Scott Benner 5/27/24 Scott Benner 5/27/24

#1209 Glucagon in an Insulin Pump

Paul Edick and Sean Saint are CEOs of thier respective companies (Beta Bionics and Xeris). Today we talk about their new relationship and their desire to create a bi-hormonal insulin pump.

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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 1209 of the Juicebox Podcast.

On today's show I'll have two guests, Sean St. Who is the CEO of beta bionics they make the eyelet pump, and Paul EDIC. Now Paul, he's from xirrus pharmaceuticals they make G voc glucagon today we're going to hear about how xirrus and beta bionics are going to team up to help make a by hormonal pump. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you are a loved one has type one diabetes and your US residents please go to T one D exchange.org/juice. Box and complete the survey when you complete the survey. You are supporting type one diabetes research and you can do that right from your house. T one D exchange.org/juicebox complete the survey. You're helping yourself you're helping other people with type one and you're helping me this episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed ever since cgm.com/juice box us med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well us med.com/juice box or call 888721151 for use the link or the number get your free benefits check it get started today with us med

Paul Edick 2:15
I Paul Edick I'm the CEO of Xerus biopharma.

Scott Benner 2:18
Hello, welcome back. You've been here before I took a look this morning. You're back in the three hundreds in my recordings, and I'm about to post episode 1200

Sean Saint 2:30
It's been a while for years. It's nice to have you back and Sean, Sean St. CEO of beta bionics Okay,

Scott Benner 2:38
now we've never done this before. This is very interesting. So we have beta bionics and seris. Why would the two of you be together on one podcast? Let's find out who wants to go first.

Paul Edick 2:50
Maybe I'll take it if that's alright with Paul.

Sean Saint 2:52
You know, beta bionics has been a wild we've had a vision of bio hormonal glucose control now for over 20 years and said Damiano our founder started thinking about exactly that. And, you know, over the years, there have been several things that have held us up, you know, heads blown through a lot of roadblocks here, but at the end of the day, we needed hardware, we have that we needed an algorithm we have that. And we needed an appropriate glucagon and enters Aris because they certainly solve that problem.

Scott Benner 3:22
So Paul, if I remember correctly, four years ago, we did an interview together. And at that time, you were just talking about G voc as a rescue glucagon and I tried to prompt you I tried to get you just say something about, Hey, you think this will ever end up in a an adult hormone pump? And you wouldn't? You wouldn't really say back then. But have you guys been working on that since then? Like or even longer?

Paul Edick 3:49
The answer is no. We I talked to Ed years ago, and we kind of talked back and forth. Beta bionics ended up with a relationship with Zealand for a while. And we've stayed in touch. And when Shawn took over, you know, we we re kind of re initiated conversations. And the net result is we said, look, we we believe we can formulate an appropriate glucagon for pumps. And we've we've maintained that dialogue. And, you know, we finally put it all together and our aim is to be the facilitating glucagon in a by hormonal system.

Scott Benner 4:24
Wow. So what were the needs? What did you need the glucagon to be able to do?

Sean Saint 4:30
Well, the primary need is shelf stable, right? There has been limited shelf stable versions of glucagon over the years. The early development of both our program our bio hormonal program, as well as a few others have primarily utilized the lyophilized glucagon, which starts to degrade immediately. You reconstituted with water and we've historically used it for up to 24 hours but it's not really a product. In order to be a product. We're going to have to have stability that goes well beyond 24 hours. And again that's I think the primary challenge that that we were looking for. There are others compatibility with the materials that we're using, etc. That's always got to be a concern. But the shelf stability of the of the solution is the main one, I think, Paul, do you have anything to add to that? No, I

Paul Edick 5:13
think that's what we do. We believe that, you know, just like Chivo, we can build a unique formulation that will be shelf stable and enable the dual or model system,

Scott Benner 5:24
what's the amount of time you need it for? Is it just the I mean, I wouldn't imagine you design it just to work for the length of the set. Right. But that's really how long you need it to be good.

Sean Saint 5:34
Yeah, that's what you need. I mean, from my perspective, I would say mimicking an insulin experience is probably a very good goal. Insulin is fine to be stored in the fridge, right? But you do bring some with you, you know, I have some in my backpack right here, that I can carry around me with for a period of time. So I always have some with me, and to me that that's sort of it's I'm not gonna put exact number on it. But that, to me, is the experience that you're looking for. Okay.

Scott Benner 5:57
I'm gonna jump around here for a second, because in the direction of the questions that popped into my head, but, you know, rescue glucagon, for people who don't have good insurance can be expensive. So I'm assuming you're going to want this covered by insurance, and you feel like insurance will cover because you're going to be throwing a lot of glucagon away. Is that right?

Sean Saint 6:17
Yeah, absolutely. I mean, I think it's, it's necessary, especially if I move for being honest, you know, we're talking about high end automated, you know, and closed loop glucose control, we're talking about insulin, we're talking about a pump we're talking about now glucagon associated with that. And it's probably not realistic for most people without insurance, unfortunately, and we'd all like to solve that problem. And we'll work toward it. Certainly, we make our products as affordable as we possibly can, in terms of out of pocket, co pays, etc. But yeah, that would be be a true statement, well, we'll definitely need to work with insurance to make sure it's good. But in order to do that, you want to show a clinical benefit, right. And I don't think we've ever been more convinced that we can do that with a product like this. And the early formative trials that we've done with glucagon and the hormonal system indicate exactly that.

Scott Benner 7:01
Okay, that's amazing. I happen to it's very interesting. We put this conversation together kind of last minute today. But I earlier in the day, put a poll up on my private Facebook group after I saw your press release about what happened today. And I just said, would you want a dual hormone pump? I didn't know we were saying by hormone or I would have changed it to that. And yes or no, I have 367 responses. So far. It's been up for four hours. Yes. 272? No. 10? And the third answer, which was, huh, is that 87. So people came in and asked a lot of different questions while we were in there. And after we talked for a minute, if you don't mind, I'd like to swing back and maybe ask you some of their questions. But overwhelmingly, I think this is a desired thing. Like I had a convert. I had a private conversation with somebody this morning, where I said, I think this is the first step and the next chapter of algorithm pops your press release today. That's what that made me think we completely agree. Yeah. Now the person I spoke to disagreed, and I said, I think there's a desire. I think there's a safety and security component to it. And I think a lot of people are going to run to this idea and enjoy it. So let's talk a little bit about how it actually works. You've done some trials, it sounds like in house like, what's the functionality of the device? How does it actually work? diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 808-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer, and we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514 or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox Podcast. today's podcast is sponsored by the ever since CGM boasting a six month sensor The ever sent CGM offers you these key advantages distinct on body vibe alerts when higher low, a consistent and exceptional accuracy over a six month period. And you only need two sensors per year. No longer will you have to carry your CGM supplies with you. You won't have to be concerned about your adhesive not lasting, accidentally knocking off a sensor or wasting a sensor when you have to replace your transmitter. That's right. There's no more weekly or bi weekly hassles of sensor changes. Not with the ever sent CGM. It's implantable and it's accurate ever since cgm.com/juicebox. The Eversense CGM is the first and only long term CGM ever since sits comfortably right under the skin and your upper arm and it lasts way longer than any other CGM sensor. Never again where you have to worry about your sensor falling off before the end of its life. So if you want an incredibly accurate CGM, that can't get knocked off, and won't fall off. You're looking for the ever since CGM. Ever since cgm.com/juicebox.

Sean Saint 11:10
Well, you know, insulin and glucagon act like the gas and brakes in your car, right one brings your blood sugar down, one brings it back up again. And it's just that number one, we can help to minimize hypoglycemia. With the additional glucagon, we can potentially be a little more aggressive on the hyper side, because we can then catch you on the lower side. And really, it's mimicking the physiology to human body, right? If you don't have type one, you have both insulin and counterregulatory or glucagon response. We're simply replacing that with this system, which is why it works better or hopefully better. If possible, Scott, I'd love to quickly address what I believe is one of the reasons why not everybody agrees with this. You know, interestingly, your poll showed an overwhelming majority wanted it. But did you tell them what their control was going to be like? No, because we can't know that right? So why did they say that? They said that, because they could see that the main point of it was eliminating hyperglycemia, which means reducing the burden of living with type one diabetes. And yes, we expect this system to give you better blood sugar control. But in my mind, more importantly, we expect it to continue to remove the burden of living with type one, I agree with you. It's a next generation system, we believe the eyelid is by removing the burden of insulin dosing. This is then the next next generation, removing the burden of thinking about your blood sugar at all. We

