#498 Dexcom Talk With CEO Kevin Sayer

Dexcom CEO Kevin Sayer is here to share where Dexcom is at and answer your questions. We'll chat about Dexcom G7, Apple Watch, Adhesive and more.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

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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 friends and welcome to Episode 497 of the Juicebox Podcast.

On today's show, I'm going to be speaking with the father of a young type one. The Father's name is Chad. And Chad has feelings. Actually, boys have feelings. We're going to talk about them today, and so much more. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin.

Perhaps you've been hearing about the pro tip series from the Juicebox Podcast and like to learn more, you can find them at Episode 210 right in your podcast player, or if you'd like to pick through a little bit online first. Diabetes pro tip.com. That's pretty much all I have for you. Here comes chat.

Have you always wanted to help with Type One Diabetes Research but don't have the time or the means to be involved in a study? Well, you should check out the T one D exchange. You can support type one research and the Juicebox Podcast by going to T one d exchange.org. forward slash juice box. When you get there. It's super simple to do and just takes a couple of minutes. You click on join our registry now. Complete a simple survey and you're done. T one D exchange research has led to increased insurance coverage for blood glucose meter test strips changes in the American Diabetes Association guidelines for pediatric a one c goals. It's helped with FDA expansion of Dexcom CGM labeling, and Medicare coverage for CGM devices. Everything you do will be 100% HIPAA compliant, and 1,000,000%. Anonymous. Sometimes after you fill out the survey, the T one D exchange will reach out to you with other opportunities that you can either take advantage of or not. I've heard some listeners of the podcast have been contacted recently and they were really happy that they were T one d exchange.org. forward slash juice box. Check it out.

Chad 2:48
Hello, name's Chad, the father to a three year old diabetic Carson. Carson was diagnosed in on September 11 of 2019. changed our life forever spoke to be on this because I noticed ever since day one, it seemed like the the doctors you know, we're talking specifically to my wife and it's like sometimes I wasn't even in the room and I just I didn't know that was a general perception in the community with with parents raising type one children or or not.

Scott Benner 3:31
What I found your note very interesting because this is really the tone that you came from. And I want to get to all of it. But before I do, you're an East Coast person, right? Just in general.

Chad 3:41
I'm in Yep, I'm in northeastern Maryland.

Scott Benner 3:44
Alright, so I want to make sure about something before we start especially after last night's Monday Night Football game. You didn't name that poor kid after Carson Wentz. Did you

Chad 3:52
know absolutely. Absolutely. Actually that's funny because we we do we live 45 minutes from Philadelphia. I grew up in New England. I'm a I'm a Patriots fan. Okay. And my wife actually wished kind of harm on Carson Wentz because she did not want the name to become popular.

Scott Benner 4:11
Well, he fixed that. Don't worry, oh,

Unknown Speaker 4:14
my God, she What?

Chad 4:16
She said, She goes, I hope he she's like this is bad, but I hope he gets injured that way. This name just doesn't start popping up everywhere. And that season later that season. He pretty much broke his leg. He's tore his ACL and then Nick foles came in and beat my patriots in the Super Bowl.

Scott Benner 4:35
So you got paid back, but yeah, exactly. Hopefully everyone's not going to be named Carson 15 years from now. Yeah, I have to admit I thought we did at the time. In 2000, actually 1999 when we came up with the name, when we chose coal we we didn't know anybody who named their kid coal and now it's it's much more common. He actually plays on a you know in in college There are two coals on his baseball team. Oh, wow. So we didn't do a great job. But yeah, Carson Wentz took care of this for you, but I love the story. So you, you put the ogopogo on Carson. And then they came back around gotcha in the Super Bowl. Yes. Yeah. Yeah. And it really did too, because we just basically sent out like, guy number two to beat the hell out of you. Yes, yeah.

Chad 5:22
Well, right. He had like the game of his life. And it still wasn't enough.

Scott Benner 5:25
You know, you know, it's so funny. And I won't we won't talk about football long. But my mom's like, almost 80. And I was driving or somewhere the other day, and we spent a good amount of time in the car talking about that Super Bowl. And she loves football. And I said it, I said it. It was just whoever had the ball last. Like they if the Patriots would just got the ball back one more time. Like I actually think there's a strong case to be made that Brandon Graham won the Super Bowl. Oh, yeah. Yeah. knocking the ball out of Brady's sack. Yeah, yeah. But anyway, I it's hilarious that that all came back around to get you by the way, your wife, your wife. I want to meet sometime vicious lady. She couldn't have just, like, wish that he changed his name or something like, Yeah, no, she's, she's, she's pretty harsh. She would write for the cat hope a car falls on. You know. Interesting. Anyway. So a couple things about your note, grab me. One that I think we're gonna spend a fair amount of time talking about was how you felt in the room where the doctor was sort of looking through you? And and how, in general, when you're paying attention online, you don't see a ton of men involved. And moreover, you do see a lot of moms complaining about their husbands? Yes. I don't know that you found. I don't know that you found an issue in the diabetes community. I think you just found that issue in the Yeah, yeah. In the world. But first, tell me a little bit about the diagnosis. We you were there as it happened. And, and yeah, it's in the very beginning.

Chad 7:07
Yep. So we, you know, we noticed the telltale signs, he was drinking, he was drinking like half a gallon of water a day losing weight. At first, we just thought, you know, Carson is a big kid, he wasn't he was a 10 pound baby at birth. And at first, you know, my wife, just I always lose those baby fat. And then he's paying for his diaper every night. And you know, she looked it up early. This was we start seeing signs in June of 2019. And, you know, she wanted to get appointment with a doctor. And it just so happened, they were able to get us in just three weeks after his second birthday. For his two year exam, and, you know, she pushed the doctor, I want to be, you know, I want to test it for type one, I see all these signs, she wasn't too concerned. And she was actually pushing against the test. And we were like, hey, it's it's a simple test. And, you know, they tested the urine and, you know, glucose showed up in the urine. She actually called me at work. I just, I just ran out 5k that morning, I was late coming into work. My my co workers and I were we were talking about 911 just where we were on that day and I had a specific co worker tell me he said, you know, not everyone nine love means the same. I have a old co worker that whose child was born on 911 he he spent the morning you know, at the hospital, you know, enjoying this this wonderful day the birth of his son, right? And he's you know, I specifically remember him telling me He's like, not everyone's nine elevens the same that walk into work and you know, so it goes so and someone's phone's been ringing off the hook and I go to my cubicle and it was like six, seven missed calls from my wife called her back and she she told me that you know, there was glucose in the urine to get home and pack bags. We there's a really good Children's Hospital in the RSA I DuPont wilmington delaware but I guess our insurance didn't cover overnight stays there and so they said you are covered up at CHOP in Philadelphia so and it up chops Lee on one the top children's diabetes hospitals in the world. So we turned out lucky there. So yeah, I packed my bag. Karstens blood sugar was was 370 something it wasn't, you know, crazy, but it was high. And yeah, we stayed there for three nights for the training. I was hands on with the training, looking up glucose monitors and and trying to figure insulin pumps very early. In fact, after In the first night he his blood sugar the next morning was that was a perfect blood Hunter. I remember that vividly.

Scott Benner 10:07
Well, it's interesting, isn't it that the 370 now, what it meant back then you were just like, oh, as they told me his blood sugar's high, and he has diabetes. And now Yeah, it feels a little different.

Chad 10:18
Yeah, yeah. And now Now we start fretting over, you know, one 180 200

Scott Benner 10:23
sounds like you guys caught it really quickly, though. 370 is, you know, elevated, obviously, but yeah, he was wearing a DK or anything like that.

Chad 10:31
Yeah, no, he was, you know, perfectly fine. We're in there with another family whose child was in was in DK and, you know, that was scary. And I, I, I'm, I'm glad that I have my wife and she still you know, part of his she's a stay at home mom. So she's she's able to see those signs day in and day out. So that helped us a lot. Is he your only child or your? So he is our only child, but we do have custody of our seven year old niece, Sophia. So it's like we have two children. Right.

Scott Benner 11:04
But he was your My point was it's the first baby Your wife had raised. It wasn't Yes. Wow. She did a good job too. Yeah, yeah. Well, she's got magic powers. Yeah, yeah. Yeah. She can find diabetes and brake professional quarterbacks legs. Oh my goodness. I just want to say one last time that the Eagles are terrible. I'm an Eagles fan. And I'm gonna say it right now. I don't I can tell you all what happened. But I don't think anybody here wants to hear but I am facing up to it. They are an absolutely pitiful football team top to bottom.

Chad 11:40
But they're only like half the game out in the in the NFC. so

Scott Benner 11:43
pitiful football team and a pitiful division. That's for certain. Yeah, I know why they're leaving the field. The announcers like the Eagles are three, seven and won or whatever they aren't. He's like they're still in it. If only they could win two games in a row, they'd be the champions. mess. Anyway. Okay, so your your 911 is not everybody else's 911 Yeah. And somebody you know, puts the specter of it overtop of you just moments before you find out. Yeah, that's the case. It would have been nice if he would have said something like, you know, I know some people who win the lottery on 911 By the way, Chad your phone's been ringing all mark. Yeah. I won the Powerball baby there are moving people around. You are magical, but they don't use their powers. Well. Well, I I mean, Ardennes. I guess by now we've hinted around it long enough that that is Arden's Children's Hospital chop in Philadelphia. Okay. Yeah. People must know by now listening. But she was diagnosed in Virginia because we were on vacation. That's right. Yeah. But I've never had anything but but good experiences a chop and they definitely are a classy hospital that that that's on the you know, on the bend of the cutting edge the way they talk to people I definitely think that you lucked out going there. But I imagine that's not your hospital anymore. You don't make the trip every time

Chad 13:15
No, we still do it's it's it's less than an hour away. So no kidding. Yeah. Oh, we we love it that much. Especially our diabetes educator. You know that that helped a lot someone someone walking in the room after your son's diagnosed and him being diagnosed as well. Shout out to Ken Yeah, just just seeing that a healthy healthy man my age living breathing diabetes every day himself. So should feel right. Yeah.

Scott Benner 13:45
So your CD he is a guy named Ken and he has typos. Yes. Look at you can do and good work making Chad's family feel better. Very nice. I the only thing about that place that I hate is parking at it and getting Oh yeah. Yeah, it's actually yeah, the Burgess area is terrible. It just yeah, I'm making laps. And like that was it. Oh,

Chad 14:06
I had to place a pin on my on my Google Maps just so I know exactly where to go every time because I miss it. You know, every time

Scott Benner 14:14
I read your thought your your child was lucky enough to be diagnosed in the age of you know, cell phones I had it scratched out on a piece of paper with a hand drawn thing that a friend of mine who would work down there once was like that you go around this corner and through this place fear and you're like, Okay, driving down my babies with me. My wife's back at work. I'm like, it's fine. Everything's fine. This is exactly how I plan life. It's gonna be alright. never really felt Alright, I guess. But now it does. You know, I think that's kind of important to say because I just recently was watching a newly diagnosed family. Ask school questions online. And it just occurred to me as they were speaking that so soon they won't feel like this and they don't And they don't realize it. You know? It's Yeah, kind of.

