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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 202 of the Juicebox Podcast. Today's episode marks the beginning of season five. And when I give you a season of the podcast, it's not 10 episodes or 12 something cute like that. No, no, no, this is a weekly show for people living with diabetes, you are going to feel connected, supported. And you're going to leave here every week with a new tool to help you do better. Alright, get your headphones on just the way you like them get comfortable, and let's get another season of being bold with insulin underway. This episode of The Juicebox Podcast is sponsored today by Dexcom, makers of the G six continuous glucose monitor. And of course by Omni pod, the tubeless insulin pump that my daughter has been wearing for over a decade, you can go to my ami pod.com Ford slash juice box dexcom.com forward slash juice box or find links at Juicebox podcast.com or in the show notes of your podcast player to find out more. Today we're speaking with Mike. Mike reached out when I was looking for people on multiple daily injections to be on the show. But it turns out he's actually doing that inhalable and some Frieza frezza. I don't know what they call it, but I didn't find that out until a little later in the episode. This episode is just a good conversation. It's a great way to start the new year. I think you're really gonna like Mike.

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

Mike Joyce 1:47
My name is Mike Joyce. I was diagnosed with diabetes on Groundhog's Day 1996. So about 22 years, and I use MDI I don't use a pump. I use the pump for 10 years and I don't use one anymore. So when you said that you needed some piece someone to talk about having success with MDI, I reached out to you. That's why we're, we're talking today.

Scott Benner 2:18
The movie Groundhog Day came out in 93. So you just missed by three years.

Mike Joyce 2:23
Actual perfect. fairing. Yes. As I've been. I've been reliving the day for the last years.

Scott Benner 2:33
There had to have been some irony, somebody in the hospital must have looked at you and said, this is gonna follow you around for Yeah. So in 96 How old were you? I'm sorry.

Mike Joyce 2:46
I was nine years old.

Scott Benner 2:47
Oh, okay. But you didn't really see the the humor in it that I would imagine.

Mike Joyce 2:52
No, I tried to I did. I had seen that movie. Okay. At least with my parents. So, I I grew up with, we joked about it in the family for the whole time.

Scott Benner 3:06
So you at nine years old in 96 are diagnosed. That's pump time. People talked about pumps with you, right? Um,

Mike Joyce 3:16
I, I, they may have been discussed my first and wasn't very keen on pumps, especially with really active children. Which I don't know, he was, he was really great. When I was first diagnosed, and we had to end up changing undos when I was ready for a pump. I wasn't I didn't really like the idea of something attached to me, right? Initially, and then I went to diabetes camp and saw people with pumps. And I was like, Oh, my God, I have to have one. And so I got one. Right around 99 2000. Okay, I know I had it going into high school. And I know I tried it in middle school, like I demoed. The five of

Scott Benner 4:10
I know I lost you there. You demo The what? I'm sorry, you cut out. Sorry, I

Mike Joyce 4:15
was getting a phone call. So I demo the 507 C in in eighth grade. And then by high school, I was on the 508 Mini med.

Scott Benner 4:26
What's the last time you were pumping? But what year was the last time you had one?

Mike Joyce 4:30
I went off the pump in 2010.

Scott Benner 4:32
Okay. So they're fairly, it's it's very, the whole thing's incredibly interesting because I find that no matter where you fall into something like that, sure. That's sort of, you know, obviously your beginning of your understanding of it. And if somebody if you come in with a doctor who's like, you don't want a pump, or if you have a doctor's like you definitely want a pop, you know, like it's you kind of get swept up in in what's around you a little bit, plus, right plus the technology at this point. mean when you stopped using a pump? Are any of them still available? I wouldn't even know. But But if they've probably mostly changed over by now,

Mike Joyce 5:08
yeah, they've, they've changed quite a bit. I think since, you know, I was using the paradigm in 2000. And when I went off the pump, and I mainly went off because I graduated college during the recession, and I couldn't find a job with benefits that would cover a pump. That was crazy. George Bush took your pump?

Unknown Speaker 5:29
Is that what you're saying? Yeah,

Unknown Speaker 5:32
nothing like that. Listen, we

Scott Benner 5:33
don't usually find the title of the episode this quickly, Mike, but George Bush took my insulin pump is probably how this one's gonna roll out just in case you're wondering. No. So that's interesting. So you get out of college, you're on your own, you're like a big, you know, an adult, but an adult with a bunch of bills and probably not a great job to start out with. And it just wasn't in the cards for you to be able to afford that.

Mike Joyce 5:52
It wasn't when I left Pennsylvania, I went to college in Pennsylvania, and they have some really great Medicaid available to, to people with, with diabetes that are working, they have like a workers with disabilities sort of Medicaid program. And I, that was incredible. Like, I've never had insurance like that, and probably will never have again, but it was like $3 co pays for just about everything. And I paid like $25 a month for the insurance.

Scott Benner 6:22
I just had to like submit pay stubs to show that I was working at least 25 hours a week, you're like, look at me, I'm working poor trying to make my way in the world. Give me $3 prescriptions, by the way, Pennsylvania Commonwealth. So not a not a state actually their own their own rules. Apparently, they make some good ones 10 years ago. So what did you mean, you move for a job at some point,

Mike Joyce 6:45
I moved for, to get at it to get out of the college town. And I was kind of stuck in my parents had moved down to Florida while I was in college, and I didn't really want to do that. So my girlfriend at the time was moving to work on a farm for like, a summer in Montana. And I looked at her when she told me this, I was like you're not coming back, are you? And so I was like I'm coming to and so we went to Montana. And I found a job at like a grocery store cooking and kind of worked as this like work. They're cooking and ski bombed for three years.

Scott Benner 7:33
We're used to Russia, I gather for those three years. Yes, she's been a heck of a girl You chased her to Montana. That's a I think that's outside of the where I might relocate to. So that's a that's pretty impressive. I think that says a lot for her is what I'm saying. She really she's like, I'm leaving. I'm going to a big flat state with mountains and it's cold and you're like, I'll come Don't worry. It's fine with me. By the way to your parents abandon you while you're in college. I

Unknown Speaker 8:00
don't know if you've ever thought of it. Like

Mike Joyce 8:04
I've had some some ups and downs about it. But now that I'm I'm now back in Florida, and it's really grown on me it's becoming home. At the time, I was a bit resentful and disappointed but now um, yeah, it's good.

Scott Benner 8:23
How much of that was wrapped around? I don't I didn't mean to turn this to it. Like one of your parents who I'm sure are lovely people. But how much of that was wrapped around the diabetes? Like how much of it? Did you just feel like, Wow, you guys are the middle I moved out of the house you guys just took off? Or was it about like, I'm alone, I don't really know what I'm doing very, as much as other people might.

Mike Joyce 8:42
I think that age group is just awful to have diabetes, just in general, like your late teens 20s, as you're forced to change to, from your pediatric endocrinologist to some adult endocrinologist that really doesn't

isn't really good with Type One Diabetes necessarily doesn't pretend to like you as much when you come into the office.

Right. And I don't pretend to be too happy to see him or her at at that point, either. Because I'm think I have it all figured out. And I want help, but I don't want help at the same time. So that age group was pretty difficult. I at least had a good support system from growing up going into camp and like working at that camp through high school. And so like I always end and Facebook came out when I was in college. So like, I at least had people that I could reach out to in the

Scott Benner 9:47
type one community sort of finding like so. It wasn't just camp anymore, where you can find people you can find people online. It can sounds like it was really impactful for you in a number of ways. Like it was a really good kind of peer pressure.

