#924 APS Wookie

David has type 1 diabetes and is using Android APS.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 00:00 Hello friends and welcome to episode 924 of the Juicebox Podcast. Today, David's on the show he's using Android APS with some refinements. I'm gonna let him tell you all about them. David has a very popular diabetes blog called bionic walkie you can check it out at bionic wookie.com. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you'd like to get 35% off at cosy earth.com, you can do that with the offer code juice box at checkout. If you'd like to get a free year's supply of vitamin D, five free travel packs, with your first order of ag one from athletic greens, you do that at athletic greens.com forward slash juicebox. And if you'd like to save 10% off your first month of therapy, you do that@betterhelp.com forward slash juicebox. David's terrific, you're gonna love him. He's from Australia. Fantastic guy. Wait, do you hear what he's doing with this Do It Yourself algorithm. It's really astonishing. This episode of The Juicebox Podcast is sponsored by touched by type one, a fantastic organization helping people with type one diabetes, check them out on their Facebook page, their Instagram page and at touched by type one.org. I'm going to be speaking at their next big event. I hope to see you there.

David Burren 01:53 I'm David Byrne. I live in Melbourne, Australia. I've had type one diabetes for 40 years now. Wow. I mean, but in my mid 50s. Now I'll be in my mid 50s later this month. That's what my wife tells me

Scott Benner 02:12 sounds like you're 54 Yes.

David Burren 02:19 Let's see. Quite a few Australians know me because I run a website called The Bionic monkey. There's a Star Wars reference in there. Which is all about diabetes technology. I've been living with closed loop systems, self built closed loop systems for about what more than five years now? And I I I've ended up coordinating a lot of the Australian community of do it yourselfers. That's cool.

Scott Benner 02:56 Okay, so you were diagnosed? Geez, when you were like 14? Yes. Okay. 40 years ago was AD AD AD to Jesus. Wow. That's a long time ago. Okay. It's crazy. You. You said you've been doing closed loop. So you've been doing? What have you tried a bunch of different versions? Or which one did you start with? I guess.

David Burren 03:24 Okay. So I started using a pump in 2010. Just to illustrate a little bit about my life, I've done various things during it at my endo had suggested to me a few times that are these insulin pumps, that might be something that you'd be interested in. You're a really technical guy. But I had been very much in the World of Goo. I know how injections work. There's going to be this strange thing of something attached to me. What happens if I fall off a boat or I get wet or something because in those days, pumps weren't waterproof. And then in late, late 2009, I attended a local event where I actually got to see and play with some of the NMS pumps, which were Hey, they were waterproof. And I decided right, this is something I wanted to do. I think that event was in September. Then I organized with my D, my data so they're getting a pump, but then I had to put it off until February. Because over December that year, I was an artist in residence on a ship traveling up and down the Norwegian coast photographing the Northern Lights. Because as well as working in it, I've also spent quite a few years as a professional natural wildlife photographer. Oh, wow. So I've done a few different things but so I started pumping and That went on for probably six years. Before I started using libre, that was the first CGM I got access to. That was 2016. And by early 2017, I'd seen the loop system and I'd seen the open APS system and I decided that open APS was the way I want it to go. So I started, I was carrying a little Android phone. And that was being my CGM and feeding the stuff into my little pocket computer that was running the open APS stuff. I was using an old Medtronic pump. And then in 2018, I got a combo pump, which were being sold in Australia at the time, and that's a pump that has Bluetooth in it. And Android APS could talk directly to it. That's the accucheck. Yes, the accucheck combo, which has last year it was discontinued. That had

Scott Benner 06:01 that had Bluetooth in it and 2018.

David Burren 06:05 That had Bluetooth in it in 2011. When it came out, wow. I have no carry. That's cool. That's a very old and primitive pump. And the interface that talks to it is quite slow. Because basically it's pretending to be a person navigating through the menus. It's not actually sending it direct commands.

Scott Benner 06:21 Oh, no kidding. Do you? Do you see it happen on screen as it's not? The screen

David Burren 06:26 is blank at that point. And it goes faster, faster than I would but it's still slower than if you're actually sending commands directly to its interest, but it works. Yeah. And that works quite well. So I've been using Android by system since 2018.

Scott Benner 06:43 Okay, so you use open APS still today.

David Burren 06:48 I don't use open APs. But Android APS uses the same algorithm. Excuse me,

Scott Benner 06:53 I misspoke. But okay, Android APs.

David Burren 06:57 And I'm not actually using Android APs. At the moment, I'm using something that's very similar to it, which is a version of the software that we've frozen, we use in some clinical trials. Because I've been involved in running a clinical trial over the last few years of Android APs. So this is on people in the real world. But it's a randomized control trial. So it was all at the level that the medicals would actually pay attention to the results rather than people saying, oh, it works for me. I haven't killed myself. Yeah. Right. And so that's through a local hospital. And basically it feels like some of the staff there look at my clinical results of me living my own life doing stuff and they say, oh, that's, that's amazing results. But we need a clinical trial. So I can actually prove this, this works. And in other words, that I'm not just a freak.

Scott Benner 08:01 Right? Well, that it doesn't just work for you and no one else but it is interesting how you are holding up your you are holding up your self as an example. It's like, Hey, look at this. This is what's working for me that like yeah, that's nice. We need to prove it. Yeah. Like I feel like

David Burren 08:16 so the that trials over and I on that one, I was the local technical expert on this hurdle plugs together and oh, when using a different insulin pump for this, so I was the guy who wrote the bluetooth driver to talk to the pump. So I'm fully involved in the technical level as well. Okay.

Scott Benner 08:37 So let me just for people listening, I want to just make sure that they understand. So loop for example, Arden uses a version of loop. Actually, I think Arden's using open APS right now. With the auto Bolus version,

David Burren 08:56 the free APS free, six,

Scott Benner 08:59 free free APS, thank you. Well, I don't this is the part that this is why you don't come to me, David on any of this stuff. Arden's using aren't using free APS, which is a version of loop that does auto bolusing. We are waiting to see the version that works with Dash pods, which I think they have been getting, I think they're getting it close to buttoning it up

David Burren 09:24 the loop world is it seems to be a bit fragmented. So there's various branches and versions that people are experimenting with, which is fair enough. That happens in all systems, but there's loop and then some guys made a branched version that they called Three APS, which was looped with some extra auto Bolus things. And then they made a different version, which is called free APS x with letter X on the end, and some people refer to it as short in shorthand is fx. And that is the open APS algorithm that It's also used by Android APs and open APs. But running on the iPhone. It's basically using all the communication stuff that was set up by Luke to talk to the pumps and the CGM. But they've put a different algorithm in the middle. But there's at least three different systems on on iPhones and to a certain extent, they all look and feel very similar. Yeah. Is there? So it's a bit hard to know what people are using when they say, Oh, I'm using free abs? Which one?

Scott Benner 10:28 Trust me, I don't know that. I know. I think sometimes I just, I, you know, I have people around me that say, Hey, this is the one you should be using right now. Like, okay, fair enough. Do you think there's a lot of outcome difference between loop Android APS, open all that stuff? Do you think people have basically similar experiences,

David Burren 10:47 I do think there's a difference. The openaps algorithm, which is called a ref one, just in case, I mentioned that, again, that has a bunch of things. It has SMBs, super micro boluses. So it's, that's where it calculates, oh, we need this much basil to do this amount of work, because we think we know where the glucose is going. So we need this much insulin. But the basil is going to take a while to get it in there. So the super micro Bolus will take a portion of that and deliver some of it as a small Bolus now, and then in five minutes, it might say, oh, we need some more. Or it might say, Oh, I better not put too much in because we've suddenly changed direction, just as well, I didn't put it all in at once. So that has made it reasonably fast at reacting to thing. It's carbohydrate model. Unlike the commercial loop systems, it's a dynamic one where you tell it how many carbs just like loop, you tell it how many carbs and then it decays those away, it has an idea of how many carbs are on board. And that's partly affected by what your glucose has been doing. So it basically only decays them away when it says oh, it looks like that that was one of the carb effects going on. Because that wasn't the same as what we predicted was going to happen without the carbs. But then it has a mode called UAM, which is unannounced meals. Where it looks at what your glucose is doing and says that looks like food, I'm going to treat it like it was food. I have not counted carbs or declared food to my system for almost two years now.

Scott Benner 12:51 I asked chat GPT to write an ad for touched by type one. And here's what I came up with. This episode is brought to you by touched by type one, a nonprofit organization dedicated to supporting and empowering individuals living with type one diabetes. Living with type one diabetes is a daily challenge. But touched by type one is here to make that journey a little bit easier. With our incredible range of resources, educational programs and community events. They're committed to making a positive impact on the lives of those affected by type one diabetes, from the dancing for diabetes event, to their annual conference, which by the way I'll be speaking at doesn't mention me but I'm not insulted by that. Touched by type one is always striving to make a difference. And the best part touched by type one is offering our listeners an exclusive opportunity to join their community and assess their resources for free. That's actually all true. Touched by type one.org. Just visit their website or find them on Facebook or Instagram. Touched by type one.org. Love this thing. I'm not even gonna have to think anymore. Don't let type one diabetes to find you were touched by type one by your side, you can lead a fulfilling life and take control of your health. So head over to touch by type one.org and get in there learn more about it. I'm adding that part because it's pretty great. They have a wonderful website. They do a lot of amazing things for people with type one. There's a bunch of programs just seriously take a couple of minutes to look into them. And if you're coming out to their event this year, I hope we meet please say hello touched by type one.org.

David Burren 14:34 I have not counted carbs or declared food to my system for almost two years now. I do not carb count. I do not Bolus I just eat and live my life. I don't know anyone who manages to do that on loop unless they're low carb. I would probably eat 200 to 300 grams of carbs most days and sometimes I go way over that. So I would not describe So for the low carbon.

Scott Benner 15:03 So the UAM on announced, what does it stand for?

David Burren 15:06 On announced meals on announced meals.

Scott Benner 15:10 So, and this is the on the Android aps that you're using, that hasn't Yes. Okay. And it sees, so you just eat, and it sees the rise, assumes it's a meal and hits it.

David Burren 15:30 Essentially, it's doing it in that cautious way of we're not going to Bolus everything we, we don't think this is a 100 gram meals. So we're gonna give it however many units of insulin right now, it doesn't piecemeal. But because it can come along every five minutes and dose another little bit more. It reacts fairly well. Now, I knew that the system had this out that the algorithm had this functionality in it back in 2017, when I started and this was one of the things that probably affected my decision as to which system was going to go for it know anyone who went completely Bolus LIS at that point. But it's always doing that in the background and saying, Oh, you missed a snack, I'm going to follow something for it. And back in those days, I was using jemalloc. That was the fastest instrument we had access to here. When I got access to figures, I thought, Oh, this is great, I'm finally going to be able to try and go hands free. And we were going out for Mexican that night. And that was a disaster. So

Scott Benner 16:41 it didn't work out though, you

David Burren 16:42 know, it took a fair bit of fine tuning. First of all, I had to get the dosing adjustments changed for fasp. Because the system was reacting slightly differently. But then I know a lot of people who see what I'm doing, and they come along and say, quite understand, but I want that right. What do I do to plug these things and turn it on? Because I want that? I want that now. And my general feeling is, well it takes a while because you need to know that you've got your underlying settings, right? Because what I started with was, yes, I was counting everything, declaring everything I was counting in declare eating protein as well as protein I can declare as as though they were a smaller amount of carbs in the future. On sort of metrics, what the body does, right, I was I was counting and bolting for food. And then I was getting great timing range, everything was going where I wanted. And then I'd start skipping announcing on some snacks, and how it worked. I stayed in range. And then you do it on a biggest accurate meal. And it all goes out the window and haven't quite got it right. Go back and fine tune. And I went through a phase where I counted and declared the carbs, but I didn't Bolus. Actually step before that. I counted and cleared all the carbs, but I Bolus less than the full amount with the expectation this system was going to take care of the rest. Essentially, in my mind, when you're Bolus for something with these systems, the Bolus is really just giving it a heads up. The algorithm should work out what's going on. And if you've told it, what curves are in there, it's going to do great. It has to guess it all by itself. It might not go quite as well. I actually found if I under counted the curves, the system. It's almost as though the system says You told me it was this much. And it doesn't react fast enough. If I over count the carbs a bit. It says oh, you've told me it's this much. But I haven't seen all of those yet. And eventually, they must have not been there. Because the algorithms always had this thing where it dynamically decays the carbs. So that if you didn't eat the second course or you dropped your ice cream, it didn't actually eat it, then it wouldn't necessarily try and deal with all that food that you might not have actually eaten. It's fairly flexible in that way. But it was a general process of taking away the bolusing but still declaring the caps clearing all the protein and yes, everything was coming in right? Oh no, I have to tune things. My insulin to carb ratio needs a bit of tweaking or my profile needs a bit of tweaking. And then I think it was November was I made some notes in my diary November was the last time I bought last and then in February was the last time that I declared carbs. Because I've gone through Christmas with not bolusing declaring all the food but not bolusing. And this was Christmas, New Year, there was lots of food on the table, and everything sort of went in range. And that gave me the confidence to stay right, let's, let's go completely hands free and see what works. And it did me ask you a little bit

Scott Benner 20:23 about the food you're eating? So, I mean, is this like a very balanced meal of natural foods and etc? Or is this Captain Crunch? At you know what I mean? Like, are we are you not taking in a lot of high fructose corn syrup? Are you avoiding things like that?

David Burren 20:41 I do have celiac disease, but I'm avoiding things with gluten in them, which means that I tend I tend not to eat too much bread. Maybe my diet isn't completely typical. I do. I do find I try to eat sensitively. But I don't all the time, we try to have meat and veggies and a mixture of things. Breakfast is the meal that I probably pay most attention to. Because I always found that I was most sensitive to carbs after fasting. Yes. And that might be because the Gus is all primed and ready to accept these carbs and leap on. There might be one way of looking at them. I have some friends who have children with diabetes and they swear by we give the kids something to line their stomachs that like bacon and eggs or something. And then they can have cereal and it doesn't spike them through the roof. So my breakfast, I have a standard breakfast and basically yogurt and some strawberries and some psyllium husks. So there's fiber in there. It's just a simple, basic breakfast that I don't have to think about, I can just get up and go to the kitchen and have breakfast and get on with my day. I'm on autopilot. And at that point. It's not a huge amount of carbs. And once my body's reacted to that, and I chose that breakfast, when I was still in still counting and bolusing because it was just easy to organize, I didn't have to think about what's my carb count this morning, I could just say, I think it's about 17 grams. Breakfast, it's not a not a high carb breakfast. But after that, whatever food I feel like eating, whether it's at an 80 gram block of chocolate, or an apple or sometimes I'll have a like I said I tend not to eat bread. So sometimes I have things in reps, but the sweet potato wraps because there's no gluten most of my I tried to go low carb in 2017 I thought this this will help me control my my glycemia which was bouncing around all over the place. But in fact, it didn't especially help i Then I was actually thinking at the time, I need to lose weight because I was classified as obese at that point. And I didn't really lose weight. But later on I worked out now it's about actually about the calories when you're trying to lose the weight. Just just ate a reasonable number of carbs. But I've never really excellent when I say never years ago when I started out it was you inject this much and then you eat this much. We ate to the insulin whereas now it's if I ate more, I'm going to inject more or more of the point if I ate more my pump will have delivered more insulin by the end of the day.

Scott Benner 24:01 When you say staying in range, what do you mean by that? What are your goals?

David Burren 24:07 Okay, so I use I'm hesitating a little bit because my brain tends to run in millimoles and I know you're used to milligrams. So in milligrams the range I aim for myself like the green band on my setup is 70 to 140 Okay. And my target is around 90 That's where the system's aiming most of the time.

Scott Benner 24:35 How often do you get under 60 allow that you need to do something about

David Burren 24:45 let's say my neighbor brain is saying what 60

Scott Benner 24:51 I can get up my my chart. I can talk to you like this

David Burren 24:58 three point 3.3 RDL Sorry, I shouldn't wear the what I should do is one of my friends calls me sir graphology let me pull up a spreadsheet my time in range 470 to 140 is generally averages around 85%. And if I just find this stuff in here, we get my time below range, or all sorts of pretty graphs, here we go um below range for 3.3. That would be around half a percent of the day, on average.

Scott Benner 26:16 So you don't, generally speaking, find yourself rescuing your blood sugar with fast acting glucose very often,

David Burren 26:22 every now and then I've had some weird things just in the last couple of days where I will, I'll be low in the middle of the night. And this is hanging out. This is not the way the world works. But it's a timing thing. With the way I've changed a few settings recently, and to do with the high insulin on board that I've had the previous night. I'm tuning that. So I've generally got rescue curves around. And I always have rescue cows with me if I'm off on a big bike ride. Exercise makes things tricky. But I generally don't go through them very often,

Scott Benner 27:00 when you talked about earlier that you had to change your settings to work in this. In this system that you use where you're you're basically you're telling the I guess you're telling the algorithm look I'm eating, but don't give me all this insulin or don't give me any of it, and then it's on you to use it as you see fit. Are you still doing a? What's my question here? Did you change your settings to make them so heavy that they wouldn't work manually? If you went back to just you know what I'm saying?

David Burren 27:32 No, my, the Basal that's programmed in is my default Basal. If my loop turns off, I know that it will keep me fairly flat, okay with as long as I'm not changing things with food, and so on. So know that all those numbers are traditional numbers. But I'm really confident in them and some of the other things that I tweaked, were tuning the insulin modeling. So for example, the duration of the insulin in the system and the way it decays. So that hours after a big meal, the estimate of insulin onboard is actually correct. And I found that made a big difference to how the system was automatically reacting I can make its predictions actually met reality.

Scott Benner 28:24 Was that easier when you move to the ASP

David Burren 28:28 I actually found that is I found it easier to chain and notice the differences when I went to Furter insurance. So I've used an ace Nova rapid and a Piedra and human log and fierce and Liam Jeff, we can't get the longevity in Australia. It's not even it's not approved as a medicine here, but we're allowed to import it for personal use. So I got some from a friend in Europe and have done some experiments and it's quite nice. The faster insulins the decay in insulin happens faster. So it makes a lot of these things more visible.

Scott Benner 29:08 Right. So it's interesting. So that so the algorithm, it's more precise. So yes, yes decision,

David Burren 29:14 I found it easier to make that tuning but at the same time, having tuned the system, I felt like the faster insulin. Let me move into this mode where the system could take care of most things for me. But I have since experimented and gone back to the slower insurance like human logon Nova rapid and life stays the same. Interesting. It's all it's all automatic. It does. I do go high after a meal and it takes longer to come down. And looking back in the old days, I probably would have said oh, I'm too high. I need the Bolus I need to correct and get things down whereas now I have confidence in what the system is doing and then that in a couple of hours, it'll help me down at the right point. I'll be flat in the morning. It'll be fine. Oh, yeah, the fat pasta rangelands. Give me more freedom. But I know the the slower insulins work. There is a complication in trying to compare them though because I compared my timing range for a couple of weeks on one versus a couple of weeks on the other. And they were about the same. I was thinking, hang on, this can't be right that pasture insurance supposed to be better. And then I realized I wasn't eating the same because I had the faster insulin, it's Oh, I just ate that and built it, it'll take care of it. So I will be keeping everything else the same. That's

Scott Benner 30:41 interesting. I tried my hardest to switch Arden over to one and she just had the fiasco she described sometimes as burning. But But the biggest problem is that when our pump site came off, it felt bruised. For for a while after that, the loon jab was significantly worse than the ps4, which is a shame because I also talked to a lot of people who don't have any trouble with it. But

David Burren 31:09 I was aware of these going in because a bunch of people in Europe have been using it for a while and have discovered things about them. So oops, my backgrounds just gone. That's fine. The with CSVs is Nova rapid with the addition of was it's nice in a mode as the main accelerant. And yes, a lot of people report stinging, some people will report occlusions sometimes they say the occlusions in the pump. Some of them reports that their site gets red and inflamed, and they have to change the cannula more often. Some people's report that after some random time, whether it's three months, six months, or whatever, it's like it turns into water and it doesn't work anymore an advocate back to something else. I was aware of all these things before I started. So what I did was I I mixed BS with non accelerated insulin. So if you think about Nova rapid, and VS by the same thing, but BS has some of this accelerant in it, if you mix them together, it's still the same insulin, but there's less tolerance spread around. So no doctor is going to say you can do this, but it's all completely off label. But I used that sort of setup for about three months, and I didn't have any steam. And then eventually, I changed to 100%. And I didn't have any stinging and I haven't had an instinct when it came to being objective. Similarly, Liam, Jeff is the same insulin as human dog. But with the addition of a little vaso dilator trip trip is still I think if I remember that name, right? Anyway. It's also used in some other therapies as a vaso dilator. And the general reports there seem to be it stings like hell, but you get used to it after six months, and your body adjusts and it goes away. So what I did with him, Jeff was I mixed it with Humalog. So I had a lower concentration. And I did that for a few months before I went 100%. And I haven't had any singing. I did notice some stinging early on, but it didn't last long. Sorry. One of the other things relating to that is, little Jeff is available in Youtube 100 as well as new 100. And a lot of people report that the YouTube 100 doesn't sting as much. Interesting. And that makes sense because the accelerant in that is the same concentration for you 100 And you're 200 by volume. So when you administer one unit of the you 200 You're getting half the amount of accelerant than you would with the 100 So it's the same sort of thing of less accelerant. Right.

Scott Benner 34:31 Last thing Arden described the longevity is unbearable. Like she she lived with the fiasco for weeks and weeks and weeks before she finally just said this isn't getting any better. But the the looms if she was like you have to take this off of me I don't think she made it may be more than an hour or so. Which I found

David Burren 34:52 I exception. I don't I don't know if my success with them has been because I took it very slowly. Introduce it slowly or just with a, I was never gonna have a problem anyway. Right? I don't know.

Scott Benner 35:06 So this process you use, do other people use it as well? Or is it just worked for you? Like, like, I mean, I mean you're describing, basically not counting carbs and and not Pre-Bolus thing at all. And you're doing it just with settings. I mean, you know that sounds a little crazy. So I'm trying to decide if your view given to other people or not.

