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

Scott Benner 0:00
Hello friends, welcome to episode 1126. This is part two of the Grand Rounds episode on technology. For part one, go to Episode 1125.

Today Jenny Smith and I are continuing on with the Grand Rounds series, we're going to discuss technology in this two part episode and the first half general overview of CGM and pumps and in the second half different pumps technology and understanding the differences between them. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com. If you're looking for the diabetes Pro Tip series, it runs between Episode 1001 1025. For subscribers to the podcast, those episodes are ad free. For everyone else. There's just a couple of ads episodes 1002 1025 diabetes Pro Tip series from the Juicebox Podcast. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. If you're interested in checking out the diabetes Pro Tip series, the bold beginning series or any of the series within the Juicebox Podcast, there's two quick ways to find them. First, go to juicebox podcast.com. Go up into the menu. And you'll see links for each of the different series, pro tips algorithm pumping, after dark etc. Click on them, there's a player in there to check them out. Or you can use that player to see which episodes correspond and go find them in your podcasts that the other quick way is to go to the private Facebook group, click on the feature tab. And there there are lists upon lists of all the series. Jenny has been a week and we're back. Yay. Last time we kind of stopped in the middle. Not really in the middle of the episode we'd already recorded quite a nice episode already. But we'd run out of time your schedule didn't allow. And you and I have just listened to the voice note that we that I left for us. So we're going to pick up by talking to doctors about why insulin pumps are so important for people. I think we should just start maybe at the misnomer that still exists that a pump is just a way to avoid injecting and nothing else.

Jennifer Smith, CDE 3:04
Yeah, that's a great way to start. I'd certainly not it takes the place of injections. But it is not a one for one conversion. By any means. There is a major difference between injections even the smarter injection devices that we have today. 100% difference when you change to an insulin pump, it's a really strong way to assist somebody in improving management, just because of the much more I guess in general, just the much more precise dosing that you are offered with an insulin pump. Yeah, you

Scott Benner 3:38
have fine control over Basal insulin, extending boluses creating, you know, patterns. Yeah, you can you can create a little here's the I think a great example is that, you know, if you experience a fat rise after a meal with fat in it, you push a button again to give yourself more insulin, or you tell it Hey, 90 minutes from now I'm expecting a rise, let's put some in here, you're not coming back at somebody with a with a needle again. And I know it feels like Oh, so you're just saying I'll avoid having to inject. But that's not it really, it's the psychological part of it, that people won't remember to do that. Or if it comes to, well, I have to do it to inject, they may just avoid it.

Jennifer Smith, CDE 4:21
And in one of one of two ways of avoidance there, that's a good thing to bring in. It's either they'll avoid doing it kind of resulting in sustained high blood sugars because they're just avoiding taking 10 injections a day versus the four that they were told were necessary, despite them knowing better. Or secondly, they may actually go the route of just avoiding additional food that may be necessary. I

Scott Benner 4:44
just interviewed a lady the other day that said that her newly diagnosed son changed his eating patterns and she couldn't figure out right away what was happening and then it hit her that she'd say Are you hungry and moments when she knew he was hungry and he's saying No, thank you. And then he kind of like soak away. But he was just trying to avoid injecting. Yeah,

Jennifer Smith, CDE 5:05
absolutely. And it is a not only from the standpoint of injecting more, there are people absolutely, who that's their desire is just to manage with an injection and to do it multiple times a day in there, they're fine, and they do a wonderful job. But then there are the people who could do so much better. By having the precision instead of the smallest dose really is about a half a unit unless you really eyeball on a syringe and assume you're getting a quarter of a unit, which is again, not very precise. But you know, the precision of a pump to be able to deliver for somebody who is ultra sensitive to insulin. It's not there with injections.