Chad 15:05
I started listening to your very first episodes, I think I'm up to 25. But it just, it was just five years ago. And that feels just, it feels like the Stone Age. And you know, the progress in these families so much Carson is diagnosed in September, and by the end of October, he was on Dexcom g six. By the beginning of November, we were testing out the Omnipod on them. And December 1, he was alive with insulin when so yeah, we we progressed, you know, chop was very good progress on us very quick. And by January 1, he has his own cell phone. So

Scott Benner 15:46
I do remember Arden being in kindergarten with an iPhone, and every parent in the town hating me and my wife for for causing that uproar. Yeah, she's just, you know, it was funny, like so we all in the beginning, we just wanted Arden to be able to call us from the bus. That was our whole that was our whole goal. And we took her to the store. And you know, no one was looking to buy an expensive cell phone when she was five, trust me. And we you know, we're like these little flip phones that used to exist in a little shells and clam shells and everything. We tried so hard in the store to teach her how to like, use it. And she just, you know, weird menus and she couldn't remember everything. But that, you know, you have to admit that through that that iPhone in front of her in five seconds later, she had the whole thing figured out how to use it. All right, well, here's your baby crack. And if you ever feel dizzy on the bus called daddy. It was pretty much the whole thing. Yeah, but the other families were pissed. They were just very unhappy that Arden was wandering around with an iPhone, you know, she is 16. And yeah, yeah, she's

Chad 16:57
she's a she's Yeah, she's 11. Then in the podcast, I'm

Scott Benner 17:01
listening. That's crazy. And the podcast you're listening to right now? She's 11? That's Yes. My point is she's 16. You know, she's never broken an iPhone. Really? Oh, she's had one since she was five. She's never broken one

Chad 17:12
ever. I think I broke five when I was 25. Alone, you know?

Scott Benner 17:17
Through mine. I tried to put mine in my pocket the other day. And for some reason, just threw it at the floor. Getting old.

Chad 17:26
I don't want to end there always within like three months after buying it brand new.

Scott Benner 17:30
Yeah. Anyway, so chat, I do want to really dig in because I don't know many. I mean, I, I guess how do I want to put this? So I have access to the demographics of the private Facebook group for the podcast. And it's, you know, just the it's obviously not everybody that listens. And it's not everybody in the world. But I can tell you that overwhelmingly, there are women in the group. And the men that are in there are more likely to be type ones themselves. Yeah, not the fathers of type ones. A lot of fathers get added to the group by the mothers. But I don't see them being active. I don't know that that doesn't mean that they're not watching because I can also see the analytics and a huge portion of the people who are members of the group are active within the group every day, although a smaller percentage of them actually post and answer questions and stuff like that. It's, you know, the way the internet works. But it is incredibly uncommon to hear from men who don't have type one. And I am aware of some type one groups for fathers of children with Type One Diabetes. And I don't spend much time in them at all, but the times I have looked, they are more of a I don't even know how to put it. It's like, like a relief valve. Yeah, it's it's like the digital equivalent of getting together and Yep, shooting or kicking or yelling at something. Yes, is what it feels like. And I don't know, you know, psychologically, I don't know what that is, I'm sure we could easily dig in and, you know, go down the rabbit hole of boys are taught not to, you know, show their feelings and things like that, or Yeah, or whatever. But it didn't strike you that way. It obviously didn't strike me that way. I was, um, you know, I, I don't ever talk about it on here very much. But in my book, I joke that I am really just too overly shy of being able to give birth, because I'm a lady basically, in a lot of ways, because I grew up through my mid 20s 30s and 40s, you know, being a stay at home parent. And, you know, became very evident very quickly that if, if my kids didn't have that, that thing that my wife would have intrinsically known that I didn't really know, that kind of care that it was going to be detrimental to them so I just sort of threw myself into it. You Completely headfirst I just yeah, that's what I'm gonna do. So I don't you know, I don't have that when you see me share or hear me share on here. It's it's a pretty direct valve right to my heart I'm not you know I'm not protecting my how I how I sound or anything like that I'm not trying to produce a veneer of, you know, masculinity. I've been over that for a while. Yeah, yeah, yeah, you only have to be a stay at home dad before it's a thing so long before you realize that you know, you are the the heel of a lot of, of you know, whispering you know, in circles I'm sure it's not like that any longer. But you know,

Chad 20:44
yeah, I yeah, I think as you know, we specially younger generations. Yeah, that that that will change with time.

Scott Benner 20:57
Having said that, john, if I could lean the other way for a second. Let me let me have 1980 Scott, talk to you for a second. I don't see a ton of guys built like construction workers who are stay at home dads, either. No, six, four guys that can benchpress a car that have just decided not to work. I mean, I'm sure there were some but they mostly look like me. You know? Although I wish I was taller, but that's not the point. I'll tell you right now. I'm gonna get your wife to wish for my height help I'd be happy if I could just get my phone back in my pocket and you tell her to just say out loud you know something about Scott always successfully putting his phone away. To do that magical work on me. But you're a working guy you know you're not the stay at home. Is there something about you or how you grew up that made you want to be involved?

Chad 21:48
So I think being a being the only boy I'm surrounded by girls and my my dad and round a lot. Maybe Maybe that helped deal with you know,

Scott Benner 22:03
Chad, you're a couple ovary shy having a baby too. Is that what you're saying? Yeah, yeah,

Chad 22:07
maybe it's too much it'd be too much pain for me. I got I rarely get sick. I got sick a couple years ago went to the doctor and and I was like, I don't know. something's really wrong with me and, and the doctor, somebody Chad, you have a cold? Yeah.

Scott Benner 22:25
Well, last week, I got sick. And I was on the sofa for four days. Kelly's like What's wrong? I'm like, I feel a little flush. And when I turned my head too fast, I feel dizzy.

Chad 22:36
Yeah, I was passed out over I mean, I swear I almost cut off my thumb. My wife says it was just a it's a paper cut. But I guess I almost passed out.

Scott Benner 22:48
It's so funny. I've really been injured in my life. Like really, really injured. And that I've handled fine. Yes, like I've, if you ever meet me look for the scar on my left hand that goes midway through my thumb down into my palm. And like I felt laid my hand open, and that I handled completely fine. I've had welders flash where I went blind for a few days that I handled completely fine. I've had a giant molten piece of steel fall into my boot. And of course I couldn't get to it quickly enough. So the moisture in my foot, put it out and like just burned a hole right into the top of my foot. That's fine. rip my ankle apart that I handled fine. If I get a little woozy when I turn my head.

Chad 23:31
Yeah. Well, that's why I told her I said I was kneeling down looking at the cut and then I stood up too fast and all the blood just rushed him. You know, as you get older when you stand up too fast. You can't like

Scott Benner 23:42
change. You got the vapors. That's what happened. Even 1860 illness you just have been overcome. That's all. So you grew up in a family where your father wasn't around a ton. You had a bunch of sisters and a mom. Yes. Yeah. Yeah. Do you feel like you'd have that that more kind of caretaker vibe about you?

Chad 24:04
Yeah, I do. I you know, I things things around the house like household chores are are pretty 5050 as much as they can be with the with the time a lot, you know, with my eight hour spent the job. What What did help out with with caring for Carson was I, you know, six months after diagnosis Coronavirus, it's our streets and I was at home with the family day in and day out. And also I had this Master's project to finish my master's and it revolved around just tracking all the different elements to type one diabetes is just a blueprint of a system. And I devote a lot of research and, and time into that so I was learning about type one a lot. And and during that time, I really was able to dig into like numbers and you know, fine tune adjustments with that.

Scott Benner 25:03
What's your background in systems engineering? Oh, do you have that classic engineering brain? Yes. Yeah.

Chad 25:11
I think that helped out tremendously with with Carson's diagnosis and then my wife, she's an accountant, she's uh, she or she has degree in accounting. She you know, she's she's good with numbers herself. So that that helped out tremendously.

Scott Benner 25:27
And you find that valuable and so like, your management is going really well. Right?

Chad 25:32
for cars. Oh, yeah. Yeah. So within a within six months, Carson was under seven, a one C and at the year mark, he was under six

Scott Benner 25:43
c that's so we I want to pick through that a little bit. Because my experience talking to people, there's there's certain buckets, I'm finding people falling in the more and more experiences I have, for instance, I've said recently, nurses tend to struggle a lot with being the caregivers of people with type one diabetes, which is fascinating is something about how they're trained, and what they do day to day that doesn't mesh with the part of type one that's more style. And you know, then then math. Yes. And I've now seen that so many times. I'm willing to say that out loud. I'm not saying you know, nurses can't figure it out. I'm just saying that they struggle. They they feel like they have a natural built in roadblock. But I've also noticed that people with engineering backgrounds seem to find their own way through it. It's not ever classically mathematical and it's not usually completely like the way I talk about it. They find their own way. So well. Yeah. What did you do and our

Chad 26:45
our our that's funny, sad because our diabetes educator, my six month mark, no Carlin's on a low Basal rate just because of his size. And like, like all night, he's at point one units while he was going high a few nights. And, you know, the problem with that size is you can only increase by 50% more insulin, and that's not really needed. So we, we kind of, we throw in some random point, one fives and two is that nightly basil rate or, you know, every other hour, and you know, is diabetes educators like what the hell are you guys doing? This is off and it's like, hey, it works. Yeah,

Scott Benner 27:24
I'm bumping and nudging with basil is what I'm doing. Yeah, yeah. Well, it's, um, have you looked into that? Are you interested in on the pod five when it comes out using only pod? So are you gonna go to an algorithm?

Chad 27:37
Yeah, very intro, but I've read that, you know, he, I think there's an age requirement to it five or six years old?

Unknown Speaker 27:45
Yeah, I'm

Scott Benner 27:45
listening. I'm not sure. But historically, doctors can write things off label for use, and it's done with diabetes and kids forever. I would think it would be more about you. exhibiting that you can handle it. Yes. Yeah. And that would be that I'm looking at Arden's blood sugar right now. It's funny, it's 94. She's in class. And, um, there's part of me that just is, like, I wonder why it's not 89. Just ridiculous, right? But, but it's, it's, um, and I don't, and I wouldn't, I would, interestingly, come to some conclusion like the one you did, except, I don't think about it in any of the terms you did. Like, I'm sure you were very just like, well, we'll you know, we'll do this. You know, we'll do a little bit here and then move it up and move it down and move it up and move down. And that'll keep the bounce, by the way, that's kind of brilliant. Chad being able to see, you know, because when I say things like, you know, Basil doesn't like when you make a change to your basil doesn't happen immediately. Yeah. You could make the leap in your head that if I just stagger it, then every once in a while, we'll get a little bit of a push down. But it won't be enough to make him low. Yes. And then you tried it, which is huge, because I spoke to someone yesterday on the phone. And she's like, I don't know what's wrong. My daughter's blood sugar has been high since she moved to an insulin pump. And people want to blame the pump right away. Like when we were on MBI it was fine. And now this pump and you know, it's so high. So I'm asking my questions picking through it. So what was her total basil on MDI? And she said, 13 units a day. And I said, you know, show me your Basal rates. Now. We added them up and it was eight minutes. Yeah. And I said, I think we found the problem. Yeah, you know, and she's like, no, but she gets low. Like, yeah, but and then that's when the explanation starts. And it's such a simple thing that I'll say it here. A lot of you experienced Lowe's make the reasonable determination that you have too much insulin. That's why got low, for some reason, take it out of the basil every time. Yeah, then blood sugars trend up because you don't have enough Basal insulin which causes you to have to Bolus too much at meals, but you probably can't bring yourself to do it. So you under Bolus a meal, the meal shoots up, the pressure of the high blood sugar gets to you, you correct it. And then as the corrections working, the food digests out of the system, there's nothing there to hold up the number you crashed down. And instead of seeing that process, you turn your Basal down more. Yeah, which just makes it worse. It's the exact opposite of what you're supposed to do.

Chad 30:39
Oh, yeah, we were Yeah. About the same week, we changed probably the Bolus numbers for for food more than more than you know, we'll see a trend over three days and be like, Alright, well, something's something's obviously up. And we will we'll change his food ratio.

