← Taking Control Of Your Diabetes® - The Podcast!
Taking Control Of Your Diabetes® - The Podcast!
Omnipod 6, Tubeless Pumps & the Apps You're Missing ft. Diabetech
00:47:08
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- [00:24]
A
So a lot of people with diabetes these days are using amazing technology, but honestly only kind of utilizing a fraction of its potential. So today we're joined by Justin Etzer from Diabetic. Is that right, Justin?
- [00:36]
B
Diabetec. But he was so close.
- [00:38]
A
Okay. To share simple tech hacks that can make using your CGM pump and apps work better for you in real life. We're going to talk about all this on this episode of the Taking Control of your Diabetes podcast. I'm one of your hosts, Dr. Jeremy Pettis, joined as always by my good friend and colleague Steve Edelman. And if you're just tuning in, Steve and I are both endocrinologists. We're both living with type 1 diabetes since we're 15. We're been working at TCOID now that Steve founded almost just over 30 years now.
- [01:05]
C
Yeah, over.
- [01:06]
A
Over 30 and a half, probably years now. So thank you for joining us and make sure to like, follow, subscribe, all those kinds of things. So, you know, as a brief intro, we're going to be talking to Justin today, who's really an expert in diabetes technology. And there's a lot going on in diabetes, but especially the technology. So it's difficult, I don't know, Steve, for you and I to even keep up. So it's nice to always have somebody that has expertise in this to come in to tell us all about the cool stuff, how it's used in real life. So as a background, Justin, just tell us about yourself. I didn't mention you have type 1 diabetes yourself. So maybe your journey, maybe starting with getting type 1 diabetes and how you ended up where you are now.
- [01:46]
B
Okay, well, first of all, thank you so much for having me. And I'm equally as excited to be here too, because, yes, I'm a tech expert at all this, but I've also only had type one for four years and I'm still learning so much every day, especially about the past two and how far we've come. So I'm just excited to hear newbie from you, too.
- [02:01]
C
Yeah, yeah, yeah.
- [02:03]
B
I'm a baby. So, like I said, diagnosed four years ago, my career started in Hollywood. I was learned how to edit in TV development. I was editing sizzle reels about TV shows that we were pitching to all the networks, later moved on to America's Got Talent and learned everything about what I don't want to do, which is 13 hour plus production days. But it was really cool to work with, you know, Howie Mandel and Heidi Klum. She's amazing. Tyra Banks, you Name it. All the judges, except for Simon, because he's a diva. Like, legitimately, he doesn't want to talk to us. But that was fun. And I learned the craft of storytelling, music, editing, interviewing, and so later left that and I started Justin Tech, which was a YouTube channel all on consumer tech. And during that and during COVID So
- [02:52]
A
it wasn't diabetes related at all.
- [02:53]
B
Oh, no. Zero diabetes in my life except for like four people I knew that had type one, which is. I'm so glad I knew these people. So, yeah, so I'm doing my thing during COVID and just feeling really ill. So I finally go to a doctor, get some blood tests, and they tell me I have diabetes and start treating me for type 2, giving me metformin, eventually working my way toward like a basal insulin, but still treatment for type 2.
- [03:19]
C
So this is during COVID right? You got it during COVID That's nuts.
- [03:22]
B
Well, yeah, I didn't get it. I don't think I got it from COVID Cause I didn't have Covid at that moment. I know some people believe that they may have gotten it in that way. But I'm making these videos on TikTok because I have a TikTok for Justin Tech about how cool I think my blood glucose meter is. Cause what it does is I can test my blood sugar and then it sends it to my phone and my watch, I get like a little pop up saying what my blood sugar was. I was like, well, that's a Justin Tech video. So I make a video about that and then it kind of does. Well for my TikTok at that time, it got a ton of comments and likes and people were saying, you may not have type two, you should look into type one. I'm like, okay, let me.
- [03:58]
A
Well, that is nuts. Just pausing there. I mean, for people that aren't watching, Justin is an extremely attractive young individual. But thin, fit, young. I mean, it's odd that this happened. I mean, we hear this all the time that people are initially diagnosed with type 2 diabetes. Justin, all the time. But this, honestly, this shouldn't have been missed.
- [04:17]
C
Yeah. Because, you know, people that get missed are, I'd say, older, heavier.
- [04:21]
A
There's some, like, blurred lines between type one and type two. Like, you should have been a little bit more of a slam dunk. So.
- [04:27]
B
And I was just. It was a primary care office and I hear it too. I think that some of these offices, they just, they don't know and they look at you and if they see that you're overweight or they see that you're a certain age, they just label you in one way. And. Yeah, I just feel like, right, shouldn't we just be tested? Shouldn't everyone. Even if it's like classic type two, shouldn't you just get the test for type one?
- [04:49]
C
Well, most of the time we're talking about that.
- [04:51]
A
That's like a conversation that's coming up, you know, like when, you know, what are the criteria that we should really look at? Yeah, and age and BMI and things like that are helpful, but they don't, like, they don't paint the full story. So, I mean, you've got a really good attitude about this. Some people are, you know, often kind of angry that they were mislabeled, that their blood sugars. I'm sure they weren't well controlled initially because you probably needed insulin. So tell us a little bit about that.
- [05:13]
B
I feel very fortunate to have been, to have gotten all this information through crowdsourcing on social media. It just shows you how powerful social media can be and how incredible this community is. So I'm so thankful for them. I finally found an endo that got me in the right track. And then I had, like I said before, those four friends that really helped me also. And I had no idea, like, the day to day that they were living.
- [05:42]
A
Yeah. Well, I was just gonna say I'm sorry that Steve misdiagnosed you initially, but I'm glad you made your way to me and we got it right. But. Okay, so I'm getting the idea here. You were doing these tech videos. Life gives you diabetes. You make one that's kind of diabetes. That's diabetes related. It does well. And now I'm guessing you're gonna say, aha, like, maybe I can make this kind of change in my career.
