August 29, 2024 • 40 mins
This week on Life in Beta, we're diving into the exciting highlights from the Australasian Diabetes Congress. There's so much to unpack that we're splitting it into two episodes.
In this episode, Benjamin gets on his soapbox to share his thoughts on the Type 1 sessions he attended—what got him excited and what got him riled up. Plus, we've got an exclusive chat with Jo Sader, the General Manager of Insulet Australia, who gives us the lowdown on the Omnipod 5, its expected release, and how to transition from Omnipod DASH to Omnipod 5.
Get ready for exciting tech announcements, some nerdy diabetes talk, and a sneak peek into the future of diabetes management.
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Episode Transcript
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(00:00):
Music.
(00:10):
This week on Life in Beta, we're bringing you the highlights from the Australasian Diabetes Congress.
There was so much to cover, though, that we're actually splitting this up into
two episodes, released a week apart.
In this episode, Benjamin will give us the highlights from all of the Type 1
sessions that he attended, what excited him and what enraged him.
Yes, the soapbox is back.
And we spoke with Jo Sader, the general manager of Insulet Australia.
(00:34):
She gave us the scoop on Omnipod 5, when we can expect it, and how you can move
from Omnipod Dash to Omnipod 5, if you want to.
Music.
Welcome to Life in Beta, the show where we talk about real life with Type 1.
We are at the Australian Diabetes Congress this week,
(00:57):
so we're getting our diabetes nerd on at all levels there's
tech there's there's drugs everywhere like just
more drugs than you've ever seen and we have
our first clip for the show there are drugs everywhere that's is
benjamin jardine the diaboss ceo of the type 1 family center what's got your
nerd on this week oh man welcome to the australian diabetes congress i have
(01:19):
my bs detector on at the moment because i have already heard there will be a
cure in our lifetime and gee that just gets under my skin Are you really that
pessimistic about The Cure? It's not coming in our lifetime.
Do you know how many times I have heard The Cure is five years?
Now, look, lifetime's a long time, but I just wish they'd stop saying it and
move on to what can we do right now, which we're going to talk about because
(01:41):
there's huge numbers of things that are happening.
There's all kinds of exciting stuff. I've got to play with technology.
I am even more of a cyborg. I am wearing two CGMs and a pump at the moment.
Yes, Dexcom G7. We're going to talk about that soon teaser carly
green community events coordinator at the
type 1 family center how is the health nuffy
(02:01):
this week yeah on that note about the g7 i'm so upset that benjamin got one
because i got denied yeah you and me both yeah because apparently we're consumers
and so is he yeah so or you're a health professional because you're a he doesn't
even know what kind of health Thank you.
I have the most relevant qualification to diabetes on earth.
(02:24):
They didn't check your credentials when they gave you that sense of those. So I call BS.
Anyway. Yeah, I've really enjoyed it so far, actually. Really interesting.
Lots of interesting chats going on. And in the downtime, I've done a few little things myself.
I couldn't get a G7, but I got my liver tested.
Didn't understand much of the results, but I've got a really low score,
(02:45):
which is good because apparently those with type 1 are prone to liver death.
Technically, yeah. Okay. We'd be looking for cirrhosis or fatty liver disease or one of those.
And I had some metabolic testing done and my metabolic age is 18.
Oh, lucky you. I know. I'm just going to brag about that all day.
(03:09):
That was the dulcet whisper of Jo Sader, who we are thrilled to have on the show today.
Jo is the general manager at Insulet Australia, Insulet make the Omnipod.
You'd all be familiar with Omnipod Dash and the exciting news that Omnipod 5 is coming very soon.
And there's a big stand and all the displays and all the tech and everything
with Omnipod 5 here at ADC.
(03:30):
So Jo's come to talk to us about Omnipod 5 and what all that means.
Welcome to Life in Beta, Jo. Thank you. Thank you. Thank you so much for having
me. This is super exciting. Your first podcast, I believe.
It is. It is. Exciting. How's your liver going, Jo?
Not as well as yours. So excited to be here. Awesome. Thanks, Jo.
So Omnipod Dash, Jo, Dash brought us tubeless.
(03:53):
There was one patch pump before that, but that got recalled,
so we won't talk about that one.
No comment. We got tubeless with
Omnipod Dash. What are people with type 1 going to love about Omnipod 5?
Yes. As you said, DASH brought us tubeless, waterproof, discreet pod therapy.
And people love DASH, by the way.
We get so much feedback about it. And our newest innovation is the Omnipod 5.
(04:17):
And so it takes all the simplicity of Omnipod DASH and it incorporates automated
insulin delivery. Yay, an algorithm!
An algorithm! And the algorithm is called the Smart Adjust.
Smart. Smart Adjust. So how that works is the Smart Adjust algorithm.
Of them. It actually lives on the pod.
And so the pod talks to a compatible sensor.
(04:40):
And it talks to, it's in constant communication with a sensor and what it's
doing is taking that CGM value as well as the trend and it's predicting 60 minutes
out where your glucose is going to go and based on a target that the user sets,
it will either increase, decrease or pause insulin delivery.
(05:01):
So that's how it works at a high level. Cool. Very exciting.
So many people that are like, I really want Omnipod, but I'm waiting for an algorithm.
I need an algorithm. So, I think this is, yeah, prayers answered.
I was like, I've still got a year left on my pump, but I wasn't willing to go
on the pod until it had an algorithm.
Yeah. Yeah. We do hear that a bit. There's quite a lot of pent up demand.
(05:21):
We're so excited to be bringing it. Are you going to ask me when we're bringing it? Yeah.
Since you brought it up, Jay, when can we get our hands on it?
Well, we expect to be bringing that to consumers by early 2025.
Cool. And so we are absolutely working behind the scenes to,
(05:42):
you know, there's a few things that you need to do to get ready for a launch, right?
Yeah. So you got through the TGA, right? That's like the first buck.
That's right. That was our first milestone.
And so, you know, there's a few things. So we're finalizing the cloud build as well.
So that's a really new thing that we're bringing with the Omnipod 5 is all this cloud capability.
Because Dash currently, I guess, your cloud for the... There is no cloud capability
(06:05):
with Dash, yeah. Yeah, so that is definitely something that's unique to Omnipod 5.
And so, as you can imagine, building cloud capability, there's privacy and compliance
considerations and all of that for every country that we launch in.
It's a policy nightmare. Yeah, so it's a big thing.
And then, you know, there's the practical things, like really nailing down the
access pathway. And so that's something that we're working on.
(06:28):
So access pathways like private health insurers and NDSS. All of that.
And, you know, we really want to make sure that that's really,
really, really clear and all locked in before we launched to consumers. You're...
CV, I assume, has a bullet point, which is negotiated with private health insurers
and the NDSS to actually get pods on the NDSS.
(06:48):
That was a big hurdle for a long time when Dash launched, right?
That was you who managed to get that over the line?
Yeah, well, you know, we have a team, an exceptional team. I'd love to say that it was all me.
No, but look, it actually was something that was negotiated by Insult Australia.
And yeah, Yeah, I mean, that was one of our proudest achievements because what
(07:09):
it meant is that we actually provided two pathways for consumers.
Previously, it was just private health insurance. But as you would know better
than I do, there is a bunch of people who don't have private health insurance,
who can't afford private health insurance.
And so it means that people are able to access the therapy, try it,
decide if it's for them, and they're not locked in.
(07:30):
People don't like to be locked in. We don't like lock-ins, right?
The unique thing about potting, I guess, is that you're literally just buying
however many pods and however long that lasts, and you can just pay for that
as opposed to a four-year commitment. I can't imagine why people would be nervous
about making a four-year commitment to a thing that's keeping them alive. Yeah, yeah.
So, yep, so as I was saying, you know, the access pathway is one thing,
(07:51):
you know, making sure we've got our onboarding processes that we've communicated
with healthcare professionals, that they've communicated with their patients and consumers.
So there's a bit of prep work, let's just say, to do that. But what I will say
is as we get closer to launch, we'll definitely be sharing more details.
People want to know exactly when, what sensor, what iteration,
(08:12):
what cost, you know, all of that detail we will absolutely be sharing as we
get closer to launch. Cool, cool, cool. Good, otherwise we'll be knocking down your door.
But I want it now. Joe.
You know that I'm a member of your pod squad, so I am very interested in the Omnipod 5.
And we've mentioned the algorithm. Now, the word algorithm causes a bunch of
(08:35):
people to run for the hills.
But what we're really talking about is adding some smarts to the pod.
So tell me a bit about how the smarts actually work. What's it going to do?
How's it going to be smarter than me? How's it going to be smarter than you?
Well, it is constantly speaking to a compatible sensor.
And the algorithm, just for a little bit of smarts,
(08:55):
it uses a model predictive control algorithm and it is essentially taking both
the value as well as the trend into account and it's predicting 60 minutes out.
