#301 Diabetes Pro Tip: Glucagon and Low BGs

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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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 0:00
Hello, everybody, welcome to Episode 301 of the Juicebox Podcast. Today in a pro tip episode, Jenny and I will talk about glucagon, emergency Lowe's, just you know, how they manage that kind of a scenario and what happens if you need glucagon and how do you use it? That kind of stuff? It's not a bummer. Don't worry, Jenny and I laughed more during this one than most of them. So we're gonna go over how to use the glucagon what glucagon is, what is it? Do the three different kinds that we could think of that are on the market? Pretty much it's a nuts the bolts glucagon extravaganza talking about low blood sugar somewhere else you're gonna talk about people having seizures, and hearing them laugh at the same time. I mean, who else is putting out diabetes content laughing about a seizure? It's not funny By the way, it's just the situation was funny. You'll see when you get to it Don't get upset. This episode of the podcast is sponsored by the Contour Next One blood glucose meter and the dexcom g six continuous glucose monitor hmm you can go to dexcom.com Ford slash juice box or Contour Next one.com To find out more about the sponsors and what they got going but trust me what they got going is some amazingly accurate blood sugar measuring tools. Arden uses both of these devices daily and they are exceptional dexcom.com forward slash juicebox Contour Next one.com take a look at both of them support the sponsor support the podcast last thing I'm going to be at the Dallas let's see how they build themselves type one nation summit northern Texas This is the greater Dallas in Greater Fort Worth slash Arlington chapter, big chapter. You're gonna be able to see me and I don't know if you know this Kyle Cochran guy's been a Ford he is a four time American Ninja Warrior. Warrior. Warrior I would not pronounce they are any? Well, any Well, I think I'm having a stroke people. This is the last episode of the podcast. Anyway, Kyle Cochran is gonna be there, I'm gonna be there, there's gonna be some other great resources. It's a really wonderful type one nation event, check them out, you can go to Juicebox podcast.com. Scroll to the bottom, click on events and there's a link right there to buy tickets. It's a great event, February 16. It's a Sunday, Please don't make me fly all the way to Dallas, and not see you. Alright, we're gonna get started. Just remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. And now, Jenny Smith, and I do the chit chat about the glucagon.

I liked your idea, a lot of doing a pro tips for glucagon. And I was wondering if we couldn't meld it together with like emergency situation ideas as well. Yeah, you know what I mean? So I just realized that what we'll talk about what we're talking about it? Yeah. I don't know how to start this. Honestly. I can tell you that. We buy glucagon religiously. I always have some, when it expires, we always get more. We've never used it. We've had opportunity to use it twice when Arden was little, and both times opted to try glucose gel instead. which worked. Here's the best place to tell the story, I guess. And I'm sure I've said it here before, so I'll encapsulate it a little bit. But, you know, when Arden was really newly diagnosed, she was probably like two and a half years old. And thinking back now knowing everything that I know, she was probably honeymooning still, right. And I had no one ever spoke those words to me ever. I didn't know that was a thing back then. And we got kind of ahead of ourselves one day and Kelly was getting ready to leave on a business trip. She was gonna go overseas. And it was like, six or seven hours before her car was gonna come to take her to the airport. And she's like, hey, I need another piece of luggage. Like, let's go to the mall, get a little piece of luggage looks like alright. So we get over to the mall, and it's a Sunday. And we're hungry while we're there. So we grab, you know, the worst thing in the world like mall, chocolate, Chinese food, just not just more food, more Chinese food. And I was just like, boom, I can have my carbs and I was like, pull up my insulin and the needle, bang go ahead and eat. I figured this out. And she ate the food. We ate we bought the bag we went home. Arden was super little so she fell asleep in the ride home during the ride home only like 15 minute ride. And I carried her into the house and put her in her crib. My wife's packing and my son's watching the football game and Everyone's living their life. And all of the sudden, it sounded like there was a wild animal trapped in the house. Right? There was like this grunting and grunting and grunting. And you know, it's like anytime like, I'm just like, What is that, and they start moving through the house towards the sound that's coming from Arden's room, and I get into a room and look in the crib, and she is having a seizure, you know, and I was just like, I did not 100% know what to do. So I picked her up, and I went through the house to where Kelly was. And we had just this kind of little area rug. And I said, I'm like, Arden's having a seizure. And so I put her on the floor, and I got out the glucagon. So the the red box, you know, it has the, it hasn't changed it forever. And this is the one Lily cells, right. And so the red box, I pop it open, and there's a needle in there, the needle needs to be put together, the needle has liquid in it, I know the liquid needs to be shot into the powder, that it has to be reconstituted and drawn back out. And I'm going to be 100% honest with you, I was so freaked out that I fumbled with that thing. And I was nowhere near getting it put together before Kelly was rubbing glucose gel into her cheek. Right? And I'm not embarrassed because I look back on that time. And I remember when they gave it to us, the nurse made such a big deal of saying, This is life saving glucagon. But don't worry, you'll never need it. And so when she said that, I was like, well, I'll never need it. No, I never, you know, and so good thing is

Jennifer Smith, CDE 6:44
that you knew where it was in the house, at least it wasn't like, you know, in the bottom of the dog's bed or something right, just giving me credit knew where it was. So he knew where it was.