Scott Benner 30:56
I think one of the most important things that we do that ends up being difficult for people to wrap their heads around and and to implement because there's no real rule to it is the part where you, you know, just understand the impact of the food. I mean, this podcast forced me to talk about glycemic load and glycemic index, because you people wouldn't listen to me when I just said, just Bolus what you think the plate needs, learn from last time and do it again, that really is how I do it. I look at a plate and I go into this much if it doesn't work, I make a correction. Next time she eats that food, I take what we Bolus plus the correction I put it in. Now I hear from people a Scott, I can't remember all that I have a job, you know, and so I don't not understand that. But that's why one day I said the Jenny, I we got to talk about glycemic load and glycemic index as much as I don't want to. Because that's not how I want to think about it. But at some point, the podcast got so big that I was like I have a responsibility here. I just you know, now I have to now I have to do it. So you guys are forcing me to learn more things. And think about things differently. Because you're, you're being resistant and not listening to me. And I have enough of that with my children. If someone would just listen chat when I speak, that would be lovely. I just want one person not to argue with me just to go, Hey, the guy said do this, I'll just do it. But that's an incredibly important part. Because, you know, as I explained to anybody out it'll sit still a listener who asks, 10 you know, 10 carbs of one food doesn't impact your blood sugar the same ways 10 carbs of another food and you can't just act like it does and then go oh, I don't know what happened. I count the carbs. You can't do that. But man, people do it. So yeah.

Chad 32:45
And that's like a lot of what like our extended family doesn't doesn't understand. My wife sister the other day, they were talking about getting pizza and my wife was just like, shaking her head and and yeah, she had explained Yeah, he kind of pizza but it just means we're up till 12 midnight. 1am chasing protein and fat and stuff. Yeah.

Scott Benner 33:08
You hear somebody talking about pizza at seven o'clock. You start thinking about what you're Yeah, then what am i binge watching right now? Am I gonna enjoy that? Will I be able to follow it when I'm tired? I have a I always have a binge watch going. It's easy to watch. And one that's more that you have to focus on more. And I know at a certain time, like right now I'm watching Deadwood. But the dialogue is so thick with like old timey euphemisms like you really have to pay attention to follow along. So I don't know I don't do that when after about 10pm is something more Poppy, you know something a little more pillory after 10. So I can pay attention. But it's interesting, isn't it? When someone mentions pizza, you start doing the math in your head. I could probably if this goes right, I could probably go to bed by midnight. If it goes wrong. I wouldn't be able to. You gotta get up in the morning at seven to go to work. Is there any chance we could just have a nice wrap with Yeah. We could put it tomato in it and sprinkle some cheese on top. It'll be just like pizza. And that's socks, man. Oh, my God. And you're you know, it's understandable that other people don't think about it that way.

Chad 34:17
Yeah. And, you know, I, I have a I have a cousin with type one. And I had, you know, I had before it's diagnosed and that I had very little knowledge of what even like type one was from type two and, and all I knew about diabetes was Walter Brimley in the diabetes commercial. So

Scott Benner 34:37
you notice a little bit about it. You called him Walter Brimley. It's Wilford Brimley. Oh, well, there you go. I don't know if you know the story about Wilford Brimley. His mom named him after a very famous sports star. And then realized everyone was gonna call the name Wilford to everybody. So she killed him. And that's why he's the only Wilford you've ever heard of. Back in 1850 it's very long time ago. Hey, I pushed him down on mine. Call it a prospecting accident sounds very sad story but he got to be the only Welford so and look how it didn't help him cuz you call to Walter. How many Walters Do you know in in your life? One? Yeah, I know two and one of them's from mash so that's not a real person that's a character. And they call them radar anyway, so really nobody called him Walter ever do people watch mash? I don't imagine they do. It must not be funny. Any My father was still growing up. How old's your dad? Now?

Unknown Speaker 35:38
He is 62 that's making me feel bad about liking mash. I gotta be honest with you.

Scott Benner 35:46
Anyway, you don't start watching mash now because it was had a 70s aesthetic where you'll just look and go This isn't funny. And I'm just I'm watching it. And um, you know, I remember watching it when I was 12. So anyway, yeah, that's not if you want to television recommendation justified is terrific. justified. God justified. I'm enjoying Deadwood. I've gone into the modern Western phase of my life for some reason right now. I just watched a terrible show on Netflix called longmire that I loved way more than I should have. am and what's the one with Kevin Costner right now that I really enjoyed? It's almost like a like an E. These they call them like, nighttime soap operas the way they were. I sound like my grandmother right now. Hold on a second. I'll tell you the name of my story. What is wrong with me? We got them old. I don't I don't recognize it completely. But I am. Kevin Costner who I can. All the sudden. I don't know how to use Google either. Hold on. I have no idea. What do you Yellowstone? Okay, I've heard of this. So good. Not good in a way like, you know, Hamlet, not saying that. Just you know, they kill a lot of people for no good reason. And there's pretty landscapes. There you go. That's, that's my high bar for tell fish. Yes. Are you writing it down? Yeah, if you hate it, don't blame me.

Chad 37:27
75% Rotten Tomatoes.

Scott Benner 37:29
I don't even know what that means to me that when I see something like that I'm so jaded about the internet. What I think is that it got popular. So they hired a bunch of people to go on and leave bad reviews for it. Like, well, that's a good review. So I used to say, yeah, yeah, that's good review. Does that mean that 75% of the people like it?

Chad 37:51
Yeah. I used to think that about Rotten Tomatoes. I thought the more Rotten Tomatoes you got the worse it was. But no, it it is a it's a good thing.

Scott Benner 38:00
Wow. Way to make something that some so confusing that Yeah, I'm on can't follow it. What a business model. It must be the same person who came up with insulin sensitivity number going down as a down stronger? Yeah. Yeah. Wow, maybe that is why. All right. If the person who made Rotten Tomatoes is listening, I want to understand where that rating came from. Please call I would like to know, so Chad, like, I really want to dig into how it feels like to, to realize you've you're being excluded in your child's care.

Chad 38:38
It's very frustrating. Especially it is a toddler, a giant toddler to to keep his numbers that you know that good and stuff out. I just kind of so that that kind of happened early on our last visit. Um, you know, it kind of involved me more just because well, my, my wife for when told them she's like, hey, Chad's. Chad's behind a lot of these numbers a lot of these changes and at that time, I think we were having too many lows so we were kind of seeking you know, some advice on on what to do, but it was also summer so yeah, who who knows it seemed like once fall hit his his need for insulin went down but uh yeah, it's just frustrating to you know, it's almost like I'm invisible in there and and maybe it's just because the note normal household the father is putting in a lot hours each week and you know, they just don't have the time for to and to review you know, numbers and go over treatment and stuff. You know, I was able to dive in deeper just because of Coronavirus and me working from home pretty much all summer. I'm back in the office now. And I'm, you know, less hands off right now because I'm at work, but, you know, I still call in daily to see how things are going. And

Scott Benner 40:11
so it would have just in general been nice if the physician would have added the extra sentence to say, Hey, you know, how are you guys dividing care here? Yes, and not just just immediately disregard you, I have to tell you, as you're, as you're explaining that I put, I tried to put myself in a classic woman's position and most of history and I thought, Man, this must be how women feel when people talk to their husbands, and not to them, which I'm sure happens to ladies Far, far more frequently than it happens to guys. So, yeah, you might have just, you know, experienced a little bit of a reversal of that. Wow, you know, I just tricked my mind to, you know, you just, it's, it's, you were finally in the scenario where people have power look to the female in the pairing and say, This must be the person in charge. And it struck you really poorly, but badly enough, by the way that you were willing to write an email to a podcast and want to come on and talk about it? Yeah, imagine if women stuck up for themselves like that podcast would be a very interesting with people saying, you know, I go into places and, you know, I go, we went to a bank to get a mortgage, and they talked to my husband, and you know, I make more money than he does. And it doesn't seem to matter. And, you know, all the crap that girls go through. Plus they get their periods. It really isn't fair. Yeah. No, I wouldn't trade it for the world. No, no, it's terrible. I tried to joke about it here. But it? No, it's never received. Well, I have to be honest with you. And Arden is very, like, you know, anytime Arden has her period, and she'll just be like, leave me alone. Like, she's very like out front about it. She's like, This is not the time for you to be talking to me about this. And I go, okay. It's like, wow, interesting tactic. My wife spent years telling me, I'm the same no matter what I'm like, I don't think you are, but I'll go with you. Arden's just like I am not the same Leave me alone. She's excellently she's taking First off, and she's, she's out in front of it. But no, seriously, Big Girls have to carry babies. And that period of thing really seems like a horror. I'm not gonna lie, you know. And I just, I don't mean the act of it. I mean, like, having to go through it and the pain and the hormonal changes and just watching how you have to adjust Arden's insulin for different you know, I don't mean times of the month like that, but But honestly, like, different weeks in the month are, you know, completely different. I was talking to a listener from England yesterday trying to help her with her basil. And, and I said, Okay, now, will this just work like for, you know, this week? You know, aren't you basically like two or three different people through the month diabetes wise, you're and then now I'm, like, embarrassed I've ever spoken to her before. And I'm like, you know, you're like the oscillating you you're like the you know, almost there you in the actual event you and she's like, yeah, I guess that's right. And so then we talked about how to, you know, move her correction ratios and our basil and stuff like that as her body is looking for more insulin and how to recognize when it is very suddenly happens to Lisa Arden needs to go back to the original setting. So it's, you know, trust me least Carson doesn't have to do that.

Chad 43:44
Yeah, eyes are like glazed over. Just think about that.

Scott Benner 43:49
He really, if you if you can wrap your head around it once you can see it, then it's just about the telltale signs, and then you see the signs and make the change. Now obviously with the glucose monitor, way easier to see those signs because the signs really just are more difficult to bring down after a meal if it goes high. Looking like your insulin to carb ratio has gone up a little bit for meals and that your basil has gone up. So as I see that happening, there's a little turns the dials we make make make the insulin, stronger, stronger, stronger but then as the as yatse happens as as as the I don't even know what to say like the event is the event weird. I just want to say bleeding but that seems wrong. So my mind can't find words in case anyone's wondering what's happening inside of my head. Does that happens as soon as that happens, I guess. Then the insulin needs for Arden go backwards. She needs less wear. I've heard that the exact opposite from other people. But the truth is, is once it happens, it happens and you just kind of follow along with it. Now if I left that to Arden, you know, would probably take her days to see all my blood sugar has been high. And you know, I don't think she'd see it as quickly as I do. But anyway, so Chad, let's let's go over a couple things you don't like being treated the way women have been treated throughout history makes you upset. I think I think that you didn't realize that I was going to turn this around on you like this, which I didn't plan on doing when we started now.

Chad 45:26
I'm gonna go through my wife's email, see if she's been talking to you.

Scott Benner 45:31
I just told you, I'm like, I'm just, I'm, I'm a mom at heart. I started, I started defending the other side of like, you know, this is what happens to me. Because I guess now that we're talking about it is what happens to me having been a stay at home dad, in a situation like that I my most vivid memories of it happened around my kids sports, where I yeah, the men, you know what you would think I'd be a party of, but rich, by the way of you know, I live in a town where a lot of people love baseball and softball, this town has won the Little League World Series for softball multiple times. So ports are a big deal around here. And my son is one of the only children from this town who plays baseball in college, you might think I know a little something about it. But when the when those collections of guys, coaches or fathers would happen, I was excluded. Like I was a mom. Wow. And and it's, you know, no one ever wants cared for my opinion about what was even when they were sitting around sharing opinions. If I spoke, it was like, Oh, look, Scott wants to say something, and I'm okay with it now, but it happened constantly. Maybe I really did see that side of it. Because of my own experience just now. And I'm not. I'll just bleep this out. I'm not shitting on you for feeling that way. Like I understand how you feel it to be excluded like that. But I think that this generation would call that male privilege. Yeah, yeah. I wouldn't call it that. Because I'm 50. Almost, and I hate all that. But

Chad 47:04
maybe I'm considered a millennial. So yeah, maybe, maybe. That's how you think of it.