- [06:01]
B
Yeah. Each video started, hey, I'm Justin and I'm a newly diagnosed diabetic. And then I heard soon people were like, we try not to say diabetic. We say personal diabetes.
- [06:10]
A
We say diabetec.
- [06:11]
B
Exactly. Yeah, exactly.
- [06:12]
C
Justin. Anybody that says, you should not say diabetic. You should say person with diabetes, they don't have diabetes. Every person I know with diabetes, we love. I'm a diabetic. I'm proud of it.
- [06:24]
B
You know what, though? I will say I don't. I don't like being called a diabetic. And I. And because someone, they'll say, oh, he's a diabetic. And I'm all sudden like, no, I'm Justin.
- [06:33]
C
No, it's how we Said it. But I understand it.
- [06:35]
B
And I understand for me. Exactly. And I understand for a long time that was totally a thing and a lot of people just hold onto it and they're totally fine with it. But actually it does give me personally this, like I've never considered myself a diabetic. I've considered myself a person for 33 years living or 30 years living a certain way. And I just. Now I have diabetes.
- [06:58]
A
I agree.
- [06:59]
B
Maybe once I'm 70 and I've had diabetes for 35 years, I'll be a diabetic.
- [07:03]
A
Well, that's Steve.
- [07:05]
B
I kind of.
- [07:07]
C
To each his own. And you know this whole thing about misdiagnosis, we can go on and on
- [07:11]
A
about that, but yeah. So then tell us, how did Justin Tech become diabetic?
- [07:16]
B
Yes. So. Well, for a while diabetic was just like a side hustle. I was making these videos and the TikTok I had, I just changed the handle to Diabetec and kept doing that. And my main job at that time was I took a full time job actually at cnet, which is like this like very legendary consumer tech front facing publication online that like my dream was to work there. But soon I realized that it was not my dream because it was just like not the best workplace anymore after a private equity firm bought it up. So I was looking for a way out and diabetic was gaining popularity. It was growing. I went from TikTok. I also started Instagram. And then I had this idea. I was like, oh, I'm going, I'm going to go full time on this, like it's going to happen. And I was planning for it. And then during the plans I got let go and I was like, this is amazing. You mean you're going to pay me unemployment? I can like start this little side hustle for real. So, so then I just started doing it. I launched the YouTube channel. I launched the podcast, like very quickly too. Because these ideas were simmering. I knew I could do it.
- [08:22]
C
Yeah.
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B
And then. Yeah, and then they just grew and grew.
- [08:25]
C
And he traveled to all the diabetes conferences where I see you at.
- [08:27]
B
Yep, yep. And that started once. I didn't know about these diabetes conferences until I like went full time, which I guess was three years ago.
- [08:36]
A
Okay, well then let's start talking about some of the kind of current technology. Then we'll go into what's coming next and maybe some of your favorite apps and things like that. So talking about what's available now, first of all, what's your formula when something new comes out. Do you kind of scramble to get on it to try it and let your followers know about it? I'm guessing you've tried most of these pumps and things like that. Tell us a little bit about your research, I suppose. Your formula.
- [09:00]
B
There's still a couple I haven't tried, which is the Medtronic 780G and the Beta Bionics, I think, and the T Slim. But I tried Moby, so I feel like that covers it. I get the gist. So, yeah, as new products come out, I want to try them as soon as I can. We work in a very annoying industry where getting the device is not as easy as I'm going to go to the store. Like, there's a prior authorization and a prescription and then maybe it's not covered and maybe you have to pay out of pocket $1,000 to try the Twist for two months, which I did. But that's a business expense and that's an important business expense to me because I want to speak all the languages.
- [09:40]
C
Why not ask the companies to let you try it?
- [09:43]
B
I don't think pump companies can't. Well, I think it's different for endos and educators. Like people who are medically qualified. I think they can legally try these devices through the companies or maybe they can't. And I. But I find that they're able to get them for me as a patient. I can't. These companies can't just give me pumps. CGMs, on the other hand, I have found ways where as long as I have a prescription, they are able to do that.
- [10:11]
A
Yeah. And we were talking about, we have samples now of CGMs, you know, in our office. So we can kind of hand them out like.
- [10:18]
C
Yeah.
- [10:18]
A
Which is funny.
- [10:19]
C
Dexcom, we got some for you 15 day. That'll cost you.
- [10:23]
A
It's odd because at UCSD and all the University of California schools, you're not allowed to see company reps. So we don't have any samples of medicines. There's no pills, there's no insulin, there's anything like that. We used to have little refrigerators you would normally go to your primary care doctor. Oh, you need some antibiotics or whatever. They have a whole cabinet full. We don't have that. But for some reason there's a loophole with technology where we can get sensor samples. So we actually have this amazing closet that's nice as somebody living with type 1 also that's filled with sensors, you know, like stacked.
- [10:53]
C
And what makes a sales rep? What makes the sales rep sad as they come back and they're still there. So, you know, and it's great to put them on people in two seconds. But the other thing Jeremy always says on many of our other shows is that with these hybrid closed loop systems, they all have return policies like 30 days. And that's something you should keep in the back of your head. You can, you know, you know how people buy clothes and then they wear it and they turn it back in. It's like hybrid closed loops. Especially someone like you that wants to try them all.
- [11:18]
B
Well, yeah, and you, you can't get a hybrid closed loop down in 30 days. Like, I mean, you can just by the end of the 30 days be like, oh, I feel like I got a handle on this.
- [11:27]
C
But you're right.
- [11:27]
B
You need more than 30 days to know if you like something.
