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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 and welcome to Episode 168 of the Juicebox Podcast Today is a special episode, a very special episode of the Juicebox Podcast. And it's brought to you by Omni pod, the world's most amazing list Everest best this tubeless insulin pump and Dexcom, makers of the G six continuous glucose monitor. Today, I'll be speaking with the Senior Vice President of Research and Development at Dexcom. Jake Leitch. You know, is this a review episode? Is it a follow up to G six? Well, you call this one what you want. But Arden has been using the Dexcom g six now for 1234 I think four insertions. So we're somewhere between 30 and 40 days, I have a firm grasp of what the product is, how it's better. And I thought all right, I'm going to do a, you know, a review episode for you guys. And I had the opportunity to have someone on from Dexcom. So instead of talking about the stuff that you can read anywhere online about what Dexcom is, I thought let's talk with one of the people who is the lead of their research and development, we can kind of dig deep on some ideas. here's just some of the topics that we'll cover. How does low predictive alert work? What's the next leap index com? What should we be excited about? Has the adhesive changed? What's the compression low? How does the inserter work? How is it designed? Talk about the auto startup? direct integration with Apple Watch the one with the cellular in it, you know? And how about that two hour warm up period? Is it ever gonna go away? All that and more right now on the Juicebox Podcast who I have to squeeze this in real quick. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making a change to your diabetes care plan. Oh my god.

Unknown Speaker 1:48
Bernie and Scott Benner.

Unknown Speaker 1:49
Hey, Scott, how you doing? Good.

Scott Benner 1:51
Thanks. How are you? Jake, I had an opportunity to talk to Kevin say again. But I asked for you this time, because I thought your background might lend a little better to the conversation. And here's why you guys are in the like iPhone space now. Like it gets a little better every time. But I can't point to why it's great. Because it's been great for a while. But if I go back 10 years, I know why my iPhone is amazing. I do know what I mean by that. So there's not a lot of space for you guys to go is the problem, I think, but maybe you know differently, which is why I thought talking to you might be interesting.

Jake Leach 2:26
Yeah, it's wonderful. It's a pleasure, pleasure to be with you.

Scott Benner 2:29
I appreciate it. So I'm going to start by telling people that this is going to be part of the review episode that I do about the Dexcom JSX. But that if I had to do a review, in all honesty, it would take about eight seconds. So I'm going to try to stretch it out a little bit here by kind of going through it step by step. So we start off with the new insertion process. I wanted to talk about maybe from your perspective, how did you go from what it was to what it is now?

Jake Leach 2:57
I'm sure yeah, so the you know, the whole purpose of the insertion, the applicator devices to get that sensor under the skin as quickly, as painless as possible. And with this little steps, and one of the things we we knew about our G five applicator and the previous manual versions was that there were quite a few steps involved, that the user has to go through to make sure that sensor gets inserted properly. And it also isn't automatic read, you have to go through each step. So the goal of that new insertion system, the one that's with G six was to develop it so that it was as simple as a push of a button, we wanted it to be single handed operation so that it could all be done without needing to use multiple hands to complete the sensor insertion. So it's very similar, the sensor and needle under the skin. It's all the same dimensions as the manual applicator. But we set the development team off to develop a way for the insertion system to insert the sensor very quickly and easily. And so the actual insertion is about 15 milliseconds is all it takes for that sensor to be placed just under the skin tickets.

Scott Benner 4:13
It goes beyond that it's spectacular. So I asked my daughter after we did the first time, I said hey, they said it's almost painless. And she thought about it for a second. And she goes is feel this award because I don't know what happened. And, and so I swear to you stick it on, you know, she's 14, she's, you know, apprehensive because it's something new. And I realized that when I thought about it in the abstract before I held it in my hand, I imagined that the pushing of the button was pushing the needle but now I realized the needles already drawn back almost like a like a harpoon or a bow and arrow and all you're doing is releasing that tension when you push that button so there's not even much of a push involved. It's it's hard to put into words you just touch that button and it's over.

Jake Leach 5:00
Yeah, exactly, there's a there's a number of spring powered mechanisms inside the device that mean when you're pressing that button, it's really just releasing the spring to pull this put the sensor and pull the needle out. And it's a, it's a lot less, we found it's a lot less intimidating than the previous version. Because it's just that much simpler to use and doesn't necessarily look like, like an injection device.

Scott Benner 5:23
Yeah, the last one was a little frightening. But But, but I'm telling you no lie. I pushed the button. Look there in the face. There was no expression on her face. And she was like, it's done. And I said, Yes, she goes, I didn't feel it. And I was like, okay, and that has been she's now worn. I want to say for and she's had the exact same experience over and over again. So kudos to engineers who came up with that, that it really is amazing. Wonderful to hear.

