dana roseman diabetes management dialogue

The T1Dialogues – Ep.16: Dana Roseman – Pregnancy and T1D, tech advancements in diabetes management

Our guest this month is Dana Roseman. Dana is a Certified Diabetes Care & Education Specialist and Registered Dietitian. She holds certifications in insulin pump therapy and obesity interventions for adults. It was such a pleasure speaking to Dana. Not only is she full of great insights when it comes to diabetes management but she also has this amazing attitude. She enjoys trail running, yoga, and downhill skiing and is committed to the belief that T1D need not slow anyone down.

Dana. It’s fantastic to talk to you today.

Same here Pete! Thanks for inviting me here today.

I was just looking over your bio before the call and I kind of almost ran out of breath by reading it. Let me see if I can run through it and do it justice. So, you are a certified diabetes care and education specialist and registered dietitian, with certifications in insulin pump therapy and obesity interventions for adults, specialized in science with honors at Boston University. Volunteer for health education initiatives, the key role in establishing the first school-based health clinic in Chicago, degree in clinical nutrition from Southwestern, insulin pump and CGM guru, research, information, liaison, JDRF, New York marathon, Not to mention trail running, yoga, skiing, jewelry. 

Yeah. I don’t know how you do it, to be honest. And there’s gonna be no shortage of things to talk about. You’re a type 1 diabetic just to put the cherry on top. 

But I do see that as a silver lining in some ways, that’s how I like to approach it. Just I think that, you know, without my diabetes, I probably wouldn’t have found a career I love so much and it has been a kind of a path to go forward. I was were just talking about it over the weekend with people: you don’t know what’s going to happen, but finding that silver lining I think, is so important. 

I’ve asked myself this question because I’m working on my businesses in the diabetes space, right? And beforehand, I was a healthcare consultant and I’ve worked in pharmaceuticals and so forth. And now this is my business where I am working on the patch business, and I’ve probably never been happier and I’ve never felt more productive and I’ve never really enjoyed my career as much before. I wonder if I had my time over, would I choose to not have diabetes? Because without it, my life was very different. And at least I wouldn’t be doing this job and have this business and kind of, you know, have this passion and be engaged with the community and it’s a weird thing to think that it’s a hard kind of question to ask, right? And I’m not sure what the answer is. I mean, I don’t necessarily want to say that I wish I had diabetes, but also I’ve got so much from it, right. 

 

I think it’s kind of what you make of it, right? I mean it is kind of a funny thing to say like you don’t wish this on anybody because let’s face it, having diabetes is a really big pain in the neck, right? I mean I don’t want to be doing all the things that we have to do to stay healthy, but I think you do focus on health more, right? Because you think about it every time you eat, you think about it every time you can exercise and so that can be a positive thing. 

 

Yeah, and I said this is a podcast recently, I think diabetics type 1s in particular have a relationship with their body because they have an insight into functions and metabolic processes and just like how our bodies interact with the world in terms of diet and exercise and all those things; so there are some advantages in a sense. 

 

You know it’s funny. I do talk to a lot of newly diagnosed families who have young Children newly diagnosed and you know, think about the technology that’s happened in the past 5 to 10 years and what their life looks like compared to how our life maybe looked like when we were first diagnosed. But I always tell them that you’re going to see your child’s mental health in a different way than you might with someone who wasn’t diabetic because of their CGMs. In fact, you’ll be able to kind of see the reactions to the whole package, right? Because diabetes touches everything and they’re more in tune to their body and then their parents are more attuned to the mental health of their child just as of their blood sugars. 

 

Yeah. It must be terrifying for kids and their parents. But yeah, I agree that finding a silver lining is a useful way to approach diabetes. Being in community groups and things like that. I do come across people who are angry diabetics, or cynical or pessimistic diabetics or people who feel a little bit sorry for themselves. So, I think we all have those moments, right, That’s true. So, please share with us your diabetes story and your diagnosis. 

