#1014 Glucagon and Low BGs (REMASTERED Diabetes Pro Tip)

September 23, 2023Scott Benner

Everyone needs to understand the role of rescue glucagon when they live with type 1 diabetes.

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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 0:03
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. 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 juice box. 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. Hello, everybody. Welcome to Episode 301 of the Juicebox Podcast. Today in a pro tip episode Jenny and I will talk about glucagon emergency Lowe's, just you know how they manage that kind of a scenario? And what happens if you need glucagon? And how do you use it? That kind of stuff? It's not a bummer. Don't worry, Jenny and I laughed more during this one than most of them. So we're gonna go over how to use the glucagon. What glucagon is, what is it do the three different kinds that we could think of there on the market? Pretty much. It's a nuts the bolts glucagon extravaganza talking about low blood sugar somewhere else you're going to talk about people having seizures, and hearing them laugh at the same time. I mean, who else is putting out diabetes content laughing about a seizure? It's not funny, by the way, it's just the situation was fine. You'll see when you get to it, don't get upset. I liked your idea, a lot of doing a pro tips for glucagon. And I was wondering if we couldn't meld it together with like emergency situation ideas as well. You know what I mean? So I just I realized, well, we'll talk about what we're talking about it. I don't know how to start this. Honestly. I can tell you that. We buy glucagon religiously. I always have some when it expires, we always get more. We've never used it. We've had opportunity to use it twice when Arden was little and both times opted to try glucose gel instead. Which worked. Here's the best place to tell the story, I guess. And I'm sure I've said it here before, so I'll encapsulate a little bit. But, you know, when Arden was really newly diagnosed, she was probably like two and a half years old. And thinking back now knowing everything that I know, she's probably honeymooning still, right. And I had no one ever spoke those words to me ever. I didn't know that was a thing back then. And we got kind of ahead of ourselves one day and Kelly was getting ready to leave on a business trip. She was gonna go overseas. And it was like, six or seven hours before her car was going to come to take her to the airport and she's like, Hey, I need another piece of luggage. Like let's go to the mall and you know, a little piece of luggage looks like alright, so we get over to the mall and it's a Sunday. And we're hungry while we're there. So we grabbed you know, the worst thing in the world like mall food, Chinese food, just not just more food, more Chinese food. And I was just like, boom, I counted my carbs. And I was like, pull up my insulin and the needle, bang, go ahead and eat. I figured this out. And she ate the food we ate, we bought the bag, we went home. It was super little. So she fell asleep in the ride home during the ride home only like 15 minute ride. And I carried her into the house and put her in her crib. My wife's packing and my son's watching the football game and everyone's living their life. And all of a sudden, it sounded like there was a wild animal trapped in the house. Right there was like this grunting and grunting and grunting. And you know, it's like anytime, like, I'm just like, what is that, and I start moving through the house towards the sound that's coming from Arden's room, and I get into her room and look in the crib, and she is having a seizure, you know, and I was just like, I did not 100% know what to do. So I picked her up, and I went through the house to where Kelly was. And we had just this kind of little area rug. And I said, I'm like Arden's having a seizure. And so I put her on the floor, and I got out the glucagon. So the red box, you know, that

Unknown Speaker 6:13
has changed

Scott Benner 6:16
forever and ever. And this is the one Lilly sells, right. And so the red box, I pop it open, and there's a needle in there, the needle needs to be put together, the needle has liquid in it, I know the liquid needs to be shot into the powder, that it has to be reconstituted and drawn back out. And I'm going to be 100% honest with you, I was so freaked out that I fumbled with that thing. And I was nowhere near getting it put together before Kelly was rubbing glucose gel into her cheek. And I'm not embarrassed because I look back on that time. And I remember when they gave it to us, the nurse made such a big deal of saying, This is life saving glucagon. But but don't worry, you'll never need it. And so when she said that, I was like, well, I'll never need it. Whatever

Jennifer Smith, CDE 7:09
was in the house, at least it wasn't like, you know, in the bottom of the dog's bed or something. Right? You knew where credit

Scott Benner 7:17
for knowing where it was. Fair enough. So So literally, during you know, the Kelly put the glucose in her cheek, she started to come out of it. I will tell you 100% of the the experience of watching art and have a seizure will never leave me i have never forgotten any of the details of it. She was blind, like she couldn't see anybody. She couldn't talk. But I don't think that meant that she wasn't aware of what was happening. Because there's a I've shared it on the podcast recently. But there's, you know, there's a video of her from a year or so later explaining how it felt to have a seizure. And so you even when you touched her, it scared the crap out of her when you touched her, you know. And so I just never even figured out how to put it together. I had shown it to nurses, I had shown it to people like everything, but when the time came, I was like, not very high. Anyway, the glucose gel did work. And then we went to the hospital, we call 911. And we went to the hospital. And then you get to the hospital and then the hospital kind of treats you like, you don't really need to be here. Like there's that kind of feeling. And then you realize like, Oh, it's over. Okay. Yeah, it's okay. So, later, while we're talking, I'll tell you about the second time I've had a seizure, people are gonna be like, Why am I listening? This podcast only happened twice, relax. It was in the beginning. So I guess, let's really start at the very beginning, right, like, what is glucagon? And what does it do when you inject it?

Jennifer Smith, CDE 8:59
It's made by the body to begin with glucagon, right. And so in the human body, it's a piece of the glucose management system that your body has in place without diabetes in the picture, right? So you've got this management system of your body releases insulin, your body also releases glucagon, which enables the body to break down glycogen, which is stored form of glucose, right? And so you get this drip, drip, drip, drip, drip, drip drip of both, and that helps to keep things stable through the course of your life. So you know, in a person without diabetes, you've got blood sugars that might start dipping down your body releases a little bit of the glucagon, which enables the body to break down the glycogen into glucose and it starts to navigate things back up, but it's a seamless system, right? I mean, nobody walking around on the street right now. Right now, even the most highly educated biochemist, whatever is probably thinking, Oh, I wonder what my body's doing. thing right now

Scott Benner 10:03
is just one of those things

Jennifer Smith, CDE 10:04
like breathing, you don't think about it, it happens. But in diabetes, we, we kind of have like a faulty system, obviously, right, our body isn't making insulin anymore. But we still do have this like drip drip of glucose into our system, or we wouldn't need Basal insulin. Right? Glucagon, however, is, as you explained, well, it's an emergency, we know it as an emergency, we have to use this if this situation is here, right? A low blood sugar, treat a, you know, a friend, a child, a spouse, whoever it might be. So when we inject glucagon, it stimulates a very large amount of breakdown of the glycogen, the stored form of glucose, so that the glucose can get into the system, thus bringing the blood sugar

Scott Benner 10:58
up. It's stored in your liver, right?

