June 17, 2025 • 47 mins
Episode Summary
In Episode 39 of Think Like a Pancreas—The Podcast, host Kathyrn Alvarez speaks with Austin Sympson who shares his journey of living with type 1diabetes while pursuing a PhD and working in the pharmaceutical industry. He discusses the challenges of managing diabetes alongside his busy life, his goals for family planning, and his transition to using open-source Android APS for insulin delivery.
Through this conversation, listeners will uncover how Austin balances academic pursuits, a professional career, and an active lifestyle, all while managing diabetes with cutting-edge technology.
Discover actionable tips, personal anecdotes, and valuable insights into diabetes management, family planning, and embracing open-source innovation for better glucose control.
What you’ll learn:- Why Austin switched from the Tandem t-SlimX2 insulin pump to Android APS and the game-changing features of this open-source technology.
- How Austin manages his busy schedule as a PhD student, researcher, cyclist, and husband while keeping his glucose levels in check.
- The flexibility and customization options offered by Android APS, including micro boluses and temporary targets.
- How Austin’s journey to lower his A1C impacts family planning and his approach to long-term health.
- How to navigate cultural differences in food, and staying active abroad.
- How the Android APS community empowers users to build confidence and overcome challenges in adopting new systems.
00:18 Welcome and Disclaimer
00:58 Meet Austin Sympson-- PhD student, cyclist, pharmaceutical researcher, and person with diabetes
05:12 Why Austin chose to work with Integrated Diabetes Services
10:14 What made Austin decide to use Android APS over his traditional insulin pump
15:19 Why Austin does NOT use a GLP-1 to help manage his diabetes
19:45 Understanding the AAPS Objectives
27:35 Did you ever have "buyers regret" about moving to an open source system?
30:04 Continuous Glucose Monitors and Open Source Systems
33:36 The Insurance benefits of AAPS
36:35 Kathryn's early thoughts on the Twist insulin pump
39:44 Navigating carb counts in foreign countries
42:41 The AAPS community is a helpful, global community
Links:
https://www.type1university.com/diy-open-source-automated-insulin-delivery-aid-systems/
https://loopkit.github.io/loopdocs/
http://integrateddiabetes.com/diy-services-support/
DisclaimerThe information contained in this program is based on the experience and opinions of the Integrated Diabetes Services clinical team. Please discuss any changes to your treatment plan with your personal healthcare provider before implementing.
Don't forget!✔️If you enjoyed today's episode, don't forget to like, follow or subscribe on your favorite podcast app.
✔️You can start working with the Integrated Diabetes Services Team by visiting https://integrateddiabetes.com/how-to-start-the-process/
✔️AND...Don’t let the complexity of open-source systems deter you from experiencing their benefits. Reach out to Integrated Diabetes Services for expert coaching and start your journey toward better diabetes management today!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary (00:16):
Welcome to Think Like a Pancreas, the podcast where our goal is to keep
you informed, inspired, and a littleentertained 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
(00:37):
healthcare provider before implementing.
Kathryn (00:39):
Hello everyone.
I am Kathryn Alvarez and I'llbe hosting the podcast today.
I have an awesome guest with me.
His name is Austin.
I'm gonna get to know him today and kindof his journey with Type one Diabetes.
He is a very busy guy.
There's gonna be a lotfor us to talk about.
So Austin, can you tell everyonejust a little bit about yourself
(01:03):
when were you diagnosed?
Some information?
Austin (01:05):
Yeah, sure.
So I'm Austin.
I was diagnosed at eight yearsold in October of, think in
the early two thousands thatI'd have to go find the date.
But I've been diabetic since I was eight.
I'm now, uh, 27.
So, 20 years as a, as a type one diabetic.
Yeah.
And what, what else canI tell you about myself?
What else do you wanna know?
Kathryn (01:26):
What are you studying?
Um, tell everyone you're going for Yeah.
PhD, which is just impressive in itself.
Austin (01:32):
Yeah.
So I'm doing like a bunch ofdifferent things at the same time.
So I'm doing my PhD in chemicalengineering studying stem cell
differentiation using electricalstimulation at Iowa State University.
Man, that's a mouthful.
There's always like a, a crazytitle for every university.
Um, so I'm about two years into that.
And then in addition, I also am anengineering specialist for Merck Animal
(01:56):
Health making swine influenza vaccines.
So I'm doing both at the same time.
Kathryn (02:02):
Do you know when you're expected to finish your PhD?
Austin (02:04):
I'm hoping in the next two years, and then in my professional
role, I can transition to somethingthat's more R and D based instead
of being more applied engineering.
So that's kind of the outlook right now.
I think with any PhD it's a little,it's always kind of uncertain 'cause
it's based on how your work progresses.
So, there's not a perfectlydefined timeline, but yeah,
(02:25):
that's what I'm hoping for.
Kathryn (02:26):
Yeah.
That's really awesome.
Did you do your undergradat Iowa State as well?
Austin (02:31):
Yeah, so my, my kind of education arc was that I went to high school
in Northern Illinois and then went tomy undergraduate degree here at Iowa
State, also in chemical engineering.
After I got done was towards the tailend of COVID, I went into industry
and then worked for about three years.
And then after that decided I wantedto get some more credentials and
(02:53):
get some more education, and itjust kind of worked out that I was
able to do both at the same time.
So, yeah.
And then went back and started doingmy PhD about two and a half years ago.
Kathryn (03:04):
Awesome.
And you also, while going foryour PhD, also live with type one
diabetes and you have a wife andyou have a cat with diabetes now.
Yeah.
Mochi
And cycle.
So, how challenging has it beenwith just everything that you
do to manage your diabetes?
Austin (03:25):
Yeah, so like you said, I have, I got married about a year
ago, uh, now, and also riding andracing my bike and there's, beyond
the diabetes side, just balancing allthe stuff together and carving out
time for everything is hard in itself.
Throwing diabetes into the mixmakes it like you have to make
more decisions more consistently.
(03:46):
And like all of the other things,you, you can't just stop and take
a break whenever you want to.
There's no, um, well, I have PTO withthe one job, but you can't just walk
away from school for a little while orlike go take a vacation or something.
And I mean, it's just like diabetes too.
You can never, you know, say I'm tired,I kind of just wanna take a break.
So putting all those things on top ofeach other makes it really, really hard.
(04:09):
And I think we'll get into this too, butthat's one of the reasons that I went
to a different insulin pump system, wasto try and mitigate how much attention
I have to give on a daily basis towardsmanaging diabetes and still staying
in good ranges and in good control.
The, the most complicated thingis the fact that I have to bring
extra supplies all the time.
(04:31):
'cause I'm at like differentlocations everywhere.
So I'm like packing stuff with me andbringing coolers for insulin and things.
And it was not near thatcomplicated when I was just working.
Uh, I used to keep a single vialof insulin at work in a, in like
a storage fridge, whatever, andsome stuff in a drawer at a desk.
And it was like, we're good,but now I have like four
(04:52):
different bags going everywhere.
It makes it a littlebit more difficult, so
Kathryn (04:55):
yeah, a little
Austin (04:56):
more complicated.
Yeah.
Kathryn (04:58):
When you're gonna go home and stuff, but at least you have these bags
that are prepared and yeah, you grab them.
Austin (05:06):
Yeah.
Kathryn (05:06):
Let's talk about your transition and just for our listeners.
So Austin, you came to IDS and whatdo you remember what your main goal
was when you came and we first met?
Austin (05:17):
Yeah, so my first goal was, uh, my wife and I are sort of doing
family planning and we're trying tomitigate the effect that diabetes can
have on our ability to have children.
So the primary goal was to lower my A1C,um, and be as healthy as possible when
we're in the stage of family planning.
And then in addition to that, mypersonal goal was that I would really,
(05:41):
really love to get down to a 6.0 A1C.
It's kind of like a big, sortof starry marker for success or
something, uh, that I've beenlooking for over the past 19 years.
So it's taken me a really long time toget my A1C down to where it is right now.
And as of yesterday, it's at 6.4.
And so I thought additionalcoaching would help.
(06:02):
And then on top of that, my wife wasalso pushing me to go do it as well.
I think when you do diabetes for like15 years, you get really comfortable
in whatever method you've, you'veadopted to try and manage it.
So then changing stuff getsmore and more difficult.
So I was looking for fresh perspective,lower A1C, better outcomes and
(06:24):
a different knowledge base tohelp me find all of those things.
So
Kathryn (06:28):
man, and so good, and I mean, a lot of the focus from a family planning
standpoint is on women, but we see moreand more how important it is for men too.
So, yeah, it's so good that you'retaking that step, and hopefully
that can be a little bit of aninspiration for more guys, too.
You were using the Tandem andwith cycling, or, I mean, just
(06:51):
in general, what do you feel likethe Tandem wasn't able to achieve?
Austin (06:56):
I ride my bike about, hmm 13, 14 hours a week.
And I race like road bikes, kind of likethe Tour de France, but the United States
doesn't have a scene that looks like that.
It looks a little bit different,but you could think of it that way.
So amateur cycling of course,and all of those sports take a
lot of time and there is like anaerobic and an anaerobic component.
(07:19):
So different ways of using energywith different workout types and the
Tandem insulin pump for me at the time.
Had control IQ and that sort ofcontrol system had a lot of buffers
in it for safety, uh, for justthe design of the insulin pump.
Kathryn (07:38):
Mm-hmm.
Austin (07:39):
Um, but those buffers became more of a constraint to
me managing my blood sugar ratherthan, um, you know, a benefit.
For instance, I would, I would goand set up a workout and then go
do the workout and immediately havelow blood sugars, even though I'd
have exercise mode on or something.
And the default turned into justtaking my insulin pump off and
(08:01):
getting no insulin until I sawmy blood sugar kind of flat line.
And then it would slowlykind of start to rise.
'cause now I have nomore insulin on board.
And then I'd have to manually plug it backin and sort of time it for some of these
workouts to go over like two hours long.
These bike rides thatare more than two hours.
That was really complicated and itrequired me to pay attention a lot.
(08:23):
I think there's been some updatesto the Tandem insulin pump, but
at the time there was nothing thatcould manage my blood sugar in an
exercise that worked effectively.
Kathryn (08:33):
Yeah, I mean we have, we, we do have Control IQ plus now, which is
really helpful for a lot of people.
But yeah, at the time we had to likecreate different profiles in order
to, because exercise mode, you know,wasn't, wasn't doing the trick.
So creating these differentprofiles with significantly higher
correction factor to try and preventsome of that auto bolus insulin.
(08:57):
But I was like, there'sjust, there's better things.
Anyone that knows me knows that I'ma huge fan of all things open source.
But for you, you're one of therare people in the United States
that use an Android phone.
Austin (09:14):
Yeah, that's a rarity in, in the US
Kathryn (09:17):
It really is.
I used to recommend Android APSA lot toparents that had little kids with type
one diabetes because it was the firstwhere you could do remote features.
So that's where majority of thepeople that come to IDS are still
from the United States, but we,we do have some people overseas.
Um, just not as, as common.
(09:38):
Well, that was like my main exposureto AAPS, and of course I ran it
because I needed to better assistthese people that I was helping with.
Then I was like, Austin,you have the Android phone.
And so AAPS is incredible.
