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- [00:00]
A
Hello, friends, and welcome back to another episode of the Juice Box Podcast. Today, I'm bringing you audio from ada. So I sat down with a number of very interesting people at a booth at the American Diabetes Association Scientific Sessions, where I was a guest of Sugar Pixel. At the Sugar Pixel booth, I interviewed these people. Top of my head, no preparation whatsoever. Some really, really interesting people. Lane Despero. You're going to learn more about him. You're going to learn more about Scott Johnson and Blue Circle Health. You're going to hear from a gentleman who's making a new product that is very exciting. Kenny Fox from Fox in the Loop House, and I had a great conversation and so much more. These are short conversations, 10, 15 minutes at a time. I'm going to put them all together
- [00:49]
B
right here for you.
- [00:50]
A
You want to know what it was like to be at ada? This was my experience. Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. And if you'd like to support me by buying a Sugar Pixel, please do it at my link customtypeone.com juicebox go get that brand new Sugar Pixel. Hey, everybody, I'm here at the Sugar Pixel booth with Delaine Desbro. I always think your name should have an X at the end of it every time I say it. By the way, Lane is a pretty spectacular guy. I'm going to let you learn about him through his words. So, Lane, can you tell me how you find yourself at ADA and a little bit about your time with diabetes?
- [01:44]
B
Sure.
- [01:44]
C
So 16 years ago, my awareness of diabetes was it had something to do with glucose and insulin. That was my level of understanding of diabetes 16 years ago. And then my son was diagnosed, and I climbed a pretty steep learning curve after that. I didn't even know. I knew insulin did something to glucose. I didn't even know whether it made it go up or down. That's my level of understanding.
- [02:08]
A
And your son's diagnosed, you throw yourself into it. But what's your background? Why did it work out for you?
- [02:13]
C
So my background is engineering. Chemical engineer. And in various engineering disciplines, you specialize. So I specialized in what's called process controller automation. So these are the brains of oil refineries and chemical plants. So there's not a bunch of people going around turning knobs and looking at dials. There's computers doing that.
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A
Right.
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C
And this is what immediately drew me to a realization that, why don't we do this with insulin? And Glucose. If I can twiddle, or if I can use computers to control chemical plants, why can't we use computers to control blood glucose?
- [02:51]
A
So what do you do with that knowledge? Where do you throw your effort? I mean, I don't want to speak for you, but I make a podcast today about diabetes because when my daughter was diagnosed, I wanted to help, and I took what I thought were my skills and put them in an area where I thought they would work. I'm assuming you did the same thing, but how do you figure out where to start?
- [03:09]
C
Yeah, so I was curious about the whole, how does this work?
- [03:14]
B
I've got it.
- [03:15]
C
I knew about CGMs. I knew about pumps at the time, 16 years ago. They weren't really connected to each other. And this really surprised me, that, okay, here's a device over here that's like the speedometer on your car, and there's the gas pedal down there, like the insulator.
- [03:31]
A
Yeah.
- [03:31]
C
They've never met. And I know how to do that. Like, that's my superpower. So that immediately got me interested in, has this been done before? Are others doing this? And I discovered fellow chemical engineers who were five or 10 years ahead of me already on that path in a research capacity, so at universities doing this. And I thought, well, maybe I can contribute my industrial experience doing that. So one thing led to another, and I wound up about nine months after my son was diagnosed, working for Medtronic. Okay, so in a complete happenstance, accidental,
- [04:10]
A
but you just switched jobs and through your effort.
- [04:12]
C
Yeah, so I kind of looked at it. Why would I work on something trivial like the world's energy problem, when I can work on something more meaningful? And so that's when I got my calling. It's like, oh, that's why I have 25 years of experience. I can go use that to something much more purposeful.
- [04:28]
A
Oh, that's lovely that it felt that way to you. Like, I've been preparing.
- [04:31]
C
I still feel that way.
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A
I've been preparing for this.
- [04:33]
C
And what I would say is that mantra, that goal. I've done different things over the intervening 16 years, but it's always with that goal of how can I leverage my skills and experience, such as they are, to further the availability of these transformational therapies like automated insulin delivery.
- [04:54]
A
Do you think most people online know you for Night Scout?
- [04:57]
C
Well, that was one of my side projects. Yeah. So maybe they do.
- [05:01]
A
Yeah.
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B
But.
- [05:02]
A
So what did you. What did you do? I guess, Let me ask you instead. What did you do at Medtronic? How Long were you there and then what did that lead you into after that?
- [05:09]
C
Well, so one of the things going back to at the time, CGMs, if you wanted to see the CGM value, you had to look at the pump. Do you remember the pump had the little display on it. So here Hayden was 10 years old at the time, and we were still going into his bedroom three times a night to see if he was still alive. Right, right. Dead in bed. And so good times. And at the time that I, that he was diagnosed, I was working for GE Energy. And GE Energy, they monitor a thousand gas turbine power plants around the world. So Saudi Arabia, the jungles of Brazil. So I was the product manager of this remote monitoring center. And I thought, it's crazy that I can monitor a gas turbine in Saudi and I can't see my son's blood glucose 20ft away in his bedroom. Like, there's no technical limit to that because we're doing far more difficult things to get this telemetry back. So that's really what precipitated Night Scout was this realization that there was no technical limitation to doing this.
- [06:15]
A
And that's the thing you did on the side.
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C
And I did that on the side at home.
- [06:18]
A
Okay. I have to ask you, once you have it and it works and you think this is a great tool, people will use it, how do you get it to people? Give it away a little bit and think like, all right, it'll make its way around. Like, are you stunned at how far it's gotten in the world? I have a phone right now and I, I have it on mine.
- [06:35]
C
So, you know, so I was really shocked. I thought. And at the time, the, there was so much technical difficulty in setting up Night Scout, I thought, there'll be three people in the world who will. How it looks classified or characterized as crawling through broken glass or learning Swahili.
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B
Like if.
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C
And I didn't realize there were a whole bunch of people who would be willing to crawl through technical broken glass and learn obscure things to make it happen. To make it happen. And that all got progressively easier. Now it's like a one click install. But that's. I really thought that what we were doing with Nightscout in terms of adding value to the community was showing an unmet need.
- [07:15]
A
Okay.
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C
Because at the time I was working at Medtronic and they said, we've seen no customer research. Our marketing department hasn't said there's a need for this. Like, I'm telling you, there's a need for this.
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A
Nobody Wants this. You're like, I want it.
- [07:25]
C
Exactly. I'm telling you, my wife, Cold, dead hands, Geraldine Heston kind of attitude to take away Night Scout. It was, it was that powerful.
- [07:35]
A
So do you feel like you're, because of your personal experience, you found a way to be ahead of the curve of where the industry is.
- [07:43]
C
So it's funny you say that because I had a talk with the then president of Medtronic one time and I said, I want you to understand that I'm kind of like an alien from the future. There are people like me, but they would not voluntarily come into this essentially backwater of technology called medical devices unless they had a personal motive for doing so. And that's really the way I felt. It was so frustrating to me just how conservative and blank sheet of paper and we need to go do primary research. So that was really, I think what triggered me to say we are not waiting. It's like, we don't need to wait. Like all these other industries have already done this before. Why don't we just steal from them, you know, Proudly found elsewhere.
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A
Yeah, yeah. And proudly found elsewhere. And make this happen. I tell people all the time that, I mean, my daughter's going to be 22 soon. She's diagnosed when she was 2. So we've been at this 20 years. And there was a long stretch of time where just someone putting out a new meter. Even though the mard wasn't any better, the meter didn't do anything differently. It just looked and you were like, oh my God, we got a new thing that was advancement back then. And then all of a sudden, I don't know, I don't know. In my world, it was, I guess Dexcom. Dexcom started and then they figured out a way to kind of get through the FDA a little faster. And then the innovation started happening and everybody kind of piled on innovation. And now you look back and you think those meters are like the equivalent of boiling needles and peeing on strips in a 20 year span. And now I guess what I'd love to ask you about next is now that things have sped up so much, it's not going to take 20 years for us to get to the next thing. So what's going to make our CGMs and our pumps look like peeing on sticks in the future? Do you see anything out there?
