#1411 GLP Essentials with Dr. Hamdy

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Dr. Hamdy, Medical Director of the Obesity Clinic Program and Inpatient Diabetes Program, discusses GLP medications and the important steps to take when using them.

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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
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I'm very excited to share this episode with you. I'm talking today with Dr Hamdy. He is a senior staff physician at Joslin Diabetes Center, the Director of International Medical Affairs, the Medical Director of the obesity clinic program and inpatient Diabetes Program, and an associate professor at Harvard Medical School. And he's here today to share his very important message for those of us using GLP meds, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin when you place your first order for AG, one, with my link, you'll get five free travel packs and a Free year supply of vitamin D drink. AG, one.com/juice, box. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help.

The episode you're about to listen to is sponsored by Omnipod and the Omnipod five. Learn more at omnipod.com/juicebox use my links to support the show. We're also sponsored today by touched by type one, and they have something great coming up on March 8. Touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Osama Hamdy, MD, PhD 2:06
I'm Osama Hamd,. I'm the Medical Director of the obesity clinical program at Joslin Diabetes Center and associate professor of medicine at Harvard Medical

Scott Benner 2:16
School. How did we meet each other? Who put us in touch? Do you remember one of

Speaker 1 2:21
our nurse practitioner, Daniel rock,

Scott Benner 2:25
what did she tell you? I'm interested. What made you be willing to do this? Yeah,

Speaker 1 2:30
he told me it is a very popular broadcast, very efficient broadcast. He follow a lot, and he thought that it would be a good idea that we comment on muscle mass and some of the work that we frequently do in that space on obesity. I had been in obesity field for 40 years now, wow, and I created the obesity clinical program at Joslin Diabetes Center as one of the biggest programs. We had been doing several weight management. You know, we did research that cost us almost $16 million to come with the the best weight management, multi disciplinary weight management program for our patients. It's called, why weight, weight achievement, intensive treatment. And then we have another program called diabetes remission outcome program, drop program, which aimed for diabetes remission in early inpatient, was early diabetes.

Scott Benner 3:27
Can I go to the beginning and ask you about how we got to that? Yeah, yeah, we can. You can ask whatever you would like. You know, you've been in it for 40 years. Let me ask you what got you into it, and what was it like back then, versus what is it now, and how did it change throughout the time? Oh,

Speaker 1 3:44
there is major, major change. You know, the whole concept that link obesity to diabetes was not clear in the old days. You know why people with obesity develop diabetes? Who will develop diabetes? Why Some develop diabetes and others are not until we discover the whole idea of insulin resistance, that once you are obese, and especially if you have more fat in the abdominal area and visceral area, you'll become insulin resistant. And this could be the reason why people, when they gain weight, the start to develop diabetes. So my early research back almost 25 years ago, we found that 7% weight loss improves insulin sensitivity by 57% Wow. So I remember I was whispering to my colleagues at that time, telling them that means diabetes is not a chronic disease. Actually, in reality, we can reverse diabetes. But that concept was not there at that time. Concept that this is a chronic disease, whatever you will do, there is nothing that can reverse it. But people who repeated those studies found 7080, even 90% after. Bariatric surgery significant improvement in insulin sensitivity, which means that if you catch it early enough, especially within the first five to seven years, you can actually reverse diabetes. So

Scott Benner 5:12
for type two, how does the bariatric help? Does it help with the weight loss, or does it help with the with something else, too many?

Speaker 1 5:19
The best to answer is that patients with after bioethic surgery, they stop their diabetes medication in frequently. Why they are in the hospital even before weight loss?

Scott Benner 5:32
Why do you think that is the what's the cause and effect? It is a

Speaker 1 5:36
reduction, significant reduction, in the anti hepatic fat, so when they are in the hospital. After surgery, they are not on oral feeding that much. It is all IV fluids or IV glucose. There is significant deficiency in nutrients in the beginning. So the easiest for the body to do is to take the fat inside the liver and use it as as a source of energy. And immediately, with the reduction in the intra hepatic fat, you will, you will start to see improvement. And then later on, when they start to lose weight, that's when you get the maximum improvement.

Scott Benner 6:17
Wow, that's insane. So, so you saw that you saw, give these people bariatric surgery, they what can reverse type two or stop pre diabetes, either or,

Speaker 1 6:29
you know, it depends in at what stage you are doing. If you are in the pre diabetes phase, definitely okay, you will prevent the type two diabetes. But if you're already on type two diabetes, when it is shorter duration, less than five years, definitely remission can occur for how long that remission will maintain. It is not studied significantly right now.

Scott Benner 6:53
So is the biggest hurdle, then, is losing the weight, not

Speaker 1 6:58
losing the weight in precisely it is when you lose weight, when you say lose weight, you lose muscles, you lose fat, but when you are when we are talking here, we are talking about the critical fat in the body. This is the intra abdominal fat and intra hepatic fat, visceral fat, intramuscular and sufficient fat, all this ectopic fat is dangerous. Okay, this is a problem.

Scott Benner 7:25
I hear people talk about all the time how extra fat impacts hormones and causes hormonal issues. Is that, is that something that you're aware of, today's episode of The Juicebox Podcast is sponsored by Omnipod. Before I tell you about Omnipod, the device. I'd like to tell you about Omnipod, the company. I approached Omnipod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet because the podcast didn't have any listeners. All I could promise them was that I was going to try to help people living with type one diabetes, and that was enough for Omnipod. They bought their first ad, and I used that money to support myself while I was growing the Juicebox Podcast. You might even say that Omnipod is the firm foundation of the Juicebox Podcast, and it's actually the firm foundation of how my daughter manages her type one diabetes every day, omnipod.com/juicebox whether you want the Omnipod five or the Omnipod dash, using my link, let's Omnipod know what a good decision they made in 2015 and continue to make to this day. Omnipod is easy to use, easy to fill, easy to wear, and I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omnipod, but please take a look omnipod.com/juicebox I think Omnipod could be a good friend to you, just like it has been to my daughter and my family. That's

Speaker 1 9:05
absolutely right, and I wrote about it before. You know adipose tissue is not an inner tissue. This is an endocrine gland. It secrets hormones like, for example, Leptin hormone, the satiety hormone, the major satellite hormone is coming from adipose tissue, from fat tissue. There is another hormone called the bone actin, which actually increase insulin sensitivity. Unfortunately, when people are obese, adiponing is low, and that's why they are insulin resistant. Interestingly, when you lose weight, adiponing start to go up. And to make it even more complicated, visceral fat is different than subcutaneous fat. Okay, those are two different organs in their genetic expression, in their hormonal secretion, in their even relationship to each other. And so the distribution of fat is. More important when it comes to the endocrine function of the devastation.

Scott Benner 10:03
How does it impact satiation? Yeah, there is a hormone

Speaker 1 10:07
comes from subcutaneous fat. Subcutaneous fat, okay, there's external fat, not the internal fat. It's called leptin. So Leptin is a hormone, one of the major hormone that induced satiety. Just to consider leptin as a defense lawyer for your fat. You know, anytime you start to lose fat, leptin goes up Shut your appetite. Try to preserve fat as much as you can. And interestingly, leptin has a circadian pattern, so it is mostly secreted between 8pm till 8am that's why we will are eating during the day, and they don't eat during during those hours, right? Exactly, right. So let me give an example. If we will get leptin abnormality or Lipton deficiency, they start to eat significant amount of food in the evening. We call them night eating syndrome. So night eating syndrome affect around 2% of the US population. And the eating average studies showed, in average is three big meals after their supper, three big meals. Each meal is 1250 calories. So you can imagine if that hormone is just deficient. Yeah, wow. Some people are, they are born, but this very rare born nose lipicsy And they are very obese from their

Scott Benner 11:34
younger childhood. For people who would say, just do a setup, go for a walk, like, can you tell them why that doesn't work all the time for people who are or in this situation,

Speaker 1 11:46
you know, your your body, need different types of exercise, and each exercise had its own benefit. It is, you know, walking is aerobic exercise. This is very valuable for your heart, for your cardiac effect. But other types of exercise has measured, measure different, different angle. For example, you you need, you need to stretch your body. And stretching your body, which people can do it just for 10 minutes in the morning, increase blood flow to to the body, reduce energy injury, improve movement across the joints. There is a lot of benefit from stretching, but the most important component of exercise is actually strength exercise. Okay, and you cannot do exercise without doing muscle strength exercise. And the reason, the reason is that as you age, you lose muscle mass over time. So normal people without diabetes lose around 5% of their muscle mass every 10 years from age 30 up, people lose diabetes lose around seven to 8% of their muscle mass every 10 years from age 40 up,

Scott Benner 13:02
do we know why people with diabetes lose more than people without?

Speaker 1 13:06
Oh, yeah, there are that is a very complex metabolic issue. But the bottom line is that from age 40 to age 70, you lose around 24% of your muscle mass. I see by ages 70 up, you lose 15% of your muscle mass during your lifetime. If you live till 40, from 40 till 80, you lose 40% of your muscle mass.

Scott Benner 13:32
Is that something that I can I can't stop it completely, but I can get in the way of it, right, try to to slow it down. Is that the idea?

Speaker 1 13:39
Yeah, yeah, no, you do all the effort to prevent it, right? Because loss of muscle mass is, in my personal opinion, is a crime. You know, if you lose your muscle, or anything that makes you lose muscle, you will be in terrible scenario. This is how frailty occurs. This is how we will get poor quality of life. You can even stand from your chair. It is a problem, but there are three major problems. Just to be clear, there are three major problems when you lose muscle mass. Number one, you will not regain muscle mass. You can't get it back, bye, bye, muscle mass. It is very difficult, because you build the muscle mass over years by three hormones, growth hormone, insulin, sex hormones, okay, when you get older, all those hormones are noose down, so you don't have them, so you cannot build muscle mass that much in your older age, or I will say, from even middle age, there's a first problem. Second problem is, once you lose muscle mass, your energy expenditure start to go significantly down, to a degree that if you return back to eat whatever you used to eat, you gain weight, and that weight is not my. Muscle and fat. It is mostly fat. So every time that you lose weight, you lose muscle, and then you gain fat. If you return the back and then recycling, go care. And this leads to what's called sarcopenic obesity. Sarcopenic Obesity means you lose muscle and then you have more fat, okay, but if you age normally, you lose muscle all the time, until you reach a sarcopenia. In this scenario, I say, Okay, the third drawback, just to complete the drawbacks of losing muscle mass, that quality of life start to go significantly down and by percentage loss in the muscle mass. So if you lose 10% your performance of the muscles start to go down. 20% you start to have reduction in your immunity, and you get infections and and problems. 30% you can get pneumonia with zords. 40% of muscle mass loss means mortality will be significantly higher. So

Scott Benner 16:00
how do we balance in I guess, starting with obese or type two community, people are getting GLP medications. They're having some of them significant benefits as far as weight loss goes, but so I don't imagine you would trade their weight loss. But how do you mitigate the muscle loss in the same situation, like, what else should they be doing that we're probably not telling them about Yeah,

Speaker 1 16:21
this is a very, very important issue, because we have to differentiate, Scott from the beginning, between quality weight loss and quantity weight loss. Okay, the weight loss was in keratin mimetic drugs. This is a group of GLP one and GIP and GIP and all this group is volume weight loss, quantity weight loss, not quality weight loss. Quality weight loss is entirely different. Quality weight loss means you lose adipose tissue. You maintain muscle mass, you maintain muscle performance. And quality of life is much better. But if you lose the adipose tissue and lose muscle mass in the same time and have poor performance, weakness in the muscles and so on, you will you will be in in trouble. And that's exactly what happens with those medication. You know, people are happy with the volume of weight loss, but it is not a quality weight loss. So is it

Scott Benner 17:23
possible? Do you think to use the GLP and be exercising and supplementing at the same time to keep a balance? Yeah,

Speaker 1 17:30
we need a lot of research in that area. But theoretically, that's absolutely right. If you take enough amount of quality protein, if you do a Strengths exercise. Very good quality of strength exercise, especially in the muscle, in the bearing muscle the body, bearing muscles around the size and back and and all this area, I think maybe you will mitigate some of the problem with loss and muscle mass. Yeah,

Scott Benner 17:59
so you don't know this, but I am 57 pounds lighter than I was two years ago, and from a GLP medication. Now I try to balance that with a significant amount of animal protein, and I do a protein drink every day to make sure my protein is high enough during that what I try to do is light to medium weight training in the beginning, arms, legs, poor, but it was harder in the beginning, because I was so I was so out of shape. Now, the irony here, I guess, is that as far as the amount of calories I take in, obviously I take in less now, because the GLP, it does, obviously, you know, kind of shut down your hunger. But at the same time, I'm not eating that much less, and so I noticed a difference immediately. I don't have diabetes, I didn't have diabetes, but I would have described to you that throughout my entire life, my body never responded to food in a way that made sense. My digestion didn't work well, and I had to, as an adult for years, get iron infusions, because my ferritin would drop through the floor, like every six months. But since the GLP, I don't need the iron infusions anymore. I now defecate like a normal person would, like, I eat, I don't get sick right away. And like, it has changed so many things for me, and I don't know how to put it all into words, like it feels like it's having impacts that weren't intended by the label, and I'm done now, like I don't really need to lose any more weight. I have some mid section fat that I'm still working through, but everything else I've been able to to get rid of. But I'm 53 I have very dark hair, so it might be hard for you to see that right now. I got to the point in my life where I thought everything I've tried supplementing, exercising, eating, right, all the things that people talk about, none of it was happening like, it just it wasn't doing anything for me. And I thought, I'm gonna die if I don't do something like I genuinely thought I'd have a heart attack in the next 10 years. So I thought, well, let me get rid of this weight the best I can. I'll try to mitigate. The the muscle loss, as best I can, and now that the weights gone, I'm upping my activity and being more strenuous and looking towards more building. Because the exact same thing that you're talking about, like, I I just watched my mother, you know, at the end of her life, in her early 80s, like, not be able to get up and sit down and get out of a chair and, like, I don't want that to be how I go out, so I'm trying, you know, but I don't know if I'm doing the right thing. Because, to your point, they came up with the meds, and they were like, here, and people got so excited that everybody started taking them, and nobody really knows what they're doing. So I'm, you know, lucky enough to have a nutritionist that I talked to on the podcast who warned me early on about the protein and the muscle building. Nobody told me about that, you know, so I don't know, like we're in a weird spot right now, I'm wondering what you feel about all that.

Speaker 1 20:50
What you did is, right? You know, you try to lose weight, because, you know, initially, you are talking about the complications of obesity. You know, Obesity is a disease. You know it is not symptom or a sign. Obesity is a disease. And you have obesity, you have many metabolic and you have many mechanical problem and you are at very high risk for cardiovascular disease and diabetes and many other problems. That's why people are basically awful in that scenario. But reality is that many obese people are malnourished. In reality, you know, study among the US population found the US population in general, obese or non obese, 40% of them have micronutrient deficiency. So when you are talking about iron or any other test elements or any of minerals, 40% have macronutrient deficiency. What do

Scott Benner 21:44
you think that is because I don't eat I'm gonna try to hold this up to the camera. I don't eat much differently now than I did then. I was eating protein, I was eating healthy, I was taking supplements. But look, can you

Speaker 1 21:56
see that? Oh yeah, yeah, I can see it different. It's a significant

Scott Benner 21:59
difference in who I am now, and so that person in that picture doesn't eat much differently than I do. I can tell you that if I inject on a Wednesday and eat normally, everything's fine, but if, even if I get to the end of the half life on the medication, I can see myself starting to gain weight having not changed one thing about what I'm doing in day six and seven. Do you think that there's an inflammation component to this for some people? Because we're also seeing people use it for PCOS. We're seeing people use it for a number of different things that it's not on label for, that all seems inflammation related, but I don't know anything. I only know what's happening to me. I don't really know what's happening.