Scott Benner 5:49
Yeah, yeah. Where my concern comes is that if a doctor were to tell you, the contour, next gen blood glucose meter, is sponsoring this episode of The Juicebox Podcast. And it's entirely possible that it is less expensive in cash than you're paying right now, for your meter through your insurance company. That's right. If you go to my link contour next one.com/juicebox You're going to find links to Walmart, Amazon, Walgreens, CVS, Rite Aid, Kroger, and Meijer. You could be paying more right now through your insurance for your test strips and meter than you would pay through my link for the contour next gen and contour Next, test strips in cash. What am I saying my link may be cheaper out of your pocket than you're paying right now, even with your insurance. And I don't know what meter you have right now, I can't say that. But what I can say for sure is that the contour next gen meter is accurate. It is reliable. And it is the meter that we've been using for years contour next one.com/juicebox. And if you already have a contour meter, and you're buying test strips doing so through the Juicebox Podcast link will help to support the show. Even as they're handing you a pump, if they were to tell you this is great. Now you don't have to inject any more and make it feel like all we've done is take away like times you're getting poked, it takes your brain away from thinking that this thing could do other stuff for me. Like do you know what I mean by that? Yes, you neglect to mention that, if you get low every night at 2am, we could turn your Basal back at 12:30am to stop the low from happening at two, which if you're injecting Basal insulin is not a thing you could do even just correct. Think about that small idea, instead of messing with, oh, maybe we should, you know, shoot the Basal insulin an hour earlier, let's do it at night, instead of during the daytime, let's try 20 units instead of 21 units. Like instead of going through all that you just go I get low every night at 2am. I'll just take away some basil and see what that does. It's magical. But if the doctor puts in your head, oh, it's just a replacement to stop you from having to get poked so much. I think you don't wonder what else you could possibly do. Right? That's not me guessing that's me, having talked to so many people who've really told me that story. So

Jennifer Smith, CDE 8:15
Right. And I think it also goes along with the lack of explanation of the pluses, or smart features, let's call them on today's pumps, even conventional versus the newer kind of algorithm and whatever that is out there. Myself example really is. Before I switched to a pump, I was taking a Basal insulin that required me to have a snack before I went to bed. If I did not, I was low by three o'clock in the morning. I was every and if I change every night, and if I changed my mind was worse with exercise and everything. If I changed my dose of the Basal insulin, it messed other things up that were not great. And so again, it brings in because food is such a center of diabetes management, it brings in the precision of a pump means that you're not feeding insulin that shouldn't be there. Yeah, yeah, right. I didn't want to have to have a snack at night. Most people don't want to have to nibble and snack when they don't want to or have to have very kind of timely meal intake to offset the action of a Bolus of insulin or their Basal action or whatever it is, as you said, if you can navigate those pump settings to accommodate for high need times are low need times you got something that can take care of that need to feed the insulin. Yeah.

Scott Benner 9:39
I want to say to to empower somebody to make an adjustment or make adjustments to their insulin through their pump is would be huge. I can't possibly tell you how many people live months at a time waiting to get back to the office where let's be honest, if you're listening in your dock You're you're throwing darts at a wall going, I don't know, try this, you know, like, turn it this way, see what happens how you suppose. And that's no shade on the doctor how they're going to know, from a couple of graphs, what happens, you know, it's ridiculous. And then it puts the doctor in a position of trying to pretend they know what's happening, which then just makes you look bad in the long run. And it leaves the person in a in a position where they're never doing as well as they could be. And you could end up turning a knob in March, that's even worse. And they don't come back till April, May June, like you don't even talk till the spring. Correct. And these people don't feel like a thing I hear the most from people about the podcast is it gave me the courage to try something.

Jennifer Smith, CDE 10:47
Yeah, people should try something specifically with the main control factor of diabetes, which is insulin. Yeah.

Scott Benner 10:52
100%. And, and my point is, is that doctors should be encouraging that, like, you can't sit there and tell people like on one hand, wow, you're gonna know more about this than I do in six months. But don't do anything till you come see me. Right? You know, it's weird mixed messaging, and it freezes people and it leaves them with higher or lower blood sugar, either some people are eating, they're like crazy trying to keep their blood sugar up. You just made that example, like if I adjusted an injectable Basal insulin. Okay, I didn't get low anymore at 2am. But all day long, I'm 45 points higher than I want to be, you know, so it's not a fix. It's a anyway, and none of that's necessary. And if you're listening to this and thinking it is, it's not plenty of people live with lower stable blood sugars that don't create crazy lows and, and huge spikes all the time. Absolutely.

