#1023 Honeymoon (REMASTERED Diabetes Pro Tip)

September 24, 2023Scott Benner

Scott Benner and Jenny Smith dive deep into the topic of honeymooning in diabetes management. They discuss the challenges faced by parents of children with type 1 diabetes as well as newly diagnosed adults. The episode serves as a valuable resource for navigating the difficulties of the honeymoon phase of 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 0:04
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 juicebox free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Okay, so we're recording I want to tell you that this lovely woman named Isabel has been helping me with the Facebook page. And she came to me recently and said, You need a pro tip for female hormones and you need a pro tip for the end of a honeymoon. She said these are things that people ask about constantly. And they must not feel like they're getting what they need out of the podcast on this. Now Jenny, you know, in my heart, the end of the honeymoon just means use more insulin. And when you get your period it means use more insulin but darn it. Let's dig in. Let's just dig into it and find out the details. Okay.

Jennifer Smith, CDE 3:05
Sure. Yes, they're both good. Good topics. Yeah,

Scott Benner 3:08
details are apparently what is needed, and I am happy to deliver what is needed. And by that, I mean dig it out of your head and record it so people can hear it. Sure. Okay. Because my only experience with honeymooning that my only experience that I'm aware of personally with honeymooning because Arden had diabetes was diagnosed so long ago, and we had a little meter and some needles. I mean, I didn't really know what was happening in her. So Right. One thing that I can tell you is that I called my friend who was my children's pediatrician one day, and I I told you this before, but it fits in this this episode. So let's put it here. And I told him I preface my conversation by saying I know what I'm about to say is ridiculous. But is there any chance Arden doesn't have diabetes? And he said he sounded sad. I think sad that I asked him and he's and he said why? And I said, but she hasn't needed insulin for about a day and a half now. Right? And that lasted maybe? I don't know, 72 hours, and then it was just going yeah, anyway, that's my entire personal experience with honeymooning but I know how difficult it can be for everybody. So

Jennifer Smith, CDE 4:28
well, another good question. And that I mean, as you sort of began with I just give more insulin right? Well, a good piece of honeymoon is or coming out of honeymoon, right? When you're you've kind of moved through that lack of insulin need or really really, some people can get by on just Basal insulin. They might not need anything for their meals or their blood sugar's don't go high enough to correct or anything right. But did you notice also Oh, that after that, like three ish days that her insulin needs were higher than they were before that. Here's

Scott Benner 5:06
the here's the honest answer. I don't know. I didn't know what you don't remember. I forget that. I don't remember. I didn't know what I was doing. Right. So like, I think that feeling maybe encapsulates more honeymooning and the and the leaving of honeymooning for people more than anything like, right so somebody you or your child gets type one. It's a whirlwind. A, it's, you know, and if you're honeymooning, insulin needs are changing kind of radically sometimes. So just when you maybe get the nerve to, I don't know, Bolus two units of a basil, you know, and then the next day Your fight is 60, blood sugar all day that won't go up. And then the next day you think, well, maybe I shouldn't use the two units of basil and then you don't and then your body doesn't help that day and your blood sugar's 300. All day, that uncertainty, I think, is the main characteristic of honeymooning, don't you

Jennifer Smith, CDE 6:00
true and honeymoon is it is really different person to person, as well as the like, movement out of honeymooning is different person to person like you didn't have Arden didn't have a very long honeymoon at all. And that's not uncommon from the studies that have been done. It's not uncommon with kids under the age of five who are diagnosed to have a much more rapid rapid onset of type one very quick, very aggressive, really high blood sugars, you know, unless they've been watching for it, or they know because of previous antibody testing that it could be coming, you know, DKA, all of those kinds of things. And what that results in is causing enough of the betas to be stressed enough, and the body kind of decreasing them enough in, you know, in amount that now diabetes presents itself. So but in older kids, and especially in adults, there is often a slower progression of type one, like, you know, here it is, and all those symptoms, and that often leaves more betas in the picture. Also, what's been found is that the sooner you get containment of blood sugars after diagnosis, you give some relief to those beta cells. And because now you know, you're either injecting or you're pumping insulin. And so that's something that's helping to take care of the blood sugar levels. And your betas that do remain can actually help out. And so honeymoon then often comes in, you know, were usually somewhere between about one to four months post diagnosis is the typical, like, honeymoon, time to expect that to come into the picture. And how long it can last again is person to person. It could be a couple months, it could be three days, it could be a year or two that you continue to have this like lack of more typical insulin need.