It's, I think it's always onestep ahead of everything else.
It has by far the most compatibilitywith the, with pumps and CGMs out
(10:02):
there, and the features are justalways so, so far in advance.
So what do you think was like the mainsell for AAPS to get you to take the leap?
Austin (10:13):
Yeah.
I think for me it was when I lookedat the, the micro boluses or the SMBs.
Kathryn (10:20):
Yep.
Austin (10:21):
One of my biggest problems throughout all the time I've
had diabetes is rememberingto get insulin before a meal.
And you'd think, you'd thinkthat like 19 years of doing it,
it's, it should be automatic.
There's this tagline that sits in mymind of when I first got diagnosed of a
doctor that told me eventually diabeteswould be like brushing your teeth.
'cause they were trying to be likereassuring and go, it'll get easier
(10:45):
sort of attitude and yeah, it's gotteneasier, but I still remember that and go,
it's nothing like brushing your teeth.
It's nothing like that.
It'll never be that easy.
Kathryn (10:53):
That's how I look at it.
Like it does feel like that for me.
Like I just feel like, like,yeah, life with type one diabetes.
I don't.
It doesn't bother me at all.
It's more the, uh, like prescriptionmanagement and trying to
figure out insurance and havingto do prior authorizations.
That is what gets me.
Austin (11:12):
I think I'm getting closer and this was one step closer, and
eventually I hope that, uh, I getthere, but it always has still, I
don't know it having to put likeOmniPods on still and prep stuff, bring
things with and make sure I remember.
Everything that I needto be successful with it.
(11:33):
Uh,
Kathryn (11:33):
to not die.
Austin (11:34):
To not die.
Putting it very frankly, yeah, Uhhuh.
To live on a regular basis.
It's a hard thing to get across to peoplewho don't have it or don't have like
somebody really close to them who they'vealso had to give them like whatever
their snack is for a low blood sugar.
But going back to your originalquestion, my problem was that I would,
I would get my insulin for every meal.
(11:57):
It just might be a few minutes behind thefirst bite because I'm excited to eat.
I'm like, I wanna sit down.
I'm really hungry.
I'm after whatever activities.
I did activity my whole life.
It was like, oh my God, I'm starving.
I want to go eat, starteating, and then go, oh crap.
I need to, get insulinfor this whole meal.
So the mixture of SMBs haskind of felt like a safety net.
(12:19):
I don't necessarily wanna relyon it, but having it for the,
Kathryn (12:24):
did you?
Yeah, yeah, yeah.
And you the big, big one.
But yeah.
Austin (12:29):
Yeah.
So that's been really, really great.
Then also the SMBs at nighttime.
Now that we've sort of gotten my profiletuned, I don't think I've had blood
sugars this sort of stable overnight inyears, and we're like within, I can be
within like 10 milligrams per deciliterof target for like a nine hour period
(12:50):
just sleeping and it feels amazing.
So that's really, really great.
But yeah, that's thecoolest tool in my mind.
And then the flexibility that that hasaround exercise with temporary targets and
adjustments to your profile on the fly todo percentages, but still keep the same
sort of profile and not have set like atemp target over just a defined period.
(13:11):
You can kind of edit based onthe day a little bit quicker
than I could on an insulin pump.
Yeah, that feels great.
Kathryn (13:17):
Yeah, and you kind of have like these scenarios and rules
you can set up too, which a lotof people like that are on AAPS.
They never go through all ofthe objectives and with the
last objective, it gives you theability to set up like scenarios.
If you get to a particular GPSlocation, then turn on like
(13:38):
switch to exercise profile, right?
Which I think is really helpfulbecause like you said, you know,
you get excited to eat, but I meanjust we're naturally forgetful.
If you're gonna go and cycle for twohours at like a particular location
and you forget to switch yourprofile, at least you can have it,
like automatically switch it for you.
Austin (13:58):
Sure.
Or like you're the person that goesand does weightlifting at the same gym.
You've had the same gym membershipfor five years to the same spot.
Yep.
Every time you show up there, it'sjust gonna solve your problem for you
without even having to do anything.
Kathryn (14:10):
Yeah.
You, yeah, it's just all set.
So it's like, it's really streamliningand just making everything easier.
You have to think about so much less,which is so amazing and so many people on
open source systems they're doing, they'rejust completely not announcing meals and
some people like they'll come frustrated.
You do announce your meals still.
(14:31):
Yeah, at least for the most part.
And the people that have like, youknow, very little movement in their
blood sugars for meal 'cause wedo more rapidly digest this food.
And if we're eating something that isnot low on the glycemic index, it's gonna
impact our blood sugar really quickly.
So unless you're on some kind of likeadjunct medication, not announcing
would cause a pretty high postprandialor post-meal blood sugar rise.
(14:55):
But a lot of people have movedto take something like a GLP-1.
So you know you have common pic andum, you know, those ozempic is the one
that people are most familiar with.
Austin (15:06):
Yeah.
Kathryn (15:06):
And um, since that slows down the impact of the food or on
our blood sugar at least then, um,I can create those smooth outcomes.
Is there any reason why you'vechosen not to take a GLP-1?
Austin (15:19):
Good question.
Yeah.
So I'm not, I'm not particularlyagainst taking GLP-1s.
For my own reasoning thatI haven't taken one yet.
I would put it down to like, I'ma, I'm a researcher and I'm also in
pharmaceuticals, and I look at dataand I don't doubt that it works,
but the current usage case has beenabout a few years and my approach to,
(15:45):
I don't know, the, so the outcomesof like GLP-1s is slower digestion.
You could have weight loss.
There's a number of other benefitsthat people have reported with food
noise and a number of those things Idon't think I struggle with right now.
And then in addition to that, if I'musing a GLP-1, I'm worried it might mask
the inadequacies of the way I manage mydiabetes and the way that I build habits
(16:10):
in my life outside of leaning on somethingto help me achieve the same goal.
And I don't think it's bad to useone thing or the other, but for me, I
would rather wait and see what happensin long-term cases and long-term
use because I'm not on the, "I needto use this. I have a high risk
(16:31):
situation. That needs to be solved inorder to ensure my long-term health."
I think for the most part, when I goback to all my labs and look at my
weight, my lifestyle, and my currentlevels for diabetes, I think I'm
in a place where I'm pretty happy.
And of course I could alwaysget better, but I'm chasing that
through different avenues first.
Kathryn (16:52):
Yeah, and I mean sometimes if you're, if you're cycling and potentially
having like low treatments that impactyour blood sugar or pull you up as
quickly could be kind of problematic.
Austin (17:05):
And I mean, another like aspect of that is that
when I eat riding on the bike.
I eat the most sugary,like, concentrated stuff.
And that's what the sports gels andgel blocks and high carb mixes and
bottles and things are meant to do isto absorb as fast as possible 'cause
you're burning through stuff right away.
(17:25):
I, I would love, I want my digestion tobe as quick as possible and to process
as many carbs as I possibly can soI can feel better later in a, in a.
Kathryn (17:35):
And as an athlete, you know, you need to consume more calories as well.
So, and protein is incrediblyimportant for muscle recovery.
It, it would make it moredifficult to consume what you
would require as an athlete.
Austin (17:49):
Yeah.
Kathryn (17:50):
GLP-1 as as well.
And I think a lot of people, you know,they are just looking for more of
that long-term outcome and researchto make the next step and take it.
Um, but for other people, I mean,as people with type one, we don't
produce a hormone that slows downgastric emptying and is also a
satiety hormone called amylin.
(18:11):
And so as people with type one, we dotend to feel a bit hungrier and see the
impact of carbohydrate a bit quicker.
So bolus timing is soincredibly important.
There's definitely people that thisjust gonna be so incredibly helpful for.
And, and it's great, but I don't, I'mnot, I'm not, I don't think athletes
(18:31):
are, are in that group at this point.
Austin (18:33):
I think there's a use case for every single thing that's made out there.
And I think the hardest part is gettingthrough who it's appropriate for and at
what time and yeah, when, when to use it.
So I'm not hesitant about drugs, that'swhy I work in the pharmaceutical industry.
I know people spend their whole livescoming up with stuff like this for the
(18:54):
sake of helping people, and it alwaysstarts in an R&D lab because somebody
has a good idea for how to help aperson and then it gets monetized later
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And now back to our program.
Kathryn (19:41):
Okay, so now let's shift a little bit.
I'm gonna talk about the objectivesbecause this is unique to AAPS and I guess
the build a little bit too 'cause you wereone of my people... usually everyone's
like, oh, I'm, so, the build scares me.
I don't know about opensource because of the build.
So I usually help peoplethrough the build.
But you just came back andyou're like, yeah, it's built,
(20:02):
going through these objectives.
Austin (20:04):
Right.
Kathryn (20:04):
So tell me about it.
Like how did you feel, uh,going through the build?
And, and then, then we'll talkabout the objectives as well.
Austin (20:14):
Sure.
So I'll say the build scared me tooinitially, and then I started doing
reading, like in my PhD program.
Whenever you need to do something,sometimes there's people that teach you
how to do it, but there's a lot of caseswhere you just have to figure it out.
So they turn you loose, go read somedocuments, figure out how to do a
thing, whether it's like 3D printingor like mixing new chemicals and
making some new solution, whatever.
(20:35):
So that was my approachto the Android APS build.
But with that said, the documentsthat they have available to
explain how to do the build itselfare relatively straightforward.
The steps might look complicated,but if you follow each individual
step and do them in sequence, thenyou shouldn't have a problem building
it and getting the right software.
(20:56):
So, they have a whole documents glossarycalled the docs, uh, Android, AAPS.
Everyone says "Read the docs.
Read the docs.
Read the docs."
People before you aska question, go read it.
It's probably in there.
Kathryn (21:10):
It's super cool too, which is so great.
I mean, 'cause I don't haveAAPS in front of me anymore.
So you can just, yeah, go in there and,and search what you're looking for.
Austin (21:19):
It's great.
They have so much detailabout, just about everything
android APS, and then they alsohave links, like outside links.
So if you wanted to know where the ideacame from for SMBs or, how much you
should get for SMBs or how you calculateyour own SMBs, there's always some
extra source for where stuff came from.
You can get as deep an explanationabout everything as you want.
(21:42):
So yeah, the components I needed tobuild it included my Apple computer.
I needed something called HomeBrew, which is a software writer,
which you can get off the internet.
It's free, and it's been used forlike years and years and years
for not just Android APS, but tonsof other stuff for writing code.
There's a file online on awebsite called GitHub, which gives
(22:04):
you all of the code you need.
You don't have to build anything,you don't have to write any code,
you just have to run it, and ittakes you through how to run it.
And then the very last thing youneed is Android Studio, which is
the application that lets you buildapps for Android phones and that's
what packages the whole thing.
Kathryn (22:21):
Yeah.
And everything is free with AAPS and youdo not like our, um, iPhone based things,
we do not require like no Apple developer.
So you don't have that $99 ayear, um, which is just great.
Austin (22:36):
Yeah, it's a really low barrier of entry in terms of cost, and once you get
the app set up on your phone, after youget past that and it's set up correctly,
the objectives will kind of take careof the rest to verify that the app is
working correctly as you work through it.
And I don't know about other open sourcesystems 'cause Android APS is the only
(22:59):
thing I've used, but can you run anyof the other systems on a virtual pump?
