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Scott Benner 0:00
Hello friends, and welcome to episode 702 of the Juicebox Podcast.

Today is the first episode in the bold beginnings series. While you're listening to this episode, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please consider going to T one D exchange.org. Forward slash juicebox. To take the survey, the T one D exchange survey benefits people living with type one diabetes, it's incredibly easy to do and will take you fewer than 10 minutes T one D exchange.org forward slash juicebox. Also today you're going to hear Jenny Smith. Jenny is a CDE. She has had type one diabetes for over 30 years. And she works at integrated diabetes.com If you're interested in learning more about what she does.

This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes in pen is an insulin pen that talks to an application on your smartphone and gives you much of the functionality that you will get from an insulin pump. In Penn today.com. The podcast is also sponsored today by us med. Don't just get your diabetes supplies from anywhere. Get them from us med Call today for your free benefits check 888-721-1514 Or you could just go to us med.com. Forward slash juicebox. Us men always provides 90 days worth of supplies, and they give you fast and free shipping us med.com forward slash juicebox. So we did this little episode recently where we talked about we're going to go through the steps of the questions that people sent in about being newly diagnosed. This is going to be our first episode about it. We have it broken down. It's not really it's still it's gonna be a lot of episodes, but we haven't broken down to honeymoon. What it's like to be diagnosis and adult. different terminology. highs and lows, the 1515 rule long acting insulin, fear of insulin, range and food choices Pre-Bolus ng carb guidelines and impact of food stalking, flexibility school exercise guilt, fear and hope. Podcast the community medical care team journaling, technology and supplies, insurance. And that's it. So that's it. That's it. I have it narrowed down to like I don't know, 15 or 20. Yeah, so we're gonna go through and have these conversations. So you and I put these in order, and we thought honeymooning went first. So we're gonna have to feel our way through this a little bit, because we've never done this before. In the past, I just started the conversation. And then we chatted to where we wanted it to go in the in the in the pro tips. But this one, we have questions from people. So why we thought this was important, is because going into the Facebook group with 25,000 people on it and asking them, What do you wish you would have known or someone would have told you when you were newly diagnosed? So under the heading of honeymoon, the first thing that we have here is a better explanation of the honeymoon phase would have been helpful. Let's talk about what that is.

Jennifer Smith, CDE 4:09
Yeah. Better is is a it's like a rabbit hole of consideration. Right, though, like, better explanation kind of starts with Well, how was it explained to the person or to the majority of people to begin with? Yeah, and I do think it's a concept that's really it's a gray area, have known, honestly. Because it's a time period, essentially, where after diagnosis, you've got some remaining beta cells, at least many people do. Not everybody but many people do. It seems like the sooner you get containment of the blood sugar levels, the more likely you are to have if there are remaining betas, their assistance and they come I'm back to help and that may eventually reduce your overall insulin needs. I mean by how much again, this is a person to person, you may need less overall dosing for mealtimes. Maybe just Basil is holding things really, you know, tight for you in that honeymoon phase. But I think a good word to go along with honeymoon is unpredictable. Honestly.

Scott Benner 5:29
So, the, you know, let me jump to another question, because I think it'll pull the conversation together, right? This person says mi honeymooning, how will I know. And I think that's such a good point. Because you really don't know what diabetes is to begin with. So whatever it is for you on day one is how you imagine it is and a lot of people get caught up in thinking, well, this is it. You know, and someone can tell you in the moment, hey, you might experience a honeymoon, and a honeymoon is going to be, you might have some beta cells that are still helping along with insulin production. That might be great. Because if it's stable, then we'll use you know, less insulin. But it also could wax and wane. It could be one day, you're getting help. And the next day, you're not the next day you are and you know, especially you're probably going to be MDI at that point, right. So you've got to for the most part, right, you've got a fixed amount of insulin in us a basil. And then one day, you're, you know, your pancreas is like, I'll help and no thanks. I already put the insulin in today, and you're feeding insulin all day. So it's a lot.

