In Episode 42 of Think Like a Pancreas—The Podcast, Kathryn Alvarez sits down with the “Trynamic Trio” to discuss the innovative Trio Open-Source insulin delivery system. Joining her are Integrated Diabetes Services clinicians Tavia Vital, Jennifer Smith, and Dana Roseman, who share their firsthand experiences beta testing the latest TRIO updates.
This dynamic team highlights several features that have improved their day-to-day diabetes management. They stress the importance of trusting the system’s algorithms once the onboarding process is complete, and delve into the advantages of tools like the cone of uncertainty and the sigmoid feature to name a few.
Throughout their conversation, the IDS clinicians underscore the collaborative approach needed for effective diabetes care and the ongoing learning that comes with adopting advanced technology.
Meet Your Host and Her Guests
Kathryn Gentile-Alvarez, MS, ACSM-CEP, EIM II, CPT, CSNC, CDCES is the Director of Exercise Physiology, Teen/Young Adult Specialist for Integrated Diabetes Services. As a Certified Diabetes Care & Education Specialist and Exercise Physiologist, she specializes in sports performance, technology integration—including open-source and DIY systems—and counseling young people and families affected by type 1 diabetes. Diagnosed herself at age twelve, Kathryn holds degrees in Exercise Physiology from Ave Maria University and West Chester University, and certifications from ACSM and ISSA. Her work focuses on using advanced technology and personalized exercise prescriptions to help people with diabetes manage their health and thrive.
Tavia Vital BSN, BA, RN, CDCES is the Director of Intensive Diabetes Management for Integrated Diabetes Services. She earned a Bachelor of Science degree in Nursing from Regis University in Denver, Colorado after receiving a Bachelor of Arts degree in Spanish from the University of Iowa. Tavia is a Registered Nurse, Certified Diabetes Care and Education Specialist, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. Having lived with type one diabetes for over 40 years, Tavia she understands that each person’s experiences and needs are unique. She strives to be an expert resource on intensive diabetes management options. She enjoys learning about the newest medications, strategies and technologies available that may help her clients reduce the diabetes burden while improving diabetes self-management skills.
Jennifer Smith, RD, LD, CDCES is the Director of Lifestyle and Nutrition for Integrated Diabetes Services. She is renowned for her expertise in nutrition, diabetes education, and athletic performance. With a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin, Jennifer is a Registered Dietitian, Licensed Dietitian, Certified Diabetes Care & Education Specialist, a certified trainer for insulin pumps and continuous glucose monitors, as well as a published author. Having lived with type 1 diabetes since childhood, Jennifer offers unique insight into day-to-day diabetes management, pregnancy, sports nutrition, and technology integration.
Dana Roseman, MPH, CDCES, RDN, LDN, is the Director of Technology and Applied Research for Integrated Diabetes Services. She is a Certified Diabetes Care & Education Specialist and Registered Dietitian with a Master’s in Public Health from the University of Illinois at Chicago, a Bachelor’s in Science from the University of Texas at Austin, and clinical nutrition training from UT Southwestern Medical Center. Diagnosed with Type 1 Diabetes, she has spent nearly 20 years improving diabetes care through technology, research, and patient education—including expertise with insulin pumps, continuous glucose monitors, and hybrid closed-loop systems. Dana serves as Research Information Liaison for the Dallas JDRF, is active on nonprofit boa
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:21):
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:42):
healthcare provider before implementing.
Kathryn Alvarez (00:44):
Hello Trynamic Trio.
So, just a little background.
When we first started Trio, I startedup just a little bit before Dana,
Jenny, and Tavia, and we decided thatwe were gonna call them the Trynamic
Trio and I gotta say, we should haveworn our trio shirts for this week.
All speakers (01:06):
Yeah, we shoulda, shoulda
Dana Roseman (01:07):
have.
How did we not think about that?
Next time?
Next time we'll do this again.
Kathryn Alvarez (01:13):
Have to do a part two for sure for sure
Dana Roseman (01:15):
just to wear the shirts.
Kathryn Alvarez (01:16):
Yep, totally.
Jennifer Smith (01:18):
I could go get it.
Kathryn Alvarez (01:20):
I'm not that organized at don't,
Dana Roseman (01:21):
and they're purple.
So that would all match.
Yeah.
Kathryn Alvarez (01:24):
Yep, yep.
Purple.
And it's perfect too, just when you dosome looking into why it's called Trio,
it's a lot of it because they said thatthey were finding patterns of threes.
So it's just funny that for youguys too, there's just that.
All speakers (01:39):
Yeah.
Another time.
Three of us.
Kathryn Alvarez (01:42):
So sweet.
But yeah, we definitely,
Jennifer Smith (01:44):
it's always fun to learn together too, I think.
Dana Roseman (01:46):
Absolutely.
And it's made it so much easierbecause there's so much to learn and
everyone's question is my question.
Jennifer Smith (01:54):
Yes.
Yeah.
Yeah.
Or you ask a question and you think,well, I didn't get to that question
yet, but now you know, when youkind of encounter that, you know
the answer already which is great.
Dana Roseman (02:04):
Right.
Kathryn Alvarez (02:04):
Right.
So, great.
But yeah, I feel like Trio is, issomething that we're definitely
consistently just in a learning curve.
I creepily go on the Facebook page and Ilike search for the developer's names and
see what they've posted just to make surethat like I'm getting everything right.
Tavia Vital (02:23):
Yep.
And I go on dis- discord to see if peopleare talking about things that I'm seeing,
or if someone's already asked a questionthat I can find, what's the math behind
the scene on this one little sub menuitem so that I can understand it better.
It's very helpful.
Dana Roseman (02:38):
Yeah, and I think more than anything, trio is like
one of those diabetes applications,
the rabbit hole is never ending.
You can go dig as deep and darkas you want to in a positive way,
but like it's just never ending.
Kathryn Alvarez (02:50):
Truly.
Yeah.
But I mean, it's absolutely incredible.
How have you guys felt about using it?
'cause I feel like all of us usedIAPS and kind of went back to Loop.
We used Trio, the original,and went back to Loop.
I used free APSX and I, uh, oh.
I used fax.
I don't know if anyone else used that?
Dana Roseman (03:09):
Well, who of this group is using Dynamic?
'cause?
I am using Dynamic, butnot, what am I not using?
Tavia Vital (03:17):
Are you not using Sigmoid?
Dana Roseman (03:19):
Sigmoid, thank you.
Using sigmoid.
Kathryn Alvarez (03:20):
Yeah.
Yeah.
Tavia Vital (03:23):
I'm using dynamic with sigmoid and with just
with the ISF side of things.
Well, and the basal,but not the car ratio.
Dana Roseman (03:28):
Mm-hmm.
Jennifer Smith (03:29):
Well, I think we've had a learning process, as you said,
Kathryn, we've, we've all started out asloopers, coming from conventional pumping.
We moved to looping.
I mean, as of this coming October,I would be technically looping or
using DIY for about eight years.
And then, you know, knowing enough people,again, it's nice within the diabetes
community being connected because youknow enough people to say, I'm super
(03:52):
comfortable with this, but look, thesefancy features look like they would help
the variables in my life for, for reasons,you know, that are even more beneficial,
so let's try this.
And I think it's nice tohave the handholding too.
All speakers (04:04):
Mm-hmm.
Jennifer Smith (04:04):
Because as we just said, it's, it's nice to have
a connection to say, well, I'mnot the only one building this.
If I have a question, I canreach out to this person.
Or I think last summer was whenwe all started trying Trio, right?
Dana Roseman (04:16):
Mm-hmm.
Jennifer Smith (04:18):
In our texting Trynamic Trio group, we all started
like complaining about similar things.
Like why isn't like, thisdoesn't seem to be working.
I'm going back to Loop.
Or like, this is an issue.
And so we could bounce ideas, but Ithink the reason we've all now stuck
with Trio is because it has gottento the development stage of, I wanna
(04:39):
say I trust it like I trusted Loop.
Dana Roseman (04:41):
Right.
Jennifer Smith (04:41):
Where I ended with Loop, I now have that trust and even more for
Trio because of the pieces that have beenbuilt into it that are just more, they
add to the variability management in life.
Tavia Vital (04:53):
And I would also say, as my understanding of all, I wouldn't
wanna say all that would be a dis,that would be a misnomer, but as my
understanding of many of the differentfeatures and settings, adjustments
how it influences how whatTRIO does or doesn't do.
I think that also builds confidencebecause if, if you just look at it as
there's this thing and it, uh, thereare so many options to adjust and I
(05:17):
don't like what my blood sugar's doing.
If you never move past that stage,you haven't really given trio
the fair chance that it deserves.
All speakers (05:25):
Right.
Tavia Vital (05:25):
And it's hard to go from one system to another.
I don't care if it's a standardsystem to loop the first time, it
doesn't, or one standard system toanother kind of outta the box system.
You have to learn how those algorithmswork to then adjust the right settings,
or expectations as the case may be, inorder to get the most from that system.
And that's hard for us, right?
(05:46):
Like
Dana Roseman (05:46):
yeah,
Tavia Vital (05:46):
humans we're creatures of stability and predictability,
even though diabetes, ofcourse doesn't do that for us.
So then forcing change on ourselves,we have to always stop and ask along
the way, like, whose idea was this?
Why am I doing this right?
Dana Roseman (05:59):
Why am I doing this?
Yeah.
Well, I think that's a great pointof, when you move from one system,
even if it's an open source like loopto trio, you have to rethink all of
your settings because, I think partof my frustration last summer was that
I really did have to adjust thingsthat worked perfectly on loop, but
absolutely did not work perfectly onTrio because the algorithm was different.
Jennifer Smith (06:22):
I, you know, and from a standpoint of others coming into
consideration of Trio, I'm really gladthat I started Loop where I did, because
I had come from a conventional pumpthat had no ability to navigate for me.
I was the thinker of everythingthe pump was gonna do for me.