- [11:30]
A
That's how they get you.
- [11:31]
C
Yeah, that's a good point. That's a very good point.
- [11:33]
B
Well, tandem, you can do three months. Twist and Omnipod are pharmacy benefits. Right. So they're kind of built in a way where you can just kind of try. And the other companies are working to be pharmacy benefits.
- [11:45]
A
Well, let's get into the system. So we mentioned the Twist a couple times, which is the new kid on the block. And Steve actually just tried it during our burrito challenge. Sensor failed when I kicked his butt. Steve's sensor failed right now? Yeah.
- [11:58]
B
Oh, great.
- [11:59]
C
But I have, I haven't, I haven't ever since too.
- [12:01]
A
Like whenever we're filming or recording something, one of Steve's devices just blows up. It happens almost all the time. And if you're not watching on YouTube, we were laughing because Steve hit his mic, which he always does. And we usually play this game now.
- [12:12]
C
You gotta shot, you know.
- [12:15]
A
All right, so the twist. So tell us about your experience with that.
- [12:18]
C
And you know, and I can add on because I tried it for two weeks.
- [12:21]
B
Yeah. And I. So I've used DIYLoop for years. So the interface, most of the controls weren't new to me, which I could imagine. The controls and app could look a little overwhelming to people at first glance.
- [12:36]
C
Yeah.
- [12:37]
B
But overall I was really surprised with my experience. I thought. I wasn't. I was so worried that I wouldn't like it. And I want every pump to succeed because I want more competition. I want more players to push each other. So I was very surprised. On a software side. I really liked the interface. All of the information I got, the controls were there that I had experienced already. The pre meal target. Gonna lower your blood sugar ahead of the meal workout feature. The workout mode, where you have to. It's not like overrides with Loop, where you can, like, pre program all of these ranges and basal adjustments, but you can alter the workout mode target whenever you want. It's not in the most simple way. You just have to go to settings. But I liked that flexibility of, like, if I was gonna go dancing versus working out, I could adjust what my workout target was.
- [13:29]
C
Yeah, it just doesn't set a higher target period for all activities.
- [13:34]
A
I was just gonna say by way of quick background in case people aren't familiar with the Twist. Steve always says it's about the size of a double stuffed Oreo. And I'll never forget it. Cause he said it a million times. And it holds 300 units.
- [13:44]
B
Right.
- [13:44]
A
It does have tubing, but it's pretty small.
- [13:47]
C
It's 2 ounces.
- [13:48]
A
So, you know, you can wear it, you know, on body. Right. With like, kind of like a body patch. And I think what a lot of people have been excited about is that Steve, for example, and a lot of other people have been looping for years, maybe even a decade. I mean, a long time. Which was a do it yourself system that has a lot of toggles in terms of being able to adjust targets and things like that. But it wasn't approved. So the Loop, or, sorry, Twist now has the Loop software essentially in it. And the interface is all through your phone. Right.
- [14:15]
C
And Apple Watch and Nights out got it approved. Then they got commercially tidepool. Tidepool. Thank you. But the other thing, too, is it gets updated all the time, like our iPhones. And it's an older version of Loop. But I do think that SQL, the company, is going to now update the app so it does more things that current Loopers are using now. And I would say this, most of the features that are on there are excellent and just missing a few intricate changes.
- [14:49]
B
Well, this version of the algorithm was ahead of its time when it came out in, like, 2016. And it's on par with many of the systems out today. Loop. The future iterations of the algorithm are ahead. And one day. Yes, hopefully we go on that trend.
- [15:07]
C
Yeah.
- [15:07]
A
Nate, what are you using now, if I can ask?
- [15:10]
B
Today, I'm using. I have to think about that for a second. Loop with the Dexcom G7 and an Omnipod and Omnipod Dash.
- [15:18]
C
Omnipod Dash, yeah. So you and me are using the same system. Yeah.
- [15:22]
A
And so did you kind of go from the Twist back to the Omnipod because of the tubing? Was that, that was with Steve's kind of main thing. You don't like tubing.
- [15:30]
C
I just don't like tubing. And I won't go on a big monologue about it, but the paraphernalia you got to carry to set up any tube system, 780G. You know, the control IQ, you got this, you know, you know what it is. The tubing, the syringe, the battery, the
- [15:47]
B
battery charger, the cord for the battery, the AC adapter.
- [15:51]
C
And that's why what we're going to talk about in the future. I saw you listed on the list of topics everyone's coming out with a patch pump. Makes perfect sense. So freaking easy to fill it up and stick it on. I put mine in my upper back.
- [16:03]
B
Yep.
- [16:04]
C
You ever do it up there?
- [16:05]
B
I've actually never done upper back. I've seen it. I'm upper back curious. I should put it into the rotation.
- [16:11]
C
No, I'll show it to you. It's an awesome place.
- [16:14]
A
Well, I think. All right, so kind of wrapping up in twist. I think we all agree that maybe the interface and like some of the like, like I said, the toggles are attractive features. I've always told people, you know, there's not one pump for everybody. People that loop tend to like to go in and set. Oh my gosh, I'm hitting the mic now. Tend to like to go and set these things and mess with things. Other people, it's just you want to deal with any of that and maybe they gravitate towards the eyelet, for example, which is kind of the other end of the spectrum. So it's different strokes for different folks. So the twist, I think, is a good addition to our armamentarium. We'll be talking about it more. We didn't mention that it's going to be the only pump to integrate with the Eversense sensor, which just got its full one year approval.
- [16:57]
C
See, I got my backup cgm.
- [16:59]
B
I think the interface is a little outdated on the Eversense.
- [17:02]
C
They're updating the ever since.
- [17:03]
B
Okay, good, because that looks like it's from Windows 95.
- [17:07]
C
No, it's from Sesame Street.
