#1433 Fox in the Loop House: Part 4
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Kenny is back!
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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, and welcome back to another episode of The Juicebox Podcast.
It took some time, but I got Kenny Fox to come back. If you're not familiar with Kenny, go look for Fox in the loop house part one, two and three. Those are episodes 312, 313, and 420, if you're interested in looping, you should listen to the fox in the loop House series straight through. Today, Kenny and I are going to talk about night scout and data tracking. We're going to talk about basal adjustments and insulin on board Kenny's new coaching service, understanding loop predictions and adapting to stress and daily routine changes. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink, ag one.com/juice box. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management, imagine fewer worries about mis Bolus is or miscalculated carbs, thanks to meal detection technology and automatic correction doses, learn more and get started today at Medtronic diabetes.com/juice box. Today's podcast is sponsored by us Med, US med.com/juice box. You can get your diabetes supplies from the same place that we do. And I'm talking about Dexcom, libre, Omnipod, tandem, and so much more us, med.com/juice box. Or call 888-721-1514, if you're looking for community around type one diabetes, check out the Juicebox Podcast, private Facebook group. Juice box podcast, type one diabetes. But everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast, type one diabetes on Facebook. Ken, you are on three of maybe the more popular episodes in the podcast about algorithm pumps. So let me see, do you know the episode numbers, or should I look for them?
Kenny Fox 2:52
I remember they're, like, almost a year apart. I remember that part. I just looked at the numbers this morning. They're in the hundreds, like 300 or something. Wow. So
Scott Benner 3:01
you were on originally, episode 312, Fox in the loop house part one. We did part two. Episode 313, so it was just one after the other. Was probably just a thing. I split up into two, but then we had you back again on episode 420, for Fox and the loop house part three. Your last name is Fox, and we talked about loop, and for some reason, that's the title that came to me. So there's no other reason why they're called that, but they're very popular, because I think not only do they do a good job of going through what loop is and how you use it and how I used it back then. But also, because a lot of that information, I think it grows people's understanding just of how algorithms work in general. And you can apply that to honestly, if you're on control IQ or, you know, Medtronic or omnipotent, like wherever you're finding your algorithms at, you know, I don't know what else is there now. Twist is coming, and I let. No, I let. I guess you can't really do much with but, you know, like all these different algorithms that are out there, the way they work informs you about how you think about insulin, and then you can kind of reverse engineer what you've learned and put it back into your management I think that's where, like, the leveling up comes from. Do you agree?
Kenny Fox 4:20
Yeah. I mean, we tried the control IQ for six weeks, we had a pump given to us, and we tried it out, and we got similar results to loop using some of the same techniques and the base understanding that comes with using a system like loop, and you can definitely translate major pieces of this to other systems. I've helped a few friends on Omnipod five, and just adding things like knowing that fat and protein needs some insulin and carbs can really help balance out that total daily dose piece of the algorithm sometimes people end up staying higher just because they're not bolusing enough, and therefore it thinks they need to hire basal. And you can fix that by just making sure. You dose more, and you dose more by adding in the fat and proteins. It helps pretty much in any system that we've used before. And the twist one will be using a form of loop when it comes out.
Scott Benner 5:10
Oh, that's awesome. See, I just learned something. Though it's awesome using tide pool. Tide Pool loop. That's excellent. Okay, great. Anyway, so listen, even if you're not a looper, my point is, check this out if you're using trio. If you're using, I mean, what else is there that's DIY at this point,
Kenny Fox 5:24
Android, APS, trio, the main ones, yeah,
Scott Benner 5:29
loop. Or one of the, one of the systems that you can get retail. I think the information here is going to help you in one way or the other. So let's just jump right in. Tell me where you want to start.
Kenny Fox 5:38
I guess I'll start a little bit with me. I been in the DIY community for a while, helping out, doing videos on loop and learn and on the podcast with you, and just helping people in the Facebook groups. And late last year, I got laid off and decided I wanted to take my coaching skills. I was doing financial coaching, budget coaching for couples, and that was fun, but it was kind of a little side hobby, and I thought I could probably do this and teach people how to use loop better and do it all the time, and help more people that way. So that's what I'm trying to do. We're starting off early 2025 with a course on how to change your settings, how to know how to read the data and know how to change your settings and loop. And we'll go from there, see how it goes. Help
Scott Benner 6:19
people your web address because I want you to say it, because I'm I'm delighted by it,
Kenny Fox 6:23
because a lot of people reach out to me, saying, Hey, listen to your episodes on the podcast. You know the podcast is Juicebox Podcast. In case you don't know, I went ahead and just leaned into Fox in the loop house. So my website is Fox in the loop house. Calm. You can find me Fox in the loop house on Facebook and Instagram and YouTube, so just lean into that identity piece of it, since that's where a lot of people find me. So I thought I'd just go with it, and you told me I could years ago when I mentioned it. So you made my
Scott Benner 6:51
day when you told me that was the URL. I have to say, it's like, oh, that dumb thing. I thought up, I've reshaped Kenny's life with it. I
Kenny Fox 6:58
thought I was a little dumb too, but I couldn't think of anything better, and that's how people know me, plus it has my name in it. And so it means I don't have to worry about, where do I slip my name in, or making a whole LLC, or whatever I need to do for that, because my last name's in there. Well,
Scott Benner 7:11
the way I have to tell you, the way I think it occurred to me back in when I when I thought of the title, was that to me, like the DIY algorithms, you know, are this not siloed, but a thing that not many people knew about? So I thought of it as almost the club. And then I was like, oh, and Kenny's like, he's going into that house and, like, showing it to people. And then, I don't know, then your name was Fox. And I was like, this is good enough. I like this. I like, I like the idea of you, like going into this place. It probably seems secretive to other people. It isn't, but maybe it feels like unapproachable, and you were just in there going, like, look, here's all the eggs. Let me show you. You can just have them too.