Scott Benner 12:32
hope you feel like you can move the target on the I let down because of the addition of the glucagon. Yeah, absolutely. Okay. Basically, you're going to be bumping and nudging blood sugars around if the number is not important. But if if the algorithm feels like we're going to get low, you're getting like a micro dose almost of glucagon, I imagine based on whatever the number is. So you're not using a lot of it is there in your testing or even Paul, like what you know of it, like, you know, you'll hear from a lot of people, I've had to use glucagon and I didn't feel well afterwards or like, is that not going to be an issue when you're just using small micro amounts of it? Yeah,

Paul Edick 13:09
so the rescue glucagon, G voc and this utilization of new form of glucagon, very different things, okay. Okay, at the end of the day, the whole situation with rescue is you've got a problem. You're beyond gummy bears, and you're beyond juice boxes, and you're going to end up in the hospital, and you get a fairly substantive dose of glucagon, which will bring your glucose back up and you know, 10 to 10 to 12 minutes, you know, from 25 or 30, up to you know, 65 or 70. That's absolutely necessary in a life saving situation, what Shawn is talking about, and I think rescue has has a future but I also think there's an opportunity to introduce a better way to convert glycemic control. And the glucagon component in a micro dose or mini dose fashion, in combination with many doses of insulin is about control. And the odds are if beta bionics or gets it right, you'll have less rescue necessary. But keep in mind, there's only a million out of eight out of 15 million people who carry a G voc or rescue device, not everyone will have a pump. So you know, there will be a future for both, but they can live together. But the goal, I think, is glycemic control at the end of the day, so you have less rescue.

Scott Benner 14:31
So Paul, you didn't just take g voc and repackage it or reconstituted somehow for this is a different molecule or how much can you say about that?

Paul Edick 14:38
Yeah, it's a different form formulation of glucagon with different compatibility characteristics relative to the components of the pump and versus the the pen, different profile relative to shelf stability and length of shelf stability, etc. So we formulated something that would go into cartridge and sit For a period of time, or we're in the process of formulating, and, you know, will will be adequate and appropriate for that mini dosing and upon it to be clear, it is a formulation, different

Scott Benner 15:12
formulations. So this might be a little bit of a diabetes geeky question here. But, Paul, are you going to have to put it through the FDA? Or is showing going to have to? How

does that work? Yeah,

Sean Saint 15:23
because, you know, in today's day and age, the FDA has, they have increased requirements on the use to right, we don't tend to get like a drug without delivery mechanism. So in our case, as nurses and betas case, the environmental pump, with the xerez, glucagon will be tested together as a system. So we'll take the lead on that. But we're obviously going to be working together on all portions of it. It's

Scott Benner 15:46
interesting, Paul, are you covered by you're not covered by this being a similar to the drug that you've already gotten through the FDA?

Paul Edick 15:55
Now this has got to its head will have its own phase two phase three program that beta bionics is going to have to go through to show safety and efficacy of the product in this system. Okay,

Scott Benner 16:07
Shawn, how long do you think that's going to take?

Sean Saint 16:10
We're probably a little early to make predictions on that. Yes, Scout. But, you know, we're gonna work as hard as we can on it. That's for sure. Okay,

Scott Benner 16:16
what is the next step? Then? There's a good question. Well,

Paul Edick 16:19
the next step is getting getting the formulation, right. And we we think we're well into that we'll deliver that this year, no question, then it's a matter of beta going into phase two and getting an agreement with the FDA on a phase two and phase three program. I say, gotcha. So this year to get the glucagon together, Sean is going to be putting stuff in place as best he can without it. And then he's got Phase Two to go through a phase three to go to.

Scott Benner 16:49
So then you come out there side, we're talking like two years or more?

Paul Edick 16:53
Well, it's not months. Okay. Yeah, we can all agree that it's, you know, this is clinical development. It'll take a couple of

Scott Benner 17:00
years right. Now, it's shown in the meantime, are you guys turning knobs on your algorithm

Sean Saint 17:04
in the backroom? Well, absolutely. But I don't think that we necessarily need to, I think continuous improvement is always something that a company like ours wants to be thinking about. So of course, algorithm is a core competency for us, which means we think about it every day. But the algorithm that we've tested in humans with our by hormonal system, up to this point, has performed in a way that we're very happy with. So

Speaker 1 17:26
even if we make no improvements, that's fine. Are you willing to say what way that is? Meaning? How does it How does it I met him about a range? Is there a range that it's able to, you know,

Sean Saint 17:36
I apologize, I can't quote this directly off top my head. And of course, you had Damiano certainly could. But I believe we've gotten about an average is published data about an average agency of about 6.5 was something like 90 92%, landing below seven, timing range gets up into the mid 80s kind of thing, with effectively very little interaction with the product and no worry of hypo. So yeah, we're pretty happy with that. But I think the important point, as I mentioned earlier, is not so much about our time and range or either even our agency, it's about the burden required to get to that phenomenal control. And that's where I think the answer to your your questions earlier really, really shined because they didn't even know what control they were going to be getting with it. Paul, I

Scott Benner 18:20
have to ask you, when you're considering doing something like this, it can't be lost on you that you might be putting yourself out of business with a new business, right? You know what I mean? Like, if everybody's one day gonna wear a pump, where they're like, I don't I never get below 60. Like, you know, or so infrequently. I'm not scared of needing rescue crews, do you think of this as a possible shift in the future? Actually,

Paul Edick 18:40
I don't see it that way. We don't see it as putting rescue out of business, you know, there, there will be a part of the population that will do very well on on this not everybody's going to have a pump. There'll be I think there'll be a good ecosystem for both glucagon and a pump and rescue device. In fact, somebody who's got the system, if they help man, they still there's still a human element to that system. And if you don't do it perfectly, things can go bump in the night. So I would say regardless of what pump, you're on what you're doing. If you get it right, cool. You might go that for five or 10 years, getting it just perfectly, there's gonna be that one time, why not have a cheapo candy, just in case for the population that large that doesn't have a pump or this particular pump? It's absolutely the you know, it's kind of like, why wouldn't you have it is right. Make sense?

Scott Benner 19:32
I listen, my daughter doesn't leave the house without Chivo chi pen. So if this is a question you can't answer, I wouldn't be surprised. But Shawn, what if another pump company walks up and taps on Paul shoulder and says, Hey, we want some of that too. Can he do that? Or does your agreement not allow for that?

Paul Edick 19:48
Look, our intent is you know,

Sean Saint 19:51
I liked your question earlier about about for Paul and sort of disrupting yourself and I think I'll first say that, you know, look, I you know my history I'm very much a pen guy. I believe in the technology strongly, there's a lot where we can do with pens, I think 93% of people give or take are still using pens instead of pumps across insulin delivery. So Paul's right, you know, there's always going to be a market for, for rescue. But associated with that similar question is, might somebody one day scoop us? You know, it's possible. And I think we, we see the development of this formulation of glucagon is, to some extent an enabling technology for that industry, if somebody figures out a way to do what we're trying to do better than us. Well, that's great. And that technology will be there. Luckily, we'll be in a position to capture some of the economics of that as well, malt, or saris. Paul, what was what do you add to that?

Paul Edick 20:42
Yeah, Scott, we contemplated that is there you know, new technology begets new technology, right? So there's bound to be other systems and other algorithms and other pumps, and disagreement enables beta and Xerus. To both participate, whoever comes up with a pump, or a better algorithm, or even if beta bionics comes up with a different system, our goal is to get an enabling glucagon into the market.

Scott Benner 21:10
That's amazing. I think this is fantastic. I, Paul as you if you may remember, it was a long time ago. But the appearance of of there's that's the first thing I thought about when I saw like, shelf stable like this. That's what I was like, Oh my God, they're gonna get this into a pump. Like because I knew people who were in some of those old studies, long, long time ago, probably before Ed's algorithm had anything to do with beta bionics. If I'm imagining if I'm remembering all this correctly, and they were probably just using, like, the old delete stuff, and just seeing how it worked. Is that right, Shawn? That's correct. Yeah. And you were you were not you. You weren't with them them, but they saw the people. Let me make sure I'm not even saying this as a question. It's a statement, the people I spoke to who are in that study, were very impressed by what was happening to them,

Sean Saint 21:59
I'm actually going to use the word we got. And I'll explain that I was really quite phenomenal in that. I mean, people use the phrase, you know, forgot I had diabetes, which I think is probably the most impactful phrase that as the person with diabetes, I can think of when you think about an experience with the new technology, I said we because oddly, I've actually been involved in this project since way back then, I went up, introduce myself to edit Ada, I think 2011 and offered to help and we ended up having a partnership with him in tandem, I was a tandem at the time, they really helped to enable the the ambulatory work that we did in 2000. And I believe it was 12 and, and 13, with the Beacon Hill trial. So I'm still pretty close to this project for over a decade now. And to be able to meaningfully push it forward with this. It's just a bit of a dream. It's amazing

Scott Benner 22:43
that it takes that much time and yet it doesn't. It's not really that much time, you know, you know what I'm saying? Like, in one person's lifetime, it feels like a chunk. But like the consideration of all that goes into it and all that has to be learned and discovered and proven over and over again. It's it's not that long, really. Pretty. It's actually pretty exciting. Do you guys have anything I'm missing? Or can I go to questions? So, okay, they want to know if the glucagon would be prefilled?

