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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 174 of the Juicebox Podcast. Today's episode is with Mike Menninger. Mike was once a longtime employee of Dexcom. But he has gone on his own to develop a smart pen CMD I users, I got you covered.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise Always consult a physician before making changes to your health care plan.

Mike Mensinger 0:50
Hi, Scott. I'm Mike Mensinger, Chief Technology Officer at companion medical. Great to talk to again,

Scott Benner 0:57
I appreciate you coming back on now with a different company though.

Mike Mensinger 1:00
Yeah, the left x com about a year and a half ago. And when what an amazing journey that was with dexcom share, and z five. And it was a such a privilege to be part of all of that transformation and in diabetes technology and happy to do it again, in injection therapy. Now,

Scott Benner 1:18
it's pretty exciting. So how long were you at Dexcom

Mike Mensinger 1:21
13 and a half years. So started in 2003. And my co founder, Sean st is the CEO, he actually built the first Dexcom short term sensor in 2004. So we have a lot of early Dexcom heritage here.

Scott Benner 1:35
And so now you and Shawn are on a different path trying something different.

Mike Mensinger 1:40
Yeah, the you know, while the technology was really amazing, and that was really great to be part of everything we did at Dexcom, we were frustrated at the lack of technology that was directed towards the injection market. So there's so many great solutions today, that's available for insulin pump users. It's very exciting to see but comparatively nothing available today for injection users,

Scott Benner 2:02
it really did feel like it does feel like honestly, that people using pumps have access to so much more data and technology. And I don't I don't know if it's a left behind situation or where it was headed. But it really did feel like there was a chasm growing between people who wanted to do MDI, and people who wanted to pump and the people who were pumping, we're getting a lot more, but you think you've fixed that, don't you?

Mike Mensinger 2:28
That's what we hope. So we've brought a lot of the benefits of pumps to syringe users. And we can get into that. But you know, things like the dose calculator, automatic dose tracking those reminders, helping you manage your long acting insulins. So complete solutions that's right there on your phone and easy to use.

Scott Benner 2:45
Okay, so let's, uh, I guess we'll go back to the beginning. Did Shawn start companion medical? Or did you or who, who had the first thought and who came along?

Mike Mensinger 2:57
Yeah, we I think we fight over that a little bit. But we had the idea around the same time from two different vantage points. So he was a tandem running advanced technology. And he says that he was trying to, he was frustrated with how to bring the benefit of insulin pumps, this great technology to really the larger set of users with diabetes. But as you know, it's only about 30 to 40% of folks in type one using some pumps, and much fewer than that it's about 7% worldwide when you look at injection, therapy for insulin in total. And so he was trying to say, Well, why aren't more people buying this product? But then he had an epiphany and said, Well, maybe we're asking the wrong question. How do we bring those benefits to the folks that don't want to use an insulin pump or can't afford it. And so that's where he came at the problem. And I came at it from a slightly different avenue, inside Dexcom, we're trying to really have the best overall solution and without influence data, which we had with our pump integrations, but without for the larger market, you know, you're really limited in terms of what you can do as a solution. And so, you know, we were looking into why isn't anybody doing this? And that's how we both came to the idea around the same time. Nice. And then he was able to actually leave tandem, and start the company. But I stayed at Dexcom for three years.

Scott Benner 4:19
build up your war chest so you could get going, right?

Mike Mensinger 4:22
Well, again, there's so many exciting things happening g five and share and you know, these really great advancements within diabetes. That was, you know, I wanted to be part of those. And that was very fortunate to be able to do that why Shawn started the company.

Scott Benner 4:35
No, it shouldn't be, it shouldn't be overlooked. what you were doing there was, um, you know, and what they continue to do with Dexcom is amazing, but I think you might have, I think you might have the answer here for people who aren't using pumps. And and that's why I was excited that you guys could come on and talk about this. So I get a lot of correspondence from people who say, you know, I listen to the podcast and I want to do these things. But I don't have a pump. And you know, we've had people who listen, no, we've had many different people come on, and we talk about MDI all the time. And what we came up with was, besides not having the ability to manipulate your, your, your slow acting insulin, when you're when you're an objective when you're doing injections. Besides that, if you're willing to inject, you can make as many adjustments to your blood sugar. As people can who are pumping, you don't have, you know, you can't, obviously, your lever mirror your lantis, or whatever your slow acting is, that you're not in control of, but everything else. If you had the data, you could, you could control. And now you're you have a way to show people, everything that's sort of going on in their body with their insulin. And, and so I want to start talking about it. So I'm excited here. Right? Yeah, yeah. So you start you so you have a product called in pen. Is that that that's what I call its intent. Okay,

Mike Mensinger 5:59
that's, yep, that's the product name. Yep. And it's iOS available since December on iOS. And we just got Android approval, actually, last Friday. That's amazing.

Scott Benner 6:09
Thank you questions, and you are FDA approved?

Mike Mensinger 6:12
Yes, we got FDA clearance, actually about a year and a half ago.

Scott Benner 6:16
So what we're looking at here in its simplest idea is it's a insolent pen, but it's a smart pen. And it's speaking to an app that people use on their Android or their iPhone, or their iPhone. And what is that app, giving me? What kind of information comes from that?

Mike Mensinger 6:34
Sure. So just like an insulin pump, you have a complete history of all of the injections. And you know, when you took insulin and how much we calculate your insulin on board for you. So you can know how much is still in your body, that's going to continue to lower your blood sugar over the next five hours or so. And that needs to be factored in, as you know, for for future injections. We have a dose calculator, just like an insulin pump. And you can input your blood sugar, and your carbohydrates and subtract out your insulin on board. We also have dose reminders. So if you forget to take, say, your breakfast dose, it'll be at nine o'clock, or whenever you configure it for it'll, it'll remind you and say, hey, maybe you miss breakfast, but maybe you forgot your dosed. Figure that out, it has solutions to help you manage your long acting insulin. And remember to take that. Let's see here, the pen itself. A couple of unexplained reasons for hyperglycemia are sometimes if you leave your pen in your trunk of your car in the summer, or in the wintertime, and it goes, it's too hot or too cold, your insulin reduces effectiveness. So the pen has automatic temperature tracking. And we'll let you know if you should consider replacing your insulin. And similarly for age, if your insulin gets too old, it's been in there too long, it'll let you know it's been been longer than 28 days, consider replacing that, wow.