Scott Benner 6:55
So So literally, during you know, the Kelly put the glucose in her cheek, she started to come out of it. I will tell you 100% of the the experience of watching art and have a seizure will never leave me I have never forgotten any of the details of it. She was blind, like she couldn't see anybody. She couldn't talk. But I don't think that meant that she wasn't aware of what was happening. Because there's a I've shared it on the podcast recently. But there's, um, you know, there's a video of her from a year or so later explaining how it felt to have a seizure. And so you even when you touched her, it scared the crap out of her when you touched her, you know? And and so I just never even figured out how to put it together. I had shown it to nurses, I had shown it to people like everything, but when the time came, I was like, not very helpful. Right? Anyway, glucose gel did work. And then we went to the hospital, we call 911. And we went to the hospital. And then you get to the hospital and then the hospital kind of treats you like, you don't really need to be here. Like, there's that kind of feeling. And then you realize like, Oh, it's over now. Okay, yeah, it's okay. So, later, while we're talking, I'll tell you about the second time our next seizure, people are gonna be like, why am I listen to this podcast when we happen to voice? It was in the beginning. So I guess, let's really start at the very beginning, right, like, what is glucagon? And what does it do when you inject it? I don't know where you are right now. But I'm on Contour Next one.com you gotta cut me a break. There's only so many ways to do these ads. Okay. I want you to know about this meter, I'm not messing around about it. Arden started using the Contour. Next One, like I told you before, like a year or so ago, maybe it's a little less a little more. I don't know, my grasp of time is uh, you know, I'm getting old. I don't really know how long ago it was. Here's what I do know, the damn thing is accurate. It's easy to carry around. The test trips are amazing, you can miss on your first try go back again without ruining the test. So you're not wasting test trips. Again, the accuracy this meter is just wonderful. So frequently matches with Ardennes Dexcom. It's amazing. And you can get a free Contour Next One meter at Contour Next one.com. So why not go see if you're eligible for it, it's only going to take you clicking on it to find out where the next time you find yourself at the end, just tell him Look, I'd like to use a more accurate meter than what I'm using. Now. Let's write me a prescription for this one. Get some test trips and get moving with the Contour. Next One. I'll tell you what the next one is next level. The Contour Next One is a highly accurate, easy to use meter. As unique smartlight feature it instantly shows you if your blood glucose is in target range, and that can help you make dosing decisions. Right like real management decisions. You know what else they have wonderful. The contour diabetes app that seamlessly connects via Bluetooth. Understand that you test with a meter boom it pops up magic, like on Your phone. And then this app is more than I can describe to you right now. But it's free, and you want to check it out. So whether or not you use my link found at Juicebox podcast.com, or in the show notes, or if you ask your doctor to get the meter, or whatever you end up doing, in the end, just make sure you click on Like, I'm just kidding. Just make sure you get the meter. It's really wonderful. It's gonna be a great addition to your diabetes toolkit. I cannot stress enough how much we're enjoying it. What is glucagon? And what does it do when you inject it?

Jennifer Smith, CDE 10:30
It's made by the body to begin with glucagon, right. And so in the human body, it's a piece of the glucose management system that your body has in place without diabetes in the picture, right. So you've got this management system of your body releases insulin, your body also releases glucagon, which enables the body to break down glycogen, which is stored form of glucose, right? And so you get this drip, drip, drip, drip, drip, drip drip of both. And that helps to keep things stable through the course of your life. So you know, in a person without diabetes, you've got blood sugars that might start dipping down your body releases a little bit of the glucagon, which enables the body to break down the glycogen into glucose, and it starts to navigate things back up, but it's a seamless system, right? I mean, nobody walking around on the street right now, right now, even the most highly educated biochemist, whatever is probably thinking, well, I wonder what my body is doing. But

Scott Benner 11:33
just one of those things that happens,

Jennifer Smith, CDE 11:35
it happens like breathing, you don't think about it, it happens. But in diabetes, we, we kind of have, like a faulty system, obviously, right? Our body isn't making insulin anymore. But we still do have this like drip drip drip of glucose into our system, or we wouldn't need bazel insulin, right? Yeah. glucagon, however, is, as you explained, well, it's an emergency, we know it as an emergency, we have to use this if this situation is here, right? A low blood sugar, treat a, you know, a friend, a child, a spouse, whoever it might be. So when we inject glucagon, it stimulates a very large amount of breakdown of the glycogen, the stored form of glucose, so that the glucose can get into the system, thus bringing the blood sugar up,

Scott Benner 12:29
it's stored in your liver, right?

Jennifer Smith, CDE 12:33
glycogen is stored in both liver and muscle cells

Scott Benner 12:36
themselves, okay? So in a functioning person who doesn't have type one diabetes, your body really is bumping and nudging on its own, it's giving you is giving you insulin, and then it's saying, Oh, this person needs a little more glucose. And so I'll release a little here, I'll release that. And that's happening constantly back and forth, back and forth all the time. So So when we're diagnosed with Type One Diabetes, when someone's diagnosed, we always I mean, for me at least, like, in my mind, what happened is Arden's pancreas stopped making insulin, but more happened in that right, but we just don't talk about the rest of it usually, like, you know what I mean, like, right in because you hear people say like, my pancreas is dead, but it's not that does Oh, no, it does way more things than

Jennifer Smith, CDE 13:24
that. Absolutely. Absolutely. It doesn't mean you've got more things in your pancreas than just the beta cells 100%. In fact, the the the glucagon actually is made in the alpha cells of the pancreas. So a completely like different little cell hanging out, you know, Lahti die here I am to do this thing, right. So, overall, our pancreas isn't dead. It's just a piece of it. That's nice.

Scott Benner 13:49
It's not purposeful function. Yeah. And, okay. So it's interesting, right, like, so how often do you think how often do you speak to someone who's needed to use glucagon in an emergency situation?

Jennifer Smith, CDE 14:05
Hmm. In if I had been doing this

one years ago,

likely more.

Mainly, because I think that with the influx of the technology that we have now, we've got alerts to actually tell us when things are dipping, before we would even get to the place of needing

Unknown Speaker 14:33
glucagon.

Jennifer Smith, CDE 14:34
Now, I mean, that doesn't mean that it isn't potentially, you know, necessary. We've got the standpoint of prolonged exercise, you know, where you've had, like, people who do like a whole entire Iron Man triathlon, and that's a huge depletion in your body's glycogen stores, even if you've been fueling along the way as you should be. That's a huge depletion. Your body has tapped into your stored glucose to fuel that long duration movement. So, I mean, if you have exercise like that, potentially, you're going to need something to boost glycogen out of the system to bring a low blood sugar up and or you've got too much insulin there to begin with, for whatever reason the dose was wrong or the dose was wrong along with a long, active active day or whatever the scenario, glucagon will potentially at some point be necessary. I knock on wood, I'm not really superstitious, but that's like my grandmother's thing to do. It's like knock on wood. Whatever works, right, but I mean, in 31, in plus years with diabetes, I've never had to be given glucagon. I haven't. I mean, my husband knows how to use it. My parents knew how to use it. My teachers at school, my girl scout leaders, I mean, everybody that I interacted, they all knew how to use glucagon. I went to sleep overs with the glucagon in my bag, I did. Never had to use it. Thankfully, in the amount of people that I now work with, I would say, it's not, it's not common to have had to use it, at least not. I mean, we may talk about this a little bit later, like different kinds of emergencies settings of use, but there is the benefit of also mini dosing. And some adults, especially the adults that I work with, are much more proactive in in trying to offset something they know is not working right, you know, and so, ability to micro dose a glucagon injection and offset a low that you don't pass out from and nobody needs to help you. You can help yourself, right.