Mike Joyce 9:59
Yeah. Yeah, Camp camp, I went to camp six months after diagnosis. And I don't know, if my mom knew what she was doing, if she just needed a break, I'm sure it was a mix of all of it. But it was the best thing that that could have happened to me that early to just see that I wasn't the only person with diabetes. Because

Scott Benner 10:26
when you said by went to camp right after diagnosis, I thought, Yeah, because your parents took off to somewhere warm, probably for a couple weeks. They're like, Hey, Mike, this is gonna be really good for you or it won't. We don't really care goodbye. We're going somewhere warm and hanging out? No, I hear what you're saying. Like, especially because if you're if you I was completely overwhelmed, it would have been fantastic. If somebody would have like, taken me out of the for a week, get on me to wax. It would have been good for art and was much younger. So I don't think you I couldn't have sent my two year old to camp. But I mean, it would have been great if somebody would have had her for a little bit. So I could have pulled my pulled my, my head together, I guess, you know, Arden was diagnosed on vacation. And after she had the hospital, we had one more day left in this vacation. And I remember my wife saying like, you know, what, what would help you the most when we get home because there was this horrible moment, like four or five days into the diagnosis where we were sitting at this carb counting class. And there must have been, I think, eight families in who'd all been diagnosed the last couple days. Yeah, they're sitting around this big conference table while somebody's trying to explain carb counting. And I it took me 20 minutes in the class to recognize that I was the only male sitting at the table. The rest were like seven women and their husbands were like standing behind them. And I was sitting at the table, my wife was standing behind me and it hit me I'm like, Oh, my gosh, when we go home, like I'm a stay at home parent, like she's gonna go back to work. Like, this is, this is me, you know, took me a couple days to like, wrap my head around that. She's like, what would help the most when we got home? And all I could think was, can you clean the whole house, like make the house like back to like, day one clean, so that I can so that I can ignore it? While I'm trying to think it was an odd thought, but I just have like somebody so I need to just simplify my life is what I thought, you know, in the end, and, and I it never worked, and I was just scrambled for a really long time was a I think your mom and dad might have done the right thing to be perfectly honest. That sounds like a really good idea.

Mike Joyce 12:25
Yeah, my parents have always been really supportive. And in diabetes, even even though I push them away at times, especially in my high school days. You know, my mom was always really good at like measuring food and counting cars, put notes in my lunch with take this much insulin and so. So it was it was really good. I had a really good support system growing up, which I think is huge for for anyone with diabetes, to have a support system, whether they're utilizing it or not just knowing that it's there.

Scott Benner 13:02
I think really, really helps you think so. So like, even if somebody's offering you if somebody's throwing you a rope down a hole and you absolutely will not grab the rope, it's still comforting to know the ropes hanging in there. There's somebody on top who's like I yeah, they need me

Mike Joyce 13:17
there's a way out if I want to take it, but it's all it's all up to you. I mean, like, my endocrinologist doesn't control what I eat and what I how much insulin I take, that's all on me. You know, I I have to take the tools that are presented to me to to actually succeed in managing diabetes. We just don't use the tools I

Scott Benner 13:46
stock. So yeah, you just said something. I want to roll back to you for a second. You said that even though you kind of pushed your parents away in high school in that age group, like what did that like look like? Like What Did pushing them away look like giving an example something sticks in your head? Well, if the amount of times you guys have clicked on my Omnipod link in the last couple weeks is any indication, you were as excited by my recent episode with Omnipod as I was, as a matter of fact, instead of a regular ad today, I'm just gonna read you a note I received through Instagram, I got an opportunity to switch over to the Omni pod for free. And I took it I was unsure about it at first but after listening to your podcast and my friend using one for a while I made the switch. Oh mg so much better than my old Medtronic pump. The feeling of not having to worry about tubes or my pump falling off my pants when I go to the bathroom is amazing freedom. I don't know. I've never worn a tube pump. And so the idea of pulling my pants down to use the bathroom and my pump just tumbling all over the place made me laugh. And I told the person I'm going to read this as an ad next week on the podcast. So to this person, your note is now an ad and everyone should go to my omnipod.com forward slash Use box, or click on the links near show notes, or use the links at Juicebox podcast.com. Because when you do on the pod, we'll send you out a free, no obligation demo of their device. That way you can feel it, touch it, hold it, actually wear it, and figure out if it's something that's right for you, my Omni pod.com forward slash juice box, no more of your pump falling off while you're trying to pay.

What did pushing them away

Mike Joyce 15:32
look like? When I got the pump? It was kind of my mom's not extremely technical, like tech savvy. So I started pretty much self managing at that point, she would help you know, measure food and count carbs and, you know, do the calculation. Since she was preparing most of the food it was it was easy, easier for her to calculate carbs and stuff right around. But when it came to like, the emotional side of diabetes, I didn't really want them in it anymore. I think it was kind of just like, I think it may have been because I found peers my own age like as as much as caregivers are super helpful and super supportive. They still it's not permanent for them. Like there's eventually they can get away, they can get a break from it. And so so I think in that age, I was getting kind of angry about how permanent this was going to be. And how on my own I was with it. So like, I wanted to figure out how to do it on my own, because I knew my parents weren't always going to be there.

Scott Benner 16:59
So So I think it was more like creating your own kind of private space where you can figure it out for yourself.

Mike Joyce 17:06
Yeah, but probably not doing it in the most positive manner because I was 1415 years old.

Scott Benner 17:13
Yeah. And angry too. Like, I mean, that's what you're describing, right? is anger, like you're like, well, this is because when you're a kid, everything feels like temporary, I think like and permanent. At the same time. It's an interesting way to think that you can imagine something different. But yet your life changes constantly. And so you can't imagine that this thing's going to stay with you for you imagine anything's gonna stay forever. And at the same time, you can't it's a weird space to be in because you don't have the, the perspective, I guess that you need to really understand time. Like I remember the first time I signed a car loan. I thought I'm not gonna be alive in four years, like four years, like seemed like a million years. Yeah, you know, yeah. And at the same time, I found it kind of like, telling and, like, interesting, but sad, like the idea that you as a mid teen at some point thought, oh, wow, this isn't gonna go away. Like, I've got this forever. And but that's just got to be. I don't know, that's got to be incredibly impactful at that age. And that, did it spin you out of control a little bit? Or how did you handle it? Um,

Mike Joyce 18:21
I, I don't know that the 20s were tough. That's where that I think that's more where it hit me. And, and high school is tough, because like you're around a bunch of people who can mindlessly eat all the time. Like, I can't really mindlessly I can it just doesn't really bode well, two hours later. Like, it's just I don't know, I, I've always I guess kind of had a detachment in a way from peers because of how aware of life's impermanence. I was at a young age.

Scott Benner 19:02
Do you just feel a different? Like, is it yeah, it gives you that feeling?

Mike Joyce 19:06
it? It was different, but it was, but it's hard, but like not different. Because, you know, on the surface, I look totally normal and healthy and fine. So I think that's where diabetes becomes really difficult is that the hidden nature of the illness.

Scott Benner 19:24
Because you can almost forget for hours at a time that you have diabetes and not think about it.

Unknown Speaker 19:29
Right? And then

Scott Benner 19:30
all the sudden someone says, Look, I brought cookies to soccer and you're like, oh my god you're waving your hands at your parents. You know, we're you know, you're in college and you know, you've had your day planned out so nicely and your blood sugar is really going along with what you want. And then all of a sudden, it's three o'clock in the afternoon everybody's done class, someone says we're gonna go for pizza and you're like, I wasn't planning on that. And then it then it puts that whole like thought in your head. Like if I go What if I if I'm mess up the insulin then my blood sugar is gonna be high all night. I got other things to do I have to study I have to do this. I'm supposed to go out again like it just it flips you right back into that mindset of I have diabetes again. Right? Yeah, it's interesting how it's like it's gone and then it's all of a sudden back. Yeah and it everything else pauses while you while you think about

Mike Joyce 20:22
it takes you out it takes you out of like the now

Scott Benner 20:26
Yeah, yeah no absolutely for people who say I live in the moment like the moment gets frozen and everything stops and then you're like I said something Darden the other day we were going into school or something and I said hey, you know what you're going to need to Bolus before you have you know, before you, you know, but now like you need to Bolus now she's like, Oh, I'm gonna be late. And I thought I don't care. Like I don't care if you're late. I care if this insulin doesn't go in now, it was interesting because in it with my other kid, if I needed them anything to do, I'd be like getting there before you're late. Hurry up. You know, like, it's, it's interesting how you stop caring about things you care about, because there's a precedence scale and diabetes always sort of rolls to the top of that of that ladder. Yeah, yeah, it's something

Mike Joyce 21:10
else. Well, cuz if my numbers aren't good, it's very hard for me to be present for life either, like so like, if I don't do actions now. To correct something that hasn't even happened yet. Thanks to CGM technology, but like, like, If I don't take action on what I'm seeing on trends like AI. It's too late.

