#73 Think Like a Pancreas Chapter 1 with author, Gary Scheiner: Time for a Little Transparency

Katie: 0:00

This episode of the sugar mamas podcast is sponsored by sugar medical. The very best place to get all your diabetes supply cases and accessories. You're listening to episode 73 of the sugar mamas podcast. And I'm your host, Katie? Roseboro. I am so excited because this is the first episode in our 10 week think like a pancreas book club series. And today I'm covering chapter one, which is called time for a little transparency. My guest for this one is the myth, the legend author of the book himself, Mr. Gary Scheiner. Listen, if you have type one diabetes or your kid has type one diabetes or someone you love has diabetes. Or perhaps you have type two diabetes and are taking insulin. I can absolutely say you need to own a copy of this book and actually read it. I call it my diabetes Bible and I refer back to it often. It will teach you how to manage your insulin better and empower you to make all those hundreds of daily diabetes decisions faster. And with more confidence. I sure do hope you will follow along with us. I will put a link in the show notes to where you can get your copy either on Amazon, or if you want an extra special signed copy from the offer, you can get it from his website. Integrated diabetes.com. Okay. Without further ado. Let's get started.

You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseborough. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks.

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Everybody. I am here with Gary Scheiner today. And Gary I'm, let's just jump in. I'm going to let you introduce yourself. Everybody probably is already familiar with that name, but please tell us a little bit about yourself and how you are connected to the world of type one diabetes.

Gary: 3:45

You're too kind, Katie. I'm a legend in my own mind. I think.

Katie: 3:49

No, I think you're a legend period.

Gary: 3:50

I've been working in the diabetes space since 1995. And I've had type one diabetes since 80, 85. So I'm going on 30. This will be my 32nd year living with it. But I run a practice called integrated diabetes services that focuses on intensive insulin therapy. Use of all the latest technologies. And we've been providing virtual care for the last 15, 20 years. So this know the pandemic certainly forced our hand a bit more, but it's not something we were, that was new to us. We've got patients all over the world, both children and adults with type one diabetes who have different needs, but we've got a great team here. I have a team of clinicians that all live with type one personally. So we're able to lend that personal connection and a little extra passion and personal experience with what we do.

Katie: 4:41

Yeah. What I was curious to know. So you guys only treat people with type one or anyone who's using.

Gary: 4:47

We've got some patients who aren't even on insulin. at least 95% of our clients have type one diabetes and all ages. But you know, we do get some type twos who are not on insulin or some that are on insulin. You're not going to turn people away, but I'd say intensive insulin therapy is really our fault.

Katie: 5:04

Okay. And you only treat people virtually or do some people could actually come into the office.

Gary: 5:09

We do have people who come into the office. And when I started this practice back in the late nineties, it was all in person. So we've built up a lot of clientele in the Philadelphia region where we're located. And we still have a fair number of people who come in, but since most of our clinicians are working from home in different parts of the country, overall, from what, for our practice, I'd say at least, you know, more than 80% of our patient encounters are virtual now.

Katie: 5:34

Yeah, I've kind of touched on it. Throughout the Instagram sessions that I've been doing every other Tuesday, just going over one chapter a week about how you have lots and lots of resources on your website. I mean, obviously if people are needed, in need of help in managing their diabetes, they can contact you directly. Cause it sounds like you work with people. Is it nationwide or is it.

Gary: 5:54

It's worldwide. And up until recently, it was all English speaking clients where now we have, we have Spanish clinicians and also a Spanish support person here in the office. So we're working with a lot of people in central America, south America, Spain, et cetera. So yeah, it is worldwide. We've got patients on every continent except Antarctica.

Katie: 6:14

Yeah. that wouldn't be a little, that would be a little tricky. Huh? Get the penguins. I don't know. Is that where the penguins are? yeah, probably. It sounds pink Winnie. So I was, what I was going to say is you know, you, you obviously help people who need it. But even just going onto your website, which I've done frequently throughout the, you know, over the past couple of months. And since my daughter's been diagnosed, like you have a ton of really great resources for people who are just looking to kind of get a little bit more competent with their diabetes management, learn a little bit more would you mind sharing some of those resources for the.

