#388 Playing Jax

Tori is a D Mom to a young child

Tori is Jax mom and she's here to talk about their life with type 1 diabetes. 

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

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

Scott Benner 0:00
Hello friends, and welcome to Episode 388 of the Juicebox Podcast. Today, I'm going to let you listen in on a conversation that I had with torey. She's the mother of two kids. Both of them are very tiny. One of them has diabetes. And here's the thing about Tory, and she doesn't know this. So this is going to come as a surprise to her. Almost every day on Instagram, Tory shares one of her son's Dexcom grants with me. And she's gotten so good at managing his diabetes, that his graphs sort of helped me believe that the podcast works. So while it's possible that I might be your cheerleader, the one who's telling you you can do it, like go ahead, try something Tory sort of mind. It's the interaction that she provides. And honestly that all of you provide, that helped me believe that the podcast is valuable. It's not an echo chamber. If somebody's talking back. I always very much appreciate seeing Tori's message. And I don't think I've ever told her that. So Tory, thank you. And people should follow Tory she's Tory tackles too. On Instagram. It's got some cute kids. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin.

This episode of The Juicebox Podcast is brought to you by the Contour Next One blood glucose meter. You're going to want to go to Contour Next one.com Ford slash juice box to check out the meter that Arden loves that I love. We all love it. It's the bomb diggity Contour Next One comm Ford slash juice box. Have you ever considered supporting people with type one diabetes by lending your information to research? super simple to do at T one d exchange.org. forward slash juice box. It's a quick and easy from your home right there on your phone simple way to advance Diabetes Research and support the podcast. I'll tell you a little more about it later in the show.

Tori 2:37
My name is Tori and I have two kids and my toddler is a type one diabetic.

Unknown Speaker 2:43
Okay.

Scott Benner 2:45
The toddlers how old

Tori 2:46
she is 21 months on March 2.

Scott Benner 2:49
Okay, we're not gonna use his name. So we're just gonna. We can if you want I just felt like you weren't.

Unknown Speaker 2:54
Oh, no, his name is Jack's.

Scott Benner 2:55
Oh, all right. Never mind that everybody. jack is a toddler. 21 months old. Yes. And he has had type one for how long?

Tori 3:04
He has had type one.

Do the math for me. I think nine months. Um, he was diagnosed in May right before he turned one a week before his birthday.

Scott Benner 3:16
May 2019.

Tori 3:18
Yes. 20. Yes.

Scott Benner 3:20
Pack ahead. Are you ready? Is it 2019? Or 2018? You're right.

Tori 3:23

2019. He was born June 2018. Just last year. Okay. Yeah.

Scott Benner 3:28
So we know each other because of Instagram.

Tori 3:32
Yes, I actually came across your podcast too, because the night that he was diagnosed, we'll go into the whole diagnosis story whenever but, um, I was sitting there crying in the hospital room and I someone told me to join a Facebook group I posted in there, what should I expect going into this with a baby with diabetes? And someone mentioned to follow your podcast. So literally day one, I found your podcast and it was actually quite funny how the training differed from what you were saying. And so I'm sitting there like with two totally different rules, I suppose of how to do things. And I was like, This is so confusing.

Scott Benner 4:19
Was it was it? Was it scary or confusing? Or like what did you think in the, in the in this first month?

Tori 4:25
Well, at first I wanted to go with what the hospital was saying. Because I was like, well, his kids 15 now. Yeah, she was diagnosed really young. But, uh, you know, he's he's a baby. Like, I can't Pre-Bolus that's not

Scott Benner 4:40
also I'm a stranger on a podcast. Listen, yeah,

real quick before you go anywhere. Is there a fan running behind your anything? It's noisy.

Tori 4:50
can make the air conditioner just kicked off?

Scott Benner 4:54
Yeah, you're not allowed to be comfortable while we're doing this.

Unknown Speaker 4:57
Can you hear me better now?

Scott Benner 5:00
Did the fan stop running on the air conditioner? If so, try speaking. Okay, well, we need you're wearing some sort of noise cancelling headphones. So when you don't speak, I don't hear anything. So I'm gonna have to wait till you're into a sentence to know for sure.

Tori 5:14
Okay, cool. Yeah,

Scott Benner 5:16
yeah, no, I've been able to hear you the whole time. Just there was a noise behind you. So we're gonna see if it's going away. And

Tori 5:22
I wanted to listen to the hospital telling me what to do. First and foremost, because they saw the kid they were listening to our day to day lives. And I was like, well, this is this is the hospital. They deal with us every single day. And I'm just going to go with what they're telling me for the first little bit. And we didn't have a Dexcom yet, obviously. So, um, I was doing the whole letting him eat, subtracting what he didn't eat, and then giving him his insulin. And then when we got the Dexcom, I saw how often really let

Scott Benner 5:58
Tory listen to sound still there. And I really want to talk to you without without it.

Tori 6:02
Yeah, so it's all just gonna get edited out.

Scott Benner 6:04
It's hard to know. Depends when I listened back to it What I find interesting. So let's figure out what's going on. What kind of headphones you're using? Apple? Are you? Are they wired or wireless? Why? Okay, you're on your phone. Is your phone on Wi Fi? Yes. Okay. Are you near any other cell phones or stuff like that? Yeah. Okay. Were you in a room with the door closed? Yes. Are you still there?

Tori 6:37
Yeah, I moved into a bedroom. Okay.

Scott Benner 6:39
Nothing on because you sound better now. So it's interesting. Okay. Cool. All right. So. So I'll recap and we'll keep rolling. So you're in the hospital. You you go on Facebook to ask for people just opinion of like, what should I expect? I've got this little baby who's got Type One Diabetes all sudden, you're younger mom, too. Is that right?

Tori 6:58
Yes. I'm 28

Scott Benner 7:00
Oh, I was trying to make you younger, and you like not really 28 you should have been like, 100%. I'm a young mom. I'm 28. So but but so but your first baby? And yeah, by the way, you look younger. So congratulations. Yeah. And so you get conflicting information. Right away. There's a guy talking to you through your Apple headphones, that saying one thing, the hospital saying another thing? Initially you think maybe the difference lies in the ages, his daughter's 15. My kids, almost the larva Still, this is probably the difference. But what did you find moving forward?

Tori 7:38
Well, so we get the ducks calm after three weeks. And, and they really rushed it because we had a trip to go to Seattle that we had planned like six months ahead of time. And so and we live in Atlanta, so I was like, Oh my god, we're gonna be traveling on a plane across the country with a diabetic baby. Like I don't I don't know. We know. I need that next column. Where you live in Atlanta? Yes. Am I seeing you in two days? You are. I'll have the newborn with me.

Scott Benner 8:06
Oh, that'll be lovely. This is This has never happened to me before. I feel like I have triplets. You know, but okay.

Tori 8:12
But yeah, and so with all this, I'm also 20 weeks pregnant when he's diagnosed. So I was very emotionally unstable. And so they rush to get the Dexcom to me as soon as possible and get like the it approved, because it's not going to prefer you know, babies right away. And so we get the Dexcom. And I go, Okay, so I've been listening to this podcast, I'm gonna, I'm gonna just do as a hospitalist told me before, but I'm going to see what happens now that we just put the sticks Come on him. And he spikes to like 400 after a meal. And we weren't checking his blood sugar until the following meal, because they were like, you also can't have carbs next. So cheese sticks and beef jerky. And that's it. So um,

Scott Benner 8:57
so you know, he was eating and then three or so hours you didn't really check blood sugar, you know, put counted the carbs, but the insulin and if he got hungry in between, he stayed with lower carb stuff.

Tori 9:08
Yeah, yeah. And so I go to feed him his lunch next. And you know, I've been watching the effects calm, and he starts to make a downward trend right before his meal. So that's where it was getting to a point where if he was 180 when I gave him his insulin, and then by the time his next meal, he was 160. I figured Oh, my goodness. Yeah, like, that's a perfect ratio. But he was going all the way up to 400 or so hanging out there for two to three hours, and then he'd come back down ever so

Unknown Speaker 9:44
gently and yeah,

Unknown Speaker 9:45
man. Right,

Scott Benner 9:46
right. Where you felt like oh my gosh, I must be doing really well with this. He's.

Tori 9:51
Yeah. And so I would call the hospital and tell them what was going on. And they're like, Oh, he's perfect. He's perfect. He's perfect. But then when we got the dexcom on I immediately take it into my own hands. I was like, No, we're gonna we're gonna start doing it Scott's way. And so ever since then it was we went to our first

Scott Benner 10:12
story. Don't jump ahead, you're doing really well. We're not telling them the first 10 minutes on while you're doing Hold on a second. needs a little showmanship here. Hold on a second. Let me let me say this to you. So when that's happening, right, like there's this giant leap up and then a giant leap down. And then they say, You're doing great. Did you think that can't be possible? We're not doing great, because look how high his blood sugar's thing for so long, or was there confliction in you? Like,

Tori 10:42
well, I just stopped calling.

Scott Benner 10:46
Okay, so my next my next question is, would you say now there's any honeymoon type of function happening? Are you? Are you completely?

Tori 10:55
I actually think that this week, like the last two weeks, we've gotten out of the honeymoon phase, I really truly think so. Because I've had to put so much more inflammation.

Scott Benner 11:06
So and so this is super interesting, man. Because, yeah, your graphs are. Your graphs make me feel like, I don't know what I'm doing?

Unknown Speaker 11:16
No.

Unknown Speaker 11:18
Hold on a second.

Scott Benner 11:20
And so I've always wondered with somebody who has newer diagnosis, such a baby, like, you know, as far as size and age, was there, some honeymooning going on and so you think there was, but yeah, it's gone away, and your results don't look any different?

Tori 11:36
Well, so basically, when we were hunting, meaning I would time it out really perfectly, where I would give him his insulin, and I knew that he would go low. And because I was being pretty bold with the insulin, um, I would make sure that he didn't have a spike. And then right when I knew that he probably go low, it would be snack time anyway, so he would get a fruit stack or pieces of Apple, and just like, you know, typical things that a toddler would eat. And he was able to eat that to fix a 75 blood sugar and bring it up to like, 100. So,

Scott Benner 12:14
so you were doing something that I think is, is brilliant, and I've done it myself, and I didn't just call it brilliant, because I've done it too. But I think it's it's a longer look at things, I guess, step back look. So you're, you're putting in enough insulin at a meal to not only keep the meal from spiking, but you're in some strange way with the tail of the insulin Pre-Bolus in his snack.

Unknown Speaker 12:37
Yeah,

Scott Benner 12:39
yeah. Yeah, that's good. Good job. Right? Because, because he's a little kid. And so he is snacky throughout the day. Mm

Unknown Speaker 12:47
hmm. Right?

Tori 12:48
Oh, for sure. I mean, he, the whole thing too, with them not wanting me to Pre-Bolus was because he is a baby. And a lot of toddlers have a problem with finishing a meal. But we did this thing called baby led weaning where I never did pre race with him. I literally just fed him what was on my table from six months on. And so he doesn't have texture issues, he can eat an adult sized meal so easily. So he gets his own meal, and we Pre-Bolus it at a restaurant, and he eats the whole thing. So it's very, I mean, hopefully that sticks because he's not verbal yet. And so he can't tell me what he wants and what he doesn't want. And I just kind of feed him and I go quick, you have to eat this i Pre-Bolus. Um, but he he's so good about food. So when the hospital was telling me like, No, you literally cannot Pre-Bolus until he can tell you like, I'm gonna eat half that sandwich. And I'm sitting there like, Okay, then

Scott Benner 13:43
even that seems strange, because my daughter, like you said, is 15 and she'll tell me sometimes super hungry, man, let's go for it. And then we put the insulin in and eight minutes in, she gets this look on her face. She's like, I'm just not as hungry as I thought I was. And, you know, so you find ways to trade insulin around and stuff like that, you know, I've definitely been in that situation where, you know, you put in enough insulin for 40 or 50 carbs. And it's, I don't know, four or five units when she was smaller. And her basal rate was like a unit an hour and you know, she'd have some of the food and then just be like, Oh, I can't do this anymore. And you're like, Alright, well, I'm just gonna shut your bazel off for an hour or two and see if trade just do what you just did. Right? Like trade the tail of the meal bolus for the for the bazel out in the future. Yeah, like how did you come? How did what led you to be able to think about the, the insulin like time travel for the lack of a better word, like like, because I'm always telling people, everything you're doing with insulin now is for later sometimes it's for five minutes, or 20 minutes later, sometimes it's for an hour later, sometimes two hours later. Nothing that's happening to you right now is happening because of the insulin that's going in right now. absorbed it really quickly and and to your credit, and I want to get too far away from this before. I say you've described yourself as very emotionally unstable. And I want to, I want to point out to people listening that emotionally unstable in first very. So when you're adding very to it, you're saying you're whacked out of your ever loving skull on the hormones, is that what was going on?

Tori 15:18
Yeah, I was very upset. But my little baby that had even turned a year old was, you know, diagnosed with something that was going to be for life. And when going through the pregnancy at 20 weeks pregnant, I also had a dog that was probably gonna have to put down soon, and that did happen. And my grandma was living with us who has Alzheimer's, and she passed away. So all dramatic things are happening while I'm growing a baby inside of me. And so when this happened, I'm a perfectionist. And I joke around that this was like, you know, life's a slap in my face, like, haha, perfectionist. Yeah. And so there was no other option to be better than to be perfect at this. And so obviously, you can't be perfect every day. But I tried my very best. Yeah. And so when, when they're telling me Oh, it's okay, if he's had 200. And he's staying there. Like, that's okay. He's a, he's a kid. listening to everything and reading when I was reading, I was like, that's actually not okay. Because why am I going to let him hang out at at 200 250. And that still be okay, and not that high. For, I don't know, 18 years of his life, like I, I'm not going to do that. And so while I, while he's under my roof, I want to make sure that he has all the same, you know, the same health as a non diabetic,

Scott Benner 16:55
right? And the best chance to sort of absorb the way of living that you're doing and hope that he takes it off with it. Yeah.

Tori 17:01
And then people are telling me Well, in order to have him be stable with blood sugars that a non diabetic would have, you have to go low carb, and I was like, well,

and I've ranted about this before, but

I don't want him to grow up with food issues, either, because he is diagnosed so young, that I don't want him being five years old at a birthday party having to eat, you know, stuff that I brought, when he can't, and he can't enjoy stuff that the other kids are eating. So it was such a big thing when I found your podcast that I was able to let him pretty much eat whatever everyone else is having, and, and just learn how to do it. Because one day he's going to be an adult at college, and I don't want him one afraid to tell me, Hey, I'm going out to eat with pizza, what do I need to do? And to not know how to do it themselves? Right.

Scott Benner 17:56
Now, listen, first of all, I think that, in my mind, the podcast is about using insulin when we're talking about management stuff. And so I don't care what you use the insulin on afterwards, it could be on a low carb lifestyle or a keto lifestyle, or just eating carbs or what anywhere in between, I just generally don't care. I just think that people should understand how it works so that they effect what they want to affect. I mean, they're, you know, I mean, listen, people have come on here who are low carb or keto, and they still talk about where they need their insulin for their fat and protein rises. And that means understanding how insulin works. And but at the same time, I understand what you're saying, like you don't want to, you're not trying to set up a scenario where your son is in a room with 25 people. And he's the odd man out although, yeah, like, that's just not cool. Absolutely should probably not say this, but my daughter grew up tangentially around a girl who was super fit, her whole family was really into fitness.

Unknown Speaker 18:58
And I don't

Scott Benner 18:59
find anything to be wrong with that. I wish I was fitter than I am. But when you stop and look back, she's a little weird. And she's probably she's probably not like, don't get me wrong. She's just, it's, and I'm not saying the difference bad. I'm just saying that they've gone over the ridge to the other side, like so I think there'd be a way to like, be fit and cool without being like somebody who, you know, if I get up at four o'clock in the morning, because I hear a sound outside, it's your mom running by in the dark with a little light on her head, like, you know what I mean? Like it's I don't know, like, I don't know, that might be judgmental. I'm just telling you that the way I've seen it shake out in front of them is that she's always more available to spotlight, if that makes sense. Like I'm joking in there and what I'm saying but this is the part I mean, like I don't care how fit they want to be again, I don't care if he keto or if you want to go for a run at four o'clock the morning doesn't mean anything but you might want to be prepared for the fact that the masses, whether they're right or wrong, We are going to look at your little side while you're doing that. And so you know, and so that's just the truth. It doesn't matter if it's right or wrong, it just is what's going on.

Tori 20:08
I have fitness background, and I used to do bodybuilding competitions. So that's also really funny because when they were teaching me about carbs and how insulin works, I already knew a lot about that not, you know, not the insulin itself, but how my body myself makes insulin. And so it was it was super interesting, because when he was diagnosed, people were messaging me like, of course, you would have a diabetic kid, you counted carbs, like 10 years long.

Scott Benner 20:36
Did you text them back? And you're like, this is not helpful or supportive at all?

Tori 20:39
Yeah, no, it was not helpful. I was like, oh, but like I said, my subconscious knew that I would have a diabetic child. So I've been training for it my whole life.

Unknown Speaker 20:52
So I was ready.

Scott Benner 20:54
So are you do you think that you're having the success you're having? Because he's such a good eater? Or do you think you could do it? Even if he was a little more pig? Like, can you imagine what you would do? In a scenario where you weren't certain what he was going to eat?

There is nothing like having a blood glucose meter that you can count on and trust. That's why I would like you to go to Contour. Next one.com forward slash juice box. And when you get there, take your time. And poke around. Sure, you're gonna see right away Arden's meter, the Contour, Next One meter, right there, big sticker on, it's like value pack, 40% more talks all about the test strips and everything. Here's some stuff that I can tell you from personal experience. The light at night is great. It's very holdable. It's just not a word, but it's small, but yet not difficult to hold on to is probably what I should have said instead of making the word pool holdable. Yeah, that's what I should have done. But you know what, let's just soldier on, shall we? Great light, very holdable, I'm sticking with that. test strips offers a second chance. So if you touch it in the blood, don't get it right the first time you can go back in without impacting the quality of the test. And speaking of the quality of the test, this thing is gold standard, accurate. Understand i'm saying is right up there. There's like good, better best, this one's best. Contour Next one.com forward slash juice box. This link is more than just a pretty face, there's real information here, you can go to the resource tab and find out about the contour diabetes app that by the way, pairs with your meter, you can find other products, there's other meters that contour makes you can looky loo through them if you want to. Personally, I like the next one. Contour. Next One. Also, it's possible you could be eligible for a free meter, that's under the meters and trips tab, there's even a choice card to see if you can save on test trips, there's a lot here, it's worth knowing, check it out. Even even even possible that you could buy this meter and the test trips, cash out of your pocket. And it might cost less than you're paying through your insurance company. I can't say for sure if that's gonna be you, but it's gonna be somebody. So head on over there and figure it out. One way or the other. This is the meter you want, in my opinion, Contour Next one.com Ford slash juicebox. I don't know if you remember the CEO of the T one D exchange was on the show a number of months ago, I had a very good feeling about him. And then they came back to me a few weeks or months later. I don't remember time, you know what I mean? And COVID I don't even know like what today is. But anyway, they came back to me sometime after that. And said, Hey, can you help us get the word out about our registry? And I was like, you want to buy an ad? And they're like, No, we don't buy ads. And I was like, ah, I don't know what to do that. They said, Well, what about we'll give you a little bit of money every time somebody signs up for the registry if they come through your link, and I thought, No, I'll try that. So I did T one d exchange.org. forward slash juicebox. Here's why I said yes to that. I know what your thing is for the money, but that's only part of it. The other part is there using this research to make real improvements in people's lives. People living with type one diabetes, and it's simple to do. It's 100% HIPAA compliant. It's absolutely anonymous. You can do it from your phone or your PC. I guess even if you had a Mac, you could do it from your Mac. In just a couple of minutes. I did it. Now you have to be from the US. So you either have to be the parent of a child with type one and live in the US you need to be an adult living with type one and before To us, but it's super easy to do. And it's worth it. A lot of goods come from it, I think a lot more coming. T one d exchange.org. forward slash juicebox. Contour Next one.com forward slash juice box. Links in your show notes. Links at Juicebox podcast.com. Okay, now let's find out the answer to this question. Can you imagine what you would do in a scenario where you weren't certain what he was going to eat?

Tori 25:27
Yeah, because we do have some days he's been dealing with typical toddler sickness for the last few months. I'm getting cold and coughs and so he's been a little bit on the pickier side. And so what I've done to combat any picky behavior is I have his fake foods, and every toddler has a safe food. And I will Pre-Bolus like half of what I think he's gonna eat. And if he does eat all of it, I'll do like a really aggressive, like post Bolus.

Scott Benner 26:05
No, no, I I this morning, right before you and I spoke Arden's blood sugar started drifting up. And I was like, Huh, what is this about? Because she was so super stable at 94. And I was just, this is working, I'd made a small adjustment to our baseline some the other day and I thought, Oh, my adjustment is so good. And you know, I was just like, right on, this is working. Then all of a sudden those 94 turned into like, one to one. And then she jerked. She was drifting off. And I'm like, What is happening? So finally, I texted her, I was like, Did you eat something? And she's like, she goes, Yeah, don't worry, I bolus for it. And I was like, Well, what was it and she goes, a Munchkin. And I was like, did you Pre-Bolus for and she goes, No, I was like, it's not enough insulin. So let's just put some more in, you know, and, and we're gonna find level here around 155 before she comes back down, which is cool, because she really tried something on her own to try to take care of it. That's I'm not like, I'm not. I'm not I don't that's great. Like, I don't care about that.

Tori 27:04
Yeah. I mean, that's probably been my biggest, my biggest like, fear grow. As he ages. I love that he's a baby. And I I've said before to people, I'm actually very happy that this happened, when it did. And, and it's crazy to think like, why would you want your baby be diagnosed, but, um, it just, I was talking to a friend of mine, whose kid I used to actually teach ice skating to. I used to be a figure skater. And he came over. Yeah, I was. And, and so she, her 10 year old kid is at the house. And she knows this all of axes here. will just the Dexcom and all of my, my needle stash. And he she's like, Oh my God, if I was diabetic, like, Oh my god, I would never eat again. Little 10 year old saying that. And I just thought to myself, like, Ha, that would be so traumatic to have, you know, him be so much older and him have to mentally go through that.

