#152 We've Got Ourselves a Conroy

Kevin is the father of a child with type 1 diabetes who uses the Dexcom CGM with multiple daily injections....

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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
Just a quick announcement on Saturday, March 3 2018. That is this Saturday, I will be speaking at the type one nation summit for the New Jersey Metro Rockland County jdrf chapter, going to be given a presentation called bold with insulin but you know, presentation. I'm going to bring a couple of slides that I'm going to talk about like I do on the podcast. Come on out. There's a link in your show notes where you can get your free ticket. It looks like it's going to be at the DoubleTree by Hilton in Somerset. The event goes from 830 till 2pm. Again, that's this Saturday, March 3, I will be there all day, though. I don't think I speak until after lunch. I think around one o'clock. I don't want to say they're saving the best for last, but that's probably what's happening. So come on out. It's gonna be like watching the podcast live. I'll be there all day. I think I have a table somewhere in the morning or you can come say hi, and I can answer questions or we can just you know, shake hands and talk about the Black Panther movie or whatever. And then you can hang out after lunch and hear my my chit chat. I hope to see you again link in the show notes. It is completely free. Alright, let's talk about the podcast now. Welcome to Episode 152 of the Juicebox Podcast. Today's episode is sponsored by Dexcom. And the pod Omnipod. Of course, a tubeless insulin pump, the one that I've chosen for my daughter, and Dexcom, makers of the G five continuous glucose monitor. You can find out more@dexcom.com Ford slash juicebox. Or Miami pod.com. forward slash juice box. And they'll be some ads in the middle. Don't skip them. I work hard at this things. Today's episode, Kevin Conroy, Kevin is the father of a child with Type One Diabetes. He's another person who answered the call when I said I want to talk to people who use multiple daily injections and are having success. Kevin Absolutely. As he was fantastic on the podcast. He's got a lovely voice much nicer than mine. And he's thoughtful and smart. So you know, bonus 150,000% absolutely nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise Always consult a physician before becoming bold with insulin. I feel like I've said that one too many times.

Unknown Speaker 2:16
Okay,

Scott Benner 2:17
I'm still getting over my head cold. I'm a little loopy, I think you can tell. Again, I was not loopy or sick when I recorded the episode, so don't worry about that.

Kevin Conroy 2:37
My name is Kevin Conroy. I'm the parent of Tyler. He's a type one diabetic. Six and a half years old. Now. I was diagnosed when he was two and a half. So we've been living with it for about four years. Have some history of of my family. My brother was diagnosed when he was 19 or 20. I forget when exactly but about 10 years ago now. And so we have seen it firsthand, both on the older side as well as definitely the younger side.

Scott Benner 3:07
How old were you when your brother was diagnosed?

Unknown Speaker 3:11
Gosh, I would have been like 2324 Okay,

Scott Benner 3:13
so you were a little rough? Yeah. Interesting. Is there any other? Now besides your your child? Is there any other instance of type one through your family line?

Kevin Conroy 3:24
My cousin on my dad's side has it as well. Okay,

Scott Benner 3:27
so you guys are you're steeped in it, then pretty much?

Kevin Conroy 3:31
Well, you know, yes or no, because when my brother was diagnosed, I mean, everybody, you know, came to the hospital, and then they you know, my mom's like, Oh, this is really serious. This is really serious. But I think none of us really internalized just how serious it was, except for my brother. Because, you know, him being, you know, like 20 years old. And in college at the time, his sophomore, I think, you know, he was really the one responsible for his care. And so none of us really thought it was as big of a deal as I know it is now because he he really took on all of the management of it. And so none of us saw the, you know, went through that same learning curve of counting carbs and dosing, insulin and everything like that, because, you know, after he was released from the hospital, he was he was right back at college. And so it was, yeah, you know, it occurs. I don't want to say out of sight out of mind, but

Scott Benner 4:28
it is a little bit you know, if you're with a group of friends walking down the street and one of your finds $100 bill on the ground, the excitement of that is for everybody. And then he leaves and takes the hundred with him and you don't you don't think about it again. You don't you know, don't get to spend it in an odd way. Your brothers given this, this disease and everybody's there going, Oh my gosh, that's incredible. Sorry, this sounds sad and blah, blah. And then he goes back to school. And you know, and it's not like you sat I'm assuming you didn't spend every day just thinking about him and his diabetes. He was going Because it probably when you saw him he was okay. You know when you when you converse with a moose, okay, you don't think about all the details on it and and now you have a child that has type one and now the details are with you all the time. So Oh yeah,

Kevin Conroy 5:11
yeah, every three minutes or so like background process in my head kicks off. What's his number? How's he doing what's on board? What do I need to do I need to do anything? No. Okay, great. Let's go on to the next three minutes.

Scott Benner 5:22
I used to joke that when my daughter was doing shots that I could, if you asked me, please tell me an hour from now? Yeah, I would get it within a couple of seconds. I just, I could I felt like I could reset this clock in my head over and over again. Like we should have, you know, that sort of thing. So what kind of um, so you're doing, you're doing MDI, is that right?

Kevin Conroy 5:45
Yeah, multiple daily injection, which I spell out just in case, any of the listeners haven't heard what that acronym stands for. It took me a while to figure it out initially. Yeah, so we're doing we're doing MDI, with my son been doing it for past four years now, are almost coming up on four years, I should say his diversity is in September. And you know, as a longtime listener of this podcast, I think a lot of the advice that you've given in terms of, you know, being aggressive with diabetes, not being afraid of diabetes is having a healthy respect, of course, for it, right, but, but being aggressive in terms of how you're handling highs, and not being as afraid of lows, but respecting lows, has really helped us get better control in the last year. So and I, you know, you've had so many great guests on the program, that are all focused on the pump, and I've got nothing against the pump. But for us right now, for our family, MDI has been the right choice. And I'm hoping at some point, my son will transition to a pump, but you know, for anybody else out there who's doing MDI or is only able to do MDI, because, you know, insurance is such a real and present concern with this disease on top of everything else, you know, maybe all you can afford, or all the all the equipment you have access to for whatever reason, sure. And I think that there's a lot that you can do with MDI, to still get great results, maybe not quite as good as you could get with a pump just because of the dynamics of insulin. And, you know, having, you know, just getting it in a shot, even if you've got even if you do 10 shots a day, it's not the same as the constant drip as a pump, but I think you can still get really great results with MDI. And I, I felt it was important to, you know, just make sure that's a part of the conversation, too. Because I think you've had you had so many rich conversations on the program. And I think it's, it's so great to that you are taking such efforts to paint such a rich picture of the full type on spectrum. Well, I

Scott Benner 7:42
appreciate that. But and I like I told you before I I'm trying so hard to add something in this space, but it's not where my you know, if you listen to me tell my story when we were empty, I wasn't doing very well. And so I have no genuine expertise whatsoever. But I do think that our conversation, you know, and I've reached out to other people before, I think you might be the third person one of them has. One of them hasn't aired yet. But you know, it's like, Hey, I'll come in and talk about MDN. I'm like, great, like, how are you doing with it? Like, we're not so good. I was like, well, that's not good. But I'm like, okay, that'll still be a good conversation. It just won't get to the right thing up here comes in with our lunch. Excuse

Unknown Speaker 8:17
me. No worries take time.

Scott Benner 8:20
This is a tough day because she was at she was a gym. And so I can only see her CGM from about 25 minutes ago. And so I don't know 100% know where she's at right now. I'm going to ask her if she can see the number or if she's been far away from it enough that she doesn't have it yet. It might pop up while we're talking. But no matter what she's gonna say, Dad, I feel fine. What's Bolus? I guarantee you that's what the see this is the tax it's about to come back to me.

Kevin Conroy 8:50
I'm in a blind spot to right now the CGM because he's out himself on range right now. So

Scott Benner 8:54
and how long have you been with the because even though the shots the whole time, but how long did this end? Yes, it is x camera. Which one are you using?

Kevin Conroy 9:01
Yeah, it's the Dexcom. We're in the g4 have been doing that too. Last year.

Scott Benner 9:04
Okay. No, I feel fine, though. So I'm just gonna give her the bullets i think is right.