Jennifer Smith, CDE 11:01
Glycogen is stored in both liver and muscle cells.

Scott Benner 11:05
And muscle cells. Okay? So, in an in a functioning person who doesn't have type one diabetes, your body really is bumping in nudging. It's giving you it's giving you insulin, and then it's saying, oh, this person needs a little more glucose. And so I I'll release a little here, I'll release that. And that's happening constantly back and forth, back and forth all the time. So so when we're diagnosed with type one diabetes, when someone's diagnosed, we always I mean, for me at least, like, in my mind, what happened is Arden's pancreas stopped making insulin, but more happened in that right but we just don't talk about the rest of it usually, like, you know what I mean, like, in because you hear people say like, my pancreas is dead, but it's not that does other it does way more things than absolutely,

Jennifer Smith, CDE 11:54
absolutely it doesn't mean you got more things in your pancreas than just the beta cells 100% In fact, the the glucagon actually is made in the alpha cells of the pancreas. So a completely like different little cell hanging out, you know, Lottie, da here I am to do this thing, right. So overall, our pancreas isn't dead. It's just a piece of it. That's, it's purposeful,

Scott Benner 12:20
as well as you want. Yeah. And, okay, so what what's interesting, right, like, So how often do you think how often you speak to someone who's needed to use glucagon in an emergency situation?

Jennifer Smith, CDE 12:35
In if I had been doing this 20 years ago, likely more mainly, because I think that with the influx of the technology that we have, now, we've got alerts to actually tell us when things are dipping, before we would even get to the place of needing glucagon. Now, I mean, that doesn't mean that it isn't potentially, you know, necessary, we've got the standpoint of prolonged exercise, you know, or you've had, like, people who do like a whole entire Ironman Triathlon, in that's a huge depletion in your body's glycogen stores, even if you've been fueling along the way as you should be. That's a huge depletion, your body has tapped into your stored glucose to fuel that long duration movement. So, I mean, if you have exercise like that, potentially, you're going to need something to boost glycogen out of the system to bring a low blood sugar up and or you've got too much insulin there to begin with, for whatever reason the dose was wrong or the dose was wrong along with a long act, active day or whatever this scenario, glucagon will potentially at some point be necessary. I knock on wood, I'm not really superstitious, but that's like, my grandmother's thing to do is like, knock on wood. Whatever works, right, but I mean, in 31, in plus years with diabetes, I've never had to be given glucagon. I haven't. I mean, my husband knows how to use it. My parents knew how to use it. My teachers at school, my Girl Scout leaders, that I mean, everybody that I interacted they all knew how to use glucagon and went to sleep overs with the glucagon in my bag. I did never had to use it. Thankfully, in the amount of people that I now work with, I would say it's not it's not common to have had to use it, at least not. I mean, we may talk about this a little bit later, like different kinds of emergencies settings of use, but mean there is the benefit of also many dosing, and some adults especially The adults that I work with are much more proactive in in trying to offset something they know is not working right, you know. And so, ability to micro dose a glucagon injection and offset a low that you don't pass out from and nobody needs to help you. You can help yourself, right? It's,

Scott Benner 15:21
it's funny the way you put it because I'm thinking back now, you know Arden's very infrequently low, but she has like a crazy low once a year that just comes, it appears to come out of nowhere, right? And when you think back on one of those, you realize that without the sensing technology, like if she didn't have a Dexcom those she would have seizures, yes. Moments, right? Because it's, it's unexpected. First of all, it's not like I've done anything different that day than another day. I'm not standing around all day going, Whoo, this is going to be the day it never happens. It never happens on a day when you're like something's gonna get squirrely today. Right? It's never that day, right. And so you know, you're it's one two o'clock in the morning, and you get the alarm, and you realize she's falling way faster than you would have any expectation for. So there's something, whatever it is pushing down on her blood sugar, and nothing to resist it in the other direction. And it's just falling and falling and falling. So we get, you know, we get an alarm to go in, you give her I mean, for me, I give her juice first, because I find that works very quickly. Like it's the way I think of it is like let's get something in there working. While we do the rest. Right? Then I look for things like that are like palatable quick. I always look for like a banana in that situation. Because it's not hard to eat a banana. It's sugary, right. And then you know, I'll roll back to another juice if I have to. But you'll see those, those crazy lows go like 70 6050. And they fall really quickly. And before you know it, you're treating at 50. And you would have treated sooner you just there was no time and you're treating it 50 You're into the 30s. Now you're testing now you're doing the like, are you feeling? Oh my mind? Yeah, let me double check this right. So you're 50 You finally have a second there's some food in. So now you hit a finger stick, and it says something like 30 or 26 or something ridiculous. And you're just like, Okay, now I'm here waiting for her to either have a seizure or not. Like that is really what it feels like, like I've put the food in, it's in there, it's going to do something. And you know, and you're just the I don't know about everybody else, but I test and then I wait like, not long, you know, it's like four or five minutes later, and you test again, and you're looking for just any sign of stability? Did the 38 stay at 3840? Good? Did it go to 40? Because if it went to 40, I don't think she's gonna have a seizure. Right, like, and so I think everyone needs to know how to handle a moment like that. Absolutely. You know what I mean? But I'm now now, you know, having seen that moment, a few times in my life. I see, as you're talking that without the sensing technology, she would have went from 50 to 30. And the, the alarm I would have gotten would have been the grunting and the disabled and the seizure. And without and then I would have been and without

