#776 Bold Beginnings: Technology and Medical Supplies

October 20, 2022Scott Benner

Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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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 friends, and welcome to episode 776 of the Juicebox Podcast.

Jenny Smith and I are back with the bold beginning series. As a matter of fact, this is the next to last episode in bold beginnings. And today Jenny and I are going to be talking about technology and diabetes supplies. Don't forget if you're enjoying Jenny, she works at integrated diabetes.com And she is for hire. If you need help with your insulin management, I'd like you to remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you're a US resident who has type one, or is the caregiver of someone with type one and you'd like to help out with diabetes research without actually having to do anything like not off your couch, you know what I mean? T one D exchange.org forward slash juicebox. When you complete their survey, you're helping people living with type one diabetes, T one D exchange.org. Forward slash juice box. At the very end of this episode, I'll list all of the bold beginnings episodes for you. So in case you haven't found them, you'll know where to look.

This episode of The Juicebox Podcast is sponsored by the Omni pod five. It's time for you to try the only tubeless automated insulin delivery system that integrates with the Dexcom G six, try the Omni pod five. All you have to do to get started is head to my link Omni pod.com forward slash juice box. There you'll see a photo of me which I imagine you'll want to scroll past quickly. And then we'll get right to the information. On the pod five is here it says the first and only tubeless automated insulin delivery system. Everything you need to know about it, including how to get started is right here. All you have to do is click that little link says talk to an omni pod specialist when you're there, and you're on your way, get the process moving, get yourself going with the Omni pod five. It's not hard to get going. You could do it right now in just a few minutes on the pod.com forward slash juice box. And if you're not looking for the Omni pod five, but you want a tubeless insulin pump, check into the Omni pod dash because you may be eligible for a free 30 day trial of the Omni pod Dash. And again, you'll find that out at Omni pod.com forward slash juice box when you complete the process with my link, you are supporting the Juicebox Podcast and for that I want to say thank you. The podcast is also sponsored today by Dexcom, makers of the Dexcom G six continuous glucose monitor. My daughter wears the Dexcom G six continuous glucose monitor and it saves us every day. Dexcom allows remote monitoring that lets users choose to share glucose data with up to 10 followers. Of course you're getting that famous Dexcom accuracy and performance, seamless integration with Dex comms expanding connected CGM ecosystem. And real time glucose readings sent automatically to the users compatible device that can be an iPhone, that could be an Android, it could be your Dexcom receiver. See your blood sugar in real time including the direction and speed of the number without finger sticks calibration or having to scan anything dexcom.com forward slash juicebox. For full on the pod safety, risk information and free trial terms and conditions, please visit on the pod.com forward slash juice box. There are links the Omni pod Dexcom and all the sponsors in the show notes of the audio player you're listening in right now. And at juicebox podcast.com. If you're going to check out on the potter Dexcom please use my links. Thank you so much. Here comes Jenny

Jennifer, we are up to technology and diabetes supplies in the bowl in the bowl beginning series on this is voluminous is

Jennifer Smith, CDE 4:23
a very broad topic.

Scott Benner 4:25
Yes it is. But there's a lot of feedback here from people. So I'm just gonna go through it in order. All right. This first person says this is very specific get a Dexcom that was the entirety of their of their thoughts. The next person says I wished I could have left the hospital with a Dexcom. But we did get it 10 days later. All right. I think advocating for a pump and CGM right away if that's what you choose. It's interesting. We always I don't know that there's something about polite I don't know, gently this is the wrong place for this, if that's what you choose, I just assume that's inferred like that. But I guess everybody's worried that people feel like they're telling each other what to do anyway. Correct? Yeah, correct. Yeah, yeah. I'm not telling anyone what to do. And if your insurance doesn't cover it, if you can't afford it, I'm sorry. Like, I'm certainly not trying to make you feel bad about that as we go through this. advocating for yourself as important as what I got from this person. This person that goes on to say, luckily, our endo was amazing and did that for us. So we had a libre before leaving the hospital. Nice,

Jennifer Smith, CDE 5:35
good, which I've actually heard. I would say more frequently, in the past two years. Interestingly, the more newly diagnosed that I've had a chance to work with a more than a handful of them have left the hospital either with a prescription for it, or knowledge that they had already gotten a message that it was approved and on its way, or they left the hospital with it.