David Burren 35:33 I started doing this because other people were doing it with some of the faster insurance in Europe. And I've, I've been doing it for a while and I've been fairly vocal in our local community about the fact that I'm operating this way, because someone says, I have to carb count for this and the Bolus are a bit mean sometimes I say the Bolus, what's the Bolus? That some people have told me since that they've basically they've been emboldened what I'm doing by what I'm doing. And they occasionally don't Bolus for some foods, and everything works. And some people don't Bolus anymore, but they do announce most of their foods or they announced the big meals. So there's these compromised lines. Because one of the nice things about this is you don't necessarily have to put everything in go completely hands free. You can do any of those stages along the way. And it's been surprising for me how many people just pipe up every now and then and say I Yeah, it's working for me too. And it's not okay.

Scott Benner 36:44 Well, we can I guess you can kind of post date a Bolus in loop. So if Arden's taking in something that I think is like, has a lot of fat in it, or it's been deep fried or something like that. Those sorts of foods, if she makes a Bolus, and Pre-Bolus is her meal, and then tells the loop, I don't know an hour from now expect 20 more, you know, the impact of 20 more carbs, for example, I find that gives the loop the autonomy to push harder when it sees a rise than it would if you didn't put these, you know this empirically in the future. That works really well.

David Burren 37:28 Yeah, I, I used setups like that early on, to try and understand what was going on. And that works quite well. A couple of things to talk about there. So there is a strong sense of yes, this stuff works for me. But maybe it's just that I'm afraid. I don't mind being called the freak as long as it's got us doing it with a smile on your face. I know quite a few other people. I've said it's surprising. This is working for quite a few people. But there's also quite a few people who say, Well, no, it doesn't work for me. I've tried that and it doesn't work. Now, I don't know if their bodies are different. Maybe their bodies are the same and then just not holding the mouse the right way. But I think that's less likely, then we are all different because that's the nature of diabetes. We're all different. I know quite a few people in Europe as saying the totally hands free stuff works. But you have to be using looms, you have to work. And you need all of these settings. And some of them use fairly aggressive setups where they enable some of the automation in Android APs. So for example, when you're going high, it changes the rates and says we need a stronger profile to try and fight it to bring it down. And essentially they start implementing another level of loop algorithm on top of what the system is trying to do. And that sort of works for them. And I tried doing some of those things early on, but I found it often overreacted. And for me, I found it was better to get the base algorithm doing the right thing. Now, there's a bunch of people who've made variants of Android APS, there's a dynamic ISF. Boost Ami. There's a tsunami, there's a bunch of different variants where people have been changing the algorithm to make it more aggressive. So it said, Oh, it looks like we're getting food. We're going to change the rates and dose for for the next half hour or do whatever changes. And if you've been using a lot of insulin lightly, we're going to assume that you're more insulin sensitive and dynamically change things. People have been doing all sorts of experiments. And a lot of people are quite enthusiastic about other systems that they're not mainstream yet they're still experimental versions on the site. I'm probably the unusual thing about me is, I'm managing to do this with the base, the standard stuff that's been around for a while and not using those advanced algorithms. Yeah. I didn't mean, I didn't mention the last clinical trial I was involved in, which is over which was using Android APs. And showing that, yes, it's safe and effective, and we get good clinical results. We're lining up to do the next one. And I mentioned before, the researchers tend to look at what I'm doing and say, we need to work out how to do that. You can guess what the next trials about.

Scott Benner 40:46 They're gonna try to figure out why you're not you're not having to Pre-Bolus your meals.

David Burren 40:50 So we're gonna have a whole bunch of people in two countries who will be doing that, in a randomized control trial. Wow,

Scott Benner 40:57 how long does that take to do that? That study?

David Burren 41:02 It's gonna take about two years to run, I think.

Scott Benner 41:06 How many people will be involved in it?

David Burren 41:08 It's less than 100. And they're not all running at once. That's why it gets spread out a little bit. But people will be involved in the trial for over six months. Ah,

Scott Benner 41:17 wow, that's pretty great. When they get that when these hospitals get this information, what do they do with it? Right, because it's not like, it's not like, Android. APS is a company, you don't go back to them and say, here's what we're learning you there's not a there's not like a dedicated group of a half a million people sitting in a circle waiting for you to come back with it and tell them what to do. Like, what happens when you get the data? Is it just inform more research? Or you know what I mean? What's it? What's the goal of it, I guess?

David Burren 41:50 Well, they call it a hospital. That's the sort of hospital I'm working with is actually not a hospital. It's a Medical Research Institute. Okay, that happened that happens to have patients and run endocrinology practice and do all that stuff. And most of the participants in trials, they do lots of trials, most of the participants in trials come from their client base. I see.

Scott Benner 42:17 Okay, so they have things they're trying to, to move forward as well.

David Burren 42:23 Yeah. And certainly, the results of this stuff gets fed back to the community. Because this stuff is used in multiple, by multiple software systems, it's used on some of the iPhone systems. So the three MPs X, for example, that same algorithm. And there's a general feeling of everyone should be able to benefit from this because the algorithm that's been used is not some secret sauce, not hoping that type zero have made up in the lab and or am I ever made up in a lab and not telling people exactly how it works, because that's their secret sauce, this is all open source, everyone can see what it's happening. So hopefully, new products will come out and be able to take advantage of this because this stuff is really making life easier and better for me and for lots of other people. And it needs to be able to do that for a lot more. Well, everyone deserves one of those systems.

Scott Benner 43:28 Yeah, that's the real goal isn't it is and what I was thinking earlier, while you were talking is even though the even though the retail systems are all really relatively new, in the last couple of years, it's still kind of astonishing that they can mass market, put it on people and get results like that. Because I mean, like what you're talking about is I have a system, but now I significantly understand the implementation of how it works. I significantly understand my settings, like really specific stuff that you put a lot of time and effort attention to, while other people are just like, look at buying this thing. It's on I wanted to go and they're having reasonable like results for the most part. And that's astonishing to me, like, I don't know how you make something that that needs this level of detail. And yet, you know what I mean? Like you don't ask the people what they eat, you don't ask them if they're hydrated. You don't ask them if they exercise if they don't exercise and people are, I don't know, it's amazing, you know.

David Burren 44:32 I do still tell my system when I'm exercising, I tell it to change targets because I'm managing the insulin on board. And I think most of the commercial systems have that whether it's ma PS has, you're going to ease off or a boost. It's basically gotten a braking and accelerator function and control IQ has exercise mode. And

Scott Benner 44:54 what I meant is that you can't you can't know that when you hand something out to the masses. they're not they're not they're not all doing it the way you are, you know what I mean?

David Burren 45:03 And this is the big compromise that we're all dealing with. And this is why the commercial systems like this, it's one of the reasons why the commercial systems don't have all the functionality that, for example, I have access to because they've had to go through the regulators, because the regulators say this needs to be safe or not kill people.

Scott Benner 45:27 And for everybody, not just people who will take a ton of time to understand it. But you know,

David Burren 45:32 that, unfortunately, some of those regular sheet decisions, I think sometimes because they don't, it may be because they don't always include people with diabetes in the decision making process, I think they sometimes end up with less safe things, such as the examples of the Medtronic system. So they had the first commercial, closed loop. And it's basically, oh, we've been working too hard with I've been giving you so much extra insulin, and you're not coming down. So I now need to stop and drop into manual mode and stop helping you because it's obviously not working. That was some bean counter said, Well, the best thing to do. Whereas if I'm sick in bed with the flu, I want the damn thing to keep delivering insulin. And to help me get through this problem.

Scott Benner 46:27 Yeah. Yeah, well, no, it's 100%. I mean, all of them are, I'm assuming, at some point, drawing a line in the sand and saying this is this is, as far as we'll, we'll say, we can help. And you know, if something happens past that, it's got to go back on the user.

David Burren 46:45 Yeah, and I think some of those fall back on the user have been a little bit primitive, in terms of, well, that's the way it used to work when you had a manual system, or we just say, or the user take care of it again. But the user at that point has gotten used to it doing a lot of work for them. So it's suddenly a bigger drop out for them and it becomes less safe. So finding a compromise on all of this is a challenge for everyone

Scott Benner 47:09 Arden's a college now, and just last night, she had a meal a while she was, you know, she's in a room working. And I think I'm watching it, like Get away from her. And I sent her a text, and I don't think she saw the first one. And then she gets this rise that just goes 141 5160 on my garden, you know, but you didn't put in a secondary Bolus if the meal was and now I'm in a bit of a loss. I don't know what she ate, you know. So I'm like, if the meal was heavy in this, or this, you know, you forgot your secondary bowl. She's like, well, it wasn't. So I'm just going to make a correction here. And I'm like, okay, but I didn't see it working. And now she's fighting with it for a few, you know, a few hours in the late evening. And she just, she loses the fight with the Bolus, and she loses the fight with being tired. And she just goes to sleep. And, you know, I tried to wake her up, I, you know, it's a higher blood sugar, not a lower one. So I'm like, alright, well, you know, I sent her a text like, Hey, you got a Bolus, again, I don't hear from her, I finally called and woke her up. And I said, Hey, you know, put put some insulin in here. But at that point, David, I don't know what to tell her. I don't know what she ate, I can see what the the algorithms been trying its hardest over the last couple of hours. It's not working, you know, it's just keeping her level at a higher number. I know she needs more insulin. But I don't know how much and I'm tired. And you and I got to we're gonna do this. I'm gonna be up early in the morning my sunlight or doing something later tonight. Like, I've been sick recently. And like, I got asleep a little bit here. And so we put in enough insulin, we weren't as aggressive with it as I would have been if we were wide awake and looking at the same example. But she woke up this morning at like 110. And, I mean, on any manual system, or if a system would have kicked into manual, she would have been, I mean, I'm assuming she would have been 200 Plus, and it would, and she would not have woken up with any kind of resolution to the blood sugar. This doesn't happen to her all the time. But it's your point about you know, I know this thing's gonna do what it's going to do. And I'm going to end up okay. It's an amazing benefit, you know. So, anyway, what, what else did you want to talk about? What, what? What made you think I want to come on and talk about this on my podcast?

David Burren 49:28 I think it was probably something I posted in the Facebook group that you responded to and thought he sounds like an interesting person to talk to.

Scott Benner 49:38 I definitely do that. But I have to admit, David, 45 minutes into this. I don't especially understand why you don't have to Bolus. I don't I don't know that I Okay. Yeah. I don't know that. I understand why it's working for you or the, you know, like if somebody's listening to this right now. And they're like, Well, I don't want to Bolus for For like, this sounds great. Like, what do I do?

David Burren 50:02 Yeah. I don't have easy answers. But I've got some things that might help understanding a little bit. Because I've talked to a lot of people who say, How can this how can this work? This person personnel at the CGM is always lagging behind. And then when when in when we inject the insulin, it's going to take a while to happen. So when the system sees the arm going up, how can it react in time, it's hard enough for me to Bolus and Pre-Bolus enough for something to act in time. But I think part of it is the way the dosing works. Because it does all these predictions, the RF one algorithm, when using loop, you see the predictions of where we're going to go. And, or I should say the prediction, singular prediction, it's a line that goes off somewhere, and it might go down below zero at some point, then come back up three hours later and go sky high, which doesn't make any sense. Because if the line went that way, you'd be dead by then. The RF one algorithm draws, that's called an announcer ensemble forecast multiple lines. One of them says, This is where we'll go. If you didn't eat any of the food you just told us about. This is where you'll go, if you did eat the food. This is where you go, this is where you'd go. If we turned off the insulin now. It makes a bunch of predictions. And there's another line of this is where we go, we'll go with UAM. So when we think you're going based on what we've noticed about the food, that's where the longer seat, there's these massive lines that go up to the right on the graph. A lot of people look at that in different colors, they look at it and say, Well, how do I know which one is right? Well, the system doesn't know which one is right, because those are all different possibilities. But it plays a safe game, so that any of those are going down into hypo territory, it's gonna make this decision to try and keep you out of there. It makes a guess as to which one of those is more likely ending point. But that guests may change in five minutes time. Every five minutes is growing new predictions, and saying, Alright, looks like we're going over there, it looks like we need this much insulin to try and get us back to target. And then, if we ever calculates the we need, oh, looks like we need three units of insulin. And then it might deliver one of those or one and a half of those. And then five minutes later, because I know, I know, no, no, we need 10 units of insulin, if that would start putting some more in. So it actually does that at a much final level. So if I was looking at my CGM and saying, oh, it's struggling along, it's going up and down, it's going up and down at about level, or is that going up? Oh, the next rating comes in. How's that going? Yeah, I think that's going up a little bit. I'm going to have to Bolus the automated system. By that point, we'll have been doing a bunch of little micro boluses. Along the way, saying looks like we might be going up we'll need a little bit. Looks like we're going up a little bit more, we need a little bit more. The point is those little bits of insulin already in your system and working. So when we're looking at things manually and saying, Alright, I need to dose now. We've introduced a big delay, and the insulin is going to have to play catch up. So I think that regular dosing actually helps the system stay on top because it's taken a few choices kind of face to face along the way and added some insulin into the system. already.

Scott Benner 53:49 It's almost like it works better when it has the insulin working, and it can adjust by taking away instead of

David Burren 53:57 well. We can never take the internet well. No, no, no, not

Scott Benner 54:01 not taking away what's in there. But taking away basil in the future. Do you know what I mean? Like instead of you using a unit of basil over an hour, it's sometimes it feels like if you just gave it the unit, and then let it decide, okay, well, I'm I'm going to I'll turn the basil off. I'll put it back on 2.2. And I'll bring it like you give it a lot of autonomy that way. And I have noticed that it, it works well. When it has the the insulin at its disposal and then kind of works backwards from that. I don't know if that makes sense or not. But

David Burren 54:35 it it sort of does in a nonliving environment. It will start off in the assumption that the basil is just constant. Whereas now now we know we can turn that off. Turn it back on in the future. Though historically endos often talk about your Basal Bolus ratio or 50 50% is a nice balance and Crazy Talk as far as I'm concerned, for a start, if you're eating, if you're having a high carb day, you're gonna have a lot more Bolus, that your Basal is not necessarily going to be more. But then it doesn't really matter if it's a Basal or Bolus, it's just insulin that goes in doesn't matter if it gets given as a bunch of separate bonuses, or as increased by basil. It's just insulin, as long as this system of tracking when it goes in, we're getting the right amount at the right time, that mix of which one it is doesn't really matter. Yeah. Which makes it a little bit hard when you have an endo who says, but the percentage,

Scott Benner 55:38 but I know something about the setup of on the pod five, they want it near 5050. But then the algorithm almost immediately makes decisions after that and moves things around. So I don't think you know, it's something about the way that one set up. It's important, but you know, when you go back and look at the insulin, it's not, not always going to be like that. Yeah, I don't see why that's I don't understand why 5050 is important. That sounds arbitrary.

David Burren 56:08 Yeah, I think it's a historical artifact. When people were dealing with Basal and Bolus injections, that was sort of a guideline as to this sort of works. For most people. That's a good starting point. But I don't think it's the goal that you need to try and get back to right.

Scott Benner 56:24 Now you need Basal you need and you need the bang, you need the Bolus you need. That's it. It's just

David Burren 56:29 well, in today's world with the pumps, adjusting things up and down, you just need the right amount of insulin at the right time. And the basil and Bolus is all the same stuff. Right? You know, whether you take away what we're going to give it by default by basil in the future, which is what you were talking about, and answer the same thing?

Scott Benner 56:50 Well, I think, too, I want to I want to mention that the idea of like, I don't understand, why do why do I notice things working very immediately on a on a looping system. When we know the data is behind from the CGM when the insulin takes time to work. I don't know how to describe why that is. But I do know it's true. Like I do, I do think it's just, I think the algorithm by by guessing at the future or predicting so many different possibilities in the future, I think it's somehow shortening the, the distance between what's actually happening in this moment, and what the data can tell us is happening. Because you can tell me if you've seen this, too, you can look at a blood sugar that's not moving, right? And the algorithm is trying it's given like with with loop, what is it giving you like I think 40% of what it's suggesting. So it suggests a unit, it gives you point four, it waits five minutes, there's still point six less than it hasn't given you, it gives you another like 40% of that it's making those Bolus as long the way you look and go, this is not enough, it's clearly not enough. If you manually in that moment, push up the Basal insulin, or you manually in that moment, give all the suggested insulin, the blood sugar almost turns, I don't want to say immediately. But it's shockingly quick after that, like it really does feel like cause and effect in a way that you don't expect. I've never seen that manually working with an insulin pump. But I have I've seen it so many times and loop that I trust that that's what's about to happen.

David Burren 58:28 And I think that's largely those earlier doses that I was talking about is been giving you partial doses along the way. And those are all adding up.

Scott Benner 58:36 Yep. And you're and you're this close, but it's just not tipping. And then you just push a little harder, and then all of a sudden, I see it. So some

David Burren 58:44 of the some of the things that I was adjusting when I was tuning my system and making it more effective is some of the safety limit. You talked to there about the 40%, right? So in the IRF, one system, there's some controls for what it will do 50% of the calculated insulin, it will do 50% Now and then in five minutes might do another 50% of the new production. But there's also a limit of it's essentially borrowing Basal from the future calculates this is how much basil we need. And then they'll say, All right, I can use the next 90 minutes of that I can bring forward into this initial dose. Yeah. Or maybe the next 45 minutes or maybe the next 120 minutes. So you can make it more aggressive and borrowing stuff in the future. And if you do that too much and your settings aren't right, then it can end up potentially overdosing and you'll go low later, right. Right. So the the safety limits are set relatively low initially because they don't want to overreacting so it was watch the system and see that I can be that I'm going up and I can see what it's dosing. And I don't think it's doing enough, I look at the calculations, there's all these messages coming out in the logs. If you go and look at the right page in the software, it says, we've constrained this because of this. And it's alright, I'll increase the safety limits a bit. So there were some tweaking, they're not just changing my, my ratios, and so on, but also freeing up the system. So it was gonna make the right choices without just opening the floodgates and letting it overdose me too much.

Scott Benner 1:00:31 So let me ask you this. There's a person like yourself, who understands all this and donates the time to it to help themselves out. But generally speaking, how many people do you think are doing this? Even across the globe? Like, how many people with type one do you think are using some sort of a do it yourself algorithm?

David Burren 1:00:53 Can it be that many? 10s of 1000s at least

Scott Benner 1:00:58 okay. I mean, that's, so that's one of those things. We're like, that's a substantial number. Until you look at the whole of everybody who uses insulin to stay alive. And then you're like, well, nobody, nobody does it. Why do you think that is? Because, I mean, Arden has been looping for years now. You know, she took a break and did on the pod five for a while, which worked exactly the way we expected it to. But she really did not want to carry around the receiver that was necessary for so bright before she went back to college. She's like, can I please switch back to to loop? And I was like, Yeah, that's fine. She's like, I just like it on my phone. And it's interesting, because she doesn't really have a lot of the concern about the, you know, the switches in the lever, she was just like, this is fine, or this is fine. And in her mind, it came down to carry a thing. Yeah, I know how well it works, David, like any of them, like but why can't we get people onto them? Like, why? Why is there not like a mass get any mean? Like in your Do you have any idea? Well,

David Burren 1:02:04 I think the commercial loop systems. The good thing about those is they become more accessible to more people easily because the doctors can just basically scribble on the books and say, right, we need to get you this and get you set up, and they've got a better chance than not having access to it at all. One of the things that's changed here in Australia is halfway through this year, we finally got CGM subsidized for everyone was tight one, right. So instead of paying 330 Australian dollars for a month's worth of sensors, we now pay $32. And, strangely enough, that's making it a lot more accessible for the companies to introduce their loop systems, because now Medtronic is saying, Well, if you look, here's what we have to do is that the subsidy is we have to specify which PGM system we're using. So Medtronic is saying, if you walk into the Medtronic CGM, we will give you a Medtronic seven ATG, we will upgrade you. Because they get to sell sensors. And everyone gets the benefit along the way of all, the closed loop system. ipso Med, you're in Australia, I had a little crypto pump. And that's they've now got cam APS, which is another closed loop system that runs against that pump that's now rolling out in Australia. And suddenly a lot more people are saying, Oh, I've got access to this stuff. Great. I think I think the uptake of people who are using closed loop systems, I think it's going up dramatically. And we want to see some more statistics and polls on that to sort of see what's going on. I ran a poll a couple of years ago on the number of leakers in Australia a couple of 100 at the time, but that was all due itself stuff.

Scott Benner 1:04:16 Yeah, I mean, here in America, where things are, I mean, these a lot of these different devices are readily available and, you know, number of people have coverage that would allow them to get them. I just, I don't know, I, I know. It's not how things work. But if this if this was me, the minute This was available, I'd be I'd take the day off and just say to myself, Well, I'm gonna sit down and figure out how to make this happen right now. And I don't I don't know. I don't know why. There are so many more people who will never pump even versus the ones who will and there are, you know, at all and all of this stuff in between.

David Burren 1:04:57 That I think of it as a sense of inertia. Like for me, my my endo suggested quite a few times. This pump might be good for you and I know how this system works. I'm still alive, it's running fine. But in my clinical results when I got access to a seat to a CGM, and I started being able to look at the data myself and see what was going on, it was, Oh, this isn't good enough.

Scott Benner 1:05:24 Right. Nick, well, back then you just alive is your Mendoza line, like, I'm not dead. This is working well.

David Burren 1:05:30 Well, I'm not dead. And I got an HBO one see from my doctor when I saw him. And it was a good one this time. So he said, Come back in 12 months time, and oh, look, it was a bad one. It's come back in three months. And it was, I didn't know what I was doing differently. Because I didn't have the tools to see what was going on. Yeah,

Scott Benner 1:05:49 even that was random. Hmm. So and yeah. So when you found yourself in that situation, if you were being given the golden ticket, if you don't have to come back for a year, it doesn't mean that six weeks from now you're a one see wasn't on its way up? And you had no idea really? Yeah, I

David Burren 1:06:04 had, I had no idea. But I've, I've got my path results back to 2000 or so. And I can see my HBO one. So he bounced around and got up to 8.1. It was down at seven, it got down to a massively low six when I started on the pump, and it was gradually started creeping up again. But after I started looping in 2017, it went down to 5.8. On down to 5.6. It has never been as high as 5.6 cents. Yeah. So it ranges between 5.0 and 5.4. And you're active

Scott Benner 1:06:43 as well. You have you're paying attention, you know, all that stuff. Yeah.

