#347 Defining Diabetes: Bump and Nudge
Scott and Jenny Smith define diabetes terms
Defining Diabetes: Feeding Insulin. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
App is free & already on your iPhone ⤴
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Podcasts - iHeart Radio - Radio Public or their favorite podcast app.
Check out the Diabetes Pro Tip episodes and Juicebox Docs
+ Click for EPISODE TRANSCRIPT
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
This episode of defining diabetes is brought to you by Dexcom Omni pod. The Contour Next One blood glucose meter and touched by type one. Please visit touched by type one.org dexcom.com forward slash juicebox. My omnipod.com forward slash juice box or Contour Next one.com. To find out more about the sponsors. In this episode of defining diabetes, Jenny Smith and I will be defining bump and nudge. Now you know, Jenny, she's in all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. Jenny services are for hire, check her out at integrated diabetes.com.
We're gonna get started in just a moment. But before we do, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.
Do you have an absolutely spectacular endocrinologist certified diabetes educator diabetes, nutritionist if you know anybody who's helping you with type one, you have one like that, that you'd love to share with other people? Where are you looking for one that fits that description? Check out juice box docs.com. If you do JUICEBOXDOCS, it's a place where I'm collecting an amazing list of fantastic support for people with type one diabetes, it's absolutely free. If you have somebody great to add, check it out. If you're looking for somebody, check it out. I want to do bump in nudge as a defining diabetes. And I actually want to do it later as an add on to the pro tip series. But for now, this is just a small definition. Listen, I don't pay any attention to what other people are saying in this space, which is sort of part of how I've come to say things in my own way. I don't know if I made this up or not. I feel like I put these two words together. Maybe you know, I don't know if I did or not I think I did. But when I first started saying oh, you can just kind of bump or nudge. To me in my mind. Somebody asked me this recently. They're like, I've always been dying to know when you say bump. Are you talking about insulin or food? And when you say nudge, are you talking about insulin or food? I was like, Oh, that's interesting.
Jennifer Smith, CDE 3:05
I know how I think of it. But yeah,
Scott Benner 3:08
I bump with insulin and nudge with food. What do you do?
Jennifer Smith, CDE 3:13
So it's kind of funny, I bump with food. And I know.
I kind of think of it the opposite way. But yeah,
Scott Benner 3:23
so it doesn't matter how it occurs to you. It's the idea of, you know, staying between the lines on the road, right? Just, you know, the the way you'll hear me if if you hear me in public talking about it, I'll just say, you know, when you're driving and you begin to drift and you touch the yellow line on the right, you don't yank the wheel back to the left, because then you end up swerving into the other lane, you just want to kind of bring the wheel back almost an imperceivable amount and bring yourself back in line again. Yep. And that's how I think about blood sugar. Say I see a 110 diagonal up, I want it to be 90. And, you know, the way that that made sense to me originally was what I noticed, you know, in the beginning, was that it took a much less insulin to stop 110 and bring it back to 90 than it did to stop 150 or 200. And then when I started using more and more insulin that started creating lows later, which then created a need to feed the insulin right. And, and I thought okay, well, I'll just keep bumping it back down again. And then, you know, I was like, Oh, why am I always treating with 15 carbs? Like who who did that to me, you know what person said 15 carbs 15 minutes, you know, and that was such a long time ago doesn't apply to now I have this technology and someone works differently. Blah, blah, blah. So I started I started doing this thing where like, I don't even know how to describe it. Like I put the juice box in Arden's mouth. And when I was like, That's enough, and I'd be I'd be like, that's it. It's over. She didn't want it anyway. So she was cool with not drinking more, right? To try to nudge you know, a blood sugar that's falling. Just Just get it back level again, right. You hear people talk about You know, I use for Skittles, or they know like, you know, but but most people, once they rip the package open, it's that feeling of like, well, there's 15 Skittles in here, and I'm not wasting, I'm gonna eat them all, I prefer to you throw away eight of the Skittles, you know, but and so this idea of bumping and nudging is an idea of how to keep stability, you know, with your blood sugar. Now, when I developed that, you know, for Arden and then shared it on the podcast, I didn't realize there was going to be more to it moving forward. And that's why there is, if you're listening to this, there is a pro tip somewhere about bumping and nudging, you should go find it. Because if you find yourself bumping and nudging too much, something's wrong somewhere, right? So it's a great tool for variable days, you know, when things aren't quite going right, but doesn't, you know, I think of it, I use it mostly still around Arden's period, because I have settings for Arden, that when she's not hormonal, it doesn't look like she has diabetes. And the minute hormones come into the picture, you know, there's needs that change for insulin, but I don't want to go make all like, I'm not gonna make a across the board changed all of her settings. So that four days later, when her hormones like settle back down, like I don't want to go back and forth. So I find myself bumping more nudging more in those uncertain times. I probably just talked way too much about it. But I do really want to think about I want to hear about how you use it in your life.
Jennifer Smith, CDE 6:48
No, that's the that's the same I and I think it goes back to making sure that for the most part, your settings are well set, because the variables are the place where you would expect to need the bump and nudge concept. You know, on the days, like you said, from a hormone standpoint, or I ended up spending, you know, six hours at the park today versus only being there for an hour, like on other days, right? Those days might be the ones where you use a little bit more bumping and or nudging, depending on what's going on. But overall, on your standard day to day, if settings are right, you really shouldn't need to be using that concept all the time. Yeah. And if you are, something's not quite right, or you're maybe not using the advantage of some of the smarter features on of your pump.
