#692 Afrezza Trial

June 1, 2022Scott Benner

Kim returns to talk about a Afrezza Trial

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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 692 of the Juicebox Podcast.

Kim from Episode 443 is back 443 In today's What 692 You're probably thinking that was like 1000 years ago, Scott 1000 years, it was actually February 2021. But, uh, hey, I'm a prolific podcaster so the number grows quickly. Anyway, Kim was here in 443, to talk about her daughter's story, and to share a bunch of information about some diabetes clinical trials with us, and she is back today to talk about another trial, this time with the inhaled insulin a Frezza. 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, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry. Take the survey help people living with type one diabetes while you're supporting the Juicebox Podcast, T one D exchange.org. Forward slash juicebox. This episode of The Juicebox Podcast is sponsored by the Dexcom G six continuous glucose monitor. You can learn more about the Dexcom G six or get started with it right now@dexcom.com forward slash Juicebox. Podcast is also sponsored by Omni pod. That's the company that makes those tubeless insulin pumps, the Omni pod dash, and the Omni pod five. That one's got an algorithm in it. If you want to learn more about them, you're going to go to Omni pod.com forward slash juice box. I just got my license retaken. So if you listen to the podcast, oh, by the way, we're recording just so you know. And I had that very low iron problem for a long time. Yeah. And so I had a photo of my driver's license where I looked like, someone hit me with three cars, and then stood me up and went smile. Like, like, I really look sick in it. And so when

Kim 2:34
they tried to make you happy at the DMV, so surprising

Scott Benner 2:37
this, I look back now and see that I did not feel well. And And anyway, I so I get the thing in the mail. And they're like, look, you can just read, you know, renew online. I'm gonna go no, I'll take the new picture, please. And yeah, so I go down there. And I put this whole effort into it, and I stand in front of the woman. And she goes great. And I'm like, why is the camera like, at my nipples pointing up? Like, Kim, I don't have that kind of face. You don't I mean, like, not many of us do. Maybe I can shoot Brad Pitt from the floor. But I don't know who else you know, Damian. really tall. I said to her, I was like, Can I crouch down? So this thing's more eye level with me. She goes into please do not. And I was like, All right. So I got back a slightly better photograph. At least I'm not sick anymore. But I still keep my head's too big for this kind of photography. You don't I mean?

Kim 3:26
Well, is that the photo that I'm seeing of you now? Because you look perfectly handsome there? No, that's not at the DMV.

Scott Benner 3:31
That's me holding the phone. 12 feet over my head to take that other angle. Okay, I threw the phone up in the air. That's how much higher it is.

Kim 3:41
Yeah, because it looks good. Well, thank

Scott Benner 3:43
you. But generally speaking, we should not be we should not be shooting people from the ground up. It's not a great idea for people to look at it that way. And they're all They're all 23 years old, by the way to

Kim 3:55
DMV is there to provide you, you know, the ultimate and customer service. So

Scott Benner 4:00
it's still 1,000% better than it was?

Kim 4:02
So do you understand sarcasm?

Scott Benner 4:05
Well, I don't see a ton of reason for me to be sarcastic in this episode, which by the way, I've been excited about so I appreciate you doing this for me. Just do do me this favor unless you have any questions. Just introduce yourself very quickly.

Kim 4:17
I'm Kim and I am let's see the mom of a type one diabetic who is 16, who was diagnosed when she was 13 on her next to last day of seventh grade. And after my daughter was diagnosed, her name is Nina. After she was diagnosed, I found out about JDRF and wanted to do what I could to help so I joined the board of Northern JDRF in Northern California and my my job specifically is as a clinical trial education volunteer to make sure people get connected with clinical trials that might benefit them and benefit diabetes research.

Scott Benner 5:02
Alright. So, Kim, have you been on the show before?

Kim 5:05
I have I was on the show about a year ago. And you did an interview with me just talking about the process of joining a clinical trial and about all the clinical trials that were available to people at the time.

Scott Benner 5:21
Right. And I do remember, I brought that up. So I could ask if you knew what episode number was?

Kim 5:25
Oh, I don't. I don't remember. And I do but I do. Remember you said, you know, if there's ever a clinical trial that you're excited about, and you want to share with people, you know, please come back on for a few minutes. So that's why I reached out to you again,

Scott Benner 5:39
no, no, absolutely. I just listen, it's my job to know what Episode You're on. I just thought like, I can't get away with it. If you were like, Oh, I know. It's a great. No, do you think that what we spoke about in that last episode? Is that still applicable today? Or was that time sensitive?

Kim 5:55
So some of it was time sensitive, because at the time, there was the plasma protect trial, there was the clever trial, which was Verapamil in closed loop systems, both both trials for newly diagnosed patients. And happily, those trials have gotten enough participants. And so they are no longer recruiting. Which is wonderful, because one of the reasons I took this role is because I learned that so many clinical trials don't get enough participants, which is such a big waste of money and halts progress towards, you know, better management and cures. So. So yeah, a few of the trials we talked about back then are full, but I think we talked a lot just about clinical trials in general. So I don't think it's, you know, completely out of date.

Scott Benner 6:44
Yeah, it's, um, it's hard to get people to do these things. And there's, it's, I mean, it's understandable why it's difficult. But to your point, they, they have these trials, they're like, look, we need X amount of people to do this. And if they don't get that many people then then the study doesn't happen. Yeah. You know, and it's not, I mean, there was a lady on maybe two months ago or so who was in the witch trial, was it the implantable cells?

Kim 7:16
But the vertex or

Scott Benner 7:18
the biocide stuff, right? Yeah. And, you know, she's an older person with not she was an older, older, but she she's a middle aged person who has type one, it's not going to benefit her, you know what I mean? And she still put herself through it, even in a double blind study where she wasn't even sure if she was even going to get the real thing or not. Right. And she let people she still let people like surgically implant pouches under her skin. You know, I just so amazing.

Kim 7:43
Yeah, I met another gentleman who did that study. And, you know, and I do, you know, hopefully, I'm middle aged, too. I hope hopefully, we still have lots of years to enjoy with or without insulin. But But I met a gentleman who did that study as well with the implantable pouches from biocide. He had two kids who are type one, so I think he was very motivated. For that reason. In that regard, too.

Scott Benner 8:05
Yeah. Okay, so is the thing about the thing, we're gonna be trying to talk right, it's gonna be in the title. Like, why am I acting like people were listening to like, I wonder what's coming next. That was the stupidest thing I've ever done. Your daughter's using? Alright, first of all, I might say it wrong. Is it a Frezza?

