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Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

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#856 Best of Juicebox: Texting Diabetes

Scott Benner

Episode 482 Too Much Insulin? was first published on Feb 23, 2015. Text messages to manage Arden's type 1 diabetes, who knew that would be so effective?! While at school or anytime that Arden is out of the house, the simple process has led to lower a A1c, better grades, an increase in self-confidence and much more. 

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

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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, welcome to episode 856 of the Juicebox Podcast

Hey everybody, we are back with another episode of the Best of the Juicebox Podcast today, we're gonna go way back way back February 23 2015 Episode number four. It's called texting diabetes. I know right? Like how do you text like hello diabetes? Are you there? No, not quite like that you'll see. 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 healthcare plan or becoming bold with insulin. If you have type one diabetes, or care for someone with type one, and are from the United States, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey. This helps diabetes research it significantly helps T one D exchange.org. Forward slash juicebox take you fewer than 10 minutes. Help people with type one help yourself maybe definitely helped me.

This episode of The Juicebox Podcast is sponsored by cozy Earth. Cozy Earth has been featured on Oprah's Favorite Things list like five times. Their products come with a 10 year warranty and cozy Earth bedding is temperature regulated and is available in either viscose bamboo which is what I have or linen. Cozy Earth loungewear offers optimal comfort while maintaining a flattering and elegant fit. You can imagine me in pajamas looking elegant, and don't miss their new waffle collection towels. And somebody online just told me they bought them last night and we're very happy with them. Now here's the best part when you go to cozy earth.com and shop sitewide no matter what you buy. All you have to do at the end while you're checking out is apply the code juicebox one word juicebox to save 35% on your entire purchase 35% What did I just say? 35%. It's an amazing amount of money. Head over Now get yourself some sheets or some socks or some jammers. I don't care what you're up to.

Unknown Speaker 2:37
Just don't forget to save the 35%

Scott Benner 2:39
you know. Welcome to the Juicebox Podcast episode four. I'm Scott Benner. This podcast is if you're just finding it a conversation about being the parent of a child with type one diabetes. Episode Four is going to take a an upbeat turn because Episode Three got kind of somber at parts, even though I thought the information was good. And I don't want to I don't want to have to bummers in a row. So although I don't think Episode Three was a bummer. I actually think it's a it's an uplifting story. It's just sometimes the topics are heavy, you know. Anyway, episode four, we're going to talk about the way that my daughter Arden and I manage her type one when she's not in my vicinity, when she's not with me. This is just a this ends up being such a great but you know, thing that happens by mistake by you know, by happenstance that ends up just informing so much of how we handle type one today. It has to do everything with an academic upswing for my daughter, it has everything to do with how an A one C that wasn't too bad to begin with is now fantastic. It has a lot to do with her confidence. It has a lot to do with the fact that she can now you know, change insulin pumps on her own. This this one moment really is a big moment. So I'm gonna take you back to Arden in second grade. She's in fifth grade now. She's going to be 11 this summer. But I'll take you back to second grade. She's upstairs in a two story house. We live in a two story house. And I need to know what her her CGM says. And to be honest, I just didn't want to walk upstairs. So I texted her, just said CGM question mark. And she sent the number back. And that was it. I was hooked. I was like, Wait a minute. Is this fantastic? But beyond it just being fantastic that I didn't have to get up and walk upstairs all the time or go find her if she was somewhere. I started realizing. Like right there. I was just sitting on the sofa thinking what's the difference between upstairs and at a friend's house? What's the difference between upstairs and in the backyard? Oh my god. What's the difference between upstairs I was at school, and there really is only one difference. It's my sense of being in control. And can you hear basil snoring? I hope you can't. A puppy he snores like crazy. It's my sense of being in control, right? It's the largely false feeling that I have that if something were gonna go wrong, I could somehow be Superman and stop it. So you can't really stop something from going long. You can plan well, you can, you know, give the right amounts of insulin, you can understand all that stuff, that stuff helps keep problems from happening. But if something unforeseen was just gonna go bonkers, that it's gonna go bonkers whether I'm upstairs or downstairs, or she's out back, or she's at her friend's house, or she's at school. We just need to be sure that there's an adult there, if that ever happens, that understands and can react, and it doesn't need to be me. And that was really a huge leap. For me, I just, I let go of that feeling that false feeling that I was somehow a guardian completely in control. And that nothing bad could ever happen if I was around. This text message ends up being the text message that launches 1000 chips, because it allows me to recognize that, you know, I falsely have an idea of control. And it gives me the bright idea that we could utilize this texting in other places, you know, when Arden's out of the house. And we do to so much success, in fact, that it starts just becoming everything, you know, it's everything. It's it's how we do school lows, highs, meals activity, it's how she goes to her friend's house and plays in the snow yesterday. It's how she's on a school trip today. Without me. It's that one little moment of letting go, that builds and builds and builds to where we are here today. So let me let me tell you some other good stuff that came from that. So first of all, in second grade, we were beginning to become concerned about artists academics, because she was falling behind in areas where we did not expect you know, as people who feel like we're reasonably, you know, we're not over or under estimating learning, we know who she is, as a person as best we can. I'm telling you Arden's grades and her grasp of concepts was not where I expected them to be for her. And, you know, you start getting worried that it's just you know, Arden is going to be a person who struggles at school. But in the end, what ended up happening was, she was leaving class to go to the nurse. And a lot of times, because of the timing of the nurses visits, it was coinciding with learning something new. So her teacher would begin to teach, she'd get out half of a thought it would leave the room come back five minutes later, and because Arden coming and going seems so natural to the teacher. And even though she's a fantastic teacher, it just seems so normal for her to come and go that it got away from her that Oh, Arden walked out during the during the explanation of this. But that didn't stop anybody from moving on the day just kept moving. So Arden would miss the direction, the instruction and then be expected to do the work. And she was struggling. We got lucky. The teacher that Arden had in second grade was really a fantastic teacher and she moved with her whole class and there's a word for it educators, it's popping and educators were heads right now I don't know it, but she moved with her whole class to the next grade. So in third grade, I didn't have to start over new explaining diabetes to someone this you know, day one was, was fantastic. But we made a big change. And here's the change we made. So we go into the 505 go into the 504 meeting after second grade in the summertime, sitting in front of a teacher and two nurses and you know, an assistant principal and I think there's a counselor there and it's me now I've been banging on these people's heads for years. Arden has to go to the nurse she's gotta go at this time. And this time she's got a test here here we can look at the CGM but there we have to test I need her to Pre-Bolus for a meal. So she's got to come down early. You know, I made them give her the aid when she was in kindergarten like there was so much that went on about Arden needs to go to the nurse she needs to go the nurses is very important. And I go and I sit down and had 504 Meeting look, everybody square in the face, thank them for the year, how great it's going. And then I say now next year, I don't want Arden Dakota, the nurse at all. I want her to stay in the class. So a couple of lucky things happen where that made that possible. First of all, her 504 plan covers her having a cell phone. The second thing that helped with the idea of Arden not having to go to the nurse's office was our outgoing governor that year, signed a bill that said that children with diabetes could test anywhere in a public school didn't have to be a nurse's office. It could be in the hallway, it could be in the bathroom. It could be anywhere you want to be so armed with the idea that a Arden was now allowed to test anywhere she wanted to, and be, I saw the light about me not needing to be so involved or anyone needing to be so involved that I thought, Okay, well, we can do this right, we could just do this texting thing while she's in class. So in that 504 meeting, after second grade, I dropped the bomb. Next year, I don't want to leave the room, she's going to test give herself insulin, you know, drink juice or eat food, if she needs it. She's not going to go to the nurse, if we can help it, and I don't want or need the teacher to be involved. It'll be between Arden and I no different than if she was upstairs in the bedroom. Now, you know, if something happens, then the teacher would spring into action. And of course, I was a little nervous about that. But because this teacher was a second year teacher that took away a little bit of that uncomfortable feeling, which is one of the lucky things. And the people in the room. You know, we had built a very good relationship slowly, brick by brick over years, people trusted me. And I think they saw a person who was like no look at she has to be in the nurse's office all the time, who flipped and said, No, she doesn't and thought, well, if this guy is saying she doesn't have to be the nurse's office, you know, maybe we don't have to. But still, you could see the the anxiety like they those nurses were going to be out of the loop. The school was going to be out of the loop. And I and in the end, what I said to them was, Look, she's my kid, if I do something wrong, if I give her too much insulin, or not enough insulin, let's be honest, it's not on you. You weren't involved. There's nothing legally that you did. So this is kind of lightening things for you. And I think that was what pushed him over the edge or like this guy's right, you know, he could, he can mess up as much as he wants. It's not on us. I think that's what they were happy about mostly. So the third grade year of school art and never goes to the nurse one time, never once. And her academics pick up.

