July 29, 2025 • 39 mins
In Episode 46 of Think Like a Pancreas—The Podcast, host Gary Scheiner, owner and clinical director of Integrated Diabetes Services, welcomes Dr. Inge Van Boxelaer. Dr. Boxelaer is an endocrinologist from Belgium, a diabetes technology expert, and the founder of Diabetotech.
Together they discuss and compare continuous glucose monitors (CGMs) and automated insulin delivery (AID) systems available in the US as well as in Europe. They share insights on the rapidly evolving landscape of diabetes tech, the challenges of comparing different systems, and the importance of patients and healthcare providers staying up to date.
Meet Your Host and his guest:Gary Scheiner, MS, CDCES, is the award-winning author of Think Like a Pancreas as well as numerous other books that act as guides for people living with diabetes. A Certified Diabetes Care & Education, Masters-level Exercise Physiologist, and person living with type 1 diabetes since 1985,
Dr Inge Van Boxelaer, is an endocrinologist in Belgium. She's on a mission to improve the lives of people with diabetes by making sure that both healthcare providers and people with diabetes are up to date on all the latest in diabetes technology. Her platform Diabotech is recognized as a top international resource for insight and education.
What you will learn:✔️ Diabetes technology is rapidly evolving, therefore ongoing education for healthcare providers is crucial for effective diabetes management
✔️Open-source and DIY systems are gaining traction but are not widely used in all regions of the world.
✔️Emerging technologies, such as implanted sensors, are changing diabetes management.
✔️Do not hesitate to try new diabetes technologies available.
✔️Healthcare providers should encourage patients to find the right system that fits their lifestyle.
Chapters:
00:13 Welcome and introduction
01:28 Dr. Inge Boxelaer
04:29 The challenges of health care teams lacking technology knowledge
06:24 How Dr. Inge von Boxelaer helps healthcare providers better help their diabetes patients
8:07 Who Dr. Inge Boxelaer works with.
10:00 What diabetes technology is hot in Europe right now?
18:14 The best pieces of diabetes technology currently available.
22:55 Meeting the challenge of getting people to pre-bolus or bolus
28:13 Which connected insulin pen gets top marks?
29:01 What is the best data software?
31:03 What systems would Dr. Boxelaer use to manage type 1 diabetes?
34:22 What advice would you give for getting the most out of your diabetes technology?
Resources Mentioned:Think Like a Pancreas (Fourth Edition)
GlucoTrack https://glucotrack.com/
https://www.medtrum.com/product/nanopump.html
Connect with Us:
🔵Website: integrateddiabetes.com
🔵 Follow on Social Media: @integrated_diabetes_services and @ integrateddiabetesservices on Facebook
🔵To work with the Integrated Diabetes Services Team , visit https://integrateddiabetes.com/how-to-start-the-process/ , or email info@integrateddiabetes.com
Subscribe and ReviewIf you enjoyed this episode subscribe on Apple Podcasts, Spotify, or your favorite podcast platform to ensure that you never miss an episode.
Also, leave a review to let us know what you think, and share this episode with others who will enjoy it as well!
More great episodes like this:✔️ATTD Discoveries with Melissa Holloway
✔️Pregnancy with Type 1 Diabetes--The Book and The Authors
✔️IDS Diabetes Experts, The Trynamic Trio Share Personal Experiences with Open-Source Application
Disclaimer
The 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 wit
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:13):
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
Welcome to Think Like aPancreas, the podcast.
I'm your host, Gary Scheinerowner and clinical director of
Integrated Diabetes Services.
The title of today's session , isTaking Diabetes Tech to the Next Level.
You know, diabetes tech is exploding,not literally, hopefully, but
(00:56):
it, it's exploding worldwide.
A, a lot of us struggle tounderstand how the various options
compare and how the functionscompare between different systems.
Today you're going to hear from notone of the top, but I consider the
top expert in diabetes technology.
I call her not an expert--she's a tech-xpert.
(01:18):
She knows this technologylike nobody else.
Dr. Dr. Inga Boxelaer, I'm trying toget her name pronounced just right.
I hope I got it well.
Inga is an endocrinologist in Belgiumand she's on a mission to improve the
lives of people with diabetes by makingsure that both healthcare providers and
people with diabetes are up to date onall the latest in diabetes technology.
(01:43):
She has a platform called Diabetotech,and it's recognized as a top international
resource for insight and education.
We'll talk more later about thatand we'll certainly have information
about it posted in our show notes.
But Inga welcome.
Tell us a little bit about your backgroundand what, what got you to this point.
Dr. Inga Boxelaer (02:04):
First of all, thank you Gary, for inviting me.
I'm truly honored to be on theThink Like a Pancreas Podcast.
It's really a name that everybodyknows, think like a pancreas, and
then you invented it a little bit.
So congratulations.
Um,
Gary Scheiner (02:17):
I should write a book about that.
Dr. Inga Boxelaer (02:18):
That would be, yeah, that would be so great.
Congratulations with your newbook that, the new update that's
coming out I just heard about it,so it's, it's gonna be amazing.
I'm definitely goingto buy it and read it.
I'm looking forward to all the updates.
Gary Scheiner (02:32):
I will send you one.
Don't worry.
The technology changes pretty rapidlybetween the first and second editions.
I think there was nine years.
Second to third wassix years, seven years.
This one was only four or five years.
Things are changing so quickly, so Ihad to do almost a complete rewrite.
All the automatedfeatures that we have now.
(02:54):
All the connected devices andnew software, it's, it's really
changed things quite a bit.
And that's your area.
I mean, how did you learnabout all this over the years?
Dr. Inga Boxelaer (03:04):
Well, so I'm an endocrinologist in Belgium
and we mainly treat, uh, adultswith, uh, all types of diabetes.
And I've always beeninterested in technology.
It, it started when I first went toATTD 10 years ago, where they saw
the first children that were usingthese computers next to their bed
that were, and they slept throughthe night for the first time.
(03:25):
And the parents werecrying from happiness.
And every year there was such a buildupof this technology, uh, that we finally
even had it in our hands in, in 2019.
So I was so excited, uh, to start it.
But then, uh, I saw unfortunatelythere were quite some barriers
to start these AID systems.
You do need some background and yourwhole team needs to be trained to be,
(03:49):
to support people on these systems.
And that's where I saw the biggestbarrier, uh, that we didn't have
any videos, uh, available yet.
It was more representatives thatgave in-person training, which took
quite some hours, and it was notdifficult... it was very difficult
to get a whole team in one room.
And that's where I got the idea, like,let's make videos of this onboarding
(04:11):
education and all the things the careteam needs to know, so we all have
confidence to start these systems better.
Gary Scheiner (04:19):
Yeah, I mean, I've had the privilege of seeing some of the videos
that you've produced and you actuallylet me participate in some of them.
Dr. Inga Boxelaer (04:25):
Yeah.
Thank you so much.
Gary Scheiner (04:26):
They're really well done.
I always found it ironic, not ironic,but really sad how little most healthcare
professionals know about diabetes tech.
If you bring your car to theshop for repair, those mechanics,
they're trained and certifiedon everything under the hood.
Dr. Inga Boxelaer (04:44):
Yeah.
Gary Scheiner (04:44):
But if you bring yourself to your doctor or to your nurse,
the tech that you're using to manageyour, your diabetes and keep yourself
alive, most of the time they, theyknow little to nothing about these.
Is that, that your experience as well?
Dr. Inga Boxelaer (05:00):
Yeah, I think, especially in, in Belgium, it's with
the, with the physicians as, likein Belgium, the nurses are very well
trained on these AID systems, becausehere we do the onboarding ourselves.
So we have, uh, it's not a companythat trains the patients, it's really
the nurses that onboard the patients.
So our nurses, they know the systemsvery well, but the physicians, they don't
(05:22):
really know how to do the button pressing.
And if you wanna change the,the carb ratio or the insulin
sensitivity, we, we would havedifficulties finding it on the pump.
So, yeah, I think it's, uh, it'sdefinitely a problem if your
nurses have gone home and you'redoing late consultations or early
consultations and the nurse is notthere, it's, it's can be quite tricky.
And it's also kind of weirdto ask, to say, yeah, I don't
(05:43):
really know how your pump works.
So
Gary Scheiner (05:45):
Troubleshooting also can be really tough if you don't understand
the ins and outs of the devices.
Dr. Inga Boxelaer (05:50):
Yeah, that
Gary Scheiner (05:51):
it's more than just pump.
Dr. Inga Boxelaer (05:51):
Yeah, it's people are complaining of something and you
don't know the typical where, whereeverything is regulated or where
the alert alerts are to check whichalert is this person talking about
then, yeah, it's difficult to help.
Gary Scheiner (06:02):
Yeah.
And you got infusion sites and infusionsets to deal with and you got the
sensors to deal with the algorithms.
Dr. Inga Boxelaer (06:10):
Yeah.
You really should know all theoptions and the difference between
the options too to support the people.
Yeah.
Yeah.
Gary Scheiner (06:16):
So what are you doing to help the healthcare providers be in a
better position to help their patients?
Dr. Inga Boxelaer (06:23):
So I made, after I made those first courses, we now have
like 10th generation of the onlinecourse, uh, available on the website.
We have in total, actually 30courses on 30 different devices now.
So all the most used sensors, pumps, andAID systems onboarding training is there.
So with all the button pressing,with all the, uh, videos on how to
(06:47):
change it and how to, uh, interpretthe reports and it's all accredited.
So for, uh, physicians who needsome points, uh, they can get
some points, uh, via website.
A lot of it is free.
It's actually seven days.
Everything is seven days free.
So you can do, if you have a lot oftime, the whole training and a lot
of points ready via the website.
Gary Scheiner (07:04):
That's amazing.
To get continuing educationcredits along with it.
Dr. Inga Boxelaer (07:08):
Yeah.
Gary Scheiner (07:09):
Is is pretty impressive.
Dr. Inga Boxelaer (07:10):
There is always some, some point in the year
that you need some extra points.
Right.
So
Gary Scheiner (07:14):
yeah.
In every, every area.
I, I'm a certified diabetes care andeducation specialist, you know, we need
continuing education to maintain that aswell, so it's something that folks can
access and, and we'll have links to thatin the show notes for today's program.
In Belgium, do you measure glucosein milligrams or millimoles?
Dr. Inga Boxelaer (07:34):
Milligrams.
But the courses are made forinternational public, so everything
is in milligram and millimole inmeters and inch and all that stuff.
So we do all the metrics.
Gary Scheiner (07:44):
The technology is available.
In every country.
We've got things available to us,
but I find when I work with internationalpatients, sometimes they have access
to things that I don't even knowexisted 'cause we don't have them
in the US and sometimes they don'thave access to much of anything.
Dr. Inga Boxelaer (08:02):
Mm-hmm.
Gary Scheiner (08:03):
So do you work with only patients in Belgium or do you work
with people in other countries as well?
Dr. Inga Boxelaer (08:08):
So, in Belgium, like virtual care is not really reimbursed.
So, and we cannot do non-reimbursed care.
So yeah, I only see patients from Belgium.
Here in this room, it's very...
Gary Scheiner (08:20):
so using Belgium as a, as a case, as an example, how difficult
is it for a patient to access pumps andsensors and the insulin that they prefer
and other medications for that matter?