Jennifer Smith, CDE 18:09
this technology. I mean, I I think fully even to this point, I I still have symptoms for Lowe's. I do even with the technology that I have that alerts me and whatnot. I still know when I know usually even before my system is going to tell me I can tell where I am. What's your number

Scott Benner 18:28
when you know you're low? My number is usually in the 60s. Arden's it's yeah, she knows it's six. But you

Jennifer Smith, CDE 18:35
know, years ago when I was first diagnosed, in fact, a good a good case where my parents probably could have used glucagon, but didn't. It was the summer like several months after I was diagnosed, we were camping, had been out playing, you know, rafting in the pool at the beach, doing everything that you would normally do when you're on vacation, you know, and it was the evening and my dad was making popcorn at the fire. And we were all going to sit around and whatever you do at play games, and it was time for me to check my blood sugar because it was like nighttime, right? It was bedtime almost. So I sit down to check my blood sugar. And my mom was like, that number is not right. And I looked at the number. And I mean, I was the age that I knew numbers and I knew where my numbers should technically be. And it was 26 on my meter.

Unknown Speaker 19:21
Like you were fine, right?

Jennifer Smith, CDE 19:22
Like old meters that took like four minutes to test you had to swipe the blood off, stick it back in the machine, push another button, wait for it to actually give you a value but yeah, 26 My mom's like, that's not right. She's like, Did you wash your you know, all the things I washed my hands again. And like, I tested again, my hands like how are you feeling? I'm like, I feel like I did like 30 minutes ago. I'm like, totally fine mom, you know, she tested again. It was like 25 It was like literally it hadn't moved and my mom was like, like my mom is the kind of person who's just like, oh my god, like seriously, you know, and my dad was right there and he's like, Oh, just give her some juice. And my mom was like This number isn't juice. This is like we got to do. He's like, give her the juice. She's talking. She's fine. She's answering questions. You know, I mean, I can remember this very vividly. Give her the juice, I drink the juice. You know, my mom's like, let's check again. You know, like, all the thing is certainly, it started coming up. It was slow. And it's a painful Wait, it really is. But maybe my mom was like, there. She was like that glucagon is going to be here in 15 minutes if this juice that your dad wanted to give you is not working. I mean, and who knows? What was the accuracy of a machine like 30 years ago? You know, I mean, my blood sugar could have been 50. Who knows? But yeah, again, I think you also have to judge those scenarios, like, okay, she can take something in to eat, she's talking, he's talking the person's, you know, with me? Can we actually like do the glucose gel? Can you do glucose tablets? Can Is it safe to do something to chew? Or should we just do some juice? I mean, but glucagon is always there, if you don't know. And you can't tell us the glucagon. It's, it's going to work for you.

Scott Benner 21:08
But it's the only thing you have at that point. So it's because, you know, just as I'm describing Arden, having a you know, a bad Lo, she could still eat and reason and talk and all that stuff. And so that's fine. But when she was seizing, you couldn't have, she couldn't have drank anything or eaten anything that wasn't happening, she was gone. You know what I mean? So she needed she, you know, in perfect world situation, we would have used the glucagon in that scenario for certain, you know, it's just it's in it's, listen, I have to say this, too. It's frightening. But if you think you're going to live a whole life with type one diabetes, and not get into a situation where you test and see a 26. And I think you're wrong. I think it's going to happen. At some point, I used to tell. It's funny, because you described how everyone in your life knew how to use glucagon. And then I've done the same thing, right? You've explained to a million people that it never comes up. And I think that sort of builds a false narrative in those people's heads like, oh, this diabetes isn't as bad as these people say, right? Because they showed us this emergency thing. We've never used it. It's this. That's not a real concern, because it never happens. I do think that's one thing that happens, but but the other thing is that is that you have this kind of feeling of I don't know, like, like, it's it's never going to happen. But it could, it just really could happen. And and if it does, you can't be freaking out in that moment. Because trust me, I freaked out once. And if Kelly wasn't there, I don't know what would have happened. Because I was like, not processing. Well. And then since then, you know, you learn the second. Yeah, you know, storytime, the second time our had a seizure. We were Disney. And we had spent the entire time day at a party. And we were coming coming back later at night. It was hot. We were walking, she was eating we were giving her insulin, you know, the way we thought we should we were testing she didn't have glucose meters long time ago. And we're we're within like visual sight of our hotel walking back through the park. And this popsicle salesman's walking at us. It's like 1030 at night. And I remember looking up and seeing this guy holding these giant popsicles thinking like, what devil sent you in my path? You know what I mean? You know? And so the kids are like, can we get those? And we're like, yeah, of course, and we gave her some insulin for it and gave it to her right? Looking back now, I never would have given her insulin for a popsicle and that sort of scenario, knowing your blood sugar or not knowing your blood sugar. And so we you know, she eats the popsicle, we walk back to the hotel kids are again, exhausted, she goes to sleep. The About an hour later, the grunting sound happens. And I'm like, this time I'm like, oh, there's no raccoon in the house. Arden's having a seizure. I know what this is. And so it was both comforting and hilarious and scary. All three, excuse me, not both, but all three. I went into the other room got her. Sure enough, she was having a seizure. We went right for the glucose gel because you're like, Well, we know this works. And take the cap off the glucose gel and go to squeeze some out. It won't come out. And in the panic, I just thought, I don't know what I thought. But just the little silver paper was still over the thing, the freshness seal. They squeezed it way too hard. The freshness seal did not come off. But it sprung a pinhole in the back corner of like the sealed part of the tube. So imagine icing tubing and M squeezing it and I am writing in calligraphy all over the ceiling of the hotel room in this laser thin beam. You know, and we all look up everyone laughs we spin the thing around and shoot the glucose challenge Her mouth out of the pinhole and out of the thing rubbing her cheeks, she wakes back up again. She's fine, she's kind of looking at you like yo, what's up, and we get, we get her stable, make sure she's not fallen, and we put her back to bed, the whole thing took like 15, right? And then that was sort of the end of it. And she's never had one since that, you know, but we learned a lot in that in that time. So if you don't think that's going to ever happen, I hope it doesn't happen to you. But to live like it can't happen. That's a mistake. And so back to my original point, when when I used to spend time before when I was younger going into school, and saying, look, here's what you really need to understand about diabetes, and I would go over the stuff. But I would always end with I know, you feel like we're sitting here today, getting ready for when it happens, because it's something we can prepare for I'm like, but the secret about the diabetes and an emergency is, you sort of can't prepare for it. Like, if you knew it was coming, you'd stop it. And that's always the weird part about this stuff is it always happens just when you would never expect that to happen, like because otherwise you'd be sitting around going, oh, you know what's going on this afternoon. It's totally a seizure situation. Like no one thinks that way. And so I don't know, I just, I think it's incredibly important to be prepared as

