#934

Ed Damiano is the Founder of Beta Bionics and he's here today to talk about the iLet Bionic Pancreas.
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[@taitekirkpatrick7972]

getting this pump delivered today! cannot wait!!!! its my first pump after being mdi since diagnosis 2 years ago

[@Sly697]

We have started the process of ordering this for my daughter, would love an update on your experience

[@patricecape]

I have had T1D since 1958 and have experienced all there is to experience, and I just signed up to self-pay for Ilet Bionic Pancreas. I would have waited until Medicare approved, but I unknowingly updated my pump in February which pushed out my warranty on the Tandem T-slim until 2028 but who knows If I'll still be here. 😂It's worth the money to me to be relieved of the non-stop dedication to staying at below 7 HbA1C. I', at 5.8 now, but I need a rest! We'll see if I can let-go of being the one running the show. I have 90 days to decide, so I'll let you know how it goes. Thanks for your podcast.

[@heathcriswell]

Did you get your ILet? What are your thoughts on it?

[@patricecape]

@@heathcriswell yes I did and I love it. It is just so easy and I have been able to let go of control now that I see my A1C is 5.9 and I’ve had very few lows. I do get spikes but the pump kicks in and brings them down, just more slowly than I am used to. But, because of not having many lies my TIR and A1C have stayed as before.

[@LeeMoraglio]

Hi Scott. Great interview with Ed who always does a wonderful job explaining the iLet. My pump warranty expires in the 1st Q of 2024 and I am definitely considering the iLet. When it comes to autonomous driving, I have heard many say that they wouldn't be comfortable allowing a Tesla to do everything. Relinquishing control of a car is psychologically hard, even though the car will avoid accidents much better than a human. I suspect that the same phenomenon will exist with the bionic pancreas. When you've been actively involved with your diabetes management for decades, it will be hard for some (myself included) to allow the bionic pancreas to do everything. After more than 30 years of tight control, however, I have become burned out from babysitting my glucose levels constantly. I've also become frustrated with the number of lows I experience every day. A low means unwanted calorie consumption which, over time, can contribute to weight gain (or difficulty in losing weight). As far as I know, Beta Bionics is the only company actively working to develop a bihormonal system. As Ed suggested, that means the algorithm can be more aggressive because it will have brakes. Having said that, I would have asked him if they considered offering different modes for the user. A "conservative" target glucose level of 150. A moderate target of 120. And an aggressive target of 90 or 100. Tesla allows you to do that too. The most aggressive mode on AutoPilot is called "Mad Max." Tidepool allows you to set a target as low as 87 and Medtronic's new 780G allows you to go as low as 100. I understand that the lower the target, the more likely hypoglycemia is to occur (and 87 does seem pretty low), but offering users a range to choose from (with their understanding and consent) would allow the T1D to decide how aggressive he or she wants the algorithm to work. Clearly, target levels are decreasing over time with the other companies, and without using glucagon, so there probably isn't a consensus on what the ideal target should be. And the FDA has approved these systems, so the regulators are allowing them in the software. Other than that, I would just be curious to know when Beta Bionics expects compatibility with the Dexcom G7 and the FreeStyle Libre 3. Great interview! Thanks for all you do for the diabetes community.

[@JuiceboxPodcast]

I expect a different conversation when the dual hormone version exists. Thank you for the kind words!

[@poodlebone]

Did he say that it was normal to go to 300 after a meal?! The whole "don't pre-bolus" thing doesn't sound like a great idea.

[@29erallday]

Still haven't heard a great response (and looked in manual) for how to excerise. My tandem w/ control I have a profile setup for working out and set the pump to Exercise (target 160-180). Ilet says don't eat, and "higher" setting is only 130. Seems ilet was designed to be dual hormone and they are pushing insulin only out in a rush without changing to work without glucagon

[@patricecape]

I find the Ilet reducible or shuts off the pump when heading low. So unless you are low when you start exercise, it hasn’t been a problem for me. Eat something if you’re starting with low BG

[@jilldevdesigns]

Ive had the worst experience with this pump. Im 30 days in and gained 14-15 lbs since starting because it repeatedly over corrects me. Stacking so much insulin I am often having to correct with 150-200 CARBS. It works amazing when bg stays in range and it brings u down super fast from highs.. too fast. The pump cant seem to accept my DIA and thinks it to be about twice as fast as it is. Low(60s) with double down arrows and 6-14 iob! But that is its idea of iob, not my full iob.. the food and basal algorythyms are finally good with a 50 lbs Less weight input but once again after a fectory reset and this lower weight it just overcorrected me again for a bg in low 200s it gave me 8 extra units over 20 minutes!! So now I just added 100 carbs to my predinner snack! I just got some lumjev to try instead of novolog to see if we can match the DIA this pump wants to keep using. This pump often stops all delivery for 2-3 hours trying to make up for its overdose... which would work if my basal were like 4-5 units/ hr. But its actually .5-1 u/ hr. Below 60 for 3 hours and in 30s for an hour straight and wake up with 7iob at 3am. Slept through 10-15 alarms cuz the loudest setting cant be heard under a blanket. I am beyond frustrated with BB as i have called to report these issues multiple times and ask someone to call me back and answer some questiona to help me and no one ever calls. I have escalated. I have met with the trainer who deliberatly gave me wrong info contradicting the manual, customer service and all the online videos. Of course causing more lows. I want this thing to work but I am scared to go to sleep each night. For reference dx 1986. Pumping with MM since 1992 ( pre bolus wizard) I understand the math clearly . This system with its overdosong and suspending insulin makes this worae than MDI.might as well just give a random shot every few hours. Maybe this comment will prompt a call from BB as basically so far the employees just shrug their shoulder and comment how great my average is. I dont understand why customwr service is so bad theu cant call patients back to help figure out whats gping on! Meanwhile basically If I havent woken up I would have been dead several times now. I have no idea why this system is working so horribly for me and a handful of others but works so But really why it expexts a correction to kick in in 5 minutes, it takes me about 20 minutes and by then its already given me 1-2 units every 5 mins!! Medtronic would have overnigjted me a new pump a couple times by now just in case it was faulty. BB makes excuses that they didnt have time to call me and tells me tontall to my dr to make adjustments. What adjustments can be made? Besides putting in a lower weight , which the trainer ridiculed me for doing despite it reducing the overdosed basal and meal boluses significantly ( half) .It's just the ISF or really the DIA / IOB issue now

[@JuiceboxPodcast]

You may find some good conversations on this topic in my private FB group. It is totally free to join. 45k members. bit.ly/JBPFBGroup

[@robingirven4570]

This one isn’t showing up on Spotify!

[@JuiceboxPodcast]

It's on my Spotify app.

[@robingirven4570]

@@JuiceboxPodcast it’s there now but wasn’t first thing in the morning- I just listened on a different app. Thank you!

[@callmescout5831]

Great interview. However, it hurts my heart to hear him go along with the, in my opinion, of normal is overrated. There is a reason that there is a cut off for a diabetic diagnosis. There is a reason that an a1c in the “normal” range is optimal. There is a reason that doctors say that diabetes is progressive and I, along with many others, believe that the reason it looks progressive is because of letting bg’s be out of normal range over time causes this. It’s still the “Don’t die right now” thinking :(