Dr. Inga Boxelaer (08:33):
Yeah, I think in Belgium we are very privileged
because it's, we not only have freeinsulin, but we also have people with
type one diabetes, they have freesensors, free pumps, free choice of
all the devices available in Belgium.
They have free choice ofhospital, of healthcare provider.
So yeah, I think they have very good care.
(08:53):
Like they even have reimbursementfor diabetes, uh, education
as much as they want.
Dietician, psychologists.
So, yeah, I, I think it's a dream scenariofor people with type one diabetes.
Gary Scheiner (09:05):
Mm-hmm.
Dr. Inga Boxelaer (09:05):
We don't really have like all the reimbursement that you have
in US for like chest-- sensors for peoplewith gestational diabetes or people
on basal insulin or people on orals.
We don't have that kind of reimbursement.
But people in type one, thelobbying was very well done.
So I do wanna congratulate ProfessorMateo for that one because she's from
Belgium and she made that happen.
Gary Scheiner (09:26):
So, yeah, we type ones are, we are not exactly quiet people.
Dr. Inga Boxelaer (09:31):
No, no.
There is a lot more lobbyingfor type one than for type two.
Right.
Yeah.
But yeah, they made it happen.
Gary Scheiner (09:37):
Yeah.
We, we raise a lot of ruckus when wedon't feel we're being treated fairly.
Dr. Inga Boxelaer (09:41):
Yeah.
And you should be, I think it's, yeah.
It's, it's bad enough that, thatyou, that you have this yeah,
disease, you should be taken care of.
I think everybody..
Gary Scheiner (09:52):
Some of, what are some of the, the hot items devices in Europe
that Americans may not be familiar with?
I was at the ADA scientificsessions and I saw some things
there that just blew me away.
There's a company that's developing athree year sensor that's implanted in
a vein so it's, there's no lag time.
It's measuring glucose in realtime in the bloodstream and
(10:13):
it's implanted for three years.
The thing is functioning, doesn'tneed any maintenance charging.
Dr. Inga Boxelaer (10:18):
Is that the glucose track?
Gary Scheiner (10:19):
The Gluco Track.
Dr. Inga Boxelaer (10:20):
Yeah, yeah.
It's amazing.
And I think the accuracy is so good.
Gary Scheiner (10:23):
Yeah.
Dr. Inga Boxelaer (10:23):
Yeah.
But we don't have it.
It's,
Gary Scheiner (10:25):
they're only testing it in Europe right now and
Dr. Inga Boxelaer (10:27):
yeah.
Gary Scheiner (10:28):
It seems like a lot of things are in Europe
before they make their way here.
So what, what's got you excited?
Dr. Inga Boxelaer (10:33):
In Europe?
Like, to be honest, we are all verymuch, much Medtronic here in Europe.
Like Medtronic is everywhere andall hospitals have Medtronic, and we
are so happy with the Minimed 780G.
We have the Simplera, which has alot of production problems at the
moment, so they only get one Simpleraand then they have to come back.
(10:53):
But, so this is really, uh, a new, sowe, we have some devices that you don't
have in the US but we mainly use thedevices that are US based, to be honest.
So now Insulet is finally herealso, so everybody's like,
we finally have a patch pump.
But what we also have in Europe, whichis very popular is the, uh, Ypsomed
(11:14):
with the, um, you know, the onethat's also being used for pregnancy.
And the Libre uh, three option isvery popular, but unfortunately,
you know, you have these
now the issues with the pump cards thatare no longer being made and they're
having some, um, how do you say it?
Yeah.
Not, not enough pump cards for everybody.
Uh, but yeah, they're, I'm, I'm surethey're gonna make a solution for
(11:35):
that and also their infusion sets.
But still, it's, it's a verypopular pump at the moment.
Yeah.
Gary Scheiner (11:40):
And what, what do you like about the Ypsomed device?
Dr. Inga Boxelaer (11:43):
I think, I think I like the, the size of it.
It's smaller.
It's, yeah, it was easier to refill.
It's, uh, with an app insteadof on the pump and the sensor.
I mean, yeah, the, the Medtronic sensorsare just not as easy as, you know.
They, uh, Abbott sensorsare very good, so..
Gary Scheiner (12:01):
I have a few patients using it and the algorithm seems
to be a very intelligent one.
Uh, it does a very nicejob of self adjusting.
Dr. Inga Boxelaer (12:09):
Yeah.
I. I'm not sure about theresults compared to MiniMed.
I do think the MiniMed has the bestalgorithm, but I know that I have some
patients who only, who are waitingand waiting for this pump to start,
because we are on the waiting list tostart, because they, they have these low
targets and they wanna have low sugars.
Right.
People wanna, and yeah, with thetargets as low as 80, that's, yeah,
(12:32):
some people are waiting for that.
And of course, for the pregnancy?
I think, um, yeah, it's, it's probablythe best option at the moment.
Gary Scheiner (12:37):
Sure, sure.
Uh, do you have much.
Interest or use of opensource DIY systems?
Dr. Inga Boxelaer (12:44):
No.
I love DIY.
It's, I think the community is amazing.
I love their mentality to, to just do it.
They made a whole AID space happen andI'm so, and they keep being in front.
It's amazing because these companies, theyhave so much more resources and then the,
the open source, they're always in front.
And that's, that's so cool to see.
(13:05):
But, uh, there's not a lot ofpeople using it to be honest.
Like in Belgium, you have free pumpsfrom the, now we also have ins... Yeah.
Insulet.
So at the moment, not alot of people using it.
Gary Scheiner (13:16):
Yeah.
Yeah.
No wonder they're able to innovatequickly, you know, when you don't have to
Dr. Inga Boxelaer (13:21):
yeah.
Yeah.
You don't have the rules.
Gary Scheiner (13:22):
You don't have to do clinical studies and
Dr. Inga Boxelaer (13:24):
I know
Gary Scheiner (13:24):
submit for approval and wait, and wait and wait.
Dr. Inga Boxelaer (13:27):
Yes.
Gary Scheiner (13:27):
You can make changes pretty rapidly.
Some people feel...
Dr. Inga Boxelaer (13:30):
Its wonderful that they're doing that, right?
And it's all-- they doit in their free time.
That's, that's alsothe cool thing I think.
Gary Scheiner (13:36):
Yeah.
And you know, they talk topeople before implementing
these to make sure they're safe.
And yeah, to this point, youknow, things, it's been very,
they've been very safe systems.
You know, Sequel Medical is launching, um,their, their Twist system now, and it's
using, uh, the Loop app, which is, wasthe first, uh, open source, DIY system.
(13:58):
But it's several years out of date.
You know, it's an older, older versionof Loop because it's had to go through
all the process to get approval.
So it's still a great algorithm,but it doesn't have all the advanced
features that the current version has.
Dr. Inga Boxelaer (14:12):
But still, it's gonna be the first that
has like the watch control.
I think that's very cool.
And it's still gonna be a first ina lot of things like, but uh, yeah,
it's amazing that, that even it's, ifit's just an older version, of course,
that they are still in front of theother AID systems on some points.
Gary Scheiner (14:29):
Yeah.
Any other cool tech thatyou've come across recently?
Dr. Inga Boxelaer (14:32):
Yeah.
I had my, because, um, maybe you'reinterested from the US, I have
here the Kaleido 2, which is the,the updated version of the current
Kaleido pump with all the cool colors.
Gary Scheiner (14:41):
Mm-hmm.
Dr. Inga Boxelaer (14:42):
It's gonna be,
Gary Scheiner (14:43):
That is tiny.
Wow.
Dr. Inga Boxelaer (14:44):
It's tiny and if you look at it next to Omnipod,
I think, and it feels very smooth.
It's still a little bigger thanMetro, which is also available
like not in Belgium, but inNetherlands and in Eastern Europe.
A lot of people are using Medtrum,which is, especially compared
to Omnipod, it's very small.
It's a little bit like the edgesare not as round, but people really
(15:05):
like this, uh, small pump also.
So, and a lot of all sorts of....
Gary Scheiner (15:09):
How far does it project off the skin?
That's, that's an issue a lotof people have with the pods.
Dr. Inga Boxelaer (15:12):
It's the same.
It's the same.
It's the same, but the edges arenot as round, so like maybe it
bumps more, but people are, it'sstill smaller, so people like it.
And there's actually also a 300unit version, which is kind of
the same size as the Omnipod.
And they're, they're alsonot that expensive, so.
Gary Scheiner (15:30):
Yeah.
Do you ever, uh, have your patientsuse concentrated insulin in the pumps?
Dr. Inga Boxelaer (15:35):
Uh, we are gonna start doing that, but I haven't done it
yet because now that Insulet is coming,I think it's gonna be, uh, there's
gonna be some candidates for that.
But before we only, we mainly usedMedtronic and Tandem, and there it
was not really necessary because thereservoirs are bigger and you can
just change the reservoirs quicker.
And also in Belgium, we don'thave any reimbursement for
(15:57):
people with type two and pumps.
So most are type one andthey use less insulin.
Gary Scheiner (16:01):
Hmm, okay.
No, that's unfortunate.
Dr. Inga Boxelaer (16:04):
Yeah.
That's unfortunate.
Yeah.
We don't have it all-- yet.
Gary Scheiner (16:06):
Yeah.
Hopefully it'll move that way.
Especially with the automated systems.
I know people with type twocan really benefit from, from
the automated adjustments.
Dr. Inga Boxelaer (16:15):
Yeah.
But then now we, we just came inwith the Mounjaro reimbursement,
so let's hope we can get all thosepeople with type two on less insulin.
Gary Scheiner (16:24):
Yeah.
Yeah.
So do you, uh, are you ableto get reimbursement for GLP-1
medications for type ones there?
Dr. Inga Boxelaer (16:32):
Well, I think we take a similar approach as in the
US where you say that people withtype one who are obese, they have
maybe also sort, a form of type two.
Like we haven't have had any denials yet.
But it's a tricky situation becauseyeah, it's, it's only reimbursed for
people with type two diabetes, so wehave to state that the person also
(16:54):
has type two diabetes, so, yeah.
Gary Scheiner (16:56):
Yeah.
We started, uh, calculatinginsulin resistance based on,
you know, how many units do yourequire per kilo of body weight?
Establish this person is insulinresistant type two as well as type one.
Dr. Inga Boxelaer (17:09):
Yeah.
So I, I am very happy with allkinds of publications that, that,
that follow that line of thought.
And then when we get a denial,maybe we can show that.
Gary Scheiner (17:19):
Now a word from our sponsor.
Byram Healthcare understands thatmanaging diabetes isn't one size fits
all with a full range of CGMs, insulinpumps, and diabetes supplies from top
brands, Byram makes it easy to getwhat you need, hassle free, shipped
right to your door and Byram's teamof experts helps navigate insurance so
(17:40):
you can focus on living your best life.
Ready for better diabetes care?
Visit byramhealthcare.com/podcast.
Or call 8 6 6 6 9 2 8 0 2 4 and selectoption three, and now back to our program.
Alright, so I'm gonna, I'm put youon the spot a little bit and granted,
(18:01):
this does not reflect anything aboutyour employer or the companies you
might do work with, but I, I wannaknow what you think are sort of the
best in class, the best devices,items in certain categories and why.
Let's start with CGM.
Continuous glucose monitors,which is, do you have a favorite?
Dr. Inga Boxelaer (18:20):
I like, uh, both Libre3 and Dexcom G7.
I like them both.
I think the companies are, are doingtheir best to level with each other.
