Vodka, Soda and Fresh Lime

In this episode, we're spilling the tea (or maybe cocktails) on handling a night out with Type 1 Diabetes and alcohol. 🍸 There's hilarious hypo stories, the latest tech updates (hello Omnipod 5!) as well as a quick look at "smart insulin"... Tune in for laughs, lessons, and a whole lot of life with Type 1.

Episode Transcript

(00:00):
Music.

(00:42):
Music.
Diabetes. My name's Adam Brockway. I'm the community manager at the Type 1 Diabetes
Family Centre. Joining me today, the one and only Carly Green.

(01:02):
Such a professional. Is that a compliment?
I have a bone to pick with you though, because Pilates this morning,
my legs have not stopped shaking since I finished that class. Is it Pilates or a hypo?
Well, I'm low now, but who knows? It was... Oh, we were all low.
Had someone have a low before they started, then went, over-corrected,

(01:25):
soaring high. Yep. Then I started crashing.
Bree wanted to take over the class. You had a sympathy hypo.
And then Adam's going down. Yeah, it was an exciting class this morning.
You missed out, Benjamin. Exciting is an interesting framing.
Well, it was exercise with type one. That's what exercise with type one is.
Hashtag life with type one. Absolutely. Yeah.

(01:47):
Also joining me, Benjamin Jardine. Howdy. The dire boss.
The dire boss. Back from the Gold Coast. Oh, and to give an update for those
who listened to our last podcast about my overpacking of insulin pumps.
How many did you go through? I felt exceptionally vindicated because I got into
those Jetstar seats, which are tiny and squishy. Large man.

(02:10):
Sat down, ripped my pump off. First thing. And I thought, yep,
welcome to travel with type one.
Lucky I've packed all the pump supplies. wise.
So I did feel incredibly vindicated. I thought of you both as I ripped my pump
off and then had to fill my Omnipod in front of two strangers sitting next to
me in the aisle. Welcome to type one. They got a good education.
I bet. Were you not wearing the pod on your arm?

(02:32):
No, for some reason I stuck it on my stomach, which I never do.
Clearly being very clever and then ripping it off as I sat down.
I can just see that, like those arm rests, either side of those quite narrow seats and just.
But I do like the diabetes education opportunity because it's hard not to introduce
type one when you are suddenly stabbing yourself with a new pod that's going
tick, tick, tick, tick, tick while you're sitting on a plane. True, it does.

(02:54):
And then beeps. And then beeps and squeals.
Yeah, it was good. So how did they take it? One looked a bit squeamish,
but at least the needle is hidden.
Yes, insertions on a plane, Omnipod's got to be the perfect thing for that,
right? Like just whack it on, press a button, nobody sees a thing.
I might have added a bit of drama to the injection.
At least you're in the company of your wife and two children.

(03:16):
It's not like you're sitting there alone.
Well, they were on the opposite side of the aisle, as they often do, leaving me to my type 1.
You've got this, honey, right? Were you on your own? I was on my own.
Okay. Speaking of Omnipods, if we head straight to the news,
the big exciting news this week was that Omnipod 5 has been given approval by the TGA.

(03:38):
Yes. Very exciting. Very exciting. Omnipods represent.
Indeed. Indeed. We got multiple text messages from the rep. Urgent. Call us immediately.
And our educators are going, did somebody die?
But no, it was just good news. Very cool. So tell us, Tech Nerd.
Yes. So Omnipod 5, this is similar to the current Omnipod, except that it has an algorithm.

(04:04):
So we will, I think, take a dive into how that That algorithm works on a later
episode because that's going to be, I think, a whole chunk.
But what's happening right now is that the Omnipod, sorry, it's been through TGA.
So now they have to negotiate pricing with the NDSS and then everybody has to be trained.
So like the reps have to be trained, the educators have to be trained.

(04:24):
And then maybe in a few months, we'll actually be able to start putting people on it.
That was going to be my question. I was like, once it hits TGA approval,
how long in the past have we had to wait? So we're giving the people at home,
like, anyway, between now and three months' time.
How is that release bit going, Carly?
G7, we all epically failed. G7 is still not here. It might be next year at the

(04:47):
same time, in which case we're still on target.
I feel like they're doing it on purpose because we all want it and pushing them.
And they're like, you know what? You can wait.
I think we're not going to get an answer more than imminent this year,
maybe. This year is my take.
But super exciting. So we're no longer going to be able to call it the dumb

(05:10):
pod. That's almost disappointing. No, it'll be the dumb pod and the smart pod.
We'll have dumb pod and smart pod, and you can choose between dumb pod and smart
pod. So you're going to try the smart pod and just see how it compares to DIY loopy? Yeah. Oh, yeah.
So I actually think this is really exciting because we meet lots of people with
type 1 who want to go on the Omnipod and they get super excited by the Omnipod,
particularly because it doesn't have tubes.
In fact, we had this conversation just earlier with another person with type 1.

(05:34):
And then they find out it's a dumb pod and then they're very sad.
And they're looking at the advanced algorithms in the Medtronics and Ipsos and
so forth and Omnipod doing none of that.
And we have constantly had to say, you know, it's coming, don't worry, it'll get there.
So people who really want that tubeless life are now going to be able to access
the same smarts as everyone one else.

(05:54):
And on the DIY looping side, super interesting, right?
Because the Omnipod is the only pump commercially available right now in Australia
that you can DIY loop with.
And not surprisingly, people do because they want the algorithm and they've
gone to all this effort to build their own application to drive their pump.
And now there's a possibility that they won't have to. So I'm going to give

(06:16):
it a try because I think it's really interesting.
And I've always said about DIY looping, you know, I love the DIY looping community
and we're going going to talk more about it later on.
They are pushing the envelope faster than the med tech companies.
There is a reason that there is the hashtag, we are not waiting, right?
This is the type one community going for, we are going to do it ourselves if you won't do it.

