#1009 Variables (REMASTERED Diabetes Pro Tip)

September 22, 2023Scott Benner

In this episode of the Diabetes Pro Tip series, CDE Jenny Smith and the host discuss the various variables that can affect blood sugar levels. They cover topics like medications, allergies, weather changes, and even road rage.

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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 juice box 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 pen. Find out more at G voc glucagon.com. Forward slash juicebox. Hey everybody, this is Jenny from Integrated diabetes services. I understand a lot of you have been contacting Jenny privately, which I think is a fantastic idea for any and all of you who are interested. Jenny, of course has been doing the diabetes Pro Tip series with me. This was supposed to be the last episode. But I think unless Jenny has changed her mind, we are going to continue to add to this series throughout the year. Yes, excellent. Jenny. I'm very excited about that. And today's topic is. So you guys don't really understand how all this happened. I wrote down what I thought were the tenants of the podcast. And I sent them to Jenny. And she put them in a different order and made changes to them. And she's like, I think this is how that this will work. And I was like that's great. And then we were supposed to Oh, well. You know what I was thinking Jenny's? We were supposed to record? Basically a like a menstruation episode. But I think I but I think it fits really well into your idea for today, which is variable. So I think we're going to combine the two of them if that makes sense. You

Jennifer Smith, CDE 3:24
agreed?

Scott Benner 3:25
Excellent. Okay.

Unknown Speaker 3:28
Why don't you tell people what

Scott Benner 3:29
made you reach to me and, and suggest this

Jennifer Smith, CDE 3:34
just the word variable brings in the whole topic of discussion, right? I mean, we're taught from the get go there are three main factors that really you know, you get educated about is impact on your overall blood sugar control, we've got an I kind of call them like the triangle of management of what you're told about to look for a fact. Exercise. The medicine you take in type one, of course, insulin Sometimes though, with the changes in some of the medicine now for type one use could be other medicines. And then you know, the third one is food. So we've got exercise, medicine and food and you know, if you contain all of those, you're going to have diabetes success, right? If you just learned about all those little pieces, when there are only three, so you're gonna do awesome. Well, that's like baloney. I mean, there's so many more factors to consider so many more variables or like icebergs, right? That can kind of come through the course of your day. I mean, some of them, you can sort of head off, you may know that they're coming if you know to look for them and that they could have impact on blood sugar. Again, the shortlist that I kind of came up with just to talk about today cuz I know we don't have like four hours to discuss everything. I think I came up with like 10 or 12 You know, variables that I could really think affect Most people, and that you really should consider. So, you know, I'm sure that you probably have some variables that you know, just with what you've seen with your own daughters management, right? Absolutely.

Scott Benner 5:12
And, and to kind of tag on to what you were saying, I found myself this past Saturday at the dancing for diabetes touched by type one event standing in front of people telling them that insulin timing is the seed of the tree that is your management. And as long as you know, we can always go back to that as the base is the root, right? But then eventually, you know, that seed grows a trunk and the trunk grows, branches, and the branches grow leaves. And all of these different parts of the tree can affect your blood sugar and will sometimes, but you can't get caught in a problem. And staring at the leaf on the 77 branch and wondering what is that leaf doing to me right now, even though it is doing something to you, it's, I like to look back afterwards and say what happened there and try to figure it out. But in the moment, as we say, here on the podcast in the moment, it just means you need, you need to change just adjust, right, maybe that means more insulin maybe means less. The idea that Basal insulin is insulin to and we always forget about it, everyone wants to set their basil and then think about Bolus, which just doesn't work, you have to think about the timing of all of the insulin. And when one of these bazillions of variables comes into play, some of them being more constant in your life than others. They have requirements, and they require of you to, to resist, right? Like you can't just, you can't walk through a day when your premenstrual may be the same way you walk through a day when you're not. Right. And so go ahead, give me your first one, what's your first good one off your list?

Jennifer Smith, CDE 6:51
So my first good one actually takes into account the three that I mentioned, right? Exercise, medicine, and food. Each of those seems like a simple like one topic blurb word, right? It's if I figure out the medicine, but you brought in a good factor, it's the dosing the timing, the consideration of the medication itself. And again, with more medications being added to the list of potential use, especially with type one, you bring in more variable there. And so with the dosing and the timing, it takes evaluation, so that that variable can be I guess, better known for you. Again, you know, we all have your diabetes may vary, right, we all have our n of one life with our insulin that we use, and we learn how to dose it, learn how to time it. So that's, you know, one and then the other two, exercise has a lot of variables to it. You know, you get the blanket statement from a doctor who says, Just take your pump off or just, you know, do a zero Basal if you're gonna go in exercise. The world of exercise is not that simple with diabetes, but if anything, there are a million variables within just the topic of exercise, if you consider you know, slow movement, like when I take my dog out for a 20 minute walk and he stops me pees in sniffs everything, my blood sugar could drop 50 points from just a dog sniffing, walk.

Scott Benner 8:19
Sniffing walk not to be confused with the brisk walk.

Jennifer Smith, CDE 8:23
Exactly. So I mean, you know, things like that, or, you know, going to like Disney World. To walk around all day, that slow, consistent movement, you wouldn't count as exercise not like going to the gym and huffing and puffing and sweating to death. But it's a variable that in my experience, I've found I need to reduce my Basal about 20% for the full extent of the time that I expect to be at like a Disney park or someplace similar.

Scott Benner 8:51
Can I ask you a question about that? Yeah, we always say that and then we never sort of not not you and I just people in general, I always say like, you know, exercise can bring my blood sugar down. In I don't want to go too deep into it. But why? Well, I My question is, when my body starts moving, what does it do that makes my blood sugar fall? Is it using the insulin more effectively? Is it speeding up the like, that's what I want understand real quick. Those of you looking for a diabetes organization to support should check out dancing for diabetes. That's it, no big sell. I just think you should. Dancing for diabetes.com That's dancing the number four diabetes.com I was at their event. A couple of weekends ago. I heard Elizabeth talk about how she started the organization. Her words just made me so proud to be there and to be supporting what she was doing. And I think you would feel the same. Just check them out dancing for diabetes.com That's dancing the number four diabetes.com

Jennifer Smith, CDE 9:54
Yeah, so the exercise piece, if you consider I like to refer to it exercises like Free insulin really, is some types of exercise again, you know, the low slow to moderate intense exercise, you're really looking those fuel cells, doors on them have, you know, little locks, right for the most part, we used to use insulin to unlock the door to get the glucose to enter, when we exercise, the body is sensitized to insulin, and those doors open freely, because your body wants to incorporate the glucose into the cells to get used and to energize the body to keep performing. So if you've got, and this comes into the first, you know, topic of medication and the timing, when you're looking at exercise, the timing of insulin is very, very important. And the dose and what you're coming into that active phase with on board, that's just it's huge. You know, so if you're looking at going into a five mile slow tempo run with five units of insulin on board from the Bolus that you just took, think again, yeah.

