#1699 On the Pen with David Knapp
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Scott and Dave Knapp break down GLP-1 medications, weight loss, metabolic health, inflammation, type 1 impacts, myths, microdosing, and why these drugs may reshape diabetes care.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:00) Friends, we're all back together for the next episode of the Juice Box podcast. (0:04) Welcome.
David Knapp (0:14) I'm Dave Knapp. (0:15) I'm the founder of the On the Pen Podcast. (0:18) It is a weekly podcast all about the news around these new medications that I'm sure that you've heard about, the Ozempic's of the world, the Majoros of the world. (0:27) Maybe you've heard it as the fat shot too from the Oval Office. (0:31) But however you've heard of it, you've heard of it by now.
David Knapp (0:33) These medications are taking the world by storm. (0:36) And I, as a type two diabetic diagnosed in the 2021, ended up on these medications after trying everything in my own power and my own might and even looking down the barrel of a metabolic surgery that would have rearranged my anatomy. (0:51) And my doctor introduced me to these medications, and I thought, you know what? (0:54) There's no one that is giving this information from the patient perspective. (0:58) Everything that's out there is for a doctor.
David Knapp (1:01) It's for an investor, but nothing exists for the patients. (1:05) And that's where On the Pen came in. (1:06) So, Scott, I'm super excited to be sharing with you a little bit today about what we talk about over at On the Pen, my favorite subject, GLP one medications.
Scott Benner (1:16) Nothing you hear on the juice box podcast should be considered advice, medical or otherwise. (1:21) Always consult a physician before making any changes to your health care plan. (1:30) Just in time for the holidays, Cozy Earth is back with a great offer for Juice Box podcast listeners. (1:36) That's right. (1:36) Black Friday has come early at cozyearth.com.
Scott Benner (1:40) And right now, you can stack my code juice box on top of their site wide sale, giving you up to 40 off in savings. (1:48) These deals will not last, so start your holiday shopping today by going to cozyearth.com and using the offer code juice box at checkout. (1:56) The podcast is also sponsored today by Omnipod five. (2:00) Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. (2:11) Learn more and get started today at omnipod.com/juicebox.
Scott Benner (2:16) At my link, you can get a free starter kit right now. (2:18) Terms and conditions apply. (2:19) Eligibility may vary. (2:21) Full terms and conditions can be found at omnipod.com/juicebox. (2:26) Today's episode is also sponsored by US Med.
Scott Benner (2:30) Usmed.com/juicebox or call (888) 721-1514. (2:36) Get your supplies the same way we do from USMed.
David Knapp (2:40) I'm Dave Knapp. (2:41) I'm the founder of the On the Pen Podcast. (2:44) It is a weekly podcast all about the news around these new medications that I'm sure that you've heard about, the Ozempic's of the world, the Majoros of the world. (2:53) Maybe you've heard it as the fat shot too from the Oval Office. (2:56) But however you've heard of it, you've heard of it by now.
David Knapp (2:59) These medications are taking the world by storm, and I, as a type two diabetic diagnosed in the 2021, ended up on these medications after trying everything in my own power and my own might and even looking down the barrel of a metabolic surgery that would have rearranged my anatomy. (3:17) And my doctor introduced me to these medications, and I thought, you know what? (3:20) There's no one that is giving this information from the patient perspective. (3:24) Everything that's out there is for a doctor. (3:26) It's for an investor, but nothing exists for the patients.
David Knapp (3:30) And that's where On the Pen came in. (3:32) So, Scott, I'm super excited to be sharing with you a little bit today about what we talk about over at On the Pen, my favorite subject, GLP one medications.
Scott Benner (3:40) Dave, I can't thank you enough for doing this. (3:42) Also, I'm I'm super amused not amused, but, like, kinda delighted watching you because you're accustomed to being on video, and I'm not. (3:48) I'm watching you be effusive and move around and smile and everything.
David Knapp (3:51) Like a maniac.
Scott Benner (3:52) Yeah. (3:53) And I realized that normally what would happen here is you and I wouldn't be looking at each other. (3:57) I would spin a 180 degrees, put my feet up over here and bring this microphone over and I and I would chat like that. (4:02) Yeah. (4:02) Yeah.
Scott Benner (4:02) So it's it's really awesome. (4:04) Well, listen, man. (4:05) I I appreciate you doing this. (4:07) I wanted to do it for a couple of reasons. (4:08) But mainly, I'm most interested maybe in a guy like you who's not a doctor, right, who does not have a medical background, who just found himself flung into this, who started making content and then realized that it was a business.
Scott Benner (4:22) Because of that, I think that you're steeped in it in a different way. (4:26) You don't get an opportunity often to talk to people who are paying a crazy amount of attention to one focused idea. (4:33) And when I realized that you're out there making, like, you know, news clips about, like, hey, there's a pill coming. (4:39) There's this. (4:39) Like, it's stuff we talk about here.
Scott Benner (4:41) Like, oh, I heard there's a pill coming. (4:43) I heard it's going to be as effective as the injectable maybe. (4:47) But I heard that from a doctor I had on, like, six months ago, you know Yeah. (4:50) Who just said to me, like, it's coming in oral form. (4:53) And, like and it's kinda how he put it.
Scott Benner (4:55) And I was like, what do mean? (4:56) He goes, oh, it's coming fast. (4:57) I wanna know what that means, but I don't have the time to dig through it. (5:00) Mhmm. (5:00) I'm digging through type one diabetes and and this podcast.
Scott Benner (5:04) So I'm I'm here to pick your brain and and everything, but I do wanna get a little background first. (5:08) So you said you're you have type two?
David Knapp (5:10) Yeah. (5:10) So I was diagnosed with type two diabetes back in the 2021. (5:15) This was after a year of experiencing what I called, like, level sleepiness. (5:21) I just knew something was wrong. (5:22) I thought maybe it was long COVID.
David Knapp (5:24) And I went into my doctor's office, and I said I knew that something's wrong. (5:28) What's going on? (5:28) And I was having kidney stones and just kind of a host of, I don't know, ailments that I just knew something was wrong. (5:33) I said to my wife, I said, either I have cancer, I'm dying, or I I have some sort of chronic disease. (5:38) The way I'm feeling is not normal.
David Knapp (5:40) Right. (5:40) And I went in, and the doctor checked my blood sugar. (5:43) He goes, the way that you're feeling is because you're type two diabetic. (5:46) And I said, what? (5:47) Like, record scratch.
David Knapp (5:48) Like, hey. (5:49) I didn't have the typical, like, to type two diabetes that you hear about where, hey. (5:54) Your a one c is creeping up, man. (5:56) Stay off the Twizzlers, whatever. (5:58) You know?
Scott Benner (5:58) Yeah.
David Knapp (5:59) I went from zero to a 100. (6:01) It had never sort of crept up on me. (6:03) Never had any warning other than the fact that I have been overweight my entire adult life, and we have this thing, this type two diabetes in my family. (6:11) I'm sort of skeptical that the coronavirus maybe kicked some people who were metabolically predisposed based upon the virus going through your body, that it had a metabolic effect on some people. (6:23) But that's definitely a conversation for a different day.
David Knapp (6:26) But, yeah, I was diagnosed with type two back in the 2021, and it was definitely a journey of I wanna try everything in my own within my own willpower Yeah. (6:36) To sort of will this disease away.
Scott Benner (6:38) How would you describe like, you know, I'm I'm sure you've probably shared this a million times. (6:42) I always end up apologizing to people first. (6:44) But, like, what was your height and weight at your diagnosis, and how would you describe your heat your eating habits at that time?
David Knapp (6:50) Yeah. (6:51) So my my height, is five ten, and my weight at that time was three hundred and nineteen pounds. (6:58) So we're talking a bit about a BMI in the upper forties, which is very, very high, morbidly obese. (7:03) What I was eating it's kind of hard to explain for somebody who's never lived with the disease of obesity. (7:08) Right?
David Knapp (7:08) Because obesity is a disease. (7:10) It's has profound metabolic effect that make it very difficult to to get your weight down. (7:15) But when we talk about what I was eating, well, I had actually yo yoed on the ketogenic diet from the time I was about 18, which is when I started really putting on noticeable weight. (7:26) Like, I even from a an adolescent, I could tell I was a little chubby, you know, to carry a little bit around my midsection that friends or family members didn't. (7:34) But then it wasn't until high school that I really started to see that there was kind of a separation in the way that my body was handling the foods I ate, etcetera.
David Knapp (7:42) I discovered this diet that everybody was kinda doing back then. (7:46) It's kinda like the GLP one of today. (7:47) It was the Atkins diet. (7:48) It was the low carb diet. (7:50) And so I started this journey where I I would get on the low carb diet, and it would work really, really well for me for about six months.
David Knapp (7:58) Like, I think the first time I went on it, I was I had got up to two hundred and twenty pounds. (8:03) And the first time I went on it within about six months, I think I was down to one seventy. (8:08) But, you know, the metabolism of an 18, 19 year old kid, not a 40 year old man. (8:14) Mhmm. (8:14) But I I sort of chased that because I could maintain it for about six months out of the year, and then for the other six months, I'd fall off the wagon hard.
David Knapp (8:22) So the way I kinda describe it when I tell this story, Scott, is I'd be up or I would be down 40 pounds, and then I'd be up 50 pounds. (8:32) And I'd be down 40 pounds and up 50 pounds, and there were different variations of that yo yo. (8:37) Yeah. (8:37) But every time on the upswing, it was up. (8:39) And so first of all, just imagine what that does to your body metabolically, like that swing back and forth and back and forth and back and forth for essentially, like, seventeen, eighteen years.
David Knapp (8:49) Wow. (8:49) And so, like, that year when I was diagnosed with diabetes, it wasn't really that much different than any other year. (8:54) I had just come off of six months of being very strict with my ketogenic diet, which is actually why I thought that I was experiencing kidney stones because I had had that happen before. (9:04) But, you know, I was minding my p's and q's. (9:07) I've never been a real sugar consumer like you may think of somebody who becomes diabetic at that age.
David Knapp (9:14) I wasn't a candy eater, still not a candy eater, wasn't a sugary soda drinker, although I've always been a diet soda drinker. (9:22) You know? (9:23) So I wasn't kinda like, in my mind, even though I was overweight, I didn't really fit the bill for somebody who was gonna go in at 36 and get a type two diabetes diagnosis. (9:31) I mean, you might the average person might go, well, you're a BMI of forty five. (9:35) What do you expect?
David Knapp (9:36) Well, I've been doing this podcast now for three years. (9:39) I've met people who are six or seven hundred pounds that aren't type two diabetic. (9:43) Mhmm. (9:44) You know, it was just it it was weird for me. (9:46) It was it was definitely a scary thing to get that diagnosis young because you know the implications in terms of what that does to somebody's expected lifespan.
David Knapp (9:55) And so the only thing I could think about, Scott, was my kids. (9:57) Like, what am I gonna do? (9:59) Like, how how am I gonna whip this thing into shape so that I can be around, with for my kids? (10:03) Because my dad own dad died of a massive heart attack at 54.
Scott Benner (10:06) Did he?
David Knapp (10:07) Yeah. (10:08) So No kidding.
Scott Benner (10:08) My story is not much different than yours, to be perfectly honest. (10:11) I never thought of myself as an incredibly poor eater. (10:14) I do look back now in hindsight and realize I grew up pretty broke, we ate some trashy food that I I wouldn't eat now. (10:20) But at the same time, it wasn't a massive amount. (10:23) It wasn't, like, constantly sugar or constantly this.
Scott Benner (10:26) And as an adult, a young adult, my wife and I did the same thing. (10:29) We were like, oh, we'll try the Atkins diet. (10:31) Mhmm. (10:31) And it did work. (10:32) Like, I was like, I I lost, like, 40 pounds.
Scott Benner (10:34) I was like, oh, magic. (10:35) Until one day, you just wake up and you're like, I can't eat another chicken wing. (10:39) I I've run out of things to to eat. (10:41) You know?
David Knapp (10:41) I've eaten enough stacks of hamburgers. (10:43) It's just just give me a bun.
Scott Benner (10:45) I think when you realize you're in trouble is when you're, like, you're out for the day driving around and you're hungry and you end up in, a drive through at a fast food restaurant, like, pulling the patties off and you're realizing, don't even think this is meat. (10:58) And you're you're like, well, at least there's no carbs in
David Knapp (11:01) it. (11:01) Right.
Scott Benner (11:02) And yeah. (11:03) So it just didn't work for me. (11:04) Then I slowly began I never had a type two diagnosis, and I don't think I was ever actually near one, luckily, though. (11:10) Like, I just think it's random because I was I'm five nine, and I was two hundred and thirty six pounds when I started using GLP. (11:18) You know, I know my body at that point.
Scott Benner (11:20) Like, I can't imagine what you were dealing with over three hundred pounds at that height. (11:24) Like, it must have been it really just difficult on you and your body and even psychologically, I I imagine it was not pleasant.
David Knapp (11:30) Yeah. (11:31) The the definitely the the upswing and the downswing. (11:34) And then you get used to this, kind of cycle of positive reinforcement from the people around you because when you're on the downswing, people are like, you look great. (11:41) And then you're kinda like, oh, you know, what are these people thinking of me when I'm on the upswing? (11:46) And then you you start to worry about all the people you're letting down and yeah.
Scott Benner (11:50) Oh, man. (11:50) When the first time I went into where did it happen to me first, maybe? (11:54) It was a friend I bumped into, then it was a post office that I only go to yearly. (11:58) Like, there's this one post office I used to mail my taxes. (12:01) And, like, so I don't see this lady very often, but it's a small post office.
Scott Benner (12:04) And I walked in and she made eye contact. (12:06) She recognized it was me, then she looked horrified, then she got quiet, and then she didn't know what to say. (12:13) And I realized, because I had been through it now twice before, I put my hand out. (12:16) I went, I don't have cancer. (12:18) She goes, oh, thank God.
Scott Benner (12:20) She's like, you lost so much weight. (12:22) I I just thought maybe you had cancer. (12:23) And I was like, I know. (12:24) And I said, I'm it's okay that you feel that way. (12:27) You're, like, maybe the fourth person that this has happened to me with.
Scott Benner (12:30) Yeah. (12:30) And that to your point, what in the hell did I look like before? (12:34) It's like right? (12:37) That, standing in front of her at a reasonable weight, she was like, uh-oh. (12:40) This one's on its So, way anyway, it it is it's been very transformational for me.
Scott Benner (12:46) But I kinda wanna, like, jump ahead a little bit. (12:49) Yeah. (12:49) Because you start making your thing you started on YouTube, I guess. (12:53) Right?
David Knapp (12:53) Yeah.
Scott Benner (12:54) Yeah. (12:54) Yep. (12:55) And tell me what got you doing that, why you why you did that. (13:00) Today's episode is brought to you by Omnipod. (13:02) We talk a lot about ways to lower your a one c on this podcast.
Scott Benner (13:07) Did you know that the Omnipod five was shown to lower a one c? (13:10) That's right. (13:11) Omnipod five is a tube free automated insulin delivery system, and it was shown to significantly improve a one c and time and range for people with type one diabetes when they switched from daily injections. (13:23) My daughter is about to turn 21 years old, and she has been wearing an Omnipod every day since she was four. (13:30) It has been a friend to our family, and I think it could be a friend to yours.
Scott Benner (13:33) If you're ready to try Omnipod five for yourself or your family, use my link now to get started. (13:40) Omnipod.com/juicebox. (13:43) Get that free Omnipod five starter kit today. (13:46) Terms and conditions apply. (13:47) Eligibility may vary.
Scott Benner (13:48) Full terms and conditions can be found at omnipod.com/juicebox. (13:54) Perhaps the best gift that you can give to yourself or to a loved one is that of comfort. (13:59) And this holiday season, if you use the offer code juice box at checkout at cozyearth.com, you won't just be getting something that's comfortable, you'll also be doing it at quite a discount. (14:10) We can talk about that in just a moment. (14:12) Right now, I wanna tell you that I use Cozy Earth towels every day when I get out of the shower.
Scott Benner (14:17) I sleep on Cozy Earth sheets every night when I get into bed. (14:21) I'm recording right now in a pair of Cozy Earth sweatpants. (14:25) I love their joggers, their hoodies, their shirts. (14:28) My wife has their pajamas. (14:30) And I know you're thinking, oh, yeah, Scott.
Scott Benner (14:31) Well, because they sent you a bunch of it for free. (14:33) They did send me some for free, but I've also bought a lot on my own. (14:37) So like I said earlier, Black Friday has come early at Cozy Earth. (14:41) And right now, you can stack my code JuiceBox on top of their site wide sale, giving you up to 40% off in savings. (14:49) These deals are definitely not gonna last.
Scott Benner (14:51) Get your shopping done now or get yourself something terrific at cozyearth.com. (14:56) Do not forget to use that offer code, Juice Box, at checkout. (14:59) You will not be sorry.
David Knapp (15:01) Yeah. (15:01) I mean, I was really, really wanting to learn more about these medications and how they worked and what they did in your body. (15:10) And I just I wasn't eager to take a drug, to be honest with you, which I think has really set me up great to lead this community because I think there's a lot of people who are reticent to take a drug, especially for obesity. (15:21) But I wanted to learn everything there was to learn about these medications. (15:25) And so when I went to YouTube or, you know, like any good millennial, that's that's where we learn things.
David Knapp (15:31) Right? (15:31) Mhmm. (15:31) So when I went there, there was a lot of really amazing stories about, hey. (15:34) I lost a 100 pounds with Ozempic. (15:36) There was nobody saying, this is how it worked, and these were the side effects that I had, and this is how they discovered these medications.
David Knapp (15:43) Like, all the things that I would want to know about these medications didn't exist there. (15:48) And so while it started as like a, hey. (15:50) This is me taking my first shot. (15:52) Look at me go. (15:52) Woo.
David Knapp (15:53) It very quickly developed into as I was reading clinical trial data, as I and I started following the Eli Lilly earnings calls almost immediately too, and then I started sharing because I was like, well, you know, you talked earlier about the pills. (16:08) Right? (16:08) Yeah. (16:08) I've actually been talking about these pills now for two and a half years because they were being talked about on these earnings calls where they were saying, you know, hey. (16:18) We're we're in, you know, phase one development for like, Eli Lilly has this one called orforglipron, which is coming out in a couple of months here.
David Knapp (16:27) You know? (16:27) And so we were talking about orforglipron two years ago because I started to see not only are these medications that appear to be changing so many people's lives, the ones that are here, there's medicines down the pike that are really gonna help people who have advanced metabolic disease. (16:42) And I've been somebody who's kinda struggled to lose a ton of weight on these, although I'm right where you would expect a diabetic to be based upon the diabetic clinical trials for weight loss. (16:51) You know, there's hope down the pike too for people who are more seriously sick. (16:55) And so really just wanted to start sharing that side of it, which is really sort of what exploded the work that I'm doing.
David Knapp (17:02) And then one of the crazy things, and we we may see some more of this in the coming months with the expansion of these drugs to Medicare, but when I first started these medications and people were learning about them, it was the heyday of GLP one because you could get Mounjaro without a type two diagnosis for $25 a month. (17:20) In those early days, they had a coupon.
Scott Benner (17:22) Really? (17:22) How long ago was that?
David Knapp (17:23) This was 2022. (17:25) At the 2022, around the time I first started, you could literally download a coupon, and it didn't matter if it you had it covered on your insurance. (17:33) It didn't matter if you had diabetes. (17:35) You could just take that to the pharmacy and get Mounjaro for $25. (17:38) And then, of course, they, you know, cut that off like a sieve once the word started to get out about how powerful tirzepatide, the active ingredient in Mounjaro, is at getting people's weight down.
David Knapp (17:49) They had to pull back on the savings card because it became so popular so fast with, mind you, zero advertising. (17:55) Right. (17:55) It was all word-of-mouth. (17:57) These drugs went into shortage. (17:58) And so very quickly, you being in the type one world, like, I know these companies manufacture insulin all day in little single dose or multidose vials.
David Knapp (18:07) Why can't they just do that? (18:08) And so I actually started a social media campaign that went viral and ended up getting covered by some of the major news outlets called Release the Vials, which ultimately, through conversations with Lilly, actually had conversations with their, CEO there, they ended up releasing Zepbound in single dose files and going direct to consumers with the cash pay price, and they were kind of the first ones to do that even before this most favored nation stuff with the with the administration.
Scott Benner (18:34) Yeah. (18:34) That's really interesting. (18:36) The things that I've seen it help people with, I really hope that we can get to a point like, I'm not listen. (18:41) I'm not confused. (18:42) I'll actually, let me share this with you, then I'll go backwards.
Scott Benner (18:45) Fifteen years my wife works in, drug safety. (18:47) Okay. (18:48) So she does kinda like the behind the scenes pharma stuff where she makes sure that, you know, reporting's done correctly and that, you know, things are being done the way they're supposed to, that kind of stuff. (18:56) Right? (18:57) She came home to me fifteen years ago, and she goes, Scott, one day, people are gonna take an injection, and they're gonna lose weight.
Scott Benner (19:03) And I was like, what do you mean? (19:05) She goes, I saw some data, and she's like, we're working on this type two drug, and she was at Novo. (19:10) But, man, like, you should see the data on people losing weight. (19:14) I really think one day people are gonna take a shot and lose weight. (19:16) Three years ago now, maybe coming up on three years ago, I started doing it.
Scott Benner (19:20) I was like, oh my god. (19:21) This is the thing Kelly was talking about. (19:22) And just like that, it it started to happen. (19:24) Now, of course, before before that, they but they had other JLPs. (19:27) Right?
Scott Benner (19:27) Like Rybelsus and there were, like, pills and stuff like that. (19:30) Didn't really work quite as well. (19:31) But now I'm seeing it help people in, like, such varied ways. (19:35) I mean, no kidding. (19:37) All the different ways that you see it impacting lives that I can see it impacting my life.
Scott Benner (19:42) You know, we talk so much about, like, trying to fix things for people. (19:46) Like, they just ate better. (19:47) If, you know, there's Mhmm. (19:48) No factory farming. (19:50) If they and you start piling up all these if if if if, and you realize, like, we're not getting any of this straight.
Scott Benner (19:54) Right? (19:55) Right. (19:55) People keep suffering, and they keep gaining weight, and they keep being ill, and they keep, you know, just not having the lives they can. (20:02) I'm not a person who's, put everybody on medication. (20:04) I'm really not.
Scott Benner (20:05) But, like, now that I've seen what it's done for me, I'm not down with just yelling like you're cheating if you're doing this thing. (20:12) Like, right like, I don't know why my body doesn't work the way it's supposed to, but it clearly doesn't. (20:18) And you add this GLP to me, and I'm better off. (20:22) I don't like, when people say to me, oh, you're have to use it for the rest of your life? (20:25) I'm like, whatever.
Scott Benner (20:26) I was like, because the other way, was gonna have a heart attack for sure. (20:28) So Right. (20:29) You know, whatever. (20:30) And now you're talking about that pill. (20:31) That pill might end up being more of a maintenance thing for someone like me.
Scott Benner (20:34) Right? (20:36) I used to hate ordering my daughter's diabetes supplies. (20:40) I never had a good experience and it was frustrating. (20:43) But it hasn't been that way for a while. (20:45) Actually, for about three years now because that's how long we've been using US Med.
Scott Benner (20:51) Usmed.com/juicebox or call (888) 721-1514. (20:59) US Med is the number one distributor for Freestyle Libre systems nationwide. (21:05) They are the number one specialty distributor for Omnipod Dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. (21:16) They have served over one million people with diabetes since 1996, and they always provide ninety days worth of supplies and fast and free shipping. (21:26) US Med carries everything from insulin pumps and diabetes testing supplies to the latest CGMs, like the Libre three and Dexcom g seven.
Scott Benner (21:37) They accept Medicare nationwide and over 800 private insurers. (21:42) Find out why US Med has an a plus rating with the Better Business Bureau at usmed.com/juicebox, or just call them at (888) 721-1514. (21:54) Get started right now, and you'll be getting your supplies the same way we do.
David Knapp (21:59) It sounds like the pills may be a great option for maintenance. (22:01) For people with, let's say, less severe metabolic disease, they're not gonna be as potent, to start with. (22:07) They're not gonna be as potent as the injectables. (22:10) They kinda tout that these high doses of so high dose Rybelsus, which is the oral semaglutide from Novo Nordisk for diabetes, is currently with the FDA for approval in high doses for what they're calling oral Wegovy, which is their injectable weight loss medication, their popular one. (22:27) They are touting that those get up there, but still, I think most people are gonna tolerate the shots, once weekly shots, better.
David Knapp (22:34) But, yeah, for maintenance, there's a whole lot of hosts and applications for these oral versions, and maintenance is definitely one big thing that they're looking at. (22:43) But one of the things I want to touch on based upon kind of what you were just saying there, because I think you hit on something that I think is what needs to be understood. (22:50) When we talk about the discourse, the public discourse around GLP one medications and this idea of taking a drug forever or or cheating or taking the easy way out, I just wanna kinda reframe that conversation for people and just kinda build on what you were saying there is we can all agree that there are likely contributing factors, confounding factors in this country specifically that contribute to metabolic disease that are beyond just your own personal agency. (23:18) Right? (23:19) Sure.
David Knapp (23:19) We don't know how what they're spraying on our crops affects our gut microbiome. (23:24) We don't know really how much or how little the prescription drugs that we're taking, we're learning more, are screwing with our gut microbiome. (23:33) We don't know how how much, for instance, alcohol screws with our gut microbiome. (23:38) What they're finding right now, we're gonna get data later this week, probably, maybe early next week from Novo Nordisk that's likely to show that Rybelsus slows the progression of Alzheimer's. (23:49) Why is that?
David Knapp (23:50) Because they have found this gut brain connection that they're just now starting to unwind. (23:55) But these GLP one medications, all they are are manufactured peptides that, in Inovo's case, they actually make it from yeast. (24:05) They're peptides that mimic hormones that are naturally made in your gut. (24:10) But there's byproducts of gut bacteria. (24:13) There's byproducts of adipose tissue called d p p four that literally is run amok in the guts of people who are diabetic and obese.
David Knapp (24:23) They've done studies on this. (24:24) It's this d p p four enzyme that destroys GLP-one, native GLP-one or endogenous GLP-one, GIP, these incretin hormones. (24:35) Right? (24:35) And so a lot of what they're learning is is this unique connection between the gut and the brain in terms of signaling satiety, signaling insulin release. (24:46) And these hormones are integral to that.