Scott Benner 7:44
So that you don't have to do that all the time. It's an interesting tool in that it's functional and diagnostic at the same time, you know, when you need it, it's a it's an amazing functional tool for type one diabetes. But if you need it too much, it is a red flag. It's a Hey, we're there's something going on here. And so bumping nudge to me is more of it started as a functional tool for me, it'd be it morphed into a diagnostic tool for me. And and it's just as simple as I find myself thinking, we're bumping a little too much lately. You know, what Arden might need a little more insulin, you know, we're not doing a little show or whatever. And Jenny has the exact opposite thought she thinks I'm pumping a lot lately. Maybe my insulin is too strong. And but it doesn't matter. However it makes sense in your head is what matters. And you can, by the way, make up two different words. I don't care. You know, I mean, off the top my head, and I don't know what they would be. But again, I'm sure you could type in bump synonym into Google and figure it out, make it your own thing. But I think that um, it's just it's very important because we watch blood sugar's move, and don't do anything about it thinking, This is my ratio, I did the right thing. This is right. And, and then what happens later is people say to me, Well, how do you know how much and that's the stuff I want to dig into into in a pro tip episode. So I'm going to leave this one here. It's a good definition for what bumping nudges if it sounds interesting to you go find the diabetes pro tip episodes. And I mean, personally, I wouldn't jump right to bump and nudge I'd listen to all of them but you'll get to it at some point. I genuinely believe Jenny By the way, I'm gonna leave this in this episode here that those episodes that you and I have done together. I think they move people's a one c point and a half. Like I think people are seeing like a point and a half out of it. I think I and then there's gonna be
Jennifer Smith, CDE 9:45
great to get some statistics just off of that, you know, even even a question or a survey to say hey, you know, for those of you who are listening to the pro tips, how much if any change Have you had in your a one See, that'd be great to collect,
Scott Benner 10:01
I'll say this out loud here, most people won't understand these words. But if the Helmsley foundation is listening, I and you want to find out if a podcast can actually make your health better, hit me up. I need a little help with the website in the data collection. And you know, a couple of dollars might not hurt that. Cuz I don't know how to do it on my own, that's for certain. Okay, so that was bumping and nudging. Hey, here's some quick contact information for the sponsors. If you're interested to get the dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com Ford slash juice box, and hit the button that says get started with Dexcom g six, it's just that simple. If you get there and you want to read a little bit, definitely check into it. Zero finger sticks, customizable alarms, and alerts, smart device compatibility with Android and iPhone, the ability to share data, or data just depends on where you live in the country or the world. Although right now, some people are like it's data, or data, you're fighting with each other, but you're just fighting with a voice in your head. So don't do that. Anyway, no matter how you say you can share that data with up to 10. People, it's amazing, right? Your kid could be at school being tracked by their mother, father, grandmother, school nurse, maybe even have your neighbor follow along just to know in case of emergencies, you know, for people who like their neighbors, so all seven of you who like your neighbors, that's an option. Anyway, dexcom.com forward slash juice box, you're also going to want an omni pod tubeless insulin pump that you're going to get my Omni pod.com forward slash juice box. And on the pod has quite a little deal where they'll send you a free, no obligation demo of the Omni pod to your home so that you can wear it. While why I've worn it on the pod demo before. It's astonishing how quickly you forget you're wearing something. And you'll really get a feeling for what it's gonna be like to have a tubeless insulin pump, right, just this little device that's with you, and nothing else to clip to your belt or stuff in your bra or do anything like that. And there's no obligation. So I mean, if it doesn't cost anything and not holding you to it, you might as well give it a try my omnipod.com forward slash juice box Podcast course if you go to Contour Next one.com. There's a button at the top of the page to see if you're eligible for an absolutely free blood glucose meter. And I have to tell you, I've a little more context now because at the moment, I'm wearing a Dexcom Pro to get the feeling for it. You'll hear me talk about that later. But because I'm doing that I'm testing a lot. So not just with Arden, but I'm testing myself to get a feeling for you know where the CGM sitting with accuracy. And all that stuff that I've been telling you has been my experience about using the meter with my daughter goes double for me. Small, convenient, accurate. pocket size. It's great, the light works great at night. And trust me My eyes are don't I mean, not what they used to be Contour Next one.com. And of course, touched by type one, please, please, please go to touched by type one.org to check out the good work that these amazing people are doing. For children living with Type One Diabetes. And people with type one diabetes in general. They raise money to support a cure. They put on all these kinds of great programs to support the community, you can be part of it touched by type one.org. plays out, I'd like to remind you about a couple of other I don't want to call them bonuses, extras freebies, that the Juicebox Podcast offers. First one I mentioned at the top of the show juicebox Doc's calm it's my list of listeners, favorite practitioners, CD ease, endocrinologist, anybody who's helping you with your type one diabetes, these are people who are forward thinking, technology friendly, aren't going to give you a bunch of problems when you come in and show them a graph where you haven't been low, you know, in three months, maybe more than like 2% of the time and you're a one sees in the sixes or the fives you're gonna want somebody who celebrates that with you. Not yells at you. So if you don't have that kind of a doctor check out the list. If you do have that kind of doctor, add them to the list juicebox Doc's calm I'm going to talk right past the music Do you mind? me Get Ready? Mm hmm. In the call me one take Scott. Watch this. No, no, hold on. Don't worry. Got a little thing caught here. Hold on a second. I might be Hold on. Make a drink. You know what? I'm all clear. Okay.
Diabetes pro tip.com. You know, at this point that there are I don't even know how many 20 Pro Tip episodes with Jenny Smith and I, if you need to find them quickly, diabetes pro tip.com no s take off the last s for savings. There's actually no savings because the podcast is free. But you know what I mean? diabetes pro tip calm if you're looking to revisit or share those episodes do that. These defining diabetes episodes are also there. If you scroll down, I think ask Scott and Jenny is there as well. If it's not, I should put it there. And maybe I will. What else? Oh, the private Facebook group juice box discussion group. 3500 members strong at this point. absolutely free place for people to talk about their type one diabetes? Are you low carb, great. These people talk about with you? Are you like, Hey, I don't do low carb, no problem. The low carb people and I guard people don't even fight with each other. It's a utopia. Seriously, people are there talking about management ideas, sharing their successes, giving each other encouragement, thoughts, whatever you need. It's there. And it's a great place. Now if you're a jerk, don't show up there. If you're looking to do the normal, old, you know, Facebook, arguing with people thing, this is not the place for that this place is lovely. If you're the kind of person who could be lovely to juicebox discussion group on Facebook, find it do a little search. There might even be a link here in the show notes. Hmm, what else have I done? What have I done? That's from The Nightmare Before Christmas, you wouldn't be able to tell? Because I have a terrible singing voice. Oh, leave a great review for the podcast. If again, that'd be terrific. Right there in your Apple podcast app, five stars. I love this pocket. Actually just don't do that. Right, something thoughtful. It helps other people be able to trust that they should check out the show. So if you've had a great result from the podcast, and you'd like someone else to also have a great result. A wonderful review would help that along the way. Not only that, share the show with someone else. pimp it out. Be like, hey, this helped me here's how, here's how you check it out. That's how the show will grow. I felt like that was gonna rhyme in that it didn't wait. It did show and grow rhyme right. That's how the show will grow. That was weird. I thought it was gonna rhyme. It did rhyme and then I doubted if it rained. I don't even know what that says. Thanks so much for listening to this episode of the Juicebox Podcast. There of course will be many, many more. We're not like podcasts. It's like here's one and then wait four weeks. Here's another one. This one sounds terrible. But I'll let them listen to it. Anyway. That's not what you're getting here is the well run show. Understand. You come back. you subscribe. Are you subscribing? Do you? You've hit subscribe in your podcast app, right? Oh my god. Are you listening online? What do you mean like 150 years old? What are you doing? Get a podcast app on your phone and hit subscribe. People. I just had an imaginary argument with a person who doesn't exist. Yeah, I think it's time to stop this.
support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#345 Dexcom CEO Returns
Kevin Sayer is here!
Dexcom CEO Kevin Sayer returns for his seventh appearance on the Juicebox podcast. Today's topics; Patient Assistance Programs (Covid-19), CGM in hospitals, G6 Pro, G6 anniversary, Hybrid closed loop, Medicare and more!
App is free & already on your iPhone ⤴
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Podcasts - iHeart Radio - Radio Public or their favorite podcast app.