Scott Benner 8:13
It's the consistency that you're that you're missing and and then yes people's hearts I think I'll tell you after interviewing so many people, I've heard, I believe every variation of time and distance about honeymooning from adults and children and, and crazy stories where blood sugars are suddenly super normal super out of whack. One lady I'll never forget told me like she thinks her honeymoon lasted years. And then I'm wondering like, is that? Is that honeymoon? Or is it a slow onset? Like is that like, and I guess it doesn't really matter? Right? Like, what matters is that you're using insulin now. And there's going to be this variability to how much until things, I guess you could just say settle. But obviously it's not settle. It's until your beta cells give up. Right, right completely. Do do some people just not see a honeymoon at all? Where does that happen? I'm not aware of it. In

Jennifer Smith, CDE 9:11
talking with so many people that I have, and you know, it's always something I asked about is diagnosis. If somebody wants to talk about it, you know, or if it's been very, very soon after I get to talk or you know, before I get to talk to them, it's been very close to that time period. And it seems like again, everybody is a little bit different. A little people again, very little people tend to be the ones that I hear the most. We didn't notice very much anyone, okay. Or, you know, parents are concerned because they're like, I don't know, I feel like we never had a honeymoon. I feel like we never needed just like a little bit of insulin. We just went from not using any really using insulin you know,

Scott Benner 9:55
so functionally, how do people deal with it? So we And you know, let's say I came to you and I said, Hey, here's my seven year old kid. Yesterday, this basil and this meal ratio worked perfectly. Today, it's a hot mess. And I'm saving low blood sugars all over the place. I don't know what's going to happen tomorrow. But as I look back, this is bouncing around. It's two days of this one day of that. But how do you find reasonable stability until things get normalized?

Jennifer Smith, CDE 10:30
Well, some of it again, in that early time period is, it's a bit of estimation, you can base it on Well, yesterday was a really sensitive day, if it looks like we fought low blood sugars all night, and we're entering morning time again today, with lower blood sugars yet again, that's a good visual that maybe today needs to be covered similar to yesterday, or even less aggressively than yesterday, right. So some hindsight can help. But then, you know, tomorrow morning, you wake up, hi. You didn't do anything strange overnight, and you're all of a sudden, hi, today might be one of those days that you're going to need more insulin. And so it, it's hard, because it takes us out of the picture, a lot of the things that we've done. In other we've discussed in other episodes, like testing, right, and doing things like Basal testing, in this time period, it's kind of hard, because you don't really know exactly day to day, how things are going to move overall, the general idea that kids before puberty, once remission, has kind of gone away, right? Once that honeymoon period, you're expecting it's over. Insulin needs usually are about point seven to one unit per kilogram per day of insulin,

Speaker 3 11:52
say 2.7

Jennifer Smith, CDE 11:55
to one unit, per kilogram per day of insulin. So and if you don't know pound to kilogram conversion, just take your pound weight and divide it by 2.2, then you'll have your weight in kilograms. But that's a it's a baseline, you know, if you were really, really, really low to begin with, and now you're doing a really low carb diet as well. You may not really see that insulin dosing kind of go along with what we would expect in terms of overall insulin need, right? Usually, people are considered in remission, if they're at, you know, point five or less point five units per kilogram per day or less of insulin. And then, you know, once you get to puberty, gosh, I mean, you could use anywhere between a unit to two units of insulin a day during puberty, and that's completely normal. Absolutely, and completely normal. So, if you're not so sensitive anymore, you definitely see these swings in blood sugar, you know, especially in that growth period overnight, or in the aftermath of meals, and is lasting and lasting and lasting. guarantee you're probably not in honeymoon anymore.

