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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
Maybe I should just start the episodes by saying of the number then jump right into the content. What do you think? We'll try, we'll just try it this one time. 761 I'll put the music right here

don't know I already don't like that. Hello friends, and welcome to episode 761 of the Juicebox Podcast. On today's show, we're going to speak with Andy. He is the father of a girl who has type one diabetes. And she is an omni pod five user Previously she used on the pod Dash. And before that she was MDI, and he's got a bit of an engineers brain. And so he keeps track of his daughter's time and range in a one sees in a very easy to understand graph, which he and I were looking at while we were recording today, you'll see why that's important later. For now, just remember this, 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. We're becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one, and our US citizen, please go to T one D exchange.org. Forward slash juicebox. Join the registry, complete the survey. That's all I'm asking you to do T one D exchange.org forward slash juicebox. You must be out of Harry Potter quizzes to take by now. Take a survey that I hope people would type one. If you enjoy the Juicebox Podcast if you love that it is free and it is plentiful. Please help me thank the sponsors Dexcom Omnipod, je voc hypo pen, the Contour Next One blood glucose meter us med touched by type one and in pen from Medtronic diabetes, you can do that by clicking on their links, today's links of choice us med get your diabetes supplies from us met. All you have to do to get started is go to us med.com Ford slash juice box or call this number 888-721-1514. Get your diabetes supplies the way we do with us. Today's offering of the podcast is also sponsored by Dexcom, makers of the Dexcom G six continuous glucose monitoring system. Find out the speed and direction as well as the number of your blood sugar or a loved ones budgeter with Dexcom. Find out if you're eligible for a free 10 day trial, the Dexcom g six@dexcom.com. Forward slash juicebox. If you're good, I'm going to start the recording. And then when you're ready, just introduce yourself and we'll start talking sounds great.

Andy 2:57
So I'm Andy. I'm a husband. I have an amazing wife and we have two kids. So I have a four year old son and a seven year old daughter. In fact today while we're recording, it's her birthday. So excited about that. So yeah, the seven year old daughter Anna, she has type one diabetes and celiac disease.

Scott Benner 3:19
She's got type one and celiac. When was she diagnosed with type one?

Andy 3:23
February of 2019.

Scott Benner 3:27
Over three years now, yeah. Okay, we

Andy 3:30
actually recently hit the milestone of more days with diabetes in our lives in her life rather than without

Scott Benner 3:38
was that an impactful thing for you?

Andy 3:41
It definitely struck me so I knew she was about three and a half when she was diagnosed. And so now we're approaching her seventh birthday here and I'm going Okay, three and a half. We got to be getting close to where we hit that tipping point. So it definitely struck us as like, wow, we were more experienced doing life this way than then before. Yeah.

Scott Benner 4:03
And what did you really know before honestly, those first three years your first kid? Yeah, not much.

Andy 4:08
No, they're just crawling around having fun.

Scott Benner 4:12
Do you have any autoimmune stuff? Is your wife anybody on either sides, your family?

Andy 4:18
Mostly? No, we have some in our extended you know, histories of some thyroid, though I'm not sure that any of its audio autoimmune. Have some diabetes, and there's a possibility that like, a great great. Somebody of Anna's, you know, had diabetes not really clear on if it was type one or type two, they definitely did injections. But not long,

Scott Benner 4:42
long time ago. Yes. Yeah.

Andy 4:44
So this would be I don't know 100 years ago or something? Yeah. Not not 100 several, several decades plus,

Scott Benner 4:53
well, let's see could they just came up with insulin in 1922. Right. So Oh, yeah, a long time ago. Nonetheless, anything over 10 years ago seems like a long time ago. So well, I want to ask you, How involved are you with the diabetes versus your wife?

Andy 5:15
Yeah, we make a really great team, we're both significantly involved. So my wife, very fortunately, is a pediatric nurse. So, in fact, we had this very odd situation of she was our daughter was admitted on the one floor below where she had worked for about nine years or so at that time. And so she's great, you know, obviously has a lot of the medical know how really good with blood and injections and stuff early on. But then, you know, I'm really involved too. I'm, we're both really type A, you know, I'm, maybe someone say pretty controlling and things like that certainly involved, like, one set,

Scott Benner 5:56
some would say, and

Andy 5:57
some might, I don't know if I believe him, but yeah, some might say that.

Scott Benner 6:00
Who are these people who might say that hypothetical people?

Andy 6:03
No, I don't, maybe my wife. But you know, so Anna's in first grade now at the school, we have an amazing nursing team, and we just have a text thread among the nurse, my wife and I, so whoever's ready for it at a given moment, we're just communicating and both really involved. Okay.

Scott Benner 6:22
So what's the management style? You MDI pumping? What are you doing?

Andy 6:27
Yeah, so, actually, for the last three months, we've been on Omnipod, five, with Dexcom, G six, of course. So that's been going great. And so we started, you know, diagnosed in 2019. Several months in there, we got on to Dexcom. Pretty quickly. About a year after that, we started just Omni pod Dash. And then, yeah, the last few months had been Omnipod. Five,

Scott Benner 6:55
how were things going, I guess, incrementally. Was there a honeymoon for your daughter?

Andy 7:00
Essentially? No. Okay, nothing weekend mark. She was

Scott Benner 7:04
just needing her insulin right from the get go.

Andy 7:07
That's right. And just pretty consistently cranking down carb ratios.

Scott Benner 7:11
Okay. So you did MDI for a little while? Yeah, over a year. Okay, shots for a year CGM for most of that time. That's right. What were her outcomes like in that first bit?

Andy 7:25
They were good. I mean, you know, we've we've been fortunate, I think, as I hear, you know, listen to podcasts, I think we were really blessed with the education and the endo team that we got from day one. So we've always been on kind of a progression of just getting better improving, really seeing things as a learning. So like, you know, when she was diagnosed, when she was almost 11, so high 10s. Even on the, you know, MDI, we were, you know, got things down into the about low eights, got onto the pod and progressed into the seven. So we've been kind of a continual progression of just improving and getting better.

Scott Benner 8:13
Do you see many lows with the MDI?

Andy 8:18
Yeah, I would say so. I mean, I don't know not, not not, but terrible now, right? Like, not like, we felt like we were fighting lows all the time.

Scott Benner 8:28
Okay, so you had some? So who sets up that insulin for you for MDI? And do you ride with what they gave you? Or did you start making adjustments to it?

Andy 8:38
Yeah. It's a good question. And, you know, part of what what I was reaching out is how I've kind of evolved, particularly myself in my thinking about controlling diabetes. So early on, you know, you get these equations and these ratios, and you go, Oh, this is great. This, these medical people, they have the answer, I'll just follow these numbers. This is fantastic. Like, I can do that. But, you know, they did give us really good training, and they kind of teed us up for, this isn't how everything is going to continue to look into the future. You need to look at, you know, patterns and see where can you adjust. And we latched on to that pretty quickly. I mean, within a couple few months, you know, maybe at first we would call the endocrinology teams, a hey, we saw this, we're thinking we're going to change your carb ratio for lunch, and they say, Yeah, give that a try. But then pretty quickly realized, like, we're the ones here with with the insulin pen, you know, why are we calling oh, what? Yeah, we know what she's eating. We're going to deal with the rim and fake ramifications either way, and really started taking that on within a few months

Scott Benner 9:49
and they were supportive of that the whole way it sounds like Yeah, absolutely.