Check out the Diabetes Pro Tip episodes and Juicebox Docs
+ Click for EPISODE TRANSCRIPT
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, everybody, welcome to Episode 345, the Juicebox Podcast. That didn't feel like enough energy. Let's try it again. Hello, everybody. Welcome to Episode 345 of the Juicebox Podcast. And that was too much. I'm going to shoot right for the middle. Give me a second. Go. Hello, everybody. Welcome to Episode 345 of the Juicebox Podcast on today's show, the CEO of Dexcom Kevin Sayer is here to discuss with me what's been going on with your favorite continuous glucose monitoring company. And there's a lot here short show lots of information. And this is very uncommon, recorded on the day it was dropped. That doesn't usually happen. So this information is up to date, June 15 2020. The Juicebox Podcast is sponsored by the Omni pod. You know what that is, is a tubeless insulin pump. My daughter's actually been wearing it since she was four years old, and she's about to turn 16. The Omni pod tubeless insulin pump is a Marvel and the company who makes it offers an absolutely free, no obligation demo. So they'll send it right to your home, you can try it to see if it's something you're interested in before you move forward. That's of course at my Omni pod.com forward slash juice box, and Dexcom, makers of the G six continuous glucose monitor and the company who does all the stuff you're about to hear about. You can find out more about the dexcom@dexcom.com forward slash juice box. The episode is also sponsored by the Contour Next One blood glucose meter. Of course, everything you need to know about that exists at Contour Next one.com. Just head over there, you can find out all sorts of things about the greatest meter I've ever used, including, if it's possible that you may be eligible for an absolutely free meter. Links to all of these sponsors are available at Juicebox podcast.com. Or right there in the show notes of your podcast player. I am joined today by Kevin Sayer, the CEO of Dexcom. This is Kevin's seventh appearance on the podcast. Kevin took a little time out today from the American Diabetes associations ADF Scientific Sessions. I don't know if you know what that is. But it happens every year. It's this very big event that usually happens in person this year because of COVID-19. Of course, it's happening virtually. And so anyway, Kevin took a little time out to talk to me about what's going on at Dexcom. At some point in this half an hour, we're going to talk about the patient Assistance Program. CGM use in hospitals around COVID-19, the two year anniversary of G six, the G six Pro, which I'm wearing hybrid closed loop partnerships with Omni pod and tandem Medicare, some new things happening in the EU. And the rest. You know, when they did that Gilligan's Island thing they were like in the first couple seasons, they were like there's so many people here we don't know if everybody cares about Marianne yet, so we'll just say and the rest. Trust me, they ended up caring about Marianne, and you're gonna care about everything that Kevin talks about here on the show. I have to do disclaimer very quickly. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan or becoming bold with insulin. Oh, yeah. How are you finding Ada being online?
Kevin Sayer, Dexcom CEO 3:39
I miss being there. I miss talking to healthcare professionals I've known for a long time I miss going actually to sit tomorrow the scientific sessions and hearing the buzz, it's on the floor. I still think a lot of data is getting presented. And I still think we're learning that we are doing much better with diabetes from done in the past. And in all fairness, Dexcom appears to be in the middle of all this.
Scott Benner 4:02
So that's all good. You really have a head things covered on all fronts. It gets to the point sometimes where I think people get confused and think that companies are one in the same because you know you've got Well, I mean, you've got a relationship with with tandem. And I can't find anybody to say anything bad about control like you that's for certain.
Kevin Sayer, Dexcom CEO 4:23
Great product.
Scott Benner 4:24
Yeah. And what's going on with did on the purchase chain is it's on the pod five is going to be the loop,
Kevin Sayer, Dexcom CEO 4:32
then I don't know their product names. I just know they've restarted they're pivotal and they're get everybody re enrolled and they're pushing to get this thing done. So we can get the horizon system out there. I don't know what they're gonna call it. I just, you know, the presentation, the patients really had a very good experience from a user interface perspective and the time and range data was it was strong comparable to the others. Yeah. So we're looking forward to another integrated system and more For our patients, do you feel
Scott Benner 5:01
like a proud parent, sometimes when you watch these things happen, like recognizing they couldn't happen without XCOM?
Kevin Sayer, Dexcom CEO 5:07
You know, I feel an integral part of it. And I do feel very proud and Oh, my, in all fairness, humbled to be here, because this is so important. Yeah, I would tell you what happens. And the people that work for me tell you the same holiday happens is when these good things happen. I just turned a pressure up to the next one, I am not very good at celebrating. I there's just so much to do.
Scott Benner 5:29
Well, then you're exactly in the right position, I have to say, I look today, because I found myself wondering, and you've been doing this podcast since 2015. This is your seventh or seventh time on. And just looking back to what we were talking about in 2015, and 16, and 17. There's never been a pause. And this will sound like I'm, I'm kissing your butt a little bit. But I'm not. I've been in the space long enough to see that innovation doesn't normally happen this quickly around things with diabetes for people. So it's incredibly exciting.
Kevin Sayer, Dexcom CEO 6:00
No, it is, in fact, we're celebrating our second anniversary of GE six right now. We lost his two years ago, okay. And we're still learning how good it is. We are learning the subtle things we can do to improve it. We are learning how important it is and everybody's lives. And just look forward to to the next wave of innovation. We Oh, yeah. Yeah. And we have moved very quickly. And in a very planned, well executed manner.
Scott Benner 6:30
What are you learning from that two years of data, because you've been on in the past and talked about, like, kind of pie in the sky stuff and always sound like like, you know, we'll be able to see enough data one day that it'll be able to tell you, Hey, don't you think you should Bolus here or something like that? Or is that stuff really, in the works?
Kevin Sayer, Dexcom CEO 6:45
You know why it hasn't happened yet. And it's still conceptually being thought of, I would tell you, if I could look back from when we talked about that two years ago, I'd love to have made more investments on that front. But in all fairness, we made the investments we need to get the technology that affects people right now in their daily lives on the market. Yeah, and and when g six and all fairness, our biggest investment in the past few years is trying to get enough manufacturing scale and get enough product to take care of our patients, right. And we've made some pretty bold promises, we said, we double our capacity by the end of 19. From the start of 19, which we did, we made a promise again, to double capacity by the first of July of this year from the end of last year, which we will achieve that as well. So we'll have the ability to build a lot of G six sensors to take this technology to a lot of places and to a lot more people. So we've kind of been catching up on the physical aspects. And I think now we can turn a bit inward and start looking at this science, this data, these integrations, all these other things and invest a little more time there. On top of going through all the same process. We went through G six, yeah, to get a G seven product out the door to
Scott Benner 7:57
he's not that I'm not in a hurry. g six works great for us. But is there a timeframe for seven?
Kevin Sayer, Dexcom CEO 8:03
We're not where we are we always we're always trying to be quick. But effective. We don't have a launch date for G seven yet. We have disclosed that the trials been delayed because of everything with COVID. Yeah, the centers aren't doing the studies, once we know that study timeframe, and how long it will take us to execute that study then that will give more dates, but like you said, g six has been a great product, it remains a great product. It's well integrated, we'll have more integrations and and we'll continue to improve it and make it better over the next several months anyway, we're not going to abandon all right, right, Mr. g seven come in yet still Well, our patient choose. So we'll continue to to make g six better while we move to to G seven get ready for that, too.
Scott Benner 8:52
So speaking of COVID-19, I guess I wanted to understand a little bit more about the patient Assistance Program. What did you guys put into place when all this happened?