Scott Benner 21:37
Right? When when reality causes a different way when your blood sugar's 190? And you don't feel good? or right, no, no, no. So I think you've just said that diabetes is rather unfair. And so do you find so you listen to the podcast I glean that from the note you sent me when you asked the you know that you want to be on obviously the only way you'd want to, you'd know that I was looking for people, but um, and even though you're doing injections, do you still do kind of how we talk here? Like, are you bumping your blood sugar around not letting it get out of range as much as possible? Because you sent it to CGM?

Mike Joyce 22:14
Yeah, I like what you say about being bold with insulin. I feel like there's a lot of there's two types of diabetics from, from my experience, there's the ones that are like super fearful of lows, and the ones that are super fearful of the highs. And I'm the ladder like, I'm, I don't want to go high ever. So I'm always my doctor sometimes doesn't like how aggressive I can treat blood sugars, but I also have some insulin resistance. So sometimes I have to be a little harder on some of my correction. Yeah.

Scott Benner 22:51
When there's a doctor seem like

Unknown Speaker 22:55
I don't know.

Scott Benner 22:57
Is it just an overall vibe you get because Mike, the reason I asked is because so many people contact me privately and say, hey, my, we got my agency went way down. I'm so excited to go to my endo. My kids, they won't see one way down. I'm so excited. They get to the end of the day, the endo yells at them,

Mike Joyce 23:11
and says it's too loud.

Scott Benner 23:12
Yeah. Because Because the endo can't imagine that they did it properly, I think is why.

Unknown Speaker 23:18
Yeah.

Scott Benner 23:19
But is that well, and interesting overall? And without their help, without their help you think do you think it's a little bit of that, like a little bit of the gods?

Mike Joyce 23:26
A little ego in that in? You know, I mean, they spent a lot of time and money getting that degree? Yeah, they they want to have some recognition for for doing well, as well.

Scott Benner 23:39
That was hilarious. I never even considered that. I'm so.

Mike Joyce 23:43
So more concerned about lows. Like that. There's this fear, like they can get sued if someone has a low overnight and doesn't wake up like, but if 20 years down the road. I go blind. I've written off at the injections and all that fun stuff. Like, that's just part of diabetes. Yeah. Yeah. We can't be blamed for that. But so, I don't know. I don't know if that's what it is. But they, like, they don't like Hello, my one. What did you do? Would you mind Tell me what it is? I just tested last week and I was 5.0.

Scott Benner 24:30
My gosh, no. And that's without like, like, you have a lot of lows in the course of a month or and what do you call low?

Mike Joyce 24:38
I mean, I'm not gonna say I don't have lows. I have diabetes. But a low for me is under 60 is really when I consider it like I need action immediately. Most of my lows are pretty gradually dropping down into the 60s, and I don't always trust the Dexcom especially overnight, if I'm running a straight line, it likes to tell me that I'm dropping 10 to 20 points lower. Okay. At least from my experience energy five,

Scott Benner 25:15
g4 we got,

Mike Joyce 25:18
I got the G five, five, okay. But

Scott Benner 25:20
it just, I always say this about CGM, like like and now Arden's on we just inserted Arden's third, g six yesterday last night actually, but prior to that I am writing with you with the G five. Like if I had a real steady blood sugar that went on for hours, I'm like, is that right? Like it's it just seems unlikely for it to be that stable. You don't I mean? That's usually the time when you test you're like, Oh, no. Okay, and then you would calibrate with the new one you don't there is no calibrating. So now I'm just I'm still new at it with the G six. I'm still figuring it out. But now if I see too much stability, I I just have to see like if I'm where I expect to be or not, and you don't count right after that. You just kind of kind of keep an eye on it. But it's been really, it's been really different in small ways. But that's one of them. I have not seen one like three hour line that told me her blood sugar was 105. You know what I mean? So but I hear what you're saying I really do. And six I have to say to Arden's low threshold is set at 70. So we know when she gets to 70. But I would do something at 70. If it was going lower, I would try to like bump it back up again. But I wouldn't get into that situation where I was like, we have to do something right this second until 16. My number 216 my like, we have to do something now like let's stop ignoring this. And yeah, get to it number.

Mike Joyce 26:48
Well, and and I think it's also I think CGM technology really helps to, to allow you to know how quickly it's happening. Like, so how urgent is it that I eat something right now? Or can I?

Unknown Speaker 27:06
You know,

Scott Benner 27:08
is this a panic situation? Or is this Yeah,

Unknown Speaker 27:10
like, am I?

Mike Joyce 27:13
Or am I just, you know, did I just dip a little bit, right?

Scott Benner 27:16
Oh, no. And I'll see sometimes I'll see like a 63 that I'm like, let me see just what happens next time. Like maybe this will kind of go the other way again. And I know last night, I saw an ad five diagonal down right before Arden was going to bed. And I thought okay, so I shut her bezel off. And that ended up being the wrong thing to do. Like had I just wrote it out for another 10 minutes ever, it would have bounced again and come back up. And yet I can tell you that from my experience an 85 diagonal down before bed normally needs something from for her. Right. Right. And so, you know, it was the one time that you know, trusting that what I knew was going to happen was going to happen, bit me in the ass. You know, but the other than the next 25 times that happens, it's going to be the right thing to do.

Unknown Speaker 28:03
Right. You

Scott Benner 28:05
know, it is what it is, I guess. I don't know if you're thinking of the JSX ever. But if you are, the insertion process is incredibly easy. It's fascinatingly simple. That's

Unknown Speaker 28:15
what I've heard

Scott Benner 28:18
three times now and Arden has said each time. Not only did she not did it not hurt, but she said that wasn't like a big enough explanation of what she didn't feel. She's like, it's just like nothing that's like, I just don't notice anything happening. And she said to me last night, she goes, how did they do that? And I said, I don't know. I said, I guess you would imagine they work on it all the time. Right? Like trying to make it better. And she was like, Yeah, like she's like, Really? You can't feel it. And I was like, that's pretty cool. So and it's excellent. I mean, I agree. I think the technology is amazing. But a five a one C on injections is really and still thinking of 60 is low. Like so you're not like walking around with your blood sugar 45 going I don't care. And then and then up with like this, this, this low a one see later. So you're also stopping spikes and and keeping like highs away. So do you find yourself you inject multiple times through a meal? Or do you have it worked out to some sort of magic or do you have a diet that you know how it kind of works? What's your plan?

Mike Joyce 29:20
So yeah, it's a whole slew of factors. So to be a little more clear, I was I've switched to the inhaled insulin.

Scott Benner 29:31
Okay, okay. So you're I don't know how to say is it a freezer or freezer?

Mike Joyce 29:35
It's a I'm pretty sure the company calls it a frezza but just about everyone else calls it a preset. Insulin, I switched to that about eight months ago and maybe nine months now. But my last day one see on injections was 5.6 is still you know, so yeah, and Look at standard deviation with my CGM data and that the difference. So then when I switched to a friend of mine, once he went down to 4.9, my standard deviation at the 5.6 was about 4045. And then with a frezza, it's down to about 20.

Scott Benner 30:20
And so, so I will say that, I mean, when it came out, I was like, that seems really amazing. It's the concept of having my kid the Huff's. Like put something in their lungs like that, that throws me off, which is, so what's your experience been so far with it?

Mike Joyce 30:38
I think it's totally changed. insulin. It's taken the like, You talk a lot about Pre-Bolus thing, which is what what I had to do to before I ever found the podcast, but when I got the CGM I could see at either just think CGM is so important for everyone. Yeah, pump or not. Because you can see how long it takes insulin to start working in your body, which allows you to decide when is the right time to Bolus for the food that you're going to eat?

