#831 Best of Juicebox: Bold With Insulin

January 24, 2023Scott Benner

Episode 11, Bold With Insulin was first published on April 14, 2015.

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

+ Click for EPISODE TRANSCRIPT

DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 831 of the Juicebox Podcast.

Welcome everyone to the best of the Juicebox Podcast. Today, we'll be highlighting episode 11 titled bold with insulin. And it originally appeared on the Juicebox Podcast on April 14 2015. I asked listeners via the private Facebook group, what their favorite episodes of the podcast were. And a number of people highlighted episode 11. Lauren said I think number 11 bold with insulin really sets the stage for the whole podcast and it's a must listen. Donna said episode 11 was the one that kicked me into gear about making decisions for my care and changing settings and amounts of insulin I needed. The episode will be presented exactly as it was originally, meaning there'll be music in it that you don't hear anymore. My microphones gonna sound different. You'll hear basil the dog snoring in the background, my chair used to Creek all kinds of fun stuff. Anyway, while you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before you make any changes to your healthcare plan or become bold with insulin. And now you know where that came from. Or at least you'll know in a minute. If you have type one diabetes, or are the caregiver of someone with type one, please take a few moments to go to T one D exchange.org Ford slash juicebox. When you get there, join the registry, complete the survey. And when you do, you will have helped type one diabetes research to move forward. It's that simple. It's completely HIPAA compliant. And it's absolutely anonymous. T one D exchange.org. Forward slash juicebox. Though this episode doesn't have a sponsor, please remember that Omni pod Dexcom Contour Next One G voc hypo pan ag one from athletic greens. The T one D exchange, US Med and touched by type one are all terrific sponsors of the Juicebox Podcast. And if you need them or you're interested in learning more, there are links to them in the show notes of the audio player you're listening in right now. And at juicebox podcast.com. Okay, we're gonna get going I listened back to this one I thought maybe I'd be embarrassed but honestly, it holds up. Before we begin a brief disclaimer, the medical information on this podcast and on Oregon state.com is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment. You can find the full version of this disclaimer by going to Oregon state.com or juicebox podcast.com scrolling to the bottom and clicking on disclaimer for those of you who have been listening to the podcast since it started, welcome back. And if you were a new listener, thank you for joining us. Let me introduce myself real quickly. My name is Scott Benner. I am the father of a little girl named Arden who has type one diabetes. Arden was diagnosed when she was two years old and is just about ready to turn 11 I write the diabetes parenting blog called Arden's Day, which you can find it on the state.com also on Facebook, Twitter, Instagram, what else? Pinterest, if it's social media, and it's Arden's day, I think it's probably me. Okay, welcome to episode 11 of the Juicebox Podcast. I appreciate you coming by. Today we are going to talk about insulin. So there's not going to be any guests on this episode. Although you may hear basil snoring in the background Basil is Arden's little eight month old puppy who she named after her Basal rate, and he is sound asleep and snoring away if you hear him. I apologize. Okay, so I want to talk about insulin because it's the main component to a lower agency and lower blood sugars in general and going to speak just from my personal experience. Again, nothing here is advice. And you certainly should talk to your doctor before trying anything that you may hear, hear, hear, hear, I hate when I say Hear hear that you may hear on the podcast. Okay. So let's go back to Arden being diagnosed. She's two years old. We're in the hospital. It's of course, incredibly stressful and frightening. And not something you were expecting certainly wasn't something we were expecting. Added Bad news, good news, bad news, good news back and forth all day long, right? Here's the bad