Scott Benner 11:06
I just spoke to an adult woman this weekend, who still play soccer, and she said, you know, the advice she got from her doctor was to take her pump off, and she said, But then my blood sugar goes sky high, and I can't play. And I don't want to do that. And I didn't have much time to talk to her. But what I said was, I said in a very basic way, that everything I say on the podcast, works for activity, you have to wrap your brain around it. But in the end, if using the right amount of insulin at the right time and taking into account that this exercise is going to happen, that's it. And it's simple to say, well, you just turn your Basal back an hour before and during or something like that. And that may be the answer in there. But there's an answer in there. And that is, you have insulin needs. During the soccer game, you have less insulin needs. So don't give yourself the dog sniffing insulin when you're playing soccer. Right.

Jennifer Smith, CDE 12:01
Exactly. Exactly. So yeah. And you know, so then we, you know, take into consideration the adjustment for exercise, but there is also exercise on the opposite side that may require more insulin. Yes, because of adrenaline, yes, things like you know, those who lift or do a lot of resistance training, or do HIIT workouts, you know, the high intensity interval training, where you've got a little cardio, but these really like short bursts of intense exercise in some of my first, I guess, personal informative about intense burst exercise for my blood sugar control was when I was starting to train for my first half Ironman and my training routine had some of the running as sprint Hill sprint, where I'd literally like fly up the hill and then sort of jog back down and fly up the hill. Well, you know, I adjusted, assuming that I'd have the similar response as other exercise where I would adjust the insulin and whatever, man I was high, like, you know, but adrenaline, you know, research adrenaline is kind of a component there to consider. The weight lifters that I work with, tend to find that they need to dose insulin before a heavy lifting session, they might need to take a unit of Bolus insulin, they may need to do a temporary Basal increase those kinds of things. So exercise isn't as simple take your pump off and go and exercise. That's,

Scott Benner 13:22
that's the Do Not that's do not die advice. That's advice that won't kill you. It's definitely not going to help you. Right, right. Exactly. And the example that I use over and over again, in my talks in here is the idea of art and showing up for basketball at a great blood sugar and then running around which makes you think blood sugar would fall but then it would go up. And then we figured out that she was competitive and she wanted to win the basketball game. So her adrenaline spiked up.

Jennifer Smith, CDE 13:50
And difference there you probably found from her game to her practices, yes. Which is very common for any athlete who is in a competitive anything. I mean, I found that with my running races, I could go out for my nice runs and for my training and have great management knew what I was doing some of my first five K's man, I was astounded at the rise in blood sugar as soon as I got in the car to head out.

Scott Benner 14:17
Yeah, it

Jennifer Smith, CDE 14:18
was like a drift off. It was like, for people who

Scott Benner 14:22
play competitive sports or have been around it this, this might make sense to you. My son always echoes this back to me that is true. He said it's kind of impossible. They always tell you to practice like you play. And he said it's kind of impossible to do because when you're practicing, the game's not there. Like right like there's these the same intensity is not there. The same desire is not there. You can't you can't duplicate the feeling of feeling like you're going to lose or let someone down or lose your spot on the field or some something like that. He's like you can't you can't make that up in your head while you're practicing. So your your insulin needs will be different because your brain is thinking differently about what you're doing. Very, it's very interesting. Yeah, yeah.

Jennifer Smith, CDE 15:06
So those are, you know, all even the time of day for exercise could make a very big difference for how you strategize adjustment. I know my morning adjustment for exercise is very different than my mid to late afternoon or evening exercise, very different just based on again, the sensitivity and all of that kind of stuff. So,

Scott Benner 15:25
and Arden, as an example, closes her eyes to go to sleep and her blood sugar goes down. It happens almost instantaneously. So it's not a huge drop. But that girl goes to sleep and the I don't know what you would call it the day life. Right? The anxiety and knowing the use of Yeah, she relaxes. And when she relaxes, her body's not forcing her blood sugar up in the same way. And it starts to drift down. Yeah. Okay. All right, Jenny, let's on that list now.

Jennifer Smith, CDE 15:56
So next one, again, of the three, the third one was the food, right? And we think okay, and we talked about this in one of our other, you know, just master carb counting, and you've got it like figured out, you've got it totally nailed, you'll be clear and beautiful post meal blood sugars, right? Well, again, I kind of it kind of takes into consideration, type, amount, combination of food, what went into the meal, you know, if you sit down and you eat, like, you know, a three cup jar of peanut, versus a three cup plate of white rice. Carbs are there in both pictures. The coverage of them, however, is very different. So those variables that kind of come in with food, we know now, thankfully, in the past, I would say five d, maybe even 10 years, we've become much more aware. And educating people a little bit better about it's not just carbs, it is the fat it is the potential protein. And with some of the I say newer, they're not technically new, they just have gotten a lot more media is things like the Paleo kind of diet or the keto diet, those kinds of past plans or, you know, eating habits, they require you to figure out the impact of the food in a different way than just carbohydrate.

Scott Benner 17:17
I know I think I've said here before, but I was with person eating no carb at a meal. And we went into a restaurant sat down. Hi, Vicki, Vicki ate food. I feel like we sat there for a half an hour and talked, we got in the car, we're driving away. And she pulled out her PDM for her mommy blog and gave herself insulin. And I was like, What was that for it? She was the protein is gonna hit me soon. Let's look, that's amazing. I don't think she ate one car while we were where we were. So different ways to wrap your head around different things. And I haven't, you know, again, I just this is fresh in my head because I just got back from a talk. But there's a slide that goes up that says all carbs are not created equal. But you have to you have to fly, right? You have to believe that 10 unit, you know, 10 units away, I cannot talk about grams, 10 grams of rice and 10 grams of watermelon or grapes are not going to impact you in the same way or for the same amount of time. And if you don't know that, then you'll struggle. You know, you can't, you can't just you can't just count your cars, put your insulin and eat your food and go away. If it worked like that. Well, then diabetes would be easier. And this pocket probably wouldn't eat this podcast.

