#327 Dr. DeSalvo has T1D
Dan DeSalvo, M.D. is a Pediatric Diabetes Endocrinologist
Dan DeSalvo, M.D. is a Pediatric Diabetes Endocrinologist at Baylor College of Medicine and a person living with type 1 diabetes. Dan shares his story and talks about how the Dexcom G6 is being used in hospitals for Covid-19 patients.
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Scott Benner 0:00
Hello friends welcome to Episode 327 of the Juicebox Podcast. Today's show is with Dr. Daniel disalvo. Now, Dr. disalvo is a pediatric diabetes endocrinologist at Baylor College of Medicine and Texas Children's Hospital. He also has type one diabetes himself. Now, you know me, Dan came on the show to talk about how decks coms were being used in hospitals during the current coronavirus. But then I started talking to him. And I think we got to that part eventually, just I enjoyed Dan's conversation. So we didn't, you know, I don't make a bullet list and be like, talk about this, then this then this. I don't know how to do that. If you want that, go to another podcast, which I'm betting will be boring. Anyway, this one is interesting and fun. And you'll still learn about how Dexcom is used during the current Corona crisis in hospitals. So you know, all the information gets out. But you're not put to sleep by a boring host and stagnant questions that have been written down on a piece of paper. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter by touched by type one Dexcom and Omni pod. Now you can go to Contour Next one.com right now to find out if you're eligible for an absolutely free meter. Why would you want to do that? Well, one reason is, it's absolutely the most reliable and accurate meter that I've used in well over a decade. So that's a pretty good reason to check into it. I'm also going to ask you to check out touched by type one.org. In these trying times, organizations that are doing good work for people, they need your help. So check out touch by type one.org. And of course, you can get a free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com forward slash juice box. And to check out the people who put these continuous glucose monitors in the hands of the people helping those who are suffering from COVID-19. Check out dexcom.com forward slash juice box.
Podcast something here. But first, let me remind you that nothing you'll hear today on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan or becoming bold with insulin. I'm going to read to you now from Dan's professional statement. It says Dr. disalvo joined the faculty in pediatric diabetes and endocrinology at Baylor College of Medicine Texas Children's Hospital in July of 2015. Previously, he was a postdoctoral fellow at Stanford University, where he was an active researcher in diabetes device technology, including closed loop artificial pancreas systems. His overarching goal is to provide compassionate and comprehensive treatment to children entrusted to his care, and to advance the field through clinical research. It says some more here, but what I'm going to tell you is as a serious guy who knows how to have a good time while he's given an interview. And now, Dr. disalvo.
Dan DeSalvo, M.D 3:35
My name is Dan DeSalvo. I'm a pediatric endocrinologist at Texas Children's Hospital and I'm on faculty at Baylor College of Medicine. And I have been pediatric endocrinologist for I guess about seven years now. And my inspiration started when I was 19 years old as a sophomore at Baylor University in Waco, Texas. When I was diagnosed with Type One Diabetes, it was through that personal journey, and his desire to help others that I sort of had this epiphany about halfway through my sophomore year, where I realized I wanted to become a doctor for kids with diabetes, not realizing the journey that would lie ahead. I switched over to pre med and never look back. And here we are 20 years later after my diabetes diagnosis. And now I have the incredible joy and privilege of being a pediatric endocrinologist where I can walk with and Shepherd families on a diabetes journey. And I feel like I learned as much from them as they probably do for me. And you know, I'm really glad to talk to you Scott because a lot of my patients actually listen to your podcasts, read your blogs, and I've really found a lot of inspiration, hope, practical kind of tips and tricks, and also community so thank you for the work that you're doing.
Scott Benner 4:49
diagnosed in college. What were you thinking of majoring in before you made the switch?
Dan DeSalvo, M.D 4:56
So I was actually a political science major and I was thinking that I Maybe he wanted to go to law school, didn't know exactly what I wanted to do. And really, it was through my my diabetes diagnosis that sort of led to this, as I called it an epiphany. My best friend, or one of my best friends growing up was Eric paslay, who I think has been on your show before. So Eric paslay is a country music singer now. But growing up, he was just a good friend of mine who had type one diabetes. And so I learned a little bit about diabetes from Eric, and, but really had no idea that that would be what I would want to do with my own life until my my personal diagnosis, it's kind of a funny side story is that I had, I had for a moment, I thought maybe I wanted to go into medicine. And when I was a senior in high school, there was an internship where I spent about a week in a pediatricians office. And at the end of the week, I decided, you know what, medicine is just not for me. But, but I'm happy to say that, you know, through my personal journey, I've decided to go on this path. And I cannot be more grateful for the opportunities that has provided me in terms of being able to edify my own knowledge, but mostly just be able to, through my clinical practice, pass it on to others, and also, as a clinical researcher, helped to really advance the field of diabetes.
Scott Benner 6:16
Before I asked my my big question, was type one. A surprise? Like, were there people in your family who had it? Or did it come out of nowhere?