- [17:09]
A
Yeah. So Steve's been wearing the Eversense for a long time. Actually two sensors. But to actually have the twist work with that will be nice.
- [17:15]
B
So exciting, you know, and I'm excited for Eversense. I want it to grow. I want more pumps to take it on.
- [17:20]
C
You're right.
- [17:21]
A
So tell us about other things that are like kind of here now, right now. If you want to talk About Omnipod, Anything with Minimed Libre, Anything you want to talk about?
- [17:30]
B
Yeah, well, Omnipod 5 getting an upgraded algorithm down to the lower target of 100 milligrams per deciliter. That's exciting. What are your thoughts on that?
- [17:39]
C
I think that's a big plus. Big plus because with the loop and this and the twist, you can go down to 95. Maybe you're trying to have a kid and a female, you want to avoid complications, but I think that's important. They have other advances too. You know, with the Omnipod 5, you can get kicked out of auto mode and that's something that a lot of people complain about. And they're updating the system where you do not get kicked out. And I think that's a big plus. And we're going to talk about that in a little video. We're doing for them what causes the getting kicked out. If you get too high or too low and you don't acknowledge that you are, it kicks you out. And they realize, listen, they did it for safety, so God bless them. And now they're just updating it.
- [18:24]
A
Yeah, I would say putting the target down is a good thing that I think in general, these algorithms probably need to be a little bit more aggressive and this is a step in the right direction. However, sometimes people can freak out and say, well, I want to be 90 when I wake up and it only makes me like 110. I've had patients that'll be on an Omnipod, for example, and then take a basal insulin because they want to try to trick the system. And at some point you have to. People listening have to realize that, you know, as long as your time and range is about 70%, you're keeping your A1C less than 7. Like, don't bang your head against the table if you're 190 or 110 or 120. Because I think when people start seeking that like perfection is when they lose their freaking minds. Yeah.
- [19:04]
C
I will just say though, we're going to do a video right after our podcast and I think I just want to say this for everyone listening, you know, we have five hyper closed loop systems, you know, what have different algorithms. What's an algorithm? It's the brains of the system that communicates the pump with the cgm. But the one thing people forget, if you don't maximize your settings, you know, your target insulin to carb correction factor, you know, duration of insulin action. If you don't make those settings as best as you can. You're not going to achieve your goal. So you can screw up on any hybrid closed loop system. And Jeremy's right. You got to pick one that has the best form factor for you. He loves tubing, wraps it around his finger when he's nervous, things like that. He's on the 780G and loves it. And I also tried it. I loved it, but I just, like I said, I'm not a tubing guy.
- [19:51]
B
I want to try it too. I'm not a tubing guy.
- [19:53]
C
You got to know your settings. That's the key.
- [19:55]
A
Well, I just, I think the algorithm is the best that I've tried. And, you know, I last tried the Omnipod a long time ago, but I had issues with occlusions and the polymer.
- [20:02]
C
And you live with the old Medtronic 507.
- [20:05]
A
I've kind of done everything too. And so I guess it brings. My other point is like, so when people ask you, and they must ask you all the time online, what's the best pump? What's the best system? What should I be on? Like, what is your response?
- [20:16]
B
I always say the best, that it's objective, that there is no best pump. It's. There's a best pump for you. And I feel the same way. I think every single pump, including DIY in its own ways, has a pro and pros and cons. So if anyone's like, what's the best pump? I'm like, well, tell me about your lifestyle. Like, what are you doing on Friday night? You know, like, that will help me understand what pump options could be the best for you. But it really, it really comes down to which the set. I think ultimately every system can work well for you if you get the settings down. Just like you were saying, it takes time and sometimes people don't give it enough time. But I really, I do believe that every system is fantastic. It's about really maneuvering them in a way that fits your lifestyle and your body.
- [21:03]
C
And one thing I want to correct. You always say, you always think that the loop is really hard. There's a lot of toggles. It's got the same toggles as every other pump. Once you put your settings in, you don't have to change it. Now, I love the fact that you can really toggle your exercises.
- [21:17]
A
Oh, so many things. You can select the little emojis.
- [21:18]
C
When's the last time you tried?
- [21:20]
A
It's been a long time. It's overwhelming, I think, to some people.
- [21:23]
B
I have heard that the home screen of Twist, seeing All of this information's a lot for people.
- [21:28]
A
See, it's.
- [21:30]
B
But I.
- [21:31]
C
Okay, you're a diabetic. What do you know?
- [21:34]
B
I love the information. You know what I think some people don't want us. They want a pump that just does it for them.
- [21:39]
C
I like to see the amount of insulin it's giving. Some systems don't do that. To each his own.
- [21:43]
A
Well, so I would say, yeah, you have to be a smart consumer now. You know, people used to kind of come and a lot of times, like, providers would just give them the pump and, you know, there wouldn't be a discussion about it. So really, people have to be smart and go to places like you to tcyd, kind of like kick the tires, do these free trials, because this is something you're gonna be using day in and day out. And I will say there's becoming less and less people that I find that are on mdi, but there are a lot of people doing well on shots out there. And there can be almost a pump stigma where they'll feel like I'm a bad diabetic, to use the word, because I'm not on a pump. And so we've got a bunch of patients that are actually doing really well on shots. Then if it's not broke, don't fix it.
- [22:29]
C
I think if we go to the next level, which is. I saw it. Which is fully closed loop. I noticed you used that acronym fcl. Is that what you meant by that on the notes? I think that's the next stage of these hybrid closed loop systems that you don't have to input anything at all because these algorithms are getting better and better. What do you think, Justin?