Jennifer Smith, CDE 18:33
Oh, that's exactly right. Well, and then the other factors, you know, that will kind of, I'll touch on as we sort of go on here. But factors of food impact, you may get many of your common things figured out, as I think I said in one of the previous ones, you know, if you figure out the 2025 most common foods, meals, things that you eat, that's like 80% of your management, if you kind of nail those, figure them out from the protein, carb fat impact, awesome. But then we bring in all of these other potential variables, like you mentioned, initially, you know, the menstrual cycle for women, well, you may have all those wonderful things figured out. And then in comes the three to seven days before your period is supposed to start. And if you haven't been told that there is an impact on blood sugar, and you just think that, gosh, it must be my insulin or it's a bad site or something crazy is going on. You get really annoyed and confused. And for women that could happen every single month that you're getting annoyed and confused. And unless you start to track things. You'll remain annoyed and I

Scott Benner 19:43
try so hard to tell people I don't want you to. I don't want you to completely forget about the possibility that your insulin went bad or that your infusion site suddenly stopped working. But if your blood sugar was at all day, and then all of a sudden it jumps to 150 and it won't move. It's probably not your insulin, you know, but you see so many people that hyper focus on the physical things, they think they can see that they that they can they can believe might be the reason, right? And you have to be able to kind of look back a little bit and say, okay, it doesn't make any sense that my blood sugar was doing doing what I expected it to do. Suddenly didn't, why am I thinking the pumps at fault? Like, why am I thinking the insulin is at fault that insulin has been working for a day and a half, you know, or that vial has been working for two weeks, or whatever it ends up being? You really sometimes just have to think it's probably the stuff I can't see. And then I think, and then I always think too, and then don't spend too much time on it, to bring it down. Yeah. And here's a great variable, say your cannulas loose and you're leaking. And you're not getting as much insulin as you believe when you push the button. Still, in the end? The answer is, you're not getting enough insulin. The reason is mechanical. But the idea is still the same. If you were getting enough insulin, your blood sugar wouldn't be that high. Correct, right?

Jennifer Smith, CDE 21:07
Absolutely. And when we take into consideration, you know, cycle changes, if you start to track things as a woman, and you do have a cycle, and you're not on birth control that completely, you know, cuts your cycle off entirely, and you just don't have it anymore. If you're having a cycle, start to track things, because that's a good way to figure out some of that variability that a woman will have has nothing to do with the male at all diabetes management strategy. So if you're a woman listening, and you're within the time period of potentially having a cycle, and you're not postmenopausal, or anything, start to track your cycles and evaluate usually, for most people, they see a rise prior to their cycle starting, as soon as their cycle starts usually needs dip back down, up until about ovulation for women can be anywhere between day 11. And day, like 18, give or take. That could be another rise in hormones, it's usually shorter, it's only about two or three days. And then things kind of drift back down again, typically before that three to, let's say, five days before your period starts again. So we have this continual roller coaster of hormones through the course of a month. And if nobody's kind of queued you in to pay attention to it. You may just feel like there are variables that you just don't know what's happening,

Scott Benner 22:28
right? It just seems random. If you don't, it seems random if you're not aware that that's an impact. And by the way, they're fantastic. I happen to know, trackers like different apps you can get for your phone to track your period with it's it was only uncomfortable period tracker, there you go. And it was only uncomfortable for me like the third time I asked her and can I see the app that tracks your period real quick. You know, she said she was like, Okay, take it. But it really is spectacular. And in the end again. You need more insulin, you need less insulin, do you need the regular amount of insulin, you know, once you recognize that it's happening, and you don't spend a day and a half wringing your hands wondering what's going on and you just stay fluid and do what it asks, then then then it's not a burden anymore. It's just I need more insulin, but our brains get stuck. You know, you and I talked about this before we started recording. But Arden's looping now and I'm seeing with her basil, that how much more Basal insulin the loop can use. And I thought back to when I used you know, I had Ardens Basal before the loop set up at like 1.4 An hour and to double it to 2.8 to me seem like all the insulin in the world. And now I'm seeing the loop do it too, sometimes four or five, six units, and not for a full hour. But it's still it's, I realized I was stuck in the number the idea of the number and that can happen to you too, when you're when your period pushes up your insulin needs. And you think that's crazy. Let you know on most days, I use 20 units all day between basil and Bolus 40 is gonna kill me. Well, it's not that day, because your needs are

Jennifer Smith, CDE 24:03
different. She needed it. Right. Right. Okay. Absolutely. Absolutely. And that I think you bring into, you know, you lightly touched on, like the site or the pump or you know, those as being variables, but they certainly are, I mean, you have to know when to definitely address it as a potential site issue. You know, if you're in the time period of, let's say, your month or you're a man and you shouldn't have hormone issues, and you've got you've been floating along beautiful for, you know, weeks and weeks and weeks. And now all of a sudden, you've got this like, high blood sugar, you know, you're usually up to like 140 Maybe after your breakfast and now you're at like, 300 Clearly that's not normal if another variable isn't there, right. So you know, you address things you say I'm high let's address the high but why is it happening as well? Could it be the site check your site, you know, those kinds of things? Could it be the insulin think about, you know, if it's a brand new vial, probably not. But if it's a vial, that's good And close to that like, end of life like it's almost empty or you've, you know, you don't use very much insulin, so you're getting to kind of that 30 ish days, especially this time of the year and through like fall, where if you keep your open vial of insulin out of the refrigerator, temperature changes will effect insulin. So it's really an important piece to consider, maybe you just need to change the insulin out. So those as you know, potential site issues, the other side issues would be the site itself, have you used this site over and over and over and over and finally, it's gotten to the point of just you can't use me anymore?

Scott Benner 25:43
When you switch to a new site, expect that it's possible that you need less insulin than you needed prior on the old site? Because maybe that sites working better and and for all my talk about don't beat yourself up about it's probably the pump it's probably the pump once you decide it's your it's your site, it's you know, it's the pump. And nobody bails on a pump site faster than me once I believe it's the site, you know, I'm like, Okay, off gone. And that's that, you know, and you if you're newer to this, by the way, this all seems I try to bring this up once a while talking about things on the podcast is an exploded view, right? Like you're really stretching things out to see in your regular life. It's not going to take the last five minutes at Jenny and I talked about this for you to make that decision. You know, you've heard me say before, like about CGM people, like how do you know how you can trust your CGM? Like you can tell. They're like, What do you mean? Like sometimes it's 30 Points off, which by the way, you know, 30 Points off a 10 year old meter. I don't know why we're believed in the meter before we believe in the CGM, but neither here nor there. My point is, is that if you have some experience with this for a while, you know what's real, and what's a ghost, you know, and you can you can look and say to yourself, alright, this is clearly the site. This is going, you can look at your CGM and say, I don't think it's possible my blood sugar has been at three for six hours, maybe I ought to use my meter to see if that's right. And those decisions become very easy over time. 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 one.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 a 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 in 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 juice box 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 free meet her go get yourself a free starter kit. while supplies last US residents only touched by type one has the back of people living with type one diabetes. Take for instance, their D box program touched by type one knows firsthand the intricacies of living with type one diabetes, and so their team has created a D box which is a starter kit that provides important resources and supportive materials to individuals with diabetes. They want you to thrive. The D box is completely free and available to newly diagnosed people. All you have to do is go to touched by type one.org. Go to the Programs tab and click on the box. While you're there. Check out all the other resources and programs available at touched by type one.org. Speaking of support, touched by type one.org is available in English and Spanish. Don't forget to find them on Facebook and Instagram too. You do not want to miss what touched by type one is doing. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it Je voc hypo pan 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 je voc glucagon.com/risk.