Scott Benner 13:09
Well, you know, you I've said it to you, I've said to everybody listening, you have to meet the need. And I don't know if I'm right or enough about that. But if one day the need is greater than meet the greater need. And if one day the the need is lesser than meet the lesser need. And, and flexibilities just it's completely key. It's what you're saying. It's like you have to sort of I don't think that I don't think that during honeymoon, you want to look real macro. Not all the time, right? You want to kind of just deal with diabetes in segments of of half days or hours or something like that. Like, here's what's happening right now. If it starts trending one way than adjust with it, if it starts trending the other way, then adjust with it. But I don't think there's a lot of value. Unless you're matching an apples to apples day and going well last Thursday. You know, she was really low. So I don't want to be aggressive six days later. You don't I mean, like, today's got nothing to know. Yeah, correlation between now and six days ago when you're in this honeymoon fluctuation. And I know that people are gonna think I'm flipping but I think you could just retitle this episode, diabetes pro tip ministration. And I don't know that we're gonna say too many different things when we get to it, which is why maybe for some people, they gloss over it when we talk about these basic ideas of like, it's not always going to be the same all the time. You can't always ask for a cut and dry answer. I mean, if you want to get through a honeymoon period, and it's, it's particularly, you know, Rocky, I think that just staying flexible, meeting the need, you know, taking a little bit of historical knowledge off of days that were similar to the one year clearancing now, I think that's really the whole thing.

Jennifer Smith, CDE 15:03
I think that's the best that you can do oftentimes, especially in honeymoon and then even, you know, coming out of honeymoon, there's, I know some people use the word like it becomes more stable. Okay. Sure. I mean, more stable in the fact that you're not like giving only one unit and that whole talk takes care of your whole day. Yes, absolutely.

Scott Benner 15:32
One day, the units necessary then the next day. It's not necessary. But there's consistency. I think they mean,

Jennifer Smith, CDE 15:37
there's more consistency is is it exactly. And I mean, in honeymoon, again, there are ups their downs, yes, you can, you can choose to use insulin from some hindsight from again, I know on a really, really busy day like this. My child needs a lot less insulin, but is running high today. Yeah. Okay. Again, it's the then meet the need in terms of where the blood sugar is right now. And thankfully, these days, I mean, you didn't have an I certainly didn't, does a kid have any visible to where my blood sugar was going at all. It was a one number, it could be rising in 10 minutes, it could be dropping in 10 minutes. And that's what it

Scott Benner 16:21
will. I wonder sometimes when I'm like, speaking to this person, now who's got a very small child who I think still their needs are, well, they're not honeymooning, they were just, they had too much basil going. So it's, you know, by using too much basil, they were getting drops, that didn't seem to make sense, right. And so it took a day or two to figure out that the basil was too high, to bring it down a little bit. But in there, while we were trying to figure it out, this person was using pens. And so they were relegated to point five units at a time. And I just said you have syringes, and she did was like just eyeball less than a half. Next time we go for this meal, and did that and fixed a lot of their problems. And so while this kind of unseen force, obviously I'm talking about basil that we needed to fix though, but you know, let the unseen force be up, you know, your pancreas working all of a sudden, was dropping her down. The limiting factor was the was the measurement on this on the pen. And like, for some reason, your brain doesn't jump over that and go, Well, this might be too much what your brain says this is all I'm able to do. Do you know what I mean? Like and so but the minute we drop, like these quarter of units, then suddenly there was far fewer spikes in the meals and then far fewer lows afterwards. And I'm just wondering like during the honeymoon period, if you are that scared of these crazy drops, do you maybe just draw back your basil a little bit? And then on days when that basil is not enough, just increase your meal insulin a little or do you really mean like, because also these these poor people are probably MDI in this moment. That remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen. It fits well in your hand and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juicebox free meter go get yourself have 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 programs there, you're gonna see all of the terrific things that touch 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 out. Both are caused their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touch by type one touched by type one.org, or find them on Facebook and Instagram. links in the show notes links at juicebox podcast.com. To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk.