Kenny Fox 7:49
And back then, it was a little chaotic. It's definitely matured, you know, the loop and learn groups. Got a whole group of volunteers, and so sure, we're funneling information a lot easier to people, but definitely back then, it was a little chaotic. So little fox and the hen house sort of play on words. Works out how it
Scott Benner 8:03
felt to me. So, oh, so that's awesome. Okay, so let me ask before we jump right in, doing financial coaching for people, there must be things that you've learned about how people learn and how they're motivated that you're moving over to this. Am I wrong?
Kenny Fox 8:17
No, I mean, part of it is just communication. When I was doing the coaching, I tried to make sure that, like, both the husband and wife, for example, if it was they were married, were both showing up because they're both trying to engage in goals, where you're going stuff you're trying to achieve, and putting people on the same page, even if one person that wasn't totally bought into it, at least they heard the words, had a common vocabulary to like work through problems together, and so I thought about doing the same thing for loop coaching, making sure that you know both parents are there, or that the type one is there, maybe with their spouse. I haven't carried that over, but it has been good to reinforce, or I'm finding that people reinforce the same language and words that I'm giving them with their kid, if they're old enough to start taking it in, and so they're picking it up on their own. It's been good that way. That's
Scott Benner 9:06
excellent. I'm just it's interesting to see how people's careers build and and sometimes lead to similar but different things. So this is the
Kenny Fox 9:13
well, knowing that you need to acknowledge the emotional side of things too. I'm a little more technical and just trying to solve the problem, but trying to make sure you they people feel heard, and that they can express their concerns, that you can empathize with them, gets you a lot further. And they and they, they listen, they take stuff in better. Yeah, so it works all the way around. Cool. So where
Scott Benner 9:34
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Kenny Fox 12:07
uh, yeah, I'll just kind of mostly step through the modules of my course at a high level, and so people can get an idea of what we're going to cover. And it's a lot of this stuff. I'm not worried about keeping the information locked up behind my portal. The information is free. The DIY system is free and open source. If someone wants the help to be with me or my community, then that's when they can show up. So we'll cover, you know, most of what I cover here, if it's helpful and it helps people, then that's great, well, but usually, yeah, I just kind of call it Module Zero, as we kind of start with night Scout, because we're going to be looking at that a lot. It's your dashboard, it's your view into all the data, especially as a caregiver, but loop only holds only shows you about six hours of information in the past, so you can't always go back and, you know, look at how the morning went, or your overnight basal was by the time you're off work or school's over or whatever. So night scouts, where we're going to live, there's just a few things. I don't take a lot of time to teach people how to use night scout. We kind of just do it as we go, and it's integrated into the process because through repetition. But there's a couple annoyances I'd like to highlight for people that people don't like about night scout. One, it's busy, and can't really fix that, because there's a lot of data that's important. But what we can do is make sure that some of your like pills, a little squares, little nuggets of information on the screen are turned off that you don't need, and then make sure there's stuff that is on that you do need. Some people use their night scout and don't have the prediction visible or the basal rates visible, so they're missing out really important pieces of information when they're doing it. So we just go through the settings and figure out that one. But there is this one cool setting that if you're using night Scout Pro. It's built in otherwise, if you have access to your little configuration variables that you have to go in and tweak. There's this one called device status, one word, underscore, days. And what that does is, on that first screen, that dashboard of night Scout, you can actually see two days worth of information on the lower graph, and it shows you, like a little snippet, you know, the bigger version on top. It's like a smaller section of time. But what you do is you scroll backwards and you click and drag on that bottom section of night scout. You can only go back 24 hours before you lose the kind of prediction information, all the details. But if you add this variable, device status, underscore days, and change it to two, you get two days of information there. Well, 48 hours. That's really helpful. If you know you're trying to figure out there's a pattern, and I feel like most patterns you would look at are within the last two to three days. So if you can access most information, you pretty much don't need to leave that front screen of night Scout, which people appreciate, because while the reports are useful, they don't want to really want to go digging into it. They just want to pull it up and take a look at it. So okay, that's one of them, and then the other one, the other big one, is the alarms. It makes a nice, loud, annoying alarm that's hard to tune out in night Scout, but most people have Dexcom follow, or they'll using the loop follow app or something else that has alarms, and they just don't need them. So they might remember to go into the menu on the side and check all the. Boxes and turn them off. But then you got to do it. Every time you are on a new device or whatever, it goes off. When you're in a meeting. You have it up at your computer at work or whatever. If you go into your configuration variables, you can find all the things that say alarm, and it's usually like a ON, OFF or true, false option. You can go turn those off. I walk through those, I'm going to put out a little cheat sheet for how to just buzz through and turn these things off on my website at some point, so everyone can go look at it, but yeah, just turn off the alarms by default. And that way, if you want them on, you can turn them on if you want them on for the school nurse, and you can talk to them and have them turn them on, but at least they're not on all the time. And you pull up night scout on your phone, and all of a sudden there's an alarm going off when you're in the middle of a meeting or whatever. So that's kind of the big stuff.