Speaker 1 22:42
You know, the medication does two jobs, okay? And this is a reason for weight loss. The first is chat appetite. It works on appetite center in the brain, chat appetite. And you know, most of the obviously, problem is related to larger abortion, frequent eating, stress eating, night eating, binge eating, all kind of stuff. So when you shut up, per se, you lose weight the second that is slow gastric evacuation. So basically, what you eat is slowly digested over time, because it takes longer duration in the Git to to move,

Scott Benner 23:22
and that's how I'm getting my iron from it now, because it's staying in there long enough for it to be extracted. Is that right,

Speaker 1 23:28
you know, but, yeah, when, when the food is slowly processed, definitely more digestion, more absorption, more rather than it, if there's, you know, a quick evacuation for, for, for that. But you know, once you lose weight, your body adjusts itself in many aspects. But the most important is that once you start to lose weight, the critical and the bad fat is a thirsty fat to go down, okay, the intra abdominal fat, the intra muscular fat, the intra hepatic fat, the intramyocardial all those ectopic fat start to go down. Once that visceral fat and intramuscular fat goes down, inflammation in your body will go way, way down. Okay, because that fat in your ectopic area is a source of the inflammation in your in your body. This was called sub clinical Corona inflammation. Why this happens? You know, when the fat cell gets larger. Let me explain it in a much better way. When the fat cell gets larger and larger and larger, it can, you know, can be a very big volume, the fat cell rupture. Actually, it is, I will not say rupture. It will be what's called fat cell necrosis. You know, the cell membrane of the fat cell get necrotized and so on. This death of the fat cell attract cells in your blood called the macrophages. Macrophages is like janitors. They come and to clean the debris of the fat cell. But. When they come in, there is it inside adipose tissue. We call them adipose tissue resident macrophage. They live in the adipose tissue. And this macrophages start to produce significant amount of what's called cytokines, inflammatory Cyto This is the reason why people get cardiovascular disease, heart attack, stroke, insulin resistance on type two diabetes is basically inflammation originated from macrophages raised in the adipose tissue in the ectopic area in your body. That's

Scott Benner 25:32
crazy. I never would have understood the pathway to that. That's really something. Yeah.

Speaker 1 25:36
So people who studied all this area, myself and many others found that the core problem of all this cardio metabolic issue is poor nutrition, because when you eat poor nutrition, you start to accumulate more visceral fat. Visceral fat attract the macrophages. Macrophages secrete inflammatory cytokines. You get inflammation, and then the three branch, dyslipidemia, hypertension, Corona, kidney disease, cardiovascular disease, until we will end up in ICU, heart attack or stroke.

Scott Benner 26:11
Is it possible that the increase in autoimmune issues like hypothyroidism, Hashimotos, type one diabetes? Could this all just be nutrient fat over generations?

Speaker 1 26:24
No, no, no. This entirely different scenario, type one diabetes and autoimmune disease, Hashimotos and autoimmune disease, those are entirely different. We are talking about the process of people who are gaining weight, and especially if they are gaining weight in this wrong area and the wrong area, the divorce tissue, in the visceral area, it can be just one to two kilograms of fat, but is extremely dangerous fat, okay, so you can, you can be lean and happy and so on, but you, if you have that visceral fat, you are at that major risk, like, For example, go, go to people living in South Asia and in India, the average body mass index, 2223 but if you do acidity scan for them, you'll find significant amount of edible station, okay, in visceral area, in the visceral area, that's why they get Diabetes at younger age you get cardiovascular disease at younger age, by age 4050, the may have heart attack. Yes, it doesn't matter how your body mass index looks like it is where that fat is located.

Scott Benner 27:33
So for people in India as an example, is that genetic, or is it food related? Is it more cultural?

Speaker 1 27:40
You know, the accumulation of fat and fat distribution in your body is based on ethnic background and some genetic components, like, for example, in the US, African American women accumulate more visceral fat than white women. In the in the in the same time, white men accumulate more visceral fat than African American. Men in Latin America, men and women accumulate more visceral fat. In South Asia, men and women accumulate more visceral fat. Middle Eastern is the same. Just to give you a very simple example of how this can be a problem. If you look to the women Indians and the Bema Indians, Native American they have the highest tendency to accommodate visceral fat. Do you know among the Bema Indians, the prevalence of diabetes 60% 60% because they accumulate significant amount of disorder of fat. You

Scott Benner 28:36
said something, I make sure I didn't misunderstand it if, if I take that same person, like you said, black women in America. Does that mean that black women on other continents don't have the same issue? Is there something to do with them being here or no? Not necessarily.

Speaker 1 28:51
Distribution of fat is entirely different across the globe. Like for example, if you are in the Mediterranean area, South Italy, South France, Greece, North Africa, we will accumulate fat in their periphery, in the lower area of the body, in the side. This is what is called pear shaped right obesity. This is entirely different than Apple shaped obesity, where the fat is accumulated around central

Scott Benner 29:17
area. Is one better than the other. Of course, yes, pear actually,

Speaker 1 29:20
if you have a pear shaped that fat will be protective. Ah, not even, not even harm. It is protective for your body. I want

Scott Benner 29:30
to get my belly into my ass. Is that what you're telling me?

Speaker 1 29:35
But not by transplantation, yeah, let me. Let me tell you something which is so funny. Yeah, when we did our study of the 7% weight loss and we found that insulin sensitivity improved that much, ballistic surgeons said, Oh, that's easy. Let us go and suck 7% of the body fat. Did that work. I will tell you they actually sucked the. 10% of body fat, 10% and I don't know how they suck the 10% i My brother is a plastic surgeon, and I asked him, how you how we can suck 10% of the body? He said, Oh, we have new techniques and and procedures and so on. But do you know the results? 00, benefit, because the what they removed is a wrong fat. They remove the subcutaneous fat, not the visceral fat.

Scott Benner 30:23
I see, oh, that's so disappointing, because I was going to start saving my mommy. When you talk about, I've heard people talk about before their doctors tell them that they sometimes have fat between and under their organs. Is that visceral fat?

Speaker 1 30:37
Visceral fat is inside the intra proteinal cavity, around the organs, around your intestine, all the entire organ and, of course, in the in the liver and around the stomach and all this, all that fat in the visceral lady, when you open the protein, the muscles and protein, you'll find that visceral fat.

Scott Benner 30:59
So the fat I'm left working on now is more about vanity and not about health or no, what

Speaker 1 31:06
you need? You need to reduce a visceral fat. That's that's the aim. You know, if you need health benefit, there's aim. But if you need to maximize the health benefit, you increase muscle mass, okay,

Scott Benner 31:18
the the way to get rid of this fat now is to build more muscle and

Speaker 1 31:22
build more muscles, okay, okay. And by the way, building muscles is the most important thing they can do in your life, especially in elderly population. Okay, so let us go back to the GLP one medication. Yeah, okay. And, but this is around the numbers about, you know what we have been talking about. If you lose weight by just cutting caloric intake, 25% of the weight loss is muscle. So if you lose 10 pounds, 2.5 pounds will be muscles, right? If you do exercise during weight loss, around 15% of the total loss will be muscles. Okay. So if you do nutrition, hypocaloric diet and exercise, the percentage of in muscle mass from the total loss is only 15% okay. When you inject the GLP one hormones. 40% of the total loss is muscle. Why

Scott Benner 32:23
is it different with the GOP than without it? You know,

Speaker 1 32:26
for, yeah, for many, many reasons. You know, a version of food loss of appetite, protein in general, is nussiating. People don't eat that much protein, macro nutrients becomes, you know, lower there is a lot once you suppress appetite and you are not eating, basically imagine someone in the hospital, sick not eating. They lose significant amount of muscle mass during that period. So 40% this is equivalent to around 20 years of loss in one year, 20 years of age, related loss and muscle mass. So this is not a small amount of loss and muscle mass. Like for example, if you look to the studies that had been done on semaglutide, the step one study, they take group of the population, and they did Dexcom to study body composition, and they found that people lost 17 kilogram in average, 17.57 kilograms are lean mass. Okay, seven kilograms are lean mass. This is around 4140 41% okay, of the that that loss, in a year, you are losing all point 5% of the muscle mass. So if you are aging normally, I told you, you lose around 5% ever, every 10 years, right? So in one year you are, you lost nearly around 20, 20% but lean mass is you have also the defined in mass. Lean mass is soft tissue, organs and muscles. Fat, free mass is different. Fat free mass is bone and muscles and all other tissues. But lean mass and muscles is nearly 50% of the lean mass. So the absolute loss in muscle mass, if you calculate it from that whole equation is around 10% 10% of your muscle mass is lost.

Scott Benner 34:25
But you still said you want people to lose the weight, so, like, Dan, so we have to, you got to keep eating, right? Like, I mean, listen, I've been using it for almost two years, and there are days that you have to just walk into the kitchen and say to yourself, I'm going to eat. I'm going to eat something good for me, because I it can happen. I'm not going to lie to you yesterday, I think at five o'clock yesterday, I thought to myself, Oh, I don't think I've eaten yet today, and I did not know it. I wasn't hungry, like my brain wasn't hungry. My stomach wasn't hungry. I was not hungry that. Doesn't happen to me often, but a number of things happened yesterday. People in my house got sick. Things got tossed around. I find it to be incredibly valuable to tell people like you have to eat like chicken, beef. You know, these things like nutrients, get your nutrition, take your supplements, do everything you can do to keep that going while being active, lifting weights, weight training. That's how I've tried to talk about it so far.

Speaker 1 35:22
You know what? We need to educate our patients who are getting on this medication, yeah, that you need to eat high quality protein and do enough strength exercise to mitigate the loss in muscle mass. So usually we will our average we will eat or the recommendation are 0.8 gram per kilogram of body weight. We recommend at our institute 1.2 to 1.5 gram per kilogram of adjusted body weight. But in general, after barretic surgery, the usual patients eat 1.5 gram per kilogram of your ideal body weight of protein, and it has to be high quality protein, right? High quality protein is not plant protein. High quality protein is mostly animal protein. So we have to differentiate, because the Amino the essential amino acids are very important. This is a building block of your hormones in your body. Insulin is insulin growth hormone, other protein based hormones are all a need for that essential amino acid.

Scott Benner 36:20
So now that we understand this about weight loss type two, like, let's sort of pivot a little bit, because a lot of type ones are starting to use glps for insulin resistance. I know it's off label still, but it's happening, and I'm seeing it more and more, to be perfectly honest. So do you have thoughts about how type one should be managing this?

Speaker 1 36:41
Yeah, it is not of label for obesity. Indication, no, no, of course

Scott Benner 36:46
not. But there are type ones now that are getting it for insulin resistance. So what they're doing is they're going to their doctor, and they're the doctor saying, Look, if you didn't have type one diabetes, you'd have type two diabetes, because I see insulin resistance here, and they're getting it covered. You

Speaker 1 36:59
know, I am among the people who created that term in the old days, double diabetes. Double diabetes, really. So double Diabetes means you are type one by auto immune mechanism. You are taking insulin, and so is a growth hormone. And every time you optimize your insulin, you're basically putting in your body more growth hormone blast. They are exposed to the same environment like anyone else, the environment of this activity and high carbohydrate eating and so on. They gain weight. Then they start to be insulin resistant, and then their need for insulin becomes higher, and the insulin is a growth hormone, makes them gain even more weight. So reality, we did that. We published a very nice article about obesity type two, and we were shocked, 53% of type one. Sorry, obesity type 150. 3% of people whose type one diabetes are actually overweight or obese now. Wow. This is totally different from 2030, years ago. Yeah. Let

Scott Benner 37:58
me tell you this, Dr him, because you don't know my daughter. The reason I come by this podcast, my daughter was diagnosed with type one when she was two years old. Yeah, and today she's 20 years old, almost 21 yes. She also seems as near as we can tell to have PCOS. Yes. It shows its head through acne, through painful, longer periods and insulin resistance. Like at some points in the last two years, my daughter's insulin to carb ratio was one to four, and her insulin sensitivity was as low as, gosh, I think 42 one to 42 and so her doctor put her on a GLP and her insulin sensitivity is now more like one unit covers 8085, her carb ratio is up to, like, almost to 10. It's like eight, between eight and 10. She did lose some weight. She did not have a weight issue, but it did, like, just through hunger. It knocked 20 pounds off of her. And she's tall, she's five seven, but she was probably 571 40 when she started, and she's more like 571 30. Now she got to 120 it was too much like she had lost too much weight. So we were stuck because she was doing Manjaro, just 2.5 and it was working great on her insulin resistance, working great for her PCOS, but it was making her not hungry. So what we ended up doing was we now take clean vials and milk the pen into a vial, and then give her less than the 2.5 and we have found the balance where it controls her blood sugars, helps her with her PCOS, but leaves her hungry still, and that has been like the sweet spot we found for so she gained back 10 pounds. She's at a very healthy weight now, and she probably uses, I'd have to guess, 20 to 25% less insulin than she was using before. And she just looks

Speaker 1 39:53
at that's usually the case. You know, we're an hour why wait program around 30 40% and. Range are type one, and we have significant experience in managing obesity in type one. You know, actually, we published several papers about it, and we have to differentiate between two issue, good. This is a benefit of JP one, or the benefit of weight loss.

Scott Benner 40:15
Yes, okay, yes, I know, and I, I struggle with the same thing. Yeah, the

Speaker 1 40:19
benefit of weight loss is huge. You know, you said that she went from 140 to 130 you mentioned at one point she lost she lost the 20 pounds. If she lost that much, she is now more insulin sensitive, she will use less insulin. For sure, the answer is more efficient, because every time that you become more insulin sensitive, your body responded to insulin is much better way. Yeah, so even less insulin can improve. But the most important is that she should continue to do strengths exercise, especially younger. Younger people benefit a lot from exercise because they they can build the muscles more than what you can do now. You know, from age of 40 up, it's very difficult to build the muscle, but in her age, it is easy to build the muscle. Yeah. So my advice for her is to eat more protein, enough protein, and by the way, protein per se, will improve hair diabetes as well. You know, we know that for years, and it doesn't raise a blood sugar up like carbohydrates, right? I have to

Scott Benner 41:22
tell you, like talking about it technically like this. It makes sense. Everything makes sense. It's the the actual living with it and losing your appetite and then having to eat and like, it seems like a vicious circle, like it's not, it's clearly not a perfect fix. But I've done two interviews this past six, eight months that I found astonishing. One was just with the mother of a then 13 year old girl who had had diabetes, type one for four years. She was using almost 70 units of insulin a day. She has antibodies. She has she's type one, right? But her mom had PCOS, and had used the GLP to lose weight and changed her life. The girl was gaining weight, so the doctor put her on the GLP for weight. But today, I'm still in contact with her. Today, her daughter's not wearing an insulin pump anymore and injects like one unit of basal insulin a day. I'm not saying it cured her. I'm certainly not saying that, but she's having an amazing impact on it. And I also had on a gentleman in his 50s who was type one for like, six or seven years, admittedly, Lata, right? It was a slower onset. He got put on zepbound for weight, which I know is Manjaro. He lost so much weight, they took him off his insulin, and he hasn't been on insulin for a while now, but he's got antibodies, and he is type one. And I expect one day that Lot of will complete its path and he'll end up on insulin. But for the moment, it's astonishing.

Speaker 1 42:48
It's quoted all. What you mentioned is not a surprise for me, Wow, because you remove the type two component, yeah, when they lose weight, the type two component, an insulin resistance component, is gone. They remain was type one. So the need for insulin becomes less and less and less. So to be down to one unit per hour on insulin pump or or sorry, or less, or whatever, not surprising, your body become insulin sensitive after you lose weight. Whether you are type one or type two, if you are type two, you get remission. If you are type one, you remain on answer, but in a very small dose.