Andy 9:53
Okay. Yeah, they they planted a lot of good seeds. I mean, I do, we had, you know, like the section She for endocrinology was our attending and she planted seeds along the way of, you don't have to start doing this right now. But this is what you need to start thinking about around Pre-Bolus saying, around looping, I mean, even that specific, like, DIY loop, hey, you may want to start looking into this people are using this and really doing great, you know, we ultimately never did that. But I give them a lot of credit for kind of giving us things to start looking into ourselves.

Scott Benner 10:26
Okay. All right. So you do really want to come on in for a specific reason. So tell me what you do for a living. You don't tell me where you work. But what are you doing? What's your training in your background?

Andy 10:37
Yeah, yeah. So I am an engineer, you know, my education is in mechanical engineering. And I work in research and development, right. So I get to put my engineering to use day in and day out some of those, you know, scientific concepts and things like that. And I've even specifically worked in like areas of manufacturing process development. And so much of what goes into a continuous manufacturing process is closed loop control in various forms. And so as I look back on the last three and a half years with with type one for Anna, and it's been an interesting journey to how I took kind of that engineering thinking, some of that control thinking from from my technical background, and it's, it's evolved and how I use that and think about it relative to diabetes.

Scott Benner 11:33
Okay, now, so there are times when I talk to people who have an engineering background, and diabetes flummoxed them, because it doesn't follow the numbers the way they're told. But you notice that, and you adjust it somehow. Is that right?

Andy 11:49
Yes, though, not right away. So you know, kind of the funny stories relating to that, right? So you get presented with this diagnosis, you get training, like I say, the equations, right, so there's, there's a carb ratio, there's a correction factor, right. So it's a number minus something, apply your correction factor. So I think early on, I was in that camp of, oh, this was great, I, I will do this math, I am fine with this math. And I will follow this, I will waste things to the 10th of a gram. And we are going to nail this and I you know, I did that for a time and and you get what you get, you don't get consistency. I actually, after the first day of of education in the hospital, I came back and the team was doing their rounds in the morning. And so they all came in attending physician and a few others. And, you know, I had come up with these odd combinations of like, what her blood blood sugar could be, and what correction factor was resolved and some carbs and like rounding, like, you know, point one of of a unit, and I'm gonna know, that's not the right rounding for this. And they're like, well, that's our that's the rule you use. And I Okay, well, that seems odd to me. But then, you know, really, particularly through the podcast, so I've been listening to the podcast for not quite a year and a half, I started realizing like, Okay, if this thing really, is this dynamic, and it doesn't follow that simple equation? Well, you should adapt, you should find out what the control really is what it really should be. And was able to get on with that.

Scott Benner 13:32
So you were able to, were you able to take the unknown parts, the parts that come from the body, and find some rhythm to it? Or did you just learn to be flexible with it, just go with it. And when it asks for something, you give it to it?

Andy 13:47
Yeah, more. So just being able to be flexible?

Scott Benner 13:51
Yeah, it really is the whole key to the thing. It's insulin works the way it works. And if you can get the same, if you can get the same response every time from the body from the need, then yeah, it all works terrific. But that's, it's not going to happen. And then there's variables like you know, infusion sets, how old they are, where you put them your hydration, and on and on and on. And you also can't sit down and there's no spreadsheet you're going to make that's going to keep all that straight for you. Because you don't know, you'll never know the input from those things. Ever. Yep, you know, so

Andy 14:25
and I do I do try to find little thing. So you mentioned spreadsheets, I definitely have lots of spreadsheets relating to Anna's diabetes. So, you know, I can tell you statistically, over time, how much leg pods have been different compared to arm pods and things and I do that just a little bit of my own, you know, fun, because when you get right down to it, even that impact is really small. And if you compare that to, hey, what's the difference between a pasta dinner and you know, bacon and eggs for dinner? That difference really washes out the other things Even though they might be fun little,

Scott Benner 15:02
like, so you may be you're on a leg. But it's pasta. So you're being pretty hard with the insulin anyway, the leg part doesn't really matter. Maybe if it was on a stomach and the stomach work better for you, then use a little bit less insulin, but not not a ton different. I'm looking at the charts, you said I'm trying to decide, like, how far are you getting into this? Are these? Are these generated in Excel? Are you in like, are instead of making these

Andy 15:28
lots in Excel? I do have a couple of other statistical packages I use, like when I when I say that comparison, you know, between different parts of the body have a couple other statistical packages I've used. Yeah,

Scott Benner 15:39
I watched my son do this for is his degree. And I'm starting to learn about it a little bit. I don't know how to use it. But I know what he's doing at least. Why aren't you telling me what I'm looking at here a little bit. So I have your time and range chart in front of me that goes all the way back to looks like May of 2019. Till. Geez. Martin last

Andy 15:59
weekend. Yeah, right here. That's right. So and this was, you know, when I think you had put out a request for people who want to be on the podcast, you know, I was certainly interested, if really love your podcast, I'm glad. And I had the data to back up, which is this chart, you're talking about the fact that the simple matter of you know, us listening to the podcast, and starting to pick up little nuances and try them out has made a shift in the data. Right. So the graph you see time and range, it starts when we started Dexcom. And we were on MDI, cc times and ranges maybe they averaged.

Scott Benner 16:45
Let's begin today with Dexcom. And talk to you about getting the Dexcom G six continuous glucose monitor. There are a ton of management reasons why you would want the Dexcom. But let's start instead, with peace of mind, alerts and alarms set at your discretion. Would you like to know when you're going lower at 9080 70 105? It's up to you. Same thing about high alarms, we have our high alarm set at 120 and 130. But maybe you want yours at 150 or 110. Again, completely up to you. Then when you reach those thresholds Dexcom will let you know when you're using insulin. Peace of mind comes from knowing that you're not going to get too high or too low Dexcom can help you with that dexcom.com forward slash juice box. You want to try it out for yourself you can you may be eligible for a free 10 day trial, the Dexcom G six, that is something you can find out@dexcom.com forward slash juicebox. You'll also be able to learn way more about what Dexcom does know what I just told you. As a matter of fact, I need to pick up my phone. I'm doing it while I'm talking I swiped up. The phone has recognized my gorgeous face with face ID and I can see that Arden's blood sugar is 109 and it's stable. That was pretty quick. I'm looking at the number, the direction and the speed of my daughter's blood sugar right here on my iPhone. You could do that as well on your iPhone, or your Android device. There are links in the show notes of the podcast player that you're listening in now. And links at juicebox podcast.com to Dexcom and to the place where we get our diabetes supplies us med us med is the number one distributor for FreeStyle Libre systems nationwide. They're the number one specialty distributor for Omni pod dash. They're the number one fastest growing tandem distributor. They're where we got the Omni pod five, and they're also the number one rated distributor index. com customer satisfaction surveys. What more do you want the what US med is offering us med.com Ford slash juice box or call 888-721-1514. They've got an A plus rating with the Better Business Bureau and they accept Medicare nationwide as well as over 800 private insurers. They carry everything from insulin pumps to diabetes testing supplies to your latest CGM, just like I mentioned a moment ago. US med always provides 90 days worth of supplies, and your shipping will always always always be fast and free, better service than what you're getting now. And better care than you expect. That's what you're going to get at US med after this episode. If you're interested in getting the Omni pod five, or the Omni pod dash, and gosh by golly you might just be when you hear what Andy says next. Please use my link on the pod.com Ford slash juice box.