Jake Leach 5:51
glad she I'm glad she's enjoying it.

Scott Benner 5:53
Absolutely. So once it's on, it's simple. That little inserter just kind of like slips off. You know, you, you click your transmitter in. Now, I do have I have to tell you, I'm having hiccups with the scanning of the Is it a QC code? What kind of code is that? The q? I don't know what they call? Yeah,

Jake Leach 6:10
it's a QR code. Yeah, like the code that's on the sensor is actually the first version of our app, the one that we released with this smaller market release, it did actually have a bug in it. So we are just in the midst of fixing that, though, we'll be deploying the fix this week. So give me give it a shot the next time around, and it should work. Yeah, it will both the Android and iOS app should be fixed fixed up,

Scott Benner 6:36
it is as easy as I think it's like a four digit code. And it doesn't take any effort. It's just that one step of scanning. So for people who don't understand what you'll do going forward is you just sort of hold your phone up to the, you know, to the cake, the packaging from the sensor bed, and it just scans it all in. And it's all set. And and you're on your way. Now. Now, the moving forward part, this part is interesting. How did you, I'll tell you the most magical part, you would think it would be the insertion process, but it's not. It's after the two hour warm up, it just starts working. So I don't I never think about it once it's on again. And then magically, it feels like there's just a number all the sudden that pops up. That really is kind of spectacular. But I'm going to ask you a question from listeners. Is there ever a spot in the future where you imagine there is no warmup period? And can you explain the what the warmup period is for?

Jake Leach 7:29
Oh, yeah, absolutely. It's a great question. So the, the warmup period is, like a couple of things are occurring with the sensor is dry, when it's in the package. And then inside the applicator device, once the sensor is inserted under the skin, there's a period of time that it takes the chemistry on the sensor to acclimate to the tissue to the body into the interstitial fluid, where it's measuring the the glucose, there are ways to reduce that warmup period, and we're very confident that our future versions, we're going to be able to reduce it, I think we're gonna be able to get it down to about 30 minutes, maybe even faster. But you, you're balancing a little bit of what's the level of performance. And if we cut it any lower than 30 minutes, we wouldn't want the system to be inaccurate. So we're very confident we can reduce it by at least an hour. And if not even maybe get to half an hour. And we do that through updates to the center, as well as the algorithm that is turning that sensor signal into a glucose reading. The more one of the big things with GS six was, we did change quite a bit of the materials that go on the center. They're all kind of the same base materials as our previous products. But we we've fine tuned it quite a bit both in the design in the process we use to manufacture the sensors. And what it results in is a much more consistent and stable sensor signal. So that's why that's what enables our factory calibration, where users no longer have to enter the finger sticks to calibrate and it's also what's going to enable us to reduce the warmup time in the future.

Scott Benner 9:13
Okay. Okay, so that leads me into my next question which is when Arden put on the G six At first, I left the G five honor we did it for about 12 hours I did it out of anxiety right you would think I might have done it for the podcast somebody I just was anxious I was like I trust how this G five works right so you're going to give me something new. I believe in you guys. So I think it's going to work but I need to see it myself. So I put it on. First of all, the concept of it doesn't work real well on the first day or it's not as accurate as you would like it to be till it's been on for a while that I've I've let go of completely I'm but what I saw initially g five g six was that they didn't exactly match. They were close but they didn't match. And then I realized that I'm calibrating the G five based off my meter. And then we get into this weird world of diabetes, right? Which is, which one of these things is closest to accurate? And what does that even mean? Like, what does? Do you know what I'm saying by that? Like, what is my accurate blood sugar mean? I've gotten to a place in my life where I've just said, I'm going to pick the device that I trust the most. And I'm going with what that tells me. But it is one of those things that if you sit down and think about it academically, it'll make you insane. So how did you how do you how do you guys think about it? Like, because I trust the G six implicitly already? It's It's fantastic. But it didn't agree with the G five. But is that because the G five was making some decisions based off my meter readings?

Jake Leach 10:41
Yeah, it could it could be the the way that we look at accuracy. And you're absolutely right, it can get really kind of mind boggling. The The main thing that we look at is the ref blood reference Are you using to calculate your accuracy. And so what we do for our systems to measure performance, is with something called a y si, it's actually a laboratory analyzer. And we compare our performance our measurement of glucose in the interstitial fluid to what the venous blood glucose concentration is. And so that it were matched to that one of the things that's a little bit different about it, fingerstick meters, it's measuring capillary, it's a finger stick at the tip of the fingers. So you're going to get flight differences between the venous blood and the capillary blood. And so when you're calibrating to the capillary meter, it's still accurate. But it's just it can be slightly different than than what a venous blood measurement would have been. And when we designed g six, it's designed to be coincide with the venous blood readings.