Scott Benner 43:24
So then this double diagnosis isn't just a way to trick your insurance company. It's important to know if you have both of those impacts,

Speaker 1 43:30
we don't have COVID for double diabetes, right? You know, you cannot tell insurance that that person has double diabetes. The insurance understand from ICD 10 that either type one or

Scott Benner 43:41
type two. Your opinion, should there be a double diagnosis code, double diabetes? Yes, we should

Speaker 1 43:45
diagnose double diabetes in in people. But my advocate for that term to be used scientifically, rather than just be used that way. I want to thank you

Scott Benner 43:54
for a second, because I didn't really know where our conversation was going to go today. You've indicated me because I took a fair amount of crap online for putting those two episodes up where type ones used the GLP and then came off their insulin. I got a lot of pushback from that. I mean, I understand why, like, type ones don't want you running around telling people, like, don't take your insulin, which is not what I was, you know, definitely not what I'm saying either. I think it does point out how much over the years, old ideas get folded into new ideas, and then along the way, like something gets lost in translation along the way. Do you know? Do you know what I mean by that? Because you said something earlier that made me feel the same way, and it was around the double diabetes, because I had heard people say that in the past, and then other people come along and they poo poo. It like you're either you're type one or your type two. It's then that becomes the argument. You know,

Speaker 1 44:43
let me Scott, let me make it more complicated. We are looking in the future in precision medicine of diabetes, and there will be no type one and type two. There are five different phenotype clusters. Okay, each cluster is treated in entirely different. Way. So type one will be under a cluster called auto immune, severe auto immune diabetes, or said sa ID, severe auto immune diabetes. This will include type one and ladder the antibodies are positive in them. There is another group that exactly similar in the phenotype, but without antibodies. It's called severe insulin deficiency, diabetes, and this is around 18% of people with diabetes, so they are not making insulin. They are lean people, but if you test antibodies, it's negative, and then you have mild obesity, diabetes. This is a common type that we think that, or most people think that this is type two diabetes. That's actually 22% only of all people with diabetes and the diabetes in mild obesity, diabetes is related to obesity. Take the obesity out of the door, diabetes will go out of the window. And this group significantly benefit from weight loss, whether multidisciplinary weight loss or by pharmacologic or by bariatric surgeon I see, and then you have another phenotype cluster called severe insulin resistant diabetes, or cert this group had the severest insulin resistance their body, all the body is resisting insulin, liver, muscles, a divorce tissue. This group, weight loss can be very beneficial. If you see one of those people, they need 100 units of insulin, even 200 units of insulin, sometimes. And then you have mild age related diabetes. This is the biggest one. When you get older, you get diabetes. This is around 39% of people whose diabetes, wow. Basically, understanding the phenotype clusters in the future can tell us who will benefit from what we call it now, type two diabetes is not all of them, but mild obesity diabetes, which is around 15% 22% and the severe insulin resistance around 15% so 27% 20 37% of people with diabetes will benefit significantly from weight loss.

Scott Benner 47:00
What's the roadblock in making this more well understood in for clinicians,

Speaker 1 47:06
you know, this is a classification that you expect to come in few years from now. Okay, there is a cooking for this classification now, and many countries did phenotype clustering, and it looks like the five phenotype clusters are reproducible in a good way. This will help precision medicine in the future. You know, similar to cancer breast, for example, not all cancer is the same. You know you have genetic based cancer. You have hormonal based you have what you know you can manage it in the very precise way. So

Scott Benner 47:42
we're in the not, maybe the infancy, but we're still in the beginning of understanding diabetes then and the way it gets treated more more over at

Speaker 1 47:50
any point in your history of diabetes, you are beginning to understand diabetes.

Scott Benner 47:55
Damn perfect. That's what I wanted to know. Awesome. And for all the people who give me crap online, ha. Dr hand, he just said that I was right. That's awesome. I'd finally write about something. This is great. Listen. I'll tell you something that maybe you'll find interesting, because you're a researcher. I have so many conversations with so many different people who have diabetes, so I record this podcast sometimes more than once a day, but at least once a day, I've had 1000s and 1000s of conversations with people. Have type one. Who are the parents of type ones with people, have type two. With people, have lot of like, all this stuff. After a while, I step back and I say to myself, like, it's not really the way that we're talking about it. Like, until somebody, until you just said what you said, I have to be honest. Like, I never, I'd never heard it, you know, put technically to me, but that all makes perfect sense to me. After having these conversations all these people, they're not all having the same experience, but we call it the same thing. And you know, it's confusing, and then the human component gets twisted into it, because often type ones don't want to be thought of as diabetic or type two, because type two is so closely related to a thing you did wrong instead of, you know what I mean, like, instead of like it happened to me. And I think that argument is where so much of the the resistance to seeing the differences comes into play. But you really think this will be lay the land in a few years the way, the way you spoke about it, yeah, yeah,

Speaker 1 49:23
absolutely, you know, change. The definition of diabetes has changed over time. Many, many times, sure, oh, at the beginning it was just one diabetes. Then they call it after that fatty diabetes and lean diabetes, and then juvenile diabetes and other tons of diabetes. And then insulin dependent diabetes and insulin non dependent diabetes, and then type one diabetes and type two diabetes. But the future will remove all type one and type two and become the five phenotype clusters. And then once we identify the cluster, and by the way, each cluster develop different complications. Okay. Okay, okay. So I told you there are three mild form, three severe form, and and one mile and two mild form. So for example, severe auto immune diabetes, develop micro vascular complications, diabetes, retinopathy, nephropathy, neuropathy, all those kind of complications, severe answer, resistant diabetes, although they are also severely insulin resistant, they only develop diabetes retinopathy and diabetes neuropathy, okay, mild obesity, diabetes, don't develop that much complications. They can develop maybe cardiovascular complication, if they have this liberty or hypertension, severe insulin resistant diabetes, develop hepatic steatosis and mesh and develop Corona kidney disease at younger age, mild age related diabetes, basically don't develop complication except cardiovascular if they have this liberdemia and hyper and hypertension. So if we know the clusters very well, I can tell you what is a prognosis will look like in each one very soon. I had been using the phenotype cluster for two years or three years now in my practice, and I hope in the future, we can educate primary care physician to identify those clusters and treat them in a proper way. Good luck. That's

Scott Benner 51:15
incredible. I'm so happy you came on. Do you see a world where who are type one who don't have weight issues are going to get in my mind, and this is probably a very simple way of thinking about it, the glps have to start coming in vials, so that doctors can help you with dosing, so that it can help you with the things you need without impacting the things you don't because the like, if you don't need the hunger to go away, But you're seeing a ton of help in other spots, just the PCOS help, right? Which is awesome for people. There are people who have PCOS who don't have weight to lose. So, like, what do they do? Like, how do you imagine that endos are going to mix glps into type one care, I guess is my question.

Speaker 1 51:59
PCOS, by the way, related to type two more than type one. Okay, you know, it's kind of care when anyone but it is mostly related because it's part of insulin resistance, and the best treatment is actually not only weight loss, but also some medication that improve insulin sensitivity, like Metformin. And you know, nearly Most cases of BCS are treated with metformin because it improve insulin sensitivity. There are several other hormone medication that also improve insulin sensitivity, but But mind that BCS, they secrete more testosterone hormone, and actually testosterone make their muscles much better. You know, this is a building a block for building hormone for muscles.

Scott Benner 52:42
If I told you my daughter has a bit of a deeper voice, that wouldn't surprise you, then, like, if she has PCOS,

Speaker 1 52:50
you have to measure the three testosterone level. That's the most important point, and then find the reasons. Maybe the testosterone is not just coming from the others. Maybe some other reasons for higher tests.

Scott Benner 53:03
Okay, okay, this is just the thing that happens. Like I said, I talk to a lot of people, and this comes up a lot with women with who have diabetes, or people who have it in their family, and they're talking about their kids or their, you know, sisters and brothers and things like that. Siblings like, I see the same stuff coming up in conversation. This probably is apropos of nothing in our conversation, but the frequency in which someone with type one diabetes tells me they also have a bipolar person in their family is pretty significant. And I don't know if that has anything to do with anything or if it's just

Speaker 1 53:38
random. Yeah, a lot, you know, if we go to the the whole issue of the causes for obesity and hormonal and neurotransmitter changes and so on, you know, we can spend, you know, 345, hours really, because, you know, I wrote many chapters about obesity in mid e medicine, Even textbook, Sister textbook of medicine, and we are explaining a lot of a lot of stuff, but there is a lot that need to be be done. But let me explain you one, one simple thing. Do you know how many hormone and neurotransmitter controlling your body weight in your brain? I have no idea. 34 hormone and neurotransmitter. 34 and it is a very delicate balance. It's like a web all interlaced with each other. So neurotransmitter that related to mood swings and reward system, there is very small, tiny area in the brain called the ventral tegmental area. You know very, tiny area. They know that very tiny area is called the reward center. Reward center is rewarding you for any behavior that you do, so if you are not addicted to anything to make that area happy. The best addiction and the easiest addiction is addiction to food. Okay, a lot of people start to work on blocking the hormonal aspect in the brain, like endocannabinoid receptors. People kill themselves during the study, really, they get severe depression, and they ended up with committing suicide. You know, the brain is very delicate in relation to all those mental issues and all the psychological issues and body weight in the same part. And that, for that reason, many of the major anti psychotic medications, the major one circle and the bricks and the cost significant to again, significant to again, even we will develop diabetes because, because they work on the appetite center, open your appetite to the maximum, okay, antigenic and the significant amount of food, and again, significant weight. So there is interaction all the time between six hormones. For example, you know, melanocortin pathway, which is responsible for skin. Do you know, if you block that bus way, or you stimulate that bus way, you can change the body weight significantly up and down. You know, there is a lot this is a web interaction in that web has to be very delicate, so we are lucky to have a hormone that's relatively safe and working on the appetite without damaging a lot, but still, psychological issue can occur in that scenario as well. How

Scott Benner 56:37
far do you think we are from glps Being a thing of the past, and what you're discussing being the way that you manipulate your body to do what it should be doing. It

Speaker 1 56:46
has to be on the periphery. It has to be with medication that makes you lose weight and preserve the muscles, okay? And there is actually medication in research now that does a job. It's called the myostatin inhibitor, or active in inhibitor. It actually makes the body fat goes down by 20, 30% and the muscle must go up by four or 5%

Scott Benner 57:08
How come that one didn't take off? It

Speaker 1 57:11
is about, it is about what is called the BMA group map, and it is infusion every month. And you know, one of the big companies now got that medication to combine it with GDP one, wow. What's it called? Again? Pima group app. Pima group app, thank you. And it is a monoclonal antibody. Sorry

Scott Benner 57:29
about that. I'll try it better. I'll just say I'm of the opinion Life is short. My body was not doing what I needed it to do to have a long life. And then I have to tell you, like, I really started doing this, like, these are not things I would have normally done till I saw the end of my mom's life, and I thought, I can't let that be how the end of my life goes. Like I'd have to try something. And this is what was available. My point is, if something better comes along, I would certainly be open minded about it. Can I ask you if you could give me some advice? I've been making this podcast for 11 years now. Can you tell me about a couple of things that are coming along that I should be paying attention to and having more conversations about? Besides what we've talked about now,

Speaker 1 58:14
it is definitely we need to understand exactly how the mechanism for weight loss, because this is not even touch it in our conversation, how we can do a multi disciplinary approach for weight management. And we have been doing it for, as I told you, for very, very long time since 2005 and do you know what b will up till now? Are maintaining weight loss? We publish data on five years, 10 years, and we resented that. And the American Diabetes Association for 15 years, and they are still maintaining 8% weight loss. So actually, multi disciplinary, which is proper nutrition, balanced exercise program and Cognitive Behavior modification and medication adjustment, by the way, for people whose diabetes during weight loss, there must be an algorithm for medication adjustment and then good education. When we do that, it is very expensive, but it works very, very well. And people can maintain weight loss for very long duration, but people just take it very, very simple, I will cut my caloric intake, and I will lose weight. This is a commercial way that commercial weight loss, that can end up with people recycling and recycling and recycle. And when you take GLP one, you are in catch catch 22 if you stop the medication, you will gain all the weight back, right? If you continue the medication, you continue to lose muscle mass. So you have to understand very, very well. And this is advice now that intake of protein is very important with those medication strength exercise is very important, and especially high muscles, quadriceps, same string, gluteal muscles, those are the muscles that get weaker and weaker. So I usually ask my brain. Chance take more protein, more animal protein, in a very efficient way. Or you can even take some shake that has protein, especially the I had a shake liberal diabetes, yeah, and do 2030 minutes of strength exercise every single day. And if you don't do it, don't take the medication you need to do 2030 minutes of strength exercise, especially with your soy muscles. Elliptical, against the resistance. Stationary bike against the resistance, squatting, stretch band under your feet. Rowing machine. Squat is quiet, yes, would a rowing machine help? Rowing

Scott Benner 1:00:35
for rubber? Oh, that's for more rubber and lower

Speaker 1 1:00:37
that's absolutely fine, okay. If it is against the resistance it will be. I'm not all looking for a speed. I'm looking for, yes, muscle action.

Scott Benner 1:00:46
You can't see this because I have a green screen, but I'm putting my hand on a bike. My office is making this podcast a bicycle to keep my legs strong. And if I'm being honest with you, a pet chameleon that's over there that you can't see Perfect, that's all to watch you need keep me relaxed. Yeah. Oh, this is, this is fantastic. I really appreciate this. Let me ask you, like, a question that I think people are wondering, we hear so much that it's the food. Like, are foods bad food? Like, you'll hear people say, like, oh, I went to Italy and I ate pasta and it didn't make me sick, but I eat pot. Like, is our food inherently causing this? Or is it just speeding it up? Like, what is it about Americans in general that that puts us in this situation?

Speaker 1 1:01:29
There are two problems in the in the US, you know, and we did tons of research and nutrition. Let me just to make it very clear, high carbohydrate intake, this one big problem, process the food is another big problem. Okay, if we eliminate as much as we can both, you know, process the food, any food you have in a refrigerator, processed or even minimally processed, you have to avoid whole food is a way to go if you need healthy eating. And then carbohies, and you have three major carbo problem, sugar, whatever, added sugar in dessert, in juice, in whatever, any sugar, wheat flour products, bread, basta, beets, bread, so bagels, P and peas, right? Starchy food like potato, rice and corn okay. If you cut those significantly down, you'll find significant with weight loss and soft drinks that has high sugar as well. So usually, when I tell people in my practice do that, say, Okay, what we eat. Vegetables is okay. Fruits are okay, legumes are okay. Bees, beans, whatever. And then dairy products are very, very beneficial all kind of dairies, eggs, chicken, fish, lean meat, Turkey, dark chocolate, even I have no problem, right? Tea, coffee, cinnamon, you know, there is a lot that people can eat, but not just a low nutrition. Sugar, for example, is just empty calories. There is no nutrient. Nutrient effect, right? It doesn't have any macronutrients or any any value. Would you

Scott Benner 1:03:10
think that I should take as low a dose of GLP as possible as long as I'm not gaining weight? Like, does the dose matter? Like, should I not stay on a higher dose if I'm not trying to lose weight? I'm not just talking about me. I'm talking about me. I'm talking about people in general. Like, should they titrate down to where it's working? But not as much as,

Speaker 1 1:03:27
yeah, you got it. You have to be, if you would like, maintenance, and you don't need to regain weight back be on the main the minimal dose that suppress your appetite, and more the state, is suppress appetite. You don't have to have what, you know, 100% suppression, because, you know there is tolerance to this medication. You need more doses and more. By the way, we don't know the ceiling of those medication you know, like, for example, semaglutide, oral revulsus. You know it is in the market, four, seven and 40 milligram, but the company is testing now, 2590 or 100 or 75 milligram. So they are testing, we don't know what is a ceiling for those medications.