Jennifer Smith, CDE 26:17
well. And one additional to that, like preparation. Let's say you are prepared, you've done all of your homework, you know, you've got the glucagon, you know how, you know to use it, your friends know how to use it or whatever. And I, I bring this in, because it's something that I do discuss, especially with like older teens, and like college students, and anybody who does a lot of socializing within their job. I think it's, it's really important to know that there may be a point at which glucagon may not work.

Scott Benner 26:50
And that is mess around drinking, right?

Jennifer Smith, CDE 26:53
And I mean, there really is, there's a real reason it's not like the glucagon is like, Oh, I'm just not gonna work today.

Scott Benner 26:59
That's not upset with you for being a drunkard. It's like, you know what? Jenny drinks too much. She doesn't deserve for me to work. It's not like, you're not being judged by the

Jennifer Smith, CDE 27:09
beer. And I would rather she had, like, you know, a Mai Tai or something? No, not at all. It's just, you know, it's the there are biological reasons, right? I mean, your liver again, your liver is like this phenomenal organ in your body. It really is. It's, it's fantastic. And it does a tremendous amount of stuff for you. One of them is, and we kind of call it your body's detoxifier. Right? I mean, that's a really like nutshell term for the things it does. But the livers task of ridding the alcohol out of the system, which it sees as a toxin, it's going to do that first. Before it does its job, it's going to see a toxin is gonna be like, this body doesn't need this, let's get rid of it. And it takes a while for your body to process that alcohol. So I think it's like one drink takes about an hour and a half to process out of the body. Okay. So in that time period, your liver isn't going to as efficiently as effectively check into what's happening with your blood sugar. Right?

Scott Benner 28:15
Yeah. It's not a multitasker.

Jennifer Smith, CDE 28:18
If you give glucagon in that scenario, and now you're asking the liver to do another task, it's not a multitasker. Juggle. I'm

Scott Benner 28:30
busy already. So are you. I feel like Jenny's saying that a liver is more like a guy. Like you give it a thing to do. And it does that thing until that thing's over. And then it moves on to something else. I know, this is a generalization. It's sexist. But, you know, I don't know that. It's, I don't know that it's that wrong?

Jennifer Smith, CDE 28:49
Yeah. And drinking in and of itself can also, you know, do some crazy things just to blood sugar levels in general, right? So if it's got carbs, and if it doesn't have carbs, if it's pure alcohol, etc, you may not have been eating with the alcohol. So I mean, there are a host of other things that could go into a low blood sugar in terms of alcohol consumption. But one of the things of course, is that the livers not doing that drip drip of glucose, right, or glycogen to turn into glucose, etc. So your Basal then that's dripping in the time period that it was beautifully tested. It should be working great. Your Basal is managing without the normal glucose drip.

Scott Benner 29:35
Right? I feel like that's a very important point.

Jennifer Smith, CDE 29:37
So yeah, if it's not doing that, then what happens you get a low blood sugar. Now when you take the glucagon, you're now telling your liver like I said before, to do something to release this glycogen and to give you some extra glucose to bring the blood sugar up. And there's either a major delay or it doesn't, it doesn't do it. So really injury thinking some emergency you know, if you're with it enough to know that your blood sugar is dropping, obviously simple carb, you can do the juice, you can do that as if you're with friends, college friends, a spouse, a significant other whatever, they should know where the glucose gel is something safe. If it's not glucose gel, they should know where the honey is, if they don't know where the honey is, make sure it's cake frosting, something that can be squirted into the cheek can be rubbed in massaged in, it starts to absorb and it can bring the blood sugar up. So

Scott Benner 30:30
we don't want it we don't want to have to swallow it to make this process happen. We want it to absorb through the lining in your mouth.

Jennifer Smith, CDE 30:36
Correct. Exactly. So that's one I think one in that like emergency time of potential Oh, get the glucagon out.

Scott Benner 30:47
Try some other stuff first.

Jennifer Smith, CDE 30:49
Obviously even calling you know, emergency services. Obviously, if you're with somebody you really don't know what to do. Call 911.

Scott Benner 30:57
Yeah, so Well, it's so interesting, because what you just said about when the liver stops making, you know, it stops dripping out this glucagon, this glucose, we always talk about, you know, you need your Basal insulin set up, I'm always saying, right, it's like timing and amount of the right amount of insulin at the right time against carbs or body function. And you know, then we talked about body function being like stress or anxiety or pain, or, you know, all that or your liver and what your liver is doing, that's a body function that's causing your blood sugar to try to go up. And if all of a sudden it's not trying to do that anymore. Now your Basal match, right? It's actually on top of everything else,

Jennifer Smith, CDE 31:35
right. And it's actually the reason that with alcohol, our standard of of education that we see to do is for every alcoholic beverage to take your Basal rate, if you're using a pump, that is take your Basal insulin down by 40% and set it to last duration, at least two hours for every drink consumed. So if at the end of the night, you've had, you know, four drinks, that's eight hours worth of a decreased Basal. So,

Scott Benner 32:06
okay. All right. So let me so now I have this question as we're having this conversation, and maybe I'm wrong. But this thing that we call glucagon that we inject inject in emergency situations, is it actually glucagon or is it something that makes your body produce glucagon? When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G Bo Capo 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. 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 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 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 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 juicebox free meter go get yourself a free starter kit. while supplies last US residents only 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 per grams. There, you're gonna 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, you just click on that to check that up ball for a cause 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 35:43
No, it I, I understand that it's glucagon.

