#1243 DIY Insulin Algorithm - iAPS

Episode 1243: Advanced Diabetes Management Techniques with Deniz

In this episode, Deniz discusses the benefits of advanced diabetes management techniques, including the use of algorithms and loop systems. Discover how technology can help you manage insulin doses more effectively and simplify your diabetes care. Deniz also touches on the psychological aspects of diabetes management and the importance of having a supportive community. Listen to learn more about these cutting-edge strategies and their real-world applications.

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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 1243 of the Juicebox Podcast

today I'll be speaking with Dan he is 31 years old from Germany he's had type one diabetes for 27 years, did a lot of MDI actually for 25 years but he's recently got a pump and become very active in the do it yourself community. We're gonna get to know Dan and then the second half of the episode is pretty specifically about Iaps which is a do it yourself algorithm. 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. Hey, everyone, I need you t one D exchange.org/juicebox. Head over join the registry complete the survey should take you about 10 minutes. They're looking for type ones, and caregivers of type ones who are US residents to complete this survey. When you complete the survey, it helps type one diabetes research significantly. I can't stress enough that your time will be well spent at T one D exchange.org/juicebox. completing that survey simple survey you'll know the answers no stress. If you have a chance to check out the private Facebook group Juicebox Podcast type one diabetes on Facebook today's episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org. Check them out on Facebook, Instagram, and go to touch by type one.org to learn everything about what they're doing, including their big event coming up. This September in Orlando absolutely free to attend. I'll be there Jenny will be there go get your tickets now touched by type one.org. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next one.com/juicebox. Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it too. So screen it like you mean it. One blood test can spot type one diabetes early tap now talk to a doctor or visit screened for type one.com. For more info. This episode of The Juicebox Podcast is sponsored by screen for type one.com. Guys, I'm going to read you something. At the time of this recording. Dennis was working on Iaps. But shortly after he moved his focus to trio, which is a new version of the Iaps app that's been started by a number of former Iaps contributors. TRiO is currently in an open beta. But keep your ears peeled for a future episode about trio once the app is officially released.

Deniz 2:58
Hi, my name is Dennis. I usually go by then I'm 31 years old. I'm from Germany. I've been diagnosed with diabetes type one in 1987 which should make it 27 years of type one I think now for the better part of my life. I've been on MDI, actually 25 years. I've gotten like very, very lately into like tech and you know, the whole CGM pumping, you know, IID EPs and stuff. So, yeah,

Scott Benner 3:27
wow, you got diagnosed when you were how old? Like, four,

Deniz 3:32
I was of five by five close to turning six a year after

Scott Benner 3:36
I got married, which just made me feel very old. How long have I been married? I've been married 27 years. Yeah,

Deniz 3:43
more than more than like, a quarter of a century. Man. That's a

Scott Benner 3:47
long time. Okay. Okay, so you're diagnosed at five? You're 31. Now you did MDI for the first 25 years?

Deniz 3:54
Yes, I've just gotten a pump. Last year. Actually. I've got my first CGM in 2019. Okay, which is quite funny. Because I'm actually super into tech, I was always into computers and gaming and stuff. I'm, I'm a, I'm a software developer by a career choice. And I actually got a degree in computer science and a postcard in computer science. So it's, it's kind of weird that I've not stepped into the old tech stuff around diabetes earlier. But for some reason, I was just, it was working. And my endo was is like, who's also type one, by the way, it was just like, you know, what, why do I change the car? When is it running perfectly fine, you know, just like, Dr. And so I've been on it for a long

Scott Benner 4:33
time. I'm always interested when people say things like, it's going great. Or it was working or I love my doctor, what what does that was working mean? What were your outcomes? Like?

Deniz 4:41
Not gonna lie when I was a teenager, you know, I had the whole rebellious phase. So they were like, some really, one high a one season there, and, like, just above 10 1011, right. But I had a very, very bad decay when I was I think 19 Or yeah, I think 19 And that basically really You know, make me get my together. Yeah. And so after that I've been in like the low 60s on MDI. Even with just fingerprints actually, I started to work out a lot. I started, you know, watching what I eat and watching my diet, basically. And then I got a CGM in 2019, which was pretty late. And while on that CGM, it was even below sixes. Like it was just between like 5864. Right? It was like ranging in between that on MDI and just just the CGM. So I switched to basically a pump because of something we're probably going to get into later. But yeah, let's let's concentrate on them. Yeah, but

Scott Benner 5:38
so like those first 14 years. So up until the dka, basically, you were, what were you always bolusing kind of bolusing sometimes Bolus, like how to like what did that look like, like skipping meals once in a while always taking your basil but not covering foods, that kind of stuff.

Deniz 5:57
So basically, I was I was diagnosed when I was five years old. And back then they used to do things in Germany very, very conservatively. Right. So you basically, you got your long acting in the morning and at night. And I had basically like set times and set carb amounts to eat and set bonuses to go with that, because they weren't really doing the whole, you know, check your sugar. And depending on what it is, you need to you know, correct your blood glucose, and then your goals for the meal. So I was basically finger printing in the morning 730 before school, and then I was like fingerprinting lunch, and there was maybe finger printing in the afternoon and before dinner, and I was just like eating at like set times and giving set bonuses. And I was giving like my set long acting insulin, which I think was lentes at the time. You know, as time moved on, I wanted to get more independent. And then they kind of put me on like a new thing, which they called the intensive therapy plan, which was basically how you would do MDI in like a modern way, right? It's just like, check your blood glucose, whatever it is, here's the ICR his eyes F right. And then you just like, correct, and you go, like, go with the flow, but you still just use pen injections. So being like a teenager and stupid and not really understanding what you know, long term complications mean, you know, you just sometimes you you stop fingerprinting, and you just go, oh, oh, well, that's two cheeseburgers, I'm gonna do like five minutes. And then maybe your sugar was like 220, or like 180. Or you shouldn't really have done just like five units, right? went along like that throughout, like, through my teenage years, my parents, they got divorced, when I was really little, even before my diagnosis, actually, my mom was like, having super big mental problems and like, personal problems, and she wasn't really like, on top of my diabetes, while I was being like, I was a child and a teenager. So I was kind of on my way, like, by myself, in that regard, like, you know, she, she took me to the regular into appointments, stuff, it's not like she was she was like, sleeping Willow bridge or whatever. She like, she wasn't really like, like you are if Arden, for example, right? She wasn't like on top of my diabetes, and like, you know, slowly educating me to like, take care of myself. And you're like, letting me off the reins, so to speak, but still pretty much on top of it because it was a teenager, right? And so it just, it just kind of went that way for a couple of years. Right? You

Scott Benner 8:01
don't recognize it's a long, long process to understand a big idea. And it's not like sitting down and talking about it for two hours. It's five seconds here and five minutes there and saying something on the first of the month and remembering to say it again, three weeks later and biting your right through your lip. If they do something that you're like, Oh, not that, but you don't want to call it it's like a pressure point. So you just cruise through it, ya know, it's okay. Don't worry about it. But then you have to make a mental note then as a parent later to come in and clean it up later. It's a lot of work. I understand why it doesn't happen. And if your mom was having other trouble on top of that, then I mean, it makes sense.

Deniz 8:41
Yeah, yeah. And so like, in retrospect, I can, I can understand what happened when I was a child. And when I was when I was a teenager. Frankly, it's still between us. And we're like various estranged with me being an adult and her, you know, not being retired. That kind of really still stands between us. Yeah. Right. Other things as well. But that's also like a huge portion of what kind of stands between us. Yeah, it's like, yeah,

Scott Benner 9:07
but then sure, I mean, that that listen, I'm standing in the middle looking at both sides, I see what could have happen to your mom. That doesn't mean that she didn't still need to do it. You don't even like it's hard, but you still have to go do it. And I just think that a lot of times people think that making a baby is like buying a house plant. You know what I mean? Like, Oh, I love the way this looks I'll put it in the corner and every once in a while dumped some water and it'll probably be okay. Very much not like that very much you making children is not for the faint of heart. And if you think it's easy, you're probably doing it wrong. So you know, they mean Yeah. So you and your mom to this day, not not a great relationship and you think it's mainly because of your diabetes,

Deniz 9:49
not because of the diabetes but basically because of like how she reacted to diabetes and but it's not about like, the main thing, right? Like my, my mom has personal problems and she still has them To this day, like, right, I'm I think she's borderline narcissistic. Right? And it just, it just builds issues. Like first of all relationships, not trying to like tell my mom, for God's sake. Right. But it's like, it's it's just a very difficult relationship with her. Right? We talk from Time and again, right, but But honestly, she lives like 10 minutes from the place I work at, right? And I don't really think I have seen her in like the past six months. And it would just basically be like, you know, guys, hey, I'm going for lunch break, and I could just like walk over and have coffee with her basically. Yeah, right. And we don't we don't do that kind of thing.