It's taking into account your insulin on board and then it makes a determination
and every five minutes it's saying, I'm either going to increase,
(09:15):
I'm going to decrease or I'm going to pause insulin delivery based on all of
those considerations and probably many, many more that I'm not probably able to even talk about.
But that is essentially at a high level how it works.
And one of the things that people really love about the Omnipod 5 is that there's
multiple targets that a user can set for themselves, different targets for different
(09:37):
times of the day. What a wide range.
Yes. This is what interests me is that you can pre-program which target you
want for what time of day.
So you can choose, I want to sit a little bit higher during the day and maybe
lower at night That's right.
And it's between 6.1 and 8.3.
And what we've seen, what's great globally is we see some real world evidence
and we see how people are actually using, and the overwhelming majority of people
(10:00):
do use the multiple targets throughout the day.
So what's one example, Jo? Why might someone pick a different target?
Yeah, so they may pick a higher target for overnight, as an example, or when they're.
Someone worried about going low is going to go, all right, yeah,
I'm worried about overnight lows. I'm going to push my target up.
(10:20):
I'm worried about exercise lows.
I'm not having a more active day. That could be beneficial. Like,
you know, unplanned, I guess, unplanned is helpful.
Unplanned exercise, you mean? Yeah. Or sometimes when you're on holiday and
you're traveling and you're walking a lot more than you normally would,
that could be beneficial.
It would be helpful at an Australian Diabetes Congress when I'm running from
booth to booth going, oh, look at the shiny thing. Look at the shiny thing.
(10:41):
I'm not checking my blood sugar.
Very interesting. Can I ask, so currently Dash is controlled by a PDM device.
Is that going to be the same for Omnipod 5?
Yes, yes. So it's called a controller. There's a lot of discussion in the community,
as you know, about controller and, you know, will there be phone control?
We get asked that all the time as well.
(11:01):
But the really great thing about the Omnipod 5 system is that the algorithm sits in the pod.
And the reason why that's so important and what it means to the consumer is
it's a full on-body experience.
You actually don't need the controller near you to be kept in that auto mode,
which means you can be out in the surf, swimming, doing your thing.
(11:22):
You don't need the controller near you. Swimming has to be the big one.
I mean, obviously you have Bluetooth issues in the water, but your CGM can keep
talking to the pod and that loop just keeps running and completely hands off.
You don't have to have your phone with you. And we see from both our pivotal
studies and real world evidence that people stay in loop well over 90% of the
time, which is what people want, right?
And really just brings it back to simplifying life and giving people the,
(11:47):
I guess, confidence that they're being kept safe and making diabetes a much
smaller part of their life.
Yeah. Amen. Before Joe came on the podcast, I put messages out in our various
platforms and I said, I'm interviewing Joe. What do you want to know?
Boy, did people have questions. So first cap off the ranks is,
will I be able to switch from Dash to Omnipod 5 even if my four years on private
(12:10):
health insurance isn't up yet?
Such a great question. And we get asked this quite a bit. And the good news
is, the short answer is yes.
Yes, you will. That's very exciting. Clip that, post it right now.
And so what we're just about to launch to the community is something called the Omnipod Promise.
And what that means is that if you are, as you just said, in your four-year
(12:33):
warranty, it is a pathway that will provide for a one-time payment of $249,
which allows you to move to Omnipod 5 technology,
whilst you are still in that four-year cycle.
So we don't want to hold anyone back. We just want people to get the technology that they want. Cool.
So, hypothetically, if you wanted, you could go on Dash now.
(12:55):
Absolutely. And then move to Omnipod 5 when it's out. Absolutely.
I told you, Carly, come to the dark side.
Yes, my four years on my current system is up in June next year.
Oh, so it'll be out. Okay, so you kind of have to wait then anyway,
unless... Do I? Well, as in... It's self-fund from today.
I've got to stop doing this. But same, release of Omnipod 5 early 2025.
(13:19):
I've still got six months left. So technically, are you saying I could transfer?
Not with another brand. Not with another. It's only if you're moving from Dash
to Omnipod 5. Yeah, I was just going to clarify. Yeah, okay.
But nothing stops you from trying it, I guess, even if you just wanted to for
a month or two before you go out of warranty.
Trying the Omnipod 5? The Omnipod Dash. Or even the Omnipod 5.
(13:43):
And how would that work? How would I, what would that cost to trial the Omnipod 5? Nice try.
We will be forthcoming with more detail around costs and details. I tried, people.
We absolutely envisage that there will be a pay-as-you-pod access pathway,
(14:05):
which just means that you can just try one month's worth of Omnipod supply apply
and that will give you an opportunity to try the Omnipod 5. Okay.
I like the sound of that. That's a full four-year commitment.
Yeah. Cool. And it probably leans into our next question. So a lot of people
in the community, myself included, love our Dash, want our Dash,
want to make sure our Dash isn't going anywhere.
(14:25):
Yes. We get asked that a bit and we love Dash too and we don't want Dash to go anywhere either.
And so absolutely for the foreseeable future, Dash ain't going anywhere.
We have no plans to retire Dash once Omnipod 5 is in the market.
Because we hear that all the time too.
Yeah, well, there's so many people, well, the growing amount of people who are
now looping with the Dash.
(14:47):
I think I just heard their collective zip, zip, zip. Do it yourself looping
to clarify. We'll talk about that when we haven't got Joe in the room.
I'm just saying, like, there are so many people in the community who wouldn't
want Dash to go anywhere. Correct.
You can cut if needed.
Last question from the community. Any plans? this is,
(15:09):
proof that we're never happy, right? So we've literally got Omnipod 5 has just
been released. We get an algorithm.
Yay. We're already thinking about
the next thing. Any plans for extending beyond a three-day wear time?
Such a good question. And, you
know, Insulate as an organization get this question all the time, right?
You know, it's one of those, I guess, challenges that you've got a pod and people
(15:31):
want that to get smaller, by the way. Yes.
Smaller and last longer. Make the pods smaller, extend the wear.
You know, it's these very contradictory requirements. Just break the rules of
physics for us, Jo. Exactly. We'd be delighted.
Breaking the rule of physics. And I'm not in our R&D department.
However, I know that this is something that the organization thinks about.
And, you know, whilst there's no product plans or timelines,
(15:55):
you know, it's definitely something we think about.
Just on innovation, what I do want to say is, you know, I was alluding to the
whole cloud infrastructure. structure.
This is quite new to Omnipod 5.
So whilst, you know, insulin delivery through a pod is our bread and butter,
and that is what we do really, really well, you know, that whole data and cloud
platform is very much a new capability for insulin as an organization.
(16:20):
And what that means is that for the user going on to Omnipod 5,
you don't need to now physically go and download something, which we know is a friction, you know.
Everyone wants to get around to uploading their pump and it doesn't happen.
But because it will happen automatically, it means that everyone who's on Omnipod
5, their data just goes into the cloud.
(16:40):
And what that means is you have huge amount of insights and rich data,
which we can understand better how people are interfacing and using their technology,
how the algorithm is performing,
trends and so much rich data, which really will inform product development,
you know? How do you then tweak the algorithm?
(17:02):
How do you tweak the user interface to keep on innovating and improving the
system, to make it simpler, to continue to make it a smaller part of people's lives? Because...
That's what we do and what we do really really well so yeah i
always you know i log into you know whatever the cloud platform is i'm using
for whatever pump i'm using at the time and there's always all that you know
do you accept the blah blah blah and we might use your data for blah blah blah
(17:23):
and i'm tempted to go no and then i'm like no hold on this like this data gets
used to for insights into future development like that's that's yeah so it also
makes an appointment with your diabetes educator so much more useful if you
have the data in front of you say that
because I can't remember the last time I actually uploaded my pump
because it is it's
(17:43):
it's such a headache and because they cancelled the the last
program that I was using attached to my pump so I still actually haven't downloaded
the new one that I meant to because everyone says it's a little bit of a headache
with the setup and I was like I can't leave it on the edge here yep so that
is very very exciting indeed last question Jo yeah so Omnipod 5 will launch with a G6. Is that right?
(18:06):
Great question. So what I can say is that we have global partnerships with two
CGM corporations. So that's Dexcom and Abbott.
And that's based on our whole philosophy around the importance of choice.
Consumers want choice and we want to give it to them. So what we do see in other
countries is we see different iterations of sensors.
(18:26):
What sensors we're going to have available here with Omnipod 5, we are still working on.
There's a range of regulatory considerations but as
i said earlier as we get closer to launch we'll absolutely be
able to share you know which sensor which iteration from when
and all the details yes i'm just looking at that dexcom g7 stand across the
other side of the pavilion and going i wonder i wonder future integration yes
(18:55):
so many options okay we'll wait yeah joe thank you so much for taking the a
time to talk to us today. Thank you, Joe.
