#1016 Long-Term Health (REMASTERED Diabetes Pro Tip)

September 23, 2023Scott Benner

Scott and Jenny discuss optimizing long-term health with type 1 diabetes.

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

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

+ Click for EPISODE TRANSCRIPT

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 Hello, everyone. Welcome to Episode 311 of the Juicebox Podcast. Today's episode is a pro tip. So you know that means it's not just me today and a guest it's me and Jenny Smith. Today Jenny and I are going to talk about long term health as it relates to type one diabetes. This one's a little less pro tippy and a little more conversational. The information rises to the level of pro tip. But the style of conversation is more like Jenny and I got together as friends. And I said, Hey, tell me your thoughts about this. And then we chatted about it a little more laid back a little more conversational. But the information is definitely something you want to have in your tool belt. And that's why this episode is part of the diabetes Pro Tip series that begins back on episode 210.

Unknown Speaker 3:18
What are we doing today?

Scott Benner 3:19
We are going to do a protip episode that you suggested and prevention of long term complications you said and you said What does optimizing glucose long term do for keeping things healthy? So I feel like what you meant by that is low less variability not low but in you know, lower than what a lot of people go for less variability, lower standard deviation, how is that going to help you throughout a lifetime? And so I feel like between that, and some other safety ideas that I'd like to bring into the conversation. I think we're going to have a good a good talk here. So I guess first, why don't we talk about a little bit through time, right? Where does everybody? Am I everybody? I mean doctors, where do they get the information that they put on their patients? You know, I'd like to see you have an A one C of x. Does that come from the American diabetes Association? Did they set the tone who sets the tone for what we should be shooting for? For somebody does it

Jennifer Smith, CDE 4:22
as far as targets? You mean? Yeah. Yeah. So I mean, well, targets count. It's funny. I just had a conversation with somebody who listened to the podcast, and I had a first visit with her just before this. She asked the same exact thing. She's like, I'm getting all of these different targets from different people. And she's like, I don't even know what to believe anymore for target. She's like, I know where I feel good. I know where I kind of want to be but what am I aiming for? And I said, well, there are a couple so the American diabetes Association aims for post meal target under one ad that comes from the American diabetes Use Association through research and gathering of all of this information and you know, whatnot and looking at complications down the road. Cumulatively, they aim for what less than 180. Now, the American Association of clinical endocrinologists recommends less than 160.

Scott Benner 5:19
So less than 160, less than 160.

Jennifer Smith, CDE 5:22
Okay, so there are two high in the ranks of diabetes management that are different already. Right. And then we bring into the mix well, what are recommendations even further than that, like pregnancy? Pregnancy recommendations, you know, are for the most part under 120, fasting under 100. And post meal no higher than 140.

Scott Benner 5:51
So, um, is what I'm hearing good, good for the

Jennifer Smith, CDE 5:54
Fusion. Yeah, right. Confusion entirely. And then I had a woman in a couple of years ago postpartum, I had her visit with her. And she's like, so I was aiming for all of these targets in pregnancy to keep my baby growing healthy, and myself. And she's like, and then my doctor tells me to loosen up my target in my palm, and tells me I don't have to be so you know, quote, unquote, tightly managed. And she's like, she's like, I want to ask your opinion, Jenny? Like, why wouldn't I want to stay this tightly controlled if it was good for me in pregnancy? And these are targets that people without diabetes, maintain? Because their body does what it's supposed to do? She's like, why wouldn't I want to maintain this? Whether I'm pregnant or

Scott Benner 6:34
not? Yeah, yeah. So here's right here. Exactly. And here's what it's making me feel like, so much like, with everything about diabetes, when you try to give someone like this just, I don't know, this is how things are right? Like it 181 6120 whatever anybody ends up saying, That's not personal. And and personal between should be considerations should be you, your intent, your involvement, your intellect, your understanding, than it should be, am I injecting? Am I using a long acting insulin that was made 20 years ago? Or am I using one of them that's been made more recently that people find more stable? A lot of the times? Am I using a pump? Do I have a glucose monitor? Is it a, you know, is it a libre? Or is it a Dexcom? Is that the G six? Or is it the g4 Like, it would seem to me that all of those variables would would make it more or less likely for me to be able to maintain targets that are lower or higher? Right? And so then you get the doctor, like what you just said about the pregnant person? I feel like that doctor was like, Look, you must have had to have killed yourself to keep your blood sugar that low. Right? Like, obviously, it ate up 99 months of your life, you did nothing but keep your blood sugar in check, have to pay and watch television, that must have been your whole nine months, right? Like, like you're talking to a guy in 1920. It's like, you know, you didn't even have time to make me my pot roast. Like that. Fake, right? You're getting old time idea, right?

Jennifer Smith, CDE 8:12
And now you come into the office and you look like you've got baby spit hanging off your ear, and you look like you haven't slept or combed your hair. So let's loosen things up.

Scott Benner 8:20
Right, right. I think that what would make your day easier is if you were less healthy. But it's not it becomes about and I get that right? Like, I think that out away from the ideas that we talked about on the podcast. Maybe that's real. Do you know what I mean? But when you start telling people, we I, when I started asking people, you've been at this for a while now six months, eight months? Is it that hard? They say no. Like most of the Pete I don't want to say most of them everyone I've ever spoken to who's picked up the ideas of the podcast, put them in practice, and gotten to the point where it's just second nature. They don't think about diabetes very much these these targets are meaningless because you get to a spot you stay at that spot. If you leave that spot, you know how to get back to that spot. Right? That seems like it to me, honestly. Right.

Jennifer Smith, CDE 9:12
And from the standpoint of, you know, prevention, I mean, that's the that's one of the biggest things that brought out beyond Well, here's your insulin, here's how to inject it. And oh, by the way, insulin can cause your blood sugar to go too low. complications are always within the first like, new onset diagnosis, discussion. There's always something about complication, right? Always, like you have to control things. I love that word control because like, like a moving target of control.

Scott Benner 9:42
That, by the way, gives you the impression that you're going to be out of control and it's your job to control the chaos. Correct. Right.

Jennifer Smith, CDE 9:49
Exactly. It's like your job to herd all of the million cats in your yard with no fences, right?

Scott Benner 9:54
What if I just didn't let the cats in? How would that be?