news. Your child's just been diagnosed with an incurable autoimmune disease, their pancreas doesn't work anymore. It's no longer making insulin. But hey, here's the good news. There's man made insulin. So unlike prior to the finding of insulin, your child's not just going to die in a couple of days, you're going to be able to manage diabetes with insulin Well, yay, that's fantastic. Small pause from the doctor. Insulin, however, is very dangerous. And if you use too much of it, it could cause dizziness, seizure and even death. Well, what? Uh, okay, great. So let me get it straight, disease. incurable. pancreas doesn't make insulin, but don't worry here some insulin, but be really careful because the insulin could kill you. Okay, I'm clear. Everything's good. Let's go home. Now I've got it. That's pretty much how I felt right? You know, I'm sure a lot of you felt the same way as well. Here's this great medication. It's clearly a lifesaver, but used incorrectly. It's dangerous. But that's okay. They'll tell me what to do. There's probably instructions, right? Except that you know, the instructions that give you a very general and don't work day to day, let alone person to person, it's their guidelines to get you started. And it doesn't take you long to figure out that. Living with type one diabetes is probably just as much about kind of the vibe of it, as it is about the science. It's probably, I mean, honestly, it's probably three times as much. You know, the vibe is such a huge part of how I manage Ardens type one, just my feeling about like, I think our blood sugar is gonna go high here, I think it's gonna go low. You know, yesterday, in a similar situation, this happened. It's trying to calculate, you know, what, not just how many carbs, but what kind of carbs? How long are they going to stay in our system, you know, how much exercise that she got is that going to affect it, it's a little bit more about the magic than it is about the science and the numbers below when you first are diagnosed. Here's the numbers. If this happens, do this. Inject this much insulin, if this happens, if you get low, you want to take in this many carbs. Those those directions from your doctor are starting points. They're jumping in spots. I think the problem is that and very rightfully so you're told to err a little on the side of caution with the blood sugar right stay a little higher. So you don't experience a seizure or a low blood sugar incident. i It's insulting that they call them low blood sugar incidences I've seen two of them their seizures. But the idea right is, you know, stay a little hide or avoid that. Well, I know for me, you know, back then 2006, no glucose monitor technology, not even an insulin pump, just injecting insulin with syringes. I was probably airing more on the side of caution than I probably should have been. And the more you did it, excuse me, the more you let a high blood sugar be because it felt safe, the more normal it got. And you start thinking well, you know, what's wrong with 151 50? is fine. 150 is not fine. I mean, it is but it isn't a my blood sugar right now I don't have diabetes, my blood sugar right now is probably 96. Maybe it's 100. Who knows, maybe it's at the point is, is that there's a vast difference between 90 or 100 and 150 or 200, or wherever it is you're comfortable. So I'm actually going to click over to a website here for a second to talk about this next little bit. So at the moment, I'm on Accu check.com, which is ACC u dash, c h e k.com. I'll put a link in the show notes. But I'm here because they've got this little agency calculator. So what do we just say? What is my blood sugar? Probably right now, let's just say 100? Well, actually, I have to say 100. Because accurate checks. Because that key checks calculator only goes down to 100. So if your average blood sugar is 100 Your average a one C for a three month period should be about 5.1. But what if, like me, you were thinking, well, I'll just stay at 150 Because that seems safer. Well, now you're a one C goes from 5.1 to 6.85. You're almost in the sevens now, because you're erring on the side of caution. But you know, it's impossible to keep a blood sugar stable, you know, without vacillating up and down for very long. So what happens when your 150 becomes I don't know 170? Well, then the a one C