Andy 19:56
The graph you see time and range it starts when we started Dexcom and we were on him The I see see times and ranges, maybe they averaged 50 something percent, then the next section on the graph is when we started Omnipod dash and just being able to get up in the middle of the night, see a number, literally from my bedside table, you know, do a bump through the wall love that about the, you know, kind of remote Bluetooth aspect of the Omni pod, we shifted up, there's a clear shift in time and range up to the high 60%, probably close to 70%, sometimes close to 80. And then there's the you know, juice box section of the graph. And there's another really clear shift up there really averaged close to 80%. Time and range.

Scott Benner 20:45
This, I'd like to explain what I'm looking to looking at for people. So you have points on a graph that that are amazing. I mean, pre pod, you have it set up, like you said, probably the average, right? There's about 50%. Time in range, what is the time in range? What's the range you're looking for?

Andy 21:04
Yeah, those are all against a 70 to 180. You know, we certainly target better than that. But it just keeps the data. Okay.

Scott Benner 21:10
So you're about in the 50%. Like, that's where your grouping is with a cluster of your most of your data points are. And then like you said, you go to using on the pod dash and it comes up. I call it like high 60s. Right. Right. Now you start listening to the podcast, and it jumps up to what would you say? 80?

Andy 21:30
Yeah, yeah, average? About 80%. There.

Scott Benner 21:33
Wow. And there are you have data points listening to the podcast, that are almost at 90, as well. That's right. Now here's here's the part that's both impressive, and exciting. And I think it speaks well for on the pod five. And for me, to be perfectly honest, which is you left, you left up a little with on the pod five. But it isn't that much better than just doing what the podcast says

Andy 21:57
that that is fair on these weekly data points. So far, though, that we are still trending up, I think in Omni pod fine.

Scott Benner 22:05
I'm seeing that too. There's no other place on your graph that's bending towards the heavens as much as the Omni pod five. So you jumped into Omni pod five, how long ago now? Tell me again, right? About three months. Okay. And so you're those first couple data points. It's pretty equal with the podcast a little higher, but then all of a sudden, it's on its way. So would you say you're seeing the algorithm beginning to work better for you?

Andy 22:30
Yeah, absolutely. Okay, so now we're, you know, the last several weeks, and each one of these data points is just the weekly charity report time and range. And we're now always seemingly low 90s. You know, percent time in range and the average glucose now we're hitting is right about one 141 30s.

Scott Benner 22:51
So give me a little perspective, pre pod a one sees in the eights you said? That's right. On the pod dash. Where do you think she was?

Andy 23:01
Yeah, they were mid sevens. And mid sevens?

Scott Benner 23:06
Did you get into the fives with me?

Andy 23:09
No. So it actually have a different graph on the thing I'm looking at. And it leads up to a one sees next that so in the in our juicebox period,

Scott Benner 23:19
I have that one, two, I'm sorry. Let me scroll guy. Yeah, yeah.

Andy 23:22
Yeah. So you know, anywhere from like six and a half to seven. One was kind of our juicebox time period. And then we actually just had our appointment here recently, after a couple months on Omni pod five and, and had our first 6.0. Wow. So really excited about that.

Scott Benner 23:39
And I would imagine and let me say, I fully expect less work with on the pod five than following the podcast.

Andy 23:48
Absolutely. Yeah. Okay. Particularly the fact that we sleep through the night you know, I I get the thing teed up where I want to go into bed and I'm I have pretty good confidence. It's gonna stay there.

Scott Benner 24:00
Yeah, I don't think I think the longer you do the podcast way. I don't know if that's a thing. The way I talked about diabetes, if you do that your real life, I think, did you notice it getting easier as time was going on?

Andy 24:17
Yes, I would say so. Right? Because you just pick up little, little nuances. You have that flexibility in your thinking. I think that's really the key thing is just be flexible. Yeah, there are cases where you need more insulin, you don't have to solve why necessarily you gotta meet the need.

Scott Benner 24:32
Right? Right. It's so cool to hear people say something that occurred to me because i i Well, okay, so let me ask you this. So as you're doing it the podcast way I can't wait. I'm saying that. I don't even believe that but, but you're being flexible. You're understanding how insulin works. You know, you're not looking at high blood sugars not doing stuff about it. You're not overcorrecting and lows, that kind of stuff when you're doing that, and it's getting a little easier as it goes along. But but is it? Was it sustainable?

Andy 25:07
Yeah, that's the it's a great question. And actually, our our endo the appointment before last. She was super kind and really drilled on that question like, you guys, this is great. But are you good? And overall, I actually think yes. So we were able to kind of have, you know, a learning mindset and know that yet we're being flexible. Yes, we're going to meet the needs, and we're not always going to be perfect. So like, we're not going to beat ourselves up if we do something or we try a Bolus and it doesn't exactly hit right. It wasn't, you know, it wasn't easy. I don't think managing diabetes in any form is, but it was sustainable. I do think so now that I get less sleep, you know, even four months ago, yes. But it was sustainable.

Scott Benner 26:06
Yeah, I agree. By the way, I just I think that this is so interesting. Looking at this on your, the way you have it graphed out because basically MDI is, is how things used to be and you were MDI with a CGM, by the way. So what are you really missing MDI that you didn't have with the pod? Where is it that you didn't want to be? You weren't looking to give her a quarter of a unit or a half a unit through an injection to move a number, you were happier to look at a higher number than to have to shoot or more, is that right?

Andy 26:39
That's right. Yeah, just the ability to you on the on the pod. And even that, that remote aspect, I don't even have to walk up within 510 feet of Anna and give a little dose I realized, man, it needs that extra even for her at the time just needs that extra point to and it's going to make the difference. I didn't even have a pen that could give a point to

Scott Benner 27:00
Right. Right. I remember thinking when Arden went from shots to on the pod long time ago, I remember believing that one of the best points of this not only what we just said about being able to give small corrections. But it was for her not to have to be interacted with as much just turned out to feel like God, this is happening again, this is happening again, because you see it on their face. And then that makes you less likely to want to do it. And then suddenly, you find yourself in that scenario where you're going oh, or budget is only 160. I guess I'll just leave it alone. I don't want to bother. I don't want to shoot it with this needle again. And that's a that's a big piece of it. Also, I would think how much did you get into looking at Basal rates once you went from MDI? That must have been a picnic for you. You must have been happy. Your little math brain must have been

Andy 27:51
Yeah, no, no, absolutely. So we did know. Definitely, like Temp Basal goals and being able to identify where we needed. Different Basal rates didn't didn't try to overdo that too much. But I mean, your point on on. And it doesn't even notice. So like the school nurse, she sneaks into the classroom all the time, and will be on the computer with her headphones on. And she's like, Yep, I said to those guys, she she didn't even see me. So there is something to that.

Scott Benner 28:19
I know, when you're on an algorithm. Sometimes, Arden and I were in the car recently, and we were driving along and we stopped at a light, the music stopped for a second it got really quiet. And we just heard click, click, click and I was like, Oh, you're getting insulin? And she's like, Oh, yeah. And you don't even really think about it just sort of happens. Okay, so what did you because you started on the pod five, three months ago, then my on the pod five episodes that I did in conjunction with insolate. They weren't out yet. So how was it starting on the pipeline without any kind of real information?