I put it in and there's a learningphase to each of these algorithms
(06:45):
and starting to use, and you, uh,you make a great point, Dana, in
that I went to loop under the kindof assistance of somebody I'd worked
with who was looping in pregnancy and,
I was like, gosh, why am I not doing this?
Clearly it does a phenomenaljob beyond what I can do.
And she helped me build, um, eonsago when it was like reading the
(07:05):
hieroglyphics on the wall to build right.
And after a 30 days was texting, i'm like,I don't know, like I'm really frustrated.
And she said, Jenny, you haveto step back and you have to
let loop do what it's gonna do.
Dana Roseman (07:18):
Right?
Jennifer Smith (07:18):
And then you have to evaluate your data and see what to change.
I was used to being the manipulator.
Tavia Vital (07:25):
Mm-hmm.
Jennifer Smith (07:25):
I turned all my own dials and wasn't really letting, I
was like overstepping the system,which I still didn't really get the
algorithm quite yet, but I think that'svaluable to know when you move into
an even more potentially aggressive,more dials to change like Trio has.
My point being,
(07:46):
I think there's a steppingstone plan of use.
I don't typically suggest for somebodyto go from MDI or even a normal pump
system directly into Trio because Ithink there's too much difference.
As you said, there are a lot of settingsthat are not gonna look the same.
Dana Roseman (08:04):
Absolutely.
Right.
Tavia Vital (08:06):
Kathryn, you asked us what we, we, what features we think are useful?
Yeah.
Is that where we were going?
Kathryn Alvarez (08:12):
I'm like, which ones do you feel like you initially messed up?
Like, I know for me the first time Istarted, I saw the duration of insulin
action and I was like, nah and I adjusted.
Dana Roseman (08:21):
Yeah.
Let me change that.
Kathryn Alvarez (08:23):
Yeah.
And then it's, it honestly,it messed things up.
So sticking with that hour actioncurve, the predictions are gonna
make a lot more sense and it's justtracking the true duration of insulin
action of the insulin that we're using.
Jennifer Smith (08:37):
Right.
Dana Roseman (08:38):
I had an issue with the bolus percentage because I just, that
I could not get that in my head thatI didn't want more insulin upfront.
And it does a reallynice job of the default.
It's what, 70%?
And then you just kind of let thealgorithm catch up on the flip side.
And so I, I'm changed that alot until I got settled on it.
Jennifer Smith (08:55):
I think there too is a mental flip of, especially coming
from being a loop user into trio.
The difference in how thesystems see a food entry, right?
And how they follow it, right?
I, I mean, from a baseline ofunderstanding, trio follows food and
ends up covering on hit of the food,whereas Loop ends up seeing a carb
(09:18):
entry, even here and now-- here andnow, like you put the carbs in, it's
starting to impact your blood sugar.
Whereas Trio has a little,
Dana Roseman (09:26):
it's a little bit more linear, I think, on Loop.
Jennifer Smith (09:28):
Yeah, and, and Trio really tries to keep up with
that change and hitting it on need.
Um, and that was again, anunderstanding difference in
using one to the other system.
Tavia Vital (09:40):
And like for me, I have slower digestion.
Slower than what I had10 years ago, let's say.
So I can't just a hundred percentbolus upfront for most things
or I'll go low on the first hour or two.
Now, if I were to eat somethingwith a really high GI all
by itself, glycemic index?
Okay, yeah, pre bolus needed, giveme all the insulin, maybe a super
bolus even, but for just normal foodsthat are a combination of fat and
(10:05):
fiber and protein and carbohydratesof whatever variety, right?
Then Trio gives me more options onhow-- easy options like where I don't
have to break my brain to try to decideexactly what to do before eating.
I can just say, this digests fast.
I'm gonna enter it as a normalbolus and take what it recommends.
(10:26):
Or I know that this is gonna digest alittle slower for me, and I can hit the
reduced bolus button that I already haveprogrammed to give the percentage that
I've tried out and adjusted over time.
Kathryn Alvarez (10:35):
Mm-hmm.
Tavia Vital (10:35):
Then I'll start my food, enter the carbs, hit the reduced bolus,
I get the smaller amount, and then itdoes a really great job of following it.
I have a lot less post meal lowsand, uh, above and below target
than I used to because of how thealgorithm follows that food entry
after settings have been adjusted.
Not saying I never have outof target glucose levels.
(10:56):
That would be also a fat lie.
Big, giant, non-truth, right?
Kathryn Alvarez (11:00):
Same.
Tavia Vital (11:00):
But I just think the system is able to help micromanage and that
lets me do my job and focus on lifeand my family and my clients a lot
more without me in there like maybe Ishould do this, maybe I should do that.
I'm doing a lot less of that overthe last few months for sure.
Kathryn Alvarez (11:16):
Yeah, I mean there's so much you can individualize because
as you say, like we're all different.
You're, the way it impacts you istotally different than the impact I see.
So being able to dial in the auto, sendmin the auto, send max the max UAM and
SMB basil minutes and change all of ourpercentages to get it like this pers-
(11:36):
perfect system packaged perfectly for us.
It's incredible what they did.
All speakers (11:40):
Mm-hmm.
Jennifer Smith (11:43):
And continue to develop.
That's what I like, is that they really dotake the voice of the people saying, this
is nice, but can something else be shiftedor changed here to improve upon this?
And the nice thing is with the waythat it's built now, um, and we were
just talking even before doing thisrecording about the build and really
understanding the navigation of howto build it the right way and make
(12:07):
sure it all maneuvers the right waybecause the updates that fall behind,
are important to keep up with or youmay not have the most fancy feature that
could be something that's an advantageor another dial for you to utilize.
Kathryn Alvarez (12:21):
Yeah.
Well, I think the build, I mean, this isa really important thing to talk about
too, because especially with Trio, alot of people are going straight to Dev.
They're totally skipping over runningit in main and the steps to build Dev,
initially pretty easy to follow for,depending on the person, and uh, so people
(12:41):
are doing that, but then they're notrealizing that they need to sink the fork.
Right guys?
Jennifer Smith (12:46):
Yes.
Dana Roseman (12:48):
Lesson learned, lesson learned.
Jennifer Smith (12:50):
Who here is guilty of not syncing the fork?
Tavia Vital (12:53):
Not today.
I'm not guilty today, but last week?
Dana Roseman (12:59):
I'm gonna sync that fork later!.
Jennifer Smith (13:00):
And Kathryn is our behind the scenes.
"Kathryn, are you aroundif I do this today?
Yes.
Can you help me if I get in here?
Help me out.
"Kathryn Alvarez: Yeah.
Um, and it, it is truly incrediblejust like watching people 'cause
there's not as many trio users asthere is loop users, but still on
that page, the response time is great.
The answers with the detail given areso good, and I like that like some of
(13:26):
the people that are involved in thedevelopment team are literally in there.
So you know that theanswer you're getting is.
The right one.
Kathryn Alvarez (13:33):
Right.
Yeah.
It's amazing.
Dana Roseman (13:34):
Well, holy smokes.
The whole open source communityfrom Loop to Trio to AAPS.
I mean so generous with theirtime and their knowledge.
It's just amazing.
Jennifer Smith (13:45):
Yes.
Dana Roseman (13:45):
It's such a beautiful place for people.
And so I would say, you know, evenif you're not comfortable with the
build, right, it doesn't mean thatyou're not gonna be comfortable
with the algorithm, because I thinkthey're really two separate skill
sets and two separate knowledge bases.
All speakers (13:58):
Right.
Tavia Vital (13:58):
Another thing I was just thinking about while we were talking,
that is a really strong feature ofthe Trio platform is the onboarding
that now exists to walk you through.
If you haven't used Trio before, oreven if you have, and now you're,
you're going to a different versionand you have to go through from the
beginning to set all of the settings up.
There's such great detailin the documentation.
(14:21):
It's very clear.
That even some of the componentsthat really are a complex math.
Dana Roseman (14:26):
Absolutely.
Tavia Vital (14:27):
There's a brief description to give you a clue,
"and here's the default by the way".
So if you're starting out, pick thedefault and then now you have an
idea about what this feature is so ifyou're having trouble, you could think
maybe that one setting could help mewith this struggle that I'm having.
Let me go back and read about it again.
And I just think it's, it's, if you wantto be involved in your diabetes management
(14:50):
and understand the algorithm that thesystem you're using, how it works, in
order to continually be able to improveor maintain your variability and time
and range, I think it's a really welldeveloped system that gives you what
you need as the individual living withdiabetes to make those decisions clearly.
All speakers (15:11):
Mm-hmm.
Tavia Vital (15:13):
I don't know.
I need to adjust something.
I'll just try this and hope it works out.
You don't have to do it that way.
For what's in the app itself,searching and the description.
Dana Roseman (15:22):
Right.
The searching feature is wonderful.
All speakers (15:25):
Yeah.
Tavia Vital (15:25):
And online you can reach out and ask, like, we just asked a question
today, and you know, how does the mathbehind the scenes really work for the
reduce bolus button, what happens?
We know what happens upfront, butthen how does trio mathematically,
what is it doing behind the scenes?
And now we have that piece.
It's just getting that,those types of details.
Now not everybody will want that.
(15:45):
That's fine.
Dana Roseman (15:46):
Right.
It's definitely not for everybody.
It is because there areso many, what did we hear?
It was like what, 120 different settings.
I mean it was something astronomical.
I'm probably over inflating
Jennifer Smith (15:56):
It could be changed.
Tavia Vital (15:58):
Yeah.
It's our part of our role.
At least my expectation for myself isto continue to get more and more of
those options very well understood, andthinking about if this option changes,
what other impacts downstream might weneed to adjust to help get it balanced.
To get optimal management forthis specific person's case.
Right?
(16:18):
Or when someone new comes and says,I started Trio and my glucose is
not doing what I want it to do.
Help.
I wanna be able to look at theirsettings and right away, and I
feel like we're there now wherewe can see big, obvious things.
