#1000 Newly Diagnosed or Starting Over (REMASTERED Diabetes Pro Tip)

September 18, 2023Scott Benner

This is the first episode in a 26-part series called "Diabetes Pro Tip”. Scott and Jenny emphasize the importance of understanding what insulin does and how it works, especially for newly diagnosed individuals or parents of newly diagnosed children with Type 1 diabetes.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - Radio Public, Amazon Alexa or wherever they get audio.

Key takeaways from this episode are available below in English, Spanish and Hindi. Los puntos clave de este episodio están disponibles a continuación en inglés, español y hindi. इस एपिसोड के मुख्य बिंदु नीचे अंग्रेजी, स्पेनिश और हिंदी में उपलब्ध हैं।.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com forward slash juicebox. And now I'm proud to present the episode that started the diabetes Pro Tip series. What was originally episode 210 diabetes pro tip newly diagnosed we're starting over Welcome to the Juicebox Podcast. I'm your host Scott Benner. I first interview Jenny Smith, the CDE from Integrated diabetes back in season one on episode 37. At that point, Jenny and I were just talking about different management ideas. But it was then that I realized how much we agreed about type one diabetes, and the management of the disease. I brought Jenny back on and episode 105. And we really drilled down about a onesies what they were and what they weren't. After that second interview with Jenny, I decided that one day I would have her back on to discuss all of the diabetes management ideas that come up on the show, I wanted to break them down into small categories, something that was easily digestible, where we'd stay focused on just one idea. I wanted to create something that you could come back to hopefully learn from and if you found useful share with others simply. And so with that in mind, I give you the first in this 10 part series, diabetes pro tip for the newly diagnosed or for those wanting to start over with Jenny Smith CDE.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to Always consult a physician before becoming bold with insulin or making any changes to your medical plan. If you're a newly diagnosed person with type one diabetes, or the parent of someone who has been newly diagnosed, what do you think the first things to understand are?

Jennifer Smith, CDE 4:20
The first things to understand beyond the glucose values are what does insulin do? How does it work? I think that's it's a huge one that is it's under, it's under emphasized, I guess is the best way to put it. Many people, especially adults who are diagnosed are kind of given a this is your insulin. This is the dose to take and kind of go experiment at home. I feel like that's kind of the way that it is and I think insulin is a first most important thing to really understand. How does it work? What's What's the purpose of it? How is it supposed to kind of finish working? And what is the effect for you?

Scott Benner 5:08
Okay, and so what are some, like bare bones ways to come up with those understanding. So I think, obviously, if you have a CGM, it becomes different, right? If you have a CGM, you can get yourself at a stable spot where you haven't had insulin or food for a while. And just give yourself an amount of insulin and see how it moves you. Let's talk for a second about like old school, do you still teach people that they need to do Basal testing?

Jennifer Smith, CDE 5:33
In a general way? Yes, I think especially for pumping is helpful in the beginning, because it does in that basil only time period, it does give you a general idea of how things are being kept with the rate that's at play. I do think that basil testing needs to be more explained, let's say, when we are talking about pumping insulin, though, because there are as you know, a lot of variables that could be at play in that Barrett basil testing time period, especially like from, from a woman's standpoint, it could very much be that it's not the right time of the month to be Basal testing. Right? Right, right. So all of these various are a kid or a teen who is a kid or a teen who is really athletic. Right, and there is consistent effect of activity level. And it may be different on different days, but there could be overlap from a day ago that you had for our practice or a tournament. So Basal testing. As a general idea, yeah, it can be a really good place to start, especially if you think things are really off in a certain place of the day. But is it the end all be all of knowing where your insulin should be? Not 100% of the time

Scott Benner 6:58
and so, so what I ended up telling people when I speak with them, is that, you know, if you're having an issue, and that issue could be anything like you're spiking at a meal, or you're drifting high all the time, or you're incredibly high all the time, you know, any of those things, you have to first look at your Basal insulin. It's it's absolutely far and away the first thing and I have to apologize to your audience texting me and I believe she's trying to tell me, it's lunch. That's okay. Hold on. So lunch question mark. So Arden has been sick the last couple of days and pretty, pretty kind of resistant like this to her insulin a little bit. But we are ahead of it now. So she's 106 and stable now. But to give you an idea, she woke up at 110. By the time she was getting dressed, she was 120. Then there was this diagonal up, I Bolus a unit and doubled her Basal for an hour. And 30 minutes later had to Bolus two more units to get her back to this 106. And what she never got over about 150. But she sees that rise every morning like that, that little bit of a rise. But this morning, I used I'm going to save three units more than I would normally use. Yeah. And it's just because she's not feeling quite well.