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C
So I think one way to answer the question is the physical, like how, how are these going to look physically in the future?
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A
Right.
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C
And that's what, that's what most people think Of So is it going to be a one, one device or smaller or smaller or thinner or purple or like some. Some physical attribute? And I think we'll continue to see some advancements there. But honestly, that's. That's not what's as interesting to me as what we're doing with the algorithms inside.
- [10:01]
A
And that's what I want. Yeah, yeah. Like, I want the data to come in and instead of it being a fixed set of if this, then that, it's if this, then that, and then something else. Thinking about it and then changing if this, then that.
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B
Right.
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A
I have no technical mind, but that's the idea, right?
- [10:18]
C
Oh, 100%. And this is where I think people who don't have diabetes and they think, oh, it's the physical part of the disease that's so hard, finger sticking or infusion sets or wearing all this stuff. But there's this cognitive burden. Right. It's a thinking disease. It is. You are never not thinking about your diabetes and it's consuming resources in your brain that would otherwise be for a better purpose. So I think that's really where the opportunity is as to how do we allow people to just live a more enriched life and not have to worry about that.
- [10:54]
A
I imagine it would not surprise you to hear that I have a little estimator on my website that I built.
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B
Right.
- [11:00]
A
You put in your carb ratio, your sensitivity. You can put in your current blood sugar. It applies some more salt math to it. Carbs, fat, protein. If you want, you can tell it which direction your CGM is moving in and your current blood sugar, insulin on board. Hit a button and it'll say to you, bolus this much now and this much later. Free bolus about 15 minutes. Make this next wave last four hours. It is the most popular page on my website.
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C
Wow.
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A
I have never shared it publicly with anybody.
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C
Wow.
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A
So I'll.
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C
Word of mouth.
- [11:37]
A
But to your point, what is it doing? It's just relieving someone's burden around a meal. That's all it is.
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C
Yeah. And is it like this is what happens with people who don't have diabetes. That's what their endocrine system is doing.
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D
Sure.
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E
Right.
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C
You're having the cephalic response, the Pavloni, like you're anticipating dinner or lunch in our case, and it's already secreting insulin, getting ready for that. Like, that's like we're not thinking about it now. When that loop gets broken, you have to think about it.
- [12:07]
A
So based on something you said earlier, I want to Ask this next question. You are at Medtronic. You say, this is important.
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B
People go, we don't think it is.
- [12:14]
A
Is that happening now? Are there a group of, you know, rebel fighters out there working on stuff and the companies are saying, we don't see this, or do you think everyone's on the same page now?
- [12:25]
C
I think that's been. That's a great question. There's been an evolution of what do we do with this people with diabetes community?
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B
Right.
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C
How do we. How do we understand what they're doing, what their needs are?
- [12:39]
D
Yeah.
- [12:39]
C
So that's. That's one of the things that drives these companies. The other one that really bothers me is this feature function checklist battle phase. Like, oh, they have a dual wave bolus calculator. We better have a dual wave bolus calculator. They have an exercise mode. We better have an exercise. And a lot of those features aren't actually helpful for people who actually use them.
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A
I used to like when they were like, we have a food library. I'm like, no one cares about that.
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C
Exactly. So that's. I think those are sort of two tensions of driving. It's like, we need to keep up with the competition.
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B
Right.
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C
But we should be paying attention to what the user needs are.
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A
Yeah. I'll share with you that because of what I do and for how long I've been doing it, the amount of people who have come to me and said, I have an app and I always think, don't care. Yeah, I don't care. Your app is. No one's good. It adds to the burden. It doesn't take away from it.
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C
Yeah. The perfect app is no app.
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A
Even if it's great. It does. It still adds. Now I got to open the app and I got to do a thing. Oh, you just log your. And I'm like, no, that. You don't understand what it's like to live with this if that's how you built this.
- [13:42]
C
When I was at Medtronic, they brought in somebody from Ideo or one of those companies that does design, and they were talking about making the app sticky and more. It's like, you're missing the point. The best app is no app. You don't want people engaged with their diabetes app eight hours a day. You've failed if that's the case.
- [13:59]
A
So a lot of companies are talking about one day. We're not going to have to put in our carbs. Do you think they're going to get to that?
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D
Because don't.
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A
Aren't they More restricted by just, I mean, listen, why does loop, you know, why is trio. Why are these things out ahead? Because they don't have to go back to the FDA and say, is this okay? And you don't get one CEO who's risk averse and one who's a little less and everything. So, I mean, is that in your opinion, is the DIY community going to stay ahead in that?
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C
I think it will. The one other point about getting to full closed loop, because I think that's what you're asking.
- [14:35]
A
Yeah.
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C
Right. If we don't have to count carbs anymore, we don't have to do hybrid closed loop, we don't have to do a meal announcement, which is the number one most burdensome thing. Right. Like three times a day. There's a huge mental burden of I am now the carb count and pre meal bolus.
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A
And it becomes more and more evident to me as my daughter gets older and transitions away from being a child. And I'm watching her be an adult
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B
in the world living with diabetes.
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A
If you ask me what she needs most, she needs the alleviation of decision making. Like I think 100%. Yeah.
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C
And it's kind of one of these things that people go through various phases in their life where they might have the headroom at a certain point to be able to contribute those decisions, but there's like new parents or new jobs or stressful jobs or puberty. Like there's other priorities in their life. So how do we help people as they're going through these various phases of their life to still be safe in.
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B
Yeah.
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A
Safe, healthy, and as uninvolved as possible is what I would. Is what I would say sort of
- [15:30]
C
at the top of Maslow's hierarchy of needs. Like instead of like worried about the primal base things like how can I self actualize because I don't have to
- [15:38]
A
worry about all this other crap.
- [15:40]
B
Yeah, yeah.
- [15:41]
A
So is that. What are you involved in right now? Like, how do you spend your time 16 years later after you've done these other things?
- [15:48]
C
So I love my job. I. Before describing what it is, I just. Some, some people say like, Lane, you're working on the weekend. It's like, no, I'm like, I'm playing on the weekdays. It's so fun. I joke that I, I love recreational math. Like some people do recreational chemistry. I do recreational math and I just love the algorithms, the data science, the analysis of the data, because it's a data disease as well.
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D
Right.
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C
It's all we got. All this Data streaming in.
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D
And.
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C
And sometimes that's confusing to people. It's intimidating to people. They don't know how to act with it. But what I would say, I'm what I am doing right now. And this gets a little bit to the DIY community. And one of the things. When I did Night Scout, I stopped. I stepped away from Night Scout as soon as it was launched for a couple of reasons, but one of them was I really felt we had shown the path. It's like, there you go, device companies. It's your job to scale. It's like the Field of Dreams model. If we build it, they will come like, there it is. We've done our thing. Now you go do it for everybody. And so Dexcom Share and Follow happens soon after that. But I was talking with somebody at D Data the other day that here we are 16 years later. There's really nothing like Nightscout from integration of insulin.
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A
And I still hear people complain about it when they're using a retail system. Why can't I see this?
- [17:13]
C
My wife was a school nurse for many years, so 25 students under her responsibility. She was the diabetes expert. So like, six schools at lunchtime, right? She's getting pink. And. And so she'd get a text and she. She had something like 12 people on Dexcom follow or kiddos. And the very first question she asked is, how much insulin is on board? Like, it's not helpful for me to know that their blood glucose is 200. If they've got, you know, tons of insulin on board, that's a different thing than if they have no insulin on board. So that was frustrating to me that we're not seeing the scaling of these pioneering things that the DIY community is doing, whether it was Night Scout or Loop or Trio. So that's what I'm focused on now is how do we get scale? How do we get these incredible technologies, whether they're coming from the DIY community or even from sponsors. Sponsors is the FDA word for device manufacturers.
- [18:06]
B
Okay.