(06:37):
And they really do push the envelope and we've seen some really significant benefits, right?
But the thought that everyone has to do that really frustrates me.
And there are people right now on DIY loops who really do not want to be on DIY loops.
They are on a DIY loop because they have no alternative and they are not willing
to go back to dumb pod land.
And now to be able to say to probably the bulk of people...

(07:01):
The five's probably going to be a better option. It has a good commercially
available algorithm. You get good tech support.
If you ring up, you're not going to have to pretend that you don't have a DIY
loop to be able to get support.
And then the 5% at the top end who really want to push the envelope and build
their own apps, the DIY loop is probably always going to run ahead of whatever's

(07:21):
commercially available.
Awesome. But for the majority of people, you're going to know that there's a
good system out there for you that's got all the benefits of what these people pioneered.
But you don't have to be trying to build your own android app which
was a fun experience so fun yeah i did
it on ios so yeah it took me a whole weekend it was like
a deep deep dive i understood about five percent of what i was doing and that's

(07:43):
not the feeling that you want when you're a life-saving device never mind i
think that's most people's take with when they hear the word looping as well
they're like just too hard i
don't know what that is i don't have the time to explore what that is So,
yeah, just to have something that's available and as simple as every other pump.
But I'll do a review of the two because I'm really interested to see now that

(08:04):
I've had access to the matrix and I can play anything that I want and tweak
anything that I want and turn on cool, super advanced features.
And I'm going to use five and I'm sure it's going to say you can touch none of these things.
How I go. But I'm super excited. Yep. And we should let people know that if
you have signed up for an Omnipod subscription, either paying all yourself or

(08:24):
with private health insurance.
Insulate have said, the makers of Omnipod, that you can swap back and forth
between the two types of pods.
So yeah, you can try it and then go back. If you are a looper and you are worried
about when the fiver comes out, are they going to stop having the availability
of the dash so you can loop?
As far as we found out, nope, they're going to keep both options on the market.

(08:44):
They're going to let people swap in and out between the two. Super cool.
I'm really excited. I look forward to doing my review of the two options and seeing what I think.
Are you finally going to come to the dark side, Miss Green?
I will give it a go. I will give it a go.
Like I've said, it takes up a lot of real estate on the body,

(09:07):
which is why I've chosen the T-Slim over it.
But I am curious, so I'll give it a go. But yeah.
Our next item, are we moving on to our next news item? Yeah,
go on. Please move on before we talk about the fact that I have way more real
estate to put pumps on than you do.
I'm so excited about this one.
Adam dug it out. So I think it's a Swiss company and they've got a patch pump called the Nia.

(09:32):
And there's actually three. They've got like a basic, what we'd call your dumb
pump. And then they've got like an intermediate.
And then they've got their signature pump. Regular student pump.
Which is, wait for it. My point, it is a CGM and a pump built into one,
into a nice, circular, aesthetically pleasing shape.

(09:55):
It does look very cool. I'm so excited. And it's like, it doesn't look that
much bigger than a Libre sensor.
Obviously, a lot, you know, bigger profile off the body, but super cool.
And then it's part disposable, so it fills a full three mils of insulin,
so you get longer wear time.
Which is super cool. I think I read five days.

(10:15):
Yeah, it can be worn for five days. Yeah, five days. Five days.
And then the CGM and the pump tech bit of it, it's the top part of the pump,
that stays the same for two years.
And it's just the disposable kind of sensor bit that adheres to the body is
what you change every, say, five days.
That's interesting. So you're actually putting a new CGM in every five days
as well because it's- Guessing so, yeah. That's the cannula.

(10:38):
Oh, like the sensor part of it. And the transmitter must be part of the two-year.
But I'm like, this is just one little circular spot on your body.
Finally, they've like found a way.
So like, yes, I am a little bit excited about Dash 5, but I'm a lot of it excited about this.
I'm like, take me to Sweden.

(11:00):
Well, yeah, not to be a Debbie Downer. That was literally just announced at
the Australian, no, sorry, American Diabetes, what does the other A stand for?
Association? Association? I guess so.
Scientific sessions a few weeks ago so this is
them saying hey it's here but i don't think
it's even had fda approval in the states yet so it's just

(11:21):
one of those exciting things that is apparently coming so carly
i don't know i'm just remaining optimistic okay all right all right i'll let
you have your your moment but that's cool um and it'll have an algorithm and
it's going to be controlled by smartphone so yes but it's a steel cannula correct
yeah yes i've never tried a steel That's my technical answer to steel cannulas

(11:43):
and my experience of them.
Yeah. I actually haven't tried them, but I would like it because you wouldn't
get a kink, right? You definitely don't get a kink.
It'll kink your body before it takes the cannula. Yeah.
I don't know how I feel. I mean, the children's hospital here puts kids on steel
cannulas by default because kids are always kinking them. Yes,
kids are remarkably good at kinking.
Most of them do pretty well on them. I know because I don't know why,

(12:07):
but like always kink on the stomach. And I'm like, how do kids get past this?
Because they're super lean.
So, yeah. This probably comes back to my allergic to, you know,
life, let alone steel cannulas. So, yeah, I get it. We'll see how it goes.
All right. Apologies to our injections users again because we're very tech heavy today.

(12:27):
But we have got something right at the end for insulins.
For insulin? I don't know. I don't remember. Oh, look, we had this conversation
like five minutes ago. podcast.
Moving on, but we will talk about things that are relevant to MDI very shortly.
In the meantime, though, announced also at the ADA conference by Breakthrough

(12:50):
T1D, formerly known as JDRF, guidance for people who have been screened for type 1 diabetes,
but aren't yet at stage three, which is type 1 as we all know it.
So this is, for example, if you are a parent and have type 1 yourself and you
have kids, you may choose to get your kids screened to see whether they have
the genes and whether they are likely to develop it in the future.

