#784 Bold Beginnings: Insurance
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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.
Test your knowledge of episode 784
1. Why is it important to build a support network for diabetes management?
2. How can staying active benefit diabetes management?
3. Why is it important to understand your medications?
4. Why should you stay informed about new treatments?
5. How can customizing your meal plan help in managing diabetes?
6. Why should you monitor your blood sugar regularly?
7. Why should you prepare for emergencies?
8. Why is staying positive important for managing diabetes?
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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 784 of the Juicebox Podcast.
This is another episode in the bowl beginning series. And I'm so confused at this point not. It's not something good to admit to you. But I wanted this to be the last episode of Paul beginnings, but I think there's going to be some more so I'm not certain, I have to go back and look at my list and confer with Jenny and do a couple of other things. But for now, this episode of bold Beginnings is not with me and Jenny, it's with me and Sam. And Sam is here to talk to you about insurance. I know that is not exciting, but you need to understand all of the varied ways that your health insurance works is impacted how you can make it work for you. And Sam is going to walk you through a lot of it right now. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please Always consult a physician before making any changes to your health care plan. We're becoming bold with insulin.
This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn, find out more at G Vogue glucagon.com forward slash juicebox. today's podcast is also sponsored by the N pen from Medtronic diabetes, if you're looking for some of the functionality that you get with an insulin pump, but you don't want an insulin pump, you can get that with the in pen from Medtronic. diabetes. Learn more at in pen today.com. Okay, so let's start like this. Don't say anything yet. Okay. Got it. Now you said something. Anyway, this is Sam, Sam, you won't be called Sam or Samantha.
Samantha Arceneaux 2:15
It doesn't matter. Okay, well, then
Scott Benner 2:17
I'm gonna call you, Sam. why people might be wondering, have I been listening to this bold beginning series for umpteen episodes. And Scott comes on. And then that lovely woman from Wisconsin comes on. And they talk about diabetes. And now today, it's Sam, why is that? Well, it's an interesting question. And I have a specific answer. Today we're going to talk about insurance for newly diagnosed people, some of the hurdles that they're going to run into answer some questions that people have had and sent into me. But Jenny and I were talking privately, and I said, Jenny, I think I know a person who's better for this conversation than you. Are you offended? And she said, No, not at all. And I was like, Okay, so, Sam, what episode of the podcast? Were you on? A lot? Oh,
Samantha Arceneaux 3:03
boy. Now be put on the spot. It was episode 6162. Somewhere in there. I believe it's 61.
Scott Benner 3:09
Wow. Okay, it's been a while. Oh, wow. That's the first year.
Samantha Arceneaux 3:14
Yes, it was 2016. I want to say,
Scott Benner 3:18
the second year, but but probably within 12 months of me beginning. Let's give people the tiniest bit of background actually. And give you your credit. Because yeah, yeah. So do I wonder if there's no way no one's gonna everyone's gonna know this. But me. But you're the entire reason that I'm a well received diabetes speaker.
Samantha Arceneaux 3:39
Well, that was kind of a mutual benefit. Because, you know, once you kind of hear what you have going on, it was kind of a no brainer for me to think about bringing you in as a speaker for the conference that we have down in Orlando, testify type one. So we were thrilled when you agreed to be part of our conference series. And luckily for you, I think it spread around and a lot of other people decided they wanted to do,
Scott Benner 4:07
but it was but it seriously. So you're so you're the mom of a girl with type one, right?
Samantha Arceneaux 4:12
Yes. So she's currently a lab and she was diagnosed at 22 months old. So we're rounding into our 10th year,
Scott Benner 4:19
okay. And you donate your time to touch by type one.
Samantha Arceneaux 4:24
That's correct. I'm actually a board member at this point, but I definitely do a lot of volunteer work for them as
Scott Benner 4:29
well. Wow. What's the difference between like doing the work and being a board member?
Samantha Arceneaux 4:35
It just comes with a fancy title and I have actual responsibilities.
Scott Benner 4:41
So instead of we hope Sam might do this for you, we it's we've told Sam to do this and she's gonna get it done.
Samantha Arceneaux 4:47
Yeah, so I have different chairs. I'm actually the AVID sea chair were touched by type one as well as the golf chair. We have a golf tournament now yearly, and I'm co chair for a casino fundraiser that we do.
Scott Benner 5:00
Oh, okay. Well, I appreciate it. Because you should know that while you were going to bat for me, and being like, Hey, I think we should let this guy speak at the conference. I was taking that very seriously up here. And I was very touched by it. Because it had been a it was one of those things where I kept thinking, I wonder why nobody's asking me to speak at things pretty good at this, you know, and, and it just wasn't happening. So the big the big ones weren't weren't calling. And you guys did. I had such a wonderful time. I've been I've been at every touch by type one event, have I not? Yes, you have? Well,
Samantha Arceneaux 5:38
every conference I should conference. Yeah,
Scott Benner 5:39
no. Well, please. Yeah, I'm not at the golf thing. Don't look for me there. I can't be flying to Florida every five seconds. But but every conference that and they've gotten, well, I I can't say they've gotten better, because they've been well run. And lovely from the get go. But they have gotten bigger and bigger. Yes. Yeah. Really, really beautiful. So anyway, thank you for tapping me in. And I'm glad I didn't let you down. Because I think now that we've all known me longer is probably a bad decision on your part right? Now. Anyway, so So when this idea of insurance comes up, I think I don't know anyone more capable, like in a regular just a regular person. You don't mean like more capable of answering these questions in you. You just have a knack for it. You're a savant around this for? I don't even know why I'll let you I'll give, like give everybody just a little bit of detail about why you find yourself so tuned into this. Yes. So
Samantha Arceneaux 6:42
in my previous life, as I like to call it, before I had kids, I was an office manager for a medical office that dealt with multiple forms of insurance. So, you know, we were pretty much trained on how to look at two sides of insurance and figure out where the benefit should go. So that kind of set it up perfectly for this whole pharmacy versus DME situation that everyone finds themselves in. And the other part of it was learning how to appeal properly. So once that started, and I started seeing the struggle in the community, from people who were going through the same thing, and I was experiencing it myself, you know, the whole, wait six months before you can get a pump, I really kind of jumped into this whole appeal process. And then throughout the years, just the different questions that people would come to me with, you know, it wasn't always something that was actually denied. A lot of times, it would just was them not understanding how their insurance works, or not being able to find the particular answer based on what they knew how to research for their insurance. So I would say like 50% of people coming to me for help actually didn't need an appeal, they were able to solve it through other means a lot quicker and a lot easier. So just throughout that experience, it's really become my, the way my brain works is I have a hard time for getting certain things. So it just kind of like adds on. But I will have the disclaimer and an insurance salesperson if there's something that is not true for your state. I am here in Florida. So what might be true for my state? You know, just don't don't hang me on the wall.
Scott Benner 8:23
Don't worry, nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, this is the other ones right here. This is the other way. But But anyway, I would believe that anything you're going to say would at least be a good breadcrumb to get started. So is exactly is it accurate to say that none of us none of us understand our insurance that well, because it's it's set up so that we have a hard time understanding it.
Samantha Arceneaux 8:50
It is definitely one of those things where they pretend they give you a lot of information without giving you information. They are going to be obviously covering a wider amount of items, you know, there, there's a ton of other health conditions out there a ton of other medicines out there. So they kind of give you like the here, here's exactly what we'll pay for. But there's all of these policy guidelines and stipulations, and that's going to be buried on a website that's really hard to get to but you think you've got the coverage for it. So yeah, they're they kind of like hide the fine print and especially with open enrollment, when it's a little bit even harder to get into all of those documents that you might need. It becomes really frustrating sometimes, but, you know, I think the best that we can do is, you know, do as much research as we can find and, you know, kind of make your assessment there. And
Scott Benner 9:53
you know if it's, I'm sorry, yeah, I didn't think I is it sometimes just the is that the word asking the wrong questions. I used to man i for a minute. I hate to throw up my little brother right under the bus, but my youngest brother was quite the schemer. And one year, Sam, my mom bought a Carvel ice cream cake from my other brother's birthday. And in the center of it was a picture of a hockey player. And we came home one day, at my house, the rule is, you get a birthday cake. Everybody has some, and then whatever's left is yours. And you can eat it as you want, give it away, whatever, but it's yours to deal with. So my brother comes home one day to have a piece of his birthday cake. And the hockey player is hacked out of the center of the cake. In artfully man I say, and my brothers, of course, like, Hey, what the hell happened? So he turns to me, he's like, did you eat my my cake? And I said, it wasn't me. I'm sorry. So he goes to my younger brother, our younger brother. And he says, Did you eat my cake? And my brother says no. And that was it. So my brother asks, and he looks at me, are you sure and I'm older and sort of like, I'm almost there Dad, to be perfectly honest. He was no like, 15 at the time. And so he doesn't just trust me. He turns back to rob, and he goes, come on, man. Did you eat my cake? And my brother goes, No. And this goes on for quite some time. And finally I went way, way, way, way. Wait. And I go, Rob, do you know who ate the cake? And he goes, Oh, yeah. So my brother asked, Did you eat the cake? And my brother on my other brother honestly answered? No. And sometimes I think that's what this insurance game is. It's like asking the right question, you gotta ask the right question because it feels like they gave you a puzzle and said, if you put this puzzle together, you get an insulin pump. And then they take three pieces of the puzzle and stick it in their pocket. And then they go I don't listen, Fair's fair, you can have the pump just put the puzzle together. And so how do you but that's incredibly frustrating. Because unlike my brother in the in the ice cream cake. I don't know all the I don't know all the pieces. Do you know what I mean? Like, I know they exist, but I don't know where they are. And you have this, this kind of, you know, intuitive knowledge because of what you've been doing for so long. But how are you? Not? Let's answer, let's ask some of the people's questions. And we'll see how this goes. Okay. So everybody knows bold Beginnings is a series of input from the listeners when I said, What do you wish you would have known when you were first diagnosed? And this is what we got for insurance? Do you listen to this series by any chance, and
Samantha Arceneaux 12:41
I don't tend to lean towards the ball beginning just because we've been going for so long.
Scott Benner 12:47
This is going to be a surprise for you how this goes perfect. So the first person just makes a statement. Navigating insurance is huge that we know.
Samantha Arceneaux 12:54
That's a whole that's you got a couple hours for me on that
Scott Benner 12:57
one. The whole thing, right? It's just, it becomes a really well, in the beginning, it feels like it's a very big part of your life.
Samantha Arceneaux 13:06
It is absolutely because that's usually the panic sets in of oh my gosh, you know, I'm newly diagnosed, or I have a child who's newly diagnosed. And then the second thing is always how are we going to afford this? So it's, you know, with With luck, they have insurance at the time that they were diagnosed. But if they don't, then you know, it's generally they're going to quickly get it or try to find better insurance.
Scott Benner 13:30
So the first question here is how do you navigate insurance to find the best coverage for insulin and supplies? So we'll start with that. Let's put ourselves in, in open enrollment, or we just got a new job. And they're like, here are three insurance options. What are you looking for?
Samantha Arceneaux 13:45
So generally with insulin and supply so the first thing I kind of like forewarn people with insulin is that people get very brand specific very quickly. You know, it's kind of a built in loyalty because that's what their doctors prescribing. But generally, you want to look at what's on the formulary. The formulary is kind of like your your go to and most people can use different insolence that are on the formulary versus what the doctor originally prescribed without complications. You know, some people have better reactions to certain insulins, or they might be allergic to one of the stabilizers in the insolence and that would be a necessitating reason to go to something off formulary. But for most people, you know, they're looking for insulin coverage in general, a long acting and short acting or a short acting. Same with supplies, you know, it's pretty, most most insurance companies are going to cover something. It's usually a law in their state that requires a base amount of coverage. Most states have that law, that insurances are required to cover certain things. They just don't specify what brand. So as far as best coverage, it really comes down to them. What's the Cost of things. And that's really where finding the formulary with the insurance that you're looking at is key because even though, you know, I was talking about how open enrollment can kind of take things and make it a little bit harder, because you don't have that as much access, generally, unless it's, you know, a self insured plan, which is where a large company basically pays for their own policy to be managed by an outside company, but at the end of the day, they're paying all of the, the costs of, of the patient's medications and their, you know, surgeries and everything. Unless it's a self insured plan. Most of the time, you can find those formularies either the current one so you get an idea of what they're covering, or, depending on what time of year it is, they'll release the 20 for us or in 2022. So you'll start seeing the 2023 formularies come out.
Scott Benner 15:52
Okay, so Sam, do me a favor trying to touch that microphone on the cable. Okay, if your hair is brushing it, move it away. Okay, so, first step, we ask, can I see the formulary so I can see if the things excuse me, so I can see if the things that I need are on there. Exactly. But if I'm newly diagnosed, I don't know what the things are that I need. So this is a great time to say for people you're looking for. Like Sam said, insulin first, long acting short acting insulin, more modern insulins like recibo over Lantus, for example for your basil, you're also looking to see does the plan cover insulin pumps, continuous glucose monitors, test strips, those sorts of things are those
Samantha Arceneaux 16:40
XCOM libre those things on the formulary are really big indicator of how later you'll proceed and getting those covered so when you're looking at your formulary does it lists the Dexcom G six or you know in the future the G seven doesn't list the libre two or the libre three. If you're seeing those items on the formulary before you even sign up for the plan, that's a good indicator that you will be able to get that through the pharmacy channel rather than having to go to the DMV.
Scott Benner 17:13
When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pan is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk. I'm going to share just a bit of a note that I got from somebody with you. This person says this podcast gave me my life back and told me about in pen, my insurance covered it 100%. And it's amazing. Just the insulin on board feature alone is a game changer. But I'm going to tell you a little more about what in pen does so in pen is an insulin pen that pairs up with an app on your phone. This app shows you a dosing calculator active insulin remaining glucose history reports activity logs, dose history meal history and your current glucose level. This person I was just talking about ended up getting it for free through their insurance. But even if your insurance doesn't cover it, it's possible that in pen will cost you as low as $35. That's because Medtronic diabetes doesn't want costs to be a roadblock to you getting the therapy you need. So with the implant access program, you could pay as little as $35 offers available to people with commercial insurance terms and conditions apply. You'll learn more at in Penn today.com. While you're there, you also see pictures of the pen. See the app, you can learn about the 24 hour technical support, they offer hands on product training, and online educational resources. The in pen is a great way to get some of the functionality that you're missing by not having an insulin pump. So if you're MDI and you're using a pen, you might as well use the pen pen because it does all this check it out at Hidden pen today.com in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information. Once again you can visit in Penn today.com I'm going to get you back to Sam Now here we're going to use more words like durable medical and other fun things like that about insurance. I know this is boring, but you'd need to know this and Sam is delightful, so that helps Durable Medical Equipment DME and a lot of the stuff now people you know old timey people like you and I know that like insulin pumps and continuous glucose monitors used to be strictly durable medical equipment. And now, I guess you I get on the pod through a pharmacy channel, I get Dexcom through a pharmacy channel to die.
Samantha Arceneaux 20:09
Yes, yeah. So definitely Omni pod is generally this day and age going to be through pharmacy, that's how they've decided to set up their distribution. There's the old style Omni pod, of course through DME, but the newer stuff is definitely through pharmacy, for the most part. Dexcom is about 5050 at this point on whether it's going to go through DME or pharmacy, and sometimes you have the option of either choice, you know, and that's really important as far as cost savings, because if you've been doing DME, and you're subject to a deductible, and you're paying, you know, hundreds of dollars out of pocket to get this product that's going towards your deductible, if it's added to your formulary, and I will, I will preface this formularies can change throughout the year. So things can get added and taken off during a year. So you, you know, I hate to discourage somebody but it's also a pro that when new things are added, you get that access to them. So if something suddenly becomes $40 copay, you're going to be saving a lot of money by switching the pharmacy side.