Scott Benner 11:50
So how do you decide I don't even know if this is a fair question, but there's an interstitial reading. There's a reading I can get for my blood. And there's what for the lack of better word God knows my blood sugar is? And so how do I know what gets closest to? Like, how do you how are you? Why don't because it's working? Great. Let me tell you why I think it's fantastic. Because I look at my daughter's clarity reports. And her a one c reports back incredibly close to what clarity tells me, you know, if I look at her her average blood sugar, what it's going to be. So to me, that makes me feel like what I'm seeing moment to moment, day to day has accuracy. But I don't but that just seems like the only way I can tell. Do you mean like what is the what do you guys talk about when you sit down and talk about this.

Jake Leach 12:39
So when we, when we talk about accuracy route, we're always looking at, you know, making the system as accurate as possible. And when we do our clinical studies for the FDA, and when we really are looking really closely at performance, we do look at that that venous blood draw, we actually draw blood out of the catheter and measure it. But the differences between the the venous blood in the interstitial and the capillaries, it's also small, it's it's very rarely going to make any clinical difference, you're not going to make a different decision based on the different glucose readings. So that's, that's how we look at it, we look at it from a Wi Fi perspective, the FDA, that's how they have specified, particularly with the new approval for G six as an integrated CGM. There they they put out some very specific standards for how AGM icdm should be studied, and the performance they need to meet and all of the different aspects that really is what sets cheesecakes apart.

Scott Benner 13:43
But spectacular. Can I ask you a couple kind of rapid fire questions or my expectation? Well, first of all, Arden used acetaminophen yesterday for the first time, it literally did not make a difference. Thank you very much. I don't know what the magic is. But that was really cool. If I told you, you could have something for free, and that giving it to you, in no way bound you to do anything else in the future. Would you take something for free? Have you answered that question in your mind now? Have you said to yourself, yes, Scott, I would take something free if I didn't have to do anything in return? Well, if you have, boy, do I have good news for you? I need you to click on the link in your show notes or go to Juicebox podcast.com and click on the link. You can type it in the browser if you want. Clicking on the link does help. I'm not gonna lie. I don't make money when you click on the link. But it does let the advertiser know you came for me and that does help the podcast keep going. Anyway, what are we talking about? The Omni pod tubeless insulin pump on the pod is thrilled to send you a demo of the pump. They actually send you a pot. It's not a working pod in as much as like you know you couldn't get insulin from it but it has all of the same parts inside. It's the same weight as a real pod. And you know that way you can really To get a feel for it, you can wear it and see what you think. You can hold in your hand and say this thing is pretty Tommy, where's the thing I hook on my belt, you might say to yourself, that attaches to my tubing that attaches to my infusion set. Well, that doesn't exist with the Omni pod. The Omni pod is an all in one device. It's controlled by a handheld, personal diabetes manager, let's take off the PDM. But that PDM is wireless, it talks to the pod wirelessly. It's not connected to you, you don't even have to have it with you most of the time. And the pod has everything you need, and it's on your body. And then once you're saying it's hard to picture, Scott, but is it not really tiny and it's small, it's amazing. And it's lovely, and it doesn't have any tubes. And if you go to my omnipod.com forward slash juice box, or click on the links in your show notes, or go to Juicebox podcast.com and click on a link, you can have a free no obligation demo right in your hands very soon. Arden Arden's about to be 14 years old, she's been using the only pod since she was four, we could not be happier with it,

Jake Leach 16:01
I really hope you give it a try.

Scott Benner 16:03
g five, I thought was really good. But I lost my signal more than I would have cared to. And it took a little time to come back. Now I figured out how to trick it back with like resetting Bluetooth and stuff like that. So I figured it out along the way. But it happened more frequently than I was comfortable with it happening. I am not seeing that at all with G six. How did you fix that.

Jake Leach 16:28
So it's a it's a Bluetooth communication protocol that we use in the transmitter to communicate to iPhones and Android phones as well as insulin pumps, and then also the receiver device that we supply. And so that Bluetooth protocol, when you start talking about mobile phones, it's complex, because on the mobile phone, there's a lot of other systems on the phone that are using a Bluetooth, whether it's streaming music, music, audio, and many times even the Wi Fi chip is the same electronics as the Bluetooth and so their their time slice. So it gets complex on those platforms. And one of the things is we work very closely with operating systems on those phones. And we we do quite a bit of optimization to do to try and limit the amount of time that Bluetooth signals are lost. And I agree with you, it still happens. It just the fact that it happens is something that means that we have more work to continue to do g six, it should be about the same. We made some enhancements. But you still can't experience the signal loss alert on on G six. And but you You got it, Scott, you you basically reset the Bluetooth. And that's often what will bring the signal back because on the phones. It's not it's not a perfect scenario. So sometimes you get great performance. Other times you don't but there is always a way to fix it by by cycling that that Bluetooth

