#900 Best of Juicebox: Omnipod 5 Pro Tip: Overview

Omnipod 5 Pro Tips: Overview was first published on Aug 15 2022

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

Scott Benner 0:00
Hello friends, and welcome to episode 895 of the Juicebox Podcast

welcome back to another episode of the Best, the Juicebox Podcast. Today we're revisiting Episode 431, which originally aired on January 22 2001. This episode includes community feedback on the topic of switching from MDI to pumping. It's very informative. So if you're thinking of switching, check it out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Are you a US resident who has type one are the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box join the registry complete the Scott Benner 0:00
Hello friends, welcome to episode 900 of the Juicebox Podcast

Welcome back to the best of the Juicebox Podcast. Today's episode was originally today's episode originally aired on August 15 2022. It's episode 736. It's called Omni pod five pro tip overview. It is the first of my three part series about how to begin on the Omni pod five. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. As I said, this is the first part of a three part series. They're available to you at juicebox podcast.com forward slash Omni pod five or, of course, right in your podcast player. If you're a US citizen who has type one or is the caregiver of someone with type one, please take the time to complete the survey AT T one D exchange.org. Forward slash juicebox you really will be helping type one research when you complete that survey T one D exchange.org forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by ag one from athletic greens. I start every day with ag one and you can as well athletic greens.com forward slash juice box if you head over there now and get started. You get five free travel packs plus a year supply of vitamin D along with your first order athletic greens.com forward slash juice box best green drink I've ever had. The podcast is also sponsored today. By the contour next gen blood glucose meter. You can learn more or grab one at contour next one.com forward slash juice box you owe it to yourself to get an accurate meter and the contour next gen is just what you're looking for. Hello friends and welcome to part one of my Omni pod five series with Carrie Birgit.

Before we get started today with part one of this three part series, I'd like to tell you that insolate has paid the host of this podcast that's me Scott Benner and my guest Carrie Bergerac a fee to create this content. Kerry is an omni pod ambassador with an ongoing commercial relationship with insolate. This podcast provides general information discussions about health and related subjects. This information the other content provided in this podcast or in any length materials are not intended and should not be construed as medical advice. Nor is the information a substitute for professional medical expertise or treatment. Never disregard professional medical advice or delay seeking it because of something that you've heard in this podcast or read in any length materials. The opinions and views expressed on this podcast and website have no relation to those of any academic hospital, health practice or other institution. Please speak with your health care team if you or any person has a medical concern. And before making any changes to your diabetes management, you can always consult the Omni pod five automated insulin delivery system User Guide for more information. In short, nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. You are about to listen to on the pod five pro tip overview. The second episode is on the pod five pro tip settings. And the third episode is on the pod five pro tip connectivity. Please listen to them in order as I think that is how they'll best serve you. If you're listening in an audio app, these three episodes went up at the same time so there'll be right next to each other or you can find them at juicebox podcast.com forward slash Omni pod five.

Cari Berget, MPH, RN, CDE 4:22
My name is Carrie forget I am a nurse and specialty nurse and diabetes care. I work at the Barbara Davis Center which is in a diabetes Center in Aurora, Colorado. It's part of the University of Colorado Anschutz Medical Campus. And I love my job I love working with families who have kids with type one diabetes, because I get to help them figure out how to make the most of their lives and still have a great life even though they're having to deal with type one diabetes, which can be really challenging.

Scott Benner 4:54
Don't have type one, is that correct? That is true. I do not have type one. How did you make it to this kind? of work.

Cari Berget, MPH, RN, CDE 5:00
My background as a nurse actually did not bring, like prepare me at all for type one diabetes care. But when I first I've been a nurse for 17 years, and when I first started nursing, I worked in the hospital and I didn't love it because it was, I didn't get to know people enough I was it was too much just put a bandaid on things and not really get to know or help or be a part of anybody's life. And so then I started working as a public health nurse where it would do the home visiting program for young mothers. And so I would go into their homes and support them throughout their pregnancy with health education, and I got to work with them until their child was two years old. So I did that for about seven years. And while I really loved that, too, I was kind of like, well, I think I want something that's a little bit more clinical, but not back in the hospital. And I had a friend from nursing school who had type one diabetes. And I learned a lot about it from her and was just amazed at how, how smart she was and how hard she had to work to manage her diabetes, but also how much self care and commitment it took. And so then when I was looking for another career, the Barbara Davis Center came up and, and I was like, you know, I think I think this is, this is the place for me because, you know, I don't want a job where I'm the, quote, nurse who's, you know, in charge, and I just tell people what to do know, like, I want I want, I wanted a place where I could connect with people and come alongside them and support them and be a team to help

Scott Benner 6:39
him because he you get to make a real tangible difference in someone's life, right? It's not, it's not like emergent care where you just kind of run in and do what you got to do with leave. But you get to know people and see where their struggles and their strengths are. And then and then and lift them up a little bit, which I think is what we're going to be able to do here with these episodes. So I appreciate you very much taking the time to let us know about yourself. We basically have our topics broken down into a couple of headlines. Right. So the first one we have here is what do we need to know before we get started with the Omnipod? Five? And I want to ask you first, how many families have you been involved with so far with Omnipod? Five?

Cari Berget, MPH, RN, CDE 7:19
Well, I've been working with Omnipod, five for over two years now, because I got to work on the clinical trial, which was the study that you do before the device is commercially approved. So I had about 30 families that were in the child from our center, and I was the primary nurse for that study. So I got to train them on the device and teach them how to use it. And then we got to work together to figure out how to use it best. So that's been for the last two years. And then now that the device is commercially available, we're rolling it out in our clinical practice as well. And we've had over 250 new prescriptions for it. And just these last couple months, and then over 80 have started the system. So there's been a lot of a lot of kids and families that I've worked with on the system. That's perfect.

Scott Benner 8:07
So you've got to we've got a couple of years worth of knowledge that we can pull from here, it's going to be terrific. We're going to start simply getting things laid out right. And person wants to start with Omni pod five. What do they need? They need on the pod five? That's pretty obvious. But they're also going to need a Dexcom G six CGM. Is that correct?

Cari Berget, MPH, RN, CDE 8:27
That is true. Yep, the Omni pod five works with the Dexcom G six, and you do need that Dexcom G six in order to use the system. In the automated mode.

Scott Benner 8:37
It's important to remember that these are separate items. You don't get a Omni pod five prescription that ends up bringing you a Dexcom. So if you have the G six, all you need is the Omni pod five. If you have neither, then you're going to need to talk to your healthcare provider about getting a prescription for each.

Cari Berget, MPH, RN, CDE 8:54
Yes, very important point. Okay. The other important point about that is that the Dexcom G six is it really is a separate device in the fact that you need to use it on your own cell phone with the G six mobile app, there is no way to download the G six mobile app on the Omnipod five controller. So that's also an important piece to to understand and that you can't use the Dexcom receiver either if you're using Omnipod five,

Scott Benner 9:22
right. So if you're already a Dexcom G six user, and you're using Dex comms receiver, you're going to need to move your Dexcom on to an app on your phone before you can use on the pod five with it.

Cari Berget, MPH, RN, CDE 9:34
Yes, that's correct. The G six mobile app to be specific. Yeah,

Scott Benner 9:37
thank you. Now you could use on the pod five, right without the G six but you would just be using it as a just a regular insulin pump. It wouldn't be an automated system. That is correct. Yes. Having said that, Carrie. I think if you're gonna do this, like get all the stuff because, you know, right?

Cari Berget, MPH, RN, CDE 9:58
Yes, absolutely not. If you're going to get Omnipod, five, use it in automated mode, that will definitely be the best way to go.

Scott Benner 10:05
Yeah. Okay. So does that mean that you can't use Omnipod? Five if you don't have a smartphone? Well?

Cari Berget, MPH, RN, CDE 10:12
Well, the short answer is yes. But let me give you the more complicated trail have that. So you do need to have the Dexcom G six mobile app in order to operate the Dexcom G SIX sensor. And as I mentioned before, you cannot use automated mode without the sensor. But if you had the G six mobile app on one smartphone, and the sensor was all up and running, and you had already connected it to your controller, the active sensor session, if you already have the Dexcom transmitter in the Omnipod, five, app, either on the controller or your own phone, then once that's up and going, you don't need the G six mobile app within range in order for the pod five to operate in automated mode,

Scott Benner 11:01
right? Well, yeah, we're gonna go over that probably a number of times. So one of the one of the great things about the system is that it's it's self contained within the things that are on your body. So the GS six will talk to the Omni pod five, without the controller for the, for the, for the on the pod five there or without your cell phone, those things could be nowhere near you. And the algorithm can run because the algorithm actually lives, like right on the circuit board inside of the on the pod five.

Cari Berget, MPH, RN, CDE 11:29
Right, the algorithm is directly inside the pod. So the pod itself that is on your body, each one of those pods has the automated insulin delivery algorithm on it. So the Dexcom actually sends the glucose data directly to the pod. And then that pod uses that CGM information from the Dexcom directly to calculate how much insulin to give. So yes, you do not have to have the controller, the Omnipod five controller nearby, in order for the automated insulin delivery to occur,

Scott Benner 12:02
okay, so we have our stuff we got, we got our gadgets and gizmos on our websites, and we know what we're doing. And we got to get started, right. So some people are going to train in person with a CDE or a nurse practitioner, whatever they have available to them. Even I guess, I'm guessing through people that on the pod provides. Is that true?

Cari Berget, MPH, RN, CDE 12:21
Yeah, there. I mean, it depends on your clinic, there's a variety of ways that clinics might go about training their patients on insulin pumps in general, a lot of clinics do use the industry trainers, so they'll have a trainer from Omni pod that covers their clinic, and that would be the trainer that they would Gotcha. They would work with Yeah.

Scott Benner 12:40
Now there's also like an elearning situation, right? Where you can go online and take no walkthrough. Isn't that great, I don't have a job, carry, I don't have a job. So I don't get to do things the way other people do. But I hear a lot of people train online and stuff. But that, but I did take the online training from the pod five, and I'm assuming that's available to other people as well.

Cari Berget, MPH, RN, CDE 13:01
Yeah, it's available to everyone who's a current Omni Potter. The way it's designed actually, is that if you are current on new Potter, and your specific healthcare provider has like, given the stamp of approval that they're good with their patients self starting, then when you get your intro kit from the pharmacy, inside that kit includes a QR code. And it's just not very complicated, just Omni pod.com backslash setup, you go there, and it'll walk you through the steps of setting up the controller. And then from there, you can access the elearning modules, which will walk you through how the system works, how to program it. And, you know, walk you through the steps of starting it up. Right.

Scott Benner 13:43
So let's talk about that a little bit. The, I think, a couple of the key words, you and I are going to hit over and over again. One of them's going to be settings, whether this means your Basal profile, your insulin to carb ratio for your meals, your correction ratio, insulin sensitivity, all these things that I mean, if we're being honest, I guess a number of people don't even understand they go with whatever set up for them. And then whatever happens happens. But on this automated system, I think the easiest way to consider this is that if your settings aren't good, it's going to be like sending, I don't know, five basketball players out to play a baseball game, right? Like, you know, you've kind of got the tools there. You got some athletic people, but they've never held a bat before. They don't know how to throw a ball overhand. And and she you've got these things, it's close to what you need. It's not exactly what you need. So having your settings correct, is I think, in my opinion, by far the most important step of getting going. Now, how does how do you do that? When you might be in a situation? I guess what I'm what I'm thinking about is what happens if someone sees automated system while an automated insulin delivery system? I'm out of this, but it's not just going to magically work. You're gonna have to give it a good starting point.

Cari Berget, MPH, RN, CDE 15:02
Yeah, that's all true. So programming the settings, the initial settings that you have, it's, I wouldn't recommend just just blindly programming whatever you have in your current insulin pump, when you go to start on the pod five, it's important that, you know, to get off to the best start, you really should have your Basal program representing about 40 to 50% of your total daily insulin needs. And the reason for this is because the algorithm is it's using this assumption that that's typically what people require. And so you'll, it'll estimate your total daily insulin best, when you first start the system. If you have about 40 to 50% of your total daily insulin coming from that Basal program, or at least that's what you have programmed in the system. So that's what it what it assumes. And that's, that's pretty physiologically accurate. I mean, that is what you would expect, you know, we have these two types of insulin delivery, when you think about it, for intensive therapy, you've got Basal insulin, you know, which is like your background, it's what's supposed to help stabilize your glucose levels and manage, you know, the livers role and storing and dumping glucose into the bloodstream. And then you've got the Bolus insulin, which is larger doses all at once that, you know, are For if the blood sugar gets high, or if you're eating. And this is basically how the, the body works with insulin delivery. So this is trying to simulate those same type of, of structure, right, so look at what your current settings are, and then see how close or far that is. So you can always start from, what is the total amount of insulin that I receive in a day. And then how much of that is coming from Basal quote from the pump, and how much of that is coming from boluses. And you know, people with diabetes, they're really smart, and they figure out how to make things work best for them. And on a manual pump, you might be getting some of what might be considered Basal through giving extra boluses and things. So that's where if if those splits are way off of that, I think that's a time to go to your health care provider, and try and reevaluate what they really should be to get off to the best start and then start from there.

Scott Benner 17:20
Yeah, Carrie, and I've kind of put that into layman's terms for people. And this is something I've learned baking the podcast over the years, there are times that people using insulin arrive at the right destination, but they don't quite get there the correct way. And just a general understanding of what that might mean is, let's say you should be using, I don't know, 24 units of basil a day, I'm obviously doing that. So it's easy for us to remember one unit an hour. But for some reason, your Basal program is set at point five, and you end up making up that other insulin through manual corrections. Or maybe you've figured out a way where your your meal ratio is really heavy, but it works because the basil is light, or vice versa. Maybe your basil is too heavy and you are eating on a schedule and feeding the the insulin like there are a lot of different ways that unbalanced settings can still look okay at the end. But this system is going to learn more quickly. If those settings are as close to write as possible, it can still learn if you if you begin with bad settings, but it will add to the amount of time is that right?

Cari Berget, MPH, RN, CDE 18:25
Yes, I'm sitting here like nodding my head, but you can't see that. So yes, that's absolutely right. And it's going back to your analogy of the, you know, baseball players trying to play basketball, or maybe it was vice versa. If you, if you teach those baseball players how to play basketball, they'll probably learn it eventually. So it's a similar concept that if it's not perfect at the beginning, or at least not optimal, it will eventually get there, it just is going to take a little bit longer to figure that out. And I think the other point I would make is that this system really operates off of total daily insulin, that is what it uses to base a lot of its automation decisions on not all of them because it's also taking your current glucose level. It's making these you know, decisions about how much to give every five minutes, but kind of the big picture factor that plays a huge role in that is your total daily insulin.

Scott Benner 19:21
Okay, and would that be the same for somebody coming from MDI?

Cari Berget, MPH, RN, CDE 19:27
Yeah, I mean, it would be the same as somebody coming from MDI, generally with MDI, you would look at, you know, what's your, what's your total long acting insulin dose, and that would typically, you know, be what you would use to figure out Basal settings and a pump. So you just would take that total Basal dose if it represents about 50% of your total daily insulin, and then you would divide that by 24 to get a starting rate. Okay, so Carrie, I'm

Scott Benner 19:57
gonna give you a little more anecdotal from my end, which is I see people frequently going from MDI, to any kind of pumping. And having a similar issue, where settings don't look the same, you know, and they, they'll, they run into it in all kinds of different ways. But, but kind of think of it like that. So you know, sometimes people from MDI go to pumping, and it takes them a while to get their setting straight, and find your you're on your way to doing that. But that pumps not trying to learn anything from what the settings are that you've told them. So have your settings really, really close before you start. And in the next part, we're going to talk about that a little bit more, but I just wanted to, to make sure to be clear about that. So So let's, let's imagine, here we are, we've done our learning, we've talked to our doctor, we have our settings straight, and we're sitting together, it's our on the pod five, we have our on the pod five controller, our Dexcom or Dexcom is on our phone, we're ready to go. Now you need to have the controller with you right to start up, you have to get it going. And earlier we talked about that the system works without being near anything. But there are of course, some things you need the controller for, for instance, you need it to give yourself a tell it how many carbs you're going to eat, right? You need it to hear alarms and alerts. There are things that if you walk completely away from it, you won't get alarms and alerts are a big part of it. The ability to control the, the system, as far as entering carbs is another one. If you happen to be in manual mode, you know, you have access to a few more settings, then you do an automated. So those things need to be nearby when you're making changes, or when you need to hear alarms and alerts. And the truth is right, you need to hear your alarms and work.

Cari Berget, MPH, RN, CDE 21:41
Yeah, the other thing is, if you want to see anything, you need to have the controller nearby. So you know, if you're gonna go swimming, just leave it on the on the chair. And you don't need to worry that it's not going to be able to deliver insulin. But generally speaking, you're going to want the controller nearby the unless you just want to be completely blind and not know what's happening. But a couple other just clarifying things there. They're calling it a controller now. So very fancy, no more PDM. But controller, that might be the lingo you hear when you like get your intro kit box and stuff. And then also, as far as alarms and alerts, I did want to clarify. Another reason for having the Dexcom G six app near you is that you cannot program any of the Dexcom CGM alerts on the Omnipod five controller. So that's another thing to keep in mind. If you want to be getting those Dexcom alerts, you have to have the G six app within range and get it through that app. There's a couple exceptions. There's a one LOW Alert on the Omnipod five, four if it predicts your glucose dropping below 55. And then there's some like pump related alarms and alerts. But I did want to make sure it was clear because this is a common question that I get that there are no CGM related alerts other than that 55 In the Omnipod five app,

Scott Benner 23:00
right so there so you have two devices that are speaking to each other but they're giving you their information on their their own separate platforms.

Cari Berget, MPH, RN, CDE 23:08
Exactly.

Scott Benner 23:15
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So let's I guess dig in a little bit into this algorithm and what we can expect it to do and what it's going to do. I feel like I want to ask you, and because I can, we've used the Omnipod five and I know a great deal about it. But I think you have a lot more than me, as far as knowledge goes. So there's a predictive control algorithm, right. And it's called Smart adjust technology. And we know how it's going to communicate back and forth with the G six that happens every five minutes to predict where your glucose is going to go. 60 minutes from now, it increases or decreases or pauses insulin, trying to get you to that level that you actually get the program right. So unlike other automated insulin delivery systems, I guess on the pod five has a 110 target, but it also has other targets.

Cari Berget, MPH, RN, CDE 27:05
Yeah, you can program the target anywhere from 110 to 150. In 10, and 10 milligram per deciliter increments. So 110 121 3141 50. And yeah, that is the only automated insulin delivery system where you can customize the target to what you want it to be. And then additionally, you can also set that target, you can have a different target for different times of day. So if you wanted to run 110 of the rent 110 target, you know, all day, but you wanted the 130 target overnight, you

Scott Benner 27:40
can do that as well. It does not go lower than 110. No, it does

Cari Berget, MPH, RN, CDE 27:45
not you cannot program a target lower than 110. Okay, that doesn't mean your blood sugar will never go lower than 110. But the the target that you program can't be lower than 110. Yeah. So

Scott Benner 27:56
that's as good a place as I need to talk about that. So your blood sugar could get lower, and then it's going to take away insulin trying to get back to the one time.

