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Podcast Episodes

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

Filtering by Category: Pre Bolus

#334 Dexcom's Tomas Walker is Back

Scott Benner

Companion show to episode 327

Dexcom's Director of Clinical Projects, Tomas Walker is back to talk about how Dexcom is being used in hospitals during the Covid-19 crisis. Companion show to episode 327.

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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
This is a recent review of the Juicebox Podcast. I am a dietitian working towards taking the diabetes educator exam hopefully at the end of this year. I don't have much experience with type one patients since I work with gestational diabetes, and type two patients most of the time, it has been great for me to hear real life experiences from people living with type one. I love hearing you and Jenny working together on the pro tip series. You guys are doing a great service. Thank you for your work. This episode of The Juicebox Podcast is sponsored by those pro tip episodes. You can find them at diabetes pro tip.com. And they are also available right here in the feed to your podcast. Just search diabetes pro tip. The pro tip episodes as well as the entire podcast are as always 100% free for you to enjoy and listen to

Hello, everyone and welcome to Episode 334 of the Juicebox Podcast. This is a good standalone or this episode can serve as a sidecar to Episode 327 where Dr. disalvo came on, and talked a little bit about how Dexcom is being used during the covid 19 crisis to limit the exposure of healthcare workers to people with type one diabetes, who are also dealing with COVID-19. While I was having that conversation with Dr. disalvo, I started having more nuts and bolts questions about how that was happening. And so Guess who's back? Tomas Walker, dex comms Director of Clinical projects. And he's here to talk a little more in depth about how the CGM is being used in the hospital environment to limit exposure. I thought it was a great little conversation about a half an hour, right? Just fill your mind a little info. And right back on your way. This is another one of the bonus episodes that I'm putting out over the weekend that are ad free. That's right, baby. You ain't gotta hear no ads. Not today. Wait, are you thinking what bonus episodes there was one yesterday with IndyCar driver Charlie Kimball. Please don't forget that nothing you hear on the Juicebox Podcast

should be considered advice, medical or otherwise, please always consult a physician before making changes to your healthcare plan, or becoming bold with insulin. Again, today, there are no advertisers. Why? Because I'm going to take a moment to tell you about diabetes pro tip.com. That's my website. It's absolutely free for anyone to use that calls together, every one of the diabetes pro tip episodes from the Juicebox Podcast all in one place. Now you can of course listen to the show in your podcast player, you can do that forever. But if you really want to get a feeling for how many episodes there are in the pro tip series, or if you'd like to share it with a friend, or countrymen and neighbor, or just some guy who you heard to say like I can't get my a one seater come down, man. And I'd like to have toast with breakfast. Send them to diabetes pro tip calm. Thank you very much. And now Tomas Walker. Honestly, we should just start calling them by one name like Madonna. Or what are some other one named people adult? Why don't keep thinking a women? Kanye? I don't know. Kanye West. Anyway, Tomas.

Tomas Walker 3:29
Thomas, it's nice to speak with you again. Thanks for coming back. I appreciate it. That's good to talk to you again, Scott, I always enjoy talking to you and you're on your podcast. Well, if you don't mean that, I still appreciate you saying and if you do mean, I thank you very much. That's very This is the third or fourth one I've done with you. If I didn't enjoy it, I wouldn't be here. Well, that sort of takes my feeling of of the power I have away you're like, Oh, I wouldn't do it. If it doesn't mean that much to us. Just so you know. Really, I know it takes time out of your day. I really appreciate it. So what happened was I was speaking recently with Dr. disalvo, about how decks coms were being used to help save PP during the COVID-19 problem. And I started having questions that I think were better asked of us. So I got you on the show. I'm glad to be here. Thank you. Happy, happy to help if I can. So I'm interested in I guess the first thing is who approach to about this? How did this begin? Okay, so by it You mean how did we get to the point where hospitals began requesting to use continuous glucose monitoring and an effort to better manage patients, reduce PP, and hopefully reduce this the burden on the health care staff at this time? Is that what we're talking about? Yeah, yeah, yeah, really like who's the person who had the bright idea and reached out? Oh, Dexcom had been in contact with the FDA. We had also been encouraged by some We'll have the healthcare companies we'd work with to make some contact and see if we could open this up. Going into the hospital has always been a long term goal, I think for everyone making continuous glucose monitoring, because there's such a clear need. You know, if a patient ends up on an insulin drip, you're trying to do a finger stick and manage their glucose every 30 to 60 minutes while you're titrating, the insulin drip following some sort of an algorithm. And what really, I think brought it to light was there was a small paper published out of China, I'm sorry, the author's first name, or the author's name eludes me. But it demonstrated that patients with diabetes had a four to 600% increase in mortality associated with COVID. And as we saw the COVID pandemic begin to get a foothold in the US. And back in your neck of the woods. We saw this incredible increase in the amount of people with DK people coming in with hypoglycemic states with no history of diabetes, we have new onset type ones, hyperosmolar crises, truly in numbers we'd never seen before. And I think that was a push on both sides, both us as a company and the FDA, and even on the side of the the frontline health care providers to say, we need to see what we can do to improve the options we have available to care for these patients. Well, it's it's a minute seems simple, right? It seems like such an easy fix. You don't want to go into the room with somebody and this helps not but how do you? How do you fix the problem of using the share and follow if What if the person who's in crisis doesn't have a phone? What How did you guys handle that? Yeah, so that actually, that actually took us a little bit to think about and what we ended up doing, and I think we've come up with a good solution that's helped a lot of people is we worked with a medical device company whose specialty was provisioning phones, for medical devices, which you know, the, the smartphone was not part of our life at all 10 years ago, and now you can't do anything without it. And it has been adapted and adopted into many clinical trial settings. So there are a few small companies whose entire program is built around creating phones as medical devices. So what Dexcom did was reach out to one of these companies, and request the provisioning of several thousand Android phones, which are preloaded with dexcom apps, including share and follow in Gen six, they already have Wi Fi on them. They're preloaded with a data plan. And we made those phones available to the self health systems that wanted to use them, to give them a data pathway to you share and follow to offer some remote access. And we're doing this for free. We're donating these phones on request to the hospital. It's lovely. How many hospitals is happening in Do you know, or how many patients? Right?

Unknown Speaker 7:55
Yeah, it's well over 100 hospitals right now. And the number of patients is in the dozens of patients not counting providing the hundreds of patients yet, but it's being adopted rapidly. And we're seeing hospitals using both the the Android phone devices, as well as the dexcom dedicated receivers to manage the data remotely. Because remember, that transmitter has got a Bluetooth radio, we've got a range of about six meters, about 20 feet there, where we can receive the data from a ways away. So can actually put the receiver outside the room or against the window of the room and be able to monitor that patient's glucose without having to have close contact with them. That's brilliant. How do you find out about new patients is, is there a red? Like, I don't know how that would happen. Like, how does the hospital even know that I have someone with type one I should contact ex con or vice versa? Yeah, yeah. So there, it's really helped if there's a champion inside the hospital. And as we've seen this rolled out, one of the things that I've really been able to see make a difference is when one of the intensivists, or one of the endocrinologist on staff says, You know what, we can use this technology, we can use it to help manage care. And we can make the difference with it. But it does take a champion. And what one of the hospitals has actually done is they've actually created a CGM referral service inside their COVID management team. So they're, they're actually putting their COVID patients with diabetes on separate units. And then they're creating this referral where they they send in the nurse practitioner, or the physician's assistant or the diabetes educator to start to CGM to get the system's going to keep the staff familiar with the data and to take advantage of that share and follow and be able to aggressively manage this patients without direct contact. Do you think this experience will serve as a pilot for the idea of getting the Dexcom into hospitals so that every time a person with Type One Diabetes is brought in for any reason that this can happen for them? I think it's probably too early. To say that because we're still, you know, we're still learning. And, you know, one of the guys who trained me a long time ago, like around 40 pounds ago, told me that there's a couple things you need to know in life, you need to really care about what you do, and you need to know what you don't know. And we don't know yet. I think that the initial impressions are really good that this is being well appreciated by clinicians and nursing staff. And CGM really can make a difference, you know, the kind of the parallel I like to drive when I was still in practice. And a few years ago, when CGM was much more novel to patients. And you first put a patient on a CGM, and they could see their glucose value, and they could see the trend. And they can see what the insulin they took did, and how much that bowl of mac and cheese really raised their sugar. And it was like, This light turned on. And we're seeing that exact same scenario with hospitalist, and intensivist. Realizing that it's not just about the glucose now, it's about how I got here and where I'm going. And once you cross that bridge, you know you're across the Rubicon there. But you don't want to go back, you see the value with Britain's I don't think it can be under valued, to be honest with you just for people in that situation. Because I've known people who have gone to the hospital with Type One Diabetes, my daughter's one of them. I've had close friends, and they get into a situation where, you know, they start worrying in the, you know, the hospitals keeping their blood sugar too high, they're worried about them getting a low, you know, they're not treating for meals until, you know, significantly after they've eaten. I've seen it slow people's recoveries down as a matter of fact, and I just I'm excited that they can see it all the sudden it seems like the beginning of something to me, at least. You know, and I think it's opened the door to a lot of discussions because there were a lot of hospitals that didn't have policies about patients showing up with their own CGM. You know, they probably had a hospital policy about an insulin pump, you know, if I show up with my pump, can I keep my pump looks like Well, yes, here's the policy. And now they're looking at this going, gosh, if the patient's coming in with this technology, if we're using this technology, we really need to think farther down the road. It's not just about now where's about where we're going? As we look at managing the COVID, the COVID issues and the hyperglycemia. And we know we'd all love to see this thing go away. But the reality is we're going to be dealing with it for many more months.

Scott Benner 12:29
Yeah, there's upticks, right now in places like think like Nebraska, and you know, just where you wouldn't expect, I think there's, you know, these places that were more rural more off the coasts. And now, there's, I was hearing about this one town that, you know, a large, I think 10% of the population of the town works inside of this one place. And now all of a sudden, 700 of the thousand people that work there are positive, that those people are going to go home to their families, and it's going to, it's going to start there, you know, these little wildfires are gonna are gonna keep popping up until, you know, and we don't know until when right like, is it? Are you looking for a vaccine? Are you hoping we're gonna get some sort of herd immunity? Eventually, you don't know what it's going to be? Exactly. So this, I guess, could go on for a while.

Unknown Speaker 13:15
Again, it's a list of things we don't know. And the answer is now or to try to provide the best options we can, and the best care available for patients that we can today, because we know their clients see their glycemic management in hospitals isn't always great. You pointed that out yourself. And if we can put one more tool on the table there to improve the outcome, to save a bad day and ICU to get that patient out the door alive and faster. We should do it. It's a big deal. It really is. So

Scott Benner 13:44
here's my question. Now, I come into the hospital, I have type one, I've got COVID-19. The hospital says, Well, you're in luck, because we're gonna put a glucose monitor on you. Now all the sudden, for the first time in my life, I see the impact of my food and how my insulin works. And then, you know, good luck comes my way. And five days, 10 days later, I'm leaving the hospital and I'm completely healthy. COVID is gone. But my Dexcom stays behind. Right. How does that happen? That That seems like those people would want to take that with them. Does that an issue?

Unknown Speaker 14:19
So it hasn't been an issue that's been discussed by patients that I've heard. But I've had discussions with clinicians who are looking at actively implementing these programs, because one of the things we have seen his, you know, new onset Type One Diabetes associated with COVID. And there have been a couple of small studies that have looked at this that we should start CGM at the time of diagnosis. And, you know, I would imagine looking looking at your own family. It's like, Can you imagine getting diagnosed today and not asking for a CGM. So I think we're going to see this driving an uptake in the outpatient world also, as more people become aware of this technology, still kind of shocking to me sometimes that when you Look across the large data sets. Looking at the population, like the Type One Diabetes exchange, the uptake of CGM is still somewhere in the 30 to 40% range.

Unknown Speaker 15:11
What do you think? What do you think the reasoning is behind that?

Unknown Speaker 15:16
You know, medicine is is a very slow beast to turn. And it, it is still some adoption on the part of clinicians. It's still some adoption on the part of patients. I don't think sometimes people realize all the benefits they can get from CGM. And it all boils down to what I was saying earlier, that aha moment when you can look at your glucose but understand that this is not a static system. Yeah. This is a system that is constantly changing.

Scott Benner 15:43
No, I, I think about it always pops into my head, because I've had a DVR for so long. If you try to explain to somebody years ago, there's this thing that will record television for you. They say, Yeah, I have it. You know, it's, it's, it's called a VCR. And you're like, No, no, no, trust me, that's not that it's this thing. And you can't explain to somebody in a minute why they need it. But once they have it, my goodness, they know forever, right? They know why. And they're and they don't want to give it back. And so it just it is one of those things, like once you have it, there's no way you would want to give it back again. I don't know I feel good that people are seeing it. I want them to be able to keep them afterwards. Because you start really feeling like I mean, you know, we've been making some little adjustments with Arden's insulin over the past three or four days. And I have to pull it up for you because it's it's there are adjustments that could not have been made without the dexcom data. last three days ardens estimated a one c five or standard deviation 25 or average blood sugar 97. wakes up at 102 goes to bed at 72 has been in range for the past 14 and a half hours. And for clarity amazing margins range is 70 to 120. So you know and and I'm telling you I've I've managed diabetes without a CGM, and I'm not that good at it.

Unknown Speaker 17:11
But with

Unknown Speaker 17:12
with one I am it's too hard to do it with just snapshots. I mean, when you get the full when you get the full High Definition movie, it changes the entire experience. Yeah. And we're see we're seeing that, with the anecdotal reports coming in from the hospital experience. people calling and saying just we never would have been able to do this without this. Yeah, there was one particularly great story I heard from a hospitalist in New York City, who had gotten a call on a woman who came in and DK with a history of type one diabetes. And they had not been on CGM, they got on CGM, and they were able to aggressively manage or DK and avoided having to intubate her, which, you know, in the hospital environment today, intubation is a necessity. And it's also a known risk. There's no there's no, no certainty you're going to get that to about again, ever.

Unknown Speaker 18:07
Sadly, true. Yeah.