Scott Benner 7:56
Okay, so let's pick through that a little bit. Because that was a lot. And I'm going to start at the end, I'll start where you finished and go backwards. So the pen knows, I guess when I put in a new cartridge, and then it starts kind of a countdown for how long it's been in there.

Mike Mensinger 8:11
Yes, exactly. So when you load a cartridge into the pen, you do this every three days or whatever, how long the cartridge last few bits automatically knows that you've put a new cartridge in, and it starts that timer for you. And then 28 days later, if you haven't put a new cartridge in, you'll get a reminder on your home screen in the app saying your influent is a little bit old, consider replacing it.

Scott Benner 8:31
Okay, now that seems obvious, but how does it know what the temperature is?

Mike Mensinger 8:36
So we have temperature trackers on the tent itself. So if you leave in the car, it knows how it seen and it's sampling the temperature, you know, periodically on the pen, and it will let you know it's it seemed this maximum temperature for this length. So you can make a decision yourself whether you want to continue to use the insolent or, or replace it at that time.

Scott Benner 8:55
Like that's impressive because I'm I have the pen here I have a demo of it. And it's not any larger than any other insulin pen I've ever seen. Actually, it looks a little it's it's a little smaller. I think if if I'm right then some of the other ones that I've held. So you've How did you get all right, listen, I guess you can't tell me how you got that in there. But that's pretty cool. Yeah, thank you. Yeah, absolutely. That that is really it's simple. When you stop and think about insurance, you tell me that but I'm assuming that the you know that the work that goes into figuring out how to get that in there and get you good information is probably probably pretty intense. So on the app if I want to say look, I you know, on the days I forget my mealtime insulin. I usually remember around nine o'clock that I forgotten so I can just set up something that does just pop up and say have you taken your insulin or does it alarm or can it do either?

Mike Mensinger 9:47
Yeah, you get a notification, just like Dexcom high alert or low alert. Yeah, it's, it's not going to make the kind of loud sound but a Dexcom alarm would, but it's more of a friendly reminder that if you If it senior breakfast dose, you're not going to see that there won't be any extra steps for you. But if it hasn't seen a dose in that configured time range, it'll, it'll let you know.

Scott Benner 10:09
Oh, so that's actually even more impressive than what I was thinking. So in that time range that you tell it, this is when I eat normally, if it hasn't seen you give insulin, it tells you. Exactly. So I'm not just setting a timer that says, hey, randomly at 10am remind me have I taken my insulin today?

Mike Mensinger 10:26
Yeah, so one of our overall design philosophies, and you'll kind of see this throughout the product is, diabetes is very hard as we know, we don't want to make diabetes extra work. So let's keep it simple. Let's keep it intuitive. And if you don't have to notify you, or make you spend more time on it, get back to life and live it. And that's, that's how we designed the MS DOS reminders.

Scott Benner 10:47
It's really something that Shawn has type one, is that correct?

Mike Mensinger 10:51
Yes. He was actually diagnosed when he was attending, believe it or not. So he was able to get a TGM from Dexcom, the same day of his diagnosis, and he's never lived the day with diabetes without

Scott Benner 11:05
jamjam. Wow. So he was working in the diabetes space, but did not have type one and then developed and while he was there,

Mike Mensinger 11:14
yeah, I'm pretty late in life. So it's very unusual. It really is crazy. I have to

Scott Benner 11:17
talk to him someday. Okay, so what else was I just looking at. So you have integration. This is one of the things I want to make sure I understand correctly integration between my CGM or my, my bluetooth meter data. So I can see my Dexcom information and my information from my in pen in your app. Yes, and though run through how. So that's done through Apple Health and iOS. So Dexcom writes all of the data, it does have a three hour delay on it, but it writes it all Apple Health. And as long as the user gets permission for our app to read that data, it's automatically flowing from the Dexcom system into our system. So if you look at our log book, you'll be able to see not just CGM data, but you can see CGM with your insulin and your carbohydrate intake. And you can see the cause and effect of how they affect each other. You can go back 90 days in our logbook of your CGM with insulin and carbohydrates, and really be able to see to really be able to tell Look, I put the insulin in here. I started eating here. And then you know, now I'm moving away from what I did with the with the pen. And now I'm seeing on my Dexcom graph, here's where my blood sugar went to. And that's when you can start making decisions about maybe my Pre-Bolus could have been, you know, it's funny, there's no there's no word for Pre-Bolus sing with MDI, we'll have to make one up sometime. But pre injecting is sounds a little clunky. But so your Pre-Bolus you know, maybe I needed a little longer, maybe I could have used more insulin, like there's ways to make those fine tune adjustments that the people who listen to this podcast or are familiar with, because you can see these data points held up against each other.

Mike Mensinger 12:53
Yeah, absolutely. Excellent. So on the we also have a report insights by intent, which is right, it's kind of like the dexcom clarity, but it has a you get to see your insulin, and your carbohydrates with your CGM data is the Dexcom user. And you can see the timing of your insulin. And you can see how insulin is stacking on top of each other, because we graph it as your insulin on board. So you see the insulin and how it's acting and actually affecting glucose over time, which is a really great tool for your doctor. But also, if you have a child, you can look at cause and effects and use teachable moments to help them understand the effects of insulin on blood sugar.

Unknown Speaker 13:30
Wow, okay. Wow, that's a lot.

Unknown Speaker 13:34
But yes, there's more, Mike.

