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Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

#175 Not Bold Britt

Scott Benner

Fear of insulin and lows...

Brittany has type 1 diabetes and is struggling with her fear of insulin and low blood sugars.  

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexagoogle play/android - iheart radio -  or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:00
Hey, everyone, welcome to Episode 175 of the Juicebox Podcast. Frequently, you'll hear me talk about having a private conversation with somebody about type one diabetes. Well, on today's episode, we're going to talk to Brittany. And Brittany reached out through email and was just looking for some private consultation, I guess. And I said, You know what, Brittany, you're a perfect person to come on the podcast, because of her background and how long she'd had diabetes and the problems that she was encountering. Britney was scared, she was leaving her blood sugar high. She didn't quite understand how to get off the roller coaster. And I said, You know what, why don't you come on the show. And we'll talk this through just like we would on the phone. We'll see what happens. And she did, which I'm very grateful for. So this episode is going to be called not bold, Brittany. Not bold. Brett. Let's go with not bold Brett. I like that. As I was editing this episode, almost seven months after it was recorded, I reached out to Brittany just to check on her and see how she was doing. And she responded with a short email that I'm going to share with you at the end of the podcast. Hey, you guys bought so many bold with insulin t shirts and magnets that my supply is pretty low. I don't have all the sizes and all the colors anymore. So I've made everything 20% off. Guess sell the rest. Get it out of my house. If you know what I mean. There's going to be a sale that goes on till August 31 20% off when you use the coupon code bold. Your purchases include free shipping within the United States. If you're outside of the United States, just send me an email. And we'll figure out how to get you something. I'm going to save whatever a little bit is left to take on my speaking engagements later this year. So I really appreciate you guys buying them all up and not sticking me with them. Thank you very much. And there's a few left if anybody else wants them. Let's get on with the show. Today's episode of The Juicebox Podcast is sponsored by Dexcom, makers of the G six continuous glucose monitor. And by Omni pod, the tubeless insulin pump that Arden has been wearing for a decade. And you know, I always talk about how long Arden's been wearing the AMI pod. She'd been wearing the Dexcom a really long time too. I wonder how long, I'll figure that out for you and let you know next time. Anyway, if you want to learn more, go to dexcom.com forward slash juicebox. My omnipod.com forward slash juice box links in your podcast player notes or Juicebox podcast.com.

For today's episode, doubly listen to what I'm about to say because it's WWE important. Nothing you hear on the Juicebox Podcast should ever be considered advice, medical or otherwise, always consult a physician before being bold with insulin, making a change to your medical plan, or pretty much doing anything you hear for this silly little podcast.

Brittany 2:57
My name is Brittany, I am 23 I live in San Diego, I got diagnosed with Type One Diabetes when I was seven years old. And and now 23. So that's about 16 years with type one.

Scott Benner 3:08
First of all, thanks for coming on and doing this. This is really great. You are excited. Oh good. I'm glad so Britney's in her card, staying away from her dogs and everything. And she's gone above and beyond to be on the podcast, which we really appreciate. But Brittany is not on to tell us that everything's going great. Or she figured something out. Britney is on to say something that I think is going to be really valuable to everybody so pretty well, you first tell us like how did you find the podcast?

Brittany 3:34
I was trying to find more connections with the type one community I don't really know any adults with type one.

So it's nice to know it was not just me going through this. I did find a Facebook group two, I think they might have mentioned you. But also from your podcast. I ended up getting the Omni pod which I absolutely love. I just want to put that out there.

Scott Benner 4:03
I hope Omni pod is listening. No, but so but so you The point is is that you were looking for some sort of feeling of not being alone. And and you found you found that initially but then I think listening, you kept listening. And then you decided I mean you've had diabetes for quite some time. So at seven years old when you're diagnosed at seven, do you take on any responsibility? Or do your parents pretty much handle

Brittany 4:30
my parents pretty much handled type my type one from seven to 18. And then my parents got divorced. My mom moved out of state and she was a main one doing my type one duties. So when she moved I was kind of thrown out into this big world of this disease that I never really handled on my own. And it's been that 23 from a team for about five years, and I still have no clue what I'm doing I feel like so I'm kind of relearning how to take care of myself because my parents Did it for so long.

Scott Benner 5:01
It almost feels like you're not just relearning it, you're actually learning it. Because if they were, if they were handling it handling, I mean, right up to you were 18. It was almost like a bell went off and your mom was like, okay, so legally, I'm getting the hell out of here. Good luck, Brittany and guy I don't like anymore. I'm gone. And, and so that's not just, I mean, like, like, be really serious for a second, like your parents get divorced, you're still 18 You're still very young. And so that's happening. And as that's happening, somebody looks at you and goes, Oh, by the way, this disease that we've been handling for you, you got this now, goodbye.

Brittany 5:37
Yeah, that was really hard.

Scott Benner 5:38
I can't I can't imagine like it. I'm assuming you didn't? Did you throw yourself into understanding the diabetes? Or did you kind of ignore it for a while? What

Brittany 5:46
was the path, I definitely went the route of ignoring it. And recently, for most nature, podcasts, I started caring more, I also got married in between that time from 18 to 23. So my husband is always like, you need to take care of yourself. And then from him and your podcast. I'm kind of realizing like, I am in control, and I need to do something about it. But I feel like without the guidance from your podcast, I might have not learned that too, like later in life. First of all, I'm

Scott Benner 6:13
glad to hear that your husband likes you. He clearly wants you. He said, and, and we like you, Brittany. So we want you to stick around. So so we're gonna, so the reason you're on today is because you sort of wholeheartedly grabbed on to the idea of like being bold. And but it just, it's not going well. Is that right?

Brittany 6:33
Yep, that's totally correct. I'm the kind of person that you talk about in your podcast that thinks 200 is a good number, just due to the fact that I'm so scared of going low. And I don't know how to get over that factor. Like it's just in my head, way back in there. And I can't really seem to pass. That fear,

Scott Benner 6:53
I guess to speak on p can't get over. So. Okay, so that's a good place to start. Let me just, um, let's break it down a little bit and talk. So you said you have it on the pod. And you were kind of insolence in that I'm in the army pod.

Brittany 7:05
I'm currently on Nova log

Scott Benner 7:07
log, and you have a CGM, by any chance. Yes, I'm on the Dexcom. Okay, so you are set up for success. Now we have to just shove you up over the speed bumps, so you can get on the bright shiny side of it. And, and get off the side with the big puddle and the puddle. So so so I think the what we're gonna do is this podcast is probably going to fall a little more along the lines of what a private phone call with me might sound like. So if you don't mind, I'm gonna, we're gonna ask a lot of questions. And we're gonna talk back and forth and see if we can figure out so let's first say, of course, Brittany, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before bla bla bla bla bla. And basically what I'm saying is if you listen to anything that I say, and you drop that, please tell your husband not to call me.

Unknown Speaker 7:54
It's good to get that serious. I

Scott Benner 7:58
think the first thing you're bringing up is your fear. And, you know, we you've probably heard me talk about on here is the first thing that I identified is when I when I decided that I wanted to try to help people understand better how to manage themselves and take care of themselves and be healthier. The first thing that I identified as being an issue was going to be to wash their fear away. Because once once you've got that fear, and it's completely founded, you know what I mean? It's not like you're just scared for no reason. Some, some people can push past it, and some people get stuck in it. So So explain to me first, that piece of it when you go to push your blood sugar down, what's the feeling. Um, so

Brittany 8:39
during the day, now I'm getting a little bit better, I kind of stay around like 150, which I know is not very good. It's one of the nighttime lows that I'm scared of. So I will literally, if I'm like 120 before I go to bed, I'll eat a snack to make myself 200. And I don't really feel comfortable going to bed under 200. So push my sugar up purposely just like to have a low overnight, even with the Dexcom I have never really had a low blood sugar overnight. I'm just scared that it would happen. I heard a bunch of bad stories about that. But during the day, because of your podcasts, I feel like I've got a little bit more tighter control during the day. So I know I could fix it easily. As for the nighttime, I'm kind of freaked out by

Scott Benner 9:21
I get that so i think that that sounds to me like your path to losing that fear is probably less based in overnight at the moment and it's more based during the day when you can see it so I would think that once you could see yourself let's see how to say this. So during the day, are you having stability with your blood sugar's are they bouncing? They're like a roller coaster. So then that's really the first step to getting rid of the fear is finding stability because once you find stability, and you can live with that stability during the day, then you can start trusting that what you're doing is causing the stability and then maybe you can get into a position Where you can start trusting overnight that that stability is going to stick around for you too. And, and then from there, I think you have to sort of lean on your husband a little bit and tell them look, you know, I'm gonna need you to listen for this alarm as well. You know, it can't It can't just be me. Because if you do get low overnight, and you know, you might need someone to help you, but but are you afraid of like a little low? So like, let's talk about low for a second. What do you consider? Well, my

Brittany 10:27
Dexcom is at 90 and under.

Unknown Speaker 10:29
Okay? Do you fat

Unknown Speaker 10:31
I start,

Scott Benner 10:32
right when you feel low,

Brittany 10:35
probably around 100. And my sugars are usually around 200 700 fields can start getting shaky and stuff. I feel like it was around 100.

Scott Benner 10:43
Okay, so I'm pretty sure that once you once we can push down your daytime blood sugar's a little bit, that 100 won't feel low anymore. And so, so try to keep this in mind. Nothing bad is going to happen to you like you're not going to become incapacitated at 100 or 90 or 80 or 70. I mean, you might feel really shaky right now, because your body's more accustomed to being at, you know, a 200. But listen, I've seen my daughter have a seizure. And it doesn't happen till you're like under 30. At least for at least for art. Now. Hold on one second. We're gonna do our Yeah, you get to be online for Arden's Arden's bolus. Yeah, she's at school today and she has a half day. And so she doesn't have a full meal. She's got she's just kind of a crappy stuff from the meal. or blood sugar 75. When are you eating? Because I don't really know the the half day schedule all that? Well. She's gonna tell me she has no idea. Because she's gonna try to make it harder. I'm waiting for the confirmation of what I know is going to happen, which is?

Unknown Speaker 11:59
I don't know.

Scott Benner 12:01
But let me think of what's in that bag. Oh, it's a cornucopia of not good stuff. Actually. She got a little mixed fruit cup. She has a small banana. She has a grab bag of Doritos. I believe they're Cool Ranch for those interested. Four or five braided pretzels that are about three inches long and about a quarter a half inch thick. And I think that's what Ooh, Oreos, three Oreos, so Oreos, pretzels chips, 247 banana, eight and a half mixed fruit cup 10. Think 10 units, although a britany. Number. Let's try 10. So she hasn't even gotten back to me yet. So she's in the middle of a class right now with the teacher who's probably not accustomed to her texting about her or her blood sugar. So she's probably being a little more covert. So now I say hello. Then she will answer me back that she's not the flash is what she told me last week, she said. Second, I'm not the flash that I sent animated gifts to the flash adder for a while. So that until that irritated her and then I stopped. I'm going to say that this is about 10 and a half units, she's probably going to eat in about 15 minutes. I love the 75 number has it's a nice steady 75 she's been around 82 all morning. Awesome. She's This is a drift, not a fall. And if I look at the three hour line on our Dexcom right now it's bending the other way. So I'm willing to bet that if we did nothing, she'd probably be back above 80 in the next five or 10 minutes. So let's be a little more aggressive here and actually go with the whole 10 and a half units. That right? Cookies are gonna really kick her in the butt. All I need now is for to answer I Brittany, we're gonna keep talking until she answers but I'm going to type my response to her now which is going to be Bolus. Let's see extend let's say 10 units, I chickened out on the other half. And we're going to do we're actually going to do to zero percent now. And the balance and the rest. Oh actually, she just answered me she's going to be eating in 10 minutes. So zero percent now and the rest over half hour. So that'll give it 10 minutes for the first let's do our rough match, first third of the insulin to go in which is going to be about what three and a half units. It'll start being active. She'll go up till about 90 when the food hits or the rest of the incident will kick in. This might work I might have to I might have to Bolus again in about 45 minutes if the if the cookies that are really fast. Anyway Brittany okay. So So our first I think our first step for you is that you feel low when you're not low. Right. And while I can't tell you exactly when your body is going to, you know, kick over, you know, I can tell you that for Arden, I've seen it twice, it's been under 30, both times, like I've seen her be 30 and be talking. And we of course, don't want you or anyone else in that situation, that information is just to help you have comfort to tell you that 100 You're still really good. So you're not just good, my blood I haven't eaten yet today, my blood sugar is probably 80. And so that's, I think, is your first hurdle. And I think the way you get past that hurdle is by pushing your daytime blood sugar's down slowly until that feeling goes away at 100. So if you're sitting at 150 now, so where's your tummy, your Dexcom lines again?

Brittany 15:53
Um, so as low as 90, and then my highest 180?

Scott Benner 15:57
Okay. So this is simple. It's it's Thanksgiving weekend, we're talking of the day before Thanksgiving. So the first thing you want to do is push your height down to 150. And start addressing your blood sugars when you as you're approaching that. And are you using kind of the bumping and nudging idea of not like because it sounds like you're not. Because here's what I think is happening. I think that you're getting to one at your decks comes telling you your blood sugar's high, your bolusing probably a significant amount of insulin or you're not, or you're just happy to just kind of leave it at 180. And then when it's time to eat, at some point, you have to be aggressive with the insulin, when is it and you're probably doing it before a meal. And then you're getting low afterwards. Is that what's happening?

Brittany 16:41
Yeah, pretty much so it's like really sturdy at 150 he then skyrockets then I'll go well,

Scott Benner 16:47
okay, so you're not Pre-Bolus

Brittany 16:50
I tried to do it 15 minutes before just doesn't seem to be working very well.

Scott Benner 16:55
So what happens? Well, so So first of all, you're starting at 150. So you're a little in the hole already. I would love to see you address the 150 before a meal. So for meals at noon, maybe at 1115 work on pushing the 150 down to 110. And then so just a small bolus or even an increased bazel, right, to push the 150 down so that when you're eating, you start eating more around 110 until you start to feel better at 100. And then, then you should be able to put in a Pre-Bolus. That would be impactful enough to stave off the spike a little bit now. So are you spiking? So tell me about the Pre-Bolus happens 15 minutes later? Are you actually seeing a decrease in the 150? Or is it not moving at?

Brittany 17:48
All? Does it move down? Yeah, just goes up, and then they'll crash later.

Scott Benner 17:52
Okay. So in, I would like to see you wait for the Pre-Bolus to be working before you start. So a diagonal down arrow. You know, if you start at 150, you get diagonal down and all of a sudden, you're right. Are you using the whole amount as a Pre-Bolus? Or not all of it?

Brittany 18:10
Um, usually I'll do like 50% up front and a 6% over the half hour.

Scott Benner 18:17
Okay, so So then, so then think about it this way. You've calculated amount of insulin you need you think you need for the food, you may or may not be right, it sounds like you're probably not, you're probably under estimating. On top of that you have a blood sugar that's in my mind 60 points higher than you want it to be at 150. And so you're not compensating for the 60 points in the bolus, and you're probably under counting the carbs. So you're just not starting with an offense.

Brittany 18:47
Yeah, I definitely. I definitely don't do carb counting. Well, I'll be like, Oh, it's probably 80 and then I'll bolus for like 60 I don't want to go low.

Scott Benner 18:56
Now that imagining that many of you have felt the way Brittany felt or maybe you still feel that way. What you need is some confidence, a backup. You need a partner, like the dexcom continuous glucose monitor. You need to be able to feel like I can bolus with confidence because if I should miscalculate this insolent, I'm going to get a warning well ahead of any kind of a problem that I might have with a low or a high blood sugar. And that's just one of the amazing things that dexcom continuous glucose monitor can do for you. Besides telling you your blood sugar is getting low your blood sugar is getting high. It's rising this fast. It's falling this quickly. What else does Dexcom do for you? Well, I'm glad you asked. How about a share and follow feature available for Android and Apple phones. where someone wearing the dexcom CGM is anywhere in the world really. And you are anywhere in the world and you can see what their blood sugar is. You can follow along with their blood sugar, maybe your child at a sporting event asleep over at school. Perhaps your spouse is a nurse who just worked a long night shift and is now at home sleeping while you're at work. All you do is set the parameters where you want. Now we have Arden set at 70. Right, her low blood sugar threshold on her dexcom is at 70. If she drops below 70, it tells us we have her high set at 130. In her blood sugar tries to go over 130 it tells us and then we can make decisions, insulin decisions that keep things from getting wildly out of hand. You You know, you listen to the podcast, you know, just go to dexcom.com forward slash juice box, the links in the show notes for Juicebox podcast.com.

Brittany 20:43
I definitely don't do carb counting, well, I'll be like, Oh, it's probably 80 and then I'll Bolus for like 60.

Unknown Speaker 20:49
I don't want to go low.

Scott Benner 20:50
Think about it this way. I think this this isn't real simple, real simple way to figure things out as far as that goes, which is if you're bola Singh, we're just going to use pretend numbers. But if you Bolus 10 units for a meal, and an hour later your blood sugar is How high do you see it go to when it when it pumps up?

Brittany 21:14
Like 270 problems.

Scott Benner 21:16
Now you're at 270, how much insulin does it take to get you back to 154 unit. Okay, so those four units belong in the initial bolus. Right, because if it if you put in a certain amount that you think is right, but not being correct, and four more units has to bring it down those four units belonged up front, you needed them. Now, you might end up finding out that those four units maybe aren't all needed if the Pre-Bolus was more aggressive. So if the Pre-Bolus was more aggressive, it's possible those four units might be three units or two units, you might you might actually be using more insulin, because of the way the timing of the you're using it than you would if you if you use more up front, because now you're not just addressing the food, you're dressing the food and the high blood sugar. And and let's remember, you're not actually getting back down to 90. So you're still that's still more in there you could use so there's there's a lot of leeway for you to be more bold to be more bold, I guess. And and and still be on the safe side. Yeah.

Brittany 22:25
Yeah, I get you. I have a question. So I know you're talking about art in the seizures. So how did you get from that point, you think to like how you are now like, how did you stop being afraid? But is there any like, key to that? No, I

Scott Benner 22:40
think the way I stopped being afraid is it took time, and it was a call. It was a collection of ideas. It was first of all, my very first situation was my endocrinologist, nurse practitioner Arden's told me that her biggest hurdle in her job was getting people not to be afraid of insulin. She said that if she could do that, she'd be the most successful nurse practitioner in the world. And so I thought, okay, if she's identifying that as her most important goal, maybe I should make that my most important goal. Obviously, having a dexcom CGM allowed me to be more like free with that idea. Because you really do have a, you know, there's an early warning system to let you know, something's going on. And so I leaned on that a little bit, then it was just sort of my desire from there about health. Right? Like, like, you start thinking about trading now for later or later for now. And thinking like, you know, why am I Why am I living? Why am I letting my daughter's health be? Oh, we'll cross that bridge when we come to it. Because when we get to that bridge, that bridge is going to be some serious, like long term effects from having diabetes, it's not, it's not going to be, you know, a fine ipay at the end, it's going to be, it's going to be any number of scary things that could happen to someone whose blood sugars are high over a lifetime. And so has it in my head, like, I don't want to trade. I don't want to trade today for tomorrow. I don't want to kill her. But I don't want to trade today for tomorrow. And then I think you're gonna find this kind of hard to believe. But the thing that really helped push me over, was talking to will hovers mom, and I don't know if you've listened back to that episode. But we'll pass away. He was at he was at college, he got the flu, I think he passed away in asleep and spoke to his mother about it for an hour. And towards the end of the episode. She just said this sentence that just impacted me. She said my son lived a great life. And I would rather have seen him live, you know, 20 amazing years than 40 just so years. And I thought to be able to say that after you know, they mean like after sometimes it's easy, Brittany just to make these big pronouncements. You're young still right. But you are You'll have this moment where you'll want to have a baby or something like that, and some some silly which, by the way, don't do that. And you want to have a baby, and you'll start having these overwhelming feelings like you would give your life for your child, right? And people have those feelings. But then when the time comes to actually execute, sometimes people back up and go, you know what I said I'd step in front of a bus. But it turns out, I don't want to. You don't mean but we'll take here to here. Linda Hoffer say, after her son had passed away, I wouldn't have done anything different. He lived a great life. I thought that courage. I want to I want to have some of that courage. Like, you know, like the courage to say that I'm gonna live Well, today, the best I can today. And I don't I don't care what happens tomorrow. You know? And when you really stop and think about it, I mean, you live in San Diego, the traffic there is insane, right? Yeah, it is driving a car. Yeah. Every day, you get in the car every day and think oh, my God, I'm gonna die.