Scott Benner 21:15
Okay, so But back to the initial idea of I'm trying to choose an insurance. So I call the just the 888 number on the back of my card and I say I need the formulary. I'm thinking I'm picking through but I guess if you haven't chosen yet, and you're stuck with,
Samantha Arceneaux 21:30
like I said, generally online is going to be your friend. What what a lot of times I'll do is I'll type in the insurance and always put the state because it does vary by state. So I'll say for instance, Aetna, Florida policy guideline, and then I'll put CGM or insulin pump. So if I want to know what are the restrictions on getting an insulin pump, or a CGM, before I choose that, that will pop it up. Or I'll say, you know, Aetna formulary, Florida, Open Access Point of Service, and that will pop up at least this year, so I have an understanding of what they're covering currently.
Scott Benner 22:08
So this is a situation that is seriously it's on you, right, like, no one's gonna come help you with
Samantha Arceneaux 22:14
it is, you know, you, if you've got a really great HR, you know, or a really great insurance broker, then, you know, they can kind of do some of this field work for you. But, you know, keep in mind during open enrollment, you and everybody else attached to them is probably asking, you know, a million questions. So even then, you know, it's not always, you know, the most thorough thing or the most timely for whenever you're trying to make your decision. So, you know, really online, they've, they've produced a lot of information online, you just have to know how to get to it. Okay,
Scott Benner 22:48
all right. So do you have, it sucks, because, think back, you, when your daughter was diagnosed, you've worked in that office,
Samantha Arceneaux 22:58
I had actually just left about a year and a half prior
Scott Benner 23:02
to that. So you still had the knowledge but I'm trying to put myself in the position of somebody who's like, I work in a ball bearing factory and now I get this diabetes and I have to go do this thing. Like you know, I mean, people with diabetes are lucky that you that you that you share your knowledge because it's it's not it's a it's a specific thing that you had this information in your head already when you when you came to need it. Okay, so So we're looking for coverage for things that you think you might need. We're looking for, I mean, I imagined to you have to see about your deductibles your out of pocket to see how much you're gonna have to pay in cash every year before you even get to your insurance.
Samantha Arceneaux 23:39
Yes, and let's let's take a moment to kind of explain that because that is a question that comes up a lot is, you know, what is? What is the deductible? What is a coinsurance? What is, you know, the out of pocket? And how does this apply to our situation? So what you'll always look at is, when you're looking at the different policies, it'll it'll explain, is this a copay? Or is this subject to a deductible. So if it is, such as a deductible, say it's $3,000. That means for anything in that category, such as inpatient, outpatient, sometimes it's DME, you will be paying the first $3,000 of those costs. So that is before any other portion of your insurance kicks in. And then after that, if there's a coinsurance listed, say, 30% 20%, whatever that is, then whatever that charge is, after the $3,000, say, you know, you're up for your next order, or, you know, you're getting an insulin pump, and it's $5,000, you're paying your first 3000 And there's $2,000 left and it's a 20% coinsurance, then you're saying $22,000 times 20%, you know, that's an another $400 added to the first 3000. So you would owe $3,400 For that insulin pump. But after that for the rest of the year, you're only paying 20% of those supplies until you hit your out of pocket Max. So out of pocket Max is kind of like the all in cost, and not including the premiums, but the all in cost of your out of pocket expenses on using your health insurance.
Scott Benner 25:10
Oh, yeah, I've just jumped out a window, Sam. Good luck, everybody, I gotta go.
Samantha Arceneaux 25:18
I know, I'm like, Oh, it gets granular talking about it. But you know, it's important to understand what those things are. Because it does get complicated, you know, what is coinsurance versus a copay versus all of these different things, especially when you're trying to calculate so, you know, kind of going back into, it's not necessarily navigating through insurance to find the best coverage, but it lends to finding the best monetary value. And I always say, do a spreadsheet. So, you know, if you've got like three or four plans that you're trying to narrow it down, I look at okay, what is, what are those copays? What are those expenses? And if I were to go in the hospital this year, versus having a typical year without a hospitalization? You know, what's kind of like my worst case scenario? And how much does that premium cost versus a premium for, you know, just your regular maintenance year? With nothing happening? And what is your risk factor? What are you willing to risk, in order to have, you know, more money in your pocket on a monthly occasion, but but per chance, you know, risking that if you were to be hospitalized, it has a larger deductible. So, you know, some of this is very individual, and what you're willing to risk, as far as saving money and finding that insurance. You know, if you're not sure, you know, how your hospital risk is, in the first year, because you're just diagnosed and you're still getting handled, you know, you might want to go a less risk, you know, maybe a little bit more expensive plan that doesn't have as high of a deductible or no deductible. But then as you kind of get a grasp of how your child or yourself is reacting with all of these variables, you know, how did they react with, you know, sickness, or, you know, they broke their leg or whatever, you know, if they're very rough and tumble child, and you know, you're always in the ER, you don't want something with a high deductible plan. You know, because there's other things besides just diabetes
Scott Benner 27:17
recourse that is there. I I know, it
Samantha Arceneaux 27:21
kind of seems like, you know, this is all over focus, but
Scott Benner 27:23
I don't know about the rest of you. But I always enjoy the phone call in February, where you're ordering something. And the person says, Well, if you've met your deductible, and I go, Oh, please, met my deductible on January 1. But thank you very much. I appreciate appreciate your concern about whether or not I've met my deductible. Right? Here's the question. When insurance is being difficult, this person says, skip the bullcrap of calling them and jump right to human resources, Department of Work, if you have one at work, it has saved me time and also gotten me answers that I wanted. Because the poor person on the other end of the phone at the insurance company is just doing what they're told and reading out of a manual. So do you find that every HR department knows what they're talking about? And will be helped? I would
Samantha Arceneaux 28:06
say, No, we've definitely say, there's definitely been a lot of feedback across the board, that various companies and various sized companies that certain hrs are a lot more dependable than others. You know, it, you're relying on an HR person to actually know what they're talking about with their insurance. And, you know, if you have somebody who isn't as enthusiastic about finding those answers, or really understand anything about diabetes, to, you know, if they're getting pushback from the insurance company to really go into it, and, you know, hammer down those fine details, they might just be coming back with the same answers that you're getting. So, you know, the quality definitely varies, but it's not to say that it's a waste of time, because you won't know until you try Of course.
Scott Benner 28:53
Yeah. So maybe you'll get lucky. And you'll have a great HR department, like the person who sent in this, this idea, and maybe you'll walk in there and find people who are just as confused as you are. So
Samantha Arceneaux 29:02
yes, and of course, you know, HR is another thing, you know, if you're finding restrictions, sometimes if it's, especially if it's a self funded plan, the HR person can be really key and getting an override on those because if the, if it's the the employer is the one deciding those things, what's covered and what's not, you know, they're the ultimate decision maker. So going to HR is alerting them that this plan isn't working for all the members and getting them to do those overrides, it's really key. But if it's a plan, that's kind of a generalized plan that you know, like a Marketplace plan or something that is not self funded, then you're kind of a little bit more restricted in what HR can do for you.
Scott Benner 29:42
Okay. All right. I will tell you just the quickest story I think I've told you here before but it fits here. When Arden was really little. She had a bunch of cavities on her baby teeth. And I'm gonna guess they were probably from juice or something like that from having diabetes and the A doctor, you know who we took her to, to fix them. He said, Look, she's got to be out for this. And this was before Dexcom. This was you know, before, I don't even think garden had a pump back then. And he was like, I'm not putting this kid asleep in my office and have a you stand next door testing or blood sugar the whole time, like it all, it just doesn't seem like something I want to be involved in. I want to do this in a hospital setting where we can have her we can put her out there be an anesthesiologist, and somebody can track her blood sugar kind of in real time. And we'll have her hooked up the dextrose this whole thing we're like, okay, like, I mean, we don't know, you know, Sam, like, whatever. So we, we find out that's gonna cost like $15,000. I was gonna say it's, it's a lot. And my wife's like, we'll just pay it. I'm like, Who is we? And where do you think we're getting $15,000? From? Like, I was like, wait, what, like, you know, so I really just kind of kept pouring into it. And then one day, I realized, I don't remember how I figured it out. But something you mentioned earlier, my wife worked for a big company. And so I contacted them. I explained the whole situation. And they said, Oh, we're, we're self insured. And I was like, What? What, you know, explain that? Yeah, explain that to me more. So let me let me tell you what, I think self insured means salmon if you tell me if I'm wrong, but basically, these really big companies use health insurance companies to facilitate the insurance. And then once a year, or once every six months, or how often they've agreed to it, they just write a big check to the insurance company to pay for what that has been covered. So they sit down in the beginning, and they create a formula they see here are the things we'll cover. And here are the things we won't cover. And if you need something that's on the will cover it list, then your insurance company says yes to it, you get to go do it. And then every few months, your company writes a big check to cover that for you and all of your other, you know, all the other people that work there. Is that about what self insuring means?
Samantha Arceneaux 31:59
Is Exactly Okay. And you nailed that. Weiss
Scott Benner 32:03
company just went, oh, we'll pay for that. Perfect. That was it. And then they call the insurance company and said, Hey, say OK to that, and then it was over?
Samantha Arceneaux 32:15
It was that's what I mean about quality. Ah, don't discount either. Everybody is gonna do that.
Scott Benner 32:22
Yeah. Also, don't discount the talking to me on the phone. It's not a big bunch of fun, Sam, just so you know.
Samantha Arceneaux 32:28
I was I can only imagine it probably about like talking for them to talk to me. I've definitely had my share of heated conversations. Companies.
Scott Benner 32:36
Yeah, I, you know, I believe this out, but back in the day, I was not above yelling during a phone call with an insurance company.
Samantha Arceneaux 32:45
Well, you know, kind of a not a little warning. But you know, one thing that I do find frustrating is, you know, you've got also things like clearing houses or you know, those facilitators, for instance. So for instance, for us, we have a company called the care Centrex, who runs all of our DME through Florida Blue, which Blue Cross Blue Shield of Florida. And when I get on the phone, they're insisting that our DME is subject to the deductible. Well, the plan that we have on Florida Blue, is a $0, copay, coinsurance deductible. It's like the one excluded category that isn't applicable to deductible, which is why I love this plan. We've been on it for five years straight, I am very intimately familiar with how this plan works. And she was yelling at me telling me this will be subject to the deduction, deductible, and I just got so frustrated, because how many other people would hear this, and be on a new plan like this, and just take her word for it that oh, my gosh, I'm gonna have to come out of pocket 1000s of dollars for this product. Now, when I thought my plan covered it, but this lady is telling me, so you know, if you're in a disagreement with somebody, and they're giving you this information that just does not jive with what you thought the plan was doing, go back to your broker and have the broker take a look at it and explain everything. Because ultimately, you know, they're going to be the one who knows how to read that insurance plan the best versus like you said, there's somebody on the other line with a manual, three, three ring binder, or, you know, they're staring at a screen and they don't necessarily understand how that applies specifically to the product that you're requesting.
Scott Benner 34:23
Yeah. Well, you first of all, you're going to be surprised a lot during this process, how the person you're talking to, you're gonna think they understand what you're talking about. And they don't like be even like the difference between a transmitter and a sensor for like, Dexcom G six as an example. They're like, they're like, Oh, we see we already sent you six of those. You only you're not supposed to get them. I'm like, No, those are the sensors. We are supposed to get them. I wouldn't get six transmitters transmitter Oh, and they go back and they're looking at codes. They don't even know. They don't know what an insulin pump is. They don't know why you need it. You can explain to them all you want how dire it is and everything. They're just people doing a job. They don't, they don't know. I think your, your best bet is to learn how to very politely say, I appreciate everything you've done for me. I don't think we're going to come to a resolution. I'd like to speak with your supervisor, please.
Samantha Arceneaux 35:15
Yeah, yeah. So be afraid to ask for a supervisor because they're generally, you know, different levels. And, you know, they might accidentally Disconnect the call, you know, that's happened to me a couple of times, suddenly, the call drops, miraculously. But, you know, don't be afraid to call back. I know that, you know, it is not the funnest thing in the world. But, you know, you've got to remember, you're the advocate for yourself, where you're your child, and, you know, it's just, I wish I had a magic answer that, you know, got around all of this. When we were, we were, but
Scott Benner 35:56
there's no magic answer. The answer is persevere. Yeah, keep your head, be well informed. Understand that what you're asking for, especially if it's covered is reasonable. And that you, there is a person who will answer in the affirmative, you have to get to them.
Samantha Arceneaux 36:13
And I would also say just remember that everything is recorded. So you know, you don't want to give too much information of kind of the the sob story part of it, where it seems like you just want this as a, I would say, there's a term I'm looking for convenience device. So a lot of times insurance companies will put those in their notes that this person is just looking for a pump upgrade, or they're looking for just something that makes it seem like you are just asking for it, because it's fancy, or it's nice. And really, that's not true for most of us, but they'll use that for a little bit. And you have to appeal it and just becomes a process. So, you know, just kind of I always tell people stick with the medical reasons. Because if it is recorded, they can sometimes take those things and hold it against you.
Scott Benner 37:06
Oh, so yeah, they're swatting flies, they they know you're eventually going to land on the countertop and make everything dirty, filthy. But they're just going to swing and swing and swing and swing as long as they can to keep you from getting what you want. So they don't have to pay for it. It's it's such a sad thing to think. But it's cheaper to pay a person to sit on the phone and bat you away than it is to pay for your insulin pump. And then the irony is, is once they pay for it, it's all good. It's never a problem again, it's just always like except, you know, at the end of the year when, when it's time to, you know, why does that happen? This this question is not on here. Sam, I'm gonna ask a question. Why is my daughter been using on the pod for a bazillion years, and every year when the calendar flips over? We all act like we don't know what we're talking about.
Samantha Arceneaux 37:57
I think that's true. A because you never know what your insurance is going to do. You know, there's no and I say this, to save people money as well, you always want to look every single year at what your plan has changes for including the formulary, especially as Omni pod is moving to formulary, those Dexcom every year those can change. So you know, it's it's okay to have like a little bit of weird, weary, kind of, let me see what this is doing phase because it is potentially something that would cost you money, if you're not on top of it, and things were to change and you didn't pay attention and select something that was better for your situation, while it was still open enrollment. Because once that open enrollment closes, you're kind of you're better at all the curse words on here, but you know, your, your skirt. You know, you're you're waiting for a special reason to get off of that plan. And onto a different plan at that point. And so, you know, it's really important during open enrollment, which it is right now, you know, with this November 1, some states have open enrollment, it's starting early, or companies have it starting early to really like analyze all this stuff and realize this is my plan for the next year. This is my deductible for next year. If this is my deductible, and I end up in the hospital, am I putting away money every year for those reserves to be able to afford this? So, you know, I know you're saying every year you kind of like forget that you're on Omni pod and stuff, but it kind of is you know, like starting a brand new year.
