Scott Benner 1/9/25 Scott Benner 1/9/25

#1402 Caregiver Burnout Series: Part 6

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Isolation and stigma: Discovering new forms of support through online platforms

Raising a type 1 child while questioning her husband's diagnosis.
How quick action saved her son from severe diabetic complications.
The fight for clear answers when doctors won’t listen.

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

Scott Benner 0:00
Hello friends and welcome back to another episode of The Juicebox Podcast.

Erica forsle is back with me again today for the sixth part of her caregiver burnout series. This is the last part for now, but we're gonna probably be adding to it again in the future. If you'd like to hire Erica, she's available at Erica. Forsyth.com, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink, ag one.com/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast, private, Facebook group. Juice box podcast, type one diabetes. But everybody is welcome. Type one, type two, gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. This episode of The Juicebox Podcast is sponsored by Omnipod five, and you can learn more right now at my special link, omnipod.com/juicebox dot com, slash, Juicebox, Erica, we are going to finish up the caregiver burnout series today. I appreciate you doing this with me. That's right. Thank you. Of course, Episode Six, look at us making time we're doing well.

Erika Forsyth, MFT, LMFT 1:56
What's this one about? So this six burden focuses on the isolation and stigma that caregivers or even people with diabetes might experience. Navigating this might feel similar to how we discussed the previous episode as you navigate social experiences post diagnosis, but this one really the lens through which we're talking about this isolation and stigma can occur even in, you know, a phone call with the family member and very small, nuanced interactions with other people. Through the research that we've we've also seen in our own lives that because of the intensity of the stigma and the isolation that people experience, one of the benefits has been the online, the social, you know, online platforms that have certainly been growing in the last 510, years, significantly. So do you want to lead? We get, do you want to lead with the quote, the parent quote,

Scott Benner 2:54
I get to read the parent quote. This one's very talky, meaning, this is a direct quote, but it's obviously like conversational. So stick with me. I'm gonna do my best to put my to put their emotion into it a little bit. I don't think people truly understand how hard it is on us, on a physical, daily, everyday thing, people don't get it. And I think because we are coping and we're fine, people just think, Oh, it must be fine, but it's really hard, and they don't get that, whereas, if your child had cancer, people, they drop off meals, and people would be running around after you, thinking, Oh you poor thing. It's terrible. But they're like, Oh no, it's fine. I hear that from a lot of yes, you hear that, yeah, from a lot of it's the comparison that gets made a lot, which is, I think what they're really saying is people know cancer is bad, right? So they have that overly empathetic What can I do a response? But when people hear diabetes, they think, like, oh, you take a pill, or you just don't eat a cookie or something, and then it just, you know, like, Oh, it doesn't sound so bad. And then you don't get the same response, and then you get that's, that's isolation, right? Yes, yeah, okay,

Erika Forsyth, MFT, LMFT 4:07
isolation and not being understood, right? They say, you know, they don't understand that the physical, daily, everyday thing of managing your child's diabetes. Oftentimes, I even saw this, you know, a lot of comments yesterday online during our, you know, World Diabetes Day of, oh, at least you know you have a diagnosis like, now you know what's going on, which, yes, there is that kind of relief. Okay, my child's been sick for so long. Now we know there is that kind of immediate relief, but then, as we know, also immediately comes the shock of what it actually means. And that's where people who don't know diabetes misunderstand what it is that you are doing for your child on a moment to moment basis. Yeah, like,

Scott Benner 4:58
it's not like, great. You're right, at least. I know now, because you hear people come on the show all the time and talk about that, like, oh, it was horrible not knowing. And you're like, well, at least now I know, yeah, that gets rid of the part where it's horrible not knowing. It doesn't fix anything else. It just, you know, that part's over. You know,

Erika Forsyth, MFT, LMFT 5:14
yes. So this kind of, this constant, either the stigma around what the other person perceives diabetes to be. You might experience that right, like, you know, all the myths that you and Jenny have talked about, you know, the myths of diabetes. Did you give your kid too much sugar, etc, etc, you can feel stigmatized based on the other person's perception of what diabetes is and why your child has it, and then consequently misunderstood around what it means to keep your child alive or keep yourself alive. And I also hear, not only from, you know, family members who are maybe trying to do their best to support but don't quite understand it, are also, you know, when you're at pickup and you're trying to connect with another parent. They I know

Scott Benner 6:04
what you're gonna say is making me laugh. Okay, go Google. Say it. Say like, when they it's like when they complain about some banal thing in their life, like, it's the worst thing that ever happened. And you're like, I haven't slept in six months. Like, yes, I look at my kid and I constantly think, is it about the die? Is that the same as having to rush to soccer practice and make dinner doesn't feel like it, because we also play soccer and eat dinner like, Yeah, I know, trust me, I know, yeah, yes.

Erika Forsyth, MFT, LMFT 6:31
And so again, those you know, those other parents are maybe they're trying to relate, you know, and trying to empathize and try to share, like, you know, we've got hard things going on? Maybe they're just having a conversation, but obviously where you are in your journey and how you're hearing other people's issues, it's okay if it's hard, right, that if you're if you're running that line in your mind, like, I'm just trying to keep my kid alive here, so that's okay. But that also can contribute to that feeling of like, oh my gosh, no one really gets how hard this is, and that sense of isolation.

Scott Benner 7:05
It's the medical thing to the seriousness of it that stops you from being able to step back and go, Oh, they are trying to connect with me. They're just, they don't have all the details. Like in any other walk of your life, you'd be like, Oh, thank you. Like, you know, you'd feel it, and you'd be like, Oh, they're they're trying to empathize with me. But instead, it just feels like, What are you talking about? I think that when you have diabetes or your child, does your perspective on the world levels up, like whatever, that low level stuff that people worry about, you don't have time for that anymore. Like that just it's gone. Now I'm worrying about bigger, more immediate problems. I can't sit around and pontificate about whether or not, you know, Scary Spice is really in love with whatever. Like, you know what I mean, like, whatever, right? What is that? What is the modern version of that? I don't care if Kim and is arguing with her sisters, yes, yeah, my kid cries when I put a pump on them. So I I'm done with that part now your perspective, you just level up your perspective and that person, and I say too, thankfully that person doesn't have that. I'm glad that they don't feel the weight of what I feel. But it is hard not to be jealous about it. Sometimes I think that's probably the wrong Yes, today's episode of The Juicebox Podcast is sponsored by Omnipod, and before I tell you about Omnipod, the device. I'd like to tell you about Omnipod, the company. I approached Omnipod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet because the podcast didn't have any listeners. All I could promise them was that I was going to try to help people living with type one diabetes, and that was enough for Omnipod. They bought their first ad, and I used that money to support myself while I was growing the Juicebox Podcast. You might even say that Omnipod is the firm foundation of the Juicebox Podcast, and it's actually the firm foundation of how my daughter manages her type one diabetes every day, omnipod.com/juicebox whether you want the Omnipod five or the Omnipod dash, using my link, let's Omnipod know what a good decision they made in 2015 and continue to make to this day. Omnipod is easy to use, easy to fill, easy to wear, and I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omnipod. But please take a look omnipod.com/juicebox I think Omnipod could be a good friend to you, just like it has been to my daughter and my family

Erika Forsyth, MFT, LMFT 9:46
to not be jealous, and then to as we talked about last episode, do you then make that decision to try and communicate how hard it is right to say, hey, it actually is really, really challenging. To do what I'm doing to keep my child alive, or keep their their sugars in range, and let them do all the things I want them to do, because then, if you don't, you feel like you're not recognized for the amount of work that you're doing. You're not doing it for like, oh, pat on the back you're doing you you want that. You just want people to know how hard it is, because it's really hard. And that's, as we've kind of talked about this issue many times before, that's kind of human nature you want to be seen and validated for the struggle, the pain that you're carrying, so that you feel supported and you don't feel as lonely in what you're carrying. Yeah. I

Scott Benner 10:34
mean, we're obviously social creatures, right? And when you don't have that feeling, you feel alienated, then, you know right away, like you're on the outside of the of the pack. I guess is the way to think about it. I need you to understand why I look tired. It's not because I'm weak. It's not because I can't do this the way you do it, like I'm a good parent too, you know, I've got more of a burden than you might also. The other thing is, you don't know what the other person's burden is either right, like, you know, they've got stuff going on as well. I don't know, the belonging, connecting, empathy, mirroring back and forth, it's all really important. But a lot of times you just lose your fuse for that conversation. And I think the explaining, some people could feel like, if I start explaining this, I'm just going to sound like I'm complaining. I also don't want to seem weak or like I'm complaining, either you think,

Erika Forsyth, MFT, LMFT 11:27
right, or a burden to other people, right? Like to and are they really going to get it? And why do I need to tell them this? You know, all those things can be running through your mind, and are they really going to get it anyway? So I might as well just not share it, right? And then you still land in a place of isolation. It

Scott Benner 11:45
kind of boils down to when someone says, How's your day, they probably don't care. So, you know, like somebody says to you, how's your day, and you start telling them they're going to be like, oh geez. Like, that's enough. I was being polite, you know. And and they really aren't wait. Diabetes is that thing you do need to live with it to understand it. I mean, in the same house, like, I think if you drug anybody into your house for a week and then let them back out, they'd go out and start complaining for you. They'd tell everybody you're not giving Erica hardly enough credit. Like she's married, she's got two kids, she's got a job, she does all this stuff. She still has diabetes. I saw her. I was in her house for a week. I saw her change her pump twice. I saw her change her CGM. I saw her get low. I saw her get dizzy. I saw her feel foggy, like she started yelling about nothing, like, you know, that's none of that was even her fault. It's crazy. I don't know how to count carbs. I couldn't figure it out I was there for a week. If you had an advocate on your side, like that, I

Erika Forsyth, MFT, LMFT 12:37
was just wow. I feel really validated. Thank you with that. Were you there last week? Eric

Scott Benner 12:41
and I have only ever been together, like, steadily, for like, an hour and a half, but I still, I know your pain well.

Erika Forsyth, MFT, LMFT 12:46
Actually, I Well, I'm debating whether I was going to share this story, but I feel like I'm just going to because, okay, when I had my high episode recently, for the first time in my I think that I can even remember, after 34 years, started vomiting due to a high due to kind of random, out of the blue, high blood sugars, everything was fine until I wasn't and I felt ill for many hours, baited. Do I go to the ER? Do I not? I ended up being able to ride it out at home. But it was probably, you know, five, six hours of really not feeling well the next day, the three people I reach out to are I email my doctor, I call Scott. Thank you very much for being there, of course, and my brother, who also has type one. And obviously my husband was there to support me. He doesn't have type one, but he watched it. I didn't need to tell him about it, and I didn't tell anybody else. I didn't tell any good friends, until days later, I told one good friend, and I went through this process of, do I need to tell people I was really ill, even not feeling well? The next day, I had to cancel some things. But it's that process if you want to reach out and feel connected with someone who understands. And I am grateful to you, Scott, for being there and helping me, you know, walk through possibly what happened. And then my brother, who understood and shared, and then he shared a story recently of having a random low that was pretty scary for him, and that was it. And then later I told a good friend of mine we were going to walk. And I found myself in this space of like, do I want to keep going and telling her why and how and how bad it was to kind of fully help her understand and for this close person, it was worth it to me to to go into depth. But I think, as we've talked about before, too, finding kind of those, those circles of people, when is it worthwhile to share the depth of how hard it is to care, give or live with it? I think

Scott Benner 14:38
I've seen in the past too, where people make that decision, like, here's a person I'm going to share this with, and then when that person's not understanding or receptive, it's heartbreaking. I've seen that happen to people a lot like, I am going to share this with a very good friend who ends up just treating it flippantly or it makes them uncomfortable to hear about your struggle, which is. Probably more we all can't go to therapy. Trust me, everyone would have to be a therapist for us all to be okay. We'd all need one. But if you open up to a close friend who you think is gonna have your back and understand this, and they, for some reason, don't, it's tough. I've seen friendships end over stuff like that, you know,

Erika Forsyth, MFT, LMFT 15:18
absolutely or even family members, right kind of pulling back and withdrawing as a result of your attempt to try and under explain what's what it's like, yeah, so we're kind of already transitioning into, you know, what can you do with this feeling of isolation, of stigma, of kind of not being totally you know, your your work is unrecognized and underestimated, and it can be it can be challenging, right? Like, based on what we've already talked about, you you don't want to be a burden to other people. Can you trust the other person? Are you naturally an extrovert? And you can confidently, and that's just kind of how you are. You're able to talk and process, and you can understand where your needs end and the other person needs begin and end. Are you introverted and feeling like, if you are sharing with other people? Does that take a lot of extra effort, energy, risk? Does it feel scary? So just wanting to to note that like, based on your past experience with being vulnerable and also your personality can contribute and exacerbate or help those feelings of isolation.

Scott Benner 16:25
What do you do if you have a personality that's not going to let you make that connection, but you still need that, right? You still need to do that for yourself. How do you find a person to do that with?

Erika Forsyth, MFT, LMFT 16:35
If going publicly or in person feels too scary, you know, I see more and more people posting anonymously right in the in the face, in the Juicebox Facebook group, which I think is fine if you feel, if it feels like, Oh, this feels too scary to share who I am or my identity, seek help. Keep it anonymous. Seek help in you know, whether, if you can't, go to therapy and other support groups, keep your screen off, right? Those are kind of more the virtual tools that I'm thinking about. If you lean more introverted, hopefully you have found, over time, those one or two safe people that you can trust when

Scott Benner 17:14
Facebook offered the anonymous posting in the private group, at first, you know, we were like, we can't let this happen, because it's going to open people up to getting scammed, right? Like, you know, if you can be anonymous, yeah, and scam somebody. And I was like, thought about it for a while, and then I came to the conclusion you did, which is, it's going to be extra work, and it's, it's, it's going to suck, like, it's, it's extra moderating work, but I think it's really important, because I kept imagining like there are some things I read and I think, why does this need to be anonymous? I can't, from my perspective, understand why this needs to be anonymous, but from their perspective, it does. So who cares that now this allows them to say it out loud. I think it's a great tool, because of that. Yes, it really if you can't walk into an in person meeting, or you can't or won't go to therapy, and you still need to say it. And the posts are, I mean, you see them too, right? Like, I just want to share this success that I had with somebody. Like, you're the only people who are going to appreciate how hard it was for us to get the standard deviation from 160 to 120 Yes, excuse me, I from, I don't know why I use that number. The the average blood sugar from 160 to 120 not standard deviation. And you can see, like they're just thrilled to tell somebody. I don't even think they care if anybody replies. They just want to be like, hey, world, look, figure this thing out, you know, or I'm struggling with this thing. Yeah, right. Just saying it helps,

Erika Forsyth, MFT, LMFT 18:37
saying it out loud, and not necessarily needing the response. And that takes courage, right to be vulnerable and knowing in the Facebook group it's already it's a safe place, because, you know, you can go do that, and that's what to be expected. It can feel really scary doing that, you know, quote, in real life. And so I wanted, I think it can feel just going back to like, you know, I feel like it's, it's a privilege, a that I could reach out to you when I was going through this DKA like experience. And my brother, who has type one, I have that, like, that's my little, you know, community. And not everybody has that.

Scott Benner 19:15
How was it helpful to you when we spoke? Because I felt like I was just listening and mirroring and, like, I brought up a couple of things, maybe. But like, it's not like you were like, Oh dear, oh my, I don't know what happened you had diabetes for like, what do you get diabetes? Like, 35 years

Erika Forsyth, MFT, LMFT 19:30
or 34 years? Yes, yeah. But this was a first time experience.

Scott Benner 19:35
You were I was listening to you process what had happened to you, and then what were you doing? You were looking for a sounding board that you could trust to see if you were thinking about things correctly. It was that what it needed to

Erika Forsyth, MFT, LMFT 19:47
be. Yes, I wanted to be, not only validated, validating that it was, it was a scary experience because I hadn't gone through it before, and I thankfully got that from you and my doctor and my brother. And then also wanted. To learn, how could I have done things differently, like have ketone strips on hand?

Scott Benner 20:06
Yeah? Erica owns a ketone meter now. Yeah,

Erika Forsyth, MFT, LMFT 20:10
yeah, to kind of learn and say, when this happened, maybe should I have gone this way or that way? So to be without having to explain to you or to my brother or my doctor what DK is like, or what you're experiencing, right? There's already that known entity. So to have that conversation with you, you have a lot of experience hearing people's stories and obviously, Arden's life journey. So to have that from an experienced there's no shame from any of the people that I connected with, also, like you should have done this. Why didn't you do this? Right? Yeah. And I think sometimes when you're scared, not really knowing what to do, and this happens a lot at the beginning of your journey with diabetes, but also 34 years in, something totally random happens, and it can feel scary,

Scott Benner 20:56
sure. And talking to me is nice, because I'm like a therapist that curses, yes, all the listening, none of the nice stuff that sometimes makes people uncomfortable.

Erika Forsyth, MFT, LMFT 21:08
Oh well, I think I mean just the validation and the support and the education. And I was really grateful for Scott for your time in that. And I think if you're listening to this and thinking, Well, I don't have a brother or a family member with type one, or I don't have Scott's direct number, or my endo isn't that supportive. I just want to validate that if you're here thinking or feeling that, and there might be somebody else out there, whether it's in the Facebook group or somebody a smaller group, but we're going to get to some of these different entities where you can maybe connect and find those two or three people to be in a text group with. Yeah,

Scott Benner 21:44
no, you just need somebody honestly there. I've seen people do it all different kinds of ways. Go over some of the things that you think are great, and I'll fill in things I've seen that maybe aren't on this list. Okay,

Erika Forsyth, MFT, LMFT 21:53
so, you know, as as we were saying, you know, to take that courageous step, to be vulnerable, like I didn't know, just go sorry. To go back to my brother. Example, I shared this moment with him, and then he was able to say, oh my gosh, me too. I just had this scary thing happen with the low and my wife, you know, when he shared his story and we talk diabetes, sometimes, not all the time. And so then I was able to listen to Him and hear him. And so there's just this beautiful moment when you are taking that courage and to be vulnerable in a space that feels safe, that often gives the other person the opportunity to be vulnerable as

Scott Benner 22:29
well, so be ready to offer what you're asking for in return. Possibly, yes, it's

Erika Forsyth, MFT, LMFT 22:35
beautiful. It's a beautiful exchange. Obviously, we know the Juicebox Facebook group. You guys know that it isn't a great resource and safe space, and as we talked about before, I think in the previous episode, I've seen people say, Hey, I live in such and such ZIP Code who wants to get together this Sunday at the park. So to kind of bring that larger group into a smaller personal perspective or group environment is really helpful, touched by type. One has monthly events. And they actually have, I don't know this is probably going to air after, but they have their dancing for diabetes show that, which is an amazing connection. And they also have monthly local events. You're just my type. They are mostly la based, but their whole mission, and I'm going to read this from her website, is to create a world where all individuals with type one diabetes feel empowered, supported and connected. She Laura is the director, creator of this group, and they have a lot of La meetups, but people from different caregivers and children and adults, most of their in person meetups are in the west coast. In LA, I think she had Seattle, she had New York, and then there's one coming up in London. I believe in January.