Sean Saint 23:10
Most likely, yes. There is a real concern of the agency today. And it's well founded, that drug confusion, of course, is an issue and I think the absolute worst thing that you could do is accidentally put your insulin your glute Gunsite and your glucagon in your insulin side. disastrous consequences on that one. So,

Scott Benner 23:25
yeah, okay. A lot of people just think it's great. I think this is great. I can't, there are days when I can't imagine swallowing another tablet or drinking another juice. See the look on my daughter's face once in a while. She's just like, are we gonna do this? And it's not like this. You do? This person just says, Hey, listen, CGM technology. Am I okay? Here, like we're gonna be letting this thing make a lot of decisions. And that's a person who clearly doesn't use an algorithm. Now, I answered people all the time. And I say, Look, my daughter has been using an algorithm forever. It is honestly never an issue. But some people don't have as good of experience with CGM. So what if we get a false low or we're going to start suddenly getting a bunch of glucagon? That's a concern, right?

Sean Saint 24:08
Well, I mean, the simple fact is, first of all, CGM technology is phenomenal these days. I mean, we've had some form of automated insulin delivery, I suppose since 530, G and 2000, whatever that was, but 12 ish. It's done nothing but get better since then. Yes, there are occasional errors. And yes, they will lead to slight versions of over underdosing. But I think the beauty here is that if you get a false low, you're right, it will lead to some level of glucagon dosing. But that's better than the alternative, which is, you know, some level of insulin dosing, which is where we live today. And so I see this as not a as an incremental risk in any way but an incremental benefit over the current technologies. And because we're micro dosing, we limit the the negative impacts of the larger bonuses, which are required at times, as Paul said, but I think that's the goal we're trying to do here is to make those those lifts More or gentle. Okay, let's say you saw a

Scott Benner 25:03
false 60. And it gave you a micro dose of glucagon. And then the CGM found itself again and realize you were 110. Is your algorithm going to think Can you compensate for the glucagon with its next Bolus?

Sean Saint 25:17
I don't know is the short answer. The longer answer is, all the closed loop technologies are built to understand that CGM is not perfect point to point. It wanders all over the place just not all over the place within a narrow band to some extent. And our algorithms are designed to be tolerant to that. So yeah, if you end up with a little micro dose of glucagon, you end up with a couple of points higher than you'd like to be, then we'll get you back a couple of points lower over time. And Paul's got some

Paul Edick 25:42
good PA. Just I was going to add to that we get that question all the time. But you know, am I going to have too much glucagon? And is my glucose gonna go too high? The answer is no. It tends to it tends to not keep driving. Once you're at a certain level. I mean, this is a hormone we're almost self regulates a little bit. The other thing too, about CGM is the technology has gotten a great deal better. But there's data out there these days, and people still run low for like an hour out of every day with some CGM. So it's a fine line, I think every every new technology, including the the both hormones, and a pump is going to advance the state of affairs, there will still be outliers, there will still be, you know, situations button there, there's this myth that too much glucagon is gonna get my glucose is going to skyrocket. And it just, it's just not the case. Okay? You

Scott Benner 26:39
know, this might be a good place for one or both of you to put into context for people. How glucagon really works like so the this thing you have in heipo pen, for example, when you inject it, I believe that there's a maybe a false understanding of how it works in the public, right? Like they think that the liquid in the pen is directly the thing that raises your blood sugar, but it really is signaling to your liver, am I right? And can you guys go through that process so that they understand, Paul?

Paul Edick 27:10
You're right. It's not the actual glucose? It's it's glucagon stimulates the production of glucose in the system. It's not straight glucose at the end of the day, right? It's so

Scott Benner 27:24
so there is an amount that you could use, that would stop being effective, right? But you don't imagine that with the system would be you'd get to a tolerance like that. I imagine.

Paul Edick 27:36
Now, you that would be mean, even the rescue doses, or you know, it doesn't, I think in our clinical program, all the people in the program and don't quote me, I don't have that right in front of me, I think people got up as high as 161 70. But you know, no, no higher than that, on average, I think it was even a little bit lower than that. And that's, and that's a full milligram of glucagon in the system that Shawn's talking about, people are going to get a fraction of that. Okay. Now,

Scott Benner 28:04
Shawn, will you have to put in your in your literature that it might not work if you've been drinking? Or what will the impact be of that? Because doesn't drinking? Like mess with the gives the liver something else to do? So releasing glucose with glucagon is not as effective, is that correct?

Sean Saint 28:21
In terms of physiology, I'll let Paul handle that in terms of the labeling frankly, we know. I mean, that's the whole reason that we go through these trials and these discussions with the agency is to figure those things out to make the most responsible and well labeled products that we can. So that'll be determined. Paul, can you comment on the drinking? But yeah, so

Paul Edick 28:38
I don't I don't know that there's a specific contraindication or warning about drinking, I'd have to look back at the label. Obviously, in a clinical study, we didn't have anybody who was drinking heavily, so I wouldn't know. But I, you know, I don't think you're going to have a situation where glucagon doesn't work, it works. You may not have the adequate dosage, and then the algorithm would adjust for that. Okay, or rescue? In any situation, I think you've got plenty of glucagon. So,

Sean Saint 29:11
I'm not a physiologist here, but I think Paul's gotta be right on this one. And the reason is that we are mimicking the body's counterregulatory response, right? And in a person without diabetes, when you tend to get low, your body releases glucagon, which acts on the liver, we're just providing that, you know, separately. And the short answer is people who are drinking are not getting hypoglycemia all the time, or to a dangerous level. So the regulatory system works. I

Scott Benner 29:36
don't know if it's a colloquial thing, but I've just heard over and over again, that, you know, be careful your rescue Gluconic might not be as impactful if you're, if you're drunk. And so I just I wasn't sure if that was something you'd be like trying to look into or not, but you know, I'm sure listen, I'm sure you're gonna have to look at everything if you want to get through the FDA. So

Sean Saint 29:55
I have no doubt I will be interested in one of the arms of the clinical trial. As the alcoholic or what have you, but we'll see how we have to do that. Listen, I

Scott Benner 30:04
don't think you're gonna have any trouble getting 21 year old people to get into your study. If you're like, we're going to need you to have a little buzz while you're in there. That might be the first study that's easy to pack with people.

Paul Edick 30:16
Another good reason to also have GMO content no matter what pump you've got.

Scott Benner 30:20
Now, yeah, you're making it true. Very true. Well, you said you guys kind of got back together again. How long was this in the process? Before we got to today's announcement? And, and Sean, how far did like how much good work? Did Paul have to show you before? You were like, Yeah, let's do this. Yeah, well, I

Sean Saint 30:37
mean, I think that deserves has been. So we've known of Xerus. And at two multiples point, you know, companies have known each other for quite a while. I mean, I would say, probably over 10 years at this point. But as Paul was saying, you know that I'll let him answer. But you know, they went one direction. And that's great. I don't know when they conceived of this new formulation. We've been working together on it for months now. But what I will say is that when they came to us with the formulation, it was quite impressive. It was tailor made for what we needed, and just turned our head immediately. So yeah, a ton of work. I will

Paul Edick 31:10
give Shawn some of the, you know, kudos here. At one point, the two of us just got on the phone and said, Look, you know, it looks like we've got something that'll work here. And let's get this together. And I think it took us what, two months? Yeah. Once we once we just got on the phone together and said, Look, we think we got the technologies. Look, we you know, we put a deal together. Yeah.