David Burren 1:06:49 I mentioned before my timing range for 70 to 140 is around 85. But my timing range for 70 to 180, which is the more traditional clinical range is about 95%. Right now. And my time below 70 is about 2%.

Scott Benner 1:07:10 You know, it's an I say, I don't see, we don't see it. I mean, lows just are very infrequent,

David Burren 1:07:17 you know, so So I feel very comfortable with where all by senior is I know day to day will go up and down and bounce around. But overall, I'm in a good place. I'm feeling quite good, because I actually had a scare a few years ago with them. That there are sclerosis. So partial blockages around the heart, I didn't have a heart attack or anything but a random stress. Echo said all that said no more than we went down the investigation path. And I thought I was going to have stents and all sorts of stuff. But I managed to get out of it without that. And this was about the time that I was advancing a bunch of my glucose management. And the cardiologist now looks at and says, Oh, you're fine. Great. I've got the general feeling that health wise, I'm in as good a place as I can be, right? A lot of what I'm trying to do is make sure that it's there, but also do what I can to make this stuff available to more people.

Scott Benner 1:08:18 Back then were you feeding insulin? Did you have a lot of like, Were you eating a lot to stop lows and things like that? Or well,

David Burren 1:08:27 they actually the heart issue was about two and a half years ago. But I think I'd already started fixing things. But we hadn't noticed anything. Made an ideal world, you know who maybe it's already healing. Who knows? There's we didn't find it because of how to Tech, we found it because I had a fight because of low blood pressure, which the cardiologist says, Oh, that was probably just that you are exercising more. And so we've reduced the blood pressure meds. And I was on mild dose on that. And now I'm on a half a mile dose, right. So we sort of found it by accident. So maybe it was something that was happening earlier. And it's been getting better through this. But it's certainly notably been getting better, because we've been looking a lot more closely our stuff over the last few years. And everything just keeps staying stable. And that's

Scott Benner 1:09:28 good for you. And that really is wonderful. You don't do you have any of what we consider. I don't know issues from diabetes.

David Burren 1:09:38 We're trying to avoid the complications that weren't I want to

Scott Benner 1:09:41 say complications. But do you have any do you have anything that you talked that you are dealing with?

David Burren 1:09:48 This there's no no. I saw my ophthalmologist a couple of weeks ago and she said Because very nice relinking accent and I'm paraphrasing slightly, but she says there are no diabetes in your eyes. Oh, good. That's what I like to hear. There's no effective diabetes, but it sounds funny the way she says it, bro. And it was going back in 18 months out and I'm in fact thing. Her particularly because of congenital thing, we found one of my optic nerves we found years ago, and we started trading that we wouldn't have found it if I wasn't having my regular diabetes examinations. So I believe in in my eyes is not an issue. But I feel that my eyes are healthier than they would have been without diabetes, because we wouldn't have found this thing.

Scott Benner 1:10:43 Yeah. So maybe saved you from a from a different issue.

David Burren 1:10:47 Yep. So the cardiologist says, the heart stuff is not related to diabetes. It's just stuff that happens when you get older. Although he's only ever known me when I've had normal HPMC, etc, levels. So I don't know if it was something in the past who knows? I've got most of the hand physiologists said, I've got the early signs of something that may turn into contracture of one of the tendons on my hand. But it's something that they can fix. It's not a thing is it's just an early sign that maybe that might develop, but that's about as close to a diabetes issue is I can imagine it sounds.

Scott Benner 1:11:32 It sounds pretty terrific. Honestly.

David Burren 1:11:35 I'm very lucky. Yeah.

Scott Benner 1:11:37 Is it in your family at all? Type one? No, no,

David Burren 1:11:40 no. Well I, I remember, you know, stories about there was an aunt or something or great art, whatever he died or something, but back then. Maybe in the 80s. Going back in time, from what people knew about 10 years ago, if they'd gone back, they might have said she had type two. But if they'd gone back now and done better tests, they might have said, Oh, she actually had type one. Who knows?

Scott Benner 1:12:11 Right? How about other autoimmune stuff?

David Burren 1:12:15 Like celiac disease? Celiac disease is the only thing and that came on after several decades. Okay, so that's the closest thing to a second autoimmune thing that I've got for

Scott Benner 1:12:26 you. How about in your family? Do you see any other thyroid stuff for digestive issues? Anything at all with people? Not? Not yet? It's interesting. Do you have children again?

David Burren 1:12:38 No, no, I have nieces and nephews, I can wind them up and hand them back. I don't have my

Scott Benner 1:12:45 listen. There are days that sounds right to me. Interesting, okay. Has it been? I mean, you said you, you've done wildlife photography and other things like that. I mean, it doesn't sound like diabetes has stopped you from doing things throughout your life.

David Burren 1:13:05 No, not, not really. If I was looking at going on a Australian Antarctic Division runs supply trips every year down to the bases in Antarctica. And they have some humanities births on there, where basically artists can go along and record what's happening, and so on. So there was an opportunity as a photographer to get on to that. So I thought this is exciting. looked into that. And as soon as you've got diabetes, you're not eligible. Because they make you go through all the same medical things, as someone who was going to overwinter and stay there, right. And if you don't have enough insulin, you're gonna die, basically. So I was basically not not eligible. So that was a little bit disappointing. But it guess what I found another way, I've been to Antarctica four times now. Really? I run photography trips down there.

Scott Benner 1:14:01 You make the rules so you, you can allow people diabetes to go.

David Burren 1:14:06 So yeah, I've that also called the travel bug. So I've been to lots of places around the world. Whether it's, you know, jungles in Borneo or up in the Himalayas, with snow leopards in the middle of winter. And most places I go, I need to worry about keeping my insulin. cool enough. There. I need to make sure it wasn't going to freeze overnight. Yeah. So yeah, I feel that I live my life and diabetes has to come along for the ride. That's one of the other things that you were asking before, what we what we should talk about. One of the other things that a lot of people might find interesting is Something that I'm not responsible for, but a lot of people seem to associate my name with. And it's the NuBus G six transmitters. So the X column G six transmitters, they run for 100 days. And then they turn off mailing lists. And in the early days, people were able to cut them open and replace the batteries and seal them up again, and then they'd go for another 100 days. But Dexcom, change things so that you can't do that. So, I know some I know some people who've did some engineering, and they basically they modify G six transmitters now. And we went through a phase where we're trying to work out how to get this working, I managed to get a bunch of people in the US, including some of the people from the Facebook group, I donated all transmitters, and we sent them over here and then basically pulling them apart and using them as test beds and how to make things work. So what they have now is a system where an old Dexcom J six gets recycle, and it becomes an A novice GC. And the NuBus comes with a battery that sealed in the bottom with clear silicone. But when it's time to replace the battery, you can actually see that's where I dig in and dig out the battery and I stick this other new battery and never seal it up again. And it automatically resets. These are really convenient because they have a bunch of other advantages. The transmitter doesn't timeout after 100 days, pumps out after 190 days because they have a bigger than normal battery. And it doesn't stop your sensor after 10 days, it stops your sensor after 60 days. So I can run my sensors for 20 days and not have to do any restarts along the way. That's really convenient.

Scott Benner 1:17:05 And you do you notice that it holds up as far as accuracy goes,

David Burren 1:17:10 Oh, it's the J six. They didn't change any of that stuff. Yeah,

Scott Benner 1:17:13 right. I just been having the wiring for that long. Oh,

David Burren 1:17:17 with J five, my record was 53 days. What I'm doing now is I used to run sensors for as long as I could, because we had to pay for them all ourselves, and it cost a lot of money. So you'd be saying alright, is it unstable yet? Is it time to change it? Now I can go another day, and then suddenly it goes out the window. And right now I've got this outage I need to start up. So I set up something where I could, if I've got two transmitters, I put in a new sensor with new transmitter and I've essentially got another program talking to it and I start the session on that transmitter. And then when it's when it's warmed up and it's ready. Hopefully before the old one has completely died. I tell my loop system use that transmitter instead of that transmitter. And it gets gets good data to I don't have to warm up as long as I've done everything right because it's already warmed up and had the first day of weirdness out of the way before I switch over. So now that we've got things subsidized, and they subsidize them for essentially one every 10 days, I'm actually putting a new one in every 12 days. And then I'll I'll switch over to the new one. After another day or so, once I know it's stable, and it's really nice being able to see two lines and say no that had old sensors going weird or the new sensors going to it. Suddenly, it's not just finger pricks and CGM. We've got fingerprints and two CGM so that we can compare. And it means that my the amount of time my system is actually making decisions and looping is pretty much 100% all the time, because the CGM never actually has to disconnect and warm up, right?

Scott Benner 1:19:07 Do you think that G seven will cause problems for the DIY community? Or do you think people will

David Burren 1:19:12 you know, not especially the g7 is essentially doing some of the same stuff because each, each sensor has its own transmitter. That's where That's where this new stuff comes on. Where after 10 days, it's not the new one. But I'll keep using the old one for 12 hours. Yeah, so it's essentially doing the same thing. And but it automatically switches over. Now it it'll be harder for people to try and extend the system in the way that we've managed to do with the newer stuff. Now the reason people associate me with somebody whenever stuff is on my blog, I posted an article saying these amazing thing and works really well because I've been testing it for them. And I get people sending me messages saying Hang on, can you sell me one? It's not mine. I'm not involved.

Scott Benner 1:20:06 I'm just using it,

David Burren 1:20:08 talked about it. But the guys who distribute those, by the way, that they're not selling them for profit, they're pretty much essentially giving the way they get donated trans old transmitters that are getting recycled. And they're just set up little machine shops that have laser engravers and everything out. And it's all automated home workshops, stuff from people who have diabetes, hell bent.

Scott Benner 1:20:35 That can't afford to do it.

David Burren 1:20:37 It's hard, hard to imagine how any of that could be applied to a G six, where everything's integrated, and then applied, and then you take it off, and then it's done. G seven, obviously. Yeah, sorry. So I am thankful that we have subsidies here. So if I have to use them one every 10 days, I'll be able to afford them.

Scott Benner 1:21:01 No, it's amazing. I've talked to people just you know, in the last two years in Australia, who are like, I can't afford anything to those same people sending me notes and say, hey, look, I have a CGM. Now or I have a pump now. It's like, it's amazing how quickly things are kind of moving there.

David Burren 1:21:16 Yeah, exactly. So I think I expect people will be able to use G seven in the with the open source software that Do It Yourself stuff. I believe that's already happening in your head to talk to them.

Scott Benner 1:21:34 Yeah, well, I mean, it's been out for just a handful of weeks now, right? In Europe. And I mean, my expectation is, it's going to be the next couple of months, it'll be in the US. So you're gonna start seeing it everywhere pretty soon saw as the FDA, I don't know what the hell they're, they're holed up. It's but as soon as that goes away, I guess we're gonna see it here.

David Burren 1:21:57 Now in Australia, because most people are getting it through subsidy. I think introducing it here. It's not as though it'll get introduced and sold will cash sales. And then eventually added to the subsidy, I think they'll be lining everything up so that when it comes here, it'll be with the subsidy. So I don't know how long that's going to take. Yeah. But we've only had G six here for about two years. I think you've had to do six for longer over there. Yeah.

Scott Benner 1:22:28 I know. I hear Canadians often talk about the feels like a chasm of time between when new stuff comes out. And they actually got it. I guess it's similar. I don't know. I wish I understood more why that happens. But I just don't. You would think that people would diabetes everywhere, right? And there's governments you can charge for this stuff. Like, let's get going.

David Burren 1:22:52 Yeah. Life is life is multifactorial. So there's a limited market in Australia, compared to the US. So all their costs for going through and setting up things with the regulators and importing and doing all those things. There's more overhead. So are they going to make enough sales for it to happen? Now that things are subsidized, if they can get onto the subsidized list, it's easier for them to say, alright, we're going to have a steady supply. Right. So hopefully, that will enable things to move quicker. But But yeah, dealing with different regulators in different places. does add a lot of time. Yeah,

Scott Benner 1:23:32 it really does. And in the meantime, there's people who mean, you would think that if you were the government, why would you not say, All right, well, maybe we were not the maybe we don't have as many people here with type one. But let's make it attractive for these companies to come in and service, at least the people that we do have. That part is a little interesting, you know, like,

David Burren 1:23:53 the other thing is only on Jeff, and Jeff has been available overseas for ages. And, and we're over here saying it's really great with important time it used it and it's great. Why can't we actually get it properly. And we're saying the same thing. We had years before fierce was approved here and then still years before it actually became available. But when it becomes available here, again, the drugs subsidized through the pharmacy benefit scheme for PBS. But the price that the manufacturer gets is controlled by the government. Basically, the Australian Government doesn't pay a lot for the drugs. Right. So that will play into are we going to make enough sales at that price to make it worthwhile to bring it in? Yeah. Novo got to CBRE approved in Australia a few years back. They don't actually import it, sell it because they're not going to move enough of it. They sell that I rise adag that mixed one. But not not peintre saber, just as an example, someone said, No, it's not going to be worthwhile. And there's all sorts of weird things. Because there's the way the drug subsidy stuff was set up. There's, you can't introduce a newer, or a different form of the same drug. You can't have too many forms of there's all sorts of controls without having to get a basically get less money for the drugs. And it's all this competitive stuff built in. But that actually meant a few years ago that when FISP was introduced here, it was available in out because VSP is actually insolent as part. So it's not actually a separate drug. It's the same as Novo rapid, which was already in the list, which was available in prefilled, pens, in pen cartridges and in vials, okay. And then faster is faster acting insulin ESPAR is available in pens, and vials. But they didn't introduce pen cartridges, because that would be too many. And then they wouldn't get as much money from the government for the drug. But it's complicated, it's

Scott Benner 1:26:23 dizzying. Yeah, it really is, um, just, you know, people need stuff, it'd be nice to find a way to get it to them in a way that is affordable, and unreasonable and easy. You know, it's tough to RDS have to have diabetes. You know, you start jumping through hoops to get things accomplished. And you can see easily why it doesn't have I mean, to take it out of diabetes for a second, my mom just moved with my brother. And she had to live with him for a little while, while she established residency in a new in a new state before she could go to this place that she wanted to go to and get the assistance she needed. And she, you know, she wanted and everything. And the amount of phone calls and paperwork. If my brother and his wife were not doing this work for him, my 80 year old mother could not accomplish any of this, like there is a system set up for people that they functionally can't take part in. And you have to have somebody helping you what if you don't? What if you don't have someone helping you? Like, then what happens? You don't I mean, like, it's, it's fascinating.

David Burren 1:27:30 That actually opens up another concern with the fancy technology we use these days. What happens when we get older? Yeah, I think and we go, and we're going to aged care. That's, I mean, we have quite a few loopers in Australia who are in their 70s. And I think some are in their 80s. Now, and it's something that people talk about what's going to happen later on at some point in my life, and I guess it could happen to all of us what happens if I'm involved in accident, I have a friend from university who has an acquired brain injury, and later develops diabetes, and isn't able to deal with any of this stuff. Everything has to be through a carer and what's going to happen when the family carer gets old. So that feeds back into winning to make this technology as accessible to people as possible, so that not just Can people without the background and experience that say I have been using, but also that someone looking after them who isn't especially skilled and more comfortable.

Scott Benner 1:28:41 No. And I think about that. I mean, you have diabetes, I'm sure you think about it for yourself, but as somebody who's looking at a child with it, I think about that constantly, because my daughter is going to be older, and in need of help at a time where I won't exist anymore. That's hard to deal with, you know, like, is she going to meet a person who will help her or, you know, will she have enough money to be in a healthcare system that can help her also, I've seen my mom in that health care system. And due respect, they're not great with giving you a pill when they're supposed to sometimes, or you know, managing things that are not nearly as complicated as diabetes. So I don't know. It's, well frightening idea.

David Burren 1:29:23 It still comes up every now and then but we still we are hopefully moving away from the world where someone would go into hospital for and they have diabetes for them unrelated thing and the doctors would take and the nurses would take their insulin away and then it's our youth you need to have your evening insulin there. But you haven't given me a food yet. The food's not here. No, no, we need to chat this now. Or you have your food now. We'll come around later with the insulin. All of this stuff is totally in integrated into into our lives that, like I have a colonoscopy coming up in a little while, and I'm thinking ahead to when it comes to what day is it on? When am I going to be starting my CGM sensor? Where is my prompt site going to be because I'm going to be lying on the bed this way. And they're going to need to put a cuff there and put a line in here. And it's no good if I have technology in the way. So all this stuff is tightly integrated into how we live our lives. Yeah. And,

Scott Benner 1:30:34 anyway, alright, you're bumming me out there.

David Burren 1:30:38 It's okay, I'm actually participating in a summit in a couple of weeks. One of the big research bodies here is having a series of panel discussions and one of the things we're talking about is how this stuff integrates. And the reason that's in my mind is that kind of some of the things we talked about before, some of the design design decisions behind this technology are often made by people who don't actually live with and don't actually realize that, oh, it affects this, or that means you're going to put this site there. For me and Omnipod, I use Omnipod dash every now and then. Not regularly, but I've got a couple of boxes. And if I'm going for watersports or something I might change to a a pod on a waterproof looping phone for that weekend. But I need to be very careful about where I put the pod. Because it's very particular about the radio reception. If someone's dealing with the PDM, which is the insolent way of doing things, you pick up your PDM. And you also you change a Basal or something and then you put the PDM away. Whereas me I've got the looping phone that's talking to it, and it needs to talk to it every five minutes. And if the part is on my right hand side, and the phone is on my left hand side, and I'm a big bag of water right in the middle blocking radio signals. Things don't always work neatly and people finding that with the Omnipod five that you need to make. It's better if the CGM has good line of sight line of sight to the to the pod, it's the same sort of thing, I have to think about where my phone is where the CGM is and where the pump is. So, flexibility for me the when I'm using a tube pump, I can have my pump in pretty much the same spot every time and the tubing just goes to wherever the site is. So in some ways, a tube to pump is better for me than a pod.

Scott Benner 1:32:50 Because you have that that option. Yeah. So you'll always know where the pump is going to be. And that you just move the site.

David Burren 1:32:57 Yeah, I mean, there have been times when it's old enough for these couple of weeks, it's on my right side. So I need to make sure I put the looping phone in the pocket on my right or a pocket on my left. Whereas these days, it's just no baby every time my pump lives in little running belt has to be built. Yep, that's underneath my clothes around my waist. It's always in the same spot. And then the tubing runs along the belt and then up or down to wherever the site is,

Scott Benner 1:33:22 you know, if you tried to make this argument, the art and she'd be like, I don't know what you're talking about, but I'm not attaching anything to me. So I can't get up. It's just so interesting. What where you're everybody's perspective comes from their entry point. Really, you know, yeah, different perspective.

David Burren 1:33:40 This thing of tubes versus unsheathed I started off with an NMS pump. And I had a a talisman around my neck and an SOS, whatever tells me medical thing. So if I was going, it was in the middle of the night, I was going to the toilet or something and I had to do my pump somewhere. I would probably clip it the bed around my neck. And then the tubing runs down to where the site is. But I always had this extra thing I was carrying around and having to put somewhere or back into a pocket or something. Yeah. But yes, there was something attached to me. But when I started using the looping systems, I no longer had to touch the pump. The pump would hide away in a pocket. And my relationship with it changed. Yeah, because now now the pump is in that little running belt around my waist and including when I go to bed. So if I wake up in the middle of the night and I have to go to the bathroom, I just get up and I walk down to the bathroom. The pump comes with me I don't have to. There's no feeling of oh, I've got something's actually the tubing somewhere is comfortable with me. Yeah.

Scott Benner 1:34:50 I know some people who put it like on their bedside table or lives in the they leave it loose in the bed with them. I've heard people describe what you just described. It's interesting how it all works differently for

David Burren 1:35:01 it, find a system that works for you. And I've used different systems along the way. And that and they've all, whatever I've been using at the time has mostly worked for me at the time. But you know, when the pugs were introduced here, a year and a half or so ago there were some people other companies find people with diabetes, who are they become advocates, basically? Yes, it's wonderful system, it's changed my life, which is great, and it's fine. But many times. Some of those people, the first pump, a lot of things they described about, oh, I can change this I can change that is, you can do that on any pump. And they say, but there are no tubes, I don't have something dangling attached to me. And I say, I don't have some, I don't feel like I have anything dangling attached to me anymore. So in fact, when I use a pod, I'm restricted in terms of I need to fill it with the right amount of insulin, because there's this decision, when I get to the end, have I put enough in it to last the 70 to 80 hours, if I've put more in it? Am I going to pull some of that out and put it into something else? Because my insulin doesn't cost as much here, you can sort of say, well, I'll just using using new pod and fill it with new insulin. When I was using these new images that I imported, myself, I was a little bit more sensitive, because every drop was was money. The and there are issues, if I have a problem with my site, then I have to put a new part on. Tonight, I put a new cannula in for my pump, and I put it in and it was out that's not working, I can feel that that's completely uncomfortable. I took it off and the drop of blood comes out. And it's no, that's a bad site, I'll just put it in somewhere else. And suddenly I've wasted 50 cents, or $1 or something on an annual that's I haven't wasted a whole pod and then have to ring up and say you know all this hassle about

Scott Benner 1:37:15 So David, here's the other the other side of it. In your in America, you get your your doctor to write you for more pods than you need. And then you draw out the insulin if it's new, and pop it in the other one and keep moving. Like it's all the same. But yeah,

David Burren 1:37:29 I know. But. And there are there are ways around this we live, we each live within the constraints of existence that we're using. Yeah. But each time we use a pod, and I get to the end of it. And it's right, I'm going back to my other hub that feels like Old Faithful, comfortable territory going back to my tube pod so that that the pod to me at the moment feels more restrictive. It's less restrictive, I can go swimming, I can everything keep running. But in terms of general where it doesn't feel the same, because I'm not used to it.