Unknown Speaker 31:13
So

Mike Joyce 31:16
but with that said, uh, frezza starts working so fast, that like, I start eating and then I'm like, Oh, yeah, I should take some of this and then I take it and then like, I it, it works within three dots on my on my Dexcom to start, like to start actually lowering my blood sugar. Okay, and whereas with novolog it was taken almost 15 minutes. Yeah. Oh,

Scott Benner 31:44
yeah, that's why that's where the Pre-Bolus thing comes in. Because you're trying to find balance between the time and the and the food and so is it in cartridges? Is it a mist when you inhale it? Is it like a powder? Like what is it like

Mike Joyce 31:55
a powder? It's a powder and they're in little little cartridges? They have four unit eight unit and 12 units.

Scott Benner 32:08
You just hit Yeah, 12 units. So four, eight and 12 units and then so there's no like partial like you take whatever's in this in the cartridge.

Mike Joyce 32:17
You can break them open and split them up. Which I I have done but the units aren't really comparable. I think one reason the company is struggling is because the units don't match unit for unit injected

Scott Benner 32:35
okay. So it's this way or but it's it's meaningless in there's no comparison really was how Yeah,

Mike Joyce 32:41
I find a four unit dose is like my correction dose and it works as like one unit, maybe one and a half. Okay. Whereas the eight units are like a five unit dose. Okay, maybe six. So

Scott Benner 32:56
So how do you use inhale bones like if your blood sugar goes to 130 it sits there how do you get your blood sugar back down again? Like he just do the four unit one and it doesn't go too far or how does it work?

Mike Joyce 33:08
Yeah. I would take a four unit dose it's out of my system in two hours at the at the most I pretty much done working and an hour and a half so like I it's hard to stack which is good because i as i said i'm can be a little aggressive with my correction. So like if I take a dose of the four and inhale that they 130 it may move it might not but within 30 minutes I know if that was enough or not and then I can do another correction if I need it I say which is kind of how I injected to maybe not in 30 minutes but you know if if in an hour and a half I was still at the same point like you were doing something about it I guess I needed to to bump bump it a little bit more

Scott Benner 34:09
so what's the real bonuses it really cut down spikes or like because you're not getting big numbers at all so you you're not spiking yeah what

Mike Joyce 34:18
when I see it start to curve up I can take like an eight unit dose and you can see the intensity of a curve and stop it and because its onset is so quick it and literally like it all start spiking up and then like flatlines and then it might start coming up again and I'll have to take another dose but like it's amazing what it does to some of my my Dexcom lines. Yeah,

Scott Benner 34:48
it sounds almost like the top when you're talking about it makes me like imagine in my head like there's a button that says Like, like like a magic button that says like more or insulin like didn't even like you'd like oh, going up button, a little more push. And then it just it's like it's interesting because it's and so and the action time being so quick and yet it the the life being so short makes you feel like you can. You can use it every time you need it and you're not worrying about like all this. So you don't ever have a situation where six hours later, your blood sugar's 30 and you can't get it to go up. Now that doesn't happen with that. Okay, now and are you taking a slow line for me? Of course Yeah,

Mike Joyce 35:30
yeah, I'm taking your C by just switched it to Seba about three months ago. And it's totally the greatest thing that's ever happened.

Scott Benner 35:40
Why did people say it's really good?

Mike Joyce 35:43
Yeah, like I have flatlines overnight, which I never had with Lantus or levemir. Like I, I used to struggle with a lot of 4am lows with lantis. And it doesn't happen anymore.

Scott Benner 36:01
Yeah, no, I've heard nothing but good things about a juicy buffer for a while, actually, you know, some people obviously, it doesn't work for everybody or something like that. But you know, overall, like the positive vibe from it, I think seems pretty consistent. Yeah. Okay. So you are so you're huffing insulin. And is it How about the I know you've only been doing it for eight months, but is there a feeling like do you feel it in your chest? Like, do you ever feel like heavy or like get like, I don't know, I have literally no idea. These are just my unfounded fears.

Mike Joyce 36:40
Now I've I've recently gotten into running quite a bit. I've been running some 10, K's and a lot of five K's and

Unknown Speaker 36:51
I

Mike Joyce 36:53
I don't have any issue with breathing. Because of it. Yeah, I just I play soccer a couple times a week. It's a there's a lot of fear there. And reasonably

Scott Benner 37:06
Yeah. Do you worry about it? Like, do you say to yourself, okay, this is only been eight months, because there's not much long term study on it. So, like, Do you ever think about that, or what's your

Mike Joyce 37:14
dad's been on the market for almost four years now. And I did folk when I was in college. So I have some concerns about it. Because of that, but at the same time, like there's the trade off of better control or a fear of something that isn't currently

Scott Benner 37:43
like may or may not happen.

Mike Joyce 37:45
I could also I mean, I also have fears of losing limbs and

Scott Benner 37:53
I have other

Mike Joyce 37:54
going blind but but that's not happening currently. So we also that happened like yeah, I

Scott Benner 38:04
you would think the price the the price of doing business, right? Like it's a what I wanted to tell you wasn't far too you could be carried off by a gator. And then a boa constrictor in that Gator could fight for your carcass? Like I mean, yeah,

Mike Joyce 38:15
well, and there's so many old people and doctors that in handle cancer that

Scott Benner 38:22
if you're like if I get cancer, I'm in Florida. It's in the best place. I mean, that's the best place I've cancer. Florida, the best place to have cancer. You don't ever see that on this is your drive. It should be it should be

Unknown Speaker 38:39
terrible.

Scott Benner 38:41
Okay, so Okay, so that's it. I mean, that's really interesting. I've been doing it for eight months. You know, as you were talking, I realized what the Dexcom you're in a Dexcom CGM and using an inhalable insulin, you you poke yourself once every couple of weeks, really except for your like, how often do you test your blood sugar even?

Mike Joyce 39:00
I test my blood sugar all the time. Do you? Okay? Yeah, after 20 I didn't get a dexcom until I was 21 years of diabetes. Like I still haven't turned over full trust the government. And especially like if I'm because I tried to keep a really tight range. Like I tried to stay around the mid 80s all day long. to like, check it make sure you were if I'm going if the ex cons show in a 70 and I feel fine. I'm gonna test my blood sugar if Dexcom is showing 100 and I, as I say I try to be around. I correct that, like 110 Oh, sure. Um, so if x I'm showing 110 and I feel fine and I haven't eaten. I'm going to check to make sure it's not.

Scott Benner 39:53
Yeah, no, no, no, Mike listen. Arden's doing standardized testing this week at school. So, I don't know, 830 this morning, she's already in class taking the test and her blood sugar went to was sitting at 110. And I was like, I think we're gonna do something about this because I kept imagining, like anxiety or just dehydration or something like that go on in that room, right? Or just the, you know, ungodly like mental anguish. And so, I, when, as soon as I saw it drift off of 110, I bumped it again. And she's been 101 for a while now. So 101, or 398 has been sort of like in that space for about the last, I'd say two hours. But yeah, I don't know what what it had we not bumped it, I don't think she would have gotten much higher. Based on that it didn't the the Bolus didn't really take her completely, very low. But at the same time, I don't know. Like, I don't know what would have happened, because because there's, there's those moments where you're like, Oh, it's only 120. And then all of a sudden it runs the 116 you're like, Oh, I should have done something. Yeah, you know, like, and now all of a sudden, you're using extra insulin. And then, you know, two and a half hours later, you're low because you had to over Li be aggressive. And yeah, I just think it's I mean, obviously, it's what we talk about all the time. But when you just bump a nudge like that you just you give yourself the best chance to not be incredibly high or incredibly low later. Yeah. And I

Mike Joyce 41:22
I'm a big fan, obviously of that. And it's, you can totally do that with injection. Yeah, yeah. Oh, sure. And yeah, and I think I think we get stuck in the back. Like, I think there's just a lot of old school approach to diabetes back that that just stuck from 20 years ago. of, you know, you take your insulin, and you wait, and you can't take more insulin until that insulins done working. And what if you didn't take enough to begin with? Like, crazy?