Jennifer Smith, CDE 9:57
How would that be? Exactly? Yes. Exactly. So you know, the prevention of complications that I mean, there's no, there's no set solution, really, on how to 100% prevent complications. In research, we've seen people with many years of diabetes, some of them poorly, you know, manage, some of them tightly managed. And complications can start for people at different points of time. And that makes it seem like, Well, gosh, I'm just gonna throw my hands up in the air if I can't 100% prevent anything. But what we do along the way makes you feel good. On a day to day basis with tighter containment of things overall, yes, you are likely 99% likely avoiding the complications down the road. Right? That 1% That's something could happen. Sure, it could be there. But I don't think there are many things in this world that are 100% Perfection. And so

Scott Benner 11:01
to your point, it's, it's presented incorrectly to people. It is like right away, like, you know, it's not your goal not to die, right. It's your goal to live really well in till you die. Right. Right. And if you can extend those years. Wonderful. But you know, it just and you just said to about how people feel? I've been talking about that a lot lately. I don't know why people don't think about that. Like just how they feel every day like, you know, are they tired? Are they sluggish? All the stuff that we've spoken about over and over again? Why is that not important to them? And I don't think it's not, I think they find it to be something they can't impact, which isn't true. It just isn't like there are times there are times genuine, I'm afraid people will realize that when I keep saying over and over again. It's about timing and amount and common sense. They're gonna go, Hmm, I don't think I need to listen to that podcast. That guy might be right about that. Like, why don't I just tie my insulin better? And when I see something happening, go, Hmm, that makes sense. I should do this now. Yeah. Right. Because I mean, honestly, there's no point if you guys all figure it out, the podcast is over. Basically, I, you know, obviously there will always be newly diagnosed people who are going to get this terrible information and start down the wrong path. I just I want I want people to think more about how they feel. And I spoke about this in my talk this weekend. And I've said it here before, too, but you have to, you have to believe that if your blood sugar is constantly high, you're altered. You just are like there is a person with a short term and long term. Yeah, there's a person you would be intellectually articulately that you don't get to be when your blood sugar's higher, or crazy low or bouncing around, right? Because your brains always just, it's just, it's not where it needs to be. I don't know within

Jennifer Smith, CDE 12:58
that, even within that day to day feeling, are those behind the scenes. Unfortunate what's happening in the body that you aren't feeling? Like, we know how high blood sugars make us feel. And if you're paying attention, you know, the containment of them, you get out of that you can think better, you can act better you can do the things you enjoy doing. But behind the scenes, internally, what's happening with better management is you're not causing damage to cells. You know, I mean, especially heart disease. I mean, heart disease is a huge component that we have to take into consideration. But it's not like it has to be there in your brain every single day. If you are managing the blood sugars, you're also managing a healthy heart. You're also managing healthy kidneys, healthy nerve cells, healthy eyes, you're managing those internal pieces that until they are damaged enough and give you indication that there's a problem. You're managing that along the way so that you don't get to the end of the road and have heart disease or kidney problems or whatnot, right? Yes. So

Scott Benner 14:09
and where do you stand? Have you ever heard me explain how I think of it with the sandblasting? Have I ever said that? Because here's the place to say it if I've never sent it to you? Okay, so the way I think about high blood pressure, high blood sugars, and back when my kid was little, and I was looking for motivation, like seriously, like, what? What's going to get me up at two o'clock in the morning to correct a 150 blood sugar. When my doctor is telling me that's okay, like, what's the motivation? And whether I'm right or wrong? Technically, in my mind, it feels like this. My body is built to withstand a certain amount, a certain content of sugar, glucose in my bloodstream. And when there's more there, on a cellular level, glucose is still sharp, right? It's like, it's like if you take a sugar and he spilled on the table, you look at it It's a course and you know, it's sharp and even on the molecular level, like smaller, smaller, it's still sharp. So when you pack too much of it into your veins and your arteries that run through your heart, and your eyes and your legs and your fingertips and everything else that sharp does is scratching at the inside of that soft tissue and those veins and those arteries, and one day, it'll wear through a little hole. And if it wears through a hole in your heart, you have a heart attack, if it wears through a hole in your eye, you have vision trouble, if it starts wearing through in your feet, you might not be able to feel your feet, and on and on. And again. So all of the diabetes complications that are on a list somewhere in your doctor's office to scare the hell out of you. What it really means is, if your blood sugar's too high, you know what inside of your body, is it going to rub through first and create a breach? And you know, and will that breach, you know, and that breach will hurt. You might you know, we talked recently about my friend Mike who passed away, he was on dialysis. So the first thing that it rubbed through was his kidneys. And then as he was on dialysis, the second thing it rubbed through was his heart. And then he had a heart attack and he died. And that's it. And he'll he'll his death certificate says he died from complications of type one diabetes. So that's it right.

Jennifer Smith, CDE 16:14
And that's a great, it's a very layman's, a way to understand it. Because I think that the textbook explanation is, it's too clinical. It's too medical. And I think that's why for the most part, people are aware of complications. But when you explain it such as that damage piece, and I used to explain it in the class, the type two classes that I used to teach is that high sugars caused damage to the inside of your vessels caused damage to the the outsides of the nerves and everything and almost like eat it away. So like a sandblast. Yes, it's like cutting and cutting and cutting and calling causing small abrasions, writes, scratches, scrapes that the body actually tries in your body is a it's a, it's a self healing. Like organism, right?

Scott Benner 17:07
It just happened to you right away in fixing little making little patches. It's like your road crew in town filling potholes, when you think can you just repave the whole road, they're like, nope, best we can do is pop in a little patch in this hole.

Jennifer Smith, CDE 17:20
And it's more inflammation, I mean, long term, those little holes are really from inflammation in the lining and along the cells and whatnot. And over time, I mean, if that inflammation causes a tear, the body tries to patch the tear. Well, if more and more tears happen, and more and more patches get placed into the vessels, you know, and I know visually, this isn't a podcast, people can see. But as you can see, my hands get closer and closer together to indicate the constriction and the narrowing of vessels. So then we have heart disease and potential for stroke and problems with blood flow, getting two kidneys to do what they're supposed to do, and circulation to your fingers and your toes and everything see.