Scott Benner 10:32
Does that bother? I noticed that's not why you're on. But does that bother you? Do you think about it? To an

Deniz 10:37
extent because because I also don't really have a relationship with a father. Right? Because, you know, they they split and he went back, like he's from Turkey. Right? So I'm half German, half Turkish. And he went back to Turkey. And I normally I don't even know if he's still alive. So you know, there's the father figure gone. And then there is also the heart relationship of the mother. Right? So it's not I'm an orphan, right? She's still there. And I had a really, really, really important relationship with my grandma. So my mother's mom, but yes, sure. It bothers me, right? Because, for example, I see how extremely close my girlfriend of nine years is with her family and her mom, especially right and also a father. So yeah, sure, sure that bothers you, right? Because you kind of want to like rely on family. But I got a tattoo on my right arm, which says true friends of family. I got that long story. But I got that when another friend of mine was going through a really hard time, and we were all drunk. And then we all like made that vow to get the tattoo. And so there's like four people running around with a tattoo now, which says true friends of family. And I really mean that though, right? It's it's like a funny story when we're like, young and stupid and drunk, right. But it's like, we didn't get into to have a drink, by the way. So you know, don't drink and drive and don't drink and get tattooed. We got it after the fact. And I still kind of live by that. Right? I kind of really consider a group of really close friends, I have my family. And I have done that for probably the past 10 1215 years, I guess. It makes solid sense to me. Right? And so it's, I've kind of, you know, chosen the family I want to have, as many people do. And the family you can't really choose, which is usually your parents or siblings and I don't have siblings. I'm an only child, you know, they're there. And there's past that happens, you know, this history? Yeah. And I kind of just, you know, have to live with it. As I said before, right, I understand what happened and they kind of understand where she is now. being where I am in my life, you know, coming from like a working class family, having myself worked up to like a post grad degree working as a software engineer, right. It's life is hard, right? Life Life isn't always, you know, a pony farm. But still, it's you know, it's

Scott Benner 12:35
I've never heard life's not a pony farm before. So you're very close to calling your episode pony farm, but go ahead.

Deniz 12:44
It's like it's like a German idiom that I just kind of translated. Because like in Germany would say the Siemens company. So

Scott Benner 12:51
Well, I definitely can't make that the title. Yeah. If you send it out to me, phonetically, I can make it the title. It's, I would, yeah, I think anyone would download it. If it was the title was like,

Deniz 13:01
Oh, we can totally try that and see how your dollar numbers are? Oh, I see

Scott Benner 13:05
you. You don't care about my downloads? You're like, Yeah, I'll just let the whole thing collapse. Scott will try it. That's hilarious. I actually, I'm gonna get you to send it to me. So okay. I think I'm just gonna kind of fast forward up to last year, because trip, I think it's fascinating to just do MDI for 25 years, being a software developer. And then one day go, hey, you know, what? Why don't I try this other thing? So my first question is, were you not exposed to it? Like, did you not know it existed? Are we just happy with how things are going? From the very beginning, your kids mean everything to you, that means you do anything for them, especially if they're at risk. So when it comes to type one diabetes, screen it like you mean it, because even if just one person in the family has it, your child has up to 15 times more likely to get it to screen it like you mean it. Because type one diabetes can develop at any age. And once you get results, you can get prepared for your child's future. So screen it like you mean it type one starts long before there are symptoms, but one blood test could help you to spot it early, before they need insulin, and could lower the risk of serious complications like diabetic ketoacidosis or DKA. Talk to your doctor about how to screen for type one diabetes, because the more you know, the more you can do. So don't wait. Tap now or visit screen for type one.com To learn more, again, that screen for type one.com screen it like you mean it

Deniz 14:37
well, so Okay, so I knew it existed but honestly, I didn't really like look into it that much. Because I was always kind of happy with what I had. And so I kind of started looking into like more tech stuff before I went to like a semester to study abroad like a semester abroad to study in Canada. I studied one semester in Vancouver. And I was like, no, no I kind of want to have like my hands more like my hands free to do stuff abroad and then so that's when I got the CGM, basically, because my Endo, he was like, Oh, now you want to CGM. Really? Yeah, sure. Let's go for it. So we did that. I'm in Germany. You know, we have like the whole universal health care thing. You know, it's easy for me to get a CGM. So I got a CGM after like some paperwork. Honestly, what made me go from MDI, after so long to pump therapy was basically suddenly out of nowhere having a macular edema in my eye, right. So I went to into the, like, the regular checkup with my, of the eye doctor guy. And they, you know, they do the whole thing where you like, drip dripping in the eye, and the whole thing gets bigger. And then they look into like the retina. And I don't really I don't have retinopathy, and I don't have anything else in the eye, basically. But suddenly there was this macular edema. And so the guy goes, Yeah, how's your diabetes? And I go, like, yeah, my agency is like, five, nine, and the one before was like, six. Oh, and the one before like, was also an A goes like, Oh, you got to be kidding me. And I'm like, No, seriously, like, the past eight to 10 years. I've been in like the low 60s. And you know, I got my act together. And so it was like, Okay, this is this is super, super bad. And we need to fix this. And so they started me on like, like, I injections for eight months. I think it's gone now. Right? So spoiler alert, it's gonna, everything's fine. But when I went back to my Endo, and was like, okay, so I got an issue. I have something in my eye. What do we do now? Yeah. So he was basically like, Okay, your diabetes is basically so like, fine tuned, we kind of need to find out, like, what the issue here is, it was like, you know, this, this could be long term complications from basically having somewhere between like, you know, eight to 10 years of both during your childhood and my teenage years, but it was like, still, it is really early to have that kind of complication. And at the time, I was 30. No, actually, I just had turned 31 to have that at 31. With like, the sugars you've been having for the past 10 years. Yeah, he called it metabolism fluctuations. So, you know, talking to you, it's basically the whole postprandial spike. So going higher, going high after a meal or going high at like a random point in the day, and then coming back down, being in range, but just the whole, you go up, you go down, you go up, you go down. And he was like, yeah, maybe that is, like some issue because they can also, you know, change things in your eyes, if you have a lot of that basically. And say was like, you know, your agency is really low, and really well tuned. And the only thing that I personally can think of is basically, let's put you on a pump. And let's try to basically replicate the human body functionality, as closely as variability with the spike. Exactly, yeah. Because if you if you're on 10 injections, if you're especially if you're along like like long lasting insulin and shortlisting like reppin, insulin, it's always you, you do the injection, and it's always a push, and the push of insulin and the push, and then it levels out. And then you know, it's it becomes effective, right? And then you have, but you always have this like certain peak. And as you know, if you're on a pump, you only use rapid acting or ultra conducting insulin, you don't really have like those high peaks, right? And he was basically trying to get the insulin dosage in my bloodstream as you know, as evenly as possible and also get blood sugar as evenly as possible, right? Yeah,

Scott Benner 18:16
I think back I just had an experience where I was talking with somebody the other day about some of the things that they learned on the podcast to the Pro Tip series. And it took me back to managing Arden like that, before you know Arden's using Iaps. Now she used loop before that she's used Omnipod, five, like, we've used a lot of different algorithms. And before that, an algorithm wasn't a thing when Arden was eight years old. You don't I mean, like, so it was just me like looking and thinking, like, we have to match the effort here, right, like blood sugar is making an effort to drive up. I need to be making an effort to push back but not too hard. And you know, once you have a CGM, it's really when it opened up for me right art and puts a CGM on you can see it in real time. And you're like, oh, I need to add, I don't know, the way I thought of I was like, I need to add resistance here. You know, and not insulin resistance, but resistance with insulin, like blood sugar is trying to go up. I'll put some resistance here. So it can't go up. I'll take the resistance away. So it doesn't create a low later, you know, if she tries to get low, we're going to add some resistance with carbs, but not enough to push her back up again. And now I look back in hindsight, and I go, Oh, I was an algorithm. That's, that's what I was doing. I was I was just about to say any of the algorithm and it was exhausting. I don't want you to be like, no one should be confused. I was exhausted and dying, I think, yeah, totally. And up in the middle of the night and etc. But Arden's a one C's were in the high fives, and mid to high fives, and she was growing up and didn't have any trouble with their diabetes and I kept thinking, I mean, hopefully something will come along, right you don't I mean, like and then all of a sudden one day like there it was. So Having that experience of living like that, having figured it out on my own, finding out a way to apply it, and then seeing a machine come in and go, Oh, I could do that for you. And then having watched them now improve over time. I keep thinking like, wow, this is insane. Like maybe, like fingers crossed, like maybe Arden doesn't go into an eye doctor ever and hear Hey, what's that in your eye? You know what I mean? Cuz that's really the one that's what I'm doing it for. Right? Like you're you're doing it for short term happiness and health and long term happiness and health. The whole thing is happiness and health. Honestly, I'm glad that they were able to fix it for you. How many injections did you get before it was clear?