Scott Benner 5:58
Okay. Yeah, I hear the same stories. It's, I think it's fascinating. And I reject the old thinking that you need to live with diabetes and let it beat the crap out of you for a while before you get technology. I just don't. I don't think that's accurate. I know people like well, what do you do if you don't have it? And I say, well, then learn it, then. Then

Jennifer Smith, CDE 6:18
learn it then. Right. Yeah. I think the first comment, but quite honestly, as I tell a lot of people, if you're going to choose technology, get a CGM. Yeah, I mean, literally, that's the bottom line of any technology. Sure, you're gonna have a glucometer? I mean, I have not heard of anybody who has left any office without a prescription for a glucometer. But for the ups and the downs and following, you know, and or any journaling, right that you might do. You You need a CGM of any technology out there yet. One. No, I

Scott Benner 6:57
agree. The next statement here is I wish they would have given me a CGM right away and not made us wait for it. Yeah, I will bring up here that if your practice says saying things like, Oh, we don't give people pumps for six months or a year, you're not allowed to have a CGM till some arbitrary date in the future. Just please know, that's an arbitrary statement. Absolutely. There's not a rule of diabetes or rule of safety or anything like that, if you're ready for it, you can afford it, your insurance covers it, there's no reason you can't have it right away. And please don't let a doctor's office tell you otherwise. Right. I've, I've seen people, circumvent their doctor, go to the company and say, I want this and they send a request for a prescription back to the doctor's office, who often just signs or signs it and sends it back, you know, right. So they'll tell you to your face? No, six months? Why six months? That's how we do it not a good answer for anything, that's how we do it is a bad answer. And then they'll just sign it when it comes to the office.

Jennifer Smith, CDE 7:58
And I think the unfortunate thing about that bad answer of that's just the way we do it, or we have to wait six months, there should be explanation behind that, it. To be clear, it's not just a random response, there protocol goes a little bit deeper, especially for newly diagnosed to make sure that there is a certain amount of insulin, that actually does work better, once you reach a specific amount of total daily insulin. Most often pumps of any kind, whether it's with an algorithm, or just conventional kind of pump will typically give you better results with a certain amount of insulin that you use. So if you are in that early phase of six months, using very, very little insulin, and the doctor is like, Nope, it has to be at six months, well, what if at nine months, you're using still a really tiny amount of insulin, then it's no more appropriate than it was at two months in. Right. So I think there needs to be better explanation to that, quote, unquote, six month rule if there is one. And also, to go into that, you shall also shouldn't have to prove yourself to be able to get a pump. If you are actually utilizing enough insulin. And you're trying as hard as you can. You shouldn't have to perfect what you're doing to get the use of a pump. The use of a pump should actually help you to perfect things more.

Scott Benner 9:28
Because I said so not a good answer. And the idea of like six months, as an example, is probably just what the the average of what the doctor expects, in your example where they're probably just guarding against a honeymoon situation where you don't need very much insulin to begin with. And a pump won't work for you. But it would be nice to have that explanation. Correct. Not just be told. There's this arbitrary date come back on this day and it'll be and by the way, when you come back in six months, and they start the process then it sometimes can take months. After that to finish the process so correct. Why don't we get this going now and you know, be ready, I listened the next bunch, a friend told us not to leave without a CGM. The best advice I ever got, I didn't have a Dexcom for three months would have made a big difference. Advocate for yourself, advocate for yourself, the more you know, and show the Endo, the faster they approved devices. So this is you just said it shouldn't be this way. And I agree with you. But it doesn't make it not true. That you are a little in there. proving yourself, you don't even interact. And that's that's tough, because I get the doctors might not know you, and they might not understand your ability to understand things. And they're judging everybody. But I mean, listen, I treat it like a first date. That I mean, let's go in there. Keep my smile up. keep my back straight. I'm not a lunatic who will kill anybody with a CGM or insulin pump. Please give me one. Thank you.

Jennifer Smith, CDE 11:00
Exactly, yeah. Well, and I think it also brings in, you know, a bit of treating somebody almost as if they're an idiot. Honestly, if you tell them well, you can't have it until this certain, like, arbitrary time, based on I'm so and so with the white coat on. And I just know about her, you're kind of making the person who's coming in and actually living this minute to minute 24/7. At home, you're making them feel dumb, when in fact, they're the ones with the amount of data that could prove that they could benefit from something if you just kind of listen to them.