Gary: 6:46

yeah, we try to keep it fun. We've got, we have a, we call the ultimate carb quiz on there for people who want to evaluate their carb counting skills. And it's up there now. We're we're updating it. It's going to be updated shortly. It gives people a chance to see where their strengths and weaknesses lie with their car. We also have a general diabetes knowledge test that has a Simpsons theme. I'm a big fan of the Simpsons. So it has a Simpsons theme to it. We have some forms on there that are, are useful for a lot of people. There's a dosage calculation form for those who don't like doing the math at every meal and using insulin to carb ratios and correction formulas as a chart they can create. That'll just show them what their doses are based on that information. We have some nice comparisons on there looking at different pumps, different sensors different closed loop systems. And these are th they're not comparing like how many grams each one weighs. This is more practical stuff about using and living with these devices day in and day out from, from our own experience, as well as the experience of, of training patients. And that's something affiliated with our website is called type one university. And this is a site that has courses people can take. It's typically about 45 minutes in length, and there are specific topics on different aspects of living with diabetes is a course on managing blood sugars with exercise. There's one on minimizing the post-meal spikes there's courses on different aspects of nutrition. So people can go in there and just take whatever course they're interested in taking. And, you know, it really gets into detail about about managing diabetes in these different situations. So between our website, you know, the integrated diabetes.com and the type one university.com, you know, we've got some good stuff out there. People can access.

Katie: 8:33

Yeah. Yeah. Actually, I went back when my daughter was diagnosed, it was, you know, middle of pandemic. I was told that under normal circumstances we would have had access. to like a, I don't know what they really called it. A gathering, we're kind of all the reps from the different pump companies would come and have everything out on tables and you can walk around and, you know, hold it and ask questions and stuff like that. But because of COVID, you know, none of, none of that exists even to this day, I don't think they brought that back yet, but so when it was time for us to choose. I I did look at your pump comparisons, I'm under your resources center on your website. And that really was helpful to me to just kind of know what the differences between the pumps were. Cause I, I just didn't feel very educated on that. So that was great well, you are also the author of many books. But the one that we're going to talk about today is think like a pancreas. It is definitely My favorite diabetes management book that I have read so far, at least I I think it's absolutely fabulous. Fabulous. It's very practical. It does it in a very unbiased way. You're not pushing anybody to, to follow a certain, you know, lifestyle or diet or anything like that. But this is going to be episode one of the think like a pancreas series on my podcast. So we're going to talk a little bit about chapter one, which is kind of your, your history. It's called time for a little transparency. But before we dive into your story, if you had to sum up think like a pancreas what, what would you tell listeners that it's about?

Gary: 10:02

I think the title says it. It's about trying to simulate a functioning pancreas with the totals that we have. Don't let us do that completely, but we can come pretty close. It's all about making sure you have the right amounts of insulin at the right times to meet your body's needs, understanding how the body is making its own glucose. And. How different factors in our daily lives raise and lower. Our blood sugar allows us to match our insulin doses properly. So it used to be when I was early days, when I was diagnosed you were put on an insulin program and you had to conform your life around that insulin program. Now it's the flip opposite. Now we conform the insulin program around your life. Around your sleep, schedule your meals and snack preferences around your activity schedule and your, your overall lifestyle. You know, unfortunately, most the vast majority of people with diabetes don't get a lot of guidance when it comes to fine tuning their own insulin. You know, it would be nice if every healthcare provider had unlimited time to spend with each patient. And had an opportunity to stay on top of all the latest research, but they just don't and it would be great if they could all be experts at data analysis and lifestyle coaching. But you know, that those are specialized things. Most healthcare providers just are not very competent in those areas. So that's something that the book helps with and, and our, our staff helps patients with as well. We have to become our own doctor and our own nurse to some extent and understand how to make, make our own adjustments and kind of do things on the fly because that's that's life, you know, adjusting to whatever life throws our way. So I hope the book is it allows more people, an opportunity to do a better job of that. We're never going to be perfect at it, but just to be able to do a better job of it as well.

Katie: 11:57

Yes, absolutely. And just feel more confident overall, and just more at peace. Even if we know we had a really bad day, one day where, we know what needs to be done to get it back on track. So no, your book has been, I mean, you know, the. Endocrinologist and diabetes educators don't have the time, but you know, we, and we on the flip side parents and in type one, diabetics themselves also don't have the time to spend hours on the phone. So yeah, I think this book has done a lot for me, at least personally, to feel more empowered in my decision-making and not have to. Just call them as often, which, you know, it's not that I mind talking on the phone with them. I just don't necessarily have the time. So I need to be able to make those decisions on my own. So it's been great. So the first chapter is all kind of, well. not all about, but a lot of it is about your diagnosis story. And I'd love for you to just kind of share the highlights or maybe, maybe highlights is the wrong word, but share, share a little bit about your diagnosis story with.