Scott Benner 1:38:01 Well, you've just described exactly why all these device manufacturers are so focused on getting people when they're newly diagnosed as customers, because then this becomes your norm. And you know, it's hard to imagine otherwise, you know, it doesn't make doesn't make the other option. untenable. It just makes it different than what you're accustomed to. So and you are right, like no matter what scenario you get put in, you do find a way to make it work as seamlessly as possible with your life doesn't matter if it's a pumper. A CGM or whatever it is you you fit it in and you make it work. And then suddenly it feels like this is the option, the only option? Makes sense.

David Burren 1:38:43 Yeah. And different systems have different advantages. And I think a lot of people as you say they get locked into the system that they're using. And they don't necessarily realize that the grass might be greener on the other side of of that fence, or maybe on the other side of the highway, maybe just in the next paddock, whatever. So when I started on an LMS pump, I was using the infusion sets that my my diabetes educator had suggested. And I was using them for years. Those were the ones that I used, oh, if there's a supply issue, and I can't get those, what am I going to do? I'll manage to get some or I've got an A got out of it. It's okay. And some of our friends who are interstate they were using some different ones and they were having supply issues and all sorts of dramas. And I realized that well, maybe I should try one of these other ones. Maybe if I wasn't tied to this one, I'd have some flexibility if there was a shortage Yeah. Now, it's convenient here that all of our infusion sets are subsidized to the same level once you've registered as a pump Use a you can get any of those at subsidized price I say so so I can, in fact switch to a different pump type. If I have the pump, I can buy the other supplies. I don't need a prescription for each one. But that meant that oh, let's try the stoop cannula. Let's try the ankle cannula. I'll get a box of those and see how they go. So I've now used pretty much everything. And I found the ones that I like. And I've got to the stage that I get all secondhand pumps of different types, I've now used pretty much every type of pump on the market. Yeah, and most CGM. So my decisions about which ones I'm going to keep using is I've used some of the others, they don't necessarily feel right. But sometimes there's something that oh, that's nicer, because, for example, I started using the were they the comfort sites, which tenem now call them the very soft Medtronic call them the silhouette, the angled one. And they turned out to be about great. They were nice and comfortable. Manual insertion, which was quite daunting. But once you got that over and done with it was fine. And it actually turned out that I can pack a lot more of them in a camera bag when I'm going to Africa. All sorts of other advantages. It's so interesting

Scott Benner 1:41:28 to hear people talk about these little things. I remember when Arden was really young, and we were looking for pumps. And we were drawn to the idea of the Omni pod, a nurse practitioner who tried everything they could to scare us away from like, don't use that. They everything they could think of like your daughter is too lean, it won't work. You're not gonna like the angle that the cannula goes in on if you don't like the angle, the cannula goes in on you can't go to a different set. And I just was like, wow, like I look back on that now. And I realized she was just coming from the perspective that she had, which was, you know, this this back then this insulin pump was brand new. She didn't have any experience with it. These were her experiences before, she didn't really know if what she was saying was going to apply to us. She was just like, here's all the things you should be scared about. And you know, I'm like, Okay, thanks. We tried it anyway. And, and then those things didn't end up being an issue. And so long story, but in 20 seconds, like two years after Arden started an insulin pump, our our practice, apologized to us. They came to us and said, We're sorry for how we tried to scare you away from using this pump. Like your daughter is having so much success with it. We're gonna start talking to other kids her age about it. And I thought like that's just always stuck with me. Like they were so adamant. They had rules and lists and reasons. They were like, This is why you can't buy this, this thing and then later, they're like, Yeah, we were wrong about that. Sorry. Jesus. Okay, what else you're wrong about, you know, is how it made me feel?

David Burren 1:43:04 Well, yeah. I, in my own head, I have lots of experience with I've used lots of different equipment, different CGM, different glucose meters, pumps and stuff. I'm not necessarily an expert in all of them. But I've noticed some of the differences. And I sometimes point those out to people because they haven't necessarily noticed those. They don't know those things going in. So try to give people as much information as possible. But yeah, I guess, the track the track there. I shouldn't necessarily be trying, I shouldn't be trying to frighten someone away from using something because I find something in issue. I can point out to them that this thing exists, then it might be an issue for them that personify that. That middle ground of trying to scare someone or trying to inform someone is always tricky.

Scott Benner 1:44:01 It's our communication had that person done what you just explained, it would have been completely different. You know, we just said, look, here's some things that could possibly happen. Here's why this may or may not be important to you. This pump over here won't do that. This one will like I would have been like, Okay, that would have been information to take in. But instead it felt like I don't know, it felt like a scared person or an anti sales pitch. Like you started looking around, like, do they work for somebody like they were so just, you know, pushy. But I don't think looking back that's not wasn't their intention. I just think they had a certain set of pride. I was gonna say priorities, but I think it's perspective. I think they've they had experiences and perspective and they were unknowingly defending that perspective against what they saw as being different. It's just, it's fascinating in my heart, I think people should use what works best for them. Like I you know, I mean, I take ads on the podcast, but, I mean, I have to be honest, like, I don't care if you buy an AMI pot or not, like I want you to have an insulin pump that works for You? And if I'm the pods the one great. I don't mean like, I'm not. I don't know, like, sometimes I think that can get blended a little bit like, well, he has ads for Dexcom. But you get a libre. I mean, what do I get?

David Burren 1:45:11 Well, presumably, presumably, you might not be so comfortable running ads for a company if you had concerns about the product?

Scott Benner 1:45:20 Of course, no, there have been plenty that I've turned down over the years. And there are some that have been easier to take, because I have that personal experience with them like I can, you know, like when Dexcom comes to me and says, Hey, can we buy an ad on your podcast? I immediately think, what are the reasons why? When anyone comes to me and asks for an ad, I, my first thought is, I want to know all the reasons why I shouldn't do this, because if they're too great, or it's bad for the people listening, I won't do that. They may, then that may sound like that may sound like I'm protecting you all which I am to some degree, but I'm also protecting myself. Because if I say, hey, use this pen, and you all run out and buy this pen and it sucks. Well, then you're gonna stop listening to the podcast and be like, Oh, the guy was wrong about the pen. I wonder what else he's wrong about, like, you know, I mean, like, there's a, there's a bit of self preservation in there as well for me, and I have comfort with the things that I advertise for. I mean, like, Chivo Capo pens, a great example, that thing came out. And I was like, well, that's brilliant. Like, like, Yes, finally a form factor. I can put my daughter's hand, her friends can understand it and etc. You ever tried to explain the lily red kit to a nine year old? You know,

David Burren 1:46:38 yeah, we, the only glucagon we have here is the NoVo hypo kit, which is essentially the same thing as the red Lily kit.

Scott Benner 1:46:47 They're gonna keep me because Lily stopping

David Burren 1:46:50 that? Well, that's no most product at glucagon product at the moment. Yeah. So it's no signs that they're stopping. We don't have access to vaccine, me or GMO? Or any of those?

Scott Benner 1:47:01 Yeah, no. And, guys, I'm sorry.

David Burren 1:47:04 I was reminded from what you're saying some of the stuff that comes up on my blog. And what we're saying about advising other people, is always when I started writing things, and putting it down on the blog, I was always conscious that this stuff is going to be up there. Anyone can read it. Yeah, and I don't want to be saying the wrong thing. But there's also this big thing with the, the open source, the do it yourself, equipment of this is not medically approved. If I tell someone, I can't tell someone, you should, you should build this system and it will work for you. I can't do that, legally, I will get myself in a lot of trouble. But luckily what I can do and stay on the right side of the law is say, this is what I'm doing. And it's working for me. These are the things that I've noticed about it example, I always try to keep that in mind. And try to not cross the line of giving something that could be misconstrued as medical advice. Always have it in the context of my experience. I write about a lot of technology. But it's mostly in terms of I have actually used this. This is my opinion of it. These are the things that I've noticed. Right. And I think that's been working very well. It's quite pleasing when I'm at a diabetes conference. As one of the community advocates there, and I get stopped in the hallway by endocrinologist to say thank you for the blog, I was able to direct some of my patients to it. Yeah. Oh, that's great.

Scott Benner 1:48:39 I completely understand what you're talking about. And I'm never not knocked over when somebody comes into the Facebook group. And they answer this quick questions about, you know, what's your attachment to diabetes? Bah, bah, how did you hear about this? When people say, Oh, my doctor sent me hear, I'm always like, Wow, that's great. Like, just terrific. And, and I take all your points to like, you're just I'm just sharing what's worked for, for my daughter, basically, and things that I've noticed along the way. And, but the, the feeling of I mean, I guess the way I handled it is I might do a good job of sometimes sounding like, I'm like, Oh, I just thought of this, which has happened a time or two where something's clicked popped into my head as we're talking. But for the most part, I don't say stuff on here, until I've seen it work over and over and over again for my daughter. That would be irresponsible. I don't understand. I couldn't do that either. So it's a it's a great thing. It really

David Burren 1:49:35 it. It does feel sometimes when I'm moderating some of the Facebook groups. And it does feel sometimes that I'm being very wishy washy with my answer saying, Well, you could do this, but you should see your doctor.

Scott Benner 1:49:53 Yeah, I tried to just say if this was me, or the way I see this, it could be wrong for you. I'm only looking at one graph, there's no way for me to relate. No, you don't. I mean, like that kind of stuff. But you should be going in this direction.

David Burren 1:50:07 I guess I just realized, I guess I had a lot of experience in that before the diabetes advocacy because I've been involved in amateur photography stuff for a long time, the Australian photographic society and various photo competitions and getting critique on photos. And you learn very early on to give constructive critique, not criticism, per se. And you can always find something constructive to say about pictures, when I'm giving feedback on photos, and it's something that I still do to some of the camera clubs. I'm very careful to try and give suggestions and things that they may not have thought about. Without saying this is good. This is bad. Yeah. Because yeah, I'm setting myself up for being attacked. At that point,

Scott Benner 1:51:00 I tend to lean into the, what is the call? Is it the Socrates questioning method? Or, like the idea of teaching by asking questions, you know, like, oftentimes, it's almost it's a version of you can, you know, teach a man to fish kind of a thing. And

David Burren 1:51:18 I have gotten into trouble with that with my family. At times when they say, don't ask me another question. Just answer the question.

Scott Benner 1:51:24 Well, online, I find, it's great to say, hey, well, do you think this or this just happened? And then you kind of let that they almost sometimes people know, they just don't know how to put the pieces together. And you know, I find that pretty, a pretty valuable way to talk to everybody. But, David, I have to jump off in a minute. But this was terrific. I just want to make sure that we covered everything that you don't have anything left hanging that you that you didn't get out.

David Burren 1:51:50 I don't think so at this point. I think I've covered a broad selection. There'll be something new and different. That's happening next month, or whatever. But that's next month, I guess this will this will take a while for this to come out anyway, it'll still hopefully be fairly up to date when it does.

Scott Benner 1:52:06 Yeah, well, because we're talking about things that are more time sensitive with technology, I will slide up on the schedule. So it doesn't, doesn't sound like it came out of left field. But the other things things change quickly, right. Like Arden is off at school right now using arrows pods and, and the version of the loop that she's using now. And she might come home and over, like the holiday break, and we might switch her to be you know, something different and send her back with something different, I have no idea.

David Burren 1:52:37 We'll just reminded me about something that went through my head earlier, when she was saying, I don't want to carry this PDM I want the system running off my phone. But she's still happy to carry around an orange link or rolling link or whatever.

Scott Benner 1:52:53 So that is the gateway what she's not happy about it. It was a trust me, she hates that. But But I got her to be okay with that by telling her that eventually there'll be a system that doesn't require that. And it's smaller. And she has it she keeps it in her diabetes bag. And the orange link seems to have a much better a field of coverage than the Riley LinkedIn. So she's the Riley Link was like you had to bring the bag with you everywhere you went. But now in you know, if she's in her dorm room, where she's in our house, she can walk away from the orange link and still has a good connection to it. So that's become less of an issue over time. And then I assumed we're gonna go to the dash version and, and lose that. That.

David Burren 1:53:42 So we never had the arrows here in Australia. So they finally got approved but never sold here. And then eventually they tried to sell but they decided to do it with the dash, they switched over. So the the reason that came to mind is I've been an iPhone user for well over a decade. But I don't use the iPhone for my diabetes, I use an Android phone. So I'm carrying two phones, right? My Android, Android phone is like,

Scott Benner 1:54:16 teeny, tiny. Yeah.

David Burren 1:54:19 Almost the size of my palm, right. And it just had enough battery to run all day. And it's doing all the stuff. It's sitting in the background. And it displays an outdoor watch. So I can just see my CGM data at any point if I need it. Yeah, but I'm happy during that second device. Whereas some people come to these systems say I'm an iPhone user. I, I wouldn't touch Android. That's, that's the dark side.

Scott Benner 1:54:48 I don't care about that. You're basically using your controller as well just didn't come from a company, honestly. Right by using

David Burren 1:54:57 and in fact, it's spades. way hidden in a pocket most of the times, I am a guy, I sometimes wear cargo pants, I have a lot more pocket options than many girls. I do understand this. Yeah.

Scott Benner 1:55:08 It just doesn't want to. I don't know if you should say like the idea of holding two devices I eat if I offer two phones, she'd be like, No, I don't I mean, I don't know why you would. But I mean, she wouldn't want to do that either. Like she just says she's trying to be very minimalistic with what she's carrying. So she's doing a good job, her bag for diabetes is it's tiny, it's got a phone in it, that orange link, G voc meter, the Contour, Next One meter test strips, and, you know, some gummy bears and a juice box and she gets it all into this little tiny thing. It's pretty crazy. But yeah.

David Burren 1:55:44 And the other thing that came to mind was sort of paraphrasing. One of the other things we were talking about in terms of people look at the stuff that's working for me with my hands free loop system. Let's not loop with a capital hands free looping system. And say, Well, you don't have to do any work. But then I can point it out to them and various friends of mine, who were there in conversations turn around, say Yeah, but he put in a lot of learning to get there. He did a lot of work early on to work out how to control it. And now he can take the benefit of hands free. So part of the the thing that we're hoping to get out of things like this trial and other stuff is more knowledge about how to actually turn it on for people without them having to put in all that homework.

Scott Benner 1:56:34 Yeah, no, that's gonna be the next big step right is not having to understand the background to make it do all these amazing things. So I don't know, like I've seen some people try to make that turn that into a business. I don't know how well that'll work out as time moves forward or not, but it seems it's a weird thing to be involved in, you know, setting up a do it yourself algorithm to give somebody else insulin like it's, I don't know, it sounds like you're gonna have to sign a couple of things and say, you're not holding anybody responsible in the beginning. To get to that what you know,

David Burren 1:57:07 well, I'm dealing with algorithms to give myself insulin. So if I make modifications to the code, which I occasionally do, it's, I'm running them, I've got a bank of test phones and test pumps here that are running on a copy of my CGM feed to make sure they're doing the right thing. And eventually, I'll decide yes, I'm willing to run that myself. Don't have to go through ethics approval once all sorts of stuff to do that. So when it comes time to running the algorithms through the clinical trials, that will give the evidence for it. Hopefully, at some point, a commercial company will say, Well, we will take that we'll make a product out of that using that algorithm, which has been proven. So I hope that'll I don't care if someone makes money out of selling that. Yeah. Hopefully, it'd be nice if I can earn a living along the way, somewhere as as well as the help I need to do but the end goal is improving everyone's lives. Yeah,

Scott Benner 1:58:09 I always think that like, like when I'm how God what's his name came along and said, We're going to bring a version of loop to, to mark it. God white power, the

David Burren 1:58:21 title tide pool?

Scott Benner 1:58:23 I mean, I'm starting to feel like that's so long ago, I can't remember the word tide pool is easy to like, and I understand that. You don't I mean, like I understand the processes. Is, is what it is. But I mean, by the time you get that thing through, there's so many more versions of it, you think, well, you should have started with that one. You know what I mean? And I guess that's also if you make that decision, you'll never get to the end. But it is what's exciting about people doing it in a in a do it yourself atmosphere is that, you know, I mean, something comes out and they go, Okay, we'll adapt it, we'll test it, you know, we'll get a few people together, we'll make a beta test out of it. We feel comfortable giving it out to people here, you know, give it a shot like that stuff doesn't isn't taking three years when it's being done by regular people. So no.

David Burren 1:59:10 So generally, the do it yourself stuff is always gonna be a little bit ahead in terms of features and functions. Sure, hopefully people do it in a safe way. Yeah. Many of us are keeping all the safety in mind when we're designing this stuff. I've seen all the meetings, I've heard an endo stand up and ask the question, now that there are all these commercial systems available. Why would anyone why would you use it yourself system that you have to build yourself? And it's because it's current technology. It's not technology from three years ago. It's got it's got more features. Not everyone will want to do this, but that's why I do it. Yeah. There's

Scott Benner 1:59:53 no reason why we should take any kind of options away from people like I don't care if it gets to Under Yeah, I guess

David Burren 2:00:02 his his thought is, why do I need to deal with this problematic dry stuff now that there's a commercial thing. So

Scott Benner 2:00:09 I can see feeling that way, I can also see like, I'm not gonna lie to you, it's still like going into I'm so bad at this, I don't even know, the program on the Mac that runs the the simulator and then puts it on your phone is called Xcode, right? And so and every time I look at Xcode, I don't know what I'm looking at. I know where I have to click, and I know what I have to do. But if you asked me to explain any of that to somebody, I'd be like, I don't know what any of this is. And so I get not wanting to feel like that, because it's uncomfortable. You know, I, I sent a complete, my daughter got a new, you know, got a laptop when she started school. And then got another one when she started college, and the one that she was done with after high school was shot, it's basically useless. And she's like, Well, what do we do with this, and most of the time, we would trade it in for credit or something like that, and try to, you know, make a little money off of it. I was like, keep it, we'll put X code on it. And you can take it to school with you because Xcode wouldn't even fit on the laptop that she had, along with all the other things she needed for school, I get not wanting to be involved in all that. But being able to text her last night and say, hey, it looks like you needed a secondary Bolus, or, you know, being able to look at a meal remotely and say, hey, the algorithm is struggling, because I don't think it has enough autonomy, you should go back to the meal from two hours ago, and tell it it was 75 carbs, not 65 carbs, like that. And then all of a sudden the algorithms like oh, I didn't know that. And then bang, it works. And like that kind of stuff is. It's pretty great. I can't lie about that. You know that stuff is? It's pretty damn great. So anyway, David, this was really wonderful. I appreciate you doing this with me. I'm sorry. I kept you so long. But thank you very much.

David Burren 2:01:56 It's totally 2am

Scott Benner 2:01:59 Well, that's why you don't know you're half of you at this point. You're just like, Ah, it's all good. But

David Burren 2:02:05 I'm a night owl. I'm a night owl. Thank you for the chat. No, I appreciate it. For people on the podcast. I

Scott Benner 2:02:12 know I'm sure people are gonna love it. I really do appreciate you taking the time. And I know it's hard to get on the show. And it takes forever. So thank you for being patient.

David Burren 2:02:20 And people with can message me on the Facebook group on there?

Scott Benner 2:02:25 Yeah, and and I wanted to say to your bionic wilkie.com. Is that right? It's dot com. That is correct. Yeah. Excellent. So people can see some of the stuff you were talking about there. It's great website. Well, I want to thank David for coming on the show and sharing all that great diabetes knowledge with us some really astonishing stuff in this one. Thanks also to touched by type one. Don't forget to go to touched by type one.org and find them on Facebook and Instagram. Give them a follow. Check out what they're doing. Long, longtime supporter of me and the podcast. Hope you can support them. If you're enjoying the show, tell someone else about it. share this episode with them. Go find the private Facebook group Juicebox Podcast type one diabetes. And of course subscribe and an app. Amazon music, Apple podcasts Spotify wherever you get your audio you don't I mean, Subscribe and follow. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast.

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#908 From Loop to Omnipod 5

Jon Fawcetts daughter has type 1 diabetes and recently switched from Looping to Omnipod 5. Jon is a font of diabetes infortmation so don't miss a moment.

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

+ Click for EPISODE TRANSCRIPT

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 908 of the Juicebox Podcast.

On today's show, we have John Fossett. Now John is the father of a child with type one diabetes a teenager. In fact, he is the creator of sugar pixel. He's helped with loop. And he's here today to talk about how his daughter went from loop to Omni pod five. We're also going to talk about a Frezza. I mean, all this is a management heavy episode, like if you're interested in taking care of diabetes. If you're especially interested in algorithms like loop and Omni pod five, or just hearing two people talk about diabetes like a couple of dorks, this one's for you. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please consider going to T one D exchange.org. Forward slash use Box and completing the survey. T one D exchange.org. Forward slash use box you can help to move type one research forward in just a few minutes by completing that survey. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash and the Omni pod five. Learn more and get started today at Omni pod.com. Forward slash Juicebox Podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapist who can help you with a wide range of issues. betterhelp.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit. For any reason at all, you can switch to a new therapist at no additional charge betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scott Benner 15:46
about five years ago,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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#896 Rise of the Machines

Edward has type 1 diabetes and is here to talk about advancements in DIY algorithms. Android APS talk.

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

+ Click for EPISODE TRANSCRIPT

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Friends, this is episode 896 of the Juicebox. Podcast. Welcome to it

today I'm going to be speaking with Edward, he is a type one, he's a father. And he's a computer programmer who uses Android APS to give himself insulin. And he's got a lot of cool thoughts about it. It's a lot to do with where things could be going where they are going. It's incredibly interesting. You're going to be daunted at first by the length of this episode. Don't be. Just settle in. Listen to the conversation unfold, and imagine what could be. While your imagination is running wild, 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. Here's a couple quick things. T one D exchange.org. Forward slash juicebox. Go complete the survey you're going to help diabetes research if you do that T one D exchange.org. Forward slash juicebox. You can get 10% off your first month of therapy@betterhelp.com forward slash juice box. And you can save 35% on your entire order@cozier.com By using the offer code juice box at checkout.

