#920 Best of Juicebox: Control IQ Ninja
First aired on Apr 12, 2022. Jeremy is a Tandem Control IQ ninja.
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Scott Benner 00:00 Hello friends and welcome to episode 920 of the Juicebox Podcast today's best of is episode 660 to control IQ ninja. This episode is with Jeremy. He is the father of a child with type one diabetes and he possesses an amazing understanding of control IQ from tandem from April 12 2022. This is control IQ ninja. 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 healthcare plan or becoming bold with insulin Juicebox Podcast listeners use the offer code juice box at checkout at cozy earth.com to save 35% off your entire order of clothing, bedding, towels wherever you can find it cozy earth.com You'll save 35% With juicebox at checkout. If you're looking for community around type one you want to talk about tandem control like you or anything else. Find my private Facebook group Juicebox Podcast type one diabetes on Facebook 40,000 members, type one type two parents adults beautiful mix don't care what you eat don't care how you live. You're welcome there. The 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 therapists who can help you with a wide range of issues better help.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. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price 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. The podcast is also sponsored by touched by type one touched by type one is a beautiful organization helping people with type one diabetes, and they just want you to check them out touched by type wine.org on Facebook and Instagram. They have a big event coming up in a couple of months that I'm going to be speaking at touched by type one dotwork Hello friends and welcome to episode 662 of the Juicebox Podcast. Today we're going to speak with Jeremy who is a past guest on the show. Today's topic is much different than his first topic. We'll cover that later in the podcast. But today Jeremy's gonna tell you about how he manages his son's type one diabetes with tandems control IQ. And let me tell you something, Jeremy is a next level guy. He's a bit of a ninja. He took what he learned on this podcast and just kept learning about control IQ and today he's going to tell you all about how he does it. 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. After the show today, if you'd head over to t one D exchange.org. Forward slash juice box and fill out the survey. I would appreciate it you need to be a US resident who has type one diabetes, or is the caregiver of someone with type one. It only takes a few minutes T one D exchange.org. Forward slash juicebox Well, episode were you on the first time?
Jeremy 04:44 Um, it was the after dark divorce episode.
Scott Benner 04:48 Yeah, we didn't really talk about like, yeah, okay, so go ahead and reintroduce yourself.
Jeremy 04:54 Okay, I'm Jeremy Ross Meyer. I'm a single dad of a type one diabetic. And then Damon is 13 years old. And we have been diagnosed for four years and our agency has been between 5.3 and 5.8 for over three and a half years.
Scott Benner 05:18 And in these three and a half years, have you always been using control IQ or if it hasn't been different matters?
Jeremy 05:23 No, we've done all three, we've done straight pumping with tandem we've done Basal IQ, pumping, and control, IQ, pumping, all maintaining that same a one C spread very nice. Okay. I mean, sometimes I feel like I was blessed to be able to straight pump because you really, really understand what adjustments do to blood sugar. But it you can start anywhere. Really,
Scott Benner 05:53 yeah, you could figure it out with needles, you could figure it out with pens, you can figure it out with a pump like it's all just watching the insulin go in and seeing what it does. It's I mean, it's great, obviously to be able to adjust your basil on the fly and not have to wait 24 hours to inject again to try to make an improvement or change. Just real quick for people. That episode that Jeremy was on before 508 After Dark adult child of divorce you actually came on that one because you started out. Let me see if I can remember this. Jeremy, this will be interesting. You weren't Oh, no, I
Jeremy 06:28 don't know if it is that when because you said adults.
Scott Benner 06:30 Oh, I thought the wrong one. Excuse me. Cheese 372 After Dark divorce and co parenting.
Jeremy 06:38 There you go start one.
Scott Benner 06:39 I'm starting to pot. Actually. There's a lot of them here. I have one too. I searched divorce in my episodes and came back with four. No, no kidding. All right, yours is 372. About co parenting because if I'm remembering correctly, you're divorced as your child is diagnosed. And and we all get along, right? And you guys actually get along, right? And that's what you're talking about. Right? I did get a lot of impact. Impactful letters back from people where they're like, can you just interview somebody who's not getting along and how they're doing it? Yeah. And I said, Good luck getting somebody who's not getting along with their ex to come on a podcast and talk about it. I was like, people are not generally excited to divulge that kind of stuff. But I have gotten a little closer in a recent episode 625 was about divorce and disagreement. And that person? Yes.
Jeremy 07:33 And it was an excellent, excellent representation of the other side.
Scott Benner 07:38 Yeah, yeah. So I finally got there. It's not I'm just saying not easy to get somebody to come on and talk about their spouse or their ex spouse. Yeah. Especially if they're not getting along very well. Alright. So Jeremy, you are back today? Because? Well, I know you. And I know you, especially through the Facebook page. But through our previous conversations, and we text sometimes, and you are very good at using control IQ. And, you know, I've had somebody on recently to talk about it. And we I thought had a pretty surface conversation about it. And I didn't know enough about control IQ to push back in certain places. So you're sort of on here to help me dig deeper. Sure, yeah. So I mean, kind of take it away. Tell me what you what you would tell somebody else if I said, Hey, should I should I try control IQ? What would you say?
Jeremy 08:28 So just to kind of give you an idea here, I also am, this is not an invitation to contact me and ask. I also can follow three other children up here in Montana that are on control IQ, I also control their pumps, they're a onesies are all below seven as well. So I've kind of done this long enough with enough samples to understand what needs to be done with control IQ to get it to work. Not just on my child, but on different age children on male females in puberty out of puberty. But what it really comes down to is that before we even get into control IQ, there's a few things that in my opinion, it doesn't matter what pump you're on, that needs to be better understood or mentioned. Before we get into control IQ. Stuff like consistency, how you treat Lowe's, what you treat Lowe's with using protein at night, and just allowing basil to do its job. The way that we treat like between my son and I is we either use Mott's apple juice, that's the all natural stuff, or we use gummies we know how much apple juice to drink to get to three carbs, we know how much to drink to eight carbs, and it's consistent. And it works the same way every single time. And you're going to hear the consistency through the control IQ point of view as well. We know that what a gummy will do to his blood sugar. We know that when he's dropping this hard, he needs this many gummies. The longer that you stick with the same sort of thing, the better results you're going to have, instead of just throwing Oreos that your child then like,
Scott Benner 10:36 let me let me make sure because I I know what you're saying. But I want to make sure we're all clear. Sure, there are impacts variables all over diabetes, including the things you don't think of as being impactful. And the idea of you're getting low. Oh, what do I do? Doing something consistent, breeds a consistent response. And more and more importantly, allows you to move forward without crazy highs or crazy lows or things that you don't expect to happen. So if you're consistent with how you bump your your low blood sugars, then you'll be consistent with what happens afterwards. Not just like, hey, this time eat an Oreo next time have a piece of chocolate cake this time. Yeah, cuz soda, like that kind of thing. Treat the Yes.
Jeremy 11:20 There's always times dt, the whole fridge. Yeah, right. You know, there's always those extremely high delta where they're about to pass out and you just grab anything and everything and throw it down their throat doesn't happen often. If it is happening, often there's something wrong. But moving moving on from that, we have to kind of talk about what I call garbage in garbage out. Which means that you know, you need to be checking your Dexcom ratings, not just doing nothing about them. That starts with a good glucometer. And I this is not an ad for
Scott Benner 12:04 you want me to do the ad Jeremy. The Contour Next One blood glucose meter. Are you about to say that? Are you about to say it's a great meter,
Jeremy 12:10 I just couldn't remember what the hell it was called. But one thing but anyways, in the thing that we've tried different, there are tons of third party studies out there that shows that that Contour Next One is the most accurate meter on the market period. Now I understand there are some people that you know, can't afford, you know, something like that, because the strips are fairly expensive. But they're, there's so many times that that meter will exactly match Dexcom it's not even funny. Yeah, I agree. Then there's certain things about Dexcom. Like you need I hear I hear a lot of people say, Oh, well, we never calibrate. We're a family that calibrates with my son. If you do not calibrate, the second it comes on, it will dump Low to low, and it will die. You have to calibrate my son immediately when it comes on. And then you're good for the first two days. You have to calibrate on the third then we have to calibrate on the eighth every other fingerstick that we do every single morning this this consistency. And every single night before he goes to bed is normally within five points.