So what I have here is, last time I saw her blood sugar, which I say is about 20 minutes ago. I think she's about 90. And she's going to eat in about 15 not 10 minutes at this point now. So I gave her an extended bolus, but I didn't give her any of it now. So it's an it's an eight unit bolus. It's all just going to start going in now. So she'll have probably four units of it by the time she starts eating. And, you know, by the time she really digs in, it needs the rest of it should be going like that. Hopefully that'll work out okay. Her school has been a cell phone Bermuda Triangle the last week or so. So okay. Make sure that she had it. She does. Okay, so you're using Dexcom. And you're using MDI, you're hoping Isn't it funny, like, you're hoping for a pump, but at the same time, you're very happy with MDI. So, yeah, I really do want to if you don't mind having a more nuts and bolts conversation, yeah, love your episode. Let's sort of like, let me ask you a couple of questions, answer whatever you're comfortable with. And then I'm gonna try to walk you through a day. So, okay, are you comfortable telling me like, what you're kind of average a one c? Is it? Is it stable? Or does it bounce around a lot? Or what do you see usually?

Kevin Conroy 10:38
Yeah, so the last year for the last year, since we've been on Dexcom, his agencies have been 6.9 6.4 6.8. And based on all the Dexcom data, projecting a 6.7 6.8. Coming up for our next endo appointment, which is Wednesday.

Scott Benner 10:54
So you do have a ton of stability that that's Yeah, because that's almost a full year of staying right in the same space before the deck sounds. Do you have any idea what you were doing?

Kevin Conroy 11:02
Yeah, I'd plot it all out. Thinking you'd probably ask when he was diagnosed four years ago, he had an A 9.4? And, you know, so he asked at the time, they said, Okay, well, you know, they taught us the rule of 15. Right, you know, so 15 carbs, and, you know, give them a unit basically. And because he's a real little guy, so he didn't need much insulin and still doesn't need a lot, you know, compared an eight unit dose is like a huge meal for us, not a lunch. You know, and he jumped up to 11.3. At the for his first check in after diagnosis, because we, you know, foolishly or naively, I should say, not foolishly naively went to the store like Great, well, let's just buy all these snack packs, let's say 15 grams of carbs on them. So we loaded up on cold fish, and raisins, and grapes, and all these other things that now we realize, oh, gosh, why are we giving him all the things that are going to spike his blood sugar, we didn't know, we didn't know, we were brand new, you know, and we didn't understand the effects that fast acting carbs have on blood sugar. And so you know, we ended up getting all of these blood sugars in the three and four hundreds constantly, right after diagnosis. And his endo at the time, who we switched pretty quickly away from just kept saying, I would just, you know, just wait six months, just wait six months, we'll get them on the pump. And we thought of this pump is this magical device that we just needed to get to and we didn't really, you know, she was like, Oh, don't worry about MDI, you know, you don't really need to understand it, we're just gonna get you on the pump. And, and it didn't really make sense to us, because we were really not happy with him being in the four hundreds as much as he was. And so we did a lot of reading. And unfortunately, the hospital and the doctor that we got right at diagnosis didn't really give us very good diabetes education. Or maybe they did on that first day, I don't know, like many parents are sitting in the room, and a diabetes educator comes in and just like, turns on a firehose of information for 45 minutes, while you're like still catching your breath from your child, nearly going DK, you know, it's hard to process and remember it all. So it took us some time, but we ended up switching to a fabulous and children's hospital here in DC. And she, you know, took a look at our numbers and was like, Okay, well, we need to, we need to switch everything around here. And you need to get MTI under control before we put you on a pump. Because, you know, you need to understand the dynamics of manmade insulin, and how carbohydrates are working, and how to, you know, all those complex interactions that happen, because once you have the pump, it's just a tool, right, you still have to operate it, you need to understand all of the variables that you're manipulating. And if you're doing that with MDI first, and you get a good handle on that is her theory that, you know, that you'll be better suited to, you know, be able to handle the pump and make sure that if something goes wrong with the pump, you know, if you've got a bad injection site or a bent tube, if you have one that has a tube, then you know, you need to know how to handle that. And of course, I'll just say I'll say anything that I say should not be used as advice, medical or otherwise.

You know, and so her medical advice for me and my family alone was that we should you know, look at MDI first and then really get that under control and so we got some nutrition counseling and really started to really understand about glycemic index and everything and so from that we got his agency down from 11 to nine and and then down to a heights and so that was that was you know, pretty good. But the more that I read about things and then eventually found your podcast that Oh gosh, like there's there's still so much room for improvement here. And I think the the decks calm was really the The game changer for us. And so I think, you know, you know, one of the issues with MDI, right is that you've got so little control over, providing kind of continuous insulin. And that if you're just giving, you know, five shots a day, let's say, of insulin, you need to figure out your timing really carefully, and not having the, without the insight that adex comm provides. It's really, really hard to make MDI work as well as it can work on its own.

Scott Benner 15:34
Yeah, then you you're, sometimes I think they give you those those intervals, like test again in three hours, because that's your best chance to be back towards where you want to be. And it's funny, they don't sometimes they don't even want you to, to see what's happening in between, because I guess you don't have the tools to do anything about it. And so it's almost sometimes I think it's more of a psychological. I don't want to, I don't mean crutch, but I think they're trying to throw you a life preserver a little bit like, Hey, don't look then, you know, like, like, don't wait an hour and a half after they've eaten you. You don't need that stress. But yeah, but it is. It really is. And I know I've oversimplified it when I talk about it. It's like, it's like, it's advice that won't kill you. But yeah, it's not advice that's going to let you live like a really healthy life. And the real problem is, is when your blood sugar's high, or, you know, too high, you know, these these issues that it's going to cause health wise or down the road health issues. So once your body adjusts your blood sugar being high, you really don't feel like there's anything wrong. And and you know, then it's just that it's just a waiting game until it becomes a real problem. That's not it, then you probably not reversible by that point. So I like knowing I think, I think it's just better to know up front what you're really doing and what you're dealing with. So prior I hear what you're saying prior to Dexcom and everything you're you were slowly coming down with with injections, but you're able to see was still sitting in the eights which you weren't happy about once you realize you shouldn't have been happy about it. And then and then you get to Dexcom. What is the first thing that the being able to see the continuous glucose is like, what is it? What's the first thing that made you feel? I'm assuming it made you feel horribly inept at first, but then once you got past that, how did you feel? Oh, well, I

Kevin Conroy 17:21
did. So not so much enough, but more just what eyes wide open, like, Oh, my gosh, I had no idea his sugar was spiking so high after a meal, and then coming right back down. Because if you're only taking, you know, right before the meal time, and then three or four hours after meal time, you're getting two very small points in time, right, and you're missing the potential, you don't know if in between those two points, you have skyrocketed up to 400 and then come crashing down. You don't know, if you've been level, you don't know, if you've dropped and then you know, is back, you know, his body was just like, ah, we need to, you know, release some glucagon and, you know, let him rise up and our glucose rather and rise up. And, and I think, for us, it was, you know, you don't drive a car with your eyes closed. Right? You are constantly making adjustments and making sure you're staying in your lane. And I think you know, for anybody who's who's got a CGM, if you're viewing that as trying to stay within your lane and stay between the lines, you know, having, knowing when you're veering off course, is really, really important. And having that data then lets you make better decisions. And so yeah, I mean, sure, even, you know, we have plenty of days where he he'll end up, you know, in the, in the three hundreds. And every once in a while 400 although it's been it's very rare now, thankfully. But it lets us you know, see what's happening and then adjust course. So, you know, one of the things that we did right away was get a Pebble watch, and get one of the nightscout watch faces for it so that I'm able to watch his numbers remotely. And for me, I think that is almost as important as the Dexcom itself. Because him being you know, I was five at the time, five year old boy, you know, very active wanting to run around, he doesn't want diabetes to get in his way. And so me being able to just glance at my wrist to know what his number is, and is a game changer

Scott Benner 19:26
for him. Because I don't want to stop you just for a second make sure people understand. So you don't have the G five so you don't have the share feature that's built in. So you have the G you have the G four so you using nightscout to,

