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Now displaying: January, 2021
Jan 26, 2021

What is it like to actually give someone emergency Glucagon? What happens next? This week, Stacey talks to Bonnie O'Neil whose son was diagnosed with T1D at age 5 and is now 24. They had a scary situation while on vacation and out of the country. Everything worked out; Bonnie shares what she learned and what she wants other families to know.

Bonnie is the author of a brand new book: Chronic Hope (learn more here). She has a unique family history of diabetes, losing a brother before she was even born and has a older sister who is still thriving today.

In Tell Me Something Good this week, a big honor for one of our favorite frequent guests and fun news if your child plays Minecraft.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.



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Episode Transcription 

Stacey Simms  0:00

Diabetes Connections is brought to you by Daria health. Manage your blood glucose levels. Increase your possibilities by Gvoke HypoPen the first premix auto injector for very low blood sugar, and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.


Announcer  0:21

This is Diabetes Connections with Stacey Simms


Stacey Simms  0:27

this week, what is it like, what really happens, when you need to use that emergency glucagon, I talked to a mom who found out while on vacation out of the country,


Bonnie O'Neil  0:37

I was just all I could do to stop my hands from shaking and mix that glucagon and get it in him. So point number one was when you go on vacation, make sure that glucagon doesn't stay in your hotel, keep it on your person you just never know.


Stacey Simms  0:52

Bonnie O'Neil's son was diagnosed at age five and is now 24. She has advice about using and carrying glucagon. She also has a unique story. She'll talk about growing up in the shadow of a family tragedy with diabetes, and how she and her sister have overcome that

in tell me something good this week, a big honor for one of my favorite frequent guests. And does your child play Minecraft? Stay tuned.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome to another week of the show where we aim to educate and inspire about diabetes with a focus on people who use insulin. My son was diagnosed with Type 1 14 years ago, my husband lives with type two diabetes. I do not have diabetes myself, I have a background in broadcasting. And that's how you get the podcast.

longtime listeners will know that this show is not really about our experience my family's experience of diabetes week in and week out. I don't share a ton of personal information about Benny, but we do talk about our experiences. And I bring that up because I did a show recently with him to mark 14 years, which was a pretty big milestone. And we've done a couple of shows together over the years. I always say Benny is a big goofball. But you know, he's got good things to say I like to talk to him. I'm very proud of him, even though I give him a hard time. And I got a really nice review that I wanted to share. I don't ask for reviews very often. Maybe I should if you'd like to leave a review, you can send one to me at the email address at Stacey at Diabetes You can leave them on whatever podcast app you're listening to. You can drop them in the Facebook group.

But this one really was nice. And so I wanted to share it and say thank you to Ruth Ann, who posted it following that 14 year episode where I talked to Benny and she says “I listened to it yesterday and came away feeling understood. I've had type one for almost 45 years diagnosed at age 12. Then he was honest in the way teenagers can be when they don't feel pressured to spin things to make other people happy. I found him incredibly inspiring.”

She goes on to write “To me The message was you can be upbeat about life. But don't succumb to pressure to sugarcoat the hard realities of managing type one. I think being real is the healthiest approach to coping with a challenging chronic illness. Please tell him thank you from a grandma in Utah, Ruth.”

And I will say thank you to you. That meant the world to me. I agree. I think it's so important to be honest to write that line of diabetes can't stop you from doing the things you want to do. But it will stop you and slow you down sometimes right not to sugarcoat things too much. I really appreciate you taking the time to write that down and share it with me. And of course, I will share it with Benny and Wow, good luck to you. 45 years with type one, you're the inspiration. If you would like to tell us something always happy to get nice messages like this. I'm always happy to take constructive criticism as well. I do have a few people over the years who have yelled at me. But I think I'm pretty easy to find either on social media or via the email address. And you can always go to Diabetes and get all the contact information there. But Ruth boy you made my day

All right, we're gonna talk about using glucagon what that is like, and Bonnie's really interesting story in just a moment. But first Diabetes Connections is brought to you by Dario health. You know, over the years, I find that we manage diabetes better when we're thinking less about all the stuff of diabetes tasks. And that's why I love partnering with people who take the load off on things like ordering supplies, so I can really focus on Benny, the Dario diabetes success plan is all about you all the strips and lancets you need delivered to your door one on one coaching so you can meet your milestones, weekly insights into your trends with suggestions for how to succeed, get the diabetes management plan that works with you and for you. Dario has published Studies demonstrate high impact clinical results, find out more go to my forward slash Diabetes Connections.

My guest this week is here to talk about using glucagon and I think we can all From that, but she has another important story that I don't want to gloss over. Bonnie O'Neil has been part of the diabetes community since before she was even born. bit of a warning, this may be hard to hear Bonnie's older brother died when he was eight, his type one went undiagnosed until it was too late. Now, this was back in the 1960s. But we know that's still gonna happen today. Her older sister was later diagnosed, she survived and is still thriving now. And Bonnie has a new book out. It's called chronic hope. So there's a lot to unpack here, including that very valuable information about her family's experience with glucagon. I found this to be a very valuable and eye opening conversation. And I hope you do too. Bonnie, thank you so much for joining me. Congratulations on your book. And I'm excited to learn all about you. Thanks for jumping on.


Bonnie O'Neil  5:48

Thank you for having me. I'm excited to be here today. Stacey,


Stacey Simms  5:51

tell me about your son. But he's doing now because he was diagnosed as a little kid. And he is all grown up now.


Bonnie O'Neil  5:57

Yes, I've lived all the stages with him. So he was diagnosed as a five year old and he is now 24. So he's living not too far away from me about 15, 20 minutes, which I guess is every T one D mom's dream when their kid grows up that they live independently, but yet, we can still get our eyeballs on them and our arms around them from time to time. So yeah, he's doing great.


Stacey Simms  6:22

You it's funny because being diagnosed, what does that 19 years ago? Isn't that long ago. I mean, my son was diagnosed 14 years ago. But in some ways, it feels like a different world. Do you mind taking us back to that time, if you could tell us the diagnosis story. And I'd love to also talk about what you all started in terms of management.


Bonnie O'Neil  6:41

Sure, yeah, that's actually an interesting story. So I have diabetes in my family. So my brother was unfortunately died in the diagnosis process when he was eight years old. And that was before I was born. And so my parents had me in their 40s, basically to, you know, replace the child that they had lost. And then my sister was diagnosed when she was 16. And I was eight years old. And so I just grew up with it. We grew up with this fear of it being there. So I was always on the lookout for it. And I remember my first pediatrician when I want to have my first child, I said to him, so how do we test for this thing? Because I don't want it to be in in my child. This wasn't Austin. This is my oldest son, Alexander. And, and he's like, oh, Bonnie, you know, it comes on acutely. We can't just run a blood test every every few months, but you'll know it if you ever see it, frequent urination, and intense thirst.

And so I was always looking and so the day that I noticed that in my son, Austin, you know, obviously, there's the major panic, but I had grown up through my three pregnancies, I had done the urine testing for gestational diabetes. And so I knew exactly what to do. I went to the pharmacy, I bought a test kit, and I dipped Austin's urine in it, and it turns deep crimson. And so I diagnosed him at home freaking out going to the doctor and saying, they're like, calm down. This is Odile, like it, maybe it's not type 1 diabetes. I'm like, Well, do you know what else it could be? And so we, you know, I bundle up the three kids and we're living in Connecticut at the time, I took them over to the pediatrician. And he didn't have ketones, because we caught it so early. And so their practice was leaning into something that they told me was what Yale was practicing at the time, although I have an endocrinologist friend from Yale, who assures me they never offered, I suggested that, but the thinking was, if your child doesn't have ketones, you don't admit them to the hospital. Hmm.

So we went home, we literally went home without so much of the shot of insulin. As you can imagine, I was just freaking out because my brother didn't make it through his diagnosis story. So I was like, you know if you can remember Terms of Endearment and Shirley MacLaine, like shaky over the crib. Yeah, that was me that night, just like leaning over my son and just making sure all night long that he stayed alive anyway, that the pediatrician, the endocrinologist that my pediatrician was able to find for us was one who really didn't work with pedes. The youngest children they saw were really about 15 or 16. So we saw him The following day, and the long acting insulin that he gave him was Lantus.


Stacey Simms  9:37

I was wondering if that was even approved, because I remember was not really 2000 so it was for little guys.


Bonnie O'Neil  9:43

Okay, it was not it was it was not under age 10 and so I don't I didn't know any of that you know, and so, so that was the first there's two things that were very interesting in our in our care different so that was the one and then when we got to CHOP the Children's Hospital. Philadelphia. A week later, I forgot to say all this diagnosis happened exactly one week before we moved house from Philadelphia. Oh


Stacey  10:07

my god,


Bonnie O'Neil  10:08

I never recommend that moving house be part of your diagnosis to be that as it may that was our case. And so when we got to CHOP our the endocrinologist there was actually very keen to see know what would happen to this child being on Lantus at age five, I'm pretty sure that it's going to work out well, I can't prescribe it. But he came to me that way. So I can leave him on his protocol. So that was interesting. And it worked beautifully. So my son never used NPH. And I had friends at that time, who were very familiar with that insulin and just told me how fortunate we were that he never had to be on that. So that was one thing. And the other was, so my sister, the reason I gave you the backstory on my sister was that I grew up in a family of using exchanges, where you counted your you didn't count carbohydrates, but you looked at food, in terms of whether it was fat, or protein, or carbohydrate. And you gave each one an exchange. And so I was used to that world. And I literally was given a counting book that had both on it, it was the exchanges and the carbs. And it was kind of you could do it however you wanted. They were recommending I just use the carbs, but the exchanges were there as well. So that was interesting. Oh, and then there's a third one.


Bonnie O'Neil  11:33

But I remember. So his diagnosis was shortly after the DCCT trial, results came out and talking about intensive insulin therapy and how important that was. And I remember several visits, going in and talking to my CDE and saying, I'd really like Austin to be on that intensive insulin therapy. And she would, she would look at me like I had 12 eyes and like to say something, and I didn't understand what she was saying. And she didn't understand what I was saying. And it was many months later that I realized that Austin was


Stacey Simms  12:11

using Lantus and short acting together. Yes, exactly, was


Bonnie O'Neil  12:14

exactly. So yeah. So I was sort of living in some a couple of old paradigms and had to get with the program pretty quickly. Yeah,


Stacey Simms  12:22

but what a transitional time. Here was that that he was diagnosed,


Bonnie O'Neil  12:26

it was 2002. Yeah. And I'm so thankful I that is it is that so spot on Stacey, because just a few years earlier, and and the story would have been very different. My sister's story is very different. Sure.


Stacey Simms  12:37

And let's talk about your family for a moment. If we could be there's so much information there. You mentioned your brother, gosh, I can't I'm not even sure what to ask. But he died before he was diagnosed or during his diagnosis story. Was


Bonnie O'Neil  12:48

this in the 70s? The 80s Yeah, it was 1962


Bonnie O'Neil  12:57

Yeah, yeah. So my sister was six years old, my my sister Barb, and my sister Johnny, my brother, Johnny was eight. And so it was Christmas week, and my sister had the stomach bug. And a couple of days later, after she got better, my brother started throwing up. And they assumed that he just had the stomach bug as well. And he may have had that, but it clearly he then slipped into decay. And so by the time he got to the hospital, which was actually New Year's Eve, what he was in a coma. And so he passed away three days later, to make the story even more unbelievable. My mother delivered my sister Betsy, just nine days after that.


Stacey Simms  13:43

Oh my gosh. Oh my goodness. Yeah. You know, DKA is I don't have to tell you this. You know, it is the most dangerous time for people with type one and it's amazing to me how now. Gosh, we are you know, more than 50 years after what happened with your family with your brother? Yeah, we are still having something like 30 to 40% of people who are diagnosed with type one diagnosed in DKA, I know you work a lot are you you've written a lot with beyond type one. You know, are you involved in efforts? Do you see the you know the DKA awareness that's something that you you talk about.


Right back to my conversation with Bonnie and we are going to hear her talk about glucagon in just a minute or two. And when you hear her talk about the emergency redbox, please remember, there are more options now and Diabetes Connections is brought to you by one of those by Gvoke Hypopen. Almost everyone who takes insulin has experienced a low blood sugar and that can be scary. A very low blood sugar is really scary and that's where Gvoke Hypopen comes in. It's the first auto injector to treat very low blood sugar. Gvoke Hypopen is pre mixed and ready to go with no visible needle. That means it's easy to use. Find out more go to Diabetes And click on Gvoke logo. Gvoke shouldn't be used in patients with pheochromocytoma or insulinoma, visit Gvoke slash risk. Now back to my conversation with Bonnie and I just asked her about her family's tragic experience with DKA and how that's influenced her with what she does now in the diabetes community.


Bonnie O'Neil  15:22

Yeah, I mean, I do write for beyond type one, and I'm very active with JDRF. I'm on the board of the founding chapter, the greater Delaware Valley chapter. And I know that we're doing a lot of advocacy work around that and, and even just trying to get the shift in titling someone has type 1 diabetes, a JDRF, has done a lot of work around that, and is seeing that that shift so that it's, you know, reframing it, so it's not Oh, they got diabetes, or my son didn't get diabetes on June 19 2002. That was when we discovered that he would be insulin dependent for the rest of his life. He was developing the disease before that. And so we're trying to change that language. I think we're making progress. So that there's there's an understanding that you are, you know, certainly with some of the antibody tests, that testing that is being done now to be able to know that, you know, this person's body is being set up to get the disease, you know, if you have, I think it was three out of the four markers. It's, yeah,


Stacey Simms  16:31

well, and I was gonna ask you about that, about T one detect, we just did a show on that. We did an episode on that a couple of weeks ago. And when you think about something like that a person who has type one in their family, like you had and was so front of mind, I would imagine that you would have taken advantage of that with your kiddos, you know, years and years ago.


Bonnie O'Neil  16:48

Yeah. And, you know, back then, and that was something that I asked my endocrinologist was, so should we do any sort of testing and their response, and I had to agree with it was, well, there wasn't anything that they could offer. Other than Gee, I'm really sorry, it looks like your child is probably going to get type one. So the way I've handled it now, as a mother of two adult children who don't have diabetes, is that decision is yours. If you want to be tested, we can get you tested. If you don't want to, I have to respect your decision.


Stacey Simms  17:25

One of the things I really was looking forward to talking to you about and looking forward as a term I really should not use there. But I was very interested in is you were one of the few people I know who has had to use glucagon on their child, and then wrote about the experience. So I really appreciate you talking about this publicly. It is a fear that so many people have, you know, we have never had to break out that red box. And I'm so thankful for that. Would you share that story with us? You're even at home, right? You're on vacation?


Bonnie O'Neil  17:54

Yeah. And I'd be happy to because you know, it's a it's a story that still brings up a lot of emotion in me, but it does have a happy ending. And there are some good takeaway points for your listeners in terms of preparedness. So yes, I'm happy to share the story. My family went on vacation to Costa Rica. So it was my oldest son's first year in college, Austin, that would have made him a sophomore, I think in high school and my daughter would have been eighth grade. And we realized that all the spring breaks were aligning all three kids were in three different schools. And we're like, Yes, let's go and do something fun. So we plan this, this sort of dream trip, you know, where you're going to be renting, staying in a treehouse. And like, I'd have some time at the seaside all kinds of great stuff. So adventure, but fun. Yeah, so we get there and the very the very next day, I think we got there like late afternoon. So the next day, spent a little time poolside and then decided to go to this restaurant for lunch that was literally like an oasis on the seashore. So like in the sand cluster of trees and this restaurant was in these trees on the sand. And so it's just a walk up the beach, it was probably, I don't know, 20 minutes of a walk.

We get up there. My son Austin actually ordered the only sensible meal he ordered a pizza which is cooked my husband and I ordered cbj which is raw and my other two kids ordered some sort of salad again raw and when you're in a developing country, you should go cooked rather than right anyway. So you know it was a big piece of pizza and or you know, personal pizza. And so we give this was before wearing a Dexcom so we have no arrows indicating the dress. In which his blood sugar is going, we just have a blood sugar of somewhere around 250 probably. So we have to give a nice correction dose, I have to give the combo bolus that we were doing for the pizza to accommodate for the, for the fat. So it's gonna be dripping in for a while. And I didn't factor in the walk that he had just had. So right after lunch, he and his brother asked to go into the sea and play. I'm like, Sure, that's fine. So they did about five minutes later, he came back and he said, I feel shaky. So I tested him and he was in the mid 60s. And we ordered him a coke. And he started to drink. And still his blood sugar wasn't going up. Eventually, he drank the whole big bottle of Coke, and still really wasn't going up. And I was getting a little suspicious. And then he said, I don't feel well. I feel nauseous. And then I knew we were in trouble. And your mind just immediately goes to like, the cheese was tainted. The basil on it hadn't been washed and was in was unclean. Something, you know. Yeah. And I knew that he had like, over 10 units of insulin on board. And then the next thing I know he he starts vomiting. And I mean, pardon me, but projectile vomiting. And this is one of those moments when you just snap into too high alert gear. And it's to my son, and my, my oldest son and my husband go back to the hotel, get the glucagon because of course the glucagon was with us. But it wasn't with us.


Unknown Speaker  21:39

Right? It was


Bonnie O'Neil  21:40

in the hotel, helping the pillows in case they had a low but now it was it was tucked away with all the other supplies. And so the two of them ran back along this shoreline. And I knew it would have to be at least 30 minutes before they would get back. Right? Because there and back. And actually my son got back before my husband did because the roads were so rutted and so circuitous, that it just took him forever, it seemed to get back in the car. So all the while I don't speak Spanish, I speak fluent French, I don't speak a lick of Spanish. And all of these people were trying to help me and they didn't speak any English. And they all they could do is bring towels and bags for my son. And you know, I knew that if he drank any more, he was just going to vomit it. So there was no point in trying to give him more to drink. And so we just waited. And I have never seen a sunset so fast in my life. Oh, I don't know if it was where we were located on the Costa Rica coast. I know we were having a late lunch. But anyway, it just started to get dim. And by the time my eldest son got back with the the glucagon and cuts all over his bare feet, it was just all I could do to stop my hands from shaking, and mix that glucagon and get it in hand. So point number one was, when you go on vacation, make sure that glucagon doesn't stay in your hotel, keep it on your person, you just never know. Point number two with practice that injecting or at least mixing up glucagon. Every year, when your glucagon expires before you throw it away. Don't neglect that gift of having the opportunity to practice drawing it up because I was going to ask you,


Unknown Speaker  23:27

did you ever do that?


Bonnie O'Neil  23:28

I did it every year, I never threw one away without mixing it up. Because I knew that if I ever needed it, I wasn't going to be able to stop and read the directions. I just needed to know what to do. Because the only reason you would use it is if you're in an emergency. And in an emergency. We don't think so clearly, or our hands are shaking, you might be thinking but your hands are shaking so much that you just need to go from muscle memory. So eventually my husband got their like gate. So I drew it up. I gave him the glucagon. My husband got there. And we're in the car. And I was just surprised Stacey, his blood sugar didn't come right back up. I expected it would come up to like, I don't know, a perfect 110 would have been nice. You can even give me a question 150 I'd be happy with and if it didn't, it was I don't even know if it hit at oh well. And so I remember being in the dark in the backseat of that car just like trying to get every little whiff of the glucagon out and into him.

And, and then I just realized I don't have another glucagon. I brought one. I didn't bring two and he's not in a stable enough place. Like I we need a doctor. So thankfully, this was probably the nicest hotel we had ever stayed at. And and I'm really thankful because they had a doctor on call. So we as soon as we got back to the hotel, we asked the concierge to call for a doctor and he was there. Oh probably within 45 minutes, something like that. What did he do for you? Did he give him more like IV glucose? Yeah, so he unfortunately was this big, you know, had a big headboard, big posters on it, and like a poster board sort of thing. And he just hooked an IV up to him and tied it up to the to the bedpost. And so the following morning, when he came back, Austin had a fever by that point. And he said, You know, I can't rule out that this isn't appendicitis, you have to get an emergency surgery in Costa Rica, this was not what I had in mind. And long story shorter, what ended up happening was he said, You've got to get him down to the Capitol to San Jose, four hours back down the way we had come up, you know, just two days before. So we have to do that, you know, it could have been the fever could have been from the food poisoning, which it was, but he said, you know, we have to be safe, it couldn't be appendicitis or something else. And so that was the longest four hour ride I've ever had in my life.


Stacey Simms  26:02

Yeah, it was not appendicitis, it turns out to just be


Bonnie O'Neil  26:07

a lot it was it was just the food poisoning. And he spent three days in hospital. And there again, you, as a diabetes parent know more about diabetes than emergency room physicians do. And it's important that you know that and that you believe in yourself about that. My son, his freshman year in college had to go to the ER for the stomach bug. And there to the emergency room, physicians relied on me for what I knew about how to take care of his diabetes. And so when we were in Costa Rica, the attending physician gave me her cell phone number, and said, I want you to be in touch with me. If this doesn't come around, if his numbers don't go in the way we want them to, we're going to take the pump off. And we're going to do it our way. But I will give you it was basically I'll give you six more hours, I think this was like on day two or something. Because she was letting me manage his diabetes. Right? And but then she said, You know, we're gonna do it six more hours this way. And let me know how things go. And it did it worked out fine. So here's two more points coming to my mind when you're traveling. Don't just take one glucagon, you might need to use a second one when we were leaving the hospital. Among the other prescriptions that the doctor wrote for me. I said, Could you write me a prescription for glucagon because I use the only one I had. And clearly, my son didn't get a stomach bug. It was food poisoning. So food poisoning could happen again. And I want protection from that. And she looked at me with these beautiful, innocent eyes and said, Bonnie, we haven't had glucagon in this country in over 10 years. Wow. And so just don't imagine that it's going to be available for you. So travel with to glucagon when you travel. The other thing was, when we were in the hospital, the only ketone tests they were doing were blood ketone tests, they weren't doing any urine ketone test. So I had to wait until they would come back. You know, they weren't doing blood tests as frequently as we would expect to be doing our ketone tests. So again, don't just travel with a bottle that has maybe 10 ketone strips in it. I had a nearly new bottle of 50 ketone strips, and I was worried that I was going to run out


Stacey Simms  28:29

going forward. I assume you're filming like to travel? I mean, this was obviously a big trip and a big treat. Did you hesitate about traveling again?


Bonnie O'Neil  28:37

I don't think I'll go to Costa Rica. I'm nothing against Costa Rica. It's just the memories are. They're profound. I do try to pay attention to where there is a hospital, which is an easy enough thing to figure out. We have continued to travel that is for sure. In my book, I talk about another episode that happened after that, where he his insulin pump broke, and we were in France, and he had to get a we had to locate him a pump in a foreign country. So that's another fun story. But no, we've continued to travel, but I think it's just being safe, bringing your supplies with you and an abundance of supplies, checking to know where the hospital is. And I think it's it's just about being comfortable. Making sure that you feel comfortable where you are. Well, you


Stacey Simms  29:32

mentioned your book. Let's talk about that. Sure. Yeah. Oh, congratulations. That's Thank you.


Unknown Speaker  29:39

Thank you very excited.


Stacey Simms  29:40

Yeah. So why'd you call it Chronic Hope? Tell me about where that title comes from?


Bonnie O'Neil  29:44

Okay. Well, you might want to edit this out. I'm not sure so I was I was thinking about how much you know, I loved my my son and the care I give for him. This As a chronic condition and the title chronic love came to my mind. And that actually had been my working title for a little while. And as I was working on my book proposal, I did a little research little Google search on chronic love, and it was a porn site. So I changed the title. And actually, once I came up with the subtitle, chronic hope, is exactly what I'm writing about. We all love our kids, we do in a way that we show our love to them, especially as full time caregivers, that just cannot be disputed. But there's some times when we as the parents just lose our way on the hope journey. Because it's, it's so long and so complicated and can be so unforgiving. And we can be unforgiving of ourselves. The message really is hope for us.


Stacey Simms  30:57

I may have to lead with the chronic love, I think that forget about editing that out. That's pretty funny. Oh, my goodness. But you've had this story and you for a long time. I'm curious what caused you to kind of write it now to release it now?


Bonnie O'Neil  31:14

Yeah, good question. Well, I love to write. That's the first starting point. I've been writing for a number of years and have been honing that craft. And as I was thinking about what the next topic was, that I wanted to write about, it just felt like it needed to be a story that I've been living, something that was really true. And that it wasn't just something I'm going through now, which so many of my blog posts words like, you know, it's that short, quick blog post is almost like an instant word. It's like what you're going through at that moment, and you write, but I felt like I needed to write something where I had come out the other side, and actually had some wisdom to share. And once I sort of landed at that place, it was well, this is what I know better than anything else. And living this story out first with my nuclear family. And then with my family with my children, I just have been steeped in that for so long. I speak for the jdrf education conferences, that type of nation summit, and that one of the earliest ones that I did, I was speaking on the psychosocial impact of T one D on the family. And it was the first time I had delivered the that talk and I was I was sharing about, you know, my nuclear family and then Austin's diagnosis and how that impacted me. And I was just really honest, and, and raw, and I talked about my anger, you know, the disease coming back into my family, and just the challenges with my husband, when the two of us were not on the same page and the fear, I carried my need for control, wanting to control the disease, and all of these things. And as I'm looking up at the group that I was speaking to, like, everybody's dabbing their eyes, and sometimes, like really crying and at the end, one man said to me, So when's your book coming out? And I chuckled and kind of tucked that away. And it later, I think informed me very well as to what I should write about next.


Stacey Simms  33:32

What is your I mean, you have more than one son, and I'm sure they are your children are all featured in the book in their own way. curious what Austin? Right Austin? Is your son with time? Yes. I'm curious what what Austin thinks of this?


Bonnie O'Neil  33:44

Well, Austin is a man of few words that he's not


Unknown Speaker  33:47

going to do. Much.