Dan DeSalvo, M.D 6:27
Scott, it was a total surprise. I, you know, I was that kid who never miss a day of school, always won the awards for for attendance, no family history of type one that we're aware of, in my family, some type two. But no family should type one. And yeah, I bet the summer after my freshman year of college, I went on a medical mission trip to Africa actually was just a mission trip, not a medical mission trip on a mission trip to Africa. And on the tail end of that got really sick. And when I came back was just continuing to lose weight, had to excessive thirst and urination, this similar story to so many have the diagnosis of diabetes, but was kind of in denial. And finally, it was my roommate, who was a really light sleeper, who every time I woke up was waking up. And finally I said, Dan, I don't know what's going on. But you've got to go find out what's going on, you know, what's wrong with you. So I went to the Student Health Center at Baylor was diagnosed with diabetes, and spend a couple of days kind of learning how to manage diabetes had a sister who was in college, about two hours up the road in Dallas, who actually came down to Baylor where I was, and such an amazing advocate would actually come to my classes with me, because she was so worried about me, you know, having a low blood sugar, this was all brand new for us, and would help me kind of talk to my professors about this in diagnosis and what to expect. So having advocates like my sister, Sarah was was really impactful. And it wasn't long before I became my own self advocate and develop my own knowledge base. But, you know, to answer your question, this was totally out of the blue. And while initially shocking, really led to, you know, learning so much building community with other people at Kent on campus who had diabetes, and ultimately leading to this sort of career calling for me
Scott Benner 8:20
so what would you How would you describe your, your goals for patients? I mean, we talk all the time here it's interesting the threw me off a little bit by saying that you knew the podcast but you know, we talk all the time here about giving people great tools, good information, so that they can make better decisions so they don't get caught sort of in the backsliding vortex that is being confused by diabetes. And and I hear back from a lot of clinicians who are like keep talking about this please this is how we do it. You know, we share the podcasts with people but I hear back from far more people who have successes after listening go back to their doctors and then are honestly yelled at like scolded in the office, even when they show data, even when they pull out a Dexcom graph and say look, no I don't have meaningful lows. You know, I've only been under 65 2% of the time you know in this 90 day period I'm getting this a one c you know legitimately the doctors you know what I always surmise is either they don't understand or they're just scared and they've never seen anybody with a good a one c before someone make a change that quickly and and that does happen people will listen and in the span of one a one c measurement sometimes dropped their their number a point or some people too, and it scares Is that what it's happening to them? Can you can you kind of put yourself in their shoes if you see somebody with an eight nine who all of a sudden has a six nine, and they tell you I heard this on a podcast. What would that sound like to you as a doctor if somebody came in and said that
Dan DeSalvo, M.D 9:59
Yeah. So a couple of things on that, Scott, first of all, you asked about sort of my my personal mission for caring for patients. And it's really, to help empower them to live well and die with their diabetes, to really take ownership of it. And I'm not only looking for improved clinical outcomes, but also less burden of diabetes. And I think part of that is, is being really tight in the community, and having a sense of purpose. And I think that's where the diabetes online community, your blog, your podcast, has really helped inspire them. I also think it's those nuggets of truth in terms of being able to have the self initiation to manage diabetes, having the confidence and the skill set that comes with time. And I think hearing other stories, what you've done with art in with so many of the parents who brought on what so many of the young adults, living with diabetes, their stories, I think, is really helping helping to empower others. You know, I think my sense, as a, you said, at the, at the onset and a younger physician, it all kind of takes the the what how I view this, for maybe some of my really amazing experience overheard colleagues, I think were from where they stand is that the diabetes control and complication trial was published in 1992. And at that time, you know, which really was in many ways, now, the Stone Age is a diabetes, having a lower a one C was associated with a higher risk of having a severe hypoglycemic event. having a seizure or loss of consciousness passing out, right to be clear with the tools that technologies that we have now, that is no longer the case. In fact, if you look at the T Wendy exchange data, which is sort of a cross sectional look at a one sees and the US, having a lower a one C is not associated with a higher hypoglycemic risk. In fact, those with the highest day onesies have a higher risk for having severe hypo, probably, because in many ways, they're managing their diabetes in the dark, maybe they have a lot of struggles with, you know, maybe their adherence and sort of where they are in their diabetes journey, it could be from a tough place, maybe it's the social determinants of health that don't allow them to have access to technologies that others may have. But you know, what I've heard on your podcast, but I've certainly experienced in my, in my clinical practice, is that so many families who have a one sees that are dropping, dropping, at the same time having less hyperglycemia on their CGM, that's sort of the holy grail diabetes, right, there's, I think, three things. One, a lower average glucose associated with the low re one C, two more time and range, the percent of I use in the 70 to 180 range, or 70, to 140. And then three less hypoglycemia, percentage values below 70, or below 54. And that can be achieved that can be done with a dynamic approach today to diabetes, with the technologies and skill sets and the self initiation. So in my personal practice, you know, my goal is really to help help to lift up and inspire my patients and their families. And really, to be sort of, in many ways, a coach and a guide, my hope is, is that they'll reach the point where they're just as self empowered and self initiated, as you and Arden are. And I do see that with so many of my patients, and it is a journey, everybody's on a different pace of that journey. And for some, they require a little bit more guidance and coaching. But they do often reach that sort of Zen state and diabetes, where they've got it, and they've got the confidence to do it. And they reach a place where it's less burdensome. And it's just so amazing to see the kids living well and thriving as students, as athletes as musicians. without diabetes getting in the way,
Scott Benner 13:42
I honestly the feet, you know, I've been doing this now for quite some time. And what I'm seeing coming back from people is that it doesn't really matter, your level of education or social status, or any of the ways we you know, quote, unquote, measure people, everyone can figure this out. And it's not as difficult as we make it seem, or you know, as others sometimes make it seem I'm not saying that taking care of diabetes is simple. I'm just saying that there's some basic kind of tenants, if you follow them, through experience trues are you know, on earth, and all the sudden you see them, and then it doesn't matter the situation I always kind of chuckle sometimes when people are like, Hey, what are you talking about on the podcast? Would that work during a soccer game too, and I was like, it works doing everything. It's it's the idea of putting insulin where it's needed. It really is all it's about I joke all the time. If you all figure it out, I'm not gonna have a podcast anymore. It's timing and amount, put the right amount of insulin at the right place. That's it. It doesn't mean there's not much more that there's other variables. Of course, that can impact those things. But you start to experience those variables and then before you know it, when something goes wrong, you just know what to do. I don't know another way to put it like when something happens with Arden's blood Sugar, I don't stop, put my hands on my hips and start thinking, Oh, okay, well, you know, I guess so she was outside, actually, I just, I can look at that graph on that Dexcom screen, I think for a brief second about what's going on, and I know what to do next. And that just comes with repetition, you just have to get your 10,000 hours. And once you have them, it's I hate saying this, but it's kind of easy, at some point and easy, not that it's not impactful and horrible. And you know, all the other things that diabetes is, it's just your time involved in it becomes so much lesser that it's sort of just a throwaway to me like it. We don't really talk about diabetes around here that often. You know, it's just something happens. We adjust, we keep moving, we don't look back. I don't know why that can't be. Well, I'm gonna I'm gonna rephrase, I believe that can be taught to anyone. But I think it's the same thing. I think the reason the podcast works is because of the repetition, the conversations around the ideas, because it's not something you can just sit and tell somebody, you know, one time how to do and write them down a rule, which is, you know, everybody wants, you know, tell me when tell me how much that's that's not how this works. So given that, I believe you believe you believe in that, too. My thought on this end always is if I can do it here, right? Like if you've ever you've never heard me speak live somewhere. But I guarantee you, I can talk for an hour an hour and 30 minutes, and a large percentage of the people in that room will leave and their agencies will go down by a point a month. So what if I can do that? Because Doctor, Doctor it Can I call you doctor Damn. Doctor Dan, I'm almost a more like an idiot. I know college barely got through high school. Okay. If I can do this, why can those even those silver hair doctors? Why can't they like were anybody like, why is every wire? Why are there a mass of people just going with you didn't die today? And that's a good day. Like, why is that the? Why is that the bar we're trying to get over?
