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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.

Filtering by Tag: Horizon

#201 Chris Ruden from The Titan Games

Scott Benner

You can see Chris on Dwayne 'The Rock' Johnson's new NBC show 'The Titan Games' beginning on January 3, 2019.….

Chris has a congenital birth defect leaving him with only 2 fingers on his left hand and a shorter left arm. 19 years into battling his physical situation, he was diagnosed with type 1 diabetes. Today Chris shares his story and talks about how insulin affects weight, workouts and more.

Chris is online, on Instagram and YouTube

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
Hello, everyone, welcome to Episode 201 of the Juicebox Podcast. Today's episode is the last of Season Four. I first began making this podcast in January of 2015. And I am very proud to have given you a weekly episode, except for a couple here and there every week for four years. While other podcasts are busy doing urine reviews and speaking blah blah blah about whatever the pops in their head because they think they have to put an episode up I am finishing this year strong the way I promised you. We did Anthony Anderson, the star of blackish Brett Christiansen was here from Omni pod to tell us about the new dash PDM coming in the first quarter of 2019. And we also talked a lot about their new artificial pancreas. And its integration with tide pool. I am bringing you the important information here. And just because it's a few days after Christmas and a few days before the New Year does not mean that the Juicebox Podcast brings you some throwaway episode because I promised you one. That's not how I work here. Today you are going to get the answer to a question that most of you at some point have emailed me and asked how is insulin impacting my weight. And I have a guy on here who's going to talk about it in ways I think you're going to appreciate. But first let me thank Dexcom and Omni pod for sponsoring the Juicebox Podcast you can go to dexcom.com forward slash juice box, or my Omni pod.com Ford slash juice box to find out more about the sponsors of this show. There are also links in your show notes at Juicebox podcast.com. Find out more today about the Dexcom g six continuous glucose monitor and get yourself a free no obligation demo of the world's only tubeless insulin pump the Omni pod go to the links

Unknown Speaker 1:39
check it out.

Scott Benner 1:45
Chris Ruden was born with a shortened arm, a smaller hand that had two fingers. Later in life. He was diagnosed with Type One Diabetes. Today, he helps people just like you. I met Chris when I was speaking in Ohio at the jdrf summit. And as he and I found some free time together and we were chatting, I thought this is the guy Finally I found someone to answer your questions about weight loss and weight gain. And insulin, finally found the right guy to bring him on. You're gonna want to listen to what Chris has to say about health and type one diabetes and the use of insulin. He's got great insight, I think you're gonna love it. Not only that, but in just a few days on January 3, Chris is going to be a contestant on the Titan games with Dwayne The Rock Johnson, like on NBC, you're gonna be able to like flip on the television and go, Hey, that guy that I just heard on the Juicebox Podcast is standing in front of me on my TV, and he is doing amazing things, crazy feats of strength. Do not miss this. People who comes through for you. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before becoming bold with insulin or making any changes in your health

Chris Ruden 2:59
care plan. My name is Chris Ruden. And I am probably the only seven fingered diabetic record holding power lifter nutritionist and online influencer that you know, and I guarantee that

Scott Benner 3:14
what's the what's the rate limiting factor in there? Chris? What makes you so simple? able to say that do you think

Chris Ruden 3:20
it's probably the gel I use in my hair? Definitely the gel I use Am I I could definitely say not many people I know have a congenital birth defect and type one diabetes and also have four state records and one world record and all the fancy letters behind my name, but I'm gonna go to jail.

Scott Benner 3:39
I met you recently and your hair was on point. So

Chris Ruden 3:41
I appreciate that. That makes me happy. life goals are accomplished. Normally, I'd

Scott Benner 3:52
asked you when you were diagnosed, but I don't think that's the lead question. So you, I don't know exactly how to talk about this. So you know, in terminology, so you'll help me please. But yeah,

Chris Ruden 4:00
that's not a problem. So I mean, when you want to talk about I was born with a disability, no, that does not mean I am technically disabled and not not abled, and just differently abled, if that makes sense. So I was born with two fingers on my left hand and a shorter left arm. And I never I didn't have diabetes growing up, but I grew up with a disability. So I know what it was like to be different, to be looked at to be made fun of to be an outcast, because you weren't physically the same. You know, I didn't realize all the other issues that were going to come into play later in life because of diabetes, but I dealt with that growing up as a kid and it was is really tough, you know, to be in a not nice area. You know, I didn't grow up rich and I was kind of alone because you don't know other people who have disabilities at that time. And Facebook groups weren't a thing. So you know, I grew up kind of alone and Mike Okay, I'm different I am. I'm supposed to be less than I guess because disabled technically is synonymous with We can bargain and useless and all these other names. So I grew up labeled and it was it was definitely

Scott Benner 5:07
let me ask you this when I know it's hard because you're young and it's it's it's asking you to think back really far. But until you leave the house and go to school, do you really think how differently Do you think of yourself? I'm assuming everyone else in the house has two arms the way I'm imagining. So yeah, so I mean, is it that easy? Do you look up and go, I'm not like my mom and dad, or my brothers and sisters. I don't know what your family situation is.

Chris Ruden 5:31
So, for me, it wasn't at home. I thought everything was good. You know, until I started going to I think it was middle school. I went to the same school my entire life. You know, in elementary school, everyone knew me and I there was some issues here and there, like people making fun of me, but like, it wasn't, it wasn't too bad. You know. Now, it wasn't until I went to a new middle school. And I was I never hid my hand whatsoever. You know, I went to New Middle School, the first day, everyone started making fun of me laughing me all this stuff. And I'll never forget, there was this girl named crystal who was just, you know, she was the Braves girl on the glass. And I wanted to go talk to her. So I went up to her in front of the class, and I turn around and everyone's laughing. I'm like, why are you guys laughing? And I turn back around look at Bristol, and she's using the stapler to make fun of my hand. And I showed my hand in my pocket. And for 17 years. I hid my hand from that point.

Scott Benner 6:29
Well, and the staplers ham fisted at best. Like I mean, she could have come up with something better.

Chris Ruden 6:33
But yeah, exactly. These middle school kids, Chris, they're not invented Middle School is by far the worst, though is they might not be invented, but they are ruthless. So any kid going through middle school? I just I feel for them. Yeah, no kidding. And it gets better. It gets better.

Scott Benner 6:50
And of course, you're the same age too. So you can't respond in any meaningful way? Oh, no.

Chris Ruden 6:55
I had no clue. I had no no preconceived notions, or like, no knowledge on how to deal with a scenario like that. You know, and I was always embarrassed to tell my parents what I was going through in school, so they never really knew

Scott Benner 7:07
not. And it's funny. It's as you're saying, and I realized too, like, as you you're walking up to Crystal, which I mean, we're we're very close to just calling this episode crystal socks, but probably not. So. But as you're walking up there, you have no expectation that she's not going to be anything but like human and polite in return and excited to meet a new person, like you're excited to say hi to Absolutely, absolutely. I

Chris Ruden 7:27
had no thought whatsoever. And it wasn't until that point that I was like, wow, I am different. You know, we're kids. We're like, Oh, don't always choose me to be the monster at recess. And then everything starts to come together. Like, wow, that's why this is why everything is happening like it is. And I went from being naive to being guarded. You know,

Scott Benner 7:48
it took away could you had you probably had a perfectly normal and healthy opinion of yourself.

Unknown Speaker 7:53
I did up until that point, right.

Scott Benner 7:55
Yeah. It's very interesting. I know. I'm not. I'm not like, lean, you know what I mean? Like, my body's not lean. I never really have been my whole life. But I don't think of myself as overweight, which is interesting. Because it, I think it's sometimes it stops me from taking better care of myself, because I don't particularly think of myself poorly. But at the same time, I know people see me and it's funny. You and I know each other I'm not like, painting myself is like grossly overweight, just like flowing through door. Yeah.

Chris Ruden 8:28
But But I'm not I'm not at the weight that I wish I was right. But I don't I don't see myself that way. But I do know other people. Look at me, and I don't I it's not there. You know what I mean? Like, a lot of time, a lot of times for me, it's a lot of people write this, whether it's good or bad. It's I'm just going to take the emotion out of it. And this purgatory of a life where they don't change, they kind of want more, but they don't change and they don't change because no one said anything. And I don't think that's a problem. Like before crystal. I was in that purgatory life thinking everything was good, you know, but life will skew your opinions of yourself based on what people say and how people act around you. So if they don't, you have no reason to feel any other way except for your confident beliefs in yourself. Now, when people start to say things to you and start to get to you, if you allow it to get to you, you will change and that's usually not in a positive or beneficial way. Kind of like what I went through, you know,

Scott Benner 9:23
so when did you At what age did you start using a prosthetic arm? Is that the right terminology for that?

Chris Ruden 9:29
Yeah, I started using a prosthetic arm last year, just last year. I hid my hand for 17 years until November of last year.

Scott Benner 9:38
And you were bodybuilding prior to that, right?

Chris Ruden 9:41
I was bodybuilding. powerlifting speaking, I was living my life. I played drums, I did martial arts, I danced. I did everything hiding in plain sight. And a lot of people tend to do stuff like that. You know, for most people. It's kind of like a mask. For me. It was literally and figuratively a glove. I wear a glove to hide my Left hand for 17 years from my girlfriend from everyone who knew me, I never took it off ever, ever, ever.

Scott Benner 10:08
Did you avoid touching people with it? Yes,

Chris Ruden 10:11
I pretended like it didn't exist. And I was so confident I had such a strong persona, that most people wouldn't ask me about it because they would feel uncomfortable to come at me. And it was this fake sort of confidence that I fixed all the problems in my life. But that one elephant in the room, and I pretended like it didn't exist,

Scott Benner 10:35
I was gonna say, I mean, there's that where's the bodybuilding initially came from? Are you just trying to perfect the parts of you that, that were, you know, quote, unquote, normal and what everyone expected.

Chris Ruden 10:45
So I've always been that super, super competitive person that wants to like compete with everyone, whether we're walking next to each other, and I'm gonna walk faster than you. And you don't even know we're racing or shift. You know, I that's exactly that's, that's me all the time. I think that's just from being born differently. I'm always like, proving to myself that I can do something. So I everything I've done has been competitive from dancing to drums to all these things. So bodybuilding was the last thing that was like, Oh, you can't do this. Because you need symmetry. You physically don't have symmetry. It's the way you were born so that you can't do this. And to me, that's, that's the biggest challenge. They I can't do something. So I kind of out of spite. I got into bodybuilding and powerlifting

Scott Benner 11:27
Yeah, I mean, I've seen images of you when I assume you were more in a training mode. And for size, and I obviously met you a few weeks ago at the jdrf event in Ohio, and you're incredibly fit, but you know, instructor Bruce? No, no, I'm very handsome man, Chris is what I'm saying. And, and so

Unknown Speaker 11:46
that works for me. Yeah, listen, whatever, right?

Chris Ruden 11:48
I will take it as working is working. Those Instagram pictures aren't lying. That makes me happy.

Scott Benner 11:53
But but it does strike an outsider because it hit me. How did he build himself so symmetrically, when I my assumption was that you're at a deficit on your left side, but you're not. And and so how do you make that work?

Chris Ruden 12:10
I think what's funny is, anytime people, people encounter a problem, like a struggle, whether it is diabetes, or whether it's anything financial friend, something they consider themselves to be at a deficit. And for me, it's not being at a desk, it's being how I've always been, you know, I do the best with what I've got was what I've given. And the biggest resource you have is just being resourceful. So if you see what you have, for me, it was my left arm and I'm like, Okay, I'm gonna need a little bit extra work on my left arm, instead of acting normal, like everyone else, I'm going to do things differently. I'm going to adapt, and I'm going to make the best of what I can. And that's what I've done. And that's what I continue to try and do is always perfect my situation and not perfect. The image of normal or not perfect the image of what everyone else thinks it should be. You know, there's no universal fix to an individual problem. So I think people that's where they messed up, they think they're going for this universal approach that doesn't fit them.

Scott Benner 13:08
You know, it reminds me of is, it's so funny. I think we measure everything out to perfection, especially the stuff we can see. So I as you're talking, I'm thinking of just today, the Phillies traded a player for another player. And involved in this trade was a kid that they had. They drafted really high they had a ton of expectations for any kind of wasn't coming through the way they expected. So as he's going out the door, I'm seeing people comment on what a floppy was, you know, good riddance, thank God, we got rid of them, blah, blah, blah. But, but the truth is, and I have a little bit of perspective on this, so my son plays baseball in college right now. But he started playing baseball when he was four years old. 2004 and 2004. That's the statistics say that in 2004 4 million children began to play baseball in America that year. Last year, when my son went on to college, he and 9500 other people went on to play college baseball of Wow, 4 million. Of those only. I think there are 3000 professional baseball players in the world of that only a handful of hundreds actually play baseball on television. Every night, all summer long. This guy that just got traded, is just a hair's breadth, not as good as those other guys. And people treat them like garbage on the way out the door. not crazy. not religious, but I think that's how we think about things like instead of and my point is, is that wherever along that path, you know, anyone stops being able to move forward. That's still amazing. If you're, if you're a 30 year old guy in a softball league because you love softball. There's nothing wrong with that. But from the outside, we tend to look at that guy and go, Oh, what a loser. He didn't make it to college. That's,

Chris Ruden 15:00
that's the unfortunate part about life today, people see other people's success and they're so engulfed by wanting to get to that when success really is individual, it's defined by you. And if you define it as you need to be, you know, Bill Gates, you're gonna have a hard time feeling successful, feeling happy, you know, but the best way to feel happy and to be successful, I think in my head is gratitude, you know, being grateful for what you actually do have, because there's millions of people who would kill to have what you have. I saw a random fact, you know, if you have clothes, shoes, and a roof over your head, you're doing better than 75% of the world. If you make over $100 a week, you're in the top 8% wealthiest people in the world. That's crazy. You know, and I know from personal experience, you might be there too. You might not consider yourself a wealthy, but to most people you are I say

Scott Benner 15:56
all the time that the the the working poor in America, and even some of the non working poor in America are still some of the more well off financial people in the world.

Chris Ruden 16:07
They 100% are that's not to take away their their struggles. But right. perspective is a crazy thing. And that's why I started to over the last, like, let's say, 10 years, I really tried to change my perspective of I was given less to I was given an opportunity to make the most of what I've got, you know,

Scott Benner 16:27
I'll tell you something that I say a lot. It's about, it's about a one C. So you know, I know that the the general feeling in the in the diabetes community is that you don't share your a one c because it makes people feel bad. And I have my own thoughts. I think some people are out there kind of Hawking their wares. And then they don't want to fall through at the end and say, you know, you know, they like to say do what I do follow me here, you know, maybe pay for my plan of this or whatever. But I don't want to tell you my one c because I don't want you to feel bad. Well, listen, if you want me to follow you along on your idea about how to take care of type one diabetes, I want to see how it works for you. Absolutely. Right, right. And so I share my daughter's a one C in that spirit. In the spirit of I'm saying all these things that we do, you should know how it works out in the end. But But still, it's it can be debilitating to other people. I'm completely aware of that. So I've come to say, and I hope that people really feel this, that looking at someone's a one C or their I don't know their Dexcom graph that seems pretty steady, or you know, somebody who's got a goal of 7130 and stays in it most of the time, you should look at that. And if you don't have that, that should just look hopeful to you. You shouldn't be angry at that person. In my mind, you should look and go, Oh my gosh, that's possible. Let me figure out how that happens. Like how do I do that? Not I can't believe they're having this success. And I'm not immediately angry at them and sad for yourself. It's such a counterproductive way.

Chris Ruden 17:58
I mean, it happens with everything. You know, with diabetes, I see it happen a lot dirt. There are two kinds of people, they're the kind of person that shares their agency, maliciously, to prove something or to have social currency saying I'm better than you. And those are the type of people saying, Hey, this is just my situation, it happens to be this. And this is how I got here, that is a lot better of a way. Same thing with people with their bodies, you know, you could have two guys with ABS, one guy could be super cocky and kind of arrogant. And then the other guy could be like, this is what I did. And this is how I got here. And this is the product, you know, it's it's a different perspective from the person who has that agency or from the person who has the body or that person who has that business, versus the person who sees it. Now, the people who see the ANC or her daughter, people see the ANC, that are really low. And people want to strive to that. It's on them as well to say, Hey, I can't take this as a negative thing. That's that's the way you perceive it. And you control your thoughts and beliefs and reactions, whether you say you want to or not, it's all you. So when you see a number like that you can't you can't go into this negative self doubt. And unless you like you said it should be Hope it should be inspiration to keep going and know that it's possible.