Jennifer Smith, CDE 30:24
You know another one that this time of the year in consideration of like insulin and viability and all that stuff. Another one that a lot of people don't realize, is this time of the year could for many people bring in the variable of allergy.

Speaker 3 30:42
Okay, how so? Right? Just because because that's almost an infection. It's

Jennifer Smith, CDE 30:48
caused it Yeah, cause it's kind of like that histamine reaction in the body, which causes an inflammatory response. You know, that's the reason you get all Flemmi and, you know, bergerie eyed and like, whatever is coming out and

Scott Benner 31:00
trying desperately to push out that dust

Jennifer Smith, CDE 31:02
push out the nastiness, right. I mean, unfortunately, my husband has nasty allergies in this time of the year. He's just like, full of sneezing and like runny eyes, and you know, that kind of stuff. And it stinks. But when you consider diabetes, insulin needs with this as a stressor on the body, we talk about stress as a variable to allergies could be a stress variable. And so your insulin needs may very well go up in this time of the year. Because of that type of you know, setting. Now, if you use some medications to help deal with the allergies, it's always important as a medication kind of component or variable, check the label or ask the doctor, make sure any of those medications that you may take for, you know, an allergy won't necessarily have impact on blood sugar, some of them have a steroid base to them. And steroids, as we know, will usually raise blood sugars as well. So you could have kind of double impact and medication impacting as well as the allergy itself impacting

Scott Benner 32:07
Do you have pain on your list?

Jennifer Smith, CDE 32:10
Pain would be another stressor within that like, kind of body sort of Yeah, I think it's something that

Scott Benner 32:16
people don't think about. But I've seen it happen so many times that you can't not trust I saw Arden get hit in the knee with a softball once. And her blood sugar immediately started going up and stayed up. State her insulin needs remained high for days while the pain in her knee subsided, and it was a significant pain. And so let me ask if I have a headache, would that push up my blood sugar?

Jennifer Smith, CDE 32:39
It could if it's a it's a bad enough headache, especially those who may have like migraine issues absolutely could be a variable. Sometimes too, you know with that as as effect. Sometimes if you notice the rise in blood sugar, you take medication to offset the pain itself. If the pain isn't felt anymore, blood sugar's should or could very well come down. And so you do have to be kind of cautious with the adjustment in insulin. If you're doing something to cover the pain, you may find that correcting the high blood sugar drives it down more than you expected, because you're not feeling the pain anymore. So

Scott Benner 33:17
funny. My next question was going to be to you say I'm in a road rage situation. And because I'm all dialed into my diabetes, and I've got a Dexcom I see my blood sugar goes from 80 to 140. I don't want to Bolus right away right because my Basal because that that burst of adrenaline is going to go away quickly and then my Basal is going to my basil is going to crush that number again, most likely,

Jennifer Smith, CDE 33:39
most likely I mean in Basil is never meant to essentially bring blood sugar down. But once the stressor is gone like that a quick impact kind of thing. Typically, your blood sugar should start kind of coming back down. And if it doesn't, it just means obviously that you are thinking about it and continuing to like dwell on the problem.

Scott Benner 33:58
Right you have extra road rage is extra road rage

Jennifer Smith, CDE 34:01
Exactly. Go home and you tell every neighbor about what happened on the way home and you know, you continue to perpetuate the issue

Scott Benner 34:08
and go ahead and Bolus Ford

Unknown Speaker 34:10
Bolus. Exactly. Yes, exactly is

Scott Benner 34:12
a quick burst of adrenaline the same as a lollipop. In that it does it does hit you but that it can't sustain the rise.

Unknown Speaker 34:20
Is that a similar idea?

Jennifer Smith, CDE 34:22
It kind of similar idea of kind of a good way to

Scott Benner 34:25
you know, something, you know, doctors used to and I I'm sort of against the idea of talking about free foods. I don't I don't really think there's free foods in general. But But I have seen it with Arden and I've always wondered is the fact that like she put a lollipop in her mouth and her blood sugar went up a little bit and came down is that because a lollipop is a quick hit that goes away? Is it a free food or is it because I've got the balance of her insulin so wrong that it's able to handle carbs I haven't. Like I used to think about that when she was younger. Like am I really like did that really not have an impact or are, you know how we talked about if, you know, I was explaining to people this week and I said, Look, you have to Pre-Bolus You can't be scared of it like insulin works the way it works, it does not work the minute you put it into your body, if you Pre-Bolus and two minutes later, your blood sugar starts falling. The Pre-Bolus did not magically start working. You probably already Yes, you were falling already or you did something hours ago that is impacting now that you're unaware of. And I always wondered about that. Like when we'd give art and like little bits of candy Mia jet, was I just premature? Like, was I just holding up a low that was coming anyway,

Jennifer Smith, CDE 35:36
could be the factor. And that's also it kind of brings up a good point. Well, it's not really a variable, but it might be if you consider it lows, when you treat a low we recommend treating with simple sugar, right? When you treat with simple sugar, that simple sugar is really its potential impact should last an hour to 90 minutes. And thus the age old recommendation. If you have a low blood sugar, treat it it comes back up if you're not going to be eating a meal or a snack within the next two hours. Treat or follow up that carb sugar with a snack that includes protein. And the reason was to sustain the blood sugar then because that quick glucose like you just said it goes in it does its job it gets things up, but eventually the Basal that's there that's supposed to be right. overpower sugar, it will overpay there's not enough laughs really, if it's working the way that it's supposed to. So yeah, absolutely adrenaline and a lollipop.