Dan DeSalvo, M.D 17:04
Yeah, so. So you know, one is, is I think I think you're exactly right that your life experiences and sort of learning from cause and effect is something that can really help to inform the next way you do it right. So using CGM is what I call it heuristic learning tool, meaning something where you can sort of learn from cause and effect. Yeah, so with the breakfasts that you eat, or the activity that you that you do, or the you know, your favorite meal at your favorite restaurant, once, you know God willing, we can all go back to doing that, again, you know, really paying attention to it. And and the approach that you took with your insulin, the timing, how is delivered, you know, the adjustments you make with your temp basals are the carbs that you take, before exercise, make taking mental notes of that, and the next time trying to do it just a little bit better, and eventually reach that sweet spot where you can do it really well. You know, one of the joys I have is to be able to sort of watch families as they progress through this process. And you probably remember it well from monogamous first is when she was a little one and how daunting that was and how you wonder how you can ever do this. And then you start to gain a little bit more knowledge and a little bit more skill. And you eventually reached that, that that sweet spot where you realize I've got this, and I can do this, and I can really become an expert, I think with physicians, I you know, I think there, there are so many also who are nimble, and who do change and who were here during dcct, way back in the early 90s. Were before and who really had advanced, so to where, you know, we are now with leveraging technologies and taking an emic approach to diabetes. I think the nature of medicine, though is is that there are others who may be a little bit less resistant to change. They're still practicing the way that they were trained. And I think the other thing is, is as providers, we can all have the humility to sort of learn from our patients as well, you know, maybe there's a new tip or trick that they've learned. And if we kind of step back, and learn from that, it might be something that we can help to impart to another family as well, in the case of diabetes, and so i think that i think that's just a matter of being, you know, willing to sort of change to have an open mind to really advance one's knowledge and to be able to take the learnings from others. And you know, if it makes sense to help to realize that everyone is different, to be able to help to take those special tips or tricks or pearls so that others can can use those to improve their diabetes improve their quality of life as well.
Scott Benner 19:41
Yeah, well, I I just listened. I I agree with what you're saying. I I would like to put myself out of business here right Joe quit, you know, after I put my kids through college, but I would like to put myself out of business. I would like it that one day. This is how doctors across the globe talk to people about diabetes and I've had private comment sessions with some who will say, Well, you know, there's some people who don't get it. And I'm just thinking, I always think, no, you just, there's a way to explain it to them. You know, I, I fall back to a conversation I had a long time ago on the phone with someone, someone online connected me with this young mother, and she was struggling helping her daughter. And I got on the phone with her. And I was like, Oh, I can help her. And I started talking. And it became kind of evident to me that I was speaking with someone who had to drop out of high school to have a baby. And that maybe wasn't on track to go to college to begin with. If that, that, you know, I'm trying to be kind. And, and she just wasn't the she wasn't the brightest person I'd ever spoken to in my life. And I was explaining Pre-Bolus thing to her, the way I explained it to everybody forever, and she just wasn't grasping it. And in that moment, I had this horrible kind of dire feeling like, I have to get off the phone, I can't help her, I'm going to put her in a situation where she's going to hurt this kid, and you know, blah, blah, blah. And then I stopped and I thought, how am I gonna do that? How am I gonna just tell her Oh, well, good health isn't for your daughter, and and get off the phone. And so in that moment, I made up a story about a tug of war. And I put insulin on one side of the rope and carbs and body function on the other. And I started telling a story about this tug of war. And now I sometimes get notes from people who say, Hey, I was in an office the other day, and my doctor explained Pre-Bolus thing to me. And I said, Do you listen to the Juicebox Podcast? And the doctors said, Yes. And I thought, that's just such a wonderful thing. But it's because I didn't listen, I'm not trying to give myself credit, I'm trying to say that you can't give up on people that everybody has the ability to understand this, this is, it's not that difficult to understand. You just have to find the words that they need. And I think that, you know, Jenny and I were talking the other day on the podcast, and I said that sometimes, you know, it's not that we're bad students, sometimes you're not a good teacher. And and you know, that, that should be it, and I get the rest of it, man, like, I get the office hours, and you got to get people in, you got to get them out. And there's this minimum amount of time. Like, I can't imagine that that seems like a heart to me. But I don't think this is, um, I don't think this is how we're going to end up helping people with diabetes, I, you know, 15 minutes at a time every three months, I think the conversations where it happens. And and, and I think they can get it. I think everybody can get it at some point. I just I'm very excited by the idea that you heard about the podcast, and that you've apparently listened to it. That's really cool. I appreciate that. It's made it out like that to people. It's a very, it's very encouraging. When someone sends a note and says, Hey, I went in with my agency, I showed my doctor my graph, he looked at the graph and said, quietly, they always whisper for some reason you listen to the Juicebox Podcast, it looks like you do buy your graph. Like that's weird, man. You know, they mean like I, it throws me It gives me chills, you know. But anyway, I just think that people like you being out there, I find it very encouraging. I really think this concept of talking to people, like they can understand should just be commonplace.
