#309 Omnipod and Dexcom Updates

With the CCOs of both companies

Omnipod CCO Bret Christensen and Dexcom CCO Rick Doubleday are both on this jam-packed type 1 diabetes technology episode. Let's talk about automated insulin delivery!

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

Scott Benner 0:00
Hello, everybody, welcome to Episode 309 of the Juicebox Podcast. Today's episode is a little different than usual. It's two different interviews. The first interview is with Dexcom, Executive Vice President and Chief Commercial Officer, Rick Doubleday. Rick and I are going to be talking about things that are going on at Dexcom. And interoperability interruptible, inter Robin to interoperate. Oh, it's a word that you're probably hearing a lot around diabetes lately, but maybe aren't 100% sure how to say? Let's sound it out together in turn app for a bill, ed d. Hmm, that wasn't helpful either. Hold on one second. Okay, hold on, I'm gonna play it through my headphones into the microphone. Let's see if this works.

Unknown Speaker 0:51
interoperability

Scott Benner 0:54
the ability of a computer system or software to exchange and make use of information. So why do we care about that around diabetes, because the information coming from the dexcom continuous glucose monitor is going to help pump companies to build their own algorithms, right, like closed loop systems that will make insulin decisions for you. So we're going to talk about that from Dexcom perspective. And then go right into a conversation with Brett Christianson, the chief Commercial Officer of insulin. Insulin, of course, is the company that makes the Omni pod and the forthcoming horizon automatic its own delivery system, which is going to be the Dexcom g six, or the Dexcom g seven when it comes out. And the pods algorithm and their pump making insulin decisions for you. This is all very exciting. Here's the one thing you need to know. Rick and I are gonna go first, then it's going to be Brett and I. Brett was calling from Spain. So he's on a cell phone. There's a bit of a gap, right? Like I'd be like, hey, Brett, you're Brett, right? And then he'd say, pause. Yes, I'm Brett. There's a little pause. It's also a little cell phone Ian noisy. It's not perfect. I don't love that. It's not perfect, but the information is great. So I hope you can hope you can just you know, listen a little extra hard, you'll be alright, you can figure it out. It might not surprise you to know that this episode of The Juicebox Podcast is sponsored by Omni pod Dexcom and touched by type one.org. So you can go to dexcom.com forward slash juice box to find out more about the Dexcom g six continuous glucose monitor. You can go to my omnipod.com forward slash juice box to get a free no obligation demo of the Omni pod sent to you right now.

Bret Christensen 2:41
And

Scott Benner 2:42
touched by type one, of course, is dancing for diabetes. They've just changed their name, expanded themselves a bit. They're doing all the great stuff they were doing before plus a lot more touched by type one.org. I'm going to get started with Rick from Dexcom right now. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Here comes Rick. Rick Scott. Hey, how are you? Can you hear me? Okay?

Rick Doubleday 3:21
I'm good. How are you?

Scott Benner 3:23
Good. Thanks.

Rick Doubleday 3:25
Hey, yeah, Scott, can I ask you a quick question hundred

Unknown Speaker 3:28
percent.

Unknown Speaker 3:30
Did you?

Rick Doubleday 3:32
Did you send a story? A letter to Dexcom once upon a time right after Arden was diagnosed about what a difference seven plus had made and include her picture.

Scott Benner 3:44
Maybe? I'm not certain

Rick Doubleday 3:46
I am. I am 99% sure that you did. Because I used Arden's picture in a sale to our national sales team. It was one of the first patient stories I had. I had received I started here in 2009. Right, No, I know.

And,

and it was such an amazing story.

Scott Benner 4:10
I'm thrilled. I have to dig through my emails and find out. You know, that sounds possible, you know, prior to I don't know how to say this, I guess but prior to companies understanding the impact, I guess that users had on stuff and it probably wasn't you didn't understand it, probably you're just a tiny company with, you know, right. Not that much ability to delve into stuff like that. I I pretty immediately realized how valuable the data was. And we struggled greatly. I tell people this on the podcast all the time, but we struggled greatly with my daughters, they wouldn't see her stability, you know, shooting highs and crashing lows. For a number of yep for a number a number of years honestly. And then a woman My name Lorraine, who was probably another person who was kind of out in front of being vocal about diabetes at a time when not a lot of people were online. She just asked me if I, you know, had ever tried this Dexcom thing. And I said, my nurse practitioner just mentioned it to us. So it's funny when I tell the story, I tell it through my nurse practitioner, but the nurse practitioner brought it up. We were thinking about it. Lorraine brought it up, where I asked out loud, and she's the one that comforted me and said, that's a good idea. And now I'm talking to you now Arden has been eating lunch for the last half an hour blood sugar 77 like, you know, that's awesome. Yeah. Very onesies cemented in the fives. She does not have frequent or, or dangerous lows. A spike to us is 150. You know, the data is it's insane. It's It's just what it does. Yeah, I really appreciate it. I can't believe you've been there that long either.

Rick Doubleday 6:02
Right? Yeah. It'll be 11 years in June, right? Oh, that's been a lot of change.

Scott Benner 6:09
Yeah. Well, I bet Actually, I'm sorry. Just Just to let you know, I started recording before we talk. That's all okay. Is that all right?

Bret Christensen 6:17
Absolutely. Cool.

Excellent.

Rick Doubleday 6:20
How old is our now.

Scott Benner 6:22
So she's 15 at the moment, and she'll be 16. In July, she was diagnosed when she was two, it was literally a couple of weeks after her second birthday. So in August of 20, of 2006.

Rick Doubleday 6:37
Wow, that's really making me feel

Scott Benner 6:43
dexcom helps you not to, to feel quite as old when you're thinking it through the timeline of the technology. Because you guys have just leapt forward so many times, in a way that was prior unheard of in the diabetes space. You know, I don't think people will ever appreciate that. At some point. The Dexcom receiver did not have the ability to share blood sugars to the internet. So you guys built this little cradle so that at least overnight? Yeah, you could slide out your receiver into the cradle. And the cradle would you know, help people see blood sugar, so at least your kid was down the hall in another room in your bed, you could have these numbers. And I can't imagine how much effort went into making those cradles and putting them into the world? And I don't think it was, was it not even a month before the receiver that had Cher built into it was okayed by the FDA.

Rick Doubleday 7:36
It was a little longer than a month. But yes, we had a warehouse with a quite a few of the share cradle sitting in them after we launched the receiver.

Scott Benner 7:48
I joked with Kevin one time that I imagine that those cradles are business card holders on everyone's desks now.

Rick Doubleday 7:55
That's right. We often thought about maybe that would be a good use. It's funny that you say that Scott, I still I still have you know, those rubber bands that people wear around their wrist. Mine is share direct that was the codename internally for the receiver that allowed people to share their data off the phone. And I keep it there because I thought I believe it was such an immense step forward. And it was driven based upon feedback from customers what they were looking for. And this was, you know, our attempt to provide even greater a greater experience for for the users.

Scott Benner 8:37
Yeah, I found the most impressive part of that story business wise to me was, you know, I don't know what they all cost you to make them and develop them. But as soon as there was a better option, you guys have ended it walked away like he didn't foist it on us. Like, alright, well use these up, we already paid for them, you know, you were just like, okay, we we move faster than we thought we were going to with the FDA. So let's get to the better thing. And

Rick Doubleday 9:01
yeah, no, that is, that is absolutely the dexcom way, you know, it's consistent with our sensor technology, as we look at, you know, what it takes us to stand up all the manufacturing capability for G six, we're gonna have to do the same amount of work, because g seven is different. And we're gonna have to go through all of that, but it's the right thing to do.

For the users, it just is,

Scott Benner 9:29
is that what's going to, I mean, I think of you guys, as the leader in this space based on just the quality of the of the data that the product brings us back and the consistency, the consistency that it provides. And honestly, if I'm if I'm being 100% honest, just feedback that I see online. That is, I think, significantly better for Dexcom products, and it ends up being for the Libra stuff. But as Libra moves forward, and I'm assuming they're gonna change Trying to make their stuff better? How does Dexcom stay in that spot that they're in? Like, how do you hold the lead? I guess?

Rick Doubleday 10:07
Yeah, I think it's a I think it's a great question. I think it's, it's everything, Scott from how do we continue to make the technology better. So faster, warm up times longer length of time, of usage, robust, you know, 288 results, for the entire length of the sensor, all of those things we know are extremely important to the user. But it's also going to be a customer experience play. And, you know, similar to what we did with with share, follow, we understood that that was a really important feature, then we continue to add to that we went from five followers to 10 followers, we've totally re skinned it. We're actually in the process right now, of implementing the ability to message in the follow app, we had the Thanksgiving outage, which we were absolutely not happy about. And we knew we needed to find ways to be able to better communicate when situations happen. So that will be coming soon. The ability to actually communicate and let people know what's going on. So it's it's technical innovation, its scale, how do we make the tech services or customer support? process better? How do we provide a greater customer experience, we think that that's really going to be a differentiator, as we look to the future.

Scott Benner 11:40
So a couple of things. I'll start with easier one first, last night, I got a call from Dexcom. Because we've placed an order for new sensors. It's the beginning of this of the year. So you know, there's a check that has to be done. They got to go back to my insurance company and make sure everything's copacetic before they send this stuff out, happens every year, completely. So the phone call is it's pre emptive. It's, it's it's not I had to call in wonder someone called and said, Hey, you know, it's time to order. Do you want to do this? And I'm like, yeah, and then they said, Okay, so a couple days later, this other guy calls back ends up being last night. And we're talking and he says, we have to do a insurance verification. And they say, verification, he used the word that made it seem scary. Maybe it was verification, like you like, you know, we have to we have to do an insurance investigation investigation. He said, he said insurance investigation. And I'm assuming that's what he's been told to say and everything. And at the end of the call, I just said to him, Hey, real quick. I said, there's a better word, that investigation, and he said, What's that? And I said, it made me feel like, scared for a second. And I said, I don't know another way to put it. I'm like, but find another word. And and he's like, thank you. And I could hear him like, he's like, I'll make sure I say that to somebody. He's typing and everything. And I'm like, he's gonna tell somebody that, you know. And I really felt good about I think I forgot my wife came up with the right word. But But she, because I don't know, it was a weird thing. But I know the process. So when he said insurance investigation, I was just like, Oh, I know what's gonna happen. But it made me think about, what about somebody who this is their first time reordering? You know? Right? And maybe they'd be like, oh, what do you mean, an investigation is that, you know, we done something wrong like that. And it's just, it's a little thing. But it was met with, you know, it was met with comfort the guy, he thanked me a couple times, we started to have more human conversation, if that makes sense. Like, if we, you know, he might not off this script a little bit. And I thought, this is where things get worked out, like in these little moments, you know?

Rick Doubleday 13:45
No, and I think that's, I think that's a great point. And we do we really do listen to customers, and there was a, I still, I will still get emails, calls from customers good and bad when they have an experience. And I think the beauty of it is Scott, we I learned from each and every one of them. And we do try to implement those kinds of changes.

Scott Benner 14:11
Yeah, I mean, honestly, the, you know, you got to take your own advice, right. Like the, the data that comes back from the CGM is how I continue to make better and better decisions, how all these people do who have it. I mean, it'd be silly for you to ignore the data coming back as valuable. Right there a little. You know, that would just be ironic. When we were talking, we were talking about bettering the g7. You know, for the, you know, working on that. And first of all, it made me think somewhere at Dexcom. There's little wristbands that keep everybody motivated about g seven with some kind of code name on it. I'm wondering what that code name is. But, but the other thing I was thinking is, it is and Kevin's mentioned to me a couple of times, but its price point, the next hill to climb. Like like and just the disposable nature of the g7 does it begin to address that?

Rick Doubleday 15:04
I think that there is price point is absolutely a hill for us to climb, we know that we have to continue to make this technology less expensive to be able to make it affordable for a broader audience. And we are absolutely focused on that Scott, everything from working with the payers, moving the benefit from a DMV to pharmacy to ease the access. g seven, you know, will not be more expensive than g six, and we're continuing to focus on how we can make it less expensive. But there are there are so many other factors that g seven brings to bear just from, you know, I'll start with a simplicity from a simplicity standpoint, the fact that it is a fully integrated transmitter and center. So there's nothing snapping and snapping out, you just insert the entire unit. A faster warmup time, we're targeting 15 days. So there's just so many different features that we're looking to add at the same time understanding we have to continue to be focused on how do we take costs out of the system, right,

Scott Benner 16:23
those features you're talking about? Are they mostly? Do they mostly happen on the algorithm side? Like I'm assuming you make you know, maybe you're doing maybe you don't I make changes to like the sensor wire itself and and the physical technology, but is it more in the in the algorithm in in the way the information is being interpreted?

Rick Doubleday 16:46
Well, that's part of it. algorithm is absolutely part of the change. But again, we were talking about how Dexcom is willing to go out and make changes across the board. That's what we did with GE six, it was a you know, a new wire new membrane, and we're going to do the exact same thing with G seven as well. That's cool.

Scott Benner 17:09
That's excellent. I mean, I just got please.

Rick Doubleday 17:13
No, I was gonna say and I wanted to go back, you were talking about people wearing little rubber bands to keep themselves motivated around g seven, right. The beauty of that is we don't need the little wristband everybody in around this place is so excited to get g7 to market. You know, it's funny, you mentioned Kevin a few times and he gets absolutely giddy when he talks about g7.

It's, it is truly going to be

an amazing product g six is amazing. g seven is just another step forward for Dexcom.

Scott Benner 17:53
I'm, I'm super excited, is there timelines yet or not yet.

Rick Doubleday 17:58
We're still taught, we are still targeting 2021.

So, you know, we have to be, we have to be I know you and I talked to earlier, Scott about, you know, my time here from 2009 to two now. And you know, one of the big differences are installed base has, has truly grown. And we really have to be cognizant now of ensuring that we've got the right amount of product on the shelves and all of that before we go into a full blown launch, so that we don't get ourselves sideways, and delay launches and things like that. So you know, we are going to be very, very focused on making sure that this launch is our best ever.

Scott Benner 18:45
I think that under promise over deliver is definitely the way to think about stuff like this. You just, you know, there's no winning, if you say if you say April, and it's May, if you're you failed, if you say March and it's February, you're a genius, you know, so, yeah, it just it makes sense. Okay.

Rick Doubleday 19:03
Spoken like a true commercial person.

Scott Benner 19:06
I just you have to, you just have to, you know, you're gonna eventually take this amazing thing and lay it on people. There's no reason for them to start with it feeling like some sort of a letdown when it's clearly not that and that last piece, you know, is, is FDA so you don't ever know exactly the length of, of, you know, time. That's that effort it's going to take? Yep, yeah, that's it's really cool. So the reason I asked you to come on tonight, although all this has been really interesting is that I'm really interested in some of the agreements you just signed. And talking about, you know, closed loop systems or algorithm based pumping, I guess whatever you want to call it. I have I firmly believe that, that this is the way forward for a great number of people. I think that you take any algorithm based system And put it on somebody who's struggling, and they're going to suddenly be doing significantly better. And I think that ends up being, you know, kind of, sadly, the larger part of the community, like the podcast is great, but it talks to people a lot of times who are super motivated to do something. And you know, if you're talking to people who have, you know, who have an eight, they want it to be a seven, they have a seven, they want to be a six, but we don't often get to talk to people who have a 12 a one C and don't know what to do. And so I just think that this is going to be such a health game changer for such a large segment of people. And you're not. And by that I mean, Dexcom Dexcom is not limiting who in the pump community can use the technologies nears like Intel. So what have you done recently with? I guess, tandem and and their control like you? That's, that's on the market now. And then horizon from insolate, from Omni pod is coming. I mean, they're saying this year, right. So I guess talk a little bit about those agreements. First, when you sign like, like a commercial agreement with the pod, you did it for just the G six or the g7, the g7.

Rick Doubleday 21:15
No. So as we as we write these, what we call commercial agreements, typically starts with a development agreement, Scott. So we sit down and lay out kind of the rules of engagement as it relates to how we're going to develop products together. And it's really about who owns what in that development process. And the same thing with the commercial agreements. So as we write these commercial agreements, it is about how we now go about commercializing the commercializing these products. So you know, let's take the insulin agreement for a second. It will be an insolent launch, we are we're there to support where we can. We will, you know, work through various things from there may be co promotions there, there will be tools to jointly make the announcements. And that's what the commercial agreement is really about. I think what I'm most excited about about these agreements is we're actually getting the products to market that, as you talked about, products that change people's lives are truly becoming real. And the tandem control IQ was the first product, I can tell you that there are a number of people that work here at Dexcom that that use that product, one that I work closely with just talks about what a game changer, it has been loved bazel iq absolutely loved it. But now is seeing the impact on his nighttime highs that he'd never seen before. So these products are just like you say they're they're allowing people to get the benefits with with maybe a little less work. And that's what it's all about, how do we make this this disease easier for people to manage? We have always, we've always approached it, you know, we started at Dexcom with this philosophy of partnering with everyone because we're about providing choice. And, you know, we'll continue to look at that and for the right partners that have the ability to commercialize a product the right way we you know, we're always open to that as a potential opportunity.

Scott Benner 23:44
And that road goes both ways too. So like when weleda Yeah, when on the pod also does something similar with I think they're doing something with Libra but not for this current generation like they're doing I think they signed up with them too for like the Libra to moving forward. And and that to me, again, you know, I didn't just have you on here to butter your ass a little bit, but I'm imagining you could stop them from doing that if you wanted to. I'm imagine you could get in a room, close the door and go listen on the pod only works with Dexcom. That's what we want. And and they might be in the position where they have to go, okay, make dinner me like, I don't know, the inner workings of it. But I'm just saying that it's all working this harmoniously through these different, you know, user bases and products. It's it's very encouraging, because things just didn't go like that, you know? Right.

Rick Doubleday 24:41
Yeah. And I think it would be.

I would tell you, I think it would be disingenuous for us to go and do that. I think that you know, whether we could or we couldn't Scott and it wouldn't be the right approach. We went into this with a strategy of offering choice and in at the core We believe that the user should have choice and where where the rubber meets the road is, it's our job to make sure that we have the best product today where the, you know, I would challenge where the only real time continuous glucose monitor out there, Libra is in the market. But we're the one that provides a result every five minutes that allows patients to see their number, their trend era, you know, all agree. Yeah. And it's, it's our job to make sure that we continue to have the best product. And like I said earlier, also the customer experience is going to play such an important role. So customers will have choice, it's our job to make sure that we give them the best choice.

Scott Benner 25:43
Oh, you're doing it for my money. I'll tell you that much. And I wonder if I can ask a couple of different questions. So how do you handle when you're taking this? This thing, right? It's metal, and it's plastic, and you know, and you're fashioning it into this amazing device. And then you're putting it on a human being right. So now you're not just bolting it to a board or hanging it from a wall? You're, you're putting it into somebody whose body chemistry is different? Who is there? hydrations different? There's so many things individually about us that are different. How, how is that? Fine? tuneable? Like for somebody like my daughter who has nothing but success with Dexcom? And then you'll talk to somebody else who's like, you know, I get my period and it goes wonky. Now, it's not that it's it seems that simple from the outset. But how do you actually talk to that person and get them through understanding things like being hydrated so that the interstitial fluid moves around properly? And like, like all that stuff that we just, do you know what I mean? Like, is there a way forward for that? That kind of thing? customer education, or I was wondering what you guys do around that, or what you're thinking about for the future?

Rick Doubleday 26:57
Yeah, no, I think that's one of the things that

one of the things I think Dexcom does extremely well, Scott is, when you look at a lot of companies, you know, you find that the organization is pretty siloed. So r&d would sit off by itself, and they would, you know, create the next latest, greatest thing, marketing is out worried about promotion. And then you've got tech services, you know, our customer support that's in another silo, and they're sitting back and just answering the phone. We're a really integrated organization. So you know, first and foremost, when we are when we're creating new algorithms and new technology, we do a lot of small trials to really get good data to understand how the algorithms performing how the sensor is performing. And we have to do that before we ever take it to the FDA. Right. But it it doesn't stop there once the product launches. And we have the ability to see the data. Our r&d, and marketing and customer support centers are really tied together, they look at the complaints that are coming in. And they work together to figure out what is the right educational components to be able to provide to that user on the phone so that they have a great experience there was there was an example. Not long ago, where I had, I had gotten an email about somebody having an issue with a sensor, and was able to connect them back through to our customer support team. And they were able to walk this person through and it's so funny that you said it. It was really a hydration issue they were they were not hydrating as well as they could so talked about drinking more water. And that really seemed to make a difference for this individual.

Scott Benner 28:58
It's the little stuff you don't think of we we talk on the podcast a lot, because the person came on in and made this analogy one day, and he was an attorney from Canada. And so he said that there are some people who see a man put a pencil in his back pocket and then rob a bank and come to the conclusion that pencils cause bank robbery. And, and and, and you know, you put your CGM on your drinking, you know, a 10th the amount of water a human being needs in a day you don't get a reading back from the century like this CGM doesn't work. Well, right. You know, the CGM is reading fluid in your body and there's no fluid in your body. It's kind of a separate thing. Right? And but that's not your brain wouldn't jump to that being the user. It's always the pencil, you know, right. It's just It's very, it's very interesting. I've had some close contact with a friend of my daughter who has type one recently. And she would make these kinds of statements like oh, that's what my Dexcom does. And I was like, yeah, that's not really what's happening. Let me try to Like help you out here and we got our blood sugar down and stable and got her hydrated, and she's in a better, healthier situation. And now all of a sudden, her CGM reports back much more consistently than it had when her blood sugar was frequently over 400. And, you know, and her body was just going a different way. Now, you know, it's, it's, I guess it's interesting, really, you guys sort of started as a safety company right? In the beginning, you were just trying to make alarms so that people don't get too high or too low. And then, as the equipment the algorithm gets better, you become a decision making company, like, like the help of actually like when insulin goes in, so that now in this timeframe, it's more important than ever, because now these, the horizon algorithm is gonna be is gonna look at information from the Dexcom and say you need insulin or don't need insulin based on this number. I guess that ratchets the game up to a different level. Hmm.