- [22:49]
B
Yeah, I think that there's going to be different approaches and different levels and moments when they'll be available. I mean, I just had someone on my podcast this upcoming Monday, it's going to come out where they're working on an implantable fully closed loop pump. Not crazy far out, which is exciting. But when it comes to the pumps that are out now, Omnipod is speaking about their fully closed loop algorithm for type 2, which would be 2028 or just beyond 2028, potentially. They say that they're working on a type 1 fully closed loop algorithm as well. I know all the other companies are working toward it too. What I'm curious about, and I'm curious about what your thoughts are on, is what dictates what a fully closed loop pump is like? What's the success? Are we trying to get fully closed loop and be at 70% time and range. I mean, because that implantable pump I was just talking about, that's fully closed loop, and that's 90% time and range. So I'm curious, like, what do you think needs to be a full. I know you're the people interviewing, but I'm very curious.
- [23:48]
C
I love to be interrogated on our own. Yeah.
- [23:52]
A
What should fully close it be? You know, we have to realize, too, that we live in a bubble. You know, we are endocrinologists. You are in this, like, tech blog. And the people that come and talk to us are very plugged in. The average A1C in this country is still north of 8%, you know, and the time and range is terrible, and people are still having severe hypos. And so we have to acknowledge that. So if we get to some place that, yeah, a system could get everybody at 70%, that is a huge win. And then you kind of build from there. So, you know, I think there's a lot of people listening that, yeah, I want it to be, you know, perfect, and I want to think about it. I think we will get there pretty soon. I mean, the eyelid is the first step in the right direction. It's, you know, I think works well for a subset of people. But I think that's going to be kind of the wave of the future, that getting rid of carb counting and, you know, all the things that we ask people with diabetes to do is insane. So just to kind of make that easier for people. And it is definitely moving that way.
- [24:41]
C
My definition is you get up in the morning and you never have to do a damn thing, and you go to bed and your time and range is 70% or higher without, obviously, a lot of lows. So I think we will get there. And, you know, it might come out with a new formulation for insulin that works a little bit like Afrezza. Fast on, fast off. But Afrezza, obviously, is inhaled insulin. And of course, we have the dual hormonal pump that might happen. Ed Damiano's, you know, glucagon and insulin together. So you can be more aggressive with the insulin and you got the brakes with glucagon. That might happen. You think so, Jeremy?
- [25:19]
A
Yeah, they've been working on that for a while.
- [25:21]
B
I still think I'm feeling less optimistic about that one, especially as I hear about, like, the implantable pump that goes into the interperineal cavity. Works like a freza, essentially. Almost feels less invasive than the two hormones. One hormone doesn't last as long as the other.
- [25:38]
A
Yeah, you know, it's always been, you need two infusion, like two cartridges and one runs out and things like that. And to be honest, in the initial clinical trials, the addition of glucagon didn't add a ton, that the people had slightly better A1Cs and a little less hypo. So it'll be a question of, like, what are the trade offs, you know? And the intraperitoneal one is interesting because Steve implanted these 30 years ago. Maybe not that long.
- [26:01]
C
20 years ago. Yeah. They worked on the implant instead of
- [26:03]
B
the original minimed ones back in the day.
- [26:05]
C
Yeah. With the catheter went through the rectus sheath, the muscle sheath went into the peritoneum. And intraperitoneal insulin is just like IV insulin. So the control was incredible. But, you know, they got clogged.
- [26:18]
A
Right. They had issues.
- [26:19]
C
There's issues with that. I mean, for me personally, being a diabetic, so long diabetic is that you give me a small patch pump and that's easy to change. And if there's a problem with it, it's easy to take off and put a new one on. You give me a good cgm. I'm really happy with that. And I like the fact that the Eversense could be totally implanted, that their next Freedom version. So there's no transmitter that you gotta stick on the outside. So, I mean, people want a simple life. And to me is the less input you have to give to stay in range is close to a fully closed loop.
- [26:51]
B
Well, and to that point, I think the same thing goes for technical failures. Right. The more technical failures that take me out of my day, a pump that fails, a CGM that fails like yours just did it, did it did. These really do affect your day, your moment, your mental health. And that's why I hope, ever since implantable glucotrax 3 year implantable, this implantable pump that's half the size of the old one, these could really remove a lot of those technical failures.
- [27:20]
C
Yeah.
- [27:20]
A
Well, let's talk about some specific things you wrote here. So you said Omnipod 6 and beyond. So I don't know anything about Omnipod 6.
- [27:27]
B
What? Oh, my goodness.
- [27:28]
C
I don't know shit about Omnipod 6. Okay, I want to know.
- [27:31]
B
Yeah, yeah, yeah. So very exciting. Omnipod, they just had their recent investor day, which is where they announced a lot of these things I'm talking about. So with Omnipod 6, this is next year it would. So this year it would go into like trials and then they anticipate or hoping for it to come out in 2027. I feel like everything takes longer than they say. But this would be a one pod system which was unique. So right now you have a pod for the G7s and the G6s and a pod for the Libre sensors, which also slows down their innovation and rollout because they have to make sure every pod gets the software that it needs, whatever. So by having a one pod solution, every sensor connects to that pod they can roll out. They said upgrade six to nine months sooner, that's exciting. Better connection, which is like they need,
- [28:21]
C
that they all need.
- [28:22]
B
But I don't think it's the pump partner's faults. I think it's the CGM's got too small and there wasn't enough testing with. Will this connect to the pump? Because it's an issue with all the pumps that they need to be on the same side.
- [28:34]
C
Right? Well, not with looping.
- [28:37]
B
Well because looping each device connects to the phone and the phone has a much stronger Bluetooth. So that's why it's not an issue. Whereas every other system the CGM connects directly to, even with Twist, connects directly to the pump.
- [28:51]
A
Well then, so what about the pod itself? Is it smaller? Is it like anything else?