Dan DeSalvo, M.D 23:18
Anyway, I agree. Yeah, no, I agree with that. I mean, I one of my favorite parts about my job is I get to interact with such an amazingly diverse group of people from so many different backgrounds, cultural backgrounds, races, ethnic backgrounds, education, socio economic status. And I think you're right, and I think everybody can get it, I think it might take a different approach, and really meeting people where they are. But if we take the time, the effort, the energy to do that, then then we can get there. I mean, everyone, you know, all these parents, they love their kids, they want their kids to be healthy and safe and to thrive. And if we take the time as a team to teach them how to do that, it's helpful, I think, something that you hit the nail on the head with is, is that it can all happen in the walls of a hospital. So finding community, and whether that's online or with with a podcast, or, you know, we have a lot of different community groups at our hospital to get families together, I think there can be shared learning there that can really help with others so that, again, we can transport this knowledge and we're not just keeping it with one family, but we can really share it, among others. I think it's also helpful for the for the providers, so the diabetes care team, and it can be there as well. Because again, we learned so many tips and tricks around diabetes management around how to use which adhesive to keep the CGM on or, or the pods or you know, how they you know, whether it's Pre-Bolus seeing or managing diabetes and exercise. And we all have a lot of learning there. And again, that knowledge can be transported to the masses
Scott Benner 24:51
being agile like that is so it's incredibly important. It's just like you said if forever allowed to travel again, I'm supposed to head out west to talk to a group of doctors About how I talk to people about diabetes. And that's, that's a cool thing, because they're those are a group of people who are going to leave their ego behind, get in a room, and, you know, stupid maze gonna walk in and say, Look, here's what I've learned about how people hear this. And that's, that's very, very exciting to me. Because, you know, listen, I have friends who are doctors, and one of them told me once he put an age on it, and he said, I'll never go to a doctor over that age. He's like, because they just stop learning. And, you know, now all the sudden you're being, you know, you're being treated 25 years ago, and that's, you know, not valuable for people. And I'm like, Wow, so everything we you know, but are plenty of doctors who are older that keep up to and that's just,
Dan DeSalvo, M.D 25:48
I don't know, man. Absolutely. Yes. In fact that a lot of my mentors so people like Bruce Buckingham at Stanford, who I trained under, people like Laurie lafell, at Joslin build terrible in at Yale, who have been doing this for a long time are not only incredible mentors, but they are, you know, at the cutting edge of diabetes. And there's so many who, you know, might be might have started this journey a little bit before me, but are way advanced in their knowledge and constantly have that agility to change and are really at the cutting edge of this. And so yes, I mean, that I wanted to specifically call out a few of those who've had such an impact for me and my training and mentoring me my career. But there are so many people like that who are out there,
Scott Benner 26:34
it can't get lost if we're talking about the problem where you know, but it can't be lost in the conversation. There are plenty of people who stay behind didn't mean they learn this thing, and then they don't run forward and keep it for themselves. They stay behind to share it with somebody else. And that's how the idea. Yeah, you know,
Dan DeSalvo, M.D 26:51
yeah, and I think that that gets back to being one's advocate, as a patient as a parent, where if you have an interaction with the diabetes provider, where you don't feel like you're learning where you don't like they're supporting the, what you're doing and managing diabetes, when you know, it's working. There are others out there too. And I don't think it's always an age thing. I think it's partly just an openness, and being really adept at taking cutting edge approach to diabetes care, a dynamic approach with Pre-Bolus. Seeing and, you know, dosing based on trend arrows and leveraging technologies like CGM and closed loop systems, you know, that that's what you want to learn from, that's you want to be in your corner, so to speak. And so if you don't feel like you're getting that, then you know, there are others out there, hopefully, depending on where you live, who can can who can be of more support to you.
Scott Benner 27:47
I just want to be a cheerleader for organizations who are out in front and thinking in a modern way. And for the rest of them who through fear or whatever. The reason is that they keep good information from people, you know, Shame on them. You know, I just I don't have any time for it. Okay, yeah, we had you on for a reason. It wasn't this, although I'm really enjoying this. I wanted to talk to you a little bit. If you have type one diabetes, you need a blood glucose meter. Even if you're using the Dexcom, g six, or another CGM, you still need a reliable and accurate meter. It's easy to transport and use. And that meter for me, is the Contour Next One blood glucose meter. Now there are links right here today in your show notes, right in the podcast player, where you can go to Juicebox podcast.com, to find them. But what I'd like you to do is to go to Contour Next one.com and check out the meter. I mean, I know it's a blood glucose mate, and you're thinking what could it possibly do? Scott, you put a test trip in it, you poke your finger. I mean, they all do that. Yeah, they all do it, but some of them do it better. So right out of the gate, the Contour Next One, accuracy is insane. Top of the level, right at the top, right there, right at the pinnacle of the mountain. If you picture a mountain and up the side of the mountain, there's different blood glucose meters, in order of how great they are. Contour. Next One, right at the peak. I think you understand it's good because of my amazing description. Now, test trips offer a second chance, which means if you hit the blood and don't get it right, you can go back in, try again without ruining a test trip. It's got a great light that works at night. It's small and easy to hold on to without being so small or slippery. You don't mean that you can't handle it. I just love it. Absolutely 100% the best meter I've ever used. Contour Next one.com Check out the link at the top of the page. You might be eligible for a free meter. When you're done there, please check out touched by type one org wonderful people doing amazing work for people living with Type One Diabetes, they need to now more than ever touched by type one.org. And of course, if you'd like to check out the Dexcom g six dexcom.com forward slash juice box, and to get a free no obligation demo of the Omni pod tubeless insulin pump, go to my omnipod.com forward slash juicebox. All these links are in the show notes of your podcast player. We're at Juicebox podcast.com.