Scott Benner 39:38
It's one of the most adult things that I do is that conversation where my wife and I sit down and decide if we're on the right insurance plan for the next year. How much do we want to how much deductible do we want to have that health care spending account, which I hate? I hate it because I always forget to you said, and then pre tax dollars. God, Sam, do you think people know so if your company offers you a health care spending account, you may be able to pick an amount 1000 2000 $3,000 A year and have your money diverted into this account. So that when you buy things at the pharmacy, for example, that are covered, you can pay for them with pre tax money, money that has not been taxed yet, which is lovely. I mean, I don't know what it really saves you in the grand scheme of things. I mean, if you did $2,000, and your tax rate was at 25%, I guess it saved you 25% or $2,000, which is great, you know, but for me, I go to the damn store, I pick up the thing, I hand them the card, I paid for it. And then I think five seconds later, God damn it, I didn't use the healthcare spending. But now the pharmacies at least brick and mortar pharmacies, even online, I guess, it is easier because you can give them the card and say put this on file and pay for my stuff with this. Yeah, so that has
Samantha Arceneaux 41:02
to save the receipt as well. And you can try to go back to them and say, you know, this was a qualified expenditure, yes. And see if you can get that applied as well,
Scott Benner 41:11
Sam, now you're getting a look into my psyche, because I really didn't want to do. And also, we get into an interesting thing where I kind of have to handle the bills at my house, but the insurance comes through my wife. So when we got into a situation like that, I was suddenly dragging her into something she didn't really get involved in very much. So I'm like, hey, I need you to figure out how to like submit this. And you don't I mean, what's your online access for your health insurance portal? She's like, I'll take care of it. I don't want you to know my codes. And I was like, No, I understand. I'll trust you either. Now, just kidding. But no, but she would turn into like she she would then get involved, it was frustrating for her, what we learned to do, because I kept forgetting to use it $25 here and $20 here and everything is we would just wait for like one big expense, you know, just a dental cost or something like that. And then we would submit that cost to the health care spending to take the money out and kind of one big chunk. That makes sense or not.
Samantha Arceneaux 42:09
Everybody does it differently.
Scott Benner 42:12
I just I every year I say to my wife, like don't put money in that she's like, it saves us money. I'm like, I hate it. So, but it is a great idea. Honestly, it's just it. Again, it's something that seems to me. Like it's it can be made to be more difficult than necessary. And I think that really is why this part of it sucks so much. It's the intersection of health and sanity and money. And you just like why do I have to deal with this? Like why? Like, the kid already has diabetes, I already have diabetes, I gotta jump through these hoops now to get medication to get to get a device like it sucks. And you know, it's reflected here. And what people said, this, this person says navigating insurance could honestly be a whole podcast by itself. With that, but that was like, she doesn't just mean an episode of this podcast. She means a there could be a podcast somewhere that just talks about this with nothing else. She said it was so confusing to me at first. Everyone's insurance is different. We've had four different insurances in the four and a half years since my son was diagnosed, I still double and triple check, calling insurance, make sure you understand what's covered and how much I didn't even have any idea what DME was, and how it was processed differently than prescriptions. I thought it was ridiculous. This person says that we had to wait a month before getting a Dexcom. But then another person says to Hey, let people know, insurance won't pay for a CGM until somebody sees the endocrinologist. And I was like, Oh, that's interesting. And but that could be specific to their state as well. Right?
Samantha Arceneaux 43:46
Yeah, I'm not sure exactly what they're alluding to. I mean, obviously, you do need a prescription for that item. And most of the time it is going to be the Endo. But you know, there's definitely plenty of family practitioners, you know, especially in the type two side who are able to prescribe that and insurance will cover it. So I'm not entirely sure what their meaning by that but I'm sorry. Okay, so, diagnosis might be the key. Maybe their insurance was saying, you know, you haven't had the seed peptide testing or whatever it is. But a lot of those restrictions I've kind of modified in recent years. So hopefully, whatever that person was dealing with it with their insurance, as you know, had some policy changes that may get a little easier access.
Scott Benner 44:30
That's very worth mentioning too, is that this process has, I mean, Arden's had diabetes, and she was to choose 18 This process has gotten better every year incrementally. Yes, you know, like,
Samantha Arceneaux 44:45
yours. Even just, you know, the last time I was on was, you know, kids under seven couldn't get a CGM without a fight so you know, that's definitely come a long way because you know, studies evolve and, you know, the manufacturers go after younger and younger target. It's to try to make sure that they're not having to go off label and you know, have those battles for those patients. So it's definitely come a long way. Obviously, it's not perfect because insurances don't want to pay if they don't have to. But
Scott Benner 45:13
yeah, this person said it was really difficult, because we wanted a pump and a CGM. But we had to wait because insurance made us wait.
Samantha Arceneaux 45:22
Yeah, so on that, so the Dexcom. For the first month, generally, what they're saying is, there's like a 30 day log, some insurances will want of blood sugars. Those, you know, if that's going on, I would just ask the doctor to advocate for, especially if it's a younger patient, who, you know, just does not understand that they have diabetes and what alo is and how to feel that and tell an adult, you know, there's definitely a lot of kids who leave the hospitals with CGM. Some doctors are very much alike. No, this is what the insurance says that's what we're going to abide by. So, you know, sometimes it's not even the insurance company necessarily blocking it. Sometimes it's also the doctors who aren't as gung ho about, you know, kind of getting somebody on index calm that quickly, because they want to make sure that somebody knows how to properly check their blood, or that they understand what the lows are feeling. Or they want you to go MDI for a while, in order to, you know, if your pump were to break down, know how to treat yourself, and they want you to go ahead and wait six months. So if it's a six month waiting period on a pump, that's a common one. And that's definitely something that is completely appealable, especially with younger children, it's, it's kind of a no brainer, you know, for for a young child to be on a pump and my, my opinion, because there's the users who are grazing their snacking, you know, you want to have that control over it. And your choices basically become no insulin, point five, one point out, you don't have those little tweaks or for that blood volume, like there are so you know, when you lay that out for an insurance company, you're talking about blood volume, and you know, the carbohydrates, and you know, how, how fast it spikes the blood or how quickly it impacts the blood sugar. Having those micro doses, it really kind of becomes a scientific equation for those insurance companies to say, Okay, why aren't we covering this? Because this is difficult for this user. So it, like I said, it goes back to what is the medical nature? And how do I get that past big insurance company to make it a no brainer for them, or to make it something where there's something called Bad Faith and insurance as well. So they have to, in good faith be given coverage for these things. And if they're denying things just to deny them, and there's no reason to deny them, then they're in bad faith, and they actually could be subject to problems with the State's Attorney General. So you know, they've got to kind of go for that line of fiscal responsibility versus not getting in trouble with your attorney general.
Scott Benner 48:06
Interesting. Well, let me read what this person here said. Please, first, they said they were insurance like long like them, just because a doctor prescribes something. Please don't think that that means that it's preferred item on your formulary. And that a lot of times high pharmacy costs are from the wrong item being filled versus what you could have saved on. You talked. You talked about this earlier. You didn't say it that way, though. You know, your prescription is written for human blog. But it's not covered by your insurance. So no vlog would have been cheaper, but you're like, No, I want Humalog you might get or
Samantha Arceneaux 48:45
my doctor prescribe this, this is what I need.
Scott Benner 48:48
And that's tough. Because in the very beginning, you have no way of knowing, like, that's the other thing we're not talking about here is it the people listening to this are going to be newer diagnosed and are going to know what they're doing. And they're going to really think that like, I don't know, the guy said, Novolog like, now you're trying to give me a pager, which I don't think would happen because nobody covers a pager, but you know, vice versa. And so, it's um, it really is. There's a there's a settling in period. And you do need experience with this, just like with diabetes, you will actually get better at this. You'll notice that there, you'll look back one day and think, Oh, I was beating my head against that wall for absolutely no reason whatsoever.
Samantha Arceneaux 49:26
And yeah, and and the other thing, too, is just, you know, for those who are newly diagnosed, just realize there are a lot of programs out there, especially insurance, or sorry, insulin based ones for copay cards, and a lot of people just, you know, kind of forget that they're available or they don't realize that it applies to their insulin, or they think that Oh, I make too much money. I'm not going to qualify for those, but they really have had kind of a kick in the butt recently with all of the investigations with the Senate committees in order to facilitate more Portable insulin. So you know, you've got the NoVo notice you've got the lily drug cards, there's, you know, the NoVo care, there's a $99 Insulin program, Lily has a $35 a month insulin value program. Sanofi also just recently came out with a $35 a month insulin program. So, you know, investigate those, especially if you're struggling to afford your insulin because obviously, that's a life saving medication that you absolutely need. And, you know, there's also a 340 b program, and I hate to bring it out, because it's government. And it's very political in nature. So sometimes it does better at helping that others. But if you are somebody who has an insurance, if you can't afford to even really see the doctor, there's community health centers that are on a sliding scale, and you can get a prescription from them and go fill your prescription out of 340, the pharmacy, and they will take into account how much you can afford. And you know, it can be relatively cheap. However, I will say depending on how many vials you need, it may or may not be cheaper than say one of these drug copay cards, but at least the Community Health Center doctor, you know, should have been less expensive than going to see an endo you know, your regular Endo, you know, as a self pay patient per $100. So,
Scott Benner 51:24
I just Googled 340 V pharmacy and I didn't know anything about that. That's interesting.
Samantha Arceneaux 51:29
Yes, it's kind of it's not just for insulin, it's for you know, a lot of different medications are included. It's just the insulin manufacturers. By doing these copay cards have kind of been pushing back a little bit. And that's why I say I hesitate to just say, Hey, this is a solution for everybody. Because, you know, sometimes they don't want to necessarily give those discounts out. And it's different per state. There's a lot of hidden information on exactly what the costs are for the pharmacy products. But you know, if you are just in need, definitely look at that for your state.
Scott Benner 52:07
You also Walmart was on here last year, because they're selling Novolog. It's kind of its rebranded. It's just it's called it's called rely on Nova log, but it's just trust me, I went through the whole thing, it's Novolog. So the problem is that talking about it brings up memories for people of older, outdated insulins that that are available at Walmart as well. And sometimes people think you're, you're talking about that, but I'm not talking about that I'm talking about Novo LOGG is available at Walmart, as long as you know, I
Samantha Arceneaux 52:42
have Have you seen the recent pricing on the Nova log at Walmart. And the reason I bring this up is it's not always the best deal because of these copay cards. So say, you know, it's $80 to go get a vial of this generic Nova log at Walmart through the rely on and the, you know, you need two vials for that month. Well, the NoVo program is $99 for up to three vials. So you know, I mean, you're getting that second vial for $19 rather than $80. So
Scott Benner 53:12
we'd really want to look at the company's code. Yeah,
Samantha Arceneaux 53:17
just do do do the math. You know, I always say like, what is your time worth? You know, when you're doing these spreadsheets to look up different plans, and, you know, the insulin costs, the affordability resources that are out there? You know, is it worth, you know, a couple of hours out of your year to figure this out and save hundreds or 1000s of dollars? You know, for me, I'm, I feel like I'm worth it. I'm way cheaper than that.
Scott Benner 53:44
I would do things you have no idea for like 50 bucks. Yeah, no, I, you know, when it goes to this last comment I have from this person here is test as much as all this sucks, anticipate that expenses are coming. My budget totally changed. And I spend a lot more on medical costs now, even though I have insurance. And I think that's just important to remember that. I mean, I can't tell you, I don't know what your insurance plan is or what it covers or anything. But I mean, I think I said it recently on here to cover a family of four. So the amount of money that comes out of my wife's check every month to cover a family of four plus the amount of money that we spend on diabetes supplies and co pays and things like that. I mean, I guess earlier, we might spend $7,000 a year maybe, like you don't think of it that way because most of it comes out of your check. You just don't see it that way. But it's the truth. You know about that much of our income goes to covering this every year seven $8,000 And that's if nobody gets sick. Yeah, yeah,
Samantha Arceneaux 54:47
that's what I'm bringing up Sunday when you when you talk about this and this is really important for those people who are especially just starting out on this insurance journey is when I say look at different things on Have insurances every single year. I also mean, look, if you're on an HR plan, you know, you've got a company health insurance plan and say your child has type one diabetes, it's okay to split off that child onto a different plan that say, on the marketplace or off marketplace that's not on your company plan. There are things called child only policies that you could get great coverage for them or a smaller deductible or you know, it has the items that you're looking for, or the network that you're looking for. That's not on necessarily your company insurance. My husband is on the his policy for work, and we absolutely have our own policies outside of him. Keep in mind you subsidies do not apply for this. So it is, you know, there's a difference in premiums, however, we're saving so much on the deductible side versus what his company plan is that it absolutely is a no brainer for us to go off of his company insurance and get our own policies. So look at those child only policies because there's actually plans like Cigna has a lot of states the thing called Cigna enhanced diabetes care plan that actually has $0 payments for preferred insulins equipment, pumps, CGM. So imagine, you know, even if you pay $100 more per month, you know, say $1,200 per year on that premium for that child, but you're it's not subject to a deductible. As a, you know, the company Plan is a $3,000 deductible, you're automatically saving $1,800 Right there, just by switching that person over? No, yeah, really look at those different things, or a lot of states have Medicare type expansion programs, CHIP programs where they'll be, you know, say about 230 $240, but it'll be $0 or $5 prescriptions. So you're just kind of like walked into the Medicaid network, but it's a self pay, like full pay program. And most states have some variation of that. And that can be a lot cheaper than, you know, paying that premium, but still being subjected on a company plan, or even a Marketplace plan to those deductibles. So there's a lot of different affordable insurances. So when I see somebody saying like, Oh, you know, my costs have like, drastically gone up, I'm saying there's ways to mitigate, you know, you just might have to play it differently and not have that four person insurance, it might be just a subscriber on their own company plan. And then other people are on different plans that make more sense for them.
Scott Benner 57:38
And then Medicare, Medicaid, Medicare, Medicare, right.
Samantha Arceneaux 57:42
Medicaid is generally going to be the majority of people under 65. And then over, you know, in the Medicare, those are the senior citizens, so to speak, are on Medicare, Medicare has its own. That's its own topic, Medicare. But that a keyed is generally for people who just do not make a lot of money, especially children. And they really want to make sure that children have some kind of insurance. So what they'll do is if you make X amount of money, say, you know, it's a percentage of the poverty level, if you make that amount, or within like, 200%, you know, you'll pay $0 to $80 a month for that kids insurance. And if you make more than that, then you'll be full pay, which is about 240. Depending on the state,
Scott Benner 58:35
is there insurance for anyone? Like is, are there if you don't have a job, for example, you have no income whatsoever? Is there insurance you can get through the government,
Samantha Arceneaux 58:45
you can try through Medicaid, if you're just making $0 Every day, that's where it gets a little tricky, because every state has different rules and what they expanded upon. So it's hard to give a blanket yes out it's definitely a blanket Look at, look up your state's requirements. But you know, sometimes people feel like, they just can't afford anything. And that's when I keep going back, you know, look at those 340 B programs, just make sure you're getting that at the very least insulin, because nobody should be going without insulin. And, you know, even if it's asking a friend for $20 to go get, you know, a month and a half's worth of insulin from 340 B program, then that's what you have to do but
Scott Benner 59:32
not sucks. I mean, it's it's interesting because you you have this conversation about like what are people with insurance so it's so hard you have to be on the phone with people and bug them about stuff and then you realize that there are far far many people who, who just don't have insurance or cash or any way to get to their their supplies at all. So
Samantha Arceneaux 59:51
exactly. And so, you know, that's it's it's heartbreaking, but you know, it just goes into what advocacy is really Something that is needed, you know, with these insulin caps. I'm very much for them. I know there's a whole conversation that could be had about politics with these days, but just know, even if something hasn't passed, you know, there's always ways to get insulin for cheaper.
Scott Benner 1:00:19
Yeah, it's interesting, isn't it that everybody thought, Oh, we got our politicians to talk about insulin pricing, it's gonna get taken care of and it almost feels like instead it just turned into a fun thing for them to talk about around election time.