Kim 8:23
You said it perfectly. Okay. Yeah.

Scott Benner 8:25
When did she start using it?

Kim 8:27
So she's actually using loop. So she has a pump and an Dexcom so she's not exclusively using a Frezza she's still using her Humalog Well, actually, she tries a lot of different things. So at the moment, she has a mix of Liam Jevons, Humalog, and her pump. And she's, she's a, she's a clinical trial herself. So she's trying that out. But she started using a Frezza in addition to loop. Oh, I'd say bout probably about nine months ago.

Scott Benner 9:02
Okay. So let's, let's start slow. She's mixing two insolence in her pump. Is that something she's doing on her own?

Kim 9:10
Um, well with, you know, with with my blessing, and

Scott Benner 9:14
you know, yeah, I'm just saying it's not like, she's not in some sort of a trial.

Kim 9:18
No, she's not in a trial. I think um, you know, I think Arden did this too. She tried fie us and loved it until it until she hated it because it worked. And then I guess it stopped working after a while and so she had heard that mixing it helped but you know, that worked for a little bit while longer and then she she I we both had heard that Liam Jeff might work a little better and a pump them by us. So she's she's trying that out now. And yeah, someone Someone gave us the vial to try it.

Scott Benner 9:49
So with Arden it was the is it Fiat fiasco? Yeah.

Kim 9:54
Yeah, I think fast or

Scott Benner 9:56
whatever. And it's the one from Nova Oh, Nora, that's right. It works terrific for her burned. We injected it. Oh, okay. Yeah. Then we actually did try the loom JEV afterwards, and that was worse. So we didn't do either, but we loved how fi aspar five, how that how that worked for the Yeah, the onset to working was amazing. And it Yeah, it didn't give up she powered through. So that that one wasn't terrible. The burning garden stayed on that a month or so if I'm remembering correctly, and we had great results with it. The loom Jen, she made me take off inside of 24 hours. Oh, burn that badly. She's like, I gotta get this pot off. And I was like, okay, so bad. So I thought your daughter might be mixing it to try to cut down on the burning, but she was trying to get it to work the way it was working when she first use it.

Kim 10:51
Yeah, I guess the the additive that they put in both of those, maybe that's what causes the burning for Arden. But it also, I think sometimes can cause maybe a little bit of, I don't know, some kind of build up or something where it just doesn't work as well over time. So yeah, she's just hoping that mixing it will help it work better and longer. And this is relevant to a friend because right these are all faster acting insulins. Yeah, and these are Yeah, and they work great. And they work and they don't hurt.

Scott Benner 11:20
Yeah. So let's go over a friend for a second. Like it's inhalable. Yes, it comes only in certain measurements. I know. But I'm not sure which ones. Yeah. How did your daughter leave? She asked her, her doctor about it. And they gave her summer? Where did she get it from?

Kim 11:37
Yeah, so and what I'm going to talk about today is the clinical trial for pediatrics. And she's 16. So still falls in that. So no, was somebody that I met said, you know, this is really great, too, you want to try it and had some extra. So that's how she ended up trying it. And it was game changing she she uses it when she's so because she's on the pump with lube. You know, she's sort of fairly well managed with that. But the Frezza she uses primarily if she's high or stuck high, although she's never stuck high anymore because of her Frezza. So she'll use it. If you know if there's no opportunity to Pre-Bolus which you know, she's a she's a gymnast and a high school student. And so there's lots of times when it's hard to Pre-Bolus, so she can use it for that. But she also uses it let's say a pump fails, or hormones or sickness or whatever, myriad of things leave you over 200 Once in a while. She will use the A Frezza to bring it down and it's like boom, like ABC Action, insulin action time ever. Frezza is 12 minutes compared to because over 30 for insolence like Humalog, so she's never stuck high because as soon as she's high, she takes an A Frezza and it brings her down and then it's out of your system. So it's it really closely mirrors, insulin production and a non diabetic. So it is in quickly, but it's also out quickly. So it tends to just go down to where she wants it to go down. And you know, take some figuring out what dose you need. But it goes down to where she wants it to go down. And then it's out of our system. So she doesn't go low with it. Yeah, so in like an hour.

Scott Benner 13:27
So everybody that I've heard talked about, and there are people I'm online that are just they they're fervent about it, if it comes up, it's you know, they're almost like, let me tell you about Jesus. You don't I mean, they Yeah,

Kim 13:38
I really do love it. Yeah, it is kind of magic. Yeah.

Scott Benner 13:43
And so, I mean, for me, again, not a doctor don't know what I'm talking about. But I'm on a fresa.com right now. And the label warnings for this scare me differently than other things. Yeah. And so I know we're not going to try it. But I don't want to not hear about other people's experience. So So in it for an example, if if your daughter was to miss on a Bolus, just forget the Bolus something and suddenly had like a 300 blood sugar, you know, 45 minutes after chasing Oh my God, I didn't need them. My blood sugar's 300 She would like take a puff of this Frezza and how long to break that 300 and bring it back.