Deniz 20:36
I got I think eight injections. So yeah, January to August every four weeks.

Scott Benner 20:41
They say it doesn't hurt. Is that true?

Deniz 20:43
It really doesn't hurt. But the funny thing is all

Scott Benner 20:48
right. Like when they're coming at you with it? Well,

Deniz 20:50
so Okay, so typically, they they put like this thing in your eye, which basically like prise open your eyelids, and you're like told to Okay, and now look at like a certain direction. I think for me, it was like, like, lower lower right corner, basically. So you were just like looking down. And then they do the injection like all the way up there. Right? The eye is numbed a bit, right? That would like a numbing drop trippy thing in there. They sanitize the shot AI as well. Like, like, did they put all this stuff on your face. And you're like not like, you're basically saying that like this, you're like not supposed to touch your head at all, like grief, or move or whatever. And then they do the injection and you don't feel it, you don't see the needle. The only thing that I felt was basically it's a bit like, as if someone like just like, precious, like, put some pressure on you. Like, if I don't tell you I'm touching your face. And then suddenly a finger touches your face, like very rarely. But it felt like that's the feeling in your eye. Like you feel like a little pressure thing. And then what you see is basically it's a bit like as if suddenly before your eyes, there's like there's like fluid or like a fog, okay, for like a minute because that's like basically when he pushes in the injection solution, right? And it kind of it kind of mixes in there on top and does whatever. But now you don't you don't really feel it magical funding your studies saying it doesn't hurt. So he does the injection I think was a third of the fourth one. And then he does an injection. And I feel like him pulling away after the injection. And he goes, Oh, and I'm like, Doc, what is Oh, like, please don't just Oh, me. And he goes like, yeah, so I think a little blood vessel just burst. That's totally fine. That's, that's all right. Nothing's gonna happen to you. And I'm like, What do you mean blood vessel verse? Yeah, there's just like, some minor bleeding, don't worry about it. And then, you know, they they took like, they took like, some tissues and put it away and then took like, some more sanitizing lotion on it right to like, stop the bleeding and stuff. And then they were like, okay, you'll be on your way Your eye might be adjusted a little bit read just a little bit read, don't don't worry about it in like a week or so it's gonna be like it's gone. Okay. And so I was like, Okay, fine. And so they basically put a bandaid on your eye after that. And you're supposed to leave it on for like six to eight hours. And so I had this bandaid on my eye. And then in the evening, because the appointment was like 10am or something. So in the evening, I took, I think the band aid off tomorrow, and they're looking like I'm in the bathroom. I took the benefit of my and I look into the mirror, and I kid you not I looked like like T one. Like, what's the terminal name? T 1000. Like my like, like my I was completely red, like completely. There was no, no white left him I was completely red. And so I'm like, what the actual F is happening here. And so it was it was like eight or nine, eight and 9pm at that time. So the the the clinic was closed. And next morning I called them and I'm like, Yeah, so the dude said there was a little blood vessel that burst and I thought like, you know, have like a weightlifter who has like a little blood vessel in the eye, right? And you just see like this little red thing in their eyes. And they're like, Yeah, you know, what, if it's really that bad, just come in tomorrow. And so I go in and I'm standing there in like the welcome area, and people are going by me and they're looking at me like I'm a zombie. Right? Because like the whole I was like, yeah, so anyways, he was like, he looked at it the next day, and he was like, Yeah, you know, it does look bad now but it'll be gone in like a week. And so I ended up looking like at five weeks. Five we'd like it. Yeah, because he was so that was like so much blown.

Scott Benner 24:05
And could you see that time? Yeah,

Deniz 24:08
no issues we've seen like little but it was just like,

Scott Benner 24:12
wasn't like a horror movie. Everything wasn't read or tainted or

Deniz 24:15
No, no, no, luckily not. Yeah. And so it took like five weeks and it went from like laundrette to like basically brown to like lightly yellow. While it was like basically decomposing the blood in the eye or whatever.

Scott Benner 24:29
Blood took you a month to explain to the entire neighborhood I don't have some weird i COVID or anything like yeah, please don't. Yeah,

Deniz 24:37
it was kind of bad because you know, at work like my close team, like the four or five guys at work, they kind of know something like everyone like everyone who asks, I'm going to tell them about Vedic right and my close team. They know it. They know the pumps from beeping and CGM from beeping right? Yeah. But if you just like suddenly walk into work with like an eye that looks like that everyone's going like stay away. Stay away. And so, once like so let me let me see if I can, once I can show me a picture, I'm gonna show you picture once like how do I,

Scott Benner 25:08
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/juice box, you're gonna 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 One 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.com/juicebox. And if you already have a contra meter and you're buying test trips, doing so through the Juicebox Podcast link will help to support the show. Dan and I are looking at each other day, which we don't do very often but he's got like a rock solid internet connection and I have to admit, I can't look at myself because I can I can I'm so stunned at how like when I hope my god that's your that was

Deniz 26:32
that was that was just like after the like after took the benefit of that was This is horrible.

Scott Benner 26:37
Part of me wants to send that to me so I can make that the cover image for your episode. Oh, please.

Deniz 26:42
Oh, please don't and so and so. Oh, I'm sorry. I'm sorry. This was this was right after the injection. Okay. And then what I showed you this this was like the next morning. Oh my god. And I walked around this for like, like a solid month. Like,

Scott Benner 26:56
you look you look like a like a robot? Like yeah, exactly.

Deniz 27:00
I looked like what's the name? TT 1000. Yeah, yeah, the Terminator. Yeah, I looked like the Terminator was like, just the right I it was it was really stunning.

Scott Benner 27:09
Wow. Did it hurt during that time? Or just looked weird?

Deniz 27:13
No, it just it just looked really weird. And it it felt a bit like as if you know you you bumped your your arm or your your like leg on on something. Right? Like, just just like a mild hematoma basically. But it wasn't it wasn't really painful, right? I could see without any issues. Right? Right. And yeah, I just I just looked like a zombie for a month. So this,

Scott Benner 27:31
this experience makes you say, I want to know about all this stuff now. So like, what pump do you go to?

Deniz 27:37
So second thing, coming back to the Hey, why didn't you get into like pumping or whatever, and did MDI for so long? I always wanted like, I always wanted to avoid tubes. I always wanted to avoid tubing. Periods. I never wanted tubes. So I'm using Omnipod. Now, right? It's the clear choice. And the thing here in Germany is we do have great health care. And we do have, you know, it's not a huge issue to get on pumps, but they are a bit picky when it you know, gets to either want that specific pump. Because, you know, or they just want to reach in the closet and give you the one they have. Yeah, kind of. And so so my end there was like yeah, that's that's gonna be a bit of a fighting, right. And so he basically put in like a bunch of paperwork to the insurance company here. Then we really actually had to fight and then I got the only pot dash I am on now I got it on trial I had like they they shipped me three months worth of supply here. And then after three months, I had to hand in a ton of paperwork, you know, glucose diaries from like, the past six months a one sees and the whole blood panels from like the past year or so. You couldn't just show him that picture of your eye. No, no, no, no, no, no. I wasn't worried. I was already on a pump when that when that happened.

Scott Benner 28:48
Okay, so yeah, I mean, like, Yeah, this is why I please,

Deniz 28:53
exactly. So anyways, I was we were really fighting. And so I got it on trial. And after three months, everything was even better than it was before. So I went from like, the agency before I went on Omnipod was six, two, and the agency right after was four or five. So I it dropped by it dropped by a weight. Within a span of three months, you

Scott Benner 29:15
eat in a low carb style or something like that. No,

Deniz 29:18
I basically, I basically did the whole I'm training with the lady from insolate at the clinic. And the second pod at home was on loop. Because I was like, you know, I'm a software. I'm gonna do this

Scott Benner 29:32
right. So you went from 25 years of MDI, almost directly into I'm gonna download an algorithm off the internet and use it. Sure. What, why does that I love I love the why not? I'm trying to figure out why not sooner.