David Knapp (24:48) And you can imagine what's happening in the guts of people who have had their good bacteria destroyed or have high adiposity where the environment there is working against your own native GLP one. (25:00) That's one of the reasons that these medications work so well is prior to GLP one medications, there was a whole another class of type two diabetes medications called DPP four inhibitors. (25:10) So that culprit that attacks your endogenous GLP-one, your endogenous the Ozempic that your body makes naturally, essentially, they had a drug that tried to block that DPP-four so that your native GLP-one could shine through and do its job, signal to satiety, signal insulin release, stimulate the beta cells in your pancreas to release insulin more efficiently, etcetera. (25:34) And so these medications are literally and this is sort of one of the more controversial things that I'll say is that I believe they are the antidote to whatever the culprit is, and it's probably many factors that are creating a hormonally dysregulated body for people who are metabolically sick.
Scott Benner (25:54) Yeah. (25:54) I don't know another way to explain it to you other than my body just works better now. (25:58) And, I mean, from, like I used to have terrible reflux. (26:02) Gone. (26:03) Had it, like, most of my life.
Scott Benner (26:04) It's just gone. (26:04) People will say, what's because you lost weight? (26:07) It was gone before I lost the weight. (26:09) I used to be anemic all the time. (26:11) Like, I'm telling you, Dave, like, I would I was in the last handful of years of my life, I was getting two and sometimes three iron infusions a year so that my ferritin wouldn't drop off the planet.
Scott Benner (26:22) And I and I I couldn't, like, I couldn't stand some days. (26:25) Like, I was so anemic. (26:26) I haven't been anemic in almost three years. (26:29) What happened? (26:29) My expectation is my digestion changed.
Scott Benner (26:32) My body is now picking up nutrients differently, and I'm not lacking in iron anymore. (26:37) That's a simple thing that to your bigger point about, like, I'm sure there's a million things happening that are impacting us that we don't know about. (26:44) I wasn't gonna unwind all that in my lifetime. (26:47) Right? (26:47) And even if I could, what am I gonna go live in a yurt?
Scott Benner (26:51) Like, you know what I mean? (26:51) Like, grow a carrot in my own like, don't know. (26:54) What was I gonna do exactly? (26:55) Right? (26:56) You're like, like, I got a house.
Scott Benner (26:57) I got kids. (26:57) I gotta live my life. (26:58) This is the world I'm in right now. (27:00) If the world's doing this to me, then and there's an anecdote, you know, quote unquote to that. (27:05) I'm in.
Scott Benner (27:06) Like, I'm in to take it because I wasn't gonna live as long. (27:09) I wasn't my days were much less pleasant. (27:11) I was never rested. (27:12) The reflux gave me, other issues that I'm hoping don't turn into bigger problems. (27:17) Right?
Scott Benner (27:18) Like Right. (27:18) There's a lot going on. (27:20) And now all of a sudden, man, I'm full of energy. (27:22) I got nothing but, like, clarity in my mind. (27:25) Like, you know, I've worn a CGM a couple of times.
Scott Benner (27:28) My glucose doesn't move. (27:30) Like, you almost can't will it to move. (27:31) Yeah. (27:31) It's been so beneficial. (27:33) And then we were able to you know, like, I think I told you before we started talking, I used it.
Scott Benner (27:38) My wife used it. (27:40) Awesome results. (27:41) My brother has type two. (27:43) I'm adopted, so not my brother by blood. (27:45) But my brother, type two diabetes, he's lost, like, 70 pounds.
Scott Benner (27:48) His a one c's dropped way down, like, two points down. (27:51) And still, he was with a doctor the other day who said to him, if I was you, I wouldn't be using this GLP medication. (27:57) Awesome, man. (27:58) Thanks. (27:58) How come?
Scott Benner (27:59) Muscle. (28:00) He kinda waved his hand at him. (28:01) I mean, muscle wasting. (28:02) And I was like, Brian, I'm like, GLPs don't magically make muscle go away. (28:06) I'm like, they can give you like, put you in situations that can cause that, and there's ways to counteract that.
Scott Benner (28:11) I was like, he's like, don't worry. (28:12) I'm not gonna stop taking this. (28:13) And I was like, oh, okay. (28:14) But, like, it's amazing that, like, in 2025 now, there's still a doctor who's just, like, waving their hand randomly saying muscle out loud and telling a guy whose a one c went from the sevens to the fives and lost 70 pounds, hey, you probably shouldn't be taking that. (28:27) So that guy doesn't understand this functionally at all.
Scott Benner (28:29) No. (28:29) And he's out there giving advice. (28:31) So in a world where there are doctors giving advice that they don't know about, that, like you said, something's getting sprayed on something. (28:37) I'm eating it. (28:38) Something in my stomach that medicine barely understands at this point
David Knapp (28:42) Right.
Scott Benner (28:42) Is getting dysregulated. (28:44) Who cares, man? (28:45) Like, do you know what I tell people? (28:46) I have a GLP deficiency. (28:48) That's what I tell them because it shuts them up.
Scott Benner (28:50) And like and I don't really know what else to say.
David Knapp (28:52) I love it.
Scott Benner (28:54) So when you see it back into this world a little bit with type one, I know this isn't, you know, your what your focus is on, but I feel like you might have a lot of information that's gonna help otherwise. (29:03) So if you don't have an answer, just say, Scott, I don't know. (29:05) This isn't my this isn't my lane. (29:07) But when people talk about GLPs reducing inflammation, for example, do you understand or does anyone understand how that happens, or do we just know it does happen?
David Knapp (29:17) I believe they're trying to untangle untangle all of that and why it works too, especially on that inflammation. (29:26) I know that with tirzepatide, they're doing some studies that are looking at, the c reactive protein, which is one of the biggest markers for inflammation in the body. (29:35) They're seeing reduction in all of those. (29:36) And and in fact, the next sort of advent of where GLP ones can take us because, honestly, they're gonna have the weight problem solved in the next ten years. (29:47) There's not gonna be there's gonna be something for everyone, I firmly believe, out there that's gonna get you to your goal weight more than likely.
David Knapp (29:54) The question now becomes, a, how do we improve the quality of weight to the doctor's point of muscle wasting, which that happens when you lose weight dramatically. (30:03) I mean, these
Scott Benner (30:03) Yeah.
David Knapp (30:04) Medications, the ones that are on the market currently, essentially help bring down your weight by reducing the amount of energy you put into your body. (30:11) And so if you're reducing the energy you put in, that's how you get weight loss. (30:15) But, unfortunately, with weight loss, you're losing a certain amount of muscle mass. (30:20) So the quality of weight loss is what they're looking at in the future pipeline of these medications, but they're also looking at other indications because there's people like you who walk around and say, you know, actually, this is how it helped me. (30:33) I, you know, I have rheumatoid arthritis, and all of a sudden, I don't need my rheumatoid arthritis medication, or I have, you know, irritable bowel syndrome, and it's cleared up.
David Knapp (30:42) Like, all these things that that really at the heart of it, you know, are inflammatory drivers Mhmm. (30:47) In the body. (30:48) And then so they're looking at that, and they're looking at combining these medications with other treatments for some of those autoimmune dis diseases. (30:56) So autoimmune diseases are kind of the next frontier of where they're looking specifically with tirzepatide, because one of the things we call these medications is GLP-one medications. (31:06) But at the end of the day, everything up until tirzepatide, which is Mounjaro and Zepbound, was just a GLP.
David Knapp (31:13) Mounjaro tirzepatide, the active ingredient, is actually two hormones in the family of they're called incretins. (31:20) They're nutrient stimulated hormones. (31:22) In other words, you eat food and your body releases these. (31:25) When your gut starts to sense the nutrients, it releases these hormones naturally. (31:29) GIP is another prominent one.
David Knapp (31:31) It's actually I think they discovered GIP before they discovered GLP one, but it's a combination of both. (31:36) And it's mostly a GIP medicine with just a little bit of GLP-one where like Ozempic semaglutide is just straight GLP-one. (31:44) Not super important, but for the purposes of what you're talking about with inflammation, what they're finding is that profound effect on inflammation in maybe some ways that GLP-one doesn't. (31:56) These molecules have protective properties in the body that they're just starting to understand, and and these properties are independent of weight loss. (32:04) Mhmm.
David Knapp (32:05) So for example, one of my favorite pieces of data on semaglutide, which is, you know, becoming kind of like an old school drug. (32:14) And when you talk about Ozempic, they're like, hey. (32:15) Have you heard of Mounjaro? (32:17) It's even better. (32:18) But when you look at GLP one receptor agonism, in the biggest study for semaglutide, which was called the SELECT trials in cardiac stuff.
David Knapp (32:27) Right? (32:27) So it was looking at people with heart failure, and then it was looking at major cardiovascular outcomes. (32:33) In this trial, there was some tens of thousands of people were enrolled in this trial, and it it lasted for four years. (32:40) And what they found was it didn't matter what dose of semaglutide you took, and it didn't matter how much or if you lost weight. (32:49) You experienced a twenty percent reduction in major cardiovascular events, a twenty percent reduction in deaths associated with major cardiovascular events.
David Knapp (32:59) And so what they thought in that trial or one of the things they're extrapolating was there's something specifically protective in the heart about the GLP one molecule. (33:10) And so they they spun off researchers spun off a smaller study that just came out a couple weeks ago, and this is just in rodents. (33:17) But what they did is they took the first GLP one that ever came out. (33:21) It's called Byetta. (33:22) Mhmm.
David Knapp (33:22) Really cool story about how they discovered that one because in the nineteen sixties, and May maybe it was the seventies, they discovered this thing called the incretin effect. (33:31) We call these the incretin drugs. (33:33) Right? (33:34) They discovered that, hey. (33:35) When you inject somebody with glucose and when you feed somebody with glucose, there's actually a quicker metabolic response when you feed it to people, and they ingest it through their stomach and their gut rather than injecting it.
David Knapp (33:48) And they called this the incretin effect. (33:49) That's because these hormones, like I said, are nutrient stimulated, but they lack the ability to, you know, create duplicate peptides of ones that were already in your body. (33:59) And so through research, these doctors were looking at the venom of Gila monsters because they found that it lowered blood sugar, and then they isolated a peptide in the venom of a Gila monster and found that it nearly mimicked exactly human GLP one. (34:16) Mhmm. (34:16) Except instead of lasting for just a few minutes in the body and getting destroyed by d p p four, they could make it last for four hours.
David Knapp (34:24) Right? (34:24) So that's that's how they came up with the first GLP one. (34:26) So this study with the rodents actually looked at exenatide, which is the first GLP one. (34:30) They basically gave it to these rodents and induced a heart attack. (34:34) And there were two subsets of these rodents.
David Knapp (34:36) There were the kind that got the GLP one, and then there were the kind that actually got a version of the exenatide that actually blocks the GLP one receptors. (34:43) And so there's these cells on the hearts. (34:45) They're called parasites. (34:47) They found that the rodent population that got GLP one receptor agonism injected into them along with the heart attack, it opened up the blood flow to the part of the heart that otherwise would have been damaged permanently. (35:01) And conversely, in the rodents that didn't, that got the GLP one blocker, that part of the heart stayed forever damaged.
David Knapp (35:08) It never got the blood restored to it. (35:10) So long way around saying that there's something that's protective about these molecules themselves independent of the weight loss. (35:17) Mhmm. (35:18) And to our earlier points, there's something within our ecosystem here that has caused dysregulation in these hormones, and I believe that's why you're seeing people that get on these medications, even ones that don't have, like, a tremendous amount of weight to lose and maybe even none, and they're just microdosing because they've read the studies and they wanna get some of these benefits that they're saying, you know, my my psoriasis is going away. (35:44) My arthritis is getting better.
David Knapp (35:47) My I mean, fill in the blank. (35:49) There's so many things.
Scott Benner (35:51) I haven't had an eczema flare in years. (35:54) Wow. (35:54) I used to have it every it just occurred to me as you're saying it. (35:58) Like, this time of year, it starts to get colder, I would get these red patches on the inside of my thighs and sometimes in the back of my arms, and I haven't had them in years. (36:06) No.
Scott Benner (36:06) No kidding. (36:07) Yeah. (36:07) Yeah. (36:08) Yeah. (36:08) Yeah.
Scott Benner (36:08) I I just heard you say I'm gonna live forever, Dave. (36:10) Thank you.
David Knapp (36:11) Appreciate yeah. (36:11) Yeah. (36:13) That is that's what I was getting at.
Scott Benner (36:14) I only got plans for the next twenty years. (36:16) I'll have to figure something else out. (36:18) It's interesting. (36:19) You're younger than me. (36:21) But and it's really let me say before I say this.
Scott Benner (36:24) It's really interesting talking to you. (36:25) What did you do before this professionally?
David Knapp (36:28) I sold traffic signals.
Scott Benner (36:29) That's amazing, man. (36:30) It's
David Knapp (36:30) a It's natural transition.
Scott Benner (36:32) Yeah. (36:32) I mean, I just I love that when you're talking about it, I'd be thrilled if my doctor understood this as well as you did. (36:37) Like, you you know what I mean? (36:38) Like, it's so cool. (36:39) I brought this up in the beginning, but it it so kinda mimics me a little bit.
Scott Benner (36:43) Like, I I'm not perfect. (36:45) I don't know everything, but I try learning all the time. (36:47) And what this job allows me to do is it allows me to be steeped in it constantly. (36:51) Yeah. (36:51) And I think we need more people who just spend a lot of time in an idea absorbing it, you know?
Scott Benner (36:56) So very cool that you're doing this and that you can speak about it so well.
David Knapp (36:59) Appreciate that.
Scott Benner (37:00) But what I was saying is, like, when I was growing up, I've said this before on here, all the time, like, biggest problem people had was their weight. (37:06) Like, oh my god. (37:07) If medicine would just figure out weight, if they would just figure out weight, like, the the society just wanted it. (37:11) They begged for it. (37:12) And then we gave it to them and people like, you're a cheater.
Scott Benner (37:14) And I'm like, oh my god. (37:15) People are fickle. (37:16) Fascinating. (37:16) But okay. (37:17) We get past that.
Scott Benner (37:18) The other thing I've been hearing about
David Knapp (37:19) weight down, but not that way.
Scott Benner (37:20) Not like that. (37:21) Do it the way you're supposed to.
David Knapp (37:22) Like, Jack And there's also, like, what drives me insane is there's also an assumption that people are just taking the medicine, and they're not also going to the gym. (37:32) They're not also watching what they eat. (37:34) Like, these medicines don't just magically work for everyone. (37:39) Most of the people we have a 160,000 people in the OTP community across the platforms. (37:44) And there are very few people, if any, that I've met that are like, I just let the drug do the work.
David Knapp (37:50) They're all in the gym.
Scott Benner (37:51) Also, wanna say, if that's what they did, like, god, like, it's their life. (37:54) Like, you know what I mean? (37:55) Like, if they're better off, let them be better off. (37:57) My point about the the weight is we talk all that's all society talks about. (38:00) We gotta help people with their weight.
Scott Benner (38:02) And the other thing I hear people talking about my whole life is inflammation. (38:05) Inflammation's such a problem. (38:07) It's such a problem. (38:07) We can't and I believe it, by the way. (38:09) Like, you can't take an NSAID every five minutes.
Scott Benner (38:11) But, you know, you've had issues. (38:12) You take an Advil. (38:13) It reduces the inflammation in your body. (38:15) You're like, oh, this is better now.
David Knapp (38:16) Right.
Scott Benner (38:16) Some people have it more chronically. (38:19) You know, I watch my daughter who obviously has, you know, an autoimmune issue, but she also has like, she has hypothyroidism. (38:26) She has type one diabetes. (38:28) She might have PCOS. (38:29) And I'm telling you that when she's on this medication, things are better for her.
Scott Benner (38:34) Mhmm. (38:34) Like, they they just are. (38:35) And I have a giant community of people who are reporting back very similar, you know, returns. (38:40) And they're a little blocked because, of course, in the studies, they found that, you know, people with type one diabetes were going to DKA sometimes. (38:50) And it's but it's really I think it turns out to be just because they eat less and they're using less insulin, and then they ended up in DKA because they type one and they need insulin and they weren't using enough.
Scott Benner (38:59) They didn't have their settings changed. (39:01) Because with my daughter, I've never had that problem. (39:03) When she's using the GLP, you just have to titrate back her basal. (39:07) You'd be surprised how much of her, how how wide her settings can swing. (39:11) Without a GLP, it could take one unit of insulin to move my daughter's blood sugar 34 points.
Scott Benner (39:18) But on a micro dose of GLP, one unit of insulin will move her blood sugar 95 points. (39:25) That's insane. (39:26) Right? (39:26) Like, she she's in involved in some sort of insulin resistance or inflammation or I don't even care. (39:32) Like, I genuinely don't even care what you call it.
Scott Benner (39:34) It doesn't matter to me. (39:35) Like, I see I see what happens. (39:37) Then I talk to other people who are having other, you know, issues. (39:41) And then everybody that comes on here, you know, you didn't start this way, but if you came on and you had type one, I'd say, hey. (39:47) Do you have any other autoimmune issues?
Scott Benner (39:48) How about in your family? (39:49) And people sit down. (39:50) They go, oh, I got celiac. (39:52) You know, there's vitiligo. (39:53) I have a friend of mine who's got eczema.
Scott Benner (39:55) There's a lot of a lot of allergies, hypothyroidism. (39:58) Like, they these it it runs through their family lines. (40:01) And I just imagine and believe that these people are experiencing a higher level of inflammation, like, just generally speaking. (40:08) Like, so if if this leads to, I don't know, ten years from now, them coming out with something else that just lowers people's inflammation a little bit, I think I think this is awesome. (40:19) Like, what was I seeing the other day?
Scott Benner (40:21) My brother got I was my brother was sick. (40:23) I told you. (40:24) And, he's got a virus. (40:25) It's just not passing quickly, and so they put him on a steroid pack. (40:29) But by the way, like, he had to beat him over the head to even get the steroids.
Scott Benner (40:33) Like, that won't help you. (40:34) Like, you know, arguing with him. (40:35) He finally gets the steroid pack. (40:37) He's on the steroids for a couple hours. (40:38) He calls me because, Scott, I feel so much better.
Scott Benner (40:40) Like, the all the pain's going away, blah blah blah. (40:42) And I I said to him, did you know that in the forties when steroids became you know, when they figured them out they started using them for a split second, they thought they had literally fixed all the problems mankind had. (40:55) And and until you realize what happens if you stay on these steroid packs too long and you get rebound and it's it's not great. (41:01) Right? (41:01) There's a lot of problems if you stay on them too long.
Scott Benner (41:03) But still, when you're on them in that short window I don't know if you've ever experienced this. (41:08) I feel like Superman when I'm on a steroid pack. (41:10) I'm almost excited when I'm sick. (41:11) I'm like, my god. (41:12) They're gonna give me a steroid pack.
Scott Benner (41:13) Next week of my life's gonna be awesome. (41:15) Man, imagine that. (41:16) Like, imagine if this stuff leads to not just people losing weight, people's a one c's dropping out of a diabetic range, type ones hopefully needing less insulin, people with autoimmune having less impacts from their autoimmune issues, and what if they could get rid of, like, some of this inflammation for people?
David Knapp (41:32) Absolutely. (41:33) I I one of the things that I've been saying for a couple years too that has been, you know, one of the more controversial things in terms of just the feedback that I get from people is I really believe these medications, these these incretin nutrient stimulated hormones, however you wanna couch them. (41:48) We'll call them GLP ones because that's what everybody else does. (41:51) But I believe they have the power to save our health care system in The United States. (41:54) And when this new administration came in, there was a lot of people who were very nervous within our community about how they were going to treat GLP ones because there was a lot of, like, anti Ozempic talk before they came in.
David Knapp (42:06) And I was just, like, hoping beyond hope that once they got in and really looked at the data objectively and maybe, you know, took their political hats off and put on their their data hats, that they would see what we have been seeing in this community for so long that that these medications really have the power at the right price to transform the health in this country. (42:29) Because, again, you know, we have the these drugs have been out for a long time. (42:33) That's another, like, misnomer that people have is that they're brand new. (42:36) They're not. (42:37) The Dyetta's been around for twenty years.
David Knapp (42:39) Mhmm. (42:39) And so we have lots of years of data with these drugs on the market to that we can go back and comb. (42:45) I don't know how much your audience gets in the weeds on, like, clinical trial data, but they have these these studies called post marketing studies. (42:52) So you have phase one to make sure that, you know, animals don't die when you inject them with something. (42:58) Right.
David Knapp (42:58) And then they put them in phase two small two, like, small human trials. (43:01) And then phase three is the last one before it gets approved, the bigger trials to figure out dosing and etcetera. (43:08) Well, they have these phase four trials once something comes to market where they're able to just aggregate data. (43:13) Right? (43:14) All these patient records and say, here's these 20,000,000 people that are on GLP ones.
David Knapp (43:19) What they're seeing in almost every single major medicine journal has showed lower CRP, lower IL six, lower TNF alpha. (43:27) What these are doing to fatty liver disease and metabolic health directly by mechanisms of of reducing liver fat and even reversing fibrosis stages, What they're showing is that, like, can you imagine the downstream effects? (43:41) Even just the twenty percent reduction of major cardiovascular events with semaglutide, you know, and the reduction in hospitalization. (43:48) So I don't think it can be understated what just happened last week, or maybe it's a couple weeks now, with the administration getting the pharmaceutical drug companies to the table and saying, hey. (44:00) Like, let's work on volume here.
David Knapp (44:02) Every almost my own personal held belief that almost everyone who lives in this country should be considering the idea of talking to their doctor about whether a medicate one of these medications could benefit them in some way.
Scott Benner (44:16) Dave, gotta tell you. (44:17) I think for a minute, people thought, like, that Lily and and Nova were sending money over here because I was like, let's spray it out on airplanes.
David Knapp (44:24) Mhmm.
Scott Benner (44:25) You're seeing, like, so many people. (44:27) You you know what I realized when I talk to people over and over again? (44:30) And this is interesting. (44:31) Right? (44:31) Is that I don't think people think they're eating poorly.
Scott Benner (44:34) Like, I think when you really like, it's it's easy to step back and, like, say, oh, like, poo poo. (44:40) People don't take good care of themselves or, like, you know, you you act like those bro podcasters, like, who's gonna row the boat, all that stuff. (44:45) Like, you know what mean? (44:46) Like, I I it's easy to say work harder, do better. (44:49) Like, you know, the last thing I need is a guy making $20,000,000 a year telling me I got a cold plunge in the morning.
Scott Benner (44:54) I'm like, I'm at work. (44:55) Like, I don't Right. (44:55) Get it, like, thanks. (44:56) Big help, man. (44:57) Thank you.
David Knapp (44:58) Right. (44:58) Right.
Scott Benner (44:58) But when I look at people, I don't think people are out there doing a poor job on purpose. (45:02) And I think, moreover, I don't think they know they are if they are. (45:05) Right. (45:06) Around nutrition, around other health issues. (45:08) I talk to people all the time.
Scott Benner (45:10) They're not like, oh, you know, I know I'm making bad decisions all day long. (45:14) You know, I have extra money to buy better food, but I just decided to buy crack with it instead. (45:19) Like like, people are doing their best in the system that they have, in the life that they have. (45:24) No one wants to be unhealthy. (45:25) Like, I find Right.
Scott Benner (45:26) Like, calling people there's a thing they do in type one, is if you don't have the outcomes that the doctors want, they tell you that you're noncompliant. (45:34) Yeah. (45:34) We told you what to do and you're not complying. (45:36) I talk to people all the time. (45:37) I don't find people to be noncompliant at all.
Scott Benner (45:39) They're trying as hard as they can with their understanding and their tools and their finances insurance and all the other things that they have and their time, by the way, Dave. (45:47) Because they get up in the morning and they got kids and they got a vacuum and they gotta go to school and they gotta go to work and, like, nobody's got time to sit and talk about this shit like we do. (45:55) Like, right? (45:55) Like, you know, so telling people do better, and then when they don't do better, go, well, you must not be trying hard enough. (46:02) I guess you deserve to die.
Scott Benner (46:03) What a bizarre thing to do to people. (46:05) And we're out here saying there's not enough food for people. (46:08) We can't do small farming because we have to make food for so many people. (46:12) You know how much less food I eat now? (46:13) I'm fine.
Scott Benner (46:14) You know what I mean? (46:15) Like, I don't eat, like, in bulk the way I used to. (46:18) You can't even. (46:19) I mean, you ever go out my wife and I go out the other sometimes we order a dish and we split it. (46:23) We still and we still don't fit it.
Scott Benner (46:25) And we're nice and full and healthy and everything's okay. (46:27) My point is that if there's all this inflammation and all this autoimmune and all this weight and all the other things that are impacting people, I want those people to open their minds up more. (46:38) Like, this is what I I you know, at the pharma level, at the doctor's level, like, look listen to what people are saying and look at your patients and say, like, could I be helping them with this? (46:49) Right? (46:49) Like, do I want the world to be fixed another way?
Scott Benner (46:52) Like, should Monsanto not spray whatever they spray on my wheat? (46:55) Like, yeah. (46:55) Awesome. (46:56) I don't how to impact that. (46:57) Mhmm.
Scott Benner (46:57) You know? (46:58) But on my side, I know what's working for me. (47:01) And, honestly, I don't even understand if trust me. (47:04) I'm making this up right now. (47:06) I wish they'd mix it into the insulin.
Scott Benner (47:08) I heard you
David Knapp (47:08) talk They are, by the way. (47:10) Yeah. (47:11) Like, Novo Nordisk and Neon Lily, I think both have clinical trials combining GLP with insulin.
Scott Benner (47:17) Dave, you don't know me well. (47:18) I'm gonna cry. (47:20) It's fucking awesome, man. (47:21) My daughter has a needle phobia. (47:23) She's a lot of trouble taking the GLPs.
Scott Benner (47:26) I sit in here and I I stare at it and I wonder, like, I would never I wanna be clear. (47:30) I wouldn't do this. (47:32) But, like, there's this little part of me that wants to just squirt some of the GLP into the insulin because it'll go into her pump and help her. (47:37) I know by trust me. (47:38) Don't do that.
Scott Benner (47:38) That's not what I'm saying. (47:39) What I'm saying is is that, like, I just I'm like, god. (47:42) Why can't they just do that a little bit? (47:44) Like, look what it does for her. (47:45) Like, how much less insulin would she need?
Scott Benner (47:48) Because also the dosing is all screwy. (47:50) Yeah. (47:50) Probably you can explain it to me better, but, like, the dosing, the way the pens are set up. (47:55) Right? (47:55) Like, it's just it's what testing what told them would work.
Scott Benner (47:59) Right? (47:59) If they spread it over the population, like Right. (48:01) Most people will have some success at this. (48:03) But there are plenty of people who do two and a half, and they go, oh, it made me nauseous. (48:07) I couldn't keep doing it.
Scott Benner (48:08) But one and a quarter might have been perfect for them. (48:11) Mhmm. (48:11) I'm saying, like, open up the dosing to people.
David Knapp (48:14) Oh, yeah.