Scott Benner 19:13
First of all, anybody who would do that, for what you called social currency, I'm old enough that I don't even think about that concept. But I you know, social media are very real thing. I definitely understand that. That's true. Those people are just, that's a horror, like, you know, the there should be a special pile for them in hell for somebody who's running around trying to make you feel bad through Instagram or whatever. That that's just odd. But the rest of it, I mean, you have to you have to believe when I tell you that years and years went by, I couldn't get my daughter's a one C to move. And I didn't know what I was doing. And I just kept building these small ideas on top of one other on top of one another with no real direction. And I'm not trying to say wow, I figured it out all by myself. But I sort of did. Like I just kept looking out into the world and thinking Well, you know, simple things. I had trouble with Arden's insulin, and I saw another person who was using a different insulin, I thought, well, let me try that, or someone using a piece of technology. And I thought, let me try that you have to believe as much as I love Dexcom. Going back to the seven plus all those years ago, I didn't know what a CGM was, you know, someone else knew. And I was like, okay, right on. And, and I'll tell you, where I give a little bit of credit to that is that I grew up. I'm an adopted person, but but my, my adopted parents split up when I was 13. And so I kind of grew up through those formative years, you know, they talked about searching for a father kind of a thing, but I didn't do it that way, what I would do is I'd look at the adult men in my life, or that I worked with, and I would identify the things they were amazingly good at. And those, that part of them is what I would mirror. Like, if one guy was a good, you know, a good talker in a group, I'd be like, that's a good skill to have one guy was more thoughtful and quiet. I'm like, that's a good skill to have. And, and I would kind of pick and choose from people, you know, I got to almost build my own dad, you know what I mean? Like, yeah, that sounds sad or not, but like, that's sort of what I was doing. And I did that with diabetes, too. I'm like, let me just take the best ideas, and bring them home here. And we'll, we'll make a plan with them.

Chris Ruden 21:15
That's what that's what life is, though, like that. That's what you're supposed to do. You're supposed to find the characteristics that you resonate with, that are going to help you be successful and achieve your ideal of success. You don't have to copy one person, like, no one's gonna listen to this podcast and say, I have to do exactly what you're doing every single minute. No, they're gonna take what benefits them and that's how people operate. That's not a negative thing. That's, that's just what we're supposed to do. We're supposed to see what helps us and helps other people. And that's fine. That's okay.

Scott Benner 21:45
All right, Chris, we fixed the world. Now let's move on. Okay, there's two ways to deal with this. You are listening to this the very end of December very likely, and your insurance is about to reset. You've probably already met your deductible. So now is the time to get moving on your purchases for your diabetes supplies. And if it's too late, if you're listening, you're like, Scott, I can't believe you just said that. It's January 5. I just heard this. I wish I would have thought of it

Unknown Speaker 22:08
two weeks ago. Where

Scott Benner 22:08
were you? That's fine, too. You still have to get prepared and understand what it is you're going to do. When you're ready to jump. You need to be ready to jump. I don't want you to find out. You know two months from now. Oh, I've met my deductible. Now I'll start thinking about whether or not I want it on the pot. Don't do that. Start today. Start right now. stop procrastinating. Are you procrastinating? You are? Aren't you? Stop doing that? right now. I mean, not right this second, you're doing something right now you listen to a podcast. But when the podcast is over, you look in the notes of the podcast, you click on the link, Miami pod.com forward slash juice box. When you get there, you fill out the tiniest bit of information about yourself name, address, phone number, and Omni pod. Such good people, they will send you a free, no obligation demo of the insulin pump that I'm talking about the AMI bot, they send you out the pod, and then you wear it or you stick it on your kid or something like that. And then you have days to live with it. And really think to yourself, Is this what I want? Do I want to be untethered, maybe I want to be like strapped to a tube that goes all through my pants down to a controller. I mean, probably not. But you know what I'm saying, you're gonna get a chance to live with it and really see what you think. And then if you want to move forward, you just tell on the pod. I want to keep going with this. And if you don't, it's no big deal. They're not going to hassle you, Miami pod.com forward slash juicebox. But the links in your show notes. Have a Happy New Year, do this for yourself. Tell people a little bit about what you do for other people. And then I'm going to ask some questions because one of the most frequently asked question through email to me is can you please talk about my issues I have with weight and insulin. And I think you're just going to be the perfect person to talk to about this. But tell tell people a little bit why you might be the right person ask.

Chris Ruden 23:55
When I was diagnosed diabetes, basically decided to switch my career from being a lawyer because I just like to argue with people to actually helping people and I found exercise and nutrition. I got my degree in exercise science and health promotion. And then my business online took off. I just started building my social media and now I work solely from social media. I run the one of the biggest type one only weight loss and body composition challenges called the fitness 81 D challenge. And I do private coaching through social media through phone, email, Skype to help people better their body composition which as a side effect also helps them control their diabetes management. And I work with other people with different conditions. So I am not an endocrinologist, but what I do is help people lose body fat or attain the body or specific performance goal that they want, so that they can just be happier in life because my end goal was better confidence in yourself because that's what I struggled with. And for me better confidence comes from better health better feeling better quality of life in total.

Scott Benner 25:00
And if you and if you need more to believe in Chris's ability to speak to people he apparently taught his parents out of I'm assuming killing him when he decided not to be an attorney. So,

Chris Ruden 25:10
exactly. They're like, do you want to do what? You want to work online? I'm like, oh, that means you're gonna be broke and living in the basement forever. I made it Mom, I made it.

Unknown Speaker 25:19
Talking to you.

Chris Ruden 25:21
Oh, yeah. And now this leads me 100%. Now they 100% Believe me before, there was a phase where it's like, maybe you should go be a janitor. And I'm like, No, I make this work.

Scott Benner 25:30
To me, this is a measure of your genius so that you calm your parents down after that situation is pretty rare. And that's when

Chris Ruden 25:37
I found out I wanted to be a speaker.

Scott Benner 25:40
So okay, so let's start slow. My daughter is diagnosed when she's two years old, she's 17 pounds, obviously gone, losing weight dying in front of us. Four days after insulin, she weighs two and a half pounds more. Now I recognize that it's her body getting back into, you know, a healthy way. But she continues to gain weight. And how is it that insulin helps a person to keep weight on like, what is it about I want to know the real, we're gonna get a little like granular here. So I want to know how that works.

Chris Ruden 26:14
So it basic lock and key mechanism. Insulin allows nutrients to be transported and stored. So without insulin, you the nutrients can't be optimally transported and stored. So if you think about it, someone could be consuming, you know, an extra 500 1000 2000 calories a day. Without enough insulin, then the body's not storing. So you see increase urination, you see increased sweating all these things to try and get rid of all this stuff. And insulin allows those nutrients to be stored. So a lot of people in my mind falsely blame insulin for causing weight gain, when in reality where you can cause is comes from calories, it comes from excess amount of calories. Now those calories weren't able to be stored without insulin. Now, when insulin is introduced, all those calories do catch up to you. Now, if insulin directly caused weight gain, like immediately 100% of the world would be severely morbidly obese, because we all have insulin in our body. So insulin itself is not the primary culprit, the primary culprit is excess caloric consumption, insulin just helps open the door. If that make sense.

Scott Benner 27:25
It does. And, oh, hold on a second, I like to let that just like soak in for a second because that is just really valuable information. It is the thought of people. Most people in the in the wild, who you know, I started using insulin, and I gained weight. Oh, absolutely.

Chris Ruden 27:46
It's called a slippery slope fallacy. Basically, if I stuck a pencil in my back pocket, and I went in root cause and I went and robbed a bank. Does that mean pencils? Cause robbery? No, no, it's the same thing because you introduced insulin and you gain weight does not mean correlation does not mean causation. You know, so we have to understand that before that insulin was introduced, you were probably over consuming Not to mention your your decreased appetite or decrease the you know, feeling of fullness. So you kept eating, kept eating kept eating as a response to your body. And now that insulin was introduced, those things are stored. So you got to understand now when we get to insulin resistance, it's a little bit different, a little bit different mechanisms, and then there's other hormones at play. But in a basic sense, once you kind of stabilize how much insulin you're consuming, dining you're taking, you have to figure out how much you're eating, how much you're eating, how many calories you're consuming, and people skip that they think diabetes management is and all life is more than diabetes management life includes diabetes management, but you also have to manage your life.

Scott Benner 28:54
Okay, so it's such a simple answer to what feels like a bigger question. It's so interesting that then people see that I started taking insulin, I gained weight, so I'll leave my blood sugar higher, and they start manipulating their weight by not using enough insulin. And then you're just in a spiral,

Chris Ruden 29:10
you know, you go now this is where we have to address this because I know someone's going to message you and say, Well, how do you explain this when I stopped eating carbs? And I use less insulin? I lost weight, right? You hear that all the time? Well, guess what? carbs are made up of four calories per gram. When you stop eating carbs, you stop eating calories, you eat less calories and you lose weight. Also, you use less insulin. So you see that whole slippery slope fallacy comes in again, people associate carbohydrates with weight gain, when in reality, it could be a part of weight gain, but total caloric consumption is what contributes to weight change.

Scott Benner 29:49
And so it's interesting that it really is it's sort of it feels insulting if you've ever struggled to lose weight for someone to say like it's all about calories,

Chris Ruden 29:58
but it really is, but that calories. The unfortunate part is now I'm going to go through just some quick diets. We talked about keto diet, a lot of people like oh, I do the keto diet works well. keto diet is very hard to over consume food because it's very restricting. When you go out to eat, you can't have a burger, or you have to have a burger without the bun. And you have to limit certain foods, you're going to limit carbohydrate consumption. So one of the three main nutrients, proteins, carbs and fats is now eliminated, you can't have carbs. So when you take one third of the way of your food consumption, of course, you're going to have one third less calories or less, you know, so it at a base level, it does come down to caloric consumption. Now, there are specifics, it doesn't just stop there, that's not the easiest answer, like Oh, just eat less, and you're fine. There are other things, you have to have proper nutrition and proper fuel, you have to have the right amount of protein, the right amount of fat, depending on how many carbs you have. There is a science to this stuff. And what's funny to me is that if your car broke down, you wouldn't try and fix it yourself. Because for me, I'd probably hit it with a hammer and duct tape. I have no clue how to fix a car. If you were had need brain surgery, you wouldn't try and operate on yourself. You know, but when people come to dieting, they think they can do it themselves. They think they know how to do it. Well my cousin's friend's brother, sister did it with less carbs in this. So I'm gonna do that. There is a specific way to do it to make you not want to pull your hair out, I promise.

Scott Benner 31:18
You know, what I did, about a month and a half ago just wasn't really on a whim, I just was looking for like a like a jumpstart like something to drive. So I did that. But I think now as I look back on a kind of a crazy thing, but I did this, um, this baked potato like, like fast basically. And it's probably something you've heard of, and I don't know that I should have done it or didn't do it. But basically, for 10 days, I eat nothing but baked potatoes. There was no salt on them, though. But there was nothing on them was the potato, you bake the potato, you eat the potato, you could eat as many potatoes as you wanted during the day. And I saw I went out bought a big bag of potatoes. And I'm like, let me try this. And I did it for 10 days, in 10 days, I lost 17 pounds. More kind of importantly, what I learned was, I was never as hungry as I thought I was. That was really the interesting part. Because you'd start with like, Oh, I'm hungry, eat this whole potato. But then by the third or fourth day, I wasn't eating a potato every two hours or every four hours, I had like two of them a day. And I was completely Yeah, you limited total consumption. And you limited variety, you limited the processed foods that can increase something called hyper palatability basically, making you want to eat more food, you limited all the crap,

Chris Ruden 32:33
you know,

Scott Benner 32:34
I wasn't hungry at all. And what I learned about butter and salt was I don't like baked potatoes, I like butter and salt.

Chris Ruden 32:41
That's it. And that's the difference.

Scott Benner 32:45
Potato was like a delivery system for the budget

Chris Ruden 32:47
was that's, that is the best way I've ever heard that put ever in my life. Honestly, when I think about baked potato, like sour cream, butter, baked potatoes, literally the delivery system, even with like bread and butter at a restaurant is like how much butter Can I fit on this little piece of bread,

Scott Benner 33:04
because without the potato, you just look like a monster eating. So

Chris Ruden 33:07
you do and you obviously you would never want to judge yourself like that. But you know, that's what you truly want. You just want to drop that bread and stick that finger right in the butter and just go go in. But we can't do that as civilized people. So

Scott Benner 33:19
it taught me a great deal, like those couple of days that the weight was neither here nor there. I just didn't want to have as much of a double chin when I was standing up on that stage. But But you know, but I did, I was trying to learn sort of a greater thing about my about myself and about the idea of eating. And then I look to see what's in a baked potato, you know, which is just a route. And it's a basic thing. But it had enough vitamins and nutrients and everything to very well keep me going for 10 days, like I was not at a deficit. Now that I'm using a word that's in my head today. But I was not in a deficit for for calories for for vitamins for

Chris Ruden 33:55
anything I was doing really. And that's the benefit when you can find a way to be in a caloric deficit because you want to lose weight, but not you know, risk malnutrition, then then you're on a good path. You know, I hate to bring this up, but I just have to there was a Kansas State nutrition professor who did a study where he ate Twinkies and protein shakes for I believe 60 days, I think he lost something like 15 to 20 pounds. And he improved his metabolic profile, his cholesterol and all that all the balance between he found a balance now he wanted to say this is not healthy. This is not what you should do. This is not a long term approach. This is not a good thing. I just wanted to show that when you calorically control for higher protein diets, and you're in a calorie deficit, you can still change make changes to your body composition. Now we want to do it the healthy way too. So we take that concept, we add healthy foods. We add a healthy balance of life, you know, you should be able to adhere to it. It shouldn't make you miserable and it should produce results if it hits those three goals. You're very successful.

Scott Benner 34:57
No kidding. I did not. I never felt better. I really am. I say this throughout my life, I always feel like a person who I'm at odds with my body in food. Like, I'm not a I'm not a big food person, like, there's no meal that you could say to me, hey, let's go out tonight and get this. And I'd be out of my mind. Like, yeah, let me play in my whole day around eating this food, like I don't get excited about food like that. And I, my bigger problem is because of that, I don't really eat very much. And I think that when that happens, my body's like, Yo, this guy is starving to death. Like we have to hold on to every ounce of fat he has, because we're on a desert island somewhere. He hasn't eaten anything in a day.

Chris Ruden 35:37
I mean, that's definitely a concept. There's something called adaptive thermogenesis. Basically, your body adapts to a lower calorie amount, a lower calorie input, and it can start getting rid of tissues that cause too much work kind of like muscle. So when people start eating too little, and they lose lean muscle mass, they retain body fat, and it just changes the composition of from what they want it to be to what they really don't want it to be. So we got to be careful with not eating enough as well as eating too much. And that's just like blood sugar management, not too high, not too low.

Scott Benner 36:07
So So is what's the, when you think about people and their calories around diabetes is their is their biggest stumbling block that they're always chasing lows with food.

Chris Ruden 36:20
So I have a few things. I just finished up a challenge with 114 people. And it was awesome to see. But the biggest compliment I got for this challenge was I tracked my food to check my calories. And I realized I was boasting for the wrong amount of carbs. I realized I was boasting for things I didn't know. You know, people were boasting for a banana that they assumed was 15 grams of carbs, but it was actually 45 grams of carbs because there's a large banana. Now, some people like to carb count, some people don't. And that's okay, whatever you prefer whatever works for you. But the realization of what you're doing and paying attention to trends is the biggest benefit to you know, diabetes management when it comes to tracking calories. So as a side benefit for people who are constantly going low, and treating with carbs, which makes them eat more calories, which kind of furthers them from their body composition goals, I have people create a low carb reserved. So if they're allowed at 100 200 however many grams of carbs you have for the day, let's say it's 100. I tell them to pretend like they only have 80 or 75. That way those 20 or 25 grams of carbs are a low carbohydrate reserve, when you go low, you eat your carbs to obviously fix your blood sugar, but now you're not going above your caloric limit. Because you planned in advance for that emergency scenario.

Scott Benner 37:43
That's it, it's just all about even if so even if you're to I'm gonna make that simpler for people to listen to. Even if you're eating well and healthy all day long. You're not taking in too many carbs, too many calories too many this that, but you get low once twice, three times drink a juice box, have some candy, you know, a squirt of frosting, whatever it is you're doing. That's there you go over top of your calories. Yeah, right and, and you're not going to not only you're not going to lose weight, you're going to gain weight.

Chris Ruden 38:10
So in certain scenarios, say you were to have an extra 50 grams of carbs a day from low treatments, that's an extra 200 calories, you know, that's almost a half a pound a week that you could be either gaining or losing less than a half a time than you originally wanted to. The average count of fat takes 3500 calories to gain a pound. So when we talk about that 250 a day for seven days, that's almost half a pound of fat.

Scott Benner 38:36
And it really and there's no way to quantify when you get into the eat the kitchen phase,

Chris Ruden 38:41
you Oh no, that's done. Oh yeah. When I destroy that box that many weeks like that is over. You know, when you realize you just had 300 grams of carbs in 15 minutes and you're like, Well, tonight is gonna suck. You know,

Scott Benner 38:53
I just I just want the real thing that everyone listening right now knows you're a fit person because like you're crazy. Go to I can't believe I'm eating. This is mini wheats.

Chris Ruden 39:03
Oh, no. Oh, trust me. I love doughnuts, too, but frosted mini wheats are the best cereal ever in my head.

Unknown Speaker 39:08
I love broccoli. Anyway,

Chris Ruden 39:09
they're also the most carb dense cereal too is crazy.