Scott Benner 35:47
So glucagon makes your body make more glucagon,

Jennifer Smith, CDE 35:49
glucagon injected makes your liver release glycogen and transition it into glucose.

Scott Benner 35:57
Okay, so is this stuff that we're injecting helping bring up our blood sugar? Or is it just making that function

Jennifer Smith, CDE 36:04
that's making that function, right? It's the glucagon that you inject is telling your body to release the stored glucose and send it into the system. That's what raises the blood sugar.

Scott Benner 36:15
Gotcha. It seems like such a simple thing. But as we were talking, we're a half an hour into this. And I'm like, maybe I don't understand what's in the vial.

Jennifer Smith, CDE 36:22
It's unless somebody else knows something else. I all the years, it is glucagon in the it's in that little vial. And it's not as very stable compound at all. I mean, that's why it's in that like, it's why it should shift the way it is. That's why it expires so frequently. That's why you have to mix it and use it. You know, I mentioned briefly before even using mini glucagon, a small portion of what you mix up, if you are you know, alone and you can use it yourself that vial that you mix up then it's only good for 24 hours kept in the refrigerator. So so

Scott Benner 37:00
and so you're talking right now about the one that comes in the red box, the one that's made by Willie so I guess let's break them down a little bit because now they're suddenly on the market more glucagon it for ever and ever. It was the you got the red box, right? And so inside of that red box familly is a vial like a glass vial. And it's got powder inside of it. And then there's a, a needle with and it's an inter muscular needle. It's not an under this. It's not an under the skin like little insulin needle. It's like a

Jennifer Smith, CDE 37:30
all the way and it's a good size. No, yeah, it's

Scott Benner 37:33
a hunk of a needle is what it is. And so you pull out the vial with a powder in it. You take the needle, and you inject the liquids, it's in the needle into the vial, then you kind of spin it together, you know, between your two hands. I know you can't see what I'm doing. But you write that and then it, it constitutes it, it mixes the powder with the liquid, then you have to draw it back into the syringe. And then you're supposed to stick that syringe like into the muscle in your butt, right? Or something like that

Jennifer Smith, CDE 38:00
right into the bot. Yep. I mean, yes, that's the easiest place.

Scott Benner 38:04
You're injecting that glucagon into the muscle. All right. Now that's one glucagon. But since that's happened, another company made a nasal glucagon who made that you remember?

Jennifer Smith, CDE 38:15
Gosh, I don't remember the name of the company. It's back shimmy is the name though? Of the

Scott Benner 38:23
so now that's sort of like, you know, everyone, I think assumed it was like an aerosol, but it's more powdery, right? Have you talked to anybody who's used it? I've

Jennifer Smith, CDE 38:32
not talked to anybody who used it. I have it myself. I did get a prescription for it. And part of the reason quite honestly, that I got a prescription for it is well, twofold. It's it's certainly much easier to use from all of the research and all the studies. The there's a significant decrease in accuracy of use, or a significant increase in the accuracy of use with the back shimmy compared to the mixed injectable.

Scott Benner 39:03
Okay, um, let me do me take it first. And I'm looking at it so it's actually also made by people and and it's so it looks like it comes in a thing that looks like you know, sailing, you'd say the tube looks like a sailing thing you'd sprained your nose, but I'm reading it here it is a powder, dry powder spray in a portable single use ready to use device now. I have only heard from a couple of people who have tried it. And so far the people who have tried it have said to me they burned their nose interesting, like so the inside of their nose. I don't they didn't say about how well or not well at work, but Jenny's hearing that it works more that it works better than the

Jennifer Smith, CDE 39:42
in terms of accuracy. It was from what I know it works the same as dosing, but the accuracy if somebody else has to give it to you, it's more accurately delivered.

Scott Benner 39:53
Okay, so in a panic situation, your friend is a little more able to stick somebody Your nose in squeezing than it is to do everything I just described, and then tricking your body.

Jennifer Smith, CDE 40:04
I mean, I guarantee that Arden was two and a half, if you had had something like this, taking it out of the bottle, sticking your nose and pushing it in, you would have had no trouble doing that, you would have been able to figure it out. And I, you know, a big part of having it in the house is because with little kids, you know, I, my seven year old is a smart kid. And while he would know to call 911, he would know to go to the neighbors if I was a whole loan with them, and I wasn't right. Yeah, this is something that I easily showed him in two minutes. And I was like, this is all you got to do and then run to the neighbors. That's that's all you got to do.

Scott Benner 40:47
You know, you're gonna sleep soundly one day and wake up burning up burning in your nose and your front door Why No, kids gonna be like mommy's down, and you'll be like, I was just sleeping. So now there's a third one on the market. And I just left Arden's appointment the other day, and I got our glucagon change to G voc. Okay, so, so g voc comes in a syringe still, but it is the I think the kind of the genius of what this company figured out is, is that it's, it's pre constituted, you don't have to mix. It's not a powder in a liquid. And it's incredibly stable. So my assumption, I'm making an assumption that you might, you know, maybe people who used to think, oh, one day, we're going to make a closed loop system with glucagon and it but we couldn't, because they couldn't figure out how to keep that glucagon stable long enough. I'm starting to think maybe that that might be the next step after these algorithms. You know what I mean? Maybe it will be a dual chamber pump with an algorithm. And this, but I went with this one, and I will be 100% Honest, why? There's two things. The nasal thing to me, seemed everything what Jenny just said, like, seems super easy to do. And all that stuff. As soon as I started hearing about the burning, I thought, okay, like, that makes sense. And I still was gonna go with it. Until and again, this is me being very honest, the makers of jokes said, we'd like to come on the podcast and talk about the glucagon. And so sometime in the future, you're gonna hear an interview with the CEO, and he's gonna tell you why the company started and all this stuff. And it was super hunched, hitting an incredibly interesting life. i It's possible that when you listen to it, I mean, if you listen to this podcast enough, you might not be surprised by this, but I don't know exactly how much we're gonna talk about the glucagon how much I'm just gonna be like, so what did you do after college? That's weird. And, you know, but that, so I went with it, for two reasons. One, because it's stable. And you know, I don't have it doesn't have to be mixed. The injection isn't intermuscular it's just normal. It's just a normal like, little needle. And I thought, maybe I can use it for bumping, like doing glucagon, like little bumps to and that wouldn't be possible with.