Scott Benner 18:03
And Jenny, the way I think of it is I was just there one day in my house trying to talk myself into not giving up before I understood what was going on. Right? So what do I need to do to not give up and this is how I put it, it's really no different than a football coach who just has a player has three brain cells in his head, and he goes, Look, see this line right here. Don't let that ball go past that line. And that really is how I dumped it down for myself. I was like, I can't let that ball go past that line. Like I have to try to figure out how to stop that. And I think everything that everyone's listened to since then, is born from that idea. Like how do I stop this from happening? Right. And I've had that moment where I realized I may not be stopping it from happening to like, maybe my kid genetically is just the one who can't withstand having type one diabetes. I don't know, you know what I mean, but she certainly has a better chance, the way the way she lives right now than she would if I just listened to, you know, just keep her under 200. You know, don't don't let her spike over 180 or 160 or whatever, after a meal if you right you know if you can. To me that was just that just made sense. In the moment when I was scared and alone and it didn't know what I was doing. I just thought like I need a I need I need a goal. You know why?

Jennifer Smith, CDE 19:25
And blood sugar Oh, sorry. Sorry to interrupt. Go ahead.

Scott Benner 19:27
No good blood sugar.

Jennifer Smith, CDE 19:28
It's gonna say blood sugar is a big piece of it. But you know, the other components to those complications too, are the other factors that also contribute to blood sugar management, right? So the kind of nutrition you take in sedentary versus more active lifestyle, all of those are also huge benefit for long term health outside of just controlling or managing your blood sugar

Scott Benner 19:58
that remastered diabetes This 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 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 Ford 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 meter 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 DI 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. G voc hypo Penn 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. And all those things become exponentially more important when you have type one diabetes. They're important to a person who doesn't have it, it becomes even more important when you do like sometimes you just feel like you know like how many how many gunfighters are going to be on the other side before I just I don't have time to get to the mall. You mean like I'm gonna get overwhelmed because there's just so much over there. So you have to give yourself a chance. You know, and aside from the idea that exercise helps you keep lower blood sugars like that aside, exercise does all the other things that exercise. You know, it's funny, it's worth mentioning here that I realized the other day that some people refer to me behind my back is like somebody who pushes carbs on people. And I thought that's odd. I've never considered that before. Excuse me, but I guess more low carb people kind of can feel that way a little bit. But I listened to it and I thought it through and I don't feel like I do that. I feel like this podcast teaches talks about preaches maybe how to use your insulin, like how insulin works. And I say all the time. Once you know how your insulin works, I don't care what you eat, you know, you do whatever you want. But I think you need to know whether you're low carb or whether you're a person who's like, wow, I think I could eat that whole box of hohos. Like Like whether whoever you are in that scenario, you know, one side or the other. If you understand how to use the insulin, you can accomplish it. I'm not saying because I know how to Bolus for Chinese food. You should do it every day, every day.

Jennifer Smith, CDE 24:45
Right every just because they know how to Bolus the chocolate chip muffin and the chocolate milk and the Hershey syrup on top doesn't mean it should comprise every meal. Because Is that better than an apple with peanut butter and nutrition well is probably not. But

Scott Benner 25:01
is there a danger, I found myself wondering of people focusing on themselves so much as diabetes that they forget to think of themselves as person. Like, you know what I mean? Like does does a piece of does a big cupcake not seem unhealthy anymore because you know how to stop a spike from happening when you eat it. And that's important to remember that it's still, it's still a cupcake, it's still something that's, you know, a once in a while thing, not an everyday thing, because I can Bolus for it. And I think that's so I think Jenny's point is important too, is that there's just a lot more that impacts your health than just your blood sugar. And we sometimes we talk too much, not too much. But we're so focused on trying to understand it, because there's so many components that people don't understand that you stop thinking about, like, hey, you know, what else is easy to Bolus for broccoli.

Jennifer Smith, CDE 25:56
It's learning to manage the insulin around what you eat, you decide what you're going to eat, and you figure out how to manage it. It's not encouraging people to eat a high carb diet.

Scott Benner 26:07
Not at all, I don't see it that way at all. I see it as understanding and so on. It's just how it is I, I was speaking somewhere recently, and I looked down and saw a person in the crowd who this has happened to me about three times since I've been doing public speaking around diabetes. But I've looked down to see what I would call like an old school person in the diabetes community. And when I'm talking, I can see on their face, they're just there somewhere between angry and horrified that I would even deign to talk about insulin, and how to use it. You know, like, you can't tell people to you guys, when I'm on when I'm up on stage, I tell people, no different than, you know what I say here, right? I'm like basil is first beat, we have to have your basil, right? Because we can't just start Pre-Bolus Singh and doing other stuff. Because if your basil is wrong, it could end up being dangerous. So first, we get your basil right? Now after that, step two, you have to Pre-Bolus your meals. And that's usually when I look down and see like somewhere like a 60 year old mom whose kids had diabetes for 30 years now. Like, you know, like their arms are moving around, and like, oh, you can't say that to people, you're gonna kill them, you know? And I'm like, Alright, and so I'm like, you're thinking about this in a different way. Before that, you're not considering the technology, you're not considering that these are not the same last lambs that you talked to 30 years ago, right? Like these people are here to find this out. They want to know this.

Jennifer Smith, CDE 27:42
And long ago to bring in long ago, timing was an insulin issue. Long ago, I've had diabetes 31 and a half years, I started on our insulin, and the cloudy what most people started on something called NPH. Or en, I was on L which was Lily's brand, okay. I did no carb counting. I use the exchange diet. I took exactly this amount of starches and fruit portion and vegetable and protein and fat at every meal. And my mom or dad gave me my insulin mixed in a syringe at breakfast and at dinnertime and I eat it strategic times in exactly the same amount of food. There was no other than measuring the food for the right portion. There was no carb counting, there was no insulin based on carb. It was you take your insulin and from the dosing standpoint, my insulin, regular insulin, you know, it's slow. I mean, we call it short acting. It's slow. I mean, it may not have a dose me 45 minutes an hour before I even started to eat in order to curb that post meal, right?