is obviously going to take a leap and you hear me click around on the web page. Now it's 7.55 I. So when I'm online, and I see people who have newer diagnose children, and they say, Well, I, you know, I put my kid to bed at 180, because I'm scared of what's going to happen overnight. And I've seen that that's a number that that people seem to like, right? It's high enough over where they think they're gonna have a problem. But under 200, just enough that it doesn't really kick your guilt in an average blood sugar of 180 is an average a one C of 7.89. So we've gone from 105.11 for your a one C, up to 180 7.89. That is a huge, huge difference. So you can see that cutting out just 10 points from a blood sugar, right seven, let's do 180 at 7.89. I'll change it to 170. And you'll see it's 7.55. Well, that's not bad. Well, that makes you think, well, if I could do 170, I could probably do 150, what's 150 6.85 Things are getting better. I think the problem is that you're you're told to err on the side of caution. And before you know what that becomes comfortable. And before you know it that comfort turns into a habit. And then it becomes difficult to break because of the fear that you feel. So I will tell you that I'm comfortable with art and sleeping overnight with a blood sugar of 80. I don't have a problem with AD. And I can't even on this website how you would add is because because the website will only go down to 100 I'm assuming for legal reasons. So let's just talk about Arden's last day one se Arden's last day one C was after Christmas. So end of 2014 It was 5.9 a different calculator on diabetes.org, which is the ADA website tells me that that I'm a one C percentage of 5.9 is an average blood sugar of 123. So you can see that even though overnight, I'm happy with 80. And trust me Arden will sleep overnight. Most nights at 90, you know down there, why are Dexcom alarm doesn't sound until she's under 80 You can still see that her average blood sugar is still 123. And why is that I sit and I think that's because I think when people think about blood sugars, and I know that we have a Dexcom CGM. And not everyone does. Not everyone has the benefit of that really great technology. But when you think about blood sugars, you think about this rolling graph line, you know, and if you have a great agency, I think people imagined that your graph must be very steady and very low constantly. And I just want to tell you that that's not the case. Arden's graph is not steady. Not nearly as steady as I'd like it to be. And it's not always low. But what I do is I take advantage of the overnight hours, because if she goes to bed and Arden's not a she doesn't go to bed early, she's going to be 11. But I think garden goes to bed between about 930 and 10 o'clock on a school night. And she gets up in the morning around seven. So let's say she goes to bed at 10 and wakes up at seven. So I'm going to just do some quick math here. That sounds to me like nine hours 678 It is it's nine hours I've, I've I've done the math in my head. So for nine hours, if I can keep Arden's blood sugar at, I don't know, we'll say 100 because the calculator says 100 That that's gives me some leeway for the rest of the day to not be able to get a Pre-Bolus on for lunch in time or to miscalculate some carbs at dinner, or to have some sort of a, you know, a hormone induced rise that that ends up taking up, you know, two hours of the day where your blood sugar is up at 150 and you can't do anything about it or it's a 200 and you're pouring on insulin trying to get it down. That's why it's an average. So when we average those 24 hours back together, I will tell you that Arden's are Arden's graph usually gets two blips a day where her blood sugar goes up and it takes us a little while to get it back down. But then we have nine hours at night where it's you know, most nights without you know, listen, growth hormones, things that go wrong could definitely be higher. But on the average every month, most nights at 90 100 I try to keep her down there. I know that sounds scary to some people. But that's a that's a fear that at some point you I think you have to get past because because you can't protect constantly for today and never think about tomorrow. You just can't do that. Because the long term effects and You know, this is something that we don't really talk about a lot because it's sad and uncomfortable. But we all know what the long term effects of, of type one diabetes can be if you have high blood sugars, and they are significant and life altering and life changing and life ending they can be. So you have to find yourself a balance, you have to find a number that that you think I can live with this, this won't make me neurotic, or I'll still be able to sleep. Now, you know if your insurance can cover it, the Dexcom share really does, really does change how overnights happen because now you're getting an alarm back in your room. If your blood sugars are going down or get below or above a certain level. It is a game changer I'm not going to put in otherwise. And prior to having a Dexcom CGM, I was not as bold with these blood sugar's as I am now. And you do have to be aggressive. But cautious. You have to be respectful without being afraid. And the technology helps a lot. So it's a good example of being aggressive. You know, I'll just use today at lunchtime Arden's blood sugar 101 Diagonal down a half an hour before we're going to Pre-Bolus for lunch. So there's a lot of stuff here to think about. But 1030 We Pre-Bolus for lunch when Arden's at school, but she doesn't actually start eating till about 1055. So if she's 100, diagonal down at 10 o'clock, it was fair to say that by 1030, she was going to be a little lower, and wasn't going to give me a lot of latitude to do a big Pre-Bolus Like I would like to do. So I had her eat, like 10 carbs of a piece of candy, just stick a piece of candy in her mouth while she was at school. And when 1030 came along Dexcom had her blood sugar at 85 and steady. Now I knew the sugar from the candy was in there and we were gonna get a bounce at some point. But it wasn't there yet. So I couldn't, you know, I made my calculations like it wasn't there. So I gave her her insulin for lunch 1030 And we didn't extend it Bolus gave her 50% of it right away at 1030 and told the pod the power on the pod give the other 50% as an extended Bolus over the next 30 minutes or so that basically she's getting a Pre-Bolus of half of the insulin and at 1055 when she goes and sits down with her food. The rest of the insulin is in not active yet probably but it's in and it's going not five minutes after 11 i i get a warning on my on my phone from her Dexcom share her blood sugar is hit her high her high watermark when we don't we try not to go above 160. And it's straight up. Now. Okay, that some of that insulin hasn't been in for very long, and the bolusing more right now is probably not what a doctor would tell you to do. It's not probably not what a doctor would tell you to do. It's definitely not what a doctor would tell you to do. They would tell you that insulin is not even live yet. It's hasn't even started working some of it you extended it don't do anything. Don't do anything would be the call the day. But at 169 Straight up which means her blood sugar's rising at two points per minute or greater. I texted Arden I said I want to increase your Basal by 95% for half an hour. And I want to Bolus a half a unit my half a unit is just my blanket. I don't like the way the arrows going up Bolus arrows going up when I don't think it should. Half a unit and y half unit half unit because you know a juice box is for art and 15 carbs about point eight five insulin maybe one unit of insulin. So let's let's Bolus the equivalent of a juice box because I think I'm right history is telling me that she shouldn't be going up this quickly after we've Bolus for lunch. But if she does if it is for you know just a blip and it's going to come back down. Then we'll cover it with a juice box so I don't want to give so much insulin that a juice box wouldn't fix things if your blood sugar went down quickly. But I want to give enough to stop that arrow I want to stop that up arrow I am aggressive about stopping up arrows and you know in the in the Oh what's this one's got Jim's