Scott Benner 28:09
And so I was like, these thoughts.

Tori 28:11
Yeah. And so I've thought to myself, like, wow, it's actually kind of a good thing. If he was going to get diagnosed at some point in this life that it got done when he was a baby. And it kind of scares me for when he gets older and has to manage it a little bit on his own when he's out and about and I'm listening to your podcast, I've kind of been like, okay, like Arden's doing awesome. She's, you know, she listens to her dad, like, baby ducks will do the same.

Scott Benner 28:39
Well, you know, it's, it's all you can sort of hope for, I think, it's sort of funny. I've been listening to a lot of physicists talking lately, so I'm gonna probably sound a little weirder than I usually do. But you know, we're all really just sort of really evolved ants, you know what I mean? Running around you know, one of you goes and gets the food one of you stays and builds the hill you know, some of you dig the holes like we all are doing like a different job. And we have life cycles. And you know, every once in a while you look down one of the answers going crazy right is running in 16 different directions and then it disappears away and probably wanders off and dies. And so there's just we're not all going to have the same level of success in life in in so many varied avenues of our life, right? Like you know, your health, your fitness, some of us are gonna lose our hair, some of us are going to do better at keeping a job. Some people are those people who are always an HR going I have a problem this is a problem you don't realize but you end up being a person who people go Yeah, we don't really want to hire you. And like and but you don't think that because on your side you have a problem. Like it's it's just we all end up being different types of people. Some people become addicts. Some people become addicts, not of their own. No issue like some people become alcoholics, some people never drink. There's all kinds of different ways people's lives are gonna go. And that's going to happen for people who have Type One Diabetes too. And so the best you can do is lay in Foundation, and tools, and reason. And then do your best to sort of Shepherd them towards that being something that's important in their life. Listen, I very well could end up at the end of this being the guy who had a podcast to help the whole bunch of people, and it didn't help his daughter. There's no, there's no way to know that, right? Like, there's absolutely no way to know if this is gonna work out for my kid any differently than it's gonna work out for somebody else's just because I understand it might not be the reason she understands it. I just don't I just do my best to see who she is, how she absorbs things, what she cares about where she gets lazy, all these things about her, and I'm just trying to take what I know and retrofit it to her. And that takes time. And that takes a lot of time. Right? I shouldn't I should not be listening to physicists talk about the nature of messing me up. Let me say something stupid instead? No, no. But the point is, is that some of you listening aren't going to end the way you want to end. But, but that doesn't mean you're not going to end the one the way you want to end because of the decisions you're making today. But that doesn't mean you can't change the decisions you're making and find a different ending. It's just more difficult. Boy, I don't know I there's part of me that wants to say it's more difficult when you're parenting because you're trying to infer what another person needs. And then there's also a part of me that thinks it's hard to do for yourself too. It's me, it's difficult one way or the other. But I think what's really interesting, what needs to be paid attention to when you're caregiving for someone else, is how often you take your feelings or interpretations of a moment and put them on someone else. Just because I feel like this in this moment. That must mean everyone around me is feeling this too. That's never right. You know what I mean? Like, like, see, you really have to want to dissect understanding the person across from you like, like, just, you know, it's, you think this is super important, this Pre-Bolus thing thing, and your kid just goes out, you know what, I don't care. And, and so, right. So and so you have to figure out, how do you make what you care about? Something they can care about? I don't know. It's just It's very, uh, I didn't think this was gonna go this way. Tory, I apologize. I just like Tories on Instagram. She's got this rad graph all the time. You You basically. So you know, when some people say like, Oh, yeah, people have flat graphs once in a while. That's the only time they share them. I feel like you send me a rock ass amazing graph. Almost every day.

Tori 33:02
He doesn't have spikes. I mean,

I today, for example, I'm looking at his graph right now. And he started his meal at 118 got ups like 150. And now he's back at 130. And you know, that's, that's high for us. nice and gentle.

Scott Benner 33:17
And listen to the second baby boy or girl? Boy, again, boy, you see? So here's what I don't understand. How is that kid's name? Not Scott, How did this get away from me? Exactly. I was counting on you being the one you know. You mean? Yeah, yeah.

Tori 33:32
After the first one that saved my first baby.

Scott Benner 33:36
I didn't save your baby. But I've just That's very kind of just saying like, I want to you eventually is going to be you know, I'm going to catch you in. What did you call yourself? very emotionally unstable. I'm going to catch someone in a very emotionally unstable moment. It's like the podcast guy. And and I'm going to get a kid named Scott one day, even though it's not a great name. But um, but anyway, I'm kidding. I had to make up for the physicists talk. And we're all just sort of evolved dance and etc.

Unknown Speaker 34:02
So yeah.

Scott Benner 34:04
Just say something stupid to keep this moving. Are you pumping or injecting? Or how do you get me

Tori 34:10
We are MDI stuff. Ah, see. And we had spoken right after he was diagnosed pretty much and I know you were telling me about the AMI pod, and I want to get it on him. As soon as possible. We're going through a little I'm trying to figure out a job change on that slide. And so we're not sure if we're wanting to spend all our money on our deductible just to start with a new insurance and then, you know, but I'm also very comfortable with them to get right now. And yeah, and so right now, it's just not been something that we are in dire need of um, I do see that we would have even more stable lines and it would become Even even better blood sugars, but right now he's doing really well. And he has been starting to pull on his Dexcom. And that's been very irritating. And I'm just afraid. Yeah, yeah. irritating to me. And so I don't want him to pull off the only pod so I'm just like a little little weary right now and being like discovering things on his body and his age.

Scott Benner 35:27
Hey, so what slow acting insulin are you using?

Tori 35:31
Basic bar? Ah,

Scott Benner 35:32
see people talk very well about those two new ones, which is what are they basically? I can't even say basic glar. We did. I did say it is the other one. To Seba. No. Yeah, there is that one. But I'm right. Those two that are kind of the newer fancier ones that don't. Yes, they seem to actually last more than 24 hours, not less than 24 hours.

Tori 35:54
Yeah, I believe so.

Scott Benner 35:57
Yeah. And so you're so you're getting a stability? A good base from your bazel to begin with? How much? Are we talking about? How much bazel does he get a day? two units?

Tori 36:12
He weighs 35 pounds.

Scott Benner 36:14
Yeah, he's a he's but are both your Is it fair to say that both of your kids are pleasingly plump. Is that a nice way of saying

Unknown Speaker 36:24
Yeah, yes.

Tori 36:27
Yeah, they both are like 99th percentile. Like, I mean, when that was the whole thing with Jack's like, we started seeing him lose weight. We were like, holy cow. Like this is a chubby baby like, this is something's wrong.

Scott Benner 36:40
Like he did someone put this kid on to CrossFit and I didn't realize it.

Tori 36:44
Yeah, like he was always eating. So I was like, I don't get it.

Scott Benner 36:47
How tall are you?

Tori 36:48
But yes, I am only five feet tall.

Scott Benner 36:51
Wait a minute. And how tall Jasmine?

Tori 36:55
Evelyn really skinny.

Scott Benner 36:57
Are the kids like 90 whatever percentile for height two or four? Wait.

Tori 37:02
Yeah, yeah. They're just big. Any, any giants

Scott Benner 37:05
in the extended family?

Tori 37:07
No, no.

That was that was a big baby, though. I was not. So I think that, okay, they're just big babies.

Scott Benner 37:17
Yeah, no kidding. That'd be interesting. I'm imagining, you know, when you're, you're like, 45. And you're out somewhere and the kids just like three feet taller than you and you just think you adopted them. You know what I mean?

Tori 37:29
Oh, for sure.

Scott Benner 37:30
Yeah. Oh, yeah. I have. I have a friend who's so short. She's just the shortest person I've ever met in my entire life, but her whole family is. And so with. Yeah,

Tori 37:39
my whole family is pretty sure. Yeah,

Scott Benner 37:41
that's uh, that's interesting. So how about diabetes in the background of either side? Do

Tori 37:46
Did you find any? No, buddy. Not a single person. I didn't even know about type one. I was bad. oblivia

Scott Benner 37:54
any other endo problems that you could find anything?

Tori 37:57
No, he was. He was so healthy. We had a perfect you know, hospital stay when he was born. He was born at 40 weeks and five days or six days. I was in do some four and five. So I was you know, full term. And then son. He was eight pounds, six ounces, very healthy. breastfed ate everything. No allergies, no health concerns and nothing. At 10 and a half months old, I noticed that he was a little constipated. And that was that was the sign that kind of started getting me thinking about things. So at a week before his birthday, I remember on a Monday or on a Friday, I called a pediatrician. I was like, Hey, can I get in the office on Monday? Cuz he hasn't pooped? So they're like, yeah, I mean, we can check and see if his stomach's hard and, and whatnot. So then I go in there and they go, Oh, he's just you know, a little blocked up I think just get him some prune juice and pure and puree now mind you, I'd never given this kid juice or even pureed food. So this was what got him into DK, I believe. So then

Scott Benner 39:18
you think the the the sugar from the burns is what pushed him away?

Tori 39:22
I think so. So well, that and on Tuesday, so the day after the appointment he was he weighed men on Monday, 29 pounds. The day after the appointment we went to do you have a Rita's Italian ice scenario? Let me know what that is. I love Rita's.

Scott Benner 39:39
So Rita's originated in Philadelphia, right where I grew up. My wife actually knew the family that started the company.

Tori 39:46
Yeah. So that morning, he'd been a little groggy and I remember telling my dad and like, I just needed to get out of this house. I'm way too pregnant to be dealing with this fussy baby. That's turning one Soon and I guess he's teething. But he's just he won't stop crying. So I'm going to go to the splash pad. It's really hot. It was a nice 90 something degrees and mid end of May. So we go to a splash pad and my baby's always been very, very happy. Just a hyper happy baby and he just wanted to stand there. He wasn't walking yet, but he was crawling and he would stand independently. So he's just standing there like, I don't like pie in the water and he just cried. So that I'm like, okay, whatever. We'll go to breeders and get some to Lottie and I'm giving him spoonfuls of that and I have a picture of me spoon feeding him in the stroller and looking back now I'm like, how did I not know? Because his eyes were sunken. And he had like these darks, super dark circles, and he just looked really emaciated. And I was like, something's wrong. I think he's just tired. Maybe he's not sleeping well. And then that night, he threw up is the first time ever if he had grown up. And so that goes, I don't I don't get it. Why is he? Why is he throwing out? What do you feed him? I was like, I mean, he had sugar today.

Scott Benner 41:17
Like how that immediately goes like, Hey, would you do to my kid? Do you give him some? Yeah. You're like, I did give him sugar. I actually gave him like soft serve mixed with water ice. So

Unknown Speaker 41:27
yeah, I

Scott Benner 41:28
mean, if I'm being honest, I'm really pregnant. I wanted him to stop.

Tori 41:32
Yeah, I wanted to give him a nice little tree feed. I felt like the slicker and the ice like it would move his gums.

Scott Benner 41:39
You're the only one that has to be pregnant, or excuse me constipated. You're

Tori 41:43
like, yeah, I'm pregnant.

I'm mind you. We still like he had prune juice and his sippy cup, and he wouldn't drink it much. But he then he started to like, get super thirsty and wanting to drink all of it. And so I'm like, That's weird. You didn't like it earlier today. But then on Wednesday, I'm doing I'm sitting on the ground playing with him. And he crawls over to me and he starts breathing really, really heavy. So I call the pediatrician. I'm like, something's wrong. He's throwing up. He's breathing really heavy. And he's very lethargic. And he doesn't even want to crawl now. And he just wants to sleep all day. And so she's like, Okay, come back tomorrow. And we'll see what's going on. And they didn't actually wait a minute or anything they just said. Let's have you scheduled to go to a gastroenterologist at Children's Hospital on Friday. So now we've gone Monday through Friday. With this, you know, baby that still hasn't pooped. He's now getting way sicker. And Friday morning at the gastro they weigh him. And he is and mind you like all throughout those. When Tuesday, Wednesday, Thursday, Friday morning. He's throwing up everything he eats. And so we're getting very concerned. And he goes, Well, there's nothing blocked in there. Let's weigh him. And he's 21 pounds. I lost eight

Scott Benner 43:09
pounds.

Tori 43:11
Yeah. And I remember holding him being like, this is this is scary. Like I was crying now. And unlike I don't know what's going on with my baby. And he goes, does he always look so his skin so modeled? And I was like no. And they go well, he's very, he looks very hydrated. I said, Well, that's impossible. He's always drinking water. And he's always being like he pees through snipers nonstop. So he's like, you just looked at me. At that point.

Scott Benner 43:38
Can I ask you do you have the it's a recent thing. So you might have the memory? Did it? Was there ever a voice in your head that thought my kid is dying? Or did you did you actually think that?

Tori 43:52
Yeah, on like Thursday, because he was just falling asleep in the highchair. I was feeding him some more Korean puree. Nothing ever said diabetes. I just thought he was dying. And so on that Thursday, I remember feeding him and he just fell asleep eating. And I walked over to my husband and he was like, um, I think we need to go to the hospital. And he was and he's very, no, no, no, he's fine. He just has a stomach. And I'm like, this is not a stomach bug. And, and so he kept on trying to reassure me like, everything's fine. But we're going to the hospital, you know, we're going to go see the gastro, they're going to figure it out. And I was like, Okay, well, that whole night, that Thursday night, he was just waking up full of pee full of thermoweb. And I was like, I don't get it. So then Friday morning. They tell us he's very dehydrated, and you need to go next door and get good the emergency room and get hooked up with IV fluids. So now we're like getting the runaround and we're like, oh my god. Like, what are you gonna find out what's wrong? And so I'm like, I'm not leaving this hospital until we know exactly why he's not having a bowel movement. And why he's, you know, so dehydrated, so to speak, because I didn't think he was dehydrated. Like first time Mom, I didn't realize this scan wasn't supposed to be modeled all the sudden. So then we get hooked up with the emergency room and they're trying to find a vein and his veins keep collapsing because he's so dehydrated. And there they have the whole IV team, pinning him down, he's crying, then he's passing out and then he's crying some more. And we're crying. And someone rushes in after they did a blood test. And they go, either of you diabetic. And we just looked at each other. We're like, no. And they go, well, his blood sugar is 360. we're transferring up to 50 right now. And they didn't tell me. They didn't say it in a very, like, bedside manner. They were just like, he's pretty sexy. We're going to pick you up. Okay. And then he just runs out. And I was like, What?

Scott Benner 46:00
What does that mean? Quick? I'm sorry to do this. Because Arden's text me Never mind the abbreviations. nvm, right. Yeah, all right. Sorry. Just got old there for a second. Like, it's an N and there's a V, and I forgot, it feels like there should be an M in it. Sorry about that. That is stupidly, like my daughter's diagnosis. Like your details are different. But the the salient points are the same. And so I'm assuming for many, many people, but yours went on for a while, like you didn't know and you kept taking him to places and they were just like, Oh, you know this that this that? What's that? When you go back home right after the fight, you want another thing? And another thing that isn't correct. I don't like that's a weird feeling. Right? Like that. Like it's gonna be okay. Like person in charge said don't worry. And and Whoa, but everything in you is kind of yelling like, no worry, this is wrong. It just there's nothing right about it's fascinating that they didn't see that I mean, a nine pound weight loss for 30 pounds is a third of their body weight. And born that that, in general, you would think that would put a person right into a hospital for a battery of tests. On that doesn't make that mistake. It just, it's unmistakable that like that. That's what should happen. And I like that your husband recognized Hey, it's hospital time, but it's gonna be fine. It's interesting. Yeah, he went into like, hey, Tori, don't worry. Just because the guy who's never once wanted to go to the hospital thinks we should go to the hospital. That's not a reason to get upset. But he was panicked, obviously, if that's what that's what he was considering to. So veins are collapsing. Nothing's working. He's completely dehydrated. What was his blood sugar when they figured it out? You know?

Unknown Speaker 48:01
360?

Scott Benner 48:04
oddly, not that high. Unless, unless it's been 360. For how long? How long do you think that have been going on?

Tori 48:10
Well, his a one C at diagnosis was 11.9. Okay,

Scott Benner 48:15
so quite a while.

Tori 48:17
Yes. So I try and go back and I try not to like get myself worked up over it. But I try and go back in pictures and try and see when it might have started. And I just can't tell because he'd always been such a happy plump baby.

Scott Benner 48:33
possible to that his blood sugar was bouncing around, maybe it would jump up stay up for a while. And then it may be his you know, his pancreas would be like, you know, come back online for a little while, bring him back down. Because the one thing I don't know. And I wonder how we could find out but in a in a if you could get a healthy pancreas, BOD in the body of a healthy pancreas up to 360. And I don't know like somehow like turn off the pancreas for a little while bring it up to 360 let it stay stable there. When you turn the pancreas back on. How long would it take a healthy body to bring a 360 back to you know at because that really is what you're talking about? You're talking about a body that doesn't have diabetes, that all of a sudden has it and then all of a sudden doesn't have it again while this pancreas is sputtering you know, to its demise. And and that's just very um, that's a weird thought I've never had before. But that didn't mean like I went because maybe he would bounce and stay there for a few hours and then come right back to normal again. Like maybe there'd be no way for you to notice. Really?

Tori 49:40
Absolutely. I believe so too. Yeah, I don't know. He never had a healthy diet or an unhealthy diet either. So I was very I didn't feed him. A lot of you know, snacks. Um, it was I was that mom that was like, Oh no, my kid will never have juice. That's horrible. So then when he was diagnosed, I was like, Well, I mean, I think he'll drink juice. And it's like, Well,

Scott Benner 50:11
turns out he's very sweet. And most people like it Arden, you know, interestingly doesn't like sweet things. Yeah,

Tori 50:17
yeah. So Oh no. Now Jax loves them because it's a hot commodity, and

Scott Benner 50:23
you're able to turn them around pretty easily.

Tori 50:25
Yeah, now now. He's all about it.

Unknown Speaker 50:29
Okay,

Tori 50:30
so horrible. I can't even eat in front of him.

Scott Benner 50:33
Do you ever do wonder about the baby? Do you?

Tori 50:37
I do a lot. Because, yes, we did not have diabetes in either side of our family that we know of.

And so we're very

uneducated on like, what type one totally means. And when he's diagnosed before he's even a year old. I'm like, Well, what does that mean for my, my other baby that I'm having? So throughout this whole training period at the hospital, I'm going What about this one? in me? It's gonna. And so they're telling me the percentages and stuff and they're like, you might not even have anything to worry about what the next one? This is just, you know, an anomaly. And I'm just thinking to myself, but why one years old?

Scott Benner 51:24
Did you? Did you try to like buy like extended warranty on the back? Like, listen, I usually I don't buy the warranty. I just figured, like, if I dropped my iPhone, I'll buy another one. You know, I never dropped my phone. I'll be okay, but I'm gonna get it on this one. If you don't mind. Where do I

Unknown Speaker 51:41
sign up for?

Scott Benner 51:44
Now, it's it's the, it's the so early in life thing that's shocking. Oh, I can tell you that. In the middle of July of 2004, my wife and I had bought a house. Maybe two years prior, we lived in a condo we were we lived in an apartment. She got pregnant, we moved into a condo, the condo like appreciated out of nowhere. So we ran away and sold it really quickly and bought what I kind of lovingly referred to as this East house in my town. Like just it was the only one we could really afford, right. But it was on an acre of ground, which is which is incredibly uncommon in my town. So our goal was always just keep doing better. And one day, we'll knock that house over and we'll build another house on this piece of property. But in the meantime, we were making babies and trying to make money and you know, all the stuff you do. And we had gotten, you know, we made Arden on purpose in October so her birthday would be in the summer, you've probably heard me tell that story. So we've got a summertime baby. We're gonna do a summertime birthday party, and we get her a pony for not not like we didn't buy her a pony. We got a pony came to the house and gave pony rides all through the party that was outside. And we were ruining our lawn, and we didn't care. And we were just like, this is like we got a house. It's outside, we got a summer baby. Boom. So I have pictures in my head and on my computer of my daughter in a dress, looking really excited and kind of scared riding around on a pony in the backyard. And maybe a couple of weeks later, she's standing on a, you know, at a beach vacation. He looks like she looks like an extra on the walking dead. Like, she just it looks like somebody's greater skin, took the weight out of her face, found the way to take the life out of her eyes. She could barely lift her limbs or walk around. And she was like quite literally dying right in front of me like your son was and I never thought of it that way. I never looked at her and thought kid seems like she's dying. I just thought, um, it's weird. She's losing weight or she's tired or she's sick or all the reasonable things that bounced around in your head. But then once that's over, it is one of the very next thoughts you have once you've got the diagnosis of like, no, that's not fair. She's so young. Or you know that that shouldn't happen to a young person, but stuff like that happens to people of all ages.

Unknown Speaker 54:28
Absolutely.

Scott Benner 54:28
Yeah. And I agree with your your assertion by the way that you know, while a person who's diagnosed that your son's age, who doesn't receive the care that you're giving him, that might not be a great thing that he has diabetes at such a young age because then if there are complications, they're going to happen sooner in his life, but but but to your assertion that he might grow up very well, not knowing a difference, and therefore unlike the people who you met, you know Maybe won't have a horrible version. That's your hope like and that that's a reasonable hope. It really is. I think you're doing such a good job. It's fascinating. Okay, no, that's fascinating because like, I can't believe you're doing it but fascinating because of how many people I hear talk about. I have a baby. This is so difficult, you don't understand. And I'm like, No, I do understand because I had a baby a diabetes, too. But But like, not a not a, you know, not one that you were counting their age still in months, but pretty close. Like, so I know. I know what it's

Tori 55:33
like to to makes me even, like more afraid because I have a niece who is newly too and she is so choosy.

Unknown Speaker 55:46
Yeah. And I just could not

Tori 55:48
imagine if she was diagnosed at at the age she sat down.

Scott Benner 55:52
Right? I please Do you have any idea how many times like I tried to make like a joke out of the fact that Arden was getting a shot like I'm like a it'll be okay. Like big smile on my heart, my heart inside completely broken. And I'm just like, it's gonna be fine, big smile. And then she'd be like, look at me and laugh and then just take off.