Scott Benner 11:39
Just that the listen and have an actual back and forth conversation. And you're done. This person here, begged their way into two months of Dexcom samples at the hospital. That's impressive, Madam or sir, whoever did that? Well, that's impressive. Yeah. Okay, let's skip past all the ones that say Don't leave without a Dexcom advocate for tech. It's interesting. I also wanted, I would have loved to know about the eye port so great is because that would have been so much easier on my boy versus sticking him so many times. So I port Medtronic owns that right? Yeah, trogons iport. It's this little, it's it. It's like this little disc, right? It adheres to your body. And then this will get Jenny's looking at me like Go ahead, buddy. See if you get this right. And then your your. So there's a cannula in it is my expectation. Yeah. And then the syringe goes into the port, and you inject without having to poke the skin over and over again. Correct. The

Jennifer Smith, CDE 12:39
eye port is a really nice, I think for for a number of different reasons. One early on, can reduce, it can reduce the amount of injections all over the body, it can get somebody on a second note, a little bit more comfortable with actually a pump site, if that's the way that you eventually want to move, and many people do. And especially for little kids who can be more prone to picking and pulling things off. It's exactly as you described it, it's almost for those who are already pump users. It's like an infusion site for like Medtronic or tandem pumps. And it has a straight in 90 degree cannula that just pops under the skin. And that leaves a hole essentially, or a tunnel in which you put your syringe right in and you deliver your insulin dose basil, or rapid acting insulin into that site. And the nice thing is that you can leave it on for several days, just like a pump site. And so you can put your injected insulin right into that place over the course of a couple of days. So absolutely. It's a wonderful, I think, really really underused tool. Add an apt sort of initial diagnosis.

Scott Benner 14:01
Okay, next person. This is long, I wish we would have gotten a pump sooner. Oh gosh, them three years. I wish someone had put in a script for a libre for us before they gave us a Dexcom Okay, here you go is the person who would prefer Libra in those first few weeks after diagnosis? Were some of the scariest of my life. And a libre. Oh, I'm getting this now a libre would have allowed me some sleep. So I think Libra is cheaper. I think so they're saying I could have been no disrespect to libre, but I think what they're saying is if I couldn't have got a Dexcom at least I could have gotten a libre. It's something that I could have scanned and looked at once in a while. I was so worried that something terrible would have happened during the night and I'd never know about it since our room was on the opposite side of the house. A reminder that people have done this for years was nice. With only a glucometer so please remind people that too, okay, I will hold on last second. And sometimes lack of tech can be crippling, even though things will likely be just fine. She makes some good points in there. And I do say that to people, especially when they talk about like the warmup time for their CGM or something. I was like, you know,

Jennifer Smith, CDE 15:15
do a finger stick? Yeah,

Scott Benner 15:16
you just, it's not that hard. What are we gonna do? And I was like, you could use your meter. And

Jennifer Smith, CDE 15:23
that thing over there as for and I do I mean, we're not laughing to the point that I understand. You know, little kids or, or people who are, you know, worried or frightful of that type of I get it. I get all the worries. But honestly, if you can get over a five second screaming because you want information, at least you're calm now because you know where things are. Right, so just do the finger stick.

Scott Benner 15:55
Yeah, I agree. I wasn't laughing at people. I was like, You're phrasing so far, you've made me laugh to myself twice once it came out that was there. And earlier when you change into your doctor's voice, it reminded me of one of the claymation Santa Claus shows. Like Rudolph kind of one. Yes, yes. When one of the characters pretends to be another character, and they go into a deeper voice. I was like Jenny definitely grew up watching those claymation shows. Oh,

Jennifer Smith, CDE 16:24
absolutely. I did I make my kids watch them. I don't know if they enjoy them. But I make them watch them because I grew

Scott Benner 16:29
up. I agree. So okay. That's funny. I

Jennifer Smith, CDE 16:33
didn't know I had a doctor voice. Yeah, you,

Scott Benner 16:35
you went into like you even like you like, you straight up your shoulders, and everything was fantastic. Okay,

Jennifer Smith, CDE 16:42
I, this one's I don't have a white coat on, though.

Scott Benner 16:45
No. But you could gently I'd give you a give you a degree before some of the people I've met that are dark. Ah, this one's going to be interesting because you see the mindset of this person. But I could make the exact opposite argument. So they said I advise people to push for CGM, but don't be too anxious for a pump. And they do say I'm sure opinions vary on this. But we're still MDI after 11 months, and it has taken us some time to learn how to Bolus how basil impacts and how to monitor the ups and downs. While a pump may take a lot of the workout, I feel like learning MDI in advance is valuable, sort of like learning math by hand before using a calculator because at some point, if you go off a pump, you'll need to know how to do MDI. Now, it's not I don't disagree. But I don't understand. I don't know if that feels conflicting. I don't disagree that it would be great to know how to manage to MDI. But if you know how to use a pump, you can reverse an MDI and two seconds, you can reverse engineer it, you can't reverse engineer MDI to pumping. Does that make sense? Or am I wrong about that?