Rick Doubleday 30:53
Yeah, I would agree. I think that

you know, we started out, and I spent, I spent 10 years at lifescan. Before Well, I spent 10 years at lifescan. And then three years at Animas before coming to Dexcom. So I, you know, I spent time in the self monitoring blood glucose face with one touch. And I think the thing for me, and really, one of the things that brought me to Dexcom was the differentiator that this technology provided, you know, you know, this better than I do, Scott, that a blood glucose result, a single point in time does not tell you the information that you need, and Dexcom with a real time continuous glucose monitor. Not only do I see the result, but I see the speed and direction. And I always believe that that was a differentiator, differentiator from a safety standpoint. But exactly what you're saying a differentiator as it relates to, you know, how much and when do I put insulin into my body? When do I not? And I'll take it the next the, you know, the next step, I truly believe that this technology has so much runway in front of it as it relates to individuals not taking insulin, because where else are you going to get a behavior mod tool that truly tells you the impact of the meds that you're taking, that you know, the therapy that you're on the impact of exercise, the impact of the food that you that you eat, I think all of those factors, there's just such a runway for this technology in the future. It's really exciting.

Scott Benner 32:37
No, I agree. I was actually just talking the other day with some I was getting physical therapy on my ankle. And the guy that was helping me was talking about how in his culture, there's a lot of type two diabetes all of a sudden, and he's talking about the things they eat being, you know, much heavier, more carbs, things like that. And how his mother is beginning to wear a glucose monitor. She's self funding at Dexcom. Because her husband got type two diabetes, and she's trying to figure out what foods are impacting her or trying to keep it from happening to her. It's really a forward thinking idea from a person. But yeah, that all exists. It really super does. So what is what's happening right now around Dexcom? Like, what mode? Are you guys in? I mean, I know you're supporting g six and that stuff, but is there like, what's your day like there? Are you trying to get stuff to Canada? Are you trying to spread out into Europe? Like, like, all this happened at once? And how much of that stuff do you have your finger on?

Rick Doubleday 33:44
So my day, let's call it hyper. Dr. Scott.

Yeah, I, so my accountability is global. So yes, all of the things that you just described, we, we've recently, let's, let's take a step back, let's start with the US for a second, we're getting ready to launch in probably the beginning of q2 quarter to our Dexcom Pro system. So this G six, so this will be a professional device that physicians will use. And they'll use it for type one type twos, and it's also the first CGM indicated for people outside of diabetes. And they'll use that within the Office. It's both blinded, meaning you can just use it if you're a physician, just as a tracker patient brings it back. I download the data into clarity, our software program, and I can make adjustments to therapy. It can also run in an unblinded mode real time, you know, similar to what Arden uses and a little bit more scaled back, but then that patient can interact with their diabetes and understand what's going on during that period. So we're really excited about bringing that to market outside the US. We've recently launched g six and the business is going extremely well. We are in GC, we're in, you know, g six, and a number of countries outside, we just recently got approval for GE six in Japan and Korea, and Australia. So the Asia Pac business is growing. So we're really excited about not just what's happening in the US where we're having, you know, tremendous growth is, is more and more people have access to this technology. But we're also excited about being able to offer it outside the US and we're in 40 plus countries now outside the US.

Scott Benner 35:45
Well, Joe, let me tell you that the podcast is in every country except for nine at this point. Most of them are right through the center of Africa, where the North Korea, there's only a couple of places people don't listen. And so I get emails that always start, Scott. Hi, I live in Saudi Arabia. I live in New Zealand, Scott, I'm in Australia, Scott, I'm in South Korea, and I want and it's either a Dexcom, or an Omnipod is the next thing they say how do I do that? And I I always giggle like when I read it. I'm like, I can't believe they've they think I know, but I'm like, okay, so. So I always get to my contact person. I'm like, Can I just forward you this email? And, and I know nothing's you know, listen, if you don't sell it there, you don't sell it there. But it's always my goal to make sure not that you don't know, but that you really, you really are aware that there are people, you know, all over the world looking for this stuff. It's so exciting that it's spreading like this.

Rick Doubleday 36:43
I agree. Yeah. No, it is it is really exciting.

Scott Benner 36:46
Well, so your day is long and tiring. And and do you? Here's a fair question. How many days and how many days end with you feeling like good day? mood for the most days go that way? Or? Like, like, what's that feel? Like? I guess I'm trying to bring people a little bit into, you know, like, it's easy for us to look from the outside and just say this thing I bought doesn't do what I want it to do. Nobody cares. Yeah, you know what I mean? Like, like, but there's a real person on the other side of the of the wall. And and they're, they're banging their head on that wall trying to get you that thing? You know, so it does most days it do most days at Dexcom feel positive, like like you're going in the right direction?

Rick Doubleday 37:29
Yeah, I it's a great question.

Yes, the short answer is yes, Scott, I think we're absolutely going in the right direction. I think that one of the things so I'm going to I'm going to take you back if you'll give me just a moment here. I'm going to take you back to I was actually at Animas at the time. And I had just started at animus. And my boss at the time says, Hey, I need you to go to a conference. I was first week on the job. I was leading the marketing team. He said, I need you to go to a conference. He said, okay, where am I going? Said conferences, children with diabetes in Orlando, Florida. My response was You do realize it's July, right? And he was like I do and you're going, so I'm like, Okay. And I went and I walked in, and I was handed my animus badge and I was walking down the hallway. And this woman who I had never met before, remember, I'm three days on the job at Animas, turns around, sees my badge and comes running to me, throws her arms around me and starts crying, sobbing saying you don't know what a difference you've made in my child's my child in my life. And Scott at at lifescan. It was a great company. And we did provide a tool. But I never understood the impact that the things that we made had on people's lives. And it was at that moment that I decided that you know what, as long as diabetes would have me, I was going to be focused on diabetes and not leave it. Then I got introduced to Dexcom. My last job was strategic partnerships and my personal relationship alliance with dexcom. And that's where I got to learn the technology, the leadership. And what Dexcom brought was this whole focus on the patient and the end user, which was absolutely what I believed in. And it was, and then with the technology, it was absolutely what I believed was the game. game changing technology second, only to answer One. So for me, it was an easy choice to join Dexcom that hasn't left here. So I know it's a really long winded answer to, yes, most days that I end up and they're long days, but they're really good days, because we're headed in the right direction. I take every one of those, you know, where we have fallen down and not provided what we needed to do. It hurts. But I know that we're working to make sure that that experience in the future is the best possible. And that's what keeps me motivated and brings me in here each and every morning. So long answer, hopefully, it was, you know, what you were looking for. But yes, I think I think we're absolutely headed in the right direction. The technology that Dexcom offers, in my mind is second to no one with our real time glucose monitor. It's what we are focused on. And we're focused on the technology and the patient experience. So I couldn't be happier about you know, the direction we're going

Scott Benner 41:03
well, I hope you get to say stay around the space for a really long time. So you can see it bear out in decades, because I interviewed a woman this morning, who's you know, toddler was diagnosed it baby even under two years old. And she found the podcast on day one, which led her right to index calm. And if you could see this kids graphs, this mother figured out the stuff I'm talking about on here, so quickly and so thoroughly. And so like, as I was speaking to her, I had troubled not wondering like, how much better this child's life's going to be over decades that might reach beyond my lifetime, even. And right and, and it's just really encouraging. I just, you know, Rick, you don't know me prior to this podcast, and diabetes and everything, but I sort of was not a Chicken Soup for the Soul person when this all started, you know what I mean? And now, I don't know if I am that. But I definitely have a really strong feeling for helping other people that maybe didn't exist in me before. And to hear somebody say something that that could to an outsider feel small, like, I'm able to concentrate while I'm doing my homework now. Or, you know, I thought I thought I was crazy, because my blood sugar would jump around. And my doctor would always say, you know, you're doing fine, but it didn't feel fine. Those little things. You know, the to a casual observer wouldn't seem like a big deal to me. They fill my heart up, like a woman once said to me, and there's a little bit of a curse in here, but not much. And it just I think it really shows the the intensity of it, she said that she thought her daughter was. And when she found the podcast and stabilized her blood sugar, and got her on the tools that we talked about here, she realized her daughter was a really lovely person whose blood sugar was bouncing all over the place. And I just thought when she said that, imagine if they would have spent their whole life thinking that about each other. And just right, what a sad shame that would be it just goes so far beyond just diabetes. I think sometimes.

Rick Doubleday 43:08
No, I agree. And I think and and the fact you're right, what their whole life could have been. But I think what's so exciting about that, that comment, Scott is what their what their life will look like, in the future. Because they the flip side, they could have been stuck in that mode for a really long time.

Scott Benner 43:24
Oh, no, I, I always come back to a single mom that I spoke to once in her late 30s, who had had diabetes since her teens, and was genuinely living with a 12 a one c forever. And then she said, you know, we spoke privately once and the next day she her blood sugar was between like 80 and 120. And she had a dexcom she had the tool, she just didn't know how to use it. And it just, there was this moment where she was grateful. But then for a minute, she got upset. And she said How come nobody ever told me this? You know, like, like, why is that not the standard of explanation and care in the space and and so the part that fills me with hope is that one day, I just hope that one day people are diagnosed, and they're told, hey, this glucose monitor exists, this is how an insulin pump works. Here's how insulin works now you can you can build off of that but at least you have those building blocks right there to start with instead of the fear and anxiety and you know, the your blood sugar starts jumping all over the place and you know, you lose you lose your personality. And before you know it you think it's it's it's hopeless. It's just a very slippery fast slope. You can fall down that hill and and never climb back up again. But it's just not necessary. So I hope one day that it just, I hope one day somebody that you know, the king of diabetes calls me and says Hey, everybody knows you can you can stop now. And you know and i i don't know what i would make a podcast about then.

Rick Doubleday 44:58
Yeah. I would be right. I, and I've said this before that, you know, nothing, nothing would make me happier Scott than a cure for diabetes. I'll happily go out of a job if we if we can solve this. I think in the meantime, you know, your comment about looking to the future, and being in this space for time to come. I can't wait for that teenager, adult that I meet in the future, that when I talk about doing finger sticks, has no idea what I'm talking about. Because they've been using a dexcom, continuous glucose monitor not having to do finger sticks. And it's ancient technology, like the rotary phone that I grew up with. That that's, that's, you know, the next thing I'm looking forward to

Scott Benner 46:01
when it just feels like you just said to them, Hey, did you you know, do you know, people used to have to boil their urine test their blood sugar, you know, like, like that guy stuff. You just just gone down? Hey, listen, what I'm going to do is I'm going to keep my Contour Next One ad off of this episode. I've I've done yet.

Rick Doubleday 46:22
I'm looking to the future. Don't

Scott Benner 46:23
Don't worry, essentially, it's gonna be a while from now. But no, no, but I, but I, Seriously though, I'm, I feel very lucky. You know, I started a podcast hoping to help people, the first month, it had a few hundred downloads. This month, it'll have no downloads. And, and I was very lucky that it was successful enough that I could pick and choose the ads I took, because I couldn't, I just don't know how I would get on this microphone, and talk about stuff that I don't believe in that I don't see doing. You know, the things that they're doing run by the kinds of people who I get to meet, you know, like you. And Joking aside that Contour. Next One is the best damn blood sugar meter I've ever used. And so that's, that's why they're the ones on this podcast, getting to talk about their meters, because trust me, they all wanted to be on the podcast, those are the ones I chose. And index comment on the potter right there with that, I just, it's just it's next level stuff. And the people, whether their voices being recorded or not, give me a good feeling. You guys, you know that that's how I feel when I walk away from a conversation with someone like you. I think I really believe you. I believe that if somebody tomorrow walked into your office and said, Hey, Rick, I got the you know, I got the cure to diabetes here. You know, you know what you want to put it in this in this drawer so we can keep this Dexcom thing going? I think you would say, you know what, we're all gonna have to find another job. Because, yep, you've met these people. And you know, what it what the disease does to them. So, yeah, that's excellent. I really appreciate you coming on. I realize we never set it in time. So as we're talking, I'm like, is he like, I gotta go or. But I really, I really do. I really do appreciate you coming and doing this. Is there anything? I know you probably did you just get back from Spain.

Rick Doubleday 48:20
I was not in Spain. I had team members there. I did just get back from your tie in about awareness, and which is still such an opportunity for us. So I appreciate what you do Scott, and helping drive that awareness. But I was had a chance yesterday to meet Sugar Ray Leonard. And he actually has a foundation, the Sugar Ray Leonard foundation. And he had his father who just recently passed away lifted the 94 had type two diabetes. So he has a real passion created this foundation that is connected with Children's Hospital of Los Angeles, and is about promoting awareness around diabetes. And the I think the thing that was so cool that he said was, you know, this is a guy that fought Marvin Hagler Duran, Tommy hearns. And he said, and he was sincere. He said, my toughest, the toughest battle I'm going to fight is fighting this diabetes thing. Because we've just got to find a way to make a difference. So I, I'm, I'm telling you that because I appreciate what you do as well to drive the awareness to let people know that there are solutions out there like Dexcom CGM, like insolate and that others are taking up that cause as well.

Scott Benner 49:57
So I appreciate what you do. Listen, it's Just a reflection of what I see working in my life with my daughter, and honestly is like I, it's you because you work it, you know what I mean? Like if it was somebody else, it'd be somebody else. But but you guys are the ones doing it right. So it's easy to talk about, I really appreciate it. Great. If I could say goodbye for a second, and would you hold on for just one second,

Bret Christensen 50:19
I would.

Scott Benner 50:22
We don't really need much in the way of ads for this episode. Let's just go over it one more time. If you'd like to get started with the dexcom, g six continuous glucose monitor, it would help me if you went to dexcom.com Ford slash juice box to find out more about the dexcom g six continuous glucose monitor, you want to know about the speed and direction that your blood sugar is going, you want to be ready for these great automatic insulin delivery systems that are here and on the way you just want to be healthier. You'd like for diabetes to be a smaller part of your life, these tools are going to help that dexcom.com Ford slash juicebox, there's going to be links in your show notes of your podcast player. And at Juicebox podcast.com. type it into your browser. But if you can, you know, hit my link, that'd be terrific. I don't get paid by the link, I don't want you to think that that's not how this works. It just lets the sponsors know that you're coming through the show. Also the Omni pod tubeless insulin pump, don't wait. Right? Don't get it into your head, like I'll wait for her eyes and just get the on the pod down Get going, you're going to be an absolute rock star stud with it by the time horizon gets here, and you'll make an easy transition to horizon, it's not going to be a problem. And by the way, if you don't want an automated system, you don't have to on the pod. They want what you want. In just a moment you're going to hear from Brett, and he's going to tell you that what Omni pod wants for you to have more than anything is choice. You'll see what I mean in a second. The great thing about on the pod of course is that they'll offer you a free no obligation demo of the on the pod right now, you don't have to buy it, you're not locked into anything. You just go to my Omni pod.com forward slash juice box, you fill in a little bit of information and they'll send a pump right to your house. It's non functioning, don't worry, can't hurt yourself with it. Give yourself insulin or anything like that. But what you can do is where you can live in it and see how you'll enjoy it. One of my favorite things about wearing the demo pod is that you just forget it's there after a little while. Touched by type ones mission is to elevate awareness of type one diabetes, raise funds to find a cure and inspire those with diabetes to thrive. They are my absolute favorite type one diabetes, charity. They're small, but they're powerful. And they're growing constantly check them out, just go to touch by type one.org. They're not looking for anything else from you. They just want you to know they're there. So you can see what they're doing. Touched by type one.org. And now, let's go to Brett Christiansen from the bot.

How are you?

Bret Christensen 53:29
Good. How you doing? Good. Where are you at?

Madrid Spain?

Scott Benner 53:37
Oh, okay. All right. How long you're there for?

Bret Christensen 53:42
all week. So I mean Friday morning. Nice. Thank you always. Great show.

Scott Benner 53:47
You're in Madrid. I'm in New Jersey, yes. Using a cell phone, which we don't usually do. But it's a big exciting kind of time. So we're making an exception.

Unknown Speaker 54:00
All right, so

Unknown Speaker 54:02
So, so you guys had a pretty big

Scott Benner 54:06
announcement the other day, I think it's sort of to me felt like a cementing of something we knew was coming as far as Dexcom. But the libri thing was a curveball for me. Can you tell me about that a little bit?

Bret Christensen 54:21
Yeah, I mean, I know that it should have been a curveball, because you know, the strategy all along right with interoperability is that you allow patients choice. And so we've been working for a long time with x calm. And as you know, we're launched on the pod horizon limited Dexcom g six. We announced last week that we're going to work together to quickly add g seven, which we know is important to our users. And then the abbot announcement was again, consistent with interoperability because, you know, what we do is we want to provide the best content delivery system out there. And so we're in the business of selling pods and pods marking pods. And so we want to allow patients, our users, sensors. And so if for whatever reason they want to use a Dexcom versus Abbott sensor, we see a product where you turn on your, your TPM, or you access the app from your smartphone. And there's a drop down box that says select your sensor, you're able to say that stop g six Dexcom g seven. That liberates you. That's the vision that we provide that choice to our users.

Scott Benner 55:34
And, and that Libra is not the current one that's available, though. There's one that's coming. That's the one that's going to work with.

Bret Christensen 55:42
Yeah, so the Libra shoe. That's right. It's the one that's coming. And and, you know, the real rationale for that is in Abbott said this bill working with the FDA to get ai CGM certification for Libra to as you know that that designates that CGM is an AI CGM. We've already been designated as an ace top. And then with horizon will be pivotal. But right now, we we intend to make the horizon algorithm the AI controller. So those are the three components necessary for an AI system. And what it actually does is it's a quicker to market pathway. So it's not a PMA product, it's not really going to add 10 kids, it's a it's a validation that the two companies should do together to make sure that that's actually works. odd. And with the rise in algorithm, it's a real short to market timeline.

Scott Benner 56:37
Not to jump around. But does that mean that tide pool also has to begin over? If they want to support the librato?

Bret Christensen 56:49
No, no, because, you know, the tide pool application is, is already being developed with the parks and effects job. And so that will just continue. So they, I guess, if they wanted to add lubri, to to that application, they could do so. But that system is being built with those three components in mind. And so then that comes g six is already an IC GM that they're working on is becoming the AI controller. And so they're working on that designation with the FDA, then they'd be able to pair that with Omni pod, the pump, those three components should be able to work together that system. I understand.

Scott Benner 57:29
Yeah, I didn't ask my question correctly. That's what I was asking. So Perfect. Thank you for clearing that up. So is it fair to say that? Is it fair to say that when horizon launches, Dexcom will probably be before Libra to where do you think Libra can catch up and get their designation in time for your launch?

Bret Christensen 57:50
No, I know, we're pretty tough. So when when we launched because we're again, we're in the trial now with Dexcom and Dexcom, kusik. So what we anticipate is that launch, which we've set it up for the second half of this calendar year, the system will be in the beginning, we will have full control on certain Android smartphones, there will be just the Dexcom gs six initially, and on the on the horizon algorithm. So that will be the component and that will be the system on day one. And then we'll look to add g7 and Libra to future developments. But there's still technical work that we have to do, even though the FDA does the clinical pathway to get there. Gotcha. And

Scott Benner 58:30
so, horizon. So I think this is a when I'm listening to people talk and ask their questions. And even just for the last two hours, I asked people, you know, that are following the podcast just on Facebook, like what would you be wondering? their questions, mimic them? I know a lot. But there were some interesting things I saw pop up where they just don't understand. So, you know, a lot of people said, Look, I can't get I can't seem to get a dash PDM. Is that going to stop me from getting horizon? Which led me to believe that they don't understand that horizon is going to be phone control, right? You're not going to need a PDM with horizon? Is that correct?

Bret Christensen 59:08
It's correct. But one clarification is that we will still distribute a PDF to every user. So even a user that says, Look, I want to I want to start off on horizon, using my own smartphone will still ship them a PDF, just as a backup device for that company we told the FDA to do. Yeah, so they'll have that right. So you don't need your need from control. For horizon, it will come Wikipedia, but anyone that chooses to just have the app on their phone, it can effectively eliminate one component of the system. So that's the beauty of phone controls. And you can do that. But but those that don't have an Android device don't want the app to want phone control, the ability to have a rising PDF,

Scott Benner 59:49
so horizon won't run off of iPhone.

Bret Christensen 59:55
Not initially. So again, that's the partnership with tide pool, but the one One of the real benefits that we get there, that's probably a shortage pack way to have Omni pod control through the iOS Apple system, because the tide pool application is built on exclusively iPhone. So it's probably the shortest path with Apple. But we have said that we are going to be working on an iOS version of horizon,

Scott Benner 1:00:21
I say, How are the trials going? Are they steaming along like you hoped? Are you learning anything from them?

Bret Christensen 1:00:31
Yet you also were blinded to the data. So we did a pre pivotal that started in December until almost the first of the year for a real small number of patients that we can have visibility to, will look to probably shoulder data potentially at ABA. But you have to be here on out we're really blinded to the data. So we'll get feedback from our investigators to fix even problems or issues that and then we see enrollment, but that's about it. So I will say this a Roman has been very strong. And if you talk to Dr. Lai, our medical director, she'll tell you that many investigators said they had people will fly from Texas to the Pacific Northwest to be in the trial. There was that much demand, so we won't have any problem during the enrollment for the trial. We know that much. But we don't see that the comfortable results and print the results until that Yeah. Okay.

Scott Benner 1:01:19
And so that you won't you don't get to see those results until the FDA comes back with a report for you about how they found the trial to be.

Bret Christensen 1:01:28
Yes, that's right. What we'll see it once it's complete in the data block and the results are in that's when we see it. We do get, you know, anecdotal stories I will have investigators will tell us how horizon has changed where their patients lives, there's, there's a story about a young patient that you know, had problems really wetting the bed, because the lot of rains, you know, the just that they couldn't keep the right, the right level. And that went away with almost immediately with the horizon. So there's some really cool patient stories, how it's changed people live, parents that are sleeping with their kids, a lot of that. But again, we don't see any time and range or you need to know clinical results. Until the completion of the trial. Do you do you see horizon as being for people who are really struggling? Only? Or do you? Or will it be able to be used by I don't know what to call it like a super user, somebody who's got a six and a half a one C and just really wants it to be a five and a half? Do you think that it has applications for for both kinds of people? Yeah, I do. I actually, I think it's for everybody. And and you'll see that is really stilted. So it's flexible enough that you could still be a super user. And really fine tune your time and arrange your will have set points from 110 to 150. But just the way it works is about you know, the beauty of CGM is it gives users really powerful information they can act on to try to get a real tight timing range. But they're not acting on that in a way that horizon writings getting a value from CGM from Dexcom every five minutes. And then it's making an interim dosing decision every five minutes or every five minutes that you've assumed a unique dose of insulin that's driving them to a target. That's just something that I could give it a power user on dash saves a hard time driving to that road. So I think it's for everybody, the ease of use and simplicity, it's gonna be great for somebody that hasn't wanted to adopt pod therapy. But I think it's flexible enough that a power user can get even better results on arrival.