Kevin Conroy 19:39
to so you can see things remotely. Alright. So we have we have the G for platinum. So it's got the share feature. So it's got the, you know, we use the Dexcom app, he's got an old iPhone that stays with him that it's just an uploader phone basically it just has the Dexcom app on it. And so it will you know upload everything to the the Dexcom website and then when We have a Pebble watch that will basically Connect straight to the Dexcom servers and download that data. So I can see his curves and his current number and his trendline, and all that other stuff. And so, and it was, as a john kostik built the initial watch face for it, and then I've made some updates and modifications to it, too, to work, uh, you know, more in line with what I'm, I'm trying to aim for. And so that has allowed me to basically, you know, he, as long as he's got his, his Dexcom on him, you know, in a little spy belt fanny pack. And his phone is within Bluetooth range of him, you know, I can manage his diabetes effectively, and he can just be a regular kid, which I think is every parent's goal, right to not let the diabetes get in the way of childhood. And that's exactly. And so, you know, one of the things that we do is, you know, there's really, I say, there's only like three things, as a parent of a young type one, you can really manage, you can control the carbs, you can control the insulin, and you can control your attitude. Yeah, right. And, and to some degree, you can control their activity. But anyone who's who's had a, you know, a three or four or five year old boy, like you really can't control. You can maybe control activity for 15 minutes. But otherwise, they're going to be up and running. And, you know, and so you have to be able to take the tools that you're given, and the attitude, you know, that you want to bring to the bring to the process, to manage it as best you can. And for us, that has been, you know, by having the decks calm, and the Pebble watch face that lets us see his blood sugar has really let us do sugar surfing, with MDI. And I think typically, you know, when sugar Surfing is a book that you can read is written by Dr. Ponder, I want to say his name is

Scott Benner 21:58
Yeah, I've interviewed Dr. ponder on the on the show. Fabulous. Bunch of a while ago, but but, but yeah, he wrote this book that just talks about, I have to kind of say, I feel like I have to say it every time. But I got him on the program, because people asked for him to be on but I didn't know who he was. And then he started talking about what he did. And I started talking about what I did, I was like, wow, we're doing the same thing. You call it something different. And but but that idea of even you, you spoke about it in a different way to about staying in your lane. And yeah, it's funny when you said that it made me think about I just taught my son how to drive last year. And that was one of those ideas that, you know, when I told him initially, I'm like, Look, when you know, you're trying to stay in the lane straight, it's not really this giant correction on the wheel. it's it's a it's just a very tiniest bump. And he's still in, you know, the first couple times, kind of, over, over exaggerated way supposed to do. And as I watched, I never really thought about, but he was only turning the wheel of, you know, a quarter of an inch and still having this giant overcorrection. And I said no last and he's like, how much less? Can I turn it? And it's like, well, you can feel it if you really pay attention in your hands. You know, and I think that has so much to do with bumping a blood sugar around, you know, just, it's, sometimes it's less than a little bit. And you know, and how much less? I don't know, you got to feel it. You know, like, you just have to just sort of have to know. And that comes with time and experience just like with the driving. Yeah. And Kevin, give me one second, I have something making noise in the corner of the room that I can stop. So I'm going to be right back two seconds from now. That's good. Oh, come on, you know, I was gonna put the ad here. It's about time and there was a break in the show. It just makes sense. Problem is I'm still live on to the weather. I need some motivation to, I know what I'm gonna do. I'm gonna I'm gonna sing and I'm a bad singer. So get ready for this. First like lesson, we feel that music done.

It goes, boom, ba doo, ba doo, doo. And I'm gonna start talking now. The pod is fantastic. It's a tubeless insulin pump, they are going to offer you a free demo, all you have to do is go to my on the pod forward slash juice box. That's where the person had to breed. They're sorry. They're going to send you out a free no obligation demo pod.

Unknown Speaker 24:21
You

Scott Benner 24:21
can try it on and see what you think.

Unknown Speaker 24:26
giving, giving, giving.

Scott Benner 24:27
Yeah, God, I love it. Like I'm saying, then you call them back and say, and I'm the BOD was pretty cool. Let's move forward and get myself untethered. I want to make small adjustments to my blood sugar without having to inject all the time. That's what I want to do. And then they're going to say, Okay, and then that'll sort of be it and you'll be using an insulin pump. I don't even hear the music. My omnipod.com forward slash juice box. Nowhere else Someone's singing so poorly to you about something so important. Go to the link in your show notes. Try it today. There's no obligation, it's absolutely free. There's no reason for you not to. I'm guaranteeing you, you're going to be happy you did. Alright, let's get back to Kevin. Had I'll never sing again, unless I maybe do it in the next ad, cuz I think I'm on some medication for my head call. I'm sorry about that, but that's much better. And it wasn't baisley didn't have to gag at all. And so, how do you do that with MDI, though? Like, how do you bump like, I know what I do. You know, this morning, this morning, Arden's blood sugar was coming down the stairs from school, for school, it was like 110, and it started to drift up. So I gave her some insulin, it wasn't enough. So half an hour later, I text her back, I said, do a little more, it ended up being too much she went down to 70 strike a little bit of juice, she came back up the 90 like, but how do you do that with injecting your son or snapping with you? What do you what do you do?

Kevin Conroy 26:00
Yeah, so it's, it's definitely it's definitely harder when he's at school. Because the, you know, the doctor's orders are just a dose at meal time. Or if he's you know, Sky High, you know, over 300, then we can get a correction dose called in. So, you know, primarily, this is something that we're doing at home, uh, nights and weekends and over the summer and breaks that sort of thing. Because there's less, you know, I've just got less control when he's at school. And that's okay, for now. So, you know, mostly what we do is we're looking at, trying to manipulate the variables that we can manipulate. So Pre-Bolus thing is a huge part of our strategy now, and it never was before, because typically, when they say MDI, they say, you know, especially with young kids, some of the recommendation is to wait, at least in the initial education, wait till after the child is done eating, because, you know, you don't know what a picky two year old is going to finish on their plate, right. And so if you, you know, are giving a dosing for, you know, say, 40 carbs, or something, they only 10 carbs worth of it, you might have a pretty big problem on your hands, you know, an hour and a half from now, especially if you don't have a dexcom. And so, you know, they're out an abundance of caution, which I don't fault them for, are advising, you know, you know, taking a safe approach and kind of, you know, keeping things out of high risk zones, but still, I would argue risky zones in the long term. You know, they're getting rid of the acute risk and trading enough for for long term risk. So, you know, a lot of what we're doing is now saying, Okay, well, let's, let's Pre-Bolus him as much as possible. And then let's also do what ever micro dosing we can do with MDI. So we've got, we've had two different insulin pens that we use, and we had no analog, and then we ended up switching to Hema log, which is a whole other story, but, you know, we can get half unit dosing on that with the insulin pen. And that, that works pretty well. He's also he only was my son when I was 50 pounds right now, 51, something like that. And so a lot of his mealtime dosing is, you know, only two to five units. And so a half a unit can make a fairly big difference for him. And, of course, I mean, me sharing the dosing does not super helpful, because everybody's dosing strategies is completely, you know, dependent upon, you know, what, what their experiences and their body type and you know, what works for them. So, you know, don't don't use my dosing as a guide for your dosing, but I provide that just to, you know, give you, you know, kind of the context, right, in terms of what is a half unit mean? Because I think, you know, probably for grownups you hear a half unit, and you're like, well, what's that half draft gonna do nothing. But for somebody with, you know, smaller body mass, a half unit can be a lot. And it can be quite effective to turn 180 into 100. Overnight, which can be helpful. And so part of what we did is really try and understand what his ratios are in terms of insulin and carb sensitivity. And I think taking the time to really do that thoughtfully over a period of a couple of weeks, and I and you have to continually update it as kids are growing. But understanding that giving him a unit of insulin for my son will reduce his blood sugar, about 100 points, all other things being equal, and giving him one carb will raise his blood sugar, about 10 points. So understanding that dynamic has led us really take control of things now, that can vary from day to day, depending on whether he's got growth hormones, or you know, how active he's been and all those other things. So it's just like our starting point for how we're handling stuff. But you know, in the middle of the night, if he is at, you know, 200 you know, a few years ago, that's great, that's awesome. And now it's like 200 is too high. I don't want him sitting at 200 all night I needed. I want to try and get that down to you know, 120 or 100. If I can Even an ad, it's possible. But I've also noticed that, you know, he's his diabetes can tend to swing a bit. And so I like to leave a little bit of padding on it. So I try not to hang out around 70 or 80, which I know, you know, some, some pumpers have told me they can do quite well. And so 100 hundred 10 hundred 20 is a little better for us right now.