Unknown Speaker 18:08
You said something earlier, I want to make sure I heard you correctly. There's people are being diagnosed with type one, as they have COVID. Yeah, this has been kind of one of the strange things we've seen. And there's a few people looking at this, that there seems to be a slight increase in new diagnosis of diabetes associated with covid. We've seen type people come in with no previous history of type two diabetes with horrible hyperglycemia people come in with no history of type one diabetes, clearly in decay. It's been kind of an interesting experience. And it wasn't really reported. And a lot of the Chinese data that's been reported on the early experience with COVID. So there's a lot of people looking at this right now, there have been a couple of small papers published on this already. And I expect we'll see quite a few more in the near term.

Scott Benner 18:58
Yeah, I mean, it. Listen, my daughter had, I forget her hand foot mouth, right before she was diagnosed. And I say that out loud. 100 people are going to come back and tell me, oh, my kid had that right before their diagnosis as well. And I think everyone knows that, you know, some sort of stressors on the body can take a person who's already got the markers and sort of push them over the edge a little bit. This would clearly qualify as, you know, a stressful on the body. So it didn't it didn't surprise me. I just was interested that people are looking at it already. So there, I guess that's another thing. It's in its infancy.

Tomas Walker 19:33
Yeah, there's been some interesting reports on this coming. All anecdotal still, but people are starting to try to gather the data and see if there's a pattern. You know, you're correct that that's the stressor of the illness on the body can unmask this? But the question is, is this virus specifically doing something that is causing this or is it just such an aggressive virus, that the overspeed stress simply becomes overwhelming?

Scott Benner 19:59
Yeah. That's it. That's a that's definitely worth looking into. I'm glad somebody is paying attention to it. I have to say that this is really cool. I think it is because I look, I'm working as hard as I can over here to tell people about what CGM is do. But I can't reach everybody and I talk all the time about, I would love it if the things that I know and the people listening to this understand about managing insulin, if that was coming from the top down, how much more quickly that that information would spread through the population of people with type one. I'm thinking about the amazing outcomes they'd have, and a lot of the struggles that they would avoid. Some of them lifelong, or, you know, feel lifelong after a few months, in a few years. So I think anything that gets the knowledge of what Dexcom does into medical people's brains, so that they can really ruminate on it and think about it. I'm sorry, this is the way it had to happen. But I am really pleased that it's happening. So it's very kind of you guys to do I know it's you said it's a few dozen people, maybe less than 100. It's still a I would think an expense.

Unknown Speaker 21:09
It's actually the number of patients who use CGM in the hospital under the under the current guidance. There's it's over 100 it's more than 100 facilities are actively involved with us. And more coming on all the time.

Unknown Speaker 21:21
Oh, I see.

Unknown Speaker 21:22
And it's growing. It's not it hasn't plateaued for you? Oh, gosh, no. Like, I know, every morning I get up, and I kind of cringe when I open my mailbox for the first time. My email

Scott Benner 21:36
is and this is a it's being used as the device no differently than if someone puts a pulse ox machine on someone. There's a company that makes that Pulse ox the cup and the hospital the body. In this scenario, you guys are donating the equipment. But it's being used like that, like you're not this isn't a study that's being done or anything like that at the moment.

Unknown Speaker 21:55
No, there are several studies that have started up, you know, under a time of challenges like this, many hospitals are in many picky academic hospitals are going to start up Institutional Review Board approved studies, to get this data to see what they can do to make an impact on the outcome. And the resource utilization, in large part knowing. So what we discussed earlier that there's going to be more waves of this coming, we are going to face this for a while and the country. And it is not been limited to just the larger institutions and just Institutional Review Board approved clinical trials. I am seeing this in 50 bed rural hospitals, they're coming to us looking to see how this technology can be used to major metropolitan medical centers on both coasts and across across the Midlands. It's growing very quickly. And people are recognizing the value. And there is a change in thinking that has to occur with this. And I mean, if you think back to your experience with Arden before CGM, and then you got introduced to this technology, with probably a small degree of apprehension at least is this really going to make it better is just going to be one more thing I have to manage every day. And then to the realization of how it can change. We're somewhere in the middle of there. And if people are still evolving their understanding of how best to use this technology, and I don't think we're gonna have that answer overnight, right? Hey, listen, I know we have a short amount of time and I wanted to be sure to ask you, when the device makes it to someone in a hospital? What's the training like for the staff? How do they How do they get brought up to speed to use the device? Yeah, so the Dexcom, we have a group of people, a group of trainers that have been stood up to assist with this process. And as they come in and request access to the systems to be used in their hospital, we make an effort to set up a training and follow up with the secondary training if needed, and then go back and touch base and make sure that they're, they're getting the results they need. Or if they have questions, we've tried to make a fairly comprehensive approach to this. So once someone comes to us, we have a pathway where we can put them into it and help them and stay in contact with them. Yeah. And I think there's too, I was wondering, is it is it a nuts and bolts training? Like this is how it goes on? This is how you, you know how it, you know, this is how you use it? Or is it how to interpret data as well? how deeply Do you go with them? Depends on the facility. If you have ability that's extremely comfortable with the CGM as, as some of them are, then it's really more about how do we deploy this and how do we get the data into the hands of the clinicians. And then you have others that are that are understand the technology but they need a little more a little more basic training and then step through the processes of of using the data. I haven't had anybody who didn't get it, it just took a little while sometimes for people to understand the the the potential of the data, right impacts the quality of care they're offering.

Scott Benner 24:58
Yeah, it's all very fascinating. You know the difference between being able to, you know, because at first glance, you know CGM to a lot of people, even consumer says, Oh, well, this thing will beep if I get low, you know, and then you start really seeing what you could be doing with the information, you think, Oh, well, there's more here I could, I could put my insulin in at a different time and really make an impact on a spike, or, you know, I could I could cut my bazel away, or maybe we could take some, you know, take some insulin away here to stop below. Like when those things start becoming apparent. It's it's very exciting. I wasn't sure if you were telling them about that idea in the beginning, or letting them sort of come to you with the ideas of Look what I'm seeing, and am I am I seeing what I think I'm saying?

Unknown Speaker 25:42
No, we make sure to touch on that early on that they understand that this data can be beneficial to understand how they're managing the patient. And, you know, it's kind of Telecom, like this got in a lot of hospitals. If you're not in ICU, you're on medical surgery or telemetry, your insulin dosing might be adjusted once a day. Yeah, based on the last 24 hours of finger sticks, though they got four finger six in the last 24 hours. The hospitalist comes around, makes rounds and adjustments and walks off. And now with the ability to look at the CGM tracings, they're able to make insulin adjustments are considerations of how to manage that diabetes 234 times a day. That's an exponential improvement in the ability to manage a patient by providing that much more information. That's me, I wonder, I wonder how long it'll be before. Hospitals think, well, when we have a person with type one in here, let's put a closed system on like, let's put you know, the horizon when it comes out, let's put the control IQ on them and let the machine do a lot of the work. I mean, there are machines doing tons of work for people in hospitals. I don't know why that wouldn't be one of them in the future. Maybe that's the beginning of this really. You know, there's a lot of things being kicked around. And I I had a great conversation with a young intensive as to said that now that I've seen this, I don't know how we're ever going to go back. Yeah, because it completely changes our ability to manage a patient with poorly controlled diabetes. It's the difference between sitting through a commercial and pushing one button and jumping through it, Tomas. That's what it is.

Unknown Speaker 27:19
You are that you are the TiVo of the diabetes world.

Unknown Speaker 27:24
I'm not sure that the comp plan, I don't think it's gonna fit on a T shirt.

Unknown Speaker 27:26
That was amazing. By the way, Tomas, if you've never used it, it is it is far and away better than any of the other DVRs on the planet. In my my humble opinion. I know where I know, we have to go. I really appreciate you doing this. Is there anything I didn't touch on that I should have? No, I appreciate the chance to come on and talk to you for a minute. You know, it's a time of incredible challenges to the health care system. And Dexcom is really trying to help improve patient care, reduce the use of personal protective exposure equipment, to improve the ability of a health care provider to manage a critically ill patient. And it's really an exciting time. And it's really a challenging time for all of us. And I think we just need to keep pushing forward to learn the lessons we can and try to improve everyone's care. I appreciate that very much. I really don't listen at some point in the future. I have questions about it. He's in G seven, all kinds of stuff. You'll come back on when when the time is more appropriate. If you if you if you would I'd really I'd love to. Excellent. All right. Well, thanks so much. Get back to work. You know, I need sensors to come by going anywhere. here that pyloric isn't going away.

Unknown Speaker 28:37
Thanks, taker.

Scott Benner 28:41
Huge thanks to Tomas for coming back and explaining to me how the dexcom g six is being used in a hospital setting to help keep people safe. And I'm gonna thank myself here, right. I mean, I made diabetes protip.com. And it's sponsoring the episode technically, like not really sponsoring because I it's not like I sent myself $1 and I was like, Hey, could you put an ad for my website on your podcast? Can you imagine if I started having a conversation like that with myself? I'd be strange. What I have to pay taxes on that. If I handed myself $1 and then I took the dollar Hmm. Diabetes pro tip.com. It's where you'll find every episode from my diabetes pro tip series. In one place. It's incredibly shareable and reusable right there at diabetes pro tips calm. Check out me and Jenny Smith, CDE and T one day discussing every one of the tools and ideas around insulin management that are talked about here in the podcast,

Unknown Speaker 29:43
telephone.

Unknown Speaker 29:46
And of course, while this episode was not sponsored by anyone, there are sponsors for the show Dexcom on the pod touched by type one and the Contour Next One blood glucose meter. I stand behind all four Have those entities and there are links in your show notes or Juicebox podcast.com. If you'd like to find out more


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#333 Indy Car Driver Charlie Kimball Returns

Scott Benner

IndyCar is back!

Charlie Kimball is back to talk about what he's doing during the Covid-19 crisis and how he's preparing for the upcoming Indy Car race season. You can do anything with type 1 diabetes!

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You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - PandoraSpotify - Amazon AlexaGoogle Podcasts - iHeart Radio -  Radio Public or their favorite podcast app.

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+ Click for EPISODE TRANSCRIPT


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

Scott Benner 0:02
Hello and welcome to Episode 333 of the Juicebox Podcast. Today's show is with Charlie Kimball IndyCar driver and type one diabetic. Charlie was first on the show five years ago. Lately I've been finding myself thinking about some of the early guests from the show and wanting to catch back up with them. And in my imagination, I couldn't decide what an IndyCar driver does during Coronavirus. What's he doing right now. And the things Charlie told me about how he's prepping for the upcoming racing season didn't surprise me, this is a hard working guy. Okay, I have something to share with you before the show starts. But before I share that, I of course have to tell you that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan are becoming bold with insulin. This is about the time I usually tell you that this episode of The Juicebox Podcast is sponsored by and then I tell you about on the pod Dexcom touched by type one, and of course the Contour Next One blood glucose meter today. Today, they don't have ads on the show. Today, I want to take just a moment to tell you about something that I've been doing that I think will help you or maybe help someone you know.

longtime listeners know that the podcast is a mix of conversations with people living with Type One Diabetes. Sometimes they have on CEOs of big type one type. Sometimes I have on CEOs of large diabetes based companies, smaller upcoming companies, people come on sometimes and talk about pumps and glucose monitors, but they also talk about glucagon. And you know the type one diabetes exchange, I tried to give you a good mix of content. But at the core of this podcast, it's always sort of been about how I use insulin and how my daughter uses it and the results that she's had. So back in February of 2019, you know that Jenny Smith came on and started doing the diabetes pro tip series with me. And it really built into a quite a nice resource. So Episode 210 is for the newly diagnosed you're starting over then to 11 goes on about MDI. And then before you know it, there's discussions about insulin Pre-Bolus and Temp Basal insulin pumping using your CGM bumping and nudging. We talked about what the perfect bolus is and variables that could get in the way of your desired outcomes. There's a specific episode about setting up your basal insulin about exercising how fat and protein impacts your blood sugar, what to do when you're ill injured or having a surgery, how glucagon works, what to do if you end up in an emergency room. And the last one that was just put out in March of 2020, is about considering your long term health. The problem is because it's in a podcast, you know, it comes out once in a while this week, then not again for three weeks. And it's hard for some people to find. So I started diabetes pro tip.com. And it's just a place where you can go and listen to all of those episodes. And I still get credit for the downloads, just like if you were to listen to your app. But more importantly, if you've ever found yourself in a situation where you wanted to re examine one of those episodes, go back and listen again, or share it with a friend. It's now incredibly easy to do. So today's show is sponsored by me. And I'd like you to know about diabetes pro tip.com. Because I believe that it is a resource that everyone using insulin could benefit from. It's of course, absolutely free. Anyone can go use it. All the episodes are with me. And Jenny Smith, who of course is a CD, a registered dietician. She's a type one diabetic for over 30 years, and just a really incredibly smart person when it comes to managing diabetes. Now if you've never heard one of the diabetes pro tip episodes here on the Juicebox Podcast, you may be interested to hear some listener reviews. This one's from Marty and Marty says the pro tip series is filled with such great information. Thank you. For someone who has been living with Type One Diabetes for 30 years. I wish I had been more proactive in finding this information sooner. I'm going to recommend this to my endocrinologist in 1971 said my son was diagnosed with Type One Diabetes about five months ago. I have learned so much from just the protip shows and will be listening to all of the episodes. And type one Tara said this podcast has changed my life. I had a desire to lower my agency and manage my blood sugar's better, but was going at it blindly finding this podcast put everything into a tangible impractical management approach that has taken my agency from 8.3 to 6.3, in less than six months. And that's just right now, it's going to keep coming down. So whether you're the parent of a newly diagnosed child, or an adult who's been living with Type One Diabetes for decades, the diabetes pro tip episodes from the Juicebox Podcast, I think, can help you make a significant and lasting change to your health and your psychological well being. spend less time thinking about diabetes, more time eating the foods that you want, and understanding how to use the insulin that those foods require. That's it. Diabetes, pro tip.com. And now IndyCar driver. Charlie Kimball, we're recording I'm sorry, but I'm laughing because you're you were doing what last week instead of driving a race car.

Charlie Kimball 5:56
It's fairly a typical, but Saturday night, my buddy runs a local trivia company. And he's gone from hosting trivia in restaurants and local establishments to virtual. So he's been doing running games through a YouTube stream and an online form submission to do these trivia games and has gotten some local companies to sponsor Him and do prizes. And he and I came up with an idea to do an Indy 500 trivia game. Saturday night, he we co hosted it sorted out some really cool co streaming on his private YouTube page. And people paid for an entry and Part A large part of the proceeds went to support charity. That's an IU Health Foundation, which supports the the Medical Center at the racetrack. We were the original date for a fundraiser called rev that they call it igniting the month of May at the Indianapolis Motor Speedway was last Saturday night. And it supports that same foundation. So we were looking for a way to talk about end talk about the 500 in the month of May and still be able to do some good charity work as we went along.

