#1242 Type Two Stories: More Jon

Episode 1242: Jon's Journey with Open Source Loop Systems

Jon shares his transformative journey with open source loop systems for diabetes management. This episode covers his transition from long-acting insulin to using a pump, the impact of continuous glucose monitoring, and the role of community support. Learn how advanced diabetes management techniques can revolutionize your daily routine and improve your quality of life​.

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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 1242 of the Juicebox Podcast.

Today I'll be speaking with a returning guest. This is John from Episode 688 type two stories, John. And John's here to give us an update on what's been going on. It's significant, you're gonna find this one crazy inspirational, I think, but let's make sure you heard 688 first because John's got quite a story. Please don't forget 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 for becoming bold with insulin. Maybe you'd like to save 30% off your entire cart at cozy earth.com I'm talking about the clothing, the sheets, the towels and everything else. Go there, fill up that cart type in the offer code juicebox at checkout and you will save 30% at cozy earth.com. 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're looking for community go check out my private Facebook group Juicebox Podcast type one diabetes, but John's over there. He's type two. There's type ones there's caregivers gestational moody doesn't matter to us. This episode of The Juicebox Podcast is sponsored by the ever sent CGM and implantable six month sensor is what you get with ever since. But you get so much more exceptional and consistent accuracy over six months, and distinct on body vibe alerts when you're high or low. On body vibe alerts. You don't even know what that means to you. Ever since cgm.com/juicebox, go find out. Today's episode of The Juicebox Podcast is sponsored by Omni pod and the Omni pod five, learn more and get started today at Omni pod.com/juicebox. Hi,

Jon 2:12
it's good to be recording with against God. I'm John kafele. and I have type two diabetes. I've had two type two diabetes for decades, three or more decades, I've been using insulin for almost 20 years. And I've been able to turn around and manage my type two diabetes and put it into remission at the age starting at the age of 60. I'm 63. As of last week, I told my story originally two years ago in Episode 688. And this is a an update on I guess what I'm doing and things I've learned. Thank you for the opportunity to share. Now

Scott Benner 2:51
it's my pleasure, and you have a lot to update us on. So that's why I was super excited to talk to you. And at some point, we're gonna get to the photo that you sent me to get me ready for this episode. That was a really like eye opening. I'll tell people more about it later. But yeah, please check John out on episode 688. And I don't know, I think these will stand alone pretty well. But if you really want to hear the whole story straight through, I think that would be the way to go. John, I'm gonna start off with something out of left field for you. What would you say if I told you that, when I released the type two Pro Tip series, I lost hundreds of listeners,

Jon 3:26
I would say that that's very unfortunate. And that a big goal I have had is to close the gap between type one and type two, by recognizing at least that type twos that use insulin are part of being bold with insulin, and that nobody else's struggles diminish your own. And that in commonality and a common cause we find strength. So

Scott Benner 3:56
I expected a little bit of blowback like a tiny bit. And I don't want you to get me wrong, I didn't lose like a large percentage of the audience or anything like that. But I lost about 400 listeners in the snap of a finger by putting up type two pro tip. And that was it. And it may be the whole series may have may have been like seven or eight episodes long. And I believe it was spread out over seven or eight weeks. So in a week where I put out five episodes, one of them was an addition to the type two Pro Tip series. And I even came at it by saying to people like look, you have type one diabetes, the show obviously is valuable for you. Maybe this information can be valuable for someone else, you know, with type two, and I thought the show would be a good way to get that information around because historically, I've watched a lot of people try to help people with type two diabetes and not go anywhere. And often. You see companies or organizations sometimes manufacturers, sometimes pharma companies, they try to kind of create a type to community and it just doesn't work over and over again. So I thought, oh backdoored, I'll come in through the type ones who already know this information is good. I'll go share it with my, you know, uncle who has type two. And I'm sure some people did that. And it's fantastic. And I actually know, personally of people that it's helped. But man, I woke up the next day, and I was like, oh, geez, it's not going to be easy to get those 400 people back, like, it's hard to get a person to listen to a podcast and to get 400 of them is a bit of a hump. But anyway, nevertheless, I persist. And here you are, again. I'm not. I'm not given up, I believe, like you that there's commonality between people who use insulin, have type two diabetes and people with type one.

Jon 5:40
Absolutely Good, good. We're stronger together.

Scott Benner 5:44
I don't see another way around it. But I'm kind of leading into it this way, so that you can maybe recap your first episode in a couple of minutes by telling us how you got to hear meaning knowing about the podcast?

Jon 5:56
Well, I've been taking insulin for over 17 years. And a big part of the story is that trying to form my thoughts here, long acting insulin for type two diabetics, people with type two diabetes can be an imprisonment of sorts, when you establish an increasing Basal rate through the use of something especially like to see but with a 42 hour half life, you and you don't modify your behaviors to lower that Basal rate, the amount of insulin that covers inappropriate eating, in the evening, eating a pizza needs to be balanced by the same amount of eating in the morning. And in the afternoon. So what you end up in is a trap you can't get out of and you can't try to modify your behaviors part of the day, you have to modify it 24 hours a day. Does that make sense? Yeah. No, it does. So I asked my GPS for over the years, I moved a lot. I've had different doctors and I would always ask the GP, the general practitioner, I would like to have Basal insulin so I can address mealtime, increases in my glucose and not be trapped in this higher increasing basil. I started at 40, I ended up at 140 and 140 units is a lot of insulin, or at least for me, you know, it's different for different people, but it was a lot of insulin, want to be able to titrate that downwards to establish a real Basal and then use Bolus insulin. And they would never do it. Finally, the last up I got, he replaced a doctor that moved away. And he is my current general practitioner still. And I said to him the same thing, hey, I want Bolus since they always told me to go exercise and lose weight. You told that to a guy who has 500 plus pounds until that guy, two guys 370 pounds. It doesn't really matter. There's something else that needs to be addressed. But this guy told me almost flippantly, the best thing that has ever been said. He said, Ah, you should go see an endocrinologist. And so a month later, I saw Liz and Elizabeth Driscoll over here at Sentara in Charlottesville. And I told her that I wanted to have Bolus insulin. And she said, Yeah, where's Is this your current pharmacy? I'll do that right away. I should also point out the before that in the beginning of our meeting, I told her that I was interviewing her for a job to be my medical assistant, but that I was in charge, and I would be making all the decisions. But the she had the control over the medicine locker as it were, we had to get along. And she was going to, you know, prescribe the right stuff for

Scott Benner 8:36
me. Do you think you knew in that moment? That? I mean, you just kind of you kind of offhandedly said that a guy over 500 pounds doesn't just need to be told to exercise as if like what you're really missing is just a brisk walk. And so like, did you know there were other factors at play in your health? At that moment?

Jon 8:55
Oh, absolutely. You know, the thing is, carbohydrate and sugar addiction is a thing. And it doesn't mean you don't you know, I imagine even if you're a heroin addict, you probably know that the last thing you need to be doing is heroin. And you probably are very intimately familiar with the failures in your life it causes. And clearly a guy is 540 pounds and cannot perform basic hygienic tasks. is aware of that, right? Yeah. Is that addressing what you're asking? It

Scott Benner 9:24
does? Yeah, I just didn't know if you were blissfully unaware and just cruising alone, or if you were aware, but unable to adjust, painfully aware,

Jon 9:34
but deeply addicted and not given access to the types of care that were necessary to break me out of that. Okay. And part of it is I have a lot of resentment over having been prescribed long acting insulin in and then ever increasing amounts, because that really became a prison that I couldn't get out of, and then not being willing to prescribe me Bolus insulin and allow me as soon as I got Bolus, insulin, everything turned around. Now, of course that required me to make use of that, right? You can't just give them the Bolus insulin it changes. But I have the tools at that point. Okay. Yeah. So Liz is happy to work with me. And then she said the thing that changed my life, she said, Have you ever thought about a pump? And I laughed, and I said, I'm here trying to get Bolus insulin for the first time. And you're asking me a person with type two diabetes, you know, how about a pump? And in my mind is the Darth Vader, you know, huffing and puffing through the mass with tubes and steam? And she says, Well, no, there's also a tubeless pumps. By the time I got home from that appointment, I went to the pharmacy, I live in the country. So it's like 40 minutes to get home. But I went to the pharmacy picked up my insulin, I'm there with it. And the insolate rep calls me and says that I was on Medicaid at the time. And he says that, you know, we just had a change in Medicaid in the state of Virginia, and I'm sending you out a whole starter kit if your game for it. And I was like, Well, absolutely. And then everything changed. And I started open source iOS loop in a few weeks of that. So

Scott Benner 11:01
how did you get to that so quickly? I've been professionally

Jon 11:04
involved in open source my entire career. And so I've always been aware of other open source projects and things like that. I've been aware of diabetes. And so I knew there was an artificial pancreas stuff out there. I see. And so I was like, Are you kidding me? I've got the Bolus insulin. I've got the iPhone. I've got the compilers and things. I have the skills. Now I have going straight to the head. Yeah, here I go. Yeah. I'm going straight to the head of the class, baby. Yeah. Nice.

Scott Benner 11:27
Okay, so, Jesus, you use just Basal insulin for 17 years,

Jon 11:33
for 14 years or so. Okay. I can't nail down exactly when I started. It was somewhere in between 2004 and 2007. Plain smoke.

Scott Benner 11:42
I'm sorry, God, no, I

Jon 11:44
was just gonna say I went to a doctor's appointment and had had an eight one C test and it was 14.5. And the doctor is like, how do you I have a very busy career and was responsible for managing operations infrastructures for large internet sites and things like this. And which is like a 24/7 very demanding job. He said, How do you do it? Um, I don't know. And so he prescribed me the insulin and I remember I went back to get started with it. And he showed me to inject your my jeans and to reuse needles from day one. How about that? There you go. So what were you going to even ask him?

Scott Benner 12:16
I know, don't be sorry. I just I want to make sure that everyone understands that idea of this person. So plainspoken Lee, you're eating poorly. And you have type two diabetes, your body cannot keep up with what you're taking in. So they give you this Basal insulin. But then what happens is your your blood sugar start to come down and then your eating goes up, and then you end up with more insulin. Is it just keep perpetuating back and forth like that? Or no. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since cgm.com/juicebox. The ever since CGM is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. And you didn't hear me wrong. I didn't say 14 days. I said six months. So if you're tired of changing your CGM sensor every week, you're tired of it falling off or the adhesive not lasting as long as it showed or the sensor failing before the time is up. If you're tired of all that, you really owe it to yourself to try the ever since CGM. Ever since cgm.com/juicebox, I'm here to tell you that if the hassle of changing your sensors multiple times a month is just more than you want to deal with. If you're tired of things falling off and not sticking or sticking too much or having to carry around a whole bunch of extra supplies in case something does fall off. Then taking a few minutes to check out ever since cgm.com/juice box might be the right thing for you. When you use my link. You're supporting the production of the podcast and helping to keep it free and plentiful. Ever since cgm.com/juicebox. The Fear Of Missing Out is overwhelming sometimes, but the fear of missing out on Omni pod. We don't want you to have that. A lot of people in my private Facebook group talk about their love for Omni pod five. Have you ever seen those posts and thought I wish I could have that experience with an insulin pump too? If you answered yes, you might be experiencing FOMO fear of missing out on Omni pod symptoms may include but of course you're not limited to wishing you could wear outfits without pockets and fantasizing about jumping into swimming pools without disconnecting from your insulin pump first. Maybe you're dreaming about walking past that doorknob or a handle on your dresser without getting your tubing caught. If you're having those dreams, good news, you don't have to suffer from FOMO any longer. You can see what you're missing by trying Omni pod five for yourself at my link, Omni pod.com/juice box, get started today with the Omni pod five Omni pod.com/juice box throw away your FOMO?

Jon 15:12
That's a good question. You know, one element of it is the insulin causes insulin resistance. And the more insulin you take, and the more food you can input, it's a cycle, you know, one feeds, it's a feedback loop that increases the amount of insulin you take for the amount of resistance you have and the amount of food you're eating. And as you turn one of those up, the others turn up with

Scott Benner 15:34
it. Do you mean that as you add Basal insulin, your body becomes less and less effective, and therefore you need more more the manmade Basal?

Jon 15:43
Well, that's part of it. Of course, in my case, in case I think, many I have an extreme eating disorder. And that is the number one propellant in my diabetes, okay? There's, there's genetic predispositions. There's economic and other access to food and things that happen and so forth. There's a lot of things in my case, it was a extreme district eating disorder related to you know, childhood trauma, blah, blah, blah. And it literally fed on itself. So the prison of long acting insulin for person and my condition is that it gives you a license to eat a large pizza for dinner. And to follow it up with big chocolaty treats and things like this. And what that eating is doing is it's creating dopamine releases that our guests just straight up like taking drugs, and it is taking a drug. It's the different method, right? And so you're addicted to that high, you're addicted to that. And so, you know, you hear about like, maybe you don't hear about it, but the idea is a person does is on heroin, and all of a sudden, everything's just hunky dory. Everything's absolutely wonderful in the world. Even if you're in an alley, you know, on a piss soaked mattress by a dumpster, everything becomes wonderful. And that's what food does to a person with my pathology. Gotcha. All right. Well, that was my history. And so if you eat that pizza and everything the next morning, you still have that high Basal rate.

Scott Benner 17:14
Yeah. And so almost functionally, what you think is like, so was there actually a time where your blood sugar was one of the reasons you finally could stop eating at the end of the day? Great. Like, I can't keep doing this. But then all of a sudden, the the insulin felt like a crutch. Or is that not right?

Jon 17:29
Insulin was always an longterm act long acting insulin was a enabler and a in trapper, does that?

Scott Benner 17:37
I think so. No, I think I understand I just, I just wanted you to really spell it out for me. So once you get a pump, and you get to an algorithm, and now you're covering your meals with Bolus insulin, how is that different from just basil?

Jon 17:52
I'll tell you what it was. And it was what I envisioned it would be all along, I remember, I'm an engineer, and so forth. So I have a very certain place on the spectrum with my mind. Once I had that tools in hand, I could see how much the foods I were eating, were directly impacting my glucose performance. So throughout my life, you know, and if you're not too, I can solve any problem. But if you're not driven to solve it, you're glib about it, right? So at one point, I convinced myself that sugar wasn't the problem. It was fat in foods and all these different things, right. And once I started taking Bolus insulin, and really paying attention to it as I do, I saw the effect of every single thing I put in my body. And I quickly realized that for me, grains were not helpful. Okay. And they're not. So I had a budget, right, I had a performance profile, I had a thing I was trying to do. And I was trying to reduce my overall use of insulin from the beginning. And I was trying to achieve at that point, I wasn't trying to achieve normoglycemic values, but I was trying to achieve achieve non life threatening values. Gotcha. And it happened very quickly, though. And I started realizing the different kinds of foods and the ways of eating that were harming me. And I just thought about, I was able to kick the drug, almost cold turkey, I remember it now. Like I thought, you know, I'll just have a sandwich in the middle of the day, just a nice sandwich with a lot of vegetables on it and some meat and just two pieces of bread that I'll dose for. And then what happened was, I realized that even though I could dose for those two pieces of bread, that they had a significant carbohydrate impact and long tail effect that I had to manage that I had to use more insulin to deal with, that I had to pay more attention to. And then it became evident to me that I could just have that vegetables with some meat on top of it and not have the other impact. And it just made more sense for me. Okay.

Scott Benner 19:49
It's interesting that you had that problem first. So I mean, would you consider this disorder lifelong?

Jon 19:54
It pretty much manifested by eight years of age. Okay, well, that yeah, pretty much lifelong.

Scott Benner 19:59
So My point is it's interesting that getting the pump, and I guess I'm assuming a glucose monitor as well. And then like, yes. Is that right?

Jon 20:09
I've been using Dexcom for a little over seven years. Yeah. So I've been using Dexcom for four years prior to being finally given Bolus insulin. It was just a waste. It was just a thing that would alarm all the time. I've gotten phone calls with friends. And they'd be like, Oh, that's your alarm. And I'd be like, Oh, whatever.