G's really, like a like a rocket, they they go back right to where you think they're going to it took a little time she had to catch up. But, you know, now in fifth grade, I don't think of Arden as having any academic instabilities, you know, it's amazing. And that's just I'm telling you, just from not going to the nurse, third grade, no nurse, now we're going to transition to fourth grade. And in our district, that means Middle School. And I know that's probably early for middle school for most of you. And it's an overcrowding issue here. But nevertheless, she's going to have to transfer into another building, same district, different building. Different building means new nurse, different building means new, you know, new principals, new counselors, new people who don't know me, and people who have no reason to trust me or understand what we're doing. So what I did was I brought a nurse from the elementary school and Ardens, teacher to the 504 meeting for the middle school, and I just let them explain it. The nurse didn't have a lot to say she was I didn't see Arden once last year. And that's it. There were no emergencies, nothing we had to run and go find her for it. She said I think she fell on the playground, I had to give her a band aid once. But we never spoke about her diabetes, the teacher spoke to the fact that Arden was falling behind academically and took a little bit of the blame. In the meeting. She said, I really feel like I should have seen it. But it was just such a normal part of the day, he just escaped me that she was leaving all the time. Hey, everyone, it's Scott, I'm just going to take a quick second out from the show to tell you that I'm very interested in talking to you, the parents of children with type one. If you are interested in being on the Juicebox Podcast, please go to Ardens de.com or juicebox podcast.com. Scroll to the bottom, click on contact. Send me off a quick note. I would love to talk to you on the show about type one about parenting about technology, about diabetes, about your frustration, great ideas. You have questions, anything at all, anything, you know, parenting or diabetes related, though, go ahead, send a note. We'll get you on the show. Now back to the podcast. It really is a matter of perspective on it's on saying that she was leaving all the time, isn't it but because you know, as a person who is thinking about diabetes in that way, like oh, I need my kid to go to the nurse's office, she only goes four times a day. That's not too bad. But if you get up, walk to the nurse handle what happens in the nurse's office takes a few minutes come back. It could be 10 minutes, a short trip could be 10 minutes, and you do that four or five times a day you've lost 45 minutes or an hour. Now if I told you I was going to send your kid to school today, and randomly take an hour of their day away from them, you'd say no, you can't do that. When you say oh, you're gonna do it because they have to go the nurse for their diabetes. Oh, that doesn't sound too bad. 15 minutes we'll be fine. It's not fine need to be in school. It was a bit of a hurdle at fourth grade at the middle school. The nurse felt so uncomfortable not being involved, but I could see in her face this the same thing I was going through, you know back before For the texting, she didn't want to be out of control. She didn't like the idea of there being a child in that school that she wanted to keep safe and healthy, that she wasn't going to have input into. And what I said to her was, look, it's okay. Arden's my daughter, she's had diabetes, and she's two, I know exactly what to do, we are going to talk all the time. And if there's a failing in the system, then she'll come to you. If she can't get a hold of me, or I can't get a hold of her, then she'll come to you. I said, but no, this if our text me from class and says, Hey, my blood sugar's 60. And it's falling. I'm not sending her to you, I wouldn't, I wouldn't call an ambulance at home. So she's gonna drink a juice box, she and I are gonna stay in contact over those next couple of minutes by text message. And when I'm comfortable that she's stable again, she and I are going to stop talking. And that's going to be we're going to keep going about our business. Nothing special. So couldn't be more, genuinely couldn't be more happy or proud to tell you that in fourth grade. Arden never went to the nurse for a diabetes related situation. She was down there if you know her insulin pump, I think twice kind of errored, and I went in and switched and we switch them in the nurse's office because there was privacy there. But Arden's never had to go to the nurse for anything diabetes related now in third grade, in fourth grade. And now this year, halfway through fifth grade, never once been to the nurse, it's so glaring, that the nurse sometimes sends me a note to say if our never just wants to come down and hang out or say hello, you know, we really don't feel like we know her. And I very privately think I'm glad I don't want her to know you. i She doesn't need to know you. She doesn't need a nurse. She's She's good. Today Arden is on a school trip. This is the first school trip I haven't gone on. And the very simple reason why I didn't have to go today. Now. Last year, I wouldn't have gone either because of the texting. But there was still an issue of insulin pumps. What if there's a real like kind of catastrophic incident with her insulin pump and it needs a new pump. I wanted to be there to change it. Up until a few months ago, Arden could do all the steps, but she'd never done all the steps start to finish. It ends up being another, you know, happenstance, he kind of thing that gets Arden to putting her insulin pump on her on the pod on by herself. So just like the text messages is born out of me not wanting to get off the sofa one day. My wife and I, Kelly and I were away for a business thing for her. Well, it was an overnight event. It wasn't very far from home, we were about an hour and hour and a half from home. But just far enough that you needed to spend the night Arden and her brother went to her aunt's house. And I think we were like on the last day of an insulin pump. And I kept saying to Kelly on the way out the door like maybe we ought to just switch this thing early. Because I have a feeling it's going to just it's going to you know, it's not going to make it till tomorrow, it's going to need to be swapped. But our blood sugars were okay. They were just starting to get stubborn. You know what I mean? And by the time we had dinner at this event, args blood sugar was great. And then all of a sudden, it just started heading up and she's texting me, hey, my blood sugar is going up and we're poor and insulin. And it's not going down. And so I guess about 45 minutes or an hour later, I texted her and I said look at it that pumps gotta get changed, you know, it's the site decides done and it can you do it, I'll walk you through it, I'll text you through it, or I'll call you if you want me to. And and I said you know what, that's a good idea. I'll call you and I'll walk you through it. Go ahead. I told her Go ahead, fill the pump with insulin and prime it and then send me a text message. And I'll call you and we'll go through the rest of it. About three minutes goes by but in my mind, you know I said to my wife like it's been a long time I told him to prime that pump and I haven't heard back from her you know something's wrong. She's lost her nerve. You know something I'm gonna have to drive home you know, I explained to my I'll explain to your sister over the phone. I'll you know something. But I had every bad scenario going off in my head. Next text message I get back from Arden is a response to me because I'm not texting her. Hey, what's going on? And she goes, Oh, I'm done. And I thought she meant that she filled the pod and primed it. I said, Okay, I'll call you and let's we'll talk about the rest. She texts back because you don't have to call. I said I'm done. I put the pump on. It's all done. I'm finished. And I was like, Oh my God. That's fantastic.

But it's the situation that made it happen. Right. Like she was in a room with a person she knew. Didn't know as much about her insulin pump as she did. She was with her aunt, her aunt knows a little bit about it, but certainly not as much as Arden does. I wasn't there. There was no one to bail her out. This was on her. And bang. She takes care of it just like that. And I really do think diabetes. You know, in the diabetes world and outside of it. Children just get so much out of being challenged. It really does bring the best out in them and this certainly was one of those times. Now that Arden can change your pod without me being there. It's a game changer for For us, and it's why I'm not on some school trip today. You know, Arden is at a science center or a Space Center about an hour and 45 minutes from our home. And isn't it great? I'm just I'm thinking now I'm not really sure where she is. I'm not 100% sure if she's at the Space Center or the science center, it doesn't matter to me. It doesn't matter where Arden is. She's on a class trip. You know, her blood sugar today's never been over 170 hasn't been lower than 115. She was 115. When they got on the bus at the end of the day to come home. She's probably on a bus driving home right now the last time she and I texted, she's like, Hey, everybody is gonna have a snack and have a snack. She Bolus for it. And she's on a bus right now laughing with her friends. I don't even know where she is. It gives me so much joy to tell you that I don't know where she is. Because she's fine. And nothing went wrong with her on the path today. She didn't need the extra pump. She took her the insulin she talked about, you know, but it's right to take the stuff. But had something gone, you know, funky, she would have just found a place and changed the pod and gone about her business. I know she would I know she would have done it. And it all starts in that second after I text her back in second grade from my living room to the bedroom upstairs. What's your CGM say, it all starts in that moment afterwards, when I start realizing I just need to not be that involved. You know, she can do more than I expect. But I don't want to throw it on or all at once. And that has been a really huge benefit of the texting at school, which is different situations come up every day, you know, everyday is not always the same with diabetes. And so their experiences, you know, a little bit of a high before a meal a little bit of a low after a meal a low before gym a high before gym? How do you handle all these things? Well, you have to, they have to happen. First of all, you can't stop every bad thing from happening or every undesirable thing from happening. Because if you stop those things from happening, you never have the experience of them happening. And you know, as well as it, you can't always stop, you know, undesirable moments with diabetes and always stop, you can't hardly ever stop them. So the only real benefit in these moments is learning from them. That's what's been happening with the text messaging. And it's been happening, you know, slowly over time Arden gets to see a situation arise, she gets to hear in the tone of my text messages that I'm not upset. I'm not frantic, I know what to do. Sometimes we choose what to do, and it doesn't work out really well. And she doesn't, you know, we have to make another adjustment. But that that's not a big deal either. And these experiences continue to help Arden grow as a person who lives with type one diabetes, to the point where she's not thrown by things when they happen. And that's probably the biggest that's probably the biggest impediment is not to see a low number and start running around with your hair on fire or not to you know, not to set a correction into into motion and the correction doesn't really affect the high blood sugar. You can't be you know, throwing your hands up constantly and going, oh my god, I can't believe this is horrible, blah, blah. You can't be like that all the time. It's just got to be what it is. I got a high I put some in some oil, it's not working. What are we going to do next? We're going to adjust the basil, are we going to? Are we going to inject some insulin? Are we going to try a new pump? You know, are we just going to Bolus again, you know, maybe this is just a carb counting mistake on our part. Maybe we should just Bolus again or she's low. not to panic when she's low. You know, everyone's got their own level of comfort and I completely respect that. But I see online sometimes people are like, Oh my God, my kids blood sugar was 70. And it was an arrow down or CGM. They almost died like oh geez, you know, most die. 7070 is a great blood sugar. I mean, the down parts not fantastic. But really think about what that means and arrow down to 70 means you're falling about two points per minute, which means that five minutes from now you're going to be 60 which still is not a panic situation for most people drink a juice. It'll stop at 60 The arrow kind of curls back around again before you know it you're fine.

Unknown Speaker 24:14
Reed trying to block his teammate Chris butcher. Here's the checker I thought I

Scott Benner 24:18
would take a second to let you know that the next episode of The Juicebox Podcast will be an interview with 21 year old NASCAR driver Ryan reed Ryan just won in Daytona in the XFINITY series. And we're going to be talking to him about his type one diabetes diagnosis, racing with type one and find out what it feels like to win a NASCAR race.

Unknown Speaker 24:39
Day total What a finish.

Scott Benner 24:42
If my daughter was a panacur because she saw a low number, then that would keep us from transferring the responsibility to her. She can't be someone who panics. And I'm not someone who panics. My wife's not someone who panics and we're teaching her that but slowly through Experience is not by saying to her art and you can't panic if your blood sugar gets low, that's not teaching anybody. You can't teach people how to be. They have to just grow into who they're going to be. And so this simple, silly idea of just texting has facilitated all of this. It has been maybe one of the best decisions I've ever made by mistake or not on purpose and in my entire life. The handoff of Arden's care happens constantly. It's exponentially growing. It's not as slow as it used to be. It used to be one little thing every couple of months. Now I can see her gaining confidence constantly. You know, whether it's today's trip, or yesterday at a friend's house playing in the snow. You know, yesterday is a great example. My son was playing in his final freshman basketball game yesterday, I really did want to go see him play. So Arden comes home from school, I say to her look, we're letting the dogs out. As soon as the dogs are done outside, we're gonna get everything together, and we're gonna go see Coldplay. So he just pack your bag up, you know, bring some snacks if you're hungry, whatever you want to do, but we're gonna go and so she's running around packing and I'm running around with the dogs. And her phone. She gets a text on her phone from a friend of hers. Can she come over and play in the snow? Now I really have to go or I'm going to be late like I need to go. So I said to her, you can go that's fine. But you know, we got to do it right now. Like there's no time to make big plans. I can't call my mother. You know, I said what's your CGM say it's on the low side. I think she was like it was after school. She hadn't had a snack yet. I think she's like 85. And I said, okay, just you know, let's get going. But you have to have a snack before you go outside. So we drove up the street. I dropped her off at her friend's house with a study 85 on her CGM. And I said to her before you go outside and play, have 15 carbs of something. Head out, put your CGM in your pocket, make sure it's zipped up so that you know it can't get wet. Pay attention to the alarms text me if you have a problem. That's it with that I dropped her off. And then I drove about a half an hour from where she was to watch my son play basketball. And not a problem. Not a problem in the whole world. Nothing went wrong or blood sugar didn't get high didn't get low. But if it had CGM would have beeped. And she would have done something about it. And you know, if she had to go inside and talk to the mother that was there, even though that mother's not, you know, some diabetes guru, she would have been fine. Absolutely fine. I was never, never nervous or never uncomfortable yesterday, even though it was a last minute thing, even though it was not a perfect situation where I was leaving her even though she was going to be doing something strenuous. I never in that hour, I watched my son play basketball. I did text with her once or twice, but I was never uncomfortable. And she wasn't uncomfortable. And that is a just a gift. Because I have spent a lot of my life feeling uncomfortable in situations like that, as I'm probably sure that you have also. But it turns out that while we've been texting back and forth, and she's been slowly, you know, her her care, her responsibility, the onus of that has been slowly shifting to her. My anxiety has been slowly shifting away at the same time. And it's always unplanned moments, moments that are not within anyone's control, and certainly not how I plan these moments are the ones that teach me to just mellow out a little bit. And a great example is that Arne and I have alarm set up throughout the day, you know, talk at this time, you know, before snack or before lunch, these are the to our texting times because the day gets, you know, out of hand I sometimes forget. And she sometimes forget. So these alarms keep us in sync with each other. But I do have a couple of alarms that I think of as being maybe not completely necessary. And so if my alarm sounds and it's one of those unnecessary times, and Arden never texts me say she never texts me. I'll throw one text Hey, what's your CGM say?