Scott Benner 7:16
Yeah, right. Keep people busy too. Everybody needs something to do. Well tell me where would we be in this in the season right now if all this wasn't going on.

Charlie Kimball 7:25
So typically, starting the month of May, we would be four races into the the 17 race calendar. We would have started the season middle of March and St. Pete Florida, gone to the Long Beach Grand Prix race at Circuit of the Americas in Austin, as well as Barbara Motorsports Park in Alabama. And this coming weekend would be the Indianapolis Grand Prix, the same race you came to a couple years ago. Right and coming out of the Indy GP. Next week, we would start practice for the Indy 500 qualify attempt to qualify the following weekend. And then the weekend after that Memorial Day weekend. Sunday. I think it's may 24. This year would have been 100 and fourth running of the Indy 500. Well,

Scott Benner 8:14
is there are there any plans right now for how to move forward or is everything on hold.

Charlie Kimball 8:20
Now the IndyCar Series has plans the Indianapolis Motor Speedway has taken the largely unprecedented step in these unprecedented times to reschedule the Indianapolis 500 for August. So August 23 will be the current plan for the hundred and third running 100 and fourth running excuse me at 500. The same timeline leading up to the race weekend with qualifying the weekend before practice the week before that. The Indianapolis Grand Prix, again, unprecedented we are running a double header with the NASCAR Brickyard 400 weekend. That's July 4. So the plan is to have the Annapolis Grand Prix at the Indianapolis Motor Speedway on July 4. In collaboration with the NASCAR's Brickyard 400 event,

Scott Benner 9:13
does that quick succession change the? I'm not sure exactly. So for anybody listening, Oh, I got to watch Charlie drive a couple of years ago, and it was the first time I'd ever seen an IndyCar race at all. It's, it's amazing. It makes you walk away and wonder why anyone would do it. Because it's going very quickly. It's hard to put into words if you've only ever seen it on television, but there's these missiles that are constantly flying past you. But what I'm wondering is, are there rules in place about equipment, cars, tires? Do those rules relax or change? Or do they need to because the races are going to be more stacked up? Does anything like that change

Charlie Kimball 9:56
completely. They've had to re invent evaluate all of those situations. The I talked to somebody in IndyCar recently. And he said, we want to be spending our time, whatever race weekends we have available, going racing and putting on shows, however, that looks rather than going to test days and practice days. And because we have a few less races and some less miles, our amount of the amount of engines we're going to use this year are adjusting the amount of tires we're using are going to adjust. And I think the track time might actually reduce a little bit a similar amount of races, because they've added a couple of double headers. So we will have a full race Saturday, go to bed Saturday night, the mechanics will re prep the cars come back Sunday and have another full race on Sunday. Which means that it's kind of a twofer. The fans that get to come out to the racetrack for Laguna Seca in September, depending on what that looks like. We'll get to see a full race Saturday, and a full race Sunday as well.

Scott Benner 11:09
double feature. That's exactly uncommon. I was wondering, are you able to get into a car right now? Like do you have track time? I guess you could social distance and drive a car but or is that not happening at all.

Charlie Kimball 11:23
It's not happening at all the the way the rules and the way they've adjusted the season. Any testing any on track is not happening. The plan, we got a couple of practice days before the start of the season. But the plan is at the moment, for the first race of the schedule at Texas Motor Speedway to be the first time that any of us are back on track. I think the the way different states are working and in IndyCar teams are largely based in Indiana. But there are teams in Illinois, in Ohio, in North Carolina and in Florida and Texas. And so the way those teams are able to get back to work and start prepping the cars. It sounds like are going to start opening up this week, next week into the end of next week with different protocols as far as the amount of people allowed in the shop based on square footage, right? And who can work from home will continue to do that. But those that need to be in there touching the race car will be with some updated cleaning and sanitation.

Scott Benner 12:38
So how do you stay in practice them? There's no simulator for driving, right? Like a flight simulator. You can't put yourself into a that doesn't exist. Am I right? So how do you

Charlie Kimball 12:47
there are some very high end simulators. In fact, Chevrolet that powers my Indy car has a great simulator, we find it extremely effective, we I will go and drive my sit in the cockpit. It's the exact same chassis that I race on the track. And that cockpit moves like it does on the racetrack. And I get out of the car at the end of the day feeling like I've done a practice day at the racetrack. But we're able to get through a lot more engineering changes because it's quicker to change a computer than it is to say change a gearbox or a differential or suspension parts or wings, that sort of thing. So we're able to work through a lot and we find that validates what happens in the simulator to the real world. But with travel restrictions, I haven't been to the simulator yet this year, I think I will plan to before the first race but honestly most of the prep I've been doing has been my Sora normal training, working from home doing doing interviews and calls with my engineers with my healthcare team sort of tied up telemedicine, working with my trainer remotely and setting up a gym in my garage so I can continue my fitness work so that I'm ready to go physically when we get back to the racetrack.

Scott Benner 14:17
My son plays college baseball, he's missing his he missed his sophomore spring. They got about 10 games before this happened and he's taking his finals right now from home. And he said to me, because we don't have gym equipment here. He said when my finals are done, would you mind if I went out in the backyard and just took a sledgehammer and tried to dig a hole with it? And I said I guess if you do it behind the shed it's fine. Yeah. But um, but he's he's that last for you know, I mean we're on the field but I can only throw them so much soft toss. It's not playing baseball. You know, you only have so many catches and do long toss so many times it it doesn't really mimic it and what you're doing is so it's You know, it's just such an intense thing and it made me wonder in the simulator when you have been in it, does it impact your blood sugar for like anxiety and adrenaline like a race does or does your brain cognitively know you're not in a race?

Charlie Kimball 15:14
There is? It's a great question really interesting. I'm not sure that I see the same impact in my blood glucose numbers. I still wear, obviously wear my continuous glucose monitor when I'm in the simulator, just like I do when I'm in the race car. And being able to see that effect. There is definitely adrenaline. But there's also the physicality I think, both of those impacts the adrenaline bump and the physicality wear off or lower, so to speak, that I see in the racecar, I think get happens in the simulator at just a reduced intensity. Okay. So it really is very similar to as a good simulator should be it. It's a great simulation of what happens in the real world, blood glucose and health wise and on track and driving wise and you're still shooting insulin, right? You're MDI correct. I am injecting insulin. And I think some some of my friends might look at me sideways. If If I said that I was shooting everything. So

Unknown Speaker 16:23
you know, parents, I do

Charlie Kimball 16:25
inject insulin, multiple daily injections, right? And I've, over the years, I've sort of evolved which insulins I've been using. I think the nice thing for me, at least being partnered with Novo Nordisk for over 12 years now is the ability to keep up with those insulin developments. And I'm using tresiba and fiasco on multiple daily injections to keep up with my blood sugar's Yeah,

Scott Benner 16:54
I have to say that it within the community and the people I speak to who are MDI, when we talk about long acting insulin, TriCity, but appears to me to be the one that people talk about. Every time I don't I I so don't know what the other one is. Because I don't hear it mimic back to me and my daughter uses a pump. So we're not we're not using it, but I can't hear anything but great stuff about it, especially what they talk about is how it it has coverage for far greater than 24 hours how it kind of overlaps itself. People love that.

Charlie Kimball 17:27
And if I can, I think if I remember correctly, the the numbers that I remember reading and I think it may even be in the package insert. I'm not 100% sure on that. But if you've been taking it for eight days, it can last in your body up to 42 hours. And it's right because I actually ran the number 42 on my IndyCar at the Indy 500.

Scott Benner 17:53
Because of that,

Charlie Kimball 17:54
because of the the duration of action. Plus I got to borrow it from at that time I was driving for Chip Ganassi racing my Chip Ganassi racing teammate. The their NASCAR car number was 42, as well. So there was the there were these really cool parallels and we had 42 names of people, either the developers of the molecule of Trey Seba or, and family members of mine supporters, my health care team, other people within the diabetes community on the racecar that year, which was a lot of fun.

Scott Benner 18:28
I wonder if people know how rigorous it is to drive the car because, you know, you're saying something earlier, and I didn't quite finish my thought about it, but you're getting an adrenaline boost, but there's still activity, they're fighting with each other. And so, if you were just doing that physicality, without the adrenaline you might see a lower blood sugar. And if you had the adrenaline without the physicality, you'd see a higher one. It's just, it's an interesting balance, how those two things are both working against you. And yet they're, they're helping to balance each other out. It's a, I don't know how much people think about that when they talk about activity and diabetes.

Charlie Kimball 19:03
I'm the son of an engineer, my dad's mechanical engineering and design racecars. So that's how I got involved in and I have such a linear mind. I, I mean, diabetes sometimes frustrates me because in engineering and in math, one plus one always equals two. In diabetes, sometimes one plus one equals banana. It doesn't always make sense. But the perspective that I use the analogy is that there's this this old school balance scale, and on one side, there are certain things that raise blood sugar, dehydration, adrenalin, carbohydrates, illness, and on the other side, there are things that lower blood sugar, exercise, insulin, hydration, things, you know, things like that. And so, it to me, it's interesting that in the race car. I've got things on both sides of the balance scale in play.

Scott Benner 20:04
Yeah. No, you hear people talk about, especially a lot with their children. They don't understand why. For instance, baseball practice doesn't make their kids blood sugar up at a baseball game does until you realize that without the actual competition of the game, you don't have the adrenaline. It's just that and it wouldn't to the naked eye, make a difference? You're playing baseball, it makes sense that they, you know, both situations would be the same, but they're not. Have you made a baby since the last time I saw, by the way, before I asked you that? Do you know you were on the 25th episode of this podcast? And if this shakes out, right, this episode is going to be the 300 and 25th episode of the podcast. So I have to thank you for lending me some gravitas in the beginning when I didn't deserve any. Because I was just starting out when when you're on the first time and the podcast is blown up. It's going to hit 2 million downloads very soon. So

Charlie Kimball 20:54
I appreciate that. That's incredible. Congratulations. Thank you. A lot of hard work and amazing and I'm I feel honored to have been there early on. and honored to now be back on talking about how life has changed. And and you were I think you're gonna say life has changed, right? Yes, very much. So. And outside of this global pandemic, life has changed. My wife and I have actually welcomed two very healthy children into our lives. And ever since we spoke, we have a toddler, a little girl. And then two months ago, just about the time I was heading to St. Pete for the first race of the 2020 season, we welcomed a healthy baby boy into our lives. So while the work from home situation and not being at a racetrack isn't quite how I envisioned these last two months, it's been an unintended unexpected and much appreciated. Slight paternity leave, it's been chaos, because two kids under the age of two, with a newborn, and being stuck at home is extremely challenging sometimes. But at the same time, I would never give back this time with my family. And as far as silver linings go, it's pretty special.

Scott Benner 22:21
We have the same feeling here. And I'm sure a lot of people who are lucky enough to be able to do their job from their home or you know, or in your situation where your job just sort of been slid into a different time frame. But I as sad as I am for my son to have missed out on what he missed out on this year. It's so great that he's here. I try not even to tell him but you know, he's 20 he shouldn't be here right now. And instead he's walking through the house and we're having conversations about things we wouldn't normally have. It's been really wonderful. Hey, the good news for you is your your new son was born early enough that next year, you will not have to endure a ton of pandemic baby jokes, people will see that he's a little older, and they won't think that you made him out of boredom during this time.

Charlie Kimball 23:01
Very true. I mean, it's you. It's interesting because you obviously work from home, typically, right. And while I think a lot of people would see that my job at the racetrack is the only time I work as a racing driver. It's not actually the case, as a racing driver driving the race car being at the racetrack is only about 15 or 20% of my life as a racing driver. The rest, I'm working from home, or working at home, headed to the gym or working with my engineers, my mechanics, developing strategies with my partners doing media obligations, things like that. So while it it looks different, and not going to the racetrack is something that's been an adjustment for sure. working from home for me is kind of normal, setting up the garage in the gym and, and finding that if I filled a five gallon bucket with sand and water to the right level, I could have a heavy enough weight to do the work I needed. That's new instead of going into my gym. But being at my desk and working from home is kind of normal, managing my blood sugar while eating at home and figuring out what activities and exercise look like stuck at home is more normal for me then I think a lot of people would expect

Scott Benner 24:34
Well, you know what you might find? bizarre, but maybe you want my daughter's 15 she'll be 16 this summer. She's a sophomore in high school. And normally her overnight bazel rate is around a unit and her daytime basal rate is closer to two units. And when school ended, she got home and she became acclimated with working from home. Her 24 hour basal rate went down to a unit an hour. So what ever happens at school? I don't want to, you know, say it's anxiety or stress, because I don't honestly know what it is exactly. But something about being at school requires her bazel to be almost doubled. And really,

Charlie Kimball 25:13
it's, it's really interesting to me because my, I haven't seen a significant change in my dosage calculations. Because I've been, like I said, I've been trying to keep my workouts up and still working virtually and digitally with my trainer and my gym. And now that the weather's getting a little bit better, we're in May, we're taking my wife and I are taking our kids out for walks around the neighborhood, we put them in the the wagon and go for a walk and, and enjoy being outside as much as we can safely and socially distant.

Scott Benner 25:55
Do you find yourself walking in an oval? Or do you just go wherever the wind takes you?

Charlie Kimball 25:59
Well, that's the nice thing about the IndyCar Series is at different races, we turn both left and right. So I have the ability to create my own little street circuit through the neighborhood with

Scott Benner 26:10
the wagon chose the driver does not feel forced to just try to turn one way. I, I have to say I was it was really nice to meet you in person. And, you know, I, I wonder if I want to ask how tall you are? Would you share that with me?

Charlie Kimball 26:25
I am about 510, depending on the day and the weight of the world between 510 and 511.

Scott Benner 26:30
So that's incredibly interesting to me, because you're not much taller than me. But when I'm standing next to you, I feel like you're a different species. And I'm three feet tall. So you're just in incredible shape. I stand there and I go, how are we both men? That's bizarre. And but but my point was, is I was wondering, is there a height limit to being in that car? Like, could you be an amazing driver but be too tall Ford? or could they build a car to accommodate different heights?