Scott Benner 17:57
crash the app go in and out of airplane mode and then back right away. So that's how it's been working for me hate this. I'm seeing. So every once in a while we see a compression low, which I'd like to get you to explain to me because in my literally untrained mind's eye, the interstitial fluids being pushed away from the wire. And that's how it reacts. But I'm sure I'm wrong. I'd like you to explain what it is when you lay on the sensor for too long or press on too long that it it reports a low that's false. But also Also, I'm seeing much quicker recovery time after I tell Arden Hey, rollover is and I don't know if that's my imagination.

Jake Leach 18:35
No, no, it's a great question the soap compression. Also, in some of literature, it's called sensor attenuation it is basically when you put that pressure on the site where the the transmitter and center are, it can reduce the diffusion of interstitial fluid in that area. So the sensor is still very measuring the glucose in that area very accurately. But it's just as the glucose in the area where the sensor is, isn't reflective of what the glucose is in the rest of the body. And it comes from that event compression where the interstitial fluid is not diffusing into the area around the sensor. When when people run into that I often know they try different locations for their sensors. But but it can happen. And we're you know, there's a number of items that we're always focusing on trying to our goal is to make the system as reliable as possible. And so we'd love to be able to detect those those compression events and so that we don't issue a low alert that isn't valid. So it is another area where we're continuing to investigate and has everything to do with the shape of transmitter and the size and the central location and all those things. So that's what causes a compression. The other part your question about the response time GG six is designed to be more responsive to glucose changes. And so that's exactly what's happening when when ardonagh rolls off, the sensor stops applying that pressure. Look, the glucose infuses back to that area very quickly in G sex detects it. I knew

Scott Benner 20:12
that wasn't my imagination, it was happening so much faster that it just it couldn't have been coincidental. Okay, as the adhesive changed at all in the G section, the

Jake Leach 20:22
G five, not the patch material, the base material itself and the adhesive have not changed, but because of the shape of the new transmitter. The shape of the adhesive is slightly different, but it's it's very similar to the shape of P five, but it is exactly the same adhesive as G five.

Scott Benner 20:40
Okay. Um, let's see, lag time, I'd like you to like, I'd like to understand that when I'm looking at like, I'm looking at Arden's blood sugar on my screen on my computer right now, which is the next thing I'm gonna ask you about. It's 114. Is it 114? Right now? Was it 114? Two minutes ago? What is how does that lag time? Is there like time and how does it work?

Jake Leach 21:03
So a couple of a couple different components to the lag time. So one part is just the time it takes for the interstitial fluid to have the same glucose concentration as the blood. And that's very quick, it's about a minute or two, there's been a couple of different clinical studies where they just are the researchers studied the diffusion of glucose from blood to interstitial fluid, and it's a matter of a minute or two. So you get a little bit of lag, they're not not really perceivable that there is some lag there. And then the rest of the lag tends to come from the system and the measurement system. So the CGM, and historically the CGM is we're a little slower to respond to glucose changes. And so the reading that you were looking at, could be, you know, a five minute average from five minutes ago. But as we continue to enhance the the systems we have, the reading is valid for that five minute time period, there's a little bit of prediction built into it. So it's not just like it's a five minute old value. Okay. So we update the readings every five minutes, but they have a component of prediction built into it. So that we are giving you as accurate reading as we can, because we're always trying to match that. What is the true venous blood glucose reading.

Scott Benner 22:21
So that makes sense to me, based on my findings, and for the people listen to this podcast. And there are a lot of them at this point who do things the way I do, which is I bump and nudge my daughter's blood sugar, I don't just you know, put in a mountain weight if I you know, if I see a 122 diagonal flop, I push a little insulin on it. And some people are like, well, that how do you you know, isn't that number behind, but I'm not finding that I'm finding that I'm, I'm working in relatively real time situation, my expectation for how the insulin works. And my expectation for what the CGM is telling me is, it feels pretty accurate to me, like it feels like it's all happening the way I expect it to. So that that makes a lot of sense. I'm a little bit about predictive. Actually, let me jump to this real quick that somebody asked this. And I have to say, I agree I'm using a third party app on my Mac right now. And I can see Arden's blood sugar up in my bar, and my menu bar, are you guys gonna ever develop something like that for PC or Mac, because it is, I'm being asked a lot by people who are at work, and whose jobs frown upon them having their cell phones out.