Tori 56:11
You know, he's starting to do that. Now. You're starting to do that, where he sees me prepping the needles. And I I'll get the pen in my hand. I go, you ready? You ready to eat? And he he smirks at me? And then he runs around the Capitol quick. And I'm like, no, no. And I throw him over my shoulder and I pull the diaper down the shot on the butt. I'm like, well, when he you know, is too heavy to get thrown over my shoulder, you probably need to get that point

Scott Benner 56:35
there. So that hit so there by the way, is a is an experience. A lot of people don't have the one of like actually being able to hold a person while you're giving them a shot. Yeah. Or, you know, as Arden got bigger, there were times like she'd run up on the sofa. And like, you know, and she tried to get away and I'd like, you know, crawl after, and then I'd like get her. And then there's then then reality comes into play. You're holding a needle. And yeah, and they're swatting around like, like no, and and you think it for me, at least one of my most panicked thoughts was, what if the amount of insulin I intend to go into her isn't what goes in, what if she bumps the plunger while I'm trying to get near or she pulls away sooner. And now the next what I felt like was like, now the next three hours of my life are going to be wrapped in even more uncertainty. Because

Tori 57:28
so happens a few times. We were trying to train my parents to be able to do all the diabetes care while I was in the hospital with the baby, the new baby. And so I'm 38 weeks telling my parents, hey, you need to know what to do so that we can be at the hospital giving birth. Yeah. And and not being wondering, you know, hey, how much do I go for? And so so I have my mom, giving him a shot. And she first off doesn't take the cap off the needle and she like goes to give it to them and like what are you doing? And and now now I'm holding taxes are like, you know, strong and and, and Jax is trying to whittle away from me and I'm like, take the cap off and she's like, okay, okay, am I gonna poke myself and I was like, take it off. And then she doesn't dial it. And I'm like, Oh my god, you have to dial it. She's like, You're making me nervous. But I was like,

Unknown Speaker 58:36
You're making me nervous.

Tori 58:37
You're making me extremely nervous because I'm gonna be giving birth and you're gonna be texting me. Hey, how do I do this?

Unknown Speaker 58:43
Look at the killer.

Tori 58:45
Yeah, I'm like, you have to listen to me. So I she finally got it. But then she took it out right after she did it. So then like a little bit squirts out. So and I'm like, now what you do? Yeah, you just did half a shot and I gave him like one unit. So I don't even know if he got anything. He's like sat there staring at the Dexcom like, Did anything go in nap Jackson's like, he like get some eggs here. So let's get any strawberries. Now,

Scott Benner 59:15
the cool thing about that experience that I had you had is that in the moment, it's ridiculous. And you know, frustrating. But But last night, so you guys listening? Haven't heard this yet? Or maybe you have, um, you know, I don't know, I record a lot of these things. So Arden has a friend named Jani, who's 15 and also has type one diabetes for six years. And Johnny's control was not great. She'd be over 400 a couple of times a day for extended periods of time, even though she had an insulin pump and a glucose monitor. And, and she was really trying to and that's the other thing that's really important. She was not passive. She was doing what she was told. So you'll hear this on her episode because I've been recording with her little bits at a time as we move forward. But I met with her one time over FaceTime, we made changes to her settings, got our blood sugar down, talk to her about Pre-Bolus saying, you know, didn't, I walked her through the steps it was, it was weird, it was almost like I was like giving the talk that I'm going to give on Saturday when you see me, except I would give one part of the talk. And then she'd go live a day. And then I'd give another part of the talk. And she'd go live a day. And we were sort of doing it like that. So anyway, in four weeks, four weeks, I'm going to her episode of go up before this, so people should go back and find it. In four weeks, her a one c needed to be tested again. So she had had an A one c done live for two months, spoke to me live for one more month had a one seat on again. The day I started talking to her, her blood sugar was no lie constantly over 250 frequently over 400. And she went from an 8981 C to a 6981 thing. He is so good at taking care of her diabetes, right? So it turns out that all the she was very willing to make the effort she just kept, you know, making the effort with the wrong with the wrong ideas. She was she was looking at multiplication and trying to apply Division Two it like it was just you know, she was just all in the you know, right church wrong pew. And so yesterday, and I'm following her DAX calm, but I never really pay attention to it, because she's just doing a really good job. And I'm just following it till we're done recording. So I have contacts more than anything while we're speaking. But she she has not needed my help in a long time in weeks. And I don't offer her any advice, usually. But last night, I finally looked, and her blood sugar had been over 304 hours. And so I just texted her I was like, hey, okay. And she said, I'm not feeling well. I mean, I said, you mean you're sick? She goes, I don't feel good. No, I don't feel good, because my blood sugar is high. And, and I'm just not used to this anymore. And previously, she talked about how great she felt now, and her focus was different, just that her attitude, like everything about her life had changed, you know, or just for the better. And so I said, Okay, and I was able to like in a split second, figure out what was going on and fix it. Because I've lived through that moment of like, Is there something there isn't there and like, I can finally see that there isn't without knowing. And so I just said to her, I'm like, you know, your your pump sites bad. I said, so she had described making a large bolus that didn't work. And I was like I said, change the pump, double your bazel for a couple of hours. Let's Bolus a little bit of insulin. And I think it took us about four more hours to get her back down to being level again. But but it's that experience that lets me see bad pump sites now. Do you know what I mean? Like Like,

I don't need to know what you did before. Exactly. To know if what's happening is what should be happening. I hope that makes sense. Right? So she said she put in seven units, where a lot of people would be like, Listen, I can't bolus more. I'm like, I get that we change the pump. But I can't bolus more because I put in seven units. I looked at like that seven units is not working. I don't I don't care about that seven years, I'm pretending that doesn't exist. And that most people would get involved in like, oh, there's insulin on board, I can't do anything. And then suddenly that 300 blood sugar would be go from a few hours to a day. And then it would just keep running and she'd go to sleep and it would go up and see how you get out of rhythm really simply. Anyway. Oh, yeah. Anyway, I get her down and I get her stable. And I told her I said I'm not going to text just like let's talk for a second. So we FaceTime. And I looked at her and I said I want you to remember something. Those 300 blood sugars, that doesn't happen to you anymore. So when so when it does, it's not you, it's something else, you have to start looking beyond you you made the right decisions. If the insulin went where it was supposed to go, this would not happen, right? And she's like, okay, and she looked at me and she's still 15 you know, and I'm like, this is not what happens to you anymore. Because what had happened was she saw her blood sugar go up and even though she had this great success for these four weeks, what she thought was okay, like she just got she was logged into it right away in two seconds again, like they're just I must just not be doing the right thing. And, and it was I was eye opening for her. And I think for me to see that happen to her how quickly she snapped back into believing. This is just my life. It was was really interesting. But anyway, I think you have to have those experiences. Your mom has to go through that so that you know you She better at it now your mother?

Tori 1:05:02
Yeah, well, so when, when I had the newborn, his name's Brolin and I had bro in. Jack's had been, he had 300 blood sugar's the day that Rowan was born. And I said, You must have not done basically this morning, you must have not dosed him right for his breakfast, something went wrong. And I'm sitting there holding my newborn at the hospital saying this. Well, he had hand foot mouth. Little did we know. And so he was sick. And they're like, I had to give him an insulin shot again at the hospital and like, they're like, well, we just gave him some insulin that morning. And I'm like, maybe it's more. So

Scott Benner 1:05:41
that's what Arden got right before she was diagnosed.

Tori 1:05:44
Oh, it's horrible. And so he didn't have a rash yet. But the next day, they call me and they go, Well, he has some, you know, a rash on his butt, and like around his mouth and on his hands. And then dad's home with him on Friday morning, he calls me and we're about to get discharged. And they go, he's like, well, that rash. It's, it's worse. And I'm like, oh my god. Well, so they took him to Florida to my uncle's. He has like a huge 30 acre lot on his home, his homes on 30 acres. And so he just got to run around and play. And they took care of the diabetes management. So well. They just had to kind of

Unknown Speaker 1:06:24
live get thrown into it. Yep.

Scott Benner 1:06:26
Yeah. Yeah, there's a person on line right now, who posted in the private Facebook group, and they're like, I don't understand I'm not having the same success as everybody else, then when you really stop and look, they hadn't been at it for very long. So I just said to him, like, Listen, it's not a great answer. But you're gonna have to do this a few times before you get it right. Like you don't just, I don't mean, it's not paint by numbers. It's not like,

Tori 1:06:47
I haven't been in it very long, either. Um, but I think having the strength to just like, let go of the fear around diabetes helps a lot.

Scott Benner 1:07:01
What was that one of the things that really moved you in the right direction is just not being afraid.

Tori 1:07:05
Yeah. Because he's a kid. Lowe's actually worked in our favor. Because he's always hungry. So when he goes to, you know, if he's coasting down at 7970 a, I'm like, perfect. Here's some fruit. Bite of my feet. Yeah.

Scott Benner 1:07:26
But for clarity, you're not constantly feeding lows. You're just sort of, right. Yeah, your graphs are way too smooth for that to be the truth.

Tori 1:07:35
Yeah, I got to a point where I wasn't afraid of that happened. And, and we don't have like, double arrows down. Unless I totally flipped on dinner. Um, but he, he's to a point now where I mean, if, if it's been three hours since he ate, and I want to give him something, I'm, I'm not afraid to give him a little bit of extra insulin, half a unit to a unit and let him eat a snack with carbs. And the hospital still to this day is very, three shots a day. That's it. Breakfast, lunch and dinner. I'm like,

Unknown Speaker 1:08:11
oh, what

Scott Benner 1:08:12
do they say to you for how you are doing things? Do they give you any trouble?

Tori 1:08:16
No, no. They asked me what is what are his ratios. And that happened maybe the the third month when we went again. And they saw just how well we're doing. And they're like, so what are you doing? I'm like, well, so his ratios are this but sometimes they're that if he's really activates this. And they're like, Okay,

Scott Benner 1:08:40
good. No, yeah, you're paying attention. It's uh, yeah, but it's also nice to hear that they didn't you know, because too many people report back that, you know, they have this the kind of success that you're talking about, and then doctors are like, no, you're using too much insulin. They take it away from you. Like, you know, yeah, I get scared of it.

Tori 1:08:56
Yeah. Anyway. Well, so because like I said, they they don't like me giving him extra shots for snacks and stuff. But I I made them aware that I'm watching the back phone all day long. And I'm he's always he's a growing baby. And he wants to eat and he's getting really tired of cheese sticks.

Scott Benner 1:09:18
Exactly. And it's and that's important. We don't bring that up enough Is this your children need to eat? You know, like they're trying to grow their bodies are trying to get bigger and if you're having to restrict certain foods or foods at all, because you're not able to manage the insulin well, then there's another day now you have a different problem is the kid you know, not saying is malnourished, but definitely not nourished the way you're you were hoping to or that you would have if you weren't worried about the insulin.

Tori 1:09:44
Absolutely. Yeah. That's so cool.

Scott Benner 1:09:46
I'm glad for you that the podcast was helpful. It really is nice.

Tori 1:09:50
And I mentioned at my last, his last endo appointment. They were telling me about the Atlanta summit and I said, Oh yeah, I definitely want to go I listened to Juicebox Podcast and they're like, oh, That makes sense.

So they were aware.

Scott Benner 1:10:04
So the hospital. So this happens more and more, which is really kind of kind. I was told recently by somebody that they went to their endos appointment. And the person just said, Listen, I just let me just ask you, do you listen to the Juicebox Podcast? And the woman said, Yes. Why? And she was, I can just tell by your graphs. And I was, I was so touched by that. I thought, that's really, that's really cool. You know,

Tori 1:10:31
they told me as his last appointment when we were discussing you. This is the best graph that I have ever seen. From one someone that's not been diagnosed more than a year and to just his age in general.

Scott Benner 1:10:47
So in seriousness, then, don't don't just say the podcast, but like, what do you attribute that to? Do you tribute it to knowledge? Or comfort? Or is it a blend? Like I want people who are listening? who are, who are healthcare professionals to understand what I believe, which is that if you tell people the right thing, it doesn't matter how early you tell them, but I want to know what impact before I let you go like, I want to know how, how it shaped you.

Tori 1:11:17
Like, what your podcast has done for me, just in general? Yeah, like, What does

Scott Benner 1:11:21
you know, what does the information like so so here's the thing, you really haven't been around diabetes that long. So he wouldn't know. There's a an old school idea that you don't tell people too much too soon, you get a you get a little bit of information, and then you get a little more in three months, then you get a tiny bit more than three months, and in a couple of years, then we can start talking about you know about and by then my contention is, what that builds is fear and a lot of psychological angst. And so it's hard to get you back from that, then I I'm a bigger fan of getting the information out in front with good explanation about how to use it. Not technical explanation or mathematical explanation, but like real like real world ways, because I even I sat next to a physician recently, who loves the podcast, and wants to move the information from the podcast to people at his hospital, and even doctors that are training at his hospital, which I was really overwhelmingly touched by. But still in that conversation, there was an assertion that the information that I'm sharing with people about how I manage my daughter, that's not something everybody can understand. And I don't I don't know if I agree with that or not.

Tori 1:12:38
Like I had to keep on listening. And and you had mentioned in a podcast that you just put up the other day like you just have to listen and listen and listen and something's gonna you know, pay you and i think i think it really helped me to want to live day to day and really look at the grass Dexcom but I need information from the get go. I need to know exactly what to do. I am very type A personality. There's like this big thing about like Enoch grams and I'm a type one in a gram. And

Scott Benner 1:13:19
Bruce past that. What the hell is that?

Tori 1:13:22
It's like personality. I'm on

Scott Benner 1:13:24
the internet. Don't worry. Hold on a second. Type. I found that already. Hold on. Oh, I see. The Nine intagram type descriptions reformer helper achiever, individualist investigator, loyalist enthusiast, challenger Peacemaker. Which one are you

Tori 1:13:44
a performer? So type one.

Scott Benner 1:13:46
I got it the rational idealistic type, principled, purposeful, self controlled and perfectionist. Whoo, I wonder which one of these you tell me about that one? Yeah. decide which one of these.

Tori 1:13:58
Yeah, so with with that personality when, when he was diagnosed, and I would see that the blood sugar is where I wanted it. And especially after I got the dexcom and I'm trying to figure out his ratios and the hospitals just telling me to hundreds, okay. 180s Okay. And, and I'm like, that's not okay. It's not and so I'm racking my brain around how do I get these ratios to where I want them to be? And by listening to your podcast, it's little bits of information from other people and what they do and how, how their day to day goes. It's one made me feel like there's

people going through the same thing that I'm going through and people that

had the same frustrations. Does that make it a little doable,

Scott Benner 1:14:52
either? Yeah. Okay.

Tori 1:14:54
For sure. And so I was like, there's like, just because he's a baby doesn't mean that I can't have a great alien. See. And so

I don't like to be frustrated. And

my husband would see me sitting there racking my brain, looking at every single graph and going through the clarity reports, and he's like, just it's diabetes, just get over it. Things are gonna get out of your control. Sometimes I was like, Well, no, no,

Scott Benner 1:15:24
no, they won't. And by the way, you're under my control. You don't even realize it.

Tori 1:15:29
Like, I tell you what, I'm not home, when to give him the insulin. And then as I'm watching, I say, Now feed him. And so like I do,

Scott Benner 1:15:36
I'm in bigger picture to not just the diabetes, but yeah, hey, listen, this, this intagram thing. I'm concerned that I might have multiple personalities, I'm alone. things is that is the Does that ever happen?

Tori 1:15:48
Yeah. No, it does. It does. You can be a couple different things. Okay. But there's like a primary one that you gravitate to best. So I would totally take a test

Scott Benner 1:15:59
because as the reformer, I am not a perfectionist. I am self controlled. I'm sometimes sometimes personal, purposeful. I'm actually a very principled person. But I am. But I have my limits. So I always tell people, I've definitely never said this here before I live my life under like, very basic rules. Like I don't I don't treat people the way I don't want to be treated. And I don't lie. If I can absolutely help it. That's those are pretty much my life rules. But now the helper caring, I am caring. Let's see, demonstrative. I'm super emotional, generous. I don't know people pleasing. I definitely am possessive. I don't know what that means exactly. Like of people or things I don't care to. I mean, I, the people around me that I care about, I want to be close the achiever pragmatic type, adaptive, excelling, driven, and image conscious. I'm not image conscious, which you'll see this weekend when I allow you to take a picture with me, and I look terrible in the photograph, and you're still allowed to keep but I'm driven about things I care about. And things like things I don't care about. I don't care about law. Am I adaptive? I don't know. individualist. traumatic. Oh, I'm so dramatic, self absorbed at times. And temperamental, super temperamental. I'm all of these things. I have a mental illness is what I'm learning here. Isolated, secretive. I'm not isolated or secretive, innovative. It's funny because of the podcast being innovative, but I don't think of myself as innovative, engaging, responsible. I'm responsible. I think I'm delightful. It's delightful, engaging the same thing. anxious and suspicious. Hmm. I'm not anxious. And I'm not suspicious. I know you people are out there trying to screw me. So don't think I'm scattered or distractible. I love to the enthusiasts. Now you guys should check this out. You can definitely distract me. And I'm not very versatile, spontaneous. I think I pretend to be spontaneous. That makes sense. I do it down here. self confidence. I project self confidence. But I don't personally feel self confident. I'm not decisive. I need to think things through from like, 9000 different angles. will fold no confrontational, less as I get older. And Peacemaker. agreeable or not agreeable? complacent. I'm not complacent, reassuring. I'm not necessarily Oh, so the peacemaker is Peacemaker for other people. Like how does your how does how you are impacted people around you? Is that kind of the idea that?

Tori 1:18:54
Yeah, I took it that way. Yeah.

Scott Benner 1:18:56
Yeah, you took it. So you didn't seem insane. You took it that way.

Tori 1:19:02
I mean, the cool thing about these is that you can take it with your partner and like, understand each other better, because when they do something like when I'm a perfectionist, next we like Well, that's just her just gonna stare at that clarity or for for days, and so she figures it

Scott Benner 1:19:18
out. How long have you been married?

Tori 1:19:20
We? Well, we we say that we're husband and wife, but we're getting married finally. All right.

Scott Benner 1:19:25
Don't worry about that. How long have you been together?

Tori 1:19:29
It'll be four years. Okay. Yeah.

Scott Benner 1:19:31
So when you're together longer, you might have this experience if I brought Kelly up here right now, and told her for instance, that I am. Let's see, hold on. Let's pick one that, you know, there was one

Unknown Speaker 1:19:46
how I

Scott Benner 1:19:46
know. Yeah, but no, if I if I said that I'm driven, exempt, for example, she would completely disagree with that. And she would not let me have my belief that I'm driven. She would stay here. beat out the idea from me that I'm driven. She's like, No, you're not. And then she'd give me examples of why not. And then I'd give her examples of why I am. And she'd say, Ah, don't argue. And so then she just she's, you know, she's a different view of me than other people do. Which I think I think is good. Sometimes it's grounding to not Yeah, somebody agree with you all the time. All right. Is there anything we have not said that you want to say?

Tori 1:20:25
Um, well, is a one C was 11.9. diagnosis and three months in, and having the dexcom for only two months, we brought it down to 6%.

Scott Benner 1:20:36
That's amazing. What is it now?

Tori 1:20:39
Is next I know, appointments next week, and I have a feeling it'll be there. 6% still, because we have been dealing with a lot of toddler sticky. Um, so the, you know, gas has been a little wonky. But I think it'll be around 5.7 to 6%. On sugar main, it tells me like it might be around 5.7. And the clarity report says 6%. So I mean, we've been really steady right around there. I think

Scott Benner 1:21:07
that's lovely. I also think it's amazing that people who listen to this podcast are like, you can hear in your voice, the disappointment of saying 6% just, I don't know, things have been going wrong. So

Tori 1:21:21
blood sugar, it's been like around 150 or a few days and

Scott Benner 1:21:27
Arden's last day one, see that they now they play that game that, you know, I don't think they do it with everybody, but they're like, what do you think it's gonna be? And I said, five, seven. And she goes, she goes, why? I said, we were five, five last time. And yeah, and I said, and I don't, I'm being genuine from it. I don't really see the difference between five, five and five, seven, I'm, I'm in that space. I'm more concerned about variability and like limiting spikes and lows and things like that.

Tori 1:21:53
Yes. And I was looking at that as well, and our standard deviations around 30.

Scott Benner 1:21:59
But the thing is, is when she said, Why do you think it's gone up? I said, God, we've had a lot of problems this time. And she laughed at me. She goes, so you've had a lot of problems, have you? And I said, Yes. And she goes, and you believe that you're a one hurry once he's gonna go up point two. And I was like, Yeah, but I think that, you can look at that and think of me and you as crazy. Or you can look at that and see it for what it is, which is that we're, I can speak for myself. I'm so confident in what I'm doing, then that I Arden's a one sees not going to just jump up if we continue to do what we do. And so we're talking about tighter tolerances, because that's where the tools we use live, you know what I mean? Like, I, there's there, it would be inconceivable of me, for me to believe that her agency could, for instance, go from five, seven, this time, to six, five next time, like I don't, yeah, that couldn't happen. Unless something catastrophic happened to our insulin delivery, or her health or something like that, like in a normal regular situation, it's not going to move around like that. And No, you don't. I mean, like, it's sort of like, when you get in a car with somebody who's been driving for 30 years, you're just like, this rides gonna be fine. Like, you know, like, they've just, they, this is how he does, you know, like this

Tori 1:23:22
happened, the hospital told me, they were like, well, you might not always have such a tight range, because he is going to keep growing, he's going to keep, you know, going through growth spurts, and eventually puberty. And I do understand that and right now we're in a very blissful stage. But with the honeymoon ending, we're on like, a one to 50 ratio just like a few months ago, I'm gonna get,

Scott Benner 1:23:44
I'm gonna tell you with your understanding of how the insulin works. I would say that, from a, from an emotional standpoint, I think that's good advice for you that it could fluctuate around, that's not gonna be for sure. And, and I will also tell you that on the hopeful side of my betting, I don't think that's gonna happen to you. So I think you know what you're doing. And so, so when insulin needs increase, I see it right away. Yeah. And you'll increase with it. What, that's what we did. What happens to most people is their insulin needs increase, and they spend a good three to six weeks really trying to pick the situation apart.

