DIY Insulin Pumps with Dr Martin de Bock

hi I'm Scott Hansel and this is another hi I'm Scott Hansel and this is another episode of Hansel minutes today I'm episode of Hansel minutes today I'm episode of Hansel minutes today I'm chatting with Dr Martin debach he's an chatting with Dr Martin debach he's an chatting with Dr Martin debach he's an associate professor at the University of associate professor at the University of associate professor at the University of ego in aloa New Zealand and he's a ego in aloa New Zealand and he's a ego in aloa New Zealand and he's a pediatric endocrinologist how are you pediatric endocrinologist how are you pediatric endocrinologist how are you sir good thank you Scott and thanks for sir good thank you Scott and thanks for sir good thank you Scott and thanks for welcoming me on today no this is great welcoming me on today no this is great welcoming me on today no this is great I've been looking forward to with you I've been looking forward to with you I've been looking forward to with you you've done a lot of really really you've done a lot of really really you've done a lot of really really interesting work in the uh diabetes interesting work in the uh diabetes interesting work in the uh diabetes space and you seem to be very kind of um space and you seem to be very kind of um space and you seem to be very kind of um unafraid to try new things and unafraid to try new things and unafraid to try new things and interesting things you've worked with uh interesting things you've worked with uh interesting things you've worked with uh Dana Lewis who is largely considered to Dana Lewis who is largely considered to Dana Lewis who is largely considered to be the Godmother of the open source be the Godmother of the open source be the Godmother of the open source artificial pancreas uh you know movement artificial pancreas uh you know movement artificial pancreas uh you know movement uh I myself am a Looper we call uh I myself am a Looper we call uh I myself am a Looper we call ourselves Looper because I have a closed ourselves Looper because I have a closed ourselves Looper because I have a closed loop open source artificial pancreas loop open source artificial pancreas loop open source artificial pancreas myself and I've had Dana on the show and myself and I've had Dana on the show and myself and I've had Dana on the show and I encourage folks to listen to the I encourage folks to listen to the I encourage folks to listen to the episode that I we had with her and episode that I we had with her and episode that I we had with her and others but um you've worked uh and been others but um you've worked uh and been others but um you've worked uh and been promoting the idea that an insulin pump promoting the idea that an insulin pump promoting the idea that an insulin pump which can cost as much as you know which can cost as much as you know which can cost as much as you know $67,000 us today really shouldn't you $67,000 us today really shouldn't you $67,000 us today really shouldn't you should be able to make your own and should be able to make your own and should be able to make your own and that's such a scary and exciting idea that's such a scary and exciting idea that's such a scary and exciting idea talk to me about all the different talk to me about all the different talk to me about all the different people that were involved and and and people that were involved and and and people that were involved and and and how they had that idea yeah all right so how they had that idea yeah all right so how they had that idea yeah all right so it really came uh born when I arrived it really came uh born when I arrived it really came uh born when I arrived back in Alo New Zealand in 2018 where um back in Alo New Zealand in 2018 where um back in Alo New Zealand in 2018 where um there's a professor here at the there's a professor here at the there's a professor here at the University of Canterbury a mechanical University of Canterbury a mechanical University of Canterbury a mechanical engineer uh Jeff Chase I knew he'd been engineer uh Jeff Chase I knew he'd been engineer uh Jeff Chase I knew he'd been doing a lot of work in the diabetes doing a lot of work in the diabetes doing a lot of work in the diabetes space for quite some time and was really space for quite some time and was really space for quite some time and was really looking for a clinical Champion so I I looking for a clinical Champion so I I looking for a clinical Champion so I I went over and saw him and went up up in went over and saw him and went up up in went over and saw him and went up up in his office and we started talking about

his office and we started talking about his office and we started talking about building hardware and how this could building hardware and how this could building hardware and how this could really revolutionize access uh for really revolutionize access uh for really revolutionize access uh for people if if they're really expensive people if if they're really expensive people if if they're really expensive and keeping in mind that of course the and keeping in mind that of course the and keeping in mind that of course the material cost you pay for for a pump is material cost you pay for for a pump is material cost you pay for for a pump is very different than a commercial cost very different than a commercial cost very different than a commercial cost for lots of reasons we can talk about if for lots of reasons we can talk about if for lots of reasons we can talk about if we need to and we started talking about we need to and we started talking about we need to and we started talking about it and he goes straight away say well it and he goes straight away say well it and he goes straight away say well I'm not going to go in this unless we I'm not going to go in this unless we I'm not going to go in this unless we make it for 100th of the price like that make it for 100th of the price like that make it for 100th of the price like that that was it was immediately straight out that was it was immediately straight out that was it was immediately straight out don't want to make money out of that and don't want to make money out of that and don't want to make money out of that and no point in doing this unless it's 100th no point in doing this unless it's 100th no point in doing this unless it's 100th of the price I was like okay all right of the price I was like okay all right of the price I was like okay all right so he's got an army of PhD students and so he's got an army of PhD students and so he's got an army of PhD students and then we went down this pathway of making then we went down this pathway of making then we went down this pathway of making this uh LEAP program or low cost pump this uh LEAP program or low cost pump this uh LEAP program or low cost pump sort of pathway for type 1 diabetes we sort of pathway for type 1 diabetes we sort of pathway for type 1 diabetes we got a large National Grant uh you on got a large National Grant uh you on got a large National Grant uh you on science challenge grant that bank rol science challenge grant that bank rol science challenge grant that bank rol this development of this whole Space of this development of this whole Space of this development of this whole Space of creating access for more people and it creating access for more people and it creating access for more people and it was not only just building a hardware was not only just building a hardware was not only just building a hardware system but also lots of sort of system but also lots of sort of system but also lots of sort of qualitative work with Healthcare qualitative work with Healthcare qualitative work with Healthcare professionals and people with type one professionals and people with type one professionals and people with type one to figure out what people's tolerability to figure out what people's tolerability to figure out what people's tolerability is around this concept of um a is around this concept of um a is around this concept of um a non-commercially back glossy brocher non-commercially back glossy brocher non-commercially back glossy brocher product if it were to come there what product if it were to come there what product if it were to come there what are the challenges and specific because are the challenges and specific because are the challenges and specific because it's a very complex area yeah as a it's a very complex area yeah as a it's a very complex area yeah as a diabetic myself now for over 32 years diabetic myself now for over 32 years diabetic myself now for over 32 years there is always this sense that no one's there is always this sense that no one's there is always this sense that no one's going to care about my diabetes more going to care about my diabetes more going to care about my diabetes more than than me uh while there are you know than than me uh while there are you know than than me uh while there are you know there are doctors like yourself who care there are doctors like yourself who care there are doctors like yourself who care there's the medical community there are there's the medical community there are there's the medical community there are researchers that care there's always researchers that care there's always researchers that care there's always this sense of being alone and needing to

this sense of being alone and needing to this sense of being alone and needing to take kind of control I like to joke that take kind of control I like to joke that take kind of control I like to joke that um on The Walking Dead uh when the um on The Walking Dead uh when the um on The Walking Dead uh when the zombies come the diabetics usually get zombies come the diabetics usually get zombies come the diabetics usually get eaten first because we need the big eaten first because we need the big eaten first because we need the big machine to make insulin we need it to machine to make insulin we need it to machine to make insulin we need it to make durable medical equipment so the make durable medical equipment so the make durable medical equipment so the idea that one could take control of idea that one could take control of idea that one could take control of their their diabetes with do-it-yourself their their diabetes with do-it-yourself their their diabetes with do-it-yourself things is is interesting however for things is is interesting however for things is is interesting however for many many years I just took shots why is many many years I just took shots why is many many years I just took shots why is time and range important and why can't time and range important and why can't time and range important and why can't we all Quote just take shots that's we all Quote just take shots that's we all Quote just take shots that's super important a good great question super important a good great question super important a good great question and and there's so much evidence now and and there's so much evidence now and and there's so much evidence now behind that automation Beyond injections behind that automation Beyond injections behind that automation Beyond injections gets you healthy glucose levels without gets you healthy glucose levels without gets you healthy glucose levels without burden and and that's the key thing burden and and that's the key thing burden and and that's the key thing really I mean everybody everybody even really I mean everybody everybody even really I mean everybody everybody even on shots not everybody but a lot of on shots not everybody but a lot of on shots not everybody but a lot of people could achieve you know healthy people could achieve you know healthy people could achieve you know healthy hpy within Target using shots but you'd hpy within Target using shots but you'd hpy within Target using shots but you'd have to live a very restrictive life and have to live a very restrictive life and have to live a very restrictive life and then you're sort of um bargaining for then you're sort of um bargaining for then you're sort of um bargaining for your quality of life versus quantity your quality of life versus quantity your quality of life versus quantity right so um we need to remove that right so um we need to remove that right so um we need to remove that bargain need to have both uh which which bargain need to have both uh which which bargain need to have both uh which which is what automation has really done in is what automation has really done in is what automation has really done in the space while we wait for the very the space while we wait for the very the space while we wait for the very smart immunologists to come up with that smart immunologists to come up with that smart immunologists to come up with that solution for us that will be the real solution for us that will be the real solution for us that will be the real cure we have a technology cure to a cure we have a technology cure to a cure we have a technology cure to a degree where we can get healthy glycemia degree where we can get healthy glycemia degree where we can get healthy glycemia that allows to longing longevity with that allows to longing longevity with that allows to longing longevity with top by Hing healthy glycemia without top by Hing healthy glycemia without top by Hing healthy glycemia without burden or a burden anyway so for those burden or a burden anyway so for those burden or a burden anyway so for those that are listening who are not diabetic that are listening who are not diabetic that are listening who are not diabetic who may not understand uh the analogy I who may not understand uh the analogy I who may not understand uh the analogy I usually use is like staying in the lane usually use is like staying in the lane usually use is like staying in the lane on the freeway and you've got people on the freeway and you've got people on the freeway and you've got people claiming to have autod driving cars but

