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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 908 of the Juicebox Podcast.

On today's show, we have John Fossett. Now John is the father of a child with type one diabetes a teenager. In fact, he is the creator of sugar pixel. He's helped with loop. And he's here today to talk about how his daughter went from loop to Omni pod five. We're also going to talk about a Frezza. I mean, all this is a management heavy episode, like if you're interested in taking care of diabetes. If you're especially interested in algorithms like loop and Omni pod five, or just hearing two people talk about diabetes like a couple of dorks, this one's for you. 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 consider going to T one D exchange.org. Forward slash use Box and completing the survey. T one D exchange.org. Forward slash use box you can help to move type one research forward in just a few minutes by completing that survey. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash and the Omni pod five. Learn more and get started today at Omni pod.com. Forward slash Juicebox Podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapist who can help you with a wide range of issues. betterhelp.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit. For any reason at all, you can switch to a new therapist at no additional charge betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy.

Jon Fawcett 2:49
Hey, I'm John Fossett. I am the creator of sugar pixel custom type one and also a lot of the loop patches for DIY loop. My daughter Lily is 17. And she's the type one in our family. So I've been thrown into this. Just like all the other parents having to learn and figure out settings, you know how insulin works and all of that. And that's transition me into doing this basically full time to spend all day learning new things, figuring out new things. She used DIY loop for three and a half years. And she's been on Omnipod, five for five months now. So still learning and every day is a new learning, but hopefully we can, you know, discuss a lot of those things to to help other people out there.

Scott Benner 3:41
Okay, well, that sounds like a good plan. John, I don't I'm trying to think of the first time I had some sort of contact with you. I think it was if you stopped me if I'm mistaken. But I think that something along the lines of your sugar pixel was being shared so much on my Facebook group that you thought that I must think you were spamming the Facebook.

Jon Fawcett 4:06
Yeah, I've had to apologize to most of the Facebook group admins. I can't stop people from sharing it when they get excited about it. I mean, you know how that goes people. People share Juicebox Podcast links all over the Facebook groups as well. It's a similar thing to that. But yeah, that's how we first got introduced through Kenny Fox.

Scott Benner 4:28
Yeah, well, you didn't have to apologize to me. I have a very, I have a very simple rule about the end. The rule, I think just exists in my head. If people are really excited about something, or they find it helpful or whatever reason, like it doesn't matter to me if it's another Facebook group, if it's a book, it can be a different podcast. It can be a way of eating that my daughter doesn't have it could be your sugar pixel. I don't care if the only time the only time you get in the way of that is you know, I don't know if you know this Johnson Some people or they have nefarious instincts, and they'll like, have like an affiliate link where they make money every time somebody clicks on it, or my favorite one is, look at this great t shirt that my sister made for my son. And it says something about diabetes on it. Isn't it great and someone else comes in, and it's only got so great. And then somebody else like, I wish I had a shirt like that, where'd you get it? And then they put Oh, I don't know, I found it here. Here's the link, well, you dig around a little bit. And what you'll learn is the person who put up the picture, the shirt is selling the shirts, the first person that came into the post to say, Oh, my God is so great. They are the same person. And then they start this fake conversation until it draws real people in. And then they sell their T shirts that way, or what have you that I don't I'm not okay with everything else I couldn't possibly care less. So

Jon Fawcett 5:56
in the last few days, this is like playing whack a mole on some of the Facebook groups where it had to have only been a few people started joining the groups, they were fake profiles, join the group immediately post, not only the G six for sale, but the G seven for sale. Like they have all this extra stock of Dexcom G seven that just came out. And it was every five minutes a new post would pop up. I couldn't imagine being the admin trying to deal with some of these scammers that do that.

Scott Benner 6:28
Yeah, that goes on forever. Anyway, my point is, you did not have to apologize. And I would be I mean, John, what kind of a horrible hypocrite would I be if I stopped people from sharing things in my Facebook group? Because I mean, I don't want to brag, but the podcast is shared about every 18 seconds somewhere. And it is, and I get the other side of that, by the way, because you have a thing. And you're trying to spread it like my thing just happens to be free to the people who listen. But even if I was selling a t shirt, I sure I need that money to pay my bills or, you know, sell mine. Yeah.

Jon Fawcett 7:07
This transition pretty quickly to my full time job, I don't know how long it took you to have juicebox sort of become what you do every day all day. But once it hits that point, you know, there is this sort of competing, been competing mentality of well, I need to generate sales to pay keep my electric lawn. But I don't want to come across like a spammer posting links all over the place. So I kind of take the approach of I just try and stay on all the groups to help people also not just, you know, not just take take take but yeah, try and help as many people as I can through questions that are posted and things like that.

Scott Benner 7:50
I stay out of other people's groups, because I think generally speaking, they don't want me there because they just see me as like, mining people. But in my own group, I'm there a lot, you know, that, that fire to get another click or another like or another sale, I liken it to the time I spent after the first time I had sex trying to get to the second time I had so you're like, Oh my God. That's a good analogy. Yeah. Could this happen again, I have to work 24/7. But seriously, people get this. It's just a fire. You know what I mean? Like they sold their T shirt, and they made $9. And they're like, oh my god, what if I sold 100 of them? That's I know exactly how their brains work. Like I could keep this going. You know what I mean? So

Jon Fawcett 8:38
yeah, and one of the things for me those the the entire mentality of it is I created it because it's like Lily's at the time. 16 She never wakes up to her alert. So here mom and dad are waking up to any alert that goes up overnight, because she doesn't hear her phone. And with my background in hardware and software and electronics, I was like I can create something that can solve this. So I created it, really, to help not only us, but other people. So it wasn't I never set out to be, hey, I need to make a profit and you know, grow this gigantic company from doing this is yeah, I'm selling a lot but I'm still doing it because I just want to help people. And I think that's also why people are posting it so much is they realize how how much of a need there was for something that pretty much gonna guarantee you're going to wake up in the middle of the night with how annoying The alerts are.

Scott Benner 9:40
Oh, John, you make that's the same thing that I find is that you just, I mean, you don't start a podcast thinking it's gonna become very popular. You just You just don't like and if you if by the way, if you've just done that, you're silly because it doesn't work out most of the time. And you're doing it because you think you'll reach a few people and that will help them and then You notice that help them and you think, Oh, that's great. You know? That was what I wanted to have happened. You didn't you just? I mean, I don't know, I take your point, I guess so you make sugar pick? Well, that's not what I want to ask you. What is your background? Like, what do you do in college? What would you do for a living kind of stuff.

Jon Fawcett 10:19
I actually dropped out of college after my sophomore year. I was working in doing engineering consulting, and got so busy and so overloaded with actual work that I was like, I need to cancel all my classes, because I can make a lot more money doing that. never figured that I wouldn't ever go back, but I never went back. Okay, so I kept down that route. And you know, that's to give away my age that was 28 years ago, or something like that.

Scott Benner 10:53
I was gonna say, in the 40s. John, everybody didn't need college. Yeah.

Jon Fawcett 10:59
So at some, at some point is like, well, at this point in my life, it's not worth it to go back. But 13 years ago, I launched a company on Kickstarter, making iPhone accessories. So we made I came up with just a stupid, simple idea to wrap an iPhone cable in metal that was flexible. And throw it on Kickstarter. I was like, I think this is a cool idea. I'd been designing products for other people. And, but then they always took them and did the marketing side and the sales side. In engineering consulting, Kickstarter gave us the chance to hey, we can now do it direct, take this idea and see if people like it. Fast forward, then. So that was 13 years ago, over the last 13 years. That company was named one set number 172. On the inc 500, fastest growing companies in the world. We had sales in like 60 countries at one point where we were in retail stores all over the world. And then right in the middle of that we're actually in the middle of a lawsuit against I'll just say the world's largest retailer, I won't name names there for for selling counterfeits. So this little company started here in Akron, Ohio selling largest retail are suing the largest retailer in the world. Right in the middle of that lawsuit, which took like three years to resolve was when Lily got diagnosed. And yeah, so I'm dealing with depositions. And just, it was absolutely insane. Dealing with this lawsuit from from this, when you get hit with, you know, a life changing diagnosis. And I sort of came out of that. And I had, you know, combined with those two things sort of lost all passion for that business, you know, just the corporate America sort of greed type of how everything runs. And I slowly started doing you know, I had I had all kinds of 3d printers, all of the computer CAD software, like all the tools needed to make our own stuff at this point. So I started making custom 3d printed cases for Riley lake. And then later for Orange, like we're all the DIY loopers little storage gadgets and knickknacks that made life with type one easier, whether it be you know, simple clips to hold insulin pens on the side of the fridge out of the way or thanks to better protect Riley link. And that just kept growing and growing. And it kept growing them to the point where I was like, why I could probably take on this sugar pixel concept that had been bubbling in my head for three years at the time. And all of a sudden, you know, life flipped. You know, you go from running this hugely successful electronics company to now complete shift where you're dealing with medical regulations and FDA requirements and all of that type of stuff in this world. Right? But, but the nuts and bolts of it is the products are all pretty much they're just electronics, whether they're iPhone powerbanks or blood sugar monitors, they're just electronics.

Scott Benner 14:44
I tell me a little bit about your daughter. How old was she when she was diagnosed? Your I know you said the timeframe. But how old was she?

Jon Fawcett 14:52
Yeah, she's 17 and I'm not good at math. She's 17. Now she was diagnosed but she was she Just after her 12th birthday, okay, so she's been diagnosed now for five years. And while I'm talking, I'm actually double checking that my math was correct. But

Scott Benner 15:11
what was the possible you're not good with math, John?

Jon Fawcett 15:15
Yeah, I don't, because, you know, my teachers in elementary school in high school said, Well, you gotta learn this math, because you won't ever have a calculator in your pocket at all times. And then now I have a computer with the entirety of the world knowledge in my pocket at all times.

Scott Benner 15:32
They were always I bet on that too. Back then, John, I was like, I'm sure I can get a calculator if I needed one.

Jon Fawcett 15:39
Yeah, so she was diagnosed in 2008 teen, January of 2018, just after her 12th birthday,

Scott Benner 15:46
about five years ago,

Jon Fawcett 15:48
but five years ago, so she was she was MDI, for the first year ish, and that it's sort of amazing looking at people now that come out of the hospital with Dexcom MPs. She was MDI with just a meter coming out of the hospital. And it was six months, I think, before the endo wanted her to have a Dexcom. You know, the endo is always were like, You need to learn how to do this without the technology. I'm kind of torn on whether that's true or not, you know, the best approach or not? Yeah, the the one the one reason, I think, or the one thing that I think helps going through that is learning, really learning more than just, I need to divide this number by this number. And that's how much I does. It's learning the why. And I think MDI can help with that. And especially so, so we did quite a bit, basically sugar surfing through that. She used an eye port for probably six months before she got her first pump. And the eye port, let us essentially sugar served without her complaining about it, because it's one shot every three days when you throw in the pork. Yeah. But what, what you learned by going through that process that I think might be missing now from some people, when it comes straight out of the hospital with a Dexcom. And a pump even is sort of how insulin actually works. You know, DIA is da duration of insulin action. It's five to six hours period, you know, a lot of people see this setting on a poem, and they're like, Oh, I'm gonna set it down to two hours, because that works better. That's just tricking. It's just tricking the Bolus calculator to be able to dose more sooner, when in actuality the insolence still in their system and working. It's just their carb ratio isn't aggressive enough, or their correction factor factor isn't aggressive enough. So those are the types of things I think we learned by being forced to be on MDI for a little bit longer than I think some people are now and then loop further enforced a lot of those underlying concepts, sort of the all the underlying math about how insulin works, how carbs work, and all of that. Yeah.