Tori 1:24:21
Yeah, no, it happened like like, two days, I saw that we weren't doing the same like we were giving the same dinner I some days, I'll get the same dinner and over and over again until I get it right. Do exactly what I did except add another unit. And so that's what I did. And so I I noticed that last night, it worked out in my favor, except he had like a little bit of a protein and fat spike three to four hours afterwards that went in and took down right away. And then this morning, for example, it was like a one to eight ratio. And I was like, that's because I didn't give him 10 extra cards. Like I would have and I just did an extra unit and, and I said, Well, Mom, here's a fruit pouch while I do this podcast, he goes low.

Unknown Speaker 1:25:10
He didn't

Tori 1:25:11
study at what a weight right now,

Scott Benner 1:25:12
that is great for people to hear you made me feel like I've let you go after this because I actually have to record another one today. But that what you just made me feel like was I've been watching for all mankind on Apple plus. And it's sort of a fictional retelling of the space race. And you made me feel like we that you were in the capsule, running a test. And you got outside of preference out of parameters. And you just were like, do it again, like to like with the with the same meal over and over again? You're like, that didn't go right. We'll do it again. tomorrow. We'll do it again tomorrow. And and it works. Like I mean, can't do everybody can't do exactly that. But yeah, but just the idea that you realized, like, I just there's something there's a small adjustment in here. Let me make it again. And then you figure it out. And then those adjustments work for other meals. Am I right about that?

Unknown Speaker 1:25:57
Oh, yeah, well, yeah.

Scott Benner 1:25:59
Okay, cool. All right. Sorry, listen, you're chatty. So obviously, we can do this forever. But

Unknown Speaker 1:26:05
I'm gonna go interview

Scott Benner 1:26:06
the hold on a second,

Unknown Speaker 1:26:09
I am gonna interview

Scott Benner 1:26:13
Rick Doubleday, he's the chief, something officer from Dexcom. And that'll actually be out tonight. So there's gonna be a an episode with him. And they got a guy from on the pod. And they're going to talk about the agreements, they all just signed together, about working together for the horizon closed loop system. And, and I guess the Dexcom guy will probably talk about the, the other companies that they have agreements with in place for G six and G seven for people to be continuing to develop, you know, closed loop algorithms for the different pumps. So cool stuff. All right. I really appreciate you doing this. Thank you so much for coming on.

Tori 1:26:54
Thank you. See you in two days. Yeah.

Unknown Speaker 1:26:56
Oh, that's right. Oh, I'll see you then. All right. All right.

Scott Benner 1:27:01
Little did I know that would be the last time I'd ever speak in public. Anyway. Oh, thanks so much to the Contour Next One blood glucose meter go to Contour Next one.com forward slash juice box to get that rockin meter. And of course the T one D exchange. Absolutely anonymous, super safe. HIPAA compliant. worth your time. T one d exchange.org. forward slash juice box. Guys, do you have a great doctor that you'd like to share with someone else? Or are you looking for one I am in the middle of building an amazing list at juice box docs.com you can take a doc or leave one just like that little Penny thing. You know, at the gas station. Take a penny leave a penny. This is the same thing except with doctors juicebox Doc's calm.

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#387 Somebody Call 911

Handling a type 1 diabetes emergency

Ginger Locke is paramedic and the host of the Medic Mindset podcast. She's here to talk about handling type 1 diabetes emergencies, medical tattoos and much more.

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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 0:10
Hello, friends, and welcome to Episode 387 of the Juicebox Podcast. Today on the show, we're gonna dig deep into an issue that I see people talking about a lot. It's their concern about what happens if they should have to call 911. And moreover, what happens if emergency services arrives, and they can't figure out that you have diabetes, or they don't know. This is such a concern for people that I wanted to get a very learned response on it. So I have a special guest for you today. My guest today is ginger lock. Now besides being the host of the medic mindset podcast, Ginger is a paramedic, and an associate professor of MS professions at Austin Community College. In other words, Ginger can do it and teach it. And she's had the experience of helping people with type one diabetes over and over again. So we're gonna get your answers for you, you're ready, you're gonna like ginger. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. The Juicebox Podcast is sponsored by touched by type one, visit them at touched by type one.org. We're also sponsored today by dexcom, makers of the G six continuous glucose monitor, you can find out more and get started with dexcom@dexcom.com Ford slash juice box, how would you like a tubeless insulin pump, you can get it the same one in fact that my daughter has been wearing since she was four. It's called the Omni pod. And to get a free, no obligation demo sent directly to your door, all you have to do is go to my Omni pod.com forward slash juice box. After a couple of quick clicks and a little bit of typing on the pod is going to put that pod experience kit in the mail. And then you're going to be able to wear it and see what you think. Both people want to understand this topic. But it's it's two different reasons. The parents want to put something on their kids so that you know, emergency emergency situations they can see they have diabetes. And adults mainly want to know if tattoos are a good way to to signal. And I started thinking about the topic and I just thought why don't we just like why don't we find somebody who has probably had this experience a billion times right? I did my research and you seem to have the most popular well liked podcasts on the subject. So

Ginger Locke 2:49
Oh, thank you for saying that. Oh, of course, um, introduce yourself. Sure. My name is ginger Lok and I have a podcast for especially for paramedic students. That was the original idea and but paramedics that are in the field, listen as well. And it's called medic mindset. And so most of what I dig into is the psychology of paramedics. And a lot of people think when I say psychology of paramedics, I think that means I'm talking about PTSD and anxiety and all that mental health issues. And we do you know, that does come up occasionally but more I'm interested in how they make clinical decisions and their thought process under what's usually a stressful environment. But but but not always how they continue to kind of show up emotionally for their patience even after like long hours of exhaustion or, you know, you flip flop back from like one a really acute patient and then the next call, maybe something very kind of low acuity kind of Monday, and if someone just needs help, you know, standing up right in they live alone or something like that. Yeah.

Scott Benner 3:57
How long does shifts usually run? And are you there throughout the country? My expectation is that there are some who volunteer and do this work. Right. And there are some who are paid, depending on your municipality, is that right?

Ginger Locke 4:09
Yeah, yeah, I think most cities, we are paid kind of paid services, sometimes embedded within the fire department. But sometimes like, for example, I'm in Austin, Texas. It's a third city service. So you have police fire and emfs. And they're three separate kind of independent things. But then for sure, there's small communities that have volunteer based system. Yeah. It doesn't mean they're lower standard or anything like that. It just means that there's people are sometimes there's a longer response time because people are responding from home, right. So.

Scott Benner 4:47
But well, we used to where I where I grew up. So when I was when I was growing up the entire time. My father was always involved in a local volunteer fire department, which I've sometimes come to think of as a way to get away from my mom. I used to drink beer that wasn't our house. But they but they also, you know, I saw him while I was growing up, there were a number of like significant emergencies in our town, from car accidents to people, you know, trapped in buildings and serious fire some there were some pretty big fires as I was growing up, and my dad was the guy who ran out of my house and went to the other place and got changed and got on a truck and went and took care of it. So I tried it a little bit in my late teens from when I was 16 till I was 19, or 20. And I did hundreds of hours of training, just to be a volunteer fireman. Oh, yeah. And then we had, you know, an ambulance service in the town that was partially paid and partially volunteered. And they would even the volunteers would spend their time, you know, in the house waiting for calls. And it was really fascinating. We really dedicated people, oftentimes not making a ton of money doing something really difficult. You know, it was, so what about you? How did you get involved? And how do you practice?

Ginger Locke 6:06
Yes. So I'm a full time faculty now at Austin Community College, I teach future paramedics now. I still get to be around patients, because we do clinical rotations in the ers that are precepted by the faculty. So we go with the students, and we, you know, do patient assessments and start IVs. And rounds is probably the common term that people have heard clinical rounds. But prior to that I was in the field for about five years working as a paramedic, and I still where I teach is in the same kind of area where I work. So just kind of networked within the MS community here and, and thinking about your question about the tattoos, I actually talked to some medics, some friends of mine to make sure you know that my my experience and what I thought was the answer. I didn't want to make sure it wasn't unique. Just to me that it was it was kind of the common thought process about tattoos or markers. Right, you know?

Scott Benner 7:05
Yeah, that's cool. So all right, so we have your INSIGHT Plus some other people's. What's the steps to becoming a producer, isn't it? Our paramedics and EMTs are two different levels of qualification? Is that right?

Ginger Locke 7:17
Correct. So an EMT. Generally, if you think of it in terms of college based programs, and you can become an EMT, in one semester, it's a certification course. Whereas a paramedic is often an associate degreed person much like this, the similar links of training as a Rn, for example, who became an associate degree nurse, so two years to become a medic,

Scott Benner 7:43
I remember listening, I'm older than you, obviously, I'm looking at you and you have here but younger than I am, but I am I'm, we used to have these little squawk boxes in our houses that they gave to us that just kind of like alerted this high pitched alarm to tell you there was a fire, and then you could kind of scratch easily here, the dispatcher, and it must have all been like FM or UHF, or I don't know how it worked back then. Because there was no internet, you know. And you could hear as you were kind of running out the door of your house, you could hear the dispatcher talking. And I always knew if it was an accident, that it was going to be bad because the police on the scene would always want to skip over the medic or over the paramedic and go right to the EMT, they'd ask for the EMTs like to be so there was not I always felt like there were two different rigs that were kind of, you know, stocks are

Ginger Locke 8:38
right, sorry to cut you off. EMT EMT. We classifies basic life support and then a paramedic is advanced life support.

Scott Benner 8:45
I have a backwards. Okay,

Ginger Locke 8:47
yeah, the way you said it was was reversed.

So EMT might, you know, most firefighters are EMTs they come and they can do these basic life support things. But then often a paramedic arrives in an ambulance for the for the transport, and they've got a higher level of medical care IVs cardiac medications EKGs ultrasound, more toys. Yeah. And, and additional schooling, additional education. So they think in a more complex way about you know, what could be wrong with the patient, they do get what's called differential diagnosis, they think about what disease could be causing this problem. Obviously, if it's correct, it's trauma, it's pretty straightforward. But in thinking about diabetes, you know, we've got to differentiate things like diabetic ketoacidosis, from sepsis, and those two can look a lot alike or maybe it's both and, and so a lot of our education is teaching medics how to think about diseases and how to sort them without all of the benefits of things like blood labs in the hospital, we do have glucometer so we do know blood glucose levels, but we don't have things like lactate ions and some of the advanced stuff that's in the hospital.

Scott Benner 9:58
So after I I decided that I was going to ask you, I put it out to the community that listens to the show. And I got a lot of questions here for here. So I apologize, but I'm gonna probably hit you with some rapid questions at some point and see if we can't give people a full idea of what they can expect from the emergency response if they have a problem. So a lot of people just want to know, do you open up the health apps on people's phones to look for the information that they put in there?

Ginger Locke 10:25
Yes, we would if they were unresponsive. I think if someone is obviously talking, we would never do that, you know, they're kind of in full consenting ability to just have a dialogue. But when people are unresponsive or in cardiac arrest,

yes, but

it's not the first thing we do. It often comes into play a little later into the call. So the one mindset of medics is a find it fix it approach, right. So if, if the person is on their back, unresponsive and they're snoring or they're gurgling, right, we just open the airway, we do some suctioning. So it's just we find this we fix it, we're not yet thinking what caused all of this. It's just some if they're bleeding, we stopped the bleeding a lot then minutes into the call when you start thinking, what caused this? And is there anything any additional treatments than Yes, we start, we start looking through you know, looking for insulin in the in the refrigerator looking for papers that look like they might be prescription, you know, papers from the pharmacy or things like that,

Scott Benner 11:36
go through purses and stuff like that look at your possessions.

Ginger Locke 11:40
But on the iPhone, there's this functionality to get into someone's medical ID and I teach that I teach that to paramedic students of how to get in there that different iOS is and talking specifically about the iPhone. Sorry to just be talking about Apple but there for a while there was a functionality where you just tap I don't know what button that is. This is volume. I guess it's one of the menu buttons right on the side. You do it five times. I think it opened up the medical info. That's interesting. Don't do it. I don't know. Sometimes it does.

Scott Benner 12:15
Let me try. Don't try to now pay with my credit card.

Ginger Locke 12:21
Doing an emergency SOS right now

Scott Benner 12:23
versus calling for help. I they just added these tap functions to the back. But that's

Unknown Speaker 12:29
that's bad calling 911 Are you really cheap?

Scott Benner 12:34
At least they'll know it's you. Right? Are you gonna say hey, it's ginger. I'm sorry.

Unknown Speaker 12:40
Oh, my gosh.

Scott Benner 12:42
She says

Ginger Locke 12:44
I'm sorry. It was a missed call. I hit my phone five times on the site, because I thought it opened up the medical alert. info. All right. Thank you.

Scott Benner 12:57
Oh, my gosh.

Unknown Speaker 12:59
Okay. Well, we won't sprint. That was great. Please leave that in the podcast.

Scott Benner 13:03
Oh, I'm not taking anything out of the podcast. Don't worry.

Ginger Locke 13:05
Now it did open up my medical ID it was the third step apparently

Scott Benner 13:09
123 opens it? I don't know. But let's go again. Hold on. No, no, don't do it. I so I know two clicks is to open up an app like Apple Pay. And so I keep running into that. But I will figure it out. I'll tell you what, I will figure it out. And I'll put it in here. But, but I think it's gonna be of great comfort to the people who asked the questions that you do look, because I I mean, listen, especially for not, you know, it doesn't matter. I should say whether you're a parent or a person living with Type One Diabetes, your thought is Oh, my God, if my kids alone, is someone going to know if I'm alone? Is someone going to know? And and that kind of brings me to what should someone do when you arrive? And there's a person with diabetes who's struggling? What should I be telling you? Hey, they have type one diabetes, like what do you want to hear from people? That's, that's helpful and actionable. And what's too much? You know what I mean, when people start telling you their life story in a weird situation?

Ginger Locke 14:08
I, of course, yeah. Um,

Unknown Speaker 14:12
so generally,

Ginger Locke 14:14
we want to listen.

And that's called the ope that, that what you just said this telling them the life story that's called the opening monologue. And we, it's actually part of training to try not to interrupt that initial what's called the chief complaint. It's like, why are we here? What are what is, what is your need, and what are we trying to address? But I think of you, for example, being a parent of someone or having a family member who has type one diabetes, and let's say they were critically ill, I think because you've lived with the disease for quite some time. Now you would know to say they have diabetes, they're unresponsive. And then we're gonna do a little bit of work, you know, for a couple of minutes, but then also That additional info is going to be port important. Like when were they last seen, okay. And it's helpful to tell us that they have diabetes, but that that can also do something called I think it's called triage cueing where you're basically sitting us down a path. Accidentally. Yeah. So it's, it's good that we know, but we don't want to only think, is this just diabetes? Could this be also could this be something else? Could this be a stroke or something else? So

Scott Benner 15:29
it's funny, I employ a similar idea, when I'm interviewing people on the podcast, you don't want to say something that takes them away from their thought, or leads them to, you know, believe that they've come to some conclusion. And they might be false, you know, like, so. This person has type one diabetes, they use insulin, we just ate and now she's unresponsive. I think she had too much insulin, or she's generally like, would it help to know this is a generally healthy person versus someone who's struggling? But yeah,

Ginger Locke 16:00
if we know this is out of norm, normally, this is well managed diabetes, this never happens. This is something and then then we think, oh, that it's important that we know that the patient has diabetes, but maybe I don't want to get tunnel vision on that one possibility. I want to remember Oh, just because they have diabetes, doesn't mean they can have all these other health problems, right?

Scott Benner 16:23
And and indicate quickly, type one to type two as well. I'm using insulin not using insulin.

Ginger Locke 16:30
I think knowing that someone uses insulin helps because that means that they're at higher risk for sudden drop in their blood glucose levels, right hypoglycemia,

Scott Benner 16:40
so in an emergency situation that the person is not expecting. The difference between type one and type two is not as important as they use insulin or they don't use insulin because Metformin is not going to make you pass out for instance, like that. I get that. Okay. Do you guys use glucagon do you carry it? will use the person's How does that work? Yes,

Ginger Locke 17:00
I have when I was in the field, we had glucagon, we used it. And then I also had patients who had it at home and what could give it to themselves and they had already used like an auto injector to give themselves glucagon. And when I got there, they were starting to get a little better, right? It takes some time. So glucagon is, as your listeners, I'm sure now releases glycogen stores from the liver. But yes, we have glucagon for that. And then also for

some other things to look at actually

has indications for other non diabetic emergency close down

Scott Benner 17:35
GI tract, right. Is that one of the things that does I had somebody told me they use it in some surgeries to keep people to slow people's gi tracks down and oh, it's interesting. I guess it does a lot of different things.

Ginger Locke 17:46
Yeah, it very well could, as I'm thinking about kind of its mechanism of action. Yeah.

Scott Benner 17:51
Okay, so do you have any stories that stick out because I'm thinking about a close friend of mine who lived his whole life with type one and you know, fell out of bed because his blood sugar was low and broke his arm, you know, got so low that his family couldn't help him? I'm wondering if you have any that that stick in your mind?

Ginger Locke 18:10
I think the the extremes, right, the hypoglycemia is and the hyperglycemia. I think they all stick in my mind because they're pretty extreme presentations. Okay. Right. The DK a patient, that's a perfect, they're profoundly ill, those are ICU Intensive Care Unit, they're going to end up in the ICU. And so they're very obviously, profoundly sick. And same for hypoglycemia, right? When they're unresponsive or altered. They're those two decay and hypoglycemia are not very quiet presentations, right? They're very in your face. The one that's sneaky, is the hyper molar hyperglycemic nonketotic syndrome.

Scott Benner 18:55
We all know that one Tell me,

Ginger Locke 18:56
well, you don't know it, because type one usually results in DK whereas type two diabetes can result in this other hyperglycaemic condition when they're not. p todich. They're No, they're they don't have keto acidosis.

Scott Benner 19:10
But their blood sugar still super high.

Ginger Locke 19:13
Well, yeah. And so they're just sitting there actually, not looking particularly sick, because there's no acidosis but their blood sugar is very, very high, and they're very dehydrated, and all that.

Scott Benner 19:22
Wow. I know, I just had somebody on recently who talked about as they were going to decay. He described it as it felt like the devil was inside of them, just a burning chest and I thought he was gonna die just kept telling people when he got to the hospital, I feel like I'm gonna die. So that's crazy. So you guys have to show up in all of these situations. It really did strike me when you said earlier and I let it get by and I shouldn't have that you could go from a situation that's, you know, an overdose and get back in a rig and drive somewhere else and somebody cut their finger making you making dinner, and you're probably still all like, like, how do you how do you do level? Or is it not possible all the time?

Ginger Locke 20:04
I think the fact that it's work helps a little bit of you can be more objective right then if it's your family member, so that what you know what you just said that we, it's our goal to not really get to maintain just a little tiny bit of emotional or professional detachment, right? We don't get quite that we have empathy. But empathy can get so deep that you're actually experiencing the other person's trauma. You know, it's, that would be terrible. If you kind of went down that Yeah,

Scott Benner 20:34
you're there to help so far not to forget that right? Yeah, I have to say that

Ginger Locke 20:37
I think I think we have it tough, but we get a little bit of wind down and wind up time. So we get to, you know, clean up the truck and do a kind of tidying up and then wait for the next call. I think I've also I've watched er, Doc's that we'll be doing cardiac arrest in one room. And then minutes later, I'll see him in another room, just sit and talk him with a family member about something kind of mundane. And I'm like, that seems like a lot of whiplash.

Scott Benner 21:04
There's definitely a scope. We we came up on a car accident one time that seemed kind of benign. And we were told to, we were going to we're gonna have to extricate, they told us and as we were getting stuff together, I sneaked. I looked in the car, to kind of try to get my vibe for what it is we were going to do. And there was no one in the car. And so I turned back to the the officer on the scene, I was like, there's no one in the car. And he pulled me aside and said, it's an older woman, she was like, in her 70s. And she had not been wearing a seatbelt. The force took her into the footwell, and she was under the dash, like, folded in half under the dash alive. And I was I just that that was the moment for me, where I realized I actually did have it in me to hold it together and still do a thing. Because I feel like, if I didn't, I would have found out that one day, you know, I mean, like, I'd seen dead people dead people wasn't too bad. I've smelled burning bodies like that. That didn't get me too bad. But this one for some reason. Like as I as I was living through it, and then look back at it later, I was like, Oh, my God, she was she was broken in half, you know? And, and I still did my job. So that's like, cool. I might I might be okay at this, you know? Because was it that exact same thing? Because if anyone was going to go running and screaming, that would have been the time it was horrific, you know, really crazy. When a persons with another person with diabetes, say they've had or they're having a seizure? Is there a way to articulate this without you believing that they've odede? Like, are there words to use or not use so you don't get confused?

Ginger Locke 22:41
Hmm. So you're saying you're you're the person you're with is having a seizure? And you believe it's because of a diabetic origin right? hypo hyper hypoglycemia is what we call hypo. Right?

Scott Benner 22:54
Yes. Where they're unresponsive, or they're, you know,

Ginger Locke 22:59
yeah. You want to quickly communicate, hey, we're not doing opiates here. This is a part of the

opioid epidemic.

Scott Benner 23:06
Right? Right. How do you start with this is not narcotics, this is diabetes in a way that we'll believe it, because people will lie about drugs thinking that there's legal ramifications on the way right. Okay. Uh, no, yes, sure. I'm sure

Ginger Locke 23:20
they do. We try to get that you know, across to them that we would never end it's in fact illegal for us to as healthcare professionals to that's your protected health information. We try to communicate that but sometimes we arrive in uniforms that look a lot like cops and it's it gets real messy and confusing, or the cops show up also. Right.

Scott Benner 23:37
So they're there at the same time. Yeah,

Ginger Locke 23:39
um, I think, you know, saying that you know, the person that they have diabetes that this sometimes happens when they have hypoglycemia, and probably just saying if you're concerned about you know, recreational drugs we we don't use or we don't use anymore we haven't used today are just directly saying it. I think medics are incredibly non judgmental about recreational drug use. And they really just want to know what they're dealing with. They're not it's not zero judgment. And it's understandable that the general public wouldn't know that right? So clarity, just

Scott Benner 24:17
just just throw it out there. Yes, I'm, we're, we're This is not drugs. This is diabetes. Please think about that as you're going towards it. Or I know this could look like something else, but it's not. Does DK look like intoxication.

