#588 Diabetes Variables: Final Episode (Sorta)

December 3, 2021Scott Benner

#588 Diabetes Variables: Final Episode (Sorta)

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 friends, and welcome to episode 588 of the Juicebox Podcast. I thought this was going to be the last variables episode. I had a lot of examples sent in by listeners left, but some of them weren't feeling like, like they needed their own episode or were really variables. So Jenny and I were going through them. And then it occurred to me how to finish up the list. is gluten one or no?

Jennifer Smith, CDE 0:30
No, I would not consider that a variable because quite honestly, gluten if you did group it with anything, it would be grouped with inflammation and it would be then grouped with like digestive stuff in terms of inflammation, and once it's gone, it's not a variable anymore.

Scott Benner 0:46
Yeah. Now I'm looking like we did a really good job of getting through these headaches, wet weather and esteem. Some people are just like, it rains in my blood sugar gets funny. Oh, I get low. It says wet weather causes highs and sunny weather causes lows. Wet weather makes you sit around. Right? And sunny weather makes you get up and move around. Is that right? Gotta be yet right.

Jennifer Smith, CDE 1:15
I would expect that that's what it is. Honestly, yes, we'll

Scott Benner 1:19
drop that into something at some point. Ooh, constipation. That doesn't strike you that way.

Jennifer Smith, CDE 1:27
I you know, I mean, the question really becomes with constipation, how much is that leading into pain or stress because you haven't gone to the bathroom? Or is it really in terms of things aren't digesting as well? So we have slow digestion I mean, that's like a bunch of things that constipation could be causing that are then the impact on blood sugar a constant Yeah. It's in and of itself is not a very

Scott Benner 2:07
Arden was little before we knew she was on the she a thyroid medication. Her blood sugar's would be more and more difficult. And then she'd go to the bathroom all at once, and it was level right out again. But it was just, you know, I don't you can't I can see how people might see it and then think it but

Jennifer Smith, CDE 2:25
right. I mean, I can see it in terms of pregnancy. Women's digestion slows in pregnancy. And if they are having significant issues with constipation, again, the question is, is there enough backed up slow digestion that is continuing to impact things enough, from an absorption standpoint that you're missing? Covering stuff that should have been eliminated a while ago? You know, or is it that there's pain because of it or, you know,

Scott Benner 2:57
I have to tell you, we have a half an hour here and our little chatting just now made me realize how to handle the rest of this list, okay.

On today's episode, Jenny Smith and I will go over the rest of your diabetes variables list. We first talked about variables in Episode 231 In a protip called diabetes proto variables. And then wow, two years later, I started the variables series. It began with trampolines went to temperature travel, exercise, hydration, food quality, leaky sites, video games, stress masturbation school, bad sites, growth hormone, sleep pump, site placement, full moon diabetes, tack weight change Walmart today is and the rest I'm not sure what the call it yet. And then by the way, there's going to be two more after this, but you'll hear about that later. While I'm talking to Jenny Smith, who by the way, has had type one diabetes for over 30 years. My friend Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most make some models of insulin pumps and continuous glucose monitors. She is also simply the best, the bestest. You want to hire Jenny. She works at Integrated diabetes. This show is sponsored today by the glucagon that my daughter carries, G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. And as season seven winds down and the end of the year approaches. I'd like to mention all of the sponsors this year we were sponsored by Dexcom they make the Dexcom G six continuous glucose monitor by Omni pod makers of the Omni pod dash tubeless insulin pump touched by type one my favorite diabetes organization, the Contour Next One blood glucose meter, G voc hypo pen that's glucagon. And towards the end of the year TrialNet did a little sample ad with us for about seven weeks. Hopefully they're happy and maybe they'll come back in 2022. I did just add another advertiser for 2022. I'm not allowed to say who it is yet, I don't think. But it's somebody who's been around before. And I'm glad they're back, we'll say that. On top of the advertisers, there's the T one D exchange, who, while they are not an advertiser, every time you hear me talk about them, they don't pay me to talk about them. But they do give me a couple of dollars. Every time you take their survey AT T one D exchange.org. Forward slash juicebox. I've thanked everybody this year, over and over again. Who has bought me a cup of coffee at buy me a coffee.com Ford slash Juicebox Podcast. What else? Have you heard me talking about these bumpers and ads? No, I tell you to go to the private Facebook group for the podcast right Juicebox Podcast type one diabetes that now has like 17,000 or more members in it. So bustling type one diabetes page full of really good people. It's very unlike Facebook, but happens to be on Facebook. I tell you about Juicebox Podcast calm, the diabetes pro tips, the defining diabetes series, the variable series how we eat algorithm pumping, after dark, you guys are just over and over again. Terrific. So much so that November, I'll tell you that today's the 29th when I'm recording this November just became the most popular month in the history of the podcast. As a matter of fact, every month since May of 2021, has been the most popular month of the podcast, this podcast will do over 2 million downloads just in 2021. And it's all because of you guys. It's how you share the show and talk about it. It's when you put great ratings for it wherever you listen,