- [18:06]
C
It's taking them 10 to 20 years from conception to wide scale of these. And it doesn't need to.
- [18:13]
A
It's a lifetime.
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C
It really is a lifetime. Yeah. And it takes the same amount for Gen 2. So, like the second generation of an algorithm, it's on the same track as a first generation. So it is incredibly frustrating to me. And I recognize this as a bottleneck or constraint in the commercial regulatory flow path. And I said, I think I have a solution to this.
- [18:35]
A
No kidding.
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C
And that's what I went to the FDA and the Helmsley Trust a year ago and said all of those innovations that are happening over there and that are happening in companies, they're running into a. Like, just imagine a flow of value. There's a pinch in the pipeline down here, a bottleneck. And if we could relieve that bottleneck, we can get faster scale.
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A
How about you come on the podcast and we'll talk about the rest of the. That'd be okay.
- [19:01]
C
That would be fantastic.
- [19:02]
A
I'm gonna share something with you before I let you go, but everybody who's listening, if you enjoyed that, we'll have Lane on to do a longer. Because I. I'm sitting here thinking, I feel like we could talk about this for a couple of hours, so. But I want to share something with you that you don't know. It's a. Thank you. So when I started doing all this, I had just like everybody else had no context for. My daughter was 2. I was a stay at home dad. I genuinely felt like I was killing her. Most days I did not find what the doctors were telling me to be helpful. And I am not a reader, I'm sorry to say out loud. So I broke diabetes down myself and I eventually came up with what I knew were like, the rules. If I did this stuff, I got the outcomes I wanted. And I did a thing that a lot of people around the world do now. I kind of coined this idea of bumping and nudging blood sugar. And I would use temp basal increases and decreases, sugar surfing. I would. To manipulate the blood sugar.
- [19:54]
B
Right.
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A
I didn't know, Steven. I'm in my house like a mad scientist trying to figure this out.
- [20:00]
B
Right?
- [20:01]
A
But my understanding of what I was doing did not open up completely until I got Night Scout and my daughter went on loop. And then when I saw the thing doing what I was doing, I thought, oh, I was doing the right thing. And it was the first time I felt comfortable and confident that I wasn't just making it all up, you know?
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D
Know what I mean?
- [20:24]
A
It was just wonderful. Like watching on Night Scout, watching Luke take away and give and Bolas and not and everything. I was like, oh, my God, I've been doing that for a decade. And then, you know, what happened next? I slept through the night. I.
- [20:39]
C
And people don't appreciate what it's like to sleep through the night.
- [20:42]
A
It's. And I didn't know I was dying. And if I. If we get off camera and I show you a photo of myself before then my body was given out, I Wasn't sleeping at all. I was in a terrible situation. I had no idea. So anyway, what you did really made up.
- [20:56]
C
That's so touching.
- [20:57]
A
No, seriously, really. And I see other people walking. I'm going to try to interview some of them today. I see other people walking around this room that I don't think half of these people know. And they don't realize how they're driving the engine behind a lot of what's going on in this room. So I really do appreciate your time.
- [21:11]
C
It takes a village. Everybody's bringing their skills to the fight. Diabetes is the enemy.
- [21:18]
A
Yeah, maybe that's really what this couple days is about. So thanks again. I really do appreciate it. Thank you everybody. And thank you Sugar Pixel, for making this possible.
- [21:26]
B
Take care.
- [21:27]
A
Why don't you start by telling me a little bit about you.
- [21:30]
B
Who are you?
- [21:31]
E
Great. So my name is Madison Smith. I live in San Diego, California and I currently work as the therapy chief engineer for MDI Systems at Minimedia.
- [21:44]
A
How do you remember that you're the therapy chief engineer?
- [21:47]
E
I've gotten used to saying it, but it's quite a mouthful.
- [21:50]
A
What does it mean? What does the job mean?
- [21:53]
E
I would say that my role is to help make sure that we're engineering the products that make sense once they get into patients hands. So how is it actually going to be used to help best manage the way that they want to manage their diabetes? Does it fit into the way healthcare teams want to introduce and use technology?
- [22:18]
A
And so we don't want there to be some like high minded idea that when it gets out into the real world, it doesn't really do the things that people intend. Okay, so what, what, what exists right now that you're working with that you think actually does help people in the real world?
- [22:34]
D
So,
- [22:37]
E
so I work on MiniMed Go or MDI systems. And so I think historically when you were looking at what it takes to manage mdi, you have pump, which I would say is the gold standard. And you saw algorithms being developed and so much sophistication and then the kind of the alternative on MDI, which more than 70% of people living with diabetes are still on MDI therapy. We're like in the dark ages of pencil and paper and calculating.
- [23:10]
A
They don't get the benefit of all these things that we've learned because they're mdi, they prefer to be mdi usually. Or is it access?
- [23:16]
E
Sometimes I think it depends, right? Sometimes it's access, sometimes it's cost. And in my case, which we didn't even cover this yet.
- [23:25]
A
But do you have type one?
- [23:26]
E
I have type one.
- [23:27]
A
Okay.
- [23:28]
E
And I just have a strong preference to be on MDI therapy, but I kept always feeling like I was being pushed towards a pump because that's where I had calculator support. It could track how much active insulin I had. And so all those features that would kind of push me towards a pump, but I really preferred MDI.
- [23:48]
A
How long have you had type one?
- [23:49]
E
I've had type one since I was 16 years old.
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A
Okay. And you're 20, 25 now.
- [23:54]
E
I wish that quick.
- [23:55]
A
So you've had it for a while?
- [23:56]
E
I've had it.
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A
And you prefer mdi. But as things progress and get better, did you have the feeling of like, oh, I'm being left behind with my health?
- [24:05]
E
Yes. So I kept. I mean, I was finding myself being pushed towards a pump, but then when I learned about the inpen. And now these smart connected devices that can track active insulin, that can help inform dosage decisions and really offered the things that I was looking for out of pump therapy. But let me be on MDI in a more sophisticated, like, raise. Like, I keep thinking, like, why did we leave MDI in such. Like an example I give is like, how often have you left the house and you can't remember if you've locked the door or you can't remember if you've unplugged the iron? And in all those cases, you can go back and you can physically check and see that the door is locked.
- [24:47]
B
Locked.
- [24:47]
E
Or you can see the irons unplugged. And then we have this medication that we have to take four or five times a day. It has serious consequences if you miss it or if you double take it. And there was no way of knowing if you took it, how much you took it, what time you took it.
- [25:06]
A
Yeah.
- [25:06]
E
And so now having that more smart, informed connected technology is what.
- [25:11]
A
So do you use the. What pen do you use?
- [25:14]
E
Do I use an inpen? You use the inpen with the MiniMed Go system.
- [25:17]
A
And MiniMed Go means in pen connected to one of your two sensors.
- [25:22]
E
Correct.
- [25:22]
A
Which one do you use?
- [25:23]
E
I'm currently using the instinct.
- [25:25]
A
Okay. And the other one is simpler.
- [25:27]
E
Simplera. Okay, so we have the choice between the two sensors.
- [25:30]
C
Right.
- [25:30]
E
And then the options.
- [25:31]
A
And I do understand it works with dexcom, but it. The data is lagged.
- [25:35]
E
That was with our prior system. So dexcom data could come in, but it was on a delay.
- [25:42]
A
Delay.
- [25:42]
B
Right.
- [25:43]
E
So now with the two sensor options we have in our portfolio, they're connected directly to the app and they're in real time. And that piece alone has also helped us to develop more informed, actionable sort of decision making.
- [25:58]
A
It's a smoother process in general with both of your sensors.
- [26:01]
E
Yes, because we're for the first time actually looking at not just sensor glucose values, but also the other part of what it takes to actually manage diabetes, which is insulin. So when did you take your last dose? How much of that dose is still actively working in your body? And so instead of just, let's say, notifying you because your glucose is rising quickly or you've crossed some threshold, we, we can look at your glucose in the context of how much insulin you have on board, let's say. And maybe there's actually, we see more than 50% of the time when you were just, if you just used a threshold based sensor glucose alert, there was no action to be taken because they've just eaten a meal and they've taken the insulin for it or you've just corrected that high blood sugar and you need time for the insulin to do its job.