Samantha Arceneaux 1:00:31
Yeah. It's it's definitely one of those mouthpieces where everybody wants to say the right things, and then it comes down to actually doing something about it, and then nothing gets done. So that's a little frustrating. But yeah, I would say this is a really good topic, I would say, not just for people with newly diagnosed situations, but for anybody, you know, who's looking to have more affordable health care? You know, I would say it's bold beginning, Scott. But I think, you know, try to to get other people listening, because I get this question from people who've been, you know, having diabetes for years, and they just are so fed up with how much it costs. And, you know, there's definitely ways to save money
Scott Benner 1:01:15
and keep you from having to give up i Well, listen, Sam, I've said it before, I'll say it again, you should be doing this for a living, although I don't know how much anybody that was. The problem is that who's going to a person who's trying to save money, can't afford to pay a person to do something for them to save money. It's, but there's, there's something here, like, this is something that, like, even as you're explaining everything, and going over it, I think this is wonderful information for people to have, but I don't know how reasonable it is to expect that they're going to absorb it and understand that the way you do and then put it into practice, and it would be lovely if they could go somewhere and just say, hey, help me with this. You can have a percentage of what I save, you know what I mean? Like, there's got to be a way to like, make this a mass mass market appeal. Like, you know, I know there's not it seems like leave me alone. I have a job.
Samantha Arceneaux 1:02:06
Yeah, I don't think my I'm actually my husband's assistance. I'm not sure he would love me, separately for him. But
Scott Benner 1:02:14
well, I, you know, back when you first came on the podcast, like, I actually contacted one of the companies I had a relationship with. And I was like, why don't you hire Sam, and put her in charge of helping people get their coverage set up? I was like, you have a problem. Like you have this, you have this thing you're trying to sell to people. One of the impediments you have selling it to them is that their insurance is a blockade? What if you help them get through their insurance. And I don't know if anybody ever took me seriously or not. But I still
Samantha Arceneaux 1:02:41
I actually, before I came on the podcast, I was actually in talks with top manufacturer about that very subject. But unfortunately, it was not a work from home, and I did not want to relocate across the country.
Scott Benner 1:02:53
I'm saying it again, because I know they're listening, it would take you a small department of people. And it would not be a tough process, somebody could contact you would already know they're having trouble because they're working through your customer service people. Yeah, it can be rerouted to this department, which would look at their situation, assess it, and show them what to do to get it taken care of.
Samantha Arceneaux 1:03:13
And honestly, Scott, you know, some of the manufacturer, there's, there's honestly, some really, really good reps out there. So I don't want to discount and say that, you know, the manufacturers don't have reps who are already doing this kind of stuff. You know, that I've seen some really strong appeal letters, some, you know, really unique ways of, of tackling these issues, from the reps and even, you know, taught me something. So, you know, it's not to say that, you know, there's me and me alone in this country doing anything like this, but
Scott Benner 1:03:43
no, I realize that. But yeah, but if I get a bad rep, not a bad rep, what if I get what if I get a new rep, and they just don't know, like, so now it's luck of the draw. I'm paying $200 more because I live in this county. And if I lived in that county that I'd have this rep and they'd know how to file it. Like you don't mean like it just didn't be centralized in my in my in my imagination. But that is not a problem for me to fix. It's just a problem for me to point out. So I've done. Sam, I cannot thank you enough for doing this. You are the last episode of The Little beginning series. Oh, wow. Thank you. You're welcome. That was really a big deal for me to do this for me. And on on late notice, too, because Jenny and I sat down to do this the other day. And I was like, This is wrong. Like, Jenny and I shouldn't be doing this. Like Sam should be doing this. So
Samantha Arceneaux 1:04:30
it's funny. We had talked about doing something like this next summer, and it's October just for reference on when we're recording. And so I got the notice I'm like, Oh, no. I mean, I get prepared. And then I realized, wait a second. I know all of this.
Scott Benner 1:04:43
There's nothing to prepare for your. I apologize to you in public right now for all the times that I tagged you in other people's problems.
Samantha Arceneaux 1:04:50
Oh, no. And it's fine, honestly. And if other people in the Facebook groups want to tag me if they notice something I'm not seeing, you know, feel free to tag I know Nico sometimes does as well. But that's not a problem always happy as long as I see the tag that's usually the only problem is sometimes it gets a little wonky on Facebook but
Scott Benner 1:05:10
Facebook is now giving my giving me my tags a week after they are given like somebody tags me. About a week later I get it. So my notification
Samantha Arceneaux 1:05:18
sometimes you know, it'll it'll come up way later or just I won't see it and I just happen to be scrolling and I'll see myself tag and I'm like, wait a sec. I didn't see this notification.
Scott Benner 1:05:29
Alright, well, Sam, thank you so much for doing this. I really appreciate
Samantha Arceneaux 1:05:32
it. Absolutely.
Scott Benner 1:05:41
Huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juice box, you spell that g VOKEGL. You see ag o n.com. Forward slash juicebox. I'd also like to thank Ian pen from Medtronic diabetes to remind you to go to in pen today.com To learn more about it and to get started. And of course, thanks so much to Sam, for coming on and pinch hitting for Jenny here in the bold beginning series. I'm pretty sure there's going to be more bold beginnings coming but yeah, it'd be you know, I'm not sure. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Okay, I'm sick. So I'm going to regret this but I may list all the bulb beginnings episodes for you. 698 Defining bulb beginnings. 702 honeymooning 706 adult diagnosis 711 terminology Part One 711 I just said that 712 terminology part to keep in mind that bold beginnings was a huge collection of statements and input from people who answered the question, what do you wish you knew at the beginning of your type one diabetes diagnosis. So we took all of this feedback, it was literally like 80 pages of feedback and put it into categories and that's what drove the bulk beginning series. So anyway, 711 and 712 is terminology Part One and Two 715 Fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility 751 school, Episode 755 was exercise episode 759 was guilt fears hope and expectations. Episode 763 Community episode 772 journaling 776 technology and medical supplies Episode Seven at treating low blood glucose. This is episode 784. Insurance and there might be more but I mean, that's a lot. So if you can't find them in your podcast player, look for them on the private Facebook group and the feature tab or at juicebox podcast.com. But if you just search bold beginnings juicebox in any of your audio players, they should pop right out. Thank you so much again for listening. I'll be back very soon with another episode of The Juicebox Podcast.
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#780 Bold Beginnings: Treating Low Blood Glucose
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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
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 780 of the Juicebox Podcast.
Welcome back everyone to the bold beginning series today Jennifer Smith and I are going to be talking about treating low blood glucose levels. At some point, in this episode, you're going to hear me tell Jenny that oh, this is the last one we're recording, but I might have made a mistake, so there's more coming. Anyway, you'll see 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. Remember that while you're listening, please. If you have type one diabetes and are a US resident, or you're a US resident, who is the caregiver of someone with type one, can you please go to T one D exchange.org. Forward slash juicebox and complete the survey. Just join the registry complete the survey takes fewer than 10 minutes. Absolutely HIPAA compliant, completely anonymous. Super simple answers to type one diabetes questions you already know the answer to your feedback helps other people living with type one, t one D exchange.org, forward slash juicebox.
Omnipod five is the first tubeless automated insulin delivery system to integrate with the Dexcom G six. And now it's available for people with type one diabetes ages six years and older. Wait till you see smart adjust technology in the Omni pod five. It adjusts insulin delivery based on your customized target glucose helping to protect against highs and lows both day and night. Anecdotally, I am seeing so many people in our private Facebook group using Omni pod five and loving it. If you're interested in automated insulin delivery, I'm talking about a system that adjusts with your blood sugar, blood sugar tries to go up, it adjusts tries to go down. It adjusts automatically. If that's something you're interested in, head to Omni pod.com forward slash juice box and learn more about the Omni pod five. If you're not looking for automation, right now, you're probably going to love the Omni pod dash and you may actually be eligible for a free 30 day trial of that dash. Again, head to Omni pod.com forward slash juicebox to find out if you are now if you'd love that, but you don't have a Dexcom this is easy to fix dexcom.com forward slash juice box head there now click the link get started with Dexcom G six today. What are you going to get with Dexcom? G six? How about glucose readings right on your smart device your Apple or Android phones don't want to use a smartphone no problem, use the Dexcom receiver along with those devices comes customizable alerts and alarms. So you can set your optimal range and then get notified when your glucose levels go too high or too low. You can even share that data with up to 10 followers. That's pretty crazy. Think about it like your, your mom could like you could be like 40 years old be like Mom, will you watch my blood sugar because at night I don't wake up. If you're planning on moving to an algorithm based system, you should really look at Dexcom or if you just want to be able to see your blood sugar, speed, direction and number again, Dexcom I can look right now. Boom, my daughter's blood sugar is 77. It's steady right now. I saw it that fast. Right on my iPhone, you could do that to Dex comm.com forward slash juice box, head to my link right now fill out a little bit of information and you're on your way. Thank you so much for listening to the ads. There are links in the show notes of your podcast player or links at juicebox podcast.com. If you're unable to remember Omni pod.com Ford slash juice box and dexcom.com Ford slash juice box. Now we're gonna get you to Jenny and I talking about how to treat low blood sugars. And there's no ads the rest of the way
I'm gonna hit record Jenny to tell you this little preamble bit that I normally would have said ahead of time, but what we're done, you and
Jennifer Smith, CDE 4:28
this is the last one we not yay, I should say, Oh no, we're done.
Scott Benner 4:32
We're done with the bold beginnings, then we will move on to the long list of things that I have to do with you for next year. So but I'm gonna throw a little curveball in here. So you and I were going to talk about insurance. And then we were finished but I'm going to bring somebody else in to talk about insurance. Cool. So because otherwise it would just be you and I you know talking about our experiences with insurance which might not have answer some of the people's questions.
Jennifer Smith, CDE 5:01
No, I think that's great. Because I think there are quite a number of people that definitely know more about the navigation. And I think in terms of this topic, it's more how to really nudge yourself into insurance and get what you need and get to be able to talk to the right person about it. Yeah. So I think that's great.
Scott Benner 5:24
Yeah. So you and I would have done, we would have had fun. And I would have told stories about yelling the F word into phones to get art and things. I can do that with someone else who can also hit the technical sides of it for us a little awesome. So instead, you and I are going to add our very last episode to the bowl beginnings series together about how to treat low blood sugars. Oh, right. Because you get diabetes. And nobody says to you, hey, you might get low. And the low might be slow. And it might be fast, and it might be harsh, and you might be dizzy. They just say if your blood sugar gets low, eat 15 carbs, wait 15 minutes. And then it
Jennifer Smith, CDE 6:07
might respond really fast. Or it might not resolve for a couple of hours. And you're thinking, Where did the food go? So,
Scott Benner 6:17
so I so I want to kind of talk through a number of scenarios. And I know, I know, I'm dropping this on you out of nowhere. And of course, is that is that anything new? No. But I don't have any notes whatsoever. Like we've been doing bold beginnings off of people's questions. So, you know, we might have gotten lazy because we're like, oh, we don't have to drive this conversation. I'll just wait and see what this person said.
Jennifer Smith, CDE 6:37
Well, I'm sure there are probably lots of questions that have come in about low blood sugars.
Scott Benner 6:42
There may have been but they were not. They were not called together for me for the situation. So we're just going to fly by the seat of our pants, which I think will be fine. Not like before. Alright, so let's think about this. Your newly diagnosed, and I guess the first thing we can consider is that you might be honeymooning, still true. All right. So if that's happening, if you're getting help from your pancreas that you don't expect, you might see protracted I saw somebody online the other day whose kids blood sugar was like low all day. And she's like, this has to be a honeymoon because like we're not doing anything different than we've done in the past. So I guess if you're MDI, and you start experiencing low blood sugars, that seem like they're being I guess, impacted by your pancreas, still, you can't cut off your your Basal insulin, because you've probably shot it already that day. Correct. But you could start limiting. I don't know, would you
Jennifer Smith, CDE 7:47
limit your Bolus insulin? Right? Right, or you could look at for that day, making your insulin to carb ratio, more conservative, you know, if you're floating around at a ratio of an in honeymoon, when kids and even some teens might be a one to 30 ratio, right? You could suggest one to 45 or one to 50. Or right if you know that you're floating, pretty stable when there's not food introduced, but the stable is low and you're having to give it a little bit of carb to keep it from like dipping, then it would be the Bolus is that would be the easiest to adjust in that day. And in looking forward into the next day thinking, this might be what it is. You could downplay your basil that day. Whether it's morning or evening time dose, you could take it down a little bit, and see if then the next day floats just slightly higher, and leaves you without having to add so much extra carb
Scott Benner 8:55
to treat. And on the day that you get surprised by it and your basil is already in. You can kind of feed the basil a little bit for the day. Yeah, right and bred out and spread out carbs to cover the timeline. But so this is where you need to understand the difference between like a faster acting car but a more sustainable impact, right. And so if you're being drugged down constantly over hours and hours and hours, a couple of skittles might stop it for a minute. But the minute you bounce back up again, and this extra Basil is there that you don't need you're gonna get drugged back down again. So you need foods that are slower to digest. Right? You start you start reverse engineering your problems from diabetes and using your problems as solutions right like, right if you ate pizza that might take that might sit in your system for hours and hours and hours impact you so what a great opportunity to have pizza a little bit of pizza or what are
Jennifer Smith, CDE 9:54
pleading some proteins with some carbs. Right. You might want to treat if you're done hoping or lower already. If you do, then knowing what you just said, you want some sustaining power after that to not drop yet again, you could do something that incorporates some fat and protein in it to hold things level because again, the other consideration that if if it is a honeymoon based, like drop in blood sugar, it could be that anytime your blood sugar does nudge up from what you treated with simple sugar, it could be that your betas are also like, Oh, look at that. There's a rise in blood sugar. Let's give some help. And it doesn't really know that you've got Basal injected, that's also there.
Scott Benner 10:39
That's C you know, isn't that interesting that you brought that up? It didn't occur to me that I've always just thought of it is like you're getting help from your pancreas, but your pancreas seeds the carbs and attacks them while the insulin you've learned the manmade insulin you've put in is also drawing your blood sugar there. Oh, wow. So you have dumb insulin and smart insulin working at the same time.
Jennifer Smith, CDE 11:01
Correct. And common time for that in honeymoon is overnight for a lot of people actually, where they may have corrections that work pretty well in the daytime, despite them being really tiny, you know, miniscule amounts of correction. But I've got person after person that says I can't correct unless my blood sugar's 300 At night, because if I correct with just a minor half unit of insulin, I'm sitting at like a 60 blood sugar.
Scott Benner 11:30
In this reason we're newly diagnosed people.
Jennifer Smith, CDE 11:33
Correct. It's specifically more honeymooning. I mean, you can even see it on nights where blood sugar is going up. You don't correct the high blood sugar because you have the hindsight to know what's coming. Blood sugar could hit 202 20. And it downplays in your wake up in a beautiful number. That's, that's not injected Basal that did that. Your body helped you?
Scott Benner 11:57
Yeah. Okay. So that's one kind of low, you could experience now another one might be activity, right? I'm trying to think of I'm trying to put myself in a newly diagnosed person's situation, right? Like, they go back to their life, like I have diabetes, diabetes isn't gonna stop me. And then they go play tennis, and then their blood sugar falls really quickly. There we need fast working sugar, correct something that's gonna hit you very quickly, and stop this freefall. So if you're in a freefall, for whatever reason, you can't eat. That's not the time to have a slice of pizza.
Jennifer Smith, CDE 12:36
That's not the time to have peanut butter cups, the slice of pizza, the nacho meal breaks, not
Scott Benner 12:41
because that's because you're going to keep crashing before it has an opportunity to start digesting and to stop you. You're looking for simple sugars. I mean, in emergency situations, I know, I know, people don't seem to talk about glucose tablets anymore. Like they've become persona non grata, right. Because they taste achy,
Jennifer Smith, CDE 13:01
they're not the greatest. I mean, they are they are okay. I think the greatest thing about them for me personally, is that I am never going to over treat with glucose tablets. Right? I mean, they do their job. They're doing the job that I want them to do. But they're not like a bag of I don't know, licorice, like licorice. I like black licorice.