 

Yeah, So I was pregnant and I started using insulin almost immediately. But the obstetrician thought that I had gestational diabetes and it was because I was pregnant and kind of in this very observed state. Indeed, I was young, healthy and nobody in my family has diabetes, but they saw high sugar and I could not manage it with diet, you know? So I went to insulin really really quickly. And when I delivered I didn’t ever think about that diabetes again, you know, you’re fine, That’s gone away. And really within five months I lost 20 pounds. I really couldn’t get out of bed. I thought I was depressed, you know? I thought I had postpartum depression and really struggled emotionally and mentally. So I went to the doctor and they said this was the least comforting bedside manner. I mean luckily I wasn’t in DKA but the long term doctor was like, yep, you got it. And I thought what do I got, you know? And when you’re diagnosed later in life, they just give you an insulin pen and a pamphlet and they’re like, good luck with your journey! 

 

Besides,  here I had this newborn baby and I was trying to breastfeed and my body was attacking itself. I developed thyroiditis also. So my thyroid was attacked at the same time as my pancreas and it was just kind of a mess. But very quickly I found a diabetes educator that I connected with and she was my lifeline. And believe it or not, I connected with her, got really quickly put on an insulin pump because I wanted more Children and wanted to really work on this and decided to go back to school to become a diabetes educator. So this is actually my second career and a kind of that silver lining, you know, making lemonade out of lemons. And because that’s kind of my story. 

 

Is it common to see women develop type one in pregnancy? 

 

So, believe it or not, this is something that people really never think about. Almost 50% of newly diagnosed type ones are over 20 and you know, we don’t call it juvenile diabetes anymore, we call it type one. But if you think about 15 to 20 years ago we did call it juvenile or JDRF so it really is quite common in pregnancy. It’s almost like a stressor, you know, because if you’re susceptible to an autoimmune disorder and then pregnancy is kind of a really huge stressor on your body then all systems go haywire and at least that kind of happened for me too.

 

I kind of sometimes reflect and think about what was happening at the time of my diagnosis.I was working quite hard and maybe a bit stressed at work. And I do mean, we could never really answer these questions accurately. But I do wonder if that stress was what caused that initial chemical cascade. I mean, the endocrinologist did say, if you hadn’t gotten pregnant, maybe this would have happened, but it would have happened much later in life. I don’t know, rip the band aid off early, I guess.

 

What do you base that on? And now, of course, just as a researcher, I always look into, you know, what’s kind of the cause and we really don’t know except, so much is pointing towards the microbiome, which I just think it’s fascinating. And the changes that bacteria get are perhaps making us susceptible to an autoimmune reaction. You know, they’re giving all transplants which are quite successful. It’s just really hard to get people to volunteer for that. 

 

I’ve heard of fecal transplants. What’s the story there? 

 

So there are a lot of studies related to this. I might be going to get the country wrong but it’s northern europe somewhere. And they’re doing it. They have successfully done fecal transplants and reverse type one diabetes in mice. In terms of humans, I really don’t know where they are. There were a couple of investigators that we’re working on and hopefully seeing benefits. So fecal transplants that make that bacteria as it’s really challenging. You know, your gut is made up of millions and billions and trillions of bacteria. And to change the diversity of your gut bacteria is really challenging because you really get that microbiome from birth and your environment from when you grow up. So they are finding that if they get bacteria that is so involved in Type one diagnosis and progression, how do we change that micro flora and the one way to do it medically is through a gut bacteria transplant by feces. 

 

So that’s not to cure diabetes. It’s to prevent it?  

 

They reversed it in type one mice. I don’t know if humans would have the same reaction. Well I mean these are unanswered questions. but it’s really fascinating. So they’re doing a lot of research. There’s actually a company in Israel called Day two and they’re doing a lot of work on glycemic control with your gut bacteria. They actually have a really smart algorithm that if you have a strong family or pre diabetes for type two,  they will do a microbiome check of your gut bacteria through a stool sample and they’ll map it out and then kind of give you a diet to follow in terms of prevention. And they are trying to do that for people who have type one as well, not as a prevention, but after you’ve been diagnosed to help you  eat in a way that makes sense for your microbiome to digest certain glycemic foods. 

 

That’s fascinating. I’m trying to wrap my head around the concept of a fecal transplant because my understanding is that beta cells aren’t there anymore? 

 

Right. but what I guess causes the autoimmune reaction. And if you kind of go before that happens I think there’s a lot of exciting research ahead. It’s just about how they will come to the forefront. 