Scott Benner 13:30 But you still do it you still do it every time.
Jeremy 13:33 You still do it every single time. Yeah, you have to the center will die. We've we've heard you know Kevin Sayer Come on, and say that it's just it doesn't work the same way for everybody. We just figured out what works for us. And with a very accurate Dexcom rating from a very, you know, accurate glucometer you can stop the garbage in garbage out. And what I mean by that is only testing the blood sugar and checking Dexcom whenever the side arrows sideways and making sure you understand how the Dexcom works.
Scott Benner 14:17 So that the numbers you're working with are good or accurate so that you can end up making good decisions with Ardennes interesting artists decks, either works, boom, or it's needs to be calibrated on the first day. Yeah, one of the other. I don't, I don't I haven't seen a rhyme or reason to it. I would tell you the last six of them we've put on I haven't had to do that. And then before that a couple of them need lit people's body chemistry is different. There's all kinds of different things going on. But your your your specific point is so incredibly important and valid which is you are making decisions, measuring a medication based on a number and you might be getting that number with a meter that's not accurate. or to CGM that's not accurate. And then you're making decisions and, and running forward. I love that you test twice a day.
Jeremy 15:07 But here's the bigger picture. Scott. Yeah, you keep saying that I'm making decisions. Now putting algorithms and control, right? You have bad Dexcom readings, you it's 100 points higher. And it's dumping more insulin than it should. Garbage in, garbage out, you have garbage information going into the algorithm, you're gonna get garbage out. So it is very vitally important to make sure that you have a Dexcom rating that is reliable. Yeah, this is this is this is all algorithms. This is Omnipod. Five, this is control IQ. This is going to be control IQ. 2.0. Whatever else comes out from Medtronic, you know, everything is based off of that blood sugar reading. And if it's not accurate, how can you expect your results to be accurate? They can't,
Scott Benner 16:02 and you have to take some responsibility for that yourself.
Jeremy 16:05 Yes, yeah, absolutely. Yeah, there's, um,
Scott Benner 16:08 can I think a tiny like, brief little sidebar here on the Sure. I'm forever interested when longtime type ones come on, and they'll say things like, I didn't want to get a CGM until there was no calibration needed. Because it's always the inference is always that it's such an inconvenience, like, why would I take on this new thing, if it still needed my effort? And I think that's an old timey way of thinking about it. You know, I think that I mean, a CGM for my daughter is first, right? Like seriously, if the house was burning down and I could grab a pump or a CGM on the way out the door. CGM, right. Not to say that it's a one of the other decision. I'm also of course, a huge fan of the pump. But But my point is that is that the idea that if it's not completely nothing, I have to touch ever or nothing, I have to think about that. I don't want to do it. I don't understand. You know, like, this is just, this is where we're at with this technology. And, you know, using Dexcom G sixes, as an example, you know, they tell you, you don't need to calibrate, that means they got it through the FDA, and you're gonna be okay. If you don't calibrate, but you that might be that one day, the thing thinks you're 130. And you're, I don't know, 150? Or you're exactly your ad and it says you're one I don't know, like it might not.
Jeremy 17:33 Here's the thing, though, Scott, is that if you want better than average control, right, you need to have better than average information going in effort. And in order to get that better than average information going in, you have to calibrate. You hear people all the time saying, oh, Dexcom is 15 minutes behind, not if your line is straight. Not it? That's only whenever it's falling or rising. If it's if you're primarily straight, and I know and I will get into this later, that I'm not saying my son is straight all day long. He is not he is just like Arden. He has trips to 180 Maybe once a day, and he comes back down. I am not one of those people that that craves a absolutely straight line. I do not go nuts. I just don't allow it to get nutty. In the long run. Yeah.
Scott Benner 18:32 But your point is, is that when you're in the middle of stability, and your the blood sugar is 96 and it's been 96 for the better part of three hours. If you're there's a way to be certain that that's true. And by checking checking with a finger stick and then telling Yes. And then calibrating sometimes,
Jeremy 18:50 and that's first thing in the morning when they first wake up. Okay, that's how it's working last a water. Check your blood. He knows every morning glass of water, check your blood. Water gets blood moving, and he doesn't have anything impacting his blood sugar. Dexcom should be pretty straight on.
Scott Benner 19:07 Yeah. And it is normally. Oh, yeah, yeah. Okay. Yeah, it's
Jeremy 19:12 like within five point if it's within five, we don't touch it. If it's within 10 Like if it's 10 or more, we're calibrating and that's both. That's way sorry for the swearing. That's that's just it's not acceptable. And I know that may sound extreme, but it's not. It really isn't
Scott Benner 19:32 from your from your experience. What's my question here? This is just proving out to you over and over again. Yes, but it is not wait Dexcom would tell you to do is that correct?
Jeremy 19:44 Absolutely not. Okay. I'm just like, you know, dumping more insulin on your kids 30 minutes after he just ate is not what an endo would tell you to do. So I guess moving On more to like the pump, the next thing that you kind of have to remember is that you have to understand the pump that you're on. Doesn't matter which pump it is you have to understand how it works, especially if there's an algorithm involved. Control IQ is not a miracle machine, like a lot of people think. Adjustments still have to be close and made and sometimes made often. But you start looking at the tandem, and I don't want to start sounding like a tandem shill, but I am. The big things with tandem is that you can adjust basil in point 001 increments after point one, like Omnipod, or Medtronic can do point 05. That's a 50 times increase in adjustability. And we all know how much Basil is how in basil, how important Basil is something that a lot of people don't know is that the on a tandem? The carb ratio, if it's under 10. You can adjust it by point one instead of one. Yeah, if you have eight isn't working. And nine is too strong. You can do 8.1 8.2 8.3 8.4 A point but you can do by point one to dial in that carb ratio. Okay. Once again, this comes back to consistency. You need it. You can't just flop on either. Or if nines too strong. You can't say Oh, well, I'll just, you know turn their basil down for a half an hour. No, get it right. I mean, let's be honest, our kids normally eat the same thing every morning at breakfast. I try to offer him a million different things, but it's always pancakes with chocolate chips, strawberries, and milk. Wow. Every single morning. A lot of cooking. Well, we always get those frozen. Okay, okay. So pancakes.
Scott Benner 22:09 Oh, I got in your mind Jeremy. You're whipping up pancake batter and cutting up strawberries? And no. So so back to that other point. You're saying that, like for instance, Arden's carb ratio is one to four and a half, but it could end up being one to 4.7 instead, yes. Right. And you have and
Jeremy 22:28 it will, it will allow the tandem will allow you to make those 10th adjustments if the carb ratio is under 10. And you may think, Oh, well, you know, that's just being too picky. Well, no, like, whenever carb ratios get below 10, they get crazy. You know, my son is 13. He, according to his Endo, I don't really understand it. There's four stages of puberty. And he's in stage three, and he's peaking right now. And he doesn't understand how he's still less than 1%. Low. And it's, you know, he doesn't understand how he's 5.6. And he doesn't understand a lot. But, you know, the proper pump adjustment is one thing, you know,
Scott Benner 23:14 yeah. So these, all these little things put together. Are the assets are the answer to stability, right? It's the Yes, making sure that the data you're working off of is sound. It's not just randomly picking an amount of insulin, but actually being able to dial it in very closely. Yes. And it's consistency with how you are addressing low blood sugars. Its consistency with drinking that glass of water in the morning, before you test your sugar. Like all those little things, do you find them to be overwhelming? Or do they just happen? Pretty?
Jeremy 23:48 No, they have they seem a little at first, and I've had a few parents tell me Well, that seems like a lot. I'm like, No, it doesn't real after about, you know, a week, you'll be like, Oh, this makes sense. And the families that I do help, you know, and that they do get this way, you'll see like a huge improvement. They go Oh, I get it now. Okay, because you'll start seeing those improvements. You know, it's not just in the pump, or the algorithm. It's how you're treating everything else.