Scott Benner 13:23
So you might be like,
Jennifer Smith, CDE 13:25
easy to keep eating with a low blood sugar.
Scott Benner 13:27
Well, that is one interesting thing that there's a plus for for glucose tablets, you will you won't eat them for fun, that's for sure. No. Gel. I mean, I don't even know Do people carry that still, they should write it,
Jennifer Smith, CDE 13:40
we should and or it's easy, especially if somebody needs to help you. Because you can just get it into kind of the gum line and sort of massage it in it. It does work really quickly. So if you don't love the taste of glucose tablets, the glucose gels might work really great. There's a nice liquid glucose that I just heard about two that I really liked. Okay, so
Scott Benner 14:04
but, but in general juice boxes, people are gonna use Skittles gummy bears stuff like that. Right? Correct.
Jennifer Smith, CDE 14:11
Exactly. But the another good thing as you bring up glucose tablets, glucose, or dextrose is the simplest form of sugar, right? So your body doesn't have to go through this breakdown of the structure of of sugar if you will. And so it gets absorbed really fast. So if you're looking for candy specifically, you really want to look for candy that has glucose or dextrose as one of the first two or three ingredients because it's going to have the fastest impact on a low or a really quick drop that you want to stop.
Scott Benner 14:45
Yeah, the timing so super important because I know a story about a person. I won't say their name, but they're an adult. And diabetes for a long time felt themselves getting low knew it. ate a bunch of carbs passed out And then just turned back on when the carbs hit them. They were just like, hey, I'm back. And so so there's an it's an example of having the timing wrong. Like you're falling at a certain degree of speed or rate of speed. And you need that sugar to come in, and to slow like a parachute almost to parachute that that number fall down and to stop it, you know, what a nice level sponsor don't go too low. So things need to work the way you need. I mean, that really is the message of this episode, right? Like if you're one if you're 120, and you're wearing a CGM, and you see this gradual fall, and you look back over at 90 minutes going down, oh, geez, like I Bolus for this meal, it clearly looks like it's too much insulin, I'm going to get low a half an hour from now. Well, there, you could just add some more carbs to your meal or have a couple more bites. Correct, you might stop that. But if that same 120 was falling quickly, you're in a different scenario, you need to use different carbs,
Jennifer Smith, CDE 16:02
you need to use quicker, exactly the simple carbs on a quick drop. If you've got a gentle sort of glide down something that's a little more complex, like crack, you know, something like peanut butter crackers, I hear a lot kind of get used, because there's a little bit more to the cracker with the peanut butter added to it, right. So something like that could use it down. But if you're really, really dropping, then sugar,
Scott Benner 16:30
yeah. And you have to, in the beginning, it'll be hard not to over treat a low. But that is a skill you need to learn. Because otherwise, the bounce comes and then you're like, I don't know what to do. I wish you have that fear from you've just been low. You don't want to Bolus like you get caught in that, that balancing rhythm. You don't want to be in that. So maybe you'll learn at some point to look at your situation and say, half a juice box here. Or, you know, take a couple of sips just have two Skittles, you know, I say to people all the time, just because you open the bag, doesn't mean you have to eat all of them. Right? Yeah, just eat what you need.
Jennifer Smith, CDE 17:07
All right, which is also why those little tiny bags, I mean, this is a popular time of the year for a lot of people to end up stocking up on simple car, because we have Halloween coming up. Whether you celebrate it or not, it's a great time of the year to find really little packets of somewhere between eight and maybe 15 grams of carb, simple sugar, Candy really prepackaged. So the whole bag of Skittles versus the tiny little packet helps you to contain things a little more.
Scott Benner 17:40
And if you're not lucky enough to have a CGM in the moment and you're just leaning on your, your finger sticks. How frequently do you tell people to after they think after they've identified a low or felt it and treated it? How often do you stick your finger and look, I find myself. You know what I mean? I use a lot more test strips in that moment than you do sometimes for the whole week
Jennifer Smith, CDE 18:05
you do but you can expect that even simple sugars going to take a little bit of time for digestion, right? So you're really not going to see much shift. If you do a finger stick, confirm your low, treat the low and five minutes later you're doing another fingerstick you're probably not going to see much of a difference, right? So that's where old school was that 1515 rule. 15 grams, 15 minutes while you might not need or take 15 grams to treat this low that you have. Waiting about 15 minutes to retest will give you enough information to say well I treated it. It doesn't look like it's come up but it hasn't also fallen. So that should give you enough to say it's not dropping. Clearly, digestion is happening. Well, let's give it another 15 minutes and test again.
Scott Benner 18:56
Yeah, you know, I have two thoughts. So one of them I'm going to make a note about and then the other one I'm going to say if you are wearing a CGM. Sometimes it will not register as quickly so you can see like a like, Oh my God, my blood sugar is 50 You know what I mean? And you take a bunch of carbs and and then there's this way to look at the arrow with the Dexcom at least I don't know how it works with libre, you'll you're stopping a low blood sugar, let's just say it's 60. And it's the arrows diagonal down and you take some carbs in and the next reading is 55 and the arrows still down. And then all of a sudden, the arrow will like sometimes disappear. Like almost like the algorithms like I don't know what's happening right now. But the number stays the same. Or sometimes the number or the number will get lower, but the arrow changes. And do you know what I mean by that? Yeah. And so your
Jennifer Smith, CDE 19:56
whereas if you were testing in a look then it said 55 with an eight Build arrow down, you've treated it. And now you can see it has a horizontal arrow, but the number is reading like 51 or 50. And you're thinking, Well, what that really indicates is the system has found a stability, even though the number has slightly nudged down yet, it's not dropping, what you've done is actually making some impact overall. So it's not really time to treat with yet another like whole box of juice.
Scott Benner 20:30
It's so weird. It's a weird moment because the CGM is a little behind. And what you did with the carbs is maybe more in the now, but you can't see it. And so there's like, there's like multiple things happening at once that the technology has, has difficulty showing you. But you can see that something's happening. And so that's when that's when I say to myself, Okay, now this thing looks stable. And we've gotten to, you know, readings in a row that say 50. But I want to know what's really going on, because either the CGM seems confused, and I didn't do well. And we're lower than we think. Or we're higher than we think. And I don't want to treat more, that's the perfect time to do a finger stick to me absolutely have to write
Jennifer Smith, CDE 21:14
Absolutely, especially for those. Those numbers where you're treating I say at a number less than 60. Honestly, if you're varying at all and decision about whether I should do a finger stick or not. If you're less than 60, and you've treated it and the numbers on the CGM just don't necessarily add up. Or you're mentally not quite like with it enough with a low blood sugar like that. Just do a confirmatory finger stick, because at least that's going to show you real time right now. Where is your number? Yeah,
Scott Benner 21:53
yeah. And I know we're trying not to over treat. But if you get caught and you don't know, like, this is the time you're going to hear me say I'd rather I'd rather just Hi. Yeah. Because Because what you're saving yourself from or saving another person from. We don't talk about very much like in diabetes in general, even on the podcast very much like it just doesn't get talked about very much. You're talking about becoming incapacitated. You're talking about having a seizure. You're talking about death, like you're talking about. There's a lot that happens between 40 and then I don't know how low anybody's ever been right. You know, but while they were still alive, I saw Arden's blood sugar. I saw Arden's blood sugar 22 once on a finger stick when she was really little, and she was okay still. And I was just like, keep eating, eat. Yeah, II keep going. And then all of a sudden, it was 30. And I was like, Oh, I might have tested moving, I might have tested her blood sugar 10 times in seven minutes. I was like, but But I mean, it's the truth, right? Like you, you have to learn to do this because you use manmade insulin and your blood sugar is going to get low. I just don't care who you are, it's gonna happen. So you need to know how to handle it or how to handle it for somebody else. And you need to know how to handle it without causing a problem in the future. Whether that problem is a high blood sugar, or calling an ambulance, like right, you're it's not. I guess we don't talk. It sounds scary. It's probably why people don't talk about it, huh? Yeah, yeah. So
Jennifer Smith, CDE 23:27
it's absolutely it's it's more around how to treat. There's not even an emphasis on like the overtreatment. It's just treat it. But why, right? Why is it so important to recognize a low sooner than later or deal with it sooner than later? Or stop it from happening? sooner than later? Because there is that scary factor of? I don't know. I don't know why some people can have a blood sugar. I might the lowest I was ever was 26. Yeah, I don't, I was fine. My mom actually thought the number had to be bad. I mean, it was really old. I mean, this was like 1988. So clearly, the meters were not what they are today. But she's like, that's got to be wrong. You feel good, right? We were camping. Did it again, it was like it was pretty much the same. Just like you need to eat. Here's the juice. Where's it? Where's the regular soda? You know, why could I be there? And fine when somebody else could be passed out, have a seizure, need an ambulance need assistance? When their blood sugar is 61 and low. Right? Right.
Scott Benner 24:36
Yeah, everybody's going to be different. And so so let me let me say a couple things here. I use a football analogy because it's football season, right? You can't like the reason the offensive linemen are these giant blobs of people is because they're trying to stop this insane force that's coming at them. Right? Correct. You can sometimes put carbs in and you I made such a mistake earlier in the day with insulin or, you know, there's just so much power on the side of the insulin. It's like the carbs aren't there, like you might as well not have anybody blocking because it runs right through them. Right? That's a panicky situation, the first time that happens to you, where you take in a juice box, and realize that it's, it's like you didn't drink it. If you're enjoying the Juicebox Podcast, and you would like it to remain free. Please support the sponsors. Today's sponsors are Dexcom G six dexcom.com, forward slash juice box, and Omni pod. Both the Omni pod five and the Omni pod dash are available at Omni pod.com. Forward slash juicebox. It's a hard moment, you know what I mean? Because this is what you know is going to work. And now suddenly, it's not working for some reason. And you're like, Oh, God, what do I do? You can't find yourself in those scenarios. Wondering what's in the cabinets? Or what's in my bag? Or what do we have in the car, like you have to be prepared? Correct all the time. Just, you know, anywhere you are. There are fast acting carbs. I don't give a crap. If you don't use them for six months. I don't care if they get stale, throw them out and replace them. If the juice, you know, in the juice box, get some spongy from being in the car in the heat. Throw it away, put another one in there. Like just don't. Don't ever find yourself in a situation where you're like, it'll be okay.
Jennifer Smith, CDE 26:30
Right? Yeah, right. I mean, It's fall now. and I were just like rotating through. We don't really have summer jackets, but like into fall into the winter jackets, we're kind of rotating them into the mix, right? So I bring up my winter stuff. And absolutely in at least like one, if not two of my like fall into winter jackets. Their old, nasty bad glucose tablets, like they've gotten the like crystallized sugar like dots. And like, if I had to, I would still use this. So like that juice box that's like nasty and squishy. If that's all you got, you use the squishy juice that
Scott Benner 27:09
spread them around your life, like your grandma's spreads around her reading glasses, do you know what I mean? There's just a pair in this room and over here, you need to be less ready, you can't be it's a weird scenario, you can't be scared, you can't live your life scared. You don't want to live your life with a 200 blood sugar because you don't want this to happen. Because also, that's not any safety from not being low. Right? As a matter of fact, that might put you in a situation where you're a little more frequently, but but I like to say about diabetes, that you don't learn these things. You don't prepare for these things so that you can stop a problem. The problem is always going to sneak through somewhere, it's never going to be where you think it's you know, because if it was where you think then you'd get ahead of it. Right. So you have to be ready for when it happens. And then the last bit of this is, if all else fails. I mean, please be carrying glucagon, you know, with you like not, it's in the cabinet in the kitchen. But we don't take it, you know, anywhere I left it in the car when I went pumpkin picking like it needs to be with you. Right. Yeah, exactly. So well, this is a fun conversation.
Jennifer Smith, CDE 28:14
Yeah, it's a harder, I think it's a harder conversation than you think about before. Because there's a lot of there's a lot more on the back end of not taking care of a low well enough. That is actually scary. Yeah, and it doesn't get talked about. We always try to like smooth it out like not to worry about it so much and whatnot. But in order to not really worry about it. Preparation is needed to have to have things in your purse or your car or your backpack or, you know, at your friend's your friend's house that you go to all the time or whatever it is. I guess it's like being a girl scout or a Boy Scout. Be prepared how
Scott Benner 28:57
to be prepared. Yeah. You know, when Artem was younger, she spent her whole day in one classroom, right where she went to art or something like that. So she had a bag and she took it with her when she hit middle school in high school, and she started having English in one room and math in another room and that started happening. We put supplies in each room. Like we didn't say to ourselves like she should be humping this stuff all over the place constantly. Let's put a little here there was a couple of juice boxes in every room. You know, it's interesting when you learn about your management to how come we're always restocking the English class. And never the math class. What's the time Yeah, it's the time of day we're doing something that's making a low around this time of day. It's actually an interesting way to learn a little bit about your management is where am I grabbing my supplies from? You know, do you think that do you think that every load is different? Because there's there are questions here from people that are like you know, after I stop a load with a fast acting, should I put a protein in every time time afterwards, but not necessarily.
Jennifer Smith, CDE 30:02
Yeah, no, I mean, the idea. Again, it's kind of an older concept. It's sort of like the 1515 rule, it's 15 grams, 15 minutes, and then you essentially may need to follow that up with a snack. But again, there's lack of enough information about why the idea really was simple carb will typically help keep your blood sugar up for about 90 minutes, give or take. Now, again, a variable in the picture is why was the low there, if it's excess insulin, you may actually need to treat with more than what you thought you would need. But the other idea is that the simple carb to keep your blood sugar up is it's meant to sustain you for that time period, before you might eat again. So if you treat a low blood sugar at, let's call it three o'clock in the afternoon, but you don't typically eat dinner until seven or eight o'clock at night. Lows can bring on another low they can. So if you treat the low, but there's something in the picture that's keeping you lower, could be honeymoon, it could be excess insulin, it could be more movement in the day, whatever. You may actually for longer than two hours before your next meal, it may be beneficial to have a handful of nuts a spoonful of peanut butter a piece of string cheese boiled egg, whatever it may be. The the idea there is that that's a little bit more sustaining and or a snack that might have a little bit more complex carbs to it long with some protein to sustain things. So you're right every low is not the same right?
Scott Benner 31:44
Art in tried art is a college right now. She tried to use a following blood sugar as a Pre-Bolus for her lunch. But it just didn't like she didn't time it well enough. So like at 60. But so listen, for anybody who's listening. Here's how I did it. Arden's in another state, she's 13 hours away. I'm able to look at her phone and see where it is. Right. So I use Find My Phone to see. Okay, she's in the cafeteria, so at least I know she's right. So now where she should be near food. I text her, Hey, what are we doing about this? Because she's got this like 70 that became 65 pretty quick. And then I looked at the arrow. And then I looked at the line and I thought this isn't stopping. Like this is not a low that's going to stop right like this is this is going to be negative 15 If we don't do something about it, right. What are you doing? I'm trying to like Miss like, you don't I mean, I don't want to be up harass Johnny. And at the same time, I don't need her dropping dead. It's College. Like I'm trying to find the middle. I'm like, Hey, what's up at nothing. Now I know she's with the food. So I'm like, you see this? Nothing. Art and I really need to know you're okay. I'm eating now. I'm like, okay, like the food's going in your mouth. Yes. But Jenny 6060 560-560-5550 5540. I'm like, Are you eating now? Yes, I'm eating. I told you. I was eating
Jennifer Smith, CDE 33:12
what are you eating lettuce leaves?