Jennifer Smith, CDE 11:42
I think that is really, it kind of goes along with the fact of teaching people about their pump in the right way, right? If you're recommending a pump, you've got a patient, you've started on a pump, you're getting them going, their education needs to go beyond the basic of filling it with insulin, putting the tubing on or slapping on, you know, the pod device or whatever, and hitting go, and it just starts delivering insulin. That's not teaching. That's just learning how to use a device. Right there, there's so much more to learning because again, of the smart features, even the simplest smart features like a temporary Basal rate, when to use it, why to use it, how long to use it for before actually making true set adjustment. When you're using an extended Bolus, write a square wave or a dual wave type of Bolus. Those are advantages in the aftermath of food, or coverage for different types of, you know, different types of intake. And you can't do that as precisely with injections, unless you're willing to be the person to give multiple multiple injections to cover that type of intake. Right.

Scott Benner 12:53
I want to say that plenty of people that I've met, manage amazingly on MDI, yes, but they understand how insulin works and when they need it. That's that, like, if you and I talked about this all the time, people would come to us and say, hey, the Pro Tip series is so like for people with pumping, can't you do more for people with MDI and I said, Oh, it's the same thing. I said, just when you hear me say, pump, think needle. And if you hear me say extended Bolus go, oh, I can't do that. I'll have to inject again. Like, that's the difference, really. But if you don't know that, Jenny, if you're the doctor, and you don't know that, and then someone comes in and says, Hey, every night at 3am, I get low, but I changed my basil, it didn't work. I'm still getting low at 3am. Now I'm getting high at, you know, 5am I don't know what's going on. The doctors gonna be like, Oh, they tried turn the basil down. That didn't work. They're gonna skip right over the idea about timing of insulin, which is why we talked about it so much in the other episode, because it's all about timing. And I don't regardless of the delivery method, no, right. It doesn't matter how you're putting it in the timing of the insulin. There's not much of a parallel about how basil works. When it's injected versus basil works through a pump. They're pretty different. They accomplish the same thing, but they're not manipulatable by the user at all. And that's it really like, and by the way, stop giving people Basal insulin that was invented 20 years ago, when there's stuff that works a lot better if they're going to be on MDI, at least give them modern basals that that have longer coverage and actually make it not just 20 more stable.

Speaker 1 14:25
Yes, just stability. You know, I don't know how much time I spent. While Arden was on Leba mir wondering what the hell was happening when the truth was this 11 year wasn't lasting 24 hours.

Scott Benner 14:39
It doesn't. I mean, a year and a half maybe of my life just staring at a wall and thinking about running my head through it trying to figure out what was going on. Then one day somebody said to me, oh, you should split that. I was like, why wouldn't somebody who said that to me sooner? I give her half now and half 12 hours now work, right? That was it, right? Yeah. So and that's timing. That's insulin time it is

Jennifer Smith, CDE 15:01
it's insulin timing. And it's also based, you know, the kind of insulin I think that's another place to, to navigate within whether you're multiple daily injection, but definitely, if you're on a pump is we're talking about Basal insulin here, the understanding from a practitioner, that you still need to really recommend and have the person understand, they need to have a Basal insulin as a backup, right? Because we're talking about technology, technology can and at times will fail. And you have to have that backup as an injectable, in case. But I think it also is really important to explain that once you're on a pump, that Basal insulin gets put in the fridge with a label that says do not use unless pump fails. I've had a number of people over the years, who couldn't understand the concept that the pump was going to do the Basal and the Bolus delivery, but with one kind of insulin in the pump,

Scott Benner 15:59
are you going to tell me they put two different insulins into the pump? They

Jennifer Smith, CDE 16:03
did not. But they thought that they still needed to tow they were shooting? Oh, along with their pump? And then you know, I mean, clearly you clear that up very quickly, etcetera. I mean, it all goes into proper information and proper education from the get go. You know, there's a checklist of things that definitely, I told them this, I took care of this, this, this and this. They're all really important pieces that I think they sort of either get missed, but I don't think from I don't think it's a miss because they mean to miss it. Okay.

Scott Benner 16:36
All right. Well, it's interesting. All right. So that would be just the conventional pump, what we would consider old school, instead of Basal rate, it gives it to you, you tell it how many carbs and you've preset your insulin to carb ratio, and it does the thing. But I mean, honestly, every company now, Omni pod has Omnipod five, tandem is control like you. Yeah, Medtronic, what is it? The mini med? was an ad G seven AG, that's the new one from them. Okay, I'm pretty new. So there now, I mean, those are the three major pump manufacturers, right? Like I'm not missing anything.

