#1697 Que Dallara, EVP & President at Medtronic Diabetes

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Scott talks with MiniMed leader Que Dallara about her refugee-to-CEO story, Medtronic’s spin-off, new MiniMed name, 780G automation, upcoming sensors and pumps, and the dream of hands-free diabetes tech.

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

Que Dallara, President of Medtronic Diabetes, joins Scott to discuss the rebrand to MiniMed and the company's turnaround. They explore the 780G system, the Abbott partnership for the Instinct sensor, and the new Simplera Sync. Que shares her inspiring refugee story and reveals future plans for patch pumps, tubeless options, and next-gen algorithms to achieve "hands-free" diabetes management.

Scott Benner (0:00) Hello, friends, and welcome back to another episode of the Juice Box podcast. (0:16) Today's podcast episode is sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed seven eighty g system and their new sensor options, which include the instinct sensor made by Abbott. (0:31) Would you like to unleash the full potential of the MiniMed seven eighty g system? (0:35) You can do that at my link, medtronicdiabetes.com/juicebox. (0:42) While you're listening, please remember that nothing you hear on the juice box podcast should be considered advice, medical or otherwise.

Scott Benner (0:50) Always consult a physician before making any changes to your health care plan or becoming bold with insulin. (1:06) Welcome, Hugh. (1:07) How are you?

Que Dallara (1:09) I would be better. (1:10) How

Scott Benner (1:10) are you? (1:11) I this has been a good morning for me so far. (1:13) I appreciate you asking.

Que Dallara (1:14) It's Friday. (1:15) So

Scott Benner (1:15) That that is why it's Yes. (1:16) Been a good Exactly. (1:18) I'm just I'm doing this and one other thing, getting my passport renewed. (1:22) I can't imagine a more boring afternoon, but at least I won't be sitting at my desk for a couple hours. (1:26) I thought it'd be cool to have you on and get to know you and to find out a little bit about what's going on at what we're, I guess, not gonna be calling Medtronic diabetes anymore.

Scott Benner (1:36) Can you first let me know a little bit about yourself and maybe how you got into this position?

Que Dallara (1:41) Absolutely. (1:42) Well, since you asked, I'm gonna bore you a little bit about myself.

Scott Benner (1:46) Please.

Que Dallara (1:47) I don't know if you remember the, you know, the pictures of boat people in the late seventies, you know, escaping Vietnam after the fall of Saigon. (1:54) Mhmm. (1:55) Well, I was one of those bird people. (1:56) I was five years old, and our family was making this, you know, grand escape on really a rickety riverboat in the South China Sea, so not really a seaworthy boat at all. (2:07) And we got shipwrecked.

Que Dallara (2:09) We got rescued by on this tiny island in the Filipino archipelago. (2:14) And my parents and my my three year old sister were on this journey. (2:18) So we were in this refugee camp for, I don't know, eight months, something like that. (2:22) And then luckily, we got granted asylum in Australia, so that's why, you know, you hear the speech impediment that I have now. (2:29) But we grew up super poor in Sydney.

Que Dallara (2:32) Character defining moment, if you like. (2:34) And, you know, I really believe that, you know, life gives you the tools depending on how you, you know, you you get brought up. (2:40) And when you grow up really poor, you get a lot of tools. (2:44) Yeah. (2:44) So, you know, what Ben followed was kind of, you know, twenty years of, you know, poverty in Australia, and my mom was she was a single mom.

Que Dallara (2:54) She actually was pregnant during this whole time. (2:56) And when we arrived in Australia, like, two weeks later, my my younger sister was born. (3:01) Wow. (3:01) So we have four kids, newborn baby. (3:05) You know, even though she was a trained lawyer, spoke three languages, you know, she worked as a postal worker on the night shift.

Que Dallara (3:12) So I work you know, grew up taking care of my three younger siblings.

Scott Benner (3:16) Right.

Que Dallara (3:16) So we couldn't afford a lot. (3:17) It was really rough. (3:18) I worked on you know, I sewed things for a dollar apiece for a T shirt, and, you know, I I learned to cook, you know, even woodworking, becoming really self reliant. (3:29) So so I have a, I guess, a lot of deep empathy for people who struggle, you know, trying to get out of poverty for really half my life. (3:37) And, you know, that's kinda how I started, and I worked for everything.

Que Dallara (3:41) So how I got to Medtronic, it was really happenstance, you know, kind of it's never a straight line, Scott, and I don't have diabetes, but I have a lot of people in my life that do. (3:52) I mean, frankly speaking, you really can't go very far to find people who know someone who really suffers from the disease. (4:00) And so my background's in software and tech. (4:03) You know, previously, I was at Honeywell, and Honeywell works on a lot of things that kinda control problems. (4:09) Mhmm.

Que Dallara (4:09) Like, you can have, you know, how you regulate temperature in a building or autopilot in an air aircraft. (4:17) That's a controls problem. (4:18) And actually, what diabetes is is a controls problem because you're sensing glucose, and then you gotta do something about that. (4:25) And so there's actually a lot of software in it. (4:27) So given my software background and manufacturing background and sort of consumer background, and given that I knew a lot of people in my life that had it, it just was a perfect marriage to, you know, to to join Medtronic and and lead the diabetes business.

Que Dallara (4:42) So that's how I kinda randomly got here. (4:45) Obviously, it was not very planned.

Scott Benner (4:47) So with your background and what you just explained about control, what do you think the people who hired you were thinking when they hired you? (4:55) What do you think they thought the future was, and how could you shepherd towards it?

Que Dallara (4:59) I think it was largely driven by the consumer experience I had with software, software and services. (5:06) Because a lot of this is, yes, you've got the medical device, but there's a lot that gets involved you know, that is involved in managing diabetes. (5:13) It's like how you get supplies, how you manage all the admin associated with, all the software tools for the caregivers. (5:21) And so I think they were probably attracted by that in my background. (5:24) And I've always been worked in areas where I love building things, building products.

Que Dallara (5:29) I've worked in launching a lot of products. (5:32) And so given the innovation cycles in diabetes technology, I think the people at Medtronic felt that that was a that was a good fit. (5:40) It was a it was probably a bit of a, if I'm honest, a very unorthodox selection. (5:48) But in some ways, given the state of where the business was when I joined with, you know, some of the challenges, especially in The US, having fresh legs and fresh eyes are probably a good thing.

Scott Benner (6:00) Yeah. (6:00) Where would you assess Medtronic as as being in this landscape before you got here, and where is it that you're trying to take it to?

Que Dallara (6:10) Well, I think to be candid, I think it you know, the business lost its leadership position in The US and, you know, fell behind. (6:17) And I think at the time, there was the the warning letter had just, you know, landed on the doorstep. (6:22) And so while there's a 41 history in the business of many firsts, the first portable sized pump, the first CGM that physicians use, the first seven day infusion set, the first CareLink, and the first AID system. (6:38) There's a lot of firsts. (6:39) That's the heritage of the business.

Que Dallara (6:41) That was always there, but the business hit some troubles, to be fair. (6:46) And so I think I don't mind struggle. (6:49) Like, you know, that's a bit of my background, and I saw something that was so important. (6:55) And if we care about choice for people living with diabetes, you know, and all the innovations that came out of MiniMed, I saw that there, and and so I was very energised to be part of restoring that heritage.

Scott Benner (7:09) Mhmm.

Que Dallara (7:09) And I think you've seen some of the innovations coming out that we are thinking differently, we are moving faster, and, you know, it just was a shame to not, you know, to let it sort of atrophy. (7:20) So that's so despite the fact that there was a warning letter, I saw a waterfront property.

Scott Benner (7:25) It's interesting the way you're talking about it because I didn't expect this today when I got on with you, but I see a a lot of similarities between what I do and what you just said because I I struggle every day with this idea that I've built this thing that I know helps people. (7:39) I watch it happen all the time, but then how do you talk another person into giving it a try or get it into their attention, like, so they can even consider it? (7:48) Like, that's most of my life. (7:49) Most of my life is spent, like, trying to serve it to people. (7:53) And it's a very, very frustrating aspect.

Scott Benner (7:55) And you don't have the same you were candid earlier. (7:58) Like, Medtronic had a stranglehold for a long time. (8:00) Right? (8:01) Like, doctors just prescribed Medtronic. (8:03) So, like, you were ahead.

Scott Benner (8:04) You probably had first movers on a lot of things, and that doesn't exist anymore. (8:08) So now, I'm I'm excited because now what I'm hearing is you're gonna have to deliver stuff that helps people that works because that's gonna be your only growth opportunity, I would imagine.

Que Dallara (8:18) Absolutely. (8:18) And look. (8:19) We wanna earn it. (8:19) Like, it's not gonna it's not an entitlement. (8:21) We wanna earn it, and we're gonna do that because we listen to patients, and we're gonna work on great ideas.

Que Dallara (8:28) We have unbelievable a great team at MiniMed. (8:32) I mean, about roughly twenty percent of our employees live with the disease, and more than seventy percent have a personal connection. (8:39) So they're related to someone that has the disease. (8:42) And so it's very personal for us. (8:44) Like, we don't like not being number one.

Que Dallara (8:46) We think we have the best therapy on the market, and we have hundreds of thousands of people in over 80 countries who use our solutions here. (8:55) And so we absolutely wanna earn it. (8:58) Actually, the first thing that I did when I joined Medtronic was I met with employees that have diabetes. (9:04) And I wanted to understand, like, you know, what were we doing well, what weren't we doing well. (9:09) And so they gave me a lot of insight, I think, you know, we've been on the path now to you know, obviously we got out of the warning letter in fourteen months.

Que Dallara (9:17) We've got an unbelievable quality system. (9:19) Obviously, that's in the news too. (9:21) It's important that that's a core foundation. (9:24) We didn't cut any corners. (9:26) We've also rejuvenated our innovation pipeline, which I'm sure we'll get to talking about.

Que Dallara (9:30) Yeah. (9:31) Which just leads to awesome senses into the market. (9:34) And so, hopefully, the other signs that we are, you know, on that trajectory, we're not there yet, but we are absolutely gonna win back, the hearts and minds of people with diabetes.

Scott Benner (9:45) How long have you been in the position?

Que Dallara (9:47) Three and a half years.

Scott Benner (9:48) Three and a half years. (9:49) Okay.

Que Dallara (9:49) Seems longer, though.

Scott Benner (9:50) What led to the name shift? (9:52) Right? (9:52) I mean, I've been saying Medtronic diabetes forever, but now that's not the case anymore. (9:57) Tell me what the shift how did it come to be, and why do you think it's important?

Que Dallara (10:01) As you know, we've announced that we're going to we're in the process of separating from Medtronic. (10:07) And while our products were still called MiniMeds, it's MiniMed seven eighty g and so forth, we need to have our own name so we can't be called Medtronic diabetes anymore. (10:16) And so it made perfect sense to go back to the original mission of MiniMed, which really was the original category creator of diabetes technology with the five zero two pump that was portable and small versus what was there at the time back in 1983, actually. (10:33) You know, we picked MiniMed because we wanted to recommit ourselves to the original mission. (10:38) I mean, we we only serve intensive insulin users in type one and type two.

Que Dallara (10:43) We're not going after wellness. (10:45) We're not going after prediabetes and things like that. (10:47) This is our sole focus. (10:50) And when you look at the history of the business, it's been the pioneer of many, many firsts in setting the standard for that. (10:58) And so while in recent years, you know, we lost a little bit of our footing in The US, we continue to be super strong outside The US, and we're regaining a following back in The US as well.

Que Dallara (11:08) Mhmm. (11:09) And so that's what that's what's behind the name MiniMed, and we wanna live up to the forty one, forty two year heritage for the next forty one, forty two years or until until old cure is found.

Scott Benner (11:21) Being a a smaller unit now, how is that gonna help you accomplish that, or or is it gonna make it more difficult? (11:29) Because I know sometimes when this happens when companies, you know, kinda sell off or separate a little bit, it's not always easy to take the I hate to say it like this, but sometimes the good the good talent doesn't go with you, And sometimes it does, like, right? (11:42) So you've gotta look at the entire reporting tree again and start over. (11:46) Right? (11:46) So I it's a great opportunity if you can put it in place.

Scott Benner (11:50) So I imagine you've been doing that for a while. (11:52) Like, do you feel like that kind of structure exists now, and and how do you think being leaner will help you?

Que Dallara (11:58) Well, a couple of things. (11:59) From a talent standpoint, the good news is we have had no trouble attracting talent into the business because people are very motivated and energized by the mission Mhmm. (12:09) To help people. (12:10) Because, as I said, most of our employee a lot of our employees have a personal connection. (12:16) So it's very personal.

Que Dallara (12:17) Like, we we hear the feedback. (12:19) We respond to it. (12:20) I mean, we're not we're not very far away from the the patient. (12:25) So that's not been an issue. (12:27) The other thing I would say is the leadership team that's gone through a lot of adversity together, restoring the business back to growth, are part of are going as part of this separation of with Medtronic.

Que Dallara (12:39) So with it's not like we have a brand new team. (12:41) We have the same team that have been executing this. (12:44) You know, there's a lot of IPOs in medtech, but one other thing that people don't realize is we're almost a $3,000,000,000 business in revenue, and that puts us as a top 20 med tech company by revenue.

Scott Benner (12:54) Okay.

Que Dallara (12:55) So we actually have a lot of scale. (12:57) And I would also say that we are in over 80 countries around the world. (13:01) We support 26 languages. (13:03) Yeah. (13:03) We have twenty four seven, you know, tech support, and we have hundreds of thousands of people in our therapy globally.

Que Dallara (13:10) So we are really not that small.

Scott Benner (13:13) Mhmm.

Que Dallara (13:13) We have a lot of scale behind I know of 8,000 people. (13:18) So we have a lot of scale behind our product and our innovation. (13:21) I'm actually excited because Medtronic is huge. (13:25) Part of being huge, one of the downsides is you can be a bit slower in places, and we're gonna have the opportunity to move even faster than we are at the moment.

Scott Benner (13:35) Right. (13:35) No more turning the Titanic when you wanna make a decision. (13:38) Right?

Que Dallara (13:38) Exactly. (13:39) Exactly.

Scott Benner (13:40) I might be wrong. (13:40) Right? (13:41) But I'm an outsider who pays a bit of attention. (13:43) So but I'm trying to understand, like, with what's going on now, new sensors, new systems, you know, thinking about algorithms, getting that all set. (13:50) What happened in there?

Scott Benner (13:51) How did you, like I don't know. (13:53) It feels like you went out to, like, a first place lead and then coasted. (13:58) Like, what happened to Medtronic? (13:59) Like, how did you get how did they start so strong? (14:01) Here's a sensor.

Scott Benner (14:02) Nobody's ever had one before. (14:03) You just got it. (14:04) You start selling it. (14:05) That becomes the the business instead of the innovation. (14:08) Like, how does that gap happen, I guess?

Scott Benner (14:10) Because you're would you describe yourself as as catching up? (14:14) Or, like, where do you think of yourself as I guess, there's two questions here. (14:17) Like, how does that gap happen, and where do you see yourself in the moment? (14:23) Unlike other systems that will wait until your blood sugar is a 180 before delivering corrections, The MiniMed seven eighty g system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range even if you're not a perfect carb counter. (14:44) Today's episode of the Juice Box podcast is sponsored by Medtronic Diabetes and their MiniMed seven eighty g system, which gives you real choices because the MiniMed seven eighty g system works with the Instinct sensor made by Avid, as well as the Simplera Sync and Guardian Force sensors, giving you options.

Scott Benner (15:04) The Instinct sensor is the longest wear sensor yet, lasting fifteen days and designed exclusively for the MiniMed seven eighty g. (15:13) And don't forget, Medtronic Diabetes makes technology accessible for you with comprehensive insurance support, programs to help you with your out of pocket costs or switching from other pump and CGM systems. (15:26) Learn more and get started today with my link, medtronicdiabetes.com/juicebox.

Que Dallara (15:33) I think, honestly, lots of companies go through it. (15:35) I think it's called the innovator's dilemma. (15:37) Right? (15:37) You kind of you you're the innovator. (15:39) You get to a position, and what's very natural is you lose sight of why you exist.

Que Dallara (15:45) Mhmm. (15:45) And, you know, hubris sets in, you don't think you're touchable. (15:51) That's a very common cycle a lot of people a lot of companies go through, to be honest. (15:56) I mean, there's many, many stories of that. (15:57) Right.

Que Dallara (15:58) Kodak, Intel. (15:59) I mean, there's a lot of examples. (16:00) So I'm sure we went through a little bit of that. (16:03) I think the other part of it is when you're part of a big company, you fight for capital. (16:07) Like, you you've gotta, you know, you've gotta be a better business case than another business.

Que Dallara (16:12) And so, you know, when that happens, sometimes the investment moves in different parts of the portfolio. (16:19) I mean, that's a bit of the focus thing. (16:20) Now Medtronic gets to focus more. (16:22) We get to focus more. (16:23) And all we do is serve people on who need it, you know, in in need insulin.

Que Dallara (16:28) So those two things, I think, contributed to, I would say, choices that were not optimal. (16:34) And so, you know, and so you see some missteps, you know, especially in The US. (16:40) But for us, I think I'm super excited by our innovation that we have in the pipeline. (16:46) And, I mean, we we see ourselves as an AID company. (16:49) We don't just do CGM.

Que Dallara (16:51) We don't just do pumps. (16:52) It's really about the automation that brings all of that together.

Scott Benner (16:54) Okay.