Bonnie O'Neil  33:51

I made sure that in the advanced copies that I have, that he was, he received the first one. And he very graciously accepted it and then said, Thank you. He has congratulated me a few times and said he was excited. I did ask him before I really started the writing, and was just sort of outlining things. I asked how he felt about it. And he said he was fine. And I did say to him, and it's the Absolute Truth. If there's anyone who looks ugly in the book, it's me. It's never hand because I am raw with how I processed my emotions. Because one of the things I feel like in that for us, parents have a child that lives with such a complicated disorder. 24 seven, we take so little time to attend to how we feel, you know, because it's how can I complain when my child has to go through so much. And so we don't really ever name what it is that we're feeling and give ourselves permission to feel what we're feeling. And so then we can't really attend to it and move along from some of those stuck places and I really feel that the You know, the emotional health of a family begins with that center of the mom and the dad. And we need to get our stuff together so that we can create a healthy family emotionally.


Stacey Simms  35:14

I agree it's so interesting because we, as you know, an initial diagnosis. And though those first few years, we as moms, I think so define ourselves by diabetes, it almost seems like we have it like and you come to a realization that Yeah, do not be do not have diabetes, we do not have our child's experience. But it doesn't make the experience of being a mom of a kid with a chronic condition, any less valid. It's just a different experience. And I think I'm hoping, kind of saying the same thing you are in that once you realize that it's a mom, that it's okay to take care of what you are going through, knowing that's different from what your kid is going through, you kind of name it and take care of it and acknowledge it and talk about how tough it is. And right now until you can do that. It's so difficult. Yeah,


Bonnie O'Neil  35:58

it's a kid. It is. And I'm so glad now that there's such increased talk about soul care, because that at least is putting it into the forefront of everyone's minds now. But I think parents of a child with a chronic illness just really need that permission to say, I too need this soul care. I am going through mourning. This wasn't what I was expecting. I was expecting my child to have the freest life imaginable. And they still do. But especially in those early years, it's a lot, we have to mourn the loss of this perfect health we had envisioned for our child, and we have to deal with the fact that Yeah, we are tired,


Unknown Speaker  36:42

a lot.


Bonnie O'Neil  36:43

And it's okay to say I'm really tired. And I think even under, like coming to terms with the fact that a lot of our friends just aren't going to get it. And there's a loneliness that we carry here as the caregivers of our children. And it's okay, and it's not it's once we begin to name it and look at it and explore it a little bit, and how it's affecting us. That's the beginning of healing and freedom.


Stacey Simms  37:09

And I meant to ask you earlier, and it's okay, if you don't want to talk about this at all, how is your sister doing?


Bonnie O'Neil  37:15

She has struggled in the last few years with some complications. She has had, I believe gastroparesis for, I think it's close to 10 years that I think, went largely undiagnosed, and then has been quite problematic in the last few years. She's begun going actually to my son's retinal specialist for some treatments for her eyes. And her second or third treatment, this most recent one, they found that the retinopathy had had gone away. So I'm very thankful for that. So she just maintains the most positive attitude through shouldering this disease through the longest time, but I can see that it you know, it has taken its toll.


Stacey Simms  38:06

And so in your family, you know, you have two people diagnosed at different times, but still almost, it's hard to describe how different it is. We talked about Lantus And then off air, you and I were talking about control IQ,


Unknown Speaker  38:19

right? No,


Stacey Simms  38:20

just a guess of reflection before we go of the technology and the advances of not only I assume your sister has is using different tools than she did when she was first diagnosed.


Bonnie O'Neil  38:30

She is for sure. And I think that has been a great asset to her. So yeah, she's using now the Omni pod and the Dexcom as well. I am so grateful for the time in which we live and for the medical advancements that Austin has been able to take advantage of. I know one of the my friends through jdrf. She said recently, I am so thankful for all of you parents who came before our family did who paved the way because my daughter her daughter was diagnosed at age two or three. I've never known what you have known. She's had the Dexcom as long almost as long as she's had diabetes. I don't know the sleepless nights that you know, I'm confident now like that each generation or micro generation is going to be able to say that to the ones who came before them that we're going to continue to advance and are the lives of our loved ones are going to continue to get better. And that also just gives me a lot of hope.


Stacey Simms  39:36

That's great. Well, thank you so much for joining me, Bonnie. I really appreciate your time. Best of luck with the book. I'm really excited for you. There's nothing like a book launch. And I hope we could talk again soon.


Bonnie O'Neil  39:47

Thank you so much. This has been such a joy to be with you. Thanks,


Unknown Speaker  39:50



Announcer  39:56

you're listening to Diabetes Connections with Stacey Simms.


Stacey Simms  40:01

Learn more about Bonnie and her book and her story at Diabetes In the episode homepage, as always, I put lots of links and info there, you could read an episode transcript, if you prefer to. Some people just like to read rather than listen to that it's fine by me as long as you get the info. In conjunction with this episode, I have a contest on social media. This is on the Facebook page for Diabetes Connections, not in the group this week. This is just on the page. And you can win a copy of her book chronic hope.

I also want to point out and I know we had a commercial in there, but I think it's really important especially for newer families to know that there are now options when it comes to using emergency glucagon because since the 60s, we've had the red box or the orange box, which were basically the same thing as you heard Bonnie talked about there mixing it up, and the big needle and all that stuff. There are new options. gfo hypopyon, is one that I spoke about, they are a sponsor of the show, they are a you know premixed ready to go shelf stable glucagon. And it's very easy. It's all in the panel ready, nothing to mix and you don't see that huge needle, it's very different. It looks more like an epi pen or an insulin pen and simple to use. There's also baxi me, which is a nasal spray. And that is also very easy to use, I will link up more information about that.

I just think it is enormously important to know that these things exist, knock on wood, knock on my head, knock on anything I can find. We haven't ever had to use emergency gun with Benny in 14 years. But as Bonnie illustrated, you just never know. So it's so important to be prepared. I'm also really interested in the future of this stuff. Because I keep hearing more and more people say that we're gonna be using it not just for Super lows, right? I mean, like me, you were probably told if He's unconscious, you know, if you can't keep anything down, that's when you use it. But now there's a new school of thought about using these in much smaller doses for less severe lows. So I don't have a lot of information on that. So I'm not gonna talk too much more about that. But I think that is very interesting. And something to watch. And certainly glucagon in an insulin pump is something that, you know, companies are working on, most notably the iLet from beta bionics. So, as we say all the time, stay tuned.

Tell me something good, a big honor for a wonderful member of our community. And that's about Minecraft to just ahead. But first Diabetes Connections is brought to you by Dexcom. And you know, when Benny was very little, and in the bathtub or in the pool, anytime his hands would get wet. I always noticed his fingertips. You know exactly what I mean. Right? We poked him so much. They were just full of these little pinprick holes. It looks horrible. I mean, you can really see it when he got wet at age 16. I am not inspecting his hands. I rarely see his hands anymore, but his endocrinologist does. And we went for a checkup in early January, his fingertips are normal. It's incredible. We've been using Dexcom for seven years now. And with every iteration, we've done fewer and fewer finger sticks G6 eliminates finger sticks for calibration and diabetes treatment decisions that we used to do 10 finger sticks in the past. It makes me so glad that Dexcom has helped us come so far. It is an incredible tool. If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions or more, go to Diabetes, Connections comm and click on the Dexcom logo.


Over the almost six years of this show, I have been so fortunate to have some guests that really made an impact on me, who I'm really lucky, I think to call friends now, but who I turned to again and again for information. I know I can rely on them. They'll give it to me straight and in a caring way. And one of those people is Dr. Stephen ponder. Many people know him because of his sugar surfing talks and books, but he's a practicing endocrinologist. He's right there in the thick of things in Texas when he can pray and hopefully post COVID runs a fabulous diabetes camp and has lived with type one himself for more than 50 years. He got a really great honor recently, and he says he was stunned to learn that he has been selected for a big honor at the University of Texas Medical branch in Galveston. This is where he went to medical school. And then he stayed there another nine years where he says he became a husband, father, pediatrician and pediatric endocrinologist and the award is the Asheville Smith Distinguished Alumni Award. He will receive that formally in June during the graduation ceremonies at Galveston and the to read his post about this was it was really inspiring he gave a lot of credit to others and he finished by saying never in my wildest dreams did I imagine an honor such as this so congratulations to Dr. Steven ponder for a great award well deserved that's just fantastic.

Another Tell me something good comes from Samantha Merwin who is the mom of Logan the elbow bump kid we've talked to them on the show before she is working to roll out a national program about Minecraft. This is a Minecraft t Wendy play project. She says she had a successful pilot and She's working to roll it out nationally, working out a lot of logistics apparently to roll it out for people outside of her home state. So more to come on that. And she's also been working on a project with the college diabetes network along with Cigna. This is a really cool program all about mentorship applications are going to open in February, I will link up the page that is already there for college diabetes network. Basically, it's a program for junior and senior undergraduate students, you got to be current junior or senior, and it pairs you with a Cigna employee who has a similar career interest. So if you want to learn more again, I'll put a link in the show notes. But this was really great. Samantha love the work that you're doing here definitely going to help a lot of people and keep us posted on both of these programs. My son used to love Minecraft he still plays it but man when he was like 12 or 13 that was all they played. It was pretty wild stuff. I don't know what he's moved on to now. Although that's a lie. He his friends are playing Uno. They were screaming and carrying on get the card game Uno. I asked him I was like why are you so loud? Kind of Be quiet. I figured there's like shooting people or doing something crazy. They're playing card games on the computer? I don't know, is there any sign that you're getting older than you don't understand the games your kids are playing. If you have a Tell me something good story, please send it Stacey at Diabetes or posted in the Facebook group.


Little bit of housekeeping before I let you go, starting next week, I'm going to be doing something different. I'm going to be releasing an additional episode every week. So we'll have the regular interview on Tuesday, the long episode with segments like Tell me something good and innovations and all sorts of stuff. The regular episodes on Tuesdays will continue that way. I'm adding an episode on Thursday. And these are going to be what I'm calling classic episodes. If you're a sharp eared listener, you will know that I dropped in a couple of these last year kind of as a test. They are interviews from several years ago, as I mentioned, we've been doing the podcast for almost six years now. This is Episode 347. So there's probably a couple that you have missed along the way. And what I'm going to do is put context to the interview, you know, kind of catch up with the person let you know what they're doing now, and then replay the interview from several years ago, we have really great stories from a lot of really terrific people that you may have missed. And this way, if you're newer, and you haven't heard it, it's super easy enough to scroll back. I mean, Apple podcasts only shows you 300 episodes Anyway, you don't have to go anywhere. It'll be delivered right to you. And you can catch up with some of the really cool people and stories that I spoke to back in 2015 and 2016. So that starts on Thursday, February 4. Right now I am scheduled to do it for about half the year. We'll see how it goes. And you'll have to let me know what you think. Because after all, the show is here for you. If you don't like it, don't wait half the year. Let me know right away. If you do like it, of course I would love to hear about that as well.

Next week, you'll be hearing from Lily I talked to the folks from Ypsomed a couple of weeks ago. Ypsomed and Lily are partnering to bring a new insulin pump to the United States. It's not a new insulin pump elsewhere in the world, but it could be here as early as 2022. We're going to talk about why Lilly decided to pivot and go in this direction. That is next week. And thank you to my editor John Bukenas from audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here next week. Until then, be kind to yourself.


Benny  48:29

Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged

Jan 19, 2021

It's been a year since Tandem Diabetes Care released their Control IQ software, hybrid closed loop technology to help increase time in range. What have they learned about how people are using the system? Molly McElwee Malloy, Manager of Clinical Outcomes at Tandem Diabetes Care, is back on the show to answer your questions and to talk about what's next in the Tandem pipeline.

Tandem Diabetes Pipeline

What diabetes tech to expect in 2021

Our innovations segment: using your CGM to get more out of exercise and.. a new study for people with rare forms of diabetes..

CGM and exercise


Fearless Diabetic Summit

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

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Episode Transcription:

Stacey Simms  0:00

Diabetes Connections is brought to you by Dario health. Manage your blood glucose levels increase your possibilities by Gvoke Hypopen, the first premixed auto injector for very low blood sugar, and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.


Announcer  0:22

This is Diabetes Connections with Stacey Simms.


Stacey Simms  0:27

This week, it's been a year since Tandem diabetes released their Control IQ software, hybrid closed loop technology to help increase time it range.1 since that day, as we do around here. We've all been asking for changes. Tandem says they're listening,


Molly McElwee Malloy   0:43

can it be more aggressive? Could it be less aggressive? Good, you know, do this or that I pick my targets. Could I put a timer on exercise? Could I do all that? We are looking at all of those things. I would say nothing's off the table right now.


Stacey Simms  0:56

Molly McElwee Malloy, manager of political outcomes at Tandem is back to talk about possible changes to controlling q to answer your questions, and to look ahead at other tech in the Tandem pipeline

In our innovations segment using your CGM to get more out of exercise, and a new study for people with rare forms of diabetes.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome back to another week of the show. I am so glad to have here. If you are just finding us if you are new to Diabetes Connections, welcome. We aim to educate and inspire about diabetes with a focus on people who use insulin, my son was diagnosed with type one right before he turned two back in 2006. My husband lives with type two diabetes, I don't have any type of diabetes, but I am the broadcaster in the family. And that is how you get the podcast.

It's funny to look back on this year. Because not only did none of us have any idea what 2020 would really be like, but more to my point here, as I'm taping this on January 15. And planning to release on the 19th. This was a time when many of us in the community were just refreshing the Tandem page over and over again. Because Control IQ had been approved. And many of us had already talked to our endocrinologists about it and tried to get the prescriptions. And if you remember that time, especially on social media and some of the Tandem groups, it was a bit bananas. But we have been using Control IQ for a year. Now Benny got his set up at the very end of January, as I recall.

And they are not a sponsor of the show. They do not pay me to say this. But it's been absolutely amazing for us, it has really made a big difference. And you know, I don't share numbers. I'm not all about the numbers and straight lines with him. But I do want him to be healthy. And I think we were doing great before but just back from the endo this time around about a week ago as you're listening now, his lowest A1C ever. And the time before that was his previous lowest A1C ever. And the best part is he's doing less work. And I am I swear I'm doing less nagging. If you ask him, he will tell you otherwise. But I promise you it's true. So I'm thrilled to talk about control IQ. I'm really excited that all of the pump companies are moving in this direction, it would be amazing for everyone to have access to this kind of technology. That is a discussion for another time. Probably

Another little bit of personal news, Benny got his driver's license. I know I can't believe it either. Here in North Carolina, you get your permit. If you want at 15, you can actually take drivers at 14 and a half. But you get your permit at 15. And you can get your license at 16 right now, because of COVID. They are not even doing road tests. I know isn't enough bananas. But what happens is you get your basically your junior driver's license, you can't drive at night, which is what he would have been issued anyway, if he passed a road test. And they cannot move on to the next level the after nines until they get a road test. In fact, I believe what he has expired in six months without a road test. So he'll have to take one. He's a decent driver, you know how superstitious I am. So I'm not going to say more than that. But I'm confident we've got a whole system with diabetes we have we've had these discussions, and he's just so excited about it. And I'm really thrilled for him that this step has taken but as a parent, and for those of you who have known him since he was two, how did this even happen?

Okay, we're gonna talk to Molly from Tandem in just a moment. But first Diabetes Connections is brought to you by Gvoke Hypopen and almost everyone who takes insulin has experienced a low blood sugar you know, that can be scary, but a very low blood sugar. It can be really scary, and that's where Gvoke Hypopen comes in Gvoke is the first auto injector to treat very low blood sugar. Gvoke is pre mixed and ready to go with no visible needle. That means it's easy to use. How easy is it, you pull off the red cap and push the yellow end onto bare skin and hold it for five seconds. That's it. Find out more go to Diabetes and click on the Gvoke logo. Gvoke shouldn't be used in patients with pheochromocytoma or insulinoma visit slash risk.


My guest this week is the manager of clinical outcomes at Tandem diabetes care. And she lives with type one, Molly McElroy is I am grateful to say a frequent guest. And if you're a longtime listener, you know, her career and her life has been shaped by the technology that is now control IQ. That's not really an exaggeration. She was one of the first to test out an artificial pancreas system. And she changed her career path because of it.

And my first interview with Molly was in 2016, when type zero technology announced their partnership with Tandem, and I will link up the previous episodes, we've done a bunch with her all about this software, you can find those links, as always, in the episode, show notes, wherever you're listening, the app should have show notes. If it's difficult to find, just head over to Diabetes And every episode now has a transcript and lots of links and notes to help you out. Please stay though, to the very end beyond the interview because there are a few questions Molly had to check on. She couldn't answer at the time. And they sent me that information. And I will give that to you later on in the show. Of course, as I said, there's a transcript so you can check it out that way as well.

Molly, thank you so much for coming back on to talk to me a year ago, you and I spoke about Control IQ it had basically just been approved. And you were kind enough to jump on that in late December. So thanks for coming back on.


Molly McElwee Malloy   6:26

Oh, you're welcome. I'm very excited to be back on this.


Stacey Simms  6:29

Yeah, well, lots of lots of questions, of course, from listeners and from me. But let's just start by taking a moment to kind of reflect what's the last year been like for you guys at Tandem?


Molly McElwee Malloy   6:39

You know, it's been really crazy great is the best way I could describe it. There's a lot of excitement for control IQ, and rightfully so. And there's a lot of the feedback via social media about people's experience. And it's been really, overwhelmingly positive. It's also been kind of emotional, because this has been a rough time for everybody, right? Like last eight months or so that we've been in. I've been calling it seclusion. But it's, you know, everybody working from home. And that's been a really high stress situation, particularly for people with chronic disease, and myself included. So I've really been grateful that control like has been out and approved. And a useful tool during this time. Because just you know, stress influences glucose. And so it's been a big, huge help for a lot of people, particularly during this time. So it's been crazy great. And it's been busy. But sure, I would love to experience control, like you and all the interaction with healthcare providers in person. But it's been great just talking to people on the phone or on video or teams. And it's been really good that we've been really busy. Yeah, sure. All right.


Stacey Simms  7:43

So what I'd like to do is take a look back, get some information from you about control IQ, and then kind of take a look forward because we know the product and the product line is evolving. So let's just start by asking you, what have you learned about control? IQ obviously had all the study information. But looking back at 2020? How are people using it? How is it working out? What is the data telling you,


Molly McElwee Malloy   8:07

you know that this is the funniest thing, and this is not something that you can plan or you could guess but our real world data is better than our clinical trial data. And I'll say that again, because it's just, it feels a little crazy to say that out loud, because that's usually not the case, right? clinical trials are very well managed. And you know, there's protocols and everybody's sticking to stuff. But it turns out when you put this put control, like you in the real world where people are experiencing significant hyperglycemia, or even hypoglycemia, it does even better. So I mean, the clinical trial population was pretty well controlled, right? And we were still able to improve on that. But when you put it into the real world where people are doing, you know, they're real people, they're doing all kinds of real things, and we're able to get even better outcomes. It's surprising. It's awesome. It's a really cool experience, and definitely unexpected.


Stacey Simms  8:59

Yeah. So let's dig into that. Can you tell us in terms of I guess you're measuring things like time and range? Can you give us a little bit more information about what you mean by they did better?


Molly McElwee Malloy   9:09

So for one, it's it's time and proven time and range, right. So in our pivotal trial, we had about 11% over baseline improvement on time and range from a very good well control group, which is awesome. But in real world, it seems to be closer to 13%. Sometimes a little bit better. We've got some results from D Q&A which is a third party vendor that does research and they're affiliated with Diatribe. And they did some survey results about time and range by insulin pump therapy and it's been really cool to have like a 33% getting 81 to 90% time and range 31% getting 71 to 80% of 11% getting 91 to 100% which is crazy. So you know all of that And it just is amazing because it really does. It whips up on the competition. But it also just shows that, you know, this works even better in the real world.


Stacey Simms  10:08

Any idea why? I mean, are people using sleep mode? Are people figuring out different ways to use it better? I'm just curious what you think might be happening?


Molly McElwee Malloy   10:19

Yeah, I don't think it's the using sleep, you know, 24, seven or something. I think using a sleep schedule has been very successful. But I think the reason for this is that largely, and not everybody was correcting aggressively, right. So while there are that subset on Facebook, or social media that are trying to get that, you know, super, super tight range, there are plenty of people who, between meals, we're not correcting, and now they're receiving those corrections. And there's some evidence that we were able to publish. And I think we showed an ADA, but that persons with type two diabetes are benefiting from this. And that's because they're getting the corrections between meals, which we don't typically ask people with type two diabetes to do that. So getting that tighter control is really, really helpful. And again, not everybody does that.


Stacey Simms  11:11

Yeah, I have one of those people in my house, who not everybody does that. I mean, we I tease Benny all the time, and he knows that I I talk about him on the show like this, he will happily, let me say that Control IQ has helped him significantly because he often boluses after he eats or forgets to bolus or didn't correct between lunch and let's say, bedtime, even if he gave himself insulin for dinner. And it really has made that burden lighter. And it's certainly not perfect. I have friends whose kids are much more engaged with their diabetes, I guess is a way to say it where they, they will you know, they'll bolus every two to three hours, or they're looking at their watch every 20 minutes. But he's never been like this. And it's really improved his quality of life. Because I'm not, I'm not willing to make him do that.


Molly McElwee Malloy   11:57

Well, and if you think about the long term, decrease the complications because of this going on in the background is sort of automating this. I mean, that's a huge improvement and quality of life. One of the things I'm really excited about is to watch this going forward to see how we can measure decrease long term complications from this, you know, the not just like seeming variability, but with those micro macrovascular complications. But this is long term complications from diabetes from having high blood sugars. And, you know, that's just something that we've never been able to really control for before. So this is going to be very cool to watch and see how it plays out.


Stacey Simms  12:36

No doubt. All right. We've gotten a little bit inside baseball, but I think most people listen to the podcast will understand some of the shorthand, I'll try to explain as much as I can. But if there are things that we mentioned, that you are not understanding, I'm going to link up lots of stuff in the show notes. But one of those things is sleep mode. And I just want to take a second to talk about that. Because you and I, when we talked last year, you said that there were some people using sleep mode, which will adjust basal but will not give you boluses, they were using a 24 seven in the studies, you called them sleeping beauties. And there have been many, many people in the real world settings who use that we do not we actually don't laugh at me, we stopped using sleep mode for sleep. Because as great as it was working for Benny with what you called a seclusion, we found that he was eating at interesting hours, you know, 1am 3am I mean, he went full nocturnal for about a month there way back when I want to say like June or July. And so we turned off sleep mode because we needed that bolus power at weird times. So it's been really funny how you can kind of use the system in a way that works for you. But getting back to my question, what have you learned about sleep mode? Is there anything you can share with us?


We'll get her answer to that question and what she can share in just a moment. But first Diabetes Connections is brought to you by Dario health and we first noticed Dario a couple of years ago at a conference. And then he thought being able to turn your smartphone into a meter was pretty amazing. I'm excited to tell you that Dario offers even more now, the Dario diabetes success plan gives you all the supplies and support you need to succeed. You'll get a glucometer that fits in your pocket, unlimited test strips and lancets delivered to your door and a mobile app with a complete view of your data. The plan is tailored for you with coaching when and how you need it and personalized reports. Based on your activity. Find out more, go to my forward slash Diabetes Connections. Now back to Molly answer my question - we were talking about what Tandem has learned about the use of sleep mode?


Molly McElwee Malloy   14:44

Yeah, yeah, there's lots like I've learned I just want to share quickly that I've seen in looking at lots of reports with lots of health care providers that during what I've been calling seclusion or hibernation this this COVID time that people schedules are very, very different. They're eating at different times. And that sleep, as originally intended right is not what it looks like during this time. So there's a lot of people who have benefited from not using sleep when they're eating right through the night, or snacking, or staying up extra late or, like really altered schedules, right. So we've seen that some people have turned sleep off, and that's been successful for them.

So sleep, what sleep is doing is it's based off of fasting metabolism. And it's using this 112 to 120 sort of target. And it's really, it's a really tight range. But it's doing this through modulating basal. And the reason it's only modulating basal and not giving corrections is because someone is sleeping, and they're not, we're not anticipating postprandial spikes, and we're not anticipating exercise or activity. And so it's really, really meant for when you are kind of static, and you are sleeping. Now, that said, Not everybody's sleeping normally, particularly during COVID. And so it doesn't always work that way. And then some people want to have sleep 24 seven, so that the basal is modulating, but that they're responsible for the corrections. And if you're willing to glance and see if you need a correction every two hours, that can work really well. But if you want to alleviate that burden, right, then, then sleep maybe isn't the best thing for you to use 24 seven, so it really depends on the user and the user's interaction.

But the other thing I wanted to mention about sleep for users is that one of the things that we've noticed, and how people are using sleep is that if their schedule have has changed drastically with COVID, that they may need to reevaluate that sleep pattern as to what time it is. So for instance, if someone previously wasn't snacking at 10pm, and now they are starting sleep a little later may make sense because they may need an additional correction before going to that, you know, that's one circumstance I've seen a lot of. And another one is, there are some patients who can't go to bed with a positive IOB. And what I mean by that is, you know, going to bed with any insulin on board that is not related to carbohydrates, right, so for correction, and for them starting sleep sooner, and you know, obviously not eating right before bed, makes sense, because they're not getting any corrections before bed. So there's sort of really two very different types of insulin sensitivities, right, the person who's eating and then needs the additional correction, who may want to start sleep later. And then the person who isn't eating after dinner, and really doesn't want any additional corrections before they go to bed, starting it sooner. So I've also seen that very interestingly playing out in the public realm, and it's it's interesting to see how people are using it to make it work for them.


Stacey Simms  17:44

Yeah. What about exercise mode? Have you learned anything about how people use that we don't often use exercise mode.


Molly McElwee Malloy   17:50

Yeah, exercise is interesting, because it's sort of like a temporary basal rate, if you will, which you set indefinitely, right? until you start it and you stop it. And we hope in future versions, we'll be able to put a timer on this. But for right now, you start and stop it. And so you could be in sleep for 24 seven, if you wish, I have seen that be useful when people want to keep an a higher target, and want to be a bit more aggressive and preventing hypoglycemia, right. So that's an interesting thing that has and can be used selectively, whether it's for exercise, or just because you would like to keep up, you know, you need to be a little bit more conservative on the hypo end. And you really do want to have a higher target, you know, and COVID times looking at how particularly the aging population is trying to stay at home rather than go into care, using something that's going to keep them a little safer on the lower end and elevate that glucose level a bit has been useful, and just allowing people to remain, you know, in a safer range with preventing hypoglycemia.