Scott Benner 15:40
How do you turn off that crazy music that plays when it loses its signal? Yeah, that's the
Kenny Fox 15:44
alarm. So there's a setting in the back that's time ago or time ago, urgent and time ago worn. So if you find those, if they're not defined in your Heroku, for example, you can just go into the configuration variables and set those to false. I can, I'll put the I'll add those to the list as well. Those are the sneaky ones that you can't turn off from the main menu screen in night Scout, you only turn off, like the highs and lows, but you can turn off. There's a few more that are hidden in there, like when loop is not looping, or and a few others. So yeah, that annoying music is those alarms. And I think most people are already have alarm fatigue, and they don't need it startling them when it turns on after like, 10 seconds of loading the screen. So that's that's a big one. And then the last couple things, just make sure you can see in night Scout that I think is really cool since we talked last four years ago, now that when you start a new pod, or when you start a new Sensor Loop, picks up on that and updates this little section called the cage, or cannula age and sage sensor age, and it updates that in night scout. So now you can see how old the pump is and how old the sensor is, which is super helpful, because you as the caregiver don't have that information readily available, index con follow or anywhere else. So I find it useful. When you're looking at maybe sticky highs, you say, well, How old's the pod? If the pods getting to be closer to that three days, then you know we're increasing our chances that there's a problem there. Or just, uh, just for planning for the rest of the day, like, do we need to change the pod or the sensor before Tesla goes to school or whatever? So that information is helpful to have, and now it doesn't require manual logging, which I used to do, but now you just use loop, and as you change those devices, it uploads this night Scout, and it's nice and available for you. That's a really practical one for people. Cage
Scott Benner 17:20
and sage are big parts of how I use night Scout, and they're a huge help with me, especially when Arden's not living here, and you can say to her, hey, look, I don't know if you saw this or not, because I know you're busy and everything, but your pod's going to expire at five in the morning. Please don't go to bed with that pod on. And you know, there's been times where she said, Okay, great, I'll, I'll do it before I go to bed. And there's times when she goes, I'm gonna get up at five in the morning and change my pot. That's my plan. And I'm like, Okay, fine, you know. But at least you can kind of remember and remind, I guess, a little bit. But your point about using it for, hey, why is this not working all of a sudden? Like, I do it all the time, you know? I'm like, the Bolus happened. Nothing worked. I don't know why. Oh, look at this. This pod's two hours from being shot like that kind of thing. Or I don't trust this number, all of a sudden, and I can't see her Dexcom, so I go look and, oh, the sensor has been on for nine and a half days, or something like that. During COVID,
Kenny Fox 18:12
my wife's grandmother was living with us. She couldn't go anywhere in other facilities or whatever, and she has type one. I never really got good at managing it. And she ended up kind of forgetting to take her insulin over time and almost in DKA. And we sort of fixed that at home, got her drink water, and then from there, kind of took her management over and added, slapped a Dexcom on her, slapped a pod and loop on her, real fast, and then got those devices covered through her insurance, and had her looping. And at some point she ended up leaving our house too. So that became even more critical to know, like, when do the devices need to be changed? We found a nice place that would, without charging us extra, would take care of changing the hardware. They were super willing to do that. And so we just night scout was important to be able to track when those things changed. And so having those pills was pretty was pretty critical for that. So definitely nice for a caregiver perspective, for sure,
Scott Benner 19:02
and I realized we didn't do this. But if you are listening and you're like, Oh, this is all exciting. I don't know what night scout is. It's an app that I have on my phone, for example, and it just lets me see in real time, Arden, who's using trio, not loop, but in real time, it lets me see where she Bolus is how many carbs she put in the things that Kenny just discussed. It lets me see when her basal gets ramped up or taken down, etc. It's pretty awesome. Yeah, it
Kenny Fox 19:30
is intended as like a dashboard for caregivers, right? And we used it when Tessa was on shots at the beginning. And we would log all the shots and stuff in an app, and open another open source app, and it would push it up to night Scout so I could see when my wife was giving injections or Tessa was eating. I mean, sometimes we forget to enter it, but it was helpful for me to learn from afar while I was at work, just to see all that data laid out. And so it's really intended just for logging data, and yeah, now it's a dashboard you can use for having automated. Stuff like loop and trio upload data to it so you can see data in real time, which, you know, I take for granted after almost six years of using it, that people don't have access to, that you can't get the T connect data or the Omnipod data in real time to be able to see, did your kid Bolus and how much and what did they enter? Did they, you know, enter too much, or whatever that is. Yeah, you can make a lot of decisions on that. I have to
Scott Benner 20:23
admit, it's not a thing I look out every day, but when I need it, that it's there is irreplaceable, honestly. So, yeah,
Kenny Fox 20:32
awesome. Yeah, that's it for night scale, I mean. And then after we kind of get that settled so everyone can see what they need to see, and I don't have to worry about them saying, Well, where is that we're all set up. Then we start getting into the basics. Rather than go over the kind of core of the prediction pieces, which I do cover later, actually just start with basal. Because people want actionable stuff. They want to make sure that their settings are right. And as you've discussed multiple times, the basal is foundational right if you don't, if you don't build your diabetes house real well, which is on the foundation of basal then kind of everything is suspect, everything's out of control. Loop gives us a lot of data. I covered this in our one of our other episodes, so feel free to go back and listen to it, you know, for extra information. But we do cover how you can see when your basal is probably too strong or too weak in loop, because it gives you all this information to be able to see where it is. Using insulin on board a while ago when Arden was looping and we helped dial in some crazy basal changes for Arden basal information, I had a very similar think when we were working together, talking a little bit Arden's needs were dropping. And there's another kid I'm helping right now, who's 11, and he just went through, like, a big growth spurt, like all at once. There's no wouldn't matter what system he was on, it couldn't have he just had his he has basal rates increase like a half a unit now, more than half a nice coming up on doubling his basal rates all in about 48 to 72 hours. Just wild. But the mom's saying, Well, what do I do? And I can go back and look at this information. We'll talk about how to get it and give a good guess about where to set the basal. I mean, I wouldn't normally like nudge basal more than, you know, point oh, five or point one on the pod. We only had to change it, like point 4.5 in a single day, which once we did that went from cruising in the three hundreds and stressed and bolusing all the time just trying to get them to everything settling down to the 90s again, so within a few hours. So it's a definitely useful information.