Jennifer Smith, CDE 17:57
I don't think you're wrong. But I think that you have you have a broader perspective on insulin than this person manipulation. I guess that's that's the best way to say it. Because I actually am more the I'm more agree with the person. I think oftentimes, there are many people who get a pump before they have figured out insulin use on MDI. And there's there is value to it, whether it takes you three weeks or six months to figure that out. It timeframe is based on what you have, I guess, done the homework to understand. So a pump could be beneficial at any point doesn't have to take this long or the short of time. But I think MDI makes a good point here that if you do have to go back to MDI, after being on a pump, and you have knowledge of what you did, for how at least your life was at the point of using MDI, then you have a base to start at. So I, you know, I think it's, again, person to person. I also think with technology and stuff today. We're using a conventional pump before starting out on an algorithm driven pump is very, very valuable. Because I mean, we all know technology will fail. At some point, your tech will not work the way that you want it to work. You have to have someplace to step back to. And if you don't know what to do outside of what the algorithm has been doing for you, you're at a loss. Yeah,

Scott Benner 19:40
I just sent a text to Arden to help her understand her algorithm. She's looping and I texted her end up end of your Let me see how I put it. So this is me trying to teach her something I said old pump site algorithm needs some help from you. And I don't know what she'll take from that or not take from that. But what I see is that the loop is micro Bolus thing like crazy and, and not getting what it wants. And so she either needs to change the site now, or make a larger Bolus if she wants this to actually go her way. And I don't see how I'll see your point. And here's what I'm taking from all this. You should not just flat out listen to anything you hear from anybody, whether it's me or Jenny or anybody else, just because and you go online where people say things like, definitely do MDI first. And then you hear that and go, Okay, that's a rule. Or, or I say, you don't have to do MDI, firstly, go, oh, the guy on the podcast said, you don't have to do that. That's not how this goes, you have to figure out like, this is MDI, I'm going to shoot some insulin, I'm going to have to give more. This is what it is. Do I want to do that? Do I want to do this? Like, who am I in this situation? And that's hard to figure out? I guess. So. I guess listen.

Jennifer Smith, CDE 21:01
And also, I mean, readiness there, too. You know, we're talking with a lot of people who have kids in the picture, right? There are there are many kids who aren't, they're just not ready for all of that stuff on their body. Yeah, they're just not. And you as a parent may be ready for it for some of the precision that you think it's going to bring into the picture. But if your child isn't there yet, it may bring in a ton more frustration,

Scott Benner 21:31
right? It's not Harlan, it's just not time. Right. The first thing you said in this episode, I'm gonna say at the end of it, which is if you get one thing, get a CGM. Yes, that's where you start. Everything else is great. And, but it's not the first thing like a pumps not going to tell you your blood sugar's go in under 50. That's pretty that's pretty much it. So alright, I want to keep going here. This person says ask about newer products, like, for example, for us v ASP as an insulin, because they wanted something that moved quicker, but the doctor's office was talking about older stuff, especially with Basal insulin when you're MDI if somebody's handing you Lantus or levemir. At this point, there are more modern Basal insulins that work better. So you know, knowing that is helpful, especially when you you know, using that as an example when suddenly you think every, every 18 hours, your blood sugar goes up for no reason. That might be because love Amir doesn't really make it 1224 hours, you know, you don't know that there's a variable you're never going to know as a new person with diabetes. So if you can get what are they true Siba

Jennifer Smith, CDE 22:37
to jail as a Glar. Yeah,

Scott Benner 22:39
the more modern Basal insolence and other stuff like listen, I do an ad for Contour. Next One meter. And in every ad, I say, not all meters are the same. As far as accuracy goes. So when the doctor reaches out to you and goes here, from my drawer, just keep in mind, those are in the drawer, because the pretty girl from the company that came in with them, gave them to him and brought him bagels, I'm assuming, I don't know if that's still illegal or not. But at the very least, she was pretty and smiled a lot while she was doing it. And he was

Jennifer Smith, CDE 23:11
he was a very handsome man, he could be a very handsome man as well. A very

Scott Benner 23:15
handsome man could have come in I listen to any variation to the doctor could be gay, gay man came in straight man came in and we found attractive doesn't matter to me what I'm saying. We're sending pretty people into these doctor's offices with big veneer smiles and handed out stuff. You don't know if you got the best meter or you got the meter that was in the drawer. So ask, say, hey, is this accurate? Or they're more accurate meters? It told me about that. You know what I mean? And I think that goes for everything you just for me, it goes back to insulin. When Arden was diagnosed, I thought Novolog was insulin. At the beginning, it never occurred to me that there was another brand or right blends