Scott Benner (48:14) Yeah. (48:15) Let them make their own decisions about how much they get.
David Knapp (48:17) I think one of the cool things that has happened unintentionally, like an unintentional consequence of those really early shortages of these medications, was that it opened up the world of compound medications and personalized medication. (48:32) I don't know how much you get into the compound world over here. (48:35) But really, essentially, a quick flyover is in this country, when a drug comes to market that's not a biologic, if the manufacturer can't keep up, we have this system called compound pharmacies, 503A and 503B compound pharmacies, that can basically step in and make and sell to doctors who prescribe them to patients drugs that are in shortage. (48:58) So you sort of bypass the intellectual property at that point. (49:02) Mhmm.
David Knapp (49:02) One of the interesting things that's happened is it spurred this whole telehealth world where doctors are prescribing GLPs on a personal level, and they're actually prescribing microdose versions of these drugs. (49:15) Because, again, we're never gonna get a trial clinical trials are are designed by the pharmaceutical companies.
Scott Benner (49:21) Yeah.
David Knapp (49:22) They want you taking more of their drugs. (49:24) So first of all, just know that about a clinical trial is that it's funded by the pharmaceutical companies that run them. (49:31) Mhmm. (49:32) But second of all, when you look at what they're trying to accomplish in a clinical trial, especially for obesity and diabetes, is they're if in diabetes, they're looking at a one c type two diabetes. (49:44) They're looking at a one c reduction.
David Knapp (49:46) And in obesity and I'm talking about this because this is my world, though type one world isn't the world that I live in. (49:52) In obesity, they're just trying to slam you with as much medicine as possible to balance side effects and get the maximum amount of weight loss because that's what Wall Street wants. (50:02) And so, really, clinical trials are designed less they're designed for regulators, and they're designed for investors. (50:10) They're not really designed for patients, and we're starting to see a shift in that. (50:13) But because the shortages led to this world of compounding, you have now millions of people who have gotten benefits of the benefits of getting on a individualized dose of these medications and finding that 2.5 of tirzepatide is the starting dose commercially.
David Knapp (50:32) But I, I just being a figurative random person, took 10% of that a week and got similar benefits. (50:40) Mhmm. (50:41) You know? (50:41) And so we're seeing in real in the real world this sort of situation play out where we're starting to see, like, a massive sort of nontraditional clinical trial going on showing that these these peptides specifically have benefit for a lot of people outside of the normal dosing that we got from the clinical trials, including, but not limited to, microdosing. (51:06) And I
Scott Benner (51:08) The way I see with my daughter and with myself so I first learned it with myself is that I'm sure most people who use these drugs will tell you this. (51:16) I'm on Zepbound. (51:17) I I do twelve and a half. (51:18) Right? (51:18) Okay.
Scott Benner (51:19) I shoot it usually on Saturdays or Sundays. (51:22) By Thursday, I start thinking about, like, maybe I should order a pizza tonight. (51:26) Like right? (51:27) Like, on Wednesday, I'd never think that. (51:28) On Friday, I actually could get a pizza.
Scott Benner (51:31) I can only eat a slice of it or so, but, like, the whole process like, I can feel it let go of my brain a little bit. (51:37) Like, I don't know if another way to put this unless you've been on these. (51:39) Like, the best way I can explain it to people is that my brain doesn't tell me I'm hungry, and my stomach doesn't tell me I'm hungry. (51:44) Like, like, I if I don't I need to remind myself to eat. (51:48) It was tough to do in the beginning, by the I used to I set alarms in the beginning.
Scott Benner (51:52) Like, have breakfast now. (51:53) Eat this. (51:53) Make sure you have protein, like, that kind of stuff. (51:56) But then I said, okay. (51:57) So, obviously, the life of this drug in my body, it wanes.
Scott Benner (52:00) It's not completely gone, but it wanes. (52:03) Even I could see, like, weight loss first four days, and it maybe drifts back a little bit in the last three days and everything. (52:08) Yep. (52:08) So I'm looking at my daughter. (52:10) And, the issue is with her not wanting to do the injections.
Scott Benner (52:13) But, you know, we started with a a 2.5 Mounjaro pen for her. (52:18) Because, by the way, my daughter has a a dual diagnosis. (52:20) She has a type one diagnosis and an insulin resistance diagnosis, so she gets Mounjaro through her insurance. (52:25) Two and a half's too much. (52:27) She'll lose too much weight.
Scott Benner (52:28) She's never hungry. (52:29) It's not it's way too much for her. (52:31) But you can argue with the fact that her a one c is, like, 5.2, and her blood sugar won't spike over, like, one fifty, like, no matter what she's eating. (52:39) Right? (52:39) Yep.
Scott Benner (52:40) Even if she can you know, she talked herself into eating through not being hungry. (52:43) And so one day, I'm like, this is not sustainable. (52:46) And so I learned about microdosing, bought some vials on Amazon, injected the pen into the vial. (52:53) I basically I didn't know how much was in there, so I drew it all out, and I and I converted it to insulin units, basically, because I had insulin needles. (53:00) And I'm like, alright.
Scott Benner (53:00) Well, there's this many units in here. (53:03) The whole of it is too much. (53:04) I'll try giving her half. (53:06) And then every week, I'd try giving her, like, an insulin unit less and and trying to look for a sweet spot where she could get a week's worth of coverage on her insulin resistance and her insulin usage. (53:16) But the truth is it should probably be shot even less than that, like, every four or five days because of the the life of it.
Scott Benner (53:24) Yeah. (53:25) It's a struggle, man. (53:26) You should see. (53:26) Like, it's I know it's a weird thing to say that a type one is, like you know, has, like, a visceral fear of injections, but she does.
David Knapp (53:32) Right? (53:32) That's unfortunate. (53:33) Yeah.
Scott Benner (53:34) Yeah. (53:34) And That's tough. (53:35) Yeah. (53:35) Yeah. (53:35) And so but I know if she didn't.
Scott Benner (53:37) I know if somebody else was here, and we could mess around with it a little bit. (53:40) I know there's an amount she should get, and I know we could figure out the pacing of it. (53:45) And it would be much less, maybe more frequently. (53:49) And I think it would change her life. (53:51) Yeah.
Scott Benner (53:51) Like, seriously.
David Knapp (53:52) Yeah. (53:53) Two things that I would just posit to you as something to to muse on over the next week. (53:58) The first thing is that with tirzepatide, if if that's the molecule that she wants to stick with, there are compounding pharmacies who do make it in oral form. (54:11) That said, they're not FDA approved. (54:13) They're not FDA inspected for you know, like, it's it's compounded medication.
David Knapp (54:19) So it it, by nature, is outside of the FDA system, but it's still a prescription you get from a doctor Mhmm. (54:24) And take under doctor supervision. (54:26) There are sublinguals. (54:27) There are and so the these compound pharmacies have found a way to protect these peptides and make them oral bioavailable. (54:33) But the question is, we don't know how much because they've never gone through clinical trials.
David Knapp (54:37) And frankly, the pharmaceutical companies pay billions of dollars for technology to make peptides orally bioavailable. (54:43) But if you can set that aside and know that that that is an option that you could explore and talk to her doctor about. (54:49) The second is when we talk about tirzepatide specifically on the injectable side, the interesting thing about tirzepatide is the half life on tirzepatide is, like, five days on average, where semaglutide is seven. (55:01) And so it's pretty normal for the those effects to kinda sort of fall off a cliff towards the end of that week when you're getting a couple days away from injection day. (55:11) And I firmly believe, like, to build on our earlier conversation about clinical trials, they chose seven days because seven days is easier for people to manage.
David Knapp (55:19) Yeah. (55:20) Not because it's ideal for the patient. (55:22) And, again, it's easier for the insurance companies. (55:24) It's easier for the pharmacies. (55:25) It's easier for the manufacturers to just four pens one month once a week.
David Knapp (55:29) Yeah. (55:29) But at the end of the day, it's probably not what's best for the patient every time.
Scott Benner (55:33) Do you know there's actual, like, human problem in that too, which is that when people feel better, one of the first things they do is stop doing the thing that helps them feel better.
David Knapp (55:41) A 100%. (55:42) Yeah. (55:42) Right?
Scott Benner (55:42) That's very common. (55:43) So Right. (55:44) You're in a terrible conundrum. (55:46) You'd start taking this injection. (55:47) Three months later, your whole life's different.
Scott Benner (55:49) And then, you know, you get the Saturday, and you're like, you don't even remember you don't feel well, and you don't think about the pen that's in the back of the refrigerator. (55:55) The other I mean, there's different issues there. (55:57) So do you think that for in my daughter's example, as I explained it, she'd be better off on Ozempic?
David Knapp (56:02) I don't know. (56:02) Because the mol tirzepatide, again, is is more GIP than it is GLP one. (56:09) It's it's it's a different hormone that it's focused on. (56:12) Although it's two, it's more so a GIP. (56:15) And so it's gonna be a different experience on semaglutide Ozempic than it is on Mounjaro.
David Knapp (56:20) And so I don't know the answer to that, but I do know that you you may she may experience and if she gets similar effects on the blood sugar control side from semaglutide, that, theoretically, it should last longer because the half life of the drug is longer.
Scott Benner (56:38) Yeah.
David Knapp (56:39) But it does seem to me, like, when you talk when you look at the studies, I can't remember what they actually are in type two diabetics. (56:47) So you can look at the SURPASS study for Mounjaro, and you can look at the can't remember what the one for Wegovy or for Ozempic was off the top of my head, but you can look at them and show it'll show you that Mounjaro is better at controlling a one c, and I think it's because of that GIP mechanism. (57:04) But you may get a a steadier peak and trough of the concentration of the drug with Ozempic just because of that seven day half life.
Scott Benner (57:12) It sounds like maybe if I wait, I can get Humalog with, GLP and GIP in it.
David Knapp (57:16) I I can't remember. (57:17) I can look it up here, but, insulin Novo Nordisk. (57:21) It's insulin icodec. (57:24) Does that sound right? (57:25) Insulin icodec.
David Knapp (57:27) There's there's one that they're that they're looking at for with Novo Nordisk. (57:32) And I I don't know. (57:33) It's it's the insulin icodec is a is a once weekly, right, just like like, Ozempic is.
Scott Benner (57:39) Oh, okay.
David Knapp (57:39) Right? (57:40) So it's it's supposed to give, you know, a smoother experience for somebody taking it and less sort of variability in the peaks and troughs of of that. (57:49) And so they're looking at combining it with with, GLP one. (57:53) Listen.
Scott Benner (57:54) Hopefully, it gets there for people who could be help I'll say this too. (57:57) I've seen people on on, type ones who use it, and it doesn't touch their insulin needs at all. (58:02) And that always makes me wonder, are these people who have type one diabetes but don't have other metabolic issues?
David Knapp (58:07) I wonder too if it it just really comes down to what level of beta cell function you have, if any. (58:14) Because in some really small clinical studies, they've shown clinically that they can give type one diabetics GLP one semaglutide, and they they come like, ninety percent of them come off all of their insulin at the right doses. (58:30) But this is a small trial, and you have to have some level of beta cell function in order to to have that happen because you have to be able to rely on your own insulin.
Scott Benner (58:40) Yeah. (58:40) It makes me think about this, researcher I I interviewed, like, fifteen years ago who was, like, positive. (58:45) She was like, I I sometimes feel like the beta cells aren't dead. (58:48) They're, like, so inflamed that they can't work is how she put it. (58:52) Mhmm.
Scott Benner (58:52) And I'm wondering, like I mean, that's a very, like, layman's, like, remembrance of her conversation. (58:57) But, like Right. (58:58) I do wonder, like, somewhere in there, there's a lot of things to be learned. (59:02) Like, hopefully, those companies are digging in labs on all of this stuff. (59:07) Right?
Scott Benner (59:07) Because
David Knapp (59:07) Oh, yeah.
Scott Benner (59:08) You know, I hear people all the time say, like, well, they'll put themselves out of business. (59:11) I'm like, the truth is if you took care of all the problems people had and that's what put you out of business, I think you'd have enough money to make it. (59:18) Mhmm. (59:18) There's that kind of cynical, like, they wanna have some of the money forever. (59:22) I think if you got all the money right now, they'd probably be happy to, you know, turn that money into a bank and stop being a pharma company and and and and on your way.
Scott Benner (59:30) I also don't want them to go out of business, obviously. (59:32) It's a it's a weird balance. (59:33) Right? (59:34) Like, to your point, like, you know, they're out there. (59:37) They're doing this work, and they're also trying to maximize their profits.
Scott Benner (59:40) It's hard to argue that I mean, I I understand what they're doing. (59:43) We don't want them not out there. (59:45) And, you know, you also want them making money and hiring good people, and it would also be nice if this stuff was affordable for people who were really, you know, in the trenches and needed it every day. (59:55) I mean Yeah. (59:56) Honestly, you know, $500 it's down to 500 a month now for people, and people are like, oh, it's cheaper.
Scott Benner (1:00:02) I'm like, my god. (1:00:02) That's still so expensive. (1:00:04) Yeah. (1:00:04) Yeah.
David Knapp (1:00:05) But the the good news is that with the addition of GLPs for obesity to Medicare, Medicare recipients are gonna pay $50 a month for it. (1:00:14) The government arbitrated their price down to 250. (1:00:18) Mhmm. (1:00:18) And so Medicare patients will get it for a $50 co pay. (1:00:21) Medicaid's gonna follow because they're gonna get the same pricing.
David Knapp (1:00:24) So most states will follow, and those folks won't even pay a co pay. (1:00:29) And then for the rest of the people, the deal with the most favored nations is that you'll be able to cash pay these things over the next twenty four months to get these down, both Wegovy, which is the obesity version of Ozepic, and and Zepbound, the obesity version of Mounjaro. (1:00:45) You'll be able to get those both for $250 within the next twenty four months, and the price just came down on the cash pay
Scott Benner (1:00:51) for it. (1:00:51) Then I'm thinking everybody should buy stock in companies that make clothes like bras and underwear and stuff that
David Knapp (1:00:56) Oh, yeah. (1:00:57) Yeah. (1:00:57) Because you
Scott Benner (1:00:58) have any idea how many times I've donated my clothes and had to rebuy stuff over the last two years? (1:01:02) Like, it's
David Knapp (1:01:03) Oh, yeah. (1:01:03) Yeah. (1:01:03) It's a there's a huge clothes swap market that goes on within the community of people who use these That's brilliant. (1:01:11) Drugs. (1:01:11) That's brilliant.
Scott Benner (1:01:12) Well so, Dave, I thank you. (1:01:14) I have taken up a lot of your time. (1:01:15) I I wondered, do you see it, I don't know, an avenue here where you and I could get back together and do this every once in a while? (1:01:20) Like, you
David Knapp (1:01:20) I would I mean, I I this is my world. (1:01:23) I love talking about this stuff. (1:01:25) I love talking to other people who are passionate about health. (1:01:28) And frankly, I just like talking to other laypeople that, you know, like you said, steeped in this stuff, immersed in it every day. (1:01:35) We've learned about this stuff because we're passionate, and we have skin in the game ourselves.
David Knapp (1:01:40) And I just think it's it helps a lot of people to hear from from other people like us. (1:01:45) So I would love to do more of this if you're willing to.
Scott Benner (1:01:47) We're gonna have to find an overlap with my audience's needs and your skill set and and your and your knowledge and and and find a way to we can do that. (1:01:56) We'll do that offline.
David Knapp (1:01:56) For sure. (1:01:57) Yeah. (1:01:57) There's a lot of people in the OnDePen community who are type one, and they're pining for more information just like you are on this stuff because everything is so focused on type two and obesity. (1:02:09) And they're saying, wait. (1:02:11) You know, my husband went on Mounjaro, he's a type one, and he's off his insulin, or he was able to greatly reduce his insulin.
David Knapp (1:02:18) What are they what are the trials saying? (1:02:20) And there's just been very little in terms of looking at GLP ones with type one, but I think that's because it's such a spectrum of disease in terms of how severe it is for people. (1:02:32) So it's hard to put together probably clinical trials for it.
Scott Benner (1:02:35) Well, yeah, also and it's scary to say out loud too because you don't wanna give people the idea that if they just took enough of this, their type one diabetes would stop needing insulin because I that's not gonna be the case for a great many people. (1:02:45) And, obviously, they would be impacted very poorly with their health for not taking their insulin. (1:02:50) You don't want that to be confused, and you also don't want people not to look into it.
David Knapp (1:02:54) Right?
Scott Benner (1:02:55) There's something there. (1:02:56) Like, I I think I told you before we started. (1:02:58) I've had, a gentleman on who's, you know, type one, and he's definitely type one. (1:03:03) People are like, well, maybe he wasn't, but he's definitely type one. (1:03:06) He has autoantibodies.
Scott Benner (1:03:07) He, you know, been using insulin for years. (1:03:09) They put him on Mounjaro or, you know, Zepbound for weight, and he literally came off his insulin. (1:03:15) Now he doesn't expect that's gonna be forever, but it is for now, and no one knows why. (1:03:20) It's not because GLP cures type one diabetes, which is how, like, simple black and white thinking ends up getting you know, people get very reactive when you say stuff like that. (1:03:30) But I've also had, you know, a 15 year old girl.
Scott Benner (1:03:34) Her mom came on to talk about how her insulin needs went down. (1:03:37) She was using one unit of basal a day. (1:03:39) She had to go off her pump. (1:03:40) She's an injected unit of basal a day. (1:03:42) She's back on a pump now, but it lasted two years.
Scott Benner (1:03:45) Like, two years where she wasn't taking a ton of insulin. (1:03:47) Right. (1:03:48) Somebody needs to be asking, like, what happened there? (1:03:50) Like, you you know what I mean? (1:03:52) Like, what was the functionality there?
Scott Benner (1:03:53) Like, what that's the stuff I want people looking into. (1:03:55) I don't think that if you just gave a type one enough enough GLP, they'd stop needing insulin. (1:04:01) Like, no one's saying that. (1:04:03) Like, I think you can hear there's a bigger conversation here about other impacts on your life. (1:04:08) And even if it just man, if it just makes something better for you, I I just I think it's really valuable to hear about more of it.
David Knapp (1:04:15) Right. (1:04:16) You
Scott Benner (1:04:16) know? (1:04:16) And then there's the functional side of it, like, actually implementing it. (1:04:19) You can start shooting this into people who don't really understand their insulin. (1:04:22) Like, you know, we've talked a lot today about, like, it would be nice if people could dose this themselves. (1:04:27) Mhmm.
Scott Benner (1:04:27) Insulin's a thing that type ones dose themselves all day long. (1:04:30) And trust me, Dave, between me and you, they're not great at it. (1:04:33) The doctors aren't great at giving you the right doses and you're and people aren't great at making the adjustments they need to make for a lot of good reasons. (1:04:41) And just flopping them on a GLP and and and reducing their needs right away, they might struggle to get their insulin, like, readjusted, which will cause them a lot of problems. (1:04:52) And some of those problems could be, you know, a dangerous hypoglycemia, hyperglycemia.
Scott Benner (1:04:57) And, obviously, you don't want that too. (1:04:58) And then you get into that more functional human problem of, like, how do you put this into practice? (1:05:04) And, I mean, I don't have any answers for that. (1:05:06) But for the people who can figure out how to do it on their own and you feel like you're up to the task, I'd look into this if I was you. (1:05:13) So A 100%.
Scott Benner (1:05:15) Alright.
David Knapp (1:05:15) Everything I I think you probably would echo this. (1:05:18) Everything that I share as a layperson here about this stuff, we just want people to have better conversations with their doctor. (1:05:25) And so that's always my hope whenever I share any of the information that I've learned is just you heard about a study. (1:05:31) You heard about a drug. (1:05:32) You heard about something that might help.
David Knapp (1:05:33) Go talk to your doctor about it. (1:05:35) And if your doctor doesn't know about it, ask them to know about it
Scott Benner (1:05:40) Yeah.
David Knapp (1:05:40) Or find somebody that does.
Scott Benner (1:05:42) Dave, I don't think there's any doubt that shows like yours and shows like mine, I think they push innovation forward because people can find out about things sooner. (1:05:51) Like, you know, forty years ago, like, you'd be like, do you, you know, do you have Pat? (1:05:55) She lives, like, three doors down. (1:05:57) She's taken the GLP. (1:05:59) That would take years for that to spread through the neighborhood, but it wouldn't help anybody.
Scott Benner (1:06:03) Right? (1:06:03) Like, you can yell it out loud now and have 10,000, 20,000, a million people hear it, and and you're not trying to make them do something. (1:06:10) You're trying to make them go home and quietly go, I wonder. (1:06:15) Mhmm. (1:06:15) What should I be asking for myself on this?
Scott Benner (1:06:17) You you know? (1:06:18) And then I think that's why this podcast works for people with type one too because I don't see a lot of difference between what we're talking about here and what ends up happening to people when they're diagnosed with type one or type two diabetes, honestly. (1:06:29) He gets sent home with, like, here, take metformin. (1:06:32) You'll be fine. (1:06:33) That's it?
Scott Benner (1:06:33) That's what you're gonna tell me? (1:06:35) So, anyway, I appreciate this very much. (1:06:37) Let me say goodbye to you, and and thank you very much for your time.
David Knapp (1:06:39) Thank you, Scott. (1:06:40) Yeah. (1:06:40) Appreciate it.
Scott Benner (1:06:47) This episode of the Juice Box podcast is sponsored by Omnipod five. (1:06:51) Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time in range for people with type one diabetes when they've switched from daily injections. (1:07:02) Learn more and get started today at omnipod.com/juicebox. (1:07:07) At my link, you can get a free starter kit right now. (1:07:09) Terms and conditions apply.
Scott Benner (1:07:11) Eligibility may vary. (1:07:12) Full terms and conditions can be found at omnipod.com/juicebox. (1:07:17) Today's episode is also sponsored by US Med dot com slash juice box or call (888) 721-1514. (1:07:26) Get started today and get your supplies from US Med. (1:07:30) A huge thanks to Cozy Earth for sponsoring this episode.
Scott Benner (1:07:33) Don't forget Black Friday has come early at cozyearth.com. (1:07:36) Right now, you can stack my code JuiceBox on top of their site wide sale. (1:07:41) This is gonna give you up to 40% off in savings, and these deals are definitely not gonna last. (1:07:46) I'm talking about sheets, towels, clothing, everything they have. (1:07:49) Get that holiday shopping going right now today.
Scott Benner (1:07:52) Do it. (1:07:52) Do it. (1:07:52) Do it. (1:07:53) Cozyearth.com. (1:07:54) Use the off code juice box.
Scott Benner (1:07:56) Thank you so much for listening. (1:07:57) I'll be back very soon with another episode of the juice box podcast. (1:08:01) If you're not already subscribed or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that now. (1:08:09) Seriously, just to hit follow or subscribe will really help the show. (1:08:13) If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes, I'll be your best friend.
Scott Benner (1:08:19) And if you leave a five star review, oh, I'll probably send you a Christmas card. (1:08:24) Would you like a Christmas card? (1:08:27) Hey. (1:08:28) I'm dropping in to tell you about a small change being made to the Juice Cruise 2026 schedule. (1:08:33) This adjustment was made by Celebrity Cruise Lines, not by me.
Scott Benner (1:08:36) Anyway, we're still going out on the Celebrity Beyond cruise ship, which is awesome. (1:08:40) Check out the walkthrough video at juiceboxpodcast.com/juicecruise. (1:08:45) The ship is awesome. (1:08:47) Still a seven night cruise. (1:08:49) It still leaves out of Miami on June 21.
Scott Benner (1:08:52) Actually, most of this is the same. (1:08:53) We leave Miami June 21, head to Coco Cay in The Bahamas, but then we're going to San Juan, Puerto Rico instead of Saint Thomas. (1:09:01) After that, Bastirie, I think I'm saying that wrong, Saint Kitts And Nevis. (1:09:05) This place is gorgeous. (1:09:07) Google it.
Scott Benner (1:09:08) Mean, you're probably gonna have to go to my link to get the correct spelling because my pronunciation is so bad. (1:09:12) But once you get the Saint Kitts and you Google it, you're gonna look and see a photo that says to you, oh, I wanna go there. (1:09:19) Come meet other people living with type one diabetes from caregivers to children to adults. (1:09:25) Last year, we had a 100 people on our cruise, and it was fabulous. (1:09:30) You can see pictures to get at my link juiceboxpodcast.com/juicecruise.
Scott Benner (1:09:35) You can see those pictures from last year there. (1:09:37) The link also gives you an opportunity to register for the cruise or to contact Suzanne from Cruise Planners. (1:09:43) She takes care of all the logistics. (1:09:45) I'm just excited that I might see you there. (1:09:48) It's a beautiful event for families, for singles, a wonderful opportunity to meet people, swap stories, make friendships, and learn.
Scott Benner (1:09:57) If you're new to type one diabetes, begin with the bold beginnings series from the podcast. (1:10:01) Don't take my word for it. (1:10:03) Listen to what reviewers have said. (1:10:05) Bold beginnings is the best first step. (1:10:08) I learned more in those episodes than anywhere else.
Scott Benner (1:10:11) This is when everything finally clicked. (1:10:12) People say it takes the stress out of the early days and replaces it with clarity. (1:10:16) They tell me this should come with the diagnosis packet that I got at the hospital. (1:10:21) And after they listen, they recommend it to everyone who's struggling. (1:10:24) It's straightforward, practical, and easy to listen to.
Scott Benner (1:10:28) Bold Beginnings gives you the basics in a way that actually makes sense. (1:10:32) The Juice Box podcast is edited by Wrong Way Recording. (1:10:37) Wrongwayrecording.com. (1:10:40) If you'd like your podcast to sound as good as mine, check out Rob at wrongwayrecording.com.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#1698 Dr. Beachgem
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Dr. Beachgem (@Beachgem10) is a board-certified pediatric emergency medicine physician and a massive, trusted voice on TikTok, Facebook, and Instagram. She translates real ER experience into simple, actionable advice for parents—helping families decide what’s normal, what’s urgent, and what to do next.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:0) As the holidays approach, I wanna say welcome and thank all of my good friends for coming back to the Juice Box podcast over and over again. (0:18) I guess I have to be careful about what I say on the Internet because a couple of weeks ago, I said, I'd like to see doctor Beach Jim on the podcast, and here she is. (0:29) You all went and told her on TikTok, Instagram, Facebook, YouTube, everywhere you could find her. (0:34) You tagged her. (0:35) You tagged me, and you said we'd love to hear you on the juice box podcast.
Scott Benner (0:38) And you guys did it. (0:39) You're the producer of the podcast today. (0:41) You got us doctor Beach Jem, and she is every bit as amazing as you think she is. (0:47) She's known all over the Internet as doctor Beach Jem or doctor Beach Jem ten and is a board certified pediatric emergency medicine physician. (0:56) She's a wife and a mom.