Ginger Locke 24:30
It can smell like it unfortunately. So you breathe off ketones. It has an acetone smell that to some people, it can smell like metabolites of metabolizing alcohol,

Scott Benner 24:44
okay, like fermentation almost.

Ginger Locke 24:46
Yeah, just kind of smells sickly sweet. Yeah, the way

Scott Benner 24:50
sweet breath is one of the ways we figured out my daughter had diabetes all those years ago. And then again, she was too so I guess I wasn't thinking maybe she had too much right brandy or something like that. That Okay, so there can be that. What about the combativeness with those low blood sugars? Like I've heard stories of grown adults whose blood sugars get low, not so low that they're unconscious, but then all of a sudden, they're like the Hulk and about half the weight of they can't think either and that situation.

Ginger Locke 25:19
Yeah, I've, I've run those calls.

Scott Benner 25:20
Yeah, what do you do?

Ginger Locke 25:22
Um, so often they're sweaty to a lot of

pale and sweaty and so

it kind of be I can kind of be a handful.

We have general approaches to what you might call an agitated patient or combative patient. I don't really like to use the word combative, I think of it as more agitated, like, it's often in fear, yeah, that people become so non, you know, not able to kind of follow along with the sequence of events that a normal person would

Scott Benner 25:56
lose the society, you know, I guess combative. I get your feeling. I didn't mean to cut you off. But combative gives the overtone that they're purposefully not Yeah, doing it. Right.

Ginger Locke 26:07
Yeah, I hate that word. Yeah, I prefer more agitated, because it gives you a sense of what's going on in their head, right, they're going through anxiety and

confusion. So

we basically have two, two approaches. One is physical, like if someone were truly combative, like swinging at you, there's basically two approaches. One is physical restraint. And the other is chemical restraint. And both can be used in conjunction as well. I think chemical kind of sedation is the humane thing to do, you wouldn't want to physically hold someone down, right? Because that could be dangerous for them. But then also just like, psychologically

terrible.

We usually try to give them glucagon or some dextrose, you know, we try to first discover that their blood glucose is level. So that means we have to stick them to get a little bit of blood. So that's sometimes exhausting. Just even get a little blood there. They're not liking that.

Scott Benner 27:05
I can tell you that even at a reason there's a spot in my daughter's blood sugar, will she'll stop caring, like the kids like in you know, I'll say hey, test your blood sugar shekel, I will. And then it say keeps falling. And it gets to a certain level. And you'll say like, Hey, this is becoming a problem. Like you really need to check and eat something at this point. And she'll get like, it's it for her. It's very jokey still, but she's like, well, if I die, I die. Like she and she's not being funny anymore. But she just gets into kind of like a it's like a twilight almost where she's just like, hey, whatever happens happens. Yeah, a little detached is a great way to put it or dissociate. And you kind of have to keep pushing her towards it or kind of, you know, take something to her and say, Look, do it now. It doesn't happen a lot. But I've seen it happen enough to to recognize the repetitiveness of it. Mm hmm. Let me ask you a couple of questions about about how people can help you if they're by themselves. So people want to know about tattoos, IDs, you know, watch bands, people now have like, you know, Apple watches and there's they make these little snap on things on the bands that people put stuff on there. a QR code bracelets, do you guys scan QR codes. If you're using an insulin pump with tubing, or you're on multiple daily injections, and you'd like to be on a pump, this little bit here is for you. The Omni pod tubeless insulin pump has been a mainstay in my daughter's life. Since she was four years old, she's been wearing it on the pod every day for I think about 13 years now. And it's been a friend in her life with Type One Diabetes. Not only is it tubeless, which is amazing, because you can wear it anywhere you can keep it on while you're swimming or bathing or playing soccer. You know, are you whatever you're doing with like friends or acquaintances, you get what I'm saying? adults, right? Like you can just keep it on. So you're getting your insulin the way you're meant to be while you're doing everything. But for those of you who are still MDI and you're like, I don't know, it's going pretty great. I'm sure it is. And I'm not pressuring you, you don't need an insulin pump. But I want you to think about do you get low, like at the same time every day, like three o'clock in the morning or something like that? Or do you rise up at the same time every day? How cool would it be to be in charge of your basal insulin to be able to make it stronger or weaker. So that things like that don't just, you know, quote unquote, happen to you. If you're always getting low at 1am you could set a basal rate that begins you know, like an hour or so before that would impact that. Same thing for rises that happened in the morning. All kinds of stuff. Being able to manipulate your basal insulin with a pump is next level stuff, being able to do it tubeless Lee, that's even better. But here's the greatest thing about on the pod In my opinion, I mean this, you don't have to listen to me. Because they'll send you a free, no obligation demo, you can try it on to see what you think. And then if you like it, you move forward with the process. And if you don't, it's no big deal. It's up to you. That's how it should be my Omni pod.com forward slash juicebox. Get that pod experience kit coming to you in the mail right now.

Guys, the dexcom g six continuous glucose monitor is maybe one of the most important tools you can have while you're managing insulin. Why? Because you can see the speed and direction that blood sugar is moving when you were the dexcom g six, you can see it right there in real time. And it's not just I'm rising, or I'm falling. It's I'm rising. And this is how fast I'm rising, or this is how slow you're falling. It's spectacular technology. Imagine you're just doing a finger stick and you find oh mama, my daughter's blood sugar. It's 135. He's at 135. And stable, is it going up? Is it going down? There's no way to know where the finger stick. But with dexcom. There is. And you can see it right there on your cell phone. They're saying I'm saying you can follow a loved one a child or a spouse, brother or sister on your Android or iPhone device. Not only can you follow them, but look at nine other people because the user can have 10 followers if they want to. That could be a school nurse, a babysitter, so many options. So many people who are able to help you with your blood sugar, hold on a second, my wife's walking in, okay, I got rid of her so that I could tell you dexcom.com forward slash juice box Dexcom is going to give you an honest chance to keep your stability where you want it, you're a one seat down. So the time that your blood sugar spends in range is greater. How's it going to do that? Well, it's gonna tell you what your blood sugar is, and how fast it's moving. And that's going to give you an honest chance to use your insulin. Trust me, it's how I do it with my daughter. And her a one C has been between five, two, and six to four coming up on seven years. There are links to all of the sponsors at Juicebox podcast.com. And right there in your podcast player. But for today you're looking for dexcom.com Ford slash juice box and my omnipod.com Ford slash juice box. So people want to know about tattoos, IDs, you know, watch bands, people now have like, you know, Apple watches and there's they make these little snap on things on the bands that people put stuff on there. a QR code bracelets, do you guys scan QR codes? Like what what's the good thing to do here? Or should I just put something on my wrist that says I have diabetes and tattooed right?

Ginger Locke 33:03
The main thing you want to communicate is that their blood glucose level should be checked, right? And so just saying diabetes even not even getting into the type, just saying that the patient is diabetic means we will. And honestly, even if someone's just has altered mental status, we check the blood glucose level. It's a screening tool, it's a very low risk high benefit screening tool to just take a little tiny bit of blood it's very inexpensive test to know and so even patients where we have very low suspicion that the blood glucose level is off.

We'll do your take that as readily as we would take someone's temperature

Scott Benner 33:40
for example on a glucometer and you test somebody's blood sugar. It's it's one of the basic tools.

Ginger Locke 33:44
It is a very basic vital sign. Yes. Okay. But to your question, I think it's a good one of you know, maybe how do you get that medic to check the blood glucose earlier in the call instead of I think of a call I had once where there was this older gentleman and he was having unilateral neuro deficits that kind of droopy on one side and we were so certain that it was a stroke. But then finally very late into the call we got a blood glucose levels very, very low. He was hypoglycemia and apparently hypoglycemia can cause unilateral neuro deficits which is bizarre to me. I don't know how that would happen. But it can and so we we miss understood what was going on with him till pretty late in the call. But the way to communicate that information to medics would be to me a necklace or a bracelet that is the universal way all the fancy tech stuff is nice and probably more aesthetically pleasing to the typical person that has diabetes is want to be walking around with those bracelets and necklaces on. But it's just it's quicker. When we see a necklace or bracelet that's got the little engraving on it that says

Scott Benner 34:58
yes, just say it's a bracelet sandwich Girl, you're looking at me now you're probably having such an easy time imagining that. But say I'm a girl and I'm wearing a bracelet that has charms on it. I can't just throw one charm on that's for diagnostic, you're not gonna sit and pick through my

Ginger Locke 35:10
I will never notice that. Right, right. And actually same with tattoos. So this was a conversation I had with other paramedics about do you ask them? Do you look at people's tattoos? And they said the general response was, yes, we noticed people have tattoos, we would not be looking at the content of what the actual image is until later in the call with a stable patient as a conversation starter. But it would never be I'm scanning this for data that can help me take care of this person. Right. So you're looking at it in a very with a different filter. So do you I mean, if it was tattooed right across the chest? That's what

Scott Benner 35:47
I was gonna say, right? Yeah,

Ginger Locke 35:49
it's pretty obvious. But if it were something subtle or small, it could very easily be missed. It's just

Scott Benner 35:54
right are acronyms in a sleeve of tattoos? You know, you're not picking through. But if someone had no tattoos, and tattooed around their wrist where you were looking for the bracelet, it's a type one diabetic, that's as good as a bracelet, you would think, right?

Ginger Locke 36:06
I don't think it's as good as a bracelet.

Scott Benner 36:08
Wow, because you're looking for the bracelet.

Ginger Locke 36:10
Because I'm looking at tattoos and thinking that's a tattoo. And I don't, there's no data in that for me, other than this is just a person that has a tattoo. Okay, but it I'm not looking at it for. I mean, sure, I may see it. And it may be helpful. But a bracelet is it's, you know, those really ugly bracelets that have the terrible chain and the rectangle, and they're just so uniform. And so kind of institutional looking. Those are the ones I'm used to seeing. Do you know the ones

Scott Benner 36:39
I do? See, what you're saying is the classic medical ID is what you're looking for, because that's just, it's what you're trained to do. It's what happens more over than not. And you're also in a heightened situation, at that moment to

Ginger Locke 36:55
correct. So you're, you're working on a little less cognitive bandwidth and somebody who's relaxed, and you may get there, it just wouldn't be as quick you. So you'll get there after you've done a couple of things and you're kind of your physiology is calming down and your field of vision expands a little bit, then you'll start noticing those little things. I've talked to people about their tattoos a million times, but it's when everything has stabilized afterwards.

Scott Benner 37:20
So if mike tyson got a face tattoo that said, type one diabetes, and you rolled into the room, and he looked low, you might just look at him and go, I don't see that and keep going, I get that I really do. And there's this extra thing that doesn't belong on the body. And that draws attention. It looks like all of the other things that sit do that job. And so that makes your brain stop and go that's a medical ID.

Ginger Locke 37:43
Yeah, right. It's about picking a lot of what we do is pattern recognition, because we're moving so quickly and thinking so quickly. And there was a study done for radiologists to find. They were told to find basically cancer on all these CT scans right in their black and white images. They're told to find cancer to screen these CT scans quickly for Do you see anything it looks like a mass chest CTS and because masses are cancer usually shows up as white on a CT, they missed. There are all these little black tiny, they place a tiny black gorilla and all the CTS and they did not see the little thin outline of a little black gorilla on a CT scan. Because they weren't looking for that they were looking for White. Okay, and so it's just what your body your brain kind of selectively notices and and the way a medic thinks is not to go hunting through tattoos, they're looking for other stuff.

Scott Benner 38:46
So I have a tattoo on my shoulder or my forearm and I'm wearing sleeves and nobody's finding that. Not until later from your

Ginger Locke 38:53
you know, you point to your forum. I think about that where we might put a blood pressure cuff or start an IV I mean, those arms are better than legs. If you're Yeah,

Scott Benner 39:03
you're not gonna get away not you're definitely not taking my pants off during this situation.

Ginger Locke 39:08
Sometimes Actually, we do make patients all the way naked. Just go hunting for what do you think? Yeah, injuries and stuff like that. But

Scott Benner 39:16
But okay, but but I hear what you're saying. How about in the car? seat belt? How about those things that go on the seat belts are stickers on the window? Do they kind of fall in this? How do I how do I brand my car say I've got a 17 year old driving with Type One Diabetes? How do I make it so that when you come to the door, you know, this person has diabetes?

Ginger Locke 39:34
I think even if it's on the car, I don't know that that person that is that person's car. Right? So we're often the way our mindset is we're thinking I want to keep all the possibilities open. So yes, I have this piece of data that says somebody put that sticker on there, but I don't know it's specific to this patient. So I don't know for sure that conclusively that that patient has diabetes.

Scott Benner 40:00
When we're buying when we are branding things is the caduceus the most like thing that makes you think medicine. It's that set the snake thing with the rod. I like that you said it like that. Yes, it is.

Ginger Locke 40:12
Yeah, yeah, that's the one in red. Oh, am I so

Scott Benner 40:14
old that I know words for things people don't use anymore? Is what I just started one.

Ginger Locke 40:19
Well, I was just kind of is, is is a good word I forgotten

Scott Benner 40:23
now I'm wondering why I know it. So, okay, so I mean, it's just like this add to that you can do as much as you want to hopefully trigger that emergency person's thought to like, oh, diabetes, but until they go through their process and do their things, there, they're not going to know for sure. Without that, that jewelry around the neck

Ginger Locke 40:46
around the wrist, or something in a wallet of someone

will help as well. So we

typically will look through a wallet looking for prescription, you know, medication lists, or names of, you know, some people have that they've had surgeries, certain type of implants and stuff in their body, they'll have little cards in their wallet that will find

Scott Benner 41:06
what about a lockscreen image? What about I push the button once the lock screen pops up? But it says Great,

Ginger Locke 41:10
well, that actually, this is pretty genius.

Scott Benner 41:14
Okay,

Ginger Locke 41:15
that's, that's pretty smart, because we will go to the phone pretty quickly. And I've watched at the hospital social workers really just the phone is the lifeline to getting to the family and trying to figure out who people are and kind of doing all that detective work.

Scott Benner 41:29
Okay. All right. Well, there you go. Finally, the cell phone, not ruining lives saving. I don't know if anybody's seen the there's that Netflix documentary about social media right now, that tells you everything about your phone that you already know is wrong, and how it's trying to kill you that you choose to ignore it because you love it. And it's not, it's not killing you immediately. So you're just like, I love my phone. Please stop saying bad stuff about it. Okay, let's see, well, while people are waiting for you to get there. Mm hmm. What do you think people fail to do in that time when they're panicking, like what could they be doing? Does that make sense? Is there something to talk about,

Ginger Locke 42:11
rather than saying what they've failed to do, I could just kind of list off some useful things to do. clearing a pathway between the road and where the patient is. So if they're in a back room, right, moving things out of the way just to get a stretcher through or even be able to walk through with bags, clearing that pathway. As far as sick and unresponsive patients that many have religious may have heard of what's called the recovery position, right? This is laying on the side that allows and if they were to have any vomitus or spit to kind of drain out of their mouth with gravity towards the floor, rather than back into their their airway. coming outside to meet the fire truck or ambulance is very helpful as well. Sometimes, homes aren't very well marked, or an apartment complex, it's may be hard to figure out exactly where you are as quickly. It could save, you know, a minute or two. Right? If you were to come out and be what's called a flagger where you kind of wave down the the

responding. It's a good

Scott Benner 43:14
idea. There really is no lights on on the outside of your house, stuff like that.

Ginger Locke 43:18
Yeah, turning lights on. That's that's a great way, especially at night when the lights are on. I'm like, Oh, I know. What's that house? Yeah. Because ever all the other houses look asleep at 330.

Scott Benner 43:24
In the morning, this house is lit up like I bet you they're the ones that called us.

Ginger Locke 43:30
That's a good one. Yeah. And then just then assembling medication lists, putting all the meds in a little baggie that we could take with us. Just kind of assembling some key stuff that if we needed to leave quickly, that stuff is all together.

Scott Benner 43:43
I guess too. If you're you're likely going to take this person with you. If they have some personal stuff that they use to manage their type one, they're going to want to make sure that gets in the rig with them and or somebody goes with them too, if possible. Do you like to take a family member if you can?

Ginger Locke 43:59
We do so COVID times is messed up all taken all the family members and things like that. But yes, let's talk non pandemic times. It's great to take a family member, especially with patients who are unresponsive because they're there all the info there. The patient's history. So we talked about when we do assessments, there's a history and a physical exam. And when a patient's not talking, you have zero history, and you only have your physical exam to rely upon. So they become the surrogate historian. Okay,

Scott Benner 44:27
yeah, no, that makes sense. Hey, when I call 911, can I say I need an EMT? Not just a paramedic? Will they take me seriously if I do that? Well, well, they'd be like, Hey, who are you buddy? I know you've seen ER and everything but you know.

Ginger Locke 44:43
So you said in reverse again.

Scott Benner 44:48
Alright, can I okay. So,

Ginger Locke 44:50
here is when you call 911. They will have already a pre planned response, right that is appropriate for whatever it is. Your job is to report what's going on where you are as best as you can, right as a patient breathing as a, are they breathing? strangely? Are they bleeding? Do they have a pulse? Are they talking? Those are the types of questions, very simplistic questions. And then the response will be kind of triage through dispatch about what resources should be sent.

Scott Benner 45:22
So I shouldn't get all obviously I definitely shouldn't. Because I'd end up asking for the wrong thing. I'd be like, I need the guy that went to more school and then I say it backwards. They'd be like, Oh, he only wants this. They send over for band aids and a nice cages on his first bag. Alright, so yeah, don't don't think this situation because obviously you're gonna do it wrong. And and be very clear about what's going on in that assessment when you're talking to 911. All right, that makes more sense.

Ginger Locke 45:51
And the first question that's usually asked is not what's going on, but where are you?

Scott Benner 45:57
Okay.

Ginger Locke 45:58
Like, are usually your location

knocked what's your we think they answer with what's your emergency? But it's not they want to know where you are? And then once they start hearing What's wrong, then they'll start sending people to that location? Gotcha. Because it mean, no one can do anything until we know where you are. Everything's on pause. Well, we know that

Scott Benner 46:21
you're in a medical crisis. I'm as if I'm the responder, my first crisis for me is getting to you. And then figuring out what's like you said, going through those checklists and getting to let's not let you die before we can figure out the bigger problem, and then stabilize you and get you to the hospital if that's necessary. Mm hmm. How many people? Have you treated with the diabetes situation and left behind versus take them with you? How often do people have to go to the hospitals that

Ginger Locke 46:51
for the hypoglycemic patients that are awake and talking and breathing when we get there? It's rare that we would transport them because what they need is food.

Scott Benner 47:01
They need to have it there.

Ginger Locke 47:03
Yeah. We will discuss you know, what may have caused the hypoglycemia? Was it too much insulin? Was it that you have an underlying infection that you didn't even realize? Or you know, and that maybe there's something more going on today? So it's not just a simple we fix your blood glucose level and lead? It's okay, let's explore why you became hypoglycemic. And are we all confident today, you just took your insulin and forgot to eat? Okay, that's the story.

Scott Benner 47:27
All right. No reason to pay for the, for the, for the taxi ride and going to the hospital and all that other stuff, because it's over. It's one of those medical things that once it's over, it's over, right. I know, my daughter had a seizure once when she was first diagnosed. And we, it was a Sunday afternoon. And we just gotten back from somewhere and put her in a crib. And she was she was napping after a car ride. And she just started grunting. And you know, it was clear she was having a seizure. We're trying to figure out how to use the glucagon. She'd only had diabetes for a short time, we didn't know what we're doing. We got our son who I think at the time was like seven, we got him to call 911. And we were messing with him the next day. I know there were a couple police officers in the house and and then you know, the emergency services were right behind them. And once we got her stabilized, we went to the hospital. And I think we were there for five minutes before my wife looked at me and when we didn't need to come here. And I was like, No, we didn't, did we and then by then it was too late. They had our insurance card already. And we already took the ride. So we just went over and and it was fascinating how little actually happened at the hospital where they were just like, well, she looks good now. So yeah, you don't want to do that. Again, it was sort of like that.

Ginger Locke 48:36
Well, that's a big trend in EMF not to go too far down the MS. Tangent, but I do want to say that emf is evolving and that the more education that paramedics are getting, the more independent they can be in making those decisions about where's the right what's where's the right paid place for the patient. Right. We used to be there's kind of a saying you call we haul, right? You just call us we're going to the hospital because we can't think for ourselves now. With more education really good physician oversight, we can have longer discussion about what's going on and create a plan that's right for you today. And not just this prescriptive, like everybody goes to the ER thing got it.

Scott Benner 49:13
Hey, um, a lot of people asked this question when someone has a low blood sugar you figured out they have a low blood sugar and they need food. Is it common to over carbohydrate them like to jam them up and make them super high because the people who are normally pretty cognizant about keeping their blood sugar stable in a lower range who've just had what they consider to be a you know, an emergency situation? They are not looking for you to make their blood sugar 450 but are you are you

Unknown Speaker 49:40
Why?

Ginger Locke 49:42
I love your question. I love the way you asked it. Yes, we are thrilled that you're no longer hypoglycemic. But, so if we're going to air we're going to err on the side of you maintaining consciousness and not becoming hypoglycemic. So sometimes Yes, that means we overshoot it,

Scott Benner 49:59
but you're not going to show up Go, hey, try these three Skittles and wait 15 minutes. So let's see what's happens you're gonna write,

Ginger Locke 50:03
you're gonna usually it's like poor, I, you know, can bring some orange juice, put some sugar in it, you know, it's like, it gets ridiculous. But we also give intravenous dextrose. Okay, right. So for patients that can't eat can't swallow.