Scott Benner 22:26
How do you do that? How do you look at the information and say, Hey, normally I would turn this dial very slightly to be careful, but in this situation, I feel very comfortable moving at this because what? Because I saw,
Kenny Fox 22:38
yeah. So the iob overnight is one of them. And I think one of those things that's helpful is that I try to keep a pretty simple basal profile. I on the podcast before, we were using one basal rate. And I, you know, I've come to learn that that is a little more common with the younger kids, but also more common with, like, mild honeymoon. We were out of like, major honeymoon, for sure, but having slight variations in your basal rates. Totally fine. People shouldn't feel bad about that. I used to be a pretty big proponent of one, just to kind of get people to simplify. And I think keeping this simple as you can is good. And so when things change, I just kind of changed all so that's the first thing I do. Is pro Tesla. She's got, I'll explain this a little bit, but I have some like normal stuff, but we've only got one rate, maybe two rate, maybe the night and a day rate. And you kind of play around with that looks like. But when I find a pattern that works for Tessa, it's about a point one an hour difference. She uses, like a one and a half units an hour. It's a lot, but so like, a 10 20% difference or something between night and day for her has been working in the last few years. And so when I look at this data, I'm going to talk about, I'm just to make the change everywhere. All the rates change when I look at it overnight. So here's how I do it. In loop, it's modeling insulin pretty well six hours, nice even like small decay rate. It's got a pretty accurate representation based on the like, if you open up the paper inside your insulin vial and actually look at the graphs in there, it shows the insulin last six hours, and loop uses a pretty close line to that. And so what I'll do is I'll just grab the bottom section of night, scout the lower graph, and just slide backwards and look at the history, and we just look at, you know, how the night went, especially, you know, 345, AM, multiple hours away from food or anything else you might have messed up with the fat and protein and whatnot from dinner, and see where everything settles out. And look at how much insulin on board there is as you go across that line. If you're pretty flat and have consistently, like, positive insulin on board or negative instant on board, you'll find that there's generally around the same number kind of across that line. For example, the kid I was helping with earlier had over a unit on board just and he's like, high at like, 170 and just constantly over a unit, and whenever it would get under that, his blood sugar would go up. And so what we do is we can use that information to say, Okay, well, obviously the basal is not right. So how much insulin is this? How much more we have to move the basal up to make this? Instead of one unit on board, how about zero units on board? Like be nice and flat and level. So. And so we just take the kind of average iob in units and divide it by the length of time that insulin lasts, which is the DIA duration of insulin action at six in loop. So we just take the iob and you divide it by six. So an easy example is point three units of insulin on board that's keeping you level, but usually probably a little higher than your correction range. Divide that by six, and you get a unit per hour. You just divided units by hours, and so you get a point, oh, five unit per hour, basal rate change that you should make. And if you make that change, that point three units will actually turn into zero insulin on board, and you'll be level and probably more likely down into your range. And if you're seeing negative, you just add the negative in front of the answer there, and that means you need to decrease your basal rates by point oh, five units per hour. It works out pretty well in the case of this kid with like, one 1.2 ish insulin on board was at a point two change in insulin needs. So that's, I mean, that's a pretty dramatic change that would take some guts to modify without a lot of experience, but instead, you can supplement that experience with math. So yeah, point two unit per hour basal change. So we bumped his basal rate up, and then Bolus a little heavy, because the insulin on board isn't real, right? The insulin on board says he's got a unit, but that's really should be, you know, your new kind of zero set point. So you Bolus little extra to get him down. And as Luke turns the basal off to get him down, the numbers sort of like fix themselves, the iob becomes a little more accurate. And then, you know, within a couple hours, he's down in the 90s, instead of, like the 170s when he woke up. So then you can go about the rest of your day with more confidence. And in his case, he kept needing more and more insulin as the day progressed. And then you could see it in the nighttime numbers for sure. And then you get a nice number again. You make the modification increase the basal rates, and then the next and the rest of the day is, you know, mostly good till the evening, when he's starting to need more again. And so he did his three days in a row. For Tessa, it's usually like kind of a day, and then hold that for a day or two. And then we're done times a week. And then, you know, maybe it'll change back down or up, but you get some consistency. Sometimes you gotta change it every day. Sometimes it's, you know, a week or two without having to make a whole lot of change. But that's basically the math that gives you. It's the only real objective thing you get with the data. The rest is kind of art. You're gonna be tweaking carb ratios and ISF and dealing with activity and counting food is difficult, but the basal stuff is pretty objective. When you look at that information. Do you work with adults ever? Yeah, I've had a couple of adults that I've helped this year trying to figure out my course content. They've had a lot of, lot of fun, lot of learning, and it's been great. Naturally, the caregivers ended up coming to me, because, similar to you, we're parents, that's what we do, and we talk from a perspective without trying, because that's what, that's our lived experience. But yeah, I get I get both.