Scott Benner 39:12
But so I mean, my my thought is if you're already struggling with your weight, then I might I do agree with Chris there's a reason Chris is on the podcast because Chris stood next to me and was saying things we were on a panel together and I'm like, this guy is smart. And I agree with him, which always makes me think people are smart because you agree with him. But no, but you were talking about calories and and i and i thought that's really smart. And if for me, or for anyone else who's not at their goal weight, I am eating more calories in a day than I I believe that I am. You know, like I might be thinking I'm doing okay, but the truth is, I know what I'm doing okay, because when I'm doing okay, my body composition goes to where I expect it to be. And when I'm when I'm not when I'm eating more than I even think I am. I'm obviously my weight. stays the same or it goes up. But I ever in the course of those days and weeks do I think, oh, I've over eaten this this week, but I have it happens. It happens all the time. And I see people automatically they they over assume their fitness level. So I asked people Oh, on a scale of one to 10, how fit Are you on a scale of one to five, I

Chris Ruden 40:19
figure, I go to the gym five days a week for an hour, I'm super fit. Well, guess what, that's five hours out of 168 hours. I'm terrible at math. But I know that fraction is not good. You know, not saying that you need to do more. But I'm saying that you got to realize where you stand. If you only go to the gym five hours a week, and you've sit down at a job, you have to consider yourself that you're not as active as someone who works doubles as a waitress or a construction worker doing 12 hours on their feet, go go go, those people are very active. People assume going to the gym means you're active. And unfortunately, just because you're in a library doesn't mean you're studying. Just because you're in a gym doesn't mean you're fit, you know, we got to we got to know the reality and not say you need to do more or less. We just have to start with transparency and realness. You know,

Scott Benner 41:06
yeah, I have a couple things in my life that keep me straight about that one, my Apple Watch, which tells me I'm not nearly as burning as many calories, I think, although, because of what I do, because I'm basically a stay at home parent, I am on my feet 12 hours a day. And I'm telling you, I think that saves me some weeks

Chris Ruden 41:23
that's going to be a lot more than someone who works at a desk job, you know, nine to five, nine to nine does not saying that those people need to quit their jobs when you're saying they have to understand that they're going to require less total calories than someone who works as a construction worker. Yeah,

Scott Benner 41:37
no, absolutely. And it's even having active children like athletic children, which is such I was talking with somebody the other day, my Arden's in the middle of having her shoulder rehab, because she just her shoulder kind of got out of place. So she's not playing softball right now. And I was standing there and watching her do this thing. And this woman asked me this, this, the therapist asked me if I had any other kids. And we started talking. And I said, You know, I gotten to this point where I was explaining to her, I'm like, there are times that I watch my children do things and I think, how are they my kids, you know what I mean? Like I get so I but I

Unknown Speaker 42:11
have

Scott Benner 42:12
that perspective, like you could take my son right now I don't know where he's at. He could go out, run three miles, go play baseball for four hours, lift weights, throw a ball from here to God knows where. And he'd be tired when it was over. But he would accomplish all of it. And if I tried to do a small fraction of what he did, it probably killed me.

Unknown Speaker 42:32
And,

Scott Benner 42:33
you know, and and so having them in my life gives me that prop that that perspective that you just spoke about. It doesn't sometimes help me do more about it. But at least I know where I stand, which I think is what you were saying and what I think is important, too, like, I'm not over estimating myself, because it is very easy to sit around 40 years old. And think, you know, and I was 18. I used to do this and you still sort of think of yourself that way. Absolutely. It's interesting, you know, that's very true. Christmas is over and the stress of the holiday is gone. There's nothing left to think about except all the bills you can't pay because of Christmas night. Well, I guess the stress never ends when you're an adult. But wouldn't it be nice to make it a little less? Here's one way you could do that could get yourself a dexcom g six continuous glucose monitor so that you know what direction your blood sugars moving in and how fast it's going. You already know what direction your savings accounts moving in and how fast it's going that direction. And that's not fun to know. But this thing about your blood sugar. This is different. This is actually great to understand. Arden's not with me right now you know what our blood sugar is 106 she's out with my wife, Kelly. They're having lunch together. I bet you Arden had a waffle because I know the restaurant they went to 106 my wife is using the information coming back from the Dexcom to tell ardens on the pod how to give her the insulin, extend the boluses bazel rate stuff like that, those decisions they get made with the data that comes back from Dexcom. All you have to do is go to dexcom.com forward slash juice box or click on one of the links that I've provided for you and you'll be well on your way to having a waffle in the middle of the day with a 106 blood sugar. And if you're the caregiver of a person with Type One Diabetes, as you just heard, I can see Arden's blood sugar remotely. That's a feature that Dexcom calls, share and follow that's available for Android or iPhone. It's absolutely amazing. In the end, I just think it's time I believe that the way diabetes technology is moving, you want to have a Dexcom g six moving forward without discounting any of the amazing things that Dexcom does today. If you go back one episode, and listen to my conversation with Omni pod about artificial pancreas, you're going to know for sure you want a dexcom g six right now. I want to exercise more but I have type one diabetes, but when I exercise my blood sugar gets low christoper I can't do that, because all I'm going to do then is eat more calories. Obviously, your whole plan sucks. And so how do we get? How do

Unknown Speaker 45:06
we get around?

Scott Benner 45:08
How do people work out without getting low?

Chris Ruden 45:11
Well, that that concept is also like saying, Hey, I can't eat because when I eat my blood sugar goes up. So I'm just not going to eat ever. You know that the concept is understanding what happens when you do x. So you can figure out why, you know, you have to understand what happens. So with certain types of exercise, like cardio, like some sports, you're going to have a lower blood, your influence sensitivity is going to increase and your sugar is going to drop with certain exercises or types of intensity, like sprinting, like lifting heavy weights, like power lifting for me, my blood sugar increases temporarily and then drops later. So you have to understand your trends before you can make any sort of preparation to fix it. Once you understand what happens, say, Oh, I'm exercising, I'm going low. Now I'm eating and now I'm gaining weight. So exercise that no, we need to figure out what's going on, why are you going low? Do you need to adjust your basis, I adjust my basis for my workouts, I set Temp Basal is you know, so I have less insulin on board when I'm working out if I usually go low, or I adjust with moving my carbohydrates for the day around my workout. So I can make sure my blood sugar is good. There are a lot of things that you can move around to adjust for that. But you have to be willing to think outside the box and not be overly frustrated with something that's it's life that happens ups and downs are normal with diabetes with life with anything. So don't get frustrated and quit say, Okay, how can I fix this? What am I doing? If you're high, you know, you need more insulin, if you're low, you know, you need less. And so I'm like, that's our base. It's kind of oversimplifying it, but at the base level of what I need to do, Chris, this

Scott Benner 46:47
podcast is all about over simplifying that. And so it's funny because what you just said, the people who listen to this show just heard you say that. And if they're not thinking that they know what I'm going to say right now then Shame on you go listen to more episodes. But what I'm gonna say right now is that I tell people all the time, and you sat next to me while I said it, most of managing insulin is about timing and amount. And that while you're learning that timing and amount, you have to go through what I call, like, it's just the, it's the non Math Math of like, insulin, which is I did this, this happened next time, I'd like this to happen. So I will increase decrease sooner or later, my insulin, whatever it ends up being. It's just, that's how you learn you. Try it, something happens. You go Okay, not quite what I was shooting for, what what I think would move this in the better direction for myself, I'll try it next.

Chris Ruden 47:39
There's nothing perfect on paper, you know, like, you can say, Okay, my insulin sensitivity is this. My, you know, my target is this. From a day to day, we know diabetes changes, we know there are differences, your sensitivity is different almost all throughout the day, every day. So there's a percentage that we know. And then there's a percentage that we don't know. So we have to be on our toes and understand how to correct in real time. And not just Oh, but according to my plan, I have to do this. You have to see where you're currently at where you've been and where you're trying to go and make those adjustments, not what your plan says, you know, so to speak, you have the plan in place, but you also have to think live, you know, in time, absolutely. More

Scott Benner 48:22
More often than not, when I hear from somebody who's a newer diagnosed person or somebody who's really struggling, what they asked for is they want a number, like, tell me the number just please tell me the number tell me how many carbs do you tell me 100%? Right. And I'm just like, it's I'm sorry to say that to you. But you have to figure that out. Like I don't know.

Chris Ruden 48:39
We don't have those answers. We don't have those numbers.

Scott Benner 48:42
And to prove that yesterday Arden's in the middle of a crazy Grossberg if I told you she is three quarters of an inch taller today than she was six weeks ago. I am not lying to. And so she is she gets on kicks. She comes home from high school, two o'clock in the afternoon, and she wants something bizarre to eat. Last year, it was nachos and case. Oh, that was it everyday she come home and she's like, I'm gonna have nachos and cheese. And I'm like, okay, so I had to figure out how to Bolus for that this year. And this might be a regional thing. But this year, it's pork roll sandwiches on hamburger buns. And so I don't know if anyone knows what that is or not, but it's basically it's meat that you probably shouldn't eat that is pig derived. And you fry it in a pan and she wants it just on a white roll. Right? So she comes home she's like, I'm gonna have pork roll today. Now we're leaving for her therapy in 45 minutes. So I'm quickly making this for she decides to have two of them. Her I've got her blood sugar already moving in the right way because I kind of know this is gonna happen. So we've been bumping stuff around an hour before as she was leaving school. Here she is in the kitchen, Chris 70 diagonal down and she's about to eat this stuff. I'm like I have I'm amazing. And so I put in this incredibly extended bolus kind of situation where I give her nothing up front, the rest over and over and hour. And she's in therapy, physical therapy now an hour later, doing all her exercises, her blood sugar is at one and is not moving. Well, I went in to pick her up, and I actually I looked at her and I was like, Did you see the balls for the pork sandwiches and she didn't she's doing something else. I'm like, I killed it. I was like, it was like, Brown was a masterpiece. Yeah. And so we get home, talk to my wife for a couple minutes, I start making dinner. And the next thing I know, I hear beep, beep. And her now she's over 120. And I'm like, Oh, just a little bump, and I bump it a little bit. And the next day, I know she's 130 and 40 and 50 and 60 and 80. And I don't know how the heck she got there.

Chris Ruden 50:38
I don't know. I mean that. So I have a I have a very relevant story similar to that to until that people understand also, just because I'm into a fitness thing doesn't mean I don't enjoy myself. I was speaking at a jdrf summit this past weekend, and I was with my girlfriend, we somehow found our way to this place that makes funnel cakes, and chocolate cake and powdered sugar happened to be my favorite thing along with donuts. So we had some funnel cake and I Pre-Bolus for this thing I said Temp Basal. I did all this stuff. It was set. In the middle of night I woke up in fear. I was like, in my head. I was like I'm gonna be so high to zoom. We ridiculous. I woke up at 93. And I was 93 the entire night. And I was like I killed that I nailed it. The next day, we went to Korean barbecue. And my sugars were through the roof. And I was like, this is just meat. What is going on? Why is my sugar doing this? And I figured out the sauces the different types of meat protein can have an effect on blood sugar. But it goes to show you like there there are going to be those perfect time there's going to be those times where you mess up. I don't take them personally, I just learned from them and adjust and move on the next time you hit that Korean barbecue, you'll do a better Oh, I know. I'll be ready. I'll be ready.

Scott Benner 51:49
That's exactly how I think that's what this whole podcast is about. It's why I was excited to have you on to talk about this one aspect of it that I don't know a lot about. And because I thought it's so interesting. We've been talking for 40 minutes now, you have talked about things that people struggle with throughout a lifetime and spoken about them. They I don't want to say they're simple, but they are much more simple than anyone imagines. I'm telling you, the people right now are going if what this guy is saying is true. This is not as complex as I was imagining in my head.

Chris Ruden 52:21
It really it is not. It's frustrating. Yes, it's eye opening. There's a lot of different things. Now, I don't claim to be a guru or anything like that. I just pay attention to my clients, I want to know how I can help them best. And if it caught it makes me disprove my own theories. That's fine. But at the end of the day, science is what science is. And when we have science backing anecdotal data, and I see the hundreds of type one diabetic clients that I've had transformed their bodies by simply tracking their macronutrients their main nutrients and hitting certain targets that I set for them, I see that it works. I know I'm going to continue doing this for my clients because it's, it's helping them. So you can have a million people line up and say no, that's bad. Insulin is bad. carbs are bad. You can tell me all these things. But at the end of the day, do you know why you're saying that or you're just perpetuating myths and not understanding your trends. There are ways to have a normal life and eat normally and eat the foods you like and still be within your body composition goals and within your diabetes management goals. Okay, so

Scott Benner 53:26
now I have some questions about stuff that a little less Diabetes Center.

Unknown Speaker 53:30
Cool. No worries.

Scott Benner 53:31
So I have is interesting. I've walked up at some point. You were in the lobby somewhere when I was with you a few weeks ago and you were putting like you had taken your your arm off and we're doing something with it and putting on much like I would have expected someone to like readjust a slipper.

Unknown Speaker 53:49
Like Yeah.

Scott Benner 53:52
Like you weren't thinking about it, you were literally you didn't look like you were thinking about it was just something you were doing. And so as you took it off, I recognize that you're you know, now you've described your hand more, you know, in detail for us having basically two fingers on a shorter arm smaller hand. Do you hold the prosthetic with the with your hand or does the prosthetic fit to your arm in a way that that's not necessary. I'm dying to understand how you how it's on you so firmly that you're able to like hang from a bar with it.

Chris Ruden 54:24
So the there's some interesting stuff about this prosthetic it's not common for people with everybody disabilities to have a prospect like mine. Some people do, but it's called a myoelectric prosthetic it picks up muscle signals off from the forum to move the hand and there's it's lined with a very high quality silicone that sticks to the skin and it's actually comfortable and it stays on very well until the basically vacuum seal is broken and then I can take the arm off. I like to take my arm on and off for certain things that are easier to do without arm or used to do with Be on. And when I lift really heavy when I started dead lifting up into the six hundreds, I can't use that arm because that's $150,000 arm that will break. So that is only rated for lower weights. So when I lift I have to do other adaptations with other implements. But for that that's my daily use hands. I can grab cups, grab plates grab different things that most people take for granted. I've never had the, you know, opportunity to do so it's cool for me. And yeah, I mean, the hand just it really helps me kind of live with both hands.

Scott Benner 55:33
So all right, that's stunning. Have you ever left a place we're driving away got five minutes away, and I left my arm.

Chris Ruden 55:41
And I 1,000% have and I usually leave it at the gym. It's ridiculous. For one, it's the best way to make sure no one steals my equipment because I just attached the arm to a bar Mike, hang it and people call I know who's there? You know. But I actually at the front desk of my gym. I was like, Hey, can you guys hold this? I don't want to carry this around and their face was just mortified. They were just like, okay, yeah, I'll climb all the time. I figured

Scott Benner 56:07
it was such a part of your life. Like it's like my cell phone. Like I just like I'm halfway up the street.

Chris Ruden 56:13
It's new to me. It's only the past a year. So I mean, I still forget things. I still forget that I have it on sometimes. And I it it's fun. You know, I've had some pretty traumatic accidents where I was jump roping in the hand flies off holding the jump rope. And there's been some very interesting times with this prosthetic, but it's nothing but a learning curve. And it's a lot of fun. It's amazing.

Scott Benner 56:34
It really is how did you how did you come upon it? Did you just did you get popular enough that a company that made it kind of came to you and said hey, we have this or do Did you? Is it something you were out in the world looking for.

Chris Ruden 56:45
So going back to you know, I hit my hand for 17 years. And I always wanted to do you know bodybuilding competition. Eventually, I've been doing powerlifting where I have to lift really heavy weights and broke all those records. I said that if I ever got a prosthetic on, that would be the moment that I take my glove off, that was more of like a fantasy type thing I never thought it would actually happen. I ended up going to this company who a buddy of mine who's also an amputee, he is a prosthetist there and works on prosthetics. She was like, we can do this, we can do this. So it took a year, I had carpal tunnel, my right hand, my non affected limb, just from overuse. So we're only using one hand. Over a year, I finally got approved for a prosthetic. And that was the moment the deciding moment. But I wanted to take my glove off. And it was terrifying. But I did it. And I actually recorded it and posted it on YouTube. The videos went viral, I got like over 3 million views went to the top page of Reddit, Washington Post all these things started picking me up. And I realized that the thing I've been hiding the thing that I've been most embarrassed about, that when I finally embraced it, it made me more successful. It made my mission a lot more successful. And it made the people I helped so much more involved. So that was a great moment, you know, for me, but that was really the deciding factor, almost the act of taking the glove off was better than getting the prosthetic.

Unknown Speaker 58:07
That's crazy.

Scott Benner 58:09
I have a couple more things when I asked about so I want to get to in a second. I get on a television show soon. I want to get to that and make sure we talk Yes. But I have a question for you about me. So you're in a an interesting situation to answer a question for me. Was it weird sitting with someone who doesn't have Type One Diabetes talking about it? And that person is talking about it? Not like they do but but the way I did was that strange for you? know, I think that's how people should be I think people should be so immersed in what they're interested in what's relevant to them, that they should be how you are and what you're doing with all that you're

Chris Ruden 58:47
doing in the community. So I The bad thing is I don't expect it anymore because of how many people don't do it, but it's nice to see. So being able to sit next to you and talk about that. I love seeing your perspective and understanding the simplicity of how to treat diabetes when I see people online all the time. Like oh my god, I'm 400 I don't know what to do. And in my head I'm screaming like take insulin What are you doing? Like I just pressed my fingers to my forehead you know that thing? Like when you're in traffic and like what are you doing? Like that's my that's my face. I don't understand why people don't do that. You know, and I it's my job to do so when I heard you talking I'm like wow, that's that's pretty relevant. And I appreciate it.