 

Absolutely. So I’m looking at your bio. I don’t know what’s the word embedded in the community. My assumption is that your diabetes management is perfect as you, yourself are a clinician. 

 

Well! I don’t think we can ever say that it’s perfect.I do actually get burned out, just like everybody else. And I have my days where I don’t feel like being a good patient and, you know, taking my insulin the appropriate time before I start eating and, I still have my days where things don’t go awry, Just technology failure like insulin pump failures. But I think one thing I’m really grateful for is that I know how to manage it If problems arise and I’m comfortable with those deviations because I know that I can always get back on track and I think one thing that happens a lot with people is just they feel like they have to be perfect with their blood sugars and I think social media has created I don’t know maybe you have a different opinion but people kind of curate your blood sugars and they post this amazing line on their CGM as if I’m 99% time in range and you know I think that we need to just be real and have those real moments where I mean my blood sugar is definitely vary like everybody else. 

 

Yeah I probably could strive to be a bit more perfect. I posted about this on instagram this week where for the last maybe six months, my sensitivity had been declining. I’d struggle with my levels particularly overnight if I’d carbohydrates for dinner. I was aggressive enough with my insulin, I’m still on injection and I know the answer is going to a pump, but I was quite aggressive enough with my insulin doses before bed essentially and went for six months. My fiance is slowly crept up because of this my  inability and I kind of was reflecting on it this week and I realized that what I’ve done, I adjusted recently and I’ve had enough, I’m going to get more aggressive with my dozing and I have got more aggressive and it’s worked and I’ve seen my control get better and I realized that it really had come down to my attitude, you know in a sense I was allowing myself, I was accepting being high, you know, I wasn’t get hard enough. 

 

I kind of kept that attitude for too long and it was interesting to see that actually it was just a pretty minor adjustment in my mindset. This has been going on for too long. I’m going to do something about it and I’m going to get a bit more aggressive and it might mean a couple of lows along the way. But that mindset change, that attitude change has kind of been everything really. 

 

But I think it’s really easy to be on cruise control like you do the same thing day in and day out. I always tell people it’s not type one diabetes, it’s type you diabetes, right? Because everyone’s diabetes is their own management. And you learn by going back to analyzing your body. Sometimes we just get in that crease control where we don’t stop to think about those adjustments because we’re just so used to doing it. But I think that’s great. Congratulations to you! You know, that’s why we have so much data, so much bombardment with all of this data now for diabetes management, it’s so easy just to turn off those alarms and just kind of go on cruise control because you’re just always, you know, fatigued by all these alarms. 

 

I think perfection isn’t an option. Ultimately, we end up choosing one side of perfection. You know, like I’m going to choose the low side for a while, you know, because I’ve been on the high side for a while so that was another sort of insight that I got in terms of  the attitude to it. You’ve almost got to make a choice given that perfection isn’t an option. I’ve almost got to make a choice on which side am I going to be on for a while and there’s going to be good and bad on both sides, right? 

 

Absolutely.I think, you know, to your point, a lot of people take that same side of control because those are easier to fix quickly, right? But for the highs, we use fast acting insulin it  is not all that fast, right? I mean if you push your high, you want it to work like this instead of an hour and a half later, two hours later that you start to see it break down. So a lot of people do kind of hair on, on those low sides. And I wish they didn’t have to make a choice, right? Someday. I think that technology will help us feel like we have a cure even if we don’t have one. 

 

When I have spoken to experts about these scenarios, so you know, pump option is really the main recommendation. 

 

Well! It’s because we have sloppy tools, right? I mean you take a unit at a time, maybe half a unit as we’ve got an in pen or if you’ve got a junior pen, but sometimes you don’t need a full half unit or full pit unit. And so I think it comes down to the delivery and the absorption because again, we’re still stuck with insulin, that’s really not perfect. We do think we’re so fancy. We’ve got these ratios and we’ve got these factors and, at the end of the day, the insulin we’re using is just not physiologically similar. In my opinion. It does pretty good. Right. We’re standing here and functioning pretty well. But you know, it’s not the same as physiologically produced natural insulin. 