Que Dallara (16:55) And I think, you know, we are leaders in AID.

Scott Benner (16:58) Why do you think that? (16:59) What is it something special about your algorithm or your hardware coupled with it? (17:04) What what do you think puts you in that position?

Que Dallara (17:06) We invented AID. (17:07) We were the first closed loop system with six seventy g back in 2016.

Scott Benner (17:12) Mhmm.

Que Dallara (17:13) We are with seven eighty, we are now in our second generation algorithm. (17:17) It's really the only system on the market with, order corrections every five minutes. (17:21) So if you miss at your bolus or you sometimes forget to bolus, the system can detect that you're eating and can give you the corrections and bring you back in range. (17:32) And so we perform very well in the hyper range because we're able to bring you back in range a lot faster. (17:39) It's a very aggressive algorithm and it's the lowest commercially available set point at one hundred milligrams per decilitre.

Que Dallara (17:44) And we can do that and be aggressive without increasing risk of hyper. (17:49) And that's why we have several hundreds of thousands of people in seven eighty around the world, and we've got incredible clinical data that says seven eighty is for many people, whether you're young or old, whether you're good at technology, whether you can good at math, if you're coming from different therapies. (18:07) I mean, it is really a democratizing therapy. (18:10) And we're working now on our third generation algorithm, which is gonna, you know, push the envelope even further on that front. (18:18) So

Scott Benner (18:18) How much can you talk about that? (18:19) What are the goals for that algorithm?

Que Dallara (18:21) Well, we we we really believe that the promise of AID is freedom, peace of mind, and safety. (18:29) And so the goal is to have the automation take over the work so you don't have to. (18:35) Mhmm. (18:36) Today, to be honest, well, you know, we like our technology, and there's a lot of AID systems on the market. (18:43) It's still work.

Que Dallara (18:43) You still have to put in a lot of work. (18:45) Seven eighty does push the envelope where you don't have to put in as much work, but the holy grail, I think, is not to actually do very much at all, and yet you can get above 70% time in range. (18:58) I think that's really our goal. (19:00) Can we help people who live with diabetes have more freedom? (19:05) They don't have to make a trade off between glucose control and lifestyle choices and therapy burden.

Que Dallara (19:12) We wanna solve all three.

Scott Benner (19:14) Does that answer lie in the hardware or in the data or in how the data is interpreted? (19:20) Where do you think holds us back from having more freedom?

Que Dallara (19:24) It's actually in the system. (19:26) So we are the only company that is commercializing CGMs, pump, or insulin dosing devices, and the algorithm around all of that. (19:37) Mhmm. (19:38) And so, you know, similar to if you use an iPhone, it just works, you know, because Apple tightly integrates the software and the hardware together. (19:48) And we're not a company that has CGM data and insulin data.

Que Dallara (19:51) And so and we've been more than ten years at algorithmic development. (19:55) We have a lot of data with both, and so that allows us to innovate very fast on how the automation algorithm. (20:03) And so now we're now third generation system in development, plus we've got two new CGMs and new form factors on the pump. (20:11) So when you think about this the trifecta of are you getting the clinical outcomes you want, like, don't want hypo, you don't want DKA, you don't want complications, Our timing range is, you know, the highest amongst all the AID systems, and you can see that in over 200 publications in in peer reviewed journals. (20:32) So then it's the second part of the trifecta is you got therapy burden.

Que Dallara (20:35) So how much interaction do you have to do to deal with alarms, to deal with imports into the devices? (20:42) Every AI distance has therapy burdens. (20:45) And then you've got lifestyle. (20:46) You know, what does it look like? (20:48) You know, how does it affect food, sleep, you know, social, you know, embarrassment if your alarms are going off and things like that.

Que Dallara (20:54) So we we want to solve we wanna solve for a very tightly integrated system that is kinda like self driving cars. (21:02) You don't have to do very much, but you're getting outcomes. (21:05) We don't want people to have to trade off. (21:07) Hey. (21:08) Lifestyle is very important to me.

Que Dallara (21:09) Like, let's say, you're a teenager, and so I'm willing to give up on safety Mhmm. (21:14) And glucose control. (21:15) Or I don't wanna do the therapy burdens too much, and so I'm gonna give up on that and, again, not get the outcomes. (21:22) We intend to solve for all three so that so you don't have to do very much. (21:28) Put insulin in, wear the device, respond to alarms if there are any, and live your life.

Scott Benner (21:35) So I'm what I'm hearing, I think, is that I shouldn't be expecting a mini med pump to work with a Libre ever since Dexcom, anything like that. (21:43) You're gonna keep it your stuff is gonna just work with itself, or do you think you'll ever have interoperability with other CGMs?

Que Dallara (21:49) We have a partnership with Abbott for instinct, so it's not interoperable in the sense of, you know, mix and match. (21:57) And the reason why we do that is we're not stubborn ups, and we've heard the feedback around our senses, and that's why we're excited with Simplera coming out as well as Instinct. (22:07) Mhmm. (22:08) Because we really believe in not having technology be yet another thing you have to do.

Scott Benner (22:14) Right.

Que Dallara (22:14) Right? (22:14) So and just as a very silly example, the Libre sensor doesn't have Apple Watch functionality.

Scott Benner (22:21) Mhmm.

Que Dallara (22:21) Right? (22:22) But the instinct in our system does. (22:24) Right? (22:24) And so we want to curate a system that just works. (22:28) You don't have to think about, does it work together, two phone numbers to call, companies pointing fingers at each other when you're troubleshooting.

Que Dallara (22:35) Mhmm. (22:36) We wanna be able to just keep it very simple. (22:39) Yeah. (22:39) The technology just works. (22:41) The automation is seamless.

Que Dallara (22:43) The devices look, you know, sexy and have a lot of appeal, and they're very designed with modern consumer electronics in mind. (22:51) And you have one phone number to call if you're you know, you need support in whatever country around the world, in whatever language. (22:58) Mhmm. (22:58) The burden of diabetes isn't just a device. (23:01) It's all the other things around it too that we wanna solve for.

Que Dallara (23:03) Like, that's part of the peace of mind. (23:05) If you happen to be on a holiday and your pump breaks or something goes wrong and you forgot to bring such and such, we'll airship it to you. (23:12) And so we can do that with our presence and scale that we have around the world, and that's one of the reasons why people value the service we provide. (23:20) That's why, I mean, it's a kind of a tidy cliche a little bit to compare ourselves to Apple. (23:24) That's the experience that we're going for.

Scott Benner (23:26) Yeah. (23:26) And want it

Que Dallara (23:27) to work. (23:27) I think that's only possible when you tightly couple all the elements of an AID system with one eight hundred MiniMed.

Scott Benner (23:36) Right. (23:37) It just occurred to me that we should be a little clear about this. (23:39) You're introducing two new CGMs, but one of them Mhmm. (23:42) Is a MiniMed CGM, and one of them is an Abbott CGM. (23:48) Mhmm.

Scott Benner (23:48) They're both gonna work with your pump. (23:50) That's right?

Que Dallara (23:50) Correct.

Scott Benner (23:51) Okay.

Que Dallara (23:51) Correct.

Scott Benner (23:52) Will the Abbott CGM work with anybody else's pump?

Que Dallara (23:55) The Instinct, no. (23:56) No. (23:57) It wouldn't be it only works with our it only works with our system.

Scott Benner (23:59) Same with the Simplera?

Que Dallara (24:01) Same with the Simplera. (24:02) Okay.

Scott Benner (24:03) And where do they stack up as far as marred and lasting the full amount of time that you say? (24:10) Like, how how do how have you seen that? (24:11) Why did it and why did it takes it feels like it took long. (24:14) Why did it take long? (24:16) What were you doing?

Que Dallara (24:17) Yeah. (24:17) It's fair. (24:18) It's no. (24:18) It's a it's very fair. (24:19) It's it's hard.

Que Dallara (24:20) Look. (24:21) Sensors are hard. (24:22) CGM is hard to do. (24:23) Mhmm. (24:23) I can't even tell you how much we've invested to do this.

Que Dallara (24:27) But, yes, it takes a long time because it it's actually technically a very sophisticated device. (24:32) Mhmm. (24:32) You gotta lot bring a lot of things together, not to mention going through clinicals and the FDA process, getting coverage. (24:42) I mean, there's there's a lot I mean, I'm not making excuses. (24:44) No.

Que Dallara (24:44) It's it's way too long.

Scott Benner (24:45) Yeah.

Que Dallara (24:46) And it is a new platform for us, but future iterations will not take as long. (24:51) But, look, SimpleraSync, the mod's about 10.2. (24:55) It's pretty accurate, and it's very accurate when it comes to dosing. (24:58) So, again, we're an AID company. (25:00) We're really not in the standalone CGM business.

Que Dallara (25:03) And so when it comes to dosing when you need to at the low and the high range, we are extremely accurate. (25:11) It's in the middle where, frankly speaking, we tune the algorithm to it doesn't really matter because you're not gonna take a different action in in the euglycemic range. (25:22) And that's, you know, you know, up to seven day sensor of with Simplirosync, and people really like pairing that with their weekly routine. (25:31) So we have a seven day infusion set, and so people like sort of the weekly, you know, site set change and site change that they have to do there. (25:40) Right.

Que Dallara (25:40) The instinct is fifteen days, and it's got a mod of, you know, sim and it has a very similar experience to a Libre a three.

Scott Benner (25:47) Okay. (25:48) I'm gonna fumfer through this because I don't have the wording. (25:50) But there's a thing with the FDA with devices. (25:53) Right? (25:53) Like, if somebody already has something similar on the market, isn't there, like, a, like, a a fast forward that you can use off of that, like, when you're bringing something else?

Scott Benner (26:02) Am I out of my mind, or what am I thinking of that or maybe I'm maybe I'm crazy. (26:07) You know what I'm talking about?

Que Dallara (26:08) Yeah. (26:08) Yeah. (26:09) No. (26:09) Understand what you mean. (26:10) I think, look, I think there's a myth that, you know, at least in The US, the the regulatory pathway with ICGM and the special controls Mhmm.

Que Dallara (26:21) Means it's fast. (26:22) It's not like a USB stick where you can just plug and play. (26:26) Because, look, we dose insulin, and you dose wrong, it's dangerous. (26:30) Sure. (26:31) So the regulatory process was actually not not long.

Que Dallara (26:35) I mean, we announced Abbott the deal with Abbott in August 2024, and we we started taking preorders in, you know, kind of late September. (26:44) It's thirteen months. (26:46) If you look at the other integrations that have happened, it's taken years. (26:49) We took thirteen months.

Scott Benner (26:50) Let's let you do this quick. (26:52) People have been telling me about how great their Medtronic pumps have have been for, like it it feels like I've I've been hearing it for a couple of years where people are like, but this new algorithm is great and you blah blah blah, but I it's always somebody from overseas. (27:04) And I maybe that is why it feels a little longer to me, if I'm being honest.

Que Dallara (27:07) You know, having a warning letter warning letter didn't help us get $7.80 in the market. (27:12) It probably was late by a couple of years.

Scott Benner (27:14) Okay.

Que Dallara (27:15) So I know how, you know, a lot of people were frustrated by that. (27:18) But since it's been here, and we've got hundreds of thousands of people on the system. (27:23) Mhmm. (27:23) And so I mean, you can look at social media, but, you know, it's for a lot of people, it's changed their life because they have to do less.

Scott Benner (27:29) Right.

Que Dallara (27:30) But, yes, I I I wouldn't fault the regulators here. (27:33) I think FDA has really made it easier to get new innovations out. (27:36) But to make it work, say, integration with with Instinct and Abbott, it takes work. (27:42) And what's what we're really proud of is whether it's our own sensor, Simpler, or with Instinct, you're still gonna get the great outcomes. (27:50) You're still gonna get the minimum work needed.

Que Dallara (27:53) The meal detection technology still works. (27:56) Yeah. (27:56) So while there are different slight differences in CGM experience, the same easy insertion process, it's actually the algorithm that delivers the ease of use and the outcomes.

Scott Benner (28:07) Right. (28:07) Right. (28:08) How do you get over so my daughter's 21. (28:11) She's been wearing an Omnipod since she was four. (28:13) If I came to her today with a tube pump and I said, hey.

Scott Benner (28:16) This will be better for you. (28:17) It'll be easier. (28:18) She'd say, no. (28:19) Thank you. (28:20) I I mean, how do you deal with that?

Scott Benner (28:21) That it's a it seems like a real issue. (28:23) Like, I can see in the in the community, there are people who are like, I don't want tubing. (28:29) There are people who are like, I don't care about it either. (28:31) But, like, how do you, you know I mean, how do you broach the subject with those different groups?

Que Dallara (28:36) Well, I think there's a couple ways.

Scott Benner (28:37) Mhmm.

Que Dallara (28:38) I think look. (28:38) There's preferences. (28:39) And so we believe in choice. (28:41) Not it's not gonna be one side, one thing for everyone, and that's why we have the broadest portfolio. (28:48) So we have two CGMs to choose from depending on your preference Right.

Que Dallara (28:53) With Sinclair and Instinct. (28:55) We have a tubeless option today. (28:56) It's called InPen. (28:57) So if you don't even wanna wear a pump at all, but you can have a bit of help with technology, we have InPen with our CGM. (29:04) We're working on our next generation tube pump called flex, MiniMed Flex, and then we also have a patch pump in development that we call MiniMed Fit.

Que Dallara (29:13) So some people are gonna want a patch pump, and some people are gonna want a a tube pump, they they like being able to detach from their pump or not having such a large surface area. (29:24) If you look at the size of the infusion set versus size of a patch, infusion set's tinier on your body. (29:30) Mhmm. (29:30) So there's gonna be preferences. (29:31) So we believe in in actually having a portfolio so people can maybe want a pump holiday or they can pick the pen the impen for that.

Que Dallara (29:41) But we actually do get a lot of people who who aren't in good control. (29:45) They're not doing well with the patch pump or our competitors' systems. (29:51) And so we offer trials, and people can trial our system, and it is a different experience. (29:55) It it's a bit like until you really get on our system, it's hard to you you go, well, it must all be the same, but it isn't. (30:03) We don't think AI systems the systems are the same.

Que Dallara (30:06) No. (30:06) And so we encourage people to try our system, and we actually get a lot of people converting from patch and seeing, actually, the algorithm, how the system work makes it worth it. (30:17) But some people won't, and that's okay. (30:19) And that's why we have a patch in development.

Scott Benner (30:21) I want people to have choice. (30:22) I think it's incredibly important. (30:23) So you see the space as tubed, patch, and tubeless? (30:27) Like, is that are those kind of the options there, and you're gonna jump into the other spaces? (30:32) I mean, what's the time frame on that?

Que Dallara (30:34) Today, again, we serve people who are on intensive insulin therapy. (30:39) Mhmm. (30:39) And if you look at that cohort, say, in the developed world, there's about ten million people. (30:46) So one and a half million of those are on tube pumps today. (30:50) They like it.

Que Dallara (30:52) And you've got about half a million who are on patch pumps. (30:55) But then the the vast majority are on MDI. (30:58) Yeah. (30:59) And we think those people should have the benefit of a bridge between just pretty low tech where they've gotta do all the work Mhmm. (31:08) And a bit more software to help them do better.

Que Dallara (31:13) And so that's where the InPen system we call it MiniMed Go. (31:16) The InPen system comes in. (31:18) It helps you not stack insulin. (31:21) You know, if you don't maybe you forget when you when you dosed insulin last time. (31:25) Yeah.

Que Dallara (31:25) It gives you data that your doctors have so you can have, you know, more a better discussion about your therapy and how you're doing things that you can do to be better. (31:34) It helps time your doses more accurately. (31:37) And so InPen has a lot of value for the, call it, six million people on MDI that don't have the benefit of technology, and we wanna help them too. (31:46) Yeah. (31:46) So we actually have a solution for all three cohorts.

Que Dallara (31:50) And our goal is, again, the the trifecta of we want you to have if you're below 70% time in range and your a one c isn't good, we have the solution for you. (32:00) Mhmm. (32:00) And that isn't gonna raise your therapy burden and isn't gonna make you compromise on your lifestyle. (32:05) Right.

Scott Benner (32:06) Oh, it's awesome. (32:07) Gosh. (32:07) I've talked to a lot of people about Impens over the years, and I know a lot of people that use them and find them really valuable. (32:13) They talk about it as having, like, a lot of the data functionality of a pump Mhmm. (32:17) Without the pump itself.

Scott Benner (32:18) I wonder about this all the time. (32:19) Those numbers you just said about there's certain amount of people on pumps, certain amount of people a lot of people just shooting MDI still. (32:26) Mhmm. (32:26) Are those people reachable? (32:28) Are they missing it because they have bad advice from physicians, insurance, because they don't have education?

Scott Benner (32:36) Like, what do you think is keeping them from pump therapy?

Que Dallara (32:39) I mean, you said it. (32:40) It's it's a lot the lot of it is just knowledge and education of what's out there. (32:45) And, you know, people may be comfortable. (32:48) Like, they may say, I don't wanna wear a pump because they don't have experience of wearing one, and so they think it's it's yet another thing you have to do. (32:54) That's why there's so much to do in a day.

Que Dallara (32:57) If you have diabetes, it's hundreds of decisions. (33:00) We don't want technology to be yet another thing you've gotta

Scott Benner (33:02) do. (33:02) Right.