Scott Benner 20:27
So it's interesting, though, isn't it that you have the information? It didn't get you to change but then suddenly, once you had another tool, you were like, Oh, I eat the bread. My blood sugar goes up. I'm gonna stop eating the bread. Let's go. I'm on this journey. Do you don't know what pushed you in like over like, it sounds like you think it's the pump, but I don't understand why. No,

Jon 20:47
no, no one. One is observational. The Dexcom is observational. The insulin is interventional. Okay,

Scott Benner 20:54
so you felt more powerful with the the Yes, Bolus insulin, okay.

Jon 21:00
Yes. And it was also a way to get off of the long acting. Gotcha. All right, I understand. And the funny thing is, I didn't titrate the lung acting because I immediately recognized that a pump with its micro Bolus ng is Basal and Bolus. So okay, that was pretty cool. Right there, I was able to holistically I didn't have to titrate it was like, MBI. Right, right. I didn't have to work those against each other, or with each other.

Scott Benner 21:25
You see the impacts, you keep you stay, it's amazing, you're able to just stay on that new path, which is laudable, it's fantastic. But you stay on that new path. And we are in there, do you find the podcast immediately? Okay.

Jon 21:39
Like, immediately, you know, you got search tools, you got Facebook, you can search there, you can search Google, you can do stuff. So you start saying like, who knows, you know, what are the outlets? Where do you learn about how to use insulin? Actually, literally, my thing was, I've got this stuff, how do I learn how to use it. And I'm very antagonistic to anybody that has anything to sell. It's just raises my spidey sense in a big way. And so when people have a miracle diet, or they want to sell you cinnamon, or they want to tell you how you need to do it, it puts me off because as you can tell, I'm pretty much think I know everything already. And I'm very, you know, engaged. And I want to form my own opinions and stuff. And I don't want to just buy a cure. And so social media is a great place. I've been on social media all my life, since the Usenet and things back in the whale days, I just wanted to find a place where I could talk to people that were doing the same things. And when you look for type two groups, on Facebook, I'm a middleman. So I don't Twitter or ticker totter talker much right? Um, looking on Facebook for groups, and every type two group I found was part of a company and had a thing that they wanted to do with you at all. And then your group was about being bold with insulin. And that made a lot of sense to me. And I reached out to you very early. And I said, Help me, what the hell do I do with this? And you know, you gave me some insight and suggested I read the group and do more there. And I did. And then before long, I actually reached out to you. And I said, I wanted to start a type two group. And you suggested that that would be a great thing. But let me know that you were also working on providing type two participation in the group and support in the group. And, and I was like, You know what, I'm just gonna wait and see where that goes. So I'm honored to have been an IRL monitor have been an early guest, and I'm honored to be part of the group. And it's really cool to be here again, with you, Scott,

Scott Benner 23:32
I appreciate that. You're also you're one of the I would say one of the key reasons that the group attracts type twos at this point, too, because you've been so open and clear about what you've been through. So I'd like to do that here, too. I'd like to talk a little bit about what happens. I think maybe we should jump into like the weight loss journey. Like how long does that go on for like, I'm right to say that you're basically a pretty low carb guy, right. And that's been since you found the pumping. That's

Jon 24:03
the funny thing. It's, you know, it's not overnight, right? Okay. And so even before getting the insulin, I was trying to modify my behaviors. And in a year or two before I finally got a hold of that the Bolus insulin, I was actually deeply hypo about a half a dozen times. The rescue squad had to come out four times and they transported me to the hospital twice. And that was because I was taking a lot of insulin and trying to eat a lot less food. And there's there's the prison you see, I'm saying, and so I've been making moves in the right direction all my life. When I was 3330 years ago, I lost 200 pounds, and I reduced from 540 to about 343 50. And then I vacillated between that range 373 50 down to 280, like five times in my life. And so the fact was, I knew how to moderate my mind Hey viewers, but when I got to 270, I couldn't lose any more weight. And so then you just kind of give up, right. And that was a thing that happened. But what I wanted to address is when I got the ball, since when it did turn around overnight, it was a sequence of continuing refinements and adapt adaptations. Okay. And so I got my a one C down from a nine, four with like, no time and range to a six with, you know, 80%, and range. And I've been under 5% for almost two years. Wow. And my standard deviation is under 15. And my time and range, my personal range that I track a 70 to 120. And I achieve mid 90s presets all the time, pretty much. The thing that screws that up is Dexcom, mankind doesn't have a way to measure glucose, whether it's a one C or your finger stick or whatever, it's always an approximation. I'm fond of saying if I became a billionaire, I would focus on not a cure for anything, but how to measure diagnostics, accurate diagnostics, right? Because more so than a cure for diabetes, or a cure for any other thing is effective treatment. That's the thing that we can do now. So that's a passion of mine. measurements include a one C and your data from your Dexcom, you have to take it all together as a bigger picture. You know, I'm saying I achieve those things. But it took a long time. It was quick. But I mean, it wasn't overnight, right? It was a continual process of refinement. And recently, in the last two months or a little bit more by diet bestie and I have have eliminated snacking. And that has had a significant improvement. So even when I was in these numbers, removing the snacking is caused an increase in weight loss and a reduction in my waist size.

Scott Benner 26:45
Well, how many calories do you think you take in a day? Ha.

Jon 26:49
You know, when I started this, I determined only to count carbs, and measure glucose and I felt everything else would fall into place. And that was largely true, you get to a point of diminishing returns on one angle of attack. And you have to add others. Yeah. So now I'm looking at actually, there's other elements of what's going on is I found that my beta cell function was at the level of a person with type one diabetes, it was insufficient to support life. At this stage of the game, I was able to turn it around. And now my latest C peptide shows me at the at the low end of normal. And so you know, they say do something about your type two diabetes now before it's too late. And what I'll tell you is it's never too late. How

Scott Benner 27:36
much insulin do you use today? Like your total daily dose? Versus the first day you put on that pump? Do you like just vaguely you don't need to be exact. But what do you think the difference is?

Jon 27:48
I'll tell you that the day before I put on that pump, I was running 140 units, which receiver, I can't remember where it was immediately, but I got it down to half of that pretty darn quickly, very quickly. And then getting it down the next half likes from 72. Right now my my total daily usage of insulin Bolus and basil combined, is running about 35 units a day. And that's been the case for a few months.

Scott Benner 28:16
Yeah, that's a quarter of a quarter of the amount of that that Basal insulin from beginning of your story. And the increased

Jon 28:23
the larger part of that insulin right when it was at the higher end resulted in things like a 9.4 a one C with no time and rage. And all of that to the to the numbers I have. So it's not even, you can't even do the simple math of one quarter of the insulin right? You're talking about orders of magnitude results. Yeah,

Scott Benner 28:43
I mean, being in the situation you were in and just giving you Basal insulin is really it's almost cruel, honestly, because it's yes, yeah, give me it's slowing down your demise, but it's not really doing anything to stop it. It's just, it's now just crawling forward a little slower than it did the day before.

Jon 28:58
I strongly believe that when a person is with type two diabetes is introduced insulin, it should be done in a very focused manner with reviews. And not just as like go take this and go away and die slowly. It should be here this is now let's do behavioral modifications and other things so that you can reduce the amount of insulin we have to give you right now and also people with type two diabetes who are on insulin should be introduced Bolus insulin as soon as possible.

Scott Benner 29:29
Okay. Do you have any idea what shifted inside of you to help with the addiction to the sugar?

Jon 29:35
I think that my ability to escape that happened much earlier than my access to the tools to enable

Scott Benner 29:42
it. Oh, okay. Oh, so it's not as it's not as instantaneous as the story makes it seemed you had made the decision but didn't know how to do it.

Jon 29:51
Well, that's what I tried to keep there with like, the year before getting it having six extreme hypose Yeah, and And and all that experience. I mean, that was me trying to change my behaviors, but getting slapped into the hypo lows by the insulin

Scott Benner 30:07
I say, Okay, can you put a weight on that? That? Let's go to when you I don't know you found the podcast like what do you weigh that around that time? 350 pounds 350. So you had gotten off 200 pounds on your own? Yeah. For like 30 years for 30 years. So you were up to five something? You lost 200 You maintain that for 30 years at this like 350 ish range?

Jon 30:31
No, actually I went from I went from 350 to 280. Okay, five times. Oh,

Scott Benner 30:36
so you would bounce in over those 30 years, you'd bounce from 350 to 280?

Jon 30:40
Yeah, like about five times four or five times? How did you get from 350 to 280. Same way I got from 540 to 350 calorie deficit for the most part, but also swimming. To get the first 200 pounds. I went and swam a mile a day three times a week at the gym here at University of Virginia. And that was a big part of it. Swimming was my thing. When I was a kid, I had some training.

Scott Benner 31:06
John, can I take a detour for a second? Yes, please. What's it like jumping into a public pool when you're 550 pounds?

Jon 31:14
That's a very good question. A little bit more background about myself. And I touched on this maybe even more depth in my first episode. I was raised institutionalized, I'm diagnosed autistic, and so forth and things. And so it was a pretty weird childhood. And when I was about 17, and living on my own on the road hitchhiking was when I just realized that I'll take my shirt off, if I want to take my shirt off, and I was, you know, over 350 pounds at that point. And I don't care what other people mock me or say about me anymore, because it's just about them. And you've probably heard the concept of flying your freak flag. Hi.

Scott Benner 31:54
I'm sorry, that was your vibe.

Jon 31:56
That was my vibe is you know what? I'm done apologizing for bap. Now, I didn't give myself that break internally as much. But I just couldn't live. I couldn't maintain hiding behind the couch and being afraid of the other

Scott Benner 32:09
kids like when I was younger, but still it made you feel a certain way internally. It was liberating,

Jon 32:15
if that's what you mean. Yeah. Or you mean the shame or something? Yeah, I had to get over that. So you know what, I got the pool I swam. And I'll tell you a funny thing. I was involved in a faculty council that met with the the administrative vice president of the university who is really the BIOS Reading University. And a guy that says, Hey, I see you in the pool all the time. And it's really impressive what you do. And that kind of feedback is rewarding, right? And I'll tell you what, man, I swim my first lap to my last lap at the same speeds going that with that much weight. Wow, it was rewarding. And you know what, when I get to share my successes in the group, it's very rewarding that people exhort me and congratulate me. But more so you know, it's about the lurkers. Right. And so I liked the idea that may be in the group, I can carry a bit of a message for the 40,000 that aren't posting every day. Yeah. And that I was making see that. Go ahead. No, I

Scott Benner 33:11
was gonna tell you that. I do like a weight loss diary, since I started using a GLP last year. And it's not talked about online, nobody brings it up. Like I don't hear from people like, Oh, I'm liking it or anything, but I get a lot of private notes about it. Like this made me feel good. Or I connected with what you said here, or you motivated me to do this or that like, but it's not online, like, whereas with the podcasts when it's about diabetes, you'll get like, people will be out front about it. They're just like, Oh, I heard this episode was really valuable blob above like, they're, they're not afraid to do that. And then like they'll jump on, but no one's mentioned it publicly. But it gets a lot of like private notes. I just think it's one of those things that generally speaking, I don't know that everybody's looking to talk about in public. It's just, it's just interesting. When you put out content the way I do, and you get to watch how people interact with it. It's a real learning experience, to see how people think and feel and what they what they think is important versus what they'll say out loud, sometimes. Just very interesting. I'm sorry, I cut you off. I didn't mean to. No, you

Jon 34:18
did not at all. And that's that's an interesting dynamic that I'm impressed by your ability to deal with the wide variety of people that come to your door, our char tribe. You're very inviting and open to people you tolerate quite a bit. But you work really hard to keep the conversation positive. And so you know what, there's people that are actively participating and everybody that's actively participating, y'all are addressing and speaking to a much larger audience.

Scott Benner 34:48
Yeah, yeah, you don't, you'll never know it. Like, I'll even never know to the extent that it happens, but I get enough feedback to realize Sit does like just to hear from somebody who said, Hey, I've lost 40 pounds since you started your weight loss journey, and I started mine because of you. And I think I don't know this person's name. I've never heard them before. I don't recognize them. I go to my group, I they're not in the group. And I'm like, wow, it's fascinating. Like I just said something positive, maybe hopeful. And I just put it out in the world. And then that person lost 40 pounds. It's crazy, isn't it? It's a message in a bottle. Yeah, man, no kidding gets a really nice way to think of it. Okay, so you mess around between 350 and 280, for 30 years or so. Swimming, not swimming back and forth. I guess the battle between the food and the exercise goes back and forth. I would also imagine that getting to 250 is great. But you're still standing there. 250 go, Oh, my God, I still have weight to lose. Like this is like is my whole goddamn life. Right, like, and so where does it really just start? Like, downhill skiing for you? Like, where do you just like, Where does it start? Where you're like, I'm on this path, and I almost can't get off it now to where you are right now. Tell people what you weigh. Right now. I

Jon 36:06
weighed this morning, I weighed 250.9 pounds on the scale. I've been right at 250 for a couple of weeks now. And

Scott Benner 36:13
this for you a weight is you think this is a good weight for you. Do you think there's more? Do you think you're too thin? What's your opinion of of your body right now?

Jon 36:22
And we'll talk about that surgery and bone. I think yeah, I weigh less now than I did when I was 15 years old. Wow. About that. That's my goal. I have stage one obesity right now. At my height, I was stage six plus, and I had a body mass index about 66. Okay. And now it's about 33. You know, it's imperfect math, right? Unless you do that thing where you get in a sling and go into a saltwater bath. And they weigh you and all that. But the math says, Yeah, so the math says I'm about 33, which puts me in stage one obesity. And my goal is to lose another 30 pounds and become overweight. You like the IRA, I already have that. My goal is to be overweight

Scott Benner 37:09
chested. I've had that goal. So how tall are you just for context for people?

Jon 37:13
I'm six foot one, okay. Or as I like to say, I'm six foot one and a half.

Scott Benner 37:18
I listen, if I was six foot one and a half, I'd added it to Okay.

Jon 37:23
I mean, it affects the BMI calculation and makes it a bit easier.

Scott Benner 37:28
Didn't get shorter when you lost weight. I've seen people lose show shoe sizes.

Jon 37:33
I would think you'd get taller when you lose weight because of less vertical compression.

Scott Benner 37:38
Oh, John, you're saying something there? I was thinking about literally fat under your feet. Well,

Jon 37:43
that's interesting. I'll tell you a thing to maybe interesting is I ended up essentially crippling myself and I use a shower in a chair in the shower, I use a chair in the kitchen, I use electric cars at the store. But I can swim a mile every day before surgery for two months before surgery. I'll swim a mile a day, six days a week. And how do you do that? Right? Well, it's the zero G thing. It's taking the compression off of the spine. And so I'm trying to make that better. I also recently had a comment, I'm glad to be able to get this in here. I had a conversation with my GP was only about two or three weeks ago. And I said we're we need to reevaluate our relationship. And we need to have a relationship where you understand that you are working for me and that I'm in charge. So I had that same conversation with him. And he was happy to do it based on I guess, you know, the results. Yeah. And I said, the first thing I want to do is I want to remove statins, statin from my portfolio. And I said I'd like your advice on how to titrate that how to reduce that dosage. And he said, You know what, let's just take it away completely. And we'll see what's up in two months. And then if we want to, we'll titrate upwards from the minimum dosage and I was like, Yeah, we're, we're, we're we're doing it. So the the reduction of the statins may help with muscular issues.

Scott Benner 38:58
I was gonna say tell people why so we will but let's go backwards a little bit. You've crippled yourself How could go through that?