Unknown Speaker 26:05
Some days.

Scott Benner 26:09
Brittany, I've driven in LA, I know what you're talking about.

Unknown Speaker 26:11
Yeah, scary.

Scott Benner 26:14
But the point is, is you still do it? So I think that in there is the answer. Like how badly do you want to live a healthy life? Would you rather be Brittany at 45? struggling to, I don't know, be healthy? Or would you rather be you know what I mean? Like, would you rather take the risk and see what you can do? Because you know, there are no, you know, we don't ever talk about this, really. But there's no guarantee that my daughter's not going to have health issues just because they're a one sees low in her blood sugars are well controlled. Like, she could still this disease could still screw with her. And, but this gives her a better shot. And so I just want, I just want to have like a tiny bit of Mrs. harbors courage. And so I used what she said, I used what my nurse practitioner said, I used what I saw, because you're seeing it too, right? You don't want your blood sugar at 200. And so I took all those things. And I thought, okay, damn it, like, let's figure this out. Like, let's really figure this out. And then that's where the rest of it comes in, like, learning how to like land a blood sugar and keep it level so that you don't have to eat when it gets you don't get too low in the FDA, you get off the roller coaster, the roller coasters is one of the next big steps like you, you have to get off. You have to, you have to learn how to bump and nudge your blood sugar so that it's not getting wildly high, you're not putting on a bunch of insulin, and then later you're getting wildly low. Because right now what you're lacking is the balance between the insulin and the blood sugar. I usually explain it to people like overhead projector stuff, but you're pretty young. So we're gonna go the tug of war route with you. Okay, so. So imagine, imagine you've got this, you know, you've got this rope, and there's a flag in the middle. And on one side, the carbohydrates are pulling it on the other side, your insolence pulling but your goal as the as the flag is to stay in the middle, you don't want the carbs are the insulin to when you want them to pull and pull and pull. So they both get exhausted and stop at the same time. So if you start with your blood sugar, where you want it, that flag in the middle, and you come to the realization that the way insulin works isn't instantaneous, and you figure out yourself how long after I Bolus this much does my blood sugar take to start moving and give give that insulin that headstart and that tug of war. And think about how long does it take for the carbs to start moving my blood sugar after I start eating. And just find that timing that balance so that the insolence pulling, but can't pull quite hard enough to move the flag. And just as it's getting strong, the carbs start pulling, and they just are in this fruitless battle, neither of them can win. And then the rest of it is of course to get the food sort of through your system, you know that the impact of the carbs to slow down as the insulin slowing down because all high blood sugar is after a meal is the existence of the carbs in your system. Still, when there is no insulin and all low is is the existence of insulin when there are no carbs. And as crazy as that might sound like sanely difficult. You have a Dexcom it's not like so in the beginning when you don't know what the heck you're doing. Just If I was you, I'd do my Pre-Bolus I'd be more aggressive about it. I would start eating I'd start eating when my blood sugar was, you know, starting to decline and more like 120 then 110 or 120 than 150 and then I would see okay, I put the insulin in at this time. It took this long for it to start to fall. That's a problem. My Pre-Bolus time right there, I started eating at this time. And then the diagonal Down Arrow, the down arrow level out that distance of time between when I started eating, and when the arrow leveled up, that's about the time the carbs take. And then before you know it, you won't think about it like that anymore. You don't I mean, you just yeah, instead, it'll just happen, you'll just, you'll just put the insulin in. And all this timing stuff that seems so important, you'll learn after a while it does, it's not very specific. He just kind of have to get the insulin going, and then put the food in. And if you miss on the insulin, and your blood sugar starts going back up, put some more insulin in. Don't wait. Like I after our needs. If she gets the diagonal up, 130. I start the bolus again. But I just assume I did not put in enough insulin or I miss timed. And if I miss timed it, then maybe she's going to try to get low later. But I'd much rather address that with some quick acting juice or something like that. Then to let her go to 270. This end? Yeah. Does any of that help you?

Brittany 31:04
Yeah, no, it totally does. I'm just on the opposite. I'd rather be 270 than, like going low.

Unknown Speaker 31:10
I don't know why.

Scott Benner 31:12
Let's not say you don't know why. Because it's freakin scary. It's really. Yeah. And and, listen, there's nothing wrong with being scared of it. It makes 100% sense. But it's just that's your goal is to get past that fear. Because? Because you I mean, you know, listen, you reached out to me, this isn't what you want. It's not what you want for yourself. Right? Yeah. So, so what do you want? And how do you think like, can you examine yourself a little bit and think about? Like, what are some of your sticking points that maybe we could alleviate, or talk through?

Brittany 31:47
Um, well, I start correcting for a low when I'm at like, 120. Like, diagonal down, I'll start correcting already, and then I skyrocket to 200.

Scott Benner 31:58
So do you ever just wait and see what happens?

Brittany 32:01
I do sometimes. And it ends up being like 105. But I freaked out. Other times, then I go to like 200. So I have to correct again. And then I go back to that point where it's like, about to go low. I just feel like my sugars are never sturdy. It's always like going up or going down. There's no like steady lines. When I see people with that steady line graph. I'm like, What are they doing? Because mine is always up and down.

Scott Benner 32:24
Here's what they're doing or not doing. They're not correcting a perfect blood sugar.

Brittany 32:31
The bad thing to do,

Scott Benner 32:32
I see 120 diagonal down. I'm like, oh, we're finally getting there. And and if it level off at 105. In my heart, what I'd be thinking is, ooh, this is perfect. Maybe it'll drift down to 85. where I'd really like, you know, I mean, like, yeah, maybe it's just your because you're not, you're not operating in a low spot where you're in trouble. It's not dangerous for you. So it is more about the way you're thinking about the numbers. And so it makes me go all the way back to one of those episodes on if you ever heard it, where there's a mother of a son who she just admitted. I didn't get it out of her just came out of her. She was being honest. And she said, I'm at the point where I think of 200 as being right. And talked myself into believing 200 not too bad. So when we're at 200 I don't do anything. Okay, that's where I'm at. Right, right. And so so I think you just changed the numbers, right? Because you're not Unsafe at 100 and you're not Unsafe at at all your your what you're you appear to be being conflicted by the actual number, suit. So you have to change your opinion of the numbers. And forget the high stuff. Don't Don't worry about the like, scaring yourself stuff. I don't want you to scare yourself. I want you to not be scared. Like, I want you to look at an ad and think oh my god, I won. Not not Oh my God, I'm low and I'm gonna die. Because Yeah, because nothing bad's gonna happen to you when your blood sugar's at 80 knots. It is a matter of fact, it's probably perfect. You know, and so at and falling, obviously. I mean, I guess we can say this at and falling would be a different situation that that would need a correction. But at instead, I mean, listen, you just heard me give my daughter 10 units. She weighs about 96 pounds at this point. I gave her 10 units of insulin while her blood sugar was 75. Do you remember how long Let me tell you how long ago that was that was fish teen have to look at my text. So I know for sure. Now I'm using a different insulin than you are. But I just figured out how it works in her. So we gave her that bolus at 1016. My time it's 1035. So let's call that 20 minutes. When we did it. Her CGM had her at 75. Right. And I told you there was a little bend up at the end of the three hour line. So she's had that insulin and for 20 minutes, we did. I think we did nothing up front. So maybe the first two thirds of the insulin are in now some of its active. What do you think her blood sugar is right now?

Brittany 35:16
I would say low, but I feel like 50 Okay, so that's what

Scott Benner 35:21
I want to get out what you think. Right? So artists are just blood sugar 72. And her her graph line is exactly the way you're talking about it. As a matter of fact, it's been like that for the last six hours. Now, I also want you to know that at 3am, she had a spike. She went all the way to 203. And it's not like Arden's blood sugars are perfect all the time. We do, we don't restrict the kinds of food sheets, so she does have, you know, she does have spikes. We've been over 133 times in the last 24 hours. One time I got it back really fast. One time, it took a couple hours to get back from about 180 to 130. And then the overnight, like I said, spiked up really high. And it actually took a couple hours to come back now. The point is, is that I think what you're seeing is happening, and what you're expecting is going to happen at this point are two different things. So I think you're in that spot where I use this very convoluted sentence to explain it. You have the CGM, you have a Dexcom you can see what's happening. You've been watching it for a while, you know what happens? Like you need to start believing that what you know is going to happen is going to happen. Because right now what you're doing is you are looking at all the data. You see for sure what's going to happen and then you decide to not believe Does that sound right? Did you know the Omni pod tubeless insulin pump has over 300,000 members it's Potter community, Potter with a D and another day today's pa odb er not Potter, like that magical guy in the movies. Potter's there's 100,000 of them and you could become one of them. Whether you're currently using daily insulin injections or a traditional tubed insulin pump to manage your diabetes. The two part on the pod insulin management system can simplify insulin delivery and help you to live your life on your terms. Type One Diabetes Type two gestational la da. They call that Lada latent autoimmune diabetes, you've heard of it doesn't matter what you have the Omni pod system may be the perfect fit for you. And here's how you're going to find out, you're going to go to my Omni pod.com Ford slash juicebox going to click on the links in the show notes or go to Juicebox podcast.com. Those links are there as well. And you get there you fill in the tiniest bit of simple information about yourself. And on the pod, we'll send you out a demo. It's a non functioning demo pod that they're happy to send to your house so that you can wear it, live with it and decide if what I'm telling you about the Omni pod is true. I think you're going to find that it is absolutely fantastic. And you're going to want to know more. It's going to be that simple. Miami pod.com Ford slash juice box. The links in your show notes are at Juicebox podcast.com. Get a free no obligation demo pod today. There is nothing better than free. And there's nothing better than not being obligated. Unless you're a magical wizard. That would probably be better. But I mean, you know, you see for sure what's going to happen, and then you decide to not believe it. Does that sound right?

Brittany 38:50
Yeah, that sounds really right. I feel like when I do like what I actually do, as opposed to that's what I always experienced by Lowe's. So I kind of just don't do what I'm supposed to do. I don't experience those. What's the low? Like first day yesterday, I was like 52. And I actually bought a little bit less for what I ate. And I did my correction I started off but a good number that have been 52 which I didn't give myself the full influence. So it was kind of weird what you

Scott Benner 39:19
do for the 50 to

Brittany 39:23
two cups of orange juice and a packet of Skittles like the small one.

Scott Benner 39:28
The answer I hear from you is I I overreacted to like 50

Brittany 39:31
Yeah, yeah, I really did. I was just feel like it's not gonna go up fast enough. It's just gonna keep going down and

Scott Benner 39:39
what was it What? What was happening on the Dexcom? Was it 52 falling? Was

Brittany 39:43
it 5252 diagnol down.

Scott Benner 39:47
Okay. So your phone you think one or two points per minute maybe? And Okay, so let's say you were scared enough to drink an orchard of orange juice which it sounds like Did you just throw the Skittles in? Because you're like hell in this, I might as well have some Skittles to

Unknown Speaker 40:06
pretty much.

Scott Benner 40:07
Then here's the funny thing if I did that, so I, I've done that, right, but I would I panic a little lower number than you do. But if Arden was like 40 die go down, they might be like, Oh, this is really not working and give her a bunch of stuff. Now here's the difference between you and me. When her diagonal arrow up happens, I would have tested because she's probably higher than the CGM says, right. And if I would see, for instance, in your situation, if I put all that food in, and then I saw a 60, and a diagonal up, I'd probably bolus for two thirds of the carbs that she took in. And why is that? Because you know what those carbs are going to do? Right? Mm hmm. So, so you can't so here's my theory about this. In the course of a month, if you hit 50, a couple of times and type one diabetes, you're doing fine. You might almost expect that, right. But what you can't start living to expect is you can't plan for something to go wrong. You have to plan for something to go right? Because getting something to go right is not easy. And something going wrong is gonna happen one way or the other. Because you're experiencing 52. And you're still keeping your blood sugar at 200. So let's so let's say to ourselves, Look, I know my blood sugar is probably going to get lower than I wanted to sometimes. But I'm not going to let that affect how I handle all the other times because those lows are an anomaly for you. So if an anomaly happens twice a month, why would we take the other 28 days and act like they're happening when they're not? So I always I used to tell artists, schoolteachers, when she was really young, we put all these things in place and everything. And they would always say, so we're going to all these, all these things we're doing this is to keep her from getting low. And I used to laugh and I went, No, no, all these things we are doing is so you can handle it when she gets low. Because she's going to get low. We're not we're not planning to stop below, we're planning to live well. And then when a low comes, we know how to handle it. And so I don't know if that makes it that's convoluted or not, but you can't you can't plan for failure. Because you're gonna get it then. Yeah, you know what I mean? So and 52 set, were you alone? Where was your husband there?

Brittany 42:35
I know I was at work.

Scott Benner 42:38
What kind of work do you do? Like if you don't have to say What? Are you doing something physical? Are you sitting in a desk?

Brittany 42:43
I'm just a nanny. I watched the little kids,

Scott Benner 42:46
not just a nanny. That's a big deal. So now you so you have two little kids with you. So not only are you worried for yourself, but if you pop over those kids are going to probably eat you alive like cats. Yeah.

You don't want to wake up after your liver kicks in and find like a three year old gnawing at your stomach. That's weird. You know, quick, those kids will panic and think they're starving and go right to like, cannibalism. You don't need that breathing. I understand. But no, you have a responsibility. So you have responsibility to yourself. You're responsible these kids. And but let's talk about the rest of it. You drank the out the citrus orchard, you ate the Skittles. Do you ever smash the Skittles together? So you get two colors at once? You're not you're not a factor. Like I see you have that going on? Right? What? And tell me what happened afterwards? Where'd your blood sugar go? And how fast did it go there?

Brittany 43:44
So I actually leveled out at like 130 which I was surprised at because usually when I do stuff like that, it's like 300. So I ended up being 130. And it went up pretty fast or no, I checked it probably 15 minutes later, I was already at 100 so I knew not to correct anymore. So I definitely overdid it.

Scott Benner 44:07
Did it. It did it stay at 130

Brittany 44:10
actually did stay at 130 I was really surprised and

Scott Benner 44:13
this is a good example of this really is an anomalous situation you really did somehow mess up your Bolus. And and or the food didn't do what you expected. Or there's one of those physiological things going on when you know that happens periodically. God knows why it happens. Right? Where where you do everything. T It is worth noting right? Like the things I talked about, like Dude, you have to expect that what's going to happen is going to happen but you have to know that once in a while. It's not like it's it. There's where the diabetes comes in. Like once in a while you're gonna do everything right, something's gonna go bonkers. But then you handled it like, I don't I don't see that you did anything wrong in this situation.

Brittany 44:55
Oh, yeah. Usually when that happens though, I will be 300 after right I definitely raised The braid the kitchen forever, like find.

Scott Benner 45:02
So what would have had At what point after like say it didn't live off at 300? what point would you have done something about a rising blood sugar?

Brittany 45:12
I probably would have let it stay high for a while because I would be really annoyed that I went low. Because when I go low, I feel like I'm honestly dying. Like, I'm like shaking and I shake my whole body's like shutting down. So I probably just let it mellow there for like, a little bit just so I know safe for like a second. Yeah, probably like an hour after I do something about it, which I know is that

Scott Benner 45:36
that's where you're at. You're 270 you're talking about all of a sudden, now you've got this high blood sugar, and it's going to take a ton of insulin to pull it back down. And then then you start roller coaster like that.

Unknown Speaker 45:47
Yep. Right. Exactly. So

Scott Benner 45:49
listen. So in this one specific situation, you did it exactly right. Had it been a situation where that 130 would have kept climbing then at some point. So then think of it this way, if you're too scared to Bolus for the food, start thinking about stopping the arrow on your Dexcom line usually have a diagonal up or a straight up arrow start thinking well, I'm going to at least Bolus enough to stop the rise. Right and, and that concept is the same way you need to stop a falling blood sugar to you don't want to overfeed the fall, you just want to stop it. And and especially before it gets to the point where you have that overwhelming feeling like you need to eat the kitchen. Be you know it could be when it becomes like physiological like this, this drive you want to try to stop that fall before you get to that spot. I've seen it in Arden. Like she could eat the countertop. Like she thought there were carbs in the in the you know in the slab that's on the counter she started. And that's where as a parent, I'm lucky I can stand in between her and go please just let's give it five minutes, you know and see how you feel. Where you don't you don't have that you don't you don't have like somebody who can step in and be the like the voice of reason when your body's going eat everything. And that's that sucks. But you you can make small incremental changes, like I said like so if you're going up a little bit don't Bolus for all of it. Bolus to stop the error. You know, how did you get some quick 252? What did you like? Was it just anomalous?

Brittany 47:18
I think I woke up. I was a breakfast time. So I woke up and that was 220. I don't go to bed under 200. And I corrected for that. And then I also was eating oatmeal at that same time. So I started eating when I was 220 and give myself insulin for oatmeal. But I only did like 20 carbs and it was only like 30 ish. And somehow I went low. I don't know, kids, I guess I'm running around with the kids and stuff. So maybe

Scott Benner 47:45
you had some activity you weren't Yeah, I'm accounting for maybe they'll oatmeal hit you a little slow to that sounds like something that digests kind of slow.

Brittany 47:52
Yeah, it has a lot of fiber. And

Scott Benner 47:54
I think that makes a difference. So okay, so So now just learn from it the next time like I always try to say on here, I don't think of that as a mistake, or you know, an error. Just use it as data like okay, I did this and this happened. So next time, I'll do it a little more like this. And hopefully that this will happen. Because Because you were you know, you're pretty far off there that because the Skittles, the orange juice, you obviously had a lot of insulin going you didn't need. But you handled it really well. And so, but I'm going to go back to something you said previously, when you're talking about the beginning of it, you went to bed at 200. And you woke up at 220 was a really good news. And there is you stayed really stable overnight. Yeah. So imagine how did you go into bed at 120? You would have woken up at 140. All right, so to me, so I think your goal here is to keep pushing down the tolerances. I think that the way I did that, because Arden's high, you know high number used to be at, you know, 225. And then I noticed while I'm really good at keeping Arden's blood sugar stable to 25. So I was like, I pushed it to 200. I was like, Oh, I'm really good at keeping it at 200. So I went to 180. And I went to 170, and 150 and 130. And I'm getting ready to move at the 120. Now, because what I learned was, after I knew how to keep her stable, I just got what I expected, like I and that's set like I set my expectation somewhere because you're working towards a goal. Right now your goal is 180, you're working towards a goal of 180. If you make your goal 150 or 140 or 130, that's the goal you'll be working towards. You'll use you'll use less insulin. And when you use less insulin, you'll get less volatility. It just it is I don't want to say it's simple, but it's kind of simple. Yeah,

Brittany 49:42
I think I over complicate everything sometimes like it's more like an emotional side for me, or I don't want to do what's right. If I just do it, I'd probably be fine. Absolutely.