Que Dallara (33:03) So if you take seven eighty g with Instinct as an example and our seven day infusion set, it's six perks a month compared to 12 to 16 with other AID systems. (33:15) Mhmm. (33:15) People used to care about finger sticks. (33:17) You don't have to do that anymore. (33:18) We got six perks, and so that matters.

Que Dallara (33:21) And that's why our male detection technology is important. (33:23) The automation is important because we don't hey. (33:25) You don't you know, perfect at bolusing? (33:27) No problem.

Scott Benner (33:28) Right.

Que Dallara (33:28) Seven eighty g has these auto corrections. (33:30) It's really the only system on the market with this meal detection, and so people find that liberating. (33:35) You know, I had patients tell me I you know, I was that they had a day where they were doing graduations. (33:40) Meals were all over the place. (33:41) It wasn't their regular routine.

Que Dallara (33:43) At seven a, the automation just kicks in and delivers that the insulin they need. (33:47) You know? (33:48) And so I think education is part of it. (33:50) I think it's also people's preferences. (33:52) And so we wanna make people where they are.

Que Dallara (33:54) We don't wanna go, well, you should be on a pump if you don't want to be. (33:57) That's why we have InPen. (33:59) Yeah. (33:59) But we do believe that we can help you and get you a little bit better. (34:03) So you have to do less work.

Que Dallara (34:05) And, actually, a lot of time when people come into our ecosystem, say, on on MiniMed Go, they then say, actually, this is good. (34:12) Maybe I'll I'm willing to try a pump now. (34:14) Mhmm. (34:15) Maybe I want more automation. (34:17) It's education.

Que Dallara (34:18) And then, you know, as you know, there's a shortage of endos around the world. (34:21) Yeah. (34:21) So a lot of it is primary care. (34:22) They don't always have the latest and greatest in terms of what's available. (34:26) And so we have to do a better job, honestly, you know, the industry to, you know, get the word out.

Scott Benner (34:32) You gotta educate the educators and make the

Que Dallara (34:35) Exactly.

Scott Benner (34:35) I think too, making the algorithm such that a doctor can feel comfortable not understanding it, but still prescribing it. (34:43) Yeah. (34:44) I mean, how do you decide then? (34:45) Like, there's only so many hours in a day. (34:47) Right?

Scott Benner (34:47) Like, there's and there's a lot of things to do. (34:49) You've gotta get your pumps and your CGMs around the world. (34:53) You've gotta improve algorithm. (34:55) You try to make your hardware smaller. (34:57) Mhmm.

Scott Benner (34:57) How do you prioritize what to do next and what's most important? (35:01) I mean, there's gotta be a big road map. (35:03) Right? (35:03) But how do you figure out which is which?

Que Dallara (35:06) Well, we think of it in generations. (35:08) So, you know, we were first with the six seventy g system. (35:12) Mhmm. (35:12) Seven eighty was a second gen system that's really five years now in the market, and we're very, very close in getting our third generation system out. (35:21) So that's come from a lot of feedback and interactions with all of our with our customers.

Que Dallara (35:27) I mean, it's hundreds of videotaped videos to figure out features that we wanna invest in, and so we've been hard at work. (35:35) Like, we can't always talk about what we do, but we've been hard at work every day getting this third generation system out, starting with the CGMs last month with new form factors on the hardware, and then, of course, our next generation algorithm, which we're super excited about. (35:50) I think really, Scott, if I reflect on how we as an industry are doing, I think the fact that the penetration of AID, which is superior to MDI, it has such low penetration in The United States and around the world is because technology is a burden. (36:08) Mhmm. (36:08) That's our goal.

Que Dallara (36:09) We got to make technology not a burden so you actually don't have to do much, and not a burden also on busy clinics, you know? (36:18) And so with seven eighty g, a clinician just has to really know the insulin to carb ratio. (36:24) That's really it. (36:25) We don't have a lot of dials you need to turn. (36:27) If you go with our recommended settings of two hours and a set target of 100 or 110, All you have to figure out is the person's individual insulin to carb ratio, and you're off to the races.

Que Dallara (36:40) That's seven eighty g. (36:41) In the future, it's gonna be even less than that.

Scott Benner (36:44) You said something a minute ago that I just got back from I don't wanna say the company, but I just went out and gave a talk to a a a pretty big organization. (36:52) Right? (36:52) Because they help people with diabetes all day long. (36:55) Mhmm. (36:55) But a very small percentage of the people that work there have diabetes or know somebody with it.

Scott Benner (36:59) Mhmm. (37:00) In their minds, it's a, you know, it's a widget. (37:02) Right? (37:03) It's a thing I do every day. (37:04) I cut I get to work.

Scott Benner (37:05) I work on code. (37:06) I don't know. (37:06) The code says this about that. (37:07) Like, it doesn't matter to me as long as it works in the end. (37:10) I've heard you say a couple of times, like, we brought people together and we asked them, like, what are we doing?

Scott Benner (37:14) Where are we missing and everything? (37:16) Can you talk about some of the things that those conversations brought to light? (37:20) What did you say to yourself, this is what's important? (37:23) Because I know what I think is important. (37:24) I think that meal detection technology is a huge thing for me.

Que Dallara (37:28) Mhmm.

Scott Benner (37:29) Right? (37:29) Like, you should be able to miscount a carb or forget for five seconds and not end up with a blood sugar of two fifty. (37:36) Mhmm. (37:37) You should be able to fall asleep without waking up at 300, like, that kind of stuff. (37:41) I think that's huge.

Scott Benner (37:42) I think sets working well, not having to be changed all the time, really great sensors that don't fail, that report accurately, that make people actually comfortable using AID. (37:52) Like, that stuff's really important. (37:54) Like, the I don't know what I wanna call, like, on the ground, like, actual lived experience stuff, I think, is what's most important. (38:00) But I'm wondering, you coming from an outside perspective and then hearing those people talk, like, what struck you in those conversations?

Que Dallara (38:07) Well, typically, our process is we always involve our customers. (38:11) We always. (38:12) And we don't go to them and say, would you like this feature? (38:15) We ask them what problem would they like to solve in their life. (38:19) And it's based on that that then we go through a very complicated process to figure out how do we innovate to solve that problem.

Que Dallara (38:27) So it's not about, hey. (38:28) Here's 10 features. (38:29) Pick the ones you like the

Scott Benner (38:30) best. (38:31) Right.

Que Dallara (38:31) And so that's how we came up with meal detection technology. (38:34) Like, it we have that with seven eighty g because no one counts carbs correctly. (38:39) Nobody. (38:39) Actually, it's estimation. (38:41) It's no one actually counts carbs.

Que Dallara (38:43) Sure. (38:43) And so that's why this was being very liberating because you don't have to be exact at all and feel bad about that. (38:50) And so you described seven eighty exactly. (38:52) That's why in our portfolio, we think about the different preferences people have. (38:57) So I'll give you an example.

Que Dallara (38:58) Let's say with Instinct, why do we have Instinct and Sinclair? (39:01) When we developed our sensor, we did that with insulin dosing in mind. (39:06) One of the things that our loyal install base likes to do is they like to be in tight control. (39:13) Right? (39:13) They they we're known for, you know, very superior clinical outcomes and really tight control.

Que Dallara (39:20) So they like to occasionally calibrate their sensor, right, because it just helps them just they wanna manage it more. (39:29) And so it with Simplera, you can do that. (39:31) You can if you want to, you can calibrate your sensor, get tighter control. (39:36) With how Libre started, they started with as a diagnostic. (39:41) It wasn't built with AID in mind in the very beginning.

Que Dallara (39:45) And so now, you know, it's a great sensor, and it's can it be integrated into AID, but you can't do that. (39:50) Now for some people, they don't care. (39:51) Right. (39:52) That's not important to them. (39:53) But for certain people who want eye control, they do care.

Que Dallara (39:56) And so that's what's behind the choice and why we have different sensor options and why we have different dosing options. (40:03) We wanna be able to meet people where they are and not force people to, well, you need to do this. (40:10) And that's what's behind all the investments we've made. (40:13) We don't want technology to be a burden. (40:15) We want it to be a companion, an aid, a tool, and the holy grail for us is if we can take away all that work and still give you the health outcomes you want, no fear of hypo, get your hyper back in range very aggressively and help you deal with long term complications.

Que Dallara (40:32) If we can deliver that but not add to the burden but help you live your life

Scott Benner (40:36) Right.

Que Dallara (40:37) That's what we work on.

Scott Benner (40:38) So how much ceiling is left in that algorithm? (40:41) Like, how many more dials can you turn until it it's giving you that kind of like, is there a world in your mind where people could be 90% in range and never low for days at a time? (40:52) Like, is there you know what I'm saying? (40:54) Like, is there room in that algorithm for improvement, or does something have to be I don't know what I'm asking. (41:00) Like, does something have to be invented before that's gonna happen next?

Scott Benner (41:04) Like, are we at a at a peak right now, or are we still in a a version of learning about it?

Que Dallara (41:09) Well, with seven eighty, I mean, in the real world, you know, we've got a lot of studies in the real world evidence of, you know, over 350,000 patients on seven eighty in this particular study, I can actually send you the the publication. (41:23) If you're on our recommended settings on seven eighty, you're getting an 80% time in range without doing a lot to get that.

Scott Benner (41:32) What's the range you're using?

Que Dallara (41:33) 7070% 80% time in range using our recommended settings.

Scott Benner (41:37) What is that range? (41:38) Like, seven 70 to one eighty, or, like, where where do you set the range to do the measurement?

Que Dallara (41:42) The range is 70 to one eighty, or the the, you know, consensus driven range. (41:46) And then if you're talking about 70 to one forty, which is where Yeah. (41:51) People who don't die have diabetes spend most of their time in, we're at 55%, what we call timing tight range.

Scott Benner (41:58) Right.

Que Dallara (41:58) So $7.80 already gets there, but we absolutely believe that where this is going is we shouldn't have any buttons at all, and you're getting above 70% time in range. (42:08) That's really, you know, where we wanna push the envelope. (42:12) But if you want to have even tighter control, because we have people in Facebook with seven eighty saying, I got a 100% time in range. (42:20) And, you know, they're they're proud of, you know, you know, hitting sort of goals like that. (42:25) Mhmm.

Que Dallara (42:25) For people who do want even tighter control, we wanna be able to give them the option that if you wanna engage get more to control, you can do that. (42:32) But you don't have to. (42:33) If you don't wanna do anything, we wanna help get you above 70% time in range. (42:38) That's that's where the future of the algorithm is gonna go.

Scott Benner (42:40) Does that algorithm need to include some AI? (42:44) At some point, I'm gonna be very, like, ham fisted about this. (42:46) But are you gonna have, like, your own little AI agent inside your pump that's, like, looking at your food and decisions and helping adjust more than just what the math tells it?

Que Dallara (42:54) We don't need to do that, Scott. (42:56) We use a lot of AI in the development of our products, but think of it as a lot of AI requires you going to the cloud and having a lot of compute. (43:06) Mhmm. (43:06) And if you think about the pumps, we have our algorithms on the pump because you're not always gonna be connected. (43:11) Like, you could be hiking in the mountains, in the wilderness Sure.

Que Dallara (43:14) And not have an Internet connection. (43:16) Our pump's gonna work. (43:17) The algorithm's still gonna work. (43:18) Right? (43:19) It's not dependent on all this infrastructure.

Que Dallara (43:22) So from a safety standpoint, we have to be extremely efficient how the algorithm works on the pump because it's not a supercomputer. (43:29) You know? (43:29) Right. (43:29) It's a pretty smart device, but AI isn't used in the development. (43:33) But we don't need you know, our algorithm is very good because we have had hundreds of millions of points of data on CGM and insulin over the last, you know, call it decade of algorithmic development that we don't need to have, you know, Gen AI working in the pump for us to deliver Mhmm.

Que Dallara (43:50) An even better algorithm in the future.

Scott Benner (43:52) So the math will handle it at some point better than I imagine it can. (43:57) Yes. (43:57) I've heard you say a couple of times no buttons. (44:00) So right now, when I hear people talk about that, they'll say, well, that was great until I got my period, or that was great till my Mhmm. (44:07) My kid hit a growth spurt, or, yeah, that was great until until until and then I need to set a temp basal.

Scott Benner (44:12) I need to do this, like, etcetera. (44:13) Is that a a long in the future idea to you? (44:16) Like, we have a couple of stops to go before it's buttonless, or is that more of a way of thinking about, like, there'll still be buttons. (44:22) I can make adjustments, but I just probably won't have to touch them very often.

Que Dallara (44:25) We wanna be able to serve people who don't wanna do anything because you got a lot of those. (44:30) Mhmm. (44:31) But if you want to do something, we will provide options if you want to engage more. (44:36) But that engagement isn't like many dials and buttons. (44:38) It's super simple, but you're always gonna have a spectrum of people who they wanna be more active in managing their diabetes, and they like doing that because they wanna be super tight.

Que Dallara (44:49) But for other people, they don't wanna do anything at all. (44:53) Right. (44:53) And so we wanna accommodate both. (44:55) But, yeah, the I think the holy grail is just not having to do Not having to do anything other than put insulin

Scott Benner (45:02) And in your mind, is that the thing that opens you up to find those other millions of people?

Que Dallara (45:06) Yeah. (45:07) I think it will attract a lot of people and, you know, probably a lot of type twos Right. (45:12) Because, you know, typically, they they're willing to do less. (45:16) Mhmm. (45:17) If technology is just in the background, you know, just imagine, like, a self driving car Yeah.

Que Dallara (45:22) And you don't have to drive it, I think the adoption will go up. (45:25) But if you still have to do a little bit of something, you know, for some people, it's not worth doing that versus what they're doing at the moment. (45:32) So we wanna make it easy because we think that people will be healthier if they are on AID. (45:37) Look at a one c's in The US. (45:40) It's above eight despite the fact that CGM penetration is 80%.

Que Dallara (45:46) Yeah. (45:47) Pretty much if you need a CGM and you're, you know, you're on diabetes, you need CGM, you're get one. (45:51) It's not good. (45:53) So people need help with insulin dosing and diabetes management. (45:58) Yeah.

Que Dallara (45:58) But it's still too much work.

Scott Benner (45:59) I talk about this a lot that it it could get easy to get into this ecosystem that I've created here and think like, oh, everybody's got, like, a six and a half or a five a one c or something like that. (46:09) But the vast majority of people that are on insulin And eight I've interviewed people all day long that, you know, they have twelves they live with. (46:17) They have complications in their thirties. (46:19) Right? (46:19) And they're not when you talk to them, what always strikes me over and over again that it is not a lack of they're they're not not concerned.

Scott Benner (46:26) They're not not trying. (46:27) It's just Mhmm. (46:28) For reasons that are hard to kind of, like, compute, like, human reasons, just not working out for them well. (46:34) Mhmm. (46:34) And those are the people I think about all the time.

Scott Benner (46:37) Also, those people often see their general practitioners about their diabetes on top of everything else. (46:41) They need a thing that you can just go, look. (46:44) Take this. (46:44) This is how it goes on. (46:46) This is how where you put the insulin.

Scott Benner (46:48) Here's your a one c in the sevens. (46:50) Like, that's life saving for a a huge swath of people who who need insulin every day. (46:55) Anyway Scott,

Que Dallara (46:56) I'm I'm with you. (46:56) It's so sad.

Scott Benner (46:57) Yeah.

Que Dallara (46:58) Yeah. (46:58) And that's why we really believe seven eighty can help people like that. (47:02) Wow. (47:02) Because, look, people try, and life gets in the way. (47:06) And you got kids, you got a job.

Que Dallara (47:08) I mean, it's not it's not easy. (47:10) Yeah. (47:10) So that's why we really believe if you're not doing well and, you know, if you're not in control and it's a lot of work, you're not getting the return on the effort. (47:19) Mhmm. (47:20) We think seven eighty.

Que Dallara (47:21) Try seven eighty because it's we think it's for very little effort. (47:26) You're gonna get great outcomes and feel better

Scott Benner (47:29) Okay.

Que Dallara (47:30) Every day.

Scott Benner (47:31) So my last kind of question, it's gonna be a little jumble here. (47:34) Seven eighty g, ready to go now. (47:37) Lots of CGM options. (47:38) You're gonna like it. (47:40) Go give it a shot.

Scott Benner (47:41) But you're working on other stuff too. (47:43) Patch pump, tubeless option.

Que Dallara (47:45) Mhmm.

Scott Benner (47:45) I'm gonna ask you, how long do you think until people see those? (47:49) And then my last last question, which I think you can dovetail into is, if you come back here five years from now Mhmm. (47:55) We started by talking about, like, you know, where Medtronic started, you know, like, that old CGM people you know, people used to call that CGM a harpoon. (48:03) Right? (48:03) Mhmm.

Scott Benner (48:04) So you've gone from there to, like, where you are now to where you're trying to go. (48:08) So five years from now, I get you back on here and we're talking. (48:12) What are we talking about? (48:13) Where are you at at that point?

Que Dallara (48:15) Great question. (48:16) So for the first part, we got seven eighty g, two new sensors, give it a go. (48:22) And on the new the new durable pump, the new patch pump, and then the new algorithm, for the durable pump, we said that we're gonna submit very soon on that in our fiscal year. (48:32) Mhmm. (48:33) In a month or so, I'll be able to share a bit more timelines on a bit squeezed with our process at the moment, from Medtronic to reveal too much.

Que Dallara (48:42) In a in a month or so, we'll be able to say the timelines on those, but it's very we're getting to the tail end of those new products. (48:48) So we're really excited to introduce that to everyone. (48:51) But in five years' time, you know, I hope people will be saying that MiniMed just works. (48:58) That's our goal and that it just fits into their lifestyle. (49:03) They don't have to do anything.