I do love a cliffhanger for the ad break. Dexcom let's talk about them. First Dex. comm.com forward slash juice box. I continuous glucose monitoring system is CGM. That's what the Dexcom is. tells you your blood sugar in real time on your Dexcom receiver or on your iPhone or Android. It's that easy. I'm actually working on getting a blood sugar down For Arden right now. And oh, this is interesting. So 20 minutes ago or so we made a Bolus to try to move a 166 blood sugar. And I've opened my phone now to see that her blood sugar still stable like the arrows telling me it's stable, but it's beginning to drift down, we have a new number of 161. But that tells me because I've been using Dexcom for a while, the numbers moving but the arrow hasn't moved yet. So it's probably going to maybe in the next reading or so indicate to me with the diagonal down arrow, that her blood sugar's moving. So think about this, not only can you see the numbers, but you can see the direction that the numbers moving in. And the arrows also tell you about speed. arrow straight down is moving faster than an arrow diagonal down two arrows down moves faster, the both of them, etc. You'll see if you get the Dexcom. If what am I sending if when you get the Dexcom you'll see how this works. It's the speed and direction and number of your blood sugar. At the touch of a button at your fingertips swipe up there it is Dex comm.com, forward slash juicebox. Now let's talk about that Omni pod five, and the Omni pod dash. Here's a couple of things you need to know on the pod is the tuples. And so on Bob, my daughter has been wearing it since she was four, she is going to be 18 Soon, she's had one on every day and that time, we love it. I think you might too. Here's how you find out, you go to Omni pod.com forward slash juice box, some of you are going to be eligible for a free 30 day trial of the Omni pod dash. That's pretty amazing. Go check that out. Some of you might just say hey, I'm gonna jump right into the algorithm. Give me that Omni pod five. That's another thing you could possibly do these things that you can do. They happen at Omni pod.com forward slash juice box head over there now and find out more tubeless insulin pumping means you can shower with your pump on swim in a lake. jump out of an airplane. You could I mean, I don't know why you would do that. But you could. Because there's no tubes to get caught on. Like imagine if you were like pulling your parachute and instead you pulled out your tubing. That'd be terrible on the body, no tubing, here's a promise I can make you right now. If while skydiving you reach and grab you will never grab tubing from your army pod to glistens on bump because it doesn't have it. Sure this is not a situation that's going to come up often. But you know, if you're plummeting from the sky, and looking for a parachute, pretty cool to know that you're not going to mistake your insulin pump tubing for that parachute. This is a reach here, but I've gotten a little farcical we're at the end. Now I feel bad about this on the pod.com forward slash juice box, find out about the Omni pod dash the Omni pod five, see if you're eligible for that free 30 day supply of the Omnipod dash. I just have to tell you now, for full safety risk information and free trial terms and conditions, visit on the vod.com forward slash Juicebox.

Kim 18:19
Podcast so the higher you are, the more you need. Right like you're becoming more resistant. Yeah, more resistant. And, you know, bless her heart. She doesn't miss a Bolus. So I don't know exactly. But there was a scenario where she had a pump fail. And it was overnight. So no one really recognized it for a while. And so she was floating up around over 250. And so I went in and you know, brought her an eight unit, a Frezza cartridge, and she took it and in 15 minutes. She was back, you know, in the mid 100, mid hundreds, maybe 140

Scott Benner 19:17
doesn't get low afterwards.

Kim 19:19
No, it doesn't. And obviously you need to figure out the dosing if she had done like a 16 unit cartridge, which we don't even have maybe she would have gone low. But it doesn't go low because it goes out quickly. So, you know, usually right? If you have a pump failure, you don't know, you don't know how much insulin you actually have on board. Right. So you might over Bolus or but with your Frezza you know, she does your Frezza and it's in it brings it down but then it's out. And so she doesn't tend to go low with the Frezza the way she might if she was stacking insulin, not really knowing how much insulin was on board with something like a pump fail.

Scott Benner 20:00
How long would you say? It stays in the body? Like, when do you stop seeing an effect from it even in a regular situation?

Kim 20:08
They say it's an hour and a half to two hours, that it's in the body. So, you know, it's in within 12 minutes, and then it stops in about an hour and a half. And sometimes it seems like it's even less than that. And and that's a you know, that's kind of the beauty of it. Because I think when you're in a situation where you're high sometimes, you know, maybe if you've listened to all of your podcasts, you know exactly how to bring it down. Right. But I feel like a lot of times when she's stuck too high, we might push it down. Too low. Not you know, it's just so hard to manage, because you're high for a long time. And you're like, wait, I'm still high. Do I give more. But the present works so fast that you can see oh, that worked. So now we can stop? Yeah. And if it starts inching up again, you can just give another another head, maybe a four unit Afrezza. Bring it back down again.

Scott Benner 21:02
Is it? Is it hard to figure out? Like what what is four units? eight units? 1216? Yeah,

Kim 21:09
I think four of us four, eight and 16. Maybe there's a 12. And we just have the foreign aid unit ones. And the it's equivalent, it's not actually four units, because when I first heard about it, I'm like, Oh, she doesn't ever use four units. So that's a lot. And you know, very different being 16 than 13. So probably she does now but but she if she finds a four unit, and most people do equivalent to like two, two and a half units, so it of Humalog. So it's, it seems a little different in terms of what the dosing means.

Scott Benner 21:44
Actually, I'm again on their website, there's a asterik it's talking about something but it indicates there's a four unit a 12 unit cartridge. So I mean, I know there's eight and 16 as well,

Kim 21:55
because yeah, okay, so there's those for you for different cartridges. Yeah.

Scott Benner 21:59
So is it basically marketed to people for like mealtime only?

Kim 22:04
Yes. So it's marketed to people for mealtime. And then they do a long acting shot with it.

Scott Benner 22:10
Okay, so yeah, so most people would do a Basal insulin injected, your daughter is actually looping with Basal insulin and then doing this for meals and highs or does she also use the loop for meals?

Kim 22:24
No, she uses a loop for meals. She just uses this in a situation where maybe she's like, at a at a birthday party. And there's a last minute thing that you know, Okay, everybody, we're gonna eat this and leave. And so she has the you know, she doesn't have to wait, you don't have to Pre-Bolus with the fries. I like your food comes at a restaurant you Bolus then. So in a situation where it's really hard to Pre-Bolus She might use it. But primarily she uses it for a situation where she's just high and stuck high. And then this just brings it down. So maybe, you know, there was a there was a situation the other day where she was at a meeting, that she had a school thing and her pump was expiring and she didn't have supplies with her. But the phrase is so tiny. She carries that it's easy. So she had that in her pocket. So even though she her pump was done, she just did some a Frezza you know, made it until she got home three hours later, and her blood sugar was perfect. So she uses it more in those situations. So, you know, maybe a couple times a week, but it is marketed as a mealtime insulin, but because we love loop, she's she's kind of using both

Scott Benner 23:33
as well. I was gonna ask you about how frequently do you think she's using it? But a couple times a week? Yeah. Yeah. Is it cutting down cutting down on lows on the other side of highs for you, as well as limiting the amount of time that she ends up spiked?

Kim 23:49
I think when she uses it, she doesn't go low. You know, because of loop suspending insulin. She doesn't go low that often. But you know, she's also a competitive gymnast. So that makes just everything hard to manage. So she still, she still has occasional lows, but not not from the Frezza.

Scott Benner 24:11
Do you ever get confused? When she's having an issue? Just meaning anything that's out of the norm for you? Is it ever confusing about which insolence doing it? Or does that not matter? Because you treat the situation the same way?