Unknown Speaker 29:15
But if she doesn't get back to me, I just imagine that she's in her classroom,

Scott Benner 29:21
you know, taking a test or you know, in their group study talking with people. My mind doesn't jump to like Arden's not texting me back because she's dead. But the first couple times it did. The first time she didn't text me back. I was like, I have to call the school. She's not answering me. This is a problem. Obviously she's died or laying on the floor behind a water fountain having a seizure. You know, every bad thought runs through your head. And the best thing I was able to do for myself the biggest gift I've ever given myself in my life is that when those things ran through my head, I told myself just to shut up, just stop. She's in a building with an adult. They're aware that she has type one diabetes, she's got a monitor on for God's sakes, the beeps like crazy, if she's getting too low, the odds of something happening to her, it is dire are so much less than the odds that she's just not hearing her text message. Or the alarm went off, and she didn't hear it. That's what common sense tells me is probably happening. So it was anxiety ridden for me the first couple times, the first couple times she didn't answer, but every time she does an answer in one of those very non critical times, takes away more and more of my anxiety to the point yesterday were when I went to that basketball game, I realized, you know, I am as I am just about as, okay with this as I could possibly be. And I don't mean, we're not paying attention to the details, I don't mean that, you know, we're just gonna throw our hands up in the air and be like, Hey, we're wild and free, and nobody's paying attention anymore, we're still paying attention to it. But in those gaps of time, there's one of my there's an alarm right now that's Arden's pre bus alarm. But of course, today, she's out on a school trip. So I've already spoken to her that one doesn't kind of count today. My point is, very simply, diabetes doesn't get easier. The concept, the very real concept that too much insulin could kill a person, that doesn't stop being true. But when you live through the situations over and over and over and over again, and build a database for yourself of, of experiences that you can draw on, you can learn to let go of your anxiety, and you can raise a child who doesn't have that anxiety. And without that anxiety, they make much better decisions about their care. Now, you know, very soon, and by very soon, I mean, in the next few weeks, Dexcom is going to release that new, a new receiver that's going to have the share built right into it. So Ardens Dexcom receiver, you know, by the end of March 2015, is going to send a little Bluetooth signal to her phone, there's going to be an app on her phone that's going to send her blood sugar to the cloud. And I by then I'm going to be able to look at it on my cell phone, or an iPad, or, you know, the Apple Watch will come out the month later if I don't have one of them. But I mean, these are the possibilities. And I keep thinking, I keep thinking, Okay, I do want that, I want that. But I only want that for the alarm. Like I want that. I don't want to look at it all the time. And I don't want to micromanage her type one diabetes, because me constantly telling her, Hey, your blood sugar is going up, or your blood sugar is going down, do something about it, is just going to do the opposite of what I want to know, in my mind, it's going to do the opposite of what I want, what I want is for her to go and no one's here to change my pot, I'll do it myself, hey, my blood sugar is going up, I'll take care of it myself. I'll be proactive, I want proactive. That's what I'm hoping for. Now, having said that, if there's this little gadget that'll throw me an alarm that says, Hey, your kid's blood sugar is 50. And it's going down. I'll take that I think that's great. I mean, I guess in the same way, if there was a magic, you know, a magic siren that would go off. If my son was about to be hit by a car five minutes from now, I would like that too. But there's no value in me walking around behind my son for the rest of his life going, don't get hit by a car, don't buy a car, don't get hit by a car that he's not going to grow up to be or he's not going to grow up to be a rational person. If I'm up his ass like that. Trust me, I get as well as anybody what the, you know, what the concerns are? I know how dangerous insulin can be. And I know how sometimes things just happen that you don't plan for you don't expect and have no way of seeing coming. But you know, my experience is telling me that those those moments aren't that frequent. And we have the technology I mean, make no mistake using an Omnipod insulin pump. And moreover, probably the Dexcom you know, continuous glucose monitor these items make everything that I'm saying a reality without a CGM. I, I'm not nearly as good at this. I'm not making all these boastful statements about I just sent it to my friend to her friends asked to play in the snow. If she didn't have a glucose monitor. I'm not sending my kids at somebody's house to go play in the snow. I would go and hang out and be there or I would be nearby or it would be a much more regimented schedule of when we were going to talk. It wouldn't all be like loosey goosey like it is now that I completely completely want to be clear about and honest about but we do we're lucky enough to have the glucose monitor and so I'm lucky enough to be able to make these decisions. Okay, hey, episode four. Right? I got four episodes going. You know, I hope you're enjoying it. I mean, I guess if you're listening still you must be enjoying it. I did see that. in its category on iTunes Juicebox Podcast is rising in its category, which is very exciting. It would help the podcast immensely if you could go to iTunes and give it a review either, you know, five stars or actually write a review. iTunes takes that very seriously and it helps the podcast quite a little bit. So if you can do that, that would be fantastic. The Juicebox Podcast is online at juicebox podcast.com on social media at Juicebox Podcast, my type one diabetes parenting blog Ardens. De is at Ardens de.com and on social media at Ardens. De you know, come find us. Check us out Facebook and Twitter is a great way to find out when new episodes go up. But you know, subscribing at iTunes or Soundcloud or Stitcher is another great way to to find out when episodes arrive. New episodes are on Tuesdays. And what else I know what else music for the Juicebox Podcast composed and performed by Sydney Mueller, Sydney. I continue to be in all of your town. Thank you very much. This is Juicebox Podcast. I'm Scott Benner. Thank you very much for listening.

Well, I bet you wish Scott in 2015 had this microphone, because he would have sounded way better. Anyway, thank you so much for listening to this episode of The Juicebox Podcast. And don't forget to head to cozy earth.com and use that offer code juicebox to save 35% on bedding loungewear sheets, my sheets are super comfortable. Check them out cozy earth.com. And don't forget to use that offer code juice box to save 35%. If you're looking for support around diabetes, look no farther than the Juicebox Podcast, private Facebook group, answer a couple of quick questions to get in proved unless you're a real person. Because it's a private group. We want you to feel comfortable there. So just a couple of questions, you know, just kind of shows the algorithm you're real. And once you're in there, 35,000 members strong support, advice, conversation, camaraderie, Juicebox Podcast type one diabetes on Facebook. And it's not it's for everybody. That's diabetes, you know? So head on over. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Did you hear me earlier? I was like there are new episodes on Tuesdays buys. On Tuesdays, there'll be a new episode of the podcast. That was a long time ago. I got more content for you now. Don't you worry. What a terrible microphone to and so like their recordings noisy and but I have really upgraded for you folks, don't you think? Ah. You're welcome. I was just kidding. Why would you thank me for that, like make a podcast you can understand. I didn't know what I was doing back then. I mean, that was 2015 and February. I had been at it for like four weeks. I mean, you gotta admit contents rock solid, but I mean, it sounds like I'm on a rail car going through the Midwest hoping that a hobo doesn't steal my can of beans or something. It's very noisy. Anyway fixed all that. And I'm not sure what purpose this serves. Probably not. Quite me giddy at the end of the day. Alright guys. I don't know. I'll be back. There'll be more. Please listen. Thanks for subscribing, downloading telling people about the podcast. That's all very important and very much appreciated. Anyway, seriously, I'll be back soon. I'll talk to you later.


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#851 Best of Juicebox: Too Much Insulin?

Scott Benner

Episode 482 Too Much Insulin? was first published on May 21, 2021 and features a conversation about how much insulin is the right amount.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon MusicGoogle Play/Android - iHeart Radio -  Radio PublicAmazon 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 851 of the Juicebox Podcast.

You may have heard this best of episode back on May 21 2021. It's with myself and Jenny Smith. Jenny, of course, is a CD who has had type one diabetes for, like 30 some years. And in this episode Jenny and I talk about a misnomer in the diabetes space. The idea that you can be using too much insulin, we're gonna have a whole conversation about it. 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, or becoming bold with insulin. Don't forget to take the T one D exchange survey, please complete that survey AT T one D exchange.org. Forward slash juicebox. And these episodes don't have ads on them right now. So I'm doing something special. I'm going to tell you about it as soon as the music's over. But don't forget that generally speaking, the podcast is supported by a ton of great advertisers, all of whom have links in the show notes of your podcast player, and at juicebox podcast.com. Before we get started, I just want to reiterate you need the amount of insulin that you need. There is no wrong amount. I have this idea, since these episodes don't yet have advertising on them, although I'm open to selling it to someone who intend. But since they don't at the moment, I thought I would give some ads to people who live with diabetes and their life. So with that in mind, this episode of The Juicebox Podcast is brought to you by Tci. answering service reliable answering services 24/7 365 Let TC eyes reliable staff handle all of your phone calls in a professional manner. TCI answering service.com Head over there and check them out. And the owner of TCI is the mother of a 12 year old child with type one diabetes. So check them out. The podcast is also sponsored today by lower left side photography. Lower Left Side photography is located in central Iowa. But Jason bold travel around. He does wedding photography, and his work is just amazing. Lower left side.com Jason's son has type one diabetes. Alright, I'm gonna do two more but I don't know how I'm going to do this one. Looks like Shannon and her husband. Fun on the columbia.com it's in rural Washington, a small resort, kayaking tours, things like that. It looks lovely, but I don't I can't say the name of the town. scammer Oh, come on scam Okowa You gotta be kidding me. Skam Okay, Awa I'm assuming if you recognize that name, then you'll know where this is in Washington. And it's fun on the columbia.com beautiful photos. You go over to the website. You can take a tour of the place. Oh, it's really great. All right. I don't know how to say skim a coat. Alright, honestly. scam. Oh, co ah. Are you kidding me? Go check it out. Last one. Let's stick with this theme. Here. Oh, barn venue weddings in the Topeka is at Indiana. Yeah, to peaky Indiana called Lakeside occasions. at Lakeside. occasions.com. They have a website which I've just said. My husband and mother in law grew up on this farm. Our eight year old son was diagnosed in 2018. With no family history of T one D so check it out. Its lake side. Oh, this is pretty good. People have lovely. Look at this. Lakeside occasions.com I'm gonna give you the address. Is there a phone number? There's virtual tours here on the properties beautiful 260-585-3211 Topeka, Indiana, right i n is Indiana, isn't it? You'll figure it out. Let me get going on the episode. Hello friends, and welcome to episode 482 of the Juicebox Podcast guest who's on the show today.