it's word of mouth, there's nothing else to it, if you enjoy the show, tell somebody else it helps the show to grow. When the show grows, more people hear it. When more people hear it, we have a greater chance of somebody needing one of the advertisers. When that happens, and you click on one of my links, the advertisers come back. And I get to keep making the podcast. And then you get to keep listening to it. It's a circle of life kind of thing. So thank you very much to everybody listening to everybody who's ever shared or told their doctor or a friend or to the lady this year who told me she bumped into somebody at a Costco wearing a Juicebox Podcast t shirt. Like my favorite story of 2021. Two people who listened to this podcast met strangers, right out in public. That's pretty cool. Anyway, I appreciate you guys so much. And I appreciate the sponsors. It's a terrific lineup of quality products, organizations and services for people with diabetes. I'm super proud of it. I really am. I've never once ever thought, Oh, I can't say this ad. You know, I'm lucky to have advertisers like this. And I'm lucky to have you guys listening to the show. So that's it. Here's Jenny and my conversation about the end of the variables list where we basically just go over a bunch of variables. We've gotten to the point on the list of variables that were sent in by listeners where there are multiple ideas that sort of they fit together. You know, they're the, you know, somebody says emotions, but then somebody says getting angry and stewing and being angry, Jenny and I can't do a variable for each and every one of them. So what were tantrums? Yes, right. That's right. So instead, what we're gonna do is run through what's left on the list, and just hit each thing very quickly will tell you if we think it's a variable or not, but probably doesn't deserve its own episode or need need its own episode. And then that'll be it. We'll move on, we're gonna start adding more stuff back to the Pro Tip series after that. So, alright, Jamie, here's what we haven't done yet on the list. And to be clear, the list is 150 things long. We've already done the things that are clear variables that, you know, translate to a lot of people, right. We can't do the, you know, the one thing that somebody is like, you know, pointing to for themselves specifically, we're not going to start doing personal variables. But here's some stuff that we didn't get to, but probably mentioned in other episodes, so showers and baths we talked about in the temperature episode for sure. Right? Yeah. So if you want that head back to their illness we did talk about and obviously being sick blood sugars, was one week could have probably made its own episode, but then you would have seen how it leaned into other ones is somebody just said Life, they're trying to be funny, I get it, right. Life is all variables, high blood sugar moves around because things happen. But that's what the whole variables episodes are about is that there are these little things that happen in your life that you don't, you don't think of as being impactful. And I think what happens sometimes, and Jenny and I were just talking about it kind of privately a second ago, is that we don't see the forest for the trees, sometimes, you know, Walmart makes me low, not usually I sit around and my, my blood sugars are at one level, and I have an insulin use at one level, and then suddenly I get up and running around, I'm grabbing things in the store. And then my blood sugar goes down, Walmart doesn't make yellow activity. When you have a bunch of active insulin, make sure though, but that's the life thing. Right? Like, there are things that happen. I think, I think that the thing to remember here is that you have your settings put together in a way that works best, during the largest swath of your 24 hour period, as you have, you've been able to figure out during your

Jennifer Smith, CDE 11:13
typical, yeah, honestly, your typical day, you have, which is the reason that we do testing on more typical days are not going to tell you do testing of settings and stuff when you're sitting at Disney World. That wouldn't be purposeful, right? So the purpose of discussing variables is to understand that in a day, variables could become part of your day. And this is how to expect your blood sugar to maybe react with this variable in the picture. But it doesn't know it's not always going to be there, you know, maybe 80% of your days of the week, you cost along just fine. Until you know, Aunt Mary comes to visit on Friday, and you didn't expect