Scott Benner 31:33
I'm going to ask you both a question that doesn't have to do with this. And I'm going to ask it to Sean first because I think it's a it's a more fair question to Shawn. I want to give Paul an extra second to think about it. What's the most difficult thing, Shawn, about getting islet into people's hands? Like, what's the speed bumps? You have to get over? Like, we know that? I mean, I don't know how how much people realize this, but of the, you know, almost 2 million Americans that have type one diabetes, not many of them were pumps, like statistically like that, we already know that it's difficult. We also know people generally don't walk around with rescue glucagon in their pocket like so like, you guys make these products that do this thing. And you have this great feeling of like, I've done it this is it here like here, world, take this, you're gonna love it. And then you get to that reality of it's hard to get into people's minds and explain to them what's up. So Shawn, like, what's your biggest, like,

Sean Saint 32:26
I guess speed bump right now, education 100%. And I'll, I want to define or maybe differentiate education, from sales. You know, we are a commercial organization, we have a sales force, and their job is to sell. In our case, we hoped that they do that by educating both the health care provider as well as the patient on what the eyelid is, what it represents, and how to best use it. But given that they have a salesperson that you know, there's some times some of that's looked at with a degree of skepticism, which I can appreciate. You know, I would say that's the biggest one is just letting people know what the hell it is and how it represents a difference in generation and evolution of the generation close with technology, right from something where you are thinking about your insulin delivery, you are using words like Bolus, basil, correction units, carbs, to a system where you no longer think about your insulin delivery and don't use those words anymore. That's very, very different. And it takes a moment to internalize that difference in the impact on your life living with a situation like that. I'll reiterate though, that you do still have to think about your blood sugar. That's not a requirement that we've removed, and hence our hopeful next generational shift in technology with despite hormonal system. But yeah, it's education. Are you wearing your production? Or not? At the moment, I have worn it, and I am, horribly, what's the term? Anyway, I try absolutely everything and wear absolutely everything. So it's going to be honest at at the moment, I'm not. And I think you know, the eyelets great, I love the eyelet if you have a need to fiddle with knobs and look on the worst kind of an engineer, you know, not always the right one for you. But there you have it. Okay.

Scott Benner 34:03
Yeah, I mean, are using a pen right now? What are you using right now,

Sean Saint 34:07
at the moment I'm using, I'm using loop, you know, the way I see these things is, there's your your most engaged, right, and then there's your your least engagement or requirements of engagement. And those probably don't anybody quote me looks something like loop is the most engaged, followed by like, Medtronic, or tandem and then the other one, and then on the pod, and then us, you know, on the bar other side taking, you know, several steps farther in terms of engagement level, and you just got to pick where they want to be on that. Now, listen, I

Scott Benner 34:38
think your product addresses a completely lost group of people that nobody was aiming towards, generally speaking, so I think it's terrific. I really do. Now, Paul, you and I, we're not you and I, but we do some business together. You guys buy ads on the podcast. So I work for you a little bit. You know what I mean? Like and I know how hard it is to educate people over and over again. And man glucagon is one of those things like I go, I speak places. I've stood in front of 400 adults with type one diabetes, and said, Hey, listen, let's take a couple of minutes to make sure we all understand how to use our rescue glucagon, and look up to see that half of them don't even know what I'm talking about. And you know, like, so I'd like to know what that feels like, from your perspective.

Paul Edick 35:21
It's incredibly frustrating. And because, you know, I got into this because of the potential to change people's lives and, and save lives at the end of the day, bend the curve, so to speak. It's not just the patient, people living with this condition, don't really understand how easily they can go from one situation to a really bad situation. But the healthcare professionals aren't helping them to understand either, okay, physicians and healthcare practitioners own a big part of this, that they they downplay the need for rescue glucagon. Because if you were a better patient, if you did this better, if you did that better, you wouldn't need that. And then on the patient side, they don't want to tell their doctor that they have to go to the emergency room because of severe low, because they're going to get the bad patient lecture. Okay. And both of those are contributing to a situation where you've got 15 million people either on insulin or sulfonylureas, which are the glucose lowering agent, that you should have a rescue device handy. It's very frustrating. And but we, you know, we continue to slugging away every single day, the new rescue products are now 80 plus percent of the market and G boek is almost 50% of that. So it's growing, it continues to grow, the market continues to grow. But, you know, we're not, we're not where we need to be. So, word of you know, my only answer is frustration.

Scott Benner 36:56
No, I try to I try to talk about it as much as I can. But you are generally met with that feeling of like, it's not gonna happen to me. Yeah. And I always just think, boy, but I hope it never happens to anybody, but if it does, you do not want to be caught short. And speaking of frustration, you should have seen me sitting right here trying to say sulfonylurea, while I was making your ad, I said it about 1000 times, I had Google saying it into my ear. I had people emailing me phonetic spellings of it, and I was like, never gonna get this right. Anyway, I appreciate you going into that, because I think you're both in a unique position. You Paul, yours is obvious with glucagon, but I think was Sean's, like, I keep imagining that the people who are his target, or maybe people who don't go to endos to begin with. So do you not maybe have to go to GPS and instruct them on what this is to try to so that they have it in their head? You know, in that moment, like, Hey, you should try this. Like, I don't know anything about insulin pumps, but I heard about this, this might be right for you. Because it's simple for us to sit here for me to make this podcast and people to listen. And I'll tell you, this podcast that the 17 million downloads, like it's crazy how many people listen to this podcast, okay. But still, there are a niche of a niche of a niche. There are people who are super focused on helping themselves. And that's just not most people are not not of their own fault. Even like there are plenty of people who get diabetes and think they're doing the right thing, because the doctor told them, hey, just don't worry about it. This is good enough. And they go off on their way. And they think they're doing the right thing. And we're just not reaching people at a level. I'm not, I guess is my point for all the people on reaching, I'm not reaching enough people. And that I find it frustrating as well. So that's why I asked

Paul Edick 38:42
Yeah, you just keep going. I mean, people need to understand you could be doing everything right. You could have the best pump in the world. And and you can be doing everything right. Something might happen. Yeah, for a $35 copay, at the end of the day, to have a GMO that could save your life. happiest

Scott Benner 39:02
thing I do is throw away genotype open. I can't tell you another way to think about it like I have. I'm lucky I have insurance. It's covered. venofer a reasonable copay, like you're saying, but the greatest thing that happens is when that thing, you know, expires, I go, we didn't need that. Throw it away. And I reach right in and pull out the new one and hand it right back to her go here. Put this one in your pocket, or put this in your purse. Keep on your side table. Yeah, no, I mean, I completely agree. Anything I missed that I should have brought up either of you think Have we left anything out?

Sean Saint 39:32
I think we primarily hit it. I'll just say that. I continue to be excited. I have been excited my whole career about the evolutions we've had in the management of type one diabetes in the last 20 years starting with CGM, you know evolving from there, maybe even going back farther to pumps. And I think that what we're doing here today is to your point earlier, Scott really the the next generational shift in management, or at least in availability and tools for people with type one diabetes and maybe beyond. Just I'm pretty excited about that.

Scott Benner 40:00
I am PA, I'm gonna let you talk and then I'm gonna answer Sean did for you. You guys seem like, here's, here's how I should put this. I have never set one of these interviews up so quickly in my life, which made me feel like both of you are getting today. Is that fair?

Paul Edick 40:16
Yeah, I think it's fair, I think, you know, our goal I said at the beginning is to participate in better management of the condition and and on both ends, and we're excited to be a part of it. And you know, to facilitate a pump, like what Shawn is building, and it's, it's important, and we'd like doing important things. So

Scott Benner 40:35
and I'm as excited as you are to be involved in this today. Because I really do believe what I said. I think that, that every once in a while we take a leap. And I mean, today's not the day it's happening. Obviously, there's a lot of FDA stuff and testing in between now and then. But I really do think this is day one, as far as people in the public are aware of. And I do wonder what happens in five years when we look back, and this isn't even the beginning of that level anymore. I'm super excited for people to continue to work on their algorithms, delivery systems, and everything else that helps people live, like you said, Without hopefully having to think about this too much. Anyway, I appreciate you guys both coming on here and doing this really is it's a pleasure seeing both of you. Thanks so much for having us, Scott. Really appreciate it. It's my pleasure. Thanks, Scott. Paul, it's good to see you again. You know, thanks.

Want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast. Learn more about its implantable sensor, smart transmitter and terrific mobile application at ever since cgm.com/juicebox. Get the only implantable sensor for long term wear. Get ever since Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all of the sponsors. If you are a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC as a registered dietician and a type one for over 35 years. And in the bowl beginning series Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. This series begins at episode 698 In your podcast player, or you can go to juicebox podcast.com and click on bold beginnings in the menu. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1208 Defining Diabetes: Intramuscular Injection

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode we define Intramuscular Injection.

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

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Scott Benner 0:00
Hello friends and welcome to episode 1208 of the Juicebox Podcast.

Today on defining diabetes, Jenny Smith and I are going to define intramuscular injections. Nothing new here on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you have type one diabetes, or are the caregiver of someone with type one and a US resident, please go to T one D exchange.org/juice. Box and complete the survey. Your answers will help to move type one diabetes research board that may help you to T one D exchange.org/juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are now 50,000 members who are sharing stories and ideas. Go check out this amazing private and free Facebook group. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now that at the very end of the episode, you can hear my entire mini interview with Mark to hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. Jenny, let's talk about intramuscular injections. Oh, no, no, I am sorry. Is that how people talk about it? Yes. Okay, I'm outside of my depth here. So go?