Kevin Sayer, Dexcom CEO 9:02
Yeah, and we've designed a patient Assistance Program, it has not gone live yet it will go live, hopefully, first in July, maybe a little bit before that. We looked at the economy and everything going on. The one thing that was very important to us is to make sure current Dexcom users get taken care of. And Dexcom users may in fact lose their insurance or their jobs during this point in time. And we unfortunately don't have Medicaid coverage in every state and even some of the states where you do have Medicaid coverage, it takes quite a while to qualify. Okay, so we put a program in place for Dexcom patients that literally for $90. Over a six month period patients will get enough sensors and a couple of transmitters to get them through this time. And we will we've had some patients sign up not a lot. I think once we roll it out live, we'll see more that we really wanted to take care of the Dexcom family and doing that.
Scott Benner 9:54
So they're actually able to sign up now getting ready for when it launches. Yes. Cool. I'll put a link to that. In case anybody's and this is going to be for people who lost their insurance, like directly, how do you? How do you figure out who that is?
Kevin Sayer, Dexcom CEO 10:09
What we did is we went to an outside service that has the systems to do all those types of checks and go through and you know, where was your last? I don't know what the process that goes through. We knew we didn't have the systems to do that ourselves. And we did find a company that that is administered types of programs like this for pharmaceutical companies, right? So apply the same type of program to Dexcom. And and go from there.
Scott Benner 10:34
Do you know much about what you guys are learning from the Dexcom being used in hospitals around COVID-19? Rick was on a few weeks ago and was telling me about it. And I don't know if you've learned anything since then.
Kevin Sayer, Dexcom CEO 10:45
You know, we've learned a lot. I haven't listened to Rick's comments, but I can tell you, the first thing we learned is just hospitals operate a little differently than we do. And we've had to learn how to get the product and how to get the cell phones, that it's going to receive the data safe and through the IT systems in the hospital. And we've learned a lot about education. You know, we're used to training patients with diabetes and endocrinologist, we had a new audience. And we had to hear our training towards them. And they understand it, obviously that and we start thinking everybody knows everything about this, and everybody doesn't always know everything about it. We've learned that the the benefits from it are everything we'd hoped they'd be a human action and PP, patients are getting out of the hospital faster if they're putting on insulin drip, that insulin drip is much more well controlled, because you have a CGM data, again, leading to earlier discharge. The biggest benefit quite honestly, for anything in the hospital is when you can improve workflow and make the lives of the people who interact with the patient's better and more effective. And while we're hearing from, you know, from healthcare professionals, we put this on we get them up on Sharon follow, we can monitor them from the hall. And when we get an alert, we're going to deal with it rather than sticking their finger some places every half an hour. Yeah, 40 finger six a day in a hospital bed costs a fortune in nursing and caretaker time. So we've learned that we've learned essential performance the way it does with our regular patients. So we've not seen any abnormalities as far as what these patients are getting as far as compounds interfering with central membranes, which is something we have had many discussions with the FDA about, excuse me. And so
Scott Benner 12:32
that'll all be good. I think we'll gather as much of this data as we can. We made a commitment to the FDA, we'd present it to them. Before we run any further with this, and then talking about what we need to do more to be in a hospital full time. I'm excited for that after Rick came on, I get so many notes from people who are like, Is there gonna be a study, we want to hear about this thing. I was like, it'll happen Hold on a second. So when it happens, I'd love to know about it. Actually, the thing that I kind of got most excited about all the stuff you just said about what's happening is great. But I like the idea of this sort of reverse education is going to happen back to the nursing staff and the doctors so that they can see things about insulin use that I don't believe they thought about in the past. You know, when people are hospitalized, they have a tough time with type one. And I'm excited for what this might do.
Kevin Sayer, Dexcom CEO 13:19
They have a tough time with type twos as well. I remember, many years ago, my mother went to hospital for valve replacement. My mom had type two diabetes, they had a harder time getting her glucose in control than they did, getting her healed up and ready to come home from a heart valve replacement because of the stress that that surgery put on her system. And just the way her body was wired. I think one of the learnings from all this is there's no one size fits all. Yeah. Where people have different physiologies and different ways their bodies and systems react to things and CGM gives you a view? Yeah,
Scott Benner 13:54
I think I really believe that Dexcom in a hospital setting, beyond COVID-19 would be amazing for anybody who uses insulin, because they just don't get they don't always get the care that they need. And actually talking about everybody being different. You guys were very kind and sent me a Dexcom Pro, which I'm about
Unknown Speaker 14:13
a pro I
Scott Benner 14:14
heard How's it going? Well, I'm in my last few hours and I melancholy that it's gonna shut off soon, honestly, because of what I'm, I know that sounds crazy. But as I looked at came up, and it said, 24 hours left in 24 hours felt hopeful. But when it got to six hours, as I call this thing's almost done, you know, and I really felt badly about it, because I'm making slightly different decisions about food based on what I'm seeing. But some of the crazy things that I've seen, I never expected I you know, I'm kind of held up in my home like everybody else. I had to go out and get food the other day. So I jumped in my car, it's hot out, I opened the windows, I'm going to go for a ride by myself. I'm kind of excited I turn on some very loud music, and my blood sugar went up while I was driving to the grocery store and I thought that's just an anomaly, right? But I get out of the car, it goes right back down and settles in. And I come out, get back in the car, turn the music back up and watch my blood sugar go up a little bit. Now not a lot, you know, it's obviously different thing then. But it was a little bit of an adrenaline rush. But there was an adrenaline rush. I was like, wow, I'm excited to go to the grocery store, by the way that felt as sad as it did experience.
Kevin Sayer, Dexcom CEO 15:19
Oh, but the things you learn and the things that people will learn from gee six Pro, particularly like somebody's pre diabetes, or type two diabetes, who hasn't had the type of interaction, you know, type one patients, their bread and butter, and that's the business we're in today. But as we look forward to the future, if you have type two diabetes, what these patients have been told for years is eat less, exercise more and take your meds. But there's nothing that shows them the effect of that. Yeah, when you put g six pro on or G six on and you see the effect of that, you kind of sit back and go, Okay, I can now do something I can now learn.