Scott Benner (0:57) I had such a fantastic time making this recording with her that after we got done recording, I asked if she would be interested in coming back and putting together a series with me about how type ones could have better success in the emergency room. (1:10) And guess what? (1:11) She is so lovely. (1:13) She said yes. (1:14) So you'll see doctor Beach Gem back on the podcast in 2026, maybe for a number of episodes.
Scott Benner (1:19) If you're here today because you're a big fan of doctor Beach Gem and you have no idea who I am, my name is Scott. (1:25) I make this podcast, the Juice Box podcast. (1:27) It's eleven years old. (1:28) We have 1,700 episodes. (1:30) An episode goes up every day.
Scott Benner (1:31) Most of them are conversations with people who live with type one diabetes or love somebody who does, some people with type two, and a lot of other autoimmune issues, Hashimoto's, celiac, stuff like that. (1:44) If you like to hear people sit down and really openly and honestly talk about their life with their condition, I think you'll really like this podcast. (1:53) It's not super serious. (1:54) It's not super jokey. (1:56) It is entertaining, and I think you'll love it.
Scott Benner (1:59) Subscribe and follow. (2:00) Give us a shot, and at the very least, you'll get more doctor beach gem in the future. (2:04) And please don't forget that nothing you hear on the juice box podcast should be considered advice, medical or otherwise. (2:09) Always consult a physician before making any changes to your health care plan or becoming bold with insulin. (2:21) The episode you're about to listen to is sponsored by Tandem Moby, the impressively small insulin pump.
Scott Benner (2:26) Tandem Moby features Tandem's newest algorithm, Control IQ Plus technology. (2:31) It's designed for greater discretion, more freedom, and improved time and range. (2:36) Learn more and get started today at tandemdiabetes.com/juicebox. (2:41) Today's episode is also sponsored by US Med. (2:45) Usmed.com/juicebox or call (888) 721-1514.
Scott Benner (2:52) You can get your diabetes testing supplies the same way we do from US Med. (2:57) The podcast is also sponsored today by the Eversense three sixty five, the one year wear CGM. (3:04) That's one insertion a year. (3:06) That's it. (3:07) And here's a little bonus for you.
Scott Benner (3:09) How about there's no limit on how many friends and family you can share your data with with the Eversense Now app? (3:14) No limits. (3:16) Eversense. (3:17) So you're being recorded already, just so you know.
Dr. Beachgem (3:21) Awesome.
Scott Benner (3:21) But so okay. (3:23) It's not and there's no video. (3:24) If you wanna pick your nose, it's cool with me. (3:27) No one's ever gonna know. (3:28) Although, I get Priorities.
Scott Benner (3:29) Priorities. (3:29) People are like, you should do a screenshot so you can do the social media. (3:32) I'm like, I'm not good at social media. (3:33) I'm gonna just hope that she enjoyed herself and posts about it. (3:37) Yep.
Scott Benner (3:37) It's like, I I'm not gonna be good at cajoling people. (3:40) We'll just jump right in. (3:41) How do you want me to refer to you? (3:43) What do I call you?
Dr. Beachgem (3:44) Doctor Beach or doctor Beach Jem.
Scott Benner (3:45) Doctor Beach or doctor Beach Jem. (3:47) Okay. (3:47) You can call me Scott.
Dr. Beachgem (3:48) Jem is Meg backwards, my maiden name was Meg Beach. (3:51) So Beach Jem is Meg Beach. (3:53) It's a play on my name, which, again, I'm not allowed to use, but that's yeah.
Scott Benner (3:57) People have got it figured out pretty well.
Dr. Beachgem (3:59) A little bit. (3:59) There's a couple people that are like, I'm on to you.
Scott Benner (4:02) I just figured that you loved the beach when I saw it.
Dr. Beachgem (4:05) And I live in Florida. (4:05) Like, it makes sense.
Scott Benner (4:07) People are confused and want me to ask you why you live in Florida, but you wear Bills gear.
Dr. Beachgem (4:12) So I did training in Buffalo. (4:14) So I spent three years. (4:15) We my husband and I packed up everything we owned. (4:18) We sold our house. (4:19) We bought two new cars that had four wheel drive, and we moved to Buffalo.
Dr. Beachgem (4:22) We didn't know a soul with our two tiny babies. (4:25) We lived there for three years. (4:26) It's I don't know. (4:27) The people who don't know Buffalo is an incredible community. (4:30) Very, very, like, welcoming and supportive.
Dr. Beachgem (4:33) And, yeah, there's snow, but, like, the people, the festivals, everything is just amazing.
Scott Benner (4:38) That's good to hear. (4:38) My daughter's friend just graduated from college, and she got her first job in Buffalo, and she's leaving in a couple of weeks.
Dr. Beachgem (4:43) She's gonna have a blast.
Scott Benner (4:44) Awesome. (4:45) I'm gonna tell her that because I think she's worried. (4:46) I think she just thought snow.
Dr. Beachgem (4:48) Yeah. (4:48) There's there is snow. (4:49) Mhmm. (4:50) If you live north of downtown, it's actually you don't get as much lake effect as, like, just south of downtown.
Scott Benner (4:55) I'll tell her that. (4:56) Yeah. (4:56) That's good advice. (4:57) Okay. (4:57) So you went to school there.
Scott Benner (4:58) Did you go to undergrad, med school? (5:02) What did you do there?
Dr. Beachgem (5:03) I did my fellowship training. (5:04) So my pediatric emergency medicine fellowship after my general pediatric residency. (5:09) I spent a lot of time in school.
Scott Benner (5:11) Did you start out thinking, like, you'd be a pediatrician in an office and then kind of expand, or did you always have this as a path?
Dr. Beachgem (5:19) You know, I wasn't sure. (5:21) There were three things that I was interested in. (5:23) I liked pediatric emergency medicine, pediatric ICU, and pediatric endocrinology because when I was in med school, I did this summer camp just outside of Tallahassee for kids that have diabetes. (5:35) And it's a one week summer camp, and they bring med students and people who are a little bit more savvy with medicine so that we're doing blood sugar checks and that kind of stuff in the middle of the night in these kids and can alert camp staff if there is something awry. (5:49) So I fell in love with die like, as much as you can, fall in love with diabetes and the management while I was still in medical school.
Scott Benner (5:56) So a lot of doctors tell me that they they make their students go to diabetes camp to really get a feeling for what happened to you? (6:03) Can you tell me, like, what you didn't know that you left understanding?
Dr. Beachgem (6:07) I think, like, the glucose is still fuel. (6:11) You still need the sugar. (6:12) Even though sugar is, like, kind of the enemy, like, we wanna keep it manageable, it is still fuel. (6:17) And so when kids come into camp, one of the first things that they do is they adjust everyone's regimens. (6:22) Like, they go rogue because the kids are gonna be much more physically active than normal.
Dr. Beachgem (6:26) Mhmm. (6:27) And so we need to make sure that they have a little bit more of that fuel accessible for what they're doing. (6:33) And we actually had a kid have a really kinda scary low at one point. (6:37) And so just to see that, like, this is what parents are worried about when they tend to want their kid's blood sugar a little on the higher side and doctors want it a little on the lower side, but this is the scary part that doctors don't always get to see that parents get worried about.
Scott Benner (6:50) Okay. (6:50) So the reason I'm super interested to have you here is because I want your perspective, but I do first want to understand, like, you know, a little bit about you and how you got to where you are. (6:59) Can we start with why you're famous? (7:01) Like, how did that begin?
Dr. Beachgem (7:03) Yeah. (7:04) It's a great question. (7:05) I because
Scott Benner (7:06) you are. (7:06) Because but I I told you before we started recording, my wife has been cajoling me for two years to try to ask you on the podcast. (7:13) I now watch you online. (7:15) And then I was telling doctor Beacham this story before we started recording, but she did a diabetes awareness video that a lot of people who listened to me must have seen, and then I kind of sicced them on her. (7:25) I was like, hey.
Scott Benner (7:26) I'd love to get her on the podcast. (7:27) Can you go tell her? (7:28) And then they tagged you a lot and me. (7:30) Appreciate you not thinking we were crazy and coming on. (7:32) Like, no one doesn't know who you are who has social media.
Scott Benner (7:36) But did you set out for that to happen? (7:38) Because it doesn't feel that way.
Dr. Beachgem (7:39) No. (7:40) I this was an accident. (7:41) A kind of a happy accident, but this was never my intention at all. (7:45) I started making content during the pandemic. (7:48) I think everyone had a million activities.
Dr. Beachgem (7:50) Life is busy. (7:50) I had four kids, and then all of a sudden, all that's gone.
Scott Benner (7:53) Yeah.
Dr. Beachgem (7:54) I go to work, I come home, and I look at everyone. (7:56) So I downloaded TikTok, and then I started creating videos that kind of broke down science a little bit, you know, talked did some myth busting, discussed some of the misinformation, and talked about real science based stuff. (8:08) Mhmm. (8:09) And I guess I did it in a way that was authentic and accessible, and so people really were drawn to that, I guess.
Scott Benner (8:17) Do you find yourself thinking about that? (8:18) Because this is not a thing a lot of people didn't try. (8:21) I don't wanna get, like, down a wormhole that's only for you and I, but I don't understand why my thing's popular and other people tried it and it didn't work. (8:28) It's hard to pull out far enough macro enough to see yourself like that. (8:32) Do you have any feelings?
Dr. Beachgem (8:34) I a 100 a 100% agree. (8:35) I don't really know why that social media kind of chose me because I there's so many people that come out. (8:42) There's and I have a bunch of colleagues who do very similar stuff that I do, but don't have the same degree of following. (8:49) And arguably, they're smarter than me, most of them. (8:52) You know?
Dr. Beachgem (8:52) But I think that one of the things that I do is I do share a little bit more of, like, my personal life and my flaws and my messy house. (9:01) And I think getting to know someone, you trust them more. (9:05) Yeah. (9:05) They know that I've got the ADHD and that my house is messy. (9:08) And I get anxious when I do public speaking.
Dr. Beachgem (9:10) And they say, now she's gonna talk to me about this, but I can trust her because I know that she's a real human. (9:14) Yeah. (9:15) And I think that letting people in a little bit keeps them here.
Scott Benner (9:18) I said something on a recording that isn't out yet that I still can't believe I even admitted about myself. (9:23) I always think, like, maybe I'll just message the editor and be like, take that out. (9:26) I don't think I should have said that. (9:28) Even the, just two days ago, I was recording with a lady, and she was talking about her antibodies for type one. (9:34) And she goes, there's three.
Scott Benner (9:35) And I went, I think there's five. (9:37) And there is five, by the way. (9:38) I was right, but I wasn't sure. (9:40) And I've been doing this a really, really long time. (9:42) And it does give you a moment where you're like, am I not the right person to have this, whatever this is?
Scott Benner (9:47) You know what I mean? (9:48) Like, I what do they talk about? (9:49) Imposter don't feel don't feel that way. (9:52) I just I'm worried that I'm not doing as well as I could be sometimes for people. (9:56) I don't if that makes sense or not.
Scott Benner (9:57) But, anyway, it seems to be going okay. (9:58) So, okay. (9:59) You did not do this on purpose. (10:00) You started making videos No. (10:01) People like you.
Scott Benner (10:02) And then when does it occur to you that you're a slave to the machine now? (10:07) Because at some point, you have to make content. (10:09) Right?
Dr. Beachgem (10:10) Yeah. (10:10) I do feel like I kind of have to make content. (10:12) There is a certain degree of pressure there. (10:14) But at the same time, I don't really feel like a slave to the machine because it's still something that I really enjoy. (10:20) I really enjoy making the content, deciding on what to talk about that day.
Dr. Beachgem (10:24) Like, this is still something that is my coping mechanism for what I deal with, what I consider the real world at my real job. (10:30) Mhmm. (10:31) This is still something that I really enjoy, so it doesn't really feel like work. (10:34) You mentioned before we got on that you work seven days a week. (10:37) And I was like, oh, I guess I also work seven days a week on this, but I I just don't look at it like that because it's still something that's really fun.
Scott Benner (10:43) Yeah. (10:44) It doesn't feel that way to me, but it's true. (10:46) And, actually, like, we're just gonna get up and exist in this house again tomorrow. (11:06) I might as well do something, you know? (11:07) That's really interesting.
Scott Benner (11:08) Okay. (11:09) So I would also tell you that when I first started doing this, there was a person who told me, well, you won't be able to do it long because you'll run out of topics. (11:17) And I have found that to be the most untrue thing that anyone has ever said to me. (11:21) Yeah. (11:21) I think that there is a way to continue to help people and be thoughtful about it infinity, just just to keep going.
Scott Benner (11:28) Like, there's so many things to talk about that people don't understand or have context for. (11:33) My question is, what do you see that you talk about that really helps people that you didn't believe? (11:39) Like, you just thought, oh, I'll just talk about this today, then you realized how impactful it was.
Dr. Beachgem (11:43) You know, probably honestly, some of the diabetes stuff that I've talked about, like, that I diagnosed a friend's child with DKA in Carline, and I tell that story every year. (11:54) Throughout the year, I get tons and tons of comments still on those videos, and then people sending me messages like, Hey, I knew what to look for. (12:03) I was able to get my child or a friend's child early diagnosed. (12:06) They didn't go into DKA because, you know, we knew the symptoms ahead of time. (12:10) So some of that content, I feel like, has been among the more impactful stuff that I've done.
Scott Benner (12:15) You might not know this, but type one diabetes is one of the best represented disease states as a community online. (12:21) It has been like that since I started blogging in 2007. (12:25) And, you know, it's interesting because back in the day, like, I'd have people come to me and say, we'd really like to start a community for type two. (12:32) There's so many more people with type two, but they don't seem as interested as being in a community. (12:36) And then and do you realize, like, there's something about type one that makes people they can't hide it.
Scott Benner (12:43) Right? (12:43) You can't ignore it, and you need support. (12:46) I didn't realize even when I started doing this, this will maybe make you laugh. (12:49) When I started making the podcast, I actually just thought I would take my most popular blog posts and read them into the podcast because I knew they helped people. (12:57) I didn't realize it was gonna go like this.
Scott Benner (12:58) And people were like, Nick, like, please don't do that. (13:01) I pivoted a little bit. (13:02) But as I started growing, I kept thinking all I was doing was sharing tools. (13:06) And then when I started seeing the tools I think tools and foundation are really important. (13:11) I think the confidence to make decisions about setting changes is a huge thing for type ones.
Scott Benner (13:17) But community and support from people who understand I don't wanna sound silly because maybe I maybe I feel old, but I didn't realize that was a big deal. (13:26) And now I see it as, like, half of it. (13:28) Yeah. (13:29) You know? (13:29) So maybe that's one of the reasons why you're seeing back from people with type one because they are engaged because they need to be.
Scott Benner (13:35) And I think when you talk about it, they're like, oh, there's somebody who's outside of diabetes a little bit who's willing to, like, talk about this. (13:41) It must just be exciting to hear somebody speak about it thoughtfully. (13:44) Yeah. (13:45) Yeah. (13:46) So now we understand how you got here.
Scott Benner (13:48) Now I'm gonna ask you my difficult question.
Dr. Beachgem (13:50) Oh, boy.
Scott Benner (13:52) I hate the word advocate for myself. (13:54) I hate to think that you like, here's how I think about it. (13:57) When I go to the to get tires on my car, I don't go, hey. (14:01) Get me four new tires. (14:03) Let me watch and make sure you pick the right ones.
Scott Benner (14:05) Let me watch and make sure you put them on the right way. (14:07) Did you balance them? (14:07) Did you fill them up with air? (14:08) Did you tighten the lug nuts? (14:09) I gotta advocate for myself to make sure you do your job right.
Scott Benner (14:12) Like, why do we have to advocate in health care? (14:16) I used to hate ordering my daughter's diabetes supplies. (14:19) I never had a good experience, and it was frustrating. (14:23) But it hasn't been that way for a while, actually, for about three years now because that's how long we've been using US Med. (14:30) Usmed.com/juicebox or call (888) 721-1514.
Scott Benner (14:39) US Med is the number one distributor for Freestyle Libre systems nationwide. (14:44) They are the number one specialty distributor for Omnipod Dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. (14:56) They have served over 1,000,000 people with diabetes since 1996, and they always provide ninety days worth of supplies and fast and free shipping. (15:06) US Med carries everything from insulin pumps and diabetes testing supplies to the latest CGMs, like the Libre three and Dexcom g seven. (15:16) They accept Medicare nationwide and over 800 private insurers.
Scott Benner (15:22) Find out why US Med has an a plus rating with the Better Business Bureau at usmed.com/juicebox, or just call them at (888) 721-1514. (15:34) Get started right now, and you'll be getting your supplies the same way we do. (15:39) When you think of a CGM and all the good that it brings in your life, is the first thing you think about, I love that I have to change it all the time? (15:47) I love the warm up period every time I have to change it? (15:50) I love that when I bump into a door frame, sometimes it gets ripped off.
Scott Benner (15:53) I love that the adhesive kinda gets mushy sometimes when I sweat and falls off. (15:57) No. (15:58) These are not the things that you love about a CGM. (16:01) Today's episode of the Juice Box podcast is sponsored by the Eversense three sixty five, the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems. (16:13) The Eversense three sixty five is the only one year CGM designed to minimize device frustration.
Scott Benner (16:20) It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping. (16:27) You can manage your diabetes instead of your CGM with the Eversense three sixty five. (16:32) Learn more and get started today at eversensecgm.com/juicebox. (16:38) One year, one c g m.
Dr. Beachgem (16:40) Oh, you know, health care is tough. (16:42) Mhmm. (16:42) And health care is not your car. (16:44) It's not as easy as putting tires on something. (16:47) You know, disease states are complicated, people make them individual.
Dr. Beachgem (16:52) I work in emergency medicine so my job is looking for emergencies. (16:57) I may say to someone, I don't know what this is, but this isn't something that's going to kill you tonight and this is the plan for follow-up. (17:06) It can be complicated because, you know, what's your insurance status? (17:10) What can you guys get approved as an outpatient? (17:12) There's so much more that goes into decision making in health care than just let's throw some tires on.
Scott Benner (17:18) Mhmm.
Dr. Beachgem (17:18) So, you know, I have to think, is this person doesn't have an emergency going to be able to get this test done? (17:25) Can they get into their pediatrician? (17:27) Can they get into this test done as an outpatient? (17:30) And so I think when we talk about the decisions that we have to make, it's just so it's not even three-dimensional. (17:37) It's four dimensional.
Dr. Beachgem (17:38) And I think there are a million different ways to approach conditions and decisions. (17:44) And I think when we're advocating, we're trying to bring everyone to the table to the same table.
Scott Benner (17:50) Okay.
Dr. Beachgem (17:51) Because a lot of times and and granted, there are great providers out there and not so great providers out there, but I'm sitting at my emergency medicine table, and they're sitting at their parent table. (18:00) And we need to be sitting at the same table, and I don't understand their insurance and their, you know, transportation and all of this other stuff. (18:06) And so I think advocating is really trying to get us all on the same table so that we're understanding all of the same things.
Scott Benner (18:12) Okay.
Dr. Beachgem (18:12) I don't wanna defend the not great decisions that happen out there, but I think some of the decisions that are made in medicine are decent decisions, just not made for the right person.
Scott Benner (18:21) And is it different for people with type one because they often have such a deeper understanding of their illness than other people do? (18:29) Right? (18:29) So when you say something that smells a little wrong in the ER for me, I'm like, oh, that ain't right. (18:34) And then, like, suddenly there's a a chasm there. (18:37) Like, oh, we're gonna take your pump off.
Scott Benner (18:38) You're like, dude, don't do that. (18:39) Yeah. (18:40) Or, you know, when somebody finger sticks you every hour when you're wearing a CGM and you think, like, you're just doing this so you can charge me for the finger stick? (18:46) Like, what is happening right now? (18:47) And, like so I ask you the question.
Scott Benner (18:49) It's a bit of a trick question because Mhmm. (18:51) People feel all the time like medicine doesn't understand diabetes. (18:56) But I've been doing this for so long, and I've spoken to so many different doctors that I think it's kind of a, like, a multipronged problem. (19:03) Like, you are you said and you said something I feel like. (19:05) Like, you as the patient, you're the variable because you don't know, am I on the ball?
Scott Benner (19:10) Do I not understand this at all? (19:11) Like, where's my diabetes understanding? (19:13) Like, so you have to treat us all like we don't know what we're doing because that is probably what you see most frequently. (19:18) Right? (19:19) People with higher a one c's who aren't quite sure about how to do what they're doing.
Scott Benner (19:23) And then there's your level of education, your level of experience, like, how tired are you? (19:27) Are you fighting with your husband? (19:29) All this is happening at the same time. (19:31) And then there's the insurance piece. (19:33) So can I even run this test?
Scott Benner (19:35) Am I right to say that, like, there's basically a checklist and if you don't meet everything, then there's a test you can't run even if you wanted to?
Dr. Beachgem (19:42) Not necessarily a check list in all situations. (19:44) Okay. (19:45) Especially, again, I'm in I'm in the emergency department. (19:47) I have relative free rein as long as I can justify it.
Scott Benner (19:51) Got it. (19:51) Okay.
Dr. Beachgem (19:52) So I can't order, you know, a random outpatient send out test that has nothing to do with your visit today. (19:57) Mhmm. (19:57) But I can order an a one c if we're concerned about x, y, and z, and it makes sense with your visit. (20:04) I do have more leeway than a lot of outpatient providers, which is cool, which is really cool.
Scott Benner (20:08) Because you're in a more of a an emergent diagnostic situation. (20:14) This episode is sponsored by Tandem Diabetes Care. (20:17) And today, I'm gonna tell you about Tandem's newest pumping algorithm. (20:21) The Tandem Mobi system with Control IQ plus technology features auto bolus, which can cover missed meal boluses and help prevent hyperglycemia. (20:31) It has a dedicated sleep activity setting and is controlled from your personal iPhone.
Scott Benner (20:35) Tandem will help you to check your benefits today through my link, tandemdiabetes.com/juicebox. (20:42) This is going to help you to get started with Tandem's smallest pump yet that's powered by its best algorithm ever. (20:49) Control IQ Plus technology helps to keep blood sugars in range by predicting glucose levels thirty minutes ahead, and it adjusts insulin accordingly. (20:57) You can wear the Tandem Mobi in a number of ways. (21:00) Wear it on body with a patch like adhesive sleeve that is sold separately, clip it discreetly to your clothing, or slip it into your pocket.
Scott Benner (21:08) Head now to my link, tandemdiabetes.com/juicebox, to check out your benefits and get started today.
Dr. Beachgem (21:16) Yep. (21:17) Like, if I can justify it with the visit today, like, we could probably make it happen. (21:22) But I think one of the things that gets complicated is that, like you said, there are a lot of situations where people have higher A1Cs, maybe not managing quite as well for whatever reason. (21:34) And so we have all of these protocols and checklists that we have for new onset diabetes or maybe hyperglycemia. (21:41) And so we click these check boxes for orders, and now it's saying everybody that comes in with hyperglycemia is going to get a blood sugar every hour.
Dr. Beachgem (21:51) And what if your CGM is not working? (21:53) So I think that we are in this super cautious over here phase where you're like, I got out my CGM, we're good. (21:59) My blood sugar is 10 points different than it was an hour ago, but we have to function in this more conservative space, and we use these protocols to do that. (22:09) And it's nice because we can override these protocols in certain situations, but a lot of times the default setting is gonna be going by these protocols.
Scott Benner (22:16) Okay. (22:16) People also want me to ask you, how can it be possible that when a kid comes into a pediatrician's office with flu like symptoms that a finger stick is part of the diagnostic? (22:25) Because that's usually where people are misdiagn like, could be diagnosed and and aren't. (22:30) Right? (22:30) Is that what like, is that a money thing?
Scott Benner (22:33) Like, like, it's such a strange idea that it's not just part of it.
Dr. Beachgem (22:37) I don't know if it's as much as a money thing as a resource thing because you have to make sure that that blood sugar meter every day has to be like you have to check it to make sure that it's working. (22:47) I forget what the thing's You have to calibrate it every day, so you have to have the person to do it, and then if it's not done, you have to calibrate it. (22:54) That takes time. (22:54) That takes you know, your nurse that's busy that you guys have 40 appointments today, and instead of doing this, now she's calibrating and then checking her blood sugar, which takes time. (23:03) So I think it's more of a resource thing.
Dr. Beachgem (23:05) I will say that's one of the more commonly missed things is gastro or flu like illness and it's actually new onset or DKA. (23:14) We do our best to check blood sugars frequently in the ER, but it is something that could easily be missed. (23:21) I would say in the ER, that's all we see all day long, and so it goes back to the resources. (23:26) We calibrate every day anyway because we check enough of them, but that's probably the biggest barrier I would say is doing it.
Scott Benner (23:32) So I often I sit around and I think sometimes doctors' jobs are really unfair. (23:38) Right? (23:38) Like, you expect them to like, first of you go to if you really were gonna go to medical school and come out with a complete understanding, you'd have to go to medical school for a hundred years. (23:46) Mhmm. (23:46) Right?
Scott Benner (23:46) Like, so you get a little bit of everything, and then you're left to just remember, oh, did I hear a thing one time about that, or have I ever had this experiences? (23:54) There's times when I think when you come into an ER, should just be talking and an AI should be listening to you. (24:00) And then it should say, here are the possibilities in case you miss something, and then layer the human side on top of it because that is what we're asking you to do. (24:08) And there's there's no way you're gonna be able to do that. (24:10) Like, even the sharpest, brightest, most focused person isn't gonna have access to everything they've ever encountered in the world, every thought and every teaching, and they might have missed one.
Scott Benner (24:20) And so I mean, your job must feel like rooting around in the closet without a flashlight in the dark. (24:26) Right? (24:26) Like, is that am I getting close?
Dr. Beachgem (24:28) Yeah. (24:29) The saying that we have is you're walking through a minefield in clown shoes because it's four years. (24:34) And in that four years, you're supposed to learn, everything that you need to have to go start practicing, and then you've got three to six years of residency where you're supposed to learn everything else. (24:44) I can tell I learned a lot during that time, but I certainly didn't learn everything that there is to know, especially when there's getting into these really rare genetic conditions and stuff like that. (24:53) It is hard, and we have to be perfect a 100% of the time or else somebody's life could be in danger.
Dr. Beachgem (24:59) As a human, being right a 100% of the time is just it's impossible. (25:03) I will a 100% agree that I think that bringing things in like AI, to help us not miss things and to help give us ideas. (25:12) I think that we're gonna see all types of new things coming onto the horizon and hopefully not missing things
Scott Benner (25:17) Yeah.