Gary: 12:52

Yeah, it was an interesting situation. I was living in a suburb of Houston at the time. Ironically, the name of the town was Sugarland and I was between, well, I was my freshman year of college. I was home for the summer working at a restaurant. And every time I would drive to work, I'd have to stop and go to the bathroom. I couldn't hold it long enough for this 20 minute drive to work. I was drinking water non-stop and just couldn't stop drinking. I was losing weight. Energy level was, was worthless. eventually I mean, I knew something wasn't right, but I didn't have no idea what it was. And, and I was watching at that time, my favorite TV show was mash and there was a character on the show who was a helicopter pilot who had diabetes. And he was talking about some of his symptoms and I'm like, wow, this is what I have. So I went to the doctor, he checked my glucose. It was, you know, 670. He diagnosed me on the spot, sent me to a, an endocrinologist in downtown Houston. It was a very nice man. Kind of gave me the usual rhetoric. You know, don't worry, there'll be a cure in five years. This was 35, 36 years ago. I said, this is not, this is manageable. You can, you can take care of it. And there was a nurse taught me how to give my first shot. I gave my own injection and. And it was off to the races from there, but, you know, again, this was back in in a time when we didn't have very effective tools for managing I went home with a vial of test strips and a color chart to match it up to, to estimate what my, my blood sugar was. So I didn't have a meter right away. At least that's better than people before me who had to check their urine, checking your urine. It's messy. And it's not very accurate. You know, it's showing if you had high blood sugar, several hours ago, it'll show up in the urine, at least with a blood test, you know, right there. And then, the test strip turned dark brown. It was one level of who is medium brown or light green, or there were different shades of green. You had to match it up. You know, growing up, I had my box of Crayolas at eight crayons. I don't know all these subtle differences in color. It wasn't so easy to use this color chart to see exactly what my blood sugar was,

Katie: 15:05

Well, and God wants the people that are colorblind. I mean, w w when the world where they supposed to do.

Gary: 15:09

you know, you look at someone else, Hey, come here. What does this look like to you? But yeah, as soon enough, a few weeks later, I was able to get set up with a blood glucose meter. And it was one of the original one touch meters. It required, I believe it was 20 microliters of blood on the S on the test strip. The test strip area was square. I don't know about you. I could never get a square dropout on my finger. It just worked that way. You had to get a hanging drop of blood and literally the blood had to be dripping off your finger to happen. To cover the test strip properly. So to get that hanging drop, you had to use a device called an auto land, which we affectionately referred to as the guillotine. It had a mechanical arm that would swing around and slam this Lansing landset into your finger. And it went pretty deep and you'd squeeze that finger to get those hanging drops. So that was always fun to do. And you had to do it before each one. To see what your blood sugar was and kind of guesstimate how much regular insulin you would take. So this was before Humalog and NovoLog became available. Regular insulin took hours to start working. It didn't do anything for the first hour or so, and it lasted a good six to eight hours, but that was the fast acting insulin that. And then for the long acting, we used a cloudy insulin that he had a mix before each injection and it was called NPH. NPH was very unpredictable. You didn't know exactly when it would peak how long it would last. You just take it and say a prayer to the diabetes gods that it'll do what you want it to. So now we refer to NPH. We say it stands for not particularly healthy. And it was tough to use. And my big challenge then was some serious, low blood sugars. I didn't like having those high glucose values. So I was aggressive with my insulin. I was also very into sports. I played a lot of basketball and then a lot of running and lifting and biking and whatnot and basketball was really a challenge. You know, after playing full court, my blood sugars would drop all night. And more than one time. It got so low that I didn't wake up and paramedics had to come and give me a IV dextrose once it happened, where, you know, my wife ended up giving me glucagon in the middle of the night. the early days of diabetes were not much fun. You know, I try to have some fun with it, you know, since I was in college, living in a dorm. My friends would gather before dinner and guess what my blood sugar was before I did the check on the meter and they give it to be pretty sharp. You know, they would ask me questions. Like, did you, did you exercise today? What'd you eat for lunch? You know, what was your blood sugar at lunchtime? So they'd all throw a dollar in and whoever gets closest, we win it. Then I went home from my diagnosis with an exchange. Oh, that's an awful awful thing. Now I was eight, an active growing hungry, 18 year old. So to be, to have to limit my food was not, not something I like to do. You know? And when you're diagnosed, you're underweight, you've lost. I lost a lot of weight before that. So my body was hungry. I just wanted to eat constantly. So having to restrict my food intake was very unpleasant and trying to follow this exchange plan where you. Like for bread exchanges and two fruits and two meats and a vegetable and a fat. And that's your meal, you know, instead of just picking your food and matching your insulin to it, you had to conform the other way around. You had to eat to conform to your insulin. So that was not pleasant for somebody my age or anybody for that. So, you know, when, when carb counting became more Vogue that really opened the doors to more flexibility and freedom with one's diet, I think that was one of the greatest things. Since my diagnosis was the ability to count carbs and then match the insulin to what I was eating nowadays. People don't appreciate what that, the value of that and how much freedom and flexibility.