Scott Benner 49:53
And do you know when did you get to Dexcom How old were you?

Brittany 49:57
I probably got it two years ago so 21

Scott Benner 49:59
Okay. So your mother, I don't know if he talked to your mom or not. But but so your mom doesn't have any experience with it. So she can't really be helpful.

Brittany 50:07
And she's actually following me on there. Her and my husband Follow me on the Dexcom. Follow,

Scott Benner 50:12
but I'm saying she didn't have any previous knowledge about diabetes. Oh, no CGM. So she doesn't really have any. She doesn't have any input that might be valuable from what worked for her previous.

Brittany 50:22
Yeah, she is. She has no clue how to work. That's

Unknown Speaker 50:27
great.

Scott Benner 50:29
Okay, so what do you think we're down into? We're getting into the last little bits here. So what do you think? Like, let's try to pick three things. Let's try to pick three things that put you in a position to be more successful. What did you What do you feel like are your biggest hurdles that that are holding you back?

Brittany 50:53
Probably, I don't Bolus, the right amount. So like I said, it's 80 carbs, I'll leave 60. I never do above probably five units. For any meal ever. I'll just rather go really high. Like it just freaks me out having that much on board. So I know like you were saying, kind of do like a extended the listening that would help.

Scott Benner 51:14
You could also Temp Basal a little bit too. You could, you could if you're using five units, and you think it should be more like what's your basal rate about average? Oh,

Unknown Speaker 51:25
I think it's 1.11. But

Scott Benner 51:27
you're 23? And it's 1.1? Do you weigh like eight pounds? How big? Are you? No, no,

Unknown Speaker 51:32
definitely not eight pounds.

Scott Benner 51:36
nine feet tall and really skinny. So so so maybe try this, right. So if you think about it this way, if you Pre-Bolus, 15 minutes before, and you were to double your basal rate for an hour, 15 minutes before you'd be getting an extra unit of bazel through that hour. Plus a little bit of a Pre-Bolus. Maybe that's a good place to start. I tell you, I find that extra bazel really helps for food. Yeah, I

Brittany 52:02
always hear you talking about that. I'm just never sure how to like, kind of like know how much and how long it took you to do it. So naturally, you're like, I'm just gonna do Temp Basal extra this, you know, for this long,

Scott Benner 52:14
guys could hear the voice in my head that just says more insulin. Like I don't really think about the numbers of it so much. So just blood sugars hot, like so there's that really basic tenet, right? If your blood sugar's high, you've either mis timed miscalculated, or a combination of the both your insulin. And if your blood sugar's too low, you've either Miss time miscalculated, or a combination of both your insulin. So if you're using five and five isn't enough, and you're looking for a way to sneak in, Let's sneak in an extra unit by doubling your bazel. And then look and say, okay, that happened. And here's the other thing. I give this advice to parents a lot, but this might really help you. And of course, it's not really advice, something I say to them. But when I'm talking to them privately, the weekend is a super great time to test these ideas, because you can do this one very boring thing on the weekend. And that very boring thing is, you can serve yourself the same meals two days in a row. So you can pick up breakfast, pick a lunch, pick a dinner, and give it to yourself, I'd start Friday night with a dinner, and give it to yourself over and over again, because you eliminate variables when you do that. So there's less to consider when something doesn't go the way you want. You know, so if you have a bar, you don't mean like so for lunch today, you choose a 15 minute Pre-Bolus. But you go to 20 minutes, and you double your Basal to, you know, 95% increase for an hour and your Bolus, your five units and your blood sugar goes up and it stops at 160. So then maybe the next day, you use the same Pre-Bolus but and you double the Basal again, but you make it six units instead of five units. And then you'll see Oh my god, that time my it only went up to 140. So then what you can really say is if I do the bazel again, and the Pre-Bolus again and add one more unit, I bet you I'm going to be at 120 after this. And then you can start moving around the Temp Basal the Pre-Bolus time, or maybe extending the base a little more and but because you take out all the other variables, you it's easier to see what's happening and make sense of it a week or a weekend or to have the same meal over and over and what's your husband's gonna love. Trust me, you're gonna hate it too. But it but it really helps. It eliminates things to think about when you're trying to make sense of the data. You're saying.

Unknown Speaker 54:36
Yeah, I

Brittany 54:37
think the data is kind of overwhelming sometimes too. Like I see all these numbers, but I don't remember you know what I ate when it spiked and then

Scott Benner 54:45
don't, don't worry. So simplify. It looks like here, I'll let you into my silly brain for a second. I don't think about the numbers at all. I just look at the line and I go Okay, well there wasn't enough there. So more or less sooner because a hard spike like a spike that jumps up. Obviously, I needed the insulin sooner because the food got way ahead. A soft rise that continues up might be a little bit sooner, but maybe Moreover, it's more. So hold on one second. Hold on, I my son is coming in the room. I genuinely asked him. I said, Please don't come in the house before 11 o'clock tomorrow. And he's like, I absolutely won't. Don't worry. You couldn't sit in a car. I bought you for a couple of minutes now. Okay. But, but so that that's another great idea, right? Like a hard spike indicates, wow, I did not give my insulin time to start working. And from there, you can't tell how much you miscounted on the insulin because you're flying up now. Now the insulin that you counted for the food, you're expecting to cover the food and the spike, it can't do that. It's not enough. But a more gradual one could be an indication that I just didn't use enough my Pre-Bolus isn't bad. Like I didn't fly up. But I am climbing. So the food's overpowering the insulin but not the same rate as a tough spike. I don't really think about the numbers. I think about that stuff.

Brittany 56:17
Yeah. Maybe an easier way to think of it.

Scott Benner 56:20
I don't have the mind. I genuinely don't have the mind for that. I really don't. So, all right, Brittany, guess what Arden's blood sugar is now.

Unknown Speaker 56:31
100

Scott Benner 56:33
c 69.

Unknown Speaker 56:35
Oh my gosh,

Scott Benner 56:36
it's probably not if I tested her, she's probably more like 75 or 80. But, but look at what's going on here. We put the insulin and now 2535 40 minutes ago. So she's easily done eating. I either got this really right, and she's going to sit around 70 or 80. Or I messed this up, and that's still not enough insulin, and it's going to cut those cookies are going to the high fructose corn syrup and those Oreos, come get me in about 20 minutes. But if that happens, I'm completely comfortable putting in a little more insulin to stop it. So my goal here is in an hour from now on this blood sugar's gonna be about 90. And think about that I won't be amazing. I'm not even whether I didn't count the carbs. I just went cookies, pretzels. Right. Right. And and I leaned on what I know worked in the past. And and for me, that's something I think you you probably need to do you have to stop worrying so much about the numbers. And think about the last time I did this, this didn't work. So I need more. Or the last time I did this, this worked fine. So I should do that again. You know what I mean? Like? Yeah, I think the numbers are they're sort of meaningless. It's, you know, like, for instance, he said, you drive a car, right? So when you push on the brake to stop the card, you know, how many pounds per square inch you're pushing on the brake. Right? But you don't you can stop the car. Okay. Imagine, imagine if I put that on you. And I said, Brittany, I need you to figure out mathematically how hard to push on that brake to stop the car. Well, you'd run into a lot of stuff because that would be really confusing. And I think we do that a lot with diabetes. I think we put these like these, you know, doctors slap these, these ranges on you. Because they're, you know, because they're safe to give to people. If you get low eat 15 carbs, wait 15 minutes and test again. That's like, Don't die advice that won't kill you. Or that doesn't keep your blood sugar high or low. It just keeps you from falling. So far, something bad happens. Yeah. And then you get stuck. Some people like you get stuck in the math of it. But the math is meaningless. You don't I mean, you're never gonna control diabetes by counting carbs. Exactly. And then using insulin, it's the other stuff. The other stuff that some people call the magic. I call it you know, I break it down into more of into kind of easy to follow things. And actually, I can tell you that I just put an episode up last night called let's talk Turkey. And it's 15 minutes long and it's just me rolling through the the tools I'm going to use for Thanksgiving tomorrow to keep Arden spunk sugar stable.

Unknown Speaker 59:21
Not to listen to that one.

Scott Benner 59:24
It's a rehash of everything we've talked about here, but very condensed and very quick. Okay, so we, you need to start using insulin more, sort of appropriately, a little more aggressively. Maybe we'll call it bold, right? And, and we need to, I think, I think you need to lower your high threshold on your Dexcom so you can react sooner with less insulin. And I think you should start believing that what's going to happen and I'd like to see you move away from a train yard because I don't see how you're getting any sleep

Unknown Speaker 59:59
yeah As your ears

Scott Benner 1:00:01
your know your podcast has the you know usually I think of like background noises noise but yours just has this wonderful ambience behind it that I think but I think those are the three good places for you to start believe believe what's going to happen is going to happen be more you know aggressive and and move your your line down your Dexcom so that you can get like I said less insulin to get the same. I don't that should stop the roller coaster a little bit and try not to over treat your lows so aggressively.

Brittany 1:00:34
My biggest my biggest downfall, what am I used to eat food?

Scott Benner 1:00:38
Well listen, let your excuse to be food your Bolus, just Bolus, honey, I wish I wish everyone could be here, when we make a last minute decision to buy like Chinese food. And everyone's blood sugar is like 140. And I'm like, okay, so order the food. Now, it'll be here in 20 minutes, let's put a unit on to get her 140 moving, I see the food coming in the door, I slammer with insulin, and try to get her to 80 when the when the Chinese really kicks in. So now I've got this aggressive amount of insulin working against this aggressive amount of carbs. But this fight they're having is at 80. And so when it ends, you're just there. And if it starts going low, then hey, a little fast acting just a little bit a little fast acting juice or something like that. And if it starts going high, I didn't use enough for I miss timed it more, and just fight to keep those that line in that in that in that space.

Brittany 1:01:34
Chinese food is the worst, my blood sugars are so, so bad. It's absolutely insane.

Scott Benner 1:01:40
But there'll be a moment where the things we're talking about today, you'll be able to use these things and fight against much bigger carbs than the ones you're trying for now. Seriously, I genuinely believe that six months from now, you could be in a completely different place. So do you have any questions or anything else?

Brittany 1:02:01
What would you put as like the low like for our numerator? Low? 7970. Yeah,

Scott Benner 1:02:07
but it took us a while to get to that. I think you're not. You're at 90 right now. Nothing wrong with being aware at 90. You know what I mean? But I wouldn't start I wouldn't if it was a slow drift. I wouldn't touch it. If it was a diagonal down, I'd nudge it with a couple like maybe five Skittles. Not not the bumping nudge, just remember bumping nudge, just a bump. I'm gonna nudge this line, I'm not gonna slam it. By the way Arden's dexcom just adjusted. She's 79 now, and I'm seeing a bend. And so it's very possible that just like I said, I might be bolusing again, in the next 15 minutes. So what else?

Brittany 1:02:50
I'm trying to think I'm really bad at question. Like, it's like, I have so many, they listen to your podcast all the time. But

Scott Benner 1:03:00
Brittany, write them down, write them down. Don't be scared to like, reach out again. And we could talk privately, or I just, I kind of nudged you towards coming on the podcast, because I want the people to hear who are like that bold with insulin is a great idea. I'm gonna try that, oh, it didn't work. I want you to, like I don't want them to then go. Oh, forget it. I guess that's just something I'm not good at. Because that's not the truth. The truth is, you just haven't kind of put the pieces together yet. So I think it's been really valuable to hear what it is. I mean, I knew I was going to do a lot of the talking in this one. And I apologize for that. But But I knew your questions, were going to be really specific. And I knew they were going to lead us to some good information. So I think you did a great thing for people today and for yourself. So I mean, Oh, please, congratulations. This is not an easy thing to do, to reach out and say, Oh, you know, I can be on a podcast and you weren't you weren't saying that when you emailed me. I was saying he was just like, this isn't working and I was like, come on the podcast. I bet you that her next email was like she was probably don't think and like, that's not why I email.

Brittany 1:04:08
I called my mom I'm like Mom, what do I do? Cuz like you

Scott Benner 1:04:13
tell your mom I said hello. I think it was incredibly brave of Brittany to come on and share like this. Thank you so much, Brittany for doing that. Thank you also to Dexcom and Omni pod for sponsoring the show and giving Brittany a place to tell her story. Please go to dexcom.com Ford slash juicebox or Maya omnipod.com forward slash juice box to find out more. Thank you also for everyone who's been putting up the great reviews and ratings on iTunes. I appreciate that very much. Okay, now I'm going to share with you Brittany's note not word for word because it's personal but the intent of it. Brittany is still struggling with her fear of insulin and low blood sugars. She is very excited to hear herself on the podcast hoping that that might help her make another leap. But she's, in her words worry that the disease is winning. Now, we all know that that's not going to be the case for Brittany long term, she's going to find a way past that. But I wanted to share that part with you, in case the changes that you're trying to make in your life aren't happening as quickly as you would hope. When you're being bold. That doesn't necessarily mean you're winning. I think it's more of an intent and a feeling inside. It's about not giving up. Not about always getting what you want. And Brittany is not giving up. I just I have a very good feeling for I know it's gonna work out. Okay, well now I'm gonna make myself cry at the end of the podcast. This is not a good way to end.

Unknown Speaker 1:05:50
Sorry about this.

Scott Benner 1:05:53
Guys, there's going to be a bonus episode this week. This is Episode 175. I think so there was also an episode 174 if you are multiple daily injections, you definitely do not want to miss it. Look in your podcast player you got to this week.


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#174 InPen is Like Other Pens, but Smarter

Scott Benner

click image to enlarge

The smarts of a pump in a pen...

Mike Mensinger (formerly of Dexcom) is back to tell us about his smart insulin pen from Companion Medical called InPen. Type 1 diabetes with multiple daily injections just got better.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexagoogle play/android - iheart radio -  or their favorite podcast app.

You can also listen on Companion Medical's media page.

+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:00
Hello, and welcome to Episode 174 of the Juicebox Podcast. Today's episode is with Mike Menninger. Mike was once a longtime employee of Dexcom. But he has gone on his own to develop a smart pen CMD I users, I got you covered.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise Always consult a physician before making changes to your health care plan.

Mike Mensinger 0:50
Hi, Scott. I'm Mike Mensinger, Chief Technology Officer at companion medical. Great to talk to again,

Scott Benner 0:57
I appreciate you coming back on now with a different company though.

Mike Mensinger 1:00
Yeah, the left x com about a year and a half ago. And when what an amazing journey that was with dexcom share, and z five. And it was a such a privilege to be part of all of that transformation and in diabetes technology and happy to do it again, in injection therapy. Now,

Scott Benner 1:18
it's pretty exciting. So how long were you at Dexcom

Mike Mensinger 1:21
13 and a half years. So started in 2003. And my co founder, Sean st is the CEO, he actually built the first Dexcom short term sensor in 2004. So we have a lot of early Dexcom heritage here.

Scott Benner 1:35
And so now you and Shawn are on a different path trying something different.

Mike Mensinger 1:40
Yeah, the you know, while the technology was really amazing, and that was really great to be part of everything we did at Dexcom, we were frustrated at the lack of technology that was directed towards the injection market. So there's so many great solutions today, that's available for insulin pump users. It's very exciting to see but comparatively nothing available today for injection users,

Scott Benner 2:02
it really did feel like it does feel like honestly, that people using pumps have access to so much more data and technology. And I don't I don't know if it's a left behind situation or where it was headed. But it really did feel like there was a chasm growing between people who wanted to do MDI, and people who wanted to pump and the people who were pumping, we're getting a lot more, but you think you've fixed that, don't you?

Mike Mensinger 2:28
That's what we hope. So we've brought a lot of the benefits of pumps to syringe users. And we can get into that. But you know, things like the dose calculator, automatic dose tracking those reminders, helping you manage your long acting insulins. So complete solutions that's right there on your phone and easy to use.

Scott Benner 2:45
Okay, so let's, uh, I guess we'll go back to the beginning. Did Shawn start companion medical? Or did you or who, who had the first thought and who came along?

Mike Mensinger 2:57
Yeah, we I think we fight over that a little bit. But we had the idea around the same time from two different vantage points. So he was a tandem running advanced technology. And he says that he was trying to, he was frustrated with how to bring the benefit of insulin pumps, this great technology to really the larger set of users with diabetes. But as you know, it's only about 30 to 40% of folks in type one using some pumps, and much fewer than that it's about 7% worldwide when you look at injection, therapy for insulin in total. And so he was trying to say, Well, why aren't more people buying this product? But then he had an epiphany and said, Well, maybe we're asking the wrong question. How do we bring those benefits to the folks that don't want to use an insulin pump or can't afford it. And so that's where he came at the problem. And I came at it from a slightly different avenue, inside Dexcom, we're trying to really have the best overall solution and without influence data, which we had with our pump integrations, but without for the larger market, you know, you're really limited in terms of what you can do as a solution. And so, you know, we were looking into why isn't anybody doing this? And that's how we both came to the idea around the same time. Nice. And then he was able to actually leave tandem, and start the company. But I stayed at Dexcom for three years.

Scott Benner 4:19
build up your war chest so you could get going, right?

Mike Mensinger 4:22
Well, again, there's so many exciting things happening g five and share and you know, these really great advancements within diabetes. That was, you know, I wanted to be part of those. And that was very fortunate to be able to do that why Shawn started the company.

Scott Benner 4:35
No, it shouldn't be, it shouldn't be overlooked. what you were doing there was, um, you know, and what they continue to do with Dexcom is amazing, but I think you might have, I think you might have the answer here for people who aren't using pumps. And and that's why I was excited that you guys could come on and talk about this. So I get a lot of correspondence from people who say, you know, I listen to the podcast and I want to do these things. But I don't have a pump. And you know, we've had people who listen, no, we've had many different people come on, and we talk about MDI all the time. And what we came up with was, besides not having the ability to manipulate your, your, your slow acting insulin, when you're when you're an objective when you're doing injections. Besides that, if you're willing to inject, you can make as many adjustments to your blood sugar. As people can who are pumping, you don't have, you know, you can't, obviously, your lever mirror your lantis, or whatever your slow acting is, that you're not in control of, but everything else. If you had the data, you could, you could control. And now you're you have a way to show people, everything that's sort of going on in their body with their insulin. And, and so I want to start talking about it. So I'm excited here. Right? Yeah, yeah. So you start you so you have a product called in pen. Is that that that's what I call its intent. Okay,

Mike Mensinger 5:59
that's, yep, that's the product name. Yep. And it's iOS available since December on iOS. And we just got Android approval, actually, last Friday. That's amazing.

Scott Benner 6:09
Thank you questions, and you are FDA approved?

Mike Mensinger 6:12
Yes, we got FDA clearance, actually about a year and a half ago.

Scott Benner 6:16
So what we're looking at here in its simplest idea is it's a insolent pen, but it's a smart pen. And it's speaking to an app that people use on their Android or their iPhone, or their iPhone. And what is that app, giving me? What kind of information comes from that?

Mike Mensinger 6:34
Sure. So just like an insulin pump, you have a complete history of all of the injections. And you know, when you took insulin and how much we calculate your insulin on board for you. So you can know how much is still in your body, that's going to continue to lower your blood sugar over the next five hours or so. And that needs to be factored in, as you know, for for future injections. We have a dose calculator, just like an insulin pump. And you can input your blood sugar, and your carbohydrates and subtract out your insulin on board. We also have dose reminders. So if you forget to take, say, your breakfast dose, it'll be at nine o'clock, or whenever you configure it for it'll, it'll remind you and say, hey, maybe you miss breakfast, but maybe you forgot your dosed. Figure that out, it has solutions to help you manage your long acting insulin. And remember to take that. Let's see here, the pen itself. A couple of unexplained reasons for hyperglycemia are sometimes if you leave your pen in your trunk of your car in the summer, or in the wintertime, and it goes, it's too hot or too cold, your insulin reduces effectiveness. So the pen has automatic temperature tracking. And we'll let you know if you should consider replacing your insulin. And similarly for age, if your insulin gets too old, it's been in there too long, it'll let you know it's been been longer than 28 days, consider replacing that, wow.