Thank you so much for having me. This was a lot of fun. Yeah, it was.
Hopefully we'll talk again soon. Yes. Come by anytime, particularly when you've
got exciting things to tell us about. Yes. I can't wait to tell you more.
Thank you, Joe. Thanks, Joe. See ya. Thank you. All right.
(19:15):
So everyone is excited about Omnipod, but definitely not the only thing on show.
Lots of things that I've seen. Keen to hear what you guys have been observing
while you're here at ADC. Well, a certain boss kind of told us we had to man
the booth, so I don't feel like I've actually seen that much of the conference.
Not that you're bitter at all. I'm bitter.
Hey, I saw you walking to the little chocolate mousse stand multiple times yesterday
(19:39):
afternoon, so I think you've seen a few things. That mousse was good, and I make no apologies.
It was really good. You landed the blood glucose as well.
Yeah, I don't know what's been going on. It's been flat lines all week.
I don't know whether it's just I've done just enough walking and my brain is
just having to go non-stop that it kind of deals with the rises from the,
caffeine and glucose i throw at it or i don't know i think
(20:00):
it's like so much talking and hand gestures and actions
it's like doing aerobics because i have been sitting
under five like all day and you know
when you go out and you eat like we can't tell what's on
the we get provided lunch here we can't tell how many carbs have
snuck in there but a big guessing game yeah carly on
that point now that we're going a completely different direction from where
(20:20):
i was going what was on the menu for this morning's morning tea oh guys morning
tea this morning was four cheese arancini followed by a double chocolate brownie
followed by fruit my blood sugar went up just listening to.
It's like yeah it's it's really it's what do they call it deconstructed pizza
(20:44):
almost like you just got fat glucose and there's many proteins in that oh it's
the triple threat Threat. It's the dribbled threat. Yeah, it's insane.
We should pick it up and take it around to the tech companies and say,
which one of you can handle this? Oh, yes.
I totally want to do that one day. I'm just going to get like four different
pump users and just get them to do the same thing and just see how the algorithm deals with it.
I thought he was going to say he was going to wear four pumps at once then,
(21:06):
and no one would be surprised. It doesn't work that way.
Anyway, I feel like the first thing I have to go to, I know I had my grumpy
pants on during the introduction and was doing my BS detector cure in our lifetime, yada, yada, yada, yada.
Which we enjoy. joy? There were a few things which are really cool.
One, we talked about smart insulin on the podcast.
Looks like it's actually a real thing and really interesting because a lot of
(21:29):
the health professionals here were sort of of the same opinion that we were
of, and then have been hearing a lot more about smart insulin.
The really cool one that they spoke about is what's called a liver preferring insulin.
So let's go nerd for just a really quick second.
This is one of the the things that frustrates the heck out of me as a person
with type 1. We inject insulin into our skin, which means it goes everywhere.
(21:53):
What actually happens if you have a functioning pancreas is that most of the
insulin goes straight to your liver, which is producing glucose all the time.
That's the thing that's giving you glucose to go to the brain because the brain only likes glucose.
So we end up actually giving ourselves more insulin than theoretically we need
because it goes everywhere instead of where it needs to go.
(22:13):
So now they're working on an insulin that will prefer going to the liver.
Liver so theoretically you'll need
less insulin to get the same blood glucose control and
given that the more insulin you take the more risk factors you
get the more weight gain you get yada yada yada yada that has
some really exciting okay and then the smart insulins
(22:33):
which are glucose sensitive so the higher your glucose the more insulin they'll
release look like they could be a real thing now we're still in theoretical
early trials etc but exciting of course there There was lots of talk about preventing
type 1 from onsetting at all. We've talked about teplizumab before.
(22:54):
That's moving along. But what I was really excited by is I think this is the
first time I've actually heard
anyone say, what about the people who are already diagnosed with type 1?
Because every time I go to one of those things where they say,
we're going to cure it by stopping it. It's about the future.
And we go, oh, good. We'll be the generation that doesn't get the cure.
Huge amounts of work on beta cell replacements. and it looks like it's going
(23:16):
to get to the point eventually.
I'm not going to put a timeframe on it because I'm not a fool.
But you are a pessimist. That's right. If they can switch off the immune response
to stop it from onsetting at all, then they can switch the immune system off
to kill the new beta cells.
So if they can then work out a way to give you beta cells, theoretically,
we could actually cure people who are already diagnosed.
(23:39):
So the two approaches are actually linked. They are.
Will they come on the same time frame? Who knows? We're still very early days,
hence my BS detector being up here somewhere.
But it was nice to hear some hope coming out there.
What was also really cool is that there's work on even faster insulins.
(23:59):
So if you thought that Fiasp is fast, it's actually still really slow.
So when endos talk about it, it's really interesting.
They kind of say, well, you can have the 15 minutes before you eat or you can
have the 10 minutes before you eat. As the difference between Fiaspa and Nova Rapid. Right.
In real life, doesn't really make a difference. And actually,
(24:20):
it was the first time that I heard an endo say, brace yourselves,
it's actually really hard to pre-bowl us for a meal.
Acknowledging just the life impossibility of that. I had to almost stop myself
from falling off my chair because they always go, it's just the person's fault.
If they would just give themselves insulin 15 minutes before, they'd be fine.
And an endo actually said, you know, that's actually pretty difficult,
(24:42):
Unless you have a crystal ball and know when your food is arriving and are always
perfectly planned and aren't eating your children's dinner that they refuse
to eat, but they've just left cooling on the table.
Or at a restaurant waiting for a meal to come and going, I'll play it safe.
Oh, no, I'm having a really carby meal. Like I'm going to pre-ballers.
It won't take more than half an hour to get here.
And then what happens? All of a sudden you're waiting 45 minutes.
(25:04):
And you're crashing all over. Yeah. Yeah.
So, yeah, they're trying to make it even faster. You know, the ideal would,
of course, be that you just take it when you eat and it acts as fast as it can,
which is kind of actually what happens in your body because it's just going
straight into the bloodstream.
So, super cool. What if we all just became druggies and just did intravenous injections?
I have often wondered about that. Like how much faster would that be?
(25:25):
Just give me a big portal and I'll just ram it in there.
It's an IV line just dangling off your arm. It's like instant.
I remember like having a C-section with my daughter. they took me off my basal from the morning.
I think I might have taken like maybe half the night before.
And then the morning of it was all intravenous, like a delicate balance.
(25:46):
They had little dials for the insulin and the glucose.
Yes. Yep. And they were just like doing this.
It's going to make a great give. Yeah.
Sorry for those of you who are listening on audio. I don't even know how to
describe that and keep this safe for work. So moving on.
Can we go to Prick of the Week? Prick of the Week.
(26:10):
I'm sorry, but it amuses us, so you're just going to have to put up with it.
For the most part, I have to say, like, it's been mostly positive in terms of
who I've been chatting to, clinicians-wise, but I do have a little prick in
my week. I met him yesterday afternoon.
Yeah, charming fellow, works in the diabetes space, and he wanted to find out,
(26:31):
like, what we do at the Family Centre.
I think he predominantly deals with those with type 2 diabetes,
but he sees a lot of teens in that space and had a 16-year-old girl with type
1 who was basically refusing to take her insulin and then sitting up, you know, in the 25s.
And he was so angry about it that he was telling the dad to go home and enforce some discipline.
(26:56):
And I was sitting there just like, oh, gosh, how do I get around this?
I had, you know, Bec, who works in the mental health space, you know,
supporting those people,
with those difficulties around why they may or may not be taking insulin.
And then the very complicated rabbit hole that goes down.
And again, I was just listening to Benjamin rant about not supporting,
(27:22):
I guess, the consumer with type one or understanding the lived experience.
And there was a prime example just standing right in front of me.
And every time I tried to offer something, it was just slammed down.
It was like, it's ridiculous. This will not do.
She must take her insulin. I was like, I understand this, but have you thought about why? Yeah.
(27:46):
Look, let me try and come back from the clinician's perspective.
I was trained as a healthcare professional originally.
Really important that we remember that people get into the healthcare professions
because they want to help people.
The challenge is healthcare Healthcare professionals are taught and want to fix things.
That's what we want to do. We get into healthcare professions to fix stuff.
(28:07):
Why is type 1 really frustrating? You can't fix it.
So I see them come in. They're excited.
They're enthused. They come into the conference. They want to learn stuff,
and they go straight to the tool.
Here's Manjaro. Here's Tujayo. Here's the new insulin sexy thing.
Here's the AID device because they want the fix.
They want the hammer. They just want to be able to go into an appointment and
(28:28):
go, ta-da. He did actually say, actually, it was one of the first things that
he said when he came over was, type 1 is a real problem.
Yep. Agreed. Furthermore, it was like, type 2 diabetes, easy. Type 1?