Scott Benner 13:36
This episode of The Juicebox Podcast is sponsored by companion medical makers of the in pen. In pen is the only FDA cleared smart pen paired with an integrated diabetes management app, the smarts of a pump in a pen, you get it right, in a pen in pen, the smarts of a pump in a pen. I mean, it's not complicated wordplay. I'm assuming you're getting it, you can find out more at companion medical comm where the links in your show notes are at Juicebox podcast.com. For if you don't want to be you know, all held up with that old timey internet stuff. You just go into the App Store, download the pen app, check it out, and then just push the button and be like, hey, button. I want to get this pen. Listen, I understand that you don't think you talked to the button? It was? I don't know. I don't know why I said that. Push the button. Really. You go in the app and you push the button. And we're off the rails here people. You just go into the app, you push the button and the process begins. It's very simple. Mike's gonna explain later how the insurance process works. But it seems like they've got all their bases covered. He said that some people get their answer back in just a day. And depending on your insurance, you might be really surprised at how low the cost out of pocket is. But we're getting ahead of ourselves. You need to find out more about the in pen before you make your decision. I get that. Mike and I are going to go over everything. It does in this next 30 or 40 minutes, and how you can get it if it's something you're interested in. But let me just say there's a lot more coming. There's integration with CGM and meter data. And it can remind you that you didn't take an injection. Now, maybe you find out how it does that. This pen is smart. Oh, I get it. Now. That's why they say hello, I got a run down the smarts of a pump and a pen. It all makes sense. I'm trying to wrap my head around. I haven't done injections in such a long time. That as you were talking, I just thought okay, so now insulin on board is in sort of one graph, but so is my Bolus, and I can see how they kind of overlap. So instead of having to imagine, I know there's insulin on board, but how much I can, I can see that visually, which I find, I find really amazing now, but let me ask you this question. Have you done it in a way? That's not? I look at it and go, Oh, there's so much here. I can't understand at all? Like, is it simple? Is it intuitive? When I look at

Mike Mensinger 16:00
it? When you tell me, we sent you an example report. So does that make sense to you? Well, Mike, I

Scott Benner 16:06
was opening you up to say nice things about your pen, but no, it does. It's very easy on your I guess as a way to say it, I don't look at the information that I'm seeing and feel like I don't know where to start looking. Or it doesn't make any sense to me. It's done in a really kind of simple and, you know, pleasing way in a way that I can I feel like I'm in. I feel like I'm in a space that I understand what I'm looking at. So so I think you've done a really good job. And you were very time not to take the bait. Just say something nice about the fine, that's fine, Mike. Let's see what some of this other stuff is. Because I don't I don't know that I understand it. We have some like thoughts here. And you and I have notes that I'm looking at, but like, how much insulin Do I need for a meal, it's going to tell me that based on what my carb count is. Okay, so

Mike Mensinger 16:57
I'll steal your phrase, it's about taking the right amount of insulin at the right time. So your bolus calculator just like an insulin pump will take your current blood sugar level, it'll calculate your correction of, say, 200. How much insulin Do I need to get back to my target of 100. And then it'll take how many carbs are about to eat, and figure out how many carbohydrates? How much insulin Do I need to cover those carbohydrates, and then subtract any insulin you still have in your body from prior injections with your insulin on board. And it's very similar to what pumps do. Not much of difference, the only difference that we do have. And this is similar to I think the Cosmo pump. So if you actually if you go to calculate a correction, and let's say you have a lot of insulin on board, if the correct action for the user is to eat carbohydrates, because that iob will bring you below target, it'll recommend the right amount of carbohydrates to eat to get you back to target.

Scott Benner 17:54
Oh, that's fantastic. So when we talk on the podcast about bumping and nudging insulin, we also talked about bumping in lodging food. And and the big problem that people come into is they run into that, you know, that old adage like 15 carbs, 15 minutes, if you think you're low or you're low, eat 15 carbs, wait 15 minutes test again, that kind of an idea, those 15 carbs can often be much too much, which sets us off on the roller coaster for the day. And so this is going to tell me no, you don't need 15 carbs, you should try more like this.

Mike Mensinger 18:26
Exactly. Yeah. So based on your current blood sugar level and your iob, it'll figure out how much to overcome the iob and your blood sugar to get back to target. So in certain circumstances, let's say you're very low, you're 50. And you have iob, you may need more than 15 grams of carbs to return to target. Right. So there's less guessing here, it'll it'll give you a more precise answer of how much to eat. And it gives you an opportunity to correct without overcorrecting,

Scott Benner 18:53
which is Yeah, exactly such a huge thing, because then your whole day becomes about chasing those lines around. Let me ask you a question. So we'll jump around a little bit here. What kind of insulin Can I use in the pen?

Mike Mensinger 19:08
So we take cartridges from novolog, or human log, and you get a separate prescription from those, instead of getting it in vials, like you normally would you get those cartridges, a cartridge, so there's nothing for me to fill or anything like that,

Scott Benner 19:19
I pop it out, I

Mike Mensinger 19:20
put it in the pen and I'm on my way. Exactly no selling, you just load it in there and begin using it and then change it out.

Scott Benner 19:27
So now you and I spoke recently about this and you were talking about there's just one aspect that I don't follow completely because I have been pumping in a while. But when people use a pen, the pen gets primed. And so I decided I want to use I don't know six units, and I dial it up but then the pen expresses some of the insulin to remove air from from the system. And then I don't quite get my six units. Is that what happens with most pens?

Mike Mensinger 19:53
Yeah, so you're supposed to change your needle for every injection. We know a lot of users don't do that. But even if you don't do that there Maybe an air bubble or some dead space in the needle that needs to be filled up before it actually gives you influence. And the action of priming is just to fill the needle out to get a drop of insulin out the bottom. This is something many injection users know how to do. But when it comes to smart therapies, like a, like a smart pen, we haven't seen the challenges with that on the system. So for instance, if you inject if you expose two units of insulin to fill the needle, and then you give yourself a small correction, like one unit, most systems if they can't tell the difference between those two, what you injected, and what was actually just filling the needle and priming, would think you've injected three units. And that was, you know, that would mean your iob is three units when it should be one, and your dose calculator is going to give you the wrong answer. So priming, and differentiating what was a therapy dose, and what was a prime dose is something that we do automatically for you, it's a very important feature to have accuracy of your data, so that your tools like your dose calculator can be counted on and

Scott Benner 21:01
stuff like that, you guys just sit down at some point and say to yourself, What is wrong with how people inject and let's hear all the complaints and all the things that that John's experience and everybody else and just like reverse engineering was that how the process began for you guys.