Kathryn (23:03):
Yes.
Austin (23:03):
Okay.
Yeah, that would make sense.
I think that was a great featureto start feeding it glucose data
and it let me double check thatmy sensor's working first and then
make fake corrections on things and
Kathryn (23:15):
mm-hmm.
Austin (23:16):
Yeah, it's just, that just made so much sense that they
included a system like that too.
So
Kathryn (23:20):
Yeah, you get to see like how it's functioning
Austin (23:22):
Yeah.
Kathryn (23:23):
Beforehand,
Austin (23:24):
right, exactly.
Kathryn (23:25):
Really, yeah, you can... so the build is great, you know, you can do it
on any type of computer, which is so good.
Um, which you can withLoop and Trio now as well.
Now the objectives.
One more thing I wanted tosay about the build, actually.
The build, I feel like is, it isdefinitely a, probably the number
one reason why people will choosenot to go like the open source route.
(23:49):
And the online communityis so incredibly helpful.
I mean, I know I just watchedso many people on there that
somebody posts and then somebodyin the community offers to help.
So these volunteers like arejust absolutely incredible.
Austin (24:05):
Yeah, right.
Kathryn (24:06):
It's amazing.
All they do too, to helppeople get through it.
And I mean, I feel like also it's kindof like my comparison I always give to
people is it's kind of like following theinstructions to put together furniture.
Putting together furniture is reallystressful, but you know, you'll probably
eventually get the end product eventhough you have no idea what you did.
Yeah.
But then I started putting togethersome furniture as I got my first
(24:29):
house and that did not go well.
So I take it back and I thinkthat building is easier than
putting together furniture
Austin (24:36):
really good at diabetes, not so great at building IKEA furniture.
Kathryn (24:40):
Yeah, definitely.
Okay, so the objectives, what wereyour thoughts going through those?
Did you have any challenges whenyou were to the point, what is it?
Objective three?
Where it's asking you toessentially prove your knowledge?
Or did you have trouble like kindof getting through any of them?
Austin (25:00):
Yeah, the prove your knowledge was hard.
Which is, at first I was like reallyfrustrated because you know, you get
handed any insulin pump through acompany and they have you train with
somebody, either a qualified educatoror somebody's like a rep for that pump,
and I was like, man, I don't wanna wait.
Just give me all, just open everything up.
(25:21):
Let's, let me just.
I'll just figure it out.
And then I thought about it a littlelonger and I was like, man, it's a
really good thing that they're checkingpeople's knowledge for an open source
platform to verify everybody knowsexactly what's going on the whole time.
Yeah.
The, the questions for theknowledge check are not easy.
And they also make you go read the docs.
Kathryn (25:40):
Mm-hmm.
Austin (25:40):
Read the docs in detail so you can't just like skim it.
You know, like prepare for yourFriday quiz or whatever in grade
school and read something real quick.
No, you, you have to know theinformation, and you have to know
it intimately to pass the questions.
Kathryn (25:55):
Mm-hmm.
Austin (25:56):
Nobody's gonna give you the answer.
That's the one thing thecommunity is not gonna do.
They're not gonna giveyou hints for the answer.
It's if you wanna use the system,you gotta get past that objective
and understand everything.
So,
Kathryn (26:08):
yeah, no, they'll guide you a little bit, like if you look in the
Facebook group, yeah, that's true.
People will kind of give you likesome pointers or where to look, but
yeah, it won't give you the answer,
Austin (26:17):
which is great.
Yeah, so getting through that wasdifficult, but once I was through
that section, after that, it wasjust introducing a complexity layer,
one piece at a time until you hadkind of the most complicated version
of Android APS that you're running.
And I think the very first thingyou do is, is set up your profile
(26:38):
and then afterward you start gettingaccess to stuff like basal suspend.
Which kind of looks like the suspendmode in the Tandem insulin pumps for when
they had first initially introduced that.
Then afterward you move to temptargets, and so you can adjust your
glucose target up and down to sort of,I don't know, take into account like
(26:59):
exercise and different activities.
And then after that, then theystart having like basal adjustments
where it can go higher and lower,and you set thresholds for that
and then make adjustments toyour basal profile if needed.
And then so on and so forth, and youkeep introducing more and more features
and building complexity into the system.
Kathryn (27:16):
Mm-hmm.
Yeah.
That's really great.
And when you were doing that, your timein range was pretty great right off
the bat, but I do think you're probablypaying a little more attention as well,
just kind of starting on a new thing.
Austin (27:30):
Yeah.
Kathryn (27:31):
You know, just starting on a new thing in general can be pretty stressful.
Did you feel like it was the wrongdecision ever to put the Tandem down?
Austin (27:38):
No, I, I don't think so.
It was refreshing to be on a totallynew insulin pump after being on the
same thing for many, many years.
And moreover, switching to anOmnipod was new for me too.
Uh, 'cause it was the first time Ididn't have any tubing on me, and
that was so refreshing that therewere enough upsides that I never felt
like, oh, I made the wrong decision.
(28:00):
It was more just figuring outthe bumps in the road for getting
proficient at using Android APS.
Kathryn (28:06):
Have you ever considered, this is just like a random thing that
I'm now suddenly super interestedin, so since you have the ability.
So with AAPS you can use theEversense, and there's talk
on like Zop chat of using it.
Um, like it'll likely becompatible with Loop as well.
Um, of course Trio I'm sure wouldbe in line for that as as well.
(28:27):
But with Eversense, like, haveyou ever given that any thought?
To potentially try that as your, your CGM?
Austin (28:34):
I haven't, no.
The current CGMs haven'tbothered me so much.
Like I've been using Dexcomsince they were on the G4.
I don't think they called itthe G3 when they came out with
the third one at the time.
Yeah, maybe it was called the G3
Kathryn (28:49):
I know.
Austin (28:49):
I have to think really far back, but I've been using those ones
for years and years since they firstgot approved for pediatrics and
haven't used really anything else.
And those have kept getting betterand better with more wear time
up until like the 10 day period.
And I think now they evenhave the 15 day period.
Mm-hmm.
Which may be a little bit longfor me to keep them actually
(29:12):
stuck on to my, mm-hmm to my body.
I think mine would fall off before I couldactually get all the way out to 15 days.
Kathryn (29:18):
Yeah.
Well, and I mean, when you lookat the data, a significant amount
did not make it to the 15 days.
So
Austin (29:25):
yeah,
Kathryn (29:26):
it is kind of expected.
Austin (29:28):
Yeah.
Kathryn (29:29):
I'd be curious to see what they're gonna do with, if they're
gonna ease up on replacements or,
Austin (29:34):
yeah.
I haven't given the Eversense any thought.
I think it's a nice idea for somepeople the implantable device.
I work on some implantable devices,some stuff related to the eye.
And I think in the, again, in theright use case scenario, I think
it's a really, really great idea.
(29:54):
And for the right patient, Ithink it could work really well.
But yeah, I also don't want to be,like we talked about earlier, I don't
want to be stuck on one technologyfor the sake of being comfortable with
it because until you try somethingelse, I don't know, maybe it is in
fact better to be on something elseand I would feel better about it.
But that one's a, that onefeels like a big commitment.
'cause it's like a six month
Kathryn (30:15):
well
Austin (30:16):
insert.
Kathryn (30:16):
Well, and well now they have the 365, so whole entire year.
Austin (30:21):
For a whole year.
That's crazy.
Kathryn (30:23):
It's different though, because you can just take that top piece off and
then it's just, you know, it's your arm.
Yeah.
And Gary, the boss, my boss has hadone in for just under... he got it
implanted and never got it removed.
So it's been in there for, Idon't even know how many years.
We'll have to ask him.
Austin (30:42):
No, he's had no issues with it being implanted that long?
Kathryn (30:45):
No.
Austin (30:45):
Interesting.
Yeah.
Huh uh, have you tried one before?
Kathryn (30:49):
No, I haven't, but I've had quite a few people ask about it recently because
Dexcom, especially with these, my littles,my littles just have a heck of a time.
Like they are all over the placeand just the sensors are jumpy,
jumping all around, which I'msure you've had jumpy sensors too.
Especially recently, it just seems likesomething's going on with the quality and
(31:14):
we're, we're not having, we're not havingsome great luck with the sensors recently,
but it's especially true for little ones.
Um, and it's like when they sleepis just, you know, they already are
worried, but then they're gettingall of this fake stuff overnight.
Yeah.
Even with like these egg, these eggcrate like covers on the bed and they
like use things to help prevent thecompression and yet-- just can't beat it.
Austin (31:39):
Yeah.
The absolute worst case scenario for mefor sensors is having a compression low
in the middle of the night, treating itwith something and then going back to bed.
And at nighttime I have a slightpreference to run a little bit
higher if I've had low bloodsugars and then keep sleeping.
'cause my sleep feels that important.
Of course, I have like a high threshold.
(32:00):
Anything over like one 90 I'll get alarmsfor, to wake up and do something about it.
But if I, if it's below that, I wouldprefer to keep getting the sleep and
then make the correction in the morning.
But like then I either get woken upagain because I skyrocketed high 'cause
the sensor was wrong and I correctedfor it because being low would be in
the middle of the night is scary enough.
(32:21):
So, yeah.
Yeah, that's a, that's a interestingsolution to the whole thing.
Yeah.
Do you know, is there likescarring for the implant or
does it look relatively clean?
Kathryn (32:31):
It looks clean.
Austin (32:33):
Yeah.
Okay.
Kathryn (32:33):
Yeah, I, I don't know.
I'd have to look more into.
You know, about using the same place?
'cause I'm, I'm not sure about that,but I mean, it is only 18 plus, so not
to be, I don't wanna confuse peopleby talking about the littles, but
yeah, it's, it's just for adult use.
And also the 15 day for Dexcomis also just for adults, 18 plus.
(32:56):
So that won't impact them either.
But yeah, I mean it's, it's definitely,it's gonna be more accurate.
Um, and based off of the scores,um, it shows better accuracy and
then the, just once a year that, Imean, I feel like that really kind
of makes it worth it potentially.
Austin (33:14):
Yeah.
Yeah.
Yeah.
I think this just kinda speaks onthe whole technology development
and how important it was for me todo, to try something new anyway.
Kathryn (33:26):
Mm-hmm.
Austin (33:26):
And even if I'm not committed to it, that's okay.
And I know you mentioned earlierabout the prior authorizations and
insurance related problems and things.
So as a PhD student and workingprofessionally, I was, I have
multiple insurances, which is great.
It also means there's a lot of likeback and forth on who's paying for
what and who's covering what, andif they're covering for whatever.
(33:50):
The switch to Android, androidAPS was by far easier than any
insulin pump I have started on.
'cause I've used Medtronics andI've used Tandem and went back and
forth from them a couple times.
And the OmniPods for me were just apharmacy benefit, and it was about
as simple as getting an order put in.
Had to get some adjustments onthat and a prior authorization so
I could have a shorter wear time.
(34:10):
Uh, on the Omnipod so I could keepgetting them, but other than that,
sent to the pharmacy and done.
That's it.
I had to get the intro kit for theOmnipod dash, but it was really
straightforward once I kind ofgot through the initial phase.
Kathryn (34:25):
Yeah.