Jennifer Smith, CDE 43:10
And there is, I mean, there is a guide, certainly for using you're talking about like that mini dosing kind of of glucagon. And there is a guide for it. In fact, it's, it's actually a guide that starts with, you know, a tiny, tiny amount for little people.

Scott Benner 43:26
And you and I talked about it on the prototyping so yeah, about Elvis, we talked about that, right. So people can check that out if they want to hear that but and so incredibly, ironically, I guess, not long after you and I recorded the the illness Pro Tips episode, Arvind, got sick for a number of days. And unlike most people who are like, Oh, I got sick, and my blood sugar went up, Arden gets sick, and our blood sugar goes down. So there was this one time her blood sugar was, you know, was at 70. And I'm like, it's gonna hold it's gonna hold eat something. And then the food didn't do anything to her. And it kept drifting down. And I gave her more and more. And then there was this moment, you know, we're like, 45 minutes into this, and she's now 55. And I'm like, Jesus, none of this food is touching her. And I so I'm thinking to myself, what's next? Like, I have to do something right now. I walked up to her with a juice box. She goes like this. Put your hand up and she goes, if it's my time, it's my time. But I'm not drinking another juice. Like girls super serious and trying to be funny at the same time. I said, right on, okay, I hear what you're saying. She's like, seriously, if I drink another juice, I'm gonna throw up and I was like, gotcha. So I went downstairs. This is probably look first of all, this is completely off label. But it's also why at the beginning of the episode, I tell you, this isn't I'm just telling you what I did. It's not medical advice. And I took my old you know, read kit from Lily and I mixed it up. I went back and listen to what you and I said to each other. This is maybe like, I'm like, I wonder what I'll do. You know, like, there's a podcast episode about this hold on. Then but and I remembered and I drew up like I kind of spit balled it a little bit. It was off based off of weight, I remember that I drew up seven units. And I gave it to her. And it took a little while. But no, why her blood sugar went back up, not too far. And it leveled out. It stayed there. And I was like, right on, I am definitely getting the G voc instead of the nasal stuff, because this might happen again. And that that was my reasoning for going that

Jennifer Smith, CDE 45:30
big question about the G voc would really be the pen itself? How How, how much is in the pen? Like how many? You know, what's the dosing because when you look at how much to give, it's, I think it's if you're over 50, in the doses, 15 units of mixed up glucagon. And that would be given kind of like we talked about before, and the other, the other episode, a certain amount of time. And then if it doesn't bring the blood sugar above 80, then you reduce with the double the amount. So just with the G voc, my question would really be how, how much do you know that you're giving as a mini dose? Right?

Scott Benner 46:12
And I'm gonna find out because you're 100%? Right. And so I'm gonna try it. I'm gonna find out. And if it's not right, I'll switch to something else. Yeah, no, but I think is this gonna work enough to

Jennifer Smith, CDE 46:22
do any of that extra stuff? That's really awesome. Yeah.

Scott Benner 46:26
I think that as a replacement for the lily one, this one's a no brainer, right? Because you don't have to mix it up. And it's not this giant needle. But I think and this is not something the company said to me. My but my assumption is, the real excitement here is about the possibilities for dual chamber pumping, right? Because it's stable. And not only that, I think the bigger excitement and I think the CEO alludes to this, if I'm not mistaken, I'd have to go back to listen. But my assumption is, they figured out the science of making something liquid stable, which now means that science could get applied to other things. I'm guessing, I'm guessing, I'm guessing this is the very infancy of this company is what I'm is what I'm thinking and run by nice people. So that's cool. Okay, so we went over the three different kinds of glucagon. What and the when? Right, you're going to use glucagon when somebody can't physically take something in their mouth? Right, right. When Arden had a seizure, we only use the gel and rubbed it into her cheeks. We weren't trying to get her to swallow it. If you try to get somebody having a seizure to swallow something, you're gonna get them to aspirate. It's bad. Right? Right. Don't do that. Right.

Jennifer Smith, CDE 47:40
Maybe even a you know something for, as we know, symptoms of low blood sugar, even if you're not passed out or having a seizure, you could be not together with it, right? I mean, many people complain about their spouse, significant other child child getting very violent, or very abusive, or whatnot. I mean, getting them to eat something is maybe impossible. So using glucagon, in a scenario like that may be your only option.

Scott Benner 48:11
Yeah, you might be maybe

Jennifer Smith, CDE 48:13
tackling them and holding them out. Exactly. But you hold

Scott Benner 48:16
the needle, I'll tackle them that hand me the needle, it's gonna be a lot of fun. Yeah, well, well, that really is, you know, I've heard the stories too. And there's been people who've come on here and told them, but I've heard them privately two of the worst scenario ends up being when you're two adults, and one of us physically smaller than the other one. And the larger person, you know, becomes combative or angry. And I've heard about, I've heard about people throwing furniture and, you know, say saying terrible things. And you know, and everything.

Jennifer Smith, CDE 48:49
From a safety standpoint, you know, if the person is up and moving and in, let's call it like a violent sort of behavior, and you're not safe. Just call 911. Call 911. That's really, I mean, don't try to get close to them with a needle and try to stab them is not a good idea.