Uh, I like their readout programs.
It's very quick, very easy.
They give free sensors when,when the sensors break, they
send them to patient's home.
Yeah, I like the support.
Yeah.
Those are my main favorites.
(18:42):
Yes.
Gary Scheiner (18:42):
Okay.
Fair enough.
I would agree with you on that.
Yeah.
We've had historically greatsuccess with the Dexcom products.
They've had some quality control issuesrecently that they're working through,
but they've always had, they've beenlike really cutting edge in terms of
advanced features and user friendlinessand even, you know, the alert settings
can be customized really, really nicely.
Dr. Inga Boxelaer (19:04):
I think Dexcom, it has more options,
but, and, and Libre is very easy.
So I think they're both, both very goodand I love that every year they have some
new features and they keep developingtheir products, so it's amazing.
Gary Scheiner (19:17):
Yep.
Okay.
Insulin pumps.
And do you have a favorite?
Dr. Inga Boxelaer (19:20):
I actually, we have most people as most centers
in Europe on the MiniMed 780G.
The results are amazing.
People are very happy.
And although it's very
Gary Scheiner (19:29):
Well, let's talk about just the pump.
Ignore the sensor and the algorithm.
Just the
Dr. Inga Boxelaer (19:34):
oh, terrible.
Gary Scheiner (19:35):
Physical pump itself.
Dr. Inga Boxelaer (19:36):
I know, but I wanted to say they don't wanna give
it back because of the algorithm.
But of course the pump, it's the worst.
It's the worst.
But they don't have another yet.
I, it, it, it just gave meso much pleasure to change
people's lives with the system.
But it's, you are right.
It's the algorithm.
Uh, for pump, I think Iwould go for the Omnipod.
I'm so happy that we have it.
(19:56):
Finally, the Omnipod 5.
before, like I try to convince all mypatients to go on a, a, uh, AID and
they all said, no, no, no, because theysaw the pump and now with this one?
They're all saying yes.
So yeah, I'm really looking forward to it.
Gary Scheiner (20:09):
You can't beat that form factor, although
the Medtrum you showed me.
Dr. Inga Boxelaer (20:13):
Yes, yes.
But we also, we don't have thatone yet in Belgium, and there
is no publications on this one.
So it's, it's gonna be like abit of a risk and it's AI and we
don't really know how it works.
But yeah, it's actually beingused and the reviews are good.
So, and there is some publication,so yeah, this, this one, I
guess it's, uh, it's bigger.
(20:33):
And, and more trusted.
And we don't have theMedtrum yet in Belgium.
Gary Scheiner (20:36):
Yeah.
And you know, I, from what I'veseen and read, there's a lot of
companies developing the patch pumps.
You know, Beta Bionics is workingon, on, um, called the Mint.
Tandem is working on their Siggy.
Dr. Inga Boxelaer (20:47):
Yeah.
Yeah.
Gary Scheiner (20:48):
Medtronics, well, MiniMed,
Dr. Inga Boxelaer (20:50):
Medtronic.
Now medtronic, if Medtronic is coming,
Gary Scheiner (20:51):
you gotta think about recall, renaming it miniMed.
You gotta change the, thenomenclature a little bit.
Dr. Inga Boxelaer (20:56):
Yeah.
It's gonna be the, the flex, right?
The flex pump from Medtronic.
I am, I really looking forward to that.
But they're not on the market yet.
So let's see who's first.
Let's see who's first.
I think Medtronic, uh, Insuletis gonna gain some market here.
Gary Scheiner (21:08):
Yeah.
Uh, what about the algorithm, that littlecomputer software that does the automated
adjustments on the user's behalf?
Do you have a, a preferenceof a certain system for that?
Dr. Inga Boxelaer (21:21):
Yeah, I already mentioned that we are
very happy with the MiniMed.
I think it's really easy asa healthcare provider also.
It's not much things you have to change.
Like with Tandem, you do have tobe a little bit more looking at
the data and changing to get reallythe results of these studies.
While with MiniMed you, you seethe results that, that they show.
Algorithm wise?
Yeah, I, I, yeah.
(21:42):
To be honest, I think the, but it's,it's difficult to say as there are no
head to head studies, and then we sawthis recent study that maybe the Guardian
and the Simplera sensor are measuring alittle bit lower than the Dexcom sensors.
So I will be very interestingto, to see the results of the
MiniMed with the Abbott sensor.
I hope that it'll come soonand then, uh, and then we will
be able to truly compare them.
(22:04):
But I do believe, that Medtronicis, is gonna be even better with
their next algorithm at Medtronic.
They're so excited abouttheir next algorithm and the
updates of their algorithm.
So even though maybe, yeah, thisalgorithm, we don't have any comparison.
I think their next algorithmis gonna be very good.
Gary Scheiner (22:20):
It, it, it struck me that all of these companies
are working so hard to automatebolus delivery as well as basal.
Yes.
They, they wanna make it so the user doesnot have to announce their meals, count
carbs, estimate carbs, do any of that.
And you know, they'restill coming up short.
You know, when people announcetheir meals and bolus in advance,
(22:41):
you can always get better glucosecontrol than waiting for the system
to realize you need more insulin.
I wish they would invest some of thatin behavioral research into, well,
what do we just have to do to getpeople to bolus, to give, to tell it
they're, they're about to eat insteadof trying to avoid that so much.
Any thoughts?
Dr. Inga Boxelaer (22:59):
It reminds me now of the, uh, the missed bolus alert
of the InPen, which is now available.
In, in the InPen, which is like a coolalert, but of course then it's too late.
So they should be remindedbefore they eat, right?
Yeah, because the mixed, the missedbolus alert is the same as the,
as the algorithms that are goingto be used not to bolus anymore.
So, yeah.
Gary Scheiner (23:17):
Yeah, the pumps often have, have those alerts.
Also, you can set customized timeframes.
Dr. Inga Boxelaer (23:22):
Yeah.
No, but the missed bolus alert with theInPen, it's actually based on the glucose.
It's not based on the timeframe.
Gary Scheiner (23:27):
I see.
Dr. Inga Boxelaer (23:27):
So if the glucose goes up and you, and they see that
you didn't bolus, then they say youprobably ate, you missed your bolus.
So I, it's like it'salready more advanced, but
Gary Scheiner (23:38):
So it's prompting you to give insulin?
Dr. Inga Boxelaer (23:40):
Yeah.
Yeah.
And I also think, yeah, no, if you'resaying like, why aren't they not
doing more research on, on bolusing?
I do love the results of Pramlintidedoing a little bit of Pramlintide
in your pump and then having,just slowing down the absorption.
So the algorithm of the, uh, mealrecognition works in time of getting the
(24:02):
bolus there, maybe that will do the trick.
Maybe then we go to 90%.
Gary Scheiner (24:05):
Well, Symlin is being discontinued, so we're gonna
have to look for other sourcesfor the amylin hormone now.
But getting people to bolus is achallenge consistently, and getting
'em to pre bolus is, is even greater.
There's a pediatric endocrinologistat Yale named Bill Tamberlin.
I don't know if you know his name,but pretty famous guy that I, I
(24:26):
heard him speak at, uh, one of theBarbara Davis conferences years ago.
And his approach working, especiallywith teenagers, to get them to give
their boluses to prompt them ishe made these little stickers up
that he would put on their pumps.
And it just had four letters, TTFB.
Which stands for Take the Flipping Bolus,and the kids got such a kick out of it and
(24:48):
it actually got them to give their bolusesmore regularly than without the stickers.
So the algorithms, you do like Medtronic,and I certainly agree with that.
Now the tandem algorithm is, it's asimpler one and they're very transparent
about how it works, but I think it,it does require the user to get their
settings dialed in a little bit better.
(25:10):
Both basal and bolus settings.
The open source algorithms though, howdo you think they compare to Medtronics?
Dr. Inga Boxelaer (25:16):
That's a good question.
That's a good question.
I think the newer, like the basicopen source, but if you start
using AutoSense and those dynamicinsulin sensitivity factor and those
unannounced meal features, I don't know.
What do you think?
That's a good question.
Would they be better than Medtronic?
Gary Scheiner (25:33):
I found them to be better.
Dr. Inga Boxelaer (25:34):
Yeah.
Gary Scheiner (25:34):
Than any of the commercial algorithms, whether it's Loop or trio.
I find that.
The secret sauce is that they account foractive carbs as well as active insulin.
Dr. Inga Boxelaer (25:46):
Ah, maybe that's it.
Gary Scheiner (25:47):
The commercial systems don't do that.
So they, they do a better job ofpredicting where the glucose is
gonna be going, and they're notjust looking 30 to 60 minutes ahead,
they're looking five hours ahead.
Dr. Inga Boxelaer (25:57):
Mm-hmm.
Gary Scheiner (25:58):
So they're able to make better predictions and make
better, I think, more appropriateadjustments for the user.
Dr. Inga Boxelaer (26:06):
Yeah, if you look at the results of the Close It that they
had, like non-inferiority, if they'renot bolusing, that's not what you're, I'm
not sure if you see that with Medtronic.
We, we have a lot of patients thatare not bolusing, but they are.
Gary Scheiner (26:17):
Mm-hmm.
Dr. Inga Boxelaer (26:18):
Their time in range is less, and so in the Close It Trial
it was the same time in range, but yeah.
So yeah, they may bebetter on some points.
Yeah.
Gary Scheiner (26:26):
Yeah.
And for some people, some peoplewho are more engaged in their
Dr. Inga Boxelaer (26:30):
yeah.
Gary Scheiner (26:30):
day to day management.
Dr. Inga Boxelaer (26:31):
Yeah.
It's not as easy.
Yeah.
Yeah.
It's not an easy to
Gary Scheiner (26:34):
Do you have any experience with the, uh, iLet from Beta Bionics?
Dr. Inga Boxelaer (26:38):
No.
I made a course on it.
I think it's amazing.
If you, if you look at the results,I love the system, just putting in
the weight and then putting it on.
I, I wouldn't even dareto invent that system.
But it works amazingly.
So I don't have any experiencebecause, but I made a course on it
and, and yeah, it looks really good.
And I love that they're progressingso fast with their integrations
(27:00):
and the updates of their pump.
Yeah, it's a fast company.
Unfortunately, they do not intendto come to Europe at the moment,
Gary Scheiner (27:07):
at some point.
But from a healthcare provider'sperspective, it's a dream because
Dr. Inga Boxelaer (27:12):
it's a dream.
Gary Scheiner (27:12):
Virtually nothing you have to do.
Dr. Inga Boxelaer (27:14):
Yes.
Gary Scheiner (27:14):
No settings that have to be, no fine tuning of the settings at all.
Dr. Inga Boxelaer (27:18):
Yes.
And also like,
Gary Scheiner (27:20):
and for users, there's that simplicity of just
estimating small, medium, large meals.
And
Dr. Inga Boxelaer (27:25):
Yes and in Belgium
Gary Scheiner (27:27):
There was some data presented at ADA about that.
Entering small, medium, large carbamounts instead of exact carb counting.
And with AID systems, theoutcomes are very similar.
Dr. Inga Boxelaer (27:37):
Yes.
Yes, that's true.
And that's actually a dream because inBelgium we don't really count carbs.
It's not in the basic educationof people with type one diabetes.
They just do, uh, carb equivalents,which is much less in detail.
So have it, if we wanna people,have people on pumps, they
first have to count carbs.