Charlie Kimball 26:55
The answer is yes, there are height limits on both sides. Because if you're too small, if you're built like a jockey, wonderful for racing horses, not wonderful for holding on to 650 700 800 horses, and no power steering and an IndyCar if you're not big enough to hold on to the car and get in a force through the brake pedal, and through the steering wheel over the bumps and things like that. You won't be competitive. And if you're too tall, you when you're wedged into the cockpit, you never get comfortable. So you never get relaxed to feel all of the information and all the messages that the car is telling you more than what's happening in your hands and your feet. You get messages through your shoulders and your back and your legs. That if you're you're wedged in there if you you're shoehorned in there, you never get comfortable and are never very good at it. I there was there are really competitive drivers, as Graham Ray Hall, I think is the tallest at the moment. And he's six foot 364 maybe. And he's our he's pushing the the upper limit of the height required or height, height opportunity in the IndyCar. So,

Scott Benner 28:17
hey, you know, I know we went over this before, but it was five years ago. I'm wondering do you still manage your blood sugar's in race the same way? like can you see your blood sugar in front of you? How does it work with the pit crew? It just would be interesting if you could, I know we're up on our time. But I'd love to hear about that. Before we go.

Charlie Kimball 28:32
I've got a couple extra minutes especially to talk about this because I think over the last few years, I've continued to evolve how I interpret the data that I get. So my tip starting at the beginning my IndyCar is different than everyone else's, because obviously my body is different, my pancreas is different. I wear a continuous glucose monitor, my receiver plugs into the car's data system. So on my steering wheel, I have speed laptime oil pressure, blood glucose, water temperature, car and body data right there together. And the cool thing is not only can I see that number in that data, but it's transmitted back to the pit lane. So the engineers that are making sure the cars running right underneath me can make sure that my body's running right. If I get I have my hands full racing side by side for at 225 miles an hour. And the nice thing about that is I know where I am, I know where I am on within that lane of blood glucose I like to see during competition and most IndyCar drivers have a drink bottle to stay hydrated throughout the event. My car again is different in that I have to drink bottles, one full of water. And the second one we use a sports drink with extra glucose in it. So it's about it's pretty intense. I think it's about 30 grams of carbs. For six fluid ounces, so it's a, it packs a punch, so to speak. And those two bottles come together at a valve that my dad the engineer designed, we got 3d printed, and it mounts right on my seat belt. So while I'm racing, depending on what my body needs either water for hydration, or that drink mix for glucose, I can switch that Valve back and forth to to bring my blood sugar's up if needed. Because even though the adrenaline of racing is intense, I find the physicality, I'm more conscious of my blood sugar burning off during a race. And that's having said that, I'm sorry, I've never needed that drink mix to keep going during an event that comes down to the preparation I do before I get in the car.

Scott Benner 30:49
So even though you have that available to you, you've never had to hit that that drink while you're driving because of how well you've got your, I guess your pre meal rituals and your insulin, all that stuff set up?

Charlie Kimball 31:00
Yes, wow. That's what I'm saying. And I feel very fortunate that I have the tools and the routine and the discipline before I get in the cockpit to not need that backup plan. It's there as a backup plan. And if I needed it, I would be very grateful to have it. But I'm glad that the work that I do with my healthcare team. I work with Dr. Anne Peters at USC medical in California, and working with my race team to make sure that I've got the right meal that's weighed carb and protein counted before the race. So that just like the mechanics spend hours making sure every nut and bolt is tight, and every fluid water fuel oil is topped up, making sure the racecar is prepared. My job is to make sure that my body is prepared. One of the things in sports is we talk about the evolution of the athlete and in racing. And in IndyCar the cars have almost reached a limit. And I'm not going to say the limit of physics but the limit of the rules. And so one of the easy ways to find a competitive advantage is within the drivers in the athletes. So we as athletes have had to learn about our bodies, we've had to learn about how to train we've had to learn about cognitive function preparation and doing I hand coordination work in the gym. And that's part of why I've continued to evolve and learn from the data that I'm getting out of the race car, and learn about the insulins that are available, so that I'm continuing to progress as a patient. And as an athlete.

Scott Benner 32:45
It's funny you bring that up because as I was thinking about you this morning, before I did this, I was thinking about how seamless the race looks. And in my mind, it started thinking about how easy it looks to hit a you know, a fat Major League fastball when you're watching it on television, or, you know, a wide receiver drops the ball, I can't believe you didn't catch that. Meanwhile, he just ran 70 yards and three seconds. And you know, there's a man behind him smacking him in the head. And but you know, but the people who don't do it, it just looks like the way it's supposed to be if we could get in a time machine and go back, we'd watch Babe Ruth and think this is the pinnacle of what baseball is. But if but athletes continue to get better and better and stronger. If you look at what a baseball player looked like 20 years ago versus today. They don't even appear to be the same people. And and that's probably, you know, I you know, as you were saying, and I thought while I was right, I couldn't believe I was right as I guess why I brought it up. But it's just amazing to watch those cars, how close they are. They're moving, almost like they're attached to each other, you know, through turns and everything. And that's just it's astonishing to see in person. I don't know if I ever appreciated it on television.

Charlie Kimball 33:55
I find that I find that if we have friends or people come out to the racetrack for the first time. A lot of my friends actually said Oh, we'll come to a race and support you. And now their race fan. Yeah, I mean, they they tune in and are paying a lot of close attention. And I think one of the things actually going back a little bit that I missed about the the setup in my car that's different is all of that work was part of that evolution. You know, part every time I get in the car I learn. And those pieces were developed in combination with IndyCar, under IndyCar medical and safety. And with my health care team, and with my exercise physiologist, and with my trainer and being able to look back at the data of my performance and my my diabetes management performance and and start to develop ties and information about how that all plays together. Is it more than levels the playing field of the mental piece of managing my diabetes? I think in fact, I've said it before. And I'll say it again, I am a better racing driver, because of my diabetes rather than despite it.

Scott Benner 35:16
The preparation is for diabetes. It's all very similar. I was wondering, and I will let you go. But what range do you try to race? And like, when you look up at that Dexcom number? Where do you hope to be?

Charlie Kimball 35:27
My aim? Originally, years ago, 10 years ago, when I started in IndyCar, we used to Dr. Peters, and I would say, Oh, we just want to be above 190, to make sure I'm safe. Well, as I've learned, as I've gotten better, as I've gotten more confident in my control, Indy cars got more confident with me as a racing driver with diabetes, we've narrowed that window down based on performance as well as safety. And that that ideal range for me is in that 150 to 175. Number. Yeah, which is higher than I would be on a normal day, right. But it allows that blood sugar to climb before I see vision, focus concentration challenges, and allows it to fall. And I'm not worried about putting myself or the other drivers on the track at risk. It's a really healthy middle road, middle ground, middle of the road number

Scott Benner 36:27
low enough where your body can still perform the way you need it to. When you pit

Charlie Kimball 36:31
Have you ever taken insulin? Like Have you ever been like I need fast but I come in? Not during a pitstop in a race now. It's not something that's like I said, the one place where I noticed the adrenaline you were talking earlier about baseball between practice and races, right. And one of the comments I wanted to make quickly was that the Indy 500 is the largest one day attended sporting event in the world. I see a because it's so big. It's the biggest race in the world. In my mind, I see a bigger bump of adrenaline at the start of that race than any other event I go to Yeah. And 5060 miles into the 500 miles, that adrenaline settles in and my blood sugar, I have a 20 or 30 point bump. And I know that 50 or 60 miles in it's gonna settle back down to where it was.

Scott Benner 37:28
That's the interesting thing about paying about adrenaline is that while it's there, it's very impactful on your blood sugar with the minute it's gone. It doesn't hold the number it you it comes back again. Makes it indeed Yeah. That's very interesting. Charlie, I genuinely appreciate you coming back and doing this. And I hope you and your family are safe and washing your hands and congratulations on your new son. A lots going on for you except for racing. So let's get you back into those cars and and watch this happen as fast and safely as possible.

Charlie Kimball 37:59
Absolutely, I appreciate it, Scott. And I think if people I mean I've said it before, but I always appreciate now is it a two time dad a great dad joke, but if people want to keep up to speed with me, they can follow me on twitter at race with insulin as well. You know when you said earlier, one plus one equals banana with diabetes. I thought one plus one often equals

Scott Benner 38:19
I need to eat a banana with diabetes. But give it give that time where you add Instagram Twitter where you at?

Charlie Kimball 38:28
So on twitter at race with insulin on Instagram at Charlie Kimball. My Websites Charlie kimball.com. And for other information about the race with insulin program, there's race with insulin.com as well. I'll put that in the show notes too, so people can click on it if they'd like. Thanks again and have a great day. You too. Thanks, Scott. hicker.

Scott Benner 38:49
Huge thanks to Charlie for coming on the show. Hey, listen, Charlie is a paid spokesperson for Novo Nordisk I think you can figure that out because the words fiasco Pinterest CBRE all over his IndyCar. But this was not paid episode. They didn't sponsor this or anything. I just like Charlie and I wanted to have him back on. If you want to support the show today, go to diabetes pro tip COMM And check out the pro tip series that I did with the CDE Jenny Smith. If you've already checked out the pro tip series, and you know how valuable it is. share it with a friend. Thanks so much. I hope you enjoyed this bonus episode of the podcast. There'll be another one tomorrow with Tomas from Dexcom you guys I'm giving away so much this weekend. I'm crazy. It's like one of those a guy comes on he's like we're selling the furniture. It's like so cheap. It was so fucking and then the guy's like he got like plaid pants on and he starts talking about the prices are insane. So I'm just like, I don't know, I've got so much content like I hate sitting on it for so long. So this weekend, you getting free shows, no ads, the listen to good content, really. I'm benevolent when you stop and think about it. If this episode was sponsored, it would be sponsored by Omni pod Dexcom touched by type one, and the Contour Next One blood glucose meter. And I only mentioned that because they're right good people. And there are still links in the show notes, your podcast player, if you know you mean, what's it, it's, I don't wanna lose the opportunity to remind you that if you click on the links, it helps the podcast, not just you, I mean, it's gonna help you immensely, you're gonna get a first rate CGM, the only tubeless insulin pump that anybody with any sense would wear the best blood glucose meter I've ever used in my entire life and a link to possibly the most lovely Type One Diabetes organization on the face of the planet. So I mean, yes, it helps me when you click on the links, but by helps me. Here's what I really mean by that. It means that when the time comes again for us, they say, shake hands and say, Would you like to sponsor the podcast again for another year? And they say yes, that lets me keep making the podcast. You know, these people did not sponsor diabetes pro tip calm, but they're why it exists there. Why I have the time to do it. So I guess you can look at it anyway you want. Support the sponsors? support the show, where they used to say on that hero show, remember that the first like comic book TV show was a save the homeless. Heroes save. I can't remember. Save the cheerleader, save the world. So think about that. And then just take out the word cheerleader. Right, and the word save. And then what you say is support instead of save support the sponsors instead of cheerleader so instead of save the cheerleaders support the sponsors. And then instead of save the world, it's support the podcast. So save the cheerleader save the world. I think that's clear. And there's no way you can come to the conclusion that I've been locked in this house for too long.


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#332 The Wright Stuff

Scott Benner

A Whole New World

Pietro is the first type 1 diabetic pilot to hold a 1st class medical certification from the Federal Aviation Administration. This is how he got it.

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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
Nothing but blue skies and tail winds from now. Hello, everybody. Welcome to Episode 332 of the Juicebox Podcast. Today I'll be speaking with Pietro, the first type one in the country hold a first class medical license given by the FAA, the Federal Aviation Administration, pitcher can fly whatever plane he wants. Now, Type One Diabetes be damned. This episode of The Juicebox Podcast is sponsored by Dexcom and Omni pod, you can go to dexcom.com Ford slash juice box, where my omnipod.com Ford slash juice box to find out more about the sponsors. On the pod, we'll even send you a free no obligation demo right to your home. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. You're gonna like this.

Pietro Marsala 1:15
Hi, everybody. My name is Pietro Marsala. And I am the first insulin treated diabetic pilot to be certified for a FAA first class medical

Scott Benner 1:36
pitcher. That's the that's the nice part. We'll get to that in a second. You and I know each other through Instagram, is that right?

Pietro Marsala 1:42
That's correct. Yeah, we've we followed each other for quite some time. And we've spoke a few times the direct messenger and it's been nice. It absolutely

Scott Benner 1:50
has and you shared a photo one time of you in a plane, like with your Dexcom graph, I think. Yeah, that was you. I used to use that in, um, in live events by boy.

Pietro Marsala 2:02
Oh, did you hear me? Let me know.

Scott Benner 2:04
Yeah. Like, yeah, I'm right on top of that, by the way. made me look interesting. You know, because somebody who's listening to the podcast and I'm playing my confusion is then you were you were in it felt like you were flying the plane. Were you not flying the plane, then?

Pietro Marsala 2:20
Yeah, so one of the pictures I think I sent you way back was just a picture, we were sitting at cruise on like 10,000 feet going to San Diego. And you can kind of set your your headset up depending on what kind of headset you have in aviation, some of them have the ability, or Bluetooth. And when the air traffic control speak to us, it blocks out whatever you're listening to, if you're listening to something on your on your Bluetooth, and immediately it turns the attention to what we're doing. And in that case, we were just sitting in cruise, there's not much going on, had your podcast downloaded. So I was listening to it a little bit. And there we went. And so then I sent you that I sent you that picture. I was listening to it at 10,000 feet. And it's not the same as listening to at home. So I couldn't do it long. But it was I was pretty cool about their podcasts open listen to kind of how, how you've how you go about your podcasts and how it's kind of changed my life in a way, as well as many other aspects of like Dexcom in different things and how they've, they've kind of influenced me to be bold and like you talk about and so yeah, I sent you that picture i thought was pretty cool. I really appreciate it. I

Scott Benner 3:27
thought it was amazing, honestly. And so I was right. You had control of the plane. So you had a pilot's license them, but that's different now, right? There's so let's kind of go backwards a little bit. Let me find out. How old were you when you were diagnosed?

Pietro Marsala 3:44
Um, so I was diagnosed. Let's see. I was diagnosed back in January 2012. With type two diabetes.

Scott Benner 3:53
How long did it take them to figure out you had type one.