They're obvious to us.
Dana Roseman (16:31):
Mm-hmm.
Tavia Vital (16:32):
We've been looking and learning and doing, and we can get things
toned down and cleaned up right away.
And then we can dive into the specifics.
Like a really physically activeday, a really hot day, a really
stressful day of whatever comes up,
Dana Roseman (16:44):
right.
Tavia Vital (16:44):
And then use those additional kind of advanced feature
options to help continue to improve it.
So I feel like where we're at as a team,from what I get from our conversations
and what, how we're seeing our timeand range in Trio overall, I think
we're there as a team, which is great.
It's a great place to be because inthe beginning it's so many unknowns.
It makes you feel really uneasy.
Like I'm supposed to be the expertand I am not, and I don't like it.
(17:07):
So I like what
Dana Roseman (17:08):
I think I was the first to say, I am just not at a place in my
life at the moment that I'm gonna enterTrio and I think I stopped and then
started again a couple months later.
All speakers (17:17):
Yeah, right.
Jennifer Smith (17:18):
Well, I think,
Tavia Vital (17:19):
and we still can learn, which is interesting, right?
There's still, every day a newquestion from a client comes up or,
a new, I don't know, something,a hiccup on the screen that
we didn't notice before.
And there are still plenty of thingsfor us to ask about and continue,
continue to learn, which tellsyou it's complex, which is cool.
I mean, it's built for us, which isjust really, it makes me so happy.
Kathryn Alvarez (17:40):
Which is great.
Dana Roseman (17:42):
Yeah, yeah, yeah.
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Jennifer Smith (18:21):
I like the, as you brought up, the onboarding, and I
always make sure for people who areinterested in moving into use of trio,
especially with the newest sort ofversion of trio, explaining to them
that that onboarding is really valuable.
Don't do this at 10 o'clock at nightexpecting that you're just gonna plug in
all your settings and get going because
Dana Roseman (18:42):
yeah.
Jennifer Smith (18:43):
The onboarding process, as you said, Tavia is like
read everything as it moves you tothe next screen the explanations are
there for, why are you setting itthis way, why is the default here?
And then as you use it and you findthings that you feel like they could be
tweaked, the search feature or even thatlittle "I" gives you more information.
(19:04):
It says, is this what I wanna touch?
Tap that "i" and see what's behind it.
How does it describe this piece and whatis it gonna do for you if you set it?
I even like the ones, I mean, there's,there's a lot of like cautionary like
medical type of information too thatsays, really, unless you really know
what you're doing, don't touch this dial.
Dana Roseman (19:23):
Right.
this is not for the basics.
Right?
Jennifer Smith (19:27):
Yeah.
Kathryn Alvarez (19:27):
Yeah, it's a nice big block pretty much
telling people get outta there.
Yeah.
That's really good.
Tavia Vital (19:32):
And I like some of the other features that I think are really
helpful for any of the open source peoplethen you already are gonna utilize, if
you're using open source, you're gonnautilize temp targets and overrides.
That's one of the beautiful pieces
Dana Roseman (19:46):
Yes.
Tavia Vital (19:46):
Of one of these systems that wins every time compared to
what you can get from the sortof out of the box systems and
Dana Roseman (19:52):
Right.
Tavia Vital (19:52):
What I really like about TRIO'S options is that you can
not only, so let's pretend I havea yardwork override where I'm gonna
need a lot less insulin inside that.
Jennifer Smith (20:03):
Do you really have a yard work override?
Tavia Vital (20:04):
I don't, but I should.
I need to make one.
I have other ones that are set upthat I just picked that work that way.
Right?
Yeah.
But maybe I should need a yardwork for this time of year.
Dana Roseman (20:13):
Yeah.
Tavia Vital (20:14):
So I want on higher target for my glucose, I want
lower amount of basal coming in.
But then you can also sub-select,do I want the corrections to be
this strong, as strong as normal?
Dana Roseman (20:24):
Right.
Tavia Vital (20:25):
Do I do I want the carbs to be the doses for
carbs to be as strong as usual?
And of the corrections, there aretwo components that you can also sub
modify in there, which is really smart.
All speakers (20:36):
Definitely.
Yeah.
Jennifer Smith (20:37):
Yeah, I even like the fact that in those, you know, sort of
adjustments, you can set whether theSMBs stay on right or not, which makes
it just enormously valuable when you arein a much more sensitive time and you
think, I don't want it kicking out extras.
Just give me some extrapositive something if I need it.
(20:58):
But I don't want these extra hits.
Tavia Vital (21:00):
Like if I go on a bike ride and I'm close to target when
I'm starting, and especially if it'shot out, I don't need any extra help.
Like, just leave that alone.
And, and
Dana Roseman (21:09):
I think for exercise, that is a huge difference
compared to other systems.
Tavia Vital (21:14):
If someone else, if they, or if I were gonna go on my ride and
let's say my glucose was elevated,had a delicious lunch, wild guessed
on the carbs, and I'm way up there.
I might want it to help me out a littlebit because I'm not gonna feel that
great on my ride if I'm that elevated.
And it would take a long timeto get it to where I want it.
I might want it to give me somecautionary little blip, you know,
Jennifer Smith (21:33):
there you can adjust the time, like, yeah.
They're all adjustable,which is so awesome.
Kathryn Alvarez (21:39):
Yes.
Awesome.
Yeah.
Do you guys use theshortcuts for Trio at all?
Tavia Vital (21:44):
I had one set up for 7:30 AM to kick on my morning walk override.
Kathryn Alvarez (21:50):
Mm-hmm.
Tavia Vital (21:51):
But now I'm doing more in the afternoon and outside in the yard
and things, so now I just ignore it.
But I had that set up.
Dana Roseman (21:56):
I have one for a Sunday yoga class that goes off every week.
Sometimes I don't go to yoga,but it goes off every time
Tavia Vital (22:04):
I switched the the shortcut to ask me if I want it to enable it.
Dana Roseman (22:08):
I should do that, I should do that.
Tavia Vital (22:09):
And that way I still have the choice and it's still there to
remind me in case I had a plan for it.
That's super handy because I used someof the other pump systems, remembering to
set something ahead of time to exercise.
I'm the worst at it.
I know what works, but do I implement?
It really hard to do and then rememberingto turn it off later too, right?
(22:30):
I
Dana Roseman (22:30):
I think that was one of our big things that we really missed.
Those scheduling of the overridesfrom Loop moving to Trio,
and then the shortcuts reallyhelp to kind of satisfy that.
Tavia Vital (22:40):
Right.
Kathryn Alvarez (22:42):
Which you have with Loop too.
I just feel like shortcuts are over...
Dana Roseman (22:45):
right.
Kathryn Alvarez (22:45):
They're just underused in general, I feel like.
Dana Roseman (22:48):
I think that's right.
Kathryn Alvarez (22:49):
So if you're listening to this, use shortcuts.
You can even use it to bolus,which is crazy for Trio.
So you know, if you're,
Tavia Vital (22:56):
you can tell Siri to give you a bolus.
I haven't done it.
I've seen people talking about it.
Do you have anybody doing that?
Kathryn Alvarez (23:02):
I don't know.
Tavia Vital (23:04):
That's,
Dana Roseman (23:05):
do you have, do you have to ask nicely?
Tavia Vital (23:07):
Maybe like, Siri, did you hear my question?
Like if you were in the middle of making
your clay pots, Dana?
Dana Roseman (23:12):
Yeah.
Oh my gosh, that would be amazingbecause I can't touch, yeah, I've
got slimy clay covered hands.
Jennifer Smith (23:19):
Dana, you should make us all, uh, Trynamic Trio
mugs so we can have coffee mugs.
Dana Roseman (23:25):
It'll be on my list.
I have a long list of thingsto make at the Pottery Studio.
Yeah.
Kathryn Alvarez (23:29):
How are you guys interacting with it?
Like I know I personally,I enter everything.
I'm not only a GLP one and I don'twant my blood sugar going up post
meal too, I know Trio can fix it.
Of course, I've accidentally forgottento bolus and it's super quick.
But yeah, I don't like, I don't like thatpost meal rise, so all entries for me.
How about you guys?
Dana Roseman (23:48):
Yeah, for sure.
It's helped me add a lot more protein.
Um, because its, it's justright there, which I love.
That's amazing.
Kathryn Alvarez (23:56):
I don't worry about protein anymore,
Jennifer Smith (23:56):
it's, I, I've only played with it more recently.
Recent being, like the last two weeks,uh, you guys know me well enough that,
like you, Kathryn, like everythingI bolus for, like it gets entered.
I try really hard to make sure my prebolus is there, even though I have
a busy life, kids, job, whatever.
Um, but in the past two weeks, I've,I, i've tried some things where
(24:20):
I actually, and I have to thankTheresa for giving a little bit of
like a, Hey, you can do it right.
Like, just don't, don't tell itanything and let it cover it.
And I can say that despite it goingprobably above the high target that
I really want to stay under postmeal, having not entered anything
at all, it does do a good job.
(24:42):
I've not gone over 180.
It's kept me, for the most part,honestly, like under 160 and has
turned it around and I've not gone low.
Tavia Vital (24:50):
That's pretty phenomenal.
Kathryn Alvarez (24:51):
Yeah.
Dana Roseman (24:52):
Which is just magical.
Yeah.
Yeah,
Jennifer Smith (24:54):
it is.
So if I had looser targets on the topend, maybe I would do that more often.
Tavia Vital (25:00):
If you're gonna transition to do that more, then you might
strengthen something to catch it.
Dana Roseman (25:05):
Mm-hmm.
Tavia Vital (25:06):
That's something else you could do.
So for me, I'm an enter also 'causeI, I think most of us have had,
whenever you get diagnosed withdiabetes, I was pre carb counting.
That's how long I've had diabetes,but since carb counting was a thing,
it's just, it's been, it's ingrained.
Dana Roseman (25:21):
Yeah.
I mean you look at a foodand you think of the carbs.