Austin (34:26):
And if I ever want to, I can jump ship at any time.
Kathryn (34:30):
True.
Yeah, you no lock in.
Austin (34:33):
So yeah, that.
Is great that I can walk away from it.
Kathryn (34:38):
Well, and I have had a lot of people that, because it's a pharmacy
benefit, um, even if they had likea lock in, um, or you know, their
contract, they could still get the pods.
It's almost like the insurancecompany just didn't realize.
I think it's only ever been once thatlike somebody got caught and they
(34:58):
were like, you have this contract.
But for everybody else didn'trealize and they were able
to get the pods even though.
Did, was your contract endedwhen you, when you did it?
Austin (35:08):
No, I still have a Tandem insulin pump in my closet with
a bucket load of supplies and itis serving as my, as my backup.
But at the same time, I could go trycontrol IQ plus at this point because I
could get the download and, and set it up.
But yeah, as I'm still, I'm reallyenjoying Android APS right now.
(35:28):
'cause like I said, there arefeatures on it that act as a safety
net for when I'm not being the mostattentive to, uh, treating myself.
And the Omnipod flexibility for nothaving tubing has been a big shift for me.
And like I said, because I'm ridingmy bike, having one less thing in
my pockets might not seem like a bigdeal, but having only a cell phone
(35:51):
instead of a cell phone and an insulinpump is also a really big deal.
Yep.
And so then a few weeks ago I wason Justin's podcast and he asked me,
well, if that's the case, then whywouldn't you use like Tandem Mobi, and.
I think Tandem Mobi's cool, but it stillhas tubing and a sleeve and a bunch of
(36:13):
supplies that you have to carry with you.
The Omnipod is so just simplifiedand in one package that, yeah.
Kathryn (36:20):
Well, and you know, there is still some shortcomings of
the control IQ algorithm for you.
Yeah.
Just you can get so muchmore customizable with AAPS.
Austin (36:30):
Yeah, exactly.
Kathryn (36:31):
Yeah.
Austin (36:32):
So, yeah.
What have you heardabout the the Twist pump?
The TidePool pump?
Kathryn (36:37):
Yeah.
So the Twist pump, it's, they compareit to like double stuffed Oreos.
It's a little bit bigger than that.
Okay.
And it's going to, so it's a veryold version of Loop, essentially.
And so it's not at all what peoplewith Loop are used to using the like
(36:58):
interface looks the same, but whenthey go into like the overrides,
they're not gonna be able to customizein all of these different overrides.
So that's like a big, big featurethat people are gonna be disappointed.
And if they were a previous looperadditionally, so there's temp basal
only, there's no automatic dosing, soit's called SMBs with AAPS, and it's
(37:20):
called automatic bolus with loop.
So no automatic bolus,just just temp basal only.
Austin (37:26):
So, so do you think that the Twist would be like a gateway for somebody that
hasn't used open source stuff to startwith that 'cause it's got FDA clearance
and then move to open source when theydecide they want more features or do you
think it'll be open source people whowant FDA company-based support and backing
who will move outta open source to that?
Kathryn (37:49):
I think, I think there'll be a lot of that.
And then I think that when theymake the switch, unfortunately
they might be a bit disappointed.
Austin (37:57):
Hmm.
Kathryn (37:58):
In that decision, and they might kind of wanna go back to open source.
And then I think some other peopleare gonna go on it that wanted
to use open source, but they werelike, you know, didn't have the
ability to build or, you know, theywere, they're scared off from it.
And I think maybe for 'em,it'll be like a gateway.
Austin (38:17):
Yeah,
Kathryn (38:17):
for sure.
Austin (38:18):
Cool.
Kathryn (38:20):
There's so many great people just working for that company, and I think that
hopefully it'll progress pretty quickly.
Yeah.
You know, at this point, I think majorityof people would still choose to go,
you know, on Tandem or another system.
Big reason is, I mean, the Twistpump is, it's not very sleek, kinda,
Austin (38:42):
yeah.
Define sleek.
Kathryn (38:45):
Um, it's like a gray circle.
It kind of reminds me of a hockey puck.
Austin (38:51):
Yeah, that's what I thought too.
Yeah.
Kathryn (38:53):
Yeah.
So,
Austin (38:54):
and it also still has tubing, but it's also a patch pump?
Kathryn (38:57):
Right?
Yeah.
Uh,
Austin (38:59):
like a Mobi, but in the middle, a little bit tube bunk.
Kathryn (39:01):
Yeah.
Okay.
So, uh, yeah.
Yeah, I don't know.
I hope they make some big, somebig updates and lemme see great
things from them-- from Sequel.
But yeah, at this point, notsomething I, personally, I'm gonna
go, but there's definitely a groupof people for every system out there.
So some people are gonna,it's gonna be perfect for 'em.
Austin (39:22):
Yeah, definitely.
Kathryn (39:23):
The other thing I wanted to talk to you about is your
wife is from Germany, right?
So Germany?
Yeah, yeah.
Austin (39:28):
Yep.
From Germany.
That's right.
Kathryn (39:30):
How often do you guys go to Germany?
Austin (39:32):
Well, as much as we can.
Right now we're doing like greencard applications, uh, since we
had just gotten married and I'mdoing my schooling here in the US.
Um, so as soon as we can get thatstuff filed and done, then we can
take more vacations that are notjust keeping us in the United States.
So, but yeah, we make it out asmuch as we can and like two to
(39:54):
three times a year if possible.
So,
Kathryn (39:56):
yeah.
Very good.
Yeah.
That's so nice.
And do you have any challengeswith the international travel
Austin (40:01):
man.
Yeah, I have tons.
So I imagine most of the audiencehere would be from the United States.
The people that are gonnasee and listen to this.
Um, but if you're going from theUS and traveling over to Europe,
understand that the food in Europethey say is different because it
tastes this, that and the other thing.
The nutrients profile isalso very, very different.
(40:24):
They don't make breadswith sugars in them.
Everything to used gonna not taste sweet.
Even the Coca-Cola formula andstuff is not at all the same.
So when you look at a food and likewe developed like the diabetics
intuition of like looking at a foodand that has X number of carbohydrates.
You're wrong.
Look it up.
Relearn, relearn everything.
It's wrong.
So here's that.
(40:45):
And then in Germany, they make someof the best bread in the world and
they eat bread with like every meal.
And they have wonderful, wonderfulbakeries around every single corner
that are open every day, but Sunday.
So they have high carb meals all thetime, and they're very long acting
high carb meals, which completelychanges how you need to treat yourself.
(41:06):
And then the last piece is,we're on vacation of course.
So how much activity amI doing by comparison?
Kathryn (41:12):
Yeah,
Austin (41:12):
not, not the same amount.
There's a lot of relaxing and thenalso eating those high carb meals.
Kathryn (41:17):
Yeah, because you told me they don't really have like
the gyms in Germany, right?
Austin (41:21):
No, everybody's so much more active on a daily basis anyway.
'cause people walk andride their bike to work.
Like my brother-in-law, the other daywe were, or a few months ago, we were
on, uh, vacation to visit my sisterout on the west coast here in the US.
We're in a city and we walkedlike, like eight miles or something
like that in a couple of hours.
And I was complaining 'causeI was like, oh, my feet hurt.
(41:43):
We just finished walking eight milesin like a small amount of time.
And he was like, really?
This is like my commute to work every day.
Not eight miles.
I'm exaggerating.
But like for him it was so easy.
But yeah, people just walk much furtherdistances to get to get places, but
they have the infrastructure for thatand people spend more of their time
doing hobbies and outdoor activities andthings rather than getting their sort of
(42:08):
fitness from a gym or resistance training.
So those things still exist if there'sathletes and, and you know, anybody who
wants to use that as sort of their hobby.
But I think people lean on adifferent sort of lifestyle there.
Kathryn (42:21):
Yeah, yeah, definitely.
Which is, I mean, it's so cool and to.
See such difference in
Austin (42:28):
Yeah, for sure.
I was thinking about, you weretalking about the Facebook group,
we were talking about the supportcommunity behind the open source stuff.
One of the most interestingthings to me is to look at all the
different languages that pop upon the Android APS Facebook page.
Kathryn (42:41):
Yeah.
Austin (42:42):
As you know, Androids are way more popular across the world
and like the US is very committedto iPhones because everybody kind
of has fallen into that sort of likecultural phenomenon of being in Apple
and being a part of the ecosystem.
And so there's a ton of users over inEurope and like to watch the different
languages pop up, whether it's likeDutch or German or French, or spanish
(43:06):
or whatever is like, is really funnyand it's a big worldwide community
that's tied into the whole thing.
Yeah,
Kathryn (43:12):
yeah.
It's so, so cool.
And I mean, it's cool too theyhave so many like systems or
pumps that we don't have here.
The one I'm very interested in is theMedtrum, which they have in Germany.
Austin (43:24):
Okay.
Kathryn (43:24):
You have to look for it.
It's, it's a lot smaller than the pod.
I mean, I guess not a lot, butlike it seems significantly.
Austin (43:31):
Is this the, it's like a little gray sort of still looks like a square.
Yeah.
Yeah.
Can you describe this one more?
Is this, does this one havelike a removable cartridge?
Kathryn (43:42):
Gotta pull up a picture of it so you can really, yeah,
Austin (43:44):
please.
Yeah.
Yeah, yeah, yeah.
So the gray piece, unclips.
Kathryn (43:49):
Yep.
Austin (43:49):
Yeah.
Okay.
So you can kind of substitute or matchup the cartridge size that you want.
Is that true?
Kathryn (43:56):
Yep.
Austin (43:56):
Yeah, that's it's,
Kathryn (43:57):
it's like,
Austin (43:58):
yeah.
That's awesome.
Kathryn (44:00):
Yeah, that's really cool.
And you can use it with AAPS.
Austin (44:02):
That's cool.
Kathryn (44:03):
Yep.
That's pretty awesome.
Apparently the sensoris not great, though.
That's what someone in, I don't knowwhat country he was in, but he told me
the sensor's not great, and that's a bigreason why he wanted to set up AAPS so
that he could use it with the Dexcom.
Austin (44:20):
They have their own sensor for it, I'm guessing.
Yeah.
Okay.
Man.
Makes it difficult.
Kathryn (44:25):
Yeah.
But you know, with AAPS, you can use,that's like the whatever you want.
Yeah.
You just use, use Dexcom.
There you go.
Austin (44:33):
Yeah, that's great.
Cool.
Kathryn (44:34):
I really appreciate you coming on here and sharing your story.
There's just, I mean, I feel like wecould talk about life for, for hours, but
Austin (44:42):
Yeah.
I. I have fun coming on these.
Not only, uh, because like every timeI talk to a new host, I find find
out about new diabetes technology.
And uh, like I said, the hardest partafter being on one thing for so many
years is to branch out and try otherstuff and start like asking things.
And I think if it's difficultfor you to get the device in hand
(45:04):
for either like a cost problem orswitching is difficult or something.
I think there's a big giant community ofpeople that have tried a lot of stuff and
you can really lean on that sort of thing.
So.
I enjoy being on the podcast like this,and I hope to some degree that this
helps somebody else who's consideringusing Android APS or even switching,
(45:24):
because if you're thinking about it,you should totally try it if you can.