Jennifer Smith, CDE 21:31
Correct most often and like you said, unless they have, you know, half half unit dosed or marked syringes in which yes, if you've got to get good eyes or you have a good magnifying glass, you can get kind of a quarter unit ish in there, whatever it might be, that I've got a good friend that does just that, and she's done it for a long time, and it works great for her. But again, you have to kind of use those microscopic doses. And on pens, it's a hard thing to definitely do, because all you can get is a half a unit. I mean, I think on pumps, honestly, in honeymoon and I know a lot of clinics often don't encourage people to start pumping until honeymoon is expected to be almost over. And I you know sometimes I agree with that sometimes I don't agree with that I think it kind of is individual in need, you have to look at what people are able to do and kind of a knowledge base of where are you already. But those doses they do, they do shift and change through honeymoon. And then you know, going out of honeymoon, you can expect the doses to definitely increase your child your teen your you know, adult that you're living with or your partner to or whatever, you're going to expect that their doses are going to increase. And while kids are growing at the same time as coming out of honeymoon, there are a lot of factors there. Another piece in the mix that often shifts things to higher insulin, and we've talked about it before we talked about illness and management is that if a child is also sick within honeymooning, and is now requiring more insulin, then by the end of the illness, they may actually either leave honeymoon sooner, or they may just be still at a higher insulin need as during the illness, the pancreatic beta cells were trying to assist, and there aren't very many of them left. So they were getting stressed out and can can leave less than

Scott Benner 23:41
that makes sense. So interesting. Yeah, I think that so I think that the next step here, I mean, besides telling people like look, it's gonna happen, you know, if it's happening, it's flexibility is key, it's going to be a little more stressful, but only if you I guess only if you're looking macro when you should be looking micro and then vice versa. Like you just talked about a lot a number of ideas where you do want to pull back and see the big picture, but not about the fluctuations day to day those you kind of got to get on like a bowl and ride them you can't step back and have an existential conversation about whether or not you should be bull riding, you know, so but but the other stuff are their illnesses is their growth, you know, activity, those things are, those are big picture items, but to now. Okay, so now you've figured out a way to ride through this honeymoon. The thing that I see from people over and over again, is that when it ends, you know, like when the honeymoons over, they can't believe it. They can't pull the trigger. They can't ramp up. Think about it any way you want to, but they get stuck in the game, and don't recognize that the game changed

Jennifer Smith, CDE 24:59
now Oh, yeah, I think the big thing there is that especially in honeymoon, the sensitivity to insulin makes people very wary. Yes, of using more, right, because you can get burned, right, by using more thinking you needed more, because yesterday, it clearly didn't work with this, you know, lunch that we provided we're giving the same lunch today. So I'm going to be more aggressive, you know, gave a quarter unit yesterday, today, I'm definitely giving a half a unit and then on the back end of the drop happens, right? The good thing to know is that in, you know, the coming out of honeymoon kind of moving out of that, that phase is that you will have again, more consistency in more need for insulin, you won't have as much potential for those drops, where you learned they typically happen even if it wasn't every day, you probably got a good idea of where things needed to be lower in dose, or, you know, that won't necessarily be the case. Once you're out of time. I

Scott Benner 26:12
feel like you I mean, when I tell people about it, I say you just kind of have to reset at that moment. That's when you go back to the setting Basal insulin pro tip, you start over again, you get the Basal straight, you reevaluate how long your Pre-Bolus time is, you reevaluate your meal insulin after you've reevaluated your Basal insulin. And you just kind of start over that. The truth is, is that I think that the transition from honeymoon to out of honeymoon is not actually much different sometimes than the transition from MDI, to pumping in that it's just the, it's the same game different players, like I don't know how to like how to think of it, it's like, you know, right church, wrong, pew, I don't know what the what the the thing is, like you're doing the same thing. But the pieces have all just sort of adjusted a little bit. And you have to just step back, take what you know about the thing you've been doing, and reapply it to the new situation. Right?