Scott Benner 36:40
So the numbers not really the power without the when it's just a simple sugar. You have to give it a protein or a fat to actually add the, the weight to that number that so that

Jennifer Smith, CDE 36:53
something slower digesting you know, if you consider something like you know, quinoa or like a piece of sprouted grain bread or you know something longer sustaining. It's got the carbs, probably more than the lollipop does. But you're gonna get the rise. It's going to be a lot slower, but it's also going to be a lot more sustained. Jenna, you're

Scott Benner 37:11
not from where you live. Are you? Like Were you born where you live? Like Jenny's like a Midwest girl. Are you from the Midwest? And still you said instill you said quinoa as an example of that was really interesting. That took me by surprise. I was like, Oh, look at fancy Jenny must have been born somewhere else then moves where she lives.

Jennifer Smith, CDE 37:34
I'm just you know, I am a dietitian.

Scott Benner 37:36
Oh, okay. See?

Jennifer Smith, CDE 37:38
I know the fatty foods I guess I should know about right.

Scott Benner 37:42
I haven't I haven't read your bio in a while. Don't worry. I just I usually do it before the episodes when I'm putting the episodes together. You keen? Well, I got me by surprise. If this was a regular episode, I would totally title this episode. Kenalog. Just so you know. It's funny, so many people. So many people came up to me this weekend and said, Can you put any more effort into making the titles match what the episodes are about? That was like No, probably not just listen, you'll figure

Jennifer Smith, CDE 38:07
you can title it the variable of Qianlong that.

Scott Benner 38:13
I'm sorry, yeah, get you off track what's next on your list?

Jennifer Smith, CDE 38:16
The weather. As we consider temperature changes. I've got you know, so many people. And I noticed myself I've got a really good friend who notices as soon as March hits. And you know, here in the Midwest, March may or may not be warmer than the winter has been. But she's like, as soon as markets, it's like a switch in her body goes off. And it's like, it's spring, hey, let's dial down the insulin needs. And she literally has about a 20% decrease in her Basal needs. From March all the way through, like, you know, October ish, when it starts getting a little bit cooler out

Scott Benner 38:51
is that an across the board rule. For the most part, the

Jennifer Smith, CDE 38:54
warmer the weather, the more and the more time you might spend in the actual warmth of the warm weather. You know what, what does warm weather do, it increases the like, your body needs to cool itself off. And so your vessels come closer to the surface of the skin so you can cool yourself by sweating a little bit more that like increase in in the vascular nature of the underlying tissue brings vessels closer to insulin and you absorb faster

Scott Benner 39:25
plus and this isn't physical but physical in in terms of inside of your body but you probably become more active when it gets warmer to write.

Jennifer Smith, CDE 39:33
Absolutely do more things I know myself I you know here and my husband talks about it all the time. He hates the winter weather and everything and he's like let's just move someplace much warmer all the time. So we can always be outside and quite honestly, if that was the case, I probably would have lower insulin needs throughout the whole year because warm weather comes I'm consistently at the park with my boys and go and doing my normal exercise. I mean, I don't even consider that exercise. That's just part of our normal daily when it's nice outside. So yes, we become more active when it's nice enough to be active more often outside. So I

Scott Benner 40:10
think what Jenny saying is if you're thinking of relocating to a warmer place, and you feel like you can't afford it, don't forget to deduct your savings, insulin, right? There you go. You might be able to afford more rent, because if you just move somewhere warmer, all the diabetics are gonna live in California now.

Jennifer Smith, CDE 40:27
Right, right. And the opposite of that, you know, the cold weather, you stay inside more oftentimes, cold weather means you're eating a little bit harder your food, you know, to kind of sustain and backup or kind of plump up almost, you eat more like stews and things that might be a little bit more protein and fat laden, just heavier meals in general. I mean, nobody eats well, maybe some people do. But nobody eats like a rockin hot chili, dinner in the middle of July summer.

Scott Benner 40:58
Food certain times, now I get that you're more sedentary in the in the wintertime and

Jennifer Smith, CDE 41:02
more sedentary. Exactly. You may get your exercise, but you may be shorter, you know, the, though it's not as light outside anymore in the wintertime. So all of those kinds of things as far as a time of the year allergies, whether cold, warm, they can all be a variable. So I have

Scott Benner 41:20
a variable for you. Is it possible? It's more of a question that you may be able to tell me to shut up. But do some of our bodies react differently to cannulas than others? Like like this? This gives it possible that because you're because that cannula goes in, right. And it's seen as a foreign body immediately. Do some people see a third day on an insulin pump less effective, but some people can make it longer or shorter because of that?

Jennifer Smith, CDE 41:49
Okay. Yes, absolutely. And I think that's part of the reason, you know, knee pod, especially did their 72 hour or up to 80 hours of you know, exploration, essentially three days on the pod because the studies have actually shown that longer than three days with a sight, it starts to impact the absorption at the site. So if you think of the consistent drip, drip, drip, drip, drip, and then these big boluses I mean, if you don't use a lot of insulin might be two units for every Bolus. If you are some of the team guys that I work with who are eating, you know, 100 plus grams of carbs per meal and the ratio is a one to three. You've got huge 20 unit Bolus going into a site and that site gets it gets saturated. It can only absorb for so long, so some of it may not necessarily be cannula. Some of it may be how long and how much is going in at the site. For the people that are sensitive to different cannulas though. It could be the angle some people do much much better with the angled type of cannula. Other people do much better with the 90 degree cannula. I myself found no issue with Omni pod at all. I mean, I was a longtime user before I started looping about a year and a half ago. But once I started looping with my Medtronic pump, I actually found the angle cannulas were horrible for my skin. They did not work. And I found the 90 degree plastic cannula also wasn't something that my system seemed to really like. Whereas the steel cannula that goes in in a 90 degree angle, it's kind of like a thumb tap. You just pop it right in. That's awesome. It is like my go to set now. Fabulous.

Speaker 3 43:32
He just t slim have steel and plastic. They do because I see people a lot talk about the

Scott Benner 43:41
people who struggle on the T slim move to the steel cannula that sometimes helps.

Jennifer Smith, CDE 43:46
Yep. The one for T Slim is called True steel and the one for Medtronic is called the shore T. Okay. They're both steel. They both they work. Lovely. I would say for most people that I've encountered who have that cannula kind of issue. Yes. And you know, as a variable, those may be things to evaluate and say, I know it's not the darn insulin, I can give an injection with the same bottle of insulin and my blood sugar moves the way that it's supposed to. Let's change the site. It's not necessarily the site. It could be the cannula, we changed the cannula. Magically, things look better. Sometimes we even need to go down in the insulin needs because you're responding better. So

Scott Benner 44:26
I would like to say at this point that when you buy a pump, you're going to get instructions from the pump company about approved sites to use. Keep in mind that the pump company had to get the pump through the FDA process. And every site they wanted to test took more time. And that took away time from them getting it to market for you. So had they decide had they had the luxury of more time they may have tested more sites and the FDA may have said hey this data Use that you can use it here to. I'm now not saying anything else about that. Other than you should consider that. Correct. That's all.