Scott Benner 1:04:08
Rebels is an example. They're seeing what's happening with the injected and they're thinking they can maybe get that pill to a point where it's in pill form and helping people.

Speaker 1 1:04:18
It will not work with I don't think that will seem like, look like I guess. But there are other medication coming in the future in oral format, synthetic, non peptide, small molecule, that will cause significant weight loss and improvement in diabetes as well. And this will Bush away all the injectable, yeah, that's good. I don't think that injectable will be the future. They will be only for people with very, very high BMI, but oral will will come in the future. And the prism, how

Scott Benner 1:04:47
long do you think for that next year? No kidding, that's awesome. I actually told my daughter the same thing, as odd as it might sound to some people, my daughter has a fairly significant needle phobia. It's pretty traumatic. Or to have to do this every week like she does Okay, putting on her insulin pump and her CGM and everything, but she's been banned with needles since she was little, and she struggles through it because she sees how much it's helping her. And I kept telling her, I'm like, Look, I think very soon this oral medication, I think it's gonna do the same thing, and you can get off of this. So it's it's comforting to hear you say that too. Thank you. Is there anything I haven't asked you about that I should have? I actually think I could talk to you all day, but I assume you have a life to get back to. It's wonderful that we've met. I'd love to invite you back on if you ever have anything else you want to talk about. This was fantastic, but anything we didn't talk about,

Speaker 1 1:05:34
we need another podcast to talk about nutrition. Yeah, because we didn't, we didn't spend enough, enough time talking about nutrition. Those nutrition, you know, people start to understand the nutrition and the history of nutrition, and how this stuff changed over time, and why we're eating what we're eating right now. But you know, this is very important. Maybe, you know, it's a very, very big topic to discuss.

Scott Benner 1:06:00
I'd be happy to also, let me tell you that. I guess you'll be happy to hear that just this morning with the nutritionist, who's also a CDE and a 35 year type one that I do some podcast episodes with. We were just talking this morning about how the next series we're going to do is about nutrition. We're going to do a whole series about it. I'd love to do an interview with you and fold it into the series, that'd be awesome. Absolutely thank you so much. All right, I'm gonna say thank you for now, because this was absolutely terrific. Ask you to hold on for one second, and then I'll set something up with you for something else. Hold on one second. Thank you

Unknown Speaker 1:06:33
again. Okay, thank you. You

Scott Benner 1:06:44
if you'd like to wear the same insulin pump that Arden does, all you have to do is go to omnipod.com/juicebox, that's it. Head over now, and get started today, and you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old, touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Are you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group, just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 I want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially an apple podcast, go into your settings and choose, download all new episodes. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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Dakota 0:00
Hi. My name is Dakota. I was on Episode 1198 and today I'm here to talk about my switch from Omnipod five to the islet bionic pancreas. You

Scott Benner 0:23
you, Hello friends and welcome back to another episode of The Juicebox Podcast. 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. If you are the caregiver of someone with type one diabetes, or have type one yourself, please go to T 1d exchange.org/juice, box and complete the survey. This should take you about 10 minutes, and will really help type one diabetes research. You can help right from your house at T 1d exchange.org/juice, box. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for AG, one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink. AG, one.com/juice box. Hey everybody. I know there's so many episodes you might be like, I don't know where anything is, but if you go to Juicebox Podcast com, or go to the private Facebook group and look in the feature tab, you'll see a complete list of all the series that exists within the podcast. Today's episode of the juice box podcast is sponsored by the Dexcom g7 and the Dexcom g7 warms up in just 30 minutes. Check it out now at dexcom.com/juice box. This episode of the juice box podcast is sponsored by us Med, us, med.com/juice box, or call 888-721-1514, 887211514, get your supplies the same way we do from us. Med, hi.

Dakota 2:07
My name is Dakota. I was on Episode 1198 and today I'm here to talk about my switch from Omnipod five to the islet bionic pancreas. Awesome.

Scott Benner 2:18
Welcome back. Thank you, of course. What'd you say? 1198, Yep, let's see what we call that one hitting cows, one of my favorite titles. Do you remember like when you look back on that? I mean, that went up. Would you say May 1620, 2322 I don't even know 24 excuse me, just this past year, I've now lost track of everything. When you think back on that episode, it's been year and a half since you since it's been up. So it's been two years since you recorded about Wow, is it 2025 Dakota, how about that? Yeah, you heard me get confused there, huh? Like I said two years ago, and put myself into 2022 when you think back on that conversation, like, what do you think the overall message is like, if I if you didn't know you and you listened to it, what would you say? Like, this is what the code is talking about.

Dakota 3:13
Probably along the lines of, this is a young guy who's just starting his journey throughout diabetes and just learning everything you can, yeah, and

Scott Benner 3:23
then what's changed for you since you recorded that two years ago? Like, what did you learn? What did you try? What did you decide?

Dakota 3:33
Uh, perfection is very hard to achieve,

Scott Benner 3:37
for sure. Were you trying at first?

Dakota 3:39
Yeah, I was trying my hardest. I got burnt out very quickly.

Scott Benner 3:44
So what was like, functionally? What did that look like? What did trying look like? Counting all my carbs, dosing as often I could, pre policing, corrections and it all just, it got to it got to be too much,

Dakota 4:00
yep, thinking about what I'm gonna eat constantly,

Scott Benner 4:03
when it felt like too much. Did it stop you from doing it, or did it just make the whole thing drudgery? A little bit of both? Okay, yeah, I dreaded diabetes, and

Dakota 4:17
at the same time I wanted to do my best, but to a point I just

Scott Benner 4:23
couldn't. Is what it felt like. So did it turn into like, no matter what I do, this is how this is gonna go. So why bother?

Dakota 4:31
Yeah, and I was seeing like, 40 to 400 in the same day, multiple days

Scott Benner 4:37
in a row. And did you think you didn't understand what you were doing? Or do you think that, how do you get to 400

Dakota 4:45
so I think I was honeymooning in the beginning, okay, and then my insulin needs just started increasing, and I didn't know the first place to kind of begin,

Scott Benner 4:57
I see. So you're now using incor. Settings, but making the same steps, and then you're not getting the outcomes you were accustomed to exactly, all right? And then can I ask why you didn't adjust the settings? I was

Dakota 5:11
adjusting the settings the best I could by myself. I think at the time, I was not seeing an endocrinologist, so I was between endos and waiting for a new one to come into the office. So I was just with my primary care, and she was doing the best she could, but didn't know the Omnipod five system.

Scott Benner 5:29
Yeah, remind people the reason your episode is called hitting cows is because you live in the middle of a field the middle of the country. Is that correct? Pretty much, yeah, you're pretty much seemed defeated. Would you like to come out here and see the city Dakota? Is that your

Dakota 5:46
as long as it's not snowing, the

Scott Benner 5:48
snow horrifying the weather is. So I don't want to talk about this, but the weather has become so strange over my lifetime. I don't know if it's just changing, and I'm locked into what I remember as a child. But I mean, it's January 2 here, and two days ago, I walked outside in a T shirt. It was like 56 degrees, and now the wind is blowing and it's freezing. I don't understand what's happening. I don't know what there used to I feel like there used to be a smooth transition in and out of seasons, but I don't think that's gonna happen anymore anyway. All right. Well, you know, you can always come out and visit come out and visit, can't stay with me, but you know what I'm saying? It's yeah, I just want space. So okay, so you get this feeling you're not getting reasonable help with making the adjustments you're trying. But what's happening are you just not making them quickly enough, and then days turn into weeks, and then you make another small adjustment, but it's not enough again, yeah? Or I'd adjust too much, and oh, it would Yeah, so then I'd dial it back a little bit. Oh, man, I just couldn't find the right place to be at, yeah, but I'm sorry. And so even on an automated system like Omnipod five, you didn't have your settings right, and it just wasn't

Dakota 7:01
working exactly. Yeah, the settings are very important on that system. They

Scott Benner 7:05
certainly are so in a normal world, a world before your new pump, you would have probably continued on, figured it out, reached out, helped people, or maybe just tumbled further into despair. Like, I don't know. I've seen it go both ways for people, but instead, what did you do? You can manage diabetes confidently with the powerfully simple Dexcom g7 dexcom.com/juicebox, the Dexcom g7 is the CGM that my daughter is wearing. The g7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smart watch. The g7 is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes. The Dexcom g7 can help you spend more time in range, which is proven to lower a 1c The more time you spend in range, the better and healthier you feel and with the Dexcom clarity app, you can track your glucose trends, and the app will also provide you with a projected a 1c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom, dexcom.com/juice box. When you use my link, you're supporting the podcast dexcom.com/juice box. Juicebox head over there. Now, eventually,

Dakota 8:24
I got in with my new endocrinologist, and he looked at my like my clarity report from Dexcom, my ANC kept rising over like six to nine months, and he had suggested that I should try the islet or the Medtronic 780, G, and I was apprehensive about Medtronic. And I had heard good things about the islet and what it can do and what the technology is and where it's headed.

Scott Benner 8:53
Tell me what made you apprehensive about Medtronic, just the things I hear or read about online. Okay, so some you heard something somewhere, and it was not a positive thing. And so you thought, okay, that's not a good option. But then you heard something positive about eyelet. Is that what happened? The more

Dakota 9:09
I looked into it, the more it seemed like this is what I wanted. This is what I needed. It was a lot for, like, mental health reasons,

Scott Benner 9:18
more of the promise of what eyelet is. That was what was attracted to you. Yep. Got you tell people how old you are? 2727 Well, used to go to we're all getting old. Are we gonna be 54 this summer? That's why, that's why it's hard to get the young people to listen. You know what? I mean, I don't have any hip things to say. I don't know any of the new phrasing for anything like,

Dakota 9:40
like you. I mean, I know of it, but I don't know what any of it means. You

Scott Benner 9:44
don't you don't use it. No. So funny, when an older person tries to throw in a word, you're like, Oh, Mom, stop. It's over. Mom, don't do it again. Okay, so the doctor is the one that says eyelet to you. I was hoping you heard about it from me or. From I had already known about it at that point. Well, that's important to say, just in case they want to be a sponsor, one day, they'd be like, Oh, Dakota. Heard about eyelet from Scott, and that's why, when his doctor suggested it, he was like, Okay, I'll try that. Is that about right? Yeah, pretty much. Excellent. Good job, Dakota. Now. Okay, so how long have you been using it nine months around there. That's how long it takes to make a baby. Yeah. Oh, wow. Your Isla could be giving birth right now. Let's take steps through it. The doctor suggested to you, do they hook you up with a company? Does they come to the house like, how do they do it? Isla

Dakota 10:37
gave me a cold or bionics? I guess it would be. They gave me a call, got me scheduled. Well, first they ran my insurance and seen if I was covered, found a place to send it to me from sent it to me, and then I had to wait, I think, two weeks before I could do a training session through zoom. Okay, because I didn't have anyone local.

Scott Benner 10:58
How was it training? Virtually? Did you have a problem with it, or was it pretty good?

Dakota 11:02
So when I was like, putting on my set, my insulin set, my infusion site, they couldn't see it in the camera, so they were like, I think you're doing it right.

Scott Benner 11:13
The sounds you're making sound right? Yeah. Okay. So not perfect, not being in person, but it worked out. Yep. Okay. Walk people through it. How do you set up an eyelet so you're

Dakota 11:22
gonna take it out of the box, and to turn it on, you have to set it on the charger, because there's no power button. And then when it turns on, it asks you how much you weigh, and that's the only setting that it needs. Did you tell

Scott Benner 11:35
it? Did you lie to it? Were you like, Well, I'm just kidding. I

Dakota 11:39
wanted to, no, I wanted to. Oh no, I'm,

Scott Benner 11:41
you know, I'm more, like, 20 pounds less than that, exactly. That's interesting. There's no power button, so you have to, you set it on the on the charger, that brings it to life, charges it up, and then on a screen, it asks you how much you weigh, or on an app on the screen, on the screen, and you like, I weigh this much? Islet go. And that's it,

Dakota 12:01
yep. And then there was something with, I think my Omnipod had ended earlier that day, so I was off insulin for a few hours, and my blood sugar was, I think, in the three hundreds when I started training, okay, but it quickly came down, and it was like 225 by the time we ended. How long was

Unknown Speaker 12:21
the training? About an hour.

Scott Benner 12:22
Okay, you pop that thing on, it makes a Bolus, and an hour later, you're falling already, yep. Now take me back to that moment right before you know if you're gonna like eyelet or not. And we don't even know if you like it yet, because we haven't gotten that far. But do you have that like, uh, there's a piece of tubing. Now I'm connected to a thing. Did you have that feeling? I did.

Dakota 12:44
Yeah, I wondered how I was gonna sleep with it, or I was gonna hook it up to if I was gonna snag it on doorknobs.

Scott Benner 12:53
Did it end up being an issue for you? A couple

Dakota 12:55
times it's fallen and ripped out, maybe twice. There was one time I was holding it in my mouth and I cracked the screen with my teeth and I had to get a replacement.

Scott Benner 13:09
Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. Us, med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us. Med. You open up the email, it's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away a responsibility instead of adding one us. Med has done that for us. An email arrives. We click on a link, and the next thing you know, your products are at the front door. That simple us, med.com/juice, box, or call 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box. I put this stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide over 800 private insurers, and all you have to do to get started is call 888-721-1514. Or go to my link, us, med.com/juice, box. Using that number or my link helps to support the production of the juice box. Podcast. Did

Dakota 14:32
you tell them? That's what happened? I told them the screen was broken. Hello,

Scott Benner 14:35
beta, bionics, I was chewing on my pump. Would you please right now? They're listening. They're like a kid snooker at us. So you're saying couple things that can happen. This is not specific to eyelet, but like, you have the pump in your hand, you drop it, the tubing tenses up, it yanks out your infusion set. Yep, okay. And one time you ran out of hands, put it in your mouth, bit down too hard and broke the screen. Yeah. Yep. Do you have a unusually powerful bite

Dakota 15:03
I am known for clenching and grinding

Scott Benner 15:09
my teeth. Are you here to ask the people of beta Onyx to please make the screen a little thicker so you can chew on it some more, right? And I have to admit the sleeping part. You know, you guys know if you guys know, if you listen like, Arden has been wearing an omnipot Since she was wearing a pump, so since she's four, which means she's coming up on 17 years with it. Is that right? Jeez, yeah. My God, I am old. The sleeping thing hits me right away. I'm like, How do you like sleep with a thing attached to you by a cape, like you wake up and it's like, I almost said something ridiculous, Dakota, that would have been funny between you and I, but not while we're making a podcast. But does the tubing get wrapped around things?

Dakota 15:50
Not necessarily. It'll get wrapped around, like the clip on the pump, if it falls off my waistband, and then it'll get tangled up in itself. Yeah.

Scott Benner 15:59
Is it cumbersome when you're I don't want to dig into your life too far, but like with the ladies or anything like that, you just disconnect. You disconnect to people, yeah, to do that part. Okay? You find that all okay, yeah, all right. Nine months later, you look back on how you felt that day. Has it been a like would you characterize it as a problem or just an adjustment. Just an adjustment. Okay, all right. So day one, it's on. Blood sugar starts coming down. What do they explain to you? Is happening? Is it figure like, you know what I mean? Is it figuring things out? Is it, you know, what's the explanation you got? So

Dakota 16:37
the first week you're supposed to eat like you regularly would, which I mean that in itself, is a loaded statement, so it can learn you and learn like you're eating, styles and how much insulin you need for each meal. Because when you dose, you choose if it's breakfast, lunch or dinner, and then if it's a usual amount of carbs, less or more,

Scott Benner 17:00
when it asks breakfast, lunch or dinner, is it asking about time of day or type of meal?