Scott Benner 1:03:34
Are the are targets definable by the user? Or is it locked in it at at some target blood sugar

Bret Christensen 1:03:44
defined by the user. And so you can set different targets for different situations. But, you know, we wanted the flexibility with the lowest one. So that's the bottom set point. And if I want to do so, in increments of 10, so 141 5130 and 2110, those are the set points that are user defined. And then there's a you know, a feature like hyper protect, where, let's say you have a child that's going to sleep over or you're going to be exercising in some extreme way, you can set it too high for protect mode, which really kind of ignores that setpoint and lets you run at a higher rate for a longer period of time. And so this is something that we think is gonna be really valuable as well for this in situations. Okay,

Scott Benner 1:04:27
so I don't know if this is your space are not like I think I'm asking one of the right people. But, you know, dash came out in, I think in the within the last year and some people are able to grab it and some people are seem to be having trouble getting covered for it. And what I'm seeing is that that's causing people concern that they're not going to be able to get horizon moving forward. Is there a way to talk about the first I guess what what people should be doing if they want bash and if that has any impact on horizon

Bret Christensen 1:05:00
Yeah, let's back up as far as I can. So, you know, one thing we did with that, we really wanted to start over with, with the way that omsa reimburse the way patients pay for pumps and the way, they're restricted to migrate from one technology to the next. And so, you know, this, but the pump market historically has been a decision that it should make, there's a large upfront fee. For the pair case, of course, and other than patients pay for course, now, because of that large upfront fee, the pair had locked a patient in for four years to that piece of technology. That's troublesome. And it's actually it's not, it's it actually is a counter incentive to innovating and innovating quickly. And so a manufacturer like us actually has an incentive to only release a product every four years, because we have a large install base that can only adopt that new technology once every four years. And so if we hadn't done that, in which imagine patients actually digit cash, so we've spent over a year now, putting patients on dash from our legacy Omni pod product, those patients in the old model would be locked into a four year warranty carrier would not have access to horizon for the work through that four year period. So that that went away with that, because we did that, you have to renegotiate contracts in pairs. And so there are some users that have not been able to get gas because their pair will not pay for it in that manner. But the one existence that we made when we watch dashes, and we want to charge these large upfront fees, we also want to lock patients into a four year period. So the good news for those patients who's literally got gas yesterday, or still haven't got it, it has no bearing on their ability to get horizon because the baby launch horizon, the only thing that matters was real their pay or pay for it. And so it doesn't matter if they've had dash haven't had dash, none of that matters because it adopt that new technology, because you're not locked in to that four year period. And we're not going to build a pair for the largest selfie, that she's not paying up front. That's the good news. But that's been a shift, and it's taken us some time to build that access. Today, we've got over 50% of covered lives that have access to this new model. So we're not charging that fee. But if you're part of the the, you know, the 40 or 50%, that doesn't, we may have a problem getting on DAC so far. But that's getting better every day. But you know, the way I always talk about this, Scott is it's like cell phones were 20 years ago, you know what I had the key to Brian, they owned by phone number, they locked me into a three year contract, and I wasn't able to switch regardless of how poor my service was. And that's the pub market today, the the durable medical equipment, so we decided go away from that. So it'll be easy for patients to get on product that it's easy for them to get off, will not do a good job. That's the model that we see patients that choice, this choice of DVDs.

Scott Benner 1:07:50
So if I'm gonna make a hypothetical here, if I'm a person who can't get dash at, you know, for whatever reason about my insurance horizon comes out, can I just get horizon and use it with my phone? Or do I have to be able to receive the dash because the FDA thing like I'm saying, are the people who are are somehow blocked right now from dash? Will they also be blocked from horizon for that reason? Or do you think you'll have that straight by the end?

Bret Christensen 1:08:20
Just depends. But look, we're we're making progress on that every day. But what's likely is that their dash coverage will be pretty closely mirrored by the horizon coverage, because we all have the same payer, right? So pick pick a large commercial payer, and let's say they are paying for gas today, they're likely to pay for horizon when it comes out, right away, right, reimburse that, if they're not, for whatever reason, if it's a holding on to this four year locking period, and this larger, upfront fee, and we haven't been able to convince them that this new model is better for patients and frankly, better prepares. Because we assume that risks, we're not charging them for four years of therapy of swans, and they don't have to hope that patients use that product. So we haven't been able to do that yet. We need to do that between now and arising. Because it'll be the same model for a rising and so it again, it's a good thing, because horizon will be we're gonna be given a software company, right. And so as we innovate through software into applications, patients should always be able to adopt that newest version of horizon without having an upfront period, this four year locking period, but we just got to establish that access for them.

Scott Benner 1:09:24
So you're making an improvement a shift into the type of business you're doing, because of the improvement in the technology. But the insurance companies are stuck in, in the model they're in so you, is it a is a Yes. Is it a Is it an explanation thing? Do they not understand or they just resistant? Like, like, I'm assuming every day is frustrating when you're trying to make this work. But is there a path to it eventually do you think?

Bret Christensen 1:09:54
Well, yeah, and I. So let me let me say one thing, so you know, what I started with in 2003. years ago, we had been on the market for 15 years, and we were the worst reimbursed influence on the marketplace at that point in time. And so it took us forever to get to really good access with our legacy Omni pod today, you know, after just after less than a year of launching bash, we have better access to the ad, when I started with and slept with, after 15 years of work, it's actually happening very quickly, believe it or not, and most of the large parents have adopted it. But there's thousands of pairs, there's a lot of small plans, every state's got their own Medicaid. And so it's just a lot of work. And the story, we have to tell, thankfully, is a useful model that takes four pumps in the way that I described, locks up free Wi Fi for your locking period. So I feel like scratching the value of this new system, that value really is that we're owning the rest, because they only get outcomes, which they want. Because they get health outcomes. And they don't, it doesn't cost them very much if the user actually uses on the pod every day. And so they don't, because we didn't do the job of the product, then they stopped paying for it, then, you know, with the historical models, they pay for the front that hopefully, usually you got, you know, every patient from an average migrate between health plans every two and a half years. So why appear would want to pay for four years of therapy for anything knowing that on average, that that patient is going to stay with their health plan for two and a half years just doesn't make sense. So once we tell that story, it resonates with payers and the adoption actually very quick. We just have to, we just have to deal with it, we were the first to market and we were the first insulin pump on the marketplace. This is how reimbursement would have been set up. Here's what if it all paid for what the patient's using it for the benefits I'm getting, but they stopped using it, I want to stop paying for it, nobody would pay for four years of allergy medicine right up front, you know, you get that prescription filled every month, and that's okay, I just want to do. So they're they're migrating actions pretty rapidly. It's improving every day, it's just you have to tell the story and reach all those health plans.

Scott Benner 1:12:02
You know, it's funny, and I'm not known for being great at being like, office, correct, my wife always tells me if you had an office job, you would just get fired in a week. But so I'm gonna say this because I have, I have like historical, you know, time with on the pot, I've been working with them in one way or another for a really long time. And so I've had access in and had impactful conversations with people throughout the years. And what I can say is that, from my perspective, around five years ago, the leadership of Omni pod changed significantly. And I mean, through the actual people sitting in the positions, but also with the idea of what the company was for, like there was a time prior to JC that I thought this company might sell or even go out of business at some point, like I used to support on the pod because I loved it. And I wanted it to exist for my daughter. And I always felt like I always just felt like that leadership prior wasn't doing what I would hope they would do as a customer. And it is completely 180 degrees from that now. And it's, it's interesting. Because I have that perspective, I see how far it's come, how fast it's come and how the focus has become something that I'm excited by. But that's not exactly something you can communicate to people as they're coming in. And they're seeing, you know, tandem, put their pump out and it looks suddenly like their head when you don't know the whole story. It's it's an interesting, I don't know if you want to talk about that. But that's my perspective of it.

Bret Christensen 1:13:38
Well, I'll tell you the good thing about being able to state that we have the right to the entire management team, and that's just the executive level, but you're hard pressed to find anybody in it for the schedule longer than five years. The good thing about that is that, you know, we were in such a state at that time, you know, just how we marketed the product, how we sold the product, the quality of the product, the the amount that we were spending on r&d, or how little we were spending, frankly, on r&d. You know, when the new management team came in, it was pretty easy to take some risks because we had to, we had to do things dramatically different. And so we've done some things and the question I get asked so often is how are you willing to make these bold decisions and take these types of risks because frankly, some of them could not have worked out and ended up in a worse situation. But you know, we made the decision to move a large portion of our manufacturing from China to the US. That's a big decision which stood over $300 million automating the manufacturing lines and why as important you know, last year we made over 30 million parts until the quality has to be really really good on those that we have the opportunity to provide a bad patient experience bad news experience every three days. You know where you get a lemon when you buy a car once in a while. You don't buy a car every three days. We're effectively delivering a new pump to a patient every three days has to be done. Quality. So we put significant investment in that, we decided to disrupt the way the products paid for and to go to the pharmacy pays to go model that where patients don't pay for this large amount upfront, they're not locked into a piece of technology for four years, that's a long time, imagine not being able to upgrade your iPhone software for four years. It's silly, and it's not the way that it should be done. So that was a bold move. You know, we took our, our business back from our European distributor. So we went direct in a really short amount of time in Europe, which enabled us to expand beyond the small amount of European countries that we're in today to expand globally, there's just there's been a lot of things we've done in the finals, we took this was a good product, you know, an omni pod, and we're manufacturing with PDM is controllers with our own proprietary software. And we realize that there are companies out there that make pretty good handhelds called Apple and Samsung and these type of companies we moved on, we pocket this mobile platform, which took a lot of time, it was really risky, very expensive. But it's set us up now. And I appreciate that it's really all that work, it's just kind of coming to a close. Now, we haven't seen the result from a lot of it, but it's going to enable us to move really quickly in the future. And to innovate very quickly. And you know, the reason why I think users and patients only have adopted, you know, insulin pumps 35% of the time, which is probably the penetration rate of all type one patients in the US, that's a that's a visible penetration rate and usage rate, considering the insulin pumps have been around for 30 years, but the technology has not been good enough. And so if you're willing to give yourself four or five shots a day, that tells me that we just just have to do a better

Scott Benner 1:16:46
I am, I couldn't be more excited about where this all is. It's it's just it's tough for the, for the casual observer to understand the big picture of it, it's you know, and when you tell them, they just want nobody wants to hear it, you know what I mean? Like, everybody just wants it now, and, and they don't know, they don't know what had to happen. It's not like it's not like, it's not like you guys made a bad decision. Like you're making these, you're making these amazing moves. I saw the manufacturing floor. You know, I don't know if I ever shared this on here. But I came up and spoke to employees last year. And I was able to I was just there to tell them what Omni pod meant to my family. But I got a tour of the manufacturing and it is incredible. It's just it's people would not believe how on the pods are made. It's it's stunning. You guys are set up for you know, I was talking to the gentleman that set the floor up who I always think I want to interview because he seems so damn interesting. And, and, and he was explaining how you know how this setup allows changes to be made without like, huge tear downs from the manufacturing. And I was just like this is this is like state of the art. And you move that into the country. And and you haven't right there. It's right there. So I don't know, it just makes sense to me. I'm jacked up. I'm excited. So I hope

Bret Christensen 1:18:04
I'm excited to you know,

I get I get that it feels like we're not doing enough. I'm not doing it quickly enough. And I frankly I was there too. When I started with inside, why don't we just put an app on the phone that controls on Wi Fi, that's easy enough to do, right? Every 14 year old kid in America has got a video game on the phone that they built in their garage, that seems like it should be something pretty easy to do. But it's incredibly complex process and then never would really, you know, developing software that's going to deliver micro doses of insulin have to be incredibly accurate because insulin is a fantastic life saving drug that can be deadly if you don't do it. So it just there's a lot of scrutiny here and technology, not real quickly. I will say this, how can we estimate credit because the other we've always had the idea to put an app on a phone and control on the pond, but nobody ever thought that the FDA would get there would be comfortable with that. So you know, we've worked with them very closely to get there. I think once we get through these pivotal roles, and if we can get horizon approved on the marketplace, it's going to solve so many of the things that people are asking us for the number one request we get from a patient that still using multiple injections and they want an app on their phone. And if they could get an app on their phone, they put it on the playground and give it a shot. We can get to that. We're gonna we're gonna have a tremendous uptick of legalization because we know it's going to be a tremendous experience. You

Scott Benner 1:19:31
know, I can't tell you how many years ago it was where JC was telling me the very same thing. She's like, Listen, we want to put it on the phone. You know, we have to prove it out to the FDA, but it always felt like yes, we wanted to do it, but we don't I mean, it seems unlikely they're gonna say yes to this and that. That was a handful of years ago, but in FDA terms, it's quick, you know, and it's a big leap for them and you can see why. Especially how you described earlier like just how pumps have been forever. You know, to go from That sort of stagnant system to Hey here, it's gonna be on your cell phone is a is a major jump. Let me ask you a couple of quick hit quick heading questions here and see if you, um, if you have answers, I know you're saying the last half of the year, and you're a publicly traded company, you can't just give me a day. But do you think you're gonna hit in 2020?

Bret Christensen 1:20:23
Yeah, absolutely, we wouldn't be saying it, you know. So again, you know, we'll finish enrollment into the middle of trial, probably end of May, the latest will submit to the FDA, a little bit by 30 to 90 days, and then and then, you know, it's just a matter of doing some sort of relief at the end of the year. And so yes, I do think we'll hit it. And, you know, then 2021 will be all about getting as many people on really the best product on the market, which will be horizon. So we'll make sure that we're ready to do the, I'm glad that we've got the time. Because your point earlier, we've got, we've got market access to build further, even though we've made tremendous gains there, we've got supply to build, we've got marketing materials, we've got to make sure you have product support worked out, because now you know, we're talking about patients calling us and saying something's wrong with my system. And we got to quickly assess it to, you know, the way Dexcom is communicating with Omni pod is is the army product is the next commerce with something in between, and we just have to, you have to serve those goods. And so we're adding some complexity here on our ends, so that life is simpler for the user. And so we just got to figure all that out. But I'm excited for it could be one sided.

Scott Benner 1:21:37
I have a follow up for that. But first, it does Canada and Europe happening concurrently? Or will that take longer?

Bret Christensen 1:21:46
Not concurrently in the US will be first. And really just the it's the regulatory pathway for each individual country? And then you know, languages units of measure, but will they'll be fast followers, both of them? But but also the first,

Scott Benner 1:22:02
can I press you and ask you do you think 2021 for Canada and Europe?

Bret Christensen 1:22:10
You can trust me, I think. But you don't have to answer.

I just don't know if I can. I guess I don't I don't think we've hit that timeline out there. But I think I think they'll be fast followers.

Scott Benner 1:22:24
So you just mentioned something that I was going to bring up. So I've seen an algorithm work. And I've been in this space where I've tried to understand it. And what you just said about support is, it can't be stated strongly enough. So we we already live in a space where you know, and I see it more from the podcast than maybe most people do. But we already live in a space where most endocrinologist struggle to help people who are pumping or using MDI, to have the outcomes that they're looking for. And when you're using an algorithm, there are settings to consider. And if you don't have those settings, right, the algorithm, you know, you can't you can't tell a robot that there's a wall, eight feet in front of it, but the walls really four feet in front of it and expect it not to walk into the wall. And so the settings, you know, the parameters you put on it are incredibly important. But moreover, the way the algorithm thinks is unlike how most people are accustomed to thinking about diabetes, so the support is it's paramount. And I think that it's even more so maybe not just for people's success. But because I truly believe that algorithm based insulin pumping is what people should be doing moving forward and what they will do and what will be the best for them as far as their outcomes and their health and their stability and the amount of time they have to put into diabetes. But what I've seen is, is that when they try it, and it doesn't do what they expect it to do, and like it or not, their expectation is set it and forget it, which it's never going to be that right now. If you aren't able to shepherd them through the process, I'm so fearful that this really amazing advancement will will scare people away. And have you guys thought about it in that in those terms. I'm wondering

Bret Christensen 1:24:27
yes or no.

You're right about your stat. If something's not working in in, you know, one of the biggest challenges we might have is patient perception in their automated insulin delivery or artificial pancreas or how it's described to them. And we might think that they don't have to do much in one day. That might be possible. Because what we have done with the algorithms we have booted simpler, we're starting to make it make it so it's the parameters are set just right to the algorithm can compensate a little But for that, and so the algorithm gets better. And each one, you know, becomes faster actually, we'll be able to get better and better at that. And the goal will be one day to eliminate parameters, right. So that, you know, the reason why physicians have these complicated data management systems, and they're all budgeted out there, and they probably have all of them in their office, because they're looking at these reports, they're trying to achieve CGM values and influence those seasons. And then they're trying to fine tune these parameters. That's a real hard thing to do. And it's something that an algorithm should be better at doing in the future. But we're not quite there yet. We haven't eliminated all the knobs and the parameters that need to be set. So we do need to make sure that you train with just diligence and training, you know, this is going to be an incredibly simple system to use. And we'll move on to dash for existing users of Omni pod, have you provided online training, some patients do the content on training, because it's so intuitive, but they've been on pump therapy, so they know how important it is to know about your meals. important is to set the right base level, they know all these things. But if the pump gets easier and easier to use, we need to make sure that we're with justice, diligence and training. So we plan on doing that with horizon review. We do live training with our users and follow up in seven days, we call them 30 days, we bought the 90 days, just to make sure that they're just as guilty, because if they're not, and they look at this as an opportunity to do a lot less, they're not going to get the results that they should be getting improved results from arise. And so I'm excited about the future one day that I think I think we will get to the point where we can eliminate a lot of defenders because the algorithms that go in technological perspective, we're not there today. And so we just got to be very good at training and make sure that we take very seriously that the user has to do it, even though that's a lot easier with horizon.

Scott Benner 1:26:50
Isn't it interesting how you're on the cutting edge of something. And in its infancy at the same time, it's when you're making a leap like this, right? It's such a it's a weird headspace to be in because you're like, this is better than it's ever been. But with the way technology grows and leaps, two years from now, you'll look back at the first algorithm be like, Ah, you know, like, it's just, it's fascinating how quickly things move. And by the way, that's exciting. Yeah, because in diabetes, there were no leaps, just just five or six, maybe seven years ago, it was I say it all the time, you get excited if somebody made a new meter? And you say, is it more accurate? And they're like, no, but it's got a, it's got a color screen, you know, like that, and that excitement. So

Bret Christensen 1:27:40
it's just there's no other time, like, you know, what, what's interesting is, you know, expectations will just keep getting higher with our users. And that's okay, we're gonna live with that, right? You know, we would actually, it was a big leap from our legacy Omni pod to dash, we just, we, we launched the view app, right, where a parent can see what's going on with Omni pod for the child to the distance, you know, you should send your child to people, but you get to see what's going on within put on board and without me but but when that doesn't work exactly the way it's supposed to work, that people are upset, right, regardless of the fact that that didn't even exist a year ago, right. So so that's the way it will be is technology gets better expectations will just get higher and higher. That's great, though, because, you know, our mission is to improve the lives of patients with diabetes. And we will do that through technology use that looks like patients will be that that continues to get better over time. And well,

Scott Benner 1:28:32
yeah, I believe it will. I mean, I've I've got a long enough lines now that I've seen it in the past. And for everybody who's newer diagnosed or, you know, prone to be a little impatient, I guess sometimes. And for really good reasons. I'm just telling you, like, just hang on, like, I think ami pods moving in the right direction. And they have been for a really long time. This is just like another example of that. So I let me ask you, do you have to once your trials done, do you have to restart for a kid's trial? Or is that being done concurrently, so will pedes be available at launch?

Bret Christensen 1:29:10
So the trials going down to the age of six, so that should be available at launch, and then we will need to do more clinical work to lower the age glowsticks so could a you know Omni pod is cradle to grave. It's there's there's no limit on the age range. And we're the leader in pediatrics. So we also you know, there's an ad system has gone down to six today. And so we've, we were really, you know, emphasizing that to at least get to six in this clinical trial, but we're going to quickly get below six. We've got some data for patients down to the age of two, so we're going to have to get there. But yeah, at launch dance, your question would have been down to the age of six.

Scott Benner 1:29:54
Huge thanks to Rick and Brett for coming on the show. Rick Of course from Dexcom Brett from Omni pod. Another thank you to touched by type one.org for their support of the Juicebox Podcast and for what they're doing for people living with Type One Diabetes. You can check out the Dexcom G six@dexcom.com Ford slash juice box, learn everything you need to know. And get yourself a free no obligation demo of the Omni pod app my omnipod.com forward slash juice box. And of course, and of course touched by type one.org. Head over, see what they're up to. Now I'm gonna put this online, go to sleep, wake up, fly to Atlanta, and tell a roomful of people about being bold with insulin. You know who's gonna be there with me, Jenny Smith. Today's Jenny's birthday. I'm gonna see Jenny The day after her birthday. That's when I'm gonna meet her for the first time in person. Isn't that crazy? If I don't look too horrible. I'll take a picture and send it to you. But if I take that picture, and I think

Bret Christensen 1:30:59
No,

Scott Benner 1:31:01
no, then you're not gonna see Jenny on the day after her birthday. Hope you guys enjoy this. coming next week, part three of she's having a baby. Sam is about ready to burst and I just talked to her the other day. Things have gotten more difficult as the pregnancy has gone on. She's doing well. She's gonna come on and tell you all about it. I just remembered she likes being called Samantha but I don't feel like going back and editing it. So Samantha and good bye.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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#308 Psyco-glycemia

Cute kitten content

Sara's daughter Adelyn was diagnosed with Type 1 diabetes in South Korea while her husband was active duty military. 

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello, everybody, welcome to Episode 308 of the Juicebox Podcast. Today's show is sponsored by the dexcom g six continuous glucose monitor. And by the Omni pod tubeless insulin pump, you can find out more about the Omni pod at my Omni pod.com forward slash juice box. And that that link, you'll be able to order an absolutely free no obligation demonstration pod that will be sent directly to you. If you'd like to hear more about the Dexcom g six continuous glucose monitor, that link is dexcom.com forward slash juice box. All the links are in the show notes at Juicebox podcast.com. Just in case you can't remember them. I have tried to record this opening six times it has not gone right once so maybe me admitting that out loud will help the seventh chance. Sarah is on the show today to tell us about her daughter's diagnosis. The diagnosis happened in South Korea because the family lived there. Because Sarah's husband is active duty military. This is very interesting to hear about the diagnosis as it happened in South Korea, and how the family quickly got back to the United States. There's some twists and turns along the way and even a kitten. But none of that explains why this episode is called psycho glycemia. This weekend, I'm going to be in Atlanta speaking at the jdrf type one nation event. I think it's sold out I'm sorry. But however, I'm very excited to see those of you who are able to get tickets. Next thing I'm doing is in Wisconsin that still has tickets available. So I'll be in Wisconsin on March 26. It's a Thursday evening, I will be speaking from 5pm until 8:30pm. all about being bold within so I'm going to talk all about the tools, how to use them, get people going in a better direction. Hopefully, you go Arden state.com forward slash events to learn more. Please remember that even though most of this story happens in South Korea, nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.