Pietro Marsala 3:56
So it's kind of weird. So I went to had all the classic symptoms, right? The we always talk about, I'm not going to bore you with those. But most people this this podcast know what those are. So I was diagnosed in 2012 in January, and it took me about 10 or 11 months until they correctly diagnosed me with type one because I went to go see an endocrinologist after you know, the oral medication wasn't stabilizing me. And so we went to go see this endocrinologist and he looked at me and he said, You don't fit the bill of a type two patient. Have they run this test? And you know, I forgot what test it was if it was a C peptide peptide, what it was, yeah. Yeah. And so they ran that test, and then they confirmed it was Type One Diabetes at that point in November, I believe is November 2012. And in January 2012, I was diagnosed with Type two November 2012 was diagnosed with type one.

Scott Benner 4:45
Okay. So basically, around 2013 you knew you had type one diabetes, and I've taken a pen and a pencil just down I've written down 2020 to 100. I wrote 2013 and then I did some subtraction, and I figured out that was about seven years ago. That's the Right. Yeah, that's about right. How old were you then?

Pietro Marsala 5:02
I was what? 21 years old. I was 21. I was diagnosed at 21.

Scott Benner 5:07
Okay. So were you a pilot then?

Pietro Marsala 5:11
Yeah, so it was interesting. So I had, I was in the middle of my flight training, when, when I was diagnosed, I was in January 2012, was working on my commercial certificate, because my goal had always been to be an airline pilot. And in January 2012, I was diagnosed with it. And so I went to go see a doctor, like I said, and he diagnosed me with type two diabetes, and kind of long story short, it was obviously a really hard day for me. But I was just excited as a 21 year old to know that, hey, you know, it's not the worst thing in life. You know, if I've got to manage my blood sugar, I could stay fit. And I could just exercise and diet and keep me in a safe range, then I could return to to the flight deck. And, you know, I looked on the FAA website at the time, and it said that if you're a type two diabetic, and you don't require insulin, that you could still carry what's called a first class medical certificate. And for those of you out there that don't know what a first class medical certificate is, is, it allows you to fly for an airline here in the United States. So as pilots, we carry both pilot certificates and medical certificates, and I was working on my pilot's certificate to be qualified for the airline. Well, in the middle of that I got diagnosed with diabetes, and that kind of threw a wrench in it, and didn't allow me to carry a first class anymore. With type two diabetes, I worked hard. I got my first class medical back about six months after that, because the FAA requires you to stabilize on the medication. And so I worked hard at it, I dieted I exercise, I got off the insulin and maintained my blood sugar on Metformin. At the time, I was taking the medication, and the FAA was fine with that. So they gave me my first class medical back well, only to take it away again, after about three or four months after that point. When I got diagnosed officially with type one diabetes, and obviously, as many of you know that it requires insulin on type one, and so that was probably harder than the original diagnosis of type two, because at that point, I had done my homework and my research on what, you know, what it what it takes to carry a first class medical, and I knew that insulin at the time was a disqualifying drug. And so that was that was just the hardest, probably the hardest day, my life to this day.

Scott Benner 7:14
Hey, can I ask you a question in the time between the type two and type one diagnosis where you're working so hard? To get stable? You know, I guess, for the lack of a better term? Do you think you were so focused on that stability? The Is that why it took longer for you to find out you had type one, like what I'm interested in what takes the time to figure out I really don't have type two diabetes.

Pietro Marsala 7:37
Yeah, so it was just weird, because, you know, I got on the insulin, and my agency was in attendance at the time, when I first got diagnosed, obviously, not knowing that I had it. And they told me I needed to be I think it was like below 9% to carry a third class medical to fly, like for fun, and you know, to be inflamed structure and whatnot. And so I was just, I started working at that I started working out like crazy. You know, I was watching what I ate, I ate basically, like zero carb, zero, carb was impossible, but very, very low carb, very, very low carb at the time I was because I was on Metformin, I wanted to get off insulin, and I was figuring out pretty quickly that the less insulin you take, the less risk you have for hypoglycemia. And so I started with this whole low carb thing I was, you know, dieting, I was exercising a lot. And, and so, as I was doing that, you know, it's life was, I'm not gonna say easy, but it got easier. I started, you know, pricking my finger, you know, 10 times a day, times a day, whatever I was doing, and it took me took me about, you know, a good six months, it was it was a good estimate for the FAA to say, hey, you need to stabilize for six months until I figured out you know, kind of how the Metformin works. And, you know, when you know, how the, how the low fields or the high fields and kind of get the symptoms of what it feels like to be in each range. I didn't have a CGM at the time when I was when I was a type two patient or what I thought it was a type two patient, right. And so I was just managing with finger six. And, you know, it took me it took me a good six months to stabilize, I was doing everything that I possibly could to maintain that blood sugar, and I felt confident in the ability to maintain it on that form. And while every morning I'd wake up and as many type two patients do, I think before breakfast, the first thing they do is they tested blood sugar they fingerprick right. And so I was seeing a rise in blood sugar, I would see like, you know, 95 and that would be crazy. Okay, cool. I'm below 100. Sweet. And then I would see 110 and 120 and 130 as the days went on, and I'm like, What the heck is going on? And I knew nothing about what a honeymoon phase man I was so uneducated about the whole thing when I was 21. Right. Um, and so yeah, so then that's when my mom was like, I think we should go for a second opinion and see an endocrinologist and see what he tells you. And of course, at first I didn't want to do it. So I was scared of, you know, what was to come if it was possibly type one. And he comes he looks at me and like I said, he told me I didn't fit the bill and ran a test and confirmed it was type one.

Scott Benner 9:49
It's interesting. You didn't fit the bill. Did he mean visually at first or through tests? Yes. Yeah. It's weird because you could, I mean, I know what you look like and you're a fit young guy and all but you Could have type two diabetes? It's not. Yeah, and wouldn't be my question.

Pietro Marsala 10:04
Yeah, exactly. And so and he, you know, he looked at me was you don't fit the bill. And I was like, confused by that. I don't know what you mean. I mean, yeah, I played soccer my whole life. And I consider myself a fairly fit person. And so yeah, I was confused. I was like, how is this possible? You know, I didn't know that, you know, type two, or the difference between type one and type two. And I just thought that people in general that had diabetes were unfortunately people that didn't take the best care of themselves. Well, obviously didn't, didn't know better. Yeah. And so yeah, so he diagnosed me with type one, and I had to go on insulin immediately. And I kept before he ran a test, I kept telling him like, it was gonna change his mind or something. He had some magic potion. You know, when I took the lab, lab test that he would, it would change his mind. And I kept telling him, you know, my endocrinologist, and I'm still with the same endocrinologist today. He's a great guy. But he kept I kept telling him, Hey, you know, I'm a pilot, I can't, you know, I can't be on insulin. They don't let me fly with insulin. And he's like, well, let's, let's get you healthy first, before you worry about, you know, what's next. Let's let's, let's take it one step at a time. And so you diagnose me and just crush my dreams, everything I had dreamed up since I was a kid, of becoming a pilot, while I was a pilot already, but I was a private pilot. And, you know, becoming a commercial pilot. And living this dream was just, everything just was just thrown so hard for me. Yeah,

Scott Benner 11:13
trashy bow juice. Listen, I want to understand if you were, you know, at that time, if this type two thing didn't happen in 2012, and then type one in 2013? At what point do you think you would have been able to achieve becoming a commercial pilot? Like what year? Do you think that that would have started for you as a as a, you know, a way to make money? And, you know, career?

Pietro Marsala 11:36
Yeah, good. Good question. So, um, so with type, like, like I said, so you're saying if I was if I was when I got diagnosed with type one, when I got diagnosed, I never got type two? No, no,

Scott Benner 11:47
I'm wondering if it never happened at all. Like, what what post were you on?

Pietro Marsala 11:52
Okay, so yeah, so I would have finished, I started in January 2012, my commercial certificate training. And I would have been done with that probably by March. At the latest, I finished it in two months, and I went back to school, but I probably would have taken me initially two to three months to finish that off. But the thing is, is that just because you become a commercial pilot, and you're certified, that doesn't mean that anybody's gonna hire you. Because the regulations, the way they're written is that you have to build flight time. Okay, so you have to have 1500 hours of flight time experience. So it would have taken me a few years to build that time. And so I would have been diagnosed sooner rather than later, eventually, I would have got to the point where I needed insulin, and I would have stopped eventually.

Scott Benner 12:30
But in a world where diabetes didn't exist, you'd probably would have taken three years or so to build up your flight time. And then you kind of put yourself out there and start looking for jobs. And so there's a whole process in there. But But what I'm getting at is because that didn't happen. How did you shift your ideas about how you were going to, you know, feed yourself like, what, what happened to your goals? Yeah, and

Pietro Marsala 12:54
so so the way for most,

I want to say the majority of pilots that go through school, a lot of times, there's multiple ways you can build time to get to that 1500 dollars. For me, it was I chose the flight instructor route. And I was able to be a flight instructor on insulin because it only required a third class medical, there's three different certifications of medicals, there's first, second, and third, or third being the lowest and first being the highest first for commercial pilots to exercise their privileges in an airline. And third, to do small stuff, like fly for fun and become a flight instructor. So in my eyes, I was like, Okay, you know what, I'm going to take the flight instructor out, because it beats sitting in a cubicle. And so I'm like, I'm gonna, I'm gonna go, I'm going to become a flight instructor, I'm gonna build my time, because that's originally what I had planned to do anyway, to get to my my airline job. Right, right. And so what I did was I built time as a flight instructor. And I kind of just stuck in an industry I've built, built experience and moved up in the company. And I'm pretty fortunate they take good care of me. And it's been a great company to work for. And so I'm really fortunate because they played a crucial part in this whole thing, too. And as I get telling the story, it'll all make sense. But they played this part where I was able to show proof that I'm stable in flight, because again, most people on insulin that have a certificate medical certificate from the FAA, they don't fly for a living like I do. A lot of them, you know, flight instructors, they typically don't make a huge amount of money. And so they you know, most people don't choose this life in this career. If you get diagnosed in the middle of your training, a lot of people just say, okay, you know, I'll fly for fun. And I'll kind of drop it on the professional side. But I continued, because this is all I ever knew, you know, since I was a kid, I was flying flight simulators. And so I decided, no, I'm just gonna stick in aviation. This is what I love to do. Unless I'm in an airplane. It's not commercial aviation, like I want to do, but at least I'm flying trucking and teaching other people how to fly and live their dreams. Yeah.

Scott Benner 14:39
Hey, listen, in the time before, obviously, before things have shifted recently, and now you're able to have that that first class medical license, but prior to that when you were doing the flight instruction, when you get into a plane with somebody who's looking for instruction, do you have to tell them you have type one prior? Did you have to look at them go Hey, listen, I use insulin. Here are the things that are out Or was that private?

Pietro Marsala 15:02
No, no. I mean, we had a test our blood sugar and flight and tune. So most people asked like, what is that? I've used using a continuous glucose monitor as well, g six. And so it didn't require fingerstick testing. But you know, I test as well. And they would see that and I obviously they would, he would ask a few questions, I would just tell me, I'm a type one diabetic. This is kind of what I have to do to maintain myself in flight. And most people were kind of embarrassed to ask any further questions, I just kind of explained to them that this is kind of what I have to do, and they didn't really, really dig too deep. We're

Scott Benner 15:32
looking forward, we're up in the air in a tin can and pay attention to what we're doing. Because I do understand, you've heard me with other pilots on here, I don't understand the concept of wanting to leave the ground and control that thing. I get partial airliner under protest, I'm a good flier. I don't you know, I'm not on the plane constantly thinking, well, this is the end of my life. But I don't you. The other day, I thought about getting a drone, and I thought if I got a drone, I'd fly it up in there. And it would come right back down. I crashed into the ground, I have no spatial awareness. Like when things start changing, like the idea of a gimbal just fries my mind, you know? So I don't understand at all. If somebody started talking to me while I was teaching them how to fly be like, please look straight ahead.

Pietro Marsala 16:15
Please stop talking. Yeah, I'll be fine. Oh, it's funny, because we train a company at work for we train, airline cadets, so future airline pilots from all over the world. And a lot of these guys in the beginning you have and gals in the beginning, you have to tell them. Because when we talk, our mics are linked up. And so we don't have to look at each other's speak. Obviously, we can hear each other on our headset. Yeah. And so a lot of them out of respect, because they're from different parts of the world. And especially in the Asian culture. It's, it's, it's a thing where they want you they like to look at you in the face, which is respectful, obviously, but not when you're flying an airplane. And a lot of times we have to tell these guys, hey, you know, we can talk by looking straight ahead. When I ask you a question. Don't look at me keep flying. But we all know

Scott Benner 16:53
someone we drive with who says, oh, you're like your brother. Listen, please. Just look over there. You can hear me Don't Yeah, no, no, I hear that. So yeah, you know, obviously, we're kind of talking around a little bit, but you work for one of the major companies, I'm assuming.

Pietro Marsala 17:11
Yeah. And so I work for a company out of out of Phoenix. It's a local flight school here. And for those that don't know, the flight training world in Phoenix, Arizona, we do. Among the most flight training in the country, us in California, Arizona has a lot of flight training here just because the weather is so promotable to fly. Yeah, I would say we have our flying days are probably over 300 days a year that we can fly. So the weather is great here to do flight training. So people come from all over the world to that flight training here. And I work for one of the bigger companies here in Phoenix. Yeah,

Scott Benner 17:39
right. Okay. So, you know, so there's a rule in place forever. You know, if you use insulin, if you're if you're diabetic that uses insulin, you can't have this certification. There's other kinds of planes, you can fly, you can fly for your own personal fun, you know, but you can't you can't take a people mover up in the air, basically, and move them around.

Pietro Marsala 17:57
Yeah. And so it was it wasn't you know, it's interesting, Scott is the FAA, the way the rules are written is it doesn't matter how many people you have behind you, as long as they're not paying you was that was the way the rule was written. It's interesting, because I have a, you know, I have a commercial certificate, I have a private pilot's certificate. And I have these certificates that if I was rich enough to own a jet, and fly across the country, I can do so even on insulin, as long as the people behind me aren't paying me. And that's kind of a way the rule is written. And I brought that up to the FAA before. And you know, that's obviously a head scratcher for them. And the guys that I spoke to weren't the ones that created that regulation. But that's what was interesting to me, it was theirs. It was just funny that I could fly with people behind me that are not paying me but the minute somebody is paying me for that flight, now it's held to a different safety standard.