claiming to have autod driving cars but claiming to have autod driving cars but they're really just kind of line they're really just kind of line they're really just kind of line followers they they know how to stay in followers they they know how to stay in followers they they know how to stay in the lane um and there are algorithms now the lane um and there are algorithms now the lane um and there are algorithms now that can help diabetics stay in the lane that can help diabetics stay in the lane that can help diabetics stay in the lane they're not complete self driving cars they're not complete self driving cars they're not complete self driving cars but they'll at least kind of like notice but they'll at least kind of like notice but they'll at least kind of like notice you floating out of the lane and you floating out of the lane and you floating out of the lane and floating back in and is that a good floating back in and is that a good floating back in and is that a good analogy does that Mak sense absolutely analogy does that Mak sense absolutely analogy does that Mak sense absolutely I've Ed that um that same metaphor a lot I've Ed that um that same metaphor a lot I've Ed that um that same metaphor a lot and it's very similar where the car and it's very similar where the car and it's very similar where the car engine is your your inulin pump that's engine is your your inulin pump that's engine is your your inulin pump that's what's driving things along the car what's driving things along the car what's driving things along the car sensors uh the continuous glucose sensors uh the continuous glucose sensors uh the continuous glucose monitor that you have uh as a person monitor that you have uh as a person monitor that you have uh as a person with diabetes that is a measuring if with diabetes that is a measuring if with diabetes that is a measuring if you're going to go outside those lines you're going to go outside those lines you're going to go outside those lines uh and then they feed together with a uh and then they feed together with a uh and then they feed together with a with an algorithm or computer program with an algorithm or computer program with an algorithm or computer program which would be your chip and your your which would be your chip and your your which would be your chip and your your fancy electronic car um that does the fancy electronic car um that does the fancy electronic car um that does the autoc correcting in with a car you know autoc correcting in with a car you know autoc correcting in with a car you know it's that auto steering back in or the it's that auto steering back in or the it's that auto steering back in or the vibrating steering wheel would you it vibrating steering wheel would you it vibrating steering wheel would you it depends on which model of electric car depends on which model of electric car depends on which model of electric car or self-driving car you have but very or self-driving car you have but very or self-driving car you have but very similar um absolutely it's a great similar um absolutely it's a great similar um absolutely it's a great metaphor and very understandable yeah metaphor and very understandable yeah metaphor and very understandable yeah and when you're driving a car and you're and when you're driving a car and you're and when you're driving a car and you're trying to stay in the lane you're not trying to stay in the lane you're not trying to stay in the lane you're not realizing that you're making tiny little realizing that you're making tiny little realizing that you're making tiny little adjustments every few minutes but if you adjustments every few minutes but if you adjustments every few minutes but if you take a shot or you are controlling your take a shot or you are controlling your take a shot or you are controlling your your diabetes with shots and food shots your diabetes with shots and food shots your diabetes with shots and food shots bring your blood sugar down food makes bring your blood sugar down food makes bring your blood sugar down food makes it go up you're you tend to be making it go up you're you tend to be making it go up you're you tend to be making big moves big jerky moves as you you big moves big jerky moves as you you big moves big jerky moves as you you know take a shot eat a bunch of food know take a shot eat a bunch of food know take a shot eat a bunch of food what does an insulin pump do to make what does an insulin pump do to make what does an insulin pump do to make that less jerky yeah it's really good that less jerky yeah it's really good that less jerky yeah it's really good there's really there's nice data to say there's really there's nice data to say there's really there's nice data to say that for a person living with type one that for a person living with type one that for a person living with type one you're making over 100 health related you're making over 100 health related you're making over 100 health related decisions a day just to try and stay in

decisions a day just to try and stay in decisions a day just to try and stay in the lane right that's unsustainable so the lane right that's unsustainable so the lane right that's unsustainable so you get this term that we call diabetes you get this term that we call diabetes you get this term that we call diabetes burnout clly happens after a couple burnout clly happens after a couple burnout clly happens after a couple years of type one um but can happen any years of type one um but can happen any years of type one um but can happen any time and some life and it's episodic time and some life and it's episodic time and some life and it's episodic even with people who are really well even with people who are really well even with people who are really well controlled and sustained for a long time controlled and sustained for a long time controlled and sustained for a long time will go through periods of just being will go through periods of just being will go through periods of just being against the W and being really fatigued against the W and being really fatigued against the W and being really fatigued by the constant decision- making process by the constant decision- making process by the constant decision- making process in my op I don't have the self uh in my op I don't have the self uh in my op I don't have the self uh acknowledgement I don't have type one so acknowledgement I don't have type one so acknowledgement I don't have type one so I don't have a experience so um it's I don't have a experience so um it's I don't have a experience so um it's really important for me to acknowledge really important for me to acknowledge really important for me to acknowledge that that I can't um share that feeling that that I can't um share that feeling that that I can't um share that feeling of those constant decisions but what I of those constant decisions but what I of those constant decisions but what I can see objectively is that when you can see objectively is that when you can see objectively is that when you take micro decisions away from somebody take micro decisions away from somebody take micro decisions away from somebody um it frees up the rest of their mind to um it frees up the rest of their mind to um it frees up the rest of their mind to deal with whatever else is going in deal with whatever else is going in deal with whatever else is going in their life to make it easier so that their life to make it easier so that their life to make it easier so that might be easy decisions around making might be easy decisions around making might be easy decisions around making Healthy nutrition choices or easier Healthy nutrition choices or easier Healthy nutrition choices or easier decisions about exercise or their jobs decisions about exercise or their jobs decisions about exercise or their jobs or whatever else is going on in the or whatever else is going on in the or whatever else is going on in the world if you're not micromanaging type world if you're not micromanaging type world if you're not micromanaging type one or opposite giving up and then one or opposite giving up and then one or opposite giving up and then letting your glycemia dictate the way letting your glycemia dictate the way letting your glycemia dictate the way that your life is L so trusting into a that your life is L so trusting into a that your life is L so trusting into a system like that we can talk about that system like that we can talk about that system like that we can talk about that if we need to but algorithms definitely if we need to but algorithms definitely if we need to but algorithms definitely are better at doing that on a micro time are better at doing that on a micro time are better at doing that on a micro time zone than our own human brain just zone than our own human brain just zone than our own human brain just because we've got got so many other because we've got got so many other because we've got got so many other things that prioritize that yeah that is things that prioritize that yeah that is things that prioritize that yeah that is extremely true uh I haven't had a formal extremely true uh I haven't had a formal extremely true uh I haven't had a formal burnout but I I refer to the psychic burnout but I I refer to the psychic burnout but I I refer to the psychic weight of the diabetes pressing down on weight of the diabetes pressing down on weight of the diabetes pressing down on you uh since I'm a programmer in my in you uh since I'm a programmer in my in you uh since I'm a programmer in my in my day job the analogy I usually give is my day job the analogy I usually give is my day job the analogy I usually give is opening up like task manager on your opening up like task manager on your opening up like task manager on your computer and going hey what's using up

computer and going hey what's using up computer and going hey what's using up 20% of my CPU well that's that's 20% of my CPU well that's that's 20% of my CPU well that's that's diabetes and you can't you know so I diabetes and you can't you know so I diabetes and you can't you know so I only have 80% of my CPU available to only have 80% of my CPU available to only have 80% of my CPU available to like live while you may have more but like live while you may have more but like live while you may have more but all the different things in your life all the different things in your life all the different things in your life that equal like the stress of the pie that equal like the stress of the pie that equal like the stress of the pie chart of your existence uh you know when chart of your existence uh you know when chart of your existence uh you know when you unpack all of your privileges and you unpack all of your privileges and you unpack all of your privileges and try to figure out how much overhead do try to figure out how much overhead do try to figure out how much overhead do you have I'd really love to have a you have I'd really love to have a you have I'd really love to have a little more yeah and if I may just let little more yeah and if I may just let little more yeah and if I may just let me digress for a moment like when I I me digress for a moment like when I I me digress for a moment like when I I see a lot of I'm a pediatric see a lot of I'm a pediatric see a lot of I'm a pediatric endocrinologist mainly see young people endocrinologist mainly see young people endocrinologist mainly see young people um with type one I see teenagers who are um with type one I see teenagers who are um with type one I see teenagers who are who may be might be struggling right and who may be might be struggling right and who may be might be struggling right and then I talked about how to motivate then I talked about how to motivate then I talked about how to motivate people on a day-to-day basis because people on a day-to-day basis because people on a day-to-day basis because longterm complications aren't a good longterm complications aren't a good longterm complications aren't a good motivator we never Ed and about how to motivator we never Ed and about how to motivator we never Ed and about how to be be your own person and I often talk be be your own person and I often talk be be your own person and I often talk about you know people when they're 16 17 about you know people when they're 16 17 about you know people when they're 16 17 care about what people think of them care about what people think of them care about what people think of them right so I I create this hypothetical right so I I create this hypothetical right so I I create this hypothetical situation so let's say you're applying situation so let's say you're applying situation so let's say you're applying for a job and you're a Johnny and you've for a job and you're a Johnny and you've for a job and you're a Johnny and you've got type one diabetes and uh your A1C is got type one diabetes and uh your A1C is got type one diabetes and uh your A1C is awesome so your gling is great and then awesome so your gling is great and then awesome so your gling is great and then you've got Jeremy it's got the same CV you've got Jeremy it's got the same CV you've got Jeremy it's got the same CV as you everything looks the same as you everything looks the same as you everything looks the same everything's the same but he doesn't everything's the same but he doesn't everything's the same but he doesn't have type 1 diabetes and they say which have type 1 diabetes and they say which have type 1 diabetes and they say which one will I employ and I usually go oh one will I employ and I usually go oh one will I employ and I usually go oh the guy without diabetes I well no the guy without diabetes I well no the guy without diabetes I well no actually I'm prob the guy with diabetes actually I'm prob the guy with diabetes actually I'm prob the guy with diabetes because you've had it way hard jemy had because you've had it way hard jemy had because you've had it way hard jemy had it easy to get H like you don't need to it easy to get H like you don't need to it easy to get H like you don't need to wear it as a badge of honor but it's a wear it as a badge of honor but it's a wear it as a badge of honor but it's a recognition of how much work and how recognition of how much work and how recognition of how much work and how much I guess organization how much you much I guess organization how much you much I guess organization how much you look after yourself and and those sorts look after yourself and and those sorts look after yourself and and those sorts of character traits that you can express of character traits that you can express of character traits that you can express in a job or in a relationship or