Cari Berget, MPH, RN, CDE 28:06
Yeah, that is correct. But I think

Scott Benner 28:09
that's important for people to hear that it doesn't happen instantaneously. If you were to, I guess there's a lot of different things right, you could you could make a Bolus for a meal that's too large for what you ate. And then you might get lower than that. And then this, the algorithm is going to just try as hard as they can to take away insulin, take insulin to create a new balance, but you could be lower while it's doing that. So there are times where you might have to step in and fix a lower blood sugar. There's it that seems accurate to you.

Cari Berget, MPH, RN, CDE 28:37
Oh, yeah, absolutely. I mean, you know, what we see with these systems is they, they do a really good job at helping prevent hypoglycemia, but they don't eliminate it altogether, usually. So you may still have a few, you know, situations that the example you gave is, is a really good one. Because if you do over Bolus for a meal, for example, once that Bolus insulin goes in the body, you can't take it out, you know it's there. So if you can't remove it, all the algorithm can do is just stop the automated delivery in the background. Yeah, so it should help. It should help kind of like cushion the fall if it's too much Bolus, but it may not always be able to 100% prevent the the low blood sugar entirely. Yeah,

Scott Benner 29:23
it comes from a personal experience I had with it because when we first got it, I was like, I bet you I could get this to keep a lower number. And I did it. And Arden's blood sugar was like 85 for like two and a half hours. I was like see, I trick the outcome. And then it didn't it tricked me because because it took away so much of her basil that her you know, once that act of insulin I used in the meal was gone. Then she just started going up and up because I had basically, you know, I had I had put the algorithm in a situation where it took away the basil for so long that the only thing that was going to happen later was arised. Like that's the only thing that could happen eventually I basically trade Did my meal insulin for basil? And it said, Well, we're going to, we're going to get you back up to 110. And then that rise happened. So I just, you know, I, it's not this stuff's all really very new to people, you know, and everybody's kind of had a way they've done things and there's going to be a different, you know, a slightly different way to do things. And these are the things that are gonna get you there. So, alright, so Carrie, we thrown on this, we got our first pot on, right? What happened? Yes, five minutes. 10 minutes later, my blood sugar's perfect.

Cari Berget, MPH, RN, CDE 30:30
So I wish Sunday. But so you put your first pot on, right, what'll happen is the with your very first pod, the system, you can go right into automated mode. So that's another cool thing about this is, even though the system operates off of total daily insulin, you can still go in automated mode with the very first pod, even though there is no insulin history. If you think about it, you might be wondering, wait, you just told me this algorithm operates off total daily insulin. But this is my very first pod. So how would the system even know you don't program your total daily insulin anywhere in the pot, it's based on the insulin you actually receive. So that goes back to what I was saying before that it estimates your total daily insulin. And it uses that to determine what they call an adaptive Basal rate. And so I would think of that as like a baseline, it's your baseline Basal rate that this system thinks you have. And then in then it adjusts up and down from that rate, based on the current glucose trend, recent insulin history, delivery history, all with the goal of trying to reach that 110 target. So the 110 is the brain's that's the number it's using when it's making these calculations every five minutes. And then, so you go along, and you give your meal boluses. Because that's really important. On a system like this. For one, if you want the best blood sugar control around meals, you should Bolus, you know 10 To 15 minutes before you eat, to get the best control around meals, but also to make sure that the total daily insulin that you need is actually accurate. Because if you miss the boluses, two things will happen. Your your meal control won't be as good, you're gonna go high, the system will increase to try and help you so still be better than missing a Bolus if you are on a standard pump. But the total daily insulin will start to be underestimated, then because you're not giving the Bolus and the automation can only do so much for you.

Scott Benner 32:26
So so if I, if and again, this is a great example of it's not, you know, it's not just like set it and forget it and walk away, you do still have to do the things you need to do Pre-Bolus In a meal is have you know, I think it's a basic concept. And and so what you just said makes sure I understand if I don't Pre-Bolus a meal, then we're going to see a big shoot up 2030 minutes after I've eaten my blood sugar is gone from wherever it was, you know, 100 and now it's it's 180 and on my CGM is telling me I got two hours up. And then all of a sudden, I remember to tell the, the Omnipod five, hey, by the way, I ate 45 carbs. So you're by doing that by not letting it know that food is happening when it's happening. It just thought you shot up out of nowhere, and it tries to stop it. And now you're putting the food in and telling it Oh, no, there was food here. But you're telling it that there's food at seven o'clock at night when really the food existed at 630. And then that kind of throws things off is that I understand that correctly?

Cari Berget, MPH, RN, CDE 33:24
Yeah, yeah. Yeah, the only thing I would add to that is, it's just that the time it's the time doesn't really matter. So like the algorithm doesn't really care when you like to eat breakfast, lunch or dinner, like it's not going to learn that it's not going to learn, oh, Scott always eats lunch it at seven, or dinner at seven, you know, yeah. But if you, like you said though, if you don't eat him, if you don't Bolus for a meal, your blood sugar will rise. And the algorithm will respond, you know, it will respond and try and increase the insulin delivery, the automated delivery, right? But the other but what happens if you put the 45 grams in an hour later, you've got a bunch of insulin on board now from this automated delivery, then you put in the 45 grams, it's just going to calculate, you know, based on your carb ratio, which is going to be too much because now you already had this other insulin in there. So it does create this yo yo effect because if you come in with the meal Bolus after, it's going to likely be too much. And then you're going to you're going to crash down and then you're going to treat that low and then you're going to rise up. So that's where it goes back again to the pre meal Bolus is is really important. Yeah, because but what I what I was saying before, it was actually more than if you just miss the Bolus altogether, the total daily insulin calculation will start to be be off to okay, it doesn't you don't give those boluses it's not going to know that you require the amount of insulin that you require.

Scott Benner 34:55
See, that's a bigger picture idea that's important. It needs to understand like I guess in this same breath. If you were a really high carb person for three days, and then decided to eat very low carb for three days, the system isn't going to magically know that you stopped eating 150 carbs a day versus now you're having 50 or something like that. Right?

Cari Berget, MPH, RN, CDE 35:15
Right? No, it won't. But it will update your total daily insulin every time you change your pod. So this is a very important point, because, you know, especially with kids, which is what you know, I work in pediatrics. And so kids grow and their insulin needs change all the time, constantly. And that's expected. And so a lot of people will ask, well, how, if it's based on total daily insulin, like how does it adjust as my kid grows, or, you know, needs more insulin, and it does that by updating the total daily insulin with each and every pot. So every pod, it's going to change the adaptive Basal rate based on the more recent total daily insulin, so it will adapt over time to changing insulin needs.

Scott Benner 35:59
Okay, so this first pod is on and it's collecting data, it doesn't know anything except the settings that we've given it. And it's just living with you. And it's seeing what you're doing. And it's seeing what's happening. After that first pod is done, you move to the next one. And that's where you really start seeing the system working a little more, right, that very, very first pod is a is a collection day, or days Excuse me.

Cari Berget, MPH, RN, CDE 36:24
Yeah, and it's, it's operating more conservatively, conservatively with the first pod, because it's only estimating your tea, it's guessing your total daily insulin. And then in so because of that, it's just more conservative, it's a little more constrained on how, how high the adaptive Basal can go how much it can increase the insulin. But then when you change, and you go to the second pod, it starts using your actual total daily insulin, and then those constraints aren't, aren't there anymore. So I see.

Scott Benner 36:55
Carry, I've been told something by my my little birds. And I want to know, if you see any value to it at all, they say, that first pod instead of going the full 72 hours, they say change it after 48, because it's learned everything it's going to learn and you want the next pot to get moving to have you heard that at all?

Cari Berget, MPH, RN, CDE 37:14
I haven't directly heard that. But my guess is that comes from the fact that you know, what's required for the system to start using your actual TDI instead of the estimated TDI after the first pod is at least 48 hours of insulin delivery and A pod change. Okay, so that might be where that comes from. But in my opinion, I don't, I don't know that I would worry too much about that. You certainly could change it after 48 hours and like, make it start using your actual TDI. But there's also concerns of like, do you, you know, do you really want to change your pod earlier than you need to you only get a certain amount of supplies. So I don't think it's essential, or will make a huge difference. But certainly could.

Scott Benner 37:55
I just wanted to get that in there because the internet always thinks it knows. And so I wanted to see what you thought. Thank you very much. All right, I have some questions here. Actually, I want to thank existing podcast listeners, they sent out a ton of questions for this. This person says, I've read that the first pot operates at a reduced Basal rate. Is that that true?

Cari Berget, MPH, RN, CDE 38:17
I mean, reduce from what I don't, and I'm not sure that that's actually true. I mean, what I would say is the first pod operates off of more conservatively than it will in subsequent pods. And I would say that the maximum delivery is more constrained. But I wouldn't say that it is operating off of a reduced Basal rate, because the adaptive Basal rate it determines is based on the total daily insulin it estimates. So a lot of that is based on what you have initially programmed for your Basal program,

Scott Benner 38:50
in a perfect situation, you're gonna put this first pot on, and you're gonna let it do its thing, you're gonna live your life and let it learn. Is that correct? Yes, yeah. What if you get into a situation where your settings were way off when you got started? So you're seeing a high blood sugar that you're just not okay with? Do you come in and correct it?

Cari Berget, MPH, RN, CDE 39:08
Yes. And I would encourage, especially in the first couple of weeks, as it's getting, you know, adapting and adjusting to your total insulin needs. If your glucose is high, give, give a correction Bolus, it all it can do is help because it does two things, one should help bring your blood sugar down. But then too, it's it's adding more insulin in to the total daily insulin. And so you know, that's going to increase the total daily insulin and then with the next pod, you're going to have a higher baseline adaptive rate, and it's all just going to balance out from there. So the principle of giving correction boluses really, really helps. But can I add one more thing about correction bonuses at this point? You're

Scott Benner 39:50
the only one here really, I'm just okay, if you don't, we're pretty dumb. You know what I mean? Yeah.

Cari Berget, MPH, RN, CDE 39:56
So, okay. And this gets to what you were saying before, a little bit. In that, you know, people who live with diabetes really figured out how to make their insulin delivery work for them. And there's a lot of different ways to get there. As you mentioned, when you're using a manual pump therapy, and the difference with an automated system is that you now have insulin delivery going on that you aren't in charge of anymore. And so my best advice for giving correction boluses is to follow the Bolus calculator recommendation. And I know that's really hard for for many people, because you know how much you need. But with an automated system, you can have a lot of insulin on board from the adaptive Basal increasing that you just may not be acutely aware of. Yeah, so what what's great about the system is if you're using the Bolus calculator, any insulin delivery that is above the baseline, so this baseline I told you, the system calculates for you, it will factor that into the insulin onboard. Point being you can see how much insulin onboard is active. And that includes the automated Basal, which is also different from standard pumps where typically Basal insulin is not incorporated into the insulin onboard calculation. And it is now if it's, you know, being given to deal with hyperglycemia. So, you can follow the recommendation and just be advised that the the correction dose may seem smaller, you know, a lot of people will say to me, oh, my gosh, this thing thought said, I needed point five and I, on my other pump, I would have given two units for this. And I have to tell them well, on your other pump, your basil was stupid, it wasn't helping you like it was stupidly delivering point five units an hour, no matter what your CGM was doing. So just keep that in mind and try to work with with the system and not against it. And that will really help with frustration, but also with getting better outcomes to

Scott Benner 42:00
carry Listen, may I make a mean, let me just be honest here for a second, I fought it. In the beginning, I was like, that's not what I would do. Or that's not what I need to have happen. Or and it really did just eventually occurred to me, I was like, this thing is gonna do stuff. I'm not going to understand it all. And if it works great, why do I even you know, you know, why am I fighting. And I was just applying what I knew prior to what was happening now. And it really did take me longer than it should have to say to myself, This is not an apples to apples situation here. I am not doing manual pumping the way I used to. That's not what this is. This isn't even another automated insulin delivery system, right? Think because they all work differently. I mean, there's a number of them that are available, and not one of them is accomplishing what they're accomplishing in the same way. And so I did find myself having to put away some of my old tools that I thought worked really well. And and look at on the pod five more and try to find the tools that I thought worked better with it. Yeah, you

Cari Berget, MPH, RN, CDE 43:03
may need to find some new tools, you know, and you will, but I think that that's, that's really, that's really the key, I think. And in admit it, I mean, that's hard to do. I mean, you know, when you've been spending years and years and years, taking care of diabetes, and then sometimes you'll you'll have to let those things go. But that can be in that can be hard to let those things go. So I usually tell people, you know, the system needs time to adapt to total daily insulin as far as thinking about expectations of like, you know, how long is this going to take to get used to this? Most people are asking, like, how long is it gonna take for the algorithm to figure out how much insulin I need? And while that's true, there's another piece, it's how long do I give myself to get used to a new type of insulin delivery. So that's another piece of it is it's you know, you as the user, you have to figure out where you need to let go and let the system do its thing. And then where you need to give insulin and do your part in how to find this, like, beautiful harmony, where the two of you work together the system and you you know, to get the best out of it. Yeah,

Scott Benner 44:11
I think we'll jump into that. We'll do a settings episode where we'll talk more about how to make those adjustments and even how to talk to your healthcare provider about making those adjustments. I'm just, I'm glad you brought it up. Because I feel like what I need to know like if I'm going to recap here is that I'm going to come in with as good a settings as possible. And could that even mean that I start on the pod five in manual mode for a couple of days, say I'm not coming from on the pod dash, maybe I'm coming from MDI or something else, right. If I start in manual mode for a little bit, I'm looking for that stability, right? It's my basil at a good place where I'm held. I mean, the way I talked about on the podcast is Bezos job is to hold you at a number, right and that number is, you know, it can be whatever you you think it is, but if your basil is set correctly, it will hold you away from food and active insulin. Add a number at 90 at 100, you could use a little more basil and have it lower, you could use less basil and have it higher. But stability is the important part. If you don't have stability, then your basil is not close to being correct away from food and away from an act of Bolus, you know, your blood sugar shouldn't be dropping very harshly, you're jumping up and down your basil. I mean, Basil is everything. I think it's the it's the bedrock of diabetes. And it's the way to, it's the way to have success is no matter what you're using. So maybe I even start on the pod five, in in manual mode for a little bit, it's still seeing if my basil is working, it's still seeing my bonuses and my corrections. And it seemed my total daily insulin, that would work as well. Right?

Cari Berget, MPH, RN, CDE 45:42
Yeah, I mean, you could do absolutely necessary, right, right, it's not necessary. And the only other caution I would give you is that, you know, the system isn't using the Basal rates themselves. So testing it, that'll give you a really great Bayes Basal profile for if you're using it in manual mode, right. But what's more important for getting the best start in automated mode is really just the total insulin. And so, you know, if your settings are just have gotten off over the years, like, let's say, you know, per your programmed settings, you only get 25% of your insulin from the Basal rate, I wouldn't recommend starting Omnipod five, with it like that, you could go into manual mode, tweak it all up, you know, test it out, if you want it to, but you could also just talk, look at what your actual total insulin is. Because if you have, you know, relatively, you know, good control that you're happy with overall, you have a total amount of insulin that you're receiving. And that seems to be working as far as the amount. So you could just re estimate what that basil really should be based on the total insulin, can I

Scott Benner 46:56
pick your brain a little more here on that? Yeah, so if my total daily insulin is whatever it is, but my average blood sugar is 180, then my total daily insulin might not be enough.

Cari Berget, MPH, RN, CDE 47:10
Right? Right. And that is a excellent point. Because, and especially I mean, I see this all the time, it's, I think this is very, very common in youth, even, especially, most kids are not getting enough overall insulin. And so I will sometimes when, because what I do at my clinic right now in prep for everybody starting up the system is I review, I try anyway, to review everybody's current pump settings, and suggest different settings for them, and work with them to you know, what they should programming Omnipod five, and if I see that somebody's, you know, got an average blood sugar of 200. And their last time in range was, you know, 45%, then I'll look at what their their Basal is. And if it's, if they're over Bayes alized on paper, as in like, Oh, they're getting 60 70%. But really, that represents more of an expected TDI, total daily insulin, then I probably just keep it. So that is an excellent point that just because on paper, the split might look off, it's all relative to whether the total daily insulin that you're getting is actually the amount that you need. Yeah, it

Scott Benner 48:25
just occurred to me that you might be, you know, doing great, you know, and thinking I'm doing fantastic. You know, my blood, my a one sees a seven and a half, and this is my average, you know, insulin intake, and then all of a sudden you put on this, you know, the Omnipod, five, and you put on target of 110. But you give it settings that led to a 170 or 180, those two things are in Congress at best. So, yeah, so that makes, there's going to be an adjustment period is what I keep thinking to say.

Cari Berget, MPH, RN, CDE 48:55
Right? Yeah. And it all starts with, I think, if you just remember that it really all starts with what's your total daily insulin? either? What is it that you're getting? Or? Or how much is it? Would you really expect that you would need? Because, yes, it is different for everybody. But it's not a complete mystery. Like there are ways to estimate how much you really should be expected to be getting based on just simply based on weight. So like, if you're really not sure that the amount you get, whether it's really close to optimal or not, you know, talk with your with your doctor. And it'd be like, what, how much should I probably actually begin, you know, and go from there.

Scott Benner 49:36
So, a minute ago, I talked about being in manual mode. And I just wanted to point out that even if you're in manual mode, the algorithm is paying attention to your total daily insulin there. But in manual mode, there's no algorithm to stop you from getting low. It's just you're using an insulin pump just like a regular old insulin pump then, and I didn't I didn't I didn't say that clearly enough. So I wanted to we ever A couple of things here, a person who started on the pod five, and they had, you know, they were like, well, I wanted to be more aggressive. And so they get to their fourth pod, and they start making all these changes to their settings, thinking, this is going to make it more aggressive, I'm going to increase my Basal the carb ratio, the insulin sensitivity factor, etc, on and on, right. Except that's not how this works. Like after that first pod, you put that first pod on the algorithm is learning. And it's adjusting those things. So if you made a change to one of those settings, that change would only be concrete if you were in manual. That's correct, right?

Cari Berget, MPH, RN, CDE 50:41
Partially, I mean, if so when you're in automated mode, I cannot stress enough that it does not care what Basal rates you have programmed. Even if it's the first pot, it doesn't care about the actual Basal rates, the profile itself, it's concerned about the total only to help it estimate your total daily insulin. So I just want to make sure that's really clear that even with the first pod, the actual rates themselves and the different ones you put at different times of day, it does not use those in any way. So no changing, no changing Basal rates at all, when you're using automated mode. Those would only be used if you were in manual mode. Okay. But for boluses, if you change your insulin to carb ratio, if you change your correction factor, that will change the amount of insulin that's recommended for your Bolus doses. And that can actually make a really big difference in your overall glycemic control. Really fine tuning those Bolus doses, because that's what you have the control over, it's your job to give those boluses for meals. And so focusing on those actually, I would highly recommend because it can make a huge difference in your overall blood sugar control.