Jennifer Smith, CDE 17:12
So you're in the States, those are the major rights.

Scott Benner 17:14
So wherever you live them, there might be others that you're using. But these algorithms are prevalent. They're available. You know, they require you to wear a CGM at the same time. But correct. Let's say this. How do I put this? If I let you, Jenny, would you put an algorithm on everybody? You could? Or no, I'm interested in your feedback?

Jennifer Smith, CDE 17:35
That's a really good question. I think, I think it depends on the algorithm. Okay. I think that an algorithm can improve the vast majority of people with diabetes, whether it's type one or insulin dependent type two diabetes, and insulin pump absolutely will be an advantage, and the algorithm within that will improve things. And I think the biggest group of people with diabetes that it improves are those who, for whatever reason, in life, they're just not navigating management, to the degree of effectively bringing glucose levels down to a place that long term is going to be healthy, right? And an algorithm again, depending on which one what system you're using, an algorithm can and will improve things. So for the majority of people, yes, I think it's a fantastic idea.

Scott Benner 18:37
So let's stick with that for a minute. If you are, what do you think the cut off is in your head? If you're a one sees above, seven, seven and a half an algorithm is going to help you for almost for sure if the settings are right, and you're even reasonable about announcing carbs, is that fair? Correct? Yeah, yes. If you're rolling around with a five, five to a one C, you might not have that same outcome. If you just let the algorithm roll. As a matter of fact, they all target God, it's a What's the target for t? So obviously, it's something weird, like 100. And

Jennifer Smith, CDE 19:12
technically, we just say 110. It's one 12.5, whatever you got, right? But yeah, one 12.5 or 110, Omnipod, five, the lowest adjustable is the 110. And then Medtronic, interestingly, with their 780 G, they have the lowest in an FDA approved product, which is 100.

Scott Benner 19:32
Okay, but so those are still your targets, they're, they're a target. And if a doctor is probably listening, they're like, Oh, my God, you mean somebody could have 110 blood sugar most of the time, like, yes, like, I don't see that with anybody. But there are plenty of people who know how to use insulin in such a way and are are thoughtful about it in such a way that they're achieving lower agencies, but I remind myself constantly Jenny, I don't know if you run into this as well. Is it making the podcast your often talking to people who are either so lost, that they're just looking for information, or they're very. And maybe this is an end or so interested in doing better for themselves. It's a certain type of personality and you forget that you're, it's also a certain type of, sometimes it's a certain type of financial ability to write because these people have pumps they have you know, CGM is oftentimes, which means they have insurance. Yeah, I remind myself all the time, that that's not nearly most people, you know. And so, you say so easily, like, you know, I say so easily will put an algorithm on, it'll help them I don't even know if they have insurance, correct?

Jennifer Smith, CDE 20:40
Yeah. Right. And those are, I think, from a provider standpoint, those are the pieces that many are trying to understand and trying to navigate. Because there are so many different carriers, right, when you get into the group of people are using Medicare, and the restrictions and the things that you have pay attention to, or Medicaid, or even the general insurance plans that are national plans. Each of them has different pieces that work in a certain way in terms of coverage. And so that may dictate product to product, what you may be able to tell somebody about, I think, in general, all products should be an offering. And then when you boil it down, what's available in terms of coverage? What can you use? Great, you can have your choice of all the products, fabulous, you know, we're looking at your lifestyle next, then what does your lifestyle dictate? Do you you know, swim six times a week? Well, great, you probably may not love a tube pump, then it's going to be a lot of on off, disconnect, reconnect, etc. Do you really want an algorithm that's a little bit, you know, less your work and more at work, or a little bit less input? You know, there are certain systems that work person to person, and that's where you individualize once you know, what is available to them.

Scott Benner 22:02
Yeah, so Jenny's point is, if you don't understand how these different algorithms work, you can't just hand somebody out and say, like, here, you know, it's not like you're just handing them a lighter, and it makes a flame at the end. You're all good, right? Like it's, I guess, be more specific. Right. On the part five is a little more, we take care of it, you don't take care of it. Right, right. Yeah. Yes. And what do you think of the other ones to what is control IQ? Is it a little more?