Que Dallara (49:04) They just live their life. (49:05) That's what we want to be able to contribute to and that we've truly entered a hands free era, that you just put insulin in, it just works, you don't have to think about it. (49:14) And so that's where we think our third generation system is gonna be there. (49:18) And life was like diabetes is a little simpler, you can move on to other things. (49:22) So that's what we hope.

Que Dallara (49:23) And, you know, but I tell you what, Scott, I'll come back in five years' time on your podcast, and we'll have a discussion about it. (49:31) Awesome. (49:32) But that's what we hope. (49:33) A free, a hands free era with MiniMed.

Scott Benner (49:36) I hope too. (49:36) Maybe you can come back a little sooner and tell me a little more about these new pumps when you're more free to talk about

Que Dallara (49:40) the details. (49:41) Do this.

Scott Benner (49:41) Help you get. (49:42) Also, I'd like to ask if you've ever owned a bearded dragon because you lived in Australia, but we don't have time for that.

Que Dallara (49:47) I do. (49:47) I do have a Rankin's bearded dragon.

Scott Benner (49:50) You do? (49:51) I do. (49:51) Oh, they're the small

Que Dallara (49:52) sort of Fizz.

Scott Benner (49:53) Yeah. (49:53) The smaller How old how old is it?

Que Dallara (49:56) One year, actually. (49:57) One year on Veterans Day.

Scott Benner (49:58) Oh, wow. (49:59) We don't have time now, but the reason you're there's a a green screen background behind me because behind me is my Parsons chameleon and, like, some other little things I keep in my office. (50:08) So we'll find more time later. (50:10) I'd love to know about your Rankin's Dragon. (50:12) I'm not kidding.

Scott Benner (50:13) Thank you very much for doing this. (50:14) I really do appreciate your time. (50:15) Thank you.

Que Dallara (50:16) Yeah. (50:16) It was fun. (50:16) Thanks, Scott.

Scott Benner (50:17) Awesome. (50:24) I'd like to remind you again about the MiniMed seven eighty g automated insulin delivery system, which, of course, anticipates, adjusts, and corrects every five minutes twenty four seven. (50:34) It works around the clock so you can focus on what matters. (50:39) The juice box community knows the importance of using technology to simplify managing diabetes. (50:44) To learn more about how you can spend less time and effort managing your diabetes, visit my link, medtronicdiabetes.com/juicebox.

Scott Benner (50:55) If you've listened to any number of podcasts or maybe watched a YouTube video, you're very accustomed to listening to the creator of that content ask you and sometimes just outright beg you without any feeling of self respect for you to follow, subscribe, share an episode. (51:15) The reason that happens in podcasting specifically is because podcast players don't have a sophisticated recommendation engine like YouTube or TikTok does. (51:24) They can't watch listener behavior and then give you content that you might like. (51:30) Word-of-mouth skips that line completely. (51:33) It's an instantly expanding reach engine and really the only thing I've ever found that helps to keep the Juice Box podcast growing.

Scott Benner (51:42) So subscribe and follow because that the algorithm understands. (51:45) Set up automatic downloads, listen to the show, but share it with somebody else. (51:50) Leave a five star review. (51:52) Make it a thoughtful review that the algorithm can understand. (51:56) I really appreciate the time it takes you to do those things, and I hate that I have to say this to you because I feel like an idiot.

Scott Benner (52:02) But subscribe and follow. (52:04) Tell a friend. (52:05) Please and thank you. (52:06) Have a podcast? (52:07) Want it to sound fantastic?

Scott Benner (52:09) Wrongwayrecording.com.

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#1696 Down On My Knees

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

Cecilia discusses fighting for a Dexcom immediately after her daughter’s diagnosis and using podcast education to achieve a 5.4 A1C despite limited medical guidance.

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

Scott Benner (0:00) As the holidays approach, I wanna say welcome and thank all of my good friends for coming back to the Juice Box podcast over and over again. (0:18) This episode of the juice box podcast is sponsored by Skin Grip, durable, skin safe adhesive that lasts. (0:25) Your diabetes devices, they can fall off easily sometimes, especially when you're bathing or very active. (0:32) When those devices fall off, your life is disrupted, and it costs you money. (0:35) But Skin Grip patches, they keep your devices secure.

Scott Benner (0:39) Skin Grip was founded by a family directly impacted by type one, and it's trusted by hundreds of thousands of individuals living with diabetes. (0:47) Juice Box podcast listeners are gonna get 20% off of their first order by visiting skingrip.com/juicebox. (0:56) Nothing you hear on the juice box podcast should be considered advice, medical or otherwise. (1:00) Always consult a physician before making any changes to your health care plan. (1:09) The episode you're about to enjoy was brought to you by Dexcom, the Dexcom g seven, the same CGM that my daughter wears.

Scott Benner (1:18) You can learn more and get started today at my link, dexcom.com/juicebox. (1:24) Today's episode is also sponsored by Omnipod five. (1:28) Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. (1:39) Learn more and get started today at omnipod dot com slash juice box. (1:43) At my link, you can get a free starter kit right now.

Scott Benner (1:46) Terms and conditions apply. (1:47) Eligibility may vary. (1:49) Full terms and conditions could be found at omnipod.com/juicebox. (1:53) I am not gonna stop you.

Cecilia (1:55) Okay. (1:56) I'm not great at that kind of thing. (1:57) Is there, like, a template for introductions?

Scott Benner (2:00) Oh, that's so interesting. (2:01) This is now your introduction.

Cecilia (2:03) Okay. (2:03) Great.

Scott Benner (2:04) What's your name?

Cecilia (2:06) Cecilia.

Scott Benner (2:07) Oh, yeah. (2:08) You're the reason I've been singing that song all morning.

Cecilia (2:11) Yep. (2:11) I get that all the time.

Scott Benner (2:12) Sorry about that.

Cecilia (2:14) That's okay.

Scott Benner (2:14) I know it probably happens to you all the time, but it a 100% has happened to me today.

Cecilia (2:19) That's quite alright.

Scott Benner (2:20) Maybe because, oddly enough, when my son was a baby, it was one of the songs that made him comfortable when he couldn't sleep.

Cecilia (2:27) That's funny. (2:28) You gotta do what you gotta do.

Scott Benner (2:29) That one and the other one was a Beatles song. (2:31) I'd let you guess, but that would be boring. (2:33) It was Blackbird.

Cecilia (2:35) Oh. (2:35) Yeah. (2:36) Well, that's a good one.

Scott Benner (2:37) I used to sit with him when we first moved into our place, we didn't have a lot of stuff yet. (2:43) And so I would take him to this quiet room. (2:46) It was kind of like a loft, and that's being generous. (2:49) There was a small loft in a condo that we got that we never used because it was so small, was unusable. (2:56) And on the other side of it was a storage room, like, literally a storage room that I made my office in.

Scott Benner (3:02) So I would basically go upstairs, go into a large closet where my computer was. (3:07) I'd lay him across my lap, rub his back, and play Blackbird until he fell asleep.

Cecilia (3:13) Oh.

Scott Benner (3:13) And now it makes me cry every time I hear it.

Cecilia (3:16) Oh, I would be the same way.

Scott Benner (3:17) Yeah. (3:17) So I can't even listen to the song. (3:19) It's, ruined the song for me.

Cecilia (3:20) Alright.

Scott Benner (3:21) Anyway, Cecilia, what are you doing here? (3:24) You have a kid with type one? (3:25) You have type one yourself? (3:26) What are we finding out today?

Cecilia (3:28) My daughter has type one. (3:29) She is nine, and she was diagnosed almost a year ago. (3:33) Was October 9.

Scott Benner (3:34) Oh, very recently. (3:35) Mhmm. (3:36) Oh, gosh. (3:37) Just a year and a couple of weeks.

Cecilia (3:39) Yeah. (3:39) Mhmm.

Scott Benner (3:40) Alright. (3:41) Other kids?

Cecilia (3:42) I have a son. (3:43) He is a couple years older than her.

Scott Benner (3:45) Okay. (3:45) You're still married? (3:46) No? (3:46) Yes? (3:46) Who ever was?

Cecilia (3:47) We've been married for oh, wow. (3:49) It's too early for math. (3:50) Since 2012.

Scott Benner (3:51) Oh, that's fun. (3:52) At least well, at least you knew the year.

Cecilia (3:54) Yeah. (3:55) Yeah. (3:55) Yeah. (3:55) He's deployed right now, so my brain's all over the place.

Scott Benner (3:59) What does your husband do for us?

Cecilia (4:01) He's in the army.

Scott Benner (4:02) Yeah. (4:03) How long has he been in?

Cecilia (4:04) Fifteen years. (4:05) Oh, wow. (4:06) Yeah. (4:06) We're at we're at getting to the end.

Scott Benner (4:08) I was gonna say, is he, looking for a job?

Cecilia (4:10) Not yet. (4:11) No. (4:11) He's got he's got his last couple I think we have one duty station after this and then retirement from the army.

Scott Benner (4:18) What's he gonna retire as?

Cecilia (4:20) Right now, he's a master sergeant. (4:22) So he doesn't think he'll make sergeant major, but we'll see. (4:26) Oh. (4:26) We'll see.

Scott Benner (4:26) Sounds like you think he will.

Cecilia (4:28) I think he's pretty good at his job. (4:29) I I always think he's gonna do better than he does, but he's pretty humble.

Scott Benner (4:33) Oh, that's very nice. (4:34) Okay. (4:35) So how long has he been gone? (4:37) Like, what kind of chunks does he leave for, I guess, is my question.

Cecilia (4:40) It depends. (4:41) This time is a long a longer time, about a year. (4:43) So

Scott Benner (4:44) He's been gone a year. (4:45) Wait. (4:45) Was

Cecilia (4:45) No. (4:46) No. (4:46) No. (4:46) He's going to be gone about a year. (4:48) We're not even halfway yet.

Scott Benner (4:49) Ah, so he was around when your daughter was diagnosed?

Cecilia (4:52) Absolutely.

Scott Benner (4:53) Okay. (4:53) Mhmm. (4:53) Tell me about that a little bit.

Cecilia (4:56) Well, do you want me to talk about how we figured it out? (4:59) Or

Scott Benner (5:00) What do you wanna talk about?

Cecilia (5:01) I mean, we can talk about how she got diagnosed because I don't know. (5:06) I I I didn't know a whole lot about it.

Scott Benner (5:08) You're so amenable. (5:09) This is this is I'm I'm not accustomed to this. (5:11) I will, I say to my wife all the time, I should have married a more amenable person.

Cecilia (5:16) Well, it's you know, I don't know what I'm doing.

Scott Benner (5:19) No. (5:20) You but you're like, what would you like? (5:21) And I was and then that froze me because I was like, oh gosh. (5:23) No one ever asked me that.

Cecilia (5:26) No. (5:26) I don't know what I'm doing. (5:27) So you're the pro. (5:28) But, no, she was

Scott Benner (5:30) Yeah. (5:31) Tell me about it. (5:31) Like that.

Cecilia (5:32) Looking back now, I know what all of these things were.

Scott Benner (5:35) Okay.

Cecilia (5:35) But she started getting really agitated just randomly or what I thought was randomly. (5:41) And I'm talking like I don't know. (5:43) We it was like she was suddenly uncontrollable, but it wasn't all day every day. (5:47) And I thought, well, maybe she's just hanging out with some kids at school that maybe she shouldn't be hanging out with, or maybe she's just really frustrated. (5:54) We couldn't figure it out.

Cecilia (5:56) And then it turned into every night. (5:58) Oh, my stomach really hurts. (5:59) My stomach really hurts. (6:00) Well, she's always been my kid that's had a little bit of anxiety, and I thought she was just trying to get out of bedtime. (6:05) Mhmm.

Cecilia (6:06) And then it turned into one day, she got home from school. (6:10) We were picking her up in the car line, and she said, I really need you to start packing me some more water. (6:15) I was like, what? (6:16) You don't you're not my water drinker. (6:18) Like, we had just moved to South Carolina.

Cecilia (6:20) It's a lot hotter here than where we came from, and I thought, oh, well, you're finally listening to us. (6:25) You know? (6:25) My kids don't wanna drink water.

Scott Benner (6:26) Mhmm.

Cecilia (6:27) So I thought, oh, maybe you're finally listening to us and you're just thirsty. (6:31) Mind you, the water bottle that she brings to school is, I think it's 24 ounces. (6:35) Traditionally, she'd maybe drink half of it all day. (6:38) She started going through two, three, four of them a day, and I thought, that's kinda weird. (6:44) My husband and I looked at each other like, And now it should be noted that I have bad anxiety myself, and I have OCD, and I'm always like, oh my gosh.

Cecilia (6:53) The sky is falling. (6:54) This is the worst case possible. (6:57) And so I thought, well, you're just being weird about it. (6:59) Don't overthink it. (7:00) And it just started tumbling into one thing to the next, and she would again, she was my kid that didn't eat much either and started, you could not get enough chicken nuggets into this girl.

Cecilia (7:10) You couldn't get enough cereal. (7:11) Whatever it was, it wasn't enough. (7:13) And I told my husband, I was like, do you think this is weird? (7:17) He was like, yeah. (7:18) A little bit, but maybe she's growing.

Cecilia (7:20) And I started comparing pictures, and I was like, well, it looks like she's lost a little weight. (7:24) But, again, I just chalked it up to a growth spurt.

Scott Benner (7:27) Mhmm.

Cecilia (7:28) Didn't think anything of it. (7:29) And then there was a couple of times that she had a couple of accidents, and I'm like she go, oh, I just laughed too hard. (7:35) And, again, she's my kid that has always waited till the last second to go to the bathroom. (7:39) So all these things I wrote off to just being something else, not really thinking about diabetes. (7:45) And then one day, it just hit me in my gut, I was like, I think this is what this is.

Cecilia (7:49) And so I went on TikTok, and I started looking, well, how much water is too much water? (7:53) Trying to find anything I could to, like, I don't know, talk myself out of it being what it was. (7:58) Yeah. (7:59) I have two autoimmune diseases myself, and my husband's side of the family does have type one.

Scott Benner (8:05) Okay.

Cecilia (8:06) Should I have been surprised? (8:07) No. (8:08) And so I, you know, I remember calling my dad. (8:10) He was a firefighter for years and years and years, and so he's been to people's houses who have low blood sugar or whatever. (8:17) And I was like, hey.

Cecilia (8:17) Do you know anything about this? (8:19) He said, no. (8:19) But you should take her to get her checked. (8:22) Okay? (8:22) Smart.

Cecilia (8:23) We go to the primary care. (8:25) I tell her what my concerns are, and she's kinda, like, waving me off a little bit, probably thinking that I'm just, you know, crazy mom. (8:32) She was like, but it's no problem. (8:33) We'll check her finger. (8:33) No big deal.

Cecilia (8:34) She leaves. (8:35) The, medical assistant comes in, and I'm standing next to my daughter. (8:38) She pokes her finger. (8:39) My daughter, by the way, is, like, an anxious mess at this point because I don't we don't go to the doctor in this house. (8:45) So we're going.

Cecilia (8:47) Something is wrong. (8:48) She checks her finger and the meter just reads hi. (8:51) And I look at my husband like, oh

Scott Benner (8:54) Yeah.

Cecilia (8:54) And we went to the emergency room.

Scott Benner (8:57) I have a bunch of questions.

Cecilia (8:58) Sure.

Scott Benner (8:59) How old are you?

Cecilia (9:00) How old? (9:00) 37.

Scott Benner (9:01) 37. (9:02) Mhmm. (9:02) When you wanted information about drinking water, you went to TikTok?

Cecilia (9:06) Yeah. (9:06) Isn't that weird?

Scott Benner (9:07) No. (9:07) I I I don't know that it is. (9:09) I'm trying to but it's not what I would occur to me. (9:11) So how do you search TikTok for that information?

Cecilia (9:14) You know, I don't remember exactly what I did, but I think I put in, like, signs of type one diabetes, and I tried to figure out I was going through people's videos to try and see, you know, when they were saying, this is how I got diagnosed. (9:26) I was hoping to find, like, a concrete amount of water that people were drinking to say, okay. (9:31) That's an excessive amount. (9:32) I didn't know what that was.

Scott Benner (9:34) Okay.

Cecilia (9:34) And I thought, well, this is an excessive amount for her, but is it so excessive that I should be worried? (9:39) I was just trying to find and I went I went to Facebook. (9:42) I I searched everything.

Scott Benner (9:44) You were all over the place. (9:45) Okay.

Cecilia (9:45) All over the place. (9:46) And she had had a friend in her first grade class who was type one. (9:50) And I messaged his mom, and I said, hey. (9:53) When he got diagnosed, how much water was he drinking? (9:56) And she I mean, she didn't remember anymore at that point.

Cecilia (9:58) It had been a year or two for her, but I was everywhere and anywhere looking for something.

Scott Benner (10:04) Okay. (10:05) What made you think diabetes initially? (10:07) Just because it was in the family? (10:08) Or did something about the peeing bring it up for you?

Cecilia (10:12) The water and the hunger. (10:14) And then I started putting all of the little sides together.

Scott Benner (10:17) Together.

Cecilia (10:17) You know, I tell people all the time, I'm an anxious mess about everything, but this was different. (10:21) Like, once I knew, I knew. (10:24) And when they told me, I was not surprised.