- [28:55]
B
Pods. Exactly the same, same form factor. I can't think of any changes there. A better enhanced algorithm, more so than just that lower. So they do say, yeah, it's like Omnipod 5. Well Omnipod 6.
- [29:09]
C
I don't follow how well companies do, but I'm not surprised that they are doing really well because it's so easy form factor. You fill it up, you stick it on, you're done well and you go
- [29:19]
B
in the doctor's office, they're like, do you want tubed or tubeless? So there's a 50% chance upon that person going to the office that they're selected because they're the only option in that side. Right. Whereas you had. And then the other ones are all fighting against each other in the tube front when it comes to tubed. Right. So they do have a little, you know, room there.
- [29:39]
A
So to that end it says more tubeless pumps. We got Beta Bionics Mint Tandem Mobi, Tubeless Tetronics, Future pumps Fit Flex. So let's start with Beta Bionics Mint. I don't know anything about that either.
- [29:49]
B
Oh, it's so fresh, let me tell you. So the interesting thing about this is that there's some semi reusable parts there's. Like the brains, which are like an L shape that then would connect to what you could call the pod when it connects. The brains are powered by the pod. The pod has two batteries in it instead of three, whereas Omnipod has three batteries, same sizes. And so that reusable part is what holds the algorithm. It's what already is connected to the sensor and automatically connects. So this device is being built in a way kind of along the lines of what Beta Bionic stands for, which is like less work. So after the initial pump, the first one you ever do, they want this to just be where you put these together, put it on, and there's a manual injector for the needle. It's a steel needle, 4.5 millimeters maybe off of my mind, press it, injects it. And you don't have to open an app, you don't have to connect the sensor, nothing. It automatically starts, which I think is such a cool idea.
- [30:51]
C
Sounds like the V go well.
- [30:52]
A
Yeah. Like, you know, do you still everything else, announce meals on your phone, things like that?
- [30:57]
B
I think it's the same algorithm. Or maybe they'll upgrade their algorithm in some way before that comes out. Because I think that this is slated like a 2028.
- [31:06]
A
It is kind of crazy it's taken this long to have other tubeless options. I know we've kind of like flirted with them totally.
- [31:13]
B
It's hard. I think, like this thing, the Omnipod is incredible engineering.
- [31:17]
A
Yeah. And like, I mean, if you show people without diabetes, hey, which of these pumps would you want? You know, this has like, without tubing, they almost always pick the Omnipod. Now I will say you guys are super pro Omnipod. There's a lot of people out there that have tried it and don't like it or, you know, I've had issues with it or whatever. All three of them are, you know, different strokes for different folks kind of thing. But the idea here being is that we can get more tubeless options. That's great. So that sounds really cool. You know, I think again, the islet can really be like life changing for the, like the right patient. More of a hands off approach, which is what everybody wants. So what about what Tandem's doing in this space?
- [31:57]
B
Well, Tandem has a couple things going on here. One which you probably know a lot about, the tubeless mobi, which is really just the mobi that's out today with a new cartridge attachment which would essentially slide into an applied patch which would have the cannula you slide it in and then it's a tubeless form of Moby. So it's like a hybrid pump. Even more hybrid, I guess with that. That's anticipated to be coming out somewhat soon. I don't know if I say 2026 or early 2027, but what's unique about that is that it would incorporate the seven day infusion set from Tandem, which is a.
- [32:28]
A
So that is huge. So, you know, one of the things that I like about the Medtronic pump is that it does have a seven day infusion, which I think is actually a really undersung benefit because for me, and I think for a lot of people, when I would change infusion sets like that first day, like I don't know where the insulin goes, but it's not working as well. It takes a while to kind of like kick in. And that happened a lot with the Omnipod. So like being able to change it every seven days is actually really nice. So
- [32:57]
C
that's a big thing for him. He changes everything. He used to change your old Gen 4 sensor at the same time as the 7 day. What do you think makes a tubing 7 days versus the typical 3 days that.
- [33:10]
B
Well, according to Tandem and I got to demo this device. So if you go to my social or my website, diabetic.info, you can see the demo of it and up close. So it is a 16 millimeter cannula, which sounds like so scary because it's long, but it goes in at an angle and it's coiled in it with metal, like a metal, so that it, I guess prevents like kinks. And then it has multiple, I believe, four punctures in it that allow the insulin. So if one or two clog up, it still has room for it to go out.
- [33:46]
A
Yeah, so it's basically just sort of just coming out the end and come out multiple points in like the infusion set. And the other thing that gets forgotten about is the tubing itself that over time insulin can actually get stuck to the tubing. So they've worked a lot on that to make that kind of like flow through better. And all these things about, you know, kind of insulin and fluid dynamics that I think are improving that. I mean you've always said that a pump is only as good as the infusion set or the tubing, like if it's not working, you know, like I don't care what kind of Lamborghini of a pump you have, you're right, you know, it's not going to work.
- [34:16]
C
So Tubing is important.
- [34:18]
A
All right, so.
- [34:19]
B
Oh, and then the Sigy. Yeah, the Sigy is the tubeless first pump that Tandem's working on. They acquired AMF Medical back in, I believe, 2023ish, which was a company out of Europe working on this device. It has semi reusable parts, very similar in shape to Omnipod, A little longer and a little thinner, but similar in the sense that you put down a pad that has the cannula, put the pump on, uses refillable cartridges like Beta Bionics, those little bullets of insulin, which I love that too. Like just ease of just putting them in and out. And that one, I can only assume it would be seven days, but that's like a little further out. That's a post tubeless Moby.
- [35:03]
A
Yep, got it. And then Medtronic Fit Flex.