Scott Benner 16:52
It's funny the way you put it, because I'm thinking back now, you know, Arden's very infrequently low, but she has like a crazy low once a year that just comes it appears to come out of nowhere, right? And we think back on one of those, you realize that without the sensing technology, like if she didn't have a dexcom those she would have seizures in those moments. Yeah. Right. Because it's, it's unexpected. First of all, it's not like I've done anything different that day than another day. I'm not standing around all day going, who this is gonna be the day never happens. It never happens. When you're like, something's gonna get squirrely today, right now that day, right? Oh, and so you know, you're it's one two o'clock in the morning, and you get the alarm, and you realize she's falling way faster than you would have any expectation for. So there's something, whatever it is pushing down on her blood sugar, and nothing to resist it in the other direction. And it's just falling and falling and falling. So we get, you know, we get an alarm go in, you give her I mean, for me, I give her juice first, because I find that works very quickly. Like it's it, the way I think of it is like let's get something in there working. While we do the rest, right? Then I look at things like they're like palatable quick. I always look for like a banana in that situation. Because it's not hard to eat a banana. It's sugary, right. And then you know, I'll roll back to another juice if I have to. But you'll see those, those crazy lows go like 70 6050. And they fall really quickly. And before you know it, you're treating it 50. And you would have treated sooner you just there was no time you're treating it 50 you're into the 30s. Now you're testing now you're doing the like, Okay,

Jennifer Smith, CDE 18:30
this number,

Scott Benner 18:31
let me double check this right. So you're, you finally have a second there's some food in. So now you hit a finger stick, and it says something like 30 or 26 or something ridiculous. And you're just like, okay, now I'm here waiting for her to either have a seizure or not. Like that is really what it feels like, like I've put the food in, it's in there, it's going to do something. And you know, and you're just, I don't know about everybody else, but I test and then I wait like, not long, you know, it's like four or five minutes later, you test again, and you're looking for just any sign of stability. Did the 38 stay at 38?

Jennifer Smith, CDE 19:08
Did he come to 40? Did it go to 40? Because

Scott Benner 19:10
if it was 40? I don't think she's gonna have a seizure. Right, like, and so I think everyone needs to know how to handle a moment like that. Yeah, you know what I mean? But I'm now now, you know, having seen that moment, a few times in my life. I see, as you're talking that without the sensing technology, she would have went from 50 to 30. And the, the alarm I would have gotten would have been the grunting and the right to see it would have been the seizure. Right. Right. And then and

Jennifer Smith, CDE 19:38
without. Yeah, and without this technology, I mean, I I think fully even to this point, I I still have symptoms for Lowe's. I do even with the technology that I have that alerts me and whatnot. I still know when I know usually even before my system is going to tell me I can tell where I am. What's your number when

Scott Benner 19:59
you know You're low.

Jennifer Smith, CDE 20:01
My number is usually in the 60s

Scott Benner 20:03
Arden's at 60. She knows Yeah.

Jennifer Smith, CDE 20:06
But you know, years ago when I was first diagnosed, in fact, a good a good case where my parents probably could have used glucagon, but didn't. It was the summer like several months after I was diagnosed, we were camping, had been out playing, you know, rafting in the pool at the beach, doing everything that you would normally do when you're on vacation, you know, and it was the evening and my dad was making popcorn at the fire. And we were all gonna sit around and whatever you do at play games, and it was time for me to check my blood sugar because it was like nighttime, right? It was bedtime almost. I sit down, I check my blood sugar. And my mom was like, that numbers not right. And I looked at the number. And I mean, I was the age that I knew numbers, and I knew where my numbers should technically be. And it was 26. You might either like those old like old meters that took like four minutes to test. You just swipe the blood off, stick it back in the machine, push another button, wait for it to actually give you a value. But yeah, 26 my mom's like, That's not right. She's like, Did you wash your you know, all the things I washed my hands again. And like, I tested again, my was like, How are you feeling? I'm like, I feel like I did like 30 minutes ago. I'm like, totally fine Mom, you know, she has to get it was like 25 it was like literally it hadn't moved. Mm hmm. I was like, like, my mom is the kind of person who's just like, oh my god, like, seriously, you know, and my dad was right there. And he's like, well just give her some juice. And my mom. My mom's like, this number isn't juice. This is like we got to do and he's like, give her the juice. She's talking. She's fine. She's answering questions. You know, I mean, I can remember this very vividly. Give her the juice. I drank the juice. You know, my mom's like, okay, let's check again. You know, like, all the thing is certainly, it started coming up. It was slow. And it's a painful Wait, it really is. But my main my mom was like, there. She was like that glucagon is gonna be here in 15 minutes if this juice that your dad wanted to give you is not working? I mean, and who knows? What was the accuracy of a machine like 30 years ago? You know, I mean, my blood sugar could have been 50. Who knows? But, again, I think you also have to judge those scenarios. Like, okay, she can take something into eat, she's talking, he's talking the person's, you know, with me? Can we actually like do the glucose gel? Can you do glucose tablets? Can? Is it safe to do something to chew? Should we just do some juice? I mean, but glucagon is always there, if you don't know. And you can't tell us the glucagon. It's, it's going to work for you. It's the only thing

Scott Benner 22:39
you have at that point to it, right? Because, you know, just as I describing Arden having a, you know, a bad low, she could still eat and reason and talk and all that stuff, right? And so that's fine. But when she was seizing, you couldn't have she couldn't have drank anything or eaten anything that wasn't happening, she was gone. You know what I mean? So she needed she, you know, perfect world situation, we would have used the glucagon in that scenario for certain. You know, it's just it's, and it's, listen, I have to say this, too. It's frightening. But if you think you're going to live a whole life with type one diabetes, and not get into a situation where you test and see a 26. And I think you're wrong. I think it's going to happen at some point I used to tell. It's funny, because you described how everyone in your life knew how to use glucagon. And I've done the same thing, right? You've explained to a million people that it never comes up. And I think that sort of builds a false narrative in those people's heads like, Oh, this diabetes isn't as bad as these people say, right? Because they showed us this emergency thing. We've never used it. It's a it's not a real concern, because it never happens. I do think that's one thing that happens, but But the other thing is that is that you have this kind of feeling of I don't know, like, like, it's it's never going to happen. But it could, it just really could happen. And and if it does, you can't be freaking out in that moment. because trust me, I freaked out once. And if Kelly wasn't there, I don't know what would have happened too hard, because I was like, not processing. Well. And then since then, you know, the second learn. Yeah, you know, storytime the second time Arden had a seizure. We were Disney. And we had spent the entire time day at a park. And we were coming coming back later and I was hot. We were walking. She was eating we were giving her insulin you know, the way we thought we should we were testing she didn't have a glucose meters long time ago. And we're we're within like visual sight of our hotel walking back through the park. And this popsicle salesman's walking on us. It's like 1030 at night. And I remember looking up and seeing this guy holding these giant popsicles thinking like, what devil sent you in my path. You know what I mean? You know, and so But the kids are like, Can we get those? And we're like, Yeah, of course. And we gave her some insulin for it and gave it to her right? Looking back now, I never would have given her insulin for a popsicle. And that's a scenario of knowing your blood sugar or not knowing your blood sugar. And so we you know, she eats the popsicle, we walk back to the hotel kids are again, exhausted, she goes to sleep. The about an hour later, the grunting sound happens. And I'm like, this time, I'm like, oh, there's no raccoon in the house. Arden's having a seizure. I know what this is. And so it was both comforting and hilarious and scary. All three, excuse me, not both, but all three. I went into the other room, goddaughter, sure enough, she was having a seizure, we went right for the glucose gel, because you're like, Well, we know this works. And take the cap off the glucose gel and go to squeeze some out, it won't come out. And in the panic, I just thought, I don't know what I thought. But just the little silver paper was still over the thing, the freshness seal, they squeezed it way too hard. The freshness seal did not come off. But it sprung a pinhole in the back corner of like the sealed part of the tube. So imagine icing tubing, and I'm squeezing it and I am writing in calligraphy all over the ceiling of the hotel room in this laser thin beam of glucose,