Sara 2:23
My name is Sarah Beth, by trial and I am an active duty spouse My husband is in the army and our daughter adilyn. Who is seven has type one diabetes.

Scott Benner 2:41
Okay, you're about 15 other children. Is that correct?

Sara 2:45
No, I have a total of four daughter.

Scott Benner 2:49
Wow. Did So did you have triplets or two sets?

Sara 2:52
No, no, we actually had two canceled appointments.

Unknown Speaker 2:57
is how that happened.

Scott Benner 2:58
You just talking about free time that we're looking at here.

Unknown Speaker 3:03
Within town,

Unknown Speaker 3:04
that's what happened. Well, I have to tell you.

Scott Benner 3:08
I'm gonna join the military immediately if that's how this works. I've never been drawn to service until I realized that it creates a lonely woman that I can visit once.

Unknown Speaker 3:23
Pretty much that is accurate.

Scott Benner 3:25
Well don't tell the kids that make up something about you wanted to have kids and you really loved the first one and couldn't get enough you'll you'll find a way to get through it. You really, I you imagine that when they get much older Sarah and you're like, you know like a wizard and veteran of life and you're like in your 50s like, Why are there four of us? Like how your father wasn't home a lot. They're gonna have this horrified look on their face for a second. And then Thanksgiving dinner. We'll just go on as normal.

Unknown Speaker 3:53
I'm gonna traumatize them. Yeah,

Scott Benner 3:54
they're gonna picture you in that moment still do. And they're just gonna be like, Oh my god, do you think they still do? Oh, yeah. And you're gonna say why do you think it's a stovetop stuffing? I didn't have time for the

Unknown Speaker 4:08
Yeah. I have time for nothing.

Scott Benner 4:09
Well, Sarah, you're a player. I think that's what we've learned right off the bat and we're gonna get going. So you are stationed or your husband is stationed in South Korea when your daughter's diagnosed.

Sara 4:23
That is correct. We were actually all in South Korea, Korea.

Unknown Speaker 4:28
So when you

Sara 4:31
get orders to go to South Korea, you can do one of two things you can go what they call unaccompanied. And go by yourself. And that usually you are you are going to be there for a year. Or you can go accompanied and bring your family and Jeff and I chose to go as a family because he had actually just returned From a nine month rotation in Korea, so he was gone for nine months. He came home for about four months. And then we went back to Korea as a family.

Scott Benner 5:11
Now, sir, that's what he told you. He wanted you to all come along. So you could be together. He really just didn't want a fifth kid and he thought I can't afford five children. If I go to South Korea and come back a year from now, I know where this is going. Yes. You guys. Yes. Bringing bringing you in the children to South Korea was birth control and your anyway, so you said that's when you choose a deployment? It's with your family? Does that mean more time? Or?

Sara 5:41
Yes. So when you take your family, you pretty much committed to two years

Scott Benner 5:47
while you're over there, except moving cost?

Sara 5:50
Yes. So we went and we had spent a year and Jeff was offered another job, that would be a two year commitment. So in order to take that job, he had to actually extend and do a total of three years in Korea, which we were on board for. And we went with that we decided to come home over the summer after the first full year in Korea, just to visit family. And I didn't notice adilyn her symptoms at that time. But it was immediately after we returned to Korea to do that second year, that, you know, she started having all the basic symptoms.

Unknown Speaker 6:45
And they

Sara 6:47
I took her in to a doctor, and it's very hot, very humid in the summer in Korea, in fact, one of our friends when we first moved there, I said this is the hottest you will ever be and the coldest you will ever be at this duty station.

Scott Benner 7:06
Terrific.

Sara 7:07
Yeah. Right. So um, so it was summer, you know, as we were rounding out summer and ready to go back to school, and I noticed she was urinating a lot. She was losing some way to just all of the basic symptoms that you know, typically show up. So I took her into the doctor. And they thought it was just the, you know, the heat, the humidity was warm, she was drinking more, she would produce more urine. She was growing, she was getting taller, but she was losing weight. So they just thought, you know, push some more. Yeah, yeah, put puts put some more fat in her diet, stuff like that. Um, so then we were on the playground. And adilyn fell off the slide and busted her chin open and had to get some stitches. So we had to take her to a local hospital off post there. And they gave her a form of an antibiotic that she had the stitches. They gave her some antibiotics and injection of it. And she broke out in a rash. And this is right before she was diagnosed maybe two weeks. She, we took her in again, she's at this point. Now she's very frail. She's we're seeing bones where, you know, it's it's,

Scott Benner 8:34
Oh, my gosh,

Sara 8:35
it's significant what she's lost. And mashed up

Scott Benner 8:39
you right there at that at that juncture, when you're like looking at ribs and things like that. Are you saying to yourself, like are you and your husband speaking to each other and saying, look, there's something incredibly wrong with her. Oh, what's the love?

Unknown Speaker 8:53
Yes, I actually had brought up

Sara 8:55
diabetes three times at the doctor's and I know it's that I'm not faulting anyone, because I know, it's something that's often overlooked that, you know, we don't get it right the first time. So it just happened that all of these other things were going on at the same time. That That is why she was overlooked. Yeah. So she broke out in the rash. I took her back to the doctor, I said, you know, something's off. She's at this point not feeling well. And they thought it was the antibiotic, which was typically an antibiotic that they don't give to kids or don't mean he prescribed in the US often, because it is reactive. So they thought that that was part of this antibiotic that she had been given. And then they just said they thought that she had, you know, picked up a virus while she was in the hospital.

Scott Benner 9:55
So we kept being excuses for what you could see right in front of you, but that wasn't leading you to end Like in, like, what was the waiting? Like was was their expectation like, Oh, this is getting better because we've done this thing or this will get better because we've taken this step, or were you at that point just staring and thinking, we're not really doing anything and she's getting worse.

Unknown Speaker 10:14
Right. And so as

Sara 10:18
a couple weeks later, we run into Halloween. And you know, every kid is excited about Halloween. She adilyn did not at this point was so she just wasn't herself. She didn't even want to do the, you know, we lived in these towers, and there were three of them side by side. And multiple floors, like 1213 floors, depending on the building. So lots of apartments, tons of candy. And she ended up just doing our building. And then she went back in and laid on the couch. She didn't want to do the additional two buildings with the other girls and it's totally not like her. And so from Halloween on, she pretty much laid on that couch. She was very lethargic. I finally it was a Saturday morning, and I got up and I said to Jeff, I said I feel like I'm watching her die. Something's not right. And so I called the doctor and said she's very lethargic. And that was the key word that threw everybody off. And they were like, well, if she's lethargic, you have to take her to the hospital.

Unknown Speaker 11:26
So

Sara 11:27
at that time, the hospital on Camp Humphreys wasn't completed. So we had to go drive about 20 minutes up to an Air Force Base, and have her seen at that emergency room. So we took her in and they again in the hospital said they thought it was a virus. And finally, you know, I had stayed home with the other three girls and Jeff had scooped adilyn off the couch because she couldn't even at this point, she wasn't even coherent. She wasn't even doing basic functions like walking. So Jeff scooped her up, took her to the hospital drove her there. She was kind of in and out of consciousness and the car is what Jeff had told me. So he took her in and they just thought again, it was this virus. And I happen to for some reason. I got on my phone and I googled type one diabetes symptoms. And I sent Jeff an article. He reviewed it. And then while the doctor came in and was saying, you know, it's a virus, he said to them, can we please test her for diabetes. And they were hesitant. They said, You know, I don't think that's what this is, but we'll do it. And a few minutes. minutes later, they came back in the room and said you were right. She's a diabetic. So that's how her diagnosis happened. We were taken from the hospital. by ambulance, I had swapped, I had a friend come up and watch the girl so I could go to the emergency room to be with adilyn. And Jeff was going to come home and be with the kids. And I wrote in the ambulance up with her to into Seoul to Samsung hospital there. And that's where she was in the hospital for about a week. We were out of that. Er,

Scott Benner 13:23
so I have a number of questions about that first part. Okay. And it'll give you a chance to regroup. It's a it's a well told story. Thank you. How much of a language barrier is there at the hospital? Do you and your husband speak Korean? A little bit?

Sara 13:40
Just I mean, I could speak very I could I could get by at the market is basically what I do. I there is a language barrier. But Koreans are very good at English. They just don't. It's like any culture. You know, if we go to another country, if I go to France, I'm not going to even if I was fluent in French, I'm going to be hesitant to actually use it in conversation. So I think that was the piece because they everybody that I

Unknown Speaker 14:12
worked with.

Unknown Speaker 14:14
They would

Sara 14:16
you're assigned a translator. So I had someone that they would speak in Korean because I mean, that's their language of comfort and they the translator would translate it for me

Scott Benner 14:31
at work

Sara 14:33
no not at well. So at at work for Jeff, is that what you're asking?

Scott Benner 14:38
I just I got lost for a second there because you said you were assigned to translate or just in your regular life or

Unknown Speaker 14:44
no at the hospital

Scott Benner 14:45
in the hospital. I'm sorry. Yeah, there was just that one piece that I missed. So okay, all right. So no, no, please don't be sorry. So there's I'm sure it was my fault. You don't realize that while you're talking I'm also trying to formulate what we're gonna say next. Once in a while I drift away and I'm Like, Oh, you know what I'm going to ask about. And then I started thinking about this South Korean zombie movie that I really liked. And I was like, I wonder how I can work this into the conversation, which is meaningless. And then I missed a key key thing that you said there. Anyway, I apologize. So there's a, there's a translator at the hospital. And that though, that makes total sense, even though you feel like the hospital staff could have probably spoken to you.

Sara 15:23
They actually, there was a few moments where, you know, you're assigned a translator, and they come into the room when you have like education classes, or your team of doctors comes in, and there would be a few moments where maybe she was running behind. And they would speak to me in English. But I think they just weren't comfortable.

Scott Benner 15:41
Yeah, one thing either I would have met.

Unknown Speaker 15:43
Yeah,

Sara 15:44
yeah. So it was, they could do it. And they were very good at it. They're the team that I had. Would you know, after the meeting, they would say thank you, you know, for being so good about my English, they would always think that their English was poor. And it was, I mean, it was phenomenal. In my opinion. They would did very well, I could understand everything.

Scott Benner 16:08
I have to say, you know, in your note, you say that her eidolons Awan see at the time she was diagnosed with 17%. I'm fairly comfortable saying if you don't Google that article and push your husband, she probably doesn't make it if they send her out of that hospital again, telling her that it's that it's something else, especially with your description of her.

Sara 16:28
Yes, she I don't think she would have made it either. I really do think that it was something I don't know what it was about that moment where I just happen to pick up my phone and say, I really think we're missing something. And I asked about this. And it just was something that was you know, I remember we went on a trip around right before she was diagnosed, I took her to Everland which is kind of like a Korean Disney Land. And it was maybe maybe 40 minutes to an hour trip and adilyn we had to stop twice there and twice on the way home for her to use the restroom. She just couldn't. I mean, in 40 minutes, she had to go twice. It was just something he was frequently urinating. It was not something with off, you know,

Scott Benner 17:17
and not drinking that much.

Sara 17:19
No, I mean, he was he was definitely chugging water. But it was it was, you know it. There was just so many things that were off it and she had all of those key symptoms. And then when we started I mean, I could see her full pelvis by the time that we took her in. So it was like she is this is not right. This is not healthy. Something's wrong. Do you have a feeling for how much weight she lost during the time it took you to kind of figure this all out? When she was taken to Samsung. I think they weighed her in and she was under 40 pounds. She was about 3837 meaty. Right now she's well over 50. So she it was it was a lot of weight.

Scott Benner 18:01
Yeah. And you said and she was getting taller. So it probably even looked.

Sara 18:06
Yeah, it was not. It was not good. I mean, I even had it was to the point that I was taking pictures of her just to have it, you know? So I could compare how much Oh, I see. Yeah, of course, she was losing just the amount of bone that was coming through.

Scott Benner 18:23
I remember Arden gaining about two pounds in the first 24 hours. She was on insulin. Yeah, because she was in that scenario. So she's much younger. But you know, she only weighed 19 pounds prior to us. figuring it out. By the time we figured out she was like 17. And then she put the two pounds like as soon as it's like he injected the insulin in her and she just you know, the weight went back on her which was this really magical. Wow. But yeah, she looked like I said on the podcast recently, like our Arden looked like a, like a runway model with a heroin problem. Like she was really, he had gotten to that like gone. thing. And it is funny because as you were describing, and I thought I did all the same things you did, you're like, well, there's reasons for this. Like everything that happened, you were like, Oh, I can see why this would happen. Instead of just thinking, you know, this isn't normal. And let's go to a hospital and banging on the door until someone fixes it. Like, why would we leave? You know what I mean? Like why would I ever walk away until there was a actual answer found? But it's just the process. It's how it goes and you know, it really is. It shows you how what happens next to most people happens right and you're gonna talk about it after a while but like you know, you doctors don't tell you everything you go home It doesn't seem right. And you still just swallow. You know what I mean? You just swallow it you just like okay, sure, you know, I'll inject the insulin and then eat right away and now I see my blood sugar spike right up. Well, they said it's okay. I saw someone online say the other day like, my blood sugar goes to like 280 but then it comes back and the doctor says that's what it's supposed The dude and the right and the person saying, I don't feel like that's right. But how do I trust myself? You know what I mean? Like and how do you trust yourself during the diagnosis when you're like, hey, this really seems like diabetes like no, no, that's a virus. Yeah, you know, you just go Okay, fine, Iris. Thanks. And can you imagine and I don't want you to, but I guess you know, for the sake of the conversation. Imagine had you not followed your instincts there and your daughter passed away?

Unknown Speaker 20:29
Yeah. Although I think about it often.

Scott Benner 20:31
Yeah, absolutely. Your husband owes you huge. And seriously, I'm seriously one of the kids you're way ahead in the marriage right now. Whether you realize that you could probably screw like three major things up. I don't even think he could say anything. Look at it. I'm keeping score over here. So that's how I know but yeah, you're you're way ahead. Just so you know, you could probably stop cleaning. I'm gonna say for six months. You know if the cleaning something you do you want to cheat once I think you get away with it. What do you think of that?

Unknown Speaker 21:03
I like it.

Scott Benner 21:04
You rollback me like a Jeff. Remember the time I save the kid? We're gonna let this go.

Sara 21:09
probably throw that out every once in a while.

Scott Benner 21:13
could at least get you out of like some mundane task you don't want to do right? Like, why doesn't somebody who didn't save adilyn come over here and pick up these toys. Right. So I would roll? I really wouldn't. But it seems like so much fun to think about it that way to me, my brain gets a little off track. I I don't want to apologize for it, because I like how I am. But I was online the other day and someone said something to me. And I responded in a way that I thought was fun. And then someone came on and said like, Man, you're not right. And I was like No, it's funny, like, don't you? And then I looked at I was like yeah, I don't see anyone else answer things like this like this. There is something wrong with me. But in a delightful way. So who cares? Right? All right. Anyway, you. So you're at the Samsung Medical Center. All this is going on? How long? Did they keep you there? And by the way, is everything named Samsung in Korea. Okay, let's go to my omnipod.com forward slash juice box and find out what we see my Omni pod.com forward slash juice box? Well, I see that I can request a free experience kit at that very web address. So if you're using MDI, and you're thinking about pumping, or if you have a pump, and you're dreaming about what it might be like to be tubeless Oh, did you not know, the Omni pod has no tubing that you won't be connected to a wired controller something that you'll have to clip to your belt or your bra or hiding your pants? or disconnect disconnected to take a shower or go swimming or to play sports? Wait a minute, you didn't know that. Now you do. The next step is to get a demo sent to your house a free pot experience kit. They're just going to send it to you. Now don't worry, it's not functioning, right. It's a non functioning, but you can try it on and wear it. And I think you very well might learn what I did when I wore my free pot experience. Get it after it's on for a few minutes. You just don't notice it's there anymore. And next thing you know, you're going about your life. So whether or not you're a person living with Type One Diabetes, with a parent or caregiver of someone who does, you owe it to yourself to check out the Omni pod. It's my Omni pod.com forward slash juice box get the absolutely free pod experience kit sent to your house, there's no obligation, they're not gonna hound you if you try to just check it out. can't hurt. The Omni pod is one half of the irreplaceable technology that my daughter uses. You know what the other half is. In case you couldn't guess it was the Dexcom g six continuous glucose monitor. I'm going to kind of keep going here with my URL trend URL, the URL URL dexcom.com forward slash juicebox. Now when you get there, you're going to find out everything you need to know about the Dexcom g six continuous glucose monitor. I'll tell you a little bit about it. Zero finger sticks, glucose readings that are right on your smart device Android or Apple customizable alerts and alarms the ability to share your data with someone else that could mean your sister in Poughkeepsie, or coming your child across the street at a playdate. But someone with Type One Diabetes, who's wearing a Dexcom g six can share their data with a loved one or friend. I'm not even gonna edit that out. That's my daughter's right there. We have a customized alarm set at 120 means my daughter's blood sugar has just drifted above 120. We're going to take care of that right now with some insulin that will avoid a high blood sugar that later will require a ton of insulin that will probably cause a low blood sugar later. Now your results may vary. Right, these are hours. But the truth is, knowing the speed and direction of your blood sugar is at the core of how you make good decisions with insulin dexcom.com forward slash juice box or the links in your show notes, or Juicebox podcast.com. I cannot believe that thing beat right then, and I wove it into the ad. I'm a genius. Alright, let's get back to the show.

Sara 25:38
Yeah, well, and I shouldn't say everything. But Samsung has a very big influence. I mean, they have everything. Air Conditioners like anything. Samsung. So

Scott Benner 25:50
I love you. I'm looking at one right now to be perfect.

Sara 25:53
Yeah, so we were at Samsung for about a week.

Scott Benner 26:00
Yeah, I think it was just maybe just shy of a week. Do you think that's because of how far along she was? Or also because they don't see type one that often.

Sara 26:10
So from my understanding, they don't see type one that often. I don't know if it's genetics. I don't know. I again, this is something that I was told. I'm not sure how accurate that statement is. But I don't think that it's as predominant as it is in the US. So, you know, they kind of in the first week, it was

Unknown Speaker 26:34
it was a very

Sara 26:37
strong learning curve.

Unknown Speaker 26:41
they

Sara 26:42
first started talking about you know, I had tons of questions, obviously. And you know, you've even mentioned it on a few of the podcasts where you're almost in like a haze. So everything's being thrown at you all this information, then you have the language barrier, as well and the translator and it's, I felt like I was drowning, like I felt like I was underwater. And then the translator would speak and my head would pop up and I could kind of understand that I go back underwater while they were speaking. So it was it was very, it was hard for a while. But I finally think I got a grasp. And I felt comfortable going home, I guess. But while we were at the hospital, the doctor that I had seen at Humphreys before we had left. She was a pediatrician there. She actually personally called me. Now I don't know how she found out that we were at the hospital. I'm not sure if the emergency room reported that we you know, this was all going on. But she personally called me while we were at Samsung, and she talked to me for maybe an hour and said, I really feel like you should pursue going back to the States. And so it was with her it was really hurt because I hadn't even thought that far ahead at that point. You know, I was still trying to understand injections and finger pokes and all of that, you know basic stuff. Yeah. We were still trying to figure out her Tarceva and you know if she was on Nova rapid at that time, and so like all of those ratios and everything we were there was still a lot going on. So

it wasn't until I got back home that

she asked to see me in her office with adalind. She wanted an immediate follow up. And that's where all of the extra work. We're going back to the States. But I'm getting ahead of myself. I guess what I meant to say is while we were in the hospital, the the staff started talking about pumps, insulin pumps, CGM, things like that. And I know that

Unknown Speaker 29:06
the specs

Sara 29:08
on the equipment in Korea don't match us specs.

Unknown Speaker 29:12
So

Sara 29:14
it was also I think, an insurance issue. Maybe I'm not exactly sure. Because in the States, try care pays for the the supplies, but over there, everything is out of pocket. So I remember they showed me a CGM. That was huge. It looked like a an old pager almost. And they were like, Well, you could this is, you know, kind of explaining it to me and how it worked and we could get it.

Unknown Speaker 29:42
But it was

Sara 29:45
the day following my phone call with a pediatrician. I said, I don't know if we're going back to the states or not. And so they kind of said, Well, I would advise that you, you know, see what's going to happen and then come back if you're going To stay and get the the equipment versus buying it because they were the ones that told me it doesn't meet us standard so it won't operate there.

Scott Benner 30:09
And so when you're in the hospital still, and you described kind of drifting away, do you recall? Did you just go to a numb place? Where were you? overwhelmed? it? Was it like being in math class and not understanding? Was it like, were you? Were you daydreaming about this not happening? Were you thinking about worse things? Do you remember what happens in that space? You may not.

Sara 30:38
I do remember. Just I, I just kept thinking, Why her? Why adilyn? Why did this happen to us? So it was more of a you know, like, I really struggled with it. I remember I cried so much that adilyn I remember asking the nurse the first day that she came in and gave her an injection before she ate breakfast because they had her fast. So that they could, I guess, you know, do some testing, monitor her stuff like that. So by the next day, after we had, we went left to the ER went to Samsung that whole entire time overnight, they were fasting her and she just kept waking up and she was crying. She was so hungry. Finally, they sedated her so that they could give her some potassium. Because you know, that burns going in. So they tried to give it to her before we left the ER, but it just she was screaming in pain. So they sedated her and they gave her the potassium. And that helped her get through the night. But by the time the next morning came, she was starving. So they came in to give her her insulin. And I remember I just looked at the nurse and I was crying. And I said, so I have to do this to her for the rest of her life. And Adam and Adam looked at me and she was like, Mom, why are you crying? You know, she just I think she had seen me cry so much in that short time. That it was like, What is wrong with you?