So I, I am very happy with allthis new data that we can maybe
(27:58):
skip that step and just let thedietician do the, uh, calculations.
Gary Scheiner (28:03):
You mentioned the InPen and that's, you know,
just one of the connected pens.
You know, you have theNovo Pen six in Europe.
We don't have that here yet.
Are there any other connected pensthat you've had experience with?
Dr. Inga Boxelaer (28:15):
No.
They were so close inlaunching the Sol Smart Pen.
Gary Scheiner (28:18):
Mm-hmm.
Dr. Inga Boxelaer (28:18):
Like the pen cap, but it didn't happen in the end.
And also the Novo Pen, we stopped usingas the, there was an integration with
Libre2, but then everybody went toLibre 3 and there is no integration
with Libre 3 and integration withDexcom is not as easy because it goes
through Glooko and Yeah people withDexcom, they don't have Glooko and Yeah.
(28:40):
Anyway, so, okay.
It was really fun with Libre two actually.
I miss it.
Gary Scheiner (28:44):
Yeah, so you mentioned Glooko, we've got a multitude of
software that we can use to collect data,generate reports, and you know, help
a little bit with the analysis being.
We have Tide Pool.
Uh, also we got Nightscout.
Plus all the company, the proprietarystuff like CareLink and Tandem Source.
(29:08):
So is there a software, software,
Dr. Inga Boxelaer (29:11):
yeah and the Libre View.
Gary Scheiner (29:13):
Is there a software that you prefer?
That you find generatesthe most helpful reports?
Dr. Inga Boxelaer (29:18):
I think it's the software that you use the most.
Because I was just talking to the peoplefrom Dexcom, now we are in the process
of switching from Libre to Dexcom.
Gary Scheiner (29:26):
Yeah I never even mentioned clarity.
Dr. Inga Boxelaer (29:27):
Yeah, clarity, yes.
So I think it's, it's just thereports that you're used to
that's, that will give you the.
It's the quickest insight because youknow where to look and you see the visual
directly, and then if you have to switchplatforms, it just takes some time.
But I guess it's like with pumps,you need like a year to adapt to
a new pump also as a healthcareprovider, to get the hang of it.
(29:50):
Yeah.
But yeah.
Gary Scheiner (29:52):
Yeah.
I gravitate towards programs thatgenerate, they call a spaghetti graph,
you know, the, the overlay of, yeah.
Yeah, I, I get so much out ofthose reports in minimal time.
Dr. Inga Boxelaer (30:05):
You take so much-- you really go into depth, right?
You really take yourtime for your patients.
I guess the reality here iswe just look at it for one
minute and then yeah, it's, it.
We don't really ha... take that muchtime and so if you, so I guess you're
the biggest expert here on the reports.
Gary Scheiner (30:20):
Yeah.
Maybe visually.
Just visually that that overlay, thatspaghetti graph just does it for me.
Or maybe it's just that I lovespaghetti and that's what it's called.
Dr. Inga Boxelaer (30:29):
Yeah.
I actually, I always look for the AGPreport because I really like Dr. Bergen's
style, one to one to three steps.
Like if you're good, thenyou're good, and it's okay.
And then so, I think that's easy.
And that report is on every,mostly on every platform.
That really helps.
Gary Scheiner (30:46):
That is true.
Yeah.
I try to teach my patients how toread those AGP reports as well.
Dr. Inga Boxelaer (30:51):
The AGPs?
Yeah.
Gary Scheiner (30:51):
And, and, and the spaghetti reports when they're available.
When they're available.
So I'm gonna put you on the spot again.
Uh, now you mentioned before that eventhough you have all of this expertise,
you don't have type one yourself.
And I, I was thinking we would voteyou into the Type one club in an
instant, and we're pretty meticulousabout who we led into that club.
But you would be one of thefew non-type one allowed
Dr. Inga Boxelaer (31:16):
One of the nerd from the type one community.
Gary Scheiner (31:18):
We're, we're cool.
Are you kidding?
Dr. Inga Boxelaer (31:19):
Yes.
Yes.
The cool Nerds.
Nerds are cool.
Right?
Gary Scheiner (31:21):
Cool nerds.
All right, cool.
Athletic nerds.
I'll, I'll go for that.
Dr. Inga Boxelaer (31:24):
Yes.
Yes.
Gary Scheiner (31:26):
If you had type one, what equipment, what
systems would you be using?
Dr. Inga Boxelaer (31:31):
I'm more of a hands off person.
Like I wouldn't be like, I thinkI wouldn't have the energy to
go for the 100% time in range.
I would be like, how can Ilive with diabetes without
thinking about it too much?
So I think, I think I wouldgo for the Omnipod five then.
Gary Scheiner (31:47):
Okay.
You might even like the iLetbecause that's probably the
most hands off system we've got.
Dr. Inga Boxelaer (31:52):
Yeah.
But I don't think, do you think theiLet is as good as the Omnipod five?
I'm not sure.
Gary Scheiner (31:58):
In some ways, if you really want hands off, not
thinking about diabetes very much.
Dr. Inga Boxelaer (32:04):
I know, but the reason I don't want the iLet.
Yeah.
Gary Scheiner (32:06):
Yeah.
But in terms of glucose management,yes, having some ability to pull some
levers and fine tune on your own.
The iLet is lacking now.
There's no way to accommodatefor exercise, for example.
Dr. Inga Boxelaer (32:18):
Yeah, if you forget your sensors and then you
have a little bit problem there,your pump is not working anymore.
And also, I, I don't like tube pumps.
Sorry.
But this is personal and I,I don't wanna say anything
against the MiniMed people, but
Gary Scheiner (32:31):
it's okay.
Dr. Inga Boxelaer (32:31):
It's, um, my pump would drop every minute, so, yeah.
Yeah.
Which actually this no problem becauseI tested the pumps and it dropped
all the time and it didn't break, so.
Gary Scheiner (32:39):
Yeah.
Dr. Inga Boxelaer (32:40):
That's good.
Gary Scheiner (32:40):
I had a meeting with ConvaTec earlier.
They make all the tube infusionsets for all the companies.
You know, we did a survey with ourown patients on pumps asking about
tubing, and for the most part, theydon't find it to be an inconvenience.
Dr. Inga Boxelaer (32:54):
No, that's true.
You're, if you ask people on atubed pump, they don't really mind.
I think after two weeksyou're probably used.
How long does it take toget used to a tube pump?
Because the first days youreally drop it all the time.
Gary Scheiner (33:05):
Couple.
A couple days.
Yeah.
Dr. Inga Boxelaer (33:07):
Okay.
So I didn't do long enough.
Gary Scheiner (33:09):
It's more a perception that, oh, this
tubing is gonna be an annoyance.
Dr. Inga Boxelaer (33:13):
If, if you have to change clothes, then you
have to put your pump somewhere.
And that's, that wasthe weird part for me.
Yeah.
Gary Scheiner (33:19):
Okay.
So you'd be using the Omnipodand the Omnipod five most
likely with its algorithm?
Dr. Inga Boxelaer (33:25):
Yeah, and like last year I would of, or maybe the open
source, because now I know how it works.
I think the main thing withopen source, the main barrier is
understanding how it works, butonce you understand it, it actually
gives you more flexibility, I think.
Gary Scheiner (33:38):
So they come to us.
That's what our team does,is teach people that.
Dr. Inga Boxelaer (33:41):
Yes, and I would definitely come to you for, for virtual,
uh, support, which is amazing thatyou support people around the globe.
I'm not sure if everybodyknows this, but Yeah.
Gary Scheiner (33:51):
Yeah.
We deal with language barriers sometimes.
Yes, we can handle English in Spanish.
Dr. Inga Boxelaer (33:54):
Everybody speaks English, right?
Yes.
Gary Scheiner (33:56):
Uh, not everybody.
I wish we had more language capability.
Dr. Inga Boxelaer (34:00):
No, because in in Belgium, we don't have a
lot of people that are using opensource, so our knowledge of open
source is very, like a lot lower.
And yeah, having access to, toexperienced healthcare providers who
really go into detail like you do, Ithink it's, uh, it's very beneficial.
Gary Scheiner (34:16):
Last question.
This is for patients, people using thesedevices, what advice would you give, uh,
for those who wanna really get the mostout of the technology that's available?
Dr. Inga Boxelaer (34:27):
I think it, it depends on, do you wanna have Yeah, the
most out of the, out of the technology.
It's definitely like...Start using an AID system.
Don't wait.
Don't wait too long.
Like deciding like, whichone are you going to use?
Just start one.
And if you don't like it, choose another.
And then if you like to, some peoplelike getting the most of the system,
is it getting the best glucose oris it getting the best life and
(34:48):
not having to think about diabetes?
And I think that's where you decideof which type of system you choose.
And also ask your healthcare provider.
Maybe for health because yeah, it alsodepends, some healthcare providers are
very much trained on specific systems andit might also be beneficial to choose a
system that your healthcare provider isvery trained in and not choose a system
(35:10):
that he never worked with or like switchhealthcare provider because of system.
Maybe that's not necessary becausethe connection with your team is also
important, but yeah, that's an idea.
Gary Scheiner (35:20):
I love what you said about don't wait.
If the AID system is available,
Dr. Inga Boxelaer (35:24):
You don't wait.
Gary Scheiner (35:25):
Just drive some and get on it.
Dr. Inga Boxelaer (35:26):
Yeah.
Gary Scheiner (35:26):
I describe it to my patients this way.
I say, you know, if you're not on anAID system, you know, you're, you're
driving a, a Honda Accord or a ToyotaCorolla, but somebody has said, here's
the keys to a Ferrari and I'll trade you.
Who's gonna turn that down?
Dr. Inga Boxelaer (35:44):
Yeah.
Gary Scheiner (35:45):
You gotta be crazy not to do that.
I mean, you can always go back toyour little car if you want, but
who doesn't wanna drive a Ferrari?
You know, you take advantage of that.
Dr. Inga Boxelaer (35:53):
I think it's the same level.
Like a few years ago we had toput everybody on sensors and there
were so many people say, oh no,I'm comfortable with the strips.
I will use the strips.
And then now they're, everybody's onsensor and, and you, I remind them,
do you remember the time you had to goon a sensor and you also were doubting
and then this is the same thing.
This is the same step up.
Yeah.
Gary Scheiner (36:10):
Yeah, exactly.
I also remind everybodythat nothing's permanent.
If you try something and you findit's just not for you, just go
back to what you were doing before.
Dr. Inga Boxelaer (36:19):
Yes.
Gary Scheiner (36:20):
No one's gonna gonna criticize you if you do that.
At least you gave it a fair try.
All right, so just a quicksummary, what we discussed.
Technology has come on, fast and furiousin the diabetes space and, you know,
certainly users of the systems need tobe up to date on what's happening, but
even more so, their healthcare providers
Dr. Inga Boxelaer (36:40):
Yeah,
Gary Scheiner (36:41):
need training, education and build some confidence in, in how
to use them effectively in order tobe able to treat patients effectively.
Dr. Inga Boxelaer (36:49):
And I also, I also wanna add if there's any
like healthcare providers who aredoubting to start AID systems in
their clinic, uh, don't be afraid.
It's not that hard aspeople say that it is.
And if you, uh, if you are unsure, youcan always check our website, of course.
But we are so happy that westarted and we are able to make...
(37:10):
there is nothing more fun asseeing a patient back after
they start an AID system.