Scott Benner 11:58
you decide to cook a big meal and it gets hot in the house. And right like there, I get it. Like you don't want to be thinking about diabetes constantly. But those things are impactful. And if you're, you know, if you're a person, for example, who's fairly sedentary and you're using a heavier Basal profile to combat that, you might not even know that's what you're doing. Right? You know, and then all of a sudden, you're running around putting a lasagna together, it's 80 degrees, you're sweating, you know? Sorry, yeah, it's impactful. You know, it just going down the list. Somebody sent in insulin efficacy, like expired insulin or insulin, let's hit like, extreme temperatures. And yeah, I mean, okay, that's a variable. But I mean, how often is that going to happen? You don't I mean, like,

Jennifer Smith, CDE 12:47
right, on a day to day basis? No, right. But on a, again, a setting where you are out of your normal environment. Let's say you're carrying your insulin around, or you're hiking through the desert with insulin in your pump, or in your backpack and a pen, or whatever it is, that is a variable that now becomes something to consider. If, in fact, you start to see blood sugars that are not the typical for you,

Scott Benner 13:14
right? But if you opened up your vial of insulin seven days ago, it's been working great. And suddenly, it's not working anymore, but it's been in the refrigerator the whole time. That's a weird place for your brain to go. But it happens, correct? Because it does, why does it happen to them? Because they can't imagine bigger picture what could be going on? So they start going through the real obvious of oh, maybe this since it's not working? It's the same thing as when we just did a diabetes technology episode where people are like, this pump doesn't work. But sometimes it's you don't know how to use it. Right? Yeah, you know what I mean? And yes, you don't see the forest for the trees again. And I think that right, not that your insulin can't go bad, like Jenny's saying if it's out in the heat, or if it's if it's way past, you know, a date, but it didn't just magically stop working. So write fairly

Jennifer Smith, CDE 14:01
well, one I would definitely add to that, though, is consider the mode of transit that the insulin got to your house as well. Okay, especially in different temperatures or different areas of the world, right? Because if you like I go to my pharmacy to pick up my insulin, I pick it up, I bring it home, it goes right in the refrigerator, there's no delay, right. Many people get their insulin supplies shipped we do. Right. So depending on time of the year, I always recommend people check you know, was the ice pack or the dry ice or whatever it typically arrives with? Was that in there Was it cold when it arrived? Did you put it right in the refrigerator? All of those things would be considerations in terms of Yeah,

Scott Benner 14:46
perfect. We there's somebody put on here gluten, if sensitive or celiac or other food intolerances. And you said when we went over it privately, you didn't really think it was its own variable, but If it was, it might be bundled together more with another one that's on here, which is inflammation. So, yes, yeah. So people who are gluten sensitive who are not eating a gluten free diet do have inflammation in their stomach lining, and I'm not a doctor, but down there towards the middle of your Yes, yeah. And that inflammation can make you seem what insulin resistant,

Jennifer Smith, CDE 15:25
more resistant, typically, because inflammation is like a stress in the body again, you know, we're talking and I said, kind of goes along with a lot of the inflammatory not only the digestive, but also things like lupus, and rheumatoid arthritis, and fibromyalgia. And all of those types of things are an inflammatory type of condition. And so uncontrolled or mismanaged, they will usually create a sort of a system of stress in the body, which will usually keep your blood sugar's running higher until they are better managed, which kind of goes along with the the gluten component, right? If you're on a gluten free diet already, you shouldn't have that inflammatory nature in your digestive system, you it should be calm, you should be digesting food the right way. If in the case that you went to a restaurant, you've been following a gluten free diet, and you do get gluten containing bread, let's say even though you ordered the gluten free bond, for example, could you have potential change in blood sugar because your body is so sensitive that you notice a difference? Digestive Lee right away and you don't feel good? Right? All of those would come along with kind of some of the things around like a stomach bug, possibly in terms of adjustment and what to plan for and how to adjust.