Jennifer Smith, CDE 2:22
Well think about it. So right now we take insulin in the sub q tissue, right? That layer that kind of sits right underneath the skin, it gets absorbed. That's why our rapid insulin is not rapid, because it doesn't go into your circulating bloodstream and get used right now. Okay, I am increases the access to circulating blood because your muscles have lots and lots of blood in them. Okay, right. So if you take an injection directly into muscle, you are going to have quite an increased response to that insulin. Significant. Significant, okay. Yes. So why would you want to do this? The biggest reason within, you know, people who have diabetes, the biggest reason to do it is to drive a high blood sugar down fast. Okay,

Scott Benner 3:20
that's it. Yeah. Healthline says insulin should be injected into the fatty tissue just below your skin. If the insulin if you inject the insulin deeper into your muscle, your body will absorb it too quickly. It might not last as long and the injection is usually more painful. This can lead to low blood glucose levels. So you're saying that this fact about how injections work some people use to their advantage to try to break high blood sugar

Jennifer Smith, CDE 3:44
100% Yes. And another reason that I have seen it although it's kind of secondary to just addressing a high blood sugar is really for really high glycemic foods that you haven't pre bolused For or right getting it right into circulation is absolutely going to help you prevent a big climb in blood checks

Scott Benner 4:04
a fairly off label thing and I think we will Yeah, usually say this is a ninja level move. Just don't try this on your own. No, but

Jennifer Smith, CDE 4:12
and to be quite honest, it's pain. It hurts. Yeah, more than Yeah, I mean, stings is to depending on how deep you get it and where you put it and what you've kind of nerve wise feel like it stings, if this is not something that you're going to do just because you're like, Honey, the whole bag of Skittles today. Take this with my muscle jam

Scott Benner 4:33
this and my bicep real quick. So I mean, it's a thing people asked about and it's something you know about have you ever done it? I have personally never done it. Arden has never done it. So it's not a thing that is done with a lot of frequency. It's just the thing that some people do. Yeah, I you

Jennifer Smith, CDE 4:50
know, and there may be some certain circumstances where a high blood sugar me it may be beneficial to drive it down a little bit faster. Let's say Uh, you know, it's been high for a while you have ketones, you have ketones starting, and you really want to get that insulin moving. And it doesn't seem to be, it may be a great reason to do something like this. But again, it's, it's certainly something to do with caution. And you know, to make sure that you're not then, oh, my pump recommended a unit, I'm going to intramuscularly inject six units, please don't do that.

Scott Benner 5:25
Well, even Do you know what one to one even be too much? Like, if your numbers I don't know, let's just make up a number and say your 300 it won't move a unit should bring you back to 100. If you were gonna do I am, you wouldn't use the whole unit even right? Because you'd get a bigger boost out of you wouldn't need all that volume, it

Jennifer Smith, CDE 5:44
would be a good thing to downplay what the calculated amount would have normally been for a sub q injection or infusion. If you're going to try an im injection, then I would downplay the dose. Yes, as a starting place. Yeah,

Scott Benner 5:57
by the way, this is not either of us telling you to try this. It's just we're just defining the term, you can find NIH articles on it, the injection technique factor, what you don't know or teach can make a difference. That's what that is called. There's plenty of stuff online if you want to learn more about it. But that's what it is. Just in case you were wondering. And apparently a lot of people were wondering, because here it is on my list. I gotta be honest with you, I wouldn't do it. Like, especially like, I mean, I've now lived through watching art and go from two years old at 20 years old with diabetes, and I can't look backwards and say, oh, there's been a time I should have tried that. I should have done this year. Yeah, I don't I don't see that one. But okay. Anyway, we've defined it fair enough. That's it. Nothing here on the Juicebox Podcast should be considered advice, medical, otherwise, just say that twice. Just in case. Great. Yeah, I'm not, I'm not dying. Let's see.

A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made the finding diabetes, go to juicebox podcast.com, up into the menu and click on the finding diabetes, to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes, the diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise the hydration and even trampolines, juicebox podcast.com, go up in the menu and click on diabetes variables. And now my full conversation with Medtronic champion, Mark. Mark, how old were you when you were diagnosed with type one diabetes? I was 2828. How old are you now? 4747. So just about 20 years? Yeah,

David 8:02
19 years?

Scott Benner 8:03
What was your management style when you were diagnosed?

David 8:05
I use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 8:11
How long had you been in the Navy? See eight years up to that point? Eight years? Yeah, I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 8:23
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 8:27
I don't understand the whole system. Is that like, honorable? Yeah.

David 8:30
I mean, essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that's that's really how it happened. So it's an honorably discharged with but because of medical

Scott Benner 8:41
reasons, and that still gives you access to the VA for the rest of your life. Right?

David 8:45
Correct. Yeah, exactly.

Scott Benner 8:46
Do you use the VA for your management? Yeah, I

David 8:49
used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Scott Benner 9:02
Was it your goal to stay in the Navy for your whole life, your career? It

David 9:05
was? Yeah, yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we love the most. So that's what made it that much more difficult

Scott Benner 9:21
was the Navy, like a lifetime goal of yours or something you came to as an adult,

David 9:26
lifetime goal. I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being flying on and off aircraft carriers. So you know, watching Top Gun in the ad, certainly a

Scott Benner 9:39
weight was a catalyst for that you've taken off and landed a jet on an aircraft carrier. Hundreds of times. Is there anything in life as exhilarating as that? No,

David 9:48
but there there's a roller coaster I wrote at I think it was at Cedar Rapids up in Cleveland Sandusky, and they've got this roller coaster rotation from zero to like, it's like 80 or something. You go up a big hill and you come right back down. So the acceleration is pretty similar. I would say to catapult shot,

Scott Benner 10:06
I'm gonna guess you own a Tesla.

David 10:09
I don't I I'm a boring guy, I got a hybrid rav4 I get made fun of I get called, you know, my wife says, I drive like a grandpa on the five miles per hour over the speed limit person. No more than that. So yeah, in the car. I'm boring Scott. So

Scott Benner 10:24
you've never felt a need to try to replace that with something else.

David 10:27
You can't replace it. It's irreplaceable. That's what I thought. So up until the point where someone you know, buys me an F 18. Or allows me to get inside a two seater and fly it you can't replace it? How did

Scott Benner 10:38
it make you feel when you saw or maybe you haven't seen? gentleman named Pietro has his large aircraft license. He's flying for a major carrier. Now he has type one diabetes. Does that feel hopeful to you?

David 10:48
Yeah, it does. You know, when I when I was diagnosed, that wasn't a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason they did that was because of the technology advancements, specifically in pump therapy, and pump management. So I don't have any aspirations of going to the commercial airlines. But one of my sons who has type one diabetes very much wants to be a commercial pilot. So, you know, in that respect, I'm very hopeful and thankful. Yeah.

Scott Benner 11:20
Do you fly privately now for pleasure?

David 11:24
I do. Yeah, one of my favorite things to do is fly my kids to the different soccer tournaments they have all over the southeast us. So last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there. And Charlie, who's my middle child has type one diabetes. So you know if I can combine flying family and football and one weekend to me that's I think I've just achieved Valhalla.

Scott Benner 11:47
So then it sounds to me like this diagnosis was the significant course correction for you. Can you tell me how it affected your dream?

David 11:54
Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn't thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we were taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to how to deal with type one diabetes, and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Scott Benner 13:01
Have you had success with that? Do you feel like you've made the transition? Well,

David 13:05
I have I mean, I believe in continuous improvement. So there's always more to do. I will say the technology since I was diagnosed specifically with pump management, it's just, it's just incredible. It takes less of me intervening. And it's really done by the pump itself and by the algorithms through the CGM EMS. And to me again, that that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us. What

Scott Benner 13:34
else have you found valuable? I've spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don't have type one, myself, and my daughter was very young when she was diagnosed. I didn't really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don't know anybody else who has type one diabetes. I wish I knew more people. But until I saw them come together, I didn't recognize how important it was. Yeah,

David 14:03
I think similarly, I didn't know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all of a sudden, people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It's amazing to me and my family, how many people we've noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don't run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I'll give an example. We're at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed you're wearing pomp and he lifted up a shirt and showed his pump as well and said, I've had type one Diabetes since I was nine years old, I played soccer in college, I'm sure that's your aspiration. And I just want to tell you don't let type one diabetes ever stop you from achieving your dreams of what you want to do. And this gentleman was probably in his late 50s, or 60s. So just having that connection and seeing, you know, the outreach and people's willingness to share their experiences, it just means the world to us and just makes us feel like we're part of a strong community. So

Scott Benner 15:23
would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others? Yeah,

David 15:33
technology for sure. And knowing how to leverage it, and then the community and that community is your friends, your family, caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to, you know, help guide away, but then help help you keep abreast on you know, the new things that are coming down the pike, and to give you hope for eventually, you know, that we can find a cure, you

Scott Benner 15:54
mentioned that your son wanted to be a pilot, he also has type one diabetes, how old was he when he was diagnosed,

David 16:00
so Henry was diagnosed when he was 12 years old. That was just at the start of COVID, we are actually visiting my in laws in Tennessee, we woke up in the morning, and he had his bed. And several years before that, we had all four of our boys tested for TrialNet. So you know, predictor of whether or not they're going to develop type one diabetes, and whether or Henry and one of his brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it. But we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer. And it was over 400. And so right away, we knew that without even being diagnosed properly, by endocrinologist that he was a type one diabetic, so we hurried home, to get him, probably diagnosed in Charlottesville. And then we just started the process, first grieving, but then acceptance and, you know, his eventual, becoming part of the team that nobody wants to join,

Scott Benner 17:03
how old is he now?