Scott Benner 16:00
It's really good. It's massive. Because if I told you that I made pizza yesterday from scratch, and that didn't impact my blood sugar as much as a navel orange, I ate the day before. That wouldn't make any sense to somebody like if you if you just said to somebody Look, there's this guy's got type two diabetes, what do you want him to have? This slice of pizza? Or this orange? What do you think's gonna spike his blood sugar less? I don't think anybody would pick the orange over the pizza. But it's really just it's fascinating to watch. And it's fascinating to see how quickly your body. And the reason I asked for it initially was because I talked to so many people about how they use it so and I really wanted to see firsthand how, how it worked like how does the pancreas really work because all I have is what I've kind of gleaned from my daughter all these years, you know, like what should be happening and what gets you back to flat again. And to see that when I eat more sugary foods, my body comes in harder and more aggressive than it does when I eat more complex carbohydrates. That was fascinating to me to see, because I don't get pushed very low. Unless I eat sugar if I have a bunch of sugar, which I don't normally do. But I've been this has been quite a little fun thing for me, I guess I've been experimenting. And so I had a piece of cake with a lot of frosting. And then I was full and would have never done more and did more. And I just washed my blood sugar shoot up and then it pushed it back down to 80. But if I eat pizza, I don't get pushed back down to 80 not nearly that fast. It was it was really fascinating and continues to be
Kevin Sayer, Dexcom CEO 17:30
how the learnings for all of us when you are in this technology are it's really fascinating. The the effect of exercise, effective timing of meals right is dramatic. Yeah. For me, in particular, if I eat that piece of cake you talked about at 10 o'clock at night, that will affect at least till two o'clock the next afternoon for me, no kid, I'll be too high. It takes a long time to my system. And then then I have the big crash like you're talking about. Right work on much lower. And so trying to run on an even keel is quite a challenge. Wow, really sings
Scott Benner 18:06
the cake took me to like 146 and as soon as I got up that high, I got yawn I started yawning I felt tired. Like it was you know, people talk about Oh, it's after lunch. It's it's maybe it's not after lunch, if you don't eat the wrong things, you know, is which is what I took from it. Just so how is this going to get used? Or what's your goal for how it's going to get used in a doctor setting you want them? Well,
Kevin Sayer, Dexcom CEO 18:28
we have you know, we have always had a lot of goals, we still are going to be focused on our intensive insulin world. And we'll design our product and our base technology for that. And it will it will be there and it will be continually offered to those patients over time our next market would be the type two non intensive patient that those patients on other compounds. So they can literally delay if not eliminate the need forever migrating to insulin if they can manage themselves appropriately. And we've learned the effectiveness of some of these drugs. For some of these patients possibly earlier intervention in pre diabetes. I spoke with one physician who's not under chronologist but in a field where there's a lot of diabetes, and she told me she puts all of her patients who have anyone see above a certain level on index comm to see what's going on and then she'll prescribe jardiance or some other type to drug before they hit diabetes to see if she can prevent it from coming.
Unknown Speaker 19:25
Wow. Well if we
Kevin Sayer, Dexcom CEO 19:26
can prevent those costs and keep people healthy like that through CGM use it it's a huge benefit to the system and to people's lives and if you've seen with your G six Pro, it really doesn't bother me much it's it's pretty easy to wear and the data is is very fascinating. Yeah, we would start there I think over time there's fitness uses and health and wellness and giant uses for this. You know a lot of very high powered technology people have warranty six as an experiment and have suggested things to me. Like, every time you eat a meal, you measure the height of the spike and the width is spike and you have a bunch of analytics and graphs that can become literally industry standard type measures for people as they want to give themselves more healthy from a nutrition perspective. I think we can go there, I and then I think over time, what we would like to do with dexcom is then see what other type of analytes and experiences are required for this total health picture. You know, and we probably talked about ketones and lactic acid, as analytes, which is what others have talked about as well. But what other things can we make, it would be important to this world and really become as you look out 10 years, a healthcare sensor company rather than just glucose, right? And then so as we look to the future, though, because we've learned a lot, we've learned a lot, you know, on the electronics and the algorithms and all of these mechanical features that make our system so good, can we apply those technologies to measuring other things, and, and really create a business around around other things. But that being said, there are several hundred million people around the world with diabetes. And we have a market to go after there that is just massive, and they'll continue to do that.
Scott Benner 21:13
Well, I believe him, obviously, both both goals. And after wearing it for 10 days, I just, I been doing intermittent fasting, and I was just at the end of thinking, I don't know if this is something I want to keep doing or not. But after seeing my blood sugar during those intermittent times, I'm like, I'm gonna keep doing this.
Kevin Sayer, Dexcom CEO 21:28
It's no, it is a great thing. Yeah, it absolutely shows that time you spend on eating set you up for a better day.
Scott Benner 21:35
It's crazy. I'm I am fully just amazed with what happens. So with everything, you know, with Ada being right now, what are you guys presenting? What are you sharing with everybody? Is it just everything we're talking about? Or is there more
Kevin Sayer, Dexcom CEO 21:47
no our presentations that we've had some type q presentations, showing that there's benefit there. And some of our partners like on duo presenting really good data, showing you CGM and talk to patients leads to significant agency reductions. We've also presented with our partners tanam control IQ presenting more pediatric data and other day with their system. And the data is extremely compelling that that system is working very well insolate present some horizon data with what they have gone so far. And that data was very compelling, particularly respect to user experience, and how the patients engage with the system. And you know, the time both those systems have tremendous time with the algorithm running, certainly over 95%, which is a big change from systems have been on the market before. So those efforts are advancing. I think, you know, the other thing is continuously the ADA, everything revolves around what the CGM says, There isn't. There are many studies done where CGM is not an outcome anymore. That timing range doesn't become the indicator that everybody's looking for. And what is the timing range of cheap with this drug or this therapy or this? Whatever? I and I think you'll see that move to time and range being more important measure over and over again, to add on day one, see if not being is certainly a more meaningful interpretation of agency than what we have today.
Scott Benner 23:14
Yeah, we had john Welch on recently from from Dexcom. And he was talking about he was really generous, he brought his own data up on the screen while we were recording, and it's pretty awesome. He was I'll tell you, I, when I reached out, I said that I'd like to have somebody on the can really explain standard deviation, that that stuff and and do it at a detailed level because it never gets spoken about. And I have to admit, when I asked, I think everybody was like, you really want to talk about that. I was like, no, it's gonna be great. And people's response to him being on absolutely spectacular because he had it in a way that I mean, you know, he had it in a different better way. And he explained it well. And he went over also how coefficient of variation can be a good telltale for Lowe's. He said, If you keep that number, and I think he said 36% you'll have far fewer lows. I was like, Wow, that's amazing that that kind of information comes from this, you know, and you know, my daughter's life is, is is just on measurably better because of you guys, so I'm just a huge fan, obviously.
Kevin Sayer, Dexcom CEO 24:18
Is that fun talking to somebody like john that's why I love working at Dexcom I can before when we all get back to work someday, right? I can walk down the hall and find somebody like john and say, Okay, tell me something I don't know. And I promise I leave the office with some I don't
Scott Benner 24:36
know every time Oh, I left that conversation very humble and you're
Kevin Sayer, Dexcom CEO 24:40
it's just it's kind of overwhelming sometimes you go well i i guess i do run the place but boy there's a lot to learn No
Scott Benner 24:48
kidding and and your to your other point. I had him for an hour and an hour and 20 minutes into it had I not moved to screen to see something I had to apologize let him go. I had no idea how much time went by. It was Just really, it was riveting. I had such a great time. A couple of things, you're starting to make some advancements in the European Union to what what's happening there.