Scott Benner 16:50
If I say if I say one of these that you think is its own episode, just stop me and go. That's actually okay. Okay, so the next one, I don't think so. Specifically, somebody said, and this is very timely vaccines. So does a vaccine impact your blood sugar? Or does the fact that the vaccine makes your body, you know, introduces something into your body that your body has to fight off and create a resistance to is that process?

Jennifer Smith, CDE 17:16
It's that process, it's really not, I mean, overall, it's not the I got a shot, my blood sugar went up, that the case at all, it's actually the content of it, that creates a system of your body reacting to it, and some people's bodies react fine. With no issues, no symptoms, they go along fine. Some people have the typical like sore arm kind of thing, you know, those kinds of injections like intramuscular, whatnot. And sometimes just that sore arm kind of feeling could be enough, again, inflammation in that site to create a little bit of a bump in blood sugar. I would say that the only thing that would coincide with actually getting a shot in terms of like a vaccination, but they're they're pretty big needles for the most part. So if you could have a quick rise in blood sugar in that like setting, because you're scared here.

Scott Benner 18:11
Yeah, that stuff. But But again, to use the Walmart reference, again, the vaccine, just the sheer, I touched the vaccine to my body, my blood sugar went up. There's a mechanism in there. It's not just that you got a vaccine, it's the rest that happens afterwards. Yes. Is alcohol its own Do you think?

Jennifer Smith, CDE 18:32
I would think so. Yeah, I think that's a good discussion.

Scott Benner 18:35
All right. So I'm gonna mark that as its own episode. Medications in general, people just put medications. So I mean, there are some sugar fillers in some medications, right. Like, there are

Jennifer Smith, CDE 18:53
kids, especially kids, like, you know, antibiotics are often a liquid of some kind that is flavored sweetened to some degree to get the child to take it. So those could certainly and usually do have some type of carbohydrate in them or sugar in them. Other people, though, in terms of medications, could have reaction. And that's where it's really important. Anytime you start on a new medication, ask your doctor if they've checked. So they can tell you whether or not you start paying attention to your blood sugar. Because some medications that you will take long term could definitely have an impact on blood sugar, either making you more sensitive or making you you know, more resistant or whatever it is, while the med is doing what it needs to do for what it was taken for. It may have an indirect you know, sort of impact on your blood sugar.

Scott Benner 19:46
Alright, I have a thought but I'm going to add it to something else. So pain we're in the same situation. We talked about that already adrenaline, like you know, reactions to, to pain. I don't. I don't think that needs its own. I mean I don't think so. For second episode was a pain Yeah, if you're on paying your budget or Miko up we'll see you later. Right? Is menopause its own

Jennifer Smith, CDE 20:12
I would say menopause could be its own definitely.

Scott Benner 20:15
I thought so too interesting. Waking up in the morning Okay, guys, we have great episodes on that. So we have what did we do? We did feet on the floor defining diabetes we did defining diabetes, Dawn phenomenon and now we're gonna we did. How do you say it Jenny's? Oh, this smoky? Yeah, we did that. So go find those defining diabetes. If you're are you thinking waking up in the morning is its own thing? It definitely is. But we've got that covered in space covered. Yeah, yes. Lots of involve our allergies, like illness.

Jennifer Smith, CDE 20:56
Allergies, or like illness or kind of like inflammation, quite honestly, I mean, allergies create right, a reaction in the body that inflames kind of somewhere in your lungs sometime most often like nose sinus cavities. And so that could create enough of a stress on the body to cause a rise in blood sugar until you get it controlled. Now, the other variable with allergies is what type of medication again goes along with meds? What kind of medication are you taking to control the allergies? Some meds for allergies have done definite impact on blood sugar and will cause them to go up? Okay? If especially if they're steroid

Scott Benner 21:38
based. Yeah. And steroids in general, just Yes. Are gonna make your blood sugar go up and yes, and be incredibly resistant. Meaning Yes, you might. I've seen people with like two or three times their Basal rate trying to fight steroids for days and days. Yes, yeah. I actually just interviewed a boy from gosh, where was he from Ecuador, who has an illness that requires them to be on steroids all the time, and the amount of insulin he uses is spec exorbitant,

Unknown Speaker 22:09
I'm sure. Alright.