This episode of The Juicebox Podcast is sponsored by us med get your diabetes supplies the same way we do from us med us med.com forward slash juice box Why would you go there it would be to get your free benefits check. And to get started. Don't like the internet. Call 888-721-1514 Get started today with us med they always provide 90 days worth of supplies. They have fast and free shipping. The podcast is also sponsored today by touched by type one. Now I'm going to be speaking at the next touch by type one big event coming up soon. Check it out, touched by type one.org. Also find them on Facebook and Instagram.

Edward Robinson 2:16
So I am Edward Robinson. I am a father of four children. I am a computer programmer. And I was diagnosed with diabetes at age 18. In 2006

Scott Benner 2:35
How old are you now? 34,634. Okay, for hit? Yes. Is that uh, are you doing that for a lot of work? Where are we? Why are you building an army basketball team? What's going on? Exactly.

Edward Robinson 2:54
So I was one of four. My wife was one of three. And so we always wanted to have a few kids. And it's turned out to be four.

Scott Benner 3:04
Wow. Well, you did it. Are you is there like a hole in your floor somewhere where you just keep pouring money to send the kids to college with later or is that how that works?

Edward Robinson 3:16
No, I just go back to work and work more.

Scott Benner 3:20
Are you prepping them now? Because they're young? They imagine right? What are their ages?

Edward Robinson 3:24
They are young. So the oldest is seven. Then five, then almost three and then one. Or almost

Scott Benner 3:32
I'd be whispering in their ear. You want to be a short order cook. Someone has to pick up the recycling. Billy. Come on, buddy. You don't need college? I don't know, man. That's yeah. Have you ever thought about it?

Edward Robinson 3:49
Yes, yes. We started 529 For them quite early.

Scott Benner 3:54
Well, I bet you did. Yeah. Okay, well, congratulations. No

Edward Robinson 3:57
birthday presents just donations to 529 Oh, we'll just go to the park and save the money. Yeah,

Scott Benner 4:05
I want a lollipop. You take this quarter you run home. You put it the home before it just shut up. Oh, my God. I mean, listen, at a an expensive education at this point. Private education is 65 $70,000 a year. Right?

Edward Robinson 4:24
Yeah. And I can only imagine what it's going to be in.

Scott Benner 4:28
I have to tell you, there is an amount of money that my wife and I imagined when Cole was born. And we were wrong by 130% Maybe. So, I mean, maybe things will change. But seriously, I'd be like there's no reason somebody runs the cash register at Target and I think you'd be great at it. And I would, I would I would just get them a nice, nice blue collar job. Although, what kind of work do you do?

Edward Robinson 5:01
So I'm a software developer, I work for a small consulting firm,

Scott Benner 5:07
do you teach them how to code? Are you like, sit down? I'll show you Python today, like, what do you do with those kids?

Edward Robinson 5:12
No. So like, I actually build the application. So we work with different, different clients. And then they have different problems that they want to solve, and will work with them to solve their problems. It almost always involves building applications. But sometimes it's just like management help, or helping them solve their process problems and things like that. But usually, there's applications involved. And recently, I've been working on a project for artificial intelligence and machine learning.

Scott Benner 5:43
Wow. So far, which is really exciting. That's amazing. Actually, I'm gonna hear more about that in a second. If I asked you this question. And this is not oppression, don't take this the wrong way. If I said to you, Edward, I want to make an app that the people that listen to this podcast can have access to the show through, like, I want to make my own podcast app. And I'd like to be able to send them information through the app and break up the series into groupings for them. Would you like chuckle and be like, that's easy? Scott, I could do that on Saturday afternoon? Or is it a big thing?

Edward Robinson 6:19
So I don't do that much. Devote? I've done some Android and iOS development. There are other people on our team who have done a lot more than me and could do it in an afternoon. It would probably take me a weekend.

Scott Benner 6:31
Wow, that's insane. What did you go to college for that? And why are you smart.

Edward Robinson 6:38
I went to college for engineering. And then I within engineering, I studied computer science. So I've been writing programming, or doing programming since 2006.

Scott Benner 6:51
That's crazy. I'm watching my son. Now he just graduated from college. He's got a quantitative econ degree. And, you know, he's going through college, and every once in a while, he'd be like, they make us these these programs we've never seen before, but they don't tell us that much about them. And, and now he's graduated applying for jobs, and in his free time just sitting in his room getting certifications and like, anything he can find because he realized a little too late, that that should have been his minor. He took a mathematics minor, and he's like, I should have minored in this stuff. Because every one of these jobs uses this.

Edward Robinson 7:26
It's amazing how many jobs these days require programming of some degree. Yeah.

Scott Benner 7:32
It's really something and he's, he's picking it up. Actually, he said something incredibly frustrating. The other day, he said, I probably didn't need to go to college, I could have just taken all these courses. And all I could think about was the month. It was like, don't say that to me as like, even if it's true. Never, ever, ever tell me. You know what I mean? Like, please just don't say it.

Edward Robinson 7:59
But something is true, especially around programming. There's just tons of things you can learn online for little to no money. And you can find examples, there are still a lot of like foundational concepts that are a lot easier to learn at a university.

Scott Benner 8:15
Right. I also don't know how you get in the door without some sort of a degree. You know, I to me, that sounds impossible. But I'm sure there's some barrier to entry. Although I'll tell you my brother, my youngest brother is 10 years younger than I am. He was we I never talked about my brothers on the show. But my youngest brother was we used to say either in trouble, or you were about to find out he was in trouble. Like there was no like battlegrounds. You know what I mean? Like he was either doing something he shouldn't be where he was. And you didn't know where the cops were there. So like, you know, there was no middle ground for him. And coming out of high school. He just worked at a pool supply place. And I have to tell you, like my I growing up, my father had a very blue collar job. I don't know that he had any more expectations than that my mom did retail. You know, I think that's probably what he was thinking. And he just met somebody while they were at the job. And they said, you know, we think you could do this entry level thing in it. And now he oversees like a huge department of people who shoot satellites into space. And so that's pretty cool. I don't know how that works. You know what I mean? Like and he sometimes I look at him and I'm like, he's like He got he got away with it. Never went to college, never done anything. And it's making you know, he's making the money just like everybody else. So it's, it's hard to hard decide, but what what leads you to that where you just always inclined or are you super interested?

Edward Robinson 9:48
So I always enjoyed math and science. And so then I went into engineering because I figured it would use those I didn't plan on doing computer science. But I took a couple of classes in college and found that I was pretty good at it. Yeah, there's the first class was like basics of programming. And you had to write programs in, you know, pretty complicated programming languages. These days, there's a lot of like, yeah, click and point programs that you can set up and you can do it with your kids. But this was like hardcore. In order to even like edit files, you needed to know specific commands, and use these like, editors are pretty complicated. And I found that I was pretty good at it and, and enjoyed it. My roommate took the same class with me, and he was really struggling, and he just hated it and want to blow his brains out. No kidding.

Scott Benner 10:46
That's, it's listen. I am a person who in Hold on a second. There's my wife, not I mean, there's she's got two jobs. And one of them stopped the dog from barking.

Her other job is to come up with reasons why we can't have sex started to be so is there a real, you know, stuff she could put on her CV where she could really speak thoughtfully about being adept for sure. If she or he stopped, maybe she stopped. I made it to I was in a very weird situation, we'll get your diabetes in a second. Where I this is so it's embarrassing. They hold on a second. Now she has questions about the dog. But now she doesn't know she needs management. And here we go. She tells me she's I can do it. I can do it. I got pulled out of my kindergarten. But this is going to pull back a curtain on me. I guess I got pulled out of my kindergarten class. And I remember it like right now to this day, my teacher, somebody knocked on the door, my teacher came over to me and said somebody wanted to speak to me outside, I went out in the hallway and this big man, you know who now I realized could have been five, six, I have no idea what was standing over top of me. And he started talking to the teacher and the teacher kind of bent down next to me, I remember her name, it was Mrs. Moon. And she said, Scott, this man thinks you're smarter than the other kids and they want to give you a test. I was like, It's not good for a five year olds ego. I was like, yeah, those other ones do seem dim to me, I get what you're saying, like, let's let's get me separated, you know. And they gave me an IQ test, which I now realize was an IQ test, I realized it because they gave it to me every year, like every year at the beginning of the year. And I'll tell you that I will not tell you my IQ. But I test the same exact number every time I take it. Even if I were to take one online right now I just hit that number, I don't understand what those tests are, how they work. And it was probably the worst thing that ever happened to me. Because in the 70s, they were doing something called a might state state they call it academically talented. And I'm gonna tell you, Edward, I am not academically talented at all. If you just you know, make the list of STEM stuff in your head and assume I'm not good at any of it. Just I don't know what my IQ helps me with. But it is not those things. And so I beat my head against that wall till eighth grade, like in a room with people who were clearly just smarter than I was that, you know, everything we did, they were better at, they understood it more quickly. And when it came to the math, I was really lost. Like really, really lost. They tried to put me in algebra when I was in sixth grade. And I don't know if I've ever told the story or not. But maybe a semester into that that year. I pulled the teacher aside after class and I said, Listen, it's too late for me to drop this class. I'm stuck. You know it and I know it. I don't understand this. I'm never going to understand this. We're in trouble here. Right? I'm making a deal. And he's like, what's this? Imagine I'm in sixth grade.

Edward Robinson 14:17
I'll give you 20 bucks. How old does

Scott Benner 14:19
that even make you in sixth grade? I mean, I was five and kindergarten. So 67892. I was like 11 years old. Okay, maybe 12. And I'm standing in front. I'm like, listen, here's what we're gonna do. I talked him into allowing me to sleep through his class for three more semesters. And I told him I was going to take a general math class in summer school to make my credit up and he said, Okay, like without even a fight. He just was like, alright, and we kept that. Three quarters of the year. We kept that agreement. I came in I didn't bother him. I failed his class. He failed me just zum zum zum and I went to summer school If I do not when you start putting numbers and letters next to each other and telling me they equal something, I can feel my brain short circuiting. I cannot follow it. Like to save my life. And the reason I tell you that

Edward Robinson 15:11
I'm always impressed by your math skills on the podcast. Sure.

Unknown Speaker 15:15
Sure.

Edward Robinson 15:17
I don't know if you have a calculator ready when you do it, but

Scott Benner 15:21
I can do simple. There's usually pretty good action. But my point is that when I listen to my son talk about math. I think our mailman must be really good at math. Because I can't imagine he's my kid. The way he understands numbers. It's really bizarre. Like, I don't know, it just happens for some people. And, and for others like me, by the way, it did not happen for so

Edward Robinson 15:47
well, on the on the flip side, I really struggled with other things like, you know, reading and history and other classes like that. So yeah, nobody gets everything.

Scott Benner 15:58
You're being delightful. I didn't do any of this. I can't believe I have a high school diploma. My I forget what year it was in middle school, we had this great English teacher, and he's like, we're going to read Romeo and Juliet. And we're going to read it together. And I was just like, Oh, I'm not reading that. And we had my senior year of high school, on my first day of my senior year of high school, the English teacher said, we're going to do a research paper, but don't worry, you have the whole year to do it. And he explained what it was and this whole thing, and I swear to you, I raised my hand. And he's like, yes, your question about the research paper? I said, I do. I said, What happens if I don't do it? Can I still graduate? And he goes, No. And I was like, Yeah, I got a job. I don't think I could do this. And I was just like, it sounded impossible to me what he was saying, and I'm sure if I was back in that room right now, he's probably saying, you know, make yourself acquainted with something and write a four page paper on there. It was not a big, it wasn't a big deal. But he was asking. And to my convictions, I kept good grades in that class that whole year. And I thought, like, he can't fail me for not handling one paper. And I didn't handle the paper, and he didn't fail me. So anyway, his bluff did not work on me. I don't know. So I think that's where my intellect works. It works in. Like, it's why you if you hear me say like, if the zombies come find me. I'll be okay. But we're not gonna do any algebra. Anyway.

Edward Robinson 17:43
So I think, God, I think it's interesting that I think a lot of times, people assume that they can't do things. But I think if they find the right ways to learn it, that you'd be surprised how people can do it. So I always thought that I was terrible at music. When I was growing up, I tried playing the piano, the guitar, it was just a disaster. It sounded horrible. But a few years ago, my wife found a piano for free on Facebook. And we went to go pick it up with a U haul. And I was like, why on earth? Are we getting a piano? This is going to be just a waste of space. But I I tuned it. And I learned a couple of songs on the piano. And I was really surprised how finding different ways to learn it. I mean, just watching YouTube videos, but how I was able to actually learn something that I had always assumed that I was just terrible at and it just wasn't going to work for me.

Scott Benner 18:43
No, that's a great point. And the truth is that I think one of the things that got in my way of expanding when I was younger is that I was adopted. So that nothing about my, the way I saw the world. Did anyone else see it in my house, and those people were in charge of giving me things to do? So they would direct me towards? I mean, no one really way I can say just like more blue collar endeavors like I went to school, because I don't want to paint them as like preppers or something like that. They're not that but I went to school because the state makes you send your kids to school. So that's why they sent me to school. They sent me to school so they wouldn't get in trouble. And it was a great place to park me lives while they were working. Yeah. It was. It was free childcare that no one wants said to me, you know, when you're in high school, you would go to college. Like I didn't take the LSAT. I went to I remember being in school the day I realized my friends were signing up to take the LSAT, and I didn't know what they were doing. Like I had to ask a friend I was like, why is everyone doing this? Is this something I have to do? And and they're like, No, you take this they give you a score and then you send the score like that that was being explained to me like I was like I was from another planet you know, and I'm I was like, Yeah, I'm not doing that. I was like, I can't go to college. I No one's ever mentioned college to me before. And then I did look into it a little bit. And even at like a local community college level, I couldn't afford to do that. And I don't mean like, I couldn't afford college. I mean, I couldn't, but I couldn't afford a car to get me to the college. Like, like, there was nothing about my life that was going to send me to school. And no one ever wants, you know, rigged the board for me to get to the end. And so I just, I went to my, my high school graduation, we came home, my mom gave me an ice cream cake to celebrate, I remember that. And then I went to bed got up at five o'clock in the morning and started working full time in my uncle's sheetmetal shop. And that was it. It's just what I thought I was gonna do. Like, my friends all went on vacation. And they were like, I was like, I gotta go to work. And I just, I graduated from high school and went to work. So I don't I think you're right, I think if someone would have pointed me in a different direction, and given me a couple of pointers, I might have been, I might have been in a different situation. But as it stands, you don't want to ask me about anything particularly technical, except for some reason, diabetes, that I see that I seem to understand. Okay. All right. So do you work with your kids with a DD? The little like, was wiggy? Like, stuff? Do you think they'll be interested? Or do you think you'll be like me one day, would you like these kids have none of my interests at all.

Edward Robinson 21:30
Um, they actually already have it in kindergarten, they've got some like, code ish. Like games and things like that, for kindergarteners, which is really amazing. I think really just getting them to enjoy math and science and other things, but also exposing them to everything as much as we can. It's what we really like to do. My son, we're actually super proud. He just had a birthday party. And we were making up pin the tail on the donkey games. And so it's like, you know, pin the arm on the robot or things like that. And he wants to do pin the science on the stem. Look at that. And

Scott Benner 22:16
yeah, let's get that get a good job on that. I like that. I think I was actually inclined to it. Because if you've ever heard me talk about it, I bought the first RadioShack computer. Like I had it. And it was all about programming. And I had programming books, I couldn't figure the first thing I tried didn't work, I gave it up. And I realized now the reason I gave up so quickly, it was financial. Like, I took me so long to save up the money to buy this computer, that when it didn't do what I thought it was going to do, which really just meant that I did something wrong. I took it back right away, because I couldn't afford to own something that that didn't that didn't do something for me. So it's interesting that how that stuff impacts you. Anyway, sorry, there's a long way to go. I was just very interested. So you're 18 and 2006. You're on your way to some sort of a dork Olympics. It sounds like to me. You get diabetes. Is there? Yeah. Is there anything that would have made you think prior to that day that type one was a possibility for you?

Edward Robinson 23:26
I knew nothing about type one. Didn't couldn't even tell you what it was.

Scott Benner 23:34
Nobody? Nobody, nothing. Yeah.

Edward Robinson 23:37
Nobody in the family. My grandmother had some thyroid problems, but nothing

Scott Benner 23:47
was linked to yourself. You wouldn't look at your grandmother and be like grandma's hair falls out a lot. I'll probably get diabetes one day. Yeah.

Edward Robinson 23:53
Yeah. So I started losing weight. I played a lot of sports growing up in high school. played soccer, lacrosse, hockey, skiing, snowboarding, tennis, all sorts of things. But I wasn't playing sports at the time. And I started losing weight. And my parents were concerned and they, they actually told me that I needed to put on weight and forced me kind of start drinking milk. Which is like the worst thing that could have happened. I'm sure my blood sugar just went straight through the roof for hours on end. And one day I went on the treadmill and afterwards, I felt amazing. I was like I'm gonna take up more running. Now like no, you can't run because you're losing too much weight.

Scott Benner 24:49
Keep drinking the liquified fan. It'll be okay. Yeah,

Edward Robinson 24:53
this is helping you. The I mean, they're they're absolutely wonderful, but it was just kind of ironic. because it worked out. And then. And then finally they're like, Okay, we gotta go see a doctor. And so I wanted to school to take a test. And then afterwards, they took me to, to the doctor. And there, they tested my blood sugar. And it just read as high. So it must have been, yeah, over 400 or some something crazy high. Yeah, to be off the meter. So then we drove to Yale, pediatrics for diabetes. And on the way there, I fell asleep or passed out in the car. And the next thing I knew, I was in the hospital, and they're trying to get me into this bed, and I woke up and I was like, trying to push people away. And they, and then I guess I fell asleep again. Okay, and you're sort of woke up? Do you think at some point later, the K

Scott Benner 25:57
or did they ever say? Uh, maybe.

Edward Robinson 26:01
I mean, I, part of me wants to call them up and see if they have my records from, you know, I mean, ages ago, but I don't know if they would, because

Scott Benner 26:09
I'm actually I'm looking at you today. And I can only see you from the shoulders up. But there's something about your frame that makes me think you're tall. Is that fair? Not particularly No, just five 510? Oh, well. All right. Listen, still, I'm trying to imagine them getting an 18 year old view from the cart into the hospital that you noticing like you had to have been out of it.

Edward Robinson 26:29
Yeah, my mom said that she tried to wake me up. And I wouldn't wake up in the car. They had, the doctor had said you could call the ambulance. But by the time the ambulance gets here to then take you to the hospital, it'll just be faster to just drive me straight there. So I went there. And so I was diagnosed, I started on MDI, so it's two shots a day with, I don't remember what the insulin was called. But it's the one that's cloudy, and you had to like roll it before taking that, and then Novolog. And so I do a shot in the morning and shot in the evening. And every day I would call in to the to the doctor's office and give them my numbers for the day. And they're telling me what shots to do and how much to eat for like the next day.

Scott Benner 27:21
How long did that go on for?

Edward Robinson 27:24
So that went on for six months to a year. And then I got it on a Medtronic pump.

Scott Benner 27:31
Wow, wait for for a year, every day you call a number, like you were.

Edward Robinson 27:39
I think that after a few months, I had to call in, like once a week or

Scott Benner 27:44
something. Okay, still, that's amazing. Even if it was just a few days.

Edward Robinson 27:48
I remember this was in like the time of like, beepers and stuff where you call a number to send a text message to a beeper, and things like that. So

Scott Benner 27:57
that must have felt like it must have felt like you were spot looking like just a disembodied voice on the other end, you're like 118, she's, she gives you coordinates back and you're like, yes, yes. Okay. And? Well, that's fascinating. That would have been a much cooler way to think about it. Yeah, you probably should have had a little of my brain that would have helped you not be sad. I'm assuming you were. And you're also missed this call. This is going to college age two. Right. So this happened to you. Sounds like in high school, because you said you still went to a PDF.

Edward Robinson 28:28
And it's actually right before spring break. And I still went on spring break to the where'd I go? I don't know, somewhere in Mexico or something for spring break. Which was a lot of fun. But you went to a probably not the best idea.

Scott Benner 28:45
But did it? See? It's interesting, isn't it? Because, you know, I interviewed a woman yesterday 72 years old, said diabetes for 50 years. She doesn't have one thing wrong with her. It's just fascinating. Like, you don't I mean, like you just It's interesting how, I mean, she describes her care in the past and you think, like, how does she not die? 40 years ago, you know what I mean? Like, like, eat and it was in a time when the expectation was I've done a few older people's interviews this week. And a gentleman who was older as well told me, you know, when as soon as I was diagnosed, he's like, they you know, it was a shortened lifespan. It was you're not going to live as long. Yeah, don't even worry about it. Like you said his care was even centered around the idea that you know, we're just trying to keep you going for as long as we can. And if you were getting cloudy, then I mean, that was still that that was that kind of care. Did you ever have that feeling? Did anyone ever say something like that to you?

Edward Robinson 29:49
It's so the doctors I remember them putting a really positive spin on it. Being like, you know, there are these basketball players who have diabetes or like these other famous People there, lots of people have diabetes, it's gonna be totally fine. And I remember thinking to myself like, Okay, I've diabetes, whatever, I'm just gonna live my life with it. And things will be fine. Little did I know. Yeah. What all that is gonna be? Yeah.

Scott Benner 30:17
I think they were probably telling you about Chris Dudley if it was 2006 He's been on the show, maybe? I don't know. I mean, he's the only one I can think of. So, you see, you're a little naive, right? went off on your trip, and then you headed off to school. But they gave you a pump your freshman year in college. Yeah.

Edward Robinson 30:37
So I started on a I forget what the maker was, but it was before Medtronic. So I started on a pump. And then a few years later, I switched to a Medtronic pump. And I was on those for a while.

Scott Benner 30:53
So did you go to human log? At that point? Do you remember?

Edward Robinson 30:57
I think it was Nova

Scott Benner 30:59
Nova log. So Nova log in a pump. And that changes your company. So you went from like calling people to doing everything yourself?