It's a problem. I'm so sorry to all those people living with type 2 diabetes
(28:48):
who just heard that it was really easy to solve.
Yeah. Woo! I think as a segue, so we should get to pick of the week,
something a little bit more. Oh, but I'm ranting.
I know. All right, settle me down. We've done a lot. I was having a conversation
yesterday afternoon with Bec Johnson who sits on our board.
She was the founding member of the Type 1 Family Centre. Sorry, Type 1.
(29:09):
She was the founding CEO of the Type 1 Family Centre. and we were having this
discussion about how the rhetoric seems to be there are two tools,
you have technology and you have insulin.
And she was like, what about the others? What about exercise?
What about food? What about wrapping a community around people?
And I'm using that as a segue because food... It is a perfect segue.
(29:32):
So let's talk about Pick of the Week. Let's talk about the thing that we're
super excited by, which is that at ADC, at this conference that has lots of
technology and lots of insulin... So many drugs.
We're about to pump ourselves up again. Warning. Yes, we're pumping up our own tires.
But an amazing panel, including Amy Rush and Beck Newton from the Family Center, Dr.
(29:53):
Joey Kane, endocrinologist on the Family Center board, and Sanjeev Balakrishnan,
who is a GP specializing in chronic disease and a friend of the Family Center,
delivered a presentation on, let me get the academic title,
therapeutic carbohydrate restriction in type 1 diabetes. What does that actually mean?
This was a conversation in front of at least 150 clinicians.
(30:14):
They packed the room, endos, credentialed diabetes educators, dieticians, et cetera.
They were all super curious. They were like, what is this? Mostly they were
thinking, why is there something here that's not technology? No, I'm kidding.
There was lots of interest, lots of excitement, because what we were talking
about is fundamentally an acknowledgement that when you have type 1,
you have a pretty weird relationship with food.
(30:35):
That's just the nature of the disease. And what we know, again,
rocket science, is that people with type 1 change their food.
Regardless of whether we tell them to or not, regardless of whether there's
education that says you should or not, intuitively people go, that food kicks my butt.
That food's really hard to bowl us for. I can never get pizza to work for me.
(30:56):
Bananas keep changing color and sugar content while I watch them.
And they start to change.
And that is a tool that we do not talk to people about because what we say instead
is eat whatever you want.
And dose for it. And dose for it. So So use the insulin to cover whatever it is that you want to eat.
And we give you the healthy eating pyramid typically, which has something like 65% carbohydrate in it.
(31:22):
So we're basically saying to people, take 200, 300 grams of carbohydrate a day.
Take this tool, which you need to match to that carbohydrate.
It doesn't work very well and you might get it wrong. And good luck carb estimating
that giant bowl of pasta that the chef has put a bunch of sugar into.
But insulin's your tool. instead of saying
to people you got that tool and you're going to need
(31:42):
it right you're going to need insulin one way or another whether you like it
or not but you've also got the choices of food that you make and what we're
not saying to you is don't eat any carbs right no one is saying go carnival
what we're actually saying to people is you should understand that you can change
the amount of carbohydrate you eat just the same way as you can change the amount
of insulin that you you take,
(32:04):
and actually changing the food that you intake to need less insulin might make things,
one, easier because your dosing might be easier.
So, the classic example on this is that when you pick up a nutrition panel on
a packaged food, like we all do to carb count, right?
And you look at that number and you plug it into your pump or into your bolus
calculator for your dose and you dial up your pen.
(32:28):
That number is wrong because that is an average and you are allowed to be 25% wrong either way.
So if that is a big bowl of pasta and it is, I don't know, 75 grams of carbs,
that might actually be a hundred grams of carbs and you don't know,
and you get it wrong. You get it wrong by that much. That's a lot of insulin.
(32:52):
You've either under bolused by a major amount or
you've over a bolus by a major amount if you replace
that pasta with a pasta that has five grams
of carbs like edamame pasta i know it's green it's
weird but let's just go with it for a second and you got that wrong by 25 that's
a gram of carb zippity-doo-dah yeah it's not going to make any difference and
(33:13):
any algorithm is going to pick it up and the algorithm will pick it up if you've
got an aid if you're on mdi you wouldn't change what you dialed up yeah that
would probably be one unit of insulin,
regardless of whether you're 25% either way.
And it's not to say everyone should shift to edamame pasta, unless edamame wants
to sponsor this podcast conversation.
But it's a tool. It's just to say, hey, you can think about that.
(33:34):
And we had the room packed out with people, some people who looked like this
was the first time they had ever contemplated that you don't just tell people,
here's the insulin, you tell people, maybe you could change your food.
And that's not saying keto, it's not saying low carb, it was just saying,
how about we have two tools in the kit and how about we
actually acknowledge that people with type 1 do it
(33:55):
anyway and maybe actually talk to them about how to
do it safely and appropriately because there's all kinds of things you
could do you could end up not eating enough food because you
just cut all your carbs you could end up eating crap because
there is some serious crap out there that replaces carbs with
other stuff yeah how about we help people of yeah
actually educating people on how they
(34:16):
can have a complete nutrition profile and they
can easily switch around these things like it's just i always
bang my head against the wall because obviously a space that i've been in for
a very long time it's like food it just seems obvious and can i can i just get
on my high horse again because i am i'm just i'm gonna do it anyway but i pretended
to ask for permission what is exciting there's only a little bit of research
(34:39):
in this space and the reason for
that is we don't have the pharma company money to put into low-carb foods because
that's not exactly going to generate the same money. Anyway,
cynicism off, doesn't matter.
The research that we have shows that even making little adjustments.
Moderate carbs, reducing it a little bit has a bigger impact on blood glucose
control than some of these sexy new drugs that are out there.
(35:04):
So can we get into a space where rather than tell every person living with type
1, and just throw another couple
of injections on and 400 bucks a month or whatever the damn thing costs.
There's also another option, which for some people might work really well.
Other people, looking at you, Adam, go, you know what?
I'm going to eat whatever the damn heck I want. I love carbs and I know how
(35:25):
to titrate my insulin. Go team.
We had a conversation about something that wasn't tech and wasn't medicine and
was what people were really doing.
What was the vibe in the room in response to that? The best thing about the
vibe in the room is that it was mostly curious, interested, excited.
Yep. There are always a couple of people who go, are you telling everyone to go keto?
(35:46):
But very little of that. Carla, you were in the room. I was.
I was towards the edge, just getting a sneak little look at all the people that were coming through.
There was definitely a lot of chit chat, particularly in the beginning.
I couldn't catch all of it.
But I certainly did have a chatty Cathy nearby providing two cents.
And I think any time that we've come in with this kind of stuff,
(36:07):
it gets people talking. So people talking is a good thing.
And it was really interesting because it wasn't putting forth a really biased
suggestion on what carb reduction looks like.
It was showing that there's a range. I think what's most interesting is that
low carb can range from 50 grams to 130 grams.
So and it was very clear
(36:29):
that we were not going to be talking about a ketogenic diet here
it was touched on a little bit but that wasn't the focus here
so i think that was super important because a lot of people their definition
of low carb is is keto when it comes to managing type one for whatever reason
so i think just re-educating within that space of what carb reduction looks
like and how helpful it can be was super positive so i think by the end of it anyone that had little.
(36:54):
Queries and concerns it's yeah it was
the approach it was a really good approach i will say that and i mean you saw
after the talk happened we got flooded at the booth with everyone saying information
do you have more of the flyers that you've been handed yeah yeah it was people
were literally taking the flyers and putting them into their handbag in in buckets
it was hilarious yeah it was really it was really really great.
(37:19):
Well, this is going to be an epic episode. I think we might have to break this
into two. We'll figure out how that's going to work. So now the seven other
rants that I've got lined up. Let's go.
No, no, Benjamin, no more. No more rations until next week.
We might need a whole episode for Benjamin's rant on 86. You know what really
grinds my gears? I look forward to it. Yep.
(37:41):
Right. Next episode, we have Duncan Reed, who is an ultra marathoner. we had a chat with him.
We're talking about exercise, food and then exercise.
Oh my God, another tool in the toolkit. We're radicals.
Duncan Reid is an ultra marathoner. Carly, do you want to give us the two cent?
Yes. Yeah. Duncan is an incredible, credible man doing incredible things in the type one community.
(38:05):
Crazy man. He has run 10 ultra marathons over 10 years with more to come.
He started, yeah, at the age of 40 and he's just decided one day I'm going to
run 100Ks through the desert and that's where his journey began.
So, yeah, really looking forward to bringing you that episode and unpacking
exactly what Duncan does, how he does it and what's looking ahead for him.
(38:28):
And super interesting, he's going to talk about how he feels like he is fitter for having type 1.
So, really looking forward to that conversation. Yeah.