Katie: 19:15

Hmm. I didn't even know. I guess I didn't realize that. When did carb counting become a thing? Like, do you remember around what time?

Gary: 19:21

I think it was kind of the mid to late nineties is when carb counting became more in Vogue

Katie: 19:27

Okay.

Gary: 19:28

now it's, you know, trying to count the carbs is the big challenge. And then do that accurately, you know, pizza for one thing is it's a challenge. So. We came up with this, this set of tricks that our team uses for teaching carb, counting, you know, forget about, you know, weighing food. We just have people use their hand and their fist to estimate their portion sizes and convert the carbs off of that. It works pretty well.

Katie: 19:52

Yeah. definitely. Especially when you're out at a restaurant or something, and you don't have any of your normal tools,

Gary: 19:58

name of food that challenges you and I'll, I'll give you an idea how to estimate the carbs.

Katie: 20:03

fettuccine, Alfredo.

Gary: 20:04

All right. So with pasta, whether it's ed genie spaghetti pastas with sauce, or generally around 35 to 40 grams, a cup and a woman's fist is usually pretty close to a one cup portion. So you just see how many fist size portions of fettuccine you're having multiply that by 40, you got a good close estimate of the carb count. Now the fat in the fettuccine. Adds another wrinkle to the equation as well. That's going to slow down digestion dramatically. After the carbs are done, the fat also causes some insulin resistance. So I'm afraid the more I've learned, the more complex things have become. I can't just take a dose of insulin and go about my Merry way. It's it's, it's a fair amount to have to think.

Katie: 20:50

yeah, absolutely. I have a random question about the regular inch insulin. You mentioned, you said it would take. Ours, you know, six or seven hours to even start working. So what about breakfast? I mean, would you have to wake up at 1:00 AM to take your insulin, to be ready to eat at 7:00 AM? Or how did that work?

Gary: 21:05

no in the perfect world, Katie you would take regular insulin a half an hour before eating, but nobody did that. It's just not practical. And even if you did it still, wasn't early in. The regular insulin would start working in about 30 minutes and it would peak somewhere in the two to four hour range. So you can imagine how high blood sugars would spike after eating. The good news is we didn't have CGM then, so we didn't know how high it was spiking, unless we did a finger stick. No one liked using the guillotine and getting that huge drop. So we just didn't check them. But on those occasions, when we did it was scary, you know, the blood sugars would routinely be in the three hundreds in the higher, right after eating, even if you followed your exchange diet and took the dose of insulin you were supposed to. And so it was tougher to manage that.

Katie: 21:55

Yes, my goodness. I bet. And then, so what was it like for you? Because in the book you got on a you know, I feel like nowadays most people get on a CGM first and then they get on the pump later on down the road. But you got on an insulin pump when they kind of first came out. So what was that like? Just those early days on on one of the older pumps.

Gary: 22:13

I was very fortunate. My first job out of grad school was at a Joslin diabetes clinic, and I had a chance to learn and interact with some of the best in the field. We didn't have. A pump program at the Joslin clinic at that time. So being the token type one on staff I went on a pump. I mean, I wasn't sold or convinced on pump therapy. I did it mainly to learn about them and be able to develop a program for our patients. So I went on my first pump in 1998. No, it was 95. I went on my first pump and it was a very old mini med model, 5 0 6, this big gray box. And it didn't have a lot of features, but it, you know, you could adjust the basal delivery and you could bolus and precise increments. There was no CGM then. So there wasn't an option of using one or the other. And we just had meters back then. So that was my first pump. And I counted since then I've used 29 different models of insulin pumps. So I try everything that comes out, including some things that haven't quite been approved by the FDA, just to see what they're like. Yeah. I've had my share of experience with different pumps, but I found the pump to be. A real asset for managing glucose levels. More effectively, you can do things with a pump that you just can't do with shots. It's just like a CGM is such a benefit over just fingerstick checks. The pump offers a lot of advantages over injection. Yeah.