Kathryn (45:28):
Yeah,
Austin (45:29):
yeah, yeah,
Kathryn (45:30):
yeah.
So we got to talk about kindayour experience of starting up on
Android APS, why you shifted fromTandem to open source, and we talked
about your travel over to Germany.
We didn't talk too much aboutcycling, but I, we did, we
did brush on it a little bit.
Thank you so very much for joining us.
Austin (45:51):
Yeah, thanks.
This has been great.
And uh, also a shout out to IDS becauseif I hadn't come out with you guys, I
would've never done the switch anyway.
So thank you guys for all of yourinformation and your help getting
the switch done and uh, yeah, all thecontinued work and stuff that you guys
do for helping me manage my diabetes, so
Kathryn (46:11):
thank you.
It's a pleasure to work with you.
Gary (46:13):
Thanks for tuning in to Think Like A Pancreas, the podcast.
If you enjoyed today's episode,don't forget to like, follow, or
subscribe on your favorite podcast app.
Think like a pancreas.
The podcast is brought to you byIntegrated Diabetes Services where
experience meets expertise, passionmeets compassion, and diabetes care
(46:34):
is personal because we live it too.
Our team of clinicians all livingwith 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 loss type one,pregnancy and emotional wellbeing.
(46:55):
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, the podcast.
I'm Gary Scheiner, wishingyou a fantastic week ahead.
(47:19):
And don't forget to think like a pancreas.
Welcome to Think Like a Pancreas, the podcast where our goal is to keep
you informed, inspired, and a littleentertained 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
(00:37):
healthcare provider before implementing.
Kathryn (00:39):
Hello everyone.
I am Kathryn Alvarez and I'llbe hosting the podcast today.
I have an awesome guest with me.
His name is Austin.
I'm gonna get to know him today and kindof his journey with Type one Diabetes.
He is a very busy guy.
There's gonna be a lotfor us to talk about.
So Austin, can you tell everyonejust a little bit about yourself
(01:03):
when were you diagnosed?
Some information?
Austin (01:05):
Yeah, sure.
So I'm Austin.
I was diagnosed at eight yearsold in October of, think in
the early two thousands thatI'd have to go find the date.
But I've been diabetic since I was eight.
I'm now, uh, 27.
So, 20 years as a, as a type one diabetic.
Yeah.
And what, what else canI tell you about myself?
What else do you wanna know?
Kathryn (01:26):
What are you studying?
Um, tell everyone you're going for Yeah.
PhD, which is just impressive in itself.
Austin (01:32):
Yeah.
So I'm doing like a bunch ofdifferent things at the same time.
So I'm doing my PhD in chemicalengineering studying stem cell
differentiation using electricalstimulation at Iowa State University.
Man, that's a mouthful.
There's always like a, a crazytitle for every university.
Um, so I'm about two years into that.
And then in addition, I also am anengineering specialist for Merck Animal
(01:56):
Health making swine influenza vaccines.
So I'm doing both at the same time.
Kathryn (02:02):
Do you know when you're expected to finish your PhD?
Austin (02:04):
I'm hoping in the next two years, and then in my professional
role, I can transition to somethingthat's more R and D based instead
of being more applied engineering.
So that's kind of the outlook right now.
I think with any PhD it's a little,it's always kind of uncertain 'cause
it's based on how your work progresses.
So, there's not a perfectlydefined timeline, but yeah,
(02:25):
that's what I'm hoping for.
Kathryn (02:26):
Yeah.
That's really awesome.
Did you do your undergradat Iowa State as well?
Austin (02:31):
Yeah, so my, my kind of education arc was that I went to high school
in Northern Illinois and then went tomy undergraduate degree here at Iowa
State, also in chemical engineering.
After I got done was towards the tailend of COVID, I went into industry
and then worked for about three years.
And then after that decided I wantedto get some more credentials and
(02:53):
get some more education, and itjust kind of worked out that I was
able to do both at the same time.
So, yeah.
And then went back and started doingmy PhD about two and a half years ago.
Kathryn (03:04):
Awesome.
And you also, while going foryour PhD, also live with type one
diabetes and you have a wife andyou have a cat with diabetes now.
Yeah.
Mochi
And cycle.
So, how challenging has it beenwith just everything that you
do to manage your diabetes?
Austin (03:25):
Yeah, so like you said, I have, I got married about a year
ago, uh, now, and also riding andracing my bike and there's, beyond
the diabetes side, just balancing allthe stuff together and carving out
time for everything is hard in itself.
Throwing diabetes into the mixmakes it like you have to make
more decisions more consistently.
(03:46):
And like all of the other things,you, you can't just stop and take
a break whenever you want to.
There's no, um, well, I have PTO withthe one job, but you can't just walk
away from school for a little while orlike go take a vacation or something.
And I mean, it's just like diabetes too.
You can never, you know, say I'm tired,I kind of just wanna take a break.
So putting all those things on top ofeach other makes it really, really hard.
(04:09):
And I think we'll get into this too, butthat's one of the reasons that I went
to a different insulin pump system, wasto try and mitigate how much attention
I have to give on a daily basis towardsmanaging diabetes and still staying
in good ranges and in good control.
The, the most complicated thingis the fact that I have to bring
extra supplies all the time.
(04:31):
'cause I'm at like differentlocations everywhere.
So I'm like packing stuff with me andbringing coolers for insulin and things.
And it was not near thatcomplicated when I was just working.
Uh, I used to keep a single vialof insulin at work in a, in like
a storage fridge, whatever, andsome stuff in a drawer at a desk.
And it was like, we're good,but now I have like four
(04:52):
different bags going everywhere.
It makes it a littlebit more difficult, so
Kathryn (04:55):
yeah, a little
Austin (04:56):
more complicated.
Yeah.
Kathryn (04:58):
When you're gonna go home and stuff, but at least you have these bags
that are prepared and yeah, you grab them.
Austin (05:06):
Yeah.
Kathryn (05:06):
Let's talk about your transition and just for our listeners.
So Austin, you came to IDS and whatdo you remember what your main goal
was when you came and we first met?
Austin (05:17):
Yeah, so my first goal was, uh, my wife and I are sort of doing
family planning and we're trying tomitigate the effect that diabetes can
have on our ability to have children.
So the primary goal was to lower my A1C,um, and be as healthy as possible when
we're in the stage of family planning.
And then in addition to that, mypersonal goal was that I would really,
(05:41):
really love to get down to a 6.0 A1C.
It's kind of like a big, sortof starry marker for success or
something, uh, that I've beenlooking for over the past 19 years.
So it's taken me a really long time toget my A1C down to where it is right now.
And as of yesterday, it's at 6.4.
And so I thought additionalcoaching would help.
(06:02):
And then on top of that, my wife wasalso pushing me to go do it as well.
I think when you do diabetes for like15 years, you get really comfortable
in whatever method you've, you'veadopted to try and manage it.
So then changing stuff getsmore and more difficult.
So I was looking for fresh perspective,lower A1C, better outcomes and
(06:24):
a different knowledge base tohelp me find all of those things.
So
Kathryn (06:28):
man, and so good, and I mean, a lot of the focus from a family planning
standpoint is on women, but we see moreand more how important it is for men too.
So, yeah, it's so good that you'retaking that step, and hopefully
that can be a little bit of aninspiration for more guys, too.
You were using the Tandem andwith cycling, or, I mean, just
(06:51):
in general, what do you feel likethe Tandem wasn't able to achieve?
Austin (06:56):
I ride my bike about, hmm 13, 14 hours a week.
And I race like road bikes, kind of likethe Tour de France, but the United States
doesn't have a scene that looks like that.
It looks a little bit different,but you could think of it that way.
So amateur cycling of course,and all of those sports take a
lot of time and there is like anaerobic and an anaerobic component.
(07:19):
So different ways of using energywith different workout types and the
Tandem insulin pump for me at the time.
Had control IQ and that sort ofcontrol system had a lot of buffers
in it for safety, uh, for justthe design of the insulin pump.
Kathryn (07:38):
Mm-hmm.
Austin (07:39):
Um, but those buffers became more of a constraint to
me managing my blood sugar ratherthan, um, you know, a benefit.
For instance, I would, I would goand set up a workout and then go
do the workout and immediately havelow blood sugars, even though I'd
have exercise mode on or something.
And the default turned into justtaking my insulin pump off and
(08:01):
getting no insulin until I sawmy blood sugar kind of flat line.
And then it would slowlykind of start to rise.
'cause now I have nomore insulin on board.
And then I'd have to manually plug it backin and sort of time it for some of these
workouts to go over like two hours long.
These bike rides thatare more than two hours.
That was really complicated and itrequired me to pay attention a lot.
(08:23):
I think there's been some updatesto the Tandem insulin pump, but
at the time there was nothing thatcould manage my blood sugar in an
exercise that worked effectively.
Kathryn (08:33):
Yeah, I mean we have, we, we do have Control IQ plus now, which is
really helpful for a lot of people.
But yeah, at the time we had to likecreate different profiles in order
to, because exercise mode, you know,wasn't, wasn't doing the trick.
So creating these differentprofiles with significantly higher
correction factor to try and preventsome of that auto bolus insulin.
(08:57):
But I was like, there'sjust, there's better things.
Anyone that knows me knows that I'ma huge fan of all things open source.
But for you, you're one of therare people in the United States
that use an Android phone.
Austin (09:14):
Yeah, that's a rarity in, in the US
Kathryn (09:17):
It really is.
I used to recommend Android APSA lot toparents that had little kids with type
one diabetes because it was the firstwhere you could do remote features.
So that's where majority of thepeople that come to IDS are still
from the United States, but we,we do have some people overseas.
Um, just not as, as common.
(09:38):
Well, that was like my main exposureto AAPS, and of course I ran it
because I needed to better assistthese people that I was helping with.
Then I was like, Austin,you have the Android phone.
And so AAPS is incredible.
It's, I think it's always onestep ahead of everything else.
It has by far the most compatibilitywith the, with pumps and CGMs out
(10:02):
there, and the features are justalways so, so far in advance.
So what do you think was like the mainsell for AAPS to get you to take the leap?
Austin (10:13):
Yeah.
I think for me it was when I lookedat the, the micro boluses or the SMBs.
Kathryn (10:20):
Yep.
Austin (10:21):
One of my biggest problems throughout all the time I've
had diabetes is rememberingto get insulin before a meal.
And you'd think, you'd thinkthat like 19 years of doing it,
it's, it should be automatic.
There's this tagline that sits in mymind of when I first got diagnosed of a
doctor that told me eventually diabeteswould be like brushing your teeth.
'cause they were trying to be likereassuring and go, it'll get easier
(10:45):
sort of attitude and yeah, it's gotteneasier, but I still remember that and go,
it's nothing like brushing your teeth.
It's nothing like that.
It'll never be that easy.
Kathryn (10:53):
That's how I look at it.
Like it does feel like that for me.
Like I just feel like, like,yeah, life with type one diabetes.
I don't.
It doesn't bother me at all.
It's more the, uh, like prescriptionmanagement and trying to
figure out insurance and havingto do prior authorizations.
That is what gets me.
Austin (11:12):
I think I'm getting closer and this was one step closer, and
eventually I hope that, uh, I getthere, but it always has still, I
don't know it having to put likeOmniPods on still and prep stuff, bring
things with and make sure I remember.