Andy 28:59
Yeah. Overall, it went pretty well, we felt great with the dash, I think it was a pretty good experience to transition from dash to five and do the online training. You know, I'm the type of person that like, I'll read the whole manual front to back. And so I did that for the Omnipod five, and I actually do think there's value so for things that helped us in going to Omnipod five, for example, and I see questions that come up a lot. It's a it's a great question. It's a logical one is, oh, this this max Basal rate that that must mean something that's a setting in Omnipod. Five, you probably know, but it doesn't have anything to do with the algorithm. That's a that's a make sure you don't fat finger typing in a Basal rate thing. So just understanding even through the manual, and through the video training, how is this thing working? What is it looking at? And knowing that it's looking at total daily insulin and that's really how it's making calculations. So then I knew, Okay, if if the knob to turn, so to speak, to get this thing to react is total daily insulin, I need to impact the total daily insulin. And if I'm an automated, the way to do that is bolusing. So we were able to, you know, I think I see, you know, people, other groups, I'm a part of their, their struggles transitioning to and as that the, the pod five is learning. There are definitely struggles, but I just sit like, we don't oblige high blood sugars. And so I gotta give a half a unit that

Scott Benner 30:35
I'm doing. And then the algorithm learns that, you know, the algorithm, I guess, is saying to itself in very rudimentary ways, I use this much insulin, but the user keeps coming in and putting in more, so I'll get more aggressive with it as well. Yep. Yeah.

Andy 30:49
Yeah. All it knows is the last three days, you know, we use 22 units of insulin. Yeah, that's like the new kind of baseline. And I do think, you know, my background, and as I understand control systems and sensing, in my world, and my technical world, I was able to say, really just dig into one of those details that matter. And let's put thrown in on that with the pot.

Scott Benner 31:15
How much of that do you think helped you? Well, I am I have a tooth. I guess I have a two ton question here, but did anything about what you learned from me help you use the algorithm?

Andy 31:30
It's a good question. Yeah. Yes, yes. Undoubtedly, particularly meet the need, like, I knew that whatever FDA approval went through, and all that, to sit there and like stay in automated mode, as it would learn and be sitting at like, 200. I wasn't going to just sit there and watch that whether or not it would mess up the learning. I was going to meet the need and give insulin. So even even if that was going to throw off the learning, which I didn't think it would write the algorithm learning. I was gonna do that. Because

Scott Benner 32:07
how do you how do you sit and look at it? Yeah, no, I know, I have I had very similar feelings. When we when we were setting up on the pathfinders. Like I got a Bolus, like what are we doing here? I have to Bolus I think we started it with not enough basil. And that I followed that idea for a while then I really, I realized that Arden was having other impacts that I was also seeing. It was flow mixing loop as well. So these impacts were flow mixing loop, they flummoxed on the pod five. And then we were able to actually change her her health in an interesting way, which I'm going to bring up a couple of times in the podcast. So we learned that Arden wasn't digesting her food, she had gastritis basically. And so food wasn't going through her quickly enough. And we were seeing these, like almost every meal looked like a high fat meal all of a sudden, because the impact was lasting too long. The blood sugar was too high. You felt like you couldn't give her enough insulin all of a sudden. And and we went through all the all the I don't I don't know how to put it like normal doctors you could to try to figure out what was going on. And I've told this, I've told this on another episode. It's not out yet. But when she got a endoscopy that, you know, looked in her stomach said, Hey, there's a lot of inflammation here. There's even some like lettuce leftover from last night in here, which shouldn't be. They did a couple of biopsies. Nothing was crazy wrong. And they said, you know, we're gonna put her on a gastro precice diet, which freaks you out because of diabetes. But gastroparesis is a generalized medical term. That means slow digestion, right? When you when you think of it, and in terms of diabetes, you think, Oh, God, there's been some nerve damage, and I'm not dying, you know? So anyway, after we all got past that moment, where the doctor is like, Oh, this is just some gastroparesis. We were like, wait, what? And? And he's like, No, it's just, it's slow digestion. And I was like, Okay, could we just, why don't we just fucking call it slow digestion. Okay, man. Let's do that. Let's stick with that. If you don't mind, you know? And he's like, okay, and I was like, Alright, good. I said, um, and then he wanted to give her you know, being a kind of a, a general doctor. I don't know what the word is. I want not an outside of the box thinker, doing what the system says, right? Here's medicine for pain. So her stomach doesn't hurt anymore. And here's this and here's that. Let's put her on a super restrictive diet, where she won't eat anything that isn't easy to digest. Well, my God, it's like no skin, no raw vegetables, no meat. No like anything that takes takes any kind of time to digest. And God bless her. She did it for like, a week. Before she was like, listen, I think I'd prefer for my stomach just to her. And I was like, all right. But we didn't want that, obviously. And she was a month or so away from going to college. And I just, I did not want to send Arden to school with stomach pain that she had had for. I mean, if I'm being honest with you, for years, maybe, you know, off and on for years getting worse and worse. And so we went to

I just, I just said, Look, this doesn't make any sense. It's like, what do we really need here? Like, what is this really need? We need food to clear her stomach quicker. We need her to eliminate the waist so that they can her stomach can continue to clear, right? This is what we're looking for. I went to a health food store. And I was like, I need digestive enzymes. Is that a thing? I was like, What do I put in the belly to make the food digest faster, and she's like, there's something called digestive enzymes. I didn't know about that before that was like, that's great. Perfect. Give me those. And she's like, let's give her a probiotic to help heal her stomach. And, and then we went back to her a week later, I was like, Listen, this is all great. All this stuff. I'm talking about these high blood sugars that meals like Gone, not even that but she's eating like high fat meals that aren't showing high blood sugars anymore. It's like this is the digestion part of this is great. I said we're not seeing the action on the other side as much though. And she's like, ah, magnesium oxide gives us one of those ardent gets on a better bah, bah, bah, next thing, you know, her system is running really well. Yeah. And in the week before, you know, we were getting ready to leave for college. I'm starting to see like low blood sugars. I was like what's going on? You know, so, at first you just do it the way you always do it, you just managing managing and four or five days into it. We're now driving down to Georgia on a long car ride where I really expected Arden's blood sugar to go up for all the sedentary, you know, just not moving all day long. And she was still in the look like she was good, not low, but like super, like good blood sugars. Like this doesn't make sense, you know. And then we get there. And that night in the hotel, her blood sugar is just low and we can't get. And then the next day, it's choppy during the day, we're correcting lows, trying to figure out what's going on her first night in her dorm, she is low all night. Like I'm up the road at a hotel. And we're we're texting and fixing her blood sugar's over and over again. And I'm like, What is going on? Now? I should tell you that right before we left a couple, I don't know, a month or so before Arden stopped using Omni pod five. And she went back to loop because she was more comfortable with it. And she didn't want to carry the PDM as she was going off to college. She's like, Yeah, she's like, I really know how loop works. On the pod five is not difficult, but I have to carry an extra thing. Can I just go back to loop? And we're like, Yeah, that's fine. So she went back to loop. But even on loop, like, we're like saving loads all night long. So I wake up the next day, I'm like, I have to rethink this whole thing. You know, like something's wrong, I looked at digestion piece, her body's working differently. So her needs different now. And if I told you that her insulin sensitivity went from like 42 to 70. Her Basal rate during the day went from 1.1 to six point 2.65. And her carb ratio went from like four, four and a half. You have four and a half carbs, a unit for four and a half carbs, two, maybe it's like six now. Wow. And then everything leveled right out. So now we're in the process of fine tuning as she's actually going through her first week of school, but it's all I could think of earlier when you were talking about like, be flexible. Its you know, its timing and its amount but then it's timing and amount and flexibility. Fighting against these other forces that you have no idea what they're going to be. And that just showed it so with with poor digestion and poor elimination Arden's insulin needs probably were 35 40% greater than they needed to be. Wow, fast. It's fascinating, you know, yeah. Yeah. So anyway, now she's good again. And we're just, you know, we're now we're just learning how to, you know, how to live through different schedules, and it's much hotter there than it is here. But she's doing really well with it. So anyway, that's great. Yeah, that's great. So how much of this? How much of the stability that you have right now? Do you ever look at and think well, sure, but there's no hormones yet? Because your daughter's young? She's seven.