(13:12):
That's a whole big conversation as to whether to do that.
This consensus statement is now recommendations on what to do if your kid or
anybody has been screened and has shown some of the markers.
Positive antibodies. Yeah.
So this was a big conversation, right? This was the thing that drove me nuts about it.
It's like, yes, we can screen for it, but what we can tell you is you've got

(13:35):
positive antibodies and what we know and why they have this consensus statement
now is you're pretty much guaranteed to end up with type 1 then.
It's pretty close to 100%. You are going to develop symptomatic type 1 if you pick those things up.
So if you're in stage 2, which is the pre-type 1 for those who are familiar
with stage 2 type 1, because yes, you were actually type 1 before you even knew you were, then you.

(13:58):
Previously, there was no consensus on what to do. So you got told this brilliant
gift of you're in stage two, you will probably develop type one diabetes at some point.
And then it's like- Oh good, you just gave me a sword to hang over my head until something happens.
And every time I feel slightly tired or thirsty or whatever it is, I'm going to panic.
And yeah. Yeah. So it's like go home and then wait until you get unwell. Go home and worry.

(14:24):
Sounds like fun for me. So, you know, there was this time when we could screen
and we could do absolutely nothing.
And I was pretty firm at that point that I'm not screening nothing if I can't do anything about it.
Then, as we spoke about on a previous podcast, we had teplizumab.
If you did get picked up in this stage two, you could get this infusion that
would delay the onset of type one.

(14:45):
By up to two years. Up to two years. And only in America.
So again, there's still no perfect answer, right? But now the consensus statement
is coming out and it is saying.
Recommendations to connect GPs and endocrinologists. So basically get your care
team to talk to each other.
I thought that was fairly, didn't really need saying, but apparently it does.
Ladies and gentlemen, rocket science in consensus statements.

(15:06):
And then also wrapping what they've called psychosocial support around the individual
and their families, which I guess we would refer to in current type one land
as wrap a community around them.
Speak to other people who have the disease, live with it day to day.
What's that like? Yeah, this I think is the really important part.
So, you know, we often say a big part of the challenge with type one is that

(15:28):
it comes out of nowhere and so all of a sudden you're in this crisis mode and.
You know, it's a complete flip. But in this instance, you're going to know for
a fair while, which if we do nothing is going to send you home and make you
worry about it and cause stress and anxiety, etc.
Or we actually have the opportunity to get in before that big crisis,

(15:50):
start to do some preparation, get people ready for it, help them adjust to the
fact that at some point they will end up with type 1 diabetes.
So it's an interesting one that we probably don't have a model for yet because
we're so used to people being rushed to emergency departments,
getting a fire hose full of information and then being sent out into the world.
And then we try to catch them and wrap them around with other people.

(16:11):
I know. This is my question because I'm thinking about particularly the adult system, right?
When you're diagnosed with type one, it's, you know, in and out of hospital
pretty quickly, get you stable, like three hour workshop on how to live with
type one. Inject an orange, there you go.
Yeah. Thrust it into the world and then you have your appointments every few
months, right? So I'm like, okay, how does this change now?

(16:34):
If we're catching these people in the early stages, what does that look like?
Do we start with, is it education sessions with the, whoever it is,
the practitioner, the endocrinologist, do they start diabetes education before
they're even diagnosed?
Like that education piece would be super important, right?
Because we're all like, we're all thrusted into this land we know nothing about.

(16:55):
Out yeah so that for me would be a massive
you know preparation point is getting educated
about what type one is what it's going to look like what life is going to
look like it's like i wonder how much of it's going to stick because
because it's not relevant yet yeah so what is it yeah that's my question is
what does this mean is it just like oh you're going in every now and then to
have bloods done and monitor what's going on in your body or are you actually

(17:17):
talking about education about i think there's a couple of things they're worried
about so one thing that they want want to avoid is DKA and ICU.
So if they can connect the team, they can monitor you, they can know when it's
going to really kick off and type one's going to really start.
So they talked about building guidelines for when to start insulin,
for example. So ideally it can be.

(17:39):
A little more gradual than perhaps our experience was as adult diagnosed.
But yeah, how do you provide education to someone who has an unknown timeframe
of something coming that they can't really understand until they've got it?
But if we can lay the foundations, then we can avoid some of the trauma that's associated.

(18:00):
So yeah, it's super interesting. It's curious because it did pop up for me last week.
I had a man come in with his son. son
was coming in for a hba1c test and he asked if
he could get one too known these people for quite
a number of years and he was screened the
dad was screened years ago and it showed that
he did he was genetically predisposed to

(18:21):
type 1 but obviously didn't have it at the time and just
about a month or so ago he was officially diagnosed with
type 1 and when he started to pick up
the symptoms of not feeling well being thirsty and things like that
he used his son's glucose monitor and yeah he
was like up at 17 so went straight to

(18:41):
get help and they he they he was dismissed as
like no not even like type two just just no not type one kind of go home it's
like well no i've got a family history my son has it and i think actually the
the granddad in the family also has it so it's like i know what i'm looking
out for i know what i can see i'm presenting now.

(19:04):
With type one and just felt like he wasn't
taken seriously and then anyway he is
now on it's obviously caught quite early he's on
just basal insulin and managing through dietary
changes at the moment but it's just kind of a watch and
wait so when this kind of conversation happened i was like okay i wonder actually

(19:24):
what this looks like and how helpful it is i mean this dad obviously knows so
much about type one because he's been you know managing it for his son for for
however many years it's been, but I just thought, oh.
It is interesting, isn't it? We do see, particularly in adults,
some people who have that slower onset and they do almost have a bit of a not

(19:46):
quite type one on the basal, not having to worry about it and then get a really
rude shock when the pancreas spurts out its last.
The basal insulin right now is giving his body that support. Yeah.
And at the moment he can keep up eating kind of very low carb.
Yeah. Always been super healthy. He's an active guy.
But just managing it that way, but just constantly, you know,

(20:07):
checking throughout the day and at nighttime just to see kind of when that little trigger is.
And we know that honeymoon phase is so different for everybody.
Yeah. But, yeah, I just thought interesting. The mental health supports are
going to have to be so good here. Otherwise, I could imagine myself finger pricking
a hundred times waiting for it to come.
I mean, yeah, it's just, if you pick it up yourself and you go to the system

(20:31):
and be like, all right, I've got this, but then you sent home.
So I'm just, I'm reading this and I'm like, yes, like we need it. It's great.
But what's it going to look like? Is it actually going to happen?
Is it going to be effective?
So rather than trot out my soapbox on those acute instances with GPs and bouncing
off, Can we give a little hint as to a guest that's coming along to a podcast?