Kevin Sayer, Dexcom CEO 25:11
We are, you know, Europe is our second biggest market and there are many cat we are in many countries here, we two recent approvals, we think that will be very helpful. One of them is we have a back of the army indication. So it is now labeled to be one in the back of the army, which many patients did off label anyway. But we think that indication is really important for us for a number of fronts, and it ties directly into our second approval. And that's an official designation that we can be used in pregnancy. Our Pregnant Patients have never quit using our product. If they have diabetes, they've been using it. But the back of the arm medication for Pregnant Patients is really important. Because there's one pregnant patient said to me, I've run out of abdomen space, what am I going to do. So having the back of the arm is a is a good thing. There, we are working on both those indications in the US. And we need to figure out what our data plan is there. But ultimately, we'll get that for G six over here. And then the G seven product, we're running a study on the arm, on the abdomen, and for Pete's on the products as well. So we'll have three labeled indications where patients can wear it with that right out of the gate or not gonna
Scott Benner 26:27
wear us again, is that one of the benefits of having the longevity that the company has that you can start looking at those other indications and spending time doing those studies so that you can get more and more on the label.
Kevin Sayer, Dexcom CEO 26:39
Yeah, it is. And it is, as you understand it, and also, as you listen, you know, one of our core values is to listen to patients, and we've heard from numerous patients get us an arm label indication, please. And the pregnancy data that we got from women who've worn this certain pregnancy, the pictures of babies and stuff. We really need an indication for pregnancy where it says hey, and not necessarily a diabetic patient with a gestational diabetic patient, right. I have a twin grandbabies from a daughter law had gestational diabetes, and she's a nurse and was told, keep your blood sugar's under 125. While four finger six a day, you have no idea how many hours you've spent about 125, right? She put a CGM on and man, she knew everything. And when she showed it to her ob gyn, the OB tear, why and says I don't know why Ray doesn't have this. So we need to get to that market for that product.
Scott Benner 27:37
It's important to keep these kids safe. Let me tell you this, and I ask you a question. And then I'll let you go. But I did a series with a person who was pregnant wearing Dexcom. So I talked to her three months in six months in right before she had the baby. And it is it's not for the faint of heart making a baby to begin with. But making one with diabetes is a it's another game altogether. Oh, yeah, we appreciate that. No kidding. Um, Medicare. I didn't ask you about Medicare today.
Kevin Sayer, Dexcom CEO 28:06
Oh, yeah. But I'm happy to talk about Okay, cuz there's a couple things that we've learned. You know, I talked about capacity earlier, and we did not have capacity supply our Medicare patients last year, and we that switch, and we've nearly got almost all of them converted from G five to G six. And so that's been a very good thing. They don't have calibrations. Also, our G six minute care pricing is actually lower for our patients. Because as CMS looked at it, since there are no fingertips required, they dropped what patients would have been paying for finger six before, to Dexcom. So it's the lowest priced offering on the market for Medicare patient right now, on top of that, as you look at our times of uncertainty, where people can't be in the clinic, and where were the highest risk population is probably our senior citizens with diabetes, we offered a tremendous telemedicine opportunity for these patients to be able to have visits with their doctors, and make sure their diabetes is under control. So our Medicare patient population has been extremely served over the past, well served over the past several months. And we look forward to continue to expand there. And we're really happy that we have been able to make this switch have the capacity to do so,
Scott Benner 29:20
you know, I would have to say I'm assuming you don't talk about clarity. Like it's a real diagnostic device. But a lot of people would you do you because I think what I'm seeing is a lot of doctors are like, Look, you can't get in here. But can you tell me on this clarity like what is this? What is this? What is this? It's a it's a great way when you can't move people into a doctor's office especially to take a blood test to help them you know,
Kevin Sayer, Dexcom CEO 29:43
and clarity, you know, and we used to have a three hour delay we dropped that three hours away. It's closer to real time there may be a little bit of time that missed that. But the average be 30 minutes would be all but we dropped that three hour place. Clarity can be used on a much more real Timing decisions for these visits. Yeah,
Scott Benner 30:02
I did it with my daughter, looking right through the same screen that her whole thing and, and it was really amazing. The only thing I didn't go over was that, you know, the company is looking very, very strong financially congratulations. I'm assuming that's probably because the ads on the podcast, you probably don't want to embarrass yourself by thanking me like in while we're being recorded, but
Kevin Sayer, Dexcom CEO 30:22
I love our sources and where we get our patients. I think some of the greatest stories we hear are where people hear about us. And and while Listen, we were running commercials on television now. emails, hey, saw your ad today. And we're we certainly have our direct digital media but I all the places we we run a report to us if somebody's listening to your podcast, I gotta guess our hit rate is pretty high on that patient.
Scott Benner 30:48
Yeah, I well listen to it. If they're listening to what's happening in my house and they're excited for it, then they would at least want to look into it. I would think it's a we're six years now. 5226281 see, oh, sheets, whatever she wants. She's, you know, getting ready to get her driver's license, you know, strong like Healthy Kids. So.
Kevin Sayer, Dexcom CEO 31:07
So when you want when you want advice from me having raised five teenagers, non diabetes related, you can give me a call. I had a daughter. I have been through five teenagers and good luck.
Scott Benner 31:18
Well, I'm just gonna say that. That's quite an accomplishment. Kevin, thanks so much for coming on. I really appreciate
Unknown Speaker 31:23
the time. Of course, we appreciate it. Thank you.
Scott Benner 31:27
Well, Kevin went over so much that I'm going to provide links at Juicebox podcast.com. So there's episode page for this episode, you'll see it go to Juicebox podcast.com. And then everything we talked about, there'll be links to I'll put them in the show notes of the podcast player as well. But just in case you have trouble accessing them there. There'll be right there at Juicebox Podcast comm huge thanks to Kevin for coming on the show and taking some time during this very busy week. While we're thanking people, let me thank you for listening to the Juicebox Podcast and for sharing the show. We had again, a huge month last month and this month is looking to be bigger. So that is because you are sharing and listening. And I appreciate it very much. If you appreciate the show, you can stay on for just a couple more minutes. Because this is how I pay the bills. This episode of the Juicebox Podcast was sponsored by Omni pod, you can get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to your door today by going to my Omni pod.com forward slash juice box. When you do that, and then provide the tiniest amount of information on the pod is going to send a pod right to your home. You can put it on and wear it to see what you think. Is it gonna bother me? Is it bigger than I thought it was? All that stuff? What would it be like to work out with it or take a shower or you know, take a tumble, all that stuff? Those are the kind of things you want to know before you buy. And only pod knows that. I think that's fair. So they're gonna send up demo to your house and let you make the decision. Like I said, I'm wearing the Dexcom Pro right now. And it's one of the things that took me by surprise, I'd never wanted Dexcom before, and I thought I was going to be bothered by it's just existence on me and I have not, I have not even noticed that. It's been terrific. Now Dexcom Pro, that's for physicians, if you're not a physician, this is not what you're interested in. But if you're a physician, check the show notes get in line like Kevin was saying they're gonna start this program very soon. no reason you can't get one for your practice. Everyone else, you're going to want the dexcom g six continuous glucose monitor, go to dexcom.com Ford slash juice box to get started today. So that's simple, high and low alerts. Right. Arden's are set at 70 and 120 we actually get a little beep lets us know if our blood sugars leaving range. And then we just gently guide it back in again. It gets rid of a ton of the highs and lows that come with Type One Diabetes gives you more time back. It also brings a real security knowing not just what your blood sugar is but how fast it's moving and being able to share it with a loved one up to 10 of them actually on an Android or iPhone dexcom.com forward slash juice box and lastly but not leastly the Contour Next One blood glucose meter I've been using hardens all week actually. Because I've been wearing the glucose monitor I've been wanting to match my results. meters terrific. I've used it on Arden for a long time you know when she's sleeping it's you know my job, but I've never used it on myself until just recently. Absolutely everything I say it is and all the other ads goes double now for me Contour Next One small, easy to use, easy to hold. Test trips that you can hit blood miss it once and go back again without ruining it. Nice, bright light for nighttime, fantastic, takes a pretty small blood drop. I didn't have any trouble with it all. Find out about all the sponsors, there's links in the show notes of your podcast player and at Juicebox podcast.com. And don't forget that all the stuff Kevin talked about today that I have links for will be in those exact same places. Little music left. So let me thank you again for your listenership. And for your desire to share the podcast when you're finished with it. I'm seeing really incredible growth over the last couple of months, even when podcasts were affected by the covid 19 crisis, this podcast kept going. So thank you, thank you, thank you. It's a really big deal. And I will continue to do a good job for you best I can appreciate that you share that you listen and that you enjoy.