 

It is interesting that Insulin has been around for about 100 years from now but the advances in insulin as a synthesized agent hasn’t been that much. And that there would be advancements and I have to assume it’s probably because it’s too difficult. They can’t be the lack of research or the lack of funding that’s available because I mean companies would invest in it and find them if they were there. 

 

Yeah, that’s above my pay grade. But certain people are definitely working for it and I think Stanford has some faster acting insulin that they’re working on. You know, Afrezza is an inhaled insulin.  It works faster, but again, it’s sloppy in terms of its delivery and absorption and the ultra rapid insulin is out now, at least in the States. Some companies even  tried to move the bell curve a little bit faster. But if I’m 300 I want five minutes working insulin, I don’t want 25-30 minutes acting  insulin. 

 

Right! So please tell us about the work you do in terms of diabetes care and as an education specialist and dietitian. Also, tell us a little bit about what that entails. 

 

I work one on one with families and people who live with type one and I would say 70% of my work is now telehealth and it was even before covid, which is kind of ironic. So I work with people all over and now we have the ability with technology to share so much information in terms of blood sugar management. I mean whether you’re on a continuous glucose monitor or on an insulin pump, there’s just so much to share now. I really see myself as a coach, you know, to work with someone to empower them, to have the knowledge that I have so that they can make decisions every day on an hourly basis and manage their blood sugars the way that they want to and achieve the things that they want to do in life, whether it’s work or exercise or family planning. So I definitely feel like I form a really close relationship with people, diabetes and food which are such a personal thing to people and everyone approaches diabetes management in a different way, similarly the stress acts in a different way. So that’s kind of what my day is filled with including coaching and maybe mentoring people to achieve the best management for their diabetes and and then achieve their best potential. 

 

And how are those sessions structured? Is it like your patients being with you for long periods of time? What do the sessions look like? 

 

So usually the initial assessment is about an hour and a half because we want a good amount of time. That’s even after a really lengthy assessment that people fill out. They don’t have to ask you what your pump settings are, how much insulin you take at mealtimes and try to capture through that assessment. Similarly, do you have fears of lows that are causing you to run high or do you have fears  for your supplies that are causing you to run low and really kind of get a feel for what your attitude is for diabetes or you burnt out? Are you feeling too overwhelmed? Are you getting a good night’s sleep? You know, diabetes affects every aspect of our life which is a really comprehensive assessment. 

 

After that during that hour and a half, we kind of get real really quickly and learn what somebody’s health goals are and what they’re trying to achieve with their diabetes and where they feel like their support system has failed them. Maybe they have an endocrinologist that only has 10 to 15 minutes every six months to talk to them and you know, maybe they haven’t been educated on how to use their insulin pump correctly. 

 

I do find that it is really different around the world in terms of what education is available. And I think oftentimes people find a lot more support online and in the  community or social media but then they go straight to the advanced chapter of the book and sometimes people go for the basic training in the beginning like sick day management. We may not hopefully get some covid or something like that, but I might get a cold or the flu or sinus infection and I want people to know how to manage their diabetes when they’re sick so that when they have got a fever and they feel lousy, they don’t have to relearn something. 

 

Also, I do make sure that we start from the beginning, even for people who have had diabetes for 30 years, I think it’s always worth the discussion of how are you treating your lows, how are you managing sick days etc.  I work with a lot of college kids to kind of have that transition between pediatrics to adulthood and that’s another different stage. So I think diabetes evolves with life cycles and so we figure that out. 

 

People get to you when they’ve got problems or are people coming more proactively? 

 

I think it runs the gamut. I mean sometimes people come and they just kind of want to check up and make sure that they’re doing what is the best for them and what makes sense for them. But sometimes people are like, you know, I just got a complication and I don’t feel like I have support and I don’t know where to turn and how to prevent other complications. So it really runs the gamut and also people have different lifestyle stages someone planning a pregnancy or someone planning to go to college or move away from their family for the first time. 

Is that everyone of your patients are on pumps or you’ll see people on even without CGM. or are you finding that everyone’s on CGM’s these days? 

 

I would say that for the past few years the access has become easier to CGMs. And so I would say there’s very few people I see who are not on a CGM. To be honest, if they’re not on a CGM, one of the first questions I would ask is why not? You know, there’s definitely a couple of people I see who are very very reluctant. They don’t want anything on their body regardless of how helpful it could be. And so again we need to meet them where they are and people need to make their own decisions and what feels good to them. 