Scott Benner 52:02
Okay. All right, thank you. I just, I'm trying to put myself in the position of somebody who just comes at it new and doesn't, doesn't quite understand what's going on. You want to do one more question? Or do you want to move on? Let's see.

Cari Berget, MPH, RN, CDE 52:17
Do you have questions? It's good for ya. It's like sending a man you know, then they want them answered. I think it's, that's good.

Scott Benner 52:23
I love you. You're very nice. I'm having a good time. It's our first time recording together. And I feel like we're doing well. What do you think give some credit for Yeah,

Cari Berget, MPH, RN, CDE 52:32
we're feeling great. I'm feeling more and more normal. And the more we go,

Scott Benner 52:36
you're not as nervous any longer. Cool.

Cari Berget, MPH, RN, CDE 52:39
Okay. Settling in.

Scott Benner 52:42
I'm oddly calm, just so you know,

Cari Berget, MPH, RN, CDE 52:46
you do seem very calm. I'm like waiting for the I don't know, waiting for you to yell at me about something.

Scott Benner 52:55
Okay, so carry, like, let's just kind of dig in. Before we move forward, let's add a little more clarity to total daily insulin in manual mode. So, okay, do you? Do you feel like we've covered it all? Or do you think there's more there? Like, I don't know, what to add to what you've said. So maybe you did.

Cari Berget, MPH, RN, CDE 53:16
I mean, I think the point you made of just making it clear that Omni pod five, it the pod tracks total daily insulin, whether you're using manual mode or automated mode, it's always tracking that. So if you went out of automated mode into manual mode, for whatever reason, for you know, a week, two weeks, a month, a year, it's still tracking it. So then if you switch back to automated mode, it's it's just going to pick up with that total daily insulin, maybe is the point there.

Scott Benner 53:49
Carrie, I believe that was a perfect explanation. Thank you very much. All right. So let's roll through a couple of questions that I have pretty simple answers. person asked, Will it be possible to decrease to decrease the target blood glucose level from the current built in minimum values? Now I know the answer to this one. So no,

Cari Berget, MPH, RN, CDE 54:07
no. No, the target is 110.

Scott Benner 54:13
Yes, yeah. And you can go higher if you so desire, up to 150. I think we've said already, all the way up to 150. If you want to target a 90 it, it's not going to do that.

Cari Berget, MPH, RN, CDE 54:25
It will not okay. All right. But can I just have one thing about that, please? Because I have stuff to say to go. Yeah, the target thing is fascinating. For me, because I work with a lot of automated systems, not just Omnipod five, and this is something that comes up with every single one. I would just realize that this target is the brains, it's the brains of the algorithm. It is not i It's not saying that your blood sugar is going to be at 110 all the time, and that it's never going to be under 110 or that you couldn't possibly ever be under 110 it's just every time The algorithm makes a dosing decision, it's doing it trying to reach 110. That doesn't mean you're always reach 110 Or never go below it. Does that make sense? So I would focus, when I think about adjusting the target, since this is the first system where you can do that, look at it more from the bigger picture. Like, if you're running high overnight, and your target set at 130, drop it, because then the insulin is gonna give more in the algorithms gonna give more insulin. So think of it more as like, if you want to try and make the algorithm more aggressive, because you're running high, overnight, drop the target, if you're running lower than you want to be, I don't even wherever that might be, like, I just worked with someone the other day who was running at five overnight, which some people would love, he, they did not love that. And so we bumped up the target, you know, so in it, it helped bring them up a little higher. So, think of it more pragmatically like that, like, it's a way for you to influence what it does and less focus on what the actual specific number, it's

Scott Benner 56:07
sorry, listen, I think if people listen to this podcast, they'll understand this. And if they're new to it, and they're finding it because of the only pod five episodes, and this might be a little lost on them for a moment. But there are so many variables that go into how insulin works for you. So if you're a person who does a set amount of exercise every day, your insulin will probably be more effective. If you're hydrated, well, it will probably be more effective than if you're not hydrated. Well, if you're experiencing a fluctuation of hormones, say, at one point, but you aren't at another point, the insulin is going to have different impacts. And so it's a lot about your behavior, as far as what you know about that, and what you and what you ask of the system. My point being, if you go along, eating, you know, a house salad for three days, and then on the fourth day, decide, I'm going to have a half a pizza, well go for it, except, just understand that if you are a person who has been eating how salads for a year, your your insulin to carb ratio, for example, is probably more tied into that style of eating. So if you're gonna slide into a completely different style of eating, all of a sudden, that insulin to carb ratio might not be the same for pizza, as it is for something else. And I'm getting a little outside of you know, I'm not a health care provider and etc. But you do need to understand how insulin works, I guess, is what I'm saying. And if you don't, you're gonna run into problems. And you could turn to, you know, and think it's, you know, you could, I don't know, you could chase ghosts around, you could think you see what's happening, but you might not be.

Cari Berget, MPH, RN, CDE 57:46
Yeah, and then I would just end that statement with I mean, I think that people give more concern to the target than I think is necessary. That it's not as big of a deal that sometimes it can be beat out to be. And so I try to encourage people not to worry too much about that back to what you were saying, just focus on doing what you can to get get the best control that you can, and the target is not really the most important factor here.

Scott Benner 58:16
Well, yeah, my only point was, is that if you're if you're targeting 110, and you know, your blood sugar's rising, and the system says, Oh, it's coming, you know, that's happening, I'll do what I did yesterday. And that'll work except that you've made some, yeah, here's, here's a better way to think of it maybe, if you are getting low overnight, for example, and the algorithm is stopping that low by taking away basil, you may have had less basil than your body really needs, you know, four or five o'clock, six o'clock in the morning, because of, I don't know, a bed Bolus, she made it about three o'clock, who knows. But when you wake up in the morning, the algorithm doesn't know to you know, that your toast is going to hit you extra hard now, because you really haven't had your full Basal for the last three hours. Like you kind of have to know that. And yeah, you know what I mean?

Cari Berget, MPH, RN, CDE 59:08
Right? That's a really good example, because it does show the interaction between, you know, things that the algorithm doesn't, and that's a perfect example of, of that kind of perspective. And that, oh, what's the word like, kind of the vision the that you see that that insight of, oh, look, I'm about to eat breakfast, I see that the system has suspended my basil for the last hour. And if I when I eat this toast, it's going to have a huge impact because I've got very little if any insulin currently working in the system. So in those cases, you know, Pre-Bolus saying as far ahead as possible, makes a really big difference because, you know, you get you make sure you have some insulin starting to work before you, you know, eat get those carbs in the system

Scott Benner 59:59
x One. I feel like care. Tell me something. I feel like we've done a good job here. Do you not agree?

Cari Berget, MPH, RN, CDE 1:00:07
I do.

Scott Benner 1:00:10
You're looking at the same notes I'm looking at. And I feel like we covered so much of it. Without getting to it in the notes, does that makes sense to you? Sure.

Cari Berget, MPH, RN, CDE 1:00:18
I, I haven't even looked at the notes. So I mean, I'm glad that you think we're covering it

Scott Benner 1:00:23
carry on me.

Cari Berget, MPH, RN, CDE 1:00:27
I mean, I've looked at the notes, but I didn't want to make a bunch of noise there right here. But I, yeah, I've seen them before. Yes, we're doing we're we're doing great.

Scott Benner 1:00:35
Okay. So I just wanted to sit down for a second and go through a couple of ideas about just making sure people understand what the adaptive Basal rate is. But I feel like we've done that. No, I'm just gonna run through them. And you tell me if you think we've done it, adaptive Basal rate is a baseline for automated insulin delivery. It is the insulin delivery calculated in units per hour than the smart adjust technology continues to change over time as only part five is used. And this is all of course, based on your total daily insulin. Yes, okay. Adaptive Basal rate is based on the total amount of Basal and Bolus insulin delivered in a 24 hour day or the total daily insulin again, updates with each pod change based on the previous insulin history to best match the user's needs.

Cari Berget, MPH, RN, CDE 1:01:21
That is true. I'd like to add one thing, this is a very common question. Can you what how do you know what your adaptive Basal rate is? The short answer is you don't? And there's no way to know you can't find it out. So we should probably get that out of the way.

Scott Benner 1:01:37
Yeah. Okay. And if for some reason, and I know, it's not a not fun to think of, but if for some reason your controller explodes, like you drop it in the pool, or you throw it across the street for some, I don't know what you might do to make it break apart. But if that happens, you are starting over again, when that next pod goes on. Yes, yes. Yeah. So I want to point out, always know, what you're like, know, your settings as best you can, right? Right. Like whatever you put to that thing, the first time write them down somewhere, don't just, you know, don't just go I don't know, know what your total daily insulin is like that, I think is incredibly important, right? Because then at the very least, even if you're just like, I don't know, any of these settings anymore, you can at least look at the total daily insulin, you could say to yourself, Okay, let me just take 50% of this and make it or break it up over 24 hours and make that the Basal. And I'll take the rest of this, and I'll look at some of my carbs, and I'll figure out my insulin to carb ratio. And these would be good restarting settings. That's a very basic way to think about it. But but at least you'd be getting that total daily insulin set in there. Does that make sense to you?

Cari Berget, MPH, RN, CDE 1:02:43
Yeah, no, it does end. But the only thing I would add to that is, you know, your insulin needs can change over time. So depending on how long it's been, since you started, before you broke your controller, I mean, if it's been a year, and your manual mode, Basal rates haven't been changed at all, they might be slightly off, if your total daily insulin has actually gone up any

Scott Benner 1:03:08
number of 1000s, changed your activity, a few pounds, lost a few pounds, etc, etc.

Cari Berget, MPH, RN, CDE 1:03:13
So the best way to really keep track of that information is to have your Omnipod five linked to gluco. Because this is one of my favorite things as a healthcare professional, because if you link your Omnipod, five to gluco, which is a data management system that you can summarize, you can get reports that summarize your insulin delivery and glucose control, then you can just log if you break your controller, you can log into gluco. And you can see what the settings were, and how much and you can see how much what your average total daily insulin has been okay, and so, and that it'll walk you through doing that when you go to the setup screens. So I highly recommend doing that and not skipping that part. Because it's, it's really cool. And then once you're set up, it will automatically upload the pump to gluco via the cloud without you having to do anything, you don't have to manually upload it. And then when you show up to see your your doctor, the data is already there, and everyone is so happy.

Scott Benner 1:04:15
I like not having to do anything that makes sense. So so keep track on your own use paper. If you still have a pencil on your house or use your computer or your phone. Most people just use their phones, right Carrie I sound very old now when I send someone to use their phones. Yeah. So keep track of all your settings and and utilize glucose. Glucose is free, right?

Cari Berget, MPH, RN, CDE 1:04:36
Yeah. And when you go through the setup, it will it'll walk you through pairing it and if you don't have a Google account, it will walk you through like creating one and everything.

Scott Benner 1:04:44
Okay. What can I see? So you've had a lot of experience with with the system and with the controller. So what can I see as a user day to day like what do I have access to?

Cari Berget, MPH, RN, CDE 1:04:57
On the controller? Yeah, like Can the app itself?

Scott Benner 1:05:01
Yeah, like, like, do I just see oh, it made a Bolus or do I see, you know how much it used?

Cari Berget, MPH, RN, CDE 1:05:07
Yeah, so what you can see on the main screen is you can see this current CGM glucose value and trend arrow. Because you've, you've paired the transmitter into your Omni pod five, so it can, the pod will send that duck that information to the PDM. So you can see the CGM data on the Omni pod five app. So you can see the CGM value and current trend arrow, you can see how much insulin on board you have. And you can see your last Bolus, it's very similar appearance to the dash interface very, very similar. So you can see the last bullet you gave and how much that was. And then there is a way that you can expand the CGM graph, you can, you can see the last three hours of the CGM values and on that graph, you can also see the insulin on board and the current CGM value as well. And then you can get a visual representation of the automated delivery. So at the bottom of the CGM graph, you can see if you're in automated delivery, or manual delivery, and then you can also see visually if the algorithm is at maximum delivery, or suspension. So you can see things categorically, but it won't show you the exact amounts. Okay. However, you could go to the history, if you want to see each five minute, you know, micro delivery that, you know, or adaptive Basal delivery, if you are so inclined. I mean,

Scott Benner 1:06:41
I think it's, it's pretty obvious, right, that the system is set up to try to take away your burden, and so that you're not constantly worried and looking and, you know, overwhelmed. I mean, I think, you know, I'm going to put my, my personal opinion in here, I think Omnipod five, for most people is going to be an incredible improvement for them. You know, like just an incredible improvement and, and getting it set up and getting it rolling is the crux of the whole thing, right? It's just why we're talking about it, because what's beyond this should very well be some fairly smooth sailing, where the algorithms learning and keeping up with you and making adjustments where it's necessary. And even you're learning as you go along. How to how to Bolus for your meals better, or how to think about things as far as the way the system works. And, and hopefully you're, you know, you're you're, you're feeling a weight lifted at some point.

Cari Berget, MPH, RN, CDE 1:07:31
Yeah, I think so. I mean, I think there's a lot of potential here for a lot of people to get much better blood sugar control than what they've been able to, you know, to get on a manual pump, as well as more stability. Because the other thing I think we often don't talk about is glycemic variability, just the ups and the downs. So sometimes the average looks fine. But when you really go and look at it, you know, yeah, you're spending 50% of your time high and 50% your time low. So this helps you kind of find the balance and be more stable with less big fluctuations. Yeah. And sleep. That's the thing,

Scott Benner 1:08:08
you still might think, oh, go ahead. Go ahead.

Cari Berget, MPH, RN, CDE 1:08:11
I was gonna say that's, that's the thing, especially for for parents. And you know, I worked in pediatrics, I always want to give that disclaimer, I don't really know much about adults. But for parents getting to sleep at night is the constant theme that that I hear, because not only is the blood sugar improved overnight, it's the stability that you just get to sleep the whole night. And that's just not something many parents and kids really experience so

Scott Benner 1:08:40
I have never slept so well, as I have, since some automated insulin delivery has become a reality. So and it sounds

Cari Berget, MPH, RN, CDE 1:08:49
overnight, it's really very exciting. If you think about it, it's half of your day. So I mean, it's, it's also super encouraging that, you know, the nighttime tends to be relatively, like, really reliable, like you can really rely that for almost everybody, like it's just it is gonna help overnight

Scott Benner 1:09:07
for sure. I think also, he had kids that go on sleepovers, or, you know, adult who's got a real heavy sleeper or no, you know, next to them or nobody next to them, they're on the road. I always think that being an adult with type one and living by yourself has got to add an extra amount of anxiety to your life. You got kids going away to college, all these things. It's just, it's, listen, I'm a huge fan of the stuff I have been saying on this podcast for years, that you do not want to get stuck in how it's done. Because, you know, people are gonna make advancements and you don't want to be back with like, Oh, I'm still peeing on this test strip. Is that not the way we're doing it anymore? You know? And so this is, it's a big deal. It really is. I can't I don't think I can quite say enough. What a big deal. Yeah,

Cari Berget, MPH, RN, CDE 1:09:53
it's a really exciting time, you know, and it's only gonna get more and more exciting as we go. I think I think we're just at the beginning. Okay,

Scott Benner 1:09:59
we're gonna hammer through couple of questions here. And then we're gonna we're gonna button this up, try to keep it around an hour, right? Okay. Realistically, how long should I expect it to take for the system to adapt, optimize the insulin delivery, do its thing, what did you see during the, during your time with it,

Cari Berget, MPH, RN, CDE 1:10:17
I think a couple of weeks is a is a good expectation to set for yourself that you've got to give it a couple of weeks, you know, three or four pods for it to really get some time to adapt. And then the other thing is that it's not even just the adaptive basil and figuring out the total, you know, giving the algorithm time to figure out the total daily insulin. That's obviously a huge part of it. But it is very, very common. And this has been true with every automated insulin delivery system I've worked with, you almost always need stronger carb ratios on an automated system compared to a manual system. And again, like, work with your doctor and look at this stuff, and talk about what your carb ratio should be. But if you're running high after meals, don't hesitate to reach out because there is something that can be done. Oftentimes, you just need to strengthen the carb ratios. And it's not a bad thing, it doesn't mean the system's not working. It's expected it's it's a dynamic Basal delivery, that's totally different than a manual pump, where it's just statically delivering. So because it's dynamic, you're going to have periods where it's turning off and then turning back on. And oftentimes leading up to a meal, you have less insulin on board, because there's been suspensions, because you're getting back to that target. And so, because of that, naturally, you're going to need a stronger carb ratio than maybe you used before. So keep that in the back of your mind. Because after those couple of weeks, if you're still running high, or higher than you'd like or high after meals, specifically, reach out to your doctor and in fine tune those carb ratios because it can make a huge difference.

Scott Benner 1:11:58
Well, it really does depend, I guess, on the person or its individual, how long it's going to take days, weeks, plus all the other stuff that we just spoke about.

Cari Berget, MPH, RN, CDE 1:12:06
Yeah, I would agree with that. I mean, everything's individualized. But I would say, you know, give it a couple of weeks. And if you're not where you want to be, you know, reach out to your health care provider to help you because there's probably, you know, some Bolus settings that can be adjusted to really help you get where you want to go.

Scott Benner 1:12:23
Let me ask you a question. Because you've seen so many people on it attached to this idea. Is there something I can be looking for that shows that we're moving in the right direction? Like, when's the when's the part where I go? Ooh, maybe I will call my doctor here. I think we're, we're at a point where maybe we've plateaued?

Cari Berget, MPH, RN, CDE 1:12:41
Yeah, that's a great question. Ooh, that's a hard question. Um, I mean, I'm a big, big picture person. I think time and range is the most important thing. And so if your timing range is not getting to where, you know, you want it to be, and you should be able to get it, you know, above 70%, and meet those targets. You know, reach out and, and help have your doctor help you get there.

Scott Benner 1:13:07
Okay, I guess in in the end, you can paint that picture to your doctor as well. And let them help you make the decision. If you can't decide if you're seeing Yeah, man or not. Carrie, I find that thinking about insulin is like a time travel movie, right? Like insulin I use now is for later. But really insulin that's happening now was from before, and it always helps to have another person to talk about that with. So you don't get a little lost. You know what I mean? Like, it's great to talk to your healthcare provider, your nurse practitioner, whoever it is that you're making those decisions with, because it's nice to just have another person to bounce it off of sometimes because, you know, like, at some point, you're sitting in the theater, and you're like, I don't understand how to slow those down. Like, you know, like, you need somebody else to chat with about it and, and make good sense of it. You sound like you would be a good person to do it. With.