Jennifer Smith, CDE 26:23
right? Oh, no,

Scott Benner 26:25
we all look up, everyone laughs we spin the thing around and shoot the glucose gel under our mouth out of the pinhole and out of the thing rubbing her cheeks, she wakes back up again. She's fine. She's kind of looking at you like Yo, what's up, and we get we get her stable, make sure she's not falling, and we put her back to bed. The whole thing took like 15. And that was sort of the end of it. And she's never had one since then. You know, but we learned a lot in that in that time. Absolutely. So if you don't think that's gonna ever happen, I hope it doesn't happen to you. But to live like it can't happen. That's a mistake. And so back to my original point, when when I used to spend time before when I was younger going into school and saying, look, here's what you really need to understand about diabetes, and I would go over the stuff. But I would always end with I know you feel like we're sitting here today, getting ready for when it happens, because it's something we can prepare for. I'm like, but the secret about the diabetes in an emergency is you sort of can't prepare for it. Like, if you knew it was coming, you'd stop it. And that's always the weird part about this stuff is it always happens just when you would never expect it to happen, like because otherwise you'd be sitting around going, Oh, you know what's going on this afternoon. It's totally a seizure situation. Like no one thinks that way. And so I don't know, I just, I think it's incredibly important to be prepared.

Jennifer Smith, CDE 27:48
It is well and one additional to that, like preparation. Let's say you are prepared. You've done all of your homework, you know, you've got the glucagon, you know how you know to use it, your friends know how to use it or whatever. And I, I bring this in because it's something that I do discuss, especially with like older teens and like college students and anybody who does a lot of socializing within their job. I think it's, it's really important to know that there may be a point at which glucagon may not work. That's right with alcohol. Mm hmm. And I mean, there really is, there's a real reason it's not like the glucagon is like, Oh, I'm just not gonna work today.

Scott Benner 28:32
Like, you know, Jenny trust too much. She doesn't deserve for me to work.

Jennifer Smith, CDE 28:37
Right. Right, right. He she had beer and I would rather she has, like, you know, a Mai Tai or something. No, not at all. It's just, you know, it's the there are biological reasons, right? I mean, your liver again, your liver is like this phenomenal organ in your body. It really is. It's, it's fantastic. And it does a tremendous amount of stuff for you. One of them is and we kind of call it your body's detoxifier. Right? I mean, that's a really like nutshell term for the things it does. But the livers task of ridding the alcohol out of the system, which it sees as a toxin. It's going to do that first. Before it does that's its first thing that is its job, it's going to see a toxin is gonna be like this body doesn't need this, let's get rid of it.

And it takes

a while for your body to process that alcohol. So I think it's like one drink takes about an hour and a half to process out of the body. Okay. So in that time period, your liver isn't going to as he efficiently areas effectively check into what's happening with your blood sugar.

Scott Benner 29:45
Yeah, it's a task I really do. Right? It's not

Jennifer Smith, CDE 29:49
but in that if you give glucagon in that scenario, and now you're asking the liver to do another task, it's not a multitasker.

Scott Benner 30:01
doesn't already so are you? I feel like Jenny's saying that a liver is more like a guy, like you give it a thing to do when it does that thing until that thing's over, and then it moves on to something else. I know, this is a generalization, it's sexist. But, you know, I don't know that it's, I don't know that it's that wrong.

Jennifer Smith, CDE 30:20
Yeah, yeah. And drinking in and of itself can also, you know, do some crazy things just to blood sugar levels in general, right. So if it's got carbs, and if it doesn't have carbs, and it's pure alcohol, etc, you may not have been eating with the alcohol. So I mean, there are a host of other things that could go into a low blood sugar in terms of alcohol consumption. But one of the things, of course, is that the livers not doing that drip drip of glucose, right or glycogen to turn into glucose, etc. So your bazel, then that's dripping in the time period that it was beautifully tested, it should be working great. Your basals managing without the normal

Scott Benner 31:03
bukal. They're very important point.

Jennifer Smith, CDE 31:08
So if it's not doing that, then what happens you get a little blood sugar. Now when you take the glucagon, you're now telling your liver, like I said before, to do something to release this glycogen and to give you some extra glucose to bring the blood sugar up. And there's either a major delay or it doesn't, it doesn't do it. They're really in drinking some emergency, you know, if you're with it enough to know that your blood sugar's dropping, obviously, simple carb, you can do the juice you can do that is if you're with friends, college friends, a spouse, a significant other, whatever, they should know where the glucose gel is something safe. If it's not glucose gel, they should know where the honey is, if they don't know where the honey is, make sure it's cake frosting, something that can be squirted into the cheek can be rubbed in massaged in, it starts to absorb and it can bring the blood sugar up.

Scott Benner 32:00
We don't want to have to swallow it to make this process happen. We want it to absorb through the lining in your mouth back.

Jennifer Smith, CDE 32:07
Correct. Exactly. So that's one I think one in that like emergency time of potential Oh, get the glucagon out.

Scott Benner 32:17
Try some other stuff first. Right? stuff first,

Jennifer Smith, CDE 32:20
obviously even calling you know, emergency services, obviously, you're with somebody you really don't know what to do.

Call 911. Yeah. And it's so

Scott Benner 32:29
it's so interesting, because what you just said about, you know, when the liver stops making, you know, it stops dripping out this glucagon, this glucose, we always talk about, you know, you need your basal insulin setup, I'm always saying, right, it's like timing and amount, it's the right amount of insulin at the right time against carbs or body function. And you know, then we talk about body function being like stress or anxiety or pain, or, you know, all that or your liver and what you're doing, that's a body function that's causing your blood sugar to try to go up. And if all of a sudden, it's not trying to do that anymore. Now you're bezels too much. It's too much, right? It's actually off the topic,

Jennifer Smith, CDE 33:06
right? I mean, it's actually the reason that with alcohol, our standard of education that we say to do is for every alcoholic beverage to take your basal rate, if you're using a pump, that is take your basal insulin down by 40%, and set it to last duration, at least two hours for every drink consumed. If at the end of the night, you've had, you know, four drinks, that's eight hours worth of a decreased bazel.