It's, it's, you're not gonnadisappoint your, your patients.
Yeah.
Gary Scheiner (37:18):
And that's the, uh, Diabetotech website and we,
we'll have that information inthe show notes for everybody.
And I also like one of your concludingstatements about not just going
with the same system for everybody,each individual needs to match
the equipment to the personality.
You know, if you're the type thathas certain specific needs to
(37:39):
manage your diabetes well lookfor systems that offer that.
If you're the type that wants ahands-off approach, look for that.
If you, if you like being involved andengaged in your management, or need to
be engaged to fine tune things, finda system that'll let you do that, and
there's a whole spectrum and everything inbetween, so you have lots of good options.
Dr. Inga Boxelaer (37:59):
Yeah.
And even, even if you don't haveoptions, like even if there's only
one system available, which is stillthe case in a lot of centers and in
some countries, don't wait please.
Gary Scheiner (38:09):
So I want to thank, uh, the top tech expert in diabetes out there.
Inge, thank you so much for joining today.
Again, the, the links to yourprogram will be in the show notes.
I'm Gary Scheiner reminding everyone outthere to keep thinking like a pancreas.
Dr. Inga Boxelaer (38:26):
Thank you.
Gary Scheiner (38:27):
Thanks for tuning in to Think Like a Pancreas, the Podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a pancreas.
The podcast, is brought to you byIntegrated Diabetes Services, where
experience meets expertise, passionmeets compassion, and diabetes care
(38:48):
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 losstype one, pregnancy and emotional
(39:09):
wellbeing, 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.
(39:29):
I'm Gary Scheiner, wishing you afantastic week ahead, 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 alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
Welcome to Think Like aPancreas, the podcast.
I'm your host, Gary Scheinerowner and clinical director of
Integrated Diabetes Services.
The title of today's session , isTaking Diabetes Tech to the Next Level.
You know, diabetes tech is exploding,not literally, hopefully, but
(00:56):
it, it's exploding worldwide.
A, a lot of us struggle tounderstand how the various options
compare and how the functionscompare between different systems.
Today you're going to hear from notone of the top, but I consider the
top expert in diabetes technology.
I call her not an expert--she's a tech-xpert.
(01:18):
She knows this technologylike nobody else.
Dr. Dr. Inga Boxelaer, I'm trying toget her name pronounced just right.
I hope I got it well.
Inga is an endocrinologist in Belgiumand she's on a mission to improve the
lives of people with diabetes by makingsure that both healthcare providers and
people with diabetes are up to date onall the latest in diabetes technology.
(01:43):
She has a platform called Diabetotech,and it's recognized as a top international
resource for insight and education.
We'll talk more later about thatand we'll certainly have information
about it posted in our show notes.
But Inga welcome.
Tell us a little bit about your backgroundand what, what got you to this point.
Dr. Inga Boxelaer (02:04):
First of all, thank you Gary, for inviting me.
I'm truly honored to be on theThink Like a Pancreas Podcast.
It's really a name that everybodyknows, think like a pancreas, and
then you invented it a little bit.
So congratulations.
Um,
Gary Scheiner (02:17):
I should write a book about that.
Dr. Inga Boxelaer (02:18):
That would be, yeah, that would be so great.
Congratulations with your newbook that, the new update that's
coming out I just heard about it,so it's, it's gonna be amazing.
I'm definitely goingto buy it and read it.
I'm looking forward to all the updates.
Gary Scheiner (02:32):
I will send you one.
Don't worry.
The technology changes pretty rapidlybetween the first and second editions.
I think there was nine years.
Second to third wassix years, seven years.
This one was only four or five years.
Things are changing so quickly, so Ihad to do almost a complete rewrite.
All the automatedfeatures that we have now.
(02:54):
All the connected devices andnew software, it's, it's really
changed things quite a bit.
And that's your area.
I mean, how did you learnabout all this over the years?
Dr. Inga Boxelaer (03:04):
Well, so I'm an endocrinologist in Belgium
and we mainly treat, uh, adultswith, uh, all types of diabetes.
And I've always beeninterested in technology.
It, it started when I first went toATTD 10 years ago, where they saw
the first children that were usingthese computers next to their bed
that were, and they slept throughthe night for the first time.
(03:25):
And the parents werecrying from happiness.
And every year there was such a buildupof this technology, uh, that we finally
even had it in our hands in, in 2019.
So I was so excited, uh, to start it.
But then, uh, I saw unfortunatelythere were quite some barriers
to start these AID systems.
You do need some background and yourwhole team needs to be trained to be,
(03:49):
to support people on these systems.
And that's where I saw the biggestbarrier, uh, that we didn't have
any videos, uh, available yet.
It was more representatives thatgave in-person training, which took
quite some hours, and it was notdifficult... it was very difficult
to get a whole team in one room.
And that's where I got the idea, like,let's make videos of this onboarding
(04:11):
education and all the things the careteam needs to know, so we all have
confidence to start these systems better.
Gary Scheiner (04:19):
Yeah, I mean, I've had the privilege of seeing some of the videos
that you've produced and you actuallylet me participate in some of them.
Dr. Inga Boxelaer (04:25):
Yeah.
Thank you so much.
Gary Scheiner (04:26):
They're really well done.
I always found it ironic, not ironic,but really sad how little most healthcare
professionals know about diabetes tech.
If you bring your car to theshop for repair, those mechanics,
they're trained and certifiedon everything under the hood.
Dr. Inga Boxelaer (04:44):
Yeah.
Gary Scheiner (04:44):
But if you bring yourself to your doctor or to your nurse,
the tech that you're using to manageyour, your diabetes and keep yourself
alive, most of the time they, theyknow little to nothing about these.
Is that, that your experience as well?
Dr. Inga Boxelaer (05:00):
Yeah, I think, especially in, in Belgium, it's with
the, with the physicians as, likein Belgium, the nurses are very well
trained on these AID systems, becausehere we do the onboarding ourselves.
So we have, uh, it's not a companythat trains the patients, it's really
the nurses that onboard the patients.
So our nurses, they know the systemsvery well, but the physicians, they don't
(05:22):
really know how to do the button pressing.
And if you wanna change the,the carb ratio or the insulin
sensitivity, we, we would havedifficulties finding it on the pump.
So, yeah, I think it's, uh, it'sdefinitely a problem if your
nurses have gone home and you'redoing late consultations or early
consultations and the nurse is notthere, it's, it's can be quite tricky.
And it's also kind of weirdto ask, to say, yeah, I don't
(05:43):
really know how your pump works.
So
Gary Scheiner (05:45):
Troubleshooting also can be really tough if you don't understand
the ins and outs of the devices.
Dr. Inga Boxelaer (05:50):
Yeah, that
Gary Scheiner (05:51):
it's more than just pump.
Dr. Inga Boxelaer (05:51):
Yeah, it's people are complaining of something and you
don't know the typical where, whereeverything is regulated or where
the alert alerts are to check whichalert is this person talking about
then, yeah, it's difficult to help.
Gary Scheiner (06:02):
Yeah.
And you got infusion sites and infusionsets to deal with and you got the
sensors to deal with the algorithms.
Dr. Inga Boxelaer (06:10):
Yeah.
You really should know all theoptions and the difference between
the options too to support the people.
Yeah.
Yeah.
Gary Scheiner (06:16):
So what are you doing to help the healthcare providers be in a
better position to help their patients?
Dr. Inga Boxelaer (06:23):
So I made, after I made those first courses, we now have
like 10th generation of the onlinecourse, uh, available on the website.
We have in total, actually 30courses on 30 different devices now.
So all the most used sensors, pumps, andAID systems onboarding training is there.
So with all the button pressing,with all the, uh, videos on how to
(06:47):
change it and how to, uh, interpretthe reports and it's all accredited.
So for, uh, physicians who needsome points, uh, they can get
some points, uh, via website.
A lot of it is free.
It's actually seven days.
Everything is seven days free.
So you can do, if you have a lot oftime, the whole training and a lot
of points ready via the website.
Gary Scheiner (07:04):
That's amazing.
To get continuing educationcredits along with it.
Dr. Inga Boxelaer (07:08):
Yeah.
Gary Scheiner (07:09):
Is is pretty impressive.
Dr. Inga Boxelaer (07:10):
There is always some, some point in the year
that you need some extra points.
Right.
So
Gary Scheiner (07:14):
yeah.
In every, every area.
I, I'm a certified diabetes care andeducation specialist, you know, we need
continuing education to maintain that aswell, so it's something that folks can
access and, and we'll have links to thatin the show notes for today's program.
In Belgium, do you measure glucosein milligrams or millimoles?
Dr. Inga Boxelaer (07:34):
Milligrams.
But the courses are made forinternational public, so everything
is in milligram and millimole inmeters and inch and all that stuff.
So we do all the metrics.
Gary Scheiner (07:44):
The technology is available.
In every country.
We've got things available to us,
but I find when I work with internationalpatients, sometimes they have access
to things that I don't even knowexisted 'cause we don't have them
in the US and sometimes they don'thave access to much of anything.
Dr. Inga Boxelaer (08:02):
Mm-hmm.
Gary Scheiner (08:03):
So do you work with only patients in Belgium or do you work
with people in other countries as well?
Dr. Inga Boxelaer (08:08):
So, in Belgium, like virtual care is not really reimbursed.
So, and we cannot do non-reimbursed care.
So yeah, I only see patients from Belgium.
Here in this room, it's very...
Gary Scheiner (08:20):
so using Belgium as a, as a case, as an example, how difficult
is it for a patient to access pumps andsensors and the insulin that they prefer
and other medications for that matter?
Dr. Inga Boxelaer (08:33):
Yeah, I think in Belgium we are very privileged
because it's, we not only have freeinsulin, but we also have people with
type one diabetes, they have freesensors, free pumps, free choice of
all the devices available in Belgium.
They have free choice ofhospital, of healthcare provider.
So yeah, I think they have very good care.
(08:53):
Like they even have reimbursementfor diabetes, uh, education
as much as they want.
Dietician, psychologists.
So, yeah, I, I think it's a dream scenariofor people with type one diabetes.
Gary Scheiner (09:05):
Mm-hmm.
Dr. Inga Boxelaer (09:05):
We don't really have like all the reimbursement that you have
in US for like chest-- sensors for peoplewith gestational diabetes or people
on basal insulin or people on orals.
We don't have that kind of reimbursement.
But people in type one, thelobbying was very well done.
So I do wanna congratulate ProfessorMateo for that one because she's from
Belgium and she made that happen.
Gary Scheiner (09:26):
So, yeah, we type ones are, we are not exactly quiet people.
Dr. Inga Boxelaer (09:31):
No, no.
There is a lot more lobbyingfor type one than for type two.
Right.
Yeah.
But yeah, they made it happen.
Gary Scheiner (09:37):
Yeah.
We, we raise a lot of ruckus when wedon't feel we're being treated fairly.
Dr. Inga Boxelaer (09:41):
Yeah.
And you should be, I think it's, yeah.
It's, it's bad enough that, thatyou, that you have this yeah,
disease, you should be taken care of.
I think everybody..
Gary Scheiner (09:52):
Some of, what are some of the, the hot items devices in Europe
that Americans may not be familiar with?
I was at the ADA scientificsessions and I saw some things
there that just blew me away.
There's a company that's developing athree year sensor that's implanted in
a vein so it's, there's no lag time.