Cari Berget, MPH, RN, CDE 1:13:56
Oh, well, thank you. I really enjoy it. And I do it a lot. So love working with people to get those carb ratios. Right,

Scott Benner 1:14:03
right. So if I even if I start the pod, and I'm like, Oh, God, I used all the wrong settings. I just might have to wait a little longer for it to figure it out.

Cari Berget, MPH, RN, CDE 1:14:11
Yeah, exactly. Yeah, you might just have to wait a little longer, but it will get there. It will all be okay.

Scott Benner 1:14:17
Okay, so time settings. bolusing. You know, the way you need to Bolus whether that means amount or timing, timing and amount, such a big deal. And then just let Omnipod five do its thing.

Cari Berget, MPH, RN, CDE 1:14:32
Yeah. And can I make one more comment about that? So the other thing is, like I already told you like, I highly recommend following the Bolus calculator for correction doses so that you can work with the system and not against it. But if you find that it's always recommending zero, and you're still running high, again, you don't have to just sit there it could be that your correction factor is two Hi, it needs to be stronger. I find that correction factor is like the forgotten about setting often. In pump therapy, you know, we're all in manual therapy, we're always tweaking the basals. And we often change the carb ratios, and we hardly ever do anything with the correction factor. And so I see this, you know, 15 year old and they have the same correction factor from when they were six

Scott Benner 1:15:22
was 350 points. Yeah, it's like, I don't think

Cari Berget, MPH, RN, CDE 1:15:25
that one unit is going to drop the 300 points anymore, you know, so the correction factor, yeah, it needs some attention to sometimes, you know, yeah.

Scott Benner 1:15:34
And I know it's, you know, it's, it sounds super simple. But the idea of, you know, if your correction factor is one unit moves you 50 points, but you haven't looked at it since you were five years old back when it was one unit moved to 350. Now you're trying to adjust the high blood sugar, and you have no hope of that working. And on top of that, you've told the algorithm this should work. And you've given a bad information.

Cari Berget, MPH, RN, CDE 1:15:59
Yeah, isn't the Bolus calculator is just going to use whatever is programmed in there to as part of his calculation, so Right, yeah, it makes a big difference.

Scott Benner 1:16:06
Okay. Well, I think this is a great time to break and say that we hope we see you in part two, where we're going to do a deeper dive on settings.

I'd like to thank Carrie Birgit for being on the show today and sharing her knowledge about the Omni pod five with us. And a huge thanks to the listeners of the podcasts who shared questions and comments that led to the building of these three episodes. If you're interested in getting started with the Omni pod five, we're learning more about it, go to Omni pod.com forward slash juicebox. And don't forget that these episodes will be available in your audio app forever. But you can also find them at juicebox podcast.com forward slash Omni pod five. This episode was just part one of a three part series, you still have Omni pod five pro tip settings and Omni pod five pro tip connectivity to listen to. If you found this episode helpful, and you're new to the podcast, be sure to subscribe or follow in your audio app for more diabetes and on the pod five content. Thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. A huge thanks to athletic greens and contour for sponsoring this episode of the Best of the Juicebox Podcast. Get started today with that green drink ag one from athletic greens, athletic greens.com forward slash juice box you and I could be doing the same thing every morning together except not really together. But I mean, we you know what I mean? And of course, you want you need you deserve an accurate blood glucose meter contour, next gen at contour next.com forward slash juicebox. When you click on the links, you're supporting the podcast and I appreciate it very much. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#899 Diabetes Pro Tip: Transitioning

Diabetes Pro Tip: Transitioning

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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

Scott Benner 0:00
Hello friends, and welcome to episode 899 of the Juicebox Podcast.

My diabetes Pro Tip series for type one diabetes began in February of 2019. Today I'm adding another episode. Jenny Smith and I are going to be talking about transitioning. We're going to do an overview of transitioning from your blood glucose meter to a CGM, from MDI, to pumping from pumping to algorithm pumping. And at the end of the episode, I'm going to add feedback from Juicebox Podcast listeners about all of these topics. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. If you'd like to help type one diabetes research, all you have to do is complete the survey AT T one D exchange.org. Forward slash juicebox. The T one D exchange is looking for US residents who have type one diabetes, or are the caregiver of someone with type one to complete a very short and simple survey. The answers that you give will help move type one research forward T one D exchange.org. Forward slash juicebox.

The diabetes Pro Tip series from the Juicebox Podcast began on February 25 2019, with an episode called newly diagnosed restarting over after that episode 211 was all about MDI episode 212 all about insulin, Episode 217 Pre-Bolus Singh, Episode 218 Temp Basal 219 Insulin pumping to 24 mastering a CGM to 25 Bump and nudge to 26 the perfect Bolus to 31 variables 237 setting Basal insulin 256 Exercise 263 fat and protein 287 illness injury and surgery episode 301 was glucagon and low blood sugars episode 307 Emergency Room protocols episode 311 long term health 350 Bumping nudge to 360 for pregnancy 371 explaining type one episode 391 was glycemic index and load 449 postpartum 470 weight loss 608 Honeymoon 612 female hormones and today episode 899 transitioning, you can find these episodes in your audio app Spotify, Apple podcasts or anywhere you get audio. You can also find them at juicebox podcast.com. And at diabetes pro tip.com. As always, these episodes and the entire podcast are absolutely free for you to listen to the information inside of this podcast. And more specifically inside of this Pro Tip series. This information is at the core of how my daughter has kept her a one C between five two and six two for over eight years without diet restrictions. Myself and Jenny Smith Jenny of course is a CDE who works at integrated diabetes.com Jenny and I we go over the topics go over the ideas in easy to listen to and digestible ways you can apply this information to your life whether you're an adult with type one who's been living with it forever, or a parent whose child was just diagnosed, I implore you to check out the entire series. It really will help. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy Earth sells sheets and towels and joggers and comfortable things really that's what I should have said cozy Earth has comfortable things whether it's sheets or towels or clothing. It is soft, it is warm. Unless you don't want it to be warmed I don't even know how to describe the sheets or they keep you cool or they keep you warm. Depends on what you want. I don't even like I don't know if there's a word for it but your body is temperate in it is temporary the word. I looked it up it is a word it. How do I put this? I wear my cozy Earth gear on an airplane the other day. I wasn't too hot. I wasn't too cold. When I got home. I got my bed with my cozy Earth sheets. I wasn't too hot. I wasn't too cold. Everything is soft. It feels terrific. Check it out at cozy earth.com where the offer code juice box will save you 35% at checkout The podcast has a number of long term sponsors, Omni pod Dexcom contour G voc, US med touched by type one, athletic greens. Of course, you heard about the T one D exchange earlier cozy earth. All of these sponsors are prominently displayed at juicebox podcast.com. Or in the show notes of the podcast player you're listening in right now, when you support those sponsors by clicking on my links or typing in those web addresses, you are supporting the production of this podcast. So please, if you have the need, use my link. What I would like to talk about today is transition. Just a an overview concept for this one, but transition from just finger sticks to CGM transition from MDI, two pumping, transition from pumping to algorithm. Sure, can we do that? Yeah. All right. I thought we could all thank Isabel here for having her finger on the pulse of the people in the Facebook group and knowing exactly what people ask about, and what they seem most confused about. Why don't we start with MDI, because everybody starts there, right? After you're, you're doing it for a while, like, let's put ourselves in that place. We've been doing MDI for a while it's working pretty well, or at least at a baseline. We're shooting a Basal insulin once a day, and we are shooting a meal insulin to correct blood sugars and to cover our carbs. That's the basics of MDI. Okay, correct. So then we're in a doctor's office, but I'm gonna make up some numbers. Let's, let's say our basil. It's like, I don't know, let's say our basil is 10 a day. And let's say were, I don't know, one to 10 for carb ratio. Okay. All right. Let's say our correction is one to 100. Let's keep it all very like, like that, so that it's easier to talk about. Okay, round 10 numbers and numbers, we're gonna do that. So the math makes sense when people are listening. So we're in the doctor's office, and the doctor says, you know, you might like a pump?

Jennifer Smith, CDE 7:24
Is he gonna say it just like that?

Scott Benner 7:25
I mean, if it's a lady, she might be like, You made like a bump? I don't know, like, people are anywhere in between. There's some women have more masculine voices, Jenny, this isn't the point of what we're talking about. Yeah. So they see, you might like a pump. You are. I'm guessing, gonna have a couple of different reactions. I see a lot of people scared. Oh, no, don't change something. I see a lot of people are like, yes, please, because this isn't working. And maybe this will they don't know why they think that just right, they're hoping for a change. So the first thing that's going to happen is the doctor is going to translate your Basal insulin to this pump. So Jenny, you do that math for me? I correct I get 10 units a day injection, what are they going to do on the pump for me

Jennifer Smith, CDE 8:13
most often on a pump, because it's expected that your Basal insulin which and this is kind of outside of it, but within your Basal insulin will now be given by the pump as rapid acting insulin. So that's the first thing to understand is that you're injected Basal insulin, which is a specific long acting kind of insulin will now sit in your refrigerator as a backup in case of pump failure, right? So you don't put Basal insulin into a pump. The only insulin that goes in the pump is your rapid acting insulin of any of the brands, right. Depending on the pump, company, they all have a little bit of different kind of recommendations for type of rapid insulin, but it's a rapid insulin and to translate your Basal dose of what we said 10 units into a pumped Basal delivery, you would essentially take 10 units into a 24 hour day. Right? And that translates into a a dripped amount, right? Because insulin pumps drip drip, drip drip consistently to deliver that total amount of basil that you want.

Scott Benner 9:32
Okay, so let's clean it up for people who get lost very easily. You may be injecting trusty Abba love Amira, Lantis what are the other ones,

Jennifer Smith, CDE 9:43
Basil Glar or these are all based in jail.

Scott Benner 9:46
These are basil insulins. These are now gone. You don't use those anymore, because as Jenny points out, you're going to take your mealtime or your fast acting correction insulin, put it in the pump, and it's going to split it up. Those 10 units are going to get split up Over, not just over hours, that's how the settings the pump work, right? You're gonna come up with what is it going to be like point four, maybe an hour if you're 10 a day about like that, right?

Jennifer Smith, CDE 10:10
Right, depending on your pump, all of the pumps differ in their precision of a single drip of insulin. Some pumps can drip as little as point one, one, some can drip as little as point oh, two, five or point oh, five. So it just depends. But if you broke this down 10 units a day into 24 hours a day would be a rate of about point four, two, if you do rounding, right? Yes, some pumps, you may have to round that 2.4, because they can't deliver the point oh two.

Scott Benner 10:42
And you're, you're gonna hear that if you're MBI. and think, oh, at the top of every hour, it's gonna give me point 14 incidents on but it's not doing that it's going to break the rack to wait for Twos Up over the entire hour

Jennifer Smith, CDE 10:53
over the course of the time. Exactly. Now, the other step to this calculation is that we expect that your Basal insulin you've been injecting I'm trying to think how to say it. So people don't think their insulin is not working. But when you inject Basal insulin as its type it, it will not be absorbed as efficiently I guess is the better way to say it as it would from a pump where it gets infused in those little tiny drips over a very precise amount of time, a very precise dose. So your rapid insulin in your pump gets infused out of sight. And so we usually take your base Basal dose down by about 10%. Some, some physicians even go down by 20%. But the general idea is taking your base dose down by 10%. So 10 units a day taken down by 10% is one unit less, so nine units instead of 10 units. So if you do the math there, nine into 24 gets your rate down instead of point, let's call it point for an hour, down 2.37 an hour, which again, we'd probably round down to point three, five.

Scott Benner 12:05
And you're going to want to keep an eye on that because I've seen it go either way. I've seen that be right. And it's amazing. I've seen that be now not enough insulin, and people are getting high blood sugars. And they immediately like you hear them say like the pump doesn't work like well, you gave yourself less insulin and turns out you need right. So pay close attention to that.

Jennifer Smith, CDE 12:27
It also translates into the next step. Once you've been making some notes on this 24 hour dose of let's call it point three, five units an hour. And you can say Well, it seems okay here. But then at this time of the day, I'm always high no matter what I can skip eating and I'm high I can eat and I go even higher. Well, that's when the next step is Basal testing. Right, we need to really look at it and say, where is that point? Three, five, sufficient and where is it not? And where might it be too much.

Scott Benner 13:01
And you might notice, and this, this might sound a little heavy if you're thinking of switching but you could put your pump on your belly and have a different reaction to the insulin that is if it's on your hip or your thigh, you know, there's reasons like Arden's thigh doesn't work as well as her stomach does,

Jennifer Smith, CDE 13:19
you know, neither does mine, I don't use my thighs anymore. Yeah, back of your arm might

Scott Benner 13:23
be better than your, the back of your butt. Or who knows, like right and with

Jennifer Smith, CDE 13:27
with this being new from coming from MDI, to going to using a pump, I would suggest initially utilizing and testing out within an area of the body, you know, we talk a lot about rotation, not only should you be rotating, if you're doing MDI, your injection should be going multiple different places, not just the same site over and over. The same goes along with pumping, those sites need to be rotated. If you're new to pumping, however, you really want to get an idea if your settings are fairly good. Stick with rotating around your abdomen, right? Get an idea. And then once you have that fairly well set, you can then move to upper body or the back of the arm or maybe your thigh or you know your lower back and see if you notice any difference some people do and some people don't at all.

Scott Benner 14:19
No, right? No. I mean, there's it's your body composition, hydration, how you know where it's actually going inside of you. Is it subcutaneous Is it very close to a muscle? We don't overwhelm people, but the muscle can kind of I don't know what the term is like what a large muscle group can. It kind of lessens the impact of the insulin but for the life of me, I can't think of why right now. Do you know what I mean?

Jennifer Smith, CDE 14:44
lessons? I know I don't know what you mean.

Scott Benner 14:46
I always thought that's why the thigh wasn't a good spot because it was a large muscle.

Jennifer Smith, CDE 14:51
Well, it might have more to do with how well the insulin at that site is getting absorbed. Like that's a big reason that I don't use My thighs is because whenever I tried using it, either I got a clusion alarms because the cannula was bumping into muscle or potentially that I had nicked, like a small vessel under and it had been clouded kind of near that site were was trying to infuse. And so that backs up into the pump and the pump tells you hey, the delivery of insulin has stopped. It gives you nice alarms. Right? So I think in some cases that may be part of the issue is the proximity to muscle, yes. But also I it was either painful or I got occlusions like it just never worked on my thighs.

Scott Benner 15:41
Okay, I'll say, Look, I'm learning from the podcast. Finally. Finally, I learned about this every day, you learn a lot. Okay, so now we've, I think here's a good place to insert that it is possible that there are some people on MDI who are achieving reasonable lower blood sugar's some how do I say this? Sometimes your doctors over baseline you because they don't think you're covering your food correctly. And

Jennifer Smith, CDE 16:12
or they may not have looked at your records enough to know why they've you know what I mean? Like, it might just be easier to backup with enough Basil with what they're seeing in your data. Yeah. And it may as you're saying, it might be wrong,

Scott Benner 16:26
right, right. So like, imagine if you're a person who has been getting more basil than they really technically need, but you kind of forget meals, sometimes you don't cover all your food. But now all of a sudden, you have this pump, you're like, Oh, it's so easy. Now, I just push the buttons for my foods, and now you're covering your meals well, and you're like, why am I low all the time? Right? It might be because you're using more insulin than you have been in the past. So those are things to look for that I see people struggle with the beginning with a pump. And I do want to say I think there's a, I think there's a period of transition there. It's not going to be like if you're nervous. It's not unfounded, you know, like you are starting a whole new way of doing something. But it really is just another way of delivering insulin to you. It's not that complicated.

Jennifer Smith, CDE 17:16
And I can say personally, when I switched from MDI, having done MDI, a long time before I started using a pump. By the time I started using a pump I was already doing. I was already doing somewhat of a Pre-Bolus. But it wasn't the same once I switched to a pump, there was a definite time difference between my Pre-Bolus with injections, and there still is, yeah, I can take an injection and my Pre-Bolus Time is not as long as it is on a pump. Right? Again, and of one. But that's what I noticed. And so those are some things to pay attention to between MDI and what you're doing along with what you said about maybe the doses you were taking on MDI, were covering a certain way for your rapid insulin for meals and corrections. And now that you're on a pump, your meals, the food hasn't changed, your strategy has stayed the same. And things are looking

Scott Benner 18:14
weird, right, right there, you do have to step back a lot and try to see what's happening. One reasonable reason for that could be reasonable reason why it wasn't right. But anyway, you use an omni pod and delivers insulin a little slowly. Like it doesn't just like you take a needle and you go Yeah, the pump is pumping over time. And I don't imagine you use very large bonuses, but larger bonuses take longer. I've seen I've sat at a restaurant with Arden and, you know, you forget you've done it and you kind of still here like that, like think like click clicking. It's still giving her insolence feels like it's been five minutes, you know, and yeah, so that's, that could be part of it. Anyway, these are things you're going to learn along the way. They're new lessons, but they're not a reason not just try, because you're going to gain what you're gonna gain so much, right? Like if, to me a pump is at its core, I've always thought of pumping as a way to be able to manipulate basil. Whereas on MDI, I shoot it in, it's in there, nothing left to do. If it's too much, if it's too little, it's what it is, you know, with MD with a with a pump, you know, you can go back and listen to the Pro Tip series. I think about like, wow, if we sit down to a meal, that's all of a sudden much carb heavier than what I usually eat, I could do a Temp Basal increase, they try to help me with this. You know, I was thinking a minute ago when we were talking about breaking the 10 units down into point 4.35 That if you think about putting a sprinkler out on a dry, dry lawn, right, and you need to give your lawn 10 Guys gallons of water, you could come along and dump it on all at once, it'll just be there, that'll be it right, or it could break it up into a little point three, five gallons every hour and go back and forth. And just a light covering, covering, covering, covering, you're never gonna soak it down, you're and it's just I think of basil like sort of like that. Sometimes you're just,

Jennifer Smith, CDE 20:20
and that's a good way to think about it too. Because if you consider that slow Basal drip that you are getting from a pump, when you inject your Basal insulin all in one clump, right? You can, depending on the kind of activity you like to do, you may have found that you have to pay attention to Gosh, I'm doing like a really heavy arm workout, I'm probably not going to inject my Basal insulin into my arm today, I might inject it someplace else, right? Because there's this whopping dose sitting underneath your skin. And any kind of insulin, whether it's rapid, or Basal can get enhanced in action, the more active you are, and especially if you're using that site. So, you know, those are the kinds of things that having those tinier doses that you can manipulate and adjust, especially with the variables that you know, are coming in the day.

Scott Benner 21:21
If somebody's listening and thinking like, well, they have spent the first 15 minutes talking about Basal insulin, it's because it's really important, and nobody tells you it's important setting. So if you listen to this podcast, like while I do MDI, they're always talking about, like, their settings on their pump or anything. This is still settings, you know, if it's MDI, it's your settings, it's, you know, these Basal carb ratio, correction factor, they're all settings. So it's just very important to have them. If they're not accurate to your needs, then everything else is just going to be a mess. And especially Basil, basil is wrong. The whole day is confused. So okay, so we've translated our basil, our insulin to carb ratio, does the doctor keep it the same? Do they usually like what is common?