Jennifer Smith, CDE 8:11
Again, another reason that basil testing. This is not it's not purposeful. In fact, I think, you know, a lot of people try to overcome that morning time rise with a Basal adjustment. But what happens then when you wake up at a different time of the day, right? Or you have a variable schedule, so a lot of times I actually tell people, you know what, let's look at what the rise is. Don't correct it. Let's let's watch the rise. Let's figure out how much of a rise Are you consistently having, you know what, we can offset it with it with a dose of it of Bolus. Sometimes that actually hits the mark better than trying to incrementally adjust a basil behind the scene that could actually change day to day.

Scott Benner 8:57
Right, right. Okay, so now this is um, this is really interesting. To the way like, tell you what just happened. So this is kind of hilarious, but my wife is here I'm gonna have to walk away for a second and back. Arden's pump only has 10 units left at it, and her and just add her lunchtime Bolus is going to be 12 units. So I just had her do a smaller Bolus as a Pre-Bolus still, and I'm going to send my wife over to like swap. I'll be back. Let me go explain this to my wife. I'll be touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org Go up to the top of the page where it says programs there you're going to see all of the terrific things that touched by type one is doing and I mean, it's a lot type one it's school, the D box program, golfing for diabetes, dancing for diabetes, which is a terrific program. Just click on that to check that out. Both are caused their awareness campaigns and The annual conference that I've spoken at a number of years in a row. It's just amazing, just like touch by type one touched by type one.org, or find them on Facebook and Instagram, links in the show notes, links at juicebox podcast.com. To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org.

Jennifer Smith, CDE 10:26
So all is okay. Yeah,

Scott Benner 10:28
my wife's it's across the street. Yeah, my wife's gonna run over. She's working from home today. And it really does just go to show, I guess, the fluidly that you have to keep around diabetes because, okay, I'm lucky my wife's here today. If she wasn't, I would have to tell you, Hey, I gotta go. But in the end, there's no panic here. Arden's blood sugar's 107. I wanted, I wanted to do a Temp Basal increase of 50% for an hour and a half. And an extended 12 unit Bolus for lunch. But she only has 10 units. So instead, I had her set the Temp Basal still and do an eight unit extended Bolus. So she's still going to have four units going when my wife gets there, they're going to swap that pump real quick. And then she's going to head off to lunch and be okay. Right? She'll be fine. She's got early lunch. Yeah, on every other day to 1030. And then on the 30, like,

Jennifer Smith, CDE 11:20
what does she get up at five o'clock, the breakfast? Really that

Scott Benner 11:24
she eats? 1030 every other day and the opposite day? She eats at 1130? And she's out of school by two. Oh, wow. Okay, it's all kind of very quick. I don't know if she's learning anything. But so so I Yeah. So anyway, what I wanted to say about Basal is that, I'm sure just like you, I meet people who are having trouble, right, they're either on the roller coaster, and they're going to 400. And they're going to 60 and up and down or, you know, somewhere in that problem. They're high constantly, they're always 180, you know, they can't really seem to do anything about it. And when they get to you, they have all of these theories about why their blood sugar is too high. Right? And I tell them, your blood sugar is too high, because you don't have enough insulin, and it's not timed correctly. And we're going to start with your basil. And they'll inevitably say, Well, what about my insulin department, that doesn't matter? I'm like, you can have a perfect insulin to carb ratio. If your Basal insulin is not right, none of this matters, right?

Jennifer Smith, CDE 12:22
That's right. That's why we call Basal insulin, the foundation of your management, it really is we, we actually tell people, it's like the foundation of a house. If you have a sound structure that you're building on top of everything you put on top of it will work. Even if the insulin, the carbon, the correction factor, and things are a little bit off. If the basil is off, those are going to also look like they're not working well.

Scott Benner 12:49
And it becomes impossible to diagnose what's happening, right. And so what I ended up saying is that you try to imagine we use round numbers for examples, but try to imagine your basil is a unit an hour. That's what that's what it should be. But you have it at point five. And then you have you look at some food and you say, Oh, well that food is two units. So you and let's say you're right about that. Let's say you're 100%, right, that the food takes two units, you put your two units in, all you've done is now replaced the basil that you needed, right? You're so you're resistant, you're high, now you're replacing your basil, it's possible those two units will only go towards impacting the problems your Basal insulin has, right. And then your blood sugar shoots up and you go, I don't understand, I put in the right amount of insulin, I counted

Jennifer Smith, CDE 13:38
my carbs, right, I counted my carbs. I looked at the label and I did everything

Scott Benner 13:42
the doctor told me why didn't this work. And in the end, and you know, through this series that you and I are going to do together I'm going to repeat a couple of things over and over that I've found to be incredibly helpful. But in the end, if your blood sugar is high or low, you've mis timed miscalculated, or a combination of those ideas. And that's pretty much it, you know that I find that to be the core of it. It's not the first step to me. Not being afraid of insulin is the first step. But we're going to talk about that in a different episode. But I think that it's it's timing and amount. And I think there's a million other things that can impact your life with diabetes. But that's the seed of the tree, right? And you could throw away all the leaves and all the branches and everything that comes off of that seed if you'd have that seed timing and amount you're well ahead of the game. Right?