Scott Benner 59:29
I just was like I always wondered if you're a person who has diabetes like is it like can it be angering to sit next to a person is like I don't have

Chris Ruden 59:37
it but here's how I can it can be it's only angry when the person doesn't get it when the person pretends not to understand both. The second you open your mouth you understand okay he gets it cool. People can figure that out really quickly. It's just like a doctor. You know if you have a doctor who really gets it my pa I go to a PA sometimes in for diabetes stuff and she goes to every meeting. She goes to every conference, she is so into it, she doesn't have diabetes. But she is explained things to me in ways that no one has taken the time to do so. So regardless of what people have, you know, yeah, listen to what they have to say, because knowledge is not, you know, disease dependent.

Scott Benner 1:00:16
I think that one of the, I think that one of the things that I have to offer is that because I don't have diabetes, but because I am so immersed in it, that I can be a bit this passionate about it when I talk about it. And I think that sometimes that's valuable for people because the emotions can take over and you can get, you know, a swell in your heart or in your head or be so upset that it's hard to think and I can, I can be disconnected from that, like, I can get emotional about what I see my daughter's life being. But when I talk about the nuts and bolts of diabetes, I'm able to step away from it, because I don't have it, I've often thought if it was me, and I had it, I bet you I wouldn't be good at explaining it to other people,

Chris Ruden 1:00:57
I see a lot of people let the emotion get to them. And that's kind of what I try and teach people mentality rises separating emotion from the real story. The real story is your sugar went high, the real story is not you're gonna die, you're gonna die, you're gonna die. You know, you have to be able to separate that emotion. So the fact that you can present that, you know, viewpoint, I think it's it's really valuable to people who are so just engulfed by the emotion that comes with diabetes.

Scott Benner 1:01:25
I appreciate your perspective on that. And I absolutely hope no one thought that I was like, Hey, here's a good opportunity for Chris to say something nice about me. Because I really just I want to I want to

Chris Ruden 1:01:34
know, I mean, it's true, because I've listened to other speakers who don't have diabetes, and I'm like, Oh my god, can this guy just stop talking? Because it's like, you can tell he read it from a book. That's the difference?

Scott Benner 1:01:45
Well, I've been putting this together for a long time, very slowly, like building a, building a house of blocks very, very slowly. And and seeing that, you know, not being afraid of insulin was really important in honing that idea. And then seeing that I can't be emotional about I can't sit there thinking, Oh, my God, I'm killing her all the time like that. Just you're not going to get Yeah, yeah. When the when when you know, the blood sugar starts jumping up out of nowhere, and you don't expect it. You can't just be like banging your head against the wall and going, I can't Why did this happen? I just gotta go, okay, happen. Stay fluid, I'll handle it. But these things were thought of very slowly over the years. And then I threw away the parts that didn't matter. And I think that's why sometimes when I talk about it, and I make it sound so simplified, it can throw some people off. But I'm telling you, I have I've distilled it down to the very, the very important pieces then from there, like you said, you take from that what works for you. And then you start building on what you think of the important pieces and how it fits in your life anyway.

So you're going to be on television. And and not just like on TV, but you're going to be on TV doing something that your amazing app, I'm assuming and you're going to be with the rock. So please explain to me how that happened first, and then where we can see yes.

Chris Ruden 1:03:08
So I am officially on the Titan games hosted and produced by the rock Dwayne The Rock Johnson on NBC. And that comes out January 3. So basically, it's a very intense event. A modification from American Ninja Warrior completely different in the sense of its head dead and the obstacles are insane. absolutely insane. I can't say much about it, because it hasn't come out yet. But I can't say I'm one of the competitors. There was over 10,000 applicants. And they ended up taking I believe 64 people and I was one of those 64 people so I'm very fortunate to be on that show. And I'm super excited for everyone to see it.

Scott Benner 1:03:51
Is this a process where you can compete when and stay on the show longer?

Chris Ruden 1:03:58
I cannot just bowled the process

Unknown Speaker 1:04:01
yet.

Chris Ruden 1:04:02
But January 3, we'll have everything and it is it is so intense. I can't I can't like stress that enough. It is

Scott Benner 1:04:12
frenzy running, jumping, swinging climb. I

Chris Ruden 1:04:14
can't like anything you can't even fathom. Like even if I said what some of the stuff is like you just wouldn't be like what? Okay, I couldn't even draw it for you. So what I can say is that the rock put a lot of effort into this show. And he originally was thought to be like American gladiators, but they veered off a little bit from that. And it's just you can't you can't describe it. You really can't describe how big is he just ginormous. Yeah. And I'll just stand there going. Yeah, yeah, this is this is the rock. This is crazy. It's so good.

Scott Benner 1:04:53
It's so funny that he comes up again because Derek feller telic feeler had a stark say his name Yeah, he was he's been on the podcast a couple of times. And he is a massive human being right? Like, oh my God really huge and has type one. He's like six, seven, I think,

Unknown Speaker 1:05:11
Wow,

Scott Benner 1:05:12
he told me, you have to go back in the episode to find it. But he told me that if you google his height, I'm doing it now. All right, if you google his height, it's he shorter. He reports himself shorter than he is. He reports himself at six, five, because at his actual height, he just thought that he was too tall to be an actor. So he, you know, he lied about being who lies about being shorter. No one. Yeah, that's crazy, right. But he said, he B's if you let's go back and watch the episode. He's a huge fan of like action movies, and he wants to be in them. And he is actually having success with it. But he said he met the rock one time and he said the rock looked at him and said, hey, you're

Unknown Speaker 1:05:52
big. And said, awesome. That's a compliment.

Scott Benner 1:05:55
So I thought, I need to understand how big the rock is. If he looked at Derek and thought, yeah, look at you. You're a mountain. slouch? Yeah. So that's, that's really cool.

Chris Ruden 1:06:04
I can promise you He did not say that, to me.

Scott Benner 1:06:09
Made me feel tall, which I appreciate it.

Chris Ruden 1:06:11
No problem. No problem. I got you. I just told everyone that way. You know,

Scott Benner 1:06:14
Chris is like I'm a life coach for your height issues, even

Chris Ruden 1:06:17
locally, you know,

Scott Benner 1:06:18
lo fi I could stand next to you and make you feel taller.

Chris Ruden 1:06:21
Hey, everyone is shorter than me when they're doing push ups in front of me. So it's fine.

Scott Benner 1:06:24
I guarantee that. I guess you know, I want to wrap up and and let people know how to find you. So

Chris Ruden 1:06:31
you said you're mainly on Instagram. Is that right? Yeah, mainly on Instagram, and YouTube. Those are my two things, just self that Chris ruden. And I also have a website, Chris are calm. I'm launching a subscription based exercise and nutrition type program that's a lot more affordable. And I wanted to reach more people. So I found a way to drop the price significantly, so that people could work with me on a daily basis. And that's my goal for 2019.

Scott Benner 1:06:59
So you're so you're trying to create a business model where you can help so many people that you can keep all their prices low? And you can still Yes,

Chris Ruden 1:07:07
yes. So I mean, I was at a point where I was charging close to $1,000, for 12 weeks of work. And now I'm at a point where I can create a business model that's less than $20 a month. So that my goal is to help more and more people. I've already had hundreds of people, you know, with their transformations, both physically and mentally. But I need to do my job and my job in the world is to help more people at that level, whether they're dealing with diabetes or any other issue. That's my job. And I'm going to do it, how do you help them? Do

Scott Benner 1:07:36
you speak to them directly? Or is it

Chris Ruden 1:07:38
though I do I constant texting. So from texting to Skype calls to just nutritional changing the regimen, to scheduling them in my private app for different workouts, there's so many different levels that people need. So it's a custom process. And with this subscription that I'm doing, it's going to be a community, which I found has helped so many people with that type one challenge that I run the fit, meaty one day challenge, just seeing people interact in the private Facebook groups and supporting each other, because they all know the struggle of having diabetes, on top of the guidance that I give them, you know, it's nothing can replace that. And it's awesome to see.

Scott Benner 1:08:16
And if you had to leave people with one thought it would be it's about calories, right?

Chris Ruden 1:08:22
My thought would be understand you have to you have to understand how much you're consuming when it comes to blood sugar management, or body composition or fat loss goals. You have to understand how much you are consuming at this point. Once you have that point, then you can make changes. If you see that you're consuming too much you can make changes. If you see that you're not consuming enough, you can make changes. But if you don't know how much you're consuming, you cannot make changes.

Unknown Speaker 1:08:50
Perfect, Chris,

Scott Benner 1:08:51
thank you very much for doing this. I really appreciate it.

Unknown Speaker 1:08:56
Absolutely. Thanks for having me.

Scott Benner 1:09:00
Find out more about Chris on instagram youtube at Chris Rutan calm and of course on the Titan games, January 3 on NBC. I'll put links in the show notes to all of that ended the year thanks to Dexcom and Omni pod for continuing to sponsor the Juicebox Podcast there again will be sponsors for the entirety of 2019. And we have a couple more supporters coming on as well that just can't quite talk about yet. I want to sincerely thank all of you for the ratings and reviews that you've left on iTunes, for the support you've shown through hashtags like bold with insulin for sharing the show the way you do it continues to grow every month because of you really, really appreciate the affection that you give back to the podcast and I hope you understand how much affection I have for all of you. Let me just wish everyone the happiest of New Year's. I am so excited for 2019 you should be as well. We are going to do amazing things together. Continue to be bold. I'll talk to you soon.


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#200 Omnipod's Bret Christensen

Scott Benner

A closer look at Omnipod DASH and Horizon with COO Bret Christensen….

Omnipod COO Bret Christensen is on the show to get us up to speed with where your favorite insulin pump is headed. We talk DASH PDM, Horizon artificial pancreas, Dexcom integration and everything else you want to know about how you'll be managing your type 1 diabetes (very soon) with the world's only tubeless insulin pump.

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.

Unknown Speaker 0:00
Hello, everyone. Welcome

Scott Benner 0:00
to the Juicebox Podcast. Before I get started today, let me just share something with you that I'm pretty excited about. This podcast launched on January 28 2015. It has had at least one episode a week since then, today is December 20 2018. And you are listening to Episode 200 of the Juicebox Podcast. There'll be one more show in 2018. And that one will be timely, because you might be able to use a lot of the information in your New Year's resolutions. If you're making one. The show will continue to be weekly in 2019. And my expectation is that it will hit 1 million downloads in that calendar year. Can you believe that? It's amazing. Anyway, thank you for letting me share that. And welcome to Episode 200 of the Juicebox Podcast Today's guest Brett Christiansen from Omni pod Brett is here to answer all of your questions all of my questions and make crystal clear the path that on the pod is on through their new PDM called dash through their artificial pancreas called horizon. And everything else you can think of we drill down really hard on a couple of these ideas. I told Brett that I thought that I was getting confused because there were so many words flying around about stuff that I didn't have in my hand yet dash horizon. You know, like there's just a lot of things. I wanted to make sure that I understood, I wanted to make sure that you understood them. Today's episode is sponsored by Dexcom you can go to dexcom.com forward slash juice box or click on the links in your show notes or Juicebox podcast.com. To find out more. The episode is also sponsored by Omni pod go to my omnipod.com forward slash juice box. Check out that link to get a free no obligation demo of the Omni pod today. Alright, let's play the music. At the end of this episode, I can promise you one thing you are going to know everything about what's going on with my favorite insulin pump in the whole world. They they've had your heads just gonna be so full of it. You'll be like an omni expert. Please don't forget though that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making changes to your care plan.

Unknown Speaker 2:24
Hello, this is Brett Brett. Hey

Scott Benner 2:25
Scott Benner.

Unknown Speaker 2:27
God, how are you?

Scott Benner 2:28
Good. Thanks. How are you? I'm just checking to make sure I'm doing everything I'm supposed to be doing over here. You sound good. Okay, good start.

Unknown Speaker 2:35
That's good.

Scott Benner 2:38
why he's gonna make a joke about that chases voice got deeper, but would have felt forced. Plus, I was able to squeeze it in like this because I'm recording already. So yeah, so so high bar shakes, has been doing a great job for years. But I think I know I think you're gonna be fine. I'm just going to place I'm turning off all my gadgets here that caused problems for me. And also, you're going to get to be part of something that the people on the podcast love, which is we're gonna get to talk about Arden's insulin for her lunch live while we're recording, which is a big fan favorite. Show ac petrovac has been coming on from Omni pod for years. She was the CEO over the company. But she I don't know what she did she maybe she asked a guy or something. But she's the CEO now. That's right. And you have taken her spot as the CEO. And so we're gonna get to talk to you about what's going on and on the pod because JC is now too fancy for us. I get it. I know what's going

Bret Christensen 3:40
okay. Okay, that sounds good. I can reinforce that.

Scott Benner 3:43
Plus bread after after this year and a half. You're gonna think I gotta upgrade myself so they don't make me go on that podcast. Yeah, are you kidding me? This will this will be a good time. This is one of the more fun things I get to do. Excellent. Excellent, really glad. So go ahead. Go ahead. Introduce yourself, just so everybody knows who you are.

Unknown Speaker 4:01
I'm Bret Christiansen, I'm the chief Commercial Officer at insulin and insulin Of course, we are the the makers of the Omni pod insulin management system. So as chief Commercial Officer, I lead a large team that's really focused on improving the lives of people that live with diabetes through the use of Omnipod. Okay,

Bret Christensen 4:21
you're the right person to talk to. So yeah, I you know, as I always do when I schedule something with you, or with Zacks comm I reach out into the community. First I let everybody ask any question they want. It's always really interesting because some people ask focused questions about themselves. And some people ask sort of broader base questions. And I'm always I'm always very interested in that because I think that the more focused questions I think they bring to light things that we want to say to you that you don't necessarily have an answer to. And you know what I mean, like, you know, I have a great example right off the bat, someone said, Look, I've been using insulin pumps for a really long time. And I've You know, I've got scar tissue now. And I wish I wish on the pot had a longer canula. Like, can you you know, can you ask them if they can make a longer candle, which is amazing. I want you to know that. But that's not, you know what I mean? Like, I'm assuming that you don't have a whiteboard behind you that starts with longer candle. And

Unknown Speaker 5:18
I'm sure it's on a list somewhere. But you're right,

Scott Benner 5:19
exactly. So I like this idea like that, I get to tell you the things that people are wishing and hoping for and why it affects them. And I like that we get to answer the bigger questions. And I think obviously, right now in this time with, with insulin pumps in general, you know, the big, big question is artificial pancreas. And, and you guys have that coming in 2020. Is that right? That's right, right. But before we talk about that, you are in the process of upgrading the PDM. So for people who don't use on the pod, which will be about three of them, because this is going to be a big fan favorite for the pod, I assume. But your PDM, the personal diabetes manager is being updated. And right, and the new PDM is going to be called bash. So I want to start there with that, because I genuinely believe that you guys have announced so many things in the last six months, that everything's kind of got muddled a little bit. So I my goal today is to break them out into pieces, so they're more understandable. So start with dash and tell me what it is.

Unknown Speaker 6:19
Okay, so you're right about dash. And the most obvious thing with dash is that is a, a new and improved PDM. And PDM is the acronym we use for personal diabetes manager. So it's the controller of the Omni pod. So Omni pod is the the patch pump that I know your listeners are pretty familiar with. It's the only tubeless pump on the marketplace. So a user will use on the pod and it will deliver up to three days of insulin, it replaces for the most part multiple daily injections, which is where most of our users come from. So they start out with multiple daily injections. They don't like the five, six shots a day they go with Omni pod, it's this sleek, really nice patch pump that delivers three days of insulin replaces those 15 to 16 shots that we give themselves over that three day period. Right. But the, the one thing that we've wanted to upgrade for a long time is the PDM. So it has that controller that you talked about. And with dash that is the most apparent upgrade. So we've taken the the old controller, which is a proprietary piece of equipment that we manufacture. And we replace that with a lockdown smartphone, it's going to be something that users are really familiar with, it's an Android device locked down. So it's it brings with it ease of use, you know, a menuing system that they're familiar with it really an intuitive interface, and also the discretion that they've been missing with Omni pod as it exists today. Because you can pull it out, you can give yourself a bolus, and it looks like you're checking a text message. So it's something we're really excited about.

Scott Benner 7:48
And quite obviously, the for anyone who's held used or seen the the old PDM what's called the old PDM. It looks like it looks like you were in a 50 sci fi movie. And you said to the scientists design something from the future.