Mike Mensinger 21:19
A lot of its evolutionary, some of the problems you kind of learned as you're putting the pieces together, and then you begin trying the system out and you discover the problems with it. And then you have to go solve those. You know, as one example, the we did a beta use last summer about a year ago. And some of our users came from pump therapy. And they said, You know, I love the product, but I'm always forgetting to take my long acting insulin, because with a pump, I have an automatic basal rate, I don't have to worry about it. There's no meal event to go along with it. So you know, they're going to bed and either forgetting it completely, or like waking up again, and going remembering to eject like, I really need a reminder for this thing. We're like, great, this is a common problem, let's go add the reminder. So now you can just pre configure your long acting amount, you get a notification, and you don't even have to unlock the phone, you can just say, Hey, I log my 18 units of Atlantis, right on the home screen of your phone without unlocking it. It's very simple, very effective. And we're trying to as we uncover those solutions, we're trying to create very graceful solutions to those problems.

Scott Benner 22:23
And I appreciate that, because it's, I mean, there's no shortage of different apps around diabetes. And a lot of them come to me people like, hey, look at this app, you know, and I look at it, I go, Ah, it's just there's so many steps or just, I think that people miss what you and I were just talking about where you're speaking about at the very beginning, which is that these things aren't intuitive, which is an overused word, but simple, like, really just don't take much of your time or your effort or your computing cycles, you know, if it doesn't do that, then what I'm getting isn't worth what I'm putting in. And, and that is a huge problem, because there are a lot of great ideas that are just implemented. Not quite right. And it really feels like you guys thought this through in a way that eliminates that feeling of Gosh, I'm spending too much time in this app doing these things. I just it's very, it's very impressive, because I like I said, I've, I've seen it over and over again, there are plenty of apps where I look at them, I go, yeah, I can't get behind this. So it's like I What am I gonna tell people, you know, they need to spend an hour a day in this app in order to get their agency down. Like, no one's gonna do that. You know? So really well, and you have a small you guys have a small group of that you don't have any employees? Are you at this point?

Mike Mensinger 23:40
We're about the size of Dexcom was when I joined in 2003. So we have about 30 people now. But definitely growing but that includes our manufacturing in house personnel and our sales team. So it's really something Yeah, pretty pretty small company.

Scott Benner 23:55
Yeah. So okay, but you guys have all the you have all the bases covered. It's a small in size but but big in in theory and grander. Honestly, how do I? How do I make the decision, right? Like I tell people all the time, if you want to try an insulin pump, and you want to try the only pot, here's the steps to go try it, but again, on the pod has made it simple for people to go try it. Have you made it simple for people to try the pen.

Mike Mensinger 24:19
Yeah, good, quick story. So when we're at Dexcom, and other products like insulin pumps, it can be very difficult. Sometimes you have to call them get their insurance insurance won't approve you right away, you have to get a prior off and get your doctor to kind of build evidence to get coverage of the product. And we wanted to make this very simple, and kind of a modern, almost in app purchase type experience. So what we did is we tried to get rid of all the hardships for users like obtaining a prescription and running your insurance and figuring that out. And one of the benefits we have is we're not a you know, five $6,000 device like some insulin pumps. This is a very cost effective therapy. So we're able to do this a little bit easier than insulin pumps can sometimes. But we built a flow in the app where you can go to the website, or you can download the app. And there's a get in pen flow. And all you do is you fill in your contact information, you take a picture of your insurance card and hit send. And then what happens on the back end is we will run your insurance for you figure out how much your copay is, we'll obtain your prescription from your doctor. And then you get a call back saying, hey, the intent is you know, your copay is $20. Would you like to move forward? If yes, take the payment over the phone and ship the pen right to you. So it's very simple. And a lot of times that happens same day. So very, very simple.

Scott Benner 25:41
It's crazy, how I'm what's the life of the pen? Like because it's doing things right? It must have a power source, how long do I get to use the pen?

Mike Mensinger 25:49
That's a one year pen. There's no recharging needed. So it has a battery that supports the full year in it. And then you just get another prescription a year later for the next 10.

Scott Benner 25:59
Okay, well, that's simple. Okay, so let's, let's talk about this real quick. So I go into the app. And before, listen, let's ask like this question before people commit to get in the pen, they can still look around the app and decide what they what they see there. Is that correct?

Mike Mensinger 26:15
Absolutely, you can go download the app today play with most of the features. The only features that you can't get access to, obviously, is communication with the pen. The insulin settings and your dose calculator and iob are prescription features that FDA wanted us to verify the prescription for, and how we do that, rather than unlock codes that some beaters have had with Bolus calculators, you're pairing your intent to your phone is your prescription. So just the act of pairing unlocks those features for you automatically. There's no complex codes are anything to deal with there. Okay. So you can do everything but that you can log into and manually, you can use a long acting reminder, you can do your MS DOS reminders, a lot of the benefits and features, you get the CGM integration, the BGM integration, all that comes for free. So go try it out.

Scott Benner 27:05
So we check out check out the app, I decided I want to take the next step. I just hit that the button in there that says listen, let's keep going. And and then you guys take care of it on the other end. I am that's really something. Okay, so now, so let's talk directly to the people here. So I always feel like I'm not doing enough for the MDI listeners. And I get a lot of notes like and I always feel like I'm not doing quite enough because the you know, because the podcast is, from my perspective, it's what works for us what I can, but I can step up and say, you know, is something tried and true for me. So I want to tell people the reason Mike came on, if you have been listening for a really long time, Mike's been on the podcast already back when he worked at Dexcom and has an incredible track record of helping people with type one diabetes, to get their insulin, understand how it's working. It's a it seems to be like for me, it seems that you are you're in for urine for more than a pound with diabetes. So I was I was I was wondering, how did it start for you? Like, how did you get to DAX common initially? And how did you get into this world?