Jennifer Smith, CDE 23:55
are well, and I think one step further in that too. While the doctor may have written a script for something, doctor isn't necessarily looking at what's going to be covered for you either, right? So you might go home with X brand glucometer or x brand of insulin. And then when you get to your insurance like well, we prefer you use this one

Scott Benner 24:18
because we've got a big pile of them. But no, but yeah, best you can afford. It is you know is what I'm saying but don't don't just assume that what you were handed was the best or the most accurate or the fastest or whatever because it might not be person says please just take the time to learn about technology on the pod five looping any control IQ like keep opening your mind up to new ideas. I put well this person just ran through everything. Oh, how to this person says make sure you understand how to suspect if a cannula is bent. Hmm very interesting. I just heard a story the other day from somebody who had a long day of high blood sugars ended up in DKA. Got home and found out their cat. Yeah,

Jennifer Smith, CDE 25:09
yeah. Yeah, I mean, and that is part of you know, we, we consider technology, just the actual like, pump or CGM or even glucose meter, right. But the pieces that work with the technology also go into what it does for you. So absolutely cannulas, you know, if you're having problem after problem with your particular cannula, pump companies will if you mean Medtronic in tandem, which use you know, a different set or you have options within the infusion sets, call them and say, Hey, this isn't working, can I try a different kind? Can I try angled versus 90 degree? Can I try the steel cannula versus, you know, the more flexible kind of plasticky one, there are options. So that consider that part of technology too. And that one size doesn't fit, all

Scott Benner 26:05
right. There's this really great story, this person told here about iport, I'm just going to boil it down to like two, yay, two ideas. But her son had anxiety about injections was crying all the time, started saying how he hated his life, and then started skipping meals to avoid shots. And the eye port. She said save them. Because it sounds to me like he was on his way to, you know, some sort of an eating disorder on top of everything else is a meltdown. You know, so simple little thing. And there, I mentioned it doesn't cost anything and iport get, you know, like the tiniest little things. I wish Okay, what does a normal graph look like? This is interesting, they found it interesting to see what a normal graph look like, or just a well, you know, manage type on graph, we got a Dexcom with no idea what our big data should look like. And it took me like, right, and so now they get all the data. And they're like, Well, what the hell does this mean? Look like this is this right? I had to find someone's random blog, I did a bunch of googling. I found graphs for people who are wearing them who don't have diabetes, I have found people who were the data without a control set doesn't help. CGM should come with sample data and give parents and users something to shoot for an idea of what should happen after meals, like the effects of Pre-Bolus Singh versus not Pre-Bolus ng versus high GI versus low carb, etc. Data more data, not just here's the CGM don't let her fall between 80 and try to stay in range 70% of the time, the endo recommendations still piss me off three years later. That's a good point, like it is yeah. How do you know what you're supposed to be doing?

Jennifer Smith, CDE 27:58
Right? I mean, they give you a range. And that range does differ. Practice to practice based on a protocol that they are trying to follow much more of a, like, a true protocol versus what their, what they feel comfortable telling you to aim for. But it doesn't tell you what that graph should look like, in that target range. Right? Should it be okay, that it looks like you're on the craziest roller coaster that you've ever been on in your entire life? Should it be smoother? Should it have no lumps or jumps or bumps at all? You know, how often are lows? Okay to see, how often could you expect? Or what could possibly cause a higher blood sugar that you're not expecting? And how to analyze that? I mean, all those things? Definitely, I think a piece that's also missed, because it's very buried in the manual that nobody reads for any product at all. But I mean, it's it's highlighted, highlighted in terms of described in the Dexcom manual about what the end arrows mean, the rate of change? I think that I have talked to maybe two people in the many people I've talked to, who actually knew before I brought it up what the arrows meant,

Scott Benner 29:22
right? Or that How about a steady arrow doesn't actually mean steady all the time. You might be vacillating. A little bit with a stable arrow. Diagonal down is one rate of change a single arrow down as another rate of change two hours down as another rate of change, same as going up. And it is spelled out. You know, it's so interesting. You say that, because I think that all the time, like for all the visual things that people share about diabetes. You never see that image anywhere. It's almost like it's almost like nobody knows maybe.

Jennifer Smith, CDE 29:55
Right? Right like I should I think that it should be a page that has one of those tabs. On the outside that says, This is important. Turn to this page.