Unknown Speaker 33:37
So

Scott Benner 33:39
right, so let me so now I have this question as we're having this conversation, and maybe I'm wrong. But this thing that we call glucagon that we inject inject in emergency situations, is it actually glucagon? Or is it something that makes your body produce glucagon? cliffhanger? You got to go check out the dexcom g six continuous glucose monitor. You have to if you don't have one, I can't even understand you. I really don't. At least looking into it. I don't understand. How would you? How would you hear all this stuff every week and not think to yourself, I need to see my blood sugar. I want to know what direction it's moving. And I want to know how fast it's going. I want to see my kids blood sugar while he's at school. I want to know what my daughter's blood sugar is at a sleep over. I want to know before I get low, I want to know before i get i three days ago, and by the way, let me say this first. These are my results and yours may vary. Okay. Three days ago, I started helping a person with a blood sugar that was completely out of whack. I'm talking about over 404 hours a day, that low and then when it sat steady, it was well over 250 it was a mess, right? And I was able to help that person make adjustments to their insulin just by seeing their Dexcom that's it took like two days. If I could do that in two days, imagine what you could do with the Dexcom for a lifetime. Please, really, really think about it. I hear all kinds of excuses from people, I don't want to, I don't want to hear it, beep, I don't want this, I don't want that. It's gonna beep to help you. And once you learn how to use your insulin, it's not going to beat that much. Because you're not going to be jumping out of range all the time, like you are now, that's a real tangible thing that could happen for you. dexcom.com forward slash juice box, the links in your show notes or Juicebox podcast.com, Please, I'm begging you just look into it.

Is it actually glucagon? Or is it something that makes your body produce glucagon?

Jennifer Smith, CDE 35:52
No, it I, I understand that it's glucagon.

Scott Benner 35:55
So glucagon makes your body make more glucagon,

Jennifer Smith, CDE 35:58
glucagon injected makes your liver release glycogen and transition it into glucose. Okay,

Scott Benner 36:05
so is this stuff that we're injecting helping bring up our blood sugar? Or is it just making that function happen?

Jennifer Smith, CDE 36:12
It's making the fun, right? It's the glue gun that you inject is telling your body to release the stored glucose and send it into the system. That's what raises the blood sugar.

Scott Benner 36:23
Gotcha. It seems like such a simple thing. But as we were talking, we're a half an hour into this. And I'm like, maybe I don't understand what's in the vial.

Jennifer Smith, CDE 36:32
Unless somebody else knows something else. I've all the years it is glucagon in the it's in that little vial. And it's not as very stable compound at all. I mean, that's why it's in that

Scott Benner 36:43
like the way it is

Jennifer Smith, CDE 36:44
pill form shift the way it is. That's why it expires so frequently. It's why you have to mix it and use it. I mentioned briefly before even using mini glucagon, a small portion of what you mix up, if you are, you know, alone, and you can use it yourself. That vial that you mix up, then it's only good for 24 hours. Yeah, kept in the refrigerator. So

Scott Benner 37:09
and so you're talking right now about the one that comes in the red box, the one that's made by Lilly. So I guess let's break them down a little bit because now there's suddenly on the market more glucagon it forever and ever it was the you got the red box, right. And so inside of that red box really is a vial like a glass smile. And it's got powder inside of it. Then there's a, a needle with and it's an inter muscular needle, it's not an under this, it's not under the skin, like little insolently looks like a all the way all the way in.

Jennifer Smith, CDE 37:40
And it's a pretty good sized needle. It's a hunk of

Scott Benner 37:42
a needle is what it is. And so you pull out the vial with the powder in it. You take the needle, and you inject the liquid, it's in the needle into the vial, then you kind of spin it together, you know, between your two hands. I know you can't see what I'm doing. But anyway, that Yeah, then it, it constitutes it, it mixes the powder with a liquid, then you have to draw it back into this syringe. And then you're supposed to stick that syringe like into the muscle in your butt, right? Or something like that. Or they

Jennifer Smith, CDE 38:08
usually say right into the body. Yeah, I mean, yeah, that's the easiest way checking

Scott Benner 38:13
that glucagon into the muscle. All right. Now that's one glucagon but since that's happened, another company made a nasal glucagon who made that? Do you remember?

Jennifer Smith, CDE 38:24
Um, gosh, I don't remember the name of the company. It's back semi is the name though of the okay. Nice. Oh, God.

Scott Benner 38:31
No, that's sort of like, you know, everyone, I think assumed it was like an aerosol, but it's more powdery. Right? Have you talked to anybody that's used it yet?

Jennifer Smith, CDE 38:41
I've not talked to anybody who used it. I have it myself. I did get a prescription for it. And part of the reason quite honestly, that I got a prescription for it is well, twofold. It's it's certainly much easier to use from all of the research and all the studies. The there's a significant decrease in accuracy of use, okay, or a significant increase in the accuracy of use with the back semi compared to the mixed injectable.

Scott Benner 39:11
Okay. Let me let me take it personally, I'm looking at it so it's actually also made by Lily. Oh, and it's so it looks like it comes in a thing that looks like you know, sailing you'd see it the tube, alien thing you'd spray in your nose, but I'm reading it here it is a powder, dry powder spray in a portable single use ready to use device now. I've only heard from a couple of people who have tried it and so far the people who've tried it have said to me that it burned their nose. So the inside of their nose I don't they didn't say about how well or not well it worked but Jenny's hearing that it works more that it works better than the this

Jennifer Smith, CDE 39:51
in terms of accuracy. It was from what I know it works the same as dosing but the accuracy if somebody else has to give it to you More accurately delivered. Okay,

Scott Benner 40:02
so in a panic situation, your friend is a little more able to stick something in your nose and squeeze it than it is to everything I just described and then stick it in your butt.

Jennifer Smith, CDE 40:12
Correct. Okay, correct. I mean, I guarantee you that, you know, when Arden was two and a half, if you had had something like this, taking it out of the bottle, sticking your nose and pushing it in, you would have had no trouble doing that, you would have been able to figure it out. And I, you know, a big part of having it in the house is because with little kids, you know, I, my seven year old is a smart kid. And while he would know to call 911, he would know to go to the neighbors if I was a home loan with them, and I wasn't right. This is something that I easily showed him in two minutes. And I was like, this is all you got to do and then run to the neighbors. That's that's all you gotta do.