Jon 39:05
Where you can't wait 540 pounds. And you have what passes for inactive life, right work and all this kind of stuff and it not have issues. A long, long time ago, I had, I think it was an MRI or something. And they said I had compression fractures in the spine. And like, kind of, of course, and so you can't weigh that much. Now. I think we're getting close to the surgery now because after losing all that weight I was carrying around a huge apron of flesh. And imagine if you wore a sack of potatoes around your belly with a belt on your back. What that would do to you after decades

Scott Benner 39:46
pulls on you. Yeah, but John, listen, I've only lost 50 pounds. Okay? And I say only because obviously you're you're in a different league. But what has changed for me? My knees don't hurt. I don't have plantar fasciitis anymore. My back's not always stiff. I feel better generally speaking, like I feel healthier, more awake, more alive. Like all that stuff like, I sleep better, I have significantly less acid reflux almost none, just, you know, all have these different things that have changed with my weight that I swear to you, if you would have asked me prior to losing 50 pounds, Hey, Scott is your plantar fasciitis from your weight, I would have said No, probably not. But I mean, now that you look at it, like, in hindsight, you're like, well, obviously it was, you don't need me like, Why did my knees hurt? Or my knee hurt? Because you know, I have little cartilage break down on my knee like, yeah, okay, it must be genetic or something. Or it's because I had 50 pounds. I don't know how to explain that I'm a pretty bright person. And that I didn't know my knee hurt because I was fat. I know that sounds insane. But I really I didn't know that. I didn't know that I was tired because of that. I didn't understand any of that. And for context, I use the GLP to lose weight. So I haven't significantly changed the things I'm eating. I honestly didn't, I wasn't a particularly poor eater. My body just didn't deal with food. Well, my digestion was wrong, I wasn't holding nutrients correctly. Like all this other stuff was happening, this GLP has changed all of that for me. On my ferritin I just had my bloodwork done. And then I forget, it's like I forget what is 166 or 188. Like, it's it doesn't matter. It's up in that range. I haven't had an infusion in like a year and a half before that, if I didn't have an iron infusion, every six months, my heart would be down to 10. And I was shutting off. My body wasn't even holding my nutrients. And I don't even know how to explain why that is exactly yet. Obviously GLP slows down your digestion, is it just leaving the food in my stomach longer so I can actually absorb the nutrients I'm eating? I don't know, do I have a GLP deficiency? I don't know. But what I do know is my knee doesn't hurt, my back doesn't hurt, my feet don't hurt. I'm more alive and awake. And I swear to God, if you would have asked me two years ago, what that was from, I wouldn't have said my weight. So I don't even know how to explain that.

Jon 42:16
Healthy lifestyle is the fundament for a better life. And whatever disease you have, whether it's curable or you know, like in my case, reversible, in type one, there is no fundamental cure, but there's treatment, eat well shake your bones as much as you can. And things are going to be better.

Scott Benner 42:36
Yeah, I just think that's true. I mean, not that, again, if you would have asked me that. I would have said that. I just didn't think it applied to me for some reason. Right? Yeah. Right. Yeah. So okay, so I'm sorry. So you've got we've got this weight off you now. And you're carrying around a lot of extra skin right?

Jon 42:55
Here, you saw the picture is pretty profound. And yeah, if you look at the size of the hands and some of the pictures, and then transfer that to the picture of the final removal, you can get an idea of the scale there.

Scott Benner 43:09
I mean, you sent me a photo of yourself. It looks like it's taken basically, like from your neck down your splayed, basically, right. And the truth is, is that you have to really focus for a minute to realize it's a person. Like it really is that like, like just, I don't know what the word is altered. And look, it

Jon 43:30
looks like a cattle abattoir kind of thing. Right? It looks like they're cutting cattle open to make meat of it or something. In my opinion. Listen,

Scott Benner 43:39
if you would have told me it was a giant tuna on a boat, and they were getting ready to cut it up. I would have believed that for half a second. Yeah. I mean, how do they measure what they took off it? Was it inches or weight? Or how do they relay it to you? That's

Jon 43:51
a very good question. Because when they take that the skin off, it has the adipose tissue attached to it, you don't lose fat cells. And typically you don't increase the amount of fat cells you have, except for when you get into extreme obesity, you actually do create new fat. So what you do is you to stem them, you fill them, right, they get larger and larger. So when you've lost the weight, there, it's still there. And people who maybe have lost the weight weight as a result of rapid weight loss due to like bariatric surgery or whatever. And then they say you know have to keep it off for 18 months or something. And by the time they take that off there might even have some adjunct liposuction to go with it right to bring everything together. In my case, the doctor noticed that the bulk of the weight loss and also this the other thing, I was down to 270 when I had the surgery, okay, were 275

Scott Benner 44:46
Oh God, John 25 pounds without a skin.

Jon 44:48
So no, no, no, the actual weight of the skin was 13 pounds. But the doctor said Had this been like an 18 month weight loss. It would have weighed considerably more Oh, because of the the condition of the fat cell. Yeah. So what I had was a very emaciated layer of fat. And that ended up causing complications with fluid with drainage later. But on the other hand, in terms of healing, I healed like a Star Trek movie. You know, I mean, like when they pass the hand over the wound, the alien does and it heals right away. Yeah, I healed amazingly fast. And the doctor pointed out and trained the staff on this as well, that drainage is just a standard component of the healing and it's not a complication. Mine took a long time. But everything else healed up so amazingly well. And I would like to say at this point, put this out, too. We as Luke during my operations, the iOS loop app was used during my operation to maintain my blood glucose levels. How

Scott Benner 45:47
long was the operation? Five

Jon 45:49
hours plus,

Scott Benner 45:51
wow. And was there someone there managing your diabetes for you when you're out? Are you just let the loop run it?

Jon 45:56
Well, so you know, there's two people in the surgery that are the the prime operators, one guy's got is keeping you alive, and the other guys is doing the surgery. So the anesthesiologist is key. And I met my anesthesiologist before the surgery. And we had meetings, and he said he was very interested in using loop. And so we use loop during my surgery. So he had my phone on his station, and did not have D five, set up dextrose 5%. Right. He did not have a dextrose solution setup for me, gets ready to do so it needed. He knew my control. And he knew what I was doing. And we we had done a zoom session where I showed him how loop worked. We ran it through my surgery. And by gum, it was just amazing. And, you know, I believe I know it opens the door for other people, because it was really, it's not likely that you're going to get a surgical team to do that.

Scott Benner 46:52
Arden's had short procedures where they've let it run. She's also had procedures where they told me to shut it off, and I pretended to shut it off and left it off.

Jon 47:03
Yeah, but this was like a full on five hours.

Scott Benner 47:06
This was a four to five hours of eight hours of recovery where you're not awake afterwards. No eight hours front end

Jon 47:13
of unconsciousness, right? Because about three hours and I mean, right, tacked on to either end. And you know, I get that out of my Nightscout to

Scott Benner 47:21
I can see Yeah, listen to I mean, the truth is, it's a good example of good settings, and how you can fast with diabetes to if you have if your settings are good, and you're on a good algorithm like that. So Well,

Jon 47:32
having said that, because of my, my diabetes is my diabetes, and what I do is what I do, but I eat once a day, one time in a day later than I should, because I work and I get involved in things. So I eat about 7pm would

Scott Benner 47:46
walk me through your day that you wake up. You don't eat you drink anything. Water. Okay.

Jon 47:51
Oh, coffee, coffee. I love coffee. But I'll tell you about coffee is I don't allow myself to have coffee every day. Because chemical dependency, I

Scott Benner 47:59
say you don't want to get hooked on it. Yeah, I don't drink coffee. But um, when I see some people, they go after it like it's a little too important. You don't I mean,

Jon 48:09
it has a physiological effect. And I need to be I need to be in control of my physiology.

Scott Benner 48:15
You think it would be a gateway to sugar and other things?

Jon 48:19
At this point? No, because I'm hell bent. But I do think it can be something that everything is kind of in moderation. And I think that too much of anything is not good. And, and caffeine is a drug. And I don't want to stimulate those portions of my brain, even if it's not going to get me into sugar. I say, I don't want to be a junkie.

Scott Benner 48:39
No, I hear what you're saying. Okay, so I'd like to know a little more about the surgery. So where does most of the I mean, are they taking it from limbs from midsection, everywhere?

Jon 48:52
I have a 30 inch suture going horizontally across my body just above the pubis just above the mons, right, yeah, and it goes 30 inches from each side, each side. I'm 5046 inches now. So you can imagine. Oh my gosh, I never even thought about this though right now. But 16 inches of me is not hitch or is the hinge right. The other is this 30 inch scar that goes all the way around. And so what they do is they cut that just below my moves. I had to get that choke and they cut me just you know, somewheres below up high north, and then they cut me right above the mons maybe a little bit deep there because he pulled it up a bit, which was lovely. Yeah. And my doc, every surgeon has a different philosophy and so forth. And some people want to be what they call snatched, so they have a tight bod. But I'm not in the tight BOD kind of category. He doesn't want to pull you too tight. So you have to walk over and a hunch for a long time and all this. So anyways, they cut you apply, they cut you down low, and they remove the section tapering towards the edges, right? It tapers down, and then they saw you back up to top into the bottom end. Wow. Yeah, it's pretty profound. Those pitchers you don't understand until you see the pitcher. Now there's

Scott Benner 50:03
no way to understand that actually, was it painful the recovery? Not at

Jon 50:07
all. And it's, again, it's different for everybody else. I have a high pain threshold, I have chronic pain. And it just it for me, I didn't take any painkillers at all. Okay,

Scott Benner 50:15
I do wonder if not to your degree, but I do wonder if this is a thing I'll need eventually. Or if I'll just because it's funny, I don't think about it. Like, I have to say, visually, I don't care. I'm so much happier being smaller that this bit that's around my midsection. Still, they're still fat there. I'm not done yet. But if it was just skin, I honestly don't know if I would care. I'm so happy, just feeling better.

Jon 50:46
And that's a lot of the way I felt about it. But it becomes physically debilitating. It is hygienic ly and sexually limiting. It is caused me to be effectively, you know, crippled, yeah. Now I'm going to turn that around to I said somebody at the store the other day, we're talking, I said, I decided to swallow my pride and take the ride. So I'm in the little electric cart. And it's funny, I used to be in that little electric cart and be a big guy in the electric cart. And now I'm in our society, a normal size guy, as it were, and I'm in the car. And you know, I want to get up and start walking. But I know that halfway through my shopping or a quarter of the way through, I will not be able to continue to be exhaust carry on. So I have to this is spoons theory of disability, you have so many spoons to spend in a day, right? And I don't want to spend all of my ability, starting to shop and not being able to finish. And then before I took the cart, I would do that I would get stuff real quick, go to the checkout, sit there leaning against the candy now trying to support my weight and my pain and sit in the car for 10 minutes before I could drive home. Yeah, so I decided at one point to give myself that break. But now I'm kind of at the point where I want to go there for a small shopping and do it without sitting down in the car. But then I don't want people to say oh, you've been faking it. Or like

Scott Benner 52:00
John's complicated. I got a quick little procedure on my big toe ones. And the next day, Kelly's like, I'm gonna go to the restroom. Like, I'm totally coming with you. And she goes, what you can't walk. I'm like, I know, I want to drive the car rolled around that place like a king on that card. I was like it was amazing. So what do you think? I mean, you're obviously on a path to get your like, what is it? You're trying to get back muscle tone, like, what do you think you're lacking right now?

Jon 52:26
Yes, the first thing I'm trying to do is get some core strength back. And when I was swimming before the surgery that was really working out well. And I wanted to add to that, a home gym component of barbells. And working on some weight training, not necessarily a complete, we would call the long, not the barbells. But the full weight thing. Maybe not that to start but just the barbells and do a bunch of different exercises to start bringing the bat in which would continue to increase the metabolic rate, it would do muscular things that are important for me and all that. I'll tell you a problem is the work I do, I don't get paid very much money at all. And I'm kind of just barely making it. And my car went completely but up. And so I don't have a car and I can't get to the pool. And I am desperately trying to find a used car. I've got a limited amount of money that I can spend on the used car market is insane. Yeah. And I live rural. So by the time I find something that's a candidate, I have to drive a whole day there and back to look at it and there's undisclosed damage. So right now the biggest thing of my life is getting mobile again, and getting back in the pool right away. And thing is, can I start doing some weight or resistance band training right now? Yes, I can. And I need to not use the swimming as an excuse for that. But the reality is that time in the pool with zero G means everything to me. Big

Scott Benner 53:45
deal. Yeah. Yeah. I wonder if your doctor couldn't get a transport for you to the pool under insurance? Well, the

Jon 53:55
problem with that is I have marketplace insurance. I'm thrilled that they cover my diabetic supplies, right? They're not going to go too far into that. The other thing is timing of it. So my work? Yeah, I guess you're right. I trained people how to use Lou, they schedule sessions with me, my calendars available, they schedule sessions with me. And I find that people are on my calendar, right that they just show up. And I have to schedule around that. I'm going to swim the mile that I do, it takes me an hour, but it takes the whole round trip at least 90 minutes. And I've got to fit that in my day. And I've got to be so you can't like oh, the transport is late today. Or, you know, I have to be back at my office home office to do the next session. And so that's a limiter and you know, again, there's all kinds of rationalizations and you have to not let this stop you or slow you down. So you know, I'm once again convicted that I need to get out some resistance bands and work with that. I do have a little treadmill under the desk thing that I give some work with. Yeah, I'm sorry. My answer is I can I can do more regardless and I need to Okay,

Scott Benner 55:00
well, I mean, it's tough. Like if the walking, I mean it, the zero gravity of the water is what's really is what's making it possible for you. Yeah, yeah. Unfortunate

Jon 55:10
it really is. Now, I'm hoping that that plus the weight training can get me core strength, it'll take some stress off of the off of the back. But I also believe that the Statins have been causing me some muscle issues that may be playing into a lot as well. I was

Scott Benner 55:25
going to ask how long of being off of them do you think until you feel value

Jon 55:30
from that? I'm very much enamored of the scientific method and not allowing correlation to be mistaken for causation and things like this. So I really try to get long data on things I can tell you that subjectively it feels like I'm feeling better, I'm sleeping, I don't have cramps. So I can't sleep more, we're more about two or three hours, and I have to get up and walk it off, okay. And I've been able to sleep I've been able to sleep five or six hours, okay, and I'm also ingesting salts. I'm increasing my specific salt intakes, not just salt on my food, but I'm using a salt supplement, I often get very bad debilitating cramps in my legs at night. And those are dramatically reduced as well. So give me another six months. And I'll tell you, you know, I'm sad. But right now, I think it's, it's I don't think it's any worse. I have to have a cholesterol test in another month or two, and just get a handle on what's happening there. I think it's better Good.

Scott Benner 56:28
I'm glad. Just thinking about your predicament. And it's hard to like, I'm trying to look for other ideas that would be valuable for you. But I don't know what they're none are popped into mind. You know?

Jon 56:39
Yeah, basically, I just need to find the miracle used car that's going to work out for me for you know, the $6,000 I've got Yeah, and I just need to run about to do groceries and stuff. And as soon as I do that, I'm going to be a regular fixture at the pool again. And that's going to be a really cool thing.

Scott Benner 56:54
I don't I don't want to get into your I'm not trying to get your finances but okay. All right. Well, I hope hopefully, this is something you can figure out. So

Jon 57:00
I have friends to talk about a GoFundMe, but I'm the guy who contributes to go fund this. So I know this

Scott Benner 57:07
is gonna sound ridiculous, but you said that when he cut you, you know, at your waist. And he cinched it up like you, you were like, which was lovely. And I was like is that my penis looks bigger joke. I couldn't tell if that's what you were doing.

Jon 57:18
No, you know what? It's funny that it's a joke. And I'll be you know what, I discovered that I have one. It's crazy. Like I mentioned earlier, hygienic, and sexual function is vastly improved, you know, when I not to be graphic or anything, but when I put my hand around my pelvis, I feel a bone. I can do the Michael Jackson thing. You know, I'm

Scott Benner 57:41
talking about you. And you and I can prior to that No, right? Like, Oh, hell no. Yeah,

Jon 57:47
let me let me let you I might turn this into an after dark episode. I hope not. But in order to use a public restroom to urinate, I would have to go into a stall because I'd have to drop my trousers to my waist. Lift up my belly and do my business. And you know, what's a wonder? This sounds so silly. I can use my fly now.

Scott Benner 58:09
I tell you that must have been exciting. I'm being serious. So yeah,

Jon 58:13
I am too. Yeah. And they sell hygenic aged we have all to take care of when you defecate

Scott Benner 58:19
when you're that large. I've seen the towel on the stick thing. Yeah,

Jon 58:23
yeah. Yeah, I used to have to take a shower. I'm, it's all of a sudden become too TMI. But it gives depth to the thing.