Scott Benner (10:26) You have other autoimmune issues. (10:28) So what do you have? (10:29) Yes. (10:29) Hypothyroidism?

Cecilia (10:30) Yes. (10:31) I have Hashimoto's and celiac.

Scott Benner (10:32) Celiac. (10:33) Oh, this is gonna be my guess as you ruined it. (10:35) I was gonna look awesome. (10:36) And you have anxiety?

Cecilia (10:38) Yes.

Scott Benner (10:39) Like, diagnosed?

Cecilia (10:40) Yes.

Scott Benner (10:41) Do you do something about it?

Cecilia (10:42) I have Zoloft and therapy.

Scott Benner (10:44) Okay. (10:45) Is it helping?

Cecilia (10:46) A 100%.

Scott Benner (10:47) When you said you have OCD, do you meant diagnosed? (10:49) Or you just meant your Yes. (10:50) Your oh, okay. (10:51) Your and how does it manifest mostly? (10:54) A

Cecilia (10:54) lot of rumination and, like, worst case scenario, what if. (10:57) And then in my head, I'm like, okay. (10:59) Well, you know that you're doing this kinda knock it off thing. (11:02) It's not like an outward, I have to lock the car four times or

Scott Benner (11:06) You're not counting or taking steps or retracing your steps or something like that. (11:09) Okay. (11:10) Well, perfect for your husband to be in a war zone. (11:12) That's a great thing for you.

Cecilia (11:13) True. (11:13) Well, luckily, he's not in a dangerous spot right

Scott Benner (11:16) now. (11:16) Okay.

Cecilia (11:16) So thank God for that.

Scott Benner (11:17) I mean, really.

Cecilia (11:19) I know. (11:20) I know.

Scott Benner (11:20) All your life?

Cecilia (11:22) Yeah.

Scott Benner (11:23) Okay. (11:23) Anybody else in your family have that going on? (11:26) Your mom, your dad, your sisters, brothers? (11:28) No. (11:29) No.

Scott Benner (11:29) Just you. (11:30) Did they have any autoimmune stuff? (11:32) Your mom have high Hashimoto's?

Cecilia (11:35) No. (11:35) No. (11:36) Okay. (11:36) Well, I should say neither of them have anything that they ever knew about.

Scott Benner (11:39) No. (11:40) Fair enough. (11:40) Anybody pooping a lot after Thanksgiving dinner?

Cecilia (11:42) You know, I don't know. (11:43) I couldn't tell you that.

Scott Benner (11:44) You don't see people running off to the bathroom after food?

Cecilia (11:46) No.

Scott Benner (11:47) No. (11:47) Okay. (11:48) I'm gonna take a big swing here. (11:49) Is there any bipolar in your extended family?

Cecilia (11:53) Yes.

Scott Benner (11:54) Okay. (11:54) And on your husband's side, there's type one. (11:56) So you guys have, like, a perfect mix to make a baby with type one diabetes.

Cecilia (11:59) Yeah. (12:00) Yeah. (12:00) And it's it's funny because, you know, as they were growing up, when we went to the pediatrician and got their vaccines or whatever, and I would say, hey. (12:08) Is this something I need to worry about? (12:10) No.

Cecilia (12:11) Don't worry about

Scott Benner (12:12) it. (12:12) Okay. (12:13) Okay. (12:13) Any PCOS in your family?

Cecilia (12:16) No. (12:16) Not that I know

Scott Benner (12:16) of. (12:17) Not that you know of. (12:17) Have had any trouble making those babies or anything like that?

Cecilia (12:19) No. (12:20) We've all I mean, I only have two kids, but the rest of them mm-mm.

Scott Benner (12:23) Gotcha.

Cecilia (12:24) They're doing fine. (12:25) Alright.

Scott Benner (12:25) Okay. (12:25) I got it. (12:26) So I have all the information I was, interested in from that part. (12:29) So you're the meter high blood sugar sorry. (12:32) I'm gonna get you back on track.

Cecilia (12:33) That's okay.

Scott Benner (12:34) And then you end up at the emergency room?

Cecilia (12:37) Yeah. (12:37) We went to Children's.

Scott Benner (12:39) What was that blood sugar like? (12:40) Were you there for days, or was it a quick one?

Cecilia (12:43) We got there around 03:00, and we got they got her upstairs by of course, we were coming in at shift change, so it took a little bit longer. (12:53) She was admitted around 08:30 to the floor.

Scott Benner (12:57) Mhmm. (12:57) The keeper for how long?

Cecilia (12:59) We were discharged the next morning straight to endocrinology, which was across the parking lot.

Scott Benner (13:05) Oh, okay. (13:06) So not much in the way of, like, her blood sugars weren't too high. (13:10) She wasn't in DK, obviously, like, that kind of stuff you

Cecilia (13:12) would have gotten ahead of. (13:13) I couldn't tell you. (13:14) I'm assuming no. (13:15) Her blood sugar was six thirty six, and her a one c was 10 something.

Scott Benner (13:19) Mhmm.

Cecilia (13:20) But she hadn't been throwing up. (13:21) She wasn't breathing weird. (13:23) The doctors didn't say a whole lot to me. (13:25) That's a whole other thing.

Scott Benner (13:26) So go dig into that for a second. (13:28) What do you mean the doctors didn't say a whole lot to you?

Cecilia (13:30) We had one resident come in, and she talked to my daughter. (13:33) She was a type one as well, and she was showing her pump and everything. (13:37) But nobody said anything about DKA. (13:39) Nobody said anything about how long to expect to be there. (13:42) None of that.

Cecilia (13:43) And, you know, my husband was kind of in denial. (13:46) I was, like, just a mess on another planet. (13:49) I was keeping it together outwardly, but inwardly, it was like, oh my god. (13:53) And so we didn't really know what was going on or what to expect. (13:56) They didn't give her insulin for quite some time, which was insane to me.

Cecilia (14:00) But, again, I didn't know how it worked. (14:02) Mhmm. (14:03) And so I went back and read through the notes, and one of the doctors said she was in DKA, and one of the other ones didn't. (14:09) So

Scott Benner (14:09) I guess the one that said that she wasn't one because I don't think they would have let her out of there that quickly.

Cecilia (14:15) I don't either.

Scott Benner (14:16) Without my worry.

Cecilia (14:16) Fine. (14:17) It's I I don't want her to have been that sick, obviously. (14:19) No.

Scott Benner (14:20) Of course. (14:20) It's just interesting to to not get

Cecilia (14:22) Right.

Scott Benner (14:23) Yeah, agreement on it. (14:24) What what are you what you mean about your husband being in denial? (14:26) Was he, like, just talking about the football game and be like, we're almost out of here? (14:29) Or was like, what do you mean by that?

Cecilia (14:31) He's very protective over her and rightfully so. (14:34) And those were his words that he was in denial for quite some time. (14:37) Like, we were not the best team together for a few months thereafter.

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Cecilia (16:49) I wouldn't say in a panic so much. (16:52) I was just like and with everything, I wanna know as much as I can know about this, figure out how to start to live normally with it, move on to the next thing. (17:01) And he was kind of like I mean, not to speak for him, but from my perspective, I wish that this didn't happen. (17:08) She's still a normal kid, which, of course, she was. (17:10) But I don't know how to explain what I

Scott Benner (17:12) mean. (17:13) No. (17:13) You are explaining it. (17:14) Keep going.

Cecilia (17:15) He was just like, well, we don't need to. (17:16) I was big on, okay, we need to check her finger, see what she is before she eats because they wouldn't give us a Dexcom.

Scott Benner (17:22) Mhmm. (17:22) His take on that was what?

Cecilia (17:24) What was that?

Scott Benner (17:25) When you said you wanted to be checking your finger a lot, but he

Cecilia (17:28) He thought I was doing too much and I thought he wasn't doing enough. (17:32) I guess that's a good way to explain it all.

Scott Benner (17:33) Okay. (17:34) A year later, what was the truth?

Cecilia (17:36) Somewhere in the middle.

Scott Benner (17:37) Did he come around? (17:38) I mean, by that, I mean, did you yell at him and then make him do what he wanted? (17:43) How did that work?

Cecilia (17:44) You know? (17:47) Yeah. (17:49) I'm not even gonna lie. (17:51) I you know, I'm working on it. (17:52) I have a really big control problem, which kinda works out

Scott Benner (17:56) For this?

Cecilia (17:57) With managing this. (17:58) But, you know, in other areas of my life, it's not always served me well. (18:01) But we're we've we're so much better at it now a year later.

Scott Benner (18:05) Why do you think? (18:06) What do you think happened that made you better at it?

Cecilia (18:08) This podcast. (18:09) Oh. (18:10) And that's part of why I had emailed you a few months ago is because our education from the office I'm so torn on this because I feel like it wasn't enough. (18:19) And I had posted about this in the Facebook group, and somebody pointed out, you know, they don't have the time, and people don't all have the want to know.

Scott Benner (18:26) Mhmm.

Cecilia (18:27) They don't want to necessarily understand all this. (18:30) And so they just kind of, for lack of better words, dumb it down and simplify it just to get people out the door and start it. (18:37) Like, they just told us about carb counting. (18:39) We didn't get anything about proteins. (18:41) We didn't get anything about fats.

Cecilia (18:43) We didn't get anything about how basil could be different at different times of the day. (18:47) None of it. (18:48) Just straight carb counting.

Scott Benner (18:49) I have to say that after a a a fair amount of time being involved in this, I agree with that sentiment that it's possible there's no good way to attack it. (18:59) Yeah. (19:00) Right? (19:00) And but still, I don't think that's an excuse for not doing it.

Cecilia (19:05) Right.

Scott Benner (19:05) You know what I mean? (19:06) Like, I think you have to lay it out in a way that is, know, something that people can absorb in those first couple days, which is obviously already like, a crazy time to begin with. (19:16) They still deserve to hear they they deserve to know whether they can do something with it or not. (19:21) That's another story altogether.

Cecilia (19:23) Right.

Scott Benner (19:23) If I was on a cliff and there were a thousand lemmings walking off the cliff, I think it's still being incumbent upon me to go, hey, guys. (19:32) You are about to fall to your death. (19:34) Even though that's what they're there to do and that's probably what they're going to do. (19:38) And this might be a weird dislike like, maybe I'm not doing a a good job here. (19:42) But you know I mean?

Scott Benner (19:42) Like, there's a way this is gonna be handled by a certain number of people, a different way by another number. (19:48) I still think you should explain to them what's ahead of them. (19:51) And then you know what mean?

Cecilia (19:52) To their defense, they could have told me all of this information that I learned on the podcast in that day. (19:56) I mean, we were there for two hours, and then we were sent home. (20:00) I wouldn't have processed any of it. (20:02) So

Scott Benner (20:02) I believe that too. (20:03) I I I completely understand what you're saying. (20:05) And I I so it's a but that's a weird thing to me. (20:09) Like, if they would have done it, I don't know if it would have helped.

Cecilia (20:12) No. (20:12) It probably wouldn't have. (20:14) And since then, you know, we're a year into it now. (20:16) We still I've made adjustments myself. (20:19) Mhmm.

Cecilia (20:19) And it's worked out great. (20:22) It's been fine. (20:23) They would still have us at a 70 to $2.50 range. (20:26) We don't we don't do that. (20:28) There's been no other education given Yeah.

Cecilia (20:31) Besides we went to one pump class, which was just different reps there saying, hey. (20:37) This is what we have. (20:38) Mhmm. (20:38) Pick one kind of thing.

Scott Benner (20:39) Then this is the extension of that conversation then. (20:42) Like, I'll give them the benefit of the doubt that telling you if they knew wouldn't be that valuable, maybe.

Cecilia (20:47) Yes.

Scott Benner (20:48) But now it's starting to sound like they didn't tell you because they didn't know.

Cecilia (20:52) And they might yeah. (20:54) I don't know.

Scott Benner (20:55) This is very interesting. (20:56) How are you supposed to know that coming in cold? (20:58) Right.

Cecilia (20:59) That was my biggest thing, and that's how I ended up I was in a different Facebook group. (21:03) It's like the mom t one d group or whatever, and a bunch of people said, oh, you gotta listen to the podcast. (21:09) And I already listened to podcasts, so that was fine with me. (21:12) And I drank it all up, and I was like, oh, okay. (21:17) This is why this is happening after she's having, say, pizza.

Scott Benner (21:20) Okay.

Cecilia (21:21) If I can understand why and there's not always an understanding of why something is happening. (21:27) But I learned so much more that I wasn't getting otherwise, and things started making sense, and it made it I don't wanna say easier because it's not easy. (21:35) When you understand it, it's a lit it's, for lack of a better word, a little easier to understand what to do and where to go.

Scott Benner (21:41) Yeah. (21:42) I I have to tell you, quite honestly, I didn't think you were gonna say the podcast when I asked you what changed things for you. (21:48) I I thought maybe you and your husband just came to an agreement or he started seeing something differently or you backed off a little. (21:54) I thought there was the story in there like that.

Cecilia (21:57) Oh, no. (21:57) I'm dead serious. (21:58) I listened to all of it. (22:02) The bold beginnings, the the math behind, I've listened to I couldn't tell you how many times. (22:08) The protein and fats, the one specific episode with Jeremy, the Control IQ Ninja, I've listened to that probably 10 times, I've taken notes each time to try and get her settings just right.

Cecilia (22:19) And we're a year in, and she's got 5.4 a one c.

Scott Benner (22:23) So Wow. (22:23) That was that's great. (22:24) Good for you. (22:25) That's

Cecilia (22:25) awesome. (22:25) Mhmm.

Scott Benner (22:26) Yeah. (22:27) Jeremy's episode is he's a great example of, like, right place, right time found the podcast, and I got to, like, like, get his his story out of him. (22:38) Because you come to realize like, I haven't talked to Jeremy in a while. (22:41) Right? (22:42) But I don't imagine that his level of involvement with diabetes is the same as it was back then.

Scott Benner (22:46) But in that moment, he found himself digging in. (22:51) He came to some great understanding. (22:52) He knew how to explain it. (22:54) It was really accessible. (22:56) I as far as his style of communication, you know?

Scott Benner (22:59) And there was. (23:00) Like, we were able to record it and put it down for somebody. (23:02) And awesome. (23:03) I can't tell you how many people have been helped by that one. (23:05) I actually wanna tell you that I am currently working with Tandem to build out a pro tip series for their pump.

Cecilia (23:12) So Even better. (23:13) Hopefully, that'll help.

Scott Benner (23:15) That'll help.

Cecilia (23:15) Absolutely. (23:16) I've learned between the podcast and a few different creators on TikTok

Scott Benner (23:20) Yeah.

Cecilia (23:21) I have learned so much. (23:22) And there is no way based off of the information we are getting from our endocrinologist and what I had known, had I not listened to anything, there is not a doubt in my mind that she would be doing as well as she is now.

Scott Benner (23:35) Yeah. (23:36) No. (23:36) It's awesome. (23:36) And it's awesome that you went and looked for it as well because you could have just said, hey. (23:41) It was 70 to two fifty.

Scott Benner (23:42) Right on. (23:42) I got it. (23:43) And no shade on him, but if you and your husband were thinking the same way, this sounds like what you'd be doing right now. (23:49) Mhmm. (23:50) You know?

Scott Benner (23:50) Because he was some people are just more ready to it's funny I called you amenable earlier, but you weren't amenable to any of that. (23:57) You were like, no. (23:57) No. (23:58) That's bullshit. (23:58) We're fixing this.

Cecilia (23:59) I don't want it to sound like I'm saying he didn't care about her and he was No. (24:03) Making dangerous decisions. (24:04) He absolutely was not. (24:06) He was more focused on, she's still an eight year old, let her be an eight year old.

Scott Benner (24:09) Oh, yeah.

Cecilia (24:10) And I was more like, she is an eight year old, we need to figure out how to make this adapt to her and try and keep her a little steady instead of up, down, up, down, up, down.

Scott Benner (24:19) Right. (24:20) I didn't take you that way. (24:21) Don't think anybody else did did either.

Cecilia (24:22) Okay. (24:22) Good.

Scott Benner (24:23) I'm just trying to say that, like, for somebody who's more floating in that direction, if someone tells you 70 to two fifty is good, you're gonna why would you question it? (24:32) You're like, oh, yeah. (24:33) I mean And

Cecilia (24:33) I didn't Man. (24:34) For about a month.

Scott Benner (24:35) I didn't question it for, like, a year. (24:37) And then I started thinking, like I I actually found myself telling this story the other day. (24:42) You know, I I finally started worrying about the higher blood sugars and the bouncing and everything. (24:46) And I said to the the nurse practitioner, like, you know, like, I don't know. (24:51) I feel like this is bad.

Scott Benner (24:52) Her blood sugars are high a lot. (24:54) And she said, oh, high blood sugars aren't a problem for young kids.

Cecilia (24:58) Oof.

Scott Benner (24:59) And I was like in the beginning, I went, oh, okay. (25:02) That's good news. (25:03) Like, there must be a physiological reason why high blood sugars aren't bad for kids. (25:08) And then it finally, like, it just stuck with me, I pushed. (25:11) And then I back to them again, I was like, what do you mean by that exactly?

Scott Benner (25:15) You know? (25:16) She just said, well, you know, like, dire circumstances from type one diabetes don't come for, like, thirty years. (25:21) And I was like, oh, she just means she's young. (25:25) I said, you know thirty years from now should be 32. (25:27) Right?

Cecilia (25:28) Right.

Scott Benner (25:28) Not really even, like, your life going yet. (25:30) Like, you you're telling me my daughter's gonna have, like, dire circumstances from her diabetes when she's 32?