Dr. Beachgem (25:18) To say like check a blood sugar. (25:19) Do this. (25:20) I feel like my other response was a little more defensive. (25:23) I am all about checking a blood sugar in literally anyone I can order it on.
Scott Benner (25:28) Right.
Dr. Beachgem (25:29) In a kid that's vomiting, I'm asking the questions. (25:31) How are they drinking? (25:32) How are they peeing? (25:33) You know, some screening things in addition as well. (25:35) But it's not an easy job, and it's a it's a heavy lift sometimes.
Scott Benner (25:38) Yeah. (25:39) It's interesting that you said you felt like you might be being defensive. (25:42) I pay attention to your content, and I know that you're having some sort of a medical issue. (25:47) I'm sorry to say this with discharge from your breast. (25:49) Right?
Dr. Beachgem (25:49) Yes.
Scott Benner (25:50) And I watched a couple of videos where it was interesting because, like, what you do professionally as a doctor, what you do professionally on social media, like, social media, you know that, like, people go to the hospital and have outcomes that aren't great and that they could be But yet, when you it was you personally, you were like, I have a good doctor and I'm gonna listen to what they say even if I don't agree with what's happening. (26:11) And I was like, well, that was such an interesting separation for me because you're a doctor and you know what it feels like to be your doctor. (26:19) Can you untwine all that for me? (26:21) Because you know what I'm talking about. (26:22) Right?
Dr. Beachgem (26:22) I do.
Scott Benner (26:23) Okay.
Dr. Beachgem (26:23) So I I had an experience where I was supposed to have a test performed and I didn't have a great experience having that test performed. (26:30) They actually weren't able to do it. (26:31) It felt to me that they were being kind of condescending and, you know, I'm not dumb. (26:36) I have an OBGYN who I trust because of other things that I can't really talk about, but I I trust her.
Scott Benner (26:42) Right.
Dr. Beachgem (26:42) She knows the system and she's she knows the stuff. (26:45) And so if she tells me, hey. (26:47) You need to do this test, like, I trust her. (26:49) It's not the answer that I wanna hear, but I will go and do it. (26:52) And she recommended that I see a specialist and in the end we're going to end up skipping the test and move right towards surgery, which is kind of what the evidence based stuff shows.
Dr. Beachgem (27:01) And I'm a big fan of evidence. (27:02) You've probably seen that in my videos. (27:03) Show me the evidence and we'll follow it. (27:06) So I know as a patient, there are things that I don't wanna do because it's uncomfortable or unpleasant, or I don't wanna go back into that situation again. (27:14) But I do trust my doctor and what she says, especially when she can provide me with the evidence to back it up.
Scott Benner (27:18) So how do you make that leap when you know I'm just guessing, but you've made mistakes as a doctor. (27:23) Right? (27:24) So when you're sitting there sick, having this problem that people are like, I don't see. (27:28) Like, I heard you say this one thing that you went in for a test, they couldn't produce the result to prove what you were seeing. (27:34) Then I think you went out into the the waiting room and, like, were having it and you kinda ran back in.
Scott Benner (27:39) You were like, it's happening now. (27:40) And they're like, don't worry. (27:41) We'll look another day. (27:42) Like, when you know you've been wrong before, how do you still say I'm gonna trust the process when you've seen the process be wrong and now you're the one who's in jeopardy?
Dr. Beachgem (27:52) Yeah. (27:52) So I was trusting my doctor who ordered the test. (27:56) Not necessarily I and I had some frustration with that situation.
Scott Benner (28:00) Mhmm.
Dr. Beachgem (28:00) And I know based on lots of things that that facility actually does really good work. (28:05) And I I go back to we're all human and we all have bad days sometimes. (28:09) Using your word, I I had to advocate for myself in the next step, and I usually don't advocate for myself. (28:15) I'm actually really bad at that for lots of reasons. (28:17) That's
Scott Benner (28:17) interesting. (28:18) Okay.
Dr. Beachgem (28:18) But I did that day, I I stepped back out and I said, look. (28:22) Here's my symptom, and they said, no. (28:24) Thank you. (28:24) I go back to the doctor that I trust, and and I she called me the next day and said, you know, what do we think about next steps? (28:31) And we talked we had a really great talk about it.
Dr. Beachgem (28:33) We kind of went over, you know, the next plan. (28:36) But I I think it's it's hard because I wanna trust my medical colleagues. (28:40) Like, this is a system that I work in. (28:42) This is these are my people, and it is maybe more disappointing for me than for others. (28:47) I'm not sure about that, but it feels more disappointing to me because, like, these are the people this is me.
Dr. Beachgem (28:52) And, like, when I'm disappointing myself, that's hard. (28:54) So I feel like like, if they're gonna do anything, like like, let's fight for the same team, and it's just, you know, sometimes it all falls apart.
Scott Benner (29:02) I just found it kinda fascinating because, like, you don't have white coat. (29:05) Right? (29:05) You that doesn't happen to you. (29:06) You don't
Dr. Beachgem (29:06) No.
Scott Benner (29:07) Know. (29:07) Right. (29:07) So you have other reasons. (29:08) So you're a people pleaser or something like that.
Dr. Beachgem (29:11) Yeah.
Scott Benner (29:11) Gotcha. (29:12) Okay. (29:12) Okay.
Dr. Beachgem (29:12) I don't wanna go against the grain. (29:14) Right? (29:15) Because this is my team. (29:16) So, like, we should all be in it together and doing the same thing. (29:18) So I don't wanna go against the grain.
Scott Benner (29:20) See, that's what I was wondering. (29:21) Like, if you're not, like, a wide receiver on television, like, not wanting to say something bad about the offensive line. (29:26) Like right. (29:27) Yeah. (29:27) Yeah.
Scott Benner (29:27) Because why? (29:29) Because you have a respect for them or because you believe that you could be in their position quite easily in another situation?
Dr. Beachgem (29:36) Probably. (29:37) Yeah. (29:38) Probably that.
Scott Benner (29:38) There's a lack of confidence underneath all of it. (29:42) So it's interesting because I think people see doctor I think doctors, teachers, and cops, right, get, like, a pass because you're brought up. (29:49) Like, be kind to the police officer, listen to your teacher, listen to your doctor. (29:53) And most of your life, that works. (29:55) And then usually, even if you get sick, it works right.
Scott Benner (29:58) I say all the time, like, break your arm. (29:59) Go somewhere. (30:00) Right away. (30:00) Like, I I've had my shoulder repaired. (30:02) I've had my ankle repaired.
Scott Benner (30:03) Like, there are things medicine is awesome at. (30:06) And then when you get into type one diabetes, it very quickly becomes, how strange is it that endocrinologists all over this country will get you in a corner and go, hey, listen. (30:18) You should go listen to the Juice Box podcast. (30:20) Do you know what I mean? (30:21) Like, how strange that is?
Scott Benner (30:22) The endo is like, you know what your best bet would be here? (30:26) Go do this, like, because I can't help you as much as you want to be helped. (30:31) I can't figure that part out for my life. (30:33) Like, I can't figure that like, how am I a better resource than your nurse practitioner?
Dr. Beachgem (30:38) Oh, I think part of it is going back to the resource. (30:41) You know, time is one of the biggest resources that we have in medicine. (30:45) And the way that insurance reimbursement goes, we have to see a certain number of patients to keep the lights on.
Scott Benner (30:52) Yeah.
Dr. Beachgem (30:52) And when you look at medicine and the way that doctor's salaries are going up, there's a lot of other people that are going up way faster than doctor's salaries. (30:59) Like, we're not really keeping up with keeping up with that. (31:01) I mean, we're doing okay. (31:02) No no complaints. (31:03) But The resource is the time because we've got to get in and get out and see the patients.
Dr. Beachgem (31:06) And so we tend to refer to resources that are going to be supportive resources, are going to be educational resources, that are going be giving great life tips. (31:15) I think that finding community is also important where you can share, and community that's gonna be giving good information is vital.
Scott Benner (31:22) Yeah. (31:23) I have such a great idea that nobody takes seriously because I I think they don't know how to bill it. (31:27) But Mhmm. (31:27) I think that instead of coming in and having a an appointment once every four every three or four months, right, and for fifteen minutes, I think a huge group of people should come to an auditorium three or four times a year and have a group experience. (31:44) Because I've gone and spoken at events where people come in, don't know what they're doing, and an hour later, they're better off.
Scott Benner (31:52) And then six months later, they send me a note. (31:53) Oh my god. (31:54) My a one c went down two points because of that thing you said. (31:56) Right? (31:56) Which is a wonderful feeling, but, like, we should find a way to do that for people.
Scott Benner (32:01) I know that that's Yeah. (32:01) Not the system. (32:02) But, like, if fifteen minutes isn't enough, then give them more time. (32:06) And who cares, like, in the end, like, my opinion is, like, who cares? (32:11) Like, just bill it the same way, but give them different tools.
Scott Benner (32:14) Like right? (32:14) Like, you could do that a few times. (32:16) I could give that talk every day. (32:18) Like right? (32:18) Like and and so could other people.
Scott Benner (32:20) And I I also think it would help the physicians at some point too because so much about type one is timing and amount. (32:25) Doctor. (32:26) Beecham, I tell people all the time, I'm like, if I if you pushed me off a cliff and said, teach people about diabetes as you were falling, I'd say, it's all timing and amount. (32:33) Like, just use the right amount of insulin at the right time. (32:35) It'll all be okay.
Scott Benner (32:36) And there's obviously more to it than that, but that really is that's the seed of the idea. (32:41) And then you have to understand how food impacts your blood sugar, how your blood sugar impacts your food, about activity. (32:47) Like, there's other stuff obviously to layer on. (32:50) But every time you look at one of those layers, the truth of it is at its distilled end, it's timing and amount. (32:57) Very few people are told to pre bolus their meals.
Scott Benner (33:00) Very few people are told that fat and protein impacts their blood sugar later. (33:04) Like, really simple things that have such a huge impact. (33:08) What I ended up saying at some point on the podcast is that you will leave your doctor with what I consider to be don't die advice. (33:14) Like, it's enough to keep you alive, not really enough to keep you healthy. (33:19) And to your point, you need more time to absorb all that.
Scott Benner (33:23) So you're telling me that what doctors need is they need to get paid by the download the way I do. (33:28) And I wonder how to fix that. (33:29) And I and I don't know because I can step back and look at it like big picture in the world and go, like, this is how insurance works. (33:35) We're not gonna fix any of this. (33:37) This is bigger than all of us.
Scott Benner (33:38) Right? (33:39) And then I can also look at people's lives one at a time when I interview them and see the incredible impact it has on them just to not be told that. (33:47) Like, as you have a million stories, I will tell you one. (33:51) Alright. (33:51) So I'm put in touch with a person who has type one diabetes and a lot of kids.
Scott Benner (33:56) She's got, like, six or seven kids, and she's in her mid forties. (34:00) And she's online looking for help. (34:02) Nobody can help her. (34:03) Somebody points her to me. (34:04) She sends me a message, and I'm just like, just call me.
Scott Benner (34:07) She gets on the phone. (34:09) I give her the talk, basically. (34:11) And the next day, I get a text back from her. (34:13) She wants to know if she can call me back. (34:15) I get on the phone, and she's angry.
Scott Benner (34:17) Not at me, I realize. (34:19) And she's like, my blood sugar was so stable overnight. (34:22) She's like, it was, like, 90 all night long. (34:25) I slept. (34:26) I feel so much better.
Scott Benner (34:28) Why didn't anyone tell me this? (34:31) That was what she was angry about. (34:32) She was angry about lost time. (34:34) And then she started talking about she has complications, and someone could have just told me this thirty years ago. (34:41) And, like, the desperation in her voice about, like, not knowing where her health was going to go, the recognition that she had lost time to a struggle that she did not need to be involved in was heartbreaking.
Scott Benner (34:52) It sticks with me to this day, you know. (34:54) I don't know. (34:54) Like, I want there to be a better way. (34:57) I don't think there is. (34:58) And but if that's the case, then how do we make it so that where people with type one or type two touch doctors, there's more understanding?
Scott Benner (35:10) Because if you ask a type one what they're most scared of, it's going to the ER or being admitted to the hospital. (35:17) So I kind of would like to shift into that now, and and I'd like you to help me help them have a better experience when they if they end up in the hospital.
Dr. Beachgem (35:25) Yeah. (35:26) That's tough. (35:26) I think especially for pediatrics, go to a pediatric facility. (35:32) The way that DKA and type one diabetes is managed in adult facilities or community hospitals is quite different than a pediatric facility. (35:42) I'll be honest, we manage a little bit of type two, a little bit of insulin resistance, but we manage so much type one.
Dr. Beachgem (35:50) I feel very comfortable with type one management and I, as much as I can, defer to the family's kind of expertise about their kid in that situation. (35:59) And and you can tell pretty quickly talking to a parent. (36:02) I could almost guess their a one c after that first discussion
Scott Benner (36:05) Mhmm.
Dr. Beachgem (36:06) With the family and kind of the way that they're managing things at home. (36:09) I think it's really important to stay on top of things as much as possible. (36:13) We do a lot of protocols. (36:15) We'll ask you to remove the pump if we are in DKA just because we're trying to you know, we're gonna end up putting on an insulin drip and stuff like that, so it helps manage a little bit more cleanly so we know how much insulin is going in. (36:27) But these times can be very tough and I do think it is really important to be at bedside and ask when they're checking the blood sugar, and what was it, and how much insulin are you giving?
Dr. Beachgem (36:37) Because, obviously, those are it's pretty big deal making sure that they're getting what they need to get.
Scott Benner (36:43) Yeah. (36:43) It's interesting to hear you talk about it because I trust you, and I know you're smart, and I know you understand this, and your answer still seems a little like, I don't know. (36:51) And I appreciate that, by the way, that you're not bullshitting me. (36:53) Like, I really do appreciate that. (36:55) My daughter has a friend who ended up in she had ketones.
Scott Benner (36:58) She got sick. (36:59) She got ketones, and she couldn't get them to go away. (37:02) She got panicked. (37:02) She went to the hospital, and then she called me 34 later, and she was exhausted. (37:07) And I was like, what's going on?
Scott Benner (37:08) She goes, I just I shouldn't have gone to the hospital. (37:11) She said it did not take long for me to realize that I knew more about this than they did, and I don't know a ton about it. (37:17) Like, she's a young girl. (37:18) Like, she's still understanding her diabetes. (37:20) You know?
Scott Benner (37:21) I asked, like, different questions. (37:22) She said they kept my blood sugar really high. (37:24) They wouldn't, like, give me insulin for food. (37:27) Like, they she's like, they kept bringing me things that were, like, really heavy in carbs to eat and then not giving me insulin for it. (37:33) And as my blood sugar got higher, I felt sicker.
Scott Benner (37:36) I was trying to, like she's trying to convalesce from some sort of an infection with a high blood sugar, which I'm not wrong. (37:42) Right? (37:42) That makes that more difficult.
Dr. Beachgem (37:44) Mhmm.
Scott Benner (37:44) So what happens in that situation? (37:46) She's there. (37:47) Is it what you said earlier? (37:49) Like, you come into the emergency room. (37:50) If it's not killing you, then I'm not focused on it.
Scott Benner (37:52) So in the hospital, if it's not the thing you're there for, is it background then?
Dr. Beachgem (37:57) No. (37:57) I I
Scott Benner (37:59) because it shouldn't be. (38:00) You're
Dr. Beachgem (38:00) No. (38:00) It shouldn't. (38:01) It shouldn't be. (38:01) Right. (38:02) And I think that my ER DKA and my ER type one diabetes with a viral illness pathways in my head are very different.
Scott Benner (38:10) Okay.
Dr. Beachgem (38:10) In which case, like, I know I'm gonna give you a fluid bolus, and I know that's gonna bring down your blood sugar automatically. (38:17) I might not wanna treat, you know, the couple sips of Gatorade that you just took. (38:21) I might wanna let you roll a little higher because I know your blood sugar is gonna come down with fluids. (38:26) Mhmm. (38:26) And I'll be honest, I may not verbalize that as well to a family.
Dr. Beachgem (38:31) I'm I may just, like, give the bolus and, like, hey. (38:33) We'll check blood sugar again in sixty minutes and see where we're at, then we can make some plans. (38:38) I may not verbalize always my thought process behind that. (38:41) And maybe I need to get better at that, and especially with families that are, like, really on top of their stuff. (38:46) They know it, and they're starting to get anxious as they see that CGM creeping up a little bit.
Scott Benner (38:50) Yeah.
Dr. Beachgem (38:50) And again, DKA management for me, it took different different pathway.
Scott Benner (38:55) Is there another side to this? (38:56) Would ignorance be bliss for me? (38:58) Would you get me through my hospital experience better if I shut up and didn't have opinions? (39:02) And then I could go home and get my blood sugar back down again, or is that not the right answer either?
Dr. Beachgem (39:07) I don't know. (39:08) I don't think that's the right answer either because I you know, sitting on the floor with a high blood sugar, like, you getting DKA in the hospital is not good for anyone. (39:16) Right? (39:17) So I think we need to be managing it, and I think sometimes there could be some oversight potentially. (39:22) I know my people in my hospital are again, we're following protocols.
Dr. Beachgem (39:26) We're checking blood sugars at these certain intervals because we wanna avoid all of that happening. (39:31) And I think, again, finding a facility that knows what they're doing, so a pediatric facility, and ask what their protocol is. (39:37) Like, can print it out and hand it to you, and I can say this is our protocol. (39:40) This is what we're gonna be following while you're an inpatient. (39:42) We're gonna be doing insulin this like this.
Dr. Beachgem (39:45) We're gonna be doing blood sugars like this. (39:47) So I I think it's reasonable to ask, you know, could you show me your protocol for, you know, patients that are admitted with diabetes and a gastroenteritis? (39:55) Okay. (39:55) Show me what you're gonna be doing. (39:56) Show me that protocol.
Dr. Beachgem (39:57) And then if they're not following it, you can hold them accountable there.
Scott Benner (39:59) So expectations should be that you're gonna be a part hopefully, they'll allow you to be, but you should be a part of the process if you wanted to go
Dr. Beachgem (40:05) more smoothly. (40:06) Okay. (40:06) Really, medicine should really be a partnership between the patient and family and the providers, the nurses, the doctors, the RTs, whoever's taking care of them.
Scott Benner (40:13) No matter what. (40:14) So would it surprise you to know that mothers who are nurses who end up with kids with type one often seem the most confused to me when I'm talking to them. (40:24) Why would that be? (40:25) Because it used to freak me out. (40:27) But you know what stopped freaking me out?
Scott Benner (40:28) When a a Hopkins brain surgeon contacted me privately and asked me to explain to him how to take care of his kid. (40:35) That's when I was like, oh, okay. (40:37) And here's my last little piece. (40:38) One of my daughter's best friends is in nursing school right now. (40:41) She's probably three or almost four years down.
Scott Benner (40:43) I think she's almost done with her first four years, her undergrad. (40:45) Right? (40:46) And she came to me a few months ago, and she's obviously grown up with Arden. (40:51) And so, you know, has a a a pretty tight understanding of what's going on. (40:54) And she said, Scott, we just went over diabetes in class.
Scott Benner (40:57) And I said, yeah. (40:58) And she goes, and I sat there, all I thought was, wait. (41:01) Is that all you're gonna teach us? (41:02) Because that would that's not enough to keep Arden alive. (41:05) And then she said she had a stark moment where she thought, what else did I now believe that I have full understanding of that I don't have an understanding of?
Scott Benner (41:13) It was, like, a real interesting moment for her. (41:15) So, anyway, I I'm not asking you say anything bad about the nursing profession. (41:19) I'm wondering, like, what happens between because when you're in the hospital, like, I I don't wanna say who, but I know somebody who was just in the hospital who tried to advocate for their diabetes. (41:28) The nurse was like, I know better than you. (41:30) Like, shut up, basically.
Scott Benner (41:32) And it that was not the case. (41:34) So Yeah. (41:34) Like but she really believed it. (41:37) Does that all make sense?
Dr. Beachgem (41:38) Yeah. (41:39) And, again, diabetes type one diabetes, I think, again and you know this traditionally looked at as a pediatric disease, and those kids do grow up and become adults, which is awesome. (41:49) So I think that there are people that can manage type one diabetes well, but I think as kids are growing up and you're seeing this more in the adult population, a lot of the people that are taking care of the adults are thinking about type two diabetes management and not necessarily having that stronger experience with the type one where you need the insulin, you need to be monitoring the ketones, you need to be getting insulin, you need to be carb counting, you need to be monitoring what you're eating, your nutrition. (42:21) It's complicated. (42:22) And I think the thing about coming in as parent without medical knowledge or a medical background, you're coming in like, I just need to learn it all.
Dr. Beachgem (42:31) Mhmm. (42:31) I need to learn it all. (42:32) I'm gonna start at the beginning, and I'm just gonna learn as much as I can possibly learn. (42:36) Or I think sometimes us as medical professionals, can go, I know a little bit about that. (42:41) Let's just go with this.
Dr. Beachgem (42:42) Let's see what we can do, or maybe we nitpick what we can learn about this or that. (42:47) So we have this baseline knowledge that sometimes we rely too heavily on, but I think if you had a nurse that had more specific, like one of my floor nurses manages type one diabetes all the time. (42:59) And I think that if you if one of their kids ended up with it, I think they would probably feel more comfortable managing it.
Scott Benner (43:05) Yeah. (43:05) I also wanna point out that I've also heard countless conversations and and stories from people who had fantastic doctors and fantastic nurses. (43:13) Right? (43:13) Like, it's not I'm not trying to say that everybody is lost. (43:16) I always say it's interesting because when you get a doctor, you don't know which one you're getting.
Scott Benner (43:20) Yeah. (43:20) And you're gonna believe them no matter what. (43:22) What if I got the one that doesn't know? (43:24) And what if I got the that's what made made me think about with your situation earlier too. (43:28) Like, you don't always know who you're getting.
Scott Benner (43:30) And then there's Yeah. (43:31) There can be ego involved too. (43:32) And I don't mean, like, in a, like, a god complex way. (43:35) I mean, like, I went to undergrad. (43:37) I went to school.
Scott Benner (43:38) I did this. (43:38) I did all that. (43:39) I got a guy now telling me what to do. (43:41) Like, you know what I mean? (43:42) Like, he's he's sitting in a room being like, no.
Scott Benner (43:44) You don't understand. (43:44) Like, I don't understand. (43:46) I mean, imagine me. (43:47) I'm a podcaster. (43:48) Like right?
Scott Benner (43:49) So imagine if I was in a room going, no. (43:51) I think this is what you should do. (43:53) I can see where that could be difficult too. (43:55) Plus, there's a ton of pressure and stress. (43:57) I mean, I can't imagine being a doctor, to be perfectly honest with you.
Scott Benner (44:00) Like, it must feel like your hair's on fire all the time. (44:04) No?
Dr. Beachgem (44:05) You know, we have days I can't imagine doing anything other than this. (44:08) This is what I was I was made to do. (44:10) And so, you know, to me doing air conditioning seems really stressful. (44:14) Mhmm. (44:15) But doing this feels very natural.
Dr. Beachgem (44:16) But there are days that I, you know, I second guess my decisions or, you know, I go to bed thinking about that one patient. (44:23) You know, did we do the right thing? (44:24) You know, did I did I do this right or, you know, wonder how they're doing, you know, now kind of thing. (44:29) Like, we second guess ourselves a lot.
Scott Benner (44:31) What do you think it is about your personality that lends itself to the job?
Dr. Beachgem (44:35) I have no idea.
Scott Benner (44:36) No. (44:36) It just works for you.
Dr. Beachgem (44:37) It just does. (44:38) It's the ADHD, and it's the seeking adrenaline and wanting to help people. (44:43) But I I don't know. (44:44) Yeah. (44:44) It's just it's just we're all made to do something, and I think I just found what I was made to do.
Scott Benner (44:50) When you put yourself out there online because I've gone through this. (44:54) I imagine you have too. (44:55) Right? (44:55) Like, at some point, somebody says, oh, you're busy telling me what to do, but look at you. (45:00) I'm sitting in front of you today, two and a half years removed from starting GLPs.
Scott Benner (45:05) I'm seventy pounds lighter than I was. (45:08) And there were times where I didn't put myself on video because I thought, know my stuff is rock solid about type one, but I don't want somebody to look at me and go, oh, there's an overweight guy trying to tell me about my health. (45:19) Right? (45:20) Like, I actually had that feeling. (45:21) I was like, I shouldn't probably do that.
Scott Benner (45:22) Right? (45:23) Have you had any experience with the people being shitty to you? (45:27) How do you deal with that? (45:29) And does it slow you down at all with the things you talk about?
Dr. Beachgem (45:33) Yeah. (45:34) You know, emergency medicine and the lifestyle for emergency medicine does not lend itself well to physical health. (45:40) The late nights, early mornings, eating on the go, not necessarily the healthiest food. (45:47) I'm sitting a couple pounds heavier than I would like, especially with the hurricanes and all the moves and stuff like that. (45:52) I do get comments occasionally like, Oh, look at this fat person telling me you know, to be healthy.
Dr. Beachgem (45:58) And for the most part, I'm not really talking about, you know, weight loss and nutrition. (46:01) I'm talking about ways to keep your kid from getting in a ebike crash.
Scott Benner (46:05) Right.
Dr. Beachgem (46:06) And realistically, people don't get to choose their provider in the emergency department. (46:10) Like you said, you kinda get stuck with whoever walks into the room. (46:13) There might not be an alternative. (46:15) I might be the only one there. (46:16) People tend not to, in real practice, say, like, hey.
Dr. Beachgem (46:19) I'd like another doctor that could is there somebody skinnier that could come in and see me? (46:23) No. (46:23) I mean,
Scott Benner (46:23) it's obviously on are people that directly horrible?
Dr. Beachgem (46:27) Yeah. (46:27) Online, are. (46:28) You know, and it's social media. (46:29) Like, everyone has an opinion. (46:31) And I I have like I said earlier, I have really good social media boundaries, and I do a lot of, like, just delete and block.
Dr. Beachgem (46:37) Like, I don't need someone Yeah. (46:39) Like that in my comment section for my own mental health and sanity.
Scott Benner (46:43) Good for you. (46:44) I brought it up because my wife is very impressed with how you manage that. (46:47) That she said to me, she's like, I really like the way she takes care of that. (46:50) And I was like, okay. (46:51) Yeah.
Scott Benner (46:51) Well, I'll bring it
Dr. Beachgem (46:52) to house. (46:52) I try to eat pretty healthy and I do work out and exercise, so I and I'm strong. (46:57) Like, I could bench press some I can bench press some stuff. (47:00) Yeah. (47:01) But, I'm like I'm like one forty.