Scott Benner 30:06
Sticky Note right on that. Well, you know what, I'm glad you brought that up. I'll do a post about that and try to remind people, that's a great I know, this person says get a great blood ketone meter. Interesting. We have the precision, extra extra. It's a blood. It's a blood ketone meter. Big Deal stops you from having to pee on things. You don't use it very often in our situation, but it's great to have I sent one to college with Arden. And I remember holding it up going, you remember what this is right? I was like, if you get sick, I'm going to ask you to find this. And she's like, she's like, okay. She's like, leave me alone. Urine ketone test strips can be messy with young kids. They can be messy with me too.

Jennifer Smith, CDE 30:55
Well, and not precise. I mean, what is mild? Versus it looks like it's in between mild and moderate. Like, do I do something differently? Right, the color change is not purposeful. It'll give you a little bit of information. But again, keep blood ketones are right now information just like a blood glucose value is right now here. Whereas urine ketones, it's older data. It's a collective of ketones, but it's not truly what's right happening

Scott Benner 31:30
now. And your doctor should give you sick day rules for how to how to Bolus for ketones. And it's nice to know that you have point five or you have one or whatever, because it's easier to make that Bolus this person said they paid out of pocket for their first X Games. He's like, I didn't know what diabetes was. But when somebody told me what that thing did, I was like, I'll take one now, please. So that's, you know if you can do that, that's amazing. Yeah, I wish they would have been able to give me a pen, not a syringe. I told them to train with a pen in the future. I didn't even know how it worked until we got home. And they showed me but I had to do it the first time alone. Oh, okay. So she trained on syringes. And then someone just said, here use this insulin pen instead. And

Jennifer Smith, CDE 32:17
it's different. Yeah. And they did. There's a different strategy. And yeah, dosing could be wrong if you're not using it the right way. The needle caps. I mean, there's a whole slew of things about using an insulin pen. And I think in terms of this being, you know, about technology, I wouldn't want to not mention in pen.

Scott Benner 32:38
Yeah, no, it's really something because you get, again, I'm gonna sound like an ad, but you get a lot of the functionality of pumping with the insulin pen. And yeah, I say it's like pumping without a pump. Yeah, no, it's really terrific. I do think people should check it out. I do think I'm, I think I'm contractually obligated to say from Medtronic diabetes every time I say we're not bad, so I'll get past this person. This person said we hesitated to move from finger sticks. But gotta libre and loved it. Excellent. No, I sent my son to school five days after being diagnosed and I was terrified. I called the nurse about eight times a day to check his blood sugar. We did not have a CGM was the hardest thing for me personally. You know, that's another good point. If you have a CGM that shares data. I don't know if libre does. But Dexcom does, right. You have followers, people can see that it's incredibly comforting. Oh, I the fact that a monitor can have a variable range, a glucose monitor can have a variable range blew my mind. And I did not see how we could trust it. Now. This is very common. Jenny, are you good on time? Do you have to go? I've got about 10 minutes. All right. We can get this done in 10 minutes. This happened to me. I recently told the story somewhere but the nurse came into the room she had this big expensive looking meter checked Arden's blood sugar with a meter. Then gave me the freestyle like little white. Yeah, whatever. Whatever they gave me like it looked like it was it was like I came out of a bubblegum machine. I always say they checked Arden's blood sugar with that. Arden's blood sugar on the meter, they were sending us home with an ordens blood sugar on the one from the hospital that looked like it costs $10,000 were significantly different. And it paralyzed me. I was like, You're telling me to make decisions about insulin based on this thing? isn't yours more accurate

Jennifer Smith, CDE 34:31
is can I just have this one?

Scott Benner 34:34
I try it I was like, give me that one. She's like, I think it cost like 10 grand. I was like, I'll steal it just like give it to me. You know? That's what this person is saying. That the minute I realized these things aren't perfect. I did not know what to do. All I can tell you about that is get the most accurate stuff you can afford. And never think about that again. I don't know what to say.

Jennifer Smith, CDE 34:57
Well, and because even as As most people who've already been using a CGM know, if you do have to calibrate it, you are calibrating off of a finger stick, you want that finger stick to be as accurate as possible. So now that you're tuning something else, that's going to give you many more data points to be more accurate.