Jennifer Smith, CDE 22:06
They may keep it the same, especially if your records prove to show that it seems to be for the most part working fairly. Okay. Right? Could there be improvement somewhere, possibly, or whatever, maybe that's also part of the reason that they feel like a pump might actually be better. Maybe you're the kind of person that just eats really slow digesting food. And so you've had problems with taking your insulin and having these big drops in your blood sugar too fast, and then it ends up catching up with you. And then you end up high later, and you've treated low blood sugars, right? And there's not a timing thing that you can really get quite right with MDI. And maybe the doctor says, Well, why don't we try a pump, because hey, you're eating these types of foods more frequently, we could actually use some of the smart features on our conventional pumps that allow you to take some insulin for food, we're calling these extended boluses. And you can just kind of like basil. It's almost like a secondary use of basil. But for a Bolus, where you drip drip, drip drip drip a Bolus in over a certain amount of designated time, you

Scott Benner 23:13
know, there's just, there's so much you're gonna get out of having a pump there, there's also going to be some things you need to know, sites can, like they're going to tell you whatever pump you have, they're gonna say this pump you can wear for X amount of days, or X amount of hours. But sometimes sites go bad. You know, sometimes new sites don't work as well in the beginning. Those are little things that you'll learn along the way. There's, if depending on Arden's blood sugar, she might put on a new pod, and we might just Bolus a little bit to get the site working. This morning. I woke up in the morning, I saw that artists blood sugar was trending up overnight. And listen, for those of you just switching like Arden is looping, but I can see how much insulin is left on a pod remotely, which most of you aren't gonna be able to see. But I can see she was down to like 30 units. So this is the end of her sight, right. And I just spent the weekend with her. And doesn't matter. But we were in a lot of restaurants this weekend. So Arden got a lot of insulin this weekend. And in my heart, her blood sugar is drifting up because this site is kind of done. So because you have experience, yes, I can just tell and you will be able to one day as well. So I sent her a text and I said I wouldn't go to class with this pump one. Because if she does, she's going to spend her whole day with blood sugar around 150 And she's going to be fighting with them constantly. And bolusing and they're not going to work and and by the way, if that happens, and then all of a sudden she gets crazy active out of nowhere. She might experience a low blood sugar from all this insulin kind of sitting in this right over us. Yeah, getting this pole right. And so like that's Here's the thing you'll learn along the way, you'll learn, you know what people worry about so much like, well, you know, do you travel with pumps? If we go too far from our house, we do. If it's a 15 minute turnaround, we don't like, you know, what, I'm gonna have to have insulin with me now, like, I don't know, we don't travel with insulin that frequently, as long as we're in your home base, you know. But if we go far, you know, half hour, 45 minutes, and it's not something we want to turn back from, we'll take insulin with us, you know, you just you, my point is, is that it becomes all second nature at some point. Just like everything else about diabetes, you're gonna have experiences they're going to teach you, you'll learn from them and move on. Speaking of moving on, you'll think I'm gonna go from MDI to pumping, to pumping to algorithm pumping, but I want to do CGM is first. So you have a meter. And that's how you check your blood sugar. And that's all you have. When you're in the doctor's office. The doctor is like, you know what you want to do?

Jennifer Smith, CDE 25:59
It must be the same doctor.

Scott Benner 26:01
I got one of the drawer here. Take this a sample you try. You'll love it. They're gonna try to give you they're gonna say to you, hey, you might want to leave Ray, you might want to Dexcom if you're on a Medtronic pump, they might ask you to do whatever the Medtronic CGM is called. And you're gonna say I don't need that or you're going to be newer. You're gonna Yes, please.

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Wherever you fall on that you do want it. Your insurance covers it you want it? That's for sure. Right? Tell me why.

Jennifer Smith, CDE 28:49
And I think it applies in all realms of diabetes as well. Right? Not just in type one diabetes, but also type two diabetes and even worthwhile and gestational diabetes. I know there are some rules in terms of when it can be prescribed whatnot. But I think it's beneficial all around what you miss with finger sticks are all of the little dots in between. So where things are trending, right, so if it is something that your doctor does bring up? Absolutely say yes. Right. You may not know how to look at the information or what you're getting from it initially. But it's so worthwhile.

Scott Benner 29:30
You want to know what you don't know. And with finger sticks, especially if you're newer to diabetes, or if you just been doing them your whole life and this is how you tend to think of it. You do the well i i test before I eat or I test before I go to bed or I test before I drive. And right. And I know you've asked yourself what's happening when I'm not looking right like and if you haven't asked yourself that. I wonder how do I go from two 50 to 50 in an hour, like how does that happen? And you'll learn you'll start seeing the impacts of activity and the lack of hydration, and different foods that you eat. The age of your, your insulin pumps cite all these different things that have a huge impact on the way your blood sugar moves. And now suddenly, it's there. A CGM is going to show you minute by minute. I think it's every five minutes. Right.

Jennifer Smith, CDE 30:32
And I think there are there are some people who have been using it long enough that can say, there can be some frustration around the amount of data that you get. And I wouldn't disagree with that I but I do think it's how you interact with the data, right? It's how you actually take a look at things and what you do with it and what you learn from it. And you'd have to, you have to expect that in the first month. Let's call it of using a CGM, you're gonna see a lot of stuff. And so rather than being so very emotionally reactive, again, taking a step back and kind of looking at the data to be able to make better decisions about what you felt like was probably happening, and now you can actually see it

Scott Benner 31:21
right. Well imagine you have your sprinkler out on the yard, and you have to keep the dirt moist because you've planted grass seeds, except every time you look out, it's kind of dry. That's the CGM. You look at the CGM ago Oh, from 3am till 6am. My blood sugar's 140. It's pretty stable, but it's 140. I wish it was lower or moister. I can turn up the sprinkler a little and put on a little more insulin and make it where I want it to be like push that number download

Jennifer Smith, CDE 31:48
and the CGM can show you that if you're really looking at it. That way the CGM can show you where did it start to lose? Right effect? Where do I start to need to add more insulin? It's not once you get stuck higher or once you get stuck lower than you want. It's before that so any drifts up or drifts down. You can see that very clearly on a CGM I, you have a really good example I think from when Arden first started using her CGM, it was like that overnight thing that you were constantly missing was at Lowe's when you had finger sticks, and I would put all you could see them.

Scott Benner 32:27
I thought I was a genius. I've said it before I would put Arden to bed at 180. And she'd wake up at 90. And I was like, Look how good I am at this. And what would happen. We put a CGM on her. She was 180, she'd go down to the 50s sit there for hours, I'm assuming her liver would be like, hey here, try not to die. Here's some, you know, here's some, here's some glucagon, I'll give you a little bit. And then she drift up to 90 overnight. It was happening constantly. So the reasons for that are mind numbing is not for this conversation. But we were bad at bolusing for dinner. We were her basil wasn't like there were so many things that weren't right.

Jennifer Smith, CDE 33:03
But you didn't know it because you couldn't see what was happening unless you really did a finger stick even an hourly finger stick, it would have caught a drift. But it still would right? But it would have still been confusing unless you've sat down and you connected all those dots. And you could say, well look, look at this. And you probably I mean not necessarily wanting to see your child sit at 50 for three hours before your body actually reacts and gets you the glucose that is needed to bring it up. But you'd have on a first finger stick probably under 70, you would have ended up treating so you also wouldn't have had the information to show. Well, how much do we need to take away? And what do we need to do differently?

Scott Benner 33:45
I can't I can't say how valuable it is to be able to see a graph and to enter look at it every three hours or you know what's it look like over six hours, like Jenny's point is great as the you you don't know why? What happened happened? It's um, if you're married here, it's nine o'clock at night. And you're now in an argument. Right? And you think I don't know what just happened. But mostly this is guys like they're like what? They searched the last five minutes their brain and I've not done anything wrong in the last five minutes. But if you could step back and see a whole graph of your day, you'd realize that at 630 at dinner, you said something really stupid, and now it's hit me at nine o'clock. So I think that that can be similar. You could have cheeseburger with french fries at dinner at eight o'clock at a restaurant and hit it with a great Bolus. And you're like, oh, wow, my blood sugar's still where I want it to be it's 140 After dinner, that's not bad. And two hours later, it starts to jump up. And that doesn't make any sense to you because you haven't listened to the Pro Tip series. You don't know about the fat and the French fries and the slow digestion and how your blood sugar is gonna go up afterwards. But at least if you see it on a graph, and then you go have those French fries and that burger again. You see it happen again. You can go Oh, I could get get ahead of this, right? Yeah, I could not say that stupid thing at dinner. And now we'd be watching television and she wouldn't be yelling at me.

Jennifer Smith, CDE 35:06
Right. And if you have a pump, you can also address it a different way than waiting for it to finally start rising and getting too high, you can offset it ahead of time knowing what is coming, because you've had the experience that, oh, it always hits around two hours. So I'm going to start doing something about an hour and a half before that. So that it actually doesn't happen. Right. So I mean, yeah, it's million

Scott Benner 35:32
ways to handle that if you're Yes, right. For for art in an hour after she has french fries, we have to Bolus for the fat. And there's a calculation you can do. And there's that heads off that secondary rise and doesn't cause a low later. That's the other great thing is the everyone. When you don't have enough data, you think, Oh, if I just keep throwing more insulin here and there, it's gonna be it's not true. Like you can match the need up with the impact of the insulin and never cause a low, right. And that's something you're going to learn looking at a CGM that, that uh, that a stable line on a CGM is really your insulin, your insulins pulling down and your food and your other impacts are pushing up. And neither of them are winning, like so if you can kind of imagine that line going off into affinity nice and stable. There's invisible lines. cables attached to it. One's trying to pull it up. One's trying to pull the line down, and neither can win because you have a great balance between your insulin and your knee. Yeah, so that in the CGM, like, seriously, like, I don't care, like there's Dex comms and advertiser, it's not like I'm saying that like, get a CGM. It's of any,

Jennifer Smith, CDE 36:43
right? Absolutely. I mean, I've said before, many times if somebody was going to take my technology, I would fight for my CGM. Before I'd fight for my palm. Yeah, no 100% would keep my CGM.

Scott Benner 36:58
I'll throw this here too. Even though it's about like, leaving quote unquote, finger sticks, you're never going to leave finger sticks by the way, you're going to need them. You're gonna test when you're not sure about your CGM. You're gonna test when you're making big decisions. I listen to my daughter's blood sugar looks high on her CGM, and we're gonna make a big Bolus. I said, Look, you gotta test we got to know this numbers, right? We can't just start throwing insulin in here. And you're actually 40 points lower than this, or whatever.

Jennifer Smith, CDE 37:23
And I think it's also really important to acknowledge what you know about how you feel around certain blood sugars. Because again, technology. It's wonderful. And it's so much better than it was years ago. But it may still not be accurate at certain points. So always those finger sticks are important to continue to use. Because if your symptoms or how you're feeling doesn't go with what your CGM is reading, I guarantee a finger stick isn't gonna lie to you not unless you still have like, apple juice on your fingers.

Scott Benner 37:58
I was gonna say and I didn't get to it just an accurate meter, just a blood glucose meter. Yes, they're not all the same. They don't all work as well. Don't just take the one that doctor handed you from the drawer, do a tiny bit of research use the one that I that advertises here because that's the one we use and it's amazing and, you know, like or do what you can do your own research and find out I will throw out a little story here. Because I did spend the weekend with my college age daughter, which I haven't done in a while as a visitor at school. Second night she was with me. We replaced her CGM. Okay. So at five o'clock at night, I said, Hey, your Dexcom is going to expire one in the morning. You should switch it now. It's before we're going to eat dinner. We'll get it back online. It will have it we can do some finger sticks through dinner. And then it'll be rolling and working well by the time we go to sleep, because it does take a little while for some people where to look right. You know, she does. I don't want to do that right now. So then when do we change her CGM? 10 o'clock 11 o'clock, you know, like, oh, so then it's done. So then it's wonky for the first couple hours. And for Arden, if her Dexcom is wonky, it's wonky low when she first puts it on minus two. Okay. So like, I mean, it'll be like you're 42. And she's 10. Like that kind of thing. Yep. So there's a lot of consternation in what you should do. I'm a fan of letting it be on for a little while and calibrating it to help it get along a little more. But now we're asleep. And it's like BP people. All I could think was I told I know I said this. Nobody listens to me. But that's fine. And I'm like, and I know she's not that low like and but it's worrying. So now she's, she's asleep. And I get up and I'm checking her blood sugar and she wakes up. She's like, What are you doing? I'm like, your CGM is going off. She goes, I'm fine. It's like okay, so I tested her and she was 130. And I was like, okay, so she's right. And I did a calibration and it came together. Other pretty quickly. And that was it. Having said that, we could have done that at five o'clock. There. So there is a way to time, your technology. Now the new g7 is going to have a shorter warmup period, which will help overlapping you'll be able to soak your sensor, which I'm not going to bother explaining here. But yeah, but as the technology gets better, so should those things. But that is not to say it's not, like hands down. The most valuable thing that's happened to people who have any kind of diabetes. Since I've since I've been aware of diabetes, so absolutely. Okay. All right, Jenny. Now we got our CGM. We're using a pump. We're looking online. And we're like, see, this isn't that the doctor is not gonna go you know, you got to do. That's not gonna happen now because this stuff's also new. Maybe Maybe you're really in tune doctor might say, why don't you get an algorithm? But for the most part, I don't think I think that's the thing you're gonna figure out on your own a little bit. So all this stuff we're talking about about, you know, the Bayes will be incorrect. And you might need a Temp Basal here. You might need an extended Bolus for fat you might need all this. There are pumps that make those decisions autonomously. Yeah, you have to be wearing at this time, you have to be wearing index calm, because it works with that correct. But

Jennifer Smith, CDE 41:19
or med tronics. Um, CGM? Yeah. Because they're their system also works with their pump.

Scott Benner 41:25
Yes. So there's a Medtronic version of this. There's a tandem version of this. There's an Omnipod version of this. All their algorithms are proprietary, they work slightly differently, but long, and the short of it is they're going to give you insulin when you need insulin, and they're going to take insulin away when you don't need it. They're going to endeavor to stop you from getting low, and endeavor to stop you from getting too high. You

Jennifer Smith, CDE 41:48
still know how they do that it was with targets. Yes. Right, right, specific targets in each of the different pump systems. Medtronic newest one was just approved, which is really nice. But they all have specific targets. So how that algorithm works is based on when and how to give you more or less based on a target and based on what the system is projecting off of your current CGM trend. So it's a very interesting, like the algorithms don't just willy nilly deliver or take.

Scott Benner 42:24
Like, I think maybe now more,

Jennifer Smith, CDE 42:26
right? Yeah, exactly. There's a map to the algorithm right

Scott Benner 42:29
Gremlin inside of your pub flipping a coin going, Oh, my God heads. Let's do it. So but it's it's it's stunning. Now there's another version. There's a number of other versions there are Do It Yourself versions. There's Android APs. There's loop. I think, Jenny, you loop. Right. I do. I think you would

Jennifer Smith, CDE 42:48
have been looping for five and a half years.

Scott Benner 42:52
And Arden has been doing it. I think since 2019. Maybe? So yeah. And you're Arden's using loop three, as am I and you just switched to it as well. So like, they're all just different versions of an algorithm making decisions about insulin based on your CGM trend. That's Yep. They're astonishing. They work incredibly well. They are not magic. I know in all settings, all knowing how to Bolus for certain foods, understanding the impacts of things, your digestion, your hydration, like all the things that are important about MDI are the same things that are important about pumping are the same things that are important about using an algorithm.

Jennifer Smith, CDE 43:38
And you made I know, people can't see you, but you were very in a line going from MDI, to pumping to algorithm. And I think that's, it's a really important piece. For those who are listening to understand if you're kind of listening to this, because these are not pieces in your life already. Right, and you want to get an idea. There is 100%, I'd say 1,000% value in learning on MDI. And then moving to a conventional pump, that does not do anything for you, meaning it does not use an algorithm. There's absolute value in that, you know, we talked about testing, and evaluating settings, and learning about all the variables, food and activity and everything and how to adjust your pump or your insulin doses to accommodate for those variables. I think as you mentioned, when you said you owe your pumps, like, hey, let's start on algorithms. I can't go as deep as you. So it's a totally different doctor, right? But in that sense, there are I think more doctors today who are thinking algorithm, but in my personal and professional In all opinion, I think some of them are thinking that too fast. Okay? They are they are moving somebody to, hey, you're MDI, let's move to this algorithm driven system, whatever the system is, whether it's Omnipod, five, or tandem or Medtronic. There is, there's a missing piece in the middle there, that if for some reason, and we talked about CGM is potentially not being always accurate or technology failing. If your pump fails in its algorithmic dosing, and you have nothing to step back to, you're at a loss. And it's important to understand that, you know, so I can't emphasize.

Scott Benner 45:42
It's incredibly important. Jenny's been talking to me about this privately for years. Honestly, she's like, people can't just be put on the machine, the machine does the whole thing. And they don't understand why it's happening. Because, you know, the general argument is, what if the machine stops working? I don't even think that's the need for that. No, I think the need is, is that this is a thing you have to understand. Like it, no matter what none of this machine stuff is at the point where you don't need to know how to how it works. It's not AI, it's not even a computer like you know, used to have to know how to fix your computer, because it would break all the time. Nowadays, you buy a Mac, it'll just do the thing you want it to do, you'll never have to touch it, and it'll die. At the end, you're like, Oh, my Mac doesn't work anymore, you get another one. And you don't need to understand how a computer works. To use a computer. You need to understand how diabetes works. To have diabetes, I don't care what version of care you're using, I don't care what the next one is. Now, if someone magically comes up with something one day, where it just works, no matter what, like a, like a laptop from Apple, okay, then then okay, then God bless. If you want to skip it, then skip it. But I'm still gonna say, that isn't happening anytime soon. Because of not just the things we've mentioned today. You know, your insulin pump site might not work on time, like your CGM might not be right right away, like all the other things, it just not happening anytime soon. So you don't want. The worst thing I can imagine is that you put an algorithm on a nine year old who it works for. And then five years later, the kid hits like puberty hard or something and you have no idea, like the algorithms doesn't know you just became a completely different person, you're gonna have to change your settings to make that work, right. And that takes experience. And if you I think if you ever find yourself listening to Jenny and I talking and thinking, How come whenever something comes up, they just fill the next space with something valuable. It's because Jenny's been living with diabetes for over 30 years. And I've been staring at my daughter for 15 years watching her have diabetes. And I have a never ending supply of experiences and answers in my head because I learned through them. Yes, that's why and that's why you? Yeah, like you didn't go to like diabetes University where they told you something secret that they don't tell everybody else, right?