You know, I was talking to Dexcom. And they were discussing with me a little bit about how the sensors are being used during the current coronavirus crisis. And I found that idea in chanting and I wanted to know a little more about it, and they said you were the one I should talk to. So can you tell me how cgms are helping during this time?
Dan DeSalvo, M.D 30:56
Absolutely. So you know, I think the main reason why CGM why the FDA is allowing CGM to be used during this unprecedented time with the public health crisis of COVID-19 is that it came out of the need to really preserve personal protective equipment or PP, and also to reduce the frequency of staff exposure with COVID-19 positive patients. So you can imagine without CGM, if someone with diabetes who also is connecting positives, you have to have pretty frequent blood glucose checks. And every time there's a bug, because check, the staff is having to dawn TP to wear peepee to walk into the room to check a glucose, that's another that staff exposure to the person with with COVID-19. And, and furthermore, you know, of course, with with blood glucose, it's just snapshots in time of what the blood sugar is doing as well. As opposed to CGM, which really is the full, comprehensive picture also with the trends and the alerts. And so in step CGM, with this ability to have this cloud based technology, where if the person with diabetes, who asked COVID-19 is using CGM, with the Dexcom g six system, the transmitter can transmit up to 20 feet. But also, if it's on a cell phone, which Dexcom is supplying Android phones, for the user to have the patient who's hospitalized via x com share a follow feature. Those CGM data can be tracked remotely by the healthcare team so that the nurse who's no longer at the bedside, can receive an alert for low or high glucose on her phone or her hospital issued device to that that the doctors, the medical assistants, whomever are part of that care team can receive those timely alerts. And also, depending on hospital protocols, you could use CGM, in some cases to supplement or even in place of a normally scheduled blood sugar depending on where that that level is. So again, you're reducing the need for PPV, reducing the staff exposure to patients. But you also have this this real time CGM, which can aid in glucose management medical decision making. So that's where it came was really out of the need to limit PE and staff exposure with patients. But I think that there will be a lot of lessons learned on how CGM as a tool can really help with keeping one safe and healthy during hospitalization. For someone with diabetes,
Scott Benner 33:34
that's a second thing. I thought when you were saying this, the first thing is I wondered what the process was like. And, you know, I guess the the FDA had to say yes to this in a quick fashion. I guess that that is interesting. But I'll I'll bug Kevin about that when I get him on. But the idea that all of a sudden, nurses and doctors are going to get to see this technology that they maybe don't know about. And I know it's easy to think of course they do. They're doctors, they live in hospitals, you know, this is this is their life. But Arden had a cyst removed, you know, just a little cyst. This is a short surgery she had to have a number of months ago, and you know, had all the conversations in the world with the surgeon. This is what Arden wears. we'd like it to stay on her while she's in there doctor was like, Oh, yeah, sure, sure. I got yesterday. That's no problem. I get to the hospital on the day of the nurse comes in the room to prepper the prep nurses like oh, yeah, that's no problem. If the doctor said it was okay, it's fine. Well, then the nurse, the next nurse comes in the one who's going to be in the procedure. And I start you know, now at this point, I've set it to the doctor, I've set it to the prep nurse, everyone's Yes, me to death for a month about this. So I'm now I'm just talking to the third nurse and I say, Hey, you know, this is great that you guys are doing the shoes. Oh, that's not hospital protocol. We can't do that. Just like that. I was like, Wait, what? No, no, I've been talking to the doctor and I started explaining it to her, showing it to her and she's like, Yeah, it's great, but we can't use that. a nother nurse walks in the room. And I just I wish you could have seen me down I pivoted right from the one nurse to the other Other ones, like the first one wasn't there anymore. I was like, Hi. And I started explaining again thinking like, let me take another stab at making this clear to somebody. Well, that nurse says, Oh, my friend has type one diabetes. That's cool. Let me see. Oh, she has this too. Oh, yeah, yeah, we'll use this. I'll keep her phone with me. Just like that. The tiniest bit of understanding, when I made that conversation go from, oh, no, there's a hospital policy. We can't do that to no problem. Give me your daughter's phone, I'll take him to the operating room with me. And that's the understanding that this kind of technology needs throughout the medical community, because a podcast shouldn't be one of the main ways that people find out about Dexcom. Like, why that hell does that have to be the case? Do you know what I mean? Like, and by the way, don't don't get me wrong, Dan, I need my ads. Okay. But, but I, but what I'm saying here is, what I'm saying is, is that this should be something people just think of not something that they're scared of, or say I don't know about this. So this is a great, it's a great opportunity for them to see it live fire, and really help spread the word to other people with type one. Because until it's thought of like that, you're still going to run into situations where insurance companies say stupid things like you're a one sees too low for CGM, as if those two things in any way have anything to do with each other. You're going to get me upset, Dan, I want people to have Dexcom. So so that that is that is very cool. So what you're saying to me is now we're keeping we're saving equipment or saving exposure, and probably giving people I would think greater care than they were going to receive. The other way. I've seen friends in the hospital with type one it it doesn't normally go very smoothly. Well, have you ever been in the hospital and been hospitalized with your diabetes and have the experience of having to manage like that?