Stacey Simms  18:51

I'm curious to see if there are any best practices, or any advice for starting the system. A lot of people who switched from Basal IQ or other pumps or no automated system, you know, just a regular Tandem x2, and I'll put myself in this camp. We were one of the first people on this in late January of 2020. We started on Control IQ before my endocrinologist or shouldn't say that way. We started on Control IQ before Benny's endo was trained. So I was in touch with him, but he was like, tell me what you find out basically, like, show me Show me Benny settings like we're gonna adjust as much as we can. But what are people saying? What are what are the you know, what are the experts saying? Trust me, my endo doesn't take advice from Facebook. But you know, it was one of those situations where we're learning together. And luckily, he trusts us to do that. But then he had, you know, we put his regular settings in, and we had massive overnight lows. And we had to adjust because of that five hour increment. We had to adjust. Basically everything works like a dream now, but it was a different transition than I had anticipated. I'm curious if you learned anything from that and what your advice might be now?


Molly McElwee Malloy   19:56

Yeah, one of the things we noticed, particularly people going from Basal IQ to To Control IQ as in basal IQ, they'd sort of artificially inflated their basal rates to sort of hug that line at 80, right or, because because it can always turn off, right? It's always preventing hypoglycemia, so why not have that basal rate a bit more. And with control IQ, it really takes that information and says, okay, that's where you are at baseline. And if that's really overly aggressive for where you are at baseline, then you're going to have hypoglycemia. So getting optimized settings is super, super important. And we do still see that people going Basal IQ to control IQ, that they've had really aggressive basal rates, and you need to back off of that, or even really aggressive meal. boluses, right. So sometimes getting that reevaluated with your healthcare provider, or diabetes educator, can be really, really helpful. But also coming from other AI D systems where you may not have as much information about, you know, what's going on with your basal rates or anything like that. But really just going when in doubt, wipe it out, you know, go back to basics with your settings, and with your provider and making sure those are dialed in. Because control IQ  is being a metabolic algorithm, it really does behave when we really did design it around sort of insulin titration as we know it. So it's not any, any crazy math, it's not an occult science, it's, you know, it's what your endocrinologist would use now, for titrating insulin and going back to those basics is is really necessary to get a good solid start.


Stacey Simms  21:23

So would you recommend maybe basal testing or just talking to your provider about what they think is best for your settings,


Molly McElwee Malloy   21:29

talk to your provider about what's best for your settings. I mean, I can't give any medical advice on on how to do that exactly. But there, there are known ways to do this, whether it's you getting your basal rate, or your carb ratio, and a correction factor all dialed in. Do that with your provider. I I personally hate basal testing, I will tell you that I don't like basal testing. The reason I don't like it is because when people are basal testing, they are altering their behavior from normal. And it is not a true test, right? They're trying to avoid hypoglycemia. They're not doing their normal schedule. Because if you get hypo right, you have to treat it's trashed, you have to do it again. And so beta testing is, in my personal opinion, a nightmare, and not a true representation of what the patient is actually needing during that time. So I would I would prefer to do is see how controller hue is changing baseline and then see what that looks like against what's programmed and kind of, you know, look at the difference between the two to get the feedback. So really think basal testing is, you know, in theory, it's a good thing, right? But nobody basal testing is doing exactly what they were doing before that because they're not eating, right, they're trying to be careful about hypoglycemia. Sometimes you're just staying home all day to try to test this out, because you have to do so many finger sticks or what have you. So I don't think it's a really good representation of what's actually going on, I think, you know, looking at your total daily dose of insulin and talking to your healthcare provider, you can get that dialed in much better, with much less frustration. What I did with Benny and


Stacey Simms  22:59

I agree with him on the basal testing, we haven't done it in years and years and years for many of those reasons. But what we did that work nicely is we made changes very slowly. And it can be very frustrating. But it really works well. For us. Again, this is not medical advice. This is me personally what we did. And it really helped, we made one change basically, like he went low at 2am. So I changed the basal rate and we waited like three days, then and even if we went low, we treated but we didn't change the basal rate, then we worked on the insulin sensitivity factor, then like it took us two to three weeks before we thought we might have it and then we adjusted again about a month later. And if you if you can be patient, which is so hard to do, you know, people especially especially, and I'll throw myself under the bus too, especially as parents, we get nervous if anything's out of whack, right? We want everything to be perfect. What happened to my straight lines, and it's really hard to dial into settings, unless you're willing to let some of that perfection slide for a few days or weeks. But I'm telling you do it slowly, it'll come out much better in the long run.


Molly McElwee Malloy   24:03

Right. And if you think about an experiment, like for instance, the one that often comes up in our household is meant to my husband likes to follow recipes. And I hate following recipes. Although I know it's absolutely necessary, right? Because if you don't get the flour and the sugar and everything else, right, it just tastes like dirt. So they when you're baking, because I have done that. But it's very important to follow those recipes because if you alter you know one thing versus another thing, you're gonna get a totally different result. So altering one thing at a time is very important in a scientific kind of experiment, which sometimes dialing and pump settings is absolutely like that. And you need to follow that recipe. You can't willy nilly. It's not an art, right. It's very much a science. There's no there's no artfulness in this.


Stacey Simms  24:51

So looking ahead, and I'm not sure how much you can tell us but I'd love to start by kind of asking you about changes planned to control like you bet He has the first question here. He wants to know when the auto correction, right that auto, I call it the auto bolus, but the auto correction, when that will be stronger, because right now it's 60%. automatically.


Molly McElwee Malloy   25:12

Yeah, 60% because we're also titrating. Basal. Right. So the combination usually gets you closer to 100%. We are currently working on what that looks like, and how we could do that safely. I don't know how quickly that comes to fruition. But I can tell you that we are working on trying to understand how you would increase aggressivity without increasing hypoglycemia


Stacey Simms  25:37

you need a teenager setting, I can tell you that


Molly McElwee Malloy   25:40

we need a teenager aggressivity setting that's, that's for darn sure. Yes, Yes, we do. Well, maybe


Molly McElwee Malloy   25:45

I should start


Stacey Simms  25:46

by really asking you what what are you looking at in terms of improving or changing control iQ?


Molly McElwee Malloy   25:52

So we've we've really listened towards to feed back, right. So one of the things we do at Tandem, which we do really, really well, is we do these surveys all the time, where I'm constantly asking you, and you probably get these, what do you think of this? What do you think of that? What do you want from this, what you want for that, and then we look at the glycemic data, and we do some comparisons, because you can't just take what somebody wants as the absolute that would be best for everybody without looking at glycemic data. So we're kind of looking at both of those things, to see how we could refine Control IQ for something in the future, that works better and something that people don't even more excited about. So we're looking at people's sort of concerns? Or how aggressive can it be? Can it be more aggressive? Could it be less aggressive? gonna, you know, do this or that, but I picked my targets? Could I put a timer on exercise? Could I do all that? We are looking at all of those things? I would say nothing's off the table right now. I don't have any promises as to what comes first. As far as the improvements go, I think, you know, the next thing that we've been working on sort of is that bolusing from your phone, and being able to bolus from the app? Because that's been a big request.


Stacey Simms  26:57

Oh, but I'm asking about that. Don't worry.


Molly McElwee Malloy   27:00

Okay, yeah, because the thing, the cool thing about working as you know, we're a software, pump company, right, software based insulin pump company, which is cool, because you can make changes to software a lot easier than you can make changes to hardware. And so since we're not reliant upon the hardware to change, to make major changes, we could kind of do this in an iterative fashion, you know, one thing and then another thing, and then you know, and build and build and build a better product as we go along. And like you said, before, doing it slowly, carefully, looking to making sure that the changes are appropriate and working for everybody. So we're gonna follow that sort of scientific process, but we're looking at a bunch of different things that we might be able to change or, or make better based on feedback that we've gotten from our users.


Stacey Simms  27:49

One of the things that the other pump companies are coming out with, or if they come out in 2021, is a lower and different range, target range, or target number, you know, Omni pod and Medtronic have said that it'll be lower than, you know, 115, or 110. It'll be down to 100. It might even be adjustable. Can you speak to what Tandem is looking on that?


Molly McElwee Malloy   28:12

I think we're looking at a lot of different things I do. And full disclosure, as everybody knows, I come out of the University of Virginia research school center for diabetes technology, and working with Dr. Boris kabocha, and working with Dr. Mark proton, and Sue brown and Stacy Anderson, and really getting familiar with what is safe, and where people can kind of push the limit and where you can't, I think that 112 point five that we've chosen as being a really safe glucose has been really safe for the majority of the population. And since we're designing for the majority of the population, it's been very successful. So I know there are people who want to choose differently and want tighter targets. Now, when you choose tighter targets, whether it's 100, you know, some people will want 80, things like that, you're going to have to trade off some hyperglycemia. And as a product that gets approved for vast majority of patients, when you increase hypoglycemia, you are inviting adverse events, right? You're inviting possible adverse outcomes. And so you have to be very, very careful and almost ginger with that, and what that's going to mean for your patients and for the whole population. So I approach that cautiously. And I think at Tandem, we're approaching that cautiously as to how do you do that without increasing hyperglycemia? I think other people choosing those targets, you're gonna see the trade off with increased hyperglycemia. At least that's what we've seen so far. And in clinical trials,


Stacey Simms  29:56

it's interesting because people listen to this podcast generally. We are found through the research that I've done, you know, are extremely well educated, you know, very much take control of their diabetes in terms of even willing to do DIY stuff, right? It's a different population.

So as you're listening and you're thinking, well, I want to ride at You know, all day long Give me that flexibility. and wondering, you know, how do we balance that, as you're saying, with the 99% of people with diabetes, type one and type two, who may use this pump, who don't have access to the education or the time to look into it, or you know, many, many, many factors that increased that chance of hypoglycemia, as you said, but the other hand, it's a selling point. And other pump companies are already saying, we were going to be better, right? Or we're going to be more flexible. And I don't know if that's even a question for you, Molly in the position you're in. But it is something that I guess you really have to take into consideration.


Molly McElwee Malloy   30:38

You do. And I can speak more philosophically about this than I can. Anything else. But you know, particularly as a diabetes educator, and as someone with diabetes, hugging that line at 80, or 82, or whatever someone wants to do, you do have increased hypoglycemia. So the most relevant experience I have to pull from is pregnancy, right? during pregnancy, we asked people to stay, you know, very controlled, which you know, is a little bit like magical thinking, because it's very, very difficult. When you get all these hormones raging and everything going on and you're sick this minute, you're hungry, the next and all this stuff is going on, I spent a miserable amount of time and hypoglycemia, this was before any automated insulin system, right? So my daughter just turned four, so we can do the math. And she's my youngest. So I know nothing was on the market at that time, that would have helped me. But that was preventing that, but in letting me ride that really close line, have you know, let's hang out at 72 all day, at personally thought that was a miserable experience, whether it's the neural glycopyrronium, right, so your the lack of glucose to the brain where you're like, I can't remember what's going on or what I need to think about next, or you're constantly tweeting hyperglycemia. Like, it's not a trade off, I would take lightly. It's a risky trade off.

And I would say for for people who are comfortable being in that space, that's fine. And that's a very small amount of people, right. And if you can hug 82 all day, with, you know, whether it's doing some sort of low carb diet and intense exercise or what what have you, that's awesome, you're also not the majority of the population, right? So while I can appreciate that people want that, and they want to be able to set a much lower target, you know, people with euglycemia, right, without diabetes, don't have that either. People with without diabetes do have, you know, 30 40 point range, sometimes with meals and things like that happening. So it's not, it's perfection that I don't know, is a realistic ask for someone with diabetes. Now, people who can do this and do this all the time, I guarantee you, they're spending a tremendous amount of time and thought on it. Again, if you want to do that, and you can do that. And that works for your sanity, then please, by all means, but for a lot of people, you know, like, we have other things that we are going to be focusing on, and it's not going to be diabetes 24. Seven, and the goal of an automated system is to relieve some of that burden. So, you know, it kind of depends on like, Are you okay, with the trade off being low? Are you okay, with more management with being more involved? A lot of that's just going to be decisions, personal decisions someone's going to have to make, but I wouldn't say that the lower target is necessarily advantageous for a large population.


Stacey Simms  33:24

Okay, as you listen, I know, you were screaming at me to go back to bolus by phone. Don't worry. I didn't let it slip by. Let's talk about that. Because the app came out spring-ish of last year for general users. And it's great to look at people love the information. Talk to me about if you can tell us a timeline or any information about bolus by phone?


Molly McElwee Malloy   33:46

Yeah, so one of the cool things about my job is that I get to work with the Human Factors department and we have really good human factors department at Tandem. And we


Stacey Simms  33:56

stop you there human factors, because that always confused me. That means how people actually interact like how stuff feels and looks and how you actually use it,


Molly McElwee Malloy   34:03

and how you understand it. And how logical is something to you? How intuitive is something to you, you know, something as simple as changing where and the menu structure you would put something we test to see if trained, can people find this? Is this intuitive? Does this make sense to you? If we use a new term, right, we test it to make sure that it's understandable the thing might, you know, this is a very much outside of the realm of insulin pump therapy. My favorite illustration of human factors is if you you know any hotel you've ever visited, you pick up the hairdryer that says do not use in the shower, right? Like someone did that there was someone I'm sorry, yes, somebody did that. Right. There's, you know, crazy warnings if you'd like pick up a pillow, it's like you know, do not use while smoking or do not, you know, things like that, but it did happen. So that warning has to occur. So if we change something with insulin pump therapy, or we Add a feature like bolusing. From iPhone, we have to test it very thoroughly to make sure it's safe, effective, understandable and intuitive, because not everybody is going to read the instructions. So we have just completed the mobile bolus testing. And we've done extensive work, testing it in a number of different scenarios, people with type one, type two pediatrics, where they are in charge pediatrics, where the parents in charge, you know, there's a wide range of people who are using the system. And we need to test in all of those different user groups and get feedback. And it went really, really well, which was excellent, which means that it can then get submitted to the FDA. So I suspect that that will be happening somewhat early in 2021, first half of 2021. But I don't have insight or line of sight as to when that is promised. Because the FDA is so so concerned with COVID right now as they rightfully should be, and approving vaccines and things like that. So there's a little bit of a backlog there. And I don't know how that's gonna affect our timeline. But we've been working really hard to get that out. We know people want it, we know people will need it. And it will be a really useful feature. But it's been tested really well.


Stacey Simms  36:08

So and again, I'm, I get a little fuzzy sometimes on the details here. What kind of submission is this? I have learned in the last few years that there are different ways of submitting to the FDA some take longer to approve. I mean, we never know how long it'll take to approve Having said that, but there are some things that are like building on previous submissions is bolused, by phone something so new, that they have to look at it in a new way, or is it building on something you've already asked them about?


Molly McElwee Malloy   36:32

It's a good question. And I'm not part of the regulatory team that is involved in that strategy. I believe that we are building on our previous submission, since this is an on an ace pump, an alternate controller enabled pump and the and the the way that the pump is built. And the way that that is structured for regulatory purposes, is that you build upon last submissions, but I can't speak with authority on that at this time.


Stacey Simms  37:12

The other thing that we are very interested in as a household and a community is that what has been called the T-sport, can you talk about where that is in the process, and that's the tiny tube pump, I guess I would call it, I'll link a picture, if you're not familiar with it, we will link up some more information. But it's not quite a patch pump, there is still a little tube on it. But it's much smaller than the x two and it's made to be worn kind of flush or flatter to the body.


Molly McElwee Malloy   37:28

Right. And the idea behind this is that you could have a variable to be linked right very, very short tube on your body to longer where you just put it in your pocket. So depending upon the patient needs, the reason that it is still has an infusion set is that we know right from feedback that if you have an occlusion with a patch pump, you take that patch pump off and you lose that insulin right, and you lose that whole thing. If you can replace a site, and not all of the insulin that's in you know in contained to their end, then that is an easier fix for somebody, it's also less expensive. So that's something that we've been very keen to keep. And addition, the the idea that you might need a different angle set. So not everybody can use the same sets as successfully as others. This will allow us for some variety there as well. And so we're pleased about that.


Stacey Simms  38:22

And I can just jump in and kind of translate because I know you're you have to be careful about what you can say. But as you're listening, if you're wondering what she's talking about Omnipod goes in one way, there's not an angled set, there's not a steel set, there's not a different set, there are a few more options if you're using a tube pump, if the inset on the pod pump doesn't work for you. And so there's also as you mentioned, the insulin that's in the tubing, you can do I don't know if this is Tandem approved, so maybe don't listen, Molly, but you can do separate site and tubing cartridge changes when you use a tube pump, which is what we have done for years. So when he said of insulin, the pump, we change the cartridge, when it's time to change the inset, we change the inset we don't do those together. So, you know, advantages and disadvantages for each pump. I know Omnipod people love the things that are great about their pump, but those are the differences that you're talking about. Just in case you can't get into the nitty gritty.


Molly McElwee Malloy   39:11

Right, absolutely. And you know, we're big fans of choice at Tandem. So if something works for you, great, excellent. And so one of the reasons that we're so big on choices, because not everything works for every person. So this book allows somebody some choice within that. That option.


Stacey Simms  39:27

So where are you in the in the test? I know you can, you can barely give us full details. But where are we in terms of T-sport? Is it? Is it in testing? Is it is it coming out soon?


Molly McElwee Malloy   39:37

I can't speak to the exact timeline. And part of that is because the FDA is bogged in and down in COVID right now, but we are working on it. I know we're working from a human factor perspective, we're working on what the difference is going to mean for the patient and training for something like this or from the healthcare provider and training and something like this. And that's the aspect that I'm involved in, is you know, how do you train on something that's a little But different like this, and how do you change the training to adapt to that, but everything is in development. The thing about Control IQ and and even basal IQ is right there already tested. So those can be implemented in a new form factor without any problems. So that's something that we don't have to worry about. So it's more of just form and function and things like that.


Stacey Simms  40:19

Here's a dumb question for you. I have heard that T-sport is the name that you all are kind of using internally, and it may not have that name when it's released. Any update on the name? Is there an update on the name? Oh,


Molly McElwee Malloy   40:31

I am not the person that would be able to tell you that. Oh, okay. But I appreciate the question.


Stacey Simms  40:38

I think you should have a contest and you could name it, you know, pumpy mc pump face or something. But yeah,


Molly McElwee Malloy   40:43

exactly. Yeah. Yeah,


Molly McElwee Malloy   40:45

we're shorting


Stacey Simms  40:46

Yeah, surely that's perfect. I was laughing when we talked about that this summer, because it's interesting. And it's such a wonderfully privileged place that I'm in I feel like we're we find out this information. So early in the process, that the branding isn't really even set. So it's when I heard that I thought, Wow, what a cool place to be in some very interesting stuff. Right. I have a few questions from listeners for you. I know you have some more information. We're getting kind of long here. But let me ask you, here's a quick Control IQ question. And this is more advice. I don't know if you can answer this. So this person says, sometimes I like to set a higher basal in advance of when I work out because adrenaline makes my blood sugar spike, can you change that. So we can manually adjust basal rates without having to turn off control IQ, I know my body better than the software having to manually adjust with boluses after and having to guess, since I can't do them based on blood sugar due to iob issues is tricky. And I will jump in and say Molly, Benny, and I do this too, we do some guessing with the manual boluses. So I'd love to hear what you think about this.


Molly McElwee Malloy   41:49

Sure. So there's a couple different directions we can go as one is you can turn Control IQ off and on and do temp basal rates. And there's no penalty, right for doing that. There's no learning time or restart up or, or anything like that, that impacts Control IQ if you turn it off and on for those periods of time. So that is absolutely an option. It's just it's super easy to do. Another thing that we've seen people do successfully is set up a secondary profile that is a bit more conservative or a bit more aggressive, depending upon the patient needs. And then switching into that profile for that period of time. And leaving Control IQ on so there's a lot of different ways you could do this, you could even do a secondary profile, and then put it into exercise, right? Like you could do conservative plus that temp basal, right, or you could do aggressive plus that 10 basal rate. So all of that is it's entirely possible. But knowing that you can turn it off and do the basal rate as you please and then resume it confidently, you know, that's still an option for you. I do know that people do want a bit more control over that. And so and, you know, allowing for some sort of ability to have a temporary basal rate is on the list of things that we would like to do. Great.


Stacey Simms  43:03

Another question was I am still using basal IQ. And this person is really curious about what percent of Tandem users are using control IQ. And and you've kind of touched on this. But do you have any statistics about user satisfaction rates for control? iQ?


Molly McElwee Malloy   43:18

Yeah, so D q&a, again, affiliated with diatribe, third parties who, you know, has done some user satisfaction surveys, and I will get you the exact number. But this user satisfaction with Control IQ is very high, very, very high. And I would say the majority of people have changed over to control like you. But there are still patients on base like you and I can't speak to the exact percentage, but there are reasons why somebody may want to choose based like you to just have that suspension rather than also, uh, you know, having the, the auto correction or something like that. So there's cases for both, and that's why they're both still being offered. But I can't speak to the exact number of people who have not switched over, but most people are switching over to control like you.


Stacey Simms  44:02

Are there any plans to make it more flexible in terms of switching back and forth? Because once you go from basal IQ we did this once you put the software in your pump and switch to Control IQ you can't go back to basal IQ. Are there any plans to change that?


Molly McElwee Malloy   44:16

Not at this time. The reason being is that you wouldn't need a script, write a prescription to do that. And when you upload your property went to your provider. If you went between one thing and another and another all the time, we would really have to differentiate those reports and make sure that the healthcare provider was familiar with why each was different because they would impact how you would titrate insulin so it adds a lot of complexity on the therapy end. And so we have not made a move to to make that something that you could toggle between. Got it.


Stacey Simms  44:51

And another question came in which I thought was really interesting about accessibility for people who are blind and I know in the past, there was a meter that I think talked about There was more audio is Tandem looking at more accessibility for people who don't have any vision or low vision.


Molly McElwee Malloy   45:07

Yeah, yeah. So Tandem is making technology user friendly for those with different abilities. And we're absolutely have this on our radar, persons with low vision or no vision, right, using a touchscreen could be difficult. And we're exploring ways to leverage apps and existing consumer technology that might be able to solve those unmet needs. It's definitely definitely something that we are looking at and can appreciate that that's something that we need to do.


Stacey Simms  45:32

Very cool. Another question came in, and this is based on an older press release. So I'm not sure if you can speak to it. But apparently JDRF in Tandem years ago, like eight years ago, put out a news release about a dual hormone, insulin pump. What we're seeing if you're familiar with the iLet beta bionics is because the only one at least in the US where they're trying to develop a pump with insulin and glucagon with more stable glucagon now on the market, any chance that Tandem is working on a dual chambered pump.


Molly McElwee Malloy   46:02

So the big message here is that that eight years ago, I think, for the press releases when Tandem was being used with two separate pumps in the iLet studies, right, right, they ran the Tandem pumps, and one was full of glucagon and one was full of insulin. And they were putting two pumps on one person,


Stacey Simms  46:13

I remember that picture. Wow.


Molly McElwee Malloy   46:21

So that's where that came from. So but our our micro delivery technology is really well suited for to hormone therapy, we currently are only approved for you 100, right? insulin and only indicated for insulin per FDA. But you know, it's a fundamental challenge for people developing dual chamber devices. And there's not an approved hormone available for use in pumps at this time. So it all be very investigational. But we do have, you know, this microdelivery technology, which is well suited for doing something like dual hormone, but I think there's a lot of things that need to get addressed before even that becomes something that we can put in a trial.


Stacey Simms  47:02

And then it's something that I started talking about this summer, I've mentioned this interview with I did with Steph Habif from Tandem. And I will link that up. It was kind of we call it the first look under the hood for Control IQ that we did this summer. And she's the Senior Director of Behavioral Sciences. But we brought up some of the questions about who gets into clinical trials and who actually tests these things out and the information that you get in terms of diversity. And so this question here, I'll read the whole question from a listener. I've heard some rumblings that most of the people who tested Control IQ were white, I would love to know that Tandem has plans to diversify this more. This is a huge issue in general for trials of any kind, and stuff this summer started to address that in terms of Tandem knows it. They're trying to be more diverse. Can you follow up on that? And let us know what's going on?


Molly McElwee Malloy   47:50

Yeah, and your listener question is totally right on, right. The FDA is on this as well. They recently told Moderna, you know, you have to go back with your COVID vaccine and get get more people, right, you have to get people of diverse backgrounds and and ethnicity. And so that's true in clinical trials overall, need to be all more inclusive. And it's true that most automated insulin delivery trials today have been largely white, and that includes our adult pivotal trial. One of the things we're seeing changing from both an FDA perspective, as well as research and industry is that there's active pivoting to change the approach. And there's more guidance on changing the approach. The FDA has issued guidance on diversity and inclusion in clinical trials, which I'm sure you could post in the show notes. But that's a really interesting sort of, if you will mandate from the FDA to please be more inclusive, but for those in the community who may have attended that D data event from diabetes mine, and I can send you a link to the YouTube video, Dr. brandmark, who's at Children's Hospital in Washington, DC presented on diversity inclusion, specifically in diabetes technology research, and it was very illuminating on how white those trials are right? And what we need to do to better accommodate and to be more inclusive in a lot of different communities.

From a Tandem perspective, we are very committed to this, particularly in our post market studies, we encourage principal investigators to do the same who are looking at different research and the FDA is mandating it so it absolutely will be happening right? The FDA says you will be providing a trial with this type of diversity you will be doing that so I think that the that everybody is aware that this needs to happen and we're trying to figure out how best to do it and be responsible stewards and industry but for a long time you're right I mean, you know diabetes technology and automated insulin delivery trials were largely white, you know, you have to be able to take off of work right? Whether you're bringing your kids to your appointment or not. And so those are jobs with that allow some flexibility. You have to be able to afford to miss work right? You have to have paid some sort Lead, whether it's sick or personal days and, and all of that does impact the person that you recruit. Right. So being able to alleviate some of that maybe it's provide compensation, the FDA suggested providing compensation for parents that can't take off time from work or, you know, meeting people where they're out whether it's in qualified public health centers, or at schools or wherever, to make it easier for them to attend, whether it's clinical appointments or whatnot, but meet people where they're at and have people run the research that look like the people who will be in the research, right? So diversified that field as well. There's a lot that needs to be done here. And Tandem is absolutely committed to making this a priority.