Scott Benner 47:09
Yeah, I don't use words like woke and privilege and things like that in my life. I just think that you know, things are. Sometimes people are awesome. You know, it doesn't. It doesn't need a branding. It really is the internet that forced us to brand like basic concepts of life. Oh, yeah. Yeah, exactly. Yeah. male privilege. This used to be called people didn't treat women. Well. That's, you know, and that's still what's happening, by the way, except now it has a name. So turn so fancy, Chad. Chad, are you very worried that this episode is going to be called Chad has male privilege? I'm not maybe I'll embrace it now. Don't worry. That's not the way I'm going. I just it occurred to me as a listener, you might right now be gone? What is he gonna call this episode of Mike? I don't give my you don't have. You don't have my, you can't use this anymore. Stop just hanging up out of nowhere. But no, I think it's interesting because it happens to I see it happen to men in this situation constantly. And, and I see how it affects them, it makes them feel badly. When I see guys talking about it privately. their feelings are hurt. They know, they know that their wives don't trust them with their kids. You know, moreover, they know that they don't have as much information and that they're not doing as much for their children as they want to be around the medical decisions. And it's really hurtful to them. You know, I can see that because I am a guy. I mean, the way they come off, you'd never Yeah, you know, from from a female perspective, they just look like idiots. You know, I mean, like just ranting children, but I can, I can see it, you know, for what it is because I felt that way too and don't do a good job of expressing myself. So, you know, for as good of a job as I do of expressing myself on the podcast around diabetes. I'm still a guy in my personal life, and I still screw it up in my personal life constantly. You know, I'm forever thinking to myself, that's not what I meant. Why did I say that? You ever had that feeling? Oh, 17 times a day. That's not what I meant. Why do I say it that way? So and I don't think that's an easy thing for a person of the opposite sex to to appreciate just as I don't understand what the hell my wife's talking about sometimes. But I you know, I see it. So for ladies listening. I I've tried to say this throughout the podcast a number of different ways, but I don't think your husbands are disinterested. I think they're concerned they're going to mess something up, or just intrinsically believe that you're better at it than they are and so they don't want to get in the way. Or some of them are lazy. I mean, some of them are playing, you know, PlayStation. I get that but Also we do stuff like that sometimes so that we don't have to be put in the position to fail. Guys guys aren't good at failing. Not that anybody is, but we take it pretty badly. When it's hardwired in you that you're supposed to go outside, clunk something over the head, drag it back to the house so we can eat it. And if we don't we all die. You know, when you can't do those things, it's a it's depressing a little bit, you know? But luckily, you don't have to feel like that around the diabetes. That's Yeah.

Chad 50:29
But it is, it is also difficult kind of CO parenting co managing, you know, me my wife had had our arguments over over what to do nothing, nothing really. He they just kinda, you know, you know, I just, Hey, can we feed them something different or, you know, dose differently, but, uh, but you know, it's been fine. And it's so far, it's that well,

Scott Benner 50:57
around here, the biggest the longest fight has been Pre-Bolus thing. So yeah, not that everybody doesn't understand how important it is. But the people who aren't me are not as diligent about it. And I have just been steadfastly just banging that drum and they, they've gotten so much better at it. But and by the way, I'm obviously speaking around my wife. My son's not Bolus thing Arden Friday. We're talking about food with her. And she's just busy. She's a busy person. She works, you know, a lot. And, you know, just like you hear everybody else say like, it's hard to think a half an hour before a meal. Hey, where's my blood sugar? What should I be doing right now? We're an hour before, you know, let's correct this 120 now, so it's easier at dinner time, that kind of stuff. And so I'll just you know, Mike, and I, but I don't always say it nicely. Like, I'm way nicer to you people than I am to my own family. Yeah, yeah. So I'm just like, come on. Could someone Pre-Bolus like I, I sometimes I'm like, if I leave the house for an hour, and I come back, I'll look at art and I'll go, because I left your blood sugar doesn't get to go up 50 points. Like, like, You're making me feel like, but here's the other side of it. It makes me feel like I have to stay here. And that's not fair to me. Right? Like I shouldn't I shouldn't have to feel like that, like everybody can take their little piece of it. But I don't know, I guess what I'm saying is, I think good. in general. Some ways that men act could easily be misunderstood for apathy, when I think it's more that we just don't want to screw things up very bad.

Chad 52:35
Yeah. No. Yeah. I think I think that's 100% correct. And, and some of those, like, those diabetes dads groups on like Facebook and other. They, you know, there's now most of the dads are very outspoken, and they kind of know what they're doing, just because they're part of the group. But there are a few dads out there that, you know, seeking advice and looking for, hey, my wife wants me to help out more. And just, you know, kind of step one, you know, ask him for help on step one. So,

Scott Benner 53:11
yeah, well, it's also hard to ask people for help, when you don't sometimes know what it is you need them to do. Yeah, you know, and I think that can happen too. Or sometimes it's like, I need help, because this isn't going the way I want it to. And then you're now going to enlist another person who has not been involved, who doesn't know anything about it, to try to figure out the things you couldn't figure out while you're involved? Yeah, and then that's just then you've let them down. You know, and then that's really the interplay I'm talking about is that, you know, I know, we don't talk about the world like this much anymore, but it's still true. Like, you know, like, for most people, there's expectations you have of your spouse, and when that person doesn't come through, you might not consciously think, Oh, I pick the loser, you know what I mean? But they're inside your brain somewhere I need has been left down, she or he was supposed to do this thing. They don't do it. And now I have a, you know, a lesser feeling about the decision I've made. And that's how 25 years later you end up gone. Could you get out of here, please. We're all trying to avoid that. And so people defend themselves by not putting themselves in positions where they can let their spouses down. And then you get this, which is you feel like you've been left alone to take care of diabetes, by a person who doesn't care when really what happened is very likely, that person just very badly doesn't want to play it out. You know, and they don't know what to do. And not everybody figures it out like Chad did. Because not everybody gets an engineer's brain and COVID-19 to sit around the house and stare at their newly diagnosed. Stare at numbers. Yeah, seriously. If you were worth doing that, if it wasn't for COVID you might not be as involved.

Chad 54:55
No, no, but so he was put on the bump pumping the seven And, you know, at that time, we were kind of scared to death of insulin, you know, scared of giving too much. And Christmas, Christmas night, we're back at CHOP. And just because there was a stomach, stomach bug and an ear infection, and he wasn't eating and is vomiting, and his, his blood sugar was through the roof and ketones, so we ended up back at CHOP, and that that kind of, you know, that kind of scare made us less afraid of insulin and then then we started listening to your podcast, and then it's just like, yeah, you know, we weren't, I didn't want to be back in that situation again. So.

Scott Benner 55:44
So it took it took a kind of a DK thing to take your fear, all you really did was shift your fear to the other side of the scale. Yes, right. You were scared to being low, right? Until you saw what happens when you got hired. And you're like, Okay, let's be scared of that instead. Yeah. I think that's that really is the game. Honestly, it really is. It's to it's to realize that none of this is you know, completely baby proof safe. Yeah, and what side of the game are we gonna play in? Are we gonna play in the side where if we do things, right, you know, we're gonna have these these successes that lead to better health, or are we going to you know, we're gonna go on the other side we're doing it right just means elevated blood sugar, but nobody gets low. So, yeah, that's the trade off. And I think that really is in most people's minds. Like that's the trade off they're making. I'm the one who's saying and hopefully other people listening are thinking that that's that's not a that's not a real decision that has to be made you don't it isn't either or it isn't either B you know, having a one C and the sixes and get low a lot or having a one C and the sevens or eights and never got low. I don't think that's the case. I think people have a one season sevens and eights get low too. I think they get low more viciously than people who have their insolence so well balanced that they can sit in a five a one see Arden doesn't get low, like like in a scary way. I don't think she's had a scary low I mean, I don't remember what in the last couple of years you know and by that I mean like oh my god get used she's gonna die drink this drink this that kind of stuff. Like I don't remember that happening anymore because our insolence so well dialed in that aside of a real anomaly that just it almost can't happen.

Chad 57:37
Yeah and and with with her age, I'm guessing She needs a lot more insulin now. It's it's easier for for you guys to fine tune that. Yeah, you can. You can adjust by 5% 10%. So

Scott Benner 57:49
you're not going from a point? Oh, five to a point. Point. One double one is insulin. Yeah. I've doubled his insulin by giving him a 10th of a unit. Yeah, right. Yeah, that's not the case. Well, you know, this is a really tough time. And you're right, it will get easier as bodyweight comes. And the difference between, you know, a half a unit a unit, it's not really that great anymore. You know, I've come to realize that in the last year, so he used to take if I had to make a wild Bolus to break a stuck blood sugar. It was two units for Arden like if Arden's blood sugar's 117. It wouldn't move like I could give her two units to break it free. That's more like three units now. Wow. So I keep wondering when when it's going to be more and more we actually chat let's uh, let's tell a story here. So at Thanksgiving we we screwed up at Thanksgiving for all of my I put up the Thanksgiving episode. I got literally hundreds of thank yous afterwards about oh my god, my Thanksgiving is so much better because of this episode. Mine wasn't. So because I was up cooking all morning. Arden's blood sugar was terrific. She's upstairs, getting a slow start to the day. She's up. And my wife's family has a tradition of making these terrible cinnamon bonds on holiday mornings, and I say terrible because they're packaged and there's just nothing it's just sugar and wrapped in more sugar with some sugar. And I know how to bowls for them. It's not a big deal. But there's like 55 carbs and one of them. Wow. And I text Arden I say mom's putting those cinnamon buns in the you know the oven now and Arden's blood sugar's like 95 like, you know, like so. Why don't you Bolus 10 carbs right now. And then, you know we're gonna do a little more in a little bit and blah, blah, blah. So she says okay, she Bolus is the 10 carbs. And I text her a little while later. And cinnamon buns are getting closer I was like now I want you to put in seven units and I figured out the carbs for those But I want to get seven units going right now, keep in mind that by the time this is over for this freakin sentiment bond, I'm going to need to give her like 14 units of insulin because it's just, no one should be eating these things I want to be, right. And so I said seven units. She goes, I can't. And I'm like, What? Just give yourself seven units? And she's like, no, and I'm like, will it not let you so now like, I'm running through, like, all the things that I'm not sure like, Why can't she just give herself insulin? And she finally text back? I'm out of insulin, the pumps almost empty. And I'm like, Oh, okay. And then I was like, Alright, come downstairs, we'll change your pump real quick. But we're going to inject this other insulin. So I kind of feel like I'm being slick. And we have some fiasco left for when we tried the fiasco like, Well, you know, I wonder if I can't do this in a way where she won't have to wait. And she can still eat this. The cinnamon bun. Well, I draw up a lot of insulin in a in a syringe. It's like 10 units. Right? And Arden's never gotten a syringe with more than probably like two or three units in it. So she goes, whoa, what are we doing? And I was inside explained the whole thing to her. And she goes, make sense. But Wow, that's a lot of insulin and that syringe and I said, Yeah, I'm like, you know, my buddy, growing up as an adult would give themselves sometimes, like 30 or 40 units of that insulin, he that old insulin he used to use in this big syringe. And she's like, it was like, full and I was like, Yeah, she's like, well, and then she couldn't imagine it. Like, I think she thought it was going to just run out of her body when we push the plunger down. Seriously, she couldn't, she couldn't like wrap her head around it. So we put it in. And I was like, see it stayed in? She goes, huh? It's just really stunning, you know? And, and I had it like I did, I did it. I really did for 45 minutes after she ate that cinnamon bond. Her blood sugar was 110. I was like, I am a genius. Those people are right, you know, and then suddenly, boom, it was not enough. And the one thing I didn't account for, because I used what I thought was enough. The Ask was that, you know, when you put a new pump site on, your Basal is not working, you don't have that that pressure I needed to Bolus for the basil. And I didn't so Arden's blood sugar got out ahead of me.