Scott Benner 27:43
Now you were just talking about how to make this adjustment. Are you planning on just taking people for coursework, or are you going to do a la carte too? Can someone get a hold of you and just say, like everything's upside down here? I don't know. Why? Could you just figure it out and tell me? Why? Do
Kenny Fox 27:58
a quick look? Yeah, I've done that. That's kind of been my MO. Throughout my time in the DIY space has been someone asking for a lot of help and to get all the information and context. You know, maybe they'll, they'll reach out to me, or I'll say, Hey, if you want, you can send me your night scout. We'll take a look together. I'll ask a couple questions around, like activity and other stuff that may not be obvious, and it within a few minutes, I can take a good stab at, you know, doing this math and a few other adjustments to get people in the right way. I don't know if I'm going to be offering that as a service, kind of standalone, probably, but most likely to be the course. And then I'll have a I'm going to create, like a little support group on the back end that's pretty affordable, so people get through the course. If they want to keep hanging out for not too much. We can hang out and, um, go over that stuff regularly, but I'll probably open up the doors for just a quick check in. And I don't mind people messaging me occasionally. If I have space, I'll, I'll message them back, but that time is going to become a little more, a little more limited. And the other thing is, I can, I have a couple of videos on loop and learn right now, and I'll put a few more on my YouTube channel in the near future that are just me talking through that exact scenario, somebody sending me something, ask them a couple questions and make some changes. So again, none of it's hidden. It's all it's all up there on on the YouTube. So you can kind of see me talking out loud with someone on the phone, usually a parent, and the adjustments we made. So yeah, yeah. Well, I
Scott Benner 29:19
mean, there are going to be some people who definitely just want to understand and the course, makes a lot of sense for that. And I wonder if the people who are just really flustered, if you could unfluster them a little bit, if that wouldn't open up some mental space for them to say, hey, you know what? I could learn more about this. Like, maybe just get out of the hurricane long enough to, like, settle yourself and think All right, now let's figure out how not to get back in the hurricane again. But I don't know if it's possible to do the figuring while you're spinning is what I'm saying. It
Kenny Fox 29:50
helps. It does help. I've seen it help people. I That's why I just reach out sometimes and help people, because they are spun up so much they can't take in any more information. They're. Fighting the system. They were maybe fighting it before loop or something big happened, like these basal rate changes, this puberty stuff kicking in, and now they they feel like loops been great for years, and now they're sideways. So it's definitely something I'll be looking into. You guys can pay attention to my website and see if I offer that. Right now, I'm just focused on trying to get the course out the door, but it's definitely I love meeting people and hanging out for a bit and putting them on the on the right way, so they feel like they can walk away and have things a little more sane, so they can start to make more mild adjustments, right? Yeah, it's been fun.
Scott Benner 30:29
Okay, do we have more in this section? Or can I ask a disjointed question before we move forward?
Kenny Fox 30:34
I would just highlight a couple things in the basal just so people know if they have kids with low basal rates. I remember doing that being the point 1.1 5.2 those kinds of things. And with this kind of exacting math loop does with the insulin on board. It expects zero insulin on board to make you level. And sometimes your kids just live between the rates their actual basal needs are just between what the Omnipod can deliver, which is a benefit to something like a tandem or something else where they have smaller increments, you can step up the basal. So if you guys are in that boat, just like give yourself a little bit of break, use the numbers the iob to help guide you, and just pick on which side of the of the fence you want to be on, on the slightly heavy basal or a slightly lower basal. And just try to maybe adjust the carb ratios and other things to kind of compensate knowing you're either heavy on the basal or light on the basal, it's a tricky spot to be in to get it just right, considering loop kind of really wants it to be exactly right. It's not very forgiving in that sense. So I think that's important to know. I was going to ask you a question about this. One thing I find challenging lately, as test has hit puberty, more near 11. You had mentioned before that sometimes Arden would get real sensitive in the evening, going to bed. I experienced for the first couple times in the last few weeks, like just a big drop, a big it looks like you collect a bunch of negative instant on board in loop terms, where blood sugar just drops and falls out, and we treat it. And she comes back up, and she goes back to sleep, and then she's fine, but it's just crazy. It's like, almost like she didn't need any insulin for like, a half an hour or an hour. Did you ever experience any of those weird drops? I hadn't had those in my six years of doing this until just recently. I
Scott Benner 32:14
don't know how to explain them, other than it feels like when she closes her eyes and relaxes her insulin needs go down. So
Kenny Fox 32:26
I don't know the whole night, though, right? I think you've expressed it's the whole night, though.