Seriously, I was really proud while other podcasts stopped putting out content during I guess, April, was a big month for everybody. It's just like, no one's listening to podcasts or we're not putting out and then they slowly kind of put some back. I'm seeing it with a lot of shows. I didn't have to do that. And that was really heartwarming to believe that people cared so much about the show that even when their lives were turned upside down, they still went to it. That really means a lot to me, and I appreciate it. Let me remind you that if you want the pro tip episodes of the podcast, you can go to diabetes pro tip.com. You can of course listen to your podcast app, but for new listeners, or someone who's trying to share just the pro tip episodes, diabetes pro tip.com no es pro tip and juice box docs. It's JU ice bo xdocs.com. I am building a list of listener approved physicians, CDs, that kind of stuff. Check it out if you need one. And if you have one, use that link to send it to me and I'll add your favorite doc. I think that's it right. It's got a big Alright, I'm out. See you guys
support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#344 Defining Diabetes: Feeding Insulin
Scott and Jenny Smith define diabetes terms
Defining Diabetes: Feeding Insulin. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
App is free & already on your iPhone ⤴
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Podcasts - iHeart Radio - Radio Public or their favorite podcast app.
Check out the Diabetes Pro Tip episodes and Juicebox Docs
+ Click for EPISODE TRANSCRIPT
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
This episode of defining diabetes is brought to you by Dexcom Omni pod. The Contour Next One blood glucose meter and touched by type one. Please visit touched by type one.org dexcom.com forward slash juicebox. My omnipod.com forward slash juice box or Contour Next one.com. To find out more about the sponsors. In this episode of defining diabetes, Jenny Smith and I will be defining feeding insulin. Now, you know Jenny, she's in all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring system. Jenny services are for hire, check her out at integrated diabetes.com.
We're gonna get started in just a moment. But before we do, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical more. Otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.
There are people and I am not bothered by it. I'm just telling you there are people who come into the podcast as new listeners who if they hit the right episodes, once they get through an episode where you're not on it. They're like, Where's the woman go? No, no, I'm like, No, I understand. And like she's on these and these knees. And they're like, Okay, I get it. Like I got a note one time, please. Like, I don't understand where did Jenny go?
Jennifer Smith, CDE 2:01
Still here, I was like, Jenny,
Scott Benner 2:02
Jenny records podcasts like, like, she's tanning. Like, she's canning vegetables, he just makes a bunch of them, and then brings them out when she needs them.
Jennifer Smith, CDE 2:11
I feel like people think that I like live in your closet.
Scott Benner 2:15
Let me get Jenny Hold on a second.
Jennifer Smith, CDE 2:18
There she is right over here.
Scott Benner 2:19
There you go. Ask me your question.
I use this phrase. And in my mind, it paints a tapestry of idea. And I hear back from people and they'll say like, I don't understand what you mean. So. So I use this a lot. I say feeding insulin. So you know, I'm like, oh, you're feeding the insulin. And that apparently doesn't make sense to some people. So when I use that phrase with you, what does it make you think of?
Jennifer Smith, CDE 2:56
Yeah, feeding insulin means that you're having to actually, I guess on a negative side of feeding insulin, it means that you're putting in food to compensate for there being an excessive insulin that shouldn't be there. Right. So whenever you're feeding insulin, especially, and that's something it's a term I use when I'm talking to people about weight management. Because if you're constantly adding extra food, because insulin is driving your blood sugar down, then there's a problem. there's a there's a balance that's off, you're getting too much insulin from somewhere, whether it's bazel, or too much bolus or whatever, and you're constantly having to put food in to avoid drops. I'm now on the positive of feeding insulin. I mean, that's what we do. We we feed insulin with the carbs that we put in, but hopefully there's a balance there when we're feeding insulin that way. So and if you find yourself feeding insulin too much, you can you'll have weight issues. Yeah, that wrap around that too. And we talked about that a lot. The idea that because you have type one diabetes, and you're using manmade insulin, food seems like medicine. And so you stop thinking about it as calories where you know, sometimes, I mean, don't get me wrong, you know, in the moment, when you're falling, don't don't hold up Skittles and go, No, you know,
Scott Benner 4:12
a moment on the lips, a lifetime on the hips, don't think that think oh, I want to stay alive and eat the Skittles. But right, the idea is to not have to feed that insulin. So if you want to get a look into my mind for a second, there's gonna be an old reference, I guess. But if Pac Man is insulin, and the dots are glucose, you don't want Pac Man to have energy when the dots are gone, because he's gonna turn on you and bite your face. Right? Exactly. And he needs to have more dots until until he's done. And so, but there's ways to reverse engineer that idea as well. And I don't think that people would think about it this way. But I think I just created that situation with Arden just now. So by way of an example, she gets up in the morning, she still goes Going into school at home. And it's the end of the school year, she has to return her books to school. So she she leaves the house, Kelly takes her. And I don't know if she was excited or not, I don't know. But her blood sugar was sitting around 110. I was recording a podcast earlier today. And I told her, I'll make you breakfast when I'm done. So she left the house and the 110 went diagonal up and it went 115 120. You know, it kept going her auto bolus started bolusing at it from the loop and it leveled off at 140. Then she gets home and she's hungry. And so we bolused for the 40 points plus her meal. And we're going to create a fall that happens. And we're going to in essence, feed the insulin to stop the fall at a level number. And so there's, that's there's a positive way to think about it. I think when I use the term in public, or in my mind, I don't think of what I just did is feeding the instant I think of it as Pre-Bolus saying and timing the food instead of timing the insulin. Does that make sense? Okay, yeah,
Jennifer Smith, CDE 6:11
absolutely.