Jake Leach 23:22
We we don't have in our roadmap right now to do software for the computers to display glucose. But what we do have is, we're working with a number of different partners that we have right now we have a Data API that's available to partners who want to work with Dexcom. Right now, it's retrospective. So the the data is three hours old. But we're looking at lots of opportunities to determine how to partner on the real time data so that we could enable the ecosystem of developers out there who have great ideas and develop wonderful solutions that maybe Dexcom is not focused on, because we're focused on other pieces of software. But we do really believe in open systems that are reliable. And I think all the different options of displaying glucose is is my vision for how it should be is you should be able to get those real time readings anywhere. You want them anytime in the format that you want. And so enabling the developer community to help us with that is is the way we want to move forward.

Scott Benner 24:34
Right? So if you have a good idea, reach out to Dexcom and get involved. I can tell you right now I'm using gluco gram it's working great on my Mac and last week I was at the Indianapolis 500. Not at the race but at the speedway and I was watching Charlie Kimball race, and I was down in the pit and I could see his blood sugar on their screen in a row. It was pretty cool. Okay, uh, geez. Jake, 30 minutes. Hold on a second a predictive alarm alerts, how soon Am I seeing that predictive alarm you are going to be? Because right now it says something like it expects you to be under 55 in the next 10 minutes.

Jake Leach 25:10
Is that? Yeah, it's, it's Yeah, the way that the predictive, low alert, or the urgent low, it's basically determining, it's trying to give you enough time to deal with a impending low. So what it does, is it it estimates, in how much time are you going to be 55. So it looks at what's the glucose and how fast is it dropping in, it also takes into account where the low glucose threshold is set. Because if the low glucose threshold is going to give you 20 minutes of time, before you hit 55, we're not going to issue their urgent, are they going low, soon alert. But if you're dropping quickly, to the point where you're low alert will go off, but it only will give you let's say five or 10 minutes of warning, we're going to advance that alert in time to give you a little more time. So our goal is to try and give you 20 to 30 minutes of warning ahead of a 55 occurrence. So that's the way it's designed. So that the goal, one of our main goals of predictive alert was not to increase the number of alerts that users receive. Because we know historically, with other systems, predictive alerts can be a little bit of a nuisance, because they're not always that accurate. And so we wanted to do a very nice job of predicting that that low glucose will alert without giving too many false alerts.

Scott Benner 26:38
This next question you might just say no to do you guys have any plans to integrate with a Bluetooth meter so that I people who need to calibrate still don't have to type it in?

Jake Leach 26:48
We don't in our roadmap, we don't. That's not to say, though, that you couldn't, you know, develop a system that took in the Bluetooth meter readings, I've seen some different, you know, prototypes of health kit on the iPhone pulling in the meter readings. And so we don't plan plan to integrate with Bluetooth meter. My goal, ultimately, is to get to the point where the system is not, you know, finger sticks, we can basically retire the finger stick meters forever.

Scott Benner 27:19
That was my expectation of what your answer would be is that we're trying to get away from that. So no, Apple watch that has the cell connectivity. Are we ever going to be able to see our blood sugar on that without a phone involved in the loop?

Jake Leach 27:33
Mm hmm. Yeah. So it's a great question. The your left just told me no, but the core, the core, the core Bluetooth, connects, basically, the functionality that Apple announced last summer, that they were opening up to particular companies, including Dexcom. So they opened it up last, or they announced it last June. And then we've been developing with it ever since. And so we are working on a communication protocol between our transmitter and the Apple Watch directly. But it's still in development, because it is actually a very complicated scenario of the phone goes out of range, and then the transmitter has to switch over to communicating with the watch on its own. And then when the watch comes back in range, you have to switch back to the phone. So both Apple and ourselves are working on a number of different prototypes. So we're, I'm confident we will, we will have a solution there. But it is quite a bit of development still ahead of us to get to the point where it's reliable and works the way users want it to and expect the experience to be so we're developing on on the Apple Watch, and some other you know, the Android systems and we're also looking at doing it with Fitbit as well. So I do think that that's a really important option that we need in the future to have, you know, kind of lightweight, easy, convenient displays where you don't have to have your phone with you at all times. So I think it is it is definitely important aspect of our displays. And we are working hard on and by working

Scott Benner 29:05
hard. I mean, there are three engineers in the room have big clumps of hair missing off of their head.

Jake Leach 29:11
There's a lot here, there's quite a few engineers working on it.

Scott Benner 29:13
Let's see. Ah, is this is my I'm gonna ask you two questions. I'm not sure if you're the right person to ask do you know about like Canada launch and how upgrades work and stuff like that? Or am I better off talking to Kevin about that?