Kim 24:26
I think you know, she's very self managing. So I'm not even sure I can answer your question. But I think with the Frezza when she does the A Frezza she doesn't do anything to loop. So it tends to suspend because it sees that she's going down really fast. So it's kinda like she's not getting Humalog when she does the A Frezza. So she knows that hey, if I'm, if I'm at 210 and I do a four unit cartridge of a Frezza that's going to bring me It's a 120 study. And it doesn't seem to be confounded by by the human log. And I think it's because just because the insulin action at the Humalog is so much longer that even if she has some insulin on board, it's okay. But I think, you know, she takes that into account too. Like she got five, eight units on board because I've been, you know, my pumps, my my loops been trying to push down this high, she might do a smaller dose of her Frezza.

Scott Benner 25:29
Okay, so let me ask you, how much input? Did she come to you with this idea? Or did you go to her with it?

Kim 25:40
Oh, third party came to us a friend was like, you should try this. It's a great tool to have in your arsenal. And she's like, Yeah, cuz, you know, it's, she wants to be well managed. She hates to have high blood sugar. So she was just gung ho about trying it. Yeah.

Scott Benner 25:58
Did you look into the safety data about it before you let her do it? Or did you just try it? Or what did you do?

Kim 26:06
Oh, yeah, I read everything. I mean, this is, you know, part of the reason I like this role of educating people about clinical trials, because I want to know all the details, like every every drug every, all the research that's happening, I am just, I'm obsessive about it. So yeah, I looked into it, you know, read the history of inhaled insulin, which is really fascinating. Like, right after the discovery of insulin, they started working on an inhaled insulin just took a really long time.

Scott Benner 26:33
In the 20s.

Kim 26:34
Yeah, in the 20s. In Germany, I guess they started working on it and inhaled insulin. That's crazy, took so long. And then this insulin called exubera came out, maybe in the early 2000s. But it failed for a few reasons, I think primarily, so this huge device that kind of looked like a bomb to inhale like, couldn't carry it around. Although I am waiting for my daughter to get busted for vaping with her friends at school, because now it's like this tiny thing. But

Scott Benner 27:07
anyway, I have some marketing materials from exubera. It's an E X, E R A. And my goodness, yeah, it looks like a flashlight. Like, it's like a big flashlight. And the girls like it. It looks like a bomb, basically. Yeah.

Kim 27:23
Okay. Does it does I think if present maybe did a little more consumer research. Or maybe maybe things evolved that they were able to bring the size of that down?

Scott Benner 27:31
always reminds me of a whistle. Yeah,

Kim 27:34
yeah, it looks like a tiny whistle. Yeah. Yeah. Very convenient. Very, yeah, very easy to just stick in your pocket. So yeah, I mean, I definitely read, you know, a lot of, you know, a lot of patients in the adult clinical trial, which, you know, happened, I think, I think it was like 2014, it came on the market had a cough. And, you know, that could be uncomfortable, but that would tend to go away. And, and probably the thing that you saw the warning was to have two adults in the adult trial develop lung cancer. But that was 2750 patient years of data, and the FDA approved it, saying that that was no more likely, no more or less likely to happen in a general population of that many adults. And those two people also had a history of smoking. So yeah, you know, right now, my daughter has been prescribed for, you know, painful cycles, birth control, and I'm like, investigating all of the different options. And there's something scary about every single one, you know, no, I, I really couldn't figure it out if you reasonable and take it into account, but it's hard. Yeah,

Scott Benner 28:56
no, I, I understand that. I mean, drugs in general, I think make people's lives better. When they're used well, and that, like, you're saying that it's not going to work great for everybody. And yeah, you know, there are it's tough, though. I mean, you know, it's it's basically right on the front of their page, it says a Frezza can cause serious side effects, including sudden lung problems. And you know, do not obviously don't use if you have long term chronic lung problems, asthma or chronic obstructive pulmonary disease, etc. See your doctor, but I mean, sudden lung problems like that's like a bet. I don't know. That's a tough one for me, because are they sudden lung problems that go away if you stop or are they sudden lung problems that you it's sort of the way I feel about getting corrected by surgery? Yes, I think it would be a great idea unless I'm one of the people that gets halos. And then I'd like a time machine, please. You know what I mean, like, absolutely. Yeah. I just wondered.

Kim 29:53
So the way you know, the way I felt about that, investigating it further was those sudden problems go away when you stop I figured, you know, try it, if it, you know, gives her, you know, sort of bronchial spasms or cough that's uncontrollable, and she won't use it anymore. So she does have mild asthma. But she did a pulmonary lung function test, she had done one earlier just to see if she should take an asthma inhaler or not. But they do recommend that you get that done when you take a Frezza and and get it done, again, six months later, and the clinical trial, they will do that for you. So they're keeping an eye out for that and making sure that, you know, your lung function is fine. But it's evidently something that just goes away when you stop taking it. So if you have a problem, you just stop taking it, and then that cough or the acute bronchial spasms, go away. Not everybody gets that. And yeah, they do have a warning on it. You know, don't take this if you have asthma that said my daughter does, and she's fine with it, she doesn't even get the cough. And there's a hack. Like if you drink a little water before and after, and you keep it at room temperature, you're way less likely to, you know, even get that like mild irritation from inhaling it. But you're inhaling something. Yeah.

Scott Benner 31:09
Right. Bronchial spasm sounds like a, like an awkward dinosaur tummy.

Kim 31:15
does, doesn't it? Yeah. And I, you know, I'm not a doctor, but it's, I think it's, you know, it's just a key, it's an acute thing that, you know, let it calm down, it'll go away. It's not right. Is it?

Scott Benner 31:28
Is this something that you've noticed? And she's only been doing it for a short time, but have you seen improvements in her time and range her a one C? Or is everything kind of just the same, you're just managing it differently?

Kim 31:46
You know, think there's definite improvements in time and range, because she doesn't stay high for more than, you know. You know, sometimes she might not, you know, take the Frezza right away. But if she takes it right away, she's not high for more than 15 minutes. So it really gets rid of highs. And again, it doesn't cause lows. So see, our time and range is better. I know, in the adult clinical study, that the time and range, you know, increased two hours a day. So I think it can have a huge effect on time and range. Don't know what her or anyone sees usually in like, high fives, low sixes, I think it's not that different. But it's probably a little better since starting a Frezza.