in a job or in a relationship or in a job or in a relationship or anything um and sometimes that seats and anything um and sometimes that seats and anything um and sometimes that seats and as as a motivational tool to say look as as a motivational tool to say look as as a motivational tool to say look you if you if you improve your glass you you if you if you improve your glass you you if you if you improve your glass you do a little bit more work how it can do a little bit more work how it can do a little bit more work how it can open things up for you rather than open things up for you rather than open things up for you rather than having doors closed as a young person having doors closed as a young person having doors closed as a young person keep your life open yeah it does feel keep your life open yeah it does feel keep your life open yeah it does feel like living life on hard mode or at like living life on hard mode or at like living life on hard mode or at least medium mode sometimes there there least medium mode sometimes there there least medium mode sometimes there there are days when it really takes a lot out are days when it really takes a lot out are days when it really takes a lot out of you y yep and this is what this whole of you y yep and this is what this whole of you y yep and this is what this whole uh automation is about let's minimize uh automation is about let's minimize uh automation is about let's minimize those days and minimize those micro those days and minimize those micro those days and minimize those micro decisions right so we talk about time decisions right so we talk about time decisions right so we talk about time and range and you're talking about one's and range and you're talking about one's and range and you're talking about one's you know glycemia one's management of you know glycemia one's management of you know glycemia one's management of the sugar again to try to make sure that the sugar again to try to make sure that the sugar again to try to make sure that the the normally sugared the Muggles the the normally sugared the Muggles the the normally sugared the Muggles that may be listening understand what that may be listening understand what that may be listening understand what we're talking about we're trying and we're talking about we're trying and we're talking about we're trying and correct me if I'm wrong to simulate correct me if I'm wrong to simulate correct me if I'm wrong to simulate having a working pancreas people are having a working pancreas people are having a working pancreas people are always telling me I should you know take always telling me I should you know take always telling me I should you know take cinnamon or eat chocolate or have do you cinnamon or eat chocolate or have do you cinnamon or eat chocolate or have do you know atic yoga I have a non-working know atic yoga I have a non-working know atic yoga I have a non-working pancreas correct it is a vestigal organ pancreas correct it is a vestigal organ pancreas correct it is a vestigal organ that is doing very little for me right that is doing very little for me right that is doing very little for me right now yeah yeah well let's be more now yeah yeah well let's be more now yeah yeah well let's be more specific the beta C okay so this the specific the beta C okay so this the specific the beta C okay so this the pancreas does many things but and in pancreas does many things but and in pancreas does many things but and in type 1 diabetes the the beta cell which type 1 diabetes the the beta cell which type 1 diabetes the the beta cell which makes insulin is the is and it's only makes insulin is the is and it's only makes insulin is the is and it's only one component of glucose metabolism but one component of glucose metabolism but one component of glucose metabolism but are really like one of the major are really like one of the major are really like one of the major obviously um strongest influence on obviously um strongest influence on obviously um strongest influence on especially after you've eaten so you especially after you've eaten so you especially after you've eaten so you were trying to simulate what that beta were trying to simulate what that beta were trying to simulate what that beta cell that you no longer have does so cell that you no longer have does so cell that you no longer have does so your glucose goes up and a person your glucose goes up and a person your glucose goes up and a person without diabetes your beta cell sees without diabetes your beta cell sees without diabetes your beta cell sees that or sees that increased glucose that or sees that increased glucose that or sees that increased glucose delivery to the bloodstream from the delivery to the bloodstream from the delivery to the bloodstream from the food you've eaten carbohydrate

food you've eaten carbohydrate food you've eaten carbohydrate specifically and produces more insulin specifically and produces more insulin specifically and produces more insulin uh to try and stop that glucose from uh to try and stop that glucose from uh to try and stop that glucose from going Soo high and it's super going Soo high and it's super going Soo high and it's super interesting that whole insulin mechanism interesting that whole insulin mechanism interesting that whole insulin mechanism around energy and glucose metabolism is around energy and glucose metabolism is around energy and glucose metabolism is highly preserved through all of highly preserved through all of highly preserved through all of evolution actually some of the simplest evolution actually some of the simplest evolution actually some of the simplest bacterial organisms that have a very bacterial organisms that have a very bacterial organisms that have a very similar likee pathway so it's a such a similar likee pathway so it's a such a similar likee pathway so it's a such a crucial part of being alive and living crucial part of being alive and living crucial part of being alive and living on this planet so it's something you got on this planet so it's something you got on this planet so it's something you got mdle with uh and you need to you need to mdle with uh and you need to you need to mdle with uh and you need to you need to be replacing it because there's no other be replacing it because there's no other be replacing it because there's no other solution cinnamon isn't going to fix solution cinnamon isn't going to fix solution cinnamon isn't going to fix this unfortunately yeah everything that this unfortunately yeah everything that this unfortunately yeah everything that I eat whether I eat sugar or I eat meat I eat whether I eat sugar or I eat meat I eat whether I eat sugar or I eat meat it's going to turn into glucose at some it's going to turn into glucose at some it's going to turn into glucose at some point and it's going to enter the point and it's going to enter the point and it's going to enter the bloodstream and if I don't get it out of bloodstream and if I don't get it out of bloodstream and if I don't get it out of the bloodstream I'm effectively the bloodstream I'm effectively the bloodstream I'm effectively marinating in my own sugar and all kinds marinating in my own sugar and all kinds marinating in my own sugar and all kinds of bad things happen at that point yeah of bad things happen at that point yeah of bad things happen at that point yeah I yeah it's like swimming three maple I yeah it's like swimming three maple I yeah it's like swimming three maple syrup right it's pretty tricky yeah it syrup right it's pretty tricky yeah it syrup right it's pretty tricky yeah it feels like that too of course so then I feels like that too of course so then I feels like that too of course so then I need and a type 1 diabetic needs uh and need and a type 1 diabetic needs uh and need and a type 1 diabetic needs uh and is the word exogenous insulin external is the word exogenous insulin external is the word exogenous insulin external insulin exogenous so insulin from the a insulin exogenous so insulin from the a insulin exogenous so insulin from the a yeah I it might be different if you I yeah I it might be different if you I yeah I it might be different if you I don't know if Americans I don't know you don't know if Americans I don't know you don't know if Americans I don't know you know aluminium and all that right we know aluminium and all that right we know aluminium and all that right we call it exogenous and you know which call it exogenous and you know which call it exogenous and you know which just means from the outside yeah and we just means from the outside yeah and we just means from the outside yeah and we can't use it unfortunately we can't take can't use it unfortunately we can't take can't use it unfortunately we can't take it as a pill we can't rub it on it's a it as a pill we can't rub it on it's a it as a pill we can't rub it on it's a cream it has to be injected into the cream it has to be injected into the cream it has to be injected into the subcutaneous tissu that's the fat tissue subcutaneous tissu that's the fat tissue subcutaneous tissu that's the fat tissue just under your skin H and you can do just under your skin H and you can do just under your skin H and you can do that with injections which we' talked that with injections which we' talked that with injections which we' talked about but also through insulin pumps about but also through insulin pumps about but also through insulin pumps where the where the little infusion where the where the little infusion where the where the little infusion canul that just goes underneath the skin canul that just goes underneath the skin canul that just goes underneath the skin uh typically worn on the abdomen okay