Scott Benner 23:56
Yep, I see it January 11. This should be out before then. Okay, yeah, I don't know the organization, but just, you're just my type.com,

Erika Forsyth, MFT, LMFT 24:06
yes, yes. Also on Instagram and probably Facebook, you're just my type, yeah.com, the next one is, let's see type one together. They have a diet buddy list, kind of similarly to what I see doing happening on the Facebook group. They're like a, they're trying to create, like a national registry list, I guess, if you will. And so you can go on, I think it's free, add your address and also learn to see who people you know, which families are near you. Those are some of the main ones that I know of. Before we go into this next point about the positive messaging. Were there other groups or things that you thought would be helpful

Scott Benner 24:49
if you or a loved one was just diagnosed with type one diabetes? And you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place. Art that series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl. Beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player. Or you can go to Juicebox podcast.com and click on bold beginnings in the menu. Well, I know people listening who have extensive WhatsApp texts set up with people with diabetes, which is awesome, right? Like hundreds and hundreds of people in a whatsapp chain, and they just talk about diabetes stuff. I think if that's the thing, you could get started with a handful of people, I think that would be a big idea. Big thing to do, too. I mean, you could do it with text messaging, obviously, if you wanted to, but just a place where you can drop in and say something that somebody might quickly get back to you about it. My private Facebook group is, it's so big as far as membership and posts go that you would think like, Oh, my post is gonna get lost. But it just usually doesn't happen. There's always somebody online, always somebody looking. And I think a text chain, if you can find the people, is another way to accomplish that. So WhatsApp text chains, beyond that, I have to tell you, I'm just so head down, doing the thing I'm doing. I don't know as much about other things that are going on as I probably should. I would

Erika Forsyth, MFT, LMFT 26:27
say, you know, even attending the local, you know, breakthrough, T, 1d summits, if you can connect with people there, or any of the conferences that you attend, finding and connecting with like a small group, right? So, and I know caregivers who have you know their diabetes caregiver text chain, just like your child might have their diabetes text chain, to have kind of that maybe more immediate result that you're you might be looking for a response, yeah? Also camps. Well,

Scott Benner 26:57
camps a great idea, if you can find a great diabetes camp that's a the people who have a good experience at diabetes camp have an awesome experience at diabetes camp. And I think there are some people who just aren't camp people. Or sometimes find a camp that's, you know, doesn't end up being great. But overwhelmingly, from what I hear from people, they they love their camp experience. I was going to say, though, if you go to a local event. Breakthrough two on the event, I would just not caution you, but remind you that you're probably going to meet a lot of newer diagnosed people. So, yeah, you're looking for a sage advice. Kind of person you're gonna you might be a lot of people standing around, going, I need help. You know, me too. What a nice way to meet people who are newly on the path you're on, because at least you're all kind of step by step, you know in sync with what's happening right now, and then you guys could grow and learn together too, which would be awesome, yes,

Erika Forsyth, MFT, LMFT 27:47
and that can often be part of your own healing journey, as you support maybe a more you know, newly diagnosed family, even if you're six months a year ahead of them. I often hear of parents saying, Wow, I didn't realize how much I already learned and knew, and we were just there. It feels like yesterday, but it was a year ago. And then you kind of have that ability to gain that perspective also, yeah.

Scott Benner 28:10
Now I say all the time, when I meet people who are really struggling in the beginning, I say, look, here's some fundamental tools that will help you. Here's some places to learn about more. And a year from now, you're going to look back and not recognize yourself from today probably sounds like bullshit when I'm saying it to them, but a year from now, you look back and you go, wow, I have learned so much. I didn't realize you don't even know what there is to learn. So you can't even imagine making such a leap, you know? But then when you do, if you are, yeah, it's funny. You put it the way you did, because I used to describe what I do. I'd say to people like, look you're looking for someone ahead of you who's already been down this dark path. Knows where all the holes are, all the sticks to trip over and can, like, just look back at you, shine a light and go, Oh, look out. Look out for that. Like, step over that. Go around this. You might want to do it this way, and you know, you'll get you get to that point two, so you could be that person, or somebody in a Facebook group, in an in person group, you could show up at an event and stand up and share your experience. I think there's an unending number of ways, once you're in the ecosystem with other people, everyone's story is really valuable at that point.

Erika Forsyth, MFT, LMFT 29:19
You know, yes, absolutely. And if you are able again, it might take some courage, some effort, some time. And I know when you're exhausted and feeling like, how could you do one more thing to then find and reach out to other people and create this group? There's so many benefits. And I just thought it would be interesting to share this recent study. They took groups of parents, and they were going to give one group of parents just positive messaging about parenting in general, and then the other group was going to get specific diabetes messaging about management. And encouragement. And so they looked at the and then when they got messages via text and Facebook Messenger, yeah, basically the parenting group that received the diabetes specific positive messaging reported higher levels of disease management, more satisfaction, and their perception of burden was also decreased that they reported. And so I just thought this was such, you know, I think it's so great to have all these the Facebook group, your Whatsapp group, your text group, your in person support group, to validate how hard it is, because that helps us decrease that isolation and stigma, right? Like, that's really important, but also to have these positive messages to send to one another randomly. Like, for example, one of them was, you know, being a parent of a child with type one diabetes. This is 24/7 365, job. Be kind to yourself. You're doing great, just randomly. You know, sharing that with your with your group, with your family, whatever is your support group, can be really effective. And you can also do this for your child. I

Scott Benner 31:10
have an example this from today, so I'm in an unfair advantage. A lot of people send me notes, so I usually have, no matter what we're talking about. I normally have an example from the last couple of days. So I will leave this person's name out of it, but let me read this and says, I've been a member of this group, and they're referring to the private Facebook group for the podcast for a little while, but I have never listened to the Juicebox Podcast. I've never been a podcast person, and usually my ADHD doesn't let me sit and listen to something for a long enough time, but I've seen so many people share about how the podcasts help them to take control of their diabetes, so I decided this week to give it a chance. This week, okay, my daughter is five, was diagnosed recently. Since then, it's been a constant roller coaster of highs and lows, and I felt like we couldn't get a grip on her blood sugar at all. And then this person includes two photos their Dexcom clarity reports. It says this first picture is an average data from the past two weeks time and range, 59% average glucose, 170, the second one is just over the last two days since I've been listening to the podcast and making changes that are suggested in the show. Time and range is now 93% and the average glucose is 116 so this person says, I don't want to do this. It's not for me. I have ADHD. I'm not good at podcasts. I don't list the pie as all the reasons in the world not to listen, right? But being in the group, and then this is my point, watching other people share what's been working for them. They finally go, all right, you know what? Let me try to overcome myself here and try this anyway, and look what happened for them. And that's why I'm always a proponent of people sharing what they're doing that's working. Because there are so many people who can't, for any number of reasons jump in. And I've heard the argument, you make people feel bad when you share how well you're doing. I make the argument you are a hope for that person when you're sharing. I think eventually somebody says, My God, they're doing that. I could do that too. I watch it pay off all the time. You don't want somebody to feel bad like you don't want somebody to look at a 116 average glucose and think, Oh, I can't get this accomplished, but at some point you got to do something. And so I say, go out there and share. Be kind about it. Be understanding about it. Don't be very Don't be like, Oh, look what I did. Like, it's not boasting. It's like, there's a way to do this. Like I did it. Like you could do it too. Anyway, I'm a big fan of that idea, and

Erika Forsyth, MFT, LMFT 33:41
she was sending, you know, a positive message to you, but also just and she chose to, I don't know if it was of those public or private, but like, what a great moment. It was private. No,

Scott Benner 33:54
no, no, this was a public post. Oh, okay, okay. I mean, in the private group of public posts, but I'm not giving anybody's details, right? But that person, like, I didn't read the end of it. The end of it is, if you have doubts about the podcast, erase them. It really does help. Like, so now this person realizes, Oh, I've been helped. I'm gonna go help somebody else. And, like, it's nice to tag me and say, Thank you, but that's not that post is, if you're like me and you think this is impossible. It's not. I just did it and I didn't know what I was doing two weeks ago. That's pretty awesome. You know what I mean? Like? So you can be that person listening right now. You can be that person for somebody else. And, you know, yes, that's all I that's how I think of it, instilling

Erika Forsyth, MFT, LMFT 34:36
hope, very important. And she, and she was being vulnerable, right? So she led with vulnerability, and that took courage, and she did something new, and then is instilling hope. And I think that the positive messaging, whether it's you know, publicly in that, in the Facebook group, or privately to your you know, your small debt. Diabetes text chain or to your child is so powerful. And again, I It's okay to validate how hard it is, that's half the work, right? But then to also acknowledge, wow, this is you guys. You're doing a great job, and we need that, you know? We need that encouragement and hope.

Scott Benner 35:17
I also think we do a very good job in the group of exactly know how to do it, because it's not like we're enforcing rules. It's just, I think I have set the tone for what the group is. And so when it was smaller, it took on that vibe of, you know how I am, which is to say, like, I want to be supportive. We're not here to like on people or tell them to do anything wrong. We're not going to tell them how to eat. We're not going to tell them how to manage their diabetes. We're just it's the supportive atmosphere the group built up around the idea of being a supportive atmosphere, and then as it got bigger, somehow it held on to that. I still don't know exactly how, but that doesn't mean that sometimes people don't come in in a bad mood, they don't come in at drunk o'clock, they don't come in when their blood sugar is real high or real low, or they don't see something that tears at their belief system so heartily that they have to they fire back a little bit, right? And people's communication skills can, you know, can vary, and so sometimes somebody's not trying to be harsh, but it feels harsh. Or someone, you know, there's a lot of different things that happen, but we try very hard to deal with those things in the light of day. We don't just, like, remove your like, it's not like, Oh, that was shitty, and just remove, like, you jump in and say, Hey, were you trying to say this? Because it feels like you're doing that. You know what I mean, like, and if you did, I think if you just take out the WoW at the beginning, like, you know, maybe you know, don't let people feel like you're judging them. This would be really valuable. And I'm going to tell you why this is important, and I say it out loud all the time, because there are more people here lurking around than are typing in this group. And those people are waiting for their moment to be that person from that note. They are waiting to jump and go like, I can do this. I'm going to do it. I'm going to do it. And I don't want them to spend six months getting to that point where they're like, Yes, I'm going to do it. And then on that day, they get on Facebook and see you waving your shit stick all over the place and decide to go back in their hidey hole for another six months because the world's a scary place, and I don't want to get involved today. That group is about helping people. That's the only goal it has. It's the only goal I have for it. It's the only goal I have. And if you're going to do something that's going to stop people from being helped, then you don't get to stay right, like so it, but you got to just be nice. I'm so scared they'll leave, and then they don't get to have the the, you know, the experience that this person just shared with you from a one? I mean, imagine a five year old kid. Can I be honest with you? This person posts this thing about that kid, and I read it and I go, Oh, that's cool. Podcast doing what I expected to do. Facebook group worked the right way. They were here long enough they saw it, they jumped in. They learned they're doing better. This is awesome. I'm not cold to it, I just see it a lot. So I was like, All right, great. It worked for them. And then I don't know what happened, I think it was sitting here editing, and it was still up in front of me, and I clicked on the person's picture, and it was a husband and a wife with like, two or three young kids, and I got so filled up, I thought, oh, that kid's gonna have a better life, you know, and they're going to have a better life, and they're going to sleep better, and they're going to be happier, and, you know? And then I just got, like my I got very So Erica. The reason I say this is my eyes filled up, and I want to ask you a question, because you're a professional. Are we at the end? Because I can ask

Erika Forsyth, MFT, LMFT 38:36
my question at the end, you have more. I always had one last point resource. Then I'm going to ask my question. Go ahead, I but we're interrupting your your beautiful, heartfelt story. I just wanted to point to which I think we've done before. Also, if it's feeling impossible to find your group or your people, you're reaching out. Obviously, therapy is a great way to do that, and the ADA mental health directory has a list of people who either have diabetes themselves, they have experience working with people with diabetes, and they also have had to take a behavioral, behavioral diabetes health class or a course to be approved to be in this directory. In the past, it has been you could only search by zip code, which has prevented you from finding people increasing the search?

Scott Benner 39:22
Yeah, close to you, but not in your zip code. Yeah, yes. Hopefully by

Erika Forsyth, MFT, LMFT 39:26
January, they will have a renewed filter just to search by state, so you hopefully will have more people to access to go through that list. Just wanted to share that my.diabetes.org/health-directory

Scott Benner 39:39
Yes, but ADA mental health directory if you're Googling Yes. Okay, so here's my question. My girls took me to that movie with the boy that used to be Spider Man and the girl from Black Widow. Again,

Erika Forsyth, MFT, LMFT 39:53
I will not be able to

Scott Benner 39:54
hold on a second. I'll figure it out for you. Hold on a second. Do you think if I typed in boy? I. Who used to be Spider Man and the Black Widow girl. Let's see if I come up with it. No, but in 2023 an eight year old boy in Bolivia was bitten by a black widow spider because he wanted to become spider man. Get out of here. Is that real? Oh, my God, Dear God, that's not okay. Look at this kid. Oh, that's so, yeah, yeah, little neck. That wasn't gonna work. Okay, hold on a second. Instead, I'm just gonna, I'm just gonna go to Rotten Tomatoes. Where is this move? I mean, they took me to this movie. It was just recently, yeah, yeah. It was like, Jesus. I don't know I I'm embarrassed. I saw this movie, like, a week and a half ago, and I don't remember the title of it, but I did. Why can't I remember the title of it? This is terrible. Also, why is it not where I want it to be? How come nothing works when I need it to work? Damn it.

Erika Forsyth, MFT, LMFT 40:49
It wasn't mo I can start listing Moana too.

Scott Benner 40:55
These are epic. This is a cancer movie, honey. You're gonna get to it just like that. Everybody had can't, like the people like cancer in the movie. What is this? What is it? What was it called? It had the word time in it. All right, I'm getting closer. My brain is coming back. I sound like I'm 1000 years old. Hold on a second. And it was Andrew Garfield.

Erika Forsyth, MFT, LMFT 41:13
I'm getting to it. Oh, we live in time. Is that what it's called? Well, I don't know. That's just a movie that has time in it.

Scott Benner 41:22
We live in time. Yes. Andrew Garfield and Florence Pugh, okay, I'm not gonna ruin the movie for you. Florence got cancer. Okay, you know you're like halfway through the movie, and it turns out Florence has the same kind of cancer that killed my mom. So it hit me pretty hard, right? But I bucked up. I held myself together. And I just want to say that I was in a theater. It was me and 350 ladies and like, five guys who were just too good of guys not to come. You know what I mean? Like so. But I just want I just

Erika Forsyth, MFT, LMFT 41:52
would have been okay. Had you cried, you would have been okay. No, no,

Scott Benner 41:55
wait. So a couple of times to the movie I get, like, filled up, where I will describe to you that my eyes were glassy, but water did not go down my face. So when the movie ended, by the way, this is what happened when I saw the person's picture their family. This is why this came up. So when the movie ended, my lovely daughter, my wife, who just are dying to make fun of me for crying, because they know I cry in movies, they turn to Me. Movie ends. You would think people would say, Hey, are you hungry? Do you want to get this to say, we have to go to the bathroom? No, right on me. Did you cry? Right like that? Okay, so I say, No, I didn't, but I got filled up a number of times, and my wife goes, Yeah, that's called crying. And I said, No, I don't think so. I think crying is when water drips down your face and you go like that a little bit. I didn't make that I didn't make that noise, and no water went down my face. So you're a professional. Was I crying? Yes, I was

Erika Forsyth, MFT, LMFT 42:49
right. Your tear ducts, your tear ducts, were releasing tears into your eyes. You just worked hard on not blinking.

Scott Benner 42:56
Erica, it's okay. Let's say it wasn't natural and normal. They said the same, oh, good, good. But I don't think I attribute crying to the noise you make when you can't breathe because you're crying. Does not everyone cry like that, like when they're real? I don't cry like that. Often. I

Erika Forsyth, MFT, LMFT 43:14
see a lot of people who silently cry, really, just, yeah, just your tear, your eyes get watery, and then they just, they slowly

Scott Benner 43:22
pour out. Okay, well, I'll apologize to them, because then I was crying. I mean, if you say and you are professional, you went to college and everything, also, we never talk about it, but you went to a really good college, so I believe in you. Oh, thanks. So anyway, when I clicked on this person's picture after they sent me this note, I got real. I got filled up. I was like, and not for the reasons why cynical people would think it's not because, like, oh, I helped them. I didn't have any of that thought. I just felt really happy for them. Because I know where this can go, and I know how much easier it is if you find other people to share the burden with, and you ask for help from people who are ahead of you on the path. And so I just was like, Oh God, good. It worked for them, because I see too many people who resist that, right? They resist this thing we've been talking about for the last 45 minutes, and then they either never find their way to it, or eventually, begrudgingly get drug to it and end up saying to themselves, I wish I would have done this sooner, you know. So I wish you would all just go out there and any of the things that Erica brought up that might help you find connection or ideas it is really, really worth your time, and I think would alleviate the burden that you feel as a caregiver. Yes, yeah, okay, well, go do nobody listens to me. So, I mean, you know, just go help yourself, damn it well.

Erika Forsyth, MFT, LMFT 44:45
And I think what that what you were just reflecting upon the story as you're seeing the picture of the of the family, the little girl you were, you felt filled up because you also had the joy of giving like you through your work. Through your podcast. I know you're not saying this to get these pads on the backs, but like that's the gift of giving that feels so joyful. And I think even in this space of when you're struggling and feeling so unrecognized, you're so exhausted, the stigma you're experiencing is so hard. It feels Hey, it's physically and emotionally difficult to reach out and say, I need help. Can you please help me? I want to, I need to be vulnerable, but that feels scary. But then, in return, you might also be able to reciprocate and give that to somebody else. And that is so powerful. So it's if that helps you move through that space of like, I don't want to, I don't want to be a burden to somebody I don't want to, you know, share all the stuff that feels so hard they're never going to get it and they might not, but also, you're giving them that gift of your vulnerability so that they might be able to respond to,

Scott Benner 45:51
yeah, you don't realize I'm in a unique position to share with you that that recharges me, right? So then when I get back up next week to do this again, like, this podcast been gone for 10 years, like, at some point you think I might just get up and go, Hey, you know what? I'm gonna go get a different job. I don't feel that way. I know this works. I have it set up in a way that it works. And there are going to be new people tomorrow who need it again. And there are going to be people who found it two years ago, who I hear from that they they lose their way again in the future, and then they find their way back through this. This place is a, you know, it's a it's a touch point. For some people, after they've been here, they can come back to it. And so you guys give me the energy and sometimes excitement that I need to make the podcast, and not that I don't like talking to people like that. The truth of it is, if you told me I had to have a conversation with a stranger every day for the rest of my life, I would just easily do that. I would love that, even if they didn't record it. Actually, if they didn't record it, be much better, because I could, you know, enough to be as appropriate and so, um, you wouldn't have to filter. I would. I could just curse way more is what I'm saying. So like, because the cursing is, then the guy's gonna edit it out, it takes time, you know, like, I pay by that minute, like, you know, I don't want to make it sound like I don't want to do it. I absolutely want to do it, but I'm still a person, and I still don't feel well some days and some days I have other stuff going on. And, by the way, I have a kid with diabetes too, and, you know, like, that doesn't become, you know, that doesn't just go away. So I get this feedback from people, and I'm like, Yeah, this is valuable and worthwhile, and it makes me feel better as a human being, like, I don't know another way to say I used to tell people that I was not a Chicken Soup for the Soul person when I was growing up. And as a matter of fact, if you've listened to this podcast and thought this is a good guy, if you would have met me when you were like, I was like, 23 you would have been like, this asshole is not going to grow up to help people with like, diabetes. Like, that's not going to happen. He seems like a prick. I did not have my head in the space at all. And yes, I got into it to help Arden, but I stayed into it because of everybody else, right? Like, she's been helped. Arden is good, and I still learn about diabetes through other people. And even that's not the whole thing, like, the whole thing is just, I somehow, I don't know how created. I don't know, like, a like, a planet of like, where the gravity pulls people in, and people who need it find it, and then they're allowed to fly away when they don't need it anymore, and that's hard to do, so even though you brought up other places that are great, that help people, but those places could work for a decade and never achieve the mass appeal that the podcast has made. So while I have this year, I want to do as much good with it as I can. But the reason I said that is because all of you can go do that thing, you know? I mean, if this podcast is the sun, then you guys could the earth. I don't know a lot about astrology, not astrology. What is it? When we talk about planets, obvious. I don't know a lot about it. But if this, oh my gosh, if this podcast is, is Earth, you guys could be moons all around it, like doing, that thing on a smaller scale for five people, 10 people, 20 people at a time, and that would be, trust me, you would feel the exact same way I feel when someone came back to you and said, This thing you shared with me really helped me. So go, go out in the world and do nice things, please. And it'll get rid of your burden too, which is what we're talking about today.

Erika Forsyth, MFT, LMFT 49:19
We're talking about planetary science. That's Is that what it is the study of planets, planetary science. Scottie

Scott Benner 49:26
slept through that one too. I just want to let you all know that you've been listening to a podcast for 10 years from a guy who barely made it through high school, I mean, and it was because I was asleep, like on my desk, face down, in case you're wondering, just slobbering on on one of those blue notebooks. They don't make any more that, like jeans, you know, what a year old? You know, yes, yes. Not as old as of course. But anyway, nearly are we going to keep doing this? Do you think there? Do you think there's more content for burnout? Or do you think this is going to be a nice, little, contained series?