Jake Leach 29:27
You've been talking to Kevin about timing, I can I can mention that. The for the the upgrade that the system if users have the touchscreen receiver from G five that is fully compatible with G six and a Connect, it can just be firmware updated so that when it does come time to transition between g five and G six, all the user needs is a new transmitter in the sensors. And they can upload the firmware right to their receiver from our website. Okay, so we've got a number of G five users who've already upgraded to G six in that

Scott Benner 30:01
And then I think the rest of it's pretty easily spelled out online. If you're out of warranty on your G five, you'll you want to be transitioned to the G six you can be. And it's that simple. Alright, so I'm going to ask you a question that I don't know if you can answer but there's going to be two of them in here at the end, we have four minutes left, restarting the sensor, you can restart a G five, it's against the FDA, you know, protocol, it's not something you guys say people should do. But it's obvious at this point that people understand that you can just, you know, for lack of a better term, check the G five and a thinking that you've put on a new sensor but and restart it. I personally have, I have good insurance. So it doesn't bother me that the new g six only lasts 10 days. And I've been watching machinations online as people try to figure out how to restart the G sex. What I see, I haven't tried, and I don't plan on trying. But what I've seen is that you guys have created a sensor bed, where you can't get that transmitter out of there until you take it off your body and break it is in kind of like like cracking it kind of the sensor, but then the transmitter slips right out. Is someone gonna figure it out? Jake, or is it not? Or can it not be figured out? That's my question. Well, is someone gonna nerd out? Or can it not be figured out?

Jake Leach 31:10
You know, so the sensor restart issue? You know, the question about it was, as we started working on factory calibration, that was a really important part of our kind of risk analysis and all the hazards involved with factory calibrated sensors that get restarted. And so it's actually part of the FDA guidance on the integrated CGM because of the performance requirements, and the fact that there's no finger stick calibration required. It was part of the the approval is to ensure that the sensors could not be restarted. Now, you know, I'm an engineer. And I know there's lots of very intelligent engineers out there and other scientists and folks who can figure things out. And so I'm sure at some point, someone will figure out a way to do it now, is it going to be easy? Or is it something that we would recommend? Absolutely not. But they, you know, it's, it's like any system, if you work hard enough, you can generally figure ways around the design intent. I wouldn't recommend that

Scott Benner 32:15
Dexcom does not want you doing that I say, I report back if you know anything. And so here's my last question that it's really very open ended, but it is genuinely my biggest interest while I'm talking to you. What's next? What should I be excited about? That's coming? Is it something you can talk about? Can you be general McCain? Sure. Yeah. Next.

Jake Leach 32:39
So, you know, for CGM, one of the things that that's coming is the expansion of the use of continuous glucose monitoring past our current users, the most of our customers, and our patients, our intensive insulin users, right? Just like ours, and they're making decisions every day, how much insulin Do I need to take lemon to cover those carbs. And so it's a critical part of their, you know, how they manage diabetes. But as we step into other realms of type two diabetes, pre diabetes, there's a lot of opportunity for that continuous glucose signal to help people live healthier. You know, there's a coaching aspect to it. So one of the things you're going to see is that the CGM is are going to continue to get simpler to use, and more applicable to the broader markets, where folks don't necessarily have all the training that some with Type One Diabetes has, in terms of, you know, doing injections or are using CGM. So one of the exciting things is the the size of the CGM is going to continue to reduce the complexity will be reduced. The connectivity and all the things that come along with the Dexcom CGM, the phone apps, the share apps, we're going to continue to enhance those and make, you know, take advantage of all the new features that come out on the mobile platforms. Every time there's a new iOS or a new version, Android, they, they put in new new features that developers like Dexcom can take advantage of. And so I think there's there's a lot of opportunity to continue to enhance the experience and the basically making diabetes, easier to manage. Whether you have type one or type two, or or just interested in blood glucose, dynamics and living healthier, there's, there's tremendous opportunity, and we're just kind of we're, we're happy where we are with the mobile platform, but we see a lot of runway left still for what we can do and engaging users and giving them more than just you know, the glucose reading and the rate of change. You can imagine helping support some of the decisions that have to be made about insulin or carbohydrates, or exercise, all the all of those aspects. We can Continue to improve and work on.

Scott Benner 35:02
Cool. Can I ask you one last thing before I let you go?