uh typically worn on the abdomen okay uh typically worn on the abdomen okay and we don't have I don't carry an IV I and we don't have I don't carry an IV I and we don't have I don't carry an IV I don't have this in my veins that would don't have this in my veins that would don't have this in my veins that would be problematic to walk around with uh be problematic to walk around with uh be problematic to walk around with uh this IV but I can we can have a hole in this IV but I can we can have a hole in this IV but I can we can have a hole in ourselves at least in the fat with this ourselves at least in the fat with this ourselves at least in the fat with this little plastic canula why is one okay little plastic canula why is one okay little plastic canula why is one okay and one is not because the human body's and one is not because the human body's and one is not because the human body's really good at getting rid of stuff really good at getting rid of stuff really good at getting rid of stuff that's not in it right it shouldn't be that's not in it right it shouldn't be that's not in it right it shouldn't be in it uh and blood vessels particularly in it uh and blood vessels particularly in it uh and blood vessels particularly and also you if you your best immune and also you if you your best immune and also you if you your best immune thing that you have on your body is your thing that you have on your body is your thing that you have on your body is your skin right uh so if you create a hole in skin right uh so if you create a hole in skin right uh so if you create a hole in it you break your immune system and if it you break your immune system and if it you break your immune system and if that hole goes all the way through the that hole goes all the way through the that hole goes all the way through the bloodstream you have a risk of inducing bloodstream you have a risk of inducing bloodstream you have a risk of inducing infe into the bloodstream and also infe into the bloodstream and also infe into the bloodstream and also creating clots in that in that creating clots in that in that creating clots in that in that bloodstream which is why if you've ever bloodstream which is why if you've ever bloodstream which is why if you've ever been to a hospital for an IV drip or an been to a hospital for an IV drip or an been to a hospital for an IV drip or an IV canul they only last a day or so and IV canul they only last a day or so and IV canul they only last a day or so and they're being replaced and often get they're being replaced and often get they're being replaced and often get infected and red and inflamed if any of infected and red and inflamed if any of infected and red and inflamed if any of you our listeners have experienced an i you our listeners have experienced an i you our listeners have experienced an i line usually it's not just a simple line usually it's not just a simple line usually it's not just a simple thing that lasts for as long as you need thing that lasts for as long as you need thing that lasts for as long as you need it it needs to be very carefully managed it it needs to be very carefully managed it it needs to be very carefully managed so um right intravenous it it would so um right intravenous it it would so um right intravenous it it would solve a lot of problems in terms of how solve a lot of problems in terms of how solve a lot of problems in terms of how we have it uh the house how fast insulin we have it uh the house how fast insulin we have it uh the house how fast insulin works but it's not a sustainable way to works but it's not a sustainable way to works but it's not a sustainable way to give insulin because of those give insulin because of those give insulin because of those okay so then you have an insulin pump okay so then you have an insulin pump okay so then you have an insulin pump which has a canula which is kind of like which has a canula which is kind of like which has a canula which is kind of like a needle but it's a little plastic piece a needle but it's a little plastic piece a needle but it's a little plastic piece that is left in or steel yeah or steel that is left in or steel yeah or steel that is left in or steel yeah or steel can steel or plastic the steel is a can steel or plastic the steel is a can steel or plastic the steel is a really tiny little thing you don't feel really tiny little thing you don't feel really tiny little thing you don't feel it uh so um yep and then this is sitting it uh so um yep and then this is sitting it uh so um yep and then this is sitting in your body I I've had my insulin pumps in your body I I've had my insulin pumps in your body I I've had my insulin pumps on earlier versions for you know 7 to 10 on earlier versions for you know 7 to 10 on earlier versions for you know 7 to 10 days without any issues I currently use days without any issues I currently use days without any issues I currently use a pump called an omnipod for three to a pump called an omnipod for three to a pump called an omnipod for three to four days with with no issues but that

four days with with no issues but that four days with with no issues but that that piece though that plastic canula that piece though that plastic canula that piece though that plastic canula and the tubing that is going to be and the tubing that is going to be and the tubing that is going to be sterile that's a piece of replaceable sterile that's a piece of replaceable sterile that's a piece of replaceable and I have to throw it away if I'm going and I have to throw it away if I'm going and I have to throw it away if I'm going to start printing or creating my own to start printing or creating my own to start printing or creating my own insulin pump are there going to be insulin pump are there going to be insulin pump are there going to be pieces I'm going to have to throw in pieces I'm going to have to throw in pieces I'm going to have to throw in replace and how am I going to deal with replace and how am I going to deal with replace and how am I going to deal with that yeah absolutely so the you need a that yeah absolutely so the you need a that yeah absolutely so the you need a system that will I guess use either a system that will I guess use either a system that will I guess use either a commercial product that you decide to commercial product that you decide to commercial product that you decide to put on your block oful pump that you've put on your block oful pump that you've put on your block oful pump that you've created and certainly though bad as created and certainly though bad as created and certainly though bad as possible pulon pumps generally if you possible pulon pumps generally if you possible pulon pumps generally if you don't count up a patch pump which you're don't count up a patch pump which you're don't count up a patch pump which you're using um I just seren drivers using um I just seren drivers using um I just seren drivers effectively um some of them are a little effectively um some of them are a little effectively um some of them are a little bit more complex and things of the bit more complex and things of the bit more complex and things of the Machinery they use but you're just Machinery they use but you're just Machinery they use but you're just pushing a PL down and so that system is pushing a PL down and so that system is pushing a PL down and so that system is pretty generic really so um opposer pretty generic really so um opposer pretty generic really so um opposer driving device okay so that's a good driving device okay so that's a good driving device okay so that's a good that's a good thing to understand for that's a good thing to understand for that's a good thing to understand for folks to visualize since this is an folks to visualize since this is an folks to visualize since this is an audio podcast you're pushing against a a audio podcast you're pushing against a a audio podcast you're pushing against a a syringe uh that is a plunger and that syringe uh that is a plunger and that syringe uh that is a plunger and that plunger though it needs to be done at plunger though it needs to be done at plunger though it needs to be done at submillimeter very very accurate type submillimeter very very accurate type submillimeter very very accurate type stuff and if it gets bumped or if it stuff and if it gets bumped or if it stuff and if it gets bumped or if it doesn't you know you could cause some doesn't you know you could cause some doesn't you know you could cause some real serious issues if you overdosed real serious issues if you overdosed real serious issues if you overdosed someone on insulin you'd give them at someone on insulin you'd give them at someone on insulin you'd give them at the very least a bad day yeah yeah yeah the very least a bad day yeah yeah yeah the very least a bad day yeah yeah yeah so absolutely so you create robust uh so absolutely so you create robust uh so absolutely so you create robust uh robust Hardware around that and you have robust Hardware around that and you have robust Hardware around that and you have an engine that allows accurate um an engine that allows accurate um an engine that allows accurate um delivery and so that's important if delivery and so that's important if delivery and so that's important if you're thinking about developing the you're thinking about developing the you're thinking about developing the system that you test that uh and you system that you test that uh and you system that you test that uh and you test its accuracy against um against test its accuracy against um against test its accuracy against um against standards uh either set by other pumps standards uh either set by other pumps standards uh either set by other pumps or actually there are international

or actually there are international or actually there are international standards for these kinds of systems standards for these kinds of systems standards for these kinds of systems about what level of accuracy you need uh about what level of accuracy you need uh about what level of accuracy you need uh for it to be um used as a house for it to be um used as a house for it to be um used as a house delivering um I guess the device yeah delivering um I guess the device yeah delivering um I guess the device yeah now I realize that you're not an now I realize that you're not an now I realize that you're not an engineer you partnered with an engineer engineer you partnered with an engineer engineer you partnered with an engineer and with a set of PhD students in and with a set of PhD students in and with a set of PhD students in engineering but it does seem like some engineering but it does seem like some engineering but it does seem like some in the last I don't know five or 10 in the last I don't know five or 10 in the last I don't know five or 10 years like quality of stepper Motors years like quality of stepper Motors years like quality of stepper Motors gearboxes uh being able to purchase a gearboxes uh being able to purchase a gearboxes uh being able to purchase a motor in in this case you have one that motor in in this case you have one that motor in in this case you have one that you get from China that really can you get from China that really can you get from China that really can perform for many many many years at an perform for many many many years at an perform for many many many years at an incredibly high accuracy I don't think incredibly high accuracy I don't think incredibly high accuracy I don't think we could have done that 20 or 30 years we could have done that 20 or 30 years we could have done that 20 or 30 years ago something happened in the last few ago something happened in the last few ago something happened in the last few years I wonder if it was 3D printers years I wonder if it was 3D printers years I wonder if it was 3D printers that made that possible yeah who knows I that made that possible yeah who knows I that made that possible yeah who knows I I I do not have the expertise or the I I do not have the expertise or the I I do not have the expertise or the industry knowledge to know what that industry knowledge to know what that industry knowledge to know what that evolutionary step was in terms of of evolutionary step was in terms of of evolutionary step was in terms of of Hardware manufacturing but there's Hardware manufacturing but there's Hardware manufacturing but there's another point to this that you allude to another point to this that you allude to another point to this that you allude to for example about it's longevity uh for example about it's longevity uh for example about it's longevity uh longevity would be an issue if you have longevity would be an issue if you have longevity would be an issue if you have a machine that cost you $5,000 or a machine that cost you $5,000 or a machine that cost you $5,000 or $10,000 but if your machine costs you $10,000 but if your machine costs you $10,000 but if your machine costs you $80 and your longevity lasts shorter $80 and your longevity lasts shorter $80 and your longevity lasts shorter it's less of a an emotion will tie to an it's less of a an emotion will tie to an it's less of a an emotion will tie to an expensive unit you're more forgiving of expensive unit you're more forgiving of expensive unit you're more forgiving of something the cheaper it is so you need something the cheaper it is so you need something the cheaper it is so you need to find a from if you're a person to find a from if you're a person to find a from if you're a person dealing with machine it's like going in dealing with machine it's like going in dealing with machine it's like going in the hardware store right if you buy a the hardware store right if you buy a the hardware store right if you buy a drill set if you go and get the cheapest drill set if you go and get the cheapest drill set if you go and get the cheapest one off the shelf you have an one off the shelf you have an one off the shelf you have an expectation that okay this might only expectation that okay this might only expectation that okay this might only lasts for six or eight months but that's lasts for six or eight months but that's lasts for six or eight months but that's okay because I can grab another one or okay because I can grab another one or okay because I can grab another one or you can go to the most expensive one you can go to the most expensive one you can go to the most expensive one that's got all its thing and maybe that that's got all its thing and maybe that that's got all its thing and maybe that will last longer and that's a very will last longer and that's a very will last longer and that's a very personalized choice about what you do or personalized choice about what you do or personalized choice about what you do or it might be a factor of your Current it might be a factor of your Current it might be a factor of your Current financial situation and which takes in a