Scott Benner 24:19 So when you hear when you hear me say that more effort upfront, saves you a ton on the back end. That's how Yeah, yeah.
Jeremy 24:27 Yes. And but the thing is, is it doesn't become a lot of front, other than the first couple of weeks while you're getting used to once you get it. You're not being strict. You're not forcing you know, I'm lucky as hell that my son loves apple juice and he's never become bored of it. I asked him like every other month or so. Hey, do you want to try something else other than apple juice? Yeah, he goes, nope, I'm good. Yeah, but, you know, boys,
Scott Benner 24:53 etc. Sometimes Tell me if this sounds familiar, you're all set up with a diabetes supplier. And they've told you don't worry, we're gonna send you your supplies on time, you're never gonna have to call us again, this is going to be easy. And then one day, your stuff doesn't show up. You run out of your Dexcom supplies, your libre supplies, your insulin pumps, and the new ones aren't there the way they're supposed to be. So you call them up on the phone? And what do you say? Well, I don't know what you say. But here's what I say when it happens to me say you guys told me this wasn't going to be a problem. They say is this always happens at the end of the year? Well, we needed a new prescription. And we reached out to your doctor, but they didn't get back to us. Then there's this long pause. Like it's not their fault. The people who told you they were going to take care of this are now foisting the blame onto someone else. What does that mean that they reached out to your doctor? I don't know. Does that mean they send them a fax? They call them on the phone? They send up smoke signals? I couldn't begin to tell you what my old suppliers did. What I can tell you is what US med does. It's simple. They get it done. There's no Nunna boom. Not supposed to curse stone. Yeah, it's but you hear what I'm saying? You asked med tells you they're going to take care of it. They're going to get a script from your doctor, then they get a script from your doctor. That's simple. US med takes over 800 private insurances. They accept Medicare nationwide. And they always provide 90 days worth of supplies with fast and free shipping. carry everything from insulin pumps to testing supplies, CGM, they have what you need, all you have to do is go get your benefits check at us. med.com, forward slash juicebox. If you don't like the internet, you could also call 888-721-1514. Well, now we know where you're going to get your blood glucose meter at. But now we need to decide which one are you going to buy. If you asked me, I'm gonna say the one that my daughter uses the Contour Next One blood glucose meter. I have no copy in front of me, I'm not looking at a website, let me just tell you why I would pick that meter. First thing that pops in my mind. It's easy to hold easy to carry, easy to put in a bag, or a pair of pants, or wherever you carry your stuff. And I mean, like a pocket. It's small, but not too small. It's easy to read has a bright screen and a bright light for nighttime viewing. The test strips allow Second Chance testing, here's what that simply means. Should you touch the blood but not good enough, you can go back and get more without interfering with the quality of the test result. And that is not to say that it needs a lot of blood, it actually doesn't need very much at all. The sample size I find to be very small. This is in fact the easiest to use, handiest and most importantly, most accurate blood glucose meter that my daughter has ever used, that I have ever used, that I have ever been in the same room with the Contour Next One blood glucose meter, go find out more about it. At contour next one.com forward slash juicebox. When you get there, you're going to see a very informative website, and easy ways to get yourself a great meter. It's actually possible that the meter and test strips could be cheaper in cash than you're paying right now through your insurance for your current meter. And there's very little chance that that meter is as accurate as the Contour Next One, there's only one thing left for you to do. Go to our browser type contour next one.com forward slash juicebox. You will also find links in the show notes of the podcast player you're using and at juicebox podcast.com. And by the way, if you're listening in an audio after this podcast, please hit subscribe or follow. Alright that's it for the ads. Let's get back to Jeremy he has a lot more to share about how he uses control IQ.
Jeremy 29:08 The biggest thing is like we're talking and once again about pump adjustment is you'll hear often people will tell you to adjust Basal by 10%. That seems to be a pretty standard adjustment. But I always tell people not to and here's why. Let's say your kid is point seven five an hour and you add 10% to that. The math to that is it will end up equaling out point eight to five I believe and that will be a difference of point 075 You're adding point 075 When adding 10% 2.75 So then they're at eight to five, which tandem doesn't have a problem doing it can go out to that Also remember, so eight point or sorry, point eight to five plus 10%, they need more, another basil increased, you're now at point 907. And that's a difference of points 082. So you've went from an increase at seven, five of point 075. And you've now increased Basal again by point eight, two, or point zero, a two. Then from 907, you add 10%, you get point 997. Now you're adding point 09. It's not consistent. Every single time, whenever I first started out, I, the best thing like the CD could have told me is every single time or she kind of showed me on an AGP report. And I'll kind of talk about that a little bit later. But every time you see a change here, I want you to just change the pump by point zero to five. That was my quote, baby step. That's what she called the baby step. But it consists and then okay, but it's consistent point zero to five, because you will know what point zero to five does. If it keeps increasing, because you're going by 10%, there's no consistency there, you're adding more and more and more or taking away less than less. Currently, point 025 is a huge jump for us. Once you get basil dialed in enough, I literally move my son's basil by five 1000s of a unit of basil per hour. I know exactly what that does. And it's normally nine out of 10 times enough to get him perfectly back in life. Wow. If you take our Dexcom, 90 day AGP report it is a straight line with very little variation. And it's all because of the consistency it's knowing what that point 005 Or a point 01 change in Basal will do and keeping it consistent.
Scott Benner 32:11 How often do you think you change this base or it
Jeremy 32:15 um, so I changed them two days ago, before that I had not touched them in a month and a half to two months, even in full bore puberty. And he's still his average blood sugar is still down there very low one hundreds. And as best he is in the mid 20s. That's excellent. And I wasn't able to I once you get dialed in and you fully understand how to keep things consistent. things stay consistent. Now I understand there are people in honeymoon that does not apply to you. There are people that you know, have sports does not apply to you while my son is active. That's it. A lot of it's about knowing how to treat before sports before jumping on the trampoline before doing all this other stuff. He knows like before PE because he's moved into independent at school. He knows before PE he goes and ask the teacher Hey, what are we doing today? And if it's something like we're playing dodgeball, or we're running the mile he knows to grab, you know, something out of his bag, and get some carbs move it. And that's just more consistency. But let's you want to get into control IQ. Yeah. And actually,
Scott Benner 33:34 no, I appreciate your overview of how you think about it, though. Yeah, I mean, really, that's very helpful to me. Because I mean, you'll admit, I would imagine, maybe you won't, but you listen to the podcast. So you're thinking at this. I think you're taking, like, things that I talked about, and you're being more granular with them much more so than I ever am. Yeah, and and you're fine tuning things down even farther, like you're, you keep tightening that that wrench until it's exactly where you want it to be. It's It's amazing. I mean,
Jeremy 34:08 but the thing is, like I said, is that once you get there, you don't have to do much work once it's about learning the patterns and staying consistent, right? And looking at the ADP report at least once a week and saying, Oh, look at that. I might want to scooch that up a little bit. Instead of just oh my god, what's going on? It's like, one day, it's just random. If it happens two days for me there needs to be a change. If the third day it's still not right you're gonna get changed again. You know, something's gonna change you don't my
Scott Benner 34:43 bigger takeaway from this is that wherever you are. You're not too far. Why do I how do I say this? Hold on. Let me think Jeremy. If your management style keeps you at a 200 blood sugar and suddenly your blood sugar tries to jump to an average to 10 blood sugar, you don't have to manage much to get back to 200. If your average management keeps you at 150, or 120, or 110, or at whatever your management style is, once you're there, and you can accomplish it, even when other variables come in and try to move you off of your success, the adjustments to come back to where your norm is, or not these great, crazy things that need to be done. Is that the thing you're telling me? Yes, okay. All right. I agree. Okay. So,
Jeremy 35:33 yeah. Let's talk about algorithms, and how, how at least control IQ works. Because I often see in post, people saying, way, way wrong things. And I often want to correct them, but I often come off as a jerk. And oftentimes, Scott has to get on there and say, Oh, well, Jeremy is a really good guy.