Stacey Simms  50:42

That's great to hear. I'm interested in following up more about it not just with Tandem, you know, I feel like it's also a question of finding people who, you know, I have the same frustration with this podcast, how do I reach new communities? How do I find people who would maybe benefit from the information but don't know why I exist? Because I don't run in those circles, right? I mean, we tend to run in the same circles, and we need to branch out and not make people find us. But But fight. Right. So it's really, I think it's also a question of finding more. Look, I'm not an expert on this by any means. I probably shouldn't speculate. But it's also a question of, you know, finding staff that is of different races, me finding more guests that are of different races and are, are in different communities. It's for us to do the work, not to ask them to come to us. And so I'm really glad that Tandem is doing that and is on top of that. So thanks for answering that.


Molly McElwee Malloy   51:37

Yeah, there's a sea change coming in society and diversity and inclusion, and that will absolutely be translated at Tandem.


Stacey Simms  51:45

we've been talking for a long time, you've been really generous with your time. Just another quick question from a listener. And that is about the mobile app. I'll be honest with you, Benny doesn't use it a lot. He says he's waiting for bolus by phone. But someone said it wasn't that fast. In terms of uploading. Have you heard about that? Is that something that you're looking at?


Molly McElwee Malloy   52:03

Yeah, absolutely. And the reason that I think some people are experiencing that is that they haven't downloaded, they're pumping some time in, right. So whenever it last downloaded, it's going to append that data going forward. And so if you have a year's worth of data, or you have six months worth of data, that's not gotten to the cloud, that takes a while to get up there. So if you could download your pump First, if you've not downloaded in a long time to connect, or upload your pump, rather than that sort of relieves that burden to append the all the data that has never been there before. So if you could do that, and then let it sync, day after day, it will be much faster. It'll be much, much faster,


Stacey Simms  52:45

And we did that I should probably get on that. But it's Yes. Good. Hey, really, before I let you go, Molly, we haven't spent a lot of time on this interview, because you've been generous in the past to come on the show for really many years now. But I haven't spent time talking to you about your personal experiences. But as you mentioned, you know, you've been in this community not just living with diabetes, but you've been in the testing for the artificial pancreas projects for for what has become Control IQ for a very long time. Would you mind if I asked you just one more time? What is this like for you? We've had this elusive piece of software in the market with real people using it for a year. You've been testing it for I want to say almost 10 years. What's it like for you?


Molly McElwee Malloy   53:30

Yeah, yeah, it's professionally, 10 years, and personally, for 14. So it's a bit of a surreal experience. But it's also it's very cool, because I can see the improvements that need to be made. And I can see how they can be made. And it's been really, really cool to teach health care providers, and particularly, which is a big part of my job about reading the data and looking at insulin needs. And how do you make this look like you are how do you make this work with bass like you are? How do you make this work? easiest for your practice. And it's just been just to put it into practice has been really awesome. Because it's, we do get notes from users on social media and otherwise about how it's impacted their life and that they feel like a normal person now and that's all I've ever wanted, right as a person with diabetes is to like, give me back my personhood, where I'm not thinking about diabetes 24 seven, and I feel like Control IQ does that. You know, it's not Is it the be all end all? No, we will improve upon that. But you're never done right. But the fact that so many people have expressed that has been really rewarding. And I really want to see that carry forward and in all of our products that we relieve reduce burden for people with chronic disease. There's no other disease in the world where we asked somebody to do all the things we asked in diabetes. You know, if you have a heart condition, we don't ask you to beat your own heart. You know, we don't there's nothing else that we ask this much of people and then that we possibly make them feel bad or shame them for not achieving these things, which is kind of crazy. So reducing that burden and making this a more realistic disease to manage, is all I've ever wanted.


Stacey Simms  55:06

Well, I can't thank you enough for your personal participation in testing this out for years and years, as you said, 14 years and for being so accessible and coming on to answer all of these questions. So Molly, thanks so much. I look forward to talking to you more. I look forward to more improvements and exciting releases from Tandem. I know you'll keep us posted. I really appreciate your time.


Molly McElwee Malloy   55:26

Absolutely. Anytime. Thank you.


Announcer  55:34

You're listening to Diabetes Connections with Stacey Simms.


Stacey Simms  55:39

Lots more information in the show notes. I'll link up some helpful things from Tandem and more information for you. And I did have a couple of follow ups. As you heard, Molly couldn't answer every question I had. So I got a couple of notes for Tandem that I want to share with you. Now, bolus by phone was submitted in the third quarter of last year. That is called mobile bolus. I don't know if there's a branded name for it. I did ask about that. But I hadn't heard back. But that has been submitted. It's in front of the FDA right now they're hoping to hear back in the first half of 2021. You know, it's hard as Molly did save with COVID, delaying everything, it's gonna be really hard to tell, as always, when the FDA will approve these things. But I'm so excited about that.

And I'm interested to see what it looks like practically, I'm going to say this with no knowledge of what was submitted, I do not have an inside track on what it would actually look like. So this is my speculation. You know, I imagine you just take out your phone and use it like your pump. Right? You can you'll have the full functionality. I don't know if that's really the case, I would imagine the FDA might be cautious. I don't know. But man, I just envisioned Benny, you know, he's got his phone in his hand half the day anyway. So beep beep, you know, let's go. Maybe that'll be their branding: beep beep Let's go.

They also let me know that Tandem is still planning to submit the Tsport to the FDA in the first half of 2021. And they are hoping for a quick turnaround possibly launching by the end of this year, which would be really exciting and nice to have another option there.

And a listener asked me about this. I didn't get it in time for this interview. But I did have a chance to ask Tandem about their agreement with Abbott, if you'll recall, Tandem and Abbott have an agreement to integrate with the Libre not just with the Dexcom. So there is apparently no update on that right now. But they are anticipating having one in the fourth quarter of 2021. We talk a lot about interoperability on this show. And you know, of course the dream is if a certain CGM isn't working for you, and another works better, you'll be able to slap that on and press a button on the pump. I don't think it's going to be that easy. But maybe down the road, I really do hope that we'll have more options. But if you had asked me five years ago, if the pump market would look like it's about to look right now, I think I would be pretty happy about that not just because of the great technology that's here from Tandem.

And we've been talking about what's next for Medtronic and Omni pod. But because we have more pump players coming to market, I am so excited to be talking to the folks from beta bionics and from Big Foot later on this year. So we will keep you posted. Innovations coming up next. Speaking of moving forward, we're going to be talking about exercise and CGM new guidelines for that and rare diabetes Could this be you it's really interesting what they're saying here.

But first, Diabetes Connections is brought to you by Dexcom. And we have been using the Dexcom G6 since it came out and we love it. It is amazing. The G6 is now FDA provided for no finger sticks for calibration and diabetes treatment decisions. We've been using the Dexcom for seven years now and it just keeps getting better. The G6 has longer sensor where that 10 day were now the sensor applicator is so much easier to use than it was in the past. We do love those alerts and alarms and that we can set them how we want if your glucose alerts and readings from the G6 do not match symptoms or expectations use a blood glucose meter to make diabetes treatment decisions. To learn more, go to Diabetes and click on the Dexcom logo.


Ran Across something I thought was really interesting for our innovations segment this week, and that is the RADIANT study. I will link this up. But radiant is recruiting people who have been diagnosed with diabetes, but they don't fit the usual characteristics of type one or type two. Apparently, this is not uncommon. I mean, most people really fit into the type one diabetes or type two diabetes. You've heard of Lada and 1.5 if you've listened to this show, but many types of diabetes are unknown, called a typical diabetes, and I really have never heard anything about this. So there's a new study called radiant, which stands for rare and a typical diabetes network and they want to discover more about what's going on here. You know, how do we better help these people? How do we treat this stuff, there's a lot more information on who qualifies are, how do you know i will link that up in the show notes, please check it out. And let's spread the word. Because this is really something that I think could make a big difference for people who are, you know, misdiagnosed or aren't getting the most from their treatment like, oh, it sounds like you have type two, but this isn't working for you. Let's get the word out and check out that link.

The other story in innovations is about new guidance for people with type one, and using continuous glucose monitoring for exercise. So there hasn't been a lot of information about this, you know how to use your CGM to safely and really exercise well. So this is new guidance from the European Association for the Study of diabetes and the International Society for pediatric and adolescent diabetes, basically, the European counterpart to the American Diabetes Association, and that second group has a narrower focus on younger people as you would assume from the name. But there are a lot of American researchers that you've heard of as the co authors on this, like JDRF CEO, Dr. Aaron Kowalski and Dr. Bruce Buckingham, who we just adore on this show. So anyway, there's a lot of information on this, I'm not going to go through what it says because I will link it up in the show notes and on the episode homepage. But it really gives you guidance in terms of if this than that, but also allowing for the complexity, because everybody with diabetes is just a little bit different, especially your exercise is going to be different to what it really like is it's not just about the exercise in the moment, they also talk about what to do later in the day and overnight. So good guidance here. Our innovations segment is for tips, tricks, hacks, studies, new stuff in the community. I also have our Tell me something good, which will return next week, please make sure you send me your good news stories for that I have a bunch that I've been holding on to can't wait to share next week. But I always like to hear from you. You can reach me Stacey at Diabetes, or drop into the Facebook group Diabetes Connections, the group and let me know what's going on.

Before I let you go quick reminder that the Fearless Diabetic summit is happening at the end of this month. This is a virtual summit that is free, you got a bunch of speakers, the videos are made, I was so excited to participate in this. And you can watch them for free for a couple of days, as many as you want. And then after that there is a fee to access. But you can check it out. I'll put a link in the show notes. But I think this is a great idea you can get kind of the appetizer and see what you like about it. And then if you want to delve further, you can go ahead and you know and pay for the content. I was not paid for my involvement, I was excited to take part I do have some goodies and freebies and stuff like that for people who are participating. So you can check that out. Also, mine I think is the only parent video that's in there. But there's lots of great information from athletes and endos and CDEs, you know, regardless of age.

Also, if you have a podcast or you're thinking of launching a podcast, diabetes, or otherwise watch my social posts, because by the time this episode airs, my new venture should be out there I am taking the dive to help other podcasters learn how to talk to sponsors, how to make money, frankly, from their shows, and how to do it ethically. And well, there's a lot of snake oil out there hanging, it's a lot like diabetes, there's a lot of not so great players out there in the podcasting space. And I'm excited to kind of help give people good advice that can help them get great shows out there and make them solid and make them more than a hobby. So watch for that. All right, lots to come. We're getting a great response for this tech heavy emphasis in 2021. Because my goodness, there's a lot out there. But we have much more than that. I'll be talking to some people with some great stories as well. And as usual, if you've got one or you've have something or a topic you'd like to hear, please reach out. I'm here for you. This podcast is to help, you know share our stories and get great information out there in this community. And if I'm not serving you, then I am not doing my job.

thank you as always to my editor John Bukenas from audio editing solutions. Thank you so much for listening. Say a prayer for me as Benny is now behind you. Oh, my gosh, I did not know how nervous I would be about this day. I think I'm doing all right. We'll see. All right. I'll see you back here next week. Until then, be kind to yourself.


Benny   1:04:15

Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged.

Jan 12, 2021

The Medtronic 770G pump was released in the United States just a few weeks ago and Robe Howe is one of the first to use it. Rob shares his first impressions and tells us what he'd really like to see in pump technology. (Rob is a paid ambassador for Medtronic, but they did not clear or review his comments for this interview).

Rob & Stacey spend a lot of this episode on other issues, talking about whether people with type 1 are "disabled" and what it means to use that word. Rob talks about achievement bias (and explains what that involves) and a lot more. We also find out about his fun modeling gig with Express and about his COVID-adjusted wedding in 2020.

Previous episodes about Medtronic here, including our in-depth discussion about the 770G and what else is on tap.

Our first episode with Rob Howe (all about using so-called Walmart insulin)

In Tell Me Something Good – legislative action, a diabetes blog gets a shout out and a new tip makes a difference for a site location.

And Stacey makes her predictions for 2021.

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Check out Stacey's book: The World's Worst Diabetes Mom!

Join the Diabetes Connections Facebook Group!

Sign up for our newsletter here

Tell me something good links:

New Washington State Law Caps Insulin Price

type 2 blogs


Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners!

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Episode Transcription 

Stacey Simms  0:00

Diabetes Connections is brought to you by Dario Health. Manage your blood glucose levels increase your possibilities. By Gvoke Hypopen the first premixed auto injector for very low blood sugar, and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.

Unknown Speaker  0:22

This is Diabetes Connections with Stacey Simms.


Stacey Simms  0:28

This week, Rob Howe is one of the first people in the US to use the new Medtronic 770Gpump. We'll talk about that. But our conversation got a lot more personal, including a discussion about whether most people with diabetes consider themselves disabled and everything that goes along with using that word.


Unknown Speaker  0:47

I want  to say like I Rob Howe, professional athlete, the guy who's goes and speaks and is like, you can do whatever you want. I identify as disabled, I am disabled, I have a disability. That doesn't mean that I'm not going to wake up tomorrow. And if my blood sugar's high, I'm just gonna quit and be like, you know, sayonara team


Stacey Simms  1:01

Rob is also a podcaster. And he turned a few questions around on me, we went a few places I wasn't expecting, including my hard “no” stance on Disney guest passes from years ago, and a lot more. And we do talk a lot about the 770G as well.

In Tell me something good legislative action, a diabetes blog gets a shout out and a new tip makes a big difference for site location. Plus, at the very end of the show, I'm going to do my predictions for diabetes in 2021, technology,  community, and more.


Stacey Simms  1:32

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Welcome back to another week of the show. I am your host, Stacey Simms, and we aim to educate and inspire about diabetes with a focus on people who use insulin, my son was diagnosed with Type 1 14 years ago, my husband lives with type two, I don't have any type of diabetes. I'm the broadcaster. And that is how you get the podcast.

I released an episode on New Year's Day about the COVID vaccine. And we've had a big response to that the episode was about health care providers with type one who had received the very first batches some of the first people in the US to get that first of two COVID shots. But the response was mostly people wanting to know where they fall in the priority order for receiving it.

Dr. Ponder Dr. Steven Ponder was in that episode. And he's an endocrinologist in Texas. He had been trying to get Texas to allow type one into the higher tier. But it looks like this is going to vary state to state, I would urge you to jump into our Facebook group. It's Diabetes Connections, the group and I'm just start a thread. Let's try to get everybody up to speed whatever state you're in, link up the health department look up a news story that you know of let us know what's happening where you live.

Here in North Carolina, they're talking about chronic conditions for one of the phases but it's not clear if it's just type two with type one will be included. As Dr. Ponder said, How are they going to check? Right? Do we really want the people giving the vaccines to have to worry about you know, give me your paperwork or your type two type one. Where's your doctor's note? I mean, it's already so much less efficient than we all had hoped. I do think they are making good progress. As I'm taping this at the end of the first week of January. Here in North Carolina, where I live, they have announced that they will be using the National Guard to help out which I think is terrific. And as I mentioned with a husband who's got type two, with my 16 year old who has type one who is eligible for the vaccine, we are going to watch closely to see when it is our turn. But again, I'm hoping we can get a big Clearinghouse going in the Facebook group with information with sourced information about when and where the vaccine will be available, where you live.

My talk with Rob Howe about Medtronic and this talk really did turn into something more. It's not a typical interview for the show. I think we'll get to that in just a moment. But first Diabetes Connections is brought to you by Dario. And one of the things that makes diabetes management difficult for us. It really kind of annoys me and Benny, it's not really the big picture stuff, right? It's all the little tasks adding up. Are you sick of running out of strips? Do you need some direction or encouragement going forward with your diabetes management and with visibility into your trends help you on your wellness journey? The Daario diabetes success plan offers all of that and more. No more waiting in line at the pharmacy. No more searching online for answers. No more wondering about how you're doing with your blood sugar levels, find out more go to My Dario dot com forward slash Diabetes Connections.

My guest this week has been on the show before with a very different focus. Rob Howe joined me two years ago to talk about so called Walmart insulin which he used for a while as kind of an experiment if you want to hear how it went. I will link up that episode from 2018. Just go to Diabetes click on this episode or the show notes wherever you're listening We have a pretty robust search on the website as well if you prefer to search it that way.

Rob is the host of the podcast, diabetics doing things. He is a former Washington Generals player. That's right. He's the bad guy. He was on the bad guy team against the world-famous Harlem Globetrotters. And this year, Rob became a model in a very cool campaign for Express and he got married. So Rob has a lot going on. And we've talked about quite a bit of it here.

There is also a video of this interview over on our YouTube channel on Diabetes Connections over on YouTube, if you prefer to watch it's kind of fun to be doing more video interviews, let me know what you think about that. In addition to the audio, Rob is a brand ambassador for Medtronic, and he started using their newest pump, the 770G in December, we talked about that, and then had a conversation about everything from the word disability to why I never got Benny, a guest assistance pass at Disney. In fact, I put my foot down and said no to what he calls achievement culture within the diabetes community.

Always great to catch up with Rob how from diabetics doing things, podcasts, and so many other things in the diabetes community. You become the go to emcee, I see you all over the place at virtual events. Thanks for jumping on. It's great to talk to you again.


Rob Howe 6:13

Yeah, thanks so much for having me. I've become what I call, and literally no one else says this except me. I'm the host with the most Insulet on board. So yeah.


Stacey Simms  6:23

Oh, I'm gonna steal that the next time I introduce you, I'll make sure to say that please


Rob Howe 6:26

  1. Please do.


Rob Howe 6:28

I love it. Well,


Stacey Simms  6:30

listen, we've got a lot to talk about today, I want to start off by just jumping in because the latest thing for you really has been not a change of technology. You've been a Medtronic guy for a long time. But you've got the latest version of Medtronic pump. So tell me, when did you start using the 770?


Rob Howe 6:49

Yeah, so I am very fortunate. I've worked with Medtronic for a long time. And I've been a patient of Medtronic for even longer. So today, as of recording, it's December 16. And I think I've been on the Medtronic 770Gnow since December 1, right around there. So it was in the first wave of of Medtronic, folks, employees Ambassador group to get access to the new pump. And it's exciting. I mean, I think for me, I've been on the 670 g now for almost three years. So you know, one of the criticisms of the new pump is that it really isn't very different, in turn from a technological standpoint, except it does have what we've always been very critical. And I mean, we as the diabetes, greater community of the 670 was that there was no Bluetooth connectivity to the phone. So I think this is Medtronic response to say, Hey, we hear you we got to have Bluetooth connectivity. And it's great. It actually, the app is super intuitive, the mini med mobile app and it has your basically your sensor glucose like you would normally see on your pump display, but it also has your 24 hour time and range. So just a quick little swipe, you can get over there and see your your 24 hour numbers, which is kind of nice, especially if you've had a really good day, you can see that you know those high time and range numbers. So it's exciting. And you know, I think for people who are, you know, really into the nitty gritty, it's also a new transmitter for the sensors. So it's still the Guardian three sensor, but a new GL three transmitter, which just has a few of the, you know, annoying, calibration tweaks that some people have, I think more vocal people than I have have, for sure lamented. So the the new transmitter is excellent and has fixed a lot of the challenges from the early days.


Stacey Simms  8:26

We talked to Medtronic a couple of weeks ago, and I'll link up that episode in the show notes here to go through all of the features and what's coming next. But it really is interesting how so often these companies and it's not just Medtronic, I would kind of compare it to Omnipod dash right so they have one version, then they almost have a stop gap, which has some improvements but isn't the big shiny thing that we're waiting for you know the if you're looking at the technology so carefully, which will be the 780 which is out in Europe and will be out soon. But you know, I have heard a couple of people who have used Medtronic for a long time like you have say the phone stuff would be nice but I don't really need it. And now that you have it, you really look at it more i mean i don't have diabetes and so I'm trying to get myself from following Benny so often to not looking at it 24 seven, but was it really that different for you to kind of just look at your phone more than your pump


Rob Howe 9:15

right now. I'm operating mostly from home so there isn't a you know, work meeting where I would feel better about pulling the phone out versus taking the pump out of my you know, pocket and I am an insulin pump in the pocket person so I don't wear like a holster or anything like that. And obviously Medtronic pumps have tubing, but I think it's nice to just be able to you know, you're on the phone all day all day. Anyway, I'll admit I spend a lot of time on my phone and being able to click over in the night. You know, I think that's been the time that I've used the app the most when you know in when I'm laying in bed,


Stacey Simms  9:47

I think it's huge to have it on the phone. My kid is a pump in the pocket kid too. And he would never look at it. If he didn't have to. He's on the phone and it would you say maybe a couple of directions. He it would be really a big deal. If he suddenly lost that which he hasn't even had for that long, right? Well, anyway, you get used to.


Rob Howe 10:04

Exactly. And I think that's where I think as consumers, and this is sort of my you know, before getting more and learning more about what goes into diabetes technology from a FDA approval standpoint, and all of the sort of hurdles that they have to go through, you know, I was sitting there streaming a movie on my iPhone on an airplane, and I'm like, wow, if I can stream a movie on my iPhone on an airplane, we for sure should be able to look at your blood sugar numbers on a phone. But I'm very much like Benny, I love the phone, very familiar with the interface, I use it quite a bit. So I think, you know, in terms of having that convenience, it's just so nice. It's kind of just takes away, you know, I think Medtronic has really done a nice job in past years. And also going forward of really relieving that mental burden and making diabetes integrated into your life. And this is definitely something that makes diabetes just more integrated in the way that you already use technology, the way that you're already on your phone. And I can get a push notification. Now my alert on high if I'm, you know, I got my high alert set at 160 get the alert on high, it pops up in my phone, just like a normal notification. And I can take care of it then. So yeah, I really love it. And I think that's kind of like what you said with Benny, you get really used to it really quickly of having it there and having those numbers all the time. So it's just nice to have it a little bit more integrated into our everyday life.


Stacey Simms  11:15

Are you a big auto mode guy? Do you use the features of the 670. And now the 770


Rob Howe 11:21

I am I stay in auto mode. I'm a big auto mode guy. And I think the criticisms that I see of it online are fair, and it's not perfect. And I think Medtronic has done a great job of talking about those, you know, initially, this was like 1.0 of the hybrid closed loop systems, you know, so the algorithm is now in technology world is a little dated. But now, like you said, mentioned 780 coming soon, in the US. You know, the next version of that, I think is really exciting. But for me, I'm an auto mode guy. And I think the the biggest example I'll give for listeners is I love to play golf, I have a weekly golf round that I play on Sunday mornings, and I set it on auto mode. And before auto mode, I would go out and you know, my basil would be what it was and I have to set a temp target or attempt basil and you know, even before cgms I just basically have to have gummy bears stashed in my golf bag. And on auto mode. Thankfully, you know, I go in with no insulin on board in the morning if my morning starts off really smooth. And I can go through my entire round walking or in the cart and not have to worry about correcting and not have to worry about high so it's it's really nice. I love auto mode. That Blue Shield gives me a lot of confidence.


Stacey Simms  12:25

That's awesome. It's funny though, looking at as we're recording this on video I can see into your house is basketball stuff all over the place. Now I know you're big basketball player. We've talked about that we talked in the past. So I'm interested that you brought up golf and rather than basketball.


Rob Howe 12:38

Well, you know, I'm aging gracefully, Stacy. Like, you know, I think I still love playing basketball. And I think that's one thing that sentimentally I think there's been so many terrible things that have been taken from us because of COVID. And the thing that's been really eating away at my heart, and my soul is not being able to play basketball and because it's just not safe. And I think in Dallas, especially we have so many cases and I've been able to do some training in a gym, by myself wearing a mask, but I just missed competing and I think golf, you know, you're competing against yourself. So it kind of scratches my itch a little bit. So that's been my COVID pivot.


Stacey Simms  13:14

That's awesome. I've been playing golf since I was 22. So I'll take you out sometime when we got


Rob Howe 13:18

ready to say no more. I'm ready.


Stacey Simms  13:22

You know, one of the things that really made me smile in the last couple of weeks was that terrific video you posted. Your it was it was announcing the partnership you have with Medtronic now but the video itself was so great. It was you know, if you haven't seen it, we'll link it up. How would you describe that like an athlete grabbing a sponsorship or getting recruited for a team?


Rob Howe 13:42

Yeah, you know, I, I was stuck on this concept of signing day. And this announcement, this announcement kind of felt like that. And for me, you know, I've worked with Medtronic for a number of years as an ambassador as a consultant. And now kind of deepening that partnership into a more formal role. It just came to mind. And I thought, you know, this is true to who I am as an athlete, and seems like a fun way for and you know, that's a big part of what we're working on together is doing some outside the box, maybe not traditional Medtronic type announcements. And I would classify this as sort of in that realm. And I'm just very fortunate that my team and Medtronic is so on board with hearing sort of outside the box ideas. And so getting to produce this fake press conference about my signing day and learning that there are no Medtronic hats and having to get a Medtronic hat made for me to put on so now I have like the one on one of one Medtronic cat, which I love. It was really cool. And the response was great. And again, I just I'm glad that my team didn't roll their eyes at the pitch. They were like, Oh, yeah, this actually sounds great. We'll we'll do this. And I can only imagine as it went through legal what legal was thinking of just reviewing that video, so very fun. That is funny. I


Stacey Simms  14:48

think I have one of the remaining animus shirts left in existence from what I used to do appearances for them.


Rob Howe 14:54

Yeah, you gotta gotta save that merge. It's like it's retro. You know?


Rob Howe 14:57

That's really funny.


Stacey Simms  15:04

Right back to Robin just a moment, but first Diabetes Connections is brought to you by g Volk, and almost everyone who takes insulin has experienced a low blood sugar and that can be scary. A very low blood sugar is really scary. That's where Jeeva kaipa pen comes in. It's the first auto injector to treat very low blood sugar. chivo hypo pen is pre mixed and ready to go with no visible needle. That means it's easy to use in usability studies, 99% of people were able to give GMO correctly. I'm so glad to have something new, find out more, go to Diabetes and click on the G book logo. g Vox shouldn't be used in patients with pheochromocytoma or insulinoma visit g VOCA glucagon comm slash risk. Now back to rob, and he is talking about new technology that he's looking forward to.