Scott Benner 58:31
No, of course. So for clarity for people. You at that weight, bowel movement. You had to move to the shower afterwards, because there was no reaching to what you needed to reach.

Jon 58:40
Yeah, and I wasn't gonna get a towel on a stick. Yeah.

Scott Benner 58:43
And that's something man. Oh my gosh, well, your life has changed. 540

Jon 58:47
pounds is profound. That's my 600 pound life. Yeah.

Scott Benner 58:51
But your life has changed so significantly.

Jon 58:55
Yeah. Can you imagine I weighed 250 pounds. i After the surgery, I got 50 inch pants. I took the four inch before that after recovery from the surgery removal of the drains. I was wearing 50 inch pants. And that was like, almost three months after the surgery is how long it took the drains to come out. Right. And I went I bought from Amazon 5250 and 48 and you know, they have to try before you buy and I kept the 50s and it was just this week that I was like my diet bestie and I were talking and she said you know you lost a lot of weight and my pants were falling off and couldn't keep my pants off. Right on so I had to I had to put more holes in my belt. Anyways, I said you know what, I'm gonna go ahead and order a 50 a 48 and a 46 and we'll see what happens.

Scott Benner 59:37
And the 46 fits nice. Oh, it's so wonderful.

Jon 59:41
44 is off there is not the big and tall store.

Scott Benner 59:44
I started last year 38 waist and I'm a 32 now and I swear to you, you go I swear to you, I appreciate you ever I swear to you. I didn't think that was possible. Like, I mean, I really didn't think if I stuck my hands on my sides that my hips and push back then or now, like, I didn't think it was any different. But it is it's so significantly different. It's crazy. Like I put a suit on today, I was out earlier. And I had a suit on him. And I got to this place where I mean, everyone was wearing suits, but people just kept coming up to me like, Oh, my God, you look terrific. And I was like, thank you. I like it's I'm just smaller. That's all there is to it. You know,

Jon 1:00:29
when you have 46 inch waist and you're wearing size 50 or 50 to pass. It doesn't reflect where you are.

Scott Benner 1:00:38
No, it makes it worse. It really does. Like, I'll tell you one of the silliest things that I've done in the last year, super simple. But I've donated a lot of clothing over the last year. And I've always been very careful not to buy a bunch because I'm like, I'm not where I'm going yet. I'm not going to buy a bunch of clothing and then give it away again, like I was living on like the same two pairs of pants, like through the winter. You don't I mean, like doing that thing. Yeah, yeah. And but I, I spend a few extra dollars now on my T shirts, so that they're a higher quality fabric. And I find that I just think I just think I'm presenting better now. And yes, you lose that like clean feeling when your clothing is too big as well. Like it's not just the fabric. Yeah, it's the way it fits you. You look, the old homeless basically, you don't I mean, you look like you're reaching your bag and you took what they gave you is basically how it ends up, you know, coming off.

Jon 1:01:32
It reminds me at the height. Oh, go ahead. No,

Scott Benner 1:01:35
I was just gonna say it actually, it impacts how you feel about yourself. And you don't realize it right away

Jon 1:01:41
when I was at my maximum weight, and went to the big and tall store, and had to go to the far end of the pants, to the 70 fours. And all they have are bright orange and checkered plaid.

Scott Benner 1:01:57
That seems that seems like a joke, doesn't it? Yeah. It

Jon 1:02:00
seems like a cruel joke. Yeah. And, you know, I ordered some jeans just, they're gonna get here tomorrow. Everything's Amazon. I ordered some denim jeans. They're not quite Levi's Bible ones, you know, I'll get this. I don't even know if they still make those. But there's some jeans and I expect, you know, to really dig on that and I'm gonna get shirts. Next couple of shirts.

Scott Benner 1:02:24
Let me ask you a question. I was sharing this with my wife the other day. If I have a larger meal than I'm accustomed to now, and I feel full tick, just have that very full feeling. When I get to a mirror, I almost consciously expect to look better. And and when I don't, I'm stunned. And it's a real I can see that. Yeah. So I told my wife. And as I was saying it to her, she goes, I know exactly what you're talking about. Like if you feel full. When you look yourself in the mirror, you expect to see the old view there. I was like, Oh, my guy suggests. Yeah, please let me suggest

Jon 1:03:01
something that comes to mind. This may or may not be true. But this is a perception I have on it is when you're full like that and satiated. You're on the drug rush. And that same drug rush makes you remember this conditions of that addiction

Scott Benner 1:03:19
could very well

Jon 1:03:21
put you in the mind of that body. Yeah, you become that person that's under the control of overeating, or bad eating. And so you feel like that person and he doesn't change just because of that one meal and you look at yourself and you're like, No, no, I'm still I'm still. Okay. But maybe that's a mechanism to make you think hey, don't it's

Scott Benner 1:03:41
been an illuminating year so far. I have to say.

Jon 1:03:44
I'd like to follow up. I enjoy the journey you've had on that as well.

Scott Benner 1:03:49
Oh, good. I'm glad. Thank you.

Jon 1:03:50
i How's your glucose? How's

Scott Benner 1:03:52
your mine's good pre diabetic diet. Okay. Yeah, I've had my endocrinologist told me last year, she said look, based on all of your, your a one sees over the years that I see she goes, I think it is incredibly unlikely for you to ever develop type two diabetes. And I was like,

Jon 1:04:11
I've noticed super obese people that are dead now, that did not have diagnosed diabetes.

Scott Benner 1:04:17
Yeah. My fasting glucose is they're always like in the, you know, 80s Nice. I think I've shouldn't talk on something probably, but I think I'll be alright. And that that's based. I don't know if I'll get type one diabetes. But well, yeah. That

Jon 1:04:31
gets triggered right? By events, right? You get you get COVID You get

Scott Benner 1:04:35
I've never done trial that personally. So I don't know if I have markers or not. Well,

Jon 1:04:42
you you know as as much as anybody more than anybody the the genetic relationships in the family tree actions. I

Scott Benner 1:04:49
don't think it's not possible, that's for sure. I'm just trying to, I mean, at this point, John, I'm just trying to eat well, and move and continue in the right interaction. Those are my goals.

Jon 1:05:02
Something I wanted to share that that I thought of just a few moments ago, is I like being hungry. Okay. It's a feeling I enjoy. I don't like being hungry to the point where I'm, I'm feeling physically impacted like, you know, I'm low sugar per se but like I'm ravenously hungry, but I like to be hungry and that's a feel. I think that's because that's a feeling I never had. I thought I was hungry. I was obsessed. I was feeding the drug needs. I was hungry for the dopamine. Yeah, but you know, like, so my fasting isn't at all difficult for me. And when I do get a little hungry, I know that dinner is coming soon. I make beautiful food. If you look at my timeline on Facebook, you'll see that I just make really, really good meals. So I was also worried am I going to have a rebound? Where I go from obsessive eating to some sort of anorexics thing, right? And absolutely not. I enjoy my food so much. Good. Good. I'm

Scott Benner 1:06:00
glad I have to say I do too. I had like a like a chicken sandwich last night for dinner. Like I took some chicken breasts and I season them and and and I put a tiny bit of oil in the pan a little olive oil. I fried them up and they were nice and tasty. I put it in a pita threw some lettuce in with it. I graded a tiny bit of cheese over it. I sat and ate it. It was half it was half a chicken breast. And I got done. I'm like I'm full. This is great. I'm good. I don't know what

Jon 1:06:26
the half of the time you spent making. It was as much a part of that meal as for

Scott Benner 1:06:30
sure. Ya know, I love making food. I still do. I like making food for my kids to like, it makes me happy to cook for them. But But beyond that I got up this morning. And I went to a viewing today. So people are like, Oh, Scott in the middle of the weekend a suit but nothing fancy. I did not eat today until about I think two o'clock in the afternoon. And I was hungry at that point. But if I wouldn't have eaten, I would have been okay to. Yep, yep, yep. Now it's 6pm. Like obviously my day is a little upside down because this viewing came out of nowhere and John was nice to move his his recording around with me. I'm probably going to finish with you and go have the other half of that chicken breast into similar pizza again, I'll probably that's probably how I'll end the day. Last

Jon 1:07:14
night I had a cup of soup for my meal. It was a very light. It was a very light day today. I don't know what I've got the frosted to figure that out. Oh, you know, I'll probably I'll probably have an omelet.

Scott Benner 1:07:28
Okay. Oh, I eat a lot of eggs. I love Yep. Yeah. Usually for breakfast, I have a couple of eggs in in a wrap with something some protein usually, you know, something like that. I do that in the morning a lot. Yeah, no, I

Jon 1:07:42
agree. I'm gonna have a sausage. Yeah, it's nice.

Scott Benner 1:07:46
All right, let's it's time for me to ask you if we've missed anything, because I know you had some pretty specific, like, you're very prepared, and I appreciate it. And yet, you're very conversational, which I also appreciate. So I want to make sure we're not missing anything that you meant to talk about.

Jon 1:08:00
You know, I wanted to talk about the consistency and the improvement, the fact that it wasn't just an overnight thing and gone. And so the idea of sustaining a healthy relationship with my diabeetus. And the other factors in my life is I think a big part of my message is that it's not rigorous for me. It's very affirming and positive, it reduces stress in my life. I'm not at odds with the way I eat. And I'm constantly rewarded with the results I see. And I continue to increase those rewards. It's, you know, diminishing returns. It's not really here yet, because there's so many things that I continue to be able to improve. And another part of the message is it's never too late. And I guess another part of the message is, there's more that binds us than separates us. And so a healthy lifestyle, healthy social interactions, healthy interactions with food, all these things will reduce our suffering, and help us to focus on the things that are effective in treating the chronic illnesses we have. And so I really appreciate that your group was open to all

Scott Benner 1:09:11
of us. Oh, no, it's my pleasure. I want very much for the group to be open to everybody. I also think that what helps you as a person with type two diabetes, what helps a person with type one diabetes? And what how, what helps the person who doesn't have diabetes? Speaking about like, just general health, food, that kind of thing? I don't know that any of us are in a different boat than anybody else. Finger you know what I mean? I mean, I think quality food at a reasonable proportion is something everyone should be aiming at. I just think that people with diabetes are forced to pay attention to it sooner in life than maybe people without it are.

Jon 1:09:47
Yes, but you know what the Epilepsy Foundation as a whole webpage about addressing diet and exercise, right? Everybody

Scott Benner 1:09:55
should be doing what you're doing to some degree or another So obviously, it wasn't easy for you, you had mitigating factors, so to a lot of other people, but I mean, it's just very impressive that you stayed after John, you're you speak like a young man, I don't know if you're aware of that or not like, and you have a younger voice, but like, it's important to remember, you're 63 years old, you know, and you're, and you're doing these things. And you have the attitude of somebody who's 25, and just gained 10 pounds and realized, Oh, my God, it's getting away from me, you're trying with that kind of energy. And I think that may be the most impressive part of this whole thing, to be perfectly honest. And if people go back to listen to your first episode, that a number of things stacked against you, when you're growing up, too. So yeah, yeah, it's a bit rough. It's a bit rough. It's a very kind way to talk about a child. But yeah, it was a bit rough.

Jon 1:10:43
I like to say, it's half jokingly or whatever. But I'm a 16 year old guy who acts sometimes like he's 12 and thinks he's like, 25.

Scott Benner 1:10:54
That's good, though. I think that there's I don't think there's anything wrong with that. I just think that it'd be easy for people to listen to you and forget that you're a 63 year old man who's been through all this and whose body has been through what it's been through, and you're still putting in this effort, and you're willing to take slow returns to?

Jon 1:11:11
Well, I believe the biggest gift I have right now is sharing my success with other people that can identify with it and adopt some of the elements, you know, see hoping it and maybe adopt some of these elements to address their needs when they're much, much younger.

Scott Benner 1:11:25
Yeah, I want to say to that, I think the GLP has helped me. So I've always, like as an adult, I always kind of endeavor to find things that make me more patient, because my patients is not is not good, right? So I do things like iraes cactuses, because they grow very slowly. Nice. And if you get it to grow an inch in a year, and you don't kill it, you've really accomplished something. And so I like the idea of doing something that doesn't pay you back right away. The GLP helped me with that, too. And here's how I knew I was going to lose weight on the GLP. I just knew I was going to, but I knew it wasn't gonna happen quickly. And I was able to, instead of saying, I gotta lose weight, I want to be 10 pounds lighter in a week or a month, or like, you know, like having that kind of like fervor for it. I was able to say, I don't care how long this takes, because I know when I get there, I'm gonna be where I mean to be. And that was really helpful. And then because of the GLP, there was weight loss along the way. So I didn't endure to in three weeks in the first six months where I was like, Oh, my God, my weights not going down. always felt like it was working, which allowed me to actually be patient, II call it a crutch or whatever you want. I honestly, I'm looking for doctors to come on and talk about how the medications work. I think I've got a couple lined up. But I genuinely believe I have some sort of a deficiency that it's covering. And just being able to see things moving in the right direction allowed me to act about my weight, the way I do about the cactus, I grow, there's a little light green ring. It grew. And I was able to say that's fine, because it's alive. And I've got all the time in the world. So I'll just wait. I don't know. It's just I think being patient is a big part of having the kind of success that you had. And I don't know what you think about that.

Jon 1:13:24
Well, I can relate in one way directly. I have eight aquariums here. And the largest are 60 and 75, gallons and small Sarkar. 40. I practice a style of fish keeping that is you would call a balanced environment. So a lot of people are focused on changing the water in the tank regularly and adding additives and all this, my focus is on doing as little as possible to achieve a balanced ecosystem. And my aquariums are just gorgeous, full of plant growth, the fish live forever, everything's pretty cool. And for me, that is a part of my diabetes, self care, the ability to maintain those environments in balance is informed by my ability to do it myself. So your thing with the cactus I can really relate to, because my thing with the aquariums is related to my self care. Yeah,

Scott Benner 1:14:15
I've talked about this in the podcast, a couple of little places, but I've almost by mistake become a person who owns a chameleon. And it's lovely that chameleon is absolutely lovely, but it was a gift. And the people who gave me the gift as much as I appreciate it didn't actually buy me the chameleon that I would have bought for myself had I bought a chameleon. So once I learned how to do you know all and it's another one of those things, it's an incredible amount of detail that you know, to do to do it right. And, you know, again, there's this living thing on the other side waiting, you know, for you to to do it right, you know, so I added a second chameleon I have to I'm not going to get any more I promise. The second one I got grows incredibly slowly. For over like three years to become, even to an adult size and may keep growing beyond that. But it needs a really large enclosure. And it's the same idea that there's this little tiny baby thing right now, that looks like it's in a world that's too big for itself. But it's but it's not an I don't get to see it fill up unless I do a good balanced, slow and steady job for this little animal for at least three years, right, then go. And I think of it the same exact way. Like I like that it can't be rushed. I think it's important for

Jon 1:15:36
people. And that's the way I feel about my goals for my diabetic control. My weight is, you know, it's been going actually remarkably quickly, but I never had any impetus to do it. Any of the feed i There's a phrase I use is one millimole at a time,

Scott Benner 1:15:51
that's a great, it's a great way to put it I if you're measuring your weight loss, your health recovery, your diabetes, care, any of that stuff in days or weeks. I think you're putting yourself in an unfair position.

Jon 1:16:03
You'll never get there. You know, you have to do you have to keep hiking. And when you get to the next rest place, you look down and you see the progress you've made. And then you snack, you rest. You drink your water and you get up and you walk the next mile. buy

Scott Benner 1:16:16
another pair of pants two inches smaller and get going again.

Jon 1:16:19
Exactly. I mean, can you imagine when I get to go to town and bypass at a store? Yeah, no, I'm

Scott Benner 1:16:26
excited for you honestly. Yeah, seriously. That's a couple months away. Yeah. Now I've had listen, I feel weird saying this. But you know, there's a death in my extended family came out of nowhere. I had to go to a viewing today. And it was yesterday afternoon, I said to my wife, oh my God, I don't have anything to wear to this viewing. And I ran out last night at like, seven o'clock. And I was like, she's like, What are you gonna do? Am I gonna go to Macy's to get a jacket? Like, you know what I mean? Like, I got a, you know, so be respectful. I met Matt Listen, he's a great guy. And, and he died. And he deserves for me to show up at his viewing in a suit. And it's just how I feel. Right? So. Yes, so I'm out. And I gotta tell you as sad as the reason was, I was shopping. I never had a better half an hour of my life in a store. I mean, I tried every jacket on, I look good. And every one of them. I was like, Oh my God. Like I thought that color wasn't for me. I thought that print was it wasn't that it was I was overweight. I didn't even realize it. And so I you know, I was able to shop I felt terrific. You know, like doing it I at one point, I was like, I'm going to try it on the slim cut. I was like, Oh my God, this fits to like, none of this makes any sense. I walked out of there, I felt like I was 12 feet tall. Like seriously.