Scott Benner 18:26
Can I make an assertion? i Yeah, I've spoken to a lot of people. And what I can tell you is that the way people answer questions, there's based on what they think and their experiences. So when you say to someone, you really should use MDI for six months or a year before you get a pump. That's how you'll learn. The rest of that sentence is, that's how some people will learn. And some people won't learn that way. There are other people who a year from now they're a onesies will be 11. And their blood sugars are pink piling all over the place. And they've given up already. And had you put a CGM and an algorithm on that person? Yeah, they probably wouldn't know how it worked. But they'd be healthier. And I just think it's such a funny thing. Because this is an argument that, you know, is as old as time and diabetes, right? And, and it just, it doesn't, you can't answer it for sure for anybody. And, you know, and what are you going to say to someone? Are you are you inquisitive? Are you good with math? Do you does your brain like to figure out puzzles? Oh, well, then you'll probably do great on MDI. Do you bump into walls? Do you not know what to do frequently forget it's Thursday, we better get you on an algorithm. Like, you know, no one talks to you that way. And by the way, just because you don't understand diabetes doesn't mean you bump into walls. I'm being bombastic but I mean, yeah, it's just it's ridiculous. To think that everyone's going to have the same experience. And yeah, and

Jon Fawcett 19:59
for for So it was our step by step through this is, was ended up being the best way for me to learn, of course for my daughter to learn. Yeah, for other people, I completely agree it might not be the best. But underneath all that is still the learning about sort of the the, not just how to manage, but why and the, you know the details about not just here's my carb ratio, and it is what it is. But why would I need to consider changing that? Why would it be odd? The first time we got to scale, my mind was blown in just one little detail of oh my gosh, the printed serving size. For instance, one cup of Cheerios is like 30%, off from weighing the same Cheerios. Yeah. And so those types of things, those span, whether your MDI, algorithm pump or traditional pump is those underlying details, so tell how someone's going to best learn those types of details in

Scott Benner 21:10
1,000,000%. And you know, what I know, and you came to a completely different way than I did, because our brains are different, this whole thing is timing and amounts using the right amount of insulin at the right time, the right amount is your Basal, your insulin to carb ratio, your, you know, other, you know, whatever else. So insulin sensitivity, like it's those three things. And it's knowing when to put it in how to time it and understanding. When the insulin starts to work, when it hits more aggressively, how long it lasts. If you know that, then you're on your way, then you start learning about the different impacts of different carbs and how, you know, 10 grams of this and 10 grams of that sometimes don't need the same amount of insulin and how fat slows down your digestion. Like you can keep growing your understanding. But at the at the core of it, it's how insulin works. It's the exactly it's everything. Really, it's how the algorithm decides everything the algorithm doesn't know from fat. And that's why it struggles with it. And you don't you mean like it, but it does everything else? Pretty damn well. Fascinating. Yeah, yeah.

Jon Fawcett 22:18
And I'm a firm believer, there's also no empirical settings that can span across different systems. And that plays into this because you go from MDI to where you're taking long acting to a pump, where you're basically short acting, or that a pump, traditional pump to an algorithm pump, even from loop to Omnipod, five, or to control IQ. Your settings aren't going to transfer so it's, it's becoming less about, here's your carb ratio, and here's your Basal rate and more about how can I make whatever numbers I can adjust, achieve the best results?

Scott Benner 23:02
Yeah, I want to talk all about this with you, actually, because you sent me and you had been, I guess, kind of booked on the show, or we were trying to get you booked. And I don't even know why you were coming on in originally other than I was like, You should come on the podcast. And then all of a sudden I get this what I would consider from you as and we don't know each other super well, John, we spoken once before this, you explained sugar pixel to me, I got it. I thought it was really cool. I couldn't figure out how to set it up. And I haven't looked at it since then. But that's not. But I also got waylaid by the fact that my daughter's dorm room. Their Wi Fi is like you can't get anything on Wi Fi that isn't like an iPhone. You know what I mean? So that I was like, I'm not gonna be able to use it anyway. not the point. The point is, is that at some point, you sent me a very what seemed to me to be an excited email. And I seriously, which is if you've really looked back, if you could find 20 year old view, and be like, one day, man, you're going to send an email to another man, it's going to be very excited and you're going to say something like hey guys, just jumping in to remind you that one of our sponsors better help is offering 10% off your first month of therapy when you use my link better help.com forward slash juicebox. That's better h e l p.com. Forward slash jukebox while we're taking a break here and I put the ads up front and this one because the conversation picks up and just really starts rolling and I wanted to kind of break it up with the ad before before the flow. Anyway, Omni pod now Omni pod makes the dash. The dash is a tubeless insulin pump that you will just love on the pod also has the Omni pod five. Now Omni pod five is an algorithm that works alongside of your Dexcom G six continuous glucose monitor, maybe you're interested in the dash, maybe you're interested in the five, maybe you haven't decided yet. Either way, all the ways, Omni pod.com forward slash juice box will help you to move forward. If you already know what you want head over there now and get started. If you're still deciding head over there now and pick around a little bit figure, do the reading, you know saying, you know, I'm saying, you know, I'm saying, you know, I'm seeing I'm not seeing anything, it's late at night, I'm woozy. You know, I'm saying you head over there, you figure out what you're looking for dash or five and if you're not sure, you can contact Omni pod right through my link Omni pod.com forward slash juice box. My daughter has been wearing an omni pod every day, every every day, since she was four years old. Arden will be 19 this weekend. And I don't think you can make a better decision than to check out the Omni pod whether it's the five or the dash Omni pod.com forward slash juice box. Both the dash and the five are going to offer you the freedom of showering without disconnecting jumping into a pool running out playing sports, going to do your machinations. Whatever you do there during the day, go to the grocery store, no tubing to get caught on like doorknobs and handles in the cabinets and stuff like that. It doesn't matter what you pick, you're gonna get all that then it's up to you to decide, do I want to make some of the decisions, I want the dash, do I want the algorithm to make the decisions, I'm gonna get the Omnipod five, you decide John's daughter's using the Omnipod five, they love it, you might to omnipod.com forward slash juicebox the links in the show notes, links at juicebox podcast.com, to Omni pod BetterHelp. And all the sponsors. When you click on these links, you are helping to support the podcast. And I very much appreciate it. Now I'm gonna get you back to John. So we can really start to geek out about all this stuff. My daughter switched from loop to Omni pod five. And it's amazing and people need to know how to use it.

Jon Fawcett 27:02
Yeah, I was I was a little giddy. Yeah, you

Scott Benner 27:04
certainly were actually and I don't know you well enough to make that assertion. But that's how getting you in the node as I figured you were. So what version of AMI loop was your daughter using before she moved to Omnipod? Five?

Jon Fawcett 27:19
Well, you could consider it loop three. Now. She was running the dev version since last February. So it was about nine months that she had been running that but for the last two and a half years, I've been customizing loop. So a lot of people using loop have seen the loop patches. Those are the ones that I've written. So they they were just my ways of trying to figure out and force the algorithm to fix things that I didn't think worked optimally. Okay. So for instance, I wrote one where if blood sugar was under a certain value loop would automatically switch to the Temp Basal strategy. If it was over that value, it would switch to the more aggressive automatic Bolus. A lot of people with loop have experience rebound lows where you have a low you take some carbs and loop sees this quick rise from the carbs and thinks you're gonna hit 400, when in actuality, you're going to hit 105. So this helps, that helps prevent those rebound lows, and I just kept adding more and more like I made one tear at the end of our time using loop that I called Basal lock. If your blood sugar was over a certain amount, we use 200. Loop would not cut basil. So loop has this habit of sticky highs where you you get too high and something wasn't correct with your carb count or whatever. And you kind of plateau and you're just riding at 200 for hours on end until you add in quote unquote fake carbs. So that's what we were using with loop was sort of this the new loop three. At the time, it was called dev but with my customized patches running alongside it.

Scott Benner 29:13
Yeah, that's what that's what Arden's using right now, by the way.

Jon Fawcett 29:18
Okay, so she is she using dash.

Scott Benner 29:20
Now? Yeah, she's using dash loop Dev and those two patches that you refer to.

Jon Fawcett 29:27
Great. Yeah. So how how did she so I noticed she was on Omnipod. Five for a while also right.

Scott Benner 29:33
Yeah. So what happened to Arden with Omnipod five is kind of simple as that it added a device and she was kind of like, out from the beginning. She just, she's like, I don't want to carry another thing. That was the thing that really got her was the PDM like I think if Omnipod five would have come out with like an iPhone control right away. Then she would have been like fine, this is fine. I wish people understood A Arden doesn't care. Like I hear other people come on and say, Oh, my kid bought this or my son wanted that or my but Arden doesn't Arden doesn't care. Like she just wants it to work. And I'll tell you what she's an interesting use case for what I believe is one of the like more valuable things about loop is that you can kind of see where insulin is going in and where it's coming out. And I learned a lot more about insulin looking at Nightscout. I mean that that really fast forwarded my understanding even beyond where it was of insulin, just seeing it take insulin away and give it back and those things. It taught me a lot about how it works. Arden doesn't even pay attention to that. She's just yeah, she just she's good at bolusing for her food. And she can make adjustments. She knows when something sticky, she'll do use overrides. If she thinks she's gonna get low, she'll override the other direction. If she doesn't do it very frequently. I'll tell you what. She's been sick this weekend and not really sick. She got a she pulled a muscle in her neck and her shoulder. And it was so bad. She ended up at urgent care while she was in college on Friday morning. And they gave her muscle relaxers. And if you guys have ever heard me say like, I don't drink or I've never been high, like stuff like that. My, my daughter doesn't do any of that either. And so the muscle relaxers hit her hard as she is what would be, I think colloquially called a lightweight. And so she was asleep for swath of time, like 12 hours at a time where her blood sugar is just super stable. I mean, they just it's she slept yesterday till three in the afternoon. And with no intervention whatsoever, and her blood sugar didn't go over like 105 the whole time.

Jon Fawcett 31:51
Yeah, that's fabulous. And that's that's actually, those times to me, are where loop has the most advantages over Omnipod. Five from what we've seen is, if you're steady, it's going to keep you really steady, especially if you're you know, most people are trying to be under 110. With lube is it can keep you in that nice steady range at those times.

Scott Benner 32:22
Also, if you've got I'm sorry. Well,

Jon Fawcett 32:25
I was gonna say for Lily. She didn't like the extra device with the controller and she's not about to switch from iPhone, but it it took a purse to bribe her into giving it a shot. So we found a purse that would fit her car keys or her driver's license everything plus the controller perfectly. And so I think that's, you know that that's made it so she doesn't mind so much carrying the extra device. But she does like that her iPhone is not dead at three o'clock in the afternoon. She always had it connected to a battery charger when she was using loop just because she's on Snapchat and whatnot all day long anyways,

Scott Benner 33:13
oh, yeah, I would say Well, anyway, so the other thing that was going on with Arden at the time that we tried on the pod five for and we used it for a long time, actually, but is that she was having hormonal problems that we hadn't figured out yet. And so we were in this weird thing where we tried to go from loop to Omni pod five Arden's insulin knees were wonky. And as odd as the sounds, as I am the person who hosted the three, you know, on the pod, on the pod five, I went pro tip Series overview, settings and connectivity, which I made along with on the pod. I hadn't made those yet when she started. So, you know, sometimes you hear me say like, the podcast helps me more than it helps you sometimes I was at a loss still when we started on the pot five. So I had initially the problems that a lot of people were not a lot of people, but some people seem to have, which is I don't think I got the settings for Omni pod five, right when I set it up. And so yeah, you know, between that and the hormonal stuff. And she was we just like fought with it for a while. And then we finally got it like, right, and it was working the way we wanted it to. And I was like, see, this works great. And she's like it does. And I was like, okay, and we used it for a while and like she had no trouble with it at all. And then one day, she's just like, I don't want to, like, you know, I'm going to college now and I don't want to carry this thing around anymore. She's like, can I just go back on loop so I don't have to carry anything. And I was like, Sure. So I think Arden ends up on Omnipod five at some point.

Jon Fawcett 34:55
Yeah, and when the iPhone app is available, I think that It's gonna change a lot of people's opinions on wanting to switch, I see that everyday you see somebody posting that they don't want an extra device? Or when is the iPhone version coming out?

Scott Benner 35:13
Yeah, and I'll say this from the other side, if you if you're starting now, that's not a reason not to do it. Because you won't know any different. And I know that's a weird thing to say, but like your kid won't care about carrying the controller. My daughter just had 10 years of, you know, not carrying it. And then suddenly, we were asking her to do something else. And she's like, I don't wonder she was more of the mind of like, I don't understand why we're switching. Like, I'm okay. Yeah, you know, and I was like, No, I know. And I gave her the other reasons, which were, you know, do you want to learn how to build a loop app in case something goes wrong? She's like, No, I was like, well, then here we are. You so it'll, it gets Yeah. But I I'm really super interested. And I want to spend the rest of the time talking to you about how you went from I mean, because you didn't just go from loop to Omnipod. Five, you went from a version of loop that you basically tailored for Lily, with your own paths. You don't I mean,

Jon Fawcett 36:14
yeah, exactly. Well, and there was a lot of learning going into Omnipod. Five. So let me, you know,

Scott Benner 36:27
lead you in? No, no.