Unknown Speaker 8:06
futuristic in the 50s. Yeah, you said It's been long overdue, you know, but this is a complete redesign of not just the the controller is a is like an entirely new platform. So for us. So the pod which doesn't look like it's changing, it looks like the the pod which our users do love, they complain about the PDM, or at least suggest that we get a smartphone like PDM, which we're doing with dash, but there is a significant change in the pod that users may not realize, but we've changed the communication method and added Bluetooth technology to the pod. So that that becomes now the platform for a whole host of things that we're going to do in the future including horizon, which is our hybrid closed loop system. And, and a number of other things that you mentioned, were some of those announcements that we've made recently. But it really is the platform for all of that innovation in this why it's been you know, kind of a long time coming but really significant

Bret Christensen 8:59
okay and of itself. And we're gonna dig deep in that in a second. But first, let me explain you what's going on with Ardennes. So it's some special day at school as Christmas arrives. I think all the teachers have given up no one's teaching anymore. And so Arden's now sitting down to eat, this will freak parents out, aren't sitting down to eat 40 minutes later than she normally does. So I right so her blood sugar was 85. And it's sort of you know, if you're familiar with Dexcom, I started getting a diagonal down arrow and I texted her, I was like, hey, when's this lunch thing happening? Because I didn't even tell the kid. So it was just like lunch is going to be later today, kids. And so she's like, I think it's in a minute. I said, Well, if it's not we're going to be in trouble here. And so five minutes later, I said, hey, you're at now and she's like, No, I'm leaving. Right right now I said, Okay, so we're not going to Pre-Bolus like we normally do. I said, Go sit down, start eating and text me. So that's where we're at Arden's blood sugar is 70 she's diagnosed down so her blood sugar is dropping a couple of points per minute, and she says she's eating. Now. We're going to use the lower blood sugar as our Pre-Bolus. So we don't have to Pre-Bolus today because tech We already have because our blood sugar is falling. So I'm just gonna do what I normally do. She's gonna get a 10 Temp Basal increase 40% I'm gonna say for two hours. Now, why is that bread? It's because she's got a peanut butter and jelly sandwich. She has some little like Oreo flats, that you spread the cream on yourself, which they're disgusting, but she seems to like there is what else is in there grapes, a yogurt and a salad from her Chinese food that she had last night that she didn't eat the salad. And I think there's something else not important doesn't matter. I think it's going to take about 13 units of insulin plus this Temp Basal. So Temp Basal increased 40% for two hours. And we're gonna Bolus what I just say I say 13. I don't put me on the spot like this.

Unknown Speaker 10:51
That's a big decision

Scott Benner 10:53
to take 13 units. Oh, okay. 13 units, I'm going to extend it a little bit. But she's got to get some of it now the rest over an hour cuz she's already falling. So I'm going to do 40% now and the rest over now. Because she's

Unknown Speaker 11:12
got What are you doing? Are you are you sending a text to somebody? Or what are you actually doing?

Bret Christensen 11:15
Yes, right. This is and this is great for you to hear. Because the key to type one diabetes, when you are helping someone else manage it is instant communication. So what would normally happen to a kid like Arden is she would have said, Oh, my blood sugar is starting to fall, they would have sent her off to the nurse, the nurse would have said Oh, you're getting low, they would have treated quote unquote, which would have meant they would have given her a juice box, they would not have covered for 10 minutes later, her blood sugar would have been 120 and flying up, and then it would have been time to go to lunch, then we would have been behind the whole time her blood sugar would have got high we never would have gotten in front of it and her right you know, blood sugar would have been for hours and hours like that. And then they would have what maybe told her to come back three hours from now to the nurse's office. And we'll check her again where I guarantee your blood sugar would have been 280. And you know, all that would have happened. Those pauses in there those hours that people wait. It's what it's what messes everyone up. So Arden is. She's a freshman in high school. And she has she has not been to the nurse for a diabetes related situation since the last day of second grade. That's great. And that's because of note No, not just because you're here. It's because on the pot it's because of Dexcom. It's because of texting. And I that might that might sound crazy to people but the texting is just as important as the Diaby, I think of texting is the third most important diabetes technology we have. So I believe it. Yeah, it really. Yeah. Yeah. Get well absolutely. It just it's, you know, to break that down further. It's the instantaneous conversation is what's important. And she sees it right says okay, and I'll keep you apprised as how it's going as we go. And she's actually 63 diagonal down now, but she's been eating for. She's been eating for a while now. I'm trying to see how long, I'm not very good in my texting machine here. About 10 minutes she's already been eating. Okay, so Okay. Anyway, to finish that thought, you know, people can, you know, always say, well pumps just about not injecting, which even as you talked about it, you said people come from MDI because they're tired of injecting. But the real, the real brilliance of Omni pod is, is being able to manipulate your basal rates to dial them back to dial them up. To put in a little bit of like, Listen, what I just did, I put in 40% of a 13 unit Bolus now and then I told to stretch the other 60% out over 60 minutes. That's the kind of stuff that if you want to do with Well, first of all, you can't do a stretch with MDI. But if you were going to do something with MDI, you'd be shooting multiple times through a meal. And that's right. And you know, when I think of diabetes, I think of the goal of diabetes is to keep a balance between the insulin and the effects that either the carbs are having on your your body's having on you. And that's just much much easier with with with an insulin pump So okay, so I apologize but I like that these were so so damn, that was good. Thank you. Yeah, dash is a Pete is the new PDM which I understand through the you know, through the grapevine that the acronyms not the everyone wish it had a better name. So now it does now it's dash. So and so so dashes here dash is the wireless controller that tells your pump what to do. I just told Arden what to do. And she picked up her PDM pushed a couple of buttons she did Temp Basal increase, she did a bola she told him to extend. She did that on her PDM that thing is not attached to her in any way. Not not through tubing, not through wires, not threading. It's completely wireless. But she was holding something that as I've said before, look like a tricorder from like a an early 60s Star Trek. Now she's gonna be holding the fancy looking thing looks like a cell phone. So she's gonna have a little bit of anonymity. Nobody's gonna really know what she's doing when she pulls that thing out next time. It's it's touchscreen. Right? fancy? That's right. Yeah. And and it's going to do what we need to do so I have some like I guess some drill down questions about it.

Unknown Speaker 15:11
Is it waterproof? Totally while the PDM isn't waterproof, right it's a it's a it's a it's a lockdown Android phones, which is waterproof is a you know a is a smartphone would be not waterproof at the pi, which when we say when we talk about Omni pod being waterproof, we're talking really about the pod, right? Because you don't want to disconnect for your point earlier that you you want to stay connected to this continuous insulin delivery. You don't want to disconnect when you get in the shower or when you swim. And essentially, so yes, still waterproof. Okay, so

Scott Benner 15:40
the pot itself is waterproof. The new dash is only as water resistant as the phone is and what will have to it. So if I want it to be actually waterproof, I'm gonna have to get like a waterproof case like I would for my cell phone.

Unknown Speaker 15:51
Yeah, that's right, gotcha.

Scott Benner 15:52
Okay. The amount of distance that I can control the pod from is it remain the same?

Unknown Speaker 16:00
It remains the same. Okay. No change that.

Scott Benner 16:03
Is there? Have you used it yet? Have you used the old PDM? And the new PDM? Like had it in your hand? Yes. Have you ever noticed with the old PDM? That for me the screen side? If I point the screen side of the pod, I seem to get like a better signal than I do if it's the backside also the rubber case on? Have you ever noticed that? No, I have not. I was just wondering if there was a bad side, I

Unknown Speaker 16:26
will say I mean, it's, you know, whenever you're communicating with something wirelessly, that there are some nuances that way. So the signal will actually change with dash. So dash will be a ble signal. So low energy, Bluetooth. And there might be some things like that, right? Where you've got, you know, if you're wearing on a certain part of the body, you know, that there might be some communication things. But for the most part, you know, the range and all that nothing has changed. It's just a different technology that allows us to really do more with innovation going forward. Okay, so

Scott Benner 16:57
the functionality of the dash is no, no really different than the PDM. But but that's the the sort of the technical functionality. There's a lot of other functionality that has changed. So I'll start with alarm notifications. Now. I know the FDA tells you what you need to do and what you don't do, I can tell you that there are some of them that people just are some people are really bothered by like nobody wants. Some people don't want to be told two hours after they put a pot on. Hey, do you remember that you just switched your insulin pump? Are you getting insulin? I like it personally, a lot of people don't like it. But I understand some of these things are gonna be user definable some of the Mark, can you can you break them down a little bit for me?

Unknown Speaker 17:34
Yeah, so I mean, two types of notifications for any insulin pump. And dash as certainly falls into the same classification. But they're critical notifications and critical alarms, that the FDA says you have to have those not only do you have to have those, they have to be at a certain sound level so that people can hear them. And then there's a lot of these non critical alarms, reminders, kind of what you talked about, that probably are more of the annoyance for any user that might want more flexibility there. So with dash with the critical arms will come through have to come through. And we don't have much to do with that. But the non critical and notifications, we have added some flexibility. So you'll be able to silence some of them. And some of them, you'll be able to get on your app, your display app. And I think, you know, we should talk about apps at some point today. But

Bret Christensen 18:23
with dash you you'll get one of the apps, you'll get us display, which just means you can see on your current phone exactly what your controller is doing. So if you do have this new dash controller, and it's in a bag, you could take your iPhone and basically turn it into a controller, it won't control at this point your pod but you'll see everything on your iPhone that you see currently on your dash controller so so you'll be able to see some of those alarms coming in. You see them coming and be able to you know to take action prior to them coming. So we it just adds a lot more flexibility and a lot more control for those alarms and notifications and dash. So I'll only really be reaching for dash when I need to make a decision about insulin like when otherwise able to see what's going on through my phone, which everybody at this point I think of myself as someone who does not use my phone very often. But I still I still turned on my screentime thing the other day. And I use my phone more than I thought. So I've been up for four or five hours today. And I've been on my phone an hour and a half so far. And and so now when that phone's crossing your face, I'm going to be able to know well I have to dig into my Okay, let me be clear about that. That's the view app is that right?

Unknown Speaker 19:40
Use that to display so the display app is what you will see on your own phone. So if you are the user so you have Arden's got an iPhone, she will have display ads on her iPhone and in won't have to take her dash controller out of the bag or wherever it's located unless your point she wants to control it in front of Some way Okay,

Scott Benner 20:00
and am I right to say that she doesn't even have to for some things, open that app because you'll have widgets to

Unknown Speaker 20:09
you another widget. You're right. So the widget is you know, on an iPhone, if you swipe left swipe to the right, you'll see, you know summaries of different applications you might have running on your phone. For dash if you swipe to the right what you will see. And we're excited about this is a widget that you'll see the your, your dexcom CGM. And you right next to that you will see a widget from your display app. So you'll be able to see on one screen real quickly what your Dexcom is doing and what your Omni pod is doing. So it's it's a form of CGM integration that really can allows you to see those two things quickly. And I'm

Scott Benner 20:45
sorry, and that's on my phone. It's on the user, or that's on the deck. That's right. That's

Unknown Speaker 20:49
no, that's on the phone. And so what I

Bret Christensen 20:51
what I think we're really seeing Brett is that is that we are taking steps towards a future, right? Like there's an it must be incredibly difficult on your end, like, I know, there's a place you guys want to get to. But but but you have to get there, through the FDA and through, you know, through through channels, the way things work. And so you're you take these, and you have to start where you start, you can't you know, you can't start magically in a better place in you were in you were in a place with a PDM that looked like it was made in 1950s sci fi movie. And so now you're in so now you're moving forward from there very nicely, by the way. And so Okay, so great. So users are going to have the ability to look at their phone and see a lot of their information about that. I'm assuming like insulin on board time of last bolus, like all that kind of stuff, right? That's right. Yeah. All those things. Now as a parent or as a caregiver, there's, there's another app. And that's the view that's called the view app. That's correct. Right? And will I be able to see the same things that they can see on the display app?

Unknown Speaker 21:51
Yeah, so the view app, so for you, and I would imagine your text messages will change just a little bit, Scott. So you know, you right, now you've got a follow up, probably with Dexcom, where you're looking at ardens bg levels throughout the day, what you would also have with view now as you'll be able to see exactly what's going on with her Omni pot in with her dash. So anything that would show up on her dash screen on her PDM, you'll be able to see on your phone with a view app. So you'll be able to get those same notifications, alarms, everything that she sees throughout the day, you'll see as well.

Bret Christensen 22:23
And now I can't make adjustments to PDM remotely, I can just That's right, you just got your text messaging to rely on. That's it. And I want to make sure I'm gonna bring it up here of one of the users or one of the people online who've made suggestions. I thought one of them was just amazing. And I realized this is just me putting this in your head through through the person who told me, but she said she understands why you couldn't like just let somebody remotely give you insulin without you knowing that would be crazy, right? But But wouldn't it be cool if I could open up my my my app as a as a caregiver and say, what I just said to argue Temp Basal increased 40% for two hours, 13, you know, blah, blah, blah, and send it as a suggestion to the user. And then instead of the user having to actually do what it says be able to just agree to it. And then it happened. I

Unknown Speaker 23:18
love that. Isn't that Yeah, actually, I love that suggestion. It You know, there's, there's two things, right? We've said this multiple times on this call, there's what technology can do? And then kind of what are we going to be allowed to do? And what will the FDA get comfortable with from a safety and effectiveness standpoint. So I love that idea. And certainly from a technology standpoint, that's something we could get to, we just have to, you know, prove that out and make sure that it's something that we can get comfortable with.

Bret Christensen 23:44
So I want to thank people because they sent in so many questions for me. And I really appreciate everybody's time and not that any question was more important, the other but usually every time I do that there's one or two that really lights my hair on fire. I think, man, that's amazing. That was the one for this round. I thought, Wow, what a great idea. Because then if you have a kid who's too young, right, like to really understand or, you know, you talk to people or like I'm afraid to let them make a bolus because I don't know if he knows the difference between one unit and 10 units. Sometimes this takes all of that away for them. And if it's somebody who doesn't even understand how to like what I just did with my daughter for her lunch, she couldn't figure that out yet. She's not up to that. And so it's just it's so anyway, whoever sent that in, thank you so much as that was a great one. I appreciate

Unknown Speaker 24:27
I love it. I'll take it back to the team. You know, we're the we're the leader in pediatrics. So the one area that we absolutely are the market leader in is in children and up to up to the age of teenagers. And so we we've got a lot of feedback on these widgets, this view app, there's a lot of excitement, the marketplace for this and certainly someplace we need to get to. I think that's taken, you know, from a technical standpoint, we could get something like that done. The first step though, is, is getting phone control, right so that you can at least the user can control on the part from their own phone and that is something we're working for, towards with

Unknown Speaker 24:59
this Ryan good tease Brett. I'll

Bret Christensen 25:01
tell you what, I'll put the Dexcom ad right here and then I'll come back and we're talking. I've been editing the podcast all morning, and about 15 minutes ago, I noticed Arden's blood sugar was starting to drift down. It was at 85 and it was 80. And it was 77. I kind of expected it because she's at school today and they're doing some holiday parties, and we were bolusing for foods that, you know, she had never eaten before. How do I see this? Well Arden's wearing the G six continuous glucose monitor made by Dexcom. Anyway, I noticed the arrow which indicates the direction that Arden's blood sugars moving, turning down, and that 85 went to 70. So I sent her a text. I asked her when she was having lunch, and it wasn't for another 45 minutes. So I simply replied, okay, then we're going to need a juice here. And now Arden's blood sugar is at seven, and stable. The feature on the dexcom g six that allowed this is called follow, right, there's a share and a follow up. Arden has a share app on her phone, it sends that information up into the cloud, I have a follow up on my phone where I can see her blood sugar in real time. But as I look at Arden's blood sugar, and I see where it's been over the last couple of hours at school, and where it is now now at six, understand that that was able to happen. As Arden was leaving for school today. She said, oh, there's going to be a holiday thing this morning, I think there's gonna be food, I don't really know, no problem. She sends me a text two hours ago that says I'm going to have a macaroon and some of these other things. That's all she said, using the information on Arden stacks calm, we made a choice about insulin, guessing about the carbs and all of those things. And sure we needed a juice box Two hours later. But there's Arden in school eating with everyone else, blood sugar between 70 and 110. all morning, all because of the information coming from the Dexcom. Go to dexcom.com Ford slash juice box, or go to the links in your show notes, or Juicebox podcast.com. To get started with the G six today, I want to tell you that I completely understand but that there's no meter in the new dash. And but I will tell you that when I initially heard it, and I heard it years ago, before the rest of you had to live with this information, I had to live with it. Because I was speaking at something for Omni pod a couple years ago in Florida. And I heard like that then before anybody else though, and so I was crushed. At first I thought oh my god, no, because all the things you've heard, I'm gonna have to carry something else with me, and blah, blah, blah. And then I remembered two very important things. The PDM is huge. And you're going to give me something that's much smaller. And, and I don't mean to malign anything, but the meter in the PDM is old. So new meters must work much better than old meters. And that's got to be one of the initial thoughts you had was you you tied your PDM. To technology that as it aged, you couldn't update it without going through the FDA process again. So we've all been using this meter for I mean, Arden's had a PDM for 10 years, right, so I've been using the same meter for 10 years, why meters get better, I'm using this one, but now that's not going to be the situation anymore. And I was lucky enough to get one of the meters that you guys are going to offer to people moving forward. And I have to tell you, it's way better. So yeah, and it's also very tiny. So when you put a new dash together with this new contour, next meter, as far as bulk, I still think you've cut your bulk of what you're carrying down in half. And I bet you the weight of what you're carrying down significantly as well. It is absolutely two separate things, but they're very tiny. So can you tell me a little bit of how you chose the meter that you went with?