Scott Benner 32:29
Arden uses a different basal rate from bedtime until she wakes up, right? Yeah, and if she sleeps in, then that's the only time you have trouble, because the the new basal rate comes on for like, general days, you know, the day she wakes up. But if she's suddenly like that, I don't have a class, I'm gonna sleep till noon. I almost have to remember to get up in the morning and do it like I'll do a Temp Basal through night scout and take her basal down to another level for a few hours, and then hopefully I notice when she wakes up, because I want it to go back to where it is as soon as she's awake. So to be honest, I don't exactly know, but to me, that's what it feels like. There are things that I've seen in throughout this time that I just trust now, like, here's an example of one, if your blood sugar stuck a little high and you go make a number two, I expect your blood sugar to come down afterwards. I don't know why. I don't even think I care why. I just know that I've seen that so many times it happens. I mean, Arden's a young person living in the world. She's got anxiety and stress like everybody else, and I expect that part of her settings are due to that. And I expect that when she closes her eyes and relaxes, that her needs change drastically, pretty quickly as soon as she falls asleep. The problem with a 20 year old is they don't just like go to bed every night at 10 o'clock. I found myself like I can't turn the basal down too early in the evening, because what if she sits up till two in the morning? That's a different problem, right? So I look a lot at the when she goes to bed, and the insulin on board. Even though you've explained it to me in the past, I think somewhere in here, I'd love for you to explain again, how you use the insulin on board number to fix a low blood sugar. Like, how do you know based on negative iob that this many carbs is what? Anyway, we'll get to that. But like, let's not forget to get to that. It's a note I made. She goes to sleep. She seems to relax. That happens. I think the same thing. When people say they get in the shower and their blood sugar goes down, I wonder if the hot water doesn't just hit the back of their neck and they just forget about their worries for a while, and suddenly they've got more insulin than the adrenaline and stress. Yeah,
Kenny Fox 34:38
I've, I've appreciated that more. I used again, used again, used to be kind of like, oh, we always need a lower basal rate during the day than we do at night or a flat one. But I have seen working with people more intensely that I even have a friend as an adult, same thing, going to work, going to school, raises their blood sugar. They just need more insulin as a result of what I can only imagine is. Stressed. My daughter, Tessa, got the same problem when we moved across the country just in August and started a new school, and she was super amped up to go to school. I think she was just excited to have a different school. She's kind of partially hybrid home school before now she's going to public school and middle school, right? And she just needed more insulin, you know, for the first few hours of the day, and then she would get off, you know, we're not the bus, so we get her from school, and then her blood sugar would kind of drop. So definitely, and it's like gone away, that that impact has disappeared, yeah, as we've gone through the school year. So it's definitely, there's definitely other things to pay attention to that you got to watch out for. I have a question for you real quick, though, does Arden need the same increase in basal on the weekends, or is it just
Scott Benner 35:38
school days on the weekends or school days. Yeah, her basal, her No, her daytime basal is seven days a week, so whatever her level of life is, it's pretty consistent with her. I mean, I'll joke, like, not just joke, but you can see her walking to a test because her blood sugar just like, like, if she leaves her dorm room and she's going to a test, I watch her blood sugar start to rise. It can go from 80 to 160 and the algorithm jumps in and it's like, Hey, what's going on? And it'll like, hold at 160 now my inclination in the past would be like, let's Bolus. But what I've learned to recognize is that when the test is over, it comes back down on its own. So,
Kenny Fox 36:21
yeah, that adrenaline or something like that, that's causing that rest. I
Scott Benner 36:24
wouldn't ask her to touch that. It's just a benefit of using an algorithm that you you know, because, you know, without that algorithm, you wouldn't just be 160 it would be 300 you know, like it would just keep going, because it's, it's pushing, it's pushing with basal, it's pushing with boluses, etc. It's magical. Kenny,
Kenny Fox 36:42
yeah, it's nice to have an algorithm, I kind of call put a lid on it, right? So even with that, with Tesla, when she has basal right knee changes overnight, or this growth spurt thing we were talking about earlier, yeah, he was 170 which is obviously a problem, if the target and loop is like 100 but what would it have been if you tried to sleep the whole night. You know, without that, with just a regular pump or shots or whatever, making that adjustment would be very difficult to do. I wanted
Scott Benner 37:07
to go back to one more thing, that if you are listening and you have a smaller child who's experiencing overnight growth spurts like what I just said might sound crazy to you, because your kid might go to sleep and their blood sugar shoots up all the time, but Arden's beyond that. Now it is really interesting. The thing that you mentioned earlier about basal rates, because I can even though it's been years since we recorded those episodes together, I remember you advocating for one basal all day long. And I don't know if I said it out loud in the episode, but I do remember thinking, Well, that's easy for you to say, because your kid hasn't hit puberty yet, I
Kenny Fox 37:43
think you did. I think you sneak it out, or maybe it was after the call or whatever. But yeah,
Scott Benner 37:47
you know, your bigger picture understanding has to evolve, as you know, if it's a kid, growth spurts happen, I mean, but also could just be weight gain. If you're an adult, you gain 20 pounds, like a lot of these things are going to change for you. I just saw something really interesting the other day where, when Arden would make the trek home from school and drive herself, her blood sugar, she I noticed her having to Bolus a little more. But the other day, she made the trek home, and my wife was with her, and my wife, I think she suckered my wife into driving and like, she didn't need as much insulin for the ride home, because, I think just the she wasn't, you know, hold on to the steering wheel, staring at the road, trying not to die, like, you know, like it's just it was more relaxing to be in the other seat. So there's a lot of stuff that's going to impact your insulin needs.