 

But I also think that CGM. Is probably the number one helpful tool in managing diabetes. I mean just the insight in that and the directional arrows and the lack of finger sticks makes it a game changer. So you know that is usually the technology that I will really try to help people understand the benefit of and it doesn’t have to be all the time right? We can just get some insight and help them feel better and then kind of you know decide if it’s worth keeping on. 

 

Yeah, it is really a fascinating mindset to think that yeah there’s a reluctance and I think its the different types of people that are out there and and the different attitudes but you know, it is hard to imagine. I know for myself being on a CGM like I want to always have access to that insight and I can’t imagine going back now as it is my security blanket totally. So I don’t have that Gap and I’ll use this radar to start the new one and use my phone for the old one so that  I don’t be without it even for an hour. 

 

I imagine it can be challenging, you know, given you’re an advocate for diabetes. So, when you come and meet people who are reluctant, what’s usually underneath that? 

 

Well, I think that it varies. I mean that’s a tough nut to crack. I think that depends on your support system when you were diagnosed like how normalized your diabetes has been made to you. I see a lot of lingering effects if they were diagnosed when they were young and maybe their parents struggled with some vocabulary that, you know, that’s good blood sugar, that’s bad blood sugar. If you always have bad blood sugar, you would say I’m not going to try anymore, right? I’m always failing. I think that the very first important thing for someone being diagnosed with diabetes is their attitude and it affects the rest of their life if it seems too hard and they’re never being successful. Well I don’t want to try something. I’m not doing well and they don’t really have a choice but they definitely have a way of having that attitude. 

 

I see fears of lows really impacting people quite a bit. People who had scary incidents or car accidents or just something that really caused a lot of fear, it’s hard to get over that because you always remember that story and you always remember how you felt when you went out of control. So I see that as a real challenge. And again, you know, CGMs with alarms, I mean that can really help, but if someone hasn’t made that leap, It can be hard. 

 

Yeah it is. I’ve had one seizure and it was funny because it was classic. I was actually talking to a mate the night before. He also has diabetes and he was an old friend. I grew up with him and he always had diabetes since he was a kid. And I literally hadn’t seen him for years. I saw him one night. Actually I had got diabetes as a 30 year old and I saw him, you know this was as a 35 year old or something and we were just kind of comparing notes and I was saying, you know, I’ve got such good control because he used to have had more seizures. I remember saying to him that night that I look after myself, you know, I’m never going to have one of those and that is never gonna happen to me. And then the next morning I woke up and I didn’t have breakfast. I took my long acting insulin and I was actually driving into Sydney to pick someone up and I just started getting all disoriented and I had jelly beans in the cars.  The next thing I know I’m sitting on the footpath and the crowd, there’s like people around me, someone hands me a big thing of juice, and I kind of pour it all over my face. I realized that I’d been told that I had pulled over, luckily because it’s very busy. 

 

The police officer described it as the best seizure I’ve seen. My car had an auto lock, the police had to smash two windows, get me out. So, I mean, kind of weird that it happened the night after saying it was never going to happen. I think there’s a lesson there. But thank goodness, they kind of knew what was going on and how to treat it. I don’t wear a bracelet or anything identifying I need to, but um, I don’t, and I don’t always think of that, you know, it’s something that happened in the car, they’re gonna know how to handle it. 

 

I have no idea how long I would have been there because you know I guess I would have had a seizure. The public must have seen me, luckily the police station was across the road. Someone ran across the police. They’ve come over and they got me out of the ambulances. So when I got there, there was police, there was an ambulance, there was public. So I don’t know how long since when it started when I came out of it but you know definitely after that I kind of had a lot more respect for it you know for being careful. 

 

I don’t know how we ended up going down that path but I only found out about CGM 3 years ago. It was funny and actually this was another lesson for me like I have been fairly disengaged with medical care because I used to have these experiences with Endo’s where I’d go in they’d ask the same questions and I walk away not really getting a lot here that’s not helpful. So I just drifted away from health care in general. And what that meant was I didn’t have that link in to find out about technologies that were coming along and I think this is a really good lesson for people that even if you maybe don’t get immediate kind of benefit like by staying engaged to some degree, you’re gonna find out about things when they come so in hindsight I wish I had been more connected to the community. So I’m guessing that they probably would have been like Dexcom 4 or 5. 