Scott Benner 6:13
Absolutely. But when I generally save, you know, you're feeding the insulin, my intent of that is to say, hey, it's possible, your bazel is too high. Because I you see, you find yourself feeding your insulin I when when people show me a graph, and it bounces. My first question is always, are you stopping highs with insulin on this graph a lot or stopping lows with food a lot? Right? And that moves me towards too much bazel or not enough? bazel? It's my first question. So anyway, when I say feeding insulin, or when you hear somebody saying that, I think that is a complete explanation of what I mean by that. Do you
Jennifer Smith, CDE 6:50
know, absolutely. And I think you know, when you talk about it in terms to have, like that weight management piece of it, I was just, I just worked with somebody who she said, You know, I feel like I'm eating more normally now. And I don't feel like I'm eating as much. And I'm actually feeling more. She called it real appetite. And I said, That's right, when we adjust your, your baseline levels of insulin the right way, technically, and she's not using loop. She's just normal conventional pumping, right? So um, you know, when she gets hungry for a meal now, she knows that she's really hungry. That it's not because her insulin is telling her, Hey, there's too much of me here, like your Pac Man example. Yeah, I need more food. Please put more in. So now she has more real understanding of what appetite feels like, rather than just insulin appetite.
Scott Benner 7:50
So I realize I'm just asking you, and it's your personal experience. But is hunger? Because you're low? Does it feel different than hunger? Because you're hungry? Where is it the same feeling?
Jennifer Smith, CDE 8:02
To me, there is a definite difference, like from my personal experience, and I think everybody might be different, but I can tell the difference. When I have hunger from being low. It's more, it's much more ravenous. It's, I need food now. And it's definitely like, I don't want to sit down and eat a nice salmon fillet and a salad hunger. It's, I would like to eat the whole entire, like container of glucose tablets, which we know it doesn't taste very nice. Yeah, right. So it's, I would say it's definitely more of you need something now. Whereas if I've, like skipped a meal, because I've been out in the yard gardening through like lunch hour or something. I can tell by the time I get to like the mid afternoon, even if my blood sugar has stayed normal, you know, hopefully has stayed normal through that time. I am. I'm hungry, right? Like I can tell the pit of the stomach kind of hunger difference from a low blood sugar. It's an it's a more now craving.
Scott Benner 9:06
I figured that out first. It was a time of day thing when Ottomans say she was hungry at like 930 at night. I'm like, she's not hungry. What is that? And then inevitably, in the next 20 minutes, her blood sugar would start to fall and I was like, Oh wow, she's feeling the drop before it's happening. And it registers this hunger for anyway, I think it's funny. It's the two small words but I think feeding insulin It teaches you a lot about how to use it you it is not your goal to be doing that. And and if you find yourself doing it too frequently, it is very possible that either your basal insulin is too strong or you're over bolusing it meals and creating Lowe's later you should not I know that seems obvious, but I don't think it is that people once they get caught in the in that little Have, I'm always low and I'm feeding, they get to that feeling of like, this is just what my diabetes is. But it doesn't have to be that way.
Jennifer Smith, CDE 10:06
Right? Especially with today's very smart, smart technology that we have to use, you know, years ago, when I was diagnosed, you did actually feed the insulin, because that's how the insulin works. And you know, your, your intermediate cloudy insulin, it peaked at a certain time. So you had to eat a meal and a snack at a certain time in order to coincide with when it's action kind of was there. Today's insulin, even though it's not as rapid as we want it to be.
Scott Benner 10:34
That's not as necessary.
Jennifer Smith, CDE 10:35
It's not as necessary. Yeah. So
Scott Benner 10:38
I, I hear that. Okay, thank you. Hey, here's some quick contact information for the sponsors. If you're interested, to get the dexcom g six continuous glucose monitor, you're gonna want to go to dexcom.com forward slash juice box, and hit the button that says get started with Dexcom JSX. It's just that simple. If you get there and you want to read a little bit, definitely check into it. Zero finger sticks, customizable alarms, and alerts, smart device compatibility with Android and iPhone, the ability to share data, or data, this depends on where you live in the country or the world. Although right now, some people are like it's data, or data, you're fighting with each other, but you're just fighting with the voice in your head. So don't do that. You can any anyway, no matter how you say you can share that data with up to 10. People, it's amazing, right? Your kid could be at school being tracked by their mother, father, grandmother, school nurse, or just a friendly guy, you met up the street, you're like, Hey, you want to watch my kids blood sugar. I mean, if you're, you know, if you're a hippie, you might do that, although do hippies have cell phones, I don't know, it's not for me to judge. Anyway, dexcom.com forward slash juice box, you're also going to want an omni pod tubeless insulin pump, that you're going to get my Omni pod.com forward slash juice box. And on the pod has quite a little deal where they'll send you a free, no obligation demo of the AMI pod to your home so that you can wear it and check it out. I've worn it on the pod demo before. It's astonishing how quickly you forget you're wearing something. And you'll really get a feeling for what it's gonna be like to have a tubeless insulin pump, right, just this little device that's with you, and nothing else to clip to your belt or stuff in your bra or do anything like that with and there's no obligation. So I mean, if it doesn't cost anything, and they're not holding you to it, you might as well give it a try my omnipod.com forward slash juice box. And of course, if you go to Contour Next one.com there's a button at the top of the page to see if you're eligible for an absolutely free blood glucose meter. And I have to tell you a little more context now because at the moment, I'm wearing a Dexcom Pro to get the feeling for it. You'll hear me talk about that later. But because I'm doing that I'm testing a lot. So not just with Arden, but I'm testing myself to get a feeling for you know where the CGM sitting with accuracy. And all that stuff that I've been telling you has been my experience about using the meter with my daughter goes double for me. Small, convenient, accurate. pocket size. It's great, the light works great at night. And trust me My eyes are you know what I mean? And I what they used to be Contour Next one.com and of course, touched by type one, please, please please go to touched by type one.org to check out the good work that these amazing people are doing. For children living with type one diabetes, and people with type one diabetes in general. They raise money to support a cure. They put on all these kinds of great programs to support the community. You can be part of it touched by type one.org. We're just gonna tell you one more thing before I go short episode today. So today we defined feeding insulin. But there are many other defining diabetes episodes. It starts way back in Episode 236. And some of you are going to say Look, I know what Bolus says Scott, I don't need that episode. But you'd be surprised about how many new people with type one diabetes don't. So Episode 236 is Bolus 241 honeymooning 245 time and range 247 standard deviation 249 extended Bolus 251 algorithm 253 non compliant 255 glycemic index and glycemic load 258 Pre-Bolus 260 Trust will happen to 69 low before high to 84 brittle diabetes 286 stop the arrows 288 ketones, 295 insulin resistance and overall singing Of course today Episode 344 Feeding insulin. And there are many more on the way that was all very confusing to you, you can go to Juicebox podcast.com and scroll down. All of the episodes are there. Actually the Ask Scott and Jenny episodes are there as well. And the diabetes pro tips and of course, all this is condensed way down at diabetes pro tip comm if you want to check out the pro tips, we're share them with somebody. That's diabetes pro tip.com.
The point is at the end of tip, see what i'm saying diabetes pro tip, there's no s. No s at the end of tip. It's just tip, and then the dot and then the calm. That's my tip for you today about how to spell diabetes. Perfect. Thank you very much to Jenny Smith for coming on the show as she always does to help us understand terms and ideas. bigger, more vexing Type One Diabetes issues. She really is the best Asus there is an S at the end of best assist, but not at the end of diabetes pro tip calm. I mean the English language is funny punctuation right
support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!