Scott Benner 35:58 Boys are not well, sometimes boys are not good at communicating and writing
Jeremy 36:02 No, no, no, absolutely not. So the first thing that you need to know about control IQ, is there's three different modes, there's normal mode, there's exercise mode, and then there's sleep mode. We do not we're not sleeping beauty, we do not use sleep mode, 24 hours a day, there's a lot of people that swear by it, but my endo would come unglued. And I'm just not going to deal with it. Our results are fine, we don't have to go there. So in normal mode, this is where control IQ is at 90% of the day, if you're using control IQ as it should be. I'm not saying it's the right way, because there's many ways to skin a cat. So in normal mode, control IQ will target 112.5. I know that's a weird number, but it is a real number. However, we'll adjust the Basal based on predicted blood glucose levels. 30 minutes out that six readings. Now, if you're maintaining between 112.5 and 160, it will deliver the settings that you yourself or your Mo has put into your pump, nothing changes, it's not doing anything but running off the settings inside your pump. Now, control IQ will increase Basal insulin. If the sensor glucose value is predicted to be above 160. In the next 30 minutes. Once again, that six ratings it looks it says okay, they're moving by plus five the deltas moving by plus five every five minutes. If I apply that six readings out, are they going to be above 160? Yes or No? If yes, it's going to start increasing the Basal. Now control IQ will decrease Basal insulin delivery. If the sensor glucose is predicted to be below 112.5. In the next 30 minutes. Once again, six readings out if you're 180 and you start dumping by 20s It's going to start you know cutting insulin control IQ will stop all Basal insulin delivery if the sensor glucose level is predicted to be below 70 In the next 30 minutes. So if you're dropping hard, and if it depending on how fast you're moving, if it thinks that you're going to be below 70 In the next 30 minutes, it will cut all insulin. Oftentimes, you have to you have to understand that when setting your Basal that while it's important with control IQ, insulin sensitivity factor is just as important as Basal if not more important than Basal with control IQ. Okay, because the pump uses the ISF or the insulin correction ratio or the correction factor. However you want to say it to determine how much insulin to increase or decrease when making its modulation to the Basal. So what I like to tell people is to think of it as an aggressiveness knob. If you're seeing big cycling, which means the start to go high and then the you start to go low and you're kind of riding a wave all night long. What that means is that you've actually got two wrongs, which looks like a right. While it's fairly steady, you're cycling and what will happen. This happens I know with loop a little bit too. Not sure if Omnipod five yet, but what happens is if you get the Basal a little loose, you'll start drifting up, then control IQ will say, Oh, they're drifting up, we need to add more insulin, then the ISF is a bit too stiff, and it will start sending you a low and you will cut insulin, and then you're stuck in it. And then you'll start going high because of the kind of insulin and then you'll go low because you end up cycling, bouncing. Yeah, so what looks normal, might be two wrongs look like a right. So and that's the biggest complaint is that Basal IQ cuts them slim, then they go high. And then they overcorrect. And they go low, right. So your pumps already trying to handle it. And you're not allowing it to because of your settings.
Scott Benner 40:47 Are you saying that this becomes obvious when you see basically the settings fighting with each other? There, there's,
Jeremy 40:54 they're not fighting each other. They're just wrong. They're wrong, but they're not fighting each other. It's just the algorithm responding the way that it was designed to respond.
Scott Benner 41:06 And using those headings, it makes you it makes you a little too low, it cuts itself off, which makes you too high, it gets aggressive again, which makes you low. And you're saying that if these two settings were more in line with what you actually needed, there'd be this stability where there'd be some insulin, but you wouldn't be taking it away and then adding extra and taking away and adding extra time. Yes. Okay. And that process of take even though the algorithm can keep up with the problem, mostly taking away giving back taking away giving back, that is not your goal.
Jeremy 41:38 No, absolutely not. Okay. So we kind of went over what normal mode looks like exercise mode, in my opinion, my opinion, is completely worthless, unless you're thinking two hours ahead, and what 13 year old looks two hours ahead. The way it works is instead of targeting that 112.5, it will target 150 instead, it will still deliver correction doses, if you're predicted to be above 180. In the next 30 minutes, it will still increase Basal if predicts by the blood glucose to be above 160 In the next 30 minutes. It will decrease insulin even if it predicts the BG lower than 160. In the next 30 minutes, it will suspend. If it predicts your blood glucose will be lower than 80 in the next 30 minutes instead of 70. Like in normal mode. So if you know that you're gonna go on a bike ride in two hours, then yes, you can turn on exercise mode, and it will protect you and it's great. If you're running a marathon, you know, an hour and a half, two hours away to turn it on. It works great. But for a lot of parents, they say oh, it doesn't work. And that's because they turn it on right before their kid gets on the trampoline, and then wonders why Johnny goes low on the trampoline. It's not great for those kids, you know, and those families that are a lot more spontaneous. And you know, I don't know about a lot of people, but like, my kid has a full sized trampoline in the backyard, next to a huge 16 foot pool. And yes, he uses them together all summer long.
Scott Benner 43:22 Well, I think that it's funny, because while you're talking about this, I'm relating it to loop in my head. Yeah. And what I'm thinking is that when I see when I look at overnight, what I want to see is that Arden's Basal insulin is not being cut away constantly. And that there's no correction that correction bonuses aren't happening all the time. And I do want to say that things happen, and you want the algorithm to work. But generally speaking away from impacts, like you know, boluses food, you know, hormones, like it just that normal time, which God knows Jeremy, how often do the normal times happen, but in those normal times, you want your settings to just work there where they are, and the result is low and stable. Yes, yeah. And that low low, like normal and stable.
Jeremy 44:17 Yes. And then that moves us into that sleep mode that everybody raves about. So, really quick sleep mode will target a very tight range of 112 and a half to 120. While it's fun, but not deliver any correction doses whatsoever. It will however, be much more aggressive with increasing and decreasing the Basal once again that's where the insulin sensitivity factor comes into great play. You have to have ISF dialed in immaculately overnight, along with Basal but Thaman normally He gets down in that. Oh, 85 to 95 range all night long. From one week after starting control IQ I slept every single night. I maybe have one or two nights a month where he has the compression low, and an alarm goes off. Other than that, if it wasn't for my sleep apnea, I would sleep all through the night.
Scott Benner 45:28 85 to 95. Yeah, yeah. And you're doing that not in sleep mode?
Jeremy 45:34 No, we're doing that in sleep. Right? Excuse me, we're just not in sleep mode. 24/7, like a lot of people do. There's, there's a lot of people that that their life is very dense normally on older type ones, or type ones that have the very, very strange, strange, stringent routine every single day where everything's the same. We eat the same breakfast, lunch and dinner, we exercise at the same point in time, every single day, there's not a lot of variation, you're able to turn that 20 That that sleep mode on 24/7. And if you're these people that have those settings, set up just perfectly, there is no reason for control IQ to dump a 60% correction. Right? They do that themselves. They're already so in tune with themselves. Because they've been doing this for so long. That they're making no they don't believe that.
Scott Benner 46:33 Yeah, they're making they're making great Bolus is around food. They're not fast letting a lot to begin with.
Jeremy 46:38 Exactly. And so they they benefit from Sleep mode being more aggressive. And you know, when they're when they're awake, because they're they're not running away. You know, running 100 yard dash when like a 13 year old, sees a girl from half a block away.
Scott Benner 46:58 Yeah. Right. Or going from the trampoline to the pole back of the trampoline or something like
Jeremy 47:03 that. Yes, exactly. I say. From there, it's it's a lot of it is understanding Dexcom reports. And we're talking about clarity, if you don't have clarity downloaded on your phone, sign into it. There's tons of different reports. And yes, they look intimidating at first. Needless to say, the only thing that matters to me on on Dexcom clarity is that AGP report, it's the very last one, it shows you your average blood sugar at a given time throughout the whole day, then it has a blue bubble around it that shows basically, without getting horrifically nerdy shows you how variable you've been around that average blood sugar. And then from there, it's using those reports to make smart, educated, experienced decisions in a very consistent manner. To get better than average results. You look at the age gap report. And if you start seeing like on a seven day average, you keep raising every single day at 3:20pm. About an hour and a half before that will kick up. You should probably have a Basal segment there. It's about a lot of people will argue over two or three or one Basal segments in a pump. Yeah, my son has nine. Wow. And the reason that he has nine is because that's what he needs. And you look at a GDP report, like I said, I can pull up a 30 day graph and it's straight as can be. And the blue line is very, very close to that red, that red line in the middle. It's I don't want to say it's not rocket science. It's all with time and experience. And staying very consistent and understanding what each thing that you're adding is going to do.