Scott Benner 30:25
In terms of sense, where you're able to see is that's exactly matches up.

Kevin Conroy 30:30
So yeah, exactly. And in part not, because I mean, I'd love it, if you could write it in at it's not that I've got anything against that. But I have just found more often than not that, you know, if I if I try and write in the ad, he the floor can fall out from under us more often than if I let them right at 100. So just searching for that stability, so that we can all get a good night's sleep, right is the goal.

Scott Benner 30:52
So is there really no, is there really no secret to MDI other than you're seeing, you know, because you have the next time, you can see what's going on, you can make adjustments, and you're just willing to inject more often.

Kevin Conroy 31:03
I mean, for us, that's been it. And, you know, I should say, you know, that's not been necessarily the doctor's advice. But, you know, we kind of went wild west and said, you know, well, let's, let's just try giving him a half unit or a unit outside of mealtime. Because it's it's not a lot of insulin. It's not like we're crashing, and then with the Dexcom, once we got good enough at Dexcom. And I should also emphasize we didn't start this the day, we got the Dexcom.

Scott Benner 31:28
You know, we got photo, the first couple weeks just started going, I have no I don't know what I'm doing again. Exactly

Kevin Conroy 31:33
right. And so it's, it's you need to you need to get good. I think, you know, the key to all of this is really making sure that you are getting good calibrations on your Dexcom. And you're getting really reliable data, I would not do anything that I'm suggesting until you are positive, that you know how to work index calm properly. And I think a lot of that is you just need some practice for a couple of months. Right? You need to know how to do insertions so that they work, you need to and you're not getting, you know, question marks or fail tensors immediately, which I think our first three failed on us. And my son was like, I don't want to do this anymore.

Unknown Speaker 32:08
Did you yell? I don't want to do this?

Unknown Speaker 32:12
Well, now we all agree on something. Exactly. Exactly.

Kevin Conroy 32:14
We've got that in common. You know, and it was, you know, turning to the, you know, the diabetes parents community, because there's a couple of great Facebook groups for that, as well as your podcast has been, you know, really helpful to help us, you know, understand how can we get the most out of Dexcom for our son. And so he was really scared initially, you know, of having the sensor inserted. And I know, you can't really see the needle unless you're looking for it. But it's still, you know, he still got the idea. Okay, great, I've got another thing that's going to be sticking something into me. And he was willing to do the first one we and we did the insertion. And, you know, for folks who have not done or, you know, if you've ever done a Dexcom insertion, or even if you haven't read that first time, you're going a little more slowly because you're not really sure what you're doing. You know, you pushing the plunger in, and then you're pulling back out. And so that needle stays in a little longer those first few times while you're getting the hang of things, and it hurts, it hurts more. And so it wasn't until we figured out that we could get numbing cream for skin and numb it out. But that really made him a willing participant in the process. And for me that has been that makes a world of difference in terms of level of care.

Scott Benner 33:28
Do you move faster now to when you're doing it?

Kevin Conroy 33:30
You're Oh, yeah, absolutely.

Scott Benner 33:32
Yeah, but, but I was just gonna say like, it's funny you as you were describing, and I felt like you were describing trying to pop a really thick balloon with adult toothpick because you just instead of just like bang like you have to go You have to depress that plunger by the way. I'm pretty sure that by the time the next iteration of the Dexcom comes out the inserter will be automatic. Yeah, so But But to your point you're introducing something to your to your son that's you know, he doesn't have an insulin pump so he's not accustomed to having something attached to so there's that plus that's gonna stick into him so there's that his framework for that is the needles he's young and easy thing I don't want to do this you know, what are you gonna explain don't know you don't understand?

Kevin Conroy 34:15
Yeah, I can get all this great data 24 seven now.

Scott Benner 34:19
Daddy Daddy Daddy's gonna go to sleep on time soon. asleep like three hours in a whole row and make a big difference and yeah, so that Yeah, there's no real way to talk them into you know, it's I'm always I'm a huge fan by the way of bribing. buying your way in if you have to I you know people all the time like oh my you know, we want to try an insulin pump up my son or daughter know, someone told us give them money or things their children just just ply them with things until it's over. And you know, it's a really weird line to walk and I think you did the right thing. You found a way to make it work because I have heard people say, Well, we didn't end up doing it because they didn't want to You know, in earlier episodes, I would say all the time, like I just, I have a hard time imagining if the doctor said, Hey, here's a pill that you have to swallow to be healthy. And my father gave me saying, Oh, no, it's too big. And my dad goes, Oh, it's too big, he doesn't want it. Forget it, you know, like, I have this image in my head of my laying on a countertop, just, you know, somebody forced feeding me a pill, which never happened to me, but I'm assuming that that's where my dad would have when at some point, and finding the center to that idea, not not going all 1970s on on kids. You know, like, there's a moment where you have to make a better decision, like you're the you know, what this is gonna do? And you have to find a way to artfully get to where you are now and no numbing cream. Sounds like it was a big deal for you. I we've never used it. But I know a lot of people do with a lot of success.

Kevin Conroy 35:47
Yeah. And I had, I don't know, thankfully or not, but you know, in the last month or so he said, Hey, Dad, what's on his own, he just came up to me because I told him we needed, you know, to do new sensor insertion because it was, you know, seven days, Rob, and he said, Hey, Dad, let's try today without the numbing cream. I said, Are you sure? I said, Yeah. And so we did it. And you know, he flinched a little bit. But he, you know, I've gotten more accustomed to the idea and he was more used to it, and so psychologically ready? You know, then I'd Jinx myself, because we did a new one last night. And it it, you know, hurt more than usual, I guess. I don't know, maybe I hit a nerve or something. You know, literally,

Scott Benner 36:22
this Dexcom ad is brought to you by my Confidence Index calm. I put it right here in the middle of a moment where Kevin's talking about Dexcom and saying, Oh, I hit a nerve with my son, he flinched. That might make you think, Oh, I shouldn't do that. No, meaningless. The good that comes from Dexcom is so immense, that a tiny bit of an uncomfortable moment, a moment in a full week. It's meaningless. I wouldn't even think twice about it. I know people do this. So I bring it up. Some people say oh, I don't want to be attached to things or I heard it hurts. Doesn't hurt. Point is, you listen to this podcast, you understand what I'm talking about? You have to understand that most of the way I manage this is the the information that comes back from Dexcom. I don't know how many low blood sugars Dexcom stop. I don't know how many spikes, tax commas. countless, countless, countless, countless, the information that comes back teaches me more every day about how to manage type one diabetes. The share feature is immense. My daughter is at school right now blood sugar, 105. nice and steady. I know that because her Dexcom g five shares information through the cloud that I can see on my phone that's available for Android or Apple. You cannot, you cannot, you can not do better than a dexcom g five continuous glucose monitor until the G six comes out. But for now, g five. It's the bee's knees, my friends dexcom.com forward slash juice box with a link in your show notes.

Of course, way outside of medical advice. Have you considered restarting the sensor at the end of the seven days?

Kevin Conroy 38:15
We have. And so we used to only do and this is where any of the Dexcom folks are listening, right? They're going oh, that's not FDA approved. And so I'll acknowledge that right now. But, you know, we had done just the abdomen and we were getting a lot of failed sensors are getting a lot of triple question marks after a few days. And in large part, I think because my son's a real skinny guy. You know, he lost he lost some weight around diagnosis. You know, even though we caught it pretty early, and it's just, he's not gained a lot of body fat. And so we ended up trying his arms and that has worked really well. We're getting fabulous readings. From there. Once the sensors had a chance to you know, get out of first 24 hours.

Scott Benner 38:59
I honestly don't know where the FDA says to put them but Arden only wears hers in her hips. So yeah, he's never put them anywhere else. It's you know it too, and you should see some weight gain. When you're

Unknown Speaker 39:12
sorry about that.