Scott Benner 32:06
Like this lady? Oh, yeah, I need someone here and you got to really help me. I'm six and I'm hungry. And none of these people speak English. And I really would love someone here was on Alan's team, you know, they midnight here. I think it's a listen, I mean, it's an adage of parenting, right? Here's a line between how much do you show them? And how much do you Buck up and do what you're supposed to do. And I'm a fan of somewhere in the middle. I like my kids to know, I'm a real person. Without them feeling the stress and anxiety of the things that I worry about, you know, I think about, um, you know, bills or, or you know, how you're going to pay for college, that kind of stuff. And I want my son, for instance, to know that this, you know, the college he's going to, it's not easy for us to pay for. And at the same time, I don't want him getting up every morning and thinking, Oh, I better not screw this up. Because my parents are paying a lot of money. I want him somewhere in the middle. You know, I like that your daughter sees that you care about her. But you got to stop short of when she thinks Oh God, I gotta grab one of these other adults and see if they'll say this woman just lost it. She's probably, you know, I mean, my dad has gotten her pregnant so many times that he's probably tired, you know, and, and what are we gonna do? I listen, I cried during the, during the first kind of like, lesson from a nurse about counting carbs, and then figuring out how much insulin to use during the ratio, like I just fell apart. And my wife was like, Cognizant enough to send the nurse out of the room just to give him a minute. He appears not to understand seventh grade math, so let's get him out. You know, like, and, and I'm gonna need this here, because he's the guy that stays with the kids. You know, so she cleared the room out. She's like, what's wrong? I'm like, I'm gonna kill her. Like, I'm gonna make a mistake with this math and I'm just gonna kill her. And then what am I gonna do? How am I gonna turn to you and say, hey, look what I did. You know, we met each other when we were kids. And we have these two children in this house and everything was going great. And then she got diabetes, and then fast forward to me killing her. You know, like, I really, you don't keep you're a nice person. You don't keep score in your head. But I know for a fact if I kill one of my kids, my wife's bailing on me. Yeah, you know, aside of the part where I would really like Arden to stay alive. I you know, but I've always had that thought before diabetes, like even driving in the car with my son when he was little. I thought I cannot have an accident hurt this kid. She's just a girl. I married like, like, you know what I mean? Like when it comes down to picking if I kill him, she's gonna leave. Like, why would she not and I really To be honest, she pays a lot of the bills. So I was like, it really I only kept my son alive to get the electric bill paid is what I'm saying. That was my was my key focus of being a stay at home parent. I wish that you know,

Sara 34:50
anyway, I do remember leaving the hospital I basically I wagered with these with the staff like You know, they were first they were going to release us the night before. And traffic in to Seoul is horrific, like highway one. It's I think six lanes per side, maybe eight. I can't remember. But, you know, it's bumper to bumper traffic and especially rush hour. So I'm thinking, I'm going to have this kid in the car. And how do I feed her? How do I give her an injection on the way home? So I just basically said, Can I leave? Saturday? Morning?

Scott Benner 35:36
There's no one outside? Well, you know, I looked while we were talking the population of South Korea's 51 million people. Most of them are in Seoul. And per Emperor perspective, there are 320 9 million people in the US and South Korea, South Korea is you know, not seven times, you know, larger than the US it's, there's there's a lot of people jammed into a very tiny space. Mm hmm. Did you ever listen to the podcast while you were there?

Unknown Speaker 36:05
I did not actually.

Scott Benner 36:08
So you thought I was meeting the people who downloaded it from South Korea, but apparently Yeah, I'm sure I

Sara 36:14
know. But at the time, I didn't have a diabetic while we were over there. I mean, it was, by the time adilyn was diagnosed November 3, we left country, December 17. That is something that

does not typically happen.

Unknown Speaker 36:31
And that was

Sara 36:33
a lot to do with our doctor being on board. Jeff's chain of command being very supportive. And they would check on things for us. I mean, it was, we were getting pushed through the system very quickly, which is this is not typical.

Scott Benner 36:51
So when you get home, I'm assuming you you don't have a home in the US at that point, did you? You're not it's not like yours a house at home somewhere that you're renting or family members living you go to another base, is that correct? Um,

Sara 37:06
so before we left, they, Jeff was getting in contact with his branch manager. And they basically give you an assignment before you leave, you have to have a place to go, you know, where you're headed, and they were in you, when a child or anyone I guess I shouldn't just say a child, but when someone in your family, if your active duty service member

Unknown Speaker 37:31
has a some form

Sara 37:34
of disablement or disability or, you know, disease, you, you qualify for what's called efmp, which is an exceptional family member program. So adilyn is now an efmp qualified member of our family and so that basically, it's an identifier on Jeff's paper paperwork that says, you know, we can, because of that, we can only go to certain places now.

Unknown Speaker 38:09
So,

Sara 38:11
they, they basically give you options that has Cara for her, okay. So they gave him a list. And I had done a little bit of research. Before I had left. My good friend Kathy was helping me kind of see where we possibilities of places we could go and where care was. And I had in my mind that I wanted to come back to Fort Bragg. We were here before we left for Korea. And they offered us a couple of places. And I said to Jeff, you know, I would really like to get back to Fort Bragg because I had already I have a support system here. I had left friends I was familiar with the area. So I knew going into this newly diagnosed that I needed that. So he got with his branch manager and asked if there was anything available here, which is not like my husband at all. We usually go wherever the job is we're not very selective

Unknown Speaker 39:11
with that, so

Sara 39:14
he he basically asked, and they they assigned him here. So that's how we ended up back here. But when we left Korea, Jeff and I are both from Michigan so we had stored like his truck, things like that at our parents homes in Michigan. So we took a direct flight out of Seoul into Detroit picked up our belongings and then headed down to North Carolina.

Scott Benner 39:42
Wow, that's a lot all while not really understanding diabetes at this point and trying to correct Yeah, together. Yeah, I have a lot of a lot of feeling for you because I was not good at even getting in the car and going to like the grocery store without pre planning for like two hours before I would take art now. I'd be like getting your blood sugar in the Exactly. place where I thought it'll stay here we can get across, right? You don't mean like, if you would have told me to get in the car in in Detroit and drive to North Carolina, then like maybe in a couple of years,

Sara 40:11
I think you know, the car trip down with a lot easier than the 16 hour plane ride back. That was terrifying.

Scott Benner 40:19
This is a plane make you feel trapped. Like if something happens, we're stuck on

Sara 40:23
Oh, I was so worried. I remember when we went to Korea that someone on the plane had some sort of medical emergency and they, you know, got on the intercom and asked for any medical providers that they could come up to whatever row seat, whatever, you know. And so I just I kept thinking, what if that happens to us? Yeah, I have to be very aware of where my child is what row we're in what seat? We're in.

Scott Benner 40:48
You overthought all of that? Yeah. Because you really did overthink all because now you know, I mean, you would fly now and it wouldn't be such a big deal. Right?

Unknown Speaker 40:55
Right.

Scott Benner 40:55
Absolutely. Yeah. Back then, without the tools, it really Oh,

Sara 40:58
yeah. And I mean, I had like a year supply of insulin. I really did. I my pediatrician, before we left at Humphreys told me we you know, we had a follow up with Samsung about a month after diagnosis. So it was beginning of December. They wanted to see her back. So I think it maybe was like the first week of December, we were up there. And before we went the pediatrician said, make sure that they give you a three month supply of insulin before you get on the plane. Because you know, there will be a gap between your care that you know, stablishing a doctor or things like that. So I went and I asked for three months supply, but they handed me you know, the pens come in those boxes where there's multiple pins in a box, and they handed me like three or four boxes. And so I had tons of insulin, that I'm walking on a plane, I'm thinking how am I going to keep this cold? You know what happened, Willie, let me on the plane with this. I have all these needles in my bag. You know, it was just,

Unknown Speaker 42:01
it was a lot

Scott Benner 42:04
going on? Not a lot of questions. Yeah. I hear you. I really do. I I so you make it home. There's actually great episodes in the podcast that people who are like really world travelers with diabetes, and they talk about how, with a tiny bit of pre planning and just understanding things a little bit how easy it really is. It's not

Sara 42:23
much yeah. Now I could get back on the plane and I would feel completely comfortable.

Scott Benner 42:28
Yeah, yeah, no, it's, uh, I know how to. I think I could go anywhere at this point. Seriously, like, but But back then. Like I said, I couldn't leave the house. So she you get home in? Right? Well, even that I didn't realize just now that sucks. Like you. You had to come home like right before Christmas. So do you celebrate your and so you're like, isn't that interesting? The leap. I made them like you're in the army and you're from Michigan. You're Christian. And so I wish I could. I wish you could have watched the synopsis make connections in my head. I was like, Oh, it's comfortable to say. And now that I said out loud, it's less comfortable. But that is how my brain works. In case you're wondering, I just let go very quickly push it for kids. No. So it just like not that quick succession like that. Anyway. So you're rolling in stateside just a couple of days before Christmas. Now I have a tiny bit of experience, but this rush, because one year we build a house. And we bought this tiny little rancher and it was junk. And the plan was always to knock it over and started, you know, because the land was what we wanted. And rd gets diagnosed, you know, right is we're thinking of like doing the work. So no lie. We had a construction person. They're moving things around, like walls and support inside of our home to facilitate the next step of the process. Okay, and one of the things we had done to get ready for the construction was we had the front stairs to our house and the sidewalk completely taken out. And the dorm moved to another position. And then Arden was diagnosed for years. My children had to jump out the front door to go to school. Arden was diagnosed, and then everything stopped while diabetes, you know. So anyway, we finally get our house built many, many years later, Arden was diagnosed in 2006. And we built our house in 2012. So for six years, I was the person in town that didn't have a sidewalk out front door didn't line up with any sort of pathway and the pizza guy would just like roll through the front yard, you know, I mean, like it was all it was like it was horrible. And we built this house, but we couldn't afford to build it and to relocate. So it's a long story but we had gotten the money all the sudden out of nowhere for the construction that that money did not matter. clewd relocation, and we were screwed, we were going to have to skip it and not do it. I said to my wife on the Kelly, there is no way we are not building this house. And so one day I called her at work. And I said, this weekend, we're going to go and buy a huge travel trailer and park it in the backyard. And we're going to live in it during the construction because we can put $1,000 down on it, pay some small payment a month on it and sell it right away when we're finished with it. And there's a whole story of what it's like to live in a trailer with a dog and two children and diabetes for six months. But he didn't do it. Okay, we did it. Yeah. Except the construction that of course, you know, I know now always takes longer than you expect. And so we are the last six weeks in that trailer, it's freezing outside, and those things are not made for the weather. We have like electric heaters going like as a fire hazard. I'm sure you know, we'd get up in the morning, I could hear my wife getting that tiny little shower and she was like, ah, like in and out like two seconds or whatever is free everything right? But we'll move back into the house about 10 days before Christmas. And rush to try to make a real Christmas was like horrible. And I wonder if that happened to you? Did you get home like because I'm you're you seem like a really good mom, like did you get home get back into North Carolina? What's your next thought? I have to make a Christmas for these people like

Sara 46:23
so it's funny that you bring this up because I had planned, you know some of the girls gifts and things like that. And I actually ended up returning them all. And I started ordering things online and sending them to my mother in law's house. My my parents, what they call snowbirds. So they leave Michigan if they stay in Michigan for six months and live in Florida for six months, so they had already headed down to Florida. We actually have a travel trailer that we store at their house. So we had to go over there and pick up the travel trailer. But we ended up staying at Jeff's parents house and doing Christmas there. So she already had it set up. And you know, I'm blessed with an amazing mother in law. And so she did like she had, I think it sparked happiness that we were coming back. And she was going to have Christmas with all of us, you know, so it was a big thing. All of us were at my mother in law's for Christmas. So myself, Jeff, the girls, his sister Jamie, her husband, their children. So it was a big thing we did. They always have a family Christmas party. So we had to go to that. So it wasn't it was very felt very normal. But I was able to step into that. Now if I had to

Scott Benner 47:47
start from you know,

Sara 47:48
yeah, it would have been completely different.

Scott Benner 47:51
Yeah, well, she owes you two. I mean, four kids get what I mean, like at some point, she must even call Jeff at some point. But like, he cut that girl a break. Like, you know, you just you know, you kept plugging away. No, there's no pun in there at all. And you you know, I think she owes you is what I'm saying. Like seriously for kids. She's gonna listen to this. At some point, this woman really came through for you with the grandchild. Yeah,

Unknown Speaker 48:11
I think I think

Sara 48:12
she knew that it was something on my mind that it was I was trying to still make it normal. So she just she was willing to. And Carol goes overboard at Christmas. There's no, there's no way around it. So it was it was nice that she was already set up. And we were good. We were taken care of

Scott Benner 48:31
right. So eventually, then you end up back at Bragg where you're at now. Right? You're speaking to me from from there. And you I'm assuming settle into a life of managing diabetes. And how did you find it to be in the beginning?

Sara 48:46
So coming back, we have this funny little story that we came back to Fort Bragg again, because we came right back to the neighborhood we lived in before. And in fact, we rented a home and our neighbors to that home. Were actually at the time trying to sell the house we're in right now. And so they weren't the movement cycle had already come and gone and it was sitting empty. So I contacted them because we're friends and I said, No, Hannah, would you be willing to rent the home to us? And because she knew us. She was like Absolutely. Anything I can do to help you guys because I mean, again, we were friends. She understood what was going on. We were communicating from Korea at that point. Once we found out we were coming back to Fort Bragg so I we actually are living in the house next door to the house we rented before. So when we moved back, I would have to like you know, the girls were in a very family friendly community and lots of children, lots of outside play. So when they were like riding their bikes, for example, and the kids had used the bathroom they would like Jump off their bikes and run to the old house and Jeff and I would have to sit outside for like the first month and scream at them not.

Unknown Speaker 50:09
And they,

Sara 50:10
they would have to like it, the light bulb will go off and they'd be like, Oh, that's right. We live in this house now, and would come in. But we also with another reason why we chose to come back is my best friend actually lives across the street. And another peaceful piece to this is that they're starting to hear her cat right now. I'm not sure why she's yelling.

Scott Benner 50:35
But I genuinely thought one of your children had fallen in the note

Unknown Speaker 50:40
that the cat actually

Sara 50:42
Yes, it's adalind cat. We had to get a cat that was at ease. Like, you know, the moment of, Hey, I have diabetes. You're gonna sympathize with me and get me a cat, which I'm allergic to. She was able to pull that

Scott Benner 50:55
off at six.

Sara 50:56
Oh, yeah. Oh, yeah. I mean, while still in the hospital, Jeff came home with a cat. The kid

Scott Benner 51:02
right? I need a cat when she saw you guys crying?

Unknown Speaker 51:06
Uh, yeah, pretty much. how that went down. So yeah,

Scott Benner 51:10
anyone listening? 810 20 years from now don't marry this girl. She's got a plan. It I mean, she's like, Look, they look sad. She got her list. She's like, what's at the top of my six year old list?

Unknown Speaker 51:20
Ooh, Cat, cat.

Scott Benner 51:22
Mom's logic. Whatever.

Unknown Speaker 51:24
Doesn't matter.

Scott Benner 51:26
Wait a minute. Did you fly from Korea with a cat? You didn't write?

Sara 51:28
Oh, yes, I did. Also, yes. Oh, yeah. a kitten. And I mean, she was just a kitten. She would just, you know, was old enough to get her rabies shot and things like that. I mean, she screeched the entire way. We were those people. It was awful.

Scott Benner 51:45
Second, what's Jeff job in the military? Is he a test dummy? How did he come through with that? And

Sara 51:51
Jeff is an aviation officer. So he he flies

Scott Benner 51:56
sounds like he's got a heart made out of putting that kid said cat and he ran right? Oh, yeah. Well, it was more me. She had asked for it. And there was this like adoption. They it just all lined up the stars were all aligned. And we ended up with this cat. I put you back in that scenario right now the person you are today that kid goes I want a cat. You look right at it and go, I don't care. And then that's the next. Right

Sara 52:18
now. She can't pull that on me anymore. It was just that weak

Scott Benner 52:20
moment. She blew all of her currency on that cat. She doesn't realize cuz she's so little. But that was the overreach there. She doesn't know. Yeah, well, whatever. Good. Now she can live I swear I wish you guys could all like, my default is no. You like if my children are like, Hey, Dad, the house is on fire. Should we go outside to go? No. And then we think about it. I say everything I started. No. And if you get me to Yes, huge win for you. I would never my son said he was in school the other day. And some kid was like, Hey, we should just go do this. And my my kids, like my dad won't pay for that. And and he's like, just you know, you have a card. Like, let's just do it. Like he's got like his, you know, his bank card. And my son was like, Oh my god, no. Like, he'll drive up here and take me out of school over over $50 you have no idea. Like, I can't do that. And I was like, proud. I was like, that's right. When Arden goes clothes shopping, she picks out three outfits. And as she's heading to the register, she stops and puts one back. Am I Oh, my wife goes. I feel bad. Like you've made her feel bad about money. I'm like, I see that exactly. The opposite is you but okay. Yeah, I see that as shit her being careful with what she's spending anyway. Yeah, your kid wouldn't I got a cat. If she was my daughter. I would have actually laughed at her. I would have like pulled people into the room but like, Hey, guys, Everybody listen to this story. My daughter thinks just because she has diabetes. Oh my God, that's delightful. You're a pushover. I like you. Okay. So we're home. And and and we you know,

Sara 53:53
we moved in next door to or across the street from my best friend who they actually have their nephew is a type one diabetic. So it was it was it was a relief for me because they were aware already how to you know, manage Addy in a sense, you know that they they understood it most people don't understand and you know, on the on that on the level that you need them to.

So yeah, it was it was extremely

it wasn't as difficult as what I thought it was going to be.

Scott Benner 54:28
And and you using a meter or pens or palm the CGM. What did you settle into when you got?

Sara 54:34
Yeah, so I had, she was using a meter. She's getting finger pokes. And I mean, it was to the point that I was so nervous with everything that was going on. I mean, just in that one month time span of, you know, we're in another country. We're getting on a plane. We're taking this huge car trip like we're moving to your house. So it felt like I was I was testing her probably every two hours, her poor little fingertips were just right.

Unknown Speaker 54:59
All.

Sara 55:01
By the time that we ended up getting a CGM, we came to North Carolina and on pote, you usually go on post to be seen for your health care, but they were over strength. So they refer you off post when you can see a medical provider that takes accepts try care. So I found a really reputable pediatrician, and then had to go in to get a referral for a pediatric endocrinologist. So they, at first, thankfully, our pediatrician, she, her best friend's daughter is a type one. So she's also aware at this point. So that was super helpful. And she had come to, you know, in the first meeting with her, and, you know, evaluating adilyn was saying, you know, I think you should go to UNC, which we had gone to UNC before, when we were stationed here for my second daughter, Kenzie needed to go to some specialty care up there. And I knew it was quite a drive, you know, about an hour, hour and a half to the main campus. So I you know, at this point, now, I'm like, Well, I don't want to be that far away from the doctor. So I said to her, you know, like I said, earlier, I had done minimal research on whether there was care here for add on or not. So I knew that there was a doctor here in the immediate, like Fayetteville area. So I said, Can I see the doctor at Cape Fear? And she, you know, was kind of like, yeah, sure, you know, but I, she did say, I want you to know, that if anything happens to adilyn, and you have to take her to the hospital, I want you to go direct to UNC, if possible. So I said, Okay, and flash forward, I go to adalind first visit here at Cape Fear for the endocrinologist and the doctor, the doctor was fine. It's just she's the only doctor in our area. She's the only pediatric endocrinologist for all of the

Unknown Speaker 57:20
Fayetteville area

Scott Benner 57:22
kids in every person that needs her. Yeah.

Sara 57:24
So I mean, she was I remember the first visit, she was very, very helpful in getting us a CGM. She said, you need this. And, you know, I come in and saying, Can I have it? I, you know, I'm finger poking her every two hours, because I'm uncomfortable. And she said, you know, you need it. So she got us that very quickly, but I do remember, you know, obviously, it's all new and uncomfortable. And, you know, I didn't understand it. And she said, if there's a video to how to put it on how to, you can watch the video, if you have any problems. She kind of I don't want to paint her in a poor light. But she said, I'm just too busy. You're not going to be able to come in here and see me if you have any problems with it. I can't make time for that.

Scott Benner 58:12
Figure it out.

Sara 58:13
And yeah, and so I I just remember standing there like, okay, and she had adalind ha once he had by the time from diagnosis, she was 17%. The month later, when we went back at the follow up in Korea, she was like nine something. And then we got back to Fort Bragg Sorry, I'm like losing my mind. We got back to Fort Bragg and that first visit her ha once he was like, 8% Okay. And so she was she was declining, and that was great. But I had in my mind, you know, we were Jeff. Jeff is very research based. So he was watching some like, like YouTube channel on diabetes, and like how they were doing it. And, you know, so I was aware of what a

quote unquote good ha one C was.

And I'm a perfectionist, so I was like, we're gonna get her there. I want her to be in a really good range. So I remember I walked into that first appointment, and I was expecting everything to get changed. I just thought

Scott Benner 59:21
I knew what that's not five and a half. So let's make some adjustments now.

Sara 59:26
Right and and I was saying, you know, there were so many times where I mean, I was finger poking her so I didn't get the the graphs. I didn't get the arrows, the number like you get with her Dexcom now, but I knew well enough that I was like, Why is she going up to 300 every time she eats and you're telling me that you want her in this tighter range. And, you know, when we left Korea to be on the safe side, they told me don't ever let her you know go under. I can't remember what number they said. But they were basically telling me the 200 Mark was it Good target, right keeper around 150 200. That's great. And then when I went into this appointment, I just knew something was off. Because, again, we're already my husband's watching all this stuff on how to figure out addys disease. And I'm seeing all this, you know, all these other success stories, and I'm like, Okay, so this isn't right, something's off. And I expected her to help me change it. But she kind of just said, You're doing great. I'm not changing anything. See you in three months. And I remember I walked out and I was like, this doesn't feel right. Something is you know, I know she can do better. And I am still not comfortable. So we get to CGM, and I ended up. I was doing I was on Facebook or something. I was on a page. And your podcast was suggested. And so I just decided, you know, I'd never listened to podcasts before. So I was like, Alright, I'll give it a whirl. And so listening to some of the stories that you had featured on the podcast, it's where you started talking about Pre-Bolus. I had never even been told to Pre-Bolus just that, in and of itself was brought down catalanes stuff I kept could keep her in a better range. She wasn't spiking to 300 with her food. You know, it was I was told give her the insulin Letteri. And then she'll come back down, like you had mentioned earlier. And I knew it wasn't right. So I finally called our pediatrician back and said, Hey, can you can I go to UNC? I'll, I'll do that. I'm going to I need to make a change. I don't, this isn't a good fit for us.