Jennifer Smith, CDE 22:28
Yeah, I think that one is the most unique of the three that are on the market, it's most unique, because for those people who have fairly good settings coming from maybe a conventional pump that isn't giving that assistive help, right, if they've got fairly good sis settings, are there willing to test some settings, the control IQ system from tandem allows the users Basal profile, insulin to carb ratio correction factors and everything to be used by the algorithm to adapt or Anatidae app to adjust up and down. Their algorithm is really simple. It takes your baseline, it adjusts up or down based on factors that are very simple. But the great thing is that it works off of a pattern that for the most part, you know, works well. You just need some help navigating cleaning up little ups and downs that you otherwise would have to do on your own. Yeah.

Scott Benner 23:23
How about the new Medtronic, I'm starting to hear people speak really well about it?

Jennifer Smith, CDE 23:27
Yeah, the new Medtronic actually has a I think of, of the three systems on the market. It's, it's auto micro boluses. Or it's micro corrections along the way, are the most aggressive quite honestly. And a lot I've heard the same thing I only have a handful of people that I've been able to use it with us far because it's again newest kind of but it really it quite honestly does a lovely job. It's adjustments in between its corrections for those climbs and whatnot makes it a lot less the person's job to try to navigate. So yeah, it's a they've done a really nice job with updating that Yeah. And then

Scott Benner 24:08
there's the the newer eyelet pump, which I don't know how like readily available that is Yeah, but there's a pump that tells you you don't really need to do anything like you just tell it I'm having a what is it a normal large or extra large meal something like that and it's breakfast lunch or dinner normal? Yeah, small normal large This is breakfast lunch or dinner and it's going to dig make adjustments where you know your blood sugar's are going to maybe go up from that it's going to I don't even know what they're saying. Like, I think they're trying to promise in a onesie in the sevens. But still, for my opinion, if you're a doctor, and you've got somebody running around with an 11 a one see that you're just like, look, they're not going to take care of themselves. This is a this is a great idea. And I don't know where that pump is with Medicare. Yeah, I don't know where they're at with that. Like I know Dexcom is good with it, right, the CGM czar now Omni pod, I think has Medicare coverage. I think they all like probably do.

Jennifer Smith, CDE 25:04
Definitely, yes, I've got a couple of people I work with on Medicare who are using tandem. But

Scott Benner 25:10
then that's the next spot is that you can't just tell somebody, oh, you should get a pump. Right. Okay. Like, I don't know how to do that. Do you know how many people don't know how to? I'm not going to sit here and argue whether or not people should or shouldn't understand how to handle their lives. Okay, they should. But if they don't, that doesn't mean they don't get an insulin pump, or that they have to have an A one C and the elevens. I think it's got to be incumbent upon that the doctor to build an office staff that can help shepherd people through these things. No, absolutely

Jennifer Smith, CDE 25:39
have an office staff that's knowledgeable in technology is really important. I think, you know, it's one of the it's one of the filters, that when you are searching out clinician who can help with your diabetes management. It's certainly one of the things that you can ask when you call to make a new appointment. How does your office navigate this? What technology do you understand? What's the especially if you're type one versus type two? How much of the clientele that you see is type one, right? The all those questions are a good way to filter when you're in the search for a new endocrine providers specifically. Because there may very well be some that are very tied to one pump, despite there being multiple options available. They have known and kind of gotten used to the one and they're very inclined to recommend that one versus the other ones being very likely just as good or maybe better for your personal need. Yeah,

Scott Benner 26:40
at this point, too. There's, I mean, if you live in the Midwest, upper midwest, you're very likely are being told about a Medtronic pump, because the company's nearby there, and it's just sort of like a thing that's happened, right? I'm assuming back from Salesforce days where people were just probably working for the hub, you know, Omni pod is very sexy online. Like it has like a social media following Do you know what I mean? Like, yes, they have that. Like, you don't see people taking pictures of their tandem pump, as much as you see people taking pictures of their on the pod, which is interesting. You never see pictures of people with their Medtronic pumps. But I also assume that those are more like that slated and people who are like, well, I'll just take what the doctor tells me to get, and I'm not going to think about it again. But they're all different segments, I guess is what I mean, like in business, if that makes sense. Yeah,