Unknown Speaker 39:14
There's I know that

Scott Benner 39:16
she's eating she's not eating fast enough. You can um, was I gonna say Oh, Baba, bah bah bah. yonder hips. I'm now going back through my own thoughts. Sorry about that. What was I gonna say about the about the sensors and oh my gosh, I'm gonna have to come back to it. I completely lost my train of thought when it first 24 hours. Now it's gone. It's gone. Kevin, I'm close to forgetting your name in this moment. My brain completely reset. I

Kevin Conroy 39:52
don't really happen to be it. This is a cost to type one, right?

Scott Benner 39:55
Yeah. Oh, please. I was Arden played softball weekend. And it wasn't just softball it was tournament's that were an hour from the house. game started at eight had to be there at seven to warm up. I was getting up at five in the morning. And, you know, rousing her out of bed, which looks like looks like a crime when it happens, you know, because you're just like you have to get up you have to get up just like and you're like no, no, I'm I get up at the you know, you've got the house near race down the highway and you get to this thing. And she plays three in a row. And the first day, it wasn't too bad. Actually, the first day in the afternoon, her blood sugar sat at like, 85 through all the games. Wow. And then I was just like, Oh, this is going great. But it's going to go sideways on me at some point, like I really know it's going to, but she gets in the car and she was hungry. And I you know, listen, if anybody doesn't believe it, I took my own advice. Like, you know, she ate food and I Bolus word I didn't give her all of it. Because I knew she was gonna get low. I gave her some, and some was still way too much. We got home and she got low and we had to address it and it was fine, you know? Right. But, but then overnight, she was okay, I did some bazel adjustments that kept overnight Okay. And then the next day, like right back to it again, like five o'clock in the morning get up she and are down there. They play this real early game that ends at 930. And we end up at a convenience store where she buys this big sandwich and what does she have sandwich cut up fruit chips, and something else. And then she's you know, I gave her insulin for and she starts eating and then she gets about halfway in the sandwich. She goes, this isn't very good. And I was like, Okay. All right. So it's like jack cutter bazel off trying to catch up. And by the time it looked good, and then going into warming up for the next game. I was like, Oh, this is not gonna work out. Yeah, so she ate a banana. Real quickly before the game started, I actually ended up shutting her bazel off a little longer. And actually, that game she played. That one was a little more on the cost. She played at 75 for a little while. And then she drifted up over 80. And then when she was eating in the car, I learned my lesson and I didn't give her as much insulin driving home because they lost that last gamma. And it was just, you know, it was it's a it's always a learning curve. But then I really used what i what i saw the night before to avoid any lows last night. We didn't have any lows overnight last night. So I slept really well overnight last night. Yeah. Which was why I'm upset that I lost my train of thought because I actually woke up this morning. Yeah, first thing I said was I feel really rested. Like it was almost at a point where around 5am I opened my eyes from it. I don't have to get up till seven during the week, and around five and I was like, Huh, I could get up now and be okay with this. And I was like, but I wonder if I could go back to sleeping or to try to bank them for tomorrow if I can, which I don't think is how sleep works. But But nevertheless. Okay, so you guys are, you're just you've made the conscious decision to inject more frequently. Yeah, and and so you are, you're still sort of acting like an insulin pump with on a rudimentary level being in as much as that you're, you know, because a lot of what a lot of people say is, well, when I get a pump, then it's not such a big deal to Bolus for a small snack or I could throw five carbs or something in my mouth and give myself a tiny little bit of insulin or my baseline. So you don't have to control your basal rates, obviously. But But you are have just made the conscious decision to inject more, how many times a day do you feel like you're injecting?

Kevin Conroy 43:27
I'd say probably at least five. But you know, some days maybe it's as upwards as 10. And many of those are going to be small doses, you know, happiness, the unit unit and a half. Yeah, exactly, just little bumps. And really, it's it's about knowing, okay, maybe a half unit or unit is going to be too much for him right now. Maybe there's a little bit of stalking that's going on with the insulin. So as long as I make sure that I've got fast acting carbs nearby, and I know what he's about to do activity wise, we can really leverage that, you know, and get us into the numbers that we want and keep him within our wider range that we're aiming for right now in MDI. You know, I suspect whenever he does get a pump will go, you know, really tight, you know, 80 to 120, as I've heard, some people do, but, you know, right now, I'm trying to keep him between 70 and 200. Okay, okay. And so you don't, when you bump you bump over 200 I'll I really let the curve, do the talking. So if he is rising quickly, you know, then I might throw an extra unit added, because maybe I just guessed the wrong number of carbs for the meal. And and when I say guest, I mean, I have a food blog where I have calculated down to the exact carb, every single one of our family recipes. But sometimes, though, right, it's sometimes it doesn't matter, right? It's just, you know, maybe we got the Pre-Bolus off by a few minutes, or maybe he's just got human growth hormone going on. Or maybe he's coming down with a little cold or something, you know, you can never tell what the day is going to throw at you. Or all the other variables that you can't See? So for me, it's just Okay. Do we have the right trend line going on? And if it's not the right trend line, what action can I take to get the trend line back into some some sort of way that I want? And so if he's starting to go up also, you know, we look at, well, can we have him go play outside or run around at all, we've got a small trampoline in the house, you know, just a real, you know, little one for indoors. And for whatever reason for him to tramp jumping on a trampoline will drop his blood sugar faster than any other activity we have found. When he goes to some of these trampoline places for birthday parties, you know, I bring like four or five juice boxes, and I'm just you know, before even though his number, his numbers are flat, before he gets on, and like, just drink this juice box, because we need to get ahead of this. And sure enough, he'll come back 20 minutes later for, you know, Smarties or Jolly Rancher or something, because he's already dropping, even with the juice box on board. So that sounds

Scott Benner 45:53
about right, it really, it really does. And you're handling it correctly, too, because you've reverse engineered the the insulin idea for the carbs, right, like, Yeah, because if some for people listening here, we're Kevin just said, you have to time the insulin correctly and Pre-Bolus correctly so that when the food starts affecting your blood sugar, the insolence and they're having a fight, and on the flip side, you have sometimes you have to time the carbs correctly so that when activity, or something like that is causing a drop, you can also get that fight happening at the same time, so you don't drop and then come back up. But maybe as the activities trying to pull you down, the carbs are trying to pull you up. And maybe that's how you say stable. It's the same idea. Just moving the moving the ingredients around a little bit. Exactly. And that's that's a huge credit to you, because because you haven't been at it that long with the Dexcom. It sounds like three endo appointments, and one more coming. Yeah. And you figured all that out that quickly. That's to be commended. That's that's really fantastic. Now imagine had someone told you that four years ago? Right, Dan, what do you think now you're you're really clear headed guy. And you're really good at describing your thoughts. So let me ask you a question. Second is, you know, first endo appointment after after you're diagnosed, it's three months, and maybe you're there for the first time, someone would have laid this out for you. Do you think you could have accepted it back then?