Scott Benner 50:22
I know, it's something that

Ginger Locke 50:23
you haven't talked about yet, which is you've talked about glucagon, you've talked about oral kind of sugar. But then there's also intravenous, what we call d 50. It's 50%, water, 50% sugar, it's a lot of talking about carb load. So we used to just give like the whole thing. Now we've started kind of giving half of it, and then wait and see how that does not we do we are cognizant of the fact of trying not to overshoot them so so much, because that's, that's rough on you guys. Yeah,

Scott Benner 50:51
it's terrible. And then I wonder, too, with all the new technology that people with diabetes are wearing. It's a lot of people have continuous glucose monitors. So an ability to see their blood sugar in real time and how it's moving. Do you will you employ those once you're aware, and things have calmed down a little bit where you say, hey, let me see your blood sugar on that you would, okay.

Ginger Locke 51:12
And we're gonna double check it with our educational course. Yeah.

Scott Benner 51:15
But I mean, in easy way to say that, like this dextrose has gotten you to like 125. And it seems pretty stable. We don't have to push the rest of this. Yep, I got it. Okay.

Ginger Locke 51:25
And going along with the clinical presentation, too. So it's like, with the number looks good. And you are looking better.

Scott Benner 51:31
Right. So yeah, so the stuff that you would normally do visual check over. It's not just these numbers. Okay.

Unknown Speaker 51:37
Right. Do you

Scott Benner 51:38
have, like at one, obviously, I think you do. But when you're teaching your course, what do you tell people about assessing diabetes?

Ginger Locke 51:49
Um, we tell tell the many things. It's a whole module. But, you know, some of the teaching points are that this may be the first day that they've realized they have diabetes that they may not have known. Often it results in some emergency to for them to even become aware. Right. And so that's, that's an important thing for paramedics, I think, to understand that. People can be having a diabetic emergency and not even know they have diabetes. Wow.

Scott Benner 52:21
Yeah. I never thought of that. Like they're everybody's first time is somebody who is Yeah, everybody has a first time and not everybody ends up in the hospital, passed out their first time, they might just have some of the symptoms of high blood sugars. Yeah, it's funny, I think so much about the problems we that people have when they're being diagnosed because doctors offices, it's, it's almost disturbing to hear you talk about how obvious it is to do a finger stick to check on somebody's general health because they don't do that doctors offices. So a lot of kids get treated for the flu or other stuff like that for a long time, then end up in DK because no one took the time to just, you know, check their blood sugar very quickly.

Ginger Locke 53:02
You know, what's interesting about that is I I've thought about that same thing, because I've got two kids. And it bugged me that they weren't they didn't know my kids blood glucose level at any point in their life until I think maybe they check there's a there's a routine, routine screening age, I think they finally do check. I don't remember for eight or what, but it did bug me.

Scott Benner 53:23
Yeah, it's a huge problem. There's a lot of different organizations that try to help you there's these letter writing campaigns that go to like pediatricians offices and all these things, because a lot of kids you know, there are people who die every year from undiagnosed type one diabetes. And really, you know, when you look back on it, you realize that for whatever a test trip costs $1, maybe, you know that somebody just kept treating the flu, the flu, the flu, the flu and never looked that next step is it's disturbing. And that's why I felt I found it really comforting and interesting that you were like, Oh, we would just do that all the time. That's a great way to

Ginger Locke 53:54
find out routine. It is. I mean, it's not only our paramedics educated to do that is very routine, we work under kind of standards of care or protocols that are written and it is a very standard thing that any altered mental status patient, right, even if they're just a little confused, little grumpy, sleepy, lethargic, and so not just unresponsive, but altered mental status, that is a very routine test. And, you know, you said it's inexpensive, it's also low risk, there's very little risk. It's not it is very hard to hurt someone with a lens set.

Scott Benner 54:31
Right, right. Yeah, you're gonna be okay. That's

Unknown Speaker 54:36
the high yield low risk test to make sense.

Scott Benner 54:38
So when people have a higher blood sugar, so you get there and you assess them and they're not DK but their blood sugar's 500. Do you help them? Like do you want them to have insulin? Or do you leave it to them? Or do you just say, hey, look, you don't have enough insulin? What if you get them What if you have to transport them do you carry you don't have to carry insulin with you.

Ginger Locke 55:00
It's a great question. We generally in the outer hospital setting, paramedics are not using insulin No. And it's because it's a very strong drug that does other things besides move glucose into the cell, it also affects other electrolytes and things like that. So abrupt changes, someone's really hypoglycemic and they take a ton of insulin that can do a lot of other things to their body, besides just fixing their blood glucose level. As I said earlier, and you guys who are listening know it's a these are very critical care, very fragile, sick patients. And so insulin is not a very common out of hospital. medication. Yes, yes. I can think of a few maybe remote places where it's used, but nope, not on the trucks in. In Central Texas,

Scott Benner 55:44
would you turn to the verse and say, Look, you have insulin here? You should probably take it as your doctor has instructed? Or do you don't mean like, you're obviously not going to give it to them? I guess? Because you don't know any other way.

Ginger Locke 55:56
I wouldn't even know I don't even know all the scales and all that stuff. I don't know how to do it. Yeah, I would be because of kind of my lack of knowledge about, you know how much insulin it takes to get someone's blood glucose level? To me. 500 is the number use is a pretty scary one. And I would be afraid it's not just simple hyperglycemia? I'd be worried is there more going on. And I would not be comfortable if they if they? So usually, if someone's quality msmes are sick, they don't feel well. Right. So to also see a blood glucose level of 500. It's like, okay, I want to make sure you get screened for many things at the hospital that I don't I feel a little out of out of my

Scott Benner 56:38
zone on that the word purview kept coming into my head, like that's outside of your purview. What?

Ginger Locke 56:42
A little bit, just because it's like 500, or you're pretty sick? And if, depending on your clinical presentation, right? If you look really sick, yeah. And there may be more,

Scott Benner 56:53
I guess, you have one problem you're dealing with, you don't need to add a secondary problem before you get somebody to help, right. But let's just interesting, like, you really are there for an emergency situation. So if somebody called you in that scenario, you got there and said, Look, you know, this is what your blood sugar is, it looks like you probably need to be checked for a number of different things. I can take you to the hospital if you want, or you should make your way to your own physician, or I guess there's a lot of different. It's interesting, your job is very specific. Yeah, we

Ginger Locke 57:22
we talk about paramedics, our healthcare navigators, so they're not just responding to emergencies. They're responding to people that aren't sure what to do next, with wherever, however, they found their condition to be and so maybe they're new, newly diagnosed, and they're not very good at taking their insulin, if it's daytime, and we can call their doctor and talk through all of that, then sure, but if it's the middle of the night and

Scott Benner 57:46
can't get a hold of people, then maybe then the hospital becomes the way

Ginger Locke 57:49
Yeah, and you you know, maybe they have a headache to go along with it. Well, headache can be a lot of things that I can't test for, like meningitis or strokes, right. So there's so many things in that hospital setting that we can't test for that we do end up taking a lot of people to the hospital for additional testing, when, you know, we can't really get in touch with their primary care physician.

Scott Benner 58:10
Do people try to use you improperly? Meaning Do you ever get to people and this is away from diabetes, I'm wondering this, and they clearly need a hospital but don't want to go to the hospital, you have no power over that. Right? If I refuse to go I just that's it.

Ginger Locke 58:25
Correct. If you don't want to go to the hospital, I'm not kidnapping you and taking you anywhere you don't want to go as long as you have mental capacity, right? So as long as you aren't incredibly intoxicated, or unresponsive, or something's in a way that you like you're not making your judgments impaired.

Scott Benner 58:43
So you can make medical judgments about their ability to make judgments for themselves.

Ginger Locke 58:48
So if I say we do it a directively with tests like Do you know what day it is? Right? Do you can you explain to me what's wrong with you today, and that you're preferring to stay home? And you understand that you might become worse and die here in your home? Or you if they can explain it back to me then.

Scott Benner 59:05
Then that side everybody's got their own freedom. But now if I say I don't want to go to the hospital, then I pass out are you allowed to go ups? Oh, well, I've been put them in the truck

Ginger Locke 59:13
is called it's that it's called implied consent. And the idea is that a reasonable person would want to go to the hospital if they had known they were about to become unresponsive, right?

Scott Benner 59:22
Oh, that all makes sense to me. Okay. Is there anything I didn't ask you or that we didn't talk about that I should have to answer these questions for people, which by the way, started out with our medical tattoos, okay, and then turned into all these great questions from everyone.

Unknown Speaker 59:40
Um,

Ginger Locke 59:45
I think you know, you're asking how does how do you signal to somebody come into your home that someone in the house has diabetes? I think the probably the top places are a bracelet in your wallet, the refrigerator Another place we go look on the front of the refrigerator, people will put lists of medications and stuff. Yeah.

Scott Benner 1:00:07
So my last question, which a lot of people ask, because of the timing of when I put this out into the community, and when everybody started asking the questions, there had been something in the news recently, where a gentleman had a very low blood sugar. And the, I guess the people who showed up his house, were just certain he had odede. And would not listen to the other people in the House about it. What do I like? What do I do? If if like, really like, Is there something you can think of that would snap you out of that mentality? If you were thinking this is drugs? This is drugs, and I knew for certain it wasn't like, what do I do to get you to stop thinking that way? Because timings of real issue at that point.

Ginger Locke 1:00:44
Yeah, I love the question. Because you're talking about cognitive pitfalls. It's not that these people are jerks, right? The medics that come to your home, they got into ms because they want to help people. And they're not just jerks. But they can if they've run, you know, maybe they're in a community with an opioid epidemic. And they're, you know, that's 2020 calls back to back to back to back, they kind of get their brain gets stuck, as you said, So what can you do to get them unstuck? There's this really great book called how doctors think, and it might be something you know, and your listeners are interested how doctors think is really neat, because it talks about how clinical decisions are made. And it's recommended to ask of your doctor. What else could this be?

Scott Benner 1:01:30
Okay, that's that's phrasing that gets them to start thinking a different way.

Ginger Locke 1:01:34
It's like, okay, right now you're thinking overdose. But what else could this be? And it just opens up their brain to

the possibility and a reminder of the

fact that other conditions can look just like this. Ah, so you're

Scott Benner 1:01:48
tricking them into doing their job that they are somehow stuck in can't figure out how to do I love language? I really do. I think sometimes I get done an episode of this show. And I'll listen back when I'm editing and think, like, I'm proud of myself how I got someone to something without telling them to go to it or, or fooling them into understanding it, but just sort of asking a question that makes them then think about something different, and then see where it leads them. And that's really what you're saying, you're somebody gets stuck on this idea. This guy, he odd, odd, odd drunk or whatever. And you start, you just kind of break that you break that, that pattern he stuck in, or he or she or stuck in, and then you you get them thinking about something different. That's kind of brilliant, and simple, isn't it?

Ginger Locke 1:02:36
Another pitfall is that we forget, it can sometimes be two things. And so it could be opiates in this case and diabetes the patient could be having experiencing both, right? And that's probably one of the harder things because we love the binary, it's this or that. And

Scott Benner 1:02:55
it's like the most human thing. Pick one who wins either or black or white. Be both. Can I not be high? And my blood sugar be low? No, he's a good guy. It's his blood sugar.

Ginger Locke 1:03:07
Yeah, yeah, no, no, I hear that. Once we once we find the cause that there's something called the I think it's called the second fracture phenomenon where, let's say you, your arm hurts, and you've been in some type of car wreck and they find a fracture in the arm. They're like we've done testing, we found the cause, well, sometimes there's a second fracture that gets missed on the X ray, that they just don't see because they think they found the cause. So same for

Scott Benner 1:03:33
this. No, it's almost like anecdotal evidence, like you feel like you've got the answer. So you stop wondering, gotcha. This is excellent. And now it's making me if I can make me wonder if I can get Jerome groopman, the author of How doctors think they come on the show. Because that's, I think, this that this specific thought translates into people's personal doctor's visits. Oh, yeah. You know, when you get into the room, and you realize, like, you've got this whole thing figured out, and they don't see it that way. And then you just sit there feeling defeated. And instead of another one,

Ginger Locke 1:04:02
as you're saying that another one I've used with my own doctor, is I'll say, How do we know it's not x? Right? So I have asthma sometimes. And I'll say to my doctor, how do I how do we know it's not pneumonia? Or how do we know this isn't?

whatever other respiratory disease? Yeah, and

Scott Benner 1:04:21
you're not asking so much for him to tell you how he doesn't know you're asking him so he'll think it through again.

Ginger Locke 1:04:27
Think of all the tests that might need to be done or not done.

Scott Benner 1:04:30
Yeah. Damn, ginger, you're pretty smart.

Ginger Locke 1:04:32
This sneaky.

Scott Benner 1:04:35
By the way, you live in the part of the country that I often tell my wife, we should run away and go live there. But I guess other people think that too. And you're probably all very sick of us coming there. So I won't say it out loud.

Ginger Locke 1:04:45
But well, you're very welcome to come.

Scott Benner 1:04:48
Thank you. I'm looking for lower humidity. Not so much snow. Is this the place or no,

Ginger Locke 1:04:52
there is pretty low humidity and definitely no snow. I'm

Scott Benner 1:04:55
on my wife's. Alright, just give me your address. And I'll just I'm gonna pack up right now and go Because I am tired of the snow, and I am tired of sweating just because it's June. So I'm done with it. Now, I don't mind a dry heat. I just don't want to be wet. While it's happening, you understand? Hey, tell everybody about your podcast.

Ginger Locke 1:05:14
Sure. It's called medic mindset. And what's neat is it started as a podcast for paramedic students, but the paramedic started listening. And then I got some medical directors who are emergency medicine, physicians listening. And so suddenly, emergency medicine kind of residents or med students started listening. So it's, it's expanded to, to reach beyond kind of its original intention. And it's, it's, I really spot one episode a month, something I really enjoy just talking to paramedics or people that work in emergency medicine about how they think through problems, errors they've made, why we you know, kind of the cognitive theory about why they may have made that error.

Scott Benner 1:05:54
That's very cool. Isn't it interesting how you start something like that, and then it grows, and it finds other avenues to help people. And like I told you at the very beginning, I started this podcast because I thought my blog was kind of dwindling, because people stop reading. And it's got millions of downloads now. I love that crazy, isn't it? Like I just I love that it helps people and it was just a very unexpected treat, I guess at how well it worked out. Um, so I'm really glad for you. And I'm gonna I'll put a link in the show notes. And and hopefully there's some people listening to this that that might come over and check you out too.

Ginger Locke 1:06:28
Nice. Yeah. Thank you so much. You're welcome. Thank

Scott Benner 1:06:30
you for being By the way, as we're as we're wrapping up here, thank you for being how you are, because I just was at my son's baseball game one day. And I decided, like, I'm going to get somebody on to talk about this who, who's got a podcast that talks about this stuff all the time. And so I'm have my headphones in, and I'm sitting in a chair under some shade, because like I said it was human. And I'm like, like, oh, here's one I tried listening a couple of people in there, you know, but I got to you and you were measured and thoughtful. And you had a nice clean microphone, I could understand you and then I started reading like reviews. And then I just started listening to an episode and I was like I would like it if this person was on my show. So you want out I didn't just like I didn't throw a dart at podcasts about this I really listened and I think you're doing a really great job not that what I think means much But

Ginger Locke 1:07:20
no, I appreciate that. It actually means a ton because

your podcasts yourself so you know kind of what you value in and talking to you what this has done. I was hoping to get to hear more about your daughter and your journey. So what this has done is made me now I want to go back and and hear your previous episodes.

Scott Benner 1:07:37
Oh, cool. Yeah, I do everything so that people will listen, everything's just a carrot on a stick to get you to download my show. I need listeners dammit. Keep listening. Tell people. No. But But seriously, I appreciate that. I'd be happy to tell you more about it. But I know we're up on time. And I you have children who I think at one point I heard outside going Hey, when's this over? So go live your life. And thank you very much. And I really I can't thank you enough. This was wonderful.

Ginger Locke 1:08:05
Thanks, guys. I appreciate you

Scott Benner 1:08:06
having me on. Oh, absolutely. Hey, huge thank you to ginger for coming on the show. And thanks so much to Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. You can go to my Omni pod.com Ford slash juice box to get a free no obligation demo of the Omni pod tubeless insulin pump. And to learn more and get started with the Dexcom g six go to dexcom.com Ford slash juice box. And please don't forget to visit touched by type one.org there are links to all of the sponsors in the show notes of your podcast player and at Juicebox podcast.com.

Would you like to hear more from Ginger? Check out medic mindset wherever podcasts are available. Or go to medic mindset.com her shows available on Apple podcast Spotify everywhere that you listen to this show. You can listen to ginger and medic mindset

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#386 Podfather

The Pod Father

John Brooks is the father of a type 1 diabetic and the guy who developed the Omnipod.

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

+ Click for EPISODE TRANSCRIPT

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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 0:08
Hello friends and welcome to Episode 386 of the Juicebox Podcast. Today, I bring to you a conversation with john Brooks, one of the men who sitting on an airplane over 20 years ago, conceived of and dreamt about, for the very first time, a tubeless insulin pump. Eventually that pump became the Omni pot. And this is the story of how it came to be. John's the father of someone who has type one diabetes, and

Unknown Speaker 0:39
he tried to figure out how to help

Scott Benner 0:40
a long time ago when his son was diagnosed. This is what came of it. It's kind of crazy, right? While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan, or becoming bold with insulin. John's actually been involved in a lot of things around type one diabetes, we'll talk about all of it. But my initial reason for having him on was to learn about the birth of the Omni pod. An interesting idea, isn't it? Just something didn't exist? And then it did.

Hey, if you're looking for a great way to support people living with Type One Diabetes, while you support the podcast, go to T one d exchange.org. forward slash juicebox. And join their registry, you'll answer a few simple questions about you or your child who has type one diabetes. And those answers will help support innovation in the type one world. It's that simple. It's completely HIPAA compliant, absolutely anonymous, you can opt out at any time. And it takes less than 10 minutes to complete right there from your phone, or your computer. T one d exchange.org. forward slash juice box. This episode is also sponsored by touched by type one. Good a touched by type one.org. To learn about an organization that is doing an incredible amount of good for people living with Type One Diabetes. Touch by type one is also putting out there good stuff on Facebook and Instagram. As a matter of fact, I believe the founder of touched by type line just had a beautiful little baby. So if you're interested in seeing cute little babies definitely hit up their social media touch by type one.org. Do you have a great doctor or need one? Check out juice box docs.com. It's a great list of doctors who have been suggested by the listeners of this podcast. The doctors that get it when you want to make adjustments to your insulin, but don't want to just do you know what everybody else does. juicebox docs.com leave a name. Take a name. If you're looking for those diabetes pro tip episodes to share with a friend. It's easy to get them to download an app I guess and say hey, started Episode 210 that's where those diabetes protests begin. Or you can just send them to diabetes pro tip.com. And please help me welcome a brand new sponsor to the weekly shows. g vote glucagon. In the next few episodes, you'll begin hearing about yoke. Arden has already got it at home. We've got the hypo pen, and it's the bomb diggity. The absolute minute I heard there was a new glucagon that did not have to be mixed. I wanted to know more. You can learn more at GE Vogue glucagon.com forward slash juicebox ge vocus GVOK eat glucagon classic way gl ewca. And that might have been wrong. glucagon. Dear God, are we gonna get involved in spelling glucagon right now? All right. GVOKEGL Uc, ag o n.com. forward slash juicebox. Or you could just you know, use your own brain instead of mine and just type it out. g vote glucagon.com forward slash juicebox. Welcome to the show, g Vogue. T one t exchange.org. forward slash juicebox. And of course, touched by type one.org. Check them out when you have the time. I appreciate you doing this very much. I've often wondered about you, not knowing who you are. And I thought this is an interesting time to get your, your thoughts. I mean, if I'm not wrong, right, it's not 20 years since you started the company, right?

John Brooks 4:55
Yeah, it started instantly. In fact, it's funny I was just on the phone like 10 minutes ago with, you know, my co founder and partner at prism, Dwayne Mason's. So we were just literally talking about that 20 years ago, 20 years ago in May 2000.

Unknown Speaker 5:11
Yeah. And now

Scott Benner 5:12
everything is getting ready to. I mean, I don't know how to think of it, they're gonna take the thing you guys made and supercharge it, right. Like, it's, it's getting ready to take a leap, don't you think?

John Brooks 5:22
Yeah, well, you know, I think, you know, if you think of the world that, you know, we started in, it was a device, right, a glucometer. You know, that? Well, a glucometer, you know, was then gonna drive an insulin pump. And now you look at it, you know, it's the whole closed loop, it's the automated insulin delivery capability. But I think what's most important is the fact that it's less about the device, it's really the data, and it's the use of that data to drive better decisions, better clinical outcomes. And I think, you know, with COVID, and the way healthcare has changed, you know, people want to be able to kind of get health care in their terms, you know, they don't want to feel like they have a job to manage your diabetes, but you know, the more of the burden we can take off of them, they want in today's environment, you know, people are more prone, they don't want to go to the doctor's office, they don't want to go to the clinic, they don't want to go to the hospital, you know, that they want to be able to, you know, get help and coaching and support for managing their diabetes, but on their terms, and, you know, I think that's the beauty, whether it's insulin or others, I mean, you know, really leveraging the data, the analytics, the ability to basically determine, you know, trends to be able to look at time and range to be able to look at, you know, where there are any hiccups, or, you know, risks of hypoglycemia. So, you know, it's kind of the evolution of healthcare that, you know, if there was a silver lining to COVID, its accelerated, you know, all this virtual care, remote care, connected care, you know, much faster than, you know, it would have happened on its own, it was pretty, pretty slow. And now it's, you know, changing dramatically.

Scott Benner 7:08
So in the beginning, really, the, it's about, it's a tool, and the tool is the whole, it's the whole story. And now really, the tool is just the way you take the data and and make the decision. And then you don't have to go back to the doctor who would look at whatever data you had, whether they were finger sticks, or log books or CGM graphs, as time goes on, and say, Look, I think you should turn this knob here make this small adjustment. Now the data kind of understands that for you, I guess.