- [35:07]
B
Yeah, the Fit and the Flex. So I guess this is for you. So the fit is tubeless. They say that it would be a 7 day tubeless pump, hold 300 units, semi reusable parts. Not much more that we know about it. And then potentially using the same algorithm that it has today, but depending on time that would change. And then there's the Flex, which the Flex is a tubeless pump, much thinner and sleeker than the current device. It looks like a vape pen. Like 100% looks like a vape pen.
- [35:42]
C
Then you should know what that looks. You know what, they publish pictures of it. It's very sleek looking. You know what, it's about time. These companies give other choices, but the other thing is the reservoir volume. So they're all going after the type 2 market, which is totally appropriate. Type 2s need help, but you got to hold at least 300 units, I think if you're going to be competitive. But also I have patients with type 2 on the Omnipod, whether it's the 5 or looping. They use the Lilly U200 insulin and you have to fake out the algorithms, you know, make everything double or half and they get the equivalent of 400 units of the U100 insulin. So I think the volume size will be important, but with the advent of GLP1s, type 2s won't maybe not need as much. And so there's going to be a good percent of type 2s that can do okay on the 200 units.
- [36:34]
B
Yeah, I think dual approach is going to be a big thing when it comes to this technology. Is like you may want medication with the system to make it perform even better.
- [36:43]
A
Yeah, well, you know, this is always What I say kind of the good news, bad news about technology is that a lot is happening, you know, so there's a lot more like, you know, choices for people. But you know, if you're listening, you're like, okay, the Mint, the Siggy, the Fit, the Flex, the Mobi, the Omnipod, there's a lot keeping track of what's going on. Just again, the point of educating yourself because a lot of providers just won't know this or they get comfortable with one particular system or the way the download works for their office and kind of try to steer people there. They're not trying to be mean or bad, it's just what they're comfortable with. This is becoming a much more consumer driven market where the customer, the type 1 or type 2 diabetic, has to really educate themselves.
- [37:24]
C
That's so appropriate because even good endos can't keep up with all the different technology. We didn't hear of half the things you're talking about and we think we're up to snuff on things. So, you know, you have to take control of your diabetes.
- [37:38]
A
So. All right, so that's a little bit of the future from these systems. So this says your favorite gadgets and app hacks. So, you know, I feel like there was a time where we thought apps were going to solve all the problems with diabetes and now we've realized that, you know, you got to get a good one, one that's user friendly and it really accomplishes a specific goal. So I have a list here. Do you want me to read them to you or do you have one that you want to start with?
- [38:01]
B
There are a few. I also just realized that this episode's like taking control of your diabetic.
- [38:07]
C
Isn't that great?
- [38:08]
B
That's what we're doing right now.
- [38:09]
C
You're welcome to play it on your channel and we'll exchange.
- [38:12]
B
Yeah, yeah. There are so many fun devices, but not just fun like very practical devices or apps that I use for my day to day and I found to be really useful for the people watch my content. One of those sectors is CGM display devices. There's a few different types. There's one called Glow coast which glows in different colors on a rainbow scale from red being low or like severely low to pink being severely high and all. It's a little like, it's a little orb that sits on a shelf or on a counter or wherever and it just lights up in color. It's actually, it's actually the least expensive of all these CGM displays.
- [38:54]
C
So you stare at that while you're vaping. Is that right?
- [38:57]
B
Yeah, yeah, yeah. You get like. It's super trippy.
- [38:59]
A
So. But it's supposed to be like an easy. An easy kind of quick visual cue of where you're at.
- [39:04]
B
Exactly. And I think it's also good for kids or people who may have, like, a mental. Mental disability or something to understand. Instead of the number, like, the color, like, red is bad, whatever that. Right. It's a little. It's just a little more simple than, like, the scale of numbers.
- [39:18]
C
Sure.
- [39:19]
B
But, yeah, great visual indicator. My roommate's always like, hey, you're red. You good. They see it in the corner. And then you've got, like, visual screens or light displays with numbers. So there's the Sugar Pixel, there's the Sugar Dash. Both are a little bit different. Sugar Dash is a touch screen. You can display up to six users, has a night mode screen, and then Sugar Pixel and the Sugar Dash, you don't need a phone, no smartphone, Apple, everything's on the device. Which is also great for, like, maybe an elderly person. Like, they don't need to have, like, this device connected. Oh, well, Sugar Pixel, you don't need a device connected, but for setup, you do. So then with Sugar Pixel, you can use an app. You can customize the screens. You can have emojis like a unicorn when you're 100, or an emoji with, like, cool sunglasses or just, like, simple screens. And has a really nice night mode where it's, like, super dim but shows you the color. So at night you could just kind of see it.
- [40:11]
A
Yeah. I'm thinking about where I would use this, and I think it would be nice to have in, like, you know, my bedroom or something that's a little bit more private. I'm thinking how this would go. Like, it was in the kitchen with the kids around. You know, I think that is a good educational tool for them, you know, specifically, like, if you got a kid, maybe they have antibodies positive, you know, they might get type one. Start, like, educating them on good numbers, bad numbers. But I also don't want to overwhelm them, you know, with like, oh, dad's in the red, or, you know, whatever. So I don't know.
- [40:39]
B
It's not for everyone. I understand that.
- [40:42]
C
I find that my kids have seen me deal with diabetes their whole life, and for them, they don't freak out about things like that. And I think your kids are pretty knowledgeable, too.
- [40:51]
A
If you had a party, would you want everyone to know Your blood sugar, if it was in your kitchen, if it was good.
- [40:57]
C
But you know what? One thing you mentioned before we started the podcast, I love the glucose projector because we know we have clocks that tell you the time in the middle of the night. You just look up, you know, and it displays your blood sugar. That is so cool.
- [41:10]
B
It's basically that shows your blood sugar and the time and it's that like that dim where it's that red color. Like what you expect from like an old school alarm clock that does not hurt the eyes at all.