Jon Fawcett 36:29
But at this point, I feel like we know the system inside and out and how it's going to behave and why it doesn't behave. At times, the biggest thing that I did was I looked at TDI, total daily insulin from Nightscout reports. And look compared to that, divided by 48, which is essentially what Omnipod uses for its adaptive Basal. So the 48 comes from 24 hours in a day, but then it uses half of half of your total daily insulin for Basal, so divided by 48. And that your hourly Basal rate that the system uses, and I compare that number to what her Basal rate was at loop, and it was within maybe 5% 10%, actually went with the slightly stronger setting than what the TDI would have been based on for the Basal rate. And it also identified five doesn't care day or night. All it cares is basically what's your TDI and what's your iob you know, it doesn't care about carbs, or anything like that. So, if you have five different Basal rates, though, if you're coming from a manual system, or even a loop, those have just been built up over time, usually to solve other issues, not just basil necessarily. And so we put one basil rate in 24/7, because it doesn't matter. And I'd actually that's my suggestion to people I talked to is, if you've got a ton of different Basal rates, it's really difficult for for a person to calculate what their actual total Basal is for the day when your Basal rates are fluctuating throughout the day. So I OB from Basal alone, if you have a fixed Basal rate is times 2.1. So if you have a one unit Basal 24/7, you always have 2.1 units of insulin on board, from Basal. So that's not to be confused with iob, that loop might show you aware that the Omnipod five controller might show you, but that's just to say that's insulin that's in your system at all times. And using a single Basal rate, I think helped us sort of grasp that. Here's how much she uses for the whole day. Split that across, you know, 24 hours, and here's a fixed Basal rate every single day. So the Basal was the first thing is in starting, and I think you see, most people that I see posting, they're frustrated because it's too high. Their their blood sugar is too high, and it's not correcting enough. And it's it's sort of a myth that iPod five has learning. It has history would be a better way to phrase it. And it only has a history of three, four pots, right? And it's taking a TDI average and it's a weighted average. So the most recent days TDI is the highest portion of the average. And that's all it uses. And it updates that during PUD changes. So if, if you're running super high and you're frustrated by it, it's because your TDI is too low. And it's not covering your Basal needs enough. And so the options are either just slowly keep correcting little by little, you know, in every day, you might be adding an extra half a unit or whatever to TDI, or do a restart and restart with more appropriate settings so that you are getting there quicker.

Scott Benner 40:44
When you said add something to total daily. And so you mean just by making extra Bolus to try to bring down a high number?

Jon Fawcett 40:52
Well, yeah, so the people that say like, after three months, it finally started learning me. In most of those people, it's the ones that I've looked been able to see their actual, like gluco data some people have shared it with me is you might be doing a correction. And you're, you know, you're getting half a unit or quarter unit. It's not correcting, it's not driving up your TDI customer to where you need to be. So if, if all your settings, you started around 20, but you actually need to be at 25? Well, it might take two months of just normal, correct when you're high type of strategy for it to start getting that average up from 20 to 25, or 20. To 30.

Scott Benner 41:40
Yeah. Oh, okay. That makes sense. Hey, let me ask you a question about that makes sense? It does actually, let me ask you a question about only pod five that, even though I've had people tell me directly from the company, I see so many people online saying the opposite that it even makes me wonder if I understand what I'm saying. Once you set up on the pod five, on the on day one, you tell it this is my Basal rate, this is my correction factor, these are all the things that's asking blah, blah, blah, go into auto mode. First day, it uses your settings. And then after that, it's it's doing what it wants to do. If I go back into my settings and change my Basal or my insulin action time, or my carb ratio, that that doesn't touch automation, right, that you're just changing your settings for manual, is that correct?

Jon Fawcett 42:34
Correct. And we've been fortunate myself and a few others who did another Omnipod five video with the loop group loop the learning group, we've been fortunate to have a lot of discussions directly with Omni pod. So we asked a lot of these questions of their chief of medicine. And there's no speculation on that one is target is the only setting that changes automation. Now, it can feel like some of the other settings, fix things. For instance, if you artificially lower duration of interaction, from four to two hours. But the reason it feels like that's improving things is you're essentially faking the Bolus calculator into thinking you need a correction sooner. So it's offering a manual correction sooner, it could be if you just click to do a correction, or it could be added on to a meal dose. And that not only brings you down at that time of that dose, but that also increases your your total daily insulin right over time. But the one dilemma there with trying to change some of these other things that may not need changed is that if you're using a lower de dia, once your total daily insulin is where it needs to be, that can actually cause lows or rollercoaster effect, from right having too, too strong, too much corrections going on. Once the system gets you figured out, so if you if you actually look at the insulin action curves, like from the clinical trials, they're all six hours. But the reported iob on the controller and the D at the DIA that's used by the user setting is actually a straight line. It's a straight line insulin decay of the insulin action rather than this smooth curve. And what I've seen is that somewhere between four to five hours makes the reported iob using the straight line most accurate to the actual curve which is you know smooth curves, not a straight line. But but that target setting is the only thing to do. And all these others just affect like either the iob you're seeing or other things like that with the Bolus calculator.

Scott Benner 45:14
Yeah. Also you put yourself at risk for when you do switch back to manual mode, your settings are way too aggressive and will make you low then as well. I can't tell you how many times I've seen somebody online say, Oh, I figured out how to make an adjustment to blah, blah, I changed XYZ. And now automation is working better. And I'll come in and I'll say, the changes that you made did not change automation. That was the only changes to your manual settings. No, no, you're wrong. And I'm like, No, you're wrong. What am I going to do now? I'm on Facebook going not on out of somebody. So I'm like, listen, that's not how it works. You might be seeing Yeah, way but but by the way, every, not everything. A lot of people see ghosts in diabetes all the time. They think they're seeing something and they're not they're misconstruing one thing for another, it happens constantly. And, and we're learning it here. You mentioned that earlier, going from MDI to a pump. It's not apples to apples, you can't just take your MDI settings, put them in the pump, and they're absolutely going to work, you can't take your pump settings and put them to an algorithm, they're absolutely gonna work, can't take your Omni pod five settings and put them in a loop, or control IQ or whatever the Medtronic thing is called, you can't do that. Like, that's not, they're not all the same. And what happens is what you alluded to earlier with the basil is that people get started, their settings are all messed up, they start having problems. And then they make adjustments to settings that fix the problem they're seeing, but don't fix the original problem. It's just patches over top of patches overtop of patches. And before you know it, you're having success. And you don't know why. You don't know how it's working. It's just working. It's it's somewhat akin to when I bought my first house, and we found one day in a dark corner in a hallway that someone had taken masking tape covered a hole and painted over very quickly. Yes, the wall looked okay, from a distance. But it wasn't right, John. And so and that ends up being that, I think, is why you're here on the pod, the company saying so strongly to people, this is about total daily insulin, this, you know, and start around 5050, please, you know, take your total daily insulin, split it in half, half of that is going to be your Basal. Like, just because that's how the algorithm is going to have the best chance of figuring it out. Like the part that's not being said by anybody is you're probably doing this wrong. And you're wrong. You know what I mean?

Jon Fawcett 47:50
Yeah, and there's, there's not necessarily anything wrong with

Scott Benner 47:54
no, because it's working at the end, it only becomes wrong when you try to go into a into into something like an odd like an automated system that that needs it to be accurate. Yeah, yeah. Yeah. So yeah,

Jon Fawcett 48:07
anyway. And one thing that's you mentioned, the basil stuff, as I was called it, Basil creep, is usually the first answer you see from if someone posts Hey, my, you know, I'm rising at this time. Raise basil. Like, historically, with traditional therapy. That was usually the first answer out of anybody's mouth is Basal needs changed? Well, when you start looking at algorithm that that's tracking more things, and and I have reviewed loops algorithm, the results of on the pub fives algorithm, I can't actually look at the math, and I've even done consulting work for a startup that has a different algorithm, where I've seen some how they're approaching approaching this. I really believe that most people, their Basal if they're coming from a traditional therapy, whether it be pump or MDI, their Basal is probably covering at least 20% of their carbs. Yeah, and there's not necessarily anything wrong with that, because it works in that system. It's easier in that system to just sort of smooth out the fat and protein and things like that, or carb miscounts with a higher Basal. But then when you switch that and try to apply it to an algorithm, it just blows up and it'll blow up loop and it'll blow up Omnipod five, just the same. And I do feel like Omnipod five makes it easier though. By that system. You said just focus on TDI. Don't worry about if you have a rise in the middle of the night or beat out For whatever, as long as you focus on TDI, it should be able to handle those types of fluctuations.

Scott Benner 50:06
John, I think this is a great example of the past still impacting the present. Because this all goes back to if you talk to old endos, right? They they would over basil, people who wouldn't, wouldn't consistently be injecting for their food. And so the the people were always seem to have uncovered food in their system. So they're like, well, we'll just jack the basil up to try to take care of that. And the person who made that decision for that person on day one was probably a good decision, you know, but then over time, it just becomes how things get done. And nobody, nobody remembers back to the first time, like, why did we do this, because bill wouldn't inject for his lunch. That's why you know what I mean, but like so becomes, it becomes the way things happen. And then before you know it, you go through a generation of doctors and a generation of people. And that's just what happens, like, what you're, we are seeing right now, the remnants of people not understanding how to manage insulin, you know, all the way back into the late 80s. And, you know, and now it's still impacting things, and we're still having trouble explaining it to people. And algorithms are just going to make it more present. Now and obvious that everyone's most people settings are not right. And you can, it's fast. I mean, it's not fascinating. It's exactly what I expected. But this is this is the next problem, right? Like, are you going to teach people? Which seems impossible? Or are you going to come up with an algorithm that one day just is so good? It doesn't matter? Do you think that's where this is headed? Like when people talk about one day, you're off the boat, like putting your carbs?

Jon Fawcett 52:02
I think it has to be headed that way. And one of the big reasons and I was floored when I started researching carb counting. There's so I found quite a few studies on carb counting, just I was curious is, is it even accurate? Even if we weigh measure percent precision, is it even accurate, and it blew my mind that. So one study, they were only with in sort of the acceptable tolerance 44% of the time on their carb counting. So the acceptable tolerance was like, if you look up what an apple, a medium sized Apple will be, it'll be like, plus or minus three grams from this. So it gives a range. So even with that, though, so 44% of the time, they were within like, three to five grams of what the actual carb count was. And I don't know what everybody's carb ratios are. But for Lily, that could be a whole unit. And a whole units the difference from ending a meal at 200 versus 100. At times, depending on circumstances. Another study. It was adolescence, and this is piqued my curiosity because we're going through this phase where Lily, we're trying to let her do everything on her own and only intervene when things go off the rails. Only 23% of adolescents were within 10 grams of the actual carbs. And when you look at that, and you're like, Okay, we're basically as human beings not capable of accurately counting carbs. And it's not just because people are, you know, guessing wrong. Not trying things like that. It's because yeah, all these variables going into food and like a bowl of Cheerios, you could easily be off by five to 10 grams every single time. So I think we have to get to the point where the algorithms are smart enough to start dosing on the rise, and some are already headed that direction. You know, Android APS is already headed that direction with unannounced meals. And I do know some people who don't enter carbs and use those systems and use them. Probably better than we use a system where we we Bolus for meals.

Scott Benner 54:48
Yeah. I've already interviewed him. I can't think of his name. I just haven't put it out yet. I can't. He's an Australian guy. He's the one it says person you're thinking of?

Jon Fawcett 55:01
No, just what I'm thinking. Yeah. Somebody?

Scott Benner 55:05
Yeah. So yeah, listen, if if I took a whiteboard right now, and I said, John, let's you and I go through all the variables that might make your Bolus wrong, I think we'd write down 50 things by the time we were done. So that's absolutely, yeah, that's why people who listen to the podcast who are not using an algorithm, you know, are just out there working on their own trying to figure things out. It's why they have so much success after they listen to the podcast, because I say, I don't care what the carb count is, I care how it's going to hit. And then you'll learn historically, this plate of food is, you know, eight units of insulin for me. And it doesn't matter if you count it up and come up with seven units, or you count it up and come up with something else. You've eaten this before. It's taken eight units, let's go with eight. It's why my daughter's successful because she's, she's aggressive. Like the, like, it's, she's She doesn't look at something and go, Well, this is probably 10. But it could be 12. She's just like 15. So and, and you're not Pre-Bolus incorrectly anyway, so you probably need a little more to begin with. And you know what I mean? Like, it's all like, you just there is a vibe to it, like you can get through life with a five a one C just vibing with how to Bolus for things. You just have to be right about it.