Jennifer Smith, CDE 27:30
absolutely. And I think sometimes to even in, you know, working with so many people, I've had people who were one pump for such a long time. And again, my job as a diabetes educator is to be able to help somebody with individualizing, their, what they need in their life. And we can say, well, you know, what, you've been using this, you're using it really, really well. But you know that this new product, think about these things in your life, this would fit you better, you're coming up for a new pump, you know, your end of warranty is coming. Research this, let's talk about this. And those are all steps that as again, a clinician, you need to have in the forefront of your mind whenever you're working with somebody. Because if you're not getting the results that you want, and they're complaining, because they're not getting the results that they want, but you're not changing anything, then you're kind of at a standstill. Something has to change. And it might be their technology. Yeah,

Scott Benner 28:32
not very well could be also I think it's important to remember that moving from MDI, to pumping or pumping to algorithm pumping, feels like starting over to people, and they're going to be very, a certain kind of person is going to be incredibly resistant to that. And by the way, a certain kind of person is going to be like incredibly enthusiastic, maybe more so than they should be like, You know what, I mean, people, some people jumped around from devices all the time. But, you know, even if it's in your head, like, Hey, I think if you use the pump, like Jenny was just saying, we we'd see a difference here. And the person goes, No, thanks. I don't know. Like, I think he maybe should dig into that a little more. Because I know you're picking up the chart and going asked about a pump check. You know what I mean? Like, like, don't

Jennifer Smith, CDE 29:15
don't do don't do don't just check a box. But there is your that's a great point. It's No, I don't think so. I mean, it begs the why, right. And if they offer some really good reasoning, I'm doing well here. I think I you know, I needed this there. Maybe there are some pieces that you could be more informative as to how could a pump actually improve some of the things that they're bringing in as concern? Right,

Scott Benner 29:41
right. I'm also not talking about badgering people. I'm just saying that. I've just spoken to too many people who will eventually say my doctor asked me for years, and I finally broke down at Oh, I wish I would have done that sooner. Right. Absolutely. All the time. Yeah, not just about pumps, CGM EMS Paying attention to like the food I'm eating like like the Oh, I wish I would have paid attention sooner sentiment is wallpapered around diabetes, you know? And yes, what I'm saying is, is, is there not a way to say something, do something, ask a question that leads to people? You know, right, giving it harder consideration and moving. Exactly. Yeah,

Jennifer Smith, CDE 30:22
absolutely. And I think your technology is, for those who are, who have grown in the years with diabetes, I think, if that hasn't been a discussion that's revisited recently, for somebody who's been using, as we said, more of a conventional pump, right? They've been on it. And they're, you know, they're doing baseline, they're doing pretty good. And they're kind of at this place of comfort. But there are some things that you can see could be better with some of the newer systems, sometimes, those are a little bit more in depth discussion of bringing in, hey, you know, I know you've probably seen this, I know, you've probably heard about this, let's have a discussion about how this could really be a benefit beyond what you're doing. Right. And sometimes that that's hard. The growth of technology is really, really, really moved in the past couple of years.

Scott Benner 31:18
It's happening much more quickly now than it has in the past, which I think is also another reason why doctors are getting left behind and why I'm, I'm talking to people who are saying, at the end of my appointment the other day, the doctor asked me if I would stop and explain how am I pumped work to them? Which by the way, the person was not filled with, like confidence when that happened? No, there's there's a two headed argument there. At least the doctor asked, I maintain, they should have asked in a way that didn't leave the person going, Oh, my God, am I seeing the wrong physician? You know, yeah, because I can see the doctors perspective, by the way, like, you know, I don't know, I don't have diabetes. I don't know how this works. Can you show it to me? So Jenny, overall, we need the doctors to understand these devices, how they work, why they're important, how they can be helpful to help people get them, help them with their insurance, that stuff. And you know, make sure they have a choice. There's a lot of different options, those options work for other people for important reasons. Know what those reasons are, ask those probing questions, make sure you're getting them on a good device. And then I just want to add from the feedback that we got from people, Oh, yes. One person said that as an older type one, they equated a pump with being a bad diabetic, which is a term you hear a lot from people, you know what I mean? Like, and so, you know, that idea, like, cuz you know, what, from type two diabetes, oh, if you can't control it with food, then you didn't try hard enough. So now we're gonna give you a pill, oh, the pill didn't work? Well, you're gonna have to give you answered, you must have the really bad kind like that right? Progression or right