Scott Benner 49:22 I'm pulling up Arden's AGP report right now so that I can ask you a question about it. Because what you said was to make you know, you talked about making smart decisions about changes but who tells you what those changes are like, what what about the report says something to you and says, you know, go ahead and you know, this means do a thing. You know what I mean? Like, like so I have Arden's last. It's interesting, right? I just, it just popped up her last two days. And she's not she doesn't have any hormonal impact and the last two days are much less. Her standard deviation cuts in half. If, when that happens, yeah, very, very interesting. It's it can go, it can be as high as 40. At times, with still an average blood sugar of 110 to 114. Yep, yep. And then as soon as the birth control pill she's on goes to placebo, her deviation goes into the low 20s. Yeah, right away. And that's just,
Jeremy 50:24 and I dealt with one other young, young, younger female, she was 13, that it was the same way. It just depending on what type of month it was, and we made those adjustments, and we made a different, you know, deal in the in the pump to deal with that time of the month. And we figured out okay, every month, she needs this much more three days before she's really regular. Let's, you know, treat this the way it should be treated, we know that she's regular, let's be brave. And let's start increasing that insulin the day before, we know we need it. But go ahead and go back to the GP reports.
Scott Benner 51:07 Let's talk about well, I got my glasses, but I'm, it's hard to put them on the console. I just got old out of nowhere a couple years ago. So I went back and I went to 30 days now. So the last 30 days, the last three weeks Arden has been trying. So I think everybody who listens knows like we're trying to regulate Ardens period with the birth control pill, it isn't going so great. But so I have her average glucose is 122. Over the last 30 days, she has been very low 1.4% of the time, which means under 54, low 6.4% of the time, which means 70 under 70. I don't particularly consider that low, but that's okay. In target. And the target, of course is you know, 70 to 180. For the report, I have AD Yes 83.4% of the time high over 180 10% of the time and very high point 3% of the time. Her coefficient of variation was 33 over the last month and like I said her standard deviation is 40. When you when you get all that involved now, in truth, I don't know I haven't looked back. I don't look at clarity as much as I should to be perfectly honest. So so when I look at this line that I'm seeing, it appears to be incredibly stable. Right around 100 110. For this last 30 days, I see a little bit of an uptick around 2pm that lasts until about six or so. So if she does get higher, she can go 130 or so in that timeframe. And when I do see the 180s it's in that exact timeframe, four o'clock, four o'clock, eight o'clock. Anyway, I don't know, what do I do with this?
Jeremy 52:54 So I focus on the red line in the middle, okay. And I kind of make sure that I understand that where meals are and that there is going to be a spike. But in that 30 Day graph lease, I normally make adjustments on the seventh day or the 14th. But the 30 tells a lot. It tells how long have you had this problem. And if and if you see on the 30 day graph, a slight uptick because I'm pretty I've seen AGP reports and I'm like holy hell, and it takes a good month to straighten that red line out like rubber bands. That doesn't mean that they're like that every single day. That just means that your average that's where your average is I don't care about day to day. Yeah, the median I care about the average over time because this is a marathon, not a race. And so if I saw on the 30 day graph, a slight increase at 2pm I would look at my son's pump, and I would say okay, that basil at 1230 Keeping in mind that his lunches that 1130 At school, I know it's not lunch, that's the basil issue to me. And I would literally go to 1230 an hour and a half before two and I found that all but one of the kids that I've helped her one of the families that I've helped every single last one of them it's been an hour and a half before the before the event on AGP. So I would go to 1230 and I would literally bump him if it's just a slight one I would literally bumped him five 1000s on his Basal, okay. And it will be at two o'clock it will hit and point 005 isn't enough to to drive them low. And then the next day if you look at it, you're like, Okay, it's still there. But if I did another point 005 It would be done. You know, and that's where I go. I don't get so granular that I go by the 1000s but I do go by the 5000s or the point one because I can look at a line and be like okay, that happened yesterday too. And at that angle or that Delta, the change in in blood sugar reading that that angle is going to need a point one instead of a point 005 It you know, you'll you'll get used to it, you'll you'll look at a line you'll be like, Okay, that's happened three days now. That's that's going to be a point one instead of a point 005. That's because you're staying consistent. And you know what point 005 does, or you know what point one does?
Scott Benner 55:32 Well, so that's
Jeremy 55:33 point 01. Sorry,
Scott Benner 55:34 now, so when I'm looking at this, looking at Arden's also, the other thing we're doing is it Arden is we're onboarding more and more responsibility to Arden as it gets closer to her leaving for college, a little bit of her practicing. And I think this is her doing a not great job of Pre-Bolus thing as much as she should for her launch.
Jeremy 55:54 So blow your mind. We don't Pre-Bolus at all,
Scott Benner 55:59 ever anymore. Because everything's so tight for you. Yes, and it doesn't matter.
Jeremy 56:06 It does not matter. Because the other thing that people don't think about is lots of people do. I'm not saying everybody but a lot of the things that people don't understand is they'll show me a chart. And they'll say, Well, I dosed correctly for this meal. And look, there's still 250 At the end of the day. But if you look at the line when they dosed, they were already climbing. And the thing is, is whenever you Bolus with any pump on the market, any pump on the market, whenever you Bolus for a meal, the pump assumes a straight line. If you hit Bolus, Ada carbs and hit enter. It's going to assume it tandem will automatically pull your Dexcom reading into that calculator. And let's say it was 150 it will assume that your blood sugar is 150. And completely steady. It does not take in and this this goes for Omnipod. This goes for everything. It assumes a straight line. So if you are 150, and you're an arrow up, it's going to under Bolus you. If you are 150 arrow down, you it's going to over Bolus you. So that comes back to like if you look at the meal and you you're having ADA carbs, your 150 and your let's say arrow diagonal up. And you're looking at the Delta and you're like Okay, so the delta is moving about point six right now. You have to think 30 minutes ahead. So okay, so 30 minutes ahead. At 630. That's six readings time, that's 30 points more, so you're gonna have to think okay, so I know my son's ISF is 55. So that looks like about an extra point seven units of insulin. So what I'll literally have him do is I'll say, hey, what does your pump say, to give you? And let's say it's it says to give him an even for four units just to, you know, throw an easy number out there. I'll tell him, Hey, can you change that to point or 4.7, please, because he's going up, the pump doesn't know he's going up, it assume sees 150 in a straight line. So you add that extra insulin based on time, you're not going to have the time they want even spike. It's understanding that that pump isn't going to deliver based on the change of Delta before meal. And I hope that's not too. too nerdy.
Scott Benner 58:57 No. Are you kidding? That's why you're here. What are you talking about? That's exactly why you're actually I've also, I didn't realize that in clarity that we had settings before the reports set where I don't care about them. Like, like I want to me a high blood sugar's 140 That yeah, that's what I mean, that's what I'm looking for.
Jeremy 59:26 So lots of people don't have that setup. correctly. Now I understand your idea of a highest 140 And there's a lot of us that you know, that is how it is. I prefer clarity to be set to 70 to 180. Okay, and I know that you know, tell me why everybody here everybody hear me out here is Ada standard says 70% and time between 70 and 180 with a SD are a standard deviation of less than 1/3 of the average BG, that is your target. And here's why I use that in clarity to make people understand 72% Of all type ones do not meet that very, very loose standard. And I need people to understand that whenever it's said to somebody to 180, I can say, look, you're 83% in range right now, between 70 and 180. Remember, 73% of all type ones, don't even get that ever, you're doing so much better. Yeah. And if you set it to 140, that's great. If you can get it's like, it's 80% in range between 70 and 140. That's more work than I care to do.