(20:53):
I was just going to say, and kind of speaking of the diagnosis experience,
I'm kind of wondering whether that was like he went to a hospital or a GP or whatever.
Next episode, we have a GP coming in for an interview who is also a diabetes educator, which...
Wow. The number of people who I see posting our Facebook groups and are like,
can anyone recommend a GP that understands type 1? That even knows what it is? It's just crickets.

(21:17):
Let us know when you find that. Anyway, hopefully this is Aldo, this guy.
And so, yeah, I mean, that's going to be one of my big questions for him is,
what do we do about this diagnosis situation?
Because we just hear so many stories of where diagnosis just doesn't seem to happen as it should.
People are either turned away or told it's the type 2 instead of type 1,
or it's missed completely or, you know, all these kinds of things.

(21:38):
It's generally largely traumatic, right?
Yeah. So it's going to be a fascinating conversation.
So tune in to the next podcast and if you have any questions that you want us
to grill Aldo on, then please let us know. Yes, indeed.
All right, I think that's the news. Shall we head on to how I type one?
This week we thought we would talk about alcohol.

(21:59):
Party. Yeah.
Okay, I was diagnosed at 11, right? Right. So I didn't get any information on
alcohol when I was diagnosed.
And then they didn't really revisit that at any point. So I had heard that alcohol
makes you go either up and then down or down and then up. And that's kind of all I knew.
And I just went through my teens and 20s or whatever, just kind of winning it. Yeah. You didn't get?

(22:22):
Nothing. Nothing? Nothing. I mean, to be fair, I didn't ask either, but.
It's not the kind of thing that you walk up to the clinical team.
I've built a great relationship with as a child. I want to get hammered.
How do I do that safely and effectively?
So it wasn't until I started working at the Family Centre and did the Type 1
Essentials course and went, oh, okay, I actually understand how alcohol and

(22:46):
carbohydrates interact and how all this stuff works.
So anyway, we thought we would just kind of go around the table and,
you know, on a night out, how we each manage our Type 1 with alcohol.
Any volunteers to kick us off?
Sure. I was just thinking about you saying that stuff about teenage years.
I was very fortunate that I did not have type 1 through my teenage years because,

(23:10):
Oh yeah.
That is a story for another time. But I do remember I went almost a year after
being diagnosed at the age of
24 without actually having a drink at all because I was quite frightened.
I think I was told something about it would have a dramatic effect or it can

(23:30):
be quite dangerous to drink with type one.
And I think for the most part, I actually just didn't feel like it
i was trying to wrap my head around new diagnosis new
pathway but when i did inquire about
it i was told and i was on mdi at the time to
have my basal insulin if i was going out for a night of drinking i found that
that was too aggressive for me i'm not a huge drinker like takes me two to be

(23:55):
like so probably not as dramatic effect as what perhaps she had anticipated
on my blood glucose. Well, it depends what you're drinking too.
Because if you're just doing shots all night, then maybe that's the way to go. But it depends.
Oh, look, from a diabetes perspective, shots all night is the way to go.

(24:16):
The next day though is a whole nother story. But yeah, I found that it was about
four units I needed to reduce my basal insulin by.
If I knew I was going to have more than say three to four drinks,
that was where it would have an effect on me, particularly the next day or early
hours of the next morning.
I never had a problem throughout the night whatsoever.

(24:37):
Like didn't even see a difference or a change. I could be dancing all night,
not see anything, but early hours of the morning and especially through breakfast
time, I was just like hypo city and I'd forget.
I'd get up and I just like do the same bolus for the breakfast and then go, oh crap.
Like not an hour hour later, just like bouncing, bouncing, bouncing off the bottom.

(25:01):
And then probably by lunchtime, early afternoon, it's kind of feels like it's
back to normal. But that early morning, first part of the day is super crucial.
And it still is now on a pump, although I don't have to worry about adjusting
basal or things like that.
The control IQ carries me.
Now is a good time to mention, I think that this is not medical advice.

(25:24):
Just before we tell you to just go straight from the bottle.
Look, I think, yeah, but it's useful to talk about what we've,
what we've heard because I, again, I was not told, Hey, if you're going to go and drink alcohol,
you'll need to make adjustments to your insulin like routine.
So I did not know that I actually actively asked for it. And that's what I was given.

(25:45):
I started with half the basil and found out that was way too much and kind of
you trial and error, but always start with the most conservative option.
Is that the right phrase? I know what you mean.
No, I think you're right. Least risky. Least risky. Yeah, which probably means
riding a little bit more on the high side than the low side, right?
Yeah, and then you manage it from there. And I used to hate going high throughout the night.

(26:08):
So, I would gradually buffer it till I find the right spot. And what's your
drink of choice normally on a night out? So.
So. That was dramatic.
I really, like, I'm a gal who loves a cocktail mixed with type one, super challenging.
You always look at the cocktail list and you're like, which has the least amount of like sugar?

(26:31):
Yeah, full of sugar. But I love an espresso martini. So I'm like, I'll only have one.
Otherwise, it's a bit of a nightmare. But I've learned to bowl this for that
one, given what's in the ingredients.
So for me, I've kind of guesstimated. It's somewhere between 15 and 20 grams of sugar. Yep.

(26:52):
So I always just bowl this for like 10 grams of carbs because you're moving around and whatever.
Yeah. I found that works and then after that I will switch to either gin or
vodka with soda and fresh lime. So it's just super easy.
Don't have to worry and I happen to enjoy it.
Otherwise, if it's not a cocktail spirits like pate, then champagne and wine

(27:13):
has absolutely no effect like on my blood glucose levels.
Maybe we should just take two seconds just to talk about a little bit about
the theory here to give this some context.
So again, not medical advice, but broadly speaking, what happens is because
your body needs to metabolize the alcohol, the liver stops releasing the usual
just steady stream of glucose that your basal normally deals with.