Scott Benner 22:12
So then it right. dreams, dreams or adrenaline. Like you just get really scared because your blood sugar grew up in the middle like that ever happened to you?

Jennifer Smith, CDE 22:21
I would guess I mean, I, I guess I if I've ever had bad dream, and thankfully, gosh, I don't remember really that many, like nasty, bad dreams where I wake up. I'm like, Oh, my gosh, you know. And at that point, I was probably just happy that I woke up like in my bed and like not in the weird scenario of my dream. Right. So whether I checked my blood sugar or not, I mean, it's typically just a it's it's sort of a an unconscious sort of reflex for me to be like, what's my blood sugar when I get up? Even if it's just to go to the bathroom? overnight? I always check. I would expect though, it would have adrenaline type of impact on blood sugar, if it was a scary enough or a worrisome enough situation in the dream? Yes.

Scott Benner 23:07
Okay. They're out. Cortisol is I mean, hormone hormone. So we've done that already. Singing makes my blood sugar drop.

Jennifer Smith, CDE 23:21
Oh, well, if singing is something that brings you a lot of like happiness and pleasure, then it could very well be that relax, you're relaxing, and you're really you're got those like feel good hormones kind of kicking. It could be that or if you are singing, again, context to the setting of singing, right? Because if you're singing and you're singing on stage, and you're in a theatre production, and you're moving around and changing, that could be a bit of activity as well as just the happiness of singing.

Scott Benner 23:55
Interesting. And then ironically, on the list the next one's emotions. So

Jennifer Smith, CDE 24:00
Oh, yes, I mean, emotions, definitely. I mean, emotions could be adrenaline based emotions, they could be happy based emotions, they these definitely kind of all go together. I would say that happy is often associated with like a drop in blood sugar, or more stability or more sensitivity, right? But I've also seen kids who are super, super excited about their birthday party, and their blood sugar rises, despite them being so happy. That adrenaline rush that they get because it's like they just were dropped off at like Disneyworld. Right?

Scott Benner 24:40
So the adrenaline overwhelms the emotion. Right? Yeah. Is caffeine its own or no,

Jennifer Smith, CDE 24:47
no, I think caffeine is an easy one caffeine. In the majority of people that I work with, and myself included Haftar years ago doing enough testing around x I was like, What is this weird strange thing after I start Drinking coffee. Most people need to Bolus for caffeine. It's it's not an unless you're not already covering like creamers or sweetened creamers or something like that. Well obviously, consider that as a first step Bolus for something that you're adding. But if you're just drinking a black cup of coffee, and you have this rise in blood sugar, nine times out of 10, more than that even is going to be the caffeine and you have to figure out usually I say, figure out how much of a rise you're getting. And then cover it with what would correct that rise.

Scott Benner 25:33
Okay. The next two we've literally talked about in the last couple of moments in a different way infections and excitement so we're good there. I will say this. If this one's an episode, I don't know because I've never understood when people talk about this daylight savings. How the heck does that change things that much it's an hour right.

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How the heck does that change things that much? It's an hour right? It is.

Jennifer Smith, CDE 26:56
And I think it's a it's a pretty quick in what I would expect in terms of explanation. Depending on what you're doing with your insulin doses, it may have some impact. Like, let's say you are the person who has different settings overnight for your Basal, right. And you don't adjust your pump accordingly. So now you could be running settings that are not jiving with the actual timeframe that they're now needed it. Okay. So in a way, could it? Yes. If you're not adjusting, so that your system can give you your right doses. Right.

Scott Benner 27:47
So then that goes right along with this one here. schedule change, same thing. Yes.

Jennifer Smith, CDE 27:52
schedule change, same thing. And in fact schedule change, especially for someone who has a very drastic schedule change from what they had been doing a nurse who had been doing day shifts, who is now working the like 11 to seven shift, right. That's a big change and a definite difference. And most likely we'd have to do some new testing around that to figure it out.

Scott Benner 28:16
Let me see if you agree with me here teething. Oh, hold on. I was almost dead right there. Just almost went down. Oh, no. Can you imagine you'd be like,

Jennifer Smith, CDE 28:29
it'd be like, 911 Yeah, I'm calling for this location, not where I live.