Cecilia (25:36) Right.

Scott Benner (25:37) And you feel like that's comforting? (25:39) You might completely misunderstand this whole thing. (25:42) And I don't know where you're at in the country. (25:43) I'm not even asking you. (25:44) But we were going to a pretty popular mainstream, you know, children's hospital.

Scott Benner (25:50) So

Cecilia (25:50) We're in South Carolina. (25:52) I had to learn really quick to advocate for her and which is not a problem for me. (25:58) I don't have a problem doing that. (25:59) Mhmm. (25:59) You know, like I said earlier, they didn't even wanna give us a Dexcom.

Cecilia (26:02) I'm sure they have some sort of equation where they figure out, you know, basal rates and all that. (26:06) And, you know, they said, okay. (26:08) Well, let's see. (26:09) She was discharged. (26:11) We went in on a Wednesday night.

Cecilia (26:12) She was discharged Thursday morning. (26:14) Friday night, she's they said, okay. (26:17) Well, you don't need to check her her finger overnight after this weekend or after Friday.

Scott Benner (26:22) Okay.

Cecilia (26:22) I was like, okay. (26:23) That's weird. (26:23) I'm not doing that. (26:24) But okay. (26:25) And so I set an alarm for I don't know.

Cecilia (26:27) I think it was, like, every three hours or something overnight. (26:30) And, you know, I'm reading in these groups, get a Dexcom. (26:33) Get a Dexcom. (26:34) Get a Dexcom. (26:35) Because she was also nervous, and she was wanting to poke her finger way more than she probably needed to.

Cecilia (26:40) But I was like, you know what? (26:41) This is for you. (26:42) If this is gonna make you feel better, go right on ahead. (26:45) So And it was, like, two in the morning, and her blood sugar was 31. (26:48) And I was like, oh, you know, I feel like that's not great.

Cecilia (26:52) So and she was a little combative. (26:55) It was hard to get her to get some juice in. (26:57) We got it we got it handled, and I called them the next day, and I said, can you give me a reason why you won't give me a Dexcom other than you wanting us to learn the traditional way in case the Dexcom were to fail?

Scott Benner (27:07) Yeah.

Cecilia (27:08) And which whatever. (27:09) I kind of understand. (27:10) But I said, there's no good reason you can't just give her a Dexcom. (27:14) So can we come get one, please? (27:17) And we did.

Scott Benner (27:17) And they said yes?

Cecilia (27:19) Yeah. (27:19) And to be fair though, I wasn't really gonna let them tell me no. (27:23) So

Scott Benner (27:23) Yeah. (27:24) Okay. (27:24) So you they pushed back. (27:25) You pushed harder.

Cecilia (27:26) Mhmm.

Scott Benner (27:27) I see. (27:28) Interesting because the guy I interviewed yesterday said that they told him a year. (27:33) Yeah. (27:34) You can't have a CGM for a year.

Cecilia (27:36) Yeah. (27:36) They tried that, and I said no.

Scott Benner (27:39) A year? (27:40) Don't you think? (27:40) Wait. (27:41) I'll tell you anybody who has diabetes could tell you that in about three days, you figured out all the stuff that can go wrong.

Cecilia (27:46) Right. (27:47) That then that was my thing. (27:48) I'm like, okay. (27:49) Well, we understand how to do this. (27:50) This part isn't rocket science.

Cecilia (27:52) I said, it's going to improve her quality of life. (27:54) Well, can't you just give it to me? (27:56) I said, cause they just said, oh, well, insurance this and that. (27:59) I had already looked up my insurance. (28:01) It wasn't that.

Cecilia (28:01) So

Scott Benner (28:02) Right.

Cecilia (28:02) We got one and it's been fine.

Scott Benner (28:04) Boy, I'll tell you, a lot of overlap this week with the the episodes and and the stuff that I said when I was away giving my talk because, I mean, thousand six, Arden's diagnosed. (28:14) We started looking for a pump for her before kindergarten. (28:18) So she was around four. (28:19) So this is 2009, February. (28:22) Right?

Scott Benner (28:23) And Mhmm. (28:23) You know, we decided we wanted to have her pump before she went to school. (28:27) We went to the, you know, the pump fair at the hospital. (28:30) Yeah. (28:31) This is very early on.

Scott Benner (28:32) Like, I believe that Omnipod was just getting going or had only been going for, you know, a short amount of time. (28:39) And they had all these pot pumps laid out on tables. (28:42) Right? (28:42) Just beautiful Mhmm. (28:43) Everywhere.

Scott Benner (28:44) I should point out that I think that every one of those pumps that was there probably doesn't exist anymore except for

Cecilia (28:48) I was gonna say probably not.

Scott Benner (28:49) Yeah. (28:49) Except for the Omnipod. (28:50) Right? (28:51) It was kind of a conference room, but it was pretty big. (28:53) There were a lot of tables in the middle, a lot of people milling around, probably fifty, seventy people in there looking at pumps.

Scott Benner (28:58) The back of the room had this kind of weird cutout. (29:01) It was sort of triangular in the corner for some reason. (29:03) There was a table in it. (29:04) And as I was looking around, my wife was looking around, I looked up and I saw this table on the other side of the room. (29:09) There was something on it.

Scott Benner (29:10) I started walking towards it. (29:12) But as I got closer and closer to it, I realized this is not part of the display. (29:16) This is like the crap table at the event where they threw all the stuff. (29:19) But I kept Sure. (29:20) I kept walking to it for some reason.

Scott Benner (29:22) And as I got closer, I saw you know, honestly, I saw an Omnipod that it looked like somebody threw on the table. (29:29) It was the Omnipod box and a, you know, a dummy controller and, you you see there for demo reasons and a pod. (29:35) The best I can explain is it looked like somebody was tasked to put it on the table, got about five or six feet from the corner and was like, screw it, and just pitched it into the corner. (29:43) You know what I mean? (29:44) Mhmm.

Scott Benner (29:44) I walked over and I picked through it and I looked at it and I took it back to my wife and I was like, hey, yo, check this out. (29:50) You know, this is not a tubed, first of all. (29:54) I think that's a big deal. (29:55) And I was like, and it's disposable. (29:57) I kinda stood there and, you know, philosophized with my wife for a second.

Scott Benner (30:00) I was like, well, they'll update this one day and we'll just get the updates. (30:03) Like, there won't be any, like, oh, no. (30:05) That's the one you bought. (30:06) You're stuck with it for a while. (30:08) And then we took it to the the practitioner and we're like, this is we've found ours.

Scott Benner (30:12) We're getting this one. (30:13) Oh, Arden can't use that. (30:15) She's too lean. (30:16) She's too young. (30:16) She doesn't use enough insulin.

Scott Benner (30:17) And we pushed back and said, like, no. (30:21) You know what? (30:22) Like, we're gonna do this. (30:23) You know? (30:23) Like, this is the one we're gonna we're gonna try.

Scott Benner (30:26) And she pushed harder, then she went and got, like, you know, somebody above her to push on us. (30:31) That person looked us in the face and gave us like, just looked at us almost like four years. (30:35) And I was like, what? (30:36) She goes, you're stuck with this for four years if you pick it. (30:40) Your insurance won't let you switch.

Scott Benner (30:42) You're stuck. (30:42) Now I realize everything's different now. (30:44) But, like, this is this is the level that they were, like, leaning into it with. (30:48) You know, it comes out later. (30:49) They just didn't they didn't know anything about it.

Scott Benner (30:51) They didn't wanna look like they didn't know what they were doing.

Cecilia (30:54) Yep. (30:55) I figured that out real fast myself.

Scott Benner (30:57) I was like, you are kidding me. (30:59) Then meanwhile, you're at home with a 31 blood sugar and your nine year old, like, being like, is this gonna be every day of my life?

Cecilia (31:07) Yeah. (31:07) That was my thought. (31:08) I'm like, I'm never gonna sleep again.

Scott Benner (31:10) Yeah. (31:10) Oh, yeah. (31:11) Oh, no. (31:11) No. (31:11) Plus, you got other, impediments on top of you.

Scott Benner (31:14) DOCD stuff and, like, that must have hit you really hard.

Cecilia (31:17) Yeah. (31:18) Yeah. (31:18) I mean, we got it figured out though, and then we got her on the Moby mid December, so she was chugging along less than two months after diagnosis.

Scott Benner (31:27) So Yeah. (31:27) It's crazy that the people who you believe are there to help you are the ones

Cecilia (31:34) And you have to fight the hardest against.

Scott Benner (31:36) Yeah.

Cecilia (31:36) Truly.

Scott Benner (31:36) They're you from getting to the help. (31:39) Yeah. (31:39) And then for some reason that if you ask them to contextualize that they have none. (31:43) Like, why do I have to wait a year? (31:45) You know?

Cecilia (31:46) That's yeah. (31:47) And I'm yeah. (31:48) That was my strategy, honestly, because I knew what were they gonna say.

Scott Benner (31:53) Alright. (31:53) How's your daughter doing with all this?

Cecilia (31:56) Really good. (31:56) I mean, she has her days, obviously. (31:59) We just had she changed her pump site the other day, and it I don't know. (32:02) It ended up being a really sore spot. (32:04) She hadn't she wanted to change it, but she didn't wanna change it because it hurts.

Cecilia (32:08) And we have moments like that. (32:09) But for the most part, she does really, really well. (32:12) When she got diagnosed, it was actually during fall break, so we weren't even in school. (32:16) And that Monday, so what? (32:19) Thursday, Friday, Saturday, five days after diagnosis, she was back to school.

Cecilia (32:23) And I had never met a school nurse before. (32:25) And I just I walked into her office with a bag of supplies and was like, I don't know what I'm doing. (32:31) Please help me.

Scott Benner (32:32) And But she said

Cecilia (32:36) She just kinda looked at me, because then, of course, I had started crying. (32:40) My husband was going into what he thought he should say, and I was we were still not on the same page. (32:45) It had been five days. (32:46) And this poor nurse, I love her to death. (32:48) She's amazing.

Cecilia (32:49) Was just kinda looking at us like, what the hell? (32:51) It's 7AM on a Monday morning. (32:53) Can we take a minute? (32:55) But, you know, she did she's been great.

Scott Benner (32:59) You were like, no. (33:00) I don't have a minute. (33:01) I'm in a panic. (33:02) Thank you.

Cecilia (33:02) Correct.

Scott Benner (33:03) Mhmm. (33:04) What did it feel like? (33:05) Because when I dropped Arden off, I felt like for sure she was gonna die there.

Cecilia (33:09) Yeah. (33:09) I was sobbing, walking out, and I said, I don't even know how to take care of her. (33:13) How am I supposed to trust this stranger to take care of her?

Scott Benner (33:16) Oh, I had that exact same exact thought. (33:18) I can't do this right.

Cecilia (33:19) Yeah.

Scott Benner (33:19) I've been at it for four years, and I'm still figuring out or I don't know how long it had been then. (33:24) Maybe three three years. (33:25) And I was like, I still don't really know what I'm doing. (33:27) You're gonna do it? (33:28) You know, that's Right.

Cecilia (33:30) Yeah. (33:30) Yeah.

Scott Benner (33:31) You're not gonna care like the way I

Cecilia (33:33) do. (33:33) She's right. (33:34) And and not that I knew what I was doing either, especially five days later, but she has turned out to be I could cry talking about her. (33:41) She's also an ER nurse. (33:42) She was just I don't know.

Cecilia (33:44) She's the best.

Scott Benner (33:45) That's awesome. (33:46) Mhmm. (33:46) What do you think about her maid or grave? (33:49) Is it empathy? (33:50) Is it her understanding?

Scott Benner (33:52) Her willingness to communicate?

Cecilia (33:53) All of it. (33:54) Really? (33:54) All of it. (33:55) She has the same sense of dark humor that I have. (33:58) She added the Follow app onto her personal phone, kept an eye on her, and she was like, you know, I wanna learn what she looks like when she's low.

Cecilia (34:06) Because this school, I think, has seven, eight hundred kids, and my daughter is I think she was the third the second diabetic at this point, and then two weeks later, they got another one, which is strange. (34:18) But she just she was she did whatever I asked. (34:22) I didn't have to fight her. (34:23) We worked together on some things, especially for gym class. (34:27) We were like, oh, well, this didn't work last week.

Cecilia (34:28) What if we tried this this week? (34:30) And she was just great.

Scott Benner (34:32) She's one nurse for 700 kids? (34:35) Yeah. (34:36) And and she still put this kind of effort into it. (34:38) Yeah. (34:39) And yet I hear stories from other people, they can't get their nurses to do anything.

Cecilia (34:43) Yeah. (34:43) She I mean, there is a health room assistant too, but she's not she's not a nurse. (34:47) She's great too. (34:48) I love her to pieces. (34:50) Yeah.

Cecilia (34:50) Emily is just she's something else.

Scott Benner (34:53) That's extra special. (34:54) That's awesome. (34:55) Mhmm. (34:56) Would you say that there's gonna be some education when your husband comes back for him? (35:01) Because he's he left six months after her diagnosis.

Scott Benner (35:04) Right? (35:04) Ish? (35:05) Am I about right on that?

Cecilia (35:07) About ten ish months. (35:07) No. (35:08) He's he's good now.

Scott Benner (35:09) He's good. (35:09) He knows what to do now.

Cecilia (35:10) Oh, yeah. (35:10) Okay. (35:10) Yeah.

Scott Benner (35:11) Be fine when he gets back. (35:13) What about her? (35:14) Like, what level of I guess, what percentage do you think she's taking care of things, and what percentage are you helping?

Cecilia (35:20) That's a good question, and maybe you'll be able to help answer it. (35:23) So we had a little incident with a sub nurse at school. (35:26) So we had her paperwork actually changed to self management. (35:31) That being said, she's not out there winging it on her own. (35:34) I text her at snack time.

Cecilia (35:36) I text her at lunchtime. (35:36) I we text all the time. (35:38) For a while, she was not feeling her lows, and she's starting to really get pretty good at that. (35:45) So she carries, like, her stuff with her, and usually after recess, she knows to have a little a little treat. (35:51) She knows how to carb count.

Cecilia (35:53) If I forget to text, you know, fifteen minutes before lunch, she's texting me, hey. (35:57) We forgot to do pre bolus. (35:59) So she's doing great. (36:02) She does all her own site changes. (36:03) She was doing all of that even with the injections Yeah.

Cecilia (36:06) The day we got home.

Scott Benner (36:07) Well, she sounds like she's doing well for a year. (36:09) And

Cecilia (36:10) Yeah.

Scott Benner (36:10) Yeah. (36:10) Honestly. (36:11) How are her friends handling it? (36:13) Is she having any trouble with, you know, classmates, people being crappy to her? (36:17) Or

Cecilia (36:18) No. (36:19) Luckily, she actually made a little PowerPoint presentation last year and and, you know, told her taught her class about it because, you know, her stuff was beeping occasionally, and they've all been really receptive. (36:30) There was one little boy this year who brought in brownies, and he his mom stopped me in the car line, and she was like, you know, he wanted me to tell tell you that, you know, we need to make sure that we have the carb count because Alan has to have insulin, and she could still have it. (36:44) We just have to know, you know, the carb count and give her some insulin ahead of time. (36:47) And I'm like, oh, that's so sweet.

Scott Benner (36:49) Yeah. (36:49) And he knew he had it right too.

Cecilia (36:51) He did.

Scott Benner (36:52) Yeah. (36:52) Mhmm. (36:52) I saw his panic attack. (36:53) It must have been a hell of a PowerPoint.

Cecilia (36:55) I guess so. (36:57) I don't know how to make those, so she was on her own.

Scott Benner (36:59) I don't know how to make. (37:01) What do you do? (37:01) Are you stay home or you have a job? (37:03) What do you do during the day?

Cecilia (37:04) I stay while I work from home.

Scott Benner (37:06) Okay. (37:07) And so it's not trouble for you to kinda keep abreast of what's happening with her blood sugar?

Cecilia (37:11) Not at all.

Scott Benner (37:12) Do you find yourself communicating with her while she's at school? (37:16) Yeah. (37:17) Texting?

Cecilia (37:17) Well, yes. (37:19) Only I I mean, I'm not texting her to say, hey. (37:21) How's science class going? (37:22) But Right. (37:23) You know, I have my alerts set.

Cecilia (37:24) I know what time she goes to lunch or recess or gym class, and I just I glance at it before she has one of those things, see if we need to be doing anything, and we kinda handle it through there.

Scott Benner (37:34) What's your backup? (37:35) Like, is your if something goes wrong, how do you have it set up? (37:38) Do you do you call directly to the nurse? (37:40) The nurse is obviously following as well, but doesn't mean they see it right away. (37:44) How do you do all that?

Scott Benner (37:46) Have you not needed it yet?

Cecilia (37:47) No. (37:47) We haven't really needed it yet, luckily. (37:50) Emily is really good. (37:51) Like, she's I have her personal phone number, and I've kinda made her my best friend now. (37:55) So Mhmm.

Cecilia (37:56) She's always really responsive. (37:58) I've never had the only issue we had was that one day when she was out sick and there was a sub that didn't want to give her insulin for her lunch because she had already had insulin that morning.

Scott Benner (38:08) Oh, one time? (38:09) Good enough?

Cecilia (38:10) Yeah. (38:10) I said, that's not how it works.

Scott Benner (38:12) Was she older? (38:14) No. (38:15) No. (38:16) Okay. (38:16) Mm-mm.