Scott Benner 18:38
Okay, so I want to go over a couple of ideas about airplanes for a second because I'm, I don't know if you realize this or not. But today, I just saw this on social media. And I don't know what they're calling it. So I can't find it very quickly, maybe you'll know there's some fighter jets that are flying some path through the Northeast today, in support of, you know, medical professionals and everything that's going on Corona, they're going to go by my house in about the next 25 minutes, which is weird that you and I are on while that's happening. So these are fighter jets. I have been on you know, I get on a plane in New York. And I want to fly let's say to Wisconsin, I sit down on a jet that has three seats on the left and three seats on the right. 30 or so rows. I don't know what kind of plane that is. Seems like a big plane to me. Sometimes I fly out of Houston to come home. And all of a sudden, I'm in a plane that genuinely feels like a mall with wings. Right? There's, there's, you know what I'm saying? There's there's two two seats on the left on the right. There's four in the middle, there's two on the left, you know, you can't see the front of the plane from the back of the plane. Can you find

Pietro Marsala 19:50
all of those planes? Are you saying now that the rules have changed now

Scott Benner 19:54
I'm saying you personally like you know, can you bro down and get those planes and make them go? I'm gonna do two ads in two minutes, hang out, see if I can do it. The only pod tubeless insulin pump is the pump My daughter has been wearing since she was four years old, she'll turn 16. This summer, she has been wearing an omni pod every day for that time. And it is spectacular. No tubing means no controller to carry around with you clipped in your bra, under your belt, wherever you have to stuff that other two pumps, you know what I mean? There's a an infusion set along tube, and then something to carry with you, not the Omni pod. Omni pod is a small self contained device, you put it on, that's it, you control the insulin from a separate device that does not need to be attached to you. It is spectacular. This may be hard for you to believe. So what you should do is go to my omnipod.com forward slash juice box and get a free no obligation demo of the Omni pod sent directly to you today. Do it right now, it's free. That means it doesn't cost you money. And there's no obligation, which means you don't have to keep it right, you'll get the demo and you can throw the trash and be done with it. Say I don't care about this, or you can keep going it's up to you. Don't let me or anyone else make a decision that you could make on your own. The Dexcom g six continuous glucose monitor is at the heart of how we make insulin decisions for my daughter. The trend arrows tell me the speed and direction that my daughter's blood sugar is moving. And with that information, we make decisions about food and insulin, they keep my daughter in a tight range, and she stays there. Most of the time. There's no big secret, we just use the right amount of insulin at the right time. And you could too, if you had a dexcom g six, head to dexcom.com Ford slash juice box to get started today, you will not be sorry that you made that trip on your keyboard.

Pietro Marsala 22:04
So our commercial certificate doesn't limit us to any specific type of airplane. So to answer your question specifically, as pilots, we need what are called type ratings. And any claim that weighs over 12,000 pounds, you need to you need to have what's called a type rating. And so what it is, is you're having a general certificate that allows you to be paid to fly. And then once you go work for the specific airline that you you choose to work for. And they assign you an aircraft and you go to school for two months. And in addition to all the schooling you've been through over the years, you go to specific school for that airplane for two months, they teach you exactly the ins and outs of that specific airplane, they type you. They give you a Type Certificate. So they basically you're a specialist in that airplane, you're certified to fly that airplane as part of your your ratings. And so these these simulators that they put us in at the airlines, their multi, multi multi million dollar simulators. In fact, most people don't know this. But the first time that if you know if you're an airline pilot, and it's your first job of flying for an airline, the first time you have passengers behind you is the first time you're flying that plane. You don't go up and just you know fly a plane around for fun, and have the company train you the old days it was like that. But now simulators being so accurate. They don't require that anymore. You can actually the first time you have the first time you fly that plane is the first time you actually have people behind you all your training is done in a simulator because it's so realistic. Wow. So yeah, to answer your question, yes. That's so cool. Hey, so

Scott Benner 23:26
we, if a person was in that simulation process, let's call him bill. And Bill wants to be a pilot. And Bill keeps crashing the simulator. How many times is Bill get away with crashing the simulator before they tell him he'd probably make a better? You know, like, I don't know, host or host on the plane instead of the pilot. Yeah. How does that, like coming? Me strikes until you're out?

Pietro Marsala 23:49
Yeah, how many strikes? Yeah, good question.

Um, well, they don't give you I mean, it's not like one time, you know, the plane crashes you're done that that's not how that works, really. So you know, obviously, it's, it's an overall picture of what you guys are doing. And there's various phases of flight that they put you in, they will run you through the simulator. I've never done this actually, because I'm not an airline pilot yet. I just got my certification. But from what I've heard from everybody that has gone that I've known people that have been there a while they put you through various phases of flight, and they put you through the hardest of the hard. And so it's very, it's very challenging, you know, there's, there's, there's a chance that people can watch out too, and they don't hold your hand, but they hold you to it. Yeah. And so they only take the best of the best and as they should obviously and so how many strikes throughout I'm not sure yeah, Tom, but I know that they they do a lot of they're pretty selective on who they allow to fly the general public around, like I said, like they should.

Scott Benner 24:43
What's the um, stress like, flying or even in a simulator? Does it affect your blood sugar? Do you need more insulin when you're flying?

Pietro Marsala 24:52
On a simulator, you're on the ground. I mean, it's just like an airplane right? I treated just like an airplane. Not so much. I mean, when I'm flying my plane triggers are probably the most stable a because I'm fasting and B because it's part of my scan uses CGM. I use a G's, a G six Dexcom. And so obviously, as you know, as most of you know that listen to this, that use the G six, it makes your life so much easier. And so while I'm scanning the instruments, and I'm flying myself or I'm instructing or whatever I'm doing, I use the Dexcom g six as part of my scan. And, you know, just a quick glance at my CGM to see where my levels are at and then just keep myself really stable in flight.

Scott Benner 25:27
Oh, wow. So your your glucose monitor becomes part of your, your checking of gauges?

Pietro Marsala 25:34
That's correct. Yeah. So the scan that we have, yeah, we check every instrument, what we call a racetrack pattern is where we go around, and we check in each individual instrument to make sure that it's working correctly, and that we're seeing what we should be seeing. And, you know, a quick glance of my my index come every, I'm kind of OCD about it. But I check it every five to 10 minutes, just to make sure it's still there, even though I'm stable. My bazel set right.

Scott Benner 25:58
On my skin, what part of the scan, do you look for the text from potential dates? Is that?

Pietro Marsala 26:04
No, you know, it's funny because you don't really get service and a lot of areas we're at and so cell service isn't isn't part of or dating isn't part of the scan.

Scott Benner 26:13
Right? I'm gonna ask you one unrelated question that I'm dying to know the answer to. And then I'm going to move on to things that are actually pertinent to what we're talking about. Yeah. All right. Why does my cell phone or yours or anyone else's work at certain elevations and not others?

Pietro Marsala 26:29
What is what is your cell phone work, as you know,

Scott Benner 26:33
we're moving to satellite conversations now, which has nothing to do with flight. So I understand that the signal is being beamed to the, to the surface, right. And they're being pointed at landmasses, too, which is why you don't get cell service out to see for instance, but but how you know, when you take off, everyone's been, listen, I think everyone's had something going on Netflix when the plane goes up. And you're pretty amazed that 25 minutes into the flight, you're still watching, right? So yeah, and then all of a sudden, it cuts off. Why does that happen?

Pietro Marsala 27:02
Well, let's people should be downloading before they they get airborne, so I don't have that issue of it cutting out.

Unknown Speaker 27:07
But

Pietro Marsala 27:09
But anyway, it's uh, you know, it's interesting, somebody, somebody asked, somebody reached out on social media to me the other day and said, Why can't we use our cell phones in flight? And truthfully, I don't have the best answer for you. Because before it was a myth that it, it could have been with the technology that they use before, with the radio signals that that we used to use in order to track what we call Airways, they're basically highways in the sky, we needed these specific navigation sources to operate correctly, and the cell phones could have distorted that signal. And so that's why the crew recommended for you not to be or not recommend or require you to not be on your cell phone to this day, why they still do it. I'm not sure because a lot of the stuff that we do is, is GPS based and has nothing to do with the with those

Scott Benner 27:48
with those cell signals. Hey, it's just a man trying to hold me down Pietro, but that's okay. Yeah. So, do you know the genesis of you know, I've had a couple people come on and talk about it. But I think it's interesting because of where we are now. You know, john came on years ago to talk about wanting to get these first class medical license back for people with you know, type one diabetes, even back then he was saying, you know, man, because there's, there's glucose monitors. Now, it's a different world, you know, you're not just hoping your blood sugar doesn't fall. There's different ways to manage. But what's the genesis of how this happened? Like, why is it okay, now with the FAA, how were you able to get this license, but what's the behind the scenes about how we got to it?

Pietro Marsala 28:29
Yeah, definitely. Um, so

CGM has become

a huge part of this game. And to give you kind of a quick backstory, I was able to go to the FAA, I was fortunate enough, I was just touring DC with a girlfriend at the time. And I was walking around dc in shorts and a T shirt. And I'm like, Hey, I gotta stop you. Did you say you can't get text so that you can ignore your girlfriend while you're flying? Is that what's going on here? Is this an elaborate?

Unknown Speaker 28:55
Right, right?

Scott Benner 28:57
I understand phones don't work in plane. Sorry. All right. You're in DC. Good.

Pietro Marsala 29:02
Yeah, so I'm in DC, and I'm toying around with an ex girlfriend at the time. And, you know, we come across, we're looking at the museums and one on the monuments. And we come across the FAA is building it's the Department of Transportation. I'm not sure if you've been there or not, but not that you would have any reason to be but

Scott Benner 29:16
how do you name it? Like, I'm just kidding.

Pietro Marsala 29:19
We came across the building and I'm in shorts and a T shirt just kind of in the summer just turned around. And I've been outside all day. And she goes, Hey, why don't you go inside and, you know, speak to the FA and this is back in 2016 in the summer of 2016. And she goes Why don't you go inside and speak to the FAA. I was like are you kidding? Look, come on dress me. I mean I'm not I'm not presentable. I don't even know what I want to say yet. I have what an idea, but she was we'll just go in there. Give it a shot. I'm just like, I find so you know, I walk in and there's this. There's a security like, it looks like a TSA kind of checkpoint. And there's this huge building I walk in. There's always people looking at me like what is this dude doing here? You don't look like you're you're supposed to be here. And so I asked the security guard I said hi is a is a doctor. Deval here. He's the deputy air surgeon for the for the FA. And he's like who? And I'm like, he's the deputy here. So I thought by me given him that title, he would know immediately who I'm talking about. Because this is a big building, man. He's like, there's a lot of people here he goes, but anyway, if you want to go upstairs, you need an appointment. I'm like, okay, so yeah.

So I just walked out.

And I walked out of there, and my girlfriend at the time was like, you know, what did he say? And I said, Well, we need an appointment to go upstairs. And so he's not gonna allow us and she goes, Okay. Alright, so I was like, You know what, I have his email. So I'm gonna shoot him an email, and see if he responds, I doubt it. But I'll give him a shot. I'll give it a shot anyway. So I did, I shot him an email, and I'm at dinner that night in DC, and my phone goes off. And it's it's it's him. It's Dr. Hall, I couldn't believe it. I was shocked. It was the first time I've ever reached out to him. And I told him, basically, hey, I'm here from Phoenix. And you know, I'd love to chat with you and share my story. If you have the time. It would be awesome to meet you. And he responded with great, I would love to meet you How about tomorrow at 12. I'm like, holy cow done. And so I put some things together and try to look presentable. And I went up there. And we had a meeting. And first we sat down, he was like, Hey, you know, I don't have a lot of time for you. And so I sat down next thing, you know, we're there for an hour and a half. And so he loved my story, I was kind of in a unique position as a flight instructor to kind of share my data with him every day and show him that, hey, I use a continuous glucose monitor. And they knew, and I think, if he didn't know nearly as much as they did today about CGM, because it was more the old school fingerstick as what they knew of, and, and so he said, you know, you know, we're, we're close, but we're not quite there is what he told me as far as getting a first class medical to fly for an airline. And he goes, this is interesting, you have a very interesting story. And I appreciate you coming up here and speaking with me. He goes, let's keep in touch, and I have his direct and I had his direct line. And so over the years, I would call him every month and a half, two months, or you know, you know, being pleasantly aggressive as I like to say, and so I'd check in with him. And every now and then, and, you know, we would he would kind of update me of what's going on and the latest and I would kind of fill him in with the latest that I've gotten, I just start sending him things randomly. And when I say things, I mean, like, I would send him CGM data, not that it was required. But I just wanted to show him prove to him that he that this is possible, if you maintain your blood sugar, if you can be stable in flight as a flight instructor, what is the difference between being stable in flight as a flight instructor and flying for an airline three, four times a day if I can manage it in flight, and I'm not having highs and I'm not having Lowe's? You know, why isn't this you know, a possibility. And so he understood and he agree with me, and he said, again, we're closer than we've ever been in this technology is definitely a game changer. And so it does help us get a good picture. Because as you know, Scott, you prick your finger. If you're only using finger sticks, you're only getting that picture, like you've talked about millions of times on your podcast, you're only getting the picture of where you're at doesn't tell you where you're going. But it tells you where you're at at that specific time of day. And you have no idea what's going going on for the rest of the day. And that's where CGM comes in and fills in those gaps and allows you to have a full picture of exactly what's going on. And of course, the FAA I love that idea. And so I kind of just left it at that we kept in touch and then I find I went a step further. And I got back to Phoenix and I start flying shopping. And then I myself along with the American Diabetes Association that I was in contact with. But I am still in contact with I decided I'm going to make a Microsoft Excel spreadsheet. And with the spreadsheet I included in there, it was basically a spreadsheet showing where my blood sugar was prior to take off where it was an hour into flight where it was two hours in a flight and what it was prior to landing. And then in the note section of this Excel spreadsheet, I was able obviously using the CGM data I was able to see go back and check exactly what time's you know these were and what my blood sugar was at those times. And in the notes section I would put in if I gave myself any insulin to maintain my my my glucose levels and also if I or if I gave myself any snacks to maintain my blood sugar in flight. And so they had a very, very, very detailed picture of what was going on in my day. Because as you know as CGM just tells you what's going on 24 seven doesn't tell you exactly what's going on. For me in flight at those specific time, so I showed him I went a step further and backed it up not only with the CGM data, but with a Microsoft Excel spreadsheet to show here's me in flight, and I would do three, four flights a day. And I logged that three, four flights a day, an hour and a flight two hours in flight before landing prior to take off all of that stuff. And so he would see exactly that I am safe and I I am maintaining my blood glucose levels in Flint.