Andy 39:57
Yeah, she's seven. So that I do think about that. Largely, though we leave that worry for a future year, it's good. You know, and I kind of look at it and go, alright, if I hear that's challenging, that's going to be really dynamic. But even then, you know, think about, okay, how can we track cycles and be able to kind of tackle them that way? So I largely stay like blissfully away from that.

Scott Benner 40:30
It's a good idea. You have many years, I mean, you might have six years. So you have to worry about that. If you're, that'd be nice. Trust me, it's not a lot of fun. But it's also not. It's also not unknowable, right? It's just and I can't wait to see how algorithms handle stuff like that, you know, so sure. And I do wonder to how they're going to improve as time goes on, because as well as Omnipod, five is working for you right now. This is the first iteration of this algorithm for them. Right. You know, so what happens in the future? I don't know. But I'm excited to find out that's for sure.

Andy 41:03
Yeah, I'll tell you, I, you know, I don't see myself going into the line of work around developing diabetes technologies, I guess, never say never. But some ideas that I have in that way. You know, if you think about, like, people are smartwatches, right? What kind of data does smartwatches have on people around heart rates? Temperatures, I assume? What is other sensing? We could do? You know, what if the the Dexcom sensor had one section of the wire that was doing what it does today? And another part measured a different or motor? It measured adrenaline, right? I think there's some, obviously you look at things like bionic pancreas is that's an area of development. But I think there's just like, we're getting into machine learning in a lot of different places. And if you can bring in more inputs, right, we all know, it's not just the carbs, and it's not just a blood sugar. Those are the two things we pretty well know and can measure today. But what else is out there that's maybe being measured just passively right by like a smartwatch? Or that you could measure alongside it and put together a really smart system. So it would pick up that adrenaline rise, because it would detect the adrenaline now, i i can i can imagine the FDA choking on this concept as I speak. But yeah, there's some really interesting things out there that will be done there, the

Scott Benner 42:26
machine learning aspect of it is, it's really, I think that's the best path to more because, you know, I mean, think you look up at the night sky, and you think you see a certain amount of stars, and there's billions more than you can see. And right now, like you said, we're looking at, you know, carbs, basically, and insulin, they don't, most doctors won't even tell you about the impact of fat or protein. So you know, and these are quantifiable ideas. And we don't talk about them. We're talking about two, two of the things. And how many of how many more can there be like, Alright, you're always the insulin on the one side, it's always gonna be the insulin, but how many more things could the insulin be thinking about? I think it's a great idea. And I don't know how well people understand the concept of machine learning. But the, the best way I can describe it from things I know, just from pop culture, is that Tesla, for example, had to build their own computers to do the computations that they're getting back from self driving, like the computer didn't exist, that was strong enough to even think about all the data that they had. And once they saw, at some point, they were like, we have all this data, we can't even compile it and make sense out of it. So we'll build a better computer that does that. And now this, you know, I don't know how well self driving is ever going to work. But however, well, it's going to work, we're gonna get to it much faster, because there are computers, looking at these data points and saying, Okay, this, we can count on this we can count on, you know, and the I don't know how long that takes those computers probably in a week do what it would take a human being a year to accomplish, I would imagine.

Andy 44:01
So we're for 1000s of years. But yeah, yeah, right. Right. Thanks, like

Scott Benner 44:05
a long ass time, because we're not so smart. And and, and look how that applies to diabetes, right? There are all these other things happening, that we just can't keep in our heads. Which is why, which is why, you know, it's funny, you said something earlier, that really fits into how I think, which is why I don't want to say dumbed down. But why I talked about diabetes the way I do, because there are some ideas that if you just give yourself over to them will cover most situations. But if you get caught up trying to think of exactly what's happening in every situation, and scenario, it'll just be analysis, paralysis, right? You'll sit there you won't be able to do anything. So some things like you said earlier data. Yes, I can see the difference between sites, but it's not appreciable enough to make some big adjustment over, right? So that's right. So your blood sugar's high, use more insulin, your blood sugar is low, use less insulin. Have you not? I mean, you spike too fast before a meal, try changing your Pre-Bolus. Like that kind of stuff is it handles most things. So I don't know, my my inability to see the bigger I can see the bigger picture, I can understand it, which made me run back to like, let's, let's let let's simplify this with T shirts locates, basically. And I can't believe it worked for you, because your mind in my mind are probably radically different. Yeah, that's pretty cool. How does your daughter do with diabetes in general? How is it on the personal side?

Andy 45:34
Yeah, super well, she's incredibly smart. And you know, so actually early, I asked my wife I science and we have when did we start? Dexcom? And so she pulled up. What was the video of Anna doing a tutorial on like, Dexcom number two that she put on, she's got this cute little four year old boys, late three year old boys. And she's going, this is my Dexcom G six, and just just talking everybody through it sharing with with anybody and everybody. So it is really nice to see, obviously. I wish she wasn't as smart about diabetes related things. Like if she wouldn't have it, but but she does. And she rolls with it. So well. You know, I think in school, navigating, well, why does Anna get a starburst? Every once in a while? Or, you know, what, how are we going to manage where the devices go? And like, is a phone a fun thing to play with? Or is that a medical device? Right? That's a little challenge.

Scott Benner 46:39
Yeah, it goes away as they get older. There was one kid in high school that tried to make a big deal out of it. Arden was the only kid that could keep her cell phone on her going into this one room. And the kids like why does she get to keep her cell phone and it became like a thing. And the teacher called me and said we're gonna have to take our cell phone from her. Because people were complaining. I was like, Well, hey, you're thinking about that backwards? And and I was like, but um, no. I said, Why don't you go back to the student and tell them if they want to get an incurable disease, they can keep their cell phone till that's what seems fair. And and that seemed to put an end to it. But it was interesting how it was interesting how the teacher went with was willing to ignore the whole health ramifications of it just to make the argument go away. Like, let's just make her happy and put on the cell phone. And I'm like, no, sorry for not doing that. But yeah, I take your point. There's things that they they get, and there's things that they understand that you would be much happier if they didn't have to understand but yeah, it isn't.

Andy 47:48
So she she doesn't know, you know, we'll say Well, Anna, you you can address that whoever you like, you know, you could if when they ask you, what's that bandage on your arm? You could say, oh, it's just something I have to wear. Or you can say that's the next common question my blood sugar, but then she is intelligent enough to say, Well, yeah, but then they'll say, Well, what's blood sugar? And, you know, now I'm funneling, I'm having a dynamic.

Scott Benner 48:12
Well, that's excellent. So she's not having any trouble that you can see so far. What and you guys are getting through? Okay. Has it caused any issues for you, anything that you would tell people to look out for?