David 17:04
He's 15 years old. Now,

Scott Benner 17:06
when's the first time he came to you? And said, Is this going to stop me from flying

David 17:12
almost immediately. So like me, he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation, and maybe something that we don't talk about as a community. But there are some things you cannot do as a type one diabetic, and that's a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be, you cannot join the military as a type one diabetic. So it was very difficult for him and for me and my wife to get over. Then we also started talking about being a commercial pilot. So I saw that same excitement in his eyes because like me, you know, he can be an FAA teen or a 737 or a Cirrus SR 20 That I fly and be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot. I appreciate

Scott Benner 17:57
your sharing that with me. Thank you. You have four children, do any others have type one?

David 18:02
They do? My oldest twin Henry has type one diabetes, and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes. My middle son, who is not a twin has type one diabetes,

Scott Benner 18:16
I see. Is there any other auto immune your family? There isn't

David 18:19
I'm really the only person in my family or my wife's family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately, pass it along to to my sons with

Scott Benner 18:34
celiac thyroid or anything like that. Not at all, nothing. We're

David 18:38
really a pretty healthy family. So this came out of nowhere for myself and for my two sons. That's

Scott Benner 18:43
really something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much. Anytime Scott, learn more about the Medtronic champion community at Medtronic diabetes.com/juicebox Where by searching the hashtag Medtronic champion on your favorite social media platform. If you're not already subscribed, or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1207 Defining Diabetes: Amylin and Symlin

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode we define Amylin and Symlin.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1207 of the Juicebox Podcast.

Today on defining diabetes, Jenny Smith and I are going to define Amylin, and similar to 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. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you have type one diabetes, or are the caregiver of someone with type one and a US resident, please go to T one D exchange.org/juice. Box and complete the survey. Your answers will help to move type one diabetes research board that may help you to T one D exchange.org/juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are now 50,000 members who are sharing stories and ideas. Go check out this amazing private and free Facebook group. Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. And then later at the end of this episode, you can hear my entire conversation with Jalen to hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. Why don't we move right to? Let's do Amylin and sembalun now sembalun Not it's Amylin sembalun Am I saying it right, or amie?

Jennifer Smith, CDE 2:18
Lin? So it's a good question. So it's Amblin that's how you say it and sembalun Okay, and Amblin is actually truly the hormone that is comes from your own body. In fact, it actually is sort of CO secreted along with insulin from the beta cells. Okay. sembalun is the analog version that you can take as an injection to combat the loss of the amlan.

Scott Benner 2:51
Am I right to say that that's if you use simulate, it's three times a day,

Jennifer Smith, CDE 2:56
in a way. Yeah. It's mealtime specific. Okay, so it's not like some of our longer acting injectables we have now that you take a once a week or even once a day or whatever. sembalun is specific for a couple of really good reasons. One, it helps to slow gastric emptying. It provides satiety, and the other thing that it does it help to sort of suppress or reduce glucagon release in the aftermath of a meal where it can increase in create a rise in blood sugar, right. And so these are the biggest reasons that amarilla Amylin essentially is released, it's in response to a meal and caloric intake. So if somebody with diabetes type one diabetes, especially it is also used in type two diabetes, mainly from sort of a loss of insulin sensitivity. And so then those pancreatic beta cells kind of get taxed. And so somebody could benefit with type two using sembalun as well. But mostly, it's type one, in fact, I think it was the first specifically type one non insulin medicine, which is interesting, but it also needs to be taken with meals that have a specific amount of carbohydrate or was the original first thought, Okay, I believe it was about 30 grams of carb had to be taken in in order to utilize sembalun at that meal time.

Scott Benner 4:17
This episode is sponsored by Medtronic, diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen. I was

Speaker 1 4:27
going straight into high school, so it was a summer getting into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went to I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people work type one diabetes was my hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 5:00
Did you try to explain to people? Or did you find it easier just to stay private? I

Speaker 1 5:05
honestly I just held back I didn't really like talking about it. It was just, it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it. Did

Scott Benner 5:20
you eventually find people in real life that you could confide in.

Speaker 1 5:24
I never really got the experience until after getting to college. And then once I graduated college, it's all I see, you know, you can easily search Medtronic champions, you see people that pop up and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more, you know, how I'm able to type one diabetes. To

Scott Benner 5:45
hear Jay Lynn's entire conversation stay till the very end, Medtronic diabetes.com/juice box to hear more stories from the Medtronic champion community. So I'm reading here emmalin is a centrally acting neuro endocrine hormone synthesized with insulin in the beta cells of the pancreatic isolates, co six islets, thank you. CO secretion is provoked by nutrient in flux to the gastrointestinal tract signaling the need to restore blood glucose homeostasis. So when you are diagnosed with type one diabetes, like colloquially, some people always feel hungry. And it doesn't happen to everybody, I don't think but you'll hear from some type ones like, Oh, my God, I'm always hungry. And why is that? Like? What happens? That? Is it because this Amylin gets secreted from the beta cells? Correct?

Jennifer Smith, CDE 6:40
Okay, it's in response to meals, which is, again, the reason if you were to use its analog swimlane. That's why it would be taken only along with meal times, you wouldn't take it just because you think you need the right to take it. But yes, so satiety in the aftermath of a meal. I mean, there are a lot of factors, even even hunger hormones, things like ghrelin and leptin, all of those have relation to whether we are feeling hunger or feeling satisfied in the aftermath of a meal Amblin because it does slow gastric emptying, creating satisfaction in the aftermath of eating right. Oftentimes, we find that appetite kind of gets curbed, right, when we have the right Amblin secretion, or we're using swimlane. Now, most people say, Well, then why are why are we not prescribed both of these? Yeah, at the same time at diagnosis, right. And I will tell you that Similan is a it's a finicky, finicky hormone to work with, there are some baseline sort of use strategies. One is usually about 30 grams of carb has to be eaten at the meal time. If not, you don't use the sembalun, too. It also requires its own Pre-Bolus time. Okay. And we also typically start with an adjustment down in the Bolus dose of insulin for that meal, until we determine how well someone is actually impacting the post meal blood sugar. And then we can kind of titrate insulin to carb ratios and whatnot a little better.

Scott Benner 8:14
So is the simple answer. It's not prescribed that often because it adds another layer of difficulty at every meal. Okay,

Jennifer Smith, CDE 8:22
I would say that's, in a nutshell 100% The reason that it's not prescribed? In fact, I would say that most doctors don't even bring it up unless somebody is doing like a deep dive search for how can I navigate my post meal blood sugars, they might despite pop up, they go back to their doctor, and they're the one

Scott Benner 8:39
that brings it up. I interviewed a woman recently who is now using someone and she said the only reason she's using it is because she went off of her GLP to get pregnant. And you and I've talked about this in other episodes, the studies on GRPs and pregnancy are happening right now they look positive, but at the moment, your package insert is going to tell you if you're going to get pregnant, like get off your GLP medication. After she told me this. She waxed poetically for five minutes about how much a GLP is helping her. And she said it's not about weight. She's a fit person. It's not about insulin sensitivity. She's already plenty sensitive to her insulin. She said it is fully because I am hungry constantly. And she's like in this stop that. And so she was sad to have to stop it. And sure, yeah, and she said the same thing that she's shooting the sembalun at every meal. It's a hassle. It's not helping as much as the GLP did. And she was only using, I want to say a milligram of of ozempic a week. Oh, and it was helping her that much. That's not even that's just starting to get into like a therapeutic dose of it. And she was getting all this help from it and I And bouche through my daughter who uses a half a milligram a week, and that it works. It works for her. So, but anyway, okay, so Amazon's the thing that the pancreas makes, it stops making it when you have type one,

Jennifer Smith, CDE 10:14
or that it has to do with beta cell, right because it is made along with insulin in the beta cells. And in type one, we lose beta cells, not 100% of them, we know that some remain, but because it's so downplayed in what can come out, it's kind of, I mean, we don't need it the same way we need insulin, right, there's a, there's a definite different reason for it. Without insulin, or just assuming that we've got enough beta cells there, we're still going to have high blood. Right? Whereas Amblin is is different, it doesn't regulate the blood sugar directly. It does help with regulation, indirectly, because of some of the way it delays the absorption. And then other ways in which like I said earlier, it it does some suppression of glucagon, which often comes in right after you eat. And unfortunately, with diabetes, we see the impact of that, that we can't really control outside of adjusting insulin doses. So

Scott Benner 11:22
just the loss of amlan effectiveness, do you think that could have something to do with people not absorbing nutrition as well, too? Could it have stuff to do with digestion, because if, if Amazon slows gastric emptying, then your body has time to pull out the nutrients. And my, my personal experience is my you know, you know, everybody knows, like, I've needed like iron infusions forever, right. And now that I've been on a GLP, for a year, I just got my bloodwork done the other day, you know, my heart is 181, I haven't had an infusion like 18 months. So now that my digestion is slower, my body is having luck pulling the nutrients out of what I eat,

Jennifer Smith, CDE 12:04
that could be a good way to think about it.