Dakota 17:05
That is a good question, and I ran into that when I was eating dinner for breakfast within the first week of having it. So I had messaged my trainer, and she said to choose breakfast, because it's a breakfast meal, but it's a different type of day. I'm recording an

Scott Benner 17:22
episode, you know this. I'm now talking to the people who are listening. I'm recording an episode tomorrow with someone from beta bionics. I'm going to write that down as a question for me is, how did I just put that? Is it the time or type for meals? It's good question. Scott, thank you. Okay, so it must have felt like a week long. Pass about eating, right? Because your goal wasn't good blood sugars. Your goal was just eat, be normal and let the thing figure things out. Yep, yeah. What'd you do? Would you eat?

Dakota 17:53
That was the same week I was going on vacation. Oh, jeez. So it wasn't really a good week to start the eyelet,

Scott Benner 18:01
because your eating was not common for you,

Dakota 18:04
right? Yeah. But at the same time, I wasn't eating three meals a day, and I knew when I was on vacation, I would be eating more consistently because I was going to be with friends and family. Okay,

Scott Benner 18:16
all right, so you go through that process, it learns how you eat. I guess that's the phrasing, right? And then that's it. Like you get up in the morning, you go, This is breakfast. It's what are the three questions, again, is

Dakota 18:29
size of its uh, usual, less or more? Usual? Less

Scott Benner 18:33
or more than normal? Is that right? Is that the phrasing? Okay? So you get up in the morning, you're like, I'm having breakfast. This is usual. Do

Dakota 18:41
you Pre Bolus? I don't Okay. And I thought I read somewhere that it's not recommended that you do with the pump, because your blood sugar starts going down and then it backs

Scott Benner 18:53
off. Because it backs off. So do you get too high after you eat? But it brings it back. How does it end up working? Occasionally,

Dakota 19:00
that does happen. It's kind of a task in itself to think about. Is this my usual amount of carbs, or is it more Okay? Something that I struggle with still is deciding the amount of carbs

Scott Benner 19:13
to choose. When you're faced with that question, you think I don't know. Sometimes,

Dakota 19:18
sometimes I'll just press a button and go on, because I know it'll correct me back down, or do whatever it needs to do, I see. But if I am thinking about it, and I say actively trying, I usually don't go high after meals, it'll keep me within range. What's the range? 70 to 180

Scott Benner 19:38
Okay, so after a meal, if you don't go over 180 you feel like this has been successful. Yeah. Okay. How long does it take for it to bring it back to 80? Like, where, actually? Where does it hold you, generally speaking, away from food and insulin. So

Dakota 19:52
there's a higher target and a lower target. I believe there might be three targets. There might be a usual two. Yeah, I'm pretty sure the number is 120 is where it's supposed to target you back down to

Scott Benner 20:06
and do you stay at 120 or how do you where do you sit? Stable?

Dakota 20:09
My average is like, 141 50.

Scott Benner 20:14
Okay, where is it? What was it on Omnipod five, when you had your settings all messed up? Oh,

Dakota 20:19
I know I was in range for like 40% of the day,

Scott Benner 20:23
between 70 and 180 Yeah, and now, now,

Dakota 20:27
on a good day, I'll hit like 90% and I'd say I'm about 70 to 80% four days out of the week.

Scott Benner 20:38
How often do you get low where you have to save yourself throughout the day. Sometimes I'll get a couple lows. They're usually nothing like intense. Are they after meals? Like couple hours after a meal?

Dakota 20:52
Yeah, and usually I'm working at the same time, so there's some activity involved.

Scott Benner 20:57
I see when you were using Omnipod five your goal. What were your goals that you couldn't get to?

Dakota 21:04
I had it set for 70 to 150 and every time it would go over 150 I would like put in a small correction, if it would let me through the basal calculator. Yeah,

Scott Benner 21:16
that. That was the game, by the way. I think Bolus calculator, I tell you. I just told that to Arden yesterday, so, like, you know, she's getting older now, obviously. And I said, you know, we had your goal, like, your your alarm was lower. And I said, but I think as you get older, I think it makes more sense to bring it up a little bit. And I said, I think maybe we should start at 150 like, we don't want your blood sugar going sugar going like, like, what I told her was, I think if she assumes a miss at 150 after a meal and makes an adjustment as she's approaching that that'll be like, a good place to begin for her to, like, find her own rhythm with it. You know what I mean? Yep. So that's what you were doing. You were at 150 you're like, oh, it's, I'm getting too high. Give myself insulin. How often do you have to inter Well, it's not just intervene. You can't intervene, right? So, like, I was gonna say, like, how often does islet put you over 180 after a meal? And you're like, oh, I need more insulin, but you can't Bolus with it. Is that correct?

Dakota 22:16
That's correct. And if you try to, like, announce another meal afterwards, and that'll just confuse the algorithm. You

Scott Benner 22:23
can't lie to it about carbs. Yep, exactly. Okay, so how frequently do you find yourself thinking, I wish there was a button on here that gave me more insulin. Maybe once a day. You get stuck, too high, too long, ever?

Dakota 22:38
Yeah, every once in a while, if I, like, Miss real big. So like, this morning, well, while I was sleeping, I ran out of insulin in it, so it holds 160 units, and I think I ran out like, four hours before I woke up.

Scott Benner 22:57
Dakota, that Mm, hmm. Was very parental. I don't know if you heard it. Yeah, I could tell Yeah. Thank you. I don't I please, please change your pump before you go to bed. Is it a cartridge or do you fill the pump?

Dakota 23:08
It's a empty cartridge that you have to fill.

Scott Benner 23:10
It's a coda. How long does that even take? So and

Dakota 23:14
I got this little container where I can do multiple ones at a time and stick them in the fridge. So you're telling

Scott Benner 23:19
me that you neglected to walk to the refrigerator before you went to bed last night and risk DKA over that.

Unknown Speaker 23:24
Yeah, yeah.

Dakota 23:29
Dakota, listen, I didn't, I didn't know that I was even getting low on my insulin before I went to bed. That's not something I checked regularly. I

Scott Benner 23:37
would like you to check it regularly. I know. Okay, so, yeah, no, it was recently. We were, where are we going? I think we were going to see wicked. Have you seen wicked? No, no, I didn't imagine you had we were going. I was going with the girls to see wicked. And we're like, you know, like sitting in the kitchen. People are like, pulling on shoes and coats and stuff like that. And Arden goes, oh yeah, this pumps almost out of insulin. Good thing I looked like, yeah, good thing while we're sitting in the movie that cost $50 for three people to watch. And like, beep, beep, beep, beep. And like, Wait, we're not near our house. Like, so we changed pump, or she changed her pump, obviously, but then we brought insulin with us, which I think is a thing I would have I think I would have done that. I don't like going to places where, if something happens to a pod, it ruins the experience, if we don't have one with us. Does that make sense? Yeah, yep. Okay, so I have questions, I guess. What are they? Is it worth it?

Dakota 24:35
Like I think, I think so for me, a big part of it, again, was for my mental health. So when I was starting to feel defeated with the Omnipod five, I would like rage Bolus, and sometimes it would be before I'd go to bed, which is not a good idea to do. No,

Scott Benner 24:52
you're making a list of things I don't want you to do here. It's okay. I like your honesty. Dakota. I appreciate you. Yeah. Okay. So it's worth it, because you were having other challenges, and they don't exist anymore. I feel like they don't. That's awesome. Yeah, did you exchange one problem for another? Like, what, I think my wife, the only reason my wife doesn't leave me. She's like, you know, the devil you know. But have you exchanged one problem for another. Like, did you fix it one set of issues, but you have a different set now.

Dakota 25:24
It feels like when my when I need to work on my mental health, my diabetes, takes a back burner. So yeah, in a way, trading out one problem for another, and it kind of goes back and forth between those two,

Scott Benner 25:37
like a slow game of tennis, yeah, yeah. The ball's on that side of the court for a while, then it comes back over here. Yep, I don't remember from our last conversation, and I'm going to apologize for that, but do you have any anxiety or any stuff like that going on?

Dakota 25:52
I did anxiety, depression. I've recently been diagnosed with ADHD, so I'm starting to deal with that too. Sounds fun, yeah, but the medication for that has helped with my anxiety a lot. And I think just like the constant mind running

Scott Benner 26:11
ADHD medication helped you with your anxiety, yeah. What's the medication?

Dakota 26:16
I'm on the lowest dose of Adderall, okay, just

Scott Benner 26:19
a little. What is that? That's actually, you live in the Midwest, you must know, what is it? Yeah, what?

Dakota 26:27
It's a D, it's a D amphetamine, salt combo.

Scott Benner 26:29
Okay, all right. Have you had any, um, it's the word I'm looking for, like, adverse events from it. Or do you, do you like the impact

Dakota 26:36
of it? No, I like the impact of it. Yeah. Is that a daily pill? It is, yep, and it's an extended release. So I just take it once in the morning just

Scott Benner 26:44
to avoid other medication with it. Or can you take it with other stuff, like vitamins and things? You know, you're 27 you don't take vitamins, but I would take vitamins. Dakota, thank you. See now look at that. See now you get the now the parental like, Happiness comes back. Awesome. Thank you. Just the vitamin. I just want you all taking a vitamin. By the way, if you buy a vitamin, it says that the serving size is two a day. Don't just take one and tell me you're taking vitamins. That doesn't count. Awesome. Oh, that's excellent. So are you able to take them together?

Dakota 27:13
Yeah, I haven't had any issues, and they didn't tell me to avoid anything while taking it.

Scott Benner 27:18
Well, I think we all know that they Dakota don't always tell you the things you need to know, so we'll find out to be sure. Excellent. Okay, so you announce the meal, and you never think about it again, or you do you think like, also, what CGM are you wearing with

Dakota 27:35
it? I'm on the g7 now. Okay,

Scott Benner 27:38
so you announce a meal, but it's pancakes, and now it's Beep, beep, beep, beep, beep, beep, that like, are you not? Is there no like, anxiety of like, oh my god, there's something happening that needs attention, but I don't have any power. It

Dakota 27:53
was very difficult at first. So at first I did. I would announce, like, a smaller meal afterwards, and then later, like, the next time I'd announced that meal, it would think I would need less

Scott Benner 28:05
insulin, okay? And so that's what you're not

Dakota 28:10
supposed to trick it, and then it would just get worse.

Scott Benner 28:13
Okay, yeah, so you felt the pressure. You're like, I just had five carbs and or a small you can't do that. You'd be like, I just had a small lunch, and then it just messes things up worse. Yep, okay, so then that doesn't fix the problem. Then, right? Like, how do you manage that feeling of, I know I need more insulin

Dakota 28:33
first. It was really hard. Now I just wait for the pump to do its thing. I've been on it long enough I've gotten used to giving that,

Scott Benner 28:42
did you you've done with that? The girl in that Frozen movie said, you just let it go. Let it go. Yeah? I like how you started laughing. You're like, Oh, I know what he's talking about. So you just, you were able to let it go, yeah? What's your a 1c, today, I was supposed

Dakota 28:56
to have an appointment at the beginning of last month that I missed. I slept through it. Dakota.

Scott Benner 29:01
What's going on there? Uncle's got the visit what's going on? Okay, it's

Dakota 29:07
rescheduled for like, in a week or two, okay, but my GMI is right at seven, and before that, my a, 1c was 6.8 before I started islet, it was 7.6

Scott Benner 29:22
Well, all right. I mean, that's a win. Yeah, right. No way around it. I mean, I'm listening to other people online talk about it, and then some of the things they're concerned about is, like, could you make the target lower? Like, have you had that thought

Dakota 29:35
I have? And then at the same time, the algorithm can be pretty aggressive at times. Okay, there's times like you don't really see insulin on board, but if you go into the settings, you can see how much it's dosed you. And there's been times when I'll look and there'll be, like, 18 units, and I'm like, oh, geez, that's a lot of insulin. So. For me, I would never do something much myself, but it's usually when I have candy after a meal, okay? And I spike, and it catches it real quick.

Scott Benner 30:09
So do you if you had a meal, like a regular meal, you're like, This is a normal dinner, and then an hour later, you're like, candy canes, Christmas. I love Santa. And you started, do you like say there's no snack button? Is there?

Dakota 30:24
No there's not. You're supposed to select the last meal you had and choose less than

Scott Benner 30:30
so if you said dinner normal, but then you're like, I'm gonna have two candy canes. That's dinner less than, right?

Dakota 30:37
And then the way the algorithm works is it gives you 75% of what it wants to

Scott Benner 30:44
upfront. So do you end up not telling it about the candy cane every once in a while? Yeah. Does that seem I should say often? Yeah. I was gonna say that seems sketchy to me. Yeah. Is that even a word the young people use anymore? No, right? That's over now. It's sketchy over, I think so? Yeah. Do you find yourself thinking I have a lot of questions about this? Or do you find yourself thinking I'm in a rhythm This is working. I'm done thinking about how eyelet works, a

Dakota 31:13
little bit of being done and thinking about how eyelet works. But there's still, like questions I do have, yeah, yeah.

Scott Benner 31:21
I mean, I've seen people online, like, because I'm gathering up questions for them, and they do feel a little like, hey, it would be great if it did this. It would be great if it the target was lower. It would be great. Like, so I think people are having the same experience you're having, right? Like, if they were struggling, if they were burned out. If they were like, You know what, this is just gonna keep getting worse on my mental health. Not here for this. There's a ton of win in islet, right? And, yeah, also, you were a person who was, like, actively trying, even though you weren't having a ton of success. And, you know, your settings were wonky. You were actively trying. I think they're also thinking about this not, you know, I don't think it's just for people who are just like, I don't know, I shoot my basal so I don't die and I don't do anything else, right? But like, that's going to be, I imagine, a huge benefit for people that are in that boat, because look at you, 781 say, boom, you know, right? Also, you got to imagine, I don't know if this is true, but ADA says seven, right? That's what they're saying right now. So it sounds like they probably set the pump up to shoot for seven, and it's giving you a seven, yep, which I'm happy with. Yeah. So the expectation here for me is like, if they could shoot for seven and hit it, maybe they could shoot for six and a half and hit or whatever else, like, maybe they'll and that's one of the questions I'm gonna have for them. Like, is there gonna be a time in i Let's life where you can turn it on and say, I weigh this much and I want an A, 1c, that's 6.3 like, Do you know what I mean? Like, why? Why not? Right? Yeah. Okay. Who wouldn't you suggest uses it? Like, if I said to you, should Arden do this? What would you say?

Dakota 33:03
I don't think Arden should do it. You guys seem like you adjust your settings quite frequently, yeah, or just, you know, like little tweaks at a time, right, right? You can't do that on the islet at

Scott Benner 33:14
all, yeah. So you have to really give away all your control. And you hear people talk about how you had to give away a little bit of control with Omnipod five, because it really doesn't tell you what it's doing, right, right? So was this more so or different? Definitely more more. Okay, yeah, so control freaks are not going to love this. I don't think so. Okay, gotcha all you Type A's out there. Hmm, how you gonna do it? Oh, we're not mocking people for being type A and being all like involved. It seems like a leap to me, like, for a person like I interviewed a guy yesterday. He is, first of all, by his own admission, way too involved with his kids diabetes. But like, if I just said to that guy, Hey, we're gonna slap this thing on now, I don't know if he'd have a moment of Zen where he's just like, Thank God, I needed this, or if it would make him pull his hair out. I can't figure that part out. Be interesting to see with the the meal announcing. Is there a chance, or has it happened? Are you concerned? Could you get burned out on this? Like, could this new normal at some point become burdensome to you? Do?