Deniz 29:45
That's true. That's true. Why don't sooner and I've actually,

Scott Benner 29:49
I mean to say I think there's a bit of a lag because you're in a different country. I'm sorry, I'm talking over you want to know outdoors. I don't mean like, Hey, why didn't you figure it out? I mean, like, why did it like it? Just see seems like such a natural step to me. Like you're a software developer, you're in your 30s. Like, if I said to you, Hey, you want a Tesla, right? You'd be like, Of course I do. Like that fits in like the narrative what you're interested in like, it just feels like this should as well, but you, but it really took like a health scare to get

Deniz 30:18
you there. It took a health scare to get there and I don't want to put any blame on my endo because he's a really super great guy. He's He's a type one himself. So great bedside manner, you know, because if you're like talking to him about a specific issue you're having at like, a specific activity or whatever, you know, he gets it, because he's, it's like 99.9% He had already had that situation right? But he's an older guy. And he is like on this super old pump and he's basically I guess, team don't change a running system right? It's working for him he's having like from you know, objectively looking at it he's having all the results in like the you know, agreed upon metrics or like in the agreed upon ranges basically, right. He you know, he has yes is a one sees in the ranges that should be in, he's, you know, he's not having a lot of high posts or whatever. He's, he's doing okay. And in retrospect, I wasn't doing okay, right. Yeah, I 100% was overweight. My Basal was too high 100%. And I was basically feeding insulin, but I didn't really know it right. Even though I had a CGM. And I was I was having more lows, like my lows were below 5%. But now I'm having like, like, looking at the Dexcom basically, I'm I don't even have 1% of loads. Now.

Scott Benner 31:32
Did you lose weight since you went on a pump? Not

Deniz 31:34
that much. And I thought, I'm weightlifting. Like six, six days, sorry, six days a week. And you know, it's eating a lot and I'm eating like 300 400 grams of carbs a day, you know, I'm not low type S Sorry, low carb rain in any kind of way. And form or shape? Yeah, no.

Scott Benner 31:50
Do you think if I named the episode six days a week, anybody will even hear it through your accent? That was fantastic. Like, I'm weightlifting, weightlifting, six days, six days a week.

Deniz 32:00
Yeah, go for it. Because because the Jerwood for six is six. Okay,

Scott Benner 32:04
I heard you get caught in between two languages. But so basically, you've got a great Endo, but he's older. His mark for what is good is different than what is good now. And he's, if it ain't broke, don't fix it person. In a world where things are moving so quickly. You always have to have an eye on what's happening. You don't need me. Exactly. Yeah, exactly. I don't know if you've ever like I don't know, then if you listen to the podcast, or you if you don't, or Oh,

Deniz 32:31
I do. I don't. So the thing is you released so freaking many episodes. I usually can't really get through like all of them by the time we release new ones, but I usually listen to like on the way to work and like my commuting. Yeah, I know. I'm also quite active in your group. Like, actually, you are a job. Yeah.

Scott Benner 32:52
Yes. Because I always I refer to one person, because the person helps me to Mike because Mike helps me with Arden's like algorithm, like the setup and stuff. And so if somebody has a question, I tagged him, and you're like, hey, you know, I can't answer that. And I'm like, I don't know you.

Deniz 33:08
But I'm actually commented that because I already had, like, answered the question of the poster. And I had, like, I don't know, like, like, 20 likes on it. And it was like, Hey, so what exactly can Mike dude I just answer here, and I was I wasn't being serious, right? It was.

Scott Benner 33:20
No, I know. You're kidding with me. But let me give you a little like, inside look, okay. Yeah, there's like 46,000 people in there. 125 new posts a day. I saw the gist of it. I ran my eyes through it. And I was like, I want to make sure sure somebody who really understands this solid, but I couldn't read all those comments. So I was just like, yeah, totally. Yeah. Like, it was, it was a lot of fun. But sorry,

Deniz 33:39
my endo is like don't fix it. Today, bro. kind of guy. Yeah.

Scott Benner 33:42
So I don't know how much of the podcast you've heard. But I put out a lot of content. There's no doubt you can't listen to all of it. And you can't, you can't have listened to the entire 10 years to know my psyche and everything. But there are a few things that drive me making the podcast right? Overwhelmingly, it's my daughter's health. Like, I think if I can stay abreast of things, then she has the best chance of being okay. And then everybody else listening gets the benefit of that. Right? Well, anonymous, and it's the community that it's created. Because, again, I've mentioned this before, I did not expect this part of it. I didn't understand that. Like, I mean, 46,000 people on a Facebook group, it gets 125 posts a day, like 9000 likes, comments, hearts. I think there's something like 28,000 of the 45,000 people are active every day in some way, shape, or form. It's like a small football stadium every day. It's insane, right? And it all flows, whether you think it or not. It all flows through me it follows my vibe, it does what I want it to do, like I'm directing it very kind of in the background. And so that all is very important to me, too. And part of what drives me because I see how the community supports people. And I see how people whose names I've never seen before, whose faces I don't recognize can come and tell me in a Facebook post. You don't know that I've been listening to this podcast for nine months but I have my kids they want CES 5.4 Yeah, like I helped that person without ever meeting them or knowing that I was talking to them. That's amazing, right. But the third kind of prong of what motivates me forward is the thing that I don't honestly talk about very much, which is my best friend who's, who's that, you know? So my boyfriend Mike was I don't know, you're, you're very kind to. But my friend Mike was diagnosed when we were just getting done High School. And we didn't talk about his type one diabetes, so much so that when my daughter was diagnosed, it didn't occur to me that I knew someone with type one for like a week. Oh, wow. Because that is just not how it worked. He was regular and mph, he shot. If he got dizzy, we fed him. Nobody wanted Mike to drive. You know what I mean? Like that was pretty much the extent of it. I knew him to be a completely lovely person, thoughtful and lovely and intelligent. But if you just met him a couple of times, you might think he was a little. It was probably like in the four hundreds I just stable, like angry like he thought he had a short temper. None of this is beautiful person. But I think about his blood sugar and how high it was all of the time. And oh boy, mike stands up in his living room and dies in his 40s, you know, just has a heart attack. And just, you know, it didn't take him that moment. But it it did in a couple of days. He was already on dialysis for years. Oh, wow. When I look back on his life, he was unlucky enough to be diagnosed at a certain time. Yeah. And then he was unlucky enough to be with a doctor who didn't push him to modernize his care. Yep. And I'm certainly not for just running forward and changing every time something new comes up. Like I'm not a new car guy every six months, kind of like idea even if I could afford it. But you can't find yourself in a situation where 15 years into your diabetes, you look up and go, what are people doing? I'm doing? I'm doing Lantis and MDI, yeah, you know what I mean? Like, because the advancements now are happening so quickly, that things are going to get better and better and better. And these are only opportunities to improve your health. And to stop you from standing up in your living room and falling face forward in front of your wife. Yeah, you know, like, so I just, these are the things that like, personally drive me behind the scenes to turn out. I mean, you if you saw my calendar, you'd pass out like I you know what I mean? Because I don't care if you please, everyone listening, listen to every episode, please. But if you can, I understand up so I put five out a week, you pick the ones you want. You know what I mean? And and that's what I do, basically. Yeah. But that's why because I'm trying to constantly reach people. I mean, if I'm being honest, then I have some guilt about Mike. Because of all the people that I've reached and helped. He would never listen to me. It's kind of ironic, right? Like, I'm like, you know, the guy that runs the thing. Like, I'll tell you, and he didn't want to he didn't want to hear it. And I do think sometimes that I just didn't try the right way or hard enough or frequently enough. And I am baffled sometimes that I'm able to help a person I've never met before remotely, but I couldn't help Mike to understand his diabetes better. I'm driven by the idea that I in very plain English do not want to die before my daughter. Yep. And I do not want to see her have health issues as an old man. Yep. Like, I don't know that in my 70s. I could look at my, my grown child have a real health issue and not want to throw myself off a building. So I'm doing a lot of things to protect my own psyche, if I'm being honest, you know.

Deniz 38:42
So just just just for the record, just for the record, Mike really got his together. I think you're talking about a person like Mike, right? You kind of know, but don't listen to the podcast. Did I get that right?

Scott Benner 38:53
No, no, my friend Mike is the friend. I'm not talking about the other mic. I'm sticking with my friend Mike is I grew up yeah, I'm sorry. I'm sorry. Okay. He just didn't. Yeah, never. I don't even think he ever wondered. Yeah. And then he didn't have the luck you I can't believe I'm saying this is luck. But he didn't have the luck. You had, like the first medical thing that popped up for Mike was his kidneys. Not like we can give you some injections in Iran. Yeah, yeah. You know, anyway, anyways. Yeah, yeah. Oh, sorry. But tell No, no, no,

Deniz 39:27
I'm very sorry. But it's basically you know, you're raising such a great, great point, because, like, my girlfriend was just, I think just the other day, we were like, sitting down for dinner. And she goes like, no, what? How come you didn't like do this all sooner? And I was like, we've been together for almost nine years now. And, you know, you've met me you've been part of my like, diabetes journey and you know, my life, right? What would you say? Like, was I living a bad life? Was I having issues with it? And she's like, You know what? No, you weren't right. And so I was like, Yeah, That's the point exactly. And it's so funny, not wanting to change topics here, but actually the great Katie De Simone, right, the creator of loop docs, I was actually following her on Instagram, because she started like a way to like, like a weight loss journey and started doing like CrossFit. I remember and I kind of knew her from loop because I had read off loop. And then I started kind of started, like, following her on Instagram. And we actually were like, exchanging messages on like, on a regular basis around her like, exercise stuff. And because I'm a gym person, she was a gym person. It was COVID. Right? We were working from home and in like a garage and stuff. And it was so funny. And it's like, it's like this thing like, these are like weird stories live right sometimes on the day, Katie passed away, right restaurant piece. I got my first pop. Okay, so I'm getting goosebumps right now talking about it. But it's it's like I've I've known these kinds of things. But for some reason, when you're like, not really pushed into that kind of direction. Because I was having like, high fives a one season, I wasn't constantly going low, or like staying super high all the time. Right. And so for some odd reason, and I can't really tell you why I honestly cannot tell you why I never got into it. And now looking back, it's like, I'm just doing so much less around diabetes. Yeah, like, right. It's like, I haven't CGM. Now I have a pump. Now I have an app that takes care of my insulin. Basically, I look at my phone, right? I've only looked at my phone. Since we've been talking because I'm getting messages all the time. I'm not even concerned about my diabetes, right? It's just I'm just, I'm doing a Bolus here and there, and the rest is taken care of. Right.