Kevin Conroy 47:22
I don't think you I think this is something you have to get to iteratively. And I don't mean that you can't that you everybody has to go figure it out for themselves. But I think it's again, back to that firehose of you know, in the hospital initially, if somebody just blasts all this information at you. It's really hard to do. And I so I think it's, it's taking it one step at a time, right. So step one is get your Dexcom. Right, figure out how to insert it, make sure that you understand how to get good calibrations. And I think that has been actually figuring out how to calibrate the Dexcom has been, I think one of the biggest secrets to our success, which is you know only calibrate, when it's level, make sure that you don't have you know that you didn't just have a lot of physical activity, that's going to be dropping your blood sugar, make sure there's not, you didn't just eat something that's going to make the blood sugar spike. You know, I think you know, sticking with the driving analogy, I always think of it. Because you know, for folks who don't know, Dexcom, and all CGM measure the glucose in your interstitial fluid, not your blood, which is what the glucometer does. And there's like a 1520 minute delay depends on the person and the time of day and all that other stuff, in terms of when it's catching up. And so I liken it to if you're looking at the traffic on a highway, right? And it is your the cars you're seeing they're left to their houses 15 or 20 minutes ago. Right? Yeah. And so if you want to control the flow of traffic, you could tell every, you know, you could tell that all those carbs to stay home and not get on the highway of the bloodstream. But it's going to take 15 minutes for that to to happen. And so if you more if you see lows coming, right, and you give a lot of you know, you give the 15 fast acting carbs, right, which is the standard line. The reason you have to wait 15 minutes to check is because it's going to take the body that much time to get it moving in there. And so making sure that you're calibrating your Dexcom at the right time, when you don't think there's a change that's about to happen, has given us the best numbers and that has given us the confidence to be able to be a bit more aggressive with MDI. Because we we can trust the data more

Scott Benner 49:35
you feel like the data coming back is is something that you're not it's not such a coin flip that you'd like that wonder if this is how correct this is and I'm going to start pumping in more insulin Am I right and all that stuff, right? You can even hear when I did Ardennes. When I did Arden's insulin for her for lunch, I hedge my bets too because I couldn't see her blood sugar for 20 minutes or so. So I was going off of what it was. Now, when it finally came back, which we never talked about was, I was off, it wasn't 90, it was 70. And so she hit 70. Now, by this point, her blood, her meal is done, she's eat. And the eight units I gave her are all in, probably only half of them are pretty active right now some of them are still probably just kind of coming online or starting to work or anything like that. She went all the way down to 60. And she's level at 60 right now. And I know that in the next two, or I would say one or two readings of the Dexcom, I'm going to see a diagnose up arrow. And I'm assuming she'll be more like 75 or 80. By the time you and I are finished talking. And you know, some Listen, a lot of people might hear that and be like, That's insane. I'm not doing that. And trust me, I would have felt like that at a number of points. But to your point earlier about just, you know, timing, the you know, just experience over and over again, I am, I am a person who's completely, you know, concerned with my daughter's safety, as I'm sure everyone else is. And I've seen this enough times now to know that this is going to go the way I expect it to. And if it shouldn't, if it should be that one time or the you know, because there's going to be three times this year that I make a mistake or it doesn't happen the way I expect it to or whatever else and it's gonna need some intervention. At least there's time for the intervention still, like, you know, after our softball game on Saturday, she was really loud. And and at the same time, it wasn't even. You know, it wasn't that big of a deal. If I told you that, yeah, that, you know, her blood sugar was it was crashing down Falling, like under 40. And I was out picking up dinner and my wife texted me and she's like, hey, she's really low. I gave her a juice. And I was like, and she goes, and I just shut her bazel off too. And I was like, okay, and you know, I said, just test again in a few minutes tested again. And she's like, she's still really low. I gave her another juice. And I'm like, Okay, now, Kevin, that's not something that happens around here. Hardly, right. But But I came back in the house with Chinese food. And her blood sugar was, we tested it again, it was like it was 70 because it was coming back up, there was plenty. Now there's a lot of juice on board. I bolused Chinese food, one of the juice boxes doubled or bazel rate. And I went right back into it again. I didn't I didn't like I didn't skip a beat. And we did not get high from the Chinese.

Unknown Speaker 52:29
That's fabulous.

Scott Benner 52:30
You know, that again, it's just it's having done it over and over and over and over again. Like I know the fear, like oh my God, my her blood sugar was just 40. Right, that was probably gonna get a lot lower. And but here's this food, I know what this food is going to do. And if I let my fear take over right now, her blood sugar is going to be 400 before I blink, Mm hmm. I can't let that happen. So so I just have to trust the foods going to do with the foods going to do the insulins going to do with the insolence gonna do, I took some experience I have knowing that she came off of a lot of activity, and I kind of tempered things a little bit for that. And I was much more careful afterwards, you know, and as soon as her blood sugar leveled out where I wanted it while she was eating, I shut off for Temp Basal. And, you know, and it just did all of that I just kept doing all those little things that if I put myself back in my, in my headspace from, you know, seven years ago, everything this mean now is saying sounds insane. You know, and and I sometimes I just tell it over and over again, because I want people to know that there's going to be a date just doesn't seem that insane anymore. Yeah, you know, and and you said something earlier that I wanted to comment on for a second, I hope you don't mind. nobody talked about how it um, you know, this understanding that you get just comes slowly. And it really made me think about the podcast a little bit like, why is the pot like, why am I hearing from people who are like I was completely lost? And six months later, I wasn't? Because that's a fast turnaround. Right? Yeah. And and of course, it's how, you know, if they're bingeing the podcast, it's how much quicker they get into it. But I think that there's possible that if you just went I'm gonna make up a number out of nowhere. I don't even know what Episode 15 is. But if you go listen to that one, yeah, you're not going to get this magical understanding of diabetes. But there is something about listening to the conversation build like there's, you know, I didn't sit down I'm not NPR I didn't sit down and, you know, hammer out what my first 50 episodes path was going to be that you. But if you sit and listen to the conversations, I begin to tell the story better. I begin to ask better questions that get other people to tell their story better and when you listen through I think it's the process of listening through it that gets you to that spot. And I just didn't expect that when I did that. When I started the podcast the understand.

Kevin Conroy 54:54
Yeah, and and for me, it's been as I've listened to, you know, more episodes and thank you for doing this. If I haven't said that already, you know, it's been hearing, you know, week after week, different people tell their stories about how they're managing it and how they're not settling for, you know, an A one C of nine. Right? And when what can you do to get down to the eight, get it to the seven, get it to the six, get it to the five, right, whatever, wherever you are, right? What can you do to get one, you know, a half a one c better or full? A one c better? And I think that has been, and part of, you know, what I want to feel compelled to share, right is that, you know, I'm in all of our currency and you know, full credit, you know, to you on that. But, you know, if you're not at the end, you've said it before, right? If you're not at the six yet, that's okay. Right? Take wherever you're at and try and just get a little bit better. Right. before your next point, no way

Unknown Speaker 55:49
to leap forward. You can't

Unknown Speaker 55:51
Yeah, and can

Scott Benner 55:53
you believe is it certain people, certain people and how their brain works and how they understand things can fast forward by listening? Like, because I'm getting enough feedback from people that says that says that to me that like, you know, I power listen through. And it made sense, I had to go back sometimes. And what I mean by fast forward is, it took me two years of my daughter's initial diagnosis, to come to the point where I could like comfortably get her in the eights. And think and think that I was like, in some odd control of that, you know, and but then the, the new things that came online that we talked about, you know, in the podcast, and it's not even worth coming up with examples, but like the things that we figured out Pre-Bolus seeing timings as important as the inside, not being afraid of the ins and all these other things, I could sit here and just list over and over again, they came to me so slowly over time, but apparently, when someone's telling you about it, if you can accept it and process it correctly, you can that's your fast forward, like, you know what I mean? Like that's you don't need these years to because look at your a great example, it took you four years, just to say, wow, I don't think this is what we should be accepting. Let me look into how to manage that better, and that I don't think there's anything wrong with what happened to you, I don't think you made a mistake or anything like that, you know, I just think that that's the, that's the life, you know, path of this thing. You're not just sitting, looking at your son's blood sugar all day, you've got a job and your house needs, I'm assuming you sweep the floor once in a while, you know, and all these other things. And, and so it takes this long to get to that idea. I just I'm thrilled that the that the thought that it's possible to speed it up a little bit, you know, because then I in my heart, then when I when I feel like is it there's no little boy sitting on the floor in his living room? His blood sugar's 300? It doesn't need to be exactly,