John Brooks 7:34
It's Yeah, I mean, you know, it's pretty much I don't want to say autopilot, because we're not quite there yet. But the idea is that, you know, the algorithms, you know, the systems get to know you, they get to understand, you know, kind of what, you know, what you do, a lot of people tend to do similar things day after day, whether it's their eating or whatever. So at the end of the day, you know, the devices are going to become smarter and smarter and more predictive. And they'll try to determine not only what the right insulin dosing is, but, you know, based on your prior history, you know, based on what they've been able to track, you know, they can almost anticipate, here's what's going to happen, and, you know, kind of get ahead of the curve. So, you know, I think it's the power of AI, it's the power of analytics. And then to your point, you know, you know, in the early days, I remember at jocelynn, you know, you'd have doctors having to look at, you know, printouts from all the different flavors of bgms, there was, you know, a few folks on CGM, you know, you had some ability to download data off of a pump, but none of it was connected, none of was integrated, none of it was aligned, you know, there was no even understanding of the dates on all the devices were the same. And obviously, everything got shifted every twice a year when there was daylight savings time. So, again, I think we've come a long ways and, you know, more to go because, you know, the sad part is, despite a lot of great technology advances, you know, we still do not have enough people with diabetes, especially people on insulin, you know, meeting their objectives, you know, getting their time and range. I mean, you know, and again, I think it's an appreciation that, you know, despite the fact we're making advances, you know, there's more to you know, managing diabetes and just tracking blood sugars, you know, standing now more about stress, understanding more about sleep habits, understanding more about, you know, the food, we eat, nutrition, and even the whole behavioral mental health aspects of diabetes. So, so the good news is, you know, I think we're getting smarter. I think we're getting there. But you know, like anything else, it just doesn't happen overnight. Yeah.

Scott Benner 9:50
Well, let's kind of walk down memory lane for a second. So tell me a little bit how you How did you come to this and like you were saying before, like, I guess that kind of Concept wasn't as much about the pot at first as it was about, just take me to the beginning, like, what were you doing when this happened? Yeah.

John Brooks 10:06
So, um, if I kind of walk back 28 years ago, or then three year old son was diagnosed with Type One Diabetes, okay. And certainly, you know, no real, immediate family history, you know, I didn't quite understand how that came about. And we were living in Colorado at the time, I was working for Pfizer, on their device business. And, you know, I decided that, you know, I need to try to understand, you know, diabetes, both type one and then eventually type two. So, you know, as my career and life advanced, you know, diabetes was always an important component. And, you know, when I, you know, when Pfizer ultimately divested themselves from all the device businesses, they were in, I came back to Boston, I was a co founder of a venture capital firm, called prism, venture partners. And, you know, that's really what I said, in the early days, you know, you know, we were looking at, I was looking at, you know, companies that we're trying to work on, you know, non invasive glucometers, you know, people are trying to work on, you know, how to determine glucose, you know, in a very effective way. And, you know, and then, you know, as I said, you know, a little more than 20 years ago, you know, my partner and I were on a flight coming back from the west coast, and I was describing, you know, the challenges with, you know, trying to figure out insulin insulin delivery, and, you know, the problem with the existing, you know, pumps as they were back then, you know, with the tubing and the priming and the all the issues, and, you know, we kind of brainstorm that entire five hour flight, you know, and thought about, you know, how do we come up with a, you know, small, disposable insulin delivery system and the disposability happened to come out of a nother deal that we had done leveraging technology out of Sarnoff Corporation, which is where the RCA color TV was invented, if you will, and they had an interesting technology for a disposable hearing aid. And, you know, that's another whole story, I won't get down there. But, you know, we had the idea that disposability could be a very disruptive innovation, the idea is that every three days, someone puts on a new pod, you know, we knew we could, you know, hopefully do that in a very cost effective way, eliminate all the problems with the two meeting and the priming. And so you know, that that's kind of where the idea came from. And, you know, we got off the plane, the next day, we called up our patent attorney and said, Hey, we have this idea for a disposable insulin delivery system. And he said, Hey, no one's ever thought of that. And, you know, we got a whole bunch of IP, and then we went to our, you know, fellow partners in prison and said, Hey, we want some seed money, to kind of flesh out this idea of get it off the ground. And, you know, we did that. And, you know, we hired some people that had worked for us beforehand, we set up shop up in Beverly, Massachusetts, had a couple people and pretty much told them, you know, in the early days, just think about all the ways you can do this, think about all the ways to create an IP position, you know, and then little by little, we, you know, had more ideas, we had more IP, we had more prototypes. And then, you know, we went ahead and started to, you know, put together a management team, you know, build on the engineering team, and, you know, little by little, we brought other investors in, and, you know, here it is what, you know, 20 years later, you know, very successful in a multi billion dollar market cap company that, you know, continues to drive innovation, but that, that was kind of the germination of it. And then, you know, as I said, you know, and most of my career since then, you know, continues to be very heavily involved in diabetes. I had the opportunity, I guess, was probably about eight almost nine years ago to run the Joslin Diabetes Center as CEO. So, you know, somewhat unusual to have a fellow that I'm a UMass Amherst, graduate, undergraduate, and accounting, finance and systems. So, you know, you can see I learned enough over the years to be dangerous to be able to run a leading academic and medical research Education Center. But again, you know, it was part of, as I said, 28 years ago, I was bound and determined to try to understand, you know, how did my son get diabetes? And, you know, is there an opportunity to think about a cure and then, you know, as I get further involved, you know, came to appreciate that, you know, certainly type one is a challenge, but, you know, the whole epidemic, you know, I used to call it a pandemic of type two diabetes. with, you know, close to 400 and 60 million people around the world. So, anyhow, I could go on and on. But no,

Unknown Speaker 15:05
it's amazing how it came about.

Scott Benner 15:07
I'm wondering how, how long after you, you you take that plane ride? Are you holding a prototype?

John Brooks 15:14
It's a good question. Um, it was probably, yeah, I want to say probably nine months to a year, I mean, because, again, we spent a lot of time I mean, you know, we probably had some drawings and ideas, but, you know, we wanted to really think about the intellectual property to make sure we had a good patent position, you know, we wanted to make sure that, you know, we had a clear understanding that whatever we did, you know, we needed to have a, you know, kind of a novel way to engineer it, because, you know, most pumps have a motor. And, you know, you're thinking, if we have a disposable device, that, you know, we said, Hey, this thing's gonna have to, you know, cost less than, you know, I think it was, I don't know, maybe 15 $20. You know, and we said, well, you know, if you put a pump in there, you know, that's not going to do it. And then, you know, we thought about how to, you know, basically deliver very precise amounts of insulin. And in fact, kind of interesting enough, you know, we went back to sawn off and said, Hey, here's our problem. And they actually come up with the idea of a heated wire, which basically, is the mechanism that enables when you heat the wire it, you know, stretches and shrinks, and that ended up being kind of the mechanism to deliver the insulin very precisely, and in a very cost effective manner. So lots of, you know, as I said, I'm sure we have prototypes and ideas along the way, but, you know, it was more important to make sure that not only did we have a great design, did we have a design that was really gonna, you know, work, especially for kids and others. You know, we used to call it hassle free. So we didn't want priming, we didn't want to being, you know, we wanted to have a very easy way for the canula to get placed. So you know, it was iteration and it took, you know, it took a while, and then you got to figure out, you know, how to really make sure it works, you figure out what the regulatory requirements are? How do you make sure how we get the insulin in? How do we make sure that, you know, we can communicate, so, you know, lots of lots of steps along the way. So it doesn't happen overnight, and I took a really long process it were

Scott Benner 17:27
there points along the way, where you thought, we'll just get this to a certain point and sell it to somebody else. Did you ever think you were gonna be the company that made the pumps and sold them?

John Brooks 17:37
Well, I, you know, I think we did, you know, you know, we thought, Hey, this is a very, you know, novel idea. And, you know, we felt good about, you know, as we did some early interaction with, you know, customers and focus groups. And we had, I think, from the very beginning, you know, thought about the fact that this was the type of product that would lend itself to high speed automation. I mean, we actually thought, you know, at the time, we had set shop in trying to think where we were Bedford, I think, at the time, and after we left Beverly, where we started, and, you know, we had the idea, hey, we're gonna have a light sound factory, all these pumps are going to put to be put together by robots. Right, you know, and, you know, and then, you know, in some ways you go full circle, I mean, a lot of what takes place today, both in this great new factory that insulin built up in Acton, you know, a lot of automation, you know, lots of ways to produce, you know, massive numbers of pumps that are high quality. But you know, the answer your question, you know, I think we always stopped that, look, you got to build a great company, and maybe along the way, is someone likely to look at it. I mean, you know, what a Medtronic would somebody else say, Hey, this is interesting, but, you know, at the end of the day, I think we said, let's, let's do this, and I remember, you know, some of the greatest moments, you know, when I was a jostling member, we had a lot of Jocelyn had the Joslin camp for boys out in Oxford baths, and it was right next to the camp for for girls, but you know, seeing all the kids, you know, with their pods on swimming in the pond, I mean, that was pretty neat. Because before that is you know, you know, you're gonna disconnect your pump, you're gonna take it off, you know, you can't get it in water if you're using a traditional, you know, to pump and all so, you know, so I think we were always motivated by the fact that hey, this is a better way to help not just kids but families and people that want to get insulin and you know that they want to do it in a way that you know, it's discreet, it works for them. And they don't have to worry about all the hassle that you know, some of the other two pumps, you know, have gotten better but still exists.

Scott Benner 19:57
You know, my daughter has been wearing it on the pod every for 13 years, so, I'm completely aware of the just the benefits of just having your basal insulin while you're in that pond, you know, so amazing as before,

John Brooks 20:10
you know, kids would take the pumps off, and you know, it's a hot summer day, and maybe they even put them under the towel. But you know, the pumps are getting warm, and you know, maybe they're not wearing them for a certain amount of time. I mean, at the end of the day, that's just not good therapy. Right. Right

Scott Benner 20:25
now, it's 100%, I actually, I, I've been through the new manufacturing facility, I've taken that it's amazing, right? It's unbelievable, just astonishing what they accomplished. And, and watching it happen. And like you said, like, you know, things are kind of moving around automatically. And it's, it's not, and I don't think the precision is, is considered like, I want to try to understand without getting too like geeky and technical, you're telling me that inside of that pod, there's not a pump sending the insulin through the kanuma? It's,

John Brooks 20:57
yeah, so it's basically a mechanism that emulates a pump, but it's not a traditional pump with a motor and all. So, you know, so it's a different approach. And, you know, and I'd say, that's really the other, you know, key thing about, you know, being able to produce the number of pods that are needed, you know, where, you know, replacing them every three days. And so, you know, I think the other important thing was to, you know, put a lot of focus on dimensions, tolerances, the tooling, I mean, you know, that this is a product that, you know, that the tolerances are critical, the, making sure you're working with the right vendors, the vendors deliver the right product, and, you know, because we did have, you know, in the early days, you know, there was always a little bit of a concern about, you know, could we, you know, batch the batch consistency, you know, in the early days, we used to joke, we were shipping dollar bills with every pump, you know, because we didn't have the volume, we didn't have the scale, we didn't have the full economic benefits. So, but, you know, that's part of the learning curve. And then when we, you know, that they went to a generation to, you know, which was smaller, more precise, and more, you know, kind of cost effective, you know, that there were some hiccups in the early days, when, you know, you know, things don't quite go the way you expect, then, you know, you just kind of work through them, and hopefully, you know, convince your loyal users that, you know, Hey, sorry, and, yeah, we'll send you some replacements Hang in there. But, you know, the good thing is, I think that's all behind the company now. And I think now they're focused on, you know, kind of what I'd say is there, you know, Gen five product, they've got dash, they've got horizon. I mean, there really, as I said at the beginning, you know, recognizing that it's no longer just about delivering insulin, but it's the context of you know, doing it in a way that understands how that individual was living there live understanding, you know, kind of what their you know, smart CGM and other devices are saying and, you know, optimizing, you know, what their requirements are, so they're staying in range, they're avoiding hypose and hyper Roisin in their care team can continue to kind of fine tune, you know what they're doing. Did you

Scott Benner 23:23
are you still involved or did you eventually sell your share? Or how did how does that

John Brooks 23:27
Yeah, so when I went to the Joslin, you know, I just made a conscious decision. I think it was certainly the right one. You know, maybe not economically, but I i divested all my shares I you know, I just because we were doing some things and, you know, if you're the CEO of a not for profit with the prestige of Jocelyn, I just didn't want to have any perceived conflicts and also, right. So, you know, I'm happy to say today, I'm still an owner, but, you know, I pretty much you know, divested everything for the five years that I was running Joslin, I say, okay,

Scott Benner 24:03
Oh, alright, that's what we wanted the president to do, that he didn't do is that we were saying that that whole, like, you just sort of take yourself not to be political, but you.

John Brooks 24:11
Look, it's the right thing to do. I mean, you know, if we were doing some work, maybe some of the doctors at Joslin, which they were were doing different, you know, studies or, you know, clinical trials. Yeah, you could argue, well, I don't have anything to do with that. But it's appearances and it's really good governance. And frankly, you know, I think it's just having a good moral ethical compass. So, you know, was I going to influence results? No, but you never want to have even the suggestion of impropriety. And I just said, Look, this is the right thing to do. Right? That's excellent.

Scott Benner 24:45
Oh, that's very cool. So you're still you're still involved that and you're so you're an owner at this point still?

John Brooks 24:50
Well, I'm a shareholder share with you know, a small one. Other people yeah, there's

Scott Benner 24:55
you're saying somebody else is listening. This right now going? I have way more than john does.

Unknown Speaker 24:59
Yeah.

John Brooks 25:01
I'm sure every major, you know, you know, public equity fund out there, you know, mutual funds, but now I'm happy to, you know, be involved that in, you know, full disclosure, I have a stock holdings and other you know, diabetes companies because, you know, you know whether it's on the CGM side or it, you know, looking at pumps in and I work with, you know, a lot of young companies that are working on, you know, what I call the next generation solutions, whether it's new new insulins, whether it's a new type of CGM, there's some companies working on, you know, new pumps, the company's working on defeating the auto immune system, companies working on you know, better real time insulin type tration, and people with type two, so, about 80% of what I do, you know, these days is still, you know, helping, especially young companies, and I'm either doing it as the chairman of the board, board member, advisor, consultant, you know, trying to make sure that, you know, what I've learned over the years, and, you know, how can I help them turn themselves into a successful company that is going to further help people, you know, with type one or type two to, you know, live better, healthier, safer lives? That's cool.

Unknown Speaker 26:18
How old's your son now?

John Brooks 26:20
My son is going to actually turn 31. Next month, so just a few weeks away, he works for this company called livongo. I know Yeah, sure. heard of them. He was literally one of the very first people there. In fact, he was with the predecessor company called EOS health. So he's based out in Chicago has been with them, you know, I guess it's been eight years. And, you know, he manages their sales effort in the Midwest. So I guess he's had another, you know, I think, opportunity, he has type one. But, you know, he devotes a lot of his time to, you know, help lavon go get, you know, solutions for self insured employer employees who need help with diabetes, and now they're moving into hypertension, weight management behavior, et cetera, et cetera. And, you know, they went public, and now they're, you know, being acquired by teladoc. So, he's keeping busy, but he's pretty excited that he made a good career choice when he graduated from college, I have

Scott Benner 27:26
to ask you, I'm not sure where you're gonna go with this, but does he wear an army fine.

John Brooks 27:31
So he doesn't, you know, it's interesting,

Unknown Speaker 27:34
all this effort that you put into it.

John Brooks 27:37
But you know, at the end of the day, and I'm sure you might even know, with your daughter, you know, what, you know, it's their live, it's their decision. And, you know, and again, he, he's always been a fan. He's talked about it, but you know, just one of those things where, you know, I don't know why it just didn't fit his schedule, or didn't have the time. So at the end of the day, he may, but you know, today, he's not on it, but it's not a sign that he doesn't believe in, it's just, you

Scott Benner 28:07
know, no, I don't think that hey, listen, on the pod has been a sponsor of this podcast for since the beginning for many, many years. And I always tell people, the same thing, get a demo pod, try it for you, or it's not, it's you know, there are other insulin pumps, you could you could do MDI, you know, get an in pen, there's 1000 things you could do. Yeah,

John Brooks 28:28
the real, the real key is to, you know, use a use technology in a way that works for you. You know, and obviously, you know, whether it's a you know, CGM with a pump, and you know, the idea of this, I think people realize, you know, that, you know, all of a sudden, they're, their lives are better. They're, you know, they're in range. They don't have the glycaemic excursions and, you know, and it fits into their lifestyle. So I think that's really the key, we get up. You know, I do some work with the ADA. And, you know, we had a discussion recently with insolate. Just, you know, kind of getting to know each other up. Bob gubbay is the new chief medical officer, Chief Scientific Officer for the ADA, and he was on the call, I had hired him at Joslin, so he, he's a great person, but the whole idea is essentially just, you know, I think an appreciation that, you know, people that have been on MDI, you know, maybe just thought luck pumps are too complicated. They look like they're, you know, not going to work for me. And, you know, obviously, you know, I think once to your point, they try them. Also, they realize they're pretty straightforward. And, you know, and I think, you know, companies are sensitive to making sure that, you know, they're affordable and, you know, that they work for people. And again, I think the payers, you know, the insurance, I think, you know, understand that they're cost effective. I mean it wasn't too many years ago where, you know, you had to jump through hoops to justify Someone get a CGM or even a pump, you know, but, you know, the good news is the data is there and the values there and, you know, the world's, you know, continuing to evolve.

Scott Benner 30:10
What was the most difficult if there's one difficult part of getting the AMI pod to market? Was it the, the function of it and the mechanics of it? Or was it the FDA? Or is it insurance? Like, I guess?

John Brooks 30:26
It's a good question, you know, part of it, you know, I would say is just, you know, a disposable pump, you know, took a little while for people to get their heads around that I remember, we had some people saying, that's a stupidest idea I've ever heard of, I think the regulatory path, you know, we went through it, but I think, you know, I'm, you know, I spent years you know, kind of, uh, you know, working at Pfizer, you know, really a lot of device companies, you know, I do a lot of biotech and other things, but, you know, still know, the device base. But you know, my partner Duane knew that. So, you know, I think the key is, we weren't all that concerned about the regulatory, a big part of it was reimbursement. I mean, you know, you have to go kind of payer by payer across the country, you know, we kind of started in New England, and, you know, kept going west, to get payers to agree, you know, because it's a different approach. I mean, everybody else, you have this upfront investment for the pump, right. And then you have all the disposables. And in our case, you know, we were kind of turning that upside down, you know, it's really a subscription model effectively, and trying to get, you know, payers to understand that, how did it fit into their reimbursement, you know, even the federal government, you know, would say, you know, if you're on Medicare, you could only get, you know, one pump every four years, well, if you're getting a new pump every three days, and, you know, just things like that, I mean, sometimes the way the reimbursement was set up, but just, it didn't understand that, hey, this was a very different form factor, economic value proposition and, you know, you had to get people comfortable with and, and then they had to understand, you know, at the end of the day, you know, if you looked at it over four years, you know, versus the cost of a traditional pump, you know, they're pretty comparable, but, you know, when you're first starting off, you know, people there will, how does this work? And that's not the way we do it, and, you know, so that there was just a lot of, you know, pioneering and, you know, I think the other part of was just, you know, understanding the manufacturing, you know, despite the idea that we thought it would make sense to have this great lights out factory. You know, we realized that, you know, we needed a different solution, in fact, you know, ended up getting involved with Flextronics, you know, and, you know, leverage their expertise at high speed automation, and, you know, ended up setting up some, the supply chain, you know, generally in China, because, you know, we wanted to, you know, make sure our economics worked. And now, it's ironic, it's kind of coming full circle, back to the US, but so, you know, getting that manufacturing and getting the cost of goods sold was something that we always, you know, spend a lot of time on, because you don't, you know, you don't have a good business, if you're, you know, losing money on every shipment, but you've got to have the volumes, you have to have the, you know, sufficient economics to support, you know, getting the cost per unit down. And so that took some time.

Scott Benner 33:34
Who's gonna say, even understanding, hearing you talk about having to go state by state and explain to payers like, this is how it's going to work. And, yeah, I know, this isn't what you usually do. But this is this. I've had those conversations for my daughter, and back in the day, you'd have to get on the phone. Every time you reordered and say no, no, listen, listen, I know we just got a pump. That's not when then you'd have to re explain it to somebody was fascinating how many times I've done that.

John Brooks 34:00
Yeah, no, and you know, the if you think on the CGM side, I mean, you know, I remember in the early days, you know, payers reluctant to allow someone to have a CGM a reimburse them for it, you know, because if their numbers are in pretty good shape, you know, they say, well, you don't need a CGM. Or maybe you don't need a pump. And then the whole idea was, well, you almost had to have people deliberately, you know, mess up their diabetes management for 30 days to show that while you're not in good control, therefore you should get on I mean, if you think of the absurdity of that, yeah, but you know, that was part of it. And, you know, we used to have a lot of our great doctors that Jocelyn I mean, spending more time on the phone with insurers, you know, and even silly things like you know, why does someone with type one Why do you need to check your blood sugar's whether BGM you know, eight times a day what just do a two dads What are you doing? I mean, just absurdity.

Scott Benner 34:57
Ya know, the lack of understanding it permeate pretty much.

John Brooks 35:02
You know, type one versus type two. I mean, you know, a lot of people just still don't fully understand, you know that. Yeah, it's diabetes. But you know, it's a very different mechanism. It's not like if you have type one, avoid sugar, you're going to be great.

Scott Benner 35:16
It's I just was speaking with a person last night Whose child is more newly diagnosed. And this podcast, john, which you probably don't know anything about, I take great pride in it. It explains to people, among other things, how to use insulin, and my daughter is a one C with the dex comment on the pod is between five two and six, two for over six years. Now, she has a great diet restriction. She's doing terrific. I talked about what we do here, it seems to get to people in a way that they can understand it and replicate it for themselves. So I'm talking to this person, and she's like, I don't understand, why does my endocrinologist not understand? Like, why am I talking to you? And not her? And I said, I don't know. I don't I don't know what to tell you about that. But it just, it's what you it's what it made me think when you were talking through it, that most people would hear this and think, well, how could an insurance company not understand what diabetes is? or How could you know? And the answer is, because people don't, you know,

John Brooks 36:12
I mean, they, you know, and again, nothing against the people there. But, you know, anytime you bring something new or a different business model, different approach, you know, it doesn't kind of fit the traditional, you know, scheme, and you got to educate them, and you got to do the analysis, and, you know, uh, you know, they just tend to be a little bit change resistant, right?