Jon 1:17:43
I don't want to be too presumptuous. But you know what? I'll bet you the old man smiled at that. No, I

Scott Benner 1:17:49
hope so. I hope so.

Jon 1:17:50
You know what I'm saying? Yeah, that's, that's the best tribute you could make anybody you love is to take care of yourself. And to be in a place where you can feel that way. I

Scott Benner 1:17:59
was the happiest person that a funeral today you've ever seen in your life on because I was just like, Man, I know, I look good in this suit. As much as it's not about how you look, it's how healthy you feel. It is like, to some degree, I feel better because I look better. And that's just you know, I didn't dislike myself before John, but and I don't like myself more now. But it's just that I'm having a different lived experience at this point. I

Jon 1:18:24
think that's a good way to put it. And when I put on those 40 sixes, I had the 46 and 48. In the 50. I said, Let's start at the 46 I can get done with this. And when they fit. It was like, you know, the heavens opened, there were trumpets, there was like, a little giggity giggity. I mean, it was a high. It felt really good. It felt like arriving

Scott Benner 1:18:43
oh my god even pushing the clothing into like a one of those bins where you make the donations. I've never been so happy to give something away that I just bought. You know, I was like, oh my god, hope somebody else can use this, but it's not mine anymore. And I don't need it. Because, um, you know, 3836 34? You know, actually, when it went to 32, I decided I was like this doesn't make sense, like so.

Jon 1:19:05
And you know what, I have that history of gaining weight back. I broken through that so far beyond that. I'm never going back.

Scott Benner 1:19:13
I feel that way too. My wife was like, Are you going to keep anything? And I was like, No, I was like, I will not. It'll be my punishment to myself. If I have to go back out and buy something at a bigger size. So then I don't know if that's healthy or not. But I just I was like, I'm not keeping any of this because it felt like a crutch if I did, honestly. Hey,

Jon 1:19:30
I did get to talk about everything. And I again, I want to thank you for the opportunity to to share my story again.

Scott Benner 1:19:38
Oh, of course. All right. Well, John, I'm terrific. I'm gonna let you go defrost your meal and I'm going to make my chicken sandwich and we're all gonna go be happy and healthy. Yes. Hold on for me for a second. I'd like to say goodbye privately. Sure, thanks.

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if you have type two or pre diabetes, that type two diabetes Pro Tip series from the Juicebox Podcast is exactly what you're looking for. Do you have a friend or a family member who is struggling to understand their type two and how to manage it? This series is for them seven episodes to get you on track and up to speed. Episode 860 series intro 864 guilt and shame episode 869 medical team 874 fuelling plan, Episode 880 diabetes technology episode 85 GLP ones metformin and insulin and an episode 889 We talk about movement. This episode is with me and Jenny Smith. Of course, you know Jenny is a Certified diabetes Care and Education Specialist. She's a registered and licensed dietitian and Jenny has had type one diabetes for over 30 years. Too many people don't understand their type two diabetes. And this series aims to fix that, share it with a friend or get started today. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day, it is completely free. And at the very least you can watch other people talk about diabetes, and everybody is welcome type one type two gestational loved ones, everyone is welcome. Go up into the feature tab of the private Facebook group. And there you'll see lists upon lists of all of the management series that are available to you for free in the Juicebox Podcast, becoming a member of that group. I really think it will help you it will at least give you a community. You'll be able to kind of lurk around see what people are talking about. Pick up some tips and tricks. Maybe you can ask a question or offer some help 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

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#1241 Mannkind CEO Talks Afrezza

In this episode of the Juicebox Podcast, Michael Castagna, CEO of MannKind Corporation, delves into the innovative world of Afrezza, the inhaled insulin. Discover the science behind this breakthrough in diabetes management, its safety profile, and how it compares to traditional insulin methods. Michael addresses common concerns and misconceptions, providing valuable insights into ongoing and future studies. Tune in to learn more about how Afrezza is changing the landscape of diabetes care​

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

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

Scott Benner 0:00
Hello friends, welcome to episode 1241 of the Juicebox Podcast.

Today, my guest is Mike Castanea. He is the CEO of the MannKind Corporation better known to you perhaps as the people who make the inhaled insulin a Frezza. Please don't forget 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. You can help support type one diabetes research right from your phone right there at home by going to T one D exchange.org/juicebox. and completing the survey join the registry complete the survey the whole thing should take him out 10 minutes and the answers to your simple questions will become part of how things move forward T one D exchange.org/juicebox. The T Wendy exchange is looking for people with type one diabetes and caregivers of people with type one who are US residents. 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 want to save 30% off your entire order at cozy earth.com It's as easy as using the offer code juice box at checkout. 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. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us med this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash Juicebox

Michael Castagna 2:28
Podcast got my Castanea the CEO of mankind Corporation.

Scott Benner 2:32
Mike, we have we've been trying to do this for like two years it feels like

Michael Castagna 2:37
it feels like and maybe longer because of COVID The time has just flown by Yeah,

Scott Benner 2:41
really interesting. People always say to me like what are you gonna have someone from mankind on? I was like, I'm trying. Like I'm trying to do my best. I guess you're here today. I'm going to ask you questions about about the inhaled insulin, the Frezza. Am I saying it right? I Frezza? Because you got it right. Nice, okay. And I'm going to kind of pick through how we got to where we are now what your goals are for the future, that kind of thing. So has the patent been sold? Like did this start out at a different company? What's the lineage of it?

Michael Castagna 3:10
Yeah, no, great, great question. never a better time to talk with us. As we get ready for new data coming out here very shortly, your listeners will be even more interested in healthy and inhaled insulin. As we go forward, the technology goes back to 1991. So actually 33 years. And there was several companies that are founder after the man owned, and he was investing in inhaled insulin back in the late 90s. Mainly because he was working on mini med the insulin pump as many your listeners are really familiar with Medtronic. And he realized that the major problem was the input of the insulin. And the everything we're trying to do is manipulate that profile the insulin to increase your ability to control your sugars. But but it was very hard to have that passed on set that he was looking for as an engineer and a physicist, he kind of knew the mechanics and engineering before any of us can even see what CGM look like he had that figured out in the late 90s. When he sold many meds Medtronic, he then stood out to build mankind in 2001 to three of his companies combined them and made mankind. And so the technology has always been within. And we've patented over 1200 patents at this point. And the company has continued to progress since 2001. Till today. And it took I always remind people and they asked me like, why are drugs so expensive. And think about insulin as 100 year old product, it took us 20 years 75 trials and $3 billion to take on your your old product and change route of administration. And you got to think about you know, that's shouldn't be that hard. It shouldn't take that long. But that's how long it took just to bring this innovation to patients. And the good news is, it'll be here for the next 20 to 40 years that I can see. And so we're we're just getting started. I hate to say that because as you know, this product has been around for a while, but we had to redo a lot of the data. And we'll talk about that today. What we're doing now and what's coming.

Scott Benner 4:55
Yeah, I mean, it's interesting because as a layperson when this first popped up in you know this like ice then people are like there's an inhaled insulin. Are you going to let because people look to me, which I don't even know how I got in this position sometimes Mike but like, you know, they looked at me like are you gonna let your daughter use this? And I said, Well, top of my head, I'm going to avoid her inhaling something if I can, only because I don't understand what comes next. And so, I mean, obviously if there's that much money and that much time being put into it, you don't have those concerns, or I'm assuming you diversify somehow. So why? Why shouldn't I be concerned about it?

Michael Castagna 5:32
Yeah, I mean, just use some color, I take the product personally, my family takes it, we're we wouldn't take something we didn't believe or have competence in. Right. And so that could just some confidence that could mean we're not that smart. But I think we're pretty smart. You know, when you when you study drug development, right, you're always looking for toxicities. And so by the time you get FDA approval, you've been through the wringer in trying to show that it's safe and effective, sort of that safety profile was established many, many years ago throughout all the clinical trials. And then people say, Well, this is a lifelong treatment. How do I know when you think about inhaled insulin? You know, in our particular technology case, we bind human insulin, water, and a particle called FTK P. And what happens is when your lot when the particle touches your lung, it releases the insulin directly into your blood. And the FTAAP gets excreted. So think about a car, taking passengers and delivering them and then leaving the FTK P doesn't metabolize doesn't do anything in your body. So what you're really taken as the human, it's on the water. And we know your body likes human insulin, and we know the shows in your body as well. It's not an analog insulin, it's not a modified insulin like Lantis or something like that. And that's what people miss. They think they're putting a novel target in their lungs, and is that going to be safe and effective? And obviously, safety's number one. And so we've studied this and over almost 3000 patients and their long term lung safety study was two years. We've done a lot of trials for six and 12 months at a time. And now we're going into kids. And so that was one of the obviously questions that we asked the FDA is are you comfortable with us going into children, and they were so we started that journey six years ago. And that trial be reading out later this year.

Scott Benner 7:14
So that is that the inhale three study. That's

Michael Castagna 7:17
the inhale one study. So inhale, one was children. And then inhale three was one I funded because I believe the number one alternative choice that people go to his insulin pumps, and we didn't have a lot of data head to head on insulin pumps. And so we wanted to do a bigger study showing usual care which would include insulin pumps or MDI.

Scott Benner 7:35
Ultimately our injection helped me understand the the process. The FDA in the United States, they lean a little more into being aggressive letting people decide what they want to use, but then they'll kind of tack a post marketing study on to you if they think it needs more looking now like the EMA, UK that kind of stuff over there in the EU. What did they say to you like how come you don't have approval in the UK for example? Yeah,

Michael Castagna 7:59
they never said no to us just to be clear, we never filed you know, okay. And so at that time, if you

Scott Benner 8:07
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Michael Castagna 9:19
When the company launched Pfizer, Sanofi was supposed to file internationally. And when they handed the product back to us, those filings were all stopped. And then mankind honestly was almost out of money. And Helen's almost disappeared, went bankrupt. And so we just didn't have the money to file around the world. We did file in Brazil, we have filed in India, we got approval in Brazil, we're expecting approval momentarily in India. And we know in Europe, they're going to want pediatric data. And so that was one of the things we are waiting for extraordinary funding and pediatric study. And it takes takes about two years to get a drug approved from the time you file and you're better off trying to get one package up front in Europe or Canada or some of these markets because the poor pricing is determined at launch. And so once you launch, if you don't have a full data package or full expectations, you may not be able to have the right price point. And then you're stuck with that. And you may not be able to launch and commercialize the product. And that's really what the holdup has been in Europe is we wanted to get the enail three data show and head to head against insulin pumps. We wanted to get the pediatric study done to show that we can have an expanded population. And we want it to look we're also looking at some other some other areas we'll we'll talk about but but that total package for you're also with the economic analysis will be really important for Europe. And that's really what we're waiting on. So that's, that's coming.

Scott Benner 10:36
Tell me more about how close did the company come to not existing anymore?

Michael Castagna 10:41
For weeks, by really twice? Yeah. When I became CEO, we had less than we were burning about 24 million a quarter to stay alive. And we had about 20 million in the bank. And so I first joined the company, we really were at the same point in 16. And then again in 17. And then at one point, COVID-19, I can remember exactly or fortunately, but we were four weeks away. He was 2018. Actually, we were signing a deal. And it was a rumor I was going we were going bankrupt and everyone's getting fired. And it wasn't true. We were about to announce a major deal. And we were holding out for that pemilik motors get the paperwork done. Now the company has been public company for 20 years, which is good and bad. It gave us the capital to bring innovation to market. But it was also brought evil side of bias. They've been a public company and people that make money by trying to make companies think. So that was a it was a love hate relationship. But I think today we've built good shareholder return over the last seven, eight years and things are going in the right direction. People

Scott Benner 11:38
would never think about that. Right? Most people wouldn't consider that somebody would try to short your stock to make money or something like that. And you're you're better off trying to make insulin and this is all happening. What made you take the job? Where did you come from before mankind?

Michael Castagna 11:51
Yeah, so I'm a pharmacist by training, I chose to want to build a career in the pharmaceutical industry because I thought I can make the biggest difference in the world by doing that versus working in a hospital or running a pharmacy chain. And I feel very good about that choice. And I look back in my career I worked in HIV and helped build the one pill once a day regimen I worked in fertility I worked in rheumatoid arthritis biosimilars growth hormone, and number and growth hormone trying to get a parent to inject their kid, just once a day for three, four years was a nightmare. And I think about now diabetes and insulin, you know, trying to inject them three to five times a day or a pump is equally as difficult when you first go down there life depends on you. And that to me is very stressful just thinking about it. Sitting around Bristol Myers, Novartis came out to California for Amgen. And I was very happy at Amgen. And then when I was a shareholder, mankind until it got approved. And then once I got approved, I sold my stock. And then about a year and a half later, I see I do turn around. That's kind of what I specialize in. It was 20 years. And I saw that inhaled insulin came back from Sanofi and it was in Valencia, California, not being from California, I didn't know where Valencia was. So I had to do a Google search. And there was an hour hour and a half for me. I emailed the CEO and said, Hey, I would love to help you turn this around. I've seen the patient profiles online, I've seen what this drug can do for people to make a difference in their life. And for me, that's what life is about. It's about how do you make someone want to happier everyday? How do you make a tremendous difference in their life. And I actually did not. Some people know this, but I didn't want to work in diabetes, because my father, I didn't know him growing up. By the time I found out who he was, he had passed away from complications of diabetes. So for me, I didn't want to work in a disease every day that I thought about I missed out on this person my life. Yeah, unless I thought I can make a difference. And that's when I saw inhaled insulin is that time Dexcom was barely popular in 2016. But I see these people these incredible time and range profiles and flatlines. And I was like, What are they doing? And how are they doing it? And that's really what convinced me that mankind was something worth taking. And so long story short, how man was supposed to meet him, our founder, and he had passed away on February 25 2016. And the only reason I remember is this my daughter's birthday. And had he not died that day, I probably wouldn't have stepped off the legend to take the risk. But you know, she's your kids are important to you. And that that was an important date. And he chose the day he died. He went and one more wedding anniversary with his wife, I was told. And that was it. He was 91 years old, do everything he could and and he had a great life and did a lot for society.

Scott Benner 14:22
So you said some people in your family use a Frezza? Who

Michael Castagna 14:26
I think for their privacy of your mind. I don't want to answer but I have a lot of family of 40 cousins and

Scott Benner 14:32
and there's type one there. type one and type two. Yeah, my dad,

Michael Castagna 14:35
my dad had seven children and he has lots of grandkids and some of them suffered in diabetes as well. I

Scott Benner 14:41
want to ask questions about using it but I want to get past the like I have listener questions here and they're gonna you know, they say, I hear some people say they have a persistent cough from it or they can't take it or that it hasn't been approved because of concerns about breathing issues or lung cancer. Like can you clear that up for me? Tell me everything you know about have that and then I want to hear about how it works and how people use it day to day. Sure. So

Michael Castagna 15:04
if you have asthma, or COPD, this is probably not the right product for you. Right. And that's because we did a study showing that a kid has me at a higher risk of bronchial spasm. And so we don't disagree with that conclusion. And that's about 10 20% of people in the world that the country that have that underlying disease, and so that's probably not the right product for them. In terms of a lung cancer, you know, you gotta remember there's been over by now 20 30,000 People took a president us there's a bunch of exuberance. So there were some imbalances in the trials of people who smoked, who develop lung cancer. And, you know, unfortunately, we smoke you probably more prone to lung cancer. But I don't think there's ever been a causation that inhale and some causes lung cancer. And so you know, when you study a drug in 4000 people, 3000 people, unfortunately, a subset of them will get cancer on them and other types of cancer, lung cancers, and that, you know, but that rate of cancer was no higher than the general population. That's remind people when you're studying drugs, and sick people, in general, you have side effects that come up, and you got to manage those. Also,

Scott Benner 16:05
the idea is, if you would have followed those people, most of them would have gotten the cancer they got to begin with, it's just you're grabbing a subsection of people and watching them closely. Is that right?