Jennifer Smith, CDE 14:31
Right. Absolutely. And I I would say the that those two pieces actually go very well together as far as not fearing insulin, you know, not being afraid of using it because i i certainly work with many people who that is a major problem it is I just want to eat 200 Because I'm afraid to give the amount my pump is telling me to give or the amount that the doctor told me to give you You know, and I think understanding Insulin is the base of that, understanding it and understanding the timing. And the action of the insulin and how it also individually works for you, helps to dissipate that fear, right?

Scott Benner 15:16
I think that I think that if you can keep your blood sugar stable at 200, then you can keep it stable at 180. And if you can do it at 180, you can do it at 140. And believe it or not, if you can do it at 120, then you can do it at 75. And, you know, and so, because the, the tools that you use to, to achieve that stability aren't different depending on what level your blood sugar is at. It's all the same. It's all the same stuff. Okay, so that's, that is that's excellent. So we'll talk about fear in an upcoming episode as well. I'm newly diagnosed, I go into my doctor's office. Now you are uniquely qualified to tell me this. What do people get told a diagnosis and why do they only get told what is shared with them. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and to carry case, but most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen, it fits well on your hand, and features Second Chance sampling, which can help you to avoid wasting strips, every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juicebox free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juice box for a meter go get yourself a free starter kit. while supplies last US residents only.

Jennifer Smith, CDE 17:53
I think it there's a wide range of what people are told, I certainly think that the younger the diagnosis, especially for type one, the younger the diagnosis, the more education there is, the more information is provided. adults that are diagnosed I think, unfortunately, get the least amount of education again, and it differs system to system and provider to provider. But in the beginning, you know they're taught how to use a glucometer. They're taught how to give an injection they're taught or you're going to be taught essentially the basics of that insulin action. And you're going to be taught carb counting, right. I mean, that is pretty much the gist of what you're going to be taught.

Scott Benner 18:40
Anyone who's been listening to this podcast for any amount of time will know that I call that do not die advice. That's the that's the advice you get so that you don't die. It doesn't keep you healthy. It doesn't help you understand anything. It just keeps you from going home and falling over.

Jennifer Smith, CDE 18:54
Well, and I think another piece of that too is it's very, very soon in that beginning is how to avoid hypoglycemia, how to avoid a low blood sugar because insulin causes low blood sugar. And unfortunately, that's where the fear starts.

Scott Benner 19:12
Exactly. And so that's where it starts where the fear starts, but try to understand it from the clinicians point of view. You are frazzled I say this all the time being diagnosed with a disease that you cannot cure. It feels like someone just walked up to you with a shovel and smacked you square in the face with it and then started yelling, Basal insulin Bolus glucometer. This is a test trip and you're like, wait, wait, why? And so the doctor sees that on your face and can't in I guess in their minds, they don't want to overload you. But the unintended problem is just what you said that you start with fear then everything starts with fear. It would be a simple sentence. It would be it would be Listen, we're going to teach this to you slowly. I know that seems counterproductive but it's not But there's no reason to be afraid. And that's what we're going to learn. Now the question is, do doctors not teach that because they don't have the time, or they don't have the knowledge? Like what like, because there are everyone's going to walk into a different endos office, you're gonna get an 80 year old guy who's been doing this, since people have been boiling their urine. And he and he's just gonna think that if you count your carbs, and inject and go to 300, and come back to 100, that's amazing. And that's that, right, right. And then you're gonna get a guy who's in his 50s, who's just starting to hear about like, this CGM stuff, and you're gonna get different advice from them, you're gonna get different advice from, you know, a woman who's been out of medical school for three years and has diabetes. How do you as the patient know what advice you're getting? When you don't know anything about diabetes?