Scott Benner 33:17
What's happening? Like, you're eating like handfuls of sugar, right? Like, and so, but so I texted or test her. So then I sent a text to test her cognitive, like where she was cognitively. Right. And I'm just like, how do you feel? And she's like, I feel fine. And I'm like, Okay, have you been eating for a while? She said yes. So I said, Okay, I got it. There's food in there. It's working. The CGM hasn't caught up yet, but I had to stand there. for like three go rounds. That CGM watching that 42 Just sit there knowing she's not really 42. She's in the mid 60s already. I know. I know this. But I only know this from
Jennifer Smith, CDE 33:59
you. Because you've lived with her. You've dealt with it long enough. You knew the questions to ask. You knew how to get her to respond and whether or not she was going to answer you the right way. And that it takes learning
Scott Benner 34:12
Oh, it's yours. Because otherwise I would have been like drinking juice. I don't care if you don't drink the juice. I'm bringing you home. I'm not paying for college. Like I don't you know, like, you know, because the number because we've done everything's over come home and live in this room for the rest of your life. Because the because the number was so scary, right? But I was able to pick together enough information. I swear to God, that CGM. One more time went from 42 to 66. And I was like, Okay, I was right. But I'll tell you, you're like, oh my god, what if I'm wrong? You know what I mean? Like, I don't want to be wrong, but I might be the next thing I think we should bring up about Lowe's. Because we're in a we're in an algorithm world now right control like you on the pod five that thing that Medtronic makes i What is it? Which one is that? Let me learn the number Medtronic, don't they have an algorithm right now?
Jennifer Smith, CDE 35:03
They do. They've I mean, they've had an algorithm for a long time I use as a their CGM. Right. And I don't know that their, to their algorithm have a name likes me pod five, six. So their new their new one in the ISC. The number is what you're looking for 770 G. And I know someplace I don't know if it's here. I don't think it's here yet. 780 G, I know is available in some places in Europe already. But seven, seven D 780. Yes,
Scott Benner 35:34
I just I feel like they buy they buy ads for in pen. So I figure I, I owe it to them to learn the name. I just can't keep saying the thing that Medtronic has they're gonna be like, How about how about if you're not the podcast that we sell the embed on anymore? Like? Alright, so the 770 G, right. So yeah, so whether it's one of those algorithms, we all live in a new space now, where the algorithm sees a low coming, and it takes away and takes away and takes away your basil and takes it away. But it doesn't, it isn't always going to get it right. And so you might end up treating a low after a prolonged amount of time of not having any insulin. And then your blood sugar shoots back up very quickly, because there's nothing to stop it. And what does the algorithm do when it sees the higher number gives you more, it gives you more insulin, sometimes sometimes can happen. That's what I'm saying. It can happen that's a better way to and when that happens, here's what I know, for certain, yeah, gonna be low again later. Because because, you know, the, you know, when you're taking, you know, sugar in for a low, if you take in the right amount, you've been getting on a regular, you know, on a regular pump or on an MDI, you've still been getting your Basal the whole time. So you're, you're correcting that low more in real time. When you do it right algorithm, the algorithm thought it was going to stop you, it does not expect these carbs. And now you jump up and it Bolus is the number or it's pushing basil at the number that the other night. I guess I should have listed lupus one of those Arden had Jenny, I think it was around her period, and she was tired. She's rundown. And she's getting her period. At the same time, we had this whole day where she was a little too low. And it persisted into overnight. And so around eight or nine o'clock, we fixed the low and I said listen, take these carbs, go into the settings and shut off micro bolusing without carbs. I was like where this thing is gonna hit your your correction. And it's gonna push it back again. And she did that we went through the night really nicely. It was a nice learning experience for her because then she brought it up the next day. She's like, should I put the microbuses back on again? And I was like, Yeah, everything looks good now. So but anyway, you have to be aware of that. So I mean, I don't know what you do. Me.
Jennifer Smith, CDE 37:53
I mean, there are other you know, for other systems, you can certainly also navigate something like that. If you've treated a low, you know that you've overtreated it, but the system is going to give back eventually, and you know that it's going to be too heavy, similar to your scenario there. The other systems do have, I guess, adjustable targets or different targets that would be higher. So then it would adjust less, if you adjust the target up and say, Hey, I'm aiming for this now. So as my blood sugar is going up, it's okay. You don't have to give me as much because I want to be higher
Scott Benner 38:30
anyway. So like an example with Omnipod five, you might tell it to shoot for the higher range and that's correct. And yes, with I'll tell you what, in that exact scenario with Arden I said, I asked her what did you take for the low? And she's like, Oh, I had gummy bears. They hit her really hard. So I was like, Oh, crap, she's gonna jump straight up. But they don't hit her and hold her. They hit her and then they disappeared on her. So I was like, oh, no, no, don't let that thing Bolus again. Yeah, anyway, this probably all sounds much more confusing than it will be you have diabetes for a few months. It's all gonna make sense. Don't
Jennifer Smith, CDE 39:05
maybe know they will. Yeah. There's still some things I throw my hands up. And I'm like, oh, clearly, like Venus is not in the right place in the orbit of something because I I just I don't know right now.
Scott Benner 39:21
You're maybe just said Good. Luck is what I heard.
Jennifer Smith, CDE 39:25
That is so not the case. Not the beginning of this is what you want to hear. Yes. Forget the maybe. I shouldn't say maybe should be like the point 1% of the time. You know, it doesn't take much to learn, especially with CGM is in the mix. These days. It doesn't take much to learn how much is needed. And as you were sort of, you know, talking into the effective algorithms, you'll see, well, gosh, I was used to using this much. I probably need to use a quarter to a third of what I used to use to treat it when I didn't have system that was helping me You know,
Scott Benner 40:01
I saw a woman yesterday say, I don't know the exact numbers, but the gist of it was on control IQ I needed 14 or 15, carbs stop below and on Omnipod five, I don't need four or five carbs to stop below. So interesting that interesting. I found that incredibly interesting actually. So
Jennifer Smith, CDE 40:16
especially system to system, given the fact that they're both doing a given take of insulin, but they are, they are very different algorithms. Yeah. So that it does make sense.
Scott Benner 40:27
Alright, so check me on this. You need to know how to stop a low they're going to happen. You're not going to stop a low from ever happening. You need to understand the different impacts that these different carbs are going to have on your low blood sugars. After a while teaching yourself to stop a low without creating a high is a great tool to have. Yes,
Jennifer Smith, CDE 40:46
if you it will happen. Yeah, yeah.
Scott Benner 40:49
Oh no, you're gonna rebound high until you until you learn how to do it in a real panic situation. Screw everything else save your life. Correct. And that's it right? Have glucagon with you have snacks with you. Don't go anywhere without ways to treat Lowe's, the people who love you and are around you should understand how to help you if you're unconscious or unable to help yourself.
Jennifer Smith, CDE 41:13
And I think another thing as you mentioned, caregivers or loved ones or you know, whoever. I think within that for Lowe's is recognizing the like what you mentioned about cognitive when you're doing kind of a check with Arden the people that are around you enough, should be able to tell whether you're responding or or talking or whatnot, the way that you normally would. And in the case that your CGM is off, or you aren't using a CGM or technology, somebody who knows you well should be able to kind of chime in and say, Hey, are you okay? You know, and don't be angry at them for that. It's just a, it's a checkpoint to be able to keep you safe. So
Scott Benner 42:02
yeah, also for I guess, caregivers, low blood sugars could leave you with people who are difficult to YES to help, right? They could become combative, or and that's a real concern, especially as they become adults. And I There's one story that sticks out in my head all the time of this woman whose husband got low, and she just wasn't big enough to overwhelm him to do what he needed, you know. And she had to call 911 because of that. But yeah, I mean, the people around you just need to know. And people should be following you. If you have CGM. Like I don't know if liberi has follow like Dexcom does, but yeah, it does it. Okay. Arden is in a suite with girls. And the girl in the next room follows her on Dexcom Oh, wow, that's awesome. He only has a 55 alarm and nothing else. But we explained to her I'm like, if this thing's beeping, please go find Arden. And make sure she's okay. That's all. Yep. And it just, I don't know, especially for adults living by themselves or kids off at college, like somebody, you know, has your back because it also not everybody hears the alarms to like I had a low last night. It was only like 65. But I was sleeping. And in my sleep. I thought did I hear something? Like that was all I thought, right? And then I'm like, I woke up and I looked, and I was like, huh, yeah, I'm gonna watch that for a second. Because to be honest with you, it was a real slow drift. The loop had been taken basil away. I'm like, I think this is gonna bounce. Like, I think it's okay. I don't want to wake her if it's not going to be okay. And it waited and waited and waited. And then I was like, Oh, it is gonna be okay. It went back up again. But I talked to her this morning. And I was like, you know, you're a little last night. She has no idea. But since she had that seizure more recently, if you listen to her last episode, she will tell you about it. If she has a she experiences any kind of a quick fall while she's sleeping now. I don't know. I don't know how that rewired her brain but she's boom. I'm up. I drank juice. I'm good. Hey, Dad. I did this. Do you think this is enough? Like she never used to wake up. And now I know she's feeling the fall while she's sleeping right now. Which has only happened twice since she's been away. But anyway. Alright, Jenny. Did we know it? We did it? I think so. Yeah. Yeah. For us then. Yay for us.
Unknown Speaker 44:24
Awesome. Thank you. Oh,
Scott Benner 44:25
I guess we should say something like thank you for listening to the bold beginning series and I hope you found it like helpful.
Jennifer Smith, CDE 44:31
Absolutely. Especially in the beginning when everything is so new. So
Scott Benner 44:35
let us know if you want us to add to this series. If you go back and listen to it and find something that should have been in there that wasn't please send me a note. And Jenny and I will we'll add it if we think it needs to be added. Absolutely. Thank you. What are we doing? What are we best here so I
Jennifer Smith, CDE 44:53
got nothing else to know right? But just hang around
Scott Benner 45:02
Well, as I mentioned at the beginning, we've already found more stuff for bowl beginning. So this was not the last episode. Let me thank Omni pod and Dexcom. While I have your attention on the pod.com forward slash juice box, see if you're eligible for a free 30 day trial of the Omni pod dash, or if you're interested in the Omnipod, five, for full safety, risk information and free trial terms and conditions, you can also visit omnipod.com forward slash juicebox. And of course, thank you to Dexcom for being a longtime sponsor to the podcast dexcom.com forward slash juice box see blood sugar in real time, the speed direction and the number right there on your iPhone, Android, or on your Dexcom receiver. There's so much more I want to tell you but I'm on about day seven of this illness that I have and to be perfectly honest, editing the show together almost killed me. So I'm gonna go take nappy, and I'll see you next week with another episode of The Juicebox Podcast.
Test your knowledge of episode 780
1. What is the significance of blood sugar monitoring before exercise?
2. How does physical activity affect insulin sensitivity?
3. What should be done if blood sugar levels drop during exercise?
4. Why is it important to adjust insulin doses based on the type and duration of exercise?
5. What types of exercise are beneficial for people with diabetes?
6. How often should a person with diabetes exercise to see benefits?
7. What should be considered when planning an exercise routine for a person with diabetes?
8. How does regular exercise contribute to diabetes management?
Please support the sponsors
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#776 Bold Beginnings: Technology and Medical Supplies
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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
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 776 of the Juicebox Podcast.
Jenny Smith and I are back with the bold beginning series. As a matter of fact, this is the next to last episode in bold beginnings. And today Jenny and I are going to be talking about technology and diabetes supplies. Don't forget if you're enjoying Jenny, she works at integrated diabetes.com And she is for hire. If you need help with your insulin management, I'd like you to 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. If you're a US resident who has type one, or is the caregiver of someone with type one and you'd like to help out with diabetes research without actually having to do anything like not off your couch, you know what I mean? T one D exchange.org forward slash juicebox. When you complete their survey, you're helping people living with type one diabetes, T one D exchange.org. Forward slash juice box. At the very end of this episode, I'll list all of the bold beginnings episodes for you. So in case you haven't found them, you'll know where to look.
This episode of The Juicebox Podcast is sponsored by the Omni pod five. It's time for you to try the only tubeless automated insulin delivery system that integrates with the Dexcom G six, try the Omni pod five. All you have to do to get started is head to my link Omni pod.com forward slash juice box. There you'll see a photo of me which I imagine you'll want to scroll past quickly. And then we'll get right to the information. On the pod five is here it says the first and only tubeless automated insulin delivery system. Everything you need to know about it, including how to get started is right here. All you have to do is click that little link says talk to an omni pod specialist when you're there, and you're on your way, get the process moving, get yourself going with the Omni pod five. It's not hard to get going. You could do it right now in just a few minutes on the pod.com forward slash juice box. And if you're not looking for the Omni pod five, but you want a tubeless insulin pump, check into the Omni pod dash because you may be eligible for a free 30 day trial of the Omni pod Dash. And again, you'll find that out at Omni pod.com forward slash juice box when you complete the process with my link, you are supporting the Juicebox Podcast and for that I want to say thank you. The podcast is also sponsored today by Dexcom, makers of the Dexcom G six continuous glucose monitor. My daughter wears the Dexcom G six continuous glucose monitor and it saves us every day. Dexcom allows remote monitoring that lets users choose to share glucose data with up to 10 followers. Of course you're getting that famous Dexcom accuracy and performance, seamless integration with Dex comms expanding connected CGM ecosystem. And real time glucose readings sent automatically to the users compatible device that can be an iPhone, that could be an Android, it could be your Dexcom receiver. See your blood sugar in real time including the direction and speed of the number without finger sticks calibration or having to scan anything dexcom.com forward slash juicebox. For full on the pod safety, risk information and free trial terms and conditions, please visit on the pod.com forward slash juice box. There are links the Omni pod Dexcom and all the sponsors in the show notes of the audio player you're listening in right now. And at juicebox podcast.com. If you're going to check out on the potter Dexcom please use my links. Thank you so much. Here comes Jenny
Jennifer, we are up to technology and diabetes supplies in the bowl in the bowl beginning series on this is voluminous is
Jennifer Smith, CDE 4:23
a very broad topic.
Scott Benner 4:25
Yes it is. But there's a lot of feedback here from people. So I'm just gonna go through it in order. All right. This first person says this is very specific get a Dexcom that was the entirety of their of their thoughts. The next person says I wished I could have left the hospital with a Dexcom. But we did get it 10 days later. All right. I think advocating for a pump and CGM right away if that's what you choose. It's interesting. We always I don't know that there's something about polite I don't know, gently this is the wrong place for this, if that's what you choose, I just assume that's inferred like that. But I guess everybody's worried that people feel like they're telling each other what to do anyway. Correct? Yeah, correct. Yeah, yeah. I'm not telling anyone what to do. And if your insurance doesn't cover it, if you can't afford it, I'm sorry. Like, I'm certainly not trying to make you feel bad about that as we go through this. advocating for yourself as important as what I got from this person. This person that goes on to say, luckily, our endo was amazing and did that for us. So we had a libre before leaving the hospital. Nice,
Jennifer Smith, CDE 5:35
good, which I've actually heard. I would say more frequently, in the past two years. Interestingly, the more newly diagnosed that I've had a chance to work with a more than a handful of them have left the hospital either with a prescription for it, or knowledge that they had already gotten a message that it was approved and on its way, or they left the hospital with it.