Scott Benner 49:09
It's such a, it's such a bad television show. You just see two people standing across from each other and one guy's ranting and raving and holding a lamp and you've got a needle in your hands. Really, it's like every bad movie I've ever seen in my life. I think the goal would be not to get that low. You absolutely can. But like we said, these are emergencies, they don't happen on purpose. I think it's just very important to remember, like, you can't plan for an emergency. I mean, you can plan for what to do when it gets here, but you can't plan for when it's going to happen. Right. So let's talk about since we're in this vein right now, and we're using up our time and we have a couple more minutes. Let's talk first about low symptoms. Some of the things you've heard people saying I will start with the one that aren't in tells me what is happening. Why or why am I being treated poorly here? Oh, you know what, actually, this is funny. It's Express Scripts I have to say okay to prescription to the to the glucagon prescription. I'll call them back off the call them back in a little bit. But I know that's what that is. Now my wife has picked it up downstairs and she's busy listening to a recording. And she's trying to figure out why she's listening to it probably. So are we the other day? She she got a little low, right? We were going right into a restaurant. So she went like quickly from like, 75 to 60. And I was like, Hey, you're dropping? And she's like, Yeah, I know. And I was like, how do you know? And she said, My lips are numb. And I was like, really? She goes, Yes, she's like, that's the one that I like. That's my physical tell. She's like, my, my lips get numb. And she goes, and if you don't take care of it. She's like, I didn't realize before. So she told me a story. She said one time she was out with my wife. And this happened. And my wife gave her a drink to have. And she drank it in orange, like, oh, this tastes terrible. And my wife said, really? And my wife tried it and said, Kelly's like no, it seems fine. And Arden kept drinking a little while later, I think we were at a baseball game for my son's and I was on the other side of the field. So I came back over eventually. And my wife said, Hey, Arden was low earlier, but we took care of it. She drank this. She said it tasted weird. And so I tasted it. I was like, I'm zone tastes fine, you know. And so it took Arden She said, It took her years to figure out that when that numbness comes, it's it's affecting like her tongue in her mouth to she feels it on her lips. It says everything. Everything tastes weird. At that moment, I was like, Oh, no kidding. So I was wondering if that happened, anybody? But what are some of the, like, what happens to you?

Jennifer Smith, CDE 51:42
So and I think that's, it's good to acknowledge symptoms and understand that there are many symptoms, because they can also change over the years. Like I, you know, when I was younger, my symptoms were the classic like, I would get, like, visibly shaky, I could hold my hand out and I was like, visibly shaky, beyond just the internal symptom. It was there was a visible cue there, too. In college, I also had something very similar to what Arden is describing. But it was more it was more like an internal mouth numbness. It wasn't really my my lips, it was more like an internal mouth like it almost like you know what it feels like to be numbed at the dentist that like you feel like your whole mouth is thick, and like, puffy. That's what it felt like to me. Now,

Scott Benner 52:36
how long did it last after you ate like after you brought your blood sugar back did it last?

Jennifer Smith, CDE 52:41
Ah, for gosh, I mean, I would say it probably lasted a bit of time after my blood sugar was actually normal. Because they specifically remember it. Like in college, I was still on injections. And so I would often have that as I came into lunch, because they had pretty full mornings of like zooming around on campus and getting back and forth to classes and whatnot. And so I would often have that at lunchtime. And I can say that, before I headed out into my next course of classes in the afternoon, I still had that feeling even though my blood sugar was already back up from having eaten. So I guess for a bit of time, it seemed to last. Whereas my symptoms now don't last after I've treated, they don't last long unless it is, unless it's been a significant drop. That's happened very, very quickly. And it takes a while for the carbs to kind of start to make me feel better. My symptoms now are much more like this, like feeling of everything rapidly moving. Like I feel like the world is spinning and moving. And my thoughts are fast. But I I feel like I'm walking through mud. I feel like I just I can't keep up with the way that my brain is thinking about things. So

Scott Benner 54:16
I wonder if we'll never know, obviously. But I wonder if your thoughts are at regular speed and your body is slowed down? Or if your thoughts are sped up and your bodies that regulate. I'm so interested in that. There's no way to know, because it's one or the other, right like your one part of you is being fooled about something. Yeah, yeah. And everything feels like it's like, you feel like that might be what it is. Maybe it's like that. Maybe you feel like you're in slow motion. I don't know. Isn't it weird? It feels like it makes me feel like you're in a country. And you're like kind of screaming like you know what's going on but you can't affect anything. Is it that kind of a feeling or no? Am I wrong?

Jennifer Smith, CDE 54:58
It's somewhat Yeah. The other one is kind of feeling like drunk. Like I get kind of tipsy. And I'm like, I've I've literally been like drunk maybe three times in my whole entire life. Right, but that's what it feels like. But that's not every time but some of my lows feel. And I'm a I'm a very happy like drunk person, like everything is fine and happy. I'm not an angry drunk. So, I get kind of tipsy with a low blood sugar sort of like, Ha ha ha, that's funny when it really isn't funny at all.

Scott Benner 55:39
It's and it's like I'm describing with Arden to like, cuz she's done that a couple of times, like, you know, I'll be like, aren't getting up, you have to do something, your blood sugar's low, and she'd be like, I'm just gonna die over here, like, but that's very jovial when she says it, like she's very like jokey about it, like, I guess. Yeah, it'll just be fine. But you know. Yeah, I think it's interesting. So when people have you heard from other people like some of the stuff because they are, before we go into that, let me ask you this one. When you wake up after you've been low for a while, and you didn't know, why are you so sweaty? Do you know, it will sweat when their blood sugar is

Jennifer Smith, CDE 56:14
low? It's a body response to the low blood sugar. All of the physiologic like mechanisms that make it happen, I, I can't really speak to, but I do know, it's very, very common to wake up in a sweat.

Scott Benner 56:30
Yeah, like bad, like change your clothes after you treat your blood sugar. Like, take the sheets and wave them around for a while. You're just like,

Jennifer Smith, CDE 56:39
right, I even kids. You know, I've heard some parents comment too, that, you know, an older child will obviously wouldn't be wetting the bed anymore. With a low blood sugar may have mainly because they've not got the conscious, I guess, ability during that time period for their brain to wake them up to actually get up and go to the bathroom. Because they're low, you know, so but I mean, outright symptoms, you know, even blurred vision can be one of those sort of like a tipsy feeling on your feet. The shakiness in the hands, people talking kind of like, kind of like off the rocker sort of like you ask them a question. They don't make sense. Yeah.