Jennifer Smith, CDE 27:08
Correct. And with pumping, you know that you've got a lot more precision that comes along with that. So if you've been doing things as precisely as possible with, let's say, Just half units, right? And basil that's given once or maybe twice a day. Now you can really address where insulin needs are heavier, and are lighter, through the course of a 24 hour day, you can meet the need more precisely, thus, the benefit of doing some Basal testing again, even if you're just doing it overnight, I mean, everybody wants to sleep. So if there's one time a day that you're gonna do it, do it overnight,

Scott Benner 27:51
part done, and you get that part time to a bunch of a one C and some just good feelings. In general, if you're if you're thinking all 24 hours or just a train wreck, like maybe you can at least get eight or nine of them straight, you know an answer. And it's a good jumping off point for figuring out the rest of the day. I think that when you were saying something a minute ago, this thought just jumped into my head, and I'm gonna put it here. And I think it fits. I think no matter the situation, maybe I'm talking about just diabetes or life in general. But do something is often the answer. People, there's a few people freeze, wondering what the something should be. But if you're watching the same thing happen over and over and over again, if you just change the variables, the stressors on the situation, you might see something new, that helps you understand a bigger picture something different. And so, you know, if blood sugars are, I mean, I don't think it's a joke, but like online, sometimes somebody will throw up a graph and be like, I don't know what's wrong with this. And I'll literally just type more insulin. Because put in some more and watch what happens and then go Oh, cause and effect. I've done this, but they

Jennifer Smith, CDE 29:05
want to know where right. Okay, they want not just more or they're like, but where should I put that more insulin?

Scott Benner 29:12
Like do something right, right. Like, if you haven't been on vacation in 15 years, take $5 a week and put it in an envelope, you know, do something, try to change the situation a little bit. And I get that it's frightening. And I used to think jetting, I used to think that all these things that I saw around diabetes, were so specific to diabetes, but I've been having some personal things going on with my mom's health recently, which Jenny knows. Probably not at all. Yeah, right away. But but the point is, is that I recognize that the confusion and the lack of knowing when to jump and feeling like you're overwhelmed and feeling like you don't understand what to do next. It's life, not diabetes, right. And maybe it's Feels a little more dire in some situations than others. You know what I mean? Like standing in the store, trying to decide between two waxes for your car might not be as crazy as I wonder if I want to add three more basil units to my kid or something like that. But the truth is, is that that inaction, that's what keeps you where you're at. So if you're somewhere you don't want to be, do something,

Jennifer Smith, CDE 30:24
right, an easier one to honestly do. Let's say you are running high, you know, all day long. And you're higher after meals, but you're still just stuck high in that scenario, and a safer thing is just add a little bit more basil. Yeah, add just a little bit more basil, right? If instead, in time periods where you're not actually eating, it doesn't look too bad. And then you've got these big excursions after you eat just about, you know, anything, even a microscopic eight grams of carb, maybe and it goes rocketing up, well, then you may be okay with basil, and maybe the next place to add more. And again, not three units more, but maybe add a half a unit or adjust your insulin to carb ratio by one gram to get a little bit more insulin around the times that you see the change that you don't want to see happening.