Jon Fawcett 56:26
And you know, a funny thing about the agency also is we don't worry about it as much as we used to. And I know a lot of people are going more towards focusing on time and rage and stuff like that. But I, I was talking with a colleague about why the GMI shown in clarity used to be called an estimated a YC. Now they call it GMI. Why is that? Usually so far off for everybody? For us? It's usually half a point higher than what her actual who wouldn't see is. And I was shocked by some of the stuff I learned. A one C is so weighted towards the recent yet the last week can shift your agency by half a point. So there is some there is some truth to all I have an endo appointment next week. I better start, you know, yeah,

Scott Benner 57:24
carry myself, I was gonna say because yeah, people sniff the endo appointment coming up, and they start paying more attention all of a sudden,

Jon Fawcett 57:30
that could drop your agency from six to five and a half. Yeah. The other thing I learned was that the actual lab agency tests that are used in the hospitals can be off by 6%. So that's a range of like six to 6.4 or 5.7. Yeah, so we don't worry about oh, gotta hit 5.8 or whatever. You know, if it's like, if she's coming in at six, I'm thrilled because that in a healthy range, no matter what that spread is. So we're we're really shifting more towards this approach of kind of goes along with the carbs what you said with carbs is you don't need all this exactness. There's too many variables and in the world in physiology to be able to get any of this exact

Scott Benner 58:24
you so you do not want to be in a situation where your your last day when he was 6.2. And the next one was 6.4. And you're running around for three months go and I failed. Like it's just, it's nominal. It might be meaningless. And yeah. And it could

Jon Fawcett 58:41
have actually been better when it said 6.4 Because that day the test was running at the high end of yes, the tolerance was allowed by the

Scott Benner 58:49
FDA, John, one of the most difficult things you'll wrap your head around when you have diabetes. Or you're caring about somebody who has diabetes, is that your meter when you test your blood sugar and you like, oh, it says 85 That your blood sugar is probably not 85 Yeah, it could be 95 or 73. Or like, you know, wherever in the range that the meter you're using, you know where its accuracy is, you know, any well

Jon Fawcett 59:21
because the FDA allows 20% on meters just like they do on on Dexcom

Scott Benner 59:28
right. So you test your blood sugar, it's 80 it could be 100 might be 60. It tested it's 100 it might be 120. It could be 80. And the day you give yourself up and go I can't worry about that. I'm looking for stability. I am looking for stability I am looking for not a bunch of ups and not a bunch of downs because these it I got a long day for John Day for my daughter had diabetes. And the girl the girl that made me sound old. The nurse came in the room. The nurse came in that room He did make that really did make me sound old. The nurse came in the room with our new meter, which was this like freestyle thing that I've described in the past as looking like it came out of a bubblegum machine, which is now not a good description, because I don't think you'd get bubblegum out of a machine anymore. And, and it was just just janky little plastic thing. And she brings in this giant thing that the hospital owned. And she tests Arden's blood sugar on the hospital thing because she's got to write it down. And then she goes here, now you do it with this meter, and I tested with a meter and the hospital thing, and the meter they gave me were nowhere near each other. And I was like, whoa, wait. I was like, What do I do? And she's like, just use that meter. I'm like, but it's like, 30 points different than what you just did. And she goes, it'll be fine. And I realized, now, she didn't know what the hell she was talking about. She was just like, Look, man, what she wanted to say was, this is the meter you got dude, good luck. Like, you know, like, like, make the best of it. When I cuz university people test with one meter then test with another like, what am I supposed to do? I'm like, I always tell them pick one of the meters. Because because of what you've been explaining. And that's a it's just, I think that's brilliant. I have to tell you, my daughter is often college now as a freshman. And her a one C went up like point. She went from like six, one to six, four or something like that. The last time but she's been doing exactly what, what Lily's telling us. We do not intervene at almost at all. Like, there are days I don't even think about our diabetes anymore. Like, you know, I the last time I thought about it was when she was sitting down doing homework, and her site was getting old. And I can see the algorithm Bolus and policy and policy and I couldn't move her off this number. And I was like, aren't you got to stop what you're doing for a second change your pump, you know, and then she fought with me about it for felt like hours. And then she finally did it. But you know, there's also the psychological component in there. Like, I don't want her to just not want to listen to me anymore. So there was a reason why I'll tell you what went through my head the other day, when I was going through this. There was a reason why she couldn't get to it. She's not ignoring it. I know she isn't. And I had just spoken to a person who has had diabetes for See, I'm gonna say 30 Some years and you're all gonna think it was Jenny, but it's not. But a person who has had diabetes for 30 Some years who probably lived with a one season the nines for a long part of their life. And that person was like, a little like, I love it when I see people like worried about their six five a one sees, you know, yeah, like, that's gonna be okay. And, and it was, but I take everyone else's point because you'll hear other people say, Well, why can't I get normally one seems like a person without diabetes, say you can't if you want to just, you know, you're gonna work at it more.

Jon Fawcett 1:02:58
And what concerns me with that? Last comment is parents with kids transitioning and we I felt us starting to get to that point transitioning from where Lily's at now. Just about done with her junior year of high school to wear Arden's that, in her freshman year of college is that transition to me felt like oh, my gosh, we should have started preparing for her to handle this fully. much sooner.

Scott Benner 1:03:30
Yeah, we've been doing it's like her junior year of high school.

Jon Fawcett 1:03:33
Yeah, and my concern is when your your kids little, and you're controlling absolutely everything, you know, you're fully measuring every single meal for carbs, you're exactly Pre-Bolus saying all of that type of stuff. Well, that just goes out the window when they start having their independence. And Lily does fabulous at managing on her own. But she's still a 17 year old kid. So there's times when she Bolus is as she's eating, you know, for BOCES after she's started eating, and I worry about burnout from both parents and kids. When you're so focused on this, you know, exactly when see number or an exact time and range, or exactly counting every single card literally has actually been using a president for the last about a month now as a supplement, because sometimes she she actually goes to two different high schools and drives from one to the other right at lunch. So sometimes she doesn't even have time to Pre-Bolus By the time she gets there. So she'll just take a little bit of a Frezza to offset and doses slightly less on the pump. But again, it's not it's not being specific about exact amount of carbs, it's okay it's going to be about this and you know at Adding this one cartridge of a Frezza will help to cut out the rise from not Pre-Bolus thing but we don't know how many carbs. She doesn't know how many carbs that actually was. Just how many units did she take?

Scott Benner 1:05:14
Yeah, do you know that art and figured out how to over Bolus meals that she couldn't Pre-Bolus For just by watching me do it. I don't think we ever spoke about it. Like, I don't think we ever ever spoke about it. And she just one day, I was like, Hey, that was a big Bolus. I texted her at school. And he was he I, I couldn't put it into I sat down. And I was like, oh, and she's like, Well, I'm just Bolus waiting for the rise. It's gonna come. I was like, Ah, I was like, wow, she didn't even.

Jon Fawcett 1:05:43
Yeah, that's the great thing about the algorithm pumps is you can steal basil from the future, right? To help prevent that rise from eating. I have noticed Omnipod five, you gotta go a little less than you do on loop loop would cut basil immediately. And, you know, it dried out much easier. But with Omnipod five, I've noticed we dose a little bit less of that sort of extra upfront, because it'll keep basil on for longer.

Scott Benner 1:06:17
Yeah, okay, that's good to know. You know, I, eventually I will get a email from someone's like, you know, why don't you talk about MDI more. I'm like, I already talked about it. I know how to. The way you use insulin with a pump with a regular old pump is the way if you want to have those outcomes, you would do it with MDI. I'm always interested when people are like, well, I want more tricks for MDM. Like, while there aren't a ton of tricks for MDI. But

Jon Fawcett 1:06:42
my biggest trick for MDI would be to get an eye port because it makes it easier to do all those extra doses. Right? Because you're not taking that extra shot.

Scott Benner 1:06:52
Exactly. And I and it's not lost on me while we're having this conversation like we're talking about I mean really think about what we're talking about right if you're talking about on the pod five and you have insurance that pays for on the pod five you're you can afford a Dexcom you know you have likely have a cell phone like that's a lot of money Yeah, and and even like with like you just said something so off handle you just like I'm like literally supplementing with a Frezza you good luck go into your endo and Telenor you'll also want some inhaled insulin for red is gonna be like, yeah, get away from me. So it

Jon Fawcett 1:07:29
Yeah, it we had to get prior authorization to add it. And even then it was that extra tear. So our, our prescription copay on that was even more, but because she's supplementing it is. It's not nearly as much as like her Novolog. Yeah,

Scott Benner 1:07:49
she's not using as much of it. As much as I'm not coming down on you. I'm saying that it's, you know, we're in this, we're in this moment where care is shifting, right. Like, let me just say, I'm not a soothsayer, I can't see the future. But if we could get a CGM and an algorithm on everybody who had diabetes and needed insulin, the vast majority of these people would be better off health wise. And today, right, and so you have good,

Jon Fawcett 1:08:22
although there's something coming up that has had us thinking, it's, to me looking like the one week basil might be released this year, finally. And if you look at a one week, basil, that, you know, keeps you steady, for your long acting for the whole week. If you were to combine that with a Frezza for your meal dosing, but a Frezza, from from what we've seen in the month of using it is, it is so much more forgiving. You don't have to carb count it's is this plate small, medium or large. That's essentially your carb counting that the combination of that might actually be drastically better than even the algorithms at least today. And to be honest, it's something we might try once once that's out, we've actually chatted about it on whether that might be a simpler way to manage them than using an algorithm pump. So what we'll see but nobody knows until it's out.

Scott Benner 1:09:35
Yeah. How did you get over because you seem like a bright guy. So this went through your head, I'm guessing how'd you get over the idea of inhaling it? Like that's a that's a leap, right?

Jon Fawcett 1:09:48
Yeah. Well, I had a zoom call with their CEO. He convinced me he had a lot of data on a Frezza. And I mean, it's just from everything I've seen about it. You know, the results are undeniable for it. The action time is as fast as the human body's insulin. Okay. So that's why it's such a game changer. If, you know we can get sort of the combination of how to best use it with long acting or with a pump that's just sort of an sort of a reverse untethered, you know, you're doing your long acting and slight adjustments. But the, you know, the inhaling part itself. Lily was a little apprehensive at first, but she got the hang of it. And, you know, the only thing I had to do is I had to email her school is giving them a heads up that, hey, if she shows up in the office, from a teacher center down there for vaping, that she's just take your insulin, that was the hardest part about the inhaled part of it.

Scott Benner 1:11:10
I mean, it's really just saying, I don't even mean that I just mean, like the idea of taking something into your lungs over and over again, like that is off putting to me, that's all like, based on nothing other than I hear that, and my brain goes, we should probably be worried about that. And I don't know.

Jon Fawcett 1:11:26
So there were, so there was a one from I think it was Pfizer. I think it was from Pfizer, it was exubera was the first one. And they pulled it from the market. But there was a lot of there was a lot of misinformation out there on why it was pulled. And I even heard doctors say it was pulled because of lung issues. But it was basically pulled because they did a horrible job with the inhaler. It was like a foot long. What am I gonna do? I mean, it was gigantic. It was like holding a bike pump up to your mouth. To do it, where the the new one is, you know, maybe two inches long the one from from mankind for a president. And so there's no studies out there that say it's harmful or anything like that.

Scott Benner 1:12:29
No, I'm not saying there is by the way, I'm just saying like it strikes me is like worrisome like and I bet could be based on nothing. I just, I wonder if that's not a hard thing to get over. I also keep wondering why someone hasn't just bought the company yet.