Jennifer Smith, CDE 6:34
It is a lot. And I think a misconception too, is that it shouldn't really be mistaken. And it could be easy to think, Well, gosh, maybe i i was incorrectly diagnosed. Right? Maybe I am really getting better. Maybe I was just sick or something was going on this downplay in insulin need. Especially being tested. I mean, most people who are who are diagnosed with type one, or assume type one, get the antibody testing and all those things that we've already talked about to to really give a positive diagnosis. But once that's there, even if your insulin needs go down in this expected honeymoon time period, you're not you're not getting better. And that's sad to say it is

Scott Benner 7:27
because it'll hit you that way. Because it happened to me. Yeah, there was a couple of days where art in just out of nowhere did not need insulin. And or at least that's how it felt like, you know, my memory on it could be, you know, right. I'm getting pretty old those long time ago. But right, my recollection is there were two days where Arden didn't need insulin, and I and I've told this story before calling our pediatrician who's a friend. And I preface what I said by going I know I'm wrong. But I have to say this because it feels imperative that I tell you that I don't think Arden has diabetes, somebody made a mistake. Right? And he sat very quiet and sad and said, she asked diabetes, this could happen. You should call the endo and talk to them. And I was like, okay. Yeah, but the problem day to day and why the question gets asked by people who are like, you know, when you ask somebody, what do you wish you knew? I think first of all, you need to know what could happen, you need to know it might not happen. Correct. You know, you might catch diabetes very early. And then your honeymoon might be longer, you might catch it later, it might be shorter, and 1000 other variables that could influence if there's a fluctuation, and if there is how big it is. This person says the lows were horrible. And we had a scary middle of the night, barely conscious, 32 blood sugar, about three weeks after diagnosis. So this is a person who didn't have this information was never told.

Jennifer Smith, CDE 8:51
Right. And that's I guess it also brings in a timeline of when, and that's a that's a major question that's also often asked is, well, how long can I expect this to last for? It could be a week, it could be a couple of days, it could be weeks, it could even be years. And for the most part, the years that length of time in honeymoon. I more often see in adults who are diagnosed who research has has shown as an adult diagnosed you more often have a reserve of betas after diagnosis that's a little bit larger than really young children or even kids or teens really. In fact, there's there are a lot of good studies for kids diagnosed under the age of five. I believe that actually so it's that the onset of type one is much more rapid and much more aggressive. And that there is more likely that there's less or almost no beta cell action left in really little kids were diagnosed very quickly. Yes, yeah.

Scott Benner 10:02
Artem was to and, you know, besides those two days, well, here's the rest of me right. Besides those two days, I'm going to tell you that I didn't notice. But I also was a guy holding the meter and a handful of syringes and a vial of insulin right? There were no CGM, I couldn't see anything happening. And these people who are listening very likely are not being handled a CGM right away either.

Jennifer Smith, CDE 10:26
Many of them are not I've had, in the past couple of months, I've had a handful of people who've actually left the hospital with a CGM on their child. Okay, well, that's fine. But again, that's it's a small percent, but it is encouraging to see how that's progressed in importance for visibility. And or they've left with a prescription to get it within a week or two after leaving the hospital or after diagnosis, which again, is, in my opinion, pretty quick turnaround,

Scott Benner 10:57
the context that the the glucose monitor line gives you, it's just, it's different. Because otherwise, in your mind, it just feels like the blood sugar is coming in and out of hyperspace. Like, it's you know, it's 78. And then the next time you look up, it's 250. And without context for how it got there, your brain struggles to make sense of it, you know, especially when it's very likely that the doctor has given you basic ideas of what to do count these carbs. Use this, you know, use this formula, inject this insulin, if you're lucky, you got that right information. Right. And because we're talking about newly diagnosed and not just children, I've interviewed a number of adults, you know, you know, over and over again, but lately, one that's sticking to my head where they just told her like your take 10 units of this and eat. Yeah, that was it, you know? Right, right, exactly. consideration about carbs or anything. Honestly, it's more

Jennifer Smith, CDE 11:55
than for adults, I've seen many more adults being diagnosed, let's say correctly with type one, but given more of a really old school, way to dose insulin, and prior to giving them any, you know, real information or education, if you will, it's like you said it's eat your meal, take 10 units of insulin, take it three times a day with each meal time and go about your business until you actually see an educator or somebody who can help adjust this for you. Where again, that's it's that's really old way to dose.

Scott Benner 12:34
But you're seeing it more and more you're saying.