Michael Castagna 16:15
Right. And you're watching them closely, and FTS, is to go back and look in time and sway, go back and look for cancer. And so you found two more people post through trial that got cancer. And so but if you think about the product and the 30, some 1000 people have taken it, we have knock on wood, only had one additional lung cancer recorded, which was in a person who smoked for 40 Pack years, and took the drug for three months and amendments. So So I feel pretty good about the safety profile, the safety and surveillance we've done. I don't see an increased signal, we'll need to work with the FDA on that question. But I always say, you know, we know how sugars, cancer, we know how sugars cause peripheral neuropathy, retinopathy, kidney disease. And so for me, it's it's about avoiding the complications of diabetes and making sure you have really, really good control. And as we know, in this country, that control has not materially changed in 2030 years. So how do we keep giving people the best set of tools that work for them. But the safety profile, this product, I think, is pretty proven at this point after a decade on the market. It's not like it's novel. It's not like it's a new drug. It's human insulin that people take. Yeah, it

Scott Benner 17:24
feels like there's a, we're in a moment here. Because I feel like you're about to tell me that you've got some news about, you know, children and Impreza, I just interviewed a man this morning who had type one, since he was 50s 58. Two and a half years ago, his doctor on a kind of a whim put him on two and a half milligrams a week of Manjaro. And now he doesn't use insulin anymore. And that's not to say that Manjaro cured has type one diabetes, but he 1,000,000% has type one diabetes, got the auto antibodies there. And as I was talking to him, it just becomes abundantly clearly, we don't even know what that GLP completely does get, like, and how long is it gonna take to figure that out? You know what I mean? Like, you need to be interested, when you see stuff like that, you know, like, you need to say, I wonder where we could take this and I feel that way about a Frezza. I think people will say like, I mean, I've had probably, I don't know, maybe five, eight people on the show who have used it, or are users of it. But I see people online who are fervent, they are like, excited to tell people about it, you know, like, where's that excitement coming from like, so for a person who's accustomed to wearing a pump or injecting and they count their carbs and they cover their insulin, they get high? They correct. They get low, they eat some food, like when that's their day to day, like how does that change? If it does with a Frezza?

Michael Castagna 18:43
Well, I think you know, the good thing I can tell you is all the people you see online, all the stories out there are all self driven, meaning we can't pay for these stories. I had someone on Reddit kick one of our patients off saying, Oh, they can't be that good. I'm like, we don't pay people we can't, they'd have to disclose that that's illegal. And so I do want your listeners to first know and he still use the other mankind to not pay to get place they they generally are people sharing their public health, which is actually why I took the job because I saw this wonderful feedback loop in social media that I said, Well, that's amazing. How can I help bring that to life. And what those patients did is a few things that were different than our trials. One, one, they figured out appropriate dosing. And what I mean by that Scott is, you know, the company at the time was developing a product that was more one to one ratio in terms of how label doses to the conversion will be seen over time as patients up to titrate, up to about 1.5 to two times their injectable dose. And so that's the studies we're now doing to show that that increase those gives, you know, more hyperglycemia number one, an equal or better control number to do what you're doing today. So a lot of the new data you'll see coming out will be in that new dosage scheme coming out. Nada and future conferences. The other thing that people ask me like why, what do they feel differently? And then I'm one thing I get is I feel free and the question is, why do you feel free You don't realize how much stress you have on counting carbs, how off you are on the ratio of counting carbs, your insulin sensitivity ratio. People don't realize the temperature of your skin, the angle of injection, pump occlusion sites, you know, back content, we miscalculate all these things. Yeah, right. And they're not that accurate. And so I always joke and say you think you're giving one unit of insulin. But if you change the angle, the injection, it's point 5% off, if your temperature was hotter North pasture, there's all kinds of things that go into batch to batch variability than insulin also happens. When you think about a present, we fill every cartridge to the same, meaning every four unit is identical for units of insulin, there is no variability, because what happens if the batch comes out a little less, we follow the pattern a little bit more. So it's always the same where biologic when you're injecting, you can't change the volume of the biologic. And so every living batch of cells that you produce in biologics, in general, have some variability inherent in the cell organism, and you can't keep in that range. And that's not the case with the present. So you pretty much get this similar dose every single time. But there's all kinds of variability that a patient goes through. And the second part of that variability is timing. And so you're trying to guess the peak of insulin to your peak of food, and those just mismatch by an hour or so. And then the insulin is in your body for four to six hours, FTO. And yet, and so that's really what people you know, we've done enough studies now that I can confidently tell you, the time I Bolus, my insulin, whether it's a pump or a pen, it's generally peaking about 90 minutes later, and it's out my body four to six hours later. And this is why people say, Oh, I got snuck up on a low hyperglycemia is because we're trying to avoid those late and lows. And you're frustrated as a person living with diabetes, that, you know, your sugars aren't coming down, you're seeing them go 200 to 6300. And you're then given another Bolus, and then you're stacking your insulin and you're crashing two hours later. And that whole process is stressful and frustrating. And when you're out at dinner and drinks with your friends and family, you don't know you're gonna have one drink or two, you don't know if you have dessert or not. And that's all you're thinking about as you're talking to somebody. And in the case of a president, it changes that entire equation, reverses that meaning you're in control your sugar, because I inhale, when I eat, when my food shows up, I'm not guessing when my food minute show up, I'm not going to the bathroom to hide, I can inhale in two seconds. And that insulin is now working within five to 10 minutes. And so because it's inhaled what people it's called monomeric versus hexamer. And we make a Frezza. We bind it in an acidic form and monomeric form, which means soon as it goes into the lungs, and it disassociated from Fe KP, it goes right into the blood in its active form at your liver very quickly. And you can show when that's why you want to get the right dose up front, because you really suppress the liver, hepatic production in the liver. And people don't realize that that process when you take injectable insulin, breaks down about 45 minutes later, and then starts to hit the liver and then steps off the signal. And that's why injectable insulin just takes about 90 minutes to kick in. It's nobody's fault. Yeah. And so our patients aren't counting carbs. That's number one, you're taking a four, eight or 12. When you want to take more, you take more, and you could take it as soon as one hour. So if I was doing Hill, and I see my sugar set up to 200, you can take another four, eight within six minutes and bring that control into your range that you're trying to import. So how

Scott Benner 23:11
do they figure out like, the cartridge size that they want to use? Because one of my notes here is just it says dosing confusion. It says like I ask people who are successful with the Frezza how to dose they're like ah, you know, like sometimes I take a four and I take an eight like, like how is that? Like? How do you direct people where to where do they start to learn? I used to hate ordering my daughter's diabetes supplies, and never had a good experience. And it was frustrating. But it hasn't been that way for a while actually for about three years now because that's how long we've been using us med us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash. The number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. They always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide and over 800 private insurers. Find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or just call them at 888-721-1514 get started right now. And you'll be getting your supplies the same way we do. This episode of The Juicebox Podcast is sponsored by the only six month where implantable CGM on the market, and it's very unique. So you go into an office, it's I've actually seen an insertion done online like a live one like, well, they recorded the entire videos less than eight minutes long and they're talking most of the time, the insertion took no time at all right? So you go into the office, they insert the sensor, now it's in there and working for six months, you go back six months later, they pop out that one put in another one, so two office visits a year to get really accurate and consistent CGM data that's neither here nor there for what I'm trying to say. So this thing's under your skin, right. And you then wear a transmitter over top of it, transmitters got this nice, gentle silicone adhesive that you change daily, so very little chance of having skin irritations. That's a plus. So you put the transmitter on it talks to your phone app tells you your blood sugar, your your alerts, your alarms, etc. But if you want to be discreet, for some reason, you take the transmitter off, just slip comes right off no, like, you know, not like peeling at or having to rub off it. He's just kind of pops right off the silicone stuff really cool. You'll say it. And now you're ready for your big day. Whatever that day is, it could be a prom, or a wedding or just a moment when you don't want something hanging on your arm. The ever sent CGM allows you to do that without wasting a sensor because you just take the transmitter off. And then when you're ready to use it again, you pop it back on, maybe you just want to take a shower without rocking a sensor with a bar of soap. Just remove the transmitter and put it back on when you're ready. Ever since cgm.com/juicebox, you really should check it out.

Michael Castagna 26:38
My doctor asked me the same time every time I get how much and LM can you use? And I said, Well, depends what you mean. It depends on if I have a big meal I take a lot. And if I don't I take a little. And he doesn't well, how do you know? And I said, Well, you kind of get to know the product. It's kind of one of those things like you know how to drive and are you going to 60 or 65 or something like you just learned through the process of experience. And what I tell people is if your sugar's at 200, right, you take a four and you're gonna see how much of four drops you know, think about a four is more like two units of injectable. And you know, tennis generally are going to drop you 160 points, which is where you'd be worried about. So a four unit cartridge, you're going to see does x maybe drops you 30 points, maybe jumps to 50 points. And just know if you're trying to bring your sugar's down, you know, a little bit more, you might take an eight and then see what that does to you. You know, I don't worry about what I eat. I was funny. One time we did an FDA commercial and FDA made us take out food in the commercial because they didn't they said people live in diabetes shouldn't be eating pizza or desserts. But our patients do often live their life and they do take their product. And yes, we don't condone that or endorse that behavior. But the reality is, it's about controlling your sugar, and us giving you the tools, whether it's our product and other products to do that. But I always tell people, you know, like, right now the studies we're doing to to your point, Scott, we're given the first dose in the office, because we give you a shake, and then we give you the president, because no one ever sees their sugars come down on the first hour. And all of a sudden, like, Oh, my God, am I gonna go low? Well, no, because it 40 minutes, 45 minutes, the President had a peak effect. within the first hour, even if you went from 190 to 90, you're pretty much you know where you're going to be at that point. Right. And so that's what people don't understand. Even unfortunately, the Dexcom arrows will still show double down, you're like, oh my god, I'm gonna go low. And I say just wait 35 to 45 minutes and see where you are. Now. Yeah, be safe, have something next if you need it. But the reality is just give yourself 30 to 45 minutes to see how the product works. And then, you know from there, you're going to learn within a couple of days. That's what we see within seven days when you live with type one diabetes. Unfortunately, your your doctor, you know exactly what your body does, you know how to respond to various foods. And you're going to see how this drug works relative to your own experience. The area, I'll give you some, for your listeners, I'm sure a lot of people do try this is a lot of people will use it on top of an insulin pump. And then they'll the Bolus are pumped and they're frustrated. And then they'll take a phrase on top of it, or present does its job it brings down your mealtime control. And then all of a sudden that pumped insulin kicks in two hours later and they go low and they want to blame the president and the reality is that Bolus just takes an hour and a half two hours that wasn't our fault. We did our job we cleared out your sugar your pump finally kicked in because you got tired of waiting for it. I just give people caution right we don't recommend using on top of a pump we know people do that. But that's some of the work that I see people often these tell me Mike price was too powerful. I need to tune a cartridge and I said you must be on an insulin pump. How'd you know because don't whoever asked me for two unit cartridges or didn't generally on insulin pumps. So

Scott Benner 29:30
are people so people generally speaking are shooting Basal insulin like Joseba or something like that. And then using a Frezza for meals were to break high blood sugars,

Michael Castagna 29:40
their meals full time meal meal tolerance. So I look at our population today and half of them have type one roughly and half of them have paid to make juice could be on GRPs basil doesn't matter. They're on all kinds of stuff right? And they add Frezza for their mealtime hives and so that's that's one population. And then that's like one population. I See it in our in our data a couple of different ways. We see some people use a Basal full time and present for meals. We see some people use it just for special occasions or stubborn highs. And we some see some people use their pump for their Basal modulation. And then if present on top, we don't have a lot of data on that third scenario of people just using it. Or on top of their pump, we have some studies we've done, but it's very limited data out there. And the data wasn't good or bad. It just showed it works. But don't show it any better than what you're doing.

Scott Benner 30:27
Yeah, would be interesting to see someone like on loop, for example, but not but not for boluses for meals, and then do that, that would probably be interesting to say, Yep, I found myself confused a second ago. So if if somebody's injecting or using a pump right now, and their insulin sensitivity is one unit moves them 50 carbs, then a two unit cartridges of a Frezza moves them how far our

Michael Castagna 30:53
trials that we're doing. Now there's a conversion table and label series taken zero to four, whatever you just the numbers you just came up came up with with, if that said, you're going to take three units of injectable insulin, our label would say change that to a four unit cartridge. If whatever ratio you just did came out the six units of injectable insulin, our label would say convert to an eight unit cartridge, we have the only comes in for age well. And you can add those up in any four unit combination of the 48. And so we've shown up the 48 units, it's linear. And you can add a two fours to stick to eights, two twelves. It doesn't matter. You pick whatever dose you're trying to get at. And it's a two second inhalation and doesn't you know, some people have like 30 seconds on the you don't need to do that. And some of the people may cough or say it's irritating me, you know, it's really a low you don't breathe really hard. It's two kilopascals, which is very low. And you can see four year olds can do it up to eight year olds can do it. And we've shown that device works. People with lung disease, we use our technology and another disease for hypertension, your lungs. And those patients have compromised lungs and interstitial lung disease and they use our same technology, same active ingredient outside of the insulin. I mean, you have to be an active ingredient. Yeah. And so you know, we know that it doesn't take a lot of inhalation effort to get the right dose into the body. Right.

Scott Benner 32:07
So your inhaler has a patent on it, and you use it with other medications as well. Yes. So

Michael Castagna 32:13
we have a patent on FTTP. We are putting on the halo rear panel manufacturing process to all this

Scott Benner 32:20
is all patented, covered. Are you going to get hit with the the orange book problem that are no,

Michael Castagna 32:26
we're protecting these in the 2030s. So I feel pretty good about the next decade, I would say it would cost somebody about $500 million to duplicate our plan. And it'll probably take them seven years and a couple 100 employees to figure it out. Yeah,

Scott Benner 32:40
maybe not worth their while. Yeah,

Michael Castagna 32:43
it'd be very hard. I won't say impossible, because I think engineering can always figure things out. But it'd be very expensive. And I think with the cost of making the product and marketing and probably everything in cost. It's a very tough business. We lost money for 33 years in those past

Scott Benner 32:58
year. And I was talking specifically about just recently, the FTC told some of those GLP manufacturers, you can't patent the injector and to buy an extra, what is it 30 months on your patent? And that whole thing is playing out right now. But I was but you're but it sounds like your inhaler is specifically designed so that it takes a very low amount of effort to draw in is that the idea?

Michael Castagna 33:25
Yeah, and the inhaler is our platform, it's not an off the shelf platform. And people asked me, I said, look, the inhaler, our powers go together, meaning if I took someone else's powder and put it my inhaler may not fly this time, it may not work is good. And if I took another inhaler and put our powder in it, the same thing would happen. It may not work the same menu different dose. So it's not an easy modification, meaning you know, you'd have to learn how to use FTK P and you have to learn how to manufacture at scale.

Scott Benner 33:50
And my question doesn't fit here, then it sounds like your device is very specific for a reason. I think some of those other companies were just like, hey, say the injectors different. So we can hold on to our patent longer. I

Michael Castagna 34:00
haven't worked on biologics, we'd often change buttons, colors, volumes, all kinds of stuff to kind of just, you know, make the patient's body a little bit easier or a little bit clearer. But yeah, you know, the drug is the drug at the end of the day inside the injector.