Edward Robinson 31:08
II? Yes. I didn't do it well, but I did it myself.

Scott Benner 31:13
That's what I'm trying to get. So what were your outcomes, like in college?

Edward Robinson 31:18
I don't know. But they weren't really great. I remember having lots of lows. And but when I had lows, I was kind of funny. These days when I get low, I just still like normal and can think, but I would like say ridiculous things or you know, do funny things. I'd get really stubborn sometimes. My girlfriend at the time, who's now my wife, she would tell me all these like stories where she would be like, you have low blood sugar, you need to have something to eat. And I'd be like, no and aren't get argumentative. And she'd be like, you know, what, if, if you don't have something to eat, I'm gonna call your mom. And then I put my hands over my mouth.

Scott Benner 32:04
Like, sort of like home alone. It's like, oh, my god like that. Like, no, like,

Edward Robinson 32:09
You can't force me, I'm just gonna cover my mouth.

Scott Benner 32:14
Like you're four years old at work.

Edward Robinson 32:18
Yeah, and then another time, I had low blood sugar, but I thought it had to be high blood sugar. And I didn't have my meter with me. And she was like, I'm just gonna eat these cookies, and put one here next to you. And of course, I snatched it up and ate it.

Scott Benner 32:35
I just had a moment with Arden the other night where I was like, you have to do something about your low blood sugar. And she's like, I will. I will. I said art. And now like, if you do it now, you're not actually going to get low. Like I can see it coming like this is going to be like, This is a 50 If you don't do something, and she's like, she's like, I will I will. I will I'm not hungry. I don't want to have a juice. No, do this. No, no, get out of my room. I'll take care of it. I'm like, okay, so I mean, you know, I walked out of her room and sat like up the hall waiting because her blood sugar was, you know that I saw it go the other way. And I was like, okay, she got it. But I know I know that thing. Like you lose your you lose your cognitive ability. You just, you know, and you think you're making a ton of sense to, which is Yeah, it's really interesting. And your friends loved it. Right? Because you turn it into a goofball. Right, exactly. Yeah. You're lucky they didn't figure out how to give you insulin just to make you a low just to pass the time. Someone give Edward a unit. So he says something stupid. She's and your girlfriend who becomes your wife afterwards? She saw all that in college and married you. Wow.

Edward Robinson 33:50
She did. She did. And my mom was even like, you know, he's got diabetes. It's gonna be a lot of work. Are you sure you want to marry him? And

Scott Benner 33:58
Oh, thanks, Mom. You want things? It's easy to get? There is it was a totally fair thing to say. Well, yeah, but someone got to be on your team. I pulled her aside. I've been like, Listen, I have no other prospects. This is not something that wasn't okay. Well, she comes

Edward Robinson 34:18
from a family of allergies. And so she had allergies to milk and eggs growing up. Like if milk touched her skin, she'd start throwing up. Oh, and her sister has like a peanut allergy. And our kids have allergies. Some of them have been they've outgrown some of them. But between like diabetes and allergies, our kids potentially hit like the Yeah. The genetics jackpot. Yeah, well,

Scott Benner 34:50
I think of it's funny. I don't know how science thinks of it. And I'm sure we could Google it and find out but i i I think of allergies as autoimmune Like you don't I mean, like it's your body, right having a ramped up response to something. So that's something else. Geez, yeah, forget college, you better start saving for medical insurance and stuff. Wait a minute. Like I, if I flick milk, get your wife and it hits her she vomits

Edward Robinson 35:22
Not anymore. Not anymore. But when she was very young, she did. Yeah. So, so there's one time when they they wanted what was it? They had to go somewhere. And they had to like change their flights or something. And they're like, sorry, you can't change your flights unless you've got a doctor and get like a refund unless you've got a doctor's note. They're like, Huh. And they gave her a little bit of milk and took her to the doctor so that they could get their flights changed and get a refund.

Scott Benner 35:57
Okay, hold on. So her family made her vomit, to get a doctor's note to get a refund on an airline ticket. Yeah, like I like this.

Edward Robinson 36:06
So it's not a for her. It's not a paid dangerous overreaction to just throw up and take Benadryl and then she'd be fine. It's not like a peanut allergy, where you have like respiratory issues and can't breathe.

Scott Benner 36:22
They explain this to her. Was she a co conspirator in this thing?

Edward Robinson 36:27
Um, maybe

Scott Benner 36:30
I don't know what the thing I don't know if I like the story better if they just are like, drink this thing in front of the doctor. Or if they were if they pulled her aside like a little like thug, and they were like, here's what we're gonna do.

Edward Robinson 36:42
The best part was that it was in Canada. So seeing the doctor is free too. So they didn't have to pay for that either.

Scott Benner 36:46
Oh, my goodness. Are you Canadian?

Edward Robinson 36:50
She is Canadian. He is your man. Her father is Canadian.

Scott Benner 36:53
Okay. Yeah. That's something where do you live? You don't live?

Edward Robinson 36:58
No, no, we live in Pennsylvania. Okay. outside of Philadelphia. Oh,

Scott Benner 37:03
we're very close to each other.

Edward Robinson 37:05
We are we are when I signed up for this. I was like, hi. I wonder if I should just go to Scott's house and you'd have a nice microphone. We could record it in person.

Scott Benner 37:12
I do have one right here. We could have done. I've never done I've only ever sat in a room with Arden and made a podcast. The only person I've ever been right in front of oh, we're done. We're gonna have to find out where you are? Because it's possible. Yeah, we're up the street from each other almost. Okay, so you've got diabetes, they start you on a pump? Not particularly well, a lot of lows. Are you going to the doctor with any regularity through college getting a one CS or anything like that?

Edward Robinson 37:41
No, the the pediatric type back office where I was going, they stopped writing the prescriptions in like, sophomore year or something. They're like, you haven't been here in two years. We can't keep writing new prescriptions. So then I went to see a doctor once or twice, so not very often.

Scott Benner 38:02
Right? So you were just you just went back to another doctor to get a different prescription? Wait, yeah. Or do you? I was gonna say when did you start seeing a doctor regularly, but maybe you don't.

Edward Robinson 38:15
So it was after college? I did. And for me, the promise was always in technology. I started on the Medtronic 670 G. Or maybe it's 630 G the one that the first one that had the automated mode. Okay. And so I went I went back I actually looked it up my A onesies were in like the sevens. And then with the 630 G, it brought my A onesies down to 6.1 6.2. So that was really amazing. For me, I found special ways to make it work. And I even found that in the settings, if you changed the insulin activity to be you could turn it down all the way to like two hours or something like that, which is obviously not how long insulin is in your body for but by doing that it made the algorithm more aggressive, because it would see that you have almost no insulin left on board and therefore it's going to give you more to bring your blood sugar down faster.

Scott Benner 39:25
So did that pump have a glucose monitor attached to it at that point? It did, right. Yeah,

Edward Robinson 39:30
so that's the one with the integrated glucose. There's one before that had a glucose monitor. But it wasn't very good. And it had this like harpoon to get it into you and it was super uncomfortable. And it was like probably half an hour to 45 minutes delayed in what your blood sugar actually was. And so I didn't really find it helpful at all. The endocrinologist wanted me to wear it. So I'd wear it for like a week before going to see them which in hindsight now I see how it could show you the trends and things like that to help you better adjust your basil, but were you focused in settings, but

Scott Benner 40:08
we're focused then on that it was such the data was so late from when it was measured that you're just like, well, how is this valuable to me, but you could have macro to it and seen? Seeing Right, exactly. Yeah, I understand they didn't even I don't even think back then the doctors probably knew enough about it to even give you that insight to you know, and this is when, what's the year for that? Do you know about?

Edward Robinson 40:33
So I started on the 6/3, the one with auto mode in 2016. Okay, so the previous version would have been 2012 to 2016. Gotcha. All right.

Scott Benner 40:47
It's so I have this problem all the time. I look at 2006 written in front of me when you're diagnosed, and it feels like it was I don't think of it as long ago. I don't know. It's just my age, like anything with a two in front of us like, yeah, that just happened. You know, and then we start telling the story, and I keep thinking it's it's 2022, you know? Yeah. Just, I mean, I don't know, there's something about those numbers. They mess with me. So you're doing this, but what you really like about it, and 39 minutes into this, Edward? It's why you're on the show. I mean, they're great at this are really bad at it. I don't know, I can't even tell the difference anymore. But but the technology part you said really attracted you to it. So when did you like you built your own algorithm? Right? Correct back. So yeah, tell me about it.

Edward Robinson 41:38
So yeah, so I was on the 630 G. And actually before being on the 630 G, the prior one with like the harpoon CGM, that wasn't very accurate. I, I found online somebody who had managed to kind of hack into the pump and extract the data. And so I worked with him and was actually able to decode the data for the CGM and load the CGM data onto a computer. And so I initially tried to create my own closed loop system. Using that, and I did it like on a laptop computer, and then I was going to put it onto like a small Raspberry Pi computer that could fit in my pocket. But between like that computer and a battery for that computer, and the pump and the transmitter to communicate with the pump, I would have to carry like a fanny pack around. And I was like, Yeah, I'm not gonna do this.

Scott Benner 42:43
Even good health,

Edward Robinson 42:44
I'll just wait, I'll just wait for Medtronic to release the 630 G and use that right. But after using it, I kind of got frustrated with it. Because it being the first one, it was very conservative. And it would bring your blood sugar down to like 150 and then slowly bring it down to like 120 but it wouldn't go. It would try to keep you above 120 all the time, and I want to start getting better control. And so when I was done with that I was looking around to see what to switch to next. And that was when I came across the loop community and the Android APS app and started using that and since then, so when I started using that my a one C dropped from

Scott Benner 43:45
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Edward Robinson 46:18
6.1 to 5.6, right, which was really amazing for me. But the best part was really the alerts and alarms. So for me, I'm a very heavy sleeper. And I would like the alarms would be going off on my pump. And it would be beeping away and I'd be sleeping through it. And my wife would kick me because it was disturbing her. And I would wake up in like a half, half asleep and I would just sort of dismiss the alarm go back to sleep. And 20 minutes later she'd kick me again. And I'd wake up and dismiss it and go back to sleep. And sometimes, and then eventually I would get up and yeah, have some sugar or things like that. But in my like, half asleep state I would sometimes do the wrong thing. So there are even times when I would give myself insulin when I was low. And my wife would look at me and she'd be like, What on earth are you doing? You just gave yourself insulin and you have low blood sugar. And like, after like a few minutes of talking to me, I would then be like really cognizant and

Scott Benner 47:26
having a meal, I need to

Edward Robinson 47:30
realize that I would need to go and chug a bunch of orange juice because I just given myself three units of insulin right when I already had low blood sugar.

Scott Benner 47:37
You know, there's a story floating around on the internet right now of a gentleman that just did that and killed himself. So it's such a crazy tightrope act, you know?

Edward Robinson 47:49
Yeah, it's so it's like Android APS, I love it because I set up alerts were ill send off an alarm and the alarm will go off every five minutes. If my blood sugar is dropping below, below 75 Or if it's dropping below 80 and dropping quickly at night. And so the the first one I usually just dismiss and go back to sleep, but by the third or fourth alarm, I've woken up and had something to eat and and then that saves me a lot from having nighttime lows. I have fewer nighttime lows, but they still happen occasionally.

Scott Benner 48:27
You keep stuff by your bedside. Yeah, looks like a little Kimmy. It's sort of a Wawa, I guess. Finally I can say yeah,

Edward Robinson 48:35
and then sometimes I come down to the kitchen in the morning and I've just like eaten everything. There'll be like candy wrappers and gummy wrappers all over the place and my blood sugar will still be coming down from like, 200 I'll be like, Oh, God. That was horrible. I

Scott Benner 48:50
overdid it. Yeah. What's that feel like in the morning after you've been through that? Is it a? Like I know people say like lows overnight, make them feel hungover. What a highs overnight. Make you feel like?

Edward Robinson 49:03
Yeah, I think it's kind of similar. I feel like dehydrated and hungover. And then having young kids there's usually one of the kids up at night at least once during the night. So then you just feel even more tired, right?

Scott Benner 49:16
Do you ever feel achy? Is that ever a thing that happens after highs just body aches or

Edward Robinson 49:22
so I've started to notice that sometimes my like tendons and stuff hurt a little bit, or they're not hurt, but they're just like more sensitive. And I can feel that, like in my hands or my ankles. They're like tighter. And stuff, especially when I have high blood sugar or extended high blood sugars.

Scott Benner 49:48
It's interesting because Arden's ribs get sore sometimes. And, you know, lace cartilage and connective tissue and stuff like that. It's interesting. Wow. Oh, okay, so you built is is that? Um, Dana Lewis? Who, who I had on the show years ago about Android APS like, is that a name you recognize?

Edward Robinson 50:10
Yes, she's one of the contributors. And there are a bunch of other contributors to Android APS as well. A lot of them are abroad.

Scott Benner 50:22
Okay, what made you go Android? It was available prior to loop. Right. Android was first Android. APS was before loop. Am I right?

Edward Robinson 50:30
I don't know which one was first one, either.

Scott Benner 50:33
You're just an Android person.

Edward Robinson 50:36
But yeah, just an Android person. Yeah. So I run with that. And so then, for that, it's, it's really interesting, it's got this really cool feature where when you start using it, it doesn't unlock all the features until you've gone through certain milestones. So it starts you out in manual mode. And you have to do that for like, a couple of weeks. And you need to answer some like, kind of test questions to make sure that you're, that you understand how it's working. And then it will do a mode where it will prompt you whenever it wants to change your Basal rate. And you do that for a few weeks and learn how that works. And then it starts to do that automatically. And then a few weeks after that, you can learn how to use the, what they call small micro boluses, which is basically where I'll give you bonuses rather than adjusting your Basal rate.

Scott Benner 51:35
I think that's, by the way, I think that's brilliant. If you listen to the show, I you've heard that I've advocated it to companies all the time, and no one seems Yeah, no one seems to listen to me. But for all different kinds of applications, I keep saying to them, like why not have a beginner an intermediate and a an expert level that you can unlock by? I mean, that's a great way even having your doctor sign off on you sliding up some things. Like imagine if you could, I mean, you know, right now what only pod fives target is one tend to control like US targets 112 and a half, like what if you could unlock a blower target or something like that?

Edward Robinson 52:16
Yeah. And you can even do even more stuff. Like, if you have lows, or if you have an extreme low, then you know, it's going to kick you out of that lower target for 24 hours to make sure that you don't get another extreme low. Things like that. Some of it is like, you know, the first couple of hours before any of the Dexcom. Sometimes it can trend lower than it really is like it says it's 46. But you test your blood sugar and your 86. But eventually, it sort of catches up, which some of that could be frustrating. But I think there's so many things that you can do. And there's tons of stuff like that built into Android APS, which I really love.

Scott Benner 52:55
I never know how to answer people's questions, because inevitably, someone says on these automated systems. What if my CGM is way off? What do I do? And I don't know how to say like, I don't know. It's never just not usually an issue. And, and when it is like you just like Arden switch to CGM day and a half ago. And for the first 24 hours, it was reading lower than she was. But her blood sugar's were higher. So she had like a like an impact from from hormones. So she was in this more like 170 range. And then I don't I don't know how to put this other than she was too steady, too high for too long. And it made me think, Why is her blood sugar not coming down with the amount of insulin we gave her? Oh, her blood sugar must actually be higher than this says. And there's something about that collection of circumstances that make me go test your blood sugar, you're higher than this says you are. And then as soon as I prove that that's correct, then you can make a large enough Bolus to actually impact it, and then boom, you're okay. But yeah, I don't know how you explain that to somebody on day one, you know?

Edward Robinson 54:05
Yeah, yeah. Like some usually when I first start the sensors, I'll just stay in manual mode, and just let my regular Basal rate run until I know that the sensor is actually working effectively. Sometimes I put it on it works effectively, immediately. Sometimes I'll do the pre soaking where you put it on, and you stick in like an old dead transmitter and then swap the transmitter in. So then it's been in underneath your skin for 12 or 24 hours before it's actually being used. Yeah.

Scott Benner 54:38
You get more accuracy from it right away. What right what pumps do does Android APS support?

Edward Robinson 54:46
So Android APS supports a bunch of pumps. Some like European pumps, and I think even like some from South Korea, as well as Medtronic, and I Omni pod, the original Omni pod as well as Omni pod dash, and I'm using Omni pod dash, which is really fantastic. Because there's nothing to carry around other than your phone which, yeah, yeah, like most people these days, I'm glued to my phone anyway. Right? My, my, it's really nice to not have anything to carry around.

Scott Benner 55:19
It's my expectation that that's the system we're going to put on. When as soon as loop is ready, there's a loop, I think loops, Badaling on the pod dash right now. And it's, I think it's very close to being done. So

Edward Robinson 55:34
yeah, I'm just, it's really great. So then, so then after doing that, for a while I, I did some contributions to it. So I tested that the I was one of the early testers for the dash capability. And then I was one of the early testers for this new algorithm that people have been working on in the Android APS community, that's called dynamic ISF, where it looks at your total daily dose from the last seven days, the last day, the last, like four hours and the last four hours before that, in order to estimate what your insulin sensitivity should be. Which is pretty cool. And there's actually some really cool science behind it. Where, which is why a lot of the pump manufacturers use it. Where if you've given yourself more insulin, over the last few days, or whatever you have, chemically within your cells, like more resistance built up. I don't know exactly how the chem chemistry works. But it's kind of like people say, when you drink more, you're

Scott Benner 56:50
gonna get drunk as fast it takes

Edward Robinson 56:52
Yeah, exactly. I thought that's a kind of similar concept with insulin, right? Which is pretty cool. So I tested out that and over the last four to six months, I've actually taken my experiences from work of working on artificial Mattel, artificial intelligence and machine learning. And built my own algorithm that uses AI and ML to build a model. And it uses a whole bunch of data, so uses those total daily dose, insulin factors, it uses the time of day, it uses activity tracked from my watching from so I wear a smartwatch, that tracks the number of steps that I take. And from the phone, and I'm actually working on incorporating heart rate monitoring. So from the watch, it monitors my heart rate and sends that to my phone. So I can include that in the algorithm as well. Well, that's as easy as

Scott Benner 57:54
well, let's stop for there for a second. So having just a step tracker on, then that allows a sort of like not unknowable variable, variable, but something that it's hard to remember to. I mean, you know, when you're, when you're making, when you're making manual decisions about your insulin, it's hard to think, oh, I walked around more today than I did yesterday, I'll cut this back, or maybe my insulin sensitivity should be a little weak or something like that. But you're saying, Yeah, you're saying that the algorithm would be able to take that into account?

Edward Robinson 58:28
So it does, yeah. So basically, what you do is you feed it, instead of writing out for machine learning, instead of writing out an algorithm, you give it a bunch of data, and you give it the answers. So you say, you know, my blood sugar went up half an hour later, I should have done more insulin half an hour earlier. And you give it all the factors and then it will figure out what the algorithm should be specifically for you. So it's really amazing. And it's just a total change in perception and way of thinking about it.

Scott Benner 59:03
Well, I definitely see the the retail space is moving that way because Omnipod five is is you know, there they won't even tell you what it's doing. So you know, it's like it's learning and I'm like okay, what does that mean it and and if you ask them directly there's there's no hiding it. They'll say this is proprietary information. And in so my expectation is I I've always thought that like I was like, well, if they're working on it, like the DIY community has got to be doing it as well. I just don't have a real in with Android APS to to hear the conversations. But yeah,

Edward Robinson 59:43
so this is something that that I've been working on independently. I've worked with a couple of other people. But it's still kind of early, and then my thought was to then find other people who are interested in experimenting with it. and help roll it out to more people and then eventually make it easy and accessible for everybody in the Android API space. There is actually a French company called Diablo loop. I don't know if I'm pronouncing it correctly. But they actually use AI and ML for their algorithm on your, which is pretty cool. It's

Scott Benner 1:00:23
exciting, actually is what it is. Yeah, yeah. Because but it's I guess, and it's, so you're you, are you using it right now? For yourself? You are? Where's it holding your

Edward Robinson 1:00:37
server right now my blood sugar is 129. It the target is 90. And it can keep it pretty stable there. But the so it's pretty cool. So it uses what else does it use? It uses the insulin on board, the the amount of carbs that I've eaten, I've recently been working on adding in the type of carbohydrates. So recording. Yeah, have I eaten pizza or salad, or, you know, orange juice, and then being able to incorporate that into the algorithm, because the algorithm should be able to learn that, hey, you ate pizza four hours ago, I'm gonna need to increase your insulin in order to account for the fat price that's going to come later on. And things like that. And even like specific types of pizza, have you eaten pizza from Domino's? Or have you eaten homemade pizza, and be able to factor those things in because it can basically see, you know, in the past nine out of 10 times when you've had Domino's Pizza, you've had arise for hours later. But when you've had homemade pizza, nine out of 10 times you've had arrived two hours later, because there's less oil and stuff

Scott Benner 1:01:56
like yeah, it might be less significant as well. Because I mean, right we make we do it here and we that's exactly what we see to the crust is thinner. I'm not dousing it in oil, there's not a ton of salt on it, like you know, it's there's not as it's not covered in cheese, there's cheese here in there. That's um, but that's exciting, isn't it? Well, we gotta get you help them. And we're we got to keep you moving. And your wife needs to be nice, no more kicking you at night, you need to be treated better. What's the sort of is the idea of like, Do you really think you can get it to a place where you'd be comfortable sharing it with other people like that?

Edward Robinson 1:02:35
Yeah, definitely. So then, so then it. So I take all the data. And then I train and build a model on my computer. And then I load that model onto the phone, and then use that model. I built in a bunch of safety requirements. As well, like if my blood sugar's dropping, it's going to be restricted and how much it can give me. You can put in restrictions around how much insulin it can give at any, for each micro Bolus. There's thresholds around how much it can give in total, like how much insulin you can have on boarded anytime. So there's a bunch of like safety around it. But all of those safety requirements are built around what I need for safety, not necessarily around what any person would diabetes needs for safety. You know, I'm pretty, relatively easy. I'm not a young child. I don't go to school, I work from home. I carry glucose tablets with me. Just in my pocket. I've got a little thing and I carry two glucose tablets with me all the time. Do you remember safety isn't really too bad for for me, but it shouldn't be that hard to make it safe for other people as well.