Scott Benner 7:56
Okay, so let's pick through that a little bit. Because that was a lot. And I'm going to start at the end, I'll start where you finished and go backwards. So the pen knows, I guess when I put in a new cartridge, and then it starts kind of a countdown for how long it's been in there.

Mike Mensinger 8:11
Yes, exactly. So when you load a cartridge into the pen, you do this every three days or whatever, how long the cartridge last few bits automatically knows that you've put a new cartridge in, and it starts that timer for you. And then 28 days later, if you haven't put a new cartridge in, you'll get a reminder on your home screen in the app saying your influent is a little bit old, consider replacing it.

Scott Benner 8:31
Okay, now that seems obvious, but how does it know what the temperature is?

Mike Mensinger 8:36
So we have temperature trackers on the tent itself. So if you leave in the car, it knows how it seen and it's sampling the temperature, you know, periodically on the pen, and it will let you know it's it seemed this maximum temperature for this length. So you can make a decision yourself whether you want to continue to use the insolent or, or replace it at that time.

Scott Benner 8:55
Like that's impressive because I'm I have the pen here I have a demo of it. And it's not any larger than any other insulin pen I've ever seen. Actually, it looks a little it's it's a little smaller. I think if if I'm right then some of the other ones that I've held. So you've How did you get all right, listen, I guess you can't tell me how you got that in there. But that's pretty cool. Yeah, thank you. Yeah, absolutely. That that is really it's simple. When you stop and think about insurance, you tell me that but I'm assuming that the you know that the work that goes into figuring out how to get that in there and get you good information is probably probably pretty intense. So on the app if I want to say look, I you know, on the days I forget my mealtime insulin. I usually remember around nine o'clock that I forgotten so I can just set up something that does just pop up and say have you taken your insulin or does it alarm or can it do either?

Mike Mensinger 9:47
Yeah, you get a notification, just like Dexcom high alert or low alert. Yeah, it's, it's not going to make the kind of loud sound but a Dexcom alarm would, but it's more of a friendly reminder that if you If it senior breakfast dose, you're not going to see that there won't be any extra steps for you. But if it hasn't seen a dose in that configured time range, it'll, it'll let you know.

Scott Benner 10:09
Oh, so that's actually even more impressive than what I was thinking. So in that time range that you tell it, this is when I eat normally, if it hasn't seen you give insulin, it tells you. Exactly. So I'm not just setting a timer that says, hey, randomly at 10am remind me have I taken my insulin today?

Mike Mensinger 10:26
Yeah, so one of our overall design philosophies, and you'll kind of see this throughout the product is, diabetes is very hard as we know, we don't want to make diabetes extra work. So let's keep it simple. Let's keep it intuitive. And if you don't have to notify you, or make you spend more time on it, get back to life and live it. And that's, that's how we designed the MS DOS reminders.

Scott Benner 10:47
It's really something that Shawn has type one, is that correct?

Mike Mensinger 10:51
Yes. He was actually diagnosed when he was attending, believe it or not. So he was able to get a TGM from Dexcom, the same day of his diagnosis, and he's never lived the day with diabetes without

Scott Benner 11:05
jamjam. Wow. So he was working in the diabetes space, but did not have type one and then developed and while he was there,

Mike Mensinger 11:14
yeah, I'm pretty late in life. So it's very unusual. It really is crazy. I have to

Scott Benner 11:17
talk to him someday. Okay, so what else was I just looking at. So you have integration. This is one of the things I want to make sure I understand correctly integration between my CGM or my, my bluetooth meter data. So I can see my Dexcom information and my information from my in pen in your app. Yes, and though run through how. So that's done through Apple Health and iOS. So Dexcom writes all of the data, it does have a three hour delay on it, but it writes it all Apple Health. And as long as the user gets permission for our app to read that data, it's automatically flowing from the Dexcom system into our system. So if you look at our log book, you'll be able to see not just CGM data, but you can see CGM with your insulin and your carbohydrate intake. And you can see the cause and effect of how they affect each other. You can go back 90 days in our logbook of your CGM with insulin and carbohydrates, and really be able to see to really be able to tell Look, I put the insulin in here. I started eating here. And then you know, now I'm moving away from what I did with the with the pen. And now I'm seeing on my Dexcom graph, here's where my blood sugar went to. And that's when you can start making decisions about maybe my Pre-Bolus could have been, you know, it's funny, there's no there's no word for Pre-Bolus sing with MDI, we'll have to make one up sometime. But pre injecting is sounds a little clunky. But so your Pre-Bolus you know, maybe I needed a little longer, maybe I could have used more insulin, like there's ways to make those fine tune adjustments that the people who listen to this podcast or are familiar with, because you can see these data points held up against each other.

Mike Mensinger 12:53
Yeah, absolutely. Excellent. So on the we also have a report insights by intent, which is right, it's kind of like the dexcom clarity, but it has a you get to see your insulin, and your carbohydrates with your CGM data is the Dexcom user. And you can see the timing of your insulin. And you can see how insulin is stacking on top of each other, because we graph it as your insulin on board. So you see the insulin and how it's acting and actually affecting glucose over time, which is a really great tool for your doctor. But also, if you have a child, you can look at cause and effects and use teachable moments to help them understand the effects of insulin on blood sugar.

Unknown Speaker 13:30
Wow, okay. Wow, that's a lot.

Unknown Speaker 13:34
But yes, there's more, Mike.

Scott Benner 13:36
This episode of The Juicebox Podcast is sponsored by companion medical makers of the in pen. In pen is the only FDA cleared smart pen paired with an integrated diabetes management app, the smarts of a pump in a pen, you get it right, in a pen in pen, the smarts of a pump in a pen. I mean, it's not complicated wordplay. I'm assuming you're getting it, you can find out more at companion medical comm where the links in your show notes are at Juicebox podcast.com. For if you don't want to be you know, all held up with that old timey internet stuff. You just go into the App Store, download the pen app, check it out, and then just push the button and be like, hey, button. I want to get this pen. Listen, I understand that you don't think you talked to the button? It was? I don't know. I don't know why I said that. Push the button. Really. You go in the app and you push the button. And we're off the rails here people. You just go into the app, you push the button and the process begins. It's very simple. Mike's gonna explain later how the insurance process works. But it seems like they've got all their bases covered. He said that some people get their answer back in just a day. And depending on your insurance, you might be really surprised at how low the cost out of pocket is. But we're getting ahead of ourselves. You need to find out more about the in pen before you make your decision. I get that. Mike and I are going to go over everything. It does in this next 30 or 40 minutes, and how you can get it if it's something you're interested in. But let me just say there's a lot more coming. There's integration with CGM and meter data. And it can remind you that you didn't take an injection. Now, maybe you find out how it does that. This pen is smart. Oh, I get it. Now. That's why they say hello, I got a run down the smarts of a pump and a pen. It all makes sense. I'm trying to wrap my head around. I haven't done injections in such a long time. That as you were talking, I just thought okay, so now insulin on board is in sort of one graph, but so is my Bolus, and I can see how they kind of overlap. So instead of having to imagine, I know there's insulin on board, but how much I can, I can see that visually, which I find, I find really amazing now, but let me ask you this question. Have you done it in a way? That's not? I look at it and go, Oh, there's so much here. I can't understand at all? Like, is it simple? Is it intuitive? When I look at

Mike Mensinger 16:00
it? When you tell me, we sent you an example report. So does that make sense to you? Well, Mike, I

Scott Benner 16:06
was opening you up to say nice things about your pen, but no, it does. It's very easy on your I guess as a way to say it, I don't look at the information that I'm seeing and feel like I don't know where to start looking. Or it doesn't make any sense to me. It's done in a really kind of simple and, you know, pleasing way in a way that I can I feel like I'm in. I feel like I'm in a space that I understand what I'm looking at. So so I think you've done a really good job. And you were very time not to take the bait. Just say something nice about the fine, that's fine, Mike. Let's see what some of this other stuff is. Because I don't I don't know that I understand it. We have some like thoughts here. And you and I have notes that I'm looking at, but like, how much insulin Do I need for a meal, it's going to tell me that based on what my carb count is. Okay, so

Mike Mensinger 16:57
I'll steal your phrase, it's about taking the right amount of insulin at the right time. So your bolus calculator just like an insulin pump will take your current blood sugar level, it'll calculate your correction of, say, 200. How much insulin Do I need to get back to my target of 100. And then it'll take how many carbs are about to eat, and figure out how many carbohydrates? How much insulin Do I need to cover those carbohydrates, and then subtract any insulin you still have in your body from prior injections with your insulin on board. And it's very similar to what pumps do. Not much of difference, the only difference that we do have. And this is similar to I think the Cosmo pump. So if you actually if you go to calculate a correction, and let's say you have a lot of insulin on board, if the correct action for the user is to eat carbohydrates, because that iob will bring you below target, it'll recommend the right amount of carbohydrates to eat to get you back to target.

Scott Benner 17:54
Oh, that's fantastic. So when we talk on the podcast about bumping and nudging insulin, we also talked about bumping in lodging food. And and the big problem that people come into is they run into that, you know, that old adage like 15 carbs, 15 minutes, if you think you're low or you're low, eat 15 carbs, wait 15 minutes test again, that kind of an idea, those 15 carbs can often be much too much, which sets us off on the roller coaster for the day. And so this is going to tell me no, you don't need 15 carbs, you should try more like this.

Mike Mensinger 18:26
Exactly. Yeah. So based on your current blood sugar level and your iob, it'll figure out how much to overcome the iob and your blood sugar to get back to target. So in certain circumstances, let's say you're very low, you're 50. And you have iob, you may need more than 15 grams of carbs to return to target. Right. So there's less guessing here, it'll it'll give you a more precise answer of how much to eat. And it gives you an opportunity to correct without overcorrecting,

Scott Benner 18:53
which is Yeah, exactly such a huge thing, because then your whole day becomes about chasing those lines around. Let me ask you a question. So we'll jump around a little bit here. What kind of insulin Can I use in the pen?

Mike Mensinger 19:08
So we take cartridges from novolog, or human log, and you get a separate prescription from those, instead of getting it in vials, like you normally would you get those cartridges, a cartridge, so there's nothing for me to fill or anything like that,

Scott Benner 19:19
I pop it out, I

Mike Mensinger 19:20
put it in the pen and I'm on my way. Exactly no selling, you just load it in there and begin using it and then change it out.

Scott Benner 19:27
So now you and I spoke recently about this and you were talking about there's just one aspect that I don't follow completely because I have been pumping in a while. But when people use a pen, the pen gets primed. And so I decided I want to use I don't know six units, and I dial it up but then the pen expresses some of the insulin to remove air from from the system. And then I don't quite get my six units. Is that what happens with most pens?

Mike Mensinger 19:53
Yeah, so you're supposed to change your needle for every injection. We know a lot of users don't do that. But even if you don't do that there Maybe an air bubble or some dead space in the needle that needs to be filled up before it actually gives you influence. And the action of priming is just to fill the needle out to get a drop of insulin out the bottom. This is something many injection users know how to do. But when it comes to smart therapies, like a, like a smart pen, we haven't seen the challenges with that on the system. So for instance, if you inject if you expose two units of insulin to fill the needle, and then you give yourself a small correction, like one unit, most systems if they can't tell the difference between those two, what you injected, and what was actually just filling the needle and priming, would think you've injected three units. And that was, you know, that would mean your iob is three units when it should be one, and your dose calculator is going to give you the wrong answer. So priming, and differentiating what was a therapy dose, and what was a prime dose is something that we do automatically for you, it's a very important feature to have accuracy of your data, so that your tools like your dose calculator can be counted on and

Scott Benner 21:01
stuff like that, you guys just sit down at some point and say to yourself, What is wrong with how people inject and let's hear all the complaints and all the things that that John's experience and everybody else and just like reverse engineering was that how the process began for you guys.

Mike Mensinger 21:19
A lot of its evolutionary, some of the problems you kind of learned as you're putting the pieces together, and then you begin trying the system out and you discover the problems with it. And then you have to go solve those. You know, as one example, the we did a beta use last summer about a year ago. And some of our users came from pump therapy. And they said, You know, I love the product, but I'm always forgetting to take my long acting insulin, because with a pump, I have an automatic basal rate, I don't have to worry about it. There's no meal event to go along with it. So you know, they're going to bed and either forgetting it completely, or like waking up again, and going remembering to eject like, I really need a reminder for this thing. We're like, great, this is a common problem, let's go add the reminder. So now you can just pre configure your long acting amount, you get a notification, and you don't even have to unlock the phone, you can just say, Hey, I log my 18 units of Atlantis, right on the home screen of your phone without unlocking it. It's very simple, very effective. And we're trying to as we uncover those solutions, we're trying to create very graceful solutions to those problems.

Scott Benner 22:23
And I appreciate that, because it's, I mean, there's no shortage of different apps around diabetes. And a lot of them come to me people like, hey, look at this app, you know, and I look at it, I go, Ah, it's just there's so many steps or just, I think that people miss what you and I were just talking about where you're speaking about at the very beginning, which is that these things aren't intuitive, which is an overused word, but simple, like, really just don't take much of your time or your effort or your computing cycles, you know, if it doesn't do that, then what I'm getting isn't worth what I'm putting in. And, and that is a huge problem, because there are a lot of great ideas that are just implemented. Not quite right. And it really feels like you guys thought this through in a way that eliminates that feeling of Gosh, I'm spending too much time in this app doing these things. I just it's very, it's very impressive, because I like I said, I've, I've seen it over and over again, there are plenty of apps where I look at them, I go, yeah, I can't get behind this. So it's like I What am I gonna tell people, you know, they need to spend an hour a day in this app in order to get their agency down. Like, no one's gonna do that. You know? So really well, and you have a small you guys have a small group of that you don't have any employees? Are you at this point?

Mike Mensinger 23:40
We're about the size of Dexcom was when I joined in 2003. So we have about 30 people now. But definitely growing but that includes our manufacturing in house personnel and our sales team. So it's really something Yeah, pretty pretty small company.

Scott Benner 23:55
Yeah. So okay, but you guys have all the you have all the bases covered. It's a small in size but but big in in theory and grander. Honestly, how do I? How do I make the decision, right? Like I tell people all the time, if you want to try an insulin pump, and you want to try the only pot, here's the steps to go try it, but again, on the pod has made it simple for people to go try it. Have you made it simple for people to try the pen.

Mike Mensinger 24:19
Yeah, good, quick story. So when we're at Dexcom, and other products like insulin pumps, it can be very difficult. Sometimes you have to call them get their insurance insurance won't approve you right away, you have to get a prior off and get your doctor to kind of build evidence to get coverage of the product. And we wanted to make this very simple, and kind of a modern, almost in app purchase type experience. So what we did is we tried to get rid of all the hardships for users like obtaining a prescription and running your insurance and figuring that out. And one of the benefits we have is we're not a you know, five $6,000 device like some insulin pumps. This is a very cost effective therapy. So we're able to do this a little bit easier than insulin pumps can sometimes. But we built a flow in the app where you can go to the website, or you can download the app. And there's a get in pen flow. And all you do is you fill in your contact information, you take a picture of your insurance card and hit send. And then what happens on the back end is we will run your insurance for you figure out how much your copay is, we'll obtain your prescription from your doctor. And then you get a call back saying, hey, the intent is you know, your copay is $20. Would you like to move forward? If yes, take the payment over the phone and ship the pen right to you. So it's very simple. And a lot of times that happens same day. So very, very simple.

Scott Benner 25:41
It's crazy, how I'm what's the life of the pen? Like because it's doing things right? It must have a power source, how long do I get to use the pen?

Mike Mensinger 25:49
That's a one year pen. There's no recharging needed. So it has a battery that supports the full year in it. And then you just get another prescription a year later for the next 10.

Scott Benner 25:59
Okay, well, that's simple. Okay, so let's, let's talk about this real quick. So I go into the app. And before, listen, let's ask like this question before people commit to get in the pen, they can still look around the app and decide what they what they see there. Is that correct?

Mike Mensinger 26:15
Absolutely, you can go download the app today play with most of the features. The only features that you can't get access to, obviously, is communication with the pen. The insulin settings and your dose calculator and iob are prescription features that FDA wanted us to verify the prescription for, and how we do that, rather than unlock codes that some beaters have had with Bolus calculators, you're pairing your intent to your phone is your prescription. So just the act of pairing unlocks those features for you automatically. There's no complex codes are anything to deal with there. Okay. So you can do everything but that you can log into and manually, you can use a long acting reminder, you can do your MS DOS reminders, a lot of the benefits and features, you get the CGM integration, the BGM integration, all that comes for free. So go try it out.

Scott Benner 27:05
So we check out check out the app, I decided I want to take the next step. I just hit that the button in there that says listen, let's keep going. And and then you guys take care of it on the other end. I am that's really something. Okay, so now, so let's talk directly to the people here. So I always feel like I'm not doing enough for the MDI listeners. And I get a lot of notes like and I always feel like I'm not doing quite enough because the you know, because the podcast is, from my perspective, it's what works for us what I can, but I can step up and say, you know, is something tried and true for me. So I want to tell people the reason Mike came on, if you have been listening for a really long time, Mike's been on the podcast already back when he worked at Dexcom and has an incredible track record of helping people with type one diabetes, to get their insulin, understand how it's working. It's a it seems to be like for me, it seems that you are you're in for urine for more than a pound with diabetes. So I was I was I was wondering, how did it start for you? Like, how did you get to DAX common initially? And how did you get into this world?

Mike Mensinger 28:11
Yeah, it was a little bit of a coincidence. I was just kind of very fortunate that it worked out this way. But I graduated college on the east coast and just wanted to move to California. So I got a job in Silicon Valley area worked in some really cool industrial automation technology. But then the.com bubble happened, dating myself a little bit here. And the whole market crashed, that industry was doing very poorly. And I wanted to move to an industry that was flourishing a little bit more. And I got all of my friends that left for startups at the time, were now looking for jobs, because they all these startups dried up, but as a different industry. And so little company called Dexcom called me, that was a startup. And I didn't really want to join a startup at the time, because, you know, I thought those were too risky. But they said no, no, it's medical. It's different. And it was down in San Diego. And so I agreed to come down and interview and I met the most amazing collection of people down there. And if you can judge a company's future success by the people they have, you know, it was a really good bet. So I took the risk, and joined an amazing collection of people. And it's just been obviously, the story of Exxon has been absolutely amazing. And they have a lot of those people. They're still today from those days. So, yeah, I kind of lucked into it, to be honest.

Scott Benner 29:30
Can I ask, have you had the experience that you hear a lot of people talk about with and I'm asking you a question you didn't know, I was gonna ask you. But I think that when you meet people who live with diabetes, and you hear their stories, it has an impact that is difficult to you can't falsify it. Do you mean like the the impact that you get from that is, did you have a lot of contact with with users at Dexcom? And do you now within Penn, do you talk to the people who are using the products?

Mike Mensinger 29:59
Yeah, I mean, that's a That's one of my absolute favorite things to do is to go to the shows to talk to folks on the phone who are using the product. And, you know, we're You and I are both extremely lucky to be able to work in an area where there's such a huge need. And you're really impacting people's lives in a major way day to day, and you're doing it through your podcast we do through technology. So, you know, everybody that works here, just loves coming to work every day and know that they make a big impact in the world. And how many people can say that in their daily lives, there's a lot of great jobs out there. But you know, we all feel like we're just in the luckiest of positions to be able to do this.