Jennifer Smith, CDE 48:14
No, no, no, not at all. I mean, I have valuable behind the scenes, like information about disease states and those types of things from a medical knowledge base. Absolutely. And understanding them helps me to understand some of the navigation of that with diabetes, but the lived experience and the work that I get to do with so many people, that's the valley that you can't teach that. In a university, you you can't teach, there's no degree and diet.

Scott Benner 48:47
And for your situation, you've been helping people for so long it professionally. I tell people all the time, like, it's, it's gonna sound self serving, but it's not like it's that I was able to get advertisers for the show. So I get to turn the show into a job so that I could put this much effort into it. Because I learned every day I talked to people, like you'll hear me say like, Oh, I was talking to a guy the other day, he said something about this. That's me. hearing something I'd never heard before and right and retaining it and being able to apply it to a situation go, oh, you know where that'll help here. And then you get to keep expanding those conversations. I'm going to get to something here and you get to keep expanding those conversations till they help other things. We did fibroid episodes. Now we hear from people are like, Oh my God, my life is different. Because I got my thyroid managed well, I'm getting a lot of my I didn't realize about my iron and my ferritin like a lot of women especially are getting back to me like they're feeling so much better, because it's something they heard on the podcast. They heard it on the podcast, because I was able to focus on this because this is what I think about And now and now it's coming to digestion. And that because we had to figure out a problem with my daughter's digestion. And then we shared Get on the podcast now I've seen that help other people. That goes for little things about diabetes too. Yes, that's how this stuff spreads. This is a repository of information, but you're gonna build that in your own mind. Correct. But not if somebody slaps an algorithm on you and tells you don't worry about the thing. I'll take care of it.

Jennifer Smith, CDE 50:18
Right? Because it one that's such a, that's such a big thing that I hear well, shouldn't it be helping me with this shouldn't be doing this shouldn't? The one word I hate is learned, shouldn't have learned that I don't need this much insulin at two o'clock in the morning. Nope, your system isn't learning. I promise you it's not learning. doesn't keep track of two o'clock in the morning, gosh, I gotta give less insulin for this person. It's not that's it's not smart.

Scott Benner 50:44
Now. And Jenny, do you know oddly enough, as we make this episode, I put up an episode today called Rise of the Machines, where a guy comes on to talk about his Android APS system and how it he does believe it's going to learn in the future. Correct is so exciting, but not now. Like, what's one of his examples? He said, location services. So if you say I'm having pizza, and it realizes you're at Domino's, okay, and you have an experience with insulin, at some day, it will remember that experience. Yeah, if you go to a different pizza place and have a different experience. It'll remember that if you go to a pizza place, it'll remember that if you head back to Domino's, it's gonna go Oh, we're back at Domino's. This. That's not happening right now.

Jennifer Smith, CDE 51:33
No, in fact, there is there are some. There are some apps that actually you can track that way. Like you can take a photo of something and tap the location indicator. And the next time you come back to that location, you'll be able to see what your dosing looked like what your CGM trend looked like. So you can learn from Bob's pizzas, Friday night, last week to this Friday night, maybe I should change my strategy, it looked like this. And I want to improve this right or do it differently. But those they need to be married right into the pump so that not only do you have Okay, now I'm at Bob's pizza, this is what I had. And hey, let's the pump then can acknowledge and I'm going to do something different for Jenny.

Scott Benner 52:17
But for that happening just automatically, that's not here yet. 2023 on the pod five doesn't do that. Tandem T slim doesn't do that the control IQ doesn't do that. The mechanic doesn't do that. Now, it may have happened one day. Sure. But the other I think the other thing is, I know you want your days to be easy, and they can be they can be much easier than they are now they can be more your intuition can come into play as you grow. But this is a lifelong thing. And what you want is you want to get to the point where I saw Arden get into this weekend, where we sat down to this meal, there were 16 different things. And she just looked at it and picked up her phone and went and pushed the button. Yeah. And I was like, how much did she give? She was I don't know, I told it was like 85 carbs. And it was and she and I was like, okay, and then she was okay. And it was okay, just looked at a table at a restaurant. And she's like, I think about this much. And and that's boy, forget this podcast and everything else. It's that's where you want to get to where just where you wake up at two in the morning, you see a high blood sugar and you go, Oh, I know what this is. And that does come it really does come. So anyway. But you're gonna transition along, by the way, I think algorithms are amazing. And

Jennifer Smith, CDE 53:42
yes, they are. Absolutely I I love my algorithm. Absolutely. But I've also learned to work with it. And I've learned what it can do and what I still need to tell it to do. I think that's the big thing about algorithms is knowing that you still have a fair amount of action to put in to it so that the algorithm can work with you.

Scott Benner 54:04
Yeah, yeah, I wouldn't want anybody to think like, oh, you're using a do it yourself loop. It's magical over the other comp there. It all is about the same. Like they all need your help. They all need your intuition. They all need your knowledge. There's nothing if you think you're going to just put a loop on or on the pod five, and it's just going to be perfect. Like you don't have to do anything. Like that's not going to be the case. No. Yeah. So but don't be afraid. No, like I I'll say something here on the hall, save myself Saturday, make a beat and make myself sad. Yesterday was my friend Mike's would have been my friend Mike's birthday. And I don't want to bring all this down. But Mike had diabetes. Type one when we were teenagers. He's not with us any longer. I believe that one of the reasons Mike's not with us any longer is because Jenny alluded earlier that I was stepping along with my hands while I was talking about things like Mike Never came along. He just somebody gave him regular and mph. And he used it long, long after he should have been, you know, didn't have updated meters and didn't you know, he didn't do the little things that you do to come along. I mean, I guess what I'm saying is you don't want to be managing your diabetes like it was 10 years ago. Right? I don't think so.

Jennifer Smith, CDE 55:25
I think you're also bringing something in here. That's really important to consider, because you've, you've talked about, you know, practitioners bringing up hey, why don't you try a CGM? Hey, why don't you try a pump? If, if you're the one always going to your doctor asking for what's new. I don't know. I you know, and your doctor is very willing and can talk about it then with you. Maybe they didn't bring it up. But they're very, they're knowledgeable about it. Once you do get on it fine. But if this is someone who's never really brought it up, and kind of like, shrugs their shoulder and like, sure you could try it, whatever you may need kind of like your friend maybe didn't have a doctor who was keeping up with what could have been better for him.

Scott Benner 56:10
Yeah, yeah. Yeah, you don't you have to take this as a, I don't know, if you want to call it a disease or like, some people don't like that word. But this is a way of living, that it begs you to be involved in it? Yes. Like, it just, it just really does. You have to be aware, you have to take some time to learn what is happening with technology, what's happening with insolence, you know, and you need to move along with it. Because if you look back 50 years, I still interview people who are like in their 70s and have had diabetes forever. And they don't even understand why they're alive. Like, like, you don't want your life to be a coin flip. You don't I mean, like there are things you can do to to, to give yourself better health outcomes. And those health outcomes are not just health outcomes, their quality of life, they're your they're your psychological state of being like there's so much good that comes from just understanding. I know that sounds silly, but how to set your basil right? And make sure your correction factors, right. And you know how to cover the foods you eat?

Jennifer Smith, CDE 57:16
Absolutely, I think and on a bigger scale. We're also we're all supposed to be a participant in our life, right? health in general, you may have been given good health to begin with, but you're the keeper of that health. Right? It's just like, you're the keeper of the car. If you continue to let the salt buildup on you never wash it off, you're gonna have a rusty car. Well, you're your body's the same way, right? You're the keeper of your health, you got to do things to maintain your health, diabetes, it stepped up a level it is

Scott Benner 57:50
absolutely. And so prepare to transition by getting as much good information as you can, but then at some point, just have to do it. You have to just dive in and do it and then learn a new thing. And then once then you'll be surprised at what else comes from that. And anyway, listen, it's also not to say that you couldn't get an algorithm pump right now and teach yourself backwards. I actually think you can. Sure. I think some people have a harder time with that than others. And I don't want you to be in a position where you're lost and something's happening. And you don't understand why because it won't be any different than a person that gets over Basal on MDI and thinks they're doing okay, but it's not really covering their meals well, right, you know, and then doesn't get hungry one day, and then it's up low all afternoon doesn't understand what happened. Like diabetes. There's no reason that if, if you have an if you have enough information and understanding diabetes doesn't have to happen to you. And I think that's maybe the most important part like I would if it feels like it's happening to you, instead of you are doing something and then something's happening. I think you have to have to look and get a deeper understanding, because it shouldn't just be happening to you. That's all. Okay. Awesome. Thank you Jerry.

Huge thanks to Jenny for helping me once again on the Juicebox Podcast, you can learn more about what she does for a living at integrated diabetes.com Jenny might be able to help you. Thank you very much cozy Earth for sponsoring this episode of The Juicebox Podcast get 35% off your entire order at cozy earth.com By using the offer code juice box at checkout. And don't miss the rest of the diabetes Pro Tip series and the other series within the podcast. If you give me a little gifts, give me two more minutes of your time after the music and I'm gonna tell you a little more about this series and the others But first tips from other listeners. I want to thank everyone who left their tips for this episode on the private Facebook group Juicebox Podcast type one diabetes and the people who left their tips on the public group bold with insulin. This first one is for going from pumping the algorithm test your basil and your ratios before you move to an algorithm. The first few weeks may be frustrating, don't give up. Reach out to people online for advice. They probably have been doing it longer than you. This person leaves a little bit of advice from going from MDI to pump says the first night they kept getting low and didn't remember that they could turn their basil down. We talked about this in the episode having access to your Basal insulin. Next one says Oh, I love this one. Listen to the diabetes Pro Tip series from the Juicebox Podcast Take notes. Here's another one from this person. Some sites have dramatically different absorption rates. We talked about that in the podcast. Here's one for Dexcom. Learn to look at the dots instead of just the number in the arrows. This person says when you're going from just having a meter to a CGM. Remember the CGM is just one of the tools in your arsenal, it's not a full replacement for a blood glucose meter. Use both tools effectively. Don't get overwhelmed. They are just numbers and data. It's not a grade for you. It's good advice to this person says no matter what you're doing, whether you're changing from MDI, to pumping pumping to algorithms, your ratios are likely going to change. And that takes time to figure out. This person says not all algorithms are the same. So make sure you understand which one you have and how it works. Their example here is if you're having trouble with a T slim product, don't use someone's advice from the pod five, it won't be the same. Don't assume that your CGM is always correct calibrated if symptoms aren't matching the number, use finger sticks to make sure other person preaching patience, and says not to make perfection your goal, just shoot for shorter peaks, and more shallow valleys in the beginning and over time, your skills will get better. And those peaks and valleys will flatten out. This person says be prepared when your technology doesn't work. And please don't expect perfection. Another person basil testing, there's a great episode about Basal testing in the Pro Tip series. Here's one that just says don't give up. I like that one. I like this one here. Don't use too many new or different foods when you're trying to figure something out. So stick to meals that you are good at bolusing for that way you remove variables, right, like you know, on MDI knew how to cover this food. So I'm doing the same thing on pumping, what's not working, then you can look at your settings and see what's different. I'd say that's a great one. I like that a lot. Educate yourself on how your pump works. Don't just trust that your rep set it up correctly. It's a lot of settings in there. It's a good one. We were used to coasting high no matter what this is an MDI, person to pumping. And we rounded up way too much on our carbs. When we switch to a pump, it took a few weeks of lows to get out of that habit and trust that the pump knew what it was doing. Interesting. So if the settings are good on the pump, I see what they're saying their settings on MDI weren't great. So they were always just, you know, doing more. But when the pump was set up, well, they didn't need to do that anymore. It's interesting. That's a good one. Here's a great one. Don't just put in settings into your palm, write them down somewhere. If something happens to the pump, you need to have them to put back into a new one. And keep a pen or needles handy in case you need to do manual injections. Even on a pump, you might have to do that sometime. That's very good to your settings in a manual pump may not work in your algorithm. This person talking about a CGM says when you start a sensor start at a time of day when you haven't eaten for a couple of hours. And you're not going to eat for a couple more hours if you can. Evening is good, especially for kids in school so the sensor doesn't run out at school. Oh, that's a good one. So he like you don't want to like put it on. I think what they're saying is you don't want to put it on at nine o'clock in the morning on Saturday. Because then at nine o'clock in the morning, you know, on a weekday it might run out. That's a good one. Don't feel bad about removing a sensor if something's wrong, whether it's causing pain or discomfort because you can always call the company and they'll respond with a replacement. You may have heard leaders or readers, that's not always the case. This person says if you haven't heard that phrase, you will eventually take pictures of your CGM sensor codes and transmitters put the expiration date into your calendar with a reminder and that way it won't sneak up on you. Here's one for going from MDI to pumping make sure the correct factor is calculated using the number, the pump shoots for not the one you were shooting for on MDI. Interesting. So what she's saying I think is if the pump gets set up in the target is 100. But when you are MDI the target was, then your correction factor won't be correct. Interesting. This is funny, I can't read you the whole thing, but it says, eventually, something's gonna go wrong. And your tech savvy husband is somehow going to push the wrong button and deactivate everything. I don't think that's as much advice as somebody who wanted to tell a funny story. Going from a blood glucose meter to a CGM. Don't look at the thing every five minutes for me that led to me overreacting to blood sugars, that may not have warranted a reaction at all. Set your alarms at a useful level. This one's terrific the person who sent this one and use that to guide your decisions rather than checking constantly on CGM. I'm a big believer in this by the way, if it doesn't beep, I don't look, there's a person here echoing this sentiment that blood sugars can be fluid, and that it's possible you can overreact and be the reason it's jumping up and down. I think that's worth repeating actually. When you're going from MDI to pumping, you don't need to wait to do a correction Bolus, make use of the insulin onboard information that the pump has great one, that's a great little tip. There's a comment here with a ton of information for the Omni pod five, I'll tell you there's actually an omni pod five Pro Tip series. Definitely listen to that before you go to Omni pod five. But I do want to add a little bit here from this post. Fluid insulin delivery, like an algorithm has to do suspending and increases and decreases and that demands a different approach than a static Basal. So in a regular manual pump, where you might just say, um, one util an hour all day long. You're making a lot of adjustments throughout the day that you don't realize, because there are times you don't need that insulin at a unit an hour might need it more may need it less. That's why the initial settings on these are so important and you kind of stepping back and watching it work for a while to see where your settings may need to be adjusted. Or maybe the way you use your insulin needs to be adjusted Pre-Bolus etc. This person says that a pump was not a cure all for their problems. And they found it very deflating when they went from MDI dual pump and it just didn't make everything better. That's important, Jenny and I definitely went over that in this episode. But keep in mind, this person says here that your doctor's office might say we don't give a pump till one year or you can have a pump till after you've been on MDI for six months or something. That'll sound like a rule to you when they say it. But that's not really a rule. You can, you can push. This is a reiteration of something we heard before. But when you're going from just a blood glucose meter to a CGM, you might want to take some time to just absorb everything. You don't want to just jump in and start tinkering right away before you know what it is you're doing. You know why you turning this dial on that dial really kind of lived through it for days, maybe weeks, even before you just say, alright, I see a trend here. I know what's happening. This is an interesting one. This is for somebody going from MDI to pumping. They don't want you to forget the tricks, you know, brain like if you see a blood sugar, and it's kind of stuck and it won't move and back on MDI, you want to inject it in a unit, there's no reason why you can't give a unit with the pump. Just because the pump says, Hey, there's still insulin onboard, it doesn't mean that that insulin was calculated correctly, and is really about to make an impact. I think they're saying trust your gut. This one's a little long, but the person says everyone's experience is going to be different. So roll up your sleeves, go into it with an open mind and be ready to dig in and do some problem solving. And don't forget to listen to the podcast, they go on to say when going from MDI to a pump, you really have no idea what to expect, you can only kind of hope that you start out with great settings. But that may not be the case. So many people end up having a poor experience when they switch and then they share that online. And then this person was like scared. That's what was gonna happen to them. But then that wasn't what happened at all.

It was incredibly easy, she said, and his numbers got much better very quickly. So I think the I think the message here is, sometimes people just share bad news online, doesn't mean everything's bad news. Here's a little tip. A pump company puts their pump through the FDA for approval, and they choose a couple of insolence to use in the pump. Those insulins are then approved in the pump. It doesn't always mean that the ones that aren't improved in the pump won't work in the pump. It just means they didn't put it through FDA testing. I want to thank everybody who share those tips and remind you that those people exist in the private Facebook group for the Juicebox Podcast. There are so many other management based series within the podcast. You're listening, of course right now to the diabetes Pro Tip series diabetes Pro, tip.com, juicebox, podcast.com, and in your audio app, but there's also the defining diabetes series, diabetes variables defining thyroid, bold beginnings, ask Scott and Jenny. And we have collections of episodes about algorithm pumping, which we talked about a little bit today, you can find out way more in the algorithm pumping episodes. There's the after dark series where we talk about all the things that people don't usually talk about about diabetes, how we eat mental wellness, there's so much to choose from. And if you happen to know somebody with type two, there's a brand new type two diabetes series for people with type two or pre diabetes. Check them out at juicebox podcast.com. Here's a little feedback from other Juicebox Podcast listeners. After devouring the Pro Tip series, I got my daily average down by 30 points. And I'm excited to continue learning from this all in one resource. If you're struggling with insulin, this is the place to figure it all out. I am so thankful that a friend recommended the Juicebox Podcast to me, and I wish that I would have found it at the beginning of my journey. I have been binge listening since I found this podcast. My son and husband both have type one man, I wish I had this when my son was still living at home. I'm learning and sharing how we're going to get our agencies lower. I've had type one diabetes for 20 years, and it was never well controlled until I started listening to the Juicebox Podcast. I've become bold with insulin. And this podcast is unlocked the solutions to so many issues I've struggled with for years. I can read you these reviews all day. But I would prefer to stop because it seems it's tricky to do this right? I just want you to go listen to the Pro Tip series, find the defining diabetes. If you're new, go check out bold beginnings. All of the information that you could possibly want and need about managing your insulin is in the Juicebox Podcast. Subscribe now in a podcast player like Apple podcasts or Spotify, Amazon music or wherever you get your audio. And don't forget to check out the private Facebook group, which is also free Juicebox Podcast type one diabetes 37,000 members and it grows by hundreds of people every week. What a resource. Please don't miss out on this community.

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#895 Best of Juicebox: Switching to an Insulin Pump

Originally posted on Jan 21,2021. The Juicebox Podcast: Type 1 Diabetes social media community sent their tips for switching from MDI to pumping.