That's just what I do.
Yeah.
Tavia Vital (25:26):
And so the only times I haven't is once or twice I've been busy
and I intended to bolus, but didn'tyet because I could see it was coming
down and so I thought, well, I'll dothis in a little bit and then I like
get on a client visit and my glucosewas rising and then Trio fixed it
without anything untoward happening.
And I thought, okay, well that wasn'tthe worst thing that could have happened.
That's pretty nice.
(25:47):
And then a couple of times I tried itafter Theresa's nudge, like, really?
You could.
And I found that I, it can handle,for me anyway, the things I threw at
it that are 15 to 20 grams of carb.
Dana Roseman (25:59):
Sure.
Jennifer Smith (25:59):
Not terribly big.
Dana Roseman (26:00):
Yeah.
Yeah.
Tavia Vital (26:01):
Without going above 140.
If I'm starting off at like 90or a hundred, it just does it.
Dana Roseman (26:07):
Yeah.
But I think that reminds me ofsomething we haven't talked about
yet, which is that cone of certainty.
I just, I love it.
Love that.
Tavia Vital (26:14):
A cone of uncertainty.
Kathryn Alvarez (26:16):
Yeah.
I love it.
Actually had someone tell me thatthey didn't like that recently.
So did you know that'ssomething you can change?
Dana Roseman (26:23):
Yeah.
Yeah, of course you can.
Right?
Because it's trio.
Jennifer Smith (26:26):
Yeah.
Tavia Vital (26:27):
Yeah.
I like it because it gives a goodpictorial of the reality of every
moment that you make a decision.
Dana Roseman (26:33):
Right.
Tavia Vital (26:33):
So you can spend 20 minutes making the best decision you could
possibly measure and weigh and calculate,
Jennifer Smith (26:39):
and there's still,
Tavia Vital (26:39):
in reality, your glucose could go this way,
that way, or head straight.
And so you do the best youcan with what you have.
You have your settings reignedin, and then let trio accommodate
by reducing or adding so thatyour glucose is more stable.
And let go of that mind gymnasticsthing that we've been trained
to do to try to make it allwork out perfectly all the time.
Dana Roseman (27:01):
Right.
Tavia Vital (27:01):
You do it
Dana Roseman (27:02):
because we know it's not gonna go to a specific number, right?
That's just not how diabetes works.
And so I, I just love that.
Jennifer Smith (27:10):
I think what it's reminded me of since, and originally we all really
disliked the multiple dotted lines.
All speakers (27:17):
Yes, yes.
Jennifer Smith (27:18):
In the original, right, where there was no cone of uncertainty
i've enjoyed having it,as you said, in a way.
But I think of it differently in thatwe can't all always, a hundred percent
have a plan for what's coming in the nexthour or two hours, four hours, whatever.
And so it gives the idea that allplans considered, I'm expecting
(27:40):
to probably be in the midpointof that cone of uncertainty.
Dana Roseman (27:43):
Right.
Jennifer Smith (27:44):
But trio is also expecting something could change and
it's giving you this wide range tobe able to tell you, you know what,
but life, we have a plaque in ourkitchen that says Life happens here.
Dana Roseman (27:57):
Yeah.
Jennifer Smith (27:58):
And it's a hundred percent the truth.
You could plan your life to a T andthere's always going to be something
that changes and shifts, and that's whatthat cone reminds me of is that Trio
is here to catch, within that, for me.
Tavia Vital (28:14):
I do like it.
Also, I use it for the predictabilityof, with my slower digestion, if
I'm eating a meal that I know isnot just gonna hit right away, I
can change the dose recommended.
So if I've already said I'm gonnahit reduce bolus button, and then
the cone of uncertainty is showingme that I'm at most likely to top out
at some number, that's way too low.
And most of the cone is downin the low flat line, like
Dana Roseman (28:36):
right,
Tavia Vital (28:36):
not aiming for life, right?
I could back off the dose furtherand it will show me in a modified
view of what it predicts.
And I can think about what Iknow, like was I just exercising?
Am I about to?
Is my prediction of that food really gonnamatch what this is predicting or not?
And I can go ahead and I can fiddlewith that dose a little bit to ensure
I have much less chance of having apost-meal hypo, which I feel are some
(28:59):
of the worst because you have bolusonboard, you have not yet digested,
and you might have a full stomach.
And so then getting the treatment in
Dana Roseman (29:07):
and you're full
Tavia Vital (29:08):
and you're, and you're full, right?
Yeah.
So inconvenient.
Dana Roseman (29:12):
Yeah,
Tavia Vital (29:12):
somewhat scary sometimes.
I mean, we'd be talking little doseswith reduced bolus, but, but still
it's just, those are one of thebiggest annoyances to me anyway.
I love that.
It's so helpful for me to be ableto just go, okay, the reduced bolus
still heads me like, looks like apretty good chance of a big, bad drop.
I don't want that.
I'll cut that in half.
How does that do?
And I'm not doing math, I'm just, well,I'm cutting in half, but I'm not like.
(29:35):
Let me do 30% less.
Let me do 18.6.
It's just cutting the dosein half until the cone looks
reasonable and I move forward.
Dana Roseman (29:42):
Right.
Tavia Vital (29:42):
And I can do that so quickly.
And I love that because obviously weall are thinkers with our doses, right?
And so the amount of, the amount ofeffort and the amount of less complex
math I'm having to do, I love it
Jennifer Smith (29:56):
better.
Tavia Vital (29:57):
Yeah.
Kathryn Alvarez (29:57):
Yes.
Yeah.
I think another great questionfor all of us to go over is
what we're choosing to use.
Like are you guys runningdefault auto sends?
Are you running log orare you running sigmoid?
Good question.
Yeah.
Tavia Vital (30:10):
What are you doing, kathryn?
Kathryn Alvarez (30:11):
Sigmoid.
Tavia Vital (30:13):
Sigma too.
Dana Roseman (30:13):
I haven't moved over to that just yet, but it's on the todo
list to kind of play around with that.
I just kind of stayed, tried and true.
Mostly defaults, except, you know,a lot of the adjustments, you know,
depending on different days, differentactivities, different, you know,
Tavia Vital (30:29):
I think that's kind of
Jennifer Smith (30:30):
right there with you, Dana.
I, I also have not switchedover to the sigmoid yet, but I
have a lot of the adjustments,
Dana Roseman (30:38):
a lot
Jennifer Smith (30:38):
as preset with differences in the SMBs and
Dana Roseman (30:42):
yes,
Jennifer Smith (30:42):
whether it's on or off and the percents and even target
adjustments and things that I haveagain named for certain scenarios.
So yeah, I haven't switched over yet.
Tavia Vital (30:51):
I think I what I think sigmoid is helping with theoretically.
Is it true or is that just my feeling?
I don't know.
I should have you guys look at my dataand we should compare notes on calendars
to see if you think the same thing I do.
I think sigmoid for me, helpsminimize the difference in
my glucose, um, for ovulation
and when I would have a period day, Idon't feel like I have to put overrides
(31:14):
on to help conquer the insulin resistance.
And I don't have to backthe doses off as often.
I still have to sometimes for thefirst, like one or two days with an
override, but I don't feel like, Ifeel like it handles that better and I
feel like it handles the certain sitesjust aren't as efficient as others.
Where I'm not feeling likeI have to chase myself with
(31:34):
adjusting to settings as often.
So that's my, that's my 2 centsfor my N of one with sigmoid.
Kathryn Alvarez (31:41):
Right.
I like that Sigmoid doesn't use totaldaily dose as much within its calculation.
I think that's a big help for meand for a lot of the littles that
I work with, I'm having them runsigmoid as well because of it.
Dana Roseman (31:53):
That makes sense.
Yeah, that makes sense.
Kathryn Alvarez (31:56):
And yeah, just like Tavia, I, like I literally in my
adjustment section, I went to showsomeone the other day and I was like,
you know, this is really shocking.
I don't have a single one in there.
Tavia Vital (32:06):
Me too.
Dana Roseman (32:06):
Oh my gosh.
I've got like a chooseyour own adventure options.
Jennifer Smith (32:10):
Right?
I know.
I've got like so many of them.
Kathryn Alvarez (32:12):
I know.
I was like
Tavia Vital (32:13):
basics in there.
Kathryn Alvarez (32:15):
I mean that just,
yeah.
I'm just
Dana Roseman (32:18):
that that's kind of amazing.
That isn't amazing.
Kathryn Alvarez (32:20):
I know.
Yeah.
I'm walking greatly, riding the bike.
Jennifer Smith (32:23):
It's the value of what you're saying, Kathryn, is that
with sigmoid enabled, you feel likeit does a good enough job not really
even having to have adjustments set up.
And I know, I mean, you exercise,you have a busy schedule.
You also work with little kids outside ofwhat you do, you know, with Integrated,
so you've got a lot of stuff going on too.
(32:44):
In which case I'd probablyhave about 10 more adjustments.
Kathryn Alvarez (32:48):
Like it's, it really is, it's incredible that I just
don't, I don't have to do anything.
Yeah.
And I mean, my time in range, likeif I wanted to really take it to
the next level, then yeah, I wouldprobably put some more adjustments in.
But like if you look at my stats.
And things have been just so wild,as you guys know, with my life
recently, but yes, for the month,um, 70 to 140 time in range is 83.7.
Dana Roseman (33:14):
I mean, yeah.
That's amazing.
Jennifer Smith (33:15):
That's awesome.
Dana Roseman (33:17):
Amazing.
Tavia Vital (33:18):
What, this is my month, 63 to 180 range, 94.9.
63 to 140 is, uh, 67.3.
Is that say 67?
I'm reading it backwards.
67.3. Below 63 is 0.6, and averageglucose is about 125, and that is me.
Kathryn Alvarez (33:36):
So good
Tavia Vital (33:38):
and underdosing, and.
All the things that areeating pizza a lot because
Jennifer Smith (33:43):
normal things.