Scott Benner 1:01:42
So worth the ride.

Sara 1:01:44
Right. And so she gave us the referral. And now we're at UNC. And between the information I've received from the podcast, and the doctor, the team of doctors, she's doing really, really well.

Scott Benner 1:01:57
Great. What is well, where were you? Where have you gotten to? Are you? Okay?

Sara 1:02:02
Um, so her next appointment is in October 2, but the last appointment her a one C was 5.7.

Unknown Speaker 1:02:11
License. You did it? Yeah, I did it. Yeah.

Sara 1:02:14
I mean, it. I don't know if I could do it without the CGM. And I don't know if I could do it if I would have stayed where I was. and accepted. Okay, I'm not doing anything wrong. I don't. We're not gonna make any changes. Everything's great. Yeah.

Scott Benner 1:02:27
Yeah. They said it was okay. So it's okay. You just have to trust yourself at some point. I mean, honestly, you retold you know, you basically told me a story about seeing how sick your daughter was, and pushing through and getting them to test her for diabetes. And then you saw that what you thought, you know, what they were telling you was right about her care. didn't look right, you push through. And, you know, that worked out as well. So I say trust your gut. I say it all the time. Actually. It's a big part of this. Is that, you know, is that idea that when you see something that doesn't make sense, you should say something you should do something can't just stand still and go. This doesn't seem right. I hope this doesn't hit me. Oh, look, it hit me. I can't believe that, you know, like, it's just yeah, gotta move, you got to do something. And you did it. That's really cool. I mean, I'm really, it's very encouraging for me to hear you say that. Because, you know, I get everyone's notes and letters, and, you know, messages and people are in different variations of this process. And at any point along the line, if you give up you'll get stuck right where you are, and then eventually you'll drift backwards. So you have to push through till you get to the point where it's just like, it's easy now. And and, of course, I don't mean easy, like, easy. I just mean, like, it's, it's old hat like you do this thing and you get the blood sugar you expect. Like that, that kind of stuff. And when it goes wrong, you know, troubleshoot it, and and you figure it out.

Sara 1:03:57
That's Oh, yeah. I mean, Jeff even listens to the podcast now. And it was just the other day with Addy going back to school now we've had to make some changes because her summer, you know, routine is different than her school routine. So our numbers that have needed to be tweaked a little bit, and I would, you know, I'm basically talking out loud to myself, I mean, I'm sure you know what I'm talking about where you're, you know, you're looking at the PDM I'm like, Alright, I know I need to change that. And I'm, you know, I'm, blah, blah, blah to myself, and just, like, just change it. You know, he's like, just like what Scott says on the podcast, like, don't wait, do it now.

Scott Benner 1:04:37
That Okay, that's great. And it makes me feel bad about considering calling this episode, Jeff bought a Korean kitten. So very, very close to that. I've made notes. And it's a it's a it's a contender, just so you know. I just keep thinking you like it's such a wonderful image of, you know, parents Love or that feeling guys have I don't know if women completely understand, like, when you guys look upset, we scramble in our brains, you know what I mean? Like, we're like, oh, how do we fix this? And I know everyone says that it's like it. But it's not just, it's not just guys ignoring the world and being like, I'll just say something, I'll make this better. You have an internal feeling like this woman that I really love is upset, and I need to fix it. And I'm imagining that there had to have been some common sense in while he was standing there with that kit and thinking, I really shouldn't do this, but that he just was overwhelmed by how much he cared about you guys. And he shows,

Sara 1:05:36
it didn't help that he had the other three with him when he adapted it, either. You know, it's like,

Scott Benner 1:05:42
it's really unfair.

Sara 1:05:44
I'm sure the feeling of this, I should not be doing this right now was going through like his mind. But of course, all three of the other children are there going. Oh, dad?

Scott Benner 1:05:56
Yeah, you guys, you're very, you're much too nice. The size of you very nice. I don't even know. There's almost nothing I think my children could say to put me in that situation. Right? Like, yeah, you're right. It's good. I just, I don't have that in me at all. I have another places not there. I defend my happiness first, does he know you're allergic to kittens when he buys this kitten? Or is that something you found out afterwards?

Sara 1:06:18
Um, no, we we knew. But I, I don't know what we were thinking. We should just get off the subject. No,

Scott Benner 1:06:26
no, this whole episode to me is about buying that kit. And just so you know.

Sara 1:06:31
Yeah, we were in a very, very bad.

Scott Benner 1:06:34
No, no, I, you know, and I highlighted a little bit to kind of, listen, I highlighted it a little bit because I want medical professionals to hear your story. And recognize that when they're standing in front of you, in a in a classroom, or in a hospital room and trying to explain this whole new world to you. And you're standing there stoically, and you're listening, the doctors, like, Oh, they got it. They didn't get it. They're, they're doing stupid things they shouldn't be doing. They can't think they're quietly in their head wondering why did this happen like that? You know, and then you send them out the door. And you act surprised that they didn't, like, you know, pick up more of it. And I'm not saying that you can stop people from being upset in a scenario like that. But you can recognize that it's happening, and spend a little more human time with them, to get them somewhere. That's what this podcast does. And I have I'm a little like, lit up about it right now. Because I see somebody I know who has some sway in this community. And they're partnering with a government agency to talk about how to talk about this with duly diagnosed people, like how do you get the people and get them the right information. And I'm seeing people talk to them. And it's all the same bowl over and over again, like the stuff I've been hearing for 20 years, like, here's what's important, this is important. That's what's important. I'm telling you right now, that what's important, is solid information. That's easy to understand, that you can put into practice immediately and see results so that you can build on it. It's not, it's not all of the stuff, you know, it's not the damn Pink Panther book. Like that's, that's not what's going to help anybody. I, it was seriously like, I don't know how many people have to listen to this podcast and have your experience before someone in the medical community hears it and says, Hey, you know what, we should probably just tell them what they need to know, in a way they can understand. And, you know,

Sara 1:08:31
I think it was helpful to that, you know, on many of the episodes, you've talked about just doing it on your own, I think I had to get comfortable with that and say,

Scott Benner 1:08:41
okay, yes, I have medical care if something were to ever happen, I feel comfortable taking her to the emergency room and letting them handle it that point because I'm not familiar with that. But the day to day, I don't really contact her team, ever. I just make the changes on my own. I don't, and doctors will say it to you, Hey, you know, some Well, some good doctors will say, Look, you're gonna have to get comfortable and make adjustments. But that's a different scenario, you standing in a in a cold room with a doctor aside, you know, saying, you know, this is on you, that feels different than hearing me say it. And so you need a person, you know, in my situation, speaking directly to other people so that they can be comfortable, they can see themselves in it. You know what I mean? And not, and not just feel like a guy just told me to do something, there's no way I can do because it's what it sounds like when a doctor tells you and then you I mean, I, I don't want to downplay what I'm doing here, but like, you know, you come on and you're like, you're listening to this regular guy here. And you know, and he's, he's doing it. If he I genuinely believe that people listening should think if this guy's doing it, I could do it. You know, because they're just there's nothing particularly special about me and I, I do it by not being scared by being the person who would have said no to Three crying girls about a kitten just by just by kind of standing up and having a backbone and saying, I'm not gonna put up with this. I don't know the answer, but I'll figure it out. And so now all the things that you guys hear now on the podcast that seemed like, I don't, I don't know how to put it, but like, they seem like staples in the community, at least for those of you listening, these ideas, just remember that they all started with me thinking, I'm not going to let this happen. And now and now I'm going to figure out how to stop it. And no direction whatsoever. Because I was not smart enough to Google anything. I don't listen to the doctor, I very much got in my own head and broke this all apart, which is now I think, why I understand it well enough to explain it easily. But but you can do that too. Like you can I hate to say think outside of the box, because that just sounds, you know, trite, but like there's a way to reverse engineer problems. And to remember that your first inclination comes from your fear, like, you know what you mean, like, the first thing you think is like defense, like, Oh, I want to make sure this doesn't happen. I want to make sure this doesn't happen. I flipped it around. And I thought, I want to make sure that this happens. You know, like, forget being scared, I want to be bold. I want to figure it out. And that's why I now talk in T shirt slogans on a podcast. I'm glad helps people. But I really think that you know, better direction better tools. easy to understand, repetitiveness. You can't let that go. Like, you know, when people always want to ask me like, which podcasts will tell me exactly how to do this. And I tell them, Look, I know there's a lot of episodes, but just listen to all of them. Because eventually something will come up that will stick to you. And I can't know. You know, I can't know what Sarah Beth we're here to make her feel good. versus what Jeff will hear versus what the rest of you listening will hear. Like, you all need to hear something different. So I had to keep prattling on until I cover all of you. Like that is sort of how it makes me feel when I'm recording it. Like it's why I like having free flowing conversations because they don't lead me to say the same thing over and over again. And I'm just really thrilled that this worked out so well for you. And how old is she now? Tell me a little bit about what's going on with her life? And then I'll let you get back to yours.

Sara 1:12:16
Oh, she's seven. She she's doing really well. I hope that it should we continue to see results. She just actually in July, she ended up going on the Omni pod. And so we've been fooling with that learning that system, which was a relief for me. I had mastered MDI, I would like to say I shouldn't say I had mastered it. I like to think that I mastered it I had done we were doing really well. I mean, she got those a one see results without that was on MDI that was not with a pump.

Unknown Speaker 1:12:50
Yeah. So

Sara 1:12:54
now that she has that, you know, I remember there was a time where she didn't want the the injections, she would do it breakfast, lunch and dinner. And then she do a lot of, you know, cheese sticks for snacks, or you know, something very low carb. So because she didn't want the shot. And she had said to me one day, she just broke my heart because she wanted something and I said you can have that. You just have to, you know, she started out by saying you don't let me eat

Unknown Speaker 1:13:21
anything.

Sara 1:13:23
And I just hurt so bad because she could have it. She just didn't want the shot that went along with it. So we finally I went into the doctor and said, I really would like to get her on a pump. Because this is now what I'm struggling with she she realizes she recognizes what's going on and doesn't want it. So and I don't want it to you know, become this, this piece for her. I want her to be normal. So

Scott Benner 1:13:53
I, I try to remind people that you know, you don't want an eating disorder and type one diabetes, and you don't want to create that kind of an adversarial relationship with food. And that's exactly what that is when she starts saying I'd rather not eat. If I have to do this, then you got to find another way. You know, right away. That's also what helped me believe it, believe it or not, that's what you know, when I talked about doing like over bolusing a meal that you can't Pre-Bolus for. I started figuring that out when artists had something similar one day when I she's like, Hey, I'm hungry. I was a great just, you know, let's bolus this much and like 10 minutes from now you can eat it and then she said never mind. Oh, and I was like, okay, she doesn't even want to wait the 10 minutes not not in this moment. She's okay with it Other times, but in this moment, she doesn't want to so instead of pushing. I just thought well how do I stop this from being a problem? And you know, then I just I just started did that math about putting in too much insulin to cover not just the food but the spike that's gonna try to happen and the numbers. Like I just sort of extrapolated out I did all that I was like, Well, I think about Did this much right here? And she eats, maybe the spikes still won't happen. When that happened. I was like, oh, wow, look, I got around another problem, you know, and kept her from feeling like she couldn't say that she was hungry. So I love that you did that. Good for you. You were terrific. You really are. And we went way over time. So I'm sorry about that.

Unknown Speaker 1:15:20
Oh, that's okay.

Scott Benner 1:15:22
Did you end up being nervous the whole way through?

Unknown Speaker 1:15:25
Oh,

Sara 1:15:26
no, I would say like, really, it was a lot to do with the podcast like it was other people's stories. having that connection, knowing that it was possible, and then be able there was I can't remember exactly which one. But there were. I mean, you've said it multiple times. But the focusing on being afraid of insulin, I there was a point where I was afraid. But you know, it's funny, because I talk to adilyn providers now. And it's, I have the opposite. I saw what happens to a kid with super high blood sugar, right? I see the effects of that. And that scares me more than the low. You know, so often, people are scared of their children going low. I've even seen people treat blood sugars that are like 8090. Because they're like, Oh, that's, that's too low. But not that that's wrong. I don't want to make it seem like that. That's what they're comfortable with. But I'm not. So it's kind of like I if I see, you know, anything above like 150 adilyn. Her whole persona changes. You know, we we jokingly sometimes I shouldn't probably say this, but we say that she turns psycho glycaemic. She's she just becomes this raging person when she's high, and it's harder to get through to her. So I mean, it's, it's stressful to see the numbers. And then it's also stressful to deal with the type of you know, her personality that evolves from this high blood sugar. So I hate high numbers. I mean, I would rather deal with a low and give her a juice box or, you know, a suite of some sort than

Scott Benner 1:17:15
and have the high so Beth

not only am I glad you shared that with people, but you just save Jeff on the cat title. Because psycho glycaemic is probably going to be the title of this episode. You really pulled his butt out of the fire, right? And then ninth hour, look at you. Excellent. 11th hour Excuse me, I forgot the saying, but you really came through unless you don't want that.

Unknown Speaker 1:17:38
Oh, I don't care what your title let you do your own thing.

Scott Benner 1:17:41
I got another note. The other day someone's like I needed an episode on this. It would be helpful if the titles had something to do with the content. I was like, too bad. Just listen to them. You'll figure it out. No, seriously, thank you so much for doing this. I really appreciate it.

Unknown Speaker 1:17:56
It was my pleasure.

Scott Benner 1:17:59
Thanks so much to Sarah for coming on and sharing her story. And thank you Dexcom and Omni pod for sponsoring this episode, please check out those links dexcom.com forward slash juice box and my Omni pod.com forward slash juice box in mere moments. I mean, it'll probably take longer than moments. But in no time at all, let's say you could be wearing the world class Dexcom, ci, six continuous glucose monitor, and the amazing tubeless insulin pump called Omni pod. Just have to get started. You're looking for results like you're hearing about from people. These are some of the tools that some of those people are using. You could be some of those people too. last little thing before I go. Like I said, I'm speaking in Atlanta this week, and it's on February 29. For those of you who snag tickets, I can't wait to meet you please come up and say hello. And for those of you who didn't get tickets in time. I know you're not used to a type one nation event selling out but you're bringing Scott down there. Yeah, Jenny Smith. These tickets are not going to last. Anyway, I hope to see you. If you're in Wisconsin, I will be there Thursday, March 26. From 5pm to 8:30pm. Doing a three and a half hour talk. It's going to be a talk followed by q&a. I'm flying all the way to Wisconsin, I want that room nice and full. Okay. These uh, you can find these links at Arden state.com for slash events. After that, I'm taking a little break to watch my son play some baseball. I'll be back at it on Saturday, May 30, at the touched by type one event in Orlando, Florida. And then I've got something coming up in August at the jdrf type one nation event in Virginia. I'll be in Richmond, that Saturday, August 22. I think there's a couple of other things that are going to get put on the calendar between now and then but for now. That's all All I have booked and trust me. I'm getting tired of flying places. So please come see me before I I'm too old for this. I just I got sick The last time I flew. There was a kid in the back of the plane. I sat down I heard it right away. Like that's it. I'm dead. Sure enough, lost my voice. You heard it in the last episode, right where I'm doing the promos and my ha I couldn't even get like my words out. Terrible. I'm better now. Thank God. I'm going to Atlanta in five days to speak for four hours. And two days ago, I couldn't speak on the telephone. So I've been resting my voice, which is probably something you can imagine and something my family seemed kind of happy about. They were like snickering at me with a doctor said I had to rest my voice if I was going to make it to Atlanta, but I will be there. Will you? I'll be back at the end of the week with some technology news. I think you're going to enjoy hearing about

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#307 Diabetes Pro Tip: Emergency Room Protocols

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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

Scott Benner 0:00
Hello, everyone, and welcome to Episode 307 of the Juicebox Podcast. Today's episode is another in the diabetes pro tip series. Today's topic, emergency room protocols. This is a really great and complete conversation about how to handle trips to the hospital. And my voice is a little broken up right now you may have just heard it. So especially when you get to the ads in the middle, you'll have you know, I'm not quite like, but it's getting there. So I'm doing as little speaking as like Ken today. That said today's episode of The Juicebox Podcast is sponsored by Omni pod and Dexcom you can get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to your home by going to my Omni pod.com Ford slash juice box. And to learn more about the Dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com Ford slash juice box now there are links in the show notes of your podcast player and at Juicebox podcast.com. For all of the sponsors, check them out. So today Jenny Smith and I are going to be talking about going to the hospital with Type One Diabetes. Jennifer Smith is not only a good friend to the Juicebox Podcast, but she is also a person who's been living with Type One Diabetes for over 30 years. So she has first hand knowledge of day to day events that affect management. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She is also my partner in these diabetes pro tips. You can check her out at integrated diabetes.com you can actually hire Jenny, she'll help you through your process. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. or becoming bold with insulin.

So Jenny, this whole time we're going to talk today, I think we're gonna just talk about this one.

Unknown Speaker 2:27
email that I got.

Jennifer Smith, CDE 2:28
Yeah. Which was great. And I think I mean, we've touched on some of these points in like some of the I know, we did like up a safety in a hospital preparedness and all of that kind of stuff. But I think this hits a really specific mark of most people that go to an emergency room in a very emergent setting. They don't really know, and why would they know that the staff there is not prepared to deal with Type One Diabetes, they're not and they're not in. I don't say that in a like a god, they're not educated they are they're highly educated, they're educated in a million different things, right. But their focus is so much not type one. And because the scope of how we manage type one, especially in the past 10 years, has changed so dramatically. They the staff, they can't keep up with that they they don't they don't have time to keep up with that. So when you come in, you know, on these fancy gadgets and all these things, and they're like, Well, I know an insulin drip and I know how to, to hook you up to glucose and that's what we're gonna do. Like and you step back and you're like, No, no, no, no, I do this,

Scott Benner 3:49
you could you come to realize what they really understand is just how to keep you from having a low blood sugar incident while you're there. That's what I know how to do. So you may or may not be surprised by the number of emails I get yearly from nurses and doctors who have children who are diagnosed or sometimes who have themselves diagnosed. And inevitably, there are three sentences or three sentences in their email that describe I'm a good nurse. I'm a good doctor. I don't understand Type One Diabetes at all, every time. It's Yeah, you know,

Jennifer Smith, CDE 4:26
I'm working with a family right now. The the father is a physician and the mother is a nurse practitioner and their little child they I mean, they came to us and they were like, We know diabetes, but we don't know diabetes. You know, I mean, we know the coded book description of this is what you do, and that should be cut and dry and playing the limit. Not cut and dry. There is no book anything nuanced just a bit, right. Right. Right. So I don't

Scott Benner 4:59
I think misty would mind her name being used, Misty came into the private Facebook group that we have for the podcast. And she shared that, you know, her child had to go to the hospital. And then she had all of these questions afterwards, and statements and things like that. And when it ended, she said, I would love it if you and Jenny talked about this stuff. And I said, Okay, you go ahead and put a list together of what you think of, you know, as emergent that came from this experience. And Jenny, and I'll try to talk about it. And she really did. So misty, congratulations, this, you are the founder of this feast today. So

Jennifer Smith, CDE 5:38
yeah, and she did not I mean, from the topics that she noted, would be helpful to cover and everything. I mean, quite honestly, it kind of speaks to the amount of medical education you get, yes, it's only in one field. But the amount of medical stuff you learn, when you become either the person with diabetes, or the caretaker for someone with diabetes, I what she has here is very much in a very, very specific way really important, and should quite honestly be like taken to the emergency department heads. And this is what your Doc's should have a list of protocol to follow up. So

Scott Benner 6:19
that's what we're gonna say the real question becomes, excuse me. The real question becomes, what happens in an emergency situation in a medical situation, when you are the most knowledgeable person in the room and have the least power? Right, apparently to you in the moment, right? Doctors, lab coats, people bubbling around, you're not a doctor. But it turns out, you do have power, you just need to know how to assert it.

Jennifer Smith, CDE 6:46
How to wield it exactly. So

Scott Benner 6:47
let me read a little bit here. This, this emails, not miss these initial post in the in the Facebook page. This is the email she sent to me. And so she said, Hey, thanks for considering making this up. Thanks for considering making an episode about emergency care. Going through the sickness with my son, which was the first time he had had a stomach bug since diagnosis almost a year ago, made me start thinking about how to figure out what else I don't know. In this instance, probably the three biggest mistakes made the ER ended up being the doctor turning off his bazel they didn't hang dextrose and refused them an absolute refusal to call an endocrinologist. And she said, I knew that these things weren't right. But by doubting herself and assuming that the doctor must know better than she did. You know, she had no idea in the end, how to make him do those things that she knew needed to be done. And she should have been more assertive, she says and sooner. Mm hmm. So she put she just puts a bulleted list here. That's terrific. I and I think we did go down the list. Right?

Jennifer Smith, CDE 7:55
Absolutely. Because it's it's a great list. And I think some of the points can actually even be kind of melded together in a way. But I it is, it's a very well put together list. It's actually In fact, many of the things on here, when we talk to people, the people that we work with in our practice, and we give them our information about prepping for a hospital stay, we have not only a hospital stay or expecting like for a planned surgery, but we also have a lot of these things covered so that you do know how to advocate for yourself, because that's really what it becomes. When you go to the emergency room. Unless you are the person with diabetes, and you're completely out. Well, you know what? They're gonna do what they can do to save your life. And you have no control there then. But

Scott Benner 8:44
yeah, and maybe you can get into a situation where you don't end up like you've heard people in the past talk about in the podcast, where they have family members sneaking them in insulin, and they're like, you know, like, wouldn't it be nice if that's not how this went? Right? It would be lovely for your, you know, your medical doctors to know about the insulin your body. So Right, right. I have a couple of experiences that I'll I'll interject if they fit, and I know you're going to have some. So first question was, how do I know when it's time to go to the hospital or even at least to call the endo? When it's a specific type one problem, I guess around illness? When do you tell people to call?