Scott Benner 41:59
Like, it's just wait,

Mike Joyce 42:00
yeah, it'll wait for hours before you can take another day. Like that's, that's insanity. Like, let yourself be 250 for four hours, because you didn't take enough insulin to begin with. It's it's and and having a CGM, if you took too much. It lets you know, before you hit a dangerous point that you can do something react before or react before you need to react. Yeah.

Scott Benner 42:26
Oh, absolutely. Or you can't react. No, no, no, no, I listened. I completely agree with you. And you will completely agree with me. It's a it's just it's a very, very simple idea. Like, I mean, going back to what you've just said, it's, you know, any number of stupid analogies like if you're, if you need to stop your car, and you push the brake halfway down, that doesn't stop, you don't go well, I've pushed it as far as the guy who taught me to drive told me to push it. So let's just see what happens. Now. I'm going to hit this car in front of me, oh, well, I've done what I just told. You don't do that. You push harder you go, oh, gosh, something undesirable is happening. I need to continue to try. And and it's the same thing with insulin, I, you know, I, I counted my carbs. And I put in the insulin and now my blood sugar's 300. So I'll just wait three and a half hours, four hours, like the doctor told me, I'll see what happens. Now your blood sugar just says hi. And your Dexcom on your meter. Like, well just keep waiting. Like, why are you waiting? Well, the doctor said that, you know, the doctor was assuming you'd get the bolus, right. Like, you know, like, that's the unspoken part of the conversation that they don't really they don't tell you. And they don't tell you because they don't want you to stack your insulin. They don't want you to get crazy low later. All that stuff, which is what we talked about earlier, which is like don't die today. Advice. It has nothing to do with you being healthy forever. It's just, you know, a doctor saying, I don't want you to get really low off of something I said to you. That's pretty much it. Yeah, you know, you still have to make the decisions. And I'll tell you, I spoke at something pretty recently. And when I was done, someone came up to me and just started thanking me and they're like, I watched my kids blood sugar be high for hours. And I know it shouldn't be like that. But the doctor just keeps telling me to do it. It feels wrong with every ounce of who this person was. They knew what was wrong. They couldn't break free of the idea because they were told don't do that. And, you know, I just told them very clearly that nothing you heard during this talk was advice. And and but but I agree with what you're saying. It is a very strange idea to sit and watch your your blood sugar be 350 404 hours because why? Yeah, you know, there's no reason.

Mike Joyce 44:37
I think we also get hung up on carbs too, as like be only an influencer on our blood sugar. Mm hmm. And I've switched to a an extremely low carb diet, which helps for my standard deviation quite a bit. But I still have to take insulin for protein and like vegetables have Some carbs in them, but like, but it's amazing how much like, I was never told that protein and affect my blood sugar or fat? Like how much fat slow down digestion for that? Like, if I Pre-Bolus? Like if I Pre-Bolus too aggressively for a pizza?

Unknown Speaker 45:21
No, you get a burrito? Why am I going

Mike Joyce 45:22
low an hour after eating pizza, and then I'm high for four hours

Scott Benner 45:27
afterwards if you're lucky, and scared to do anything about it, because you were just low and you put all that insulin,

Mike Joyce 45:33
right man. That's a, again, the Dexcom is, or any CGM in general is, is going to be helpful, because you can actually see the bigger picture, you know, like, I know, you, you might be like a marketing guy in there used to test people are used to test art in at like, an hour after eating and like doctors would be like, why are you doing that? It's like, they want to see the whole picture like, which is like, totally, that makes sense. And it's totally changing how to approach diabetes, and our doctors are teaching to approach diabetes hasn't picked up on that yet.

Scott Benner 46:19
It's incredibly behind. There was it, it's fascinating, like I had someone so close to who's in medical school to be an endo, so close to having them come on the podcast, and not give their name and just talk about how kind of archaic things still seem to be about what they're being taught. And then they for reasons that I completely understood, didn't couldn't, couldn't do it. You know, they're afraid for themselves. And I understand. But at the same time, I really do think that about like, like, I use the pipe, use the podcast as an example, in my mind, like, you are a person who, I'm thrilled you found the podcast, I think whatever you got out of it has been really valuable for you. And it's what I intended. But this is just going to happen over and over and over again, ad nauseum forever if people keep churning out new diabetics who think things like, count my carbs, put in the insulin, wait for hours, like that kind of thing, again, until this becomes the norm for how people talk about it. At the diagnosis side, it's not going to change. And it's tough because you're fighting I was in a room with a lot of people who have diabetes this weekend. And I guess by the time your episode goes up, it'll be a long time ago, but I was at a you know, a blogger summit put on by Novo Nordisk. And it was mainly wrapped around insulin pricing. But what I saw when I was in the room is there were some people in there who had diabetes for 40 years. And no matter what they they're using the new technology, they understand things exactly the way you understand them. But when they stopped to talk about it, everything they talked about is they're scared. Like somebody made them scared 40 years ago, and they're still it's their default, right now today. And so until generations of scared people, you know, I hate to talk about like this, but move through the disease and, and stop being impactful in the space. You're still going to always be fighting with these ideas like, Well, you know, give yourself more insulin if your blood sugars have well, you have to be careful. Well, why do you have to be careful using a dexcom? That's care. Isn't that being careful? Like you have a CGM on is I would say that's being careful.

Unknown Speaker 48:36
If you look at it,

Scott Benner 48:37
yeah, yeah, right. Pay attention. You have insulin that works incredibly, more efficiently than the insulin that you were using when you were eight years old. 40 years ago and scared. It's a different world, you're applying old rules to a completely new game. Right? They almost don't having diabetes with a CGM and an insulin pump has nothing. It almost has no relationship to having diabetes on mph and regular, like they're almost a completely different thing. You know, besides the fact that your blood sugar can get high on your blood sugar yellow, I mean, other than that, every the process is completely it's completely changed. Yeah. But you know, good luck having that conversation in front of somebody who has rightfully been scared most of their life about something and can't shake that feeling. You know what I mean? Like that's the human piece of it and why the teaching won't change more quickly. Because people are still listen, I said to Sean Busby. Two weeks ago, I don't go in the ocean because I can't get eaten by a shark in the ocean. Where does that come from? When I was five my parents let me see jaws the bad idea that was right, right. Like so. I listen, I go on the ocean. Don't get me wrong, but but my point is, is that when I'm in there, there's part of me is like, this is how I die. You leave it like this. And it's just some long lasting, childish fear that's rooted rooted in nothing. Sometimes I think you guys will think I'm just making this stuff up. But I'm not. 10 minutes ago, while I was editing, Arjun texted me from school, out of nowhere. 845 in the morning, I'm going down to the cafeteria to get a muffin. This high school, they just let the kids be to free and I mean, back in the day you sat in your class today? It's a I have a minute Can I go get a muffin? So okay, I say how big is the muffin? I don't know. It's big. said Okay. Well, Bolus a half a unit now go get them off and text me again. When you know which one you have. I start getting the Hello I'm here I have the muffin Baba ba. I said, I don't know what to do. Is it? You know, I don't know. Like, I can't see it. I don't she's not like texting. It's uh, you know, it appears to be a blueberry muffin with about 45 grams of carbs. It's just a muffin. She's grabbing off a tray. So I looked at her blood sugar, which by the way, was 102 and steady. And I said, All right, let's just give it a whirl here. Let's do five units in total. So we've already done a half a unit to four and a half more, do you think you're going to eat the whole muffin she said, Yeah, she's gonna eat the muffin. If she doesn't, we'll make an adjustment. But this kind of like woo free and fluid kind of feeling you're hearing from us. It comes from the data, we get back from ardens Dexcom, g six continuous glucose monitor, we are gonna do a muffin unexpectedly on the fly using that data. And whether you're the parent of a child with type one, or you have type one yourself, you could handle a muffin the same exact way dexcom.com forward slash juicebox to get started today, you will not be disappointed. Free and Easy muffins. Think about it. I'm excited for a changeover

Mike Joyce 51:59
as well. Yeah, meat meat, I'm just excited to see doctor Well, I see a lot of doctors just be like, Oh, you're struggling to have control of your diabetes here, taken it get an insulin pump. And that's not really gonna fix it,

Scott Benner 52:16
you start to understand how the insulin works,

Mike Joyce 52:20
work and the tools in the like the the different plays that you can do with basal rates. And, you know, you know, there's a lot of tools within a pump that if you don't understand like, and I think that's why a lot of doctors used to be resistant to putting patients immediately on a pump, because I think a lot of the patients that immediately go on a pump don't really recognize how many great things there are to do with the pump that so they're just stuck, basically, doing MDI, with a pump with my bazel Ray, and they just take insulin, when they

Scott Benner 52:59
feel they're pumped, it was cut down on their injections, but they're

Mike Joyce 53:02
not getting them excited to test their blood sugar a little bit more.