Rob Howe 15:52

I'm very excited about the integration of the phone as the software back end to the pumps and the devices. I think that adding diabetes technology to the Internet of Things is a huge milestone in healthcare. It's a huge milestone for people with diabetes. And it's just going to make this whole user experience more intuitive. I think the DIY loop community has shown how you know how powerful it can be when technology and people helping each other and really dialing in features that they need and that are important. And working with some of these larger manufacturers, I think kind of opened up this Pandora's box of questions for these bigger companies to ask themselves are our technologies right for our customers, are we meeting them where they are, and I'm sure as you encountered in your conversations with Medtronic, that's a big focus for them right now is meeting patients with diabetes where they are. So you know, you've seen this year now the acquisition of companion medical, to bring multiple daily injections into the Medtronic suite, which previously they were a pump company. And I think now they're really focusing themselves on being a diabetes technology company, which is cool. And I think it's good for patients good for Medtronic good all around?


Stacey Simms  17:01

Well, it's interesting, because for years, people were saying, you know, this stuff's got to look better, you live with it, it's on your body, you want it to look less like a medical device. And there was a lot of pushback from people within the community, as well as on the technical side, who were saying who cares, just make it work better. And I think we are at a place now at a point now where there is enough, even though there seems to be fewer pump companies, there's enough competition, that they do have to look good, they do have to feel better. I mean, I don't remember what you used when you were first diagnosed, but it's changed a lot in the Gosh, in the almost 14 years I've been he's been using an insulin pump, it's not a brick anymore.


Rob Howe 17:35

Right, it doesn't have a Gameboy screen, it doesn't look like a calculator, you know, I think all that really comes down to me is just user experience in general. And you look at iPhone, for example, and the transformative qualities that that piece of technology has had on society in general. And I think that that is sort of the the gold standard now and that filters down to healthcare companies, something that we talked about in my agency world is that, you know, most people, when they think of competition, they think of, you know, immediately in their industry, their top two or three competitors. for consumers, they don't look at it necessarily that way, they're looking at you online as your competition is Apple, and Chase, and Amazon. And if your online experience, if your device experience doesn't mirror those, and isn't on par with those companies, which is really unfair for a lot of businesses, a lot of brands, because they're they don't have the ability that or the scale or the infrastructure to deploy at that level. But if you're not on par with those companies, users will tune out, they're looking for best in class. So I think that's been a big shift for all the major diabetes technology companies, and I think outside of diabetes as well.


Stacey Simms  18:40

Alright, let's move on just one of those other issues, you and I saw a conversation online that we wanted to talk about, I think this was mostly on Twitter, where the word disabled or disability, it's interesting when using that with diabetes, because Ben, he was diagnosed before he was two. And all I heard for this first few years was he can do anything, it's not going to stop him. But then you get to school. And it's like, he needs a 504 plan because he has a disability. And he's covered. I have my own take on it. And I'm curious what you think is the person who lives with diabetes? Is that a bad word for you?


Rob Howe 19:11

You know, that's really interesting. I seen that conversation. I think I want first of all people to know that I see both sides. I think I see people who argue on one side or the other. I you are seeing and I think for me, it's very similar to your story of Benny, you know, I was told from the get go from the jump that whatever dreams you have for your life are still within reach. I have perpetuated that idea at the beginning of all of my talks, all of my messaging, I believe I'm living proof that you can do things with diabetes if you want to and take care of yourself. I mean, there's other factors involved, obviously, but at the same time, I think denying the fact that you're disabled denies all the hard work that you put into your life to stay alive every day. And let's be honest, I think none of us would put the amount of work mental, physical, financial into anything else that we put into diabetes without compensation, expected compensation or some sort of like just reward you know, and I think that's really where it nails home for me is like if you factually like scientifically, under the Americans with Disabilities Act or the ADA, people with diabetes have a disability. That doesn't mean that you can't do the things that you want to do. But it also doesn't mean that you're not disabled. And what really reinforced this for me was a few months ago, there is a documentary on Netflix called Pistorius, which is about Oscar Pistorius, the Olympian who was born with defects in his legs, and he runs on the Nike blades, the legs that that allow disabled runners to run. And he competed not only in the in the Paralympic Games, but also against non disabled athletes. But in this documentary, and obviously, tragically, he murdered his girlfriend, killed his girlfriend, and you know, is on permanent house arrest, I believe it was so interesting to see the rhetoric by which he referred to his situation, his disability, and he's like, I don't identify as disabled. And that was something that I think, in the early years of my life with diabetes, when I was a younger man, less gray hair. But I identified with that I was like, I don't want people to treat me differently, I want to show them that I can do this. But when you deny that disability, again, when you when you close yourself off from things like diabetes community, when you close yourself off from benefits, like your 504, when you close yourself off to identifying as disabled or taking advantage, God forbid, you don't take advantage of the concessions that have been granted to you because of the struggle and the burden that you're carrying because of this disease. You know, I think you close yourself off to all the work that you're doing. And that's really where I want people to know that like, hey, yeah, I at face value, am a fit, athletics, successful, quote, unquote, successful person with diabetes, but I very much identify with Own your disability, that doesn't make you and I think there's a lot of conversations about ableism that I think we as a culture need to do better about because I think you alienate people who are disabled by saying, Well, I'm not I don't identify as disabled or I have a disability, but I'm not disabled, I think those are our negative, you know, negatively affect people who you know, really identify as disabled. So I want to say like, I Rob, how professional athlete, you know, the guy who goes and speaks and it's like, you can do whatever you want, I identify as disabled, I am disabled, I have a disability, that doesn't mean that I'm not going to wake up tomorrow. And if my blood sugar's high, I'm just going to quit and be like, you know, what, sign our team, but it What it does mean is that I see you out there struggling, the burden of diabetes is taxing, I feel you, I see you. And I think it's better for all of us to just work harder on accepting the fact that with diabetes, you have a disability that allows you some advantages, and allows you access to some things that people without this disability don't have access to. And to deny yourself that is, I think, a disservice to yourself.


Stacey Simms  22:57

It's such an interesting topic, because you really centered on what bothers me the most about it. And that is that as a society, we look down on disabled people in our language and our actions, it's just baked in. And it's come out so much better in the last few years that we're even able to talk about it. You know, even in the elections, I never thought about that. You know how we don't help. We don't even make it equal access for people with disabilities. And so there's this whole society burden of not wanting to admit that we have anything wrong with us, because then we're stigmatized, it doesn't even it's not even just diabetes. But I also think that, you know, trying to raise a child with type one, many would never say, I don't think he would say even today, and you know, it's not it's his voice is not mine to speak for, I don't think he would say I have a disability, I don't think he would raise his hand like you were doing. But I do think that he should, because all of the fights that have gone before, you know, it's easy, or it's easy, it's never easy, but it's easier to be a elementary school kid or a middle school kid. Now with a pump or a CGM. And with all the education and with a 504, than it would have been in the 70s, or the 80s, when a kid was doing shots and couldn't leave to go to the bathroom, and we've heard all these horrible stories or an employee back then it wasn't protected. And I will say he's had an easier because he has a lot of access and a lot of privilege, you know, these words that we throw around, but he really does. He's got me as his mother with a big mouth and a microphone. But also, you know, I guess I'm trying to say is all that work that went into protecting people with disabilities, as you said, it's really important to honor now, and to understand that if you're a cashier, and this happened in North Carolina, and in other states, leave your cashier at the Piggly Wiggly, and you need to treat your blood sugar with juice, and they won't let you you're covered. You're not gonna lose your job, we're gonna get paid back. And that's the kind of coverage that I think we need to think more about. But I will tell you a funny story about how I didn't help me and I stand by this when we went to we've gone to Disney World many times never been to Disneyland. We live on the East Coast but we've been to Disney World many times. We've never used the disability pass or the guest assistance. Pass or whatever they call it. The reason is, because when we first started talking about it, it was presented to us like a reward. It was like, Oh, you have diabetes, you have this great thing, and you can cut all the lines. And it wasn't presented to me as, hey, Benny might have a low blood sugar or might have a high low blood sugar, you know, high situation, you might need it. And I said to myself, I'm a crazy Disney planner, like, I am good to go. We don't wait in lines, whenever because I plan it. I'm, I love it. So we never did it. And I've talked about this, I was called out on it at a conference, once we're just having a casual conversation, and somebody in their 20s said to me, you know, you're doing him a disservice, because you're teaching him that he shouldn't take advantage of what's out there. And I said, Well, he shouldn't because it's not a reward. And she said, it's not a reward. It's not like a golden ticket, it's there if he needs it. And if you don't need it, fine. But if he needs it, when he goes, he shouldn't feel bad about using it. And she reframed the whole thing for me, and we still haven't had to use it. But I have definitely been less judgmental, and Kinder about other parents that I know who have used it. So if you're somebody that I've, I've been snarky too. I apologize. That's what I think


Rob Howe 26:05

that speaks to your capacity to learn, Stacy, I mean, you know, we all this would be shocking, probably not to no one. But we don't always make the right decision. You know, and we learn new information. And we reframe conversations. And, you know, I'll piggyback on that I, when I was younger, I was traveling a lot for basketball. And I like to get on the plane early, because I was like, Oh, I'm flying Southwest, I'm in the the B section, I'm not going to get a great seat. But since I have diabetes, that's, that's all good, I can go get whatever seat that I want. And then I stopped doing that. And I did that bait for a couple of reasons. I think consciously, I would see people who needed real assistance to board the plane early. And I wanted to be respectful of their space. And whether it's wheeled wheelchair access, or, you know, just extra medical supplies, I find that the you know, like the the accommodation that is made on airlines for people with diabetes is mostly to make sure they can get their medical supplies nearby on with them. And I, for the most part, my supplies, because I'm a dude probably are always a smaller footprint than some of my lady counterparts. And also, maybe I'm just a little bit more of a free spirit and be like, Hey, you know what I'm going to take, I'm going to be out of town for a week, I'm going to take two or three infusion sets and a couple of miles Insulet in my backpack, and we're going to go for it. So it was always close by to me anyway, and all that to say I don't do it today. But I know it's an option. And if I feel like the flight is oversold, or I'm gonna have to make a quick connection, and I want to make sure that my medicine is within reach, I will take advantage of it because I know it's there. And I think having that knowledge and being willing to accept that assistance except those accommodations. And and knowing that that space is available for you is positive. Yeah,


Stacey Simms  27:51

I mean, for me, as I have learned and changed my mind, and I probably will continue to my philosophy is now if you need it, or think you might take it, it's there to help you if you think it's going to you know it be if there's someone else's more need. If you know you don't need something, right. It's like parking in a handicapped spot. When you really don't need it, you're driving your grandmother's card, it's got the ticket on it, and you're just like I'm in a hurry. Don't do that. Right. But you know, but if you need it, use it. And don't be embarrassed or ashamed. And I hope all of you don't even know how to if I'm even saying this the right way.


Rob Howe 28:27

I think there is there is shame wrongfully pointed out, people who look. And I think that's back to that sort of ableism narrative perpetuated in this country. You mentioned like the election. I'll give you another example. Governor Greg Abbott in Texas is in a wheelchair. He had a there was an accident when he was a child, and it caused him to be paralyzed from the waist down. So while I don't agree with a lot of the things that he does, politically, I stay away. And there's been a very big movement online of people who disagree with him, staying away from the low hanging fruit of making fun of his wheelchair, and his disability, because that's not what makes him make poor decisions. from a policy standpoint. That's just the easiest, most that's just like a kid, when you're young kids pointed the first different thing that they can see. And oftentimes, that's very hurtful. But we are adults. And we can see that, you know, that that's unproductive. And I think, again, coming back to not not alienating anyone who has a disability. It's it's more focusing on policy and actual, you know, politics in the case of Governor Abbott that are detrimental to what's going on here, not his disability, I think his disability is completely off of the ballot.


Stacey Simms  29:37

Yeah, it should be it really should be in the diabetes, so much of what you all deal with is invisible, or, you know, you're able to make it invisible. So it's even harder in some ways. So I don't know. And I


Rob Howe 29:48

mean, I think even even on that point, there seemingly is a stigma to, you know, letting your diabetes be shown. And I think there's a lot of people who share they're now very proud of their cgms they're proud of their pumps. To wear them out. They're proud of sharing their numbers on social media. I you know, I get a lot of laughs from people sharing your 69 blood sugar's with me and, you know, I think that that sort of empowerment and saying hey I can I can be publicly facing with this and there's a community with that is great because, you know, look at me I'm like the poster child for some of the negative achievement culture things around diabetes I am you know, handsome white guy who used to have a six pack and you know, got to play sports and live his best life. And you know, he's not held down by his diabetes and what you don't see our bloody sights. And you know, all of the adhesive that you got to wipe off your arm after you change the site, or, you know, the feeling of less than after you're at a pool party pre COVID, and your site got too wet and you got pulled out really easily and you have to go home, you know, or just waking up on a vacation with a high blood sugar and it ruined your day. Like, those things don't always get shown. And I need to be better about sharing some of those low moments personally, on our platforms. But you know, just because you're not you don't look like a Olympic endurance champion with, you know, hollywood abs and a great tan and you know, living in your best life always time in range at 100%. If that doesn't sound like you, that's super okay. And I see you and that doesn't mean that your life with diabetes is less than I think there's there's downsides. And I and I've benefited a lot from achievement, culture and diabetes, but my love, I'm an I'm an achiever, that's what I try it. That's, that's sort of wired into me. And, you know, as I get older, I learn more about myself and why I do things. And I love following the rules. I love having a structure so I can try to achieve that's just what speaks to me.


Stacey Simms  31:40

Wait, I need to ask you though. Okay. I love everything. You've said, achievement culture, though. I'm not up on that as the world's worst diabetes. Mom. I mean, I'm kidding. But you know, I'm all about mistakes. And that's been my platform. And I mean, my brand, I have to call it that. But that's truly how I parent and I've never gone for more I'm what does it cheapen culture mean? Is that that you can do anything? Or I'm only showing the beautiful stuff? or What


Rob Howe 32:04

does that mean? I think that's part of it. I'll reinforce something that I'm sure will speak to you, in a way think about podcast guests. What's more interesting to someone who like at face value, we have two people, we've got a mom with three kids who gets her kids to school on time, leaves with diabetes, and you know, is just juggling a regular life. Or we have you know, two time Olympian bobsledder who, you know, has been around the world 50 times and you know, has been on the ESPN body issue or whatever the case, right? So at face value as a journalist, who are you going to pick for the more juicy story? Yeah, the bobsled guy, the guy, the boss like guy. And I don't know, any type ones that bobsled. So I think it's a good sport, because I'm not singling anybody out in particular. But I think as a diabetes community, I have also been guilty of like, Oh, I'm in this position where I can go speak or I can have, you know, people follow me and they follow the podcast, and I get these opportunities to represent people with diabetes. So I got into this sort of negative pattern of thinking where I was like, What do I have to do next? Like, what is my, I've already given my podcast, talk to all these jdrf chapters? Well, they're not going to invite me back next year to give the same talk, I've got to do something else that achieve something else. So like, right now, even the talk that I give is called from professional basketball player to professional diabetic. And inherently in that title, while it is good, and people click on it is ableism. And it's like, oh, you're only worth speaking at these events. If you achieve something crazy, like proven playing pro sports. And I think I'm really trying to be more aware and more, not cautious is the wrong word. But just more mindful of the things that I say and the things that I do that are rooted in an achievement culture that rewards extraordinary feats, and also tends to erase living a normal life and making that unsuccessful.


Stacey Simms  33:56

I'm going to arm chair psychologize on why it didn't resonate with me, moms aren't allowed to have achievement culture, we are not allowed. And I'm using that term very loosely, because Screw it, I'll do whatever I want. You won't allow me. But truly, if my brand was the best diabetes, Mom, I got it right. And you don't or professional mom, right? You're not going to see anybody talking about that, because we don't talk about moms that way. And I think that's, I know, this isn't about me, I'm glad to have you on as a guest. But I couldn't help but share that because of what you said, I was thinking to myself, How on earth would I achieve something like that? Or what can i and it's really interesting to think about it in those terms. And I think a lot of diabetes moms, what resonates with us is you know, oh, I'm the worst I made a mistake. I'm failing my kid, I got a report card. You know, it's all this negative talk. And that's a problem in and of itself. And you got other things to work on. You got to worry about. I'm succeeding. I'm great. You want to bring me to talk because I'm doing so well. It's so fascinating how we can do this.


Rob Howe 35:00

You know, and I think too, you know, speaking to diabetes moms, which I love, and I think that's a demographic of people, I never thought I would get to meet as intimately as I have. And, you know, I think people like me, and people who achieve are great to show to kids, you know, because hey, look at look at Rob, he's living his best life. He has a podcast, he talks about diabetes, he's not embarrassed. And I live for those moments where I can be the person that I needed when I was 16 years old, and have somebody who's accessible and wants to give back and wants to have those hard conversations and can say, you know what, I do see you man, like, you know, your 16 year mom doesn't know what's going on. You don't want to talk to her. And somehow I managed to remain young looking enough that I can communicate with somebody, hopefully,


Stacey Simms  35:43

you when you talk, you're like with Newsela What are you like, 30?


Rob Howe 35:46

I'd like 32. So yeah, I mean, I see. But you know, Stacy, you're not on tik tok. Right, you know, you know, if you put me on Tick tock, I'd be so canceled. I can't dance. You know, I mean, so I think for me, I just want to try to remain like as tuned into what people with diabetes are going through, that they may not even be aware of. And I think this is in this sort of chronic, all the chronic things that we're juggling, I think chronic focus on achievement, within, you know, some of the diabetes online community cultures is important for us to call out and I think I've benefited from it. And it's important for me, it's important to me, that I make sure to bring people in, who maybe haven't benefited from it and use that to highlight important stories, because you know, what's crazy, and surprised me back to the podcast example, when I first started, and I was really, really digging into what episodes are resonating with people, the one that was far and away the most resonant of my first like 15 episodes, was really the most simple basic, it was a story of a type one mom and how she prepared for her first and second pregnancies with T one D. And, you know, for me at the time, like a 27 year old jock tech bro. I was like, you know, it was a great conversation. And my my friend, Lindsay, who's my friend in real life, did an amazing job. But I never would have guessed that that would be the one that would have taken off of the first group. And it wasn't necessarily the achievers. It's the people who achieve in spite of there being no big reward publicly.


Stacey Simms  37:15

Yeah, well, I think we need and I know you'll agree with this, we need everybody in this community, right? We need the people who go up Mount Everest meet the people sitting at the desk job. But what has resonated with my listeners is anybody they can learn from. And I think it's interesting. And especially at first you want those high, high achieving successful people, those Olympians, and those rock stars, because as a parent of a kid, you can look at this person and say, Okay, this person was type one is super successful. So my kid probably has a pretty good chance of being a mid level executive, you know, at Staples, or whatever, right? They're going to be okay, or IBM, I shouldn't, whenever IBM even exists anymore, I'll show my age. But, you know, we do need those other people who have shown us how it's done something as complicated as a pregnancy with type one to something as simple as, it's not really that simple. But how did you transition from elementary school to middle school with your kid, right? Those are the things that we all want to learn. And I think what's really cool about social media, and somebody like you who's you know, super big on Instagram, and all that stuff, is you get to show, as you said, the cool looking stuff, but you know, it looks great, it looks perfect, but then it's also a chance to show all those crummy site changes. And those days when you don't feel good. And you don't have to polish it all up. I mean, you just snap a picture or talk about an Instagram. And you do that all the time. I think it's great.


Rob Howe 38:29

Yeah, it's new. You know, I think maybe I've even mentioned it before in this pod. But in 2018, at ADA, I found this poster board study in the in the poster Hall, talking about the ANC outcomes and involvement in the diabetes online community. I mean, just that sort of osmosis of encountering people with diabetes on a regular basis, and the things that they do makes you better at diabetes, I don't know. It's just it's normalizing. And I think that's what's so important, and what the Internet has brought. And I think even still, I'm even more learning about sort of the micro communities and diabetes, where you're able to find people that look like you people that are interested in the things that you're looking for. And otherwise, like, where would you find those people. And you go back to when Benny was diagnosed, you basically had the only people in your immediate area were the people that you could stay in contact with early blogs, maybe kind of just starting to sprout. And now you can just go to some of these big diabetes accounts and search for people or look on the hashtag and look at the locations and say, well, wow, there's somebody with diabetes there. You know, I got to be a part of this really great campaign this summer with express a global brand, you know, and


Stacey Simms  39:34

Oh, yeah. Wait a second. Wait a second. Tell me about that. Because that wasn't diabetes, you're like this, like a model? I mean, right. Or model. What was that? That was amazing.


Rob Howe 39:42

I can I guess I can put like publish model on my resume. Now. You know, what's cool about that campaign, and first of all, the Express team was really great to work with. They're all pros. And I think just hearing sort of the creative outline of what they were trying to do as a person with diabetes as a person with a disability as a person with something that makes them different, was just really cool to be there representing people with diabetes. So they sent out like a cold casting call, it had a bunch of stuff, as you know, or maybe not like, I'm very interested in fashion, I love style is something that I just I don't know why you


Stacey Simms  40:16

post your outfits on Instagram,


Rob Howe 40:19

feel free to gather fit pics are my thing. I love them. And you know, my wife and I are currently you know, just having a turf war over who needs more closet space. And I will not lose, I will not lose that, that I just don't put it on put on record. But the cool thing about Express was they said, Hey, we're looking for people who are on Instagram, but it's not a requirement. We're looking for people who have some sort of social good or community type. It's not required. We're looking for people who have an interest in fashion, but it's not required. And I was like, wait a minute, I have all three of those things. Let me like really try to get this. And so it was a cold call. I put together a pretty good application and response. And then I set it and forget it. And like it was 90 days later until they got back to me. And I sort of put it out of my mind. And they said, Hey, Rob, like, we're really excited to have you part of this campaign. Like, can you talk on this day? And I was like, wait a minute, did I book it? And they said, Yes. And so it was really cool to be able to out a big panel. I know, first of all, I was all over the world. inexpressive. I mean, it was a year of COVID, obviously, so not as many people saw me, but like on the front page of Express calm, very visible. And I was not just a model, I was representing myself, I was like Rob, like, hey, Rob is the Express model, and he lives with diabetes. And that was something I had never experienced on a mainstream level before. It's one thing to go to these diabetes events and celebrate those all together. But to be different on a panel full of other amazing superstars, frankly, like, who have achieved way more than I have. I was there as a person with diabetes. And I got to talk about like at base level what type 1 diabetes is and talking about the insulin affordability and talking about what it's like to have an insulin pump attached to your body at all times. And to see people be like, wow, I had no idea about any of that was just really cool to be a part of and like tan France from queer. I was the host on one with tan France. It was unbelievable.


Stacey Simms  42:07

Was he nice?


Rob Howe 42:08

Oh, yeah. Oh, how can he he's like he was so giving. He seems like the nicest guy, an absolute Pro. And honestly, I've done a lot of interviews. I was admittedly not really super nervous for our conversation today. Because I know you and I figured it would be nice and easy, but I was like sweating bullets. Getting ready in my like this in this office in here for 10. France. I was like, like, What's my name? Like? What do I do just like to make sure I don't stumble, you know, but it was a really awesome experience. I'm so grateful to have had the opportunity. And, you know, hopefully it's the the first of many. That's awesome. You know,


Stacey Simms  42:39

I worked at Express. When I was in college, I worked at the express in the carousel center mall in Syracuse. So if you shopped there in 1991 or 92, I helped you out. Not you, Rob, you're looking like you're looking through the time. You were not there. It might be wondering. Well, the


Rob Howe 42:57

thing I was actually thinking about is my wife was born in Cheryl in New York. So he was born in 1991. So maybe her mom this call


Rob Howe 43:05

is over?


Rob Howe 43:06

Yeah. Yeah, sorry. Technical difficulties were not cut off. But yes, my wife is a is younger than I am. Which is really funny. And yeah, that's a small world. I didn't know that. You had the upstate New York time?


Stacey Simms  43:19

Oh, yes. I went to Syracuse University. And then my first job was in Utica. And then I moved back to Syracuse for my another job. And then I came to Charlotte where I am now. I was up there for 10 years in the snow.


Rob Howe 43:30

Oh man. very snowy. Very Yeah.


Stacey Simms  43:31

But I grew up. I grew up in New York, so not too far.


Rob Howe 43:33

People were asking me like, so do you shop at Express. And I said, You know, I haven't shopped there recently as much. But when I was getting my first job, and I needed to get rid of my college, bro clothes and like, put on some real professional clothes I went to express so it was like cool to be like, oh, they're like, yeah, like, that's a big part of the consumer that we're trying to reach. And you know, really people who have an interest in fashion, this is a first step for them. And it was it was cool to be very, I felt very seen and very, the team that express was awesome.


Stacey Simms  44:01

That's terrific. Yeah, I worked there. And then I got a job at a radio station in Syracuse. And then that was the end of that. never looked back and worked weekends. Why are


Rob Howe 44:09

you found it you found your Yeah,


Stacey Simms  44:12

I knew what I wanted to do was very cool. Are you going to be working on things like that is modeling something you would like to continue to pursue or the fashion industry?


Rob Howe 44:20

Yeah, tell me what you're advertising I do to being a model for Express wasn't on my vision board for 2020. But I don't know, it was cool. It was just just to be a part of it to, you know, be in front of camera. Like you mentioned, I work in advertising and have been parts of shoots like this, behind the camera and working on the campaign and working on the creative direction, but to be in front of the camera and kind of collaborate with people whose jobs I know intimately. And it was a very small crew because of COVID. And they came they came to Dallas and it was cool to just be able to be in a small collaborative group of people who like I was just a photographer, the director and the videographer and myself. And we just got to hang out all day and talk about ideas and be creative and Yeah, I think I would love to do that again.


Stacey Simms  45:01

Nice. You know, we've been talking for a long time, I didn't even ask you or congratulate you on your wedding, which happened this year. Yeah. So congratulations on that. That's Thank you big, big,


Rob Howe 45:10

wiseguy big fan of my wife.