Dr. Beachgem (47:03) I could bench press. (47:03) I'm doing alright. (47:04) Yeah. (47:04) Good. (47:05) You know?
Scott Benner (47:06) I well, listen. (47:06) I hear you. (47:07) I sit still a lot. (47:08) And also, in truth, I do not eat much differently today than I did two and a half years ago. (47:13) I am a pretty much a fan of the idea that there might be some metabolic help that's coming from GLP ones for some people because it hasn't really changed a lot about I mean, it's true.
Scott Benner (47:23) You're not hungry ever. (47:25) Like, you know, like, I ate breakfast this morning because I know I needed to. (47:28) So I'm not saying that it isn't benefiting me in that way, but I had an instant, like, an a very instant impact from I lost 14 pounds, like, the first five days.
Dr. Beachgem (47:38) Wow.
Scott Benner (47:38) Yeah. (47:39) It was crazy. (47:40) I used to be anemic. (47:41) Like, I had to get iron infusions three times a year. (47:44) I don't have to do that anymore.
Scott Benner (47:46) So I don't know if maybe I'm just digesting my food better now or I'm holding on to it long enough to extract it. (47:51) I don't even care. (47:52) I've never been in a situation before where was like, actually don't care. (47:55) I just I'm happy it's working. (47:56) So I've seen it with other type ones too.
Scott Benner (47:59) I've seen it with type twos. (48:00) I know plenty of type twos who've lost weight, a one c, like, their variability is better, everything. (48:05) But more and more type ones are getting a hold of it now. (48:08) And it really is interesting to see their insulin needs sometimes go down 30%. (48:13) And their spikes get lesser, and I'm like, wow.
Scott Benner (48:16) I wonder where this is all going. (48:17) Like, it seems like so new. (48:20) But I would imagine the only probably the only intersection you have with is probably the people who don't do well with it. (48:25) Right? (48:25) Because in the ER, you're just coming in because what?
Scott Benner (48:28) Have gastroparesis from it or low motility or something. (48:30) Right?
Dr. Beachgem (48:30) Pancreatitis, vomiting, dehydration, chronic abdominal pain, gastritis. (48:35) But, you know, in pediatrics, I think Wegovy has been approved for 12 and older, but for, like, just obesity and not diabetes. (48:43) Mhmm. (48:44) So there's we've only seen a handful in the pediatric population so far, and I don't really treat adults when I can manage it. (48:51) But I think we are going to see more and more of the kids that have the type one and type two diabetes on these medications and the kids that are struggling with obesity on these medications to avoid the longer term complications.
Dr. Beachgem (49:05) The research that's coming out about the GLP-1s is really cool. (49:08) I mean, some of these conditions that you wouldn't even think are related. (49:12) I saw something the other day on pseudotumor cerebri, which is extra CSF fluid that's produced creating pressure, and it can create, you know, injury to the eyes and really bad headaches. (49:22) They're seeing improvements on GLP ones. (49:24) Just some really cool stuff coming down the line with these medications.
Scott Benner (49:27) Yeah. (49:27) I would have kissed the Gila monster twenty years ago if I knew about this, I'll tell you. (49:31) Ladies with PCOS getting pregnant out of nowhere Wow. (49:34) That's crazy. (49:35) Right?
Scott Benner (49:35) My wife swears that it helps with inflammation so much so that she thinks that, her perimenopause was easier because of it. (49:42) You know, I've seen people say that it's lessened, impacts of long COVID. (49:46) Oh, that's something I wanted to ask you about. (49:48) That's real. (49:48) Right?
Scott Benner (49:49) Long COVID? (49:50) Yeah. (49:51) Okay. (49:51) Alright. (49:52) So if I told you please don't disconnect.
Scott Benner (49:56) If I told you that, I don't know, eight months ago, I was listening to a podcast and I randomly heard some guy say, like, nicotine helps with long COVID, and I didn't really register it. (50:05) Right? (50:05) And then two months ago, I had a lady on the podcast, and she said just kind of offhandedly, I've had long COVID for a while, but it's really getting better. (50:13) And I just said, oh, what did you do? (50:15) Because my wife has it, suffers with it pretty badly.
Scott Benner (50:17) She said I did a twenty one day nicotine patch protocol. (50:21) And I was like, googled that, And there was a website, and I was like, well, this doesn't look like it was made by a serial killer. (50:26) So I read it, and I said to my wife, I'm like, I don't think a nicotine patch is gonna hurt you one way or the other. (50:32) Right? (50:32) Like, so she was in the middle of a bad flare to real foggy.
Scott Benner (50:36) She couldn't get rest and everything. (50:38) And my you don't know my wife, but this was not a thing she was up for. (50:41) Right? (50:41) Like, she and I just I caught her in a day where she was so bad off. (50:44) I'm like, look.
Scott Benner (50:45) I'm just gonna stick this on you. (50:47) Then I was like, and we'll stick another one on in twenty four hours. (50:50) And about seven days later, goes, hey. (50:52) You know, I feel better. (50:53) And fourteen days later, she's like, telling other people about it.
Scott Benner (50:56) Now, teach them, I don't know how how long you've been married, but I've been married thirty years. (51:00) My wife doesn't run around saying nice things about me out of hand. (51:03) So she's now telling other people, I think Scott saved me with this nicotine patch thing. (51:07) Now when I know that's happening, I know something's really going on. (51:10) Okay?
Scott Benner (51:10) And now it's been a month later and she's a different person.
Dr. Beachgem (51:14) Oh.
Scott Benner (51:14) Something about, like, receptors that nicotine sticks to I don't even again, I can't believe I'm saying this. (51:21) Don't care. (51:22) Like, she's so much better off, and she's not using the patches anymore.
Dr. Beachgem (51:25) That's pretty crazy. (51:26) Nicotine is interesting. (51:28) Mhmm. (51:28) There's a couple different disease processes that nicotine influences in a positive way. (51:33) And, again, no, not to encourage people to go out smoke or use at any but there are it it is something that works in your body and and can do certain things.
Dr. Beachgem (51:43) And I I think it deserves continued research, especially with things like that when we're seeing positive effects.
Scott Benner (51:50) Okay. (51:50) How willing are you to talk about, like, what's happened over the past ten years about people's concepts about vaccines? (51:58) Are you comfortable talking about that?
Dr. Beachgem (52:00) Yes. (52:00) I can't get too controversial.
Scott Benner (52:02) I don't want you to get controversial. (52:03) I want you to tell me your opinion.
Dr. Beachgem (52:04) I think that we have tremendous evidence for at least the childhood vaccines and influenza vaccines that they are low risk, extremely effective, and I think we're already starting to see the impact of decreased vaccine uptake.
Scott Benner (52:22) Yeah. (52:22) You think the population is getting sicker in ways that it doesn't need to be?
Dr. Beachgem (52:26) I mean, we're about to lose our measles elimination status because we've had, you know, a pretty significant measles outbreak since I don't think we've had this many measles cases since 1992. (52:36) I believe we've had three deaths this year from measles, one in an adult, two in previously healthy kids, all unvaccinated, unfortunately. (52:44) We've seen polio in wastewater in up in New York. (52:47) I think that we should have a level of concern that some of these, like, really bad things are gonna come back.
Scott Benner (52:54) How frequently do you find yourself talking to a patient where you think, oh, gosh. (52:59) They've been radicalized by some sort of online thing, they have a belief that is completely just bull Do you find yourself standing in front of people who you're like, oh my god. (53:08) I can't believe I have to explain this to you, but here we go?
Dr. Beachgem (53:11) Yeah. (53:12) So, you know, online all the time.
Scott Benner (53:15) Oh, sure. (53:15) Sure.
Dr. Beachgem (53:16) All the time. (53:16) In my practice, about two to three in ten kids under two years old are not vaccinated. (53:22) The younger kids, it's it's between seventy five and eighty percent are vaccinated. (53:26) Mhmm. (53:27) But when kids are not vaccinated in under three years of age, there are increased risks for bacteria in the bloodstream, something called epiglottitis, which is an airway blockage, meningitis.
Dr. Beachgem (53:37) And so I have to talk about the risks and potentially an increased workup because they have these additional risk factors or at least don't have the protective factors of vaccines. (53:46) And I try not to ask why they are not vaccinated. (53:51) I really just wanna present it in a nonjudgmental way because the most important thing is creating that partnership that they're willing to trust me. (53:58) And if I start
Scott Benner (53:59) Sure.
Dr. Beachgem (53:59) Asking too many of those questions, I don't wanna alienate them. (54:02) I wanna be able to really have that discussion about, these are the things I'm concerned about. (54:05) This is what I like to do, and this is why. (54:07) Yeah. (54:08) I try to limit anything that could be interpreted as judgment.
Scott Benner (54:12) Right. (54:12) I appreciate you being willing to talk about it. (54:15) Can you please take me back to the day that you got really famous online and somebody had to have pulled you into an office at your job and went, hey. (54:21) What the hell are you doing? (54:22) Did that not happen?
Scott Benner (54:24) I mean, did. (54:24) Right? (54:24) Yeah.
Dr. Beachgem (54:26) Yeah. (54:26) So, you know, I started making content. (54:28) It it was kind of in the 2020, and I had a video actually about vitamin k deficiency bleeding, so a baby that hadn't received vitamin k Mhmm. (54:37) At birth. (54:38) And I presented, like, a Google article.
Dr. Beachgem (54:40) Like, I googled an article. (54:42) So it was a research paper, and I I put it up. (54:45) Someone told my job that I had used a patient picture and a patient case, which I, again, I'd used. (54:52) You could clearly see the Google. (54:54) And so that's kind of that was my job's introduction to, I'm putting stuff online now.
Dr. Beachgem (54:59) And I obviously, like, they were like, You know what? (55:01) Don't you're good. (55:02) Obviously, be careful. (55:03) But I've had many a discussion with HR and vice presidents of things. (55:08) Again, open communication, partnership, they're fine with me doing what I do as long as we have certain boundaries and obviously protecting patient privacy and stuff like that.
Dr. Beachgem (55:18) So we have some rules and boundaries in place. (55:20) I'm very appreciative that they're letting me do all of this.
Scott Benner (55:23) Yeah.
Dr. Beachgem (55:23) And they I think, you know, they appreciate me putting, you know, evidence based information out widely.
Scott Benner (55:29) I was gonna say it's gotta be good for them too. (55:31) Right? (55:32) Maybe you're really well liked.
Dr. Beachgem (55:34) Yeah. (55:34) You know, I don't know.
Scott Benner (55:36) You don't know?
Dr. Beachgem (55:37) Like, you know, because I think any anything you do on social media, there's gonna be someone that is upset. (55:41) Like, even if you just say, like, have a great day, there's gonna be someone that's like, I don't wanna have a great day. (55:49) I think that a hospital that really is focused on taking care of kids in the best way possible, and all of a sudden you've got someone on social media and it's like, focus is really trying to do this and you're over here, you know, making these little videos. (56:03) I I think that they're they are really supportive, but I I think that, you know, they're really focused on their mission of trying to help kids.
Scott Benner (56:09) Do you have people that hate listen or hate watch you?
Dr. Beachgem (56:12) All the time. (56:13) Yeah. (56:13) Of course.
Scott Benner (56:13) I I have a small band of, people who I think maybe are unwell who, enjoy listening to me, but don't seem to like me or anything that I say. (56:22) Yeah. (56:22) I always explain to them when they're listening, your downloads sell to the advertisers just like everybody else's, so thank you very much. (56:29) What about being, like, this person online? (56:33) Is there anything about it you don't like?
Dr. Beachgem (56:36) No. (56:36) No? (56:36) I I the negativity that comes with it sometimes, I think that gets a little frustrating. (56:41) But my main goal of, like, I wanna educate people. (56:44) You know, I wanna use this as a coping mechanism to avoid burnout at work.
Dr. Beachgem (56:48) Like, I think it's functioning well in those aspects. (56:50) So
Scott Benner (56:51) Good. (56:51) That's awesome. (56:52) I I I'm glad to hear that. (56:53) I don't have a lot of downside to what I do either. (56:55) I just I was wondering if there was, like, how's the business y side of it?
Scott Benner (56:59) Like, you have like, obviously, you guys listening reached out to doctor Beach Jem and she she gave up and and and messaged me, like, so thank you. (57:07) At the same time, like, then you passed me off to, like, a management company or something like that. (57:11) Like, the day you did that, were you like, oh my god. (57:13) I have a management company? (57:14) Like, that's gotta be crazy.
Scott Benner (57:16) Right? (57:16) No?
Dr. Beachgem (57:17) Yeah. (57:17) Yeah. (57:17) I am really bad at answering emails as it turns out. (57:22) Mhmm. (57:22) And so when I was doing brand deals and they were trying to do, like, onboarding stuff and I had to answer emails to get paid, like, I I wasn't doing well with that just because I wanna focus on the the good stuff.
Dr. Beachgem (57:31) And so I hired a management team or I kind of was approached By somebody. (57:36) That encouraged me to find a management team. (57:38) I am absolutely in love with the the group that I have. (57:41) Lanea is amazing. (57:42) They really just help get everything organized and on board, and she kind of knows when I'm awake and when I'm sleeping and can just make things happen when it needs to happen.
Scott Benner (57:51) No kidding. (57:52) I don't have anything like that. (57:53) Like, so but there's something that sounds incredibly attractive about it. (57:57) I don't I don't wanna ask you this question because I feel like I'm gonna ask you, do you make enough money that that makes sense financially? (58:02) But I don't wanna ask you that.
Scott Benner (58:03) Like, so
Dr. Beachgem (58:04) I think the thing that most influencers or creators will tell you about a management company is that they will sift through the deals and find the ones that work for you. (58:12) They will also go out and find deals if that's something you're interested in.
Scott Benner (58:17) Mhmm.
Dr. Beachgem (58:18) And most of the time, they will ask for more money from whatever brand deal you're gonna be working with enough that it more than covers their portion of it.
Scott Benner (58:27) Are you saying I'm not charging enough? (58:29) Okay.
Dr. Beachgem (58:29) It could be. (58:29) And
Scott Benner (58:30) Alright. (58:30) No.
Dr. Beachgem (58:30) A lot of times, we undervalue ourselves. (58:32) Like, we talked about this. (58:33) Like, we're Yeah. (58:34) We're in it to educate. (58:35) We're in it to talk to people and and help people be better be their better selves.
Scott Benner (58:40) Mhmm.
Dr. Beachgem (58:40) And so we undervalue ourselves, kind of as it is, and I never would have thought, you know, this brand deal would have brought in, you know, near what it did. (58:50) Yeah. (58:50) But I have someone who believes in me that said, you know, this is what you're worth.
Scott Benner (58:54) Is there ever been a moment where you wondered if you're gonna keep practicing? (58:59) No. (58:59) It's not gotten that. (59:00) And you love it too much to stop doing that anyway is what I'm hearing. (59:03) Yeah.
Scott Benner (59:03) Yeah.
Dr. Beachgem (59:03) And if I stopped, I think I would have a hard time restarting just because you can lose skills. (59:08) So I this is not something that I would change.
Scott Benner (59:11) Oh, so you do see this as something that could possibly flare out, the social media thing?
Dr. Beachgem (59:15) Everyone asks my five year plan, and there is no plan. (59:18) I'm just, you know, one day at a time, and whatever happens happens. (59:21) And if I can work for another fifteen years and keep doing it, we'll keep doing it.
Scott Benner (59:26) Yeah. (59:27) You you would probably connect much with the idea that every year, I think this is the last year I'm making the podcast. (59:32) Anybody who works with me on a professional side, I'm like, well, I mean, obviously, it'll be over after this year. (59:37) And then, you know, we'll all go on our way. (59:38) And they're like, why do you think that?
Scott Benner (59:39) I'm like, well, I mean, because this is ridiculous. (59:42) That's why. (59:43) Like, it's not a real thing. (59:45) I keep thinking I'm just gonna end up being, a really popular Walmart reader. (59:49) Because unlike you, I can't fall back on being a doctor when I think it was bad.
Scott Benner (59:52) Like, I'm a I was a stay at home dad who became a popular podcaster. (59:57) Like, I don't have a there's nowhere for me to go exactly. (1:00:00) I I don't it's funny you said the same thing that I always think is that I don't have even the life skills I had before this, I don't even think they're transferrable to now. (1:00:08) And I don't know that I really remember what I was doing before that, actually. (1:00:12) It's really interesting.
Scott Benner (1:00:13) Your family at all. (1:00:14) Do your kids I heard you say you have kids. (1:00:16) Kids or your husband, do they mind any of this, or they're good with it?
Dr. Beachgem (1:00:19) They don't seem to mind very much. (1:00:21) I think I've been doing it so long. (1:00:23) They've just gotten kind of accustomed to it, and it's been kind of slow growth. (1:00:26) Like, it hasn't just jumped very quickly. (1:00:28) It's really just kind of been a slow growth over time.
Scott Benner (1:00:30) Mhmm.
Dr. Beachgem (1:00:31) You know, I think we've created some, like, safety things for them, like, when we're out in public. (1:00:35) I get approached quite often by people that just wanna say hi or selfie, but, you know, there have been times where they've been more interested in the kids, and so we've had to create good boundaries there. (1:00:46) The kids, I don't think it registers as much for them
Scott Benner (1:00:49) Yeah.
Dr. Beachgem (1:00:50) You know, what this actually
Scott Benner (1:00:51) is. (1:00:51) I have to tell you the coolest part about you besides the fact that you're incredibly normal and yet lovely to speak to and knowledgeable is that you don't have any of that, like, influencer vibe. (1:01:01) Like, I've never felt that once from you. (1:01:03) I've never felt like you've turned the camera on and willed yourself to be excited. (1:01:06) Do you know what I mean?
Scott Benner (1:01:08) Like, everybody. (1:01:09) Like, you know, like, that kind of thing or, like or ask one of those leading, like, social media questions that, like, they they know the algorithm. (1:01:15) You don't think about any of that, do you?
Dr. Beachgem (1:01:17) I do try to, you know, sometimes bring a hook.
Scott Benner (1:01:20) Okay.
Dr. Beachgem (1:01:20) Like, a little something to bring it in, and maybe it's, like, the top of the screen or the bottom of the screen because I want you to hear what I have to say. (1:01:27) Like, I think what I have to say is important, but I try not to do the, like, the cringey hooks as much as I can. (1:01:33) Yeah. (1:01:33) Like, I made a Christmas one yesterday where I very quickly said something that would catch someone's attention, and I'll avoid saying it out loud at this point. (1:01:41) But you can go see that Christmas video if you wanna find that out.
Scott Benner (1:01:45) Follow and subscribe. (1:01:46) I
Dr. Beachgem (1:01:48) I just I I don't know if there's kids listening, and so I just
Scott Benner (1:01:51) Oh. (1:01:51) Oh, no. (1:01:52) I saw that one. (1:01:53) That one's awesome. (1:01:53) Yeah.
Scott Benner (1:01:54) And there might be kids listening. (1:01:55) Yeah. (1:01:56) It's so funny you said that because the way you did it with the visual, I thought that's what everyone wants to know from an ER doctor. (1:02:02) What have you found in people's butts? (1:02:04) And you have to go home and tell people.
Scott Benner (1:02:06) Right? (1:02:06) I mean, you keep their details out of it. (1:02:07) You don't not go home and say to your husband, I found a Christmas tree candle and how would you not?
Dr. Beachgem (1:02:12) Yeah. (1:02:12) You know, people always ask, like, what's the most interesting case you've ever seen? (1:02:16) And they actually don't wanna hear about the most interesting case. (1:02:18) They wanna hear about the butt stuff. (1:02:20) Yeah.
Dr. Beachgem (1:02:22) And, you know, I don't know. (1:02:23) Maybe, like, the first couple cases that I saw, you know, like, someone put something somewhere up. (1:02:28) But at this point, like, working in pediatrics, like, we see it pretty commonly and Wait.
Scott Benner (1:02:32) Kids put stuff in their butts?
Dr. Beachgem (1:02:34) Yeah. (1:02:34) And I see up to the age of about 21, and so some of our teenagers or some of our young adults.
Scott Benner (1:02:38) Gotcha.
Dr. Beachgem (1:02:39) I don't know how to say this in a way. (1:02:41) You know, I think it's important to talk to kids about their bodies. (1:02:44) Mhmm. (1:02:44) And sometimes kids experiment with their bodies in in ways that we wouldn't necessarily expect, and kids are way, way more honest than adults are about that situation. (1:02:54) Like
Scott Benner (1:02:55) Yeah.
Dr. Beachgem (1:02:55) They'll tell you, you know, what happened and, you know, they're kinda like, yeah. (1:02:58) Okay.
Scott Benner (1:02:58) Uh-huh. (1:02:59) Well, listen. (1:03:00) I I think it's when people are honest and and communicate well, I think everything seems to go better. (1:03:05) Did you enjoy doing this with me? (1:03:06) Was this okay for you?
Dr. Beachgem (1:03:07) Did. (1:03:07) I did. (1:03:08) This was good.
Scott Benner (1:03:08) This was good. (1:03:09) I will thank you very much for doing this and ask you just to hold on one second for me. (1:03:13) But please, first, before you go, tell people how to find you. (1:03:16) Mean, I don't think they need my help, but are you everywhere? (1:03:19) Or
Dr. Beachgem (1:03:19) I'm on TikTok at Beach Gem 10 and YouTube, Facebook, and Instagram at doctor period beach gem ten, or just Google beach gem, and you could probably find me.
Scott Benner (1:03:28) Wow. (1:03:29) That's awesome. (1:03:29) Alright. (1:03:30) Well, doctor Beach Gem, thank you so much for doing this. (1:03:32) I really do appreciate your time.
Dr. Beachgem (1:03:34) Appreciate your time as well. (1:03:35) Thank you.
Scott Benner (1:03:41) Thank you so much for listening. (1:03:43) I hope you enjoyed my conversation with doctor Beach Jam. (1:03:45) Don't forget, she'll be back soon, so subscribe and follow not to miss any of that. (1:03:49) And in the meantime, if you have type one diabetes or you know somebody who does, please don't forget to suggest this podcast to them. (1:03:56) If they need management help, we have the bold beginnings series, the diabetes pro tip series, and much more.
Scott Benner (1:04:02) Having trouble with burnout, mental health issues, anything related to diabetes? (1:04:07) We have that information for you. (1:04:09) Check out those lists at juice box podcast dot com slash lists. (1:04:13) The podcast is completely free, always has been, always will be. (1:04:17) Nothing's behind a paywall.
Scott Benner (1:04:18) Everything you need to know is available to you right now. (1:04:22) The podcast episode that you just enjoyed was sponsored by Eversense CGM. (1:04:27) They make the Eversense three sixty five. (1:04:30) That thing lasts a whole year. (1:04:32) One insertion.
Scott Benner (1:04:33) Every year? (1:04:34) Come on. (1:04:35) You probably feel like I'm messing with you, but I'm not. (1:04:38) Ever since cgm.com/juicebox. (1:04:42) Head now to tandemdiabetes.com/juicebox and check out today's sponsor, Tandem Diabetes Care.
Scott Benner (1:04:49) I think you're gonna find exactly what you're looking for at that link, including a way to sign up and get started with the Tandem Mobi system. (1:04:57) A huge thanks to US Med for sponsoring this episode of the juice box podcast. (1:05:02) Don't forget, usmed.com/juicebox. (1:05:05) This is where we get our diabetes supplies from. (1:05:08) You can as well.
Scott Benner (1:05:09) Use the link or call (888) 721-1514. (1:05:14) Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from US Med. (1:05:23) If you're looking for community around type one diabetes, check out the Juice Box Podcast private Facebook group. (1:05:29) Juice Box Podcast, type one diabetes. (1:05:32) But everybody is welcome.
Scott Benner (1:05:34) Type one, type two, gestational, loved ones, it doesn't matter to me. (1:05:38) If you're impacted by diabetes and you're looking for support, comfort, or community, check out Juice Box podcast, type one diabetes on Facebook. (1:05:47) Alright. (1:05:48) Let's get down to it. (1:05:49) You want the management stuff from the podcast.
Scott Benner (1:05:51) You don't care about all this chitting and chatting with other people. (1:05:54) [Juiceboxpodcast.com/lists] (1:05:58) They are downloadable, easy to read. (1:06:01) Every series, every episode, they're all numbered. (1:06:04) Makes it super simple for you to go right into that search feature in your audio app.
Scott Benner (1:06:08) Type juice box one seven nine five to find episode 1795. (1:06:13) [Juiceboxpodcast.com/lists] (1:06:18) Have a podcast? (1:06:19) Want it to sound fantastic? (1:06:20) Wrongwayrecording.com.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#1697 Que Dallara, EVP & President at Medtronic Diabetes
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Scott talks with MiniMed leader Que Dallara about her refugee-to-CEO story, Medtronic’s spin-off, new MiniMed name, 780G automation, upcoming sensors and pumps, and the dream of hands-free diabetes tech.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Que Dallara, President of Medtronic Diabetes, joins Scott to discuss the rebrand to MiniMed and the company's turnaround. They explore the 780G system, the Abbott partnership for the Instinct sensor, and the new Simplera Sync. Que shares her inspiring refugee story and reveals future plans for patch pumps, tubeless options, and next-gen algorithms to achieve "hands-free" diabetes management.
Scott Benner (0:00) Hello, friends, and welcome back to another episode of the Juice Box podcast. (0:16) Today's podcast episode is sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed seven eighty g system and their new sensor options, which include the instinct sensor made by Abbott. (0:31) Would you like to unleash the full potential of the MiniMed seven eighty g system? (0:35) You can do that at my link, medtronicdiabetes.com/juicebox. (0:42) While you're listening, please remember that nothing you hear on the juice box podcast should be considered advice, medical or otherwise.
Scott Benner (0:50) Always consult a physician before making any changes to your health care plan or becoming bold with insulin. (1:06) Welcome, Hugh. (1:07) How are you?
Que Dallara (1:09) I would be better. (1:10) How
Scott Benner (1:10) are you? (1:11) I this has been a good morning for me so far. (1:13) I appreciate you asking.
Que Dallara (1:14) It's Friday. (1:15) So
Scott Benner (1:15) That that is why it's Yes. (1:16) Been a good Exactly. (1:18) I'm just I'm doing this and one other thing, getting my passport renewed. (1:22) I can't imagine a more boring afternoon, but at least I won't be sitting at my desk for a couple hours. (1:26) I thought it'd be cool to have you on and get to know you and to find out a little bit about what's going on at what we're, I guess, not gonna be calling Medtronic diabetes anymore.
Scott Benner (1:36) Can you first let me know a little bit about yourself and maybe how you got into this position?
Que Dallara (1:41) Absolutely. (1:42) Well, since you asked, I'm gonna bore you a little bit about myself.
Scott Benner (1:46) Please.