Today on the podcast, I'm joined by Jenny Smith. Jenny of course, is from all the defining diabetes episodes and the pro Tip series. And she's here today to answer a question that I have based on watching people. I have a watching people question. I listened to a lot of people who use insulin. Some of them say this thing that doesn't make sense to me. And I want to ask Jenny her opinion. And while you're getting her opinion, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Were becoming bold with insulin. You know, I'm wearing headphones and I can hear myself and my voice sounds amazing right now. Jennie holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. And she just celebrated her 33rd anniversary.

The T one D exchange needs 6000 people to join the registry. And I have to keep saying this to you until you do it. So that he 1d Exchange is looking for T one D adults and T one D caregivers who are US residents. They want you to participate in a quick survey that can be completed in just a few minutes from your phone or computer after you finish the questions. And they are very simple. I completed the survey in about seven minutes. You may be contacted annually to update your information. And they may even ask you a couple more questions. But this is 100% Anonymous, it is completely HIPAA compliant. And it does not require you to ever visit a doctor or go to a remote site. See, this is interesting. This is a way for you in just a few minutes to help other people living with type one diabetes. past participants have helped bring increased coverage for test trips, Medicare coverage for CGM, and changes in the ADA guideline for pediatric a one sequels. These are important behind the scenes things that people with type one diabetes need, and you have a unique opportunity to help them. These are not deep probing personal questions. They're pretty simple, basic surface diabetes stuff, but they just need the data. Help them at T one D exchange.org. Forward slash juicebox. And at the very least, if 6000 of you go right now, by not to say this again. Do it for me. I'm kidding. Do it for the other people living with type one diabetes. But I mean, if you want to think of me while you're doing it, it's fine. This topic, absolutely mesmerizes me I because I can't make sense of it. And I know I can't make sense of it. Because I don't have diabetes. I know this is one of those things that I can't wrap my head around because of it. And it comes mostly from adults. Although I've seen parents lean into it a little bit too. And I'm I really want to kind of dig into this with you. Why do some people think that there's an amount of insulin that's too much insulin to use? And that they're actually embarrassed if they use that amount? Or feel like they're failing? Where does that thought come from?

Jennifer Smith, CDE 8:24
It's a good question. First off, I would think that it probably starts with some like, sort of off the cuff kind of comment from a doctor. Not that the doctor is really implying what the person takes out of it. Like doses of insulin usually go along with each other, you're not going to have a Basal rate of point two, and have an insulin sensitivity factor of 20, which is unbelievably aggressive, right? I mean, that's not going to typically happened. So in terms of like evenness of insulin distribution, they may have heard the doctor say, well, you're on a lot of insulin. So your ratios should be such and such, right? So it may initially come from something like that. But, you know, they even might compare them selves to another person with diabetes, who they maybe they work out together, or maybe they are close enough friends that they're just comparing things. And they say, Well, gosh, you know, I eat really well or I follow this type of exercise pattern. And gosh, it looks like I use like twice as much insulin as you and you're like a couch potato, whatever, you know,

Scott Benner 9:39
the closest I can come up with listening to people and I really mean that this isn't from one or two people. This is over the years. I hear this constantly. Like I'm a bad diabetic. I use too much insulin. I've heard those words come out of like grown people's mouths and it's Sometimes it feels like, it's I don't know if this is gonna sound crazy, but sometimes it feels like it's impacting them almost like an eating disorder, but it's like it's like disordered insulin use it feels like, and no matter how many times I talk to them, and I'm like, Hey, you just need what you need, or your body has a need meet the need, whatever I ended up saying to them. It doesn't feel like it's enough. Like, it feels like it's psychological. And you know what I mean? Like it really, and it's sad, too.

Jennifer Smith, CDE 10:28
I think some of it too, probably comes from those who are trying to manage weight. Because if you know really, what insulin is, it's a storage hormone, right? Its job is to move food from one place your bloodstream into a place to either get used or it gets stored. So, you know, if, if that's the fact then a lot of people also don't see what does insulin do, if you don't have diabetes, if it's really still being made from my pancreas, its job is still the same thing. So in terms of weight management, you may find that, well, gosh, I use an awful lot of insulin, if I was just using less insulin, maybe my body wouldn't pack away as many calories. And thus, you know, my insulin use would go down. And I also wouldn't be, you know, heavier than I maybe want to be. And it certainly brings into the discussion, kind of the whole, the whole things like eating disorders within the realm of diabetes, specifically, yeah.

Scott Benner 11:28
So I get the idea. But I've seen it a side of people who are concerned about their eating, like like this, you know, like, if somebody comes to me recently, and wouldn't use their name, but I don't think they'd mind being an example here. So they come in, and they're like, hey, you know, lately, my, you know, my blood sugars have been going up, right? Like my, my resting blood sugars are more like 170 that used to be more like 100. And showed me the graph, and I look at it pretty hard. And I'm like, it just feels like you need more basil here. And you know, like, then we could look at the meals. And, well, that's a lot of insulin, the person said, I don't usually use that much insulin. And I was like, Is there a problem with that? And the person said, it's embarrassing, but couldn't tell me why it's embarrassing that I'm using more insulin. And I,

Jennifer Smith, CDE 12:23
I guess, I would feel like maybe it's the thought that they're not managing well enough. So they need more insulin to compensate for their lack of management, which shouldn't be, right. Be the piece of like thought,

Scott Benner 12:38
that's how it feels to me too, that somehow, if I'm using more insulin, I'm doing something wrong. I didn't even see it connected to eating in this person's example. Although it's funny, because when it is connected to eating, it's the last thing people see, when you know, like, I'm using more insulin because I'm taking in more carbs. Insulin makes me gain weight. Although insulin didn't make you gain weight, the calories made you gain weight, the insulin was helping you keep your blood sugar down, they conflate the two somehow, right? You know, they mean, and then it gets but they're tortured by it. Yeah, like really, really. And I didn't know if you would talk to anybody that this would come up for or if you felt personally,

Jennifer Smith, CDE 13:18
I would say that more. I mean, at least once a week, I have somebody both young and old, meaning both parents of kids with diabetes, as well as adults managing their own diabetes. I I'd say you know, their, their typical question is, well, what does somebody else this age use? Is this the right amount of insulin? For me? Am I supposed to be on I guess, this much insulin? Or, you know, is this too little insulin? I mean, that's kind of the opposite with some kids or whatever. But it's always a question of, shouldn't it be specific to like, my age, or where I am in life or whatnot. And really, there's a physiologic personal physiologic need for insulin for everybody. And good, good point is that I've got a really good friend who is, she's tiny, she's like three inches, and I'm not tall, I'm only five, three, and she's like three inches shorter than me and probably weighs 10 or 15 pounds less than me and she uses more insulin than me. And she's single and more active than I am. So, you know, from that standpoint, it kind of gives you a visual that the right amount of insulin for you is the right amount of insulin for you, as long as it's keeping your glucose where you want it to be. Is it in the target that you're aiming for? And in the case of the person that you talk to, you know, their needs had gone up? Why? I don't know some variable in the picture that was new and causing something to happen but they just need more. And sometimes it's figuring out well is the more going to stick like, Is there is there or body reason like is thyroid? Is there something going on that's causing the need for more? And will it be short lived? While this other thing is going to be taken care of and managed and gotten into control as well. But overall, you know, it is? It's a good question. I know the other piece of that too much insulin, sometimes also comes from people who have sort of been scarred by really like, low blood sugars, in the aftermath of what they deemed was a big amount of insulin for a meal. Yeah. Right. They're very weary of gosh, I mean, I've worked with a number of adults who won't take more than like two or three units of insulin at a given time, no matter what, no matter what. And so, you know, then it becomes well, okay, well, what's your ratio covering then? Because you can only eat this much at a time. The way that it works.

Scott Benner 15:59
So you see people who spread like little meals out throughout the day. No kidding. Jenny is nodding at me knowingly Okay, so so that they won't have to take too much. That's what? So you said, I haven't ever thought but I want to go back to something you said. The comparison to others, is huge. And I always thought of it as looking for the answer through somebody else. But when you brought it up, I thought maybe there is just a comparison in their head, like, I don't want to do more or less than other people do. Like maybe there's a real human failing in this, it has nothing to do with diabetes, that like comparison thing.

Jennifer Smith, CDE 16:36
Right? And I would, I would say that that's, especially with the teens that I talked to the teens themselves are not really so concerned, it's more the parents that are concerned. He's using so much insulin, I remember when he was diagnosed, he was six, and he was on this tiny, tiny amount of insulin. Now he's got like, you know, Basal rates that are like 1.9 units an hour. And I'm like, well, he's a TI and he's growing. And he needs a lot more insulin. I mean, so comparison wise, you do have to look at time of life. But even with, you know, this tea, and let's say, compared to his friend, his needs may be very different. His friend might be getting along just fine on point nine units of basil an hour versus his 1.9. So

Scott Benner 17:23
yeah, yeah, I get that. It's interesting, too, because I think my brain I know yours does my brain kind of slips into that like slicked back, go macro, look at the whole picture. See, like, you were like maybe your thyroids out of whack or like, I don't think mostly people think about stuff like that. Right, and the impacts of other things on your blood sugar, the one that you just brought up now, which I'm always fascinated by is you'll get a note from somebody who says, I don't understand my kids had diabetes for two years. You know, all of a sudden, his blood sugars are high all the time. And my first question is, have they gained weight in the last like, three months? Oh, yeah, he's put on like, 10 pounds, it's like, well, you know, a gallon of gas moves a car that weighs 1000 pounds this far, it moves, it moves a car that weighs 1010 pounds, a little less, you know, like that. And, but they don't see that a lot. Everyone's so locked in on making a number. Be right, and, and holding on to some hope that it's just going to be like that forever. maybe that has something to do with this as well, I have no idea. I know, all I can tell you is that when I hear adults say it, there is sadness in their voice. And they feel like they failed somehow. And the other thing that, that I hear, too, that I want to know if you've heard and wondered where it comes from, if you know, is the idea that you can use too much insulin, and it's not healthy for you. Not that it will make your blood sugar low. But using too much. It's almost like giving me the person who's like, has pain and you say, take an Advil and I go, I don't want to put medication in me. Like and you go all right, right on, you know, I it feels like that a little bit like they're almost I don't want to say irritated but they're disappointed that they have to take insulin law. And somehow by using less of it, it's going to be healthier for them. When that's of course, the opposite. But do you know what I mean by that?