- [26:58]
C
Job.
- [26:58]
B
Right.
- [26:59]
E
And so what this system does is actually reduces the, let's say the alert fatigue and waits to find the right opportunities to alert you when there's action to be taken and then tells you what you need to do.
- [27:12]
A
Now would be a great time to do something. So you lived so long with MDI and nothing like this and now there's all this data in the world. Did it actually benefit you? Like having the data, having the, the automation, like can you just from your personal experience, has it improved your A1C, your time and range, anything like that?
- [27:32]
E
It has, I mean it's improved my, my overall glucose control. I would say in a lot of ways we had the, I had the capacity to do the decision making that I was doing.
- [27:43]
A
Right.
- [27:43]
E
But now I get to be more hands off and wait for the system to identify an opportunity. And when that opportunity comes, I take action. And so I'm say like, I think about it less, I check in less because I know that it's monitoring in the background and when I need to do something, it engages me. So the less time, I get to spend less time thinking about diabetes, but
- [28:10]
A
taking advantage of the benefit of the data and of the automation that comes through the impact. That's pretty awesome. Has it like, has it like personally alleviated anything for you? Is it made like, is it a measurable difference in your life or is it just a nice thing and my health's better and I don't think about I don't know what I'm asking you exactly.
- [28:29]
E
I mean, and I also don't know that I mentioned this part, but I'm a certified diabetes care and education specialist, a nurse. And I think that, you know, from a professional standpoint point, you would think I have it all together, right?
- [28:46]
A
But like, no, I've interviewed enough people. I know that's not the case.
- [28:50]
E
That's where I'm going, right? So like, I'm still a person living with diabetes and it comes with all.
- [28:58]
A
It comes with.
- [28:58]
E
It comes with everything. Diabetes comes with like, I can know the information, but it doesn't mean you'll do it. Yeah, do what I say, not what I do.
- [29:08]
A
Everyone says that for a reason. I used to have this where I'd always wonder, like, why would my daughter, like, ride her pump out to the last possible second? Like, when I'd be like, why don't you just change it a little sooner? You know, it'll be. It'll be helpful, blah, blah. And I mentioned one time to a friend of mine, said, diabetes for like almost 40 years and she's also a therapist. And I said, you know, it's so frustrating. Like, I know if she just changed it a little sooner, she did this a little sooner, she'd have much better outcomes. And that therapist with almost 40 years of diabetes living said, oh, I do the same thing.
- [29:38]
B
Yeah.
- [29:38]
A
And I said, why? And she goes, I don't know. That was sort of it, right? It's the living with it everything. So anything you can do that makes it not have to be front of mind, but is still getting the benefit of all this data that's available. Listen, I'm a huge fan of the M Pen, a million percent, because I believe exactly what you're saying is that a lot of times places like this, these people we get to meet, it's lovely, but they are not exactly an accurate slice of the population. And a lot of people don't wear pumps. A lot of people. And they don't not deserve to have what they could get out of all this. So, you know, I mean, if you were. If you were talking to a person who is you in the past, like, how would you talk your old self into trying something like this sooner? Because why? Because you didn't do it for a long time.
- [30:27]
C
Right.
- [30:27]
A
But also impen.
- [30:28]
E
It wasn't around when I first didn't
- [30:30]
A
exist as much,
- [30:33]
E
but I would say so. Well, I come back to especially like newly. Let's say you're newly diagnosed and I've been Newly diagnosed. And I've also been the nurse educator sitting down with families that are newly diagnosed. And it's completely overwhelming. You've been kind of given this diagnosis. In my case, I didn't even know what diabetes was, and now I'm being told I have it and I'm being given a vial and a syringe and like, okay, give yourself your first injection. Oh, and by the way, here's how insulin works. And this is when it spikes and it peaks. And you can do this and don't do this. And here's the formulas and it's like so much overwhelming.
- [31:18]
A
And then, and then. Would you like to stick a thing to you? Do you want to get a cgm? Do you want to get a pump? And listen, I hear from people all the time. I don't know how well, you know what I do, but I've been making my podcast for 12 years. I've interviewed nearly 2,000 people over and over again.
- [31:34]
B
They'll say the same thing.
- [31:35]
A
When my kid was first diagnosed, when I was first diagnosed, I didn't want anything on me. It felt weird. I didn't want to be a robot. Often they'll come around and realize the benefit of it, but in the beginning, like you're saying, they're being told all this stuff, all this terminology. They don't understand the shock of the trauma of what's actually happening to them. Let's not forget they might have crazy brain fog from high blood sugar. There's a lot going on and they start off, but often they start off the way they start and then never reassess it again. And that, to me is kind of a shame that you almost walk the path you're upset on. You know what I mean? So back to it. What do you tell that person?
- [32:16]
E
Well, I think, I think that there's just so much to, like there's diabetes experts for a reason, because there's so much to learn and understand. And so if you can have a system that is, you know, your healthcare team helps inform how it should be, let's say your therapy settings, how it should be configured. But your day to day interactions are, you have a sensor that's telling you what your current glucose is, you're choosing your meal type, your meal size, or if you carb count, you can put in carbs and it's recommending the dose, but it's doing all that, you know, the informed decision making behind the scenes. So I just think that there's a big opportunity to give more support to the person to allow you to kind of ease into the education, so to speak. Because as an educator, actually there was a study cited that people only retain about 30% of what they first learn.
- [33:20]
A
It's 20% more than I remember, but go ahead. That's awesome.
- [33:22]
E
So imagine, I mean, I've been the person that then goes home and you're kind of lost and confused and you're hoping you're remembering everything and doing it correctly. And then as an educator, you're hoping this family can go home safely. And.
- [33:40]
A
And then how do you start to walk them through the whole process Slowly.
- [33:43]
B
Right.
- [33:44]
E
But if we could have these. I mean, I would just love to see these tools being used. Like, the more visibility we have, people can be aware of them, know that they have access to them. And then if it could be used as a tool even early in diagnosis, to not put so much pressure on the patients or the persons with diabetes and the family to be these experts going out the door on day one.
- [34:09]
A
Yeah. In Penn, the whole mini Med Go system, like, it's a great entree where you get the health benefit without all of the burden of, like, what's all this stuff? Why do I have to remember all this thing? So you'd go back in time and tell yourself, get an in pen.
- [34:25]
B
Yeah.
- [34:25]
E
I tell my health guys, team, give me an infinite diagnosis, not make me start with a violent syringe and kind of listen.
- [34:35]
A
He's preaching to the choir. I don't understand the concept of like, make them struggle so they really understand it. Then we can give them a cgm. Like, I don't, I don't get that. I think it's old. It's probably older thinking and I don't not understand it. But, you know, I've heard people say to me, like, what if at all disappears? I'm like, if it all disappears, we're in a lot bigger trouble than that. So don't worry about it. Like, I think you're going to be okay. I like the idea of, listen, you can't minimize, like, joking aside, you can't minimize the, the information and the education that comes back from wearing a cgm. You learn about diabetes so much more quickly wearing a CGM so much more quickly using the, the Impen app. So you can see I put insulin in here. It did this. You know, like, you start to see, it all starts to just make sense.
- [35:22]
E
How insulin impacts the glucose, how meals
- [35:25]
A
impact, and that information helps you make better decisions personally and with your diabetes care. And to me, it's all just Better.
- [35:33]
D
Okay.
- [35:33]
E
And then everything that's being collected, too, goes into reports that then you can bring to the healthcare team. And instead of sitting down and feeling like, you know, it's 21 questions and you're.
- [35:45]
A
What'd you do here? Do you remember what you ate last Saturday?
- [35:48]
E
I don't remember what I. Yeah, yeah, yeah.
- [35:49]
B
Right.