Erika Forsyth, MFT, LMFT 49:57
I think this could wrap up. You know, this, the. Like the caregiver, the burden, the burnout. I'm sure there are more hot topics that we did not address, but my hope is that these themes kind of encapsulate all of what you do experience on a minute to minute basis. But certainly you can let us know, well, I'm

Scott Benner 50:17
sending you back into the world Erica then to have another great idea for the podcast. Thanks so much for doing this. I appreciate it.

Erika Forsyth, MFT, LMFT 50:23
You're welcome.

Scott Benner 50:33
Omnipod five sponsored this episode of The Juicebox Podcast. Learn more and get started today at omnipod.com/juice box. Links in the show notes, links at Juicebox podcast.com, are you starting to see patterns? But you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would, I think I see something here, but I can't be sure, once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 Hey, what's up? Everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you. Wrong way recording.com. You got a podcast. You want somebody to edit it. You want Rob. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#1401 Beta Bionics (iLet) Clinical Services Director

Kelly Postiglione Cook, Director of Clinical Services for iLet (Beta Bionics) answers listener questions. Kelly holds a Master of Science in Nursing from Vanderbilt University, is a Certified Diabetes Care and Education Specialist (CDCES), and board-certified in advanced diabetes management (BC-ADM).

What makes the iLet pump different from other insulin delivery systems?
How does it handle meals, highs, and the unexpected?
We’re answering your questions about this new approach to managing type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I have a treat for you today. Kelly, who is the Director of Clinical Services at beta bionics, is here to talk about the eyelet insulin pump, and she's going to answer every one of the listener questions that you guys sent in. Thank you so much for doing that. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d exchange.org/juicebox, and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa. This is the way t, 1d, exchange.org/juice, box. It should not take you more than about 10 minutes. This episode of the juice box podcast is sponsored by us Med, US med.com/juice, box, or call 888-721-1514, get your supplies the same way we do from us. Med, this episode of The Juicebox Podcast is sponsored by ag one, I start every day with a delicious drink of ag one, you could as well drink. Ag one.com/juice,

Kelly Postiglione Cook 1:57
box. My name is Kelly postiglione Cook, and I am the Director of Clinical Services with beta bionics. Wow, is that a hyphenated name so well, it's technically two last names with all the nursing licensure and whatnot, it was an easier route to go that way. I'm proud of my Italian roots. I was gonna say that in there. Did

Scott Benner 2:16
you grow up with postic Leone is your last name? I did. Wow, that's awesome. I've never heard that name before, and

Kelly Postiglione Cook 2:23
I'm a southern Italian too, so pronouncing that was a bit of a nightmare growing

Scott Benner 2:27
up. It's absolutely awesome. Not often do people say a name, and you think I've never heard that before, but that's really that's wonderful. I really appreciate you Kelly, coming on and doing this with me. So we have a ton of questions from listeners about islet before we start with people's questions, can you just tell me a little bit about your path to the company and what you do there?

Kelly Postiglione Cook 2:50
Yes, well, I guess it's kind of a long, long, long path, if you think about the nursing background and all of that. I got into nursing after being an exercise physiology several years back, when I started getting into healthcare, I thought I wanted to do physical therapy, and kind of quickly realized that I wanted to be involved in medication management, and ended up going the route of nurse practitioners. So I got my NP from Vanderbilt University in Nashville. So I started out working in an endo clinic as a registered nurse before I finished my MP, and I just loved it. There's so much detective work and endocrinology, you know, you do a lot of trying to investigate and figure out what's causing certain symptoms, and even the same thing with diabetes management, there's a lot of Q and A and trying to figure out how to help people, you know, meet their their personal goals. So spending time as an RN in an endo clinic really kind of opened up the world of of diabetes management to me, and I had a great physician that I worked with, Pascal do fan, who's outside of Nashville, who's just a really great teacher. So once I finished up my MP I stayed in the outpatient diabetes world for a few years. Then I did some inpatient diabetes management, health diabetes management, and ended up moving into industry after that and working with an insulin pump company as a clinical rep. So actually, you know, training patients on the device and going that route, did some sales and diabetes tech as well, and then got into clinical leadership a few years after that. So I've worked with tandem diabetes care, companion medical, and then came over here to beta bionics in June of 2023, so right when we were launching this product, is when I came on board. And I'm here because of Ed Damiano, Steven Russell, their mission, the time that they spent putting into this project, and really their why behind it is why I'm here,

Scott Benner 4:48
what attracted you, and I'm guessing too, the there's got to be a connection between Sean and you, right? If you were a companion, is that? Right?

Kelly Postiglione Cook 4:56
Yeah. So he was at, we were at tandem, overlapping. The same time frame, and then companion medical too. He's just brilliant. He's a brilliant guy to work with, Mike men, singer, our Chief Product Officer, the two of them together are just outstanding. They move fast and furious and really do so much for the diabetes community. It's just it's a really fun place to be and a really great mission to be behind awesome. So that's kind of my why for being here.

Scott Benner 5:22
That's excellent. Mike came through Dexcom, right? Am I remembering that right? Yeah.

Kelly Postiglione Cook 5:26
Mike was at Dexcom, and he also was a co founder for companion medical.

Scott Benner 5:30
Gotcha Okay, all right, I'm putting all the pieces. I feel like I'm solving a mystery, and there's yarn on my wall. Does anybody watch only murders in the building? Or is it just me?

Kelly Postiglione Cook 5:40
That's funny. Fun fact, my dad was a homicide Sergeant in Nashville for about 30 years. I think that's why I like the detective work of diabetes management and also endocrinology. Oh,

Scott Benner 5:53
tell your dad if he wants to start a podcast with a guy who doesn't know anything about it, I'll host it and he can tell his stories. That'd be awesome. Oh, oh, my God, He must. Is he still with us? I'm so sorry. Yeah, he

Kelly Postiglione Cook 6:03
actually did. He's done quite a few podcasts. He's the pro with this type of thing, not me. That's awesome. No, no kidding, yeah, so some of that and a show on the ID channel at one point.

Scott Benner 6:13
So cool. All right, okay, so fun fact, yeah, no, that's really wonderful. All right, we're gonna get to it here. So why don't you tell me where the device is right now, meaning how it works for people who don't know, and you know day to day how people use it. Yeah. So

Kelly Postiglione Cook 6:32
where we are currently. We have an insulin only bionic pancreas. So the device itself is fully autonomous insulin delivery, meaning that the system determines 100% of the insulin dosing for the user, and it does that through the work of three separate algorithms that work in conjunction with each other to get the user to goal. Hopefully, those three algorithms, I know you guys have talked about them on previous podcasts, but just as a reminder, you've got a basal algorithm that's going to modulate every five minutes, layered over that you have our corrections algorithm, which I think really sets us apart from other devices on the market, because it's a really it's got strengths to it. So if a user you know forgets to announce a meal or has a snack that's not covered, that sort of a thing, our corrections algorithm can really provide that, that safety net for them, and also work with those postprandial highs as well. So the corrections algorithm is truly a separate algorithm layered over that, that basal algorithm, and again, can also dose up to every five minutes as needed. In addition to that, you've got the meal announcement algorithm, so that will determine the user's meal needs based on their usual size, breakfast, lunch or dinner. Meal announcements, those three work in conjunction with each other, and the device itself doesn't ask the user to specifically carb count. It asks them to be carb aware, which means, you know, you're aware that a bowl full of spaghetti noodles, for example, is going to be higher carb than, you know, two slices of bread on a turkey sandwich. So just being aware of kind of general amounts of carbohydrate, how

Scott Benner 8:07
does it handle fat, and the impacts of like fat and protein,

Kelly Postiglione Cook 8:11
that's actually been a really interesting thing watching this system work, is you don't have to make any adjustments for that so that corrections algorithm will come in after a meal is announced and doses received for that so if a user is absorbing carbohydrate more slowly in that postprandial time frame, that corrections algorithm will come in as needed with the strength that's needed. So you don't ever have to adjust an announcement or the timing of that announcement based on the fat or protein content of a meal, which is relieving for people who've had to worry about that before. Yeah,

Scott Benner 8:47
in a situation where it doesn't work out, like, for whatever reason, and we see, like, a stuck high blood sugar, I'm right to say, there's no ability for the person to just, like, say, correct like, there's no ability for them to give themselves a Bolus, even, right? And you don't want them announcing fake carbs. So how does that get handled? I used to hate ordering my daughter's diabetes supplies. I never had a good experience, and it was frustrating. But it hasn't been that way for a while, actually, for about three years now, because that's how long we've been using us Med, us, med.com/juice, box, or call 888-721-1514, us, med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. Us. Med. Carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7 they accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with a better business bureau at US med.com/juicebox, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do. I have two resolutions for 2025 keep doing what I'm doing. So that means drink AG, one and get on a rowing machine the AG, one thing that's going to be easy, because that's every day. It's super simple, and I enjoy it. I'm hoping I get myself on that rowing machine. The way I'm trying to think about being healthy is by creating a sustainable pattern to my day. Get up in the morning, drink, AG, one exercise, shower, get ready for work. I need a routine, and it's never too late to start that routine. You can start today with ag one. And ag one is offering new subscribers a free $76 gift. When they sign up, you'll get a welcome kit, a bottle of d3, k2, and five free travel packs in your first box. So make sure to check out drink. AG, one.com/juice box to get this offer that's drink. AG, one.com/juice, box to start your new year on a healthier note.

Kelly Postiglione Cook 11:30
That's a great question. You're correct in that you should never use a meal announcement to correct for a high glucose value. So with the corrections algorithm when you're using fully autonomous delivery. That doesn't mean you're never going to have higher low glucose values. Those will still happen, and if there ever is a high that's lasting longer or higher than the user is really comfortable with, you definitely want to make sure that the infusion site is not bad. We have an alert on the device for high glucose. If you're above 300 for 90 minutes, we would ask that you check the integrity of the insulin site and make sure that or the infusion site, and make sure that that is not compromised, because it's pretty rare that you're hitting that value for that time frame using the islet, because the corrections algorithm does have strengths to it, and it will work to bring the user down. Now, if you see someone who has a high glucose value after a meal, let's say maybe the meal announcement, you know, wasn't sufficient. There was, you know, maybe it needed to be a more than usual, but it was announced as usual, something along those lines. I completely Can, can sympathize with that. It's frustrating to see a high glucose but because the the corrections algorithm has some strength behind it. You don't want to intervene because you've got insulin on board. It's already come in, and it's doing that work for you. One of the things Dr Russell says, our chief medical officer, is it's not your job anymore to correct a high glucose. So even if you see that value, just rest assured that it is going to come down, even if it took a little bit longer than than you necessarily wanted it to. And that singular event, you know, that's not going to change things long term for the user, and the system will resolve it for them, but intervening and trying to deliver either external insulin, announce a meal, that sort of a thing, can really mess with the learning of the system, but also put the user at risk for hypoglycemia, because that corrections algorithm is already working hard to bring it down, right?

Scott Benner 13:24
It's almost like you're stacking at that point exactly. And listen, I'm not trying to put you on the defensive about how, I mean, I think the device works the way it works. And, yeah, right. So you're not trying to, like, if you're a person listening, and you've got, like, a, five, one, A, 1c, and you're tinkering all the time and making adjustments and everything like, good for you, but then this probably isn't for you. Is that fair or no? Do you think a person could have a five a 1c on islet?

Kelly Postiglione Cook 13:52
We have five a one CS on the islet?

Scott Benner 13:53
Is it with eating strategies too? Or,

Kelly Postiglione Cook 13:56
honestly, we don't have published real world data yet, so I couldn't speak to that, and it wouldn't involve, like, you know, any kind of patient interview type things. But I think typically, if a user has normal hemoglobin levels and their a 1c or G m i values, I shouldn't have said a 1c G m i values, is what we can see. If they're running that low on the A 1c side, and they're not having hypoglycemia and that sort of a thing, I'd say they probably have their insulin doses pretty tailored in and there's, there's not a lot of maybe variation to carb amounts in a lot of scenarios. So in that situation, they probably were going to do fantastic on any automated system. But people who eat really low carb on our system do really well. So it's not uncommon to see really low GMI values without hypoglycemia. Got it.

Scott Benner 14:42
Got it. I understand, yeah, do you think, I mean, I know you can't tell me anything. You can't tell me, but like I have, I mean, go to one of my questions here this, this person said, Is there any chance that islets going to be able to offer lower targets? So they said, lower a, 1c, results. But I think what they. Mean is like targets. So right now, what is the target for the device? So

Kelly Postiglione Cook 15:04
you've got the option of three different CGM targets, but keep in mind the our system works so differently than others. I think the idea when people think of a numeric value associated with those targets is that, like, that's where the mean glucose is going to be. You know, if you have it set to that target, and our system just works a little bit differently from that. But we have our usual setting, which is at 120 milligrams per deciliter. Lower is at 110 and then higher is 130 milligrams per deciliter. Okay. And

Scott Benner 15:34
do you foresee a world where one day I can target 80 or 90 and that that will make it more aggressive and search for lower GM eyes. We

Kelly Postiglione Cook 15:44
have a lot of active projects going on, and I don't think that's out of the question. I couldn't speak to, you know, timelines and things like that, but I understand. I think definitely looking at changes to the algorithm is definitely not out of the question, right. Okay,

Scott Benner 15:57
all right. So here's a real like user question, how do meals adapt when the meals are less than four hours apart? So it was explained to me that if you announce a meal at 9am and then have another meal at 11am that the system can't, I don't know, like the user wasn't sure, but he felt like there was an issue, and he wanted me to ask that question. So am I making sense to you? Like, do you know what the question is? Okay, go ahead. Sorry, yeah.

Kelly Postiglione Cook 16:25
So part of the way that the system learns is from those meal announcements. So let's say you announce a breakfast meal, like you said, At 9am I've announced a usual breakfast the system is actually going to look at that four hour postprandial window, and within that window, it's going to see how much correction insulin was necessary. Do we need to adapt this dose for this user's specific needs? That dose will carry a 1/7 weight for breakfast announcement, so it uses an average there of the last seven breakfast announcements. So it needs the four hours to be able to adjust that dose or adapt. So in the beginning, when you first start the system, that four hour window is important. We want to make sure that we set the system up for success, that it learns the user's baseline needs and that it's effective. So in the first few days, we do ask the user announce your meal. Give it about four hours before you announce another meal, or have any kind of snacks with carbohydrate in them that would impact the glucose levels, because the system is still figuring out what your needs are. Now, once you've been on it for several months, you know that sort of or really after that first week, and the system knows what your needs are, there's no need to space those meals out by four hours anymore, because every dose doesn't necessarily have to be counted for adaptation. So if occasionally you know breakfast and lunch are closer together than than that four hour window, it won't adapt based on that dose. But it's not a big deal because it already knows what your needs are or write about what they are, so it doesn't have to adapt for every single meal announcement that is made so long term. It'll adapt when it's got that four hour window, and then if it doesn't, no big deal, it'll catch it on the next one.

Scott Benner 18:05
For how much time in history is it considering the user? Like, if a person's on this for 10 years, is it going to be thinking about 10 years worth of data, or, like, what's the window it thinks inside of? So

Kelly Postiglione Cook 18:16
for meal announcements, it's looking at the last seven for that particular type of announcement. So the last seven breakfast announcements, seven lunches and so on. Okay?

Scott Benner 18:25
So seven meals or 21 meals, seven, seven and seven

Kelly Postiglione Cook 18:30
No. Seven meal announcements, yeah. All right.

Scott Benner 18:34
So it's making decisions about insulin for food based on the last seven meals that you've experienced and the outcomes and what it needed to do, et cetera. Exactly gotcha. I had someone say to me that I moved to islet to get away from carb counting. They talked about the mental health stress that they were under, always carb counting, getting it wrong, feeling that pressure, et cetera. Yeah, but they did tell me that it has been replaced a little bit with the fear that they're going to pick the wrong meal size. Like, how do you ask people to judge, is this a I never get these right. It's a normal small How do you guys

Kelly Postiglione Cook 19:15
usual? Usual is, and that could be anything. So if your usual is 80 grams of carb with a meal. That's totally fine. That is your usual meal. Okay, yeah, but that's a big range. Usual can count for a large chunk of your meals, if you will, because you don't go to a more than usual unless you're eating one and a half times what you normally would. And you wouldn't go to a less than unless you're eating less than 50% of what you normally would. So it's a pretty wide range. So for most of our users, a vast majority of what they announce is gonna be usual. Gotcha,

Scott Benner 19:49
okay? And then, like less than usual, it's still too big for I'll get to another question here. A person said, Hey, can I get you to add a snack button to this thing? So I. Guess what they're saying is that less than usual is not quite the same as like, I grabbed a candy cane off the Christmas tree, or I had a handful of nuts as I walked through the kitchen. Like, I think that is that right? Or are they not seeing it correctly? So

Kelly Postiglione Cook 20:14
it depends on what usual means for that particular user. If their meals tend to be significantly higher in carbohydrate than their snacks. So for a less than meal, you wouldn't use that announcement unless you were having at least 25% of what you typically would have in a meal. So if the snack is smaller than that, you would not announce it in that scenario. But you can use the less than announcement for any particular meal, for your snacks as well, if you are having something with enough carb to be considered a less than announcement. Okay,

Scott Benner 20:44
so in a scenario where my blood sugar is 110 I haven't eaten in hours, and I quite literally walk past the Christmas tree and grab a candy cane, I can't Bolus for it, but my blood sugar rises, then what happens? So the

Kelly Postiglione Cook 20:57
corrections algorithm would come in and handle that for you, we have quite a few users who never announce snacks. You know, they may have a small granola bar that's, you know, not super high in carb content, and do totally fine without announcing that snack. Or other users may want to announce that snack and use one of the less than options, like I said, if it's appropriate based on their usual carb content.

Scott Benner 21:21
Do you think I know again, you I'm not asking you to guess for the company, but is the goal that one day it's just a button that says I'm eating. You know what I mean? Like, is that where you're trying to get to, because either people using, you know, DIY algorithms that have their settings jacked up in a way where they're not announcing meals anymore, like literally not even announcing them. They're just the eating, and they're probably a lower carb eater, but still, they're eating and seeing insane outcomes, like, so, I mean, now that's a very learned person making some pretty significant adjustments to their insulin. But like, bigger picture, I mean, if I'm in a board room at beta bionics, is that the big conversation, like, how do we get it to towards, like, as close to that as possible? Because that seems like what you guys are trying to do with this system. But I think

Kelly Postiglione Cook 22:08
if it can be done, we have the right team to do it. I can't speak to you know, exact product changes, things like that, that are coming down the way or timelines, but I can tell you, if it can be done. We have the team to do it, and like I said, they work fast and furiously. It's never out of the question. How can we improve? How can we make things even easier than they already are, right? That's definitely a part of the conversation, absolutely interesting.

Scott Benner 22:34
Okay, person here who is a user says, I need a better solution for when I don't have CGM supplies, or CGM data. What does that mean? What are they telling me? So

Kelly Postiglione Cook 22:43
with the islet, the system is not designed to be used without CGM, so it goes into what we call BG RUN mode, which means it's running off of blood glucose meter readings at that point. So it's not designed to be used like that, but it does have built in where the user can use it in that BG RUN mode for up to 72 hours. So if they lose CGM connectivity and they're out of sensors, they've got 72 hours to get back online with a sensor so that they can get back into going bionic and having that closed delivery. So they have 72 hours there. What I will say is what we've seen in a real world setting, Bg, RUN mode, just hasn't been a problem. Very low risk that users end up actually to the point where insulin delivery stops, because that's what would happen at the end of that 72 hour time frame. But we're just not seeing it happen frequently, which is fantastic. And then the other part of that is we innovate quickly. So we have the option to use either Dexcom g6 or g7 and now the FreeStyle Libre three, plus previously, when it was only one sensor connected to it, it was a little bit more difficult to get access to, you know, samples and that sort of a thing that can sometimes help to bridge a gap. If a user, you know, forgot to place an order or something like that, or there's a delay at the pharmacy, or now there's more options, and you can switch between the sensors at any point in time. So you can go from, you know, a Dexcom g7 to a FreeStyle Libre three plus, and then back to a Dexcom g7 so you can do that as needed. So that's I think it improved some options for patients if they do run into an issue where they don't have CGM supplies for whatever reason, but they do have a 72 hour time frame, and there's on the screen itself, it will let them know the timing of when the system would stop delivery. I see, okay,

Scott Benner 24:38
you've been going pretty fast and furious. Here, I'm going to give you an easy one so you an easy one so you can breathe. Will I let be coming to Canada? So we

Kelly Postiglione Cook 24:46
actually have talked about international plans. We just don't have a public timeline on it yet. So that is our plan to be available internationally. We just don't have a timeline for that yet.