Kevin Conroy 57:39
you know. So, exactly. And I think that, you know, back to what I was saying, like, you can control the carbs, you can control the insulin, you control your attitude about it. And I think what your podcast has done is help people see, oh, wait a second, the attitude is not a fixed thing, either, right? It's not just 15 carbs, 15 minutes, right? I can I can take a different approach to this. I can challenge maybe some of the more static thinking that has happened in you know how to risk reduction, you know, that that many? well meaning endos provide, but that maybe hasn't quite caught up with where we're at technology wise, right? Because the guidelines we were given when my son was diagnosed nightscout didn't exist, right? So they didn't they didn't give us the advice of, well, what can you do differently if you can just glance at your wrist and see your son's glucose? Right. And so that opens up a whole different world of actions that I'm able to take, and interventions that I can provide for him. You know, and it's funny, even to we, as part of a study we did, through children's, we got a Fitbit for my son and for the rest of the family. And my wife wisely came up with the idea of, there's no screen time until you hit your 10,000 steps for the day. Okay. And so that led us actually start to quantify the impact of physical activity and play on his blood sugar. And we still, I mean, no, we don't hold it that everyday, right, you know, Saturday mornings, Mom and Dad want to try and sleep in whatever we can. But, you know, it lets us see more around, you know, if he's going to go outside and play, how does that impact his blood sugar and it forced us to really start, you know, thinking about that and using that as a tool in our tool bag, and it really, I think, at least in the MDI right, at first you think okay, all I have are insulin that I can give it meal times and fast acting carbs if it goes off. And that is a very limited toolset. And so expanding that to have the CGM data, but also thinking around are, hey, I can give small units of insulin because it's not dangerous, right? It's not high amounts, if you're not stacking big, you know, big doses, for whatever the person is, if you're not going at it with a high you know, high numbers of carbs. You know, and that was, that was a thing. You know, I think that, you know, I learned on your podcast really is, you know, don't come at it with 15 carbs necessarily try five. And and maybe that's good enough. Yeah. And that, you know, for us, you know, you know jolly ranchers are now his go to, to bring up a low because they're five carbs and it takes him you know five or 10 minutes to suck on it. So it actually that's kind of a slow release five carbs at that. And it gets him back to where he needs to be most of the time. And we still got the juice boxes on hand if we need them and, you know, a soda in case one direction or something but exactly, yeah,

Scott Benner 1:00:37
but bumping nuts, right like just that like just a little bit art. And she bought bubble gum for the for the softball this weekend. And it had it had sugar. And I was like, that's great, because then I can still stay aggressive with their stuff. And she can chew the bubblegum and it kind of offsets the drop that wants to happen. Yeah, and just little things like that. Like you said it before, like, you can't fault the doctors 1515. You know, the 15 rule is what it is because they're not with you in that moment. And that rule is probably I'm guessing, derive from the idea that Okay, look, how much would save a life in a bad situation get probably 15. And so that seems fair. And then it gets set enough. That seems like law, you know, and then before you know it, the school nurse says, oh, I've seen it on so many orders. I know, it's 15 they don't know anything about diabetes, you know, 50 must be 15. It's on every one of the orders. And then and it's easy to, to dovetail back to what you're talking about with your brother in the beginning, just sort of out of sight out of mind a little bit like, you know, like, oh, that these papers say 15? I do 15 none of these kids have died here. 15 is the answer. And you know, right and and if 15 is taken one kid to 90, because they were going to fall faster. That looks amazing. And then while three other kids are going to 250 at that school, and nobody ever thinks twice about it. And then you have doctor's orders that won't even let you adjust until you're what would you say? 300 300? Oh my gosh, that would make me mental? Yeah, and I'm sure it does you a bit too bright. Yeah, they're dead days. So have you ever have you considered going to the nurse and saying, look, we're going to the doctor and say, Look, I want these orders to be changed.

Kevin Conroy 1:02:14
We looked at it. He's in kindergarten right now. And so we've just been trying to, you know, look at, you know, trying to minimize things. And it's also the kind of thing too, you know, he's checking my watch right now. He's He's 216. Right now, after lunch. He had lunch maybe an hour ago. And he's got two units on board. And so that'll pull them down a little bit. But, you know, if he's got PE or something, he can lose 100 units in 30 minutes. Start hundred points in 30 minutes, right. So it's, it's again, it's it's understanding, like, what's the buffer that I need, given that he's remote from me, and I'm not hovering on him, so I get less, much less aggressive with it. When he doesn't have a parent around?

Scott Benner 1:02:51
Does he think differently? Do you think? Have you ever have you ever had that? Like, I know how easy it is to have a conversation with a kid in kindergarten? But

Kevin Conroy 1:02:58
yeah, I mean, we've tried it. He says he feels fine. I think he's gotten adjusted to some of the highs, right, which is, which is a bit of a danger. But you know, the other day he hit 400 for the first time and I don't know, maybe even a year. I like to think it's a year I'm sure. You know more more than that if I go back through the CGM data, but you know, is 400 middle the day just you know, we had, I don't know what happened, just the lunch hit him the wrong way. We tried to you know, put more insulin at it, but it just it wasn't catching up fast enough. And, and he was there and he just felt awful. You know, he was he was hot, he was sweaty. And he was just like, Daddy's you know, something's wrong. I was like, you know, it's your blood sugar's just really high buddy. You know, this is why, you know, we say no cotton candy, which he didn't have cotton candy, but it's like the one food he can't do. Because it's, it's just, you know, it was too hard. And so we threw, you know, an extra three units at it and give him water. And, you know, eventually he came, you know, double arrowing down. But you know, a big part of that was, you know, since I've got it on my wrist, I don't need to, you know, interrupt his play to have him come over and have me check his Dexcom I don't have to pull my phone out of my pocket and unlock it. And, you know, go check the share app, as great as it is. I can just glance at my wrist, you know, every few minutes, and I don't have to touch anything. I don't have to do anything. It's just a quick glance, and I know where he's at. And so when I see he's, you know, part of what has made the MDI stuff work is is if I see if we've had to aggressively correct a high that he's gotten because that's just part of what you get when you don't have a pump. And he's double arrowing down on 190. I know for him, if I intercede with a quarter cup of Gatorade. I can I can land that plane at 100 Yeah, right he will cut he will pull up out of that nosedive in the next 20 minutes and he will level out right where I want him to back in range. And if he and if he you know if I if that's not enough, and I do another quarter cup Gatorade or you know half cup Gatorade whatever it is, which is we have found you know, and part of this is like finding what are the right fast acting carbs for you or for Your child, right to respond to those situations. And so we know Jolly Ranchers and Smarties and Gatorade work really well for him. They're our go twos. But everybody's different.

Scott Benner 1:05:10
So it's there's so many different things that you can use to, you know, and different situations call for different things to like, last night at the, you know, again, the end of a long weekend a softball, and she comes home, we both after to 5am, we got home at one o'clock and I said to my wife, I'm like, I'm woozy. I want to lay down. So R and I both lay down on the sofa. We slept for like three hours, which not a big thing. And my wife kept Arden's blood sugar good while she was sleeping. And when we woke up, had something to eat. And she did her homework and got a shower. And at nine o'clock, she's like, I'm really hungry. And our blood sugar wanting to be low, like it was giving me that it was giving me that feeling like it was it was gonna push down. And I said, What do you think you want, she thought from and she said, I'll have a couple of chips with like some friend Johnny Depp. And I was like, okay, and she ate that, and her blood sugar just didn't move. It's like ha, and then she said, I want some cut up fruit and said, Okay, so give her cut up fruit. And that actually raised her up a little bit, to the point where I had to give her a little bit of insulin, and she was so good overnight, and then she woke up this morning and it but you know, a doctor's not going to tell you you know, what you need here is a nice combination of ruffles and cantaloupe with a little bit of info, because other people are listening, we're like, oh, I, I worry about the fats and the glycemic index. And I mean that all stuff works, I just can't keep stuff like that in my head. So I just know, you know, traditionally what works for us here or what this is going to do or what that's going to do when you get to that point. So much of this goes away. It's just it's it's fabulous. Like, even right now, you know, talking about instex come in and talk about next time, sometimes it can be right on it right off. It was it was 12 o'clock. So we were 40 minutes past her. The 12 1210 we were 15 minutes past the insulin you heard me give her at the beginning of the eight. And I know what she ate. I know when she ate it. I know the whole time may have and I'm like man, why is her blood sugar not in the 80s. And I'm sitting here looking at a 6055. And all of a sudden the 55 went to 42. And I'm like, and I texted I said hey, test your blood sugar. You know what it was when she tested 82? And so I'd say that because listen, the deck sounds beautiful. It's fantastic. Because it could be off a little bit once in a while. That's no reason that I want to turn my nose up at that law. what I'm telling you is that because of the Dexcom I've seen lunch happens so many times that even when the technology tells me one thing, I'm like, That's not right. I I'm more in tune with it, then then I don't even know sometimes you don't I mean, like and so that's, that's a great place like you get into that spot I think is amazing. I think you will you will send me an email one day and say, Hey, I figured out how to let my kitty cotton candy. I really do. Yeah, you know, and I think that's just the you know, not only the the day to day, moment to moment, safety and, and education that the technology can provide to you. But at some point, there's a you're learning in ways you don't even know. You know, like, I don't even I don't even get afraid of the two hour warmup period. Like I used to because I'm like, No, I can you know, if I test here and here, it'll be Yeah, you don't even so it's just it's it's the repetition. It's fantastic. It really is. Kevin, you were fantastic. By the way, why do you sound so good? What kind of a headset do you have?