Scott Benner 1:00:49 So I just changed it. And I did it for the last 90 days. And in Target Range 83%. So, you know, so right
Jeremy 1:00:59 now, like Thaman, let's do the 90 days, average glucose of 127. Very low point, one, low 1.3%, in target 91.3, highest 7.4. And very high at 0.6.
Scott Benner 1:01:21 That's interesting, our, our high and our very high are very similar. And our targets very similar. That's interesting, because
Jeremy 1:01:26 we don't put up with it. And we look at things before they happen, and we take care of them before they happen. It's trusting what you know is going to happen is going to happen. And making sure you do something about it, you know, don't just I mean, control IQ. Like I said, no algorithm is perfect. Yeah, if you just think that you're going to turn on control IQ, or Omni pod five, for that matter, or loop for that matter or any other algorithm and just be able to set it and forget it, you're sorely mistaken is not going to work out what control IQ does for me, is it provides sleep every night. And a reduction in the time that I have to study things. And the amount of changes I have to make by a better fold of 90%, I still have to do a little bit of lifting. But that's like I said before that comes with with time and experience and understanding how insulin works in your or your child's body and taking things in a very consistent manner. Once you understand how that point, you know, one change and basil is going to hit and you're accurately able to change basil? Or are you correct a low blood sugar in a very consistent manner, things become so much easier because you understand what the impact of the insulin or the carbs are going to have. And your outcomes are going to be more precise and better done. Now, this, I know it sounds like I'm being like so strict, and everything else I'm not. It's just understanding it. And like once I understood it, and I got everything dialed in, I do even less work. Because I've done figured it out for my son. And I've done figured it out for these other people that they can just go on cruise control. And we know that whenever a change in Basal needs to happen, or a carb ratio change needs to happen. It's not a big deal. Make the small change to make the impact and let it go. If it happens, again, make that small change again and let it go. It's not a big deal.
Scott Benner 1:03:42 Right. I think I think what you're saying has far reaching implications to not I mean, is this specific situation you are really motivated guy who's incredibly smart and tuned into this. Obviously, listen to a great podcast that got you going and you've just run with absolutely, yeah. I'm joking, but I'm not joking. I think the podcast is terrific. But you know what I'm saying? So, but what I'm going that is that everyone doesn't need to do it at the level that Jeremy's talking about to get the benefit of the of the big picture of what he's talking about. Because I feel like you're I almost feel like I'm hearing my voice come back through you on a lot of a lot of points about you know, stay involved. You know, pay attention. Don't settle for high blood sugars don't over treat low blood sugars like this. Some. Those things are just universally true.
Jeremy 1:04:38 Yeah. But when those things happen whenever you do give too much insulin or you're too bold, don't let that be afraid. Just that is something that happened. And as long as you say okay, that happened. Let's move past it and keep going and don't get scared with it. If you over treat a lot When he goes in your child goes high. That's okay. That's one high in the time of their life is a marathon, not a race. Don't beat yourself up. I see all these parents beating themselves up that. Oh, well, we overcorrected. And now they're high for the next three hours, and I corrected three hours ago. And it's like, Stop, just stop beating yourself up, take care of it, drop it, learn from the situation and move on. Right, your mental health as a caretaker, is just as important as your child's health. Yeah, do not allow your child's diabetes to take control of your mental status. I mean, I ended up having to go on to Paxil, just to deal with the anxiety. I ended up in the hospital with heart attack like symptoms and ended up being stressed and anxiety. Learn what you can, so you understand what's going on. keep things consistent. So you have consistent outcomes, make small, impactful decisions and drop things that don't work. If it happens one day, it's random. If it happens more than once, change something, don't wait. And then because you get just the third day, it happens, you get frustrated. The fourth day, you start feeling down that you can't take care of your child make the change. And if it's something small, just just try one small thing, and then go okay, that kind of worked. Let's do it a little bit more, and work your way up to being able to do things by yourself, but don't allow this disease to overcome yet.
Scott Benner 1:06:41 Let me let me get some clarity on something you just said. So are you saying that prior to you understanding all of this, the stress was a lot is the stress still there now? No, no,
Jeremy 1:06:52 we live life man. Yeah. So they know everybody. There's some people that say, Oh, your son may not must not be doing anything. The dude, this kid is more active than most. He's not in any sports. He is. He's a nerd like me. He's in all honors classes. He has straight A's. He's in the National Honor Society. The kid, I can't even help him with his math homework anymore. The kids smart is wet. But he is still active. He goes for bike rides, he goes jumps on the trampoline, he wins. He runs around with his brother and sister. He does all types of very active things. He goes to the jump Park. And we do this spontaneously. We don't do it in fear go, oh, well, we're gonna go swimming tomorrow. Oh, guy can't wonder wonder what's gonna happen with his blood sugar. No, take extra carbs go in there, give him some extra cardio before he jumps to the pool. Let them have fun. Let's go. Let's live life. I know it's terrifying. But the thing is that you got to try. And if it doesn't work the first time try again. I think a lot of eventually something's gonna work. Right.
Scott Benner 1:08:03 And I think a lot of the mental comfort that comes eventually is from seeing things happen that you expect. And yeah, and paying attention to the beginning to these things. Your Basal if you're on it, you know, if you're on an algorithm, even more so for insulin sensitivity, but still on just a regular pump insulin sensitivity, carb ratios, correction factors, you get those things close even, and things get better. And then once they're close, then you can kind of see them a little better, that it's not so wildly out of tune that you have to guess. I know that all sounds like Yeah, sure. That sounds easy. How do I do that? I mean, you know, I mean, I've talked about it a million times in the podcast, I think the way you do it is by getting your basil right? First, then start worrying about your meals, your ratios, and then start thinking more about different impacts and different foods correction factors from there, etc. Like, you do have to it takes time to get it straight, you're not going to just your doctor is not going to magically set your settings in the right spot. And even if they do, even if they get like, slot machine lucky, you know, the kid's gonna still grow or you're even as an adult or going to gain 10 pounds or lose 10 pounds or start walking more sitting more and then suddenly those settings aren't right anymore. It takes it takes paying attention. I think one of the most important things you said here's, you know, you got to take a little responsibility and, and put a little effort into it, you know, and not the kind of effort where you're just like I'm trying I'm trying but like focus the effort that that may lead to
Jeremy 1:09:37 a lot of educating yourself properly. Then understanding what is actually going on inside of your child's body and understanding what your body, their body, how their body is different than yours and understand how food digests differently in your body compared to the Here's the other chance to wear index calm do it. Scott's done it, I've done it lots parents have done it. Once you understand what it's supposed to look like, it becomes so much easier to do it yourself.
Scott Benner 1:10:12 And it's a little more relaxing to you know, we see 140 blood sugar for two hours doesn't feel like you've, you know, made some pain for failure. You just realize that that that happens to a lot of people, you know, everyday people would fully functioning pancreas is that are working perfectly. Still see elevated blood sugar sometimes. I mean, I had to eat pretty hard to get my blood sugar to 160. But I still was able to do it with a nerf pizza. You know,
Jeremy 1:10:40 I like crap. And that was not an issue with me.
Scott Benner 1:10:44 That's interesting. Yeah, I had to eat so much just to hit 161 time. Other than that, I was eating cereal like, like, I don't know, if you remember at one point, I took two different kinds of sugared cereal, mix them together in the same bowl and eat them. Yeah, my blood sugar did
Jeremy 1:10:59 I think it was what sugar smacks in Fruity Pebbles pops or
Scott Benner 1:11:03 something like that. And my blood sugar never even went up. I was almost disappointed by it. I was almost like, oh, you know? But anyway, geez, Jeremy, this is great. Like, how long do you think it took you to figure all this out put into practice.