Katie: 23:47

Yeah. I would agree. I mean, it's not a magic wand. I always like to tell people that cause they, I think people assume that once they get on a pump, they'll, everything will be better, but it is, it does take a lot of. Learning. I mean, you have to really learn how to use it properly. But Yeah, I, I agree. My SIS, my daughter went on a little pump break last December for the whole month. And you know, at the beginning it was just so nice. Cause kinda like you said, like you just, you just take your long acting and then you don't have to think about that for the rest of the day. You're not thinking about adjusting basal rates. But at the same time when the month was over, I was like, oh my gosh, thank goodness. This is so much more convenient and you can just fine tune it so much, so much more. And I'll entertain it again if she wants to take another pump break, but I do prefer her to be on the pump. And then, you know, you mentioned getting on a CGM when they first came out and I'm sure that was just, that had to be just mind blowing to be able to see your, your numbers all of a sudden all day long. What was that like?

Gary: 24:41

my first CGM didn't show me my numbers. It just. It was also the Medtronic product. There was a black box that stored the information and a cable. It connected the sensor to your body. So it wasn't wireless and it wasn't waterproof. So you had to cover it all up with plastic when you showered and you'd wear it for three days. And after three days, you'd put it on a cradle that would read the data into the computer transmitted. Generate some reports. That's what I found fascinating was the reports, just seeing what was going on between meals and overnight, the times I wasn't doing finger sticks just to see what my glucose was doing. And I learned that I was spiking still pretty high after meals, even though I was using Humalog at the time. So it taught me I needed to make some adjustments and meals to, to keep that from happening. But when the Dexcom came out, boy, that was great. Just being able to see my data in real time and know not just what my glucose was, but what direction it was headed. That makes such a difference. Yeah. Just in terms of your own safety and decision-making having that, that level of information at your fingertips all the time is really not. The alerts. I find also to be a godsend. I'm like most people with diabetes, I can't really feel when I'm low until I get really low. Know if I hit 70. I have no idea. 60, no idea. I have to get down into the fifties before I have any sense that something's right. And by then, you know, I'm close to a point where I can't think clearly enough to take care of it. So what would the, the CGMs now being alerting me when I'm approaching 70, I can prevent the lows. I can keep it from becoming a dangerous situation and the same thing at the high end. Most people don't feel any different when their glucose is slightly elevated. You know, a 180 doesn't feel any different from a one-time. For a lot of people two 40 doesn't feel any different from a one 20. So having a device that lets, you know, when you're trending out a range and you can fix it before it gets to a severely high level or stays high for many hours, that's tremendous, you know, that's, that's really, that's that's value that we can get from these. So.

Katie: 26:55

I feel like it not only is shifts the way that you manage diabetes, but it had to have shifted your, just your mindset around the whole. Disease. Did you find that to be true? Was it, was it just less resentment or.

Gary: 27:07

it's instant feedback, which is good, but sometimes I don't always want the feedback, you know, I'll eat something that I probably shouldn't then I don't want to see that blood sugar rising the way it does. But it does provide so much feedback and you can learn kind of cause and effect relationships. You see how different foods impact you had different activities, emotions, just different life situations, and you can learn right away what it does to your glucose levels. And it helps you prepare better for the next time around. Something like fettuccine, Alfredo. I learned eating things like that. I see on the Dexcom, how my glucose drops right after eating it and then rises hours later. So I learned from that, that I have to extend your spread out my bolus to cover it. I can't give the whole dose at one time. Same thing with popcorn at the movies I've learned from experience that if I bolus for the popcorn, before I eat it, I'm going to go low by the middle of the month. So I wait until afterwards and give my insulin then, and it works much better, different sports. Also, you can see immediately how those sports affect you. And there were, it's hard to understand, but you know, weightlifting can make my sugars go up or down, depending on the types of lifts on doing it. If it's maximal low repetition lifts, my sugar will go up. And if it's. Lower weight, higher repetition lifts. I go down, it becomes a little more aerobic at that point. So it just, as a learning tool, these are, these are amazing. And it goes for any system, any CGM that, that shows you your info, whether they have alarms or not, they can all be a great learning tool for the.

Katie: 28:48

Oh, absolutely. I'm so grateful for our Dexcom. And I would, I know many, many people came before us and lived without them and, and did just fine, but I'm, I'm grateful for ours. Cause I like to, you know, I like to try to keep her in range as much as possible. And I feel like it's just so much easier to do when you have. Feedback and you can use it as a tool to just help you make better decisions. So I agree. Well, I want to know what your favorite or actually let's start with the hardest, what was like the most challenging chapter in the book to write.

Gary: 29:19

for me, the toughest chapter was the one on resources which came near the end. Not that it was tough, but it just took the most work to put together. I did want to share, you know, what's out there. What websites and companies and associations are there. To serve the needs of the diabetes community and it's constantly changing and updating and trying to make sure that all the contact information was right and the organizations are still in existence. I found that tough to do. It was just so much minutia and so many details to that. You know, the chapters on all the different aspects of glucose management that float. I mean, that's just, just kinda came pouring out of my brain onto paper. Those, those were not that tough for me to write out. I don't think any of those, you know, preliminary chapters or middle of the book chapters were difficult. It was, it was all that, all the resource list things, all the little millions of details that went in.