Jennifer Smith, CDE 9:23
Yeah, I mean, we usually tell people to call at least to call their endo or I guess even a step before that is make sure that you've addressed with your endo a 24 hour emergent line to be able to contact somebody at because I guarantee that your specific endo isn't going to be there at two o'clock in the morning, everything every time something happens, right. So the step ahead of that is knowing who to call, what's the number who will I actually talked to you? Is it just going to be a nurse triage or is it really that I'm going to get to talk to somebody that's going to give me some information without playing phone tag writing

Scott Benner 9:58
services still exist to you might just be They do person taking a message,

Jennifer Smith, CDE 10:01
right? Correct. I mean, most systems, most healthcare systems do have 24 hour nursing care within your, like, you know, whatever your insurance coverage or whatever system you're in, right? And that nurse should also be the one who can help determine what are your symptoms? What's going on? Or what what's happening with your child? Is this emergent enough? I'm going to call the doctor on call, and we're going to get some answers for you or no, you need to go to the emergency room there. I mean, we've used it a couple of times for for our boys when they have been like, sick fever, like, you know, rolling around, not feeling great. I'm like, Okay, let's call the nurse and see if it's time to go to the doctor, you know, um, but so they're, from our experience, they've been very, very helpful and good. So that's a first step, if it's daytime, certainly try to call your endo office get in a very emergent message that, hey, this is what's going on and have some very good facts to give them, you know, we've checked blood sugar, we've given insulin, we've checked ketones, you know, my child won't take any fluids, or my child can't stop vomiting, or those are very, very important things to be able to give facts, so they know what to do with you.

Scott Benner 11:15
I also think that it's important not to get caught up in the emotion of it, telling stories and like, they need the facts. They don't need the extra stuff. My mother in law was over. And yeah, let that go. That's not

Jennifer Smith, CDE 11:31
a kid's friend was over three weeks ago, and had you know, the flu Two days later, they don't care. They don't need to know,

Scott Benner 11:37
we've all been around a person telling a story who's telling a story. They're five minutes into it, you're bored out of your mind, and then they go. So anyway, it was one o'clock in the afternoon. Wait a minute, was it one o'clock? Or was it 130? Right? I you know, I think and you're like listening, going, it doesn't matter. Just tell me the story. Right? So yeah, and I think to to recall, to remember, is that it's possible, you'll get a really learned person on the phone who can hear you and respond from their own brains knowledge. And you might also get someone on the phone who's just following a flowchart waiting for you to say a key word. So you know, exactly. So expectations, I guess, right?

Jennifer Smith, CDE 12:19
And definitely, you know, like I said, Have the facts in order that you can tell them so they can direct what they need to tell you in the right way. And then, you know, if you really just don't know, you know, when is it actually time to just pick up and go to the hospital? I mean, certainly, we usually say if it's, in this case, you know, her son had a stomach bug. So my expectation is that there was a lot of vomiting, or maybe there is vomiting, and the other end as well, kind of coming out. I don't know, stomach bugs are pretty nasty. And for little kids, or kids of any age, even adults, you could be so like, just out of it, that even remembering to take a sip every couple of minutes or remembering to get, you know, some food in or some carbs in or to try adjusting your insulin this way. Some of that may completely go out the window. So I mean, when is it time to go to the hospital when you've put everything in, and you've adjusted, and you've tried all the sick tape protocol that you've been given to try. And it's not working, and especially if there are more. So that higher ketone level, you need to go to the emergency room, don't play with it.

Scott Benner 13:36
There's the idea. The illness is not fixable, you are ill now you're ill, you're either able to manage it at home in a way that isn't going to become dire. Or you need to be at the hospital prior to it becoming dire. Right, right. That's correct. That's the idea.

Jennifer Smith, CDE 13:52
And a lot of some of the evaluation in this case would be hydration, for a stomach bug, when to go to the hospital, especially for little kids. If they haven't been able to even take anything in fluid wise or fluid with a little bit of carb. It's It's time to go hydration is a really, really, if you get dehydrated, it's hard

Scott Benner 14:15
to recover from that and pay attention to your ketones. I would imagine when you're sick, yep. Alright, so then she says, What do I take with me? Maybe you should talk about this stuff you have prepared in case you're too sick or unable to speak for yourself a list of medications, outlining of what your normal type one care is like, what hospital is best for you to go to if you have a choice. She gets there. She lives very far from her hospital, which is interesting. I live in a metropolitan area. I never think about that. Like, I never I don't realize that some people have to take an airplane to an airport to fly somewhere else. Like that's not the life I live. Yeah, if I wanted to go to a children's hospital right now. I could go to five of them if I wanted to. Right. Yeah, right. So but that's not everybody's story. So what should you I mean, you've talked before though about having a go bag for yourself,

Jennifer Smith, CDE 15:05
yeah, next to the next to the door or even if you keep it in the car, as long as doesn't have any, like meds or anything that will freeze, you know, if you live in a cold place or way too hot place. But I mean, some of those things that should be in a bad bag, especially if you're on a pump, things like extra reservoir tubing, infusion site, even a bottle of water, extra batteries, tapes, adhesives, you know, all those kinds of things, even some extra like glucose, glucose, gel, juices, simple sugar, all the things that you would pack, to potentially take along on like a vacation, let's say, could be in that bag along with and I love that, you know, she pointed out things like a list of meds 100% because you know what, when you're bringing your child someplace emergently like that, while you may the back of your hand know exactly what the rates are of bazel delivery and what they get, and maybe if they're on injections how much and when, when you're in that emergent situation that may completely go out of your brain, and you may be fumbling to remember. So having that all, you know, written down even, you know, if you upload your pump, do a printout once a month of the changes that are in your rates, ratios, you know, time of action and everything that's available on every pump load site, right? download it, put it in the bag, that way it's there.

Scott Benner 16:31
Yeah, yeah, I think to as you were talking, it made me realize I'm gonna do something. So Jenny, and I have topics for some of our episodes. And we just keep them in a simple note in an iPhone, right. And it's a shared note. So I type in a list, Jenny goes back and strikes things out or add things we go back and forth. And as we make changes to it, the other person can see the changes, you could just simply have a note in your iPhone that is shared with your husband and your mother and and those people, that is a list of medications, what basal rates are stuff like that, so that everybody has access to that information. The second,

Jennifer Smith, CDE 17:06
the other really good like I'll like I never take off my ID bracelet. But many ID bracelets like mine on the very back of it. Now of course I can't get it off. But on the very back of my ID bracelet is actually a an 800 number and a website, that's it's free. All they would have to literally do is look at my ID bracelet. and log into that and all of my medical history is there. So if your child wears a necklace or a bracelet or something like that, many like American medical ID does a really good job. Most of the other websites. I don't know if they offer that as a free service when you buy a bracelet, but it's a nice way that again, you don't have to have that list, like printed out. It's there. It's excellent.

Scott Benner 17:55
Okay. Okay, Misty says what are the universal non negotiable things once you're at the ER, like for your safety? She says that in their case, it was not shutting off the pump, you know, they hanging dextrose not sailing way. That's a way that one's Interesting, isn't it that they gave him because the sailing drops your blood sugar,

Jennifer Smith, CDE 18:17
like well, and the dextrose versus the Sallie Mae, you know, in her circumstance, she's right. But in other circumstances, depending on where blood sugar was, you know, hanging sailing versus dextrose. If somebody's coming in, in DK, obviously feeding them more glucose, at least initially, you know, you're gonna actually you need hydration. So there are some pieces that go along with the illness that you've come in for, to pay attention to. But I think what she's really saying here is asking what's being hung? Right? Right. It's it's knowledge to say, okay, you're hanging Sally, and he's come in with a stomach bug, I understand that you're trying to provide some hydration. But let's look at where blood sugar is. Let's look at all these things, then she, you know, again, also very correct. And it's a big thing that I go over all the women and men and parents that I work with. If you go to the emergency room, do not let them take your pump. Do not let them take your pump. I mean, like, if you have to, like scream and yell and whatever, then advocate and don't let them take your pump. If you come in because you've had a pump malfunction. Obviously, your pumps not gonna be doing what you need to

Scott Benner 19:32
take your busted pump.

Jennifer Smith, CDE 19:34
There's a difference in the story, right, but definitely not shutting off the pump. The other thing here too, is they don't necessarily know pumps well enough to even be able to know whether you shut it off.

Scott Benner 19:47
So Jenny just brought something up. And

Jennifer Smith, CDE 19:49
so I kind of, I kind of sugarcoat that in a way, like, they don't know. It's like,

Scott Benner 19:58
it's like when my kids were little We used to go into a spare room, pull the sofa away from the wall a little bit and hide Christmas presents behind the sofa. And the kids never knew where they were because they just didn't know to think about that. Right. So So I have two hospital experiences with Arden. And they both come within the last year. So they're fresh in my mind. One of them is an emergency room visit where Arden had abdominal pain. It was bad. We went into the ER, the first thing I started doing and now keep in mind that this ability to do this comes from a confidence standpoint, like I was confident when I got there, so you know what you're doing. So I got I said to the nurse, and anybody who walked in Arden has type one diabetes, she's wearing an insulin pump and a continuous glucose monitor. Her continuous glucose monitor is reading her blood sugar live, here it is I held it up and showed it to them. And her insulin pump is giving her basal insulin and boluses in case she gets larger, we want to keep these devices on her. Okay. Now you would think they'd be like, Oh, I don't know. But But when people realize, you know, and they realize they don't know, they get a little smaller in the conversation, if that makes sense. like someone's in charge and someone's not. Now it is not the you're not trying to lord it over them. You don't want them to be like, you're not like, Hey, I'm here. I know what I'm doing back up. It's a very symbiotic thing you're trying to set up

Jennifer Smith, CDE 21:21
as you've also come in for help for something else respect.

Scott Benner 21:24
Right, respect what they know, try to get them to respect what you know. Mm hmm. It's very important not to come off crazy during those initial conversations. Correct. flustered, like you don't realize it. But if they look at you and your hair on fire, they read that as I'm not listening to that person, right? You know, and that's good on them, they shouldn't. And also keep in mind, that emergency room people deal with a lot of crazy people. So know if you're crazy or not. And so you have to build a little quick rapport, simple conversations, ask questions. And I also found that I'm was kind of, in my mind scoring the people, what did they understand what right, when did they get a blank look? Or when did they have a response that made sense, you know, try to figure that out, then sometimes, there were people in the scenario I just stopped talking to about diabetes, I directed it more towards the nurse who seemed to understand what I was saying, the one who wanted to give me a little space, and did and that's how I did that. Right. And, and it worked out really well.

Jennifer Smith, CDE 22:27
And I think at the same time in your scenario, kind of bringing in until she mentioned a little further down, not until the nurse really was like, I need to set you straight. And I'm going to call in somebody else to talk to you and set you right and whatever. And she called it an endo consult, quite honestly, when you go to the emergency room, and you know that you may have a stand up and put your hands up and say I got this I know. And you know what you can call an endo bring them in, because I would like another advocate for what I'm doing. right up front. Ask for them. There is always an endo on call. There's there's always a specialist on call that will come.

Scott Benner 23:12
And if I could play psychologist for a second, when the nurse says that the misty that's the nurse saying, well, I really don't know enough to write to be the stop in this situation. I think that woman should stop telling me what to do. But I don't have enough facts to stop her. I'll get a person with facts that come in, then we'll see later that the person with facts came in and, you know, right, told them.

Jennifer Smith, CDE 23:36
You know, hopefully overall, the nurse may have learned something in that setting, too. You know, everything is kind of with diabetes, I find it if people are willing to listen, it's a teaching moment. So you know, hopefully for the next person who comes in or the next parent with a child who comes in this nurse will be a little bit more in the know and be able to say you know what, I don't know enough about this. I do understand that you feel like you know what you're doing? I'm going to call the endo. Let's just make sure everything is is good. Everything is the way that it's supposed to be going based on what you came in here for, you know, three.

Unknown Speaker 24:11
Yeah, exactly.

Scott Benner 24:15
One second, I gotta tell ya, I found myself at a speaking event last weekend. And outside of the event, there were vendor tables, and one of those tables was on the pod. So I went up to the person working the table and I said, Hey, I'm pretty good at telling people about on the pod Could I try? They said yes. And then the next person that walked up to the table, I stepped up. I said hello, how are you? Are you interested in the Omni pod to boost insulin pump? And the guy said Not really. I saw Whoa, why not? Let me tell you. So first I found out was he interested in a pump? And he was then I explained how the Omni pod work did It was a standalone device that didn't have any tubing, but he could wear it while he was bathing or working out, going swimming in the ocean even. Then he started Listen, I talked to him about how important it was to continue to get his basal insulin during those activities, and how if he had a tubes pump, you'd have to disconnect to do those things. And I had his attention. After that, we talked about the personal diabetes manager that's used to control the pump, and even discuss that sometime at the end of 2020. On the pod would be adding an algorithm that their horizon system would be coming out that this was the perfect time to get acquainted with the Omni pod. Just like that he picked up the free no obligation demo, and took it home. And you can get one for yourself at my Omni pod.com forward slash juice box. When you go there on the pod, we'll send you an absolutely free, no obligation demo of the Omni pod. Check it out. All right, I'm gonna keep going and do the last ad for the show right here. And of course, it's for the Dexcom g six continuous glucose monitor, my voice is failing me. But the Dexcom will always be there for you. The dexcom g six is the only continuous glucose monitor that I would ever put on my daughter. It gives back information about the speed and direction that her blood sugar is moving, that is so necessary and needed in our life. It is how we make every great decision about food, insulin, how we stop low blood sugars from happening, how we head off high blood sugars before they become high. It is how we do everything. Every insulin decision we make begins with the information that comes back from the dexcom g six continuous glucose monitor. I look there are links in the show notes of your podcast player and at Juicebox podcast.com for both on the pod index calm. But you can just remember this right here, you'll get to where you need to be dexcom.com forward slash juicebox. Go read about the alerts and the alarms about the share and follow features. Figure out if this is something you want. Don't take my word for it because my word is do it. That mean if you want to trust me just jump right in. But if you don't want to trust me, Go read about it at least go find out how your child or loved one can be anywhere using index calm and you can be somewhere else remotely seeing their blood sugar's my daughter's blood sugar right now is 71. She's at school. It's 1030 in the morning. I can see that right on my iPhone dexcom.com forward slash juice box are the links in your show notes. Were at Juicebox podcast.com. And don't forget, if you're thinking about moving to an algorithm based pump at some point, you're going to want the Dexcom so now's the time. One second, I gotta tell her something.

Jennifer Smith, CDE 27:57
She fallen asleep in class because she's so tired from studying so late last night.

Scott Benner 28:02
She's actually on our way to lunch. She's been at school for 25 minutes and she's going Watch now which is you know,

Jennifer Smith, CDE 28:06
we always we always talk at the time that she's heading into lunch. Yes. And you're always texting her do this or did you do this or eating today?

Scott Benner 28:15
Want me to pull the curtain back a little bit people like hearing about that. So there's a reason why I'm always recording all Ardennes at lunch and I'm much more well thought out than I give myself credit for Do you believe I am. Okay, and then she asks the end. Is it ever okay to shut off insulin. So misty, I'll tell you that. I was rockin Arden's blood sugar for hours in the emergency room and there was no food going into her like we had some juices once in a while we were sipping juices always let the nurse know juices happening. Because the nurse was always like, Look, if you can't manage this, we'll use I don't know what it is dextrose or glucose or something like that. Right? And I was like, okay, you know, but I was trying really hard for that not to happen because just like the nurse who called the endo on misty, I didn't have any perspective for that. I did not know what was gonna happen next. And I use texting Jenny, I was like, what's gonna happen if they give her this? Like, what trying to be ready because I've taken insulin away, like, I don't know what to do. Right. And we kept going for a long time. But finally I just couldn't. I couldn't keep it up anymore. Right. And so they gave it to her. And the woman's like, let it go for a minute to see what happens. She was right like it shot up. But it came back down pretty quickly again, like had I given her insulin for that that would have been a major, like problem, right? Yeah. And then once we got that drip regulated, and then got her bazel rate to where, like I just adjusted her bazel to manage the dextrose instead of what it was usually managing. She was getting a very tiny bit of insulin. Yeah, but a little bit. And that was it. And it's making me realize as we're talking, the tools really do work anywhere. Like they were in that situation too. So I guess confidence and honest actual confidence that comes right that comes from experience that you No, it's gone over and over again, the right way, is really helpful.

Jennifer Smith, CDE 30:05
And I think that, you know, as far as what you were doing, because you know how to manage and you know how to adjust, you know how to turn things down or turn them up or micro adjust with little bits of juice, if you know that if the person can take a little bit by mouth, and it's okay, according to what, you know, their protocol is in the emergency room, or again, like a dextrose drip, if that's an option, and you can adjust accordingly with your basal insulin drip. Great. But it's and I hesitate to say, is it a yes or no? Is it ever okay to shut off insulin? Technically, no, for somebody with type one? I mean, really, it's not. I mean, we, we know what happens if there's 100% deficit of basal insulin, you're not going to see the impact right now. But you are going to see the impact in the next several hours based on that deficit of bazel. That was supposed to be there. Even if they needed less basal insulin, they will always need basal

Scott Benner 31:05
insulin, and you and if you get to that spot where your it all is out of control, they're going to take it over, then they are going to take a minute your life feels a danger. And they don't think that what you're trying helps them you're going to lose control the situation. Right, right. And that's, that's obvious. I want to fill in here that misty said that eventually, it seemed like the ER doc was probably confused about pump therapy in general, and didn't realize that her child wasn't also getting a long acting previously injected insulin. So that doctor did not understand what the pump does

Jennifer Smith, CDE 31:42
know. And that's not a common misunderstanding, quite honestly, like I said, initially. The doctors and the nurses and the staff that work in the emergence and the emergence setting of an emergency department, they know a lot, they really do. But they're they're not schooled in, in this setting. What was the difference? Again, between type one and type two, they're just, I mean, they know if they sat down at a desk to somebody, they could tell you the difference, right? But I think because they don't work it all the time. There really is this disconnect in understanding someone with type one diabetes, and I hope lots of healthcare professionals. Listen, Amy, but there is a definite you don't have insulin production, you have got to have at least the background drip drip, drip, drip drip of insulin. And if you're somebody on MDI, which misty also asked, you know, what about people who are using multiple daily injections, what about them, if and that kind of goes along with the emergency preparedness bag, if you can grab your supplies and take them along to the hospital with you, and you're on multiple daily injections, I guarantee you need to grab your basal insulin, whether it's you know, whatever brand you're using, bring it along, because while the hospital will have within their formulary, a basal insulin to use. They may want not know how much you're using, and they'll base it on a formula to calculate how much to give you. But if you don't tell them when you've taken your last dose, or when you usually take your doses of basal insulin, in the hectic nature of what they're trying to do for you. Maybe you take it at 5pm every night, and you end up going to the emergency room at 3pm in the afternoon, and you're there for seven hours. Well, you know what 5pm comes and you don't get your basal insulin, you're going to be at a deficit, they don't know that.

Scott Benner 33:39
And they're gonna be not inclined to give you a eradications they don't understand. So here she says, How should you advocate for yourself for your child if things aren't happening, right? Like, she's like, what if like asking nicely just doesn't work? I think then it's okay to ask to speak to someone else. Correct. You know, like, at some point, you have to just say, Listen, I really do see that you're trying to help. And I don't I'm I always put it back on myself. So there's a little trick I use sometimes in personal communication, where if things aren't going the way I want them to, and I believe it's because the other person is not understanding me. I put that misunderstanding on me. Right. Maybe I you know, I think maybe

Jennifer Smith, CDE 34:22
I didn't explain it right.

Scott Benner 34:25
I'm not explaining this correctly. But it's obvious that we're not on the same wavelength here. Could I just talk to someone else and maybe re explain, maybe they'll hear me differently, you know, maybe how I'm saying it will hit them differently, whatever. But just know that I've been at this a long time. And I know this isn't right. And so despite this can't be the end result where we're at right now.

Jennifer Smith, CDE 34:48
And that's where I think advocating sooner than later. If you are getting any pushback, even in the first you know, minutes of being there. Ask for a console. With an endo, ask for somebody to come in who can from an understanding place, advocate with you and or for you based on what you then tell them? And I think another piece that obviously goes into it is, what is your typical plan of care for a day? Right? How much insulin, how sensitive Are you all those dosing, you know, strategies that you use all those doses and everything that you use from a ratio standpoint, sometimes having it just written down, rather than trying to explain it visually to somebody who is medically trying to help you at that point. They could read it, and it may just click

Scott Benner 35:41
Yeah. Because they're not used to looking at your pump settings are thinking about it, maybe even the way you talk about it. And I listen, I speak to a ton of people as you do. There are a million different ways that people explain the same things all the time, right? Like you hear somebody say it one way, then someone else says it another way. And then a third person found a fun way to say it. And like, you know, versus the situation, you don't want to be using the fun way around the house to explain the doctor because they don't know what the heck you're talking about.

Unknown Speaker 36:06
No, no.

Scott Benner 36:08
So So Arden's emergency room visit was eventually, it turns out because she had a cyst next to her fallopian tube, caused her like incredible, like stomach pain. So eventually, after a lot of testing for other things, we figure that out. And we found ourselves getting surgery for art and to have the cyst removed. So we must have met with the surgeon, four times prior to the surgery. And every time at the end, I would just say, hey, just wanted to remind you that Arden has an insulin pump, and a glucose monitor, right? And that we want to keep them on her doing, but it's really only a 45 minute procedure. And the doctor was, oh my god. Yeah, that's great. Right? You guys are doing great. Just do it. She just boom, yeah, sure. Then we get to the hospital that day, and we're doing intake. And I realized the first nurse is just getting her set. She's not going to be part of the procedure. But then eventually another nurse comes in, who's obviously going to be in the room, I say, Hi, I don't know if the doctor told you. But my daughter has type one diabetes, and she picks the chart up. And look, she has no I didn't know that. And I was like, okay, and I said, Well, she she does. And she's wearing an insulin pump and a continuous glucose monitor and look at her blood sugar right now, look that I've kept my daughter's blood sugar between 100 and 130 for the last 12 hours, because for this, okay, right? And so keep in mind that that's incredibly difficult to do. And I don't want you to take this the wrong way. I've done it. Okay. So and if you need it for another 45 minutes, I can I want to Okay, she goes, Well, protocol is and I went Oh, okay, so now my brain starts going argue with the doctor said it was okay. No, don't do that. Ask for the doctor, maybe. Then another nurse works walks in the room, I swear to you, I turned away from the woman I was talking to look at the next one went Hi. I don't know if you know this or not like the first nurse wasn't even standing there anymore. But my daughter has type one. And I went all through it. And luck habit She goes, my best friend has type one diabetes. While you're doing great. Let me see your graph. I think my daughter, I think my friend has a dexcom too. We talked about this sometimes. You're doing great. You do whatever you want. Yeah. And that was it. And I said, Okay, great. I said, if she does get low, feel free to give her glucose to bring her blood sugar. Would you like to take her phone into the operating room? And they were like, Yeah, absolutely. And they put it in a surgical bag, they stuck it on the operating table so that it could stay connected to everybody. Once I found somebody who got it, she was thrilled to not be involved in it. Right? Much like your school nurses, and your and your administration school, once they realize you can take care of this and you're like, we don't want to go to the nurse anymore. That's their dream not to take care of your kid, you know. So I found that very same situation kept our blood sugar nice and stable during the procedure. And then as soon as she was out, and her blood sugar tried to go up, I stopped and I was much less aggressive than normal. But I had a goal like I'm going to try to keep under 170 you know without getting her low because she was she was loopy.