- [41:22]
C
What if my ceiling was painted red?
- [41:25]
B
It may still work. It's super bright but like in the right way.
- [41:28]
A
Yeah. So we haven't. This is wearables. We haven't talked about watches at all. You know, Apple Watch, whatever you want to talk about anything now or coming that you want to mention?
- [41:38]
B
Yeah, well, so there are a few softwares that I use that show like live projection of your glucose levels on the home screen of your phone and. Or the watch which I like though. I mean I'm wearing my smartwatch right now. I actually try not to wear my smartwatch because I don't like having access to things on my watch like an alerts on my wrist. But for things like this, this is perfect. I can see, you know, right on the home screen. I'm 145. This is good. I can look away, whatever. So that's using, that's using Sweet Dreams which is also on my phone.
- [42:09]
A
It projects where you're going.
- [42:10]
B
Also it doesn't do predictions and it would be cool if like one day it could take Twist information and show you what the prediction from Twist is.
- [42:21]
C
Although.
- [42:21]
B
But there's the Twist watch app which is.
- [42:24]
A
Right. So how's that different than just having like the Dexcom app or something so.
- [42:27]
B
Well, it's different in the sense that it's a widget on my home screen with the number that changes automatically, which maybe the Dexcom does do that as a widget, I'm not sure. But it also does a live activity on your phone which is a live number constantly changing. Dexcom can't do that. See a Libre can't do that. And also Libre.
- [42:46]
A
You mean like every minute? Like more automatically?
- [42:48]
B
Well, every minute or every five minutes depending on what sensor you're wearing. Also Libre does have a smartwatch app. They just released it for Apple Watch. So for. But the widget that they provide doesn't show or at least the little round one doesn't show the number changing. So there's all these little intricacies that the main big companies miss. So then these smaller companies come in and fill in the gaps.
- [43:11]
A
The new watch, right. You can get your it to go directly to the watch, right? From the sensor to the Apple watch.
- [43:17]
B
You can, yeah.
- [43:18]
C
You can, yeah.
- [43:19]
B
I've never, I've done it, I've never felt the need to do it.
- [43:23]
A
So it comes up a lot in my surfers. You know, like I'm out in the water, I don't want to have my phone or like pump or whatever. And so they've been just like dying for that like functionality.
- [43:32]
B
Water's terrible for Bluetooth.
- [43:34]
A
Yeah.
- [43:34]
B
Well I'm curious how well it's working for them.
- [43:37]
C
You know what, I believe it or not I use the, I use the Dexcom, this little monitor which is, I use it when I ride my bike. I put it right on the little holder on my bike and if something happens with my connection, Bluetooth goes out.
- [43:54]
A
It still works except just now where it.
- [43:58]
C
That's cause the sensor failed.
- [44:00]
B
The connection from the receiver to the G7 is a better connection or more like reliable.
- [44:07]
C
It's more reliable. And so whenever I can't get it on my phone I just look at this. And also it's nice to bring this out at meetings versus your phone. People think you're texting, you know, you're just trying to check your blood sugar but I find it really, really quite valuable. So that's you know, once again it works for me in certain situations and you know normally if my sensor didn't go out but Bluetooth was unavailable. I think it's low energy Bluetooth but it definitely works you know when the other system doesn't.
- [44:37]
B
And the 15 day lets you connect to now three devices whereas the 10 day was two.
- [44:42]
A
Yeah.
- [44:42]
B
So you got the receiver, watch, phone.
- [44:44]
A
Well then any kind of last apps, devices, things that you find yourself using every day that you want to.
- [44:51]
B
There's one software I didn't bring up that's interesting and good for Android users is got cgm. It is out now or just came out but it does something similar to Sweet Dreams but also for Android devices. And I don't want lots of people on Android. They should have this ability to so on their Pixel Watch or they'll be able to see their live CGM readings as well. And a lot of these companies, a lot of them are American so they kind of do. They're very iPhone, Apple Watch first centered.
- [45:20]
C
Yeah.
- [45:20]
B
So there are options as well for Android.
- [45:24]
A
Well I would say with that you know, we've covered a lot. What's going on now, what's coming, and, you know, again, hopefully leaving people with some hope, some inspiration. Things are moving and moving very quickly, and these companies are energized now to get, like, there's some competition in this space. It's healthy competition and ultimately serves us well. So anything, any kind of closing remarks, including where people can find you, how they can follow you, all that kind of stuff.
- [45:47]
C
Sure.
- [45:48]
B
They can find me everywhere. At Diabetec D I A B E Tech, we've got a website where we post all of our videos, our podcasts, our news articles. We put out news articles throughout the week. The latest in diabetes tech@diabetic.info and then the podcast is the Diabetic podcast. And we're on YouTube, of course. Diabetic.
- [46:09]
C
Awesome.
- [46:09]
B
Or everyone.
- [46:10]
C
I'm gonna. I see you all the time, but I think I have to be more aggressive at following you more. And, you know, because you put out a lot of good information.
- [46:18]
B
You too. I want to do more, like, more stuff like this. It's been great talking to you, and I love what you're doing, and I also love your energy. And it's just. This has been a great conversation. I can't wait to listen to it.
- [46:27]
A
Yeah. Well, let us know if Steve starts following you too aggressively. But just want to say thanks. And, you know, I learned a lot. So these are always fun podcasts to do to kind of educate Steve and I on what's going on. So thank you so much, Rich, Justin, for coming. Nice for you to be here physically in person, too. So appreciate that and hope everybody enjoyed it. And again, just make sure to, like, follow, subscribe, all those kinds of things, and we will see you on the next one.
- [46:52]
C
Thank you, Justin.
- [46:52]
B
Thanks,
- [46:59]
A
Sam.