Everything that I needto be successful with it.
(11:33):
Uh,
Kathryn (11:33):
to not die.
Austin (11:34):
To not die.
Putting it very frankly, yeah, Uhhuh.
To live on a regular basis.
It's a hard thing to get across to peoplewho don't have it or don't have like
somebody really close to them who they'vealso had to give them like whatever
their snack is for a low blood sugar.
But going back to your originalquestion, my problem was that I would,
I would get my insulin for every meal.
(11:57):
It just might be a few minutes behind thefirst bite because I'm excited to eat.
I'm like, I wanna sit down.
I'm really hungry.
I'm after whatever activities.
I did activity my whole life.
It was like, oh my God, I'm starving.
I want to go eat, starteating, and then go, oh crap.
I need to, get insulinfor this whole meal.
So the mixture of SMBs haskind of felt like a safety net.
(12:19):
I don't necessarily wanna relyon it, but having it for the,
Kathryn (12:24):
did you?
Yeah, yeah, yeah.
And you the big, big one.
But yeah.
Austin (12:29):
Yeah.
So that's been really, really great.
Then also the SMBs at nighttime.
Now that we've sort of gotten my profiletuned, I don't think I've had blood
sugars this sort of stable overnight inyears, and we're like within, I can be
within like 10 milligrams per deciliterof target for like a nine hour period
(12:50):
just sleeping and it feels amazing.
So that's really, really great.
But yeah, that's thecoolest tool in my mind.
And then the flexibility that that hasaround exercise with temporary targets and
adjustments to your profile on the fly todo percentages, but still keep the same
sort of profile and not have set like atemp target over just a defined period.
(13:11):
You can kind of edit based onthe day a little bit quicker
than I could on an insulin pump.
Yeah, that feels great.
Kathryn (13:17):
Yeah, and you kind of have like these scenarios and rules
you can set up too, which a lotof people like that are on AAPS.
They never go through all ofthe objectives and with the
last objective, it gives you theability to set up like scenarios.
If you get to a particular GPSlocation, then turn on like
(13:38):
switch to exercise profile, right?
Which I think is really helpfulbecause like you said, you know,
you get excited to eat, but I meanjust we're naturally forgetful.
If you're gonna go and cycle for twohours at like a particular location
and you forget to switch yourprofile, at least you can have it,
like automatically switch it for you.
Austin (13:58):
Sure.
Or like you're the person that goesand does weightlifting at the same gym.
You've had the same gym membershipfor five years to the same spot.
Yep.
Every time you show up there, it'sjust gonna solve your problem for you
without even having to do anything.
Kathryn (14:10):
Yeah.
You, yeah, it's just all set.
So it's like, it's really streamliningand just making everything easier.
You have to think about so much less,which is so amazing and so many people on
open source systems they're doing, they'rejust completely not announcing meals and
some people like they'll come frustrated.
You do announce your meals still.
(14:31):
Yeah, at least for the most part.
And the people that have like, youknow, very little movement in their
blood sugars for meal 'cause wedo more rapidly digest this food.
And if we're eating something that isnot low on the glycemic index, it's gonna
impact our blood sugar really quickly.
So unless you're on some kind of likeadjunct medication, not announcing
would cause a pretty high postprandialor post-meal blood sugar rise.
(14:55):
But a lot of people have movedto take something like a GLP-1.
So you know you have common pic andum, you know, those ozempic is the one
that people are most familiar with.
Austin (15:06):
Yeah.
Kathryn (15:06):
And um, since that slows down the impact of the food or on
our blood sugar at least then, um,I can create those smooth outcomes.
Is there any reason why you'vechosen not to take a GLP-1?
Austin (15:19):
Good question.
Yeah.
So I'm not, I'm not particularlyagainst taking GLP-1s.
For my own reasoning thatI haven't taken one yet.
I would put it down to like, I'ma, I'm a researcher and I'm also in
pharmaceuticals, and I look at dataand I don't doubt that it works,
but the current usage case has beenabout a few years and my approach to,
(15:45):
I don't know, the, so the outcomesof like GLP-1s is slower digestion.
You could have weight loss.
There's a number of other benefitsthat people have reported with food
noise and a number of those things Idon't think I struggle with right now.
And then in addition to that, if I'musing a GLP-1, I'm worried it might mask
the inadequacies of the way I manage mydiabetes and the way that I build habits
(16:10):
in my life outside of leaning on somethingto help me achieve the same goal.
And I don't think it's bad to useone thing or the other, but for me, I
would rather wait and see what happensin long-term cases and long-term
use because I'm not on the, "I needto use this. I have a high risk
(16:31):
situation. That needs to be solved inorder to ensure my long-term health."
I think for the most part, when I goback to all my labs and look at my
weight, my lifestyle, and my currentlevels for diabetes, I think I'm
in a place where I'm pretty happy.
And of course I could alwaysget better, but I'm chasing that
through different avenues first.
Kathryn (16:52):
Yeah, and I mean sometimes if you're, if you're cycling and potentially
having like low treatments that impactyour blood sugar or pull you up as
quickly could be kind of problematic.
Austin (17:05):
And I mean, another like aspect of that is that
when I eat riding on the bike.
I eat the most sugary,like, concentrated stuff.
And that's what the sports gels andgel blocks and high carb mixes and
bottles and things are meant to do isto absorb as fast as possible 'cause
you're burning through stuff right away.
(17:25):
I, I would love, I want my digestion tobe as quick as possible and to process
as many carbs as I possibly can soI can feel better later in a, in a.
Kathryn (17:35):
And as an athlete, you know, you need to consume more calories as well.
So, and protein is incrediblyimportant for muscle recovery.
It, it would make it moredifficult to consume what you
would require as an athlete.
Austin (17:49):
Yeah.
Kathryn (17:50):
GLP-1 as as well.
And I think a lot of people, you know,they are just looking for more of
that long-term outcome and researchto make the next step and take it.
Um, but for other people, I mean,as people with type one, we don't
produce a hormone that slows downgastric emptying and is also a
satiety hormone called amylin.
(18:11):
And so as people with type one, we dotend to feel a bit hungrier and see the
impact of carbohydrate a bit quicker.
So bolus timing is soincredibly important.
There's definitely people that thisjust gonna be so incredibly helpful for.
And, and it's great, but I don't, I'mnot, I'm not, I don't think athletes
(18:31):
are, are in that group at this point.
Austin (18:33):
I think there's a use case for every single thing that's made out there.
And I think the hardest part is gettingthrough who it's appropriate for and at
what time and yeah, when, when to use it.
So I'm not hesitant about drugs, that'swhy I work in the pharmaceutical industry.
I know people spend their whole livescoming up with stuff like this for the
(18:54):
sake of helping people, and it alwaysstarts in an R&D lab because somebody
has a good idea for how to help aperson and then it gets monetized later
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And now back to our program.
Kathryn (19:41):
Okay, so now let's shift a little bit.
I'm gonna talk about the objectivesbecause this is unique to AAPS and I guess
the build a little bit too 'cause you wereone of my people... usually everyone's
like, oh, I'm, so, the build scares me.
I don't know about opensource because of the build.
So I usually help peoplethrough the build.
But you just came back andyou're like, yeah, it's built,
(20:02):
going through these objectives.
Austin (20:04):
Right.
Kathryn (20:04):
So tell me about it.
Like how did you feel, uh,going through the build?
And, and then, then we'll talkabout the objectives as well.
Austin (20:14):
Sure.
So I'll say the build scared me tooinitially, and then I started doing
reading, like in my PhD program.
Whenever you need to do something,sometimes there's people that teach you
how to do it, but there's a lot of caseswhere you just have to figure it out.
So they turn you loose, go read somedocuments, figure out how to do a
thing, whether it's like 3D printingor like mixing new chemicals and
making some new solution, whatever.
(20:35):
So that was my approachto the Android APS build.
But with that said, the documentsthat they have available to
explain how to do the build itselfare relatively straightforward.
The steps might look complicated,but if you follow each individual
step and do them in sequence, thenyou shouldn't have a problem building
it and getting the right software.
(20:56):
So, they have a whole documents glossarycalled the docs, uh, Android, AAPS.
Everyone says "Read the docs.
Read the docs.
Read the docs."
People before you aska question, go read it.
It's probably in there.
Kathryn (21:10):
It's super cool too, which is so great.
I mean, 'cause I don't haveAAPS in front of me anymore.
So you can just, yeah, go in there and,and search what you're looking for.
Austin (21:19):
It's great.
They have so much detailabout, just about everything
android APS, and then they alsohave links, like outside links.
So if you wanted to know where the ideacame from for SMBs or, how much you
should get for SMBs or how you calculateyour own SMBs, there's always some
extra source for where stuff came from.
You can get as deep an explanationabout everything as you want.
(21:42):
So yeah, the components I needed tobuild it included my Apple computer.
I needed something called HomeBrew, which is a software writer,
which you can get off the internet.
It's free, and it's been used forlike years and years and years
for not just Android APS, but tonsof other stuff for writing code.
There's a file online on awebsite called GitHub, which gives
(22:04):
you all of the code you need.
You don't have to build anything,you don't have to write any code,
you just have to run it, and ittakes you through how to run it.
And then the very last thing youneed is Android Studio, which is
the application that lets you buildapps for Android phones and that's
what packages the whole thing.
Kathryn (22:21):
Yeah.
And everything is free with AAPS and youdo not like our, um, iPhone based things,
we do not require like no Apple developer.
So you don't have that $99 ayear, um, which is just great.
Austin (22:36):
Yeah, it's a really low barrier of entry in terms of cost, and once you get
the app set up on your phone, after youget past that and it's set up correctly,
the objectives will kind of take careof the rest to verify that the app is
working correctly as you work through it.
And I don't know about other open sourcesystems 'cause Android APS is the only
(22:59):
thing I've used, but can you run anyof the other systems on a virtual pump?
Kathryn (23:03):
Yes.
Austin (23:03):
Okay.
Yeah, that would make sense.
I think that was a great featureto start feeding it glucose data
and it let me double check thatmy sensor's working first and then
make fake corrections on things and
Kathryn (23:15):
mm-hmm.
Austin (23:16):
Yeah, it's just, that just made so much sense that they
included a system like that too.
So
Kathryn (23:20):
Yeah, you get to see like how it's functioning
Austin (23:22):
Yeah.
Kathryn (23:23):
Beforehand,
Austin (23:24):
right, exactly.
Kathryn (23:25):
Really, yeah, you can... so the build is great, you know, you can do it
on any type of computer, which is so good.
Um, which you can withLoop and Trio now as well.
Now the objectives.
One more thing I wanted tosay about the build, actually.
The build, I feel like is, it isdefinitely a, probably the number
one reason why people will choosenot to go like the open source route.
(23:49):
And the online communityis so incredibly helpful.
I mean, I know I just watchedso many people on there that
somebody posts and then somebodyin the community offers to help.
So these volunteers like arejust absolutely incredible.
Austin (24:05):
Yeah, right.
Kathryn (24:06):
It's amazing.
All they do too, to helppeople get through it.
And I mean, I feel like also it's kindof like my comparison I always give to
people is it's kind of like following theinstructions to put together furniture.