financial situation and which takes in a financial situation and which takes in a a very a whole different meaning of a very a whole different meaning of a very a whole different meaning of personalized care in terms of what your personalized care in terms of what your personalized care in terms of what your current situation is which is a really current situation is which is a really current situation is which is a really interesting concept you know that is a interesting concept you know that is a interesting concept you know that is a really great point to call out because really great point to call out because really great point to call out because you know I'm going to feel one way about you know I'm going to feel one way about you know I'm going to feel one way about a $30 Android phone that I get at a $30 Android phone that I get at a $30 Android phone that I get at Walmart versus the latest and most fancy Walmart versus the latest and most fancy Walmart versus the latest and most fancy iPhone and if I'm a child because you're iPhone and if I'm a child because you're iPhone and if I'm a child because you're involved in pediatric uh Endocrinology I involved in pediatric uh Endocrinology I involved in pediatric uh Endocrinology I might be concerned that I'm going to put might be concerned that I'm going to put might be concerned that I'm going to put a $6,000 insulin pump you know in a a $6,000 insulin pump you know in a a $6,000 insulin pump you know in a pocket pouch on a 5-year-old and send pocket pouch on a 5-year-old and send pocket pouch on a 5-year-old and send them off into the under the ocean oh them off into the under the ocean oh them off into the under the ocean oh yeah the first thing you're doing is yeah the first thing you're doing is yeah the first thing you're doing is ringing your insurance company right and ringing your insurance company right and ringing your insurance company right and figuring out what your insurance policy figuring out what your insurance policy figuring out what your insurance policy is should you be the one at vot for is should you be the one at vot for is should you be the one at vot for destroying it P and obviously commercial destroying it P and obviously commercial destroying it P and obviously commercial pumps are really they're pretty pumps are really they're pretty pumps are really they're pretty industrial strength it's pretty hard to industrial strength it's pretty hard to industrial strength it's pretty hard to smash them but we see smash pumps regly smash them but we see smash pumps regly smash them but we see smash pumps regly yeah so access has been super important yeah so access has been super important yeah so access has been super important and you have uh actually done studies and you have uh actually done studies and you have uh actually done studies across folks in New Zealand that have across folks in New Zealand that have across folks in New Zealand that have different races different economic different races different economic different races different economic environments and have found that folks environments and have found that folks environments and have found that folks that have less access have less Health that have less access have less Health that have less access have less Health outcomes like they have negative Health outcomes like they have negative Health outcomes like they have negative Health outcomes yeah and that's seen globally outcomes yeah and that's seen globally outcomes yeah and that's seen globally and what's interesting we did one step and what's interesting we did one step and what's interesting we did one step further we took AC crosssectional status further we took AC crosssectional status further we took AC crosssectional status of all the people living in New Zealand of all the people living in New Zealand of all the people living in New Zealand and saw those who were using technology and saw those who were using technology and saw those who were using technology and not technology and found that it was and not technology and found that it was and not technology and found that it was a great equalizer so the disparity You' a great equalizer so the disparity You' a great equalizer so the disparity You' seen between low socioeconomic status seen between low socioeconomic status seen between low socioeconomic status and high soci social economic status or and high soci social economic status or and high soci social economic status or by ethnicity often minorities have lower by ethnicity often minorities have lower by ethnicity often minorities have lower socionomic status and poor outcomes you socionomic status and poor outcomes you socionomic status and poor outcomes you see that difference AAR quite see that difference AAR quite see that difference AAR quite considerably actually for our ethnic

considerably actually for our ethnic considerably actually for our ethnic minority our most importantly now minority our most importantly now minority our most importantly now founding I guess native indigenous founding I guess native indigenous founding I guess native indigenous population newel Marty we found that CGM population newel Marty we found that CGM population newel Marty we found that CGM for example on its own which is for example on its own which is for example on its own which is continuous glos monitoring removes the continuous glos monitoring removes the continuous glos monitoring removes the difference based that would be predicted difference based that would be predicted difference based that would be predicted on social economic status or ethnicity on social economic status or ethnicity on social economic status or ethnicity um that's a really important message to um that's a really important message to um that's a really important message to get out access is so important and get out access is so important and get out access is so important and something that needs to be uh it's a something that needs to be uh it's a something that needs to be uh it's a global problem that needs to be sorted global problem that needs to be sorted global problem that needs to be sorted yeah cgm's uh continuous glucose meters yeah cgm's uh continuous glucose meters yeah cgm's uh continuous glucose meters the idea that I don't have to prick my the idea that I don't have to prick my the idea that I don't have to prick my finger I used to prick my fingers you finger I used to prick my fingers you finger I used to prick my fingers you know 10 15 times a day knowing full well know 10 15 times a day knowing full well know 10 15 times a day knowing full well that each time I pricked my finger it that each time I pricked my finger it that each time I pricked my finger it was costing me a dollar this like that was costing me a dollar this like that was costing me a dollar this like that was signifant and and there are those was signifant and and there are those was signifant and and there are those still to this day who ration their still to this day who ration their still to this day who ration their finger sticks because they know it's a finger sticks because they know it's a finger sticks because they know it's a buck every time cgms can check your buck every time cgms can check your buck every time cgms can check your blood sugar via interstitial fluid every blood sugar via interstitial fluid every blood sugar via interstitial fluid every five minutes and it's it's huge it is an five minutes and it's it's huge it is an five minutes and it's it's huge it is an absolute GameChanger but it's largely absolute GameChanger but it's largely absolute GameChanger but it's largely only available in Australia New Zealand only available in Australia New Zealand only available in Australia New Zealand and then the Northern Hemisphere yes and then the Northern Hemisphere yes and then the Northern Hemisphere yes absolutely so so that's a problem but absolutely so so that's a problem but absolutely so so that's a problem but it's a problem that luckily or hopefully it's a problem that luckily or hopefully it's a problem that luckily or hopefully in technology which is slightly in technology which is slightly in technology which is slightly different than Pharmaceuticals is that different than Pharmaceuticals is that different than Pharmaceuticals is that technology as it becomes created on mass technology as it becomes created on mass technology as it becomes created on mass it tends to drive prices down where we it tends to drive prices down where we it tends to drive prices down where we don't see that in Pharmacology unless don't see that in Pharmacology unless don't see that in Pharmacology unless you come off patent and come into you come off patent and come into you come off patent and come into generics which takes a long time we're generics which takes a long time we're generics which takes a long time we're seing increasing competition in the CGM seing increasing competition in the CGM seing increasing competition in the CGM Market uh a lot of startups coming in Market uh a lot of startups coming in Market uh a lot of startups coming in from China and from South Korea for from China and from South Korea for from China and from South Korea for example great uh technology example great uh technology example great uh technology manufacturing uh Power heavy weights manufacturing uh Power heavy weights manufacturing uh Power heavy weights that are entering this Market uh with

that are entering this Market uh with that are entering this Market uh with much lower cross um just as long um much lower cross um just as long um much lower cross um just as long um wearable they last between 10 to 14 days wearable they last between 10 to 14 days wearable they last between 10 to 14 days for example and great accuracy and the for example and great accuracy and the for example and great accuracy and the true test is when they become more true test is when they become more true test is when they become more marketable access or wider to see what marketable access or wider to see what marketable access or wider to see what people like them or not whether they're people like them or not whether they're people like them or not whether they're accurate enough um you can only believe accurate enough um you can only believe accurate enough um you can only believe so much you see and so we've actually so much you see and so we've actually so much you see and so we've actually had it patient in front of you with with had it patient in front of you with with had it patient in front of you with with it on but I think that we will see it on but I think that we will see it on but I think that we will see finger pricking as something that will finger pricking as something that will finger pricking as something that will be like urine glucose testing over the be like urine glucose testing over the be like urine glucose testing over the past that really is the Hope because CGM past that really is the Hope because CGM past that really is the Hope because CGM price will come down to a point where price will come down to a point where price will come down to a point where that it's competing directly with a that it's competing directly with a that it's competing directly with a disposable strip do you think that's disposable strip do you think that's disposable strip do you think that's happening now we're in the middle of happening now we're in the middle of happening now we're in the middle of that being driven to nothing are already that being driven to nothing are already that being driven to nothing are already there like um and in Health Systems there like um and in Health Systems there like um and in Health Systems where CGM is fully funded you think of where CGM is fully funded you think of where CGM is fully funded you think of countries like Australia New Zealand's countries like Australia New Zealand's countries like Australia New Zealand's about to become that some of the about to become that some of the about to become that some of the Scandinavian countries confirmation if Scandinavian countries confirmation if Scandinavian countries confirmation if you're not happy about the CGM reading you're not happy about the CGM reading you're not happy about the CGM reading or this inaccuracy that you're concerned or this inaccuracy that you're concerned or this inaccuracy that you're concerned about but generally speaking they are about but generally speaking they are about but generally speaking they are seem as as not requiring finger pricking seem as as not requiring finger pricking seem as as not requiring finger pricking I never say it's never no CGM is ever I never say it's never no CGM is ever I never say it's never no CGM is ever that but you know a little bit of finger that but you know a little bit of finger that but you know a little bit of finger pricking compared to like as you said pricking compared to like as you said pricking compared to like as you said you know eight 10 times a day to get you know eight 10 times a day to get you know eight 10 times a day to get healthy do that so access in the healthy do that so access in the healthy do that so access in the southern hemisphere when I say the southern hemisphere when I say the southern hemisphere when I say the southern hemisphere I'm of course southern hemisphere I'm of course southern hemisphere I'm of course talking about South America Africa parts talking about South America Africa parts talking about South America Africa parts of uh of Asia we still see people of uh of Asia we still see people of uh of Asia we still see people getting diagnosed they get handed getting diagnosed they get handed getting diagnosed they get handed syringes a vial of insulin maybe pens syringes a vial of insulin maybe pens syringes a vial of insulin maybe pens and finger pricking and they're sent on and finger pricking and they're sent on and finger pricking and they're sent on their way can they live long and healthy their way can they live long and healthy their way can they live long and healthy lives H generally speaking no it's lives H generally speaking no it's lives H generally speaking no it's heartbreaking isn't it that your health