Jennifer Smith, CDE 19:21
I do and, you know, in terms of too much insulin, if you need a certain amount of insulin, you need it. I mean, that's the base fact. Right? But getting into the fact of where I remember years ago, even before I was I was working clinically. And I started a young girl teens on a pump. And prior to the training, we always go through like what's your insulin dosing, so I could figure out like the strategy for the pump settings, right? When she was telling me her doses and I was like, you're gonna be going through a reservoir a day. Like I'm serious that How much insulin this this team girl was using. And I was like, We need better insulin. Use you 100. At that point, I mean, you 500 was on the market. But it was not at all something that was typically used an insulin pump, we had to actually go about like getting a doctor's order to use it off label in her pump, in order for her to actually get enough insulin. But at that point, there, there are other reasons. And in that significant insulin resistance, then, if you're not a growing teen, or a growing child, or maybe you know, woman going through pregnancy, or some other type of like body, like health issue that might be impacting, yes, there are certain doses of insulin that typically you will need for your own body. But if you have all of a sudden, like climbed in need, for some reason, that's a reason to get a check in with your doctor to see if something else is going on. But then thankfully, there are, there are other meds on the market now that, you know, they're starting to be used. Thankfully, in type one, they started out mainly as type two because insulin resistance is a hallmark of type two specifically. But it's kind of becoming more visible now in the type one community. And so some of those meds that help with resistance, can actually help you get back to a more normal need for your own body of insulin. Because yes, exorbitant doses of insulin. At some point, you know, as I think we've talked before, like large depot's of insulin under the skin take a longer time to disperse and get absorbed. So while that active insulin time of let's call it three to five hours, or whatever, from a single one shot dose of insulin, if you've got two units, probably over the course of that time, you're going to see its action, the way that it was meant to be, if you've got a dose, that's like 30 units in a shot. That's a huge amount of insulin to get dispersed. So in terms of decreasing resistance, especially if it's climbed for you, you may want to explore the other medications that are on the market that are very helpful for that.

Scott Benner 22:27
Well, as as we're sitting here talking, I do think that there's this one aspect that's, that's kind of creeping into my mind and making sense to me that I've just never thought of, which is, if my insulin needs are going up, I know I'm eating more food or eating less healthy foods maybe? And possibly it could it could, that could be I shouldn't said I should I know that could be one of the reasons like say, say for a person, that is the reason instead of wanting to face head on the idea that I'm eating in a way that I'm not thrilled about. I focus on Oh, I don't want to take so much insulin. And then like you said, you have a higher blood sugar, which then keeps your body weight down. hurting you in other ways, right? Correct. I'm trying to like put myself in someone's shoes there. You don't I mean, that whole like,

Jennifer Smith, CDE 23:26
it's a difficult it's, it's it is it's very difficult. And I think even in this past year, was so much change to people's schedules. And I mean, even the people have worked within like cities where they were used to doing their their commute and getting on a train and walking and walking to the office and like that disappeared. And that might have been like 5000 of their 10,000 necessary steps in a day out of the picture. And now you're just getting up in the morning sitting at your desk and look at that you gain some weight and hey, you're going to probably need more insulin. In that time period,

Scott Benner 24:02
I would imagine plus the activity itself. Put your insulin requirement down. Yes. So now there's maybe you're going to gain weight because you're not moving as much and you're off as much. Yeah, blood sugar. Yeah. Well, that all makes a lot of sense. Like I it didn't not make sense to me. It's just that uh, it's happened so many times and people seem so sad when they say it. And I just wanted to really, like have a conversation and try to understand it because I really, I'm at a loss because I just come at it from like a clinical way but when they said I'm like wait, just put more in, you know, or exercise more, eat a little less or like these your options. It's that one specific sentence that I need more insulin, I don't want to use that much insulin or insulin is not good. Too much. Insulin is not good for you. I always expect they're gonna say because I don't want to get low. I don't want to have a ton of insulin in me. But that's not always the concern.

Jennifer Smith, CDE 24:58
It's just the actual Oh, that's the concern. Yes, the number,

Scott Benner 25:02
it's the number that messes them up. It's got nothing to do with anything out like if you, if you, I don't know, let's say I put you in charge of the world, and you decided that a unit of insulin was actually equivalent to two units of insulin. So we started calling to units one unit, then they'd be okay with it, then they'd be like, Oh, I'm only using three. Right? Right. But do you tell them it's six? And they're like, oh, it's still it's still like in I'm putting my fingers on. But it's still this much insulin in the syringes this much in a little tube. But if the number was different, they'd be okay with it. And that's got to be psychological. Right? Yeah,

Jennifer Smith, CDE 25:43
a lot. And I think it kind of goes back to what you brought up initially, is just that, that feeling of I need so much, I must be doing something wrong. Like the feeling of just you're like beating yourself up. Because why else would I need this much insulin? And that that's not normal? Why should I have to take 50 units every single day? Should I be more on like 20 units a day. I mean, from a standpoint of like, overall weight management, sure, doses of insulin can make a difference. But there are other lifestyle pieces that go into that. It's not just the management of the dose of the insulin.

Scott Benner 26:26
So the way we do it here is is interesting, like are no go through swings of you know, there'll be a day or two where suddenly there's just like, way more carbs than usual. And you don't notice it when it's happening. But then you do notice that if you're especially if you're on an on the pot or something with a cartridge in it when you're like, oh, I have to change my pump sooner than I thought I was going to. And yes, and so she used to be like, Why are we changing it now? And I was like, it's empty. And then you know, and she goes, Oh, why? And I was like, Why do you think she goes, Oh, I got nachos at Moe's yesterday. And I and I had a milkshake today. And I was like, That is why so you know, in a very, like, simple way. It helps her go. Alright, maybe I'm, maybe I'm carb crazy right now I don't realize that I'll pay a little more attention to it. I see it as a kind of a, it doesn't well, because it doesn't impact her adversely. In her mind. I see it as a positive thing. Because she she can kind of see like, oh, you know, pay attention to look what's happening to me. But anyway, okay. I appreciate you talking about this with me. Yes, I really did not meaningfully understand. And I think this helped a little bit. And I want people like, let me ask you this, though. If there aren't outside influences. In general, you're comfortable saying more insulin is not unhealthy for people.

Jennifer Smith, CDE 27:48
As long as it's managing their blood sugar, and everything is in target and they have no other health concerns, then the dose that they're taking, is obviously working to help them maintain control. Yes.

Scott Benner 28:02
So when I say meet the need on the podcast, that's what I mean. I just mean there's an amount of insulin you need. Use it. Use it. Yeah. Okay. Thank you.

How about Jenny? I love Jenny. You love Jenny, who doesn't love Jenny? There's no one. No one law. I mean, maybe once in her life, she cut a guy off in traffic. And that guy is still like, a person that cut me off in traffic, but they don't really know it's Jenny. They knew this Jenny. They want them. They'd be like, God cut me off, you're fine. Anyway, Jenny does this for a living it integrated diabetes.com. And you can check her out there. There's a link in the show notes. Alright, look, one last time in this 25 minutes that you've been with me, the T one D exchange needs your help. And the help they need is super simple to give. You just go to T one D exchange.org. Forward slash juicebox. That's my link, use that link. And then when you get there, click on Join our registering now. And after that, you complete this simple, quick survey. It's for US residents only. But it's so easy. Like right now, if you did it right now look at your watch. Or you probably want to watch to pick up your phone touch the face of it. If you did it right now, you'd be done in less than 10 minutes. It took me three hours to bring you this episode. And this is all I'm asking in return. T one D exchange.org. Forward slash juicebox. I mean, seriously, I booked Jenny. Record the thing. Edit it. I mean you notice how there's no like pops and clicks and noises and nothing distracting while you're listening. You're welcome. That was me. Scott. click click click with the mouse. They fixed the whole thing for you. hours it took like you're just like, oh, it was a quick 25 minute episode. It was nice. God said insulins important. And, Bob? No, no, there's more than that. It's deep. It's deep. It's building a narrative in your life about type one diabetes, giving you the tools and the access to information for the free. And all I ask is that you go to T one D exchange.org, forward slash juicebox. I only need 6000 of you to do it. I mean, there were hundreds of 1000s of downloads last month, I just need six of you. And I'm saying of the hundreds of 1000s of downloads, I need 6000. I'm tired of saying it, too. I know you're tired of hearing it. I'm tired of saying it. But I mean, at some point, one of us has got to pick up the mantle and do their part. I can only do this I filled out the survey is easy. Alright, I'm going to stop. I apologize. That was I, that was too much, too much. I should just say T one D exchange.org. Forward slash juicebox. You need to be a US resident who has type one, or is the caregiver of someone with type one. Please go fill it out if you have the chance. I mean, that's that's how I should say it. But I mean, come on this podcast is amazing. And it's free. Free. And what do I say to you? If you want to try out an on the pod, go to omnipod.com forward slash juice box I say if you want to check out at Dexcom go to dexcom.com forward slash use box I say you want to get a great meter contour next.com forward slash juice box. I say hey, my daughter's got this G voc hypo pen, you should check it out. That's it. I mean, you don't have to check it out. I'm not telling you to buy an AMI. But it's not like if you don't buy an omni pod, you're not allowed to listen anymore. I'm just saying if you're going to go check it out. But this T one D exchange thing. I mean, you're on the internet constantly. I see the people in my life. I know you don't put the phone down. And I'm not judging you. I'm just saying while you're doing it. You don't I mean, P one D exchange.org. Forward slash juicebox. Help a guy out a little bit. Don't make me beg you. It's embarrassing. I'll tell you what, if the T one D exchange contacts me at the end of the month, next month at the end of June and says we've added 1000 new people to the registry. Thanks to you. If they say that, what will I do? I will do an online talk about using insulin. Once a week, in July, once a week. Okay, I'll come on. I'll do it on Zoom. It'll be free, obviously, because you helped me out with the D one D exchange thing. And I will answer everyone's questions as long as I can. If we reach 1000. Now if we reach 1500, I'll get Jenny on one of those calls. If you do 2000, I'll do the call. Right? Every day every what I say every week in July. Jenny wants and what else will I do? I'll do something else. That's cool. I don't know what yet, but trust me, I'll come through T one D exchange.org. Forward slash juicebox. Use the link, complete the survey. That's it.