Putting together furniture is reallystressful, but you know, you'll probably
eventually get the end product eventhough you have no idea what you did.
Yeah.
But then I started putting togethersome furniture as I got my first
(24:29):
house and that did not go well.
So I take it back and I thinkthat building is easier than
putting together furniture
Austin (24:36):
really good at diabetes, not so great at building IKEA furniture.
Kathryn (24:40):
Yeah, definitely.
Okay, so the objectives, what wereyour thoughts going through those?
Did you have any challenges whenyou were to the point, what is it?
Objective three?
Where it's asking you toessentially prove your knowledge?
Or did you have trouble like kindof getting through any of them?
Austin (25:00):
Yeah, the prove your knowledge was hard.
Which is, at first I was like reallyfrustrated because you know, you get
handed any insulin pump through acompany and they have you train with
somebody, either a qualified educatoror somebody's like a rep for that pump,
and I was like, man, I don't wanna wait.
Just give me all, just open everything up.
(25:21):
Let's, let me just.
I'll just figure it out.
And then I thought about it a littlelonger and I was like, man, it's a
really good thing that they're checkingpeople's knowledge for an open source
platform to verify everybody knowsexactly what's going on the whole time.
Yeah.
The, the questions for theknowledge check are not easy.
And they also make you go read the docs.
Kathryn (25:40):
Mm-hmm.
Austin (25:40):
Read the docs in detail so you can't just like skim it.
You know, like prepare for yourFriday quiz or whatever in grade
school and read something real quick.
No, you, you have to know theinformation, and you have to know
it intimately to pass the questions.
Kathryn (25:55):
Mm-hmm.
Austin (25:56):
Nobody's gonna give you the answer.
That's the one thing thecommunity is not gonna do.
They're not gonna giveyou hints for the answer.
It's if you wanna use the system,you gotta get past that objective
and understand everything.
So,
Kathryn (26:08):
yeah, no, they'll guide you a little bit, like if you look in the
Facebook group, yeah, that's true.
People will kind of give you likesome pointers or where to look, but
yeah, it won't give you the answer,
Austin (26:17):
which is great.
Yeah, so getting through that wasdifficult, but once I was through
that section, after that, it wasjust introducing a complexity layer,
one piece at a time until you hadkind of the most complicated version
of Android APS that you're running.
And I think the very first thingyou do is, is set up your profile
(26:38):
and then afterward you start gettingaccess to stuff like basal suspend.
Which kind of looks like the suspendmode in the Tandem insulin pumps for when
they had first initially introduced that.
Then afterward you move to temptargets, and so you can adjust your
glucose target up and down to sort of,I don't know, take into account like
(26:59):
exercise and different activities.
And then after that, then theystart having like basal adjustments
where it can go higher and lower,and you set thresholds for that
and then make adjustments toyour basal profile if needed.
And then so on and so forth, and youkeep introducing more and more features
and building complexity into the system.
Kathryn (27:16):
Mm-hmm.
Yeah.
That's really great.
And when you were doing that, your timein range was pretty great right off
the bat, but I do think you're probablypaying a little more attention as well,
just kind of starting on a new thing.
Austin (27:30):
Yeah.
Kathryn (27:31):
You know, just starting on a new thing in general can be pretty stressful.
Did you feel like it was the wrongdecision ever to put the Tandem down?
Austin (27:38):
No, I, I don't think so.
It was refreshing to be on a totallynew insulin pump after being on the
same thing for many, many years.
And moreover, switching to anOmnipod was new for me too.
Uh, 'cause it was the first time Ididn't have any tubing on me, and
that was so refreshing that therewere enough upsides that I never felt
like, oh, I made the wrong decision.
(28:00):
It was more just figuring outthe bumps in the road for getting
proficient at using Android APS.
Kathryn (28:06):
Have you ever considered, this is just like a random thing that
I'm now suddenly super interestedin, so since you have the ability.
So with AAPS you can use theEversense, and there's talk
on like Zop chat of using it.
Um, like it'll likely becompatible with Loop as well.
Um, of course Trio I'm sure wouldbe in line for that as as well.
(28:27):
But with Eversense, like, haveyou ever given that any thought?
To potentially try that as your, your CGM?
Austin (28:34):
I haven't, no.
The current CGMs haven'tbothered me so much.
Like I've been using Dexcomsince they were on the G4.
I don't think they called itthe G3 when they came out with
the third one at the time.
Yeah, maybe it was called the G3
Kathryn (28:49):
I know.
Austin (28:49):
I have to think really far back, but I've been using those ones
for years and years since they firstgot approved for pediatrics and
haven't used really anything else.
And those have kept getting betterand better with more wear time
up until like the 10 day period.
And I think now they evenhave the 15 day period.
Mm-hmm.
Which may be a little bit longfor me to keep them actually
(29:12):
stuck on to my, mm-hmm to my body.
I think mine would fall off before I couldactually get all the way out to 15 days.
Kathryn (29:18):
Yeah.
Well, and I mean, when you lookat the data, a significant amount
did not make it to the 15 days.
So
Austin (29:25):
yeah,
Kathryn (29:26):
it is kind of expected.
Austin (29:28):
Yeah.
Kathryn (29:29):
I'd be curious to see what they're gonna do with, if they're
gonna ease up on replacements or,
Austin (29:34):
yeah.
I haven't given the Eversense any thought.
I think it's a nice idea for somepeople the implantable device.
I work on some implantable devices,some stuff related to the eye.
And I think in the, again, in theright use case scenario, I think
it's a really, really great idea.
(29:54):
And for the right patient, Ithink it could work really well.
But yeah, I also don't want to be,like we talked about earlier, I don't
want to be stuck on one technologyfor the sake of being comfortable with
it because until you try somethingelse, I don't know, maybe it is in
fact better to be on something elseand I would feel better about it.
But that one's a, that onefeels like a big commitment.
'cause it's like a six month
Kathryn (30:15):
well
Austin (30:16):
insert.
Kathryn (30:16):
Well, and well now they have the 365, so whole entire year.
Austin (30:21):
For a whole year.
That's crazy.
Kathryn (30:23):
It's different though, because you can just take that top piece off and
then it's just, you know, it's your arm.
Yeah.
And Gary, the boss, my boss has hadone in for just under... he got it
implanted and never got it removed.
So it's been in there for, Idon't even know how many years.
We'll have to ask him.
Austin (30:42):
No, he's had no issues with it being implanted that long?
Kathryn (30:45):
No.
Austin (30:45):
Interesting.
Yeah.
Huh uh, have you tried one before?
Kathryn (30:49):
No, I haven't, but I've had quite a few people ask about it recently because
Dexcom, especially with these, my littles,my littles just have a heck of a time.
Like they are all over the placeand just the sensors are jumpy,
jumping all around, which I'msure you've had jumpy sensors too.
Especially recently, it just seems likesomething's going on with the quality and
(31:14):
we're, we're not having, we're not havingsome great luck with the sensors recently,
but it's especially true for little ones.
Um, and it's like when they sleepis just, you know, they already are
worried, but then they're gettingall of this fake stuff overnight.
Yeah.
Even with like these egg, these eggcrate like covers on the bed and they
like use things to help prevent thecompression and yet-- just can't beat it.
Austin (31:39):
Yeah.
The absolute worst case scenario for mefor sensors is having a compression low
in the middle of the night, treating itwith something and then going back to bed.
And at nighttime I have a slightpreference to run a little bit
higher if I've had low bloodsugars and then keep sleeping.
'cause my sleep feels that important.
Of course, I have like a high threshold.
(32:00):
Anything over like one 90 I'll get alarmsfor, to wake up and do something about it.
But if I, if it's below that, I wouldprefer to keep getting the sleep and
then make the correction in the morning.
But like then I either get woken upagain because I skyrocketed high 'cause
the sensor was wrong and I correctedfor it because being low would be in
the middle of the night is scary enough.
(32:21):
So, yeah.
Yeah, that's a, that's a interestingsolution to the whole thing.
Yeah.
Do you know, is there likescarring for the implant or
does it look relatively clean?
Kathryn (32:31):
It looks clean.
Austin (32:33):
Yeah.
Okay.
Kathryn (32:33):
Yeah, I, I don't know.
I'd have to look more into.
You know, about using the same place?
'cause I'm, I'm not sure about that,but I mean, it is only 18 plus, so not
to be, I don't wanna confuse peopleby talking about the littles, but
yeah, it's, it's just for adult use.
And also the 15 day for Dexcomis also just for adults, 18 plus.
(32:56):
So that won't impact them either.
But yeah, I mean it's, it's definitely,it's gonna be more accurate.
Um, and based off of the scores,um, it shows better accuracy and
then the, just once a year that, Imean, I feel like that really kind
of makes it worth it potentially.
Austin (33:14):
Yeah.
Yeah.
Yeah.
I think this just kinda speaks onthe whole technology development
and how important it was for me todo, to try something new anyway.
Kathryn (33:26):
Mm-hmm.
Austin (33:26):
And even if I'm not committed to it, that's okay.
And I know you mentioned earlierabout the prior authorizations and
insurance related problems and things.
So as a PhD student and workingprofessionally, I was, I have
multiple insurances, which is great.
It also means there's a lot of likeback and forth on who's paying for
what and who's covering what, andif they're covering for whatever.
(33:50):
The switch to Android, androidAPS was by far easier than any
insulin pump I have started on.
'cause I've used Medtronics andI've used Tandem and went back and
forth from them a couple times.
And the OmniPods for me were just apharmacy benefit, and it was about
as simple as getting an order put in.
Had to get some adjustments onthat and a prior authorization so
I could have a shorter wear time.
(34:10):
Uh, on the Omnipod so I could keepgetting them, but other than that,
sent to the pharmacy and done.
That's it.
I had to get the intro kit for theOmnipod dash, but it was really
straightforward once I kind ofgot through the initial phase.
Kathryn (34:25):
Yeah.
Austin (34:26):
And if I ever want to, I can jump ship at any time.
Kathryn (34:30):
True.
Yeah, you no lock in.
Austin (34:33):
So yeah, that.
Is great that I can walk away from it.
Kathryn (34:38):
Well, and I have had a lot of people that, because it's a pharmacy
benefit, um, even if they had likea lock in, um, or you know, their
contract, they could still get the pods.
It's almost like the insurancecompany just didn't realize.
I think it's only ever been once thatlike somebody got caught and they
(34:58):
were like, you have this contract.
But for everybody else didn'trealize and they were able
to get the pods even though.
Did, was your contract endedwhen you, when you did it?
Austin (35:08):
No, I still have a Tandem insulin pump in my closet with
a bucket load of supplies and itis serving as my, as my backup.
But at the same time, I could go trycontrol IQ plus at this point because I
could get the download and, and set it up.
But yeah, as I'm still, I'm reallyenjoying Android APS right now.
(35:28):
'cause like I said, there arefeatures on it that act as a safety
net for when I'm not being the mostattentive to, uh, treating myself.
And the Omnipod flexibility for nothaving tubing has been a big shift for me.
And like I said, because I'm ridingmy bike, having one less thing in
my pockets might not seem like a bigdeal, but having only a cell phone
(35:51):
instead of a cell phone and an insulinpump is also a really big deal.
Yep.