(27:33):
So, you've got less glucose going into the blood because the liver is busy dealing
with the alcohol, which will, if you keep your insulin levels the same,
tend to make you trend down.
Now, the effect of this is obviously different for different people.
So, you've got insulin heading, sorry, the alcohol making you head down and
then whatever carbs are in the beer or whatever you're eating or in the espresso
martinis or whatever are going to push you up.

(27:55):
But they don't equally cancel each other out.
No. Yeah. And I mean, it takes time for the body to recognize that it's then
processing a toxin, which is why I don't think it's an immediate low for a lot of people.
But yes, you've obviously built the required amount of insulin that you need
on a daily basis around that general functioning that's happening inside your body.

(28:15):
So, obviously that gets cut off, as you said, when you're processing alcohol.
So, all of a sudden you are left with a bit more insulin on board than what you normally need.
And it's the timing for everybody to look out for. And that That might happen
midway through the night.
Again, if you're going to drink high sugar drinks throughout the night,
then it gets a little bit more complicated if you're adding in Ebola speech

(28:38):
of those and then that's just too much of a headache for me,
which is why I like start with the cocktail and the stuff where I can think
about right at the beginning. You don't need to come up with excuses for your
drinking habits, Carly.
It's a judgment-free zone. We'll still love you. But like, you know,
once you're under the influence, you've got less like judgment.
Yeah so do calculations yeah and you don't want time for that you're enjoying

(29:00):
yourself you you know so i'm like i keep that at the beginning and then i pick
something less risky to head through the rest of the night yeah and that's me,
Benjamin, what's your drink of choice? I'm still recovering from Carly's statement
of she's a gal who likes a cocktail mixed with type one.
That's fantastic. Put that on a t-shirt. Put that on a t-shirt.

(29:21):
Anyway, right. So alcohol, type one.
I came from the diagnosis generation of they just don't talk about alcohol.
This is the harm. Minimization didn't exist. It was you just don't talk about it.
So I never got any education on it. I never knew anything. think?
And so I went out assuming the only thing I had to worry about was the sugar

(29:43):
in alcohols, which, you know, meant that I would go for things that didn't have any sugar in it.
Shots. Shots all night, straight from the whiskey bottle.
And as we said, you know, the problem with that is you actually go low.
So alcohol used to frustrate the heck out of me because I would think I was
doing the right thing, go low every single time.
And then because it takes so long for the liver to get all the alcohol out of

(30:07):
your system, you're dealing with that low overnight, which back in the days
before good algorithms helping out a bit made sleeping pretty dangerous.
So, you know, alcohol is this great joy of it's going to kick me when I go finally
go to bed, which is the most dangerous time when I'm not awake and actually checking and so forth.

(30:27):
Also, I'm not in the best judgment space when I've been a bunch of shots.
So, you know, it gets worse over time.
This is actually one of the times where I really like having a dire buddy.
I hate that word, but actually having someone who understands type one and knows
that that is the vulnerable time and knows that is the time when you are the
least intelligent and probably going to make the least intelligent decisions

(30:51):
is actually super important.
And making sure your dire buddy is sober. Well, this is the problem, right?
So yes, super important. Anyway, learned that the hard way.
There is a reason that I don't drink a lot of champagne anymore.
And that is back to this type one requires lots of brain space.

(31:12):
Over time, I've got better to, you know, and it requires less brain space,
but it still requires brain space.
You're still carb counting. And typically when you go out for a couple of champagnes,
there's a meal involved, right?
What I always find is the champagne comes quicker than the meal and champagne
goes to your brain really fast. Yeah.
So by the time that your food arrives, your decision-making capability is through

(31:35):
the floor, at which point you think, I will eat all the things.
I will not worry about it. That dessert looks amazing.
I'll have that too. And then I end up smashing through the roof with an incredible
high and then crashing later on. So yes, champagne goes to my brain.
It is funny that you say that because there's a saying goes around in my,
well, an alter ego, I should say.
Her name's Champagne Carly and she's so

(31:58):
fun like she is a great time but yeah
I have a rule for myself unless it's a
wedding where it's like I will only ever have one champagne firstly the hangover's
horrendous on champagne secondly judgment totally out window like wouldn't count
a single thing what is it about champagne it's like it's so good at the time

(32:20):
the bubbles go to the brain it just floats That's right.
Hashtag science. You know what I really struggle with when it has been one of
those big nights, particularly when I was younger and you're going home to your
friends and they all want to go through the Macca's drive-thru,
and it's like there's nothing more than you want than like a big dirty burger at that time of night.
But like the judgment on how to bowl this.

(32:42):
Like I stare at the burger for ages going, do I bowl this half the amount?
Well, I can't bowl this nothing because that's going to be a huge mistake.
But like, how do people do that?
Yeah, good question. And as you say, when brain not working.
Like the snack is a good idea and it's telling you that. And it is a good idea,
but then you never get it right.

(33:04):
Always wake up. So despite the fact that I'm very aware that I sound like the
old dad of the podcast, and I am the old dad of the podcast,
when you are not making good decisions is when you should have a diet buddy.
That diet buddy should not be drunk as well, or they're not particularly helpful.
You know, type one takes lots of responsibility. We know that it takes lots
of brain space. There's a few times when you don't have that brain space.

(33:24):
On alcohol is one of them. On general anesthetics, another one.
Yes. That's when you have a pre-plan.
So before you go out that night, you have the things left by your bedside table,
or Or, you know, carry the things that you need to out with you so that once
you do get home and you jump into bed, you've got everything that you need.
Make sure your alarms are on and they're loud.
Make sure you've got your source of sugar, something to back it up. Yep.

(33:45):
Oh, make sure that you've got identification that says that you're a type 1
because I hear way too many stories of the police throwing people in drunk tanks
who are hypo. And that is very dangerous.
Really? Not what you want. Not at all. I also, for our injections listeners,
what's the advice here? I think it was take your long acting if you can before you go out.