Stacey Simms  45:13

Good to hear good to hear what's up with you all in 2021. I mean, you're moving ahead with Medtronic. Moving on with the ad agency, you are married, man. I mean, 2020 was a difficult year, let's admit that. But any anything on top, I think I'm almost afraid to plan for 2021 in a way,


Rob Howe 45:29

me too. I I don't want to get too far ahead of my skis, you know, I think we are still a ways away of putting COVID completely behind us. And I also want to be very present in like, how What a tragedy it is. And I think even personally, within my friend group, there's been some very recent developments that are just awful. So I think we need time to heal. And I think we need time to, you know, mourn sort of our old selves, you know, like it or not one way or the other, we're all different because of 2020. And hopefully, we can build sort of on the ashes of everything and be better to each other longer term. We got some cool projects. I think this this question came from Peter from the, from the Instagram story that I posted the other day. And, you know, we're I have a cool series that I'm working on called more than a diabetic, which is going to be debuting next year with some awesome community members. So that's up first. You know, in terms of brand partnerships, obviously, Medtronic has a couple other long term partners that I've had that I want to do some deeper, cooler campaigns with, I'm sort of in a, I don't need new stuff I really want to care for and sort of nurture my existing relationships. And my existing, I don't know whether partnerships are you know, I have my a lot of irons in the fire, I don't need more irons, I need to just really focus on you know, my relationship with my wife, my relationship, my family, my my two businesses, and really focusing on being a good steward of what we have and continuing to do, right for people with diabetes. That sounds like a great plan. I want to have some fun, you know?


Stacey Simms  46:55

Yeah, definitely. And hopefully, we can see each other again and travel a little bit towards the end of the year. And I would just love that. That would be wonderful for me.


Rob Howe 47:03

Yeah. If I want to manifest anything for 2021, I put my hands in the air because I'm manifesting this my manifesting. Okay, if you're listening, you're missing out. I want to go on a honeymoon with my wife in 20. Oh, love that. That would be a fun thing. Travel, you got my wheels turning, I love to travel. And I have missed that sort of being held down at the house this year. So Excellent. Well,


Stacey Simms  47:22

I hope we can do that. I'll keep you posted on anything I can help with. Thank you so much for spending some time with me, Rob, it's always fun to catch up. And you caught me, you know, me talking more than I usually do on these interviews, I think but thank you.


Rob Howe 47:33

I like that. I think it's just the my inner interviewer. And, you know, thank you for all the work that you put in Diabetes Connections. I think when you're a diabetes mom, there's so much work that goes into that anyway, and I just applaud people like you. And then frankly, there aren't that many like you at this point. You've been doing this a long time and do a great job. So I hold you in high regard. I'll just leave it at that you do a great job and I appreciate you.


Stacey Simms  47:55

Well, that's very good. Thanks, Rob.


Announcer 48:02

You're listening to Diabetes Connections with Stacey Simms.


Stacey Simms  48:08

I'll link up lots more information about the topics we spoke about, especially the Medtronic pump if you'd like more information on that, and you can go back just a couple of episodes. We had the folks Medtronic on in the fall of 2020. To go through all of the details. I'll link that up in this episode as well.

And I'll put a link into Rob's Instagram where you can see everything we talked about. He is quite prolific on Instagram and his wonderful wedding photos, the modeling, even the Medtronic signing announcement that I kind of teased him about there. It was great to talk to him and I hope it was okay that I talked so much. It was odd to be on the other side of the microphone, but it was fun to hopefully you enjoyed it as well.

We are going to have my favorite segment of the week coming up Tell me something good. But first Diabetes Connections is brought to you by Dexcom. It is so hard to believe with Benny 16 years old now, almost six feet tall that he was ever a toddler. And I mean it was also just like it was yesterday. It's bananas. When you have a toddler diagnosed with type one. You do hear rumblings for a long time about the teen years people start scaring you about that right away. But when it hit us at full force a little early, I was really glad we had Dexcom Benny's insulin needs started going way up around age 11 and along with the hormone swings all the growth, I cannot imagine managing diabetes without the dexcom continuous glucose monitoring system. We can react more quickly to highs and lows. see trends adjust insulin doses with advice from our endocrinologist. I know using the Dexcom g six has helped improve Benny's agency and his overall health. If your glucose alerts and readings for the G six do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. To learn more Just go to Diabetes and click on the Dexcom logo.


I got a bunch of Tell me something good submissions this week. So if you are not featured and you popped one into the Facebook group. Please stay tuned I will be sharing them in the weeks to come. Corinna posted a great article from Washington and New laws taking effect this year from Washington State caps the cost of insulin at $100 per month health plans issued or renewed after January 1 2021. Must cap Insulet co pays deductibles and other forms of cost sharing at $100 per 30 day supply. I'll link up that article and I do think we're gonna see more and more legislative action this year and next year when it comes to insulin so Corinna thanks for sharing that

and Corinna’s blog also got an honor. Recently, she writes type two musings, and she was featured in an article on everyday health about the top type two diabetes blogs to watch this year. So I'll link that up as well if you haven't checked her out. She's a longtime advocate and blogger in the diabetes community. Thanks for sharing that.

And just a little good news from Carol Who says I discovered the secret to five sites use six millimeter cannula instead of nine millimeter, whatever works. The thigh site is one that Benny has struggled with. He just does not like it. He's done it here and there over the years. And you know, it's just not his favorite. So Carol, I'm really glad that that worked. You know, we used a longer canula for a while and if you're not familiar for not a pumper. So the canula is how the pump gets the insulin infuses the insulin under the skin, you have usually an inserter of some kind, it puts a needle under the skin immediately withdraws and leaves a tiny canula six millimeter or nine millimeter under the skin where the insulin drips through when Benny was 10 or 11. And we kind of noticed his insulin use going way up. We didn't really think about the cannulas and the insets being overwhelmed. We thought well, maybe we just need to use a longer inset maybe it's a problem with scar tissue. And we switched to the nine millimeter for a couple of months. It made zero difference for him. It was one of the things that led us to untethered, which if you're new to the show, we used a combination of long acting and pumping for two years when Benny's insulin needs went way, way, way up. And it took a lot of the strain off the inset. It helped him measurably it was just wonderful. His insulin needs have gone down. He is 16. He is coming out of puberty. And so we are off untethered. But I didn't mean to be under there, Carol. Sorry. Thank you so much for sending that in.

And I'll add something good in that Benny has started back with wrestling practice. Now this season is going to nothing like any season in the past. I'm not sure they'll ever even actually wrestle for the rest of this school year. But we're back practicing. They are either indoors with masks, I think when they're outdoors, they're wearing masks depending on where they are and how close they are together. But he is really psyched to be back with the wrestling team and working hard. And he's really been working hard all this year. And I'm really proud of him. I don't like to say too much. I'm very superstitious. I'm knocking on wood even as I'm talking, which is why I don't brag about him more. But isn't that ridiculous, but I am superstitious, but he is doing well. And it's cool to have the wrestling practices back again. So that's my Tell me something good. Please feel free to email me with your good news or post in the Facebook group when I ask and just tell me something good.


One of the conversations we had in the Facebook group recently was about predictions for the new year. And I meant to give mine during the last episode, I want to put this on tape so you can laugh at me. We can play it back next year and see if I cut anything right. So here were my predictions. And this was about diabetes technology. I'll go big. I think we're gonna get Tandem bolus by phone approved that has been submitted according to investor calls, I think we're gonna get that approved and rolled out by third quarter of 2021. I think we're gonna get Dexcom g7 approval and rolled out by the third quarter of 2021 as well, that one I don't think has been submitted yet. So that one might be a little bit more hopeful. But come on. I do also think no direct to watch. Sorry, for g7 I still think you'd have to use a phone. But I do predict that the DIY crowd will find a way to crack it. And you'll be able to go direct from the g7 transmitter to a watch. That's very, very helpful. And it's also set up with zero knowledge about what it would take to do something like that. Love you guys. I have no idea. I think you're all geniuses. I think we're gonna get Omni pod five powered by horizon. Not until the fourth quarter. I think they're just a little bit behind only because I mean COVID delayed everything and my understanding is that have not submitted yet. Omni pod folks, you are more than welcome to come on the show. I'd love to get an update about that. Let me know. And I do think we'll also see another viable CGM competitor ready for submission to US FDA by the end of the year by the end of 2020. I think it will be submitted.


So those are my technology predictions. I think, as I've said, really, in this episode in many in the past, I think this is going to be a big year for conversation and education about insulin pricing, not just because the democrats are in charge in DC because let's face it, they didn't do anything last time around about insulin pricing, but I am very encouraged by the education and the advocacy. Frankly, the impatience among many people I'm seeing now, I think it is going to be different than last time around. Look, don't misunderstand my comment. Nobody said anything about insulin pricing for 30 years under any administration, it has nothing to do with party. It hasn't so far, maybe we'll see federal action. But I do think that the state legislators are going to make the big difference here. I refuse to make any personal predictions. I'm hoping that I continue to let Benny become more independent. I hope that he continues to put up with my digital list. Are you okay? Do you need to think Can I help you for at least a little while longer. He's a sophomore in high school. So I've got him here for a couple of more years.

And I predict that the podcast will stay a place for me to serve you. It is really a privilege to do this. I hope we continue to grow at the pace we are I love reaching more people. But bottom line, this is still the most rewarding project of my professional career. I've been in broadcasting a very long time, longer than I'd like to admit sometimes. And this is it. For me. This is the big deal and the one that has made just an enormous difference for me personally. So thanks for that. Got any predictions? We already have a thread going in Diabetes Connections the group I'll bump it up when this conversation goes live. Thank you, as always to my editor John Bukenas from audio editing solutions. And thank you so much for listening. I'm Stacey Simms. I'll see you back here next week.


Benny  56:25

Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged

Jan 5, 2021

For the first time in several years, a new pump company is making a reach into the US market. Meet Ypsomed, the Swiss company teaming up with Lilly Diabetes. Their device, The YpsoPump, is available in Europe and Canada and has some unique features. But when it launches in the US, likely in 2022, it will only use Lilly insulin. That kind of proprietary design is unique and is raising eyebrows. Stacey talks to Simon Michel, Ypsomed's CEO (she'll talk to Lilly in a separate interview airing in a few weeks).

In Innovations this week, what is an inverse diabetes vaccine? And could you be part of a trial for one?

Learn more about City of Hope's Inverse Vaccine trial here 

This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.

Check out Stacey's book: The World's Worst Diabetes Mom!

Join the Diabetes Connections Facebook Group!

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Episode Transcription:

Stacey Simms  0:00

Diabetes Connections is brought to you by Dario Health, manage your blood glucose levels increase your possibilities by Gvoke HypoPen, the first premixed auto injector for very low blood sugar and by Dexcom take control of your diabetes and live life to the fullest with Dexcom.


Announcer  0:22

This is Diabetes Connections with Stacey Simms.


Stacey Simms  0:28

This week, my first interview with Ypsomed, the Swiss company teaming up with Lilly diabetes to bring a new pump to the US. A few features make YpsoPump unique, including their infusion sets which can help to cut back on insulin waste.


Simon Michel  0:43

Yes  it's terrible. It's throw away so much insulin all the time. But you can disconnect Of course from your body, you change a cartridge, you put it back on. And that's how you don't lose your insulin in the tube.


Stacey Simms  0:54

That's Ypsomed CEO Simon Michel, we talked about more features and he answers questions about the partnership with Lilly in innovations. What is an inverse diabetes vaccine? And could you be part of a trial for one This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider.


Welcome to our first full episode of 2021 Happy New Year. I'm so glad to have you here. Here we go. Another year of the podcast. My goodness, I'm your host, Stacey Simms. And as always, my goal here remains the same. We aim to educate and inspire about diabetes, with a focus on people who use insulin. any of that line sounds a little bit different if you're used to my intro where I talk exclusively about type one. But you know, more and more people with other types of diabetes are listening as the show is growing. And I think that's really important to acknowledge and to kind of dial back and see who we're serving here.

My son was diagnosed with Type 1 14 years ago, my husband lives with type two diabetes, I do not have any type of diabetes. I'm the broadcaster in the family. This year on the show, I'm going to be focusing a lot on new technology, I think the delays that we saw in 2020, because of COVID are going to result in a lot more news than was originally planned or expected for 2021. You know, a lot of that innovation, a lot of those FDA submissions and approvals are getting stacked up, especially as we're looking at the second half of 2021 and into 2022. So you know, why not get ready. And you all have told me that you are very interested in episodes about technology.

In this episode, we're gonna learn all about Ypsomed and their plans for the US market. I have an interview scheduled with their US partners, Lilly diabetes, to talk more in depth about the proprietary nature of this pump. You can only use Lilly insulin in it in the United States. That's interesting. We talk about that here in the interview. And then there are a bunch of questions that Ypsomed, really cannot answer that are more for Lilly. So I'm excited. I'll be talking to them soon.

And just in the technology front, you're going to hear from the folks from Tandem. I've got a Medtronic interview, I'm excited to share with you. And as we look forward, of course, I will still be doing the personal stories interviews because I love those too. But please let me know if there are companies that you would like to hear from this year, and we will get them on and yes, Big Foot beta bionics. I'll be talking to everybody.

Okay, Ypsomed in just a moment. But first Diabetes Connections has a new sponsor this year. Yes, I am so happy to welcome our newest partner Dario, I cannot wait to tell you all about them. You know, we first noticed Dario a couple of years ago at a conference and Benny thought being able to turn your smartphone into a meter was pretty amazing. I'm excited to tell you that Dario offers even more now, the Dario diabetes success plan gives you all the supplies and support you need to succeed. You get a glucometer that fits in your pocket, unlimited test strips and lancets delivered to your door and a mobile app with a complete view of your data. The plan is tailored for you with coaching when and how you need it and personalized reports. Based on your activity. Find out more go to my forward slash Diabetes Connections.

My guest this week is the CEO of Ypsomed. And if someone is a leading maker and developer of injection and infusion systems, pumps and pens around the world, and not just for diabetes, as you'll hear, they've been in the space for a very long time. But we're talking to them because I know I have listeners around the world and I appreciate you all so much and many of you may have experienced with this pump, but we are us centric and Ypsomed announced that it is partnering with Lilly diabetes to bring their pump to the US market.

That announcement raised some eyebrows when it came out this fall because it will be the first pump in the US that will only be used With one type of insulin that can only be used with one type of insulin, and the US market is the only place where that will happen, this pump will be available in other countries that already is with different types of insulin. In other words, to be clear, you'll only be able to use Lilly insulin, such as human log in the US, if so, mid pump. Now, Ypsomed has been around for a long time before this, of course, many of you who've been in the space for a long time will recognize some of the technology names and the brands that come up here. I was really excited to talk to the CEO, of Ypsomed Simon Michel, for the very first time, he's been the CEO since 2014, at the company since 2006. And as you'll hear, he kind of grew up in the company. And here's our conversation.

Thank you so much for spending some time with me. I'm excited to have you on the show and learn more about this. Thanks for being here.


Simon Michel  5:53

Thank you, Stacey. I'm to give us a chance to talk and explain to what we're doing. Yeah.


Stacey Simms  5:58

So let's just start with the basics if you could tell me about Ypsomed because we're really not that familiar with it here in the US. So if you wouldn't mind taking me through. Let's start with the the company history before we talk about the product because you are not a new company. You've been around for a while.


Simon Michel  6:14

Yes, I'd love to Absolutely. Thank you. So my father in 1985. Around the time when MiniMed founded the first company, the first pump in in Europe Disetronic. Some of you might still remember the name. And we were quite a successful pump company. And we sold the pump company at the Disetronic to Rouche in 2003, Rouche is still a name in Europe, roughly 80,000 patients on the product. But as they didn't really innovate anymore, we decided to go back into pumping in 2010.


Stacey Simms  6:44

When you went back into the pump business, what was the product at the time.


Simon Michel  6:48

So we did two things in 2010, we signed with Insulet. We took over the DC distribution of the Omnipod in Europe. So basically build up the business for for Insulet. between 2010 and 2017. When we've given it back to them, and the parallel we have started to develop our own YpsoPump so in back into tubed pumping and thought what can we do better? What can we do better in terms of pumps? What is the community needing tomorrow? versus the old Disetronic pumps, what can we do better?


Stacey Simms  7:17

What did you find that you could do better? We're going to talk about what the pump looks like and what it does, but big picture.


Simon Michel  7:24

So when we look at Ypsomed today for a whole, we make roughly 400 million in revenue, we grow at roughly 15% per year. So quite a healthy company despite of COVID we still grow and we have two businesses and it's quite important to understand we do both pumps and pens. today. I'd say you're by far largest pen and auto injector manufacturers in the world. We close roughly seven out of 10 deals in the pen space that's pens for insulins, solostar pen some of you might know it's also many of the Chinese pens, pens all over the world but all the injectors for autoimmune diseases migraine Astham, osteoporosis, So this is our device business. And the other half of our company the other 12 million is where we are very invest in pen needles in blood glucose monitoring and heat pump systems. And this we sell in Europe very successfully now for the past years in Europe and our own brand was owned subsidiaries and own people.


Stacey Simms  8:20

I'd like to know more about maybe we'll talk more about the pens a little bit later on. But when you started talking about the pumps and the systems that you started making in the 2000s I'd love to get back to what was lacking in the pump market. What did you think needed to change that you could do differently and better.


Simon Michel  8:37

So a couple of things you know, I mean to the pump was very much medical device centric. It's a very strong technic focus site is designed by engineers, great engineers from America from Switzerland from Germany, great people that think about what features we can add. But in the end of the day, we use these devices daily we don't really want to know and hear and feel and about this device. So number one criteria for us was to make it small and light. Ypsopump is roughly 80 grams. I don't know what this is in American weight measures but it's a it's a roughly half the weight of a Medtronic pump. I mean that gives you some kind of feeling very important, you wear it all day. The other thing is simplicity. We don't need all those features. I mean if you look at the at the iPhone, some of these phones they have many features but they only show the features that you actually use. So really simple in a way what is really required you don't need eight basal menus, you need two or three. Some might use but the big, big majority of us don't need this vast opportunities.


Stacey Simms  9:38

When I look at the the pump that we're talking about today. It does look tiny, it does look light and I did the I had to convert as well using my iPhone and that weight that 80 gram weight is point .176 pounds so very, very, very light. It looks like it's smaller, it looks like obviously it's lighter and doesn't have a touchscreen. It Looking at his buttons?


Simon Michel  10:01

Yes, absolutely. So it has a touchscreen. It's used like your mobile phone, you have one button to turn it on and off. That's basically it. But other than that you have a regular touchscreen, which works at night perfectly.


Stacey Simms  10:13

It's basically white on black. So it's a very good contrast that you see, is the pump controlled by phone? Is it controlled remotely? Or is it still used as the touchscreen?


Simon Michel  10:22

So yes, very important. We are a compared to other manufacturers, we are a iPhone app centric company. So you everything you do we do from your phone. So you have your Dexcom data on your phone, you give your bolus from your phone, you do your basal rates from your phone, that's that's our strategy, we have the firmware updates that go via phone onto the pump and back. It's very much app centric. The reason is we can be much, much faster and adding elements and adding new functions, new features, you don't need to change the device, you know, you don't want to change device or every year, simply too costly. This is why we set it up that way.


Stacey Simms  10:59

So that's a huge deal. Because here in the States we're all waiting for, you know bolus by phone, we're waiting for pump control which Tandem and maybe Omni pod will have and hopefully 2021. But just to be clear, you have that already.


Simon Michel  11:12

So we have the apps and the whole app control features are now launched in q1 in all over Europe. Yes. All the other things integrate the integration. The data this is this is in place the apps is in the market. But the integration of this bolus button and the CGM together is Dexcom is launched now in the beginning of ‘21, q1.


Stacey Simms  11:32

But let's talk I brought up the United States market. Let's talk about this partnership with Lilly, what is that partnership going to look like? And we can talk about consumers in a moment. But what will that partnership look like? For you all? Tell me about the system? What will the Lilly IP so mad Dexcom system look like when you bring it to the States?


Simon Michel  11:52

Well, basically, for my relationship, it's simple Ypsomed innovates and be manufacturer really supports in innovation and does the marketing and sales it was for us crystal clear from the beginning Ypsomed is a European company, it would be very tough for us to enter the big US market. So if you're looking for a partner, and luckily Lilly was looking for a pump, so we found each other a year ago Ypsomed would be the is the comet actually registered a product to the FDA, the expected approval in the second half of 22. But it's a fully branded Ace pump. So Dexcom is integrated as a bolus calculator calculator, the remote bolus  function as a Type Zero controller that will follow by mid 23. And it is a Lilly product from a user perspective, but it's manufactured in Switzerland.


Stacey Simms  12:35

It's so interesting to hear you say these things that a few years ago would have been very foreign to us. I think my audience is familiar now the ACE designation, Type Zero, which is the software that's inside. It's incredible, just to take a moment and think how far things have come


Simon Michel  12:52

across fast pretty fast. Yes,


Stacey Simms  12:53

goodness. But to be clear, Type Zero is the I would call that a hybrid closed loop software. So that's the software that will in very plain terms, work with the Dexcom to increase insulin or decrease insulin to try to keep people more in range. I just want to be crystal clear about that.


Simon Michel  13:11

None of those days. Absolutely. I mean, I mean, Type Zero belongs to Dexcom. And of course Type Zero is further working on on new versions of the controller. It's a constant enhancement. At the moment, the features that you described are the ones it's the low suspend function. It's the hybrid adaptation of the baseline rate. There's the micro bolus element, there are a couple of features which have one goal to bring us to bring patients with type 1 diabetes in in time and range


Stacey Simms  13:35

the ACE  designation, and I get a little confused on this. So I apologize in advance. That's all about interoperability. Right That's about making these new technologies compatible with other devices.


Right back to our conversation, but first Diabetes Connections is brought to you by Gvoke HypoPen, and almost everyone who takes insulin has experienced a low blood sugar that can be scary. A very low blood sugar is really scary. That's what Gvoke HypoPen comes in Gvoke HypoPen is the first autoinjector to treat very low blood sugar Gvoke HypoPen is pre mixed and ready to go with no visible needle means it's easy to use. How easy is it, you pull off the red cap, push the yellow end onto bare skin and hold it for five seconds. That's it. Find out more go to Diabetes and click on the Gvoke HypoPen logo. g book shouldn't be used in patients with pheochromocytoma or insulinoma visit slash risk.

Now back to Simon talking about interoperability and the East controller.


Simon Michel  14:40

Well, I mean, the great thing is that it's much easier to add different devices or different controllers to it. Once you have the ACE type designation you can actually change or upgrade a controller as it only is doing a lot of research on on controllers. So think about the might use their own controller in the future. Together with their new insolence. You can Think about situations where you can do better therapy better time and range when you combine new insulins with new controllers to actually use the insulin data to make better controllers. And also on the sensor side, it's possible that other sensors would come to the system at the moment, we love our partnership with Dexcom. It's great. It's really works perfect. But it's just it just shows an openness, that it's basically easy to add something else.


Stacey Simms  15:22

I have another question you may not be able to answer. I will be talking to Lilly about this. And it's really a question about them. I was at Lilly's headquarters in Cambridge, the headquarters for this project a couple of years ago, where they showed us their pump prototype because at the time they were working on building their own hardware. And obviously that project, I don't know if it's put aside I'll ask them about that. But this is not that pump. Correct. This is not the the pump that Lilly developed their partnership with you is using your hardware? If so meds pump, not this Lilly, it was a little circle disk pump that they showed us at the time.


Simon Michel  15:56

Yes. If the pump is purely manufactured by IP summit, it is the product designed here in Switzerland, that will be the pump that Lilly will use. You're absolutely right, Lilly was working on our own pump program, patch pump type program for many, many years. But you have to ask them they recently paid to our knowledge, they recently recently stopped the project, and are now fully focusing on our joint partnership to bring a cement Lilly pump to US patients.


Stacey Simms  16:25

I appreciate you answering that. I know that's more of a question for Lilly, and we'll talk to them about that for sure. But you know, insulin affordability is a huge issue in the United States. And we are we are struggling with that and a lot of our health care system right now. But making a pump that only uses one type of insulin is going to limit options. And I gotta be honest with you, I think people are, it's it may not be seen as a very popular feature. You know, we have insurance issues in the United States. I just went through this with my son, where we'd been on one insulin for many years. And then my insurance company said, No, you you have to use this other insulin. And that can happen here. Are you concerned about that at


Simon Michel  17:02

all, this will happen, of course, but it is ultimately beneficial for a health care system. And I can make the comparison with mobile phones. So if you have a mobile subscription, and you have your fixed lens subscription or internet subscription, you get a better deal. Now, this approach is to really bundle all these elements, and it will ultimately very much be much better beneficial for people with diabetes, it will be better for the healthcare system as of lower cost. So it's definitely not increasing the cost. Yes, it is increasing, its increasing to some extent, your choice of insulin, whether it's a short acting insulin for novel from Lilly, I fully agree but it will lower costs for healthcare system because of the bundle approach. It's a really innovative partnership. Where is the entity manufacturer really decides to go the full way the first time in history? And this will be beneficial for us us healthcare system for sure.


Stacey Simms  17:49

That's really interesting. So they'll have to work with insurance companies to say if you cover this pump, you must cover this insulin. Again. Again, I have to talk to Lilly but I would imagine Yes,


Simon Michel  17:59

well, of course that's a fair question. But I mean really wouldn't invest so much in a partnership if they wouldn't want to sell their core asset which is their insulin and in a prefilled cartridge, it will work with our pump. So it is the way this relationship is built up. But again, for Americans and for the healthcare system, I personally only see benefits in the end of the day in terms of cost.


Stacey Simms  18:23

That prefilled cartridge is something that is not currently available on any pump system in the US It was here for a while with some older pumps that are not on the market anymore.


Simon Michel  18:33

Well it was our pump Yes, it was the Disetronic pump with the three ml humalog cartridge was available in America between I would say 1998 and 2004 ish before Rouche stopped it, it will come back but it will come back in 1.6 format in a shorter version. We basically have this in the market already in Europe together with Novo Nordisk . So there's a novel called pump cart that works with our pump that's available in the market now since 2017. And is going the same way now this is a huge benefit to work with prefilled you don't have to fiddle around and fill your cartridges you could just take it out of a fridge make it a bit warm, put it into pump and that's a huge benefit.