 

I think it would probably be G7 but access is a huge issue. In the States, it’s all about the dollars and how accessible the best and the brightest of technology is. But Yeah 10 years ago there was definitely a CGM that wasn’t as accessible. 

 

I guess now it seems like if you’re type one and you’re not aware of CGMs, then that’s weird. But I’m guessing that back then and I don’t know what the percentages of type ones would be on a CGM. 

 

I remember there was an old CGM from the navigator and it was really big and I was kind of the only trainer so I would travel quite a bit to train people on this  and it was really an in depth training. I mean, now, you know, you just watch the app on your phone or you just kind of watch a youtube video, you’re up and running in five minutes, but back then it was really cumbersome. it was actually really expensive.

 

I suppose it wasn’t as accurate as the ones we have today, right? And so there was a cost benefit like what am I getting out of this technology and wearing this thing and is it all that great? 

 

So I guess it would have been reserved probably for more people, people who have seizures or people who were hypo. You know people just wanted the newest and greatest. I mean I chose not to wear a CGM back then for that reason like what am I gaining from that because there were so many issues. 

 

I’m curious to know about your experiences with pump technology, you know what the landscape looks like at the moment in that space?

 

The landscape is bright, it is a really exciting time. I call this the golden age of diabetes technology and I think that things are getting so much smarter, but it all starts with the CGM right? That to me is the quarterback for american football of our diabetes management is like, it centers around a really accurate CGMs. And then the pump can start to deliver insulin based on that information. I do think, you know, on the market right now, there are automated insulin delivery systems, soon to be there at least in the States such as  Medtronic has an automated insulin delivery system, tandem T slim has this system and then Omnipod is soon to have a patch that will work for automated insulin delivery. Medtronic talks to the Guardian 3 CGM and then the tandem and omnipod will talk to the dexcom. But you know, they’re soon to be two more at least in the states that will be the automated insulin delivery systems. 

 

There will be a library like  there’s dual hormone pumps that are being tested now with liquid stable glucagon. So instead of treating low blood sugars by either the absence of insulin delivery with a pump or carbohydrates, the pump will deliver glucagon. And so all of a sudden that’s kind of the holy grail of perfection right? Because when we’ve got our blood sugars going up, you get insulin, your blood sugar is going down, you get glucagon and you don’t have to carry your jelly beans in your car anymore. So this evolution is  going to be a huge game changer, not just in pump therapy but in micro dosing with a gun for exercise or for people who don’t want to have sugar all the time, People who are super sensitive to insulin having trouble with low, so that, to me, this is going to be a really exciting addition to diabetes therapy that we just don’t have right now. 

 

In terms of pump therapy, I think that we’re just getting smarter. CGMs,  more accurate CGMs and then the algorithms that are giving the insulin based on those CGMs projections are getting smarter too. 

 

So you had mentioned before about looping which is the most exciting thing. I think that’s what happened to the diabetes community and if you’re not familiar with it, it’s a grassroots coming together of people around the world and putting their big brains together and pairing the CGMs not through traditional business ways but just kind of you know, the hashtag as we are not waiting and it just exploded in the past two years. So a lot of people that I work with call it as looper that pairs a continuous glucose monitor with an insulin pump and builds an app on your phone. And that app combines all of the pieces of this system and helps to manipulate and deliver insulin based on parameters that are set by the individual. I mean to me it’s an amazing story. 

 

Yeah, I love it. I love the term looper as well. It sounds pretty  cool and I love the idea that people are not waiting and they’re pushing the boundaries. So as you say this looping approach isn’t led by research or by a company per se? Which is a pretty unusual scenario. What’s the general attitude because I guess you know my experience has been that companies won’t really be able to comment on these things because if it’s not backed by data, they’re restricted in what they can say. Do you have any insight into the attitudes of companies to the concept of looping? 