- [35:50]
E
For breakfast. And you want me to remember why my blood sugar went high two weeks ago, and then you're gonna try to use that to make a decision around my therapy. So having that full picture.
- [36:02]
A
Yeah.
- [36:03]
E
I also feel like you can get to the more meaningful conversations that'll actually help address. Is it a behavior, is it an education, or is it a settings change? It's not always a settings change.
- [36:15]
A
It's awesome. Now, I really do appreciate your time and your insight. Thank you so much. You're delightful. You should come back sometime on the regular podcast, not when we're here at ADA and talk about this more seriously. Thank you so very much. And thank you so much to Sugar Pixel for making all this possible. Thanks so much, guys.
- [36:31]
B
Bye.
- [36:38]
A
Kenny, how are you?
- [36:39]
D
I'm good, Scott. Nice to see you in person for the first time.
- [36:42]
A
Never met Kenny in person, but it's crazy.
- [36:44]
D
Apparently, this is your first conference have.
- [36:47]
A
This is my first ada. It is massive, and I cannot believe all these people are here.
- [36:52]
D
It's my first as well.
- [36:53]
A
You've never been before either.
- [36:54]
D
I have not. Yeah.
- [36:55]
A
So let's find out a little bit about you first. You have kids with diabetes?
- [37:00]
D
I have four children. One. My second child, Tessa, is just turned 13, and she has type one. She's had type one for going on almost eight years, or at seven and a half years, I think eight years.
- [37:10]
A
And what does she do for her manager?
- [37:12]
B
Management.
- [37:12]
D
So she's using the DIY loop system, and we've been using that since about six months after diagnosis. Okay. Yeah. She got started with injections and a Dexcom and then immediately got the pods, and about a month later, we started looping.
- [37:27]
A
So she's been looping with an omnipod for years?
- [37:31]
D
Seven years, yeah.
- [37:32]
A
Okay. And you. I know you because you came on to Juicebox to talk about your knowledge
- [37:39]
D
of how to loop seven times.
- [37:41]
A
Yes. Well, you've been on a lot. Kenny's been on episodes called Fox and the Loop House. If you want to listen, they're fantastic. But why do you know so much about loop? Like, why are you the person to talk to about how to actually use it day to day?
- [37:54]
D
I think part of it is I'm a technology person by trade, and I've always been attracted to how do we use technology practically in our lives. So when I worked at a credit union, it was all about. About, okay, we have this tech how to. And understanding how someone did their job and figure out how to apply it, just streamline their life, basically their day to day job in technology. And so when Tessa was diagnosed, my go to was I need to understand the mechanics, the flow, the workflow. And that's just how I coped was part of it was just understanding diabetes mechanics. And by trying to look all that stuff up, I found all the DIY apps, all the information, and then I ended up looping. And then from there it was all just like. I basically treated Tessa's diagnosis like a. Like a game or a problem to be understood because that's all I knew how to do once I could see the data.
- [38:42]
A
So are you telling me that at her initial diagnosis you felt a little hopeless or were you very helpful?
- [38:49]
D
Yeah, it was very overwhelming at first, but for us, my wife understood diabetes. My sister in law has type 1 diabetes. And so she knew to check my daughter's blood sugar when she started getting cranky and losing weight and needing to go to the bathroom and then not wanting to eat dessert was actually when we got figured that one out. And so she tested her blood sugar. We had a meter in the house from before. Yeah. And found out she was diabetic. And all my wife said is, pack a bag. My sister had to stay the night a few nights. And Tessa has type 1 diabetes. And I'm like, I don't know what that means.
- [39:23]
A
Right.
- [39:24]
D
So I took her to the er. They like moved us up the chain. They saw her blood sugar and immediately told the guy who popped his head in that she's next. And so I go, the severity hit me. And then as she's sitting there, I just tried to keep her calm, gave her a movie to watch on an iPad. And I'm like googling, what is type 1 diabetes and how do we fix it?
- [39:43]
A
What was the movie? Do you remember it?
- [39:44]
D
I don't actually. I should ask Tessa if she remembers.
- [39:47]
A
So the movie that we ran over and over again when Arden was diagnosed, that my wife can't watch it, it makes her sad. But it was sky high, so. But my daughter will watch it still. So sky high on a. On an iPad. Or maybe not even. Actually, I'm pretty old. It was a compact DVD player that we played sky high on.
- [40:07]
D
How many times did you have to watch it?
- [40:08]
A
I mean it was countless. It's all we had. It just. And she was 2. So it just ran over and over and over again.
- [40:15]
D
Tessa was five and a half. And our process was we got diagnosed and we were only in the ER for two or three hours. And they said, gave her a couple injections and said, go home, we'll see you tomorrow in the afternoon. And we had a four hour session with our. That was that.
- [40:29]
A
It's pretty awesome. But when this is over, you realize I don't know what I'm doing. I'm going to dive into the thing that I'm maybe more adept at. It ends up being this do it yourself algorithm. And now I feel like there's nothing I couldn't ask you about Loop that you wouldn't understand. And you have a business around it now?
- [40:45]
D
I do, yeah. Somebody came up with a good name called Fox in the Loop house. So I grabbed that and so a couple Years ago in October 2023, I got laid off from my job. And I'd been always thinking about trying to figure out a way to help people even more than I already had with all the years in the DIY community. And I thought, well, I could probably do this if I could do it all the time without stealing time from my employer. Right. That would probably be more fair for everyone. And so once that happened, I took the severance and then made a plan to start rolling stuff out, try to give it a go.
- [41:15]
A
So now you're helping people virtually or.
- [41:18]
D
Yeah, it's all virtual. I mean, I guess if someone to come over to my house, we could do that, but it's all virtual. And right now my. I help people with building because I know people want help building when they get started. And being a tech person, that actually was like the easiest part to do. So we set up the build if they want to do that. And then mostly it's teaching you how to use Loop in your day to day life, but at the same time understand the data so you know what settings to change. Okay, so there's a lot of application. I like to say I focus on teaching you how to adjust your settings, which is my focus. But in practice you got to know how to just live life, understand diabetes variables and apply them to the system. And so I do that in two, two ways. I have created a video course essentially that we watch once a week and then you either join a group and we do it through a group method where we meet once a week in small groups or you can do private coaching and Then there's some way to get help in between. In case you have a question come up.
- [42:15]
A
Generally, how long does it take people to go from the build part to the part where they're comfortable enough to have the outcomes they're looking for?
- [42:22]
D
Yeah, building is. I got it down to about. About two, two and a half hours, but teaching how to use the system takes a little bit longer. I. It's a seven week process is what I walk people through. And I would say that everyone that goes through it as everyone's been happy and they feel very confident in what they're doing. But I would say there's about a third of people that when they finish, they still. There was so much new stuff. Just basic diabetes mechanics.
- [42:47]
B
Sure.
- [42:47]
D
That they need to go back and refresh. And so it takes them a few more months to either watch the videos again or I have a membership on the back end if they want to join and get some help.
- [42:56]
A
Kind of refreshing up till the comfort sets in.
- [42:58]
D
Yeah, yeah. They're adjusting their own settings by the time the seven weeks is over. Here and there, at least they're basil.
- [43:03]
A
Yeah.
- [43:04]
D
And making some good adjustments in meals. But a few people linger a little bit. But I'd say most people are pretty confident in changing their basal and carb ratios.
- [43:11]
A
What do you think? What's the thing you see most people trip on? Where do they get stuck?
- [43:17]
D
I would say a lot of the adults, it's counting food. So it's either some of them don't want to enter all the carbs that are required because they feel like it's like, oh, it's not healthy enough, I shouldn't be eating it or something like that. There's some fear around entering all of the food.
- [43:35]
A
Do you think that they're worried about the amount of insulin or does the number scare them?
- [43:41]
D
It's both the amount of insulin and the calories sometimes.
- [43:45]
A
Okay.