It's measuring glucose in realtime in the bloodstream and
(10:13):
it's implanted for three years.
The thing is functioning, doesn'tneed any maintenance charging.
Dr. Inga Boxelaer (10:18):
Is that the glucose track?
Gary Scheiner (10:19):
The Gluco Track.
Dr. Inga Boxelaer (10:20):
Yeah, yeah.
It's amazing.
And I think the accuracy is so good.
Gary Scheiner (10:23):
Yeah.
Dr. Inga Boxelaer (10:23):
Yeah.
But we don't have it.
It's,
Gary Scheiner (10:25):
they're only testing it in Europe right now and
Dr. Inga Boxelaer (10:27):
yeah.
Gary Scheiner (10:28):
It seems like a lot of things are in Europe
before they make their way here.
So what, what's got you excited?
Dr. Inga Boxelaer (10:33):
In Europe?
Like, to be honest, we are all verymuch, much Medtronic here in Europe.
Like Medtronic is everywhere andall hospitals have Medtronic, and we
are so happy with the Minimed 780G.
We have the Simplera, which has alot of production problems at the
moment, so they only get one Simpleraand then they have to come back.
(10:53):
But, so this is really, uh, a new, sowe, we have some devices that you don't
have in the US but we mainly use thedevices that are US based, to be honest.
So now Insulet is finally herealso, so everybody's like,
we finally have a patch pump.
But what we also have in Europe, whichis very popular is the, uh, Ypsomed
(11:14):
with the, um, you know, the onethat's also being used for pregnancy.
And the Libre uh, three option isvery popular, but unfortunately,
you know, you have these
now the issues with the pump cards thatare no longer being made and they're
having some, um, how do you say it?
Yeah.
Not, not enough pump cards for everybody.
Uh, but yeah, they're, I'm, I'm surethey're gonna make a solution for
(11:35):
that and also their infusion sets.
But still, it's, it's a verypopular pump at the moment.
Yeah.
Gary Scheiner (11:40):
And what, what do you like about the Ypsomed device?
Dr. Inga Boxelaer (11:43):
I think, I think I like the, the size of it.
It's smaller.
It's, yeah, it was easier to refill.
It's, uh, with an app insteadof on the pump and the sensor.
I mean, yeah, the, the Medtronic sensorsare just not as easy as, you know.
They, uh, Abbott sensorsare very good, so..
Gary Scheiner (12:01):
I have a few patients using it and the algorithm seems
to be a very intelligent one.
Uh, it does a very nicejob of self adjusting.
Dr. Inga Boxelaer (12:09):
Yeah.
I. I'm not sure about theresults compared to MiniMed.
I do think the MiniMed has the bestalgorithm, but I know that I have some
patients who only, who are waitingand waiting for this pump to start,
because we are on the waiting list tostart, because they, they have these low
targets and they wanna have low sugars.
Right.
People wanna, and yeah, with thetargets as low as 80, that's, yeah,
(12:32):
some people are waiting for that.
And of course, for the pregnancy?
I think, um, yeah, it's, it's probablythe best option at the moment.
Gary Scheiner (12:37):
Sure, sure.
Uh, do you have much.
Interest or use of opensource DIY systems?
Dr. Inga Boxelaer (12:44):
No.
I love DIY.
It's, I think the community is amazing.
I love their mentality to, to just do it.
They made a whole AID space happen andI'm so, and they keep being in front.
It's amazing because these companies, theyhave so much more resources and then the,
the open source, they're always in front.
And that's, that's so cool to see.
(13:05):
But, uh, there's not a lot ofpeople using it to be honest.
Like in Belgium, you have free pumpsfrom the, now we also have ins... Yeah.
Insulet.
So at the moment, not alot of people using it.
Gary Scheiner (13:16):
Yeah.
Yeah.
No wonder they're able to innovatequickly, you know, when you don't have to
Dr. Inga Boxelaer (13:21):
yeah.
Yeah.
You don't have the rules.
Gary Scheiner (13:22):
You don't have to do clinical studies and
Dr. Inga Boxelaer (13:24):
I know
Gary Scheiner (13:24):
submit for approval and wait, and wait and wait.
Dr. Inga Boxelaer (13:27):
Yes.
Gary Scheiner (13:27):
You can make changes pretty rapidly.
Some people feel...
Dr. Inga Boxelaer (13:30):
Its wonderful that they're doing that, right?
And it's all-- they doit in their free time.
That's, that's alsothe cool thing I think.
Gary Scheiner (13:36):
Yeah.
And you know, they talk topeople before implementing
these to make sure they're safe.
And yeah, to this point, youknow, things, it's been very,
they've been very safe systems.
You know, Sequel Medical is launching, um,their, their Twist system now, and it's
using, uh, the Loop app, which is, wasthe first, uh, open source, DIY system.
(13:58):
But it's several years out of date.
You know, it's an older, older versionof Loop because it's had to go through
all the process to get approval.
So it's still a great algorithm,but it doesn't have all the advanced
features that the current version has.
Dr. Inga Boxelaer (14:12):
But still, it's gonna be the first that
has like the watch control.
I think that's very cool.
And it's still gonna be a first ina lot of things like, but uh, yeah,
it's amazing that, that even it's, ifit's just an older version, of course,
that they are still in front of theother AID systems on some points.
Gary Scheiner (14:29):
Yeah.
Any other cool tech thatyou've come across recently?
Dr. Inga Boxelaer (14:32):
Yeah.
I had my, because, um, maybe you'reinterested from the US, I have
here the Kaleido 2, which is the,the updated version of the current
Kaleido pump with all the cool colors.
Gary Scheiner (14:41):
Mm-hmm.
Dr. Inga Boxelaer (14:42):
It's gonna be,
Gary Scheiner (14:43):
That is tiny.
Wow.
Dr. Inga Boxelaer (14:44):
It's tiny and if you look at it next to Omnipod,
I think, and it feels very smooth.
It's still a little bigger thanMetro, which is also available
like not in Belgium, but inNetherlands and in Eastern Europe.
A lot of people are using Medtrum,which is, especially compared
to Omnipod, it's very small.
It's a little bit like the edgesare not as round, but people really
(15:05):
like this, uh, small pump also.
So, and a lot of all sorts of....
Gary Scheiner (15:09):
How far does it project off the skin?
That's, that's an issue a lotof people have with the pods.
Dr. Inga Boxelaer (15:12):
It's the same.
It's the same.
It's the same, but the edges arenot as round, so like maybe it
bumps more, but people are, it'sstill smaller, so people like it.
And there's actually also a 300unit version, which is kind of
the same size as the Omnipod.
And they're, they're alsonot that expensive, so.
Gary Scheiner (15:30):
Yeah.
Do you ever, uh, have your patientsuse concentrated insulin in the pumps?
Dr. Inga Boxelaer (15:35):
Uh, we are gonna start doing that, but I haven't done it
yet because now that Insulet is coming,I think it's gonna be, uh, there's
gonna be some candidates for that.
But before we only, we mainly usedMedtronic and Tandem, and there it
was not really necessary because thereservoirs are bigger and you can
just change the reservoirs quicker.
And also in Belgium, we don'thave any reimbursement for
(15:57):
people with type two and pumps.
So most are type one andthey use less insulin.
Gary Scheiner (16:01):
Hmm, okay.
No, that's unfortunate.
Dr. Inga Boxelaer (16:04):
Yeah.
That's unfortunate.
Yeah.
We don't have it all-- yet.
Gary Scheiner (16:06):
Yeah.
Hopefully it'll move that way.
Especially with the automated systems.
I know people with type twocan really benefit from, from
the automated adjustments.
Dr. Inga Boxelaer (16:15):
Yeah.
But then now we, we just came inwith the Mounjaro reimbursement,
so let's hope we can get all thosepeople with type two on less insulin.
Gary Scheiner (16:24):
Yeah.
Yeah.
So do you, uh, are you ableto get reimbursement for GLP-1
medications for type ones there?
Dr. Inga Boxelaer (16:32):
Well, I think we take a similar approach as in the
US where you say that people withtype one who are obese, they have
maybe also sort, a form of type two.
Like we haven't have had any denials yet.
But it's a tricky situation becauseyeah, it's, it's only reimbursed for
people with type two diabetes, so wehave to state that the person also
(16:54):
has type two diabetes, so, yeah.
Gary Scheiner (16:56):
Yeah.
We started, uh, calculatinginsulin resistance based on,
you know, how many units do yourequire per kilo of body weight?
Establish this person is insulinresistant type two as well as type one.
Dr. Inga Boxelaer (17:09):
Yeah.
So I, I am very happy with allkinds of publications that, that,
that follow that line of thought.
And then when we get a denial,maybe we can show that.
Gary Scheiner (17:19):
Now a word from our sponsor.
Byram Healthcare understands thatmanaging diabetes isn't one size fits
all with a full range of CGMs, insulinpumps, and diabetes supplies from top
brands, Byram makes it easy to getwhat you need, hassle free, shipped
right to your door and Byram's teamof experts helps navigate insurance so
(17:40):
you can focus on living your best life.
Ready for better diabetes care?
Visit byramhealthcare.com/podcast.
Or call 8 6 6 6 9 2 8 0 2 4 and selectoption three, and now back to our program.
Alright, so I'm gonna, I'm put youon the spot a little bit and granted,
(18:01):
this does not reflect anything aboutyour employer or the companies you
might do work with, but I, I wannaknow what you think are sort of the
best in class, the best devices,items in certain categories and why.
Let's start with CGM.
Continuous glucose monitors,which is, do you have a favorite?
Dr. Inga Boxelaer (18:20):
I like, uh, both Libre3 and Dexcom G7.
I like them both.
I think the companies are, are doingtheir best to level with each other.
Uh, I like their readout programs.
It's very quick, very easy.
They give free sensors when,when the sensors break, they
send them to patient's home.
Yeah, I like the support.
Yeah.
Those are my main favorites.
(18:42):
Yes.
Gary Scheiner (18:42):
Okay.
Fair enough.
I would agree with you on that.
Yeah.
We've had historically greatsuccess with the Dexcom products.
They've had some quality control issuesrecently that they're working through,
but they've always had, they've beenlike really cutting edge in terms of
advanced features and user friendlinessand even, you know, the alert settings
can be customized really, really nicely.
Dr. Inga Boxelaer (19:04):
I think Dexcom, it has more options,
but, and, and Libre is very easy.
So I think they're both, both very goodand I love that every year they have some
new features and they keep developingtheir products, so it's amazing.
Gary Scheiner (19:17):
Yep.
Okay.
Insulin pumps.
And do you have a favorite?
Dr. Inga Boxelaer (19:20):
I actually, we have most people as most centers
in Europe on the MiniMed 780G.
The results are amazing.
People are very happy.
And although it's very
Gary Scheiner (19:29):
Well, let's talk about just the pump.
Ignore the sensor and the algorithm.
Just the
Dr. Inga Boxelaer (19:34):
oh, terrible.
Gary Scheiner (19:35):
Physical pump itself.
Dr. Inga Boxelaer (19:36):
I know, but I wanted to say they don't wanna give
it back because of the algorithm.
But of course the pump, it's the worst.
It's the worst.
But they don't have another yet.
I, it, it, it just gave meso much pleasure to change
people's lives with the system.
But it's, you are right.
It's the algorithm.
Uh, for pump, I think Iwould go for the Omnipod.