Scott Benner 41:33
I've been unaware of Arden's blood sugar for hours. Now, I don't know what it is or what it's doing. I haven't thought about it. The only reason I even thought about this morning is because we just upped her ozempic dose from 1.25 2.5. And then, like a day and a half after we opted, she started having these weird lows. And it was like, Oh, God, I think it's the ozempic and we're making changes to settings and stuff like that. I'm also a little panicky, because I have all the auto tuning turned on on Iaps. I think we realized that the ozempic needed to be turned up for a couple of weeks, but didn't like do it yet. Yeah. And so the the algorithm was pushing harder. And then suddenly, we thought, Oh, now it's helping and the algorithm is still pushing, so I'm trying to make adjustments and stuff. It turns out by the way, that's not where her lows were coming from her pocket. nicked up blood vessel. It's a second time. Second time it's happened since she's had diabetes. But we were basically she was mainlining insulin, like, yeah, it's like, it's like they're like this. Yeah, so quickly. So like, last night, I was like Arden luck. And like, we keep making these changes and nothing's happening. You know, like, We're chopping at your ISF. We're chopping it your carb ratio, Mike, you know, something's wrong. And and then two o'clock in the morning, she sent me a picture of like, this blood on her leg? Oh, yeah. Because she pulled upon it just like a fountain. Yeah. And she goes, Oh, I know what happened. And I was like, okay, so she put a new pot on, and we got her set. And I just sent her a text, like six hours ago. And I was like, hey, put the ISF back to this. And that said, I haven't thought about it again since

Deniz 43:06
then. Yeah, no, yes. It's the funny thing is, yeah, but I

Scott Benner 43:11
mean, all that turmoil and unknown ideas and things you couldn't imagine. And still in a 24 hour period, I had the whole thing worked out, and we're good again. And now I won't look at it again, should just go live her life. You know? Yep. So now I take your point. So, so when you get on this algorithm, and you're you're managing an agency in the forest, Jesus, that's crazy. Why are you able to do that? I know you're exercising, and you're probably

Deniz 43:36
in the five, sorry, five, excuse

Scott Benner 43:39
me, low five. So if you're exercising and eating well, and you're using an algorithm, and you understand how the algorithm works, I get how you end up there, like it's pretty simple. But can you lay it out for people? Like why does it work for you?

Deniz 43:50
Well, so I always when I'm getting asked and like the Facebook groups that I'm part of, right? I always say I'm just proactive Rama diabetes, basically. I work out six days a week. So there's like a certain exercise level already in there. Right? I try you had the glucose goddess on your podcast, and I really enjoyed that episode, actually. But um, she talks about like, clothing the carbs. And I've like intuitively been eating like that for four years now. Right? It's always basically a handful of carbs a handful protein a handful, the veg. I like that, right? It's, it's been like that for like the past. I don't know how many years. If I have my CGM Allah, it's quite low. Right? I have during the day I have it at 155 milligrams, deciliter. I haven't on 155. So I'm kind of proactive around that. Right. If I'm working seated for most of the day, I'm a software engineer. So after lunch, I tried to take a walk. First of all to like get my blood going because I've been sitting for the past five hours so you don't just you know a poor, right? But but it's just it's just I have lunch with my colleagues. I really enjoy having that and then I just go for like a 10 minute walk, get a coffee, have my coffee in my hand and just walk around like like take a walk around the block. that kind of stuff, right? If you basically understand how, like the human body's metabolism works, and how insulin affects it, and how like glucose affects it, it's like, this is gonna sound like pretentious analysis, but it's not rocket science. Once it clicks, once you've understood, like, how to how the heck it works, it's not really that hard. I'm gonna

Scott Benner 45:20
say something. It's gonna sound crazy for a second. I mentioned this to you before we started, but you can see it behind me because the cameras on Yeah, so my kids at Christmas time. I don't know if I have to tell the story. Like I can tell it in two seconds. But we basically were standing around a few days before Christmas. Yep. And I said to everybody else, like name, something you wish you'd done that you haven't done? It was just like a thought exercise to have a conversation. And it got around to me. And I think I blew everybody away by saying I've always wanted to raise a chameleon. And everybody was like, you've never mentioned that once. And I was like, No, it's not a thing I talked about, it's very difficult to do. It's a lot of effort. It's not a thing I would actually do because of all the effort. But it's a thing. And I think about what some I wish I would have tried that. Anyway, now there's a chameleon here with me. And, and I've had to learn about like it very quickly, because it's a delicate animal. And I don't have months to figure it out. I had like, days to figure it out. And oddly enough, I figured out how to keep this chameleon healthy the same way people use my podcast to learn about their diabetes. And these intersecting ideas have just been falling on me for weeks now, like, found a man named Bill out in the world who just has a like a ton of knowledge, and he's good at communicating it. Yep. And I absorbed what he said. And in no time put this thing in a really healthy situation. Neither here nor there. I'm watching how it eats. And it eats to ensure its bowel movement. It's very interesting. Like it. It's got like these four or five bugs that it really likes. Some of them have more fat in them. Some of them have more. I don't know. calcium in them, etc. Yep. And that thing will like yesterday, just boom, boom, boom, and it'll eat for crickets. Like it's nothing. Yep. And then the next day you show it a cricket? And it's like, no, no. And then you wait, and you come back to a very well hydrated bug that's high in fat. And it goes, Yes, that one. And it hits that cricket. And then every then it it's fascinating. It's all about it's digestion. Like it's whole light. But it knows, like it knows how to turn its nose up at something when it has an option. And as people, we don't know what we're talking about. You know what I mean? Like, we don't understand food. Nope, most people don't understand food. And so it mean, anyway, that's exactly what you're talking about, is putting in the right things, giving yourself the right exercise. This chameleons case, it's about humidity. In your case, it's going for a walk and exercise. Yep. You know, and then your body works. Well. It's interesting. Oh, yes. Sorry.

Deniz 47:52
So and also with like, the whole eye thing, I finally talked to me. And I was like, Yeah, so what do we have to do? Right? And I was I was talking about, like, how he said, we have to, like, try to keep the fluctuations low and stuff. So I've been in like the high 80s range on MDI. And since I've, I've jumped ship, and I'm on I'm on an AI D now and I got the top now, I'm on a certain app now. You know, it's, it's basically I have to cut things to not be 100% Time Range. Okay. Yeah. Right. But but for me, and this is this is actually whether this whole thing is an issue on like, the mental side of things. If I am 100%, time in range, but if I'm 160 for the past six hours, I get achy. Yeah. Right. And, and it's not like it's not because I know, you know, I'm gonna die, but it's like, you know, I'm just above like, a certain level I don't really want to want to be at right. And so I I'm kind of getting like, slightly irritated. I'm like, Okay, guys, I'm gonna go for a walk now. Right? Or, Hey, guys, I'm gonna go on a treadmill alone. So it's, it's like, I've really, I really try to be in like a, what they call tight timing range. So between like, 7140, ideally, even below that, right. And I really tried to be there. And because I also came to find out, you know, if I'm, if I'm basically above 160, I start to feel a certain cognitive decline. Yeah, I really feel it at work, for example. So I tried to be below that, because it just affects me in my day to day life.