Dana Roseman (33:45):
Because it's summer.
Kathryn Alvarez (33:47):
Yeah.
Yeah.
It's amazing.
Dana Roseman (33:49):
Well, I think we'll have to go in a deep dive another time with more
of the options that we're doing on Trio.
'cause it, I think we're allhaving great success and definitely
still learning from each other.
Jennifer Smith (33:58):
And as things get developed more and change, but we will
have more of our trio discussions.
We'll have to remember towear our trio shirts then
Dana Roseman (34:05):
next time.
For sure.
All in purple.
Kathryn Alvarez (34:07):
Yeah.
Jennifer Smith (34:07):
Yep.
Awesome.
Kathryn Alvarez (34:09):
Love it.
Alright.
Thank you for joining ustoday for the podcast.
Myself, Tavia.
Jenny and Dana all shared our experiencesusing trio, the latest version.
So we all got to beta test and arenow running the latest version of Dev.
We talk about the differentfunctionalities that we're each
(34:30):
utilizing, why we like some ofthe different functionalities.
What it took for us to dial some of thethings in and how we all are learning
on our own and, and still in a state oflearning this beautiful, lovely system
that we have the option to build and use
thanks to the open source community.
Gary Scheiner (34:52):
Thanks for tuning into Think Like A Pancreas, The podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a Pancreas-- the podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
(35:12):
care is personal because we live it too.
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech,
sports, and exercise, weight losstype one pregnancy and emotional
(35:33):
wellbeing, we've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas--the podcast, i'm Gary Scheiner, wishing
(35:56):
you a fantastic week ahead and don'tforget to think like a pancreas.
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:42):
healthcare provider before implementing.
Kathryn Alvarez (00:44):
Hello Trynamic Trio.
So, just a little background.
When we first started Trio, I startedup just a little bit before Dana,
Jenny, and Tavia, and we decided thatwe were gonna call them the Trynamic
Trio and I gotta say, we should haveworn our trio shirts for this week.
All speakers (01:06):
Yeah, we shoulda, shoulda
Dana Roseman (01:07):
have.
How did we not think about that?
Next time?
Next time we'll do this again.
Kathryn Alvarez (01:13):
Have to do a part two for sure for sure
Dana Roseman (01:15):
just to wear the shirts.
Kathryn Alvarez (01:16):
Yep, totally.
Jennifer Smith (01:18):
I could go get it.
Kathryn Alvarez (01:20):
I'm not that organized at don't,
Dana Roseman (01:21):
and they're purple.
So that would all match.
Yeah.
Kathryn Alvarez (01:24):
Yep, yep.
Purple.
And it's perfect too, just when you dosome looking into why it's called Trio,
it's a lot of it because they said thatthey were finding patterns of threes.
So it's just funny that for youguys too, there's just that.
All speakers (01:39):
Yeah.
Another time.
Three of us.
Kathryn Alvarez (01:42):
So sweet.
But yeah, we definitely,
Jennifer Smith (01:44):
it's always fun to learn together too, I think.
Dana Roseman (01:46):
Absolutely.
And it's made it so much easierbecause there's so much to learn and
everyone's question is my question.
Jennifer Smith (01:54):
Yes.
Yeah.
Yeah.
Or you ask a question and you think,well, I didn't get to that question
yet, but now you know, when youkind of encounter that, you know
the answer already which is great.
Dana Roseman (02:04):
Right.
Kathryn Alvarez (02:04):
Right.
So, great.
But yeah, I feel like Trio is, issomething that we're definitely
consistently just in a learning curve.
I creepily go on the Facebook page and Ilike search for the developer's names and
see what they've posted just to make surethat like I'm getting everything right.
Tavia Vital (02:23):
Yep.
And I go on dis- discord to see if peopleare talking about things that I'm seeing,
or if someone's already asked a questionthat I can find, what's the math behind
the scene on this one little sub menuitem so that I can understand it better.
It's very helpful.
Dana Roseman (02:38):
Yeah, and I think more than anything, trio is like
one of those diabetes applications,
the rabbit hole is never ending.
You can go dig as deep and darkas you want to in a positive way,
but like it's just never ending.
Kathryn Alvarez (02:50):
Truly.
Yeah.
But I mean, it's absolutely incredible.
How have you guys felt about using it?
'cause I feel like all of us usedIAPS and kind of went back to Loop.
We used Trio, the original,and went back to Loop.
I used free APSX and I, uh, oh.
I used fax.
I don't know if anyone else used that?
Dana Roseman (03:09):
Well, who of this group is using Dynamic?
'cause?
I am using Dynamic, butnot, what am I not using?
Tavia Vital (03:17):
Are you not using Sigmoid?
Dana Roseman (03:19):
Sigmoid, thank you.
Using sigmoid.
Kathryn Alvarez (03:20):
Yeah.
Yeah.
Tavia Vital (03:23):
I'm using dynamic with sigmoid and with just
with the ISF side of things.
Well, and the basal,but not the car ratio.
Dana Roseman (03:28):
Mm-hmm.
Jennifer Smith (03:29):
Well, I think we've had a learning process, as you said,
Kathryn, we've, we've all started out asloopers, coming from conventional pumping.
We moved to looping.
I mean, as of this coming October,I would be technically looping or
using DIY for about eight years.
And then, you know, knowing enough people,again, it's nice within the diabetes
community being connected because youknow enough people to say, I'm super
(03:52):
comfortable with this, but look, thesefancy features look like they would help
the variables in my life for, for reasons,you know, that are even more beneficial,
so let's try this.
And I think it's nice tohave the handholding too.
All speakers (04:04):
Mm-hmm.
Jennifer Smith (04:04):
Because as we just said, it's, it's nice to have
a connection to say, well, I'mnot the only one building this.
If I have a question, I canreach out to this person.
Or I think last summer was whenwe all started trying Trio, right?
Dana Roseman (04:16):
Mm-hmm.
Jennifer Smith (04:18):
In our texting Trynamic Trio group, we all started
like complaining about similar things.
Like why isn't like, thisdoesn't seem to be working.
I'm going back to Loop.
Or like, this is an issue.
And so we could bounce ideas, but Ithink the reason we've all now stuck
with Trio is because it has gottento the development stage of, I wanna
(04:39):
say I trust it like I trusted Loop.
Dana Roseman (04:41):
Right.
Jennifer Smith (04:41):
Where I ended with Loop, I now have that trust and even more for
Trio because of the pieces that have beenbuilt into it that are just more, they
add to the variability management in life.
Tavia Vital (04:53):
And I would also say, as my understanding of all, I wouldn't
wanna say all that would be a dis,that would be a misnomer, but as my
understanding of many of the differentfeatures and settings, adjustments
how it influences how whatTRIO does or doesn't do.
I think that also builds confidencebecause if, if you just look at it as
there's this thing and it, uh, thereare so many options to adjust and I
(05:17):
don't like what my blood sugar's doing.
If you never move past that stage,you haven't really given trio
the fair chance that it deserves.
All speakers (05:25):
Right.
Tavia Vital (05:25):
And it's hard to go from one system to another.
I don't care if it's a standardsystem to loop the first time, it
doesn't, or one standard system toanother kind of outta the box system.
You have to learn how those algorithmswork to then adjust the right settings,
or expectations as the case may be, inorder to get the most from that system.
And that's hard for us, right?
(05:46):
Like
Dana Roseman (05:46):
yeah,
Tavia Vital (05:46):
humans we're creatures of stability and predictability,
even though diabetes, ofcourse doesn't do that for us.
So then forcing change on ourselves,we have to always stop and ask along
the way, like, whose idea was this?
Why am I doing this right?
Dana Roseman (05:59):
Why am I doing this?
Yeah.
Well, I think that's a great pointof, when you move from one system,
even if it's an open source like loopto trio, you have to rethink all of
your settings because, I think partof my frustration last summer was that
I really did have to adjust thingsthat worked perfectly on loop, but
absolutely did not work perfectly onTrio because the algorithm was different.
Jennifer Smith (06:22):
I, you know, and from a standpoint of others coming into
consideration of Trio, I'm really gladthat I started Loop where I did, because
I had come from a conventional pumpthat had no ability to navigate for me.
I was the thinker of everythingthe pump was gonna do for me.
I put it in and there's a learningphase to each of these algorithms
(06:45):
and starting to use, and you, uh,you make a great point, Dana, in
that I went to loop under the kindof assistance of somebody I'd worked
with who was looping in pregnancy and,
I was like, gosh, why am I not doing this?
Clearly it does a phenomenaljob beyond what I can do.
And she helped me build, um, eonsago when it was like reading the
(07:05):
hieroglyphics on the wall to build right.
And after a 30 days was texting, i'm like,I don't know, like I'm really frustrated.
And she said, Jenny, you haveto step back and you have to
let loop do what it's gonna do.
Dana Roseman (07:18):
Right?
Jennifer Smith (07:18):
And then you have to evaluate your data and see what to change.
I was used to being the manipulator.
Tavia Vital (07:25):
Mm-hmm.
Jennifer Smith (07:25):
I turned all my own dials and wasn't really letting, I
was like overstepping the system,which I still didn't really get the
algorithm quite yet, but I think that'svaluable to know when you move into
an even more potentially aggressive,more dials to change like Trio has.
My point being,
(07:46):
I think there's a steppingstone plan of use.
I don't typically suggest for somebodyto go from MDI or even a normal pump
system directly into Trio because Ithink there's too much difference.
As you said, there are a lot of settingsthat are not gonna look the same.
Dana Roseman (08:04):
Absolutely.
Right.
Tavia Vital (08:06):
Kathryn, you asked us what we, we, what features we think are useful?
Yeah.
Is that where we were going?
Kathryn Alvarez (08:12):
I'm like, which ones do you feel like you initially messed up?
Like, I know for me the first time Istarted, I saw the duration of insulin
action and I was like, nah and I adjusted.
Dana Roseman (08:21):
Yeah.
Let me change that.