Jake Leach 35:04
Of course God,

Scott Benner 35:05
did you guys ever consider taking a shot at smacking freestyle when they came out with that Libra thing and put because I'm assuming that their product is just it's an aspect of Dexcom. But it's not the entirety of it. I'm assuming you could create something like that Lieber fairly simply, based on we could. Yeah,

Jake Leach 35:24
we could we think one of the you know, there's the there's a couple aspects of Dexcom CGM, the performance of courses are is paramount to the reliability users have learned to trust and and rely on. So the performance aspect of Dexcom is different. But also the real time connectivity. So for alerts, alarms, and powering of closed loop systems, and all of those things, the integrated CGM is, you know, where we think is the right place to focus. And so that's where we are focused. And it's one of the reasons we implemented Bluetooth on our system was so that it could be integrated with more devices. And it's also why our partners are enabling their systems with Bluetooth, so that they can communicate with our our transmitter. So Tana being the first and intellect to working quickly on a Bluetooth version as well. So I think there's a lot of opportunity, and we're gonna stay focused on real time CGM.

Scott Benner 36:25
Yeah, I just I can't. If I can't see it, if it's not always there. It just takes away a big part of what it is. I don't know one other way to put it like when I look at that other that other product, what it looks like, to me is a fingerstick meter where I don't have to poke my finger,

Jake Leach 36:41
which is very similar. Yeah, we don't get the alerts and alarms at night, like when you expect, you know, that's one of the times it's critical for Yeah, monitoring glucose when you're asleep. And so yeah, you don't you don't get any of that functionality.

Scott Benner 36:51
No, that's it. I was just I was mulling around my my house today, thinking about what I was going to talk about with you. And I just kept thinking, I wonder if they thought, Wow, we could do that too, you know, but we don't want to. And so because it ends up being a pricing thing, right? It's just, it's cheaper. And so it's a it's, it's like a bit of it's almost like, if I buy my homeowners insurance from Dexcom in my house burns down, you'll you'll pay me back completely. And if I buy it from freestyle, you'll pay me back like half. And so it's not. And so it's not a bad deal. It's just not as good as it could be. But the price is lower, I guess if you're paying out of pocket, so I don't know that this wasn't for you. So anyway, everyone I had Jake on because Jake knows the r&d. And I thought everybody can do a review where everybody just goes over, you know, the stuff you see on the website. Again, it does this it does that. But it seemed to me like it would be more interesting to understand why it does what it does. And so that's why Jake, I thought I'd have you on today. And I really appreciate you taking the time. For everyone listening, I'm assuming Jake came into the office sat down, and I called him so it is very early where he is and we appreciate you taking the time very much.

Jake Leach 37:55
Thanks so much, guys. Pleasure.

Scott Benner 37:57
Have a great day.

Unknown Speaker 37:57
You too.

Scott Benner 38:00
I'll be sharing my dexcom g six review with you right after these words from our sponsor. It's very simple. If you heard something today about the dexcom g six continuous glucose monitor and you're interested in finding out more, click on the links in your show notes. In your podcast player, go to Juicebox podcast.com, where there are also links, or go to dexcom.com Ford slash juice box Dexcom would be thrilled to get you started right away. And when you use my link, they know you came from the podcast, which is very helpful. It's not financially helpful. Like I'm saying I don't get paid by clicks, which is important to know. But they do know that the podcast ads are bringing people to them, which helps me get more podcast ads, which helps the podcast keep going. Let's go over it really quick. You were a dex comm product, g fiber, the G sex, what you're getting is a real time understanding of your blood sugar, where it is and where it's headed. And how fast is it headed there? Is my blood sugar 80 and is it real stable? Is it 80 and about to be 50? Is it 90 and about to be 120? These things are very important to understand. Here's the next thing that's very important. The concept of sharing blood glucose data. The user, whether it's your child or your spouse, or just a good friend can be wearing the dexcom and sharing their information with others. Imagine what that means no matter where you are right now. You can know someone else's blood sugar. Maybe they're gonna be incapable of helping themselves. Maybe they're just not hearing it. Maybe it's your son or daughter at their sports event. Maybe they're at school. Maybe you're just giving some backup to a friend. But the share and follow functions of the dexcom g six are spectacular. They're available for Android and for iPhone. And they present a peace of mind that is unmatched in the world of living with type one diabetes. Again, go to the links in your show notes at Juicebox podcast.com, or dexcom.com Ford slash juicebox. To get started today, to find out more to switch from the G five, that a G six, use that link for everything.