Jon Fawcett 1:12:46
Maybe they're maybe they're not for sale? You know, maybe they don't want to I don't I don't know those details. I will say so you do you do need to do a pyrometry Spire, I don't know how to pronounce it. Basically a functional lung test before you start. So you go in, you basically blow in a tube like five times or whatever. And then they they gave her I don't know if it was a stair na steroid, but almost like an asthma inhaler type of breathing treatment. Yeah. Then once that sets in, you repeat the test. So they make sure that your lung function is what it should be. And also that, like if you take an inhaler, it doesn't improve drastically, because that would indicate you have some issues, I say. So you do that at the beginning. And then after six months, and then they recommend yearly after that. And that's just to make sure that long term you don't develop any issues, but I think the bigger the biggest reason for that seems to me like it's you know, somebody who had asthma and maybe didn't even know it, or it got worse in the future, things like that. You know, it can not necessarily be the right insulin to take Yeah, I'm not smart COPD

Scott Benner 1:14:15
Yeah, I'm so I'm so worried that like by me playing devil's advocate that I come off like I'm against, I'm not against, I'm not against it at all, like I I can see a world where Arden would try it as well. And I've spoken to people who swear by it, like really are just doing what you're talking about. They're injecting their Basal insulin and using it for meals and having like, wonderful success with it. So I'm not against anything by the way, like I whatever's best I want you know what I mean? And I want everybody keep trying, I want all these companies to keep pushing and trying to figure out something better and new and

Jon Fawcett 1:14:54
yeah, well and even whatever's best for each person because I'm your top fives not going to be the best As for everybody looks not going to be best for everybody. Some people would manage best with complete MDI.

Scott Benner 1:15:09
Yeah, and for for variable reasons that you that are hard to figure out at first, like, why is worked better for me? Or if this does?

Jon Fawcett 1:15:18
Yeah, all I mean, the first thing that pops in my head is, a lot of people have adhesive reactions, you know, to the pumps and stuff, is, I'm thankful that Lily doesn't have bad skin reactions to those adhesives, like I see some people posting, because that would probably ship us out of out of using Omnipod. Yes, she was having really bad skin reactions, there's all kinds of reasons. But the end result is, whatever system you're using, your settings need, tweaked, to best, get the best results out of that system, and even then is the best results are trying to hit an exact 5.8. It's getting in a good range on a good range over time, you know, not fluctuating everyday, throughout the day, all day or even over months.

Scott Benner 1:16:17
You know, I listen, you made a point earlier, that is not lost on me, which is you can be doing an amazing job for a young kid. And I'm not saying you shouldn't be, but that person is going to leave your house at some point, if you're if you're doing a good job, they're gonna move out, which is the weird part about being a parent and, and they're gonna go live their own life, and they have to be able to, they have to be able to intersect with new responsibilities and stresses and all this stuff and still be able to do their diabetes thing. Like that. Yeah, not and that's not as simple. That's not simply as it's not as simply done, as it is said, it just a lot of stuff happens to them. Like I, like I think this about any number of things like you know, if you're eating like super low carb, and that works for you, I think that's terrific. I also think if you think you're going to go to a college and eat on campus and be super low carb, you're in for a shock. Because a lot of colleges don't offer foods that might might help you with that. And so now you're there. And what do you do? Same thing as if you're always controlling the insulin pump for somebody, and then they get the school and now they're there. And what do they do? Like, it's you know, it's got to be a transferable skill.

Jon Fawcett 1:17:36
And that, even if it's, even if your kid is, you know, highly data, statistics, and all of that loves just digging through those numbers. As a parent, all we're dealing with is looking at, you know, this data to figure out what to do. When that transitions to the kid, they have to add that on top of and I think you sort of hinted at this, they have to add all of that back end, sort of management, on top of actually doing the management. Yeah, taking the insulin, changing their pump sites, refilling prescriptions, and that's a lot to put on a 1718 year old.

Scott Benner 1:18:15
Yeah. And that that's, that's an a scenario, John, we're, we're, we're, we're imagining, like, a kid just being like, I'm gonna take care of myself and actually going and doing it, it's still hard. One of your kids might end up drunk all the time at school, or one of them might end up high as a kite all the time. Or you don't know what's gonna happen. I know everyone thinks they know, they think they're like, Oh, I know how it's gonna go. Yeah, I've interviewed too many people, John, who will tell me like, it was a big shock to my parents when I ended up in rehab. But you know what I mean? Yeah, and I'm just, again, I'm just going to the extremes here. But you don't, you don't know what they're going to what they're going to have to deal with, when they get there. You also don't know how much anxiety and stress they have from diabetes right now that they can't wait to leave the house and try to forget about. And, again, you just need to put them in a situation. And like you said, for some people, you throw on the pod five on the kid, and the kid doesn't pay much attention to it, and it's still going to work out for them. Or, you know, you can't put a loop on somebody who doesn't want to be, you know, responsible for the things that come with that. I've seen. I've seen people on tandem control IQ think it's the greatest thing since sliced bread, and I've seen people that thing doesn't work. And I don't know if that's true, or if they just aren't using it right. But when it happens, it won't matter. Like the reason won't matter if your things not doing what you need it to do. You're going to be in a weird situation where your kids 1000 miles away, and suddenly their blood sugar, sugar 300 And you feel like there's nothing you can do about it and they feel like there's nothing they can do about it. And eventually everybody gives up and I just don't want that to happen. That's all well and

Jon Fawcett 1:19:58
that was So that perfectly explains, one of the main reasons we switched to Lilly to Omnipod. Five is there's less, less thought that has to go into running the system, once it's running smooth, you know, not having to modify basil, or even ever do a basil test, it's basically there's only thing she essentially needs to change in it is carb ratio. If all of a sudden she starts running lower or higher after meals, just change the carb ratio. And through throughout the month, there'll be times when we don't even need, we don't even change the actual setting. She's running low, it might say, those 10 units for the carbs you put in, she'll just those eight, instead, it's about knowing how, how the insulin is going to work. And that, oh, I don't need as much this time, as I normally do, because I've been low today. So for us, it was it was about simplifying the system for her to try and give her the best chance of success based on her personality. And, you know, her how she goes about her day to day and for other people that for other people loop might be the best for that or control IQ or MDI. You know, it's it's all individual, individual to individual.

Scott Benner 1:21:25
Yeah, yeah, for a number of different reasons. It's funny, I would think I haven't I haven't thought about this while we were recording, but I'm thinking about it now. Like, I would think that if the companies that make the different products that we've talked about heard this, they'd all be upset. They'd all be like, No, don't say that. Don't say that. Don't say that. But you know what I heard today, I heard that the guy who figured out patches for loop that I'm using for this kid on on the pod five to me, that's, that's very telling, you know what I mean? And it's not telling that there's something wrong with loop three, or it's telling that these things all work for, for people in certain situations. And that, you know, 10 years from now, you might be on something else. For me, if Arden couldn't use on the pod, we that would be an issue for us. You understand? I'm saying like, if the loop only worked with a tandem pump, I'd use Omnipod. Five, I just wouldn't carry in the thing just shut up. And she and she would agree with that. And for somebody else, they don't care about tubeless. There are other people like I've heard people say, I honestly don't care that I'm attached to my pump. And, and good for them. You know, they mean? Like, what?

Jon Fawcett 1:22:43
Yeah, Lily, Lily would be Lily would choose MDI over a two. So if she couldn't use Omnipod, she would be MDI.

Scott Benner 1:22:51
Exactly. Right. So there's, you know, there's what it is, it's just all I don't know, John, it well, that is confusing as it sounds to people who don't understand. I think people who really know what we're talking about are like, yeah, there's, you know, there's options here, here, here, you just pick the one that's right for you. I'm just thinking that, you know, companies are like, well, please use our thing. But that's just, I mean, and they even know, by the way, you've you've had conversations Yeah, no, it's not for everybody, you know. So?

Jon Fawcett 1:23:23
Well, I have seen, you know, I've been trying to figure out like, when LOOT might be better for someone versus Omnipod. Five, I don't, we've never used to hand up. So I can't speak much to that. But it does seem like the me. Loop is going to be better for the people who have loop not better. Let me back that up. Loop has the ability to achieve better results. For people who are low carb. And people who have pretty consistent lifestyles, you know, they get up, they eat, they do the same thing pretty much every day. Omnipod five, is going to be better for people who either don't know how to manage, tweak their settings or don't want to, or don't have time to write people who just basically want something that works without having to think about it as much. Now obviously, the caveat in there is you have to get your TDI up to the point where it is working like that. But then also, I've seen people with low insulin needs have a difficult time with Omnipod five. So, you know, some of the really young kids is I've seen some of them, but I've seen others who have success in it. So I don't know enough to know if you know it. Is there something about the algorithm that Under certain TDI I can't quite achieve as good of results, I tend to think there is and I think the same in loop is, you know, if you're delivering point one units per five minutes to be your Basal rate, which is like 1.2 units per hour. But point one you can do increments up or down and point 05. Every five minutes. Well, if somebody only has a quarter unit Basal per hour, they're only getting one click of that point, oh, five dose like every 15 minutes that you can't really take that much basil away. There's not as not as many increments, right to transition smoothly up and down to the lower insulin

Scott Benner 1:25:52
people, I would say that with the exception of what you just mentioned, there's people with that low of need. My takeaways always been no matter what the system is, is that if the system's egregious ly working, if it's that far off, if you're experiencing a ton of highs or a ton of lows, that boils down to settings and your understanding of how to use insulin. Like I just, it doesn't work that badly. None of them. Like none of them are that bad. You know what I mean? Like and I'm, that's the wrong phrasing. But if you're like crashing low all the time, and jacking up super high and crashing low, you can't point to the algorithm and go like that's that fall, it's the it's the control, like use a probably your, that thing's not set up correctly, but you don't know how to use it. Same with Looper on the pod five, if you're having like, if it's all over the place like that, the worst thing you can do is step back and go the thing doesn't work. Like it's, you know, yeah, it's it, you don't I mean, you something's wrong, that could be adjusted.

Jon Fawcett 1:26:54
And for the most part, what I see, with people posting out with Omnipod, five is they're, they're starting settings, we're basically what they were using before, which doesn't work lilies, lilies, carb ratio, got 30% more aggressive. So she went from one to seven and a half, or six and a half throughout the day, she is now one to four and a half. I mean, that's drastic change. And that's coming from loop, which is also an algorithm, you know, so even from loop, it needed a drastic change. So for Omnipod, five users, it seems to be they're not increasing the carb ratio. If they increase their cart, or make it more aggressive, right out of the gate, even if their TDI was too low, that would get them in line much quicker. So they wouldn't be riding in the two 5300s all the time, they might be at 200 Until TDI catches up. But it'll be catching up much faster. Two or three pods in. Yeah. And then for, for systems that use basil in the algorithm, I think it's people that don't have a grasp for sort of how insulin works and how basil works with, you know, sort of like the phrase I mentioned before is the first response was always all increased Basal? Well, it's normally fat and protein. In my experience, like, I'm going to say it's fat and protein until I'm proven, until it's proven that it's not fat protein. That's really my take on that actually had quite a few loopers, who look at this, you know, like midnight to 3am rise. So I'm sure you've seen the graphs for that. And then point to several studies that will show that, oh, there's a typical growth hormone rise at that time. So you raised basil at that time? Well, what I the test I tell people to do is don't have any carbs, or don't have any fat or protein in your meal. Within six hours of going to bed, and anything you after that. Make sure it's at least three hours before going to bed and it's 100% carbs, like a bowl of completely dry cereal is just pretty much zero fat or protein, right. And you know what happens every single time

Scott Benner 1:29:30
that the rise goes away? Yeah,

Jon Fawcett 1:29:32
there is 00 Rise and they have a perfectly flat night. Now it is growth hormone. You can say it's growth hormone. But growth hormone is triggered by gluconeogenesis from the fat and protein. So it's, you know, I mean, the culprit is actually the meal. Yeah,

Scott Benner 1:29:52
it's fascinating how, how infrequently we talk about things like digestion nutria Certain things like that we tend to want to treat diabetes, like a math problem always, like there's 15 carbs. That's all. It's 15. That's a that's three units for me didn't work, something else must be wrong. Could it be? Yeah? Could it be that those that you ate something that's laying in your stomach like a brick, and you know, can't be digested very quickly, because people aren't supposed to eat a half a pound of mozzarella cheese?

Jon Fawcett 1:30:29
Well, and to add on to that is, the conversions for fat and protein from your meals, they're not going to always be the same. For the most part of carb is a carb? Obviously, it's not, but it's pretty close. But if you had lower, what is it, glycogen or something like that stores, your body's going to replenish those it's going to use potentially use more fat and protein to replenish those. If you have a high carb meal with high fat meal, it's going to convert less fat than a low carb meal with fat and protein. You know, all of those you can't just you know, I know we started with that. I forget the the book reference that everybody uses, but you know where you do the 25% at this time and 50% at this time for the fat and protein. But the more I get into it, the more I realize it's, I mean, you might as well put a blindfold on and throw a dart and just guess so it's more insulin now. Yeah, so now we're like, okay, take a unit or take two units. It's, that's, that's the math we do is yet you need another unit, or you need another to unit yeah,

Scott Benner 1:31:50
I've made quite a few people. situation better by dumbing it down to if your blood sugar is high, you don't have enough. And if your blood sugar is low, you have too much. And that really ends up just being true. You know, like if your blood sugar is going up, and it's going up and up and up, we can all sit around and talk about like, well, maybe I didn't Pre-Bolus Or my insulin to carb ratio might be off or there could be fat or protein in this and I didn't account for it. But here's the real truth. Blood sugar is going up, you know, what makes it come down? Insulin, lets go. And so yeah.