Scott Benner 36:35
Yeah, you fall into something that you're comfortable with. And it works, whether you're a company or a person, and you stop being stop having reasons to wonder about other ways to do things. So exactly, you come along with this little pod, and you're like, Hey, listen, this is the way to go. And

John Brooks 36:49
that's like, what do you mean it after three days and throw it away? Like, why are you throwing it away? Right? That's designed that way. That's what it's for. Exactly.

Scott Benner 36:58
It really is. So if you if you can't say or you shouldn't, I'm not sure. But I've forever want to understand, while you know, you get your pot out, you fill it up it Prime's take off the needle cap, you put it on, and you say Go ahead, insert it, and then there's this clicking that is sometimes four times it clicks, sometimes it's five, sometimes it's six, and then, you know, blink of an eye, the candle is in, in my estimation, it's always been that something fires. A needle that's wrapped in a candle and the needle comes out leaves the candle behind, but is it not functionally firing? Is it tension? How does it do? Are you can you tell me how it does that?

John Brooks 37:40
Yeah, you know, I don't know what it does today, it's probably different than it was. But, uh, but I think your points accurate. And the whole idea was to get rid of needle phobia, to be able to have a very simple way to your point to deploy a Candela, you know, with a needle that would place it properly, and then, you know, disengage itself. So all you had was the candle lit to deliver the insulin. So yeah, I mean, I mean, I don't want to speculate, because I'm not sure how it works today. You know, the idea was to basically, you know, deliver it in a way that, you know, it would get into the skin at the right level, you know, and, you know, not caused any bruising or hypertrophy. I mean, there was a lot of work that went into the, you know, the needle design and the, in the shape and the insertion, pressure force, whatever you want to call it. So, but yeah, I'm probably, you know, it's been a while since I've looked inside one, it prompts me, I probably have an old one around here, I should look into

Scott Benner 38:38
I'm now wondering about the the day in the office where somebody was, like, I put it on me and push the button, and let's see what happens. That's how many how many people do you think in total? Were there in the beginning?

John Brooks 38:52
Well, in the very beginning, you know, there were two of us on an airplane. Right. But then, you know, we ended up as I said, we we had a team, we were up in the Cummings facility in Beverly mass, you know, after we have put our partners that put some seed money in, you know, we hired a guy that, you know, really brilliant in terms of, you know, just looking at the entire intellectual property landscape, you know, were there any other patents? Was anyone else doing anything? You know, and how would we, you know, think about creating the product? How would we think about, you know, what type of plastic what type of, you know, materials, you know, we thought a lot about, as I said, quote, unquote, the pumping mechanism, we thought a lot about the canula and the insertion mechanism, and, you know, what the battery life is and how to make sure that, you know, those accuracies, so in the early days, you know, was a bunch of really bright people, probably more engineering, you know, you know, folks had new devices, folks and new IP folks that understood we had to be able to make this thing very cost effectively and You know, you're kind of designing it and building it on the fly. And, and then, you know, we reached the point where, you know, I think we felt we had a good plan, we had a good business plan, we hired a fellow as our CFO who eventually became the CEO Dwayne to Cisco. And then, you know, we, as the company advanced, you know, we brought more money in, we brought in other venture partners, our our team continued to support it. And then, you know, we ended up getting, you know, new space, we left Beverly in, you know, we started to hire more, you know, a larger team, you know, in terms of, you know, recognizing that, you know, what do you need to have in, in, in addition, engineering, you know, you got to have people that are, you know, working on the supply chain, you got to have people that are working on, you know, understanding the whole regulatory process quality process, you know, starting to think about reimbursement starting to think about, you know, packaging. So, you know, you start building a team, and, you know, that took place over you know, a number of years, we go from kind of a, an idea that we had to you know, starting to think about, you know, what it should look like and again, just simple things, like, you know, what type of plastic and what type of plastic you're going to mold and what's the shape? And how much stuff can you fit into it and still have it work, but not be too big. And, you know, just lots of, you know, iterations that you know, you get a team and then you start getting people thinking about, how do you market it? What are we going to call it all that stuff, right? You know, in the early days, we used to call the op,

Scott Benner 41:42
it must be crazy to be a startup in a space that is, like, you know, pharma and device manufacturers, like bigger companies like Indy, you're sort of just these, your two guys coming off a plane and putting together things, by the way, the company still has a really good vibe, you know, throughout it, you can tell what the, as you're explaining what the roots of it are, it doesn't surprise me. Because I think it's grown in that direction.

John Brooks 42:07
And it's pretty neat. I mean, every now and then, in fact, at the last Ada meeting, not the virtual one, but, you know, My son was with me, and, you know, we were kind of walking the floor and, you know, went by the booths. And, you know, it's kind of one of those funny things where, you know, a couple of people start putting the dots together, wait a minute, you're the father, You're the son, I mean, yeah, you know, all sudden, they realized that, you know, we were kind of the, you know, that the, you know, My son was the inspiration and, you know, I was one of the co founders, every I kind of needed it, and again, you know, still having that, you know, you could call, you know, kind of that entrepreneurial spirit and, you know, really thinking, you know, what, I always like to think of disruptive innovation. And, and again, you know, I spent, especially back in those days, you know, most of my career was in the device world, I, you know, had ran a couple of businesses for Pfizer, and one of them was actually a company that had infusion pumps, and, you know, so, you know, we certainly knew a lot about, you know, delivering, you know, whether it's insulin or other drugs knew a lot about, you know, device manufacturing, regulatory, you know, so, anyhow, you leverage all that. And, you know, at the end of the day, you hire bright, smart, capable people who, frankly, thrive in a small company environment. I mean, you know, in a small company, I mean, you know, forget about your title, everybody's working hard. Everybody's working late, everyone has a passion for, you know, doing what we're doing, because we're going to improve the lives of people with diabetes really have honestly, hey,

Scott Benner 43:42
listen, is this to ham fisted? Or maybe this happens all the time. But do people call you the pod father? I mean, I've never heard anyone call me that. Well, then I'm doing it right now. Because that seems like an obvious pun. I mean, honestly, and, and, and what a, what a, what a, what an absolute parenting story, it is to like, you're like, let me do this thing for you. And you do it and you build this entire thing for it at the end, like, that's nice, but I'm not gonna use

John Brooks 44:12
it. And again, you know, he may very well you know, decide at some point he wants to do it. Yeah. And again, you know, he's a, he's doing great things in the world of, you know, helping employers and payers and all help their patients with diabetes. And now hypertension, weight management, as I said, it's really nice soon, you know, to be, you know, part of Tella Doc, which takes it even to a bigger stage.

Scott Benner 44:37
I'm having. I honestly, the experience that we've had with my daughter, doing telemedicine over the last number of months, I think has been an incredible improvement over what we had been doing prior to that, honestly, yes,

John Brooks 44:50
I agree. I mean, if you think of it, I mean, you know, and I did some piloting a Jocelyn. I mean, this is many years ago, and, you know, it was hard to get Add, you know, great clinicians, but you know, they were just used to, you know, meeting people in their, in their office, if you think of diabetes, I mean, it's the best, you know, way to treat people, because what do you do physically, you don't really need to do anything. There's no procedures, you're, you know, helping people and the diabetes nurse educators and the dietitians. And so but, you know, before we had to do it with COVID, you know, it's just people are convinced that you have to do it that way, right? Now. And in some ways, you know, it was just the, you know, people were resigned to the fact that I'm going to spend an hour to drive in the Boston, I got to spend 4050 bucks to park, I'm going to sit in the waiting room and wait, because this is a, you know, global leader and all the clinicians or bright and busy and, you know, that's the price you get to pay. And, you know, now if you said, hey, let's go back to that, you know, people there Nope, not gonna do it.

Scott Benner 45:57
I don't think that anything's been more gratifying in the last three months and sending an email to somebody and saying, hey, my daughter has hypothyroidism, too. And saying, Hey, I think Arden's a little hyper right now. And she fat and she emails back a script, we get a blood drawn, the next day, they move the tiersen down a level, and it's it's done in 24 hours almost. And before, like you said, get an appointment come in, take a day off from school, like all this other stuff to maybe get an answer in a month, if you're lucky. Really,

John Brooks 46:26
it's a it's a change. And again, I think it says we're saying I mean, I think diabetes lends itself to you know, having smart devices, analytics, AI and the ability to basically let the care team, you know, monitor from afar, how people are doing and make sure they get the right coaching, the right encouragement, you know, but but the idea is essentially, make the lives of people with diabetes easier, and take the burden off of them and, you know, give them an opportunity to basically live a, you know, healthy life and, you know, avoid, you know, the, you know, what, what used to happen, you know, was people developing complications, and, you know, not that they don't exist, but you know, I think we're doing a much better job of, you know, making sure we get ahead of the curve and not waiting for someone to have, you know, eye problems or kidney problems or vascular problems. I mean, the whole idea is, you know, a keep people in range and keep the excursions in, you know, don't let things get to the point where, you know, the the problems start arising.

Scott Benner 47:34
Yeah, you have to be proactive for certain I have two last questions for I thought I was only gonna have one, but now I have to because of your time at Jocelyn, how do you? Or do is it obvious to somebody like you that there's an issue with clinicians not understanding diabetes, as well as the people who have diabetes? And how do you speed up their understanding so that they can help newer people?

John Brooks 47:58
Yeah, no, it's it's a great question. And look, you know, whether it's Jocelyn or other place, Sherman just very talented individuals. But, you know, you know, especially a place like Joslin, you know, part of the Harvard complex, I mean, you know, academic medicine, you know, people are brilliant, but you know, there tends to be a lot of clinical inertia, you know, they want to see data, they want to see papers, they want to see peer reviewed journal articles before they fully get on board. And the other part of it is, you know, I think, you know, they're busy people. And, and, you know, as much as they're going to keep up with all the new developments, all the new information, you know, it just, it takes a little while and, you know, but but I think today, you know, with a lot of, you know, capabilities built into the electronic health records, you know, there's ways for, you know, clinicians to be able to, you know, get a better handle on how this individual is doing, what are the other potential comorbidities or factors that are going on? And then, you know, which is the right approach? And, you know, if you have type one, you know, what type of devices and, you know, do I still think about putting you on some sort of, you know, Sdlt, to inhibitor, I mean, so, but, but, but the issue is, I think it was just, you know, busy people and, you know, just trying to deal with all the stuff they had to deal with, and then after they get done seeing patients, make sure they put all of their information into the, you know, billing systems, so the bills could go out on time. And so, you know, I think it was just easy for people to kind of get into a, you know, I don't have time to think I just got to react. And so, you know, now I think it's easier with, you know, as we said, with kind of the whole virtual care, you know, I think it's just easier to be able to focus on for an individual, you know, what, what is it that we should talk about during this time we haven't, you know, that the doctors don't have to spend time kind of reviewing or trying to make sense on the fly out of CGM plots, and, you know, now that the information is there, it's more a question of helping, you know, determined for that person with diabetes, you know, what's the best way to, you know, help you even further improve? And, you know, to be there, you know, if people are still struggling, you know, because it's, you know, there's still challenges on the board of the college diabetes network Chairman there, and, you know, we spend a lot of time if you think of it, college students, you know, dealing with diabetes in this environment, you know, virtual hybrid classes, and, you know, the whole, you know, sided diabetes around depression, and, you know, behavioral health and also, you know, so in some ways, you know, life is getting easier, but life is getting more complicated, right, right

Scott Benner 50:48
now, it's interesting, I just have, I have such a personal experience over time, where it's gonna sound crazy, but I could sit down with you in an hour and explain diabetes to in a way where you would just understand it. And you'd, you'd be able to put it into practice, I've practiced for a decade or more writing about it and talking about it and, and just when you see someone struggling, who has great care, what really is considered great care. And then they come along, I mean, think about it, really Jimin, they come on and listen to our podcast, and then all of a sudden, they're like, Oh, I understand now. And then they're often there. Okay. It feels like there's a disconnect somewhere in between that, you know, what I mean?

John Brooks 51:26
Sometimes, you know, maybe, maybe the key is, you know, you know, you got to make sure you're connecting with people at their level, maybe some people I mean, you know, especially in type two, I mean, a lot of people are told by their, maybe it's your primary care doctor. And again, I'm not trying to malign anyone, but you have diabetes, and here's what you need to do. And I'm going to put you on Metformin. Well, you know, at the end of the day, I mean, I used to hear from many people, well, I don't really know what it means when I have diabetes. I mean, they don't understand things. And maybe they say, well, I'll avoid sugar. But you know, I can have pasta rice, that's healthy, right? I mean, no understanding, you know, kind of how our bodies work. I mean, when I was a kid, you know, many, many years ago, you know, we actually had something in school called nutrition class, and health classes, you actually had some idea how our bodies work, I don't think we're teaching that to kids anymore. So the idea is a lot of people just, even though if you're in it, it's kind of like, Well, why don't you understand it? Some people just don't fully understand like, Well, you know, what do you mean, my pancreas isn't gonna produce insulin or, you know, it's not producing enough insulin or, you know, I'm watching my blood sugar's but, you know, I'm in competitive sports, or I'm stressed out or, you know, when people start realizing there's all these other factors that affect your your glucose, I mean, you can eat the same meal every day, do the same thing. But if you're stressed out one day, or you didn't sleep well, or something, you know, you're going to have different results. A lot of people don't fully appreciate. Well, why is that?

Scott Benner 52:57
Yeah, I think that when, when I start talking to people, privately, which I do sometimes, just as I don't know, I think it makes me better at being on the podcast to have one on one conversations with people that aren't recorded sometimes. But when I start off by 10, I'm looking at to get your basal insulin, right, because nothing's gonna work. If that's not right. And then you really need to Pre-Bolus to understand how your insulin works. When I get to the third thing and say, You need to understand the glycemic load and the glycemic index foods, I don't think that's what they think they're going to hear next. And when you tell somebody that, you know, 10 carbs of one food in 10 carbs or another food are going to impact you differently. I completely agree with you, it fries their mind. They're like, no, they told me that not the

John Brooks 53:36
cause. And, you know, and again, we were learning a lot about, you know, again, you know, what else is affecting, you know, gastric emptying, you know, which foods tend to get into the bloodstream faster. I mean, again, there's a lot of complexity that, you know, not that we want to make it even more confusing for people. But the hope is that, you know, over time, you know, devices are going to start incorporating in, if you think of all the wearables, people are starting to pick up on heart rate variability, they're starting to pick up on sleep, and at some point in time, maybe those additional inputs, you know, might further cause the algorithms to be even smarter. Yeah. So all of a sudden, you know, we're having a better way to help people with diabetes, you know, understand that, yep. Blood Sugar is fine. But that's not the only ingredient that's kind of driving, you know, what's going on.

Scott Benner 54:26
Yeah, maybe one day the, the pump will know that, hey, I had pizza. So the cheese is slowing down the digestion. But now the cheese is gone. And everything's going through me quicker and not impacting me the same.

John Brooks 54:37
Yeah. And again, a lot of pumps are going to say, you know, hey, I remember the last time you had insulin and here's, here's what happened. And you know, instead of you having to figure out a square wave bolus, whatever, you know, the system is going to basically say, Yeah, I remember that. You know, let me make sure that I'm adjusting your insulin or if you're an athlete, I remember you know, when my son Played high school sports or you know, we've had a lot of kids that Jocelyn, you know, playing competitive sports and you know, the the issue is, you know, your blood sugar's you know, you may be fine during the game and then eight hours after game time you're crashing and you know, understand why why do that's, you know how do you get muscles reload? So anyhow, it's complicated but we're chipping away at, you know, getting it there and maybe in the background we've got people working on, you know, either, you know, beta cell regeneration protecting the immune system, I mean, you know, there's lots of other good things going on that I'm on top of as well. So maybe someday, we'll make all this moot.

Scott Benner 55:39
That's my last question is, what do you see coming that is exciting to you, because I just had a Dr. Jeffrey Millman on the other day from Wash U. And he was talking about stem cells and how they're getting cells. Now the sense glucose make insulin not seen as you're bound by your body as a farm. You know, that's, it's all amazing. Like, yeah, no,

John Brooks 55:59
it is, but you know, and it's happening, you know, in different parts of the world, you know, that there's people working on, you know, defeating the autoimmune process people working on, you know, basically protecting the beta cells, there are people working on regenerating the beta cells or people working on in capitalization, there are people working on, you know, new treatments. I mean, you look at some of the stuff, you know, the nice salsman, you know, at mgh with ECG, and you know, so lots of advancements, people are making headway, you know, you look at, you know, semma, which was a Doug Melton company, now part of vertex and all sudden, you get a very big pharmaceutical company working on, you know, kind of, you know, beta cell and capitalization, you know, you get other kinds of companies that are in that space. And little by little, you know, we're kind of cracking, you know, wider regulatories T cells go awry. And, you know, how do you do that? So, yeah, I mean, we could talk for another couple hours on, on, things that I see. And, you know, I'm usually involved because, you know, I just get motivated by that. And again, companies sometimes seek me out, because they know, I know enough to be dangerous, and maybe I can help them either get financed or advanced, right,

Scott Benner 57:15
understand how to get through the whole process. And that's got to be such a huge part of it. It's just having somebody with you, that can help guide you around the pitfalls, right. That's got to be

John Brooks 57:24
Yeah, I mean, you know, I've been, you know, doing this for a while, and, you know, seeing the good bad, the ugly, but, you know, the hope is that, you know, at the end of the day, you know, a lot of these companies to challenges, you know, getting the financing and having a value proposition that's compelling to investors, and, you know, making sure that they thought through the timelines around, you know, regulatory issues, quality issues, reimbursement issues. And in today's day and age, it's the old Wayne Gretzky line. You know, you don't want to develop something, you know, to solve today's problem. It's, where's that puck gonna be five years from now to

Scott Benner 58:01
skate? Where the puck rolling, right?

John Brooks 58:03
Yeah, where's that competitive landscape gonna be? Who else is out there? And how to make sure that you're, you know, kind of leapfrogging the competition, not just incrementally saying, Hey, I got a better mousetrap. And, you know, if you're already kind of behind the times, so I tell people when they're using their insulin, that everything you do now is for later, and everything that is happening now is from something that you did in the past. And I think that thinking like that, in general is a great idea. Well,

Scott Benner 58:29
john, thank you. I don't want to take up any more your time, but I do want to leave you with something. Because I, I don't know that I fully wrap my head around this sentiment that gets given to me a lot until you were talking about your son. But people thank me, my daughter does not come on this podcast, right. She's 16. She doesn't care about a podcast. And and people tell me all the time, how grateful they are that her situation led to their success. And now I'm realizing as I'm sitting here is that, that this podcast really is born out of my concern for my daughter, and she's wearing an insulin pump that was born out of your concern for your son. So it's very kind of chilling, honestly.

John Brooks 59:09
Well, I would, I'm sure he'd be interested. So at some point in time, you want to do a podcast with my son, I think you're gonna find you know, he's even sharper than I am. So I'm gonna do

Scott Benner 59:19
that. Yeah, No, I haven't. Yeah.

John Brooks 59:22
Yeah. I mean, he, I mean, if you think of it, I mean, you know, he, he's, you know, understands this disease, because he Elizabeth every day, and, you know, working for a company that you know, now is extremely successful. And, you know, what had some interesting experiences along the ways. So, you know, so yeah, you might want to get him on a podcast, I think you'd find it pretty entertaining. Well, it'll be easier for me to find him than it was for me to find you. Because, you know, you just would go around saying to people, like, you

Scott Benner 59:48
know, the guy that made the pot What's his name? And said, finally, somebody one of my friends had on the pods like, it's john. And I was like, Oh, is that him? And she goes, Yeah, I said, I think I know someone at t Wendy exchange. I'll be fine. Cuz like, I'll figure it out, which is another great organization that you you sit on the board of Is that right?

John Brooks 1:00:05
Yeah, yep. T Wendy exchange college diabetes network. You know, so you know, places diabetes related. You know, I'd like to think I can be helpful in some way.

Scott Benner 1:00:16
Well, I'll know I'm doing well, when you want to invest in me. Chad, thanks so very much. I really appreciate it. My pleasure. All right. Take care. Have a good day here.

Unknown Speaker 1:00:24
Yep. Bye. Bye.

Scott Benner 1:00:27
Hey, huge thanks to the pod father, john Brooks. Can you imagine it if people by the way, if you know john, start calling in the pod father, I'd like to see that pick up if you guys can make that happen. Thank you. Anyway, john, thanks so much for coming on the show. And for sharing your amazing and very unique experience dreaming up an insulin pump. Thanks also to the T one D exchange T one d exchange.org. forward slash juice box. Join that registry today support Diabetes Research, support the podcast and touched by type one touched by type one.org. Thank you to those sponsors. And of course, welcome g Vogue glucagon to the family of sponsors here at the Juicebox Podcast. Learn more about that pre mixed prefilled, glucagon or the hypo pen at GE Vogue glucagon.com. forward slash juice box. There are links in your show notes. And at Juicebox podcast.com. To all of the wonderful And may I say delightful sponsors of the Juicebox Podcast. Check them out if you would. Thank you. Hey, last thing, the Facebook page for the podcast is blowing up. I mean, that is what the kids would say. Right? It's it's blown up. Be like you know what they said about their phones and stuff. I'm I'm very old. I don't know what people say. But that's not the point is on Facebook. There's a public group. It's called bold with insulin. And there's a private group Juicebox Podcast, type one diabetes, that private group up to 6000 users just about, huh? Is that bananas, 6000 people and they're just helping each other out. It's amazing. It's the kindest place you'll ever find on Facebook hand to wherever you want to hold your hand up to when you're swearing on things. I mean, it I've never seen a nicer, kinder, more thoughtful, less egotistical, more lovely and delightful group of people helping each other with Type One Diabetes than I have right there in that group. I am as proud of how that group functions, as I am about anything else connected to this podcast. It's really, it's quite something. And the public group has like 10,000 people following it. I'm really stunned. I am not really a Facebook person, but turned out to be quite a little resource and I'm super happy about it. Alright, I hope you have a great day. I hope you've enjoyed this conversation with john learning more about how the Omni pod came to be. I really did and what else feels like I have nothing left to say. So that is that

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