Jennifer Smith, CDE 45:09
Yes. And even some of those approved FDA sites. Don't work for some people

Scott Benner 45:14
at all. Yes. Just because they're approved doesn't make them good for you. Doesn't make them good for you, because they're not approved doesn't make them not good for you always, always take into account the photograph on my blog that Chris Freeman, the Olympic skier allowed me to use of him wearing his pump on his pectoral. And I believe the man has the same body fat makeup of this metal microphone that's in front of me. So yeah, I think

Jennifer Smith, CDE 45:43
as well, even though they don't technically have, they've got pectoral muscles, they're just hidden underneath a breast

Scott Benner 45:48
I love when someone shares like a cleavage picture with their pump on them. And I show it to my daughter and she's like, Never, never. And I'm like, Okay, I'm just saying this lady says works really great. Get away from me.

Jennifer Smith, CDE 46:01
Again, all those variables to definitely consider. I mean, we're talking about location here, I clearly had location for a different reason being a variable. Go ahead location, being like travel. Travel is a variable. If you notice, changes in your blood sugar. When you are flying or traveling long distance, we usually find that over two hours of sedentary travel will usually require more insulin because of the sedentary nature and the potential bit of stress that travel brings in

Scott Benner 46:42
weight. On a three hour flight. We always have to Bolus art and two hours into a three hour flight. I never thought of it before, but it's constantly that

Jennifer Smith, CDE 46:49
yep, yep. So I personally have found that I use about a 20% Basal increase. When I fly I get to the airport, I turn the Temp Basal on so that by the time we get on the plane, it's already like circulating at a higher level. I continuing until we get the notice of dissent. And then I cancel it. And that works really well. For me I do the same thing on long travel I'm when we lived in DC, and we would drive back to the Midwest to visit family. That's a long drive lots of sedentary sitting in a car, the stress of driving on the road and everything I would need a Temp Basal increase for that. So travel in and of itself can be a variable for those on tube pump. The variable could be the pressurization in flight. Many people find and there's actually some really good I guess, blogs on what people found with a tube pump in flight. So the recommendation now is to disconnect before ascent. Check the tubing once you're at cruising altitude check if there are any bubbles, purge them out with a priming Bolus and then reconnect. Same thing for descent disconnect once you land look at the tube and clear the bubbles if there are any, some people have noticed that they get a bit of insulin Bolus that won't show up in the pump. Because of pressurization of the pump and the reservoir and everything. Some people find that they've got this huge air bubble in their tubing. And so if they didn't look at it, they would get a huge missed amount of potential basil or Bolus the next time they're pump pumps out.

Scott Benner 48:22
And that's something with the change of level elevation.

Jennifer Smith, CDE 48:26
Yeah, it has to do with the pressure pressurization within, you know, the cabin and unfortunately, there's not a lot of it. In fact, there's nothing that I've seen in any of the tube pump companies that they talk about doing that, but it's something that we know is common to happen. So on Omni pod, obviously there is no tubing, I've had a random couple of people who've noticed that in flight, they have these lows, having not bolused having not done anything different having sat at the airport for like an hour or two before their flight took off. Again, no Bolus, is there anything and they are low through the course of the flight. So potentially, I guess it could happen even without the tubing component there. I mean, the pods still have a reservoir. But I've really primarily heard it with tube pumps.

Scott Benner 49:15
I always wonder about you. Some people get like, like, we all most people have the same reaction, right? Nervous upset adrenaline, blood sugar goes up, but you do see sometimes, like people have the complete opposite reaction that you expect from them. And it's that's their norm, right? Or, like, here's one, how come when Arden has a head cold, it's like she doesn't have diabetes anymore. And other people say when I'm sick, my blood sugar goes through the roof aren't get sick or blood sugar goes to 80 and sits there for days. It's faster, right? And it's just so the other variability that we haven't spoken about yet is you? Right, right. So yeah, your response to all of these things. So You know, the variables may treat you differently than other things.

Jennifer Smith, CDE 50:04
Similarly, I have my friend, who I have done races with in the past not recently, but she actually has a considerable drop in her blood sugar once she gets to the race day, okay, that's it. She doesn't have that adrenaline spike, she has the opposite. I mean, there's adrenaline there, but whatever reason it's causing her to drop.

Scott Benner 50:22
And so for Jenny's friend, the the point here is, don't say, Well, I heard on a podcast that you know, when adrenaline hits your blood sugar goes up, and everybody online says it, but mind goes down. Don't Don't bang your head against the wall. Just accept that. That's what happens to you and address it accordingly. Correct.

Jennifer Smith, CDE 50:39
Exactly. Yes, exactly. The other travel one was altitude. Many people don't consider altitude. And if you are someone who goes to Colorado skiing or somewhere fancy in Europe, and you go skiing, or whatever you do, you could notice that going to altitude, I noticed that when my husband and I took a trip to Peru, and we hiked the Inca Trail, which is we got to Cusco and we were like, oh my god, can we just sleep the like the altitude was like crazy, we felt like we had never exercised before. And my insulin needs go up about 30% for about 24 to 36 hours, once I get to altitude, and then they come back down. It's like my body just needs this like adjustment period. And then it kind of comes back, you know, to my normal. But that's a pretty common one to consider.

Scott Benner 51:31
And that is incredibly common. And even though it is incredibly common. There are three people that I know of right now listening to this that are thinking AI it's the complete opposite of what happens to them. I correspond with people who live in Colorado and are afraid they're going to die because their insulin just crushes them they use the tiniest bit and their blood sugar's falling constantly they don't know why pumps injected doesn't matter. They just the the elevation that altitude just it Wrexham So yeah, that's their that's their normal, you know,

Jennifer Smith, CDE 52:02
that's their normal, right? Absolutely. So, you know, all those, I guess, all those things to consider. You know, they're all there are lots and lots and lots of variables. What else is on my list? I have

Scott Benner 52:14
Jamie prepared for you people, I hope you appreciate that I

Jennifer Smith, CDE 52:19
did just because I was like, gosh, there's so many of them, I need to like make sure I get the primary ones that I appreciate to people about considering, you know, a variable I know we've talked about previously, when we're talking about like being bold with insulin is high blood sugar itself, like extreme high blood sugar can be a variable in how you expect your body to respond to insulin. Typically, when blood sugars are higher than about like that 250 mark, which, huh? You know, they recommend testing ketones anytime you're higher than 252. Right. So along with that comes the consideration. So you've got it all like squared away, you know, your Basal, you know, your sensitivity to boluses to correct blood sugars, or carb ratio is all dialed in, and you feel like things are working and, wham, you're high now. And you take your correction, and you're like, Well, that looks like I put water in my body. And it did literally nothing. Sugar. So we've got this like, like this toxic state, almost like they actually call it glucose toxicity that comes into play when you've got extreme high blood sugars, where you'll need more insulin than your sensitivity factor would normally