Scott Benner 34:21
So it's just that it's, it's possible was probably a big deal for him. Because, you know, they set a rule like that God knows how long ago and then it gets in people's heads like oh, people will tell you know, people use insulin can fly a commercial plane, boom. That's it. It's a rule. So it must be there must be a really great reason why this exists. And then somebody like you comes along and says, Well, you know what, things have changed. And let me show you how this could work. However, real quick question. Do you still talk to Dr. Duvall?

Pietro Marsala 34:47
Absolutely. Yeah. And in fact, when I conclude the story, I'll kind of tell you how it kind of all came together but up to this day, we still keep in touch and he he and I I don't want to say become friends but we've definitely he you know He answers every one of my calls. If he doesn't answer he'll call me right back. I have his direct line to his desk and Monday This is the deputy or surgeon for the FAA. This is this guy's top dog. Yeah. And so we've established a good working relationship over these last couple of years. And I've and I've told him, you know, you can be my guinea pig, if you I'll fly you out to Arizona on my own dime, to show you that I can maintain my blood, my sugar levels in flight. And, and he was like, Oh, no, no need to do that. And he goes, you're done enough. You've done so much. By sending us the data, we appreciate your generosity, and I've gone and again, this was all at my own risk. There were pilots out there in the past that didn't want to share this data with the FAA, even if they had it, because they were afraid of the FAA denying them. And my, to me, it was like, Well, I have nothing to hide. I'm not perfect, but I know I'm controlled. And to give you an idea in it, obviously, anyone see doesn't tell the full picture, but anyone sees her six 6.2. I hang around that range consistently. And my you know, my Dexcom backs everything else up to show that I'm at a low risk for hypoglycemia. And you know, I consider myself a, I do a pretty good job. Like I said, I'm not perfect, but I do a fairly good job of managing my diabetes. And they see that and they appreciate that. And so, again, I sent in all this data to back up what I was saying, because anybody could say their control. Anybody could say they're stable, but it's another thing to prove it with the CGM. And on top of that, a Microsoft Excel spreadsheet. So yeah, yeah, we've kept in touch over the years. And they kind of use me and my data and it's interesting they, I found out later, a couple weeks ago, somebody from American Diabetes Association called me and said, they spoke to Dr. Duvall and I kind of unofficially knew this. But I then found out that he said that it was your data that convinced the federal air surgeon and the deputy air surgeon that this is something that is obtainable. It's not as this is safe, and it can be done safely. And granted, not every applicant that applies for this that has diabetes on insulin is gonna qualify. They're very selective. It's a very

Scott Benner 36:51
are they detailed process? I was gonna say, are they asking other people for CGM data? Does everyone get asked yes or no.

Pietro Marsala 36:58
So before all this happened, they changed the rule back in November 2019. On November 7 2019, the FAA changed their stance on first claros first class medicals with insulin treated diabetes, and that regardless if that's type two or type one, if you if you need an insulin, they treated it the same, and so now they require a CGM. Before CGM was never required to obtain a third class medical. But now, since the rules have changed, they now make it they now make it to where you need a CGM. And there's certain sea gems that qualify. And so yeah, so now, the rules have changed. And since they've changed these rules, now they're looking at each individual case, and there's only been a few of us certified now. But they use that CGM data to basically paint the picture of somebody who's safe or not, and they assess your level of risk and in their doctors up there at aerospace medicine, but they're not diabetes specialist, so to speak. And so they brought in a team of experts, like endocrinologist, some of the leading endocrinologist in the country, some consultants and some people to help them make these decisions to assess people's level of risk. So it is a hard process to go through and, and you know, only the safest are going to qualify as they should if they're flying the general public around. And so they're very either, you know, they're picky on who they're selecting. And, you know, is there a, you know, people have asked me these last couple days, like, what did you do? What exactly do I need to do? And it's each individual case is different. They send you to a cardiologist, they send you to an endocrinologist, they send you or you have to go yourself, and that's just paperwork, obviously. But yeah, it's it's a pretty detailed test that you have to go through.

Scott Benner 38:32
That's an astonishing story. And you know, what I took of it most is that you have a longer relationship with Dr. devolve than you did with that girlfriend who was with you. And

Unknown Speaker 38:41
really what I took from this occasion that

Unknown Speaker 38:44
that is true. I always kept in touch. He's a good guy. He really is. Well, he doesn't nag you.

Unknown Speaker 38:49
Right. So.

Pietro Marsala 38:51
Exactly, exactly. Just on the picture. And he will always be

Scott Benner 38:54
you call every six weeks. He's not like Why don't you call him or I have a question about your your blood sugar targets? Are they the same when you're flying as when you're not flying? Or do you have different ideas for range in different situations?

Pietro Marsala 39:09
Okay, so good question.

Scott Benner 39:12
When you tell me it's a good question, it makes me feel better. I don't know what that says about my psyche. But thank you.

Pietro Marsala 39:18
Yeah, so no, it is because I keep myself you know, if I'm in the 80s, and I'm hovering in the 80s, or the low 90s. When I'm at home, I'm good with that. Because I know that if my base will set right, as you've talked about with Jenny and multiple people on this podcast, that if your base will set right you can hover in those areas, and you don't need a tree, you can go a couple hours without even eating anything and hanging the 80s and 90s. And you'll float right there if your basal set right, right and mind you, I'm on MDI still, I'm not on a pump, but I'm on a G six. And so I kind of just hang out and you know, if I'm at home, yeah, do I treat it a little bit differently? Sure. I'll hang out in the 80s I'm fine with that. If I'm at 8283 i can i can be comfortable with that as long as it's staying in that room. But if I'm flying 80s, that much closer to 6060 is that much closer to 5050 is that much closer to 40. And so I don't take these risks. I don't I don't do that. And so what I do is I keep myself slightly more elevated in flight, I like to keep myself in the low one hundreds is my target between, I would say, between 100. And, and 141 30 is a good range for me to be in. And that's kind of the target range I have while I fly because I know I'm nowhere near hypoglycemia. And granted, if I was in the 80s, in flight, I know that I'm not going to pass out either you and I both know that, you know, at an 8590 of blood sugar on your CGM, you're doing just fine. But again, it's just that much closer to the range of hyperglycemia. And so I out of respect for you know, everybody else and whatnot, I keep myself slightly more elevated.

Scott Benner 40:42
Do you only fly planes where there's a copilot? What's the standard for that?

Pietro Marsala 40:47
No, it's interesting. Scott, right now I'm a flight instructor and I fly with people that don't know how to fly. Yeah. And so I will be flying. Eventually, once, you know, COVID passes in the airlines pickup hiring again, it's kind of an ironic time. But eventually, my goal is to get to an airline and I will be flying with somebody who knows how to fly, thankfully, and it's just gonna be a different world. And so it's going to be in my opinion, in many people's, many people, many people's opinion, it's going to be much easier once I go to airline because now I don't have to worry about so much of the other guy not knowing how to fly. Now I've got my blood sugar, and I've got my own job, right instead of my blood sugar, my own job. And now his job was for her job.

Scott Benner 41:25
I was just thinking you spent eight years getting to a to a place and you got there and now nobody airplanes are flying anywhere. And it's probably Is it a little bit of a bummer that I mean, not that, you know, not to specifically target Coronavirus in your life. But I mean, did it feel like that a little bit like, wow, I got here and then all of a sudden this happened.

Pietro Marsala 41:46
It is such an ironic time. It's, it's been a wild ride. But you know what, when you're working on something for eight years, and you just cleared the biggest obstacle of your life. And you recognize that, you know, you just did this. It's only a matter of time, I'm 29 years old. And I've got 35 plus years of a career ahead of me, right. And so I know that eventually this will pass I'm optimistic that this will go away one day. And whether that takes a year, two years, three years for the airlines to return to where we were, we will get there. And I'm confident that the general public will be flying around again. And there will be a need because there was a shortage for pilots only about a month ago and went from you know, this huge need for pilots to nobody needs pilots right now, obviously put what's going on nobody traveling. Well, you have so

Scott Benner 42:27
you have unique perspective and patience, obviously around this because you could have given up on it at any time and just thought it's not going to happen. It's pretty neat. Listen, I'm interested, like you said, when you got on, you're the first person to get this distinction. Is that is that true? Or you're like, How do you know? Yeah, yes, I have a number one on it or something or

Pietro Marsala 42:48
what has first class, but that doesn't mean I'm the first I'll tell you how I know I'm the first and this was a special conversation I had with Dr. Laval he I was driving with my current girlfriend and my smartwatch goes off. Does she know you?

Scott Benner 43:02
Dr. Deval better than her? Has she not figured that out yet?

Pietro Marsala 43:05
Oh, yeah, she knows. She knows I've known him for four years now. He's okay with it. She shared the love

Scott Benner 43:09
you just real quick that you were on a boat. It's thinking it only hold two people you Dr. Deval and your current girlfriend on it, what happens? And we need you to find the point home so I'm just

Pietro Marsala 43:19
gonna answer this. Eventually she's gonna listen to this. Boy,

Unknown Speaker 43:23
so

Pietro Marsala 43:24
So yeah, so I'm driving. And you know, Dr. Boyle told me weeks ago, we were close. And obviously this protocol came out in November, and I've kind of been pleasantly aggressive just checking in with him here and there. And just kind of asking him What's going on? What's the latest? When are we getting, you know, certifications? And I was thinking by Christmas, because it came out in November, I was like, Oh, this will be an awesome Christmas present. You know, I'll go to an airline come January 1, and that'll be awesome. I'll be able to live my dream and this is gonna be great. Yeah. Well, it took a little bit longer, obviously. And as things do in government, as we know, they take a little bit of time. And so I was patient, and I kind of just checked in with him. And he kind of hinted to me here and there that, you know, we have looked at your paperwork, we have looked at your data, and it's checking out in favor, everything is looking good. And about three or four or about a month ago now I called him up and I said, Well, what's, you know, what's going on? What's the latest? Do you have any updates for me? And he said, I can confirm that you're, you know, you you are in Dr. Barry's inbox ready to send out and whatnot. And it's, it's getting close. And so, so I was like, Okay, great, you know, but again, it's government talk, right? These things take a little bit of time. And so I wasn't I wouldn't want to get my hopes too high. But then eventually he said he calls he sent me that email and he told me it was going to come in an email format. And it did and so my smartwatch went off and I was like holy cow and I was freaking out my girlfriend's okay you know, pull over because you're too excited to drive right now like just pull over. So I did I pulled over to a safe spot before I open email. And I wasn't even sure what it said yet, but it was like this this secret not a secret email, but it was a security email. And so I put

Scott Benner 44:55
my name and email if we could because I think it makes it more exciting. You got a secret email from the government. It said you're a pilot now. Yeah, but right now, yeah. So it's one of those you have to put in a code to get to it and all that.

Pietro Marsala 45:07
Yeah, exactly. Put in a password. And then I scroll to the bottom of this email. And I just saw my name was on it said first class, medical. And I start obviously, just crying emotionally. It was just really, it was really important time in my life, probably the biggest, biggest day of my life to this day, there's something that you work so hard at, finally come to reality. And just knowing that your boyhood dream of doing what you wanted to do your whole life, and people telling you that, you know, maybe this career choice wasn't for you. Maybe this isn't for you, when I was first diagnosed, maybe you know, there's different God has a different place for you in life. And that was really hard pill to swallow. And so, like I said, I decided to do something about it. I went to the FDA, and I'm glad that they took me seriously. And so I called the doctor, not even a minute later, I'm on the phone with a doctor in DC. I call him up and I said, Yeah, obviously it was I was still emotional. I didn't even I wasn't even done crying yet.

Scott Benner 45:54
And that was my question. By the way, I was going to jump in right there and say, did you pull yourself together before you call? No,

Pietro Marsala 45:58
no. And looking back, I probably should have

Scott Benner 46:01
been thinking probably Yeah, but God.

Pietro Marsala 46:04
So yeah, I call him up. And I was like, Hey, you

know, and he obviously knew cuz he just sent the email is coming from him. And I said, Dr. Ball, I just want you to know that you've forever changed my life. And, you know, this is the biggest day of my life. And I can't thank you enough. I'm forever grateful for everything that you did. And thank you for believing in me all along, and trusting me and allowing me to share my data with you and my story with you. And he said, he's a pitcher, he goes, I want you to know that you were the first one I sent out. So you're firstly the first the first treated diabetic diabetic pilot to be certified for an FA first class medical. And of course, that made me feel great, not that I was racing to be the first but I just wanted this change. And I'll get to what I'm getting at in a second. But he knew how much that meant to me because of our conversations over the years. And he shared with me, he said, you know, if I didn't shed a tear, when I sent out that medical he goes, I'd be lying to you. And so this that was just, it just told me a lot about you

Scott Benner 46:58
guys are dating.

Pietro Marsala 47:01
Yeah, it was a little bit of a bromance there. I'm not gonna lie. I'm gonna

Scott Benner 47:03
get him on the podcast and see if he cares about you as much as you

Unknown Speaker 47:09
change my life, I didn't change it. So I don't know about that sounds

Scott Benner 47:12
like it sounds like the the process of taking somebody like you and I'm, I'm thinking the countless other people like you who have type one diabetes or using insulin, wanna fly this kind of an aircraft? and can't, I would think he'd feel some sort of a real emotional charge behind changing people's lives. It's a it's undeniable. On it's definitely, yeah.

Pietro Marsala 47:33
And Scott, I told him from the beginning, when I first met him in 2016. I said, Look, that would be awesome. If I get certified, if I become certified. But I said, I don't want this just for me, I want this to be a change in a protocol, a change in regulation, I want it to be instead of a blanket, no, for people that have diabetes, I would like to see more people like myself that are qualified, that are controlled to be certified. And I said, I, I can't imagine being a kid at 10 years old, having the stream and then being crushed minutes later, when you're told not only are you living with a chronic illness, and it's hard enough, especially for these kids, that can't go to birthday parties and eat cake and ice cream like everybody else. But, you know, to be told that, hey, I'm sorry, you're you know, you have diabetes, and this is one of the things you can't do. And so that really, you know, meant a lot to me for for this to become a change in regulation. And so I shared with them, how I want this to be something that you know, isn't obtainable goal, and I think that kids, you know, when they're 10 years old, these parents, you know, could almost bribe these kids and tell them, you know, and use it as a as an incentive to, Hey, take care of your health. And this is definitely an attainable goal. Look, these people did it, these people change the rules for you guys. And so growing up, you know, I think that's a crucial time in their life when they're, you know, 1011 years old to learn that your dream is not crushed. In fact, you can dream big, because this is definitely obtainable goal, look at these people have done it, take care of yourself, take good care of your health. And when it comes time to go to flight school, if you have good blood sugars, and if you maintain yourself in a good range, and you use the CGM and to prove your data, that this is something that can be done. And so I was so thankful for that. And to know that it's not just me, it's other people as well, to me means an incredible amount.