There's a slogan. All right, thanks for joining us. We'll see you next time
on Life in Beta. Ta-ra. Ta-ra. Come on, Carly, say it.
Music.
(38:52):
If you've been listening today thinking that is so relatable you should consider
joining our online community where over a thousand other people with type 1
are sharing their experiences learning and supporting
each other head to type1familycenter.org.au forward slash connect.
Music.
(00:10):
This week on Life in Beta, we're bringing you the highlights from the Australasian Diabetes Congress.
There was so much to cover, though, that we're actually splitting this up into
two episodes, released a week apart.
In this episode, Benjamin will give us the highlights from all of the Type 1
sessions that he attended, what excited him and what enraged him.
Yes, the soapbox is back.
And we spoke with Jo Sader, the general manager of Insulet Australia.
(00:34):
She gave us the scoop on Omnipod 5, when we can expect it, and how you can move
from Omnipod Dash to Omnipod 5, if you want to.
Music.
Welcome to Life in Beta, the show where we talk about real life with Type 1.
We are at the Australian Diabetes Congress this week,
(00:57):
so we're getting our diabetes nerd on at all levels there's
tech there's there's drugs everywhere like just
more drugs than you've ever seen and we have
our first clip for the show there are drugs everywhere that's is
benjamin jardine the diaboss ceo of the type 1 family center what's got your
nerd on this week oh man welcome to the australian diabetes congress i have
(01:19):
my bs detector on at the moment because i have already heard there will be a
cure in our lifetime and gee that just gets under my skin Are you really that
pessimistic about The Cure? It's not coming in our lifetime.
Do you know how many times I have heard The Cure is five years?
Now, look, lifetime's a long time, but I just wish they'd stop saying it and
move on to what can we do right now, which we're going to talk about because
(01:41):
there's huge numbers of things that are happening.
There's all kinds of exciting stuff. I've got to play with technology.
I am even more of a cyborg. I am wearing two CGMs and a pump at the moment.
Yes, Dexcom G7. We're going to talk about that soon teaser carly
green community events coordinator at the
type 1 family center how is the health nuffy
(02:01):
this week yeah on that note about the g7 i'm so upset that benjamin got one
because i got denied yeah you and me both yeah because apparently we're consumers
and so is he yeah so or you're a health professional because you're a he doesn't
even know what kind of health Thank you.
I have the most relevant qualification to diabetes on earth.
(02:24):
They didn't check your credentials when they gave you that sense of those. So I call BS.
Anyway. Yeah, I've really enjoyed it so far, actually. Really interesting.
Lots of interesting chats going on. And in the downtime, I've done a few little things myself.
I couldn't get a G7, but I got my liver tested.
Didn't understand much of the results, but I've got a really low score,
(02:45):
which is good because apparently those with type 1 are prone to liver death.
Technically, yeah. Okay. We'd be looking for cirrhosis or fatty liver disease or one of those.
And I had some metabolic testing done and my metabolic age is 18.
Oh, lucky you. I know. I'm just going to brag about that all day.
(03:09):
That was the dulcet whisper of Jo Sader, who we are thrilled to have on the show today.
Jo is the general manager at Insulet Australia, Insulet make the Omnipod.
You'd all be familiar with Omnipod Dash and the exciting news that Omnipod 5 is coming very soon.
And there's a big stand and all the displays and all the tech and everything
with Omnipod 5 here at ADC.
(03:30):
So Jo's come to talk to us about Omnipod 5 and what all that means.
Welcome to Life in Beta, Jo. Thank you. Thank you. Thank you so much for having
me. This is super exciting. Your first podcast, I believe.
It is. It is. Exciting. How's your liver going, Jo?
Not as well as yours. So excited to be here. Awesome. Thanks, Jo.
So Omnipod Dash, Jo, Dash brought us tubeless.
(03:53):
There was one patch pump before that, but that got recalled,
so we won't talk about that one.
No comment. We got tubeless with
Omnipod Dash. What are people with type 1 going to love about Omnipod 5?
Yes. As you said, DASH brought us tubeless, waterproof, discreet pod therapy.
And people love DASH, by the way.
We get so much feedback about it. And our newest innovation is the Omnipod 5.
(04:17):
And so it takes all the simplicity of Omnipod DASH and it incorporates automated
insulin delivery. Yay, an algorithm!
An algorithm! And the algorithm is called the Smart Adjust.
Smart. Smart Adjust. So how that works is the Smart Adjust algorithm.
Of them. It actually lives on the pod.
And so the pod talks to a compatible sensor.
(04:40):
And it talks to, it's in constant communication with a sensor and what it's
doing is taking that CGM value as well as the trend and it's predicting 60 minutes
out where your glucose is going to go and based on a target that the user sets,
it will either increase, decrease or pause insulin delivery.
(05:01):
So that's how it works at a high level. Cool. Very exciting.
So many people that are like, I really want Omnipod, but I'm waiting for an algorithm.
I need an algorithm. So, I think this is, yeah, prayers answered.
I was like, I've still got a year left on my pump, but I wasn't willing to go
on the pod until it had an algorithm.
Yeah. Yeah. We do hear that a bit. There's quite a lot of pent up demand.
(05:21):
We're so excited to be bringing it. Are you going to ask me when we're bringing it? Yeah.
Since you brought it up, Jay, when can we get our hands on it?
Well, we expect to be bringing that to consumers by early 2025.
Cool. And so we are absolutely working behind the scenes to,
(05:42):
you know, there's a few things that you need to do to get ready for a launch, right?
Yeah. So you got through the TGA, right? That's like the first buck.
That's right. That was our first milestone.
And so, you know, there's a few things. So we're finalizing the cloud build as well.
So that's a really new thing that we're bringing with the Omnipod 5 is all this cloud capability.
Because Dash currently, I guess, your cloud for the... There is no cloud capability
(06:05):
with Dash, yeah. Yeah, so that is definitely something that's unique to Omnipod 5.
And so, as you can imagine, building cloud capability, there's privacy and compliance
considerations and all of that for every country that we launch in.
It's a policy nightmare. Yeah, so it's a big thing.
And then, you know, there's the practical things, like really nailing down the
access pathway. And so that's something that we're working on.
(06:28):
So access pathways like private health insurers and NDSS. All of that.
And, you know, we really want to make sure that that's really,
really, really clear and all locked in before we launched to consumers. You're...
CV, I assume, has a bullet point, which is negotiated with private health insurers
and the NDSS to actually get pods on the NDSS.
(06:48):
That was a big hurdle for a long time when Dash launched, right?
That was you who managed to get that over the line?
Yeah, well, you know, we have a team, an exceptional team. I'd love to say that it was all me.
No, but look, it actually was something that was negotiated by Insult Australia.
And yeah, Yeah, I mean, that was one of our proudest achievements because what
(07:09):
it meant is that we actually provided two pathways for consumers.
Previously, it was just private health insurance. But as you would know better
than I do, there is a bunch of people who don't have private health insurance,
who can't afford private health insurance.
And so it means that people are able to access the therapy, try it,
decide if it's for them, and they're not locked in.
(07:30):
People don't like to be locked in. We don't like lock-ins, right?
The unique thing about potting, I guess, is that you're literally just buying
however many pods and however long that lasts, and you can just pay for that
as opposed to a four-year commitment. I can't imagine why people would be nervous
about making a four-year commitment to a thing that's keeping them alive. Yeah, yeah.
So, yep, so as I was saying, you know, the access pathway is one thing,
(07:51):
you know, making sure we've got our onboarding processes that we've communicated
with healthcare professionals, that they've communicated with their patients and consumers.
So there's a bit of prep work, let's just say, to do that. But what I will say
is as we get closer to launch, we'll definitely be sharing more details.
People want to know exactly when, what sensor, what iteration,
(08:12):
what cost, you know, all of that detail we will absolutely be sharing as we
get closer to launch. Cool, cool, cool. Good, otherwise we'll be knocking down your door.
But I want it now. Joe.
You know that I'm a member of your pod squad, so I am very interested in the Omnipod 5.
And we've mentioned the algorithm. Now, the word algorithm causes a bunch of
(08:35):
people to run for the hills.
But what we're really talking about is adding some smarts to the pod.
So tell me a bit about how the smarts actually work. What's it going to do?
How's it going to be smarter than me? How's it going to be smarter than you?
Well, it is constantly speaking to a compatible sensor.
And the algorithm, just for a little bit of smarts,
(08:55):
it uses a model predictive control algorithm and it is essentially taking both
the value as well as the trend into account and it's predicting 60 minutes out.
It's taking into account your insulin on board and then it makes a determination
and every five minutes it's saying, I'm either going to increase,
(09:15):
I'm going to decrease or I'm going to pause insulin delivery based on all of
those considerations and probably many, many more that I'm not probably able to even talk about.
But that is essentially at a high level how it works.