Scott Benner 5:58
Okay. Yeah, I hear the same stories. It's, I think it's fascinating. And I reject the old thinking that you need to live with diabetes and let it beat the crap out of you for a while before you get technology. I just don't. I don't think that's accurate. I know people like well, what do you do if you don't have it? And I say, well, then learn it, then. Then
Jennifer Smith, CDE 6:18
learn it then. Right. Yeah. I think the first comment, but quite honestly, as I tell a lot of people, if you're going to choose technology, get a CGM. Yeah, I mean, literally, that's the bottom line of any technology. Sure, you're gonna have a glucometer? I mean, I have not heard of anybody who has left any office without a prescription for a glucometer. But for the ups and the downs and following, you know, and or any journaling, right that you might do. You You need a CGM of any technology out there yet. One. No, I
Scott Benner 6:57
agree. The next statement here is I wish they would have given me a CGM right away and not made us wait for it. Yeah, I will bring up here that if your practice says saying things like, Oh, we don't give people pumps for six months or a year, you're not allowed to have a CGM till some arbitrary date in the future. Just please know, that's an arbitrary statement. Absolutely. There's not a rule of diabetes or rule of safety or anything like that, if you're ready for it, you can afford it, your insurance covers it, there's no reason you can't have it right away. And please don't let a doctor's office tell you otherwise. Right. I've, I've seen people, circumvent their doctor, go to the company and say, I want this and they send a request for a prescription back to the doctor's office, who often just signs or signs it and sends it back, you know, right. So they'll tell you to your face? No, six months? Why six months? That's how we do it not a good answer for anything, that's how we do it is a bad answer. And then they'll just sign it when it comes to the office.
Jennifer Smith, CDE 7:58
And I think the unfortunate thing about that bad answer of that's just the way we do it, or we have to wait six months, there should be explanation behind that, it. To be clear, it's not just a random response, there protocol goes a little bit deeper, especially for newly diagnosed to make sure that there is a certain amount of insulin, that actually does work better, once you reach a specific amount of total daily insulin. Most often pumps of any kind, whether it's with an algorithm, or just conventional kind of pump will typically give you better results with a certain amount of insulin that you use. So if you are in that early phase of six months, using very, very little insulin, and the doctor is like, Nope, it has to be at six months, well, what if at nine months, you're using still a really tiny amount of insulin, then it's no more appropriate than it was at two months in. Right. So I think there needs to be better explanation to that, quote, unquote, six month rule if there is one. And also, to go into that, you shall also shouldn't have to prove yourself to be able to get a pump. If you are actually utilizing enough insulin. And you're trying as hard as you can. You shouldn't have to perfect what you're doing to get the use of a pump. The use of a pump should actually help you to perfect things more.
Scott Benner 9:28
Because I said so not a good answer. And the idea of like six months, as an example, is probably just what the the average of what the doctor expects, in your example where they're probably just guarding against a honeymoon situation where you don't need very much insulin to begin with. And a pump won't work for you. But it would be nice to have that explanation. Correct. Not just be told. There's this arbitrary date come back on this day and it'll be and by the way, when you come back in six months, and they start the process then it sometimes can take months. After that to finish the process so correct. Why don't we get this going now and you know, be ready, I listened the next bunch, a friend told us not to leave without a CGM. The best advice I ever got, I didn't have a Dexcom for three months would have made a big difference. Advocate for yourself, advocate for yourself, the more you know, and show the Endo, the faster they approved devices. So this is you just said it shouldn't be this way. And I agree with you. But it doesn't make it not true. That you are a little in there. proving yourself, you don't even interact. And that's that's tough, because I get the doctors might not know you, and they might not understand your ability to understand things. And they're judging everybody. But I mean, listen, I treat it like a first date. That I mean, let's go in there. Keep my smile up. keep my back straight. I'm not a lunatic who will kill anybody with a CGM or insulin pump. Please give me one. Thank you.
Jennifer Smith, CDE 11:00
Exactly, yeah. Well, and I think it also brings in, you know, a bit of treating somebody almost as if they're an idiot. Honestly, if you tell them well, you can't have it until this certain, like, arbitrary time, based on I'm so and so with the white coat on. And I just know about her, you're kind of making the person who's coming in and actually living this minute to minute 24/7. At home, you're making them feel dumb, when in fact, they're the ones with the amount of data that could prove that they could benefit from something if you just kind of listen to them.
Scott Benner 11:39
Just that the listen and have an actual back and forth conversation. And you're done. This person here, begged their way into two months of Dexcom samples at the hospital. That's impressive, Madam or sir, whoever did that? Well, that's impressive. Yeah. Okay, let's skip past all the ones that say Don't leave without a Dexcom advocate for tech. It's interesting. I also wanted, I would have loved to know about the eye port so great is because that would have been so much easier on my boy versus sticking him so many times. So I port Medtronic owns that right? Yeah, trogons iport. It's this little, it's it. It's like this little disc, right? It adheres to your body. And then this will get Jenny's looking at me like Go ahead, buddy. See if you get this right. And then your your. So there's a cannula in it is my expectation. Yeah. And then the syringe goes into the port, and you inject without having to poke the skin over and over again. Correct. The
Jennifer Smith, CDE 12:39
eye port is a really nice, I think for for a number of different reasons. One early on, can reduce, it can reduce the amount of injections all over the body, it can get somebody on a second note, a little bit more comfortable with actually a pump site, if that's the way that you eventually want to move, and many people do. And especially for little kids who can be more prone to picking and pulling things off. It's exactly as you described it, it's almost for those who are already pump users. It's like an infusion site for like Medtronic or tandem pumps. And it has a straight in 90 degree cannula that just pops under the skin. And that leaves a hole essentially, or a tunnel in which you put your syringe right in and you deliver your insulin dose basil, or rapid acting insulin into that site. And the nice thing is that you can leave it on for several days, just like a pump site. And so you can put your injected insulin right into that place over the course of a couple of days. So absolutely. It's a wonderful, I think, really really underused tool. Add an apt sort of initial diagnosis.
Scott Benner 14:01
Okay, next person. This is long, I wish we would have gotten a pump sooner. Oh gosh, them three years. I wish someone had put in a script for a libre for us before they gave us a Dexcom Okay, here you go is the person who would prefer Libra in those first few weeks after diagnosis? Were some of the scariest of my life. And a libre. Oh, I'm getting this now a libre would have allowed me some sleep. So I think Libra is cheaper. I think so they're saying I could have been no disrespect to libre, but I think what they're saying is if I couldn't have got a Dexcom at least I could have gotten a libre. It's something that I could have scanned and looked at once in a while. I was so worried that something terrible would have happened during the night and I'd never know about it since our room was on the opposite side of the house. A reminder that people have done this for years was nice. With only a glucometer so please remind people that too, okay, I will hold on last second. And sometimes lack of tech can be crippling, even though things will likely be just fine. She makes some good points in there. And I do say that to people, especially when they talk about like the warmup time for their CGM or something. I was like, you know,
Jennifer Smith, CDE 15:15
do a finger stick? Yeah,
Scott Benner 15:16
you just, it's not that hard. What are we gonna do? And I was like, you could use your meter. And
Jennifer Smith, CDE 15:23
that thing over there as for and I do I mean, we're not laughing to the point that I understand. You know, little kids or, or people who are, you know, worried or frightful of that type of I get it. I get all the worries. But honestly, if you can get over a five second screaming because you want information, at least you're calm now because you know where things are. Right, so just do the finger stick.
Scott Benner 15:55
Yeah, I agree. I wasn't laughing at people. I was like, You're phrasing so far, you've made me laugh to myself twice once it came out that was there. And earlier when you change into your doctor's voice, it reminded me of one of the claymation Santa Claus shows. Like Rudolph kind of one. Yes, yes. When one of the characters pretends to be another character, and they go into a deeper voice. I was like Jenny definitely grew up watching those claymation shows. Oh,
Jennifer Smith, CDE 16:24
absolutely. I did I make my kids watch them. I don't know if they enjoy them. But I make them watch them because I grew
Scott Benner 16:29
up. I agree. So okay. That's funny. I
Jennifer Smith, CDE 16:33
didn't know I had a doctor voice. Yeah, you,
Scott Benner 16:35
you went into like you even like you like, you straight up your shoulders, and everything was fantastic. Okay,
Jennifer Smith, CDE 16:42
I, this one's I don't have a white coat on, though.
Scott Benner 16:45
No. But you could gently I'd give you a give you a degree before some of the people I've met that are dark. Ah, this one's going to be interesting because you see the mindset of this person. But I could make the exact opposite argument. So they said I advise people to push for CGM, but don't be too anxious for a pump. And they do say I'm sure opinions vary on this. But we're still MDI after 11 months, and it has taken us some time to learn how to Bolus how basil impacts and how to monitor the ups and downs. While a pump may take a lot of the workout, I feel like learning MDI in advance is valuable, sort of like learning math by hand before using a calculator because at some point, if you go off a pump, you'll need to know how to do MDI. Now, it's not I don't disagree. But I don't understand. I don't know if that feels conflicting. I don't disagree that it would be great to know how to manage to MDI. But if you know how to use a pump, you can reverse an MDI and two seconds, you can reverse engineer it, you can't reverse engineer MDI to pumping. Does that make sense? Or am I wrong about that?
Jennifer Smith, CDE 17:57
I don't think you're wrong. But I think that you have you have a broader perspective on insulin than this person manipulation. I guess that's that's the best way to say it. Because I actually am more the I'm more agree with the person. I think oftentimes, there are many people who get a pump before they have figured out insulin use on MDI. And there's there is value to it, whether it takes you three weeks or six months to figure that out. It timeframe is based on what you have, I guess, done the homework to understand. So a pump could be beneficial at any point doesn't have to take this long or the short of time. But I think MDI makes a good point here that if you do have to go back to MDI, after being on a pump, and you have knowledge of what you did, for how at least your life was at the point of using MDI, then you have a base to start at. So I, you know, I think it's, again, person to person. I also think with technology and stuff today. We're using a conventional pump before starting out on an algorithm driven pump is very, very valuable. Because I mean, we all know technology will fail. At some point, your tech will not work the way that you want it to work. You have to have someplace to step back to. And if you don't know what to do outside of what the algorithm has been doing for you, you're at a loss. Yeah,
Scott Benner 19:40
I just sent a text to Arden to help her understand her algorithm. She's looping and I texted her end up end of your Let me see how I put it. So this is me trying to teach her something I said old pump site algorithm needs some help from you. And I don't know what she'll take from that or not take from that. But what I see is that the loop is micro Bolus thing like crazy and, and not getting what it wants. And so she either needs to change the site now, or make a larger Bolus if she wants this to actually go her way. And I don't see how I'll see your point. And here's what I'm taking from all this. You should not just flat out listen to anything you hear from anybody, whether it's me or Jenny or anybody else, just because and you go online where people say things like, definitely do MDI first. And then you hear that and go, Okay, that's a rule. Or, or I say, you don't have to do MDI, firstly, go, oh, the guy on the podcast said, you don't have to do that. That's not how this goes, you have to figure out like, this is MDI, I'm going to shoot some insulin, I'm going to have to give more. This is what it is. Do I want to do that? Do I want to do this? Like, who am I in this situation? And that's hard to figure out? I guess. So. I guess listen.
Jennifer Smith, CDE 21:01
And also, I mean, readiness there, too. You know, we're talking with a lot of people who have kids in the picture, right? There are there are many kids who aren't, they're just not ready for all of that stuff on their body. Yeah, they're just not. And you as a parent may be ready for it for some of the precision that you think it's going to bring into the picture. But if your child isn't there yet, it may bring in a ton more frustration,
Scott Benner 21:31
right? It's not Harlan, it's just not time. Right. The first thing you said in this episode, I'm gonna say at the end of it, which is if you get one thing, get a CGM. Yes, that's where you start. Everything else is great. And, but it's not the first thing like a pumps not going to tell you your blood sugar's go in under 50. That's pretty that's pretty much it. So alright, I want to keep going here. This person says ask about newer products, like, for example, for us v ASP as an insulin, because they wanted something that moved quicker, but the doctor's office was talking about older stuff, especially with Basal insulin when you're MDI if somebody's handing you Lantus or levemir. At this point, there are more modern Basal insulins that work better. So you know, knowing that is helpful, especially when you you know, using that as an example when suddenly you think every, every 18 hours, your blood sugar goes up for no reason. That might be because love Amir doesn't really make it 1224 hours, you know, you don't know that there's a variable you're never going to know as a new person with diabetes. So if you can get what are they true Siba
Jennifer Smith, CDE 22:37
to jail as a Glar. Yeah,
Scott Benner 22:39
the more modern Basal insolence and other stuff like listen, I do an ad for Contour. Next One meter. And in every ad, I say, not all meters are the same. As far as accuracy goes. So when the doctor reaches out to you and goes here, from my drawer, just keep in mind, those are in the drawer, because the pretty girl from the company that came in with them, gave them to him and brought him bagels, I'm assuming, I don't know if that's still illegal or not. But at the very least, she was pretty and smiled a lot while she was doing it. And he was
Jennifer Smith, CDE 23:11
he was a very handsome man, he could be a very handsome man as well. A very
Scott Benner 23:15
handsome man could have come in I listen to any variation to the doctor could be gay, gay man came in straight man came in and we found attractive doesn't matter to me what I'm saying. We're sending pretty people into these doctor's offices with big veneer smiles and handed out stuff. You don't know if you got the best meter or you got the meter that was in the drawer. So ask, say, hey, is this accurate? Or they're more accurate meters? It told me about that. You know what I mean? And I think that goes for everything you just for me, it goes back to insulin. When Arden was diagnosed, I thought Novolog was insulin. At the beginning, it never occurred to me that there was another brand or right blends
Jennifer Smith, CDE 23:55
are well, and I think one step further in that too. While the doctor may have written a script for something, doctor isn't necessarily looking at what's going to be covered for you either, right? So you might go home with X brand glucometer or x brand of insulin. And then when you get to your insurance like well, we prefer you use this one
Scott Benner 24:18
because we've got a big pile of them. But no, but yeah, best you can afford. It is you know is what I'm saying but don't don't just assume that what you were handed was the best or the most accurate or the fastest or whatever because it might not be person says please just take the time to learn about technology on the pod five looping any control IQ like keep opening your mind up to new ideas. I put well this person just ran through everything. Oh, how to this person says make sure you understand how to suspect if a cannula is bent. Hmm very interesting. I just heard a story the other day from somebody who had a long day of high blood sugars ended up in DKA. Got home and found out their cat. Yeah,
Jennifer Smith, CDE 25:09
yeah. Yeah, I mean, and that is part of you know, we, we consider technology, just the actual like, pump or CGM or even glucose meter, right. But the pieces that work with the technology also go into what it does for you. So absolutely cannulas, you know, if you're having problem after problem with your particular cannula, pump companies will if you mean Medtronic in tandem, which use you know, a different set or you have options within the infusion sets, call them and say, Hey, this isn't working, can I try a different kind? Can I try angled versus 90 degree? Can I try the steel cannula versus, you know, the more flexible kind of plasticky one, there are options. So that consider that part of technology too. And that one size doesn't fit, all
Scott Benner 26:05
right. There's this really great story, this person told here about iport, I'm just going to boil it down to like two, yay, two ideas. But her son had anxiety about injections was crying all the time, started saying how he hated his life, and then started skipping meals to avoid shots. And the eye port. She said save them. Because it sounds to me like he was on his way to, you know, some sort of an eating disorder on top of everything else is a meltdown. You know, so simple little thing. And there, I mentioned it doesn't cost anything and iport get, you know, like the tiniest little things. I wish Okay, what does a normal graph look like? This is interesting, they found it interesting to see what a normal graph look like, or just a well, you know, manage type on graph, we got a Dexcom with no idea what our big data should look like. And it took me like, right, and so now they get all the data. And they're like, Well, what the hell does this mean? Look like this is this right? I had to find someone's random blog, I did a bunch of googling. I found graphs for people who are wearing them who don't have diabetes, I have found people who were the data without a control set doesn't help. CGM should come with sample data and give parents and users something to shoot for an idea of what should happen after meals, like the effects of Pre-Bolus Singh versus not Pre-Bolus ng versus high GI versus low carb, etc. Data more data, not just here's the CGM don't let her fall between 80 and try to stay in range 70% of the time, the endo recommendations still piss me off three years later. That's a good point, like it is yeah. How do you know what you're supposed to be doing?