Scott Benner 40:55
You know, you're gonna sleep soundly one day and wake up with a burning, burning in your nose and their front door wide open. Gonna be like mommy's down, and you'll be like, Nah, he's just sleeping. So now there's a third one on the market. And I just left Arden's appointment the other day, and I got our glucagon change to G Volk. So, g Volk, comes in a syringe still, but it is the I think the kind of the genius of what this company figured out is, is that it's, it's pre constituted, you don't have to mix. It's not a powder and illiquid. And it's incredibly stable. So my assumption, I'm making an assumption that you might, you know, maybe people who used to think, oh, one day, we're gonna make a closed loop system with glucagon in it, but we couldn't, because they couldn't figure out how to keep that glucagon stable long enough. I'm starting to think maybe that that might be the next step after these algorithms, you know, I mean, maybe it will be a dual chamber pump with an algorithm. And this, but I went with this one, and I will be 100% honest, why? There's two things. The nasal thing to me, seemed everything what Jenny just said, like, seems super easy to do, and all that stuff. As soon as I started hearing about the burning, I thought, okay, like, that makes sense. And I still was going to go with it. Until and again, this is being very honest, the makers of GE Vogue said, We'd like to come on the podcast and talk about the glucagon. So sometime in the future, you're gonna hear an interview with the CEO, and he's going to tell you why the company started and all this stuff. And it was super interesting and incredibly interesting life. I it's possible that when you listen to it, I mean, if you listen to this podcast enough, you might not be surprised by this, but I don't know exactly how much we're gonna talk about the glue gun, how much I'm just gonna be like, so what did you do after college? That's weird. And, you know, but but that, so I went with it. For two reasons. One, because it's stable. And you know, I don't have to it doesn't have to be metal. Yeah, the injection isn't intermuscular. It's just, it's just a normal like, little needle. And I thought, maybe I can use it for bumping, like doing glucagon. Like little bumps, too. And then and that wouldn't be possible with the nasal. Right.

Jennifer Smith, CDE 43:19
And there is I mean, there is a guide, certainly for using you're talking about like that mini dosing, kind of of glucagon. And there is a guide for it. In fact, it's, it's actually a guide that starts with, you know, a tiny, tiny amount for little people.

Scott Benner 43:34
And you talked about it on the pro tip about celiac illness. We talked about that, right? Yep. Yep. You people can check that out if they want to hear that, but and so incredibly, ironically, I guess, not long after you and I recorded the the illness pro tips, Episode ardyn got sick for a number of days. And unlike most people who are like, Oh, I got sick and my blood sugar went up, Arden gets second or blood sugar goes down. So there was this one time her blood sugar was you know, it was at 70. And I'm like, it's gonna hold it's gonna hold eat something. And then the food didn't do anything to her. And it kept drifting down. And I gave her more and more. And then there was this moment, you know, we're like, 45 minutes into this since she's now 55. And I'm like, Jesus, none of this food is touching her. And so I'm thinking to myself, what's next? Like, I have to do something right now. I walked up to her with a juice box. She goes like this. puts her hand up and she goes, if it's my time, it's my time. But I'm not drinking another juice. Girl super serious and trying to be funny at the same time. I said, Right on, okay, I hear what you're saying. She's like, seriously, if I drink another juice, I'm gonna throw up and I was like, gotcha. So I went downstairs. This is probably the first of all this is completely off label. But it's also why at the beginning of the episode, I tell you, this isn't I'm just telling you what I did. It's not medical advice. And I took my Old no red kid warm Lily and I mixed it up. I went back and listen to what you and I said to each other. This is me like, I'm like, I wonder what I'll do. You know, there's a podcast episode about this Hold on. Then but and I remembered and I drew up like I kind of spit balled it a little bit. It was off based off of weight, I remember that I drew up seven units. And I gave it to her. And it took a little while, but no lie, her blood sugar went back up, not too far. And it leveled out. It stayed there. And I was like, right on, I am definitely getting the gfo instead of the nasal stuff, because this might happen again. Now, that was my reasoning for going that way.

Jennifer Smith, CDE 45:39
The big question about the Evoque would really be the pen itself, how? How, how much is in the pan? Like how many? You know, what's the dosing because when you look at how much to give, it's, I think it's if you're over 50, in the doses, 15 units of mixed up glucagon. And that would be given kind of like we talked about before, and the other, the other episode, a certain amount of time. And then if it doesn't bring the blood sugar above 80, then you re dose with the double the amount. So just with the G Volk, my question would really be how, how much do you know that you're giving

right as a mini dose? Because

Scott Benner 46:20
I used to find out because you're 100%? Right. And and so I'm going to try it? I'm going to find out. And if it's not right, I'll switch to something else. I you know, yeah.

Jennifer Smith, CDE 46:28
Yeah, I pre mix that you don't have to do any of that extra stuff. That's really awesome.

Scott Benner 46:34
I think that as a replacement for the Lilly one, this one's a no brainer, right? Because you don't have to mix it up. And it's not this giant needle. But I think and this is not something the company said to me, my but my assumption is, the real excitement here is about the possibilities for dual chamber pumping, tested stable. And not only that, I think the bigger excitement and I think the CEO alludes to this, if I'm not mistaken, I'd have to go back and listen. But my assumption is, they figured out the science of making something liquid stable, which now means that science could get applied to other things. Sure. I'm guessing I'm guessing this is the very infancy of this company is what I'm thinking and run by nice people. So that's cool. Oh, okay. So we went over the three different kinds of glucagon. What and the when? Right, you're going to use glucagon when somebody can't physically take something in their mouth anymore? Right, right. When Arden had a seizure, we only use the gel and rub it into her cheeks. We were trying to get her to swallow it. If you try to get somebody having a seizure to smell something, you get them to aspirate. It's bad. Right? Right. Right. Right.

Jennifer Smith, CDE 47:49
They may be even a you know, something for, as we know, symptoms of low blood sugar, even if you're not passed out or having a seizure, you could be not together with it, right? I mean, many people complain about their spouse, significant other child child getting very violent, or very abusive, or whatnot. I mean, getting them to eat something is impossible, maybe impossible. So using glucagon, in a scenario, like that may be your only option.

Scott Benner 48:19
Yeah, you might be tackling a,

Jennifer Smith, CDE 48:21
you may be tackling that and holding them down.

Scott Benner 48:25
I'll tackle them that hand me the needle, it's gonna be a lot of fun.