Que Dallara (1:47) I don't know if you remember the, you know, the pictures of boat people in the late seventies, you know, escaping Vietnam after the fall of Saigon. (1:54) Mhmm. (1:55) Well, I was one of those bird people. (1:56) I was five years old, and our family was making this, you know, grand escape on really a rickety riverboat in the South China Sea, so not really a seaworthy boat at all. (2:07) And we got shipwrecked.
Que Dallara (2:09) We got rescued by on this tiny island in the Filipino archipelago. (2:14) And my parents and my my three year old sister were on this journey. (2:18) So we were in this refugee camp for, I don't know, eight months, something like that. (2:22) And then luckily, we got granted asylum in Australia, so that's why, you know, you hear the speech impediment that I have now. (2:29) But we grew up super poor in Sydney.
Que Dallara (2:32) Character defining moment, if you like. (2:34) And, you know, I really believe that, you know, life gives you the tools depending on how you, you know, you you get brought up. (2:40) And when you grow up really poor, you get a lot of tools. (2:44) Yeah. (2:44) So, you know, what Ben followed was kind of, you know, twenty years of, you know, poverty in Australia, and my mom was she was a single mom.
Que Dallara (2:54) She actually was pregnant during this whole time. (2:56) And when we arrived in Australia, like, two weeks later, my my younger sister was born. (3:01) Wow. (3:01) So we have four kids, newborn baby. (3:05) You know, even though she was a trained lawyer, spoke three languages, you know, she worked as a postal worker on the night shift.
Que Dallara (3:12) So I work you know, grew up taking care of my three younger siblings.
Scott Benner (3:16) Right.
Que Dallara (3:16) So we couldn't afford a lot. (3:17) It was really rough. (3:18) I worked on you know, I sewed things for a dollar apiece for a T shirt, and, you know, I I learned to cook, you know, even woodworking, becoming really self reliant. (3:29) So so I have a, I guess, a lot of deep empathy for people who struggle, you know, trying to get out of poverty for really half my life. (3:37) And, you know, that's kinda how I started, and I worked for everything.
Que Dallara (3:41) So how I got to Medtronic, it was really happenstance, you know, kind of it's never a straight line, Scott, and I don't have diabetes, but I have a lot of people in my life that do. (3:52) I mean, frankly speaking, you really can't go very far to find people who know someone who really suffers from the disease. (4:00) And so my background's in software and tech. (4:03) You know, previously, I was at Honeywell, and Honeywell works on a lot of things that kinda control problems. (4:09) Mhmm.
Que Dallara (4:09) Like, you can have, you know, how you regulate temperature in a building or autopilot in an air aircraft. (4:17) That's a controls problem. (4:18) And actually, what diabetes is is a controls problem because you're sensing glucose, and then you gotta do something about that. (4:25) And so there's actually a lot of software in it. (4:27) So given my software background and manufacturing background and sort of consumer background, and given that I knew a lot of people in my life that had it, it just was a perfect marriage to, you know, to to join Medtronic and and lead the diabetes business.
Que Dallara (4:42) So that's how I kinda randomly got here. (4:45) Obviously, it was not very planned.
Scott Benner (4:47) So with your background and what you just explained about control, what do you think the people who hired you were thinking when they hired you? (4:55) What do you think they thought the future was, and how could you shepherd towards it?
Que Dallara (4:59) I think it was largely driven by the consumer experience I had with software, software and services. (5:06) Because a lot of this is, yes, you've got the medical device, but there's a lot that gets involved you know, that is involved in managing diabetes. (5:13) It's like how you get supplies, how you manage all the admin associated with, all the software tools for the caregivers. (5:21) And so I think they were probably attracted by that in my background. (5:24) And I've always been worked in areas where I love building things, building products.
Que Dallara (5:29) I've worked in launching a lot of products. (5:32) And so given the innovation cycles in diabetes technology, I think the people at Medtronic felt that that was a that was a good fit. (5:40) It was a it was probably a bit of a, if I'm honest, a very unorthodox selection. (5:48) But in some ways, given the state of where the business was when I joined with, you know, some of the challenges, especially in The US, having fresh legs and fresh eyes are probably a good thing.
Scott Benner (6:00) Yeah. (6:00) Where would you assess Medtronic as as being in this landscape before you got here, and where is it that you're trying to take it to?
Que Dallara (6:10) Well, I think to be candid, I think it you know, the business lost its leadership position in The US and, you know, fell behind. (6:17) And I think at the time, there was the the warning letter had just, you know, landed on the doorstep. (6:22) And so while there's a 41 history in the business of many firsts, the first portable sized pump, the first CGM that physicians use, the first seven day infusion set, the first CareLink, and the first AID system. (6:38) There's a lot of firsts. (6:39) That's the heritage of the business.
Que Dallara (6:41) That was always there, but the business hit some troubles, to be fair. (6:46) And so I think I don't mind struggle. (6:49) Like, you know, that's a bit of my background, and I saw something that was so important. (6:55) And if we care about choice for people living with diabetes, you know, and all the innovations that came out of MiniMed, I saw that there, and and so I was very energised to be part of restoring that heritage.
Scott Benner (7:09) Mhmm.
Que Dallara (7:09) And I think you've seen some of the innovations coming out that we are thinking differently, we are moving faster, and, you know, it just was a shame to not, you know, to let it sort of atrophy. (7:20) So that's so despite the fact that there was a warning letter, I saw a waterfront property.
Scott Benner (7:25) It's interesting the way you're talking about it because I didn't expect this today when I got on with you, but I see a a lot of similarities between what I do and what you just said because I I struggle every day with this idea that I've built this thing that I know helps people. (7:39) I watch it happen all the time, but then how do you talk another person into giving it a try or get it into their attention, like, so they can even consider it? (7:48) Like, that's most of my life. (7:49) Most of my life is spent, like, trying to serve it to people. (7:53) And it's a very, very frustrating aspect.
Scott Benner (7:55) And you don't have the same you were candid earlier. (7:58) Like, Medtronic had a stranglehold for a long time. (8:00) Right? (8:01) Like, doctors just prescribed Medtronic. (8:03) So, like, you were ahead.
Scott Benner (8:04) You probably had first movers on a lot of things, and that doesn't exist anymore. (8:08) So now, I'm I'm excited because now what I'm hearing is you're gonna have to deliver stuff that helps people that works because that's gonna be your only growth opportunity, I would imagine.
Que Dallara (8:18) Absolutely. (8:18) And look. (8:19) We wanna earn it. (8:19) Like, it's not gonna it's not an entitlement. (8:21) We wanna earn it, and we're gonna do that because we listen to patients, and we're gonna work on great ideas.
Que Dallara (8:28) We have unbelievable a great team at MiniMed. (8:32) I mean, about roughly twenty percent of our employees live with the disease, and more than seventy percent have a personal connection. (8:39) So they're related to someone that has the disease. (8:42) And so it's very personal for us. (8:44) Like, we don't like not being number one.
Que Dallara (8:46) We think we have the best therapy on the market, and we have hundreds of thousands of people in over 80 countries who use our solutions here. (8:55) And so we absolutely wanna earn it. (8:58) Actually, the first thing that I did when I joined Medtronic was I met with employees that have diabetes. (9:04) And I wanted to understand, like, you know, what were we doing well, what weren't we doing well. (9:09) And so they gave me a lot of insight, I think, you know, we've been on the path now to you know, obviously we got out of the warning letter in fourteen months.
Que Dallara (9:17) We've got an unbelievable quality system. (9:19) Obviously, that's in the news too. (9:21) It's important that that's a core foundation. (9:24) We didn't cut any corners. (9:26) We've also rejuvenated our innovation pipeline, which I'm sure we'll get to talking about.
Que Dallara (9:30) Yeah. (9:31) Which just leads to awesome senses into the market. (9:34) And so, hopefully, the other signs that we are, you know, on that trajectory, we're not there yet, but we are absolutely gonna win back, the hearts and minds of people with diabetes.
Scott Benner (9:45) How long have you been in the position?
Que Dallara (9:47) Three and a half years.
Scott Benner (9:48) Three and a half years. (9:49) Okay.
Que Dallara (9:49) Seems longer, though.
Scott Benner (9:50) What led to the name shift? (9:52) Right? (9:52) I mean, I've been saying Medtronic diabetes forever, but now that's not the case anymore. (9:57) Tell me what the shift how did it come to be, and why do you think it's important?
Que Dallara (10:01) As you know, we've announced that we're going to we're in the process of separating from Medtronic. (10:07) And while our products were still called MiniMeds, it's MiniMed seven eighty g and so forth, we need to have our own name so we can't be called Medtronic diabetes anymore. (10:16) And so it made perfect sense to go back to the original mission of MiniMed, which really was the original category creator of diabetes technology with the five zero two pump that was portable and small versus what was there at the time back in 1983, actually. (10:33) You know, we picked MiniMed because we wanted to recommit ourselves to the original mission. (10:38) I mean, we we only serve intensive insulin users in type one and type two.
Que Dallara (10:43) We're not going after wellness. (10:45) We're not going after prediabetes and things like that. (10:47) This is our sole focus. (10:50) And when you look at the history of the business, it's been the pioneer of many, many firsts in setting the standard for that. (10:58) And so while in recent years, you know, we lost a little bit of our footing in The US, we continue to be super strong outside The US, and we're regaining a following back in The US as well.
Que Dallara (11:08) Mhmm. (11:09) And so that's what that's what's behind the name MiniMed, and we wanna live up to the forty one, forty two year heritage for the next forty one, forty two years or until until old cure is found.
Scott Benner (11:21) Being a a smaller unit now, how is that gonna help you accomplish that, or or is it gonna make it more difficult? (11:29) Because I know sometimes when this happens when companies, you know, kinda sell off or separate a little bit, it's not always easy to take the I hate to say it like this, but sometimes the good the good talent doesn't go with you, And sometimes it does, like, right? (11:42) So you've gotta look at the entire reporting tree again and start over. (11:46) Right? (11:46) So I it's a great opportunity if you can put it in place.
Scott Benner (11:50) So I imagine you've been doing that for a while. (11:52) Like, do you feel like that kind of structure exists now, and and how do you think being leaner will help you?
Que Dallara (11:58) Well, a couple of things. (11:59) From a talent standpoint, the good news is we have had no trouble attracting talent into the business because people are very motivated and energized by the mission Mhmm. (12:09) To help people. (12:10) Because, as I said, most of our employee a lot of our employees have a personal connection. (12:16) So it's very personal.
Que Dallara (12:17) Like, we we hear the feedback. (12:19) We respond to it. (12:20) I mean, we're not we're not very far away from the the patient. (12:25) So that's not been an issue. (12:27) The other thing I would say is the leadership team that's gone through a lot of adversity together, restoring the business back to growth, are part of are going as part of this separation of with Medtronic.
Que Dallara (12:39) So with it's not like we have a brand new team. (12:41) We have the same team that have been executing this. (12:44) You know, there's a lot of IPOs in medtech, but one other thing that people don't realize is we're almost a $3,000,000,000 business in revenue, and that puts us as a top 20 med tech company by revenue.
Scott Benner (12:54) Okay.
Que Dallara (12:55) So we actually have a lot of scale. (12:57) And I would also say that we are in over 80 countries around the world. (13:01) We support 26 languages. (13:03) Yeah. (13:03) We have twenty four seven, you know, tech support, and we have hundreds of thousands of people in our therapy globally.
Que Dallara (13:10) So we are really not that small.
Scott Benner (13:13) Mhmm.
Que Dallara (13:13) We have a lot of scale behind I know of 8,000 people. (13:18) So we have a lot of scale behind our product and our innovation. (13:21) I'm actually excited because Medtronic is huge. (13:25) Part of being huge, one of the downsides is you can be a bit slower in places, and we're gonna have the opportunity to move even faster than we are at the moment.
Scott Benner (13:35) Right. (13:35) No more turning the Titanic when you wanna make a decision. (13:38) Right?
Que Dallara (13:38) Exactly. (13:39) Exactly.
Scott Benner (13:40) I might be wrong. (13:40) Right? (13:41) But I'm an outsider who pays a bit of attention. (13:43) So but I'm trying to understand, like, with what's going on now, new sensors, new systems, you know, thinking about algorithms, getting that all set. (13:50) What happened in there?
Scott Benner (13:51) How did you, like I don't know. (13:53) It feels like you went out to, like, a first place lead and then coasted. (13:58) Like, what happened to Medtronic? (13:59) Like, how did you get how did they start so strong? (14:01) Here's a sensor.
Scott Benner (14:02) Nobody's ever had one before. (14:03) You just got it. (14:04) You start selling it. (14:05) That becomes the the business instead of the innovation. (14:08) Like, how does that gap happen, I guess?
Scott Benner (14:10) Because you're would you describe yourself as as catching up? (14:14) Or, like, where do you think of yourself as I guess, there's two questions here. (14:17) Like, how does that gap happen, and where do you see yourself in the moment? (14:23) Unlike other systems that will wait until your blood sugar is a 180 before delivering corrections, The MiniMed seven eighty g system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range even if you're not a perfect carb counter. (14:44) Today's episode of the Juice Box podcast is sponsored by Medtronic Diabetes and their MiniMed seven eighty g system, which gives you real choices because the MiniMed seven eighty g system works with the Instinct sensor made by Avid, as well as the Simplera Sync and Guardian Force sensors, giving you options.
Scott Benner (15:04) The Instinct sensor is the longest wear sensor yet, lasting fifteen days and designed exclusively for the MiniMed seven eighty g. (15:13) And don't forget, Medtronic Diabetes makes technology accessible for you with comprehensive insurance support, programs to help you with your out of pocket costs or switching from other pump and CGM systems. (15:26) Learn more and get started today with my link, medtronicdiabetes.com/juicebox.
Que Dallara (15:33) I think, honestly, lots of companies go through it. (15:35) I think it's called the innovator's dilemma. (15:37) Right? (15:37) You kind of you you're the innovator. (15:39) You get to a position, and what's very natural is you lose sight of why you exist.
Que Dallara (15:45) Mhmm. (15:45) And, you know, hubris sets in, you don't think you're touchable. (15:51) That's a very common cycle a lot of people a lot of companies go through, to be honest. (15:56) I mean, there's many, many stories of that. (15:57) Right.
Que Dallara (15:58) Kodak, Intel. (15:59) I mean, there's a lot of examples. (16:00) So I'm sure we went through a little bit of that. (16:03) I think the other part of it is when you're part of a big company, you fight for capital. (16:07) Like, you you've gotta, you know, you've gotta be a better business case than another business.
Que Dallara (16:12) And so, you know, when that happens, sometimes the investment moves in different parts of the portfolio. (16:19) I mean, that's a bit of the focus thing. (16:20) Now Medtronic gets to focus more. (16:22) We get to focus more. (16:23) And all we do is serve people on who need it, you know, in in need insulin.
Que Dallara (16:28) So those two things, I think, contributed to, I would say, choices that were not optimal. (16:34) And so, you know, and so you see some missteps, you know, especially in The US. (16:40) But for us, I think I'm super excited by our innovation that we have in the pipeline. (16:46) And, I mean, we we see ourselves as an AID company. (16:49) We don't just do CGM.
Que Dallara (16:51) We don't just do pumps. (16:52) It's really about the automation that brings all of that together.
Scott Benner (16:54) Okay.
Que Dallara (16:55) And I think, you know, we are leaders in AID.
Scott Benner (16:58) Why do you think that? (16:59) What is it something special about your algorithm or your hardware coupled with it? (17:04) What what do you think puts you in that position?
Que Dallara (17:06) We invented AID. (17:07) We were the first closed loop system with six seventy g back in 2016.
Scott Benner (17:12) Mhmm.
Que Dallara (17:13) We are with seven eighty, we are now in our second generation algorithm. (17:17) It's really the only system on the market with, order corrections every five minutes. (17:21) So if you miss at your bolus or you sometimes forget to bolus, the system can detect that you're eating and can give you the corrections and bring you back in range. (17:32) And so we perform very well in the hyper range because we're able to bring you back in range a lot faster. (17:39) It's a very aggressive algorithm and it's the lowest commercially available set point at one hundred milligrams per decilitre.
Que Dallara (17:44) And we can do that and be aggressive without increasing risk of hyper. (17:49) And that's why we have several hundreds of thousands of people in seven eighty around the world, and we've got incredible clinical data that says seven eighty is for many people, whether you're young or old, whether you're good at technology, whether you can good at math, if you're coming from different therapies. (18:07) I mean, it is really a democratizing therapy. (18:10) And we're working now on our third generation algorithm, which is gonna, you know, push the envelope even further on that front. (18:18) So
Scott Benner (18:18) How much can you talk about that? (18:19) What are the goals for that algorithm?
Que Dallara (18:21) Well, we we we really believe that the promise of AID is freedom, peace of mind, and safety. (18:29) And so the goal is to have the automation take over the work so you don't have to. (18:35) Mhmm. (18:36) Today, to be honest, well, you know, we like our technology, and there's a lot of AID systems on the market. (18:43) It's still work.
Que Dallara (18:43) You still have to put in a lot of work. (18:45) Seven eighty does push the envelope where you don't have to put in as much work, but the holy grail, I think, is not to actually do very much at all, and yet you can get above 70% time in range. (18:58) I think that's really our goal. (19:00) Can we help people who live with diabetes have more freedom? (19:05) They don't have to make a trade off between glucose control and lifestyle choices and therapy burden.
Que Dallara (19:12) We wanna solve all three.
Scott Benner (19:14) Does that answer lie in the hardware or in the data or in how the data is interpreted? (19:20) Where do you think holds us back from having more freedom?
Que Dallara (19:24) It's actually in the system. (19:26) So we are the only company that is commercializing CGMs, pump, or insulin dosing devices, and the algorithm around all of that. (19:37) Mhmm. (19:38) And so, you know, similar to if you use an iPhone, it just works, you know, because Apple tightly integrates the software and the hardware together. (19:48) And we're not a company that has CGM data and insulin data.
Que Dallara (19:51) And so and we've been more than ten years at algorithmic development. (19:55) We have a lot of data with both, and so that allows us to innovate very fast on how the automation algorithm. (20:03) And so now we're now third generation system in development, plus we've got two new CGMs and new form factors on the pump. (20:11) So when you think about this the trifecta of are you getting the clinical outcomes you want, like, don't want hypo, you don't want DKA, you don't want complications, Our timing range is, you know, the highest amongst all the AID systems, and you can see that in over 200 publications in in peer reviewed journals. (20:32) So then it's the second part of the trifecta is you got therapy burden.
Que Dallara (20:35) So how much interaction do you have to do to deal with alarms, to deal with imports into the devices? (20:42) Every AI distance has therapy burdens. (20:45) And then you've got lifestyle. (20:46) You know, what does it look like? (20:48) You know, how does it affect food, sleep, you know, social, you know, embarrassment if your alarms are going off and things like that.
Que Dallara (20:54) So we we want to solve we wanna solve for a very tightly integrated system that is kinda like self driving cars. (21:02) You don't have to do very much, but you're getting outcomes. (21:05) We don't want people to have to trade off. (21:07) Hey. (21:08) Lifestyle is very important to me.
Que Dallara (21:09) Like, let's say, you're a teenager, and so I'm willing to give up on safety Mhmm. (21:14) And glucose control. (21:15) Or I don't wanna do the therapy burdens too much, and so I'm gonna give up on that and, again, not get the outcomes. (21:22) We intend to solve for all three so that so you don't have to do very much. (21:28) Put insulin in, wear the device, respond to alarms if there are any, and live your life.
Scott Benner (21:35) So I'm what I'm hearing, I think, is that I shouldn't be expecting a mini med pump to work with a Libre ever since Dexcom, anything like that. (21:43) You're gonna keep it your stuff is gonna just work with itself, or do you think you'll ever have interoperability with other CGMs?
Que Dallara (21:49) We have a partnership with Abbott for instinct, so it's not interoperable in the sense of, you know, mix and match. (21:57) And the reason why we do that is we're not stubborn ups, and we've heard the feedback around our senses, and that's why we're excited with Simplera coming out as well as Instinct. (22:07) Mhmm. (22:08) Because we really believe in not having technology be yet another thing you have to do.
Scott Benner (22:14) Right.
Que Dallara (22:14) Right? (22:14) So and just as a very silly example, the Libre sensor doesn't have Apple Watch functionality.
Scott Benner (22:21) Mhmm.
Que Dallara (22:21) Right? (22:22) But the instinct in our system does. (22:24) Right? (22:24) And so we want to curate a system that just works. (22:28) You don't have to think about, does it work together, two phone numbers to call, companies pointing fingers at each other when you're troubleshooting.
Que Dallara (22:35) Mhmm. (22:36) We wanna be able to just keep it very simple. (22:39) Yeah. (22:39) The technology just works. (22:41) The automation is seamless.
Que Dallara (22:43) The devices look, you know, sexy and have a lot of appeal, and they're very designed with modern consumer electronics in mind. (22:51) And you have one phone number to call if you're you know, you need support in whatever country around the world, in whatever language. (22:58) Mhmm. (22:58) The burden of diabetes isn't just a device. (23:01) It's all the other things around it too that we wanna solve for.
Que Dallara (23:03) Like, that's part of the peace of mind. (23:05) If you happen to be on a holiday and your pump breaks or something goes wrong and you forgot to bring such and such, we'll airship it to you. (23:12) And so we can do that with our presence and scale that we have around the world, and that's one of the reasons why people value the service we provide. (23:20) That's why, I mean, it's a kind of a tidy cliche a little bit to compare ourselves to Apple. (23:24) That's the experience that we're going for.
Scott Benner (23:26) Yeah. (23:26) And want it
Que Dallara (23:27) to work. (23:27) I think that's only possible when you tightly couple all the elements of an AID system with one eight hundred MiniMed.
Scott Benner (23:36) Right. (23:37) It just occurred to me that we should be a little clear about this. (23:39) You're introducing two new CGMs, but one of them Mhmm. (23:42) Is a MiniMed CGM, and one of them is an Abbott CGM. (23:48) Mhmm.
Scott Benner (23:48) They're both gonna work with your pump. (23:50) That's right?
Que Dallara (23:50) Correct.
Scott Benner (23:51) Okay.
Que Dallara (23:51) Correct.
Scott Benner (23:52) Will the Abbott CGM work with anybody else's pump?
Que Dallara (23:55) The Instinct, no. (23:56) No. (23:57) It wouldn't be it only works with our it only works with our system.
Scott Benner (23:59) Same with the Simplera?
Que Dallara (24:01) Same with the Simplera. (24:02) Okay.
Scott Benner (24:03) And where do they stack up as far as marred and lasting the full amount of time that you say? (24:10) Like, how how do how have you seen that? (24:11) Why did it and why did it takes it feels like it took long. (24:14) Why did it take long? (24:16) What were you doing?
Que Dallara (24:17) Yeah. (24:17) It's fair. (24:18) It's no. (24:18) It's a it's very fair. (24:19) It's it's hard.
Que Dallara (24:20) Look. (24:21) Sensors are hard. (24:22) CGM is hard to do. (24:23) Mhmm. (24:23) I can't even tell you how much we've invested to do this.
Que Dallara (24:27) But, yes, it takes a long time because it it's actually technically a very sophisticated device. (24:32) Mhmm. (24:32) You gotta lot bring a lot of things together, not to mention going through clinicals and the FDA process, getting coverage. (24:42) I mean, there's there's a lot I mean, I'm not making excuses. (24:44) No.
Que Dallara (24:44) It's it's way too long.
Scott Benner (24:45) Yeah.
Que Dallara (24:46) And it is a new platform for us, but future iterations will not take as long. (24:51) But, look, SimpleraSync, the mod's about 10.2. (24:55) It's pretty accurate, and it's very accurate when it comes to dosing. (24:58) So, again, we're an AID company. (25:00) We're really not in the standalone CGM business.
Que Dallara (25:03) And so when it comes to dosing when you need to at the low and the high range, we are extremely accurate. (25:11) It's in the middle where, frankly speaking, we tune the algorithm to it doesn't really matter because you're not gonna take a different action in in the euglycemic range. (25:22) And that's, you know, you know, up to seven day sensor of with Simplirosync, and people really like pairing that with their weekly routine. (25:31) So we have a seven day infusion set, and so people like sort of the weekly, you know, site set change and site change that they have to do there. (25:40) Right.
Que Dallara (25:40) The instinct is fifteen days, and it's got a mod of, you know, sim and it has a very similar experience to a Libre a three.
Scott Benner (25:47) Okay. (25:48) I'm gonna fumfer through this because I don't have the wording. (25:50) But there's a thing with the FDA with devices. (25:53) Right? (25:53) Like, if somebody already has something similar on the market, isn't there, like, a, like, a a fast forward that you can use off of that, like, when you're bringing something else?
Scott Benner (26:02) Am I out of my mind, or what am I thinking of that or maybe I'm maybe I'm crazy. (26:07) You know what I'm talking about?
Que Dallara (26:08) Yeah. (26:08) Yeah. (26:09) No. (26:09) Understand what you mean. (26:10) I think, look, I think there's a myth that, you know, at least in The US, the the regulatory pathway with ICGM and the special controls Mhmm.
Que Dallara (26:21) Means it's fast. (26:22) It's not like a USB stick where you can just plug and play. (26:26) Because, look, we dose insulin, and you dose wrong, it's dangerous. (26:30) Sure. (26:31) So the regulatory process was actually not not long.
Que Dallara (26:35) I mean, we announced Abbott the deal with Abbott in August 2024, and we we started taking preorders in, you know, kind of late September. (26:44) It's thirteen months. (26:46) If you look at the other integrations that have happened, it's taken years. (26:49) We took thirteen months.
Scott Benner (26:50) Let's let you do this quick. (26:52) People have been telling me about how great their Medtronic pumps have have been for, like it it feels like I've I've been hearing it for a couple of years where people are like, but this new algorithm is great and you blah blah blah, but I it's always somebody from overseas. (27:04) And I maybe that is why it feels a little longer to me, if I'm being honest.
Que Dallara (27:07) You know, having a warning letter warning letter didn't help us get $7.80 in the market. (27:12) It probably was late by a couple of years.
Scott Benner (27:14) Okay.
Que Dallara (27:15) So I know how, you know, a lot of people were frustrated by that. (27:18) But since it's been here, and we've got hundreds of thousands of people on the system. (27:23) Mhmm. (27:23) And so I mean, you can look at social media, but, you know, it's for a lot of people, it's changed their life because they have to do less.
Scott Benner (27:29) Right.
Que Dallara (27:30) But, yes, I I I wouldn't fault the regulators here. (27:33) I think FDA has really made it easier to get new innovations out. (27:36) But to make it work, say, integration with with Instinct and Abbott, it takes work. (27:42) And what's what we're really proud of is whether it's our own sensor, Simpler, or with Instinct, you're still gonna get the great outcomes. (27:50) You're still gonna get the minimum work needed.