Jennifer Smith, CDE 20:52
That's a very good question. Absolutely. And I think, you know, with today's technology, honestly, I personally, as people have come to, to work with me, or to work with us that integrated, you know, it's people come because very soon, they realize they're not getting what they need. That's not quite, they're not sure what they're missing. But they know from researching and looking and Googling it, that the information that they've gotten is so just literally the tip of the iceberg, that they're missing so much more beyond and that, you know, that the doctor is saying, Well, you have to be in good control for a year to be able to start on a pump. And most parents or even adults are saying, that's not the case. Right? Does that make sense? That's that's not doesn't make sense. I want to know what I should be doing. I want to know, what is the best for my child or for myself? I want to know, and I think those are some of the things that as a as a newly diagnosed, asking more questions of your provider, even though you may not know exactly what you're asking, when you've Googled it, and you've researched and done some of your home's searching, and even asked, you know, some people I think more and more people are, they're kind of they have acquaintances or whatnot, who might have diabetes. And so they, they will ask them, they'll say, Well, they're doing this, you know, maybe I should ask about this. And I tell all the people that I work with, you know, what, if your providers not able to meet you or can't answer, even those basic questions in the beginning, it's, it's time unfortunately, to find a new provider. It really is.

Scott Benner 22:34
And based off of that idea, I want to say, I want to say the same thing to two different segments. So if you're a clinician, and you're listening to this, or if you're a person who has diabetes, or is trying to care for someone who does, there's a space that a lot of people get into, they're not given enough information up front. And they're, they're paying attention, right, they want to do well, they're paying attention, and they see inconsistencies with what's been taught to them in the doctor's office. But because you're the doctor, or because you're looking at a doctrine, you were raised to listen to a police officer, your teachers and a doctor, you're raised to believe that a person in a white coat is infinitely more intelligent than you are, there's no reason to question them. And so when they give you these concrete laws of diabetes, you go home, put these laws into practice, and they don't give you decent results. This is for the doctors, it puts people into such a psychological bad place. It just wrenches their gut, they feel like they're killing themselves or their children. And they don't understand why. And even when common sense things about their diabetes show up. They can't bring themselves to make the leap, because you've told them or not told them anything about that idea. And I will give you a great example. And it's a very simple example.

Jennifer Smith, CDE 23:52
Or kind of before your example. You know, it's kind of a cut and dry too. As you know, kind of going with what the doctor said, the doctor said to do this, the doctor said I should take my my insulin and eat right away. Well, if that's not working, and you don't, if you don't know that and clinically, clinicians, I think, really do need more information about what really is the real life of diabetes. What's the real life use of insulin and mastering its action and all of that because clinical book does not mean it meets what happens at home. And when your clients come to you and your patients with or people with diabetes come to you and they say, This isn't working. I'm following all of your rules. It's not working. Instead of saying well, you must be doing something wrong because that that happens often whether as a clinician you want that expression to come out or not. It does you make them feel like they're not doing something right. Right. And you don't give him a way to to help you don't explore with them. Say, Okay, I hear what you're saying, I hear that you've tried everything I thought would, excuse me would work. And it's not let's, let's see why it's not working, maybe something is variable for you.

Scott Benner 25:12
And let's have more of a conversation and explain what's happening. So that so that the doctor can glean more from what's going on. I'm at the point now, and I'm sure you're there, too. I can look at a 24 hour graph, and make changes in five minutes that improve somebody's life. immeasurably in 24 hours. I don't know why a doctor can't do that. So I mean, I figured some can

Jennifer Smith, CDE 25:34
Yeah, some are, some are awesome, but some are not gonna know me

Scott Benner 25:37
well enough. Now to know that, you know, I'm not the greatest person in the world. And I can look at it and go, Okay, this is this like this. My example of, of how powerful the doctor suggestion or non suggestion can be to people is that I was speaking with a woman in her 40s, who had diabetes for 25 years. I looked at her graph, she was distraught. And I said, you just need more insulin? And she said, Well, no, no, because in the oceans, like I said, all these reasons why it that wasn't the case. And I said, No, that doesn't make sense. And in a brief 32nd, Explanation, over a telephone call, I could literally hear the light bulb turned on in her head, and she went, Oh, my God, I just need more insulin. And I was like, right? That's it? I mean, can we go now or, you know, but but think about, think about that. A well intended, intelligent, educated person who goes to her doctor's visits, and in 20 years, can't figure out why their blood sugars are the way they are, and no one's ever helped her. Right. So what I'm saying to people who are newly diagnosed, or people who have gotten to that point and want to start over, you have to sort of think different, you have to, you know, if you're, if you're in a situation where you're newly diagnosed, and you've gotten some real, like what I call like old timey information, you need to think differently. And if you've had diabetes for a long time, or have been caring for someone forever, and it's not going the way you want, that's the first thing you have to do. You have to say to yourself, I must not be thinking like flip it upside down, look at it all the time, I have a friend who every decision they make is wrong. And I once said to them, How come when you have a reaction to something, you just don't wonder what's completely opposite of that, and then just do that. I was like, I was like, You're right, you're always wrong, you know, so like, and, and that's what happens every day, you get up and you do this thing with this insulin and this pump and all this stuff, and it always goes wrong, but yet, there you are the next day,