Scott Benner 35:20
I listened. I say all the time. I don't know if people believe me or not, but the people who advertise on the show are very carefully curated by me. So I'm not just I'm not Hawking a Contour Next One blood glucose meter because they they knocked on my door and asked to buy an ad, somebody else knocked on my door and asked to buy an ad. And I said, I'd rather do one for contour. Thanks. So you know that just surrounding yourself with as good of data as possible, is the best thing but that part in there the part where you like, well, this might not be right. I guess the answer. There's a lot of people living with diabetes, and they're all okay. Might be the thing you say here. Okay. I wish I would have known about sugar meat. Okay, third party apps that also give you data. That's great. The different CGM options. That's interesting. So somebody told them either libre or Dexcom. They didn't know there was a different company. Getting the T slim help for my mental health because I started sleeping. algorithms can help you sleep. That's a good thing to know. What are the different glucagon options? That's a great, right. So right now there's, there's old school, are they? Oh, no, they're being discontinued.

Jennifer Smith, CDE 36:38
As of the end of December 2022. The old school red Lily glucagon box will no longer be available. That's, that's it. And then there's, there's G voc which comes in multiple different like, options, as well as the back shimmy, which is the nasal glucagon.

Scott Benner 36:58
Okay, so right now, G voc and back to me are the ones that are available. There's a third one coming, isn't there? I don't know.

Jennifer Smith, CDE 37:07
Now. Of course, it's not in my brain. Can I tell you the talked about it not too long ago in our staff meet AI. It's escaped me. Sorry.

Scott Benner 37:16
It's interesting. Here's a little back back room. The only reason I know about that is because the company approached me to buy ads. Oh, and I said, I'm sorry, I already take ads from a glucagon company. That's the one we use. I apologize. Can't do that. But that's the only reason I know there's another one coming from how to use a lancing device. Don't laugh at me. It says first time I tried it out. First time I tried without the top and kept stabbing my finger until it bled. Oh, so they weren't clicking it they were stabbing

Jennifer Smith, CDE 37:47
stabbing which was the old you never had to use it. I we refer to it as the guillotine the one that snapped over it literally you pulled back this like post that had a spring you loaded in a Landsat to it. And then you put your finger Neith finger underneath the platform, you push the button and the thing literally jammed into

Scott Benner 38:12
like pots. What I use is like pulling a long time pulling chopsticks apart and letting go one side right and it just snapped down.

Jennifer Smith, CDE 38:20
Oh area go. Absolutely. They were not nice. I mean, the good ones. Now I there's the Genteel. I know a lot of people use that one because it's very adjustable in multiple different ways. It is not a small device to carry around and use. But it is very gentle. Honestly. The one that I really liked the best that I like, baby because I know it's still in the market because I can still get the lands and

Scott Benner 38:48
I tell you what you're gonna say. Yeah, ask the multi clicks. Yes. Multi clicks from X. Yes. Ardens Ardens just died. We kept going for like so many years. And we went to the fast clicks but it's not the same accucheck if you're listening, what are you doing?

Jennifer Smith, CDE 39:06
Right? Yes, the accucheck is it are the the melty clicks was it was the best and I still I have the fast clicks because I couldn't get any of the things anymore for the clicks. And the fast clicks is certainly the next best in my opinion. But yeah, the those are another thing to consider because the typical ones that come with your meter. Yeah, many of them don't feel the greatest.

Scott Benner 39:35
Get a good one. I listen, I could go on, I get you. You're limited on time and I have to get a couple of things. I could do a dissertation on what accucheck did leaving the multiplex and go to the fast clicks. It was a huge mistake. This is my opinion. I wish this person says I knew about different ways to keep insulin cool, like from gadgets to packs and things like that because that's a big deal. Right? Like you're MDI and you're moving around with insulin. Arden's going through it now because her classes are very far from her dorm. And so on days, she's she's kind of stuck taking insulin with her and a pump just in case we can't, not how she's used to traveling. So we had to go over that with her.

Jennifer Smith, CDE 40:13
Did you guys get it there is a really good device. It's called the Vivi cap. Vi VI, the Vivie cap,

Scott Benner 40:19
if that was just for pens,

Jennifer Smith, CDE 40:21
it is for pens, but at some point, I do know only having talked to them at the educator conference. They are working on one for the vials. Yeah. But right now the Vivi cap is just for pens of any kind. So if you carry your pens with you, it's it's an excellent

Scott Benner 40:42
option. Well, I hope they make one for vials. Because Arden's in a hot weather climate right now. So she's using a tiny little, like, very hot. Yes, she's using this tiny little Yeti thing that she has to throw ice in and then throw the thing and to travel around with her insulin every day. And there's already been days where she's like, look, I didn't take it with me. Because what, what about the frill get wet? If I trust me, I know it works well. And if I asked her to do that, she'd be like, I'm not carrying a wet bag around with me. It's definitely what I would hear from her.