Dan DeSalvo, M.D 36:48
No, but you know, there was Adam brown from diatribe wrote a really, really interesting piece on this his experience in the hospital, somewhat diabetes, I've seen and you know, you're right, it's it can it can be there can be some challenges there. You know, that's one of the things that Dexcom is doing here is since Dexcom has or CGM has not been approved by the FDA for in hospital use previously only for in home use. There may be less knowledge or experience with it. So they're really doing a nice job of of providing training to those healthcare teams who will be deploying it. The other thing that hospitals are doing is looking to who are the experts, for example, diabetes educators, or maybe the the diabetologists, or their teams to help train the trainer so to speak, to help to teach and empower the the hospital staff to use these systems and also how to sort of set up and operationalize what that remote monitoring would be like. And then also, it requires a little bit of a new protocol. Right. So since in many cases, this will be the first time that CGM is being used by those care teams. What do you use for your low and high alerts? And what do you use for low and high alerts in a hospital setting may look a little bit different than it would be at home. For example, a hospital might decide that they would use a low alert of maybe 90 or 100, so that they can intervene in a little bit more timely manner, or a high alert of something more like 200 or 250. There have been some studies that have looked at sort of health outcomes as it relates to blood sugars. And actually in a hospital or especially an ICU setting, having a blood sugar that's more in the 100 to 100 to 100 range is associated with improved clinical outcomes, as opposed to running really tight like you might, when you're otherwise health and safety, health and safety in your own home. And so developing the systems and protocols is something that a soldier having to do. We've been talking for a while just as a industry about how we really need disruption in health care, right, so that we can do things a little bit more and a little bit more efficient. And I think technology forward way. And while COVID-19 has been such just a terrible tragedy for our country, the countless laws lives, lives loss, the impact it's had on our economy, how it's impacted almost every one of us personally in some way or someone we love has been so horrible. You know, one of the one of the silver linings, I think that may emerge is that we will see things like the plane these technologies and a a smarter, safer, more efficient way and move to telehealth where we can you know, instead of having families being disrupted from their their normal, you know, job or education having to do with traffic be able to do things by telephone, and diabetes, where we have cloud based CGM technology, where families can in some cases, download their pumps from home or at least provide a log of what their doses have been, actually lends itself nicely. So my hope is is that many of these lessons learned from this really horrible crisis can be used going forward too. deliver healthcare deliver medicine in a much smarter and better way for patients.
Scott Benner 40:06
It is normally in emergency times that medicine leaps forward, it's, you know, it's hard to think about, but wartime brings all kinds of revolution to medicine, because you put doctors in a situation that isn't perfect. You give them, you know, you give them less tools than they might normally have in a hospital. And all of a sudden, they've got to be MacGyver, and they figure something out. And some of that stuff ends up, you know, becoming commonplace in in practice. And I'm just, I'm excited about this, I'm, I'm imagining a nurse, getting an alarm on a CGM at 100, like you're saying, and intervening, and then watching the blood sugar bounce back up, and having that thought, like, wow, maybe I didn't need as much glucose drip as I thought I did here. And maybe next time, that'll stop them from driving some poor patients blood sugar to 250. Because, you know, because of fear, maybe you'll it'll teach the the fine tuning ideas around diabetes to them, you know, and, and then who knows where that goes from there? Like, where do they take that information? And where does it spread to next? This is the stuff to me, that's macro very, very exciting for people with diabetes. If you have no idea what's going to happen to that, that nurse in that, you know, made up situation, goes home becomes a, you know, the parent of a kid, but Type One Diabetes five years from now. And then that kid becomes a doctor like you 20 years from now, and blah, blah, blah, and where do we end up because of this? You know, I, I just I can tell you that where I am now, in my understanding of Type One Diabetes was held back by the direction I was getting from my daughter's doctor, I was seeing things. And I was having thoughts and desires about changing practice. But everything I heard on the doctor's office side, was telling me I was wrong. And I had to break out of that feeling that Oh, no, I am doing it. Right. This is just what diabetes is. I don't know man, like I'm very excited for people to not live the way some people do now in the way my daughter did for a number of years when she was first diagnosed, I just don't think there's a need for it. And I think that anything that moves us towards that is exciting. And this is particularly interesting and how it came about. Do you happen to have any numbers on how many people are actually wearing it? Who were infected with? COVID-19? Do you know?
Dan DeSalvo, M.D 42:30
I do not know how many it is. And I can tell you I've been hearing from a lot.
Dan just disappeared.
Hello, this is Dan. I'm back. Yeah, what happened? I'm wondering as zoom kicked us out, I don't know.
Scott Benner 42:44
I sang while I was waiting for you to come back, which I'll take out. Because I can't say
Dan DeSalvo, M.D 42:48
you were slacking picked up with your last question, which was in regards to how many people are using it right now? And I don't know the answer to that I can tell you from speaking with my colleagues, from all across the country, we're all eager to use this in our hospitals just because of the reasons we mentioned, in terms of being able to preserve PP to reduce staff exposure, but also to have that helpful tool for aiding diabetes management. You know, to your earlier point, one of the things that is helpful with CGM, in addition to having the comprehensive glucose stream to having the the alerts, it's having the arrows also, and in many cases, this will be the first time that some of the hospital staff will see that. So you know, I always describe glucose as being like a vector or an arrow has both a current level, but also direction. Yeah, glucose that's 150. And headed down is different from a glucose that's 150 and double arrow up change by more than three milligrams per deciliter per minute. And so to be able to kind of, you know, and in the case of daily management, you know, and leveraging those trend arrows for daily diabetes decisions is so important. And I think that that can play an important role in a hospital setting as well with managing insulin doses, or insulin drips, or IV fluids and dextrose, concentrations, and so on. So it's another one of the things I think will be born from this. This use of real time CGM during the covid 19 pandemic.