Jennifer Smith, CDE 27:35
doing it over and over and over again, which is a another reason that I you know, working especially with the women through pregnancy that I work with, that's a piece of the variability that I try to encourage them to sort of work on prior to pregnancy. Okay, you know, because if you can figure out, it's why many people with diabetes, eat some of the same things over and over and over again, they have a standard breakfast, I know that it works, I know that I need this much insulin, I knew they need to use a temporary basil for this much or for you know, whatever extended Bolus, and it works for me, it's, that's the reason because once you figure it out, you're like, great, I like little magic, this magic piece right here and I'm not gonna screw it up. Now

Scott Benner 28:21
I'm just gonna have this half a piece of wheat toast two eggs over easy and two tablespoons of avocado for the rest of my life.

Jennifer Smith, CDE 28:28
Right? Exactly. Every morning, if that's

Scott Benner 28:31
happening to you, if you're listening, and that's happening to you, I say this proudly, the there are some low carb people who will get upset and I want to tell them right now you can eat low carb your whole life. I don't care. I'm just saying that if you ended up there because you couldn't figure out insulin. You know, if you're if you're eating something you don't want to be eating, there might be a way to manage this. But I tell people very proudly, that at this point, my daughter is 14 years old when I'm recording this. She has had type one diabetes since she was two. And for the last five years, her agency has been between five two and six two, with absolutely no diet restrictions whatsoever. Anything you can think of Arden eats and eat frequently.

Jennifer Smith, CDE 29:14
And I bet her more important within that I think we talked about this in the A one C discussion and podcast. But more important than even the a one C is per standard deviation the variability which I would estimate without even seeing her information, I would estimate that her standard deviation is very nice meaning she's got these juicy little gentle rolls through the course of the day rather than this major roller coaster because you can have anyone see a 5.4 Yes, but you can have wrong major, you know, standard deviation,

Scott Benner 29:45
and we will talk about that in coming episodes. You can't run around with your six a one C but be at 300 Half the day and 50 the other half of the day. That's you've just tricked the a one C test, right,

Jennifer Smith, CDE 29:56
Doctor? Yeah, because again, that goes back to clinic shins. A onesie is is certainly it's a starting place. It is not the end all be all there is more in depth that needs to be looked at with that a onesie. Yeah,

Scott Benner 30:08
we try very hard. Well, you know, as you go on and listen to these episodes, you'll realize I'm not trying that hard anymore. I figured it out to the point where it doesn't really take that much involvement from us. But Arden's low alarm on her Dexcom is set at 70. On my follow app, it's 120. For the high alarm on hers, it's 130. And so we'll talk about like bumping and nudging later on, but that's my concept is that smaller amounts of insulin as you try to leave a tight range, get you back into that range more quickly. And cause far fewer lows later. Yes. Give me one second here, we'll take a pause. Okay. I'm gonna text art and she's now wearing a new pump. I need to know how much insulin delivered from the last Bolus. And then because it's a new pump, and she's literally going to walk right into lunch. Excuse me, I'm going to double her basil for I was only gonna do 50%. Now I'm just going to double it for an hour and a half. And that way, if there's any slow start with that site absorbing and having action I'm just going to do, I'm going to do something that at some point during these you'll hear me talk about where I call it over bolusing like I just I imagined not just what her needs are now, but the momentum and higher number that I know is coming. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Yep, so

Jennifer Smith, CDE 32:10
that's hard change was one thing that I was always in in. In the beginning, I was very thankful that I had noticed a difference with my animus pump change that I needed that site to just be like, just saturated with insulin to get absorption sooner. So and I was glad because when I started Omnipod in 2006, I started doing the same thing that I did with my other pump sites, you know, just Temp Basal going up by almost 100%. For about it was usually about an hour to two hours depending on kind of where I was at that point. And if it was if I was having to change that pod, especially if it was before a meal, and I was going to need insulin for that meal with the new pod. I actually instead of doing it through the pod, I gave an injection, because I just found that a Bolus with that new pod site. It never went well. Whereas if I did a Temp Basal increase, I took a Bolus via injection for that food that I was going to eat and let the pod get settled in. I didn't have any blood sugar issues. Okay.