Mike Mensinger 28:11
Yeah, it was a little bit of a coincidence. I was just kind of very fortunate that it worked out this way. But I graduated college on the east coast and just wanted to move to California. So I got a job in Silicon Valley area worked in some really cool industrial automation technology. But then the.com bubble happened, dating myself a little bit here. And the whole market crashed, that industry was doing very poorly. And I wanted to move to an industry that was flourishing a little bit more. And I got all of my friends that left for startups at the time, were now looking for jobs, because they all these startups dried up, but as a different industry. And so little company called Dexcom called me, that was a startup. And I didn't really want to join a startup at the time, because, you know, I thought those were too risky. But they said no, no, it's medical. It's different. And it was down in San Diego. And so I agreed to come down and interview and I met the most amazing collection of people down there. And if you can judge a company's future success by the people they have, you know, it was a really good bet. So I took the risk, and joined an amazing collection of people. And it's just been obviously, the story of Exxon has been absolutely amazing. And they have a lot of those people. They're still today from those days. So, yeah, I kind of lucked into it, to be honest.

Scott Benner 29:30
Can I ask, have you had the experience that you hear a lot of people talk about with and I'm asking you a question you didn't know, I was gonna ask you. But I think that when you meet people who live with diabetes, and you hear their stories, it has an impact that is difficult to you can't falsify it. Do you mean like the the impact that you get from that is, did you have a lot of contact with with users at Dexcom? And do you now within Penn, do you talk to the people who are using the products?

Mike Mensinger 29:59
Yeah, I mean, that's a That's one of my absolute favorite things to do is to go to the shows to talk to folks on the phone who are using the product. And, you know, we're You and I are both extremely lucky to be able to work in an area where there's such a huge need. And you're really impacting people's lives in a major way day to day, and you're doing it through your podcast we do through technology. So, you know, everybody that works here, just loves coming to work every day and know that they make a big impact in the world. And how many people can say that in their daily lives, there's a lot of great jobs out there. But you know, we all feel like we're just in the luckiest of positions to be able to do this.

Scott Benner 30:37
I completely agree. I think there's nothing better than seeing someone start at one level get to another or be struggling and then not struggling or to even help somebody, you know, this, this episode is going to go up this week, and it'll go up with another one. Right? So this is Episode 174, there'll be Episode 175. And that episode is with a person who is just they're afraid of their insulin, they're doing their best, but they just can't kind of conquer that fear. And, you know, interviewed that person, now we've gone back, I keep in touch with Brittany, and we're trying to, you know, I'm trying to help her work through it. And it's, you know, it's just finding friends, it's just finding someone else out there who understands, and seeing the value in that. And, and, you know, I this is might be a leap, and I hope it's not. But like I said, in the very beginning, when I started talking, I always feel like we're not quite doing enough for the people who inject. And I have a lot of hope and a lot of excitement around impairment and what you guys are trying to do, I really feel like there's an opportunity to take those people and kind of like in one fell swoop just yank them up into the same kind of tech world that everybody else gets to live in with their pumps.

Mike Mensinger 31:49
Yeah, thank you. That's exactly why we're here. And there's some other great technology coming now. The world I think is catching up to, to be able to give solutions to the users who don't want to pump. And it's great to see is it's a really big need.

Scott Benner 32:03
Well, let's talk for a second about what people are going to find when they decide they want to they want to try the pen. are most of them going to get a good response back from their insurance companies. What have you been saying? Okay, we're more than halfway through our conversation with Mike talking about in pen today, you must be, at this point, starting to get the vibe that this is something you're interested in finding out more about. I've made it completely simple for you to do that. There are links in the show notes of your podcast that there are links at Juicebox podcast.com. For this episode, there are links, there are links, there are links, there are links, you might click to the key click on and the next thing you know, everything is clear, you can do it. It's not hard. It's not hard to do better for yourself. If you're using MDI, now, this is an opportunity for you to get almost all of the technological. But it's is the word I one benefit. That's a good word. Almost all of the technological benefits that pumping brings you. You know what? Sure you can't manipulate your temp basals. But that's, you know, that's the world you live in with MDI. It's not the worst thing in the world. Can you imagine having all this other information to make these great decisions with you listen to this podcast all the time, and you hear about the return of data, and how we can turn that data into better decisions, better outcomes, less spikes, less lows, this is what you want, if you're using MDI, in pen is worth a look. companion medical comm links in your show notes links at Juicebox podcast.com. Or just go to the app store right now download the app, check it out, and then right through the app, you can apply to get the patent. It's super simple. The embed app is currently available for iOS, that's your Apple products. If you're listening in the summer of 2018, it has just been cleared by the FDA for Android phones. So give companion medical, you know a little bit of time to get it into the Android store for you. are most of them going to get a good response back from their insurance companies? What have you been saying?

Mike Mensinger 34:24
Yeah, so right now and you know, the normal process of a new category of product introducing into the market is you have to go to every company, one by one, you go to the blue Cross's and the kaisers and get knows of the world and tell them about the product and convince them of the benefits. But we've been very fortunate, largely due to our low price point. So compared to other insulin therapies, this is very affordable. So we've had very good coverage right out of the gate. So a lot of I would say about 70% of our users are getting covered at some level. It's pharmacy benefit, so on Like insulin pumps, which are kind of a different channel. Usually it's whatever your copay is based on your your individual medical benefit or your pharmacy benefit design. So it may be $20, or maybe $50, and maybe zero dollars. That totally depends on your plan. But we're seeing, you know, we had someone the other day that filled out to get in pen flow at the diabetes conference in Orlando, they had a call back same day and their copay was $5. So it's, we've had some really, really good experiences with getting getting folks covered. And we're working with the insurance companies to get that better every day.

Scott Benner 35:35
Do you have a mechanism? If somebody should find that they're not covered at all? Do you have a mechanism for an out of pocket cost?

Mike Mensinger 35:41
Yeah, absolutely. So if if you get that we will work with you, we have some programs in place to make that affordable. We don't want anybody who wants this product not to be able to get it. So just give us a call directly at companion. And we'll work through that with him. Okay,

Scott Benner 35:55
so I'll put links in the show notes to all this so people can find it. And there'll be links back at Juicebox podcast.com. And I'll give, I'll give you guys everything, how to get the companion medical, how to find the apps, all that kind of stuff. So when I have now I've done this, right, I've got the pen, it's tracking my data, I'm hooked up with my Dexcom data. I'm not through, you know, through my healthcare. What am I going to be? How do I go about taking that to my healthcare provider when it's time for my endo appointment? What do I have to bring with me or do?