Scott Benner 53:05
I was talking to somebody again this weekend about that, and they not understanding so many aspects of what their pump does. And I realized I was like, Oh my gosh, this would be like if I made you the quarterback of a football team. You'd never seen a football game before. And I explained you that football is the man in front of you hands you the ball between his legs, you turn around to the man behind you hand it to him, and he'll run and see how far I can get. And then like 20 years later I go you can throw the ball to it and you'd be like, Oh my god, what did you say that before? Like, it really is like this sort of? I don't know, I you know, I put it a million different ways. And I've outright said on the pod. I've been in the room with them. I said, Look, I know that you're they're stuck. They can't teach. It's funny, they sell this product they can't teach too much about because their FDA approval doesn't allow for them to say certain things like but you have a you know, you have this this rocket launcher. And you've so far taught people how to like kill flies with it for some reason, like like, like, it's not a flyswatter it does so much more. It has so much more. There's so much more to it. And they can't really come out and talk about it because they're, they're limited by by the FDA about what they can say that their product does. Because the minute they tell you it does something. Hey, you can set up an extended bolus. And then you set up an extended bolus and it doesn't work for you. They're skirt so they so they can't say anything you know it's an interesting world we we live in around the diet about around this stuff. It's funny to it came up this weekend we were talking like why is the phone ringing? Nobody calls here let's see what its gonna be Hold on a second. I'm gonna go Big Brothers Big Sisters is I don't know my phone. We all have the same phone in the room. Now have you noticed that it's down to like two home phones you can buy at Best Buy

Mike Joyce 54:58
because I didn't know that people still have At home phone Did you don't even

Scott Benner 55:02
listen? I'm running from alligators. I don't have time for phone calls.

Mike Joyce 55:08
Well, actually, I think Florida has the most flip phones per capitals and any state.

Scott Benner 55:14
There's still the flip phone going on. Because what is this whole lesson like, baby boomers don't need don't want smartphone, I'm being offered something at no cost. If I push one, I could have opted out. I would have definitely opted out Had I known. Maybe baby boomers. I just like I know right now is in his late 50s. He has a flip phone. He seems completely happy with it.

Mike Joyce 55:38
Yeah. It might be it might be the way to go refreshing to to get a like, like a pump vacation. Yeah,

Scott Benner 55:45
right. Yeah. Right. A phone vacation? Well, I'm sorry, I was gonna say that while we were we were together in the room. You know, we were talking about, you know, what everyone, you know, what people do? Some people had blogs. And you know, I set up a podcast and and a guy across the room, who I know really well said, you know, how valuable the podcasts have been for him at some point. But somebody says to me, we have to be careful, you know? And I was like, you know, of course, you know, I mean, I don't run around like, something doesn't work one time in my life. And I'm like, Hey, guys, new way to handle diabetes stuff. Like, if you hear me saying something here, I've been doing it for six months, for a year for longer, like I have a ton of confidence that I can share my experience with you. My experience has been very consistent. And I said, Yeah, of course. But we know. And then and then the fear came in. It's all about fear. Like every day, I'm like, Oh, my God, even you on this side of it is are scared. Like, you're a person who people look to for, for their experiences. And you're telling me you're holding back things, too? I mean, how valuable is that? Really? If you're only going to say part of what you think? Because then it leaves everybody to fill in the holes themselves. And they're blind. They don't know what pieces to use to fill in the holes. Just like with the doctor, Hey, take the insulin. Wait this many hours take it again. Well, yeah, but there feels like there's gaps. No, no, there's no gaps. I mean, None None that I'm comfortable telling you about at least. It's just like, you know, what are you doing? Like either help be helpful or don't be helpful? Don't be partially helpful. seems odd to me. But

Mike Joyce 57:24
I don't know. And I think everyone should have a CGM. I think doctors are so quick to say, oh, a pump gives more better control. But really, more data gives you the ability to have better control, you

Scott Benner 57:37
know, no scanning of what's happening. Yeah, absolutely.

Mike Joyce 57:40
Just having a tool to give you the same insulin in smaller quantities. Like, like, Yeah, that's great, especially for children that have, like, point two units will totally make or break life for them. Like for small children's, for me, point. A half a unit isn't really gonna

Scott Benner 58:04
is meaningless, right?

Mike Joyce 58:06
Yeah, it's trivial at that point. But, um,

Scott Benner 58:09
well, I think I think you're right, I think that, I think if you put me in the very false situation where I had to choose one, and I had to move forward with just one, I would be able to make a very strong case for just having the DAX gone. But if you put me in a more real situation where I could explain to someone how to use their pomp in a in a in a very, like, impactful way, then I would tell you, oh, gosh, I mean, can we just make up a new scenario because I don't want to give one of these away you know, like, let's make up a new made up scenario where I get to keep both of them and and let me tell you how to do that thing. Like you know, I mean, listen yesterday, it's completely it's incredibly complex afternoon for art and yesterday it day in general, she goes into school, she does four solid hours of standardized testing so jammed in a room for four hours. The anxiety hit her in the beginning, we were able to with a Temp Basal stop that from being a problem. Arden tests in the room with everyone else. So even though this has nothing to do with this episode, no one will ever hear this. I'm really very, very proud of is pulled aside by an administrator the other day, who said that because of how I pushed to allow art in to have contact with me about her diabetes while she was doing standardized testing without making her leave the room with everybody else. She said it is now possible for children in New Jersey to do what Arden's doing and she's like, I swear to you, she goes I'm not the woman's like I don't spend a lot of time telling parents that they've changed the system. She's like, but you you did she's like there's possibilities that exist now that have never existed before for how kids can take standardized testing in New Jersey, which was really cool.

Mike Joyce 59:57
So I didn't know that. I didn't know that I grew up in New Jersey, and I didn't. I took standardized testing with everyone else.