twice over the next hour and a half, I cut it down at 150. And, but then I went back to Cooking. And then the next thing I knew what I thought was falling, did that, you know that little hump on the Dexcom it starts heading down, then it rolls around and comes back up again. Right? That happened. I had to be more aggressive. I stopped it at 180. And then I had to I had to hit it again. Because she got up to like two 220 or something like that. So it's all just because the insulin was you know, was messed up the delivery, the insulin was all messed up because we literally I changed for clarity, we changed an insulin pump and immediately went into a cinnamon pod. And I had enough hubris to think I could do it. But I was I missed. But once I saw that happening, I said to Kelly, I'm like, I'm not messing with this. And I gave her a lot of insulin like I I put her blood sugar into a fall on purpose, and then caught it so that the rest of thanksgiving wouldn't be ruined. So if you see Arden's 24 hour graph for Thanksgiving, it's fascinating because she's sweet 70 and like 100 for you know, 21 hours and then there's this like mountain in the middle that I don't usually see the flags roller coaster. It's worse the it's like freefall. It went up so sharply and came down so sharply couldn't even call it a roller coaster. But I To me, the key is that as badly as it all when I knew what to do at every step of the way, I never made her low. You know, and that to me is like that's how I know I'm good at it. Like she didn't get low afterwards ever. And then right away, boom, the rest of the day was right back where I expected it to be again. I got the insulin in where it needed to be. I cleared out the carbs and right back in the game. I was proud of it actually by the time it was over. I was disappointed and then proud. a weird feeling. Oh, what the cinnamon bun. Oh my god. They're the worst. Like, I don't know who makes them Pillsbury or something. They come in like that. cardboard. Yeah. Like, you literally should not eat it. It's just bad for you. And my,

Chad 1:04:41
my father was recently diagnosed with Type two and he cleared out his fridge and I think like he brought over to two of those cans. Yeah. It's like we can't use this. Yeah, I was like that. This is this is why you're just diagnosed with Type two.

Scott Benner 1:04:59
You're asking too much of your system dad. And this right here is you asking too much of it. And I want to be clear like, you know, Arden has one of those cinnamon buns like on Thanksgiving morning and Christmas morning and yeah, that's really the only time of year she ever has has them. And I one of them and I have to be honest with you. It was sugar if ik I don't know why marketers don't just go right for it and just say, Oh my god, so much sugar, you're gonna love this. It's no crack, but in food is what it should say, you know, but it's just all processed food. And which even makes it worse. Like the carbs are if you counted the carbs on those muffins, and just Bolus the carbs. I don't see how your blood sugar wouldn't be 500 Yeah, you know, so Oh, probably higher. Yeah, just a it's just insane. How how impactful that those that is? And, you know, definitely tells me Don't eat it. And I don't just mean if you have diabetes, I just mean in general, this is clearly this is clearly not okay. Yeah, once or twice a year and, and yeah, that's it and still be prepared to be a little dopey afterwards, you know, from all the insulin that your body is going to be really even if you don't have to type on just all the insulin your body's gonna be releasing, you're gonna be tired as hell. Chad, is there anything that we we didn't talk about that you wanted to? Um, I

Chad 1:06:25
don't think so. I think we covered a lot we've covered football. Men, menstruation cycles of teenage girls.

Scott Benner 1:06:35
Everything you thought you were going to talk about today now as a two year old little boy with male privilege. That's right. I'm gonna call this episode boys have feelings. What do you think of that? Boys have I like it?

Chad 1:06:48
My wife wants me to talk about more my my feeling she was saying the other day there was a children's cancer. Commercial on and you know, I start getting teary eyed and stuff. And she's told me I love when you cry. Yeah.

Scott Benner 1:07:05
I don't believe them. Chad, and I've just lumped together. Yeah, hold on a second. All right, we're down a rabbit hole here chat. I have always been a sensitive kid. Like as growing up, and I'm a sensitive adult. And you know, I'll cry it. Almost any movie adulation from a group in a film will make me cry every time like when they let Rudy play? Do you know what I'm talking about? Yeah, yeah, I just start crying. I'm like, Oh my god, we're gonna let him play. He works so hard. You're gonna let him in. It's gonna be something. You know, the high school puts a video up of, you know, the kid that helps with the team who's disabled and they let him run a touchdown back. I'm just crying. Like, just Just so you know, people come on the podcast and say the podcast helps them. I'm like, okay, it's good. Thanks. You know? So I've always been that person. I'm also not not masculine in other ways. But I don't think I don't think they mean it. I think not everybody. I'm not I shouldn't say they like I'm generalizing every woman on the planet. But in general, I just said I shouldn't generalize. And then I follow up with in general, but in general, I think you do want to see people open up a little bit. But there's, there's a line where I do think there's some hard wiring in you that's like, I that's the guy I need to, you know, kill the thing and drag it back to the house. Like he can't be crying all the time. I killed a deer. Like, you know, that's not what you're looking for. Yeah, you're looking for, hey, it's out front of the step. Let's cut the skin off at neath this thing. And and, you know, I don't I don't disagree. That being vulnerable is a bad thing in a interpersonal relationship. I think you should be. And I am. But I do think you pay attention masculine tax for it. Yeah, if that makes sense. I do think you lose some points somewhere else in the back of somebody's brain. And not all the time. Maybe. But once you turn into me and you're just like, you know, you ever see that horrible movie life as a house? You haven't because it's terrible. No, but it's, it's don't look it up real quick. Yeah, Rotten Tomatoes. You think it's got a lot of rotten something. It's about somebody who has cancer. I don't really remember the whole thing. All I can tell you is my wife wanted to see it. I was like, I don't want to go see this terrible movie. But I went with her because I'm a good guy. And we're in the theater, and the lights are coming up at the end and she looks at us like are you crying?

Unknown Speaker 1:09:36
I'm like, No.

Scott Benner 1:09:42
But yeah, I don't think that that then makes my wife look at me and go, I should probably take him out in the car and have sex with them. I think it makes you think. I hope if they come for us, he can protect us. But I don't think he can What is he starts talking about the, the, the war and how sad it is, like, in the middle of when I need him at the front door to shooting, you know, I don't know, like, I'm not disappointed with who I am. And I'm not sad that I that I'm willing to be like that. But I will be honest and say that I grew up with my mom, as a single mother telling me Oh, women are going to like that you're sensitive. But I think what she was really saying was, I wish your father was a little sensitive. Yeah. And I did find through dating, that I don't think that's what, at least the girls I was meeting, you know, more or more, more than less, we're looking for, like, I really think that they wanted more, whatever standard masculinity is. But I found my sweet spot here. They haven't kicked out, you know? Yeah, so I'm allowed to stay. I always tell the kids I'm like, Listen, when mom gets rid of me. I need you on my side a little bit. Like, what am I eventually it's gonna happen. There's no way she can put up with me forever. So I'm just saying. Like, what it happens. If you're older and you you're not in the house anymore. Just believe that I tried his hardest. Anyway, Chad, when do you think you're getting kicked out? You probably have time. Your kids are younger.

Chad 1:11:28
Yeah. Hopefully I'll make it to college. You know, Carson reaches college. Oh,

Scott Benner 1:11:34
you're gonna at least need to be there to make another baby that looks like Carson. Yeah, she's going to need you for that. And then she's gonna want you to help pay for school without arguing with you. Plus, she'll figure out in like four or five more years, and she doesn't have to have sex with if she doesn't want to anymore. So that takes away a lot of the burden. And but also the your niece that you said you have custody of is that your niece or her niece, her niece. So see, you're also you got that going for you? Yeah, you're doing that extra family thing. So yeah, that'll probably buy your five years. I think you can make it to like 2044. Wow, good for you, Chad. Do you not think every guy just wonders when it's over? Yeah. Well, they say divorce rates are going down. So he gets a financial thing. Like, why can't afford to leave? Yeah. I can't afford two Christmases. I don't like him. But I do like my car. And if I just drive in the car more, I won't be around him as much. This all makes sense. And I'm not I'm not saying because you're providing I'm saying that. I think most people have a two income situation. And yeah, so you're hearing divorce rates are going down?

Chad 1:12:55
Yeah, I've read it the other day. Now. Now it's kind of skewed. because not many people are getting married. So obviously they can't get divorced. Yeah, exactly. Yeah. Is one of those one liner like articles, you know, the headline article, and then you go and read to it. And, you know, but but the most successful marriages are the people that you know, go to college and kind of wait, before they get

Scott Benner 1:13:24
Oh, I tell my kids all the time, like you don't like 30 is probably the low number for where I would ask you to get married if I got to be in charge of it. Is it 2019 the US divorce rates fell to a 50 year low in 2019. Yeah, but you're telling me if I keep reading, what I'm going to learn is that marriage rates are also down so they're eligible for divorce. Yeah. Wow. It's a big drop. Yeah, look at that. 19 7085 your wife's gonna listen to this. He's like so what you ended up talking about is when we're going to get divorce This is 85% number of newly married people get per 1000 unmarried population at age 15. Plus the US marriage rate reaches all time low. It went from in the 70s. This numbers at 85.9 in the 80s. It was 68.8. By the time it gets to 2010 35.1. It's 33.2 and 2019. I don't really know what the numbers represent. Because I'm trying not to read while I'm talking to you, but it's a it's a harsh drop.

Unknown Speaker 1:14:31
Wow.

Scott Benner 1:14:33
Yeah. Next thing we should Google is have marriage. Oh, wait. Here it is. The US marriage rate just hit an all time low in 2019. Yeah, there's the rest of it was clickbait. Yeah, yes. You can't get divorced if you don't get married. Well, that's my common sense. I'm always telling people like Yo, if you don't get high, you can't get high. So just don't do it. Oh my gosh. Sorry, Chad, you're delightful. Thanks for coming on and doing this. I appreciate it. Thank you. Seriously, I'm I'm really thrilled that you're doing so well so early on and diagnosed and

Chad 1:15:12
a Scott that it's, it's all to you man like, you know, I think you know all I can think of is what my son's diagnosed at two he's gonna have you know the rest of his life with with crappy blood sugar numbers and stuff and you know my wife started listening to you and I listened to you especially your bold with insulin podcast and and you know that that changed our life and we you know well we'll change Carson's life, you know, he'll have a healthy normal, normal can be life because of you and your podcast. That's really

Scott Benner 1:15:50
nicely to say thank you tell him to grow up and learn how to be a quarterback so that in my declining years, I don't have to watch the garbage I watched last night. Honestly. Well do you know when you're watching a sporting event you think I honestly feel like I could have done better there and yet I know I can't. That's the horrible feeling. I have watching the Eagles now at this point. I'm like, I think I could block for a half a second. Yeah, yeah.