Unknown Speaker 28:42
Yeah, so I'll back up a little bit and say that, you know, the first my first feeling was much like yours, Scott with it, you know, and we heard a lot about the same, he communicated that, hey, you've got to have an integrated meter into the controller. But you know, the other thing we heard was, hey, I want it to be a basically a lockdown smartphone. And so you can't really have both right? So we kind of had to make a bit of a leap in our planning to look into the future and say, Look, you know what, what users are really going to value is that discretion, that smartphone like device, and the meter should be separate in there's a lot of advantages to doing that, because we don't really tie ourselves to a technology because you can quickly adjust. Right? So dash when it launches, it will be compatible with the contour next meter from ascensia. Something that we're excited about, they've been tremendous partners of ours, we think it's a fantastic meter. But the user really can use any meter they want to with dash, it's just that that's what's integrated right now with that. So we wanted to leave ourselves with flexibility to continue to innovate, because we got to move quickly with technology. And so to you know, to have this this controller again, did you say looks like a tricorder? I think, you know, it's it's tough to change those things. We want to get onto this mobile platform and move very quickly with innovation and so that that was a key part of the decision with dash,

Bret Christensen 30:01
you need to stay fluid you can't be chained to one thing that can't be changed, right. And so so for everybody listening I have been using or Arden has been using this meter for months now. And I find the accuracy to be amazing. It really matches up well with the G six that she's wearing. I don't see a ton of discrepancy between what the G six thinks and what the meter things. And so I'm, we're very happy with it. She doesn't, you know, Arden has not been bothered beyond the normal stuff, like when you log on to Facebook, and it's different than it was yesterday. Like, why they change it. You know, like that kind of thing she was at first I'm like, hey, use this meter now. And she's like, what, and I was like, just do it. And then she was like, Alright, and she did it. And it's been fine. So, you know, it's got a little light for overnight, it doesn't take if somebody told me what you know, one of the great things about the freestyle, of course, is that the small blood drop, but the contour is not asking for any more or less blood than then we've seen in the past. So anyway, I think it's terrific. But more importantly, I think it's terrific that you guys have an eye on how to stay sleek. And, and, and and be moving forward constantly. Because you don't want to say that you're a little behind right now. But you're a little behind right now. And so and so we but once you jump in the rest of the way, now you're on equal footing again, you got nothing holding you back and you can keep moving, I think that's going to be the story of Type One Diabetes over the next decade is going to be how quickly we get from where we are to where we're going. And I always just say, look back a few years, you know, dex comes like, Hey, here's the g4, this thing's great, then it was the five then it was the six and now the seven. And like and it's they figured out how to move and you guys, I think have figured out how to move quickly to so I think it's when you get it. So you you sent these dashes out into the world. In a limited release. I did not get one. I'm not Don't worry, Brett, I'm not hurt. And so

Unknown Speaker 31:52
I think you I'll check the list. I don't know how you went on it.

Scott Benner 31:54
Well, apparently it was randomized. And so it was randomized through your endo. And if your endo wasn't part of it, then you didn't have any chance. And even if your what endo was part of it, it was still up to their discretion to randomly pick somebody. So I think my doctor's office wasn't actually even a part of the release. So it's fine. Don't worry, I'm not again, it's fine. So I need to understand a little bit about what the release was for and why you started with a one minute release.

Unknown Speaker 32:22
Okay, so yeah, we are in a limited release, we got approval from the FDA middle of 2018. This was a really big change for us. Because again, this is this is an entirely new platform for future releases, where we're taking dash, and we're making it a little bit better, there's probably not as much risk to that type of a release. But for us, this was an entirely new release almost an entirely new product, even the pod, which looks the same is a has some new components, but the Bluetooth technology, so we wanted to make sure a couple of things. We were ready for one The technology was performing the way we want it to perform. So that's something that we've been getting feedback from from all the users that are in the limited market release, we want to make sure that there aren't any bugs, not any issues. So that when we go big with this, because again, we've got 150,000 users worldwide already using Omni pod, you don't want to get out there with 10s of thousands of patients and discover that you've got an issue. So we've been cautious with this, even though the temptation is to move quickly, and get this to the market. But we're getting close to that now. We've got fantastic feedback from the users that have used it. They rave about the simplicity, that convenience, the ease of use, all the things that we do, they would love. But the other things we're trying to make sure that we're we're ready for inventory levels. Of course, we've seen you know, competitors and partners alike in the market, launch a product and not really be ready for the inventory rush. So we're building up inventory today. And then the probably another big thing, Scott that's unique about dash is that we're really kind of reinventing the payer marketplace in reimbursement. And that takes some time to so you know, typically when a company comes up with a just a newer version of an insulin pump, you've already got market access contracts established with reimbursement companies. We're doing something really different with dash and we think it's going to be fantastic for patients because as you know, there's this thing in the insulin pump world called a warranty period where if you get an insulin pump, you've got to stick with that insulin pump for years, and you can't change and that's because of that huge upfront cost that payers pay for. They make you stick with that insulin pump for four years. It's it's a lot like I started my career in Telecom. And I remember getting a phone and i'd love that phone. But I was stuck with that phone for two years. So it couldn't you know change from at&t, I had to stay there. That's how the insulin pump world works. Today, we're going to change that because we're taking away the upfront costs, there will be no upfront costs with dash and therefore there will be no warranty period. So we're going to put the onus on us if we're not providing a good product, a pump that you want to use every day. Can you stop using it Yeah, that's right. So but we got to establish those contracts. And so that's the other big piece of the limited market or at least is establishing those reimbursement levels with theirs. Okay, so

Scott Benner 35:07
you guys are you guys are doing, you know, your diligence on does this thing work the way we expect it to? Are we able to support it from stock and from customer service and you're trying to get the incent the the insurance side together at the same time? And I think maybe, that, yeah, and you just said a lot of amazing stuff in there. The one thing that maybe got glossed over that I want to make sure that I understand is it's free, right? Like the data doesn't cost so. So pie in the sky, right, I'm, I'm a dash user, I'm walking around, and I whip my dash out to do something and it slips you ever have this happen, you pull your phone out, and you just there keeps going. And you're just like, I don't I don't have a grip on my phone, it's flying across the room. And like, so that happens. And I throw my dash out into the street, it's hit by 17 cars, I call you on the phone and I say I just threw my dash in the street, trust me, it wasn't on purpose got hit by 17 cars. You're not gonna charge me $500 for another

Unknown Speaker 36:00
one, I'm going to charge you $500 for that, but there might be a fee for that we're keep. Yeah, that's right. And you know, we'll look well, we we don't want to make money off of the hardware, we really don't because I think it's a barrier to access. What we want to do is get patients using Omni pod. And so anytime you charge a patient anything for the use of that PDF, just for an upfront fee, and they got deductibles, we know high deductibles are these days. It's why all these insulin pump companies, CGM companies, they all have a drop in utilization beginning of every year. It's not because patients don't need insulin in January. It's because their deductibles reset. So they they go off the pump, they don't choose a new pump and all those things. So we want to we want to remove that there might be a fee for the scenario that you just described to break it. But it's free up front, and there's no warranty period,

Scott Benner 36:49
or something like that. And, yeah, but also, it's interesting what you say, because back in the infancy of the internet, I remember them this person having a web board where you could go talk about their movies, right? And it cost 99 cents to register for the board. Now, did this person do that to make money? They didn't. They did it? Because it weeded out the next right? Like if you had to like go through a little bit of trouble to do it. It kept me honest, a little bit, but you wanted to be there. And I think that's what you're talking about. It's like we can't be we can't we can't foster society where people like, Huh, I left my dash at school again, and it got stolen. Hey, on the pod, this is the 16th time I'm calling you this year, send me a free way. It's not that, but but right? Because you gotta be somebody out there. And by the way, if you are that person make an adjustment in your life. Just try a little harder. But but but so yeah, you don't have to say that. Right? I'm saying, and so, but But yeah, so I love that. It's amazing that you're doing that. And, and it's and it's honest, too, because let's be honest, it doesn't cost that much for that dash. And so for you to like put an arbitrary number on it that keeps you in business or whatever it just, that's how people feel on the other side, like, you know, like, What do you mean? Like, what do you mean, I used to break the screen on your iPhone, and you go into an apple store, I dropped my phone, they like oh, that sucks. I'm sorry. And 10 minutes later, someone come out and you hand your phone back. So what I owe you and they say nothing. And now it's $200. So what happened? Generally mean? Like, is it does it cost $200 to get my or, and so I like that you're doing that I very much do. I'm not just buttering your ass here. But I really like that. So now we've talked about dash a lot, and the apps a lot. But really the most important thing to all of us out here is just grubby, needy people, when am I getting it? I can't do better in this ad today to tell you about on the pod on the episode itself is going to tell you so let's just focus on one aspect. It's that on the pod offers a free, no obligation demo of the product. What that means is you go to my Omni pod.com forward slash juice box, quite literally just put in your name, your address your phone number, and they will send you out a pod. Now it's not a functioning pod, like it doesn't have, you know, like canula that pops out and goes into your skin and stuff like that. That would be crazy, because it's a demo. But what it is, is everything else. It's the pod and the internals of it so that you can feel the weight of it and how the adhesive works. And you can place it somewhere on your body and actually wear it for days. And I think what you're going to notice while you're wearing it is that you forget that you're wearing it. And that is really one of the aspects of the on the pod that gets overlooked sometimes is that, you know, we say it's tubeless we say you don't have a controller hanging from you, which is all very true. But it's never pulling on you, right? It's not it's not hanging on your belt. It's just somewhere. You put it on and you forget about it. This demo this free, no obligation demo is a fantastic way to find out if you would like the Omni pod. You hear us talk about it. It's exciting. There's a lot coming. Yeah, but you still got to make sure you like it. And a free no obligation demo is the way to go. Miami pod.com COMM forward slash juice box or if you can click on the links in the show notes or at Juicebox Podcast comm I'd appreciate that you get started today with the demo. If you like it, you just keep going. And if you don't, no big deal.

Unknown Speaker 40:21
When am I getting?

Unknown Speaker 40:23
When you get in it? Yeah. So So we've we've said all along and we're on we're on track for this, that it's going to be a q1 for March release. So, you know, sometime after the new year, when we get comfortable with all three of those things that I that I mentioned to you, we have to check the box on will will watch a full Mark release will tell the world we're ready and indash will be available, where there are market access contracts established. So it's so it's coming soon. It'll be here in q1.

Scott Benner 40:49
So Brad, I'm just gonna start saying months and you cough when I hit the right one January, February. I hear you. So listen, it's soon. But now but so now here's the here's the rest of it, you launch it and it launches, if some people are going to want to stay with their old PDM and their old pods. Are they going to be able to do that? They will Yeah, there's no for us. If you want to stay with your existing Omni pod, then then by all means do so. You know, it's probably not for everybody. And you know, one thing that is true is some people just don't like change, right? When I get a an update from Apple almost every single time I'm frustrated with it. I remember when used to you know, whatever it is you swipe right or left now to delete an email used to be the opposite. I couldn't believe it, change that. And now I can't imagine going back so that you look, if you're happy with the current system you're on then yeah, great stay on that we're not we're not going to promote change, we're not going to, you know, ask people to upgrade. This is really as a result of what people been asking us for to deliver on simplicity, ease of use that sleeker, touchscreen, PDM. And then some of those apps and functionality that a lot of users have been asking for. But if you're happy on the current product, we have no plans of discontinuing it. So but if we all call tomorrow, by the way, that's a good point. When do you want people to start telling you that they do want that, like, should I call now and tell somebody or should I wait till it's been released? Or how does that work? Yeah,

Unknown Speaker 42:16
I mean, will, you know, when we when we kind of announced that full market releases is on. That's when you know, people should to call and inquire about gas. So we've had people call us now and you know, we make notes of that. But really, it's not going to increase when you get dashed. So it just would withhold Mark releases out, you should call us and inquire about it.

Scott Benner 42:35
Listen, come back here. I'll tell you when it's available. And so and Okay. All right. Let's take a breath here. Brent, I gotta pull myself together. Okay, so we understand everything. When you say locked down phones, I think that's something that in the industry is understood. But tell people who don't know why you're saying that, why you're saying that.

Unknown Speaker 42:55
Okay, so it's just kind of as a sound, it's a phone that cannot be used as a phone. So so we lock it down, and the only thing that you can use it for is for dash and for the control of your insulin pump. And that that really is a safety feature. So again, with with horizon, you know, we're going to try to change that we're going to submit for horizon that we'll have full control of that horizon is our hybrid closed loop system that we interface with Dexcom g six. And with full control, it's it's really though, for now, until we get the FDA comfortable with the cybersecurity risks associated with phone control has to be on a lockdown device. So this is an Android phone. But you can't use it for forever surfing the internet for texting for anything you use your phone for except for controlling your Omnipod

Scott Benner 43:43
basically how you're having my mom uses her phone, it's like for three guests. Mom, it does so much more what Nevermind. Okay, so, you know, let's delve a little bit into security. And then we're going to jump there horizon. Because you just said something that I'm my mind wanders a little bit. So I'm going to make a note, right, hold on, because I don't want to forget this. Okay, so security, you guys have gotten a couple of really cool designations from some from some outside, I don't know what to call them. Like they're the companies that judge security about technology. Yeah. And and on the pods received a couple of accommodations that I think you're first in, in the insulin pump world Is that right?

Unknown Speaker 44:27
That's right. So

Scott Benner 44:30
like, dude, I'm tired. It's lunchtime. That's right, man. Next question.

Unknown Speaker 44:36
No, they are very meaningful, and they're meaningful, because, you know, because of where we're going. So you said this, you know, we know where we're going. We know we want to get to phone control. The hang up with that has always been cybersecurity. So when I started with insolate, you know, we get feedback from all of our users all the time and, and I can't tell you how many times somebody told me Hey, you got to do this. Built make an app and allow me to control Omni pod from from my app on my phone. Yeah, that's great. He also do that we never thought about that. But, you know, it's the, to be honest see we was on the list for years is something we'd love to do. It wasn't working Ernest being done to get there, because nobody believed that it would ever be allowed in the industry. So, so that's changed dramatically. And they give the FDA a lot of credit for, you know, at least expressing openness for kind of where we can go with this technology. But the certifications that you mentioned, this ISO 3000, and our DTS certification are, we are the only insulin pumps to get those. And essentially, if we get too deep on these, I won't know what I'm talking about. But really, it's just a nod toward the security of Omni pod. And and that's going to be critical for us as we move toward horizon, and phone control with the FDA just to prove that we have a secure system, that somebody can't hack and try to control somebody's insulin pumps. So cybersecurity is going to be a key consideration. And these certifications help tremendously. So what we want to go when I'm

Bret Christensen 46:08
at home yelling, just shut up on the pod people and make it work through my phone. This is the stuff that you guys, this is the hard work that you have to do to make this actually that's it and you're doing the other thing we Yeah, we are We also now Scott have a few we're gonna get there. But a partnership with Samsung, which is probably another one of those announcements that you said confuses the picture of where we're going. But that that is another key partnership for us. So Samsung has a technology called Knox security. And you might see signs, you know, around that that kind of tout Knox as a secure platform for Samsung, but they really are the leader in cybersecurity there. So with our partnership with Samsung, we're working on horizon and hope again, to even strengthen even further the confidence levels that that we can get a phone control product that has a hybrid closed loop system and is very secure. Okay, so that's what what your very good friend, that's why I wrote down my note. And so this is so this is the thing that I'm still a little baffled by when JC came out and said we're working towards phone khatron like right on lady, and I don't understand what you're saying. And so and so let me make sure let me break it down a little bit. So we fast forward to the future. And I have a horizon system, which is an artificial pancreas, which we're going to talk about in a minute. And I'm holding, is it my cell phone? Or is it the dash that now works with horizon but also has a connection to the Internet?

Unknown Speaker 47:35
Well, I think that's yet to be determined. But I think what we anticipate with horizon is that we would issue a PDM. So a, a locked down to a phone like device like we do today with dash. And I the way I like to think about horizon Is it really is almost dash 2.0. So you can when you get horizon, it will just have the functionality that says you know, do you want to pair with your Dexcom CGM. If you say yes, now you're in your loop. If you say no, you're just using dash the way you use dash today. But phone control, there will probably be a a few phones, we'll probably have to pick some that we certify that we know are secure and that we actually submit with. But there might be two or three different Samsung devices that you could go by and use your phone, surf the internet, text your friends, and at the same time control your Omni pod. That's the thinking.

Scott Benner 48:28
Okay, and so now I'm going to ask the question that everyone who doesn't have a Samsung or android phone is thinking and will this work? Okay, so at some point?

Unknown Speaker 48:36
Well, the answer is always Yes. It's just what at some point means. So but but there is a solution for iPhone. And I know you're probably going there with your questions as well. And this is really kind of our tide pool partnership because lube, which is the application that they use today is on the iPhone. And we're partnering with tide pool for interoperability and hope to establish Omni pod as an AI pump. Which just means you can take an AI pump with an AI CGM and an AI algorithm, put them all together and and make a loop system of your own. So that would be on iPhone, that for at least in the short term could be an alternative to an Android device.