Scott Benner 1:03:59
That's what I was wondering is like, Can you can you imagine a world where the thing you're working on could be that what's How do I want to put this where it can be where it can do the job that is doing for you, but be generic enough that it could just be a retail item?

Edward Robinson 1:04:21
Yeah, so I think that this is going to be that the way that it will be for pump manufacturers, I think that they'll probably have another couple of iterations of doing it manually, like writing the algorithms manually, but then eventually, over the next maybe five or 10 years out, it will be using machine learning. And actually, I've you know stocked Omnipod pod and Dexcom online and they actually hire a lot of like data scientists and machine learning people. So they're using a lot of this but then they're translated and sort of what they're learning and what they're seeing in the data into still handwritten algorithms that then use inputs, like, I know that Omni pod uses, like total daily dose of insulin in their algorithm. And they probably use, like, I know, they use total daily dose from last three days, they probably use it from the last day in the last few hours or things like that, to figure out how much insulin to give you, but they don't factor in things like, you know, exercise, hormones, stress, food, types of food, things like that, which you can really get, and a machine learning algorithm can do and use for figuring out how much insulin to give people

Scott Benner 1:05:47
ever do this for me, tell me something that's that exists in the world today that people would be aware of that is employing machine learning.

Edward Robinson 1:05:59
Oh, Tesla cars, that's one of the simplest ones. So like, you know, Tesla's got their autopilot, and self driving car features. So that's all around machine learning. So they take in basically tons and tons of video data. And then the answer is, you've got to stay on the road. And times when the car drove outside the road, from the audit from the AI and machine learning system, but the person steered back into the road. Those are areas where you need to adjust the machine learning algorithm and provide it more data and say you should have turned right, when you tried to turn left to stay in the road. And, and therefore learn from this experience and build that back into the model.

Scott Benner 1:06:44
So in there, in that example, and I don't know why I know this, but I know that Tesla had to actually build their own computers to do that process, because they couldn't buy powerful enough computers to do it. Right. Yeah. And they're getting data from every I guess every car that checks off. Yeah, you can have my you know, you can have my cars data. And right, so So these computers are just running these simulations over and over. And then from what it sees, the computer says, Alright, well, line whatever in the code should be this instead of this, because, or what I know, I'm oversimplifying greatly, but it's learning and making adjustments to the, to the software that's onboard in the cars.

Edward Robinson 1:07:32
Yeah. So like, another way to think about it is. So when you write a traditional program, you say, if your blood sugar is high, if your blood sugar is x, then you need to bring it down. 50 points, right. So for 50 points, if your total daily dose was 100, then your insulin sensitivity is going to be 50. So you need one unit to bring you down 50 points, we're gonna give you one unit, right? So you basically write all that out to say if this than that, and if something else, then do something else. And you write out that logic by hand. But the machine learning basically figures out what that logic should be. So you can actually have a generate out this machine learning algorithm approach called Random Forests, where it will write out those sort of if then statements for you, and it builds kind of like a little tree that you could imagine that at the base, you say, is your blood sugar high or low? Okay? If it's high, then do this or that. And if it's low, then do X or Y. And l build out like hundreds of these trees, and then each tree will make a prediction of what it thinks it should do. And then it will take an average to figure out how much insulin to give you.

Scott Benner 1:08:53
Okay, so it could in that scenario, it could say, Listen, normally, I need we want to move 50 points, that's a unit, but I see that you've walked more today than normal. So we're going to use point 100.8 instead, something like that, or, or over the last 24 hours, we've been using 30% more insulin than we expect to so I'm gonna give you a 1.3 in this situation. Yeah,

Edward Robinson 1:09:19
yeah. So then, one way to do it,

Scott Benner 1:09:23
you understand? That puts, as I said, that puts me out of business. That's, that's for sure.

Edward Robinson 1:09:31
So I've been using an algorithm that it's called neural networks. And so it's kind of similar, but think of it more around probabilities. So you know, when you're high, you probably need one unit nine out of 10 times, but you've exercised so when you've exercised, nine out of 10 times you need half of the amount of insulin. But I can also see that you've eaten Oops, 60 grams of carbs. So when you've eaten 60 grams of carbs usually need, you know, a little bit more. And so then it adds all those pieces up to then figure out how much insulin to give you,

Scott Benner 1:10:10
right? It looks at the carbs, then it looks at the activity. And here's your number. And then this happens. In a blink of an eye, like you don't notice it happening, so yeah,

Edward Robinson 1:10:24
yeah, so it makes predictions every five minutes when it gets the reading from the Dexcom. And then it takes in all those factors, and then calculates what it should give you. So right now, let's see. For example, it says, so this is my, my current blood sugar is 136. And it's going up plus three. And so it says, the AI model predicted a small micro Bolus of point 207 units. And then it goes in and factors in a bunch of safety requirements. And then it rounds it to point 05. So it's gonna give me point two units of insulin. Okay. And so it did that.

Scott Benner 1:11:12
That just happens automatically. It's not done through basil. It's done in an auto Bolus.

Edward Robinson 1:11:17
Yeah. So then every, everything's done through an auto Bolus. Yeah. And and so then it sends the communication with the pump, and then gives me the amount of insulin that it that it should do.

Scott Benner 1:11:29
Yeah, I'll tell you for Arden loop made a big leap for her when we left, the version that was just using basil to try to stop and it moved to the auto Bolus version that was a was a big deal for her. There are still some times very infrequently, but it can happen, where if she has a low, and she puts in some carbs to fix it, but uses too many carbs and then hits her threshold again, it boluses and you're like, No, please don't Bolus here. You don't I mean, and then and then she's low again, 30 minutes later. And then yeah, I've showed it to her, I'm like, you just you can't, you can't over treat it. Because you're also not telling it you took in the carbs. And that's weird. So

Edward Robinson 1:12:15
there's some cool things that you can do. I used to run into that a lot. And so with Android APS, you can set up automations. And so one of them that I had set up was anytime that I went low, I would set a temporary target of 130 for the following hour, in order to avoid having a second low by overcorrecting because you eat fast acting carbs, and it thinks your blood sugar is going to shoot up to 200. But then the carbs are gone. And then there's too much insulin right on and then it crashes down again. And you got sort of a yo yoing effect. So

Scott Benner 1:12:47
you just did a temporary target that was higher.

Edward Robinson 1:12:51
Right, right to say, you know, let's avoid doing a second low, which then I'm going to treat and over treat. Let's just keep it steady for a little bit, and then bring it down slower.

Scott Benner 1:13:01
You know, the woman I spoke to yesterday, who I told you a 72 She's looping, which I'm like, just I thought was terrific. And she said when she goes and does things like meets new people, she gets a little adrenaline. And she's like, I don't like the Bolus for instead, I set my target lower. So the Yeah, so then the algorithms a little more aggressive, not a ton aggressive. And then the bump she gets wasn't as you know, isn't as as significant. And she doesn't end up low later.

Edward Robinson 1:13:31
It's really Yeah, the other thing that Android APS can do, which is really cool, is that it can see based on how many carbs you put in and how much it thinks it's seen of those carbs. It can say, you know, you're likely to go low in the next 45 minutes, and you should eat, you know, 15 carbs, or 10 carbs are eight carbs, which then really helps with overcorrecting, and it can see it far enough out that you can have it to then totally avoid the low. That's which is really nice.

Scott Benner 1:14:06
It pops up and tells you like you should have eight carbs. Yeah.

Edward Robinson 1:14:10
Right. Right, exactly. And then the other thing that I really like is so I use another app called X strip, which works with Android APS, but it allows you a lot finer control over the the alerts and alarms. And so I always find it funny when I hear you ask on the podcast, what people have their alarm set to because what you can do is you can set different alarms. So at like 130 I just get like a nudge that's like, Hey, your blood sugar is going up a little bit. At 160 It's a little bit more of a poke. And then at like 190 My phone starts vibrating like crazy. It's like hey, your blood sugar is really going up. You should do something about this and and then also when the alert goes it starts with vibrate. But if you ignore the vibrate for a few minutes, then it starts with like a small chime. And then it gets louder and louder and louder for the alert to make sure that you actually acknowledge it. Which is really cool.

Scott Benner 1:15:15
Is this a job interview? Or did you think I'm gonna come on this podcast, I can get a job with one of these. Somebody over here, because they're going to hear it. At this point, I think every diabetes company listens to the podcast. So I feel like I feel like you're on an extended job interview right now you don't even know. Like, why? So I'm fascinated by this part of it. And maybe you have insight in this. And maybe I'll just ramble and you'll say, I don't know, Scott. But when all this is possible, right now. I don't understand why. You know what I mean? Like, I was in a meeting with somebody one time, and I said, like, I don't know who Ivan is, but find him and hire him. You don't mean and? And, you know, I don't know who Edward is. But is there a reason somebody hasn't run in and gotten him and put them in a room and said here, do the best you can? Let's see what you come up with. You know, like, I don't, I don't know why. I mean, I guess big companies have more to consider than I'm, then I'm absorbing right through the FDA and all this other stuff. But it's just I mean, what you're talking about sounds like the future, but you're sitting in front of me using it. So

Edward Robinson 1:16:22
yeah, yeah. And a lot of it is just like common sense. Like, it gives you an alert, if it thinks you're gonna go low within the next 15 minutes. So then, when that comes up, I just take, you know, two glucose tablets. And then I avoid, though entirely, rather than getting the alert when you go low. And from what I've listened to of the interviews that you and other people have done with, like Kevin Sayer from Dexcom. When he answers the questions around the alerts in the apps, it does sound like Dexcom is going to build some of those things into the next version of the CGM. And I really do hope that they build in a lot of these types of alerts because it just makes it so much easier. Rather than getting the Dexcom alert, that's like, incredibly loud, when your blood sugar's 130. Just getting a little nudge is so much more convenient and effective.

Scott Benner 1:17:21
Yeah, it also doesn't give you that like, feel anxiety. Yeah, she's this again. And then you look down, you're like, Oh, I'm only 130. And you know, it's not right, I take your point, I just I'm not even pointing out anybody specific. I mean, pumps, pump manufacturers, CGM, or whoever. It just, it's all right here. I don't know what you don't I mean, so

Edward Robinson 1:17:44
we don't Yeah, and the funny part is that the code is all written, where it's, it's open source, I mean, you can just take the source code and just have that be the Dexcom. App, you don't have to do anything, you can just take it and use it.

Scott Benner 1:17:58
Right. Even that part of the world, I don't understand I for the life of me don't understand, like open source. Like I think it's wonderful. But like, my brain doesn't understand why people do it. Because it doesn't, it doesn't lead to I guess it does. It just leads to it. So slowly, getting to mean like, like, Wouldn't it be better if you just sat down and wrote out your thing and incorporated it and made it? And then? Or does that like the as soon as you get into regulatory stuff, it just it stops that I

Edward Robinson 1:18:29
get? I think yeah, because I think that the regulatory stuff, and then also making it safe and effective for everybody. So like, I can build this algorithm and test it on myself. But if I'm doing it in a company, and you know, I get low blood sugar, I just treat it whatever, I don't, I don't care. But if a company gives somebody low blood sugar, then it's like, well, what are you guys doing? This is terrible, right? And if it falls apart, and somebody dies, you know, then the company is dead. It's over for them. I completely understand they have to be extra safe and cautious when working on all these things.

Scott Benner 1:19:09
I'm being to people here. I'm being like, 10 year old man who's like, Just do it. And you know, the rest of me is like, No, I know why this isn't happening. But it's just it's, it's frustrating. You know, it's and it's, and yet, in the diabetes space over the last eight years, things have moved forward. Incredibly dramatically. Yeah, you know, just really it's

Edward Robinson 1:19:31
amazing. Having lived through like multiple daily injections and eating a certain amount of carbs at a certain time to now having this like incredible algorithm. Yeah. Which so the other part that's really cool about the algorithm is that there are no settings in it. There's there's no insulin sensitivity factor. There's no Basal rate. There's no Are count, there's no car sensitivity factor, it just figures it all out for you. And all I do is I put in the amount of carbs that I'm eating 20 minutes before, I mean, you still have to like, put it in before so it can Pre-Bolus. But 20 minutes or half an hour before I eat, I put in what I'm eating, and the amount of carbs and then it slowly builds up like a wave of insulin as a Pre-Bolus, which is really nice. Yeah. And then you also get fewer like crashes because it's slowly building up the insulin through multiple doses, rather than just like one dose that then so I use fiasco and I would find that if I Pre-Bolus. With the right amount of insulin, it would all hit within like a 15 minute period, half an hour, 45 minutes later. But the food absorbs over a longer period of time. So being able to have it, slowly build up the wave of insulin makes it a lot more effective.

Scott Benner 1:21:05
Arden had a five guys the other day, and we went and picked it up. And we left there. I was like, I think I think I said something like Bolus 20 carbs now. And then we drove home. And then we did 40 More like I'm telling you this meal is right. It's got to be 100 at least carbs. And then we did a little more and did exactly what you just said, like we created. You know, in my you it sounds like you do listen to the podcasts like in my mind, like I'm creating like different timelines of Bolus is different. You know, they live on their own plane of existence for me, this one's going to peak here, this is going to peak here, this is going to peak here. And that should lay over top of this fat and protein that she's going to see from this food pretty well. That I'll tell you that Bolus went so well that when it was over, I was stunned by it. Like Like, like, like four hours later, I looked at her graph, and I was like, huh, wow. Like, even I was like, okay, yeah, that's crazy that that works. And then the next day. She has a waffle in the morning. And we did a little bit. And then I said I was cooking and I said, Hey, Bolus 30 more. And then I don't know, 15 minutes later, she sat down, and I said, Okay, we're gonna do the rest of the insolence she goes, we haven't done any of it yet. Just the first bit. And I was like, No, I said, Do 30 more. And she goes, I didn't do that. And just not hearing me say that. kept her blood sugar 180 for like, four hours. I appreciate the waffle. Just just missing it in that spot. You know what I mean? Was it's really something. But yeah, obviously, I, I want this because that I mean, what you're describing does what I do. And I think there's other things in the world, I would do, Edward if I didn't have to think about this. So sounds pretty cool.

Edward Robinson 1:22:50
Yeah, yeah. And it's amazing. So it really, machine learning works well, when you have a lot of really precise data. And there's, there's just so much precise data for diabetes, like the amount of insulin that a pump gives you. It's just mind blowing how precise it is, I think like, point 05 units that the Omni pod can give you. I think you if you take like a drop of water, and slice it up into like 1000 pieces that that's the size of one of those bonuses. So it's like incredibly precise, it's just mind blowing. And then, you know, people are pretty good at counting carbs. So that's pretty accurate. Be able to track your exercise and activity and heart rate and be able to incorporate that one of the things that I'm really excited for potentially doing this with other people is to be able to factor in things like location. So you've got the GPS on your phone, it knows if you're at school, if you're at work if you're at home. I mean, I work from home, so not really that important for me. But you know, being able to factor in like hormones and menstrual cycle, you can easily just put into the app, like hey, today's the first day of the menstrual menstrual cycle, and then from that it can figure out you know, throughout the month, how much more or less sensitive it needs to be based on that.

Scott Benner 1:24:19
Yeah, I'll tell you that's what we just went through that last week where through the event, Arden didn't need very much insulin. And then when the event ended for like four days her needs were significant. And Rachel and I, we track it in a in a period tracker, but that's just enough for you to go Okay, looks like the four days after need more edits. You know, for people who think like all this stuff is just magic like Arden's insulin sensitivity and needed to be changed for Bezos needs to be changed, like a lot needed to be changed in those four days and then when it ends Edward, it's fascinating. Like, I watched it end, at four o'clock in the morning on the fourth day, it was just it. It was like someone walked in a room and was like, Oh, who left this switch on? Click, she does not need these settings any longer. And boom, we had put them all back. Stop. Hello. And then Yep, good, was fascinating.

Edward Robinson 1:25:21
And that was that was one of my frustrations with with the other Android APS is that algorithms is that on, on some days, I skipped breakfast and do intermittent fasting, some days, I'll even skip skip lunch as well. And then you have to go into it. And you have to say, okay, reduce the profile settings, and then potentially reduce them further, if you skip lunch as well. And needing to do all that I just found to be annoying, and it should just be able to figure it out for you.

Scott Benner 1:25:52
Right. And the override for loop is I know we're jumping back and forth between systems. But the overriding loop works for her for lower days. But for higher days, it's just not enough. Like you can't like you can go 150% On the override, and it still doesn't do it. And then there's a moment when you get too high, and you're just going to cause a low. And then those are the moments when you're just like, Well, I'm just gonna, I'm just going to open the loop and run it like a regular pump, then. And then you inevitably forget that the loop is open. And you're and you're reminded three o'clock in the morning and you're like, Why is her blood sugar low? Oh, we didn't put the algorithm back on. You know, like that kind of stuff. Those things being for Android

Edward Robinson 1:26:32
APS, you can disable it for a time period, which is really awesome. You can just say, pause it for an hour or pause it for four hours. Yeah. So then you don't drop it into that?

Scott Benner 1:26:41
No, it is really well listen, it's amazing. And here's the here's the scary part to me. That it's it's all based on whether people like you find out about it, and are interested enough to put effort into it. Because this is this could literally be like a softball league, where one day we all just don't show up for practice. And then the team has gone. You know what I mean? Like like that could happen. Like I it's so far hasn't, but it could it like what happens if there could you know what I mean? Like, but

Edward Robinson 1:27:17
I mean, I think it's, I could see that happening if there is you know, but I think because people still have diabetes, it's still going to happen.

Scott Benner 1:27:26
Yeah, I hope so. I mean, I'm I'm like what you're saying is, is exciting to me that you're interested in it. Yeah, that you're doing it is fantastic that you think that other that the companies are looking at that stuff as well, is very cool. And I'll tell you why even more important. And not just because I spoke to her yesterday, but 72 year old woman using a loop. And one of the questions I had to ask her was, Are you worried about the moment when this stops making sense to you? Or that you can't keep track of how this technology works? And if it was the machine learning technology would help you later into life? Because you wouldn't need to know much of anything, you know? Yeah, like, I

Edward Robinson 1:28:10
don't know. I don't know at all how it works. I mean, I know like, you know, how it all works. But the idea is that the algorithm, it it's multiplying so many numbers that you just can't possibly read through it and understand how it works. And but the magic is that you can see that it's effective, because it's saying at the end of the algorithm, it says how accurate it is. So like right now, it says that it's off by like point 05, on average point 05 units on average. Initially, when I started the algorithm is off by like, point eight or things like that. But I've seen as I've developed further that it's gotten more and more accurate, even though I can't sort of crack it open and tell you how the algorithm really works. You can build similar ones that kind of show you that like tree structure that are readable and understandable. Which is pretty cool.

Scott Benner 1:29:09
But but that's not what most people need. What most people this is where I actually I firmly believe that Omnipod five is on to something, they're just like, look, we don't think you want to know this. You mean like we want this to work, right? You and without you having to understand what all these things are? And that's what I'm saying is they absolutely either you're a person who gets it. I mean, that's one of the reasons why looping and all this hasn't blown up more than it has like, it's exciting that, I don't know, 10,000 people have downloaded the loop app or whatever the number is, but there's like 1.8 million people with type one diabetes. So basically, none of them have loop. You know, statistically speaking, what keeps it from blowing up is that you have to understand all this stuff and that most people either aren't going to have the ability or the time or the inclination. And so if you need it if you want it to really grow, it's going to need to, like, you know, steal the line from Steve Jobs, right? It's going to need to just work. And, you know, that's it.

Edward Robinson 1:30:09
Yeah. So that's actually what I want to do, eventually, when I make it so that other people can do it. And I've actually done a lot of this for myself as well, just to make it easier. But have it just like automatically it uploads your data to the cloud, the cloud trains a new algorithm. It says, Hey, this algorithm, is this much better? Do you want to accept it? Yes or no? And then you're on your way? Or even just have it automatically upload the algorithm if it is more effective,

Scott Benner 1:30:40
right? Is there? Is there a business way, maybe you haven't looked into it, but is there a business way where, where that could be set up, and someone could earn a living from it, without it being a legal entanglement.

Edward Robinson 1:31:02
Um, it's not easy. Because as soon as you start having people give you money for it, it's kind of like a service. And then if they run into any problems, you know, you've been providing this to them, and therefore you are, you're responsible, liable. Now, it's, but in the open source, it's just I'm providing I'm setting this information out into the world. And take it or leave it up to

Scott Benner 1:31:32
you, because someone needs to, I mean, this is what I figured out for making the podcast is somehow is completely different and exactly the same. If the podcast is helpful to you. It's because I can treat it like a like a business. Like, I can make sure that there's an episode there for you when you turn on your phone, and you expect it to be there. And the only way I can do that is because I can pay my bills and live my life while making it. And the only way and the way I found around, and I didn't want to charge people, because I not only do I not want to take money from people, I very badly don't want to take money from people. But I also know that the amount of people who would be willing to give money to it probably wouldn't be enough so that my wife wouldn't make me go get a job. Right? So like so. So I thought, all right, well, I'll take advertising, but you can't take advertising until you have numbers that are big enough to support advertising. So as much as this might just seem like a podcast to you. I've had to put a number of different structures in place, and will them into existence and make them popular enough to support the next step to get you to the content that would help you. And this is the same problem. Like you don't even Yeah,

Edward Robinson 1:32:44
I think I think with the open source community, it's like, I could have never done what I've done with the machine learning stuff, and building my own algorithm. If Android apps didn't exist on its own, previously, I wouldn't have had the time and the effort to build out all the foundational pieces to then build on top of it. So it's all like just building on top of what other people have done. It my point. And that's I think the magic too.