Mike Mensinger 36:27
Yeah, the Yeah, the MDI. Users have traditionally had these log books. If you're lucky enough to have a CGM, you can bring your CGM report, but you haven't had any source of integrated data. So we just released prior to Ada being in June, our insights by intent report, which is kind of our version of clarity, or you know, any of the other reports out there, but we did, as we mentioned, integrate insulin insulin on board, you can see the effect of every day and every decision that you made. And that made it very easy to share. So, given the mobile technology, it's not a separate app, it's right there as a tab on your main app. And when you want to share it with your healthcare provider, you can email it, you can message it, you can fax it directly in the app to your doctor. So it's extremely easy to print share directly from your phone,

Scott Benner 37:17
okay. And then the other one, which is something that happens to me a lot in the in the office is I just hand my phone to the doctor,

Mike Mensinger 37:25
or you can print ahead of time and

Scott Benner 37:27
just here just swipe through this and look real quick. But know that that's listen to one of the main things you hear people kind of wringing their hands over as their endo appointments come as I haven't put this information together, I you know, I have to write out logs, and I have to find everything. And then I think they just end up not doing it. And and then it's a shame because it's an opportunity missed. You're going into the endocrinologist, now's your time to ask your questions. And wouldn't it be great if you could lay the information out the simple way that the endo could follow that you could point and say here, look, I did this here. And this happened? And what do you think, you know, should I try something different? And so you guys have made that easy, too?

Mike Mensinger 38:07
Yeah, I mean, who has time for manual logbooks, just no one does this, if you know most of them are filled out the day before if you do have a logbook, but you know, your doctor is only as good as the data they have. So if you have some, if you have a CGM alone report, which is fantastic. And you have some hyperglycemia, you know, what's the cause of that? Did you forget to take your insulin? Or did you underestimate the carbs in that meal, are your bolus calculator parameters wrong and need to be adjusted, there's many, many causes there, or maybe your temperature of insulin was went out of range, and your insulin is less effective. So the more tools and getting to the root cause of those problems, that report can help your provider with, you know, the more actionable data they can use to make better therapy adjustments with you.

Scott Benner 38:52
Yeah, for sure. The idea that, you know, I talk a lot about people, people, sometimes they have a, you know, some sort of anomaly with their blood sugar, right. And instead of doing something about it, they spend a lot of time wondering what happened. And I tried to kind of coach them through the idea of like, in the moment, it's not important what happened, just take care of it, think about it later. But what you're able to do with just little things, like, you know, seeing on a graph when the insulin went in, or knowing that the insulin got too warm or too cold, is you're removing, when those anomalies happen, your your what your your apps doing is it's removing possibilities like it Well, it wasn't this, like I know the insulin didn't get out of temperature, so I can eliminate that. And when you could eliminate things from that thought process from that. It becomes more streamlined and you can get to your answer a little quicker to an absolutely yeah. And I like the idea of not having people in a situation where they have to unnecessarily wonder about things because I think it adds anxiety because you can't really know about some stuff, right? You just sit there and kind of just turn over and go well, maybe it was this. Maybe I do. didn't do that. And the more of those things that can be removed from your thought process, I think I think the better. Yep. I totally agree. That's excellent. Okay. Okay, so I've gone to my doctor, you know, they've made some great adjustments for me. And I come home and I try stuff. And I come back, I look at my data again. And I see, I did this. And we always talked about that, you know, kind of this. I don't know what to call it even. But it's a process, right? I did this, I expect this to happen. Instead that happen. So next time, next time, I'll try sooner, more, a combination of sooner and more longer. Whatever. It's, it's right there for everybody. So everybody who's been listening, who uses MDI, and is always wondering, like, how do I get what, you know, what I'm hearing these other people talk about, and this, this is an incredible leap for you. You know, Mike, we talked about it here, because it's, you know, I think it needs to be spoken about. So people understand, we're talking about, but at this point now, with a pump, and index calm, my daughter's a one has been between five, six and six, two for over four years. Amazing. It's It's spectacular. But it's because of it's because of technology, right? I can't trust me, I know who I was before. pumping. I know who I was before. Dexcom. I know who I was, before getting that information that I needed to make better decisions. And I think that when I hear people with MDI talking, what they're saying is, I can only get so much done with injections, because I lack the rest of these things. And it sounds to me like for, but somewhere between five and $50, I get a pen that works for a year, and gives me everything that I need. Does that sound about like what you guys are shooting for?

Mike Mensinger 41:45
That's exactly what we're trying? And then, you know, we we don't think we're done. We have a lot of, there's still a lot of low hanging fruit, that we'd love to hit everything from hydration, you know, can the system help you determine? You know, if you're only going back into your healthcare provider, making big adjustments every three months? You know, can we help your healthcare provider do that at a faster interval to get you into the right range and personalize your bowls, calculator settings. You know, androids coming out, we're looking at Europe and other markets that should be coming out later this year, or maybe next year. solutions for exercise, because as you know, exercise is a big challenge with diabetes. So the one great thing about Android and iOS devices is they track your steps and fitness thing. So can we look at the history of you walked a lot today, or you exercise a lot. And therefore, you know, that's why your blood sugar went lower, and you're more sensitive to insulin. So just taking all these variables that affect your blood sugar, and demystifying those and making those understandable for you and actionable. Okay,

Scott Benner 42:51
yeah. So it's really getting people to a better outcome with less effort on their part and it not costing as much is, that's an amazing goal. Let me ask you about a couple of things that you just talked about there. So the, the idea, the idea of an algorithm algorithms, a word everybody's hearing now, because there are so many, you know, closed loop systems that are being developed by insulin pump companies. And so you have, it's no different for you, right, you have there's something living in that app that sees the information coming in and makes better decisions, and how will I and that's something you're thinking about for the future? But how will that look? Do you imagine? Is it in the form of feedback or, you know, suggestions? And can the app make suggestions about my insulin? Or is that a gray area?