Stacey Simms  19:12

It was very popular I think I want to say the Asante snap pump also had it for a while and that's the one that I look at because


Simon Michel  19:20

yeah your idea right it wasn't it wasn't this one was not a market so it was not so successful. This pump You're right. I mean the issue was with the D Tron pump, it was a bit too big, you know, it's three ml cartridge, the 1.6 is shorter. That's how we can build such a small pump. And the good thing about a pump is with our infusion set, you can actually keep the tube on. So you can change the cartridge you can keep the tube on you don't have to throw away the insulin which is in your tool because you can change the cartridge. Keep the cube you're using and you don't lose insulin.


Stacey Simms  19:49

Okay, I have many questions. Wait, let's go through those all at once. And I will get to the keeping the inset on but staying with the cartridge for a moment. So that's 160 units In the cartridge and you said take it out of the fridge, pop it in the pump, is it good in the refrigerator for a long time, because right now if people kind of pre fill when they're not supposed to the cartridges that are available on the market will start to break down. I'm assuming that's not the case.


Simon Michel  20:15

Well, it's, as we are used with pens a single expired expired date of two to three years. It depends on market by market, but you can keep it as your pen,


Stacey Simms  20:23

I was thinking two to three weeks for a filled cartridge right now, we're not supposed to do that with the Tandem or the Medtronic pump.


Simon Michel  20:30

It's a prefilled closed system as we are used with prefilled three ml cartridge. Some of you may use a reusable durable pen. Of course there you need regular in Europe, quite a lot of people use durable pens. And now it's Medtronic coming this Companion, you will see more and more durable pens in America as well. This smart pen trend will definitely lead to more cartridge based pens where you exchange the cartridge. So it's a standard closed cartridge system. You can keep it for two or three years in the fridge.


Stacey Simms  20:57

So talk to me about keeping the inset on. When you're changing out the cartridge. You're not priming the tubing, you're not doing things like that,


Simon Michel  21:05

yes, we built in a valve in a way that you can take the connector off the pump, you exchange the cartridge, you put the connector back on the pump, and there's no air coming into the tube to kick can continue to pump Of course you would disconnect it, you orbit set has a nice feature disconnect at the head. It has a 360 degree rotation feature. So it never cranks. But you can disconnect Of course from your body. You change a cartridge, you put it back on. And that's how you don't lose your insulin in the tube.


Stacey Simms  21:35

That's wonderful people you know, it's very difficult when you're losing units upon units when your primary


Simon Michel  21:41

yes and no, it's terrible. You throw away so much insulin all the time. So you can use this tool for seven days. So two or three cartridges. Of course it depends. If you if you need more insulin, you use it for two or three colleges if you use less insulin, use it for so it's just I think seven days is what is what makes sense.


Stacey Simms  21:59

Tell me a little bit more about that inset because I I've said for years and years that insects are the weak link of pumping, they leak. They don't work so well. You mentioned it rotates. Talk to me about your inset


Simon Michel  22:10

is a fully agree it's definitely the space where part manufacturers have to spend much more effort in innovation. Our infusion set is today a three day infusion set we work on a five and seven day version to just keep it longer on it's also regulatory work that has to be done here. It has a skin color. plaster so it doesn't show so much if you wear it. When you're at the beach. It has a 360 degree rotation at the head. So it really doesn't crink that's quite nice. It pops up clicks very nicely. You can click it behind your back without looking at, you hear it and it's safe and close. It has a Blue tube so it doesn't show so much on black clothing. A couple of nice features.


Stacey Simms  22:52

Is the skin tone one skin tone?


Simon Michel  22:55

It is a I would say it's a as neutral as possible one skin tone. Yes. I mean, it's better than white. You know, I think White is really shiny like we are used from other part manufacturers. It's just a more neutral skin tone.


Stacey Simms  23:08

Yeah, I know. You know what I'm asking though? I mean, is a Caucasian. Is it more peach than brown?


Simon Michel  23:14

Yes, yes. Yes. Yes, it is.


Stacey Simms  23:17

All right. Well, your first feedback is you have to work on that for especially for the US market and other markets. So I'll give you that piece of feedback.


Simon Michel  23:23

But input Thank you. No, you're absolutely right. It's a very good remark. I think I guess we are not so much used. From a diversity perspective over here in Western Europe. I think it's a very, very important remark you're making. And I definitely think it's possible to do that. I think it's a great idea.


Stacey Simms  23:38

That would be wonderful. Because, you know, I chuckled as I said it, but I appreciate you taking it seriously. It's difficult to talk about these things. And I find myself sometimes I shouldn't have left, they're trying to defuse the situation a little bit. But we are a very large and diverse country over here. And we have lots of


Simon Michel  23:55

love. No, no, no, I fully agree. And they beat this doesn't stop bad skin color. I think it's a great idea. And I don't see a reason why we should innovate on that to something we have never seen over here. It's not a topic that we get from customer feedback over here in Europe, but it's a great input. Thank you.


Stacey Simms  24:10

I appreciate you taking it that way. So let's talk about the pens for a moment because we tend to focus on this show a lot about pumps. But at the same time, you have already mentioned so many interesting things about pens. Do you plan to bring you mentioned smart pens, you've talked about the different types of pens that Ypsomed makes already outside of diabetes? Is any of that available in the US market or do you plan to bring it here,


Simon Michel  24:34

so from the insulin pens today, only the Solostar pen from Sanofi is on the market. It's a disposable pen. Also the to chill pen so the for the other type of Sanofi insulin. Other than that we are at the moment in discussion with several parties. For our smart pen. We have a smart pen for a 1.6 ml version and a three ml version, which connects to the app and the cloud. Of course, you have all the benefits of a smart pen you can use the CGM data including all the injection data which we really need. I mean, you need both sides, you need to be GMC champ data as well as the injection data when you have injected IV correctly. In fact, we have a lot of nice features on the pen tells you if it's styled correctly or not. There's a lie. It shows your holding time. How long enough to hold on many nice features you can do with smart pens today.


Simon Michel  25:21

Yeah, because a lot of people don't still want pumps attached to them. And a pen is a real option


Simon Michel  25:26

Yeah, absolutely. I mean, worldwide, we have 50 million people that take shots every day, but only 1.5 million user pump. So I think a lot of the vast majority uses pens, so it definitely have to innovate more in that space. And I'm so happy now that Medtronic decided to do to make that step to make that move, and also Novo Nordisk making the move. Now Lilly will come with a solution and the space is now moving. And that's very important.


Stacey Simms  25:51

It's okay, if you can't answer this, but can you give us an idea of what an Ypsomed smart insulin pen would do? I mean, we've The only frame of reference we have here in the States right now is companion medical, as you mentioned with Medtronic, could you give us an idea of what features might be available?


Simon Michel  26:07

Yes, absolutely. I mean, this pen is available in the analog version, so the non digital version in China for over 10 years, it's a very robust pen the piston drop, push back with your finger, it has a bayonet coupling for the cartridge. It has a spring driven support for injection. So it don't need to force if you have, or if you're old or don't have strength anymore. You just put a button in checks with a spring support. Very nice feature, we have a large display, which works at night, you have a light that gives the signal whether your dial is correct or wrongly, it's red and green, it shows how long you have to check that it stops blinking when it's injected fully out of his holding time, I think is the old time is very important. You have its Bluetooth connection, of course to the app connects automatically, it stores everything on the pen and on the app.

So all the features that you are used from Companion are now in there, as a will be a great, great product that we are working on here. And hopefully be able to introduce to America, we will take two two and a half years to come. We have to go through registration program together and still need to make the decision what partner will be the one that will bring it to the market. You know,


Stacey Simms  27:14

I should have asked you right at the beginning. But I'm curious, do you have any kind of personal connection to diabetes?


Simon Michel  27:21

Well, not personally, not not nobody in our family has type 1 diabetes, we have a couple of uncles and aunts that are on insulin on type two. But you know, I spent my whole life with diabetes. I think when I was 10 years old, I was throwing the first insulin pump. I still have this picture somewhere I can check and send it to you. It was it was an H Tron pump. Remember 1987. So I was my whole life. I mean, we went to the factory pump factory with my father, when I was a boy, my brother and me We ran around. And so he was my whole life. And then I went to university and I started in telecom industry. And it was very clear for me that I will come back. So I'm in this in this industry now really, for almost two decades. But we don't have diabetes, but I'm very, very connected to it.


Stacey Simms  28:02

That's great. I would love to see that photo or anything that you might want to share for sure. So I guess that leads me to this question, which is what gets you excited. I mean, your family has been in this business for so long, you've seen it change, you're bringing something brand new to the United States in a couple of years. But what gets you out of bed every morning that you're still excited to work in this space.


Simon Michel  28:22

I believe we are extremely privileged here to be able to work on products and services that make life easier for people with diabetes. And this is our business for 30 years. It's a family business we are stock listed but the majority of the shares in our in our family. So we do have a large responsibility on it. It's just great to see we are 2000 people now here working every day tried to make better devices, better solutions for people with chronic diseases also outside of diabetes and it's it's a huge privilege and motivation to work on it.


Stacey Simms  28:53

Well I feel like I just scratched the surface starting to talk to you about the partnership with Lilly and the pump and the pens. So I hope I can circle back maybe next year and check in on the progress and and talk to you as you get closer to bringing this to the US.


Simon Michel  29:06

Yes, let's do that. That's right to give an update. Once we filed we tried to file in summer 21 we still sorority and they will definitely be a good time again to give you an update.


Stacey Simms  29:17

Wonderful. Thank you so much for your time. It was wonderful to talk to you and I'm so excited to learn more.


Simon Michel  29:22

It's a pleasure talking to you.


Simon Michel  29:29

You're listening to Diabetes Connections with Stacey Simms.


Stacey Simms  29:34

So what do you think? I'll be posting in the Facebook group to get your questions for my upcoming interview with Lilly and that is Diabetes Connections the group Do you think it's possible that overall, this pump system will turn out to be less expensive as Simon thinks. I certainly hope so. But any kind of proprietary idea on a market that is already so limited just makes me nervous.

And I said this when I was at Cambridge a couple of years ago looking at their prototype for the pump that they're no longer developing, apparently, I think they got into this pump partnership, because they know the writing's on the wall for insulin price controls may be too strong a word, but limitations. I won't get into it too much here. But you know, we've had this conversation many times before, I think that there's going to be legislation at the state level, if not the federal level, to really change how insulin and other medications other treatments are priced. So we shall see.

And oh, my goodness, I hope our conversation about skin tone on the inset came off. Well, I mean, these things are awkward, as I said in the interview, but once he said skin colored, I mean, most of the inserts are just bright white. So once he said skin color, I had to ask, I had to follow up. I hope that came off. Okay. And look, we can seem to take it very seriously. So we shall see. Wouldn't that be nice if medical devices could be a little more discreet on the skin on any color skin tone?

Okay, up next, let's talk about an inverse vaccine for diabetes and explain what that is. But first Diabetes Connections is brought to you by Dexcom. Do you know about Dexcom clarity, it's their diabetes management software. And for a long time, I really did think this was just something our endo used. You can use it though on both desktop or as an app on your phone. And it is an easy way to keep track of the big picture. I try to check it no more than once a week. Although I'll be honest with you, there are times when I'm checking it every day, it really does help me and Benny dial back, I look for longer term trends. And I try not to overreact to what happened for just one day or you know one hour, the overlay reports help context to Benny's glucose levels and patterns. And then you share the reports with your care team, which makes appointments a lot more productive. managing diabetes is not easy. But I feel like we have one of the best CGM systems working for us find out more, go to Diabetes and click on the Dexcom logo.


In our Innovations segment, this week, I want to talk a little bit about something called an inverse vaccine. This is a City of Hope, phase one trial. And the City of Hope is an organization that is looking to try to find cures for type one, I will link up more information in the show notes about them. And we really should talk to them. I it's hard for me to believe we haven't had them on the show yet. So that's going on the list.

But basically, this would use someone's own immune cells, a beta cell protein, and vitamin d3 to potentially treat type one, I'm sure that is a very simplified explanation. But these inverse vaccines are trying to stop certain immune responses rather than activate them. When you think about a regular vaccine, right, like the flu shot are the COVID-19 vaccine that we talked about just last week, what they're doing is trying to stimulate the immune system, right, here's a germ learn how to fight it, go immune system, right, the inverse vaccine is, here's something coming in, don't do anything stand down. Again, this is a very simplified version of what they're trying to do. But they are recruiting, they can't start the actual trial, they say until the pandemic is under control a much more but they are recruiting and they are screening patients right now. So I'm going to put up a link in the show notes.

And as always, you can go to Diabetes And look at the episode homepage. If you're listening on an app, a lot of them are great to listen to, but the show notes aren't so hot. So if you have any trouble, just head on over to the homepage. As usual. The trial I should say is open to adults with type one between the ages of 18 and 45. You have to have been diagnosed in the last one to four years. There's a lot more listing after that. And by the way, this is a follow up on a small study in the Netherlands where they they looked at safety. So you know if you get into this definitely keep us posted. I'd love to know more.

A couple of quick housekeeping things before I let you go this time around. I am taking part in a free summit at the end of this month. It is the fearless diabetic summit. And I will be posting more about that in the group. And on our website. This is a really interesting summit that is trying to answer the question, what would you tell yourself if you could go back to your first two weeks of diagnosis, and they talk to 30 different people in the diabetes space, you know, experts and educators and NGOs and athletes and I think I'm the only parent that they talk to. But it's a really interesting concept. And I'll talk more about that as the month goes on. I'll put a link in the show notes to the fearless diabetic summit.

Also, if you haven't seen it yet, I have a free ebook Diabetes Connections extra that I put out late last year and this is a set of transcriptions and they are proofed and they're beautifully laid out easy to read. They are the extra episodes that I did a little while ago all about the basics of diabetes management ketones. What is insulin? What are lows? How do you use a CGM to its best practice insulin pumps, all that kind of stuff. I think it's a really good read for newer diagnosed families and for you to give to people in your life that you would like to better explain diabetes to it is an email signup. But you know, I don't spam anybody, most of you are on the email list already. But if you want to send that out, I'll always put the link in the show notes to that as well. That is the free ebook.

And finally, I'm this close to announcing my new project. And it really doesn't have anything to do with diabetes. But if you're interested in podcasting, you'll want to sign up, I am going to be teaching a course this year, I'm teaching two courses actually, on podcast, monetization, get paid to podcast, I have been really interested in this subject, because I've helped a lot of people kind of behind the scenes for the last couple of years to do this, ethically to do this. Well to do it in a way that makes sense so that your listeners don't have to pay anything, but that if you want to spend enough time on your podcast to make it quality, you eventually are going to look at options like this. And you know, like diabetes, there's some snake oil in the space. There's some stuff out there. That's pretty questionable. And I want to help people do this with transparency with disclosures to do it right. So stay tuned for more than that. I will not be hammering you with this. You’re here for diabetes news, but I wanted to let you know, and I'm really excited about it.

Thank you so much to my editor John Bukenas from audio editing solutions. Thank you so much for listening. I'm Stacey Simms. I'll see you back here next week. Until then, be kind to yourself.


Benny  36:32

Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged

Jan 1, 2021

Let's start off 2021 with some hope! This week you'll hear from five health care providers who received a COVID vaccine in late December 2020. They all live with type 1 diabetes and share their experiences leading up to the vaccine and how they felt after getting it. These folks all got the first round of the Pfizer vaccine, which means they are all scheduled for another shot right around the time this episode goes live.

Back in September, Stacey interviewed a women with type 1 who is in the Moderna vaccine trial. Helene Cooper lives with type 1 diabetes and asthma. She has completed the vaccine part of the trial – two shots – and says she's had no bad reactions and no regrets.

This episode:

3:00 Danica, a diabetes educator

8:48 Dr. M, a pediatric endocrinologist

14:00 Michelle, an ICU nurse (who's breastfeeding)

18:40 Geoffrey, a hospital worker

22:30 Dr. Stephen Ponder, a pediatric endocrinologist who's lived with type 1 for 55 years.

Check out Stacey's book: The World's Worst Diabetes Mom!

Join the Diabetes Connections Facebook Group!

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Episode Transcription: 

Stacey Simms  0:00

This episode of Diabetes Connections is brought to you by The World's Worst Diabetes Mom: Real Life Stories of Parenting a Child With Type 1 Diabetes available as a paperback ebook or audio book at


Announcer  0:19

This is Diabetes Connections with Stacey Simms.


Stacey Simms  0:25

Welcome, everybody. And Happy New Year, I am so glad to have you along for a little bit of a different and special episode of Diabetes Connections, I thought it would be a really nice way to start off this new year with some good news.

Look, we're far away from leaving 2020 and everything that happened behind right, there's a long way to go. But this is an opportunity to sort of turn the page and look ahead to brighter days, and give you some news and information and stories from people with type one, which as you know, is what I am all about. And if you don't know if you're new, Hey, welcome.

We aim to educate and inspire about type 1 diabetes by sharing stories of connection. I am your host, Stacey Simms, and my son was diagnosed 14 years ago with type one right before he turned to my husband lives with type two diabetes. And I don't have diabetes, but I have a background in broadcasting. And that is how you get the podcast

in about mid December. late December. I noticed like a lot of you did I'm sure that people I knew were posting photos of themselves getting the COVID vaccine, right. These are healthcare workers. These are our front line in hospital, usually who are able to get the vaccine in the very first batches. And how exciting is that? And the photos were really hopeful and really gave me just, I don't know, a feeling I hadn't really had for most of 2020. So I wanted to talk to some of these people and find out more and get you some information as you live with type one or if people in your family do, what to expect what their reactions were.

So here is what we've got. For this episode, I spoke to five health care providers who all live with type one who received a COVID vaccine in late December 2020. These folks all got the Pfizer vaccine. That means they're all scheduled for another vaccine. There are two doses in the Pfizer protocol. And for most of them, that second vaccine is coming right around the time this episode goes live. There are four shorter interviews with a diabetes educator and endocrinologist registered nurse at a hospital worker. And those are more about personal experiences. And then there's a longer interview with Dr. Steven ponder who is likely a familiar name and a voice maybe to longtime listeners, Dr. Ponder goes a little bit more in depth with me about the vaccine and about staying safe with type one. As we head into this new year. He also talks about things you might want to think about and questions you might want to bring to your physician.

Please keep in mind that all of these folks were kind enough to share their personal experiences. They are not speaking for their hospital systems or workplaces and they are certainly not giving medical advice.

Okay, Up first is Danica, who you might know as Diabetic Danica, she has been on the show before she has big YouTube and Instagram following and she is now a diabetes educator. I started out asking her about her reaction, when she found out she be able to get the brand new vaccine.


Danica  3:21

Or at first we didn't think we would get it so soon because we knew the frontline people were going to get it first. So we work in the clinic but we're not like on the floor that treats COVID patients. We have COVID patients, we do it via telehealth like on an iPad video call. So we've got to do a little bit but the day after or hospital got it we got to get it to so I was really excited to kind of definitely was the most I've ever been excited to get a vaccine before. Just because there's been all this buildup and it's been such a hard year. And I don't know just overall just excitement, which is kind of weird when you're just getting a vaccine.


Stacey Simms  3:56

No, I think we're all feel very hopeful, right? I mean, we all kind of started hearing about it and think I can't wait. So it just explained this is the the shot where you need two shots where you'd be going back for the second.


Danica  4:07

Yeah, so it's a two shot one. But it's nice because they have you schedule it while you're waiting afterwards. Because just to be safe. Since it's a newer vaccine, they want you to wait 15 minutes after to make sure you don't have like an allergic reaction. So while we're sitting there, they had us just schedule our next one. So I already have it scheduled. And I'll just go in and get it just something. I honestly was a little nervous after I got it. I was excited. But I was like, Well, what if I do have a reaction? You know, because that's what everyone's worried about. I feel like and that's the majority of the questions I got afterwards was How are you feeling? Was that effective you had I think everyone's really worried about that but I felt fine. I the only side effect I had or symptom, wherever you want to call it was my arm was sore, just like the muscles in it. But that happens to me when I get my flu shot. So it wasn't super alarming to me. I'd say the arm soreness was worse for me than with a flu shot but the actual poke it didn't even feel so like when I got the shot. There was absolutely no pain for me. And then later, I just got sore for about a day like probably 24 hours. I didn't notice any changes in blood sugar, it seems like just run of the mill for me. I don't think it affected anything there.


Stacey Simms  5:14

What has it been like for you in the clinic? Can you talk about your routine and how you stayed safe?


Danica  5:18

Yeah, you know, it was it was really stressful at first because things were changing. And it was very and so like, every day, I felt like we were getting multiple emails about new protocols and things we had to do. Now it's more routine, which is helpful. You know, we wear masks and eye protection. And we really thoroughly wipe down high touch areas, they call it in our patient rooms, the doorknobs and the chairs and the keyboards and everything, this stuff that kills the virus. And I guess I thought it was I don't know, if anything major has changed. I mean, other than me looking at the numbers every day to see how they're going up or down and making sure I'm on top kind of what's new with the virus, just in case patients ask. But I thought it was a lot more stressful at first, like we're getting super used to wearing masks in the room, but I'm still looking forward to the day when I don't have to because it's kind of hard to talk to someone for an hour with a mask and everything covering your face. You know,


Stacey Simms  6:10

how has this year been for you? I mean, you've been able to go to work, which I think is probably has been very helpful. But what has it been like, you know, how are you holding up? I guess is what I'm asking.


Danica  6:20

Yeah, it was it was harder for us, like I mentioned, just work stress, that kind of thing. My day to day work, life hasn't changed a whole lot other than the extra precautions. And initially, we were shut down in my state. So I, I couldn't see my family and I was spending a lot of time at home. So mostly on weekends, I would notice it the most where I'm like, I'm not doing anything fun. And then it opened back up. And so with precautions, we could go out and do things. I feel like I'm hiking a lot more this year for the outdoors and distance and just beautiful one so fun to do. But in my personal life, it's actually been a great year, it is so funny to say to say overall, it's been such a crazy year, but my parents moved to the same town I live in which I'm super excited about. I became an aunt this year, and my little niece was born. And I started seeing my boyfriend as well. So just a lot of like personal life things that have been really exciting for me. So it's been kind of nice to have those as a happy distraction in the midst of the


Unknown Speaker  7:13



Stacey Simms  7:14

I'm so glad to hear that. It's great to talk about good news. That's wonderful.


Danica  7:18

I know. Yeah, there's always something good. And all the bad.


Stacey Simms  7:22

I wonder to the people who are giving the other health care workers the vaccine, were they very Matter of fact about it. Were they excited? I imagine there was more words in your mouth. It's like there be more joy than there hasn't been for a while.


Danica  7:37

I thought it was exciting. Yeah. Anyone the person one of the people who checked me in and someone I worked with in the diabetes clinic today, she's a nurse practitioner. So we were just catching up to and talking about that. We were excited about it. She hadn't got her vaccine yet. So she was looking forward to getting it most people working there hadn't gotten it yet, you know, because they're just volunteering, I assume to to kind of help out with it. So it was a cool process to be a part of. She ended up getting it low later that night, because they had two extras, and they were already out of the freezer. So they had to give them so Wow, that was kind of fun to hear about later, too. But yeah, I think overall compared to me getting my flu shot, it was a much more exciting thing. And you could tell it was a little new just because they they couldn't remember all the questions they had to ask me they had to look at their little cheat sheet, which is totally fine. And you could just tell she's like, I gotta do this a couple more times to be able to drink it. But it was like a teamwork. And yeah, they were doing a really good job.


Stacey Simms  8:29

My next interview is with Dr. Jacob masse check. He's a pediatric endocrinologist who was diagnosed with type one as a teenager. He's been in and out of the hospital this whole year and his clinic as well. And he goes home to his family, which includes two children. So he was thrilled to hear that the vaccine was available through his hospital.


Dr. M  8:48

I feel excited about it as well. I think this is, you know, the light at the end of the tunnel. So I'm thrilled that we have vaccines. I know


Stacey Simms  8:57

you work in an office that probably more than most has had so many questions about COVID because you treat kids with type 1 diabetes yourself live with type one, what was your reaction when you found that you'd be among the first


Dr. M  9:10

I'm very excited to receive the vaccine, we get regular updates on vaccines and get a sneak peek into how these vaccines are developed and how they work. And I actually think that this vaccine will be very similar and will work in a very similar fashion to the way that the flu vaccines work. So I think it's a safe vaccine. And I'm excited that it's going to be available for most of us very, very soon.


Stacey Simms  9:38

It's going to be interesting for you to balance being a healthcare provider. You know, you want a vaccine because you see patients you're in a hospital system, but you also live with type one, any more thoughts kind of for yourself in your protection or all about your patience or a little bit of both?


Dr. M  9:53

Well, being a type one, I am at a greater risk for having poor outcomes. If I worked To catch COVID and develop severe symptoms, so that thought is always in the back of my mind, being able to get the vaccine will put me at, I guess at a more comfortable level, seeing patients every day, knowing that I, I am protected. And knowing that I'm also less likely to develop it not only because of my risk, but also the risk of my family members that I love.


Stacey Simms  10:26

I imagine that most of the people that you see, I'm making an assumption here, but you know, your pediatric endocrinologist, most of the kids are not eligible, certainly this first wave of the vaccine coming out. But you some of your patients will be some of your older kids and maybe some young adults that you see, what are you telling them? When they're asking, should I take the vaccine? Is it safe? What do you know? What are you advising patients?


Dr. M  10:48

My understanding, and I am not an infectious disease expert. But from the kind of peek behind the curtain that we have received as physicians is that I think it will be a safe vaccine, it will work very similarly to the flu vaccination. So I think it's safe, sort of advise my patients to follow the restrictions on their, you know, local scale or state scale. But don't rush out of restrictions are lifted, wait and see what happens wait on the sideline, ever restrictions get lifted, or bans get lifted, we kind of have to think that we are, you know, at a higher risk. And it's better to wait and see what happens instead of rushing out if things open back up. So that's been my advice from the very getgo is, don't be a trendsetter when, when restrictions get listed,


Stacey Simms  11:45

when I look at the pictures of health care providers getting vaccinated right now, it has surprised me how excited I am, was that your reaction to tell me a little bit about your you know, the emotion of it.