Jennifer Smith, CDE 48:28
Right? Right. So

Scott Benner 48:30
well, that really is, you know, I've heard the stories too. And there's been people who've come on here and told them, but I've heard them privately two of the worst scenario ends up being when you're two adults, and one of us physically smaller than the other one. And the larger person, you know, becomes combative or angry. And I've heard I've heard about people throwing furniture and, you know, saying terrible things. And, you know, yeah, and everything in between. So

Jennifer Smith, CDE 48:58
and from a safety standpoint, you know, if the person is up and moving and in, let's call it like a violent sort of behavior, and you're not safe, just call 911. I mean, that's really, I mean, don't try to get close to them with a needle in China

Scott Benner 49:16
is not a good idea. It's such a bad television show, like you're just standing across from each other one guy's ranting and raving and holding a lamp and you've got a needle in your hand. Every bad movie I've ever seen in your life. Exactly. I think the goal would be not to get that low if you absolutely can. But like we said, these are emergencies. They don't happen on purpose. I think it's just very important to remember, like, you can't plan for an emergency. I mean, you can plan for what to do when it gets here, but you can't plan for when it's going to happen. Right? Right. So let's talk about since we're in this vein right now, and we're using a part time and we have a couple more minutes. Let's talk first about low symptoms. Some of the things you've heard people saying I will start with the one that Arden tells me What is happening? Why or why am I being treated buddy wants to reach you? Oh, you know what actually this is funny. It's um, Express Scripts I have to say okay to prescription glucagon prescription. I'll call them too funny to call them back in a little bit. But I know that's what that is. Now my wife has picked it up downstairs and she's busy listening to a recording. And she's trying to figure out why she's listening to a problem. So are we the other day? She She got a little low, right? And we were going right into our restaurant. So she went like quickly from like, 75 to 60. And I was like, hey, you're dropping, and she's like, Yeah, I know. And I was like, How do you know? And she said, My lips are numb. Mm hmm. And I was like, really? She goes, Yeah, she's like, that's the one that I like, that's my physical tell. She's like, my lips get numb. And she goes, and if you don't take care of it, she's like, I didn't realize before. So she told me a story. She said one time she was out with my wife. And this happened. And my wife gave her a drink to have. And she drank it and orange like, Oh, this tastes terrible. And my wife's like, really? And my wife tried it and said, Kelly's like, no, it seems fine. And Arden kept drinking a little while later, I think we were at a baseball game for my son and I was on the other side of the field. So I came back over eventually. And my wife said, Hey, Arden was low earlier, but we took care of it. She drank this. She said it tasted weird. And so I tasted it. I was like, I'm zone tastes fine, you know. And so it took Arden she said, it took her years to figure out that when that numbness comes, it's affecting, like her tongue in her mouth, too. She feels it on her lips. But she's like everything. Everything tastes weird. At that moment, I was like, Oh, no kidding. So I was wondering if that happened, anybody but what are some of the of like, what happens to you?

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

Scott Benner 52:44
hello, now is there for you ate, like, after you brought your blood sugar back did it last?

Jennifer Smith, CDE 52:50
Ah, gosh, I mean, I would say it probably lasted a bit of time after my blood sugar was actually normal. Because I specifically remember it. Like in college, I was still on injection. And so I would often have that as I came into lunch, because they had pretty full mornings of like zooming around on campus and getting back and forth, the classes and whatnot. And so I would often have that at lunchtime. And I can say that, before I headed out into my next course of classes in the afternoon, I still had that feeling even though my blood sugar was already back off from having eaten. So I guess for a bit of time, it seemed to last. Whereas my symptoms now don't last after I've treated, they don't last long, unless it is, unless it's been a significant drop. That's happened very, very quickly. And it takes a while for the carbs to kind of start to make me feel better. My symptoms now are much more like this, like, feeling of everything rapidly moving. Like I feel like the world is spinning and moving. And my thoughts are fast. But I I feel like I'm walking through mud. I feel like I just I can't keep up with the way that my brain is thinking about things.

Scott Benner 54:24
So I wonder if we'll never know, obviously, but I wonder if your thoughts are at regular speed and your body is slowed down? Or if your thoughts are sped up and your body's that regular. I'm so interested in that. There's no way to know but because it's right, like you're one part of you is being fooled about something about something and it feels like it's like you feel like that might be what it is. Maybe it's like that maybe you feel like you're in slow motion. I don't know. Isn't it weird? It feels like if it makes me feel like you're in like a dream right? And you're like, kind of screaming like, you know what's going on, but you can't affect anything. Is it that kind of a feeling or no? Am I wrong?

Jennifer Smith, CDE 55:07
It's somewhat Yeah, the other one is kind of feeling like drunk. Like I get kind of tipsy. And I'm like, I've literally been like drunk maybe three times in my whole entire life feels like and but that's not every time but some of my lows feel. And I'm a I'm a very happy like, drunk person. Like, whenever Everything is fine and happy, I'm not an angry drunk. Ah. So I get kind of tip with a low blood sugar sort of like, Ah ha ha, that's funny when it really isn't funny at all.

Scott Benner 55:47
It's like I'm describing with Arden to like, because she's done that a couple of times. Like, you know, I'll be like, Arden get up you have to do some your blood sugar's low. And she'd be like, I'm just gonna die over here, like, but that's very jovial when she says it, like she's very like jokey about it. Like it's cold and

Unknown Speaker 56:02
funny and totally fine.

Scott Benner 56:04
Just be fine. But you know, yeah, I think it's interesting. So when people have you heard from other people like some of this stuff, because they are, before we go into that, let me ask you this one. When you wake up after you've been low for a while, and you didn't know, why are you so sweaty? Do you know? Why did they did well, though,

Jennifer Smith, CDE 56:23
it's an it's a body response to the low blood sugar. All of the physiologic like mechanisms that make it happen. I can't, too, but I do know, it's very, very common to wake up in a sweat.

Scott Benner 56:38
Yeah, like mad, like, change your clothes after you treat blood sugar, like, yep, take the sheets and wave them around for a while. Yeah.