Scott Benner 28:57
Yes. And so everything you just said, is about using the right amount of the right time. Hi, Nick. Yeah, it's timing. It's all timing. Like I, again, I that I figured it out. I mean, we should all be able to figure it out. Right? Really, I know myself, trust me. It's there's not a lot like I'm not, you know, I'm not over here. Figuring out the Pythagorean theory after or a theorem, whatever it's called. I don't know, after I get off the podcast. Yeah, I just don't think I think there's so much fear in now that we forget later. And you know, what we're talking about right now is long term health. And so, let me jump to I can't quote it. I don't have it in front of me. I don't know where it came from. But I think everyone's fairly aware of this article that came out in the last six months that tried to say that lower a one sees aren't necessarily an indicator of health. And that did you see that one they started talking about like, you can have a one seat like this here. It'll be fun. if it tried to give the impression to me that the way I saw it was someone trying to say, Look, I know a lot of you are using this technology to do better, but you really shouldn't do that. Like it's not necessary. And I thought, well, how do you know? You don't even mean? Like, like, I thought the same thing. I thought when I saw vaping the first time I was like, I have no interest in that. But if I did, I wouldn't do it. Because I don't want to be the one to find out 10 years from now what happens? Because no one knows, you know, right? So is there any in your mind? If you're safely at, if you're in the fives, and you're a one C and look, you know what I'm going to do here, I'm going to actually pull up an email. To make my point, hold on one second, it's going to take me a second to find it. I apologize for that. But I got this email this morning from a person I know who listens a lot. And when she emailed I thought, wow, this is gonna work right into what Jenny and I are talking about today. It's crazy. And it's from Laura. And this note from Laura mimics many, many, many, many notes that I get. Scott, I achieved a 5.4 a one see, first time I've ever been under 6.4. But my doctor freaked out at the number of lows. And she's asking, what's an acceptable amount of time under 70? Like, how many times can I dip under 70? And you know, and so I there's first of all, it's it's a two step thing, right? Everybody who goes to any kind of a doctor who's more like the lady in the crowd, who's thrown her arms around y'all and don't talk about it like this, when they get their blood sugar down, and they find a way to keep it stable, and it starts impacting their variability and it starts impacting their agency, the doctors flip out, they make this assumption that they have all these crazy lows, and it's throwing them off. So I know what I'm okay with. But what where do you stand in your personal life? I guess like how often do you find yourself under 70? Do you think?

Jennifer Smith, CDE 32:10
So personal versus professional, I kind of I really aim for the same thing, quite honestly, overall. And this is where I think that that data is very helpful from a CGM standpoint. Because especially when I speak for clarity, the other reports or the other CGM is do give you something similar as far as data. But from a clarity standpoint, clarity always gives you that overview gives you your glucose management indicator there, quote unquote a one see right from CGM, not from your blood glucose, right? It gives you your average glucose, it gives you your standard deviation, it also gives you this little like chart that shows you time in range, right? And it is based on what you have your time and range numbers set for 70 To 180 60 to 140 90 to 200. So you have to adjust those parameters. But clarity has it set 70 to 180, for the most part, right? We aim for the lows specific to be less than 5% of the time. So from all of the gathered data, whether it's two months or two weeks, or one week, or whatever you're looking at that percentage of time, we're aiming for less than 5% to the low and low being less than 70, less than 70. That's, that's the goal is to be low, less than 70. Less than 70, less than 5% of the time. So from the standpoint of overall a one see though, you know, if, if a clinician is coming in saying, hey, you know, wow, that's way too low. And they're looking at data, which proves that, well, gosh, you're hanging out in the 50s consistently, and that's why you're achieving a five point for sure. And if you're low, let's say 12% of the time, okay, there's some work to do to bring that back up into range. So that that 5.4 is actually better, for lack of a better word. Better, right? It's more real 5.4 In a target range that's healthy, safe, and good for you, overall,

Scott Benner 34:23
you're reaching that number with quality decisions, not good. Not with, you know, being low. And just coming out

Jennifer Smith, CDE 34:31
and saying 5.4% As of Oh, my goodness, that's, that's way too low and not even looking at what what is that 5.4 The person could have very low standard deviation, maybe their variability is 20. And they're ranging somewhere between 70 and like 120 pretty consistent or 70 and 100. Great, fabulous. You're, you're knocking it out, have at it, continue what you're doing

Scott Benner 34:59
so When I gave the explanation of a Pre-Bolus this week, this weekend, I used something that had happened an hour before because my wife was at home with Arden. And I said actually my wife did a great job this morning with breakfast. About an hour ago Arden's blood sugar was 70 and it was time for lunch. Now Arden is at school, and I think 70 is a great blood sugar right before a meal. Arden's blood sugar was able to stay at that level for a number of reasons. But those reasons are evident to us as they play out, because we can see her blood sugar in real time with the Dexcom G six continuous glucose monitor. Not only can Arden see her blood sugar right there on her iPhone, but I can see it here at home on my phone as well. Because of that knowledge and seeing the stability that had existed within Arden's blood sugar for the hours prior to lunch, we were able to make a good Pre-Bolus and give her a nice launch into her mealtime. Now that our later Arden's blood sugar is 132. The data that comes back from the Dexcom G six continuous glucose monitor is life altering with type one diabetes, but being able to see it remotely, that takes life altering to another level. So if you'd like to know what your blood sugar is, the speed and direction it's moving, and find those things out without a finger stick. The Dexcom G six is something you should check out. I have a link you can use dexcom.com forward slash juice box. There are links also right here in your podcast player notes and at juicebox podcast.com. But I think you should check out the Dexcom Arden's results are hers and yours may vary. But I'm telling you right now Dexcom is a game changer. Now moving from continuous glucose monitoring to insulin pumping. I'd like to talk about the AMI pod. Until you first I have just as much affinity and love for the AMI pod as I do for Dexcom Arden has been wearing the AMI pod tubeless insulin pump since she was four years old, she'll be turning 16 In just a couple of months. The Omni pod brings so much freedom along with the ability to pump your insulin right no injections all day long. No slow acting insulin and fast acting insulin let the Omni pod take care of your background Basal insulin for you. It does that put your insulin in the pump, you get your Basal insulin from the pump. And when it's time to Bolus for a meal or to crack the high, same insulin, same pump, no tubing, right so not an infusion site on your body somewhere that's attached to this plastic tubing that runs through your clothing out to a controller that has to clip to your belt. You know whether you're an adult or a little kid, you're not looking to have something clipped to you. Here's what you can do. Go to my on the pod.com forward slash juicebox. There you can ask on the pod to send you an absolutely free, no obligation demo of the Omni pod. It'll come directly to your house. You can try it on and see what you think for yourself. You can see the difference between wearing a shirt and not having tubing running down your sleeve. Every time I've worn a demo pod. What I thought first was, it's amazing how quickly I forget that it's there. This is super important. This is something you have to do every day. You don't want it to be constantly bugging you. Check it out my Omni pod.com forward slash juice box with the links in your show notes. Were the ones you'll find it Juicebox Podcast icon, an absolutely free no obligation demo can be in your mailbox before you know it.