Andy 48:26
Yeah, I mean, definitely, more stressful. So you got to just give yourself grace, give, give whoever your team is. For us. Like I said, I have an amazing wife. We are so fortunate with the school team, we have both the teachers, counselors, Principal, nursing staff. So I could definitely see if you didn't have some of those support systems and people that were on your team and going along, saying, Hey, we're taking your lead mom and dad because you know, this the best. I can see that just being incredibly frustrating and stressful. So, you know, as much as possible, getting those those support teams on your side, you know, family, we were fortunate to have family locally, and they get involved and learn. So yeah, overall goes pretty well. I think. You know, I'm able to compartmentalize the things, it. I think it weighs on my wife a little bit more mentally just around feelings of guilt. Like if something isn't like if a budgetary is right, and I and she's like, I gave this Bolus and you know, and I'm like, You made exactly the right decision. So I think being able to coach yourself just around I need to kind of separate what was this outcome, you know, from this given Bolus? Or Or did I give the right amount of juice to start bringing something up? It's not a reflection on you as a person, right? It's just you tried something And here was the result, it either worked great and you brought the high down, or maybe it stayed up for another two hours.

Scott Benner 50:07
Now, I think it's incredibly important not to ignore what you learned, but not to take it on as some sort of a personal failing, either. It's just, it really is all. It's just you're having these experiences over and over again, and you should be incrementally learning from them, you know, and not spending your time beating yourself up. Because I do think you lose the, I think you lose the the teaching of the moment, if you spend that time saying, Oh, I did it wrong. It's not what happened. I mean, you know, it's, it's an extension of when you hear people say, diabetes, I do everything the same one day as I do the next day, and I get totally different results. And I understand the feeling, but it's not true, something's different. Right? You might not know what it is, but something's different. You can't, you can't take that on as a personal failure. Because I don't know you had a hormonal shift overnight that you're unaware of at the moment, that's not you messing up. It's a it's a variable you can't see. So don't worry about that's why I tell people like don't worry about why. Just fix it. You know what I mean? Like, you can't, I mean, I know you want to understand, and you're hoping to stop it next time. That all makes sense. But in the moment, why is not important. And the amount of feedback I get from people that say that that that one idea was like a saving grace for them. It's fascinating, really, you people get stuck on the wrong things. And then they just can't let go of it. They get their teeth into it, and they just can't let go of it. Tell me about starting on the pod five. So how did you decide what settings to put in? And now first of all, I want to say there's somebody has to be listening to this from insolate, who is so thrilled you read that manual there probably any I wrote, I wrote chapter for how much work must have went into that manual. And people probably pick it up and flip through the book and set it back down again. And you're like, I read it cover to cover. And I'm sure when that happened, somebody giggled and was like, thank you. But But tell me, you know, what did you do? I guess where were her settings on Dash? And how did you put them into Omnipod? Five? Yeah.

Andy 52:20
So we had, you know, we were pretty consistent with making sure that her Basal profile was where we wanted it. It wasn't too crazy, segmented. But we knew some areas like in the nighttime that needed to be a little different than a morning than a daytime. So overall, we took things directly over. So right just based on profile, as it was carb ratios as they were because again, we do we do carb count and just Bolus, you know, put the carbs in and use that. So put them straight over, I will say, looking back with what I know now, and I think you said a similar thing, I would, I would have punched up just all the numbers across the board a little bit. So I had to punch up the basil in our basil. Average is probably about 0.4 units an hour. And you know, even if it just bumping them up to that point four or five, just give everything a little bit more or maybe touch because ultimately some of what we did, for example was we edged carb ratios down a little bit, right. So more insulin a little bit more insulin for the same amount of carbs. So just knowing how that algorithm learned and the total daily insulin, I would have just set things up so they got a little more insulin starting out. Okay, give it a better starting point, a better learning starting point.

Scott Benner 53:45
Okay, I actually just thought of something I want to tell Arden just jotted it down in front of me based off of what we were just talking about. So, a little more aggressive on all the numbers, because let me guess why? Because you still bump and nudge a little bit with my system. So you're adding extra insulin in along the day? Because you can't figure out where it goes yourself. You're not sure does it belong in the Basal does it belong in the meal correction, like that kind of stuff. So if your settings are what your settings are, but you're adding in a few more units across the board, you're like, let me just split that 5050 I'll put some of it in the carb ratio and I'll put some of it in the Basal so that the algorithm understands how much total daily insulin I'm using. Right Yeah, and now

Andy 54:30
and I think based on what I see feedback from from people I think the way they set up the learning for the starting out with only five five was was conservative, right? I mean, if you think of the FDA and what these companies have to do, they need to ensure that that safety, so I would just try to take out a little bit of the conservatism.

Scott Benner 54:55
Okay, I take your point. I think you're probably right. I've never obviously been in One of those meetings, but I would imagine what the meeting is, is, look, you're gonna give this to X amount of people. And our goal is for zero of them to experience low blood sugars. So, you know, how do you do that? You probably lean in that direction. Yeah. Now that that makes total sense. Is there anything that we haven't talked about that you want to talk about?

Andy 55:21
Maybe I'd share a couple just kind of like hospital, you know, admitted stories, and then maybe have one funny question slash bone to pick with you. Cool. We'll see if we get that

Scott Benner 55:32
every day, every day. I'm not lying to you. I plunk this thing down, I put this I put this microphone in front of me. And I think this is going to be a someone just says, You're an asshole. I don't agree with you. Let's go, we're gonna have some great conversation about it. Maybe today will be that day.

Andy 55:47
There you go. So I mean, a couple of the stories were reflecting on you. I mentioned my wife, she was a pediatric nurse at the Children's Hospital went to on her specialty had been oncology for years, right? So get the get the surprising news that hey, you got to go down to the ER, and then hey, you're getting admitted. So it was this really bizarre situation, particularly for my wife that, you know, she's seeing physicians walking around, and they're all doing double takes with each other? Like, haven't you floated to this floor before? And so that was that was definitely just a bizarre situation. But then it also resulted in you know, it really good intention people but saying, oh, oh, yeah, you're a nurse here, you you know, all of this probably. And then they, they were literally going to cut short our education, because they're called we she's a nurse, like, you guys know this. But really, fortunately, Laura is like, my specialty is oncology, not diabetes and Endocrinology. So I don't know this, you should assume I don't know this. And in fact, I don't. So I give her a lot of credit for that. And and then we did we actually got a really good education, you know, the full whatever it was three day deal. Which I do I give our, our team in the hospital there. A lot of credit. I hear, obviously, unfortunately,

Scott Benner 57:17
bad stories, everybody gets, well, you know, what, to? Everybody's different? Is that a nice way of saying it? You know, like, even the things that I say on the podcast, what I said, you were like, Oh, that makes sense. And then you went and did it in the manner that I would hope that you would, but there are plenty of people who probably hear me and then go off and don't do it the right way. You know, like, and so then you get caught in that scenario where you're like, Well, what are we not gonna say it out loud, because some people aren't gonna understand it. Like, that doesn't make sense, right? Like, everybody's not going to be on the same, you know, starting level, and that doesn't mean that they don't get to hear the information. It's, it's it's the one thing you can't fix about this. You can't, you can't put everybody in the same place, and then tell them something and have them go off and have the same I mean, you have had an astonishing outcome with your daughter over and over again, like switching from MDI, to pumping from pumping, listen to podcasts and party, you just keep doing it. This thing, whatever this is, fits well with how you think. And that doesn't make you smarter or doesn't make somebody else stupid, or you know what I mean? It's it's a, it's just the situation you get into, and then they do the same thing in the hospital. Right? They're just like, here, here it is, like, I don't know, like, I'm sad. I'm upset. This isn't my vibe. I'm super artistic. I'm not good with math. Meanwhile, you don't have to be good with math. I'm my my major. Like I want to remember to say about you I'm super impressed at how you how you gave away the parts of your thinking that didn't that didn't jive with what you needed to do because I've I have talked to other people who beat their head through five concrete blocks not wanting to give up the idea that this is the carb ratio. Yeah, I mean, so I don't know why you hang on

Andy 59:16
to bits and pieces you know, I we got to scale in the kitchen I use it more than anybody else that but it's all good.