heartbreaking isn't it that your health heartbreaking isn't it that your health outcome is dictated by where you live outcome is dictated by where you live outcome is dictated by where you live and the social status of the nation you and the social status of the nation you and the social status of the nation you live and you could put any health live and you could put any health live and you could put any health condition in that bucket and and type condition in that bucket and and type condition in that bucket and and type one is is one of those and it's really one is is one of those and it's really one is is one of those and it's really sad and you know you can see it at a sad and you know you can see it at a sad and you know you can see it at a local level like our all at a clinic So local level like our all at a clinic So local level like our all at a clinic So currently we don't have CGM funded but currently we don't have CGM funded but currently we don't have CGM funded but it's coming we basically have Hales and it's coming we basically have Hales and it's coming we basically have Hales and Have Nots we have everybody walks in Have Nots we have everybody walks in Have Nots we have everybody walks in with the CGM and don't know all abouted with the CGM and don't know all abouted with the CGM and don't know all abouted system the gly is awesome thees are system the gly is awesome thees are system the gly is awesome thees are great and then we have the rest that great and then we have the rest that great and then we have the rest that come in who don't and it's it's that come in who don't and it's it's that come in who don't and it's it's that obvious and it's dictated completely by obvious and it's dictated completely by obvious and it's dictated completely by social eom status which is just sad yeah social eom status which is just sad yeah social eom status which is just sad yeah another thing that I think is so uh another thing that I think is so uh another thing that I think is so uh Insidious about diabetes is that when I Insidious about diabetes is that when I Insidious about diabetes is that when I when I give my presentations on it and I when I give my presentations on it and I when I give my presentations on it and I talk about it I talk about how who would talk about it I talk about how who would talk about it I talk about how who would design such a disease where people who design such a disease where people who design such a disease where people who are good at math live longer than people are good at math live longer than people are good at math live longer than people who are less good at math like what an who are less good at math like what an who are less good at math like what an evil disease to design yeah yeah y so evil disease to design yeah yeah y so evil disease to design yeah yeah y so often say that the people with type one often say that the people with type one often say that the people with type one who who live longest are accountants uh who who live longest are accountants uh who who live longest are accountants uh they they like things in rows and they they like things in rows and they they like things in rows and columns and type one likes things in columns and type one likes things in columns and type one likes things in rows and columns um and very consistent rows and columns um and very consistent rows and columns um and very consistent uh and that's what I was talking about uh and that's what I was talking about uh and that's what I was talking about earlier at the start about the burden earlier at the start about the burden earlier at the start about the burden and the restrictiveness that if you're and the restrictiveness that if you're and the restrictiveness that if you're on a simple way of I could call it on a simple way of I could call it on a simple way of I could call it simple I guess uh what the traditional simple I guess uh what the traditional simple I guess uh what the traditional injections and and finger Pricks you injections and and finger Pricks you injections and and finger Pricks you have to live a very restricted life to have to live a very restricted life to have to live a very restricted life to have healthy Leman yeah now eight years have healthy Leman yeah now eight years have healthy Leman yeah now eight years ago when I started looping when Dana and ago when I started looping when Dana and ago when I started looping when Dana and her husband Scott met with me and showed her husband Scott met with me and showed her husband Scott met with me and showed me the very begin of what would become me the very begin of what would become me the very begin of what would become open APS the open artificial pancreas

open APS the open artificial pancreas open APS the open artificial pancreas system that they had designed um most system that they had designed um most system that they had designed um most practitioners most doctors and you're practitioners most doctors and you're practitioners most doctors and you're you're practicing pediatric you're practicing pediatric you're practicing pediatric endocrinologist if someone came in and endocrinologist if someone came in and endocrinologist if someone came in and said you know I'm going to put my kid on said you know I'm going to put my kid on said you know I'm going to put my kid on some Python scripts uh and they're going some Python scripts uh and they're going some Python scripts uh and they're going to carry a Raspberry Pi around in a to carry a Raspberry Pi around in a to carry a Raspberry Pi around in a little backpack sounds like a plan right little backpack sounds like a plan right little backpack sounds like a plan right it would be fair to say you'd probably it would be fair to say you'd probably it would be fair to say you'd probably be against that eight to 10 years ago be against that eight to 10 years ago be against that eight to 10 years ago this is interesting because I think that this is interesting because I think that this is interesting because I think that it depends on the healthcare it depends on the healthcare it depends on the healthcare professional that you're seeing so there professional that you're seeing so there professional that you're seeing so there are a few Healthcare profession who have are a few Healthcare profession who have are a few Healthcare profession who have I guess a different view than that like I guess a different view than that like I guess a different view than that like the tricky thing is is we live in a the tricky thing is is we live in a the tricky thing is is we live in a highly regulated healthare system where highly regulated healthare system where highly regulated healthare system where we what we're allowed to do and not to we what we're allowed to do and not to we what we're allowed to do and not to do is often dictated by Health do is often dictated by Health do is often dictated by Health regulatory bodies and not by the person regulatory bodies and not by the person regulatory bodies and not by the person in front of you so you have to have a in front of you so you have to have a in front of you so you have to have a comfort level but also be willing to one comfort level but also be willing to one comfort level but also be willing to one educate yourself around what they're educate yourself around what they're educate yourself around what they're using be be willing to learn and using be be willing to learn and using be be willing to learn and secondly know enough to be able to have secondly know enough to be able to have secondly know enough to be able to have an educated conversation with the person an educated conversation with the person an educated conversation with the person around the pros and cons of what you're around the pros and cons of what you're around the pros and cons of what you're going through uh and be very good at Doc going through uh and be very good at Doc going through uh and be very good at Doc menting um you know there's consensus menting um you know there's consensus menting um you know there's consensus statements that are now published and statements that are now published and statements that are now published and available so if you're if you're available so if you're if you're available so if you're if you're listening and you're a healthcare listening and you're a healthcare listening and you're a healthcare professional wondering how to navigate professional wondering how to navigate professional wondering how to navigate this process in a way within your own this process in a way within your own this process in a way within your own health regulatory framework there's very health regulatory framework there's very health regulatory framework there's very good documentation on that and if we good documentation on that and if we good documentation on that and if we need to we can pop a link up somewhere need to we can pop a link up somewhere need to we can pop a link up somewhere uh on your podcast through that if you uh on your podcast through that if you uh on your podcast through that if you are Health listening that how you might are Health listening that how you might are Health listening that how you might navigate that yeah absolutely and it's navigate that yeah absolutely and it's navigate that yeah absolutely and it's also worth saying that Dana and folks also worth saying that Dana and folks also worth saying that Dana and folks like her have really championed uh like her have really championed uh like her have really championed uh putting data Behind these things this putting data Behind these things this putting data Behind these things this isn't just a bunch of weirdos writing a isn't just a bunch of weirdos writing a isn't just a bunch of weirdos writing a for Loop this is really formal and has