Scott Benner 49:24
Ya know, I noticed that first when Arden was younger, and she played softball that over a certain number, her foot speed literally diminished. Yeah, she just she was slower all the sudden. Yeah. And you're saying because you're doing a, you know, a thoughtful job, you can feel your cognition. And I would imagine to a third wheel, a third prong of this wheel is you're also thinking, ooh, complications, like you now have that in your head where you didn't have that before. Right? So it's how I actually feel it's how I actually think and it's an eye on the future, which is the thing by the way you brought up earlier when you asked your girlfriend like was I did I really look like I wasn't doing well. The one thing you didn't have during that time. I was an eye on the future. I didn't mean to say I on that's seemed like a weird pun. But I didn't mean it that way. No pun intended a red eye on the future. Should I call it red eye on the future? Oh, wait a minute now we're getting there. Red eye on the future. It's a little long, but I don't hate. That, to me is what you were lacking. It's what everyone's lacking. I know that sounds overly simplistic, but we're all lacking giving enough consideration to the thing we can't see or imagine. Yes. You know, that's pretty much what you're doing here. So yeah, exactly. There was part of me that when I knew you were coming on, like, I really did want to talk about IEPs a little bit and how it works. But I don't know how comfortable you are with that because of things that are well,

Deniz 50:45
I mean, if you got questions, let go, right, I can, I can totally answer questions. I've been on it for the better portion of like, oh, eight, nine months now. Okay, because so I'm See I got on loop. And I didn't just get on loop. I also jumped into the whole, you know, DIY community. And I basically jumped like both feet and head ahead, through the wall, basically. So like, two months later, I was I was answering questions. And like three months later, I was I started contributing to the projects, right? Because I was like, this is, you know, I want to pay it forward. And so by now, I'm a moderator in the loop of learn group, if I may plug them here, right. I was a moderator in the IPS group. But I still helped around that application, I contributed in a major way to what people may or may not know, as the browser build methods, right? I improved the build method there and, you know, improved automations in that regard. And yeah, I'm just I'm just part of like, a bigger community now that I kind of want to see thrive. Yeah. Right. And so ask away by any means.

Scott Benner 51:49
So I am in the position where the other mic that you thought I was confusing earlier, Mike, Mike has been on the podcast and who helped me build Arden's app? Yes, he gave me the lead in settings. He's just basically went through every menu and was like this, that make that one this this like that. So I don't know why I started where I started. And the truth is, is that once it was set up, it didn't need a lot of dial turning to get it there. Yep. You know, I just had to get her Basal rate or insulin sensitivity and or carb ratio. And once I got all that, right, it ran pretty well. And then one day, I was like, this thing says, it has like dynamic settings and like auto tuning and stuff like that. And I was just like, blink. I'll turn that on and see what happens. Yeah, this is the first system that I'm using with Arden that Arden's using, yeah, that I don't think I can thoughtfully talk about its execution. I just know it's working. And I know if I keep her settings commensurate with her needs, that the rest of it kind of works. Yep. Do you know all those settings? Because it feels like there's 50 settings? Like do you could you go to every one of them say, Oh, this one's 3.8. But I know why it needs to be 3.7. Like, you're not asking well,

Deniz 53:00
even though there was like a bunch of settings in there, which is also what makes it like very much more complicated to like get into compared to loot, basically, right? There are like a handful of settings, I want to say maybe like a dozen at max, right, that you kind of have to look at. And then if you get those settings and your like normal profile stuff, so like Basal carb ratio, ISF fine tunes. And then also, depending on what kind of dynamic algorithm you choose, there is logarithmic and sigmoid in it. It uses your profile settings in a different way. Basically, you are kind of, you know, off to a really good start and off to like, oh, not a good start. Do you really? It's gonna work? Well. Yeah. So I have said, if you're talking about auto tune, and if Auto Tune is on for Arden, while using dynamic please turned off.

Scott Benner 53:48
Okay, so auto tune and dynamic can't be on at the same time. It shouldn't be on No. So what's auto tune?

Deniz 53:55
Auto Tune is basically does every 24 hours, it kind of looks at what what happened, so to speak, and it adjusts your Basal and if you choose to do to let it do it. Also your eyes F and your corporations. Okay. And it basically overrides what is in your settings for that. And but mainly basil here is the problem because depending on what dynamic algorithm you're on, I think you're on logarithmic, I guess I don't know if I'll

Scott Benner 54:21
say that. And I thought I have no idea which one that is,

Deniz 54:25
I think you're on the default one. And the default one doesn't really rely that much on the profile is F okay. If you if you got if you got auto tune on. And the way this algorithm that works are like the grants below the IPS interface works is basically with every loop that it does, like with every cycle that it does, which is every five minutes there comes a new CGM rating. And with the new CGM rating, that's basically the heartbeat and then it takes a bunch of things into consideration. Your IRB, your current glucose, and then it does predictions. You've seen those four lines, right? Basically it's five lines But you've seen several lines. And depending on certain conditions, it's averaging those multiple lines basically into like one prediction is what it wants to use. And based on this prediction, it basically decides, Okay, I'm going to issue a zero temporary Basal, I'm going to issue a temporary Basal that's increased, or I'm gonna give you an SMB, which is a super micro Bolus. And based on this algorithmic choice, you're getting insulin. And so now, while it does that, dynamically for our now, because you've toggled on the dynamic stuff, so it will also change like every five minutes, it may also adjust basically her ISF, and it may adjust for Operation depending on if you toggle that on or not. Basil is very, very, very important in that decision, basically, because because it takes your basil profile into consideration when it's doing the whole calculations around it, like whether it should issue a temporary basil or whether it should issue an SMB and what the dosage of that SMB should be like, if you got auto tune on to like, come back full circle here, if you got auto tune on, you have something that check like that may change Arden's basil every day of the week. So you're now trying to do like math calculations, it's a bit like you're in high school, and they give you a math test. And every five minutes I come to you and I just rip the paper out from you give you a new paper with like new numbers, and you have to restart all over again. Okay, that's kind of what happens when you got auditory with dynamical. So it's like me shouting at you giving you new numbers and expecting you to get perfect results with it. It's like an ever changing bases. So

Scott Benner 56:31
it's one of the other dynamic settings on or auto tune on not either not both, but which which do you have on,

Deniz 56:39
I have dynamic on I have never used auditing, because I know that my the Basal profile that I have in here is basically really, really well set. If I look at my IPs, when I get up, I am basically flatlining and I do intermittent fasting or like, I don't want to call it intermittent fasting. But I usually have like the first meal of the day between like 1130 and 1pm ish, right? So and I had my last thing to eat, like maybe 10. Right 10pm. So there's at least like 10 to 12 hours in there. And I'm usually quite flat in there. So I know my basic settings are pretty well and pretty well tuned, right. And so I don't want something in there that just keeps keeps changing it. And also, I know the math behind it to an extent. So I just don't I want to avoid basically the whole, ever changing thing, unlike me shouting new numbers for you while you're doing them off test. Gotcha.

Scott Benner 57:31
Is there a world where being a female that's getting your period? Is there a value in like, once a week going to the auto tune and be in like, here, do it now? And then like instead of it happening all the time? Because you're gonna get like, I mean, your, your trust me?

Deniz 57:51
I'm aware of what you mean, because everyone

Scott Benner 57:55
is lucky. But yeah, like, you know, you could be three or four different people every month, as far as diabetes is concerned. So

Deniz 58:01
I don't want to give like advice on that kind of stuff. Because I am no woman, right? I don't get I get don't get my period, right. But just from like, where I stand and what I know about the algorithm, I wouldn't, I still wouldn't turn on auditing, because basically, the EPA is taking care of those fluctuations for you. Okay, and if you really feel like you're not getting enough insulin, I would just put on like a temp target, that just raises you a bit sorry, that like drops, you bet. So to increase the thing, IVs also got the profiles. So you could you know, you could use that and just go on like 120 a person profile if you feel like that. But usually the way this whole thing works, if it sees you are more resistant, it will like lower the ISF number which basically makes the algorithm more aggressive, and it gives you a bit more insulin. Yeah. And the same thing around, right. If if you know the period has ended, and you're back to normal, quote, unquote, right, or normal world period. Sorry, I don't want to say that. But it's like the bodily resistance and insulin needs go back to your fewer impacts from hormones. Exactly. Yes. If you go back, if you go back to that, the app should also kind of like sense that an extent. And, and also what's what's very important, and I kind of want to like really, really emphasize all that while being on here with you. None of the applications that we currently have, apart from a very specific sub branch of Android APS, which I'm not going to get into because I don't really know a lot about it. They do not learn. People talk about learn dynamic is F in IPs or the other apps and it's learning how you function and that kind of stuff. It doesn't learn it is not a machine learning thing. It doesn't do like neural networks. It doesn't do machine learning or artificial intelligence. What it does is it looks at your total daily delivery insulin right from between the past hour to up to 14 days in deferral different like weightings, right and it averages that basically and based on More or less on your use insulin usage use stuff. Yes to decide how to doesn't. Exactly right. It doesn't learn in any kind of way. Yeah. And also, if you jump on to the app, and you want to toggle on the dynamic, it'll actually tell you the first 24 hours, it can't do it, because it doesn't have enough data. So