Scott Benner 31:22
Arden has been getting up in the morning going to school, and her blood sugar has been rising this this school year, like 30 points in the morning. And I tried to let the algorithm mess with it didn't work. I tried making just some simple basil adjustments wasn't enough. And then finally I just said, Doris, like when you leave the house from now on, we just Bolus three units, please. And she's like, what I was like, just throw in three units, get the car go to school, I was like, because whatever's happening is happening enough. I believe it's happening, I trust that what I know is going to happen is gonna happen. And she's using an algorithm. So if you make an uncovered Bolus, it removes her basil immediately. So her Basal is like 1.2 in the morning. So I figured it was about a unit and a half or so to fix the number or to get ahead of the number. And we got to cover the Basal that's gone. So I was like, just three. And then we adjusted off of that ended up being a little too much the next day, we did a little less than next day, we had a better outcome. The next day, she forgot to do it. You know, on the third day, I was like, see it happened again, like, you know, like, do this thing that made her trust that tried to do it, and it becomes a little more important to her. I just think it's another example of do something. Right, you know, I I've been saying online a lot to people lately. And you'll forgive me because I can't pronounce it. in its in its origin language. In Latin, but I've been telling people lately, Fortune favors the bold. Just try something, you know, they mean, stand up thump your chest and go, I'm gonna take a swing here. Let's see what happens. And then you get back to this stuff you hear in the earlier pro tips, you know, right, it's all well,

Jennifer Smith, CDE 33:13
and I think the bigger thing too, that you're you're bringing in is try something, right? But then analyze what that training did. Right? Don't just try it and be like, Wow, that clearly didn't work. Like, still focus on it. Well, it didn't work, your adjustment either left you too high, or like, you know, happened for you and caused it to be a little bit too low in the algorithm couldn't really save you from that extra insulin well, but now you know, so you use that for that information and you move forward and you say, Okay, tomorrow, we're going to do it this way. I mean, that goes into you know, a lot of things in terms of kind of the exiting of the honeymoon. It does it's try this it looks like consistently in the past week, he's needed more insulin. Okay, great. You're trying to add more insulin? Is it enough? Is it getting to you to the place that you want to be? Insulin needs may actually continue to climb a little bit? It's not like a night and day like yesterday, we needed one unit and tomorrow we're going to need 10 units. That's not typically the exit of honeymoon. But over time, that lack of beta cells that is that was helping you is going to show up very evidently in that you don't return to that minimal amount of insulin.

Scott Benner 34:33
Do you know what made me do this episode when Isabel told me that she thought it was necessary? It was that I had to get over that thing in my head that it's already in the podcast. Like I was like, No, it's in there already. You just have to listen to it. And then I thought, well, it's in there but it's in a different way because what we just talked about what about that? It really is the way when I'm when I was talking about God I don't even know what episode it was now. I guess maybe That's a good point. It's hard to find them all but but when I was talking about like sometimes you know, people's meal insulin meal ratio, sometimes their insulin to carb ratio can be like spot on for a number of meals, but not work for a certain meal. And I always use that silly example, if you have meatloaf and mashed potatoes and green beans, and you count the carbs and it says the carbs say, Oh, this is five units, you make your Pre-Bolus, you spike, you end up correcting later with two units, which brings you down and you don't get low. Well, the next time you have the meatloaf in the mashed potatoes or whatever, seven units, you seven units, right, like you see it happen. And then you take the leap, you stop looking back at the meal ration going no, that's not right, I counted the carbs, it's right, this is five units, very similarly to the idea of you're using a pen that only goes up to a half of unit, and you keep using it and then watching a low blood sugar happen. I go, I'm powerless, but you're not powerless. Like you just need to go get a syringe and do it a different way. And you're not at the mercy of your carb ratio just because it works five days a week, but not on Sunday when you have meatloaf like Right. So it's all kind of the same idea. Like, I know, it sounds trite. But it's all well, and that's