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

Scott Benner 0:00
Hello friends, and welcome to episode 895 of the Juicebox Podcast

welcome back to another episode of the Best, the Juicebox Podcast. Today we're revisiting Episode 431, which originally aired on January 22 2001. This episode includes community feedback on the topic of switching from MDI to pumping. It's very informative. So if you're thinking of switching, check it out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Are you a US resident who has type one are the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box join the registry complete the survey. When you complete that survey, you are helping type one diabetes research to move forward right from your sofa. You also might be helping out yourself and you're supporting the podcast T one D exchange.org. Forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by us med us med is where my daughter gets her Dexcom G seven and her Omni pods from you can to us med.com forward slash juice box or call 887211514 Use the link or call the number to get started. And by the way, they don't just have Dexcom and Omnipod. That's just what we use. You got the liberi over there. 10 a bunch of stuff I'll tell you in the ad. today's podcast is also sponsored by touched by type one great organization helping people with type one diabetes. I'm going to be speaking at their big event later this year. Go find out more about it right now at touched by type one.org A couple other great ways you can save through the podcast 35% off your entire order at cozy earth.com with the offer code juice box at checkout for 10% off your first month of therapy when you go to the link betterhelp.com forward slash juice box and free years supply of vitamin D and five free travel packs with your first order of ag one from Athletic Greens when you go to athletic greens.com forward slash juice box. And while I'm plugging stuff, check out diabetes pro tip.com for one of the greatest series that this podcast has ever put together the Pro Tip series Hello friends and welcome to episode 431 of the Juicebox Podcast. Today's show is about switching from multiple daily injections to a pump. And what I've done is gone on to the Facebook page for the podcast and gotten people's feedback about what was most valuable to them when they did the switch from injections to Bombay.

Before I jump in and get started I'd like to remind you to check out T one D exchange AT T one D exchange.org. Forward slash juicebox. And here's why. You can support T one D research and the Juicebox Podcast by checking out the T one D exchange because they're looking for type one adults and caregivers who are US residents to participate in a quick survey that can be completed in just a few minutes. You can do this survey from your phone or your computer and you never have to leave your home or visit a doctor's office to make a substantial impact on type one diabetes research. This is 100% Anonymous HIPAA compliant. And every time one of you completes the process by using my link, T one D exchange.org. Forward slash juicebox. You'll be helping to support people with type one and the show. past participants just like you have helped to bring increased coverage for test trips, Medicare coverage for CGM, and they've helped to change the ADA guidelines for pediatric Awan seagulls you can give back in just a few moments

okay, I've done this a couple of times and it's incredibly popular. So we're doing it again and went on to the Facebook page Juicebox Podcast type one diabetes. It's a private page where listeners can talk about whatever they want. It has well over 8000 members at this point and it's just a hotbed of discussion. And around diabetes management. So I put the question up there. For those of you who have transitioned from MDI, to pumping, please share your tips, things to look out for and remembrance. Here's what came back that I thought was very interesting. Right off the bat, Nicole says, start with what the endo suggests, but only give them 24 hours. If you've listened to all the podcast episodes, you know what to do, if you have a Dexcom Be bold. Maryann said that, initially, it was a little difficult to get over having a device attached to her, but that she eventually did. She said, you'll probably need to adjust your dosages with the team, be prepared for that. And nothing's really permanent. So if you don't like it, she's like, just send it back. She also suggested trying to create a time for the transition, that's a less stressful time in your life. Because there is a commitment involved in understanding it. I take Mary Ann's point. But I also think sometimes there's never a perfect time. So I guess, you know, figure out what would be best for you. But I would caution against waiting for the perfect time. And I would also caution against immediately wanting to give up, because it is going to be different. And if you've been doing shots for a while, and succeeding with it, you know, you might just be used to things working. And the truth is you're gonna have to start over might not just work perfectly immediately. Jen said that she switched from MDI, to pumping over 20 years ago. And all she really remembers was being terrified. She got a quick doctor's office visit tiny bit of training, they sent her home. But she called technical support a number of times the beginning. So she wants to let you know not to be afraid to ask for help when you need it. Katie says not to forget that you're no longer using a slow acting or long acting insulin like love Amir to recibo, one of those that your pump is giving you all of your insulin, it's doing your Basal insulin, as well as your meals and corrections. So if there's a problem with your pump site, you need to be aware that DKA can set in much more quickly than is likely with MDI. So if you get up in the morning, and you're, you know, MDI and you shoot your your Letelier Lantus, let's say, it's in there, it's doing something, but if you get up in the morning and put a pump on, and there's some sort of a problem with the site, and you're not getting your Basal insulin, you may not know right away. So you know, what I would do in that situation is test more frequently or pay attention to your glucose monitor if you have one. In my opinion, it's not something to be scared of, it's just something to remember, you're getting your Basal insulin from your pump. Now, Ashley said that the first few pumps that she put on just didn't go well. And she didn't realize that she could have them replaced the infusion sets or if you haven't on the pot, the pot itself, and she was just throwing them away. But if you have a failure, especially in the beginning, when you don't know what you're doing, call the company, they very well may replace your items. That would lead me to say that it is not uncommon in the first week or so of using a pump to have user error with the insertion or wearing of the pump, that it's important to, you know, keep trying get information, don't just think that the first experience you have is how this is going to be now because there are a lot of people who use insulin pumps of all different kinds very successfully all day every day. So when you're starting at the beginning, and it's not working, if it's not working, maybe look inward before you look outward is my best advice from what I've seen people talking about online all these years. Josh says that his remembrance for the beginning was that he just immediately felt more in control. And he started tweaking his Basal insulin and extending his boluses that that made him comfortable. Amy brings something up that I see a lot. They had fairly good control with MDI and then move to a pump and recognize the transition, that it's not just a flick of the wrist, and everything's okay. Again. What I would say that I notice is that sometimes doctors offices can be careful when they set up Basal insulin. I guess they think of it as careful when they set up Basal insulin for the first time. So say you've been doing MDI forever and you get 24 units a day. What I would do there is the quick math and say, Well, maybe I'm about a unit an hour then. But sometimes doctors offices are scared to send you out. dollar for dollar from the way you did it to the pump. And they kind of go without better high than low theory, and a lot of them will take back some. But if it was me, if Arden was using 24 units a day of Basal insulin, I'd start by saying Adding her Basal at one unit per hour, and I'd see what happens and make my adjustments from there. I guess the problem comes in where the doctors don't want you to touch the Basal insulin. So they set it low to show where the highs are, so they can come back in later and add insulin. Being a person, the way we are here that makes those changes on our own, I would start about where I thought, because here's what I see happen. Those ratios are kind of lost in the moment for people often. And what happens is, instead of thinking, Oh, I used to use 24 units a day MDI, and now I'm only using 19, or something like that, I'm probably not using enough Basal insulin, they think pumps don't work. So your brain makes this illogical leap that feels logical. And then you get caught in a little bit of a, you know, a shitstorm. And if you don't have a doctor's office that quickly gets back with you and makes adjustments, which a lot of them don't do sometimes, then you start blaming the pump, and you start having these feelings like oh, it was better on shots, you know, and you could lose faith pretty quickly. I've seen that happen a lot. So that is definitely something to look out for. So Mara warns that once you're on a pump, it's not a free for all of food, just because it's easy to Bolus, so you know, do your best to stay on track with how you eat. She also mentions that it's possible your insulin usage might go up, and that that's okay. I would say it's also possible that people lose track of the fact that they were taking 30 units of Basal insulin of one kind. And using, I don't know, let's say they use 20 units or 25 units of, of, you know, Novolog, fast acting insulin for meals and corrections. So in their head, they're only using like 25 or 30 units of insulin a day because people just generally don't think of Basal as insulin for some reason, they think of it when they're on MDI, like, I inject this once during the day. And then my fast acting insulin is for meals and corrections, somehow the two don't go together. To me, that might be where some of that comes in is then you move over to a pump. And instead of using 30, and 30, you're using 60 of all one insulin. And I guess I'll just say here in case people don't understand that a fast acting insulin like a nova lager humor, log art and uses a PG or there's fiasco, those kinds of insolence. Go into the pump, and you get little bits of it, you know, spaced out all day long to act as basil. And then you get more of it to act as a Bolus. So you're used to using to insulins on MDI. Going forward with a pump, you'll only be using one. Bob says have backup supplies, things will fail from time to time and you need some backup supplies. He's talking about MDI stuff, don't give away all your needles. I still have syringes from when Arden was four years old, and we still use them once in a while. Bob's 100%, right? He says and if you're using an omni pod have a paperclip around. So if a nominee so different pumps have different situations where they're going to all fail at some point, something will happen to the flow of insulin. The pump will recognize it and shut itself down for safety reasons. They all do it. When on the pod does it it beeps and sometimes the beeping doesn't stop and you have to flip it over. There's a little hole in the back and you stuck a paperclip in there, and it stops the alarm. So a paperclip is definitely something to have around. Bob. You're 100% right. I seem to remember one time when Arden was young and it happened at a baseball game we use the post of Kelly's earring to stop it. That was a desperate moment. Janelle says you're not going to learn everything in one day. It's trial and error. Pay attention to your CGM. If you have one adjust accordingly. small bumps and nudges. She says I have anxiety and was freaking out when I didn't have good numbers at first, but I had to just keep adjusting, and now she's in range 80% of the time and she's happy with her pump. Tara says that patience is key. It can take a few days or even weeks to get all the settings correct. She said they started without a Dexcom so it initially took longer for her son. Since then they've changed pumps twice with a CGM and with being bold and the transition went much faster and smoother.

What she's saying is is that when you can see the blood sugar and you feel the reading into what she's saying, but I feel like what she's saying is when you can see the blood sugar in real time and you have that faith in yourself to make changes. It will go much easier. Some of you will use pumps that offer soft cannulas or steel cannulas She said that they had great success with the steel ones. And that you can get your endo to write prescriptions for changes more frequently, if you need it to, to avoid absorption issues. And that's with any pump. Misty says it may get worse before it gets better. It takes time to dial in your settings. She's saying again, your rates from MDI will change and change again, but it's worth pushing through. And she suggests that Basal testing is definitely necessary. She found pick a timeframe at a time like I think that to start with overnight, then, you know, pick pick segments of the day to get I have to tell you, too, and I say in other parts of the podcast, I'm a fan of as few basil programs as possible. Like I don't think you're outsmarting diabetes by having like a different Basal program every hour, you know, it's point three, five at three o'clock and point four or five at four o'clock and point to like, Yeah, I think there's a balance in there you find you can find eventually, where maybe you'll have one, two, maybe three standard Basal settings throughout the day. I think if you start having more than that, there are other things you could be looking at. So let's go says start with the endo settings. But keep in mind they keep it on the safer side. I said this earlier, we give it a week to see they gave it a week to see how the body was adjusting. But she didn't want to keep things high too long. After a week, they started to make slow adjustments after talking to the Endo. And once she was confident and she understood how the body was reacting to the insulin, started making the insulin adjustments on her own. She says you can be as bold as necessary as long as you're paying attention. Joanne said what I said earlier, which is don't panic right away and just decide this is a bad idea if it doesn't go exactly right. A lot of people came in to agree with her about that. And Jessica wanted to offer that she loves using the extended Bolus features and Temp Basal is that pumping allows a different Jessica says listen to the pro tip episodes. Thank you, Jessica. Don't rely solely on your endo to make adjustments, watch the Dexcom keep track of your trends and make adjustments when it's necessary. I'm going to tell you about one of the better decisions I made last year I switched Arden's delivery of her diabetes supplies from where we were getting them to us Med and US med is more than edging out the service that we were getting from that previous company. right from the comfort of your home or office, you can join over 1 million satisfied customers who rely on us med for courteous, knowledgeable and trained customer care and their representatives are going to keep you up to date with your medical and diabetic supplies. All delivered right to your door. Us med.com forward slash juice box or call 888-721-1514 To get your free benefits check right now. US med features a litany of things that you're going to love. How about an A plus rating with the Better Business Bureau. They accept Medicare nationwide and over 800 private insurers. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM like the FreeStyle Libre three, the Dexcom G six and a little bird told me the Dexcom G seven coming very soon. They always provide you with 90 days worth of supplies, and fast and free shipping. better service and better care is what you're going to get when you go to us med.com forward slash juice box on top of all of this US med is now dispensing Novolog insulin aspart and human log insulin lispro through their pharmacy benefits. What are you waiting for us med.com forward slash juice box 888721151 For us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash. They are the place we got our hands on the pod fives from us med provides Arden with her Dexcom supplies and are the number one fastest growing tandem distributor nationwide. I mean, I guess I could say it again. But are you just already online getting it done? Are you even listening to me anymore? Wherever you already called 888-721-1514 don't like the phone us med.com forward slash juice box. The other day I got an email from us Med and it said are you You want some more supplies? I guess it was time and I said yes. Click the button and then they just showed up. You want to do it like that. It's pretty damn easy. Us med.com forward slash juice box

when you leave the house, it's more than 20 minutes away take an insulin pen as a backup because in case you have a bad site, so I have to say we don't bring extra insulin with Arden. If we're in what I think of driving distance. Like if it's an amount of time I wouldn't care If I had to go back, if I'm going to try to spend the afternoon at someone's house for a picnic, and it's a half an hour from my house, we take extra insulin and some pumps with us. I don't bring needles, I have to admit. But her point is valid and worth considering having backups is not a bad idea. Brent makes what I think is a great point. He said that it's just the new ballgame when you start over. And this is something I find myself telling people privately as well. Well, let's see how to put this. You might be doing terrific on MDI. But what what comes with a pump, you know, maybe you just don't want injections, or you want more control over Basal insulin or something like that. Anyway, it took you a long time to figure out injections. And it's going to take you a little bit of time to figure out pumping, it is a different game. But at the same time, it's really exactly the same. It's the mechanics of the pump, the nuts and bolts, how it works that you have to get accustomed to. And while you're getting accustomed to it, you will feel like where you could feel like I should say that you don't know what you're doing, which might lead you to have that feeling like why did I do this, I knew what I was doing. And now I don't again, but trust me, it's worth the effort. If it's something you're looking for. Amy makes a great point here. She said that after you're up and running and things are working, take a step back and look at the pump data, right look at what it's doing. Especially she says if you're using an algorithm based pump, because you'll be able to see the increases and decreases in Basal when corrections go in and stuff like that. And it'll give you an insight into what's happening. Heather says that she felt like every new step was scary for her son, who was just diagnosed recently, and eight years old. They got their demo on the pod and just left it on the table for a few days until he was ready to try it on. She also figured out things about how to remove adhesive and overlay patches that help hold things on. So there's a little bit of a new world in there. Some people use patches, Arden doesn't we never put a patch on Ardens Omnipod. It stays on fine for three days. But I liked that she didn't rush here, she went out and got the on the pod demo. And just was like, alright, let's just leave it here till we're ready. It gets a good vibe. Even though this episode doesn't have a sponsor, it's a great place to say, I really do believe when I say during the app in the ads for on the pod, one of the greatest things about Omnipod is you can get a free, no obligation demo, you can actually try it on and where the other pumps just don't lend themselves to that. But on the pods tubeless nature makes that accessible to you. My on the pod.com forward slash juicebox to get that free demo. And you're helping out the podcast if you use the link. Allen's recommending the book pumping insulin which I've never read, but I've heard so many good things about I'm absolutely happy to say it here. He also wants to point out that the information that's available in doctors offices can often be lacking. And that's what led him to pumping insulin. He said back in. Let's see back in 2007. My doctor at the time told me they'd write a prescription for a pump. But if I needed help with it, I'd have to get it somewhere else. He said he appreciated the honesty but finds that a little frightening. Lauren says Keep in mind that you are probably rounding up your insulin amounts of MDI. So the same ratio on a pump might not work. So this is the exact opposite of what I was talking about earlier. But it's still really valuable to say that you might what she's saying, Laurie, I'm Lauren, I'm sorry, Lauren, I'm speaking for you here. But what I'm saying is you might have been using a unit or a half a unit because that's what you could measure with a syringe when maybe point four or point six or 1.1 was more like what you needed. Brianna says to do your research to decide what pump is right for you. She spent a long time looking at the pros and cons of all the pumps that are on the market. She says that she eventually found that her body responded differently to insulin going in through MDI and through a pump that there was a big learning curve for she had to end for 19 years and was previously on a pump years ago as a child but didn't use insulin correctly then it eventually transitioned to MDI, having been well controlled with MDI. She just thought the transition to a pump would be seamless. And it wasn't. Kristen says try not to put too much pressure on yourself when you make this switch. She found it stressful to learn to use a new piece of equipment, and says give yourself or your child some time to adjust. And you may hate it at first, but give it time. She said it can be strange to wear something on your body at first, but one day, you'll probably barely notice it. I must say that I've worn a couple of Dexcom and some Omnipod demos on my time. And I have to agree with that. I've obviously never used them for insulin or for actually taking care of diabetes. But when I've worn the things myself, I have forgotten that they were there eventually they do become pretty seamless. And that's probably hard to imagine especially for parents who are looking at their kids and thinking Oh they're so small on this thing, but I do think you just get accustomed to it. I know Arden did. Kristen continues on that for her switching to pumping was life changing, it just took time to adjust. She says as far as management goes, you already know how to use insulin and pumps to the same. This is a great point that I really want to echo. You're just delivering the insulin a different way. That's it, the basil is going in a different way. The boluses are going in a different way. Instead of pushing in a needle and pushing on a plunger, you're pushing a button, and it's going through a tube, she finishes by saying, take your time. And if you need help, come back to this Facebook group, we'll help you Kaylee's saying something that I've heard people say before, a pump is not a cure for diabetes. And while it makes life much easier with type one, or type two, I guess if you need insulin, it still sucks, you still have diabetes, it's going to be work to learn a new method for both you or if you have a child for your child, too. Don't forget to write down your settings, she said. So you're not scampering around trying to remember things. And remember that technology can fail at times. So you're going to want to not just rely on that programming to remember all your settings forever, write them down somewhere. But what she's saying is valid, that sometimes you can hear people outside of diabetes say, Oh, do you have one of those pumps, and they say it like oh, you must have if you have a pump, it's probably just super simple, right? Probably makes the whole thing go away. If you're feeling that way, like a pump is just going to make diabetes disappear. That's not going to you're still gonna have diabetes, you're still gonna need a Bolus, your meals Pre-Bolus You know, understand your settings, just the delivery of insulin is going to be different, easier, in my opinion, and you're not gonna get stuck as much, which is a big deal to me, Arden also being on the pod user, I really enjoy the fact that she does not have to take her pump off to bathe or to swim, which means we can get a nice stable Basal setting and use it 24/7 Kate just jumped in and thanked me for doing the episode and said that they've been MDI for three and a half years and the idea of pumping scares everyone in her family. And I'm, I've got to tell you, Kate, that is unfounded fear, you really don't need to be afraid you're just delivering the insulin a little differently. You get rid of the shots, and you're picking up your ability to manipulate your Basal insulin and create extended boluses. It's not scary. I know you're scared, but trust me, it's not actually scary. Christy said she wished that someone would have told her that her on the pod beeps to let you know when it's done. She was in a board meeting the first time it went off and she had no idea what to do. Christy, I would tell you that the on the pod came with a book and it would have explained all that in there. But I get your point, it would be nice if someone would just go over it real quickly with you. That's one of the great things about I don't know about other pumps, but on the pod for certain. Let you know when your reservoirs getting low, let you know when it's coming time to change it. It's good stuff. Linda says they got a pump quickly and not had and at that time had not known about the podcast. So they were very reliant on their endo team for help. She said her diabetes educator was awesome and called several times after we placed the pump. In the days and weeks that followed. They were calling to make sure everything was going good to help with adjustments. See, this is great if you've got this kind of Endo. Good knock on some wood good for you. She still says she remembers being overwhelmed at first by all the steps that it took to replace the site and being afraid that she'd forget something. That's just the I get that but that's the not knowing right? It's like you don't know what you don't know. So you're worried about everything. She has a T slim pump. She said it's user friendly, told her exactly what to do. Her biggest advice would be to just know that there will need to be adjustments made. Julia says something I've heard a lot of as well. She remembers feeling like she had just been diagnosed all over again. We kind of touched on it earlier, but it could give you that feeling. Heather says take your time. Listen to the instructions on how to change your sight. And if you're getting persistent highs, it could be that your cannulas bent or something like that happened while you were changing your infusion set. We've only ever had that once where Arden got a bent cannula. And it took a couple of hours to figure out because we were swimming and she was away from her CGM. Had she been right with her CGM. At the time we would have noticed the rise right away.