Scott Benner 1:00:07
Well, you did it before cell phones. So now the state is very concerned that my 13 year old will be very worried about a math equation so much so that she'll go on the internet and cheat about it or take a picture of it and share it with somebody else. So, Arden had been relegated to an office with a teacher she'd never met before. So when it was time for testing, Arden had to walk down to guidance or to a conference room, sit down by herself in the room for four hours with another person in there who proxy the task for that person sat there and stared at her and hat and and, and if she had to stop for diabetes related it should they stop the clock there was all this stuff that happened. The first thing I was able to do was to talk them into Okay, look, let the proxy hold Arden's phone, I'll waive my rights to HIPAA. I don't care what you hear about Arden's diabetes. So if I text her and I say, hey, you need insulin, or Hey, drink a juice, the the proxy can then stop the clock real quick hand the phone to art and watch her use the phone do or diabetes and get right back to the house instead of having to take these big breaks and all this stuff, which was really cool. Yeah, but about two years ago, two and a half years ago, Arden came to me and she's like, I hate going to a room by myself to take those tests. I just want to stay in the room with everybody else. So I began the process of telling them Look, why can't we just continue to do what we're doing, but she's in the room with everybody else. And you know, all the standard bs came up? Well, things beep and that's not fair to other kids. And I'm like, I don't care. And it's not fair that my kid has diabetes. So what are we talking about? Exactly? Like, it's fine. These kids are all have been in class with her for years. No one's but I've never once gotten a note from someone. Dear Scott, your daughter's beeping is causing my son to have a low grade math. Like this has never happened. You know what I mean? Like it's another one of these false flag things that people worry about. Because they're, their little brains make up a problem before they even know if there's a problem. They hear something. This is their knee jerk reaction to it. We're human. we're wired to believe that what we think is right. And like See, this is going to be a problem. Like we haven't even tried it yet. How do you know? And so I got them to go to the state. We had to petition the state we had to like write these letters and do all this junk that was not fun. And finally, that's how it works. Now. So right now Arden's in standardized testing, she'll be down a little bit, and her friend and her phone is with the proxy. And so I was able to bump Arden's blood sugar this morning via the proxy, basically. So the test never stopped are not to do anything. She didn't have to leave a room, she doesn't have to be trapped in a concrete box by herself with like, some weird teacher that they don't let near kids usually, you know, none of that had to happen. You know, I hope no one ever listens to this. I'm sure it's not a weird teacher. But But you know what, actually, it ends up being usually as your gym teachers, they get stuck proxying the test, you know. And so all that stuff is it's just incredibly important to keeping our blood sugar stable. So we were able to keep her blood sugar stable all the way through the testing yesterday. She went right into lunch where we were still able to Pre-Bolus everything went good then it was supposed to rain here yesterday, I was planning on the rain very, very very, very closely, Mike and then it didn't. So all of a sudden, Arden had to play a softball game after school. So we do all the lead up to the softball like change your basal rates, like everything and kind of like, you know, do some Temp Basal raise, get her where she's going tell her to start hydrating, a little more. She gets to the field and she says, I get a text. I'm just the aging today. I'm not playing in the field. So now most of the things that we set up about our insulin are now wrong. And so like I saw, I'm like Alright, we'll cancel this Temp Basal do this like do that video Bolus here a little bit. She does all that. Then the worst thing happens. The worst thing happens. She's sitting on the bench with the girls who usually don't play. Turns out those girls get bored so they bring snacks with them. So Arden's like I have a giant sugar cookie with ice in here. Can I have this? I was like, Yeah, sure.

Absolutely. Now what am I gonna tell her Let's Pre-Bolus wait till the third inning to start eating it. You can't get couldn't do that. So I doubled or bazel or bolt a double or bazel for an hour and I over Bolus the cookie like I looked at the cookie. You know, I knew what kind of cookie was enough to look at it. I thought that cookies three minutes, but I gave her almost five instead. Because there was no Pre-Bolus like I knew she was gonna her blood sugar was going to try to jump up and if I could put enough insulin in there, I could probably stop at around 150 and like hold the spike back until the spike stop trying and the rest of the of the second pull it off. It almost worked. Okay. She went to 170 But, and then she came back down again, which was like not, would not have to have happened if it wasn't in that situation. But what I thought about it in that moment was my daughter got to hang out on that bench with all those other girls and like eat like, sugared up like sugar cookies, and she didn't think anything of it. And it didn't change how she played. So I thought, you know, no, no crash

Mike Joyce 1:05:21
from taking the extra insulin either. No, no,

Scott Benner 1:05:24
no, no, because I don't think it because it's not really extra insulin, you're just pre conceiving what a spike and then bolusing

Mike Joyce 1:05:32
Yeah, up front. Well, and there's so much insulin resistance once you get over a certain number, which doctors also leave out is how, you know, when I'm 150 a correction is much different than when I'm 250. Of course, yeah, like this, it the ratio does not stay the same as I get higher. Like I need significantly more to bump that down.

Scott Benner 1:05:56
Yeah. Oh, absolutely. I mean, that's why I use Temp Basal to bring I blood sugars down when they used to happen more, I would be like, okay, more bazel and Bolus at the same time to try to, you know, because you need more insulin. Now, your blood sugar's higher, and you have this resistance all the sudden, no, actually, she didn't. Not only was it not too much, but coming home from the game we bolused again. Okay, yeah, because it hit that 170 Peak, and it sat. And then it started to drift. But I didn't love the giraffe. That didn't feel fast enough to me. Yeah. And I had food in the oven that I knew was going to be ready in a certain amount of time. So I basically started Pre-Bolus and dinner on the ride home from the school, knowing that she was still a little high The food was going to be ready in about a half an hour. It was just a lot of Yeah, that stuff, you know. Yeah. But it works. It works really well. So yeah, just all timing and amount to be perfectly honest. It's, it's, it's, it's, it sounds incredibly good. sounds incredibly difficult, but it really isn't like once you're doing it, it all sort of like everything I just described, again, is blown out long form, but it it encompassed about three minutes of my entire attention over two hours. Yeah,

Mike Joyce 1:07:09
it becomes second nature. Yeah. I mean, we're basically doing what it's overwhelming to think about that you're, we're, we're doing all these actions that our body should naturally do on its own, like without thought. But it becomes how we stay alive. So it becomes our own natural, instinctual way that we handle life as Yeah.

Scott Benner 1:07:40
And I'm sure it's not the same forever, I'm sure the anxiety of it maybe sticks to some people differently than others. Like, I'm not saying that I'm saying for me, I don't think about it that often. You know, like I have, I don't stare at Arden's blood sugar while she's at school. I have pretty tight tolerances set up, I'll find out if she goes outside of it. You know, I'm not gonna bother wondering, you know, is she 85 right now? Or she 100? Like, I don't care, Either is fine, whatever, you know, like I prefer if it was 85 to be perfectly?

Mike Joyce 1:08:10
How, how's the trend? Is there gonna be a transition to where she starts making more of the decisions? Or is that?

Scott Benner 1:08:19
Yeah, I talked about a lot in doing when people ask because it is a really it normally is an interesting question. From your perspective. It's an interesting question. From my perspective. You know, like, I wondered the same thing, like, Is there gonna be a moment where she's just like, Oh, go to hell, I'm not doing this like this, you know, I but I don't know. All I can tell you is that we slowly hand off knowledge that she understands a little better every day. And that there is clearly going to be a time in these next couple of years through here. I'm assuming before she's 16, where she's really not going to want people to be as involved. And when she gets to that spot, that's when we have more serious conversations about Okay, well, then here are the things you need to understand on your own, then, you know, on your own, and you could always reach back to me and ask but bigger ideas. I did have one of those conversations with her a few weeks ago. And I think I talked about it on here. At some point. It was about Pre-Bolus thing, and I was just busy one morning. And she and my wife, there was confusion on my wife's side, my wife, I thought her blood sugar was lower than it was. And you know, my daughter just like asks for pancakes. And I said to her, I'm like, you know, you have to Pre-Bolus pancakes. She's like, yeah, I'm like, why didn't you and she said, Well, Mom said I'm like, Yeah, but there's got to be a point where you hear something you know, is wrong and say, Hey, I don't care who you are. Listen to me. That's not right. I can't eat pancakes without Pre-Bolus saying like, you know, why are you saying that? Let's figure this out. And we had a really serious like, 20 minute conversation about and that I think grows around Understanding a little more, but I am just not the person. I am not going to sit my kid down in a room on a sofa for three hours explaining diabetes to her and go Okay, do you understand now? Like, I just yeah, doesn't make any sense to me.

Mike Joyce 1:10:13
Well, and you also, I like the relationship with. I mean, I don't have kids, but I was a kid. And like, if every conversation I ever had with my parents was about diabetes, like, be mortified make me really hate diabetes, and like, really start to not enjoy the relationship with my parents and right, I've been working as a Youth Ambassador, or a coordinator for the Youth Ambassador Program down here in the they're in Sarasota is for jdrf jdrf. Okay. Yeah. And, and so I meet with some of the kids and meet with some of the parents. And I think that's a common thing that that seems to arise in the teenage years with, with some of these parents says, The kid finally snaps and says, like, the only thing the only time you ever reach out to me is when you see something on my Dexcom

Scott Benner 1:11:08
Yeah, it's a horrible feeling. Do You

Mike Joyce 1:11:09
Do you like it? And I have the same problem sometimes too, with, with parents, it's just like, we talk, like, things that we like in life. Because life's not about diabetes. treating diabetes is well is how I live life. Or how I give myself the opportunity to live and enjoy life, so. But finding balance in that is never easy.