Scott Benner 49:08
Well, sure. It's that moment, right? When you realized I have type one, I don't have type two, your back in the doctor, like, are you sure like let's not do this? This is Yeah, you said that's probably the worst moment of your life hearing that you couldn't fly these planes. And, I mean, let's face it, it's already an uncommon thing for someone to feel so strongly about something they want to do for the rest of their life. To take that thing from someone is specific especially because they're, you know, not a million people run around who want to fly airplanes around. It's, it takes a special person I know you don't know that about yourself in some small way. Being a pilot is a lot like being like a professional athlete in that you just do this thing that feels normal, and you don't realize that most of the rest of us, you know, can't throw 103 mile an hour fastball like like it's just like if honestly if you put me in a plane and said you can do Scott, I'd be like, No, I can't, and then I would get out of the plane and I'd yell at you, because I'd want you to Yeah,

Pietro Marsala 50:05
I mean, it does take somebody, you got to want it. And, you know, I see this all the time in flight training, and there's people that, you know, become pilots for various reasons. But, you know, most people that do this, they love what they do. And this is something just like you said, professional athletes and, and whatnot, this is something that we dream of, you know, as kids, most of the time, it's something that you just have in you, and it's something that you just desperately want. And, and it just shows that, you know, there's pets are a certain type of people, you know, they're very, let's just, I'm just gonna put it out there, a lot of them are narcissistic. And they like the attention and they like the but overall, they, they are people who have a lot of pride now, and they take very seriously what they do. And so it's just one of those things that you know, as a kid, if you're that kid that has that, and in you and you want to fly

to diabetes, that shouldn't be something holding you back,

Scott Benner 50:50
take it from Listen, I cost me $300 a year to have a company come to my house three times a year, and clean the leaves out of my gutters because I'm not climbing up on a ladder. I do not want that as my that's not how I'm going to understand what I'm saying.

Unknown Speaker 51:03
Yeah, I do not,

Scott Benner 51:04
I am not going to open my eyes back up, have St Peter standing in front of me, which is oddly not something I even believe in, and then have to tell him that I was trying to clean my gutters out and now I'm dead. I can't write I can't do that. I don't like leaving the ground. It's it's a bad.

Pietro Marsala 51:18
You know, you're not gonna believe this. If I tell you this, I have a fear of heights. Get the hell out of here.

Scott Benner 51:23
Why would you say that? To me.

Pietro Marsala 51:24
I don't like being on balconies. I don't like being on ladders. I don't like being on the roof. I just get weird when I'm at edge. However, in an airplane, I've never had this fear. I don't, I don't feel like I'm not secured. It's just a completely different feeling. Being in an airplane, I feel like I have control. I feel like you know, the wings are not going to fall off this thing. And so we're flying. But being on a balcony being on being on the edge of a building, I just I get kind of uneasy I don't like being and it's funny, because a lot of pilots will tell you that too. They don't like they don't like being up high where they don't feel like they have control.

Scott Benner 51:54
Well listen, you're younger. So you probably don't know about these, these old documents that you could, you could watch they were the colors were a little strange. Anyway, it was about this, um, a rabbit, and he could talk. And sometimes he would get on a plane. And then a gremlin would come and like bang with a hammer and knock the wing off the plane. So you're saying they can't fall off. But I've seen documentaries about it. And I'm fairly certain it can happen. So

Unknown Speaker 52:17
maybe in those days, so I'm just telling you,

Scott Benner 52:18
60s and the rabbit cursed. It was amazing. You guys suck now.

Pietro Marsala 52:23
I didn't know that would come out now, would it?

Scott Benner 52:26
No, I don't believe so. But anyway, they used to smoke cigars, and everything was fantastic. Honestly. Nevertheless, the world Bugs Bunny aside. I think this is really one of the more interesting conversations that I've had. And it wasn't so much of a conversation, I kind of loved it because you have been so immersed in this over the years. You You didn't need me here. Like I could have, I could have gotten on and said, Hey, real quick, tell me about that whole thing with the flying, I'm gonna go make a sandwich. And I think I would have come back and you'd still be telling your story, which I mean is a it's amazing, because, but but it's a testament to how much you were involved in it to make it happen is what I'm saying.

Pietro Marsala 53:09
Yeah, it was, it was quite, it was quite a road. And I'm so thankful I've got to the end of the, you know, on this road. And it was it was hard. I'm not gonna sit here and tell you it was easy and blue skies until wins the whole

Unknown Speaker 53:19
way.

Pietro Marsala 53:20
Because it was a it was a challenging road. You know, there were times where I was like, This is never gonna happen. And there were so many people in my life, my family's close to me, and there's so many people that picked me up and made me believe and truly to never give up on the stream and that I could be in I knew I was healthy. And it was only a matter of time. But there were times where, you know, I would sit up at night and think to myself like why why me with diabetes number one, like like a lot of people do, I'm sure. Yeah. And why out of it's interesting because I'm the only person in my family and I have a big family. My family is Italian and the majority of still live in Italy. And out of all my cousins that have all my aunts, uncles, nobody has diabetes, except me. And I was just like, how is this possible with every Not that I would wish this on anybody? Don't get me wrong, but it's interesting. nobody in my family has diabetes. But yet the only person that can't have it, or at the time couldn't have it for his career was me. And this is the career choice that I took. And I'm the one with diabetes. It's so weird to me. It was hard to hard pill to swallow.

Scott Benner 54:17
Do you want me to tell you how I knew you were Italian? How's that? All right, on your on your pilot's license that you were really cool put up on your Instagram, which by the way, if people want to see it where what's your Instagram handle?

Pietro Marsala 54:29
Yeah, it's a it's Marsala like my last name. It's an AR s a la nine zero. Okay, is

Scott Benner 54:36
my Instagram handle so everybody should check it out. It's very cool. But it's because you're five, eight on the license and every Italian. Every Italian guy I know grew like they were like five eight when they were nine years old and they never got

Pietro Marsala 54:51
to exactly tell us kid in sixth grade and then hundred percent loosens? Yeah.

Scott Benner 54:54
I mean, listen, I don't know a lot about you know, about lineage and things like that, but I've seen that enough times. I can make that generalization with a lot of coffee. Definitely. Yeah. No, that's,

Pietro Marsala 55:03
that's, that's a good point. I'm about as tall as my dad. Yeah.

Scott Benner 55:06
All right. So I'm gonna I want to thank you, this is terrific. And I can't let you go before I find out and not on the recording because this isn't anybody's business. But I want to know if you broke up with the girlfriend from Washington or if she broke up with you because I have a theory that when you failed, she lost like faith in you. And she was like, No, that's it. This kid couldn't get it done. And I'm on my way. Exactly. That's what happened. No,

Pietro Marsala 55:28
no, it's interesting. Just kind of short story. She she's an airline pilot herself now. And we met in the industry and so

Scott Benner 55:36
don't wait, wait, hold on. The planes are going by. Keep Oh, really? Don't you? There's no way you can hear them. Hold on.

Pietro Marsala 55:44
A fighter jets.

Scott Benner 55:45
Yeah. Oh, nice. Yeah, there's, um, I think it's a two squad flyover for they're celebrating people who are working in hospitals during the Coronavirus, COVID-19 thing. And on this weird path up and down that I can't believe I just my house just crumbled. And I was like,

Pietro Marsala 56:01
I suppose you're flying pretty low. Are you far from New York?

Scott Benner 56:06
No, I'm not far from New York. But I think they came out of Fort Dix. And I'm pretty close to there. Okay, so I think I'm catching them on the return to to the base. Anyway. Well, I'm sorry, you were about to share personal details about how your relationship broke up. And I don't want to stop you.

Pietro Marsala 56:22
Yeah, so anyway, so

yeah, so she's, she's an airline pilot herself. And, you know, kind of life just took us in different directions that she started traveling. And, you know, I was here in Phoenix. And so we kind of just grew apart from each other at that point. But no, I wish her nothing but the best. She's a good person. But yeah, it just wasn't for us. You know,

Scott Benner 56:37
it's amazing that you said something real and not stupid like I was getting at. And because that was the one question I have here on my notes that I've been making while you've been talking. Just because you talk quickly. And I didn't want to Yeah, I didn't want to run you over. I'm not saying you shouldn't have I'm saying I don't usually make notes. Usually I just run people over and just say something. But I made notes because I didn't want to stop your your vibe he had going. And that was my one question about one day being an airline pilot. Is that idea of like how transient you are all the time? Is that something you're prepared for? And how have you prepared for it? If If so,

Pietro Marsala 57:11
you mean like for me personally? Or for like my relationship? Or what guess?

Scott Benner 57:15
Yes, like all of it, right? You're constantly going to be in a thing yapping back and forth. And you don't end up at home at the end of the day all the time.

Pietro Marsala 57:22
Yeah. And so I know a lot of pilots now that I've been in the industry 10 years, and I can tell you that it is not easy. There's a reason why there's a lot of pilots out there that are divorced. And so I think it is hard on a lot of families to be gone. I mean, you're missing, you know, you're close to your kids, I've heard you talk about your son's baseball and whatnot, you've been very active in his life with that. And so you do miss these things, you miss birthdays you miss, especially in the beginning, you know, if you start your career in your 20s, your early 20s, and you're, you know, an airline pilot in your early 20s, I think it becomes a little bit easier because seniority in this world of aviation, at least in the commercial aviation part of it is everything. And so if you start in your early 20s, by the time you're in your 30s, you have pretty good seniority built at your company, typically. And so you're able to, you know, get these days off, you bid your schedule a month in advance. And so if you have your son's baseball game that's coming up, and you see his schedule, you know, you can, you know, request these days off, you can get these days off in advance if you're senior enough, but if you're a guy like myself, who's just starting out, now, you're gonna be at the bottom of the seniority list. And unfortunately, you're gonna miss things like birthdays, you're gonna miss things like, you know, baseball games, and special events and weddings and whatnot. Not to say you don't get time off, but it's a lot harder when you're at the bottom of the seniority list. And so yes, it is it is a challenge, not just for relationships, but just all the above it, it does become really hard. But again, going back to pilots, and there's nothing else I'd rather do than then stare outside. And that be my office when I'm looking out, you know, at 30,000 feet, 35,000 feet. That's what I dream of doing. And I know it sounds kind of selfish to some people. But you know, at this point in my life, I'm just focused on my career. And in one day, you know, if I meet the right person who wants kids, and at that time, if it's the right time that kids and whatnot that don't, then I'll cross that bridge when I do but, yeah, it's gonna be a lot of sacrificing and it's not for everybody. There's not a life. Anybody that travels in general for a living can tell you that it's it's not easy on any family.

Scott Benner 59:11
Yeah, I have to say I mean, it being sincere. I'm jealous of the idea that you know how to fly a plane. I think it sounds incredibly peaceful. I wish I had the type of mind that was interested in that. But mostly, I guess what I've learned there at the end is that until you gain seniority, yours and Dr. devolves relationship is probably going to be the best one you have.

Pietro Marsala 59:33
Exactly, exactly. I think he's got like five or six years left till you retire. So yeah, whoa.

Scott Benner 59:40
Nice. You guys have plenty of time once he doesn't have anything to do.

Pietro Marsala 59:43
Yeah, there you go. Exactly. I'll go visit and we can hang out and talk about the good times when I didn't have a medical and how

Scott Benner 59:48
we got there. All right, man. Listen, I genuinely appreciate you coming on and doing this. It was It was great. You were terrific. And I wish you nothing but success. I mean, hopefully, obviously everything you know comes together. It's all about, you know, being able to move around more freely, and you're able to get out there and find the job you've been for for so long. I'm, I'm incredibly happy for you.

Pietro Marsala 1:00:08
Thank you. I really appreciate that. Scott, it was nice to speak with you on the phone, not just hear your podcast and actually kind of meet, officially. So thanks for making me laugh, as well as a good conversation. Yeah, I've done a lot of these interviews. I did one with CNN and I did one with the local Fox station here in Phoenix, and mine was the best Is that what you're trying to say? Yeah, I'm getting that that I was the most. I'm a little bit more experienced now with podcast even though I still speak quickly. And I've listened back on these podcasts that I've done. I'm like, Guys, I don't even want the guy talk. Hopefully, it wasn't like that with you. And I, I let you speak a little bit because I get going. And like you said, I don't

Scott Benner 1:00:42
even know that I'm still talking. Well, that's how I go. And I don't know anything about how the FAA made it possible for people with type one diabetes to get this first class medical license. So I figured I'd be better off letting you talk now and listen to your passionate it comes through, and it's much preferable, you can ask anybody who does an interview, it's much preferable that you have too much to say, then I'm sitting here pulling thoughts out of you for an hour. So I thought it was terrific. But I do like the ranting on I was better than CNN. Is that what you were getting ready to say?

Pietro Marsala 1:01:10
Yeah, I'm getting there. I'm getting there. No, it was fun. It was it was uh, it was it was very relaxed the podcasts on I enjoyed it. I appreciate that. We'll keep in touch. And obviously I follow you on Instagram, you follow me? So you'll be able to see my career progression. Hopefully in the not too distant future. We could get back at it after the salt passes. I'm excited for one day, there'll be the technology where you and I can record one of these while you're flying a plane. That would be amazing. I don't know if the FAA would like that. You know, the guy that would work it out. I know the guy. Exactly.

Scott Benner 1:01:37
All right. Have a great day. Thanks so much.

Unknown Speaker 1:01:38
Hey, YouTube.

Scott Benner 1:01:41
Huge thanks to Dexcom g six continuous glucose monitor. And to the Omni pod tubeless insulin pump for sponsoring today's show. There are links to all of the sponsors at Juicebox podcast.com. Or right there in the links of the show notes in your podcast app. Don't forget, g six is just a decision away. Just do it. dexcom.com forward slash juice box. And at the very least get yourself a free no obligation demo viavi pod. That's just fun to get stuff in the mail.


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