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Jennifer Smith, CDE 16:41
I see it, I see it often enough that it sort of frightens me, given all the technology we have today. And the types of insulin we have today and the way that they are meant to work to specifically especially our rapid acting insulins to mimic sort of digestion for the food that it was formulated to cover which is carbohydrate. So why don't we just educate people? Well, give me an idea what your meals look like. I mean, this is pretty easy question to ask people upon diagnosis, okay, your meal seemed to be this. And as an educated clinician, you should really have an idea about how to carb count, especially if you are in the profession of diabetes. And that's you should be able to say okay, let's start easy and just say, for every 15, you take one, right, at least

Scott Benner 17:36
it gives people context,

Jennifer Smith, CDE 17:38
something's starting to work with a starting point, even if it's completely wrong, and they need to be a one to five, at least, then in a couple of days, you can say, well, that's clearly not working, let's adjust it, but they already have the concept of counting and dosage.

Scott Benner 17:52
Your, your your story makes me think that maybe at diagnosis, people are like, well, they're gonna get great technology. And then now this is going to matter. So I'll just say something that won't kill them today, then they can go to the next person, and the next person will do a better job of this. But your point is, I mean, listen, it's not a brag, but I think you could bring me up to any person using insulin. And I think I could probably ask them four or five questions and make a pretty educated guess about how to cover their meal. Yes. So absolutely. Yes, it just doesn't it's not I hate to say it's not that hard. But you know, it shouldn't be if you're a clinician, I guess. Just this next thing here says, What do I need to know, during the honeymoon stage, you really have to put yourself in the position of a person who's just been whacked over the head with a shovel while someone's yelling, you have diabetes. And they're like, wait, what she's she said before they teach carb counting. Like when do I know if it's a true DKA? Or hold on a second? These are broken up questions. So let's skip the car panic and go. When do I know if it's a true DKA situation are just part of the honeymoon stage? What do you think they mean by that?

Jennifer Smith, CDE 19:01
Well, high blood? It's a good question. Because if high blood sugars are just sustained high,

Scott Benner 19:07
and then they again, do ketones because somebody told them if you're over this for a certain amount of time test your ketones, right. And they're fresh from a traumatic moment in their life where these kids had or they had a high blood pressure and they were in the hospital for it. Right. Oh, I see. Okay.

Jennifer Smith, CDE 19:22
I mean, that's what I that's what I would certainly expect but it is it's a it's a good question. But I think it's a pretty complex question. Because if you're in this window where honeymoon could be the case, and all of a sudden you're running high blood sugars, okay, great. Go ahead, do the steps. You know, test for ketones. dose, call your call your doctor and say, Hey, we've been running higher all of a sudden, it seems like without visible illness or stress or anything in the picture. Seems like you're likely at that point then coming out of honeymoon and you actually need To increase your doses, potentially basil to start, maybe the doses that are covering mealtimes, especially if they've been very, very, very conservative. But I mean with high blood sugars, regardless of what point of diabetes diagnosis you're in, if it's a stain high test for ketones, right, good first step.

Scott Benner 20:20
You know, it's funny, I always think about these things, all these topics about I think of them as like, if we were in an elevator for three minutes, and you said to me, Scott, honeymooning, what do I do? I think, and I don't want to give away that I've watched more than one season of Big Brother, which I'm embarrassed by, but I think you have to expect the unexpected. Like, if Thank you, if you just need to live in the in the reality for a little while, that things are going to change more frequently. Or they could change more frequently, I should say. Then you hope and right. And that's where you hear people online, say stuff that I don't like that they say, but I understand where it comes from, like, you know, carbs, times this plus this equals elephant, you know, or when they say like, nothing makes any sense, right. But if you expect it to be varied, then it does make sense, but it's varied. Right, you know, if you if you put yourself in a position where you say, This is what should be happening, I did what the doctor told me, I measured it correctly. This is wrong. None of this makes sense. I give up. You're gonna, you're gonna make yourself crazy. Right? Yeah, you just have to stay very flexible in the beginning.

Jennifer Smith, CDE 21:29
And I think that the flexibility and especially in terms of what people should know, after diagnosis around honeymooning is that expect that it may be in the picture for you at some point, sooner than later after diagnosis. And that once you're exiting the honeymoon, it doesn't necessarily mean that you're doing anything wrong. Right? This isn't it's not really, it's not your fault, that you're coming out of the honeymoon time period that you need more insulin. It is what it is. Yeah. So I mean, there's a lot of, I mean, in the grand scheme of diabetes management, there's like, a lot of psychological stuff anyway. But I think this is a, this is a period where you may feel really, really confident. And honestly, during a honeymoon time period, it may seem a lot easier for some people because they have these really tiny insulin doses is they're only on basil. They feel like oh my gosh, I'm an eating and checking my blood sugar looks like it's in this target range. And they may not even be dosing mealtime insulin, maybe Basil is just cutting it for them, right? And then it starts to inch and creep and change. And that's where again, like that psychological piece of management kind of comes in, because a lot of people think, well, well, maybe I need to cut back. Maybe I'm doing too much, maybe I'm eating too much. So I'll just eat iceberg lettuce. And that means it's okay.