Kathryn Alvarez (08:23):
Yeah.
And then it's, it honestly,it messed things up.
So sticking with that hour actioncurve, the predictions are gonna
make a lot more sense and it's justtracking the true duration of insulin
action of the insulin that we're using.
Jennifer Smith (08:37):
Right.
Dana Roseman (08:38):
I had an issue with the bolus percentage because I just, that
I could not get that in my head thatI didn't want more insulin upfront.
And it does a reallynice job of the default.
It's what, 70%?
And then you just kind of let thealgorithm catch up on the flip side.
And so I, I'm changed that alot until I got settled on it.
Jennifer Smith (08:55):
I think there too is a mental flip of, especially coming
from being a loop user into trio.
The difference in how thesystems see a food entry, right?
And how they follow it, right?
I, I mean, from a baseline ofunderstanding, trio follows food and
ends up covering on hit of the food,whereas Loop ends up seeing a carb
(09:18):
entry, even here and now-- here andnow, like you put the carbs in, it's
starting to impact your blood sugar.
Whereas Trio has a little,
Dana Roseman (09:26):
it's a little bit more linear, I think, on Loop.
Jennifer Smith (09:28):
Yeah, and, and Trio really tries to keep up with
that change and hitting it on need.
Um, and that was again, anunderstanding difference in
using one to the other system.
Tavia Vital (09:40):
And like for me, I have slower digestion.
Slower than what I had10 years ago, let's say.
So I can't just a hundred percentbolus upfront for most things
or I'll go low on the first hour or two.
Now, if I were to eat somethingwith a really high GI all
by itself, glycemic index?
Okay, yeah, pre bolus needed, giveme all the insulin, maybe a super
bolus even, but for just normal foodsthat are a combination of fat and
(10:05):
fiber and protein and carbohydratesof whatever variety, right?
Then Trio gives me more options onhow-- easy options like where I don't
have to break my brain to try to decideexactly what to do before eating.
I can just say, this digests fast.
I'm gonna enter it as a normalbolus and take what it recommends.
(10:26):
Or I know that this is gonna digest alittle slower for me, and I can hit the
reduced bolus button that I already haveprogrammed to give the percentage that
I've tried out and adjusted over time.
Kathryn Alvarez (10:35):
Mm-hmm.
Tavia Vital (10:35):
Then I'll start my food, enter the carbs, hit the reduced bolus,
I get the smaller amount, and then itdoes a really great job of following it.
I have a lot less post meal lowsand, uh, above and below target
than I used to because of how thealgorithm follows that food entry
after settings have been adjusted.
Not saying I never have outof target glucose levels.
(10:56):
That would be also a fat lie.
Big, giant, non-truth, right?
Kathryn Alvarez (11:00):
Same.
Tavia Vital (11:00):
But I just think the system is able to help micromanage and that
lets me do my job and focus on lifeand my family and my clients a lot
more without me in there like maybe Ishould do this, maybe I should do that.
I'm doing a lot less of that overthe last few months for sure.
Kathryn Alvarez (11:16):
Yeah, I mean there's so much you can individualize because
as you say, like we're all different.
You're, the way it impacts you istotally different than the impact I see.
So being able to dial in the auto, sendmin the auto, send max the max UAM and
SMB basil minutes and change all of ourpercentages to get it like this pers-
(11:36):
perfect system packaged perfectly for us.
It's incredible what they did.
All speakers (11:40):
Mm-hmm.
Jennifer Smith (11:43):
And continue to develop.
That's what I like, is that they really dotake the voice of the people saying, this
is nice, but can something else be shiftedor changed here to improve upon this?
And the nice thing is with the waythat it's built now, um, and we were
just talking even before doing thisrecording about the build and really
understanding the navigation of howto build it the right way and make
(12:07):
sure it all maneuvers the right waybecause the updates that fall behind,
are important to keep up with or youmay not have the most fancy feature that
could be something that's an advantageor another dial for you to utilize.
Kathryn Alvarez (12:21):
Yeah.
Well, I think the build, I mean, this isa really important thing to talk about
too, because especially with Trio, alot of people are going straight to Dev.
They're totally skipping over runningit in main and the steps to build Dev,
initially pretty easy to follow for,depending on the person, and uh, so people
(12:41):
are doing that, but then they're notrealizing that they need to sink the fork.
Right guys?
Jennifer Smith (12:46):
Yes.
Dana Roseman (12:48):
Lesson learned, lesson learned.
Jennifer Smith (12:50):
Who here is guilty of not syncing the fork?
Tavia Vital (12:53):
Not today.
I'm not guilty today, but last week?
Dana Roseman (12:59):
I'm gonna sync that fork later!.
Jennifer Smith (13:00):
And Kathryn is our behind the scenes.
"Kathryn, are you aroundif I do this today?
Yes.
Can you help me if I get in here?
Help me out.
"Kathryn Alvarez: Yeah.
Um, and it, it is truly incrediblejust like watching people 'cause
there's not as many trio users asthere is loop users, but still on
that page, the response time is great.
The answers with the detail given areso good, and I like that like some of
(13:26):
the people that are involved in thedevelopment team are literally in there.
So you know that theanswer you're getting is.
The right one.
Kathryn Alvarez (13:33):
Right.
Yeah.
It's amazing.
Dana Roseman (13:34):
Well, holy smokes.
The whole open source communityfrom Loop to Trio to AAPS.
I mean so generous with theirtime and their knowledge.
It's just amazing.
Jennifer Smith (13:45):
Yes.
Dana Roseman (13:45):
It's such a beautiful place for people.
And so I would say, you know, evenif you're not comfortable with the
build, right, it doesn't mean thatyou're not gonna be comfortable
with the algorithm, because I thinkthey're really two separate skill
sets and two separate knowledge bases.
All speakers (13:58):
Right.
Tavia Vital (13:58):
Another thing I was just thinking about while we were talking,
that is a really strong feature ofthe Trio platform is the onboarding
that now exists to walk you through.
If you haven't used Trio before, oreven if you have, and now you're,
you're going to a different versionand you have to go through from the
beginning to set all of the settings up.
There's such great detailin the documentation.
(14:21):
It's very clear.
That even some of the componentsthat really are a complex math.
Dana Roseman (14:26):
Absolutely.
Tavia Vital (14:27):
There's a brief description to give you a clue,
"and here's the default by the way".
So if you're starting out, pick thedefault and then now you have an
idea about what this feature is so ifyou're having trouble, you could think
maybe that one setting could help mewith this struggle that I'm having.
Let me go back and read about it again.
And I just think it's, it's, if you wantto be involved in your diabetes management
(14:50):
and understand the algorithm that thesystem you're using, how it works, in
order to continually be able to improveor maintain your variability and time
and range, I think it's a really welldeveloped system that gives you what
you need as the individual living withdiabetes to make those decisions clearly.
All speakers (15:11):
Mm-hmm.
Tavia Vital (15:13):
I don't know.
I need to adjust something.
I'll just try this and hope it works out.
You don't have to do it that way.
For what's in the app itself,searching and the description.
Dana Roseman (15:22):
Right.
The searching feature is wonderful.
All speakers (15:25):
Yeah.
Tavia Vital (15:25):
And online you can reach out and ask, like, we just asked a question
today, and you know, how does the mathbehind the scenes really work for the
reduce bolus button, what happens?
We know what happens upfront, butthen how does trio mathematically,
what is it doing behind the scenes?
And now we have that piece.
It's just getting that,those types of details.
Now not everybody will want that.
(15:45):
That's fine.
Dana Roseman (15:46):
Right.
It's definitely not for everybody.
It is because there areso many, what did we hear?
It was like what, 120 different settings.
I mean it was something astronomical.
I'm probably over inflating
Jennifer Smith (15:56):
It could be changed.
Tavia Vital (15:58):
Yeah.
It's our part of our role.
At least my expectation for myself isto continue to get more and more of
those options very well understood, andthinking about if this option changes,
what other impacts downstream might weneed to adjust to help get it balanced.
To get optimal management forthis specific person's case.
Right?
(16:18):
Or when someone new comes and says,I started Trio and my glucose is
not doing what I want it to do.
Help.
I wanna be able to look at theirsettings and right away, and I
feel like we're there now wherewe can see big, obvious things.
They're obvious to us.
Dana Roseman (16:31):
Mm-hmm.
Tavia Vital (16:32):
We've been looking and learning and doing, and we can get things
toned down and cleaned up right away.
And then we can dive into the specifics.
Like a really physically activeday, a really hot day, a really
stressful day of whatever comes up,
Dana Roseman (16:44):
right.
Tavia Vital (16:44):
And then use those additional kind of advanced feature
options to help continue to improve it.
So I feel like where we're at as a team,from what I get from our conversations
and what, how we're seeing our timeand range in Trio overall, I think
we're there as a team, which is great.
It's a great place to be because inthe beginning it's so many unknowns.
It makes you feel really uneasy.
Like I'm supposed to be the expertand I am not, and I don't like it.
(17:07):
So I like what
Dana Roseman (17:08):
I think I was the first to say, I am just not at a place in my
life at the moment that I'm gonna enterTrio and I think I stopped and then
started again a couple months later.
All speakers (17:17):
Yeah, right.
Jennifer Smith (17:18):
Well, I think,
Tavia Vital (17:19):
and we still can learn, which is interesting, right?
There's still, every day a newquestion from a client comes up or,
a new, I don't know, something,a hiccup on the screen that
we didn't notice before.
And there are still plenty of thingsfor us to ask about and continue,
continue to learn, which tellsyou it's complex, which is cool.
I mean, it's built for us, which isjust really, it makes me so happy.
Kathryn Alvarez (17:40):
Which is great.
Dana Roseman (17:42):
Yeah, yeah, yeah.
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Jennifer Smith (18:21):
I like the, as you brought up, the onboarding, and I
always make sure for people who areinterested in moving into use of trio,
especially with the newest sort ofversion of trio, explaining to them
that that onboarding is really valuable.