Scott Benner 34:11
It's fascinating how you don't think about these little things like this is apropos of nothing but I know there was one company that they had an injector but when it was all the way drawn out to give yourself a big injection people's thumbs couldn't reach the plunger. And they didn't realize that till they gave them out to people. And then they were like, Oh my God, and then they had to go back and change. It's just it's so crazy. Some of the stuff that has to happen. The answer here is if you try a Frezza it's going to be a little bit of a science experiment for the first week while you figure it out. And but you're going to but it's interesting because when you're like if it says six the eight cartridges is good, I'm not gonna get low then it's just why

Michael Castagna 34:47
well think about your changing the route of administration. So it's something called the bioavailability of the product and what you really want is to get anytime I go from an injection to a patch or an oral pills to a to an injection, those those has always changed because the body breaks down drugs in different ways. And so when you think about a president, we don't have this first pass metabolism that goes through the liver, we get it in the body, and it's active permanent livers. So that, but you lose some of the product in the in the device, you lose some of the product that you know, through your back of your throat. And so we calculate all that in there. So as long as you're inhaling pretty consistently for yourself, you're gonna find that those the doses are pretty much the same, meaning how you inhale every single day, some people will heal very quickly, some people have long, slow, but that those, your body's gonna figure out the right that this is, this is what works for you. And you're gonna say, Okay, it's typically take this much down or 12. And so the inhalation variability, we actually have a Blue Hill device that's called Blue Hill, and it goes on the back of the inhale, and we show you how to properly inhale in the office. And so that's something we can show technique. If you're struggling a little bit, you think you're not doing it, right. Even our best employees who use the product for five years, we show we take into our lab, and we show them how, like, Oh, I've been inhaling wrong, or I've been healing for too long. And it doesn't really matter to you for too long, it's not going to change the kinetics. But it's really if you go too short, that's why I tell people just two seconds, like as long as you because I've seen that, that's not going to be the right the right way. And then

Scott Benner 36:13
you're getting some of it, not all of it right and up in your mouth and then just gone. It's

Michael Castagna 36:17
gone. It's because insulin doesn't work in the gut, right? So the gut deteriorates. That's why we have another drug that we're doing that if you inhale it, you swallow it, it's gonna have some activity from the part that you swallow, it will have some activity that goes directly into the lung, and of blood. And so that's, that's more complicated drug development than insulin, which generally comes in there.

Scott Benner 36:34
So you said the the inhale, one study is almost finished, or is that your your right to present data,

Michael Castagna 36:40
we have two trials coming out, we started inhale one a couple of years ago, that's in kids. That's why it was one. And then the inhale, three study is an adult. And the reason we did three was its receiver of present and Dexcom. So we're trying to say, hey, here's a free tools you need in health rate. And in that study, we wanted to show that you could safely switch off an ad system or a regular pump, or multiple daily injections. And maintain control was the primary goal to study. And so it wasn't to show that it was better It wasn't to to show a better time and range. The main thing is everyone believes, right that AI D is the best system out there for you as a human being, or your child. And we want to show that you could safely choose an alternative and that doctors should be providing more choice to patients. So we've gone head to head against multiple daily injections in our trials, that's really shown behind what people perceive pumps to be a little bit better. And so that's what we wanted to be able to show that were as good as the standard of care that's out there. Kind of how you define it, you may define as multiple injections, you may define it as an ad system. And so we wanted to show you how you could convert from either process to maintain control and hopefully so

Scott Benner 37:50
what is control mean, what what do you mean, if I asked you what a one C and what variability could I maintain with with the Frezza? Do you have like an answer for that.

Michael Castagna 38:01
So our goal was to maintain a onesie. And we also looked at timing ranges, secondary analysis, so you can see, you know, whether you want it whether your goal is below seven 7.4, I think that's something we do in societies, we say, Oh, you need to be below seven. Well, the reality is 75% of people on insulin are not below seven. They may be personally okay with a 7.5, they may be fine with an 8.5. I've interviewed patients who say, Hey, I like my Starbucks every day. I like my food, and that's my life. And that's my choice. And I have to respect that. Right. And I think that's somewhat challenging from a clinical perspective, when else decide because you gotta get the goal. And you're, and you're failing, if you're not, and I think we don't we don't we got to accept people's choices. And so in this trial, can

Scott Benner 38:41
you give me a second, do you think a person who would categorize themselves like that as, hey, I have an eight, five, but I eat the way I eat? Would they do better with a Frezza?

Michael Castagna 38:49
I think if you dose your insulin properly, you can always do better. And I would say that with injectable insulin or inhaled insulin, right? It's about getting your Basal ratio, right. It's about getting your mealtime coverage, right. And, you know, remember, all you have is a deficiency of insulin, a normal healthy person, right, can eat whatever they want, and their body corrects it. So I just believe you got to just give the right insulin dose and it's harder with injectable insulin because it's less predictable, the further you go out. And that's what makes it harder with a president you just get that little bit more near term predictable. Maybe gotta give a second dose of a big meal two or three hours later, because you see your sugars are still 261 to bring them down to 150. So it just gives you a different tool to rethink about how you define control or how you want to be in control.

Scott Benner 39:33
So would it be fair to say that injectable or insulin through a pump is a game you're playing in like this four to six hour window, but with a Frezza. The window is more like 45 minutes to two hours, two hours. And so if I shorten the window, then I can decide if I need more insulin faster and not be worried about like a late and low later. So it's not necessarily that with a Frezza, I'm gonna see fewer spikes or even less spikes if I'm or less aggressive excursions, if I'm using it incorrectly, it's more about how I can come back at it again and again and again, and the profile short and it comes out of my body quickly.

Michael Castagna 40:18
So we would say our data would show you, if you were to use it at the right dose right up front, you would have lower peaks, your glucose excursions might be 40 to 60, instead of 90 to 100. So we would lower the excursion a lot. And we think those peaks have caused a lot of damage. Right. And so we do think reducing those peaks over time. As you know, we haven't been able to show that in clinical trials, nor have we tried in fairness, but but there's data out there talking about that, right. And so we do know, we work roughly 3040 minutes faster, and you can lower your peaks by 3040 20 points.

Scott Benner 40:51
So I still can Pre-Bolus with the President. I should retiming.

Michael Castagna 40:55
Yeah, I mean, why would you just take when your food comes, because what you're trying to do is suppress your endogenous glucose production. And the faster you can do that, and it doesn't really start to until you start smelling the food and everything right, then it starts producing pickoff.

Scott Benner 41:07
Oh, I see. So putting it in 15 minutes early wouldn't help me. No, you shouldn't do that. No, okay. Because

Michael Castagna 41:13
it works fast, right? So if you don't, then God forbid, you don't need for 15 more minutes, then you're gonna go home, be upset and be really soon as your food shows up. That's the most important part. You don't have to worry about guests hurry. You know, people say, Oh, I missed my, I forgot my insulin in my car or something. You know, as soon as you get back to your car, you get your insulin, you can take it no, it's going to kick in an hour. That's important.

Scott Benner 41:33
I feel like I cut you off earlier. I'm sorry. Like, so what's the what's in a one seat goal? Like in your label? What what do you expect that I

Michael Castagna 41:41
was gonna say is in this trial in particular, and then he'll three we lead 25% of the people in the trial, who had less than a seven a one C, which we've never really studied? The people doing the best, right? And could they maintain that control? versus those that aren't doing well? And can you maintain or improve their control? And so you know, that's this is the first time in one of our trials where we took people that were doing fairly pretty well. And the question was, would they stay there? Would they get worse when they get better? That have results aren't out yet. So I can't say too much. But just know when when people do see the results, we went down as low as 6.5 and 6.0. A once these always high as nine and 10. When I think about those people, the people that probably are nine and 10 aren't taking their insulin. And whether they take inhaled insulin ready to take your pump or they take them. Yeah, they're just not complying in many cases. Right. And when some people just don't have the right dosing, right Basal ratio? Yeah, I think that's another thing to pay attention to is, you know, traditionally, in type one, you're told that the percent your insulin units a day should come from basil and roughly 50% should come from bolusing. I think as we get to a Frezza, because of this higher dose conversion, roughly 70% of your Bolus units are going to come from your, your inhaled insulin 30% company or Basal when you get to your titrate try to get those. So I think that's what we're trying to get give you as goalposts, like, Hey, I was talking to a priest once about us, put on a friend and he was struggling. And I think as basil was, like 10%. And I said, I said, I can't tell you what to do. But I can tell you, your ratio is way off, you should go back and talk to your doctor. Right. And and I think that's, that's important. Well,

Scott Benner 43:12
I make a living telling people that it's timing and amount, this podcast is incredibly popular, because all I say about insulin is that if you use the right amount at the right time, and balance it against the impact of your foods, there's actually almost no reason to see an excursion whatsoever, but it's just a difficult thing to do over and over and over again, it takes a lot of effort. Let me ask you this. And I know it's not a label thing or something that companies but do you know anybody personally using a friend who has anyone seen the fives? Oh, yeah, yeah. Oh, you Okay, all right.

Michael Castagna 43:43
No, but I know that many of our best patients right are 545758 they compete. I always tell people look, the data out there less than seven is, you know, whether you're 6.5 5.5 Don't, don't stress yourself out trying to get the lowest a one C. But but stress yourself out trying to get below seven if you can, because that's where the damage is really occurring.

Scott Benner 44:03
Are there other things you're accomplishing that with you personally? Like? Are you on a low carb diet or something like that? No, no,

Michael Castagna 44:09
I mean, if you saw my lifestyle, right, I eat out a lot for work. I travel I have a Starbucks every morning. And so, you know, when I try to express to people, you know, I have my sugars were way out of control, right? I'm sure I eat a lot differently. But I feel like I have tools in my bag that helped me maintain good control. And so I do not stress over what I eat as much. And so that's that's something that I think a lot of people do stress over what they try and maintain low carb diets. So to say all I can't take that too high of a dose. I've seen our data, I mean, people are coming in to whether it's our arm or the control arm, they're coming into these trials 170 Premium 180 pre meal, you're so far from going low, that you have a long ways to go. So I tell people, right and these are patients come in our trials are out of control. And so I think about that, you know, what are you doing to get your Basal dose right, what are you doing to Get your mealtime dose, right? Because you should be coming into meal at 120 100. And whatever you can think about your postprandial spike, let's say you only go 40 points, you're at 110. Well, you're gonna be time and range all day long, right. And instead what happens is people are 170, they're afraid to go low, and to go on to 290. And two hours later before the insulin kicks in, then a good man to take another call center go on the 60. And then they eat a bunch and they go back up to 190 200. And so you're just this Yo yo, all day long. And it's very frustrating when it's out of whack.

Scott Benner 45:28
I'll never forget the first time somebody came to me and said, Look, you know, my blood sugar's 180? Should I still Pre-Bolus? I said, it's not a Pre-Bolus that one ad, it's a correction. And then you have this conversation, right? And this is how I tell people, I'm like, Look, you know, a person over here without diabetes, they're standing here before lunch, their blood sugar is probably 85, it's probably 90, you're 90 points higher to them asking me Do you think I'll go low? If i Pre-Bolus, 10 minutes before I eat up? Like, you should correct the 180 You should Pre-Bolus your food. And you know, like that you're correcting right now and eating at the same time. It's, it's, I mean, I tell people all the time, like if you if you said to me, You have one minute, you're about to leave the planet, what are you going to tell people with type one diabetes, I'd say it's timing and amount, just use the right amounts on the right time. That's it.

Michael Castagna 46:18
And if you look at a president's profile to a natural human insulin profile, we're the closest insulin out there to what your body naturally done. Right? Now, right, it peaks in 30 to 60 minutes, right, and it's out of your body in two hours. And people don't realize that, you know, most meals are cleared within two hours. And so they think, oh, dinner, lunch breakfast, I just looked at all our data, the doses don't actually change too much by breakfast, lunch, and dinner. In fact, what I always tell our patients is the make sure you get your dose right before you go to bed. Meaning if you have a big dinner and you don't take enough, then you're going to bed at 190 200. Now figure out if you can take a foreign aid, whatever is gonna bring you down closer to 100 while you're sleeping, because within your ticket, those are the 30 before you go to bed an hour later, check it to see where you are. Because if you go to bed normal, you wake up normal, you go to bed, how you're waking up, hi, yeah,

Scott Benner 47:08
especially with yours, because once I go to sleep, it's not like I'm gonna go into hell more. Whereas like my daughter, she's an Iaps. Right? Now she goes to bed high, it's gonna keep working her down overnight, what do I do in a high fat meal situation, do I have to a Frezza, wait two hours and then see that next rise from the fat and hit it again,

Michael Castagna 47:28
I said scientifically, we should do is take whatever dose you thought would cover that, that meal you're taking, and, you know, multiply by two and run now, which is what we're doing our trials. And that should cover the whole meal.

Scott Benner 47:40
So I can put in enough for the carbs and the fat rise in one shot, you could

Michael Castagna 47:46
take it right up front, okay, and you know, make it up. Because normally your body would just release more insulin on that on that bigger meal, right? Sure. And so you would take more insulin up front. And then when you do that, if present has a longer curve, right, the more you take, the higher goes the longer it list. And so you know, for I'll make it up as they all work about the same speed, they come out of your body at different times, right. So for you, it'll be done in about 35 minutes at 12pm Peak effect in 45 minutes, that's out of your body within 180. So if you're going to have this big meal, you're going to be 16 to 20 units a meal. And that's just going to cover you for the full 234 hours. Now I'll say that's the science, the reality as a human is, I'm going to worry the whole time and I'm probably going to underdose. And therefore I just say see, we're sugars aren't one hour, and those again, if you need to, or two hours, okay? And but the bigger dose you give up front, the better, you're going to shut down that endogenous glucose production. And that's what people don't quite understand. Because injected ones that just doesn't do that that fast. But if you can shut down that liver, you're shutting down the signaling pathway that's causing this huge rise, I say and the faster you do that, the better control you have. Because

Scott Benner 48:49
you're working with type twos. Will Will there be us that I'm spending your money over here? But Will there be a study with people using GRPs? I

Michael Castagna 48:57
don't know. I mean, we redirected our focus to type one diabetes. That's why you've seen us in kids with adults, pumps, you know, this is what we're focused on going forward, we are looking to bring your presence to the rest of the population around the world. So we will hopefully be in India by next year, Brazil, and us that's about a third of the world's diabetes population. And then we're gonna be going to Europe, China, and Asia and Australia. So we think that over time, you're gonna see it now be global, which is great for society, the GLP has worked pretty well. And so that doesn't mean that they're not delaying the use of insulin or you still need insulin I do think we're going to see in the long run, but everyone can tolerate GLP or eventually they were and you were talking about long term safety earlier about these things. It's funny because I I I tried to Olympic at one point and I just did not feel well. I started wondering like, Okay, what's the date on these things long term? So I called one of the manufacturers I won't say who? And they said oh, we haven't studied to be on two years. What do you mean you want me to take this for the rest of my life? So what will happen when a person stopped taking and what did they wants to do with their waking go back? We don't have any that they don't people discontinue we only people do. After the trial and followed up, so there is no when we asked me what inhaled insulin I can tell you, we studied it for two years non stop, we looked at I think they only have one year data on this one drug. And I'm like, and so now it's been in the market 10 years. So we feel pretty good about our profile. We're GLP is are still, you know, they've been around 20 years in fairness. Yeah. But using them for long term weight loss. And these other things. I think once

Scott Benner 50:22
they're really popular right now, we're thinking about like, the Stata. Right, right. Exactly the stuff that the you're shooting every day at one point right now it's all a crapshoot, I, I've lost 47 pounds on a GLP in the last 14 months. And thank you fundamentally changed my life. That's fantastic. My daughter's using it, it decreased her. I, my math tells me that my daughter will use 16,000 fewer units of insulin over the next year, because of a small dose of a GLP. Like, that's crazy, right? But I'm just I'm wondering about that. Because as you're talking, I'm thinking, there's obviously is obviously a population for inhaled insulin, like, obviously, and so you're gonna make it available for children. At some point, FDA is gonna say yes, it sounds like and then that's going to be another group of people who can try it. Now we're looking at people who might inject basil, do the inhaled, etc. so on then, but then people are going to hack it along the way. There's already people micro dosing GLP is, and like, so like, you're gonna I just was wondering, like, what happens once you really lower my insulin need, with a GLP, I have Basal insulin running in the background, and then I hit a meal with this, like, it's just, it's gonna be interesting to see what people do with it, and what doctors prescribe it. To

Michael Castagna 51:45
your point, you know, the kids, they don't will, this trial is fully enrolled. So the pace less patient will pull here in September, October timeframe will crunch the data in the fall. So we'll know on pediatrics very shortly. And hopefully, it looks good. And we'll file that with FDA next year, the inhale three results will we'll try to get will debate whether it goes up to now or later to try to change some things in the label around the conversion chart. But otherwise, to your point, you know, our job is to make people aware of the science, the safety and efficacy of the product. And we didn't have much money in the last seven years to fund a lot of that stuff. Now we have, okay, and so that's what I think you'll start to see nothing but new data. Now we got 30, we trial 17 weeks, primary endpoint 30 weeks of follow up coming out next year, you're gonna have keys, which will be a 52 week study and 26 weeks as a primary endpoint. And then we're just approving a gestational study that we'll look at friends use and gestational diabetes, and PK PD and make sure women can inhale properly, their diaphragm and all that you're seeing us invest more as we go forward. And we're not backing down from where we've been. I think this is a useful tool. And to your point. GLP has definitely reduced the need for insulin. But I can tell you looking at the National insulin statistics, the market stopped growing, but it's not shrinking. You know, more people have diabetes in the future, more people need insulin, you always know there's a seven to 10 year delay in type two now, maybe 11, or 12. Who knows? Eventually, we're gonna need insulin for patients. And honestly, if we can lose weight and use less insulin in society better off health wise, we're all federal, right? Yeah.