Scott Benner (38:16) Misinformed a bit.

Cecilia (38:18) Yeah.

Scott Benner (38:18) Did she work in a hospital previously?

Cecilia (38:21) I have no idea.

Scott Benner (38:22) You know

Cecilia (38:22) what mean?

Scott Benner (38:22) Would Try to

Cecilia (38:23) I don't think so.

Scott Benner (38:24) Trying to think where that that idea came from.

Cecilia (38:27) I don't know, but I was we fixed that real quick.

Scott Benner (38:30) We fixed that real quick.

Cecilia (38:31) Because we we kinda got into it a little bit, and I was like, no. (38:35) We we're not playing this game.

Scott Benner (38:36) I don't know if I'm proud of this or not or if I'm ashamed, but in high school, I mean, Arden used the nurse's office as a place to, like, go swap a pot if she needed to. (38:46) You know what

Cecilia (38:46) I mean?

Scott Benner (38:46) Yeah. (38:46) Like, she was not not involved with these people at all. (38:50) Yeah. (38:50) One day, I realized that one of the nurses called Arden's endocrinologist for something.

Cecilia (38:57) Oh, I feel like did you do an episode about this? (38:59) Because I feel like I listened to it and was yelling along and

Scott Benner (39:01) I don't know. (39:02) But that lady might still be afraid of the telephone because I lost my head, you know?

Cecilia (39:08) Yep. (39:09) I did too. (39:09) To we had an emergency 504 meeting with the nursing director for the district, everybody. (39:15) And I was like, you guys aren't touching her anymore. (39:17) It's Emily or it's nobody.

Scott Benner (39:19) I was like, you gotta mind your own fucking business. (39:21) You know what I mean? (39:22) Like

Cecilia (39:22) Yes. (39:24) A 100%.

Scott Benner (39:24) I was like, I don't care. (39:26) I really don't. (39:26) I I have absolutely no care at all in the world why you thought it was okay to contact her doctor without telling talking to me first.

Cecilia (39:33) And No. (39:34) Not.

Scott Benner (39:35) It's crazy. (39:36) And then, by the way, I've heard other people like, oh, it's nice. (39:38) They got ahold of the doctor. (39:38) And then I'm like, I maybe it's just the way I think of it, but, like, that seemed like a line to me. (39:43) You know?

Cecilia (39:43) You know, I don't even really trust the doctor at this point. (39:46) So that would be a hard no for me.

Scott Benner (39:48) Well, yeah. (39:49) I mean, that's it's a good point. (39:50) The doctor, if I line all the years up and really look through it, didn't wanna increase Arden's thyroid medication when she needed it, misdiagnosed her thyroid thing as a heart problem, told us her eight A one C was okay when she was younger, you know, on and on and on and on. (40:08) And by the way, lovely people. (40:09) If I met them right now, I'd sit down at dinner with them.

Cecilia (40:11) Awesome people. (40:11) Percent.

Scott Benner (40:12) Yeah. (40:12) Yeah. (40:12) Yeah.

Cecilia (40:12) 100%.

Scott Benner (40:13) But so now I got those people and the school nurse, and they're gonna autonomously make decisions about Arden without talking to me even? (40:20) Yeah. (40:20) Yeah. (40:21) Of your mind.

Cecilia (40:21) My mind.

Scott Benner (40:22) Yeah. (40:22) Yeah. (40:23) I wouldn't what? (40:25) Snow. (40:26) And, you know what, I think I started out okay on the call.

Scott Benner (40:29) I wanna be clear. (40:30) I don't think I jumped on the call. (40:31) I don't think I was yelling while the phone was being

Cecilia (40:33) I started out that way too. (40:35) I did not finish that way.

Scott Benner (40:37) Well, I thought and then I was just like, oh, good. (40:40) You thought. (40:41) It's great. (40:41) Go make your own goddamn baby.

Cecilia (40:43) Yeah. (40:44) Yeah. (40:45) Uh-huh.

Scott Benner (40:47) You want something to take care of? (40:48) Get a puppy. (40:49) Leave my kid alone.

Cecilia (40:50) Oh, yeah.

Scott Benner (40:51) Here's what I need you to do. (40:52) It's all written down right here. (40:53) It's very simple. (40:54) Just do

Cecilia (40:55) And that was my thing. (40:56) I said you it was made clear to me that you did not even read the orders that are there. (41:01) And it just snowballed from there.

Scott Benner (41:03) I have to tell you, not only that, at this point, nor does Kara at school, these people were not involved with her at all.

Cecilia (41:10) Yeah. (41:10) That's even weirder.

Scott Benner (41:11) Like, how did I get in your crosshairs today?

Cecilia (41:14) Right.

Scott Benner (41:14) You know what I mean? (41:15) Like, what? (41:16) You're bored? (41:17) Like, was this before they put games on your phone? (41:19) Like, what's happening exactly?

Scott Benner (41:21) Oh my gosh. (41:22) Anyway. (41:23) Alright. (41:23) She has I'm sorry. (41:23) She has TandemObi.

Scott Benner (41:24) I wanna just say tandemdiabetes.com/juicebox if you'd like to learn more about that. (41:28) We should use Dexcom with that. (41:29) Right?

Cecilia (41:30) Yeah. (41:30) The g seven.

Scott Benner (41:31) Dexcom.com/juicebox. (41:33) And where are you at with the technology? (41:35) You love it? (41:36) You hate it?

Cecilia (41:37) Oh, I love it.

Scott Benner (41:38) You see room for improvement? (41:39) Like, what what's your feedback on all of it?

Cecilia (41:41) You know, the Dexcom, we've had some fights.

Scott Benner (41:45) Mhmm.

Cecilia (41:45) But overall, it's great. (41:49) I can't complain. (41:49) It's better than not having it.

Scott Benner (41:51) Well, yeah. (41:52) That's for sure. (41:53) You know, it feels like you're only in it for a year, so it'd be real it's interesting to hear from you on that because you had enough of an experience in the beginning to know that not having a CGM is tough. (42:05) Right? (42:05) And then Mhmm.

Scott Benner (42:06) And you've only been using it for, you know, I would imagine, like, eleven months now. (42:10) Yeah. (42:11) Right? (42:11) And Mhmm. (42:12) Not I mean, technology.

Scott Benner (42:14) Nothing's perfect. (42:15) It's got its limitations. (42:16) It, you know, probably fails sometimes or whatnot. (42:19) But it's interesting to hear your feedback on it because you're so new. (42:23) You're not, like, entrenched.

Scott Benner (42:24) You don't have a ton of, you know

Cecilia (42:26) Yeah. (42:26) Bias. (42:27) Mean, I really don't know what I'm doing. (42:30) Mhmm.

Scott Benner (42:32) I don't know what I'm doing.

Cecilia (42:33) We're doing the best we can every day.

Scott Benner (42:36) No. (42:36) It sounds like you're doing pretty well. (42:39) You know? (42:39) Don't you do you not feel that way?

Cecilia (42:41) Figuring it out.

Scott Benner (42:42) Do you do you feel accomplished at this point with it?

Cecilia (42:45) Yeah. (42:45) I don't feel, panicked about it anymore. (42:48) Even, you know, this summer, we have a trampoline in our backyard. (42:51) And that proved to be quite challenging over the summer, and I got to a point where I'm like, have tried this. (42:57) I've tried that.

Cecilia (42:58) I'm I'm not getting it right, but there's gotta be a way we can make this work. (43:02) And we had an appointment over the summer because they still have a score every three months. (43:07) And I you know, I was talking to the endocrinologist. (43:09) I'm like, you have any suggestions? (43:10) She was like, oh, well, have you tried doing this with basil, doing that with basil?

Cecilia (43:14) And I'm like, yes. (43:15) I've tried all of that. (43:16) And she kinda just stared at me. (43:17) And I'm like, oh, okay.

Scott Benner (43:19) That was the end?

Cecilia (43:20) I'm I'm on my own with this again. (43:22) And

Scott Benner (43:22) Sorry. (43:23) I'm not lit. (43:23) It is. (43:23) I'm just imagining It was I

Cecilia (43:25) was just like, are you for real? (43:26) Have

Scott Benner (43:28) you tried to tempt Basil? (43:29) I have. (43:30) Okay. (43:31) Well, we're done, I guess.

Cecilia (43:32) We kinda got into, like I don't wanna call it an argument, but she was trying to tell me the pump couldn't do something that I knew that it could. (43:40) And it got to the point where she took my daughter's phone, left the room with the diabetes educator. (43:47) They had a little powwow somewhere and came back and basically had to be like, oh, yeah. (43:50) You're right. (43:51) I know.

Cecilia (43:52) We left the appointment and my husband goes, cool. (43:54) You do not like her, do you? (43:56) I said, oh, was it that obvious?

Scott Benner (43:58) We googled it and figured out you were right. (44:00) Thank you.

Cecilia (44:00) Right. (44:00) Like, sorry.

Scott Benner (44:02) What were you trying to tell them the phone did you or the the app did? (44:05) Do you remember?

Cecilia (44:06) That you could set a temp basal for however long or?

Scott Benner (44:09) Wait. (44:09) Your diabetes educator didn't think you could set a temp basal for a certain amount of time?

Cecilia (44:14) Yeah. (44:15) They thought you could only do it I don't know. (44:17) It was right after Tandem came out with a Mobi that you could Oh. (44:20) They did the Control IQ Plus update or something. (44:23) I don't remember exactly what it was called.

Scott Benner (44:25) But In fairness to her, they had just updated the software to do that. (44:28) It didn't do it before.

Cecilia (44:29) No. (44:30) It did. (44:30) It just did it for longer now, and she thought it didn't do it at all. (44:33) And so I was just I thought, okay. (44:35) Well

Scott Benner (44:35) Again, like, doesn't fill you with confidence. (44:38) Forget the Tempezil thing and the and the bouncing and the trampoline. (44:41) Put all that aside. (44:42) It makes you feel like, oh my god. (44:45) I'm alone in this.

Cecilia (44:46) Yeah. (44:47) Yeah. (44:47) That's the very couldn't problem. (44:48) Even print out the right they can look up the pump settings on however they do it. (44:54) They couldn't even print out the right ones to give to school, and so I was having to call back and get the new ones mailed.

Cecilia (45:00) And it was just, I don't know. (45:01) I mean, I guess it's kind of fine that I've figured it out on my own and I make the settings, you know, I adjust them myself. (45:08) She doesn't seem to care. (45:09) I mean, how what is she gonna argue with me? (45:11) She has a 5.4 a one c.

Cecilia (45:12) What is there to argue? (45:13) Right. (45:13) She doesn't have a bunch of lows. (45:15) So

Scott Benner (45:15) Yeah. (45:15) You're not getting to that a one c dishonestly with

Cecilia (45:18) And I Yeah. (45:19) Know. (45:19) And I just I feel bad for the new families that go in there who don't know what they're doing, who don't know to look for the podcast. (45:27) They're out there drowning, I feel.

Scott Benner (45:29) Yeah. (45:29) Well, I'm pretty sure they are. (45:30) I I there's a lot of people and I don't mean just because they haven't found me, but, like, there are a lot of people struggling with this.

Cecilia (45:36) Yeah.

Scott Benner (45:37) Yeah. (45:38) Much more than you think. (45:39) And it all you can really do is, like, tell people and and hope they are able to put put it together. (45:46) You know?

Cecilia (45:46) Mhmm.

Scott Benner (45:47) Yeah. (45:47) Just it's important to remember, I think. (45:50) The limitations of most things in life come down to humans at some point. (45:55) Like, at some point or another, you're gonna bump into the chain where you're counting on a person to know a thing, to care, to have the communication skills to, you know, get it out to you if they do know and care. (46:07) But you're also gonna bump into people who are just at work, couldn't possibly care less, don't have the knowledge at all or misguided somehow, are just poor communicators and don't know what they're talking about.

Scott Benner (46:18) And then they kinda turn that on you and they're like, oh, it's your fault. (46:22) You know, like, imagine imagine this has only been eleven, ten, you know, ten excuse me, eleven, twelve months for you. (46:28) But imagine if you never found any of this information out. (46:31) In a decade from now, your daughter's struggling and someone turns to you and says, well, you guys are noncompliant. (46:36) You're not doing what we're telling you to do.

Cecilia (46:38) Oh, I'd be so pissed off.

Scott Benner (46:39) Right. (46:39) But you might also believe it.

Cecilia (46:41) Right.

Scott Benner (46:42) Yep. (46:43) So Mhmm. (46:44) I don't know. (46:44) There's part of me that thinks the machines are gonna save us sometimes. (46:47) If it hasn't become obvious already listening to the podcast for a year, it's become obvious to me after making it for eleven years that it's completely random who's gonna be good at this and who's not going to be.

Scott Benner (46:58) And I mean on a professional side of it. (47:00) And you can't like, imagine you're diagnosed, for everybody listening, you or your kid are diagnosed. (47:06) Right? (47:07) And the hospital you go to, what they tell you, where they send you, what the people at that place understand. (47:15) Are they gonna tell you, here's a CGM, go home?

Scott Benner (47:19) Are they gonna tell you, you can't have a CGM for a year? (47:21) Anywhere in between on their understanding and their compassion and their capacity to educate, there's a spectrum of that. (47:29) And you are not in charge of which person you land on that gives you that information.

Cecilia (47:34) Mhmm.

Scott Benner (47:34) And so it is literally like a lottery whether you end up with a good endo or not.

Cecilia (47:41) Yeah. (47:41) And I wish people, and I say this outside of diabetes too, weren't afraid to question things.

Scott Benner (47:49) Yeah. (47:49) Well, that's another human limitation. (47:52) Some people can't speak up. (47:53) I'm not saying, like, they're you know, they don't have the juice or whatever. (47:57) Like, it's just some people are not wired for that.

Cecilia (48:00) No. (48:01) Mm-mm.

Scott Benner (48:01) Like like I said, like, there are just some people who are told what to do, and they're rule followers. (48:07) I think it's a pretty simple way to say it. (48:08) Which

Cecilia (48:08) I outside of my kids

Scott Benner (48:11) You are.

Cecilia (48:12) I'm kind of one of those people. (48:13) But Yeah. (48:13) When it comes to my kids, no.

Scott Benner (48:15) Yeah. (48:16) It just it doesn't happen for everybody. (48:17) No. (48:18) And and by the way, if they're listening, this is not a judgment on you either. (48:23) I just think this is how it goes.

Scott Benner (48:24) It's like, you know, it's like that thing where they hold up the picture of the dress and it's purple or it's yellow or something. (48:29) And, like, sometimes you see one and sometimes you see the other. (48:32) Sometimes you react a certain way and sometimes you don't. (48:34) I don't think it's because you're not paying attention or you don't I don't think it's any of that. (48:38) I think it's just, you know, people's personalities.

Scott Benner (48:40) So imagine what happens when a very get along to get along person bumps into an endocrinologist who doesn't know what they're doing. (48:50) That ends up with ten years from now, your a one c is, like, eight, and you're like, I'm doing good. (48:55) They told me I was doing good. (48:56) Yeah. (48:56) You don't know any better, and they don't know any better.

Scott Benner (48:59) And then your two year old is thirty two one day and says, hey. (49:03) Why are there clouds floating in front of my eyes?

Cecilia (49:05) Right. (49:05) Well, and that's why I was getting so frustrated once I started listening to more episodes. (49:09) I'm like, why are we not telling people this?

Scott Benner (49:11) That's why I'm making the podcast, honestly.

Cecilia (49:13) Yeah. (49:14) I appreciate it.

Scott Benner (49:15) Yeah. (49:15) Very beginning, my wife was like, I don't know about all this. (49:18) And I was like, are you comfortable knowing this and not telling other people?

Cecilia (49:21) Right.

Scott Benner (49:21) I was like, because I'm just not we got lucky and figured it out. (49:26) And what now we're gonna go, like, just off and live our lives and and know all those people are still, like, being diagnosed or or forgetting even being diagnosed at this point, like, plenty of people. (49:38) I found myself telling a story this weekend, and I think it fits here. (49:43) So give me give me a second if you don't mind. (49:45) Mm-mm.

Scott Benner (49:46) Before the podcast was, I guess, somehow online known as a person that if you got in contact with, I had this kind of sharp forty five minute chat I could give you on the phone. (49:55) It would kind of put you in the right direction. (49:57) Right?

Cecilia (49:58) Mhmm.

Scott Benner (49:58) And so people would often say you know, see someone online struggling and say, oh, you should reach out to this guy. (50:04) He might help you. (50:05) And I I ended up on the phone one day with a woman, best of my recollection, was kind of in her mid forties, but she was a single mom with, like, seven kids, like, a lot of kids. (50:15) And, she had type one. (50:18) So she had type one, and she gets on the phone and says, hey.

Scott Benner (50:22) Like, I struggle all the time. (50:24) People said you might be able to help. (50:25) I gave her the talk. (50:27) You know? (50:27) Next day, she reaches back to me and asks if she can text me.

Scott Benner (50:31) I say yes. (50:32) She sends me a graph. (50:34) It's super like, looks so much better. (50:36) Asks if she can call for a second, and I say, sure. (50:39) She gets on the phone.

Scott Benner (50:41) We're chatting a little bit. (50:42) She tells me what she did, how it worked, you know, she was happy. (50:46) And then she just got angry, like, really, like, viscerally angry.

Cecilia (50:50) Mhmm.

Scott Benner (50:51) And I was like, hey. (50:52) You alright? (50:53) And she goes, why didn't anybody tell me this? (50:55) Yeah. (50:56) And then she kinda started to repeat it.