Jennifer Smith, CDE 36:14
I think it brings in a good a good piece too, in terms of, you know, multiple daily injections, and then we moved to pumping. And then we move to the fancy features of pumping. And then you might move to an algorithm driven pump, right? All of these things take. They take like evaluation. And a good example from somebody I worked with a while ago, who had started using one of the algorithm driven pumps. And she's like, this is fantastic. I love it. It's working so awesome. Like doesn't work on Friday night. And I was like, Okay, well, what were you doing on Friday night, that this doesn't work anymore for you. And she had this like, whole thing figured out for her dinner Friday nights that she would go out to with her husband. And on a conventional pump. She could use like, you know, a temporary basil. She could use an extended Bolus, and she had it down, Pat. I was like, just go to manual mode in your pump. And use it that way overnight and Saturday morning, turn your algorithm back on. And she's like,

Speaker 3 37:20
why didn't I think I was like, Oh, I don't know, either. But I hope that

Jennifer Smith, CDE 37:25
it helps. And it it seemed to be much better. Right. So

Scott Benner 37:31
yeah, because we went to a bar and art and got nachos with cheese steak on top of it and had French fries. And I crushed my first Bolus. I was like, I haven't been this excited about a Bolus. And while I was like I was on top of it. And then I started seeing the fat rise. And we hit it again. And I want and like I was over. And then I go upstairs to start working. And suddenly she jumps up her blood sugar jumps up and I go downstairs to my lab. And what happened? I had some gummy bears. She told me and I was like, no, no, we can't put simple sugar on top of fat and protein. I was like, are you all out of your minds? Without like significant I said art, if you were any gummy bears in this situation, the Pre-Bolus would have needed to be causing a fall before you put the bear the bears in, you know what I mean? Then that would have been okay, but she just did the like my blood sugar is great thing through and some insulin, wait a little while and ate it. And it was not nearly enough. We needed to be more drastic with it. And so I was like, so my text, my text said this, I'll bleep it out. It said that it said, open the loop Bolus for you.

Jennifer Smith, CDE 38:43
And let and let the Basal

Scott Benner 38:46
pumping for a minute and stop asking this algorithm to do something that it doesn't know how to do. You know,

Jennifer Smith, CDE 38:51
because it's not it's not a learning algorithm. Unfortunately, it doesn't, you know, it doesn't react the way that we have the experience to say, I know this is what's going to happen. Please don't fiddle with the insulin that I put in purpose

Scott Benner 39:08
is not the time to take the basil away algorithm. Cheese Steak nachos happening right now. Anyway, Jenny, you know, there was in the past, there was a moment when I, I used to worry. And I think like Well, we've already said these things. And people will find it. And now I realize that that's not how this is going to work that these continuing conversations are incredibly important. I think maybe the conversational part of this episode and many episodes is more important even than the technical aspects of what was said inside of it. Right. So like, if you listen to the Pro Tip series, and you had your brain or my brain or your experience in my experience you could derive from the Pro Tip series how to manage a honeymoon. But for people who are in that situation I think they need Get the information here. Yeah, I mean, in one spot. Yeah. And I just, I don't know if I was just like, super hopeful or lazy, I'm not sure. But I used to think like, just go listen to the protest episodes, it explains the whole thing, you know, and it really does. So I appreciate this, I think we're gonna have to, you know, like I said, I want to do one for you know, female hormones, menstruation, that kind of thing. So yeah, pick the next time we record. And then from there, I'm going to say this year, Jenny, because it'll put us both on the hook. In 2022, Jenny and I are gonna go back to certain pro tip episodes, were going to re listen to them on our time, and then incorporate questions that I'm collecting on Facebook, on how to supercharge those episodes. So they're going to kind of that's gonna get part two, kind of a situation. That's what cool that's how we will you and I will spend our time seeing each other through the winter of 2022 sequels to certain episodes, I'm thinking of them as director's cuts for oh, there you go. Older people who you remember the director's commentaries? Yes. You know, where do you mean you flip the movie on and the audio goes away, and you just hear the guy go? In this shot. What I was thinking was that if the sun came in from the left,

Jennifer Smith, CDE 41:18
we could could pan over here and listen to this music from this producer, you know, whatever.