Kevin Conroy 1:08:33
I've got a blue microphone.

Scott Benner 1:08:35
Oh, you're using the like this? Nope, not the snowball. But do you have a good mic? I don't know. You sound fantastic. You record any audio over there? You just have a microphone?

Kevin Conroy 1:08:47
Well, I went ahead and stole the audio studio at work for this.

Scott Benner 1:08:52
Just you'll take it back.

Kevin Conroy 1:08:54
I'm assuming no, yeah, no, I did. I mean, I'm at work in the audio, you're

Scott Benner 1:08:57
actually working. Okay, that's, that's, um, I want to thank you so much for doing this. And I think that I mean, to kind of recap, you know, everyone, I get a lot of notes, how do you do what you do with MDI? How do you do with MDI and I went over, and I thought the only thing I can think of is you have to inject more. And we have a guy here who's doing a good job with MDI. And, you know, I think I pre approved out a little bit, what I'm saying is you have to inject more, you have to just be able to put it in some at odd, incremental times. And your son's good with it. He doesn't, he doesn't mind shots.

Kevin Conroy 1:09:29
No, he doesn't, he doesn't matter. We just do him in the arm, whichever arm we don't have the Dexcom in, you know, and he's, he's liked it. I think the one thing though, you have to be careful with if you're doing this is to be really careful about insulin stacking. We've had a couple instances, and this is just part of the learning curve process where, you know, we've, you know, we like we go out to a restaurant, right, and they have an appetizer course, and a main course, and then a dessert course and, and so with MDI, we're having to dose for each one. And I have found that, you know, because normally he I mean, he usually eats whatever's on his plate. He's good, he's good about that. Which is, which is nice. But, you know, if he packs his stomach full, his digestion seems to take longer slows down is what we've learned. And if I dose him for that dessert, even though it's got a lot of extra carbs, if I do it at the time, I would normally dose for something it's going to drop in. And we've had to use the Google gun before when that's happened. And so this last year, like two weeks ago, we went out to eat and he was having, you know, like, chocolate lava, you know, like cupcake thing. And I said, You know what, the last time we did this, he tanked and we got into a real dangerous flow, I'm not gonna wait to give him this MDI shot for his desert until I see he needs it on the Dexcom. Because at that point, he was about 100. And he had had like, five units on board. And, you know, he already had had maybe, you know, 60 carbs or something is gonna have another 30 carbs, I thought, you know, I'm just gonna, I'm just gonna wait this one out, because I'm worried about stacking effect. And sure enough, he leveled out at 90

Scott Benner 1:11:05
Yeah, you're getting close Kevin to being able to close your eyes and see what the insolence doing. And when that's done yet, that's, I think that's a fit, because that's where I would have if I thought I needed the insulin for that for the snack or you know, the dessert, then I would have extended it so that I could adjust it. So I could have cheated and bailed on it if I needed to. And and that's just that, I don't know that I could put into words, but I feel like there's a point you'll get to where you can say, Okay, I know what the insulins doing and it hasn't finished yet. Or I know there's some in there that's not being counterbalanced by carbs, or I right now, I know I'm being pushed back harder from the carbs, but these carbs are going to stop at some point and, and it's like a garden has, this year, she's, she doesn't eat sandwiches. So this year, Arden is taking a half of a bagel almost every day to school with her with some kind of like spread on it. And I can tell. I know when that the bagel is done being digested at this point, because then I had to give her a certain amount of insulin up front of the bagel within spiker, and then it holds steady. But then once that bagel is gone out of her stomach, it's not releasing, you know, sugar anymore. Yeah. I know, she's gonna she could go the other way. And so I just recently, I was certain most of the year that I needed nine units at this lunch to make this work. And we were always having to address at the end for a little bit of allow. And I finally just cut back the insulin for the for the Bolus to eight units. And now we're having like a much better, great another, a much better situation at the end, but but I was forced to figure it out because she joined the softball team at school and she had to leave right from school to go play softball. And so I was putting a bolus in at 1120 and 132 hours in sometimes we were having to cut her bazel off for an hour or so it was enough insulin to hold the food at bay. But then when it became too much, and she didn't need any more, and there's just all that weird stuff is it's so great. Like, I want to ask you one thing before I let you go We're over an hour night and I held you up long enough. But But you mentioned once that you do want to get a pump? Yes. So what stops you at the moment?

Kevin Conroy 1:13:23
I want him to get a pump. At some point when he's ready for us. He has had a great attitude about type one so far. And I have been we've been trying to you know, recognize that it is his body. Right? And it's it's his disease and yes, we're his parents and we're managing it we're responsible for his health and you know, completely you know, you know, take that seriously. But I also don't want to scare him off from the tech too soon. And so his you know, his uncle has a pump and so he's been able to see it up close and we've talked about it he's seen he said you know look I like the arm shots still, which is what we call it as we call it skim a log because that's where he gets it and he's you know, I don't mind that I don't want to have another device on me right now. And I go well, you know, look I respect that and if we're able to you know from there I said okay, well can I What can we do with with MDI can we get him down into the kind of level he has and so is put the challenge more on myself for a period of time to say okay if he doesn't want to pump yet how can I figure this out and so so far has endo is saying look you know you're below a 781 c you're great I don't need to fix this I'm in no rush to get you on a pump is new is new endo saying and she said you know we've got you know, we've got all the pump tech and and everything here so whenever you guys are ready, you know we'll get you set up you know and I'm hoping you know before puberty hits to that so I can write out the teenage years you know with a little more sanity but you know for right now you know he's he's able to, you know, just go and run around and play and not have to worry you know too much about the devices and You know, part of it was, you know, we figured let's start with Dexcom and get used to carrying around that expensive medical device on a young boy. Right? And then go from there. So

Scott Benner 1:15:08
yeah, I think I think you'll see in the, in the near future, that I think there's gonna be a big shift in, in the technology again. I mean, yeah, everyone's working on an algorithm further, exactly, Chris. And that's gonna be, that's, you're gonna see a shift again at that point, because so many of the things you're talking about right now as being speed bumps are impediments along the way, most of them less than pretty greatly.

Kevin Conroy 1:15:35
Yeah. And part of it is that, as I've learned more, seeing that the artificial pancreas is in the various projects are just seemingly around the corner. You know, it's kind of like, well, let's just wait and get the really good artificial pancreas pump. whenever it comes. You know, if it really is only 18 months to market still, you know, let's wait another 18 months

Scott Benner 1:15:53
to close. So you really are pretty close. Yeah, listen, I could listen, I could argue in the other direction if you want me to. I don't think you're I don't think you're making a mistake at all. I think you're doing a great job. So I appreciate you coming on and doing this and giving your time like you did and talking about your son and and what you guys are doing with MDI because I know there's a lot of people like you said we're in the situation, either because they want to be because they can't afford to be not B or B or insurance, or whatever it is what it is. So thank you very, very much. Thank you. huge thank you to Kevin for coming on the show. Also, thank you dex comment on the pod for sponsoring. You can go to my Omni pod.com Ford slash juice box or dexcom.com Ford slash juice box if you don't know which one of the forward slashes go in the show notes click on the link it'll take you right to it. I haven't said this in a while there are bold with insulin t shirts on sale at Juicebox podcast.com. You can follow me on social media at Juicebox Podcast or at Arden's day. Basically Instagram, Facebook and Twitter would be the places to look and say hello. Also the podcast grows when you share it with people who can use it. Please continue to do that. I know how much you guys do it. I appreciate it.

Unknown Speaker 1:17:06
Don't stop

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