Scott Benner 32:41
This is like one of those things where you're looking for a problem, but it's still popping into my mind enough that I'm gonna ask, Does the fact that it works so quickly? Can it make you ignore that you need insulin? Like, do you mean, can you get too comfortable? I guess it's not that you could ever be too comfortable. But you know what I mean by that, like, can you kind of get can you get kind of laissez faire about it? Because you'd know how quickly it works? Or have you not noticed that?

Kim 33:09
That's an interesting question that you might have to ask my daughter. Yeah. Yeah. I don't know. I mean, I think she's 16. Yeah, so you know, I mean, I can only imagine that it might not be as terrifying to go high. But you know, everybody it happens though, right? Like, you go high, whether you want it to or not, you're gonna have hormones, you're gonna have sickness, you're going to have pump fails, you're going to have temptations or food coming at a restaurant when you didn't know when to Pre-Bolus Like, these things are just going to happen. So you know, I don't know whether, you know, it makes her act differently. But when these probably not, she's a very, you know, she's, she's always wanted to manage really well. So I don't think she's not a laissez faire kind of kid. But could that happen? I guess so.

Scott Benner 34:11
No, I it's funny. I don't even as I asked the question. It's not even something I'm wondering about as much as I'm wondering if somebody else would wonder about it. So yeah, I just asked it that. Yeah.

Kim 34:20
Yeah, I mean, but then again, it's like loop like it's or, you know, Omnipod, five or candidum control like you like, these things don't necessarily make your time and range better, although they often do. I think primary The primary benefit is just giving your life back and making life easier. And I feel like that's what our Frezzer really does, is she's, you know, she's not in the middle of an AP test with her blood sugar going up and going. Doomed. She's like, Yeah, I can fix this. It's okay. All right.

Scott Benner 34:55
That sounds I mean, it really does sound terrific. I've never not thought it didn't sound good when any But he's explained it to me to be perfectly honest. It's yeah. I mean, I'm just being perfectly honest, like something. Inhaling something unnecessarily seems weird to me. But, you know, I don't know. And I know people say, Oh, that people have been using it for a decade or longer. And, you know, they have data now. And I mean, that's Yeah, but I'm not. I don't know.

Kim 35:22
Yeah, it's newer. I mean, people have been, you know, I mean, if you if you sort of looked at inhaling versus injecting, and they were both as new, you might be like, Well, I'm not going to inject something. I don't have to inject. But now we've been doing that for 100 years. So there's, there's more data for sure.

Scott Benner 35:36
Right? Yeah. Right. It's just like, right, nothing about using a liquid insulin is gonna make your lungs stop working. So, yeah, well,

Kim 35:45
and, you know, the, you know, I've been, I've been inhaling, you know, albuterol for, I don't know, 35 years, and Steroid inhalers. And so maybe having asthma I'm, I'm really used to inhalers and they've made my life better. So. Yeah, so I'm not, you know, and then the, the technology is getting better too. Right. It can be you know, I don't understand the material science so well, but they can break things down so that they're just doing what they're meant to do. Now, you know,

Scott Benner 36:18
the molecule passes easier. Yeah, they refine Yeah,

Kim 36:24
it's tinier. It's yeah. But I just, you know, for me, it's just like, wow, this is just, it's just game changing. So I, you know, I want people who want to try it, to have that opportunity. And so, I think it's, you know, it has been on the market, people have been doing it for 10 years, it's been approved for adults and feel like kids more than adults, you know, need that spontaneity need to be able to eat without Pre-Bolus Singh needs to be able to, you know, bring down highs more quickly. So, you know, as adults, I think, you know, maybe you're more inclined to like, okay, my blood sugar's high, I'm gonna go for a walk, I'm going to Pre-Bolus and eat in 15 minutes. And, you know, my kid wasn't diagnosed till 13. So she was already, you know, managing pretty well, but I just feel, I just feel for families who have younger kids, and and I want them to have the opportunity to try this if they want to. So I am telling people about all the clinical trials that are going on, whether it's cure research, or device research or insulin research, but this one is one that I'm really passionate about, because I've seen how well it works for my daughter. So. So yeah, so now that they've got the clinical trial for kids, and it's a phase three trial, so they have tested the safety. And they've tested that it works. And so now they're on the phase three trial, which is just trying it in a broader population of four to 17 year olds, and and I hope it, you know, fills up quickly so it can become available to other kids

Scott Benner 37:59
question about the trial, do you get the drug through the trial?

Kim 38:05
Yeah, so the way the trial works, it's a 14 month trial. So it's long. And for the first month, they kind of do some tests, you know, test your agency do the pulmonary or the lung function test. And, and then for the next six months, they have I think they have twice as many people doing the Frezza as shots but they have a group doing shots and a group doing a Frezza. And then for the second six months, everybody does a Frezza for mealtime, insulin. And then then there's one more month where they do some follow up. And, and that's it. So it's 14 months in total. And they provide you with the inhalable insulin, they provide you with a free Dexcom for the entire year of the trial. Fun. Yeah. And then they also pay you I think it's around $750 to participate.

Scott Benner 39:05
Is that still going on? Could people get into it right now?

Kim 39:08
They could, yeah. And they have 17 locations throughout the United States. So everywhere from you know, California, Florida, Indiana, Texas, Tennessee, you know, 17 different locations. So it's all over the US. And you go into the office just a few times. So even if there's not a site like super close, it's still possible to do it. Most of it is done remotely like they give you the stuff to give you the goods and send you home. And and to find it I think people just Google a Frezza and clinical trials.gov. They can find it that also the name of the study is inhale one. So that's another way to find it, but I think just Googling a Frezza it's a Frezz a and In clinical trials.gov, or pediatric clinical trial, they'll come up with the study. And then if, if they scroll down to the bottom of the information about the study, they can see the locations with phone numbers and emails. And so what they'll want to do is contact their local Study Center, the one closest to their home, and ask about getting into the getting into the study or ask for any clarifying information they might need the, you know, I, I know a tiny bit about many different studies, but the study coordinators know everything about this study. So they're the ones to contact for more information.

Scott Benner 40:37
Yeah, excellent. What? Are there any other studies that you want to share with people that are happening right now? Oh,

Kim 40:46
yeah, there's, there's a couple other studies

Scott Benner 40:49
on if someone would know, it would be you. So yeah.