Scott Benner 24:55
I see you pretty lean organization still. Is that a is that like? Head count issue sometimes, like just having the people to put on

Kelly Postiglione Cook 25:03
it. I mean, we do run lean, but I think, no, I think we just got some other projects that we need to kind of take priority for the time being, and then we'll probably have some timelines around that, hopefully in the near future. Okay,

Scott Benner 25:16
all right, I'm gonna jump back to a user question. Can I select breakfast as usual for me, if it's not breakfast time. So this person said, what happens when I do breakfast for dinner? Is it dinner or breakfast? Like, is the algorithm thinking about the kinds of impacts that normally come at that meal time? Like, do you see the question? Yeah, okay, cool. So

Kelly Postiglione Cook 25:40
you have two choices there, either you can announce based on time of day, or you can announce based on meal content. So for example, if pancakes are typically a breakfast food for you, and you want to always call pancakes breakfast, that's totally fine. You can announce that at any time of day. Or if you want to call pancakes dinner because you're having it at dinner time, that's okay, too, and just announcing based on the carb content for that particular meal. The key in those two strategies, whether you're announcing by time of day or content of meal, is just be consistent with it, because that's going to teach the system the most accurate information about you if you're consistent with the way that you announce. Okay, so

Scott Benner 26:19
it's not that the algorithm thinks breakfast foods are carbier. It's that if you have breakfast foods that are more aggressive in nature, then it will start considering breakfast to be like that. Is that? Right? Right? Yes. It's not like magically thinking like, oh, they eat steak at dinner and they eat pancakes at breakfast. It's not like that. I gotcha. Okay. I didn't think it was, but this person, again, real world situation. They said they made breakfast for dinner one day and they stood there going, I don't know what button to push.

Kelly Postiglione Cook 26:52
I think a good takeaway from that is, you know, typically, if you just don't have to overthink it again if you mess up a meal announcement. On occasion, it only carries that 1/7 weight, so it's not a big deal in the grand scheme of things. It'll all kind of come out in the wash, if you will. But I would say, try to be, you know, consistent in the way that you announce. If that's something that you do frequently, then you would want to announce the same way with with that type of a meal. I told

Scott Benner 27:19
this one person I was talking to that when they describe how they Bolus with their eyelet, I feel like I'm listening to somebody discuss how a Fresnel works because, because the Fresno users are always like, I don't know, I did a four and then an eight and then a four, and I'm like, I don't know what that means. But anyway, I'm gonna jump to a long question here from a parent. Okay, I'd like to know how to handle teenagers when basal is changing so rapidly and the pump doesn't seem like it wants to keep up. I honestly thought about giving him some long acting on top of his pump, but I didn't know how that would affect the pump algorithm, which you already said, don't do that or mess things up long term. His endocrinologist states that this is totally normal practice for kids on other pumps, but she was uncomfortable doing it with eyelet, like layering over other basal. He's literally the only one in the practice that's using eyelet, so it sounds like they're not getting a lot of help there when he doesn't dose for a meal, because that happens. How does the pump go about interpreting that? I feel it's a semi counter intuitive to the basal and pump runs because the company tells you not to Bolus if you realize you missed a meal 30 minutes out. So she's got two different questions in a very quickly shifting landscape of maybe weight gain or like, I mean, listen, honestly, Kelly, if you gained weight, if you suddenly became sedentary, if you suddenly became active, if your basal needs change for any reason. Like, how does it keep up? And when it doesn't keep up, what are you asking them to do? So

Kelly Postiglione Cook 28:44
it adapts really quickly to scenarios like this, where, you know, a growing teenager that's a tough population for, you know, trying to manage their glycemia in general, but especially with the growth. So with the islet as a user's needs change, the system can adapt really quickly to that. So it does it in about a day or so again, if someone's hitting a growth spurt and all of a sudden their insulin needs are going up, the way that that basal and corrections algorithm is looking at what's happening right now, which is always going to trump historic data, right? So if you're sky high right now, you're going to get more insulin, even if you were not that high previously. So what's happening now always Trump's historic data, but it does know your historic data too, so it has a starting place. So for example, if somebody has Dawn phenomenon, it learns diurnally. It will learn that your needs are higher in the first part of the day and lower in the next part of the day. So we'll learn that information, but it takes about a day or so to adapt to the user's new needs. I would be curious with this particular user, it's rare that we see that it can't keep up at all. So I have additional questions about that, and I would encourage the user's parent to call into our customer care. You can actually get connected with our diabetes education team. And they'll review reports with the parent and kind of talk through what they see on there as well, and can kind of coach to how to get the best outcomes using the islet. And I would also encourage the endocrinologist or the clinic in general, they could check out. We have several webinars online about managing users on the islet that they could take a look at as well. But the question about you the basal not being able to keep up. I kind of have questions about it. Not being able to keep up. I want to look at a report, but you can use a basal insulin as well. We usually see that more in those who have really high insulin needs, like if they're above 100 units a day, we may see someone add a basal dose to that. Or we may see for athletes who want to disconnect for several hours per day, they'll add a small basal dose as well. We do have a healthcare provider guide on our website that the endo can reference to see kind of dosing for that. But generally, we don't recommend exceeding 50% of the users basal dose on the islet with any kind of external basal, but it'll adapt to that user's new needs in about a day, even if you add basal insulin to it. Okay, so of course, you'd always want to be vigilant watching for hypoglycemia, because that that first day of taking the basal dose will be different than historic data. But again, what's happening now will trump historic data? So it is an option to use a dose of basal. They also can get some help from our diabetes education team at beta bionics. And then, of course, we're happy to connect with that endocrine office and help educate them as well, because it's a totally different approach to insulin delivery, and it's, it's a lot to wrap your head around. I have

Scott Benner 31:43
to say, you have a the ability for them to contact you and talk to, like a, like a practitioner of some kind diabetes

Kelly Postiglione Cook 31:49
educators, a Certified Diabetes Care and Education Specialist. We have a full team of remote educators, and they're fantastic. We cover all the time zones so they're available during business hours. Yeah, we can set up additional coaching. Because what's really great about this product we talked about, there's CGM targets in the system. But other than that, there's not settings. It's all discussions around, how is the user interacting with the system, what kind of information is it learning from, and how can we best optimize it so that the user gets the outcomes that they want from the system. So it's great. They can basically help to coach the user to get where they want to be. So

Scott Benner 32:26
there's still the second part of this question, and your answer just gave me another question, and I saw and I want to show you something, but first I have to say I have a couple of chameleons. So I keep chameleons. I've never heard anybody use the word diurnal outside of reptiles before. So that was,

Kelly Postiglione Cook 32:43
that was fun. That's, that's an ED Damiano, uh, special there. That was

Scott Benner 32:47
fun. Like, I've been making, I've been making the pies my 11th year, and I've made, like, 1400 episodes. And I was like, no one's ever said diurnal before. Anyway, the second half of her question was about, what happens if the kid just whiffs and doesn't Bolus at all. So are you saying? Is what she said, right? If, if I forget, it's fine five minutes later, but after 30 minutes, I don't do anything. Yeah.

Kelly Postiglione Cook 33:12
So if you don't announce a meal and it's forgotten, if you're more than 30 minutes out, typically, the glucose has already started to climb, and you're going to start getting a reaction from that corrections algorithm. So after 30 minutes, if a meal announcement wasn't made, then we usually recommend not making the meal announcement at that point and let the corrections algorithm cover it, so that the user is not at risk for stacking and hypoglycemia if they do announce at that point.

Scott Benner 33:39
Okay, I have to tell you that I'm happy to say that my daughter has been using an Omnipod since she was four, and she's going to be 21 this summer. It's been fantastic for us. And I've always, steadfastly, over the years, said I'm very happy with Omnipod. I have no reason to move but at the same time, the advice I give anybody, and the advice I would take myself is that you do not want to wake up one day and say, I'm doing this thing. Nobody does. Nobody do it this way anymore. Or did this thing not come along with the times? And I'm not saying that Omnipod five isn't coming along with the times. I'm saying I love you guys all fighting with each other. It's awesome.

Kelly Postiglione Cook 34:18
I think it's good for everyone. Yeah, I think we all push each other to be better. And I think for the diabetes community, the more options that are out there to meet needs, the better beta biotics, it's been such a cool place to be because we have helped people get onto product that maybe wouldn't have been considered device candidates before. I have my own very like staunch soap box around that in general. But, you know, there's people using our product that really wouldn't have been considered for other products, and they're doing fantastic, which is been really rewarding to be a part of.

Scott Benner 34:53
Well, I first of all, I think you guys should just all get into a fight, of all fights, and keep trying to innovate and make things better and better. Forever. That's awesome. And I have to say, the first time I heard about eyelet, what I thought was, wow, you're telling me, I can put a pump on somebody who might be wandering around with an 11. And by the way, this is a thing. I think people listen, oh, that doesn't happen. There are a lot of people wandering around with 1112, 13, a one, CS, much more common than you think. And you know, even if it's a nine or an eight, like you're telling me, like, you could put a thing on something, somebody could just go, it's breakfast. This is usual, and they do better and be healthier. Awesome. Like, really awesome. I think when I was talking to Ed or Steven, I said I would put sales effort into GP offices, because I bet that's where those people are getting their help with their insulin to begin with. I bet you they're not even seeing endocrinologist. Yeah,

Kelly Postiglione Cook 35:44
I think you're right. There's about half of the people that live with type one don't receive endocrine care. Yeah, that's a tough place to be, because, you know, you're in a primary care or internal medicine setting, and the time frame around that visit, it's really difficult to address everything that's happening in your health, and that that small window, let alone discuss diabetes technology, or, you know, yeah, be able to interpret reports, that sort of a thing. So, yeah, I think that there's some, some room there. In general, it

Scott Benner 36:12
just makes sense to me, like, if they seem like people who could really use it and who are not going to hear about it, because, I mean, you just got a question from somebody who listens to my podcast who is telling you that they're in their endocrinologist office and they're the only one using an eyelet there, and the endocrinologist is like, well, this is what I would normally do, but I don't know if I can do it with this. So we're not going to do anything. And you know, like, that's I'll give you more work to do. I think you guys should be doing that. I think it would be awesome. Okay, so here's my next question, how does one use the eyelet for exercise? Growth hormones, like periods, like anything like that, like that seems to be not just for islet, by the way, but most algorithms that let me say it like this, most, what I'll call retail algorithms, seem to give people problems in those situations. So what do people see? Their kids sit in school all week long, and then on Saturday morning they get up and run around like a lunatic at a soccer game, and they're like, Oh, my kids, blood sugar gets low on Saturdays because the algorithm thinks this is how much insulin they need. But then, you know, etc, or growth hormones overnight, or, you know, period. So my daughter has PCOS, like, I'm sitting here the whole time wondering, like, I don't know if this could handle Arden or not. Like, so, like, what do you like, what's the direction right now for people who are in those situations? Yeah,

Kelly Postiglione Cook 37:30
I think any kind of physiologic stressor, you know, whether that's hormonal, whether that's illness, anything that's going to cause a higher need for for insulin. It usually takes about 24 hours for the system to adapt to the new you, if you will. What we see is about that 24 hour time frame to get to the new mean glucose. You know, we've seen. They did a sub analysis of the people in our pivotal trial, for example, that use corticosteroids and and found that they reached their new time and range and main glucose within about a day or so. So you actually, you don't have to do anything with the system. You could be proactive with the CGM targets, and of course, you have to speak with your healthcare provider about that. But let's say you're at usual and you want that corrections algorithm to come in a little bit earlier in a in a glycemic excursion, and just run a little bit lower, you could drop it down to lower to be a little bit more proactive. So you have the CGM targets in there, but otherwise, you just give it a day and it'll adapt to the new you, which is really a great piece of this system. So when people have had illnesses, just anecdotally, what we're seeing in the real world, the system adapts really well to their new need pretty rapidly. Now, if someone's needs decrease significantly, keep in mind the system will what's happening now will always trump historic data. Again. That doesn't mean you're never going to have a low glucose, but the system is going to recognize the trend that you're, you know, average CGM reading, you're different today than you were yesterday, and it's going to adapt to that new need as well. So again, you kind of become a new you in those scenarios. Exercise is different, though. Exercise is a little bit different if we're talking about kind of episodic exercise,

Scott Benner 39:16
yeah. I mean, there's more than I didn't send all the the people to you that said, I really this thing, this thing really needs exercise mode. So, and by the way, I want to give you a bit of credit here, like, I had three follow up questions while you were talking, and you hit each one of them. I was just like, oh, I don't have to ask that now. And then I had another one. I was like, Oh no, she got that one too. Somebody should give you a raise or something. So you really,

Kelly Postiglione Cook 39:42
I don't know if I'm John, are you listening? No, I'm just kidding. I don't

Scott Benner 39:44
know, Kelly, if I'm in charge of that, but if I was, I'd like to see with a nice, at least 15% bump. But go ahead, tell me. How come you won't just give them an exercise button. I

Kelly Postiglione Cook 39:52
would say that we won't just give them one. It's definitely a project that we've been working on. I don't have a timeline that I'm able to share currently. Hmm, but it is something I think, that, you know, we regularly request feedback from our users, and that is something that we've heard, along with the snack option. And those are both two active projects. We just don't have a timeline for release, and need to do some testing around those. For exercise. Currently, the strategy is, you know, if you're someone who you can either wear it while you're exercising, you know, depending on the type of activity, if it's not something that typically causes you lows, you could leave it on for that. If you do choose to wear the device during exercise, like with all aid systems, it's not a great idea to pre load with carbohydrate, because you're going to kick in some correction insulin, and you could cause a low because of that. So if you're going to stay connected, don't pre load with carbs. If you do want to pre load with carbs, you can disconnect. And we added a pause feature to our device last year, where when you disconnect, you pause it. It's not learning or anything like that, during that time frame while you're disconnected. And then you know, once you complete the exercise, reconnect and UN pause. It's got a little timer on it too to remind you to UN pause your insulin as well. I have to fish a

Scott Benner 41:06
little bit here, because I feel like I heard you say something earlier that would indicate to me that you and I would get along really well. Talking about diabetes, you said you had an opinion about not putting certain people on products, which I felt like. You wanted to say that some endos don't give people pumps because they're struggling, but they should. Is that what you were going to say?

Kelly Postiglione Cook 41:23
You know, not in my capacity as a beta bionics employee, I'll start there, but as a diabetes educator, I you know, if someone understands the risk involved with going on a device, I don't think it's fair as a prescriber to not consider them for a device.

Scott Benner 41:41
This is awesome. Okay, if so. Now I asked that to ask you, would you, as a diabetes educator, tell people to take their pumps off to for activity you want them having active insulin, right? So

Kelly Postiglione Cook 41:52
it depends. I think disconnecting and taking the device off is really common. I just wouldn't leave it off for really long, extended periods of time. So like, if you have someone who's going to be doing, you know, hours of activity, that's the kind of and they want to take their device off for that, then that's the kind of person I would say, well, maybe we should consider adding a little bit of basal insulin so that you're not completely without insulin, because you don't want to be in that scenario either. So, you know, typically, if you're disconnecting for about an hour or so, and then reconnecting. You should be in good shape there. I think that's a pretty common practice. But I also think, you know, there's exercise modes available and other devices. I wish we were better at exercise in general, as people who recommend things to people who live with diabetes, exercise is just a tough one, because people respond differently with different intensities, and it's just kind of a tough one to conquer in general. But even with the exercise modes on other systems, you know, I'm sure they help, but I think there's a lot to be desired there still. So I think people do want an exercise option on our device, and we'll bring them that first

Scott Benner 43:00
of all, definitely, right? Like, exercise, it's not a, it's not a catch all. Like, I think it's just a more of a, hey, pump, I'm about to get way more active. Like, that's the mode. And then if, if the button doesn't work, the button, if the button doesn't work for you in that situation. Now, at least you know, but at least you have the option. I think that's what they're saying about the snack thing too. Like, I don't want to go up 20 points because I had eight carbs of something. Can't I just tell the thing I'm snacking now, so that it gets a little more aggressive sooner. Like, so, like, let me pivot into my other question. Like, do I not want to Pre Bolus my meals? Or do I, like, some companies are, like, Don't Pre Bolus, Pre Bolus. Like, I don't know, like, how much that has to do with the algorithm. But, like, Listen, my daughter uses trio, okay, and it's about as aggressive as a DIY algorithm as I've seen so far, that in the loop, and she has to Pre Bolus. Like, so like, what do you guys tell people to do?

Kelly Postiglione Cook 43:57
Yeah, insulin. It'd be great if we could keep getting it to be a little bit faster, right? Yeah, be nice. So the way it was done in the pivotal trial is that they told them to announce the meal when they sat down to eat. So that's the recommendation that we go with. However, if someone is a Pre Bolus er, and they come to us with that habit established, whether it's from MDI or from another device. Absolutely continue doing that. You just want to be consistent, because the meal is going to learn from your behavior around that. So if you're a Pre Bolus, or, you know, no more than 15 minutes before the meal, and be consistent about it. Otherwise, our kind of general recommendation is, you know, announced at the time of of eating. But I do think there's some people that get better postprandial control. If they're Pre Bolus. Saying a bit with that, yeah, for sure, the big thing is just don't forget to eat. A few pre, I guess I'm saying Bolus, but really, pre announced, just don't forget to eat, right?

Scott Benner 44:53
I see what you're saying. I see you're covering your ass. I see what you're

Kelly Postiglione Cook 44:55
doing. That one was for regulatory I hear you.