Scott Benner 30:37
I completely agree. I think there's nothing better than seeing someone start at one level get to another or be struggling and then not struggling or to even help somebody, you know, this, this episode is going to go up this week, and it'll go up with another one. Right? So this is Episode 174, there'll be Episode 175. And that episode is with a person who is just they're afraid of their insulin, they're doing their best, but they just can't kind of conquer that fear. And, you know, interviewed that person, now we've gone back, I keep in touch with Brittany, and we're trying to, you know, I'm trying to help her work through it. And it's, you know, it's just finding friends, it's just finding someone else out there who understands, and seeing the value in that. And, and, you know, I this is might be a leap, and I hope it's not. But like I said, in the very beginning, when I started talking, I always feel like we're not quite doing enough for the people who inject. And I have a lot of hope and a lot of excitement around impairment and what you guys are trying to do, I really feel like there's an opportunity to take those people and kind of like in one fell swoop just yank them up into the same kind of tech world that everybody else gets to live in with their pumps.

Mike Mensinger 31:49
Yeah, thank you. That's exactly why we're here. And there's some other great technology coming now. The world I think is catching up to, to be able to give solutions to the users who don't want to pump. And it's great to see is it's a really big need.

Scott Benner 32:03
Well, let's talk for a second about what people are going to find when they decide they want to they want to try the pen. are most of them going to get a good response back from their insurance companies. What have you been saying? Okay, we're more than halfway through our conversation with Mike talking about in pen today, you must be, at this point, starting to get the vibe that this is something you're interested in finding out more about. I've made it completely simple for you to do that. There are links in the show notes of your podcast that there are links at Juicebox podcast.com. For this episode, there are links, there are links, there are links, there are links, you might click to the key click on and the next thing you know, everything is clear, you can do it. It's not hard. It's not hard to do better for yourself. If you're using MDI, now, this is an opportunity for you to get almost all of the technological. But it's is the word I one benefit. That's a good word. Almost all of the technological benefits that pumping brings you. You know what? Sure you can't manipulate your temp basals. But that's, you know, that's the world you live in with MDI. It's not the worst thing in the world. Can you imagine having all this other information to make these great decisions with you listen to this podcast all the time, and you hear about the return of data, and how we can turn that data into better decisions, better outcomes, less spikes, less lows, this is what you want, if you're using MDI, in pen is worth a look. companion medical comm links in your show notes links at Juicebox podcast.com. Or just go to the app store right now download the app, check it out, and then right through the app, you can apply to get the patent. It's super simple. The embed app is currently available for iOS, that's your Apple products. If you're listening in the summer of 2018, it has just been cleared by the FDA for Android phones. So give companion medical, you know a little bit of time to get it into the Android store for you. are most of them going to get a good response back from their insurance companies? What have you been saying?

Mike Mensinger 34:24
Yeah, so right now and you know, the normal process of a new category of product introducing into the market is you have to go to every company, one by one, you go to the blue Cross's and the kaisers and get knows of the world and tell them about the product and convince them of the benefits. But we've been very fortunate, largely due to our low price point. So compared to other insulin therapies, this is very affordable. So we've had very good coverage right out of the gate. So a lot of I would say about 70% of our users are getting covered at some level. It's pharmacy benefit, so on Like insulin pumps, which are kind of a different channel. Usually it's whatever your copay is based on your your individual medical benefit or your pharmacy benefit design. So it may be $20, or maybe $50, and maybe zero dollars. That totally depends on your plan. But we're seeing, you know, we had someone the other day that filled out to get in pen flow at the diabetes conference in Orlando, they had a call back same day and their copay was $5. So it's, we've had some really, really good experiences with getting getting folks covered. And we're working with the insurance companies to get that better every day.

Scott Benner 35:35
Do you have a mechanism? If somebody should find that they're not covered at all? Do you have a mechanism for an out of pocket cost?

Mike Mensinger 35:41
Yeah, absolutely. So if if you get that we will work with you, we have some programs in place to make that affordable. We don't want anybody who wants this product not to be able to get it. So just give us a call directly at companion. And we'll work through that with him. Okay,

Scott Benner 35:55
so I'll put links in the show notes to all this so people can find it. And there'll be links back at Juicebox podcast.com. And I'll give, I'll give you guys everything, how to get the companion medical, how to find the apps, all that kind of stuff. So when I have now I've done this, right, I've got the pen, it's tracking my data, I'm hooked up with my Dexcom data. I'm not through, you know, through my healthcare. What am I going to be? How do I go about taking that to my healthcare provider when it's time for my endo appointment? What do I have to bring with me or do?

Mike Mensinger 36:27
Yeah, the Yeah, the MDI. Users have traditionally had these log books. If you're lucky enough to have a CGM, you can bring your CGM report, but you haven't had any source of integrated data. So we just released prior to Ada being in June, our insights by intent report, which is kind of our version of clarity, or you know, any of the other reports out there, but we did, as we mentioned, integrate insulin insulin on board, you can see the effect of every day and every decision that you made. And that made it very easy to share. So, given the mobile technology, it's not a separate app, it's right there as a tab on your main app. And when you want to share it with your healthcare provider, you can email it, you can message it, you can fax it directly in the app to your doctor. So it's extremely easy to print share directly from your phone,

Scott Benner 37:17
okay. And then the other one, which is something that happens to me a lot in the in the office is I just hand my phone to the doctor,

Mike Mensinger 37:25
or you can print ahead of time and

Scott Benner 37:27
just here just swipe through this and look real quick. But know that that's listen to one of the main things you hear people kind of wringing their hands over as their endo appointments come as I haven't put this information together, I you know, I have to write out logs, and I have to find everything. And then I think they just end up not doing it. And and then it's a shame because it's an opportunity missed. You're going into the endocrinologist, now's your time to ask your questions. And wouldn't it be great if you could lay the information out the simple way that the endo could follow that you could point and say here, look, I did this here. And this happened? And what do you think, you know, should I try something different? And so you guys have made that easy, too?

Mike Mensinger 38:07
Yeah, I mean, who has time for manual logbooks, just no one does this, if you know most of them are filled out the day before if you do have a logbook, but you know, your doctor is only as good as the data they have. So if you have some, if you have a CGM alone report, which is fantastic. And you have some hyperglycemia, you know, what's the cause of that? Did you forget to take your insulin? Or did you underestimate the carbs in that meal, are your bolus calculator parameters wrong and need to be adjusted, there's many, many causes there, or maybe your temperature of insulin was went out of range, and your insulin is less effective. So the more tools and getting to the root cause of those problems, that report can help your provider with, you know, the more actionable data they can use to make better therapy adjustments with you.

Scott Benner 38:52
Yeah, for sure. The idea that, you know, I talk a lot about people, people, sometimes they have a, you know, some sort of anomaly with their blood sugar, right. And instead of doing something about it, they spend a lot of time wondering what happened. And I tried to kind of coach them through the idea of like, in the moment, it's not important what happened, just take care of it, think about it later. But what you're able to do with just little things, like, you know, seeing on a graph when the insulin went in, or knowing that the insulin got too warm or too cold, is you're removing, when those anomalies happen, your your what your your apps doing is it's removing possibilities like it Well, it wasn't this, like I know the insulin didn't get out of temperature, so I can eliminate that. And when you could eliminate things from that thought process from that. It becomes more streamlined and you can get to your answer a little quicker to an absolutely yeah. And I like the idea of not having people in a situation where they have to unnecessarily wonder about things because I think it adds anxiety because you can't really know about some stuff, right? You just sit there and kind of just turn over and go well, maybe it was this. Maybe I do. didn't do that. And the more of those things that can be removed from your thought process, I think I think the better. Yep. I totally agree. That's excellent. Okay. Okay, so I've gone to my doctor, you know, they've made some great adjustments for me. And I come home and I try stuff. And I come back, I look at my data again. And I see, I did this. And we always talked about that, you know, kind of this. I don't know what to call it even. But it's a process, right? I did this, I expect this to happen. Instead that happen. So next time, next time, I'll try sooner, more, a combination of sooner and more longer. Whatever. It's, it's right there for everybody. So everybody who's been listening, who uses MDI, and is always wondering, like, how do I get what, you know, what I'm hearing these other people talk about, and this, this is an incredible leap for you. You know, Mike, we talked about it here, because it's, you know, I think it needs to be spoken about. So people understand, we're talking about, but at this point now, with a pump, and index calm, my daughter's a one has been between five, six and six, two for over four years. Amazing. It's It's spectacular. But it's because of it's because of technology, right? I can't trust me, I know who I was before. pumping. I know who I was before. Dexcom. I know who I was, before getting that information that I needed to make better decisions. And I think that when I hear people with MDI talking, what they're saying is, I can only get so much done with injections, because I lack the rest of these things. And it sounds to me like for, but somewhere between five and $50, I get a pen that works for a year, and gives me everything that I need. Does that sound about like what you guys are shooting for?

Mike Mensinger 41:45
That's exactly what we're trying? And then, you know, we we don't think we're done. We have a lot of, there's still a lot of low hanging fruit, that we'd love to hit everything from hydration, you know, can the system help you determine? You know, if you're only going back into your healthcare provider, making big adjustments every three months? You know, can we help your healthcare provider do that at a faster interval to get you into the right range and personalize your bowls, calculator settings. You know, androids coming out, we're looking at Europe and other markets that should be coming out later this year, or maybe next year. solutions for exercise, because as you know, exercise is a big challenge with diabetes. So the one great thing about Android and iOS devices is they track your steps and fitness thing. So can we look at the history of you walked a lot today, or you exercise a lot. And therefore, you know, that's why your blood sugar went lower, and you're more sensitive to insulin. So just taking all these variables that affect your blood sugar, and demystifying those and making those understandable for you and actionable. Okay,

Scott Benner 42:51
yeah. So it's really getting people to a better outcome with less effort on their part and it not costing as much is, that's an amazing goal. Let me ask you about a couple of things that you just talked about there. So the, the idea, the idea of an algorithm algorithms, a word everybody's hearing now, because there are so many, you know, closed loop systems that are being developed by insulin pump companies. And so you have, it's no different for you, right, you have there's something living in that app that sees the information coming in and makes better decisions, and how will I and that's something you're thinking about for the future? But how will that look? Do you imagine? Is it in the form of feedback or, you know, suggestions? And can the app make suggestions about my insulin? Or is that a gray area?

Mike Mensinger 43:35
Yeah, there's, there's multiple different ways to do this. And there's a lot of research groups already working on it. So one way this could look is, for example, users on fixed dose therapy, which we are looking to have solutions for them to and then increase their diabetes awareness and move up to more sophisticated bolus calculators. The normal process that doctor takes is they put you on therapy, they guess, at your settings, and then they're going to titrate up a little bit until you get close to your goal. And then if you have any hypoglycemia, they're going to back off pretty simple algorithms that the doctors use in order to make these adjustments. Same thing for both calculator users, that just adjusting your your correction factor in your carb factor. So it's just an incremental little steps and looking at the outcome of those changes, and making sure you're you're getting a lower average glucose without a lot of hypoglycemia. So these algorithms are pretty straightforward. And these are something we think we can help offload the doctors and increase the frequency of those changes. So you get to control and get the target faster. Obviously, there has to be coupled with education and, and other things in order to be effective, though,

Scott Benner 44:46
is there? And you mentioned just briefly, but I want to understand like ideas about getting my long acting insulin to be more effective. Is that something you're working on as well?

Mike Mensinger 44:57
Yes, that's something in our roadmap that we're doing interested in getting to as soon as possible. So it could look like your doctor starts you on the product, you're on a Dexcom or CGM. And so it's looking at your overnight control. And if your glucose is rising steadily, you need more long acting insulin. If it's dropping, if your glucose isn't stable, it should back down your long acting insulin. So the user could see a notification that says, maybe it's approved by your doctor, maybe maybe the algorithm can do it. These are things we'll have to work out with, between our clinical partners and the FDA, right. But you get a notification, it says, we recommend this change, maybe instead of 18 units of lantis, you should be taking 17 now, and the user would be able to approve that and it updates your setting. And now your next time, your reminder goes off to say I'm take your lantis it'll say take 17 units rather than the 18. So very simple, all the user has to do is approve or say no, that I don't agree with that change, let's

Scott Benner 45:56
talk to my doctor, the rest just happens. It's those little things that we don't really consider as much and, you know, I've seen, I've seen it with my daughter, and I'm with other people as well, like, you know, you just inject your slow acting in some when it's you know, it when it's comfortable for you during the day. And that doesn't necessarily mean it's going to work for 24 hours the way it's supposed to. But we just make that assumption that it does. And we move on. And then you see problems that come down the line and you never go back to that you never say well, maybe it's my slow acting because because in the doctor's office, someone said, Hey, this is how much slow acting insulin used, you know, put it in in the morning or put it up before you go to bed, whatever they told you and in your mind, that's a set it and forget it idea. It that must work. I've been told to do it like this. I think it's it's incredibly valuable to have this technology, looking at those ideas and saying to me, Look, don't overlook the fact that maybe this needs to be considered. So, you know, without you having to run around all day thinking about a million things in your head.

Mike Mensinger 46:57
Exactly. It's the system working on your behalf and helping make recommendations, obviously, the user has to play a role in that you don't want to completely remove, you know, the human element of that, whether it's your doctor, whether it's you a parent or or the person with diabetes themselves. So you have to have the right experience that leverages the benefits of each one of those technologies and the person themselves. Yeah,

Scott Benner 47:21
no, that's excellent. And are you guys, I know you and I are speaking I'm sorry, I asked like I didn't know. But I know. So we're talking on the 10th of July right now. And this is going to go up pretty much right away. And in Penn is going to be at children with diabetes this week. When are you guys getting there?

Mike Mensinger 47:36
Yeah, so that that's one of our favorite conferences of the year, just so much excitement and engagement and great opportunities to make everybody aware. So we will we're having a booth, please come by to the booth and say hi, check out the product, we'll have demos there. You can fill out the get in pen form right there. And and also let us know what you like about the product or what you want to see. We love hearing from everybody and just excited to hear what people think

Scott Benner 48:04
microwave colors. It's a pretty superficial question. But can I choose different colors in the pen?

Mike Mensinger 48:09
Well, funny, it's not a superficial question. Because there's a there's a concern of mixing up your long acting and your bolus insulin. Okay, so one of the things we did there was we provided the pen in three different colors. So there's six different models. So we have novo pen, and we have a human log pen. And we have to do that because the cartridges are different. And so the pen has to make sure it's dispensing the right insulin amount for each of those devices to pick your insulin type. And then you get pink, gray or blue. And what we recommend is if you if your long acting pen, if you're using a long acting pen is gray, you know pick blue or pink, and vice versa to make sure you don't mix those up. That's great. Okay,

Scott Benner 48:49
so listen, I don't know if you're gonna be comfortable with this. I haven't told you I was gonna say this, but I'm going to so we'll see where it goes from here. Other companies make pens, right? What Why do I Are you comfortable saying Why do I want yours and not theirs?

Mike Mensinger 49:04
Well, right now, we're the only smart choice that's out there. So eventually, there will be alternatives. We expect to see some competition in the next say two years on the market. So whatever solution works for you, we want the best for users. So of course a decision that you didn't make for yourself. But I think when you really take a look at the solution, what you'll see is it's very user centered design. So we're trying to reduce the work that you have to do day to day and get better outcomes. We've put the data together in an intuitive way such that you can see cause and effect of insulin, carbohydrates and other factors on your glucose so you can learn from that data. The reports doctors are giving us great feedback on really the features in their understanding of doses are missed if you're using the calculator, the split between your basal and bolus insulin along with the daily charts of Seeing all the effects and you can have real powerful conversations and then adjust therapy together. So when you look at the total package, we think you'll see that this is a really great solution and brings a lot of the benefits that computers have had, but really haven't been on available. So

Scott Benner 50:17
Mike, that was very professional, you didn't go all WWE on us there and start telling me why that's a good for you. So No, but seriously, there's there's other pens on the market. So in and they're from companies that people have heard of before. And, and it's important for them to understand that they're not all equal. And that there may be not just maybe, but there absolutely is benefits that far outreach, you just have to try to understand them. And I think that's the last kind of thing I want to ask you about. So trying to understand what I have my pen now I've decided, Hey, Mike made a lot of sense on the podcast, I'm getting an in pen, I have it in my house. Is there a learning curve? If there is how steep? Is it? I mean, how soon before I feel comfortable with it? I think I I think from looking at it, it doesn't seem like it's much to me, but what are you seeing from people who are using it,

Mike Mensinger 51:09
most people are able to pick it up and use it. And it's just very intuitive. Our human factor study, pumps require two hours of training. Typically, as a start, a lot of settings, a lot of configuration that's required for setup, ours, our prescription form that the doctor fills out for all your personal settings for your dose calculator, your insulin type, etc. It looks like the screen you enter it now. So we validated that there's zero training required, and the users are able to set up the product and get going on their own. But we've shown that from very young ages all the way up to, you know, into the Medicare population. And so we've seen great response. And if you do have some challenges, please give us a call. We have a great support department that can help you through any of those issues.

Scott Benner 51:55
But it's just as easy as going into a screen and putting my information in and then it starts helping me make those decisions. And then it went How long do you think it takes to because this is something that you hear people say a lot when they start a pump, like my doctor set me up with this insulin to carb ratio, this but I guess if you're MDI already, you're not going to you're not going to a new way of managing. See, I just answered my own question there, Mike. So when you go from MDI, to a pump, it's not apples to apples always about your your insulin to carb ratio, and other things like that. But from just injecting to injecting nothing like that should change. So I shouldn't see a big, I shouldn't have a spot where I have to make more adjustments afterwards, should I?

Mike Mensinger 52:38
Well, like you said, just like a pump, you have an influence to carb ratio and insulin sensitivity factor, these are your personalized settings, your dose calculator, if there's a process of dialing those in, that would be the same as starting on a pump. So if you know those, and those are correct, and you've been using a dose calculator, maybe it's not a smart pen connected one, well, then you just transfer those settings in and being in using it. If you don't know how to count carbs, that's not a skill that you're comfortable with yet. And maybe you're on meal estimation or other ways of approaching, sizing your doses. And those are things where you can still do that. But you get the benefit of subtracting your insulin on board. And you can see what that number is and just subtract that from the dose you would have taken. Or you can begin kind of learning the skill of using a dose calculator depends on where the user is starting from. And the biggest hurdle would be if you're not familiar with carb counting, and those calculators. But that's an optional feature, you get the benefits of automatic insulin tracking, the reporting, the Dexcom integration, the connected meter integration, the Miss dose reminders, your tempo, all those other things, you don't have to have the skill of carb counting and get all those benefits.

Scott Benner 53:48
And in my case, I don't have a dexcom, I don't lose it. Having a dexcom helps me integrate that information in your app. But if I don't have it, I'm not losing any of the other features.

Mike Mensinger 53:57
Yes, exactly. And obviously, we're talking to the other PGM makers as well to integrate that data because it is so valuable if you have that stream of data to integrate that into the product and see the full picture. But we work with the Vario connected meter, the one drop the agamatrix meter, the sensor meter will be writing to health soon. And it's kind of a magical experience. As a side note here, when when the user has their phone off, they they're on their Vario meter, they take a finger stick, and then they unlock their phone, open our dose calculator without opening a second app, they go into the dose calculator and their BG is already there from your finger stick, the bit magical. You don't have to enter that. So it's wonderful that we could remove that step.

Scott Benner 54:40
What I'm seeing here is there's leaps for two people who are if you're using MDI right now and you're, you're counting your carbs and you're making decisions based on that or if you're not if you're put on more of I don't even know what they call, you've used the phrase a couple of times, but it's so like, it seems so foreign to me the idea of just taking some insulin and letting it roll through the day but Both of these people, these people in these two segments have a real opportunity to make a leap forward in their understanding and their management, if they can have this information at their fingertips. So I don't, I don't see how I mean, if I'm objecting, I don't see how this isn't worth it to me to try. So I really appreciate you coming on talking about all this. Thank you very much.

