome. She gets very she just can't manage it, like, it stings or it burns, or it leaves her bruised or something like that, which is a real shame, because the ASP did work really well for her, but it would leave her sights sore and loom Jeff burned her so badly, like she had to take it off, like she just hated it. Now that could just be her, right? Yeah, it does work great for other people. I've also heard people who it works great for then it sort of stops working great for them, like finding a way to speed up that insulin awesome, making cannula technology better so that you don't get, you know, agro. Activated, you know, inflammation, which obviously slows down absorption and messes things up. That would be awesome. Like there are little things that along the way, with these algorithms could definitely turn diabetes into a little more of a back of a mind thing. As far as the moment to moment management comes in, I honestly think I'm gonna live to see it. So super excited. Keep working over there. Also don't take that raise. I need them to have that money to innovate. I'm sorry. I know I promised, I know I promised it to you, but you
Kelly Postiglione Cook 1:05:28
can't have it. You dangled it right out there, and I'm just pulling it back like that. I just want to keep
Scott Benner 1:05:31
you working. Kelly, that's there anything we didn't talk about that we should have let
Kelly Postiglione Cook 1:05:36
me think about that we talked about new innovations. You know, we've just, we've been out there for a year and a half, and I think we will be publishing some of our real world data hopefully in the coming months this year. It's just unbelievable what the system is doing. It's crazy. So I'm excited to get that out there for everyone to kind of look through and see how well it's working. I think for the community, if your end does aren't familiar with beta bionics, or they're not familiar with the islet and they want to learn more about it, please direct them to our website so we can get someone out there to talk with them and help to educate them, because it is a really different way to help people get their glucose to gold. And you kind of have to wrap your head around it a little, because you don't get to go in and just start pulling levers and say, All right, well, we'll see in three months. Good luck. Yeah, they have to have a totally different conversation. So I think that's an important thing, you know, the HCP education and bringing everyone up to speed on beta bionics, so that the technology is made available for for more people living with diabetes. Well, Kelly,
Scott Benner 1:06:38
I appreciate your time, and I appreciate you being so good at this, like you really were, like every time, like you're talking and I'm making notes to follow up, and I never had to go back to them. I think I could have just said, Hey everyone, this is Kelly. She's going to talk about eyelet. And I could have went and made a sandwich and come back, and about an hour later, I think, I think you would have been
Kelly Postiglione Cook 1:06:56
done. So I'm from the south, and I have the gift of dab, so listen,
Scott Benner 1:07:00
I appreciate it made my day very easy, and it's Friday, so it's awesome. Oh, great, yeah. Hold on one second for me, this was terrific. Thank you. Thank you.
This episode of The Juicebox Podcast is sponsored by us med. US med.com/juice box, or call 888-721-1514, US med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, thanks also to AG one for sponsoring. And don't forget with your and don't forget that you're and don't forget that new subscribers are gonna get a free $76 gift when they sign up. You're gonna get that welcome kit, a bottle of d3, k2, and five free travel packs in your first box when use my link drink, AG, one.com/juice box, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. Hey, what's up everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you wrong way recording.com, you got a podcast. You want somebody to edit it? You want rob you?
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