(34:07):
And obviously you might want to reduce your dose if you're drinking,
et cetera, et cetera. You've got to make that decision yourself.
But the likelihood of mucking up your dose when you come back or forgetting
to take it or whatever and then – Those numbers are really small and the blurry eyes.
Yeah, trying to get a dose in the dark on a pen after drinking, yeah.
No, you always do. I would move it because mine used to be 9 p.m.

(34:29):
Every night. so I would move it to like, I don't know, whatever,
7pm or I would always move it earlier and reduce the dose.
It's the joys of basal insulin. We talked about this before.
Once it's on board, you can't get rid of it. Yes, I think algorithms.
So this, okay, story time. This is my little alcohol stories before.
I was on an algorithm but I wasn't wearing CGM at the time so aka no algorithm.

(34:53):
New relationship, I think we were, I don't know, two months in or something or other.
I was staying at her place. we'd had a big night the night before i
had basically gone low throughout
the night she wakes up the next morning all happy lala yeah yeah oh yeah like
waking me up no adam's not really responding she's like oh he's just sleepy

(35:15):
okay then she actually tries to kiss me awake at one point she's like oh maybe
this will work to which apparently i quote spat her out oh,
Things I didn't need to know.
And then I started kind of just wriggling away and ended up upside down off

(35:35):
the side of the bed, like my head on the floor and my legs still up on the bed,
like took the doona with me off.
At this point she realises, okay, something's not right.
So goes and tries to find sugar. I did not have any hypotreatments with me.
Oh, that sounds like you. No, there was no like soft drink or anything at her place.

(35:55):
So what she got was warm water, dissolved sugar in the microwave and brought that to me to drink.
Now my, like I'm completely delirious, right? Conscious, but like off the planet.
And I looked at this glass, which was blue and had like bubbles in the glass.
And when I tasted it, it didn't taste normal because it was sugar and water, right?
If someone had handed me a glass with lemonade, I think instinctively I just

(36:18):
would have gone, oh yeah, I know what this is. But I was like,
I can see bubbles, but I can't taste bubbles, and it doesn't taste right.
She's poisoning me. Yeah. Took a lot of convincing for me to actually drink it all.
And then I think 10 minutes later or whatever, I came to, and then there was
tears once the stress was over, and I had to apologize, et cetera, et cetera.

(36:39):
So, yeah, that was a fun morning. But the lesson is that's what happens when
you drink a lot. Don't monitor your blood sugar properly.
Aren't wearing CGM. and don't plan accordingly. You're trying to impress the
new girl that's with you. Yeah, you don't want to be explaining type 1 to the
person who's just had the same life. Luckily she knew, but, like,
yeah, you don't want that to be the first experience.
I like that it took him standing on his head pulling the doona over before someone

(37:02):
said, that's not normal.
Oh, that could be, like, a whole other segment on this podcast is,
like, dating with type 1. Oh, yeah, after dark episodes. After dark episodes.
Now, before we... Oh, but, like, the ways that you explain it,
like those who know nothing about type 1. I was like, I've been nicknamed iRobot like before.

(37:23):
Oh, yes. This is as the clothes are coming off.
Whoa. And we're back to After Dark. Moving on.
Can we stay on the alcohol theme just for a second? Because I have an amusing,
amusing drug-related story.
So you might have noticed I've got my glucose shoes at the front,
and I have had my soapbox rant on how much I hate glucose shoes and the fact

(37:44):
that they are literally chalk in a tube.
So I was low this morning, as we know, as we all know.
And this has been sitting in my jacket pocket for a while, which clearly meant
that it had been bouncing around for a while. So I had a new experience,
which was that I opened it and you saw me trying to open it before.

(38:04):
These things are pretty tough to open.
Pulled the thing off and this puff of dust just went everywhere over my jacket
and I looked like I had done cocaine.
And then I had to meet with donors this morning.
I really hope that people know that this is glucose.
Hard to explain. Speaking about After Dark episode.

(38:26):
I'm listening to adam's story before i'm like was it just alcohol.
Scouts on a just alcohol moving on benjamin you're going to talk to us about
medication reviews yes let's take a moment for a little ad break shall we let's
well we compose ourselves so So, listeners,

(38:47):
if you have ever wondered what medications do to insulin and how they might
change your insulin requirements,
or you've just never had a chat about all the medications that you're on because
every person that you speak to is afraid of the fact that you're a type 1 and
won't talk to you about your other medications.
Did you know that many other medications that people are on quite regularly

(39:08):
can impact your blood glucose, they can change your tolerance.
They can change the amount that you require and no one will talk about it. We'll talk about it.
So the Family Centre has a clinical pharmacist by the name of Mira. She is amazing.
And wherever you live across Australia, she is providing telehealth-based medication reviews.
So come and chat to her about all the things that you're taking,

(39:31):
including your supplements and things you might've tried.
And she will help you work out one, whether they help, to whether they interact
with each other. And there's something that we should be aware of.
And she also promises that she can help save money from a lot of those supplements,
which actually don't work. So she's more than happy to chat about that.
And if you listen to one of our previous podcasts and heard about Fiasp and

(39:53):
are interested, she can talk to you about that as well.
She's a diabetes educator and a clinical pharmacist, right? That's the bonus.
Where do we find these people? We've got a GP diabetes educator,
a pharmacist diabetes educator. They're just special.
They're special. They are very special. Mira is amazing. So,
yes, anywhere across Australia, Darlene, check out our website for more details
on our medication reviews.
Awesome. Beautiful. It is time for Prick of the Week.

(40:18):
Did you two coordinate that before this? No. Just got a natural.
Spontaneous dorks. I like it. Okay, let's talk about Prick of the Week.
Benjamin is so ready for this one. Oh. I came in from lunch and he's sitting
there reading this report and he goes, the soapbox is out, couldn't proffer.
All right.