Don't do this at 10 o'clock at nightexpecting that you're just gonna plug in
all your settings and get going because
Dana Roseman (18:42):
yeah.
Jennifer Smith (18:43):
The onboarding process, as you said, Tavia is like
read everything as it moves you tothe next screen the explanations are
there for, why are you setting itthis way, why is the default here?
And then as you use it and you findthings that you feel like they could be
tweaked, the search feature or even thatlittle "I" gives you more information.
(19:04):
It says, is this what I wanna touch?
Tap that "i" and see what's behind it.
How does it describe this piece and whatis it gonna do for you if you set it?
I even like the ones, I mean, there's,there's a lot of like cautionary like
medical type of information too thatsays, really, unless you really know
what you're doing, don't touch this dial.
Dana Roseman (19:23):
Right.
this is not for the basics.
Right?
Jennifer Smith (19:27):
Yeah.
Kathryn Alvarez (19:27):
Yeah, it's a nice big block pretty much
telling people get outta there.
Yeah.
That's really good.
Tavia Vital (19:32):
And I like some of the other features that I think are really
helpful for any of the open source peoplethen you already are gonna utilize, if
you're using open source, you're gonnautilize temp targets and overrides.
That's one of the beautiful pieces
Dana Roseman (19:46):
Yes.
Tavia Vital (19:46):
Of one of these systems that wins every time compared to
what you can get from the sortof out of the box systems and
Dana Roseman (19:52):
Right.
Tavia Vital (19:52):
What I really like about TRIO'S options is that you can
not only, so let's pretend I havea yardwork override where I'm gonna
need a lot less insulin inside that.
Jennifer Smith (20:03):
Do you really have a yard work override?
Tavia Vital (20:04):
I don't, but I should.
I need to make one.
I have other ones that are set upthat I just picked that work that way.
Right?
Yeah.
But maybe I should need a yardwork for this time of year.
Dana Roseman (20:13):
Yeah.
Tavia Vital (20:14):
So I want on higher target for my glucose, I want
lower amount of basal coming in.
But then you can also sub-select,do I want the corrections to be
this strong, as strong as normal?
Dana Roseman (20:24):
Right.
Tavia Vital (20:25):
Do I do I want the carbs to be the doses for
carbs to be as strong as usual?
And of the corrections, there aretwo components that you can also sub
modify in there, which is really smart.
All speakers (20:36):
Definitely.
Yeah.
Jennifer Smith (20:37):
Yeah, I even like the fact that in those, you know, sort of
adjustments, you can set whether theSMBs stay on right or not, which makes
it just enormously valuable when you arein a much more sensitive time and you
think, I don't want it kicking out extras.
Just give me some extrapositive something if I need it.
(20:58):
But I don't want these extra hits.
Tavia Vital (21:00):
Like if I go on a bike ride and I'm close to target when
I'm starting, and especially if it'shot out, I don't need any extra help.
Like, just leave that alone.
And, and
Dana Roseman (21:09):
I think for exercise, that is a huge difference
compared to other systems.
Tavia Vital (21:14):
If someone else, if they, or if I were gonna go on my ride and
let's say my glucose was elevated,had a delicious lunch, wild guessed
on the carbs, and I'm way up there.
I might want it to help me out a littlebit because I'm not gonna feel that
great on my ride if I'm that elevated.
And it would take a long timeto get it to where I want it.
I might want it to give me somecautionary little blip, you know,
Jennifer Smith (21:33):
there you can adjust the time, like, yeah.
They're all adjustable,which is so awesome.
Kathryn Alvarez (21:39):
Yes.
Awesome.
Yeah.
Do you guys use theshortcuts for Trio at all?
Tavia Vital (21:44):
I had one set up for 7:30 AM to kick on my morning walk override.
Kathryn Alvarez (21:50):
Mm-hmm.
Tavia Vital (21:51):
But now I'm doing more in the afternoon and outside in the yard
and things, so now I just ignore it.
But I had that set up.
Dana Roseman (21:56):
I have one for a Sunday yoga class that goes off every week.
Sometimes I don't go to yoga,but it goes off every time
Tavia Vital (22:04):
I switched the the shortcut to ask me if I want it to enable it.
Dana Roseman (22:08):
I should do that, I should do that.
Tavia Vital (22:09):
And that way I still have the choice and it's still there to
remind me in case I had a plan for it.
That's super handy because I used someof the other pump systems, remembering to
set something ahead of time to exercise.
I'm the worst at it.
I know what works, but do I implement?
It really hard to do and then rememberingto turn it off later too, right?
(22:30):
I
Dana Roseman (22:30):
I think that was one of our big things that we really missed.
Those scheduling of the overridesfrom Loop moving to Trio,
and then the shortcuts reallyhelp to kind of satisfy that.
Tavia Vital (22:40):
Right.
Kathryn Alvarez (22:42):
Which you have with Loop too.
I just feel like shortcuts are over...
Dana Roseman (22:45):
right.
Kathryn Alvarez (22:45):
They're just underused in general, I feel like.
Dana Roseman (22:48):
I think that's right.
Kathryn Alvarez (22:49):
So if you're listening to this, use shortcuts.
You can even use it to bolus,which is crazy for Trio.
So you know, if you're,
Tavia Vital (22:56):
you can tell Siri to give you a bolus.
I haven't done it.
I've seen people talking about it.
Do you have anybody doing that?
Kathryn Alvarez (23:02):
I don't know.
Tavia Vital (23:04):
That's,
Dana Roseman (23:05):
do you have, do you have to ask nicely?
Tavia Vital (23:07):
Maybe like, Siri, did you hear my question?
Like if you were in the middle of making
your clay pots, Dana?
Dana Roseman (23:12):
Yeah.
Oh my gosh, that would be amazingbecause I can't touch, yeah, I've
got slimy clay covered hands.
Jennifer Smith (23:19):
Dana, you should make us all, uh, Trynamic Trio
mugs so we can have coffee mugs.
Dana Roseman (23:25):
It'll be on my list.
I have a long list of thingsto make at the Pottery Studio.
Yeah.
Kathryn Alvarez (23:29):
How are you guys interacting with it?
Like I know I personally,I enter everything.
I'm not only a GLP one and I don'twant my blood sugar going up post
meal too, I know Trio can fix it.
Of course, I've accidentally forgottento bolus and it's super quick.
But yeah, I don't like, I don't like thatpost meal rise, so all entries for me.
How about you guys?
Dana Roseman (23:48):
Yeah, for sure.
It's helped me add a lot more protein.
Um, because its, it's justright there, which I love.
That's amazing.
Kathryn Alvarez (23:56):
I don't worry about protein anymore,
Jennifer Smith (23:56):
it's, I, I've only played with it more recently.
Recent being, like the last two weeks,uh, you guys know me well enough that,
like you, Kathryn, like everythingI bolus for, like it gets entered.
I try really hard to make sure my prebolus is there, even though I have
a busy life, kids, job, whatever.
Um, but in the past two weeks, I've,I, i've tried some things where
(24:20):
I actually, and I have to thankTheresa for giving a little bit of
like a, Hey, you can do it right.
Like, just don't, don't tell itanything and let it cover it.
And I can say that despite it goingprobably above the high target that
I really want to stay under postmeal, having not entered anything
at all, it does do a good job.
(24:42):
I've not gone over 180.
It's kept me, for the most part,honestly, like under 160 and has
turned it around and I've not gone low.
Tavia Vital (24:50):
That's pretty phenomenal.
Kathryn Alvarez (24:51):
Yeah.
Dana Roseman (24:52):
Which is just magical.
Yeah.
Yeah,
Jennifer Smith (24:54):
it is.
So if I had looser targets on the topend, maybe I would do that more often.
Tavia Vital (25:00):
If you're gonna transition to do that more, then you might
strengthen something to catch it.
Dana Roseman (25:05):
Mm-hmm.
Tavia Vital (25:06):
That's something else you could do.
So for me, I'm an enter also 'causeI, I think most of us have had,
whenever you get diagnosed withdiabetes, I was pre carb counting.
That's how long I've had diabetes,but since carb counting was a thing,
it's just, it's been, it's ingrained.
Dana Roseman (25:21):
Yeah.
I mean you look at a foodand you think of the carbs.
That's just what I do.
Yeah.
Tavia Vital (25:26):
And so the only times I haven't is once or twice I've been busy
and I intended to bolus, but didn'tyet because I could see it was coming
down and so I thought, well, I'll dothis in a little bit and then I like
get on a client visit and my glucosewas rising and then Trio fixed it
without anything untoward happening.
And I thought, okay, well that wasn'tthe worst thing that could have happened.
That's pretty nice.
(25:47):
And then a couple of times I tried itafter Theresa's nudge, like, really?
You could.
And I found that I, it can handle,for me anyway, the things I threw at
it that are 15 to 20 grams of carb.
Dana Roseman (25:59):
Sure.
Jennifer Smith (25:59):
Not terribly big.
Dana Roseman (26:00):
Yeah.
Yeah.
Tavia Vital (26:01):
Without going above 140.
If I'm starting off at like 90or a hundred, it just does it.
Dana Roseman (26:07):
Yeah.
But I think that reminds me ofsomething we haven't talked about
yet, which is that cone of certainty.
I just, I love it.
Love that.
Tavia Vital (26:14):
A cone of uncertainty.
Kathryn Alvarez (26:16):
Yeah.
I love it.
Actually had someone tell me thatthey didn't like that recently.
So did you know that'ssomething you can change?
Dana Roseman (26:23):
Yeah.
Yeah, of course you can.
Right?
Because it's trio.
Jennifer Smith (26:26):
Yeah.
Tavia Vital (26:27):
Yeah.
I like it because it gives a goodpictorial of the reality of every
moment that you make a decision.
Dana Roseman (26:33):
Right.