And now after over 30 days of use with the Dexcom, GS six, this is my very unbiased and honest review of Dexcom latest product. It's fantastic. There you go. That was the whole thing. I'm kidding. I'll tell you more. Listen, we went over a bunch of it just now with Jake, those are my unfiltered thoughts as you can imagine. But I'll go through it step by step for you. Now, it's not going to take long though the honest truth is if you see some long review of this product, people are just using filler, because it is simple to use. And it works. So the insertion process, he take out the insertion thing, the device, the little potty comb, I don't know what to call it, exactly, it's a thing. And it has the sensor bed already installed, and you take it out the package, take off the adhesive coverage, you stick it on, you push the button, you pop in the transmitter, you know, I think there's something you have to do with the phone like push start sensor or something like that, or on your on the Dexcom g six receiver if you're not using your phone, start sensor. Two hours later, a blood glucose value just pops up on your device. That's it, there's no calibrating or testing necessary. If you want to calibrate and test, it actually has a function for you to still do that. But we haven't and we are having no trouble whatsoever. Now the actual process of the insertion is amazing. It's as smooth as silk. I mean, that's the review. The accuracy is better. The first day accuracy is fantastic. The insertion is painless, and easy. There's no calibration necessary. If you experience a compression load, once you take your weight off of the sensor, the accuracy comes back in moments. I've had no issue with connectivity between the app and the transmitter. It's working great. I mean, the last real thing I can't tell you, which is I have to wait for Arden to get an A one see to see how closely it matches her clarity app. You know what what has her average blood sugar been as far as the Dexcom is concerned over 90 days, and does that closely match with what her a once he ends up being? That's the last really measure I can use. And I can't tell you about that for a couple more months. And that is going to be incredibly important. I need to know that the information I'm getting back from the G six is helping me make accurate decisions. But in all honesty, I can't imagine it's going to be in some way not as good as the G five and the G five was fantastic. And I've been managing Arden's agency really well. With the information coming from the G five, I expect it just to get better with G six. So I'll be back to you with that information in the next couple of months. But for now, if you're looking to me for my opinion, if you're able to move from the G five to the G six, or from the G four to the G six, do it for the first time I'm able to actually give advice on the podcast. My advice is use the G six if you can. It's fantastic. It's quick, it's easy, it's painless, it's accurate. You know what it's making me think of honestly, back in episode, I think 158 I did a whole hour interview with the CEO of Dexcom. Kevin Sarah, we did it right around the announcement that the G six had been approved by the FDA. And at that point, I think Kevin called it an evolutionary leap. The G six was an evolutionary leap from the G five. I'm calling that statement an incredibly accurate description of the improvements that have been made. Okay, guys, I hope you enjoyed this episode. Also, two episodes dropped this week. So I hope you didn't miss the other one. Episode 167 is out too. If you got this one and you didn't get another one. Go back and look in your podcast app. It's there. It's a full one hour interview with the mom of a girl with Type One Diabetes, who is also quite the Instagrams thought it's actually a really great conversation about type one diabetes, but we also talk a lot about life low carb and not low carb, which is really interesting. That's Episode 167. Thank you so much. Dexcom for sending me Jake. Thank you Jake, for coming on. Thank you Omni pod for sponsoring. Thank you, Dexcom for sponsoring. Thank you for listening. Thank you. Thank you. Thank you. Thank you. Thank you. There's a lot of factors there. Actually, while we're at it, let's keep going. A lot of great reviews coming on iTunes. Really appreciate it. I love it. I love it. When you guys share the podcast. It is the best and pretty much the only way for the podcast to grow is word of mouth. If you like it, tell someone else. If they look at you funny when you use the word podcast, snatch the phone out of their hand and show them how to listen. People need help sometimes. You could be that person for them. You could be a podcast Sherpa, and official Juicebox Podcast Sherpa. Hey, I'm gonna do something they don't usually do. I'm gonna shout out a couple of people Trish for telling me that she loved when I babbled on at the end of a previous episode. bad jokes and asking while you were still listening. Trish said her hands I think were busy or dirty or something and she couldn't shut off the podcast, or switch to another episode. And that gave her something to do. So for all of you whose hands are dirty right now,

Unknown Speaker 45:12
I'm still talking

Scott Benner 45:14
is another shout out to I don't want to use the name but someone who contacted me recently to let me know that they went to their endocrinologist with a decreased day one C, and they were super thrilled. And the endo treated them poorly about it. You know, the endo gets scared that you don't know what you're doing and that you're achieving some sort of a lower a one C, by having scary lows. This person was not and told the doctor, the doctor said, What are you doing? And she replied, I'm being bold with insulin. I like write that in the email and was like,

Unknown Speaker 45:46
yeah,

Scott Benner 45:46
shout it out loud. Good for you. stick up for yourself. Also great notes from Europe lately, Germany.

Unknown Speaker 45:52
And

Scott Benner 45:53
where else Portugal? Am I am I right about that? I'm writing today from Portugal. A small country in the western part of Europe. Yeah. What's up, Rita? Thanks for writing. I'm going to email you back as soon as I can. Here's the point. The community built around this podcast is worldwide. You are not alone. I am not alone. together. We are. We are each other's support system, even though we can't hear each other's voices. That's really important to know. All right. I'll see you guys next week.