I'm so happy that we have it.
(19:56):
Finally, the Omnipod 5.
before, like I try to convince all mypatients to go on a, a, uh, AID and
they all said, no, no, no, because theysaw the pump and now with this one?
They're all saying yes.
So yeah, I'm really looking forward to it.
Gary Scheiner (20:09):
You can't beat that form factor, although
the Medtrum you showed me.
Dr. Inga Boxelaer (20:13):
Yes, yes.
But we also, we don't have thatone yet in Belgium, and there
is no publications on this one.
So it's, it's gonna be like abit of a risk and it's AI and we
don't really know how it works.
But yeah, it's actually beingused and the reviews are good.
So, and there is some publication,so yeah, this, this one, I
guess it's, uh, it's bigger.
(20:33):
And, and more trusted.
And we don't have theMedtrum yet in Belgium.
Gary Scheiner (20:36):
Yeah.
And you know, I, from what I'veseen and read, there's a lot of
companies developing the patch pumps.
You know, Beta Bionics is workingon, on, um, called the Mint.
Tandem is working on their Siggy.
Dr. Inga Boxelaer (20:47):
Yeah.
Yeah.
Gary Scheiner (20:48):
Medtronics, well, MiniMed,
Dr. Inga Boxelaer (20:50):
Medtronic.
Now medtronic, if Medtronic is coming,
Gary Scheiner (20:51):
you gotta think about recall, renaming it miniMed.
You gotta change the, thenomenclature a little bit.
Dr. Inga Boxelaer (20:56):
Yeah.
It's gonna be the, the flex, right?
The flex pump from Medtronic.
I am, I really looking forward to that.
But they're not on the market yet.
So let's see who's first.
Let's see who's first.
I think Medtronic, uh, Insuletis gonna gain some market here.
Gary Scheiner (21:08):
Yeah.
Uh, what about the algorithm, that littlecomputer software that does the automated
adjustments on the user's behalf?
Do you have a, a preferenceof a certain system for that?
Dr. Inga Boxelaer (21:21):
Yeah, I already mentioned that we are
very happy with the MiniMed.
I think it's really easy asa healthcare provider also.
It's not much things you have to change.
Like with Tandem, you do have tobe a little bit more looking at
the data and changing to get reallythe results of these studies.
While with MiniMed you, you seethe results that, that they show.
Algorithm wise?
Yeah, I, I, yeah.
(21:42):
To be honest, I think the, but it's,it's difficult to say as there are no
head to head studies, and then we sawthis recent study that maybe the Guardian
and the Simplera sensor are measuring alittle bit lower than the Dexcom sensors.
So I will be very interestingto, to see the results of the
MiniMed with the Abbott sensor.
I hope that it'll come soonand then, uh, and then we will
be able to truly compare them.
(22:04):
But I do believe, that Medtronicis, is gonna be even better with
their next algorithm at Medtronic.
They're so excited abouttheir next algorithm and the
updates of their algorithm.
So even though maybe, yeah, thisalgorithm, we don't have any comparison.
I think their next algorithmis gonna be very good.
Gary Scheiner (22:20):
It, it, it struck me that all of these companies
are working so hard to automatebolus delivery as well as basal.
Yes.
They, they wanna make it so the user doesnot have to announce their meals, count
carbs, estimate carbs, do any of that.
And you know, they'restill coming up short.
You know, when people announcetheir meals and bolus in advance,
(22:41):
you can always get better glucosecontrol than waiting for the system
to realize you need more insulin.
I wish they would invest some of thatin behavioral research into, well,
what do we just have to do to getpeople to bolus, to give, to tell it
they're, they're about to eat insteadof trying to avoid that so much.
Any thoughts?
Dr. Inga Boxelaer (22:59):
It reminds me now of the, uh, the missed bolus alert
of the InPen, which is now available.
In, in the InPen, which is like a coolalert, but of course then it's too late.
So they should be remindedbefore they eat, right?
Yeah, because the mixed, the missedbolus alert is the same as the,
as the algorithms that are goingto be used not to bolus anymore.
So, yeah.
Gary Scheiner (23:17):
Yeah, the pumps often have, have those alerts.
Also, you can set customized timeframes.
Dr. Inga Boxelaer (23:22):
Yeah.
No, but the missed bolus alert with theInPen, it's actually based on the glucose.
It's not based on the timeframe.
Gary Scheiner (23:27):
I see.
Dr. Inga Boxelaer (23:27):
So if the glucose goes up and you, and they see that
you didn't bolus, then they say youprobably ate, you missed your bolus.
So I, it's like it'salready more advanced, but
Gary Scheiner (23:38):
So it's prompting you to give insulin?
Dr. Inga Boxelaer (23:40):
Yeah.
Yeah.
And I also think, yeah, no, if you'resaying like, why aren't they not
doing more research on, on bolusing?
I do love the results of Pramlintidedoing a little bit of Pramlintide
in your pump and then having,just slowing down the absorption.
So the algorithm of the, uh, mealrecognition works in time of getting the
(24:02):
bolus there, maybe that will do the trick.
Maybe then we go to 90%.
Gary Scheiner (24:05):
Well, Symlin is being discontinued, so we're gonna
have to look for other sourcesfor the amylin hormone now.
But getting people to bolus is achallenge consistently, and getting
'em to pre bolus is, is even greater.
There's a pediatric endocrinologistat Yale named Bill Tamberlin.
I don't know if you know his name,but pretty famous guy that I, I
(24:26):
heard him speak at, uh, one of theBarbara Davis conferences years ago.
And his approach working, especiallywith teenagers, to get them to give
their boluses to prompt them ishe made these little stickers up
that he would put on their pumps.
And it just had four letters, TTFB.
Which stands for Take the Flipping Bolus,and the kids got such a kick out of it and
(24:48):
it actually got them to give their bolusesmore regularly than without the stickers.
So the algorithms, you do like Medtronic,and I certainly agree with that.
Now the tandem algorithm is, it's asimpler one and they're very transparent
about how it works, but I think it,it does require the user to get their
settings dialed in a little bit better.
(25:10):
Both basal and bolus settings.
The open source algorithms though, howdo you think they compare to Medtronics?
Dr. Inga Boxelaer (25:16):
That's a good question.
That's a good question.
I think the newer, like the basicopen source, but if you start
using AutoSense and those dynamicinsulin sensitivity factor and those
unannounced meal features, I don't know.
What do you think?
That's a good question.
Would they be better than Medtronic?
Gary Scheiner (25:33):
I found them to be better.
Dr. Inga Boxelaer (25:34):
Yeah.
Gary Scheiner (25:34):
Than any of the commercial algorithms, whether it's Loop or trio.
I find that.
The secret sauce is that they account foractive carbs as well as active insulin.
Dr. Inga Boxelaer (25:46):
Ah, maybe that's it.
Gary Scheiner (25:47):
The commercial systems don't do that.
So they, they do a better job ofpredicting where the glucose is
gonna be going, and they're notjust looking 30 to 60 minutes ahead,
they're looking five hours ahead.
Dr. Inga Boxelaer (25:57):
Mm-hmm.
Gary Scheiner (25:58):
So they're able to make better predictions and make
better, I think, more appropriateadjustments for the user.
Dr. Inga Boxelaer (26:06):
Yeah, if you look at the results of the Close It that they
had, like non-inferiority, if they'renot bolusing, that's not what you're, I'm
not sure if you see that with Medtronic.
We, we have a lot of patients thatare not bolusing, but they are.
Gary Scheiner (26:17):
Mm-hmm.
Dr. Inga Boxelaer (26:18):
Their time in range is less, and so in the Close It Trial
it was the same time in range, but yeah.
So yeah, they may bebetter on some points.
Yeah.
Gary Scheiner (26:26):
Yeah.
And for some people, some peoplewho are more engaged in their
Dr. Inga Boxelaer (26:30):
yeah.
Gary Scheiner (26:30):
day to day management.
Dr. Inga Boxelaer (26:31):
Yeah.
It's not as easy.
Yeah.
Yeah.
It's not an easy to
Gary Scheiner (26:34):
Do you have any experience with the, uh, iLet from Beta Bionics?
Dr. Inga Boxelaer (26:38):
No.
I made a course on it.
I think it's amazing.
If you, if you look at the results,I love the system, just putting in
the weight and then putting it on.
I, I wouldn't even dareto invent that system.
But it works amazingly.
So I don't have any experiencebecause, but I made a course on it
and, and yeah, it looks really good.
And I love that they're progressingso fast with their integrations
(27:00):
and the updates of their pump.
Yeah, it's a fast company.
Unfortunately, they do not intendto come to Europe at the moment,
Gary Scheiner (27:07):
at some point.
But from a healthcare provider'sperspective, it's a dream because
Dr. Inga Boxelaer (27:12):
it's a dream.
Gary Scheiner (27:12):
Virtually nothing you have to do.
Dr. Inga Boxelaer (27:14):
Yes.
Gary Scheiner (27:14):
No settings that have to be, no fine tuning of the settings at all.
Dr. Inga Boxelaer (27:18):
Yes.
And also like,
Gary Scheiner (27:20):
and for users, there's that simplicity of just
estimating small, medium, large meals.
And
Dr. Inga Boxelaer (27:25):
Yes and in Belgium
Gary Scheiner (27:27):
There was some data presented at ADA about that.
Entering small, medium, large carbamounts instead of exact carb counting.
And with AID systems, theoutcomes are very similar.
Dr. Inga Boxelaer (27:37):
Yes.
Yes, that's true.
And that's actually a dream because inBelgium we don't really count carbs.
It's not in the basic educationof people with type one diabetes.
They just do, uh, carb equivalents,which is much less in detail.
So have it, if we wanna people,have people on pumps, they
first have to count carbs.
So I, I am very happy with allthis new data that we can maybe
(27:58):
skip that step and just let thedietician do the, uh, calculations.
Gary Scheiner (28:03):
You mentioned the InPen and that's, you know,
just one of the connected pens.
You know, you have theNovo Pen six in Europe.
We don't have that here yet.
Are there any other connected pensthat you've had experience with?
Dr. Inga Boxelaer (28:15):
No.
They were so close inlaunching the Sol Smart Pen.
Gary Scheiner (28:18):
Mm-hmm.
Dr. Inga Boxelaer (28:18):
Like the pen cap, but it didn't happen in the end.
And also the Novo Pen, we stopped usingas the, there was an integration with
Libre2, but then everybody went toLibre 3 and there is no integration
with Libre 3 and integration withDexcom is not as easy because it goes
through Glooko and Yeah people withDexcom, they don't have Glooko and Yeah.
(28:40):
Anyway, so, okay.
It was really fun with Libre two actually.
I miss it.
Gary Scheiner (28:44):
Yeah, so you mentioned Glooko, we've got a multitude of
software that we can use to collect data,generate reports, and you know, help
a little bit with the analysis being.
We have Tide Pool.
Uh, also we got Nightscout.
Plus all the company, the proprietarystuff like CareLink and Tandem Source.
(29:08):
So is there a software, software,
Dr. Inga Boxelaer (29:11):
yeah and the Libre View.
Gary Scheiner (29:13):
Is there a software that you prefer?
That you find generatesthe most helpful reports?
Dr. Inga Boxelaer (29:18):
I think it's the software that you use the most.
Because I was just talking to the peoplefrom Dexcom, now we are in the process
of switching from Libre to Dexcom.