Scott Benner 45:00
So I mean, listen like I heard what you were saying earlier, and I see the value in this, and I see the value in where I think all this is going. But if you told me that my daughter's blood sugar had to be 180 for an hour and a half or two hours after she ate, that's a non starter for me. Like, and I think a lot of people listening are in that boat, but love everything else that's being said. And so they're trying to figure out, like, well, how can I use this but not have that experience like and also I think it's possible that from the way you're talking and and how other people who have come on from Benny have spoken in the past, I also think it's possible that I wake up two years from now, and that's not a concern anymore for now, for the people who are like, Oh, I'd like to try this, but I think that's what this conversation is. It's trying to assuage their butts, so that they That came out wrong, like, so that they, you know, so they can say, like, is this a viable thing for me right now? So I appreciate you asking all these questions. Here's another one that's not going to be covered by any testing, but is going to become more and more prevalent as each day passes. So this person's questions a little longer. I know weight is a factor in how the pumps algorithm works, and that you just, you know, do meal size and versus carbs and etc, but what about people who are also on other medications that help them with insulin resistance? So this, I know this is a GLP question, so I know you can say like, look, glps aren't FDA approved for type ones, but, you know, Wake up and smell the coffee, if that's how you think. Because there's a lot of people who have type one who are using GLP medications. So I'm assuming you guys have tried to look at it like, does that change anything? The slower digestion, the slower spikes like, this is going to be weird, because we're not on camera, but I'm going to pop my camera on for a second for you to show you something. So this is my daughter's last 24 hours, wow, and her top line is 120 and her bottom line is 70. Okay, so you see that she hasn't been over 120 or under 70 in 24 hours, right? That's trio. It's and it's also Manjaro. So I put her on a GLP. I watch her insulin needs drop. I go in and I tell it, all right, hey, let's make the insulin sensitivity weaker. Let's make the basal weaker. Let's make the insulin to carb ratio weaker. Boom. We're back in it again. Is what you said earlier about the 24 hour window. Like, do you think it would keep up with that? That change. So

Kelly Postiglione Cook 47:21
for basal and correction, absolutely, if it impacts the way that the user's eating, and that the amount of carb for their usual is no longer the same, and it's significantly less, for example, and they need a much smaller dose of insulin for the usual amount of food that they're eating, you've got a couple of options there. You can kind of announce and and let it adapt down. Or you can do what we call as a factory reset and take it back to zero and just start over with it. You're a brand new person, and now it's learning from zero with you. If you started a medication like that and thought that the really it's you would factory reset it. If the meal doses had gotten too strong, and we were worried about a risk for severe hypoglycemia, if you were to announce for your meal. So if that's the case, you would factory reset it to bring it back to zero if you really changed how you were eating. So same thing would go if someone, you know, woke up tomorrow and decided, I'm going keto, and I've never done this before, and you know, I'm really going to need, like, significantly less insulin than I typically would. That would be a scenario where you would talk to your health care provider about starting over and kind of factory resetting the device. But that being said, if someone's using that medication, it'll adapt to how their body's absorbing food, similar to, you know, we have users who have gastroparesis, didn't specifically test it for that, or have special indications or anything like that, just kind of watching how the system works. You know, the correction insulin will come in as needed. So if their carb absorption is, you know, delayed to some degree, it will adapt to that specific need. So same thing with the GLP ones as well. So we do have users who are just anecdotally using the GLP ones as well. I didn't I wanted to circle back to something you said earlier about meal announcements and hanging out at 180 for like two hours after the meal. That shouldn't be a typical experience on the islet. I mean, if it happens occasionally, because maybe you ate on the the top end of your your usual amount of carb, or it could have gone either way, with a more than announcement or a usual Sure, you may see it happen in those scenarios. But if you're in that hyperglycemia area, I mean, you're getting correction insulin, and it's trying to bring you down, which means your meals are adapting up right? So it's going to adapt up until that's not something that's happening routinely. So if that is happening regularly, and again, you know, the user feels like they need a little bit of coaching to get that, you know, to stop happening, or have someone review reports with them, have them call into the Customer Care. Again, we've got that great education team that can work with them, right, and review that. That for them, because that really shouldn't be a an everyday or regular occurrence. I

Scott Benner 50:04
mean, also, I don't want to, like, try to say that, like, in case people are listening, like, my daughter's blood sugar does that too. Like, just because, you know, I showed you 124 hour graph, like, it doesn't mean it doesn't happen like that. Although, honestly, Kelly, you saw that graph and you thought my blood sugar might not be that good, didn't you actually,

Kelly Postiglione Cook 50:20
literally thought that I also have PCOS in my blood sugar does not look that good. Listen,

Scott Benner 50:26
I won't go down this road with you on this, but if you want, after we're done, I can tell you how the GLP has been helping her with her PCOS symptoms. So it's been really valuable. I'm gonna move on here. Let's see, is there or will there be an option to take over? So I think this person's asking you, are you ever going to give them manual control of the pump? I don't think you're going to, but I'm asking anyway,

Kelly Postiglione Cook 50:49
there is not a plan to have any kind of manual mode, if you will. So it goes into when it's in BG run when you don't have CGM capability. That's about as manual as it gets. So what happens in that status is it runs off of what we call a nominal basal. So it will learn what your needs are and look at kind of the last seven days, and average that out and figure out what your body needs at specific times of day. So that would be your nominal basal when you aren't running CGM. And it's conservative, you know, because we don't have have CGM values there for that. So it would run that nominal basal, and then when you you still would announce your meals, and it will give you that adapted dose for each meal announcement the same way it would, or similarly to how it would if you had CGM connectivity as well, but realizing there's no correction in there and all that good stuff. So that's about as manual as it gets. I don't foresee us adding anything further to it to make it manual. Let

Scott Benner 51:49
me answer that. Listener, no, okay, how about God who came on? Sean and from zeros, Paul this past year on the podcast, they were very excited about their their agreement about glucagon. So I'm going to ask, are you guys working on, can you talk a little bit about dual chamber, the ability for this pump to, maybe one day, give a tiny bit of glucagon to save a low blood sugar? Yeah.

Kelly Postiglione Cook 52:16
So that is definitely an active project that we are committed to, and obviously our, our kind of flagship reason we were were founded so super excited about that potential here down the road, I can't speak to any timelines other than it is an active project. Zerus is our partner on that, and we are again working fast and furious, as we do with all things, to make that a reality for people living with diabetes. Awesome.

Scott Benner 52:41
Zeros is a sponsor of the podcast. I just want to point out, I have to tell you, I recall back however many years ago that that picture of Ed and he was like, I'm gonna make a pump that gives you glucagon and insulin. And I mean, I don't know how long ago that was, but I do think it's interesting to think back on it. You know, it's fun to say, like, can you give me a button for this? Can you do that? Can you this stuff takes time. You know what I mean? Like, yeah, and you need people who are dedicated, don't give up, stay in the fight, that kind of stuff, to get something like this out there. So, you know, I think people's questions are great, but I would always tell people, like, just don't imagine. You're just gonna wake up tomorrow and it's just gonna be magically happening. Like, this is a thing that's gonna happen over time. And I mean, I like people being progressive about the thinking, because, yeah, when I think about all these algorithms, Kelly, when I think about them, what I think is, I hope that every one of these companies is treating their algorithm the way Tesla treats self driving like. I hope there's a whole bunch of people looking at data constantly trying to figure out, like, how do I tweak this so it works better? Like, not just like we made a thing and it works, so let's sell it now, but like, we made a thing, it works. Let it go help people. And behind the scenes, we should be continuing to figure out how to use this data to make better decisions, to help more people, a broader range of people, a broader range of people's, you know, who have different implications, you know, variables in their physiology, etc. Because I think it's there, like, I think the answer is there. You just have to dig through it and be persistent to pull it out. So anyway, that's me. You're, I mean, I think you're

Kelly Postiglione Cook 54:20
I mean, I think you're describing exactly what happens on a daily basis with our team, like there's no attitude of, oh, well, that's good enough. They will never stop innovating. Like they're some of the most creative and brilliant people I've ever been around, and it's fun to watch them work and see how quickly they come up with solutions to things. I mean, you know, we've rolled out several software updates just since we've been on the market that have been really exciting. You know, we've got the Share feature, like they built out our circle app, so you can, you know, share the glucose values with your family. Have up to 10 people in your circle. I mean, that was a tremendous lift, and done so quickly. You know, the. Know, the integration with Dexcom, g7 with libre three plus, like, That's fast. It's just been really fast. And they will, I don't think that they will ever settle, which is why I want to be here. And I think most of the people that are here, they just aren't satisfied with with the status quo, which is a cool place to be.

Scott Benner 55:18
Yeah, I hope everybody is taking big swings and not playing from a scared position. Like, that's what I want, you know, for my daughter, for my daughter, like, I don't want her to have to think about this forever. Like, I'm telling you I don't care. Listen. I want to be clear. I don't care if it's you or somebody else, right? I want somebody to, like, send me an email one day that says, hey, guess what? Our pump now has the just push this button feature. Yeah, get to it. You know what I mean? Because I think it's out there. And I think, I mean, this is me, but I think AI is going to help people parse the data faster and get to the answers more quickly. So I'm excited. Oh, I agree. Yeah. All right, let me roll through some of these other questions. How is my data uploaded at my provider's office? Like I take my Omnipod in and gluco blah, blah, blah, do you have something like that?

Kelly Postiglione Cook 56:04
Yeah. So we have an HCP portal, so users connect their islet to the islet app, and then it pushes it up to the cloud, and the HCPs can log in, and they have their patient list, and they can review reports right there. So really similar to other cloud based reporting systems.

Scott Benner 56:21
This is a user question here. Could you ask about the islet for getting the last six hours of data if we just choose Fill cannula option? Does this also happen when changing cartridges and tubing, when the user selects fill cannula, when they do a complete site change? If yes, is there a better time to do a site change? I want to be honest, I don't completely understand that question. I'm gonna

Kelly Postiglione Cook 56:44
assume you do. I do. I was actually surprised to see it in there. I was like, wow, they were really listening. That's great. So when the user fills the cannula, it will not learn from the previous six hours before that site change. So whether that site change takes place on its own, or it takes place with a full cartridge change the previous six hours. Won't be your used for learning. Can you tell me why? Just in case someone had a bad site, you don't want it to think that the user's baseline insulin needs are crazy high. Okay, so

Scott Benner 57:15
meaning, if you guys produce a patch pump at some point, this will persist through that device too, that

Kelly Postiglione Cook 57:21
I can't speak to yet for the current setup. It is in there with the six hours previous not learning from that data, but it is specifically for a bad site, and really where it's going to be most important. Because the second part of their question says, Is there a best time to do the site change, when the device is first learning you you don't want to do it within that four hour window after you've announced a meal because you want those to adapt pretty quickly. So maybe first thing in the morning would be a good idea. You're only doing it every few days, so you know, if you have something going on, like Dawn phenomenon, that kind of a thing, it's going to figure that out anyway. But first thing in the morning might be a good idea while you're still getting your meal announcements dialed in, but otherwise, you can do it whenever, like I said, it doesn't have to adapt to every single meal that's announced. You really can loosen that up once you've been on the system for a long time. You don't have to be really strict or do that four hour spacing between the meals at all I

Scott Benner 58:18
see earlier, I advocated for you to get a 15% increase in your payment. I'm payment. I'm going to 20 because, like, it my note here, after the GLP question was, ask about gastroparesis, and you just, like, you pivoted right into it. I was like, oh my god, I love Kelly. At first, I was like, Did I leave my camera on? Can she see my notes? You're a great example of somebody who came up through it and your understanding of it like you were speaking so effortlessly about this. It's not I'm trying to give you a compliment here, Kelly, like, I know you've sat with attorneys and they've taught you how to talk about regulatory stuff, but it doesn't feel like that. And it also feels like, do you have type one?

Kelly Postiglione Cook 58:57
I don't. My husband loves the type one, but I do not okay,

Scott Benner 59:01
because you talk about it like you have it too. Like, that was the other thing. Like, I could, you know what I mean? Like, you have that, like, there's a naturalness about like, where you pick up, it doesn't just feel like your job, I guess is

Kelly Postiglione Cook 59:10
what I was saying. I'm definitely passionate about what I do. Yeah, no,

Scott Benner 59:14
it's obvious, for sure. Just so, you know, I'm assuming you know already, but it, but it was obvious, because I have a couple things here. I don't know that. We haven't gotten to all of them, but they're inside of other questions. Like this person says, If my CGM goes bad and I don't have a backup on hand, does it create a profile? But we've gone over that, is that correct? Like, so we have that one tape, yeah, would

Kelly Postiglione Cook 59:32
be that BG run setup where it's running the nominal basal and your meal announcements would still be that adapted. Dose,

Scott Benner 59:39
yeah, there's another one here about teens forgetting to eat, but we've got that or forgetting to Bolus. I'm going to give you a statement here. It's not a question. I just want to hear you respond to it. I guess this person said I tried islet, unfortunately, did not like the fact that I had no control over carb counting and that it holds 160 units of insulin. So it went back to my Medtronic cell. Have an ADG pump with a guardian sensor. I might try again in the future. Right now, I'm disappointed. Like, how would you talk to a person who who had that experience?

Kelly Postiglione Cook 1:00:08
Yeah, I think I would want to ask a few questions to understand exactly which parts were difficult. I think, you know, you talked to Ed, you talked to Stephen, they talked about who's right for the eyelet, that, that sort of thing. I do think if being really methodical in, you know, entering carbohydrate values or intervening on high glucose, if it's going to be anxiety inducing to not be able to do those things, this might be a little bit of a lift for someone kind of on the psych side of it, because that is a stressful thing, especially if you've done it for years, right? Like, if that's something that you're used to doing and it, you know, having that control over that aspect of it is important to you, or or anxiety inducing, if it's not there, that's definitely something to consider. I will say, when we've had people go on product who are like, you know, I've been doing all of those things, and I'm ready to let that go like it's it is a burden in the background, if you will, of having to do this all the time. It's not like a one week thing where it's no longer anxiety inducing. It really takes some time. You know, in my talking to, you know, colleagues and friends of mine who have made that transition from doing a lot of input on their aid devices to, you know, using an eyelet and using it as it's designed, with the meal announcements. And that's it they talk about, you know, sometimes it's like a six week time frame for them to really get to the point where it's like, Oh, I get it now rewind, like it's a it's a long time frame for some people to get there to where it's no longer anxiety inducing. They've had enough time with the system to sit with it and say, Okay, I did have that high that was frustrating. It resolved. I've moved past it, you know, I didn't intervene. Yeah, then it's just a longer time frame, I think, for for some people, but for that user, you know, like I said, I'd want to understand more about what it was, how long they used it. You know, hopefully they will try it again in the future, but understand if it's not the right fit for everyone, what you

Scott Benner 1:02:08
just said reminded me of over the years, I've so many times heard the question asked, like, if you could, like, get rid of your diabetes, would you? And most people are like, yeah, obviously. But some kind of old heads will come in, like, people have had type one for a long time, and they'll talk about, like, I don't know who I'd be without it. It's an interesting perspective, and I'm wondering if a little bit of that isn't what you're talking about here. Like, how do I just decide not to be worried or thoughtful about these things that I've had to think about for so long? Like, just letting go of them seems like, for some some people might just feel free like, Yeah, I'll let it go. But some people might be like, I don't know how to let that go. That's interesting. It really

Kelly Postiglione Cook 1:02:46
is. Yeah, I completely understand that. And especially if you're really good at it, like, it sounds like, you know, you've been really good at that for a long time working with your daughter. You know, that's a hard thing to let go of, especially if, you know, sometimes you feel like you would have done something differently than the system. So I feel like, if someone is going to inter try to intervene on the system frequently, like, that's just not a good fit, because the eyelet is not going to learn any good information, and you're not going to get the outcomes that you want.

Scott Benner 1:03:14
You'd be fighting with it forever. I also want to make clear that I am not that person. I am good at it, but I would be happy to be rid of it, and I would be, yeah, you're talking to a weird person. I was just focused enough to help my daughter. But I'm not type a like, I don't love it. I know people listening who might be like, that's not true. I do not love it. Like, yeah, I'd love to wake up one day and go, hey everybody. This is the last episode of The Juicebox Podcast. Buy a thing, put the thing on, push the button. It's all done. Congratulations. I'll see you later. Like, I'd head to a beach. You know what I mean? Like, I'm good to get away from diabetes if I can. And I have to be honest, like, I don't know if it's you, like, if it's I led, if it's somebody else, but I do think we're within like, a reasonable amount of time before these systems are just, like, kind of bulletproof for most people. So like, I'm super excited about that. I'd like to see cannula technology get better, right? Like, I'd like to see, I would like to see that, like you said earlier, it'd be cool if, if insulins worked quicker. But, you know, a lot of people with those faster acting insulins, my daughter is one of them. Like, she can't tolerate whatever one of the ingredients is. So I think it's the I've looked into it a little bit, but not enough. Like, I guess they use, like, vitamin B to speed up the process, or so, I don't know exactly I'm talking out of my ass right now, but like, I think you're right. Oh, awesome. She gets very she just can't manage it, like, it stings or it burns, or it leaves her bruised or something like that, which is a real shame, because the ASP did work really well for her, but it would leave her sights sore and loom Jeff burned her so badly, like she had to take it off, like she just hated it. Now that could just be her, right? Yeah, it does work great for other people. I've also heard people who it works great for then it sort of stops working great for them, like finding a way to speed up that insulin awesome, making cannula technology better so that you don't get, you know, agro. Activated, you know, inflammation, which obviously slows down absorption and messes things up. That would be awesome. Like there are little things that along the way, with these algorithms could definitely turn diabetes into a little more of a back of a mind thing. As far as the moment to moment management comes in, I honestly think I'm gonna live to see it. So super excited. Keep working over there. Also don't take that raise. I need them to have that money to innovate. I'm sorry. I know I promised, I know I promised it to you, but you

Kelly Postiglione Cook 1:05:28
can't have it. You dangled it right out there, and I'm just pulling it back like that. I just want to keep

Scott Benner 1:05:31
you working. Kelly, that's there anything we didn't talk about that we should have let

Kelly Postiglione Cook 1:05:36
me think about that we talked about new innovations. You know, we've just, we've been out there for a year and a half, and I think we will be publishing some of our real world data hopefully in the coming months this year. It's just unbelievable what the system is doing. It's crazy. So I'm excited to get that out there for everyone to kind of look through and see how well it's working. I think for the community, if your end does aren't familiar with beta bionics, or they're not familiar with the islet and they want to learn more about it, please direct them to our website so we can get someone out there to talk with them and help to educate them, because it is a really different way to help people get their glucose to gold. And you kind of have to wrap your head around it a little, because you don't get to go in and just start pulling levers and say, All right, well, we'll see in three months. Good luck. Yeah, they have to have a totally different conversation. So I think that's an important thing, you know, the HCP education and bringing everyone up to speed on beta bionics, so that the technology is made available for for more people living with diabetes. Well, Kelly,

Scott Benner 1:06:38
I appreciate your time, and I appreciate you being so good at this, like you really were, like every time, like you're talking and I'm making notes to follow up, and I never had to go back to them. I think I could have just said, Hey everyone, this is Kelly. She's going to talk about eyelet. And I could have went and made a sandwich and come back, and about an hour later, I think, I think you would have been

Kelly Postiglione Cook 1:06:56
done. So I'm from the south, and I have the gift of dab, so listen,

Scott Benner 1:07:00
I appreciate it made my day very easy, and it's Friday, so it's awesome. Oh, great, yeah. Hold on one second for me, this was terrific. Thank you. Thank you.

This episode of The Juicebox Podcast is sponsored by us med. US med.com/juice box, or call 888-721-1514, US med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, thanks also to AG one for sponsoring. And don't forget with your and don't forget that you're and don't forget that new subscribers are gonna get a free $76 gift when they sign up. You're gonna get that welcome kit, a bottle of d3, k2, and five free travel packs in your first box when use my link drink, AG, one.com/juice box, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. Hey, what's up everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you wrong way recording.com, you got a podcast. You want somebody to edit it? You want rob you?

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Scott Benner 1/7/25 Scott Benner 1/7/25

#1400 Canadian Invaders

Erica shares her journey navigating type 1 diabetes with her young son while managing her husband's possible LADA diagnosis.

Raising a type 1 child while questioning her husband's diagnosis.
How quick action saved her son from severe diabetic complications.
The fight for clear answers when doctors won’t listen.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Here we are back together again, friends for another episode of The Juicebox Podcast.

Erica's five year old son has type one diabetes. She has two boys. Her husband just got a type two diagnosis, but it seems clear he's Lada, and we talked today about what it's like to raise a child with type one diabetes. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years. Having an easy to use, an accurate blood glucose meter is just one click away. Contour next.com/juicebox, that's right. Today's episode is sponsored by the contour next gen blood glucose meter. This episode of the juice box podcast is sponsored by the Dexcom g7 the same CGM that my daughter wears. Check it out now at dexcom.com/juice,

Erica 1:56
box. My name is Erica. I have a son who is five now, who is type one diabetic, um, he was diagnosed at three and a half, and we've just kind of been going along as we can, and I've learned a lot from this podcast, so I think more than at a doctor's office, unfortunately,

Scott Benner 2:14
oh, yeah, I know that's how it feels. It feels that way to me, even if you're if you're wondering, yeah, so wait, he's five. He was diagnosed. He's five, three and a half, three and a half, yep, so about a year and a half and yeah, other diabetes in your immediate family or your extended family, no,

Erica 2:31
real significant. I mean, some type two. My husband has some, some form of diabetes. It was very sudden after COVID, they have him treated as type two, but he's had some lab work done that they think it might be like late onset type one other than those two. No How about

Scott Benner 2:51
in his extended family? Do we see celiac, thyroid, vitiligo, bipolar disorder, anything inflammation related

Erica 3:01
some thyroid but that's really it,

Scott Benner 3:05
not him. No, not him. Okay, not that. I'm saying it's him. But the frequency in which I meet people who are like, No, I don't have a thyroid issue. They test it, though, they keep after it. I was like, oh, what's your TSH, like, What's five? But the doctor says it's okay. And I was like, How do you feel? And they're like, Well, I'm tired all the time. I have muscle aches and joint pain. My hair falls out, but it's not my thyroid, because that's in range. And I went, Yeah, okay, right? Every day, by the way, every day. And then I just sent a family friend to their doctor, because they have all these symptoms. TSH is, you know, five and a half. And the doctor, doctor goes, nah, it's not that, I was like, but you have five thyroid symptoms, and TSH is five and a half. And the doctor, okay, we're gonna, we're gonna. And, by the way, elevated liver enzymes, which are another thing that you can have happen if you have untreated thyroid and all anyway, it's just really funny how nobody I, I guess my point is, I don't know how many people are walking around with an unbalanced thyroid who think it is, I know,

Erica 4:09
and the people who even, I mean, there's a ton of people who have thyroid issues that you would think that they would more people have to have it. Why is that not?