- [43:46]
D
So they feel like, oh, well, I shouldn't eat that. So then they don't want to enter all of it. So they enter 30 grams, but it should be 50. So there's a couple different reasons that my adults, I try to put them all in the same group in my group coaching. And so I'm learning more about their hesitancy, especially if they've been diabetic for a long time. I had one recently that told me I was just told a piece of bread is 15 grams and that's the only thing she's ever been told. So. So everything is like either 15 grams of bread or nothing. And so her counting was way off and she. Eventually I had her adjust her settings and then she's like, you know what? I looked at the package on this bread I'm eating. It's healthier bread than I used to eat when I was a kid and it's 20 grams. And I looked up this other thing. I have her breakfast and I had oatmeal and she had a pretty flat line. So she's like, it's amazing. I entered all my carbs and then I was okay.
- [44:32]
A
So you think if she doesn't take the time in this example, if she doesn't take the time to just re understand things, she might go on like this forever?
- [44:40]
D
Yeah, yeah. That calibration, that forcing people to calibrate, to count, you know, a lot of them pick it up after just like a week or so of really putting some effort in.
- [44:49]
A
Right.
- [44:50]
D
But they hadn't done it in a while. So I usually encourage people in general, like if you just take a couple days once a year and maybe kind of pretend like you're a brand new diabetic.
- [44:59]
A
Yeah.
- [44:59]
D
Just reset. Especially. Especially for parents that have kids that are growing up. This is where someone get hung up is they were diagnosed at 2, 3 or 4 and now they're 8 or 9 and they're eating twice as much. And so I had one mom in my group recently realized that she's like, I'm the problem. Because she thought the lunch she's packing her daughter was 35 grams, but she's now four years older than that and she eats 55 grams for her lunch at school, simply counting it all in the serving sizes. All of a sudden lunch was looking better.
- [45:25]
A
It's funny, isn't it? Because you're sitting here talking about it, it seems so obvious, right? But it's not. Once life gets going and people, yeah, you get your rhythms, you find a rhythm and you get into it and then you start thinking, oh, the pump doesn't work, this doesn't work. I. This is just diabetes. Yeah, that's the one I find that mostly people fall back on. This is their expectation. This doesn't go well. It's not supposed to. And I'm like, no, I think you're just maybe not putting the insulin in at the right time or doing this or that. It is really interesting to watch somebody do the thing they do and be able to step back from a dispassionate third party situation and look and go, oh, actually what's happening here is you don't like thinking that you're not eating a healthy meal, so you're making a smaller number to lie to yourself into feeling better. It's really something. It's interesting you saw it that way.
- [46:10]
D
Yeah, the, the, the most common situation I see is a combination of there's the mystery. Fat, protein rises. They're a mystery to someone else. But I understand kind of where they are once you break down what they're eating and the timing of them. And so over time, either themselves or their endo has increased their basal rates all day long. Yeah. And so then they occasionally go low when they mix up their meals, or they're always going high when they eat more because it doesn't scale well when their meals change or when life changes. So the classic situation is someone comes in, we look at the data, wind up scaling all their basal rates back, back a fair amount, making their carb ratios stronger. And then for loop specifically, we end up adjusting a few more things to make sure that the meals are properly tracked and managed in loop. But the bulk of the success comes from modifying the basal rates and simplifying them. Some people have like 10, 20 basal rates in a day. Just getting a couple, like a night, like a sleeping one and a daytime one. Scale back the daytime one, make the ratio stronger and add in some fat and protein carbs, and all of a sudden, poof, it just works. They're good. Yeah.
- [47:13]
A
I love talking to you about this
- [47:14]
B
because you, it just rolls off your
- [47:16]
A
tongue and I use too many flowery words to get to the same ideas most of the time. But I mean, I've been for years just telling people like, it's timing, it's amount, it's understanding the impact of your food. It's kind of it really, you know, be flexible, don't be afraid to knock a high blood sugar down. I appreciate the way you do it. So, so it's foxintheloophouse.com FOXTintheloophouse.com There's a
- [47:42]
D
couple free resources if you want to check that out. I got a basal rate cheat sheet, kind of most common basal rates and kind of tips for why it's like that. And then there's another one around meal absorption time, which in loop, you declare how long a meal is supposed to be. And so I give some bullet points on how you can pick the right absorption time. And there's in that one is a really important one for sleeping is a nugget around how we manage dinner or evening meals. They tend to be a little bit slow. Everyone struggles with going Low before bed and then rising after.
- [48:12]
A
Right.
- [48:12]
D
So give some tips around modifying your absorption time and how you would count food in that same handout. So you guys can find that on my website.
- [48:18]
A
Very nice. Give me one now. What's a tip that you like? If I walked up to you and I said, I'm struggling with loop, and I don't know, I'm. I don't know, I'm high three hours after iu, what would you look at first?
- [48:32]
D
So I always. I have a framework. I give people. It's four steps, and then we just. I have to say, someone look at your graph and ask these questions or these things in order. And the first is, well, I have a step zero that I'm building out. It's check your POD site. Because inevitably the pump site's not working right for a lot of things. So learning how to check. That's good. And then first one is basil. And so we're always looking at the insulin on board, or the active insulin is what Luke calls it. Overnight is the easiest kind of your 3, 4, 5 in the morning. If you have a morning rise, kind of get before that, like the flat spot when most meals should be chill and just kind of see where are you. If you're near zero insulin on board and in your range that you've asked Luke to put you in, you know, 87 to 93 or 100, 110, whatever it is, then you're probably good. And then I always just say, okay, that means your nighttime basil is probably fine. But if there's lots of them, then we say, well, how do we. How do we average those out to get to the rate that's basically working around that time. And then after that, it's a lot of that, the pushback comes. What about the rise at night after I go to sleep?
- [49:37]
B
Right.
- [49:37]
D
And because everybody has to crank their basil up for that. And so then we start talking about fat and protein for dinner. So it's really just a overnight basil. Daytime is inevitably for, like, I'd say 90% of people, the daytime basil is a little bit lower than the nighttime one. Some people, that's not true.
- [49:53]
A
But my daughter's opposite.
- [49:55]
D
Yeah. Yeah. Some people have kind of a stress of the day, and they end up going up a little bit.
- [49:58]
A
Right.
- [49:58]
D
There's different reasons why, but I always ask people to try either one rate or two, and with a slightly lower one during the day, and then we kind of start entering meals. Well, and that's what I. If I only had like a couple Minutes with people. That's what I would tell them. You know, pick one or two rates, one for sleeping, one for awake, and then read my little handout on entering meals. And then so you can enter some fat and protein, and you'll be good to go.
- [50:22]
A
I'm smiling because, like, as you're talking through all this, it. I. When I started doing this, I didn't know what I was doing. I had no idea about diabetes. I didn't know anything about it. Everything that I talk about on that podcast now is just hard to earn, like, through experience and hashing it over and over again, trying to figure out the basics. And the basics really are get your basil right, you know, do this, do that, look overnight, find stability, take that into the daytime. It really is awesome to hear you talk about it.
- [50:49]
D
It's a lot of fun now because it's. It helps me because I have helped people in the community. I think I had, like, seven or 800 Night Scout sites bookmarked in my browser at one point before I started this business. Really just looking at people's stuff or whatever. Yeah. And then now with meeting with people and getting to sit with them for seven or eight weeks and really digging into their settings, asking about their lifestyle, it's nice to see that these basics do apply to most everybody. And then we can very quickly find the outliers. And as I'm working on documenting the more common outliers so people have a place to go in that basilary cheat sheet to know where to start if they happen to be that special. But I would tell everybody you're not as special as you think. So please try and do basic settings and then kind of roll from there.
- [51:33]
A
Yeah. When people tell me your diabetes may vary, I'm like, not that much.
- [51:35]
D
Doesn't vary that much.
- [51:37]
A
Well, I really appreciate you doing this with me. I want to say that just hearing you talk about how you used to help people, just not, you know, saw all those Night Scout things, I think people wouldn't know that, like, most of my daughter's health is because people came onto the podcast and shared their thing. Like, I got to build my understanding. Understanding through talking to people. It sounds like you helped build yours.