Jennifer Smith, CDE 41:13
Yeah, it's not I mean, I use it for my travel. But again, she has to do what she can do.

Scott Benner 41:18
Yeah, trust me what she's going to what she did was she set up with her counselor that if she needs to go back to her room, she's allowed to call Campus Security and they'll zipper back to change your pod real quick. So that's awesome. Talk about getting the combination. That was a pretty good. Last couple things here. bracelets. Okay, I just interviewed Jennifer stone the other day from Wizards of Waverly Place who has type one diabetes, and she's talking to me on camera, she lifted up her hands and I brought up that she was wearing an ID bracelet. She said nurse now as well as being an actress still, I think you just supposed to say actor but and she said yeah, it doesn't take too many people coming into the ER without one of these Alon to realize you should be wearing one. So mine never comes off. I know Jenny's always got hers on.

Jennifer Smith, CDE 42:10
I don't I don't it doesn't it never comes off. Yeah, I made sure that I got waterproof, won't tarnish won't rust won't blah, blah, blah just sits there so well. So

Scott Benner 42:21
that's it. I mean, that's everyone's list about technology and data, or technology for diabetes. Excuse me. I mean, from my perspective, I mean, we've been using Omni pod forever. I can stand behind it. I also talked to a ton of people who love control IQ. To me, I think it comes down to to Bolus versus tubed and what you want. But yeah, this is it. No one's going to explain it to you. You gotta get out there and figure it out. So hopefully this will help. Cool. All right. Thank you, Danny. I appreciate it.

Jennifer Smith, CDE 42:52
Of course, you're welcome.

Scott Benner 43:00
I hope you've been enjoying the bowl beginning series. I want to thank Jenny Smith for lending her time to it. And of course, I'd also like to thank Dexcom, makers of the Dexcom G six continuous glucose monitoring system and Omni pod makers of the Omni pod five, get yourself some automated insulin pumping with Omni pod Omni pod.com forward slash juice box or to find out if you're eligible for a free 30 day supply of the Omni pod dash use the same link. In just a moment, I'll go over all of the episodes that are available right now in the ball beginning series. And I was like in a sorry about that. But first, let me tell you if you're living in certain countries in Europe, the Dexcom g7 is available already. And you can still use my link for that dexcom.com forward slash juice box. Today is the 20th episode of the bowl beginning series and there's going to be 21 One more coming next week. So far, here's what we have. Episode 698 Defining bold beginnings. It's a toss up of what the series is going to be. Then 702 honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology Part Two episode 715 Fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility 751 School 755 Exercise 759 Guilt fears hope and expectations 763 community 772 is all about journaling today's episode 776 technology and diabetes supplies and next week's episode which will be seven Adi think is going to be all about insurance. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Oh, and by the way, if you're wondering where you might be able to see this list, you can find it in the private Facebook group Juicebox Podcast, type one diabetes, right at the top, under the feature tab. You Oh, are you not in the Facebook group? You should be it's really cool. 30,000 people all using insulin, asking questions, answering questions, being supportive. It's the most unfaced book like experience you're ever gonna have. It's actually nice. And it's free, free, mean, Scott, you're not trying to nickel and dime people to get access to information. So the Juicebox Podcast is ad supported. I don't want your money. That's it, I want you to have information, I want you to have access to each other to community. That's all I care about. There are no classes, you don't have to sign up for any kind of, you know, $60 a month of call me on the phone. I'm not going to give you 10 seconds of information in a podcast and tell you to come find me for the rest of it. I'm not up for that. But understand. I don't care about that. I'll make a living. But it's not going to be off your ass. You understand what I'm saying? That's all, head over to the Facebook page. Check it out. It's amazing. Listen to the podcast. It's amazing. And it's free. Everything's free that Juicebox Podcast brings forth. Everything is free to you as it should be. Having decent blood sugars and understanding how insulin works shouldn't cost you money. It shouldn't cost you a membership. You shouldn't have to pay a fee. You don't have to take a class, this this podcast, set your speed. You want to listen to the diabetes pro tip episodes in three days. Go do it. You want to listen to it over three weeks. Cool. Whatever is good for you. If you don't like listening, I've got transcripts on the website juicebox podcast.com. Go read it if you want to. You want to read a podcast. I'm not judging you couldn't possibly care less how you learn as long as you learn. That's it. Again, I thank you for listening, and I'll be back very soon with another episode of The Juicebox Podcast.