Mike Mensinger 43:35
Yeah, there's, there's multiple different ways to do this. And there's a lot of research groups already working on it. So one way this could look is, for example, users on fixed dose therapy, which we are looking to have solutions for them to and then increase their diabetes awareness and move up to more sophisticated bolus calculators. The normal process that doctor takes is they put you on therapy, they guess, at your settings, and then they're going to titrate up a little bit until you get close to your goal. And then if you have any hypoglycemia, they're going to back off pretty simple algorithms that the doctors use in order to make these adjustments. Same thing for both calculator users, that just adjusting your your correction factor in your carb factor. So it's just an incremental little steps and looking at the outcome of those changes, and making sure you're you're getting a lower average glucose without a lot of hypoglycemia. So these algorithms are pretty straightforward. And these are something we think we can help offload the doctors and increase the frequency of those changes. So you get to control and get the target faster. Obviously, there has to be coupled with education and, and other things in order to be effective, though,

Scott Benner 44:46
is there? And you mentioned just briefly, but I want to understand like ideas about getting my long acting insulin to be more effective. Is that something you're working on as well?

Mike Mensinger 44:57
Yes, that's something in our roadmap that we're doing interested in getting to as soon as possible. So it could look like your doctor starts you on the product, you're on a Dexcom or CGM. And so it's looking at your overnight control. And if your glucose is rising steadily, you need more long acting insulin. If it's dropping, if your glucose isn't stable, it should back down your long acting insulin. So the user could see a notification that says, maybe it's approved by your doctor, maybe maybe the algorithm can do it. These are things we'll have to work out with, between our clinical partners and the FDA, right. But you get a notification, it says, we recommend this change, maybe instead of 18 units of lantis, you should be taking 17 now, and the user would be able to approve that and it updates your setting. And now your next time, your reminder goes off to say I'm take your lantis it'll say take 17 units rather than the 18. So very simple, all the user has to do is approve or say no, that I don't agree with that change, let's

Scott Benner 45:56
talk to my doctor, the rest just happens. It's those little things that we don't really consider as much and, you know, I've seen, I've seen it with my daughter, and I'm with other people as well, like, you know, you just inject your slow acting in some when it's you know, it when it's comfortable for you during the day. And that doesn't necessarily mean it's going to work for 24 hours the way it's supposed to. But we just make that assumption that it does. And we move on. And then you see problems that come down the line and you never go back to that you never say well, maybe it's my slow acting because because in the doctor's office, someone said, Hey, this is how much slow acting insulin used, you know, put it in in the morning or put it up before you go to bed, whatever they told you and in your mind, that's a set it and forget it idea. It that must work. I've been told to do it like this. I think it's it's incredibly valuable to have this technology, looking at those ideas and saying to me, Look, don't overlook the fact that maybe this needs to be considered. So, you know, without you having to run around all day thinking about a million things in your head.

Mike Mensinger 46:57
Exactly. It's the system working on your behalf and helping make recommendations, obviously, the user has to play a role in that you don't want to completely remove, you know, the human element of that, whether it's your doctor, whether it's you a parent or or the person with diabetes themselves. So you have to have the right experience that leverages the benefits of each one of those technologies and the person themselves. Yeah,

Scott Benner 47:21
no, that's excellent. And are you guys, I know you and I are speaking I'm sorry, I asked like I didn't know. But I know. So we're talking on the 10th of July right now. And this is going to go up pretty much right away. And in Penn is going to be at children with diabetes this week. When are you guys getting there?

Mike Mensinger 47:36
Yeah, so that that's one of our favorite conferences of the year, just so much excitement and engagement and great opportunities to make everybody aware. So we will we're having a booth, please come by to the booth and say hi, check out the product, we'll have demos there. You can fill out the get in pen form right there. And and also let us know what you like about the product or what you want to see. We love hearing from everybody and just excited to hear what people think

Scott Benner 48:04
microwave colors. It's a pretty superficial question. But can I choose different colors in the pen?

Mike Mensinger 48:09
Well, funny, it's not a superficial question. Because there's a there's a concern of mixing up your long acting and your bolus insulin. Okay, so one of the things we did there was we provided the pen in three different colors. So there's six different models. So we have novo pen, and we have a human log pen. And we have to do that because the cartridges are different. And so the pen has to make sure it's dispensing the right insulin amount for each of those devices to pick your insulin type. And then you get pink, gray or blue. And what we recommend is if you if your long acting pen, if you're using a long acting pen is gray, you know pick blue or pink, and vice versa to make sure you don't mix those up. That's great. Okay,

Scott Benner 48:49
so listen, I don't know if you're gonna be comfortable with this. I haven't told you I was gonna say this, but I'm going to so we'll see where it goes from here. Other companies make pens, right? What Why do I Are you comfortable saying Why do I want yours and not theirs?

Mike Mensinger 49:04
Well, right now, we're the only smart choice that's out there. So eventually, there will be alternatives. We expect to see some competition in the next say two years on the market. So whatever solution works for you, we want the best for users. So of course a decision that you didn't make for yourself. But I think when you really take a look at the solution, what you'll see is it's very user centered design. So we're trying to reduce the work that you have to do day to day and get better outcomes. We've put the data together in an intuitive way such that you can see cause and effect of insulin, carbohydrates and other factors on your glucose so you can learn from that data. The reports doctors are giving us great feedback on really the features in their understanding of doses are missed if you're using the calculator, the split between your basal and bolus insulin along with the daily charts of Seeing all the effects and you can have real powerful conversations and then adjust therapy together. So when you look at the total package, we think you'll see that this is a really great solution and brings a lot of the benefits that computers have had, but really haven't been on available. So

Scott Benner 50:17
Mike, that was very professional, you didn't go all WWE on us there and start telling me why that's a good for you. So No, but seriously, there's there's other pens on the market. So in and they're from companies that people have heard of before. And, and it's important for them to understand that they're not all equal. And that there may be not just maybe, but there absolutely is benefits that far outreach, you just have to try to understand them. And I think that's the last kind of thing I want to ask you about. So trying to understand what I have my pen now I've decided, Hey, Mike made a lot of sense on the podcast, I'm getting an in pen, I have it in my house. Is there a learning curve? If there is how steep? Is it? I mean, how soon before I feel comfortable with it? I think I I think from looking at it, it doesn't seem like it's much to me, but what are you seeing from people who are using it,

Mike Mensinger 51:09
most people are able to pick it up and use it. And it's just very intuitive. Our human factor study, pumps require two hours of training. Typically, as a start, a lot of settings, a lot of configuration that's required for setup, ours, our prescription form that the doctor fills out for all your personal settings for your dose calculator, your insulin type, etc. It looks like the screen you enter it now. So we validated that there's zero training required, and the users are able to set up the product and get going on their own. But we've shown that from very young ages all the way up to, you know, into the Medicare population. And so we've seen great response. And if you do have some challenges, please give us a call. We have a great support department that can help you through any of those issues.