Que Dallara (27:53) The meal detection technology still works. (27:56) Yeah. (27:56) So while there are different slight differences in CGM experience, the same easy insertion process, it's actually the algorithm that delivers the ease of use and the outcomes.
Scott Benner (28:07) Right. (28:07) Right. (28:08) How do you get over so my daughter's 21. (28:11) She's been wearing an Omnipod since she was four. (28:13) If I came to her today with a tube pump and I said, hey.
Scott Benner (28:16) This will be better for you. (28:17) It'll be easier. (28:18) She'd say, no. (28:19) Thank you. (28:20) I I mean, how do you deal with that?
Scott Benner (28:21) That it's a it seems like a real issue. (28:23) Like, I can see in the in the community, there are people who are like, I don't want tubing. (28:29) There are people who are like, I don't care about it either. (28:31) But, like, how do you, you know I mean, how do you broach the subject with those different groups?
Que Dallara (28:36) Well, I think there's a couple ways.
Scott Benner (28:37) Mhmm.
Que Dallara (28:38) I think look. (28:38) There's preferences. (28:39) And so we believe in choice. (28:41) Not it's not gonna be one side, one thing for everyone, and that's why we have the broadest portfolio. (28:48) So we have two CGMs to choose from depending on your preference Right.
Que Dallara (28:53) With Sinclair and Instinct. (28:55) We have a tubeless option today. (28:56) It's called InPen. (28:57) So if you don't even wanna wear a pump at all, but you can have a bit of help with technology, we have InPen with our CGM. (29:04) We're working on our next generation tube pump called flex, MiniMed Flex, and then we also have a patch pump in development that we call MiniMed Fit.
Que Dallara (29:13) So some people are gonna want a patch pump, and some people are gonna want a a tube pump, they they like being able to detach from their pump or not having such a large surface area. (29:24) If you look at the size of the infusion set versus size of a patch, infusion set's tinier on your body. (29:30) Mhmm. (29:30) So there's gonna be preferences. (29:31) So we believe in in actually having a portfolio so people can maybe want a pump holiday or they can pick the pen the impen for that.
Que Dallara (29:41) But we actually do get a lot of people who who aren't in good control. (29:45) They're not doing well with the patch pump or our competitors' systems. (29:51) And so we offer trials, and people can trial our system, and it is a different experience. (29:55) It it's a bit like until you really get on our system, it's hard to you you go, well, it must all be the same, but it isn't. (30:03) We don't think AI systems the systems are the same.
Que Dallara (30:06) No. (30:06) And so we encourage people to try our system, and we actually get a lot of people converting from patch and seeing, actually, the algorithm, how the system work makes it worth it. (30:17) But some people won't, and that's okay. (30:19) And that's why we have a patch in development.
Scott Benner (30:21) I want people to have choice. (30:22) I think it's incredibly important. (30:23) So you see the space as tubed, patch, and tubeless? (30:27) Like, is that are those kind of the options there, and you're gonna jump into the other spaces? (30:32) I mean, what's the time frame on that?
Que Dallara (30:34) Today, again, we serve people who are on intensive insulin therapy. (30:39) Mhmm. (30:39) And if you look at that cohort, say, in the developed world, there's about ten million people. (30:46) So one and a half million of those are on tube pumps today. (30:50) They like it.
Que Dallara (30:52) And you've got about half a million who are on patch pumps. (30:55) But then the the vast majority are on MDI. (30:58) Yeah. (30:59) And we think those people should have the benefit of a bridge between just pretty low tech where they've gotta do all the work Mhmm. (31:08) And a bit more software to help them do better.
Que Dallara (31:13) And so that's where the InPen system we call it MiniMed Go. (31:16) The InPen system comes in. (31:18) It helps you not stack insulin. (31:21) You know, if you don't maybe you forget when you when you dosed insulin last time. (31:25) Yeah.
Que Dallara (31:25) It gives you data that your doctors have so you can have, you know, more a better discussion about your therapy and how you're doing things that you can do to be better. (31:34) It helps time your doses more accurately. (31:37) And so InPen has a lot of value for the, call it, six million people on MDI that don't have the benefit of technology, and we wanna help them too. (31:46) Yeah. (31:46) So we actually have a solution for all three cohorts.
Que Dallara (31:50) And our goal is, again, the the trifecta of we want you to have if you're below 70% time in range and your a one c isn't good, we have the solution for you. (32:00) Mhmm. (32:00) And that isn't gonna raise your therapy burden and isn't gonna make you compromise on your lifestyle. (32:05) Right.
Scott Benner (32:06) Oh, it's awesome. (32:07) Gosh. (32:07) I've talked to a lot of people about Impens over the years, and I know a lot of people that use them and find them really valuable. (32:13) They talk about it as having, like, a lot of the data functionality of a pump Mhmm. (32:17) Without the pump itself.
Scott Benner (32:18) I wonder about this all the time. (32:19) Those numbers you just said about there's certain amount of people on pumps, certain amount of people a lot of people just shooting MDI still. (32:26) Mhmm. (32:26) Are those people reachable? (32:28) Are they missing it because they have bad advice from physicians, insurance, because they don't have education?
Scott Benner (32:36) Like, what do you think is keeping them from pump therapy?
Que Dallara (32:39) I mean, you said it. (32:40) It's it's a lot the lot of it is just knowledge and education of what's out there. (32:45) And, you know, people may be comfortable. (32:48) Like, they may say, I don't wanna wear a pump because they don't have experience of wearing one, and so they think it's it's yet another thing you have to do. (32:54) That's why there's so much to do in a day.
Que Dallara (32:57) If you have diabetes, it's hundreds of decisions. (33:00) We don't want technology to be yet another thing you've gotta
Scott Benner (33:02) do. (33:02) Right.
Que Dallara (33:03) So if you take seven eighty g with Instinct as an example and our seven day infusion set, it's six perks a month compared to 12 to 16 with other AID systems. (33:15) Mhmm. (33:15) People used to care about finger sticks. (33:17) You don't have to do that anymore. (33:18) We got six perks, and so that matters.
Que Dallara (33:21) And that's why our male detection technology is important. (33:23) The automation is important because we don't hey. (33:25) You don't you know, perfect at bolusing? (33:27) No problem.
Scott Benner (33:28) Right.
Que Dallara (33:28) Seven eighty g has these auto corrections. (33:30) It's really the only system on the market with this meal detection, and so people find that liberating. (33:35) You know, I had patients tell me I you know, I was that they had a day where they were doing graduations. (33:40) Meals were all over the place. (33:41) It wasn't their regular routine.
Que Dallara (33:43) At seven a, the automation just kicks in and delivers that the insulin they need. (33:47) You know? (33:48) And so I think education is part of it. (33:50) I think it's also people's preferences. (33:52) And so we wanna make people where they are.
Que Dallara (33:54) We don't wanna go, well, you should be on a pump if you don't want to be. (33:57) That's why we have InPen. (33:59) Yeah. (33:59) But we do believe that we can help you and get you a little bit better. (34:03) So you have to do less work.
Que Dallara (34:05) And, actually, a lot of time when people come into our ecosystem, say, on on MiniMed Go, they then say, actually, this is good. (34:12) Maybe I'll I'm willing to try a pump now. (34:14) Mhmm. (34:15) Maybe I want more automation. (34:17) It's education.
Que Dallara (34:18) And then, you know, as you know, there's a shortage of endos around the world. (34:21) Yeah. (34:21) So a lot of it is primary care. (34:22) They don't always have the latest and greatest in terms of what's available. (34:26) And so we have to do a better job, honestly, you know, the industry to, you know, get the word out.
Scott Benner (34:32) You gotta educate the educators and make the
Que Dallara (34:35) Exactly.
Scott Benner (34:35) I think too, making the algorithm such that a doctor can feel comfortable not understanding it, but still prescribing it. (34:43) Yeah. (34:44) I mean, how do you decide then? (34:45) Like, there's only so many hours in a day. (34:47) Right?
Scott Benner (34:47) Like, there's and there's a lot of things to do. (34:49) You've gotta get your pumps and your CGMs around the world. (34:53) You've gotta improve algorithm. (34:55) You try to make your hardware smaller. (34:57) Mhmm.
Scott Benner (34:57) How do you prioritize what to do next and what's most important? (35:01) I mean, there's gotta be a big road map. (35:03) Right? (35:03) But how do you figure out which is which?
Que Dallara (35:06) Well, we think of it in generations. (35:08) So, you know, we were first with the six seventy g system. (35:12) Mhmm. (35:12) Seven eighty was a second gen system that's really five years now in the market, and we're very, very close in getting our third generation system out. (35:21) So that's come from a lot of feedback and interactions with all of our with our customers.
Que Dallara (35:27) I mean, it's hundreds of videotaped videos to figure out features that we wanna invest in, and so we've been hard at work. (35:35) Like, we can't always talk about what we do, but we've been hard at work every day getting this third generation system out, starting with the CGMs last month with new form factors on the hardware, and then, of course, our next generation algorithm, which we're super excited about. (35:50) I think really, Scott, if I reflect on how we as an industry are doing, I think the fact that the penetration of AID, which is superior to MDI, it has such low penetration in The United States and around the world is because technology is a burden. (36:08) Mhmm. (36:08) That's our goal.
Que Dallara (36:09) We got to make technology not a burden so you actually don't have to do much, and not a burden also on busy clinics, you know? (36:18) And so with seven eighty g, a clinician just has to really know the insulin to carb ratio. (36:24) That's really it. (36:25) We don't have a lot of dials you need to turn. (36:27) If you go with our recommended settings of two hours and a set target of 100 or 110, All you have to figure out is the person's individual insulin to carb ratio, and you're off to the races.
Que Dallara (36:40) That's seven eighty g. (36:41) In the future, it's gonna be even less than that.
Scott Benner (36:44) You said something a minute ago that I just got back from I don't wanna say the company, but I just went out and gave a talk to a a a pretty big organization. (36:52) Right? (36:52) Because they help people with diabetes all day long. (36:55) Mhmm. (36:55) But a very small percentage of the people that work there have diabetes or know somebody with it.
Scott Benner (36:59) Mhmm. (37:00) In their minds, it's a, you know, it's a widget. (37:02) Right? (37:03) It's a thing I do every day. (37:04) I cut I get to work.
Scott Benner (37:05) I work on code. (37:06) I don't know. (37:06) The code says this about that. (37:07) Like, it doesn't matter to me as long as it works in the end. (37:10) I've heard you say a couple of times, like, we brought people together and we asked them, like, what are we doing?
Scott Benner (37:14) Where are we missing and everything? (37:16) Can you talk about some of the things that those conversations brought to light? (37:20) What did you say to yourself, this is what's important? (37:23) Because I know what I think is important. (37:24) I think that meal detection technology is a huge thing for me.
Que Dallara (37:28) Mhmm.
Scott Benner (37:29) Right? (37:29) Like, you should be able to miscount a carb or forget for five seconds and not end up with a blood sugar of two fifty. (37:36) Mhmm. (37:37) You should be able to fall asleep without waking up at 300, like, that kind of stuff. (37:41) I think that's huge.
Scott Benner (37:42) I think sets working well, not having to be changed all the time, really great sensors that don't fail, that report accurately, that make people actually comfortable using AID. (37:52) Like, that stuff's really important. (37:54) Like, the I don't know what I wanna call, like, on the ground, like, actual lived experience stuff, I think, is what's most important. (38:00) But I'm wondering, you coming from an outside perspective and then hearing those people talk, like, what struck you in those conversations?
Que Dallara (38:07) Well, typically, our process is we always involve our customers. (38:11) We always. (38:12) And we don't go to them and say, would you like this feature? (38:15) We ask them what problem would they like to solve in their life. (38:19) And it's based on that that then we go through a very complicated process to figure out how do we innovate to solve that problem.
Que Dallara (38:27) So it's not about, hey. (38:28) Here's 10 features. (38:29) Pick the ones you like the
Scott Benner (38:30) best. (38:31) Right.
Que Dallara (38:31) And so that's how we came up with meal detection technology. (38:34) Like, it we have that with seven eighty g because no one counts carbs correctly. (38:39) Nobody. (38:39) Actually, it's estimation. (38:41) It's no one actually counts carbs.
Que Dallara (38:43) Sure. (38:43) And so that's why this was being very liberating because you don't have to be exact at all and feel bad about that. (38:50) And so you described seven eighty exactly. (38:52) That's why in our portfolio, we think about the different preferences people have. (38:57) So I'll give you an example.
Que Dallara (38:58) Let's say with Instinct, why do we have Instinct and Sinclair? (39:01) When we developed our sensor, we did that with insulin dosing in mind. (39:06) One of the things that our loyal install base likes to do is they like to be in tight control. (39:13) Right? (39:13) They they we're known for, you know, very superior clinical outcomes and really tight control.
Que Dallara (39:20) So they like to occasionally calibrate their sensor, right, because it just helps them just they wanna manage it more. (39:29) And so it with Simplera, you can do that. (39:31) You can if you want to, you can calibrate your sensor, get tighter control. (39:36) With how Libre started, they started with as a diagnostic. (39:41) It wasn't built with AID in mind in the very beginning.
Que Dallara (39:45) And so now, you know, it's a great sensor, and it's can it be integrated into AID, but you can't do that. (39:50) Now for some people, they don't care. (39:51) Right. (39:52) That's not important to them. (39:53) But for certain people who want eye control, they do care.
Que Dallara (39:56) And so that's what's behind the choice and why we have different sensor options and why we have different dosing options. (40:03) We wanna be able to meet people where they are and not force people to, well, you need to do this. (40:10) And that's what's behind all the investments we've made. (40:13) We don't want technology to be a burden. (40:15) We want it to be a companion, an aid, a tool, and the holy grail for us is if we can take away all that work and still give you the health outcomes you want, no fear of hypo, get your hyper back in range very aggressively and help you deal with long term complications.
Que Dallara (40:32) If we can deliver that but not add to the burden but help you live your life
Scott Benner (40:36) Right.
Que Dallara (40:37) That's what we work on.
Scott Benner (40:38) So how much ceiling is left in that algorithm? (40:41) Like, how many more dials can you turn until it it's giving you that kind of like, is there a world in your mind where people could be 90% in range and never low for days at a time? (40:52) Like, is there you know what I'm saying? (40:54) Like, is there room in that algorithm for improvement, or does something have to be I don't know what I'm asking. (41:00) Like, does something have to be invented before that's gonna happen next?
Scott Benner (41:04) Like, are we at a at a peak right now, or are we still in a a version of learning about it?
Que Dallara (41:09) Well, with seven eighty, I mean, in the real world, you know, we've got a lot of studies in the real world evidence of, you know, over 350,000 patients on seven eighty in this particular study, I can actually send you the the publication. (41:23) If you're on our recommended settings on seven eighty, you're getting an 80% time in range without doing a lot to get that.
Scott Benner (41:32) What's the range you're using?
Que Dallara (41:33) 7070% 80% time in range using our recommended settings.
Scott Benner (41:37) What is that range? (41:38) Like, seven 70 to one eighty, or, like, where where do you set the range to do the measurement?
Que Dallara (41:42) The range is 70 to one eighty, or the the, you know, consensus driven range. (41:46) And then if you're talking about 70 to one forty, which is where Yeah. (41:51) People who don't die have diabetes spend most of their time in, we're at 55%, what we call timing tight range.
Scott Benner (41:58) Right.
Que Dallara (41:58) So $7.80 already gets there, but we absolutely believe that where this is going is we shouldn't have any buttons at all, and you're getting above 70% time in range. (42:08) That's really, you know, where we wanna push the envelope. (42:12) But if you want to have even tighter control, because we have people in Facebook with seven eighty saying, I got a 100% time in range. (42:20) And, you know, they're they're proud of, you know, you know, hitting sort of goals like that. (42:25) Mhmm.
Que Dallara (42:25) For people who do want even tighter control, we wanna be able to give them the option that if you wanna engage get more to control, you can do that. (42:32) But you don't have to. (42:33) If you don't wanna do anything, we wanna help get you above 70% time in range. (42:38) That's that's where the future of the algorithm is gonna go.
Scott Benner (42:40) Does that algorithm need to include some AI? (42:44) At some point, I'm gonna be very, like, ham fisted about this. (42:46) But are you gonna have, like, your own little AI agent inside your pump that's, like, looking at your food and decisions and helping adjust more than just what the math tells it?
Que Dallara (42:54) We don't need to do that, Scott. (42:56) We use a lot of AI in the development of our products, but think of it as a lot of AI requires you going to the cloud and having a lot of compute. (43:06) Mhmm. (43:06) And if you think about the pumps, we have our algorithms on the pump because you're not always gonna be connected. (43:11) Like, you could be hiking in the mountains, in the wilderness Sure.
Que Dallara (43:14) And not have an Internet connection. (43:16) Our pump's gonna work. (43:17) The algorithm's still gonna work. (43:18) Right? (43:19) It's not dependent on all this infrastructure.
Que Dallara (43:22) So from a safety standpoint, we have to be extremely efficient how the algorithm works on the pump because it's not a supercomputer. (43:29) You know? (43:29) Right. (43:29) It's a pretty smart device, but AI isn't used in the development. (43:33) But we don't need you know, our algorithm is very good because we have had hundreds of millions of points of data on CGM and insulin over the last, you know, call it decade of algorithmic development that we don't need to have, you know, Gen AI working in the pump for us to deliver Mhmm.
Que Dallara (43:50) An even better algorithm in the future.
Scott Benner (43:52) So the math will handle it at some point better than I imagine it can. (43:57) Yes. (43:57) I've heard you say a couple of times no buttons. (44:00) So right now, when I hear people talk about that, they'll say, well, that was great until I got my period, or that was great till my Mhmm. (44:07) My kid hit a growth spurt, or, yeah, that was great until until until and then I need to set a temp basal.
Scott Benner (44:12) I need to do this, like, etcetera. (44:13) Is that a a long in the future idea to you? (44:16) Like, we have a couple of stops to go before it's buttonless, or is that more of a way of thinking about, like, there'll still be buttons. (44:22) I can make adjustments, but I just probably won't have to touch them very often.
Que Dallara (44:25) We wanna be able to serve people who don't wanna do anything because you got a lot of those. (44:30) Mhmm. (44:31) But if you want to do something, we will provide options if you want to engage more. (44:36) But that engagement isn't like many dials and buttons. (44:38) It's super simple, but you're always gonna have a spectrum of people who they wanna be more active in managing their diabetes, and they like doing that because they wanna be super tight.
Que Dallara (44:49) But for other people, they don't wanna do anything at all. (44:53) Right. (44:53) And so we wanna accommodate both. (44:55) But, yeah, the I think the holy grail is just not having to do Not having to do anything other than put insulin
Scott Benner (45:02) And in your mind, is that the thing that opens you up to find those other millions of people?
Que Dallara (45:06) Yeah. (45:07) I think it will attract a lot of people and, you know, probably a lot of type twos Right. (45:12) Because, you know, typically, they they're willing to do less. (45:16) Mhmm. (45:17) If technology is just in the background, you know, just imagine, like, a self driving car Yeah.
Que Dallara (45:22) And you don't have to drive it, I think the adoption will go up. (45:25) But if you still have to do a little bit of something, you know, for some people, it's not worth doing that versus what they're doing at the moment. (45:32) So we wanna make it easy because we think that people will be healthier if they are on AID. (45:37) Look at a one c's in The US. (45:40) It's above eight despite the fact that CGM penetration is 80%.
Que Dallara (45:46) Yeah. (45:47) Pretty much if you need a CGM and you're, you know, you're on diabetes, you need CGM, you're get one. (45:51) It's not good. (45:53) So people need help with insulin dosing and diabetes management. (45:58) Yeah.
Que Dallara (45:58) But it's still too much work.
Scott Benner (45:59) I talk about this a lot that it it could get easy to get into this ecosystem that I've created here and think like, oh, everybody's got, like, a six and a half or a five a one c or something like that. (46:09) But the vast majority of people that are on insulin And eight I've interviewed people all day long that, you know, they have twelves they live with. (46:17) They have complications in their thirties. (46:19) Right? (46:19) And they're not when you talk to them, what always strikes me over and over again that it is not a lack of they're they're not not concerned.
Scott Benner (46:26) They're not not trying. (46:27) It's just Mhmm. (46:28) For reasons that are hard to kind of, like, compute, like, human reasons, just not working out for them well. (46:34) Mhmm. (46:34) And those are the people I think about all the time.
Scott Benner (46:37) Also, those people often see their general practitioners about their diabetes on top of everything else. (46:41) They need a thing that you can just go, look. (46:44) Take this. (46:44) This is how it goes on. (46:46) This is how where you put the insulin.
Scott Benner (46:48) Here's your a one c in the sevens. (46:50) Like, that's life saving for a a huge swath of people who who need insulin every day. (46:55) Anyway Scott,
Que Dallara (46:56) I'm I'm with you. (46:56) It's so sad.
Scott Benner (46:57) Yeah.
Que Dallara (46:58) Yeah. (46:58) And that's why we really believe seven eighty can help people like that. (47:02) Wow. (47:02) Because, look, people try, and life gets in the way. (47:06) And you got kids, you got a job.
Que Dallara (47:08) I mean, it's not it's not easy. (47:10) Yeah. (47:10) So that's why we really believe if you're not doing well and, you know, if you're not in control and it's a lot of work, you're not getting the return on the effort. (47:19) Mhmm. (47:20) We think seven eighty.
Que Dallara (47:21) Try seven eighty because it's we think it's for very little effort. (47:26) You're gonna get great outcomes and feel better
Scott Benner (47:29) Okay.
Que Dallara (47:30) Every day.
Scott Benner (47:31) So my last kind of question, it's gonna be a little jumble here. (47:34) Seven eighty g, ready to go now. (47:37) Lots of CGM options. (47:38) You're gonna like it. (47:40) Go give it a shot.
Scott Benner (47:41) But you're working on other stuff too. (47:43) Patch pump, tubeless option.
Que Dallara (47:45) Mhmm.
Scott Benner (47:45) I'm gonna ask you, how long do you think until people see those? (47:49) And then my last last question, which I think you can dovetail into is, if you come back here five years from now Mhmm. (47:55) We started by talking about, like, you know, where Medtronic started, you know, like, that old CGM people you know, people used to call that CGM a harpoon. (48:03) Right? (48:03) Mhmm.
Scott Benner (48:04) So you've gone from there to, like, where you are now to where you're trying to go. (48:08) So five years from now, I get you back on here and we're talking. (48:12) What are we talking about? (48:13) Where are you at at that point?
Que Dallara (48:15) Great question. (48:16) So for the first part, we got seven eighty g, two new sensors, give it a go. (48:22) And on the new the new durable pump, the new patch pump, and then the new algorithm, for the durable pump, we said that we're gonna submit very soon on that in our fiscal year. (48:32) Mhmm. (48:33) In a month or so, I'll be able to share a bit more timelines on a bit squeezed with our process at the moment, from Medtronic to reveal too much.
Que Dallara (48:42) In a in a month or so, we'll be able to say the timelines on those, but it's very we're getting to the tail end of those new products. (48:48) So we're really excited to introduce that to everyone. (48:51) But in five years' time, you know, I hope people will be saying that MiniMed just works. (48:58) That's our goal and that it just fits into their lifestyle. (49:03) They don't have to do anything.
Que Dallara (49:04) They just live their life. (49:05) That's what we want to be able to contribute to and that we've truly entered a hands free era, that you just put insulin in, it just works, you don't have to think about it. (49:14) And so that's where we think our third generation system is gonna be there. (49:18) And life was like diabetes is a little simpler, you can move on to other things. (49:22) So that's what we hope.
Que Dallara (49:23) And, you know, but I tell you what, Scott, I'll come back in five years' time on your podcast, and we'll have a discussion about it. (49:31) Awesome. (49:32) But that's what we hope. (49:33) A free, a hands free era with MiniMed.
Scott Benner (49:36) I hope too. (49:36) Maybe you can come back a little sooner and tell me a little more about these new pumps when you're more free to talk about
Que Dallara (49:40) the details. (49:41) Do this.
Scott Benner (49:41) Help you get. (49:42) Also, I'd like to ask if you've ever owned a bearded dragon because you lived in Australia, but we don't have time for that.
Que Dallara (49:47) I do. (49:47) I do have a Rankin's bearded dragon.
Scott Benner (49:50) You do? (49:51) I do. (49:51) Oh, they're the small
Que Dallara (49:52) sort of Fizz.
Scott Benner (49:53) Yeah. (49:53) The smaller How old how old is it?
Que Dallara (49:56) One year, actually. (49:57) One year on Veterans Day.
Scott Benner (49:58) Oh, wow. (49:59) We don't have time now, but the reason you're there's a a green screen background behind me because behind me is my Parsons chameleon and, like, some other little things I keep in my office. (50:08) So we'll find more time later. (50:10) I'd love to know about your Rankin's Dragon. (50:12) I'm not kidding.
Scott Benner (50:13) Thank you very much for doing this. (50:14) I really do appreciate your time. (50:15) Thank you.
Que Dallara (50:16) Yeah. (50:16) It was fun. (50:16) Thanks, Scott.
Scott Benner (50:17) Awesome. (50:24) I'd like to remind you again about the MiniMed seven eighty g automated insulin delivery system, which, of course, anticipates, adjusts, and corrects every five minutes twenty four seven. (50:34) It works around the clock so you can focus on what matters. (50:39) The juice box community knows the importance of using technology to simplify managing diabetes. (50:44) To learn more about how you can spend less time and effort managing your diabetes, visit my link, medtronicdiabetes.com/juicebox.
Scott Benner (50:55) If you've listened to any number of podcasts or maybe watched a YouTube video, you're very accustomed to listening to the creator of that content ask you and sometimes just outright beg you without any feeling of self respect for you to follow, subscribe, share an episode. (51:15) The reason that happens in podcasting specifically is because podcast players don't have a sophisticated recommendation engine like YouTube or TikTok does. (51:24) They can't watch listener behavior and then give you content that you might like. (51:30) Word-of-mouth skips that line completely. (51:33) It's an instantly expanding reach engine and really the only thing I've ever found that helps to keep the Juice Box podcast growing.
Scott Benner (51:42) So subscribe and follow because that the algorithm understands. (51:45) Set up automatic downloads, listen to the show, but share it with somebody else. (51:50) Leave a five star review. (51:52) Make it a thoughtful review that the algorithm can understand. (51:56) I really appreciate the time it takes you to do those things, and I hate that I have to say this to you because I feel like an idiot.
Scott Benner (52:02) But subscribe and follow. (52:04) Tell a friend. (52:05) Please and thank you. (52:06) Have a podcast? (52:07) Want it to sound fantastic?
Scott Benner (52:09) Wrongwayrecording.com.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!