Scott Benner 28:34
Making a podcast with a man in New Jersey just fell right out of his chair. Please help. Teething and getting a tooth is going to be pain, inflammation, and maybe

Jennifer Smith, CDE 28:47
an irritability, more temper tantrums, probably less sleep. I mean, all a collection of variables in one.

Scott Benner 28:55
And we be looking for higher blood sugars from that correct. Okay. Moving. I mean, is Walmart, right? Like you're moving? Yes. Either excited or nervous? And probably more active than you think. So emotions, adrenaline. Yeah, hopefully this is you know, I'm actually enjoying this.

Jennifer Smith, CDE 29:15
But yeah, it's kind of fun going through them because I think people think about it in terms of words, right? People have a lot of different explanatory words for the same thing,

Scott Benner 29:26
the same thing over and over again. Yeah. And they give you an insight into their lives, injuries, breaks and concussions. I feel bad for this person. Oh, that's not good. Yeah, but but that's, uh,

Jennifer Smith, CDE 29:37
maybe they're a hockey player.

Scott Benner 29:38
I hope so. Alright, but we definitely covered that. Okay, so here's one where people I mean, we've talked about illness over and over again, it's in an illness episode. I'm going to skip that. Hormones we've done I mean, carbs and protein. You know, guys, there's tons of episodes on that we you know, if you

Unknown Speaker 30:00
go back and listen.

Scott Benner 30:03
If carbs is like the OG variable, right in diabetes, I don't think that its own episode, but I appreciate you putting it on here. This person, you know, talks about work about how they need different Basal rates on different rotations of their job, which is really just spoke about cyclical hormones in a tween who hasn't had their first period yet. So, I mean, in the lead up to your first period, you can start seeing hormonal impacts. If I was you, I would take that as a nice thing. It's like, they're like training wheels. Yes, yeah. For for learning how to do that. Yep.

Jennifer Smith, CDE 30:43
And I think we talked a lot about that in hormone based episode. Yes.

Scott Benner 30:49
Definitely did absorption injection sites we did site. We talked about sites, scheduled transitions, shared custody of families. I'll tell you what, I don't I get that that's a variable. But I still haven't found a good way to talk about that. And when we do, it won't be in a variable episode, it will be in a longer one. Because agreed there is a huge there's a huge problem. If you're managing one way and someone else is managing a drastically different way. And you're passing this person back and forth. Correct? Yeah.

Jennifer Smith, CDE 31:21
And I've worked with plenty families where it can work really well, as long as everybody's on the same page in terms of the best interest of the child. And it can work really, really poorly.

Scott Benner 31:35
Yeah. If if they were just hey, do you have enough information in your head to do a pro tip about how to do it? Well, you think? Yeah, yeah. All right. I'm gonna mark out for that one. inactivity is, you know, I think obviously, if it's not your if it's not your normal situation, right? If it's not your typical, like you said, then inactivity could make your blood sugar rise, if you're usually more active and suddenly inactive, you would probably get a rise from that. Mm hmm. This one's really interesting. But we already talked about being around different people. This person says that their steps on their blood sugar goes down when they're around their daughter, which is probably just the happiness and comfort thing, I don't believe I would think, yeah, unless their daughter is magically giving off. Insulin in the air.

Jennifer Smith, CDE 32:26
Right? Or again, I mean, it kind of does go back to like us a separate household type of management, you know, maybe the child whose blood sugars now even out when they're with you. It could be because they feel more secure, they feel more supported. They feel like somebody is actually helping them to pay attention versus the other scenario.

Scott Benner 32:47
And here's another one. The next one, my daughter is blood sugar rises, the minute we walk into the my parents house, so either your daughter's really excited to be at your parents house or doesn't like being there would be my guess, right? Correct. Okay, yes. No. Isn't that interesting that you kind of have like a little meter on you, that tells you? Oh, yeah, it's interesting. Time Zones, I think, are the same thing, as you just talked about with daylight savings time, except it happens quicker, right? Instead of happening

Jennifer Smith, CDE 33:17
in time zones are it is it's kind of the same thing as just paying attention to remembering especially if you're on some type of technology that delivers your insulin, right, some type of pump, making sure that you change the time, once you arrive at your final like, stay their destination. So that you have all of your settings that are now coinciding with the time that you're in.