Scott Benner 12:09
I'm trying to think about all this journey. I've tried to fix everybody's problems before I get sick of making this podcast. So

Jennifer Smith, CDE 12:15
ya know, and that's it. I think in terms of that, too, it brings in another piece to that slower digestion, you know, the biggest thing that you really talk about all the time, regardless of what the topic is, is that insulin, you need to learn about how insulin works, right. And because of that, with something like adding sembalun, we do have to be really concerned about hypoglycemia with it. Because if insulin dose is not adjusted accordingly, because of the way that gastric sort of slowing happens, you're much more at risk for lower blood sugars, unless somebody has really directed you well, in how to include sembalun, along with insulin along with your meals. Yeah, like I said, it's a it's a finicky medication. And if you don't have somebody who's really willing to hand in hand kind of work with you. It can be kind of hard to figure out,

Scott Benner 13:16
right? So maybe this problem, generally speaking, dissipates in the type one community if and when g LPs are made available to people with type one, maybe a lot of this would go away, then

Jennifer Smith, CDE 13:28
possibly it's not because it's replacing what's lost. It's just masking it. It's kind of masking it, but for a different reason. That is still replacing something that's not really working the right way in the Yeah, no,

Scott Benner 13:43
it's a patch on a patch, really. But yeah, like, I mean, it's not like Yeah, I mean, at the moment, you're not just going to make your pancreas start working again. So alright, cool. Well, listen, I'm happy to have gone over this because it's been in my head forever, because I've heard some, like old timey type ones talk about it, like they used to give us this or one of the insolence used to have it in it. Is that what Um, no, that's not it. They used to, they used to give it to people. Right. Okay. Yeah.

Jennifer Smith, CDE 14:09
I mean, it's still available, you can still absolutely ask for it. It is just not highly prescribed prescribe.

Scott Benner 14:16
Okay. All right. Thank you. I appreciate it. Yeah. No, that

Jennifer Smith, CDE 14:18
was a great. It's a clever ask. That's a great question.

Scott Benner 14:21
Absolutely. All right, what else we got here? Let's see. Let's see, let's say, well, since we're going down this road

Jalen is an incredible example of what so many experienced living with diabetes. You show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juicebox And look out online. On for the hashtag Medtronic champion. Thank you so much for listening. I hope you enjoy my full conversation with Jalen coming up in just a moment. A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made defining diabetes. Go to juicebox podcast.com up into the menu and click on defining diabetes, to find the series that will tell you what all of those words mean. Short, fun and informative. That's the finding diabetes. The diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about. Travel and exercise the hydration and even trampolines juicebox podcast.com, go up in the menu and click on diabetes variables. If you're living with type one diabetes, the afterdark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juicebox podcast.com up in the menu and click on after dark. There you'll see a full list of all of the after dark episodes. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com Thanks for hanging out until the end. Now you're going to hear my entire conversation with Jalen don't forget Medtronic diabetes.com/juice box or the hashtag Medtronic champion on your favorite social media platform.

Speaker 1 16:55
My name is Jalen Mayfield. I am 29 years old. I live in Milwaukee, Wisconsin, where I am originally from Waynesboro, Mississippi. So I've kind of traveled all over. I've just landed here in the Midwest and haven't left since

Scott Benner 17:10
ice. How old were you when you were diagnosed with type one diabetes?

Speaker 1 17:13
I was 14 years old when I was diagnosed with type one diabetes

Scott Benner 17:17
15 years ago. Wow. Yes. Okay. 14 years old. What are you like? Do you remember what grade you were in?

Speaker 1 17:22
I actually do because we we have like an eighth grade promotion. So I had just had a great promotion. So I was going straight into high school. So it was a summer, heading into high school

Scott Benner 17:32
was that particularly difficult going into high school with this new thing?

Speaker 1 17:35
I was unimaginable. You know, I missed my entire summer. So I went to I was going to a brand new school with, you know, our community, we brought three different schools together. So I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people work type one diabetes was

Scott Benner 17:55
did you even know? Or were you just learning at the same time? I

Speaker 1 17:59
honestly was learning at the same time, my hometown did not have an endocrinologist. So I was traveling almost over an hour to the nearest you know, pediatrician, like endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 18:16
Was there any expectation of diabetes that somebody else in your family have type one? No, I

Unknown Speaker 18:21
was the first one to have type one of my family.

Scott Benner 18:23
And do you have children? Now? I do not know. Do you think you will one day, still thinking

Speaker 1 18:28
about it? But right now, I've just been traveling books at all my career myself. So

Scott Benner 18:33
what do you do? What's your career? Yeah, so

Speaker 1 18:35
I am a marketing leasing specialist for a student housing company. So we oversee about 90 properties throughout the US. So I've been working for them for about

Scott Benner 18:43
eight years now. And you get to travel a lot in that job. Yes,

Speaker 1 18:47
I experienced a lot of travel. It's fun, but also difficult, especially with all your type one diabetes supplies, and all your electronics. So it's a bit of a hassle sometimes. What

Scott Benner 18:58
do you find that you absolutely need with you while you're traveling? diabetes wise,

Speaker 1 19:02
I have learned my biggest thing I need is some type of glucose. I have experienced lows, whether that's on a flight traveling, walking through the airport, and I used to always experience just being nervous to ask for some type of snack or anything. So I just felt, I felt like I needed to always have something on me. And that has made it my travel a lot easier.

Scott Benner 19:23
So growing up in the small town. What was your initial challenge during diagnosis? And what other challenges did you find along the way? Yeah,

Speaker 1 19:34
I think the initial one I felt isolated. I had no one to talk to that it was experiencing what I was going through. You know, they were people would say, Oh, I know this is like hard for you. But I was like you really don't like I just felt lonely. I didn't know you know, people were watching everything I did. He was like, You can't eat this. You can't eat that. I felt like all of my childhood had been you know, I don't even I remember what it was like for life before diabetes at this point, because I felt like that's the only thing I could focus on was trying to do a life with type one diabetes,

Scott Benner 20:08
when you found yourself misunderstood? Did you try to explain to people? Or did you find it easier just to stay private?

Speaker 1 20:15
I honestly I just held back I didn't really like talking about it. It was just, it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just, you know, kept it to myself didn't really talk about it was I absolutely had to,

Scott Benner 20:33
did you eventually find people in real life that you could confide in. I think

Speaker 1 20:38
I never really got the experience until after getting to college. And then once I graduated college, and moving to an even bigger town, that's what I finally found out was people were I was like, Okay, there's a lot of other people that have type one diabetes. And you know, there's a community out there, which I had never experienced before, is

Scott Benner 20:59
college where you met somebody with diabetes for the first time, or just where you met more people with different ways of thinking. So

Speaker 1 21:05
I met my first person with diabetes, actually, my freshman year of high school, there was only one other person. And he had had it since he was a kid like young once this was like, maybe born, or like, right after that timeframe. So that was the only other person I knew until I got to college. And I started meeting other people, I was a member of the band, and I was an RA. So I was like, Okay, there's, you know, there's a small handful of people also at my university. But then, once I moved to, I moved to St. Louis. And a lot of my friends I met were like med students, and they were young professionals. And that's where I started really getting involved with one of my really close friends to this day. He was also type one diabetic. And I was like, that's who introduced me to all these different types of communities and technologies, and which is really what helped jumpstart my learning more in depth with type one diabetes.

Scott Benner 21:56
Do you think I mean, there was that one person in high school, but you were young? Do you really think you were ready to build a relationship and around diabetes? Or did you even know the reason why that would be important at the time?

Speaker 1 22:07
I didn't, uh, you know, I honestly didn't think about it, I just was i Oh, there's another person in my class that's kind of going through the same thing as I am. But they've also had it a lot longer than I have. So they kind of got it down. They don't really talk about it. And I was like, Well, I don't really have much too late connect with him. So sorry, connect with him. Oh, yeah,

Scott Benner 22:27
no. So now once your world expands as far as different people, different backgrounds, different places in college, you see the need to connect in real life, but there's still only a few people. But there's still value in that. Right?