Katie: 30:16

Yeah, that's very true. I didn't think you were going to say that. So that's very interesting, but yeah, that would require a lot more, you know, research and. Kind of compiling all those lists of things. Hmm. Interesting. Okay. So this, the second edition of this book came out a little over 10 years ago now, right in 2010. So why did you decide to write a third edition now? A little little about a decade later.

Gary: 30:39

Yeah, well, things changed a lot in those eight to 10 years from a technology standpoint, from a methodology standpoint, from a resources standpoint. And, you know, to have a book that still talks about NPH insulin as a mainstay and you know, insulin pumps without CGM link to them, it it's a disservice. I feel that we have to have to stay current. I feel badly that it's in printed form because it feels like every week there's something new. I love to be able to update the book. And make that available. You know, the hybrid closed loop technologies now are kind of taking over the type one space. And we only touch on that kind of tangentially, even in the third edition because they were pretty new and just coming out at the time the book was written. So another edition might not be too far.

Katie: 31:31

I was just going to ask that. Yeah, because yeah, the hybrid closed loop systems are just taking, taking off and running and Yeah. I feel like he might have to write it. I know you said in the book that you were hoping not to have to write a fourth edition because you were hoping they would have found a cure by then, but

Gary: 31:45

Yeah. Everyone thinks while these hybrid closed loop systems mean, well, you don't really have to do as much. You don't have to adjust as much. What are busier now than we've ever been. These hybrid closed loop systems can be complicated. They don't always get people. The results they're looking for and people are, they're wanting more. They want better results now. And it's not all just about the technology. It's a marriage between the user and the technology. The user has to know what they're doing. They have to be engaged with their care and having the right insulin program in settings is still post. You know, these, these hybrid closed loop systems, they'll clean up our little messes. It's like a Butler that follows you around. Just tidying up. You run a little high, a little low and it'll it'll fix it. But you know, the, the, the big highs, the big lows, the rapid rises and falls, these systems are not really adept at handling that that's still, the users domain. And there's a lot to look, people can learn about bolusing, properly, timing it, right. Et cetera. So we're still, we're very busy working with patients who are moving towards these systems or already experienced and just want to get better results with.

Katie: 32:56

Yeah, we actually just got an email this morning. It's been over a year that I've been trying to. Get our insurance to approve the Omnipod dash we're on the classic Omnipod system. And it's honestly not really, even the dash that I, that I care so much about. It's just that the dash is covered as a pharmacy benefit. And I know that the new Omnipod fives hybrid closed loop system is going to be covered as a pharmacy benefit. So I'm like we have, we need to get this pharmacy. Approval and, and they just emailed. I actually, I, I mean, we went through, I, we filed three different appeals. They all got rejected. Just I've was on the phone for hours with all the people. And anyway, I finally told my husband who we get our insurance benefits through. I was like, it's okay, it's up to you now. Like, I need you to go to HR and I need you to. Tell them that they need to check whatever boxes need to be checked to get this approved our insurance company. And, and so that took them months of digging and calling and all that. But anyway, I just got the email this morning that they approved it. So I don't,

Gary: 34:01

Well, kudos to you for persevering. A lot of people would have given up long ago.

Katie: 34:06

Yeah. no, I knew there had to be there. I knew there had just had to be a way to work around it some somewhere. So very excited about. Yeah. And I think my husband was happy too. Cause he felt very, you know, he did, I do most of the diabetes management just cause I'm, I'm home more and he travels more and all that stuff. And I felt like he was like, I did something. I was able to make some changes for our diabetes journey.

Gary: 34:31

Yeah. It's a nice list of, you know, we, we just got trained on all the technical aspects of Omni pod five, so we can start training our patients. It's got some very nice features to it. Every CLA we call automated insulin delivery system. Each one has its share of, of pros and cons compared to the others. I'm using one that's, it's a non FDA approved system called the loop. It uses the older Omni pods and then the Dexcom sensor. And it there's a lot of customization that you can do with this one that you can't do with the commercially available systems. That's why I kinda like it. The, you know, the Omnipod five looks like it's really gonna be a winner. The tandem system. Also the control IQ has been overwhelmingly successful. It's one of those like turnkey systems where you just put it on and it's going to start working well for you. And that's what this is all about. Having a system that. Requires less work and produces better results. That's a great combination. You know, not every diabetes device and system does that. You know, some of them require a lot more work and some of them don't produce great results, but these automated insulin delivery systems are these hybrid closed loop systems. It's a nice combination of, of less work and better reasons.