Actually, my wife did a great job this morning. With breakfast. She made a Pre-Bolus at like 83. Right. And it was a big kind of breakfast. And Arden drifted down drifted down and she actually hit like 63 for like a split second and came back up. So imagine this 63 probably happened 30 minutes after my wife pushed the button right? And probably 10 minutes after she had already started eating. So if you want to say she missed I guess you can. But it's funny. Had she been at 68 Everyone would have been like That's amazing. But 63 is a number that somehow gotten in somebody's head. So I'm like so she hit 63 one revolution of the CGM and right back again, and I said if she didn't have a CGM, you never even would have known that that happened, right? She's She just wasn't dizzy. Nothing happened like that. I can see it because I'm looking at it that this same person in the crowd, this person who's you know, you know, from a property from a different era with diabetes, you know, fell just shy of, you know, back of the hand on the forehead. Oh, Scarlet, what happened? I've got the vapors, you know what I mean? Like that kind of thing. And I was just like, I looked over second. I was like, You got us like I was thinking to myself, like, just stop, like, don't like the look at the rest of these people. These people are enthralled, they're excited. These are people who are half an hour after they put their insulin in or running around with their blood sugar's 250? And Are you really telling me that that's what you want to say is okay for them. Because when I speak to them privately, when they come up to me as I'm trying to walk around you guys, we're all delightful. But people would come up and be like, hey, look, this is my, you know, my 23 year old son's CGM, the kids like 403 100 all the time. Like, are you telling me it's not worth trying to do better for this kid. And so I think sometimes, both in the community, in people's minds, in doctors minds, in some older doctors minds, there's just more of that idea. And we talked about all the time, like, it's better not to like, like, I don't want you to have a seizure. Like that's it, like when I say don't die advice, like, that's what they're trying to say that I don't want you to have a seizure. I don't want anybody to have a seizure, either. But I don't want your blood sugar to be 300 all day. You know, it just it's, it's not okay. Because we say these nice things out loud, and other people who are maybe well meaning but don't have good information. They're like, Oh, you know, I want you to be safe, blah, blah, blah. But those people you're talking to online, or whatever your whatever that person's ability to get to people is, you don't get to see those people 20 years later, you don't know what's happening to them. And so I'd rather take a bet on what I'm saying being good for them 20 years later, than what I hear some of those other people saying, I think that if you're going to if you're going to roll the dice one way, you ought to roll the dice and try to be healthy, not hope. I hope that your body's the one impenetrable thing that diabetes can't find its way through. Yeah, you know, right.

Jennifer Smith, CDE 41:38
Right. Well, and there's also the safety of bringing those high numbers down to, right. I mean, it's like, you don't want to end up going from an average of 280, which means you're drifting well above 300, and not quite into the low two hundreds to average a 280. Right? So you're not gonna say, Okay, today we're at, you know, an average of 280. And tomorrow, you're gonna be averaging 100, right? That goes, well, that would be a pie in the sky one, it's not actually healthy. She drops you that fast, drop that fast. I mean, you will have significant changes in your body. And you know, I remember when I came home from the hospital for two to three weeks after I was released from the hospital. And I think I started with an A onesie in the twelves, when I was first diagnosed, and my blood sugar was coming down and coming down. My vision changed so much, that my mom had to read me my homework in order for me to answer and she had to write things down. Because my vision was so blurred, I couldn't actually see well enough to read what I needed to get my homework done. Right. So and that was gradual. So again, you can imagine bringing a really high blood sugar down that's been consistently stable high, yeah, it will be problematic.

Scott Benner 43:01
What I said to this group of people was luck. Like, don't go home, I'll shot out of a cannon, you know, and be like, I usually give a unit for this, but now I'm gonna do five. I'm like, no, no, a unit and a half, maybe, you know, and I was like, the next time go, Ha, that could have been more I said, you know, over days, bring it down over weeks, bring it down, not, don't go home and just be like that. Because that's probably not gonna go so well. You know. And, and again, Basil first. And it's funny, no matter how many times I say it, and how many times I preach how important it is. The look on people's faces. When you say to them, I need you to get your Basal insulin right is like, oh, that I give up. Like, it's quick. It's they're so quick to be like, That's not possible. I can't do that. And I'm like, No, of course she can. And that's why I've got it down to like, they're like, Well, how and I was like, Look, there's a great episode on it that you could go listen to them, like, but if you're looking for how I think of it, I think of it like volume, like I turn it up until it's too loud. And then I start bringing it back down. So you turn it up a little, not loud enough, turn it up a little not loud enough. And what I mean by that is turn it up a little my blood sugar's not sitting stable, where I want it to, you know, blah, blah, blah, and then all of a sudden, you get to a spot and you go, Alright, that looks like it. Or maybe it's Oh, I went a little too far. I'll turn it back down a little bit. I'd like but don't you know, one woman's like, by Bezos point nine, you know should but my blood sugars are 250 Should I try one and I'm like, I mean, okay, I'm like but an hour later when that doesn't work, but could you push it up a little more for me like I was like thinking about what you're saying? You Your blood your your basil is holding you at 250 1.9 Like, but you want it to come down 150 points, but you only want to move it up. Point one I was like, that doesn't make sense, right? Like, don't you feel like it might need more than that. She's like, Yeah, I guess you're right. But that but that's a doctor that scared her not to touch her Basal and so on. And so she's it just it's I don't know, I'm a little heartbroken. Like, it's a little It's very exciting and uplifting to talk to people and see them have some ideas they're going to take. And at the same time when they come up to you, and they show you how bad things are, you know, after the fifth, sixth 10th One, you start feeling like, oh, gosh, like I'm not never going to reach enough people to make a difference in the world like it starts feeling mutual to

Jennifer Smith, CDE 45:18
might even have like, from the adjustment standpoint, sometimes comes from the people who had diabetes a long enough time to have actually had a long enough experience with Basal injected insulin. And how long it did take to really see the difference in an adjustment up and or down in the actual dose and the imprecision in which that Basal insulin works on a 24 hour scale. Right. I mean, I noticed an immense difference, going from Lantis to using an insulin pump in immense difference. It was amazing

Scott Benner 46:01
is that where that kind of that that adage is like making an adjustment to your Basal wait three days and see what happens is that what that's from,