Scott Benner 59:23
And then I hear

Andy 59:26
you know, a couple of our other a couple things blew my mind while we were admitted there you know to start this journey. The first one being that I don't think we were ever sat down and presented a test result that said Your daughter has type one diabetes right so it all it all played out. Pediatrician couldn't you know was like I don't know what's going on. Let me do as an as they're putting on their coats to leave the pediatrician. And we had taken her in saying something's off. He goes You're not let me do it. Let me do a finger stick real quick. And so you progress from that. And obviously there's high blood sugars like they're all like, well, she you know, she has diabetes, so you need to go and but it blew my mind I there in the chart probably but we were never presented like, either these are the the the antibodies or whatever it is so one that just blew my mind have we just started acting that way, right? You just started giving her insulin. I thought that was a funny thing. And then the other one is the first time maybe it was on day one or day two, the nurse said, Okay, Dad, you know, it's your turn for this injection for lunch, maybe. And I was like, what? You were in the hospital? You're the you're the nurse. That's, that's what you do we come to the hospital for the medical people to do the medical things. Why would I do this and just being so naive at what, the next days, weeks, months years was gonna look like, but I look back on I mean, it was it was just so startling to hear that like what I mean, like, you know, a patio layer comes to your house and Gaza, here's how he puts the bricks down. Okay, you put the breaker turn. Oh, I'm not. So that was just so fun. We reflect

Scott Benner 1:01:20
we stopped in the commissary at the hospital when we were discharged. Because I think we didn't want to do the first shot not in the hospital. But then went downstairs bought food. And then we're sitting on those like horrible plastic chairs and I'm holding this needle like down on my knee to put it in her leg, you know, and, and I'm just like, I don't know what I'm doing. You know, like this is this is not going to work out well. And it does. You know, they may like it eventually works out well. But I take your point, like just Why are you involving me in this and that's when it hits you right? Oh my god, we're gonna leave here. Yeah, that lady is not coming with us enough to do. Yeah, it's gonna be us. Two o'clock in the morning. Um, I called that poor doctor in the middle of the night, the first night and I said, Arden's blood sugar is high. And I think I want to give her a half unit of insulin. And she's like, okay, and I'm like, Can I do that? And she goes, yeah. I was like, okay, she goes, What's the blood sugar? And I told her and she goes, yeah, go do it test again. And a little while and I was like, Alright, thank you. I'm sorry, I woke you up at three, four o'clock in the morning, you know, this lovely endocrinologist. But I didn't know what to do. I had no idea. So anyway. Alright, you want to pick a bone? Is that right? Yeah. Good. So

Andy 1:02:37
one thing I'm curious about? And again, I'm not I'm just curious about this. It's a question. You often will ask people particularly around basil. It's like, away from food and insulin. What's a number your your blood sugar will sit at? And I think you're often asking around, you know, is the Basal rate right? And I think I hear you describing it as you know, if their answer was well, yeah, I sit steady overnight. At 160 you might propose while your Basal isn't, isn't heavy enough there, but my my bone to pick with that is I'm thinking if that line is flat at whatever number it may be away from food or away from insulin. That's actually telling you your Basal is right at that time. You just need this shifted starting point. So I don't know

Scott Benner 1:03:32
this is my one of my favorite online arguments about diabetes. I have a couple of them. This is one of them. It's so oh my god, how did you pick on one of them that I love it unless you were gonna bring up the about diabetes at Disney and not being an it not being a disability. That is an argument. I also enjoy watching people. So here's what I think. I am in this odd scenario in people's minds, the Great and Powerful Oz. Okay. And they're coming to the Emerald City to ask a question. And I can't possibly know what the answer is. Like, I don't live with them. I don't see it happen over and over again. They're throwing a graph at me. And they're like, Hey, tell me everything that's wrong with my kids basil right now. So I asked the question away from active insulin away from a correction or an insulin you've used for food? Where does your blood sugar most often sit stable? And if it's a higher number, okay, what would happen next? If you corrected that number? Would it drop down and stay down? Or would it drop down and come back up? I'm trying to get them to think it through because I can't be sure of anything I'm saying. So the idea is, let's get away from active insulin first because then we're seeing stability right so the Basal is working on some level, are you at 150 Or are you at 75? If you're at 75, your basil is either great depending on what you want, or a little heavy, maybe Maybe you want your blood sugar to be a little higher, if it's at 150, and you want your blood sugar to be 150 than right on, but if you don't want it to be 150, here's the next question. If we just turned the basil up magically, would it bring you down to 130? And hold you there? Maybe? Also, maybe the basil is perfect. And you made a mistake earlier with a meal or there was fat in the meal that you didn't? Didn't think of. So then let's correct it and see, does it go down? And come back up? Or does it go down and stay down? If it goes down and comes back up? I think it's likely your Basal is not strong enough. If it goes down and stays down, then you did something in the past that maybe your basil is okay. I'm just trying to get people to think about it that way. Because in my mind, that's the simplest way to do it without basil testing. Because when you tell somebody to basil test, what they think is, oh, I'm not doing that. So

Andy 1:05:54
we haven't done that.

Scott Benner 1:05:55
Right, right. So I'm trying to get them to where they need to be. Because I think that the establishment tells them I can't answer that question Basal test. And they know damn, well, when you tell people to Basal test, they're not going to do it. So it's a cop out. So I didn't want to cop out on people when they asked the question. Another way of saying all this is are you more frequently stopping lows with carbs or highs with insulin? If you're more frequently stopping lows with carbs, maybe your Basal is too heavy, you know, it's not for sure, maybe you're screwing up your meal, insulin, and you're constantly having to stop it later. I don't know I'm not there. If I was there, I could figure it out in about an hour and a half. But I'm not I'm not there. And I can't be there. And what I've learned is people are not going to stop asking me this question. So does that make sense? And do you still think I'm wrong? Because you felt

Andy 1:06:50
it does make sense? And earlier you said our brains probably work differently? And I think that is the case on this point, I'll say, like diplomatically, say I think about it differently. To me, it's that point on particularly, where it tends to be away from insulin and food are those overnight hours, right? So let's say you know, midnight to five or whatever. To me that key question around Basil is, is it stable? So forget the number if it's able at 70? If it's stable at 100, or 150? If it's stable, right, that rate of change of the blood sugar. That to me is answering the question on the basil, because let's say it's stable at 150 Most of the time, you know, overnight hours. And you you increase that basil, I think what you could end up with is you've actually just been slightly missing your, say, a dinner Bolus, but then you sit stable because the basil keeps you right there. And if you increase that, basil, you're actually going to get a declining line, right? Like a slow down hill, right overnight. Now, is that good? Is that bringing your blood sugar down? Yes. But I'd really rather just sit stable at like, 98.