Jennifer Smith, CDE 56:48
That's exactly right. Even kids. You know, I've heard some parents that comment to that, you know, an older child, obviously, wouldn't be wetting the bed anymore. With a low blood sugar may have mainly because they've not got the conscious, I guess, ability during that time period for their brain to wake them up to actually get up and go to the bathroom. Because they're low, you know, so But I mean, outright symptoms, you know, even blurred vision can be one of those sort of like a tipsy feeling on your feet. The shakiness in the hands, people talking kind of like, kind of like off the rocker sort of like, yeah,

Scott Benner 57:29
they don't make sense. Yeah, we're confused. Yep. And it, I guess it it's funny to like I, I've read, you know, back in the day, like all kinds of blog posts from people where they talk about being low, and everyone describes it like slightly differently, but I think it's situational, too. It's really interesting. There's somebody I keep thinking of having on just to describe below one time because this person's love was, like an amazing story to see if I can figure that out someday. Okay, treating things. Like let's so let's talk about it for like to finish up real quick. My blood sugar's falling, but I don't want to get high again. I'm ahead of it now. Like, you know, I know people know Arden's a juice box person, if you know if, if she's looking for a quick hit, if she's not hungry, juice boxes work for us, we use this very specific juice box. I think it's important to remember that you're not looking to drink so I found the smallest box I can with the most carbs in it, so that she's not having to like I I started helping Arden's friend the other day. Yeah, and you're gonna and she's doing great by the way. Oh, yeah. And but you know, if the first time was like, hey, I need you to drink some juice. She pulled out this juice box and it was huge. And I'm like yeah, you that's here. I sent her a link I was like get these like you're killing yourself you drinking eight ounces of juice to get 15 carbs. Yeah, I only want you to know the juice is medicine. It's not for fun like you don't even so juice boxes work I've talked to people who use jelly beans glucose tablets Skittles like so you're you're looking for something that's a real simple sugar that's getting absorbed in your mouth and then hitting your body quickly when you swallow it like that's it so what sometimes people say milk but I don't think milk is fast right?

Jennifer Smith, CDE 59:16
So that's Yeah, I mean ages ago that was one of the treatment things even on my list when I was little for low blood sugars it was milk right well when you consider like whole milk one there's fat there there's protein there and the body actually have to has to break down the milk sugar in order to get the glucose part out of it. Which is what actually brings your blood sugar up so I I don't ever recommend milk. I really don't I wouldn't. I don't think it's a I don't think it's a good low I mean obviously if you don't have anything else around have added drink your milk, but there are much better simple sugar things to carry along with you. Even dried fruit. And you know when I was little, my mom actually used to give me a little mini mini boxes of raisins. Okay. And then I had, at the end of the school year had these like, dead raisins sitting all over the bottom of my backpack that had to be like, they were disgusting. They were like, you know, full of dirt. And they were gross. But that was what worked. I mean, raisins were easy. They they worked well. They got the glucose tablets when I was little were horrid. They were horrid. I mean, if you think they're bad now, they were like, bad, bad years ago. I mean, now, the only ones and I don't even I don't I don't know if they're on backorder still, but the gluco lift brand is the only one that I love. They taste good. They don't come from a GMO glucose source. All the colors and the flavors come from natural fruit and fruit extract. So they're not artificial. You know, nail Lake number 70, or whatever it is. So but something simple. I like your juice box though. I actually have kind of the opposite. I look for the smallest juice box that has the least amount of carbon it because

Scott Benner 1:01:07
when I drink I

Jennifer Smith, CDE 1:01:09
either have I'm either I'm like half awake. If I ever do you have to treat a low overnight, which thankfully, I haven't had to do in a really long time. But I don't want at two o'clock in the morning to have to be completely fully conscious.

Scott Benner 1:01:21
I say to yourself, I really need this juice box,

Jennifer Smith, CDE 1:01:24
right? I mean,

and so the juice boxes I get are actually there. They're four ounces, and they're only eight grams of carbs apiece. Okay. Yeah. So you know, they work Nice,

Scott Benner 1:01:35
nice. I know, Arden also carries those little pouches or fruit snacks with her. And they always have like eight or nine fruit snacks in them, and it will sometimes texture and be like eat for two for snacks. So the other morning, we were heading to school and she was here, throw this out for me. And she gives me a package of open fruit snacks. I still have four in them, but they're hard as a rock, you know? And she's like, they're hard. And I was like, Okay, I'll get rid of them for you. And but yeah, she always has one of those. So in her bag, she has a juice, a small juice box and a small pack of fruit snacks. And she always has that weather. And yeah, and then there's juice boxes sort of spread around the school. So Martin's in high school, so she changes obviously, you know, Ross's Yeah, so there's, you know, in a closet somewhere, there's a couple of juices in each class. And then wherever she is, and she has to take one out and drink it from reverse. If she does, she just hits the closet and replenishes her purse. Yep, you know, I have to say that we don't you know, the beginning of the school year, it's not as it's not as intense when you're older. And you've done it for a while, we just take two bricks of juice boxes and spread them around like, you know, right rose petals at a at a wedding. We're just like, there are some here are some here, throw some there. And you're done. And then maybe once a year are they'll be like, hey, I need more juice boxes. So she might go through. I don't know, she might go through 1020 of them a year at school. But that's pretty much it.

Jennifer Smith, CDE 1:02:56
Yeah, pretty new. That's pretty minimal. That's actually pretty good. You know, when you when you get to be an adult with diabetes and have kids in your house,

you actually have to be

kind of good at hiding thing,

Scott Benner 1:03:09
or disappears.

Jennifer Smith, CDE 1:03:10
Or it or it disappears, like literally, I mean even I mean even my husband don't drink them or eat them. And he I mean, you know, he'll tell me if they're obviously not there anymore. But I mean, my kids if I have my glucose tablets out, they'd love them. So I hide them and so it's like it becomes really important like purses, by purses, I have like these internal like hidden packs, pockets and many of my purses because when they see an open purse on the table or the floor, they're like, oh, does mommy have any of her stuff in here? Like mommy stuff is for really important reason.

Scott Benner 1:03:44
reminded me that during during a family vacation once there was an argument, because we were we were in a moment where it was summertime. And we need help by the way we now because of Disney new hell like magical popsicles were right they give you a little bump, but they didn't make you go too high or anything like that. And for our net lease, and so we bought these box of popsicles like you know, you get to a shore house you go out and go shopping. And someone said Oh, I'm gonna have a popsicle and cozy Hey, you know, I just needed not to touch those. We've got them in case Arden gets slow, which prior to all the technology was going to happen like you were going to use those popsicles. And one of the parents said that's not fair to the other kids. And I remember Kelly going will tell them to get diabetes and then they can have all the popsicles they want to know but like for right now just don't touch the popsicles. But it actually caused it was like a like you know, that's that's not fair. Our Kelly's like, are we talking about fair because my kids are measuring fair. I think I win. Anyway, right. Do you feel like we did a good job here if you needed to? All right, cool. So I will so let me say goodbye let you get back to your business and Jenny's businesses she does this for a living at integrated diabetes.com this is not an ad. This is just me telling you that Jenny is the bomb diggity. Check her out at integrated diabetes.com there's also a link to her email address right there in the show notes look in your player right there. Thank you so much to Dexcom for sponsoring this episode. Don't forget to take a look at the Dexcom g six continuous glucose monitor today by going to dexcom.com Ford slash juice box or clicking on the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And of course, you need to run out and get yourself a Contour Next One blood glucose meter Contour Next one.com

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