Jeremy 1:11:18 Um, slowly over the course of about two years, I was about 80%. There over three years. I was like, completely relaxed. And like, it is what it is. Let's fix it move on. And was able to just look at things a lot smoother. Now there are those families out there, though, that have those Alpha moms that I love to death. Because whenever they get a hold of me, and I'm like, what do you do for a living and they're like, I'm an accountant. I'm a numbers person. Those people and literally, it takes me two weeks to figure them out. Explain what's going on. And they move right on their way. And they still have you know, under seven agencies to this day. I was that person. I am a type of person that while I was the kid that took the VCR apart and put it back together and it still worked missing three parts. I need to understand what's going on. I'm just one of those people. And I really dove into it. Especially the biology part of you know, what happens in what what why is his body so much different than mine? And why is it doing this? And understanding what the tug of war as you describe it? What can I do on each end of the rope to pull harder, pull less or get it right, you know, that's making small concise adjustments.
Scott Benner 1:12:57 Well, I tell you while we were talking, I adjusted Arden's basil. So I looked, I looked at that clarity report and I thought this, like this a one C that I've been okay with, which is her right around a six because she's making more decisions and, and choosing Bolus and things like that on her own. Without too much input right now, I thought, Oh, this is a reflection of that she's, I don't know that she's, you know, just kind of finding her stride with it. But then when I looked at that report, I thought, That's not fair. Because I have a lot of stability, away from food, that's still a little higher than I want it to be. So I just changed her basil from 1.1 to 1.2, just to see what would happen. And I'm gonna I'm gonna watch it over the next day or so and see if I, if I can find some consistency. Maybe we have incredible consistency. But to find it a little lower, would be interesting. And then I think that'll probably help with the food too. That's happening. The food impacts that are happening, like I said, between probably around 132 o'clock and six, seven o'clock in the afternoon. So I appreciate you making me think about it. So I get busy sometimes to get an amen.
Jeremy 1:14:06 Yeah, and I mean there are and that's that's just the basis of it. There are other things that I do that are more on the ninja level then. Then just the standard stuff. I don't expect people do that like stuff like understanding like, my son eats the same food at the same time every morning during the weird weekday. So what I literally do is I will just like you know, you would I purposely make his basil, a little stronger, about an hour and a half before he eats on a weekday. That's my Pre-Bolus That is not normal. I don't teach people that but the thing is, is like I know that at school, his lunches at the same time, every single day, right? Yeah, and you can't get this kid peanut butter and jelly sandwiches with a bag of chips, a Diet Coke and some strawberries. You just can't get that kid off of that meal. I offer him all different types of things grandma puts in different types of things. It all comes back to peanut butter and jelly sandwiches. This is what I want. Maybe he'll have some pistachios one day.
Scott Benner 1:15:20 So you're upping basil as a Pre-Bolus. Knowing that these meals, these exact meals are going to happen over and over again at the same exact Yes. Okay.
Jeremy 1:15:29 Because it's it's, it's literally, you know, knowing or expecting, you know, the day I'm saying I'm getting frustrated. But expect what you know is going to happen is going to happen. Oh, okay.
Scott Benner 1:15:43 Yeah, I probably should have come up with a saying that was easier to say there. But well, yeah.
Jeremy 1:15:47 And then, like the only variable I have is after lunch and seeing immediately going to go outside and start chasing girls around, or is he gonna stand and do nothing? Yeah. Because Jesus, like, you like the end like, Dude, why are you dumping? And he's like, Oh, I ran around and chase girls at lunch. I'm like, Dude, if you're gonna do that cuts some carbs out of lunch. If it's 80, carbs covered 50 carbs. I don't think you can chase the girls all day long. Jeremy. I
Scott Benner 1:16:22 don't think he knows till he sees them.
Jeremy 1:16:24 Yeah, exactly. I know.
Scott Benner 1:16:27 That's amazing. I appreciate you doing this very much. Is there anything else that we should be adding to this thing? Because I'm going to ask you a question. At the end, I just want to make sure you've got out what you want to say.
Jeremy 1:16:41 No, I don't I mean that that's a pretty good understanding of control IQ and how I do it and how I teach people to do it. And how we how we adjust things to live a more, I guess, productive life while having great blood sugar's and not having to worry all day about diabetes and more.
Scott Benner 1:17:10 So okay, so if I were to come to you, and I'd said, Hey, Jeremy, I use Control IQ. By the way you do this out of the goodness of your heart, you help people?
Jeremy 1:17:20 Yeah. And once again, not an invitation to start messaging me Do not I got four families on my plate right now.
Scott Benner 1:17:29 It's about enough. Jeremy's gonna job you know. So, alright, so Well, that's very kind of you to help people. So if I come to you right now, and I'm like, Hey, Jeremy, listen, I'm on control like you. But I'm seeing, you know, spikes at meal times that aren't correcting for hours at a time. And I'm getting some lows overnight. What do you look at first, you just pull it
Jeremy 1:17:51 from them? Is the seven day AGP report and they're pumped settings. No kidding. And then I maybe ask 20 questions about how what do you normally eat? When do you normally eat? What insulin do you use? Is bedtime, consistent on a nightly basis? What kind of activity does your child choose to have? Or that type of thing? Or do they are they on their period yet? If so, is it regular? Just the normal questions that, you know, either your CDE or your Endo? Or
Scott Benner 1:18:32 should probably be asking Yeah. And if
Jeremy 1:18:35 they ask those questions for a very specific reason, because it paints a picture, at least in my head of when I look at that AGP report. What am I actually seeing? Am I seeing basil that's way off from a kid that has no activity and eats five or six times a day nonregulated in time and whatnot? Do I have a very protein based diet? Do I have a low carb diet? Personally, Damon, he eats whatever the hell he wants whenever he wants. Most I've ever Bolus for in a single meal was 543.
Scott Benner 1:19:22 Wow. 543 carbs.
Jeremy 1:19:24 Yes, you go and look at these damn milkshakes at this. This burger shop that's up here. And they're just gigantic and they're like $17 and they have waffles sticking out of them and everything else and you look at it, you start thinking and you you're like, yep. And then we came to 547 after staring at it for about 15 minutes. And that's what we did and
Scott Benner 1:19:47 how much insulin was that for him? No. Sorry about what
Jeremy 1:19:54 it was. His carb ratio was six or six point Five at the time. Um, let's see here. I can divide by 690. Some odd units.
Scott Benner 1:20:10 Wow. Did a 90 unit Bolus? Yeah. And he wasn't low. Nope.
Jeremy 1:20:17 You know, did I have to hit it again about an hour and a half later when I knew the fat was going to kick in, because I trusted that I knew what was going to happen is going to happen. Yes, I did. Do you think control IQ is going to be able to do that? Or Omnipod? Five or loop or anything? No, it can't. You have to be proactive. Do it. override the pump. All pumps can be overrated, whether it has an algorithm or not.
Scott Benner 1:20:41 Yeah, Jeremy, I gotta tell you, if I had if I had a diploma for this podcast, you'd be the first one to get it. It's amazing. I would not have the nerve to give that much. I don't think and I'm pretty ballsy about it. Wow. That's, uh, I'm assuming most of his bosses are not nearly that large. But yeah, but that's a great example of
Jeremy 1:21:07 he sees like 100 car Bolus maybe once every other week. Dinner averages are about 80 to 90 carbs. Lunch is at 90 carbs. Breakfast is 65 Every single day.
Scott Benner 1:21:23 Hey, Arlindo had Arden just had a lunch. That was a salad. And then she asked for a bowl of vegetables. She had rice, basmati rice, corn, steamed corn and steamed carrots. And it's a pretty big bowl of, you know, a vegetables. And I think we bolused I know it was I know we picked 45 for the vegetables, which was the carriage the rice and the corn. And then I think the salad was even 20. So she got like 65 carbs for salad and vegetables this afternoon. And her blood sugar still sticking at like 120. So we missed a little bit on
Jeremy 1:22:08 that. That's fine, though that that's low glycemic food. Do you understand that? But I mean, you didn't to me, you didn't miss? No, it's like in my brain. Like, the 140 is okay. But I'm sure once you saw that you're like sticking a little bit. You either let Luke get a little aggressive on the on everything or you told her to take a half a unit.