Scott Benner 53:35
cover. And that's what people commonly say, I'm insulin resistant, when I'm high. That's the That's the common way that people talk about it. So if you have that feeling in your head, this is what Jenny's talking about. Now, from my very non scientific perspective. I learned years ago, and we've been talking about here forever, that bringing a high blood sugar down and coming in for that landing that you're hoping for and not a crash, right? You have to in my opinion, it's a mix of basil and Bolus. Jack, you don't just if you're thinking in my mind, if you're thinking it's two units to get this 300 back to 100. I like to find a good portion of that insulin from basil and I don't know why that makes more of a difference, but it certainly does. So

Jennifer Smith, CDE 54:24
it's also a I call it as let's say a safer way to also manage potentially because if you've got a Temp Basal increase going along with a part of a Bolus that you've used to address that higher blood sugar, the Basal can be canceled, right you can always bail on Okay, once you see the movement that you want, you can bail on the Temp Basal whereas if you've taken your rage Bolus in your like, it's telling me all you need to units man I'm gonna nail it. I'm gonna get it down with like eight units and you like nail Well, once it's there, you can't get rid of that eight units. It's

Scott Benner 54:58
you know, whereas you just Pre-Bolus For your next meal, you better eat it at the right time.

Jennifer Smith, CDE 55:03
That's exactly right. So, you know, if you do some of it as Bolus, like you said, and some of it is this Temp Basal insulin, you can cancel that term, you may need to cover a little bit, but at least you're going to drift down better without a huge crash. And

Scott Benner 55:17
also, you can also cancel it and go back to it, which I found myself doing before, right? You're, you know, 300, it's now it's 280 is 250. And then you're like, oh, my gosh, is two hours down, I'm shutting the basil off, then all of a sudden to 20 levels out and like, Oh, should left the basil on, and you put it back on again. But at least you're in control of it to a degree, right. And you didn't just put in this giant like, you know, mallet full of insulin that you can't stop. It's already hit you. It's hit you and you're done with it. Yeah, I want to say too, and this maybe doesn't fit here. But when you find yourself in those situations, I think it's incredibly valuable that when you cause that fall that that the sent in blood sugar, and you have to eat some food to stop it at some point. I know everybody thinks of that as like some failure. But there's so much to learn from watching the food going and watching how it affects your blood sugar on the CGM, that that that experience of stopping a drop like that will inform a lot of what you do in the future. Because just like you can see, oh, wow, I was 152 hours down. So I ate this. And I came in at at that knowledge. And I can't really explain to you how in the moment right now, how in this example, but it will inform your understanding your greater understanding in a way that will help you in the future. It's absolutely very neat to see how the food affects the insulin.

Jennifer Smith, CDE 56:40
Actually. So awesome. Yesterday, I talked to somebody who she works very hard, you know, with strategy management, we knew something was kind of going on in the evening for her. So we said, well, let's do like an evening basil test, let's see what's happening truly behind dinner without the dinner, you know, being there. So she did this awesome basil test, we saw the drift happen that we kind of assumed was from basil, we, you know, could counter it, but she ended up having to treat the drift down. And she didn't want to eat at 10 o'clock at night. So she just treated the low. She had three glucose tablets to treat it. And she thought, you know, all we're getting out of this is the Basal testes. So we know where to change things. Yeah, you know what? So we could actually get the evaluation of what the Caribbean takes she did right? How much of a rise did she get with it from it, because there was no other food, there was nothing I mean, the only other food she had in our system was from lunchtime at noon, at 10 o'clock at night, there is no impact of that whatsoever. She had no exercise, we treated the low it came up, we saw how much she could use it pointed out, she's like, Wow, we got like more done than I thought we got done, she was so excited that she could actually see. And it was simple sugar, right. So she didn't treat with something that had the fat or the protein that would have later potential impact that you couldn't figure out, it was just glucose tablet.

Scott Benner 58:05
Not so there's so much to learn. If you just step back a little, and widen your vision, and you know, and you have to get rid of that I failed or this is a mistake or a problem feeling. It's just data coming back, like look at it and really accept what it is instead of being upset with yourself. Because you can't because I said it this you know, I say it a lot. But this weekend, I was really pointed with a pretty large group I said, every time something goes the way you don't want it to go. And you don't use that as a as a moment to collect the data and make decisions and, and and further your understanding. You wasted that moment. And you're going to have to have it again now because you didn't pay attention to what happened. It's just like I mean, what's the saying Right? Something about history doomed to repeat it right? I don't know the exact thing. Right? All of you who know it now are repeating it in your head in your car. But that's the idea. The idea is it's happening. Learn from it. Don't just wring your hands and go I can't believe that happen. That sucks. I bet at this you know, right? This isn't fair at all. That's true, but isn't gonna help you the next time. So right cool. Jenny keep got anything else. I mean, we're right. Yeah, I

Jennifer Smith, CDE 59:13
had two other one was something that I think is not addressed. Usually not addressed at all. Unfortunately, health factors, I guess, that we don't really want people you know, doing really, it's things like smoking. Okay, if you're a smoker, I'm sorry. But you know what smoking can have impact on on on blood sugar and some of the research that's out there that can actually show that smoking can impact by causing some insulin, because King is it's suggesting an inflammatory response in the lungs might make sense. So could have impact blood sugar wise. The other one would be drugs. Drugs can have impact potentially on your diabetes management. To, you know, depending on the kind of drug that you're using,

Scott Benner 1:00:03
you're telling me that if I'm sitting at home really trying to figure out my insulin problems, and I'm not taking into account my heroin addiction, I make I'm leaving something out that's important to think about. Absolutely. Which which might be, which might be reasonable. Like, I think that people compartmentalize their thoughts sometimes. And you really sometimes don't see where the impact is actually coming.

Jennifer Smith, CDE 1:00:24
Yeah. And as a variable, you may not be considering all of the things you could be doing for your diabetes management. If you are utilizing a drug, and it's, it's really your main like focus, right? Because diabetes isn't going to be a focus.

Scott Benner 1:00:38
Are you gonna say drinking next, because I have one I want to ask about, okay, I'd say drinking.