Scott Benner 4:17
Yeah, or you have it and the doctor doesn't give you the correct medication or you don't take the medication, you know, it's, trust me, there's a lot of people dragging their ass that don't need to be, yeah, that's all. That was my point. Okay, so your husband probably has Lada, but they're telling you it's type two. Yeah,

Erica 4:34
they haven't labeled as type two. He's being treated as type two, but he wears a Dexcom just so that they can keep tabs on what happens with his blood sugar. He's lost like almost 100 pounds and still needs medication and trulicity to keep his blood sugars in range. So has

Scott Benner 4:48
he lost 100 pounds because he's been trying to lose 100 pounds? Or do you think he's been in and out of DKA? I don't know about

Erica 4:54
in and out of DK. He hasn't had any other symptoms, but since diagnosis, he had lost about 30. Pounds before he was diagnosed, just out of the blue, and then he started having similar symptoms to my son, with the urinating and the very thirsty. Then they diagnosed him with type two, I think just because he was over 30 and overweight. Then they ran some blood work, and his gad antibodies came back a little elevated. All the other ones seemed to be okay for now, but, I mean, they keep testing them, I don't know, especially now they're sons diagnosed. They're like, that's kind of weird. Yeah,

Scott Benner 5:26
I was gonna say, did that spark anybody's like, interest the

Erica 5:31
Endo, my son's endo at our Children's Hospital. Found it very interesting. And he was like, if I could test him and run things, I would his doctor. It was more, I find it kind of frustrating, honestly, because I have, we have to be the one to be like, listen, here, our son was diagnosed. I find that bizarre and completely out of the blue that now he's, you know, it was right after he was sick too. He was diagnosed. So it's been more us fighting almost. We had to ask them, Can you please rerun this blood work? And that was about a year ago. So every year we just kind of, I mean, I'll pay for it. But I would like to know I have another son who isn't right now type one, and I want to have him screened if I really do think that. I mean, if his dad has it and his brother has it, I would like to know that,

Scott Benner 6:12
can I just point you to a new sponsor screen for type one?

Erica 6:16
I just saw that yesterday that you had posted that I am gonna, I'm gonna look into that. Thank

Scott Benner 6:20
you. Feel free to use my links. Yeah. So listen, I'm not a doctor, so sometimes people think say things to me, and I'm only drawing off ever my personal experience or a conversation I've had on the podcast, right? So I did go to, uh, chat GPT 4.0 and I asked it, I said, chat GPT 4.0 what do elevated gad antibodies indicate? And it says type one diabetes, latent auto immune diabetes in adults, and that those are the two things that it indicates that goes farther into that. And I said, would that appear with type two diabetes? And it said gad antibodies are not typically associated with type two diabetes, so elevated gad antibodies typically indicate an autoimmune response against the insulin producing beta cells in the pancreas. So, yep, I don't understand, like the people not why they're questioning

Erica 7:11
it. Yeah, I don't know. And according to them, when he was first diagnosed, the cutoff is five, and his was at six. So and I, again, I'm not a doctor. I work in pharmacy, but I don't know anything, I mean, about get antibodies and all of that. I don't know if that goes up over time, if that level would go up, if that's what they're looking for. I don't know the reasoning behind Not, not thinking like, boom, yes, this is definitely type one, or if it's because, I mean, with, you know, my son, and probably most type ones, obviously, once your body stops making insulin, it's very evident where, my understanding the Lata is slower. So I don't know if it's because he's got a slower response than not making insulin, and that's why I have no idea it's well,

Scott Benner 7:55
Erica, can I? Can I tell you what the thing that some people think is going to end the world, and people think it's going to save it. Thanks. Yeah, it says the levels of Gad gad antibodies do not typically increase over time. Instead, their presence usually indicates an ongoing autoimmune process. Okay, so that's good to know, yeah. Also, I'm going to say I I've said this a couple times the podcast. I know some people probably think I'm crazy. Some of the best conversations I've had over the last couple of months have been with chat GPT 4.0 because, because everything I wonder. It's like, oh yeah, here this and here's why. I'm like, okay, cool. Like, Listen, I'm not jumping ahead. But there is some point in time in the future, where you will think a think, and your thinker will go to something else, and that thing will tell your thinker what you know, and now you'll know it. And it's just really like fascinating, how quickly and directly and completely it does this and then. And the reason I bring it up is because all I have is a web portal, and I pay $20 a month for this. And you'd think a doctor wouldn't go, Hmm, I don't know. Like they'd go, Hey, I bet you there's 1000 ways we could find out. Hold on one second. What are they managing your husband with? That was my question.

Erica 9:15
He takes Metformin daily, and then he's on trula city once weekly. And

Scott Benner 9:21
does he have excursions at meals with his blood sugar,

Erica 9:24
certain things he does when he got diagnosed, he was originally on Humalog Atlantis, so they were doing that, and then they ran all this blood work, and they're like, oh, no, you're actually, we're not finding anything to make sure you don't need to be on insulin every day, you know, like every meal, long term insulin every night, and then they switched him. But if he eats, I mean, let's say pizza or he has a huge breakfast with toast and potatoes for breakfast, it eats very evident. You can see his blood sugar spikes, probably higher than it should. To

Scott Benner 9:56
where do you have a number around 300 OH. Oh yeah. He needs insulin. That's Yes, yeah, yeah. That's not for Metformin to deal with.

Erica 10:05
I know, like, last night, we had pizza at my grandma's, and his blood sugar when we got home was, like, this was hours after 200 Yeah? Which, yeah, I'm not diabetic. My blood sugar wasn't 200 after pizza.

Scott Benner 10:17
No. He needs, you know, a doctor who can, like, think completely, yeah, yeah, agree. I wouldn't wait,

Erica 10:25
yeah, yeah, I know, yeah, yeah. We're gonna find a new endo in a different location. I hope I don't mean that bad, but, like, especially after my son being diagnosed and talking with his Endo, it's like, man, somebody's got to know, and I don't know if it's you know, you can't teach an old dog new tricks kind of thing, where they're so set in their ways, and there's been now so many like sub categories of diabetes that people are, oh, no, it's only type one or type two. And there's that, you know, that fine line, but I it's becoming and I was told this by we live in Michigan, like Helena boss Children's Hospital, that no, that fine line is getting more blurred. And I don't know if we just have to find an endo that knows that a

Scott Benner 11:00
lot of people talk and say things, yeah, people hear things. They don't completely understand them. They pass them on. They have experiences. They let it color their you know? It happens to me. It happens everybody, right? Like I see something, and I tend to believe that that's the case. You need somebody who's willing to step back and try to just see it fresh eyes, you know? And the truth is, is that there's no world where I don't care what he eats. His blood sugar shouldn't be going to 300 Nope. I don't care if it's pizza. That doesn't matter to me. You know, I had pizza the other night, and I was wearing a CGM, yeah, and pizza combined with a GLP medication and a person who doesn't have diabetes, my blood sugar never moved off of 89 ever

Erica 11:41
see exactly? Yes, thank you. Yeah. And, I mean, that's what trulicity should be doing, right? If you're not diabetic, and, I mean, you he was on ozempic, same kind of thing. I mean, it doesn't matter, yeah,

Scott Benner 11:52
you would think, because Trulicity is a GLP, right? It is just an older one, yeah, yeah. So you would think, if he's on what did they used to call it once weekly. Truly? Is that what they call it? Yeah, yeah, yeah. And Metformin. And he's, they think he's type two ish. I don't care. Like, I guess it doesn't matter to me if he's type two or type one. I don't want his blood sugar to go to 300 and stay there for hours. That's all I'm saying.

Erica 12:18
I agree. I it's and I find this I get so heated talk because I get so frustrated, because here I am, you know, as a mom of a five year old, and it's like in every bone in my body to make sure he understands how to work his insulin so he can be a kid and eat those things, and somebody go to college and be an adult and live a long, happy life and not be running around the blood sugar if 200 300 you Know. And then I have my husband who, like, because he's not a kid. It's just seems like people are like, oh, you know, it's fine. Like, well, he's I still want him to, like, die at 50. I mean,

Scott Benner 12:48
he's still young. How old are you? 35 you've lived your life. It's fine. It's like, Come on,

Erica 12:55
kid learning from that too. It's just bizarre. It's just a lack of

Scott Benner 13:00
the Dexcom g7 is sponsoring this episode of The Juicebox Podcast, and it features a lightning fast 30 minute warm up time that's right from the time you put on the Dexcom g7 till the time you're getting readings. 30 minutes. That's pretty great. It also has a 12 hour grace period so you can swap your sensor when it's convenient for you, all that, on top of it, being small, accurate, incredibly wearable and light, these things, in my opinion, make the Dexcom g7 a no brainer. The Dexcom g7 comes with way more than just this, up to 10 people can follow you. You can use it with type one, type two, or gestational diabetes. It's covered by all sorts of insurances and, uh, this might be the best part. It might be the best part alerts and alarms that are customizable, so that you can be alerted at the levels that make sense to you. Dexcom.com/juice, box. Links in the show notes, links at Juicebox podcast.com, to Dexcom and all the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. The contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar, and Arden has them at school. They're everywhere that she is. Contour, next.com/juice, box, test strips and the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance. For another meter. You can find out about that and much more at my link. Contour next.com/juicebox contour makes a number of fantastic and accurate meters, and their second chance test strips are absolutely my favorite part. What does that mean? If you go to get some blood, and maybe you touch it, and, I don't know, stumble with your hand and like, slip off and go back it? Doesn't impact the quality or accuracy of the test. So you can hit the blood, not get enough, come back, get the rest, without impacting the accuracy of the test. That's right. You can touch the blood, come back and get the rest, and you're going to get an absolutely accurate test. I think that's important, because we all stumble and fumble at times. That's not a good reason to have to waste a test trip. And with a contour next gen, you won't have to contour next.com forward slash Juicebox, you're going to get a great reading without having to be perfect. I don't know what it is. I mean, I have these conversations with doctors all the time, and I can't figure out what it is, but it's in the end, it's the coin flip of dealing with people like, Yeah, you get who you get. And sometimes you get a great one, and sometimes you don't. That's what I and that, and everyone's gonna seem like they know what they're talking about, because they're gonna

Erica 15:51
exactly right, and they don't like to hear that. It might be something else that someone else said, you know, because, oh, no, then I'm not right. My, uh, we go to my son's endo tomorrow, and I'm gonna just ask, like, Who do you Where can I get this figured out with fresh like, Who do you think he would have someone to recommend? I would think, yeah, I really like how he thinks and what he says, right?

Scott Benner 16:09
So, yeah, can you find a guy from me for my husband who's not going to tell him he has type two diabetes and take Metformin because and then tell him what's happening, because the he'll recognize it as type one immediately. Yeah, when

Erica 16:20
my son got diagnosed, and we were actually in the hospital in the ICU, I was talking to him, he came in, and we had a very long conversation. And he even had never even met my husband at this point, and he was like, Oh, your husband's, for sure, type one. And I was like, Okay, so, like, he's even, I've only talked to him as much as I've talked to you, and he already was like, No, you're he's type one. If you look at my son's chart, they have my husband labeled as type one. Children's Hospital does just based on what I've told them. So it's just crazy. Of course, now

Scott Benner 16:49
you have a doctor and a podcaster agreeing with you, so you must be on the right

Erica 16:52
track. Yeah, we must be right.

Scott Benner 16:55
I've given myself over to it. Erica, by the way, I'm a podcaster. I used to say, like, Oh no, I'll do this, but I have a podcast. I'm like, I gotta give that up now. Like, I gotta give it up. Yeah, I gotta embrace this thing. Like, let's it's funny when I tell young people, they're like, really to get super, like, interested. Like, you don't see young people, like, laser focused very often, and they're like, hey, you know what is your like, you'll be together with a bunch of people. Or, like, my daughter brings somebody new home or something. And like, you know, the kids, they've been trained to try to act like humans. So they ask questions. They don't care the answer for you know, they're like, What do you do, sir? And I'm like, Oh, sir, this is nice. I like this. And I say, I make a podcast. And they then they're like, What? Really? Because they're like, in my home, you know what I mean? Like, they walked past the mailbox. You're like, this guy pays his bills with a podcast. And I was like, well, the lady makes money too, but, like, you know, yeah, yeah. And then they get super interested. If I tell somebody over the age of, like, honestly, like, 28 what I do, they're like, Oh, this guy is probably homeless, you know, like, he doesn't have I can't ask him for $1 he doesn't have it. He makes a podcast because they all have friends who think they're influencers. Yeah, that's yeah, oh, it's fantastic. Eric, I swear to God, I know no one will ever hear this that can, like, drill this down, but my daughter's high school graduation, all the kids are like, you know, I'm thinking of going to this college. I might go to this one. I've got a job. I'm gonna do this, this one kid. I said, Uh, hey, what do you? What do you? What do you got planned? He goes, I'm gonna become an influencer. I was like, you're just gonna become it. And he goes, Yeah. I said, How you gonna do that? He goes, I'm traveling overseas, and I'm going to, like, go on. I figured if he said it was an adventure or something like that. I was like, Oh, this kid's gonna get killed. He's like, I'm going overseas and blah blah, and I'm just gonna document everything and put it online and blah blah. My daughter comes to me, like, eight months later, and she goes, remember that kid? And I said, Yeah. She goes, here's a picture of him in a bar with men 25 years older than him. And I was like, Oh, he is definitely gonna end up dead, for sure. There were almost 20 people following him on his, uh, his account. So I think he's, he's really funny, wow, oh yeah, he's onto something. But Erica, all I could think was, why, when I was 17, did my parents not have enough money to let me travel abroad and pretend that I was starting a career?

Erica 19:18
Right? Where are these kids getting all this? It's nuts, unreal.

Scott Benner 19:21
You live in Michigan, yeah? You know about working? I know where you live, yeah, yeah. So military, right, working. This the area you're from, yeah,

Erica 19:30
very blue collar. Yeah. We're in like, Western Michigan. So Grand Rapids area. There's a lot of Yep,

Scott Benner 19:37
okay, no, no, no, it's a nice place. I know people live there, yeah. So let's talk about this, this kid of yours, three and a half year how many kids do you have? First of all, I have two. Yep, two boys. Are they? What? Ages seven and five. Okay, so the five year old a year and a half ago, what? Peeing, thirsty, that stuff,

Erica 19:56
his little daycare school program. I. On Thursday started just complaining about being really thirsty, wanting more water. Thursday night, he starts wetting the bed, which he never had an issue with after potty training. So at first, I was like, oh, that's, you know, kind of weird. But okay, Friday comes, we're supposed to be leaving that Saturday to go out of town for a wedding. Friday comes, and he's more thirsty at daycare. And then Friday night, we're in our backyard having a bonfire, and he and my husband are there, and he, I'm not even kidding you, in an hour, asked me for like, at least four bottles of water and chugged them, and he probably peed like eight times. And I looked right at my husband and I said, I know exactly what this is. I said, and I am not going out of town with this kid, because I will not end up somewhere that I don't know with my kid in the hospital, right? I mean, I work at a hospital in the pharmacy, so I took him, I said, my husband, I'm just going to take him in. And I got, you know, I knew we probably aren't coming home tonight, but I took him in. They poked his finger right then in triage, and it didn't register a number. So right then his blood sugar was like over 500 sent us all back, and we didn't have to wait. Obviously, they put us in and do a bunch of work, you know, blood work. And little bit later, they come in, and his blood sugar was 794 and he was starting to spill ketones he just had, like a bedtime snack, obviously, without insulin, because we didn't know at this time, this all happened at the same time. So I think his blood sugar was probably the eye because of what he had had, had, too. Doesn't matter. So then, right then they started them on an insulin drip and ambulanced us to the Children's Hospital, and we were in the ICU. What

Scott Benner 21:29
was this? Day? 1c 8.7 you caught it very fast.

Erica 21:34
Yes, we caught it very early. The endo was like, shocked. They were like, how did you do How did you know? And I it was honestly, because I watched my husband the exact same thing. Really, I was like, yeah, it was like, spinning in my my husband even had said to me, he's like, if this is what this was with me, he's like, you could keep giving that kid water and he will not punch his thirst in between. Like me, you know, me, watching him do what my husband did, and him saying that to me, I was like, Okay. Like, I just knew in my gut, yeah, how

Scott Benner 22:01
recently prior to your son's diagnosis, did your husband go through that like, how? You know what I mean, my

Erica 22:09
husband was diagnosed January of 2021 and then my son was October of 22 so about a year and a half ish, little bit more. Okay, okay,

Scott Benner 22:19
so you it was fresh enough in your head that you remembered, yeah, and you really acted on it too.

Erica 22:24
Yeah. I think if we wouldn't have been going out of town, I don't know I say that, but I still think in my gut I knew enough to be like, even if we weren't going out of town, I still would have taken him in that night. But I just remember telling my mom and my sister, who were supposed to go into the same wedding. I was like, I'm taking him in. And they're like, Okay, like, I think they thought I was crazy. And then I remember being in the hospital and giving them an update, being like, Oh yeah, we're being transferred to children's and the ICU. And my mom was like, Oh, like that, that moment, I think they were like, you're not crazy. But I just knew, you know, like, Mom got real. I think my boy stood by that. And then once I kind of put that with watching the same thing with my husband, I was like, yeah,

Scott Benner 23:03
yeah. I say this sometimes, but I find it interesting. The Egyptians, like ancient Egyptians, they recognized diabetes. They didn't understand, like, the pathology of it, but they called it the great drain, because they believed that you were like, You were urinating yourself to death, and it

Erica 23:23
literally looks like it's insane, like watching somebody with a blood sugar that high. I mean, I'm glad I didn't wait, because who knows what would have happened. I'm glad that I knew enough. Yeah, you know, with that and some of my medical background, because it literally does, like, how does somebody consume that much water, too? It's he was three and a half. He's tiny. I mean, there's no reason you should be that thirsty.