for Loop this is really formal and has for Loop this is really formal and has been proven that these algorithms are been proven that these algorithms are been proven that these algorithms are now better than than me at calculating now better than than me at calculating now better than than me at calculating how much insulin that I need so how much insulin that I need so how much insulin that I need so effectively what you what you all are effectively what you what you all are effectively what you what you all are asking me to do is to let go of the asking me to do is to let go of the asking me to do is to let go of the wheel and let the car drive itself which wheel and let the car drive itself which wheel and let the car drive itself which is a very nerve-wracking feeling yeah is a very nerve-wracking feeling yeah is a very nerve-wracking feeling yeah yeah yeah and we all watch space Audy yeah yeah and we all watch space Audy yeah yeah and we all watch space Audy didn't we and and we don't want to be didn't we and and we don't want to be didn't we and and we don't want to be locked out of the podcast we don't want locked out of the podcast we don't want locked out of the podcast we don't want to ask how to uh open the the Pod day to ask how to uh open the the Pod day to ask how to uh open the the Pod day door do we um so we have this this door do we um so we have this this door do we um so we have this this strust of Technology that it's going to strust of Technology that it's going to strust of Technology that it's going to um fail us and that's healthy we need um fail us and that's healthy we need um fail us and that's healthy we need some CR um ability to critique it but we some CR um ability to critique it but we some CR um ability to critique it but we also have a lack of forgiveness for also have a lack of forgiveness for also have a lack of forgiveness for technology it doesn't deliver what you technology it doesn't deliver what you technology it doesn't deliver what you want it to do to set expectations is want it to do to set expectations is want it to do to set expectations is very important as a healthcare very important as a healthcare very important as a healthcare professional that no system is going to professional that no system is going to professional that no system is going to be 100% foolproof it's not going to cure be 100% foolproof it's not going to cure be 100% foolproof it's not going to cure your type one that you are handsfree your type one that you are handsfree your type one that you are handsfree just like you said yeah so that's a just like you said yeah so that's a just like you said yeah so that's a really important disclosure around this really important disclosure around this really important disclosure around this whole point I've had in eight years of whole point I've had in eight years of whole point I've had in eight years of looping uh you know one or two that I looping uh you know one or two that I looping uh you know one or two that I can think of moments where where to use can think of moments where where to use can think of moments where where to use our analogy the car swerved suddenly in our analogy the car swerved suddenly in our analogy the car swerved suddenly in an unusual Direction and because it's an unusual Direction and because it's an unusual Direction and because it's open source I was able to log the bugs open source I was able to log the bugs open source I was able to log the bugs and have the bugs fixed for people and have the bugs fixed for people and have the bugs fixed for people Downstream but I've certainly made more Downstream but I've certainly made more Downstream but I've certainly made more than one or two errors myself in 8 years than one or two errors myself in 8 years than one or two errors myself in 8 years so certainly the argument is that it's so certainly the argument is that it's so certainly the argument is that it's better than a human and the risk is better than a human and the risk is better than a human and the risk is letting me do the work right that's letting me do the work right that's letting me do the work right that's really interesting because we we're really interesting because we we're really interesting because we we're quite able to forgive our own misgivings quite able to forgive our own misgivings quite able to forgive our own misgivings our own mistakes you know I really I'd our own mistakes you know I really I'd our own mistakes you know I really I'd shouldn't have eaten that or drunk it shouldn't have eaten that or drunk it shouldn't have eaten that or drunk it man I've had a bit of a blowout my man I've had a bit of a blowout my man I've had a bit of a blowout my glucose liel oh well ho life goes on but

glucose liel oh well ho life goes on but glucose liel oh well ho life goes on but if you do everything right and the in if you do everything right and the in if you do everything right and the in the code or the technology or you get an the code or the technology or you get an the code or the technology or you get an infusion set of failure or something you infusion set of failure or something you infusion set of failure or something you get really frustrated because you've get really frustrated because you've get really frustrated because you've done everything you need to do in your done everything you need to do in your done everything you need to do in your own uh in own capacity to to keep in the own uh in own capacity to to keep in the own uh in own capacity to to keep in the lane if you like it down by hardware and lane if you like it down by hardware and lane if you like it down by hardware and so as health professionals we spend a so as health professionals we spend a so as health professionals we spend a lot of time educating around how you lot of time educating around how you lot of time educating around how you troubleshoot if you Le the Lan and and troubleshoot if you Le the Lan and and troubleshoot if you Le the Lan and and how you keep yourself safe yeah it very how you keep yourself safe yeah it very how you keep yourself safe yeah it very much is a disease that requires one to much is a disease that requires one to much is a disease that requires one to give give themselves a little grace even give give themselves a little grace even give give themselves a little grace even though we are told to be in range 80% though we are told to be in range 80% though we are told to be in range 80% 90% of the time and really try to 90% of the time and really try to 90% of the time and really try to pretend that we're not diabetic you're pretend that we're not diabetic you're pretend that we're not diabetic you're going to have lousy days I I know I had going to have lousy days I I know I had going to have lousy days I I know I had a lousy day yesterday yeah yeah a lousy day yesterday yeah yeah a lousy day yesterday yeah yeah absolutely there are so many um so absolutely there are so many um so absolutely there are so many um so coming back to that pancreas thing and coming back to that pancreas thing and coming back to that pancreas thing and glucose what we talked about the start glucose what we talked about the start glucose what we talked about the start glucose metabolism is not just a simple glucose metabolism is not just a simple glucose metabolism is not just a simple eating an insulin equation uh there are eating an insulin equation uh there are eating an insulin equation uh there are so many other things that affect your so many other things that affect your so many other things that affect your way your insulin works or how your way your insulin works or how your way your insulin works or how your glucose is absorbed or metabolized by glucose is absorbed or metabolized by glucose is absorbed or metabolized by the rest of the organs in your body the rest of the organs in your body the rest of the organs in your body including your liver and your muscle uh including your liver and your muscle uh including your liver and your muscle uh and we haven't even begun talking about and we haven't even begun talking about and we haven't even begun talking about exercise which is still I think the exercise which is still I think the exercise which is still I think the greatest challenge in type one diabetes greatest challenge in type one diabetes greatest challenge in type one diabetes you know that's funny that you mentioned you know that's funny that you mentioned you know that's funny that you mentioned that because I feel like let me give you that because I feel like let me give you that because I feel like let me give you this I just got back from Spain where I this I just got back from Spain where I this I just got back from Spain where I went with my son and you can see my went with my son and you can see my went with my son and you can see my pedometer app on my phone go from you pedometer app on my phone go from you pedometer app on my phone go from you know 6 to 10,000 on a regular day to know 6 to 10,000 on a regular day to know 6 to 10,000 on a regular day to 25,000 30,000 steps I was walking 10 15 25,000 30,000 steps I was walking 10 15 25,000 30,000 steps I was walking 10 15 miles a day my blood sugar was am miles a day my blood sugar was am miles a day my blood sugar was am which means if I just walk 16 waking which means if I just walk 16 waking which means if I just walk 16 waking hours a day I could eat and do anything

hours a day I could eat and do anything hours a day I could eat and do anything I want but I just can't there's a I want but I just can't there's a I want but I just can't there's a there's a there's a really good case there's a there's a really good case there's a there's a really good case study on that when you look at the guys study on that when you look at the guys study on that when you look at the guys in the I don't know if you've heard in the I don't know if you've heard in the I don't know if you've heard about the team noo the cyclists yep team about the team noo the cyclists yep team about the team noo the cyclists yep team type one yeah and and hardly any of them type one yeah and and hardly any of them type one yeah and and hardly any of them are on pumps actually they're all on are on pumps actually they're all on are on pumps actually they're all on just a little bit of Basil in because just a little bit of Basil in because just a little bit of Basil in because they just burn out all their glucose they just burn out all their glucose they just burn out all their glucose because they spend every day on a bike because they spend every day on a bike because they spend every day on a bike just fueling up and that's what we need just fueling up and that's what we need just fueling up and that's what we need to remember that so much of your glucose to remember that so much of your glucose to remember that so much of your glucose disposable is what I call insulin disposable is what I call insulin disposable is what I call insulin independent and the more fit you are the independent and the more fit you are the independent and the more fit you are the more efficient that is so when that's more efficient that is so when that's more efficient that is so when that's why we spend a lot of time at diagnosis why we spend a lot of time at diagnosis why we spend a lot of time at diagnosis actually in clinics talking to people actually in clinics talking to people actually in clinics talking to people about Lifestyles well that that doesn't about Lifestyles well that that doesn't about Lifestyles well that that doesn't change whatever type diabetes you have change whatever type diabetes you have change whatever type diabetes you have lifestyles are super important aspect to lifestyles are super important aspect to lifestyles are super important aspect to the way you live life for everybody but the way you live life for everybody but the way you live life for everybody but diabetic or non-diabetic that's a very diabetic or non-diabetic that's a very diabetic or non-diabetic that's a very good comment for anyone yeah certainly I good comment for anyone yeah certainly I good comment for anyone yeah certainly I don't want to make anyone feel guilty don't want to make anyone feel guilty don't want to make anyone feel guilty and I want to make sure that folks that and I want to make sure that folks that and I want to make sure that folks that are listening understand that type one are listening understand that type one are listening understand that type one and type two are so different that they and type two are so different that they and type two are so different that they might even not be called diabetes might even not be called diabetes might even not be called diabetes they're such different diseases but they're such different diseases but they're such different diseases but movement what do they say motion is movement what do they say motion is movement what do they say motion is lotion just keep moving the body and the lotion just keep moving the body and the lotion just keep moving the body and the body will help you figure these things body will help you figure these things body will help you figure these things out to the best of your ability I always out to the best of your ability I always out to the best of your ability I always tell people when they're diagnosed the tell people when they're diagnosed the tell people when they're diagnosed the number one thing you can do is don't eat number one thing you can do is don't eat number one thing you can do is don't eat and then just plop on the couch go for a and then just plop on the couch go for a and then just plop on the couch go for a walk walk after dinner just don't just walk walk after dinner just don't just walk walk after dinner just don't just eat and then sit because you're telling eat and then sit because you're telling eat and then sit because you're telling your body that you're not moving and your body that you're not moving and your body that you're not moving and then you're just going to store all of then you're just going to store all of then you're just going to store all of that and that's where highs happen yeah that and that's where highs happen yeah that and that's where highs happen yeah absolutely so how can someone learn more absolutely so how can someone learn more absolutely so how can someone learn more about this I certainly they can go about this I certainly they can go about this I certainly they can go Googling around they can find your Googling around they can find your Googling around they can find your website at the otago website uh you've website at the otago website uh you've website at the otago website uh you've written extensively on this and been