Scott Benner 23:04
It's such a good point that in the beginning, you're very likely using such a small amount of insulin and it can make you feel like I've got this it's so easy. But if your Basal is point one an hour, and you know your whole meal, insulin is like a unit for a meal or something like that, like, I'm not belittling, it's hard, and it's scary and everything else. But you're basically playing wiffle ball in the backyard with your dad, you're not hitting up a Clayton Kershaw right now, yeah, go crazy. When you put the ball over the hedge line, you know, they may just say, okay, and to me, it's all experiences. I mean, I don't know how many times I could talk about it, but you have to do a thing. You have to see how the thing works out. And then you decide, do I need a little more, a little less, a little sooner? A little later? How does this insulin work? And you do it again, and again and again, until one day, it just makes sense every time you do it? And? And the truth is, is that, you know, in the beginning, you do have more going against us than just understanding that you have the other parts, the psychological aspects of it, and what could really be, you could be suffering with depression at that point, or, you know, there's a lot happening. I interviewed an adult recently, she's in her mid 30s. And she said they were explaining to her about her diabetes, and she just sat there thinking I don't have diabetes. Like she wasn't listening to anybody. You know, she's like, a young fit person. And she's like, I don't this is wrong. Like she couldn't get past the I think they're wrong about this. You don't know how many important things were said to you. While you were staring at the wall thinking, hey, what was wrong? Yeah, what the hell just happened to us? Yeah. Okay. Yeah. Is there anything here we're missing? I do want to go to one more question here. But I want to make sure you have everything out that you want to say.

Jennifer Smith, CDE 24:49
Um, I don't. I don't think so. I mean, outside of just one other question that I think has come up in conversation in discussing with some newly diagnosed people that I've worked with, a lot of people end up asking, is there anything that can sustain this honeymoon? Right? And there's, there's only one study that I know of, and it was done in adult men. So not even a broad spectrum of, you know, gender or anything. But it showed that exercise in newly diagnosed men proved that the honeymoon lasted a fair amount of time longer than those who didn't include exercise in that time period post diagnosis.

Scott Benner 25:40
I wonder why that is. So

Jennifer Smith, CDE 25:43
again, I mean, something like that, certainly, you need to study it in more people more, you know, kids, teens, women, but at least it was a good visual that there is that one thing that was shown that could potentially prolong it, and I would, I would expect, it's just from a sensitization standpoint, right building muscle making the muscles work, which makes your insulin work better. And if your body is more sensitive, your pancreas also doesn't have to work as long so maybe it preserves the beta cells longer, right would be my expectation

Scott Benner 26:17
what let's put this part in here to like, so we know about like Tomislav, for example. Right. There's that drug trial. Yeah, about a long gating people's honeymoons? What's the real benefit of that? For the patient? Beyond that you don't need to use insulin, and you don't have to have diabetes, as soon like, I mean, the lesson to think of put off three, four years, then hey, you know, I'm saying, that's amazing. But if I'm just doing something that's going to extend my honeymoon by a week, or a month or two, like, what's the real benefit of that? Is there one?

Jennifer Smith, CDE 26:50
I guess the benefit to me especially would be for if it's even keeping people from some type of diagnosis, you know, in those who are tested with antibodies and are given the drug in order to extend the time without diabetes, any years without diabetes are definitely a benefit.

Scott Benner 27:10
I get that one I'm talking about, like, if running around like a lunatic makes it take three less. Like, if it gives you three weeks back, you know what I mean? Like, like, you've had diabetes for over 30 years? Yes. Would it be any different if you had it for three weeks less? No, no, right. But I would not, but three, three years less, God bless we would like that. Right.