Kim 40:53
Let me just pull up my list to see what I think would be most helpful to share. Some of them I stay, stay really on top of Northern California. But I mean, you've talked about this a ton on on your podcast, so I don't necessarily need to repeat it. But I think, right now, it's more important than ever to get loved ones screened for antibodies through trial net, or to end detect is another way to do it. But trial net is free. And trial. net.org is where people can go to find out about how to get test kits sent to their home to screen siblings and other family members to see if they have antibodies that will determine their risk of developing type one. And I think this one's more important than ever, because to lism AB, which was in clinical studies last year is on the cusp of being approved by the FDA and has been shown to prevent the onset of type one for three years, on average. So if you have somebody who is at risk of developing type one in your family, I know a lot of people used to be like, Oh, do I even want to know, I know, I recognize the signs and symptoms, but and it's I think it's always been important to avoid people from getting diagnosed in DKA, or having it get too bad. But now it's even more important, I think, know that. That that's available, and then you can find out that there is a risk. And I have to say when my 12 year old did the trial net clinical study, she was really, I think, grateful. She's She got a little shirt that said, I'm contributing to science. And I think she was grateful to be able to do something like feel like she was contributing to her sister's disease. So I didn't mention that. But I and I'll mention one other clinical trial, but I feel like one of the big benefits to being in a clinical trial like this and Frezza one or any other clinical study, not so much with TrialNet but is you get a generally kick ass endocrinologist to stay with you over the course of a study and, you know, give you advice on dosing and other things that you might need to manage your diabetes better. So just that relationship, it's like having an extra endocrinologist who is really at your side, guiding you through these studies, but also guiding you through your diabetes journeys. I think a big benefit, and a lot of times these researchers who are the, what they call principal investigators on these studies are some of the, you know, some of the, you know, world renowned endocrinologist and it's, it's great to have them working with you and answering your questions and learning more from them.

Scott Benner 43:44
People paying attention to the cutting edge a little bit. Yeah. And there's a heart and they're a sounding board if you need them. Yeah,

Kim 43:51
yeah. Yeah. So the one other study I'll mention is it's dump a it's D O M, P E. And this is the one study that I know of right now. That is for people who are recently diagnosed or diagnosed within the last 120 days, which is a little bit better than some of these past trials, they wanted to get you in three weeks. And they want that because they're trying to help you preserve the beta cell functionality or the insulin producing cell functionality so that you stay in the honeymoon longer. And there's a lot of benefit to that. So the dump a do NP E is an oral drug that's thought to preserve the beta cell functionality. And it's it's also offered in a bunch of different locations. So you just have to, again, Google don't pay and clinical trials.gov. And this, I wish this had been around when my daughter was diagnosed because she's needle phobic. So the idea of doing the studies that were available at the time, which required an infusion of you know, sitting there with a needle in your arm, but we're not just not viable for her but this one is a an oral drug that you take at home. So you, it's 10 study visits over a year. Like with all these trials, they generally they provide you a Dexcom. And then they give you the pills, and you take this at home, and it can help preserve the, you know, the honeymoon period and make your diabetes easier to manage for a longer time period. And then I always think, like, it's great to preserve that, you know, insulin producing cell functionality, because there's other things coming down the road that, you know, maybe can make them work better again, and you know, like, I just feel like, the more you can do this, or stay in that state, the better. So, that's another trial I'd love to share with people.

Scott Benner 45:43
Cool. Yeah, I know the lie. No, I'm imagining that Tomislav is getting close to something because they're on my schedule this summer to record Oh, good. I mean, I don't know why they're coming on. But I didn't imagine that they contacted me and said, hey, we'd love to share bad news with you or tell you how we're refurnishing the offices or something like that.

Kim 46:07
Oh, that's great. Glad you got that little hint there. No, I definitely expect that to be news that we hear hear about soon. So yeah, I guess it's almost summer. So that's

Scott Benner 46:17
yeah, you know how like you hear on your favorite radio show, like Robert Pattinson is going to be on and you think he must have a movie coming out? Maybe we'll find out one day. It is fun to not know anything and sort of know something at the same time, because I really don't know anything. And then, but I mean, they are right there on the schedule, I think in August may be good anyway. That's excellent. Do you ever get tired of this burned out from it being involved with these things?

Kim 46:49
Oh, gosh, no, I mean, being involved. Like I, first of all, I am so grateful, you know, to work with the people that I work with at JDRF. Because they're brilliant. I mean, I feel like, you know, just people get involved because they felt loved ones with this disease. And then sometimes they're, you know, they've, they've run companies, they're doctors, they're, you know, like, the people that I interact with, who are all working towards, you know, better management and a cure for type one I just feel so blessed to be working with. And I feel lucky that my job is to keep up on what's the cutting edge research and diabetes care. Because I want, you know, I want to know, and from the minute my daughter was diagnosed, I wanted to know, what can we do about this? Right. And it's, it's a disease, it's a little bit out of our control, but it's also within our control on a day to day basis. And on a, you know, let's see what what's coming down the pipeline to make this more manageable? And then getting people into these studies is, I think is really going to make a difference, because no idea. Yeah, I mean, we're all like, either donating our money or our time, or our expertise. And this, to me, just like, leverages all of that, because, you know, a lot of the money is going to this clinical research. But if this clinical research doesn't find the people to participate, then, you know, it's more expensive, and it takes longer, and we all want this to happen as fast as possible. And it's also right now, it's just so exciting. I mean, there's so much going on in terms of both, you know, all these, you know, all these closed loop systems getting approved, and the research on insolence that are going to work faster and better, whether they're inhaled or injectable, or in a pump, you know, there's research on you know, faster insulin insulins, insulin that, you know, is just recognizes when you need it, like Foucault's responsive insulin and, and then this cure research is just, it's, it's such a, I think we're just at a really exciting time, where there's a lot that can happen, and you know, if if people just, you know, got focused on working on it, and I want to do whatever I can to make that happen faster. So, yeah, no, I feel really constantly just excited by what I'm working on.

Scott Benner 49:18
It's interesting. Sometimes you see someone online, they're like, You know what, they should hurry up and do this or this. And then you say, like, have you done, you know, anything? Like involved with research now? I'm not doing that like, Okay, well, that's why it doesn't go faster.