Scott Benner 1:00:19
I want to be clear, too, I don't think auto tunes on Ardennes. I just wanted to have a conversation, but You scared me enough that I'll double check. I'm sorry. No, no, no, not scared in a bad way. So let me ask a different question about IEPs. Yes. What about the people I've had one of them on here, who tells me I'm on IEP s, I don't even bother bolusing for meals, how I can't figure that one out. I

Deniz 1:00:44
can't really tell you how they do it. A lot of the people that do that they have very, very aggressive settings. Right. And so they may run like may or may not run into specific issues around like, you know, unannounced exercise. So if you just like, give me a bunch of insulin, because it's sense that you were like eating and then suddenly you decide to oh, you know what, I'm, I'm gonna go to the gym after all right? So they might have to cover all the iob. So the sorry, the insulin on board with a quick snack or whatever. A lot of the people that also do focus looping, have a long history of basically diabetes, and they have fine tuned the living s out of their settings. Yeah. So a lot of people hear about these kinds of algorithms. And then IPS is like the only one they hear about these kinds of apps. And then they hear about certain people that you know, they are like FCL, so full closed loop, and they don't Bolus they just start eating and the app takes care of that. And then they go like, I want that. Yeah, it doesn't work that way. It's basically like you're saying, you're looking at the sky, and you seeing an aeroplane and you go, oh, I want to fly that and expecting to just because you like board a 747 you can just fight. It doesn't work that way. It takes a deck and figure it out. Yeah, it takes a decade and you know, a long time educating yourself and becoming a pilot and getting a license and you know, getting trained on that kind of stuff. And it's similar on that with FCL. What I personally do, I'm not gonna lie, I'm not FCL, right. And by any means, I might or might not announce my meals. So sometimes I don't really feel like it. Sometimes I put in something, it's all it's always eyeballed. Right. I don't really weigh that much of my stuff. Yeah. And I do a Pre-Bolus every single time. So I do Pre-Bolus. But I will only do Pre-Bolus If it's a bigger meal. So if I just I don't know, if I just want to have an apple, which is between 15 to 30 grams of carbs, depending on you know, the size of apple and how sweet it is. Yeah, I might not even announce it. I might not even Bolus food. But if I'm sitting at work, and I feel like oh my God, I need a coffee into Snickers because this problem I'm working on right now is really bad. I will give myself you know, one or two units just to like, get things going. And you know, that's how I use the app. So I'm kind of hands off, but I'm not entirely.

Scott Benner 1:02:53
It's interesting to hear you talk about it the way I think about it, you know, like get things going throw some insulin in there, get it on our site, like, you know, that kind of stuff. Yeah, it's, I think how you have to think about it. I had one other question about this. Sure. I find it it heavily manages with boluses. And taking away Basal Yeah, but I can see long segments of zero Basal with

Deniz 1:03:16
good blood sugars. That's because how the algorithm which which is the the so it's the RF algorithm, which comes from an application you might or might not know, it's called the Open APS algorithm, invented by Dana Lewis and Scott Lybrand.

Scott Benner 1:03:29
They found them I guess, years ago. Yes. Okay. So it

Deniz 1:03:33
basically uses a version of that heavily adjusted and heavily built on like stuff on that. But it's like, the basic algorithm, I want to say is RF and, or if that's the thing that I explained earlier, which is like, it takes certain metrics every five minutes, and it does like those five predictions, and then it depending on certain conditions of those predictions, it does averages of those predictions. And then it comes out with like the quote unquote, final prediction, and then it goes based on that. And that entire algorithm is heavily based on Super micro Bolus. So and that's why you see a lot of like, timespans during the day where where the user might not be getting, like basil. Yeah, but that's usually around glucose fluctuation and usually also involves food. So for example, you like when I go to bed? I don't have an SMB between like midnight and 6am. Yeah, I only have a slight I only have like slight temporary basil adjustments operates maybe, but I usually don't get an SMB. But the minute I wake up and then have a coffee, and I usually spike quite badly on coffee, even though I drink it black or just like splash of milk. I see SMBs going in, boom, boom, boom, boom, boom. But that's just the way the algorithm works. Yeah, the algorithm basically decides on is it okay if I just do a mild, temporary Basal, so mild increase of the profile bezel, but do I need to give a Supermicro Bolus? And then also there's this thing with orif, which is Like, I don't want to say like this, but I'm gonna say it. It kind of borrows basil. But but not that, that you're not getting insulin, but it basically looks at your current basil. And then depending on certain settings, it looks at like what is your basil profile right now and what may be in so and so many minutes, and it kind of takes that number as a basis for the calculations. And that's why it's so super important than sort of swearing. But it really is important that you have a really, really good Basal profile, even though you may not be seeing Basal being dosed. Because it takes that number as like a calculation basis. And that's why I was saying don't use auditing, because it keeps changing that basis.

Scott Benner 1:05:36
Basically, when it gives you one of those super micro boluses. It's already thinking about here, take what you need, plus let me throw some of this basil into and then it'll manage backwards with a lower basil.

Deniz 1:05:47
To an extent to an extent, it'll often do like a temporary Basil of zero. So, like, you would call it zero tamping out or zero tamping because he kind of knows, okay, you are currently on one unit of Basal for the current hour, and you know, you need this much insulin, so I'm going to Temp Basal you zero for the next seven so many minutes, because I gave you this much insulin. And then if you start if you if you rise more and more and more, because maybe you've we've ate something or whatever it factors other things in and then it might may give you more insulin. But if it just gives you a correction, for example, and it, it may take that away, it's very math heavy, and it's a lot of calculations in the background, you know, and I don't want to like say false things. To go back to your question, I'm sorry, I'm kind of going over things, you're fine. It is a very normal thing to be seeing, like a Bolus Basal distribution of around like, I don't know, like 1010 to 90, or like 15 to 85. I also want to add that personal side note here, and to the listeners or whatever, if you've got an endo, and you're on one of these systems, or if you even if you're on oh five, and the end goes like you need a Basal Bolus distribution of 5050. Tell him to himself, because that is such an antiquated, like, way of thinking about this, because at the end of the day, this is insulin in your body. And you as a healthy person, your pancreas doesn't think like, oh, well, I'm going to give Scott points something of basil now. And now he just stuffed a doughnut in his face. And now I'm gonna give him a Bolus, it'll just secrete insulin, right? Personally, I think that we really need to stop thinking about like, things like like that and try to basically apply thinking of like a healthy pancreas to diabetics, right? It is insulin, you're in your body and you need insulin in your body. And we just make up these, these these things in these systems to like, make it easier for diabetics. And like the people that you know, go through it, but still it's, it's it's insulin, even

Scott Benner 1:07:32
when you talk about Omnipod, five, like when you first started up, they want you like 5050, but within 36 to 48 hours the pumps make it'll change completely different decisions that exactly don't look anything like that. But it means that on day one, yep. And you're right, as far as antiquated, goes, it's just the way that people like you mentioned earlier, I was over basil, when you were with an older doctor, he had your basil up high, because that's how they used to think about it. Like we'll give him extra basil, because we know they're not going to Bolus for their food, like and then all of a sudden that becomes like a rule. And no one knows how it became a rule. You know what I mean? And then Yep, on and on and on. But these algorithms are not like you're right, like the settings have to be right. And they need the autonomy to work within the good setting. But then the ratio in which you get insulin from Bolus to Basal, it could look nonsensical to you like to the naked eye. But it's working. It's so yeah,

Deniz 1:08:26
sometimes I think about like apps like IPs or loop or Android APS, right? Because they may do some things differently. But you know, ballpark, they're more or less the same. Yeah, I sometimes think about them, like, like a German Shepherd on my site, but on a leash. Right? He might bark at you. And if I if I let it go run, it might have to do for me, or it might, you know, do do aggressive things, if I let it do it, right. But if I say here, and if as I come, it's gonna come back, right? Because it's a very, very well trained German Shepherd on my leash basically. And it's super important that I kind of let it run and let it roam to an to an extent, but also to kind of know what is happening. That's that's this. That's the thing. And that's also why IPS is a very non beginner friendly application in my in my personal opinion, and why beginners shouldn't be getting onto the application, despite certain issues with with that whole ecosystem right now. Because essentially, you need to really understand diabetes well, because as a new beginner, especially with things like dynamic ISF, and dynamic harp ratios, and auto sense adjusting stuff for you, you might actually like you might not be realizing if things are actually going wrong. Or if the app is behaving the way it's behaving like the amount of people that come to the loop and learn group and go like it's taking basil away right now, but I am at 220 Why is it doing that? And then you go like, Yeah, but it's just given you like 10 SMBs over the past 50 minutes. Yeah, right. So you got your answer, but it's taken Basal away. I need my I need my basil. No. You need to understand how it works. And if, and I don't want to say like, you know, like, I don't want to sound like a teacher, you know, pointing the finger up. But it's important that people understand what they kind of use. Because with these types of applications, you know, it's yeah, they do give you insulin right. And you kind of need to understand that it's pretty important. So, yeah,