Jon Fawcett 1:32:24
And you see, you also see so many people that post like, Well, can I do a correction? Now, you know, things like that. And my first thought is always it's only stalking, if you don't need the insulin, right? So you figure out how the insulin works. And then you can know just almost gonna say, you know, by gut feel, but really that gut feel is the billions of pieces of data your brain has already processed, you know about how much you need to take, based on that. Blood sugar,

Scott Benner 1:33:00
if you want to know the uphill battle that we're all against. I saw a post the other day that asked the very serious question, how did you correct a blood sugar two hours after the meal and not have child protective services called on you? And they weren't kidding. Like they were they were talking about something from their life. So you know, there's always a thing at school where the kid you know, Bolus they missed. And they had the nurse add on extra things. And the person asking the question was seriously thinking, I don't know how to Child Protective Services not get called. And I'm like, wow, that's in someone's head. None of you have any chance. Like

Jon Fawcett 1:33:45
we've, you know, we've corrected while she's still eating. we've corrected 15 minutes after the meal. But yeah, that was definitely not enough. We know already, after 15 minutes,

Scott Benner 1:33:57
there are times when the pump is still pumping, and I tell Arden go back in there, add 10 more carbs. So she's like, I have to wait till it's done. I'm like, I will wait till it's done and then puts up our carbs on that, because that's not going to be enough. But my

Jon Fawcett 1:34:12
Lily Lily obviously hasn't gone to the nurse in years. She's been independent at school. But when she was we actually had it written that the nurse calls the parent for meal doses. So the nurse wasn't allowed. Now she started in middle school. You know, so it wasn't like a tiny little kid, but we would talk to her on the phone and we would tell the nurse what to dose

Scott Benner 1:34:37
but just imagine that statement. So the person making the statement is living a life where they don't even understand how to manage their diabetes. They think they do but they don't. The nurse doesn't know what they're talking about. And obviously someone has called the state on somebody at some point for doing the right thing and being told it's the wrong thing. Fast.

Jon Fawcett 1:34:58
Yeah, and the problem is it, is there anybody up that chain? All the way to CPS and doctors or whoever? That would actually no,

Scott Benner 1:35:09
no that no John, they would be doing the right thing. Somehow it's a guy who started making a living selling iPhone cables. guy who was a stay at home dad, and some lady who blah, blah, blah and this person over here and you know, and whoever the hell Ivan is? And like you don't you mean like these are the people who understand how insulin works? Yeah, Jenny. Yeah, people who understand how insulin works, and none of them are, it feels like are in a position to help anybody. Like and that's why, you know, when you stop and look at like the like, the incredible success that the podcast has had, it's because it actually has a way to reach people. Like so

Jon Fawcett 1:35:57
Laos, it allows average people like you and me to share our experiences, but not. Not basically say, here's what your medical advice is to do.

Scott Benner 1:36:12
Without some nerd Nick riding in on a sheriff's going like nothing says three hours. Like what a great you don't know what you're talking about. No one knows what they're Listen, you're lucky when you bump into a doctor that knows what they're talking about. And now I'm expecting just random people to understand who are in some bureaucratic chain. I don't know how I've gotten off on this thing at the school, like because it's fascinating. But the point should be you should distill down everything that was just said into this idea. There's no rules. It's what works. Like Find What Works and do what works. And if it's not working, then keep looking. Don't just throw your hands up in the air and say like, well, that's just diabetes. Like he just gets high at 3am. It's, it's not it's not that easy. I mean, listen to the high at 3am thing from like the fat and protein. Here, how many people are on and acids and explore and experience heartburn overnight. Right? You're going to bed with a stomach full of food that you probably shouldn't have eaten to begin with. And your digestion slows down while you're sleeping. So it just sits in there. And that's what happens. You're gonna get Berets. You want that get don't look. Okay? You don't want that. So like just don't, don't don't eat a slab a beef with cheese on it and spaghetti sauce at 9pm. Like eat that earlier in the day if you're gonna eat that, like the good

Jon Fawcett 1:37:44
that that reminds me of you see the posts of why am I gaining weight? Now that I started insulin, and you see people saying, oh, insulin, you know, insulin, it's known that insulin can make you gain weight. And my just find non my non medical brain is like exploding over here saying no, it's you gaining weight for the basically the same reason that anybody gains weight calories. Except, yeah, except having high blood sugar is coincidentally a nice diet to lose weight.

Scott Benner 1:38:18
Because it's also an eating disorder and a really unhealthy way to be. And so yeah, but Right, yeah, I know, okay,

Jon Fawcett 1:38:25
your glucose isn't getting into yourself. Now it is, and you're eating too much so that glucose is getting converted,

Scott Benner 1:38:33
but see where your brain and my brain says so obviously, blah, blah, blah, there are other people's brains who go so if I don't take insulin, then I'll never get I'll never gain weight. They don't think about like, what's going to happen to them, you know, five years from now. And that's and, boy, you know, what, if this conversation is revealed one thing, it's how many patches there are, it's going all the way back to your basil like because you said about basil, what I would have said in the beginning, if you've got five different basil rates, you're just covering up other problems. Like this is the hole, you haven't figured out something magical. You have other problems that could have been fixed that you've put a patch on, but so much of it, care through school. It's all everything's being patched. Like that's the problem with diabetes care, and probably about everything else in the world is that we've been around so long, that we don't know why we're doing what we're doing anymore. We're just, we just started with a thing. The next decision was wrong, then someone patched it, then the next decision was right, then two decisions in a row were wrong. Then somebody threw a patch on it. Now you're 50 years later, and you're you're riding this motorcycle that's held together with duct tape, but it's running. And so you're like, yeah, it's all good. But then you start making decisions based on what you're seeing and what you're seeing isn't right. It just works. But I don't know if that'll make sense to everybody but trust If you step back far enough, you can see, everything's, I don't want to sound like a conspiracy theorist here because I'm, but society is being held together with luck and spirit. And so as your diabetes, but it doesn't have to be, you can get one of these systems get good setting start over and have success based on on what it's supposed to be based on. I don't know if that makes sense or not. But

Jon Fawcett 1:40:30
it does. But it's it I don't know if this is, I don't know if the statement is in agreement with that are in disagreement. It's a lot more black magic than science, if you will. So it's science, don't get me wrong on managing, but we are looking at, take Omnipod five, I can change basically, five settings that control what the pump does. And only one of those controls the automation, the others just control the Bolus category. Five things, there are probably 5 million variables. Physiologically, environmentally. When I say sort of like, emotionally which ties into physiologically like stress or whatever. And even technologically, how you know, is the cannula at a one degree angle from where it's supposed to be? That causes that drip to just be slightly less. So we're looking at five variables to try and manage something that has millions of individual things that can completely make it go off the rails, right? Yeah, that's why so much like your comment before about sort of not worrying, is it? 30 carbs or 35? carbs, it's, it's worse or whatever? Yeah, it's what works. Because the reasons that I chose for the same thing today that I did yesterday, and yesterday was perfect. And today, I'm 250 The reasons are those other 495,000 variables or whatever, it's that oh, the the temperature was one degree hotter, and my skin was slightly warmer. And so the injection didn't quite absorb in the exact same manner. As it did yesterday. Yeah.

Scott Benner 1:42:37
Oh, no, 100%. I just meant on the setting side, like, like getting like that stuff can be right? It can be or at least better than you have it. Like if you've been patching and patching and patching. You don't know what your basil is anymore. Like you said your daughter's insulin to carb ratio was what one to four and a half. Yeah, and I bet you many people are like, Oh my God, that's sad. You know, we know why I didn't say that John, right, because that's about my daughter's but ratio is and, and so it's just, but her Basil is also not like, you know, super high. And so like it's end, and she's got an algorithm working for it. But the one thing you said earlier that makes, I'll tell you, if you ask me why an algorithm is great, it's being able to steal basil from the future, the way you put that, yeah, I love that about about being able to use a loop to just say like, Look, she's about to eat something, we're not Pre-Bolus thing, right, it's going to hit her so hard, you can literally put in like two hours of basil into the Bolus. And if it's too much, then the algorithm just keeps taking the basil away. And it's the only way I get to help people to like imagine in their minds, is like, if you like a scale of justice, like a big scale right on two sides. And the algorithm is just is just faster than you can think about it. There's carbs on one side and insulin on the other of the scale. And the algorithm is just like, takes all the it takes all the insulin off of the scale. And as soon as it sees it starts to go the other way to here, take the insulin back, and then it keeps it balanced. Too much too little more or less. And it just it's it's adjusting in the moment. And and

Jon Fawcett 1:44:29
that's why it's also important to know that 2.1 times number for basil iob because like a loop loop shows negative things. Which is drives me crazy because it's just a made up thing. Because if your basil is one unit per hour, when Luke when Luke showed zero, you have 2.1 units on board. If loop shows negative one you still have 1.1 units on board. But knowing that number of at any time if the algorithm has been cutting my basil, well, I know that my basil is keeping me right about 2.1 iob at all times. Well, that tells me approximately how much I can add in even from what had been cut from the last hour. For instance, like last night, Lily was like, at five for four hours, probably from like, 7pm until 11, or something, came home wanted to eat before bed, and I just said, look and see if basil has been cut. And if it has, you probably want to add an extra unit. Because I knew that you know, the IRB it or system from the Remove basil before would need to be added back. Yeah. And that would make that meal hit harder she think

Scott Benner 1:45:57
about in our own because that's something Arden doesn't track still.

Jon Fawcett 1:46:01
I'm I'm trying to get her to do that more. So I'm just doing reminders. And then not but but not necessarily following up. To make sure she doesn't like our newest thing is she she goes to bed way later than we do. And she usually wants to go eat half of the kitchen at midnight. So our our newest thing is just telling her head Check, check where you're at when you're falling asleep. And if you're still rising and not coming down from that food, you need to consider how much more to add, because we all know it's going to start slowing down as soon as she falls asleep. And that's going to make make her rise more. So she's getting there, not fully, but she's definitely getting there with that type of Yeah,

Scott Benner 1:46:53
I knew it was gonna get high this morning because she had class at 8am. And her blood sugar's been like 90 for 24 hours. Like she's just been super stable for like a whole day. And she spent the whole day in her room doing homework, you know, she had a couple of meals, but they were smaller. And she's gonna get up this morning, she's gonna go to that horrible cafeteria at that. Pool, John. And I don't know what they feed them. And, you know, she's she made a big Bolus she she was on top of it for the first few hours this morning. It was working. But then she ate again on top of it. And I was like, Oh, here we go. Like so she's gonna go to like, 190 200 it's gonna sit there for a little while, and it's gonna come back. And yeah, it's funny, because I think a lot of people listening to that are like, really, this is what you're worried about. You know, that's not so bad. And I don't think it's I don't think it's, I don't judge it as bad or not. It's just where she's at now. And her understanding of the impact of the food she has, what her schedule is, like, like all that stuff. But if she would have thought the way you just said, like, Hmm, I've been super stable for a long time, let me look to see if my basil has been cut back. Because when I go to Bolus here, I'm going to have a deficit. And I'm not going to be covering it. That's the next step. Like I don't know when she'll get to it. But we're moot like, same thing with you. Like, I'll mention it once in a while. And I figure one day, she'll figure it out.

Jon Fawcett 1:48:18
Well, and that's what's been nice with a Frezza. So Lily went out to get coffee this morning. And I just said, you probably want to take at least one cartridge of a process. So we only have the smallest cartridge, which is 40 units, but it's actually conversion from Nova log, it's like two and a half, two and a quarter units of Nova logs. So what she's started doing at times like that, when you know, she knows she's going to have a quick rise for whatever reason, if she'll take one cartridge over Frezza, at the same time that she doses the rest on the pump. So the Frezza helps them knock down that first hour while the Novolog is getting started. And that's that's actually been pretty amazing to see how it is able to stop the rise with that combination of interests, sort of replacing that replacing that missing Basal but doing it with a Frezza because you know, everything's hitting from, you know, 60 carb, Starbucks, you know, death drink.