Katie: 35:48

Yeah. We my daughter was pretty adamant about not having a tube, which is why we went with Omnipod and, you know, obviously that was a great choice. But yeah. I've heard great things about tandem and my husband. Wasn't a huge fan of the fact that Lupe wasn't FDA approved, which, I mean, I, I feel like I could have talked him into it eventually if we never got approved for the, for the Omnipod five system, but we'll try this first and then see how. But, yeah. I mean, I'm hoping that isn't loop, like trying to get an app approved isn't Tide pool pulling for that to get that.

Gary: 36:20

yeah. Tide pools working on it. There's no telling when or if that'll actually happen. And something tells me that the version they finally get approved, won't offer all of the customization that the current one does that it's going to have to have certain guardrails put in and limitations. Just to make it safe for general population. I mean, right now, most of the people using the, either the loop or the open APS type systems tend to be very tech savvy tend to be pretty engaged in their care. So it's, it's a little safer for that population, but for more of a general diabetes population, they have to build a safer.

Katie: 37:02

Hmm. Okay. Interesting. All right. Let's see. Oh, I wanted to ask you, there was something that really stood out to me in the first chapter. You said that you may have found, you may have found out that today's healthcare systems simply aren't equipped to manage diabetes properly. And myself being in healthcare for the past 13 years, I'm a, I'm a physical therapist. I, you know, I feel like I know what you mean, but would you mind clarifying what you meant by that for the listeners?

Gary: 37:30

I'm sure. I mean, I alluded to this before. There are such limitations on what healthcare providers are able to do right now. They have to see so many patients an hour just to stay in business and they don't have the time really to spend with patients that that's necessary to analyze their data. Do all the exams that are necessary, evaluate their overall health status. Talk to them about their diabetes, what they're struggling with, et cetera, answer their questions, guide them on their dosing, guide them on lifestyle changes that they may need to make. There's a lot that's needed from a guidance and consulting and a coaching standpoint that providers just don't have the ability to do. And that's why as patients, we have to become empowered to take care of a lot of this ourselves utilize our healthcare providers more as, as just consultants, if we're having a specific issue, but the day-to-day stuff, we've got to become our own experts at. And that's, I guess one of the main reasons the book is there and. Yeah, the type one university webinars are there is to empower people to become better managers of their own diabetes.

Katie: 38:46

Yeah. Absolutely. And I feel like with all the new, well, the new technology and the new insulins and the CGMs and everything that, you know, the insulins that mimic more of what the insulin would do actually do in our body and whatnot, like we are able to make, or we need to make more decisions, I guess, are we, we don't, we don't have to, but we feel the need because we have all this information. So I feel like they couldn't possibly feel. All those questions, you know, we've, we've got to take some of that responsibility onto ourselves.

Gary: 39:15

and in that matter, most endocrinologists who are supposed to be specialists in diabetes, they don't just treat diabetes. You're treating dozens of metabolic conditions and endocrine disorders. Diabetes, isn't their specialty. They're dealing with a lot of stuff. So they can't usually stay on top of all. That's going on in the diabetes field. You know, they don't have a chance to really know how the pumps and CGMs work and be able to counsel patients properly. A good certified diabetes educator or diabetes care and education specialist is what they're called. Now. Those are the folks that I think have a better opportunity to guide patients properly, but you have to have a provider there that also knows what they're doing when it comes to type one. It's a lot of them are used to dealing with mainly with type two diabetes. They're not as up to speed on all the intricacies of insulin management and the technologies that we use.

Katie: 40:13

Yeah, it was funny after Sarah got diagnosed The main certified diabetes care and education specialists that we would talk to that also happened to be a family friend. She said something to me one day about her type two patients. And I'm like, wait a minute. Y'all y'all cover type two diabetes also, you know, in my little narrow brain of just receiving this diagnosis, I was just thinking like, certainly all you could possibly handle is type one diabetes. Right.

Gary: 40:37

Yeah. And they actually treat families other than yours. It's not just,

Katie: 40:41

It's not just, me.

Gary: 40:43

see people come on.

Katie: 40:45

Yeah, I thought that was funny. Well thank you so much. I mean, I feel like we're, you, you've shared a lot about integrated diabetes, which I just want to encourage listeners. I mean, you, you treat people all over the country and apparently all over the world. So if they feel like they need help with their diabetes management, you can always hop onto their website. It's integrated diabetes.com. Correct. Yeah. And reach out to them and, and get hooked up that way. But is there any, anything else you'd like to share before we, before we sign off?