Jennifer Smith, CDE 46:09
for the most part because the well, you know, the Basal insulin clears technically within like a 20 to 24 hour time period right from let's save the example of Lantus is supposed to work 24 hours, most people somewhere between like 20 to 24 hours. And so you adjust, you need kind of at least a 48 hour period, at least after that adjustment of incremental change by let's say, two units, to see if that was enough to now hold things level and steady. And then it also depends on were you taking your Basal insulin in the morning? Or were you taking it in the evening, you know, the evening time was a little bit easier to see, because you could notice an overnight with only true Basal insulin there. No boluses no food, no activity component, you're sleeping on that, right? And then through the course of the rest of the next day, how did things look in between meals or after the meal Bolus was gone? Did you kind of get into the next meal on a nice stable level where you where you wanted to be where you still too high, or you're drifting way too low? And then we adjust again, you know, so I, then it is probably where that like, adjust wait three days to see if the adjustment held things where you wanted them and then adjust again, it's kind of where that would have started, I would expect

Scott Benner 47:29
because someone from the crowd asked me, How long is it going to take me to get my basil, right? And I was like, Well, I said, if I think if you listen to that episode, and you really understand it, so maybe a few days, you know, she says How long would it take you? And I was like What time is it now? She goes, it's like, it's one o'clock. I'm like I could have it done by dinner, you know, like so. And then we would adjust off the the rest of the clock moving forward, like but there's, there's somewhere there's a good number. And it's funny because I just I realized that I could just keep looking at the CGM and decide. I said, now if you didn't have a CGM, it take me a couple of days to write, right? Because now we're kind of blind. And we're testing and seeing things and, you know, making sense and seeing if we can see repeating that and stuff like that. It was like But, but looking at it. That's like, that's cheating, almost like that. That's pretty easy. But I also infer things from pitches and lines. And and there's no and then people all the time are like, can you do an episode about how you see that? I don't even know how to talk about it. Like, I wish I did, like I just look and I'm like, okay, that's not enough insulin. That's too much this is here. You don't I mean, like, it's just, I don't know, it pops into my head. But I don't know, I really don't know how to quantify it. If I'm being right. Come on. I'm not joking. Well,

Jennifer Smith, CDE 48:45
you've, you've looked at things enough and you understand, you understand insulin action, I think better because of the way that you've looked at things and the way that you've talked about things. Sometimes it is hard to just nail it down and explain, hey, if this is happening here, this is why and this is how we would adjust more. And that's kind of mean that's kind of what we do. We get people's graphs and information and their insulin here and like basil testing for a pump, especially you know, we'll do a basil test within a time segment. I get the data the next day, I look at it adjust here test again tonight. They do great, that looks awesome. We're perfect. We've got it like checked off, move on to the next time period. So it shouldn't be like six days in a row that you have to test that to make sure that each single one of them exactly was nailed. Because we adjusted it four days ago. Nope. If you adjusted it looks beautiful with the adjustment. Great. We're moving on. We got it. I've

Scott Benner 49:44
learned from talking to people face to face to that. The stuff they want to tell you that they think is going to help you help them is never the stuff I need to know. Do you know what I mean by that? They start giving me like and it's it's not I don't even mean to be funny. about like, they're, they've been paying close attention. And they're like, Okay, like, here's a piece you absolutely have to understand. I'm like, I don't care about that. That doesn't matter. You know, like, like, I'm like, How much do they weigh? How old are they? What kind of insulin are you using? What's your Basal rate right now? You know, where do you sit steady when you don't have insulin, and you blah, blah, blah. And then from there, I'm just like, Okay, turn this up, turn that down, make this this. And then let's wait and see what happens. But it's interesting, because the information they've been given so far has led them to ask almost all the wrong questions. Right? That's the part that I find fascinating, right, is that somebody has been directing them along the way. And now I talked to them. And then I talked to them again, two weeks later. And now they want to make a small adjustment. And they're asking the right questions. It's very interesting. Like, it's just where you, it's who talks to you first. Like it really is, it's like, whoever talks to you first, you win. Or you lose, like right then and there. You don't even realize it. And it's happening. There's somebody being diagnosed right now, in the world, who's talking to a, an endo, who understands, and they're gonna go on one beautiful path, they'll never find this podcast, because they don't need it. And then there's somebody else being diagnosed right now who's being told all that stuff that we, you know, have to debunk, and then reteach? It's just, it's bizarre. I mean, you don't like, do you get cancer and get two wildly different ideas like this one cancer doctor say to you, Hey, listen, we're gonna try a little radiation. And then if that doesn't work, we'll try to cut it out. Is there another doctor that says you should go home, blow up balloons and eat birthday cake, and I'll fix the whole thing? Because it feels like it's that far apart, you know, like, one ideas, right? And one ideas? I mean, I'm sure there's variations in between? Well, I

Jennifer Smith, CDE 51:45
think the extremes truly are the people who still to this day, for whatever reason, will go into their clinical diabetes team, and they get the hand me your pump. It's like handing over like, you know, your foot. I think I said that before and after. So it did nothing. And you're like, that's great. Thank you. Your pump is like, like your foot, like, well, that really my foot, just a body part, right? You hand it over, they like take it away from you. And you're like, Oh, my goodness, you've taken like my body part from me, you know, and then they bring it back to you. If they've dumped this data in, they look at the data, they don't ask you anything, the doctor might actually sit there and actually might push your buttons on your pump. Yeah, physically make all the adjustments for you. And your left, then handed back reconnected with your pump. And the doctors like, oh, we adjusted some of the Basal or we did this and this because I thought I saw this happening here. What's lacking there the education? Why did you adjust? What were the explanation? So the person could go home and say, Okay, I understood the doctor adjusted here, because he was seeing this. I'm gonna now watch this. I'm gonna see did it help? Does it make it better? Did it make it worse? Do I need to readjust this? How should I readjust it? That's the missing chunk. And, you know, I think that that piece of not educating people, nor even letting them push their own pump buttons to make the changes, or add in hay, three days in a row. This past week, I was at grandma Joe's eating like sloppy joes and birthday cake. And please, please don't pay attention to that data. It's not my true trend. But the doctor is basing adjustments off of it.