Scott Benner 1:08:02
No, me too. Yeah, I think that's a great number. Also, there's more to consider when you're talking to masses of people. So if this conversation is between you and I, I think yeah, that makes sense. Because you see this input of data, and then you make more decisions, right? You don't just stop, whereas most people are just they don't want. I hate to say this, but most people don't want the level of granularity that you're interested in. They just want it to work. They don't have the time, the interest or the ability to think it through to the nth degree. And they're looking for what works. So you go back to old days, and MDI, when they knew people weren't bolusing for their food, their food, they would just keep jacking up their Basal, because they're like, they'd be like, Look, this guy is never going to give himself insulin for food. So what are we going to do to try to keep them alive as long as we can? Is that the right way to do it? It's not, it ended up being the best thing they could do for that person. And so my expectation is, anybody who thinks that the podcast is some set of rules set in stone, and if you just do it, everything works out, right? I don't intend it that way. I'm telling you, this is how we do it. And then once you do it that way, you probably are going to then take it and adapt it to the way your body works, your exercise schedule, the way your brain thinks about things. There's a lot more coming that I'll never have any input on. And, and what I think I've done, if I'm gonna give myself credit for something, is I think I found a medium is medium, the right word, where nobody is screwed, and everybody has a chance to do better. That's what I think the information I shared does, I think it doesn't, it isn't going to screw you up. And depending on how far you want to dig into it, you can do better and better and better. Yeah, yeah, that's all I because I as I look back on it, in the very beginning, I was like, Well, I know if I do this, this works, but it's not going to work that way for everybody. So then what most people did in the space? Or what most people do in any space is they go, Okay, there's no answer, we're not going to do anything. We're not going to help people. And I just thought, like, that can't be okay. Like, there's got to be a way to adapt this enough that it helps somebody. So if I get to the person who's got an 11, a one C, who listens to the podcast now has an eight a one C, that's terrific. If they never do better than that. I still took three points out of their a one C, you know, if I take somebody from a seven to a five and a half, that's great. You know, but it's also why I love the the idea of the algorithms because you put an algorithm on somebody, and just give it that Omnipod five is a great example. Because it is a really hands off device, you really do not need to know anything about how it works, right? You put it on somebody. And some people say, Oh, it's better. My Awan sees this now, but I still have high blood sugars. But I want the thing to take care of it. So they won't Bolus it. Whereas you looked at it. You're like, I don't give a shit how this thing works. I'm not letting my kids blood sugar be 180. I'm giving her more insulin again. Right? Everybody's different. And I can't be with everybody. So I just tried to find a middle that helps as many people as possible, if that makes sense.

Andy 1:11:15
It does. And undoubtedly, you do help a ton of people. We obviously hear that a bunch. I have the data that backs it up. I may have to put these graphs out there when this airs. I do have a prediction. I'll be right about 880 ish. Absolute number. That's That's my guess.

Scott Benner 1:11:34
So well, no, you're way off on this. Andy, I'm putting this out really quick. Well, because why? Couple things. Here's why. I think our conversation should make people interested in looking into on the pod five, and I want people to be healthy. So I want to get that out quickly. I also think that your charts really highlight that my podcast works really well. I'd like that to get out into the world as quickly as possible. Not I don't, it's not for me, I enjoy that. It's true. Like I have to admit, when I looked at this graph, I was like, wow, it just made me feel. I don't know, it gave me some like justification. You don't I mean, I was like, wow, this is this isn't just how I like this isn't just me thinking like somebody went and plotted points and it shows like, if you want if you want to do as well as you can, with your time and range, you should either listen to this podcast or get an on the pot five, like that's what I'm looking at here. And that's to say that the words inside of this podcast are slightly mimicking an algorithm for people's. I'm just, I'm proud of that. Yeah. And if it really is true, then it should be out there. So people knows they can do better. Because the difference between your daughter's outcomes, MDI and Dexcom versus Omnipod, and Dexcom versus Omnipod, Dexcom. The podcast are, I mean, it's substantial. It's a big difference for her in her health and her happiness. So that's what I want people to know. You know, me too. Yeah. Cool. All right. That was it. That was your bone. I don't talk too much. You don't hate my accent? You think I'm an idiot? Nothing like that. All right, maybe one day, I, I, by the way, just try to imagine, I will actually have the conversation. If it ever happens. I'm not going to back away from it. It's going to turn into like a giant screaming match. I think it's going to be incredibly entertaining.

Andy 1:13:34
We need to get those people that come on,

Scott Benner 1:13:37
I need somebody to call me call me names and like to have a real conversation about that. And so

Andy 1:13:42
I just think I just think you asked the basil question wrong. That's all.

Scott Benner 1:13:46
So so how would you ask the Basal question? Yeah.

Andy 1:13:49
So I would ask the basic question. You know, similarly when away from food when away from impacts of food, or you know, Bolus insulin of any kind? Does your blood sugar stable consistently? At any number? And it's really about that rate, right? So it does the does the Dexcom graph look flat and horizontal? Or is it slowly climbing up a hill or slowly going down? And

Scott Benner 1:14:15
let me ask you a question. If the person's blood sugar overnight, in your example, keeping in mind by the way that your kid does not have the hormonal impact that a lot of other people have because of her age. If your kids blood sugar was super stable at 225, overnight, which you think or basil was okay. Yes. What if you corrected it? It went down that went back up to 25. Again, yeah, then something would be off. Okay. Sure. So you just don't like the way I phrase it? That's right. You don't even disagree with what I'm saying very much. You just don't like my entree into the conversation.

Andy 1:14:47
That's right. Yeah. You just asked that question differently.

Scott Benner 1:14:50
I've had there's a part I wish I knew her name. She argues with me on every time I say it online. She comes in and she's like, You're wrong. And I was like, Oh, here we go. And and I love the conversation. I wish I could explain to her how much I enjoy the conversation. Because the truth is, is that in this specific scenario, while we're talking online, either I'm right or she's right. It's one or the other. Either it's the Basal or it's something from before bed insulin to carb ratio, carb counting, etc, etc. It's always one or the other it when this question is being asked, but it's almost like politics, because the person who comes in to argue with me always acts like it couldn't possibly be the basil. And I think that comes from their personal experience. And I don't I I've had enough experience talking to people that I don't really I try to come in very down the middle. Like, I don't assume it's one or the other. And I think and I think, I don't know, it's just it's one of the great diabetes arguments. I love them. We should make a list of them one day. Yeah, yeah. All right. Well, Andy, hold on one second. I appreciate you doing this very much. And let me tell you about when this is gonna go up so you can prepare yourself. Sounds good. Thank you. Thank you.

Huge thanks to Andy and if you're hearing this in the first week of its release, you should probably go check out the private Facebook group because Andy's gonna put his charts in there. I want to thank Dexcom, makers of the Dexcom G six continuous glucose monitor and remind you that you may be eligible for a free 10 day trial the Dexcom G six dexcom.com forward slash juice box. Get your diabetes supplies from us med either call 888-721-1514 or go to us med.com forward slash juice box get your free benefits check and get started today with us med.

Thank you so much for listening and for supporting the podcast. Please subscribe or follow in an audio app like Spotify, Apple podcasts, Amazon music, something like that, whatever you use. And don't forget to tell a friend about the Juicebox Podcast. Thank you so much for listening. I'll be back very soon with another episode.