Scott Benner 33:26
Yeah, it's everybody's strategy is different, right? But I'll tell you what it what it what that tells me is, again, this is going to be another sentence you hear over and over again, you have to trust that what you know is going to happen is going to happen. Yeah, so if you make a pod change and your blood sugar's 90, you still need to do that. Right? Right. It's okay, hold on, since you got 5.6 units, so I'm gonna do a Temp Basal increase 95% for an hour, and Bolus seven units. All now go eat as soon as possible. So she's got 5.6 units in from 20 minutes ago or so she's still 102. And so I'm not scared of those seven units. She's going to be eating in five minutes. And look, the 5.6 units didn't do anything over the last 20 minutes. So I'm good. My goal here on this Bolus is 75. Diagonal down while she's about halfway through her meal. Anyway, that's again stuff we'll talk about later. Yes. Okay. So

Jennifer Smith, CDE 34:32
and comfort level with you know, will happen.

Scott Benner 34:36
Yeah. And because, and by the way, and this, these, you have to you have to have these experiences like I'm going to leave this in this episode so that you know, that things have to happen that you don't expect, because it's data, right it's, it's, I did this and this happen next time I'd like this to happen, so I'm gonna do sooner or later. More or less, whatever it is I'm going to do. But you can't know that unless something goes wrong. Right, right. And so and so here's a great tip for somebody starting over or who is newly diagnosed. There are no mistakes. There are only experiences that build on for next time. That's it, I see something happen. Instead, you can't get dramatic. You can't get upset. You can't cry. You can't go, Oh, my God, I'm killing her. You can't do it. Right. You say to yourself, Okay, bare bones, what just happened here, I put insulin in here. It went up to there. And then it came down and crashed. I bet you if I would have put that much insulin in sooner and spread it out a little bit like I could have created the resistance that that blood sugar needed. Right and right. But if you're busy running around, wringing your hands, and just you gave away an amazing opportunity, and, and I will use this as an example. This past weekend, I was helping a mother with a five year old four or five year old boy. And while I was talking to her, this kid's blood sugar went to 300 off of some Cheerios. And we talked for 20 years, that breakfast cereal. Oh my gosh, we're talking about 20 minutes or so. This poor kids blood sugar's at 300 It's not moving. And we're getting ready to get off the phone. She's like, he's hungry. I don't know what to do. And I was like, Are you? Would you like to do something that's gonna sound insane. I'll help you. And she goes, I think I'm desperate enough to try something insane. I was like, great. How much insulin Do you think it'll take to bring a 300 to 90? And she says a unit? And I said, How much do you think lunch is going to take and she said a unit and a half. I was like cool. Bolus two and a half units right now. And she said, she's like, what's going to happen? We're going to put his blood sugar into a freefall. And then we're going to add the lunch at exactly the right time. And then with a little bit of fast acting carbs, if we need to, we'll bring it in for a landing. I said, I'll never leave you. We'll we'll text the whole time. We'll talk again and we have to, so she does it. We get diagonal down to 90 to 75 to 52 hours down to 50. She's texting. Oh my god. I'm like, no, no, perfect. Like, a whole lot. I actually texted her a picture of the guys from Star Wars who are trying to blow up the Death Star. Stay on target like just don't don't flinch. Like don't flinch to 52 down to 42 3200. I said, Okay, now's the time to start getting the lunch together. And she laughed. She goes, Oh, it's already it's just here on a plate. And I was like I said when we get the one ad given the food. So one ad to down kid gets the food 10 minutes later. Now isn't this interesting? We're dropping 10 points every five minutes on the CGM. Then he eats. Then all of a sudden the dropping stops. The arrows are still there. But now it takes longer to get to 170 took even longer to get the 160 and she gets the watch this happen 150 Still to down 140 Still to down. I said okay. It's not going to catch the arrows. Do me a favor, give them a few ounces of juice. She says we don't have juice in the house. And I thought to myself, Oh, I just killed a kid over the phone. Give it wrong number. So she said she says we treat Lowe's with jelly beans because they hit him so hard. I said that's great. But do you have any liquid in the house that has carbs in it? That's not soda. And she said oh, we have lemonade. I said that's great. I want you to give them four ounces. Eliminate. So she gives them I said and don't go crazy measuring it. Just give them a little bit of lemonade, right? So she gives them the lemonade boom. goes to one arrow goes to diagonal down. The kid comes in I swear to you 75 Nice and stable. Yeah, it's foods been in for a half an hour. And when it was over, she's like, wow, that was nerve racking. I said, Okay, I know that. Clear your head, and then go back and look at the boluses. Look at the time you put the food in and look at the CGM and figure out how that insulin works in him. Because you just had a Master's class how insulin impacts blood sugar and how food impacts insulin.