Scott Benner 53:35
It messing up everything else that may have been working better than that. I brought a poor kid up on stage from the college diabetes network this past weekend. And I just we stood Arm's length apart, we put our palms together, you know, standing side to side. And I said, you know, I'm going to be insulin, and he's going to be body function and carbs. And I was like, right now, he and I are pushing, you know, an equal amount into each other. And we could stand here forever, like this. I was like, but as soon as I don't push quite as hard. And he started like overpowering me. I was like, now the carbs and the body function are winning, which means my blood sugar is going up. And should I push too hard. I start driving that down and your blood sugar gets too low. But as long as we stay balanced, and we're pushing equally on each other, this could go on like this forever. While I'm saying it, audibly I can hear people going. Oh, like out in the audience like, right. Oh, wow. Okay. And they just as I was saying it I thought a doctor couldn't think of that. Like, like, you know what I mean? Like cuz dumb me figured it out. And you know, put it into words. Like Like that was it and just them watching that. And it's something I'd done before with my own hands like palm the palm. I've explained. I've gotten people on the phone and I've made them put their palms together and like and like done it. And I just think like, it's just it was so simple. You could see like nodding going on and people were like, oh, okay, I get it. I found a million ways to talk you added since then I've talked about like, bringing in more blockers to like, you know, stuff like blocks, like in football, like I've talked about it a million different ways. And every time you kind of paint a picture around it, you get somebody else to understand it. I just don't know. It just doesn't make sense to me. So these doctors are telling you, I want you to be healthy forever. But then they kind of some of them don't tell you how. And so. So optimizing your glucose, right for long term is going to keep you as healthy as hopefully possible. Right? Yes,

Jennifer Smith, CDE 55:32
absolutely.

Scott Benner 55:32
What about gaps of fall off? Right? I don't like the word burnout so much. But what if they just stopped paying attention for a week that turns into a month, that turns into six months, is that if I, if I come back from it, no, I'm not trying to give people like, like, I feel like I'm saying, you know, you can go off and, you know, go off and do heroin for six months and come back, and it's not going to hurt you. But I'm saying like, if you have one of those moments that a slip up or your life gets, you know, busy and all of a sudden you start leaving your blood sugar at 140 instead of 120 or 180, instead of 150. Is there any way to quantify what that means to you long term? Or there isn't really right? It really

Jennifer Smith, CDE 56:18
isn't? Because again, there's nobody has kind of quantified exactly what amount of mismanagement equates to this amount of complication down the road. If you don't do this for three years, you will have this amount of heart damage 10 years from now, right? There's no you can't quantify it, but I think you can also not bank control that was optimal. Yeah, for the next month and saying, Okay, I was really really awesome for six months. And now I'm gonna go on like an eat all convention blowout in Italy and just not care or pay attention. detrimental stuff could be happening, could, I don't know what's happening in your body. It's not great for you, but it's, you know, but you you're not, you can't bank on the six months previous being like a code over for smoothing that out and being like, Okay, this whole month of like, mismanagement doesn't really count because I was so good before it's

Scott Benner 57:25
like sleep, you could get great rest six days in a row, and then STAY UP 24 hours, you're still gonna be exhausted, you can't, you can't bank sleep, you can't bank health, you can't like that. That kind of stuff is really super important. Understand. But you know, it's funny, because the same time when I'm teaching people how to get going, like within a one season I started trying to impress upon them that overnight is easier than you think you know. And like, once your basil is right, and you're not bolusing too much or too little, you're not going to get these wild swings. Now you've got this third of the day, you don't as like, so if you see a 160 in the middle of the week, in the middle of the day, you can feel a little better about it, because you had like, you know, you're at five or eight hours last night, right? It doesn't make whatever impact the one at Spike has. And like you said, I don't know what it does or isn't is or isn't doing to your body. But if it is doing something being at all night long, doesn't stop that. Right, you know, like being safe right now doesn't mean that if I burned my finger, five minutes from now, you know, it doesn't make it go away. It's still happening. I think that's really that's good information. So what are we in your own personal life? Is that how you think about it like just I'm gonna do my best and hope this works out?

Jennifer Smith, CDE 58:41
I do because I you know, I I try really hard not to like I go to all my checkups, right? I mean, I get like, my heart checked and I make sure that I go to the podiatrist I make sure that I get my feet checked. I've never had any problems thank goodness but I still go for all my checkups I go on I see my ophthalmologist to make sure they check all the vessels and you know, do the test for the puff of the air in the eyeball, right? Like you always like you're always like an idiot when it hits when it hits like anticipation of that puff of I have puff of air is worse than the actual puff is but you know I do all of those things because I know that they are a check in the long term. And you know what, if something does come up, then the checking is also prevention for furthering problem, right? If he says get a check on something and up now something is happening. Okay. One might beat myself up a little bit of I could have done this better. I could have done that. But that doesn't help. That's past you can't go back and fix it. What you can do is continue to go forward and say okay, I can try to do better here or maybe I need to add This now I just need to see the eye doctor every three months instead of every six months or once a year, or they've got this treatment that could help me and it could make it better. And if I continue to do what I need to do, then I can prevent further complications down the road. So

Speaker 3 1:00:16
yeah, I also want to say that, I think

Scott Benner 1:00:21
I've never met anybody so far, I should say, that has told me, I decided I don't care, I'm going to run full force straight ahead, I'm not going to pay that much attention to my diabetes. And however long I make it as how long I make it, whenever one of those people runs into a complication, they have always said the same thing to me. I wish I wouldn't have done this, like you don't, I mean, like, I wish I would have bla bla bla or tried something else, or it wasn't my fault. Even I didn't know. But I wish I would have kept searching. And and I think that that's the truth like it, whether you make it, you know, till you're 40, when all of a sudden, you're finding out UD dialysis, or you make it to 70. And you're like, I made it to 70. And then all of a sudden, you're having a heart attack, a seven year old type one who's having a heart attack doesn't go at least I made it this far, you start thinking, Oh, I would like to stay alive a little longer, you know, like, like, it's, I don't think many people get to the point of no return whatever it is, and go, you know, I did my best and, and I'm happy with this, I think I think that people really do feel like that, like, Oh, I wish I would have whatever that means, you know, whatever they wish they would have done. I mean, if you're a person who can make it the whole way, and just be like, you know, 35 years old, jumping your car over a canyon and realizing you're not making it the other end to go, oh, well, I did my best. You guys, like that's a special like, that's a special gear you have. But what I'm saying is is that caring now will keep you from that feeling of I don't know what that feeling would be what how to describe it. When people talk about their they are disappointed in themselves. And then they can't shake that feeling for the rest of their life. Right? Like every day, they wake up with a problem. And they have this feeling like, oh, maybe I could have done something about this. And then you have to live with the problem and the guilt. And it's hard, you know, so I say all the time. I think with what we talked about on the podcast, diabetes becomes pretty. You know, I don't like to say easy, but I think it becomes like a second nature thing for you. I would rather put that effort into understanding a Pre-Bolus or, you know, something like that, then I would spending six, eight hours a day fighting with high blood sugars that cause a low they have me eating, that make my life feel like turmoil that I'm not living, I'm just existing through rack. So I don't know, that's how I feel.