Scott Benner 51:55
But it's just as easy as going into a screen and putting my information in and then it starts helping me make those decisions. And then it went How long do you think it takes to because this is something that you hear people say a lot when they start a pump, like my doctor set me up with this insulin to carb ratio, this but I guess if you're MDI already, you're not going to you're not going to a new way of managing. See, I just answered my own question there, Mike. So when you go from MDI, to a pump, it's not apples to apples always about your your insulin to carb ratio, and other things like that. But from just injecting to injecting nothing like that should change. So I shouldn't see a big, I shouldn't have a spot where I have to make more adjustments afterwards, should I?

Mike Mensinger 52:38
Well, like you said, just like a pump, you have an influence to carb ratio and insulin sensitivity factor, these are your personalized settings, your dose calculator, if there's a process of dialing those in, that would be the same as starting on a pump. So if you know those, and those are correct, and you've been using a dose calculator, maybe it's not a smart pen connected one, well, then you just transfer those settings in and being in using it. If you don't know how to count carbs, that's not a skill that you're comfortable with yet. And maybe you're on meal estimation or other ways of approaching, sizing your doses. And those are things where you can still do that. But you get the benefit of subtracting your insulin on board. And you can see what that number is and just subtract that from the dose you would have taken. Or you can begin kind of learning the skill of using a dose calculator depends on where the user is starting from. And the biggest hurdle would be if you're not familiar with carb counting, and those calculators. But that's an optional feature, you get the benefits of automatic insulin tracking, the reporting, the Dexcom integration, the connected meter integration, the Miss dose reminders, your tempo, all those other things, you don't have to have the skill of carb counting and get all those benefits.

Scott Benner 53:48
And in my case, I don't have a dexcom, I don't lose it. Having a dexcom helps me integrate that information in your app. But if I don't have it, I'm not losing any of the other features.

Mike Mensinger 53:57
Yes, exactly. And obviously, we're talking to the other PGM makers as well to integrate that data because it is so valuable if you have that stream of data to integrate that into the product and see the full picture. But we work with the Vario connected meter, the one drop the agamatrix meter, the sensor meter will be writing to health soon. And it's kind of a magical experience. As a side note here, when when the user has their phone off, they they're on their Vario meter, they take a finger stick, and then they unlock their phone, open our dose calculator without opening a second app, they go into the dose calculator and their BG is already there from your finger stick, the bit magical. You don't have to enter that. So it's wonderful that we could remove that step.

Scott Benner 54:40
What I'm seeing here is there's leaps for two people who are if you're using MDI right now and you're, you're counting your carbs and you're making decisions based on that or if you're not if you're put on more of I don't even know what they call, you've used the phrase a couple of times, but it's so like, it seems so foreign to me the idea of just taking some insulin and letting it roll through the day but Both of these people, these people in these two segments have a real opportunity to make a leap forward in their understanding and their management, if they can have this information at their fingertips. So I don't, I don't see how I mean, if I'm objecting, I don't see how this isn't worth it to me to try. So I really appreciate you coming on talking about all this. Thank you very much.

Mike Mensinger 55:32
You got to remember when I, when I started Dexcom, it was a startup. I really love that early phase where we really get to transform and define and we're new, a new category. And this is a very exciting time in a product life.

Scott Benner 55:47
I think you're the exact right mindset because there are just a lot of people who couldn't leave something that is that stable and successful to try something new. So I am I'm making a leap here. It's not something you've said to me. But I really believe you must believe in this if you've done this. So but you know, I appreciate you continuing to take, take your stabs at making people's life with diabetes easier. And and thank you very much for coming on and sharing this all with me. Yeah, thank you. Yep, have a good day. The impact is bringing the technology found an insulin pumping to multiple daily injection users. If you're injecting insulin, and you don't have in pen, you are missing out on a lot of information that can help you make better quicker and easier decisions about your type one diabetes. The in pen app is absolutely free. And once you've downloaded it, and you've decided that you want to move forward, like Mike said earlier, it is a super simple process to get your insurance coverage figured out and get the pen in your hands. All the links you need are at Juicebox Podcast comm or in your show notes. You can even just go to companion medical.com and find out more. Hey, guys, if you found this episode through the children with diabetes conference, if you were down there and you saw in pen and they told you Hey, if you want to hear more, go back and listen to Episode 170 for the Juicebox Podcast, if that's how you got here, welcome. You may not realize it but you're listening to the best user reviewed Type One Diabetes podcast online, please consider taking a moment to subscribe in your podcast app and listen to other episodes. There are many many to choose from, I would probably started Episode 11. It's called bold with insulin. From there, you're going to meet people who are living with type one diabetes as adults as children and as caregivers. You're going to hear their stories, you're going to hear their management techniques, you're going to be uplifted. So if you're interested in hearing real day to day management techniques that have my daughter's a one c between 5.6 and 6.2 for over four years. And as the kids say spoiler alert, cheats everything. No food is restricted. We talked about how to use insulin on this podcast at its core. That's what this podcast is about. Stick around. Subscribe, listen to new episodes as they come they come every week, or go back in the catalogue. There are 174 other episodes that you haven't heard. Thank you so much for listening. I hope you try and enjoy the in pen. And hope you come back next week for the next episode of the Juicebox Podcast.