will be texting in a second if you hear that in the background but her blood sugar is now it's an hour and a half. Excuse me two hours since that Pre-Bolus and her blood sugar is 150 and I know that part probably sounds pretty good 152 hours after her lunchtime Bolus at school, but I really wish it was 130 right now. Now with Jim coming up, I'm going to admit to you probably not going to do much about it. I don't think I would Bolus while there was still active insulin on the way to gym. That doesn't sound not not in a 150 If her blood sugar was 200 Right now, I would absolutely Bolus but not at 150. So does that sound aggressive to you? Does it sound scary? It did to me at one point. And I'm sure it does to you. Now, again, the technology helps having a CGM will make it easier for you. Because you'll see a fall before it happens with any luck. And it's not not as scary. So the doctor tells you to err on the side of caution. It's good advice. But then it becomes comfortable and you probably live inside of those higher blood sugar's much longer than you could, you know, you have to change, you know, you need to be more aggressive. You know, the A one sees up because you're not using enough insulin or because you're erring on the side of caution too much. But you have to find, I think there's a big difference between when you're ready to make that decision. And when you're comfortable making that decision. And I don't know that you're ever going to be comfortable making the decision ready is, when in your mind you say to yourself, I I understand that my child's blood sugars are higher, because I'm not using enough insulin, I understand that the onesies are higher than I want them to be because I'm not using enough insulin. I don't think you're going to be comfortable using more. But I think I can give you a couple of tricks to you know, get yourself there. Because the comfort comes later. Obviously after you do it a number of times and nothing goes wrong, you become more comfortable, you be a little more bold and you're pushing you're pushing your push an overnight blood sugar of 80 I want to be really clear would have scared the crap out of me before a CGM, I never would have done that. But having the ability to see a blood sugar falling or rising is is a game changer. So once you're ready, once you understand that you need to be doing this do it incrementally, you know whatever that means if if you're seeing that a dinnertime Bolus is a certain number, just randomly put a number on it, let's say you're using four units of insulin at dinner, five, six doesn't matter, whatever it is.