Jennifer Smith, CDE 1:02:46
And then I agree and I kind of the way that I feel about my own management is I do the things that I do every day to make it less of a visible upfront in my face, to let it be more of a yes, I have to manage it, I still have to look at my blood sugar, I still have to take my insulin, I still have to count my carbs and Bolus the right way and whatnot. But those are like more second nature things that I just

Speaker 4 1:03:15
do now. And until I have like

Jennifer Smith, CDE 1:03:19
a bad sight or something that I really have to completely put my focus into and, you know, take care of the normal things that I do every day are just, they're part of my day. Exactly.

Scott Benner 1:03:31
And those bad sight moments, because I recognize what you're saying is how Arden's life is in mind with helping her is that most of the time, we are just sort of cruising along. And when something really goes funky, and you're all of a sudden you have to stop thinking about life and you're now you're focused on this diabetes thing. In my heart. I know that some people live like that all day long every day. Right? And that's just because that's an explanation to me, like you're bad cites a great explanation because you're but all that means is you're not getting insulin the way you need to. And if if your Basal is off if you're not Pre-Bolus And if you're not doing all those things in every moment, you're not getting insulin the way you should. And so your life is always going to be you know, I like that.

Jennifer Smith, CDE 1:04:13
And in the instance then of blood sugar's being all over. You never really know unless the pump tells you if you are on a pump, that you have an occlusion and that there is a real problem. You never really know. If there's a pump problem you should be addressing. Yeah, and I know when I know even ahead of an occlusion alert coming, that something's not right. Yeah, I can tell because things are contained. And if I see something odd happening and I know that nobody is like, injected me with like the sugar tube of glucose right, then clearly I am not getting insulin for whatever reason I don't know, change it out, I don't care. Well, I'm going to address it, I'm going to take care of it, I'll just change my pot out and move on. Let's see you and

Scott Benner 1:05:07
Arden have a scenario a life where your expectation is a lower, more stable number that reacts the way you expect to we said this the other day, when we were talking like I, I talked about how I think of the site as doing what I expect it to do. So the minute I don't see it, doing what I expect, or I see a blood sugar, that's all of a sudden 150 My my I start thinking, like, I can look back, if I didn't mess this up somewhere. This is this is I'm not getting enough insulin. So I don't mess with that either. Like there's a moment. Like I think some people end up looking at a bad site for days. And then and then they they'll change their property. Oh, it turned out to be the pump 48 hours later, right? Yeah, I'm not into that, you know, the second or third time I Bolus and what I want to happen doesn't happen. And I'm getting out of it.

Jennifer Smith, CDE 1:05:57
I actually had it this morning. I mean, I wasn't, I wasn't actually supposed to change. My pod out until this evening is when it was supposed to expire. And I woke up this morning. Not at my normal like Ed ish blood sugar. I was like 130 Something is like, that's kind of odd. Right now. Like, that's not where I should be. And I could see all this, like, positive temping that been kind of happening. And so I look at my site. And it's bloody in the window of my pod site. And I'm like, had I not checked, I just got I got about three, though. I'm higher than I normally am this morning. And I'll just correct some insulin, I'll eat for my or I'll take for my breakfast. And hope all goes well. Well, I just I know that that's not the norm for me. So what did I do? I changed out my pod and dealt with it, you know?

Scott Benner 1:06:49
Yeah. Because you're you would have been fighting with that all day. Otherwise, right?

Jennifer Smith, CDE 1:06:52
Correct. And my post breakfast would have been orange. I'm sure I'm sure.

Scott Benner 1:06:56
I bet you for whatever. 220 then in that situation, right, right.

Jennifer Smith, CDE 1:07:00
Yeah. Right. At least. Yeah, exactly. So,

Scott Benner 1:07:04
Jenny, if you and I were one person, we'd be a super diabetes brain.

Unknown Speaker 1:07:07
Oh, my goodness.

Jennifer Smith, CDE 1:07:11
No, in one place.

Scott Benner 1:07:12
Oh, my gosh. All right. I know you gotta get going. I'm not sure if we talked about what we said we were gonna talk about, but I found this to be a really great conversation about, about long term health and, and ideas of how to get to it and why it's important. So thank you very much.

Jennifer Smith, CDE 1:07:27
Yeah, absolutely. It was, it was good. I think sometimes, you know, the stuff about complications and whatnot gets, it gets to clinical. And I think people just need a return to that. That's why I am aiming for just keeping things tighter, or why I'm keeping things more in this range, or whatever. I mean, they know that the complications are out there. But this is the reason I'm doing this

Scott Benner 1:07:54
instead of talking about a thing that seems like it's so far away or so impossible, that there's no real reason to try to plan for it not to happen, because it's so far I will always use this example. My father smoked cigarettes all day long, two and three packs of cigarettes a day and not like not some like Marlboro light thing like Chesterfield kings, no filter, you know what I mean? Like it was left over on the floor of the place that they just roll up and sold the people you know, and in his 30s in his 40s in his 50s, smoke, smoke smoke so 60s, he'd come back from doctor's appointments doctor says I can't even tell you're a smoker and he would wear that with a badge of honor right up until smoking killed him right up until he had COPD and then and then he died. So you know can only you can only you only stay ahead of a charging bull for so long, right? And that's right. You don't want to be you just don't want to give yourself

Jennifer Smith, CDE 1:08:57
rather step off the path and be like let it run by run by.

Scott Benner 1:09:02
My dogs are barking like crazy. I think someone's breaking into the house. I might be killed soon we'll find out. would be cool. Not for me. Kelly. Oh my God finally dating. I doubt that. Oh, I hope not. All right. I will talk to you soon.

Unknown Speaker 1:09:19
Okay, awesome. Have a good day.

Scott Benner 1:09:22
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 juicebox 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 GVOKEG l u c h ag 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 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 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 in Episode 1025, we talked about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning 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.