Kim 49:33
Yeah, and I'm, you know, like I said, I'm not a scientist, I'm not a doctor, I don't have any background in any of this. So anyone could do this, right? Like, just read about these things and try to understand them and then tell people about them. And I feel like in some ways, it's it's almost better, you know, if you can communicate about it in a way that other people understand because you don't know all the details of the medical, you know, and I think just a lot of people want to do this like they want to get in Follow up, like you talked about that that woman who just did this study, because you feel like she just wanted to give back. You know, there's a lot of selfish reasons to be part of studies, like I said, just, you know, getting to hang out with these top endocrinologist getting free devices getting, you know, the latest cutting edge, you know, drugs or devices, like there's, there's a lot of selfish reasons to be involved in a trial. And then, you know, to just give back and help everybody else that's going through this, I think, is something that motivates a lot of people to like the way to help help. Like, I think it just helped my my younger daughter to be a little bit involved. So I think the biggest issue with clinical trials is people just they don't know about them, they don't know how to find them. And so I think it's, you know, wonderful that, thank you for having me back on and having the people from, you know, TrialNet and other places on the podcast, so that people just can find out about it, and then make their own decisions about what they want to do about it.

Scott Benner 50:58
That really is the case, they just need to be aware, and then they can decide what to do.

Kim 51:02
Absolutely, yeah, but that awareness is I think, a little bit lacking, like, you know, when when I met when my daughter was diagnosed, it wasn't like, let me tell you about all the clinical trials she can participate in. And I kind of would have wanted to know, like, I feel like we're doing a disservice to people if we don't tell them, but I think a lot of times, endocrinologist, either they don't have time. Or they think, Oh, that would be too overwhelming. And I just think we should give people the choice.

Scott Benner 51:27
To prove your point. I get paid every time somebody signs up to the to 1d Exchange survey. Because it's that hard for them to find people. Like it's so difficult for them to find people that they had to come to me and say, Can you please direct people to this thing? Here's an amount of money we can pay you every time somebody finishes the survey? Well, that's not you know what I mean? That's not what they want to do. They want to keep that money for something else. But instead they're out incentivizing. It's not just me, it's other people too. But sure, you know, and it's just and so they're not advertisers. So they don't pay me like a set amount of money every week, right? I make based on how many people sign up a month. But you'll hear me on every episode say like, you know, if you're a US resident, or you're the caregiver of someone with type one, who's also a US resident, Baba ba T, one of the exchange.org forward slash us like go, it helps people, it helps people it helps people like in the ways it helps is to almost convoluted you don't mean like, I just need you to believe it helps people and you're just filling out a survey. It doesn't even take very long and still difficult to get people to do it. Yeah, you know,

Kim 52:39
yeah. Obviously, they're finding it worthwhile in terms of the money they're spending to pay you to send people to this and fill it out. Oh, why they're benefiting? You know,

Scott Benner 52:51
I hear Kim that the podcast puts people on the survey at a at a much greater rate than other places, though. Yeah. But it's but that's not really the point. The point is that is that someone has to spend money to get people to take a frequent survey, because it's that hard to get people to take a survey. And you're talking about like, swallowing a pill for 14 months. Like, will you get a free Dexcom? And most people have insurance like yeah, we kind of get a free Dexcom already, like doesn't cost me that much, you know? And yeah, and the people who could probably really use it might never hear about it. To your point. Yeah, because doctors don't talk about them. I've never once been told about a trial a doctor's visit. Never.

Kim 53:31
Yeah, yeah, no, absolutely. It's interesting. Ya know, you have to figure out why, like, why you'd want to do it for me, you know, and again, it's my daughter, so it's up to her, it would be the motivation would really be to get to make her life better, like I would do, she would have done this a Frezza trial, but you have to be there with your friends at trial. You have to be on shots for two weeks before you do the trial. And then there is a there is a group that stays on shots for six months. And like I said, my daughter's needle phobic. So this is not a trial for her. But she loves the A Frezza she'd be happy to try it for her mealtime insulin for over a time period. Have a

Scott Benner 54:08
question about that? Yeah, when the first trial ends. It's not how she couldn't get it anymore, right? It'll just though she'll be done getting it and then she'll have to hope they get it approved for the FDA for her age range. So that it can be is that right? Well, I think the

Kim 54:24
benefit of this one and that does happen. Like you could go through a trial and be like, wait, wait, give it back. Eventually, it does come. I mean, I have a friend who did the Dexcom g7 trial it was like okay, you know, can I keep out? Soon enough?

Scott Benner 54:43
I've heard people talk about it with the pod five. I mean, the woman who was not talking about the vitae site, you know, it's double blind you don't know if you got the medication or not. But she said that her blood sugar's were easier to maintain and etc. And like I'm like, Oh my God, they're gonna take those out of you one day. Right. Like I'd run away if I was you, like, I'd go, I'd be like, I gotta go, you know? Yeah. So

Kim 55:05
there are times, you know, I mean, with Omnipod, five, they, you know, they let the trial participants get the, you know, the pre release. And so there was a, you know, hopefully not too much of a gap for people who did that trial and then got to actually use the product. But for the Frezza trial, it's a little bit different. And again, it'll depend on your endocrinologist, but my daughter gets his prescribed from her endocrinologist, even though she's 16. And it's only approved for 18. And up it's a it's an off label prescription, and they absolutely have the, you know, prerogative to do that. Mankind corporation who makes a phrase also has a list of endocrinologist who prescribe it. So you know, you can figure out a way to get it if if you want it, even if you're a kid. Yeah.

Scott Benner 55:51
It's nice that you brought that up, because as an example, right now, on the pod fives out in the world, and people are like, well, it's not approved for my insulin, and I answer as many people as I can I say, Look, I'm not a doctor. I don't I don't work from a pod. I come from No, no positional power in this scenario whatsoever. But they didn't test it with your insulin in the FDA trial. They didn't say it doesn't work with your insulin. They say they didn't test it with your insulin. Yes, exactly. And then you're like, the feel the rest of what I'm saying here, like, you know, because people are like, are you going to use a pager and on the pod five? And I was like, yeah, that's that's the insulin rd uses. Right? Yeah. Well, it's not it's not it's not. They said, it doesn't work. I'm like, nobody said it didn't work. What they said was, they didn't test it. And so it's little nuances of, you know, everybody's covering their, you know, there are people covering their butts legally all over the place. Most people can't hear through the nuance of the conversation. And then they get stuck saying, Oh, I'm not allowed to do that.