Scott Benner 23:44
Also just can't afford it, to be honest. Like, once the fourth bottle of water comes out, you're like, Listen, I don't know what you think we got going on over here, but

Erica 23:51
it's at least two bucks, man,

Scott Benner 23:54
I'm doing the math, and we're going to be broke by Wednesday. Get you to the hospital, unless health insurance wants to start paying for bottled water, and then maybe we can keep going a little longer. Well, yeah, that is really cool that you caught it that quickly. Now, how does the hospital handle it? Because he's not that far along. Do they keep him for a while? Or how did they talk to you about it? So it was a Friday. Now you're stuck there for the weekend. Then, yeah, it was a weekend,

Erica 24:19
but they were actually really awesome. They his endo that came in. I don't know if you, I mean, I know on your website you have some lists of that, you know, Children's Hospital, but the I know that is actually his was on call that weekend. We just fucked up. He's the chief of the the department that is lucky, yeah. So he came in and we were kind of talking, and my husband had gotten brought up, and they had kind of, I mean, I work in pharmacy, and I have some medical backgrounds, so they actually only made us stay one stay one night. We met with a dietitian that day. They called one in for us, and kind of were like, here's his ratios to start with. Here's what you're going to do. And even though I knew I had the basis of it, I mean, it's he's still three and a half, it was still kind of nerve wracking to be like, oh God. Like, I'm in charge of this kid. Oh, you know, it's like the hospital with a brand new baby. We. You're like, Okay, I guess now I have to keep this kid alive. But like, more so, you know, 10 times more

Scott Benner 25:05
Erica, one of the like, enduring, horrible memories of my life is the moment it occurred to me in the hospital that I was a stay at home dad, because I like, it was such a blur. It was. We were days into it. And, you know, there's, they're giving you classes and everything, and, and I, and it hit me out of nowhere. I was like, oh my god, we're gonna go home. My wife's gonna go to work, yes, and I'm gonna be here with this two year old kid that has diabetes, and there's needles and, like, math. And I was that was overwhelming, like, I still remember how

Erica 25:40
in needles, but, like math, that's a guess. You know, they're guessing, like, okay, based on his age and his weight and how, you know, this is where you're starting with ratios. But like, my son, specifically with us, I mean, he was tiny, those little humolog Biles or, I mean, pens, you know, the doses they were he He's so sensitive to insulin that, like, we were either having to make him eat enough to make up for what insulin we're giving him, or we were just giving him food because he was it wouldn't work. So the math wasn't even nothing. You know, you're like, this math that they're giving us is not is not good enough. It was about

Scott Benner 26:15
when the nurse comes in and she says, Well, here's your blood glucose meter. And I was like, okay, she goes, we're gonna practice together. And I was like, Oh, we're practicing. That's nice. And so she's like, I'm gonna use my meter because I have to put it into charting, and you'll use your meter. And I thought, why can't you just use my meter to put it into charting? But okay. And so she tests Arden's blood sugar with her meter, and the number comes up, whatever it is. I forget the exact number, and then I test with the meter they gave us to go home with, and the number was like, 2530 points different. And I was like, well, which one's right? And I remember her saying, what? And I went, well, the meter you have said that, and the meter you gave me said this, and mine looks like it fell out of a bubble gum machine, and yours looks like it cost $20,000 so like, Is yours right and this one's wrong? Like, every time I test your blood sugar, should I just assume it's 20 points higher than this? Because that, you know what I mean, I'm like, and she's like, No, don't worry about that. And that was the end of that direction. And I was like, I still, it's funny, because still on the podcast today, when people ask me about that, I go, Yeah, I know doesn't end up being too much of a problem, like, just, it really

Erica 27:24
is so true in the beginning, you know, every little thing, it's like, I mean, we're almost two years in now, and I can kind of look at a meal, you know, and kind of, I used to be, I was counting every single carb, and I was measuring and weighing everything, because that's how in your brain, you realize, okay, I have to keep this good. But now it's like, after two years. I mean, what is 20 points difference really? Yeah, I get so, like, immune to it and comfortable, and now I can, like, Look at me. I'm like, oh, it's probably about that many carbs, and you just kind of catch a high or catch a low as you go. And, I mean, hope for the best. Kind of,

Scott Benner 27:56
I almost hate to say it, but I agree with you, if you didn't have diabetes and you were trying to, like, chart your blood sugar, and your blood sugar was really 89 and you thought it was 109 Well, that's a big problem, but if you have type one, and your blood sugar is somewhere between 89 and 109 I mean, you're just killing it. You know what? I mean, like, yeah,

Erica 28:14
all right, that'd be a risk, yeah. I mean, it is just funny how and then the doctors, I think if you don't live it, I mean, no, I and those, they're great dietitians. The diabetic educators, they all know, like book the books part of it, you know. And they've learned a lot, obviously. But I think unless one of the diabetic educators at my son's office is a type one, and like I would choose to pick her to talk to over if you live it, you just get it more, I think. Yeah. So that nurse being like, oh, that 20 bit, you know, at the beginning of a diagnosis, that's scary. When you don't know

Scott Benner 28:49
what anybody's talking about, you're like, I don't understand. Why does it not matter that these two numbers aren't

Erica 28:53
Yes, exactly, yeah, that's that's my point. Yep. And by

Scott Benner 28:57
the way, perfect world, it does matter. And it would be nice to follow the technology. And again, I want to point out Arden was dying. Arden was diagnosed when she was four, and she's going to be 20 next week, so this was 16 years ago. Yeah, I could not imagine that young nurse who told me that is 40 now, yeah, yep, because she looked like she started like the week before, and now she's literally, literally, probably 40 years old. Now I tried one time to reach out to the doctor at the diagnosis, she's like, I'm retired. And I was like, oh, oh yeah, I'm old. I forgot you get this information. I mean, I assume I don't. I'm gonna ask your situation at home. Are you a stay at home parent, or are you the one that's with your kids? Or how does it work? We

Erica 29:40
have a very weird dynamic. I work third shift at a hospital, and I do week on week off, so during the day I am home, and then on my week off, I'm home, and then the weeks I'm at work at night, my husband is home at night. So it's a very we do a very my husband I are a great team. We do a very good juggling act. I I could not do it without him. He. That do it without me. I would hope he would say, we're both home with him at all times, but

Scott Benner 30:05
we both work. So how do you do that? How do you work for a week and then not work for a week and then work for a week? Doesn't it make you mental every time you have to go back to work?

Erica 30:13
Yes, I get pissed every Wednesday. I'm like, I do Wednesday to Tuesday night, and I get very, very mad. I've actually been off for two weeks. I have one more week off because I took a week of PTO, and I am not going to want to go back next week, three weeks off. It's going to be like, you know,

Scott Benner 30:29
when Kelly and I were first married, we went on a vacation for like, two weeks, and we came back on like, Sunday afternoon, and we were sitting, you know, in the living room. We were, like, we were doing laundry that we brought back from the vacations. And we were really young, like, I want to be honest, like we were like, first of all, we were too young get married. And like, when we were really young, like, I was maybe, my God, I was maybe 24 and she was like, 22 you know what I mean, like, and we had just, like, taken off these two weeks. We're sitting there watching something on television on Sunday evening, and I spontaneously, and I mean, out of nowhere, start to cry. She's like, Oh my God, what's wrong? And I was like, I do not want to go back to work. And I wasn't kidding,

Erica 31:16
that'll be me. That'll be me. I sit there every, you know, Tuesday night before I go back and my husband, I watch TV because watched TV, kids go back, and I'm like, I don't want to go back to work. And he goes, You say this every Tuesday, I know, I know, but I feel the same every Tuesday you just

Scott Benner 31:31
feel like, which is why you're getting a very consistent response from me, right? Must be real. No, it just that just hit me. Like, once you're in the swing of it. It is what it is. But like, you stopping and starting, like, oh, I

Erica 31:44
have to just remind myself, like, between my husband and my son, they both have CGM, and my son wears an omnipot. And I'm very, very grateful where I work. I have very good insurance, so I have to work for the health insurance. I mean, yeah, it is what it is. So if I guess, if you put it in that way, like, I don't really have a choice, I have to go. I don't want to, but I have to, yeah, I've noticed

Scott Benner 32:05
things are easier when you don't have a choice, right? Yeah. Okay, so, like, is there a main caregiver of the diabetes, or are you guys, like, literally, a team on it?

Erica 32:14
As far as, like, home life, we very much are a team as now when it comes to, like, schools, because I'm home during the day, when he's in school, I am the one who trains the teachers usually, and the nurse and all of that. And when it comes to appointments, I bring him to appointments. But I mean my son or my husband, like, I have a weekend coming up where I'm going away for a bachelorette party, and I my husband will be just fine, like he he does very, very well. So we are very much 5050, he knows exactly what to do. Yeah, it which makes it a lot easier, I think, on a parent, because it's hard. It's hard being a parent of a type one and making sure everything's good. But yeah, when

Scott Benner 32:54
you signed up to come on, you didn't write a lot, but you said that there's a determination that's necessary to give your kids guidance and the drive that they need to succeed. And I was wondering, like, Is that why you wanted to come on? You want to talk about that?

Erica 33:06
Yeah, I I feel like when it's something that does make you realize, I mean, it smacks you in the face at first, you know, when you you are the parent of a kid diagnosed, and you know this, I'm sure it's your job to make sure that kid can grow up and be a full fledged adult and be able to manage their diabetes as I don't ever want my son to feel like he is only diabetes. You know, like Arden, she goes to college and she lives a very happy, healthy life. I I would assume they send a podcast doing good, and to be honest like you, with how you are with her has been such an inspiration to me that if me going on and talking about my kid and the determination that we have as a couple to make my son's life like that, I that is why I wanted to go on, really because it is possible. I mean, you have these people, and I think I'm blessed and lucky that my kid was diagnosed at three, because he doesn't remember life without diabetes, where you're diagnosed at 1415 it's probably a little harder to get your you know, they now realize, Oh, my life's a lot different.

Scott Benner 34:15
Um, that's one of those questions I don't know how to answer. I

Erica 34:18
mean, either people ask me that all the time, and I'm like, I don't know it's like, I can see it completely both ways, right?

Scott Benner 34:25
But I see the virtues. I mean, if you're gonna call them virtues, but I see the virtues of both, you know, the being young and not having this like feeling of, you know, like loss maybe. But I don't know that. It doesn't matter. When you get to a certain age, you can look around and see other people and feel like, oh, I don't have this thing they have, you know, like, like, a carefree nature, or like, you know, like, Arden and her friend got up the other morning at, like, three o'clock in the morning, and they drove to the beach to watch the sun rise right, which I thought was lovely and everything. And so she's, like, her alarms going off, and she's getting up and, you know. As she's leaving, I'm texting her, like, don't forget to take your supplies. Like, don't, you know. Like, it sucks because you know her friend's gonna roll out of bed and just like, you know, wander outside and get in the car and leave and and I'm telling Arden, like, don't forget, you know, bring a pod. You know, bring insulin. You know, don't forget to put the insulin ice. It's hot out. Like, yeah, so, I mean, I don't know that at some point you're not gonna even though you don't remember it. It's not like you can't see it in other people and go, Oh, I I'm missing something that they don't have. You know,

Erica 35:32
that sucks, and that pisses me off, actually, as a parent, because, I mean, I have nieces and nephews who like, Oh, you want a snack. Go to the pantry, get a snack. Oh, you want to go ride your bike around the campground. When we camp in the week, like, but it's always with my son. I'm like, Okay, we have to dose you for your snack. And, oh, make sure you bring your, you know, your phone with you so you hear your alarm go off and bring your fruit snacks. So if you you know, it's like, we always, yeah, we were camping with some friends a couple weeks ago, and one of them asked me. She was like, Do you ever just, like, get a break and you don't, you just don't. You literally don't. Yeah,

Scott Benner 36:03
no, you're like, I have it on my calendar. I'm planning on dying when I'm 86 right? That's gonna, I'm gonna, I'm taking the day off that day, for sure, you don't,

Erica 36:09
yeah, you don't get a break. And it made me think it's like, no, I guess you really don't. But, I mean, it just becomes second nature, I guess, yeah, back your mind. I always say I only ever really relax when my son is eating, and I know why time is Pre Bolus, right, or when he's sleeping at night, and I know that OmniPods got him all night, and we're just fine solo. Those are like, the only two times where you're not really like so in the back, it's always there, in the back of your mind.

Scott Benner 36:32
I'll tell you that I don't have that overwhelming feeling any longer, but I know what it was, and I lived with it for very long time. But I do have the it doesn't stop feeling like that for sure. I don't know. It's like a noise in your house you can't find. You know what I mean? Like, you're like, what is that buzzing?

Erica 36:50
And I do think, I mean, I couldn't be 60 years old and him be married with his own kids, and if I'm on his Dexcom, which he probably won't let me be, but, you know, I'll hear I'll probably be like, oh, you know, are you okay? How's your low you know, did you eat something? But I just think, as it's just always probably gonna be there. You're always gonna worry.

Scott Benner 37:06
I think if you could see my brain like, you know, when you open up the activity monitor on your computer and it shows you where all the memories being used? Yeah, I guarantee that there's a portion of my memory that is constantly being used for diabetes, whether I'm aware of it or not?

Erica 37:20
100% Yeah, 100% yep, I would agree. And I haven't been doing it near as long as you. So I feel like, I mean, if you're telling me I'm just going in because it's forever,

Scott Benner 37:31
like, it goes away more and more. But I try to think about people with type one my daughter and other people, and maybe when people say they're burned out and they're just like, I just like, I just stopped paying attention. Like, I wonder if that's not a defense mechanism. Almost like, Oh

Erica 37:45
yeah, you know, I want that. I wondered that, yeah, it sucks. I mean, it does suck. I can't imagine those kids. I mean, even the people that aren't kids that deal with it on a daily basis. I'm like, my kid is stronger than I would, I would probably be. I mean, if you have to be, you have to be. But just even the way that these kids take it in stride and do with life, it's amazing. It's a

Scott Benner 38:09
good lesson that maybe you could ask more of your children than we do sometimes as well. You know what I mean? Like, like, look, they're handling this. They could probably handle taking out the garbage. Or, for sure, yes, working a little harder at school, or being a little more whatever. Like, we can act like, oh, you know, they need to be kids, and they need to do this. And I don't even know what that means, honestly, like, what does they need to be kids? Mean? Like, they're kids, don't worry about it. They'll be alright, yeah. And it feels incumbent to say, if you let the lessons that come from diabetes really get to you without being just pissed about it, you will see there's like, a leveling up that happens in a lot of areas of your life. That's for the people who make it. You know what? I mean, like, that's an easy story to tell if you're doing great, but if you're at home and you can't pull your head out of your, you know, blankets, then, you know, being told that there's great lessons to be learned from diabetes is not a valuable statement. So, yeah, yeah. And that's the thing you think about a lot, like, where's my kid gonna end up with all this? Right?

Erica 39:14
Yeah. I mean, you could, we could go on all day about what it costs to be a diabetic, you know? And these kids didn't ask for that. I'm very lucky now that, like, I don't pay a lot for our things because I have very good health insurance at the hospital I work at. But, like, when he gets kicked off my insurance someday, you know, it's just things like that where it's you're always wondering Maureen, about things that most I feel like most parents don't ever have to worry about their health insurance when their kid's 26

Scott Benner 39:36
you know, yeah. But feels like a time bomb in my house. It

Erica 39:39
does. Yeah, it does, you know, compared to two years ago, it's been almost two years. I breathe a lot easier than I used to, and it's just another day. And some days are great, and we have an A 1c of six currently, like you put it into the grand scheme of things, it's just life, and we're doing what we gotta do, and he's having a healthy, healthy life. And if you ever do, sit back. Back and think about it. You're like, dang, you know, this is forever for this kid. People ask me about all the time because type one's still misunderstood too, you know, I had somebody ask me this pets weekend, so he'll have that forever? I'm like, Yeah, he'll have it forever, you know? And it's like, when you put it like that, like, dang, it's got a lot of years still, they

Scott Benner 40:15
have to Yeah. Like, even when you're saving for your retirement, like, I we find ourselves in this position all the time, like, there's this party that's like, oh, I would like to retire one day. You know what I mean? Like, I wonder if I could put some money together and do that. And then my wife will say, like, shouldn't we just leave it to the kids? Like, what if Arden can't get insurance when she's an adult? Yeah. And I'm like, Oh, God, is that what we have to do? Like, you know? And then some people hear that and say, they'll be all right, and Bye, bye. And she probably will be. But what if she's not? You know what I mean, like, like, what if I'm, like, drifting away, and one day I go, Oh, I did go on vacation five times when I was retired. Or I could have left art in that money, and maybe she could have bought insulin with it for a decade, or something like that. You know what I mean, so and maybe not that long. Honestly, I don't go on extravagant vacations. At least she could have something like, what if, like, I mean, God, we say this to each other all the time, like, what if she just, again, ends up being a near to well, and she just kind of can't pull it together. Or, what if she marries a guy who takes advantage of her and takes her money one day? Or, like, like, like, all the like, nobody else thinks about that because, like, you could fall on your ass 1000 times. But if you're on your ass and you can't afford insurance and you can't afford insulin, right, that's a different falling you know? I don't know it sucks, yep, well, try not to think about it, because I will tell you this worries a waste of imagination, and that'll probably not happen. Yeah,

Erica 41:39
no, I love that. Yeah, I'm always been like a worst case scenario, hope for the best, but you'd ever know kind of person? But, and back to the diabetes lesson thing. I feel like that's a lesson that we've all kind of learned. It's like, it is what it is it it will work out. Try not to worry about it. You know,

Scott Benner 41:56
it's nice to have an actual, physical representation in your life, of what doesn't kill you makes you stronger, right? But at the same time, there's that other side of you that's like, I would like to not know that lesson, yeah, yeah. I could use for some ignorance. Like, I'd like to walk around just pretending that, like life's just easy, like, that would be nice, you know. Anyway, yep, this is a bummer, Eric, did you know you were gonna be such a bummer? I

Erica 42:21
know what a Debbie Downer I am.

Scott Benner 42:24
Oh my gosh. So kid is on

Erica 42:27
a pump, right? Yes, he's on Omnipod five. Omnipod

Scott Benner 42:31
five, so he's using Dexcom g6 right now, yeah, okay, three and a half. He's always with one of you, or he goes to daycare. Well,

Erica 42:41
he goes to school now. So he was just in preschool this past year, and they did great. How'd that go?

Scott Benner 42:48
How did you get that set up? What did you do to set it up? I

Erica 42:50
started in the summer, reaching out to the school and just saying, you know, my son has type one, figuring out, is there a certain classroom he needs to be in? Which teacher Do you think he'd be best with once we kind of got all those ducks in a row. I've met with the teachers a couple times over the summer, and just kind of they met him, and we kind of went over the basis of this is what we'll do. I'll send him with I always send him like with his lunch and the carb count. They don't have to figure out the math. I try to make it as easy as possible. And it is easy with the Omnipod, you know, they just have to know how to work the controller and all of that. And then I made up folders with just some basis information, like, if this ever happens, here's this paper you can pull out, you know, pull out and talk to each other if you need to call me, text me. They had a group ride with my husband and I, so anytime they would have a question, we would just respond in a text message. But they did, what's

Scott Benner 43:42
that paper label? Does it say oh shit on the top of it?

Erica 43:47
It doesn't, I think, when you hand it to them, though, that's what they think. Oh yeah. People's faces, you know, they're like, Oh God, I have to keep this kid alive. This is a teacher. What? But, yeah, we're actually starting that process right now with kindergarten. He'll be switching schools and going to kindergarten in the fall, so I'm actually like, updating all his papers and going to the end of tomorrow to get papers signed, and I'm hoping it can go the same way. You know, kindergarten a little more freedom than preschool was. So yeah, it'll be an adjustment, but

Scott Benner 44:17
it's going to be like that every year. Yeah, even if it's just because he gets older, or even if it's because the structure of the day changes, or all of a sudden there's more recesses. Or, you know, wait till some time, wait till they put recess before lunch. And you think, this is terrible, and then the year later they put the recess after lunch. You're like, oh my god, yeah, this is worse we

Erica 44:41
just had. So that's to figure that in, okay, after, and then after, after recess is nap time, you know? So you're running, running, running, and then all of a sudden, now you're laying down. You're like, oh, pump

Scott Benner 44:52
them full of insulin, give them some to eat, run them around and let them take a nap. Yeah, yeah, exactly. But you figured out, like, what did you do? Like, gave them basically. And if this. Then that type of a list, yeah,

Erica 45:01
if this, then that, if this and that, if you still can't figure it out, call or text me if he was ever, you know, a couple days where his pump wasn't working right. It was a million degrees, or he didn't drink lot, whatever that list of things could be, why his pump wasn't working as well and his blood sugar was higher than normal. I went up to school and changed his pump a couple times and tucked them for ketones. And if he was fine, they were very good about it, like adjusting him. It was, I mean, we maintained a a 1c of, I think it was 6.2 at the start of the year, and 6.0 at the end. So you

Scott Benner 45:32
well done. Yeah. Is that you, or is that Omnipod five? Is it a balance of the things? Omnipod

Erica 45:37
five definitely helps, but that's the only pump we've had before we were MDI, so I, I guess that's all I have to know to compare it to dosing wise. I mean, the podcast actually has helped, because I am not afraid to kind of maybe over correct once in a while if I know a highs come in, which you don't know to do until you know to do it, but his his teachers only knew what I would tell them, you know, so and we had it written. I think this actually came from one of your podcasts. You know, have the endo in the papers, right? Parents have the say, the last final say. So it doesn't matter what this document says, If I'm telling you to do this, you better. You better do it as his mom,

Scott Benner 46:18
yeah, just an out clause at the very bottom, like, here are all the rules, unless lady or guy says something different than do what they say. Yeah,

Erica 46:25
so we did that, but the Omnipod, the Omnipod is, mean, very, very good. It can't keep up with all the highs sometimes. I mean, he's five, and we have birthday cake at school sometimes for birthdays. But I don't know, we're very vigilant about it, and maybe we're too vigilant at times, but whatever I gotta Why

Scott Benner 46:44
would you say that? Why would you say maybe it's too vigilant sometimes, I don't

Erica 46:47
know. I just think maybe sometimes we're too hyper focused on it, like I've had people say, Well, I think if you just again, and this is people who aren't parents of a type one, so maybe this is just me thinking that I'm over zealous about it, but, you know, you have people be like, can't you just, won't it just come down on its own? Won't it just the pump on its own? Do it? But it's if he's riding a little high. I mean, eventually that pump will bring him down, but those little micro boluses are going to bring him down a lot slower than me just giving him a half a unit or a unit here or there. You know, I

Scott Benner 47:20
think a person who doesn't understand diabetes, I understand why they would say that, if they, if they understood the impacts of the higher blood sugar, I think they wouldn't say that. But yes, I also see a lot of people who are willing to live like that. So maybe I agree, maybe, maybe not. It's just, it's just different. It's different perspectives that people have on levels of effort that they want to put into things. Yes, that's kind of all it is, really. And, you

Erica 47:49
know, I will say I don't even think it's just diabetes. I'm kind of like that in every aspect of my life, yeah, so maybe just my personality, and that's just what I do for everything. So it's just normal for me, and it doesn't feel like extra work to me, you know? And I feel like, as a mom, that's what I signed up for, you know, I'm going to do whatever I need to do for this kid, and if that's this, is that, then I hear you. I

Scott Benner 48:09
feel the same way. I have to tell you the I was so busy yesterday, I looked at today, and I thought, I'm going to record with Erica at 10am but I've been working since seven and and the truth is, is that right before we recorded, I thought to myself, I gotta eat something like, what am I doing? So like, I'm gonna take the time to eat after you and I are finished, I have to record new ads. Today. I have a new series that I'm doing with the Arden that I have to get the microphone set up for. I'm paying more attention to my social media now, because it occurs to me that I have a really strong social media presence that I don't do anything with. I was like, Maybe I should do that. I'm setting up some paperwork for something. I just set up new things with Dr Blevins to come back on and talk again about a couple of different topics. I want to get Jenny set up for, like, the next 25 things we're going to record together, and I'll do that all day, and I'll have to remind myself tonight to stop and like, I really will, like, I'll just keep working. Yeah, and I don't feel put off by that. Now, I'm not digging a hole. Listen, I've worked in a sheet metal shop before. I wouldn't be like, Oh, I was super excited to weld 100,000 tanks today. Like, I wouldn't have said that, you know what I mean, but I get that, but I don't know what people think life's supposed to be full of. You know what I mean? Like, I'm doing a thing that I'm really good at, and it's helping people. And like, I like that. It fills my time, and I think that about kids too. Like, what? And anything else I'm not doing, by the way, I'm gonna be doing something I helped Arden last night, she's filling out an application for something. I sat with her and helped her with that kind of stuff. And she needed some feedback on some stuff she had to put in with the application. I was happy to sit with her. My son and I watched four innings of a baseball game together, like, I don't know, like, I don't find myself bored, right? And I don't get that when people are bored. I guess there's so many fun things to do or things. That people can benefit from.