Jennifer Smith, CDE 27:33
Absolutely. Three years less. Absolutely. And, you know, from the standpoint of ease to the body and whatnot, I think more information needs to be gathered as to people who were diagnosed without use of something like this. What type of outcome with control, like healthy management long term? What was their end outcome compared to people who got the use of this drug and had an extended let's call it honeymoon time, where their body was allowed to help them a little bit more. They had to use less injection, less pumped insulin less, right? What did that bring in down the road? Did it improve anything down the road? And that's going to take years to look at differences

Scott Benner 28:26
from I think, from my perspective, from a person who talks to a lot of people. When I hear about people wringing their hands about honeymooning what I really hear from them, mostly, they just wanted to stop. They just they just like, can we just get to the part where this is reasonably predictable? Please? Like, like, what what is happening, Jenny?

Jennifer Smith, CDE 28:46
I don't know. That's not me. It sounds like you're getting a weather. Emergency weather alert.

Scott Benner 28:51
Maybe a tornado here. Oh, great. Now live, you're gonna ever hear this episode? Scott, he's on his way up.

Jennifer Smith, CDE 29:01
I was gonna say do you need to go to the basement? I don't live

Scott Benner 29:03
in that kind of an area. This is the kind of an area where people go like, why don't we get these tornado alerts. But But, but to go back to my thought that was very odd. They just, I mean, listen, if it's a situation where one day your kid can go to baseball practice and the next day, they can't because one day the pancreas isn't doing anything and the next day it is. It's it's it makes you nuts. Like it just does. And I you mostly hear people say I just want to get to the next part at this point. All right. And I don't you know, I don't not understand that. I think but but this person asked this last question that says they're talking about a two year old who overnight is experiencing lows with no insulin at all. And they say he can hover at 90 for hours and then slowly creep down to 70. But here's the thing. Isn't this interesting? If Jenny's blood sugar would hover it 90 For hours overnight, and then slowly creep down to 70. She would text me in the morning, a picture of her CGM ago, look how good I am at this. And that's the thing you don't have context for when you're looking at your two year old baby who's had diabetes for two months. Right? That, you know,

Jennifer Smith, CDE 30:19
there's not enough history to it for it, this example, this family, this person, there's not enough. I, I have a sense of, of what that means to me. I also have a sense, if I got an alert overnight, and I saw what was happening. Even without using the system that I'm using previous to this, I would have a strategy that I 99% of the time would have worked, right to say, Okay, it's drifting, this is happening, this is what I need to do, or I can go back to bed, because I know that it's all gonna be totally fine. Right? So knew there are, there are a lot of kids, especially kids that I work with, who are still using multiple daily injections or MDI. Because once that Basal injection is there, you can't take it away.

Scott Benner 31:09
Yeah, this is an example from someone who obviously pumps because they were able to turn their basil off off, right? If they were MDI, they would continue to get low. It's funny, yes, I just was explained to somebody the other day, a person who just doesn't know anything about diabetes, and we're talking about low blood sugars. And they said, Why does it keep getting low? And I said, well, the insulin is dumb, it doesn't know. I think that the insulin is pulling glucose out of your blood, pulling it out, pulling it out, pulling it out, it doesn't get to a number and say, Oh, good, we're done. It just, it will continue to take glucose out of your blood until the power of the insulin is gone. And it doesn't care that you are where you want to be too low, having a seizure doesn't matter, it's going to does taking

Jennifer Smith, CDE 31:52
correct. And that's, you know, on pumpers if it was happening enough, again, in this particular example, you could say okay, well, this has happened night after night, I've had to turn the basil off. But if you've got a pump, you can program it just program is zero basil from this point of drop to this point of leveling out and and take care of it. You know, but on again, injections, it's it's really difficult. And so often, what we end up having to do is really make sure that the morning is when the Basal is adjusted, assuming that the overnight lows in this case, and assuming it's honeymoon in this case, is the pancreas is just kicking out at this point. Yeah, this is where it's taking most of its action. And so you don't need any injected or pumped insulin here, because your body is helping.