And you're seeing high blood sugars. Two hours later, an hour and a half later, we'll just use another half a unit and something like that, and see what that does. You know, just try it. Keep an eye on it. You know if you don't have a CGM test, but but give it a shot. Because I bet what you would find is that after a couple of dinner times, maybe

that half a unit was good. Maybe it was maybe it was what we needed.

Maybe I'll try a little more, maybe you're on a pump, and you can go very incrementally point five at a time. And the next day you try point six over and you get a slightly better result again, and just keep trying to show yourself that it's not the end of the world, show yourself, it's not going to cause some great problem. It's not like your blood sugars are at 90 and you're trying to get them to 85. Those are those are tight tolerances. I'm talking about people who are happy to see a blood sugar of 202 hours after lunch, two hours after you know a meal. People who are looking at a 180 overnight and going hey, it was steady at 180. That's great. Well, what's the difference between study at 180? And study at 130? Go for study at 130. Right? What what are you going to do? I mean, what are you afraid you're afraid it's gonna fall? You're not gonna have time to figure it out. But I mean, everyone's different. But I don't think Arden starts to feel dizzy until she's under 70. So even if you went from 130 to 80, you know, in art and situation, if she goes from 130 to 80 overnight, I'm still in a good space for her. And that's 50 points, 50 points. And we did it before and let's do it again. 6.85 is your average a one see if your blood sugar's 150. If it's 100, it's 5.1. Now, some quick math for me. That's a 1.7 difference in a one see between 150 and 100. So 1.7 for for point for for 50 points, which means that if you can be comfortable at 130 instead of 180 You're That's how far your agency's gonna go down. 1.7 So think about that right now. If your child's a once he is eight, eight, would you be much happier if it was 6.7? What if it was nine would you be more happy if it was seven point And 750 points, we'll do that 50 points will take you down that far. Now that is to me, that's when it hit me. You know, when I started really understanding that I felt well, then I want to shoot for lower. Now, this next bit comes from having a Dexcom receiver, I noticed something. You set a high line and a low line, right? I don't want my blood sugar to go below this. I don't want to go over that. If it does, I want it to alarm. I think when I first got the receiver, it was 250 for the high. And the low was like 130. Like I was like, oh my god under 130. She's low. And one day I realized I do a pretty good job of keeping Arden's blood sugar between 130 and 250. I wonder how much is expectation? That was my question for myself. Except these lines up, these are my expectations for myself. And I'm able to meet these expectations. What if I close the tolerances on my expectations? So I did, I pushed the high number from 250 to 200. And I don't think you're going to need to guess what happened. I was still staying between the lines. Most of the time, I set a new expectation for myself. And I was staying with it. So I pushed it again, I said to myself 190 Just a little bit. What's 190? I could stay there. Well forget 130 is the low let's go to 120. So do you think I could keep her between 190 and 120? Turns out I could. It turns out if you stop and really think about it, the only difference between a blood sugar of 90 and a blood sugar of 190 in your mind is that if 190 starts falling, you have time to do something about it. If 90 starts falling, it's more of a panic situation. Do you want to send your child with a budget of 90 in a car with somebody who doesn't know anything about diabetes? No, you probably don't want to. But if you add education and the ability to speak communication, and Dexcom that you can see the blood sugar as it's happening in case it's beeping away and your kids back and they don't notice it, then all of a sudden 90 is not scary. 