Scott Benner 53:16
So that's faster. It's fantastic. I appreciate you coming on doing this with me. I really do. I have to jump off. I apologize. I'm short on time, which is not usually what happens because I make a podcast that usually just I'm like I can keep talking. Maybe we can get back together and and learn some more again, I actually have some of your users like lined up this year to be guests. People are very excited to talk about it. So there'll be some of that there. But I really do appreciate you taking the time. Real quickly am I going to see problems getting it covered by my insurance? If I have type one, just

Michael Castagna 53:49
about say a scar? Don't let me leave it I'll talk about access. So generally, if you're type one, you're in a better position, then type two is because the insurance company wants to know you tried and failed their preferred agent. And failed means you could have hypo means you could anyone see could be 7.2. Right? So the failure definition is quite broad. And we've created a program that as long as you go through our pharmacy and reimbursement support, if it's not approved, for whatever reason we charge $99 a month, or $3 a day. So I've tried to take the excess burden off of society and say, people should have access to insulin. We think $3 A day less than a Starbucks these days with inflation is a fair price. Or it can I guess most states, and so that's where we are as a company. That's our position our policy and if anyone has any problems, they can feel free to reach out to me and I'll make sure we take care of them. But we want as many people have access to the product. We will work with insurance companies to make this happen.

Scott Benner 54:40
And it's fantastic. Thank you very much. Thank you

a huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G voc glucagon.com Ford slash Juicebox Podcast spell that GVOKEGLUC AG o n.com. Forward slash juicebox. I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever since cgm.com/juicebox. To learn more about this terrific device, you can head over now and just absorb everything that the website has to offer. And that way you'll know if ever sense feels right for you. Ever since cgm.com/juice box 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 bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC es a registered dietitian 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. The 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. I know that Facebook has a bad reputation. But please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day. It is completely free. And at the very least you can watch other people talk about diabetes, and everybody is welcome type one type two gestational loved ones, everyone is welcome. Go up into the feature tab of the private Facebook group. And there you'll see lists upon lists of all of the management series that are available to you for free in the Juicebox Podcast, becoming a member of that group. I really think it will help you it will at least give you community you'll be able to kind of lurk around see what people are talking about. Pick up some tips and tricks. Maybe you can ask a question or offer some help Juicebox Podcast type one diabetes on Facebook. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com. 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.

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#1240 Weekly News 6/29/24

Diabetes News for 6/29/24

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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 1240 of the Juicebox Podcast

I'm back with another News episode and other type one diabetes informative little what's going on in the world 15 minute podcast episode just for you while you're listening to it, 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. In just a moment, Scotty is going to read you the news. 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 Hey guys, T one D exchange.org/juice box head over there. Now take the survey we're looking for type ones and the caregivers of type ones who are US residents to spend 10 minutes completing the survey to help type one diabetes research T one D exchange.org/juicebox. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. I'm introducing a new advertiser today, hold on one second to learn more.

Your kids mean everything to you, and you do anything for them, especially if they're at risk. So when it comes to type one diabetes, screen it like you mean it because if even just one person in your family has type one, your child is up to 15 times more likely to get it. But just one blood test can help you spot it early. So don't wait. Talk to your doctor about screening. Tap now or visit screened for type one.com To get more info. This episode of The Juicebox Podcast is sponsored by screen it like you mean it.com Everybody seemed to enjoy when I read the news last week and a short episode. So I'm going to do it again this week with a twist. This week I'm going to tell you a little bit about stuff. I've heard a little bit about stuff I've read and we're going to let chat GPT tell us a little bit. Let's start with the old chatter GPT or I asked it for a brief synopsis of some of the latest type one diabetes news and it broke it down into five different areas. First area was vertex pharmaceuticals. Stem cell therapy, says that positive results had been reported from a trial where participants with type one diabetes were able to produce their own insulin following treatment derived from stem cells. And then I said to chat GPT break that down for me with some easy bullet points and it did positive trial results. Vertex pharmaceuticals reported successful outcomes from a stem cell trial for type one, participants in the trial were able to produce significant participants in the trial were able to produce sufficient insulin on their own after receiving the stem cell therapy says that the therapy mechanism is that the treatment involves using stem cells to regenerate insulin producing cells in the pancreas. This therapy offers significant hope for more effective and long term treatments for type one impact on patients. It says the ability to produce insulin independently blah, blah, blah research significance. Yeah, but was this a human trial? Or mice? Let's see if it knows it's looking on the interweb boopity boopity boopity Boop it's looking at clinical trials sense.com. Let's see here the key points recent advancements, I guess of action, safety and tolerability, clinical trial details global expansion. The stem cell therapy VX 880 is currently undergoing a phase one slash to clinical in trial on human so that's cool. Participants in the trial have shown significant improvement with some achieving insulin independence. For example, one patient achieved insulin independence at day 270 With an HPA once they have 5.2 v x eight ad involves the infusion of stem cell derived fully differentiated isolated cells into the hepatic paddock excuse me, portal vein. These cells are designed to restore pancreatic isolate cell function enable glucose responsive insulin production is very cool. You got to ask yourself though, couldn't your autoimmune issue just go get those cells too but sure we're getting to that. They say the therapy has been well tolerated with most adverse events being mild to moderate no serious adverse events related to the treatment have been reported. Clinical Trial details. The trial is multi centered, single arm and open label designed to evaluate the safety and efficacy of VX 880. It includes multiple parts with approximately 17 patients expected to be in one rolled. All right. That's pretty cool. Thank you chat GPT Overlord, that was lovely. Let's go to the next thing it told us about. The FDA has approved land teacher the first donor cell therapy specifically for type one diabetes patients with severe and reoccurring low blood sugar. Clinical trials showed that many participants lived without external insulin for up to five years post therapy that's led tindora has an FDA approval. Let's find out more about that, shall we? I'll say to the Overlord, tell me more about the Latendresse approval. From the very beginning, your kids mean everything to you. That means you do anything for them, especially if they're at risk. So when it comes to type one diabetes, screen it like you mean it because even if just one person in the family has it, your child is up to 15 times more likely to get it to screen it like you mean it. Because type one diabetes can develop at any age. And once you get results, you can get prepared for your child's future. So screen it like you mean it type one starts long before there are symptoms, but one blood test could help you to spot it early, before they need insulin, and could lower the risk of serious complications like diabetic ketoacidosis or DKA. Talk to your doctor about how to screen for type one diabetes, because the more you know, the more you can do. So don't wait. Tap now or visit screened for type one.com. To learn more. Again, that screen for type one.com screen it like you mean it give me some bullet points. Boop boop, boop, boop doesn't make that noise. It's actually very high tech. It's already typing here. Here's some key points about the FDA approval. The tindora is the first ever approved cell therapy for type one diabetes patients with severe and reoccurring but while we already read that, it involves the infusion of ice blood cells from deceased donors into the patient's liver, enabling the production of insulin with the body. In trials 21 of 30 participants did not need insulin for at least one year after receiving the therapy. 11 participants remained insulin dependent independent excuse me for one to five years and 10 participants. For more than five years, five participants required external insulin after the therapy and did not achieve insulin independence. There were serious adverse events including two deaths during the trial, one from multi organ failure and sepsis and another from progressive confusion and global atrophy. These events were associated with unnecessary Amin Oh, immunosuppressant therapy that goes with it. So they're given you the cells but you gotta get the your immune system suppressed. Ah, okay. This is this, this treatment is aimed at patients with a type one diabetes experiencing recurrent severe hyperglycemia and those with hypoglycemia unawareness, making it a crucial option for those who cannot maintain stable glucose levels through current methods into the liver. Okay, so All right, well, this is I mean, it's interesting stuff you don't I mean, it's just I don't think it's ready to be on your Walgreens counter just yet. How about this CRISPR therapeutics and vitae site have received Health Canada approval to begin trials for VCT x 210 and CRISPR edited stem cell therapy aiming to replace insulin production beta cells without the need for immune Oh, suppression. Hold up a second. Let's let let's let him tell me more in bullet points, because Scotty doesn't wanna have to break down a paragraph. Therapy overview VC T X 210 is a CRISPR edited system stem cell therapy designed to replace insulin producing beta cells and patients with type one. The therapy uses CRISPR cast nine gene editing technology to modify stem cells making them capable of evading the immune system and eliminating the need for immuno suppression. Now we're talking Health Canada let's see the clinical trial application has been approved by Health Canada making it the first gene edited therapy for diabetes to approach clinical trials. Hey, Health Canada. Lovely. The mechanism of therapy V CT X to 10 involves editing donor derived stem cells to create insulin producing beta cells that are implement implanted, excuse me into the patient. These cells are engineered to avoid immune detection and destruction. I would like to maybe do that with some other cells too. About the ones can I could we fix people's thyroid? Could we who wait a minute, there's a lot here isn't there? The phase one trial will evaluate the safety tolerability and immune evasion of VCT x 210 and type one patients oh god bless you. I hope this goes well. therapy is a joint effort between CRISPR therapeutics and vitae site via site. Hey, if anybody wants to come on and talk about this, I'd love to hear more about this from one of these entities and I will reach out and see what I can figure out. Hey, this chat GPT tells us what's going on segment is pretty freakin great. And inhaled insulin study the new data presented at the ADL at fourth Scientific Sessions indicates that inhaled insulin are present safe and effective for improving glycemic control and HPA once the levels and type one patients. I'm actually going to have an episode about this with Dr. Blevins coming up in a couple of weeks. You know Dr. Blevins from the GLP episodes, and he's going to be talking to us about Frezza and something else. I don't want to give it everything away right now but stuff is coming. All right. Well, there's

there's the chat GVT effort. diatribe came back with a little little recap of stuff. They heard about pumps. They talked about tide pool being at Ada with their new twist AI D system, which of course is tide pool loop and this new twist pump. That Dexcom stello will be available in August. This is already something we've talked about on the podcast before Dexcom stello. Of course, the CGM is designed to be worn on the back of the arm. Though people with diabetes tend to get creative with placement says the author for up to 15 days and the readings are displayed directly using a smartphone app spokesperson said pricing will be announced closer to the launch date. This is like no. This is for type twos that don't use insulin. You won't need a prescription for this. This will be a walk in and buy thing. By the way. This article was written by Paul Helsel for diatribe. Paul, thank you very much for letting us read your article. What else does Paul say? There's some study results from tandem Medtronic and insolate. At the ADA conference tandem highlighted at small mobi pumps. Citing a recent study conducted by the Barbara Davis Center for diabetes the University of Colorado, which showed time and range improved without an increase in time below range using control IQ. The device integrates with iPhone Babaji 67, Medtronic offered data showing that its mini med seven ADG AI D system reduces sleep interruptions and improve time and range during sleep cool. The system's ability to deliver small bonuses every five minutes company said also helped reduce the dawn phenomenon rate from 12.2% to 4.5. And slightly increased the time and range from 12 to 6am. It's insolate. Excuse me, insula which is Omni pod presented a study at Ada showing its Omnipod five system could benefit people with type two diabetes who use insulin participating participants excuse me who were previously using injections or pump therapy saw improvement, they wouldn't see reduced blood sugar spikes and hyperglycemia. The company said as well, time and range improved by 20%. And overall insulin was used by overall insulin was reduced by 23 units a day. That's really great. Thank you diatribe. Thank you, Paul. Lovely, lovely. Lovely. Like I said, I'm gonna have Dr. Blevins on to talk about a Frezza. And actually, he's gonna come on and talk about some other stuff too. Maybe we'll I don't want to give it away. Again, I look at me, I'm teasing myself. I shouldn't do that. This ain't bad. This is not bad for a little bit of news this week. Hmm. Looks like there are people out there working with stem cells, people working on automated insulin delivery systems to get them working better and to cover more people. Dexcom is going to be helping out with type two diabetes with their new product. So all in all, a good week at Ada. I got a lot of reports back from Ada, my, my people were everywhere telling me the good and the bad and sometimes the ugly. And I'll tell you what made me think maybe I'll go to ADA set up a little booth and do a little Juicebox Podcast thing at the 85th annual EDA. So Scott he's looking into that there's little news for me to you. I don't need other people running around talking about me. I can talk about myself. What else we got here, kids, anything anything else you want to know? Oh, July 2, the juicebox cruise goes on sale. Head into the private Facebook group or the public Facebook page. We are doing a cruise for Juicebox Podcast listeners. You can get all the details there that goes on sale July 2 in the Facebook group. First we want to make sure that everybody who is a Facebook group member has an opportunity to get a cabin before we go wider with the offering. So go check that out. We want to get a bunch of Juicebox Podcast listeners together family, adults, anybody who's interested in coming, be a great five day trip. We're going to make a couple of ports of call in Mexico all the details of the details will be in the post. And there'll be a private Facebook group for people who put down a deposit so you guys can meet each other and really get to know each other before the cruise embarks on June 14 and 2025 I'll add a little bit of my own news. A group of coders have split a branch of IEPs off to something called trio. It's in beta right now. Arden's running it loving the loving the branch very much. If you're a DIY looper and you've ever thought about looking into IEPs I might look at trio instead. For me to you, I think that's worth looking into. Alright, so I guess that's the end of Scott reads the internet today. I wish you were here to say no Scott s this of the chat GPT overlord. But I don't I don't have anything else. Although you know what, hold on. What's that new Canadian insulin that once weekly, we're going to be just seeing if Chechi here is what I'm talking about. We talked about a genuine Yeah, it's called a weekly. I will say again, Novo Nordisk Whoever named it genius. Aw, IQ li a weekly. Health Canada approved a weekly on March 12 2020. Ford is set to become available across Canada starting June 30th. Geez, that's like right now. 2024. Weekly is a Basal insulin designed to be administered once a week. It works through a time release mechanism gradually releasing insulin over the course of a week. Clinical trials included both type one and type two patients, but the therapy is expected to be most beneficial for those with type two diabetes. type one diabetes patients will still require additional fast acting insulin injections at mealtimes. Well, yeah, but that that might just be Chachi Beatty, not quite understanding. I mean, if it's a once weekly Basal, then that's valuable for everybody. The most common side effects included hypoglycemia, and injection site reactions with bruising, pain and swelling that's from Yahoo Finance. A weekly aims to improve glycemic control with fewer injections, potentially increasing adherence to insulin therapy and reducing the risk of diabetes related complications, etc. and so on. Hey, if somebody in Canada ends up using a weekly I'd love for you to come on and tell me about it. That'd be absolutely wonderful. But I guess that's gonna be it for now. I will. I will see you again soon. Let me know if we should keep doing this little news thing. I'm up for this. I like this a lot. But if you guys hate it, like I'm not gonna You don't I mean, send me an email.

Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it to screen it like you mean it. One blood test can spot type one diabetes early. Tap now, talk to a doctor or visit screened for type one.com For more info. 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. 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 to hydration and even trampolines. juicebox podcast.com. Go up in the menu and click on diabetes variables. 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.

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