Kenny Fox 38:35
Maybe, maybe when it starts settling and she's driving, you'll feel like she's matured in her ability to drive. It'll correspond, right? I
Scott Benner 38:41
don't know she's a good driver. I just think she might be a fairly aggressive driver.
Kenny Fox 38:47
Nice, nice. Yeah. I mean, I've seen I was counting through my messages, like, a year or two ago, and I think I have more than 600 different people or more that I've like, gotten messages from in Facebook over the years. And so, yeah, since those episodes, I've seen a lot more graphs, a lot more ages, and then experienced more too with my own daughter. So it's definitely, like, opened it up. But you know, the idea of keeping it simple is definitely guiding for a lot of people. Hey,
Scott Benner 39:12
let me jump in here and ask you a question with opening up box in the loop house. Calm, you're not a doctor, I guess is my statement. Like, so like, how do you set something like this up? Like, what, what was the back room to getting something like this set up? A little
Kenny Fox 39:24
bit of concern. I definitely have a lot of like, notices that say, Hey, I'm not a doctor. Everyone understands that. And when I'm going to be talking about whether it's one on one or with the course, I'm always talking about how this is what I do for my daughter, this is the and then we'll talk about the data. I don't get into the code, but I do reference the algorithm, so part of it's just strictly teaching math and function. And I'll reference some, you know, studies and things like that, just to look at, like the facts. And then I'll tell how I apply it to Tesla's life and the numbers we just talked about and why that math. Works, and so I might make suggestions, say, if this was my daughter's graph, or I've seen something like this before with my daughter when she was that age, if it if it applies, I might change something like this based on the information we just described. So I'm definitely trying to stay clear of saying you need to change this. But this is why the emphasis is on educating people how the system works, and then how I tend to apply it so people can keep up. Because I do find that, in general, my drive to do this lately has been, I just feel like I'm not working quite as hard as some of these other people that are trying putting in more energy and effort into looping and getting worse results. And I don't think that's fair, and I think I've settled on, I worked on dialing back my own involvement, and we do just a couple things that with you understanding builds on. But the couple of things is, wake up in the morning, scroll back, look at night Scout, try to see if we need any basal changes, or if she's starting to run higher. Then I check to see if her pods leaking first, and we address that. And then, you know, we just avoided a catastrophe for the rest of the day, or running higher or running lower. And so it really only takes a minute, maybe less longer if you have to go, you know, change the pod, yeah, but we do those things. And then the rest of the information I can just glance through the rest of the day, maybe end of the day, take a look at the meals, and we'll talk about how we adjust meals a little bit. But I kind of have a certain order. I go through the settings and prioritize those, but the big ones, the basal every night, if it's just a couple minutes. Once I started doing that and making the adjustments, ever since I was on the last podcast four years ago, I've just gotten better at it. If I can teach people to do the same thing, I think they'll be able to put in less effort and get better results, or at least the same results with less stress, they'll know what to what to change. That's one of the feedbacks I've gotten from people is, hey, how do we feel at the end of this? Like, your numbers may not have improved dramatically at the beginning, but the amount of energy and effort it takes to get those numbers is significantly less. You're like, No, I know what to change now. I know right. Basal, I know that's a carb ratio, and I can make the change. And then we adjust, and we move on, rather than mentally, like mulling it over in your head for way too long, trying to figure out what it is. Yeah, that's really what a lot of people get out of the initial modifications, is just knowing where to start. It's interesting
Scott Benner 42:12
to hear you talk about it, because you sound like me talking about making the podcast. There's a way I do it. I don't know. It just works. Here it is. I don't care. Try it yourself. You know, take some of it, take all of it, do whatever you want with it. I do get the same kind of responses back. It's great, like, so in the end, you've, you've got this compendium of information in your head, and you're just going to share it back with people and and let them try to put it into play and see what they do with it. I think it's awesome. So yeah, this is
Kenny Fox 42:36
exactly like the podcast is trying to zero in on loop and and slightly more technical, just so I feel like I can talk objectively about it, and people can make their own decisions. I love it. It's a fine line to walk, but you're my inspiration, Scott.