Scott Benner 1:49:25
I'll tell you I would I I don't know if Arden would be up for it, but I'd be up for trying it if if she was just the idea.

Jon Fawcett 1:49:34
I don't think you should necessarily try it yourself. Oh, no, no,

Scott Benner 1:49:37
no. I mean, I mean, just I'd be up for like, like trying to figure it out with her if she was interested in doing it. You know, although, you know, it's interesting. You're kind of talking about biohacking a little bit earlier. I was watching this woman online last night she I think she's using the Lilly version of one of those objects injectables that was first brought bought out for type two, but it's been I guess FDA approved now for weight loss and you're seeing a lot of people use it. I don't know what the lily ones

Jon Fawcett 1:50:07
Yeah, the awesome pic or whatever it.

Scott Benner 1:50:10
Honestly I don't know what it's called. But I mean she's this this. I'm just kind of watching this woman on Tik Tok. She doesn't have diabetes or anything like that. She's lost like 42 pounds in a month. And I'm like, I'm so I'm sitting in bed last night with my wife. I'm like, why is that happening? And she's like, well, it quells your because your desire to eat. But I'm like, but there's got to be something else going on. Like she didn't lose 42 pounds from like cutting back on food in a month. Like, that doesn't make sense to me. I'm like, I want to understand that better. That's like, and yeah,

Jon Fawcett 1:50:43
so one pound is 3500 calories. Yeah, that's 150,000 calorie deficit in a month. That's like, you'd be dead. Yeah, it was just cutting down cravings.

Scott Benner 1:50:55
That's what I said to my wife. I'm like, it's not. That doesn't make sense. It's just crazy. She's like, Well, I think it's about how the insulin gets used to. And I'm like, Okay, and so I'm like, I'm gonna figure it out. And then I'm gonna go on to talk about, you know, what

Jon Fawcett 1:51:07
I think I saw when you said that it clicked something in my brain. I think what it's doing is it's actually dumping the glucose through without it getting into your cells. So it so some of the glucose just gets dumped straight through your digestive system. Interesting. If that's the one I'm thinking of, because there was one that I was reading about that.

Scott Benner 1:51:37
I don't know what it's let me take a look. See if I can figure out what it was called. You're saying it's mon Jarrow or something like that? Is that what you thought?

Jon Fawcett 1:51:49
I don't remember which one. But there was one I was reading that was seemed really unusual how it worked. At least part of how it worked.

Scott Benner 1:52:00
Yeah. Now I'm going to find out I'm going to talk to I listen. I'd love to talk to somebody about it just to understand what it's doing. And I mean, it's it's a significant, like, I mean, 42 pounds in a month, and she doesn't look unhealthy. She doesn't look like I don't know, I'm not there. But I mean, like, she's not like, she's not pulling herself on the desk like Gollum going, Yeah, I'm okay. It looks like that's really sound like something's going on in there. Like that's not allowing this to get stored. The way it would normally without it. And I don't know, I just thought it was interesting. So I'll try to find out about it. Anyway, John, is there anything? We haven't talked about that we should? I thought this is a great conversation. And yet I'm not 100% Sure what we talked about. So

Jon Fawcett 1:52:43
yeah, we talked about a lot. So I don't know, I think we talked about everything we should talk about. Oh, no. One more thing. We didn't talk about the single most important thing for Omnipod pipe. So I started counting. How many times a day, I was posting this exact same response to people. They put a new pod on. Patrol, it says it can't find the CGM. So basically the pod isn't connecting to Dexcom. And this goes all the way back to G five restarts. And then you had to do it a lot with loop in the early days, where what was happening is the pod that you just deactivated is not correctly disconnecting from Dexcom. So because the pod is taking the place of the receiver and Dexcom can only be connected to one receiver and one phone at a time. You pull your old pot off, throw it in the trash, it's still connecting with the transmitter even though it's supposed to be deactivated. Okay, so what we do every single pod change, Lilly deactivates the pod as soon as it beeps deactivated, she throws it in the microwave. Don't turn a microwave on by the way, throws it in the microwave. Prime's the new pod starts it connects perfectly every single time because the microwave has a Faraday cage that blocks Bluetooth signal. So you're basically blocking the old pod from continuing its connection to the transmitter. So that's, that's the number one tip I post that more often than anything else to people, because it seems like everybody runs into that we were at 50% of the pods were having connection problems. Since we've before we started doing that, since we started doing that, we've not had a single one that is not connected immediately and reliably.

Scott Benner 1:54:51
Go over it again step by step.

Jon Fawcett 1:54:54
deactivate the pod, pull the pot off and put it in the microwave. And then prime and pair and start up the new pod. And it will connect an app only after it connects. So on the controller, when you see the actual CGM Val value showing, only after that happens, pull the old pod out and throw it away. Okay? So leave it in the microwave that whole time.

Scott Benner 1:55:20
And I'm just gonna say this for people who didn't hear Faraday cage and go, Oh, I know exactly what that is, John, because you're fancy. But it's, it's used to block electromagnetic fields, right? So a microwave has one because if your microwave didn't have one, my, gonna say my testicles would be burned by now. Exactly. But that's,

Jon Fawcett 1:55:40
that's the the little grid pattern you see in the microwave window. That's the Faraday cage. It's just the wire mesh. And for some reason, a wire mesh causes signals to not be able to escape.

Scott Benner 1:55:53
So if your CGM is still improperly connected to the old pod, putting the pod in there basically makes the pod disappear off the face of the earth for the CGM connection.

Jon Fawcett 1:56:03
Yep. And, and we saw about half of the pods having trouble with the connection. And before we started doing that, and once I started doing that, it's not a single one. And all the other things that like people say, reboot the controller, delete the transmitter re enter it, all those types of things. They're all just getting lucky with something with specific timing of maybe when it's trying to ping, the solution is that you have to get that signal, no longer connected to the decks. And the easiest is throw it in the microwave. You could also just throw the pot out down the street, it was gonna

Scott Benner 1:56:40
say I'm laughing and how many people like open their back door and just thrown it into the yard.

Jon Fawcett 1:56:47
That'll do the same thing. I mean, it's about 50 to 60 feet if you have clear line of sight. So you could connect,

Scott Benner 1:56:56
you get a really good arm. So anyway, oh, well, that's great. I appreciate you adding that in here. Thank you very much. Yeah, listen, let's, I don't normally do this. But let's pimp your thing. So the sugar pixel is at custom type. one.com. Right? Yes. Okay. It's really it's a terrific device. Like, it's absolutely amazing. I thank you, I find it to be on the level of glucose as far as like how valuable it was. Because I did. I did run it while Arden was here. And it was terrific. Now that Arden's gone, I need to set it back up. And I haven't yet but I kind of need your help a little bit. And, but for the glucose is the same thing. Like it almost just trains you. Like I woke up in the middle of the night last night. And I fixed my eyes on where that little glucose thing was. And it was green, and I went good. And I shut my eyes again. And I did the same, the sugar pixel when I had it set up, okay, you open your eyes, you're like, Okay, I didn't have to pick up my phone. I didn't have to unlock my phone, all that kind of wakes you up. You don't I mean, like all the machinations with the phone and everything, when you don't have to intersect with the phone, and you can still get a tiny bit of like, a feedback about blood sugar. It's very helpful, and it doesn't break your sleep as well. In the same way, I mean, so anyway, what do you sell anything else that custom type one.com Or just sugar pixel.

Jon Fawcett 1:58:30
That's the biggest thing we sell is sugar pixel. And evidence, we actually have ideas for other products. I have a this Christmas past Christmas, I actually had on my own Christmas tree, a fully functioning version of sugar pixel driving my Christmas tree lights. So that might be something you see in the future is a Christmas tree version of sugar pixel. But yeah, the biggest. The biggest reason I made it I said earlier was Lily wasn't waking up to alerts. And it could be for any number of reasons. She left her volume too low. She left it on vibrate, you know, all kinds of stuff. She's just sleeping harder. And even then it's like, even if everything's perfect. The alerts just the tiny iPhone speaker. So I put a giant speaker in it compared to what you have in the phone. And then also have a vibration puck that you slide under the pillow. So you can get audio and vibration. And we just recently added I think, what has been the most popular feature. We added emoji screens so there's like six or eight different displays you can choose, depending on if you have one user or two users that you're following. But one is emojis. So for little kids that might not be able to rejects. Yeah, we could just have a, we have a single color display. So a kid could No, green is good, red is bad. But we've also added these emojis. So there's Smiley's that have all different smiley faces to indicate the big range. And then there's also icon so like the urgent low is a lollipop is one of the icons. Urgent high, there's a dumpster fire is one of the icons, which is my personal favorite. And then even unicorn, unicorn icon. So you know, little kids get excited. They they hit their perfect number and a unicorn icon pops up on the screen with it.

Scott Benner 2:00:40
Can I set what my number is for my unicorn?

Jon Fawcett 2:00:43
Yes, that was you know, everybody ever about any, you always see the posts of 100. But I know a lot of people that use a different number for their unicorn. So we want to make sure that that was set up.

Scott Benner 2:00:58
That's excellent. John, that's terrific. of sugar pixel is that custom type? one.com. And the word and one is spelled out o ne? So yeah, check it out. Yeah, it really is terrific. It's is it? Is it? Is it still? Like, are you you're not printing them on site? Like how do you make them? I guess, is my question. Are they manufactured somewhere?

Jon Fawcett 2:01:22
It's, it's a lot of custom work. So we are, all of the plastic components are now injection molded. You know, the first one, you bought it within like the first month, we, I didn't know if there were going to be 10 people that wanted this or 10,000. So I couldn't, I didn't have the money to invest to build injection molded. So we were three printing the housings originally, there now injection molded. The then we would purchase all the individual components from, I think, five or six different places. And our circuit boards are manufactured here in Akron, Ohio. And then we do all the finished assembly here, no matter where the parts are coming from. So we have parts coming from all over the world. For it, but everything is finished right here, which I like. Because, you know, it lets us lets me run down right to the factory there. If we have to update something, or, or fix something, make changes, things like that. John,

Scott Benner 2:02:25
how many employees do you have making sure every pixel?

Jon Fawcett 2:02:29
So employees in quotes, there are exactly two of us with custom type one. But our you know, we basically rely on outside contract factories for the various pieces parts. So like our LEDs have, like, comes from a place that has probably 500 or 1000 people that are making LED panels. And our circuit board manufacturer, I think they are probably about 20 people. Yeah, as far as the actual company. You know, if you send a, an email to our support, you're gonna be talking to me. And yeah, and it's, we're just a small place, which, which is good and bad. It's good because we connect, we, you know, I personally can connect with almost everybody. And, in fact, because that can sometimes be overwhelming. Yeah,

Scott Benner 2:03:25
John, you and I are doing about the same thing with a different product. But people I love getting an email, there's like, Hey, can you tell Scott, I'm like, Oh, you think there's another person here? I am Scott. Yeah. Yeah, the guy is the guy. There's no other guy. So

Jon Fawcett 2:03:44
yeah, the the funniest ones are the ones that you'll every now and then get somebody coming in with a raving and ranting message that is acting like we're this, you know, multibillion dollar global conglomerate company that they're dealing with

Scott Benner 2:04:05
a CEO that All right.

Jon Fawcett 2:04:08
Well, I'm just like, I've actually replied before, I've replied to people before, you know, thanks for your patience. I'm sorry. It took me so long. I was up all night with high blood sugars. And so I'm running out a few hours asleep. So that's why I'm deleting replying. I think that's the price is people that, you know, hey, we're, you know, we're the same as the people that are using our product. So there's gonna be days when we might be extra tired, and it takes us a little bit longer to reply to emails.