And one of the things that people really love about the Omnipod 5 is that there's
multiple targets that a user can set for themselves, different targets for different
(09:37):
times of the day. What a wide range.
Yes. This is what interests me is that you can pre-program which target you
want for what time of day.
So you can choose, I want to sit a little bit higher during the day and maybe
lower at night That's right.
And it's between 6.1 and 8.3.
And what we've seen, what's great globally is we see some real world evidence
and we see how people are actually using, and the overwhelming majority of people
(10:00):
do use the multiple targets throughout the day.
So what's one example, Jo? Why might someone pick a different target?
Yeah, so they may pick a higher target for overnight, as an example, or when they're.
Someone worried about going low is going to go, all right, yeah,
I'm worried about overnight lows. I'm going to push my target up.
(10:20):
I'm worried about exercise lows.
I'm not having a more active day. That could be beneficial. Like,
you know, unplanned, I guess, unplanned is helpful.
Unplanned exercise, you mean? Yeah. Or sometimes when you're on holiday and
you're traveling and you're walking a lot more than you normally would,
that could be beneficial.
It would be helpful at an Australian Diabetes Congress when I'm running from
booth to booth going, oh, look at the shiny thing. Look at the shiny thing.
(10:41):
I'm not checking my blood sugar.
Very interesting. Can I ask, so currently Dash is controlled by a PDM device.
Is that going to be the same for Omnipod 5?
Yes, yes. So it's called a controller. There's a lot of discussion in the community,
as you know, about controller and, you know, will there be phone control?
We get asked that all the time as well.
(11:01):
But the really great thing about the Omnipod 5 system is that the algorithm sits in the pod.
And the reason why that's so important and what it means to the consumer is
it's a full on-body experience.
You actually don't need the controller near you to be kept in that auto mode,
which means you can be out in the surf, swimming, doing your thing.
(11:22):
You don't need the controller near you. Swimming has to be the big one.
I mean, obviously you have Bluetooth issues in the water, but your CGM can keep
talking to the pod and that loop just keeps running and completely hands off.
You don't have to have your phone with you. And we see from both our pivotal
studies and real world evidence that people stay in loop well over 90% of the
time, which is what people want, right?
And really just brings it back to simplifying life and giving people the,
(11:47):
I guess, confidence that they're being kept safe and making diabetes a much
smaller part of their life.
Yeah. Amen. Before Joe came on the podcast, I put messages out in our various
platforms and I said, I'm interviewing Joe. What do you want to know?
Boy, did people have questions. So first cap off the ranks is,
will I be able to switch from Dash to Omnipod 5 even if my four years on private
(12:10):
health insurance isn't up yet?
Such a great question. And we get asked this quite a bit. And the good news
is, the short answer is yes.
Yes, you will. That's very exciting. Clip that, post it right now.
And so what we're just about to launch to the community is something called the Omnipod Promise.
And what that means is that if you are, as you just said, in your four-year
(12:33):
warranty, it is a pathway that will provide for a one-time payment of $249,
which allows you to move to Omnipod 5 technology,
whilst you are still in that four-year cycle.
So we don't want to hold anyone back. We just want people to get the technology that they want. Cool.
So, hypothetically, if you wanted, you could go on Dash now.
(12:55):
Absolutely. And then move to Omnipod 5 when it's out. Absolutely.
I told you, Carly, come to the dark side.
Yes, my four years on my current system is up in June next year.
Oh, so it'll be out. Okay, so you kind of have to wait then anyway,
unless... Do I? Well, as in... It's self-fund from today.
I've got to stop doing this. But same, release of Omnipod 5 early 2025.
(13:19):
I've still got six months left. So technically, are you saying I could transfer?
Not with another brand. Not with another. It's only if you're moving from Dash
to Omnipod 5. Yeah, I was just going to clarify. Yeah, okay.
But nothing stops you from trying it, I guess, even if you just wanted to for
a month or two before you go out of warranty.
Trying the Omnipod 5? The Omnipod Dash. Or even the Omnipod 5.
(13:43):
And how would that work? How would I, what would that cost to trial the Omnipod 5? Nice try.
We will be forthcoming with more detail around costs and details. I tried, people.
We absolutely envisage that there will be a pay-as-you-pod access pathway,
(14:05):
which just means that you can just try one month's worth of Omnipod supply apply
and that will give you an opportunity to try the Omnipod 5. Okay.
I like the sound of that. That's a full four-year commitment.
Yeah. Cool. And it probably leans into our next question. So a lot of people
in the community, myself included, love our Dash, want our Dash,
want to make sure our Dash isn't going anywhere.
(14:25):
Yes. We get asked that a bit and we love Dash too and we don't want Dash to go anywhere either.
And so absolutely for the foreseeable future, Dash ain't going anywhere.
We have no plans to retire Dash once Omnipod 5 is in the market.
Because we hear that all the time too.
Yeah, well, there's so many people, well, the growing amount of people who are
now looping with the Dash.
(14:47):
I think I just heard their collective zip, zip, zip. Do it yourself looping
to clarify. We'll talk about that when we haven't got Joe in the room.
I'm just saying, like, there are so many people in the community who wouldn't
want Dash to go anywhere. Correct.
You can cut if needed.
Last question from the community. Any plans? this is,
(15:09):
proof that we're never happy, right? So we've literally got Omnipod 5 has just
been released. We get an algorithm.
Yay. We're already thinking about
the next thing. Any plans for extending beyond a three-day wear time?
Such a good question. And, you
know, Insulate as an organization get this question all the time, right?
You know, it's one of those, I guess, challenges that you've got a pod and people
(15:31):
want that to get smaller, by the way. Yes.
Smaller and last longer. Make the pods smaller, extend the wear.
You know, it's these very contradictory requirements. Just break the rules of
physics for us, Jo. Exactly. We'd be delighted.
Breaking the rule of physics. And I'm not in our R&D department.
However, I know that this is something that the organization thinks about.
And, you know, whilst there's no product plans or timelines,
(15:55):
you know, it's definitely something we think about.
Just on innovation, what I do want to say is, you know, I was alluding to the
whole cloud infrastructure. structure.
This is quite new to Omnipod 5.
So whilst, you know, insulin delivery through a pod is our bread and butter,
and that is what we do really, really well, you know, that whole data and cloud
platform is very much a new capability for insulin as an organization.
(16:20):
And what that means is that for the user going on to Omnipod 5,
you don't need to now physically go and download something, which we know is a friction, you know.
Everyone wants to get around to uploading their pump and it doesn't happen.
But because it will happen automatically, it means that everyone who's on Omnipod
5, their data just goes into the cloud.
(16:40):
And what that means is you have huge amount of insights and rich data,
which we can understand better how people are interfacing and using their technology,
how the algorithm is performing,
trends and so much rich data, which really will inform product development,
you know? How do you then tweak the algorithm?
(17:02):
How do you tweak the user interface to keep on innovating and improving the
system, to make it simpler, to continue to make it a smaller part of people's lives? Because...
That's what we do and what we do really really well so yeah i
always you know i log into you know whatever the cloud platform is i'm using
for whatever pump i'm using at the time and there's always all that you know
do you accept the blah blah blah and we might use your data for blah blah blah
(17:23):
and i'm tempted to go no and then i'm like no hold on this like this data gets
used to for insights into future development like that's that's yeah so it also
makes an appointment with your diabetes educator so much more useful if you
have the data in front of you say that
because I can't remember the last time I actually uploaded my pump
because it is it's
(17:43):
it's such a headache and because they cancelled the the last
program that I was using attached to my pump so I still actually haven't downloaded
the new one that I meant to because everyone says it's a little bit of a headache
with the setup and I was like I can't leave it on the edge here yep so that
is very very exciting indeed last question Jo yeah so Omnipod 5 will launch with a G6. Is that right?
(18:06):
Great question. So what I can say is that we have global partnerships with two
CGM corporations. So that's Dexcom and Abbott.
And that's based on our whole philosophy around the importance of choice.
Consumers want choice and we want to give it to them. So what we do see in other
countries is we see different iterations of sensors.
(18:26):
What sensors we're going to have available here with Omnipod 5, we are still working on.
There's a range of regulatory considerations but as
i said earlier as we get closer to launch we'll absolutely be
able to share you know which sensor which iteration from when
and all the details yes i'm just looking at that dexcom g7 stand across the
other side of the pavilion and going i wonder i wonder future integration yes
(18:55):
so many options okay we'll wait yeah joe thank you so much for taking the a
time to talk to us today. Thank you, Joe.
Thank you so much for having me. This was a lot of fun. Yeah, it was.
Hopefully we'll talk again soon. Yes. Come by anytime, particularly when you've
got exciting things to tell us about. Yes. I can't wait to tell you more.
Thank you, Joe. Thanks, Joe. See ya. Thank you. All right.