 

Maybe it was before the pandemic started. There was a joint agreement with the big names in diabetes technology to all play nice with each other. So there is a kind of underlying statement now that at some point we will be able to choose technology to kind of mix and match almost like an ala carte menu like I want this CGM to talk to that pump and kind of create a system. So it was a public announcement that everyone was kind of like, okay, we’re going to play nice with each other. But in terms of loop, one of the really amazing things that has come out of this is that there’s a non profit organization called Tide Pool which has now put this technology to research. I actually was a participant in the study and submitted my data along with Several other 1000 people. And just to really push this to be accessible to everyone around the world. And so tidepool is now sponsoring this technology in hopes of bringing it to the masses in kind of a traditional way, but like the hashtag is we are not waiting, it’s still accessible today, even until that happens. 

 

So you’re a looper right? How did you become a looper? 

 

So ironically, I was at a professional networking dinner and the speaker was the medical director of insulin, who is the manufacturer of the Omnipod pump. And she had just moved from Stanford and I was talking to her and she was like, it was something that was whispered, right? Nobody really kind of talked about. This was four years ago. These were early days of looping. And I just made up my project to find out everything I could. And back then it was a little bit more difficult to build. You had to find a really old vintage medtronic pump that worked on radio waves and could kind of be manipulated. Of course, there weren’t a lot of those that existed. So, I found one that was a little bit more complicated back then. 

 

Now there’s a really beautiful website accessible and detailed and a lot of very generous people with their time have made it accessible to people to follow and learn more about it. However,  when I did it, it was kind of like I was doing something bad, you know? but one of the things about Type one diabetes, and I’m sure you agree, as people are so generous with their time and with their support for other people who have Type one. it’s not a club you really want to join, but if you do join it, you will find some really amazing people. And so, you know, I had someone who helped me and kind of mentored me through. I’ve been doing it ever since. 

 

So what’s your setup like? And what do you use?  I think by the end of this year, the omnipod is going to be on the market in Australia because I got one from the States. 

 

So see, this is what I use for training. Here’s an omni ipod. It holds 200 units of insulin. There’s a small little cannula that goes underneath your skin that delivers insulin. This works on a radio wave. And so the whole idea with loop is that the radio wave needs to be converted to a Bluetooth connection so that it can run on a smartphone. So this radio wave talks to something called an orange link. And this is like a translator. So it’s translating the radio wave to a bluetooth connection. There’s a couple of other kinds of translators that you can get and that do the same job. I happen to use this one. It looks like an air pod case and I put a case on it because I drop it all the time. And so that way is protected. This converts the radio wave to Bluetooth. It also connects to my dexcom continuous glucose monitor that also runs on bluetooth. And then we call an orange link as It’s orange that goes to my smartphone and goes to the app on my phone. 

 

Here you can see a loop app that shows all systems are on the go, I’m looping and things are golden. This shows my blood sugar. So this is my dexcom number. And then this is how much insulin I’m getting from manipulation. So right now I’m running just on a steady course of insulin. I haven’t eaten dinner yet. So it’s projecting. I’ll be 114 in the future. So this number might change a little bit. It might give me a little bit more insulin to keep me steady. This is active insulin. 

 

You’ll see the manipulation may not make so much sense right now, but this is actually my insulin delivery. So I’m getting the baseline as the long straight line. And this is giving me less insulin at some points. And more insulin in the form of these micro boluses which are throughout the day. So a normal functioning pancreas does those micro adjustments all day long. A traditional pump therapy or traditional basil insulin through injections doesn’t make those micro adjustments. Every five minutes, the loop is making a decision: do I need more insulin or do I need less insulin? But the best part about loop is that there are emojis involved. So this is just fine. I gotta fix some parts of diabetes fine. So for example, I’m having a pizza or something like that, I’ll put, you know, the number of grams I’m about to eat and then depending on what I’m eating, there are emojis that match the food absorption.So I know the images are just so fantastic.

 

There’s ways to manipulate the insulin for exercise. I can adjust when you know, when I’m sick or stressed or have high fat foods and so that’s kind of the system in a nutshell. 

 

I’m trying to get the understanding of what the looping part is. So is it just the combination of data?

 

It is  really a combination of the CGM pump and just kind of a closed loop.  And my assumption is that we have always considered artificial pancreas technology needed to be a closed loop that maybe the user wasn’t even involved in carb counting. You know, that would really be the Holy Grail like I’m done with counting carbs and there are some systems that are being used similar to loop. It’s another DIY or Do It Yourself. They work on small, medium and large announcements of carbohydrates and not necessarily fine tuning your carb counting skills, you know, that’s available to the masses. 