(40:41):
Some of you may have heard that the federal government undertook a review view
into diabetes and inquiry into diabetes care.
And if you have been following the socials of any of the companies involved
in type one, you've probably seen some celebration of a couple of announcements.
There were some good outcomes of it, including a recommendation that we fund
insulin pumps for all people with type one. I know, shock.

(41:04):
Wow. What a breakthrough. But yes, good to see more momentum coming behind making
insulin pumps available for everyone.
But if you took the time to read the 270-page report,
The Joys of My Job, it reminded me of everything that I hate about the way that
type 1 diabetes is managed from a health policy, from an overall population perspective.

(41:27):
There was so much that was just, let's talk about diabetes, not type 1 diabetes.
There was so little acknowledgement of what goes into managing type 1 diabetes.
Of course, there was an incredible focus on health promotion for type 2 diabetes,
which I get, all the lifestyle factors, obesogenic stuff, etc.,

(41:47):
etc., sugars in drinks, yada, yada, yada, yada, yada.
But every time the report would go back and just talk about diabetes.
And then we wonder why people go around saying, should you eat that?
Did you eat too much sugar as a child?
And then the thing that really ground my gears is that.
Yes, they got behind insulin pumps. We've spoken before about insulin pumps are not for everyone.

(42:08):
They're also not a miracle cure. As much as people like to imagine it,
there's still a lot of work that goes into using insulin pumps.
But the only recommendations to deal with type 1 at all were improve the technology.
Great. We're pretty sure we're on that. We've spoken about plenty of those. Or improve insulin.
Nothing about maybe help people manage day to day. Maybe give people alcohol

(42:31):
education when they're diagnosed at 20 before they go off. Education,
connection to a community.
Talk to other people with type 1, you heretic.
Absolutely did not come up. There is a section on changing a diet, low-carb diet.
The only thing that it has is one person with type 1 saying it works for me
and then no comment whatsoever.
So, yes, I am planning a long ranty post about this as well.

(42:54):
But I am so sick of diabetes being lumped together and confusing the heck out of everyone.
And then naturally what happens at the policy level is they look and say,
well, 90% of people have type two. That's the epidemic. That's what we're going to focus on.
Great. Here I am trying to keep myself alive with 180 decisions a day.
And this whole report has abandoned me and said, maybe we should tax soft drinks.

(43:18):
It's going to help my type one. And again, it's not like there's not many of us.
We are legion and also
i mean i'm 130 000 130 000
plus i am surprised actually that they did
put that little bit in about you know change your diet well to be clear no recommendation
on changing your diet just a hey someone commented on it during the consultation

(43:42):
period oh i just like sorry to give you false hope but it's like that's the
same thing with everything right it's like Like,
why can't it be addressed, like, from a more holistic point of view?
Like, why is food not in there as, like, something that will impact?
Nothing on food, nothing on alcohol,
nothing really on diabetes education generally, nothing on community.

(44:04):
That is such a point of frustration for us. I mean, talking about before,
you know, just diagnosis, right, through the GP.
Like, we're always banging on about education and lack of education,
and we lose our trust and faith in the medical system. and we feel like it's
all back on us as people with type 1.
And then, yeah, you read something like this, like,

(44:26):
Actually, there was a really interesting piece of the report,
and we need to do another deep dive on this, which talked about personal responsibility
and was saying, maybe there's too much focus on people taking personal responsibility.
And it was talking about type two and saying, you know, if you're surrounded
by sugary drinks and that kind of thing, then it can be quite hard to make good decisions.
So I kind of get where they got. But as I'm reading it, I'm thinking,

(44:47):
if I don't take personal responsibility for the insulin I'm about to take, I'm probably dead.
And this is really weird. So, yeah.
It's interesting. the we've talked before about how you've said that if if type
one wasn't lumped in with type two we wouldn't get any media attention because
there's just not enough of us but then at the same time it's like when we do
get lumped in then it's like there's not enough specific information so it's

(45:09):
you know it's damned if you do damned if you don't damned if you don't we're never happy.
Hence prick of the week it's just like do better do
better that's my takeaway diabetes australia has been making a lot
of noise this week on social media about the the
campaign to get automated insulin delivery
systems funded for people with diabetes

(45:31):
but be interesting to see where that actually lands because
that's as you say a small part of that report look i yeah and we are a hundred
percent behind give access to as many people as possible get rid of all of these
barriers go team technology is not the only solution if it was amazing if i
could get my pancreas replaced with a cybernetic one,

(45:51):
sign me up right now. I'm already half cyborg, why not?
But that's not reality. Yep, yep.
All right, we'll see what happens with that. The end.
Do we need a jingle? We need a jingle for pick of the week.
Alas, since one is not spontaneously incoming.
Did you seriously hope that we would just come up with one? Well,

(46:13):
you never know. You put it out there in the universe and, you know.
What is it you said to me once? Once you regret a hundred percent of the chances
you never take. Oh, that's the Wayne Gretzky quote.
You miss a hundred percent of the shots you don't take.
Okay, there we go. That's it. That's better. Yep. While Carly comprehends that.
I'm just like waiting for that to land. Where the gears turn.

(46:34):
How many double negatives? So remember when I said we were going to talk about
something that's relevant to people with MDI and all people with diabetes,
and now we're going to talk about smart insulins, which are totally applicable to everyone.
This is cool. So once again, this is not commercially available.
This is something that research is looking into. There's companies working on it.
They reckon there's big money in it if they can crack it.

(46:54):
Essentially, what this is, is instead of injecting insulin as you need it,
and we all know how well that works. Perfect science. We've talked about this before.
The concept of smart insulin is that you inject basically more than you need at any one time.
And then around each of the active insulin molecules, there is a,
what was the word I used before.

(47:16):
Protective barrier, membrane thing. Membrane thing that is reactive to glucose.
So as glucose levels rise in the bloodstream, those glucose molecules react
with that membrane, disintegrating it and allowing the insulin to then come
out and do its thing, hence lowering blood glucose levels.
And knows exactly how many of those. Well, you have to calibrate the membrane

(47:37):
to be reactive enough that as your blood sugar is considered to be high,
that enough insulin is released and activates. I don't know about this.
The thing that I really like about this is that it's an investment in something
that I can imagine eventually having a really significant impact on people living with type 1 today.