(19:15):
So everyone is excited about Omnipod, but definitely not the only thing on show.
Lots of things that I've seen. Keen to hear what you guys have been observing
while you're here at ADC. Well, a certain boss kind of told us we had to man
the booth, so I don't feel like I've actually seen that much of the conference.
Not that you're bitter at all. I'm bitter.
Hey, I saw you walking to the little chocolate mousse stand multiple times yesterday
(19:39):
afternoon, so I think you've seen a few things. That mousse was good, and I make no apologies.
It was really good. You landed the blood glucose as well.
Yeah, I don't know what's been going on. It's been flat lines all week.
I don't know whether it's just I've done just enough walking and my brain is
just having to go non-stop that it kind of deals with the rises from the,
caffeine and glucose i throw at it or i don't know i think
(20:00):
it's like so much talking and hand gestures and actions
it's like doing aerobics because i have been sitting
under five like all day and you know
when you go out and you eat like we can't tell what's on
the we get provided lunch here we can't tell how many carbs have
snuck in there but a big guessing game yeah carly on
that point now that we're going a completely different direction from where
(20:20):
i was going what was on the menu for this morning's morning tea oh guys morning
tea this morning was four cheese arancini followed by a double chocolate brownie
followed by fruit my blood sugar went up just listening to.
It's like yeah it's it's really it's what do they call it deconstructed pizza
(20:44):
almost like you just got fat glucose and there's many proteins in that oh it's
the triple threat Threat. It's the dribbled threat. Yeah, it's insane.
We should pick it up and take it around to the tech companies and say,
which one of you can handle this? Oh, yes.
I totally want to do that one day. I'm just going to get like four different
pump users and just get them to do the same thing and just see how the algorithm deals with it.
I thought he was going to say he was going to wear four pumps at once then,
(21:06):
and no one would be surprised. It doesn't work that way.
Anyway, I feel like the first thing I have to go to, I know I had my grumpy
pants on during the introduction and was doing my BS detector cure in our lifetime, yada, yada, yada, yada.
Which we enjoy. joy? There were a few things which are really cool.
One, we talked about smart insulin on the podcast.
Looks like it's actually a real thing and really interesting because a lot of
(21:29):
the health professionals here were sort of of the same opinion that we were
of, and then have been hearing a lot more about smart insulin.
The really cool one that they spoke about is what's called a liver preferring insulin.
So let's go nerd for just a really quick second.
This is one of the the things that frustrates the heck out of me as a person
with type 1. We inject insulin into our skin, which means it goes everywhere.
(21:53):
What actually happens if you have a functioning pancreas is that most of the
insulin goes straight to your liver, which is producing glucose all the time.
That's the thing that's giving you glucose to go to the brain because the brain only likes glucose.
So we end up actually giving ourselves more insulin than theoretically we need
because it goes everywhere instead of where it needs to go.
(22:13):
So now they're working on an insulin that will prefer going to the liver.
Liver so theoretically you'll need
less insulin to get the same blood glucose control and
given that the more insulin you take the more risk factors you
get the more weight gain you get yada yada yada yada that has
some really exciting okay and then the smart insulins
(22:33):
which are glucose sensitive so the higher your glucose the more insulin they'll
release look like they could be a real thing now we're still in theoretical
early trials etc but exciting of course there There was lots of talk about preventing
type 1 from onsetting at all. We've talked about teplizumab before.
(22:54):
That's moving along. But what I was really excited by is I think this is the
first time I've actually heard
anyone say, what about the people who are already diagnosed with type 1?
Because every time I go to one of those things where they say,
we're going to cure it by stopping it. It's about the future.
And we go, oh, good. We'll be the generation that doesn't get the cure.
Huge amounts of work on beta cell replacements. and it looks like it's going
(23:16):
to get to the point eventually.
I'm not going to put a timeframe on it because I'm not a fool.
But you are a pessimist. That's right. If they can switch off the immune response
to stop it from onsetting at all, then they can switch the immune system off
to kill the new beta cells.
So if they can then work out a way to give you beta cells, theoretically,
we could actually cure people who are already diagnosed.
(23:39):
So the two approaches are actually linked. They are.
Will they come on the same time frame? Who knows? We're still very early days,
hence my BS detector being up here somewhere.
But it was nice to hear some hope coming out there.
What was also really cool is that there's work on even faster insulins.
(23:59):
So if you thought that Fiasp is fast, it's actually still really slow.
So when endos talk about it, it's really interesting.
They kind of say, well, you can have the 15 minutes before you eat or you can
have the 10 minutes before you eat. As the difference between Fiaspa and Nova Rapid. Right.
In real life, doesn't really make a difference. And actually,
(24:20):
it was the first time that I heard an endo say, brace yourselves,
it's actually really hard to pre-bowl us for a meal.
Acknowledging just the life impossibility of that. I had to almost stop myself
from falling off my chair because they always go, it's just the person's fault.
If they would just give themselves insulin 15 minutes before, they'd be fine.
And an endo actually said, you know, that's actually pretty difficult,
(24:42):
Unless you have a crystal ball and know when your food is arriving and are always
perfectly planned and aren't eating your children's dinner that they refuse
to eat, but they've just left cooling on the table.
Or at a restaurant waiting for a meal to come and going, I'll play it safe.
Oh, no, I'm having a really carby meal. Like I'm going to pre-ballers.
It won't take more than half an hour to get here.
And then what happens? All of a sudden you're waiting 45 minutes.
(25:04):
And you're crashing all over. Yeah. Yeah.
So, yeah, they're trying to make it even faster. You know, the ideal would,
of course, be that you just take it when you eat and it acts as fast as it can,
which is kind of actually what happens in your body because it's just going
straight into the bloodstream.
So, super cool. What if we all just became druggies and just did intravenous injections?
I have often wondered about that. Like how much faster would that be?
(25:25):
Just give me a big portal and I'll just ram it in there.
It's an IV line just dangling off your arm. It's like instant.
I remember like having a C-section with my daughter. they took me off my basal from the morning.
I think I might have taken like maybe half the night before.
And then the morning of it was all intravenous, like a delicate balance.
(25:46):
They had little dials for the insulin and the glucose.
Yes. Yep. And they were just like doing this.
It's going to make a great give. Yeah.
Sorry for those of you who are listening on audio. I don't even know how to
describe that and keep this safe for work. So moving on.
Can we go to Prick of the Week? Prick of the Week.
(26:10):
I'm sorry, but it amuses us, so you're just going to have to put up with it.
For the most part, I have to say, like, it's been mostly positive in terms of
who I've been chatting to, clinicians-wise, but I do have a little prick in
my week. I met him yesterday afternoon.
Yeah, charming fellow, works in the diabetes space, and he wanted to find out,
(26:31):
like, what we do at the Family Centre.
I think he predominantly deals with those with type 2 diabetes,
but he sees a lot of teens in that space and had a 16-year-old girl with type
1 who was basically refusing to take her insulin and then sitting up, you know, in the 25s.
And he was so angry about it that he was telling the dad to go home and enforce some discipline.
(26:56):
And I was sitting there just like, oh, gosh, how do I get around this?
I had, you know, Bec, who works in the mental health space, you know,
supporting those people,
with those difficulties around why they may or may not be taking insulin.
And then the very complicated rabbit hole that goes down.
And again, I was just listening to Benjamin rant about not supporting,
(27:22):
I guess, the consumer with type one or understanding the lived experience.
And there was a prime example just standing right in front of me.
And every time I tried to offer something, it was just slammed down.
It was like, it's ridiculous. This will not do.
She must take her insulin. I was like, I understand this, but have you thought about why? Yeah.
(27:46):
Look, let me try and come back from the clinician's perspective.
I was trained as a healthcare professional originally.
Really important that we remember that people get into the healthcare professions
because they want to help people.
The challenge is healthcare Healthcare professionals are taught and want to fix things.
That's what we want to do. We get into healthcare professions to fix stuff.
(28:07):
Why is type 1 really frustrating? You can't fix it.
So I see them come in. They're excited.
They're enthused. They come into the conference. They want to learn stuff,
and they go straight to the tool.
Here's Manjaro. Here's Tujayo. Here's the new insulin sexy thing.
Here's the AID device because they want the fix.
They want the hammer. They just want to be able to go into an appointment and
(28:28):
go, ta-da. He did actually say, actually, it was one of the first things that
he said when he came over was, type 1 is a real problem.
Yep. Agreed. Furthermore, it was like, type 2 diabetes, easy. Type 1?
It's a problem. I'm so sorry to all those people living with type 2 diabetes
(28:48):
who just heard that it was really easy to solve.
Yeah. Woo! I think as a segue, so we should get to pick of the week,
something a little bit more. Oh, but I'm ranting.
I know. All right, settle me down. We've done a lot. I was having a conversation
yesterday afternoon with Bec Johnson who sits on our board.