Scott Benner 32:39
And then the last question that people constantly ask is, How do I know when it's over? And yeah, that one's easy, because you need a lot more insulin,

Jennifer Smith, CDE 32:48
your insulin needs go up. And it's again, this is a visible Okay, was it today because it was a birthday party or a cookout or something? And so we just had a lot more that was different, or is it ongoing in the next? Okay, this was today, tomorrow looks similar. The next day, it looks similar By day three of needing more insulin and nothing else has really shifted or changed. You're probably getting to that point of honeymoon is ending

Scott Benner 33:15
experience after experience day after day showing the same thing. Yeah, you're probably not being helped by your pancreas anymore. The other thing too, is I don't want to be like ham fisted about it. But you know, when you have type one diabetes, and you're not getting any help from your, uh, you know, the way I used to explain it to one of my daughter's teachers when they wouldn't understand I said, Look, here's Arden right now, her blood sugar is perfect. If I take this pump for her, take it from her, just she got no more insulin, and we give her a half a bite of this cookie. She's going to be dead in four days. And you're like, I'm laying there like what? And I'm like, Yeah, her blood sugar is going to continue to rise and there is nothing her body can do about it. I said it will put it into decay, it will end her life a bite of this cookie without insulin. And so you can see it. When you don't have insulin, your blood sugar wants to go up. And if you you know if you can, you know, if you have some stability, say you are using a CGM and you have some stability at 120 and then you eat something and you know, you Bolus for it and three hours later, you're 120 Still but then it keeps rising and keeps rising and keeps rising. Your Basil is probably not strong enough. And then you need to probably go over and listen to the pro tip episodes about how to get going and taking care of your blood sugar. So alright, did we do it? Is this good?

Jennifer Smith, CDE 34:29
I think this is pretty good. Yeah,

Scott Benner 34:31
I you know, every time we do this, I wait for you to look at me and go, Dude, you're so wrong. Stop talking.

Jennifer Smith, CDE 34:38
I don't think I've ever said that to you.

Scott Benner 34:40
You just keep there's that little kid inside of me. It's like I'm gonna mess up eventually. And Jenny's gonna be like shaking her head at me and be like, What are you talking about? Stop but I think

Jennifer Smith, CDE 34:48
the only one time that I did correct you is when you told me that I wasn't nurse and I'm like, Yeah, I'm not a nurse, dietitian.

Scott Benner 34:55
I misspoke and there's the truth right now. We're still recording she would stop me if you I misspoke one time in how many years have we been doing this together? Oh my god, you're like, I'm not a nurse. Oh my god, I felt like I was married to you for a second. I was like, Oh, she finally got me he's so excited

new episodes of the bold beginning series will come out every Friday. Thank you so much to Ian pen from Medtronic diabetes, for sponsoring this episode of The Juicebox Podcast. Please remember to head over to Ian pen today.com. If you'd like to learn more about that insulin pen that talks to that app, through Bluetooth, I also want to thank you s Med, and remind you that you can get a free benefits check right now at us med.com forward slash juice box or by dialing 888-721-1514.

It would be a great companion to these episodes to become a member of the private Facebook group. For the Juicebox Podcast. It's absolutely free. But it's a private group so that you can feel comfortable speaking openly with other people who are living in a similar situation as you it's called Juicebox Podcast type one diabetes, you'll just have to answer a couple of questions to prove to that Facebook algorithm that you're a real person, and then you'll go right in to a space with over 25,000 members. There's so much activity on that Facebook page every day, there's bound to be a conversation. That's about something you've wondered about something you're experiencing, or something that you know enough about to help someone else with Juicebox Podcast, type one diabetes on Facebook, in that same group, at the feature tab at the top, you'll see lists of other series of the Juicebox Podcast, like the diabetes pro tip episodes that have been mentioned, or the defining diabetes series, which will also be mentioned here. If we haven't already, everything you need to know is it juicebox podcast.com are right there in that private Facebook group Juicebox Podcast type on diabetes. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Let me just remind you again, before we go that Jenny works at integrated diabetes.com If you're interested in hiring her, she's interested in helping you. Also, for US residents, T one D exchange.org Ford slash juice box, it really is a valuable thing for you to do to complete that survey. And it genuinely helps people with type one diabetes, and it supports the Juicebox Podcast. So if you can spend just 10 minutes today taking that survey, I would just greatly appreciate it t one D exchange.org. Forward slash juicebox. I've seen listeners of the podcast be involved in a number of different trials around diabetes, they got the opportunity from the T one D exchange. The one that comes to mind right now is that there was one person involved in a new adhesive study for the Dexcom G six. But there are many other opportunities. So beyond answering the questions in the survey and helping people with type one by lending your your data to the T one D exchange and I don't mean like super personal stuff. I mean simple questions about type one diabetes, which by the way, are HIPAA compliant and anonymous. Anyway, by by answering those questions in the survey, you will also give yourself the opportunity to hear about trials and studies. T one D exchange.org forward slash juicebox