Scott Benner 41:24
missoma Hi, X eyes are glistening. I did. I told the DP like, I don't know if you ever listen to them. They're pompous exchanges, Jenny and I will not do that. But we're gonna go back and listen to what we've said. Because I've done it a couple of times, like in Episode 500. I went back to Episode 11. That's bold with insulin. And I listened to it and like tucked over top of it like so people listening in episode, I think it's 100 Oh, my God. 105. Sorry. In Episode 100, I just basically did a director's cut of that, because I realized that when I said it, I was just saying it. Like there was and now I've lived all this time since then, and had these interactions with people that maybe there'd be more to add to that. And I think that exists for the protest series. Like and I'm excited. I'm sorry that you're going to start getting emails from me that say, please listen to this one before we talk again. But

Jennifer Smith, CDE 42:13
no, that's fine.

Unknown Speaker 42:16
You're a busy person well, and I can do it during

Jennifer Smith, CDE 42:18
my workouts. That's not usually I just, that's my mental like, my moving like mental sort of like strategizing time is my exercise time. I am not like a sit in one space and like meditate. I'm a moving meditator, but I can meditate on the episodes so we can make them better for everybody else.

Scott Benner 42:40
I have a question, then I'll let you go. How do you make out listening to your own voice? Does it freak you out?

Jennifer Smith, CDE 42:49
It's I don't know. It's I guess it's kind of weird to me, because I like I hear myself speak, you know, in your brain like, but when you hear yourself, it sounds different. I guess. I don't mind listening to myself. But yeah, I don't know. I don't think that I sound like what I sound like when I listen. No,

Scott Benner 43:12
no, no, I sound so right now we're recording, I can hear you and me and my headphones. I sound different in my headphones that I sound on the recording. And if I'm just speaking out into the world, I don't think I sound like the person on the podcast at all, but people think I do. But in my ear doesn't sound the same. Although And do you ever get on? Do you ever? Do you ever say anything and hear yourself? I go oh, Jenny, you should not have said it. You should have said it like this. You ever correct yourself?

Jennifer Smith, CDE 43:37
I do. Absolutely. And a lot of the ones that I listen to I'm like, Oh, this would have been a better explanation. Or I could have put this in as an example. And that would have been better. So maybe we Yes, I think it's great to sort of rethink them. Because then we can

Scott Benner 43:51
walk and I agree that there's there's just always going to be other stuff to say. And as we move forward into 2022 and beyond more people are going to be using algorithms. And there's going to be a whole new layer of understanding for diabetes, there's going to be things that you and I don't haven't experienced yet, that that through these experiences over and over again, abusing this technology, you're gonna come out I don't see an end to this podcast, I used to think it was finite. And now I think somebody is going to need to, you know, make up a cure for this podcast not to be necessary. So Well, that's

Jennifer Smith, CDE 44:25
what I was gonna say. I don't think until there's honestly a true like, you don't have to use any technology or anything. You just go in and get your bloodwork done and make sure your doctors like yep, you still look great. It's all perfect. I don't think you know the information that people need, especially with life changing and everything. I think it's purposeful.

Scott Benner 44:47
I appreciate you doing this with this. It's sort of the end of the year. So let me thank you for giving your time so greatly to the podcast. I want to thank assenza diabetes for sponsoring the remastered diabetes. Pro Tip series don't forget you can get a free contour next gen starter kit at contour next one.com forward slash 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 GE Vogue glucagon.com forward slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juice box. 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 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, he'd really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jennie Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link. If you're living with diabetes, where are the caregiver of someone who is and you're looking for an online community of supportive people who understand check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something If that you've learned Juicebox Podcast type one diabetes on Facebook and it's not just for type ones any kind of diabetes any way you're connected to it you are invited to join this absolutely free and welcoming community