Mike Mensinger 55:32
You got to remember when I, when I started Dexcom, it was a startup. I really love that early phase where we really get to transform and define and we're new, a new category. And this is a very exciting time in a product life.

Scott Benner 55:47
I think you're the exact right mindset because there are just a lot of people who couldn't leave something that is that stable and successful to try something new. So I am I'm making a leap here. It's not something you've said to me. But I really believe you must believe in this if you've done this. So but you know, I appreciate you continuing to take, take your stabs at making people's life with diabetes easier. And and thank you very much for coming on and sharing this all with me. Yeah, thank you. Yep, have a good day. The impact is bringing the technology found an insulin pumping to multiple daily injection users. If you're injecting insulin, and you don't have in pen, you are missing out on a lot of information that can help you make better quicker and easier decisions about your type one diabetes. The in pen app is absolutely free. And once you've downloaded it, and you've decided that you want to move forward, like Mike said earlier, it is a super simple process to get your insurance coverage figured out and get the pen in your hands. All the links you need are at Juicebox Podcast comm or in your show notes. You can even just go to companion medical.com and find out more. Hey, guys, if you found this episode through the children with diabetes conference, if you were down there and you saw in pen and they told you Hey, if you want to hear more, go back and listen to Episode 170 for the Juicebox Podcast, if that's how you got here, welcome. You may not realize it but you're listening to the best user reviewed Type One Diabetes podcast online, please consider taking a moment to subscribe in your podcast app and listen to other episodes. There are many many to choose from, I would probably started Episode 11. It's called bold with insulin. From there, you're going to meet people who are living with type one diabetes as adults as children and as caregivers. You're going to hear their stories, you're going to hear their management techniques, you're going to be uplifted. So if you're interested in hearing real day to day management techniques that have my daughter's a one c between 5.6 and 6.2 for over four years. And as the kids say spoiler alert, cheats everything. No food is restricted. We talked about how to use insulin on this podcast at its core. That's what this podcast is about. Stick around. Subscribe, listen to new episodes as they come they come every week, or go back in the catalogue. There are 174 other episodes that you haven't heard. Thank you so much for listening. I hope you try and enjoy the in pen. And hope you come back next week for the next episode of the Juicebox Podcast.


You can download InPen for IOS here. Android has been cleared by the FDA and is coming soon.

This episode of the Juicebox Podcast is sponsored by Companion Medical makers of the InPen.
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#173 The Nanny

Scott Benner

A teaspoon of sugar makes the BG go up...

Mairi is Jacob's Nanny and she has an interesting and unique perspective on type 1 diabetes that you won't want to miss.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexagoogle play/android - iheart radio -  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, welcome to the Juicebox Podcast. This is Episode 173. Today's show is called the nanny. And it is sponsored by ami pod, and Dexcom. On the pod, of course, is the tubeless insulin pump that Arden has been using since she was four years old. And Dexcom makes the GS six continuous glucose monitor. You can learn more about both of those products later in the show in the show notes, or at Juicebox podcast.com.

Mari 0:39
My name is Mari and I am a full time nanny for two little boys, one of which was diagnosed about seven or eight months ago with Type One Diabetes. So I spend a lot of time managing that because he's very young and relies on me 100%.

Scott Benner 0:57
Please remember that nothing you hear in the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your medical plan.

Thanks for coming on and doing this. I really appreciate it. Let's figure out a couple of times. You've been in any for this family for how long? almost four years for your see you were over three years into the into the life with them when when their child's diagnosed? Is it their younger or older child who was diagnosed?

Mari 1:39
It's the younger one. And so I've been with the family since before he was even conceived like he is he is essentially the closest thing I've ever had to have a baby of my own.

Unknown Speaker 1:50
I gotcha. Can I ask how old you are?

Mari 1:52
I am 33

Scott Benner 1:54
Okay, so 29 years old. Had you been a nanny prior to that part of this family?

Unknown Speaker 2:00
Sorry, did you say 29?

Scott Benner 2:02
You were 29 when you started working for this family?

Unknown Speaker 2:05
Oh, I guess so. Yeah.

Scott Benner 2:06
I was what you were like was I

Unknown Speaker 2:08
I'm like wait, I'm 33 now. Okay,

Unknown Speaker 2:10
I got it. Um, were you prior to that prior to the family you're with now? We're Yeah.

Mari 2:15
So I started babysitting when I was 11. And I've worked with kids on and off ever since. I think I was a full time nanny for just a few years before that, and a part time nanny before that. And also a caregiver for an 87 year old woman. So I've done a lot of just like, preschool stuff with kids. But full time meaning it's probably been about eight years. So this

Scott Benner 2:38
kind of work. Would you say it's it's who you are really like? Are you a caregiver at heart Do you think?

Mari 2:45
I think so, especially with kids and young kids. I really love like just little little kids who are just so curious and learning about everything and explaining to them, you know, why a leaf falls down and turns different colors or something like that, you know, I I studied biology. So I love talking about science with little kids. And fortunately, the two little kids I watch are really into that kind of stuff.

Scott Benner 3:12
It's funny, I was just thinking this morning about stuff like that, because my son is getting ready to leave for college. And he's our first and I've been a stay at home dad for you know his entire life. And I was thinking back on the things I wanted to share with him before he left and I can only kind of the memories I have of when he was really little are of things like that, that I think some people might find benign, but I thought were some of the best times, you know, just describing something they've never seen before letting them sit and watch something watching them see something for the first time. Like that stuff really impacts me. It's cool that it that it reaches you the same way. That's really okay. So can we use the little boy's name?

Mari 3:53
Yeah, so his name is Jacob. It's a pretty common name.

Scott Benner 3:57
The game is gonna pick you out. Alright, so Mari so Jacobs diagnosed at what age?

Mari 4:02
And it was about a little over a month after his second birthday. Okay. Okay. Sounds familiar.

Unknown Speaker 4:09
He does a little bit. Yeah.

Scott Benner 4:11
So you're on in a really kind of, like, strange way. So Jacobs mom listens to the podcast. Is that right? Yeah. Yeah, she

Mari 4:18
does. And she introduced me to it. And you

Unknown Speaker 4:21
know, I say that she forced you to listen to it.

Mari 4:25
On this great podcast, and I said, Okay, sure. Yeah. Hmm. And, you know, because a lot of podcasts or whatever, but, um, I ended up after maybe a month or so of her just talking about things she learned on it, just checking it out. And, and now I've listened to a lot of episodes.

Scott Benner 4:42
I'm really interested in, he's home. His parents have this information that were given to them to them by doctors. Were you in the room at the doctor's office, or did they pass this information on to you in the house?

Mari 4:54
So add diagnosis, actually, I brought they come to the doctor and met his mom there and I was in The room for it all it was, that was hard. But and then yeah, and then they went to the hospital with him like dad came home from work, he was on like a Skype call basically, in the room with us all. But then they went to the hospital together and I picked up the older kid and hung out with him while they were at the hospital, you know. And, but then like the next day, during all the kind of the, you know, when they're trying to teach you everything all at once. I came in on on the weekend, and it was a Friday. So I came in on Saturday and Sunday to the hospital to learn some stuff. And I think other than one doctor's appointment, and I have been at all of the diabetes appointments, all the intro appointments,

Scott Benner 5:47
did you or Jacob's mom pick it up faster than one of the other? Did you find yourself helping each other? Like, what was that process in the beginning of like, how did you complement each other in that situation?

Mari 5:58
So I just want to mention that his dad is just as involved as his mom and I are okay.

Unknown Speaker 6:03
Okay, do they work in the home? Or they work out of the home?

Mari 6:06
No, they both work. And that's why I'm there. So much. Gotcha. Um, but they're even when they're at work. They're still very involved. And you know, if I have anything that I'm not sure about I text with them. I keep them in the loop. Like if he's dropping because he has a CGM. So he's dropping fast. I text them to let them know like, Hey, I just gave him some juice. He's actually 70 he's not 40. Yeah, whatever.

Unknown Speaker 6:33
Well, that's beautiful.

Mari 6:35
Because I know if I was looking at that, I, I'd want to know, someone is handling it.

Scott Benner 6:40
Yeah. Yeah. Can you imagine watching it fall and thinking, Oh, I know. I know, Mari has it and then you don't. And then you just sat there and did nothing while it was happening. Like that would be a finder's fee. I think what you're doing is so kind, not that it just to let them stay in that loop. Take that anxiety away. That's really because that's extra work for you as well. Right?

Mari 7:00
It was, but I always deal with the problem first, and then I make sure that they know I I've been doing it right. But so I think that for the three of us, we learned different things at different rates. I mean, and we all learn from each other. And I think it you know, even if you hear from someone else how to do something or listen to the podcast and get ideas, you kind of have to troubleshoot, you kind of have to experiment yourself. And you know, it's just it's different hearing about something that she learned to do than doing it myself or something.

Scott Benner 7:39
It's it's an important message that everyone really needs to hear as I just was just speaking to somebody the other day, and you know, at the end of the conversation that was so just in this spot, again, how much insulin is like, No, no, I was like, I can't tell you. I don't know, try, you know, pick a number that makes sense to you give it a try. See what kind of a response you get. Try it again, it

Unknown Speaker 7:59
is a look, it's gonna be a little bit of an experiment until you figure it out. And at this age, it changes so much like his needs one week or so different from his needs the next week.

Scott Benner 8:10
Yeah. How much is he? Why do you think?

Unknown Speaker 8:13
Too much? Pick me up carry me up the stairs? I,

Mari 8:18
I should know, I feel like he's like in the low 30s. Yeah.

Scott Benner 8:22
And so that's not a lot of body weight. Because you you need we need the fat to distribute that insulin around.

Mari 8:27
Luckily, he does have a good little chub layer, which, you know, helps, but I'm sure it's gonna disappear in the next couple years. For that whole four or five year old, were there just so any?

Scott Benner 8:40
So did you have any personal or family experience with diabetes? Um,

Mari 8:46
I have like a family friend who has type two, but I didn't like when, when he was diagnosed, I did not know the difference between type one and type two other than that they had different names. So I have come very far I didn't even though I studied biology, like we never talked about diabetes. I studied animals and ecology and plants and stuff.

Scott Benner 9:05
So I just was trying to establish whether you had, you know, with any backgrounds at all, no. Yeah. So you're you're without any, you know, any idea of what's happening? You're been with the family long enough. You saw the baby you saw Jacob Lauren's you probably feel as close to them as anyone who's not blood related them could possibly feel I would imagine.

Unknown Speaker 9:26
I think so.

Scott Benner 9:27
Yeah, of course. And and so would you describe it as heartbreaking when he was diagnosed?

Mari 9:32
It was one of the it's one of the hardest things I've ever been through. Yeah, for sure. And, you know, I, because I was also at work. I was trying my very, very hardest not to completely fall apart and be there and supportive for his mom. I was sitting there thinking, you know, the best thing I can do right now is not fall apart and be strong for her so that she can fall apart. Right. And then I can make sure that Yeah, Jacobs, okay, then

Scott Benner 10:06
I was just gonna say 10 minutes into this conversation, and I already think you need to be paid more money. And I don't know how much you make because you are fantastic. Really like, That's such a, that's such a human like response, like the idea of let me be the strong person for them because that's not part of your job, right? I mean, like, there's no other in the, in the four years prior to that you never like, I'll be the rock here. Like that's, you know,

Mari 10:29
that's the nanny, your job really, essentially is to make the parents life easier and facilitate them being able to work while still having their kids raised in a way that they, you know, care about and are a way that they relate to and to take care of their kids so that they can go to work and not worry, you know, that that is my job is to make their lives easier, right?

Scott Benner 10:53
I didn't I didn't think of it like that. But you're obviously 100% right? Okay, so you're in the hospital, you're being the you're like, I'll hold it together. How hard was it to hold it together? What did you want to do? If no one could see you? What do you think your action would have been?

Mari 11:08
Oh, I definitely would have just cried. I'm a crier. I cry almost every episode I listened to just so you know. Yeah, I know. It's okay. I mean, especially when they get to the diagnosis stories, I always cry, like, Oh my God, because I just feel that moment again, when, you know, we were all in the room together. Um, but what I did was, I took him home, he fell asleep in the car, thankfully, because he really wanted to eat and we couldn't give him anything, you know. And while he took a nap in my car, his mom packed everything up. And then they went to the hospital. And then I sobbed for like, two hours. Until I had to go pick up his brother. So yeah, I mean, it was definitely it was heavy, you know. And I didn't really even know what it meant. At the time, I just knew that it just meant a lot was going to change. You know,

Scott Benner 11:58
like this promise of whatever you feel like life is when you start a family, like it just feels like it's dashed in that moment. And especially without perspective of what can be done or how you can live, it all seems really, like finite, like, oh, gosh, like, it's almost like you fast forward to the end of your happiness. Like you used it all up or something like that. But that's not the case. And so how long did it take you to get clear of that? That feeling? Like when did the when did the clouds break? Do you think?

Mari 12:28
Um, I think one thing that really helped me was that very first weekend, when we went in, it was very overwhelming, you know, all the training and, okay, now you're giving him a shot, like, but I've never given anyone a shot before, you know, it was that the nurse that we worked with, is a type one. And, you know, she has two healthy kids. And she's a nurse, she's successful. She's really involved in the diabetes community. She does diabetes education. And she works obviously with the endocrinologist and stuff. And she, she's amazing. And just such a lovely, successful person. And so meeting her and made me feel a lot better. That's, that's pretty immediate. I mean, it was still all very overwhelming. And I think that probably another breaking point would be like, about them a few weeks or a month after we got the CGM. And the first year like, Oh, my God, this is what's happening, right. So Well, once you start learning how to better manage it through what you learn from seeing that. Then I started feeling like, oh, okay, like, this is manageable. We can do this, you know, it's like a roller coaster like you hit these hard spots. And then you kind of find some relief once you learn from them. And

Scott Benner 13:52
it gets better and better as it goes, Well, how old was Jacob when he got the CGM? Now that school's over, I let my kids sleep in a little bit, you know, for the first couple weeks to let them rest up. That would Arden's diabetes, sometimes that could be problematic. I guess if I didn't have a dexcom g six continuous glucose monitor. Here's what happens. And it's happening right now. It's early in the morning, as I'm recording this for you. I wake up Arden's blood sugar has been 98 overnight, really steady, great night's sleep. That was exciting. But then I noticed a little trend down. So what I do is I go into a room and I set a temporary basal rate, a little decrease of her insulin, just enough to catch that drift down and brings it back up again. Now here I am an hour later, and her blood sugar is 100. It was going to be low. Her blood sugar would have went from 80 to 70. And it would have kind of kept drifting. Anyway, that's what would have happened if I didn't have Dexcom g sex but because she did. I woke up. I got dressed. I looked at my phone my phone showed me Yeah, I think I'm seeing what I'm saying, I made a little adjustments or insulin. And the next thing you know, everything's okay. Again, no drinking juice in her sleep, not having to wake her up, and she still gets to sleep. And I get to come down here and get the podcast together for you. If you're interested in learning more about the dexcom g six continuous glucose monitor, please go to the links to your show notes to Juicebox podcast.com or you can type into your browser dexcom.com forward slash juicebox. I'll tell you what, let me screenshot Arden's 100 blood sugar real quick, and I'll put it up on Instagram and on Facebook. So if you follow me on social media, go take a look. Is it official yet? are we calling a 100 blood sugar on a dexcom CGM a Quincy? How old was Jacob when he got the CGM? Oh,

Mari 15:46
I mean, this was like, I feel like it was around a month after diagnosis. But I'm a little fuzzy on the timeline. But quickly in the beginning. It I mean, we we asked for it that weekend. And obviously they were like, Whoa, bah, bah, bah, bah, bah. But, you know, we pushed for it. And it didn't take a lot of pushing. But

Unknown Speaker 16:03
we did. How'd you find out that quickly about it?

Mari 16:07
Well, our nurse that I was telling you about, she was wearing one. And she just she just kind of mentioned like, well, in the future, like there are things that we can do, you know, like this, and there's pods, and there's, you know, you were

Unknown Speaker 16:19
like the futures now.

Mari 16:21
And you know, his mom was like, we want one of those right? And they're like, Oh, you don't want to talk about it? Or you know, we want one definitely, you know,

Unknown Speaker 16:27
like, yeah, so yeah, quickly, please.

Mari 16:30
We're all very glad about that. I can't believe they let like nine month olds who are diagnosed out of the hospital without one. Crazy.

Scott Benner 16:38
Yeah, I haven't said it in a while. But I think if you want it, you should just you should have it the day you're diagnosed. I it's just a strange idea that something this kind of fragile and difficult to understand is left up to your imagination. Most of the time

Mari 16:53
are like nine month olds, and they say like, oh, let's stay on MDI, like, but you can't even go small enough for a child. But

Unknown Speaker 17:01
but is Jacob using a pump?

Mari 17:04
Yeah. So he's on the Omni pod. And he has a dexcom. Okay, we just got the G sec. On Friday. So it was as I was leaving work, it showed up? I don't know if he's wearing it yet or not.

Unknown Speaker 17:16
But it's exciting. We do you see how easy the insertion process is. It's so like, simple and fast. And yeah, I

Mari 17:24
mean, I can imagine based on what I've seen,

Scott Benner 17:27
yeah, it's pretty cool. So let me ask you this, Mark. What's your schedule? Like? I mean, you can't work seven days a week for the rest of your life for somebody, right? You must go home, like when does that happen?

Mari 17:38
So I work 730 to 530, Monday through Friday, and sometimes I say an hour late if someone has a meeting or something. So I'm about 50 hours a week, I do come home on the weekends, and I do have a husband and a stepdaughter. And I do have a life outside.

Scott Benner 17:54
Well, the only reason I ask is because what I'm really wondering is is when you leave. And you know if it's just for the evening, or it's for overnight, it's for the weekend. Can you forget about Jacob's diabetes ever? No.

Mari 18:08
I mean, maybe like while I'm watching a movie.

Unknown Speaker 18:11
Yeah, I understand.

Mari 18:13
Like, like, taking a shower. I'm like thinking about like, Okay, how could I have done that bolus yesterday? Better? Like, I think about him all the time, because he's like, my baby.

Unknown Speaker 18:24
You know, what his blood sugar is when you're not with him?

Mari 18:26
Yeah. And sometimes they look, they don't I mean, I know that they're both very proactive, and they pay a lot of attention. And he's in good hands. But sometimes I look, you know, I'm eating lunch. I'm like, Well, I wonder what happened to him today?

Scott Benner 18:42
Is it strong enough that? Could Is there something you could see on that? Dexcom when you're at home, and it's not your job anymore to be looking after Jacob? Is there something strong enough that could make you cross that line and contact them? and say, Hey, what's going on? Like, I need to know, like, the same way? I don't, because it seems inappropriate. Like, as I'm thinking about it, right?