written extensively on this and been written extensively on this and been involved in a number of different papers involved in a number of different papers involved in a number of different papers including uh that create trial with Dana including uh that create trial with Dana including uh that create trial with Dana Lewis uh and then uh Matthew Payne and Lewis uh and then uh Matthew Payne and Lewis uh and then uh Matthew Payne and the others have that design of an open the others have that design of an open the others have that design of an open source ultr lowcost insulin pump at source ultr lowcost insulin pump at source ultr lowcost insulin pump at Hardware X we'll put links to all of Hardware X we'll put links to all of Hardware X we'll put links to all of this but should I go right now after we this but should I go right now after we this but should I go right now after we get off of this call and make an insulin get off of this call and make an insulin get off of this call and make an insulin pump here in my house it's super super pump here in my house it's super super pump here in my house it's super super interesting and challenging question interesting and challenging question interesting and challenging question we're about to publish a study where we we're about to publish a study where we we're about to publish a study where we we built these pumps and put them on we built these pumps and put them on we built these pumps and put them on people it's about it's just under people it's about it's just under people it's about it's just under production now so maybe by the Tess's production now so maybe by the Tess's production now so maybe by the Tess's broadcast it will be available for you broadcast it will be available for you broadcast it will be available for you um it will be open source in terms of um it will be open source in terms of um it will be open source in terms of anybody can reach that paper anything anybody can reach that paper anything anybody can reach that paper anything you do uh in the space is obviously your you do uh in the space is obviously your you do uh in the space is obviously your own uh your own risk uh it's not been own uh your own risk uh it's not been own uh your own risk uh it's not been thoroughly tested it hasn't been real thoroughly tested it hasn't been real thoroughly tested it hasn't been real life tested uh in terms of you know the life tested uh in terms of you know the life tested uh in terms of you know the normal crashing and bashing of daily normal crashing and bashing of daily normal crashing and bashing of daily life so um I would uh ER on the side of life so um I would uh ER on the side of life so um I would uh ER on the side of caution out of Interest build one let it caution out of Interest build one let it caution out of Interest build one let it make some insent put it into something make some insent put it into something make some insent put it into something else rather than yourself for a bit get else rather than yourself for a bit get else rather than yourself for a bit get get a feel for it and and be interested get a feel for it and and be interested get a feel for it and and be interested in the process around it I guess is is in the process around it I guess is is in the process around it I guess is is fascinating I I I don't think we're fascinating I I I don't think we're fascinating I I I don't think we're we're there we be just go and build it we're there we be just go and build it we're there we be just go and build it yourself and put it on yourself at this yourself and put it on yourself at this yourself and put it on yourself at this point we still need to um iron out point we still need to um iron out point we still need to um iron out everything regarding the safety of everything regarding the safety of everything regarding the safety of something like that it is amazing though something like that it is amazing though something like that it is amazing though that it is happening uh and that it's that it is happening uh and that it's that it is happening uh and that it's the possibility that the door has been the possibility that the door has been the possibility that the door has been opened uh when I was diagnosed you know opened uh when I was diagnosed you know opened uh when I was diagnosed you know Ultra fast and Ultra rapid insulins Ultra fast and Ultra rapid insulins Ultra fast and Ultra rapid insulins didn't exist uh before that people were didn't exist uh before that people were didn't exist uh before that people were boiling their needles and using Pig boiling their needles and using Pig boiling their needles and using Pig insulin so many many things have insulin so many many things have insulin so many many things have happened we always joke that diabetes

happened we always joke that diabetes happened we always joke that diabetes will be healed and cured in five years will be healed and cured in five years will be healed and cured in five years uh that's probably not going to happen uh that's probably not going to happen uh that's probably not going to happen but we may solve this thing with uh with but we may solve this thing with uh with but we may solve this thing with uh with software and hardware and hopefully software and hardware and hopefully software and hardware and hopefully it'll be open source yeah another it'll be open source yeah another it'll be open source yeah another interesting to about cure right how do interesting to about cure right how do interesting to about cure right how do you define cure so um and I talk a lot you define cure so um and I talk a lot you define cure so um and I talk a lot about with families around that if about with families around that if about with families around that if you're in the oncology field or cancer you're in the oncology field or cancer you're in the oncology field or cancer field Cur is defin there's living beyond field Cur is defin there's living beyond field Cur is defin there's living beyond 5 Years From diagnosis right um so you 5 Years From diagnosis right um so you 5 Years From diagnosis right um so you know with that respect we have cured know with that respect we have cured know with that respect we have cured type one but we're now doing and saying type one but we're now doing and saying type one but we're now doing and saying okay well how do we make sure that that okay well how do we make sure that that okay well how do we make sure that that that life is as as good as everybody that life is as as good as everybody that life is as as good as everybody without type one uh so it's about without type one uh so it's about without type one uh so it's about expectations and mindset again around expectations and mindset again around expectations and mindset again around how we have those conversations say yes how we have those conversations say yes how we have those conversations say yes of course holy graas we'll find a beta of course holy graas we'll find a beta of course holy graas we'll find a beta cell that will do the job that will hide cell that will do the job that will hide cell that will do the job that will hide from your immune system that that's from your immune system that that's from your immune system that that's what's caused you type one and that what's caused you type one and that what's caused you type one and that might be some way away but for the might be some way away but for the might be some way away but for the moment you use technology which we're moment you use technology which we're moment you use technology which we're really good at and can hide from a very really good at and can hide from a very really good at and can hide from a very good at immune system it's because good at immune system it's because good at immune system it's because humans live on this planet because we've humans live on this planet because we've humans live on this planet because we've got an awesome immune system and you got an awesome immune system and you got an awesome immune system and you don't want to suppress that so in the don't want to suppress that so in the don't want to suppress that so in the meantime let Embrace technology let make meantime let Embrace technology let make meantime let Embrace technology let make it accessible for everybody uh so that it accessible for everybody uh so that it accessible for everybody uh so that we don't have the Habs and the hab Nots we don't have the Habs and the hab Nots we don't have the Habs and the hab Nots in the space for people with type one in the space for people with type one in the space for people with type one yeah that cannot be overstated how how yeah that cannot be overstated how how yeah that cannot be overstated how how lucky I feel that I will probably die of lucky I feel that I will probably die of lucky I feel that I will probably die of old age and that's what we want everyone old age and that's what we want everyone old age and that's what we want everyone to have that privilege to die of old age to have that privilege to die of old age to have that privilege to die of old age and not die of diabetes if and not die of diabetes if and not die of diabetes if if diabetes doesn't catch up with me if diabetes doesn't catch up with me if diabetes doesn't catch up with me yeah absolutely that that's what we're yeah absolutely that that's what we're yeah absolutely that that's what we're all in this in this game for and uh it's all in this in this game for and uh it's all in this in this game for and uh it's not really a game actually it's it's not really a game actually it's it's not really a game actually it's it's what what we do what wakes me up in the

what what we do what wakes me up in the what what we do what wakes me up in the morning is is you know this is not a r morning is is you know this is not a r morning is is you know this is not a r rare Condition it's Global it's non rare Condition it's Global it's non rare Condition it's Global it's non selective and that means I mean you know selective and that means I mean you know selective and that means I mean you know this is not something you choose to have this is not something you choose to have this is not something you choose to have during lifestle or not affects all walks during lifestle or not affects all walks during lifestle or not affects all walks of life all around the world and all of life all around the world and all of life all around the world and all ethnicities and so if we can make this ethnicities and so if we can make this ethnicities and so if we can make this better and healthier and while we're better and healthier and while we're better and healthier and while we're waiting for a cure a real cure if you waiting for a cure a real cure if you waiting for a cure a real cure if you like um let's let's get on This like um let's let's get on This like um let's let's get on This brilliant brilliant thank you so much brilliant brilliant thank you so much brilliant brilliant thank you so much for chatting with me today oh you're for chatting with me today oh you're for chatting with me today oh you're welcome it's been it's been a pleasure welcome it's been it's been a pleasure welcome it's been it's been a pleasure and uh please reach out anybody out and uh please reach out anybody out and uh please reach out anybody out there if you want want to talk more there if you want want to talk more there if you want want to talk more about it and uh and just a big shout out about it and uh and just a big shout out about it and uh and just a big shout out of course of Dar Lewis who have had on of course of Dar Lewis who have had on of course of Dar Lewis who have had on this podcast series previously who who this podcast series previously who who this podcast series previously who who really um with her we are not waiting really um with her we are not waiting really um with her we are not waiting Monica is really what this all about Monica is really what this all about Monica is really what this all about we're not waiting for people to find a we're not waiting for people to find a we're not waiting for people to find a solution we're going to find the solution we're going to find the solution we're going to find the solution because we've got the lived solution because we've got the lived solution because we've got the lived experience and we'll get on with things experience and we'll get on with things experience and we'll get on with things and that's still true today fantastic and that's still true today fantastic and that's still true today fantastic this has been another episode of Hansel this has been another episode of Hansel this has been another episode of Hansel minutes and we'll see you again next minutes and we'll see you again next minutes and we'll see you again next week week week [Music]