Scott Benner 57:21
Confused, confused. Right. And I guess it's funny to like I, I've read, you know, back in the day, like all kinds of blog posts from people where they talk about being low, and everyone describes it like slightly differently, but I think it's situational, too. It's really interesting. There's somebody I keep thinking of having on just to describe a low one time because this person's low was like an amazing story. And I'll have to see if I can figure that out someday. Okay, treating things. Like let's so let's talk about it for like to finish up real quick. My blood sugar's falling, but I don't want to get high again. I'm ahead of it now. Like, you know, I know people know Arden's a juice box person, if you know if, if she's looking for a quick hit, if she's not hungry, juice boxes work for her, we use this very specific juice box. I think it's important to remember that you're not looking to drink. So I found the smallest box I can with the most carbs, so that she's not having to us like I started helping Arden's friend the other day. And you're gonna and she's doing great boy. Yeah, and but you know, at the first time was like, hey, I need you to drink some juice. She pulled out this juice box, and it was huge. And I'm like, Yeah, you that's fine. here and I sent her a link. I was like, get these like, you're killing yourself. You drink eight ounces of juice to get 15 carbs. I only want you to know, the juice is medicine. It's not for fun, like you know what I mean? So juice boxes work. I've talked to people who use jelly beans, Skittles glucose glucose tablets Skittles like so you're you're looking for something that's a real simple sugar that's getting absorbed in your mouth and then hitting your body quickly when you swallow it like that's it so what sometimes people say milk but I don't think milks is fast right that's

Jennifer Smith, CDE 59:08
yeah, I mean ages ago that was one of the treatment things even on my list when I was little for low blood sugars it was milk. Well when you consider like whole milk when there's fat there, there's protein there. And the body actually has to has to break down the milk sugar in order to get the glucose part out of it, which is what actually brings your blood sugar up so I don't ever recommend milk. I really don't think it's I don't think it's a good low I mean obviously if you don't have anything else around, have at it, drink your milk, but there are much better simple sugar things to carry along with you even dried fruit. And you know when I was little, my mom actually used to give me the little mini mini boxes of raisins. And then I at the end of the school year had these like dead raisins sitting all over the bottom of My backpack that had to be like, they were disgusting. They were like, you know, full of dirt. And they were gross. But that was what worked. I mean, raisins were easy. They they worked well. They got the glucose tablets when I was little were horrid. They were horrid. I mean, if you think they're bad, or no, they were bad years ago, I mean, now, the only ones and I don't even I don't I don't know if they're on backorder still, but the gluco lift brand is the only one that I love. They taste good. They don't come from a GMO glucose source. All the colors and the flavors come from natural fruit and fruit extract. So they're not artificial. You know, no Lake number 70, or whatever it is. So but something simple. I like your juice box, though, I actually have kind of the opposite. I look for the smallest juice box that has the least amount of carbon it because I want to drink either I'm like half awake, if I ever do have to treat a low overnight, which thankfully, I haven't had to do in a really long time. But I don't want at two o'clock in the morning to have to be completely fully conscious like

Scott Benner 1:01:14
to say to yourself, I really just need half of this juice box.

Jennifer Smith, CDE 1:01:18
boxes I get are actually they're they're four ounces. And they're only eight grams of carb apiece. That's Oh, cool. So you know, they work Nice.

Scott Benner 1:01:27
Nice. I know. Arden also carries those little pouches of fruit snacks, whether and they always have like eight or nine fruit snacks in them. And it will sometimes eat for fruit snacks to eat to for snacks. So the other morning, we were heading to school and she goes here, throw this out for me. And she gives me a package of open fruit snacks. I still have four in them, but their heart is a rock, you know. And she's like, they're hard. And I was like, Okay, I'll get rid of them for you. And but yeah, she always has one of those. So in her bag, she has a juice, a small juice box and a small pack of fruit snacks. And she always has that whether and then and then there's juice boxes sort of spread around the school. So Arden's in high school, so she changes, obviously, you know, classes. So there's, you know, in a closet somewhere, there's a couple of juices in each class. And then wherever she is and she has to take one out and drink it from her purse, if she does, she just hits the closet and replenish his or hers. You know, I have to say that we don't you know, the beginning of the school year, it's not as it's not as intense. When you're older. And you've done it for a while, we just take two bricks of juice boxes and spread them around, like, you know, like rose petals that are at a wedding, we're just like, there are some here and there, then you're done. And then maybe once a year, Arden will be like, hey, I need more juice boxes. So she might go through. I don't know, she might go through 1020 of them a year at school. But that's

Jennifer Smith, CDE 1:02:49
pretty minimal. That's actually pretty good. You know, when you when you get to be an adult with diabetes and have kids in your house, you actually have to be kind of good at hiding things. before disappearing, appears like literally I mean even I mean, even my husband will drink them or eat them. And he I mean, you know, he'll tell me if they're obviously not there anymore. But me my kids, if I have my glucose tablets out, they'd love them. So I hide them. And so it's like it becomes really important like purses, by purses. I have like these internal like hidden pucks pockets in many of my purses. Because when they see an open purse on the table or the floor, they're like, Oh, does mommy have any of her stuff in here? Like, mommy stuff is for a really important reason.

Scott Benner 1:03:37
You actually reminded me that during during a family vacation once there was an argument. Because we were we were in a moment where it was summertime. And we now by the way, we now because of Disney knew how like magical popsicles were right. They give you a little bumper that didn't make you go too high or anything like that. And for our net lease, and so we bought these box of popsicles, like you know, you get to a shore house, you go out and go shopping. And someone said, Oh, I'm gonna have a popsicle. And I was like, hey, you know, I just need you to not touch those where you've got them in case Arden gets low, which prior to all the technology was going to happen like you were going to use those popsicles. And one of the parents said, that's not fair to the other kids. And I remember Kelly going will tell them to get diabetes and then they can have all the popsicles they want out of the box, you know, but like for right now, just don't touch the popsicles. But it actually caused it was like, ah, like, you know, that's that's not fair. Are Kelly's like, are we talking about fair because my kids

Jennifer Smith, CDE 1:04:34
got diabetes got.

Scott Benner 1:04:38
If we're measuring fair, I think I win, you know, like, so anyway. Do you feel like we did a good job here? I do too. All right. Cool. So I will so let me say goodbye let you get back to your business. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free Contour. Next One. 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 forward slash juicebox you spell that GVOKEGLUC A G o n.com. Forward slash juice box. 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 or 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 Bumping 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 talk 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 this 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 the 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.