Scott Benner 1:22:33 Yeah, I told her to add. I told her to add three carbs to her last Bolus, which is something you do and loopy you can't do in in some of the proprietary algorithms, which I think is if
Jeremy 1:22:46 you can do it in control IQ, you can add carbs to an old but I, I prefer not to do it. I prefer a straight overwrite. Okay, because once again, I know what half of a unit is. Now if I put three carbs in. If it's been more than one hour, since the last correction, it's also going to correct his blood sugar. It's going to add extra, or it's going to take away extra depending on delta. So I would rather say okay, I'm looking at his line. It's fairly straight. I know I OB says he has two units on board, but it's not real. So I'm going to hit him with a point font, because I know what point by dots, right? If I was to put three extra carbs in, it may give him point two, it may give him point seven, it may give him point six depending on which way the arrow is going, which how his blood sugar is going. If he's had a correction in the last hour or not. If there's been an auto Bolus in the last hour or not, there's so much very variability there. I'm not going to deal with that. I know what half the unit will do and what the half the unit let him go do we override the pump all day long every day? No, no, I don't either. It is so dialed in that you don't have to. But when you do, we do.
Scott Benner 1:24:14 Yeah. Hey Jeremy. I have to tell you i i know that after you talk to somebody the first time you probably Converse back and forth with them and text and things like that and takes some days and weeks probably to to adjust it right down. I found myself wishing we could record every interaction you had with somebody just to see how it happens. I know we can't but yeah, it that's the piece that's missing is that somebody like you remind people you work in a motorcycle shop. Is that right?
Jeremy 1:24:44 Yes, I'm I'm the marketing manager of a Harley Davidson dealership. That's I actually well, I'm actually from two dealerships here in town. We own a sister store. I ride Harley's I own Harley's I have a beard You're a typical biker with weird ass hair cut. And I swear a lot, I drink Mountain Dew a lot. And I talk about how fat I am all the time,
Scott Benner 1:25:12 it turns yourself into a pretty damn good endocrinologist. So yeah,
Jeremy 1:25:17 I'm not gonna go into our Endo, not gonna say that you're not going to work me into that. But I mean, the other awesome thing is like, I may be all those things, I may be a pancreas to my son and a few other kids and whatnot. But to me, giving back to the community is what really matters. And like, I am also a voting board member and a marketing director for the Montana youth diabetes Association, which is after the ADA camp, left Montana and left all the type ones high and dry. All the volunteers that have been going to that camp for since they were kids said, let's get a camp going and get these kids back to camp in Montana. Very nice. And so we, I'm giving back that way I have to, because the community has given so much to me, and my son's health, you know, mostly, you know, the podcast and you and everybody in the group that I have to give back some way that I can.
Unknown Speaker 1:26:27 Yeah, no,
Scott Benner 1:26:29 I understand feeling like that. I think you're doing amazing stuff to on top of everything else. And I appreciate you coming on here and sharing this with people because there's just no, nobody really tells you what to do. They just give you the thing, and then it works out as well as it does. And then they call that good. And, and that's where it stays forever. So
Jeremy 1:26:48 just understanding how the algorithm works and, and how it doesn't work and when to step in and when not to step in. And it's time and experience and not just sitting on things and doing things and trying things and failing and succeeding. And you know, you do something enough, eventually it's going to work out. Yeah.
Scott Benner 1:27:12 I agree. All right, Jeremy, I can't thank you enough for doing this man. I really do wish you would have named your kid Thanos because when you say his name, that's what I hear anyway. But that's not that's not your problem. It's mine. I'm glad he's doing so well. And that you're doing so well. It really is. It's a testament to what I mean what you can accomplish if you get good information and you want to put some effort into it. It really is astonishing. You know, I hope you're proud of yourself. Seriously.
Jeremy 1:27:43 I try Yeah,
Scott Benner 1:27:44 no really, man it's a it's really something that you've accomplished. So that boy might never know but I know and the people listening know so like I said I would I would send my first my first ever degree off from the podcast will go to you if I ever make one. Sounds good. Don't look for me to do that. That sounds like a lot. But I really I really can't thank you enough for taking the time to do this. Thank you very much.
Jeremy 1:28:09 Not a problem Scott.
Scott Benner 1:28:20 Well, first we want to thank Jeremy for coming back on the show and sharing what he's learned about control IQ. And then we want to thank us Med and remind you to go to us med.com forward slash juicebox or call 888-721-1514 To get your free benefits check thanks also goes out to the Contour Next One blood glucose meter. You can find out more and get started right now you can actually buy one right there at this I know you can buy one at my link contour next one.com Ford slash juicebox All right, everybody. Thank you so much for listening. What else should I tell you? Oh, there are many other episodes about algorithm based pumping. I have a list of them in fact, let me tell you what they are. Now what the hell we're all here together right? What do you do a big hurry to get back to your job? Let's just listen for another second. Okay, here they are. The first episode I ever done I ever done boy. The first episode The episode is going well. The first step the first start over. The first episode I ever did about an algorithm was looping it was episode 227 called diabetes concierge. Did one then called a loopy few months episode 252 Then episode three or four loop de loop Episode Three toe of Fox in the loop house part one episode 313 Fox in the loop house part two, Episode 326. We talked about the mini med 670 G, and an episode 420. Fox in the loop house part three, those are with Kenny Fox, all of those. In episode 537. Haley came on she's a tandem pump trainer. In Episode 601, we told the story of how I started looping. In an episode called Gina made me loop. Episode 620 was an exclusive interview with on the pod CEO called exclusive on the pod five interview. And of course today, in Episode 662, Jeremy breaks down how he uses control IQ, we're going to be talking a lot more about these algorithms in the future. So if you're enjoying these, go check out the old ones. And if you just got done with this and thought I'm not getting an algorithm to check out the Pro Tip series, and they will definitely help you pump without the algorithm. As a matter of fact, they'll help you pump with the algorithm too. But you know, I'm just trying to find a way to mention some more stuff in the podcast. I think you see what's going on. Alright, thanks again for listening. Your support means everything wonderful ratings and reviews pouring in for the podcast, downloads and streams are at an all time high. And all that means that you are sharing the podcast with someone else and for that I cannot thank you enough. It is the most important piece about how the podcast grows. 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 juice box that's better h e l p.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 juicebox I also want to thank Jeremy for you know even though this is the best of He really put his heart into this one it's a fantastic episode that just people seem to love over and over again. So thanks so much Jeremy we should have you back sometime. And let me thank touched by type one for their sponsorship and support and remind you to go to touched by type one.org and find them on Facebook and Instagram.
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Summary
Intro to the show. 0:00
Welcome to episode 915 of the juicebox podcast.
Nothing on the podcast should be considered medical.
Understanding insulin action and time of action. 2:49
Fear of insulin is the biggest sticking point.
Insulin action and time of action.
Tug of war analogy, insulin and carbs.
How blood sugar works in the body.
Take insulin and start to eat. 8:37
Rapid is a misnomer for insulin.
Rapid insulin is 100% in most settings.
Continuous glucose monitor, dexcom, continuous glucose monitor.
The story of a 17 year old boy.
Timing and amount of insulin. 12:12
Timing and amount is the first step to insulin use.
The importance of visualization.
Dexcom g6 continuous glucose monitor.
Share and follow features for android and iphone.
How to make good decisions. 15:38
Omnipod headquarters in massachusetts.
Request a free experience kit.
Dancing for diabetes and dancingthenumberfourdiabetes.com.
Making the first move is the key.
Diabetes is a science experiment. 19:22
Diabetes is a daily science experiment.
The pre-bolus piece is 80% of control.
I don’t count carbs. 21:28
Don't get mad, don't count carbs.
No accurate insulin to carb ratio set up.
The importance of the arrows in dexcom.
The least important aspect of dexcom is the direction.
What is pre-bolus and pre-basal. 24:54
Temper basal is a fraction of the basal rate.
Pre-bolus time is 20 minutes.
The importance of pre-bolus and extended bolus.
Pre-bolus vs extended boluses.
Trading bolus for basal. 28:08
The concept of super bolus.
Never suspend basal insulin.
Pre-bolus and multiple daily injections.
Sponsor, better help. 10% off first month.