Scott Benner 1:33:14
Yeah. And that's it is but the way to make it faster is if all those people could have drawn some sort of a salary from it and put their entire eight hours a day, like I'm sure I'm assuming this is something your hands go to bed, you know what I mean? Right,

Edward Robinson 1:33:27
so yeah, when when they go to bed, and they're not awake? Yeah, well wake up screaming, then

Scott Benner 1:33:32
think about it. Everyone's got to put his kids to bed, then he's got to look at his wife for the nod, the nods, not there. And then he's like, Alright, I guess I'll work on the injury. I want I want I wanted to get up in the morning at 8am with a cup of coffee in his hand working for eight hours, 10 hours on it. I want 510 20 people doing that. And then all the sudden, here we go. And what are we really talking? Yeah, you don't I mean? Like, how much money would you really have to generate every year to pay a small band of people to do that? It wouldn't be overwhelming. Somebody just needs. It's the situation where I don't I'm not calling anybody out. But I'm using him as an example. Like, I don't know how Helmsley doesn't hear this conversation and wrangle up 10 people and be like, here, look, how much do you make a year? Well, you work for us now. Go make this, go do this thing. I mean, they support companies when they do it. But then the minute you support the company, you get caught up in the you get caught up in the red tape. And then it's Yeah,

Edward Robinson 1:34:32
I think that there are potentially ways that they could get around it. Like if Omni pod just built the pods, and they just built the pump, but the pump and the pods, they're open to any algorithm, and then they just provide and then they work with people who build the open source algorithm. And they publish the algorithm for free and then it's easy for people to connect the dots. Then they they make their money Selling the pods, yeah. And then people use the pods because of the open source that they release. Right,

Scott Benner 1:35:04
right. And then that started to happen with tide pool as an example. But then tide pool seems like it got sucked right into the machine. And now, like, I it feels like it was two years ago where they're like, look, what we're gonna do when I'm like, it's two years later, my daughter's using three different versions a loop since then, you know, like, so it's the time that bothers me. And I knew, you know, there's gotta be a, there's gotta be a way to get around. That is all I'm saying. At least

Edward Robinson 1:35:32
Yeah. And that was kind of how, how I got here was that I thought, the 630 GE was going to come out, and it was going to be amazing. And then a few years later, they're going to have, you know, an algorithm that is just night and day, so much better. And so by the time I build something, you know, there's going to be something incredible by the time I do that, but 630 D was good. And it was really effective for me, but it's just a rate of innovation and releases just too slow. And that was how I then ended up building my own algorithm and stuff like that.

Scott Benner 1:36:11
And that, and even the idea that something might be coming could be holding back other people like you who are like, I could probably make an you know, an improvement to this. Anyway, I I'm not, listen, I'm grateful for all this stuff. It's amazing. You don't I mean, like it's without these companies. I remember what it was like, I want a lot of fun. So yeah.

Edward Robinson 1:36:34
And I've seen people's graphs on on Facebook and things from Omnipod. Five, and it, it really is fantastic. And yeah, for most people, that's maybe just good enough. And you know, it provides excellent control. And, you know, maybe that's good enough control that, you know, you're gonna run into the same long term health issues that other people do. Like, on average, people maybe get their knee replaced when there. Yeah, 75 or whatever. And if you have control through Omnipod, five, you're just as likely to get your knee replaced at 75 or things like that,

Scott Benner 1:37:16
which is good news, because it means you're alive at 75. And you need your knee replaced. Yeah, yeah. I listen, it's amazing. I love having these conversations is great. Is there anything? I mean, I'm out of my element here. So did I not bring up anything I should have?

Edward Robinson 1:37:34
Um

No, I don't think so.

Scott Benner 1:37:42
Nice. You have notes in front of you.

Edward Robinson 1:37:45
I do have some notes. I wrote down a few things. I even built an Excel chart of my agencies over the years.

Scott Benner 1:37:52
Well, what's not wasted? What have they been?

Edward Robinson 1:37:56
So I downloaded the data from from LabCorp. I, I wish I had it when I was diagnosed, but it only goes back to 2012. So it was in like, the sevens, the high sevens. And then in 2016, when I started on the 630, G, it dropped down below seven for the first time. And then it was still in the high sixes but then eventually got down to like the lower sixes. And then there's just a dramatic drop at the end. When I started using the Android APS,

Scott Benner 1:38:36
we're on to 5.6 5.6 is about where you sit.

Edward Robinson 1:38:40
Yeah. So that's where I am right now. I think that would. So that was before the last day once you that I had was before using the machine learning algorithm that I built. So I'm curious to see what it'll be with the machine learning algorithm.

Scott Benner 1:38:59
Do you have any insight through clarity or something like that where it might be?

Edward Robinson 1:39:04
So I think it's probably going to be very similar. I want it to be lower. And I think that I can kind of make it lower. Right now the big benefit of it is not having any settings and having it be more dynamic and less, less manual overrides and input.

Scott Benner 1:39:25
Well yeah, that sounds much better. Do you eat a certain kind of diet?

Edward Robinson 1:39:30
No. So with with young kids, sometimes, you know I have a pop tart or half a pop tart for breakfast, which I love. There's a great quote and one of your episodes where you like pop tarts are poison, which I think is very correct. Especially when it comes to diabetes. It just like shoots your blood sugar through the roof.

And then but in general, we eat pretty healthy. Lots of fat adjustables but eat pasta, I don't restrict myself in any way.

Some days, I do intermittent fasting for like the health benefits, there's some really amazing science out of like Harvard, and some other places around extending lifespan. And one of the effective ways to do it is to do intermittent fasting, which is really cool.

Scott Benner 1:40:28
Yeah, I haven't been like, precision careful about it recently, like this time to this time. But in general, I have a pretty short eating window in the course of every day. And I think it's a major, I can see a major benefit from it just on on how my body weight stays, you know, not necessarily eating, like Jenny. And if we're keeping that window, shorter stops me from gaining weight. If I expand the window, my body starts to hold on to weight. It's really interesting. And I do want to pay more attention to it. I, it's tough, because we're at a really rude time right now, Edward, where a lot of people have opinions about things. And you don't know if their opinions are rooted in any kind of, like, the only me like, there's, it's so funny, because I'm about to like, I guess what I'm gonna say it's gonna make it sound like I could be in that group, too. And I understandably, could be, but like, I have a podcast. So I know how to make my voice on the internet. And I know how how people can find it. A podcast has grown the way it has, and it's existed the way it has, I believe, because what people learned from it ended up being valuable, and they told somebody else. But I don't know if I look for intermittent fasting podcasts, I'll find 25 of them. I don't know what those people know, or what they don't know. And it's the same even with simple things like I want to do more content about just like vitamin supplementation. But how do you find somebody who knows what they're talking about? Who's not a crackpot? Or just trying to pimp their

Edward Robinson 1:42:10
How do you know that they're not correct? Exactly. And that's the challenge. Yeah. And

Scott Benner 1:42:14
when you talk about intermittent fasting, the same thing comes into my head that most that some people are going to hear that and go, Oh, yeah, sure. You know what I mean, or I'm sure that I'm sure that's the feeling people get when I had somebody tell me the other day, they stood up at an event, and they're like, who, who listens to the Juicebox? Podcast, there's a bunch of people there with type one diabetes, and I thought this was gonna be a story about how they all did. And it was not many of them, you know? And then, and so the, so the process starts, like expanding on why they think they should listen to the podcast. And he said that at the end, a guy came up to him and said, Amen, I'm not gonna listen to that, man. Just sounds like you're doing a sales pitch. And the guy's like, no, he's like, I believe in it. Like, you should try it. And so how do you you don't I mean, how do you make that leap? Anyway, there's no answer to that statement. It's just it's, we're in a time where anybody can express their opinions. And it's easy for other people to get to them. And how do you pick? Who's who, because I've had people come up to me, they're like, I know about supplements, you start talking to them? Like, I think you think that there are spaceships coming to get us? Like, so? I don't know. I don't know how to take you on vitamin D right now, you know. So, anyway,

Edward Robinson 1:43:23
yeah. So personally, I like finding stuff that's more like research based with and like, read, or even sometimes reading the research. But it takes a lot of time to do that. And then it's amazing how often, like research is just done terribly, terribly bad. There's this fantastic book about, about pregnancy, and it's called expecting better. And it goes into a lot of like, the deep dive deep dives into a lot of the research around pregnancy. And one of the fantastic things was they recommend, you know, not drinking when you're pregnant. And I'm not a medic, don't take this as medical advice. But the the book then talks about how in some of the studies, the people that they studied, were drinking, but the people who like admitted to drinking in the study also had a number of other really bad complications, like doing heroin or crack or things like that, that you probably would conflate the results. And so it's amazing how even like, research with the best intentions can still be done poorly. And just because you publish some paper doesn't mean that it's valuable. And so it's really hard to sift through that and find the right answer.

Scott Benner 1:44:44
Basically, think about during the height of COVID. When you couldn't, you couldn't make a turn on the internet without somebody telling you like just zinc and vitamin D. And I'm like, listen, there's no doubt I should probably have a certain level of zinc in my system and a certain level of vitamin D in my system, but they would say Like, that's all you need. And yeah, that COVID It just, you know, vitamin D heap your vitamin D up, you'll be fine. I'm like, how, what? And, yeah, can you prove that? You know, I heard it. And then that ends up being the problem is that someone says it, and then people start repeating it. And then before you know, it's a rule, and you're like, wait, what, like, did anybody look into this? And you know, it's, it's just very interesting. I'm not saying even that, you know, maybe thinking vitamin D did stop COVID? I have absolutely no idea. I just don't know how to believe any of it is my bigger problem. So, yeah, I want to ask you one last question before I let you go. And I have you wait too long, I apologize. It's still with the system you're using right now. You still have to Pre-Bolus your meals, right.

Edward Robinson 1:45:48
So I don't actually Bolus you but you still have to put in the car at least 20 minutes beforehand. And then it will it will Bolus on its own Yeah. Sometimes if it's like there's safety restrictions, if my blood sugar is dropping or below the target and things like that, it will be conservative when Bolus thing. And so I still will Pre-Bolus Then, because I know that even though it's dropping, the food is going to make it go up. And so then I still Pre-Bolus

Scott Benner 1:46:16
Yeah, but I just want people to understand that even when we're talking about something that sounds as futuristic as what you've talked about today, they still have a responsibility. There's still

Edward Robinson 1:46:27
Yeah, yeah, exactly. So the, the French company that I talked about, the CEO of that company has given a few interviews, and they have said that, you know, if you don't Pre-Bolus And if you don't even Bolus your meals, you can still get reasonable results. Like, it's just gonna take a while for the insulin to catch up with the food is the reality. But I mean, there's still things that any algorithm just can't predict,

Scott Benner 1:46:58
right? There was a company, I mean, I assume they're still working on it, but it feels like it's 10 years ago, now. I'm sure it wasn't that long. And they said they were gonna have an algorithm where you could just tell it, I'm having a large meal, a small meal, a medium sized meal. And yeah, I don't know, whatever came up with that.

Edward Robinson 1:47:16
So that's, that's interesting. That's one thing that I want to try and do is see if I just use purely the description of the meal, to see if that can be sufficient. Because usually, when I eat pizza, I eat about the same amount of pizza. And when I eat a bowl of cereal, it's roughly the same bowl of cereal. Yeah. So it should be sufficient. And then sort of the next mind blowing idea would be to take a picture of it. You just take pictures of your food. And the there already already are algorithms that can tag food and pictures. So you just take the tags out of the picture. And Google can already tell you if you're eating, if a picture contains a hamburger or a chair, or, you know, a salad. And so you could just use that to then predict how much insulin to give.

Scott Benner 1:48:12
I mean, pretty amazing. If one day you just held your phone up over your plate and got insulin for that'd be that'd be insane.

Edward Robinson 1:48:18
I think that there is an app that tries to estimate the number of carbs based on doing

Scott Benner 1:48:23
is because they tried to buy ads on the show one time and I was like, let me try the app. And then I tried it. And I was like, Thank You didn't exactly how I was hoping. But yeah, I

Edward Robinson 1:48:35
think if you did it like on a if you trained it on like a per person basis, because most people eat pretty similar meals most of the time, right? And like humans are creatures of habit. So you can learn those habits.

Scott Benner 1:48:49
Yeah. Well, that I believe and trust me. I don't know anything about science or machine learning. But I knew the say that years ago, and I think the first time I said it, the Jenny. She was like what now? And I'm like, people eat the same things. Right? And she's like, Yeah, I guess so. And I was like, yeah, it's not like you're like, you don't I mean, not like you haven't frog legs one day in a McDonald's cheeseburger the next day, you probably live in a certain existence, by the way, it was Ed Dimino that I was thinking of. And this is back in 2014. I think it's at Boston labs. I forget, but he was working on. I forget what he calls it even some sort of bionic pancreas was what the phrasing they were using back then. But it's one of those things. I have no idea where that is in the process. It's eight years later, and I haven't really heard much about it. But I think that he was the one who was saying, or maybe it was the other company. That's the other problem is that sometimes these people have ideas that they incorporate. And then suddenly, and I'm not saying this about anybody specific but then suddenly raising money to keep the company going He comes the company's job. You don't I mean, yeah, you get in that situation and

Edward Robinson 1:50:04
trying to roll it out just becomes So, so difficult. Yeah, yeah. i The other thing that I found, though, is that, so people are creatures of habit. But for me at least, we, we eat the same meals, but just not often enough where I've forgotten by the time we come back around to the same meal. So you know, we'll have pizza from this great pizza place near us, but we only eat it. I don't know, every two months or something like that. And I don't remember exactly what I gave myself two months ago. Sure. Yeah, but an algorithm can remember that and learn that for you.

Scott Benner 1:50:42
Right. And you can say, you're even saying that at some point in the world, it might be able to say, I know you're a Domino's right now. And yeah,

Edward Robinson 1:50:53
I mean, you can track your location on your phone, right within Domino's versus Pizza Hut versus school or whatever. And, and you can use that to, to predict how much insulin to give,

Scott Benner 1:51:06
hey, I want to give whoever on the pod hire to do this search engine optimization. I want to give them a big shout out because I Googled Ed Dimino insulin pump and I got a return back for Omni pod five at the top. So somebody's doing their job extra well over there. I could be

Edward Robinson 1:51:24
that or it could just be Google monitoring everything and put recommending ads for you pushing you to ads. Yeah. Because you've gone to Omnipod site.

Scott Benner 1:51:32
And here it is. He was calling his pump. I let from beta bionics i l e. T. Yeah. Interesting. delayed by the FDA. In mid to late 2021. This could be delayed by the FDA. It says, I don't know. Yeah. Anyway, listen, I am. I was drugged into the world of looping by a lovely woman named Gina who just wanted to hear more about it on the podcast, and I can't thank her enough. I think it's made a significant improvement in my daughter's life. And as to be perfectly honest, I don't see a world of we've used on the pod five, and it was absolutely terrific. But, you know, we went back to loop after after a few months. And we really understood I understood, I understand on the pod five forwards now. But yeah, you know,

Edward Robinson 1:52:24
do you still use an orange link?

Scott Benner 1:52:26
Yeah, but I heard there's a better one now. So

Edward Robinson 1:52:29
yeah, so that's what we're using dash though using on the dash, you don't have to carry that round anymore. So it's just carrying around your phone. And it's it's fantastic. So

Scott Benner 1:52:38
Edward, if you would do me a favor of keeping in mind that you and I are recording something that people won't hear for six months, so that I have to keep the timeline of my podcast intact and keep Yeah, keep this to yourself for the next six months. So your episode comes out. So aren't used on the pod five for a couple of months. It was exactly what I expected it to be. I learned how to use it. I understand how to use it. And she said to me, can I go back to loop? Because she didn't want to carry the controller for the only part five she loved having loop on her phone. Right? And yeah, it's a good, it's interesting, because it wasn't about the care to her. It was about the functionality, right? So what I did was because you have to carry the controller, yeah, she wanted to carry the controller, she didn't wanna have to carry an extra thing. And so we have listened. Everybody should be getting enough. I have enough arrows pods to last us for a little while. Okay. So when she went from arrows to on the pod five. And then we left on the pod five, I did not go back to Eris pods, I went back to dash pods. And I'm going to try so we're going to use up the arrows pods we have and then by that I think the dash version of loop will be ready and out of beta. And then I'm going to translate Yeah, I'm thinking around the holidays, that should probably happen. So she's gonna go off to college on loop. And we're actually sending her with the on the pod five stuff as her backup. Yeah, in case her algorithm crashes and somebody we can't do something about it from a distance because she's going away pretty far to school. But yeah, that that that's the next step is I think looping with Dash for us. I would imagine by the time someone hears this we're doing it is my expectation.

Edward Robinson 1:54:23
It's it's really great. Being able to use the dash without needing to carry around anything else.

Scott Benner 1:54:30
When we bring that when I bring this up to Jenny, she keeps bringing it up that she thinks that you can't change the impact time in the dash version yet of loop. I don't know you probably don't pay attention to loop. But in the you know what I mean? The ers version, you can say I think this meal is going to hit over three to five, six hours. And at the moment okay, I guess you can't do that and dash but I hope I'm hoping somebody adds that to it.

Edward Robinson 1:54:55
Interesting, I wouldn't have expected that to have any impact because you Like the pump, at least in Android APS, because it's poured so many pumps, that pump like integration is its own separate piece from all the rest of the algorithm stuff. So the algorithm should continue to work, no matter which pump you plug in to use.

Scott Benner 1:55:15
Yeah, I think specifically, what Jenny heard was that the dash version of the loop did not have that ability yet. And she was hoping that somebody would put it in. But it does, it does. It's a big deal, because you can, you can make a Bolus at three hours. And this thing's like alright, well, you're good. But you're looking at a blood sugar that's 170. If you just go in, that's one of the amazing things about loop that I missed with Omni pod five is that I could go back in and change the parameters of that Bolus from two hours ago and say, hey, you know what, this is actually hitting over four hours now. And boom, here's how much insulin I think you should put in for that. And you can't you can't edit your boluses and Omnipod. Five. So once you put them in there in that, that's one of the things I love about loop the most is being able to go back and edit the previous Bolus.

Edward Robinson 1:56:08
Yeah, I do think that for Omnipod, five, they, they will roll it out to more phones pretty quickly. I mean, so pretty quickly would be like, over the next six months to a year or something like that, that they're going to add more and more phones.

Scott Benner 1:56:26
There's also the last part of this is I want her to be on a retail system. I want it to get to the point where I'm like, Yeah, put that on it does these three things we needed to do for me. Yeah, for me, the truth is that Android APS loop, tandem control IQ, and on the pod five, these are not things that are competing with each other. They're not they're not apples to apples situations, like I think I think control IQ and on the pod five are similar. And I think loop and Android APs are similar. I don't like somebody asked me like, are you going to compare the two? And I was like, that's, that's just there's just no reason to do that. You know, right. They're not the same thing.

Edward Robinson 1:57:13
Yeah, they each have like pros and cons of like, tighter control versus more, more effort and work to set it up. And right. Yeah, no, there's a complete trade off so many different things. Yeah,

Scott Benner 1:57:25
if we've only had five if it if you could target a little lower. And if it would be more aggressive on a rising blood sugar, I think, you know, we would have held out until the phone was available. And the problem is that art is a young girl, she's, you know, she's hormonal. And we were having to leave the algorithm to stop some of these big rises. But having said that, I do that, too. It's not like loops was magical with the blood sugar's I would say that the biggest difference is that loop holds Arden steady at a lower number. Like that was it especially like overnight and stuff like that? Overnight? Other than that, 85 Yeah. Other than that, they were very similar for us. You know, yeah. So, you know, but needing to

Edward Robinson 1:58:15
carry around a phone and an extra controller. I would imagine it would be a pain

Scott Benner 1:58:20
when I opened the Omni pod five box, and the controller came out art and said, and this is a quote, what is that?

Unknown Speaker 1:58:28
And I said,

Scott Benner 1:58:31
that's the controller. And she goes, Oh, no, no. I said, No, we're gonna we're gonna use this and we're gonna try it, you know? And, but yeah, it was just, she was like, I don't want to carry another thing. And I was like, okay, yeah, like, and that was a big deal to her like, so I'm like, Alright, so

Edward Robinson 1:58:46
yeah, totally. Yeah, totally get that. So I just carry my phone, my wallet, and two glucose tablets in a little like, pill container that I found on Amazon. And that's all I carry with me.

Scott Benner 1:58:59
That's amazing. Yeah, that's, that's what you're looking for. You're looking for less impact. They're all gonna get there. I mean, I can't tell you. I have no trouble suggesting on the pot five to people. I think it was really, it was terrific. It just was slightly less customizable than I was accustomed to. And she was carrying another thing. So who knows if that app was already on her, like ready for her phone? She might not have ever brought it up. You know? Yep. So because she doesn't use the functionality and on the in loop. Like, you know, it's not like it's not like artists like oh, I should probably change my insulin sensitivity because it's after my period. I tell her that's what's happening. And she goes Oh, okay. That's why I loved what you were talking about so much. Because as interactive as Arden is she's still not she's not that person. You know what I mean? That if she becomes an adult, I get less involved. I imagine that means her blood sugar's are gonna go up if she doesn't have something that's going to think for like that.

Edward Robinson 1:59:56
Yeah. Anyway, and it's, it makes so much sense for the algorithm to just do cared for you. It does the me it has all the data. Why can't it do it? Yeah,

Scott Benner 2:00:04
especially after talking to you it does to me so Alright, let me say thank you very much I appreciate you doing this

of course, we're gonna thank Edward for spending so much time explaining all of this to us. And I actually spoke to him last night for a second his a one C last one 5.5 And this episode was recorded six months ago. So it seems like things are working pretty well for Edward and his choice of insulin delivery. Or the thank us Med and remind you that we get our supplies from us Med and you could to us med.com forward slash juice box or call 888721151 for links in the show notes links at Juicebox Podcast a US med touched by type one and all of the sponsors. Since this one went long, I'll just tell you check out the private Facebook group where you can meet people like Edward Juicebox Podcast type one diabetes on Facebook private group. You'll love it. And goodbye. Thanks for listening. I'll be back very soon with another episode of The Juicebox Podcast. It won't be as long as this one

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