Kim 56:56
It's an important point, such an important point with this disease, because we know so much by managing it at home on a day by day, hour by hour basis. We can't Yeah, and I mean, that's, you know, certain devices are only approved for, you know, the arm, but that doesn't mean they don't work wonderful on the calf. Yeah. I've tried it. No, no, no. And ran that through a clinical trial be so expensive to like, do that clinical trial with every part of the body? Just couldn't? Yeah, isn't

Scott Benner 57:22
it funny people like I need this stuff right away. I'm like, you know, we'll every place they tested on every insulin they try it with is going to elongate the testing process, the FDA and elongate that process. And it's not that it wouldn't work out. It's not that you can it's not that you couldn't wear your insulin pump on your calf. Yeah, it's that is that the company locked in when not enough people are going to try this to make it worth the amount of time it's going to take to get through the FDA.

Kim 57:49
Yeah. And I will tell you, we had the opportunity to try a Frezza without a prescription because someone gave it to us. But then I wanted to get our own prescription so that I could keep getting it because it worked so well. And I switched windows to get it and you know, it's not just Yes, I want to Frezza. So I'm going to switch into this, but I want I want somebody who is going to be thinking a little more flexibly and not going to sort of just put up barriers. So there are some people who will not prescribe something off label. But I you know, I mean, first of all, like I know now a friend has been through trials with pediatrics, and it's been totally fine. But my daughter is 16 she's, you know, she's the same size as I am. And I'm, you know, older than that. So, you know, the

Scott Benner 58:38
other day we took so you mentioned all your daughter's cycling through, like hormonal birth control hormone tried to, like, take care of a problem, right? Yeah. So Arden has that issue as well. And you know, sometimes she's she still has some sort of residual stuff. We're trying to figure it out. So we're up to the point where she's gonna see a GI doctor. So we find the best GI doctor, we can make the appointment, I call up. I said, Hey, I'm calling from my daughter. She's a minor. Okay, blah, blah, blah. You know, we get the appointment, we wait five weeks for the appointment, she has to take off school to go my wife takes off work. We all drag ourselves over there. We fill out all the paperwork that the place has. And we're sitting in the outer office, they Mr. Banner, could you come here from my coffee window? Because I'm so sorry. This is so strange. We can't see your daughter. She's a minor.

Kim 59:22
No. And I said, and she's like, almost 18

Scott Benner 59:25
I'm like, I'm like, Yeah, I mean, she's 17. But she'll be and so literally aren't going to be 18 in under 60 days. And I said but she'll be you know, in under 60 days, she's it's, you know, it's okay. You can say no, no, we have. And so it turns out, it's about their insurance. Of course. They're only covered to help people over 18 years old. And I said that this is ridiculous. Look at her. She's a lady. You know. She's got all the lady bits and everything. She's totally a lady. And you know, like, let's do it. And no, a bit of a tussle in the chem I might have been unnecessarily loud. I got upset, because Arden's in pain. And they're like, called the Children's Hospital. I said the children's hospitals just gonna go by the book, they're gonna tell her she's fine. And then that's going to be the end of it. I'm like, we need you. We need a ninja in there looking around. That's why we're here. We understand we can make you an appointment for after her birthday. Oh, my God. I said, but she's going to be in pain between now and then that's okay with you. Nothing we can do about that she could go to the Children's Hospital. Oh, I'm so sorry. They were, trust me the people saying it. They didn't want to be saying it. They were just following some arbitrary rule that they set up. And now is how we do it and blah, blah, blah. And you don't you're right. You don't want an endocrinologist As another example, who talks to you that way about diabetes, about like, oh, no, it's not okay. Or it's not this or it's not like just Arden's tried. I mean, the r&d has been great. Every time we want to try different insulin, I just send them an email. I'm like, Okay, can we try fiasco short here comes description. You know, no big like, well, we'll have to get you in here and talk to you and run you through the mill. It's just like, yeah, sure, given. You know,

Kim 1:01:13
it's yeah, it's not always the case. So that's really nice.

Scott Benner 1:01:17
Not at all. I know. Is there anything that we haven't talked about that you want to talk about?

Kim 1:01:23
Um, no, that I think we should we should connect offline about these other issues that you were at the doctor for.

Scott Benner 1:01:30
So Oh, because you might have some thoughts, or you're wondering what we found out? both Yeah. Yeah. Well, why don't we just say goodbye. And then we'll talk right now. Oh, it sounds great. All right. Cool. Well, thank you for doing this. Kim. I enjoyed having you back again. I hope you do it again.

Kim 1:01:45
Yeah, wonderful to be back, I will come back to share their trials.

Scott Benner 1:01:48
Excellent. Hold on one second.

I have found Kim to be delightful both times I've met her and I really do appreciate her passion around these clinical trials. If you're looking for that a Frezza clinical trial, I have the link here. I can't read it to you it is way too long. But I can tell you that I got to it by googling. Inhale one, that's the number one a Frezza. So it's inhale, classic spelling of inhale, one of Frezza and you'll find it right there. It's at clinical trials.gov. Thank you so much to Kim. And thanks to Dexcom and Omnipod, for sponsoring this episode of The Juicebox Podcast. You can learn more about the dexcom@dexcom.com forward slash juicebox more about Omni pod at Omni pod.com forward slash juice box. You can learn more about all of the sponsors. In the show notes of this podcast player that you're listening in right now like in your apple podcast app or something like that. They have a show notes section you can find it or these links are also at juicebox podcast.com. It helps me a great deal if you use my links when you're finding out more about the sponsors. Like don't get me wrong. If you end up in your doctor's office one day and you're like Hello, doctor. I would like to get an omni pod. I still feel good for you. I'm super excited about that. But you know what I'm saying like I don't get no credit for that. So use the link, please. dexcom.com forward slash juice box Omni pod.com forward slash juice box. links in the show notes links at juicebox podcast.com. Got a great episode coming up for you on Friday. Hang out. And what else? Oh, I have that thing about the insulin. Yeah. Oh, I know what I'm gonna get I know what I'm going to give you next week. Oh, you're gonna love it. Love it love. Very interesting thinking of it actually a number of things. I could look here and tell you let me take a look. Thank you know what the Why Why spoil the surprise, right? You just subscribe in your podcast app and next week, the episodes will pop up and you'll get new ones. That's what I would like from you. If you could just do that. Please, to be perfectly honest with you. If you're listening and you're not subscribed in a podcast that you make the inside of me sad by not doing that. Please don't make me sad subscribe and a podcast that. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Did I do that already? I don't think I did. Let's just let it go. If I did already, then you heard it twice. And it's a free podcast. Stop complaining.