- [51:58]
D
Yeah.
- [51:59]
A
Through helping people.
- [52:00]
D
Very similar. Yeah. I saw what was working, and I just pinged a couple people in the early days of using Loop and be like, parents that were struggling. And I'm like, hey, can we try some of the stuff I'm trying? And then it evolved and grew, and then I'd run into really smart People in the community that would, like, enhance my understanding of how the algorithm works.
- [52:17]
B
Right.
- [52:17]
D
And then with a little bit of, like, okay, fine, I'll go look at the code, because I can. I start reading some stuff, but mostly I just found the smart people. And so it was a very community effort. And so I try to give back as much of that information as I can on my website or in handouts. And I do free pre consultations. There's a button on my website to do that. You schedule 45 minutes with me. We'll talk about whatever you want about Loop. Whether it's, like, diving into some settings or just, like, what is Loop? Like, I'm not sure I want to do it ultimately. Talk about anything you want. And then I'll just share my programs in case you're interested. And if you're not, that's fine. Like, no harm, no foul. I just really like talking to people.
- [52:54]
A
It's awesome. Me, too. Well, Kenny, thanks for joining me here at the Sugar Pixel booth. Yeah, man, you should come back on the podcast again, and we should chat some more. We do have plans, don't we?
- [53:02]
D
We talked about doing, like, a little series, little Q and A or something like that.
- [53:05]
A
Yeah, we'll figure that out. Well, thanks so much for doing this, and thanks to everybody for listening and visiting us here today at the Sugar Pixel booth. If it wasn't for Sugar Pixel, we wouldn't be able to to do this. So check them out and learn all about their new device. Thank you so much. Thanks again, Kevin. Yeah, we're all set. All right, John, why don't you introduce yourself? Because I'm super afraid I'm going to mispronounce your last name.
- [53:28]
B
Thank you. My name is John Sjoland Sholand. Like Showtime or something like that.
- [53:32]
A
Okay. Okay. Where do you work?
- [53:36]
B
I work for a company called Luna Diabetes. Started it about five years ago. Tell you more about it. It's about trying to help people that are using insulin pens, which is most of us living with diabetes, how to be able to take advantage of automation.
- [53:51]
A
That sounds crazy. So I can't wait to ask you more about that. But first, let me find out a little bit about yourself personally. You have type one?
- [53:56]
B
Had type one about 40 years now.
- [53:59]
A
40 years. Have you always worked in the diabetes space?
- [54:02]
B
No, I didn't think I would ever work in diabetes. I started my career in digital marketing and advertising.
- [54:08]
D
Really?
- [54:08]
B
So a whole, whole new thing.
- [54:09]
A
How did you make the shift?
- [54:11]
B
You know, I just got frustrated that some of the products that I wanted were for myself or things that problems I had weren't being solved. And so I made a. I made a cap for an insulin pen that told me when I took my last dose of insulin.
- [54:25]
D
Really?
- [54:25]
B
And I started showing it to people. People wanted it. And all of a sudden I was a medical device entrepreneur.
- [54:30]
A
So you don't work for Luna. You created Luna.
- [54:33]
B
I created Luna, yeah. So this is the next one second company I've created in diabetes.
- [54:38]
A
No kidding. All right. So you just said something that, like, fried my mind. How is an insulin pen gonna work as an. Like, just tell me what the idea is, because I don't even know. I don't think I understand.
- [54:49]
B
So the first thing I was telling you about is we made. It was called Thymecillin.
- [54:52]
A
Okay.
- [54:53]
B
And we made a cap for any insulin pen that told you when you last took your insulin dose.
- [54:59]
A
Okay.
- [55:00]
B
We subsequently sold that to Bigfoot Biomedical and made a really cool product that then Abbott bought and the world hasn't yet seen, really. So that's hopefully coming.
- [55:09]
A
And it's as simple as when you uncap the pen.
- [55:12]
B
It.
- [55:12]
A
What marks the time. And then so you look again. Oh, I last took. That's really simple and brilliant.
- [55:18]
B
That was the original product from a long time ago.
- [55:20]
A
Okay.
- [55:20]
B
And the stuff.
- [55:21]
A
So you sold that off and then you said, I don't want to go back to work. I'm going to invent something else. Or did you have an idea a
- [55:29]
B
couple hops along the way? I worked for a CGM company for a while.
- [55:32]
A
Okay.
- [55:33]
B
But then, yeah, we came up. You know, I was really. I was early in building the do it yourself automated systems. And it just totally changed my life.
- [55:41]
A
Yeah.
- [55:41]
B
Of having these automated systems. And I was always frustrated that more people weren't experiencing it, more weren't seeing it. And at first it was, you have to build it yourself. It was hard as a technical barrier to do it. Now, of course, you know, whether it's Tandem and Medtronic or Beta Bionics, there's really great products that do it. But still, so few people are willing to wear a pump. And I want more people to experience what it feels like when you live with diabetes. Just be able to go to sleep and not be nervous, not be scared, not be stressed about it.
- [56:12]
A
Okay.
- [56:13]
B
And so, Luna, what we've created is about bringing the best of insulin automation to people that want to continue to use pens during the day.
- [56:22]
A
I've been doing this a long time, John, and I normally think I know where people are going to go when they're explaining something and I can't imagine how you're going to tell me this works, so please lay it out for
- [56:33]
B
me as simply as you can. Yeah. So during the day, you use your pens exactly as you did before. If you're type one, you're taking your basil and your bolus. Type two, maybe basil only you might be using a GLP one. And before you go to bed, you fill it with rapid acting insulin. We've made the world's smallest patch pump.
- [56:49]
D
Okay.
- [56:50]
B
And when you're sleeping, it talks to your cgm. And if you need insulin to get you back to target, it will give you these micro boluses of insulin while you sleep.
- [56:59]
A
So there's an inset somewhere like you're wearing a. And then you just connect the pen to it.
- [57:06]
B
Nope. You fill it from your pen and then you put it on. So imagine you're wearing.
- [57:10]
A
I'm starting to get there. So I'm wearing something. You're wearing something on your body and it knows everything that happened during the day. You put some insulin into it and overnight it uses that insulin to fight highs.
- [57:23]
B
Yep. And it also helps with lows. And so there's some other tricks up our sleeve to help with lows.
- [57:28]
A
So how does it help with lows?
- [57:31]
B
We have some tricks up our sleeve for doing that.
- [57:33]
A
Nothing you can say yet. Okay. So are you brilliant? What happened? Did you know you were brilliant?
- [57:38]
B
Look, it's just, you know, I've lived with diabetes a long time.
- [57:41]
A
Yeah.
- [57:42]
B
And I want more people to be able. You know, I was lucky. I got good health care and I'm able to get the medications that I need.
- [57:50]
A
Yeah.
- [57:51]
B
So many people are having such a tough time with it, so I feel obligated to try to come up with these ideas and try to make it happen.
- [57:57]
A
So you just, you've taken your experience of living it was so long and saying, what would I like to happen? What would I need to happen? And then I listen. I see the same thing. It's easy to sit in these settings and think, everybody uses an insulin pump, but a majority of people with type
- [58:09]
B
1 diabetes do not use pumps. Do not.
- [58:11]
A
Right. And I listen. I don't know what you're running, if you have a pump or what you're doing, but my daughter's using a DIY algorithm too, and they are, they have been and are fascinatingly good for her health.
- [58:23]
E
So.
- [58:24]
D
Great.
- [58:24]
A
Yeah, yeah, absolutely. So.
- [58:25]
B
So the real insight for us was the following is we were looking at data from one of the pump manufacturers in Their study. And they ran a study where they had a group of people that wore their normal system, no automation, and then automation only at night. So they turn it on before they went to bed and turn it off in the morning.
- [58:46]
A
Yes.
- [58:47]
B
And what the data showed was that over 80% of the improvement to glucose happens at night when you're sleeping.
- [58:55]
A
Yeah.