Mari 19:07
Yeah. I mean, I don't think so. Because, I mean, I don't know, I guess I would have to be faced with something. That would, that's scary. But I mean, I've I've seen scary when I wasn't there, and I just waited it out. And then it was fine. You know, it's fine. And then on Monday when I came in, and they said, yeah, that's when we tried pizza. You know? Like, that's when we tried pizza, but something else was going on, you know, I mean, and I've been there too, where like, I have double arrows down and I'm like, How did this happen so quickly. And sometimes on the CGM. It looks so much scarier than it is in real life because you can do a quick check and you can know where they really are. Right? Yeah, no, yeah, it's it's delayed. So sometimes it's it's kind of like making when you're not there. You're panicking over Something that doesn't need to be panicked over, you know, yeah, it's

Scott Benner 20:02
interesting that you bring that up. So this, it's Monday. Now you and I are talking on Monday morning. It's right before the Fourth of July. And last weekend, which is just the last two days of my life on Saturday. I think Arden played a softball game at 8am 11am and 2pm. It was 100. And some degrees, the heat index was crazy. It was that it was terrible. And then she came back the next day and had to play 11am and 230. And it was hotter the second day than it was the first day. So the first day, we get there, and her pump is scheduled to be done, I think around seven o'clock that night. So as we get there early in the morning, I'm like, you know what, everything's great. This is gonna be fine. Like, I can make this pump last this day, you know. And so first game starts adrenaline hits, or I start bolusing for the adrenaline. I try again and again, it seems resistant, but I feel like I'm having success with the pump and I am and I get her blood sugar to come back and went up to like 165 I got it back down I go. game ends we go off to you know, I don't for people in the northeast, we went to wah wah, which I just found out is named after the noise a goose makes I don't know if that's interesting for anybody. But we went to while while we picked up like snacks and and you know, different foods and Arden had to eat. So I'm bolusing on top of that, but knowing she's going to go back out and play again in this incredible heat. I keep her blood sugar down. But around the third game, something happened. And I just could see on the CGM like this climb that's happening in her in her blood sugar. Like I started thinking this pump is on its third day it's coming up on its you know, its last couple of hours. We've been out in this hundred degree heat all this time. And I bolused once I bought this twice, and I didn't get what I expected. So I went over to the bench. I asked her coach, like just leave her out for one inning, one half inning, and we changed her pump right on the bench. It just 110 degrees. And so you know, I've got this big wad of like paper towels and art and splashes some water on it to clean off her stomach. And she goes, this is just like Grey's Anatomy. I said, Marie, I said, it's not really sweetie. And she was like, No, no, it is and she's all excited and she's done it. we swapped that pump in three minutes on a bench, you know, in a baseball field, got it going and had her blood sugar to come right back down again, was great. That night, her blood sugar wanted to be low. And so she ate a meal later in the evening. I don't even think I gave her 15% of the insulin for that I thought I should have given her. And I still had to cut her bezels off over the night to keep her from crap like from getting under 50. Or Now, the next day is I just know I'm like the next day I'm like I'm new pump. Same situation. This is there's going to be a moment right where this is worse. She goes to the first game, everything's great. We go, you know, grab some food, we're sitting in the car, and I said to her, Hey, I'm like your 79 diagonal down time to start eating. And so she starts eating, and 79 becomes 75 becomes 69 becomes 40. Like before, I know it's 40. But she's taken in an incredible amount of food by that point. And that's to your point, like herb CGM said 40. But I thought she's not 40. You know, if she ate, she ate 20 minutes ago, even if she's 40. For the second, it's going to come right back up. And it did it did exactly what I expected it to do. But to believe that for a moment to be able to look at that number that you rely on so much throughout 24 hours a day and be able to sometimes look at it and go, I can't worry about what that says for the moment. That's a difficult leap to make. And that's a difficult leap to make when I'm there and I'm with her. And I'm 100% confident that that I know that what's happening is happening. I just really I feel. So it's a very long way of saying I have a ton of compassion for you having to be in that situation and not be able to make sure. Like that must be just genuinely very difficult. I I would find it incredibly difficult, I guess is what I'm saying?

Mari 24:20
Well, I mean, like I said, I have a lot of confidence in his parents. They're both smart people, and they both are really paying attention. I feel so that does ease my worry a lot, right? Like if I knew he was a babysitter, I might be a little bit more.

Scott Benner 24:41
So can I ask you on your side? You said you have a husband and a stepdaughter? Does your husband ever said to you, Mario, we're talking more about Jacob's diabetes than we are about our own life does it? How far does it bleed into your into your real life?

Mari 24:56
Um, he has never said that to me, but he's just kind person. You know, I, I don't like non stop talk about it definitely my some of my close friends. They're like, wow, I know a lot about diabetes now. No. I think my friend said to me the other day, I can tell how much you care about Jacob. Because every single time we talk, we talk about him. You know?

Scott Benner 25:24
Yeah. What do you think? Does that do you think? Are you trying to subconsciously or consciously create advocates? Or do you think it's just so on your mind?

Mari 25:33
I mean, I like to educate people about it, because I feel like nobody knows anything about it really, unless they're involved in it. But also, I mean, anytime you talk to any of your friends, and you kind of catch up, you just talk about what's going on in your life. And a huge part of what's going on in my life is diabetes management, you know?

Scott Benner 25:51
Yeah. And so that's just really, it's not eye opening, I would, I'd expect you to say it, but it's incredibly interesting that even in your removed situation, you're having the same exact experiences and feelings that everyone else who lives with it as, like, there's, I guess there's no escape. I you know, I don't know, I don't, I don't mean to make it sound, you know, like scary, but like, it's just a difficult thing to walk away from at the end of the day and never think about again, I don't I

Mari 26:18
definitely. And when you have like such a strong bond, I mean, I've I've raised him, you know, I held him when he was just a little baby. And I took over care for him full time when he was about four months old. I like slowly took over, over those four months. And then four months, you know, she went back to work and it was just us. Wow, she

Scott Benner 26:41
must really trust you. Because that's, uh, that's pretty cool. Like, you know what I mean? Like, I don't just mean with their kids. I mean, for me, you know, that young that that that amount of time since diagnosis, that's really a, that's really something, you know, like, even four months just with your baby, great, but two years with the.in, a two year old diabetes is, is like a four month old. But you know what I mean? Like, it's like, here, I don't like her killed this thing. Take it from me. It's not easy.

Mari 27:11
I mean, I'm also a very meticulous person, kind of a perfectionist, and I studied biology. So I went through physics and calculus and all that. So the math aspect of it was pretty easy for me to pick up and stuff. And I remember them saying, like, you know, it's a good thing. You're our nanny, or I'd have to like, quit my job, you know?

Unknown Speaker 27:33
Yeah, that makes sense.

Mari 27:35
I think that my personality is a good fit for taking care of a diabetic kid.

Scott Benner 27:40
Okay, so let's, let's talk about that. Then she goes off to work, and you're with a two year old who has diabetes. What an awesome two year old Jacob has an awesome two year old could very easily be the name of this podcast episode. I don't know if I've spoken about it yet in the podcast, or if it's still coming up. But this is a very infrequent situation where you're hearing a podcast that I just recorded. So it's July 4, finishing up with the edits right now, putting in the ads, and I'm going to upload it for you. Anyway, you're gonna have heard me talk about art and playing five softball games last weekend three on Saturday, two on Sunday, in hundred degree plus weather very humid. I cannot tell you how indispensible per on the pod was the obvious stuff, first of all, it's to bliss. So she's wearing it constantly, she can get her insulin while she's playing. It's wireless. So when I use the PDM, to make decisions about her insulin, it can be done from, you know, outside of the dugout, you don't have to bother, nobody has to walk in, she doesn't have to pull out some sort of a controller from her. You know, I don't even know where you would put that while you're playing softball. But anyway, the grander point is that Arden still needed her insulin, and I was still able to be bold and aggressive with it while she was playing. But there were times when she didn't need the insulin as much. And I was also able to set temporary basal rates to restrict her insulin. If I saw dips in her blood sugar, she got high from adrenaline at some point, we needed a bunch of insulin, then a little later, it was a little too much, and we were able to tail it back. These are things that you just can't do with shots. You can't restrict insulin with shots, but you can with a pump. And you can do it much better and much easier. And much simpler, would be on the pot. Go to my omnipod.com Ford slash juice box, the links in your show notes or Juicebox podcast.com to get a free, no obligation demo of the AMI pod today. Don't forget to listen to the story where I had to change her pump at the game. I did it on the bench took three minutes. The on the pot is amazing. She goes off to work and you're with a two year old who has diabetes. What are your findings early on like you you're you're pumping at that point, right?

Mari 29:50
Well, early on we were doing MDI, like, a month or something or maybe even longer. I'm trying to think okay, he was he was diagnosed very early December. And mid January, I think is when he went on the pump. And he was already on the CGM at that point for a little bit, but we first tried with diluted insulin because his basal rate was so low. And we were not having good success with that at all. And as soon as we switched to regular concentration, it went much better. Like even though we're giving him supposedly the same amount of insulin, it was just working a lot better. And I'm not sure why.

Scott Benner 30:33
So when you said you weren't having good success, you were having high blood sugars?

Mari 30:37
Yeah, like, it wasn't affecting him. Like it should, given the amount we were giving him. We thought,

Scott Benner 30:44
right. And so you stopped diluting it you went started using it? Were you drawing like little, like bits with syringes in the beginning? Like, yeah, I

Mari 30:53
mean, because a lot of his doses ended up being like quarter units. Yeah. Or like point seven, five or something. I mean, he's a small guy, you know, you talk about giving Arden like nine units for a meal. And I'm like, he doesn't even have nine units in a day, you know, including his bazel.

Scott Benner 31:08
Where do you Where do you see that change? We everyone who's seen a change knows exactly how that feels. I just talked to somebody the other day, who I was telling, like your sounds to me, like they need more insulin. And the sticking point was, but it seems like so much. And I said, I know, that's that's how, you know, they're growing, like right there when you start having that feeling. Because, you know, we are adults who are listening to this, who use, you know, 60 units for a meal, you know, and they're, and they're laughing at the nine units and definitely thinking, gosh, a quarter,

Unknown Speaker 31:37
what is that, like, for me?

Mari 31:38
Most meals are under one unit.

Scott Benner 31:41
Okay? Still, when he's four,

Mari 31:44
and we still use carb ratios, and I still carb count, but I, I, as my boss says, not all carbs are created equal. And if it's something processed, I tend to almost double the carb count. You know, if it's like, crackers, and it says that this is 10 carbs, I'm like, no, it's 20. Or if it's something like a cookie, I've learned to triple the carb count. Well, so I'm still using carb counting. Right? But it?

Scott Benner 32:13
Yeah, but you're still making a big deal. Yeah, you're using bigger to say I did the other day, we were on our way to that first softball game on Sunday. And she's like, I'm gonna have this chocolate chip granola, but I don't know what it was like it was you know, like pho healthy, you know what I mean? And I was like, Okay. And she's like, how much do you think? And I said, How much do you think and she's looking? And I did say, Well, I'm a shark. I was like, how many carbs is insane, isn't it? She was like, 17. And I said, Okay, I said, try two units. But it wasn't I was wrong. It was probably more like two and a half. Because by the time we got to the field, 20 minutes later, I gave her more insulin again. Because I saw a hit, I was about 135 diagonal up, and I thought, ooh, you know, we missed on that a little bit. So, so I bumped it back down again. And, and and then I then my timing was off, because then an hour and a half later, she was like 80 diagnol. down. And that's I

Mari 33:13
need a handful of fruit. Right, right. Yeah.

Scott Benner 33:15
Oh, please. She drank a half a juice box on deck. She had a bunch of bad over shoulder and a helmet on. And I stuck the straw through the fence. I was like, just drink half of this. And she said I don't want it. I was like, yeah, just drink out of it. And so she just did a two little sips, because I have I have found the tiniest juice boxes. It's Yeah, ours are eight carb, our juice boxes.

Mari 33:36
So what I do if I want him to drink half, because he's too and doesn't have good self control, is I hold the straw with my finger halfway out of the out of the juice box so he can only drink half of it.

Unknown Speaker 33:48
That's a great tip.

Mari 33:51
I'm learning all these little tricks which make it so much easier one that I've come up with recently, which may help anyone who has a young boy with potty training. He can use almost any public restroom standing up if he stands on my feet. That has saved us so much hassle. He just stands on my feet and then he's the perfect height to be in the toilet without sitting

Scott Benner 34:14
because Mario If not, you're holding him under his arms and now you're in charge of aiming.

Mari 34:18
He can't relax. How can you relax if someone's holding you up in the air over toilet?

Scott Benner 34:25
I love that. Put this put it halfway in idea which sounds dirty but I don't mean it that way. And so with the with the straw like that's brilliant because when he when the juices gone, you're like oh, it's done buddy and then in his mind he got what he what he was there for he doesn't you have

Mari 34:40
to watch out because it starts compressing

Unknown Speaker 34:44
Yes. Oh

Mari 34:47
yeah, to take it away. Nope. It's fine for now. Thanks.

Scott Benner 34:51
I don't think anybody thought they were gonna get a physics lesson on juice boxes today on the podcast, but they've done it. That's it. Yes. That is simply brilliant. It really is.

Mari 35:00
Then you have the rest, in case, you actually needed a whole one. Oh, please. Yeah, I

Scott Benner 35:04
told her I'm like, I'm keeping the other half of this

Unknown Speaker 35:06
the other day. Oh, sorry, no, no, I

Scott Benner 35:08
just was gonna say we did end up using it, that's all.

Mari 35:11
And the other day we went swimming. And usually we only swim for maybe half an hour or so. And it's so much of me just holding him because he's learning he's only two or two and a half, you know. And he had so much fun. He was just jumping in and out of the pool. And I think he actually got a lot more exercise than he usually does. And plus, we've been a little aggressive with insulin all day, because lately we've been having to be to get him down. And after swimming, he just, everything was really steady for a long time. And then suddenly, it was like 86, double down or something. And I looked at how much insulin was on board. It wasn't that much. I think it was like point two units. And I just gave him for carbs of raspberries real quick. And he steadied out at 75, or 77. Somehow, I guess he came back up a little bit. And then he started slowly drifting down, he just hit 75. And I just gave him two more raspberries, one more carbs, so five carbs or raspberries, just like and then it was like it was beautiful. He just slowly floated up to like mid 90s, or something over the next hour.

Scott Benner 36:22
And then that highlights very well something that I've been talking about, which you won't know about if you're listening to the podcast, because I'm ahead of everyone else in real time. But that it just struck me six, eight months ago, like wow, I'm talking about bumping and nudging insulin, I should also be talking about bumping and nudging food. It's a similar idea. Like you don't have to drink the entire juice box, you don't have to open up, you know, fruit snacks and eat every one of them just because they're there. You know, like,

Mari 36:50
whatever it is, you're using, like one or two gummy bears, like if he's going down. And that's what we have, I'll give him one gummy bear, maybe two,

Scott Benner 36:59
I sometimes on the way, on his way to school, if she looks like she's gonna drift a little low, I just I'm like, Hey, here's these chewy vitamins that usually have a dinner time just have them now, because they have a few carbs in them. And sometimes that's all you need is just a little nudge in the other direction. You know, a little gas a little break. Like,

Mari 37:18
I feel like the bumping and nudging is a little harder with such a small kid. Sure, I'm sure versus an older kid or an adult because sometimes point 05 units can take him from let's say, like 120 to like below 80. You know, it can drop him that much. Little.

Scott Benner 37:39
That's nice. And that's in a situation where you're pretty confident. There's no other reason from earlier.

Mari 37:44
I'm never authentic. There's no other thing going on. I'm, I'm convinced there's always something else going on. But my point is like, he's just so small and so sensitive. And then he's got like, growth hormones and like, constantly eating and I mean, even though we really do kind of space things out, I just, like, constantly eating. It's like, every three hours you have to eat again, like just to do this again.

Scott Benner 38:09
Why don't we eat again next month, I got your blood sugar at 85. Let's just leave it here forever. By the way, the sentence I'm never confident is maybe the funniest thing anyone's ever said in the past, I was fantastic. I'm never confident either Mario, I hope people know that. I hope they know that I'm always just sort of like this will probably work. I'll try that I'll try this.

Mari 38:31
I'm never confident that there's not other things going on. You know, I'm always like, well, it could be this, this or this. And I can come up with so many reasons why this could be happening. But really what I need to do is do my best to feel in the moment, you know, reach a stable ish blood sugar, and keep him feeling good.

Scott Benner 38:50
So was it helpful for you? If you heard it when I said that idea that a lot of times I see people frantically trying to figure out what happened instead of dealing with what is happening. Because I don't know if you ever heard me say that. But I once said it and a person I know who has had Type One Diabetes for a very long time. An adult recently told me that was one of the most impactful things that they heard on the podcast was just that idea of like, when my blood sugar starts going up or starts going down. I used to spend so much time trying to diagnose why it happened. And I wouldn't do anything about it. And any and he said now I just I deal with what's happening in front of me found that very helpful. And it just seems like what you just described like that idea of like not getting lost in the water. What what this could have been scenario.

Mari 39:36
I mean, I definitely the most important thing is to pay attention to what's going on and do whatever needs to be done. But I think that trying to figure out why it's helpful to because you're trying to prevent it from happening in the future or predict that it's going to happen in the future. You know

Scott Benner 39:53
what later after though, whatever is happening is over

Mari 39:56
that's like the tax to the parents comes later. After Right, you have the priority, especially with a low is below, right making sure he's okay making sure he feels good making sure that we stabilize at least prevent it from dropping further and bring it back up. Without overshooting it incredibly,

Scott Benner 40:16
you don't, especially with somebody that little, like that rollercoasters that much worse than, yeah,

Mari 40:23
I remember, we were, you know, at the gym, you know, like a little gymboree thing. And he had been he spiked pretty high after breakfast meeting in the 200, I think. So I was really aggressively trying to get him down. And I knew I probably overdone it a little bit. But I was going to catch it with some fruit, right. And then when he was dropping, I was like, Okay, I'm gonna catch this with this fruit and gave him the fruit. I didn't catch it. And he was still dropping, and he was he was going to go low, and he still had a lot of insulin on board. So then I gave him juice, because I didn't want them to be really low. And then as soon as he started going up, I knew he was going to go up probably to 180 or higher. based on the amount of carbs I'd given him, so I immediately bolus him for all the fruit I gave him but not the juice.

Unknown Speaker 41:16
I was thinking more Yes, my

Mari 41:18
moment, one year something unsettled in the you know, near 100. And I when I got home, I told his mom what I did. And she was like, Oh, I was really surprised, actually that you gave him juice. And he didn't spike super high. But that makes sense. You know, now I know why. This is one of

Scott Benner 41:33
my prouder moments. Mario,

Mari 41:35
I try to catch lows with fruit. That's my thing. I always have like five carbs of raspberries or strawberries or blueberries or something like that weighed out in my purse, right? In case you know, when we're driving, I'll be passing him strawberries, when we're going to pick up his brother. I'm like, Hey, are you just want to eat a couple of these real quick. And I always try and catch it before I have to go to the gummies or the juice. Yeah,

Scott Benner 41:57
you're hoping to stay away from that stuff, obviously,

Mari 41:59
is actually low. I go.