Scott Benner 33:43
What do you think about times of day eating? Do you think do you think that chicken parm with little pasta takes a different amount of insulin at 3pm that it takes at 8pm than it would take at 9am? Or do you think that people's just have such varied Basal rates? Maybe. I mean, can food really hit because I don't think of food that way. I Bolus for something the way Bolus for it. I've never considered the time of day but Arden's settings are really rock solid, so I don't know.

Jennifer Smith, CDE 34:13
Right? Which means that you've tested and if she and I don't know what her settings are like, but if you have more than one insulin to carb ratio through the course of the day, her dose may be different for something like she decides at nine o'clock in the morning she's going to eat chicken parm versus at eight o'clock at night. The doses may be different but your strategy for managing that meal should remain the same in terms of that she needed a Temp Basal increase does she need an override does she need some kind of you know assisted in in something like that. But most often, people's insulin to carb ratios are what are going to drive the control around the same meal despite it being a different I just got that question the other day from a family so well you know, he's getting two and a half units of insulin for dinner for this. He eats it for breakfast Shouldn't he also always get two and a half units? Depends on what the ratio of the time of the day

Scott Benner 35:11
yeah and it's important that I'm glad you pointed that out because the reason I don't notice it is because Arden's carb ratio is the same 24 hours today it's super aggressive and it's the same

Jennifer Smith, CDE 35:23
are her ISF is different based on the system that she's on or her ISF different through the day then that may make a difference?

Scott Benner 35:29
Yeah overnight but not when well d times the same yeah day times always the same. Yeah. Lobby insulin go Yes. We'll work it out later. Let's stay ahead of this blood sugar. Eating girl lots of insulin. She and she eats a fair amount it's um she's a definitely a she's got a good appetite when she has a good appetite. We talked about this one because we found it interesting. Off off off microphone but this person says during wet weather that causes high blood sugars and sunny weather causes low lows. And the best agenda and I can come up with is

Jennifer Smith, CDE 36:13
that you're less active if it's wet and rainy and whatever outside and you're more active when it's sunny, and you're probably outside more or you know just enjoying even being out in your yard and gardening versus sitting inside.

Scott Benner 36:26
It's got to be like barometric pressure doesn't move your blood sugar, right?

Jennifer Smith, CDE 36:32
I've never looked that one up. That'd be an interesting thing to look up. I've never, I've never checked.

Scott Benner 36:37
All right. Well, if it turns out that it does, we will come back and apologize. Yeah, Anastasia, does that make your blood sugar go up or down?

Jennifer Smith, CDE 36:46
I think it's probably what I would expect is that it's more relative to how your body reacts to anesthesia. Honestly, I mean, my personal and one is that I react horribly to anesthesia. In fact, I always tell the anesthesiologist I'm like You Give me whatever cocktail has the most to stop the nausea and whatever after because after everything that I've ever had anesthesia for. I am knocked for a loop and I feel horrible and that actually drives my blood sugar up because I feel horrible.

Scott Benner 37:21
Okay, so alcohol is does that need its own?

Jennifer Smith, CDE 37:26
I think we set Yeah, I think calls definitely. We're gonna make

Scott Benner 37:29
that its own episode. One that we talked about, about people said constipation and stomach motility and Jenny's like I'm not sure about that. But I have seen that a little bit with Arden. If she hasn't gone to the bathroom in a while her blood sugar can get sticky. And then the minute the event happens, it starts to come down. Come down. Yeah, but I mean, it's got to be a pretty drastic scenario. Constipation scenario, like I just haven't gone since yesterday. You know what I mean? Like?

Jennifer Smith, CDE 37:57
Everybody should go to the bathroom every day.

Scott Benner 37:59
I was gonna say that to everybody poops and everybody should poop every day. And if you're not, yes, fine Metamucil or eat a vegetable.

Jennifer Smith, CDE 38:07
My boys love that book. It's I think, actually, it's called everybody poops. They love that. They think it's hilarious.

Scott Benner 38:12
I'll tell you what, at a certain age. I thought it was hilarious too. And that age for me was 37

Jennifer Smith, CDE 38:19
is another fun you want to say? I need a new but oh my god. We laugh and laugh when we read it. It's so funny.