Jennifer Smith, CDE 39:17
Yeah, yeah. anaesthesia is not fun.

Scott Benner 39:20
Right. And, and it worked. But it didn't work because I had the conversations with a doctor didn't even work because I had it worked because I kept having the conversation. Right? So don't get into a position where you feel like I've said this once because said it once to somebody doesn't understand.

Jennifer Smith, CDE 39:38
And it's also hard in that scenario when you've explained it. And now you come in and you have to explain it yet again. And then they come in with more people and you have to explain it yet again. It's hard not to start to get like this escalation of, oh my god, if I seriously have to explain this to one more person. I'm gonna like my head's gonna explode. We I mean, you really have to take that level down. So that you can advocate well for yourself, and you don't start to look like the crazy person, right? Really think

Scott Benner 40:08
about the suspension of, I don't know what it is expectation or ego or something like that. You're just, you're just and I always explain, I never explained it from a asking point of view, I was always being Matter of fact about it. Like, you don't mean like there's there's, there's an idea behind having you know, whether you're buying a car or any kind of like a situation like that someone's in charge, right? Like someone's in charge. And when you start at the hospital, by default, the hospital people are in charge. If you become subservient in the conversation, you are immediately under them, and you'll never go anywhere else. Right, right. And it's just it's all human interaction. So you start with Hi, you know, I don't want to sound crazy are full of myself, were really good at this. Let me show you how good we are at it. I promise. I'm, you know, this is the truth. And here's what I'd like to do. Here's what I think I can accomplish with that work for you, then you kind of loop them back into the process again, showing them they're important. It's manipulation, really, but other people call it communication, but you know, what you gotta do?

Jennifer Smith, CDE 41:16
You do. And sometimes it's sometimes even the team might have, you know, in a scenario of going to the hospital, even for like a planned procedure, like the case of art and surgery, right? I mean, in in August, I had surgery for kidney stone. And it was entirely different than the surgery I had just a couple months before that in May. In August for my kidney stone. I had to, like my mom came to the procedure with me after it when she was bringing me home. She's like, I can't believe how many times you had to explain to different people the same exact thing. And I was like, yep, I know. I've done this many times now. And she's like, I know, but she's just like, you know, really proud that you didn't get so flustered. And like she's like, I would have like hit somebody over the head with a charge. She's like, I wouldn't have done that. I'm like, well, you would have but you know, it was actually the anesthesiologist who was the most besides the admitting nurse, who was the anesthesiologist, for me who was really phenomenal. He, he was really interested in my CGM graph he was really interested in in fact, he kept my phone in his pocket. The whole entire procedure, you know, and he, he was awesome. It was actually the surgeon who kept asking me like, how much did you turn your basal insulin down? And like, I didn't turn it down? Because I know what my basal insulin does. Totally fine. Are you sure you don't want to turn? I'm like, Look, buddy. I know what I'm doing.

Scott Benner 42:49
Do your part. I'll do mine. How's that? So

Jennifer Smith, CDE 42:51
yeah, it was but yeah, you'll encounter different people. And just continuing to kind of continuing to know that you have rights, you have rights, you as long as you do know what you're doing. Your Rights include advocating for yourself, and also asking for other care team members to come in, that may be able to help you better, right,

Scott Benner 43:16
right. It's like being on the phone with customer service, you realize the person you're talking to is does not have the power to do what you need them to do. And you got to get somebody else you just gonna have an argument. All right, Misty says, you know, What rights do patients have once they're in the hospital setting? And what she means specifically by that is, can you demand things be done in a certain way? But then it's interesting in her in her question, she doubts herself, she says, and how do I verify that what I'm asking for is actually the best for treatment? So how do you like how do you make the leap in your head that this is what we do at home, but maybe this doesn't work here. Right now, maybe they know more than I do.

Jennifer Smith, CDE 43:53
Some of it's also in terms of, you're going to the hospital with a condition that you know how to manage, but you're going to the hospital, let's say it has nothing to do with that condition. You're going to the hospital because you got severe abdominal pain. Clearly, Scott, you don't have any idea why Arden had abdominal pain, you can't like see into her belly and see what was going on. I mean, some of those things, you have to say, You know what? I came here for this. You're the team, you're the experts, I expect you to figure out what the pain is, but I've got this part of it. I've got the diabetes management part of it because I do this 24 seven, and you don't. So some of those things, you have to you know what you're requesting. I mean, if you're requesting something like jelly beans that your kid needs to eat, but he's throwing up quite honestly, they're probably going to look at you like you're crazy and say you know what jelly beans might be what works really well but he's not going to keep them down. So let's do a deck straw strap. Yeah.

Scott Benner 44:56
Again, I'm a big fan of keeping people in involved. So when I The last thing we did before our knee surgery was I said to the doctor, here are all the places I can put Arden's insulin pump for the day of surgery. Which of them would you like it on? Now, let me tell you a secret Jenny. It would no matter which one it was on, I was actually giving her something like, do you know what I mean? Like, I do the same thing in 504. It's like, I find something in a 504 that I'm like, well, we don't need that anymore. And when I go into the meeting, the next year, I give it back like it's a present. I'm like, Oh, you know what? We don't need this line anymore. Take that out. I'd like to make this as easy for you as possible. Yeah, like, oh, look how nice he is. Right? So in this case, it's a little ego stroke for the doctor. You tell me what's best here. Right was arm or it was thigh. Mater. Like neither of those were going to be in their way. And I let the doctor pick. Yeah, that was it. Right. And And, by the way, double down on my maniacal thinking. I was trying to get Arden to use her arm again. And I thought he'll probably say, she'll probably say arm over thigh. So I'm just going to give her arm or thigh. she'll pick arm. I'll make her feel better. And I'll get Arden's pumped back on her arm. Haha, ha like a double? Yeah, I was like an evil genius in that moment. Uh, what is okay to let slide? And she's like, what hill? Should you die on? I think we're answering that question on the way right? Like you just you what's important to the management of the diabetes? What keeps insulin going as best as you can? So what do I do about pumps settings that I don't, I don't even follow myself all the time becoming and so so she's a fluid person, like she listens to the podcast, right? And so what happens when your management is fluid, and then all of a sudden someone wants to make it static for the situation? Right? To me, I would tell them that, I'd say, look, let's start here. If this doesn't hold it down, we might have to amp it up a little bit. And if it's too much, we might have to take it away. But I don't know, because this is a different scenario than we usually manage it. These numbers are not set in stone like Jesus, that's the that's the core of the podcast, right.

Jennifer Smith, CDE 47:13
And I think a better part of it too, is to explain in a more simple way, maybe to them. This is the baseline that we work off of based on what's happening with glucose, because we've got a trend on our fancy CGM. I can because the pump settings, the smart features of my pump, allow me to do this, if, if his blood sugar is starting to go up, I'm going to do something that temporarily allows me to just stop, I'm also going to temporarily adjust down in this scenario. So explaining that in the simplest way that you can help them to see that what's there as settings, is it's meant to be fluid. You know, it's these are what we start with, and, you know, in the in the case of something like the carb ratios, you know, she's like, well, then carb ratios are a little bit more of a suggestion. They're really not something that we 100% hard number go off of, you know, what, if in the emergency room, you get to the point that they're bringing you food, and your bolusing? You know what, you give them the ratios that are in your pump, and you do what you know, works. What they will usually ask for is what dose Did you give, because they need to put that in the medical record? Right? They don't know that it's been adjusted or adjusted down based on you know, whatever you say, this is what my pump suggested I take this is what I'm taking adjustment up or down that that's a piece that quite honestly, they're not really going to care nor know about. I mean, when I was in the hospital for both post deliveries of my boys, the nurses every shift, they would ask what is your bazel running at? Have you made any adjustments? Where's your blood sugar? Have you taken any boluses? Have you eaten? all they needed to do was really document what was going on? That's it. There's

Scott Benner 49:10
a lot of but covering going on?

Jennifer Smith, CDE 49:12
It is a lot of covering? Exactly. 100%

Scott Benner 49:16
Yeah. And so even if you're MDI, that's really the same advice like, no, if she does make the point that they like to give like a set dose? They do. Right. And so, you know, but then that kind of leads into one of our other questions. Is it ever a good idea to just do things on your own and not tell the staff? And I would have to say, I mean, no, but but probably

Jennifer Smith, CDE 49:42
in some of it is a little bit of like, coding an answer, right? Like I said about the bolusing. Right. It's is it ever a good idea to do things and not tell the staff not to not know, but if you're bolusing for a meal and they ask you Did you go Less or to have you taken any corrections or whatnot? I mean, the simplest answer yes. And this is what the dose is. That's kind of the level that they need. They don't need to know that you factored in. Well, it looks like his blood sugar is dipping. So I adjusted back by this much. They don't, again, too much story, right? They don't need to know that.

Scott Benner 50:19
They're long,

Jennifer Smith, CDE 50:20
because they don't have. Right and then they start thinking, I've got a crazy person who's like just giving willy nilly doses of insulin. I don't I don't agree with it. Let's shut the pump off.

Scott Benner 50:30
Yeah, it might seem disconnected. But you know, when you hear a late night talk show host make a joke about diabetes. And you think, how could they possibly do that? When I know all of this stuff about life would die? They don't know, that's the answer. The answer is they don't know any of that stuff. And so these people you're talking to very well may not know most of what you're saying. So listen to what Jenny's saying. I've said it one way, she's saying it another way, get them to do what you need them to do, if they say five units, because that's what we do. But you know, it's six, and maybe it's okay to do six, if they want to do five, and you think it's 15, that you're probably gonna have to say to them, right, because you're crafting your own safety, that's what you're really doing, right? You're trying to protect your safety against your blood sugars. And going high is how it feels most of the time. But the truth is to, you would need to protect it from going low, you would not want to give yourself way more insulin than your doctor knew about. Because if you did get low, that we wouldn't know how to eat it. Yeah,

Jennifer Smith, CDE 51:30
exactly. And you know, for some of the MDI users that I've worked with, and a very good friend of mine, some don't even really have a true set ratio as a dose to use. And I think you had done this for a while, too. It's like, you can look at a meal. And you can say, like, my good friend, ginger, she can look at she knows her apple and her peanut butter is this many units of insulin. This is what she takes for it all the time, unless her blood sugar's higher, or lower or whatever. But this is always what she takes for it. That's not really a ratio, Could she figure out a ratio to tell them? Sure, right? She could. But technically, there's no ratio there, because you've just figured it out. Because they're standard foods that you eat. And you know that five units or two units or 12 units always works for it.

Scott Benner 52:17
And so when you're not ginger, or you or me, or maybe a lot of the people in this podcast, what do those people do, people really don't understand this year about their diabetes, are you just in the hands of that,

Jennifer Smith, CDE 52:29
and that's where these protocols are put into place, with the expectation that the medical staff knows best, and that the people coming in, aren't taking that type of level of care for themselves. So they have protocols, they've got these, if this, then do this, if this is where it is adjust by this much change to this, add this, plug this in whatever. And those are safety protocols they are. But I think from the staff position, or the medical, you know, person position, you do have to look at the individual, you have to look at the person who like you comes in with Arden and says I got this, I'm following it, we do this, we do it this way. I know where things are. She's beautiful, she's level, I can manage it, versus the person who comes in and can't even tell you the last time that they took their insulin, or what their rates are running at in their pump. Okay, that person baby, the kind that one, the staff should then get an endo consult in and to the staff needs to follow their protocol, because they can definitely say this person has no idea what they're doing.

Scott Benner 53:44
Maybe that would be a wonderful opportunity for somebody on staff to help that person, you know, because at the end of Arden's initial emergency room visit that I mentioned, as we were packing up and leaving and getting ready to go home and everything the nurse did come in and say, I really appreciate all the help. I hope I was good. You taught me a lot today. Mm hmm. You should understand, though, the way you and I started today because it was a little contentious at the big Yeah, I just tried to stay away from it, because 99% of the people I see in here don't understand their diabetes in any way.

Jennifer Smith, CDE 54:18
Right. And the majority of people she sees that come in are likely type two, and have had much less education. Even if they are on insulin, have had much less education than somebody with type one.

Scott Benner 54:33
No, of course. I mean, so it's just in to kind of go on the side of the doctor for a second and talk about it from their perspective. You and I talk to a lot of people in our private lives who are constantly raising and crashing their blood sugar's like all day long, but by what they're doing, they don't realize that they think it's happening to them, but they're doing it, you know, and they don't know what they're doing. And what if I get you into a situation where you have multiple units of insulin going? And your blood sugar's crashing? You want to have a seizure here at the hospital and in front of the nurse who doesn't particularly understand it to begin with, like, you know, but then you know, you have, you just have to understand their perspective, and not just understand it for like, you know, nicey understand it, so that you can tell them what they need to hear, like, right, like, you just, I don't know a better way to say it when you're, you know, when you're arguing with your spouse, right? And you in your heart, you're like, why are they not hearing what I'm saying? It's because they think differently than you think. But if you understood how he thought, or vice versa, you could say to him, the thing that would put him at ease, and help him understand you. And that's what you're trying to do here, you're trying to communicate on a better level than we all communicate on most days. Right? That's all

Jennifer Smith, CDE 56:00
right. And, you know, when I worked clinically with an endocrine group, in DC, at our hospital, we actually worked with the emergency room staff to develop a protocol for both type one and type two diabetes for when somebody was admitted to the emergency department. And we also had a protocol within the type one. If somebody came in on an insulin pump, it was an automatic endo call. They got somebody there. And if the endo couldn't make it, which was most often because they were busy, one of us the CDs got called to the emergency room to help the ER Doc's manage. So you know, not all hospitals obviously have that. But we did it mainly because we saw the need, we were getting called so frequently to the emergency department to manage that they were like, well, let's just get something in place. So we better know what we're doing, and when to actually bring you guys here,

Scott Benner 56:58
right? That's a it's a it's not an easy fix. But you're just ideas that hopefully some of them will make something better for you or the conversation or your health. It's, there's no, there's no like, do this, this and this, and now we're going to be okay. After the song got posted online, I actually sent me a follow up question. And it was from another person. And the idea basically was, what if you're an adult friend of a person who has diabetes, and is not capable of talking, right, can't speak for themselves in the moment? Like, is there a way to advocate for them? I mean, as I read that, I thought, that's a wonderful idea. I just mean, if you're not a blood relative, first of all, you can't, they're not going to listen to you to begin with. I mean, they might listen a little bit, but what are you even going to say you don't understand their diabetes, probably any better than?

Jennifer Smith, CDE 57:50
Right? I think the easiest, the easiest way to advocate then would really be to ask the emergency room staff, if they could get an endo console consult, quite honestly. Because you know, you can, if you know your friend well enough, and hopefully you do, if you're taking them to the emergency room, you haven't just met them on the street corner, and you know, took them in or whatever, this guy passed out, and I decided to help you. It looks like he's wearing this pager with a tube. And I'm not quite sure what that is. But But you know, if you're enough of a friend, bringing another friend to the hospital, you would, you would typically know that they've got a pump, or that they use injections, you may not know how they use it, but you could at least say hey, you know, he or she has the pump on here. He or she wears and uses this thing that tells them what their blood sugar is, you know, those kinds of things would be easy enough to be able to share with the staff at least

Scott Benner 58:52
Yeah, I think instead of trying to find a way to talk to the friend, we have to be talking to you listening who has diabetes, you you have to as crazy as it sounds, you probably have to try to break down your diabetes into six bullet points. And explain that to your friend so that they have that information to ask somebody, listen, you've all been diagnosed, right? And someone downloaded an hour's worth of talking into your head and you got home and went Ah, so you know, like your friend over you know what dinner once in a while when you mentioned your blood sugar. That's not how they're gonna do. But if you had a bullet pointed like five point lists, like make sure they know, this is what my basal rate is. Make sure they know you know that I'm MDI and that means I inject my slow acting insulin and my fat there are two different instant like that kind of like simple stuff, like break it down into t shirt slogans for Yeah, right, exactly.

Jennifer Smith, CDE 59:44
Then even even when you change therapy, then it's important to share with them, Hey, I'm not using injections anymore. I'm using an insulin pump. Even that as a simple statement can be very helpful within those simple bullet points. So, do this, or do this, if I behaving this way, you know, help me this way, whatever, that just the other day I brought up with my husband in the, you know, couple of years that I've changed over the type of pumping strategy that I use. I, my husband was very good with my other pump. He knew how to push the buttons and how to do everything. And since I've changed over, while he knows what I'm doing, the button pushing and stuff. I've never gone over with him again. And just the other day I was thinking, I really need to like reteach him. Yeah, all of this in case of need,

Scott Benner 1:00:39
you know, I really do. Yeah, hundred percent. Jenny, we've done it again, I really believe that this

Jennifer Smith, CDE 1:00:46
is a good episode in a really great awesome that you're, Miss misty, decided that it was a really good topic because

Scott Benner 1:00:55
it was hard for her to do. Really, super, actually. That's what I like about Listen, all of you listening are terrific. You know whether I've ever met you or I'll never meet you, or you'll never say a word to each other. But I've gotten to meet some of the people online a little closer. And it's really wonderful like that Facebook group is little more than a couple thousand people who really understand what's being spoken about on the podcast. So when new people come in, they're really helpful. And I just put a post up the other day where I very proudly said, no one's ever been banned or deleted from this place. And even when they when they don't disagree as much as they think they have conversations. It's really lovely. Actually, that's nice. Yeah, it's wonderful. You can actually talk to people you don't know who disagree with you and not yell at them.

Jennifer Smith, CDE 1:01:44
And it's still okay.

Scott Benner 1:01:45
Yes. So do that while you're at the hospital. Awesome. Let me say this right, before I let you go. Yeah, I don't know that most of what we just said here today does not apply also to when you're in your general practitioners office. Right, like the idea that they probably don't understand as much about your diabetes as you hope they do. Correct. Right. So don't make that assumption. I think I think that's really it. Like, don't assume anyone understands. And, you know, and if you're an adult with type one, and you're worried you're going to be in the hospital by yourself, make that bullet point list for yourself and keep it keep it on you. You know?

Jennifer Smith, CDE 1:02:21
Yeah, absolutely. Even. You mentioned the, like the iPhone with the notes or the you know, the phone with the notes and whatever. I know some people even use, I know iPhone has the the swipe screen that you can actually have your medical ID right up there with all of your information within that medical ID. You can put it right there. Right. In the Health app. Yep.

Scott Benner 1:02:43
Yeah. And again, for all and please don't take this the wrong way. But for you type A lunatics be brief, okay. Yes. doesn't need to be a dissertation. Right. Then one time when she was six, okay. The doctor stopped reading when they got to that

Jennifer Smith, CDE 1:02:59
planters war that I treated this way. 40 years ago.

Scott Benner 1:03:03
My blood sugar was a little higher during that week. And I really think that plantur word infer a medicine is what was so please keep that in mind. I don't have one now. But I mean, say I'm unconscious for four or five months here at the hospital and I develop planners where you decide to take it off for me, I really want you to keep in mind what happened to me. 40. Yeah, just keep it simple. What do they say kiss keep it simple, stupid, right? Like, I don't think they're calling the person stupid. They're saying super simple. And there is a way if you think about it. And if you listen to this podcast, really, you probably have it now. There's a couple of simple ideas that will keep you within a reasonable range and safe. So right tell the doctor that stuff. All right, or just don't get sick. I say is my nose is stuffy this

Jennifer Smith, CDE 1:03:46
year. So it's harder to do that than other years Really?

Scott Benner 1:03:50
100% right. There's a lot going on.

Jennifer Smith, CDE 1:03:52
There's a lot of illness going on. So

Scott Benner 1:03:54
I'm gonna tell Jenny, a really gossipy story that you guys don't get to hear so goodbye. A huge thank you to Jennifer Smith. Don't forget you can check Jenny out at integrated diabetes.com. And to the sponsors of this episode Dexcom and Omni pod, please, please, please get your no obligation. absolutely free demonstration pod sent to you today by going to my Omni pod.com forward slash juice box and then roll right around to the dexcom@dexcom.com forward slash juice box. There are links to all of the sponsors. So not just on the pod index calm but also the Contour Next One blood glucose meter and touched by type one.org right there in the show notes of your podcast player. And of course at Juicebox podcast.com. I'm sorry about my voice. I'm trying. I actually have to go to Atlanta and speak next week. Don't freak out Atlanta. I'll get this fixed. I need a band aid for my uvula. Hey, there's a giveaway going on on the blog. It's ardens de.com. Scroll down a little bit to recent articles. I have one brand New Omni pod pullover it's really super nice and soft. It's given to me for Arden and she never fit in it. So we just found out the back of the closet super nice. There's pictures there. It's a lady small, but if that's your jam, actually, it's a lady's extra small. So if that's your jam, go check it out. Real simple to enter. One of his gonna win it might as well be you. It's been a while since I've said this. So let me just remind everyone who may be newer to the show. The diabetes pro tip series began back in February of 2019 and Episode 210. And in my estimation, these pro tips should really be listened to an order. The first one number 210 was diabetes pro tip newly diagnosed are starting over at Episode 211. We get to all about MDI, at Episode 212. All About insulin. Episode 217 is about Pre-Bolus Singh. There goes my voice. Episode 218 Temp Basal. Episode 219. Insulin pumping to 24 mastering your continuous glucose monitor. Episode 225. bumping in nudging blood sugars to 26. The perfect bolus 231 variables at Episode 237. Jenny and I talked about setting basal insulin. That's what about getting your basal rate right. Episode 256 diabetes pro tip, exercise 263 fat and protein. I bet you didn't know you had two bowls for fat and protein go find out about that in 263 then Episode 287 diabetes protip illness injury and surgery Episode 301, glucagon and low blood sugars and then of course today 307 emergency room protocols and there will be more. Check them out. The feedback on them from listeners is really terrific. I think there'll be an abundance of help to you. I hope you have a great day. Thank you so much for listening, and for sharing the Juicebox Podcast with others. I'll see you next week.

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