Bret Christensen 49:17
Okay. For people who care, Arden just got an up arrow at 120. So I cancelled the extended bolus. It had delivered nine units so far, and we're rebalancing for more units. Okay, so all right. It's interesting, because what you're saying is backwards from what I'm used to. I've been accustomed to Dexcom telling me for years, we're developing from iPhone because it's easier because iPhones are all the same. It's all the same operating system. The problem with with Android is is it's a new phone all the time and blah, blah, blah, but what you're telling me is, right, but you're telling me is that it's easier for you on Android because of their security system. Is it not as easy on iPhone or did you just decide to start With Android to make the FDA more comfortable, I'm trying to like look between the lines here, something happened that made you do something that and I don't mean to insult to people who don't use an iPhone, but there's a lot more iPhones and there are Android phones. So

Unknown Speaker 50:14
yes, I'm in the US. Right? Yeah. Right. So

Scott Benner 50:16
something led you in that direction that I get to it, if you're not allowed to say, and if you're allowed to say, please just tell me?

Unknown Speaker 50:22
Well, I, you know, I don't know if it was one thing, but I will say that, you know, if you look at kind of the flexibility, the willingness to partner, all those types of things, Samsung probably tends to be a little bit more flexible with some of those things. And in in this Knox platform that they have really is, you know, recognize is probably the market leader in security. And just they're kind of willingness to work with us because we think we do need a partner that can work with us to develop this technology, and that we can go to the FDA with and that we can really kind of drive towards approval, I think that we kind of just assess the likelihood of us getting there and getting there quickly. And, and understood that that would probably be on an Android platform with a Samsung partnership. And so that's why we're doing that. I don't think it doesn't say anything about whether or not we can get there with iPhone. But speed to market. You said this week, we felt like we've been behind with technology and we want to get horizon to the market quickly. So we will have iPhone compatibility at some point and tide pool, certainly it will probably be our first and most likely chance of getting there quickly. And

Bret Christensen 51:33
there's even a chance I think JC said this on on the last call is that that tide pool is to market quicker than horizon. So there's a chance for that. And it will be an option for anyone that wants to keep their iPhone and use Omnipod. If you want to learn more about tide pool back in Episode 189, Chris came on from tide pool talked all about this. It's called the tide is high. Okay, so here's what I just heard Brett, I just heard simpler to get us to market with this Android thing. Once we have it all figured out and through FDA, then we just have to put three guys on figuring out how to put it on the iPhone, which is going to be super simple anyway. And then everything is good. But in the meantime, you can use tide pool as your artificial pancreas. That can I don't even know how to discuss that like right now. But as the as the software who controls now, this leads me to a question you may not have the answer to. Okay, if I use tide pool, I'm using their algorithm. If in the future, I'm using horizon, I'm using your algorithm. And I liked it. I liked it. There's this interoperability and that people get to choose because one of these algorithms might work better for you than the other one. I love that on the pod saying, look, it doesn't need to be ours, it can be that one too. I really think that's really forward thinking. So I can bet you're thinking I'm going to be able to jump. I know timelines are a weird thing to talk about in the business world. But it seems like to me that if it's not available right away through on the pod for iPhone, then I can just use the tide pool, which is literally downloading an app and then connecting my CGM with my pump. And I'm on my way. Okay, I understand. So now, let's let's do this. Now we've gone through dash extensively. Now everyone understands that dash is the new PDM. For Omni pod, if you want to upgrade, you'll get slightly different pods, you won't be able to tell the difference. But it'll talk differently with Bluetooth to this new dash system. If you want to stay with your old PDM and your old pod you absolutely can no one's changing. But moving forward past that you guys are pretty deep into your artificial pancreas, which you're calling horizon. And so I guess the first just kind of overarching question is, where is that in the process? What have you guys accomplished so far that you can tell me about and what's left to do?

Unknown Speaker 53:47
Well, we've done a lot of work on the algorithm, which you just mentioned. So a lot of work around human factors, we've done three different ID. So where we're kind of looking at use cases and refining that algorithm, we've published a lot on how it's working so far, including it in in children, and we're really happy with the results of the algorithms. So that's kind of the first piece is getting comfortable with the algorithm, how it works. We're doing a lot of human studies where, you know, we've got essentially horizon working from a tablet in will we'll have people in a hotel and have them on it for a period of time, and just track how they do so the next step, it will be putting it on the phone and then going to pivotal and so we'll start are pivotal trials. Second half of 2019. So we're getting close to that now we're thinking about enrollment and all that today and with a release date, probably the second half of 2020 for horizon so not soon enough, but we are getting close now Wait, and it's getting exciting with kind of development work and what we're seeing early on.

Scott Benner 54:52
Okay, so I guess you're gonna skip me to on this. I can't get this early. I say Well, hold on. No, no, no, wait, can I apply? Like Can anyone Apply to be part of the testing.

Unknown Speaker 55:02
Yeah, we, the best way to kind of look at that and register is clinical trials.gov will be will start posting information on that site, you'll be able to see it. And I believe this is probably a question for training lie our medical director, but I do believe that you'll be able to register or at least get that information on that site. So anyone listening that's interested in applying, I would check that website for information as we get close.

Bret Christensen 55:28
Excellent. All right. Look at this. Now we're getting somewhere. Okay. So you do you understand it's funny because you work in a bubble, right? So do you understand that on the outside that there are people who have been using Omni pod forever, and still are like that horizon? I don't know what any of it is, like, it's a lot of words right now, because I'm not holding it. And I'm not using it. It's it's really tough. I was telling someone a story the other day about I was speaking to someone who's been a, like, almost a lifelong Omni pod user. And in the course of the conversation, they said to me, like, you know, I took the thing, and I was like, the Why don't you like the thing? And I'm like, the, she was the thing, the thing, the controller? I'm like the PDM. And she goes, is that what they call it? And I thought, I thought to myself, can you imagine the marketing team and on the pod, if they heard that woman go? Is that what they call it, they all would have just been like, I quit, there's no i, whatever, it doesn't matter. And, and so but but in her life, it's this thing. And it does what she needed to do. And she doesn't really care if you call it dash, or horizon or follower viewer display or whatever, you know, whatever. And it's just interesting to, it's interesting to understand that it's why I'm really happy you're coming on, because I know a lot about all of this. And there are times when I stop and think about it, I'm like, wait, what did she mean by phone control. And so I love that you got on and explain it because I did not understand phone control the way the way I do now just after discussing it. And so I do really want to understand a little more about for people who really don't get it, the idea of artificial pancreas, just to lay it out your decks, you guys are working with Dexcom. So I'm wearing a Dexcom CGM holding my dash 2.0. Basically, it's got an algorithm on it, which just means a computer program on it that is going to, you know, take what it learns from the Dexcom about my blood sugar. And it is going to make decisions about giving me insulin to keep my blood sugar in a certain range. Now, that's amazing. You're going to change people's lives with that. But when you say that out in public, do you know the only thing they want to know back?

Unknown Speaker 57:37
But that

Bret Christensen 57:39
is the target blood sugar user definable. Because that's that's what people care about the most. Because when you talk to me, you're talking to a guy whose daughter's a one sees 5.2 if you're telling me that the horizon is gonna keep my daughter's blood sugar nice and stable at 140 I kind of don't care. And so right, right, and so and and again, for you living in a bubble, I know that might be crushing to hear Brett, but but there's a small segment of us who are you know, doing really well, who don't? Who that wouldn't be better for now the masses, more people are gonna hear like 121 4110 go right on man. Like, like, give it to me. And I think it's amazing for those people. I think it's transformable for transformational for people living with diabetes, don't get me wrong, but much like everything else in life, right? What are you gonna do for me? I want to know about me. And so is his horizon user definable? Or is that the goal?

Unknown Speaker 58:36
Yeah, that is the goal, I think, I think you know, what you have to do is consider both both, you know, views, right, you have to, you have to make this technology, simple enough. so that people can have, you know, preset boluses can have wider tighter ranges. But But you also got to allow for people that are really diligent in in wanting to keep a really, you know, tight range, to also have kind of that flexibility. So the horizon is going to be built for each of those assists. But you don't want to make it too complicated, right? Because I think complexity really is kind of the enemy to pump adoption. Right now, there are, you know, closed loop systems on the market that are complex, and you kind of don't want that, right. You want simplicity, but also flexibility. So the short answer is yes. You'll you'll have the ability to adjust and to kind of define those settings and do what you want there with with your physicians guidance, of course, right.

Bret Christensen 59:36
So for anybody who's been listening or listened to me kind of like gild the lily about ami pod being behind other people. They're ahead. Somebody else just got here first, and I know that that's right. That might be a competing idea, but there's a lot of good that comes from not being the first one out of the gate. Because that other insulin pump that I hear from people, some people say it's okay and some people don't. It has a target. To get gold, it's higher than what I would want by a significant amount, it is not changeable. And that is probably one of the concessions that company had to make to get to market. And so you're going to come in behind them and have the benefit of seeing that that is a mistake. And being able to make a better decision for you. I like and this will, again, it may sound like, you know, like I'm kissing your butt a little bit. But the person I speak to on the pod about my podcast, I know that I've told this story in the past, but I don't have the traditional route through your PR department, I, I somehow pitched my idea a lot higher up the ladder than a lot of people get. So I have a little I have a little more contact than most people do. And years ago, she will tell you, I said I like that you're not first, I like it a lot. It's gonna be good. And this and if it's just for this reason, I'm thrilled to be perfectly honest with you.

Unknown Speaker 1:00:51
Yeah, the caveat to all that, of course, got right is that, you know, the technology we can make do anything. It's it's the, you know, what can we agree on with the FDA and get approved. But, you know, we do want to provide all the flexibility that, that we discussed, and we're optimistic that we'll get there.

Bret Christensen 1:01:08
Yeah, it's amazing. It really is. And, you know, everyone here, you know, people listen to this podcast, we are all if you're doing it the way I'm doing it, you're basically trying to act like an algorithm. You know, that's what you're doing, you're trying to kind of guess the future a little bit, you're getting insulin moving, you know, beforehand, so that it can do what it needs to do so that your balance is good between the timing of events and the timing of your food. It is it is exciting to me, a person who doesn't sleep as much as they should, to think that, that there'll be a day when my daughter's iPhone, you know, an app running on my daughter's iPhone will know that her blood sugar has been getting high at three o'clock in the morning and start giving her insulin at two o'clock in the morning. Like that is and and if for some reason it doesn't get high at three o'clock in the morning, that night, it'll cut it back again and catch it or do its best to do it. That's amazing. I mean, it's absolutely life changing, I might be able to live till 60 if you guys get this out quick enough, and I'm

Unknown Speaker 1:02:07
47 now for that reason alone, we're gonna get it out,

Scott Benner 1:02:10
you got to get it out for me cuz I'm going downhill. So let me hit on a couple of other things. This is the one I always tell JC, I never quite understand enough. And I want to spend just a minute or two on it. But where is all this at for people with Medicare?

Unknown Speaker 1:02:29
Okay, so, you know, it's a good time, I'm sure when you've had these conversations with JC depending on when they were you know, we may not even have had Medicare coverage. But, you know, we were the only insulin pump on the market without a CMS decision and without Medicare covers for probably 10 years. And the reason for that is because we are so unique and different that honestly, I don't think they could make up their minds on whether we belonged in a DMA channel. Because we're not this, you know, $6,000 durable piece of equipment that should last you for years. The same time we're not a drug that belongs to the pharmacy were somewhere between because we are disposable three, they were pod. So they struggled with that. But we did get a decision in January of 2018. And it was a part D decision. And what that means is Part D is a designation for the pharmacy channel. And that's exactly what we had hoped for unwanted because it helps us facilitate what I told you already, which if we're going to remove that upfront cost, we're going to make this a page to go model to remove that barrier for patients. And it will be a great fit for the pharmacy channel. So many cases, dash will be in the pharmacy and you'll get you'll get it the same way you get your insulin. So it's been a fantastic ride for us. We've started to sign those Medicare contracts. And now we've got many of those contracts in place. Really, most of them should start to come on in 2019. But so many of them adopted the the contract and the agreement early. And so we'll have pretty good Medicare coverage starting in 2019. We have a lot right now. And one of the things we tried to do was go out to our existing users and let them know which plans have already adopted Omni pod because there was an enrollment period in October that went to about the middle of December, where patients could switch their Medicare plans. We want to do it for them to make sure they knew exactly which ones were covering Omni pod, but we're thrilled with Medicare coverage and kind of how far we've come in a short period of time. Okay.

Scott Benner 1:04:26
Yeah, it's it's fantastic. I think that you can age out of the way you want to take care of yourself was exactly as Harper Yeah. So that's really exciting. I have one question about horizon that I don't understand. I'm looking at my notes here. It's been the FDA breakthrough device program. What does that mean?

Unknown Speaker 1:04:45
It's an accelerated pathway for the FDA. So you know, horizon is a because it's a loop system. It's a class three device and breakthrough technology is something that they they gave to some hybrid closed loop system. terms, which essentially just means an accelerated pathway to approval and something that we're excited to work closely with him on. So we'll see how that goes. But it should provide us with a, a quicker pathway to market than might have existed years ago.

Bret Christensen 1:05:16
Okay. All right, Brett. Now this is your this will be I'm assuming you've heard maybe JC on the program or, or Kevin from Dexcom, or other people, this is going to be the least favorite part of it for you. So just, you know, guard your lines. So in exchange for you getting to tell us about your stuff, we get to beat you up for a little bit, it's gonna be a lot of fun for you. And okay. But no, seriously, I have a lot of feedback from people that that I want to give you, there are going to be things I'm going to say that you're gonna have no answer for. And it's fine. I just think it's valuable that people get the same. And there's going to be some things that I know. You know, that I passed, I passed over that have already been sent up the ladder, which is exciting. I want to tell people what those are. But but but so let's start with them the hardest. First, I'll start you hardcores. The one thing this podcast has taught me that I did not expect when I launched this, I just thought Oh, a lot of people in America will listen to my podcast, except it gets listened to in almost every read well, in every region of the planet. There's downloads in Iceland. So live downloads in Japan and China in you know, Australia is starting to beat out Canada. You saw so it's it's every so I get to hear back from everyone. You know, the last two people were on the podcast before you actually go to Anthony Anderson was the one before you. But from blackish. I don't know if you're a fan, but I just I know I saw the sort of the post

Unknown Speaker 1:06:46
Instagram and you have my picture on there. I don't think I'm quite deserving is the least likely celebrity on that poll. I do appreciate these people

Scott Benner 1:06:53
not to the people are listening right now you're the most first there were three people on that one, you were the most important person that I now hear from everybody to, to no lie. There's a group in Australia who's trying to put together the money and the planning to bring me to Australia to do this podcast live there. And so I get to hear from everybody, which sadly means I also get to hear from the people are like I listen to podcasts, and I want an omni pod. But I live in the Middle East. But I live in Australia, but I live here. But you know, can you sort of explain now, and I'm going to take a little the heat off you here because I can't sell snow cones at the North Pole, right. But there might be three guys at the North Pole who need a snow cone. And so but but I can't put a company together to take my snow cones to the North Pole because I'm gonna lose my shirt and I can't do it. So I I think I understand that that's a situation. But how is it you guys see global expansion?

Unknown Speaker 1:07:48
Good question. So, and I understand the questions and concerns and that you get and look, you're talking to the chief Commercial Officer of insolate. Right. So I want to sell Omni pod everywhere. I want to sell pods in Iceland and every everywhere. But I'll tell you kind of what's been going on and then what our process will be to kind of evaluate some of these markets. Because, look, we do want to expand globally, we do want to get into some of these markets, we do want to offer Omni pod to all these people that want it. You know, historically we've we've had a single distributor in Europe that's really had worldwide rights outside of Canada in the United States for Omni pod. So that's the way it's existed from the beginning of time within solet, where where we kind of offloaded all of that work to a single distributor, we recently gained control over all of those international markets this year. So July 1, we went direct in Europe, which means all of those patients that have been getting Omni pod for years are now we are servicing them directly. And that that's given us a lot of insight into those patients the opportunity to work closely with those patients, which we have not had. It also gives us the right and the ability to expand internationally. And so we've started looking at all of these markets, and there are many and we're we're looking at expanding probably some of those in 2019. But certainly beyond 2019, we'll probably have an aggressive global expansion plan. The challenges Scott are probably twofold, I guess, well, maybe three. So there there are two features and kind of product deficiencies we have to address in most markets before we can get there. One is language, right? So if it's a language that we currently have on Omni pod or will have on dash we're set if it's in the others unit of measure, so internationally that many countries measure insulin millimoles per liter. And that's something that we have to have we have in Omni pod, the current version built for dash we got to make sure we get that program so that we can expand these countries with dash with right language with the right unit of measure. And then it's just about you know, the regulatory path. And getting approval to, to sell the product in those countries. So we're evaluating all of those where we've got, you know, a stack rank of markets internally that is constantly evolving and where we'll go first with those criteria. And we'll start to get more color on that kind of once we have the plan outlined. But you know, the markets you mentioned are on our list, and we just got to get a set date for when we're going to be there.