Thanks so much for listening to this episode of the Best of the Juicebox Podcast. If you're interested in hiring Jenny, she works at integrated diabetes.com. And don't forget all the great businesses owned by people who live with the type one diabetes, either parents or adults that I mentioned at the beginning, I closed all the tabs already where I would tell you about them again. So just rewind back to the beginning if you want to hear about them. Sorry about that. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast. And by the way, in the shownotes of your podcast player or at juicebox podcast.com are links to all of the regular sponsors of the show. So if you need an omni pod or Dexcom or G voc or something like that, use my link please


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#806 Dexcom G7 Approved By FDA (with Dexcom COO Jake Leach)

Scott Benner

Dexcom COO Jake Leach is here to talk about the FDA approval of the Dexcom G7.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon MusicGoogle Play/Android - iHeart Radio -  Radio PublicAmazon 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 806 of the Juicebox Podcast.

What we have here is a bit of a Christmas miracle it seems. On December 8 2022, just yesterday, the FDA announced approval for the Dexcom G seven. And so of course, I have Jake leach here today to tell you all about it. Jake is the Chief Operating Officer at Dexcom. But more importantly, he's worked there for nearly 20 years, and his understanding of all things Dexcom is fascinating. I mentioned at the end of the episode when Jake and I finished talking, but I'm throwing questions at him from like, accuracy. You know, when's it gonna be available? How did you make this? What do you plan on doing about that? And Jake, just man, he just has the answers. Absolutely fantastic. It's a great conversation is only 30 minutes long. But it's a ton of questions that came right from you, the listeners a few of my own, and all of Jake's answers. So settle in, and enjoy. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan.

If you're new to the podcast and you don't know anything about it, you should hit subscribe in your favorite audio app, Spotify, Apple podcasts, Amazon music, wherever you get your shows, follow or subscribe. The Juicebox Podcast puts up new content four times a week, Monday through Thursday, you'll hear interviews with an adult living with type one, or a parent of a child who has type one. And we talked about all kinds of stuff. For instance, there's an entire series of after dark episodes where we talk about topics that most people don't talk about. There's ask Scott and Jenny where I and Jenny Smith CDE, who has had type one diabetes for 34 years answer your questions. We have entire episodes about algorithm pumping on the pod five control, IQ and looping. There's the bold beginning series for people who are just starting out with type one diabetes. And all of the questions and topics were suggested by listeners of the show when they were asked, What do you wish you would have known in the beginning, there's the defining diabetes series, which is just every conceivable phrase and term that you'll use with type one explained in short, fun, understandable episodes, we define thyroid issues in the defining thyroid series. Talk about the different variables that impact your blood sugar's than life. In the diabetes variable series. There's an entire mental wellness series and heard about it. I wouldn't be surprised that diabetes Pro Tip series from the Juicebox Podcast, I could explain to you what it is. But instead, I'll read you this. And then we'll get to Jake, and the Dexcom g7 excitement. This is from a listener. My son was diagnosed type one about five months ago, I have learned so much from just the pro tip shows, and I will be listening to all of the episodes. This podcast is amazing, both for the information and for the shared experiences from Scott and his guests. They make you feel less like you just got hit in the face with the shovel. And more like you can find a way to keep your loved ones happy and healthy. Check out the diabetes Pro Tip series at juicebox podcast.com. Go to the top in the menu where all the series I mentioned and much more are listed. Or you can go right into your audio app and search Juicebox Podcast pro tip. And they should all pop up right in front of you the first Pro Tip series. Is it episode 210. It's called newly diagnosed or starting over. Yesterday, I woke up to an email about g7 being approved by the FDA. It's a number of months. If I'm being fair. It's a lot of months since it was approved in Europe. That surprised me. Did it surprise you?

Jake Leach 4:21
Yeah, it did. Yeah, we anticipated those two review cycles to be similar in time. And so our goal was to launch the product globally around the same time but the approval in Europe came as expected and the FDA approval took a little longer than we anticipated. So it did yeah, it very happy to have it now very excited to get the product in users hands now but it it did take a little longer than expected.

Scott Benner 4:49
Okay. Can you tell me why? Like what the

Jake Leach 4:53
primary reason was we had to, we had a feature in there called silence All that we had to remove it's it's in the product, it's outside the US, but remove it from the US product. It's basically a feature that allows users to silence the alerts for up to six hours. You know, so that if they're in a situation where they understand this, basically, I got it, I don't need to be alerted by my CGM. At this point in time, I'm gonna, my glue is gonna be high for a while I know that it's low. Really just silence those audio alerts, the FDA wants to see a little bit more information before they get comfortable with that. So we basically had to take that out of the product. For the US for now, we intend to put it back in very quickly here, working with the FDA. But that was the reason why the review took a little longer, because we had to actually make that change and then respond to the FDA with the changes.

Scott Benner 5:47
Well, it's interesting that it's making a change responding with all that all the backroom stuff takes that many months to get accomplished. It's, it's really crazy. Alright, so why do you like that feature? Why did you want to add it.

Jake Leach 6:02
So it's a highly requested feature by users, because they while they love their alerts and alarms for glucose, and the other aspects of the product, they, they, when they understand their glucose is out of range, they don't always need to be reminded every 30 minutes. And so with some of the particularly the low alerts, it'll continually remind you even if you acknowledge it, pick, you can only acknowledge, acknowledge it, and it'll come back in 30 minutes. So that is the primary reason it's really strong user request. And so we are getting very good feedback about the feature outside the US. And like I said, we intend to bring it in as soon as we can.

Scott Benner 6:39
Okay. I'm gonna ask you to be paired to you. If there's anything you want to say before I hit you with a delusion of questions that people gave me to ask you. Do you have any app happy

Jake Leach 6:49
to answer all the questions, but just wanted to share in the excitement of the community, and you know, everyone who we now have, you know, g7 approved, we're working very quickly to get it out. Early 2023. And my say early means quite early. And we be on the heels of Medicare, the CMS recommendation for coverage for folks, Basal insulin, so not just intensive insulin anymore. So really a lot of expanded coverage for use of CGM. On top of that you see the g7 approval. So could be more exciting time. For Dexcom. And for the community in general,

Scott Benner 7:30
is the Medicare distinction, a first step to private insurance accepting those ideas?

Jake Leach 7:36
Yeah, absolutely. Usually Medicare leads. And then private insurance generally follows quite quickly after that. And so its expansion of CGM to many people who could benefit from it who weren't previously covered.

Scott Benner 7:49
It. Is that an early step towards getting type twos covered?

Jake Leach 7:53
Yeah, so that that Basal coverage is type two. You know, most folks on Basal insulin are type two as well as anybody would take to it there has hyperglycemia challenges. That's also part of the recommended recommendation from CMS to Medicare. So yeah, and then there's, there's still, as you mentioned, there's still a group of type two individuals who would not be covered by Medicare. But that's our next focus, we want to focus on how do we get coverage because we know CGM has clinical benefit in that population. And so do it basically generating the evidence that's required to show that to payers,

Scott Benner 8:30
in my mind, getting it on to type twos without forcing them to get into a situation where they have to use insulin makes a lot of like, health sense to me.

Jake Leach 8:39
Absolutely. And I think we're a years from that. Um, you know, nothing ever goes as fast as I want it to go. So, you know, I think there there's, you know, a lot of folks are you know, CGM, it's continuing to expand and there's a lot of folks are working through, you know, glucose programs, the level two program at United is an example of, you know, an insurer, basically taking CGM and using it strategically in their type two population, to generate better outcomes. And so there's, there's gonna be a lot more to come over the coming years here.

Scott Benner 9:12
It's exciting. I've been interviewing a lot of type twos lately, and all of their successes seem to come from when they start to think about their type two diabetes, like type one diabetes, and they start using insulin in targeted ways, and they have all these great improvements afterwards. So anyway, that's way off the track for for a conversation where I only have here for 30 minutes, but well ask the big questions that I imagine you know, everybody wants to know, right? When early 2023 That's great. Will you have will it be like a wide rollout or is it going to be one of those things where you know, like, three guys at Tesla drive in the car and nobody else has one?

Jake Leach 9:51
It is a great question because, you know, we, we often do limited launches to make sure we got every word comfortable with everything the support of the product, the product itself. But we had the opportunity to do that overseas in Europe. So we did a limited launch there. And then we moved into full launch. And so our US launch will be full launch. We don't intend to constrain it. We feel comfortable with the amount of product we have as as well as the timing. So it's basically going to or early 2023, it's going to be generally available.

Scott Benner 10:25
Do you think it will create more initial customer service needs? Or do you think that the ease of use might actually take back your your need for CSR coverage?

Jake Leach 10:36
What we're seeing with a g7 o u s, is that it definitely has resolved a number of the things that we experienced with the G six launch that needed support. Any new product generally requires some level of new education. And so we were ready for you know, we have the support, we've done this is the seventh time we've done a product launch each one's bigger, but we learn every time we do it. And so we learned quite a bit from our G six launch about the expectation and customers and the support needed. And so we'll be ready for for it. We've been handling the European launch quite well. And so we're we'll be ready for us.

Scott Benner 11:17
Alright, well G six transmitters can continue to be made. And do you have Is there a timeline for that not to happen are

Jake Leach 11:25
we basically will continue to supply we are planning capacity for G six will continue to supply that product until everyone has transitioned over to G seven, the the folks that are kind of some of the end customers that were waiting for compatibility with G seven, those folks will definitely we've always loved sensors and G six transmitters as needed for that tire group until everybody shifts over we do intend to roll out G seven faster than we did G six globally in terms of, you know, kind of upgrading everyone up to the g7 product and so, but we'll we'll continue to make GSX as long as we need.

Scott Benner 12:09
Sometimes I noticed when I asked people hey, if you have questions for Jake put them here, sometimes I noticed you see their fears in the questions. And some of the questions. I think, if they weren't afraid they wouldn't ask, but this is one that I think I'd like to cover anyway, I know the answer. And I have no idea what the answer is. But a person asks, every time I changed my my G six transmitter right now, I kind of have to go into my pump and tell it I've put on a new transmitter. And now they're hearing that the g7 every device they put on, it basically does its own transmission, and they're worried they're gonna have to go into the pump, but that's going to be automated, I imagine.