(48:00):
I read so much research about here's how we're going to cure it in the future,
which means not getting it in the first place, which awesome,
too late for me, past my use by date.
Smart insulin. If If we could get to the point where we know the biggest problem
with insulin is that you put too much or too little in at any one time,
you can't take it out, it has its effect whether you like it or not.
If we can find a way where insulin can be smart enough to say you need a bit

(48:23):
more, you need a bit less, awesome.
It's a long way away, but it's pretty cool.
Yeah, the thought of it's pretty cool. It's interesting because insulin on board
would go from being how much is still active in The Last Bowlers to just, do I still have enough?
How would you know how much is still going? Exactly. That's why I'm like, I don't know about this.

(48:44):
But how cool would it be to be about to go out on a night,
drinking oh yeah and instead of having i'm going out there's
a big wad of insulin there it'll do its job when it needs to
burgers and fries coming up and that mackers meal
you wouldn't have to worry about it dirty burgers for all that's a great question
how would you know i feel like we would have solved type one like with this

(49:06):
you know magic insulin just like one injection and it knows everything but sure
we can dream harley's not convinced all right we're going back to just putting
out into the universe what we want to see,
but this is actually research that's live and happening. So it's pretty cool.
It's pretty cool. But let's talk about something that is happening right now. Indeed.
Yes. So we've obviously talked about DIY looping a fair bit on this podcast

(49:30):
and the king of DIY looping, Mr.
David Burren. Bionic Wookie. The Bionic Wookie.
He's based in Melbourne. In the house.
He's going to wonder at where he's going when he hears this.
He is coming to Perth for a conference in August.
What conference is it again? The Australian Diabetes Congress.

(49:51):
ADC. ADC. That's right. Which is also the Australian Diabetes Educators Association's
conference, because why not? Let's do it together.
Okay, more acronyms. So, he's coming over for that conference,
and we thought, well, while he's in town, we will nab him for a workshop.
So, we're going to spend a Saturday from, I think it's 9.30 through to about 3.30.
We are going to- You just scared everyone off in one go.

(50:12):
It's gonna be fun this is exciting it's gonna be super fun yeah so
benjamin and david are going to have a chat in
the morning kind of talking about what is diy looping who might
it be applicable to what are the advantages of it what can it provide that the
commercial systems can't and then david's going to present some data on some
of the real like bleeding edge stuff where you're not announcing meals the algorithm

(50:34):
is just going i see a rise i'm going to bolus for you and you never have to worry about bolusing.
So this is what David actually has managed to program into his system and has
been using for the last few years.
Yes, Carly? And so does the algorithm learn over time, over the kinds of meals that you're having?
Save it for the workshop. David's going to tell us all about it. But is he?

(50:55):
Yes. Okay, but I'm just, you know, asking a question. I'm just laughing that
you had to raise your hand.
Mr. Brockway, could I please ask a question? That's true. So, yes.
So for those who don't know the bionic wookie, the bionic wookie,
David is a super tech nerd, lives with type one.
He, you know, we talked before about there being this 5% of people who are not

(51:18):
waiting and are pushing the boundaries and experiments of one,
and will do all kinds of crazy things to see how insulin works and how they
can make it better and what technology can do. That is David.
He has tried a whole bunch of stuff himself.
He's networked into all the latest tech developments, part of every community I can think of.
East Coast has had him for too long, so we're napping him for WA when he comes over for the Congress.

(51:43):
Indeed. And then I just want to add that six hours. It's not just David and Benjamin talking.
For six hours? What's wrong with it? That's the morning. And then after lunch,
we're going to come back and you actually get to start building your own loop.
That's what I was going to ask. Right. So he will show those how this thing
works, like how to set it up so that you would have the confidence to do this.

(52:05):
Yeah. Yeah, basically everybody will probably just dive in following the instructions
that are available in the community.
But then when you hit various bumps in the road, as you inevitably will,
various errors or whatever, I don't understand what this term is or whatever,
you've got David and we're going to have another couple of experts from the
community who have done and built loops themselves to help you.
So they'll be roving the room just answering people's questions.
To be clear, for the looping community, no one can set it up for you.

(52:29):
These are not regulated, approved systems. systems, how they happen is that
individuals decide to build the apps themselves using community sourced information.
You know, the tribe has got together and said, this is how it works.
And people muddle on through.
If you want to muddle on through surrounded by a bunch of other people muddling
on through who can all help you, awesome.
But yes, we won't be building apps for you. That is against every regulation.

(52:54):
No, you'll be building your own. And if you get stuck, then there'll be people
to help you. There'll be people you can chat to.
Just like happens now with any person using a DIY loop, they will throw out
questions to the community and muddle it through together.
Or you can wait for Omnipod 5 when it arrives at time indeterminate. Indeed.
So if you want to register for that, you're going to need to be in Western Australia.
So sorry to our Eastern States listeners. You've had him for too long. Yeah, he's ours now.

(53:18):
Type1familycenter.org.au forward slash what's on.
Or just go to the website and you'll find events from there you can register.
Super awesome opportunity.
Even if you're not interested in building your own loop, So come and listen
and learn about what the latest is and how they're pushing the boundaries.
You're welcome to come along just to the presentation and hang out and have
a chat. Yeah, it'll be super interesting. Just get ready to nerd out.

(53:40):
Yeah, and go talk type one, hind leg off a chair.
All right, that's everything for this week. Thank you for joining us.
Next week, interview with Aldo. DP in the hot seat.
In a very hot seat. It's going to be an interesting discussion.
We have to not scare him off too early. I know.
I can almost feel you just cracking the knuckles. Got my questions ready.

(54:05):
No, look, we're super excited to have a GP come along, willing to talk about
type one and all the stuff that happens in GP land, which is a mystery to me.
Music.