Chad 1:16:12
At least I could have done that was like a I think it was the Broncos over the weekend. They couldn't feel the single quarterback because Coronavirus and I read the stat line. So the guy they played quarterback and he was like one for nine for 15 yards. And I was like I

Scott Benner 1:16:28
could have done that. I definitely could have accomplished that. Well, I have to be honest with you. I thought the NFL completely dropped the ball this weekend because as soon as I heard that story, I wanted to watch the Denver Broncos football.

Chad 1:16:39
Yeah. So that Yeah, I turned it on came on right at four o'clock. I turned it on and just just I watched a couple possessions for the Broncos. And I was like, wow, this is this is really bad.

Scott Benner 1:16:49
Well, you're lucky because I couldn't even find it on television here. But I and I didn't want to watch him fail. Like I really thought this is fascinating. Like this, this an athletic person who has no business doing this thing being put in it at the most difficult level. Like I wonder how, like, I just thought it would be interesting to watch him try. You know, and you don't ever get that opportunity. Yeah, but I couldn't find the game anywhere. So I couldn't watch I did watch highlights. And the one thing I noticed was that the arm strength that are that a successful pro quarterback has is is insane compared to everybody else because this kid threw a nice ball. But when he tried to go down the field, he just did not have enough to get the ball there before the cornerback could react and step in front of the ball. And I thought well, if this cornerback is this good, but can't make a play like this in a normal football game, that means that the quarterbacks arms are just way more powerful than you think. So the next time you see a guy drop a ball on an NFL football game and you think just catch it. I guarantee if he threw it at you like that it would kill you. By fingers would fall your hands would just break and it would hit you in the face and that'd be the end of it. Yeah, maybe be a look these guys are. They're just insane athletes because this kid like I said, He's I saw him throw an out pattern, maybe 25 yards down the field. And it's a good ball. He was set up. Well, his mechanics were good. The ball traveled well. And the quarterback looked like he had time to have a sandwich before he stepped in front of it. And yeah, he'll never be a quarterback again in the NFL, but I think good for him and going out there and try that that's a I thought that was ballsy as hell or something. Anyway, all right, Chad, thanks so much. I am I appreciate you doing Hey, huge thanks to Chad for coming on the show and sharing so openly. And I want to remind you again about the T one D exchange. Past participants like you have helped to bring increased coverage for test trips, Medicare coverage for CGM, and changes to the ADA guidelines for pediatric a once eagles. And it's exciting to imagine what your participation could lead to next T one d exchange.org. forward slash juice box support type one research and support the Juicebox Podcast. And don't forget if you're looking for those diabetes pro tip episodes, they begin in Episode 210 in your podcast player or can be found at diabetes pro tip calm

COMING SOONScott Benner 0:00
Hello friends, and welcome to Episode 498 of the Juicebox Podcast. Today's show is with the CEO of Dexcom Kevin Sayer.

Well, it's that time of year, the American Diabetes Association's 81st annual Scientific Sessions. those meetings are happening right now they're online this year virtual, but they happen every year around this time, which always means Kevin Sayers coming back to tell us what's going on at Dexcom. Today, Kevin and I are going to talk about the Dexcom, g seven, Apple Watch, adhesives, and much more. Kevin tells me where dex comes at. What they're getting ready to do any answers questions from listeners of the Juicebox Podcast. It's very cool. I had a very good time talking to him. By the way, this never happens. I just recorded this. Usually you guys are hearing stuff that was recorded months ago. This was recorded on June 28 2021. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan for becoming bold with insulin.

This episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump. See if you're eligible for a free 30 day trial of the Omni pod dash now at Omni pod.com forward slash juicebox. And what the heck, let's throw the Dexcom out on this episode too. Because by the time you get done hearing Kevin talk about Dexcom you're likely going to want to go to dexcom.com Ford slash juice box to learn more about the Dexcom continuous glucose monitor. And to get started dexcom.com forward slash juice box on the pod.com Ford slash juice box and last thing you want to check on touched by type one. It's an organization doing great things for people living with type one diabetes, and you can find them at touched by type one.org or on Facebook and Instagram. Kevin how goes? Hey, I'm alright. How are you? I'm good. Excellent. I'm surviving the day. Are you at Ada right now? Where are you at? Well, there's I'm at work at ADA. Okay.

Kevin Sayer, Dexcom CEO 2:41
Virtually. There's no live sessions this year. It's all remote. See, there's everybody down there. I am starting to pop in.

Scott Benner 2:51
Excellent. We were early. How's that for?

Kevin Sayer, Dexcom CEO 2:54
Yeah, I know. I just can't let this happen too often, or they'll expect me early for every meeting.

Scott Benner 3:01
Yeah, I always just expect you to swoop in like one minute afterwards. I'm good. Excellent. Well, I mean, I'm used to talking to you this time of year. around eight. Yeah, we talk this time every year. Yeah. So what's the good news?

Kevin Sayer, Dexcom CEO 3:16
There's a lot of good news. You know, I think very importantly, we we just get CGM validated every time we go to one of these things. Every time I turn around, there's a Dexcom presentation that or presentation where an artificial an AI D system has been driven by Dexcom sensor. Great outcomes have been achieved in studies. One of our biggest wins this year, there's a study called mobile where type two patients on basil Ensign got access to CGM for six months and saw the same type of improvement in their a Wednesday to type one patients. See, there was a another study done over in Europe called alert where a consortium of physicians in Belgium took a bunch of Libra users and moved them over to G six and at the end of six months, every single measure. They were better with G six and they were before no good. And, and so big win on that one. Just a lot of good Dexcom News, our products going well. We did talk about the G seven system and attd and a great length Jake's put quite a bit about it and a lot of questions on that one that we're getting, but it's it's a good show for us. And I really think you know, we've long envision this being the standard of care with everybody on insulin. I think that day is coming and I I think we can get this where CGM becomes a standard of care for all diabetes if we if we do this, right. Yeah, we solve the right problems.

Scott Benner 4:48
I actually have a question here from you or for you that I don't think we'll even get to but it was from someone who said do you imagine that one day anybody who's interested in understanding their health better will wear a CGM? Yeah. Do you It was really something

Kevin Sayer, Dexcom CEO 5:01
I do. But it'll be different experience than the experience that somebody who's having insulin delivery, of course, will have. And that's okay.

Scott Benner 5:12
Well, do you want to hear some questions? Or do you have some things you'd like to talk about? First?

Kevin Sayer, Dexcom CEO 5:16
I am good to go on your questions. And if there's something I need to talk about, I'll, I'll be happy to add it.

Scott Benner 5:22
That is excellent. Okay. So some of them are g seven, obviously, but just from what you said, I want to know if there's any changes for people on Medicare. So when g seven starts, what happens to people who are using g six with Medicare right now?

Kevin Sayer, Dexcom CEO 5:38
Well, one of the things we're being very cautious about with G six, even when it gets approved, is making sure that when we launch, we have capacity to serve, all those who have G six, because they're going to want to switch over very quickly, we have to go through a process was CMS or with the state Medicaid plans, quite candidly with the commercial insurance carriers to whereby we go change those contracts, we'll keep a G six contract, but add g seven to the mix. So patients can get g seven, that will take some time. And I don't have a good, I don't have a good estimate of that for you, you know, we got g six approved for Medicare patients much faster than we will deliver it because we couldn't make enough of them. And we made the decision to go ahead and launch I think this time, we're being a little more thoughtful, on the scale up side, getting more lines in place, getting more inventory, build, getting things like that ready to go. And we'll probably wait, I think this time, I'd probably wait a little while and make sure we have everybody covered then launch and have to feel the phone calls of Jean, we're not going to offer that to you as an individual patient group that that was not very fun. So we'll uh, we're still working through that. But we have outlined all those tasks, who we have to call what we have to go through, we have to come up with some different pricing strategies, because there's different product transmitters been eliminated. So there's not a transmitter anymore. So what is the value equation with G seven versus g six, and we're getting ready to present that, but we need to improve product first.

Scott Benner 7:14
How much of that is? Do you think about because of competitors too? I mean, you have to stay in the game, right?

Kevin Sayer, Dexcom CEO 7:23
Oh, no, both we well, we have always negotiated pricing for Dexcom. And the in what we do. And we have always been able to successfully negotiate negotiate pricing for our product in most markets. There are times when we have had to move prices because of competition. But those are very thoughtful things that we go through. There may come a day when we turn something down. Yeah, you know, this isn't a business worth $300 a month like strips, I mean, $3 a year, right, like strep sigh. We're not headed there. We can't make product that cheap. I'd love it if we could. But we really can't, and service it and answer the phone and do all the things that we do. So there we are cognitive in competition. We're also cognizant that we perform a lot better, we are connected to more devices, we can do a lot of things that no other competent, she can do right now. And we expect to be compensated for that.

Scott Benner 8:21
Yeah, that makes sense. Um, does the form factor change, change the durable medical distinction,

Kevin Sayer, Dexcom CEO 8:28
there will still be two reimbursement paths for G seven, there'll be durable medical equipment, which is where Medicare resides right now and where some of the payers continue to keep us. We will have a receiver available for G seven, it'll be a different receiver than the G six receiver. We think people will be very happy with it. It's a really neat device. And a surprising number of patients use the receiver only.

Scott Benner 8:53
Yeah, no, I'm not surprised.

Kevin Sayer, Dexcom CEO 8:54
I have everything. I just figured once we went to the Thunder Bay, go the phone. And guess what, it's not that simple. Yeah. And people really some people really like the receiver and having the comfort of a medical device doing this so we'll have a new receiver and we will have reimbursement durable medical equipment will focus more on the pharmacy and try and get g seven the primary channel at the pharmacy channel rather than damy channel but Medicare patients are going to have to go DMV and there are some patients who won't move to the pharmacy. me some not patients but payers and quite county there's some doctors who would rather go to the DMV channel because they know it. Well, I know since everybody in where I live in Wyoming that blue shield of Wyoming has a very simple DMV procedure. I'm not changing, you're all going to I just wrote that as an IP hypothetical. So we need to give everybody choice but we really want to make it easier right? So the primary distribution focus for g7 will be in the drugstore. Cool.

Scott Benner 9:52
Alright, so I feel like this is the last time I'm ever going to get to say this to you. So I'm a little excited. Dexcom g7 will go directly to Apple

Kevin Sayer, Dexcom CEO 9:58
Watch Not initially, but eventually, I think our first pass it won't. The nice part about it is it has the hardware chops, the Bluetooth configuration and all the capability to go direct to Apple Watch, to get the app done. So we can get the app out, we're going to have to launch the first app without direct watch connection. There's a lot of things we have to work out just day to day for that it is a different experience if if the watch is your primary receiver, because you're planning on spending at least some amount of time every 36 to 48 hours with that thing out on your wrist, while it charges. And so we we are looking at all of those consumer experiences and making sure we address them as best we can. And like the FDA views, alerts and alarms is one of the primary functions of the system. If you're going with no alert or alarm for a couple hours, what happens, right. And so those are some of the things that we have to address. I mean, if a new user is going direct to watch and then goes to bed at night and puts a watch on a charger in another room and doesn't get any alerts alarms on light. How do we deal with that? How do we make sure the customer knows that that's the experience that they're going to get before they do it? And so they're just some nuances we have to work through gotcha.

Scott Benner 11:15
The you just mentioned this, the apps are they changing for g7

Kevin Sayer, Dexcom CEO 11:19
app is changing completely new app for g7. a different experience will certainly be focusing on again, more patient friendly. The FAQs that we've added to G six, we're gonna try and go a level higher to whereby there's more self diagnostic and self education. So you don't have to call us for tech support. That'll be how the app continues to evolve. Over time, there will be more educational information, some of the clarity stuff will be taken to the GCs app. So you can see how you're doing a little easier without logging into another app. This app has been in development for quite some time, it'll be a really nice customer experience.