Jake Leach 12:45
So there's a couple of things there. So we'll start with the, with the pump. So one of the things, advancements with G seven is there's a four digit pairing code. And it's just numeric. It's not alphanumeric, so there's only four numbers that identify the transmitter you're trying to pair with. And so there's some sophisticated analytics under the hood there that make allow us to do that. Because clearly the identification number for the transmitter is quite a bit more than just four digits. But the pairing code is four digits. So with a pump, you have to you do have to enter in the four digits. But because that's a more frequent process, it'll be more easily accessible on the mobile phones, the actual applicator has a QR on it, that you can just quickly take a picture and it loads all that information into the into the display device

Scott Benner 13:39
processes is sort of it happens quickly during it. But it's not some great thing where I'm scrolling through screens and that kind of No,

Jake Leach 13:46
it's designed, it's something that you have to do it. But it's very simple. And that's why we put made the pairing code we reduced it so that it would be even simpler for users. Cool.

Scott Benner 13:58
Well, people still be able to calibrate a g7 if they want to.

Jake Leach 14:01
Of course, yeah, absolutely. Yeah. Is it that feature is still there, if you want to use it

Scott Benner 14:06
is the adhesive on g7 the same as the adhesive on G six.

Jake Leach 14:09
Now it's different. If you look at the patch, it may look very similar from the surface, but it's actually a new, new adhesive. That is we've seen in our early clinical studies as well as early performance outside the US that there's less irritation with with the sensor patch. For those, you know, the very, you know, it's a small group of folks that there are folks that do have, you know, patch rotation issues. And so we've seen a reduction in the number of that. And the occurrence rate.

Scott Benner 14:39
Is there any chance that this is the time you're going to tell me that it's going to work directly to an Apple Watch.

Jake Leach 14:47
Not not right out the gate, Scott, but it's not far off. We built it into the hardware, we finally have the capability to have that directly in the g7 hardware. And so it's going to be an app release that unlocks that feature

Scott Benner 15:01
makes me remember, you know, you might have context for this when I was young, Kevin Smith, the film director was like blowing up. And he used to have these little private film festivals. And every year, I'd go to one that he would hold. And there was a, you know, you'd say, Hello. When you get there, you start to know them after year after year, people recognize each other. And the last time I ever went to one, I shook his hand, and I said, Will you tell me when I'm too old to come to these? And he said, if you tell me when I'm too old to make these movies, and I just had that feeling in my head, like, you and I are like, you're on the edge of retirement. I've been making a podcast for 20 years. And I'm like, is it gonna work with the Apple Watch? I don't know why that popped into my head, or why wasted time with it. But it just delighted me just now what I was thinking about. Alright, so it's built into the architecture at this point? Yes, absolutely. Yeah. Bluetooth architecture has been updated to include it. Do you expect that to happen with the g7? Yeah, absolutely. Okay. Yeah. All right. What's happening to the apps? Right, now we're gonna get a new, like, will a g7 users gonna get a new app? But will the followers like what all is going to happen there?

Jake Leach 16:08
Yeah, so the g7 plugs seamlessly into the end of the architecture. So when a new when, for example, when the user basically upgrades from G six to G seven, they actually use their same G six username and password. They enter that into the g7. And all their data is still in there clarity, still links in so now G seven is just updating their data, it also moves over their settings. So similar to when you enter your past user name and password into a new G six app, it remembers your previous settings, G seven, does the same thing. So it makes it easier, easy for customers to transition over. And then the followers, clarity app, all of that just they work. You don't have to get a new one. It works with g7, will you be updating the follow up? We will we've So over the past couple of years, we've been kind of laser focused on rolling out G seven, basically getting it ready for global launch as well as our Dexcom. One product. So both of those are on this completely new software platform. So we've been spending a lot of time our teams have been focused on that. But as we were rolling, we've been rolling out Dexcom one g7 has now got our US launch coming in a few more rollouts globally, through the 2023. In early 2024. The team is going to be we're going to be able to focus a bunch of the resources on continued innovation in the both the follow space clarity, as well as the g7 and Dexcom. One app, so bringing more features to those. So you'll be seeing a more rapid cadence, we've built a lot of software capacities, you know, basically the capacity to develop software to be able to do both Dexcom one ng seven at the same time. And across the globe. So we get a lot of capacity we can unleash on new features.

Scott Benner 17:56
Give those people something new to do. So at launch, no delta, no rate of change.

Jake Leach 18:02
No rate of change at launch. Not yet. Not yet. But it's on the list

Scott Benner 18:06
on the list for the new app. Okay. Android as well, right? Android? Oh, yeah. Yeah, okay. Yeah. How? Where do you, it's just kind of gets away from G. Seven for a second. But it doesn't really open access for things like looping sugar, pixel glucose, stuff like that, is that you guys? Stay in the course on how you think about that?

Jake Leach 18:33
Yeah, I mean, we've always thought about it in terms of, we want to have as much accessibility as we can. And so that's the reason why we have our API's. It's the way we do our partnerships. So I think it's, you know, we, we've always kind of embraced the community, the innovation in the community, and all of the great stuff that's being done there. And so, you know, we walk a fine line between, you know, regulated devices, and in making sure that users get access to their data. So our philosophy there hasn't changed. So while new systems do, you know, things change with new systems, for in all kinds of different aspects, and so there'll be no work to do for compatibility for anything, but we definitely understand how important some of those systems are to people.

Scott Benner 19:22
I think every time you make some sort of an announcement about something, excuse me, it brings up anxiety for people who loop or, or something like that, like they think like, is this going to be the time I wake up and it just doesn't work anymore? So it's nice to hear. Accuracy stuff first. 24 hours? Same better different than G six.

Jake Leach 19:42
Yeah, it's, it's, it's a little better. You know, it's still the lat the first day is, while good, the days after that are even better, in particular with the seven with the 8.2% Ameri D in the ice CGM. US study that's, you know, most most accurate I CGM data ever produced so we are very excited about that and so G seven is you know it's it's based it's based in the technology that we've been working with with G six and other generations but we've made quite a few enhancements both to the sensor probe and as well as the glucose algorithm

Scott Benner 20:22
that mark number is that just for arm where is that anywhere that it's okay to where

Jake Leach 20:27
it's arm, its arm where so it's 8.2% and adults 8.1% arm were in in peds. And then with peds, we also have the upper buttock location indicated.

Scott Benner 20:41
Okay, how about somebody is asking me about accuracy at higher numbers when people are fighting with high blood sugars. Do you see any improvement there? I guess I should just ask you how you see this as an improvement over GSX? Really?

Jake Leach 20:55
Yeah, it's what it really is, is it's all about even more consistent sensors, right? When you look at a population of sensors, in a clinical study, you know, it's not like every single one has an MA or d of eight, you get some with, you know, Emiratis have four and some of the you know, in a particular individual or particular sensor, you want to get to be, you know, a little bit higher than that. So, what we're seeing with G seven is there's less outliers, it's more it's a tighter distribution of performance. And so that's one of the things that really helps drive down overall system performance. Because the M or D number you see is it's a average across a an entire clinical study.

Scott Benner 21:33
So if I said to you just do a clinical study of day three today, eight, you'd see a better number than me making you put in my entire 10 day where yeah, of course, yeah, that's how

Jake Leach 21:45
people game CGM systems, right you do. You do a clinical study and don't do any data on day one, or you don't do any hypoglycemia data. I mean, there's there's all kinds of ways to game clinical studies, the ice CGM criteria that the FDA said basically specifies exactly how you're supposed to run your clinical study, which is why it's a rigorous standard.

Scott Benner 22:05
My buddy's a good guy, if you don't think about the fact that he takes our wallets when we're together. Have a look at the whole picture. All right. Out of pocket costs, is it going to be similar to G six. So this episode doesn't have any ads on it, because it came up rather quickly. You know, the Dexcom G seven announcement was yesterday came out of nowhere. I wanted to get this episode with Jacob for you right now. And I've already I've already done all the ads I need to do this week. So I don't have any left. But I do want to just take a second to acknowledge that I'm able to make this podcast and on a Friday afternoon, surprise recorded episode with Jake leach from Dex calm and get it right online for you. Because this podcast is my job. And it can be my job because of the sponsors. They keep they keep the whole thing going, they keep the lights on they helped me pay my bills. And I want to give them a second because it's the end of the year. And we've had we have a lot of great sponsors. And I want to take a moment to thank them for their sponsorship in 2022. And to thank the ones who were staying with me for 2023 and they are on the pod makers of the Omni pod tubeless insulin pump and that Omni pod five automated system, you can learn more about it at Omni pod.com forward slash juice box. Of course Dexcom is a sponsor dexcom.com forward slash juice box. Another sponsor of the show is the Contour Next One blood glucose meter. My daughter has been carrying this meter forever. It's absolutely terrific, incredibly accurate, and you can learn more about it at contour next one.com forward slash juice box. If you want to use the glucagon that my daughter carries, you can get ge vogue at GE Vogue glucagon.com forward slash juice box check out that GE Vogue hypo pen. US med is where we get our diabetes supplies us med.com forward slash juice box or call 888-721-1514 They carry all the latest supplies, but check them out. And last but not least touched by type one is a beautiful organization supporting the dreams of people with type one diabetes at touched by type one.org. I'd also like to take a moment to thank in pen from Medtronic diabetes for their support in 2022. They won't be back in 2023. But that's okay. They were a great great supporter of the show in 2022. And one of the reasons why you were able to get the show so plentifully and for free, and while I'm thanking people, I have a new sponsor in 2023 athletic greens. If you're looking for that AG one from athletic greens, a green drink that actually tastes good, athletic greens.com forward slash juice box, there are links in the show notes of the podcast players you're listening in right now, and links at juicebox podcast.com, to all of the sponsors, and they're not a sponsor. But if you go to the T, one D exchange AT T, one D exchange.org, forward slash juice box, join their registry and fill out their survey, you'll be supporting people with type one diabetes, and helping to move diabetes research forward, you also end up supporting the show by completing the survey. So they're not quite a sponsor, but you are supporting the show when you complete the survey. I want to say again, that this podcast is it's a full time job, it is a ton of work. And without ad support, this would not be my job. And today, you would not be hearing this information. And I'm very grateful for the people who support the show. And for the people who support the sponsors, if you have the need. And I have the advertiser, I hope you use my link, because it's actually a huge help. Let's get back to Jake.

Out of pocket costs, is it going to be similar to G six?

Jake Leach 26:22
Yeah. So yeah, basically out of pocket cost coverage? So that's a really good question, Scott. So we anticipate a GS six ng seven will be very similar. In the beginning, though, when you launch a new product coverage is, you know, some there will be some coverage. And then it continues to build over time. And so we've the second we've got approval, we can now start kind of finalizing all of those agreements with payers, Medicare appeals. And so what we we do intend, though, even at time of launch to have some very accessible cash pay options for people whose coverage hasn't quite kicked in there, they can stand at six for, you know, until they have their g7 coverage, or they can switch right over and we'll have some, like I said, very accessible cash paid pricing for them.