Scott Benner 1:10:18
I agree. I do see once in a while, if, if Arden gets a stuck higher blood sugar, yep. If you manually push the Basal even sometimes just for 20 minutes, you can break that high blood sugar without causing a low. And if you left it alone, it'll stay stuck there. So but it's, it's a very infrequent thing that I can't put my finger on exactly when it's happening, or why it's happening. It's just it happens. Sometimes you don't I mean,

Deniz 1:10:46
usually, when I go hypo on on this application, it's when I think I'm smarter than Okay, when I look at it, and I see, okay, it just gave me six SMBs. And I have like, 15 grams of carbs on board. But I'm, I'm already at two point something iob. And I decide like, you know, I'm at 161, I'm gonna give like half a unit. And then I do stuff. And then like, you know, 30 minutes later, I'm suddenly like, two arrows that like double arrows down. Yeah. And I'm like, Oh, dang, yeah, I shouldn't have done that half unit. I shouldn't have I should have known better. And, and it's the funny thing. I know how this works. And I still fall victim to that kind of thinking sometimes. And then I just give the half unit. And then you know, then you have like a sip of juice, or I don't know, right. But it's it's a human thing. I think it's like, I am the human here. I know. I know. I know.

Scott Benner 1:11:34
I'll figure it out. And then it's like, no, you are wrong. Yeah, exactly. Then this has been terrific. I'd like to, at some point in the future to talk like more nuts and bolts about how the algorithm works. Oh, sure. Yeah. But for now, this was this was really good. Did we miss anything that you want to talk about? I mean, we started off very oddly talking about your relationship with your parents, which I didn't think was going to happen at all. And I think we've gone on a little bit of a journey. So I feel like we've done a good job.

Deniz 1:11:58
We did. Yeah, we did we Yeah, no, I don't know if I may plug them. I already plugged them before, but I'm gonna say it again. If you guys like if there are guys out there, they want to get into DIY looping with on iOS, because it's kind of iOS centric, but we help on all systems. There's the loop and they're a Facebook group. There's also websites, looping learn.org, we're happy bunch of people, from all timezones all around the world. So we are literally 24/7 365. Yeah, around questions. We also provide much of the like built infrastructure for iOS loop, and also for IPs. So if you're building these kinds of apps, you're using tools that we provide on like a volunteer basis. If I also may plug in other organization, if you want to donate and help out people, I may ask to donate for the night Scout foundation. Yeah, a lot of people in the DIY space know Nightscout. Because it's a cool tool that, you know, you can view sugars on and you know, use a CGM data. And if you're on one of these apps, you can also see the insulin going in. But what many don't know is that the NSF isn't just, you know, keeping the Nightscout ecosystem alive. They also, you know, pay for, like help pay developers pay for, like testing devices. So for example, I know, I know, developer that got an iPhone, you know, got some money for an iPhone to test things by the NSF. I was given some money to go to conference in San Diego last November by the NSF. So if there are people out there that can spare $1, to donate it to the ISF. Right? That's a cool thing for us. And apart from that, no, I don't have any more things to say, Man, I really enjoyed being here.

Scott Benner 1:13:31
I did, too. i It's funny how much of what we use, I don't even understand. Like, I know, that's odd. Like, I know, I pay somebody every month to house something. I don't even know what it is, like information somewhere in this mystical, you could use this one or that one. I'm like, I don't know what to do. Like, you didn't mean like, it's just it's working. So I'm not touching it. But But I don't know, like, I know how important like the night Scout foundation is. I don't know why. It's funny. Like I'm like, I mean, I know it, we need it to work. And but it's the give and take between having something centralized and controlled by a company. And how important that is for so many different ideas. But if you do it this way, and it's you know, a community based and open source, you know, well, then you keep the, you know, everything keeps moving forward, because it's not a business. You're not like, Oh, we got there, we're selling it people like it, it's good. Leave it like this, you're like, oh, let's make it better. Let's improve. Let's hear from other people, to both aspects of it, have real positives, and then they both have negatives, too. If we just said to a company, just go by that just go take this algorithm, make it make a pump with it. Right? I bet you I know about where my data is being housed, and like I'd understand what was happening then that would be very smooth for me. Yeah, but they'd probably also sit on the algorithm for five years and not do anything with it. And so you don't mean like it's also

Deniz 1:14:54
I would have a very funny story. I don't think we have enough time for it. But I was at this conference last November, and a guy from a Tronic was there. And he was basically presenting the, I think they call like, something about about miss meals, I don't want to mispronounce the name they have for it, right. But the 780 basically has like a missed meal function. And another very known, dry veteran went up to him and asked him, hey, what you presented today, it sounds a whole lot like the unannounced meal feature in in the aura algorithm. He didn't say much. But the face that he gave, and the expression basically said a lot, right. And we were standing in like a crowd. And you know, everyone kind of like just chuckled in you, right? It was almost kind of those kinds of moments where you go like, Ah, okay, yeah,

Scott Benner 1:15:44
I there's got to be a blend of Yeah, I don't know what the answer is, obviously, I'm pretty far on the outside of it. But I think of my job around algorithms, like Do It Yourself algorithms is like, I think I'm doing the thing I can do for it, which is to let people talk about it and let people hear about it. I mean, there's this one thing, I'm always disappointed at the limitations of Facebook, because I see like looping learn that Facebook group is a great example. If there was a way that I could start a suite of Facebook groups, and fold things not that they would want me to, but like just supposing out loud, if you could have, you know, how the you remember the old, just how old boards used to work link, you know, there was a tree on the left, and it's like, Hey, we're gonna talk about black and this one white, and this one green in this one purple and this one. And you could jump if you could do that. And Facebook, like a message board could like a proper message, oh, my god, like a message board, then you could fold these things together. And then you would have like, not for I mean, Lupin learns a great Facebook group, but you're not touching the number of people I am and the kind of traffic I am like, imagine if those conversations could happen in front of more people how much more quickly it might expand. And but that doesn't exist. So like, everything's a given take, I don't know, I just went down a weird road there. But everything's that give and take. And there's moments where I wish we could go faster in some spots. And there's moments and when I wish there was more money involved in some things. And I mean, like, organizational structured money, and you know, that kind of thinking, anyway, it's all working pretty well. It's hard to argue with it.

Deniz 1:17:19
But yeah, it's working pretty well. And you know, all the money. It always comes with, like strings attached. Right. So we, the thing is, I think what we got right now it works pretty well. And I've got this for 27 years now Arden's going on I don't know, close to 20, I guess. Oh, God, 18 or something. Anyways, yeah, what I'm trying to make is I was diagnosed, like in the last millennia, and I was told in the next five years, there's a cure. And I've talked to so many diabetics, diabetics that had diabetes for like, 6065 years. And you know, even back then they were told guys in five to 10 years, there's going to be cure, it's common. So, right. So it's what we got here is pretty awesome. And it's amazing, like, the disk space I am in is basically like, you know, improved and driven and by volunteers, and that put like, countless hours every week into this. And I hope it stays healthy for a long time until it's not needed anymore. Essentially.

Scott Benner 1:18:16
Oh, damn, listen, I'll go through them all. Medtronic 670 G tandem control, like QX two Omnipod, five, loop Iaps you know, Android all Android API.

Deniz 1:18:28
All of it. At Domino's. I let the bionic pelgrane Do the very the

Scott Benner 1:18:33
things. As long as you understand basic concepts of diabetes have access to insulin, a CGM. The stories about people like my friend Mike, that they're not going to exist anymore. Like this is this is it? You know, like we're, we're running at this point. Yeah. Yeah, it's fantastic. All right. I'll let you go. I don't what time is it? Where you are?

Deniz 1:18:54
It's three past 831

Scott Benner 1:18:58
You're gonna fall asleep and you're very old. Oh,

Deniz 1:19:00
no, I'm gonna head to the gym now. And then when I'm back, I'm gonna eat and then I'm gonna go to bed. Because I've just I've just sat on a podcast with you for two hours. I gotta move. You gotta get oh yeah.

Scott Benner 1:19:11
As soon as I get done speaking to hold on for me one second.

A huge thanks to a longtime sponsor touched by type one, please check them out on Facebook, Instagram, and at touched by type one.org. If you're looking to support an organization that supporting people with type one diabetes, check out touched by type one. A huge thanks to the contour next gen blood glucose meter for sponsoring this episode of The Juicebox Podcast. Learn more and get started today at contour next one.com/juicebox. Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it to screen it like you mean it? One blood test can spot type one diabetes early? Tap now? Talk to a doctor or visit screened for type one.com For more info. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

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