- [58:56]
B
Which is very dramatic. Right. So if you're wearing a CGM during the day, you do about as well with a pen as you do with the pump. The pumps are. They don't do very much and it just really changes at night time.
- [59:07]
A
Right.
- [59:08]
B
And so that was the really key thing of. Whoa. If you can give me 80% of the benefit of a tandem system or a Medtronic system at night, let's make that happen.
- [59:17]
A
You don't know me, I imagine, but like, I been making a podcast for a very long time and I've been telling people forever. Like, the first thing we want to do is get your basal right. But then after that we got to figure out overnight, like, get over. You can steal so much. A1C overnight is the way I think about it. Right. And then what you learn overnight about your settings often applies easily to the daytime. And then it takes, you know, people don't. They don't want a basal test, they don't know how to do things, or doctors don't help them with their settings very much.
- [59:43]
B
Right.
- [59:44]
A
And it just becomes. So you figured out that. And then I still can't. Do you have the device with you?
- [59:49]
B
It's in my backpack over there. I gotta go up and get it.
- [59:52]
A
Would you get it for me?
- [59:52]
B
Sure.
- [59:53]
A
I can't imagine we'll edit this part out of you walking over, but I
- [59:56]
B
thought I had one in my pocket. I didn't.
- [59:59]
A
He's a wizard. Kenny, you hear what I'm saying? This man might be a wizard. Hold on a second.
- [60:09]
B
So there's stuff in this box that I don't want to show.
- [60:13]
A
Okay. Sure. Keep out whatever you need to.
- [60:17]
B
So here it is. So this is the world's smallest patch pump. And you use it with a single use reservoir like this.
- [60:23]
A
Okay.
- [60:23]
B
So before you go to bed, you'll fill this up with rapid acting insulin. It holds 20 units, the average overnight need for someone with type 1. So this is in addition to your basal. Right.
- [60:35]
A
Okay.
- [60:35]
B
So the Average need is 1.66 units. We put in up to 20.
- [60:38]
A
Okay.
- [60:39]
B
Connect it with this device. This is an actual bump. And then you put it on your body.
- [60:43]
A
How long does it stay on for
- [60:44]
B
just while you sleep?
- [60:45]
A
That's it.
- [60:46]
B
Do you take it off in the
- [60:46]
A
morning, fill it, put it on at bedtime, get up in the morning, take it off and it manages high blood sugars overnight, keeping your blood sugar down, giving you better stability, better overall A1C, better health. And you're telling me that there's a way that it might help with lows, but you can't share with me what that is yet?
- [61:04]
B
Yeah, I mean, look, if you, if you're. Yeah. If you're avoiding big boluses, if you have your basal titrated, well, you are going to increase your time and range. You're just going to. Every night you just. This is your reset button every night for diabetes.
- [61:19]
A
Do you imagine that this will be an entree for MDI users that make them think, maybe I should try an insulin pump? Or do you think that people like. What is your finding when you talk to people generally do not want to wear pumps, but wish they had better control?
- [61:32]
B
Generally is do not want to wear a pump. And are there going to be people that try this and say, I want to wear an Omnipod.
- [61:37]
E
Sure.
- [61:38]
B
And are there going to be people that wear an Omnipod and say, I don't want to wear it 24 7?
- [61:42]
A
Sure, maybe that too.
- [61:43]
B
So this is sleep only automation, you know, and it hasn't existed before. Right. You're either going to go wear a pump and all the cost and the complexity that it is. Yeah, but great. I mean, pumps work. Or you're stuck with no technology, you no help, and going to bed at night just going, oh, man, am I going to make it?
- [61:59]
A
Yeah. It always strikes me that way, too. It's all this way or all that way.
- [62:03]
B
Nothing ever in the middle, nothing standing. So we're creating this new therapy that sits in between and people are loving it.
- [62:08]
A
And so. And what is it? How does it make the decisions overnight? Is it by talking to your cgm, or is it also by knowing how much insulin you've had during the day, what your basal is like, what is it thinking about?
- [62:20]
B
So it's speaking to your cgm. Yeah. And then we've developed our own algorithm which is that determines how much and when to give insulin. And importantly, we've really rethought the experience of insulin pump therapy. When you start the first time you use this, all you have to do is enter one thing once into the system and then it starts learning about you. When you put it on at night, you don't have to take out your phone you don't have to prime it. You just fill it, put it on, take it off. So it's super simple. There's no settings, there's no targets, there's no isf. There's no carb ratios. There's none of that stuff.
- [62:53]
A
Is the brain inside of it or do I have an app on my phone or.
- [62:56]
B
Brain's inside of it.
- [62:57]
A
Inside of it.
- [62:58]
B
Y.
- [62:59]
A
It feels like magic to me. Like, seriously? And this all just came to you one day? You were like, you know, it would be great. And that's where this idea started.
- [63:07]
D
How do you.
- [63:08]
A
How do you go from, like, I don't imagine. I mean, maybe you are, but you're not a product engineer. Right. Like, what do you do when you have that idea? Like, where do you. Like when you say to somebody, I need to build a thing, how does that all work?
- [63:20]
B
Yeah. So, I mean, now I've been doing this for a while, so we're in San Diego. We have the most exceptional team of engineers that are responsible for many of the products that you see around here.
- [63:30]
A
Sure.
- [63:31]
B
So some of us. It's our fourth company together. We have a team of just outstandingly committed mechanical engineers, electrical engineers, and get a team to do it. But it's hard. You know, there's clinical. Big clinical studies. Costs a lot of money to do it.
- [63:47]
A
Where are you at in that process?
- [63:50]
B
We have about 1700 nights of use of this. We just have some new studies starting next week.
- [63:54]
A
Okay.
- [63:55]
B
And so people are using it and people are liking it, and we're on the path to launch it as quickly as we can.
- [64:00]
A
Do you imagine running this business and doing the manufacturing and the. Or do you imagine selling it to some. Somebody.
- [64:06]
B
You never know. Yeah, I mean, we're going to. I think we'll probably launch it ourselves.
- [64:09]
A
No kidding.
- [64:10]
B
Yeah.
- [64:10]
A
What's the time frame, do you think?
- [64:12]
B
As quick as we can. You never know. Just sometimes it slows down. Doing as quick as we possibly can, that's where.
- [64:18]
A
Can people learn more about it?
- [64:19]
B
Luna Diabetes.com is our website. Yeah. Go check out the product.
- [64:24]
A
When you have more to share, would you come on the full podcast and talk to me for an hour about it and like, yeah, that would be awesome. I really appreciate that. I know you have to run.
- [64:32]
B
Like, people told me you were a
- [64:33]
A
little bit on a time crunch, but. But thank you so very much. That's awesome. Thanks to Sugar Pixel for making this possible. Thank you, guys. That's awesome. To learn more about the Sugar Pixel, please go to my link. It's in the show. Notes custom type1.com juicebox there's a brand new actually there's two brand new sugar Pixels. One with a big beautiful color screen. The other one's more portable. They connect now in hotels. I know people wanted that as an addition to the Sugar Pixel. John brought it to you. Speaking of John, thanks so much to him and Sugar Pixel, the entire team, for having me out at ada. We're also going to get together at Friends for Life. Meet us there if this comes out before Friends for Life. Very loud car going by. Won't be much longer. My studio is just about finished. If I could just stop going to these events, I'd have time to finish up then.
- [65:33]
B
No more noise.
- [65:34]
A
What else I got for you? Check me out on Facebook juiceboxpodcast.com We have a private group with over 85,000 people and I think you would love it. Follow on Facebook, subscribe or follow in your favorite podcast app. Check me out on Instagram. I think that's all I got for you. I hope you enjoyed this. I hope you check out customtypeone.com juicebox and of course I'll be back very soon with another episode of the Juice Box podcast. In fact, I believe coming up next week is the longest episode of the podcast ever. I think it clocks in 2 hours and 45 minutes. Maybe see if you can make it to the end.
- [66:20]
B
Is.