Scott Benner 27:07
Can people still soak their sensors with g7? Define soak, they want to put them on and wear them for a few hours before they start them?

Jake Leach 27:17
Yeah, yeah. Now you could do well actually on to be real precise their ID, you can insert a g7 sensor. What happens is though, the second you insert it, it starts the sensor session. So all of that information is being recorded on the display device, or I mean, on the g7 itself. And so you know, it has the 30 minute warmup time, as soon as 30 minutes goes by, after insertion, it's going to start calculating and saving data. When you pair it to it. It'll be up and running.

Scott Benner 27:46
But if some so if I'm wearing one now, and I and I say this one, I don't know it's done in six hours. I want to put this one on now and let it soak. But as soon as I do that, do I lose the first one I'm wearing? Or I can just decide to just watch the first one while they are just losing the life of the second one during that. Yeah, exactly.

Jake Leach 28:07
That's it. Yeah, use the none of the devices, whether it's an insulin pump, or zebra or phone, they don't talk to to CGM to, you know, she says the same time you said you have to you have to switch over. When you're ready to the other one, it's just it's more around the unique feature ng seven as the auto start the second you deploy, it starts session, which is great, because I've talked to customers who would insert sensors and then forget to start their session and then realize, Oh, now I started, I have to wait two hours before I have data. So the g7 is much faster.

Scott Benner 28:38
I've not pushed that button once or twice. Will is this gonna be a pharmacy a DME? Both just one? Oh, yeah, we

Jake Leach 28:46
have customers that get product through different channels, you know, vast majority of get product through the pharmacy. And so we'll continue to push that. But we also support DME for for Medicare and for men and for others.

Scott Benner 28:59
If I'm in a household where multiple people have type one diabetes, can I follow a G seven and a G six on the follow up at the same time? Yes, you can. Excellent. See how easy this is tick. I can't believe people are so kind like just yesterday, I was like give me questions. I have enough questions here. We could make a training manual for everyone. So can alarms be silent for certain durations of times? That's going to be a no right now. Right?

Jake Leach 29:24
Right. It's basically the ability to sounds Alerts is just like GS six, but we are we do want to bring that feature. It's on the short list of things to put into the US product. We're working closely with FDA to get them comfortable with it and then we'll get it out very quickly.

Scott Benner 29:40
Your new readings every five minutes. Do you ever consider doing it? With I mean every minute or why is it every five minutes I guess.

Jake Leach 29:51
It's basically it's kind of a it's a balance of a lot of things like like almost any kind of engineering design project. There's a you're balancing multiple things So the system measures glucose continuously all the time, it's not like every five minutes, it takes a measurement, it's measuring the entire time you're wearing the sensor, it's just every five minutes is when the glucose reading is communicated between the wearable and the display devices. And so that's kind of a balance of, you know, battery power. As well as you know, the frequency of glucose change all of those things around five minutes, you know, we've we've contemplated doing it more frequently, but we haven't found a specific use case, where it's, it makes sense to do that, and change the way the whole system works. But it is something that we've, you know, we've talked about in the past, but five minutes, we feel pretty comfortable with it, you know, and with the extremely minimal lag time of the sensors. Now, it's it's much less of an issue than it was, you know, years ago when it took quite a while to see the glucose change in your CGM after you made a treatment.

Scott Benner 30:56
Right. So as time goes on that kind of adage of like, the next column is showing you something that happened in the past. It's becoming less and less of the past really. Yeah, yeah. A piggy back to that question. On the follow up, it'll tell you basically, it's been three minutes since the since the number changed. And I know for parents, like sometimes you lay in bed going Okay, one more minute. Let me just refresh this app one more time. Will you ever put that countdown on the user's app?

Jake Leach 31:26
Ah, that's a good. That's an interesting idea. Well, I don't know if our team has contemplated that. But basically add, so the user knows when that things come on. Yeah, it's a Yeah. Because when you I guess, when you're sitting there, you've made a treatment. And you're basically trying to see the glucose change. I understand. Yeah, exploring a

Scott Benner 31:45
low blood sugar when you're sort of like, yeah, tests do I drink? Do I eat like that kind of thing? What's the Bluetooth range from the g7? To the phone? Is that the phone?

Jake Leach 31:56
Yeah, it's the same as G six. Yeah, it? You know, it depends a lot on the, you know, the environment that you're in and how the distance, right? It's really good when it's just like, line of sight, you can get, you know, well north of 10 feet. But, you know, in crowded environments, it's less that, but it's the same as G six.

Scott Benner 32:14
Since it's been out already in Europe. Are you already working on things that you've seen? Like, have you? Are you making adjustments on what you're learning already? Yeah.

Jake Leach 32:26
Yeah, we've, we've got quite a few. I mean, many of the, you know, with any product, you do an initial launch, and you're always improving it, you're learning things about, you know, the way it's manufactured, you learn ways, but the way it performs. We haven't seen any surprises in the US launch in terms of product performance. And we have we have a number of updates, that will be cutting it over time that will basically be invisible to users. But you know, continuing to improve reliability. And, you know, just meeting all the needs of users. So yeah, I'd say the most exciting thing we've learned from our LRS launches that more than half of the customers are brand new to Dexcom. So they haven't, they're not just upgrading from G six G seven, they're actually new users coming in to Dexcom family. So it really helps us. You know, reiterate the fact that G seven is a really good platform for expanding the use of CGM.

Scott Benner 33:20
Is there been any change on compression lows? Do you see fewer with the new design?

Jake Leach 33:27
Um, you know, we haven't done a study that compares that exactly. But what one of the things that I've talked to folks about that of Warren G seven, as well as kind of experience myself as the size of g7 allows you to move it around a little bit more in terms of the locations where you can wear it. And that seems to be the best way to avoid compression laws is to find a place that you aren't compressing as often. Yeah, we're gonna for myself, it's I went up on the top of my upper arm that tends to help me

Scott Benner 33:57
okay. Okay, so Canada, Australia, this year, not not 2022. But do you see them in 2023? Having g7?

Jake Leach 34:07
Yep, very, very likely. They're both of those are their, you know, their approval processes, right? Regulatory submissions. g7 is already in New Zealand, and so open to bring it Australia soon. So yeah, I mean, we're, the vast majority of the countries will switch over to g7 in 2023. And then there's a few of the longer regulatory cycles that will take us into early 24.

Scott Benner 34:31
So somebody asked this question, what, it's the internet. So I don't know. I hadn't heard this. But are you seeing any lost connection data on g7 in Europe, to the point where you think of it as a problem?

Jake Leach 34:44
No, no, I think it's similar to G six, it can happen. And we actually do have technologies in our pipeline that we've been working on, that we implemented on G six some of it and we're also looking to do it on G seven to even further enhance the Bluetooth range and capabilities. But I think one of the things with a new product anytime you experienced something, it's like, oh, is it the new product that's causing that? So? It's no, it's definitely not a problem. But we do something that we are striving to improve it always.

Scott Benner 35:15
Yeah, I never know the difference between like, something someone heard, and now they're asking, and you know, I'm pretty clued into this space. And I was like, I hadn't heard that. So I think it's obvious I saved the big questions for the end. And so here they are. I know this isn't your company, and but you're gonna have as much insight to it right now is anybody that I have access to talk to on this day? So how soon until people who have just decided I want to use on the pod five or people who using control like whew, like when they're they're all at home, like looking at their sensors, trying to decide like Toyota or G six one more time? Like, how soon do you expect those companies? I mean, you guys must have conversations about it. Right? Like, when is February to work with that stuff? Yeah, we work

Jake Leach 36:02
super close with those partners, to ensure that the g7 is the integration goes smoothly. So they've both both tandem and solid. And our other partners have been working on the g7 integration for quite a while because the technology has been around. And so they, you know, when it comes to actually launching those upgrades for users, it's really, they're in control of the timing there. Now that we have the FDA approval for use with AI D. It's really around them doing their upgrades. I think their public comments, a tandem, I think is talked about middle of 23. So that's not too long after we launch, and then I think insulates a little they're a little bit farther behind that. So but they they've made and they continually update their public comments around when they'll have that compatibility. But the trust me they're working very diligently on getting those those systems upgraded.

Scott Benner 36:53
I wouldn't imagine that they're taking their time. Jake, I have to tell you, I know we're going your institutional knowledge of Dexcom is it's incredible. Like I just out of order. We I didn't send you these questions. I'm rattling things off. I'm jumping from topic to topic. And you're like that, yeah, this this that? Yeah, like, it's very impressive. So please, please work there for as at least as long as I have this podcast. Because this was very easy and just full of information. And I'm gonna pat myself on the back for getting through that many questions in 30 minutes, because I feel like my head is spinning down like, look, I'm watching this list window in front of me. And I'm like, No, don't ask that as this one. That's that one. So anyway, I congratulations for me. And for everybody listening, everybody said thank you. It's a big deal. We were all really excited yesterday. And you know what I'm, you know what, you know, what people are gonna want you to do next go make Dexcom GA right now, Jake, you can maybe take a couple of days off, but then we would like we're working on it. We'd like to see it as big as the head of a pin. And I'd like to be able to wear it on my watch. If you don't mind. Go ahead, get going.

Jake Leach 37:56
lots lots innovation still to come. We're not nearly done. So yeah, appreciate the time, Scott. It's been great. And I look forward to bringing g7 to us here very soon.

Scott Benner 38:07
You guys push this space forward in a way that just wasn't happening before. Dexcom. And I'm there. I've been around this a long time. I'm never gonna forget, you know, when a new meter every three years seemed like a big deal. So thank you. Thank you very much. I hope you have a great night. Appreciate it. Thanks,

Jake Leach 38:23
Guy Garth. Yeah.

Scott Benner 38:30
Well, I'd like to thank Jake for coming on the show so soon after the announcement. And of course, thank all the people who listen to the podcast for the great questions. How did I get them? You might be wondering, well, I got them. In my private Facebook group Juicebox Podcast, type one diabetes. on Facebook. It's a private group with over 32,000 people in it. People who live with type one diabetes, type two their parents of people with type one, they have type one themselves. The gamut is run in there. You don't even you don't even have to say anything to learn in that group. It's amazing. Juicebox Podcast type one diabetes. Thank you all for the great questions. I hope you enjoyed this episode. I hope you check out some others. Tell a friend share this episode with people. There's a Share button in your podcast app or you can if you're listening online, send somebody the link. When you share the show, you're helping it to grow. And the truth is that's that's the crazy best part of this whole thing is you guys and how supportive you are. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.


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