Scott Benner 1:11:39
Yeah. No, no, please. It's this simplistic question to a very complicated problem. How am I going to hand off what I learned about Type One Diabetes to my kid? And in my mind, I treated the way I treat everything else, how am I going to hand off? What I know about being a decent person to my job? What am I going to hand off about hard work and dedication and perseverance? And well, how do you how do you hand those things off to your kid? And the truth is, we all are not very successful at it, like not everybody's successful. I know some really wonderful people have some really terrible kids. Like you don't I mean, like, how did they not? How are they not able to translate a little bit of who they were into that monster, and they weren't? Or vice versa, the terrible people who their kids end up great, you're like, how that happened? You know, like, like, how did that like, wonderful person come out of that storm of disaster. And, and so I can tell you this, Mike, when you have kids, it is everyone's intention to the best of their ability to have a child who is successful and happy, and etc. And we all have different levels of accomplishing that. And it's funny, because parenting is an interesting thing, it's, um, you make a decision without knowing if that decision is going to bear fruit, or if it's going to be a horror. And the best you can do is take what you think is the best thing to do. Put it into action, and see what happens. And maybe if you're smart enough to adjust when your ideas don't do the best all the time, that's great. But most people just go with what their gut tells them as their parenting along. It's the best you can do. You know, I mean, you can read a book, you can talk to a friend, you can find out how other people do things. But in the end, something arises, your best intention pops into your head, your best idea pops into your head and you put it into action. You see what happens. My son got a detention for being late. And it's the end of the school year, and he's a senior. And he told me, I'm not going to detention. He's never had one before his whole life. He goes, I was late four times this year. This is stupid. I was like born you're gonna get in trouble. He's like, at the end of the year, by the time they figure it out all graduate. And tonight I said to him, I when I should have said to him was no, you were late. Go to the attention. I said, Okay, good luck. I hope that works out for you. Here's the one thing I'll tell you, you can't get in more trouble. So work this out any way you want to, but you can't get in more trouble. If you get in more trouble than just this detention. I'm gonna, I'm gonna get involved, and then you're gonna have problem with me. And so, because I want him to try it, like it's a very meaningless thing over the course of his life, like whether or not he goes to detention or not as senior like, let him try to negotiate it and see what happens. Let them get in trouble and find out what happens.

Mike Joyce 1:14:18
That reminds me of my, my senior year of high school I was I was in AP Physics. And the AP tests are like in April. Okay, you know, like that was taken early May that is so but we had all these labs built into the schedule that we weren't using anymore because we had taken the AP test, but my teacher didn't really care anymore. And so you know, where that where the AP like, like nerds in physics class, and so we left campus and went down and got breakfast sandwiches. And the only door to get back in that was unlocked was the front door and as we walked in, it was our Our principal was like walking out of the office and sauce. All right. And so the whole AP physics class got detention.

We went to get breakfast,

Scott Benner 1:15:09
dedicated kids in the school probably.

Mike Joyce 1:15:12
Yeah, it was. None of us had ever been to detention for it. And I kind of said the same thing to my parents. And they're like, go like, you'll have detention. Like, it's enough. Yeah, big deal.

Scott Benner 1:15:25
Well, and you're like, we

Mike Joyce 1:15:26
all we all did work together.

Scott Benner 1:15:29
I once I once had a pizza delivered to detention, I'm going to tell you, so I'm obviously older than you. So my senior year of high school would have been 89. And there was no like, you could not leave the campus like you just couldn't. But I drove to school. And one day, I was like, I really want to go out to lunch. So it wasn't like now like my son has to like key card in the school, all the stuff. I walked out the back door, I wandered into the parking lot, I got my car, and I drove away and I had lunch. I came back in, I parked my car, and I went back in and I went to class. I was never, I wasn't late. I didn't miss anything, you know, but that was completely against the rules. The number of hours later, I'm in a class and the phone rings. And the guy says to me, Hey, you have to go see the the principal, but the one who's in charge of like, you know, bad stuff, not the happy principle, the principles in charge of getting you in trouble for it. Yeah. So I assumed I knew what this was about. I went down to the principal's office, knocked on the door, went and sat down. I said, Hello, how are you? And he's like, good. Listen, your truck was seen leaving the school premises at 12 o'clock. And without missing a beat Mike. I went, my truck got stolen. And he looks at me and he goes, No, it came back about 45 minutes later, and I said someone stole my truck and brought it back. 45 minutes later, I'm like, that's really lucky. And he stared at me blank and I stared at him blank. And I was like, You think I'm gonna admit to this right now? Like, what is this? What? What are you? What am I an idiot? I'm almost 18 years old. I'm like, I'm not just gonna, like be like, Oh, no, you caught me. I'm like, let me see where this goes. So we looked at each other for a long minute. He goes,

Unknown Speaker 1:17:10
you're not gonna.

Scott Benner 1:17:13
And I just looked back and he's fumbling for words. You know what I mean? Like, he doesn't have a sentence and he goes on your truck left and it came back. You were in it? And I went, No, I wasn't. And he goes, Okay, go back to class. And I went, actually, I'm gonna need a pass to go out to check my truck to make sure nothing's been stolen. Then I spent the next 20 minutes of my truck listening to the Guns and Roses album. Because screw him. That's why, like I did. And I had a pass Now, like I was out in the parking lot was nice, warm day. And I just realized, like, as I look back on my life, that moment, is more helpful to me, then, had I not screwed around, got caught, figured out my way out of it. Like that whole thing. Like, it's such a stupid story, but it's, but it really is important to go through things. So it's my belief that when Arden's ready, her blood sugar is going to get messed up. And it's going to take her a while to figure out how to do it. and with any luck, she'll lean on me, and I'll be able to pass on the things that I understand further. And she'll get to them. But the truth of the matter is, is that the secret that every parent of a kid with Type One Diabetes wants to know the answer to there is no answer to like, how do I transition them into being an adult? It's not a fixable solution. It's just you, you got to roll with it. You got to do the right thing. Sometimes you yell at your kid for getting attention. Sometimes you tell them hey, go see what see what happens. And I think this is I think of this in the very, very same way. But like we've been on way too long. So you must have a life to get back to I mean, I'm assuming.

Mike Joyce 1:18:50
Yeah, I just took a long break at work.

Scott Benner 1:18:55
Let me let me say thank you very much. I really appreciate you doing this. I don't know if we know if it's a frazzle or freezy, but we'll never really know I guess. Huge thanks to Mike for coming on and sharing his story with us. Thank you also to Dexcom, makers of the G six continuous glucose monitor and on the pod the makers of the only tubeless insulin pump in the world, you will love them both. Check out the links in the show notes at Juicebox podcast.com. Go to my omnipod.com Ford slash juice box or dexcom.com Ford slash juice box to find out more. Now listen, I know I didn't give you a brand new episode on the first Tuesday of January because it was like the first or the second. It's like everybody's gonna be they don't care. So wait until the next week. And I gave you an extra long episode. See what I did there. extra minutes. Hey, how'd you like a little update about Mike I spoke with him by email. He said he's still using a freezer. And a lot has happened to him since we recorded this podcast. most interestingly, he's taking up endurance sports and running like ultra marathons. 30 mile races backpack Over 300 miles this year, and he's planning on thru hiking the 2200 miles of the Appalachian Trail this summer. Alright, Happy New Year. I'm excited to get 2019 underway. Don't forget Chris Rudin is going to be on the Titan games this week. I think it's Thursday on NBC. Check him out. Have a great week. I'll see you next time.