 

I think we can call that a big win for all of our work against diabetes because, you know, we don’t have to work so hard for our management. But we’ve got technology that suggests us all the time and we don’t have to work so hard at choosing foods and glycemic index and you know counting carbohydrates and not subtracting fiber. All that goes into your food choices. And then my goodness, if we get glucagon to help with low blood sugars, I think it’s called a day, pack it up.

 

It would be great if we had like how you take a photo of your plant and diagnose what the problem is. If there’s a problem and it helps you fix it.

 

Yeah it would be great. I mean it would be fantastic.  There was an app that was working on it several years ago and I mean talk about something complicated, right? Because like the sheen of the marinade that you’re using and how much sugar is in that food item and I mean there definitely was some attempt. I mean food logs or carb counters on the phone have become so amazing and asking your smartphone assistant, Siri or Alexa google home, I mean they can just do the carb count for you, which I always tell families just ask your technology. So just say, hey Siri, I’m having this brand of pasta and tell me what the amount of carbs it has. 

 

Yeah, that’s a great idea! What about your diet? I wanted to ask you, do you have any special diet? Do you take something in your diet that is different or to manage your diabetes? 

 

Yeah, I get this question a lot. So, I happen to be a pescaterian, so I eat a ton of fish. I eat lots of fruits and vegetables and whole grains. As a dietitian, I definitely have a lot of colorful vegetables and fruit in my diet as someone who lives with type one diabetes. To me, it’s a big cost benefit. What’s the cost of eating an ice cream sundae every night and spiking my blood sugar to the benefit of a taste of the ice cream. And so, you know, there’s a joke in my family that I say, is it insulin worthy? I mean, what is the cost benefit of that chocolate cake? Is it insulin worthy? I’m going to eat it all day long if that’s insulin worthy. But is it always insulin worthy? And that’s definitely something I think about. 

 

I am more comfortable not spiking my sugars up so that does change what I eat. Maybe even at work, I want to be sharp, I don’t want to have a high blood sugar spike. You know, if I go out for a special occasion and I want that ice cream or I want that chocolate cake or I want that huge hamburger, I’m going to eat it. I would not always want to deal with the aftermath. And so for me, that’s how I approach it. I mean everything in moderation is what a good dietician would tell people. And so, you know, if I’m craving for M&M or some sort of gummy bear then that’s what I’m gonna eat, I’m gonna deal with it and strategize my insulin around it. But most of the time I do kind of subscribe to that, 80/20 rule,  80% of the time I’m eating for wellness, I’m eating just to not to deal with my diabetes because I know something is going to strike my blood sugar and 20% of the time such as I’m going on vacation then I’m gonna eat whatever I love to.

 

That’s good to hear. So what’s next for you in terms of the work that you’re doing? What’s the stuff that’s coming up which is exciting for you?

 

Well, it’s the technology for sure, and I’m really passionate about diabetes technology, helping people and reducing the burden of diabetes. That’s what my goal is!  I want to help people manage this very cumbersome, all encompassing diabetes disease. But making it easier through technology.  

 

I think we’re getting closer but my concern is that, you know, it may not be accessible to everyone. So, I want to work to help make it accessible to everyone who wants it and who needs it whether that’s through advocacy, whether it’s through education. That’s my help and kind of the next step because the technology is moving quickly. I don’t think we’ll have a cure, but I think technology will help us feel like we have a cure. I just want to help kind of get that out there. 

 

Your work and contribution is quite commendable, so well done for that!  I think that it’s helpful to have people like you and I’ve learned so much on this call. So you know, I think our listeners will be really grateful to have picked up the odd tidbit from the call.  I can’t thank you enough for your time. 

 

Yeah, absolutely. I am actually pleased to be here. 

 

Where can we find you and do you want to let people know if they are interested to contact you?

 

Yeah. So our website is integrateddiabetes.com and you can reach me directly through email at dana@integrateddiabetes.com. 

 

Thank you so much, enjoy your evening. 

 

Thank you. Take care. Thanks, Dana.

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