Jennifer Smith, CDE 32:47
or failure, right? That really brings into the person with diabetes, I've clearly failed. And then you're on a slippery slope of getting them back up. And acknowledging this isn't a failure. This is progression. This is many times where things navigate and let's get you using what's going to be appropriate to improve and prevent further issues down the road. It's

Scott Benner 33:11
another reason why the communication is so important. Because if you communicate failure to them, they might then start getting what they expect. And if they expect that they're failing, then they might let go of things, the amount of times that people just like throw their hands up, because they're so frustrated is true. So, you know, please let them know that getting these devices doesn't mean they're doing a poor job. This is going to help them experience something they didn't think existed, right? Not, you're doing a bad job, we need to do better. This is like, Hey, you should see what exists now, like, this is incredible, you know,

Jennifer Smith, CDE 33:43
should be put out there as a step forward, not a step back. Yeah, it should be an example of, well, this hasn't been working the way that we wanted. But you know what, if we bring this into the picture, we're going to be moving forward with your health, overall quality of life, all these things that should be given examples as why it would be positive to include this type of technology. That's where you should be explaining things and coming from a clinician standpoint, so that you don't get that negative. Oh, well, I failed anyway, I guess I have to do what the doctor says. And then you do the baseline, right? You never go forward with asking for more information, because clearly, I've failed. I just have to deal with this new thing now and not learn any more about it. I'm gonna

Scott Benner 34:32
leave this here at the end for anybody listening agenda. You can do this too, if you want to. I'm not pressuring you. I'm looking at my daughter's last 24 hours. She manages her diabetes the way I told her to she understands timing. She understands how insulin works. She understands how food impacts her. She's wearing a CGM and an algorithm. Her highest blood sugar in the last 24 hours was 154. That was a spike after a meal that lasted for no more than an hour and a half. And since Then her blood sugar has not been over 125 or under 72 For the last 24 hours. That's fabulous. That right there. That's an algorithm right there. Yay, no input, Jennifer, not like nobody's doing anything except announcing carbs and right. That's it, right. So please, if you're a doctor, and you don't know about this stuff, please learn about it. Because you could move an entire generation of people with diabetes, not forward, you can delete them. It's the difference between driving from New Jersey to Connecticut for vacation, and getting on a rocket ship and going to Mars. So,

Jennifer Smith, CDE 35:40
you know, we talked to talk to clinicians about, you know, educate yourself, one one step of navigating education for yourself is get in touch with your area reps, get in touch with the clinical for all of the companies for these technology, you know, driven devices, and learn about them. Many times, they've got demos, they can pull, bring in for button pushing and whatever. There are even online resources like Dana tech for the clinical who, you know, if you look under their Panther services, essentially, you can look up all the devices you can play with simulated devices online. Yeah, I mean, they're wonderful resources for your reference,

Scott Benner 36:19
whereas CGM, I mean, you can wear dummy, like, No, you can wear like a, like a Omni pod. That's not a real pump. That's just gonna give you the idea of what it's like to wear it. But you could actually wear a CGM and watch it work. Yes, that would be a big deal. And take a meter homes, you know, if you have to calibrate it,

Jennifer Smith, CDE 36:37
and learn how the meter works. Yeah, learn how the

Scott Benner 36:39
meter works. First, it really would be incredibly beneficial for people. Okay, gentlemen, thank you so much. Appreciate it.

Jennifer Smith, CDE 36:45
Oh, course thank you.

Scott Benner 36:52
Arden started using a contour meter because of its accuracy. But she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter, there's already so many decisions. Let me take this one off your plate. Contour next one.com/juice box. If you know a health care professional that could use this series, send it to them, or anybody else for that matter. And if you're really enjoying it, please take the time in your favorite podcast app to leave a five star rating and a thoughtful review. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Die diabetes Pro Tip series is available for you from Episode 1000 to 1025. And for subscribers in Apple podcasts. You'll get those same episodes ad free. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com