Scott Benner 38:27
Glycemic Index of food is definitely a variable and we have multiple episodes on them. Please go find Yes. Hot tubbing shopping Pre-Bolus thing versus non Pre-Bolus. And these things are all self explanatory playing hockey is act in track and field violin lessons, which is probably stress or anxiety I would imagine.

Jennifer Smith, CDE 38:46
Could be I don't know I was a violin player. But I also didn't have a CGM at the point at which I was playing violin so who knows what was happening?

Scott Benner 38:55
So I'm gonna draw a line here because you're out of time but let's just end with this. Were you any good at the violin?

Jennifer Smith, CDE 39:00
I was really good at the violin I haven't played in years I just I don't really have the time or you know keep up with it. But I yeah, I played from kindergarten all the way through college.

Scott Benner 39:11
Oh, wow. Do you think you could pick it up and like knock something out with it?

Jennifer Smith, CDE 39:15
I could I actually I really right now I need a new bowl for my violin because the strings on my on my bowl are done. So but other than that I could

Scott Benner 39:25
your violin is good. You just need a bow.

Jennifer Smith, CDE 39:27
I just need a bowl. And I've looked into getting it repaired and getting a new one and I just I look at it and I'm like, Ah, I could spend that money.

Scott Benner 39:38
Just don't do it. If I leave this in someone's gonna send you a bow so the other night somebody went on my buy me a coffee link and left me so much money. I was like, stunned Oh, and with this really wonderful note and I wish this was more and it made me I was very happy that they felt that way. And I took the money and I bought hard drives to backup episodes. This sounds awesome. Yeah, but I was also it's weird. It makes me uncomfortable. So that is I know if a bow like if somebody said to me, how do I send a bow to Jenny? Okay? No, you'd be like, Oh my god, don't do that, please.

Jennifer Smith, CDE 40:16
No. I mean, I've gotten really nice thank you is, which are, I think they're, they're the most appreciated. I just, I love hearing how much this helps people, honestly. And those are, those are the best, like feedbacks kind of thing. You know,

Scott Benner 40:33
sorry. I really do. Okay, so the next time we get together, we'll do a couple of them that we've that we've set on and then we might do another run through the rest. And I thought this was good. So awesome. Cool. All right. Yay, one second. Yeah, I like it when things work.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G folk glucagon.com Ford slash juicebox. you spell that GVOKEGL. You see ag o n.com. Forward slash juicebox. That's it for this one. Thanks so much for listening. And for sharing the show. I'll be back soon with another episode of The Juicebox Podcast. If you want to wait till after the music, I'll run through the links for every one of the advertisers just in case you need them.

So on the pod is a tubeless insulin pump, my daughter's been wearing it forever. And you can find out more get started and see if you're eligible for a free 30 day supply of yummy pod dash at Omni pod.com forward slash juice box. The Dexcom G six continuous glucose monitor is a mainstay at this house dexcom.com forward slash juice box. The Contour Next One blood glucose meter is in fact the meter that my daughter uses. It is literally the favorite one that I've ever held or used. I am not kidding. Contour next one.com forward slash juice box. If you want to see people doing wonderful things for people with type one diabetes, go to touched by type one.org Or visit them on Facebook, or Instagram. And of course the GMO hypo Pan was today's sponsor, so we don't need to do that one. You can find out if you have auto antibodies that lead to type one diabetes at trial net.org forward slash juicebox. Tell them I sent you touched by type one mentioned oh and the T one D exchange. Take the survey. If you're from the United States and you have type one, or you're from the United States, or you're from me, I came to say the words. I'll try again. Or you're from the United States and you're the caregiver of someone with type one. You can take the survey probably in less time than it told me to. Then it took me to tell you all this because I see him a little gobbly goo in my mouth. He won the exchange.org forward slash juice box check out the Facebook page. There's a public page called bold with insulin, a private page Juicebox Podcast type one diabetes, I'm on Twitter and Instagram and tick tock just look for Juicebox Podcast. diabetes pro tip comm is where the diabetes pro tips and the defining diabetes stuff is. It's also at juicebox podcast.com. It's also in your podcast player. There's great lists of them in the Facebook page. I think that's pretty much it. I really appreciate you listening. I'll be back really soon. Take care