Scott Benner 42:02
Yeah. And you know, fruits great too, because fast acting sugar that doesn't hang around a long time in your system too

Mari 42:09
well, and it's not as fast acting as gummies, right? Because there's fiber and stuff. So it's a little bit slower. But it's fast enough that as long as you're not dropping super quick, you can catch it, you know, and I'm really excited about this preventative, or predicted low that the G six does, because that's what I'm doing. I'm looking at him. I'm looking at how much insulin he has on board. I know how like what I've set his basal rate at, and I, you know, he'll be like 130 and but he's dropping fast enough and has enough insulin on board. I'm like, I need to be giving him food now. But if I was just pricking his finger,

Scott Benner 42:45
you still see the 130

Mari 42:47
I'd be like 130 word great. And then like 20 minutes later, he'd be you know, 60 or 40. Or

Scott Benner 42:54
I don't see the predictive pop up that often. But it actually did last night. And I wasn't surprised after all that softball that he'd been Arden took a shower when she came down from the shower. I always wonder if people like see this the way I do. When Arden asks me for food. She's like I'm hungry. That's genuinely or generally, excuse me, a precursor for a blood sugar that's going to fall. If Arden asks for food at times of the day when she's not normally hungry. Even if her blood sugar looks good. I'm like, Oh, I bet you're her bunch of resets are coming down. So she asked me to pop popcorn. And I was like, Okay, I'll do that. So I just put it in a pot with some canola oil and make popcorn, right. And so I walked out to start doing that. And I got the predictive low alert, she went, she was just under 70. And it said, You know, I forget what it says like, we expect that your blood sugar will be under 55 and 20 minutes or something like that, whatever that message is on the G sex

Unknown Speaker 43:48
about

Scott Benner 43:48
Yeah. And so I said to her, Hey, bonus time, it was like you can have more carbs. And so you know, let's turn this into a real like kids snack now at 839 o'clock at night. And she came out into the church came out into the kitchen and she's looking around. There's never any food. She says even though I'm pretty sure if we locked ourselves in here, we could stay alive for two months, but but she's you know, she's looking around. And she saw that at lunch in between the softball games. She bought this, like chocolate doughnut that she thought she was like, I want this chocolate doughnut. Then she got outside of the car. And she's like, I can't eat this while I'm playing softball. And I said, well, it's just gonna melt and but I jammed it in the cooler. And I guess I must have kept it from turning into a horror show. And so when we got home, I slid it into the refrigerator. She opened it up and she's like, Oh my god, I'm going to have this chocolate doughnut. And I was like, Okay, and so knowing that she was the predictive low was coming. It's hard. It's not hard to put into words. But if somebody can tell you you're 70 now, but you're going to be 55 in 20 minutes. Then what is going on is a perfect Pre-Bolus for something like this right she's got a low blood sugar to begin to lower blood are going to begin with, it's still trying to go lower. She ate this donut. And then she had some popcorn, and I gave her a little bit of insulin for the popcorn and golden was really something like I was like, wow, that predictive, low alert. Actually, it did not, I don't think she ever would have gotten that low because the popcorn would have hit her. But she would have gotten lower than I expected. My popcorn bolus probably would have made me think I use too much insulin there when it wouldn't have been that it would have been from probably from the shower earlier. You know what I mean? Like all these things conspiring against you that I wouldn't have been able to imagine without that information.

Mari 45:35
compared to many. There's too many factors going on all the time, right? Yeah.

Scott Benner 45:41
Well, listen. Now I want to call the episode Mari has strawberries in her purse. So I don't know what to do. I'm really up in the air here. It's going to it's going to, I don't know, it'll be down. It'll be a last minute decision.

Mari 45:54
So I always have like a beef stick, or something like that, which doesn't go bad, right? Which is like a one carb snack. In case he's like, I'm starving. I need food right now. And I always have the carbs. Always.

Scott Benner 46:07
So how do you deal with? What's the impact on Jacob's brother? How old? Is he again? I'm sorry.

Unknown Speaker 46:13
He's five.

Scott Benner 46:14
He's five. Does this all is he very involved with the diabetes thing? Or is he feel separate from it? Or does he like

Mari 46:21
to like enter the calibration numbers and stuff and he likes to be there when you're doing like a big check or something? He's he can do math, basic math and stuff. So he's very into like, the numbers and stuff and you know, if he sees the, the your cell phone open, and it says he's like to something, he's like, oh, Jacobs 237. That means he needs insulin, you know, like,

Unknown Speaker 46:48
you see it out. So

Mari 46:50
I mean, even Jacob, you know, if you ask him, like, what do you do if your blood sugar's too high? He goes, small incident. What do you do if you're low? gummies? Or eat food? You know, he knows. Yeah, and

Scott Benner 47:01
you're keeping it light hearted around them, too, which is great. Listen, don't let that older kid learn too much, you lose your job. And so

Unknown Speaker 47:09
they'll keep the money in the family.

Mari 47:11
Oh, is the nanny, make him learn everything?

Scott Benner 47:14
No, I'm just kidding. But you know, listen, we, you have to live to this is really, I'm fascinated by by how entrenched you are in it. And I don't see another way around it. So let me ask you this, from what you've learned so far. Do you think it's possible to bring a school nurse along to this depth? Or do you think they don't, it requires time together that doesn't exist in that relationship?

Mari 47:42
I don't think and I'm not an expert. But I don't think that anybody can get to where I am or where you are, or where any of these people are, who are taking care of type one diabetics, young type one diabetics, I don't think anybody can get there. Unless they are actually day to day with somebody, I think even like, like the endocrinologist, like she's seeing all these different cases. And she's seeing all these graphs and stuff. And I haven't spent enough time with her to know if she's actually spent, like a lot of time with just one patient. But I just think I just think it's different when you're sitting there day to day with somebody watching what their blood does, from every single meal, you know, every single hour, it's just, it's different. You know, it's a

Scott Benner 48:36
podcast would have any value for like a school nurse or somebody who is in that position of being around the more but not a lot.

Mari 48:43
I mean, I think that Yeah, the podcast would have value for anybody who has a loved one or somebody that they need to take care of, you know, a babysitter or a school nurse, anybody you know,

Scott Benner 48:55
but that for that real, that real like, entrenched understanding, I think you're right, I think you just have to be around it. And I think it's important for people to know who have kids who don't feel like they're picking it up yet. Like, you might just not have enough time in the simulator yet. You know, like, maybe you just need to go through these things, more and more and more until they start making better sense.

Mari 49:16
And, you know, it's, this has been hard for me because as I said before, I'm very meticulous, I'm kind of a perfectionist, and I like things where, if I do this, I get this result. Like I loved chemistry, it was one of my favorite classes. But in this case, if I do the same thing three days in a row, I don't get the same result. And that's really hard. For me, it was really hard for me to let go of the idea that I could keep him between 80 and 120, which is my goal is to constantly keep him there. It is not what I accomplish, but that's what I wish from moment to moment I could do that. And that that was really, really a tough one for me to give that up. And to give up the idea that I was actually going to be able to accomplish that I still try. But you know, if he's if his spikes after a meal stay below 180 I really do feel successful when they're like, they below 130. I'm like, What? How today's awesome, you know, I'm super happy. And when he goes above 200 I try not to beat myself up. But you know, breakfast is harsh man. We have him on a higher carb ratio. And a lot of times I end up doubling his bazel. And he just, you know,

Scott Benner 50:33
yeah, I had over Bolus for breakfast this morning. Because besides you and I recording at 1130 my time at 1030. My time I had a phone call with somebody at a company that everyone would know about something that everybody cares about, which is pretty much all I can say about that, I guess. But, but Arden comes cruising downstairs like in her pajamas and her sports bra. And she's like I'm hungry. And I was like, Well, I'm going to be talking to a gentleman 10 minutes from now for a half an hour. And then I'm getting off and I'm getting rid of the podcast. And she said something quick. And I was like, Yes, so something quick. And her blood sugar had just gone from like she slept in very late to like, God 1030 so I had Qatar Bayes law for a little bit. And I was getting arise the good 90 diagnol up so she bought us a little bit when she got out of bed, but it still made it to 120. So now she was going to be eating at 120. And I didn't really get to give her too much of Pre-Bolus. And by the way, she chose pancakes that weren't handmade. So the ones that are handmade, because they're in there from good natural ingredients, they're fine, but those ones that are like, hey, just add water. So you're gonna have pancakes really quickly, which we keep a couple around the house for these situations. They're harsher. So I over Bolus, yeah, terrible. They're really bad actually. So I over Bolus I double bazel the whole thing, it wasn't enough time. And I needed to get her out of the room so I can get on this call, basically. And she did she got up to like 175 diagonal up before we stopped that I had to Bolus again, to stop the stop the arrow and bring it back down. And now it's two hours, you know, it's two hours since then. I can look real quick. Her blood sugar's 140. So this was not the most successful bolus I've ever made in my entire life. I didn't do all of the things that I knew I would have had to do, I could have controlled those pancakes with more time or opportunity. But to your point, 300, right. It's also not 300. It's also not stuck there for two and a half or three hours. It's just a spike, that that was easily controlled and brought back again. And I'm where you're at, I don't beat myself up about it. I just you know, it's not my goal, but it's also not a failure. And I think that's really important what you said like, it's just, you have to keep in perspective.

Mari 52:53
I also said I try not to beat myself up.

Scott Benner 52:57
What's it look like Marty, when you do beat yourself up?

Mari 53:00
I just feel bad. I just sit there and think about what I could have done better, which I think is somewhat productive.

Unknown Speaker 53:07
Yes. But not the part where you feel bad.

Mari 53:10
Yeah, I, you know, or on days when I just keep bonusing him and I can't seem to get him down. You know, there was one time where that was happening. And I really aggressively Bolton and he dropped fast. And it was really scary. And I had to give him you know, it was scary because it was my first time experiencing that. Now I think I'd handle it a little better. But I had so much adrenaline you know, and I gave him fruit and I gave him juice and he was fine. Even though the CGM did drop down to 47 for one cycle. But after that, I learned that I really shouldn't bolus him more than once an hour. But on stubborn days, my rule is to wait at least half an hour

Scott Benner 53:55
to see so, so much to my points that I've made previously. As much as a mistake feels like a mistake, a mistake. If you treat it correctly. If you pay close attention to it, you learn way more from those moments than you do from the other ones. Right? Because you saw how much insulin is too much insulin, but you can also use that information to make a slightly better decision next time still be very aggressive, but not to the point where you're 47 when it's over.

Mari 54:21
And I will say that occasionally I do Bolus and then Bolus like five or 10 minutes later, if he's rising, rising, rising, and I say okay, like I'm giving him point two units to stop this. But then for the next few cycles, he still rises. Yeah, I might add in like another point one or point 05. But I'll call that, you know, then I won't Bolus for another 40 minutes or an hour or something.

Scott Benner 54:45
And keep people should keep in mind when you're, when you're saying point, you know, point one that's, you know, half that's 50% of the original Bolus, it's a lot more insulin then you know, it's like saying I it's like if I said do i Bolus j units and I put four more In, you know, like it's a, it's a, it's a fair impact.

Mari 55:03
But you have to think that like, when he ate, I gave him say like, for breakfast, it might be like point nine, and then maybe his blood sugar was like 140. So that's another, like, I don't know, we just changed all the correction factors that don't quite have it. But something like point two or I don't know. But let's say the original Bolus was then you know, 1.1 or something. But then he's still going up past 180. I might add in another point one or point two or something and double his bazel rate. Because I think of it this way, if I'm adding in 2.2, and I double his bazel rate 2.1 an hour. Like, I can make that up by giving him like three strawberries. Yeah. So I always try and think about like how much extra insulin I'm giving him versus how much food I would need to give him to make up for that. Is it feasible that I can make him eat that amount of food easily. Because I never want to give him an extra Bolus that is so much that I wouldn't be able to make it up in food. I think of things that way. Like,

Unknown Speaker 56:10
that's a smart way to think about it.

Mari 56:12
When I think about a unit or a dosage of insulin. I think about it and how it equals in strawberries or blueberries.

Scott Benner 56:19
That's that's the sillies. That's the story that gets sent here over and over again about when I was trying to figure out how to Bolus for for adrenaline during basketball. I was like, I know I need more. But at the moment doesn't seem like it makes sense for more insulin. So I just my initial bolus was for what I knew I could cover with a juice box.

Mari 56:39
And also you don't know like, I've heard you talk about this. You don't know when that influence. I mean, sorry when that adrenaline is going to stop. And I'll say for for your age, adrenaline makes sense and competitive situation. For Jacobs age, I should say for Arden's age, right. But for Jacob age, adrenaline is tantrums. Right. And so when he has a tantrum, he doesn't usually have the kind of tantrums that wear him out and drive his blood sugar down. He has the kind of tantrums that drive him up really fast. And, you know, like we're in a great place where maybe we're like at 120. And I've just bolus him to bring him down before we eat our afternoon snack and then he starts having a tantrum. And it's like, he'll be 180 all of a sudden.

Unknown Speaker 57:26
And that's not fair.

Mari 57:27
How long the tantrum is going to last is going to last five minutes is going to last 20? I don't know. And I don't I haven't quite figured out how to deal with the gentleman. So then I give him insulin and hope it was the right amount. But how do you know? I don't know how to combat that hormone. I don't I don't know what the right amount of insulin is for that situation yet. Is it out every day? You know, I haven't had as much experience as I have with, Oh, well. I know how to deal with blueberries. Because we have a lot of blueberries, you know, so that

Scott Benner 57:58
I can do and you have plenty of practice in one day, you'll realize that'll have happened enough times or hope or maybe he'll grow out of it. But you'll be able to figure it out at some point. I saw something incredibly interesting yesterday, and have a tie in the last inning of a tie game. So it was the they were so is the bottom of the sixth inning, they were getting ready to go back out on defense. And Arden ran out to her position and her blood sugar started going up. And I thought it was weird. The timing was strange. And I couldn't do anything about it because she was on the field. So when she came back in, I kind of met her at the fence and I gave her some more insulin. And when we in the car later she said, Why did you have to Bolus before I've added in that last inning and I said oh your blood sugar jumped up. And I said I couldn't figure out why. And she was I know why. And I said I said why she goes the game was tied. I delete off the next inning. And she's like I got she's like I just got nervous that I was gonna it was gonna be on me when they came back around again. And I was like nervous. Yes. I don't know it not really nervous. It just it just like she couldn't really put it into words. But I think she was getting amped up to go play defense get three outs not let them score and come back. And then she felt like it was on her to get them that run they needed. And that actually made her blood sugar go up this fast.

Mari 59:14
Yeah, if you think about just how it feels like as a person when you get an adrenaline rush, it's intense,

Unknown Speaker 59:20
you know, really, so

Mari 59:22
you're probably releasing insulin and sugar at the same time to you know, good times and

Scott Benner 59:27
it's hot and everything else is going on and she's hydrating as much as she can but it never feels like she told me at one point she said I drank so much water today. I could feel it moving on my stomach when I was writing.

Unknown Speaker 59:38
I'm so sorry.

Mari 59:38
That happens to us when he has ketones. He'll be like my tummy feels weird like that because you just drink a lot of water.

Scott Benner 59:44
Did you ever shake them and put your up to them? It's fine. You can hear it slosh around.

Mari 59:48
I can just bear it when he's moving. Move enough. I mean, he's too you know how they are always in motion. You know,

Scott Benner 59:55
tomorrow we're coming up on an hour. This was really great. Did I not? Did we not say anything? That you were hoping that would come up?

Mari 1:00:02
Well, we could say that one month after diagnosis, Jacob had an 8.6, a one C, and three months after that. So about four months after diagnosis, we got him down to a six, seven. And I think that that may be the difference between using MDI with no CGM to using up a pump with a CGM. Um, and also as learning a lot.

Scott Benner 1:00:26
But look how quickly you got to it to once you had that feedback. And that information, how quickly you were able to go from, you know, to to lose points off that a one c just but what do you think is average blood sugar is in the course of a day.

Mari 1:00:40
Even now, and also I'm not there at night, you know, so I'm not part of that whole thing.

Unknown Speaker 1:00:45
Yeah.

Scott Benner 1:00:46
That's what you don't have to get involved in that. That's kind of lucky.

Mari 1:00:50
Yeah. I mean, they're very diplomatic about it. They take turns. You know, I think it's really nice, because they both work full time. You know, in your case, you're at home so you take care of the night. That makes sense,

Unknown Speaker 1:01:04
right? No, I agree. Yeah, just

Mari 1:01:06
work full time. So they just take turns. I think that's so diplomatic and

Scott Benner 1:01:11
awesome. Understand, we're gonna rock paper scissors in the middle of the night, just like, like, how do you

Mari 1:01:16
know they take turns? For each night? Tuesday night is me Wednesday night is you know, like, yeah, so sometimes though, he'll have a good night, bad night. Good night, bad night, and I feel so bad for the parent who gets the both bad night. You know,

Scott Benner 1:01:31
they never match up for me, by the way. I like like on the nights. I don't know if this happened to other people. But Arden's blood sugar's perfect. It never goes up, it never goes down. I get in bed and I can't sleep. And I'm like, this is some sort of a cruel joke. Like, how is the tonight's not the night, I couldn't just like lay down and fall asleep the nights when I need to do something. I'm struggling to keep my eyes open to do it as like, why but just one time?

Mari 1:01:55
Well, it could have to do with just being exhausted over the idea of having to do it and make you tired. I don't know. No,

Scott Benner 1:02:02
I don't disagree. I also think that like there's that when the blood sugar's not giving me a problem. My brain immediately goes, Oh, what are the other things I would do if my daughter didn't have diabetes? And then I get overwhelmed with things I'd like to do. You know what I mean? Like, like, maybe watch an episode of something on Netflix, like, oh, like, maybe I'll do that maybe I'll do this, maybe I'll think about things like maybe, and then I just get, I get the I get the opportunity to use that free time. And for some reason, I can't use it to sleep sometimes. And it's disappointing when you don't fall asleep, and the blood sugar never beeps never moves. You're like, Oh, I know, tomorrow night, I'll,

Unknown Speaker 1:02:40
I'll zonk out.

Mari 1:02:42
I'm gonna feel like sometimes when we have these, like amazing days, where I'm just like, wow, this all just went so smooth. And then they'll be like, a terrible night, right? Or they'll have like, a really smooth night where I'm like, wow, that's beautiful. And then we just have the crappiest day. And I'm like, and there's just no rhyme or reason. Sometimes, well, Mari, I

Scott Benner 1:03:03
think that as he gets older, as Jayco gets older, you'll see more rhymes and more reasons, and you'll have less fluctuation like that. And, you know, a lot of it will come with his body getting bigger, a lot of it will come with you got the three of you having more experiences, but but I think you're well on your way to finding more of that balance that I think is, you know, everybody desires, and you guys are really to be commended. Like the three of you working together like this is just really, it's fantastic. Like it's not, you know, some people have real trouble and there are people listening now who are, you know, in their husband, their wives, and they fight about this stuff all the time, I hear about it a lot. So it's, it's not it's not like

Mari 1:03:43
we all agree 100% on everything. But, you know, ultimately, they have the say, right, and I'll do what they want. But they also are totally open to hearing my ideas and letting me try out things within reason. So

Scott Benner 1:04:00
yeah, okay, the freedom to just, you know, to get your thought out in the world with somebody judging it, and then give it a try and see what happens

Mari 1:04:08
when all that, you know, they're like, if you feel like you need to make a call, make a call, do it, you know, and then if we didn't like that call, we'll let you know, afterwards, you know, but like, in the situation, I don't have to sit there, you know, questioning myself too much.

Unknown Speaker 1:04:23
Just act you know,

Scott Benner 1:04:24
so Jacob's parents who are not naming you guys are handling this incredibly well. And maybe one day one of you will come on and we'll, we'll talk about the other side of this conversation. Marie, I really appreciate you doing this. I know it's early where you are. Listen,

Mari 1:04:39
it's it's like 930 right now, right?

Scott Benner 1:04:41
It's still it's the morning. I'm like looking at the rest of my day going on wonder what I'll do now. It's like 1230. So I'm actually going to run. I'm going to take Arden to get her teeth cleaned because that is the excitement that is my life. And, and I just genuinely appreciate you doing.

Unknown Speaker 1:04:56
Yeah, thank you for having me on.

Scott Benner 1:05:00
Thank you so much on the pod to Dexcom tomari, to the family that Mario works for to Jacob for being awesome. And all of you for listening. Don't forget, you can go to Miami pod.com forward slash juicebox or the links that I've put everywhere to get a free, no obligation demo pod today on the pod would be thrilled to send you out a demo so you could wear it, try it and see if everything I'm telling you is you know, copacetic also dexcom.com forward slash juice box or again, the links in your show notes or Juicebox podcast.com. To get started today with the Dexcom g six continuous glucose monitor. Happy Fourth of July to those of you living in America. I'm super sorry to those of you living in England and everyone else. It's Wednesday. I'll be back next week.


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