She was the founding member of the Type 1 Family Centre. Sorry, Type 1.
(29:09):
She was the founding CEO of the Type 1 Family Centre. and we were having this
discussion about how the rhetoric seems to be there are two tools,
you have technology and you have insulin.
And she was like, what about the others? What about exercise?
What about food? What about wrapping a community around people?
And I'm using that as a segue because food... It is a perfect segue.
(29:32):
So let's talk about Pick of the Week. Let's talk about the thing that we're
super excited by, which is that at ADC, at this conference that has lots of
technology and lots of insulin... So many drugs.
We're about to pump ourselves up again. Warning. Yes, we're pumping up our own tires.
But an amazing panel, including Amy Rush and Beck Newton from the Family Center, Dr.
(29:53):
Joey Kane, endocrinologist on the Family Center board, and Sanjeev Balakrishnan,
who is a GP specializing in chronic disease and a friend of the Family Center,
delivered a presentation on, let me get the academic title,
therapeutic carbohydrate restriction in type 1 diabetes. What does that actually mean?
This was a conversation in front of at least 150 clinicians.
(30:14):
They packed the room, endos, credentialed diabetes educators, dieticians, et cetera.
They were all super curious. They were like, what is this? Mostly they were
thinking, why is there something here that's not technology? No, I'm kidding.
There was lots of interest, lots of excitement, because what we were talking
about is fundamentally an acknowledgement that when you have type 1,
you have a pretty weird relationship with food.
(30:35):
That's just the nature of the disease. And what we know, again,
rocket science, is that people with type 1 change their food.
Regardless of whether we tell them to or not, regardless of whether there's
education that says you should or not, intuitively people go, that food kicks my butt.
That food's really hard to bowl us for. I can never get pizza to work for me.
(30:56):
Bananas keep changing color and sugar content while I watch them.
And they start to change.
And that is a tool that we do not talk to people about because what we say instead
is eat whatever you want.
And dose for it. And dose for it. So So use the insulin to cover whatever it is that you want to eat.
And we give you the healthy eating pyramid typically, which has something like 65% carbohydrate in it.
(31:22):
So we're basically saying to people, take 200, 300 grams of carbohydrate a day.
Take this tool, which you need to match to that carbohydrate.
It doesn't work very well and you might get it wrong. And good luck carb estimating
that giant bowl of pasta that the chef has put a bunch of sugar into.
But insulin's your tool. instead of saying
to people you got that tool and you're going to need
(31:42):
it right you're going to need insulin one way or another whether you like it
or not but you've also got the choices of food that you make and what we're
not saying to you is don't eat any carbs right no one is saying go carnival
what we're actually saying to people is you should understand that you can change
the amount of carbohydrate you eat just the same way as you can change the amount
of insulin that you you take,
(32:04):
and actually changing the food that you intake to need less insulin might make things,
one, easier because your dosing might be easier.
So, the classic example on this is that when you pick up a nutrition panel on
a packaged food, like we all do to carb count, right?
And you look at that number and you plug it into your pump or into your bolus
calculator for your dose and you dial up your pen.
(32:28):
That number is wrong because that is an average and you are allowed to be 25% wrong either way.
So if that is a big bowl of pasta and it is, I don't know, 75 grams of carbs,
that might actually be a hundred grams of carbs and you don't know,
and you get it wrong. You get it wrong by that much. That's a lot of insulin.
(32:52):
You've either under bolused by a major amount or
you've over a bolus by a major amount if you replace
that pasta with a pasta that has five grams
of carbs like edamame pasta i know it's green it's
weird but let's just go with it for a second and you got that wrong by 25 that's
a gram of carb zippity-doo-dah yeah it's not going to make any difference and
(33:13):
any algorithm is going to pick it up and the algorithm will pick it up if you've
got an aid if you're on mdi you wouldn't change what you dialed up yeah that
would probably be one unit of insulin,
regardless of whether you're 25% either way.
And it's not to say everyone should shift to edamame pasta, unless edamame wants
to sponsor this podcast conversation.
But it's a tool. It's just to say, hey, you can think about that.
(33:34):
And we had the room packed out with people, some people who looked like this
was the first time they had ever contemplated that you don't just tell people,
here's the insulin, you tell people, maybe you could change your food.
And that's not saying keto, it's not saying low carb, it was just saying,
how about we have two tools in the kit and how about we
actually acknowledge that people with type 1 do it
(33:55):
anyway and maybe actually talk to them about how to
do it safely and appropriately because there's all kinds of things you
could do you could end up not eating enough food because you
just cut all your carbs you could end up eating crap because
there is some serious crap out there that replaces carbs with
other stuff yeah how about we help people of yeah
actually educating people on how they
(34:16):
can have a complete nutrition profile and they
can easily switch around these things like it's just i always
bang my head against the wall because obviously a space that i've been in for
a very long time it's like food it just seems obvious and can i can i just get
on my high horse again because i am i'm just i'm gonna do it anyway but i pretended
to ask for permission what is exciting there's only a little bit of research
(34:39):
in this space and the reason for
that is we don't have the pharma company money to put into low-carb foods because
that's not exactly going to generate the same money. Anyway,
cynicism off, doesn't matter.
The research that we have shows that even making little adjustments.
Moderate carbs, reducing it a little bit has a bigger impact on blood glucose
control than some of these sexy new drugs that are out there.
(35:04):
So can we get into a space where rather than tell every person living with type
1, and just throw another couple
of injections on and 400 bucks a month or whatever the damn thing costs.
There's also another option, which for some people might work really well.
Other people, looking at you, Adam, go, you know what?
I'm going to eat whatever the damn heck I want. I love carbs and I know how
(35:25):
to titrate my insulin. Go team.
We had a conversation about something that wasn't tech and wasn't medicine and
was what people were really doing.
What was the vibe in the room in response to that? The best thing about the
vibe in the room is that it was mostly curious, interested, excited.
Yep. There are always a couple of people who go, are you telling everyone to go keto?
(35:46):
But very little of that. Carla, you were in the room. I was.
I was towards the edge, just getting a sneak little look at all the people that were coming through.
There was definitely a lot of chit chat, particularly in the beginning.
I couldn't catch all of it.
But I certainly did have a chatty Cathy nearby providing two cents.
And I think any time that we've come in with this kind of stuff,
(36:07):
it gets people talking. So people talking is a good thing.
And it was really interesting because it wasn't putting forth a really biased
suggestion on what carb reduction looks like.
It was showing that there's a range. I think what's most interesting is that
low carb can range from 50 grams to 130 grams.
So and it was very clear
(36:29):
that we were not going to be talking about a ketogenic diet here
it was touched on a little bit but that wasn't the focus here
so i think that was super important because a lot of people their definition
of low carb is is keto when it comes to managing type one for whatever reason
so i think just re-educating within that space of what carb reduction looks
like and how helpful it can be was super positive so i think by the end of it anyone that had little.
(36:54):
Queries and concerns it's yeah it was
the approach it was a really good approach i will say that and i mean you saw
after the talk happened we got flooded at the booth with everyone saying information
do you have more of the flyers that you've been handed yeah yeah it was people
were literally taking the flyers and putting them into their handbag in in buckets
it was hilarious yeah it was really it was really really great.
(37:19):
Well, this is going to be an epic episode. I think we might have to break this
into two. We'll figure out how that's going to work. So now the seven other
rants that I've got lined up. Let's go.
No, no, Benjamin, no more. No more rations until next week.
We might need a whole episode for Benjamin's rant on 86. You know what really
grinds my gears? I look forward to it. Yep.
(37:41):
Right. Next episode, we have Duncan Reed, who is an ultra marathoner. we had a chat with him.
We're talking about exercise, food and then exercise.
Oh my God, another tool in the toolkit. We're radicals.
Duncan Reid is an ultra marathoner. Carly, do you want to give us the two cent?
Yes. Yeah. Duncan is an incredible, credible man doing incredible things in the type one community.
(38:05):
Crazy man. He has run 10 ultra marathons over 10 years with more to come.
He started, yeah, at the age of 40 and he's just decided one day I'm going to
run 100Ks through the desert and that's where his journey began.
So, yeah, really looking forward to bringing you that episode and unpacking
exactly what Duncan does, how he does it and what's looking ahead for him.
(38:28):
And super interesting, he's going to talk about how he feels like he is fitter for having type 1.
So, really looking forward to that conversation. Yeah.
There's a slogan. All right, thanks for joining us. We'll see you next time
on Life in Beta. Ta-ra. Ta-ra. Come on, Carly, say it.
Music.
(38:52):
If you've been listening today thinking that is so relatable you should consider
joining our online community where over a thousand other people with type 1
are sharing their experiences learning and supporting
each other head to type1familycenter.org.au forward slash connect.
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