Jennifer Smith, CDE 39:14
Absolutely, absolutely. And that's, that's the place that as you know, clinicians, they don't have the time to do that. And it's unfortunate is it's unfortunate in the stance that with somebody something like diabetes, type one diabetes, specifically, you need that hand holding in an instance like that. You need the ability to be with somebody who can say, you're okay, write it out. You're okay. He's going to be fine. You've got jelly beans, you've got juice, you've got honey, you've got something in the house. You've got a mini glucagon that you could use if you need to. You're going to he's going to be okay. She's going to be you're going to be okay. It's it'll be fine. But you do you have to use those learning pieces. I think it kind of goes Along with a really good friend of mine, who has had diabetes a bit longer than me, which is 30 plus years, her, her doctor actually gave her kind of a good little hint for numbers, you know, we we start to view numbers in diabetes as good and bad, right? And that comes with that feeling of frustration then, and oh my gosh, I'm like killing myself, I'm doing something bad or whatever. And he said, you know, the numbers are information. So just like you said, it is okay, I'm here. Why am I here? You know, what can I learn from this? What can I do better next time. And maybe you analyze it, you know, three hours from now, maybe not in the instant, but it's information. So he told her, you know, when the number is going to come up on the glucometer, you put this test strip in, you put your blood on the strip, and you tell yourself, I am awesome. And here comes a number,

Scott Benner 40:59
right? Yeah. Because I just need to be it'll tell me what to do next. And it can't be a judgment, you can't feel judged by it. You can't let you can't, you know, you can't look at it and say bad luck, you can say not what I wanted, not what I was shooting for. But what makes me what gets me to what I'm shooting for. And you know, it's funny as, as you and I are pretty much wrapping up this first thought, right? I have so many people asked me when they're first diagnosed, what are the things I need to know? And I find around diabetes in general, everyone's looking for an amount or a number from you. Just please tell me how many minutes I should Pre-Bolus? Please tell me how many units I should do if his budget is like this. And I tell them all the time, I don't know figure it out for yourself. And you will write like you have to but I can't give you no one can tell you that a 10 minute Pre-Bolus is going to be what's right for you. In any given situation, let alone all the time. I think it's insane that we think that just because we've set a Basal rate of you know, one and a half units at 2am, that we think that that's what our body's going to need every day at 2am. It's, it's insanity to think that it's just the best we have with the technology we have at the moment. Exactly. And so if you listen to this thinking, someone's going to tell me the rules about what I need to do. And I'm starting with diabetes, we did, we told you what to do. It just isn't what you expected. Right? Right. And so I get that, I understand that it's, it's not a pill disease, it's not take three of these a day, and you have to have food with them. Like it's not that easy.

Jennifer Smith, CDE 42:33
And I think as a general too, in the beginning of of learning that comfort level and learning, you're learning what works for you by watching, you also have to take into that the variables, that can mean what you did figure out needs to change because of such and such variable, right. So you know, my breakfast in the morning, if I don't get to go to the gym before or after my normal breakfast, which I just I like it, which is why I eat almost the same thing every single day. And it works nicely blood sugar wise, but I like it. So it's easy. So but I the variables that I had to figure out were pre eating it, exercise, post eating it, exercise there, those are the variables, you know. And so what works in a morning, where I'm not exercising at all, is completely different than the mornings when I have exercise at such or such time.

Scott Benner 43:36
The variables are forever changing, which is why you have to, interestingly, know what they are, and at the same time completely ignore them. And what I mean by that is that you're not a machine, right? So there's certain things that are going to make sense. Like you just said, I know if I exercise prior or post that this changes how this Bolus needs to be. But if you're walking around trying to decide constantly, am I anxious? Did I just bang my knee? Like, like, you know, like, am I going to get a client the thing I see people saying online all the time, like his blood sugar is going up, he's gonna get sick three days from now I'm like, Oh my God, just give him more insulin. Like, who cares if he gets sick three days from now, I and so that's what I think of. When I say be fluid. I just that it's going to keep changing at such a rate that for you to try to apply static rules to it is insane.

Jennifer Smith, CDE 44:30
You've got that piece of of life with diabetes that you can then bring into education, which is why people usually come to us because we understand it from the Living standpoint, not from the this is what the clinical book says should be happening. So do this.