Scott Benner 44:17
That's a great point I talked about stopping the arrows I consider not just the, you know, the direction and the speed, I call it the momentum, like you have to stop the momentum of the blood sugar. And you know, you know, talking to people about I don't know about a Pre-Bolus idea. I'm like, you know, you you count your carbs, your blood sugar's 90, you put your insulin in, but you don't Pre-Bolus now all the sudden the food starts impacting your blood sugar before the insulin has a chance to before you know it, your blood sugar is 180. It's 190. It's 200. It has momentum, you only have enough insulin in there to cover the carbs if you're if you're lucky. And you know, the glycemic load of this food actually matches up with your carb ratio that's set up Right. And so now, you're staring and watching this, this number go up and up and up, you don't realize you need the insulin for the carbs you need to be, you need the insulin to stop the momentum, and you need the insulin to bring the number back, you know, you're sitting on one third of the insulin now that you need, you know, one third of the picture. And, you know, most people stare at it and stare at it, they think, Oh, I counted the carbs, right, like they're back at that point. That's not, that's not even a tiny bit of the picture. It's, I couldn't do what I do for my daughter, and what she does for herself, and what the people listening to the podcast end up doing for themselves. Without the data that comes back from the Dexcom. Like, it's just it's no bowl, you know, like I, I, there's a lot of people I could have, as advertisers on the show, there's a reason I chose the ones that are here. I was wondering about your management, do you have like, like, what are your goals day to day for yourself?
Dan DeSalvo, M.D 45:55
Yeah, you know, I think for for me, it's, you know, I live a pretty busy active life, professionally, but also as a father of two young kids. And so, certainly, for me, being able to watch my glucose and trend arrows closely is important. And, you know, I aim for pretty tight control. And so I have pretty tight thresholds on my low and high, you know, that works for me, it may not work for some of my patients, depending on where they are, and their diabetes journey. And so, you know, I pay, I pay pretty, really close attention to the trend arrows and a lot of what you're talking about in terms of, you know, stopping the glucose in its tracks, looking at the momentum of whether it ties or lows with insulin or carbohydrate, respectively. And really trying to sort of guide the glucose and, and sort of hone in on on that, that maintaining the time and range, and you guys seem strange that the range of, you know, for me, I'm aiming for 70 to 140, typically. And I also, you know, I do a bit of, you know, nutritional approach diabetes, for me as an adult works, you know, it's not, it's not necessarily advocate for my patients, but I tend not to eat breakfast on weekdays. And so I need to sort of ride my basal rate, usually, and within range glucose in the morning. And then for lunch, I usually fairly low ish carb lunch and get most of my carbs at dinner. And so I don't have to worry about blusher quite as much during the day. And then in the evening time is where I tend to have my largest meal. It's also when I exercise and so that can present some challenges with management. And so just like, the patients I care for, I'm always learning in my own diabetes on how to how to best manage it.
Scott Benner 47:39
Have you ever taken information from a patient and applied it to your own life?
Dan DeSalvo, M.D 47:44
Oh, yeah, I mean, absolutely. I mean, they're their little tips and tricks that I pick up from them that I might use my own. You know, I'll give you an example. Sort of a concrete example is with the adhesive that I use for my Dexcom you know, I run cycle and swim, I lead a pretty active life. And I have two kids who like to wrestle with me. So, you know, for a while I was having some challenges and keeping an eye out for 10 days. And, you know, some patch, this was a while ago, but some patches adhesive that's available on Amazon and other places. And it's also hypo hypoallergenic. And so that was something I was able to use to really buttress down the CGM, the sensor transmitter to prevent it from coming off. And, you know, I've really not had any trouble keeping it on for 10 days. And I usually wait until it starts to maybe on the edges start to come up just a little bit, and then apply the adhesive. Okay. And with that, it's really works well. And so that's something also for my patients who, you know, they may be athletes, or, you know, Texas, it gets really hot in the summer, people do a lot of swimming, using these sort of things can be really helpful. So that's just one of many examples I can I, you know, I can share, you know, that I've learned from from patients,
Scott Benner 49:01
I just thought you have a even interesting, you know, opportunity for yourself. Do you think that having Type One Diabetes is a benefit for you in what you do? Or does it give you an advantage? I mean, if I'm looking for an endo what I I want them to have diabetes.
Dan DeSalvo, M.D 49:22
You know, I think I think anyone can do this. And I think I think it really takes having a passion, but also having the kindness and just the the willingness to go the extra mile in terms of having the knowledge and skill set and diabetes management. I don't think you have to have diabetes to do that. I do think that living with diabetes does give you a way to really connect in a really powerful and impactful way with patients and families. And so I i do some time and I do oftentimes share that I have diabetes and and i don't really talk about how I manage my own diabetes as much But I do try to convey a message that, again, you can live well and die with your diabetes, you can become absolutely anything. You can become a professional athlete, a movie star, you can become a US Supreme Court Justice, a lawyer, a doctor, really whatever it is that you're passionate about, you know, I used to say there's only two things you can't do. One is become a commercial airline pilot. And the other is join the military. Well, the FAA has now a law now allows with a doctor's letter, the potential for someone to become a commercial airline pilot with diabetes. That was a huge win.
Yeah. And yet with Yeah, go ahead.
Scott Benner 50:39
I'm sorry to mean to cut you off. I had Owen Lieberman on the other week, and he was talking about this. And now I'm starting to see people holding their letters from the FAA. All of a sudden, in the last couple of days on social media. So it's happening, people are getting their their pilot's license back, and sometimes for the first time who have type one,
Unknown Speaker 50:57
it's super amazing.