Jennifer Smith, CDE 1:00:42
Yep, alcohol itself, drinking, it's big one that I discussed with, you know, my teens and my college. Because it comes into the picture it does. Learning how to do it safely, is an important thing, because the impact of the alcohol itself, you may have your fantasies, sugar, you know, juice sweetened beverage, the alcohol in it, however, is going to have impact later on your blood sugar. So what we find is that hours later, if you've had enough alcohol, it could cause a drop in your blood sugar.

Scott Benner 1:01:17
And and not for nothing. But when you're really loaded, you're probably not doing your diabetes, math as well as you probably could be. So is it fair to say maybe have a buddy with you explain to them, like, you don't just need a sober driver, you might need a sober basil tester to somebody. These things just made me think of her because I just did an interview with somebody who's like clinically depressed and has type one. And to watch the cycle of how it hit this person over and over again, was just like, it's crushing, you know, to see, but for them to have to live with. So now I'm thinking, if I'm on a depression medication, is that affecting my blood sugar? Is it making my blood sugar higher? Giving me anxiety more, that it's higher and making me feel more anxious about you having to use extra insulin in What about just the, the, the physiological, and maybe you don't know, but experience of being depressed? Like Does that have an impact on you?

Jennifer Smith, CDE 1:02:20
It's, well, depression is a stress, right? So it could be it could go various ways. If the depression isn't being managed with, you know, assistance, whether it's counseling, or use counseling, and medication or whatever it might be, you know, that in effect could be enough of a stress that it is bringing your blood sugar levels up. It depression can also mean that you're just, you're just not eating. So it could very well maybe bring insulin needs down, because you're just literally not taking in anything through the course of the day. Now, some of the some of the medications, some of the oral medications, will make you feel so much better, which is purpose, right? That's the purpose. But some of them also increase appetite. If it increases appetite enough, and you're not cognizant that that's what's kind of happening and kind of rein that in, you could have weight gain that could impact your insulin sensitivity.

Scott Benner 1:03:18
I'm going to add a thought to this, because I had a conversation with somebody online, who told me something I never considered. So this person was overweight. And so their eating was more than they wanted it to be. And so when they counted their carbs, and when to give themselves insulin, they wouldn't give themselves all the insulin they needed, because it reminded them that they were eating more than they wanted to be eating. And I know that's a real interest, you have to wrap your head around it for a second, but they were disappointed in themselves for eating that much. And one of the ways they pretended that it wasn't going on was to use an amount of insulin that a more normal meal would have. Yeah. So there's a lot of things I wrote, you know, as we started this conversation today, I wrote down life because the variable really is life. Right? Like it's your living, and there are different things happening to you. And whether you're, you know, addicted to drugs, or you're depressed, or you just don't have your basil, right? Or what are all the things that Jenny's brought up here today. Really, it's just it's you're alive, and you have diabetes. And so they're going to be variables. Are there any more on your list if you're looking over? The other one

Jennifer Smith, CDE 1:04:28
was kids growth cycles,

Scott Benner 1:04:34
oh, growth hormone.

Jennifer Smith, CDE 1:04:36
And I think you know, I mean, that is a it's a broad topic. So I bring it up as a variable. It may need full nother discussion potentially, but it is it's and people act. You know, we're the last kid. Lots of ages. I mean, little younger than two is my youngest person, and kind of up until like seven days is my oldest and but the key Kids have these variables of growth that just drive parents crazy. Because become, you know, we've got things smoothed out and beautiful and one of the biggest things I tell people is the needs will change. We'll get them figured out, they'll probably look like they're going along pretty nice and that oh, you know, little Johnny is going to burn up, you know, a half an inch. And so for the next couple of nights, they may get these like, like you said, Arden goes to bed and her blood sugar, kind of like drops off in a growth spurt. Many kids go to bed, as soon as their head hits the pillow pillow and they're snoozing, man, it's like a rocket ship to the moon blast off blood sugar. That

Scott Benner 1:05:43
is the worst part about growth hormone and children is that it happens while you're trying to sleep. That really I have to give Arden her Bolus really quickly. This one's gonna be easy, though. Because Arden's doing the loop right now at carbs. Taco. That's it. Wait, wait, hold on, hold on. Time, 10 minutes from now.

At carbs Taco Time, change time to 10 minutes from now, that isn't going to make sense to you guys yet. But it will one day when Jenny and I talked about that and and Katie De Simone comes back on and tells me all the things I did wrong while I was setting up my art and sleep. And how I could have been how I could have avoided them.

Jennifer Smith, CDE 1:06:35
Yes, I can. That's great. Because that was like my last little tidbit of a variable, which is a total different discussion. I'm glad you're gonna have it with Katie, but you should discuss with her the looping variable. Because these all have different if you are using a looping pump.

Scott Benner 1:06:55
Oh, Jenny, this is going to come out before I talked to Katie. And so I'll just tell you now and then you guys can all hear it now and then hear me talk about later with Katie. Every every thought I had trying to set up the loop was wrong. Like, like, like you don't I mean, up, down left, right. Like everything. If you asked me, you know, yes, though, I'd say yes. And you'd like oh, no, you know, I sent Jenny attacks. I'm like, I'm seeing this. Should I move this up? She go, no, no doubt, I'm gonna How do I get that wrong? It's just it's so all of us. Right now, everybody who's listening. If you're being bold, if you're following along with this podcast, obviously, it works fantastic. And there's no you don't need to change. But if you go to looping at any point in your life, or into a closed loop system, the variables, the settings that allow the loop to think are counter intuitive to what we're all doing, when we're not looping. But I am putting myself through this so that I can explain it to you all better. Because if you guys want to move to a closed loop in this future, I think that's not a bad idea. And I want to make sure you understand how to transition from being bold with insulin to being I don't know, bold with

Jennifer Smith, CDE 1:08:07
blue, or how to maybe let loop Be bold with itself.

Scott Benner 1:08:11
Yeah, there's a way but trust me, I still only understand that about 65%. But by the time I'm done talking to Katie, and by the way, now that Jenny has been kind enough to say that she's going to continue coming on like this. I don't think we'll be putting them out like three at a time, but maybe once a month, or as often as Jenny can do it. And trust me, we're gonna get to talking about that as well. So thank you so much for doing this. Thank you, wherever you are right now, I imagine you applauding for Jenny, just a slow, deliberate and lovely clapping. That's how I feel every time she's on. Hey, how about that great news. Jenny is going to keep coming back on the show. The diabetes Pro Tip series is going to go on into the future non stop pro tips just for you guys for listening to the Juicebox Podcast. 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 free 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 Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juicebox 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 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and an 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. Jennie 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.