Scott Benner 11:59
Yeah, I'm excited. I remember giving my feedback. I want to say like four years ago, like during it, I remember we had the discussion, and I hooked you up with everybody. And I'm just like, I'm like, I want to see if anything, I said it's not going

Kevin Sayer, Dexcom CEO 12:11
well, and you can always add more or take less away, I think one of the things we have learned is becoming a software driven entity rather than just a hardware driven entity is a culture change for us. Okay, we've invested a lot in software over the past several months to get this app and some other things working on ready getting g7 ready for a global launch. All the translations require work. There's different phones in different countries that we have to certify for. I mean, there's a lot of pieces that we're checking the box to as we get ready for this,

Scott Benner 12:47
I can't even ask you all the questions from all the different places on the globe that I got them from United Kingdom, Australia, Canada, Saudi Arabia, people want to know, like, it's, I can't imagine what it's like the service that on an international well, and we're

Kevin Sayer, Dexcom CEO 13:01
not in all those countries. I'll be honest with you. And we are in some, in some we're in very small. And you know, one of the interesting things about Dexcom Scott, and we've been wildly successful, and it's like it's the users of our system that make us that way. But when we look at a country to go into, I'll give you a prime example. We're not in Mexico right now. We get hundreds of letters come to Mexico come to Mexico, we don't have a single employee there. Yeah, we don't have any connection with the government or regulatory authorities or anybody, where's you're looking at our larger competitors have infrastructures built for other businesses? Sitting in Mexico, we don't have any. And so we go to a distributor. And that works. And we have distributors all over the globe. But it takes us a while to build our international business. And one of the things we continually struggle with is how do we go faster. And these other geographies without infrastructure? already existing? You know, we're direct in the UK, we're directing Canada. We're direct in Germany, we pick selected markets where we control our fate. And that has worked fine. But again, the size of our teams in those countries pales compared to the competitive entities that that we that are in our space. Oh, how much do we want to spend over there? And how do we do it and how do we lead it's it's really one of those growth challenges that nobody really thinks about till it kind of smacks you right in the face. Yeah.

Scott Benner 14:28
No, I can't imagine. I'm jumping around but the warmup time for the g7 will be half hour 30 minutes. Excellent. Is there people wanted to know is there a way to put the first one on to eliminate because now you don't have to change the transmitter from one site to the next? Could there be a way to do that? And I was like, wow, everybody's always trying to make it go Can't have two of them running at the same time. That would have been my expectation to but how about it he's of formulation is that

Kevin Sayer, Dexcom CEO 14:56
we it is a different he said than the G six and he said that it is You know, some of the things that cause the G six adhesive issues we've identified, you know, we're testing numerous tapes. I don't know if any of your users are in some of our adhesive tests for G six, we are going to eventually swap it out to something that will not cause as much reaction as this one has. But some of the things that cause it are not present in g7, some of the processes. So we're hopeful that we'll have a better experience. We're putting a piece of overtype in every sensor box. So no one ever has to call us for overtype again, you got one, okay, and you can use it, and it's, it'll be fine. That adhesive has been very good. I'm sure we'll have people where the adhesive doesn't work as well as we'd like it to, or it works too well, like it does for some of the others now, and we're hopeful that noise is minimal. And in all fairness, because of what's going on with G six already testing for other g7 tapes, and we haven't even launched the first one. Yeah. So we are we've realized what a hassle the tape is, for somebody who has an allergic reaction. The flip side is, if you're going to the drugstore, we can't expect the drugstore to stock for different brands of Dexcom g7. Right, because we have four different tapes. So we've got to find the right answer for our customers, and and I think we've done a better job.

Scott Benner 16:19
Okay. The where time is how long 10 days to start? Is it longer in other countries?

Kevin Sayer, Dexcom CEO 16:29
Well, and we have a 14 day version of G six, even approved, okay, in Europe, but what we focus on more than the length of where, you know, the length of wear boils down to two things, number one, and number one above all others, it costs us less to make two centers a month and three, just like it costs us less to make three sensors for GE six instead of four, for the old seven plus, okay, that's savings we can pass on to our shareholders or we can eventually pass on what cost savings to our customers, depending on how well that goes. The second reason is convenience. If you only have to change it once a you know or to a month, that's that's an easier experience for people as well. But what we found if we if we promised 10 days and delivered 10 days, people are usually fine, I think. And I think and what we focused on is reliability. You know, we've studied a great length, how long others are other sensors are g five. And some people you know how long some people could get you five to last that was? That was sometimes absurd. And then 36 Yeah, yeah, yeah, yeah. I walked into a physician, a diabetes clinic one day and all for the diabetes educators would put their Dexcom on the first day of the month, and whoever could where there's the longest got a free lunch. And most everybody was past 24 days. The day I was in there, as you guys come on. Does your insurance pay for these? Well, yeah, then what are we doing? in any manner, it's about delivering the experience that we promise, what we found, and we did a trial with our 14 day g six, and in a very small geography, we didn't find enough of the lasting out as long as it needed to be now we didn't have any the new adhesive configurations, or any of the other things, you know, in place that we've learned, I, I think we'll eventually get to a longer g7 In fact, I'm very hopeful that we will, but we wanted to make the first experience a good one. We didn't want to make it that 13 days, you're all calling and saying I need a new sensor. Right. And, and and and our percentage on reliability is very high, 90 or better. And for a new product. That's a Yeah, that's a tough bar to get over.

Scott Benner 18:45
I'd never thought about until you just said that. If you promise a date and you fall short of it, now you have to pay for a replacement. But if you can make it to 10, then it's just good business and people's experiences better. And people's experiences better if you meet their expectations.

Kevin Sayer, Dexcom CEO 19:00
Yeah, well and then think about that. Just think about the dollar impact if if we give you 27 days of sensors, in a month, everyone falls off it or let's do worse, let's say 21 days and everyone falls off at seven days. And you call it seven days every time and say send me a new sensor and we send you new sensors. We've now given you six sensors that end up being 42 days of revenue that we build the insurance company 30 days for so getting these things to to match and creating a better experience for pay what what I would ultimately love to see but this is just an Kevin's pipe dream vision bucket that we keep track of how many days of sensors you've purchased from us every year. And if you bought 30 days and one of them you know fails early, we send you another one and you don't even worry about it. system keeps track of it but at some point in time, let's say one failed after seven days. You got seven days of free sensor three replaced in the old When we make sure you get, and we get paid for 365 days of sensors, and it's fair for everybody here, and I think that's a value equation everybody can live with. We have very few people who abused us, if anything, we're way worse. As far as getting, and we try hard to get product to people, I promise we create a lot more problems than our customers do.

Scott Benner 20:23
Yeah, once g sevens up to is ramped up, and it's out does, do any of the older products go out to pasture?

Kevin Sayer, Dexcom CEO 20:30
Well, we still have some g4 we're selling in some countries, believe it or not, we'll get rid of all yeah, it wants to seven. So we're in the process of getting rid of all the G foreign g five. And we have a launch coming on to Japan later this year, we've shipped our first product Japan now. g Ford in the product for use in Japan only professionally, that's going to go away. There will engine g five is about done. And then we will phase out GE six over time. But there could be other uses for it as well. Because we have a lot of manufacturing capacity. It could be used in other geographies. It could be other use cases. So we're not looking per se to rush to shut g six down. But we are looking to rush to scale up g seven, and then leave our optionality open, I say,

Scott Benner 21:18
is there any chance you'll tell me when you're going to release it?

Kevin Sayer, Dexcom CEO 21:20
Now? I wish I knew. If I knew that I could, then I could really look at you and say we're not going to tell you that I don't want we don't have all all the answers? Well, I'll give you an answer. I'll give you an example of why we can't shut down g six. All of the tandem and insulated and other pump users g sevens, I'm going to talk to their pump out of the gate. Okay. So if you shut down g six, you're taking a large group of our loyal constituents and saying Haha, you don't get anything for a while. Not good business practice, right. And we have obligations to support that with our partners for quite some time. So we'll keep it with respect to the launch date. You know, our public statements have been very much launched this year in Europe, but not a huge financial impact, because it's going to be in certainly in the fourth quarter, the earliest. The big rollout comes in 2022. We haven't filed in the US yet. We had said in earnings calls previously that that we, you know, the clinical trials making good progress. And we'll get more information on that. On our second quarter earnings call in about about a month from today. tell everybody where we are, we'll get filed, then you've got the variability of the FDA, and you're hearing from numerous companies, that the FDA has got a bunch of stuff backed up because of the COVID backlog. You know, our goal is to create a filing that is so enticing that they'll look at it anyway. I guess we're very comfortable, the data is going to be very good. We presented some data at attd. And the data we presented is better than anything we ever presented on G six. The product is going to rock and we changed everything we've changed the algorithm, the software, the sensor, the hardware, everything. There's not a single thing in there. That's the same

Scott Benner 22:59
what are some highlights of how well it works that you're most excited about? Well, your listening skills are a ninja level if your brain said to yourself, oh, Scott's gonna put an ad right here after ask him that question. You were 100% right. But I'm going to do them very quickly today. Find out if you're eligible for a free 30 day trial of the Omni pod dash tubeless insulin pump at Omni pod comm forward slash juice box that is a free 30 days to try the Omni pod. You might be eligible for this go check it out. I mean, there's just no better time. It's summertime. You're swimming and running about doing your things. You don't I mean, you know you don't have to take off the on the pod to get into the water. Not like every other insulin pump. Mm hmm. This might be a great time to check it out. I mean, everybody showers 24 seven, but if it's summertime, where you are right now Splish Splash, you might be taken more than a bath might be going for a swim. The Omnipod is absolutely terrific. My daughter has been using it since she was four years old. We are about to celebrate her 17th birthday. Now. That's a really long time to use something every day. And I can tell you from my heart that I think you'll enjoy using the Omni pod to just the freedom that comes with being tubeless is hard to put into words. But the pod is just terrific. We love it. It's absolutely been a friend on this journey with Type One Diabetes. So if you're using insulin, and you want to try an insulin pump, or you've got yourself like MDI thing they're using a pen and you want to switch, this might be the time to give it a whirl omnipod.com forward slash juice box. And of course, if you'd like to learn more about the Dexcom g six continuous glucose monitor and you know get on board here before the Dexcom g seven comes dexcom.com forward slash juice box. I can't honestly say enough about this continuous glucose monitor, and what its abilities have added to my daughter's health and happiness. And my, my sanity, the Dexcom g six is absolutely terrific. It takes magic diabetes and makes it it makes it a little more human. It makes it I know that sounds strange because it's a device but it just sort of takes the worry away. It lets you see where to use the insulin better. I mean, I know I'm talking about my results, and yours Of course could vary but for us, it has been a lifesaver. It has been a health improver, it has been a life lifter dexcom.com forward slash juice box. I am. I am absolutely 100% underplaying how much I love Dexcom. So check them out. And another thing close to my heart, of course, touched by type one.org. It's an organization helping people with type one diabetes. And they've asked me to let you know that they would just like you to check on them. See what they're about. Touched by type one.org. You can also find them on Instagram. And on Facebook, you want to smile a little bit. Go get yourself a pump. Get yourself a CGM. Check out touch by type one. You'll be having better days. Alright, let's get back to Kevin. And he can answer the question what he's most excited about.