Scott Benner 2:04:40
I remember when was it Athletic Greens reached out to me because they wanted ads, and they were like, you know, can we talk to somebody in your marketing department? And I was like, that's gonna be me. She goes, Well, after that, we need to speak to somebody in like, you know, accounting and I was like, yeah, that's gonna be me. To my eye, it's me. And she goes, but you chart with like, huge, like podcasts like the large companies running them. And I was like, Yeah, it's me. Like anything you need us my dress? Yes. Why don't you hire people? Oh my god, how much money do you think I make doing this? People hire people? I'm barely paying my own bills. What are you talking about? So yeah, anyway,

Jon Fawcett 2:05:26
well, and that that actually is funny because we, when we were looking at pricing sugar pixel, I wanted it, my main goal is to help people with it, it's a happy benefit that I was able to make it my job. But without cutting corners on the actual product. Like I look at every single penny that goes into it. And I'm like, okay, to offer phone support, I would have to charge everybody, every single person, like an extra 50% of the cost just be to be able to hire people to handle phone support. Right? And is that actually worth it? Probably not. Because I'd much rather it help way more people and the handful of people that might need a little extra help getting it set up, you'll figure it out. Maybe it takes an extra day over email. But that meant that all these other 1000s of people still have an extra $50 in their pocket,

Scott Benner 2:06:28
right? Well, I understood your situation, because when I got one, you're like, I'll send you one. I was like, well, I'll pay for it. John, like, I'm not You're not gonna just send me one. Like, I know, I know your situation, you know, like, I mean, it's, I live it too. And yeah, I you know, so I say to people all the time, like, I just need you to click on the links for the subscribe for the for advertisers, like if you if you listen, if you want to buy a Dexcom do me a favor and buy it through my link if you don't want to buy one. I mean, don't buy one just to support the podcast, just use the links if you're going to you know, and yeah, and I every once in a while. And it's not bad. But somebody will come after me that like you just this is all about money. I'm like, You don't understand what you're talking about. Like if people don't click on those links, by by podcast, like, the podcast that you love so much that you're texting me about how much has helped you like, I actually had a person who's told me these words, this podcast saved my life. And you shouldn't have advertisers. I'm like, Well, you need to pick one. Because that's not how the world works. I, I live inside of a place and my kids go to college, and I eat food and electricity, etc. Like, I can't just make you this podcast, like I'm, I'm an actual person. You know, like, I have things I need to so like, do you want to pay for the podcast? Like I sent it to person like privately? I was like, Look, if you want, I can just charge you like $20 a month to listen to the podcast, and we're all good, then you want to do that? Oh, no. Oh, you don't want to do that. Okay, so you don't want to pay for it. And you want it to save your life your words, but I shouldn't make money. How's that gonna happen? Then? Yeah, so.

Jon Fawcett 2:08:10
And that's the hard part. I mean, it's, it's, um, you know, we all spend way too much money managing this disease. But it, you know, everything can't, can't be free. It's not how the world works, it would be great if it could, the whole night Scout issue with Heroku. Everybody started initially, they discovered railway was working. And they started initially pushing everybody over to railway. And I looked up railway, and I'm like, they're a 12 person startup. And we're going to, as a community push 10s of 1000s of free users onto them, they're going to shut that down, they won't be able to afford that service, if too many users, right. Just all of a sudden start taking their free service you know, so it's it's a line on how you deal with all of that. And I think your approach is the most elegant because it is the the big corporations.

Scott Benner 2:09:30
Yes, someone else just wanted to tell the person Hey, just say thank you. Like, like, I figured this out, like I got you the information for free. Thank you and I'll go you're very well. Yeah, it My pleasure. Like you know, not not like hey, you're pushing ads. Like yeah, do you want the podcast? Like I wonder if people think like after I record with you, you know, if it wasn't for advertising, I it would take me three minutes to go to the front of this and be like, Hey, everyone, welcome to episode blah, blah, blah, the Juicebox Podcast today Jon's gonna be on the show, we're going to talk about sugar pixel and loop and Omni pod five, you're gonna love it. John's daughter, Lily, like I could do that boom, at the end, say thanks for come and see you later, check out the Facebook page. Instead, I spend hours getting each episode together to put ads on them. So that hopefully you'll click on one of the ads if you're gonna buy an omni pod or a G voc hypo pan or whatever the hell you're gonna buy. And so that those people will then send me money, which, by the way, I don't keep much of because I don't know if you've heard about taxes. And then and that is no overhead. I'm a podcast. So like, there's no right or like, like, if you want to know who's like supporting the, all of you through taxes. It's me. Okay. And, and so then that all happens. And then at the end, I just like, like, I mean, my God, like, if you want to contour meter, could you just click on the link? Like, I'm not telling you to buy a contour meter, I guess I got pushback from somebody recently. Like, I don't like athletic greens, and I responded, I was like, don't buy it. When you think you're under like some like, you know, like, it's not a law, if I have an ad, you have to buy the thing, you know, like it's okay. And like, I'm like, I respond back. I said, don't buy it. Other people like athletic greens. And those people who use it, if they buy it through my link, you get the podcast for free. Like, do you really want the podcast to go behind a paywall? Because that's the other option? Yeah. And then how many people to your point about sugar pixel, that how many people don't get it if you make it more expensive? And I'm like, I don't, I don't want to do that. So, and

Jon Fawcett 2:11:42
well, with a podcast especially is, you know, that's along lines of it's mobile, sort of mobile first is a podcast because you're getting it through your phone through the app. And it's just like all the stuff in the App Store is you've put it at $1 next to an app that's free, and nobody's gonna buy the dollar done. Yep. So it's almost like it's almost a you can't put a single, a single dollar amount on on the podcast, without losing probably the majority of your

Scott Benner 2:12:17
life. I had a company come to me one time and said, Hey, let's you should put your your podcast behind a paywall. Because, you know, how many listeners do you have? And I said about this many, how many downloads you have about this money? And they said, Well, if you just charged 99 cents for download, this is how much money you would have? And I'm like, yeah, that wouldn't happen. I said once it's 99 cents, nobody would download it. Like sure they would I'm like, not all of them. And she goes, Well, let's say that I'm sitting at this meeting, I'm like, Oh, my God, I gotta get out of this, you know? And, and they said, they said, well, let's say you lose three quarters of the people, you still have a quarter of them. And by the way, the number was impressive. Like if I lost three quarters. Yeah, listeners, the amount of money would have been apparent, like trust me, I could have made the podcast for like two more years. And then like off. And so I was like, but I said, but the podcast helps people with their health. And she's like, Yeah, and I'm like, Yes. So you're telling me that three of every four people who are now being helped by the podcast are no longer being helped by it for the love of 99 cents. And I was like, You don't understand what I'm doing. Like, I'm helping people, she does know you have a very popular podcast you can monetize the hell out of and I was like, I don't want to do that. I was like, I was like, can you find a way to monetize it? We're all for people are helped with their health, and they doesn't cost them 99 cents. And she goes, Well, you need an ad revenue for that, as I guess I already have that. So you're no help to me at all? And she's like, No, and I'm like, Okay, we're done. Thank you. And that's the last one of those calls I've ever taken. Because by the way, they come constantly. And what I've come to realize is is that she wanted a piece of the pie too. So, you know, like, you know, I was going to make X amount they were going to take 20% of it. And I was like, well, that's the other people that come to me. You should set up a class and charge people $50 for it. And she's like, they would pay that and I was like yeah, they would, but they can get it in the podcast for free. And she's like, you're not making enough money. And I was like, I don't know what's enough. Like I do. Okay. Yeah, I mean, like, I'm not over here struggling, like what are you talking about? Like, how much am I supposed to make off of this? You don't I mean, like, it's all just very, I don't know, but

Jon Fawcett 2:14:36
it's just so opposite of, of capitalism, basically. You know, I mean, it's the opposite. But it's, it's not going to the nth degree to make every single penny you can because it's not entirely about just making a living at this. It's also because we're helping people, you know,

Scott Benner 2:14:56
people that I tell people all the time. I have the It's a triad. I help people, I enjoy this and I pay my bills. You go back two years ago, find me and say, Scott, one day, you'll have a job that helps people that you'll enjoy that will pay your bills. And I'd go like, Sign me up. What is that? You know, like, who's lucky enough to have that? And so, I'm just I don't know, I'm not going to wring every red cent out of everybody. Like, it just seems. It's 30 seems wrong. And by the way, I'm okay. Like, you don't I mean, like, it's not like, I'm not over here. Like, yeah, like, how are we gonna pay the water bill? You know? So? Yeah, anyway, by the way, I don't care. I'm sorry, John, I don't even think about it right up till you get the one email from one person who's like this. You just want money. I'm like, Oh, you have no idea how much money I can make out of this. And and that I'm leaving on the table, you've son of a bitch.

Jon Fawcett 2:15:52
It's your, your, maybe more polite than I am. I just I get those emails. And I'm like, Oh, my gosh, I just, I can't even reply.

Scott Benner 2:16:02
Well, I don't know. Like, I'm not trying to, like, talk everybody into liking me. But I mean, there's, here's my next thought. I've said this before, like, you can't like the reason you don't tell people like I don't understand this, this thing. And in society now where people brag about what they have. I saw somebody in the diabetes space do it recently. And I thought, why in God's name, would you show anyone that car? Like, like, what are they like? What are they going to think? Like, I know what I think when I say it, I think, wow, you're making a lot of money. And, and you're telling me you're helping people like so let's say, John, that this person's making, like a massive amount of money, but they're still helping people, then okay, I mean, good for them. Right? Like, I don't have a problem in the world with that I live in America. I'm okay with that. What about but what I think about is the people who see that are put off by it and stop taking the help. Like, yeah, now you've like, you've hurt someone else's health, so that you could show them you had a fancy car? Oh, just enjoy the car. No one needs to say. Yeah. And that I really do think about that. Because people can get put off by that. Like, if I made. Listen, if I made $30,000 a year off the podcast, and somebody making $15,000 a year is gonna look at me and go, Oh, my God, look at this guy. Like, just, you know, I'm not gonna listen to this, that that person. And I understand that. So like, I wouldn't want that person to think, to not know how to Pre-Bolus because I'm making 30. And they're making 15. And so I just think that's a private thing. You just keep that quiet. Because no matter how little or much money it is, you're going to end up pushing someone away. Anyway, that's like back well, and

Jon Fawcett 2:17:51
so we, that reminds me, I just got a booth at both rents for life, and ADA in San Diego in the summer. Okay. And in doing that, I was like, Oh, my gosh, I have to think through how to make the booth look nice, but not too nice. Yeah, you know, I mean, because I, we can't come across like, oh, my gosh, they they're so this way too much because of how nice their booth is.

Scott Benner 2:18:25
See, these are the things that people in your in my position have to think about that other people don't have to think about. And if they got put in this position, they would very quickly understand it. It's not Yeah, it's not that easy to make something that actually helps people and doesn't offend their sensibilities and all the other things that people can rub up against. I feel it every day on the Facebook page. Like sometimes there are people who are just like, I'm like, You're not like you're not getting this like you don't mean like you're being nasty, you don't realize that. And then it's my job to tell them that except I'm the guy on the podcast. So I don't want I don't want them to like stop listening because a it'll hurt the podcast and be because it'll, because they're not going to hear the thing next week that we talked about that might really help them. And so it's always this balancing act. I was like, I'm gonna be the bad guy. I'm like, I don't want to be the bad guy. But but you're not the bad guy. You look they're like they're out of their minds. You know?

Jon Fawcett 2:19:24
The majority of the people look at those posts and are like, Oh my gosh, this guy this guy did put it like Scott put them in line.

Scott Benner 2:19:31
And it's funny because people will say privately, we'll just block them and again, I think the same thing I'm like no like the like they're having some sort of an issue right now. They'll get through it and they still deserve to know how to take care of their blood sugar's like one bad moment on Facebook doesn't you shouldn't get exiled for that. You know, so anyway, well,

Jon Fawcett 2:19:51
other than other than all the people posting G seven Kenya accounts scammy

Scott Benner 2:19:59
people are Doug, I'm not okay with. Anyway, John, you're really terrific. I appreciate you doing this very much. And

Jon Fawcett 2:20:06
yeah, I had a lot of fun doing it. Good, I'm glad.

Scott Benner 2:20:14
Hey, I want to thank John for spending so much time talking about Omnipod five and looping in the present all the stuff today. Thank you, John. I want to thank Omni pod makers of the Omni pod five and the Omni pod dash and remind you that you can learn more and get started today at Omni pod.com forward slash juice box and of course, save 10% On your first month of therapy at my link betterhelp.com forward slash juicebox. Can't remember the links to type them in the browsers. You can find them in the show notes of your audio player or a juicebox podcast.com. We talked a lot about the Facebook group today. You can find it online Juicebox Podcast type one diabetes fantastic group 40,000 people in it right now. Going Strong. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Don't forget to subscribe or follow to the podcast in the audio app you're listening in right now. Apple podcasts Spotify, Amazon music wherever you are, hit follow or subscribe whichever your app offers. A huge thank you to one of today's sponsors better help. You can get 10% off your first month of therapy with my link better help.com forward slash juicebox that's better H e lp.com. Forward slash juice box. If you've been thinking about speaking with someone, this is a great way to do it on your terms betterhelp.com forward slash juice box