90 is completely reasonable. Oh, it's 90 Diagonal down. I'll text the parent, hey, you know what our blood sugar is falling? Can you have a drink half of a juice box? Can you ever take a glucose tablet? Can you do this, you know, whatever your adjustments going to be? It's going to be. So think about what I said there because it's a leap. The only difference between a blood sugar of 190 and 90 in your mind is patting it's time. It's the ability to react without a low. But after years go by, you won't need that much time to react anymore. If you're newly diagnosed, I completely 100% in my heart understand that a 90 blood sugar would could be scary for you. And that you might need that time to make better decisions. But trust me as time goes on, you'll get better and better at this, it's not going to get easier. But you'll get better and better at it. You won't need as much time, it won't seem like a panic situation when a 90 is going down. I don't feel like that anymore. I don't I mean, I don't I cannot remember the last time I panicked about a low blood sugar or even a falling blood sugar. Because I've got so much information right so much time in the simulator that I know what to do to make it stop. I take the information I had from what we've been doing that day, what food we've used, how much insulin we've got going. And I look at historically what it takes to stop but 90 Diagonal down, what it takes to stop is 72 hours down. And I just make that decision, almost without having to think about it and I get if you're not in that spot, you need to be a little higher. But if you just continue to close the tolerances on what you're willing to accept as a blood sugar, then I believe in least in my experience, if you can hit inside of those lines, then just squeeze the lines a little bit. And I bet you'll keep heading. I really I believe you will. Well one second, I have to pause. Before we get back to talking about insulin. I just wanted to let you know that there are a number of ways to listen to the Juicebox Podcast and any podcast. And I want to tell you what some of them are. You can listen through iTunes. That's a simple, easy way to do it. Apple has an app called podcasts that you can download for free from the App Store and you just search for the podcast and that and hit subscribe and you're listening there. You can use stitcher SAP or go to stitcher.com. I have The podcast is also posted on Stitcher. You can listen at Juicebox Podcast inside of each blog post for the episodes is an inline player where you can listen right there. And I'm posting the episodes in Facebook luck with an online player that you don't even have to leave Facebook to listen. So between your web browser and podcast apps, of which there are many, if you have a favorite podcast app, just search us up. There are limitless ways almost to listen to podcasts like the Juicebox Podcast. If you're enjoying the show, I implore you please go to iTunes and leave a review or a rating. It really does help the program be found in searches. Okay, let's get back to talking about insulin, shall we? Talking about this today, because a lot of people on the blog asked me after I write about different things about a one C's and things like that I always hear about like, you know, I always talk about being bold with insulin and being being bold in general with diabetes, and I get a lot of emails, correspondence privately back from people who say things like, you know, I took your advice about being more aggressive, my son's a one C fell, you know, I'm being bolder, it's hard, it's scary, but I'm doing it, I want to thank you. And these are some of the most heartwarming notes that I've received, when I stop and think about when I stop and think about kids who are walking around with in range blood sugars that aren't causing them to feel foggy, because their blood sugar is not high. And I think about their a onesies being more aware they want them in that, what that means for them health wise, and what that means for their parents. Stress wise, I mean, this all, it's just, it's just information that that you want for there to be in the world for people like you to hear. It's more difficult to write about these things, because you feel like everything in writing sort of seems very official. And I don't want people to think that I'm saying do this, and do this and do this and everything will be fine, because that's certainly not true. Your diabetes will absolutely vary from person to person. And it is something that takes time for you to kind of figure out the flow of, you know, to get the vibe of your child's diabetes and, and the things that affect it and don't affect it. But I really felt like the podcast was a place to talk about this, because you can hear my voice when I'm telling you like, look, this isn't advice. This is just what I do. This is how I feel about it. And I believe that if you could try to feel a little bit about this too, in a similar way that you might have some similar luck with with with a little bit of luck. But what pushed me over the edge of the podcast, besides the emails was Arden's last day one see 5.9 right around Christmas time. And we go in and the our nurse practitioner comes in the room with the with a test result. And she says My God, you you decreased not a lot. I think we went from six to to 5.9. But any decrease is amazing. And she says