Kevin Sayer, Dexcom CEO 26:45
I'm very excited about well, first of all the half hour warm up, I'm excited about the fact that we are good enough to turn it on. And that make you wait 12 hours to use it effectively. And we are focusing what same we did with G six. Once it's warmed up to go and use it. I'm very happy just the overall accuracy, the thing has been extremely good. And the ones I've worn it's a G six is good to mind you. You have to be kind of a sensor savant to recognize the differences and have worn a lot of very consistent performance across the board. I think what I'm most excited about is what we've learned. We've learned little things in the process of G seven that are we've never even contemplated before. That Hey, what what happened here. And we're doing digging into the data and figure it out. It's one of the reasons we've taken as long as we have. One of the things we've learned, for example, there is a difference between the arm and the abdomen with respect to sensor performance. We have designed algorithms work for both. It's really easy to design one that only works for one and are the differences between the army the abdomen settle they really are. But you got to make sure that you get it CGM level accuracy for both. And our algorithm that we've designed and put in here will cover both of them. So that type of thing, the

Scott Benner 28:08
Can I jump in and ask you will you be able to get Will you be able to add sites? Because

Kevin Sayer, Dexcom CEO 28:13
we are we're doing the arm in the abdomen? And then we have the upper box for kids. We've always had that too. So we're testing it on the arm and on the abdomen? Both will the school will have labeled sites. I don't think people have paid much attention to that over time as I travel arm

Scott Benner 28:31
on her hip. I don't think she's been a kid for a while now. But yeah, that's where it works really well for how about like, Is there any change to like, if you experienced this connection, The Reconnection time? Is that any different with the new?

Kevin Sayer, Dexcom CEO 28:44
It's different? I haven't experienced that much. And you know, no answers got this is one place where you have to go out in the field and have the product work. You have to see how it works with individual phones, individual users. If somebody had a very positive g six experience and a very negative g7 experience, how are we going to deal with that? I promise it's going to happen. I just don't know who are aware. I mean, just expect everything to happen. Yeah. I mean, after g six, I didn't think I'd ever have anybody write me a letter saying how much they loved g five. got several. Okay, so

Scott Benner 29:23
and I'm in the weird position where Arden doesn't have it an issue like that. And so I have to wait for somebody to ask the question because yeah, if hers disconnects that, like if she walks away from her phone, she comes back and it's back in a minute or two. So I knew that was for different people. The inserting device itself, I imagine is going to be

Kevin Sayer, Dexcom CEO 29:41
significantly smaller. Okay, g six and it's a one button push it literally you don't have to peel any tape off it. You take it out, box, put on the skin push button, you're done. Wow. Throw it away. We have made this as easy as we possibly can.

Scott Benner 29:57
That's cool. First 12 hours Do you feel like the accuracy will be

Kevin Sayer, Dexcom CEO 30:01
okay? It'll be better in G six. Wait, we've, we've dialed the algorithm in. But first of all, ours is also very much a physiological reaction on individual patients. As you well know. There are some people who never have a problem at startup. There are others who always have a problem at startup and there's nothing you can do, right. But we it won't be nice CGM standards for those 12 hours. Okay. We're very confident with that.

Scott Benner 30:28
And I know it's gonna come factory calibrated. But does that mean we can't calibrate it anymore?

Kevin Sayer, Dexcom CEO 30:32
Oh, we leave you the option of calibrating, though can try. Okay. I think it's absolutely critical coal again, to give people that optionality can save a sensor, you know, I agree. Yeah. I mean, I just think, Well, nobody wants to stick their finger in a lot of patients never do. I think I think taking away that option, it's not a good thing. Okay.

Scott Benner 30:55
So compression Lowe's, I think everybody listening understands what they are you roll over on your transmitter g six, it presses down and disperses the interstitial fluid, you get a lower reading, which is actually accurate for the spot, but not for your body. Does the new form factor help that which

Kevin Sayer, Dexcom CEO 31:11
I haven't? I don't have an answer to that question. I don't know that we have enough experience in the clinical studies. Remember, you bring them in a clinic and they sit in the chair and we draw blood from a provider side machine? You don't Yeah, I I'm hopeful. I'm hopeful mainly because of the volume and so much less, you know, you've got this big bump for transmitter. This laying flatter, I'm hopeful will be better, but time will tell

Scott Benner 31:33
cool. Yeah, no, I am too. I don't I although my daughter can hear rollover in her sleep and just roll over now. So she'll probably make a great spouse one day if she snores, because somebody will be able to just be like Arden rollover. And she'll be like, Oh, I know this girl. Okay, yeah. That's, that's very funny. I have, somebody asked me to ask you, it's kind of a big ask, but I know you've gotten away from distribution at Dexcom. Right? Like, I used to buy art. And she says we have, they're hoping that you could do something to help educate the places that are. I hear from a lot of people, they enjoyed buying them from you better, I guess it's the statement.

Kevin Sayer, Dexcom CEO 32:14
I agree. And I understand that, let me explain a little bit what went into that decision. One of the things that was important, and we heard loud and clear was important to new users and clinicians was to be able to sample product to be able to try Dexcom, before you bought it, because they don't know what they're getting into. And to go through all the insurance process. Now we believe, you know, obviously very busy gonna like your product when they get it. But the fact is, is much nicer if they can sample we could not directly bill Medicare, and, and the government and sample because of all the stark laws and all that other stuff. And we felt the sampling was extremely important for our business to increase awareness. So we pulled away from Medicare. When we did our net promoter scores of our customers who use the distributors and those who use us, the distributor scored every bit as high as we did. And getting the feedback. I know that people have problems with these diabetes distributors from time to time. But the amount of noise we hear is not a whole lot different than it was before. And yet, you're occasionally going to have an experiences and great my hope, the best answer is to go to the drugstore. And for us to get distribution to the drugstore more than through the DMV channel. Medicare's not moving there anytime soon. But several of the large payers you can go get the product at the drugstore, more than half of our patients that come in now is distributed through pharmacy benefit. And it and that really takes all of those questions out if we can do that. And I believe co pays are lower in the pharmacy in general than they are in the DMV side. So our customers will spend less, quite candidly, insurance companies will spend less. It's it's a very good business model. And it's easier for us. And what we found is we had quite a few people who were not handling a very large percentage of our business. Then when we did it in house, and we think we made the right business decision to to move out I understand frustration from patients for that. But that was the right business decision for us. as a whole.

Scott Benner 34:22
I would imagine as time passes, these other companies will get better at talking about it and supporting i o they will I years ago before we switched you we had edgepark and I have to say it was fairly laborious to deal with them. And then when it switched back, I was scared, but it was terrific. So I felt like I was talking to a different company and maybe other people will get that experience, I hope as well.

Kevin Sayer, Dexcom CEO 34:42
I hope so too. Yeah. But if they're not, they're more than welcome to reach out to us. We do have a team that monitors the distributors and distributor noise. And if we are somebody who's not doing very well we get on. Nice.

Scott Benner 34:55
So reach out to you if that's happening.

Kevin Sayer, Dexcom CEO 34:58
Now they can send emails to our Customer Support. Yeah, you don't know email right here? Oh, no, they send them to me. Trust me. People find me, Scott. Come on.

Scott Benner 35:08
I don't know that I know how to get ahold of you directly. Yeah, that's right. I think that's terrific. I mean, unless you have anything else to add. Do you expect that I'll see you again this year to talk about g7? Hope so. You hope so. Let's see. Let's see where we are. Yeah. So you are you're coming up on buttoning things up and then making your, your pitch to the

Kevin Sayer, Dexcom CEO 35:29
left? Well, again, we're we I really can't talk a whole lot about where we are until we get to the earnings call. Right. So give me till till the end of the month, and you'll hear a lot more about where g7 we were very happy with our progress.

Scott Benner 35:43
Fair enough. The earnings calls when? end of the month, end of July. Okay. All right. Well, that sounds exciting. You said something earlier that I don't know if you can answer because it involves another company. But what I felt like I got from you was on the pod five won't work with G seven initially.

Kevin Sayer, Dexcom CEO 36:01
Well, Eleni pi, Omnipod, five, and tandem both have to get g seven integrated into their system. Their tandem is already out with G six. So they're working on G seven, we got to get Omni pod and G six on the market first. And then the g7 they are working on it. But I there's going to be a bit of a delay. I just don't that that integration is more on them than on both companies than it is on so we're devoting significant resources to helping him go as fast as I can. We need to get on we bought five which is six out first.

Scott Benner 36:31
Yeah, no kidding. typos in the same situation. Yeah, they're alright. Kevin, I always appreciate you doing this. Hey, thank you. Thanks for the time again. Hey, thanks very much, Kevin, for coming on the show. Again, I love having you. I hope you're back soon to tell us more about the G seven. Thanks also to Omni pod makers of the Omni pod dash tubeless insulin pump, find out if you're eligible for a free 30 day trial of the dash at Omni pod.com forward slash juice box, also touched by type one, find them on Facebook, Instagram, or at touched by type one.org. And if you'd like to get started with the Dexcom today, it would help me if you use my link dexcom.com Ford slash juicebox. And one more thing to tell you after the music ends, and then I'll leave you to enjoy the rest of your day.

Now some of you are not going to be regular listeners to the show. I've learned that about the episodes where Kevin comes on. It makes its rounds on the internet. And people find it. It's just amazing. But I'm going to ask you stick around, try a couple more episodes, see what you think we're at the very least, go check out the defining diabetes series and the diabetes pro tip series from the Juicebox Podcast. Just give them a whirl, you know just go to diabetes pro tip.com. Take a look. If you're not interested. Fair enough. But if you've heard enough, and you're like, Oh, I want to hear more from this podcast, just hit subscribe or follow in your podcast app right now. And if you're not listening in the podcast app, they're very easy to find and very free. There are plenty of them at Juicebox Podcast comm links right at the top of the page to podcast players that will work on your phone. I'm actually on diabetes pro tip calm right now. And I'm going to read you just one review from a listener of the show. This podcast has changed my life. I had a desire to lower my agency and manage my blood sugar's better, but was going at it blindly finding this podcast put everything into a tangible and practical management approach that has taken my agency from 8.3 to 6.3 in less than six months. And that's just right now, it's going to keep coming down. Thank you, Scott. I'll be quoting you forever. There are more listener reviews there and access to all of the pro tip and defining diabetes episodes. I want you to be sure to know that this podcast is ad supported. The content never costs any money. There's no introductory episode, and then the real good stuff behind a paywall that does not exist here with Juicebox Podcast. Every episode, every episode is free for you to listen to. We haven't we have a how you eat series where people come on and talk about all the different ways they eat more recently. We've done keto in a couple days flexitarian will be up we've done carnivore all kinds of different stuff. Vegetarian doesn't matter. The way people eat. I'm interested in hearing about we have an episode coming up with a psychologist talking about communication and relationships. I have an episode coming up About people who in Canada took on the health care system and the and the government and got CGM coverage for their people. There's so much here in the Juicebox. Podcast beyond technology, conversations and management. The real core of it is conversations with parents and adults who are living with Type One Diabetes, or who loves someone with Type One Diabetes. I really think you'll love the show. Give it a shot. Thank you so much for listening today. I really, really appreciate it. And hey, regular listeners if you're still listening. You guys are great. Right? I love you. I'll talk to you soon. I'll be back with another episode of the Juicebox Podcast before you know it. Because they come out Monday, Wednesday and Friday. Oh, geez. I forgot something. One last thing. The podcast has a absolutely kick ass Facebook group has over 12,000 people on it. They're all talking about diabetes stuff. It's the most chill, adult, helpful Facebook community I've ever seen in my life. It's called Juicebox Podcast, type one diabetes. Check it out. All right now I'm really gone. Goodbye.

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