Dakota 34:25
I think the most burdensome part is changing out the infusion set. There's a lot of parts and steps. So as it mean, it's, it seems quick, but it's just you got to think about it, and the rest of it, you don't really have to think about an

Scott Benner 34:41
omnipot is so automatic, like, it's so easy, yeah,

Dakota 34:43
yeah, yeah, omnipot is a lot more user friendly in that aspect. Somebody,

Scott Benner 34:47
the person who designed that, like, I've interviewed him already, I was gonna be but, like, she's genius. You know what I mean? Like, peel, stick, button, done. Get out of here. You know? I mean, like, awesome. And two, it's funny, too, 200 units, everybody, and not everybody, but a lot of people, like, they'll bitch up a store about omnipotent you know, only holds 200 units, but you went from 200 to 160 Are you changing your site with eyelet more frequently than you were changing Omnipod? No,

Dakota 35:16
I wasn't filling up my Omnipod. Oh, all the way completely. And I had my prescription to change out every two days if you needed to, so I was changing it every two days. And now with Isla, I make it to the third day, but I don't make it through the third

Scott Benner 35:32
day. Okay. Is that a problem for you? No, no, because you're accustomed to changing every two days to begin with. Yeah. Why'd you, like, every two days with Omnipod? Was it for, like, having a nice site that was working? Yeah, yeah, I see that Arden does really well riding pods till the end, like, as far as, like, absorption goes. But if she didn't, she would, I mean, I would definitely ask her to change more frequently. There's no way she would do that. Yeah, I could see that being a problem. Sorry, I'm drifting off in my own head. It's now a podcast between me and my brain. Sorry, what don't I know about it that I should be asking you, what don't I know? Because I'm not using it like what? What are the things that you love about it? What are the things that you hate about it that we haven't spoken about,

Dakota 36:22
right? So there's no activity feature or exercise it's recommended that you either disconnect or take in carbs before

Scott Benner 36:33
you exercise. So

Dakota 36:36
I don't like exercise regularly, but when I am being more active, yeah, I get low pretty quick.

Scott Benner 36:44
Okay? Because it doesn't know and there's no way to tell it, right? I'm gonna run around now. Yeah, that is one of the concerns I've heard, especially people with like, little running around kids get what I mean, those little, like, whirlwind kids, yeah, that they're like, Well, how do I like this thing's out there doing what it's doing. I mean, I've heard people say the same thing about Omnipod five. Actually, any of the, I guess, the algorithms that are kind of built on this idea of, you know, like, this is how we do it. Like, you're not going to get a ton of, like, user control, and then if your situation changes greatly, sedentary to active, active to sedentary, then there's problems and so, so you would like them to put some sort of an Activity button on there. Yeah, just pause.

Dakota 37:32
There's a pause button, but there's no Activity button.

Scott Benner 37:35
Does it feel unfinished? A little bit like it's still a work in progress. Yeah, they feel like you bought a beta sometimes.

Dakota 37:45
Yeah, from beta bionics. Oh, I didn't mean

Scott Benner 37:48
that, but awesome. Look at you making dad jokes. Good job. I'd like to see you put that effort into changing your pod before you go to bed or you're pumping. I mean, like, Listen, I'm not digging at them. Like, I think they're great. It's possible they might come on as an advertiser at some point, like, but I'm just saying, like, does it feel like, like, it's an early product where they're just like, hey, you know, it would also be cool. Like, and do you know, as a user, are they thinking about that stuff? Is there any communication from them or stuff online that makes you feel like they're moving in a direction

Dakota 38:21
I'm not sure. As a user, I don't, I haven't heard anything from them about it. Yeah, it's not but since I've got so the one I have has a black and white, a black and white screen, and they've since come out with a smaller one that has a colored screen,

Scott Benner 38:36
colored screen, saved tandem. Oh, did it? Oh, it absolutely did tandems, a rags, the richest kind of insulin pump story. They were on their way. Like, I've heard like, this is years and years and years ago, I want to be clear, but I heard that they were starting to make internal decisions about maybe not selling the pump in America anymore, and like it was getting dicey, like it didn't look like it was going to take a foothold. They came out with that color screen, and people were like, Whoa, color. And that was it. Now they're here. It's like, it's interesting. What changes the experience for people? Yeah, yeah. So do you prefer the color screen? So

Dakota 39:14
I don't, I don't have it. The replacement one that they sent me was another

Scott Benner 39:18
black and white one. You should have written a strongly worded email. He should

Dakota 39:21
have. I asked for the new style of clip, though, so it wouldn't, so I wouldn't have to hold it in my mouth,

Scott Benner 39:27
Dear Sir or Madam. I am tired of putting this pump in my mouth. I need a new clip, and don't make me bite this thing again. I want a color screen right size wise, not, not bothers them to carry you're happy with that.

Dakota 39:42
I'm happy with that. I don't like rolling over on it in the middle of the night. Sometimes that wakes me up a

Scott Benner 39:48
little clunky, like square, too square, too pointy. What is it? It just feels,

Dakota 39:53
yeah, it kind of feels like a brick on your hip. I mean, it's not that big at all, like this. It's a little bit, it's about the size of a deck with. Charge. Somebody

Scott Benner 40:00
from beta bionics is listening to this right now, and they're like, awesome. We'll put that in the brochure. Thanks. Did you feel Omnipod when you rolled over on it? No, it's that curvature. Maybe what was helping? Yeah, interesting. All very interesting. Well, listen, let's be fair, like we're talking about things very specifically, Omnipod five and eyelet right now, none of these pumps are perfect. They all have things, you know. And at the same time, I think it's incumbent upon you and everybody else to find the one that works best for them. Exactly. Yeah. I think that's important. Like, like, if people are listening to this and thinking like concrete things, like, he said this, so no, or he said that, so yes, I don't think it works that way. Like you're a specific person, you have diabetes, you have other issues going on, like you're trying to balance a lot of different things you're saying for this moment. You think this fits best with who you are, not that this is perfect, correct, all right? And exactly. And if Omnipod five would have worked the way you expected it to, if you would have got your settings together sooner. Do you think you'd still be on it? I think so. Yeah, okay. It's interesting, because, you know, we have those Omnipod five pro tip episodes, and I still know, like, not everyone's gonna intersect with it. Like, maybe you listen to them and you're like, I don't understand. Or maybe you just were like, I didn't even know about those. Or you were like, I know about them, but I don't feel like listening whatever. Like, I don't know how you did or didn't intersect with that information. You you specifically Dakota, but like, it's important that it's there, because these algorithms, if your settings aren't right, it's just as random as, you know, a needle in a meter, and you know, it being 20 years ago, yeah, you know it's everything is settings. Listen, I'm excited about eyelet. I'm going to tell you right now. I don't think Arden would ever leave a tubeless pump, but if she did, it would have to be for a reason, like the one you're explaining, like the promise of being less involved, yep, right. But that promise would have to come with a six, A, 1c, in my opinion. Like, that's that for me and and maybe the difference between a SEVEN and a SIX is manually making adjustments. And maybe the way islet works, I'm not I'm gonna ask, like, maybe the way I look works, like, if they let you get in there and start monkeying with things that algorithm can't respond. Like, maybe it can't rebound fast enough from you making a mistake. Like, I don't know, I don't know what the the engineering ideas were behind not giving you any autonomy beyond, this is the size and this is the type of meal, right, you know? But it's, I think it's an interesting idea, and I can't tell you that, you know, if they don't keep going the 10 years from now, I won't say like, wow, like, out of sight, out of mind, six, A, 1c, let's go, you know, yeah. And

Dakota 42:49
I'm especially excited if they get, like, the glucagon part working

Scott Benner 42:53
the dual chamber, the dual chamber, yeah, well, I mean, then listen, anybody who figures that out, if that really works for you, trying to imagine a scenario where the pump is like, Hey, you're 90. I think you're going to be 50. Here's, you know, drip, drip of glucagon, and it stops the 90, like, and holds it at 70 or whatever. Like, you know what I mean, like, something like that. You never get under 70. You never get dizzy. You never have to intervene with food. Man, I'd like to see that. Yeah, you know, that'd be pretty awesome. I know there's a, you know, a handful of days of my life. I think it would have been awesome if something like that existed. So I'm just here, Listen, man, I want everybody to keep pushing. That's what I want. Like, people are probably like, oh, Scott, Omnipod. You're said to think it's not about that, like it's, I love Omnipod. I think it's awesome. I think if you got an Omnipod you'd be thrilled with it. I think if you got an Omnipod five, and you've got yourself set up, well I think you'd be thrilled with it. You know, I also think it's possible that Dakota is thrilled with eyelet, and I think that's awesome too. And I know people who use that new Medtronic device, right? The 780 G, yep. They love it. Love it. You know what else they love? Hand them. They love control like you. Some people love the movie like, you know what I mean? Like, and that's only good for you. It's only good for you. It's only good for the people listening. It's good for me. It's good for my daughter. If we have a number of people in different companies, and they are all motivated by success and money to do better for you. That's what we want. You don't want just one company making a thing, right? Just doesn't work out. Go, get out there and kill each other. Go, try to make a good thing. You know what I mean? Like, try to make it better. Don't. Don't sit back all the time and go, Oh, this is good enough. You should be doing R D on this stuff. Listen. Let's be honest. Dakota, when there's loop and trio and Android APs and that kind of stuff that you know between you and me and anybody listening works really well, really. Really well, and they all know it works well, like, and I know they're fighting with the FDA, and, you know, the person making, you know, an adjustment, the loop is not but, I mean, those are goals. I think those should be everybody's goals. I'm not on the board of directors at these companies, and I don't make any decisions, but I don't see how you're not shooting for that. All of you, right? Yeah, Jesus, this is I yelled at you. I yelled at them. Who else am I gonna yell? What else is going on? Dakota, how's your life? Pretty good, yeah, yeah, good place right now. I don't really have any complaints. That's a good place to be. No complaints. You still doing the same kind of work,

Dakota 45:37
yeah, still doing the same kind of work. I think I should be getting a promotion here in a little bit. Good for you. Yeah,

Scott Benner 45:43
very nice. What about people in your life? You got any relationships brewing? How do you kids date nowadays? Hinge, what is it? How does it

Dakota 45:50
work? It's a lot of apps. Definitely.

Scott Benner 45:55
Do you respond when someone swipes? You go, okay, yeah. Or I, because I see, I see Arden and her friends, and they sit around, they go, Oh, I wish something like this would happen. Blah, blah. And then somebody swipes up and they look like that person. They're like, nah. I'm like, Wait, how do you expect to meet people ever?

Dakota 46:10
Yeah, I don't like the apps. I feel like everybody's just judging on there.

Scott Benner 46:16
Yeah, right. It's not like for dating. It's for like, fun. Yeah, you blaming girls for this, or guys too? Uh, both of us. Okay, all right. So where do you meet people?

Dakota 46:26
I don't go out much, but the people I do meet usually are customers at my store.

Scott Benner 46:33
That's how you generate

Dakota 46:35
friends of friends.

Scott Benner 46:36
You guys confuse the hell out of me. DECO, I'm gonna, I'm gonna share something with you from this is one of the places where, like, I'll get an email later, I'll be like, Oh, why does he have to be creepy? I'm just telling you how the world worked. Okay, I was born in the 70s. I was a teenager in the 80s. And from the time Dakota, and I don't want to make you uncomfortable, but from the time of my sexual awakening till a half an hour ago, 78% of my day is spent trying to make a lady like me, like, I don't get how you guys aren't like, I don't know, like, how are you guys not all driven by sex? Like, I don't understand what's happening. Do I sound like a, like, a, like, like a caveman to you when I say that? No, no, I don't think so. My whole life, Dakota, as a teenager and young men in his 20s, was trying to figure out how to make a girl think I was a reasonable person to be naked with. Like, I don't know. You guys are just like, I don't go out much.

Dakota 47:36
There's too much going on right now. Oh

Scott Benner 47:39
yeah, I don't know, man, like, go find a go find a pretty girl. Change your attitude. You know what I mean, she'll at least make you want to buy your she'll at least tell you you have to buy her a house, and we'll give you something to do. No? Yeah, yeah. Trust me, my wife has got a to do list for me that she started writing the day that she decided to date me. And I believe I saw her put three things on it. Actually, I don't have to guess. She told me this morning, my car needs an oil change, and I think there's something wrong with my driver's side rear tire, which meant to me, you got to get my tire replaced and get my car an oil change. Yep. I said to her, and I want to say, this is a very capable lady. Okay, I said to her, how about later, when I check on that tire, I bring you out to the car, and I'll show you how to do it like, you know, in case I die or something one day. You know what she said in response, she left not even that total silence. She acted like she didn't hear me. Oh, what? No, I'm okay. Thanks. Here's what you should do, buddy, go fix my tire and don't die so you can fix the next one. That's what I heard. Anyway. That stuff gives you, um, motivation. Is that what you're calling it? Dakota, I grew up in a very transactional world, but I know that you guys all want to say, like, if I do enough nice things, somebody shows me a boop. That's how my life has been run for like, 35 years, and you guys are like, I meet I met somebody on apps, but the apps really don't work, and I don't go out like, I don't get you guys, the ladies would love you. Dakota, you're full of personality. Why are you not answering me? What are you doing? I don't

Dakota 49:17
know. I was taking a drink of my coffee.

Scott Benner 49:21
COMM, I want you out. In the world. I want you changing your pump before you go to bed, if it's gonna run out. I do not want you sleep. Listen to me. This is for everybody. I do not want you sleeping in a situation where you could be running out of insulin. Please don't do that. Okay, and don't change your pump eight seconds before you go to bed, because if there's an occlusion or a problem or something like that, you're going to be asleep and not have any insulin. Yeah, Jesus Christ. And now, you know what just happened there, Dakota. Now all the people who like me, but wish I wouldn't say Jesus Christ are passed so, and that's your fault. I

Dakota 49:54
just want to you write down the time and have your editor take it up. No, because I'm not going

Scott Benner 49:59
to. End to their will, God damn it. And I added god damn it, because that's the other thing they don't like. And I know because they sent me a lot of notes about

Dakota 50:10
you're gonna get a one star review, dude, my

Scott Benner 50:12
emails just sound like this. Don't be creepy, which means we don't talk about sex anymore. But screw you guys. You should and my end, please stop saying Jesus Christ and God damn, those are pretty much my emails. Anyway, I apologize to everybody who I've offended. All right, what have we not talked about that we should have? Dakota? Where should this conversation end? A few more things about the Iowa. Go ahead, roll it out to me, from what I understand, the way the meals adapt, they'll only adapt if they're spaced four hours apart. What do you mean? Explain that to me. So

Dakota 50:50
say you dose for breakfast, and then three hours later you dose for lunch, and you choose those two separate options, breakfast and lunch, the pump isn't gonna know which one to adjust for the next time you choose the option, the

Scott Benner 51:08
second choice or the third time. Like you're saying, If I said, Hey, I had a normal meal, a normal breakfast, excuse me. And then three hours later, you're like, I'm having a normal lunch. It's not gonna know what, what? Won't understand.

Dakota 51:21
It won't know which, if it's breakfast or if it's lunch, that the insulin needs adapted for. Ah,

Scott Benner 51:27
because so it can't hold those two meals independently in its thinking, right? Ah, it's just, it's just attacking carbs and highs at that point. Yeah, is that problematic for you? Do you find yourself not eating inside of that four hour window on purpose?

Dakota 51:45
I find myself eating more in the four hour window. You're like,

Scott Benner 51:49
I'm like, No, you.

Dakota 51:53
And then, and then nothing in my settings change.