Scott Benner 42:49
People need the help. Like, they just do, you know, we went from just fast acting insulin and in a pump, you know, however many years ago, and people would just go, like, I don't know what's happening. Like, it's all over the place, like, you know, nobody helps. Doctors don't help you. Like, you know, then that's your hell. That's you go live that life, and you say to yourself, like, well, that's just diabetes. I guess this is what it is. And then that's the level of torture that you now live with every day. And I came along and said, like, I don't think that's right. I think you should maybe move some of these settings around. Learn how this insulin works a little bit, and then these algorithms came along, and it's great for the people it works for, but for everybody else, you know, they used to say, well, that's just diabetes, and now they say the thing doesn't work. Like, you know, I bought the thing. You told me it works. It doesn't work. And now they're just, that's their hellscape, and it goes on forever, like, people need to understand how insulin works, no matter where they're using it. And, you know, I think this is awesome. I'm really excited that you're that you're doing this. Do you think we stop here, call this an episode and move to the next thing? Or do you think we keep talking? I'll
Kenny Fox 43:55
add one more thing, and then, yeah, we can probably go on to, like, food in a different one. I think one of the things you mentioned here is like clarifying things for people, looking at the all the variables that exist, I think with loop, loop is unique in that it's trying to model everything. Is just trying to you, just tell it, and it trusts you. And so it puts the settings out there, and it calculates everything with a fair amount of accuracy, as long as you, you know, do your part. There are other systems that try to handle the fudge factor, which is great, try to help the fuzziness of all the stuff you're entering. But what's cool about loop is, once you settle on like you get basal rates kind of dialed in. It seems to me, when I'm talking to people about this, that it kind of clears the fog. What people say is, Oh, I see so many more things now. So they level their basal rates out, kind of find what works, and they understand what the basic pieces of the data they're seeing in loop is like, Oh, well. Now I see when there's a bad pump site. Now I see when activity is causing a problem. Now I see when fat and protein is causing the problem. I found the same thing for me. Is once, you know, you talked about fat and protein, and we had pretty good settings, that was like, Oh, now I know why there's a rise, you know, 345, hours after a meal. So instead of looking at a meal on a graph as like, oh, well, there's two hours. I don't the meal seemed fine. I don't know why we're going high now and now, as you can see, those pieces, once you understand what the variables are, and you get really good basal. It sort of clears the fog, and people can now know what those things are very quickly, without too much energy, and they can just fix it. They can address it. We can add more carbs or fat and protein or whatever we'll talk about that later, but that's the clear and the fog thing. People need the help. I think because of that, there are systems, DIY systems, that are working on adding layers on top of those basic models to help with that fuzziness, to help to the point where maybe you don't even have to enter carbs, like with trio and all that kind of stuff. But I think to start with loop helps you learn. So either you can learn it by listening, you can learn by watching the videos, or you could try loop out for a little while, and it'll force you to see variables that maybe you didn't quite see so clearly before that have been talked about on the podcast all over the place, especially in like the pro tips and those kinds of things. And you'll just be able to see them working and then be able to address them without really spinning your wheels a lot. So I think that was that's been helpful. The way loop is designed, it really externalizes and draws the picture of all these other things that you can then see. So
Scott Benner 46:22
I really enjoy talking to you, because you do a very good job of contextualizing the thoughts in your head. Whereas I can tell you that by watching night Scout, I've learned a lot about diabetes, but I don't know that I can tell you what, like, I watch the graph, and I look at the graph and I go, Oh, I think the pods going bad, or, you know, like that kind of stuff. It didn't happen the other day, like, I said to Arden in the middle of the day, she's home, and I was like, I don't like this pod. Something's wrong with a pod. And she's like, it's fine. Leave me alone. I was like, Okay, fine. I pinged her a couple times during the day. I was like, Look, that Bolus was too big for what just happened here, and it didn't move. There's something wrong with the site. The site's not right. Blah, blah, I got such a begrudging text from her. A couple of hours later, my pod just errored, and I was like, do I be an adult here? How do I handle this? Exactly? And I just responded back, Scottie knows. I mean, I guess I could really, like, talk it through, but I don't know mathematically. Like, what did I just see that told me that, but I can just tell you that things were happening. There were Bolus is happening and basal adjustments happening, and the results were not matching my expectations. And I was like, this has got to be a site.
Kenny Fox 47:31
Yeah, there is a lot of that. For sure. I have the same kind of thing, and I'm working on trying to articulate what it is that I'm seeing. But part of it is just, I think everyone else is pretty sharp at picking up those things. Once you can get the basal pretty good, like, Oh, now you have more consistent. We'll talk about meals next time. But once you get consistency in your meals, then you when you lose it, like something's wrong, exactly we discussed, like you're, yeah, there's a big Bolus, but it just didn't move. That's strange. And I see the same thing when the pod site. And I get pushed back. Now that my daughter's 11. She's like, I don't really want to change it. So I'm like, Well, looks like there's some staining around the the tape on the on the pod, it's probably leaking. Well, can we just run it for a while? Sometimes we do, right, but at least I know what's wrong once, if she ends up high. Okay, well, we need to change it. And, you know, yeah, let's Bolus it and get it back down. And it's not confusing, it's annoying, but it's not confusing, and I let her make that decision. So
Scott Benner 48:24
yeah, okay, yeah. Well, we'll get to that, because, like you said, once you can clear out some of that noise, everything comes into focus much easier. So we'll do that in the next one. Thank you.
This episode of The Juicebox Podcast was sponsored by us med. Usmed.com/juice box, or call 888-721-1514, get started today with us. Med links in the show notes. Links at Juicebox Podcast com, thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juice, box. Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d, exchange.org/juice, box and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa, this is the way t 1d exchange.org/juicebox It should not take you more than about 10 minutes if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.
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