I can't tell you how many people at the holiday time a year. I tell them oh, it only went up a point. It's okay. You did good. She's like you don't see decreases at the holidays because of all the extra meals and food. How did you do that? And I thought about it for a second because I didn't do anything differently than I did the quarter before. All I did was act aggressively, not wildly and appropriately, but aggressively. Arrow up I want to stop that arrow high blood sugar, I want to get it back down as soon as possible. I would much rather get a blood sugar down quickly than to watch it exist for three hours and bring it down slowly. I mean, the less time with the high blood sugar in my opinion, the better. So that's how we got 5.9 We were just bold we were aggressive we weren't scared. And when the times came where we did use a little too much insulin we combative the insulin with you know something that worked quickly for Arden juice a lot of the time just to kind of go over everything. One last time. Aggressive but cautious. Respectful but not afraid. Definitely have to lean on the technology. I genuinely don't know how to give you advice about doing this without a Dexcom CGM. I feel like it would be impossible for me to do. overnights find a way to be comfortable with a steady lower than what you're used to now because there's so much a one see that can get cut out. Like we talked about earlier difference between 180 and 130 is huge. Difference between 130 and 80. Same difference. Stop and think about that for a minute at some point Arden's blood sugar overnight was 180 and now I'm comfortable with it at 80. It's obviously not always one ad, obviously isn't always ad. But those are our goals, right? There's what we're shooting for 100 points 100 point difference. And that's the story of how Ardens eight, one si went from nine to eight to seven to 5.9. And don't get me wrong, not just insulin. There were a couple of meals that things we cut out of eating. Arden used to eat cereal for breakfast, she doesn't eat anymore. Here's a great blog about Froot Loops on on origins de.com Where Arlen came out of an endo appointment and just asked me one day, how can I get my agency to come down, and I said, you could probably stop eating cereal in the morning that would help and we got a big reduction out of that. So it's not just insulin and being aggressive. There's basil up from his nap. It's not it's not just insulin, and being aggressive is also diet and exercise and a lot of other things. But But anyway, while my my nurse practitioner I talked like she's my nurse practitioner, while Ardens nurse practitioners asking me how do we get a reduction at the holidays. And I explained to her, she paused and she looked so serious and thoughtful and sad all at the same time. And she said, getting people to not be afraid of insulin is probably the hardest thing I do. So then I decided to make a podcast about it. And it looks like we're going to take a little break here while basil finishes barking. And I'm going to come back in a second and just talk about Apple Watch for a second. And a couple little news things. I'm gonna let you out of here and get back to your life. Okay, I'm back and basil is calm again. You know, I just thought this would be interesting, because I recorded this. You know, basically while Arden was at lunch at school, and you remember earlier in the episode, I told you we Pre-Bolus at 1030 in the morning, and at 11 She was 160 something straight up and I actually gave her more insulin than it is now. 110 my larger dog is now moving around. It's now 110 Her blood sugar, I'm looking at my follow up for her Dexcom share to her blood sugar is 97 Diagonal down. And I expect that to level off in the next few minutes. You know, hopefully by the time she's 85. That's That's my goal. But just so you can really see it in real time. You know, she was what I say 100 And something 203 Or so diagonal down at 10. We took in some carbs. By the time it was ready to Pre-Bolus at 1030. She was 85 and steady. I figured that the sugar from the candy hadn't kicked in yet. I did a extended Bolus 50% of the insulin at 1030. The other 50% went in over a half an hour at 11 o'clock she was eating her blood sugar was 160 something straight up, I gave another half of a unit just a blind half of a unit. And now you know 1130 12 almost three hours since the beginning of the extended Bolus, she's at 97 Diagonal down. And I do believe that I that diagonal down will level out. And if it doesn't, then we'll just take a few carbs in here. And her blood sugar will probably stay around 110 For the rest of the school day for the two hours before she comes home. So it's a good look at what aggressive means, you know, the difference between the 97 after lunch and what probably without that extra half of unit would have been more like 150 And you know, we've talked about that 50 points is 50 points is a lot. Okay, so hey, I hope you enjoyed talking about insulin. We can do it again in the future if you'd like to send me an email or hop on the blog and let me know what you thought if you want to talk more about it or about different topics. I'd love to know your thoughts. We are we me it's on by myself. It's a blog I wrote by myself and I said we I have two more interviews coming up for for some upcoming shows. I'm going to be talking to a mom from Canada, whose child lives with type one diabetes and celiac disease. And I'm going to be talking to Karen who runs diabetes blog week about diabetes blog week. So that's that's coming up. I ordered an Apple Watch. Yay. Yay. There it is. It was expensive. Here's what happened. I'm up with a high blood sugar at night. High I think she was like 180 and I couldn't get it to move is one of those like I felt like I could have poured the insulin over Arden's head, her blood sugar wouldn't have gone down. So I'm struggling with this one at trying to get it down. And I'm running out of ways to keep myself amused. I end up on Twitter. And I see on Twitter and there's not a lot of people tweeting by the way at 330 in the morning, but I see on Twitter, that there's some macroom or websites are saying that the Apple Watches are about the stock's about to run out they're gonna push the ship date and I feel like get out of here like I did not expect that. So I went on Apple's website threw my iPad through my like Apple Store app, which works too well, because you can pay by putting your thumbprint on the, on the home button. And I had never really looked at the watches and thought, Oh, I wonder which one I would buy. But there I am laying in bed trying to stay awake 333 40 In the morning, and I'm swiping through watches. And I see one that I think, Hmm, that one looks attractive, I think I would actually wear that watch. And then I go back to Twitter. And they're talking about some watches aren't shipping till June now, you know, it's April 24. With the ship they then they were saying four to six weeks after that. Now all of a sudden, they were saying June and I thought I'm just gonna buy one because if, if I don't want it, like I'll just sell it like I'll probably be able to sell it on eBay and make money. So it didn't scare me a lot to buy it. Anyway, I picked one that I liked. And I stuck my thumbprint on the on the home button and just like that, I'm going to be getting one. They say four to six weeks, I think I'm supposed to get around May 13. So I will be back in the end by the end of May. Talking about Dexcom share to an Apple Watch and how they integrate together. And so I just thought that might be something you might be interested in. My phone is ringing Hello.