Dr. M  11:59

I think having vaccines that are FDA approved, and that the FDA feels are safe, I think is a wonderful step towards seeing the light at the end of this tunnel. I think it gives us hope that we will soon be able to put this horrible year in the past and move towards a more normal life. I'm very excited about it. I'm thrilled. I think it's everybody's stress level will go down as we see that these vaccines are safe and are working. And we see that trends will start going in a positive direction. By positive I mean fewer numbers of patients testing positive and having complications. I feel great about it.


Stacey Simms  12:46

I know you're not like an operating room all day. But I imagine when you come home from work, you've got to take a lot of precautions to


Dr. M  12:51

absolutely make sure that I changed my clothing I wash up before I give them a hug. And that is something that I do. And I've been very fortunate knock on wood that I've stayed healthy during this entire ordeal.


Stacey Simms  13:06

I've talked to a couple of health care providers who have similar stories of you know, changing outside and doing this for so many months. I can't imagine how great that's going to feel the day that you can be like, come on, I can hug you I'm home.


Dr. M  13:18

I think we all look forward to that day. There's a lot of things that we look forward to and you know, this year has been very trying but it also made us appreciate kind of the silver linings in a lot of things. And it's been a reset for a lot of things. So I think we'll come out of this ordeal being stronger and having a greater appreciation for things that we may have overlooked in the past.


Stacey Simms  13:43

You will next hear from Michelle, she's a registered nurse and she has spent this year working with COVID patients. She has two small children. And as you'll hear, she's breastfeeding which was something she gave a lot of thought to before she decided to get the vaccine. I asked her to kind of describe of what's going on with her day to day.


Michelle  14:02

I'm I'm busy. a mom of three year old and a 10 month old. I'm a wife.


Unknown Speaker  14:10

I'm a registered nurse,


Michelle  14:11

I work taking care of COVID patients. Normally I work in the ICU and like on a telemetry unit. And then I'm also in grad school pursuing family nurse practitioner. So I have a lot going on.


Stacey Simms  14:24

Yeah, what is this year been like just with COVID patients? Well, we


Michelle  14:27

we prepared in March for this huge surge because we're in Pennsylvania and New York's right next door, and it didn't come. But our surge is now like our inpatient census is around 100 patients total for our hospital and we have 60 COVID patients right now. It's more than we can handle. It's all hands on deck.


Stacey Simms  14:46

What's your routine like for coming home?


Michelle  14:48

So with the two little ones, they don't understand that you can't touch mommy. So I shower at work. And then I come home so I end up getting home kind of late. If I finish everything On time 715 731 I've done so I don't get home till 815 at the earliest.


Stacey Simms  15:05

So tell me about the COVID vaccine. When did you find out you were eligible? And how quickly did you say? Yes,


Michelle  15:11

so I've been thinking about it long before it was even a possibility, and doing research and reading. And when I saw that the Pfizer vaccine was approved, our CEO, she's awesome. She's very transparent. She sent us emails all along. And she said that our hospital had applied to be a distributing center. And then she emailed us and said that we were approved, so I knew it would be coming. And I had already done my homework to know that I care for COVID patients, right, I see like the worst of what COVID can do. And to me a vaccine with a little risk or COVID with intense risk,


Stacey Simms  15:48

it wasn't really much of a question. Were you concerned? Or did you ask about type 1 diabetes? Did you talk to your endocrinologist? Or did you say, Okay, I know enough, I've seen enough.


Michelle  15:58

I actually, my endocrinologist doesn't know that I took it, I I did talk to my primary care doctor, who's also the pediatrician for my children, and I am breastfeeding. So I just wanted to check and make sure that it was going to be okay in that way. But the research shows there hasn't been breastfeeding research on the vaccine. But in general, vaccines are safe for moms to get when they are breastfeeding, and the chance of passing through breast milk is very small. So I considered all that I consider the risk for myself of getting COVID with type 1 diabetes, and I just didn't feel like the vaccine was going to be the big risk. Actually, I think I haven't gotten the COVID assignments as much as some of my other co workers have. And I honestly think that's because nobody else say it out loud. But my co workers know I have type one. And I think they're looking out for me, which is huge.


Stacey Simms  16:52

I'm curious what advice you would give as a you know, as a health care practitioner, as someone with type one who has seen COVID this year in a way that most of us have not, you know, what is your message about the vaccine? Oh,


Michelle  17:04

I think Americans like to think that life is about us and my choices as an individual and individual freedom. And the reason that I got the vaccine is actually about all the people around me more than it is about myself, I got it because my in laws are in their 70s. And they're helping provide child care for my kiddos. And if we give them COVID, and they get really sick, that's a big deal. If I as a nurse, bring home COVID and give it to other people I love. That's a big deal. So I got the vaccine to try to protect other people. Now at this point, though, I do want to say it hasn't been demonstrated that the vaccine keeps other people from getting sick, it just helps the person who gets the vaccine to not get a severe case of COVID. So protecting other people still needs to be demonstrated. But that's generally how vaccines work. So that's, I'm hoping that it works that way.


Stacey Simms  17:54

What was it like in your hospital,


Michelle  17:56

the message I keep seeing people say is hope. And that's how it feels. It's like this huge drop of hope that there could be an end to this huge thing. I don't know, there's so much I could say I think there's so much skepticism about vaccines and what it can cause but I just want people to remember, look into history, look and see what measles did to people before we had a vaccine. Look at what polio did to people before we had a vaccine, look at the impact of disease. And also think about that, when you think about the risk of a vaccine, what's the risk of not getting it?


Stacey Simms  18:35

My last sort of personal interview is with Geoffrey, he works in more of an administrative role. But he does spend enough time in the hospital and around staff that does see patients that he qualified to get the vaccine, he wasn't originally thinking that he would get the shot in this first batch. But then he explained why he changed his mind


Geoffrey  18:54

what my original thought was that I was going to talk to a number of providers a number of people and get their opinions. I wasn't going to do this based on my own research. I was gonna do it based on the research of my doctors. And my original thought was that I was going to wait a while to let more people get it and see what happens. But once I had the opportunity to do it, then after talking to a handful of doctors and decided the basic sentence was why wait, what are you waiting for? What do you want to see? And I kind of realized that what I want to see is I want to see people 234 years out with no complications and realize that I don't want to wait four years to get the vaccine. So what I want I couldn't get so I decided let's just do it.


Stacey Simms  19:35

So then what was the process like


Geoffrey  19:37

it was very quick, got signed in, got the shot, waited about 10 minutes 15 minutes, and was clear to go for me again. This was super early. It was really exciting for me because I got to see a lot of physicians that I know from what I do for work and and seeing all these doctors and that obviously believe in this enough to be standing there. first in line, this is required of us. So everyone that was there wanted to be there wanted to get this.


Stacey Simms  20:06

How about afterwards? What was your blood sugar? Like any issues? You know, sometimes with vaccines people have. I mean, Benny really never had any issues. Sometimes he had slightly elevated blood sugar, you know, when he was very tiny and he'd get the measles, mumps and all those vaccines, but he was tiny, but flu shots never really elevated his blood sugar. I'm curious what your reaction was.


Geoffrey  20:26

Now, I can't tell you for sure. This is a reaction from the from the actual vaccine, but my blood sugar's were low for a while. Whether it was really related to the vaccine, or if it was just sometimes you just run low for a day or two. I don't know, I don't have a clear cause for it. So it's a possibility, but I can't guarantee and waiting to hear some some things for other type ones that get that, honestly, the biggest issue that I struggled with, and it wasn't really struggle, I wouldn't say struggle. The biggest issue that I had was arm pain. There's a little bit worse than your normal intermuscular flu vaccine, but nothing horrible, nothing that prevented sleep, or there's just noticeable.


Stacey Simms  21:07

What's it been like over the last 10 months of it's a horrible year to be where you are hasn't been very difficult as has been busier.


Geoffrey  21:15

It's definitely been busier than normal. It definitely has not been easy. I think the energy right now is still we're, we're exhausted from all of the work we're putting in. But we're excited because we're starting to see the light at the end of the tunnel.


Stacey Simms  21:30

And what would you say for other people with type one, but what would you say to people who are you know, kind of asking about it or thinking about it? What should they do?


Geoffrey  21:38

I mean, if they've got questions, talk to your physicians like these doctors, especially in this, but what are we calling 2020. In this unprecedented time?


Stacey Simms  21:47

I'm calling it the great awful.


Geoffrey  21:51

During during the Great awful these doctors are spending a lot of time doing research, especially these specialists, they're trying to figure out how the Coronavirus and everything else related to it is going to affect their specialty patients. So I'd say talk to your specialists and and see what their get their thoughts on the matter.


Stacey Simms  22:11

I'm going to link up a lot of information in the show notes. But as everyone has been saying, of course, please check with your own physician. We took a lot of information here from Dr. Steven ponder, I was really excited that he made time to talk to me about his personal experience and a lot that he's learned Dr. Panda has lived with type one for more than 55 years. I started out asking him about the great photo he posted when he got his vaccine.


Dr. Ponder one of the nicest pictures I've seen on social media recently was when you posted yourself, I believe in a Santa hat with a big smile, getting the COVID vaccine. Tell me about that day.


Dr. Stephen Ponder  22:47

That day, I was coming back from an outreach clinic, I was contacted by the chairman of our department asking if I was interested in getting the vaccine that evening, as opposed to, I suppose waiting several weeks, because they just come into the vaccine. And the system is prioritizing getting all the health care providers vaccinated. I instantly said yes. And so I arranged for that evening to go in and get the vaccine done was given about 730 on Thursday evening, last week, it was very, not painful. It was just like a flu shot. Even very straightforward. They had a very, very sophisticated process for handling all the people that were coming in, they had a scheduling system, you filled out a piece of paper and look to get your disclosure paperwork for the vaccine, the vaccine Information Statement, which is about nine pages long, then you go right in get your injection, they give you a card where they give the lot number for the vaccine and the date you were vaccinated. And you're supposed to bring that back with you. For the second vaccine, which is approximately three weeks later, they watch you then for 15 minutes to make sure you don't have any adverse effects from the vaccine. So you're oftentimes sitting out in the large lobby with people you might know that are six to 10 feet away from us chatting for about 10 or 15 minutes. And if you've not had any, then you walk up to the check in desk, give them your little time card, which gave you the time you needed to wait. And then you're done. And you go on home. One thing I did do was I did sign up for the Wii safe, which is an app that's part of the vaccine Information Statement, which you can use to track your daily outcomes. ask you if you've had any soreness or any side effects that gets affected your work or your health in general. And I get a message like that once every day since I've got received the vaccine. That's interesting process from beginning to end.


Stacey Simms  24:42

Is that app something that's local to Texas, or is that a nationwide app?


Dr. Stephen Ponder  24:46

It's actually a CDC app. It's actually there's a QR code that everybody that receives the vaccine should get a vaccine Information Statement that's universal for any vaccine. You probably remember that with yourself or with your family members, but it In the last page, they have a an advertisement, if you will, for the be safe program. It's optional completely. And so you just need to go to the website, download the app, or you just scan the QR code that's on the ninth page of the vaccine Information Statement and download the app, it takes 1015 seconds to do the question. Every day, there are three or four questions in that said, I'm not sure how long it will continue. But I've been answering it every later in the afternoon every day. As I said, 15 to 20 seconds is all it takes to do it comes to the text message, time for your check in and just go in and answer the same questions. And all of mine had been negative, except for the first two days, which said I had a little bit of arm soreness where I received the injection. And by two days after that was done, I had no more symptoms whatsoever.


Stacey Simms  25:49

And I'll be nosy and ask as a person was type 1 diabetes, How were your blood sugar's because there's always a little bit of concern after vaccinations or anything like that, that blood sugars could be a little bit more erratic.


Dr. Stephen Ponder  25:59

My blood sugar's were fine. It did not change anything, quite honestly, Stacy, everything was nice and steady. As you know, I've developed a set of skills that I've shared with the world about how to manage this. And I really didn't have to invoke any additional skills to stay in control, I maintain my usual diet intake, insulin regimen, course I have a continuous glucose monitor on which allows me to see things as they are happening, which gives me a huge advantage in being able to detect changes before they become significant, and then decide how and when I'll step in and do something about them. So that process never changed. In fact, that process allowed me to do better, and to maintain the control over my, my diabetes, in the wake of this vaccine. That's great. And just to be clear, and I know you never self promote, but


Stacey Simms  26:50

you're talking about sugar surfing, and I always link up information when I speak to you because people are always curious. But to be clear, you didn't have to do extra sugar surfing to stay in range after the vaccine. That's what you're saying,


Dr. Stephen Ponder  27:01

right? I don't want to make sure you're serving sound to, you know, way up there. It's basically decision making based on pattern recognition on these cgms. I look beyond just the number I'm looking at the trending pattern. And as you probably know, from the research you've done on this, it's more involved with shapes of the trend lines, and learning how to to interpret those shapes and then in turn manipulate them. If you activity, food intake, insulin, what have you, it's really nothing more than a decision making model that looks at information coming at you dynamically as opposed to a single point in time, which is what blood glucose leaders have given us for decades, and form the whole basis of pattern management, which was looking at trends over large stretches of time, looking at short stretches of time, with data in motion, that's what sugar Surfing is really all about is interpreting those data.


Stacey Simms  27:55

I am sure that your patients have had many, many questions about the vaccine as information started coming in a couple of weeks ago, what are you telling them? I mean, many of them are too young to get the vaccine, I would assume but what kind of questions and information you're sharing with most of your patients?


Dr. Stephen Ponder  28:11

Well, the information I've received from our infectious disease experts, the data I've read and heard from other sources are overwhelmingly in support of receiving a vaccine if you happen to have diabetes. As you know, there is an increased risk, whether you have type one or type two diabetes, for having more severe outcomes, and if you don't, so there's a huge onus on encouraging more people to get this vaccine, assuming they're eligible, assuming they don't have a history of adverse reactions to vaccines. The CDC has a well described list of considerations you should take into account when you're contemplating getting the vaccine. I would certainly review those. Anybody that's listening to this podcast, review those and making your decision. But assuming you don't have any of those contraindications, I would wholeheartedly endorse COVID vaccination for anyone with diabetes, and quite frankly, anybody without diabetes is eligible as well. This is not just focused just on diabetes friends, yeah.


Stacey Simms  29:15

Are there situations where parents have asked you, you know, hey, should my 10 year old with type one look at a vaccine, you know, what are we doing for younger kids? Can you reassure parents of younger people with type one?


Dr. Stephen Ponder  29:26

There are two points of view answering that question. One point of view is if you're a 10 year old with type 1 diabetes, what is your relative risk of having a severe outcome with COVID-19? I have patients, I've had patients over the last several months that have come down with this to a person they have all gotten through the infection successfully. Some have had some mild symptoms, some have had virtually none at all. On the other hand, their parents and other members of the family who are older or who may have other comorbidities were while are likely to show signs of illness, some of them moderate to many Maybe even severe, requiring hospitalization. So, for the individual that young with Type One Diabetes, their chances of getting through this without a vaccine is quite good. It's very, very high. Quite frankly, I'm unaware of anybody with Type One Diabetes that's had a very, very serious outcome. That doesn't make me totally knowledgeable of what's happening out there. But it's been my experience in my clinical experience. I'm in clinic five days a week. I think that from the larger perspective, children may be included at some point down the road. As eligible for the vaccine. Those studies still need to be done. The Pfizer vaccine covers down to age as young as age 16. And the maternal vaccine is 20. I don't know about the other vaccines that are still under phase three twapp trials yet, but there is a discussion ongoing that children should be included in trials over the next year, and to determine who would best benefit from the vaccine. Now, if your child with type 1 diabetes could serve as a vector to the disease, I can see those who are more prone to illness in the family would be at risk. So dismissing them or ignoring them into consideration of who gets the vaccine could be harmful in the long run if they're trying to fully eradicate or get as much herd immunity against this condition as we possibly can.


Stacey Simms  31:20

Can you speak a little bit to autoimmunity and this vaccine? In other words, I've seen people posting on social media, and it's a little confusing, and they're worried about people who have compromised immune systems, or have you know, immunosuppression, and type 1 diabetes, which is an autoimmune disease, which is different. Could you just take a moment and talk to us about the maybe the difference there or if people with autoimmune diseases are okay to take the shot?


Dr. Stephen Ponder  31:49

They are in general they are I had a request from a former patient of mine, who's now in her 30s, who had a renal transplant A number of years ago, and she's on program, which is an anti rejection medication, and prednisone relatively low dose, both of those medications are used to prevent her kidney from being rejected. Her question was, just as you asked is, is my compromised immune system a reason why I should not get the vaccine. I wanted to verify that I would give her the most accurate answer. I asked my infectious disease experts, is this a problem? And I knew what he was going to say. But I wanted to make sure I could tell the family that I heard the strep in the source, yes, they should consider getting the vaccine. The only caveat would be that the compromised immune system might result in less of an immune response to the vaccine, not that it would be harmful or hurtful to her renal transplant, but that it might blunt her individual response to the vaccine. And that's just one isolated example of a question like that auto immunity in general is become more or less a tagline or become a category. Unfortunately, because type 1 diabetes is You and I both know an autoimmune disease. Most forms of thyroid disease have some element of autoimmunity, celiac disease, and the list goes on and on and on. And so I think we've gotten lost in a categorization a stereotype if you will, what autoimmunity really nice. If you're talking about a compromised immune system, the result of that is most likely that your response to the vaccine might be blunted, but not necessarily eliminated. That's important to remember. I think, as always, because there's so many different forms of compromised immune systems, that it's wise to discuss with your primary care provider or the care provider that manages your particular condition which creates the immunocompromised state, and ask them their opinion on whether it would be wise to take the vaccine or not. So my general response is, there should not be any major reasons not to do that, unless there are specific elements of your immune system that are known to result in perhaps a significant overreaction to the vaccine. And that's where I think a lot of people are getting confused, is they're thinking more in terms of the the adverse side effects like hives and, and anaphylaxis. And those are conditions that anybody can have, regardless of whether they have a classic autoimmune disease or not. And to that point, as I referred to earlier, when, after I received my vaccine, the CDC has recommended, at least in the short term, that all the vaccine sites be adequately staffed and equipped with medication to manage an acute immune reaction like an anaphylaxis and so our injection area was right adjacent to the emergency department within about, you know, 100 yards. And so just in case Plus, they would have epi pens epinephrine tans, in case somebody were to develop an acute reaction to the vaccine. As far as I know, there were no reports of any significant immune reactions and certainly you can add hives and itchiness and so on, but you're talking about the situations where somebody gets an enlarged tongue may have some problems breathing, and so on. Those are some of the reports that have made the new the national news international news. And those are treated effectively with epinephrine injections. And in many cases, these individuals already knew they had those kinds of responses to certain things. And they've already well equipped or prepared with FM Fm 10s,


Stacey Simms  35:20

just with autoimmunity and type 1 diabetes, to put a fine point on it. I think many people are concerned that by getting vaccines when they already have an autoimmune issue, that their immune system may somehow become confused or overreact to the vaccine. It sounds like you're saying that's not what is happening with the COVID vaccine.


Dr. Stephen Ponder  35:37

I've not seen any evidence of it say that if I receive the COVID vaccine, that I need to be worried about having a higher risk of developing other autoimmune conditions, I've looked at this autoimmune condition for 55 years, as you know. So that's not a consideration. I also think that we have to look at this in the big picture of risk. And if there is a risk, it would be infinitesimally small compared to the much greater risk of getting COVID and having an adverse outcome from the COVID. So we live in a world of risk, whether we acknowledge that or not. And we make our decisions based on our perception of that risk. If we over perceive a risk, which is not as great as it really is, then it's going to tend to deter many of us from doing something that might be in our best interest, such as the COVID vaccine, but just to be safe, certainly Always consult with your primary doctor, if you have any questions about whether I should or shouldn't take this vaccine, or perhaps wait a little bit longer. But again, even delay, in theory increases risk further, since we now do have a way to at least fight back against this pandemic.


Stacey Simms  36:43

You know, it's been such a rough year for everyone. My family's been so fortunate we've been home or doing our part has meant watching Netflix and podcasting and you know, being here, but for folks like you, you have been in hospitals, you've been in clinic, you've been seeing patients, I'm sure you have you are tired of wearing your mask and you want to hug your patients again, can you give me a little bit of your perspective of what it was like when you when you walked into get that vaccine,


Dr. Stephen Ponder  37:10

nothing could have been more hopeful and optimistic. And I'm sure my mood and attitude may have changed. And in the days following the vaccine, I did feel I was doing something constructive, that was going to ultimately result in an improvement in my health and reduce my risk of getting this condition. On the other hand, they were very clear about the fact we need to continue to wear our masks, wash our hands, maintain our distance, avoid crowded places, and so on. I'll be honest with you, Stacy, as you were asking that question, I was thinking back to the fact that for 55 years, I have to take injections every day, I have to do certain things to stay healthy and live with diabetes. And eventually they became sort of just routine and Matter of fact, for me, and it dawned on me that wearing the mask and doing the hand washing is also over the last several months become kind of a matter of fact, behavior for me. And I don't personally my personal personality is not to begrudge that I just do what I need to do, because I'm helping other people as well as myself, family members, you know, neighbors, co workers, patients. And so, to me, I don't see it as an excessive sacrifice, given the benefits that I get from it, from hopefully staying free of the virus, which I have been able to do for the last whatever nine or 10 months since we've been doing this. And I do work with patients on a regular basis. I'm sure I come across patients who may be sick or may have this but I have my mask on I keep my distance I keep my hands away from my face. I do things I didn't do as much of a year or so ago. But those behaviors have now become kind of ingrained in my behavior and I no doubt probably in yours too. And you don't necessarily think about it but then it becomes kind of a way of life. So just like the diabetes has become a way of life. Now I know that many of us look forward to the day when we don't have to wear the masks and but I'm not sure that we look forward to the day where we don't have to wash our hands. I don't know about that one. I didn't know about that.


Unknown Speaker  39:06

Yeah, I


Dr. Stephen Ponder  39:06

think I think closer being closer and masks are fine getting rid of those, but I'm okay with people still washing their hands. Me too.


Stacey Simms  39:14

Hey, before I let you go you share wonderful photos of your granddaughter Cammy Do you mind if I ask how how she's doing and how. And I don't be too nosy if she's still living with you. You know what what your routine is like coming home we just protect not just her but the other people that you live with. You know what have you been doing the last couple of months as you come home from work?


Dr. Stephen Ponder  39:32

Well, my granddaughter Cameron, she is actually in a preschool setting, which is very safe. It's she's been there for six months and nobody's fallen ill that was COVID she's been doing fantastic there. She wears her mask faithfully every day. They hand sanitizer and of course it is a daycare for four year olds three and four year olds, so they're all in each other's faces all the time but so far we've been very fortunate where we live not to have any obvious outbreaks. She still living with us. She's actually visiting part of her family down in the US Virgin Islands right now. And I have to tell you a funny story. She was at the beach down there. She's on St. JOHN. She was telling her father, I'd like you to take me to another beach tomorrow. And he asked her why Cameron, because this speech is too salty.


Unknown Speaker  40:19

Oh, I love it.


Dr. Stephen Ponder  40:21

She's used to going to Lake up here. Yeah. And so they took her to a different beach yesterday. Of course, it's ideal like down in the Virgin Islands. And that's where her where her father and grandparents live. So she's down there visiting right now for three weeks. And she'll be back with us in about three weeks. So we're looking forward to having her back. And yes, it's interesting, being a full time grandparent with your grandchild who lives very close to you. But it's a blessing as well. And it's one of my primary motivations for taking care of diabetes, for staying waiting COVID my motivations are not medical motivations, mine are very personal, for taking care of myself, and I want to see that little girl grow up, I want to see my family thrive. I want to be able to continue to help people in whatever way I can. And that's why I take care of myself now, because I'm looking for some agency or something or some time and range light sensor. But for more transcendent types of purposes.


Stacey Simms  41:16

Well, I always appreciate you sharing the information. It's always so useful. And this time, right now is such a turning point. I hope it'll be a long way to go. I certainly don't expect to throw off the masks in a week or two or anything like that. It'll be a long time coming. But it's so nice to have something hopeful. Finally, and I gotta tell you, this is a selfish episode for me talking to all you people with, you know, in the healthcare industry, because I'm so excited when I saw the photos, it just made me happy. Who knows when we'll get the vaccine here. You know, I'm younger. I don't know. I'm not that young anymore. Doctor ponder, but I, you know, I'm not in healthcare here. Yeah. Yeah. So it'll be it'll be a while. But boy, thank you so much for sharing your stories. And you know, you I know you'll keep us posted on social media. But thanks for everything you've done to encourage people to, you know, to stay safe and stay healthy. We really appreciate it.


Dr. Stephen Ponder  42:02

Well, thanks for all you do for the diabetes community, Stacy and getting the word out and being the advocate that you are. It's an honor to know you and it's an honor to speak to you this morning. Thank you very much.


Announcer  42:17

You're listening to Diabetes Connections with Stacey Simms.


Stacey Simms  42:23

It is possible by the time this episode airs that 20 million Americans might be vaccinated against COVID. I don't have anything more profound to say than that. Yes, it is the beginning of a new year. It is hopefully the end of what I jokingly called there the Great Awful when I was talking to Geoffrey and I have been referring to that throughout the year. It's gonna be a while before we go back to normal before we can stop wearing masks. Everything that all these wonderful health care workers that I talked to, for this episode, have said,

So again, I will link up more information in the show notes, you can always go to Diabetes and click on the episode homepage. There's a transcript for every episode. I started that in 2020. And we are working backwards now to fill in the previous five years of transcripts as well started this in the summer of 2015. My goodness, a lot of episodes to get transcriptions for but I am working on that.

If this is the first episode you've heard, thank you so much for dropping by and checking it out. I hope you liked what you heard. I put out new episodes every Tuesday, and you can find out a lot more on the website. Please join our Facebook group as well. That is Diabetes Connections, the group and you can follow me on social media, Stacey Simms or Diabetes Connections on pretty much every platform still not Tick Tock. That's not gonna happen. Not even 2021 Thank you, as always to my editor John Bukenas from Audio Editing Solutions. Thank you all so much for listening. Happy New Year. Here's to brighter days ahead. I'll see you back here next week. Until then, be kind to yourself.


Benny  43:57

Diabetes Connections is a production of Stacey Simms Media. All rights reserved. All wrongs avenged