And so then a few weeks ago I wason Justin's podcast and he asked me,
well, if that's the case, then whywouldn't you use like Tandem Mobi, and.
I think Tandem Mobi's cool, but it stillhas tubing and a sleeve and a bunch of
(36:13):
supplies that you have to carry with you.
The Omnipod is so just simplifiedand in one package that, yeah.
Kathryn (36:20):
Well, and you know, there is still some shortcomings of
the control IQ algorithm for you.
Yeah.
Just you can get so muchmore customizable with AAPS.
Austin (36:30):
Yeah, exactly.
Kathryn (36:31):
Yeah.
Austin (36:32):
So, yeah.
What have you heardabout the the Twist pump?
The TidePool pump?
Kathryn (36:37):
Yeah.
So the Twist pump, it's, they compareit to like double stuffed Oreos.
It's a little bit bigger than that.
Okay.
And it's going to, so it's a veryold version of Loop, essentially.
And so it's not at all what peoplewith Loop are used to using the like
(36:58):
interface looks the same, but whenthey go into like the overrides,
they're not gonna be able to customizein all of these different overrides.
So that's like a big, big featurethat people are gonna be disappointed.
And if they were a previous looperadditionally, so there's temp basal
only, there's no automatic dosing, soit's called SMBs with AAPS, and it's
(37:20):
called automatic bolus with loop.
So no automatic bolus,just just temp basal only.
Austin (37:26):
So, so do you think that the Twist would be like a gateway for somebody that
hasn't used open source stuff to startwith that 'cause it's got FDA clearance
and then move to open source when theydecide they want more features or do you
think it'll be open source people whowant FDA company-based support and backing
who will move outta open source to that?
Kathryn (37:49):
I think, I think there'll be a lot of that.
And then I think that when theymake the switch, unfortunately
they might be a bit disappointed.
Austin (37:57):
Hmm.
Kathryn (37:58):
In that decision, and they might kind of wanna go back to open source.
And then I think some other peopleare gonna go on it that wanted
to use open source, but they werelike, you know, didn't have the
ability to build or, you know, theywere, they're scared off from it.
And I think maybe for 'em,it'll be like a gateway.
Austin (38:17):
Yeah,
Kathryn (38:17):
for sure.
Austin (38:18):
Cool.
Kathryn (38:20):
There's so many great people just working for that company, and I think that
hopefully it'll progress pretty quickly.
Yeah.
You know, at this point, I think majorityof people would still choose to go,
you know, on Tandem or another system.
Big reason is, I mean, the Twistpump is, it's not very sleek, kinda,
Austin (38:42):
yeah.
Define sleek.
Kathryn (38:45):
Um, it's like a gray circle.
It kind of reminds me of a hockey puck.
Austin (38:51):
Yeah, that's what I thought too.
Yeah.
Kathryn (38:53):
Yeah.
So,
Austin (38:54):
and it also still has tubing, but it's also a patch pump?
Kathryn (38:57):
Right?
Yeah.
Uh,
Austin (38:59):
like a Mobi, but in the middle, a little bit tube bunk.
Kathryn (39:01):
Yeah.
Okay.
So, uh, yeah.
Yeah, I don't know.
I hope they make some big, somebig updates and lemme see great
things from them-- from Sequel.
But yeah, at this point, notsomething I, personally, I'm gonna
go, but there's definitely a groupof people for every system out there.
So some people are gonna,it's gonna be perfect for 'em.
Austin (39:22):
Yeah, definitely.
Kathryn (39:23):
The other thing I wanted to talk to you about is your
wife is from Germany, right?
So Germany?
Yeah, yeah.
Austin (39:28):
Yep.
From Germany.
That's right.
Kathryn (39:30):
How often do you guys go to Germany?
Austin (39:32):
Well, as much as we can.
Right now we're doing like greencard applications, uh, since we
had just gotten married and I'mdoing my schooling here in the US.
Um, so as soon as we can get thatstuff filed and done, then we can
take more vacations that are notjust keeping us in the United States.
So, but yeah, we make it out asmuch as we can and like two to
(39:54):
three times a year if possible.
So,
Kathryn (39:56):
yeah.
Very good.
Yeah.
That's so nice.
And do you have any challengeswith the international travel
Austin (40:01):
man.
Yeah, I have tons.
So I imagine most of the audiencehere would be from the United States.
The people that are gonnasee and listen to this.
Um, but if you're going from theUS and traveling over to Europe,
understand that the food in Europethey say is different because it
tastes this, that and the other thing.
The nutrients profile isalso very, very different.
(40:24):
They don't make breadswith sugars in them.
Everything to used gonna not taste sweet.
Even the Coca-Cola formula andstuff is not at all the same.
So when you look at a food and likewe developed like the diabetics
intuition of like looking at a foodand that has X number of carbohydrates.
You're wrong.
Look it up.
Relearn, relearn everything.
It's wrong.
So here's that.
(40:45):
And then in Germany, they make someof the best bread in the world and
they eat bread with like every meal.
And they have wonderful, wonderfulbakeries around every single corner
that are open every day, but Sunday.
So they have high carb meals all thetime, and they're very long acting
high carb meals, which completelychanges how you need to treat yourself.
(41:06):
And then the last piece is,we're on vacation of course.
So how much activity amI doing by comparison?
Kathryn (41:12):
Yeah,
Austin (41:12):
not, not the same amount.
There's a lot of relaxing and thenalso eating those high carb meals.
Kathryn (41:17):
Yeah, because you told me they don't really have like
the gyms in Germany, right?
Austin (41:21):
No, everybody's so much more active on a daily basis anyway.
'cause people walk andride their bike to work.
Like my brother-in-law, the other daywe were, or a few months ago, we were
on, uh, vacation to visit my sisterout on the west coast here in the US.
We're in a city and we walkedlike, like eight miles or something
like that in a couple of hours.
And I was complaining 'causeI was like, oh, my feet hurt.
(41:43):
We just finished walking eight milesin like a small amount of time.
And he was like, really?
This is like my commute to work every day.
Not eight miles.
I'm exaggerating.
But like for him it was so easy.
But yeah, people just walk much furtherdistances to get to get places, but
they have the infrastructure for thatand people spend more of their time
doing hobbies and outdoor activities andthings rather than getting their sort of
(42:08):
fitness from a gym or resistance training.
So those things still exist if there'sathletes and, and you know, anybody who
wants to use that as sort of their hobby.
But I think people lean on adifferent sort of lifestyle there.
Kathryn (42:21):
Yeah, yeah, definitely.
Which is, I mean, it's so cool and to.
See such difference in
Austin (42:28):
Yeah, for sure.
I was thinking about, you weretalking about the Facebook group,
we were talking about the supportcommunity behind the open source stuff.
One of the most interestingthings to me is to look at all the
different languages that pop upon the Android APS Facebook page.
Kathryn (42:41):
Yeah.
Austin (42:42):
As you know, Androids are way more popular across the world
and like the US is very committedto iPhones because everybody kind
of has fallen into that sort of likecultural phenomenon of being in Apple
and being a part of the ecosystem.
And so there's a ton of users over inEurope and like to watch the different
languages pop up, whether it's likeDutch or German or French, or spanish
(43:06):
or whatever is like, is really funnyand it's a big worldwide community
that's tied into the whole thing.
Yeah,
Kathryn (43:12):
yeah.
It's so, so cool.
And I mean, it's cool too theyhave so many like systems or
pumps that we don't have here.
The one I'm very interested in is theMedtrum, which they have in Germany.
Austin (43:24):
Okay.
Kathryn (43:24):
You have to look for it.
It's, it's a lot smaller than the pod.
I mean, I guess not a lot, butlike it seems significantly.
Austin (43:31):
Is this the, it's like a little gray sort of still looks like a square.
Yeah.
Yeah.
Can you describe this one more?
Is this, does this one havelike a removable cartridge?
Kathryn (43:42):
Gotta pull up a picture of it so you can really, yeah,
Austin (43:44):
please.
Yeah.
Yeah, yeah, yeah.
So the gray piece, unclips.
Kathryn (43:49):
Yep.
Austin (43:49):
Yeah.
Okay.
So you can kind of substitute or matchup the cartridge size that you want.
Is that true?
Kathryn (43:56):
Yep.
Austin (43:56):
Yeah, that's it's,
Kathryn (43:57):
it's like,
Austin (43:58):
yeah.
That's awesome.
Kathryn (44:00):
Yeah, that's really cool.
And you can use it with AAPS.
Austin (44:02):
That's cool.
Kathryn (44:03):
Yep.
That's pretty awesome.
Apparently the sensoris not great, though.
That's what someone in, I don't knowwhat country he was in, but he told me
the sensor's not great, and that's a bigreason why he wanted to set up AAPS so
that he could use it with the Dexcom.
Austin (44:20):
They have their own sensor for it, I'm guessing.
Yeah.
Okay.
Man.
Makes it difficult.
Kathryn (44:25):
Yeah.
But you know, with AAPS, you can use,that's like the whatever you want.
Yeah.
You just use, use Dexcom.
There you go.
Austin (44:33):
Yeah, that's great.
Cool.
Kathryn (44:34):
I really appreciate you coming on here and sharing your story.
There's just, I mean, I feel like wecould talk about life for, for hours, but
Austin (44:42):
Yeah.
I. I have fun coming on these.
Not only, uh, because like every timeI talk to a new host, I find find
out about new diabetes technology.
And uh, like I said, the hardest partafter being on one thing for so many
years is to branch out and try otherstuff and start like asking things.
And I think if it's difficultfor you to get the device in hand
(45:04):
for either like a cost problem orswitching is difficult or something.
I think there's a big giant community ofpeople that have tried a lot of stuff and
you can really lean on that sort of thing.
So.
I enjoy being on the podcast like this,and I hope to some degree that this
helps somebody else who's consideringusing Android APS or even switching,
(45:24):
because if you're thinking about it,you should totally try it if you can.
Kathryn (45:28):
Yeah,
Austin (45:29):
yeah, yeah,
Kathryn (45:30):
yeah.
So we got to talk about kindayour experience of starting up on
Android APS, why you shifted fromTandem to open source, and we talked
about your travel over to Germany.
We didn't talk too much aboutcycling, but I, we did, we
did brush on it a little bit.
Thank you so very much for joining us.
Austin (45:51):
Yeah, thanks.
This has been great.
And uh, also a shout out to IDS becauseif I hadn't come out with you guys, I
would've never done the switch anyway.
So thank you guys for all of yourinformation and your help getting
the switch done and uh, yeah, all thecontinued work and stuff that you guys
do for helping me manage my diabetes, so
Kathryn (46:11):
thank you.
It's a pleasure to work with you.
Gary (46:13):
Thanks for tuning in to Think Like A Pancreas, the podcast.
If you enjoyed today's episode,don't forget to like, follow, or
subscribe on your favorite podcast app.
Think like a pancreas.
The podcast is brought to you byIntegrated Diabetes Services where
experience meets expertise, passionmeets compassion, and diabetes care
(46:34):
is personal because we live it too.
Our team of clinicians all livingwith 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 loss type one,pregnancy and emotional wellbeing.
(46:55):
We've got you covered.
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, the podcast.
I'm Gary Scheiner, wishingyou a fantastic week ahead.
(47:19):
And don't forget to think like a pancreas.
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