Gary Scheiner (29:26):
Yeah I never even mentioned clarity.
Dr. Inga Boxelaer (29:27):
Yeah, clarity, yes.
So I think it's, it's just thereports that you're used to
that's, that will give you the.
It's the quickest insight because youknow where to look and you see the visual
directly, and then if you have to switchplatforms, it just takes some time.
But I guess it's like with pumps,you need like a year to adapt to
a new pump also as a healthcareprovider, to get the hang of it.
(29:50):
Yeah.
But yeah.
Gary Scheiner (29:52):
Yeah.
I gravitate towards programs thatgenerate, they call a spaghetti graph,
you know, the, the overlay of, yeah.
Yeah, I, I get so much out ofthose reports in minimal time.
Dr. Inga Boxelaer (30:05):
You take so much-- you really go into depth, right?
You really take yourtime for your patients.
I guess the reality here iswe just look at it for one
minute and then yeah, it's, it.
We don't really ha... take that muchtime and so if you, so I guess you're
the biggest expert here on the reports.
Gary Scheiner (30:20):
Yeah.
Maybe visually.
Just visually that that overlay, thatspaghetti graph just does it for me.
Or maybe it's just that I lovespaghetti and that's what it's called.
Dr. Inga Boxelaer (30:29):
Yeah.
I actually, I always look for the AGPreport because I really like Dr. Bergen's
style, one to one to three steps.
Like if you're good, thenyou're good, and it's okay.
And then so, I think that's easy.
And that report is on every,mostly on every platform.
That really helps.
Gary Scheiner (30:46):
That is true.
Yeah.
I try to teach my patients how toread those AGP reports as well.
Dr. Inga Boxelaer (30:51):
The AGPs?
Yeah.
Gary Scheiner (30:51):
And, and, and the spaghetti reports when they're available.
When they're available.
So I'm gonna put you on the spot again.
Uh, now you mentioned before that eventhough you have all of this expertise,
you don't have type one yourself.
And I, I was thinking we would voteyou into the Type one club in an
instant, and we're pretty meticulousabout who we led into that club.
But you would be one of thefew non-type one allowed
Dr. Inga Boxelaer (31:16):
One of the nerd from the type one community.
Gary Scheiner (31:18):
We're, we're cool.
Are you kidding?
Dr. Inga Boxelaer (31:19):
Yes.
Yes.
The cool Nerds.
Nerds are cool.
Right?
Gary Scheiner (31:21):
Cool nerds.
All right, cool.
Athletic nerds.
I'll, I'll go for that.
Dr. Inga Boxelaer (31:24):
Yes.
Yes.
Gary Scheiner (31:26):
If you had type one, what equipment, what
systems would you be using?
Dr. Inga Boxelaer (31:31):
I'm more of a hands off person.
Like I wouldn't be like, I thinkI wouldn't have the energy to
go for the 100% time in range.
I would be like, how can Ilive with diabetes without
thinking about it too much?
So I think, I think I wouldgo for the Omnipod five then.
Gary Scheiner (31:47):
Okay.
You might even like the iLetbecause that's probably the
most hands off system we've got.
Dr. Inga Boxelaer (31:52):
Yeah.
But I don't think, do you think theiLet is as good as the Omnipod five?
I'm not sure.
Gary Scheiner (31:58):
In some ways, if you really want hands off, not
thinking about diabetes very much.
Dr. Inga Boxelaer (32:04):
I know, but the reason I don't want the iLet.
Yeah.
Gary Scheiner (32:06):
Yeah.
But in terms of glucose management,yes, having some ability to pull some
levers and fine tune on your own.
The iLet is lacking now.
There's no way to accommodatefor exercise, for example.
Dr. Inga Boxelaer (32:18):
Yeah, if you forget your sensors and then you
have a little bit problem there,your pump is not working anymore.
And also, I, I don't like tube pumps.
Sorry.
But this is personal and I,I don't wanna say anything
against the MiniMed people, but
Gary Scheiner (32:31):
it's okay.
Dr. Inga Boxelaer (32:31):
It's, um, my pump would drop every minute, so, yeah.
Yeah.
Which actually this no problem becauseI tested the pumps and it dropped
all the time and it didn't break, so.
Gary Scheiner (32:39):
Yeah.
Dr. Inga Boxelaer (32:40):
That's good.
Gary Scheiner (32:40):
I had a meeting with ConvaTec earlier.
They make all the tube infusionsets for all the companies.
You know, we did a survey with ourown patients on pumps asking about
tubing, and for the most part, theydon't find it to be an inconvenience.
Dr. Inga Boxelaer (32:54):
No, that's true.
You're, if you ask people on atubed pump, they don't really mind.
I think after two weeksyou're probably used.
How long does it take toget used to a tube pump?
Because the first days youreally drop it all the time.
Gary Scheiner (33:05):
Couple.
A couple days.
Yeah.
Dr. Inga Boxelaer (33:07):
Okay.
So I didn't do long enough.
Gary Scheiner (33:09):
It's more a perception that, oh, this
tubing is gonna be an annoyance.
Dr. Inga Boxelaer (33:13):
If, if you have to change clothes, then you
have to put your pump somewhere.
And that's, that wasthe weird part for me.
Yeah.
Gary Scheiner (33:19):
Okay.
So you'd be using the Omnipodand the Omnipod five most
likely with its algorithm?
Dr. Inga Boxelaer (33:25):
Yeah, and like last year I would of, or maybe the open
source, because now I know how it works.
I think the main thing withopen source, the main barrier is
understanding how it works, butonce you understand it, it actually
gives you more flexibility, I think.
Gary Scheiner (33:38):
So they come to us.
That's what our team does,is teach people that.
Dr. Inga Boxelaer (33:41):
Yes, and I would definitely come to you for, for virtual,
uh, support, which is amazing thatyou support people around the globe.
I'm not sure if everybodyknows this, but Yeah.
Gary Scheiner (33:51):
Yeah.
We deal with language barriers sometimes.
Yes, we can handle English in Spanish.
Dr. Inga Boxelaer (33:54):
Everybody speaks English, right?
Yes.
Gary Scheiner (33:56):
Uh, not everybody.
I wish we had more language capability.
Dr. Inga Boxelaer (34:00):
No, because in in Belgium, we don't have a
lot of people that are using opensource, so our knowledge of open
source is very, like a lot lower.
And yeah, having access to, toexperienced healthcare providers who
really go into detail like you do, Ithink it's, uh, it's very beneficial.
Gary Scheiner (34:16):
Last question.
This is for patients, people using thesedevices, what advice would you give, uh,
for those who wanna really get the mostout of the technology that's available?
Dr. Inga Boxelaer (34:27):
I think it, it depends on, do you wanna have Yeah, the
most out of the, out of the technology.
It's definitely like...Start using an AID system.
Don't wait.
Don't wait too long.
Like deciding like, whichone are you going to use?
Just start one.
And if you don't like it, choose another.
And then if you like to, some peoplelike getting the most of the system,
is it getting the best glucose oris it getting the best life and
(34:48):
not having to think about diabetes?
And I think that's where you decideof which type of system you choose.
And also ask your healthcare provider.
Maybe for health because yeah, it alsodepends, some healthcare providers are
very much trained on specific systems andit might also be beneficial to choose a
system that your healthcare provider isvery trained in and not choose a system
(35:10):
that he never worked with or like switchhealthcare provider because of system.
Maybe that's not necessary becausethe connection with your team is also
important, but yeah, that's an idea.
Gary Scheiner (35:20):
I love what you said about don't wait.
If the AID system is available,
Dr. Inga Boxelaer (35:24):
You don't wait.
Gary Scheiner (35:25):
Just drive some and get on it.
Dr. Inga Boxelaer (35:26):
Yeah.
Gary Scheiner (35:26):
I describe it to my patients this way.
I say, you know, if you're not on anAID system, you know, you're, you're
driving a, a Honda Accord or a ToyotaCorolla, but somebody has said, here's
the keys to a Ferrari and I'll trade you.
Who's gonna turn that down?
Dr. Inga Boxelaer (35:44):
Yeah.
Gary Scheiner (35:45):
You gotta be crazy not to do that.
I mean, you can always go back toyour little car if you want, but
who doesn't wanna drive a Ferrari?
You know, you take advantage of that.
Dr. Inga Boxelaer (35:53):
I think it's the same level.
Like a few years ago we had toput everybody on sensors and there
were so many people say, oh no,I'm comfortable with the strips.
I will use the strips.
And then now they're, everybody's onsensor and, and you, I remind them,
do you remember the time you had to goon a sensor and you also were doubting
and then this is the same thing.
This is the same step up.
Yeah.
Gary Scheiner (36:10):
Yeah, exactly.
I also remind everybodythat nothing's permanent.
If you try something and you findit's just not for you, just go
back to what you were doing before.
Dr. Inga Boxelaer (36:19):
Yes.
Gary Scheiner (36:20):
No one's gonna gonna criticize you if you do that.
At least you gave it a fair try.
All right, so just a quicksummary, what we discussed.
Technology has come on, fast and furiousin the diabetes space and, you know,
certainly users of the systems need tobe up to date on what's happening, but
even more so, their healthcare providers
Dr. Inga Boxelaer (36:40):
Yeah,
Gary Scheiner (36:41):
need training, education and build some confidence in, in how
to use them effectively in order tobe able to treat patients effectively.
Dr. Inga Boxelaer (36:49):
And I also, I also wanna add if there's any
like healthcare providers who aredoubting to start AID systems in
their clinic, uh, don't be afraid.
It's not that hard aspeople say that it is.
And if you, uh, if you are unsure, youcan always check our website, of course.
But we are so happy that westarted and we are able to make...
(37:10):
there is nothing more fun asseeing a patient back after
they start an AID system.
It's, it's, you're not gonnadisappoint your, your patients.
Yeah.
Gary Scheiner (37:18):
And that's the, uh, Diabetotech website and we,
we'll have that information inthe show notes for everybody.
And I also like one of your concludingstatements about not just going
with the same system for everybody,each individual needs to match
the equipment to the personality.
You know, if you're the type thathas certain specific needs to
(37:39):
manage your diabetes well lookfor systems that offer that.
If you're the type that wants ahands-off approach, look for that.
If you, if you like being involved andengaged in your management, or need to
be engaged to fine tune things, finda system that'll let you do that, and
there's a whole spectrum and everything inbetween, so you have lots of good options.
Dr. Inga Boxelaer (37:59):
Yeah.
And even, even if you don't haveoptions, like even if there's only
one system available, which is stillthe case in a lot of centers and in
some countries, don't wait please.
Gary Scheiner (38:09):
So I want to thank, uh, the top tech expert in diabetes out there.
Inge, thank you so much for joining today.
Again, the, the links to yourprogram will be in the show notes.
I'm Gary Scheiner reminding everyone outthere to keep thinking like a pancreas.
Dr. Inga Boxelaer (38:26):
Thank you.
Gary Scheiner (38:27):
Thanks for tuning in to Think Like a Pancreas, the Podcast.
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a pancreas.
The podcast, is brought to you byIntegrated Diabetes Services, where
experience meets expertise, passionmeets compassion, and diabetes care
(38:48):
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 losstype one, pregnancy and emotional
(39:09):
wellbeing, 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.
(39:29):
I'm Gary Scheiner, wishing you afantastic week ahead, and don't
forget to think like a pancreas.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.