Unknown Speaker 22:39
Correct.

Scott Benner 22:40
What do you think that value was at the time?

Speaker 1 22:43
I think it was just what making me feel like I was just a normal person. I just wanted that. And I just, I needed to know that. Like, you know, there was other people out there with type one diabetes experiencing the same type of, you know, thoughts that I was having.

Scott Benner 22:58
When were you first introduced to the Medtronic champions community? Yeah.

Speaker 1 23:02
So about two years ago, I was, you know, becoming more I was looking around and I noticed stumbled upon the Medtronic community. And I was like, this is something I really, really, I kind of need, you know, I said, I, all throughout these years, I was, you know, afraid to show my pump. You couldn't, I would wear long sleeves, like, didn't want people to see my CGM, because I didn't want people to ask me questions. And you know, I just felt so uncomfortable. And then I noticed seeing these people really, in the Medtronic community, just, they embraced it, you could see and they weren't afraid to show it. And that was something I was really looking forward to.

Scott Benner 23:38
How is it knowing that your diabetes technology is such an important part of your health and your care? And having to hide it? What did it feel like to have to hide that diabetes technology? And how did it feel to be able to kind of let it go,

Speaker 1 23:51
I will refuse to go anywhere, like, I would run to the bathroom. I just didn't want to do it in public, because I felt like people were watching me. And that was just one of the hardest things I was trying to overcome. You know, I was fresh out of college, going into a young professional world. So you know, going out on work events and things like that. I just, I just didn't think I just didn't think to have it out. Because I was so afraid. But then, once I did start, you know, embracing again and showing it that's when the curiosity came and it was actually genuine questions and people wanting to know more about the equipment that I'm on and how does this work? And what does this mean and things like that, which made it kind of inspired me because I was like, Okay, people actually do want to understand what I'm experiencing with type one diabetes.

Scott Benner 24:36
What did you experience when, when the internet came into play? And now suddenly as easy as a hashtag and you can meet all these other people who are living with diabetes as well. Can you tell me how that is? Either different or valuable? I guess compared to meeting a few people in real life?

Speaker 1 24:53
Absolutely. I think if you look back from when I was first diagnosed to now, you I would have never thought of like, you know Oh, searching anything for someone with, you know, type one diabetes. And now it's like, it's all I see, you know, you can easily search Medtronic champions, and you see people that pop up and you're like, wow, look at all this content. And I think that's something that that kind of just motivates me and which is how I've kind of came out of my shell and started embracing more and posting more on my social media with about, you know, how I'm able to type one diabetes. And I think that's something that I hope can inspire everyone else. What

Scott Benner 25:27
was it like having more personal intimate relationships in college with type one,

Speaker 1 25:32
I think it was kind of hard to explain, you know, just, for example, like, no one really knows and understands, like what alo is. And I think that was a very hard thing for me to explain, like I, you know, it can happen in any moment. And I'm sweating. I'm just really like, not all there. And I'm trying to explain, like, Hey, this is what's going on, I need your help. And I think that was something that was hard for me to, you know, I did talk to people about it. So when this happened, they were like, oh, you know, what's going on with your mate? I'm actually a type one diabetic. This is what's going on? I need your help. What about?

Scott Benner 26:10
Once you've had an experience like that in front of someone? Was it always bonding? Or did it ever have people kind of step back and be maybe more leery of your relationship?

Speaker 1 26:22
After I would tell someone I had type one diabetes after subtype of regenerate DNA, they were kind of more upset with me that I didn't tell them up front. Because they were like, you know, I care about you, as a person I would have loved to knowing this about you. It's not anything you should have to hide from me. And that was a lot of the realization that I was going through with a lot of people.

Scott Benner 26:40
Okay, let me ask you this. So now we talked about what it was like to be low, and to have that more kind of emergent situation. But what about when your blood sugar has been high or stubborn? And you're not thinking correctly, but it's not as obvious maybe to you or to them? Yeah.

Speaker 1 26:54
So I also I go through my same experiences when I have high blood sugars, you know, I can tell like, from my co workers, for example, I didn't really talk to you know, when I go out backtrack, when I visit multiple sites for work, I usually don't announce it. And so sometimes, I'm working throughout the day, I might have smacked forgot to take some insulin, and my blood sugar's running high, and I'm a little bit more irritable, I'm all over the place. And I'm like, let me stop. Hey, guys, I need to like take some insulin, and I'm sorry, I'm not I didn't tell you guys. I'm a diabetic. So you may be wondering why I'm kind of just a little bit snippy, you know, so I like to make sure I do that now going forward, because that's something I noticed. And it was kind of hindering me in my career, because I was, you know, getting irritable, because I'm working nonstop. And I'm forgetting to take a step back and focus on my diabetes, right?

Scott Benner 27:46
Hey, with the advent of new technologies, like Medtronic, CGM, and other diabetes technology, can you tell me how that's improved your life and those interactions with people?

Speaker 1 27:56
Yeah, I can. I feel confident knowing that it's working in the background, as someone and I've always at least said it, I have been someone that's really bad with counting my carbs. So sometimes I kind of undershoot it because I'm scared. But it allows me to just know that, hey, it's gonna it's got my back if I forget something, and I think that allows me to have a quick, have a quick lunch. And then I'm able to get back into the work day because it's such a fast paced industry that I work in. So sometimes it is easy to forget. And so I love that I have that system that's keeping track of everything for me.

Scott Benner 28:30
Let me ask you one last question. When you have interactions online with other people who have type one diabetes, what social media do you find the most valuable for you personally? Like? What platforms do you see the most people and have the most good interactions on?

Speaker 1 28:46
Yeah, I've honestly, I've had tremendous interactions on Instagram. That's where I've kind of seen a lot of other diabetics reach out to me and ask me questions or comment and be like, Hey, you're experiencing this too. But I've recently also been seeing tic TOCs. And, you know, finding on that side of it, I didn't, you know, see the videos in different videos. And I'm like, I would love to do stuff like that, but I just never had the courage. So I'm seeing people make, like, just the fun engagement videos now, which I love, you know, really bringing that awareness to diabetes. Yeah.

Scott Benner 29:16
Isn't it interesting? Maybe you don't know this, but there's some sort of an age cut off somewhere where there is an entire world of people with type one diabetes existing on Facebook, that don't go into Tik Tok or Instagram and vice versa. Yeah. And I do think it's pretty broken down by, you know, when that platform was most popular for those people by age, but your younger people, I'm acting like I'm 100 years old, but younger people seem to enjoy video more. Yes,

Speaker 1 29:43
I think it's just because it's something you see. And so it's like, and I think the one thing and obviously, it's a big stereotype of our diabetes is you don't like you have diabetes, and that's something I always face. And so when I see other people that are just, you know, normal, everyday people and I'm like, they have type one diabetes just like me, they're literally living their life having fun. That's just something you want to see it because you don't get to see people living their everyday lives with diabetes. I think that's something I've really enjoyed.

Scott Benner 30:11
What are your health goals? When you go to the endocrinologist and you make a plan for the next few months? What are you hoping to achieve? And where do you struggle? And where do you see your successes, I'll

Speaker 1 30:22
be honest, I was not someone who is, you know, involved with my diabetes, I wasn't really focused on my health. And that was something that, you know, you go into an endocrinologist and you get these results back. And it's not what you want to hear. It gets, it makes you nervous, it makes you scared. And so I have personally for myself, you know, I was like, This is my chance, this is my chance to change. I know, there's people that are living just like me, everyday lives, and they can keep their agencies and their blood sugar's under control. How can I do this? So I go in with it, you know, I would like to see it down a certain number of points each time I would love for my doctor to be like, Hey, I see you're entering your carbs. I see. You're, you know, you're not having lows. You're not running high, too often. That's my goal. And I've been seeing that. And that's what motivates me, every time I go to the endocrinologist where I don't dread going. It's like a an exciting visit for me. So

Scott Benner 31:10
you'd like to set a goal for yourself and then for someone to acknowledge it to give you kind of that energy to keep going for the next goal.

Speaker 1 31:18
Yeah, I feel as a type one diabetic for me, and it's just a lot to balance. It's a hard, hard journey. And so I want someone when I go in, I want to be able to know like, Hey, I see what you're doing. Let's work together to do this. Let's you don't want to be put down like you know, you're doing horrible you're doing it's just, it's not going to motivate you because it's you're you're already fighting a tough battle. So just having that motivation and acknowledging the goods and also how we can improve. That's what really has been the game changer for me in the past two years. Jalen,

Scott Benner 31:55
I appreciate you spending this time with me. This was terrific. Thank you very much.

Unknown Speaker 31:59
Absolutely. Thank you.

Scott Benner 32:01
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