Scott Benner 44:49
I'm incredibly proud to say that I've gotten to the point where if I can talk to somebody for about 45 minutes or an hour they can have a major change in just a couple of days. And that's that's commuter Keishon that's what that is right? Well, that's what I have in mind Jenny for this series. Today we talked about being newly diagnosed or starting over. The next episode will be about multiple daily injections or MDI. We'll do an episode about insulin bolusing pumping CGM EMS and on and on until you and I finish covering every aspect of the things that we talked about on the show. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juice box for E meter while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G voc glucagon.com. Forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com If you're interested in hiring Jenny, you can learn more about her at that link. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bump and nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1009 teen explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025 We talked about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you Eat but means timing your insulin so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months, I've never met Scott. But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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Key takeaways from episode 1000 of the Diabetes Pro Tip Series from the Juicebox Podcast

Episode 1000, “Newly Diagnosed or Starting Over

Key Takeaways:

English:

Understanding how insulin works is crucial for diabetes management.
Basal testing can help determine the correct basal insulin rates.
Basal insulin is the foundation of diabetes management.
Timing and amount of insulin are key factors in blood sugar control.
Don't be afraid to adjust insulin doses and experiment to find what works best for you.
Doctors may not provide comprehensive education, so it's important to seek additional resources and support.
There are no mistakes, only experiences to learn from.
Trust your own observations and make adjustments based on your individual needs.
Numbers are information, not judgments. Use them to guide your decisions.
Be flexible and adapt to the ever-changing variables of diabetes management.

These takeaways are sourced from the audio above. It is currently only available in English but when technology allows; more languages will be added. Translations are A.I. generated. Additions, corrects or suggestions can be sent to me by email. Translations are not guaranteed. Please read the full disclaimer here.

Spanish: español

Comprender cómo funciona la insulina es crucial para el manejo de la diabetes.
Las pruebas basales pueden ayudar a determinar las tasas de insulina basal correctas.
La insulina basal es la base del manejo de la diabetes.
El momento y la cantidad de insulina son factores clave en el control del azúcar en la sangre.
No tengas miedo de ajustar las dosis de insulina y experimentar para encontrar lo que funciona mejor para ti.
Los médicos pueden no proporcionar una educación completa, por lo que es importante buscar recursos y apoyo adicionales.
No hay errores, solo experiencias de las que aprender.
Confía en tus propias observaciones y realiza ajustes según tus necesidades individuales.
Los números son información, no juicios. Úsalos para guiar tus decisiones.
Sé flexible y adáptate a las variables en constante cambio del manejo de la diabetes.

Estos resúmenes son obtenidos del audio arriba. Actualmente, solo está disponible en inglés pero cuando la tecnología lo permita; se agregarán más idiomas. Las traducciones son generadas por inteligencia artificial. Adiciones, correcciones o sugerencias pueden ser enviadas por correo electrónico. No se garantizan las traducciones. Por favor, lea el descargo de responsabilidad completo aquí. Disclaimer descargo de responsabilidad

Hindi: हिन्दी

इंसुलिन काम करने का तरीका समझना मधुमेह प्रबंधन के लिए महत्वपूर्ण है।
बेसल परीक्षण सही बेसल इंसुलिन दरें निर्धारित करने में मदद कर सकता है।
बेसल इंसुलिन मधुमेह प्रबंधन का आधार है।
इंसुलिन की समय और मात्रा रक्षा के नियंत्रण में महत्वपूर्ण हैं।
इंसुलिन खुराकों को समायोजित करने और अपनी जरूरतों के अनुसार परिवर्तन करने में डर नहीं होना चाहिए।
डॉक्टर व्यापक शिक्षा प्रदान नहीं कर सकते हैं, इसलिए अतिरिक्त संसाधनों और समर्थन की तलाश करना महत्वपूर्ण है।
गलतियों की बजाय, अनुभवों से सीखने की आवश्यकता होती है।
अपनी अवलोकन करने पर भरोसा करें और अपनी व्यक्तिगत आवश्यकताओं के आधार पर समायोजन करें।
नंबर जानकारी हैं, निर्णयों के लिए नहीं। उन्हें अपने निर्णयों के मार्गदर्शन के लिए उपयोग करें।
लचीलापन बनाए रखें और मधुमेह प्रबंधन के स्थायी बदलते परिवर्तनों को स्वीकार करें।

ये संक्षेप ऊपर के ऑडियो से लिए गए हैं। वर्तमान में, यह केवल अंग्रेजी में ही उपलब्ध है, लेकिन जब प्रौद्योगिकी अनुमति देती है; अधिक भाषाएँ जोड़ी जाएंगी। अनुवाद कृत्रिम बनाए गए हैं। संशोधन, सुधार या सुझाव मुझे ईमेल द्वारा भेजे जा सकते हैं। अनुवादों की गारंटी नहीं है। कृपया यहां पूरी अस्वीकृति पढ़ें। Disclaimer अस्वीकृति