Scott Benner 51:00
And, I mean, honestly, that's in no small part to Dexcom as well. I mean, that that's a that's a an ability for someone who doesn't understand diabetes, to be given a visual way to understand it, and then be able to make that leap like, Oh, you know, we just, you know, the government just thought people randomly get low. And that's what we were talking about earlier, doctors 20 years ago, we're telling you keep everyone see higher, you know, keep your blood sugar higher. You don't want to randomly get low. And now there's, there's real concrete ways to stop that. Listen, last night. Last night at 1130 Arden's blood sugar started to trend down. And I couldn't figure out why. So we're talking and I was like, hey, it's holding, but it's like it's at 70. And I'm like, if you look at the line, I don't think it's going to, I don't think it's going to hold up for us. So we started taking bazel away to see if we could get it to rise and it wouldn't rise. So we're talking, I'm trying to find out what's going on, she see she pulls out her period tracker, and there are days prior to her period where her blood sugar, just that she just doesn't require that much insulin. And so this is where we're at, right? So from 1130, last night, no light or three in the morning, I kept Arden's blood sugar up using the dexcom. And without it, I can't tell you how low I think she would have gotten because I was able to, with confidence, take away the basal insulin in a way that held her up in the 60s, which is, by the way, the best we could do for a couple of hours, even with food intervention and everything else. I'm just trying to imagine if we were blind there, I would just see a low number I would treat her and then that, you know, I think oh, it's gonna come back up again. But for for four hours last night Arden's blood sugar just didn't want to come up. And I had the comfort of knowing that that was true and being able to manage her through it. And, you know, eventually, obviously, it started to move again. And then we were able to re add the insulin and bolus with confidence. After four and a half hours of not eating any insulin, I was able to look at a trend and say, whatever that was, is over now. And you need your insulin again. And so because we were able to bolster confidence, she didn't get high, you know, all the sudden when her body had different needs. And she had a, you know, a reasonable period of time where she didn't have very much basal insulin. It's just It's magical man. Like, it just is, you know, so?
Dan DeSalvo, M.D 53:25
I don't know I love Yeah, I think it's essential. I mean, yeah, for people who have busy professional lives, no matter what it is having that real time data on your phone or on your wrist. And I only know where you are, but where you're headed, so that you can actually, you know, as Wayne Gretzky said, it's not enough to know where the puck is, you got to know where it's headed. And really think 123 steps ahead. I think that that is absolutely essential for being able to do all the things we do to have that that information that helpful data, you know,
Scott Benner 53:55
the genesis of that story was Wayne Gretzky.
Dan DeSalvo, M.D 53:59
His father was something he was his dad, right? I don't remember the exact details.
Scott Benner 54:03
His dad was teach him to play. And he always seemed like he was behind the game. And he told his son, you got to skate where you got to skate where the puck is going, not where it is.
Dan DeSalvo, M.D 54:12
And it's just an analogy.
Yep. So So, you know, perfect for diabetes management, right?
Scott Benner 54:21
I tell people all the time, the insulin you're using right now is for later, it's never it's never for now, nothing you're doing with your diabetes. In this moment is for right now. It's always for later and more importantly, and it's a weird distinction that might seem like it's not a distinction, but it is if you really think about it, it's not so much the insulin you're using now is for later it's the insulin you used in the past is for now, and I know that seems like the same thing. But if you really kind of like really go into a Wavy Gravy plays and think about it for a minute then it's um, it's different. It's, it's more about it's about controlling the energy of the inside the power of insulin that's coming at you. It's about it's about being in It's, I know, I don't know, maybe you'll have to wrap your head around it. And other people will too when they're listening, but it's not so much about now for later, it's about before for now. And if you can wrap your head around them, this is kind of easy, you know? Anyway, Oh, dude, I'm really thrilled you did this, I didn't expect to have such a great conversation with you. I thought we were going to just be like, Hey, COVID-19 Dexcom That's cool. And then you'd be gone. But uh, but this turned into an excellent episode. And I'm really excited that we did this. I might have to ask you to come back on again sometime, and maybe talk more about your personal story, if that's something you might be interested in?
Dan DeSalvo, M.D 55:37
Absolutely, I'd be more than happy to. And Scott, thanks again for the work that you're doing to advance the cause that people living on thriving with diabetes for the community built and for getting this message out there. You know, again, it's it's so I think important for using real time CGM in this area of COVID-19. And I think that there will be many lessons learned from this, both in the hospital setting as well as with telehealth that will be propelled forward as we one day reenter normal life. It's hard to imagine that right now but we'll all be there and so my thoughts and prayers for everybody out there and hope you and your family stay safe well, and I'm adding sane to that list because it can be mind numbing sometimes to be stuck at home, but you know, my my best wishes for for all your listeners as well.
Scott Benner 56:23
I really appreciate that. Then, you know, we last weekend ended up I staked my entire family and we played poker. I played poker to get my own money, just to just to try to pass the time. I said to my kids, I'm like, Here's 25 for you. 25 I gave my wife $25 I took $25 like Alright, this pots worth 100 bucks. We played for seven and a half hours.
Unknown Speaker 56:45
No one wanted to give the money away.
Dan DeSalvo, M.D 56:48
Yes, we need distractions these days. Absolutely. I saw
Scott Benner 56:52
a woman online say that she spent four hours yesterday watching a truck get towed out of some mud. She said it's the most exciting thing that's happened to her. So Alright, man, wash your hands stay safe as well. I really appreciate this. Huge thanks to Dr. Sabo for coming on the podcast and sharing his story and telling us more about how the Dexcom g six is being used in hospitals to aid with the Coronavirus fight. Huge thanks also to the Contour Next One blood glucose meter for sponsoring this episode. Don't forget also, sponsors like touched by type one.org Dexcom and Omni pod. They make the podcast possible. So check them out, use the links support the show. I'm still here. I'm so bored. I don't know what to do. I mean, once I finish this, I'm just gonna go downstairs and like clean something or make something or put something away. All my options. Here's my here's my day. I sleep and then I wake up and take a shower and work on the podcast. cook something clean something. cook something clean something. Take out the recycling. cook something clean something. Watch Ozark and go to bed. That's it. It's the whole thing. It's my life. It's your life. It's our lives, but not for much longer. Hang in there people. Stay strong. Wash your hands. Cover your cough. You know what I'm saying? Don't be disgusting. Say
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