Unknown Speaker 41:22
Hello. Hello. Hi, good afternoon. My name is Robert calling you from Green Energy Solar. Am I speaking with the homeowner?

Scott Benner 41:30
You are Robert but I do not have any interest in solar energy for my house. But thank you for calling. And could you while I've got you put me on your do not call us please. That sounds like a no he just hung up. Sorry about that. I'm not against solar energy. I just don't think it's a perfected thing yet. And I'm really scared about putting like panels over the roof of my house because I feel like what happens when like the roof underneath gets weaker. Anyway, I have too many questions about I like the idea of solar. I don't like the idea of putting panels on my house. I don't feel like I have to explain this to you. Okay, so I'm going to be talking about Apple Watch and integration with Dexcom share to probably by the end of May. Hopefully I'll get a little sooner and I can do it sooner. But I have to admit it does look looks pretty tasty. So we'll say You know, I want to mention too that. This past weekend, Arden had a softball tournament, she played three softball games in one day. She got up in the morning at 6am. We drove to the field, she had to be there at 745 It was an hour away. They practiced and worked out until 845. When the first game started, she played a game at 845 then they wouldn't play at the playground. Then we went to lunch. Then we came back they played another game around noon 1230. Then they played another game at five o'clock. And then we didn't get home until eight that night. I think we were out of the house for almost 13 hours. And I can't say enough and I am not being paid to say this but that Dexcom share too. I don't think Arden and I spoke face to face about her diabetes more than about three times the entire day. And honestly one of those times was me throwing a juice box into the dugout and saying to her drink half of it. I saw her rip the straw off. She punched it in, drank half of it. She stuck the other half underneath of the bench. And she went right back out on the field again, I think that was for a blood sugar that looked very steady at 90, which I knew wasn't going to last in the middle of all that exercise. But she had a lot of adrenaline going early on so I wasn't quite sure what to do. And by the time you know she went she went right back out on the field. She was fine. She never got below 75 Ooh, I just watched Arden's blood sugar 91 and steady say 91 in study two hours and 45 minutes after the first Pre-Bolus Two hours and 15 minutes since the point five extra unit we gave her when she was 160 Straight up at lunch. I'm sorry, I'm jumping around but I know if you're listening you're following so Dexcom chair to made the softball tournament. A delight. I really want to say that diabetes was not almost any consideration for us during the day she even when we were at a restaurant at lunchtime. Arden had a season she's a real she's not a she's not strictly a vegetarian, but aren't it's a lot of vegetables. But she also eats a lot of other stuff. So at lunch, she had a Caesar salad. And when she was done she's like, can I the churros with the chocolate sauce? And I was like yeah, sure. When I was thinking like God, no, please don't do that. But she did. And so excuse me we Bolus a completely made up number that I just pulled out of my butt. And I thought I'll be a little heavy handed here and we'll watch She with the CGM. I ended up giving her a little too much insulin and she I think she drank a half a juice box before the second game started. But she had churros at lunch. So, like I said, it was a great day. And diabetes was hardly a part of it. It was in huge thanks to Dexcom Dexcom share to RT and I you know, I never had to walk up to her when she was with her friends and ask you about our blood sugar. I was looking on my phone, saying, you know, by the time we were talking about this next week, I guess I'll be looking on my watch. Really just a game changer. I don't want to call it a lifesaver, although at night I think it is but a real game changer. Okay, so Apple Watch. That sounds pretty cool. We're gonna be talking about diabetes blog week coming up on the on the podcast pretty soon. And speaking to a mom, like I said, Child has celiac and type one, I don't have any frame of reference for celiac disease. So I think that's going to be really interesting to learn about, from somebody who's living through it. You know what, let's make it a short one today. Juicebox Podcast is something that I'm really enjoying doing. And I hope that you are enjoying listening to it. I have every intention of continuing on. I think it is a great standalone piece. And I think it's a wonderful addition to Arden state.com. So, you know, check out my type one diabetes parenting blog, Arden state.com Please leave a review for the Juicebox Podcast on iTunes. And subscribe subscribing might be more important than reviewing. But if you can do both huge. You know what the music for the Juicebox Podcast is written and performed by Sydney Mueller. And I love saying that because Sydney is she is the greatest and I can't believe she was able to write such great music for my for my new podcast. That's it except go to the blog and Arden state.com and check out the tutorial for how to use the podcast if you don't really know how to do it, although you're listening to it now. So that doesn't make a whole ton of sense. Basically, you want to bark again. Anybody? Dogs? sure now that I'm done, everybody's quiet

thank you so much for listening to best of juicebox with me today. If you have a suggestion for Best of go to the blog, and send me an email. I know I just said the blog URL is Arden's de.com. It used to be and still if you type it in the browser, it'll forward you to the website, but the website is at juicebox podcast.com. So if you have a suggestion for Best of go over there, generate an email and send it to me. I'd love to hear what you think. And if you want to include a couple of thoughts about why the episode you're suggesting, should be on Best of include that in the email as well. If you're wondering, Where's this Facebook page that everybody got to do this on? Well, that's Juicebox Podcast type one diabetes on Facebook, over 33,000 members, everyone in there is talking about insulin and diabetes and you would just love it Juicebox Podcast type one diabetes on Facebook