Jennifer Smith, CDE 27:58
Right? I mean, they give you a range. And that range does differ. Practice to practice based on a protocol that they are trying to follow much more of a, like, a true protocol versus what their, what they feel comfortable telling you to aim for. But it doesn't tell you what that graph should look like, in that target range. Right? Should it be okay, that it looks like you're on the craziest roller coaster that you've ever been on in your entire life? Should it be smoother? Should it have no lumps or jumps or bumps at all? You know, how often are lows? Okay to see, how often could you expect? Or what could possibly cause a higher blood sugar that you're not expecting? And how to analyze that? I mean, all those things? Definitely, I think a piece that's also missed, because it's very buried in the manual that nobody reads for any product at all. But I mean, it's it's highlighted, highlighted in terms of described in the Dexcom manual about what the end arrows mean, the rate of change? I think that I have talked to maybe two people in the many people I've talked to, who actually knew before I brought it up what the arrows meant,
Scott Benner 29:22
right? Or that How about a steady arrow doesn't actually mean steady all the time. You might be vacillating. A little bit with a stable arrow. Diagonal down is one rate of change a single arrow down as another rate of change two hours down as another rate of change, same as going up. And it is spelled out. You know, it's so interesting. You say that, because I think that all the time, like for all the visual things that people share about diabetes. You never see that image anywhere. It's almost like it's almost like nobody knows maybe.
Jennifer Smith, CDE 29:55
Right? Right like I should I think that it should be a page that has one of those tabs. On the outside that says, This is important. Turn to this page.
Scott Benner 30:06
Sticky Note right on that. Well, you know what, I'm glad you brought that up. I'll do a post about that and try to remind people, that's a great I know, this person says get a great blood ketone meter. Interesting. We have the precision, extra extra. It's a blood. It's a blood ketone meter. Big Deal stops you from having to pee on things. You don't use it very often in our situation, but it's great to have I sent one to college with Arden. And I remember holding it up going, you remember what this is right? I was like, if you get sick, I'm going to ask you to find this. And she's like, she's like, okay. She's like, leave me alone. Urine ketone test strips can be messy with young kids. They can be messy with me too.
Jennifer Smith, CDE 30:55
Well, and not precise. I mean, what is mild? Versus it looks like it's in between mild and moderate. Like, do I do something differently? Right, the color change is not purposeful. It'll give you a little bit of information. But again, keep blood ketones are right now information just like a blood glucose value is right now here. Whereas urine ketones, it's older data. It's a collective of ketones, but it's not truly what's right happening
Scott Benner 31:30
now. And your doctor should give you sick day rules for how to how to Bolus for ketones. And it's nice to know that you have point five or you have one or whatever, because it's easier to make that Bolus this person said they paid out of pocket for their first X Games. He's like, I didn't know what diabetes was. But when somebody told me what that thing did, I was like, I'll take one now, please. So that's, you know if you can do that, that's amazing. Yeah, I wish they would have been able to give me a pen, not a syringe. I told them to train with a pen in the future. I didn't even know how it worked until we got home. And they showed me but I had to do it the first time alone. Oh, okay. So she trained on syringes. And then someone just said, here use this insulin pen instead. And
Jennifer Smith, CDE 32:17
it's different. Yeah. And they did. There's a different strategy. And yeah, dosing could be wrong if you're not using it the right way. The needle caps. I mean, there's a whole slew of things about using an insulin pen. And I think in terms of this being, you know, about technology, I wouldn't want to not mention in pen.
Scott Benner 32:38
Yeah, no, it's really something because you get, again, I'm gonna sound like an ad, but you get a lot of the functionality of pumping with the insulin pen. And yeah, I say it's like pumping without a pump. Yeah, no, it's really terrific. I do think people should check it out. I do think I'm, I think I'm contractually obligated to say from Medtronic diabetes every time I say we're not bad, so I'll get past this person. This person said we hesitated to move from finger sticks. But gotta libre and loved it. Excellent. No, I sent my son to school five days after being diagnosed and I was terrified. I called the nurse about eight times a day to check his blood sugar. We did not have a CGM was the hardest thing for me personally. You know, that's another good point. If you have a CGM that shares data. I don't know if libre does. But Dexcom does, right. You have followers, people can see that it's incredibly comforting. Oh, I the fact that a monitor can have a variable range, a glucose monitor can have a variable range blew my mind. And I did not see how we could trust it. Now. This is very common. Jenny, are you good on time? Do you have to go? I've got about 10 minutes. All right. We can get this done in 10 minutes. This happened to me. I recently told the story somewhere but the nurse came into the room she had this big expensive looking meter checked Arden's blood sugar with a meter. Then gave me the freestyle like little white. Yeah, whatever. Whatever they gave me like it looked like it was it was like I came out of a bubblegum machine. I always say they checked Arden's blood sugar with that. Arden's blood sugar on the meter, they were sending us home with an ordens blood sugar on the one from the hospital that looked like it costs $10,000 were significantly different. And it paralyzed me. I was like, You're telling me to make decisions about insulin based on this thing? isn't yours more accurate
Jennifer Smith, CDE 34:31
is can I just have this one?
Scott Benner 34:34
I try it I was like, give me that one. She's like, I think it cost like 10 grand. I was like, I'll steal it just like give it to me. You know? That's what this person is saying. That the minute I realized these things aren't perfect. I did not know what to do. All I can tell you about that is get the most accurate stuff you can afford. And never think about that again. I don't know what to say.
Jennifer Smith, CDE 34:57
Well, and because even as As most people who've already been using a CGM know, if you do have to calibrate it, you are calibrating off of a finger stick, you want that finger stick to be as accurate as possible. So now that you're tuning something else, that's going to give you many more data points to be more accurate.
Scott Benner 35:20
I listened. I say all the time. I don't know if people believe me or not, but the people who advertise on the show are very carefully curated by me. So I'm not just I'm not Hawking a Contour Next One blood glucose meter because they they knocked on my door and asked to buy an ad, somebody else knocked on my door and asked to buy an ad. And I said, I'd rather do one for contour. Thanks. So you know that just surrounding yourself with as good of data as possible, is the best thing but that part in there the part where you like, well, this might not be right. I guess the answer. There's a lot of people living with diabetes, and they're all okay. Might be the thing you say here. Okay. I wish I would have known about sugar meat. Okay, third party apps that also give you data. That's great. The different CGM options. That's interesting. So somebody told them either libre or Dexcom. They didn't know there was a different company. Getting the T slim help for my mental health because I started sleeping. algorithms can help you sleep. That's a good thing to know. What are the different glucagon options? That's a great, right. So right now there's, there's old school, are they? Oh, no, they're being discontinued.
Jennifer Smith, CDE 36:38
As of the end of December 2022. The old school red Lily glucagon box will no longer be available. That's, that's it. And then there's, there's G voc which comes in multiple different like, options, as well as the back shimmy, which is the nasal glucagon.
Scott Benner 36:58
Okay, so right now, G voc and back to me are the ones that are available. There's a third one coming, isn't there? I don't know.
Jennifer Smith, CDE 37:07
Now. Of course, it's not in my brain. Can I tell you the talked about it not too long ago in our staff meet AI. It's escaped me. Sorry.
Scott Benner 37:16
It's interesting. Here's a little back back room. The only reason I know about that is because the company approached me to buy ads. Oh, and I said, I'm sorry, I already take ads from a glucagon company. That's the one we use. I apologize. Can't do that. But that's the only reason I know there's another one coming from how to use a lancing device. Don't laugh at me. It says first time I tried it out. First time I tried without the top and kept stabbing my finger until it bled. Oh, so they weren't clicking it they were stabbing
Jennifer Smith, CDE 37:47
stabbing which was the old you never had to use it. I we refer to it as the guillotine the one that snapped over it literally you pulled back this like post that had a spring you loaded in a Landsat to it. And then you put your finger Neith finger underneath the platform, you push the button and the thing literally jammed into
Scott Benner 38:12
like pots. What I use is like pulling a long time pulling chopsticks apart and letting go one side right and it just snapped down.
Jennifer Smith, CDE 38:20
Oh area go. Absolutely. They were not nice. I mean, the good ones. Now I there's the Genteel. I know a lot of people use that one because it's very adjustable in multiple different ways. It is not a small device to carry around and use. But it is very gentle. Honestly. The one that I really liked the best that I like, baby because I know it's still in the market because I can still get the lands and
Scott Benner 38:48
I tell you what you're gonna say. Yeah, ask the multi clicks. Yes. Multi clicks from X. Yes. Ardens Ardens just died. We kept going for like so many years. And we went to the fast clicks but it's not the same accucheck if you're listening, what are you doing?
Jennifer Smith, CDE 39:06
Right? Yes, the accucheck is it are the the melty clicks was it was the best and I still I have the fast clicks because I couldn't get any of the things anymore for the clicks. And the fast clicks is certainly the next best in my opinion. But yeah, the those are another thing to consider because the typical ones that come with your meter. Yeah, many of them don't feel the greatest.
Scott Benner 39:35
Get a good one. I listen, I could go on, I get you. You're limited on time and I have to get a couple of things. I could do a dissertation on what accucheck did leaving the multiplex and go to the fast clicks. It was a huge mistake. This is my opinion. I wish this person says I knew about different ways to keep insulin cool, like from gadgets to packs and things like that because that's a big deal. Right? Like you're MDI and you're moving around with insulin. Arden's going through it now because her classes are very far from her dorm. And so on days, she's she's kind of stuck taking insulin with her and a pump just in case we can't, not how she's used to traveling. So we had to go over that with her.
Jennifer Smith, CDE 40:13
Did you guys get it there is a really good device. It's called the Vivi cap. Vi VI, the Vivie cap,
Scott Benner 40:19
if that was just for pens,
Jennifer Smith, CDE 40:21
it is for pens, but at some point, I do know only having talked to them at the educator conference. They are working on one for the vials. Yeah. But right now the Vivi cap is just for pens of any kind. So if you carry your pens with you, it's it's an excellent
Scott Benner 40:42
option. Well, I hope they make one for vials. Because Arden's in a hot weather climate right now. So she's using a tiny little, like, very hot. Yes, she's using this tiny little Yeti thing that she has to throw ice in and then throw the thing and to travel around with her insulin every day. And there's already been days where she's like, look, I didn't take it with me. Because what, what about the frill get wet? If I trust me, I know it works well. And if I asked her to do that, she'd be like, I'm not carrying a wet bag around with me. It's definitely what I would hear from her.
Jennifer Smith, CDE 41:13
Yeah, it's not I mean, I use it for my travel. But again, she has to do what she can do.
Scott Benner 41:18
Yeah, trust me what she's going to what she did was she set up with her counselor that if she needs to go back to her room, she's allowed to call Campus Security and they'll zipper back to change your pod real quick. So that's awesome. Talk about getting the combination. That was a pretty good. Last couple things here. bracelets. Okay, I just interviewed Jennifer stone the other day from Wizards of Waverly Place who has type one diabetes, and she's talking to me on camera, she lifted up her hands and I brought up that she was wearing an ID bracelet. She said nurse now as well as being an actress still, I think you just supposed to say actor but and she said yeah, it doesn't take too many people coming into the ER without one of these Alon to realize you should be wearing one. So mine never comes off. I know Jenny's always got hers on.
Jennifer Smith, CDE 42:10
I don't I don't it doesn't it never comes off. Yeah, I made sure that I got waterproof, won't tarnish won't rust won't blah, blah, blah just sits there so well. So
Scott Benner 42:21
that's it. I mean, that's everyone's list about technology and data, or technology for diabetes. Excuse me. I mean, from my perspective, I mean, we've been using Omni pod forever. I can stand behind it. I also talked to a ton of people who love control IQ. To me, I think it comes down to to Bolus versus tubed and what you want. But yeah, this is it. No one's going to explain it to you. You gotta get out there and figure it out. So hopefully this will help. Cool. All right. Thank you, Danny. I appreciate it.
Jennifer Smith, CDE 42:52
Of course, you're welcome.
Scott Benner 43:00
I hope you've been enjoying the bowl beginning series. I want to thank Jenny Smith for lending her time to it. And of course, I'd also like to thank Dexcom, makers of the Dexcom G six continuous glucose monitoring system and Omni pod makers of the Omni pod five, get yourself some automated insulin pumping with Omni pod Omni pod.com forward slash juice box or to find out if you're eligible for a free 30 day supply of the Omni pod dash use the same link. In just a moment, I'll go over all of the episodes that are available right now in the ball beginning series. And I was like in a sorry about that. But first, let me tell you if you're living in certain countries in Europe, the Dexcom g7 is available already. And you can still use my link for that dexcom.com forward slash juice box. Today is the 20th episode of the bowl beginning series and there's going to be 21 One more coming next week. So far, here's what we have. Episode 698 Defining bold beginnings. It's a toss up of what the series is going to be. Then 702 honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology Part Two episode 715 Fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility 751 School 755 Exercise 759 Guilt fears hope and expectations 763 community 772 is all about journaling today's episode 776 technology and diabetes supplies and next week's episode which will be seven Adi think is going to be all about insurance. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Oh, and by the way, if you're wondering where you might be able to see this list, you can find it in the private Facebook group Juicebox Podcast, type one diabetes, right at the top, under the feature tab. You Oh, are you not in the Facebook group? You should be it's really cool. 30,000 people all using insulin, asking questions, answering questions, being supportive. It's the most unfaced book like experience you're ever gonna have. It's actually nice. And it's free, free, mean, Scott, you're not trying to nickel and dime people to get access to information. So the Juicebox Podcast is ad supported. I don't want your money. That's it, I want you to have information, I want you to have access to each other to community. That's all I care about. There are no classes, you don't have to sign up for any kind of, you know, $60 a month of call me on the phone. I'm not going to give you 10 seconds of information in a podcast and tell you to come find me for the rest of it. I'm not up for that. But understand. I don't care about that. I'll make a living. But it's not going to be off your ass. You understand what I'm saying? That's all, head over to the Facebook page. Check it out. It's amazing. Listen to the podcast. It's amazing. And it's free. Everything's free that Juicebox Podcast brings forth. Everything is free to you as it should be. Having decent blood sugars and understanding how insulin works shouldn't cost you money. It shouldn't cost you a membership. You shouldn't have to pay a fee. You don't have to take a class, this this podcast, set your speed. You want to listen to the diabetes pro tip episodes in three days. Go do it. You want to listen to it over three weeks. Cool. Whatever is good for you. If you don't like listening, I've got transcripts on the website juicebox podcast.com. Go read it if you want to. You want to read a podcast. I'm not judging you couldn't possibly care less how you learn as long as you learn. That's it. Again, I thank you for listening, and I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 776
1. What is the significance of regular blood sugar monitoring?
2. How can stress affect blood sugar levels?
3. Why is carbohydrate counting significant in diabetes management?
4. What is the primary function of basal insulin?
5. How often should blood sugar levels be checked in a newly diagnosed patient?
6. What role does physical activity play in managing diabetes?
7. How should insulin doses be adjusted during physical activity?
8. What is the best way to handle a low blood sugar episode?
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