Scott Benner 51:55
What do you mean? So, like, it'll

Dakota 51:59
decide for a normal lunch. Say it wants to give me 14 units, and I think that's too much. My normal lunch should be a little bit less than that. Okay, I have to eat that lunch, choose the normal or the usual, and then I have to wait four hours before I can eat anything again to get that insulin dose to decrease. Okay, I feel

Scott Benner 52:24
like I'm talking about a fresn now, so like, a four and an eight to 12. And I'm like, Oh, yeah.

Dakota 52:28
So I think that's something that you should ask. Okay,

Scott Benner 52:32
well, hold on a second. Let me get my marker on my whiteboard and ask you to, like, put that into words for me. Like, simplify that question, how do the meal doses adapt? How do meal dosing doses adapt when they're less than four hours apart? Yeah, okay, I'm gonna go blank when they're explaining that to me, because that's how I feel when, when the guy was like, so I took a four, and then another four, and then I'm like, can you just please easily explain to me how to dose of friends? It's an eight, the 12. And I'm like, oh, in the end, the answer ends up being like, it's kind of an art and you figure it out. And I'm like, that I accept. I'm like, okay, I get it. Okay, so I'm gonna ask, How do meal doses adapt when they're less than four hours apart? Okay, that's good. Thank you. I'll add it to my list and what else. And then

Dakota 53:32
I have heard that. So you can change the cartridge and the tubing at the same time, or you can just click an option that says fill tubing, and that's when you just change out your your infusion site, and not the tubing or the cartridge. So so you get an occlusion or it rips off, and you just need to change the part that's in your skin. You put that on, and then you click a button on the eyelet that says, Fill tubing. From what I understand is it forgets the last six hours of data that it's learned.

Scott Benner 54:02
Wait, when you change, look at everybody here Dakota, he's got a he's got a direct line to bite of bionics right now, through me, somehow, when you change the tubing or the site, the site, the site, and what then Phil, Phil canula and fill canula. Does the system what forget the

Dakota 54:28
last six hours of data that it's learned? All right, I got it

Scott Benner 54:33
cool. We're gonna make a nice episode with them. We'll learn a bunch of stuff. How does it adapt when the meals are less than four hours. They're gonna get this email. They're gonna be like, Oh, he was talking to people. He knows stuff. That's good, though. That's what they want. They want good questions so we can get good answers out there for people also, I'm gonna hit them up about dual chamber. Yeah, they've been on talking about that already. They were very excited when they made the agreement with the gluteagon company. Was the G, VO was, I think so, yeah, was it right now, the people at, uh, at zeros who are like, Oh, good job, buddy. Way to, way to remember things we buy ads, you know? No, I have that there. So, so I'm actually going to find out, because this is a good episode if you've heard this one and you want to hear something that is potentially exciting about islet, I'm going to type in here islet, and then glucagon at Juicebox podcast.com and let you know that I have a couple of great eyelet episodes, actually, 1217, islet from beta bionics with Dr Stephen Russell. He was a great conversation. I've spoken with Ed Damiano. It's Damiano right in episode 934 when they first released. But how come I'm not seeing my episode with them and the look at me, I'm like pimping the Juicebox Podcast. Calm. Search button, and we're not getting what we want. Let's try this again.

Dakota 56:04
You didn't even talk about how the site was recently redesigned. Oh, I

Scott Benner 56:08
did redesign this. I do like it. Is it better? Yeah, I like it. Awesome. Good. Thank you. Five days of my life sitting here, not moving, terrible, staring at the screen. Oh, my God, my elbow hurt. I just, like, people are like, I dug a ditch today, but I make a podcast. And, like, I still had to make the podcast. And then in the like time, I was like, Oh, I'm gonna take off a little bit of time for the holidays. Instead, I sat here for a week like a lunatic redoing the website. Because I was like, I've been wanting to do this for like, two years, and I just, there's never time I'm just gonna do it. You know, I got it 1209,

Dakota 56:46
glucagon in an insulin pump. You

Scott Benner 56:48
found it. Paul and Sean are CEOs of their respective companies, beta bionics and zeros. Today we talk about their new relationship and their desire to create a BI hormonal insulin pump like that's an interesting conversation, too. Anything else?

Dakota 57:01
I am working with a dietitian through a company called nourish, okay? And I meet with her every two weeks and we review my report that my eyelet pump puts out. Kind

Scott Benner 57:14
of report does it put out? Like, how is that valuable with the nutritionist, is my question.

Dakota 57:18
So she'll look at like, how often I'm dosing like when I'm announcing meals, and I'll make a meal log in a separate app, and we'll go back and see like if I went high afterwards, what did I eat? And we will decide if I chose like the wrong

Scott Benner 57:40
meal announcement, like the size,

Dakota 57:44
yeah, that's so then the next time I have that meal, I can

Scott Benner 57:47
choose the correct option. Does your insurance cover that? Yep, my insurance covers it, and I have a $0 copay. That's wicked. Excellent. You finding it valuable? Definitely awesome. Yeah. Is that online as well? Yep, through zoom nice, do it on your phone or at a computer.

Dakota 58:05
I do it on my computer. Important stuff you got to do on my computer. My

Scott Benner 58:08
kids are like, Do you want a laptop? Like, I'm not a child. Like they don't they don't understand. And I generally, I don't understand either. I like sitting at a desk with a computer in front of me. I think it's just because it's how I interacted with the computer. Computers when I was younger. I hate laptops. I hate that how small the screen is. I'm the same way. Oh, good. That makes me feel good. Yeah. Like, I like my phone because it's interesting. It's like, the pumps the phone presents a ton of convenience, but like, there are certain things you go to do on a phone, and I'm like, I would rather this not happen than me have this experience on this tiny screen. So, all right, Dakota, this was awesome. Thank you. I appreciate you reaching

Unknown Speaker 58:50
back out about this. Yeah, no problem. Thanks for having me back on. No,

Scott Benner 58:53
is my pleasure. Listen, I'm not your dad, but you know what you're gonna do this weekend, right?

Dakota 58:59
Change my insulin cartridge before I go to bed.

Scott Benner 59:03
All right, how about if you change your insulin cartridge and then go out in the world and try to find a cute girl who seems like she might like you, and then be nice to her and really be nice to her. Don't pretend to be nice to her, really be nice to her. And see if you guys get along. And maybe you'll get along and talk and have things in common. And then one day a baby will come, oh, a baby, yeah, like a baby. Or, if you don't want a baby, a puppy, but there's a girl in your house while you have it. I think this would be good for all of you listening, and vice versa. Girls like, go. I know boys are icky. I'm one. I get it. Like, there's got to be one out there that you would like, you should go look for him and see if you can find him. Now also, let me speak to the gays. Same thing, girls that like girls, boys that like Boys, boys that used to be girls that like girls that like boys. I don't give a shit. Like go out there and find somebody. You don't want to be alone. It's not good. And then when you find them, and I can't. Stress this enough, Dakota, when they're in the room with you, don't look at your phone. Please. Just don't look at it. Just pretend it doesn't exist. And then look at them, and you'll be like, Oh, she's pretty. Maybe, if I'm nice, she'll touch my hand, like, this is the stuff you should be working on. Well,

Dakota 1:00:22
maybe someone listening can go find me on the Facebook group and, yeah,

Scott Benner 1:00:28
that's fine. That's what you want me to do. I gotta hook you up. I need you out in the world, my friend,

Dakota 1:00:34
you gotta go turning into a dating podcast. Yeah,

Scott Benner 1:00:37
oh my god. Can I do that? By the way, I've done two life coaching episodes so far, they've been awesome. I definitely need more people to do that. I coached a 12 year old kid about his Pre Bolus thing that was fun. A woman in her 50s about her desire to get divorced. I did see you post that I'm super excited because Dakota, I'm completely unqualified to have these conversations with people. But at the same time, who else you gonna talk to? You know what I mean?

Dakota 1:01:06
Yeah, yeah, no one better than Scott. Have

Scott Benner 1:01:09
either of your parents told you to go out there and try to make a person with boobies like you? Nope, no. Well, they should have. Your mom is like, how long she gonna stare at you? You know what I mean? Right? All right. Maybe you got to talk a little bit man, but like, yeah. Like, we got to get out there. Like, this should not make you uncomfortable. This should make you be like, Yeah, I do want to see a boob. That's how it should make you feel. And then, and I don't just mean see and for all you girls out there, like, I'm not being like, not just like, somebody like just has to show you one, but somebody like is like, super excited to show it to you. Like, like, you don't need to like this, Dakota, he could be. I love him. He's awesome. I'm gonna let him see my boobs. Yeah, now you're getting it. Get out there, Dakota. Listen to me. If you all don't start fcking you're gonna us all. Do you understand what I'm saying? I'm gonna get old. I need one of your kids to work in the nursing home I'm gonna live in. You gotta get moving to go. No, I'm not making this up. I'm serious. I am one day gonna need a 21 year old with not great job prospects to carry me to the bathroom, and one of you has got to get out there and make that baby we're gonna cease to exist. You understand what I'm saying? Yep, I need you out there. I don't understand. Sex is so wonderful. How is it you're not like, just like, all day long thinking about, like, how do I get to have sex? That is not in your head constantly. I'm working 14 hours a day. I don't care. I work in a sheet metal shop with a bunch of dirty guys. And in any spare moment I had, I thought to myself, I wonder how I could have sex I once had a brief relationship with the of age. I just want to be clear daughter of the guy that drove the lunch truck to the shop I worked at like I want you to imagine that a truck would roll up at the filthy pit that I worked at, okay, and it just had sandwiches in it and drinks, and we'd walk out and it's just owned by a guy, you know, or a girl, I forget who owned it. But one day that person started bringing their teen I was young still, I want to be very clear, but one day that person started bringing their teenage daughter with them, like I think the girl was being punished. Do you know what I mean? And she was my age, and I successfully at a sheet metal shop, hit on this girl, started a conversation with her, got her phone number, went out with her, and eventually, through the goodness in her heart, she gave herself to me, and I'm telling you right now, I also gave myself to her. I just want to say it was a very loving exchange. And I want to tell you right now that I don't think someone your age in 2024 could pull that shit off if their life depended on it. We're all too awkward in personal interactions that are online. I feel bad for you. The

Dakota 1:03:56
internet's ruined everything

Scott Benner 1:03:58
it has. It made boobies too available. They have to be a thing. I would just want to say that for people who are understanding this, like, we're probably bleeping out boobies or we're not, I haven't decided yet

Dakota 1:04:08
that could be the name of the episode.

Scott Benner 1:04:12
I don't understand. It motivates most of my existence, like, just a girl being kind to me, like, I don't mean like, I don't actually mean them exposing their price being intimate with a girl like, or having them want to do that with me, that like, motivates my life. Like, I think if that didn't exist, I wouldn't, like, I don't even know if I'd have a job. But what motivates you guys? Like, what do you get up in the morning and go to work for pay my bills? Yeah, but I had bills too. I didn't give a about the bills. What I cared about was girls. Like it's not girls. I'm so confused by this I

Dakota 1:04:50
don't know what does motivate me, not a whole lot. How to take a

Scott Benner 1:04:54
phrase that seems more reasonable to me than how you guys treat like dating and interaction. Options. So weird. I don't know how to fix this. I think we've gone in a direction at this point. We went from free love in the 60s to this. 60s, 70s, 80s, 90s, 2000 to 1061. Years. 6070 years. We went from like, get high have sex with anybody you bumped into to I don't know. I'm awkward, and I need to pay my bills. They

Dakota 1:05:27
looked at me weird. Yeah, they looked

Scott Benner 1:05:29
at me weird. I don't know what to say. I was very upsetting. All right, listen, good luck. God bless and we're all, we all need help. I don't know who's carrying you to the bathroom. You guys are really screwed. Like, I might still get you to carry me to the bathroom when I'm like, 80, but, like, I don't know who you're getting. You have a plan, Dakota, you've had sex, right? Yeah. And is it awesome?

Dakota 1:05:57
Yeah.

Scott Benner 1:05:58
Okay, go. Wash your hair, clip your fingernails, put a little file on them so they're not sharp, you know what I mean? And then, and then, like smile, stand up straight, make eye contact and engage with people. You'll it'll happen again, and then again and again. And then eventually, get married, and it'll stop.

Dakota 1:06:20
That's what I hear. What happens, 100%

Scott Benner 1:06:23
true, Dakota, I just want to say like they're not lying to you about that at all. I

Dakota 1:06:28
read your book over the summer. Did you really? Yeah? I mean, three of my friends, we had a little book club. Three

Scott Benner 1:06:34
of your friends read my book. Yeah, that's why you're not getting laid. I mean, was it any good? It was, yeah, I liked it. Oh, good. It was funny, I'm glad. But that was about making a family, right? I thought it was gonna be a little bit more about diabetes. No, it's got nothing to do with diabetes. Yeah, I realized. But when you read it, were you like, oh, I should make a family. I thought about it first was second, and then somebody looked at you weird, and you walked away. Yeah, a lunch truck. I'm not even attractive. Do you understand me? You have to try, because there are other people out there who are also uncomfortable, and they they don't know how to try. And if someone tries, they'll go, who me? Oh, yeah. Like, you know what he means, like, because if a girl came up to you and you're like, hey, Dakota, he'd be like, huh, Dakota? Me, okay, do you see how you would get immediately? Like, they're waiting for that too. But if you don't talk to each other, neither of you are gonna know you won't know that. Yeah, everyone's awkward. That's why you can turn the lights off in the lights off in the beginning. When you're figuring it out, you don't do it with the curtains open till you're like, you know, really good at it. We're super comfortable, I guess is the way to put all right. I don't know how this got down this this road, but for everybody listening, in your 20s, please, would you start having sex with each other? I really am worried about who's gonna fix the roads, but I'm older, I'm worried about who's going to be at the grocery store. I'm worried about who's going to make the food at the restaurants. I'm worried about who's going to work at IBM. I need you out there. Again. It's not going to happen like this. What about those Tesla bots? Jesus Christ, Dakota, that's what you're hoping for. So first of all, I want to be clear, I would buy a robot and have it in my house if it was safe and affordable. I do think that sounds awesome at the same time, like in my house with my children and my wife, not by myself, in my domicile. You understand? Yeah, life is for the living, my friend, it's a saying. Have you ever heard it? No, you know what it means. Um, don't it means get out there and live your life. Oh, okay, did you not know that? Yeah, no, that makes sense now. Yeah, you sure you understood the book?

Dakota 1:08:56
I read it in sections.

Scott Benner 1:08:57
I broke it down into bits. See, you have good sarcasm.

Dakota 1:09:01
I'm full of sarcasm. Yeah, I get in I get in trouble for it, yeah, but there's

Scott Benner 1:09:05
some girl will like that. And then eventually, when she decides that you're okay to marry, she'll make you stop. But like, you know, she'll like it in the beginning. It'll be fun watching her change you.

Dakota 1:09:18
Well, I'll get right on that, and then I can bring her on to talk about me on the next time.

Scott Benner 1:09:25
All right, the phrase life is for the living suggests that life is meant to be actively experienced, enjoyed and embraced. It emphasizes the idea of seizing opportunities, being present and making the most out of the time we have, rather than merely existing or being being consumed by fear, regrets or excessive caution, it's a call to action.

Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice, box or call eight, eight. 87211514, my thanks to us, med for sponsoring this episode and for being long time sponsors of the Juicebox Podcast. There are links in the show notes and links at Juicebox Podcast com to us, med and all of the sponsors. The conversation you just heard was sponsored by Dexcom and the Dexcom g7 learn more and get started today at dexcom.com/juicebox,

if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. Hey, what's up, everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording, doing his magic to these files. So if you want him to do his magic to you, wrong way. Recording.com, you got a podcast. You want somebody to edit it you want rob you?

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#1409 Weight Loss Diary: Sixteen

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Sixteenth installment of my GLP journey

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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, to another episode of The Juicebox Podcast.