Scott Benner 1:10:24
While you're thinking and working on that. Keep in mind that I know of people who get on a plane in the Middle East and fly to America to buy on the pots. So yeah, I know. Yeah. So it's on our list. Let's FedEx them to them and stuff. Hey, this whole dash thing is Canada getting any love here, Canadians are always sending me like, we always get things. Second, second, are they gonna come online in q1,

Unknown Speaker 1:10:48
two, they won't be q1 and really just be for the same reasons. So you know, we'll get to Canada quickly. But we've got to have the the languages unit of measure, and we've got to make a few changes, and then work with Health Canada to get approval, which we don't have yet for dash. And as soon as we do, we'll, we'll get that to the market. I you know, our our target for Canada really is probably the end of 2019. So so we'll get it there, it'll be quick, we won't need to do the same type of long limited release, like we've done in the US where we're testing the product, because it's some small changes that we'll make so that we can, we can be in Canada, but yet, it's something we talked about all the time, Canada is our really our second best market, it's a phenomenal market for us, we have a tremendous amount of really good patients there. So we say

Scott Benner 1:11:35
it's high on our priority list. And you're growing direct with them this year, too, right? Like you said, in Europe, they're there. Because basically, what you just described was that sales, you had a sales impediment, you were you know, you had a distributor, you had an agreement with them, you're away from them now. So now you'll be able to direct sell. It's really it's funny, it's like the integrated meter, you finally got that you finally got that monkey off your back. And now you can kind of move forward a little bit. And it's the little things that people don't know to be excited about. But for overseas, that's right, there was their contracts had been in place around on the pod for a lot longer than Brett's work there. And they're they're kind of throwing some of those chains aside and moving forward.

Unknown Speaker 1:12:11
Yeah, that's right, we're setting now. So we you know, we don't have the excuse for very much longer, because we are direct there. And we do have control. We just got to get the product ready to go. We're working like

Scott Benner 1:12:23
I like the guns are pointing at your bracket working. Listen, if you want to knock JC out of that chair, like she knocked that poor guy out, you're gonna have to awesome. I'm assuming you just retired but nevertheless. concentrated insulins you 200 to 500. A lot of questions about that. I always think of that as a type two issue. But it's also for type one to us who have a big insulin use. Just timelines for that if you could.

Unknown Speaker 1:12:50
Yeah, so you know, you 500 will come first. And what we said is the end of 2019, we'll be ready to go with you 500, we've done a lot of work with partnering with Lilly for both of these, you 500 and you 200 and then you 200 will come sometime after you 200 really is probably the greater need in the marketplace, right? That's two times the concentration of influence. And you 500 is five times the concentration. But with the work that we've done, we'll be ready to go with you 501st probably the end of 2019.

Unknown Speaker 1:13:21
So what we're saying, Okay, so

Scott Benner 1:13:22
I've one other thing I want to ask you, if you can kind of talk about a little bit, and then I'm going to hit you with a bunch of little like rapid fire stuff, and I'll let you go to lunch. Okay. This time of year, some people get static failures from their pods, and I need you to kind of explain what that is.

Unknown Speaker 1:13:42
Sure. Okay.

Bret Christensen 1:14:04
Sorry, I missed that on my pre podcast checklist. So, I so here's an interesting thing about static failures. I haven't Arden hasn't had one in years and years and years. No panda God, no lie. But I've seen them before. I think they happen because of the school building she was in Believe it or not, there must have been a dryer like situation but so one of the great things I think about on the pod is that it finds out when things are wrong. And it says hey, something's going funky on my end, we got to stop giving you insulin now because we don't want to hurt you. But static is one of those things I don't get so when it gets hot out in the hot air heat comes on. Some people get like the pump failing because the static Can you explain to me what that means, you know, you we do see a spike in static discharge complaints.

Unknown Speaker 1:14:55
You know, really kind of at the end of the year. So for us, it's essential. With two things, the winter, and the dry air, you know, so if you've gotten in bed before with your socks on when it's cold out, and you live in the north somewhere, and you see, you know, number of sparks under the sheets, that's all static discharge. And so the acronym we use internally is ESD, electrostatic discharge. And those ESD complaints that we get from our users do spike up around the wintertime. So essentially, what's going on is that static electricity is somehow traveling into the pot and causing an error or a short circuit of some kind. So we've done a lot of work on this issue, it's been really one of our top complaints in the wintertime probably is our number one complaint. But we just sort of looked at the components, how that electricity could travel through the pod. And we've made a number of changes that we're already seeing results on. So I honestly can't wait Scott, to get some of the the call volumes and the you know, the complaint rates for that issue this winter, because I think it's going to be dramatically lower than it has been, it'll still always probably be the time of year when if it's going to happen, that's when it will happen. But some of the changes that we've made, we can solve for the majority of those issues. So two things.

Scott Benner 1:16:15
That's great news. And secondly, when people hear this later, as it's edited, they won't know that just as I asked you that question, my FedEx guy rang my doorbell. It made my dogs run across the house and bark. You never broke from that answer. Now I will edit out all the barking on my side. So

Unknown Speaker 1:16:31
okay, good. Yeah,

Scott Benner 1:16:32
but that was impressive. I see how you made it to see Oh, that was really something because you literally did not blink. And I just tell you

Unknown Speaker 1:16:40
I was really impressed.

Unknown Speaker 1:16:43
Well, you know what, I appreciate you acknowledging that was on your end, people think I'm taking this call on in the backyard with with the dog.

Bret Christensen 1:16:50
It's so here's the funny story is that in my town right now, as as, as disgusting it is that people run around and steal packages. There's a guy doing it right now in a full Grinch costume in my town. He's wearing a Santa outfit with a Grinch mask on. He's popping up on everybody's ring doorbell video stealing their baggage as he looks right into the thing takes their baggage and locks away. I'm both disgusted and absolutely amused by it. But it's why know that now our delivery people are ringing bells when they drop stuff. Anyway, I'm so sorry. That was spectacular. Okay. Couple of things rapid fire. People want you to know that they want that I know you're not going to all you're going to say is Hey, not at this time, we're not doing this. But of course, people would always love it he is of options for you know, you know, more stickiness. You know, people who are a little more sensitive, you know, they've heard over and over on this podcast with Dexcom. That's not as easy to do as you think. Of course, larger reservoir and smaller reservoir. It's great. If you talk to an adult, they're like, I wish this thing held more insulin. And if you if you talk to the parent of a kid, they're like, I wish this thing held lessons on. You know, we'd like the pod to be flatter. Which it's funny, isn't it? I want it to hold more insulin, but could you make it smaller? And so, so bright so far, I would like you to make the reservoir bigger, smaller, and then make the pod smaller. Yeah, they don't like the needle. If they fill the pod with casual links, there should be more options. So is the pod being reimagined was the overall question I'm assuming at this point? It's not being reimagined right now. Right? The pod well, or no?

Unknown Speaker 1:18:27
Yeah, I mean, these things take time. And we're always reimagining the pod, right? That is really the foundation of our technology. But and we, you know, the one that we have done over the years is, you know, people don't think we've had a product launch in 10 years, but what we have done is kind of change the size of the pod. But in, I constantly hear those same things needs to be flatter and smaller. And he saw a whole more influential last longer. So and those are trade offs, right. So it's one of the reasons why we've turned to concentrated influence to try to solve for that. But we were always looking at ways to try to make it smaller and flatter. And we do know that if, you know if patients could choose right between, you know, smaller and flatter, they do typically say flatter than So, you know, they don't want to something that sticks up but it's something we're always looking at the adhesive thing is something we're always trying to fine tune. The challenge with that is, you know, everybody's skin is different. So we can make it stickier and some people won't be able to get it off, we could make it less sticky and it would fall off more often. So depending on if you work out or you don't and where you live, there's all sorts of factors for adhesive. One thing we are doing is you know, we're we're developing a kind of a supplement that it we call it a pod pal where you could kind of put it over the top of an omni pod just got a hole in the middle of it, and it would just kind of extend the area. So if you're, if you're about to run a marathon or you're going to do something where you know, it could test the adhesive, it could be something you could do to to add some, some adhesive to that. So we're working on all those things. None of them are quick fixes, you know, but but they're all good ideas and things. We absolutely need to Keep looking at this is

Scott Benner 1:20:00
what I tell my daughter, you have diabetes, that sucks. But this thing is amazing. And so if we have to use like opsite Flexi fix to hold it down once in a while, then we got to do I mean it's, it's way better than boiling your urine, which is where you would have been 70 years ago.

Unknown Speaker 1:20:14
So there we go.

Scott Benner 1:20:15
So here's one. This one's from my, not only from the everybody online who's got little kids, but my daughter actually asked about, she's like, are you talking on the phone? I'm like, Yeah, she's like, find out about this. I said, Okay. So when you put the pot on the pot is self inserting. And so anybody that has it knows you put it on, you push a button on the PDM. And then the pod makes these kind of faint clicks. And then the pod inserts, my daughter would like to know, why does it not insert on the same click every time? Why is it sometimes five clicks, sometimes six clicks once in a while for clicks once in a while seven clicks? She wants to know, tell me now right? Hmm.

Unknown Speaker 1:20:50
I don't know.

Unknown Speaker 1:20:53
Probably a technical answer to this. But we'll we'll we'll see what we can do to you put me in just two clicks to make sure it happens. I you know, I would imagine it's just the mechanism is mechanism of action inside that, you know, if it clicks, it's lining up. But who knows? I'm going to say something that's absolutely not true. So here's my I'll send that to our engineers and get an answer for you.

Scott Benner 1:21:12
I always tell her I have no idea. But in my mind, I imagined it like a catapult and like a medieval movie. And someone's just cranking it back waiting to get enough tension on it that it can throw the bucket guitar. And so that's my, I have no engineering whatsoever. That is how I go with that one for now. That's great. Wait, wait, Oh, she has to explain on the conference call next time. But that's

Unknown Speaker 1:21:35
not what's going on.

Bret Christensen 1:21:38
I took it seriously. Okay, so I already hit you with and now these are things that we're passing on. But I want everyone to know that Brett and and the team, they've already passed these things on that you guys have sent in? So the biggest one was what I mentioned earlier, how great would it be if somebody could remote dose based on a suggestion from a caregiver? be great. So other people want to know hey, once in a while I shoot insulin through a you know, a syringe, even though I'm wearing a pump, I'd love there to be a way to add that insulin to my insulin on board. Can you please make ratios by half units? Like somebody I guess the idea is, you know, one unit per 20 carbs. Like Bob, I think they'd like to see a little more functionality there. I don't write completely why I don't use I actually don't use insulin to carb ratios. I just we just ballpark my daughter's insulin and roll. Low glucose. Now here's one that seems more possible. So you know, tandem came up with this bass like you tandem which, by the way, if you people using I'm glad if you have a pump that you like, but they were almost out of business last year, and they held on to the skin of their teeth with that pretty color screen. And now they're back. And they have bazel iq, low suspend, right. But if you have, is there a way to get the question directly from somebody was, could you guys figure out a way to add low suspend while we're waiting for horizon to come?

Unknown Speaker 1:23:07
Yeah, good, really good question. And something that we've all asked internally, it's not as simple as is adding that and in keeping horizon on the same timeline, right. There's, there's an approval pathway. That's a kind of a big add. And if we thought we could do it as a just an add on, while horizons when it we would do it, what we don't want to do. And you know, internally, when we look at our priority list, horizon is at the top dashes at the top of our priorities right now. horizon is right there with it. And we won't do anything to slow down horizon. So

Bret Christensen 1:23:39
the short answer is if we think it's going to slow down getting horizon to the marketplace, we just won't do it, even though we know that that's something that would add value today. Do you think that in the future, and this is something you're not prepared to even answer I don't match. But do you think in the future for people who don't want to use horizon that that might be something that exists between the pod and the dash?

Unknown Speaker 1:23:59
That sounds crazy. horizon is kind of just an extension of dash, right. So as you as you integrate the CGM, which is really a requirement of knowing what your glucose levels are, right? Then you get some of that functionality. So you know, I don't know that, that it exists without closed loop with horizon but it's certainly functionality that would exist in a version of dash this like horizon.

Bret Christensen 1:24:23
It's funny as I was coming out of my mouth, I thought no dummy, because they won't have a CGM, so it doesn't matter. Yeah. Okay. So all right. Yeah. So I've never had this happen. But some people say like, you can get an occlusion that'll stop the pump from working you have to change your pump. I, I don't really see it happen on my end, but somebody said, sometimes you can get a false occlusion. And so they'd love it if you could restart the pod after a false illusion. So go ahead and fix that real quick. We work that out and let us know. Will we be able to bolus from a phone without dash in loop? Well, we've talked about that. Why can't on the pod do smaller increments like other pumps? Yeah, why can't and Multiple temp basals, you know, would be cool if I could set a 95% increase for an hour, but then, you know, the hour after that I'd like it to be at a 50% increase, it would be cool if I didn't have to an hour later reset it again. Yeah, that's it. But so I will ask you, and if you don't know, I know that this side of it's not exactly your you know, it's not where your bread and butter is. But do you? Do you know why the pump goes to the increment? It does and doesn't go lower than it does?

Unknown Speaker 1:25:29
As far as you know, I've had it Yeah, I've had it explained to me, Scott. So you know, it just, it just kind of is is the way that that Omni pod works and the way that we kind of got certified for it. But what I will say is, you know, with the zero basal rate that you get with dash, so dash now the big change, which as you can go down to a zero basal rate. So that allows for a lot of flexibility, as you alternate between zero and you know, 1025, you can get some of these smaller increments and get a tighter basal rate, if that is something that you need. So we that's something we've been asked for a long time, why can't I get a zero basal rate, you can do that with dash. And so that's another big ad that will help with that scenario. Okay, so

Scott Benner 1:26:09
I'll distill that for people listening for us, people with the little tiny kids. Yeah, the only pods not gonna have a smaller increment than you're used to, but you are going to be able to manipulate your bezels in a way to make it work. So there's a lovely workaround, plus, and here's what I tell people, when they ask me all the time, just feed the kid more, I'll get bigger, I'll need more insulin, you'll all be sad. And so what I do with my kid to fatten that kid up, and then we can move there. bazelon. That's all. That's some quality parenting right there for me. Brett, I think you've done it. I think you've done it. I think I think we're finished. I really appreciate you not having a heart out at one hour. I appreciate you speaking to me the way you did. I think that I think that everyone else will have the same level of appreciation, we're all going to run out and get to ash as soon as it comes out. So please make a bunch of them. And and I guess that that would lead me to my one last question. So I'm, I'm coming up to Boston in a few months to, to speak to speak at an internal Town Hall, I think in March. And I don't want to I don't want to brag breath. But apparently the Town Hall was going to be in February, but I couldn't make it. So now it's in March when I can make it so. Okay, treat me nicely when I get there. I'm very important. And absolutely

Unknown Speaker 1:27:23
lovely to see you. Here we are in our new offices and acted right. So we just moved this last week. So we got this phenomenal facility can't wait to show you. And that's

Scott Benner 1:27:31
what I'm wondering about. So now when you tell me you're building stock, are you guys manufacturing these things yourself? are we up to that? Yeah. Well, so

Unknown Speaker 1:27:39
you know, we have a contract manufacturer flex, that is manufactured already pots to date. But we just we just built a phenomenal facility enact and I'm standing in it right now kind of staring at our manufacturing facility. And it is It is amazing to see but you know, starting probably the first of 2019 will be manufacturing pods right here in Acton Massachusetts, made in the USA pod. So we're really excited about it. It's a it's a state of the art manufacturing facility, all robotic, it will take you through it when you get here. But it is phenomenal. Yeah, it's phenomenal.

Scott Benner 1:28:18
I would really like to see I think that's absolutely amazing. So I'm certain sure the flex people are running around now looking for other work. But hey, it's good news for you. So

Unknown Speaker 1:28:29
this is a challenge for you know, we last year, we had a manufacturer over 20 million pods right now we'll do way more than that this year. But we need redundancy in manufacturing. You don't want something to happen where you know, a hurricane hits or earthquake something where all of a sudden you can't get pods to you know, the hundred 50,000 patients that use it today. So it's been by design all along. We need the redundancy, we need the extra capacity and yeah, we'll we'll we'll keep that partnership with flex as well.

Scott Benner 1:28:55
Okay, well, as long as you're gonna keep up, then I'm gonna keep selling your Omni pods for you. So go, go go. I really have a great holiday. Merry Christmas if you celebrate Happy New Year. And thank you very much for doing this.

Unknown Speaker 1:29:07
Thank you very much for having me. Have a great day.

Scott Benner 1:29:09
But first, let me thank everyone who follows the podcast on Facebook and Instagram who lent their voice to this interview and ask their questions. I hope I got to everyone. I really, really tried. And thanks to JC too for passing us on into Brett's very capable hands. I think you'll agree he did a fantastic job. Jc we will miss you. Maybe you can come back. But hey, Brett did such a good job. You've been replaced. There's gonna be one more episode of the show this year. It'll launch on December 27. Yes, December 27. It's going to be with Chris root. The guy's like a bodybuilder and he's got type one diabetes. It's crazy. And he's going to be on this new TV show with Dwayne The Rock Johnson called Titan games. I think it's called or something like that. Anyway, he's going to tell you all about on the 27th. The reason I put that episode there is one because Chris is going to be on the show that starts a couple days later and he'd like you to know about it. But to and this is the more important part, Chris and I are going to talk a lot about weight gain and weight loss and insulin. It is something that I hear from you guys about a lot that I don't understand very well. So I got Chris on to talk about it. So you know, just in time for your New Year's resolution, maybe you'll understand a little better what you're doing as you try to reach those goals. Thank you so much to Dexcom to ollie pod for sponsoring the show. Thanks so much to Brett for coming on and being so open and honest. I hope everyone's is excited about dash and horizon tide pool and integration with Dexcom CGM and artificial pancreas as I am. This is gonna be an amazing, amazing time. We are so close guys. I'll talk to you soon.


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