Gary: 41:11

no I'm thinking covered things pretty well. The book gets into a, into a lot of details, but everybody's situation is different. It's important not to take things too. Literally you want to learn concepts and try to apply them. So some of the things like the dosing formulas that are provided, don't worry so much about those. It's really about understanding the overall concepts and being able to make reasonable adjustments, better adjustments than you might've made in the past. Nobody's perfect with this. I mean, just during our discussion, my glucose dropped into the fifties because I had some pizza for lunch and I forgot to extend my bolus. So none of us is perfect when it comes to our diabetes. And, and that's okay. We don't need to be perfect as long as we do reasonably well, we should be in good shape long.

Katie: 42:04

Yes, absolutely reasonably well. Did everybody hear that? That's the, that's a good goal. Yeah, I loved, I just went over. What was it? The LA the three keys to better control on Instagram. That was on Tuesday, whenever that on. And that was the one at the end of the chapter you were talking about, you know, you need a good attitude to, to do well. And you, you definitely made it a point. To encourage us to set reasonable expectations and you had a line and I actually quoted it when I, when I was going over it, but it was like, even people that have outstanding control are out of range a, you know, I forget your wording, but it was like even those people with excellent control and good, good times and range and all that, they're still, they're still out of range, a fair amount. Well, thank you so much, Gary. Thank you. Just thank you for letting us do this book series. I know it's going to be a huge help to a lot of type one families out there. And I appreciate your time today. Thanks for coming on.

Gary: 42:57

no, thanks for inviting me into your living room there. And hopefully it will provide some good info.

Katie: 43:03

you really did. Thanks. All right. That's it for our show today. I did want you guys to know that there was one question I forgot to ask Gary that I really was curious to know the answer to. So when I emailed him a few days ago to let him know, the episode would be up this week. I went ahead and asked him the question, and I wanted to tell you what his response was. All right. Here's the question. In the first chapter, you make a running joke about a cure for T one D being just another five or 10 years away. Where do you think we are now? Another 10 years? Winky face emoji. Honest answers apply. And he said, and he gave me permission to read it. He said, my thoughts about the cure for type one have changed. It's now more of progression towards life that is relatively free of the burden of managing diabetes along with excellent glucose control. Rather than a single pill or procedure that makes diabetes magically disappear. That was a pipe dream from the get-go. The progression is going quite nicely and we're seeing it already with aid, automated insulin delivery technology, and it will continue to improve. And that was his response. While, of course I wanted him to say, I think a cure truly is five years away. I knew that he probably wasn't going to say that. And I think that that was a great answer. And this is just me venting for a minute, but I. Continue to be frustrated that. The second or third thing out of the diabetes educators mouth, when we got diagnosed was. They're really close to finding a cure for type one diabetes, because my little eight year old sweet, precious daughter. Clung to that sentence and still clings to that sentence. And I don't necessarily think that's a bad thing because we all need to cling to hope. Um, and I truly do hope and believe that there will be a cure for type one diabetes but if I'm being completely honest, who's to say that it's going to be in her lifetime. It might not, it might be. Several lifetimes from now. I'm not sure. I think the day will come. I just don't know when. And it does break my heart. When Sarah said that says things about a cure coming really, really soon. For example, when we were on vacation last week, we got her, her all access national park pass that she can use for the rest of her life. And I said, How exciting Sarah, you get into national parks all around the country for free. For the rest of your life because of type one diabetes. And she looked at me and her eyes were wide and she said, but mommy. What if there's a cure for type one diabetes soon. And of course I just said, well, if there's a cure for type one diabetes, then you won't need this card. And I would be more than happy to pay the entrance fee to get into these national parks. If it means that you could live your life without type one diabetes. But I don't know. I do think what Gary said is very true. And I know that diabetes educator mint, nothing but the best for us. When she said that she just saw a scared little girl in front of her and wanted to give her hope and make her feel better. I totally get that. I cannot blame her for that. But sometimes it does break my heart. When Sarah says things about a cure being right around the corner. I sure hope so, baby girl, but we'll see. Gary. I just want to thank you again for agreeing to let me host this book club series. I truly am honored and do not take this responsibility of shepherding people through the advice you laid out in this book. Lightly again, get your copy today so you can follow along with us. There'll be links in the show notes for that as well as a link to Gary's company's website, which is integrated diabetes.com. Take a look and join us next week for chapter two, called glucose control. Y'all. What is it good for? All right. I will chat with you soon until then stay calm and bolus on. Bye.