Erica 50:01
Yeah, and I do think like you, how you don't get bored of the podcast, and it doesn't, it probably doesn't feel like work to you, no, because you you know it's enjoyable. You're good at it. People learn a lot from you. You have life experience. And I think you know me coming on and talking. I mean, it's not nearly as what involved is what you do. But it doesn't feel like I'm sitting here, like it doesn't feel like I'm trying to fill my time, like I'm enjoying doing it, and I feel hopefully it helps people too, but that's what I kind of feel like taking care of my son. It's like I don't it's just, what else am I going to be doing, really, with my life? I mean, those days I don't work, I might as well I'm not just going to sit on my TV and my couch watch TV all day. You know, what else is there to do? Yeah,

Scott Benner 50:45
I hear that like, people are like, well, I, you know, I don't know what to do, or I don't I'm like, Yeah, I don't know. What did you think this was? Like, I always wonder that. Like, you know, especially now, kids grow up with so much stuff to do as kids, yeah, when they stop being kids, and their times not overly managed, and they're not in 17 sports or something. They're like, what is life? I'm like, Oh, this is life. The thing you were doing before we were like, like, just holding up shiny objects in front of you. Yeah, exactly. Now, run to soccer. Now, run to this. Now, do your homework. Now do like, you know, I don't know I like tasks. I like but I don't think of them that way. And I just know I don't either. Yeah, I enjoy having things to do. That's my point. I don't know. And there's no reason why diabetes can't be one of the things you just do without feeling like, oh, this is so unfair that I have to do this. I reserve this is unfair that I have to do this for the laundry. Yeah, right, that I'm happy to be pissed at. Like, do you know I recorded an episode yesterday, like, and I I, like, two minutes before I recorded, I ran, I put a load of laundry in, and I set up a timer so that it would turn on and and be done right when I was done recording the podcast, so that I could put it the dryer and, like, even that I enjoyed. I'm like, oh, people need clean clothes. Like, I'm I'm like, yeah, like, but it's the folding. It, the folding it makes me mental. Oh, I'll fold

Erica 52:15
it, but I don't want to put it away. Oh,

Scott Benner 52:18
putting away. Do you leave it stuck Do you leave it piled around everywhere? Currently

Erica 52:22
have a pile on my dryer and in the clothes basket, and I'm hoping that we can just wear it all, and I can just and I don't have to put it away.

Scott Benner 52:30
Is there a better feeling than putting on a pair of underwear that you didn't put in a drawer? You're like, no wasted time here, baby service. Well, yeah, well, we're all living the same life. It's crazy. When you said the podcast was helpful to you, can you explain to me how you found it and what it was that you found helpful? Yes,

Erica 52:54
so actually, my the endo office told me they were like, You should really listen this podcast, you know? And then they closet where it's like, you know, it's not medical advice, you know, how they Yeah, they do that. Which I was like, No, that's okay. But for me, it was having you as a dad and the experience, and then listening to, like, Jenny talk, you know, she has diabetes, so listening to her first hand experience, and just the be bull with insulin, to me was like, it just hit home. Because I, I think it goes back to me saying, when you're when you're first the parent of a kid diagnosed, I mean, it can kill you, you it scares you. Yeah, you know, like, don't give too much, because that can kill you. But if you don't give enough, you're going to have long term offense, and that can kill you too. And it's, I think it feels like such a fine line, but for me, the podcast, it made that line, like easier to understand. You know, yeah, you can be bold and insulin if you can understand how to catch the low that's probably going to come after you're bold. But for me, like that was less scary than always having to make sure I'm counting right, or not giving my kid pizza or not letting him have birthday cake, or right? You know, we'll just figure it out. So helpful in the way that it taught me not to be afraid, really, of I mean, it is insulin, and it can be scary, but it doesn't have to be, Oh,

Scott Benner 54:12
that's interesting. I'm glad to know that I really don't know. Like, I'm just, obviously, I make a lot of content, but so I'm of the mind of just like, I know a lot of things, I'll just keep saying them, you know what I mean, and people will hear them, and hopefully they'll help. But I never, I never quite understand, because different people find different parts of it valuable, yeah, so it's interesting to hear that part, yeah? Like, so you're almost like, I'm almost like a baseball coach to you. I'm like, you can do it. Get out there, hit the ball.

Erica 54:42
Yeah, no. 100% Yes, yep. It's interesting.

Scott Benner 54:46
I didn't know all this before I started, seriously, like, before I started, I was like, here's what's going to happen. I'm going to do this, and they're going to react like that. And it like, very quickly. I was like, Oh, I guess that's not how it works. I guess I. Don't just, I don't just control what everybody thinks. It's actually freeing once you recognize that not everybody's going to take the same thing from it, because then you just, you realize, like, I'm like, I'll just dump what I know out into the world, and people can pick from it. It's like a garage for me,

Erica 55:15
like, you know, first being diagnosed when that, you know, the doctor said, oh, you should have said this podcast, you know, the the beginning series was so helpful. Then when I then I knew about the podcast. So then when we went from MDI to omnipot, I was like, Oh, well, I'm gonna listen to the omnipotent I listen to all that before we went to the training, you know. So then I, but then my favorite episodes are the ones where parents come on and just talk about their kids, and just hearing like how other people do things and how other kids are getting through life, and it I just, I've learned. I've learned a lot. I've

Scott Benner 55:46
Excellent. Well, it's working then, which is really all that matters, like, like, at some point sounds so, trust me, it sounds so stupid, and I know it does. I think of this almost, like, as an artistic endeavor, like I painted it. It's up to you to tell me what it is. Like, I don't get to tell you how the painting's supposed to make you feel, yeah, like, once I was able to let go of it like that, and then to hear it back from somebody like you, this is really excellent because, because, in the end, all I should be doing, like, there are people close to me that, you know, help me with kind of the emotional support it takes to make this thing and, oh, I can Yeah. And, like, I get from a friend, and it's a person you guys know, but it's a private thing for me, so I'm just gonna keep who it is to me. But you know, she'll say to me, like, just keep doing what you think is right. Yeah, like, it's working. And I'm like, because I'm like, Well, I don't understand. Like, what did we do here? What should we have done? Like, what am I missing? And she's like, it doesn't matter. She's like, just do what you just keep doing what you're doing. And she's like, people, people jive with what you say. Just keep talking. And I'm like, okay, because I can get caught up in like, what is it I'm doing and what am I supposed to be doing? And she's like, just whatever comes to mind, just do it. And I'm like, okay, great. So I make lists and I stare at them until I go, that's the next thing I'm going to do, and then I do it, and it generally works out well, so I should knock on

Erica 57:13
No, yeah, I kudos to you for doing what you do. And I She's right. I hope you do keep doing it, because it is very helpful as I mean, I haven't even been doing it that long, and I feel like, compared to even a year ago, like when we were six months in, I feel like I know even more. I learned more, and I don't think I even try to, you know, I think just listening and it you're you're relatable. So I think you just talking and being relatable is what makes it like, Oh, if he can do that, I can do that.

Scott Benner 57:40
That's exactly my that's exactly how I feel about it. I'm like, I'm obviously an idiot. So they must be like, he's doing it. Well, hell, you know, like, um, but, but you said something that I actually find to be true. Like, it's something I tell people all the time when they're newly diagnosed. I'm like, you know, the biggest takeaway you should have today is that a year from now, you will look back on yourself and not recognize yourself like you will, you will be so much better at this a year from now. If you just listen to the podcast and they're like, Well, what episodes? I'm like, almost like, I don't know. Like, just listen. It'll get to you. Yeah, then keep going. Yeah, right, yeah. It is that learning through it just seeps in. It's not, it's not learning the way people it doesn't

Erica 58:20
feel like learning. It's not like you're sitting school and you're taking down notes, which is, I think, what it felt like, and feels like when you're just diagnosed, you know, they hand you this binder, and they're like, here are all the foods you should eat, and here's but then when you listen to the podcast, then you I listen to an episode about the glycemic index, and then you're like, Well, I want to know more about that. You know, it's like, just listening, I think makes you want to learn more. Yeah, as somebody living with it or taking care of somebody with it. So it's yeah, keep doing it. It's I thank

Scott Benner 58:49
you. I appreciate it. I had a business call yesterday with like, a long term sponsor who's like, these, you know, a lot of these companies use, like, outside PR departments to help them, like, figure things out and stuff. And this one company wanted me to sit down with, like, like a consultant that they have, and they wanted to know what it is like. They're like, Well, what do you do? Like, basically, like, they they buy ads from you, but what is it you do? And I and I sat down, and I was like, okay, so I get on this call with this person I don't know, and she goes, What? What do you do? And I said, I trick people into taking better care of themselves. And she goes, what? And I said, and I just told her about the interview from that day. And I was like, I interviewed a lady today. This was her story that, you know, like you would think we would have went in this direction, but instead, we talked about this. And, you know, she's like, Well, none of that has anything to do with diabetes, like I know I said, But interject it into that conversation. I would take excursions into diabetes stuff, and you'll listen, because her story is insane. You won't realize that three or four times along the hour you heard stuff very specific about diabetes that helped you, and it'll stick. To you. And I was like, Yeah, right. And I was like, and that's my that's my model. It's not just, by the way, it's not a model. Like, I sat down and I thought, hey, Erica, what's going to work best here the way I make this, but this is just how it comes out of me and like, and to call it my model is reverse engineering. I'm looking back to see what it actually is. And I said to her, I'm like, I'm sure there are other people putting good diabetes thoughts into the world. I'm like, but it's so goddamn boring. Like, who would want to listen to that? No, that's for sure. Yeah, no one wants that. And I don't mean them. Like, if a person who's making a podcast right now, and it's very like, very like, every word they say is about diabetes is like, oh god, he's probably right. It's very boring, or you're mad at me, or whatever. Like, don't take it personally. I'm not talking about you. I'm talking about like, In what world do I want to live Erica's life and then sit down once a week and listen to an hour straight talk about diabetes? Horrible. I need it. I don't want it, right? That's how I think about it. So I'm like, so entertain people, or tell them bigger stories or whatever, and then slip it in, you know what I mean? So yeah,

Erica 1:01:02
and I think then too, it will go back to, if I have to sit down every week and know that I have to learn this information, it's going to feel like a chore, which, in turn, I don't want my diabetes to be like a chore, yeah, because you'll resent the whole thing, right? So let's that's why I think your podcast is up, because it just makes it it makes it easy to want to try new things. It makes it exciting, because if it works, then you're like, holy cow. Like, yeah, I can do that. I can let my five year old have pizza and ice cream and mac and cheese and keep an A 1c of six.

Scott Benner 1:01:30
You know, you push the button dummy says something, it's funny, you laugh. And then and you buy mistake. You understand how to Pre Bolus when it's over, whatever. Like, how, you know, like, I swear, the the I won't bore you with it. Well, it wouldn't boring, it wouldn't bore you, but it's probably going to come out around the same time as your episode. So I don't want to just tell I don't want people to go, Yeah, I just heard that one yesterday when I'm explaining it. But the woman I spoke to yesterday had a really interesting personal story, and it had all to do with diabetes, like, just like nothing, you know, but we still talked about our diabetes interspersed into it, and that's all I got

Erica 1:02:08
that works interesting, and I think that's what's relatable. And, yeah, nuts about the podcast. Years ago,

Scott Benner 1:02:14
my son said, How long do you really think you can make a podcast about diabetes? And I said, I don't even think about it, like it's about diabetes, and he's like, what is it? And I was like, it's about people, they happen to have diabetes. That's how I think of it. Like, I'm not talking to you because your kid has type one. I want to hear your whole story. Yep, you know you're the one I'm talking to because, yeah, because your kid has type one. But I would talk to you anyway. You know what I mean? Yeah, no, of course. Well, you're from Michigan. You know what to do? Yeah, we're gonna be counting on you. People with those Canadians ever come over the border? You're our first line of defense, yeah, yeah, our partner. Can you fight them off? They're gonna come with penguins. Are you gonna be ready? Yeah, seriously, they're gonna throw penguins at you. I just want you to be ready for

Erica 1:03:02
that. I'm ready. I'm ready for anything. You guys have

Scott Benner 1:03:05
four wheel drive trucks and shotguns, right? Yes, yeah, okay. All right, you'll be fine then, all right, because we're counting on you, because if they get to us, well, then we're all in trouble. Yeah? You think, listen Erica, when they get to the podcasters, I don't know how we're gonna fight back.

Erica 1:03:23
We got lots of noodles.

Scott Benner 1:03:27
I got Texas in the south and I got you in the north. That's it. When they get to the middle in Texas.

Erica 1:03:31
So we're covered all directions. Perfect. This is perfect, yeah? Because

Scott Benner 1:03:36
whenever an invader gets to me, I'm gonna be like, Would you like to be interviewed about how you feel about something, and they're gonna kill me. Meanwhile, I don't believe that the Canadians are coming, but everybody seems pretty happy with where they live for the most part. Yeah, okay, what is there anything we didn't talk about that we should have? I don't think

Erica 1:03:56
so. I feel like I've covered my story. I don't know

Scott Benner 1:04:01
good. You think I'm going to call this episode Canadian invaders? Oh, my

Erica 1:04:05
God, that would be funny, like maybe many listeners would you get?

Scott Benner 1:04:11
I think calling it the Michigan militia is going to be weird, but I think as it's as Canadian invaders sounds like Space Invaders to

Erica 1:04:19
me, it does. Are you too young for that? No, what a fun game. Do you know Space Invaders? Yeah. I mean, my mom probably knows it more, um, but my grandma had a that

Scott Benner 1:04:31
was unheard full Erica. There's no reason to say that to me, Jesus Christ.

Erica 1:04:36
We were kids. My grandma had this little, I don't even know if you can call it a video game. It was literally, that's what it was. It was a Space Invaders game, but it was my mom's years ago, yeah, but we used to play it when we were kids.

Scott Benner 1:04:46
I guess Space Invaders is basically Tetris that you shoot at, right?

Erica 1:04:50
Yes, yeah, that's how I remember it from what a great she still has that. I'm gonna look for it.

Scott Benner 1:04:56
Well, I used to play it in an arcade. I. Whole fun. You don't know what an arcade is. Stop it. I know

Erica 1:05:04
what an arcade is from, like,

Scott Benner 1:05:05
from a movie, yeah, because you saw strangers. Yeah, no, oh my god. There was an arcade in the little mall by my house, and we'd go there and with quarters and play video games and space for a quarter. Anyway, anymore, nothing. Listen, don't get me started. I will start bitching about how people treat $20 in a second, if you like, talk to me. I'm mad. I had a long angry conversation with a stranger in a Wawa parking lot because I was like, you guys, don't He's a young guy. And I was like, I said, it must sound like such an old man. I'm like, but you got I'm like, You don't understand. You just walked out of there with 216 ounce bottles of soda that you paid $5 for. And because it was two for five, you think you got a deal? I was like, there's 18 cents worth of soda in your hand. I was like, and you just paid $5 for it, and you did it gleefully. And he's like, what? I'm like, it shouldn't cost that much. And I was like, and your sandwich was $10 you just spent $15 for a glass of poison and a sandwich.

Erica 1:06:09
Now it's, that's so true. You know, I'm 32 almost, but it's almost like, even if you look at five years ago, like, I went to the store the other day and I was gonna buy, we were going camping, so I was gonna buy, like, Diet Coke in a can, and I, like, could not bring myself to buy it because of what it costs. Good for you, I could used to buy four of these for $12 and I'm gonna buy one. You're no, not a chance. Good for you

Scott Benner 1:06:30
saying, I swear to you, I went out to dinner like my kid came home, and then, you know, his girlfriend came over, and then Arden came home from college, and she brought a friend. And next thing you know, there's six of us sitting in a restaurant, and the bill came, and I looked at the bill, and Kelly goes, What's wrong? And I was like, Is this $180 she goes, yeah. And I'm like, yeah. I'm like, You're not in charge of the money. Obviously, I was like, but I was like, this doesn't this? Like, physically, doesn't make any sense. And she goes, Well, there's six of us. And I was like, so I was like, a

Erica 1:07:04
lot of money a person,

Scott Benner 1:07:06
$30 a person. I think we've only been here for 45 minutes, and my stomach already hurts from the thing I ate. Like, I don't understand what we're doing. So

Erica 1:07:15
crazy. No,

Scott Benner 1:07:16
no, it's a very, it's very, very, very, very upsetting.

Erica 1:07:19
That's why the idiots aren't coming over either? Oh, yeah, the

Scott Benner 1:07:21
Canadians, they don't want any part of this. Like, so, yeah, they'll just filet a polar bear and eat that they can cook them on the oil fields that they work on, from what I understand from the interviews that I've done. Like, that's all that's awesome. I still, I still don't believe when people tell me they're from a city in Canada. Like, there are no cities in Canada. People tell me Toronto looks exactly like New York City. Really. I don't believe it. How can they on top of all that ice? What are they doing? Yeah, I don't see how it's possible. All right? Erica, thank you very much for doing this. Yes, thank you for having me. It's my pleasure. Hold on one second. You. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next.com/juice box, I'd like to thank Dexcom for sponsoring this episode of The Juicebox Podcast, and at the same time, I want to remind you that seeing your blood glucose levels in real time, not only the number, but the speed in the direction, is going to help you in ways that you maybe can't imagine right now, You should definitely check it out at dexcom.com/juice box. You Juicebox.

Okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Uh, why don't you tell a friend about the show or leave a five star review. Maybe you could make sure you're following or subscribed in your podcast app, go to YouTube and follow me or Instagram. Tik, Tok. Oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page you don't want to miss. Please do not know about the private group. You have to join the private group as of this recording, it has 51,000 members in it. They're active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now, and I'm there all the time. Tag me. I'll say hi. The episode you just heard was professionally edited by wrong way recording, wrong way recording.com, you.

Okay, Erica has three and a half Well, excuse me. Eric is three and a half year old. Was diagnosed a year and a half ago. So she's the kid's five now. It's a boy diagnosed with type one. Talked the beginning at the husband who just got a type two diagnosis, but fairly clearly, he's Lada. And we talked a little bit about, you know, termination that goes into having to raise a kid. And this was just a nice, chatty one that I am going to call Canadian invaders, even though she's not from Canada. I just think it's hilarious. I think that's it, man, I gotta go Robbie, say it. Bye.

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