Scott Benner (50:58) Yeah. (50:58) Like, why didn't anyone tell me? (51:00) She goes, I have complications. (51:02) The part I'm not telling you is that, like, during the conversation she she shared with me, she was worried not that she wasn't gonna see her kids grow up and have grandchildren. (51:11) Like, she wasn't sure she was gonna get them out of high school.

Scott Benner (51:14) Like, Jake, she was worried about dying. (51:16) Yeah. (51:16) You know what I mean? (51:17) And over and over again, the part that stuck with me, that one sentence, why didn't anyone tell me this?

Cecilia (51:23) Mhmm.

Scott Benner (51:24) And that's kinda how I feel about it now. (51:26) Like, I sort of feel like with diabetes information, I feel like this. (51:32) There's a volcano in town, and it's about to erupt. (51:36) And if I don't tell you all, you're definitely gonna get hit by the lava.

Cecilia (51:39) Yes.

Scott Benner (51:40) And if I tell you, some of you are gonna get away and some of you are gonna decide to stay and some of you might trample each other in the street, but at least you've all got a fair shake to get away from the lava. (51:51) Yes. (51:51) That's how I feel about this now. (51:53) So Yeah. (51:54) Because that woman's tone in her voice, she was crying.

Scott Benner (51:57) Why didn't anyone tell me? (51:58) I've lived with this for thirty years or more. (52:01) You only talked to me for forty five minutes on the phone. (52:04) Yeah. (52:05) Yeah.

Scott Benner (52:05) Anyway, wasted time, I find I find that deplorable. (52:09) I find it deplorable wasting people's time. (52:11) So Mhmm.

Cecilia (52:12) And that's how I felt listening to the episodes. (52:14) I would tell my husband, you know, I'd listen to them on the way to the grocery store. (52:17) I'm like, how, you know, are all these people not knowing this information? (52:20) Like, this can change everything. (52:22) It changed our whole way of how we helped her deal with it.

Scott Benner (52:25) And it's super simple too. (52:26) Like, I'll go

Cecilia (52:27) It really is.

Scott Benner (52:28) Yeah. (52:28) Let me go on to make this point. (52:29) I am not some genius telling you some super difficult thing to understand that I just happen to know and no one else knows. (52:36) And it's it's I mean, it's really it's basically diabetes common sense. (52:41) You just have to know enough of it to make sense of it to put it together before you can regurgitate it.

Scott Benner (52:46) But, like, to be a diabetes educator or anywhere in between, to be somebody at a at a clinician's office who says, come here, and we'll help you with your diabetes, who doesn't know at least as much as my dumbass does.

Cecilia (53:00) Right.

Scott Benner (53:01) It's really disgusting. (53:02) Yeah. (53:02) Yeah. (53:03) Really is. (53:04) Anyway, I'm glad you found the information.

Scott Benner (53:06) It was helpful.

Cecilia (53:07) Yeah. (53:07) Me too.

Scott Benner (53:07) Seriously. (53:08) If there's any other nice things you wanna say about me, now would be a good time. (53:11) Just kidding. (53:12) Is there anything else

Cecilia (53:12) you I mean, I just really like the podcast, and I to everybody, you know, every new mom that comes on the Facebook group, oh, we just got diagnosed. (53:19) Tag the podcast. (53:21) Tag it in TikToks. (53:22) There's a really fun girl that I follow on TikTok. (53:24) I've been telling her she needs to come on here.

Cecilia (53:26) Addie Taylor, I think her last name is. (53:30) I know Marley has tried to tell her to go on there.

Scott Benner (53:33) Marley's on it last week.

Cecilia (53:34) I was yep. (53:35) I was just listening to part two this morning, actually. (53:37) Wait.

Scott Benner (53:39) Is Addie the one who does the she have dark hair and she puts her devices on a lot? (53:43) Is that her? (53:44) Yes. (53:44) Oh, I like her. (53:45) I feel like I've been in contact with her.

Scott Benner (53:46) I don't know.

Cecilia (53:47) Well, I tagged you and she was like, no. (53:49) I can't do that. (53:50) And you said, why not?

Scott Benner (53:52) Oh, I

Cecilia (53:52) said, yeah, Addy. (53:53) Why not? (53:54) She's about to run the New York City Marathon too. (53:56) So

Scott Benner (53:57) Yeah. (53:57) Some people don't have the, I don't know, long form. (54:00) They don't wanna sit and talk or whatever. (54:02) Maybe she may listen. (54:03) Let's be honest.

Scott Benner (54:04) Maybe she thinks I'm an asshole, and she's trying to be polite. (54:08) You know that. (54:08) Maybe. (54:09) Who knows? (54:09) You have no idea.

Cecilia (54:10) But we've learned so much from her too. (54:12) And so it's, you know, it's great.

Scott Benner (54:15) Yeah.

Cecilia (54:15) It's a really good con I hate to say it's a really good community to be a part of, but I have not met one person, whether it be through a TikTok, a Facebook group, whatever, that has not been willing to help.

Scott Benner (54:28) Yeah. (54:28) No. (54:29) I hear you. (54:30) I think that the community part is super important.

Cecilia (54:32) Mhmm. (54:33) So, you know

Scott Benner (54:34) Can I ask one more question then before I Absolutely? (54:36) Yeah. (54:37) Are you more comfortable in chaos?

Cecilia (54:40) Yes.

Scott Benner (54:41) And does calm feel like something bad's about to happen?

Cecilia (54:45) Yes. (54:46) I'm always waiting for the other shoe to drop.

Scott Benner (54:48) Mhmm. (54:49) Mhmm. (54:50) Mhmm. (54:50) Catholic, by any chance? (54:52) No.

Scott Benner (54:53) No? (54:53) Okay. (54:54) So this is just the divorce thing?

Cecilia (54:56) I mean, yeah. (54:57) It's probably yeah.

Scott Benner (54:58) Any drinkers in the family growing up?

Cecilia (55:01) Yes.

Scott Benner (55:02) Have you ever looked at the Aces list?

Cecilia (55:04) Oh, I score high on that.

Scott Benner (55:05) Yeah. (55:06) Yeah. (55:06) You've already already checked that out?

Cecilia (55:07) Yeah. (55:08) Yeah. (55:08) I have. (55:09) My therapist had me do that. (55:10) Uh-huh.

Cecilia (55:11) Here it Yep.

Scott Benner (55:12) It's weird because it feels like you're playing an online game where you're winning because you're like, oh, yeah. (55:15) That's me. (55:15) That's me. (55:16) That's me. (55:16) Then you realize

Cecilia (55:17) I was like, oh, I scored so good. (55:19) And my therapist was like, no. (55:21) That's weren't this is not as funny as you think it is. (55:24) Yeah. (55:24) But, you know, you gotta laugh.

Scott Benner (55:26) Yeah. (55:27) So you have that going on. (55:29) Blah blah blah. (55:29) So how has that tran how has that translated into your parenting? (55:33) Are you are do you look

Cecilia (55:35) into I joke now that my kids are gonna have to go to therapy because I'm too involved.

Scott Benner (55:39) Oh, okay. (55:41) Way too nice to them. (55:42) Yeah. (55:43) We never had anything bad happen. (55:45) One time, I almost fell, but my mom threw herself under me before I hit the ground.

Cecilia (55:49) A 100%. (55:50) Yes. (55:51) Yeah. (55:51) I just

Scott Benner (55:52) bounced off my mom and came right back up again from my feet.

Cecilia (55:54) Yeah. (55:55) Yep. (55:56) Absolutely.

Scott Benner (55:57) It's interesting to know that. (55:58) Okay. (55:58) Alright. (55:58) I appreciate you sharing that with me here at the end. (56:00) Thank you so much.

Cecilia (56:01) You're welcome.

Scott Benner (56:02) Hold on one second for me. (56:03) I wish you would have been horrible because I could've I could have called this episode, Cecile, you're break you're breaking my heart or something like that.

Cecilia (56:10) Oh, sorry to disappoint.

Scott Benner (56:11) No. (56:12) I don't think it's I don't think you should apologize for it. (56:15) But, really, if you were just a dick one time, it would have been awesome for the title.

Cecilia (56:19) Do you know? (56:21) Didn't happen in

Scott Benner (56:22) day. (56:22) Say something terrible if you no. (56:23) I'm just kidding.

Cecilia (56:24) It's too early in the morning.

Scott Benner (56:26) It is, isn't it? (56:26) Alright. (56:27) Hold on one second. (56:34) Dexcom sponsored this episode of the Juice Box podcast. (56:37) Learn more about the Dexcom g seven at my link, dexcom.com/juicebox.

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#1695 Bolus 4 - Lettuce

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Scott and Jenny talk about how to bolus for lettuce.

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

Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox podcast

in every episode of Bolus for Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a roadmap called meal bolt. Measure the meal, evaluate yourself. Add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to Juicebox podcast.com. Forward slash meal, dash bolt. But for now, we'll find out how to Bolus for today's subject,

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? Number four on the US Top most consumed vegetable list. I thought this was going to be number one because of how many people I see eating salad. I just thought lettuce has got to be up there. Like and I mean, number four is pretty high on the list, obviously,

Jennifer Smith, CDE 1:39
well, and it's also not just salad, but it's used in sandwiches. It's everywhere. It's everywhere, right?

Scott Benner 1:46
But here, here it is. Some of the other ones have been talked about about, like, the pounds that people take in a year. This doesn't get spoken about this way. On my list, it says it's one of the most purchased leafy greens, and about 20% of all vegetables consumed, iceberg and romaine lead it out. So that's it. So mostly people are eating romaine or iceberg, lettuce or iceberg, yeah, that's a lot. So carbs in lettuce, I don't like. How do you even want people to think about this? Is it like, what when we're doing this, you know, when we're measuring? Is it like? Am I counting leaves? Am I just trying to, like, see the size of the bowl and get like, a vibe, you know what I mean?

Jennifer Smith, CDE 2:28
Because it goes along with that fist again. Yeah, a fist is a cup, a cup of greens that are either romaine or iceberg, which are primarily like, especially iceberg is primarily Hollywood and, like, fibrous structure, really, right? It's like one, or maybe one and a half grams per fist sized portion. It's really not, it's not countable. In the grand scheme of things, like you've got a lettuce leaf on your sandwich, are you counting a gram of carb? I can guarantee it's probably, from a legal standpoint, counted in the carb content in nutrition facts for a chain type of restaurant, right? Should you be adding it? Oh, you added three lettuce leaves to my burger today, really?

Scott Benner 3:17
Yeah, that's the way I'd like to talk about, like, how much leafy lettuce would you have to eat to get to like, this is five carbs I need the like, Would it be a, like, a ziplock bag of it? Like, a lot,

Jennifer Smith, CDE 3:31
five fists, really, if you consider, if you just dull it down to one gram per fist, like five cups of greens that are not really nutrient, it's a lot of just Iceberg lettuce.

Scott Benner 3:42
Okay, so we don't need to think too hard about that, but no, let us think about the rest of it. So I just randomly picked one chain restaurant that I happened to drive by the other day. So sorry, Red Robin if you're offended by this, but I have here a Red Robin Caesar salad, 230 calories, 190 of those calories are from fat. There are 21 grams of fat in this salad, or saturated cholesterol, not bad. 15, sodium, 368, carbs or protein. That's their little Caesar salad, right? But they have a list of of salads here. And there's an avocado. Excuse me, there's an avocado salad. I don't know who named that, but well done. 25 carbs, the Caesar, like I said, eight chicken tortilla soup, going back down the salad, crispy chicken tender salad. We've all seen that ordered that's got 60 carbs in it.

Unknown Speaker 4:44
I was gonna guess about 50.

Jennifer Smith, CDE 4:46
Yeah. And where do you think all the carbs come from? I It's not from the iceberg lettuce.

Scott Benner 4:50
No, it's gonna be the breading on the chicken. The protein itself, there's more, although protein in that salad is, let's see crispy chicken tenders. Wow, there's. 38 grams of protein in that.

Speaker 1 5:02
So 38 grams, they're about, what is that? That's like seven that's about five ounces of protein.

Jennifer Smith, CDE 5:13
And so if I consider the carb content being where it is, there's got to be something in the dressing that's pretty carby.

Scott Benner 5:22
I'm gonna guess there's also in this crispy chicken tender salad, 50 grams of fat, yeah, and sodium, wow. Go ahead, guess the sodium in the salad.

Speaker 1 5:36
I'm gonna guess either. It's probably about 1200

Scott Benner 5:41
milligrams, almost 1500 Yeah, almost 1500 milligrams. So, yeah. Anyway, that's it. Now you go down here and you say, Oh, well, the there's the mighty Caesar salad, because there was a little side Caesar and that didn't seem bad. It only had, you know, certain amount of carbs in it. But the mighty Caesar salad, first of all, has 760 calories in it. I don't think you're buying a salad for to get 1000 like, that's a lot of calories, yeah, 18 grams of fat. It's got a lot of cholesterol on it. 70 milligrams of cholesterol, 14 180 milligrams of sodium, 36 carbs, 28 protein. It doesn't say there's chicken in it, though. Anyway, like, this is the kind of stuff that I'm talking about. Like, the southwest salad, 910, calories.

Jennifer Smith, CDE 6:26
I think the big picture that are the behind the scenes that I see in terms of how to Bolus for lettuce. Like, if you have eaten something like this, this was your your meal choice, and you really go off the rails. Blood Sugar wise, after the meal. You shouldn't be blaming not counting the lettuce. Yeah, it's, I guarantee it's not the miscount of five grams of lettuce.

Scott Benner 6:48
That's the point of putting this one here. It's your lettuce is a delivery system for something else. That's it. Like, I once heard somebody describe baked potato as a delivery system for butter or in sour cream, like that. Sort of it like i There are items on this menu. I'm not picking on them. I just literally randomly came to it. But there are items on this menu that you would think of as not healthy for you, and some of them are better for you than the southwest salad, I'm sure. Yeah, which you know, 910, calories, 61 grams of fat. Gosh, that's crazy. 18 150 milligrams of sodium, 47 carbs. That's a lot like that. Literally, there's the whiskey river barbecue chicken wrap. Ain't much worse for you. Like, so, right? And again, a lot like, just rolling down here, like, I'm not even, like, forget what I'm looking at. These are just their their menu stuff. When you get into the meals, the carbs, everything is 40, 5060, like, and you go out to dinner and you do your gazethas from home, you're not getting up to that, you know what I mean.

Jennifer Smith, CDE 7:58
Well, and even 40 grams for a restaurant meal that's actually pretty low in carb. Or a typical today restaurant meal, usually it is much heavier, and unfortunately, that is the place that a lot of people get frustrated, because they may use their whole meal as a comparison tool. They might say, Well, when I eat pasta at home, it's 45 or 50 grams of carbs. So then they get to the restaurant and they count that, and they end up not with the results that they had at home. Well, you knew all the ingredients at home. It was a good base. It was a good place to estimate or swag from, but there are so many more pieces to it, like the portion probably was double what you would normally put on your plate. At home, the sauce absolutely was made with more sugar than maybe your no sugar or homemade marinara sauce. At home, did you eat the bread before the meal that maybe was miscounted? And at home, you don't have the bread before the meal grease, you

Scott Benner 9:01
know, everything, everything's fatty because it tastes better. So I just, you know, I know this isn't lettuce, but because we're talking about going out real quickly, there are two different size chocolate shakes available. They call them malts, but there's a monster size and a kid size. The monster size has 160 carbs in it, and the kids size has 83 and that's a kid size, Kid size is 83 Yeah, so the monster size is 1080 calories. So that's pretty much half your calories for the day, right? Anyway, that's the kind of stuff like. I just think when you're in a restaurant, you look at that salad, you don't think about everything else. And, you know, I'll throw in, I'll throw in this little piece here, because I don't, I think it's hard to count carbs in a restaurant. You know, you're fighting with your kids, 250 303 50 blood sugar, and you're nickel and diming it with like, I'll give them another half a unit. Like, you know what I mean, a half a. Unit you're you missed by 4050, carbs here, you know, like, this is gonna be all day. And then people like, from the missed lettuce. And it wasn't the lettuce, if you want to, if you want to just eat a hand, like Jenny said, if you want to have a fistful of lettuce, you know, it's a carb. It's a carb, you can evaluate that and do everything you want to do. But anyway, it's not the lettuce. It's getting you. That's the delivery system for whatever is getting you. Yes, all right, I'll see you, Jenny. Thank you. Thanks.

In each episode of The Bolus for series, Jenny Smith and I are going to pick one food and talk through the Bolus thing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward slash, meal, dash, bolt. But here's what it is. Step 1m. Measure the meal. E, evaluate yourself. A, add the base units, l, layer a, correction. B, build the Bolus shape, O, offset the timing. L, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load, and then we evaluate yourself. What's your current blood sugar, how much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress, hormones, illness, what's going on with you. Then a we add the base units your carbs divided by insulin to carb ratio, just a simple Bolus l layer, a correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape. Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes? Are we going to have to, again, consider combo square wave boluses and meals, figure out the timing of that meal, and then L, look at the CGM an hour later. Was there a fast spike? Three hours later? Was there a delayed rise? Five hours later, is there any lingering effect from fat and protein? Tweak, tweak for next time t, what did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus for measure the meal, evaluate yourself. Add the base units, layer a correction, build the Bolus shape, offset the timing. Look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox podcast, the episode you just heard was professionally edited by wrong way recording, wrong way recording.com,

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