Tavia Vital (26:33):
So you can spend 20 minutes making the best decision you could
possibly measure and weigh and calculate,
Jennifer Smith (26:39):
and there's still,
Tavia Vital (26:39):
in reality, your glucose could go this way,
that way, or head straight.
And so you do the best youcan with what you have.
You have your settings reignedin, and then let trio accommodate
by reducing or adding so thatyour glucose is more stable.
And let go of that mind gymnasticsthing that we've been trained
to do to try to make it allwork out perfectly all the time.
Dana Roseman (27:01):
Right.
Tavia Vital (27:01):
You do it
Dana Roseman (27:02):
because we know it's not gonna go to a specific number, right?
That's just not how diabetes works.
And so I, I just love that.
Jennifer Smith (27:10):
I think what it's reminded me of since, and originally we all really
disliked the multiple dotted lines.
All speakers (27:17):
Yes, yes.
Jennifer Smith (27:18):
In the original, right, where there was no cone of uncertainty
i've enjoyed having it,as you said, in a way.
But I think of it differently in thatwe can't all always, a hundred percent
have a plan for what's coming in the nexthour or two hours, four hours, whatever.
And so it gives the idea that allplans considered, I'm expecting
(27:40):
to probably be in the midpointof that cone of uncertainty.
Dana Roseman (27:43):
Right.
Jennifer Smith (27:44):
But trio is also expecting something could change and
it's giving you this wide range tobe able to tell you, you know what,
but life, we have a plaque in ourkitchen that says Life happens here.
Dana Roseman (27:57):
Yeah.
Jennifer Smith (27:58):
And it's a hundred percent the truth.
You could plan your life to a T andthere's always going to be something
that changes and shifts, and that's whatthat cone reminds me of is that Trio
is here to catch, within that, for me.
Tavia Vital (28:14):
I do like it.
Also, I use it for the predictabilityof, with my slower digestion, if
I'm eating a meal that I know isnot just gonna hit right away, I
can change the dose recommended.
So if I've already said I'm gonnahit reduce bolus button, and then
the cone of uncertainty is showingme that I'm at most likely to top out
at some number, that's way too low.
And most of the cone is downin the low flat line, like
Dana Roseman (28:36):
right,
Tavia Vital (28:36):
not aiming for life, right?
I could back off the dose furtherand it will show me in a modified
view of what it predicts.
And I can think about what Iknow, like was I just exercising?
Am I about to?
Is my prediction of that food really gonnamatch what this is predicting or not?
And I can go ahead and I can fiddlewith that dose a little bit to ensure
I have much less chance of having apost-meal hypo, which I feel are some
(28:59):
of the worst because you have bolusonboard, you have not yet digested,
and you might have a full stomach.
And so then getting the treatment in
Dana Roseman (29:07):
and you're full
Tavia Vital (29:08):
and you're, and you're full, right?
Yeah.
So inconvenient.
Dana Roseman (29:12):
Yeah,
Tavia Vital (29:12):
somewhat scary sometimes.
I mean, we'd be talking little doseswith reduced bolus, but, but still
it's just, those are one of thebiggest annoyances to me anyway.
I love that.
It's so helpful for me to be ableto just go, okay, the reduced bolus
still heads me like, looks like apretty good chance of a big, bad drop.
I don't want that.
I'll cut that in half.
How does that do?
And I'm not doing math, I'm just, well,I'm cutting in half, but I'm not like.
(29:35):
Let me do 30% less.
Let me do 18.6.
It's just cutting the dosein half until the cone looks
reasonable and I move forward.
Dana Roseman (29:42):
Right.
Tavia Vital (29:42):
And I can do that so quickly.
And I love that because obviously weall are thinkers with our doses, right?
And so the amount of, the amount ofeffort and the amount of less complex
math I'm having to do, I love it
Jennifer Smith (29:56):
better.
Tavia Vital (29:57):
Yeah.
Kathryn Alvarez (29:57):
Yes.
Yeah.
I think another great questionfor all of us to go over is
what we're choosing to use.
Like are you guys runningdefault auto sends?
Are you running log orare you running sigmoid?
Good question.
Yeah.
Tavia Vital (30:10):
What are you doing, kathryn?
Kathryn Alvarez (30:11):
Sigmoid.
Tavia Vital (30:13):
Sigma too.
Dana Roseman (30:13):
I haven't moved over to that just yet, but it's on the todo
list to kind of play around with that.
I just kind of stayed, tried and true.
Mostly defaults, except, you know,a lot of the adjustments, you know,
depending on different days, differentactivities, different, you know,
Tavia Vital (30:29):
I think that's kind of
Jennifer Smith (30:30):
right there with you, Dana.
I, I also have not switchedover to the sigmoid yet, but I
have a lot of the adjustments,
Dana Roseman (30:38):
a lot
Jennifer Smith (30:38):
as preset with differences in the SMBs and
Dana Roseman (30:42):
yes,
Jennifer Smith (30:42):
whether it's on or off and the percents and even target
adjustments and things that I haveagain named for certain scenarios.
So yeah, I haven't switched over yet.
Tavia Vital (30:51):
I think I what I think sigmoid is helping with theoretically.
Is it true or is that just my feeling?
I don't know.
I should have you guys look at my dataand we should compare notes on calendars
to see if you think the same thing I do.
I think sigmoid for me, helpsminimize the difference in
my glucose, um, for ovulation
and when I would have a period day, Idon't feel like I have to put overrides
(31:14):
on to help conquer the insulin resistance.
And I don't have to backthe doses off as often.
I still have to sometimes for thefirst, like one or two days with an
override, but I don't feel like, Ifeel like it handles that better and I
feel like it handles the certain sitesjust aren't as efficient as others.
Where I'm not feeling likeI have to chase myself with
(31:34):
adjusting to settings as often.
So that's my, that's my 2 centsfor my N of one with sigmoid.
Kathryn Alvarez (31:41):
Right.
I like that Sigmoid doesn't use totaldaily dose as much within its calculation.
I think that's a big help for meand for a lot of the littles that
I work with, I'm having them runsigmoid as well because of it.
Dana Roseman (31:53):
That makes sense.
Yeah, that makes sense.
Kathryn Alvarez (31:56):
And yeah, just like Tavia, I, like I literally in my
adjustment section, I went to showsomeone the other day and I was like,
you know, this is really shocking.
I don't have a single one in there.
Tavia Vital (32:06):
Me too.
Dana Roseman (32:06):
Oh my gosh.
I've got like a chooseyour own adventure options.
Jennifer Smith (32:10):
Right?
I know.
I've got like so many of them.
Kathryn Alvarez (32:12):
I know.
I was like
Tavia Vital (32:13):
basics in there.
Kathryn Alvarez (32:15):
I mean that just,
yeah.
I'm just
Dana Roseman (32:18):
that that's kind of amazing.
That isn't amazing.
Kathryn Alvarez (32:20):
I know.
Yeah.
I'm walking greatly, riding the bike.
Jennifer Smith (32:23):
It's the value of what you're saying, Kathryn, is that
with sigmoid enabled, you feel likeit does a good enough job not really
even having to have adjustments set up.
And I know, I mean, you exercise,you have a busy schedule.
You also work with little kids outside ofwhat you do, you know, with Integrated,
so you've got a lot of stuff going on too.
(32:44):
In which case I'd probablyhave about 10 more adjustments.
Kathryn Alvarez (32:48):
Like it's, it really is, it's incredible that I just
don't, I don't have to do anything.
Yeah.
And I mean, my time in range, likeif I wanted to really take it to
the next level, then yeah, I wouldprobably put some more adjustments in.
But like if you look at my stats.
And things have been just so wild,as you guys know, with my life
recently, but yes, for the month,um, 70 to 140 time in range is 83.7.
Dana Roseman (33:14):
I mean, yeah.
That's amazing.
Jennifer Smith (33:15):
That's awesome.
Dana Roseman (33:17):
Amazing.
Tavia Vital (33:18):
What, this is my month, 63 to 180 range, 94.9.
63 to 140 is, uh, 67.3.
Is that say 67?
I'm reading it backwards.
67.3. Below 63 is 0.6, and averageglucose is about 125, and that is me.
Kathryn Alvarez (33:36):
So good
Tavia Vital (33:38):
and underdosing, and.
All the things that areeating pizza a lot because
Jennifer Smith (33:43):
normal things.
Dana Roseman (33:45):
Because it's summer.
Kathryn Alvarez (33:47):
Yeah.
Yeah.
It's amazing.
Dana Roseman (33:49):
Well, I think we'll have to go in a deep dive another time with more
of the options that we're doing on Trio.
'cause it, I think we're allhaving great success and definitely
still learning from each other.
Jennifer Smith (33:58):
And as things get developed more and change, but we will
have more of our trio discussions.
We'll have to remember towear our trio shirts then
Dana Roseman (34:05):
next time.
For sure.
All in purple.
Kathryn Alvarez (34:07):
Yeah.
Jennifer Smith (34:07):
Yep.
Awesome.
Kathryn Alvarez (34:09):
Love it.
Alright.
Thank you for joining ustoday for the podcast.
Myself, Tavia.
Jenny and Dana all shared our experiencesusing trio, the latest version.
So we all got to beta test and arenow running the latest version of Dev.
We talk about the differentfunctionalities that we're each
(34:30):
utilizing, why we like some ofthe different functionalities.
What it took for us to dial some of thethings in and how we all are learning
on our own and, and still in a state oflearning this beautiful, lovely system
that we have the option to build and use
thanks to the open source community.
Gary Scheiner (34:52):
Thanks for tuning into Think Like A Pancreas, The podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a Pancreas-- the podcast isbrought to you by Integrated Diabetes
Services where experience meets expertise,passion meets compassion, and diabetes
(35:12):
care is personal because we live it too.
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-carestrategies, the latest tech,
sports, and exercise, weight losstype one pregnancy and emotional
(35:33):
wellbeing, we've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas--the podcast, i'm Gary Scheiner, wishing
(35:56):
you a fantastic week ahead and don'tforget to think like a pancreas.
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