Guys, I know I'm way behind on this. I apologize to those of you who have been following the series, I'm back on track now. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Don't forget if you're a US resident who has type one or is the caregiver of someone with type one visit T 1d exchange.org/juicebox right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for ag one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink, ag one.com/juice box.

Well, it's World Diabetes Day, Thursday, November 14. I'm late. I was supposed to put this shot in yesterday. I think Scotty messed up. That's okay, though we still have some good news on the health front regarding this weight loss extravaganza. Let me pull up my app. We'll start this episode off with a little go through, if you know what I mean. Let's start right out of the gate by telling you I weigh 180.6 pounds today. Yesterday, I was 180.4 the day before 181 80 is my lowest. Going back like a week or so, I don't really know where to go to. I'm gonna go to like the sixth, one 80.21 80.4 on the seventh, 181 one on the eighth, one 80.4 on the 11th, 180 as I said, on the 12th, that was awesome. Today. I was 180 point 6.6 pounds higher than my lowest weight since I started this whole thing to remind you, or to catch people up who are maybe finding this for the first time, weighed myself the first time and shot back then it was we go V on the 28th of March, 2023 on That day, I weighed 233.4 pounds. Today, 180.6 that is, I can tell you, 52.8 pounds. I'm down. My BMI is down 7.9 and my body fat down 11.8% I feel awesome. Let's see my let's see where the trends are. Shall we wait? As we know, down. BMI has been pretty steady the last week. 26.7 I'm under that magical 27 number all of a sudden, body fat steady. 23.2 body water, staying steady. 55 and a half. Skeletal muscle staying steady. BMR, staying steady. Fat free. Body weight, staying steady. Like an example, fat fee, fat free. Excuse me, body weight, 130 8.6 on the day I started this 150 1.8 subcutaneous fat today is 20.3 on day one back there in March, 2023, it was 30. My visceral fat is holding at 10. My muscle mass is holding at 130, 1.8 my bone mass is steady at seven. Protein is standing very steady, and my metabolic age is 54 but I'm almost 54 so six, seven more months, nothing will be right. Hopefully it'll go down from there. Anyway, I'm gonna take my shot. I'll be back next week, excited to talk to all of you. I hope your World Diabetes Day was great. All right, I found my spot here. As you guys know, I enjoy this enjoys, really, the wrong word. I like to put the shot like, at the very bottom of my belly, like there's a kind of, like, a softer spot there. I don't know. Why don't really care? Why? Just doesn't hurt there at all. I take the cap off of my zepbound 12.5 milligrams like that. I unlock the cap. Want to hear it ASMR, Oh, you heard it, and we're gonna put this thing in. Get done. Get back to work. What works, Scott, I have to put an episode together for Saturday. We're doing a beautiful best of about Michelle Bauer, I hope you guys caught it back then. All right, ready? One, two, A, 1234, what's that? Billy. Joel, yeah. Thanks, Bill. Joel, ready, didn't feel a thing. All right, kids, Hey, what's up? I have not been doing well with recording for you. I apologize for that. I've actually injected twice without recording. So today is the fifth of December, but I can walk you through what's been going on. It's not frustrating, but I feel like I'm learning some things. Most important thing I learned yesterday, I'll get to that at the end. Anyway, this morning, I was 182 pounds, which is, I mean, awesome. And going back, you know, I'll go back a couple of weeks the you know, I'll even go back, like almost a month to November 12, when I was 180 so 180 has been my kind of low water mark right now, going forward, I did hit a 179 for one day. That was the 23rd of November and but right from there I went, you know what? You know it was Thanksgiving, and I held on there, 179 two on the 24th one 80.2 on the 25th 27th 183 28th 182 two. And today is December 5. See if I can get back to it. Why is it messing with me here? December 5, 182 Yeah. So I was one 80.6 on the 30th. Here's what I did. So, you know, I'm supposed to be injecting on right now, Wednesday. I've moved it around a little bit on Sunday last week, so if today's the fifth Sunday was the first. I actually shot two and a half milligrams that day. So we have some extra pens. So I did the two and a half, and then I don't know what happened to me. I just like, I whiffed on injecting yesterday, so I hadn't had my 12 and a half, you know, today now for eight days, the two and a half was like a nice little bump, and I think it helped me that Monday, Tuesday, but it didn't really do much. It wasn't going to do much to to offset the fact that I forgot to inject on Wednesday, yesterday. Now here's the super it sucked, but I learned something. I woke up this morning at 4am having a dream about having heartburn, and I woke up and I had heartburn. I have not had heartburn in forever on the GLP, and then one day without it, I had heartburn while I was sleeping. I'm telling you, it's helping me with more than I know. Anyway, back on the weekly am I going to try to do another two and a half on Sunday? I'm thinking about it for now. Today's Thursday, the fifth. I've got this 12.5 of zepbound. I've taken off the cap, I've unlocked the pen. I'm gonna slip it in here, and then I'm gonna make podcasts. I like this spot on my belly at the kind of the bottom of the bell the belly, which basically, at this point, looks like someone took a fluffy pancake and taped it to the front of me. So that's awesome. Here we go. Little bit of pressure, not bad, little bit of a drip, not bad. I promise. I'll be back next week. I'll keep having these trying to add whatever I learn. I think the heartburn thing is really important, as you know, I'm sure I've mentioned on here. I was told a couple of years ago I have the beginnings of what could be Barrett's esophagus, which is not good and definitely heartburn related. Tried a bunch of different things for heartburn. You know, some of it works, some of it didn't. Overall it wasn't working. I can't remember the last time I've had heartburn since I've been on a GOP. And then, boom, I. Missed my GLP for one day, basically. And I mean, what did I eat last night? That's the other thing. It wasn't anything crazy. What I have for dinner yesterday afternoon, I had an egg wrap. So egg and I had an egg and a wrap, maybe two eggs with some pork, like bacon. I think it was bacon, a strip of bacon. Later in the day, I had some turkey left over from Thanksgiving, but nothing really else with it. Maybe there was stuffing, a tiny bit, not much, if any. But I had a slice of pumpkin pie with my son, like in the evening, and that was it a slice of pumpkin pie. Not a big slice of pumpkin pie. Had a slice of pumpkin pie for no no GOP going at 4am bad heartburn. Had to get up, take couple of Tums, sit up till it went away so I could lay back down. I guarantee I'm gonna come back here next week and tell you I haven't had heartburn again. I'll see you soon. Hey, friends, what's going on? I have good news. Let's take a look. So I did not, I'm sorry. Today is December 11. I did not do an extra.

I did not do an extra so I just got a text message. I should probably not look at my phone while I'm making the podcast. I did not do an extra two and a half this week, but I was losing weight, so I was just like, let me see how this goes. I might do it this week. The extra. Let me get out my app and my glasses. I am 170 9.2 this morning. Also, I've gone to the bathroom since then, so maybe 179 but 170 9.2 that's fine. It is not, wait a minute, it is. That is absolutely Oh, I didn't even realize this. Look at me. I'm getting ahead of myself. That's as low as I've been so far. Get out of here. Oh, awesome. 182 two, back on the fourth, fifth, sixth, seventh, eighth, ninth, 10th, 11th. Look at me knowing how long seven days ago was. Next day. Excuse me, a 12 five, yeah, next day 182 12, six, 182 12, eight, I have to tell you, this rocked me. I did not expect this. I went from 182 to 179 four, and it wasn't it wasn't like dehydration. Oh, and I just lied to you the next day, 12, nine, the ninth. Just a couple days ago, I was 170 8.4 a few days ago, I had, what did I eat? Oh, I think I had a soft pretzel. Yeah, that put me back to 170 9.2 the next day, and then today, so the 10th and 11th both 170 9.2 feeling great. What I want to say about how I was feeling? Oh, I I heard this, this person on their social media saying, like, If I hear one more person say they have a GLP deficiency, they don't have a GLP deficiency. She's ranting and raving and everything. And I'll tell you, I don't know if I do or I don't, but man, it feels like I do. So if there's another way to say that, or a better way to put it, I'm going to try to figure out what it is. But all I know is that when this stuff is flowing, I eat. My body manages it correctly, like, I mean, listen, a soft pretzel. I don't know if you're all from, you all been out to the east coast before, but if you ate a soft pretzel, you wouldn't gain three pounds, but I would. And now with this, you know, 4.4 pounds, like, that's just, that's a fluctuation, that's not even a weight gain. But if I wasn't on this and I had a soft pretzel, I mean, trust me, it wasn't like yesterday. Was like an orgy of food that I capped off with a soft pretzel. I had my regular day. I had what I eat yesterday, two eggs. Had them in a low carb or wrap with some steak. That was breakfast. Actually, at lunch, I did something yesterday, mixing in protein powder. Now I'm not ready to tell you about it yet, because I yet, because I just started it, but I had eight ounces of milk with a big scoop of chocolate protein powder in it. I'm trying to I realized that I was eating protein, but did the math on it. I was like, and Jenny helped me. And I was like, this is not quite enough protein, she told me. So I was like, Okay, so I'm gonna do the drink. I'm gonna go every other day for the first couple days, make sure my stomach's good with it. But I went with like a I went with a pretty gentle one. I felt like I was okay today, but I'm skipping it today, doing it tomorrow. I'll give you more about that later. So I had the protein powder, I had the eggs, the wrap, the steak. At some point during the day, somebody had soft pretzels, and was like, I'll have one of those. I had a soft pretzel. I put. Yellow mustard on it. Then last night for dinner, we did, I did pasta. It was leftover linguini with shrimp, so four or five medium sized shrimp with, I mean, I a handful of pasta, maybe, anyway, 170 9.2 today. I was 178 something a couple days ago. I think this is it. I think I think I smell 175 caps off, talking about zepbound, 12.5 milligrams, unlocking the lock. Check on Chuck. I was gonna try to say chuck a con. I got like, stuck in my voice, stuck in my voice, stuck in my mouth, whatever. Oh, God, do you hear that? Sorry, that's my, um, I'm so embarrassed. That's the misting system for my chameleon. And now Arden's calling me. Hold on, a second. Arden, hold on. I'm doing my injection. I'm recording at the same time. Give me one second. Do you want to watch? You're watching. Look away. Look away. Look away. All done. Okay? Well, it's December 19, and been a bit of a roller coaster this week with Scottie his journey. It was good. It was less good in the end, you know, all the benefits are still there, but I'm one 80.8 this morning, but at some point this week, my goodness, what was I 179 two last time on the temp. I'm a day late, by the way. I forgot to do this yesterday. Well, here we go. I was 179 two on the 10th and the 11th. On the 12th, I was 170 7.4 It was awesome. But then on the 13th, I was 178 but still, like 178 awesome on the 15th, 179 six, then one 80.8 now one 80.8 I didn't eat enough this week. The big drop coincided with the first time I took a drank a my got a protein drink. I was like, is this it? I mean, I know it couldn't have been, but still, I did the protein drink the first day I skipped the next day. I just wanted to see how my body reacted to it was fine. And then somehow, this week, well, not just somehow, honestly, I've been revamping the website, Juicebox, podcast.com, I'm basically doing the work of like a five man team this week, plus making the podcast, plus Christmas is coming, plus Arden's home, plus, plus, plus, you know, I just it's gonna sound crazy, but I didn't eat enough this week. I didn't eat enough. I didn't stay with the the protein drink, even though it was awesome and easy to drink, and I'm gonna do it, continue it, but I just, I got lost in my work, no lie, and I'm one 80.8 today. Now, having said that, if you just go back, you know, a couple of weeks, I was 183 as a high on November 27 as an example. I was 183 I was 183 on the 18th of November. This is awesome, like 180 I'm a little higher than almost 181 and I'll love it, but still, I'm two pounds down from my highest. I'm not gaining weight, you know, just drifting around, and I'm not doing the right things. So let's do the right things, right let's, uh, do the 12.5 min jar of zbound. Excuse me, 12.5 milligrams of Zep bound today. Let's eat more food. Scott just needs to eat more. That's all I got chicken downstairs. I made sure I had beef. I make sure I had shrimp. I have. So I've got shellfish, I've got chicken, beef, I've got the protein drink I'm just gonna eat. And the podcast website's almost done, so it's a big load off, or got one more big project left for the end of the year. And then, you know, have some Christmas and then get back into making the pod for 2025 I don't talk about this much on here, but I think all of the sponsors are back for next year, and I think we have some new ones too. So huge shout out to all those people. Links in the show notes for the sponsors, keeping all this going. All right. Where am I gonna put this thing? How about it? Right here. Here are you gonna move the microphone so you can hear it better? Hold on. All right, ready?

All right. Let's go. Mary happy. You.

At least when it comes to this series. And I apologize, it's January 17, I've been taking my shot every week, just like I'm supposed to. But because of, you know, I don't know the holiday and running around and stuff like that. I'd be like, Oh, I have to take my shot. I forgot it. And then I'd be like, I don't have time to go record while I do this. And I'll just remember and it doesn't work. And then things go back and forth, and you forget where the hell you were. So what I'm going to do is I'm going to button up this episode and just commit to starting over. I with you guys. Like, don't get me wrong. I'm doing I'm doing good here, but I'm going to commit to starting over with you all. So I'm going to go back to because A lot's happened. What was our last time I was here? What was December 19? Let me find that it's been a bit of a thing. December 19, I was one 80.8 I'm not going to give you every day, but I went down, down, up 181 180 161 80. This is around the 29th of December, stuck in the 180 to 182 range to the second. Then on the third, I was 179 four. I'm gonna tell you right now. I thought I was I thought I had it on the fourth of January. 176 four, next day, 179 78 177 I ran 177 to 179 for about a week and a half. And now it's today, and I'm 179 four. I was 177 for the other day, on the 10th, now on the 17th, a week later, two pounds the other way. I gotta tell you like I know the problem, so I just have to start over. It's gonna sound crazy. I'm not eating enough food. That's it. I started doing protein replacement to make sure I had, you know, like, extra protein judge, and that was working great, and I just had trouble doing it every day, meaning, like, I just, I don't know, I didn't have a system around it. I guess I have to commit to having a system around the protein shake, which is not hard to drink. It's nice. It's chocolate. It's like eight ounce. It's not a big deal, you know. So here I am, January 17, Friday. You can even see I was supposed to inject Wednesday this week, and here I am. It's freaking Friday, and I'm finally getting to it. It's where the two pounds came, by the way, I was 177 this week, and the medications, like it's gone out of my system now. And I've, you know, I grabbed a couple of pounds already last night, I ate, I didn't even eat, well, like, I don't even know what if I made my I think I had, like, leftover pasta or something like that. So anyway, let me just I'm not going to say New year, new me. That sounds ridiculous, but it's January 17, 2025 I've got 12.5 of zbound right here. I'm going to stick it in. I'm going to commit to my my protein shake every damn day, and I'll be back on Friday, and I'm going to report something good if it kills me also, we're getting an aerobic, kind of like workout machine set up here at the house to help with that and kind of muscle building things we got, like a rowing machine. I'm getting that set up, and I want, I want to have better information about that next week too. But right now I just, I know for sure, protein, protein, protein and muscle training. I know these are the two things that I have to commit to, especially if I'm going to use this medication long term. Cap off, unlock, I'll tell you what the trash cans near. I don't think I'm going to miss I'm I found a nice jelly spot to put it. You ready? Hold on. I'll move the mic so you can hear it

better. Oh, that's some pressure at the end there. Damn, that's a goddamn. Oh, all right, all right, guys, I'm putting this I'm putting this I'm putting this one out because I don't even want the I don't even want another file to have any of this on it, of my inability to be consistent. So I'm going to be consistent. I'll see you next Friday. Enjoy this one. I'll see you soon. You

Are you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would, I think I see something. Here, but I can't be sure, once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 if you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. You.

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