And he says I remember being in high school and pumped started really being used that her endo was all about it. Her mom really wanted her to get it and she didn't want anything to do with it. She didn't want the tubing, the pumping attached to her all the time, the newness of it. She just didn't want it. She got a two pump and had it less than a year and hated it. She'd get it caught on doorknobs drop it never had a pocket to put it in. She was in private school. She wore skirts sounds like everything was not going well. It wasn't until her sophomore or junior year of college that she got an omni pod and it was a game changer. Oh, well. Thank you, Miami bah Calm forward slash juice box. That was nice for you to say any Thank you Carmen figuring out how to adjust the Basal rates on time of day was a huge advantage. So, you know, my daughter, you guys hear me talk about all the time but Arden needs less insulin from basil overnight and she does during the day. And you have the ability to make those changes. You can say from midnight to seven, I want it to be point nine, five but from seven to, you know, midnight, I want it to be 1.2. Sara says she's a type one she's had it for 29 years, she used the pump for about 13 years got tired of it went back then di was never super comfortable with extended Bolus and stuff. But she says however, I am now trying to regain better control. And I'm about to switch back to a pump. She's got a Dexcom G six now, for about six months. She loves it and she's eager to get going with a pump again. And she's hopeful to lower her one season to the sixes Sarah, I definitely think you can do that. Christine is talking about the power of temp basals and extended boluses. There's things that I think a lot of people don't think about. I talked about them pretty extensively with Jenny in the diabetes pro tip episodes. I think these things are amazing tools that pumping offers. And please take a look at those episodes and try to figure it out. Dee says that when they started on on the pod, she had a couple of errors in the beginning. And it all seemed like a pretty big mess, but she stuck with it. Just remember Basil is not going to be right right away. And the need to make changes. It's obviously you're hearing a lot of people say the same things. It's because it's just what happens. Meghan basil testing and patience is huge, especially if you're moving to an algorithm based pump. Like the Medtronic 670 G, for example. Both of these systems should be started with the algorithm off until basil testing is complete. So if you're thinking about doing that, she's 100%. Right? If you're starting with an algorithm, you start with the algorithm not working so that you can get the basil right before you start expecting the algorithm to do something. She said juice box listeners know the importance of Basal testing. However, it seems there's not enough follow up in the transition from MDI. long acting insulin to pumping Basal rates I very much agree magnets. We do not talk about Basal insulin the right way overall. Tara says if you have a younger child, this is a good point that on the pod like ticks as it's getting ready to go in and she said it made her daughter anxious. They gave her headphones and an iPad so she wouldn't hear it. It's click click click. I have to tell you Arden has been wearing it on the pod for 13 Maybe years. And she still counts the clicks as they go in. So I hear you I think everybody within Omnipod knows about the clicking. But the clicking is it's part of the game. It's how it makes tension to put the insert. It's not important. It's just you know, tout works, but the headphones to eliminate you being able to hear the clicking smart coordinates reminding us that the pump is only as smart as the settings that are in it. She had to remind yourself that the pump was only going to do its job once she did hers. Here's a fun story from Danielle. She said my daughter was six years old when we told her how she wasn't going to have to get shots anymore because she was getting in on the pod. So she was very excited. The first time they put on the pump. The clicking and insertion scared her but they told her Don't worry because you're not going to feel it anymore. No more shots than it came time to give her her first Bolus. They explained it again no more shots that her daughter ran from the house down the street to avoid the Bolus. She said when they finally got her to calm down and gave her the insulin. Her eyes went very big and she suddenly realized no more shots. She thought she was going to feel the insertion every time she got insulin. That was the one thing they didn't think to explain to her. That's a great little piece of advice and an amusing anecdote. Sara just says please everyone share your tips so we can get this episode up. I need it for making the transition soon. Big smiley face. That's really great. People here we're waiting for insurance approval. A lot of people in the thread are just talking about we're getting a pump. Laura, I would say that the fear of making the move from MDI to pumping at least for her fear of change. Yeah, what's worked we already doing something it's working. And then she said we should have they were worried about and then she says they were worried about cost. Is this really something everyone would like? So a lot of those concerns. Okay, good. I was hoping this one came up with. Okay, good. I was hoping this one would come up. Marta says that her total Basal insulin went down, that the initial formulas for pump therapy starting with about 80% of original Basal dose had to be dramatically reduced. She went from injecting 18 units of Toujeo to 12 units on the pump. See, everyone's not the same. And I'm not saying this happened to this specific person. But you There are many people on MDI who are using way too much Basal and find themselves feeding their insulin constantly. So as long as they eat on a certain schedule, they don't notice that they're using too much Basal insulin. And it mimics really great control because you're being held low and steady. And as you try to drop you add food. I hope that makes sense. So there's a lot of different scenarios people find themselves in with their Basal. Some people don't have enough some people have too much, you know, etc. You'll find out who you are. When you change your pump. Jennifer says, if you're using a tube pump, remember that you're going to disconnect it for, you know, bathing, for example, she says, Be aware that your child may take the pump off for a shower and forget to put it back on. Of course, whether you're a child or an adult for getting to hook back up to your pump, you know, you don't have insulin, and you will be surprised how quickly your blood sugar will rise to a dangerous level without any insulin. Tommy asks for me to talk about transitioning during the honeymoon period. Tell me what I would say there is if someone's honeymooning, and they maybe don't need very much insulin or at times it feels like they don't need any for 15 or 20 minutes at a time. Your ability to shut basil down or to tamp it back is going to be amazing for you. Here I'll bring this up. Never turn your Basal insulin off, so you don't suspend your pump. When you want your Basal to go away. You always do a Temp Basal decrease, because when they end, you go back to your regular Basal rate. Suspending insulin and again, maybe forgetting to turn it back on is another quick way to get into DKA always Temp Basal never suspend. Now I hope all of you find the diabetes pro tip episodes that are here in the podcast, they begin at episode 210. With an episode called diabetes pro tip newly diagnosed we're starting over, but if you've been through them, and just want to get back to some things that might be specific to this to 19 is about insulin pumping to 26 about the perfect Bolus setting Basal insulin to 37 Pre-Bolus ng 217. These are all things that might have more stuff for you about using a pump like episode 218 Temp Basal. There's also one here about fat and protein rises, which we'll talk a little bit about using extended boluses. And that's episode 263. You can find them all in your podcast app or at diabetes pro tip.com. All right back to the list. Kyle says Don't forget to rotate your sites, that's a great one. Don't always put your pump in the same exact place. Oh, he also says you can do a Temp Basal like 0% type Temp Basal off when you first start pumping until your old injected Basal insulin get through your system and then boom, pop it right back on again. You can just sort of match them up as close as possible, so you don't have an overlap of your injected Basal insulin, and your pump Basal insulin on your first day. Eva says that for her pumping was the first time she had any concept of insulin onboard, since it was now being displayed right there on her pump and sometimes scared her away from being as bold with insulin as she was with MDI. It was only once she pushed that out of her head that she was able to add insulin when she knew she needed more. So we talked about insulin on board through the Pro Tip series, I hope you've heard them. There's a lot about how your settings get set up on your pump, your doctor chooses an amount of time that they think the insulin stays in your system. If that number is not accurate, then the pumpkin imagine that there's insulin that's still active when there's not. In other words, imagine that the pump thinks that the insulin stays in your system for four hours. But really, you use up the insulin most times in three hours. Then between that third and fourth hour. The pumps gonna still think there's insulin active in there working and say you go to have like three or four carbs. The pump might say no, you don't need any insulin. You still have some active, but he may not. It's you'll figure it out. But don't just maybe I'll do an episode of insulin on board with Jenny sometime might be a good idea.

Alright, let's see what's next. Abby says I need this episode now. very forceful IV it's coming. Carrie remembers being excited that she would not wait. I remember being excited that I would not be as lazy of a diabetic since I would not have to get all the paraphernalia out just to give myself a single shot. But I wish I had a provider that once we had all the settings in would have done the little small tests with me to really hone in the settings. Also remember that it's a tool not a savior or cure. We've gone over that you're still responsible for understanding. Absolutely true have a backup plan for are failures with your pump. It is an electronic device it could fail to and describes learning about a pump as an elephant that's charging at you. I think she's mixing her metaphors she'll join. I think you're mixing your metaphors, but I love it. I'm just starting this week. So I'm super new. But here's what I know. It's an elephant, a giant elephant that feels like it is charging you the classes and forms the logging pump. The represent the logging, the pump reps, the saline start actually starting it more logging, it feels like you'll never see the end of the tunnel, but you get there. So an elephant one bite at a time. So worth it. So where she mixed is she said I love this. You said it's like an elephant charging eight. But I think the saying is how do you eat an elephant one bite at a time, right? I'm not sure what you did there join. But I like you kid who I like what Vicki does here. She says I can wholeheartedly say it was the worst thing I've gone through in 25 years of having diabetes. Looking back, I wish I really understood all the terms in the defining diabetes series before getting a pump. I went from MDI and basically had no knowledge of carb counting. I was diagnosed in 95. And I really didn't stay up with it. So overnight, I needed to understand Basal correction factor, insulin on board, extended Bolus, etc. Also, she says work with your diabetes educator when you're setting the Basal rates, get them to teach you when you should make the changes. I was on 14 units of Lantis on MDI, my diabetes educator who I hate her fired started me on four units. Yeah, that wasn't going to work out with a pump. And would only let me increase it if she said it was okay, they need to teach you how to use the pump. I agree. And Vicki, I appreciate you bringing up the defining diabetes series. There is a series within the podcast called defining diabetes. And this is going to be a big deal for you. Because new terms are gonna pop up with a pump. If you don't know what they mean, you might as well be reading a different language when someone's explaining it to you. You need to understand the terms that you're going to be using. And I do believe just you know, I know I made them. So I might be a little bias but those defining diabetes series are an amazing way to learn a lot of things very quickly. Hey, Katie, you have a great post here. But we covered everything that you said already, but I want to thank you for it. Oh, Jennifer says I recall being nervous about my son accidentally dosing. When he first got his pump. He had an animus ping. So I learned how to lock the pump or use the second security feature that helped ease my anxiety. Apparently there was a pin number she could use. Also, I recall being thrilled that our world got bigger once parents don't have to worry about the needles. He got invited to a lot more playdates and sleepovers. People were just more comfortable with the electronics. That's an excellent point. And leads me into the idea that I'd like to bring up which is that I know the Omni pod has limits that you can set I'm sure every other pump does as well. Max Bolus Max Basal rate so that you can't by mistake want to give one unit and give 100 units is a Bolus or so you can set it wherever you want. I think Arden's Max Basil is set at like six units or seven units an hour. So I can't mistakenly type in nine or 10 or 77, or something like that. And same with her Bolus. I don't remember where it's at at the moment, but I just took the biggest Bolus I've ever made in my life added a couple of units to it and limited it at that so that somebody doesn't end up doing, you know, 175 if they mean 17, but I'm also not in a situation where if suddenly she eats something more than usual, the pumps not stopping us from giving a couple of more units than we normally do. It's a very important safety feature. Please check it out. Kelsey, you're asking a lot of good questions here in the thread. They're all covered in the diabetes pro tip episodes. Stephen says best tips I got were in my original training from a CDE, who was also a T one D. The first was about changing sites, be sure to prime the cannula and add the appropriate amount of insulin to create the puddle of insulin. So it can able so it can enable the insulin to start the absorption, breaking the clumps of insulin into single molecules so the body can use them. Steven, I'm not following you because orange never used the to pump but I trust you as a great person on this site. So I'm going to continue reading. The second grade tip was to use skin prep as a skin barrier and adhesive enhancer been using it for over 20 years. The third was to understand that the Basal rates will change and that the insulin to carb ratio will change no matter what you do. Don't take it personally, Steven, I'm gonna say I'm guessing tube pumps get air in them you have to prime them through. It's not something I understand. Because I've never used the tube pump but I do know it's important. So if you have a tube pump, make sure you understand how to prime it. If you have an omni pod, it takes care of that automatically. And what else did I want to say here? I just had a thought in my head Stephen What the hell you made me think of something and now it's gone. Oh, Tim, what about Basal rates? I got it, but you may have lost my mind yet. Basal rates are going to change. That's whether you're MDI, or you're pumping, you're gonna gain weight become more or less sedentary. There's all kinds of reasons why the amount of insulin you'll need will change, hormonal changes. It's not ever going to be set it and forget it, you're never just going to be like, Oh, my Basal rate is point seven, five an hour. I'll never think of that again. Don't think that's gonna happen. Jenna, this is brilliant. Start your first few sites around the same place on the body. For consistency. Different locations can require different Basal rates. Like for instance, Arden's thigh needs a little more insulin than Ardens arms, very good. Her belly doesn't need as much as your thighs, etc. That could be different from every for everybody. Jenna goes on to say different locations can require different Basal rates, Pre-Bolus times and just overall insulin need and action time. Personally, when doing MDI, I recognize that I have poor arm absorption and great belly absorption. Jenna has great belly absorption. If you're ever on the podcast. Yeah, that's gonna be the title of your episode. So I started putting my pods primarily on my belly for the first few months. So I could figure out how to best use my pump. And its features without adding confusion of absorption differences. That's pretty brilliant. Also a great time to read, mind you that you can't just put the pump in the same exact spot over and over again, very similar to you just can't inject over and over in the same place, you have to have a few sites and you should rotate them often. And don't forget that please. In the same vein, Arden has times of the month where she is more easy to control and less easy to control. I don't think that was English. But when I know she's going to be harder and need more insulin, I make sure that her pumps are on her sites that work better. And times when she's going to be easier. I put it on the sites that need a little more work. So it's not that drastic, but it is significant enough to mention that you should be paying attention to it. Okay, well, that's it. I appreciate everyone jumping in the thread and leaving their thoughts remembered his and tips of switching from MDI, to pumping. I remember the time personally as not that confusing or different because I was pretty bad with MDI. So I didn't notice if I was bad at it would pop, just just move one show from this side of the room to that side of the room. You know what I mean? I can say now looking back with hindsight that everything that everyone mentioned here is well worth understanding. But in the end, you're changing insulin delivery systems, you're eliminating using two different insolence, you're using just one fast acting insulin that's being dispersed by the pump, both for basil and Bolus. You need to know the terms of the pump stuff, because otherwise you're like, I don't understand what a Temp Basal is. You learn that kind of stuff, you learn what a cannula is, that kind of thing. You start figuring out what spots on the body work better, which spots need a little more insulin, get that Basal insulin, right? Don't sit and stare at it, especially especially just do the math. If you were using 10 units a day, and now all of a sudden you're using five units a day of Basal insulin. And you're like, Oh, the blood sugar is always high. Please don't say pumps don't work. Think, why are we not using all the Basal insulin we used to? That's just such a big thing.

Just I just see it so much with people. And here's one last tip from me. When you're wearing an insulin pump, and you think this site might be bad for whatever reason, and you're pumping in insulin, you're not seeing anything happen, and you're not sure if the site's bad. Or if you just have a high blood sugar and you're not using enough insulin. Making an injection, as a correction will bypass the pump, right? So if you inject in that scenario, and your blood sugar starts to move down pretty quickly, that's a good way to figure out that the site might be bad. You say makes sense, Scott, but what I think of it in the moment, you probably would not just why I've mentioned it here. Anyway, I hope you enjoyed this. I really want to thank the people on the private Facebook group for the podcast. It's called Juicebox Podcast, type one diabetes, I hope to see you there. And that's it. They don't forget the T one D exchange. If you can go to T one D exchange.org. Forward slash juicebox. And get involved in the registry. You'll be helping people with type one diabetes, a huge amount you'll be helping the show. That by the way is for US residents who have type one diabetes or US residents who are the caregivers for someone who has type one diabetes, and because we talk so much about it. I know there are plenty of other pumps. But of course the on the pod is a sponsor of the show, and they offer a free, no obligation demo it will be sent right to your house and you can actually try it on My Omni pod.com forward slash juicebox. There's still links in the show notes, and links at juicebox podcast.com. I forgot to mention that the defining diabetes episodes are of course available, they're spread throughout the podcast. But if you go to diabetes pro tip.com, and scroll to the bottom of the page, there's, they're all there. So you can find them that way, if you just want to find out what number they are, and then listen to them in your player or you can listen to them right on the website. I really appreciate you listening. I'll be back soon with more episodes of The Juicebox Podcast.

If you think you'd be a great guest for the podcast, reach out to me by emailing me at Scott at juicebox podcast.com. I'm currently booking for the second half of 2021. I think that's August or later, I'm looking for anyone who thinks they have a good story. Somebody who really wants to share help people or just want to be involved in the podcast. Bonus if you think you have a good after dark episode and you email me. I'll wait for this. I'm Scott at juicebox podcast.com.

Want to thank you for listening today. And of course thank you s med for sponsoring this episode us med.com forward slash juice box or call 888-721-1514 You can get your diabetes supplies the way we do from us met. Of course 35% off cozy earth.com with the offer code juice box at checkout, save 10% On your first month of therapy@betterhelp.com forward slash juice box. And if you want to get started today with ag one from athletic greens, you will get five free travel packs and a year supply of vitamin D with your first order at my link. All the links are available at juicebox podcast.com. And in the show notes of the audio app you're listening in right now. When you click on these links, you're supporting the production of the podcast and I can't tell you how much that means to me keeps the thing free and plentiful. So if you're enjoying the podcast and you need one of these services or products, please consider using my link. Thank you so much for listening. Don't forget to check out the private Facebook group Juicebox Podcast type one diabetes online. That's where all this came from absolutely great community. It's absolutely free. I said absolutely twice but whatever. Still good Juicebox Podcast type one diabetes on Facebook. You don't have to have type one. You could have type two. You could have Lada you could be the caregiver of someone with diabetes. It's just a great place in general. Thanks again for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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